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Person Approach David A Hanscom, MD Orthopedic Spine Surgeon - PowerPoint PPT Presentation

Curing Chronic Pain: A Whole Person Approach David A Hanscom, MD Orthopedic Spine Surgeon Swedish Medical Center, Seattle, WA The Junction Box Oxytocin Dopamine GABA receptors Junction Neutral Box Nervous System Adrenaline

  1. Curing Chronic Pain: A Whole Person Approach David A Hanscom, MD Orthopedic Spine Surgeon Swedish Medical Center, Seattle, WA

  2. “The Junction Box”

  3. Oxytocin Dopamine GABA receptors “Junction Neutral Box” Nervous System Adrenaline CortisoL Endorphins

  4. “There is nothing either good or bad, but thinking makes it so.” ~ William Shakespeare Hamlet , Act 2, Scene 2 The first neuroscientist?

  5. Suffer Mask Suppress

  6. Paradoxical Effects of Thought Suppression Daniel M. Wegner, David J. Schneider, Samuel R. Carter III, and Teri L. White

  7. Why is Chronic Pain So Persistent?

  8. Pain Circuits are Reinforced

  9. Mystery of Phantom Limb Pain

  10. “Rage”

  11. It’s the Adrenaline

  12. Direct diagnosis and management of emotional factors in chronic headache patients • Striated muscle tension • Smooth muscle tension • Cognitive-perceptual disruption • Conversion • Abbass A, et al. Cephalalgia, 2008

  13. Benefits of Anger

  14. Coping with Anxiety

  15. Solving the Unsolvable

  16. Awareness Address all variables Patient takes charge

  17. Awareness

  18. Address All Variables

  19. Variables • Understanding Pain • Sleep • Stress • Meds • Life Outlook • Physical conditioning

  20. Prehab


  22. 62 y/o female with neurogenic claudication

  23. Hunting elk

  24. Patient Takes Control

  25. Write and Rip

  26. Awareness


  28. Awareness Address all variables Patient takes charge

  29. Thank You!

  30. Thank You

  31. A Silent Epidemic 116 million Americans suffer from chronic pain $635 billion is spent each year on treatments that are often ineffective and frequently do more harm than good

  32. The Many Faces of My Neurophysiologic Disorder • Migraines • OCD • Tinnitus • Acid Reflux • Burning feet • Back/neck pain • Anxiety/ panic attacks • Migratory skin rashes • Insomnia • Itching scalp • Severe depression • Tension Headaches • PTSD • Crushing chest pain • Chronic tendonitis • Palpitations

  33. Unresolved Pain Shifts in the Brain Over Time Study reviewed in Brain: A Journal of Neurology

  34. Prospective fMRI Study LBP • Acute pain = 94 – < 2 months • Chronic pain = 59 – > 10 years

  35. Location of brain activity • Acute pain – nociceptive area • Chronic – emotional area

  36. Longitudinally followed 39 acute LBP • 19 recovered • 20 become chronic

  37. Scans every 3 months for 12 months Became Chronic Pain Resolved • Nociceptive area quiet • Activity shifted to emotional centers • Nociceptive quiet

  38. Chronic pain exists in the emotional not the nociceptive areas of the brain

  39. Rita

  40. Behavior is guided by your body’s chemical response to sensory input

  41. Neurological pathways are permanent Strengthen with Repetition

  42. Solution Principles

  43. Awareness Hope Forgiveness Play

  44. Awareness Hope Forgiveness Play

  45. I believe that one of the most basic needs that makes us human is to be in charge of our destiny with a sense of purpose. Successfully treating patients suffering from chronic pain requires re-connecting them with their original sense of vision and purpose in life.

  46. Awareness Hope Forgiveness Play



  49. “C” first

  50. Addressing anger is the “Continental Divide” of healing from chronic pain

  51. Awareness Hope Forgiveness Play

  52. Does Rejection Hurt? An fMRI Study of Social Rejection • Science 302, 290 (2003) – Naomi I. Eisenberger, et al.


  54. Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional life. Thus the physician who attempts to take care of the patient while he neglects this factor is as unscientific as the investigator who neglects to control all of the conditions that affect his or her experiment.

  55. One of the essential qualities of the clinician is interest in humanity, for the secret of care is in caring for the patient.

  56. Frances Peabody The Care of the Patient - 1927

  57. Awareness Hope Forgiveness Play

  58. Anxiety is a Neurophysiological Response to Sensory Input

  59. Why is Chronic Pain Hard to Treat?

  60. “We propose that chronic pain is the consequence of plastic changes in cortical-limbic circuitry, leading to new learning and to memory formation that are continuously reinforced and thus cannot be extinguished, as a consequence of the emotional and motivational associations with the painful stimulus …….” Mansour 2014

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