by David Hanscom and Frederic Luskin
As a spine surgeon and a psychologist we see patients with devastating back problems whose lives often can be transformed with surgery and others with acute injuries who can, fairly quickly, return to their lives after a simple non-surgical course of treatment.
Unfortunately, the majority of pain patients reside in a vast middle territory: one filled with deep suffering – mental and emotional, as well as physical. These men and women have complex chronic conditions, layers and layers of problems that make their lives miserable. Living with pain makes people angry. The medical solutions aren’t easy the treatments don’t have great success rates and it’s frustrating for all involved.
Jane, a woman in her early 60s, was exactly such a patient. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving and the following year, she had a bad fall while grocery shopping. By the time she came to see me she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She took multiple medications, including high-dose anti-anxiety drugs and 200 mg of morphine/day.
When I (David) examined Jane, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery but I warned her the treatment had a high rate of complication. Because of this it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile.
A little known fact is this magnitude of surgery actually has a high chance of increasing back pain, which is why I wouldn’t perform it until her pain had lessened. Also I have seen too often that surgery fails in patients like Jane, who are anxious, depressed, hurting and deeply discouraged about their prospects.
Surgery often is ineffective in patients like Jane because they have something called Mind Body Syndrome (MBS) . In Jane’s brain pain signals continually fired along what had become permanent neural pathways of pain and would continue to do so unless and until new pathways developed. The premise behind MBS is the same one that has athletes endlessly practicing their sport: It is possible to create new neural pathways with practice. The treatment for MBS works by calming down and re-directing these disruptive pathways of pain.
We gave Jane some materials outlining a self-directed, structured pain management program she could do on her own and referred her to a colleague at the Pain and Headache center. We gave her information on forgiveness and sent her on her way. Eight months passed. A few weeks ago I (David) saw her name on my schedule of patients and, I’ll admit it, I dreaded the visit.
I was shocked when I walked into the room and there was no wheelchair, walker, or cane. There was just Jane standing up to greet me. She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.
Jane admitted that she had spent the last 12 years sitting alone in her house stewing over all the wrongs that had been done to her. Finally, understanding the linkage between anger and the pathways of pain in her brain, Jane decided to forgive. She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle and the medical system that had not helped her. This process took several months– but within weeks of starting, her pain began to abate. She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back and now is able to stand straight and tall.
Forgiveness researchers such as Dr. Luskin understand the influence of rumination and anger on central and autonomic nervous system function and impaired functioning of the hypothalamic-pituitary adrenal cortical axis (stress system). They know that forgiveness affects the emotions but also has direct and indirect effects on health and nervous and endocrine function. In research higher forgiveness has been shown to be related to less pain in physical therapy, chronic pain and low back pain patients.
Jane forgave….she rewired her brain. She relieved her symptoms of MBS and didn’t need surgery. Every time we see this we are amazed. So simple, so inexpensive and unfortunately necessary as each of us has been hurt at many points in our lives.
David Hanscom is a spine surgeon in Seattle, Washington and the author of Back in Control. Frederic Luskin directs the Stanford Forgiveness Projects and is the author of Forgive for Good and Forgive for Love
Picture courtesy of David Hanscom