You've probably tried everything. The physical therapy that didn't stick, the injections that wore off after three weeks, and maybe even a surgery that "fixed" the anatomy but left you hurting just as much as before. It's exhausting. Honestly, it’s soul-crushing to feel like a prisoner in your own body while doctors keep looking at MRIs that don't tell the whole story.
That is exactly where the Back in Control book enters the room.
Written by Dr. David Hanscom, a former complex spinal deformity surgeon, this isn't your typical "stretch more and think positive" health manual. It’s a paradigm shift. Hanscom spent decades performing high-stakes back surgeries before realizing that for many of his patients—and for himself during a fifteen-year battle with chronic pain—the scalpel wasn't the answer. He eventually quit his surgical practice to focus entirely on helping people exit the "pain trap" through neurological reprogramming.
Chronic pain is rarely just about a herniated disc or a worn-out joint. It's about a nervous system that has learned to stay in a state of high alert.
The Problem With "Structural" Thinking
Most of us are raised to believe that if something hurts, something is broken. If your back hurts, there must be a bone pressing on a nerve, right? Not necessarily. Dr. Hanscom points out a glaring truth that many surgeons won't tell you: many people with "terrible" looking MRIs have zero pain, while people with "perfect" spines are doubled over in agony.
The Back in Control book argues that chronic pain is a complex neurological circuit. It’s like a software glitch in your brain that keeps the "fire alarm" ringing long after the fire has been put out. When you're in pain for months or years, your brain actually gets better at feeling that pain. It carves out deep neural pathways. It becomes a habit of the nervous system.
Hanscom calls this the "Physiological Protective Profile." Basically, your body is stuck in a fight-or-flight response. Your adrenaline is spiked. Your cortisol is through the roof. This chemical soup makes your nerves hyper-sensitive. So, even a small movement that shouldn't hurt suddenly feels like a lightning bolt.
Why surgery often fails for chronic back pain
Surgeons love to fix things. They see a structural abnormality and they want to straighten it out. But if the pain is being driven by a sensitized nervous system, cutting into the tissue often just adds more trauma to an already overreactive system. This is why "Failed Back Surgery Syndrome" is a real medical diagnosis. The Back in Control book suggests that unless you address the underlying neurological stress, the physical "fix" is often just a temporary band-aid—or worse, a trigger for more pain.
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The DOC Journey: A Roadmap Out
Hanscom doesn't just complain about the medical system; he provides a framework called the Direct outbound Collective (DOC) journey. It's a structured process to calm the nervous system.
It starts with something remarkably simple: writing.
One of the core tools in the Back in Control book is expressive writing. You take a piece of paper and write down whatever is bothering you. Thoughts, fears, anger, frustrations. You don't save it. You don't re-read it. You rip it up immediately.
Why? Because it physically breaks the cycle of ruminating thoughts. It’s a way of "offloading" the mental data that keeps your nervous system in a state of high alert. It sounds like "woo-woo" science until you look at the research by Dr. James Pennebaker, which shows that expressive writing can actually improve immune function and reduce physical symptoms of stress-related illnesses.
Sleep is not optional
If you aren't sleeping, you aren't healing. Period. Hanscom is militant about this. Chronic pain destroys sleep, and lack of sleep lowers your pain threshold. It’s a vicious cycle. The book emphasizes that aggressive sleep management is often the first real step toward recovery. Sometimes that means temporary medication, and sometimes it means radical sleep hygiene, but you cannot think or exercise your way out of a pain circuit if your brain is sleep-deprived.
Forgiving the Unforgivable
This is where the Back in Control book gets uncomfortable for a lot of people. Hanscom discusses the link between anger and pain. When you are angry—at your doctor, your insurance company, your spouse, or your own body—your body produces inflammatory chemicals.
Anger is a high-stress state.
You can't heal in a high-stress state.
Forgiveness, in the context of the DOC journey, isn't about being "nice" or letting someone off the hook for hurting you. It's a selfish act of health. It’s about deciding that you are no longer willing to keep your nervous system on fire just to prove that you were wronged. It is about "letting go" to lower your own adrenaline levels.
Moving Beyond the "Patient" Identity
When you have chronic pain, it becomes your whole world. Your hobbies disappear. Your social life shrinks. You become "the person with the bad back."
The Back in Control book pushes you to stop talking about your pain. This sounds harsh, but there’s a neurological reason for it. Every time you complain about your pain or describe it in detail to a friend, you are reinforcing those neural pathways. You are practicing being in pain.
Instead, Hanscom encourages "re-engagement." This isn't about running a marathon. It’s about finding small, meaningful things that have nothing to do with your identity as a patient. Maybe it’s painting. Maybe it’s listening to music. Maybe it’s just sitting in the sun. You have to give your brain something else to focus on besides the alarm signals coming from your spine.
The role of "Mind Body" medicine
We have to stop separating the mind from the body. They are the same system. The "Back in Control" philosophy aligns with the work of others like Dr. John Sarno, though Hanscom brings a more modern, neurobiological perspective to it. It’s not that the pain is "in your head" in the sense that you’re making it up. The pain is very real. It’s just that the source of the pain is the brain’s processing system, not just the local tissue in your lower back.
Actionable Steps Toward Relief
If you're looking at the Back in Control book as a last resort, don't just read it. Use it. It’s a workbook, not a novel.
- Start Expressive Writing Immediately: Do it twice a day. Five to ten minutes. Write the darkest, angriest, most "unfiltered" stuff you can think of. Then destroy the paper. This is about output, not reflection.
- Stop "Pain Talk": Make a pact with your family. No more updates on your pain levels unless there is a medical emergency. If someone asks how you are, say "I'm working on it" and change the subject.
- Prioritize Sleep Above Everything: If you're getting less than seven hours of decent sleep, talk to a professional about a strategy to fix that first. Your nerves need the downtime to desensitize.
- Practice Active Meditation: You don't have to sit on a cushion for an hour. Just spend one minute, several times a day, focusing intensely on a single sensation—the taste of coffee, the feeling of your feet on the floor, the sound of a bird. This pulls your brain out of the "pain loop" and into the present moment.
- Educate Yourself on Pain Neuroscience: Read the book, but also look up "Central Sensitization." Understanding that your nerves are just "stuck on loud" can take away the fear that you are constantly damaging your body. Fear is the fuel for pain.
The path outlined in the Back in Control book isn't a quick fix. It’s a slow rewiring. But for those who have been told there's no hope left, it offers a scientifically grounded exit ramp from the cycle of chronic suffering. You aren't just your MRI results. You are a complex system that can, with the right inputs, find its way back to a state of balance.
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Critical Resources for Implementation
- The DOC Journey Website: Dr. Hanscom has expanded the book's concepts into an online course that provides more structure.
- Pennebaker’s Research: Look into "Opening Up by Writing It Down" for the science behind the writing exercises.
- Cognitive Behavioral Therapy (CBT): Many people find that working with a therapist who understands chronic pain can accelerate the "unlearning" process described in the book.
The reality is that most back pain doesn't require a knife. It requires a new way of handling the stress, emotions, and neurological patterns that keep the body in a state of high-alert. By shifting the focus from the spine to the nervous system, you stop being a victim of your anatomy and start becoming the architect of your own recovery.