The DOCC Program

Pain is a multi-faceted experience. For a given pain problem ALL of the factors that affect the perception of pain must be successfully addressed. In regards to low back pain there are three categories of issues: 1) potential structural problems 2) the soft tissues supporting the spine 3) the central nervous where the pain impulses are received and interpreted.

In the current surgical culture, surgeons tend to look at low back pain from a mechanical perspective. The assumption is that there must always be an anatomical problem, which is the “pain generator.” If the problem can be solved surgically, then the pain should resolve. A high percent of surgery currently being performed for low back pain is done for non-structural problems. The soft tissues and central nervous system components of the pain experience are not addressed in the context of many surgeons’ practices. The resulting problems can be and are often severe. The central nervous system is now even more stimulated from dealing with a “failed back surgery.” The soft tissues may still be inflamed. The downward spiral of chronic pain is intensified.

The underlying hypothesis of the DOCC (Defined Organized Comprehensive Care) project is that repetitive pain impulses to the brain will sensitize the nervous system. The pain continues to increase over time even though the severity of the source of the pain may not change. Eventually the brain may “memorize” these pain pathways. Additionally the emotions of anxiety and anger are intensified over time. These emotions alter the body’s chemistry in a way that further magnifies the pain. Sleep is usually affected, which not only increases the perception of pain, but also decreases the ability to cope.

The DOCC protocol is a framework that organizes the thinking of all parties involved in a way that the each and all of the variables can be systematically addressed. As sleep, anxiety, anger, obsessive thinking, and depression are addressed, the central nervous system will calm down. The perception of pain will decrease and coping abilities will increase. Once the nervous system is calmed down then the soft tissues around the spine can be more aggressively treated.

Surgery is considered as a separate issue. The decision to perform surgery is based just on whether there is a specific structural problem that needs to be corrected. Surgery works well for structural problems. It does not work well for soft tissue pain.

The ultimate tragedy of failed surgery is that the resultant breakdown of the spine around a fusion can cause devastating structural problems. What began as a treatable soft tissue problem may become unsolvable.