Dr. David Hanscom: The Spine Surgeon Who Stopped Cutting

Published March 7, 2026 · 8 min read

By Tauri Urbanik, Pain Science Researcher

Who is Dr. David Hanscom?

Imagine spending 32 years performing spine surgery. Thousands of operations. Decades of training and expertise. And then concluding that most of your patients never needed the surgery in the first place.

That's David Hanscom's story. And it makes him one of the most credible voices in the neuroplastic pain field, precisely because he came from the other side.

Hanscom was a complex spine surgeon at Swedish Medical Center in Seattle. His specialty was the hardest cases: deformities, revisions, multi-level fusions. He was deeply skilled and deeply committed to his surgical work. And he was also, for a significant period of his career, suffering from his own chronic pain and burnout.

His personal experience with chronic pain forced him to look at the problem differently. He started observing his surgical outcomes more critically. He noticed that many patients with "successful" surgeries, where the technical goals were achieved perfectly, still had pain afterward. And he noticed that many patients with identical imaging findings had wildly different pain experiences.

The same disconnect Sarno had identified at NYU, Hanscom saw in the operating room.

This led him to develop the DOCC protocol, a framework for chronic pain recovery that didn't involve surgery. And eventually, it led him to stop performing elective spine surgery entirely. A spine surgeon who stopped cutting because he realized the problem wasn't in the spine. You can't get more credible than that.

Hanscom's approach to pain recovery

The DOCC protocol, which stands for Direct your Own Care, is Hanscom's framework for taking control of chronic pain recovery. It combines several elements:

Expressive writing. Like Nicole Sachs' JournalSpeak, Hanscom emphasizes the power of emotional writing. He asks patients to write freely about their frustrations, fears, and anger, then destroy what they've written. This practice, he argues, disrupts the neurological circuits that maintain chronic pain.

Nervous system calming. Hanscom focuses heavily on the autonomic nervous system. Chronic pain keeps the body in a sustained fight-or-flight state. His approach includes specific techniques for downregulating the stress response: breathing exercises, mindfulness, sleep optimization, and reducing stimulant intake.

Education about the pain system. Hanscom teaches patients that chronic pain is a neurological problem, not a structural one. He presents the evidence that spinal fusion outcomes are often no better than conservative care, and that imaging findings poorly predict pain. This aligns with the broader research on structural findings in pain-free populations (Brinjikji et al., AJNR, 2015↗).

Taking ownership. The "Direct your Own Care" philosophy puts the patient in charge. Hanscom argues that relying on doctors, surgeons, and external interventions perpetuates the passive patient role that chronic pain thrives in. Taking active ownership of recovery, making daily choices that signal safety rather than danger to your nervous system, is itself therapeutic.

What makes Hanscom's approach unique isn't the individual components. Expressive writing, nervous system calming, and pain education all appear in other practitioners' work. What's unique is the messenger. When a spine surgeon tells you that surgery probably isn't the answer, it lands differently than when a psychotherapist says the same thing.

Key contributions to neuroplastic pain

Hanscom's contributions carry a particular authority that comes from his surgical background.

A surgeon's dissent. Hanscom documented what pain researchers had long suspected: that spinal fusion for chronic back pain often produces outcomes no better than placebo. This isn't an outsider's critique. It's an insider's confession. He performed these surgeries for decades and eventually concluded that most were unnecessary. That testimony is powerful, especially for patients facing surgical recommendations.

Failed back surgery perspective. No one understands back pain after surgery like a surgeon who has seen it repeatedly. Hanscom estimates that 10-40% of spine surgery patients develop chronic pain that's equal to or worse than their pre-surgical pain. His unique position allows him to speak to this population with credibility and empathy.

Bridging surgical and neuroplastic medicine. Hanscom serves as a bridge between conventional spine surgery and neuroplastic pain science. He speaks the language of surgeons and the language of brain-based treatment. This makes him effective at reaching patients who wouldn't normally consider a psychological approach to their pain, because it's not coming from a psychologist. It's coming from the surgeon.

The burnout connection. Hanscom's openness about his own chronic pain and professional burnout adds a personal dimension to his work. Physicians suffer from chronic pain too. And the stress, perfectionism, and relentless demands of surgical practice can drive the same neuroplastic processes as any other high-pressure life situation.

How to access Hanscom's work

Hanscom's work is accessible through multiple channels.

Book: Back in Control (2012). Hanscom's comprehensive guide to the DOCC protocol. Written with a surgeon's directness and a patient's empathy. Available on Amazon. Particularly valuable for anyone considering spine surgery or dealing with pain after surgery.

Website and blog. Hanscom maintains a website with articles, resources, and updates on his work. His blog provides ongoing insights from a surgical perspective on why chronic pain often doesn't respond to operations.

The DOCC protocol. Hanscom's self-directed recovery framework is available through his website and book. It's designed to be followed independently, making it accessible to anyone regardless of location or budget.

Speaking and advocacy. Hanscom continues to advocate publicly for neuroplastic approaches to chronic pain, speaking at conferences and in media about the limitations of surgical solutions for most chronic pain patients.

Structured daily practice options

Hanscom's DOCC protocol provides a strong framework for self-directed recovery. For people who want to complement his approach with additional resources, several options pair well.

Alan Gordon's The Way Out adds somatic tracking and the fear-pain cycle framework, which extends Hanscom's nervous system calming approach. The Boulder study validates the brain-based approach Hanscom advocates with rigorous clinical evidence (Ashar et al., JAMA Psychiatry, 2022↗).

Schubiner's Unlearn Your Pain offers a 28-day structured program that builds on the emotional writing Hanscom recommends. His free Coursera course "Reign of Pain" covers the same principles at no cost.

For people who want daily structure alongside Hanscom's approach, PainApp offers pain tracking that reveals the neuroplastic patterns he describes, condition-specific courses, and an AI-powered Pain Coach available anytime. At $29.99/quarter, it's an accessible complement to the DOCC protocol.

Frequently asked questions

Who is Dr. David Hanscom?

Dr. David Hanscom is a complex spine surgeon who practiced for 32 years at Swedish Medical Center in Seattle. After experiencing chronic pain and burnout himself, he developed the DOCC protocol and eventually stopped performing elective spine surgery, concluding that most chronic back pain patients don't need operations.

What is the DOCC protocol?

DOCC stands for Direct your Own Care. It's Hanscom's framework for chronic pain recovery that combines expressive writing, stress management, nervous system calming, and taking ownership of your recovery process. It shifts the focus from surgical intervention to neurological reprogramming.

Did Hanscom really stop doing spine surgery?

Yes. After 32 years of performing complex spine surgery and documenting outcomes, Hanscom concluded that most chronic back pain patients were better served by neuroplastic approaches than surgery. He stopped performing elective spine operations entirely.

Is Back in Control worth reading?

Yes, especially if you're considering surgery or have already had failed surgery. Hanscom's unique perspective as a spine surgeon who changed his mind about surgery carries authority that no other neuroplastic pain author can match. The book explains his DOCC protocol for self-directed recovery.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.DOI: 10.1001/jamapsychiatry.2021.2669
2. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.DOI: 10.3174/ajnr.A4173
3. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review. Physiotherapy. 2016;102(1):3-12.DOI: 10.1016/j.physio.2015.10.007