Speaker 1: Do you ever feel like life is just one problem
Speaker 1: after another. You finally feel like maybe there's a break,
Speaker 1: and then bam, another problem. This is how it is
Speaker 1: for many of us. But there is a better way
Speaker 1: to respond, a way of responding that brings greater ease
Speaker 1: into your life and returns some of the energy that
Speaker 1: the problems drained from you. We are hosting a free
Speaker 1: live master class on Sunday, February called Learn the Spiritual
Speaker 1: Habit to unlock energy and ease in your life, even
Speaker 1: if each day seems to bring a fresh pile of
Speaker 1: problems in it. I will teach you how to tap
Speaker 1: into the resources that are already within you so that
Speaker 1: life feels less like a never ending fight and more
Speaker 1: like an ever evolving dance. You will learn the number
Speaker 1: one source of unhappiness that drains your energy and keeps
Speaker 1: you feeling stuck, and a simple mindset shift you can
Speaker 1: make right away so that life doesn't feel like such
Speaker 1: a constant struggle. This will be a live event and
Speaker 1: you'll have a chance to interact with me and with
Speaker 1: each other. I've really grown to love these community events
Speaker 1: where we get to meet each other and deepen our connections.
Speaker 1: I hope that you can become part of that. Go
Speaker 1: to one you feed dot net slash live to learn
Speaker 1: more and register for this free event. Again, that's when
Speaker 1: you feed dot net slash live. And I really would
Speaker 1: love the chance to meet you and see you there.
Speaker 1: Tons of people who have no pain at all have
Speaker 1: all kinds of anatomical find things. If you go in
Speaker 1: take a hundred healthy pain for people off the street
Speaker 1: and scan their bodies, you will see a wonderful symphony
Speaker 1: of bulging discs and herniations and protruding this and tears
Speaker 1: on this tendon and this ligament. And they're typically not painful,
Speaker 1: or they're often not painful. Welcome to the one you feed.
Speaker 1: Throughout time, great tinkers have recognized the importance of the
Speaker 1: thoughts we have, quotes like garbage in, garbage out, or
Speaker 1: you are what you think, ring true. And yet for
Speaker 1: many of us, our thoughts don't strengthen or empower us.
Speaker 1: We tend toward negativity, self pity, jealousy, or fear. We
Speaker 1: see what we don't have instead of what we do.
Speaker 1: We think things that hold us back and dampen our spirit.
Speaker 1: But it's not just about thinking. Our actions matter. It
Speaker 1: takes conscious, consistent, and creative effort to make a life
Speaker 1: worth living. This podcast is about how other people keep
Speaker 1: themselves moving in the right direction, how they feed their
Speaker 1: good wolf. Thanks for joining us. Our guest on this
Speaker 1: episode is Yonia shar, a clinical psychologist and neuroscientist. Yoni's
Speaker 1: research uses brain imaging and other tools to understand how
Speaker 1: beliefs and emotions influence health, especially pain, and to develop
Speaker 1: novel neuroscience based treatments for chronic pain only. Is a
Speaker 1: postdoctoral associate at wild Cornell Medicine and completed his doctorate
Speaker 1: at the University of Colorado. HIONI, Welcome to the show.
Speaker 1: It's great to be here. Thanks for having I'm really
Speaker 1: excited to have you on. We're talking about some really
Speaker 1: important work that you have been a researcher on and
Speaker 1: involved in. It's detailed in a book called The Way Out,
Speaker 1: a revolutionary, scientifically proven approach to healing chronic pain. And
Speaker 1: I'm particularly interested in this one because obviously I know
Speaker 1: a lot of people who have chronic pain, but one
Speaker 1: in particular is my mother, and so I'm really excited
Speaker 1: to share this episode with her when we get done.
Speaker 1: The book is written by Alan Gordon. However, I think
Speaker 1: I got the better end of the deal here because
Speaker 1: he describes you in the book as the man who
Speaker 1: ran the show, a thirty two year old wonder kind
Speaker 1: with the mind of Aristotle and the effortless cool of
Speaker 1: James Dean. Don't believe him. I'm not sure. All right.
Speaker 1: We will get into pain reprocessing therapy here in a moment,
Speaker 1: but let's start like we always do with the parable.
Speaker 1: There is a grandparent who's talking with their grandchild and
Speaker 1: they say, in life, there are two wolves inside of
Speaker 1: us that are always at battle. One is a good wolf,
Speaker 1: which represents things like kindness and bravery and love, and
Speaker 1: the other is a bad wolf, which represents things like
Speaker 1: greed and hatred and fear. And the grandchild stops and
Speaker 1: thinks about a second and looks up at their grandparents
Speaker 1: as well, which one wins, and the grandparents says, the
Speaker 1: one you feed. So I'd like to start off by
Speaker 1: asking you what that parable means to you in your
Speaker 1: life and in the work that you do. I love
Speaker 1: that parable, and I think it's very relevant to the
Speaker 1: work we're doing with the chronic pain here. There really
Speaker 1: are two wolves that can feed chronic pain. There's the
Speaker 1: fear wolf, and the more that wolf is active and
Speaker 1: hungry and feeding than the bigger and the bigger the
Speaker 1: pain will get any of the wolf of something like
Speaker 1: safety or ease that eventually, you know, can lead to
Speaker 1: the large reductions or even elimination of chronic pain, which
Speaker 1: you may not believe me quite yet, but hopefully at
Speaker 1: the end of the conversation I'll make a case for that. Yeah,
Speaker 1: you guys actually use the parable in the book, and
Speaker 1: there's a funny line at the end which says, you know,
Speaker 1: we might call it the tale of two neural pathways,
Speaker 1: but it doesn't quite have the same ring to it.
Speaker 1: You know. I used to say when I was talking
Speaker 1: about this early on, I would say, you know, in
Speaker 1: Buddhism we talk less about good and bad, and we
Speaker 1: might say skillful and unskillful. But I was like, you know,
Speaker 1: a skillful and unskillful wolf isn't a very good story, right,
Speaker 1: It just doesn't. It doesn't capture the imagination. So let's
Speaker 1: talk about the core of your work. It's really around
Speaker 1: recognizing that I guess correct anything I say it's incorrect
Speaker 1: that certain types or even maybe a lot of chronic
Speaker 1: pain is what you guys would call neuroplastic pain. Can
Speaker 1: you describe what neuroplastic pain is? Yeah, you've got it right.
Speaker 1: So there has been a revolution in our understanding of
Speaker 1: chronic pain that's been unfolding over the past several decades
Speaker 1: due to advances in medicine, in neuroscience and in psychology
Speaker 1: and other fields. And what we now know is that
Speaker 1: a person could get injured, of course they'll have pain,
Speaker 1: you know, surrounding the injury, but then the injury can
Speaker 1: heal and the pain can persist for years or decades
Speaker 1: beyond that, and at that point the pain is no
Speaker 1: longer caused by the injury because the injury is long
Speaker 1: since healed, and there are other factors, particularly you know,
Speaker 1: factory processes in the brain that are causing the pain
Speaker 1: to persist. And this is called neuroplastic pain. Actually goes
Speaker 1: by many names. It's also called primary pain and no
Speaker 1: sip plastic pain. But that the main idea here that
Speaker 1: the pain is not due to physical, structural, biomechanical factors.
Speaker 1: It's not due to tissue damage. And we think that
Speaker 1: you know, this might be a really large portion of
Speaker 1: chronic pain. Actually Now what you're saying here, I think
Speaker 1: there's nuance to this. It's important because you know, we've
Speaker 1: all heard the it's all in your head thing, right,
Speaker 1: which is a way of sort of dismissing something it's
Speaker 1: all in your head. And what you guys are saying
Speaker 1: is the pain is absolutely one real. It is there.
Speaker 1: It's just that what's causing it is loops in the brain,
Speaker 1: not signals from the body. That's exactly right. And it's
Speaker 1: so important to emphasize the pain is real. The pain
Speaker 1: is always real, and this view of your making it
Speaker 1: up or you're exaggerating really upsets me. I find that
Speaker 1: really offensive, you know, to all of us who have
Speaker 1: had any kind of chronic pain. It's especially been used
Speaker 1: to marginalize people like groups like women or other groups
Speaker 1: have been written off as hysterical or exaggerating, and it's
Speaker 1: not true at that level. Now from the total flip perspective,
Speaker 1: while the brain is in the head, and we now
Speaker 1: know that all kinds of brain processes that can amplify
Speaker 1: or inhibit pain, that those are very important and they're
Speaker 1: no less real in any way. Ye, what are some
Speaker 1: of the things that have happened neuroscience wise that have
Speaker 1: caused us to start to uncover this and for us
Speaker 1: to be able to start to tell the difference between, say,
Speaker 1: what is neuroplatic pain versus other types of pain. You
Speaker 1: talk in the book about short term versus chronic pain
Speaker 1: and how that's in different parts of the brain. Share
Speaker 1: some of that science with this. Sure, there's been a
Speaker 1: lot of research in both animal models of chronic pain,
Speaker 1: particularly in rodents where they kind of create chronic pain conditions,
Speaker 1: and in people who have chronic pain. There's one study
Speaker 1: that comes to mind in particular that was, at least
Speaker 1: for me, a kind of lightning bolt moment of like, whoa,
Speaker 1: this is really a big deal. So this is a
Speaker 1: study from the Carrion Lab at Northwestern that came out
Speaker 1: five or ten years ago, and they recruited people who
Speaker 1: had recently injured their back, and these people had back
Speaker 1: pain because they had recently injured their back, and they
Speaker 1: scanned their brains and what they saw was that the
Speaker 1: pain lived exactly where you would expect it to be
Speaker 1: the pain processing parts of the brain. This includes smata,
Speaker 1: sensory cortex, singulate insula. These are brain regions that any
Speaker 1: neuroscientists would say, yep, that's where the pain belongs. That's
Speaker 1: the part of the brain that does pain processing. Then
Speaker 1: they follow these people for a year out and in
Speaker 1: half of them the pain resolved right the injury. Hell,
Speaker 1: they went back, life is normal. It's kind of like
Speaker 1: typical course. Yeah, you pulled your back, and now everything
Speaker 1: is better. In the other half the pain persisted. And
Speaker 1: now this is a year after injury, and the back
Speaker 1: still hearts. And when they scanned their brains, they found
Speaker 1: that the pain was now associated with a totally different
Speaker 1: set of brain regions. It was associated with the medial
Speaker 1: prefrontal cortex and with the amygdala, and those are brain
Speaker 1: regions that have a lot to do when learning and
Speaker 1: memory and emotion and meaning. And what they basically did
Speaker 1: in the study was they caught on camera using the
Speaker 1: brain is no scanner. They caught on camera this transition
Speaker 1: of pain to moving to these different brain circuits where
Speaker 1: it can now, as you said, like live on loop
Speaker 1: in their way, relatively independent of any injuries in the body.
Speaker 1: That is absolutely fascinating. That really is amazing to be
Speaker 1: able to show that transition and what those different parts
Speaker 1: of the brain tend to be more involved in. And
Speaker 1: there's been eric this other kind of surge of research
Speaker 1: that's also been looking at not clinical researcher, I would say,
Speaker 1: but it's trying to understand what is pain fundamentally, because
Speaker 1: the old view of pain was that pain was a
Speaker 1: direct read out of problems in the body. So this
Speaker 1: is like, you know, you stub your toe and your
Speaker 1: toe hurts, because that's letting you know that something happened
Speaker 1: in your toe. That's true. Pain can be that, And
Speaker 1: we now know that pain is much much more complex.
Speaker 1: And one of my favorite ways of thinking about pain
Speaker 1: is as a learning signal for guiding behavior. So the
Speaker 1: job of pain is to keep us safe and healthy,
Speaker 1: keep our bodies intact. Now, in order to do that
Speaker 1: job well, the pain system has to be predictive. It
Speaker 1: has to be always thinking ahead about how damaging some
Speaker 1: action or activity might be. That way you can keep
Speaker 1: us if the pain system are always just reactive, would
Speaker 1: all be dead if the one step the head of
Speaker 1: the lion. And once you know we understand that pain
Speaker 1: is predictive, that opens up a whole host of thorn
Speaker 1: new problems because prediction is really challenging, like it's really
Speaker 1: hard to you know, to tell the future, and there
Speaker 1: can be mispredictions. So for example, person injured their back,
Speaker 1: they're bending over. That's not good. That's for the injuries.
Speaker 1: So so pain is you know created. But now the brain,
Speaker 1: you know, we'll start to predict pain when bending over,
Speaker 1: and even if the injury is healed, there's a prediction
Speaker 1: that's present in the nervous system, not consciously in any way,
Speaker 1: just kind of in the brain as prediction is there,
Speaker 1: and the pain will be generated because it's been associated
Speaker 1: with that motion in the past, and it can be
Speaker 1: a misprediction. You guys also reference another study which I
Speaker 1: think is also Northwestern, about researchers ability to predict pain,
Speaker 1: you know, like who's going to have pain? And apparently
Speaker 1: they were accurate at the time, So what was going
Speaker 1: on there that was actually the same group of subjects
Speaker 1: and what they did They said like, okay, so these
Speaker 1: are the changes that happened with people as the pain
Speaker 1: went from you know, post injury pain to chronic pain.
Speaker 1: And I was look at the brain scan from right
Speaker 1: after the injury and see if we can predict who's
Speaker 1: going to get better and who's going to develop chronic
Speaker 1: back pain, and what they found was that patterns of
Speaker 1: brain activity in the media prefrontal cortex and the nucleus
Speaker 1: accumbants was able to predict who would develop chronic pain
Speaker 1: and who would resolve. And that's really important for at
Speaker 1: least two reasons. First, those two brain regions are very
Speaker 1: involved in learning processes, so it suggests that there's a
Speaker 1: learning about the pain that's happening in the brain. And
Speaker 1: then once the pain becomes learned, you can basically become
Speaker 1: a habit, can become a pain habit. Again, not in
Speaker 1: an intentional habit. No one's choosing to be in pain.
Speaker 1: No one's like, you know, wanting that, but it can
Speaker 1: recruit the same circuitry the nucleus that come this is
Speaker 1: actually really involved in you know, so like addiction. I
Speaker 1: was just listening to your last episode. The second reason
Speaker 1: that's really important because when you look at like a
Speaker 1: scans and MRIs of the back, you know, if someone
Speaker 1: injuries their back, those are completely non predictive of who's
Speaker 1: going to recover and who's gonna get worse. So it's
Speaker 1: really striking that a brain scan but not a back scan,
Speaker 1: can tell who will get better and who will not. Yeah,
Speaker 1: that is just amazing that the brain is more predictive
Speaker 1: than the back, even though we're the pain is in
Speaker 1: the back, the injury is in the back. What I
Speaker 1: love about what you guys have done here in the
Speaker 1: way you've brought this together is I mean, this is
Speaker 1: not a brand new idea, right. There's a guy Dr
Speaker 1: John Sarno who's been around a long time who's advocated
Speaker 1: similar ideas, but there's way more actual science here and
Speaker 1: there are differences. I'm not trying to tie your work
Speaker 1: to his. I'm just saying that there are similarities, which
Speaker 1: is saying that there is a clear mental element to this.
Speaker 1: And I would even a based on your work and others,
Speaker 1: there's a clear mental and emotional element to what we
Speaker 1: have with chronic pains. So, I mean, I guess one
Speaker 1: of the big questions would be how does somebody know
Speaker 1: is my pain neuroplastic or is it still real signals
Speaker 1: from the body. So there are some indicators that can
Speaker 1: really be helpful in sussing this out. And I want
Speaker 1: to give credit here to my friend and colleague, Dr
Speaker 1: Howard Schuberner, who in my mind, has really helped develop
Speaker 1: these methods as well as you know, many others in
Speaker 1: the field. But I must have learned it from him,
Speaker 1: so that's why he's my guru when it comes to assessment.
Speaker 1: So two components of figuring this out. First is the
Speaker 1: rule out. You can see a doctor, see a relevant specialists,
Speaker 1: try to you know, get clarity. Is there anything clear
Speaker 1: and physical in the body that's a clear cause to
Speaker 1: the pain. I note of caution, there is not to
Speaker 1: go overboard. If you see enough specialists, one of them
Speaker 1: will find something wrong. I guarantee it, so, but you know,
Speaker 1: do basic due diligence to rule out any obvious medical problems.
Speaker 1: The second component is the rule in. And here's where
Speaker 1: I think there's actually a lot of value and juice
Speaker 1: for a lot of people to try to figure out
Speaker 1: what kind of pain is this? So if any of
Speaker 1: the following are present, these are indicators of neuroplastic pain.
Speaker 1: One spatial spread of pain. Pain started in my shoulder,
Speaker 1: but now it's spread down my arm. Injuries don't travel
Speaker 1: but h right, but sensations spread. And we actually now know,
Speaker 1: thanks to the work of Bob cog Hill and others,
Speaker 1: some of the neurobiological mechanisms of this there these neurons
Speaker 1: called dynamic wide range neurons in this dorsal horn of
Speaker 1: the spinal cord that sensitize each other and cause spatial
Speaker 1: spread of pain. And just something that that you know
Speaker 1: happens in our nervous system. If one area hurts, it'll
Speaker 1: sensitize neighboring neurons and cause the signals coming will sensitize
Speaker 1: neighboring areas and cause spread of pain. Okay. Second indicator
Speaker 1: spatial variability, So like sometimes it hurts on the left,
Speaker 1: time that hurts on the right. Again, that really suggests
Speaker 1: the brains involved here, because the brain is really good
Speaker 1: at kind of moving things around in the body. Three
Speaker 1: temporal variability. You know, some days the pain is ten
Speaker 1: out of ten, you know, the next day zero out
Speaker 1: of ten. That again does not sound characteristic of like
Speaker 1: an injury. If you have a broken foot, it's not
Speaker 1: gonna you know, it'll hurt every time you step on it.
Speaker 1: You're not gonna have ten out of ten one days
Speaker 1: out of ten of the next day. It doesn't have
Speaker 1: to be quite as dramatic as ten to zero. It
Speaker 1: can be you know, an eight to three, and that's
Speaker 1: still quite large swings four, presence of multiple chronic pain
Speaker 1: or you know, somemat of sensory syndromes. You know, in
Speaker 1: the person's history, if you have a history of headaches
Speaker 1: and stomach aches and sound and light sensitivity, and you know,
Speaker 1: now your hip is hurting, so it's possible that you
Speaker 1: have a stomach problem and the hip problem and the
Speaker 1: head problem. But it's also, you know, even more likely
Speaker 1: that there might be something in how the brain is
Speaker 1: processing input from the body that is causing this gain
Speaker 1: of signals volume amplication, and that can be an explanation
Speaker 1: for for multiple symptoms. Oh, another one that's really important
Speaker 1: here is when the pain is really contextually sensitive. And
Speaker 1: so what I mean is they have pain in some
Speaker 1: context but not in others, and it doesn't make any
Speaker 1: sense from a biomechanical perspective. So for example, when I had,
Speaker 1: you know, years of chronic back pain, my back would
Speaker 1: always hurt when I stood, but it never hurt when
Speaker 1: I ran, And I could run for you know, miles
Speaker 1: and my back felt great, and then I would you know,
Speaker 1: stop at the end of the run and my back
Speaker 1: would start hurting. And it's just like, what's going on
Speaker 1: that's that's kind of something little fishy here, like why
Speaker 1: would that be? And I later understood when I got
Speaker 1: into all this research that I had developed a conditioned
Speaker 1: response that my brain, you know, had paired standing still
Speaker 1: with pain, and so whenever I stood stall was started
Speaker 1: to create pain, just like now Pavlov's dogs learned to
Speaker 1: link a bell to food. You know, we can link
Speaker 1: a certain position to pain, even though that position isn't
Speaker 1: objectively more dangerous or putting our body at risk than
Speaker 1: like running or some other position. Is is it possible
Speaker 1: that you would have both that you might have, say
Speaker 1: you're an older person and you have some arthritis, which
Speaker 1: you know is probably actually causing some pain, So you
Speaker 1: might also have neuroplastic pain. Is there a place where
Speaker 1: it's not one or the other. Yes, So it's a spectrum,
Speaker 1: and you could be anywhere along the spectrum for more
Speaker 1: say peripheral tissue causes or something in the body that's
Speaker 1: really driving it to you know, centralized central nervous system,
Speaker 1: brain causes. And so people can be you know, what
Speaker 1: we call mixed pain where there's both of those. That
Speaker 1: being said, I think some of us suspect more and
Speaker 1: more that a fairly large portion is centralized or primary pain.
Speaker 1: Neuroplastic pain, for example, eric like arthritis is not necessarily painful.
Speaker 1: No severe arthritis is painful, but mild to moderate arthritis
Speaker 1: is often not painful. So if you have arthritis, you
Speaker 1: could have our threatis and you could have pain, but
Speaker 1: the arthritis might not be the cause of the pain.
Speaker 1: For example, exact numbers eluding to something of pain free
Speaker 1: necks have a bulging disc in them. So tons of
Speaker 1: people who are of no pain at all have all
Speaker 1: kinds of anatomical findings. If you go in take a
Speaker 1: hundred healthy pain for people off the street and scan
Speaker 1: their bodies, you will see, you know, a wonderful symphony
Speaker 1: of bulging discs and herniations and protruding this and tears
Speaker 1: on this tendon in this ligament. And they're typically not painful,
Speaker 1: or they're often not painful. And so knowing that you
Speaker 1: might have one of these findings in your body, it's
Speaker 1: is you know, great, now, is that the cause of pain?
Speaker 1: Does that explain? You know? If there's spatial variability, if
Speaker 1: the pain is moving around, well, gosh, that's not so
Speaker 1: consistent with like, you know, this one injury and this
Speaker 1: one site, or if the pain is very variable, I mean,
Speaker 1: is the injury moving you know from day to day?
Speaker 1: Is the disc bulging one day and not the next?
Speaker 1: Al Right, there's probably something else going on. Pain has
Speaker 1: multiple components to it, right. If I were to think
Speaker 1: of my back pain right now, right, Okay, I've got
Speaker 1: a physical sensation that I would ascribe to it, right,
Speaker 1: And then there are a couple other elements, right that
Speaker 1: are very obvious if you sort of watch your mind.
Speaker 1: Element one is just my overall resistance to it. No, no, no,
Speaker 1: I don't want it. My resistance, my amplification, my all that.
Speaker 1: And then the third is all the stories I start
Speaker 1: saying about what this pain might mean. You know, Mine
Speaker 1: is if my back hurts like this at fifty, what
Speaker 1: will I be like at eighty? Will I be able
Speaker 1: to do this? So there's all this stuff that goes on,
Speaker 1: and so I've talked about that with various people on
Speaker 1: the show, and when I was reading your work, you
Speaker 1: lead into the primary thing that drives the neuroplastic pain
Speaker 1: engine is fear. Yeah, this is really important, Eric, And
Speaker 1: it also gets to a way that our work is
Speaker 1: potentially different than some current framework so everyone agrees that
Speaker 1: there is this whole layer of resistance and storytelling and
Speaker 1: unhelpful narratives that can be on top of the pain,
Speaker 1: and that can make us miserable and make things worse,
Speaker 1: and everyone would agree that limiting that or reducing that
Speaker 1: will be helpful. What I think is really provocative about
Speaker 1: our work is suggesting that mind brain processes could really
Speaker 1: be at the root of the pain, and by changing
Speaker 1: some of these processes, you can eliminate the pain. It's
Speaker 1: not an added layer on top that you can remove
Speaker 1: and now you're left with no pain still there, but
Speaker 1: it's not as bad. You can actually eliminate the pain
Speaker 1: by changing some of these mind brain pathways. Put it
Speaker 1: slightly differently, Now, if the pain is due to mind
Speaker 1: brain processes, then the solution might lay there as well,
Speaker 1: and we could eliminate the pain by changing those pathways. Yeah,
Speaker 1: I think that's an important point. In using my analogy,
Speaker 1: you're saying, not only can you take away element two
Speaker 1: and three in what I just described, you actually might
Speaker 1: take away element one the sensations themselves that are there.
Speaker 1: And what's interesting though, is that, and I want to
Speaker 1: get into your method, it seems to me that these approaches,
Speaker 1: even if you start to buy targeting two and three,
Speaker 1: you may very well, just by that very nature of
Speaker 1: doing it, be working on one also, because targeting two
Speaker 1: and three is the same mechanism you're talking about, which
Speaker 1: is basically becoming a little bit more present to the
Speaker 1: pain and a little bit less afraid around it. So
Speaker 1: let's move into your method. Well, actually, before I do that,
Speaker 1: I want to hit a couple other quick things. One
Speaker 1: is in the book it says this shows up over
Speaker 1: and over again that there are sort of three habits
Speaker 1: that are seen again and again in patients that trigger
Speaker 1: fear and aggravate neuroplastic pain. They're worrying, putting pressure on yourself,
Speaker 1: and criticism or self criticism. So I think of two
Speaker 1: broad categories of fear, pain related fear and a general
Speaker 1: fear or threat. And when I say fear, I'm thinking,
Speaker 1: you know, threat or a sense of there's something threatening.
Speaker 1: So there's fear and sense of threat about the pain
Speaker 1: or the gosh that, like you were saying elean and
Speaker 1: two and three to pain so bad and you know
Speaker 1: it's gonna get worse. And then there's these other general
Speaker 1: patterns of putting our brains and high alert mode of
Speaker 1: threat is worry and pressure on themselves and self criticism.
Speaker 1: That could be completely unrelated to the pain. It could
Speaker 1: be about how we're you know, performing work, or it
Speaker 1: could be about you know, beliefs we have that we
Speaker 1: have to keep everyone else around us happy and if
Speaker 1: someone is unhappy with us, then then that's a big problem,
Speaker 1: or that you know, uncertainty about the future is dangerous
Speaker 1: and I have to eliminate all uncertainty. So there could
Speaker 1: be all these habits and these drive our brain into
Speaker 1: high alert mode and that will take the whole pain
Speaker 1: system and just turn up the volume, you know, any
Speaker 1: sense of threats. So pain is the appraisal of the
Speaker 1: or danger. Pain is our brain's way of saying, that's
Speaker 1: something dangerous here. And if there's a more global sense
Speaker 1: of threat or danger, like you know, like someone putting
Speaker 1: a lot of pressure on themselves, like I'm not good enough,
Speaker 1: whatever the flavor is, then that's gonna you know, add
Speaker 1: to that sense of danger and amplify the pain. Yeah.
Speaker 1: You describe at one point neuroplastic pain being a false
Speaker 1: alarm in essence, right, which I think speaks to that
Speaker 1: as I'm hearing you say all this, you know, in
Speaker 1: my brain, I'm thinking, man, that sucks, right, Like it
Speaker 1: sucks that if you've got excessive amounts of self criticism, worry,
Speaker 1: and you know, put an extra pressure on yourself, that's
Speaker 1: miserable mentally and emotionally. And now on top of it,
Speaker 1: I'm driving a physical pain engine potentially that isn't miserable.
Speaker 1: I have a lot of compassion that comes out. Yeah. Yeah,
Speaker 1: it seems to me like it's kind of like a
Speaker 1: culturally like contagious thing going around right now. Like you know,
Speaker 1: I just saw this. There was a survey that went
Speaker 1: out where you in a lot of stress yesterday a
Speaker 1: gallop Paul, and over half of Americans said yes to that.
Speaker 1: They're in a lot of stress yesterday. And like, that's
Speaker 1: that's very sad. The ideas I want to get to
Speaker 1: the method. There's a couple of other places I could go,
Speaker 1: but let's let's go into you know, the broad strokes
Speaker 1: of how you work with somebody. We think it's a
Speaker 1: neu a plastic, right, we think that's what's going on here.
Speaker 1: So that's step one, and that's actually I don't want
Speaker 1: to glide over that because It's really important because this
Speaker 1: is a huge mental shift for many people. I need
Speaker 1: to like emphasize, like, yeah, and our research. I just
Speaker 1: did a study where I asked people, tell me, in
Speaker 1: your own words, what do you think is the cause
Speaker 1: of your pain. This was back pain because that's the
Speaker 1: most prevalent pain condition, so that's the easiest to study.
Speaker 1: And what people said, people were saying old age and injury,
Speaker 1: her neate a disc So by and large, many many
Speaker 1: people are think even that the cause of their pain
Speaker 1: is something on the structural bio mechanical level. And so
Speaker 1: shifting from that to saying, oh, the cause of my
Speaker 1: pain is neural pathways and fear is a major shift
Speaker 1: that happens. So step one is kind of assessing that,
Speaker 1: you know, if you know as a clinician, you would
Speaker 1: assess that, and then step two is getting the person
Speaker 1: and pain on board with that assessment. And for that
Speaker 1: it really helps to have evidence. Actually, this is not
Speaker 1: any leap of faith we're asking anyone to take. This
Speaker 1: is a scientifically grounded, evidence based process where you can
Speaker 1: look through your life and if you know, when I
Speaker 1: was earlier listing the indicators of neuroplastic pain, if you're
Speaker 1: sitting there going check, check, check. That's a list of
Speaker 1: evidence right there, you know. And on the flip side,
Speaker 1: what's the evidence that there's actually something wrong in your body?
Speaker 1: And don't say, well, my back hurts, because we know
Speaker 1: that's not evidence that there's something wrong in the back. Yeah,
Speaker 1: that's just that's where the sensations are felt in the moment.
Speaker 1: But how do you know that's something actually wrong there?
Speaker 1: You know, what's the evidence for that. Maybe they're strong evidence,
Speaker 1: maybe there isn't. And what's the evidence that now it's
Speaker 1: neuroplastic pain? And in the book, the appendix has a
Speaker 1: more detailed elaboration of all these factors that was mentioning earlier.
Speaker 1: So we call it building the case. So building the
Speaker 1: case that this is really what's going on for me,
Speaker 1: there is a really major first step. Yeah, and you
Speaker 1: talk about different barriers in the book to overcoming that,
Speaker 1: and one of them, you know is indeed medical diagnoses. Right,
Speaker 1: And you know, I know from being involved with people
Speaker 1: in chronic pain taking them to doctors. You can see
Speaker 1: a doctor and you're like, I'm in an incredible amount
Speaker 1: of pain. There's a lot of pressure on that doctor
Speaker 1: to go, well, this, you know, like to come up
Speaker 1: with something right. I know in those experiences that it's
Speaker 1: been like you know, you start to go when one
Speaker 1: doctor is like it's this, and the next doctor is
Speaker 1: like it's this, which is a different thing, and then
Speaker 1: they both disagree on the way you treat me. You
Speaker 1: should do physical therapy. No, you shouldn't do it at all.
Speaker 1: Mean you start to go, Wait a second. Nobody really
Speaker 1: knows why I hurt this bad? Yes, and that is
Speaker 1: another great positive indicative ferent neuroplastic pain getting different or
Speaker 1: contradictory stories from multiple different providers. I mean, they don't
Speaker 1: know even if they sound confidence. Is it possible to
Speaker 1: have neuroplastic pain in one part of your body and
Speaker 1: go through a normal healing process with pain and another
Speaker 1: part of your body. So for example, you have let's
Speaker 1: make the assumption, we've gone through the process, we've done assessment,
Speaker 1: we go, you know, you're lower back pain, neuroplastic. That
Speaker 1: same person breaks their arm. M they're in pain, but
Speaker 1: then the arm heels and the pain goes away. So
Speaker 1: in that case, they went through a normal pain cycle. Right,
Speaker 1: body was hurt, body healed, pain went away. I've still
Speaker 1: got neuroplastic elsewhere is that possible? You can have that,
Speaker 1: and you can also have what we're called secondary pain
Speaker 1: or like structural biomedical like this, the pain is secondary
Speaker 1: to some injury. You could have that in one body
Speaker 1: site and neuroplastic and another body site. Got it. You know,
Speaker 1: it's really based on evidence and really hold any explanation
Speaker 1: you might get from a provider, including from what I'm saying.
Speaker 1: I hold it up to the evidence that does this
Speaker 1: whold water? This doctor says, Oh, I'm having this pain
Speaker 1: because this is pushing on that you know, nerve, and like,
Speaker 1: all right, well you know what's the evidence for that
Speaker 1: being the cause of pain? Yeah? Okay. We've gone through
Speaker 1: the work of really sort of gathering the evidence, trying
Speaker 1: to determine is this what I have? If I arrive
Speaker 1: at the conclusion by myself or by working with a clinician,
Speaker 1: I arrive at the conclusion that at least some portion
Speaker 1: of what's going on here is neuroplastic pain, where do
Speaker 1: I start in unwinding this? So we view neuroplastic pain
Speaker 1: as the brains misperception of threat to the body. So
Speaker 1: that's what we want to start to unwind this mispercept
Speaker 1: of threat. And the way that you unwind misperceptions of
Speaker 1: threat is with you know, perceptions of safety. Actually that
Speaker 1: this kind of antidote. There's a particular technique that we
Speaker 1: have developed that seems to be quite you know, to
Speaker 1: our knowledge, one of the most effective techniques for changing
Speaker 1: this perception. We call it somatic tracking, and it's a
Speaker 1: particular way of paying attention to the sensations. And it
Speaker 1: has three components. The first is this element of mindfulness,
Speaker 1: so becoming a bit you know, like interested and curious
Speaker 1: about the sensations, watching them the way you might watch
Speaker 1: clouds float through the sky. Oh, the sensations, um, you know,
Speaker 1: kind of tingly and moving a bit, you know, towards
Speaker 1: the center of my body. Second component is safety reappraisal,
Speaker 1: and this is as you're paying attention to selling yourself
Speaker 1: there's nothing wrong in my hip while I'm watching the sensations.
Speaker 1: My hip is healthy, my hip is safe, my hip
Speaker 1: is intact. These sensations are being caused by my brain.
Speaker 1: Basically literally saying those things to yourself while you're watching
Speaker 1: the sensations, you know, being genuine about it. It It seem like, oh,
Speaker 1: there really is nothing wrong because I've done this assessment.
Speaker 1: And then the third piece of semantic tracking is bringing
Speaker 1: some fun and some playfulness. We call it positive affect
Speaker 1: induction in the science world because this sense of fun
Speaker 1: and playfulness and humor will cut the threat appraisal right.
Speaker 1: When you're having fun, when you're being playful, when you
Speaker 1: know you're in a good mood, it's much harder to
Speaker 1: feel afraid. So that can really pull the rug out
Speaker 1: from under this feeling of threat. And is semantic tracking.
Speaker 1: It's got these three components. It sounds a little bit
Speaker 1: like the sort of thing that might be helped will
Speaker 1: to be guided through. Is that some of the work
Speaker 1: that clinician will do is guide someone through that. Are
Speaker 1: there guided quote unquote meditations for it. It strikes me
Speaker 1: as the sort of thing, like a lot of types
Speaker 1: of mindfulness that you can get really lost in and
Speaker 1: having somebody to sort of guide you through and bring
Speaker 1: you back and do all that could be really helpful,
Speaker 1: exactly having a guide and you could google it and
Speaker 1: you'll find some examples, and there's clinicians and apps that
Speaker 1: can also, you know, guide people through it. It's very
Speaker 1: important for me to emphasize that some tracking is not mindfulness.
Speaker 1: Mindfulness is one piece of it. Yep, mindfulness can help
Speaker 1: with pain. Actually, you know, one of the first, if
Speaker 1: not the first study like scientific study of mindfulness was
Speaker 1: in chronic pain with John Kevin's in back seventies. But
Speaker 1: mindfulness alone is not likely from the from the data
Speaker 1: we see, mindfulness alone is pretty unlikely to get someone
Speaker 1: out of pain. It's just one piece of the zuzzle
Speaker 1: for on learning pain. So if you think you have
Speaker 1: a mindfulness practice and that's like all you need, there,
Speaker 1: there's more to it. Yeah, that's probably not quite enough, right,
Speaker 1: because the other two components that you mentioned are this
Speaker 1: creation of of safety and then you know the positive
Speaker 1: affect exactly. Yeah, you talk about a couple of mindsets
Speaker 1: that can help with doing somatic tracking more effectively. Yeah,
Speaker 1: so this is like a light and easeful state of
Speaker 1: mind that can be really helpful. There is a strong
Speaker 1: tendency that makes so much sense to like when we
Speaker 1: pay attention to the pain, to tighten around it, to
Speaker 1: clench around it, like you said earlier, to resist it,
Speaker 1: to fight it, or to be like laser focused on it,
Speaker 1: like oh no, what's it gonna do next? Is it
Speaker 1: gonna get worse. So the mindset of like you know,
Speaker 1: ease and safety and mindfulness and relaxation and doing it
Speaker 1: because it feels good. What's really amazing to me and
Speaker 1: what I'm super interested in as a scientist is that,
Speaker 1: you know, sometimes, I would even say many times during
Speaker 1: semantic tracking, as people start doing this practice and paying
Speaker 1: attention without fear, the sensations start to shift and often
Speaker 1: to diminish, and sometimes they even disappear. We've even had
Speaker 1: you know, sessions with the clients that they'll do somatic
Speaker 1: tracking and then the pain's gone ten minutes later and
Speaker 1: they're like, oh my gosh, this is the first time
Speaker 1: in eighteen years, I haven't felt any pain. We just
Speaker 1: did a little exercise, you know, tell them an exercise.
Speaker 1: So that's a really good sign that you have neuroplastic pain.
Speaker 1: You know, if you change how you're paying attention to
Speaker 1: the pain and the pain goes down, guess what. Your
Speaker 1: brain is playing a big role. We just proved that
Speaker 1: you guys talk about when you're doing this, you know,
Speaker 1: turning down the intensity and trying to be outcome independent,
Speaker 1: which is really hard to do, right when what you're
Speaker 1: trying to do is get rid of pain. But Alan
Speaker 1: describes several times in the book when he's talking about
Speaker 1: specific clients, you know that there's a natural tendency to
Speaker 1: be like, all right, this is going to fix me,
Speaker 1: and I'm going after it right, Like, you know, there's
Speaker 1: a mindset that says like, Okay, I'm gonna do somatic tracking,
Speaker 1: like I'm gonna nail it right, And that is the clenching,
Speaker 1: intensing around it. And so it strikes me a little bit,
Speaker 1: as we talked about in Zen, you know, trying not
Speaker 1: to try exactly, you know, which is a little bit
Speaker 1: of an art total art as really hesitating whether to
Speaker 1: even mention that sometimes the pain goes down during somatic tracking,
Speaker 1: because then people will listen and be like, oh, I'm
Speaker 1: gonna go do this thing to get rid of my pain,
Speaker 1: and that, unfortunately, is going to backfire because as soon
Speaker 1: as you're trying to get rid of your pain, you're
Speaker 1: reinforcing the idea of the pain is a dangerous problem
Speaker 1: and a threat that needs to be gotten rid of.
Speaker 1: Ye And actually, so that's just gonna you know, add
Speaker 1: fuel to the fire. Really, what we're trying to build,
Speaker 1: this attitude of pain is something we can be curious
Speaker 1: about and be unafraid of UM, and so we can
Speaker 1: somatic track to kind of get to know it a
Speaker 1: bit better and to welcome it in because it's not dangerous. Yeah,
Speaker 1: we talk about this mindfulness communities, meditation communities, but Zen
Speaker 1: talks a lot about this. And I'm a Zen practitioner,
Speaker 1: and you know, one of the ideas that I found
Speaker 1: really helpful in that regard is that outcome oriented focus
Speaker 1: is sort of necessary for you to do the practice
Speaker 1: at all, Like, otherwise, why are you gonna do it right?
Speaker 1: Nobody's gonna do somatic right. So you want to get
Speaker 1: rid of the pain, so you're gonna do somatic tracking.
Speaker 1: But then and the spiritual teacher said this to me
Speaker 1: when he said your will is good for getting you
Speaker 1: to the meditation cushion. At that point you have to
Speaker 1: shift and you have to let go of that and
Speaker 1: and and that's kind of what we're saying here, like, Okay, yeah,
Speaker 1: of course you want the pain to go away. That's
Speaker 1: gonna get you to the front door of the semantic
Speaker 1: tracking session. At that point we have to try and
Speaker 1: let go and become more outcome independent. It's kind of
Speaker 1: knowing which tool to apply when you know which mindset
Speaker 1: to apply. When that's very helpful. Thanks for that. I'm
Speaker 1: going to use that with my fins. So we're doing
Speaker 1: semantic tracking. It's got these benefits. You say at another point,
Speaker 1: if you want to overcome any fear, and we're saying
Speaker 1: that the fear is kind of the engine of this thing,
Speaker 1: exposure to the thing you're afraid of is important, so
Speaker 1: say more about the role of that in this process.
Speaker 1: Super important. So this is starting to engage in the
Speaker 1: things we've been afraid to do because of the pain.
Speaker 1: If it's sitting down, starting to sit, if it's biking,
Speaker 1: starting to bike, So starting to do these activities, but
Speaker 1: definitely not overdoing it. And what's really important is the
Speaker 1: quality which we bring to the exposures. So something we
Speaker 1: call white knuckling. This is when you're doing an exposure,
Speaker 1: but you're white knuckling your way through it. You're like
Speaker 1: intensely gripping and holding on and internally you're tight and
Speaker 1: clenched and terrifying. That's unlikely to be a helpful exposure.
Speaker 1: It's unlikely to be something that you learn something helpful from.
Speaker 1: We want to do with the exposures where we can
Speaker 1: learn that our bodies are stronger and healthier than than
Speaker 1: we believed. And so doing semantic tracking during an exposure
Speaker 1: is an important piece of this approach. So using these
Speaker 1: same tools to bring attention to the sensations while you
Speaker 1: are doing the thing that's been feared. Remembering a client
Speaker 1: I worked with who you know, we must have we
Speaker 1: stood up and we probably like a hundred times in
Speaker 1: a row, just bend to over, stand up, bend over,
Speaker 1: stand up, just watching the sensations like you would watch
Speaker 1: no water flowing down the waterfall, because you know, as
Speaker 1: we were bending over, that was kind of the image,
Speaker 1: and just watching the sensations and like, oh, look what
Speaker 1: happened when you're bend over? Look what happened? When did
Speaker 1: you get up? You know that bending over was totally safe.
Speaker 1: There's nothing dangerous. Bending over was great for your back.
Speaker 1: It's not dangerous for your back in anyway. It's actually
Speaker 1: really good for your back to bend and cracking some jokes.
Speaker 1: And you know she had a lot of pain at
Speaker 1: the you know, first few times we've bend over and
Speaker 1: buy a number a hundred, it didn't hurt at all. Yeah,
Speaker 1: and you guys talking the book very well about not
Speaker 1: doing this, as you're saying, like, when you have a
Speaker 1: high level of pain, and if you're in a high
Speaker 1: level of pain, is not the time to be doing
Speaker 1: somatic tracking and exposure. It reminds me of coaching work
Speaker 1: with people, and we talked about some of these skills
Speaker 1: that we practice to deal with difficult thoughts or emotions.
Speaker 1: You don't want to practice those on the hardest thing
Speaker 1: in your life. It's not the time to do it.
Speaker 1: You know, you want to start practicing at a place
Speaker 1: that's manageable. You know, you can't practice if there's none
Speaker 1: So as you guys say, you can't really do this
Speaker 1: if you don't have any pain. But you want to
Speaker 1: look for those medium to low level times as the
Speaker 1: time that this exposure and semantic tracking can be most effective.
Speaker 1: That's so important to emphasize to you know, start using
Speaker 1: these sorts of skills when the pain is at the
Speaker 1: low to medium range. Yeah, And what I really like
Speaker 1: is you say, you know, if your pain is really high,
Speaker 1: then don't try semantic tracking, use your avoidance behaviors. And
Speaker 1: so I love how it's not saying like avoidance behavior bad,
Speaker 1: semantic tracking good depending on the scenario. Avoidance behaviors are
Speaker 1: perfectly good thing to do if your pain level is
Speaker 1: really high. When it's at a lower level, that's the
Speaker 1: time to work on semantic tracking and exposure exactly because
Speaker 1: want the exposures to be corrective learning. So an exposure
Speaker 1: from which you you learn that the pain is not dangerous.
Speaker 1: And when the pain is super high, it's gonna be
Speaker 1: very hard to get that takeaway. If you encounter it
Speaker 1: when the pain is raging, you know, it'll be very tough,
Speaker 1: and so at that moment, just anything that's kind of
Speaker 1: can help bring it down, you know, ice packs, cold cocks,
Speaker 1: laying down for a bit, you know, until it becomes
Speaker 1: more unmanageable range and then get back on the horse
Speaker 1: and do the exposures. The semantic tracking, which is an
Speaker 1: internal exposure really to the sensation, and is that the
Speaker 1: primary tool in the method. By doing semantic tracking, by
Speaker 1: having exposure to the pain which causes what you guys
Speaker 1: are calling a corrective experience. Describe corrective experience for us
Speaker 1: so that I can tie all this together. And corrective
Speaker 1: experience is learning that the sensation is not as dangerous
Speaker 1: and threatening as you thought, So this strikes me as
Speaker 1: similar in ways to exposure therapy in other domains, right
Speaker 1: where the ideas exposed yourself to the feared stimulus in
Speaker 1: a manageable dose, you learned that it's not so frightening
Speaker 1: and you're able to handle more and more. So there's
Speaker 1: a corrective experience here. I want to talk a little
Speaker 1: bit about some of what this path looks like if
Speaker 1: you get on it and you start to have some healing,
Speaker 1: because there's, like any path, there's some ups and downs
Speaker 1: that can occur, and I'd like to hit a couple
Speaker 1: of those, but I definitely want to hit Also the
Speaker 1: study that you guys recently published, so tell me about that.
Speaker 1: So this was the first trial testing PRT. We took
Speaker 1: a hundred and fifty one people and we randomize them
Speaker 1: to one of three groups. Uh course of pre T,
Speaker 1: which was nine sessions over the course of the month.
Speaker 1: There was a placebo control they got this placebo injection
Speaker 1: into their back, and then the usual care control group
Speaker 1: of people who kept doing whatever they usually did to
Speaker 1: care for their back, whether it was acupuncture, higher prector
Speaker 1: or medication, and we asked people to tell us how
Speaker 1: much pain they were in before and after and how
Speaker 1: much fear of pain they had, what they thought was
Speaker 1: the cause of their pain, And we also scanned their
Speaker 1: brains before and after, and what we found was very
Speaker 1: large reductions in in back pain for people in the
Speaker 1: PRT group as compared to the control So people in
Speaker 1: the control groups, so everyone came in on average about
Speaker 1: four out of ten pain and in the control groups
Speaker 1: people left with about three out of ten pain, but
Speaker 1: in the pre T group people had one out of
Speaker 1: ten pain on average, and it was a really large reduction.
Speaker 1: And what was especially striking was that a number of
Speaker 1: people were pain free at the end of the study.
Speaker 1: They had zero pain, you know, to put some numbers
Speaker 1: on it. We found that two thirds of people were
Speaker 1: pain free or nearly so at the end of p RT,
Speaker 1: as compared to in the placebo group of ten percent
Speaker 1: in the usual care group. And this is really striking
Speaker 1: because you just don't really see psychological treatments making people
Speaker 1: pain free. So this is part of what this kind
Speaker 1: of conceptual framework that PARTY is coming from, that that
Speaker 1: is different than some of the existing psychological approaches to pain,
Speaker 1: where like we said earlier, they target mostly elements two
Speaker 1: and three, but purity really goes after element one the
Speaker 1: pain itself, and PRT is pain reprocessing therapy, which is
Speaker 1: your guys method. I just think the case any listener
Speaker 1: didn't didn't catch that, sorry for that. And we followed
Speaker 1: people for one year after no treatment ended, and the
Speaker 1: gains were largely maintained. So one year out, half the
Speaker 1: people were paying free or nearly so, even though they
Speaker 1: had received no treatment in that intervening time. And when
Speaker 1: we looked at the mechanism to try to understand, well,
Speaker 1: how does year T work, what we found is that
Speaker 1: people who have the biggest reductions and fear of pain
Speaker 1: had the largest pain intensity decreases. And the people with
Speaker 1: the biggest shifts and how they think about the causes
Speaker 1: of their pain shifts from you know, structural mechanical causes
Speaker 1: to mind brain causes, they had the biggest reductions in
Speaker 1: pain as well. And we also saw these really interesting
Speaker 1: changes and how people's brains were processing pain when when
Speaker 1: we put them in the brain scanner as well. Tell
Speaker 1: me about that last piece a little bit. What shifted? Yeah,
Speaker 1: So we saw reduced activity for purity versus control in
Speaker 1: these three brain regions as people were processing or experiencing
Speaker 1: back pain. So we put people in the brain scanner
Speaker 1: with this back pain evocation device as basically this inflatable
Speaker 1: pillow that went under people's backs while scanning, and when
Speaker 1: we inflated it, it caused back pain. It might sound
Speaker 1: nice to have a pillow under under your back, but
Speaker 1: this this was not feel it. The way we positioned
Speaker 1: it and the way it was inflating, people did not
Speaker 1: like it. It was hurting. And what we saw is
Speaker 1: when we exposed people to the same stimulus post treatment
Speaker 1: in the PRT group, there was less activity in the
Speaker 1: interior insula, the mid singulate, and the anterior prefrontal cortex.
Speaker 1: And these are brain regions that do many things, but
Speaker 1: one of the things they do is track threatening stimuli.
Speaker 1: And the more threatening stimulus is the more activity you'll
Speaker 1: see in those brain regions. And so the reduced activity
Speaker 1: we observed in those regions is consistent with this idea
Speaker 1: of that treatment helped people see the sensations as less threatening.
Speaker 1: Did you screen people before the study to see if
Speaker 1: you thought they had neuroplastic pain or did you just
Speaker 1: take a bunch of people's back hurts. Yeah, we had
Speaker 1: some criteria for trying to get neuroplastic pain. We excluded
Speaker 1: people with leg pain worse than bad pain, because that's
Speaker 1: a sign that there might be ridiculopathy. There might be
Speaker 1: a disc that's bulging onto a nerve, pushing onto a
Speaker 1: nerve that's causing black pain. Black pain is not necessarily
Speaker 1: neuroplastic are not necessarily structural or mechanical. It just diagnosis
Speaker 1: can be a little more involved there. So we screened
Speaker 1: that out. And there's a couple other criteria, but on
Speaker 1: the whole we end for pretty broad inclusion criteria. Now,
Speaker 1: if someone has scoliosis, no problem, history of back surgeries,
Speaker 1: no problem. Uh ten, her needd disks, no problem. That
Speaker 1: those are all welcome, got it? Got it? Because those
Speaker 1: are often just not the cause of the pain, like scoliosis,
Speaker 1: not necessarily painful. It could be painful, but you need
Speaker 1: to do a thorough assessment to see you know, you
Speaker 1: might have painful scoliosis, or you might have pain and scoliosis,
Speaker 1: but the two aren't connected. And is it possible that
Speaker 1: with a lot of these conditions, there was an initial
Speaker 1: burst of pain from that condition and then the body
Speaker 1: adjusts to it and heal stop sending the pain sensations.
Speaker 1: But at this point we've learned, you know, to use
Speaker 1: the term used earlier, we've learned the pain. It reminds
Speaker 1: me so much of you know, PTSD, where a person
Speaker 1: will go you know, to use like a classic example
Speaker 1: of like military PTSD. Person will be in a very
Speaker 1: dangerous context where loud noises could mean you're being attacked,
Speaker 1: and it will come home and they'll still respond to
Speaker 1: the same noise as if there's a threat, but actually
Speaker 1: the threat resolved long ago once you you know, left
Speaker 1: your deployment. The threat is not there anymore, but you're
Speaker 1: still responding as if the threats present. Complete parallel to
Speaker 1: this injury healing model where the threat was there but
Speaker 1: there's no longer a threat, but your brain responding as
Speaker 1: if it's still there. I'm curious in this may be
Speaker 1: extrapolating out multiple steps from where you are, but is
Speaker 1: there thought of trying to measure psychological well being as
Speaker 1: well as pain reduction. Do you think that you perhaps
Speaker 1: killed two birds with one stone, so to speak. Yeah,
Speaker 1: chronic pain can be a really like shitty you know,
Speaker 1: snowball of depression, anxiety, insomnia, pain, the depression from each
Speaker 1: of the anxiety at least insomnia. It's the pain and
Speaker 1: against psycho and if you can take out one component
Speaker 1: of that cycle and everything else can also start to
Speaker 1: come down as well. You start sleeping better, you start
Speaker 1: feeling better, you start getting more active, oh, exercising more. Well,
Speaker 1: that's for depression. So it's all interconnected. And conversely, we
Speaker 1: know that you know, depression, anxiety, and insomnia, they all
Speaker 1: amplify pain as well. Yeah, and if the method brings
Speaker 1: down these three types of thoughts that you guys say
Speaker 1: really trigger fear, worry, pressure, and criticism, if your method
Speaker 1: is actually helping with the reduction in those areas, you know,
Speaker 1: the benefit continues and continues. Yeah. Well, you know people
Speaker 1: in our study told us was that, you know, beyond
Speaker 1: bringing down pain, people are saying like, oh, I learned
Speaker 1: to listen to my feelings for for the first time
Speaker 1: I got in touch with myself. I've realized that was
Speaker 1: such a bully to myself. So me, I'm putting so
Speaker 1: much pressure on myself and I've stopped doing that. That's
Speaker 1: really important and meaningful. Yeah, it really is. Well, thank
Speaker 1: you so much for taking the time to come on.
Speaker 1: I've really enjoyed the conversation. I really enjoyed the book.
Speaker 1: I think the work you guys are doing is incredibly important.
Speaker 1: I get a lot of requests for people to be
Speaker 1: on the show. I get a lot of pain stuff,
Speaker 1: and a lot of it to me looks really like
Speaker 1: that seems a little sketchy. But when I saw the
Speaker 1: work that you guys are doing, I saw the studies
Speaker 1: that were behind it, I felt like, this is a
Speaker 1: really important thing to try and put out there. So
Speaker 1: thank you for the work you're doing. Thanks Eric. There
Speaker 1: is a big shift happening in the field. And yeah,
Speaker 1: the way a lot of us are thinking about chronic
Speaker 1: pain is shifting to really appreciate everything we've been talking about,
Speaker 1: how mind and brain processes can play a bigger role,
Speaker 1: and and just narrowly looking at you know, problems below
Speaker 1: the neck are unlikely to really work as an approach
Speaker 1: for most forms of chronic pain. Yeah, I mean, I
Speaker 1: think anything that sort of tries to divide the mind
Speaker 1: from the body. You know, we talked about the mind
Speaker 1: body division as if it's a thing, and I'm like,
Speaker 1: it's not. I mean, like they're they're pretty clearly connected
Speaker 1: in any anatomical diagram. I have seen like you know, like,
Speaker 1: I'm not sure where we got the idea they were separate,
Speaker 1: but nonetheless, thanks so much for having me on. Yeah,
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