Speaker 1: Tons of people who have no pain at all have
Speaker 1: all kinds of anatomical findings. If you go in take
Speaker 1: a one hundred healthy pain for people off the street
Speaker 1: and scan their bodies, you will see a wonderful symphony
Speaker 1: of bulging disks 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.
Speaker 2: Welcome to the one you feed. Throughout time, great tinkers
Speaker 2: have recognized the importance of the thoughts we have. Quotes
Speaker 2: like garbage in, garbage out, or you are what you think,
Speaker 2: ring true. And yet for many of us, our thoughts
Speaker 2: don't strengthen or empower us. We tend toward negativity, self pity, jealousy,
Speaker 2: or fear. We see what we don't have instead of
Speaker 2: what we do. We think things that hold us back
Speaker 2: and dampen our spirit. But it's not just about thinking.
Speaker 2: Our actions matter. It takes conscious, consistent and creative effort
Speaker 2: to make a life worth living. This podcast is about
Speaker 2: how other people keep themselves moving in the right direction,
Speaker 2: how they feed their good wolf. Thanks for joining us.
Speaker 2: Our guest on this episode is Yoni A shar A
Speaker 2: clinical psychologist and neuroscientist. Yoni's research uses brain imaging and
Speaker 2: other tools to understand how beliefs and emotions influence health,
Speaker 2: especially pain, and to develop novel neuroscience based treatments for
Speaker 2: chronic pain. Yoni is a postdoctoral associate at wild Cornell
Speaker 2: Medicine and completed his doctorate at the University of Colorado.
Speaker 3: Hi, Yoni, Welcome to the show.
Speaker 1: It's great to be here. Thanks for having me Eric.
Speaker 3: I'm really excited to have you on. We're talking about
Speaker 3: some really important work that you have been a researcher
Speaker 3: on and involved in. It's detailed in a book called
Speaker 3: The Way Out, a revolutionary, scientifically proven approach to healing
Speaker 3: chronic pain. And I'm particularly interested in this one because
Speaker 3: obviously I know a lot of people who have chronic pain,
Speaker 3: but one in particular is my mother, and so I'm
Speaker 3: really excited to share this episode with her when we
Speaker 3: get done. The book is written by Alan Gordon. However,
Speaker 3: I think I got the better end of the deal
Speaker 3: here because he describes you in the book as the
Speaker 3: man who ran the show, a thirty two year old
Speaker 3: wonder kind with the mind of Aristotle and the effortless
Speaker 3: cool of James Dean.
Speaker 1: Don't believe him? Not true?
Speaker 3: All right, we will get into pain reprocessing therapy here
Speaker 3: in a moment, but let's start like we always do
Speaker 3: with the parable. There is a grandparent who's talking with
Speaker 3: their grandchild and they say, in life, there are two
Speaker 3: wolves inside of us that are always at battle. One
Speaker 3: is a good wolf, which represents things like kindness and
Speaker 3: bravery and love, and the other's a bad wolf, which
Speaker 3: represents things like greed and hatred and fear. And the
Speaker 3: grandchild stops, thinks about a second and looks up at
Speaker 3: their grandparents says, well, which one wins? And the grandparent says,
Speaker 3: the one you feed. So I'd like to start off
Speaker 3: by asking you what that parable means to you in
Speaker 3: your life and in the work that you do. Yeah.
Speaker 1: I love that parable, and I think it's very relevant
Speaker 1: to the work we're doing with the chronic pain here.
Speaker 1: There really are two wolves that can feed chronic pain.
Speaker 1: There's the fear wolf, and the more that wolf is
Speaker 1: active and hungry and feeding, then the bigger and the
Speaker 1: bigger the pain will get any of the wolf of
Speaker 1: something like safety or ease that eventually you can lead
Speaker 1: to the large reductions or even elimination of chronic pain,
Speaker 1: which you may not believe me quite yet, but hopefully
Speaker 1: at the end of the conversation I'll make a case
Speaker 1: for that.
Speaker 3: Yeah, you guys actually use the parable in the book,
Speaker 3: and there's a funny line at the end which says,
Speaker 3: you know, we might call it the tale of two
Speaker 3: neural pathways, but it doesn't quite have the same ring
Speaker 3: to it. You know. I used to say when I
Speaker 3: was talking about this early on, I would say, you know,
Speaker 3: in Buddhism we talk less about good and bad, and
Speaker 3: we might say skillful and unskillful. But I was like,
Speaker 3: you know, a skillful and unskillful wolf isn't a very
Speaker 3: good story, right, It just doesn't. It doesn't capture the imagination. Right,
Speaker 3: So let's talk about the core of your work. It's
Speaker 3: really around recognizing that I guess correct anything I say,
Speaker 3: it's incorrect that certain types or even maybe a lot
Speaker 3: of chronic pain is what you guys would call neuroplastic pain.
Speaker 3: Can you describe what neuroplastic pain is?
Speaker 1: Yeah, you got it right. So there's been a revolution
Speaker 1: in our understanding of chronic pain that's been unfolding over
Speaker 1: the past several decades due to advances in medicine and
Speaker 1: neuroscience and psychology and other fields. And what we now
Speaker 1: know is that a person could get injured, of course
Speaker 1: they'll have pain, you know, surrounding the injury, but then
Speaker 1: the injury can heal and the pain can persist for
Speaker 1: years or decades beyond that, and at that point the
Speaker 1: pain is no longer caused by the injury because the
Speaker 1: injury is long since healed, and there are other factors,
Speaker 1: particularly you know, factor processes in the brain that are
Speaker 1: causing the pain to persist. And this is called neuroplastic pain.
Speaker 1: Actually goes by many names. It's also called primary pain
Speaker 1: and no syplastic pain. But that the main idea here
Speaker 1: is that the pain is not due to physical, structural,
Speaker 1: biomechanical factors. It's not due to tissue damage. And we
Speaker 1: think that, you know, this might be a really large
Speaker 1: portion of chronic pain.
Speaker 3: Actually, now what you're saying here, I think there's nuance
Speaker 3: to this. It's important because you know, we've all heard
Speaker 3: the it's all in your head thing, right, which is
Speaker 3: a way of sort of dismissing something. It's all in
Speaker 3: your head. And what you guys are saying, is the
Speaker 3: pain is absolutely one hundred percent real. It is there.
Speaker 3: It's just that what's causing it is loops in the brain,
Speaker 3: not signals from the body.
Speaker 1: That's exactly right. And it's so important to emphasize the
Speaker 1: pain is real. The pain is always real, and this
Speaker 1: view of you're making it up or you're exaggerating really
Speaker 1: upsets me. I find that really offensive, you know, to
Speaker 1: all of us who have had any kind of chronic pain.
Speaker 1: It's especially been used to marginalize people like groups like
Speaker 1: women or other groups that have been written off as
Speaker 1: hysterical or exaggerating. And it's not true at that level.
Speaker 1: Now from the total flip perspective, while the brain is
Speaker 1: in the head and we I know that all kinds
Speaker 1: of brain processes that can amplify or inhibit pain, that
Speaker 1: those are very important and they're no less real in
Speaker 1: any way.
Speaker 3: Yeah, what are some of the things that have happened
Speaker 3: neuroscience wise that have caused us to start to uncover
Speaker 3: this and for us to be able to start to
Speaker 3: tell the difference between say, what is neuroplastic pain versus
Speaker 3: other types of pain. You talk in the book about
Speaker 3: short term versus chronic pain and how that's in different
Speaker 3: parts of the brain. Share some of that science with this.
Speaker 1: Sure, there's been a lot of research in both animal
Speaker 1: models of chronic pain, particularly in rodents where they create
Speaker 1: chronic pain conditions, and in people who have chronic pain.
Speaker 1: There's one study that comes to mind in particular that was,
Speaker 1: at least for me, a kind of lightning bolt moment, like, WHOA,
Speaker 1: this is really a big deal. So this is a
Speaker 1: study from the A. Carrion Lab at Northwestern. It came
Speaker 1: out five or ten years ago, and they recruited people
Speaker 1: who had recently injured their back. And these people had
Speaker 1: back pain because they had recently injured their back, and
Speaker 1: they scanned their brains and what they saw was that
Speaker 1: the pain lived exactly where you would expect it to
Speaker 1: be the pain processing parts of the brain. This includes
Speaker 1: smatisensory 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 followed these people for a year out and in
Speaker 1: half of them the pain resolved right the injury heel
Speaker 1: they went back, life was normal, it's kind of like
Speaker 1: typical course, Yeah, you pulled your back and now everything's better.
Speaker 1: In the other half, the pain persisted, and now this
Speaker 1: is a year after injury and the back still hurts.
Speaker 1: And when they scanned their brains, they found that the
Speaker 1: pain was now associated with a totally different set of
Speaker 1: brain regions. It was associated with medial prefrontal cortex and
Speaker 1: with the amygdala, and those are brain regions that have
Speaker 1: a lot to do when learning and memory and emotion
Speaker 1: and meaning. And what they basically did in the study
Speaker 1: was they caught on camera, not using the brain scanner.
Speaker 1: They caught on camera this transition of pain to moving
Speaker 1: to these different brain circuits where it can now, as
Speaker 1: you said, live on loop in their way, relatively independent
Speaker 1: of any injuries in the body.
Speaker 3: That is absolutely fascinating. That really is amazing to be
Speaker 3: able to show that transition and what those different parts
Speaker 3: of the brain tend to be more involved in.
Speaker 1: And there's been eric this other kind of surge of
Speaker 1: research that's also been looking at not clinical researcher, I
Speaker 1: would say, but it's trying to understand what is pain fundamentally,
Speaker 1: because the old view of pain was that pain was
Speaker 1: a direct readout 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, it can keep
Speaker 1: us safe. If the pain system are always just reactive
Speaker 1: with all we did, if they one step ahead of
Speaker 1: the lion. And once you know, we understand that pain
Speaker 1: is predictive, that opens up a whole host of thorny
Speaker 1: problems because prediction is really challenging, like it's really hard
Speaker 1: to you know, to tell the future. And there can
Speaker 1: be mispredictions for example, personal injuries. Their back they're bending over. Ah,
Speaker 1: that's not good, that's for the injuries. So so pain
Speaker 1: is you know, created, But now the brain, you know,
Speaker 1: will start to predict pain when bending over, and even
Speaker 1: after the injury is healed, there's a prediction that's present
Speaker 1: in the nervous system, not consciously in any way, just
Speaker 1: kind of in the brain. This prediction is there, and
Speaker 1: the pain will be generated because it's been associated with
Speaker 1: that motion in the past, and it can be a misprediction.
Speaker 3: You guys also reference another study which I think is
Speaker 3: also Northwestern, about researchers' ability to predict pain, you know,
Speaker 3: like who's going to have pain? And apparently they were
Speaker 3: accurate eighty five percent of the time. So what was
Speaker 3: going on.
Speaker 1: There that was actually the same group of subjects and
Speaker 1: what they did They said, like, okay, so these are
Speaker 1: the changes that happened with people as the pain went
Speaker 1: from you know, post injury pain to chronic pain. And
Speaker 1: now let's look at the brain scan from right after
Speaker 1: the injury and see if we can predict who's going
Speaker 1: to get better and who's going to develop chronic back pain.
Speaker 1: And what they found was that patterns of brain activity
Speaker 1: in the media prefrontal cortex and the nucleus occumbents was
Speaker 1: able to predict who would develop chronic pain and who
Speaker 1: would resolve. And that's really important for at least two reasons. First,
Speaker 1: those two brain regions are very involved in learning processes,
Speaker 1: so it suggests that there's a learning about the pain
Speaker 1: that's happening in the brain, and once the pain becomes learned,
Speaker 1: it can basically become a habit. It can become a
Speaker 1: pain habit. Again, not an intentional habit. No one's choosing
Speaker 1: to be in pain. No one's like, you know, wanting that,
Speaker 1: but it can recruit the same circuitry the nucleus accumbans
Speaker 1: is actually really involved in, you know, so like addiction.
Speaker 1: I was just listening to your last episode. Yeah. The
Speaker 1: second reason that's really important is because when you look
Speaker 1: at like a scans and MRIs of the back, you know,
Speaker 1: if someone injuries their back, those are completely non predictive
Speaker 1: of who's going to recover and who's gonna get worse.
Speaker 1: So it's really striking that a brain scan but not
Speaker 1: a backscan, can tell who will get better and who
Speaker 1: will not.
Speaker 3: Yeah, that is just amazing that the brain is more
Speaker 3: predictive than the back, even though where the pain is
Speaker 3: in the back, the injury is in the back. What
Speaker 3: I love about what you guys have done here and
Speaker 3: the way you've brought this together is I mean, this
Speaker 3: is not a brand new idea, right. There's a guy,
Speaker 3: doctor John Sarno, who's been around a long time who's
Speaker 3: advocated similar ideas, but there's way more actual science here,
Speaker 3: and there are differences. I'm not trying to tie your
Speaker 3: work to his. I'm just saying that there are similarities,
Speaker 3: which is saying that there is a clear mental element
Speaker 3: to this. And I would even say, based on your
Speaker 3: work and others, there's a clear mental and emotional element
Speaker 3: to what what we have with chronic pains. So, I mean,
Speaker 3: I guess one of the big questions would be how
Speaker 3: does somebody know is my pain neuroplastic or is it
Speaker 3: still real signals from the body.
Speaker 1: Yeah, so there are 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, doctor
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 specialist,
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 their plastic pain.
Speaker 1: One spatial spread of pain. Pain started on my shoulder,
Speaker 1: but now it's spread down my arm. Injuries don't travel
Speaker 1: but right, but sensations spread. And we actually now know,
Speaker 1: thanks to the work of Bob Coghill and others, some
Speaker 1: of the neurobiological mechanisms of this. There are these neurons
Speaker 1: called dynamic wide range of neurons in this dorsal horn
Speaker 1: of the spinal cord that sensitize each other and cause
Speaker 1: spatial spread of pain. And just something that that you
Speaker 1: know happens in our nervous system. If one area hurts,
Speaker 1: it'll sensitize neighboring neurons and cause you know, the signals
Speaker 1: coming will sensitize neighboring areas and cause spread of pain. Okay.
Speaker 1: Second indicator spatial variability. So like sometimes the hurts in
Speaker 1: the left line, it hurts on the right. Again, that
Speaker 1: really suggests the brains involved here, because the brain's are
Speaker 1: really good at kind of moving things around in the body.
Speaker 1: Three temporal variability. You know, some days the pain is
Speaker 1: ten out of ten, you know the next 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 will hurt every time you step
Speaker 1: on it. You're not gonna have ten out of ten
Speaker 1: one days, zero out of ten the next day. It
Speaker 1: doesn't have to be quite as dramatic as ten to zero.
Speaker 1: It can be eight too. A three, and that's still
Speaker 1: quite large swings. Four Presence of multiple chronic pain or
Speaker 1: you know, somemat of sensory syndromes. You know, in a
Speaker 1: person's history, if you have a history of headaches and
Speaker 1: 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 signal, its volume amplification. That can be an explanation
Speaker 1: for these multiple sometimes. 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'd 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 just like, what's going on this?
Speaker 1: That's kind of something's little fishy here, like why would
Speaker 1: that be? And I later understood when I got into
Speaker 1: all this research that I had developed a conditioned response
Speaker 1: that my brain you know, had paired standing still with pain,
Speaker 1: and so whenever I stood still and started to create pain,
Speaker 1: just like now Pavlov's dogs learned to link a bell
Speaker 1: to food. You know, we can link a certain position
Speaker 1: to pain, even though that position isn't objectively more dangerous
Speaker 1: or putting our body at risk than like running or
Speaker 1: some other position.
Speaker 3: Is is it possible that you would have both that
Speaker 3: you might have, say you're an older person and you
Speaker 3: have some arthritis, which you know is probably actually causing
Speaker 3: some pain, So you might also have neuroplastic pain. Is
Speaker 3: there a place where it's not one or the other.
Speaker 1: Yes, So it's a spectrum, and you could be anywhere
Speaker 1: along the spectrum for more, say peripheral tissue causes there's
Speaker 1: something in the body that's really driving it to centralized
Speaker 1: central nervous system brain causes. So people can be you know,
Speaker 1: what we call mixed pain where there's both of those.
Speaker 1: That being said, I think some of us suspect more
Speaker 1: and more that a fairly large portion is centralized or
Speaker 1: primary pain. Neuroplastic pain, for example, eric like arthritis is
Speaker 1: not necessarily painful. No severe arthritis is painful, but mild
Speaker 1: to moderate arthritis is often not painful. So if you
Speaker 1: have arthritis. You could have arthritis and you could have pain,
Speaker 1: but the arthritis might not be the cause of the pain.
Speaker 1: For example, exact numbers eluding to something like eighty percent
Speaker 1: of pain free necks have a bulging disc in them.
Speaker 1: So tons of people who have no pain at all
Speaker 1: have all kinds of anatomical findings. If you go in
Speaker 1: take one 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. And so knowing that you
Speaker 1: might have one of these findings in your body, is
Speaker 1: you know great?
Speaker 3: Now?
Speaker 1: Is that the cause of pain? Does that explain? You know,
Speaker 1: if there is spatial variability, if the pain is moving around, well, gosh,
Speaker 1: that's not so consistent with like, you know, this one
Speaker 1: injury in this one site. Or if the pain is
Speaker 1: very variable, I mean, is the injury moving you know
Speaker 1: from day to day? Is the disc one day and
Speaker 1: not the next, Right, there's probably something else going on.
Speaker 3: Pain has multiple components to it, Right, If I were
Speaker 3: to think of my back pain right now, Okay, I've
Speaker 3: got a physical sensation that I would ascribe to it, right.
Speaker 3: And then there are a couple other elements right that
Speaker 3: are very obvious if you sort of watch your mind.
Speaker 3: Element one is just my overall resistance to it. No, no, no,
Speaker 3: I don't want it. My resistance, my amplification, my all that.
Speaker 3: And then the third is all the stories I start
Speaker 3: saying about what this pain might mean. You know, mine
Speaker 3: is if my back hurts like this at fifty, what
Speaker 3: will I be like at eighty? Will I be able
Speaker 3: to do this? So there's all this stuff that goes on,
Speaker 3: and so I've talked about that with various people in
Speaker 3: the show, and when I was reading your work, you
Speaker 3: lead into the primary thing that drives the neuroplastic pain
Speaker 3: engine is fear.
Speaker 1: Yeah, this is really important, Eric, And it also gets
Speaker 1: to a way that our work is potentially different than
Speaker 1: some current framework. So everyone agrees that there is this
Speaker 1: whole layer of resistance and storytelling and unhelpful narratives that
Speaker 1: can be on top of the pain that can make
Speaker 1: us miserable and make things worse. And everyone would agree
Speaker 1: that limiting that or reducing that will be helpful. What
Speaker 1: I think is really provocative about our work is suggesting
Speaker 1: that mind brain processes could really be at the root
Speaker 1: of the pain, and by changing some of these process
Speaker 1: you can eliminate the pain. It's not an added layer
Speaker 1: on top that you can remove and now you're left
Speaker 1: with no pain still there, but it's not as bad.
Speaker 1: You can actually eliminate the pain by changing some of
Speaker 1: these mind brain pathways. Put it slightly differently, Now, if
Speaker 1: the pain is due to mind brain processes, then the
Speaker 1: solution might lay there as well, and we could eliminate
Speaker 1: the pain by changing those pathways.
Speaker 3: Yeah, I think that's an important point. In using my analogy,
Speaker 3: you're saying, not only can you take away element two
Speaker 3: and three in what I just described, you actually might
Speaker 3: take away element one the sensations themselves that are there.
Speaker 3: And what's interesting though, is that, and I want to
Speaker 3: get into your method, it seems to me that these approaches,
Speaker 3: even if you start to by targeting two and three,
Speaker 3: you may very well just buy that very nature of
Speaker 3: doing it be working on one also, because targeting two
Speaker 3: and three is the same mechanism you're talking about, which
Speaker 3: is basically becoming a little bit more present to the
Speaker 3: pain and a little bit less afraid around it. So
Speaker 3: let's move into your method. Well, actually, before I do that,
Speaker 3: I'm going to hit a couple other quick things. One
Speaker 3: is in the book it says this shows up over
Speaker 3: and over again that there are sort of three habits
Speaker 3: that are seen again and again in patients that trigger
Speaker 3: fear and aggravate neuroplastic pain. They're worrying, putting pressure on yourself,
Speaker 3: and criticism or self criticism.
Speaker 1: So I think of two broad categories of fear pain
Speaker 1: related fear and say general kind of fear or threat.
Speaker 1: And when I say fear, I'm thinking, you know, threat
Speaker 1: or a sense of there something threatening. So there's fear
Speaker 1: and sense of threat about the pain the cost like
Speaker 1: you were saying ele in two and three, the pain
Speaker 1: so bad and you know it's gonna get worse. And
Speaker 1: then there are these other general patterns of putting our
Speaker 1: brains on high alert mode of threat, this worry and
Speaker 1: pressure on the selves and self criticism that could be
Speaker 1: completely unrelated to the pain. It could be about how
Speaker 1: we're performing work, or it could be about you know,
Speaker 1: beliefs we have that we have to keep everyone else
Speaker 1: around us happy, and if someone's unhappy with us, then
Speaker 1: then that's a big problem or that you know, uncertainty
Speaker 1: about the future is dangerous and I have to eliminate
Speaker 1: all uncertainty. So there could be all these habits and
Speaker 1: these drive our brain into high alert mode and that
Speaker 1: will take the whole pain system and just turn up
Speaker 1: the volume, you know, any sense of threat. So pain
Speaker 1: is the appraisal of threat or danger. Pain is our
Speaker 1: brains way of saying, that's something dangerous here. And if
Speaker 1: there's a more global sense of threat or danger, like
Speaker 1: you know, like someone putting out of pressure on themselves,
Speaker 1: like I'm not good enough, whatever the flavor is, then
Speaker 1: that's gonna you know, add to that sense of danger
Speaker 1: and amplify the pain.
Speaker 3: Yeah, you describe at one point neuroplastic pain in a
Speaker 3: false alarm in essence, right, yeah, which I think speaks
Speaker 3: to that. As I'm hearing you say all this, you know,
Speaker 3: in my brain, I'm thinking, man, that sucks, right, Like
Speaker 3: it sucks that if you've got excessive amounts of self criticism, worry,
Speaker 3: and you know, put an extra pressure on yourself, that's
Speaker 3: miserable mentally and emotionally. And now on top of it
Speaker 3: I'm driving a physical pain engine potentially.
Speaker 1: That is miserable. I have a lot of compassion that
Speaker 1: comes up. Yeah, yeah, it seems to me like it's
Speaker 1: kind of like a culturally like contagious thing going around
Speaker 1: right now. Like you know, I just saw this. There
Speaker 1: was a survey that went out, you know, were you
Speaker 1: in a lot of stress yesterday? Like a gallop Paul,
Speaker 1: and over half of Americans said yes to that. They're
Speaker 1: in a lot of stress yesterday, And like, that's that's
Speaker 1: very sad.
Speaker 3: Yeah, ideas, I want to get to the method. There's
Speaker 3: a couple other places I could go, but let's let's
Speaker 3: go into you know, the broad strokes of how you
Speaker 3: work with some we think it's neuroplastic, right, we think
Speaker 3: 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, ninety to ninety five percent of
Speaker 1: people were saying old age and injury herniated disk. So
Speaker 1: by and large, many many people are thinking that the
Speaker 1: cause of their pain is something on the structural biomechanical level,
Speaker 1: and so shifting from that to saying, oh, the cause
Speaker 1: of my pain is neural pathways and fear is a
Speaker 1: major shift that happens. So step one is kind of
Speaker 1: assessing that, you know, you know, as a clinician, you
Speaker 1: would assess that, and then step two was getting that
Speaker 1: the person in pain on board with that assessment. And
Speaker 1: for that it really helps to have evidence. Actually, this
Speaker 1: is not any leap of faith we're asking anyone to take.
Speaker 1: This is a scientifically grounded, evidence based process where you
Speaker 1: can look through your life and if you know, when
Speaker 1: I was earlier listing the indicators of neuroplastic pain, if
Speaker 1: you're sitting there going check, check, check, that's a list
Speaker 1: of 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 there's something actually wrong there?
Speaker 1: You know, what's the evidence for that. Maybe there's strong evidence,
Speaker 1: maybe there isn't, And what's the evidence that you know
Speaker 1: it's neuroplastic pain. And in the book, the appendix has
Speaker 1: a more detailed elaboration of all these factors I was
Speaker 1: mentioning earlier. So we call it building the case. So
Speaker 1: building the case that this is really what's going on
Speaker 1: for me is a really major first step.
Speaker 3: Yeah, And you talk about different barriers in the book
Speaker 3: to overcoming that, and one of them, you know, is
Speaker 3: indeed medical diagnoses right. And you know, I know from
Speaker 3: being involved with people who had chronic pain taking them
Speaker 3: to doctors. You can see a doctor and you're like,
Speaker 3: I'm in an incredible amount of pain. There's a lot
Speaker 3: of pressure on that doctor to go, well this, you know,
Speaker 3: like to come up with something right. I know in
Speaker 3: those experiences that it's been like, you know, you start
Speaker 3: to go hmmm when one doctor's like it's this and
Speaker 3: the next doctor's like it's this, which is a different thing,
Speaker 3: and then they both disagree on the way you treatment
Speaker 3: you should do physical therapy. No, you shouldn't do it
Speaker 3: at all. I mean you start to go, wait a second, Yes,
Speaker 3: nobody really knows why I hurt this bad.
Speaker 1: Yes, And that is another great positive indicative of neuroplastic
Speaker 1: pain getting different or contradictory stories from multiple different providers.
Speaker 1: I mean they don't know. Yeah, even if they sound confidence.
Speaker 3: Is it possible to have neuropl plastic pain in one
Speaker 3: part of your body and go through a normal healing
Speaker 3: process with pain in another part of your body. So
Speaker 3: for example, you have let's make the assumption, we've gone
Speaker 3: through the process, we've done assessment, we go, you know,
Speaker 3: your lower back pain neuroplastic. That same person breaks their arm,
Speaker 3: They're in pain, but then the arm heels and the
Speaker 3: pain goes away. So in that case, they went through
Speaker 3: a normal pain cycle, right right, the body was hurt,
Speaker 3: body healed, pain went away. I've still got neuroplastic elsewhere?
Speaker 3: Is that possible? Protaly?
Speaker 1: You can have that, and you can also have what
Speaker 1: you call secondary pain or like structural biomedical like this,
Speaker 1: the pain is secondary to some injury. You could have
Speaker 1: that in one body site and neuroplastic in another body site.
Speaker 1: Got it. You know, it's really based on evidence and
Speaker 1: really hold any explanation you might get from a provider,
Speaker 1: including from what I'm saying. I hold it up to
Speaker 1: the evidence. Does this hold water? This doctor says, Oh,
Speaker 1: I'm having this pain because this is pushing on that nerve,
Speaker 1: and like, all right, well, you know what's the evidence
Speaker 1: for that being the cause of pain? Yeah?
Speaker 3: Okay. We've gone through the work of really sort of
Speaker 3: gathering the evidence, trying to determine is this what I have.
Speaker 3: If I arrive at the conclusion by myself or by
Speaker 3: working with a clinician, I arrive at the conclusion that
Speaker 3: at least some portion of what's going on here is
Speaker 3: neuroplastic pain, where do I start in unwinding this?
Speaker 1: So we viewed neuroplastic pain as the brain's misperception of
Speaker 1: threat to the body. So that's what we want to
Speaker 1: start to unwind, this misperception of threat. And the way
Speaker 1: that you unwind misperceptions of threat is with you know,
Speaker 1: perceptions of safety. Actually, that's this kind of antidote. There's
Speaker 1: a particular technique that we have developed that seems to
Speaker 1: be quite you know, to our knowledge, and one of
Speaker 1: the most effective techniques for changing this perception. We call
Speaker 1: it sematic tracking, and it's a particular way of paying
Speaker 1: attention to the sensations. And it has three components. So
Speaker 1: the first is this element of mindfulness, so becoming a
Speaker 1: bit you know, like interested and curious about the sensations,
Speaker 1: watching them the way you might watch clouds float through
Speaker 1: the sky. Oh, the sensations, you know, kind of tingly
Speaker 1: and moving a bit, you know, towards the center of
Speaker 1: my body. Second component is safety reappraisal, and this is
Speaker 1: as you're paying attention, telling yourself there is nothing wrong
Speaker 1: in my hip while I'm watching these sensations. My hip
Speaker 1: is healthy, my hip is safe, my hip is intact.
Speaker 1: These sensations are being caused by my brain. Basically literally
Speaker 1: saying those things to yourself while you're watching the sensations,
Speaker 1: you know, being genuine about it, like, oh, there really
Speaker 1: is nothing wrong because I've done this assessment. And then
Speaker 1: the third piece of semitic tracking is bringing some fun
Speaker 1: and some playfulness. We call it positive affect induction in
Speaker 1: the science world because this sense of fun and playfulness
Speaker 1: and humor will cut the threat appraisal right when you're
Speaker 1: having fun, when you're being playful. When you know you're
Speaker 1: in a good mood, it's much harder to feel afraid,
Speaker 1: So that can really pull the rug out from under
Speaker 1: this feeling of threat.
Speaker 3: And is semitic tracking. It's got these three components. It
Speaker 3: sounds a little bit like the sort of thing that
Speaker 3: might be helpful to be guided through. Is that some
Speaker 3: of the work that a clinician will do is guide
Speaker 3: someone through that. Are there guided quote unquote meditations for it.
Speaker 3: It strikes me as the sort of thing, like a
Speaker 3: lot of types of mindfulness that you can get really
Speaker 3: lost in and having somebody to sort of guide you
Speaker 3: through and bring you back and do that could be
Speaker 3: really helpful exactly having a guide. You could google it
Speaker 3: and you'll find some examples, and there's clinicians and apps
Speaker 3: that can also, you know, guide people through it.
Speaker 1: It's very important for me to emphasize that somaut of
Speaker 1: tracking is not mindfulness. Mindfulness is one piece of it. Yep,
Speaker 1: mindfulness can help with pain. Actually, you know, one of
Speaker 1: the first, if not the first study like scientific study
Speaker 1: of mindfulness was in chronic pain with John Kevin's in
Speaker 1: back in the seventies. But mindfulness alone is not likely
Speaker 1: from the data we see, mindfulness alone is pretty unlikely
Speaker 1: to get someone out of pain. It's just one piece
Speaker 1: of the puzzle for un learning pain. So if you
Speaker 1: think you have a mindfulness practice and that's like all
Speaker 1: you need there, there's more to it. Yeah, that's probably
Speaker 1: not quite.
Speaker 3: Enough, ye, right, because the other two components that you
Speaker 3: mentioned are this creation of safety right, yes, and then
Speaker 3: you know the positive affect exactly. Yeah, you talk about
Speaker 3: couple of mindsets that can help with doing somatic tracking
Speaker 3: more effectively.
Speaker 1: Yeah. So this is like a light and easefull state
Speaker 1: of mind that can be really helpful. There is a
Speaker 1: strong tendency that makes so much sense to like when
Speaker 1: we pay your attention to the pain, to tighten around it,
Speaker 1: to 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 going to do next? Is
Speaker 1: it going to get worse? So the mindset of like
Speaker 1: you know, ease and safety and mindfulness and relaxation and
Speaker 1: doing it because it feels good. What's really amazing to
Speaker 1: me and what I'm super interested in as a scientist
Speaker 1: is that you know, sometimes I would even say many
Speaker 1: times during somatic tracking. As people start doing this practice
Speaker 1: and paying attention without fear, year the sensations start to shift,
Speaker 1: often to diminish, and sometimes they even disappear. We've even
Speaker 1: had you know, sessions with the clients or they'll do
Speaker 1: somatic tracking and then the pain's gone ten minutes later
Speaker 1: and they're like, oh my gosh, this is the first
Speaker 1: time in eighteen years, I haven't felt any pain. We
Speaker 1: just did a little exercise, you know, ten minute 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 3: So listener, consider this. You're halfway through the episode Integration
Speaker 3: re Mind. Remember knowledge is power, but only if combined
Speaker 3: with action and integration. It can be transformative to take
Speaker 3: a minute to synthesize information rather than just ingesting it
Speaker 3: in a detached way. So let's collectively take a moment
Speaker 3: to pause and reflect. What's your one big insight so
Speaker 3: far and how can you put it into practice in
Speaker 3: your life. Seriously, just take a second, pause the audio
Speaker 3: and reflect it. Can be so powerful to have these
Speaker 3: reminders to stop and be present. Cant it. If you
Speaker 3: want to keep this momentum going that you built with
Speaker 3: this little exercise, I'd encourage you to get on our
Speaker 3: Good Wolf Reminders SMS list. I'll shoot you two texts
Speaker 3: a week with insightful little prompts and wisdom from podcast guests.
Speaker 3: They're a nice little nudge to stop and be present
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Speaker 3: get lost in the busyness and forget what is important.
Speaker 3: You can join at oneufeed dot net slash sms and
Speaker 3: if you don't like them, you can get off the
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Speaker 3: community on the list, and we'd love to welcome you
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Speaker 3: slash sms and let's feed our good Wolves together. You
Speaker 3: guys talk about when you're doing this, you know, turning
Speaker 3: down the intensity and trying to be outcome independent, which
Speaker 3: is really hard to do right when what you're trying
Speaker 3: to do is get rid of pain. But Alan describes
Speaker 3: several times in the book when he's talking about specific clients.
Speaker 3: You know that there's a natural tendency to be like,
Speaker 3: all right, this is going to fix me, and I'm
Speaker 3: going after it right. Like, you know, there's a mindset
Speaker 3: that says like, Okay, I'm going to do somatic tracking
Speaker 3: like one hundred percent. I'm going to nail it right.
Speaker 3: And that is the clenching, intensing around it. And so
Speaker 3: it strikes me a little bit as we talk about
Speaker 3: in Zen, you know, trying not to try exactly, you know,
Speaker 3: which is a little bit of an art.
Speaker 1: Total art that's really hesitating. Whether it's to even mention
Speaker 1: that sometimes the pain goes down during somatic tracking, because
Speaker 1: then people will be like, oh, I'm gonna go do
Speaker 1: this thing to get rid of my pain, and that, unfortunately,
Speaker 1: is going to backfire because as soon as you're trying
Speaker 1: to get rid of your pain, you're reinforcing the idea
Speaker 1: of the pain is a dangerous problem and a threat
Speaker 1: that needs to be gotten rid of. Yeah, And actually,
Speaker 1: so that's just going to add fuel to the fire. Really,
Speaker 1: what we're trying to build is this attitude of pain
Speaker 1: is something we can be curious about and be unafraid of,
Speaker 1: and so we can somatic track to kind of get
Speaker 1: to know it a bit better and to welcome it
Speaker 1: in because it's not dangerous.
Speaker 3: Yeah, we talk about this and mindfulness communities, meditation communities,
Speaker 3: but Zen talks a lot about this, and I'm a
Speaker 3: Zen practitioner, and you know, one of the ideas that
Speaker 3: I found really helpful in that regard is that outcome
Speaker 3: oriented focus is sort of necessary for you to do
Speaker 3: the practice at all, Like, otherwise, why are you going
Speaker 3: to do it right? Nobody's going to do somatic right.
Speaker 3: So you want to get rid of the pain, So
Speaker 3: you're going to do somatic tracking. But then and a
Speaker 3: spiritual teacher said this to me while he said your
Speaker 3: will is good for getting you to the meditation cushion,
Speaker 3: at that point you have to shift and you have
Speaker 3: to let go of that. And that's kind of what
Speaker 3: we're saying here, like, Okay, yeah, of course you want
Speaker 3: the pain to go away. That's going to get you
Speaker 3: to the front door of the sematic tracking session. At
Speaker 3: that point we have to try and let go and
Speaker 3: become more outcome independence.
Speaker 1: That's exactly.
Speaker 3: It's kind of knowing which tool to apply when you
Speaker 3: know which mindset to apply when.
Speaker 1: That's very helpful. Thanks for that. I'm going to use
Speaker 1: that with my clients.
Speaker 3: So we're doing sematic tracking. It's got these benefits. You
Speaker 3: say at another point, if you want to overcome any fear,
Speaker 3: and we're saying that the fear is kind of the
Speaker 3: engine of this thing. Exposure to the thing you're afraid
Speaker 3: of is important, so say more about the role of
Speaker 3: 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 we believed.
Speaker 1: And so doing somatic tracking during an exposure is an
Speaker 1: important piece of this approach. So using these same tools
Speaker 1: to bring attention to the sensations while you are doing
Speaker 1: the thing that's been feared. Remembering a client I worked
Speaker 1: with who you know, we must have we stood up.
Speaker 1: We probably did like a hundred times in a row,
Speaker 1: just bend over, end up, bend over, stand up, just
Speaker 1: watching the sensations like you would watch no water flowing
Speaker 1: down the waterfall, because you know, as we were bending over,
Speaker 1: that was kind of the image, and just watching the
Speaker 1: sensations and like, oh, look what happened when you bend over?
Speaker 1: Look what happened when that you get up? You know
Speaker 1: that bending over is totally safe. There's nothing dangerous. I
Speaker 1: think over is great for your back. It's not dangerous
Speaker 1: for your back in anyway. It's actually really good for
Speaker 1: your back to bend and cracking some jokes. And you know,
Speaker 1: she had a lot of pain that the you know,
Speaker 1: first few times we bend over, and by a number
Speaker 1: one hundred, it didn't hurt at all.
Speaker 3: Yeah, and you guys talk in the book very well
Speaker 3: about not doing this. As you're saying like, when you
Speaker 3: have a high level of pain, that's right, And if
Speaker 3: you're in a high level of pain, it's not the
Speaker 3: time to be doing somatic tracking and exposure. It reminds
Speaker 3: me of my coaching work with people, and we talk
Speaker 3: about some of these skills that we practiced to deal
Speaker 3: with difficult thoughts or emotions. You don't want to practice
Speaker 3: those on the hardest thing in your life. It's not
Speaker 3: the time to do it. You know, you want to
Speaker 3: start practicing at a place that's manageable. You know, you
Speaker 3: can't practice if there's none So as you guys say,
Speaker 3: you can't really do this if you don't have any pain,
Speaker 3: But you want to look for those medium to low
Speaker 3: level times is the time that this exposure and sematic
Speaker 3: tracking can be most effective.
Speaker 1: One hundred percent. That's so important to emphasize to you know,
Speaker 1: start using these sorts of skills when the pain is
Speaker 1: in the low to medium range.
Speaker 3: Yeah. And what I really like is you say, you know,
Speaker 3: if your pain is really high, then don't try sematic tracking,
Speaker 3: use your avoidance behaviors. And so I love how it's
Speaker 3: not saying like avoidance behavior bad, sematic tracking good. Yes,
Speaker 3: depending on the scenario avoidance behaviors are a perfectly good
Speaker 3: thing to do if your pain level is really high.
Speaker 3: When it's at a lower level, that's the time to
Speaker 3: work on sematic tracking and an exposure.
Speaker 1: Exactly because we want the exposures to be corrective learning.
Speaker 1: So an exposure from which you learn the pain is
Speaker 1: not dangerous. And when the pain's super high, it's going
Speaker 1: to be very hard to get that takeaway. If you
Speaker 1: encounter it when the pain is raging, you know it'll
Speaker 1: be very tough, and so at that moment, just anything
Speaker 1: that's kind of can help bring it down, you know,
Speaker 1: ice packs, cold packs, laying down for a bit, you know,
Speaker 1: until it becomes more in an manageable range, and then
Speaker 1: get back on the horse and do the exposures. The
Speaker 1: sematic tracking, which is an internal exposure really to the sensation.
Speaker 3: And is that the primary tool in the method. By
Speaker 3: doing somatic tracking, by having exposure to the pain, which
Speaker 3: causes what you guys are calling a corrective experience, describe
Speaker 3: corrective experience for us so I can tie all this together.
Speaker 1: The corrective experience is learning that the sensation is not
Speaker 1: as dangerous and threatening as you thought.
Speaker 3: So this strikes me as similar in ways to exposure
Speaker 3: therapy in other domains, right where the idea is expose
Speaker 3: yourself to the feared stimulus and a manageable dose you
Speaker 3: learn that it's not so frightening and you're able to
Speaker 3: handle more and more. So there's a corrective experience here.
Speaker 3: I want to talk a little bit about some of
Speaker 3: what this path looks like if you get on it
Speaker 3: and you start to have some healing, because there's, like
Speaker 3: any path, there's some ups and downs that can occur,
Speaker 3: and I'd like to hit a couple of those, but
Speaker 3: I definitely want to hit Also the study that you
Speaker 3: guys recently published, so tell me about that.
Speaker 1: So this was the first trial testing PRT. We took
Speaker 1: one hundred and fifty one people and we randomized them
Speaker 1: to one of three groups a course of PRT, which
Speaker 1: was nine sessions over the course of the month. There
Speaker 1: was a placebo control they got this placebo injection into
Speaker 1: their back, and then the usual care control group of
Speaker 1: people who kept doing whatever they usually did to care
Speaker 1: for their back, whether it was acupuncture, chiropractor, or medication.
Speaker 1: And we asked people to tell us how much pain
Speaker 1: they were in before and after and how much fear
Speaker 1: of pain they had, and what they thought was the
Speaker 1: cause of their pain. And we also scanned their brains
Speaker 1: before and after, and what we found was very large
Speaker 1: reductions in back pain for people in the PRT group
Speaker 1: as compared to the control So people in the control groups,
Speaker 1: so everyone came in on average about four out of
Speaker 1: ten pain and in the control groups people left with
Speaker 1: about three out of ten pain, but in the PERT
Speaker 1: group people had one out of ten pain on average,
Speaker 1: and it was a really large reduction. And what was
Speaker 1: especially striking was that a number of people were pain
Speaker 1: free at the end of the study. They had zero pain,
Speaker 1: you know, to put some numbers on it, we found
Speaker 1: that two thirds of people were pain free or nearly
Speaker 1: so at the end of PRT as compared to twenty
Speaker 1: percent in the PLACEBA group and ten percent un usual
Speaker 1: care group. And this is really striking because you just
Speaker 1: don't really see psychological treatments making people pain free. So
Speaker 1: this is part of what this kind of conceptual framework
Speaker 1: that PRT is coming from that is different than some
Speaker 1: of the existing psychological approaches to pain, where like we
Speaker 1: said earlier, they target mostly elements two and three, but
Speaker 1: PRT really goes after element one.
Speaker 3: The pain itself, and PRT is pain reprocessing therapy, which
Speaker 3: is your guy's method. I just think in the case
Speaker 3: any listener didn't catch that.
Speaker 1: Yeah, sorry for that.
Speaker 3: Yeah.
Speaker 1: And we followed people for one year after no treatment ended,
Speaker 1: and the gains were largely maintained. So one year out,
Speaker 1: half the people were pain free or nearly so, even
Speaker 1: though they had received no treatment in that intervening time.
Speaker 1: And when we looked at the mechanism to try to understand, well,
Speaker 1: how does PRT work, What we found is that people
Speaker 1: who have the biggest reductions and fear of pain had
Speaker 1: the largest pain intensity decreases. And the people with the
Speaker 1: biggest shifts and how they think about the causes of
Speaker 1: their pain shifts from you know, structural mechanical causes to
Speaker 1: mind brain causes, they had the biggest reductions in pain
Speaker 1: as well. And we also saw these really interesting changes
Speaker 1: in how people's brains were processing pain when we put
Speaker 1: them in the brain scanner as well.
Speaker 3: Tell me about that last piece a little bit. What shifted.
Speaker 1: Yeah, So we saw reduced activity for purity verus control
Speaker 1: in these three brain regions as people were processing or
Speaker 1: experiencing back pain. So we put people in the brain
Speaker 1: scanner with this back pain evocation device as basically this
Speaker 1: inflatable pillow that went under people's backs while scanning, and
Speaker 1: when we inflated it, it caused back pain. It might
Speaker 1: sound nice to have a pillow under your back, but
Speaker 1: this was not. It didn't feel good the way we
Speaker 1: positioned it, in the way it was inflating, people did
Speaker 1: not like it. It was hurting. We saw as when
Speaker 1: we exposed people to the same stimulus post treatment in
Speaker 1: the PERT group, there was less activity in the interior insula,
Speaker 1: the mid singulate, and the anterior prefrontal cortex. And these
Speaker 1: are bringing regions that do many things, but one of
Speaker 1: the things they do is track threatening stimuli. And the
Speaker 1: more threatening stimulus is the more activity you'll see in
Speaker 1: those brain regions. And so the reduced activity we observed
Speaker 1: in those regions is consistent with this idea that treatment
Speaker 1: helped people see the sensations as less threatening.
Speaker 3: Did you screen people before the study to see if
Speaker 3: you thought they had neuroplastic pain or did you just
Speaker 3: take a bunch of people's back hurts.
Speaker 1: Yeah, we had some criteria for trying to get neuroplastic
Speaker 1: pain We excluded people with leg pain worse than back pain,
Speaker 1: because that's a sign that there might be ridiculopathy. There
Speaker 1: might be a that's bulging onto a nerve, pushing onto
Speaker 1: a nerve that's causing black pain. Leg pain is not
Speaker 1: necessarily neuroplastic, are not necessarily structural or mechanical. It just
Speaker 1: diagnosis can be a little more involved there. So we
Speaker 1: screened that out. And there's a couple other criteria, but
Speaker 1: on the whole we end for pretty broad inclusion criteria.
Speaker 1: You know, if someone had scoliosis, no problem, history of
Speaker 1: back surgeries, no problem, ten hernia, the discs, no problem.
Speaker 1: That those are all welcome, got it, Got it, because
Speaker 1: those are often just not the cause of the pain,
Speaker 1: like scoliosis, not necessarily painful. It could be painful, but
Speaker 1: you need to do a thorough assessment to see you know,
Speaker 1: you might have painful scoliosis, or you might have pain
Speaker 1: and scoliosis, but the two aren't connected.
Speaker 3: And is it possible that with a lot of these conditions,
Speaker 3: there was an initial burst of pain from that condition
Speaker 3: and then the body adjusts to it and heals and
Speaker 3: stops sending the pain sensations. But at this point we've learned,
Speaker 3: you know, to use the term you used earlier, we've
Speaker 3: learned the pain.
Speaker 1: It reminds me so much of you know, PTSD, where
Speaker 1: a person will go, you know, to use like a
Speaker 1: classic example of like military PTSD. Person will be in
Speaker 1: a very dangerous context where loud noises could mean you're
Speaker 1: being attacked, and they'll 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 threat's 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.
Speaker 3: I'm curious, and this may be extrapolating out multiple steps
Speaker 3: from where you are, but is there thought of trying
Speaker 3: to measure psychological well being as well as pain reduction.
Speaker 3: Do you think that you perhaps kill two birds with
Speaker 3: one stone, so to speak.
Speaker 1: Yeah, chronic pain can be a really like shitty you
Speaker 1: know snow of depression anxiety. Insomnia. Pain leads the depression
Speaker 1: feats to the anxiety, which leads insomnia needs the pain
Speaker 1: against cycle, 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 good for depression. So it's all interconnected. And conversely,
Speaker 1: we know that you know, depression, anxiety, and insomnia, they
Speaker 1: all amplify pain as well.
Speaker 3: Yeah, and if the method brings down these three types
Speaker 3: of thoughts that you guys say really trigger fear, worry, pressure,
Speaker 3: and criticism, if your method is actually helping with the
Speaker 3: reduction in those areas, you know, the benefit continues and continues.
Speaker 1: Yeah. What you know people in our study told us
Speaker 1: was that, you know, beyond bringing down pain, people were saying, like, oh,
Speaker 1: I learned to listen to my feelings for the first time,
Speaker 1: I got in touch with myself. I've realized that I
Speaker 1: was such a bully to myself, so me, you know,
Speaker 1: putting so much pressure on myself and I've stopped doing that.
Speaker 3: That's really important and meaningful.
Speaker 1: Yeah, it really is.
Speaker 3: Well, thank you so much for taking the time to
Speaker 3: come on. I've really enjoyed the conversation. I really enjoyed
Speaker 3: the book. I think the work you guys are doing
Speaker 3: is incredibly important. I get a lot of requests for
Speaker 3: people to be on the show. I get a lot
Speaker 3: of pain stuff, and a lot of it to me
Speaker 3: looks really like that seems a little sketchy. But when
Speaker 3: I saw the work that you guys were doing, I
Speaker 3: saw the studies that were behind it, I felt like,
Speaker 3: this is a really important thing to try and put
Speaker 3: out there. So thank you for the work you're doing.
Speaker 1: Thanks Eric. There is a big shift happening in the field.
Speaker 1: And yeah, the way a lot of us are thinking
Speaker 1: about chronic pain is shifting to really appreciate everything we've
Speaker 1: been talking about, how mind and brain processes can play
Speaker 1: a bigger role, and just narrowly looking at problems below
Speaker 1: the neck are unlikely to really work as an approach
Speaker 1: for most forms of chronic pain.
Speaker 3: Yeah, I mean, I think anything that sort of tries
Speaker 3: to divide the mind from the body. You know, we
Speaker 3: talk about the mind body division as if it's a thing,
Speaker 3: and I'm like, it's not. I mean, like they're pretty
Speaker 3: clearly connected in any anatomical diagram I have seen, like
Speaker 3: you know, like I'm not sure where we got the
Speaker 3: idea they were separate, but nonetheless.
Speaker 1: Thanks so much for having me on.
Speaker 3: Yeah, thank you so much.
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