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Speaker 1: Pushkin.

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Speaker 2: When you think about the pain a thousand times a day,

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Speaker 2: when it's the first thing you think of when you

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Speaker 2: wake up, the last thing you think of before you

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Speaker 2: go to sleep, you're constantly checking in to see if

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Speaker 2: it's there. When you attend to the pain, there were

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Speaker 2: a lens of fear, frustration, despair that reinforces to your

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Speaker 2: brain that these sensations are dangerous and it becomes this

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Speaker 2: terrible cycle.

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Speaker 1: Typically, when we think about pain, we assume that something

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Speaker 1: structural is causing it, like a muscle strain or a

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Speaker 1: ruptured ligament. But psychotherapist Alan Gordon studies how pain can

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Speaker 1: also emerge when our brains misinterpret safe signals as dangerous.

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Speaker 2: Pain is a survival mechanism. It helps us when it's

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Speaker 2: working the way that it's supposed to, but sometimes the

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Speaker 2: brain can make a mistake. Sometimes the brain could interpret

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Speaker 2: danger where there is none and generate pain even in

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Speaker 2: the absence of an injury or structural damage.

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Speaker 1: On today's episode, a novel Approach to treating chronic pain,

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Speaker 1: I'm maya Shunker and this is a slight change of plans,

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Speaker 1: a show about who we are and who we become

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Speaker 1: in the face of a big change. Alan is an

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Speaker 1: assistant professor at the University of Southern California, and he's

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Speaker 1: a therapist who helps counsel patients with chronic pain. He's

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Speaker 1: also the author of the book The Way Out, a revolutionary,

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Speaker 1: scientifically proven approach to healing chronic pain. The idea behind

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Speaker 1: Allan's work is that a lot of the pain we

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Speaker 1: experience isn't actually caused by structural issues. Instead, it's the

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Speaker 1: brain misinterpreting the body's signals. In those cases, Rather than

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Speaker 1: endlessly searching for medical interventions, we're better off refocusing our

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Speaker 1: attention on practices that can rewire our minds and relieve

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Speaker 1: our pain. Later in the episode, you'll hear Allan guide

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Speaker 1: me through his process to relieve some knee pain I've

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Speaker 1: been experiencing lately. But first I wanted to learn more

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Speaker 1: about what drove Allan to enter this line of work

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Speaker 1: in the first place. Alan, I know that your work

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Speaker 1: has very personal undertones, and I was wondering if we

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Speaker 1: could first start by hearing the story of your experience

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Speaker 1: with chronic back pain.

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Speaker 2: It was back in my mid twenties and I was

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Speaker 2: a really active person. I was on a kickball team,

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Speaker 2: I would play sports all the time, and I was

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Speaker 2: in graduate school at USC at the time, and one

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Speaker 2: day I woke up and I had back pain. And

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Speaker 2: it was very strange because I didn't have an injury.

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Speaker 2: There was no car accident, there was nothing like that,

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Speaker 2: and I just thought, Okay, well, it'll pass. And by

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Speaker 2: the end of the week it was still there and

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Speaker 2: it was horrible. Every time I would walk, I would

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Speaker 2: have pain. Every time I would sit, I would have pain.

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Speaker 2: I remember going to a movie with some of my friends.

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Speaker 2: By the end of the movie, I was in so

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Speaker 2: much pain. I literally didn't go to another movie for

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Speaker 2: years after that because it was such a traumatizing experience.

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Speaker 2: And so I started having all of this fear around

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Speaker 2: the pain. Is this what my life is like? Now?

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Speaker 2: What's going on? I went to the doctor, got an MRI.

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Speaker 2: I actually saw three of the best orthopedis in Los Angeles,

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Speaker 2: and each one of them had a different take on

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Speaker 2: what was going on with me. The first one said,

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Speaker 2: this is definitely due to a discarnation. And I remember

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Speaker 2: him holding up this MRIs and there's this five millimeter

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Speaker 2: discreanation with partial nerve root compression. I could still see

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Speaker 2: it in my mind. Then the next one I saw said,

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Speaker 2: you know, I don't actually think that's what it is.

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Speaker 2: I think it's due to disc degeneration. And once again

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Speaker 2: he holds up my MRI scan and shows me all

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Speaker 2: of these flattened discs up and down my vertebrae. The

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Speaker 2: third one that I saw just looked me up and

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Speaker 2: down and said, I think you have back pained because

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Speaker 2: you're just too tall. Nothing I can do about that.

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Speaker 2: I just remember thinking, how did my genes even survive

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Speaker 2: through evolution that I have this much wrong with my back.

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Speaker 2: When I'm in my mid twenties, and I did every

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Speaker 2: treatment under the sun, everything that you could think of, acupuncture, acupressure,

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Speaker 2: physical therapy, and I ended up having to move home.

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Speaker 2: I'm living with my parents, and over the next couple

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Speaker 2: of years, I start getting more and more symptoms. I

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Speaker 2: got chronic headaches, I got wrist pain, knee pain, chronic fatigue,

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Speaker 2: getting more diagnoses, more treatments, and nothing worked.

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Speaker 1: Yeah, when you experienced chronic pain, it can be so

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Speaker 1: all consuming, right, and mean, it's like the only thing

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Speaker 1: you think about. It comes to define who you are

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Speaker 1: in this fundamental way. I mean, what eventually led you

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Speaker 1: to a slightly better place.

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Speaker 2: Well, I was at home. My mom comes in to

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Speaker 2: my room one day and she's holding a book and

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Speaker 2: she says, I want you to read this book. My

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Speaker 2: friend's son had back pain and he read this book

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Speaker 2: and it helped him. I got so mad at her.

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Speaker 2: It felt like an attack on the fact that, like,

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Speaker 2: you know, my pain wasn't real or something like that.

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Speaker 2: And I said, Mom, a book isn't going to help

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Speaker 2: me get better. This isn't in my head. I have

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Speaker 2: these real structural problems in my body. I think I

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Speaker 2: pulled out my MRI report and was going over all

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Speaker 2: the findings with her, and she was like, all right,

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Speaker 2: I'm just trying to help. And she left the book

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Speaker 2: there and I think it sat on my bookshelf for

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Speaker 2: maybe something like nine months, and finally one day I

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Speaker 2: picked it up and I read it. And there's one

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Speaker 2: thing that jumped out at me that really struck me.

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Speaker 2: There was the study that I read about in the

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Speaker 2: New England Journal of Medicine, and it found that the

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Speaker 2: majority of people with no back pain have disc bulgess

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Speaker 2: herniations distogeneration, that essentially these are just normal abnormalities and

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Speaker 2: not the cause of pain in most people. I mean,

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Speaker 2: I had seen probably two dozen doctors by this point.

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Speaker 2: How had I never heard this before? And so I

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Speaker 2: went down the rabbit hole of learning everything I could

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Speaker 2: about pain and neuroscience, and I found that very often

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Speaker 2: with chronic pain, the symptoms are the result of misfiring

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Speaker 2: pain circuits in the brain as opposed to structural problems

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Speaker 2: in the body. And then from there, I, you know,

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Speaker 2: working with my own symptoms as well as some patients

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Speaker 2: I started working with as a therapist myself, I developed

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Speaker 2: a set of techniques that we now call pain reprocessing therapy,

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Speaker 2: and I was able to overcome all of my own

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Speaker 2: symptoms from a brain based approach.

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Speaker 1: So let's dig into the basics here. Tell me what

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Speaker 1: pain is, and then tell me how you would define

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Speaker 1: what you call normal pain.

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Speaker 2: So all pain is generated in the brain. If you

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Speaker 2: put your hand on a hot stove, the pain is

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Speaker 2: your brain's way of letting you know you need to

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Speaker 2: move your hand so that you don't cause more damage. Essentially,

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Speaker 2: what's happening is the nerve endings in your hand or

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Speaker 2: sending danger signals to your brain. Pain is a survival mechanism.

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Speaker 2: It helps us when it's working the way that it's

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Speaker 2: supposed to. But sometimes the brain can make a mistake.

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Speaker 2: Sometimes the brain could interpret danger where there is none

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Speaker 2: and generate pain even in the absence of an injury

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Speaker 2: or structural damage. And we call this neuroplastic pain, which

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Speaker 2: just means learned pain. And more and more studies are

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Speaker 2: showing that many forms of chronic pain are actually neuroplastic

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Speaker 2: And just like this pain can be learned, it can

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Speaker 2: be unlearned.

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Speaker 1: Yeah, And I think it's so important at this point

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Speaker 1: in the conversation to clarify that all pain, whether it's

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Speaker 1: normal pain or neuroplastic pain, is real pain, right, because

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Speaker 1: all pain originates in the brain. So there's no thing

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Speaker 1: as saying like, well, this is all in your head

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Speaker 1: versus this other type of pain isn't in your head.

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Speaker 1: It's all in your head. So you're not in any

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Speaker 1: way invalidating the existence of the pain or the intensity

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Speaker 1: of the pain. You're simply saying that the cause of

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Speaker 1: the pain might vary depending on whether it's caused by

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Speaker 1: a structural issue in the body versus something that's originating

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Speaker 1: because your brain has made this mistake.

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Speaker 2: Yeah, all pain is real, Yeah.

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Speaker 1: You know, a foundational message of this work is that

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Speaker 1: pain does not imply that there is a physical injury.

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Speaker 1: And I mean that is a seismic shift in perspective.

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Speaker 1: I mean, I remember growing up, I was on the

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Speaker 1: cross country team. Something hurts, I instantly think, oh my god,

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Speaker 1: what did I injure? I mean, it's the only question

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Speaker 1: I asked myself. But there's a couple really amazing studies

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Speaker 1: that show how you can experience pain in the absence

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Speaker 1: of a physical injury. So the first is this simulated

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Speaker 1: car crash study, right, and I'm wondering if you could

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Speaker 1: tell me a bit more about that one.

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Speaker 2: Yeah, this was brilliant. This was in Germany, and these

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Speaker 2: very creative scientists created a condition where the subjects were

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Speaker 2: sitting in a car on a track and they thought

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Speaker 2: they were rear ended from behind by another car. And

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Speaker 2: what the scientist did is they had crash sounds come

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Speaker 2: up over a loudspeaker. There was an actual dent in

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Speaker 2: the back of the car that was there previously that

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Speaker 2: the person didn't see, and the car was on an

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Speaker 2: inclined plane and so it slightly moved forward, but there

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Speaker 2: was no actual impact between the two cars. And what

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Speaker 2: they found was that eighteen percent of people had neck

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Speaker 2: pain after this fake placebo car accident, and a month later,

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Speaker 2: ten percent of them still had neck pain. So even

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Speaker 2: though there was no injury, the brain thought there was

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Speaker 2: and generated pain.

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Speaker 1: You also been one of the lead researchers on a

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Speaker 1: big back pain study. This is the boulder back pain study, right.

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Speaker 1: Tell me a bit more about that.

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Speaker 2: All of the patients in the study had had chronic

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Speaker 2: back pain for an average of ten years going into it.

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Speaker 2: What the study did is we looked at three different groups.

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Speaker 2: One group got pain reprocessing therapy, one group got a

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Speaker 2: placebo treatment, and then one group got no treatment. There

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Speaker 2: were fifty patients in each group. We got fMRIs of

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Speaker 2: everyone's brain before and after, and amazingly, in the pantiprocessing

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Speaker 2: therapy group, we found that sixty six percent of the

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Speaker 2: patients were either pain free or nearly pain free after

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Speaker 2: four weeks, and remarkably a year later, they were still

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Speaker 2: out of pain.

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Speaker 1: That's extraordinary. And you know, to clarify for listeners, there

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Speaker 1: was no physical intervention like as part of pain reprocessing therapy.

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Speaker 1: Alan and the other researchers never touch people's backs or

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Speaker 1: gave them physical exercises to do, which is again just

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Speaker 1: such a significant shift in the way that we think

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Speaker 1: about pain or what we were taught for, at least

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Speaker 1: for me for decades of my life.

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Speaker 2: Yeah, everything we've ever known about cause and effect is

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Speaker 2: telling us if you have pain when you walk, if

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Speaker 2: you have pain when you sit, then it's the walking

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Speaker 2: or the sitting that's causing the pain. Really, so it's

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Speaker 2: counterintuitive to really wrap your mind around the fact that, like,

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Speaker 2: I have pain, but there's nothing wrong with my body.

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Speaker 2: So I was even shocked by how regenerative of the

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Speaker 2: body is and how such a high percentage of chronic

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Speaker 2: pain could actually be neuroplastic.

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Speaker 1: Yeah, what about for people bull for whom this chronic

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Speaker 1: pain is instigated by an acute injury, what's going on

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Speaker 1: in the brain in that case.

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Speaker 2: Yeah, that's a great question. So the injury is real,

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Speaker 2: there's maybe a lot of fear or preoccupation around the symptoms.

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Speaker 2: The brain learns and remembers the pain, and the pain

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Speaker 2: persists even after the injury heals. There was another study

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Speaker 2: where they looked at a lot of patients who had

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Speaker 2: initial episodes of back pain and they took scans of

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Speaker 2: their brains, and they found that the pain was present

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Speaker 2: in the areas of the brain that are normally associated

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Speaker 2: with pain. And then they followed the patients who went

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Speaker 2: on to develop chronic pain, and they took brain scans again,

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Speaker 2: and they found that the pain had actually moved to

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Speaker 2: the parts of the brain associated with learning and memory,

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Speaker 2: so that even after the symptoms heal, it could still

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Speaker 2: be chronic. You know, I had knee pain for a

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Speaker 2: while and I ended up getting imaging on it, and

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Speaker 2: I had a severely torn meniscus tear and there's no

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Speaker 2: blood flow to the meniscus, and I ended up needing

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Speaker 2: to get surgery to fix that injury. So I don't

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Speaker 2: want to be so black and white about it and

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Speaker 2: say that all chronic pain is neuroplastic.

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Speaker 1: So, Alan, you've established that neuroplastic pain is very, very prominent.

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Speaker 2: Right.

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Speaker 1: It is responsible for so much of our chronic pain,

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Speaker 1: for so much suffering in the world. Right, how do

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Speaker 1: we get rid of the damn thing? What is your

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Speaker 1: process for getting rid of neuroplastic pain?

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Speaker 2: This is the exciting thing is that it's very treatable.

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Speaker 2: Even in the Bolder Back Pain study, there were some

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Speaker 2: patients who had had chronic back pain for forty years

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Speaker 2: and they were able to overcome their symptoms in just

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Speaker 2: a few weeks. So it doesn't matter how long you've

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Speaker 2: had the pain. If you have neuroplastic pain, then you

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Speaker 2: are able to overcome it. So the first thing that

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Speaker 2: you want to do is determine whether or not you

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Speaker 2: have neuroplastic pain or structurally caused pain. And there are

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Speaker 2: twelve or thirteen different criteria that we look for. I'm

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Speaker 2: not going to go over all of them right now,

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Speaker 2: but a few of them are did the pain come

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Speaker 2: on during a time of stress. Another thing we look

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Speaker 2: for is does the pain spread or move around right

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Speaker 2: Sometimes it's on the left side of your back, sometimes

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Speaker 2: it's on the right side of your back. Another thing

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Speaker 2: we look for is inconsistency of symptoms, so you know,

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Speaker 2: maybe it is really bad during the week, but on

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Speaker 2: the weekends or when you're on vacation it's a lot better.

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Speaker 2: Or you know, maybe it's there in certain positions but

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Speaker 2: not other positions, and it's not really consistent. All of

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Speaker 2: these things are indicative of the fact that it's neuroplastic pain.

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Speaker 2: But even if you're able to wrap your mind around

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Speaker 2: the idea that you have neuroplastic pain on an intellectual level.

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Speaker 2: It's really hard to embrace on a gut level because

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Speaker 2: it's it's counterintuitive, and so it actually involves embracing a

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Speaker 2: reality where your senses are lying to you. So it

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Speaker 2: can be very tricky to do, even if you have

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Speaker 2: all the evidence in the world. So sometimes it can

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Speaker 2: be helpful to create an evidence sheet so that you know,

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Speaker 2: you can put up on your fridge and constantly look

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Speaker 2: at it to reinforce.

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Speaker 1: This is neuroplastic.

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Speaker 2: There was a patient that I saw a while ago,

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Speaker 2: and she came into my office and she had chronic

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Speaker 2: back pain. Every time she sat. She sits down and

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Speaker 2: she says, I know that you're going to tell me

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Speaker 2: that the pain is being caused by my brain, but

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Speaker 2: I don't believe it. I just don't believe it. And

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Speaker 2: I go, okay, we'll see what happens. And halfway through

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Speaker 2: the session I did a meditation with her, and by

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Speaker 2: the end of it, her pain was completely gone. She

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Speaker 2: opened her eyes and I said to her, well, now

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Speaker 2: what do you think? And she looked at me for

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Speaker 2: a few moments and she said, I still don't believe it.

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Speaker 2: It was so funny that even in the face of

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Speaker 2: overwhelming evidence that the pain went away.

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Speaker 1: Yeah, it's really really hard.

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Speaker 2: It's hard to wrap your mind around. And so the

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Speaker 2: main technique that we use for pain reprocessing therapy is

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Speaker 2: something we call somatic tracking. So normally when we pay

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Speaker 2: attention to the pain, it's with a sense of fear, preoccupation, worry, despair,

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Speaker 2: and all of these negative emotions. When we're attending to

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Speaker 2: the pain through that lens reinforces our brain that the

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Speaker 2: pain is actually dangerous and keeps the pain alive. So

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Speaker 2: somatic tracking is is it's a way to try to

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Speaker 2: break that pain fear cycle, where you're attending to the

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Speaker 2: pain in a new way to show your brain that

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Speaker 2: the signals that are coming from your body are actually

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Speaker 2: safe and not dangerous.

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Speaker 1: After the break, I asked Alan if you could coach

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Speaker 1: me through somatic tracking. I've never tried it before, but

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Speaker 1: I've had this annoying knee pain for a while and

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Speaker 1: I really wanted to see if it could help me.

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Speaker 1: We'll be back in a moment with a slight change

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Speaker 1: of plans. I have a personal story that really error

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Speaker 1: is yours, So probably at this point eight or nine

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Speaker 1: years ago, I was taking a one of those bar

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Speaker 1: classes and I remember during the ab part of the workout,

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Speaker 1: I kind of just strain lightly my lower back. A

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Speaker 1: week goes by, two weeks goes by, it's not quite

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Speaker 1: getting better. And the more time that passes, the more

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Speaker 1: stressed out and freaked out I am that I've done

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Speaker 1: something terrible to my lower back. Fast forward a year

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Speaker 1: and a half, I'm struggling with chronic lower back pain.

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Speaker 1: I was not able to sit without pain for a

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Speaker 1: year and a half. I became terrified of sitting. It

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Speaker 1: was just like it was a stressful. And so the

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Speaker 1: moment it was unlocked for me as I remember seeing

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Speaker 1: the head of orthopedics at George Washington University and he

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Speaker 1: looked at my MRI scan and he said, Maya, there's

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Speaker 1: nothing structurally wrong in your back.

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Speaker 2: Wow.

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Speaker 1: He just said that to me. He's like, there is

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Speaker 1: nothing wrong with your back. This is logical pain. And

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Speaker 1: it's so interesting because in that moment, because I'm trained

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Speaker 1: in neuroscience, I was so thrilled by this news. It

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Speaker 1: did not feel like he was invalidating my pain at all.

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Speaker 2: Yeah.

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Speaker 1: I mean, it's so empowering to learn that. However, to

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Speaker 1: your point, knowing it intellectually is very different from intuiting

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Speaker 1: this emotionally. So it took me still years to unwind

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Speaker 1: the pain. And there are still times now where I'm

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Speaker 1: sitting on a chair that's at a not appropriate angle

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Speaker 1: given what I'm comfortable with, and I start to feel

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Speaker 1: that pain return. So it is definitely a process. It's

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Speaker 1: really hard to buy into because you still feel really

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Speaker 1: threatened by it. So this is to say, I know

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Speaker 1: one thing that you've discovered in all of your work

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Speaker 1: is that fear is a huge reason why neuroplastic pain

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Speaker 1: is so sticky, right, like why it sticks around for

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Speaker 1: so long. And I think that's what happened. The more

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Speaker 1: it stuck around, the more fearful I got, and it

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Speaker 1: was this negative vicious cycle.

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Speaker 2: It's the pain fear cycle. So when you think about

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Speaker 2: the pain a thousand times a day, when it's the

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Speaker 2: first thing you think of when you wake up, the

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Speaker 2: last thing you think of before you go to sleep,

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Speaker 2: you're constantly checking in to see if it's there. When

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Speaker 2: you attend to the pain, there were lens of fear, frustration,

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Speaker 2: despair that reinforces to your brain that these sensations are

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Speaker 2: dangerous and it becomes this terrible cycle.

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Speaker 1: So, Allen, I've never tried somatic tracking before, and I

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Speaker 1: would absolutely love to give it a shot. Do you

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Speaker 1: think it's something you can coach me through right now?

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Speaker 2: Do you have pain right now?

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Speaker 1: Yes? I'm aching in my knees right.

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Speaker 2: And so are you still struggling to determine whether or

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Speaker 2: not this pain is structural or neuroplastic?

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Speaker 1: Yeah, it's like I'm not totally convinced that it's neuroplastic.

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Speaker 1: That's part of the problem.

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Speaker 2: Yeah, and so this is like it's real. Yeah, this

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Speaker 2: is I mean again, all pain is real.

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Speaker 1: I know, I know, I know, but here I am

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Speaker 1: it feels structural, really feel structural.

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Speaker 2: Let's let's go through the evidence. Well, we know that

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Speaker 2: you're very prone to neural plastic pain. That is a

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Speaker 2: big piece of evidence in and of itself, but that's

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Speaker 2: not definitive. So you know, even if you're prone to

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Speaker 2: neural plastic pain, you want to be scientific about this.

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Speaker 2: You never want to make assumptions, and so, you know,

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Speaker 2: we want to gather as much evidence as possible. What

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Speaker 2: other evidence do you have about your knee let's do

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Speaker 2: an investigation.

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Speaker 1: Okay. I think another is that I've had this history. Okay,

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Speaker 1: I have had long periods of time in which this

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Speaker 1: right knee of mine was so achy it put me

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Speaker 1: out of working out for a while. I had a

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Speaker 1: lot of anxiety around it.

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Speaker 2: So we know that those neural pathways are already laid down, right,

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Speaker 2: So maybe sometimes when you feel stressed out, that kind

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Speaker 2: of may be your go.

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Speaker 1: To, And it's worth mentioning that in this particular case,

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Speaker 1: this episode of knee pain transpired following a legitimate physical injury.

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Speaker 1: So I had a swollen bursa and I'm still stuck

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Speaker 1: with this deep aching of my knee.

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Speaker 2: Okay, quick question. When the burso was swollen, was your

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Speaker 2: knee hurting in the way that it's currently hurting or

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Speaker 2: was it hurting in a different way.

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Speaker 1: My knee actually was not hurting at all when the

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Speaker 1: bursa was swollen, So the verse is a few inches

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Speaker 1: from my knee that I was not feeling any aching

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Speaker 1: in my knee. As the burso was resolving, I started

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Speaker 1: to develop this aching in my right knee.

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Speaker 2: Okay, yeah, this is neuroplastic. Okay, this is the evidence

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Speaker 2: that we needed. Whenever you have pain that is delayed

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Speaker 2: from the onset of the actual injury, that is like

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Speaker 2: the holy grail of evidence that your pain is neuroplastic.

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Speaker 2: If the pain that you feel right now was caused

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Speaker 2: by this bursa swelling, you would have had it while

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00:21:54,836 --> 00:21:57,556
Speaker 2: the burso was swollen. It wouldn't happen days later. What

397
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Speaker 2: it did is it refocused this level of attention and

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Speaker 2: preoccupation you had around this already scary part of your body.

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Speaker 2: And so you know, your brain was like, yay, we

400
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Speaker 2: have a way we could bring her back into fear

401
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Speaker 2: preoccupation mode.

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Speaker 1: Yeah.

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Speaker 2: So now all we need to do is show your brain,

404
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Speaker 2: get your brain experiential evidence that there's nothing wrong with you.

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Speaker 1: You want to try, I really do. I'm so excited.

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Speaker 1: I've never done this before, so I'm really excited.

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Speaker 2: So all you're doing right now is you're trying to

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Speaker 2: give your brain the experience of attending to this pain

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Speaker 2: in a new way. So close your eyes and just

410
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Speaker 2: bring your attention and maybe just take like a couple

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Speaker 2: breaths at first, just to calm your system down. Good.

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Speaker 1: And it's so interesting, Alan, Like, as I'm taking these

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Speaker 1: deep breaths. My brain is constantly trying to redirect attention

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Speaker 1: to the knee.

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Speaker 2: That's okay, I mean it's hard not to. Your brain

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Speaker 2: is trying to help you. It's just misreading the signs okay.

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Speaker 2: So let's so indulge in in the messages that your

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Speaker 2: brain is giving you. See if you could bring your

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Speaker 2: attention to your And what I want you to do

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Speaker 2: is just see if you can be a little bit

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Speaker 2: of an investigator. And the first thing we want to

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Speaker 2: do is just explore where you feel it. Is it

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Speaker 2: a widespread sensation? Is it localized? How do you experience

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Speaker 2: this sensation?

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Speaker 1: I feel it. It's fully under my kneecap and right

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Speaker 1: below my knee cap.

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Speaker 2: Okay, And how would you describe the quality of this sensation?

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Speaker 2: Is it a burning sensation? Is it tingling? Is it

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Speaker 2: a little throbby? Is it a pressury sensation?

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Speaker 1: Yeah? I would say a combination of throbbing with a

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Speaker 1: little bit of pressure.

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Speaker 2: Good. Good. Just even the fact that you're able to

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Speaker 2: describe it as good. Oftentimes people think pressure means bad,

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Speaker 2: but I imagine getting a massage, right There's all this

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Speaker 2: pressure putting on you, but it feels good. So we

436
00:24:06,036 --> 00:24:09,636
Speaker 2: don't need to get rid of this sensation. So this

437
00:24:09,756 --> 00:24:12,316
Speaker 2: is the first thing that is important for you to

438
00:24:12,316 --> 00:24:16,156
Speaker 2: wrap your mind around. You don't need it to go away,

439
00:24:16,996 --> 00:24:19,196
Speaker 2: you don't need to get rid of it. All we

440
00:24:19,236 --> 00:24:21,156
Speaker 2: need to do is help your brain wrap your mind

441
00:24:21,156 --> 00:24:23,356
Speaker 2: around the fact that it's safe. I would not tell

442
00:24:23,396 --> 00:24:26,156
Speaker 2: you this was neuroplastic pain if I had any doubt.

443
00:24:26,316 --> 00:24:29,796
Speaker 2: What's going on right now is your knee is sending

444
00:24:29,836 --> 00:24:32,476
Speaker 2: safe sensations to your brain. But because you have so

445
00:24:32,556 --> 00:24:35,556
Speaker 2: much fear, so much preoccupation around these signals, your brain

446
00:24:35,636 --> 00:24:39,436
Speaker 2: is making a mistake and it's interpreting these sensations as

447
00:24:39,476 --> 00:24:44,236
Speaker 2: if they're dangerous and generating this kind of unpleasant pressury

448
00:24:44,316 --> 00:24:48,116
Speaker 2: throbby sensation. So we don't need to lower the intensity

449
00:24:48,156 --> 00:24:50,876
Speaker 2: of it. But I want you just to lean into

450
00:24:50,876 --> 00:24:55,356
Speaker 2: the sensation and just breathe into it, knowing that it's safe.

451
00:24:56,076 --> 00:24:59,996
Speaker 2: It's just your brain overreacting to a perfectly safe, perfectly

452
00:25:00,076 --> 00:25:06,436
Speaker 2: neutral sensation, and breathe into the sensation and just let

453
00:25:06,476 --> 00:25:11,876
Speaker 2: it go. And what do you notice happening to the

454
00:25:11,916 --> 00:25:16,716
Speaker 2: sensations as you're paying attention to them. Does the intensity increase,

455
00:25:16,796 --> 00:25:17,716
Speaker 2: does a decrease?

456
00:25:17,916 --> 00:25:21,636
Speaker 1: What do you notice, Yeah, I feel kind of lightness

457
00:25:21,636 --> 00:25:24,356
Speaker 1: in the area, So I still feel that throbbing.

458
00:25:24,516 --> 00:25:26,236
Speaker 2: That's okay, but I feel that.

459
00:25:27,716 --> 00:25:29,676
Speaker 1: There's like a little lightness and a little tingly.

460
00:25:29,996 --> 00:25:32,036
Speaker 2: Okay, good now, so just ride it out.

461
00:25:33,156 --> 00:25:35,316
Speaker 1: Just jumping into say that. Alan and I did this

462
00:25:35,396 --> 00:25:38,476
Speaker 1: exercise for far longer than what you're hearing, but we

463
00:25:38,556 --> 00:25:41,396
Speaker 1: wanted to just share the highlights with you.

464
00:25:41,556 --> 00:25:44,116
Speaker 2: Really breathe into it with each in breath and h

465
00:25:44,196 --> 00:25:49,996
Speaker 2: out breath. See if you could actually feel what happens

466
00:25:50,036 --> 00:25:54,356
Speaker 2: to the sensation as you breathe in and out. Bring

467
00:25:54,396 --> 00:25:57,556
Speaker 2: your attention back to that sensation, your need, and I

468
00:25:57,596 --> 00:26:02,916
Speaker 2: want you to just let it go away.

469
00:26:03,076 --> 00:26:08,556
Speaker 1: This is really extraordinary. I really feel a significant reduction

470
00:26:08,796 --> 00:26:11,316
Speaker 1: in the throbbing. Yeah, under my cat.

471
00:26:11,356 --> 00:26:14,516
Speaker 2: And here's the thing we're so tempted to say, like

472
00:26:14,556 --> 00:26:17,116
Speaker 2: I'm feeling a reduction and intensity, that's a good thing.

473
00:26:18,196 --> 00:26:21,836
Speaker 2: I'm jumping for joy and celebration in a totally neutral way.

474
00:26:21,836 --> 00:26:24,876
Speaker 1: Neutral way. Yeah, I understand, I understand. I very much

475
00:26:24,916 --> 00:26:27,396
Speaker 1: could have not had that response and it would have

476
00:26:27,436 --> 00:26:29,876
Speaker 1: been totally fine. And this is a practice that I

477
00:26:29,876 --> 00:26:31,116
Speaker 1: would do exactly do.

478
00:26:31,316 --> 00:26:34,436
Speaker 2: Yeah, when your attention goes back to the sensation through

479
00:26:34,436 --> 00:26:38,236
Speaker 2: a lens of fear, of preoccupation or hyper vigilance. It's

480
00:26:38,276 --> 00:26:40,676
Speaker 2: going to be there, but that's okay, And this is

481
00:26:40,716 --> 00:26:42,796
Speaker 2: the point of all of it. We don't want it

482
00:26:42,836 --> 00:26:45,756
Speaker 2: to go away. We just want to teach your brain

483
00:26:46,116 --> 00:26:47,356
Speaker 2: to attend to it.

484
00:26:47,876 --> 00:26:50,996
Speaker 1: And right now I'm feeling that aching just as much

485
00:26:50,996 --> 00:26:52,876
Speaker 1: as I did before. Yeah, so I have to be

486
00:26:52,916 --> 00:26:57,556
Speaker 1: okay with that. So to summarize this pain reprocessing therapy approach,

487
00:26:57,596 --> 00:27:03,236
Speaker 1: step one is gather evidence around whether it's neuroplastic or not. Right.

488
00:27:03,676 --> 00:27:05,876
Speaker 1: The second is to do the exercise we just did,

489
00:27:05,876 --> 00:27:09,636
Speaker 1: which is to attend to the sensation simp so that

490
00:27:09,676 --> 00:27:12,116
Speaker 1: your brain learns this is safe.

491
00:27:12,476 --> 00:27:12,596
Speaker 2: Right.

492
00:27:13,076 --> 00:27:15,516
Speaker 1: So tell me about what step three is of this

493
00:27:15,916 --> 00:27:16,956
Speaker 1: reprocessing therapy.

494
00:27:17,156 --> 00:27:24,636
Speaker 2: Yeah, so step three is really addressing the psychological issues

495
00:27:24,676 --> 00:27:27,716
Speaker 2: that may have made you more prone to developing neuroplastic

496
00:27:27,756 --> 00:27:31,076
Speaker 2: pain in the first place. Some of the personality traits

497
00:27:31,076 --> 00:27:34,836
Speaker 2: that we find that make people prone to developing neuroplastic pain,

498
00:27:35,196 --> 00:27:39,876
Speaker 2: along with anxiety, along with depression, chronic fatigue is the

499
00:27:39,956 --> 00:27:43,276
Speaker 2: tendency to put a lot of pressure on yourself, tendency

500
00:27:43,316 --> 00:27:46,036
Speaker 2: to beat yourself up a lot, and the tendency to

501
00:27:46,076 --> 00:27:48,876
Speaker 2: worry yep, because these are really all things that are

502
00:27:48,916 --> 00:27:52,236
Speaker 2: going to bombard your brain with messages of danger and

503
00:27:52,356 --> 00:27:56,676
Speaker 2: make you more prone to eventually attending to these sensations

504
00:27:56,676 --> 00:27:57,716
Speaker 2: through a lens of danger.

505
00:27:58,196 --> 00:28:01,796
Speaker 1: So those are working to identify internal stressors putting pressure

506
00:28:01,836 --> 00:28:05,876
Speaker 1: on yourself worrying. What about external stressors, of which there

507
00:28:05,876 --> 00:28:07,836
Speaker 1: are an abundance in modern society.

508
00:28:08,156 --> 00:28:10,636
Speaker 2: I think there's two different of external stressors. One is

509
00:28:10,676 --> 00:28:12,436
Speaker 2: the type of thing that you can't control, Like if

510
00:28:12,476 --> 00:28:14,996
Speaker 2: you have a ton of kids, they're always running around

511
00:28:15,076 --> 00:28:17,516
Speaker 2: and a really tough job, tough job. What you do

512
00:28:17,556 --> 00:28:21,516
Speaker 2: in those situations is you increase your capacity to regulate

513
00:28:21,556 --> 00:28:26,076
Speaker 2: your system on more of a moment to moment basis

514
00:28:26,356 --> 00:28:28,796
Speaker 2: so that those stressors affect you less. But a lot

515
00:28:28,836 --> 00:28:32,436
Speaker 2: of this external stuff we bring on ourselves. You know,

516
00:28:32,916 --> 00:28:35,236
Speaker 2: there was a time when I was reading the news

517
00:28:35,716 --> 00:28:38,756
Speaker 2: on my phone every day, two hours a day, every

518
00:28:38,756 --> 00:28:41,116
Speaker 2: different outlet. I was reading it, and you know, I

519
00:28:41,196 --> 00:28:43,876
Speaker 2: was bombarding my brain with danger signals because they're not

520
00:28:43,916 --> 00:28:47,436
Speaker 2: putting like happy, fuzzy stories on the news. It's the

521
00:28:47,556 --> 00:28:49,396
Speaker 2: kind of thing that's going to stress your brain out.

522
00:28:49,676 --> 00:28:52,436
Speaker 2: I mean, you're either communicating messages of danger to your

523
00:28:52,436 --> 00:28:55,076
Speaker 2: brain or messages of safety to your brain, like all

524
00:28:55,116 --> 00:28:56,716
Speaker 2: throughout the day. So what you want to do is

525
00:28:56,756 --> 00:28:57,836
Speaker 2: shift that balance.

526
00:28:58,716 --> 00:29:00,996
Speaker 1: It's so interesting, Alan, because I feel like the work

527
00:29:01,036 --> 00:29:05,876
Speaker 1: you're doing is so important, and I can imagine how

528
00:29:05,956 --> 00:29:10,196
Speaker 1: challenging it is to tell people about pain might not

529
00:29:10,276 --> 00:29:14,516
Speaker 1: be the results of an underlying injury because you're running

530
00:29:14,596 --> 00:29:18,916
Speaker 1: up against, you know, billion dollar healthcare industry. You're running

531
00:29:18,956 --> 00:29:22,316
Speaker 1: up against all of these pharmaceutical companies. Like ye, what

532
00:29:22,356 --> 00:29:26,316
Speaker 1: you're offering is a free technique that is available to

533
00:29:26,396 --> 00:29:28,876
Speaker 1: every person in the world. It's not like you're hiding

534
00:29:28,876 --> 00:29:30,596
Speaker 1: the ball. You just went through the process with me,

535
00:29:31,156 --> 00:29:36,556
Speaker 1: and it can be really hard to convey science that

536
00:29:37,436 --> 00:29:42,876
Speaker 1: cuts against other people's financial interests or like industry financial interests.

537
00:29:43,276 --> 00:29:46,476
Speaker 2: Yeah, it's really the biggest inefficiency in all of medicine.

538
00:29:46,516 --> 00:29:46,716
Speaker 1: You know.

539
00:29:46,756 --> 00:29:50,836
Speaker 2: They found that chronic pain is actually costing the US

540
00:29:50,916 --> 00:29:56,756
Speaker 2: economy over six hundred billion dollars every year. So one

541
00:29:56,796 --> 00:29:58,876
Speaker 2: of the things we're working on right now is partnering

542
00:29:58,916 --> 00:30:01,756
Speaker 2: with health insurance companies so that this treatment can be

543
00:30:01,796 --> 00:30:05,636
Speaker 2: provided to people for free and everybody wins they get

544
00:30:05,636 --> 00:30:09,036
Speaker 2: better health insurance companies are saving money and it could

545
00:30:09,156 --> 00:30:11,036
Speaker 2: eventually lead to this paradigm shift in the way that

546
00:30:11,116 --> 00:30:13,556
Speaker 2: chronic pain is treated and understood.

547
00:30:14,436 --> 00:30:18,476
Speaker 1: Yeah, such a hopeful message. And it is true that

548
00:30:18,596 --> 00:30:22,236
Speaker 1: for whatever reason, pain reprocessing therapy might not work for you,

549
00:30:22,596 --> 00:30:24,556
Speaker 1: like we really hope it does, and it works for

550
00:30:24,596 --> 00:30:27,036
Speaker 1: a ton of people, but there was no downside to

551
00:30:27,036 --> 00:30:30,076
Speaker 1: giving it a try, even for the biggest skeptic out there.

552
00:30:30,236 --> 00:30:32,476
Speaker 2: Yeah. I mean, the saddest thing in the world is

553
00:30:32,716 --> 00:30:35,956
Speaker 2: when we did this boulder back pain study. These patients

554
00:30:35,996 --> 00:30:39,116
Speaker 2: had had pretty debilitating chronic back pain for an average

555
00:30:39,156 --> 00:30:42,996
Speaker 2: of ten years before learning about this study, and they

556
00:30:43,076 --> 00:30:45,396
Speaker 2: all said the same thing to me, why didn't I

557
00:30:45,476 --> 00:30:49,876
Speaker 2: learn about this sooner? So that's really what we're hoping

558
00:30:49,916 --> 00:30:52,396
Speaker 2: that we're in the beginning of a paradigm shift, so

559
00:30:52,436 --> 00:30:54,596
Speaker 2: that in the future this is going to be a

560
00:30:54,636 --> 00:30:57,156
Speaker 2: frontline treatment for chronic pain and not just the thing

561
00:30:57,196 --> 00:30:59,076
Speaker 2: that you try after everything else failed.

562
00:31:23,516 --> 00:31:26,836
Speaker 1: Hey, thanks so much for listening. Join me next week

563
00:31:26,916 --> 00:31:29,836
Speaker 1: for a two part conversation with my friend Kelsey Snow.

564
00:31:30,716 --> 00:31:34,196
Speaker 1: When Kelsey first met her husband, Chris, she fell hard.

565
00:31:34,356 --> 00:31:37,276
Speaker 1: They soon fell in love, got married, and had two kids,

566
00:31:38,116 --> 00:31:42,516
Speaker 1: but then Chris received a devastating diagnosis of ALS, a

567
00:31:42,556 --> 00:31:47,556
Speaker 1: progressive neurodegenerative disease, and Kelsey's identity had to shift from

568
00:31:47,596 --> 00:31:51,676
Speaker 1: wife to caregiver. If you enjoyed my conversation with Alan,

569
00:31:51,876 --> 00:31:54,116
Speaker 1: we on, the Slight Change team would be so grateful

570
00:31:54,156 --> 00:31:56,116
Speaker 1: if you could share the episode with someone you know,

571
00:31:56,836 --> 00:31:58,556
Speaker 1: it helps us get the word out so we can

572
00:31:58,636 --> 00:32:01,676
Speaker 1: keep making more episodes for you. And if you're looking

573
00:32:01,716 --> 00:32:04,316
Speaker 1: for more stories of Change, you can always check out

574
00:32:04,316 --> 00:32:07,516
Speaker 1: our back catalog. Thanks so much and see you next week.

575
00:32:18,236 --> 00:32:21,316
Speaker 1: A Slight Change of Plans is created, written, and executive

576
00:32:21,316 --> 00:32:25,236
Speaker 1: produced by me Maya Shunker. The Slight Change family includes

577
00:32:25,276 --> 00:32:29,596
Speaker 1: our showrunner Tyler Green, our senior editor Kate Parkinson Morgan,

578
00:32:30,076 --> 00:32:34,196
Speaker 1: our senior producer Trisha Bobida, and our engineer Eric o'huang.

579
00:32:34,876 --> 00:32:38,276
Speaker 1: Louis Scara wrote our delightful theme song and Ginger Smith

580
00:32:38,356 --> 00:32:41,596
Speaker 1: helped arrange the vocals. A Slight Change of Plans is

581
00:32:41,636 --> 00:32:44,556
Speaker 1: a production of Pushkin Industries, so a big thanks to

582
00:32:44,596 --> 00:32:48,196
Speaker 1: everyone there, and of course a very special thanks to

583
00:32:48,276 --> 00:32:51,156
Speaker 1: Jimmy Lee. You can follow A Slight Change of Plans

584
00:32:51,156 --> 00:32:54,876
Speaker 1: on Instagram at doctor Maya Shunker. See you next week

585
00:33:09,396 --> 00:33:09,436
Speaker 1: to