Speaker 1: Pushkin.
Speaker 2: When you think about the pain a thousand times a day,
Speaker 2: when it's the first thing you think of when you
Speaker 2: wake up, the last thing you think of before you
Speaker 2: go to sleep, you're constantly checking in to see if
Speaker 2: it's there. When you attend to the pain, there were
Speaker 2: a lens of fear, frustration, despair that reinforces to your
Speaker 2: brain that these sensations are dangerous and it becomes this
Speaker 2: terrible cycle.
Speaker 1: Typically, when we think about pain, we assume that something
Speaker 1: structural is causing it, like a muscle strain or a
Speaker 1: ruptured ligament. But psychotherapist Alan Gordon studies how pain can
Speaker 1: also emerge when our brains misinterpret safe signals as dangerous.
Speaker 2: Pain is a survival mechanism. It helps us when it's
Speaker 2: working the way that it's supposed to, but sometimes the
Speaker 2: brain can make a mistake. Sometimes the brain could interpret
Speaker 2: danger where there is none and generate pain even in
Speaker 2: the absence of an injury or structural damage.
Speaker 1: On today's episode, a novel Approach to treating chronic pain,
Speaker 1: I'm maya Shunker and this is a slight change of plans,
Speaker 1: a show about who we are and who we become
Speaker 1: in the face of a big change. Alan is an
Speaker 1: assistant professor at the University of Southern California, and he's
Speaker 1: a therapist who helps counsel patients with chronic pain. He's
Speaker 1: also the author of the book The Way Out, a revolutionary,
Speaker 1: scientifically proven approach to healing chronic pain. The idea behind
Speaker 1: Allan's work is that a lot of the pain we
Speaker 1: experience isn't actually caused by structural issues. Instead, it's the
Speaker 1: brain misinterpreting the body's signals. In those cases, Rather than
Speaker 1: endlessly searching for medical interventions, we're better off refocusing our
Speaker 1: attention on practices that can rewire our minds and relieve
Speaker 1: our pain. Later in the episode, you'll hear Allan guide
Speaker 1: me through his process to relieve some knee pain I've
Speaker 1: been experiencing lately. But first I wanted to learn more
Speaker 1: about what drove Allan to enter this line of work
Speaker 1: in the first place. Alan, I know that your work
Speaker 1: has very personal undertones, and I was wondering if we
Speaker 1: could first start by hearing the story of your experience
Speaker 1: with chronic back pain.
Speaker 2: It was back in my mid twenties and I was
Speaker 2: a really active person. I was on a kickball team,
Speaker 2: I would play sports all the time, and I was
Speaker 2: in graduate school at USC at the time, and one
Speaker 2: day I woke up and I had back pain. And
Speaker 2: it was very strange because I didn't have an injury.
Speaker 2: There was no car accident, there was nothing like that,
Speaker 2: and I just thought, Okay, well, it'll pass. And by
Speaker 2: the end of the week it was still there and
Speaker 2: it was horrible. Every time I would walk, I would
Speaker 2: have pain. Every time I would sit, I would have pain.
Speaker 2: I remember going to a movie with some of my friends.
Speaker 2: By the end of the movie, I was in so
Speaker 2: much pain. I literally didn't go to another movie for
Speaker 2: years after that because it was such a traumatizing experience.
Speaker 2: And so I started having all of this fear around
Speaker 2: the pain. Is this what my life is like? Now?
Speaker 2: What's going on? I went to the doctor, got an MRI.
Speaker 2: I actually saw three of the best orthopedis in Los Angeles,
Speaker 2: and each one of them had a different take on
Speaker 2: what was going on with me. The first one said,
Speaker 2: this is definitely due to a discarnation. And I remember
Speaker 2: him holding up this MRIs and there's this five millimeter
Speaker 2: discreanation with partial nerve root compression. I could still see
Speaker 2: it in my mind. Then the next one I saw said,
Speaker 2: you know, I don't actually think that's what it is.
Speaker 2: I think it's due to disc degeneration. And once again
Speaker 2: he holds up my MRI scan and shows me all
Speaker 2: of these flattened discs up and down my vertebrae. The
Speaker 2: third one that I saw just looked me up and
Speaker 2: down and said, I think you have back pained because
Speaker 2: you're just too tall. Nothing I can do about that.
Speaker 2: I just remember thinking, how did my genes even survive
Speaker 2: through evolution that I have this much wrong with my back.
Speaker 2: When I'm in my mid twenties, and I did every
Speaker 2: treatment under the sun, everything that you could think of, acupuncture, acupressure,
Speaker 2: physical therapy, and I ended up having to move home.
Speaker 2: I'm living with my parents, and over the next couple
Speaker 2: of years, I start getting more and more symptoms. I
Speaker 2: got chronic headaches, I got wrist pain, knee pain, chronic fatigue,
Speaker 2: getting more diagnoses, more treatments, and nothing worked.
Speaker 1: Yeah, when you experienced chronic pain, it can be so
Speaker 1: all consuming, right, and mean, it's like the only thing
Speaker 1: you think about. It comes to define who you are
Speaker 1: in this fundamental way. I mean, what eventually led you
Speaker 1: to a slightly better place.
Speaker 2: Well, I was at home. My mom comes in to
Speaker 2: my room one day and she's holding a book and
Speaker 2: she says, I want you to read this book. My
Speaker 2: friend's son had back pain and he read this book
Speaker 2: and it helped him. I got so mad at her.
Speaker 2: It felt like an attack on the fact that, like,
Speaker 2: you know, my pain wasn't real or something like that.
Speaker 2: And I said, Mom, a book isn't going to help
Speaker 2: me get better. This isn't in my head. I have
Speaker 2: these real structural problems in my body. I think I
Speaker 2: pulled out my MRI report and was going over all
Speaker 2: the findings with her, and she was like, all right,
Speaker 2: I'm just trying to help. And she left the book
Speaker 2: there and I think it sat on my bookshelf for
Speaker 2: maybe something like nine months, and finally one day I
Speaker 2: picked it up and I read it. And there's one
Speaker 2: thing that jumped out at me that really struck me.
Speaker 2: There was the study that I read about in the
Speaker 2: New England Journal of Medicine, and it found that the
Speaker 2: majority of people with no back pain have disc bulgess
Speaker 2: herniations distogeneration, that essentially these are just normal abnormalities and
Speaker 2: not the cause of pain in most people. I mean,
Speaker 2: I had seen probably two dozen doctors by this point.
Speaker 2: How had I never heard this before? And so I
Speaker 2: went down the rabbit hole of learning everything I could
Speaker 2: about pain and neuroscience, and I found that very often
Speaker 2: with chronic pain, the symptoms are the result of misfiring
Speaker 2: pain circuits in the brain as opposed to structural problems
Speaker 2: in the body. And then from there, I, you know,
Speaker 2: working with my own symptoms as well as some patients
Speaker 2: I started working with as a therapist myself, I developed
Speaker 2: a set of techniques that we now call pain reprocessing therapy,
Speaker 2: and I was able to overcome all of my own
Speaker 2: symptoms from a brain based approach.
Speaker 1: So let's dig into the basics here. Tell me what
Speaker 1: pain is, and then tell me how you would define
Speaker 1: what you call normal pain.
Speaker 2: So all pain is generated in the brain. If you
Speaker 2: put your hand on a hot stove, the pain is
Speaker 2: your brain's way of letting you know you need to
Speaker 2: move your hand so that you don't cause more damage. Essentially,
Speaker 2: what's happening is the nerve endings in your hand or
Speaker 2: sending danger signals to your brain. Pain is a survival mechanism.
Speaker 2: It helps us when it's working the way that it's
Speaker 2: supposed to. But sometimes the brain can make a mistake.
Speaker 2: Sometimes the brain could interpret danger where there is none
Speaker 2: and generate pain even in the absence of an injury
Speaker 2: or structural damage. And we call this neuroplastic pain, which
Speaker 2: just means learned pain. And more and more studies are
Speaker 2: showing that many forms of chronic pain are actually neuroplastic
Speaker 2: And just like this pain can be learned, it can
Speaker 2: be unlearned.
Speaker 1: Yeah, And I think it's so important at this point
Speaker 1: in the conversation to clarify that all pain, whether it's
Speaker 1: normal pain or neuroplastic pain, is real pain, right, because
Speaker 1: all pain originates in the brain. So there's no thing
Speaker 1: as saying like, well, this is all in your head
Speaker 1: versus this other type of pain isn't in your head.
Speaker 1: It's all in your head. So you're not in any
Speaker 1: way invalidating the existence of the pain or the intensity
Speaker 1: of the pain. You're simply saying that the cause of
Speaker 1: the pain might vary depending on whether it's caused by
Speaker 1: a structural issue in the body versus something that's originating
Speaker 1: because your brain has made this mistake.
Speaker 2: Yeah, all pain is real, Yeah.
Speaker 1: You know, a foundational message of this work is that
Speaker 1: pain does not imply that there is a physical injury.
Speaker 1: And I mean that is a seismic shift in perspective.
Speaker 1: I mean, I remember growing up, I was on the
Speaker 1: cross country team. Something hurts, I instantly think, oh my god,
Speaker 1: what did I injure? I mean, it's the only question
Speaker 1: I asked myself. But there's a couple really amazing studies
Speaker 1: that show how you can experience pain in the absence
Speaker 1: of a physical injury. So the first is this simulated
Speaker 1: car crash study, right, and I'm wondering if you could
Speaker 1: tell me a bit more about that one.
Speaker 2: Yeah, this was brilliant. This was in Germany, and these
Speaker 2: very creative scientists created a condition where the subjects were
Speaker 2: sitting in a car on a track and they thought
Speaker 2: they were rear ended from behind by another car. And
Speaker 2: what the scientist did is they had crash sounds come
Speaker 2: up over a loudspeaker. There was an actual dent in
Speaker 2: the back of the car that was there previously that
Speaker 2: the person didn't see, and the car was on an
Speaker 2: inclined plane and so it slightly moved forward, but there
Speaker 2: was no actual impact between the two cars. And what
Speaker 2: they found was that eighteen percent of people had neck
Speaker 2: pain after this fake placebo car accident, and a month later,
Speaker 2: ten percent of them still had neck pain. So even
Speaker 2: though there was no injury, the brain thought there was
Speaker 2: and generated pain.
Speaker 1: You also been one of the lead researchers on a
Speaker 1: big back pain study. This is the boulder back pain study, right.
Speaker 1: Tell me a bit more about that.
Speaker 2: All of the patients in the study had had chronic
Speaker 2: back pain for an average of ten years going into it.
Speaker 2: What the study did is we looked at three different groups.
Speaker 2: One group got pain reprocessing therapy, one group got a
Speaker 2: placebo treatment, and then one group got no treatment. There
Speaker 2: were fifty patients in each group. We got fMRIs of
Speaker 2: everyone's brain before and after, and amazingly, in the pantiprocessing
Speaker 2: therapy group, we found that sixty six percent of the
Speaker 2: patients were either pain free or nearly pain free after
Speaker 2: four weeks, and remarkably a year later, they were still
Speaker 2: out of pain.
Speaker 1: That's extraordinary. And you know, to clarify for listeners, there
Speaker 1: was no physical intervention like as part of pain reprocessing therapy.
Speaker 1: Alan and the other researchers never touch people's backs or
Speaker 1: gave them physical exercises to do, which is again just
Speaker 1: such a significant shift in the way that we think
Speaker 1: about pain or what we were taught for, at least
Speaker 1: for me for decades of my life.
Speaker 2: Yeah, everything we've ever known about cause and effect is
Speaker 2: telling us if you have pain when you walk, if
Speaker 2: you have pain when you sit, then it's the walking
Speaker 2: or the sitting that's causing the pain. Really, so it's
Speaker 2: counterintuitive to really wrap your mind around the fact that, like,
Speaker 2: I have pain, but there's nothing wrong with my body.
Speaker 2: So I was even shocked by how regenerative of the
Speaker 2: body is and how such a high percentage of chronic
Speaker 2: pain could actually be neuroplastic.
Speaker 1: Yeah, what about for people bull for whom this chronic
Speaker 1: pain is instigated by an acute injury, what's going on
Speaker 1: in the brain in that case.
Speaker 2: Yeah, that's a great question. So the injury is real,
Speaker 2: there's maybe a lot of fear or preoccupation around the symptoms.
Speaker 2: The brain learns and remembers the pain, and the pain
Speaker 2: persists even after the injury heals. There was another study
Speaker 2: where they looked at a lot of patients who had
Speaker 2: initial episodes of back pain and they took scans of
Speaker 2: their brains, and they found that the pain was present
Speaker 2: in the areas of the brain that are normally associated
Speaker 2: with pain. And then they followed the patients who went
Speaker 2: on to develop chronic pain, and they took brain scans again,
Speaker 2: and they found that the pain had actually moved to
Speaker 2: the parts of the brain associated with learning and memory,
Speaker 2: so that even after the symptoms heal, it could still
Speaker 2: be chronic. You know, I had knee pain for a
Speaker 2: while and I ended up getting imaging on it, and
Speaker 2: I had a severely torn meniscus tear and there's no
Speaker 2: blood flow to the meniscus, and I ended up needing
Speaker 2: to get surgery to fix that injury. So I don't
Speaker 2: want to be so black and white about it and
Speaker 2: say that all chronic pain is neuroplastic.
Speaker 1: So, Alan, you've established that neuroplastic pain is very, very prominent.
Speaker 2: Right.
Speaker 1: It is responsible for so much of our chronic pain,
Speaker 1: for so much suffering in the world. Right, how do
Speaker 1: we get rid of the damn thing? What is your
Speaker 1: process for getting rid of neuroplastic pain?
Speaker 2: This is the exciting thing is that it's very treatable.
Speaker 2: Even in the Bolder Back Pain study, there were some
Speaker 2: patients who had had chronic back pain for forty years
Speaker 2: and they were able to overcome their symptoms in just
Speaker 2: a few weeks. So it doesn't matter how long you've
Speaker 2: had the pain. If you have neuroplastic pain, then you
Speaker 2: are able to overcome it. So the first thing that
Speaker 2: you want to do is determine whether or not you
Speaker 2: have neuroplastic pain or structurally caused pain. And there are
Speaker 2: twelve or thirteen different criteria that we look for. I'm
Speaker 2: not going to go over all of them right now,
Speaker 2: but a few of them are did the pain come
Speaker 2: on during a time of stress. Another thing we look
Speaker 2: for is does the pain spread or move around right
Speaker 2: Sometimes it's on the left side of your back, sometimes
Speaker 2: it's on the right side of your back. Another thing
Speaker 2: we look for is inconsistency of symptoms, so you know,
Speaker 2: maybe it is really bad during the week, but on
Speaker 2: the weekends or when you're on vacation it's a lot better.
Speaker 2: Or you know, maybe it's there in certain positions but
Speaker 2: not other positions, and it's not really consistent. All of
Speaker 2: these things are indicative of the fact that it's neuroplastic pain.
Speaker 2: But even if you're able to wrap your mind around
Speaker 2: the idea that you have neuroplastic pain on an intellectual level.
Speaker 2: It's really hard to embrace on a gut level because
Speaker 2: it's it's counterintuitive, and so it actually involves embracing a
Speaker 2: reality where your senses are lying to you. So it
Speaker 2: can be very tricky to do, even if you have
Speaker 2: all the evidence in the world. So sometimes it can
Speaker 2: be helpful to create an evidence sheet so that you know,
Speaker 2: you can put up on your fridge and constantly look
Speaker 2: at it to reinforce.
Speaker 1: This is neuroplastic.
Speaker 2: There was a patient that I saw a while ago,
Speaker 2: and she came into my office and she had chronic
Speaker 2: back pain. Every time she sat. She sits down and
Speaker 2: she says, I know that you're going to tell me
Speaker 2: that the pain is being caused by my brain, but
Speaker 2: I don't believe it. I just don't believe it. And
Speaker 2: I go, okay, we'll see what happens. And halfway through
Speaker 2: the session I did a meditation with her, and by
Speaker 2: the end of it, her pain was completely gone. She
Speaker 2: opened her eyes and I said to her, well, now
Speaker 2: what do you think? And she looked at me for
Speaker 2: a few moments and she said, I still don't believe it.
Speaker 2: It was so funny that even in the face of
Speaker 2: overwhelming evidence that the pain went away.
Speaker 1: Yeah, it's really really hard.
Speaker 2: It's hard to wrap your mind around. And so the
Speaker 2: main technique that we use for pain reprocessing therapy is
Speaker 2: something we call somatic tracking. So normally when we pay
Speaker 2: attention to the pain, it's with a sense of fear, preoccupation, worry, despair,
Speaker 2: and all of these negative emotions. When we're attending to
Speaker 2: the pain through that lens reinforces our brain that the
Speaker 2: pain is actually dangerous and keeps the pain alive. So
Speaker 2: somatic tracking is is it's a way to try to
Speaker 2: break that pain fear cycle, where you're attending to the
Speaker 2: pain in a new way to show your brain that
Speaker 2: the signals that are coming from your body are actually
Speaker 2: safe and not dangerous.
Speaker 1: After the break, I asked Alan if you could coach
Speaker 1: me through somatic tracking. I've never tried it before, but
Speaker 1: I've had this annoying knee pain for a while and
Speaker 1: I really wanted to see if it could help me.
Speaker 1: We'll be back in a moment with a slight change
Speaker 1: of plans. I have a personal story that really error
Speaker 1: is yours, So probably at this point eight or nine
Speaker 1: years ago, I was taking a one of those bar
Speaker 1: classes and I remember during the ab part of the workout,
Speaker 1: I kind of just strain lightly my lower back. A
Speaker 1: week goes by, two weeks goes by, it's not quite
Speaker 1: getting better. And the more time that passes, the more
Speaker 1: stressed out and freaked out I am that I've done
Speaker 1: something terrible to my lower back. Fast forward a year
Speaker 1: and a half, I'm struggling with chronic lower back pain.
Speaker 1: I was not able to sit without pain for a
Speaker 1: year and a half. I became terrified of sitting. It
Speaker 1: was just like it was a stressful. And so the
Speaker 1: moment it was unlocked for me as I remember seeing
Speaker 1: the head of orthopedics at George Washington University and he
Speaker 1: looked at my MRI scan and he said, Maya, there's
Speaker 1: nothing structurally wrong in your back.
Speaker 2: Wow.
Speaker 1: He just said that to me. He's like, there is
Speaker 1: nothing wrong with your back. This is logical pain. And
Speaker 1: it's so interesting because in that moment, because I'm trained
Speaker 1: in neuroscience, I was so thrilled by this news. It
Speaker 1: did not feel like he was invalidating my pain at all.
Speaker 2: Yeah.
Speaker 1: I mean, it's so empowering to learn that. However, to
Speaker 1: your point, knowing it intellectually is very different from intuiting
Speaker 1: this emotionally. So it took me still years to unwind
Speaker 1: the pain. And there are still times now where I'm
Speaker 1: sitting on a chair that's at a not appropriate angle
Speaker 1: given what I'm comfortable with, and I start to feel
Speaker 1: that pain return. So it is definitely a process. It's
Speaker 1: really hard to buy into because you still feel really
Speaker 1: threatened by it. So this is to say, I know
Speaker 1: one thing that you've discovered in all of your work
Speaker 1: is that fear is a huge reason why neuroplastic pain
Speaker 1: is so sticky, right, like why it sticks around for
Speaker 1: so long. And I think that's what happened. The more
Speaker 1: it stuck around, the more fearful I got, and it
Speaker 1: was this negative vicious cycle.
Speaker 2: It's the pain fear cycle. So when you think about
Speaker 2: the pain a thousand times a day, when it's the
Speaker 2: first thing you think of when you wake up, the
Speaker 2: last thing you think of before you go to sleep,
Speaker 2: you're constantly checking in to see if it's there. When
Speaker 2: you attend to the pain, there were lens of fear, frustration,
Speaker 2: despair that reinforces to your brain that these sensations are
Speaker 2: dangerous and it becomes this terrible cycle.
Speaker 1: So, Allen, I've never tried somatic tracking before, and I
Speaker 1: would absolutely love to give it a shot. Do you
Speaker 1: think it's something you can coach me through right now?
Speaker 2: Do you have pain right now?
Speaker 1: Yes? I'm aching in my knees right.
Speaker 2: And so are you still struggling to determine whether or
Speaker 2: not this pain is structural or neuroplastic?
Speaker 1: Yeah, it's like I'm not totally convinced that it's neuroplastic.
Speaker 1: That's part of the problem.
Speaker 2: Yeah, and so this is like it's real. Yeah, this
Speaker 2: is I mean again, all pain is real.
Speaker 1: I know, I know, I know, but here I am
Speaker 1: it feels structural, really feel structural.
Speaker 2: Let's let's go through the evidence. Well, we know that
Speaker 2: you're very prone to neural plastic pain. That is a
Speaker 2: big piece of evidence in and of itself, but that's
Speaker 2: not definitive. So you know, even if you're prone to
Speaker 2: neural plastic pain, you want to be scientific about this.
Speaker 2: You never want to make assumptions, and so, you know,
Speaker 2: we want to gather as much evidence as possible. What
Speaker 2: other evidence do you have about your knee let's do
Speaker 2: an investigation.
Speaker 1: Okay. I think another is that I've had this history. Okay,
Speaker 1: I have had long periods of time in which this
Speaker 1: right knee of mine was so achy it put me
Speaker 1: out of working out for a while. I had a
Speaker 1: lot of anxiety around it.
Speaker 2: So we know that those neural pathways are already laid down, right,
Speaker 2: So maybe sometimes when you feel stressed out, that kind
Speaker 2: of may be your go.
Speaker 1: To, And it's worth mentioning that in this particular case,
Speaker 1: this episode of knee pain transpired following a legitimate physical injury.
Speaker 1: So I had a swollen bursa and I'm still stuck
Speaker 1: with this deep aching of my knee.
Speaker 2: Okay, quick question. When the burso was swollen, was your
Speaker 2: knee hurting in the way that it's currently hurting or
Speaker 2: was it hurting in a different way.
Speaker 1: My knee actually was not hurting at all when the
Speaker 1: bursa was swollen, So the verse is a few inches
Speaker 1: from my knee that I was not feeling any aching
Speaker 1: in my knee. As the burso was resolving, I started
Speaker 1: to develop this aching in my right knee.
Speaker 2: Okay, yeah, this is neuroplastic. Okay, this is the evidence
Speaker 2: that we needed. Whenever you have pain that is delayed
Speaker 2: from the onset of the actual injury, that is like
Speaker 2: the holy grail of evidence that your pain is neuroplastic.
Speaker 2: If the pain that you feel right now was caused
Speaker 2: by this bursa swelling, you would have had it while
Speaker 2: the burso was swollen. It wouldn't happen days later. What
Speaker 2: it did is it refocused this level of attention and
Speaker 2: preoccupation you had around this already scary part of your body.
Speaker 2: And so you know, your brain was like, yay, we
Speaker 2: have a way we could bring her back into fear
Speaker 2: preoccupation mode.
Speaker 1: Yeah.
Speaker 2: So now all we need to do is show your brain,
Speaker 2: get your brain experiential evidence that there's nothing wrong with you.
Speaker 1: You want to try, I really do. I'm so excited.
Speaker 1: I've never done this before, so I'm really excited.
Speaker 2: So all you're doing right now is you're trying to
Speaker 2: give your brain the experience of attending to this pain
Speaker 2: in a new way. So close your eyes and just
Speaker 2: bring your attention and maybe just take like a couple
Speaker 2: breaths at first, just to calm your system down. Good.
Speaker 1: And it's so interesting, Alan, Like, as I'm taking these
Speaker 1: deep breaths. My brain is constantly trying to redirect attention
Speaker 1: to the knee.
Speaker 2: That's okay, I mean it's hard not to. Your brain
Speaker 2: is trying to help you. It's just misreading the signs okay.
Speaker 2: So let's so indulge in in the messages that your
Speaker 2: brain is giving you. See if you could bring your
Speaker 2: attention to your And what I want you to do
Speaker 2: is just see if you can be a little bit
Speaker 2: of an investigator. And the first thing we want to
Speaker 2: do is just explore where you feel it. Is it
Speaker 2: a widespread sensation? Is it localized? How do you experience
Speaker 2: this sensation?
Speaker 1: I feel it. It's fully under my kneecap and right
Speaker 1: below my knee cap.
Speaker 2: Okay, And how would you describe the quality of this sensation?
Speaker 2: Is it a burning sensation? Is it tingling? Is it
Speaker 2: a little throbby? Is it a pressury sensation?
Speaker 1: Yeah? I would say a combination of throbbing with a
Speaker 1: little bit of pressure.
Speaker 2: Good. Good. Just even the fact that you're able to
Speaker 2: describe it as good. Oftentimes people think pressure means bad,
Speaker 2: but I imagine getting a massage, right There's all this
Speaker 2: pressure putting on you, but it feels good. So we
Speaker 2: don't need to get rid of this sensation. So this
Speaker 2: is the first thing that is important for you to
Speaker 2: wrap your mind around. You don't need it to go away,
Speaker 2: you don't need to get rid of it. All we
Speaker 2: need to do is help your brain wrap your mind
Speaker 2: around the fact that it's safe. I would not tell
Speaker 2: you this was neuroplastic pain if I had any doubt.
Speaker 2: What's going on right now is your knee is sending
Speaker 2: safe sensations to your brain. But because you have so
Speaker 2: much fear, so much preoccupation around these signals, your brain
Speaker 2: is making a mistake and it's interpreting these sensations as
Speaker 2: if they're dangerous and generating this kind of unpleasant pressury
Speaker 2: throbby sensation. So we don't need to lower the intensity
Speaker 2: of it. But I want you just to lean into
Speaker 2: the sensation and just breathe into it, knowing that it's safe.
Speaker 2: It's just your brain overreacting to a perfectly safe, perfectly
Speaker 2: neutral sensation, and breathe into the sensation and just let
Speaker 2: it go. And what do you notice happening to the
Speaker 2: sensations as you're paying attention to them. Does the intensity increase,
Speaker 2: does a decrease?
Speaker 1: What do you notice, Yeah, I feel kind of lightness
Speaker 1: in the area, So I still feel that throbbing.
Speaker 2: That's okay, but I feel that.
Speaker 1: There's like a little lightness and a little tingly.
Speaker 2: Okay, good now, so just ride it out.
Speaker 1: Just jumping into say that. Alan and I did this
Speaker 1: exercise for far longer than what you're hearing, but we
Speaker 1: wanted to just share the highlights with you.
Speaker 2: Really breathe into it with each in breath and h
Speaker 2: out breath. See if you could actually feel what happens
Speaker 2: to the sensation as you breathe in and out. Bring
Speaker 2: your attention back to that sensation, your need, and I
Speaker 2: want you to just let it go away.
Speaker 1: This is really extraordinary. I really feel a significant reduction
Speaker 1: in the throbbing. Yeah, under my cat.
Speaker 2: And here's the thing we're so tempted to say, like
Speaker 2: I'm feeling a reduction and intensity, that's a good thing.
Speaker 2: I'm jumping for joy and celebration in a totally neutral way.
Speaker 1: Neutral way. Yeah, I understand, I understand. I very much
Speaker 1: could have not had that response and it would have
Speaker 1: been totally fine. And this is a practice that I
Speaker 1: would do exactly do.
Speaker 2: Yeah, when your attention goes back to the sensation through
Speaker 2: a lens of fear, of preoccupation or hyper vigilance. It's
Speaker 2: going to be there, but that's okay, And this is
Speaker 2: the point of all of it. We don't want it
Speaker 2: to go away. We just want to teach your brain
Speaker 2: to attend to it.
Speaker 1: And right now I'm feeling that aching just as much
Speaker 1: as I did before. Yeah, so I have to be
Speaker 1: okay with that. So to summarize this pain reprocessing therapy approach,
Speaker 1: step one is gather evidence around whether it's neuroplastic or not. Right.
Speaker 1: The second is to do the exercise we just did,
Speaker 1: which is to attend to the sensation simp so that
Speaker 1: your brain learns this is safe.
Speaker 2: Right.
Speaker 1: So tell me about what step three is of this
Speaker 1: reprocessing therapy.
Speaker 2: Yeah, so step three is really addressing the psychological issues
Speaker 2: that may have made you more prone to developing neuroplastic
Speaker 2: pain in the first place. Some of the personality traits
Speaker 2: that we find that make people prone to developing neuroplastic pain,
Speaker 2: along with anxiety, along with depression, chronic fatigue is the
Speaker 2: tendency to put a lot of pressure on yourself, tendency
Speaker 2: to beat yourself up a lot, and the tendency to
Speaker 2: worry yep, because these are really all things that are
Speaker 2: going to bombard your brain with messages of danger and
Speaker 2: make you more prone to eventually attending to these sensations
Speaker 2: through a lens of danger.
Speaker 1: So those are working to identify internal stressors putting pressure
Speaker 1: on yourself worrying. What about external stressors, of which there
Speaker 1: are an abundance in modern society.
Speaker 2: I think there's two different of external stressors. One is
Speaker 2: the type of thing that you can't control, Like if
Speaker 2: you have a ton of kids, they're always running around
Speaker 2: and a really tough job, tough job. What you do
Speaker 2: in those situations is you increase your capacity to regulate
Speaker 2: your system on more of a moment to moment basis
Speaker 2: so that those stressors affect you less. But a lot
Speaker 2: of this external stuff we bring on ourselves. You know,
Speaker 2: there was a time when I was reading the news
Speaker 2: on my phone every day, two hours a day, every
Speaker 2: different outlet. I was reading it, and you know, I
Speaker 2: was bombarding my brain with danger signals because they're not
Speaker 2: putting like happy, fuzzy stories on the news. It's the
Speaker 2: kind of thing that's going to stress your brain out.
Speaker 2: I mean, you're either communicating messages of danger to your
Speaker 2: brain or messages of safety to your brain, like all
Speaker 2: throughout the day. So what you want to do is
Speaker 2: shift that balance.
Speaker 1: It's so interesting, Alan, because I feel like the work
Speaker 1: you're doing is so important, and I can imagine how
Speaker 1: challenging it is to tell people about pain might not
Speaker 1: be the results of an underlying injury because you're running
Speaker 1: up against, you know, billion dollar healthcare industry. You're running
Speaker 1: up against all of these pharmaceutical companies. Like ye, what
Speaker 1: you're offering is a free technique that is available to
Speaker 1: every person in the world. It's not like you're hiding
Speaker 1: the ball. You just went through the process with me,
Speaker 1: and it can be really hard to convey science that
Speaker 1: cuts against other people's financial interests or like industry financial interests.
Speaker 2: Yeah, it's really the biggest inefficiency in all of medicine.
Speaker 1: You know.
Speaker 2: They found that chronic pain is actually costing the US
Speaker 2: economy over six hundred billion dollars every year. So one
Speaker 2: of the things we're working on right now is partnering
Speaker 2: with health insurance companies so that this treatment can be
Speaker 2: provided to people for free and everybody wins they get
Speaker 2: better health insurance companies are saving money and it could
Speaker 2: eventually lead to this paradigm shift in the way that
Speaker 2: chronic pain is treated and understood.
Speaker 1: Yeah, such a hopeful message. And it is true that
Speaker 1: for whatever reason, pain reprocessing therapy might not work for you,
Speaker 1: like we really hope it does, and it works for
Speaker 1: a ton of people, but there was no downside to
Speaker 1: giving it a try, even for the biggest skeptic out there.
Speaker 2: Yeah. I mean, the saddest thing in the world is
Speaker 2: when we did this boulder back pain study. These patients
Speaker 2: had had pretty debilitating chronic back pain for an average
Speaker 2: of ten years before learning about this study, and they
Speaker 2: all said the same thing to me, why didn't I
Speaker 2: learn about this sooner? So that's really what we're hoping
Speaker 2: that we're in the beginning of a paradigm shift, so
Speaker 2: that in the future this is going to be a
Speaker 2: frontline treatment for chronic pain and not just the thing
Speaker 2: that you try after everything else failed.
Speaker 1: Hey, thanks so much for listening. Join me next week
Speaker 1: for a two part conversation with my friend Kelsey Snow.
Speaker 1: When Kelsey first met her husband, Chris, she fell hard.
Speaker 1: They soon fell in love, got married, and had two kids,
Speaker 1: but then Chris received a devastating diagnosis of ALS, a
Speaker 1: progressive neurodegenerative disease, and Kelsey's identity had to shift from
Speaker 1: wife to caregiver. If you enjoyed my conversation with Alan,
Speaker 1: we on, the Slight Change team would be so grateful
Speaker 1: if you could share the episode with someone you know,
Speaker 1: it helps us get the word out so we can
Speaker 1: keep making more episodes for you. And if you're looking
Speaker 1: for more stories of Change, you can always check out
Speaker 1: our back catalog. Thanks so much and see you next week.
Speaker 1: A Slight Change of Plans is created, written, and executive
Speaker 1: produced by me Maya Shunker. The Slight Change family includes
Speaker 1: our showrunner Tyler Green, our senior editor Kate Parkinson Morgan,
Speaker 1: our senior producer Trisha Bobida, and our engineer Eric o'huang.
Speaker 1: Louis Scara wrote our delightful theme song and Ginger Smith
Speaker 1: helped arrange the vocals. A Slight Change of Plans is
Speaker 1: a production of Pushkin Industries, so a big thanks to
Speaker 1: everyone there, and of course a very special thanks to
Speaker 1: Jimmy Lee. You can follow A Slight Change of Plans
Speaker 1: on Instagram at doctor Maya Shunker. See you next week
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