WEBVTT - A Novel Approach to Treating Chronic Pain 0:00:14.956 --> 0:00:15.396 Pushkin. 0:00:29.756 --> 0:00:33.076 When you think about the pain a thousand times a day, 0:00:33.116 --> 0:00:34.796 when it's the first thing you think of when you 0:00:34.836 --> 0:00:36.876 wake up, the last thing you think of before you 0:00:36.916 --> 0:00:38.956 go to sleep, you're constantly checking in to see if 0:00:38.996 --> 0:00:41.676 it's there. When you attend to the pain, there were 0:00:41.676 --> 0:00:47.276 a lens of fear, frustration, despair that reinforces to your 0:00:47.356 --> 0:00:50.516 brain that these sensations are dangerous and it becomes this 0:00:50.676 --> 0:00:51.516 terrible cycle. 0:00:52.436 --> 0:00:55.076 Typically, when we think about pain, we assume that something 0:00:55.196 --> 0:00:58.676 structural is causing it, like a muscle strain or a 0:00:58.756 --> 0:01:03.556 ruptured ligament. But psychotherapist Alan Gordon studies how pain can 0:01:03.636 --> 0:01:08.076 also emerge when our brains misinterpret safe signals as dangerous. 0:01:08.556 --> 0:01:12.676 Pain is a survival mechanism. It helps us when it's 0:01:12.716 --> 0:01:16.196 working the way that it's supposed to, but sometimes the 0:01:16.236 --> 0:01:20.316 brain can make a mistake. Sometimes the brain could interpret 0:01:20.396 --> 0:01:24.276 danger where there is none and generate pain even in 0:01:24.316 --> 0:01:26.996 the absence of an injury or structural damage. 0:01:30.436 --> 0:01:34.476 On today's episode, a novel Approach to treating chronic pain, 0:01:37.436 --> 0:01:40.316 I'm maya Shunker and this is a slight change of plans, 0:01:40.756 --> 0:01:42.956 a show about who we are and who we become 0:01:43.156 --> 0:01:58.676 in the face of a big change. Alan is an 0:01:58.676 --> 0:02:02.356 assistant professor at the University of Southern California, and he's 0:02:02.396 --> 0:02:06.196 a therapist who helps counsel patients with chronic pain. He's 0:02:06.276 --> 0:02:10.076 also the author of the book The Way Out, a revolutionary, 0:02:10.156 --> 0:02:14.876 scientifically proven approach to healing chronic pain. The idea behind 0:02:14.916 --> 0:02:17.036 Allan's work is that a lot of the pain we 0:02:17.156 --> 0:02:22.116 experience isn't actually caused by structural issues. Instead, it's the 0:02:22.156 --> 0:02:27.316 brain misinterpreting the body's signals. In those cases, Rather than 0:02:27.436 --> 0:02:31.716 endlessly searching for medical interventions, we're better off refocusing our 0:02:31.716 --> 0:02:35.516 attention on practices that can rewire our minds and relieve 0:02:35.516 --> 0:02:39.036 our pain. Later in the episode, you'll hear Allan guide 0:02:39.116 --> 0:02:41.356 me through his process to relieve some knee pain I've 0:02:41.396 --> 0:02:44.796 been experiencing lately. But first I wanted to learn more 0:02:44.836 --> 0:02:47.276 about what drove Allan to enter this line of work 0:02:47.356 --> 0:02:50.916 in the first place. Alan, I know that your work 0:02:50.956 --> 0:02:54.796 has very personal undertones, and I was wondering if we 0:02:54.796 --> 0:02:59.716 could first start by hearing the story of your experience 0:02:59.716 --> 0:03:00.636 with chronic back pain. 0:03:01.556 --> 0:03:03.596 It was back in my mid twenties and I was 0:03:03.636 --> 0:03:06.756 a really active person. I was on a kickball team, 0:03:06.796 --> 0:03:09.476 I would play sports all the time, and I was 0:03:09.516 --> 0:03:11.596 in graduate school at USC at the time, and one 0:03:11.676 --> 0:03:15.196 day I woke up and I had back pain. And 0:03:15.276 --> 0:03:18.356 it was very strange because I didn't have an injury. 0:03:18.356 --> 0:03:20.556 There was no car accident, there was nothing like that, 0:03:21.156 --> 0:03:23.676 and I just thought, Okay, well, it'll pass. And by 0:03:23.716 --> 0:03:25.996 the end of the week it was still there and 0:03:26.036 --> 0:03:28.476 it was horrible. Every time I would walk, I would 0:03:28.516 --> 0:03:31.596 have pain. Every time I would sit, I would have pain. 0:03:32.116 --> 0:03:36.116 I remember going to a movie with some of my friends. 0:03:36.596 --> 0:03:38.356 By the end of the movie, I was in so 0:03:38.556 --> 0:03:41.636 much pain. I literally didn't go to another movie for 0:03:41.756 --> 0:03:44.676 years after that because it was such a traumatizing experience. 0:03:44.756 --> 0:03:47.716 And so I started having all of this fear around 0:03:47.756 --> 0:03:50.356 the pain. Is this what my life is like? Now? 0:03:50.436 --> 0:03:53.316 What's going on? I went to the doctor, got an MRI. 0:03:53.996 --> 0:03:57.076 I actually saw three of the best orthopedis in Los Angeles, 0:03:57.676 --> 0:04:00.996 and each one of them had a different take on 0:04:01.036 --> 0:04:03.676 what was going on with me. The first one said, 0:04:04.236 --> 0:04:07.076 this is definitely due to a discarnation. And I remember 0:04:07.156 --> 0:04:11.076 him holding up this MRIs and there's this five millimeter 0:04:11.196 --> 0:04:14.876 discreanation with partial nerve root compression. I could still see 0:04:14.876 --> 0:04:17.636 it in my mind. Then the next one I saw said, 0:04:18.076 --> 0:04:19.916 you know, I don't actually think that's what it is. 0:04:19.996 --> 0:04:23.396 I think it's due to disc degeneration. And once again 0:04:23.516 --> 0:04:25.956 he holds up my MRI scan and shows me all 0:04:25.996 --> 0:04:29.796 of these flattened discs up and down my vertebrae. The 0:04:29.836 --> 0:04:31.956 third one that I saw just looked me up and 0:04:31.996 --> 0:04:34.036 down and said, I think you have back pained because 0:04:34.076 --> 0:04:37.836 you're just too tall. Nothing I can do about that. 0:04:38.316 --> 0:04:42.076 I just remember thinking, how did my genes even survive 0:04:42.196 --> 0:04:45.036 through evolution that I have this much wrong with my back. 0:04:45.076 --> 0:04:49.876 When I'm in my mid twenties, and I did every 0:04:49.956 --> 0:04:54.036 treatment under the sun, everything that you could think of, acupuncture, acupressure, 0:04:54.716 --> 0:05:00.876 physical therapy, and I ended up having to move home. 0:05:00.916 --> 0:05:03.676 I'm living with my parents, and over the next couple 0:05:03.716 --> 0:05:07.036 of years, I start getting more and more symptoms. I 0:05:07.116 --> 0:05:12.396 got chronic headaches, I got wrist pain, knee pain, chronic fatigue, 0:05:12.516 --> 0:05:17.116 getting more diagnoses, more treatments, and nothing worked. 0:05:17.756 --> 0:05:21.316 Yeah, when you experienced chronic pain, it can be so 0:05:22.356 --> 0:05:24.636 all consuming, right, and mean, it's like the only thing 0:05:24.676 --> 0:05:27.636 you think about. It comes to define who you are 0:05:28.036 --> 0:05:32.196 in this fundamental way. I mean, what eventually led you 0:05:32.436 --> 0:05:33.756 to a slightly better place. 0:05:34.836 --> 0:05:38.516 Well, I was at home. My mom comes in to 0:05:38.596 --> 0:05:40.836 my room one day and she's holding a book and 0:05:40.876 --> 0:05:42.876 she says, I want you to read this book. My 0:05:42.996 --> 0:05:45.996 friend's son had back pain and he read this book 0:05:46.236 --> 0:05:49.636 and it helped him. I got so mad at her. 0:05:50.116 --> 0:05:52.316 It felt like an attack on the fact that, like, 0:05:52.396 --> 0:05:54.556 you know, my pain wasn't real or something like that. 0:05:54.996 --> 0:05:57.356 And I said, Mom, a book isn't going to help 0:05:57.396 --> 0:05:59.836 me get better. This isn't in my head. I have 0:05:59.876 --> 0:06:02.396 these real structural problems in my body. I think I 0:06:02.436 --> 0:06:04.676 pulled out my MRI report and was going over all 0:06:04.716 --> 0:06:06.476 the findings with her, and she was like, all right, 0:06:06.556 --> 0:06:08.876 I'm just trying to help. And she left the book 0:06:08.916 --> 0:06:11.156 there and I think it sat on my bookshelf for 0:06:11.196 --> 0:06:15.116 maybe something like nine months, and finally one day I 0:06:15.156 --> 0:06:18.916 picked it up and I read it. And there's one 0:06:18.916 --> 0:06:21.196 thing that jumped out at me that really struck me. 0:06:21.636 --> 0:06:24.156 There was the study that I read about in the 0:06:24.196 --> 0:06:28.316 New England Journal of Medicine, and it found that the 0:06:28.356 --> 0:06:31.996 majority of people with no back pain have disc bulgess 0:06:31.996 --> 0:06:37.356 herniations distogeneration, that essentially these are just normal abnormalities and 0:06:37.716 --> 0:06:40.236 not the cause of pain in most people. I mean, 0:06:40.276 --> 0:06:44.116 I had seen probably two dozen doctors by this point. 0:06:44.116 --> 0:06:46.876 How had I never heard this before? And so I 0:06:46.956 --> 0:06:49.756 went down the rabbit hole of learning everything I could 0:06:49.796 --> 0:06:54.356 about pain and neuroscience, and I found that very often 0:06:54.396 --> 0:06:58.276 with chronic pain, the symptoms are the result of misfiring 0:06:58.356 --> 0:07:02.196 pain circuits in the brain as opposed to structural problems 0:07:02.196 --> 0:07:06.396 in the body. And then from there, I, you know, 0:07:06.596 --> 0:07:09.796 working with my own symptoms as well as some patients 0:07:09.836 --> 0:07:13.076 I started working with as a therapist myself, I developed 0:07:13.116 --> 0:07:16.876 a set of techniques that we now call pain reprocessing therapy, 0:07:17.236 --> 0:07:19.676 and I was able to overcome all of my own 0:07:19.716 --> 0:07:21.756 symptoms from a brain based approach. 0:07:22.676 --> 0:07:25.556 So let's dig into the basics here. Tell me what 0:07:25.676 --> 0:07:29.676 pain is, and then tell me how you would define 0:07:30.116 --> 0:07:31.756 what you call normal pain. 0:07:32.196 --> 0:07:34.596 So all pain is generated in the brain. If you 0:07:34.596 --> 0:07:37.556 put your hand on a hot stove, the pain is 0:07:37.596 --> 0:07:39.516 your brain's way of letting you know you need to 0:07:39.556 --> 0:07:43.076 move your hand so that you don't cause more damage. Essentially, 0:07:43.116 --> 0:07:45.996 what's happening is the nerve endings in your hand or 0:07:46.076 --> 0:07:50.596 sending danger signals to your brain. Pain is a survival mechanism. 0:07:50.676 --> 0:07:53.396 It helps us when it's working the way that it's 0:07:53.396 --> 0:07:57.756 supposed to. But sometimes the brain can make a mistake. 0:07:58.636 --> 0:08:01.716 Sometimes the brain could interpret danger where there is none 0:08:02.196 --> 0:08:05.556 and generate pain even in the absence of an injury 0:08:05.636 --> 0:08:10.156 or structural damage. And we call this neuroplastic pain, which 0:08:10.276 --> 0:08:14.396 just means learned pain. And more and more studies are 0:08:14.476 --> 0:08:19.196 showing that many forms of chronic pain are actually neuroplastic 0:08:19.276 --> 0:08:21.596 And just like this pain can be learned, it can 0:08:21.636 --> 0:08:22.356 be unlearned. 0:08:24.076 --> 0:08:26.196 Yeah, And I think it's so important at this point 0:08:26.236 --> 0:08:30.356 in the conversation to clarify that all pain, whether it's 0:08:30.436 --> 0:08:35.036 normal pain or neuroplastic pain, is real pain, right, because 0:08:35.076 --> 0:08:37.476 all pain originates in the brain. So there's no thing 0:08:37.516 --> 0:08:40.516 as saying like, well, this is all in your head 0:08:40.596 --> 0:08:42.396 versus this other type of pain isn't in your head. 0:08:42.436 --> 0:08:44.516 It's all in your head. So you're not in any 0:08:44.556 --> 0:08:48.916 way invalidating the existence of the pain or the intensity 0:08:48.996 --> 0:08:52.076 of the pain. You're simply saying that the cause of 0:08:52.156 --> 0:08:56.316 the pain might vary depending on whether it's caused by 0:08:56.396 --> 0:08:59.756 a structural issue in the body versus something that's originating 0:08:59.756 --> 0:09:01.476 because your brain has made this mistake. 0:09:01.956 --> 0:09:04.676 Yeah, all pain is real, Yeah. 0:09:05.036 --> 0:09:07.876 You know, a foundational message of this work is that 0:09:08.796 --> 0:09:13.356 pain does not imply that there is a physical injury. 0:09:13.756 --> 0:09:17.676 And I mean that is a seismic shift in perspective. 0:09:17.716 --> 0:09:19.316 I mean, I remember growing up, I was on the 0:09:19.316 --> 0:09:23.196 cross country team. Something hurts, I instantly think, oh my god, 0:09:23.276 --> 0:09:25.356 what did I injure? I mean, it's the only question 0:09:25.396 --> 0:09:29.476 I asked myself. But there's a couple really amazing studies 0:09:29.836 --> 0:09:33.236 that show how you can experience pain in the absence 0:09:33.276 --> 0:09:36.436 of a physical injury. So the first is this simulated 0:09:36.556 --> 0:09:38.876 car crash study, right, and I'm wondering if you could 0:09:38.916 --> 0:09:40.996 tell me a bit more about that one. 0:09:41.196 --> 0:09:43.676 Yeah, this was brilliant. This was in Germany, and these 0:09:43.876 --> 0:09:49.476 very creative scientists created a condition where the subjects were 0:09:49.476 --> 0:09:52.836 sitting in a car on a track and they thought 0:09:52.996 --> 0:09:55.556 they were rear ended from behind by another car. And 0:09:55.596 --> 0:09:57.956 what the scientist did is they had crash sounds come 0:09:58.716 --> 0:10:02.676 up over a loudspeaker. There was an actual dent in 0:10:02.716 --> 0:10:04.796 the back of the car that was there previously that 0:10:04.836 --> 0:10:07.116 the person didn't see, and the car was on an 0:10:07.156 --> 0:10:10.076 inclined plane and so it slightly moved forward, but there 0:10:10.156 --> 0:10:13.716 was no actual impact between the two cars. And what 0:10:13.756 --> 0:10:17.796 they found was that eighteen percent of people had neck 0:10:17.876 --> 0:10:22.996 pain after this fake placebo car accident, and a month later, 0:10:23.236 --> 0:10:26.436 ten percent of them still had neck pain. So even 0:10:26.476 --> 0:10:29.036 though there was no injury, the brain thought there was 0:10:29.076 --> 0:10:30.036 and generated pain. 0:10:31.476 --> 0:10:34.956 You also been one of the lead researchers on a 0:10:34.996 --> 0:10:38.476 big back pain study. This is the boulder back pain study, right. 0:10:38.516 --> 0:10:39.556 Tell me a bit more about that. 0:10:40.076 --> 0:10:42.516 All of the patients in the study had had chronic 0:10:42.556 --> 0:10:45.316 back pain for an average of ten years going into it. 0:10:45.956 --> 0:10:50.356 What the study did is we looked at three different groups. 0:10:50.796 --> 0:10:54.316 One group got pain reprocessing therapy, one group got a 0:10:54.356 --> 0:10:57.556 placebo treatment, and then one group got no treatment. There 0:10:57.556 --> 0:11:00.036 were fifty patients in each group. We got fMRIs of 0:11:00.116 --> 0:11:04.676 everyone's brain before and after, and amazingly, in the pantiprocessing 0:11:04.716 --> 0:11:08.196 therapy group, we found that sixty six percent of the 0:11:08.236 --> 0:11:11.956 patients were either pain free or nearly pain free after 0:11:12.076 --> 0:11:16.076 four weeks, and remarkably a year later, they were still 0:11:16.116 --> 0:11:16.676 out of pain. 0:11:17.036 --> 0:11:20.996 That's extraordinary. And you know, to clarify for listeners, there 0:11:21.076 --> 0:11:25.036 was no physical intervention like as part of pain reprocessing therapy. 0:11:25.596 --> 0:11:28.716 Alan and the other researchers never touch people's backs or 0:11:28.716 --> 0:11:31.916 gave them physical exercises to do, which is again just 0:11:31.956 --> 0:11:34.796 such a significant shift in the way that we think 0:11:34.836 --> 0:11:37.716 about pain or what we were taught for, at least 0:11:37.716 --> 0:11:39.116 for me for decades of my life. 0:11:39.476 --> 0:11:42.436 Yeah, everything we've ever known about cause and effect is 0:11:42.516 --> 0:11:44.916 telling us if you have pain when you walk, if 0:11:44.956 --> 0:11:47.236 you have pain when you sit, then it's the walking 0:11:47.356 --> 0:11:49.956 or the sitting that's causing the pain. Really, so it's 0:11:49.996 --> 0:11:53.676 counterintuitive to really wrap your mind around the fact that, like, 0:11:53.716 --> 0:11:55.876 I have pain, but there's nothing wrong with my body. 0:11:56.356 --> 0:12:00.996 So I was even shocked by how regenerative of the 0:12:00.996 --> 0:12:03.676 body is and how such a high percentage of chronic 0:12:03.756 --> 0:12:05.996 pain could actually be neuroplastic. 0:12:06.636 --> 0:12:11.196 Yeah, what about for people bull for whom this chronic 0:12:11.236 --> 0:12:14.916 pain is instigated by an acute injury, what's going on 0:12:14.996 --> 0:12:16.676 in the brain in that case. 0:12:17.036 --> 0:12:20.196 Yeah, that's a great question. So the injury is real, 0:12:20.676 --> 0:12:23.516 there's maybe a lot of fear or preoccupation around the symptoms. 0:12:24.036 --> 0:12:27.196 The brain learns and remembers the pain, and the pain 0:12:27.316 --> 0:12:31.356 persists even after the injury heals. There was another study 0:12:31.556 --> 0:12:34.916 where they looked at a lot of patients who had 0:12:34.956 --> 0:12:37.836 initial episodes of back pain and they took scans of 0:12:37.836 --> 0:12:40.916 their brains, and they found that the pain was present 0:12:40.996 --> 0:12:43.836 in the areas of the brain that are normally associated 0:12:43.876 --> 0:12:47.436 with pain. And then they followed the patients who went 0:12:47.516 --> 0:12:50.516 on to develop chronic pain, and they took brain scans again, 0:12:51.116 --> 0:12:54.076 and they found that the pain had actually moved to 0:12:54.156 --> 0:12:57.676 the parts of the brain associated with learning and memory, 0:12:58.116 --> 0:13:00.796 so that even after the symptoms heal, it could still 0:13:01.476 --> 0:13:05.476 be chronic. You know, I had knee pain for a 0:13:05.556 --> 0:13:07.876 while and I ended up getting imaging on it, and 0:13:07.876 --> 0:13:10.876 I had a severely torn meniscus tear and there's no 0:13:10.876 --> 0:13:13.556 blood flow to the meniscus, and I ended up needing 0:13:13.596 --> 0:13:16.156 to get surgery to fix that injury. So I don't 0:13:16.196 --> 0:13:17.596 want to be so black and white about it and 0:13:17.676 --> 0:13:19.396 say that all chronic pain is neuroplastic. 0:13:20.236 --> 0:13:25.076 So, Alan, you've established that neuroplastic pain is very, very prominent. 0:13:25.236 --> 0:13:25.356 Right. 0:13:25.476 --> 0:13:28.156 It is responsible for so much of our chronic pain, 0:13:28.396 --> 0:13:32.076 for so much suffering in the world. Right, how do 0:13:32.116 --> 0:13:33.956 we get rid of the damn thing? What is your 0:13:33.996 --> 0:13:35.876 process for getting rid of neuroplastic pain? 0:13:36.156 --> 0:13:38.636 This is the exciting thing is that it's very treatable. 0:13:38.796 --> 0:13:40.956 Even in the Bolder Back Pain study, there were some 0:13:41.036 --> 0:13:44.556 patients who had had chronic back pain for forty years 0:13:44.876 --> 0:13:46.916 and they were able to overcome their symptoms in just 0:13:47.116 --> 0:13:50.636 a few weeks. So it doesn't matter how long you've 0:13:50.636 --> 0:13:54.076 had the pain. If you have neuroplastic pain, then you 0:13:54.116 --> 0:13:55.836 are able to overcome it. So the first thing that 0:13:55.876 --> 0:13:58.396 you want to do is determine whether or not you 0:13:58.436 --> 0:14:02.956 have neuroplastic pain or structurally caused pain. And there are 0:14:03.036 --> 0:14:05.676 twelve or thirteen different criteria that we look for. I'm 0:14:05.676 --> 0:14:06.916 not going to go over all of them right now, 0:14:06.916 --> 0:14:09.396 but a few of them are did the pain come 0:14:09.436 --> 0:14:12.756 on during a time of stress. Another thing we look 0:14:12.836 --> 0:14:16.476 for is does the pain spread or move around right 0:14:16.556 --> 0:14:18.676 Sometimes it's on the left side of your back, sometimes 0:14:18.716 --> 0:14:21.076 it's on the right side of your back. Another thing 0:14:21.116 --> 0:14:24.516 we look for is inconsistency of symptoms, so you know, 0:14:24.636 --> 0:14:27.796 maybe it is really bad during the week, but on 0:14:27.836 --> 0:14:30.996 the weekends or when you're on vacation it's a lot better. 0:14:31.156 --> 0:14:33.916 Or you know, maybe it's there in certain positions but 0:14:33.996 --> 0:14:36.876 not other positions, and it's not really consistent. All of 0:14:36.916 --> 0:14:40.196 these things are indicative of the fact that it's neuroplastic pain. 0:14:40.836 --> 0:14:44.396 But even if you're able to wrap your mind around 0:14:44.516 --> 0:14:47.356 the idea that you have neuroplastic pain on an intellectual level. 0:14:47.716 --> 0:14:51.596 It's really hard to embrace on a gut level because 0:14:51.596 --> 0:14:57.436 it's it's counterintuitive, and so it actually involves embracing a 0:14:57.516 --> 0:15:00.916 reality where your senses are lying to you. So it 0:15:00.956 --> 0:15:02.796 can be very tricky to do, even if you have 0:15:02.836 --> 0:15:05.276 all the evidence in the world. So sometimes it can 0:15:05.316 --> 0:15:08.076 be helpful to create an evidence sheet so that you know, 0:15:08.116 --> 0:15:10.036 you can put up on your fridge and constantly look 0:15:10.036 --> 0:15:11.676 at it to reinforce. 0:15:11.196 --> 0:15:12.276 This is neuroplastic. 0:15:12.716 --> 0:15:15.476 There was a patient that I saw a while ago, 0:15:15.596 --> 0:15:18.516 and she came into my office and she had chronic 0:15:18.516 --> 0:15:21.396 back pain. Every time she sat. She sits down and 0:15:21.436 --> 0:15:23.556 she says, I know that you're going to tell me 0:15:23.916 --> 0:15:26.076 that the pain is being caused by my brain, but 0:15:26.236 --> 0:15:28.396 I don't believe it. I just don't believe it. And 0:15:28.396 --> 0:15:32.396 I go, okay, we'll see what happens. And halfway through 0:15:32.436 --> 0:15:35.676 the session I did a meditation with her, and by 0:15:35.716 --> 0:15:38.876 the end of it, her pain was completely gone. She 0:15:38.956 --> 0:15:41.716 opened her eyes and I said to her, well, now 0:15:41.756 --> 0:15:44.156 what do you think? And she looked at me for 0:15:44.196 --> 0:15:47.076 a few moments and she said, I still don't believe it. 0:15:48.196 --> 0:15:50.116 It was so funny that even in the face of 0:15:50.276 --> 0:15:52.756 overwhelming evidence that the pain went away. 0:15:52.956 --> 0:15:54.356 Yeah, it's really really hard. 0:15:54.436 --> 0:15:57.196 It's hard to wrap your mind around. And so the 0:15:57.276 --> 0:16:00.276 main technique that we use for pain reprocessing therapy is 0:16:00.276 --> 0:16:03.876 something we call somatic tracking. So normally when we pay 0:16:03.956 --> 0:16:11.556 attention to the pain, it's with a sense of fear, preoccupation, worry, despair, 0:16:12.196 --> 0:16:14.916 and all of these negative emotions. When we're attending to 0:16:14.916 --> 0:16:18.236 the pain through that lens reinforces our brain that the 0:16:18.276 --> 0:16:21.836 pain is actually dangerous and keeps the pain alive. So 0:16:21.996 --> 0:16:24.436 somatic tracking is is it's a way to try to 0:16:24.516 --> 0:16:27.916 break that pain fear cycle, where you're attending to the 0:16:27.996 --> 0:16:31.916 pain in a new way to show your brain that 0:16:31.956 --> 0:16:34.756 the signals that are coming from your body are actually 0:16:34.876 --> 0:16:36.516 safe and not dangerous. 0:16:37.676 --> 0:16:40.276 After the break, I asked Alan if you could coach 0:16:40.316 --> 0:16:43.796 me through somatic tracking. I've never tried it before, but 0:16:43.836 --> 0:16:46.036 I've had this annoying knee pain for a while and 0:16:46.076 --> 0:16:47.676 I really wanted to see if it could help me. 0:16:51.036 --> 0:16:52.956 We'll be back in a moment with a slight change 0:16:52.956 --> 0:17:09.356 of plans. I have a personal story that really error 0:17:09.436 --> 0:17:13.196 is yours, So probably at this point eight or nine 0:17:13.276 --> 0:17:16.196 years ago, I was taking a one of those bar 0:17:16.356 --> 0:17:19.396 classes and I remember during the ab part of the workout, 0:17:19.436 --> 0:17:22.476 I kind of just strain lightly my lower back. A 0:17:22.516 --> 0:17:25.396 week goes by, two weeks goes by, it's not quite 0:17:25.436 --> 0:17:29.316 getting better. And the more time that passes, the more 0:17:29.476 --> 0:17:31.956 stressed out and freaked out I am that I've done 0:17:31.996 --> 0:17:35.596 something terrible to my lower back. Fast forward a year 0:17:35.636 --> 0:17:39.276 and a half, I'm struggling with chronic lower back pain. 0:17:39.996 --> 0:17:42.236 I was not able to sit without pain for a 0:17:42.316 --> 0:17:45.476 year and a half. I became terrified of sitting. It 0:17:45.596 --> 0:17:48.476 was just like it was a stressful. And so the 0:17:48.596 --> 0:17:51.076 moment it was unlocked for me as I remember seeing 0:17:51.876 --> 0:17:55.676 the head of orthopedics at George Washington University and he 0:17:55.716 --> 0:17:58.916 looked at my MRI scan and he said, Maya, there's 0:17:59.156 --> 0:18:02.396 nothing structurally wrong in your back. 0:18:02.636 --> 0:18:02.996 Wow. 0:18:03.676 --> 0:18:05.236 He just said that to me. He's like, there is 0:18:05.476 --> 0:18:11.116 nothing wrong with your back. This is logical pain. And 0:18:11.276 --> 0:18:14.596 it's so interesting because in that moment, because I'm trained 0:18:14.636 --> 0:18:17.716 in neuroscience, I was so thrilled by this news. It 0:18:17.756 --> 0:18:20.076 did not feel like he was invalidating my pain at all. 0:18:20.236 --> 0:18:20.556 Yeah. 0:18:20.596 --> 0:18:22.916 I mean, it's so empowering to learn that. However, to 0:18:23.036 --> 0:18:28.756 your point, knowing it intellectually is very different from intuiting 0:18:28.796 --> 0:18:33.196 this emotionally. So it took me still years to unwind 0:18:33.236 --> 0:18:35.116 the pain. And there are still times now where I'm 0:18:35.156 --> 0:18:38.556 sitting on a chair that's at a not appropriate angle 0:18:38.676 --> 0:18:40.796 given what I'm comfortable with, and I start to feel 0:18:40.836 --> 0:18:44.236 that pain return. So it is definitely a process. It's 0:18:44.316 --> 0:18:46.836 really hard to buy into because you still feel really 0:18:46.876 --> 0:18:49.156 threatened by it. So this is to say, I know 0:18:49.676 --> 0:18:51.836 one thing that you've discovered in all of your work 0:18:51.876 --> 0:18:55.876 is that fear is a huge reason why neuroplastic pain 0:18:56.396 --> 0:18:58.596 is so sticky, right, like why it sticks around for 0:18:58.636 --> 0:19:00.716 so long. And I think that's what happened. The more 0:19:00.996 --> 0:19:02.996 it stuck around, the more fearful I got, and it 0:19:03.036 --> 0:19:05.076 was this negative vicious cycle. 0:19:05.516 --> 0:19:09.796 It's the pain fear cycle. So when you think about 0:19:09.796 --> 0:19:11.796 the pain a thousand times a day, when it's the 0:19:11.836 --> 0:19:13.596 first thing you think of when you wake up, the 0:19:13.636 --> 0:19:15.796 last thing you think of before you go to sleep, 0:19:15.836 --> 0:19:18.356 you're constantly checking in to see if it's there. When 0:19:18.396 --> 0:19:22.116 you attend to the pain, there were lens of fear, frustration, 0:19:22.676 --> 0:19:27.236 despair that reinforces to your brain that these sensations are 0:19:27.316 --> 0:19:29.836 dangerous and it becomes this terrible cycle. 0:19:30.676 --> 0:19:33.756 So, Allen, I've never tried somatic tracking before, and I 0:19:33.796 --> 0:19:36.356 would absolutely love to give it a shot. Do you 0:19:36.356 --> 0:19:38.676 think it's something you can coach me through right now? 0:19:39.276 --> 0:19:40.436 Do you have pain right now? 0:19:40.756 --> 0:19:44.076 Yes? I'm aching in my knees right. 0:19:44.196 --> 0:19:47.236 And so are you still struggling to determine whether or 0:19:47.236 --> 0:19:49.516 not this pain is structural or neuroplastic? 0:19:50.476 --> 0:19:54.356 Yeah, it's like I'm not totally convinced that it's neuroplastic. 0:19:54.396 --> 0:19:55.316 That's part of the problem. 0:19:55.636 --> 0:19:59.916 Yeah, and so this is like it's real. Yeah, this 0:19:59.956 --> 0:20:01.676 is I mean again, all pain is real. 0:20:02.156 --> 0:20:03.996 I know, I know, I know, but here I am 0:20:04.476 --> 0:20:06.436 it feels structural, really feel structural. 0:20:06.556 --> 0:20:10.356 Let's let's go through the evidence. Well, we know that 0:20:10.396 --> 0:20:13.036 you're very prone to neural plastic pain. That is a 0:20:13.036 --> 0:20:15.956 big piece of evidence in and of itself, but that's 0:20:15.996 --> 0:20:18.956 not definitive. So you know, even if you're prone to 0:20:18.956 --> 0:20:22.036 neural plastic pain, you want to be scientific about this. 0:20:22.076 --> 0:20:24.516 You never want to make assumptions, and so, you know, 0:20:24.556 --> 0:20:26.716 we want to gather as much evidence as possible. What 0:20:26.756 --> 0:20:28.836 other evidence do you have about your knee let's do 0:20:28.916 --> 0:20:29.716 an investigation. 0:20:30.276 --> 0:20:35.316 Okay. I think another is that I've had this history. Okay, 0:20:35.716 --> 0:20:38.356 I have had long periods of time in which this 0:20:38.516 --> 0:20:41.316 right knee of mine was so achy it put me 0:20:41.356 --> 0:20:43.436 out of working out for a while. I had a 0:20:43.476 --> 0:20:44.876 lot of anxiety around it. 0:20:45.396 --> 0:20:49.956 So we know that those neural pathways are already laid down, right, 0:20:49.996 --> 0:20:53.076 So maybe sometimes when you feel stressed out, that kind 0:20:53.116 --> 0:20:54.316 of may be your go. 0:20:54.396 --> 0:20:57.516 To, And it's worth mentioning that in this particular case, 0:20:57.556 --> 0:21:04.396 this episode of knee pain transpired following a legitimate physical injury. 0:21:04.396 --> 0:21:07.596 So I had a swollen bursa and I'm still stuck 0:21:08.076 --> 0:21:10.596 with this deep aching of my knee. 0:21:10.596 --> 0:21:13.556 Okay, quick question. When the burso was swollen, was your 0:21:13.636 --> 0:21:15.756 knee hurting in the way that it's currently hurting or 0:21:15.796 --> 0:21:17.556 was it hurting in a different way. 0:21:17.716 --> 0:21:20.036 My knee actually was not hurting at all when the 0:21:20.036 --> 0:21:22.076 bursa was swollen, So the verse is a few inches 0:21:22.116 --> 0:21:25.236 from my knee that I was not feeling any aching 0:21:25.236 --> 0:21:28.756 in my knee. As the burso was resolving, I started 0:21:28.796 --> 0:21:30.716 to develop this aching in my right knee. 0:21:30.796 --> 0:21:35.996 Okay, yeah, this is neuroplastic. Okay, this is the evidence 0:21:36.036 --> 0:21:39.836 that we needed. Whenever you have pain that is delayed 0:21:40.196 --> 0:21:43.316 from the onset of the actual injury, that is like 0:21:44.036 --> 0:21:46.836 the holy grail of evidence that your pain is neuroplastic. 0:21:47.436 --> 0:21:50.796 If the pain that you feel right now was caused 0:21:50.916 --> 0:21:54.076 by this bursa swelling, you would have had it while 0:21:54.836 --> 0:21:57.556 the burso was swollen. It wouldn't happen days later. What 0:21:57.636 --> 0:22:00.516 it did is it refocused this level of attention and 0:22:00.556 --> 0:22:04.956 preoccupation you had around this already scary part of your body. 0:22:05.676 --> 0:22:08.476 And so you know, your brain was like, yay, we 0:22:08.596 --> 0:22:11.116 have a way we could bring her back into fear 0:22:11.156 --> 0:22:12.276