The BEST WAYS To Heal Chronic Pain & Trauma WITHOUT Medication | Howard Schubiner

the research you have done around chronic pain I think is game changing I think it's helping so many practitioners it's helping so many patients all over the world find Healing where previously there was stress and heartache so right at the top you know what is chronic pain what do those two words mean yeah and how common is that yeah well everyone's experienced pain and we need pain is is a protector pain is something that it turns out our brain creates and generates so what I say to all of my patients pain is a discomfortable experience basically but it's also an emotion and so when you get down to it we kind of think as every time someone has pain that there must be something wrong with their body and it turns out as we'll discuss the vast majority of people who have chronic pain actually don't have a structural problem in their body most people with acute pain probably do because if you break an ankle or something and if you break an ankle you want pain because it tells you it's a message that your brain is giving you just to stop don't walk on a broken ankle but it turns out if you have a broken heart you might get chest pain but it might be due to your brain giving you the message that there's something amiss there's something wrong in your life and so what I say to all my patients is you can't understand pain unless you understand how the brain works so we start with that because it's a much broader view of understanding pain that you know that we can get into yeah when you say acute pain versus chronic pain what does that mean and do you have some examples of common conditions or syndromes or or diagnoses that fit under this chronic pain diagnosis yeah for sure take headaches in the U.S 25 million people suffer with chronic headaches and so if you have headaches you think there must be something wrong there is something wrong you have pain but it's chronic it's not like you you know you hit your head and you have a you have an injury to your forehead and it hurts and it's going to go away in a couple days or you have a tumor or an infection or a bleed as Physicians we know there's certain structural problems that cause headaches but the vast majority 95 98 of people with chronic headaches don't have a structural disorder they go to the doctor they get their CAT scan or MRI they get tested for their sinuses their teeth their ears their their mouth Etc and there's nothing wrong so what's the cause it's chronic headache pain what we call primary headache right so what's the cause of that most doctors say well it's genetic or I don't know or whatever and what we're saying is we know exactly why people get have chronic headaches because we can talk to them we can listen to them we can hear their story and we understand how the brain works and how the brain can create a cycle of pain due to neural circuits that get activated due to stress and emotions and life situations and then it continues to get activated by this vicious cycle of pain leading to fear of pain which leads to more pain you know I I reflect back on my career to date and I remember early on as a primary care doctor some of the most frustrating cases were those patients who would come in with chronic pain whether it be chronic migraines headaches bilateral arm pain you know whatever it might have been because as a medical doctor certainly back then as a very Junior medical doctor I I didn't really feel I had the tools to help these people I you know as I say that I would I remember distinctly one afternoon I was in timperley I was in a practicing simply I can remember this lady coming in maybe 60 62 you know she would smoke 15 or 20 cigarettes a day she was really struggling with life she was on a whole host of painkillers you know I had all these letters from the from the pain clinic the you know you know just increased the pregabalin by 25 milligrams or I remember seeing her thinking everything we're doing nothing's working and all I've got was a specialist letter telling me to increase the dose of a pain medication by 25 milligrams even though nothing's working anyway I I wish I could go back to that patient now knowing what I know uh through your research through my own clinical experience I wish I could go back and help that lady because I think she's an example of a that patience is struggling and suffering okay but I also think doctors I think they feel really powerless and frustrated with cases like that and I think what ends up happening in my experience is that the patient often feels that they haven't been hurts this guy this woman whoever it be this Healthcare professional is not taking me seriously we are spending billions and trillions of dollars for Band-Aids we're talking about Band-Aid care put something over it as opposed to look and and find the underlying cause and the pain that is experienced in chronic headache and migraine and irritable bowel syndrome and fibromyalgia and chronic pelvic pain and we've done research in looking at the cause of these and the most people with neck and back pain we'll talk more about that in a minute the pain they experience is real it's not imaginary it's not in their head it's be but it is in their brain because of neural circuits in their brain when the doctors can't find anything wrong which is the case most of the time as you've experienced so the doctors are frustrated they can't find anything that's wrong they can say oh have this surgery or or do this to fix it it's that's not going to happen but it they can get better and that's the work that we've been doing and a lot of other people are doing as well but it starts with understanding the person it's listening to them and understanding them and getting to know them and understanding what's going on in their life so they can see what are the things which led to this situation and they can know that you're not invalidating them you're not stigmatizing them you're not blaming them that the pain is real and that they can get better what a hopeful message as opposed to the incurable message that are mainly given by so many doctors and groups that are working in that space this idea that when we experience pain most of the time there's nothing actually structurally going on in our body I think it's quite profound for people because I think I think we grow up with the understanding that if we have pain there's a physical cause of that pain and you mentioned earlier on that the brain creates this experience of pain you mentioned something that I think most people many people have experienced when they have a broken heart they can literally feel a pain in their hearts right but nothing physical has actually happened so help us understand that what's going on how does the brain generate this experience of pain and why does it do it as well yeah yeah it is amazing um the book that I recommend to people is how emotions matter by Lisa Barrett uh neuroscientist in the states and and there's some very famous British uh neuroscientists friston and Clark particularly have written about this extensively their work is a little harder to read it's very deep but this isn't this is emerging Neuroscience of how the brain works well how does the brain work our brain creates what we experience how do we see we don't see with our eyes we don't light comes in our eyes but those delayed impulses have to be transformed electrically through the visual cortex to create the images that we see and so our brain creates what we see and part of it occurs in what we expect to see the other day I was driving by my friend's house I hadn't seen him in a while he was on vacation I drove by he's standing in his doorway it's like oh wow he's home awesome I drive up to the drive knock on the door there's no one home my brain created the image of him standing there basically a hallucination and police officers this is controversial my wife doesn't like me to talk about it but they go to the scenes of crazy stuff especially in the states and uh they have to say do I see a gun or not well sometimes they see a gun that's not actually there or vice versa if I gave you prism glasses that turn the world upside down you'd see everything upside down but ever only for a few days and then your brain would switch the images to be right side up again because our brain creates what we see our brain creates what we hear the other day I was at a meeting a young woman got up and said Good Morning America which is like that's a weird thing to say she actually said good morning I'm Erica but I didn't know her name but our brain my brain was just latching on to something and creating something and so when you break an ankle it's not your ankle causing pain an ankle can't cause pain when you touch a hot stove it's not your finger the impulses go to the brain but the brain decides and this is the craziest thing it's true neuroscientifically the brain decides whether to actually turn on pain or not whether to give you the experience of pain or not how do we know that because a lot of people and a lot of people have experienced themselves you get an injury and you have no pain at all so the brain decides whether to turn on pain or not and it's there to protect you it's something that everyone needs it's like a smoke alarm and well the research shows Neuroscience research shows that emotions and stress activate the exact same parts of the brain as does a physical injury and and like we can talk about why our brain might do that we don't know for sure but whether God created us that way or we evolved that way but that's how our brain works so the pain that occurs due to a a fracture is exactly the same as the pain that occurs due to a stressful situation that occurs in our life it's real pain and it's can be severe pain and that's what people say how can the pain be so freaking severe yeah and not be due to a structural injury it's it's amazing but it's true we see it every day yeah and that's I think the powerful a lot of your work a lot of your research is helping to give scientific validity to something that many practitioners have experienced many patients have experienced that emotional pain emotional injury can totally manifest as physical pain I have found like you Howard I think that many cases arguably the majority of cases with chronic pain can be healed in my experience at least I'd love your view on that without using any medication if you take time to help the patient understand what's going on get to the root cause I mean what would you say to that exactly it's 100 true and we have data now uh showing that I can talk about that in a second but the most important thing is that it's not all in your head when the doctor says or anybody says it's all in your head it's cruel yeah and it's ignorant because it implies that it's their fault that they want the pain somehow that they're crazy or mentally deficient you know are making it up and none of that is true at all and so that validation is so important I guess you know you can look at it this way if someone had a physical injury but we could see let's say their ankle and it was red it was hot it was swollen and they were hobbling for a few weeks and had to I don't know take crutches to work with them people would be sympathetic they could see that they could understand yeah oh man you need some help you know I get it you're in pain right we have an understanding of that but a lot of emotional pain is hidden we can't see it the people around you can't see it so therefore one of them we have sympathy for as a society the other one we kind of ignore right and we're not really looking at the whole person so if you take for an example it's kind of a common story right you take a young young woman say whose father was critical um yelling and screaming sometime maybe alcoholic kind of that sort of thing and she grows up with this sense that life isn't safe that people are unpredictable people in my life are unpredictable around me and can can yell or scream at me or even worse and then she grows up and then when she's 15 she has a boyfriend and then he betrays her cheats on her sends pictures of her around the school or something like that and then she gets migraine headaches do you have sympathy for her of course you do and then she's in her 20s and she marries a guy who happens to be kind of like her father kind of maybe abusive or maybe harsh with the children and then she starts getting irritable bowel syndrome or pelvic pain do we have sympathy for her and then when she's 35 she divorces the jerk but still not paying child support or whatever and then she gets in a small car accident and then her neck starts to hurt and it gets worse and then her whole back starts to hurt and then she starts to feel anxious or depressed and then maybe she gets pain all over and they say she's got fibromyalgia and now at the end of this she feels completely broken and people maybe are looking at her like you know just get on with your life what's wrong with you nothing do we have sympathy for that person are you kidding me her whole life has been one which cries out for understanding and cries out for her to to be heard listened to respected cared for and when you look at it that way yeah this pain is real and all these pains are due to the stress that's been caused in her life that none of which is her fault when you use the term chronic pain are you able to list some of those conditions that fall under that umbrella term and I've got a reason for asking this you mentioned headaches already but if you could just sort of go down a common list because I think this conversation and what we're talking about is relevant to almost everyone whether in their own lives or someone very close to them and I wonder if you might just make it super super clear for us who we're referring to yeah exactly well chronic pain just means any pain that's lasted for you know they say three months or six months as the definition but the conditions that are commonly what I would call Neural circuit based pain in other words brain generated pain in the absence of structural problem our primary headaches like tension and migraine headaches and other headache conditions like occipital neuralgia trigeminal neuralgia most people with TMJ problems do not actually you can find that there's problems in the on the X-ray but actually when you talk to them and take their history and take time and we can we can talk about how we do that how we assess people to know for sure TMJ pain most of the time is neural circuit base or mind body type pain um if you take people with costochondritis chronic chest pain again in the absence of heart disease or lung disease most people with the vast vast majority of people with irritable bowel syndrome and what's called um non-ulcerative dyspepsias the word I'm looking for uh if you take people with chronic pelvic pain they may be diagnosed as having pudendal neuralgia or pelvic floor dysfunction or vulvodynia but all those things are just names they're just describing that you have chronic pain fibromyalgia fibromyalgia absolutely and most we did a study of chronic neck and back pain and we haven't published it yet uh but a colleague I have in the states examined 220 consecutive patients coming into his Clinic with chronic neck and back pain he's the physiatrist Physical Medicine physician and he determined that 88 of them had non-structural pain I mean that is shocking because if you go to a doctor with chronic neck or back pain or a chiropractor or or a massage therapist or a physical therapist they're going to say oh well you have degenerative disc disease look it's on the X-ray of the MRI you have got bulging discs but everyone has those and if you look closely at the data we can share this data with with with you and your listeners yeah the vast majority of people have those things on x-ray as I do in my neck uh without pain at all and so we have to be very clear and very careful what we're talking about and everyone needs a very careful evaluation but those are the main conditions but the brain can produce anxiety and depression when we're under stress obviously the brain can produce fatigue that can be severe and overwhelming we see that all the time the brain can produce Eating Disorders the brain can produce well we can talk about long covet as well of course so there's just so much the fact is is that if you're the reason that my patients and your patients have these conditions is because they're human they're just human they have a brain they have a body they react to stress that occurs in life and everybody has some of these everyone does you know when I I like to say when I started my internship I was a young doctor I got diarrhea for six months what was that diarrhea real well it's real you can see it but it wasn't because I had something wrong in my bow if I can say this on here I was scared shitless you know of being a young doctor and making mistakes and hurting people and I was just being human you know what's interesting about all those conditions that you've just listed is the almost without fail I would say those are the conditions that we manage in medicine pretty poorly I I I don't think that's controversial to say I think patients know it we as medical doctors know it those are the conditions where it's often as I've already mentioned quite frustrating because actually the tools with which trains the tools that we learn at Medical School just don't work that well um and this is I guess one of my biggest realizations as a doctor throughout my career has been how important the mind is in Our Lives of fiscal Health our Vitality how much a role it plays but we are literally taught zero about that medical school now that could all speak because research was limited at the time when I was at med school but I don't see much evidence of that changing at the moment you know when I've spoken to a mutual friend of ask Gabor mate in the past we and couple talks a lot about trauma and how cillin many medical schools the trauma word doesn't even come up at all in the entirety of medical education and now that we know how much early life trauma affects our risk of autoimmune disease and all kinds of other conditions later on in life it's it's baffling as to why it's taking this long for it to get into medical school training because doctors are getting frustrated patients are feeling underserved but that thing you just mentioned Howard about MRI scans I think that's a really great point to dive into I wonder if you could share some of those statistics if you happen to hand uh if you take 30 year olds people in their 30s and you do an MRI these are people with no pain at all 40 percent of them have degenerative disc disease 30 have a bulging disc these are 30 year olds these are normal findings that occur with aging so what happens when you're 50 50 year olds 80 percent of people have degenerative disc disease with no pain 60 percent have bulging discs with no pain 30 percent have herniated discs with no pain so here's the problem that I've seen as a medical professional right the the patients there they've either seen a specialist or got a scan as the primary care daughter you get the scan results and it will say um bulging disc at L4 L5 right no nerve impingement or something that'll be some kind of reports and then you'll say or as a professional will often say oh the reason you have your pain is because of that disc problem on your scan and that's a very dangerous thing to say to that patient I think what would you say to that incredibly dangerous and maddening well because it not only gives them the erroneous diagnosis and we and also I want to talk to you more later about how we assess to make sure that we know that the bulging disc isn't the cause of pain but uh it's giving them an erroneous diagnosis so it's making them think that there's a problem that can't be fixed or needs fixing with it medication or injections or even surgery yeah and we see so much maybe not quite as much here as in the States but so much so many surgeries that are being done on people's necks and backs for treating the MRI not treating the patient and there's never been a randomized controlled trial so in showing that surgery for neck or back pain axial pain is better than watching it or exercise or physical therapy or anything there's no evidence that this is what we should be doing but we're spending billions of dollars trillions of dollars but well billions but it's not it's not that so much it's that it also makes people worse because what happens is in the brain we'll talk more about this what happens in the brain is that the more you're fearful of the diet every time if you have back pain the more fearful you are of it it's going to get worse over time because the neural circuits in the brain you're getting a positive feedback loop whereas pain leading to fear focus on it worry about it frustration with it it actually makes it worse because that's how those neural circuits work so it's really yeah and it and it's all out of I don't know how to say this nicely but not understanding the brain and not understanding the data the scientific data we have about these mri's because because these these abnormalities go up to 90 percent when you're 60 and Beyond but but these are people without any pain it's like saying you've got wrinkles on your skin and that's the cause of your con that's the cause of your headaches because you have wrinkles or that your your hair is getting gray and that's the cause of of your of your migraines you know that's the kind of thing that we're doing and I think this is a key Point Howard for me how we as Healthcare professionals can unwittingly make the problem worse because as you say this can worsen things this can create a fear and it also what we say is Healthcare professionals certainly as doctors has real power it can really positively or negatively influence what that patient believes what they feel like let's say they're one of these many people who have abnormal MRI scans are their spine they've got a bulging desk let's say they probably had that for years well before they actually had the pain maybe that bulging disc has nothing to do with their pain at all and then here's the problem the way the way I see it is that if we say that to the patient oh yeah oh you know we've we found the cause of your pain that patient then goes out into the world with the belief my spine my disc is causing my pain so everything they do after that is based on an erroneous belief system whether they're trying treatments or therapy or anything it's all based on that truth and that truth actually may not be true now what if I might share with you my own Journey with through and now Beyond chronic pain because I think perhaps if you hear that you might be able to explain various bits along the way would that be yeah that would be great yeah so I'm now in my early 40s okay so really you look much older I'm sorry I was going to say younger but then somehow that's good yeah I when I was um again because I really feel it's a thing of the past for me that it's hard now to remember step by step what happened but let me share with you some of the key things it's always been I've always been pretty fit and active and I think it was in the final year of medical school that I was helping my flatmate at the time move into a new flat they were all going to move into and all afternoon I was lifting heavy boxes out of a car uh probably with appalling lifting technique because I knew nothing about it at the time I never had a problem with my back or anything so I wasn't thinking and at one point during the afternoon I remember getting something out out of the back I had a sharp pain in my lower right back drops everything and I just went onto the floor that's the first time to my uh recollection now at least that I experienced back pain now that led to maybe a 10-year history where the quality of my life was hugely affected I sorted up against the doctor you know the university doctor I went to what happened immediately so you fell down you had this acute pain right yeah and then did you keep did you get up and finish the work or did you have to stop for the day and what happened in the next two or three days if you recall honestly I cannot remember with any degree of accuracy um I probably would have stopped I may have sat down for a while I may have rested maybe I helped get the remainder of the boxes up I don't really know but all I remember now at least is that I went on a journey for several years where I would take painkillers I would go and see a physio you know I remember I got referred to a physio I think I paid privately for loads of physio sessions limited use again I'm not here to have a go at physiotherapy I'm just saying for me it was you know I was doing some strengthening exercises but was the pain coming and going was it turning on was it turning off was it there constantly I think I don't think it was there all the time yeah uh I think I would just have an awareness of it if I sat down for too long I think I'd feel it um at some point in that journey I think I don't know when that was it was probably I don't know something like 1999 2000 something like that I moved back to the northwest of England from from Edinburgh in 2003 to help look after my dads and I was having real problems like I was I was a junior doctor at the time I was really struggling sometimes with the long Ward rounds and my back was really bothering we had to take time off and I think I I once went to my GP and they referred me for an MRI scan or I actually think it was at the hospital I worked I I got an MRI scan there and this is the first time and I give the the spinal surgeon who had the consultation with me a huge amount of credit for this this would have been back around 2003-2004 there was a disc abnormality on my MRI scan and I would have been you know in my mid-20s something like that and he said to me yes you have a disc abnormality L4 L5 but you've got to understand that I could take a hundred people off the streets and your age do an MRI scan on them a lot of them would have the same scanner shoe and most of them would have no pain at all so to be fair to him back then he was basically saying this is a static scan this simply cannot tell me if you have the pain so I've got other things to share but any comments so far yeah well first of all the data of these MRIs being abnormal in normal people goes back to the 1980s so it's not really all that new we've come it's been compiling over the years but the thing is is that what happened at that initial moment you might have twisted your back you might have had a back injury due to lifting improperly or whatever or your brain might have said you know it's been a long day Ryan you've been working really hard maybe this guy's not really appreciative maybe he's got too many boxes maybe they're too heavy you know there's a certain amount of stress going on and your brain might have said time out you know you got to stop doing this and your brain can't talk to you it doesn't speak English it can only speak in some kind of message so it might have sent a pain so in either case the point is is you had pain in your lower back at that moment and then you did the appropriate thing you rested and then you didn't stress out about it too much and you didn't use your body too much but then you gradually started to get back into action and if it was an injury it had healed it all because all injuries heal and so if it's an injury it healed and then you would be fine unless the neural circuit for that pain continued and what causes a neural circuit for pain to become chronic or to continue it's that memory of it it's the fear of it next time you go to lift something there's a little subconscious reaction going on in your in your brain there uh oh be careful don't lift uh you might get pain again and then that actually can cause that neural circuit to turn on pain yeah and so and then it can enlarge not just the lifting but to other stressful situations like being on rounds for a long time standing up for a long time sitting for a long time yeah these can all become conditioned responses and so the chance that you know you didn't you may have a little muscle pull or something minor like that but that healed yeah and then what happened is the pain became chronic because those neural circuits got activated and then reinforced over time it's so interesting looking back at that now with fresh eyes with some Allah in front of me because bit by bit it became chronic and it would affect how I felt about myself I would become fearful oh I can't let I know I can't help anyone I can't lift the sofa and then again the narrative you know you're six foot seven you're really tall of course you're gonna have back pain but I actually there was there was a deep part Within Me Howard he thought that's just nonsense right I do not have to be committed to a life of backache in my mid-20s because I'm you know Mega tall I just refuse to accept I thought there's some are going on here I'm gonna find the way to heal this I'm not accepting that yeah and I won't go into the whole story necessarily but there's two specific things I wanted to share with you one is that on this journey I like many people spend a lot of money on different therapies because like this is just I can't play Squash anymore I can't sit for long periods of time I can't drive for more than an hour like all this kind of stuff was real and for me it was like oh it's because you're tall you look at your posture you look at all these things and again I'm not saying they have no value ever but I found this guy uh it was a ski video actually this chap called Gary Ward who I've written about he's he's an incredible incredible guy in terms of biomechanics and I went to see him I went to study with him and he was basically saying to me that my wife thought the time was flat and he said wrong and I don't feel you're and this is not exactly what he said word for word but essentially that your right foot is stuck in pronation it's not uh you know I think we can help that right foot get better he gave me some uh five minute exercise to get my right foot going and literally instantaneously I felt relief in my uh lower back and that continued for years so I could get back to squash I could get back to long drives I'd still have tightness it would still come back from various times but that made a huge difference so I thought I got my quality of life back but even though it was significantly better it was still there it was still come on at times of stress I would notice yeah now see now you're getting to the harder now I'm getting started because when I got the Deep realization so just a quick overview when I was in second or third year at Medical School My dad became seriously ill with lupus his kidneys failed he was 15 years on kidney dialysis that's why I moved back in 2003 so the Northwest that's why I live where I lived today because I was helping my mum and my brother look after Dad for many years now at my dad's funeral in 2013. so contacts again my back had been good for a few years like I've been back to doing stuff playing squash back to the stuff I wanted to do in my life but I'd still feel it now I I mean this moment like my dad was cremated and I can still remember wearing my suits at the end of the um the service I went my dad's coffin I could see it being bought out and it went into the I don't know the official term like the oven yeah yeah you know I saw the the door open I saw the orange yeah and I am not kidding you right I can I can almost feel it now as I as I say it to you as my dad's coffin went into the oven I could feel my back is off wow and I was I was like I I know that just happened I wasn't thinking about it it wasn't like I was planning for this to happen and I thought about that and I thought oh my God this is the the weights of looking after my father I honestly felt as I analyzed it afterwards oh wow in that moment where you knew that Dad was literally going to be gone but because his body's about to be burnt there is no more dads yeah on some deep level it was like I knew I no longer need to care and take on that weight well you had fulfilled your obligation you came here to do what you needed to do and it was a great gift to your father and your family and it was a great gift to you as a son and it was a beautiful thing but it was a hard thing and you did it for many years and when at that moment you realize I fulfilled my obligation I've done it and you can relax to that degree and that's what happened in your back emotions matter emotions are real we are psychological human beings and the connections between emotions and our physical body are very real these are neural circuits that get ingrained get built in get activated get turned on and off and um I I just think it's it's it's a beautiful process to understand because when we can understand that we can understand ourselves and the people we love and care about and as doctors we can understand our patients and people can understand that the symptoms they're getting in their bodies sometimes are really just a message they're a message from our brain telling us something but we have to interpret it and oftentimes and this is really hard for some people to hear but oftentimes they're a blessing in disguise they're pointing us towards something that we need to do or we need to take care of if we are in a situation in your life which is difficult and overwhelming you need to change your job or change a spouse or change your relationship or set some boundaries or do something in your life you may be having headaches or stomach pain or chest pain or back pain and you have no idea why but if you look deeply and you are open to understanding these simple Concepts you can see it and it's very real you're touching on a concept that often comes up on this show and I say this with compassion with I hope a great deal of sensitivity but many people have shared with me when the mics are running if they have got through to the other side of something they'll say my disease was the best thing that happened to me my cancer was my greatest teacher and again yeah these are people who have got through to the other side so I understand this you know if you've had cancer and you've had real problems with it and you know or someone's had a had a friend or a family member who's died from cancer um I understand that I'm not trying to in any way invalidate that of course but what you're really speaking to for me is this idea that our pain our chronic pain it's a signal and if we can get to the root cause of what that signal is the learnings we're going to get from that will not only help our pain but it will help every other aspect of our life as well the pain is not the problem it's the solution what a weird thing to say it's the solution that our brain has come up with to alert us to a problem it's a signal it's a message and it's a protector it's it's a guide your brain is saying like look I'm worried about you you know there's all this stuff going on I'm worried about you there's something wrong there's something to miss and here's here's a signal for you to stop doing what you're doing stop and think stop and evaluate whatever the message is and oftentimes I remember there was a woman I was on I was on a video call with a bunch of people a young woman was having neck pain and it had started when she was in her University days and I just asked her to close her eyes and put her hand over her heart and think about that person who was her you know eight or ten years ago whatever it was and think about what that person what she needed what she was going through what was happening in her life at the time that the neck pain started and she just started to cry you know because she felt compassion for herself a lot of people have trouble with that right she felt compassion for herself at that age and what she was going through and how much pressure she was putting on herself and how hard she was working and other things that were going on in her life and all of a sudden it made sense to her why she got the neck pain at that time and what happened as she started to cry as she had her hand over her heart as she was turning those tears into into compassion for herself neck pain disappeared just like that it's amazing you mentioned that it's important to properly evaluate a patient who's suffering with chronic pain because of course there might be a structural component that is amenable to some sort of treatment yes of course and you know related to that you mentioned the brain is what creates the pain do we need to sort of outline what happens right what happens when we touch a hot stove is it worth us kind of unpicking that to help people understand that yeah for sure the signals that go to the brain go up through the peripheral nervous system through the spinal cord into the brain into several centers of the brain and the different centers of the brain have different functions so metal sensory centers and emotional centers and thought centers and memory centers all those things are activated when you get these kinds of nerve signals coming up to the brain and there's an immediate and this is all subconscious you're not you're not thinking like oh I hid myself oh should I get pain or not you can't think that it's not a conscious process it's all happening on a subconscious level and so most of the time when you have an injury the brain will immediately turn on that pain as a signal just stop stop doing what you're doing get help swear you know do whatever you have to do to take care of yourself um so that's what happens in an acute injury but sometimes those signals are overwritten in an acute injury the brain may not activate pain because there's something else going on you know I like to say if you're running across the field and you break an ankle you're likely to get pain if you're running across the field and break an ankle but you're being chased by a lion you probably wouldn't get pain in that situation so the so there's a decision mode that's going on in the brain that can override that the point is is that injuries that occur that cause pain which is almost all the time those injuries heal because our body always heals but what happens is is that sometimes the danger signal of what's going on in people's lives is also activated through memory through prior injuries through stress that's going on in our life that can activate this dangerous signal to make the pain continue even though the injury heals so we see this all the time that's why I was asking you like what happened in the aftermath of of you know hurting your back initially did the pain go away for a while and then it started coming back well if the pain went away for a while he started coming back chances are the injury healed this makes sense but the neural circuits had been learned by the brain and then had gotten activated so the brain learned that the brain then learns has this pathway that's sometimes becomes a default pathway of neural circuits that keeps turning on paint every time you wake up in the morning or every time you bend over uh as a condition responds and so then those neural circuits become activated sometimes all the time or coming and going or in whatever pattern occurs but those neural circuits are real and they're causing real pain but it's not because of the injury so that's the critical thing that we and Physicians and PTs and everyone need to understand to look carefully to really listen to people of what happened with the injury what happened with the healing and what is the history of the pain because if the pain is turning on and off structurally if you break your arm it does the pain doesn't turn on and off yeah if you go away on vacation it goes away and you come back to work it comes back again that's that's a neural circuit problem if the pain is triggered by stress if the pain is triggered by the wind or cold or the weather you know there's all these signs and clues that we have as Physicians and other professionals to listen to people intently and make sure that we've ruled out a structural problem I'm a physician we're both Physicians you know we know that you the last thing we want to do is Miss a tumor miss an infection Mis miss an inflammatory condition miss something we desperately want to avoid doing that yeah I I as you say that I I think about aerosol bowel syndrome IBS super super common and for years it was that diagnosis of exclusion oh well you've got these problems these stomach cramps this constipation this diarrhea you know bloating whatever it might be but your scans are all fine the Bloods are all fine oh you must have irritable bowel syndrome but there's something inherently wrong with that source of phraseology because we're not giving weight to the fact that look you've got really bad symptoms they're affecting the quality of your life now from a physical standpoint okay we've ruled out the serious stuff okay that's great news but now we need to start digging into the emotional stuff what's been going on in your life like we miss out that part so the initial part happens oh there's nothing seriously wrong with you but actually that's very condescending because actually what do you mean you know for many pages like what do you mean there's something physically wrong with me I can't go to work I have to open my bowels 20 times a day it's awkward for me at work it's socially embarrassing but the dots are saying there's nothing wrong with you do you know what I mean I think this is such a big point you said about if you're running across a field and you hurt your ankle whether your brain decides to give you a pain signal it's gonna depend on the context but I think that's really powerful like if the context says the line is chasing you your brain which is always trying to predict the future based on the past is going to be like hey we have no time for pain I need you to keep running now whereas if you can stop it might go Hey listen you know let's give him pain so that he stops like is that an oversimplification no no that's exactly is that what happens that's exactly what happens yeah compare that to endurance running right or endurance events because I think many people may be familiar with this experience of I don't know people always say like David Goggins this uh former I think U.S Navy Seal in America who's known for doing all kinds of ultra endurance events I think he has something to the effects of when you think you can't go on you're not even 40 of the way there in terms of you you've got so much capacity left that you don't even know now I don't know if that's based on science or just says viewpoints but I think that kind of fits in here yeah Tim Knox is a exercise physiologist from South Africa and he's written about this and he calls it the governor and there's yeah there's a governor and it's like up there and at some point you're hitting the wall at some point you're saying oh I can't go on I can't go on but it's a Feeling it's a protection again the brain is protecting you it's saying like hey why are you doing that you know it's way too much you know you can't handle it everyone talks to themselves all great athletes talk to themselves but everyone talks to themselves if you think you're not talking to yourself you're the one who's crazy because we're always giving ourselves messages and if we're saying to ourselves oh my back is always going to be bad that's a message that's making the brain make it worse and worse over time if you're saying to yourself I can't handle this Marathon or I can't handle this 5K or whatever that message is going to affect how you feel and how tired you are and how much you can run literally we'll do that because the brain has power over our muscles and over our Sensations and over our feelings that's just how the brain and the body work and so if we can really understand and great athletes understand it they know say oh yeah I know I know I'm really tired that's okay I can handle this and then they keep going it's just so fascinating to me another thing just came up that Howard from literally a few weeks ago so I consider myself for many years now to not have a back problem I will lift beds sofas I I I I'm not limited in anything I do anymore because of my back it was a long journey I've shared with you some of the things in the journey therapy ifs which we may talk about and other things this kind of holistic approach to my own healing has massively helped I'm sure listeners at the show will know that I I've spoken about my mum several times mum's quite elderly now she's she's very immobile she needs a lot of care and sometimes she'll slip off the bed or have a fall and maybe the carer or often it's me or my brother will go around and try and help mum and get her back on so the bed will get onto a chair now what's really interesting is even though my back has been healed for years usually before I'd lift mum up I would be thinking oh man I hope this doesn't strain my back oh man I've got something important this weekend I hope I don't pull my back you know there's there's this kind of almost self-fulfilling narrative before I do it and invariably the next day I'd feel a bit of tightness and then it would go and sometimes it would last a few days and I'd be thinking oh man it's because I lifted mum which kind of makes sense based upon the narratives that we pick up but a few weeks ago this is exactly what happened I was in my kitchen I got a call from my brother it was about 5 P.M and he says hey mate are you are you around like Mom slips off the bed um I need some help I said is mum okay is this an emergency because then mum's okay but we need to get her up a few deep breaths and I thought hey wrong you'd go around don't show any stress be totally calm this is not a bad thing I'm lucky that I live nearby I can go and help my elderly mother now like I reframed the narrative in my head this is my self-talk so I went in I said hey Mom how you doing oh you're sitting there in the side of your bed he slips off and she had a little smile she had a little giggle like in the past I've gone around feeling quite anxious and quite stressed I was I intentionally went in and I thought before I left it mum I just said hey I'm a strong human honestly that's why I said I'm a strong wild resilient human lifting my mum is no problem and I went in with a big smile on my face got mum up got her back into bed again this is an N equals one Howard right I'm aware of that but I'm sharing this because it really speaks to your experience this was just a few weeks ago I consider myself to no longer have back issues but again there's a memory oh if I do this in an awkward position it's going to cause backhate but when I went in with complete stress-free smiling on my face telling myself I can handle this no problem I felt nothing um so that I think I think that speaks to what you just said so you just described what we would call pain reprocessing therapy this is the so when we treat people I can back up just please when we evaluate people we're listening to their story we're validating them we're understanding them we're looking at what symptoms they have and making sure there's not a structural problem and we're listening to the symptoms they have in making sure that it is a neural circuit Problem by the fact that it'll turn on that'll turn off it'll shift it'll move it'll be triggered by innocuous things it'll be inconsistent a whole variety of criteria that we use and that we're using that back pain study that I described earlier and then we'll look for any emotional stuff that might be going on or has going on in their life that may have contributed to it so we do all that and then we decide oh this is a neural circuit problem this is amenable to reversing by two types of solutions and the one solution that we're calling pain reprocessing therapy and the other type of solution that we're calling emotional awareness and expression therapy so the first one dealing with the neural circuits in the brain directly and the second one dealing with emotions and in our Boulder back pain study uh we evaluated well they were a randomized controlled trial there were 45 people randomized to our arm of the study of the 45 I evaluated all of them of the 45-43 had nothing wrong with their back structurally structurally and structurally nothing wrong they had MRIs or abnormal of course but based on all the history as I described this was a neural circuit problem 43 out of the 45 the other two I'm not 100 sure about again being cautious and so I could and these people had an average duration of back pain of 10 years wow now of those people 44 were treated of those people 33 were pain-free in one month so 75 of the people we treated were pain-free after 10 years of back pain in one month simply using what we're calling pain reprocessing therapy and you just described it to a t really because what is pain reprocessing therapy it's changing the narrative it's thinking about yourself differently it's thinking about the back differently it's understanding why it's there and it's understanding that it is a neural circuit it's having hope that it's reversible because it is and then it's as you go to the lift or bend or move you're telling yourself I'm okay I'm safe I'm not in danger and you're smiling I mean you you know you did it and when you smile and when you give your brain reassurances you're turning off that danger alarm mechanism that is the actual cause of the pain and so for these for these folks we didn't go into emotional issues we didn't go into their past we didn't deal with their emotions at all we just changed the narrative change the narrative and how powerful that was to have 75 percent of people pain-free in one month I mean it's amazing there's never been a study with chronic back pain or any chronic pain that's shown that kind of result yeah that's incredible 75 better after a 10-year history in 30 days yeah it's incredible and and I hope that that gives people listening and watching this hope that actually no matter how long you've been suffering there may well be something you've not tried yet that could help now again do you face much skepticism from people about this you know what's the pushback where does that pushback come from I know this is real yeah because I've I've also I don't again I did that I didn't know it was uh pain reprocessing therapy I didn't know I was doing that by myself I was just based on everything I've learned everything I've seen with patients it's like no just you don't need to have the same experience you can change your experience of this same event um but yeah where does the pushback come from well you did that because you felt that you could yeah you were saying I don't have a back problems that's step one and then it's talking to yourself with this positive I mean it sounds silly to talk to yourself you know give yourself affirmations how stupid is that but those have been shown in random in in fmri studies of the brain to change the brain yeah our brain is neuroplastic and when you're giving yourself these positive messages and then you start we use a graded exposure technique where you start to maybe move a little or even imagine yourself moving with joy imagine yourself moving with a smile imagine yourself moving with these messages of safety and we do this right in the office and I've got videos of folks in my office where you know they're having pain with bending over and then I have them imagine bending over and then it hurts and saying oh you're imagining bending over and it hurts your brain is afraid of you bending over oh yeah that's what's happening and now tell yourself you're safe and you're not in danger and smile and bend over five degrees and then 10 degrees and pretty soon they're bending over because those neural circuits are changeable because it's not a structural problem that's amazing that we see this happening on a oftentimes really quick basis not always but oftentimes you know it's interesting that as you were describing that the name Elliot kipchogey came to mind for me are you familiar with Elliot kachogi he's um he's a Kenyan marathon runner oh he's the from what we know he's the fastest marathon runner of all time um with with help from his sponsors and and a lot of Pacers he actually broke two hours for running a marathon maybe a year ago or something like that um but why that came to mind even though I don't think Elliot talks about pain describes pain in fact I'd love your uh comments on this when he's running because I was watching that sub to our marathon race with my with my two kids we were watching it on my computer and at various times he just starts smiling yeah and I I think I've heard him say in interviews that when he's really hurting when there's pain he smiles he intentionally chooses to smile yeah now again he's not someone with to my knowledge a history of chronic pain but it's the same idea isn't it he's kind of almost trying to yeah battle or buffer the Pain by changing his experience effects yeah if you're into interested in running the the book by Chris McDougall called Born to Run is amazing amazing book uh and he talks about the research showing that the more the more structure the shoes you know the the shoe companies the more structure they give the more people have pain as opposed to the less structure and he talks about running with freedom and running with joy in that book and how these ultra marathon runners from Mexico do it you know really in the same way and so it's it's amazing how powerful our mental experience is in determining how we function day to day in our lives now was there a pushback on this it is massive I mean prepare yourself for letters and and you know people you know really and you know misunderstanding the idea of the pain being real of the of the symptoms of the suffering being real you know and I've been there and you've been there you know when my mom was dying I had all this horrible upper back and neck pain and it just lasted and lasted and lasted and when my dad was dying I had leg pain shooting down my leg and I still get pains now sometimes uh even for no reason that I'm walking around or you know I'm going to play golf which is you know supposed to be relaxing but it's actually kind of frustrating and humbling and but the point is is that this stuff that we're talking about is really misunderstood and it's so easy to take it as it's all in your head and that you're making it up and we're we're mean and cruel people uh and on the other hand the Other Extreme is that oh yeah you're incurable there's nothing we can do because the chronic fatigue or the fibromyalgia or the irritable bowel or the or the back pain is total you're going to have to live with it the rest of your life and what kind of message is that so so horrible and so we're talking about a new way of dealing with these disorders which are the major cause of disability worldwide by far a major cause of disability worldwide is chronic neck and back pain headaches anxiety depression irritable bowel fibromyalgia etc etc etc I think I heard you in a in an interview once say that the increasing prevalence of chronic pain has mirrored or certainly followed the increase in anxiety and depression in society 100 and there's a great study on that by Tim Brown from Berkeley and he took in the U.S he took Berkeley uh California he took um data Nationwide data on Stress and Anxiety in the country following uh 9 11 2001. and you can see it rising up over those next couple years and then he took data in the country on back pain and you start mirroring rising up in the same exactly the same and then as the stress went down after a couple years I think it was the back pain started to go down a little bit before back pain has doubled in the U.S in the last 20 years backs haven't changed our backs haven't changed uh but the the rates and we know anxiety and depression have sword are soaring as well and in this and in this pandemic era everything every and the polarization here and the political era everything is just getting worse because of the simple fact that our brain creates what we experience tell me about repetitive strain injury because as you said in you know butt Pain's going up that Pain's coming up and much of the time it's put down to posture and the fact that we're looking at computers and phones and exactly what's your view on that yeah there's a lot of research that's been done on posture and the bottom line is posture matters but not very much you know if you were you're hunching over a computer yeah if you sin that way for a couple hours your neck's going to be sore of course it's going to be sore everyone's neck is going to be sore over there but it's not going to cause chronic pain unless something else is going on in your life the fear of it the worry about it the newspaper articles about posture and sitting up straight and everything that's scaring you plus the stress that's going on in your life all that can feed into this a repetitive strain injury with typing you know yeah it's like okay we're typing I mean if you look at the actual effect of typing you're moving you know the fingers a little bit remember type well you're too young prices yeah you had to and and people mainly women were in these positions of typing eight hours a day and these things we really had to bang on the keys they didn't get repetitive strain injury there was an epidemic of of RSI in Australia in the 80s it started Rising people talking more about it it's very well documented and and people um writing about it and doctors diagnosing it and the rates just kept going up and up and up and then finally the government said what's going on we're not paying for that and all of a sudden it makes me feel is that a an unintended consequence of doing this I don't just mean with mental health I mean with everything yeah you want to raise awareness of things you want to raise awareness that emotional pain emotional things that we haven't processed can cause physical pain but that there is probably a sweet spot whereas if we start talking about stuff too much saying oh that loads of people have got RSI your posture and your computer is causing problems you hear that more that becomes your reality there's a potential problem there isn't there well there's been a long long history and there's a great book by Edward shorter called from paralysis to fatigue where he examines the history of psychogenic type illnesses over the last couple two or three hundred years and he talks about how indifferent societies different symptoms tend to arise as a cultural phenomenon right now anxiety and depression are cultural phenomenon young people look at the rates of anxiety and depression in teenagers now the rates of back pain there was a study recently where one third of teenagers reported having back pain and when I you know I studied Pediatrics and Internal Medicine when I studied Pediatrics no teenagers had back pain it was unheard of a kid had back pain you were it was an emergency situation because there was some major problem and so I have a friend who's from Iraq is a physician and uh he was he's here we were talking a great guy I was saying you know what's what was surprising about you when you came to the U.S about medicine here and he said back pain and I said why is that he said well people didn't have back pain in Iraq or Jordan where I practiced it was very uncommon people had stress but their stress was manifest in different ways because culturally there were different outlets for it sorry since we're UPS if you are enjoying this content there's loads more just like it on my channel so please do take a moment to press subscribe hit the notification Bell and now back to the conversation um and so when we when we think about these things on a societal level and we think about how people are treated how we treat each other the major the thing that in in longitudinal studies of people in workplaces uh and like factories the people who are more likely to develop musculoskeletal pain who are workers in a factory are those who are being treated poorly by their management and that's been shown not how much work and physical activity they're doing how they feel about their work and how they're being treated did you know what Sheriff's study once I think about how well back surgery is going to go for you something like that I think there's a study on how well back surgery will go for you based on childhood Adverse Events wow so people who had zero you know according to the a scale right the adverse childhood events scales that Fellini put together in the 90s uh people had zero had 85 percent chance of having a successful surgery for their backs people with one to two had seven one to two of these adverse childhood events like abuse neglect alcoholism the family Etc one to two at 75 chance of having successful back surgery if they had three or more they had 15 chance of having successful wow and this there was no difference in the surgeries or their backs uh this had to do with adverse childhood events being powerful forces that were still affecting them all those years later what you said about culture and how we have different cultural expressions of our stress and our emotions it really Rings true that and I think it's something that medicine you know and I'm I'm obviously biased by my experience here in the UK because that's where I practice that's where I've trained I'm not sure we take that seriously enough because we get taught how to take a history we ask a certain set of questions that's great if the patient has the same understanding of what those questions are designed to elicit great then but for example in some cultures they just don't have a word for indigestion which doesn't exist if you don't have a word for indigestion you may have uh be suffering from something but it may manifest in a different way in a different physical sense of a bit like your colleague from Iraq was saying about back pain yeah yeah there's been some studies about um I think the word is granularity in language and how people use language in a granular way meaning more granular meaning having oh well is it a an ache or a sharp or a herd or is it a is it an emotional level it is a more Rage or contempt or or or annoyance or you know the language that we use for things can be very specific and granular but it can be very Broad and it's like it just hurts you know it just feels bad yeah you know it just feels bad but that's that's that's communicating there's something bad there's something bad and that's if we have an open mind to looking at on one side the medical and the structural but also on the other side the the psychological and what people are or what people have to cope with and deal with in their life it makes sense yeah you feel bad well let's you know we'll do some tests make sure there's nothing actually structurally wrong but what is this bad what is it what does that mean bad and what's going on in your life that might make you feel bad that maybe we can't change or maybe some things can change a lot of things you can't change in life but how can we help you be more at peace yeah and then like you know just when I say those words I think about you know you're you're dead you know going into the is there's a peacefulness and maybe he was at peace as well if there's if we can somehow find peacefulness you know in our lives and if we can somehow find peacefulness in our societies that are so so uh turn apart that's what's causing suffering yeah and but it's manifest in this physical ways and go to doctors like doctors are the ones to to solve these problems doctors are not well equipped I was I was in Australia last week and giving a lecture and uh there was a GI physician there it's been his whole career seeing people with irritable bowel syndromes and doing diets and medications and things like that and he heard my lecture and he said to me Howard you know your lecture was depressing to me and I go why is that he says well I realize that I'm very ill-equipped yeah to care for these patients I don't know how to do that um because I've been trained in in this whole other way yeah but about what he said though I have a lot of respect for because at least he had the courage to say that dude and accept that and acknowledge that you know it's interesting how this morning and this was in preparation for talking to you I found that one of my best mates Steve who is a brilliant spinal surgeon on the south coast of England and I said hey mate listen I'm talking to Howard tube and a letter we're going to talk about chronic pain you see a lot of pain in your view what is the most important therapy you give your patients with chronic pain because you know he's a super specialist you know people who've got chronic pain who can't get better get referred up to him and she already said to me he said the most important thing that I do for my patients when they're coming to see me is I listen to them and I show them empathy and it was really profound for me to hear that I mean he's a great guy he's a brilliant surgeon he goes look surgery is great for acute cases where we can see something's going on but for a lot of the time we just don't need to do it for these people with pain what they need is to feel heard and validated because Often by the time they come to me no one has ever heard or validated their pain their symptoms that it was real and he goes the truth is with chronic pain for me as a surgeon it's a lot more touchy feeling that's exactly what he said to me yeah and he goes all kinds of things kind of work but what I can offer is honesty but the surgery probably will not help them and then listen and empathy and I thought that was really powerful yeah I mean don't do something just to do something because you can make it worse you know there's just there's a saying in surgery when you operate on pain you get pain and but to be but to be honest and to be open and to be empathic and now what we're saying is that this touchy-feely stuff it's not Hocus Pocus it's not what we would say woo-woo yeah it's neuroscience and we're talking about the Neuroscience of the brain yeah and why these things happen we have data showing that people can get better and we have data and we have techniques and we can train doctors and we can train therapists if if you're a psychotherapist a psychologist or a social worker doing therapy fifty percent of the people coming to you for anxiety or depression also have a chronic pain condition and the question is who should be caring for these people with chronic pain it should actually be the therapist the behavioral health people because they can take the time and they can develop the skills your surgeon friend doesn't have the time he has the skills to be honest and and have integrity and not operate on what he shouldn't and to be caring and empathic and listen he can do all that but he can also learn how to talk this language of the brain causing pain how to how to assess and say oh your pain is Shifting and moving that means it's not due to this disc here yeah this this would cause pain going down your leg you don't have pain going down your leg right he can tell people that which that's what we do right in the assessment and then maybe he can point them to there's a bunch of apps there's a bunch of online programs in there and we're training Physicians and we're training nurses and psychotherapists and massage therapists and acupuncturists and we're training folks how to do this pain reprocessing work and how to do emotional processing work as well I mean it's incredible what you're doing and you know as I've already said you you're doing research which is giving this a real scientific robustness which ultimately is what's needed if we're going to change the profession I want to get into some of these therapies and in terms of what people can actually do before we do that there's two cases I've heard you talk about before which I think are beautiful illustrations of how powerful the brain is in generating pain one was I think a chap who had been in the Vietnamese War and 20 years later something happened on a street yeah the other was a UK construction worker yeah um I don't know if you remember those cases would you mind sharing them so I think they beautifully illustrate this yeah of course I always tell the three pain stories okay the first paint story is a friend of mine who was at a construction site alone shot and nail nail gun shot a nail in his hand had no pain why did he not have pain he has a nail in his hand well I don't know why his brain decided not to turn on paint at that moment probably because he was all alone his brain had to decide look be in pain and suffer or drive to the hospital his brain said drive to the hospital I mean you know I can't speculate why that is but he had no pain he had no pain at all yeah exactly so not all injuries cause pain okay number two it's a guy in Britain a construction worker jumps off a scaffolding onto a nail sticking up in the ground the nail goes completely through his boot he can see the nail sticking out on the other side of his boot he starts screaming in pain he has severe pain they Rush him to the hospital they give him IV pain medication when he gets there and they take his boot off and the nail is right between his toes there's no injury at all wow is this pain real yes because all pain is real all pain is created by his brain and his brain predicted and the science of the brain is called predictive processing his brain predicted that he should have pain based on the nail just made an error but it created this pain and the pain is real the never underestimate the power of the brain to create severe symptoms severe pain severe fatigue severe seizure type activity that we see all the time that's actually due to the brain called paroxysmal non-epileptic attacks we know that because people are having these looks like seizures and the neurologists are there to they know how to treat seizure disorders but they put them in the EEG machine while they're having the thing they monitor them and then the EEG is totally normal while they're having this seizure activity it's not a seizure they don't need medication they need to understand that they're not actually damaged they need to do this these kinds of therapies we'll talk about so um that's the second case that's the second case yeah thanks for getting me back on track and the third case is the guy again somebody I met who happens to be a physician now but he was in the Vietnam War as a young man and he got injured with shrapnel wound a lot of guys died it was a lot of Gore and he got helicoptered out and meta back down so he had pain from the shrapnel wound what happened to his injury they healed why because all injuries heal those injury healed now did his brain turn off that danger signal and make his pain go away yes it was he was fine he was pain-free but for what 15 20 years yeah 20 years later he's walking down the street he gets startled by the sound of a helicopter in the sky and all of a sudden he gets the same pain in his leg that he had hit 20 years earlier that neural circuit for pain had been learned had been remembered and then had been activated through a triggering response and that's part of our assessment that we do to help people see that gee why is why is your pain occurring when you sit in that chair but not that chair why is your pain occurring when the wind blows why is your pain occurring when the weather changes why is your pain occurring in cold or why does it go away when you take a shower why does it all these changes that we're looking for to demonstrate these neural circuits so this understanding of how the brain works and predictive processing is critical and we're not taught that in medical school with a very very powerful cases to to just illustrate what you're talking about about the brain generating the pain it's all the brain so we need to retrain the brain exactly to eliminate it and help people heal yeah now I know so many people will be suffering or they'll have loved ones who are suffering with some of their chronic pain symptoms and conditions you've mentioned I would strongly recommend your book unlearn your pain that's for patients and that's the people who are struggling I think it's really easy to read it's it's got the research it's got some really great practical exercises and I think you also train Healthcare professionals how where can people find out about that yeah absolutely um we do have a book called hidden from view which is for professionals we also have two other books we've written uh that are compendium uh one is a textbook of psychophysiologic disorders uh that's available through the psychophysiologic disorders Association here in Britain is Serpa sirpa.org yeah do great work here um and then we've got trainings that we're doing virtual live and recorded trainings we just launched a mobile app to train people it's called ovidx.com that's the name Ovid you know was a Roman poet who wrote when the mind is zilities the body suffers it was one of his quotes says it all a big theme throughout this conversation is that emotions unprocessed emotions that get stored inside of us that we don't do anything with can in some individuals generate pain right what happens is we respond normally with fear of them their success fear of them worry about them worrying what's going on focus on them paying attention monitoring all the time fighting them trying to push back which gives them so much power frustrated by them because we're angry and upset uh trying to figure them out going to all sorts of practitioners and and therapies and then finally trying to fix it but the harder we do all those things that gives the brain the message there's a problem and it makes it worse so this vicious feedback cycle of pain and other symptoms leading to these responses the six F's fear being one of the most important leading to more pain so when we interrupt that cycle which you did when you lifted your mom that time when you told yourself you were okay and you smiled you interrupted that cycle you just interrupted the pain cycle by giving the danger signal in the brain these calming and safe messages and that's what pain reprocessing is at its core and we've got a whole bunch of techniques of how to do that so that people can you know step it you know do this do this do this uh change your relationship to the symptom and uh see what happens and then when you start seeing you start investigating looking oh hey it hurt then but it didn't hurt then oh my God it is my brain oh my goodness I'm going to be okay and then there's that relief I imagine even that knowledge alone even if you do nothing else even when the penny drops inside you that wait a minute this is nothing serious physically this is not anything structural I'm okay like even that you must also help in and off itself I would imagine well I started this work in 2002 and I read a book by John Sarno Dr cerno right and Dr cerno has passed away I just got an email from his daughter yesterday and she's a therapist and she's doing this work carrying on and anyway his beautiful email and he taught me and I've been doing this for almost 20 years now well I guess 20 years and his books are still best sellers Dr sarno's books which state this and he was brilliant in how we thought about it he keeps getting bashed like everyone loves to bash Dr Sarno so I'm here to find his coin he wasn't right about every little detail but Einstein wasn't right about every little detail come on anyway so but people will read his book and then the pain will go away just from the knowledge and it's called the book here and it's happened you know many and there's a documentary on Dr cerno there's a couple documentaries to mention one is on Dr Sarno called All the Rage produced by Michael golinski it's a it's great it's just a great picture of him and uh and then there's a documentary Kent Bassett and Marianne Cunningham made of my work called this might hurt so there's a couple documentaries out there and there's a new one coming out soon hopefully called brain pain which was a documentary done about the boulder back pain study that I was telling you about right so there's some films that people can watch to really kind of get a firsthand glimpse of of some of this work but but yes the question the answer is yes just knowing that you're okay can and and maybe 10 15 of people just turn off that dangerous signal where do things like journaling and meditation fits in here yeah so once you've done the uh understanding part of it and then you start doing this pain reprocessing part of it of lowering the fear reaction beginning to start moving again and challenging any of these triggers by smiling at them it sounds silly but you know the pain is not the enemy is their message so if you have a child lying in bed fearful of a monster in the closet you're not going to be mad at the kid hopefully you're going to open the closet door say look there's no monster you're okay lie down with them tell them you love them that you're okay read a story get them to laugh they'll go to bed right that's how we're treating the brain because the brain is just fearful it's worried about you in the sense of causing these symptoms when a kid falls off a bike they look to you to see if they should cry or not and if you freak out they cry but if you smile and say oops that was fun then maybe they don't so this is this pain reprocessing part now meditation can fit into that because we use mindfulness meditation type practices in this work and mindfulness minute I've been teaching mindfulness since 1999. and everyone should learn mindfulness there's no one who's studied mindfulness who doesn't agree with that children everyone should learn it but the fascinating thing rangan is that mine in research studies mindfulness has not been particularly helpful in reducing chronic pain why is that cognitive behavioral therapy is not particularly helpful acceptance and commitment therapy not particularly helpful in actually reducing chronic pain in randomized controlled trials why is that because none of them are doing the first step of the assessment of categorizing the pain into a neural circuit problem as opposed to a structural problem so when you do mindfulness you're you're noticing your Sensations in your body but it hurts it's painful it's uncomfortable and you're interpreting those Sensations as being dangerous because there must be something wrong with you you're not getting better you have to reframe first yes you have to re-categorize the symptom into basically and this again I'm doing this with saying this word with love and compassion and the reality is that the symptom this pain or whatever it is is basically a thought it's basically created by the brain and now if you can observe that now you can step back from it and observe it and just watch it and not try to fight it and be frustrated by it but set that aside and then be with it and see what happens and then maybe it shifts maybe it gets a little worse oh my brain just made it go up well that's interesting what's going to happen next oh it just went down oh that's interesting oh it moved over here and all of a sudden you see and then it really as you said it drops all of a sudden you you get it and then so so meditation has a really important role in this but not just meditate yeah understand and use the tool in a way which is going to help reverse the pain as opposed to cope with it there's studies on yoga I think as well aren't there that yoga uh deep breathing practices whether whether it's part of yoga or not can help change our perception of pain I think there's quite a lot of studies on that sure of course because what you're doing is you're making yourself feel safer you're calming the dangerous signal you know the autonomic nervous system responses and all that sort of stuff yeah you're calming it and you're giving yourself a sense of control that you can do something yoga of course is is beautiful because your move you're pairing that with movement you're pairing the the calming and the reassurance and the joy with moving your body so neurons that fire together wire together so when you when you're moving with fear you're reinforcing these neural circuits of pain fear pain but when you start moving gently with calm or with joy or with control or with peacefulness now you're training your brain that these movements are not dangerous and those neural circuits start to get ingrained I've written on this quote that you have written in an article um over the past decade I've learned that migraine along with other related conditions such as chronic tension headaches pelvic and abdominal pain syndromes chronic neck and back pain are often caused by a combination of Life events and emotions that are neither expressed nor processed all of these conditions are associated with early onsets of I think symptoms which sensitizes the danger signal for the onset of stress like adverse childhood events yeah yeah which sensitizes the brain that's the key isn't it sensitive is the brain yeah and as you say the the yoga or the the Deep slow breathing is switching off the stress signal saying hey I'm safe it's okay um but then we can get into the emotional side of it because you mentioned journaling so journaling is part of the techniques that we would use on the second part of the treatment not the pain reprocessing part but the emotional awareness and expression therapy which we've developed and worked on it has components of intensive short-term Dynamic Psychotherapy that my friend and colleague Alan Abbas has the foremost researcher and teacher in the world on that plus some internal family systems work as well so if you put kind of those things together you start to deal with the emotions of it and that's a whole nother area that can really lead to healing healing on the inside yeah not just recovery from the symptoms but using using the symptoms as a way to decide what's important in your life so that's a whole other area that we can discuss as well how much does our personality type influence whether we're going to suffer with chronic pain and I guess why I'm thinking of that is if early life trauma if Aces uh are hugely influential in what's going to happen later on in life including with chronic pain I've had three conversations with Dr skebomase on this show about um how our childhoods can affect our adults experiences how we are when we get triggered by our partners all kinds of different things but often we develop certain traits certain personality traits so not really who we are they're who we became to get through childhood you know so poor self-esteem so you know being a people pleaser wants to do things for other people right those personality traits as I believe escabel believes are not necessarily who people are or how who they have to remain if they go and do the emotional words about to go oh actually that was a defensive mechanism that I took on to help me through childhood I want to let go of it now that I'm in adulthood it's no longer serving me do we see patterns have you seen patterns in your clinical practices of certain types of people who tend to be the ones who suffer with a lot of these chronic pain syndromes yeah there's no question about them there's really kind of three ways to think about it one way is we're we're are actually born not blank slaves there's been really nice studies of children and and temperament so to speak some kids are more sensitive than others some kids are Shyer than others you can breed sensitivity and shyness and fearfulness into mice by doing genetic breeding studies so there's some stuff that we actually are born with but the longitudinal data on that on that shows that those change over time some kids are very sensitive my daughter was super super sensitive as kids now she's lecturing around you know around the world so you know there's there's that but what you're addressing is more important which is the acquired personality traits and those are highly uh connected to uh later life uh pain and other of these type of neural circuit type problems for sure and the reason is is like you say they're adaptive you know if you if your dad comes home every day and sometimes he's really nice and kind and sometimes he's really angry and and critical you learn to be on edge you know you learn to be a people pleaser if you're if your sibling is sick and they're getting all the attention in the family because they're sick they've got leukemia or they've got bad asthma or whatever they've got a mental illness well you learn to get into the background and be a people pleaser and be a perfectionist and be always being good and putting yourself last because everybody else matters first and these are adaptive techniques that get you by but when you get on into adulthood sometimes your brain is going to say like what about me you know what about you how come you're putting yourself last all the time and that's putting more pressure on ourselves more pressure on this danger signal and so that is a a an important component of this situation is condition that oftentimes people as you say can address and it can begin to change in them so it's not that you shouldn't be good or shouldn't be kind it's just that you also have to stand up for yourself sometimes sometimes you have to learn to say no it took me until I was 50 until I could say no it took a long time I think it might mean till I was about 42. I'm sorry my generation below us will uh we'll start to do it earlier I like to say it's a magic word it has two letters an n and an o but uh but not every I mean it's The Human Condition to have some of these things of course so it's just part of the mix and each person is unique and individual in terms of how that mix plays out in their life I would I I always think what yeah what you're doing with your clinical work with your research is a great service to humanity there are so many people struggling with this this is a topic we've never really covered on the show at all so I'm I'm so delighted that we finally got to cover chronic pain in all its many different forms in all its different guises um I feel that what you have done certainly to me is is help people feel less alone but actually no no your pain is real yes maybe your doctors haven't found anything structural maybe you think you're going crazy with pain but you're not it's just that no one's helped you yet get to the root cause if you want to solve anything you need to get to the right cause exactly I'm hoping there have been some penny-dropping moments for people in this conversation there are a lot of people Howard who well where do painkillers fit in here in your view well when when people are suffering you know we want to alleviate suffering I mean that's part of being a physician part of being a caregiver so Dr cerno kind of had an idea he wanted people to throw away their pills throw away their crutches you know throw away their the things that are helping them cope which is fine when you have that amount of confidence and you know it's not too bad but you know some people need pain medications certainly if they have ongoing you know if you have metastatic cancer kind of situation uh you know doctors have gotten worried about giving pain strong pain medications of people who are dying of cancer I mean that's silly you know why should we not alleviate suffering in that way and if someone's suffering with severe pain due to a neural circuit type problem they may need pain medications while they do this work certainly and so I don't want to I don't want people to feel like they can you know never take a pain medication um but if you if you can alleviate pain with pain medications temporarily while you start investigating your life while you start the pain reprocessing work yeah well you start dealing with some of the emotional situations in your life then over time you can reduce the pain medication yeah one of the problems we've had in our medical profession recently is people are put on forced uh reductions of of opiates and saying okay you're going to taper and what happens is now instead now you get what's called as I'm sure you're aware the nocebo effect kicking in so people are fearful that their medications are being taken away from them forcefully and now the pain is going to be worse because the brain is put into a bigger state of fear and lowering the medication is much harder so what we try to do is we try to First just stay on your medication let's see if we can get you out of pain first if we can get you out of pain using these methods then tapering that medication is going to be easy I guess this speaks to personalization doesn't it if if a patient rocks up at your door and they've been on painkillers for 10 years they think that they're helping you've got to take a different approach from let's say someone who's coming into you for the first time where with this new information hopefully yeah you can actually set them on a different path and I think it this is why I think healthcare professionals need to understand this stuff because we can be hugely influential in what that patient believes when they walk out of that door I've always said like you know migraines are really common you know my preference is always to try and help patients get to the root cause so they don't need any medications but sometimes a patient you've got to meet them where they're at first of all and sometimes it is so bad that maybe in the short term you give them something but you also need to make it clear in my view that Hey listen this medication is not going to help us get rid of this it's simply going to help you manage this so you can tolerate your work at the moment but I can also help you if you want try and find out what's causing this I don't think that second part of the conversation is often had I know the time of consultation certainly in the UK doesn't make it any easier but it's not just that right really it's not just time I think times the easy thing to say it does play a huge role but I think our understanding is simply not there as well for this um I I don't know about you Howard I've I've often found with some of these pages in chronic pain though that they're taking huge amounts of medication and they're still in pain right right for sure what we're doing is the Band-Aid technique the coping Technique we keep adding on to that more and more and more and we need a different path there's no question about that but we can't force this path on people yeah because you said the words if you want if you want if you want because what we're doing is we're offering and we're as you say we're meeting people where they're at and we're meeting with empathy and kindness and caring and understanding and a lot of people not a lot I mean most of people come to me understand this that's why they're coming to me as a physician but you know sometimes they they don't or you know it doesn't really make sense to them and I'm like fine you know this may not be the right path for you there are lots of other paths to Healing there's lots of other other ways of of healing that could be you know all sorts of stuff in the alternative fields or whatever I try to be careful of that and I try to help people not spending too much money or you know getting on other diagnoses that don't make sense but there's lots of other paths to healing and maybe there's other medical paths that you haven't tried yet let's let's sort it out you know isn't that what you say here let's sort it you know and let's just take it step by step and let's see what happens and let's investigate once you have this kinds of information now you can look at what's happening over time and you can look for those experiences that you can have which show that oh the pain this happened in my life and the pain went up or this happened in my life and the pain went down yeah or it's inconsistent why is it happening sometimes and not other times and now that you have a framework for understanding that you can say hmm maybe it is my brain after all wow wouldn't that be something yeah how this podcast is called feel better live more when we feel better in ourselves we get more out of our lives I clearly pain is something that makes people feel worse it affects every single aspect of their lives for people who are listening who are watching who are struggling in their lives they're struggling with pain or someone close to them as suffering with chronic pain do you have any final words for them well I think the the starting point has to be compassion and caring and understanding and if we take away if we can strip away some of the fear and some of the pejorative words and it's all in your head if we can strip away the the way that sometimes people are treated uh in being treated you know in that pejorative way but if we can also strip away some of the diagnoses and some of the some of the words that people have been given like incurable and bulging discs and you know the names you know the the you know oh it's chronic fatigue it's and there's so many names I don't know we have time to get in there there's so many names have been given to people oh you've got chronic lyme disease you've got ehlers-danlos syndrome you've got your posture is all bad all these things if we can just start over strip away the unkindness and strip away the incurable and start in a middle place with investigating carefully and taking time to look at people's lives and look at their symptoms and see what you can find yeah because when you do that usually you'll see maybe there's something here that we can work in yeah just just on that points you mentioned chronic fatigue uh chronic lyme disease these kind of things and um I don't want anyone to go away from this conversation uh feeling there at the end that hey um oh so I don't have that or you know I I do have that and having children just said forget about that I think I think it's really important that we um we help people understand that what exactly did you mean by that did you say those things are not helpful or are you saying that look if you've had that for a while temporarily why don't you just park that start again from scratch evaluate it as if nothing had happened before what what exactly did you mean yeah let's evaluate it like I say you know as Physicians everyone needs an individual assessment yeah and do you really have is it really chronic line let's look at the tests and let's look at the symptoms you know with with long covet you know if you look at the symptoms very carefully uh I saw a woman with and there's a lot of research on that now research showing that um uh people with pre-existing anxiety depression loneliness fear are more likely to get lung oven and those that don't have that prior to getting coven there's research showing that people who didn't have covid who had as high or higher rates of long covet as people actually did have covet and a big large French study and if you just take take each person as a unique individual and just yeah look at them talk to them do the testing you know if there's no explanation for it medically and the symptoms are brain fog and fatigue and aches and pains and and diarrhea and headaches and anxiety and depression it's all there what's the harm in looking at it closely and looking at it from this lens of neural circuitry what's the Herman just looking at it you know I had a patient who had lung covert young women had it for about a year and a half really bad and she saw me just one visit and two weeks later she was 80 better it was amazing but what was really interesting is she had loss of taste and smell which is part of coven right you get coven you get lots of taste and smell that's got to be a structural problem right I mean how could it not be well she had loss of taste and smell for 18 months and then I saw her one day and then the next day She chased and smell returned and then the day after that it was gone again and then it returned again and then it was gone again her brain had the capacity to turn on and turn off this thing which seems completely neurological and it's certainly real but the power of the brain is immense and if we're just open to that that's all I'm saying is I'm not I'm not judging people or pre or assuming that what they have because of their label is is or isn't real but it's taking the time to investigate it in a careful and compassionate way that's what I'm trying to say what did you do with that lady oh well just what we just what we do every day we went over her her whole life and the story linked think stressful life events to her situation looked at the symptoms that she was having the brain fog the fatigue the all the testing that she had making sure that there was nothing structural wrong and then we started having her change her relationship to her symptoms knowing that she could get better yeah starting to smile starting to move starting to reassure herself little by little and that is what and then she saw the symptoms shift get better get worse yeah oh my God it is my brain and then they started getting better yeah so powerful um whenever I am faced with a patient who's accumulated lots of different diagnoses and labels I will often take that approach okay let's just put them to the side for a minute let's just go back to basics I I did this very publicly on BBC One in 2016 with a lady who I've actually spoken to on this podcast in the past who had fibromyalgia she had me she had I think 10 different diagnoses including anxiety IBS depression she had everything all the buckets that we can give you in modern medicine yeah she had been given all of them she was on 20 pills a day I've got many other cases like this but this is one that the public saw millions of people saw this case and I remember saying to her but the camera's falling look let's just put them to the side you know you picked I think we used an analogy for truck you know you're this you just picked up all these kind of carriages and you're walking around your life with them you're on 20 pills a day you're still in pain you can't work you can't be a mother you can't be a wife the way you want to let's just start from scratch let's just focus on you as an individual let's start creating Health in you and so this this is often how I approach things instead of it's not it's not so it's not saying that those are all wrong it's just saying instead of focusing what on what's wrong with you let's just see how I can help create Health in you with you know Emotional Self sleep stress movement whatever it might be yeah and as we did six weeks later she was pain-free pain-free and then two years later so this is after the show would finish two years later she's on zero pills a day yeah amazing and I say that you will have seen this many times at your clinic but I I say this to lead people with a message of Hope at the end it's not that we're saying that's not real it's just saying maybe we need a kind of different approach yeah yeah the power of the brain is immense the power of our connection to each other our social connection the power of what goes on in our lives is immense and has tremendous impact on how we live day to day and there's just so much suffering in the world so much suffering that I think we can do better and I think we're just trying to point the way little by little step by step to doing a little bit better and you're you're doing this work and you're helping in this in in your work and in this kind of work and everybody who sees this work every patient that I see they ask this question how come my doctor didn't tell me about this how come people didn't know about this how come I never heard about this in the last five years or ten years or 20 years of suffering how come nobody told me that there was a different path and it's not for everybody and I don't expect that everybody who's listening is gonna like Oh yay you know we found the way but some people will yeah some people will I guarantee then well how you're a huge part of this change in thinking about pain that's going on all across the world I hope like you that it speeds up and gets out to more and more people more and more Healthcare professionals thank you so much for all the work you're doing and that's coming on the show thank you it was a pleasure and an honor appreciated if that conversation about chronic pain resonated with you I think you are really going to enjoy this powerful conversation all about the common reasons that many of us feel lost and unhappy addiction is the most human thing there is all addictions do attempt to gain pain relief emotional pain relief or something or another then this whole society is so expert at selling us stuff to fill those holes temporarily this is the whole ethic of this culture

Channel: Dr Rangan Chatterjee

Views: 693,124

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview

Id: kYK7utae7Cg

Length: 116min 28sec (6988 seconds)

Published: Wed Nov 09 2022