Dhru Purohit Show - The True Root Cause of Chronic Pain and How To Manage it Using the Latest Science with Dr. Howard Schubiner

Episode Date: February 12, 2024

This episode is brought to you by Vivobarefoot and AquaTru.  Chronic pain impacts millions of people, and yet traditional methods focus solely on pain management, failing to address the root cause of the pain. Today’s guest is here to share a groundbreaking approach to treating pain, revealing that the brain creates pain as a signal of an underlying emotional issue that needs to be addressed, and treatment can be achieved by rewiring our brains.  Today, on The Dhru Purohit Show, Dhru sits down with Dr. Howard Schubiner to discuss why chronic pain is more prevalent and how it is connected to our brains. Dr. Schubiner explains why the current approach to pain management is flawed and why Emotional Awareness and Expression Therapy has been clinically proven to be more effective in treating chronic pain compared to traditional forms of treatment. He also explores how adverse childhood experiences can trigger chronic pain later in life and how we can rewire our brains, ultimately changing our response to pain. Dr. Howard Schubiner is an internist, pediatrician, and the Mind-Body Medicine Center director at Ascension Providence Hospital in Southfield, Michigan. He is a clinical professor at the Michigan State University College of Human Medicine and has authored more than 100 publications in scientific journals and books, including three books, Unlearn Your Pain.  In this episode, Dhru and Dr. Schubiner dive into (audio version / Apple Subscriber version): Why back pain has doubled in the last twenty years (2:24 / 2:24) What is pain in the body (5:36 / 5:36)  The current approach to pain and pain management is broken (11:13 / 8:55)  The Symptom Perception Model and its effectiveness (18:30 / 16:09) Incentives that lead to failure in the system (20:03 / 17:45) Why MRIs don’t provide a complete picture of the pain (25:00 / 23:07) Adverse childhood experiences and the relationship to pain (31:50 / 28:00) Awareness of how the brain generates pain (37:15 / 33:09) Tools for assessing and combating pain (44:51 / 40:54)  Pain reprocessing therapy: Changing your response to the pain (51:38 / 47:46)  What is Emotional Awareness and Expression Therapy (59:50 / 56:00)  Next steps on addressing chronic pain (1:21:00 / 1:17:13)   Also mentioned in this episode: Unlearn Your Pain website Reign of Pain  PPD/TMS Peer Network Curable App Cure of Chronic Pain Let your feet do their natural thing, and upgrade your shoes. Just go to vivobarefoot.com/dhru and use the code DHRU15 to get 15% off any order.  AquaTru is a countertop reverse osmosis purifier with a four-stage filtration system that removes 15x more contaminants than the bestselling water filters out there. Go to dhrupurohit.com/filter/ and get $100 off when you try AquaTru for yourself.  Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

All pain is generated in the brain and all pain is real, not imaginary, not fake. There's no such thing as, well, this pain is real because I have an injury and this pain isn't real because I don't have an injury because research shows that stress and emotions activate the exact same parts of the brain as does a physical injury. And this is mind going. If you're someone who's struggling with chronic pain and suffering through life, today's episode is absolutely for you. Hi everyone, Drew Prode here. Today's guest is Dr. Howard Schubner, and he's here to talk about the important topic of chronic pain and most importantly teach us

and walk us through the path of unlearning our pain by getting to the root cause of understanding where it comes from. Now, a little bit more about Dr. Howard Schuminer. Dr. Howard Schubner is an internist, pediatrician, and a director of the Mind Body Medicine Center at Assensin-Providence Hospital in Southern Field, Michigan. He's a clinical professor at the Michigan State University College of Human Medicine and has authored more than a hundred publications in scientific journals and books. Dr. Howard Schubner is the author of three books, Unlearn Your Pain, Unlearn Your Anxiety and Depression, and Hidden from View, a practical handbook for clinicians written with Dr. Alan Abbas. He's collaborated extensively with Dr. Mark

Roomley, a professor of psychology at Wayne State University in a series of studies to develop psychological treatments for chronic pain, which will be talking about on today's episode. Together, they developed emotional awareness and expression therapy, which has now been tested in various formats for people with different chronic pain conditions. And this methodology has not only been found

to be effective compared to standard treatment, as usual, but superior to cognitive behavioral therapy in two clinical trials. Stay tuned for a fantastic episode on all things chronic pain and the root cause of it from Dr. Howler-Shoo. Dr. Howard Schubner, welcome to the podcast. Today we're talking all about chronic pain, why it's so common and how to unlearn our pain

by reprogramming the brain. You know, something mind-blowing that I learned from you on the topic of chronic pain and is a great place for us to start just about how pervasive this issue is in the world, and especially here in America, is one mind-blowing statistic that you shared is that back pain. has doubled in the last 20 years in the United States. Share with me, and there's a whole story about why that might be the case and how pain evolves, but give us a little bit more of a state of the union of pain today and why it seems to be increasing every decade or so.

Yeah, thank you so much for having me. Why would pain be increasing, especially back pain? But it's also other pains, headache pain, joint pain, stomach pains, it's not because our bodies have changed. We haven't evolved or changed our backs significantly in the last 20 years over how our backs have been in the last thousand years. And when people see these statistics, they're always quick to find something in our environment that is causing this huge increase in pain like kids. Like when I started, both pediatrics and internal medicine.

And, you know, when we had a kid, teenager, or a child who had back pain 30 years ago, 40 years ago almost when I was studying pediatrics now, it was an emergency. There was back pain in a kid. Kids never got back pain. And then in recent years, I saw a study that showed that one third of teenagers had reported back pain.

And so everyone's quick to say, well, it must be their backpacks. their backpacks. They're carrying too many books. Or it must be that they're exercising too much, or they're exercising too little, or they're sitting too much, or it's their computers, or it's their cell phones. And none of that is true. There's nothing to do with that. It turns out that pain follows cultural standards. If you look at the history of medicine, you see that there are certain illnesses that tend to become more prevalent in populations over time, and then they tend to wane, and then they tend to come back. And I'm not talking about cancer or heart disease or diabetes,

because those are the things that we know have changed over time in relation to a variety of things, such as diet and environmental pesticides and whatever. I'm talking about, so obviously I'm talking about pain, but what else is doing? What else is dramatically soared in young people in the last 20 years, anxiety and depression? What else has risen is fatigue? And so if we can look broadly at our society, and if we can look broadly at how our brain works and our body works, I think we'll find the answers to these questions. But I can promise you it won't lie in some change in how we move our body or how our backs.

Not that I can tell you for sure. Tell us a little bit more about the basics. It sounds so fundamental, yet so many of us don't understand the connection between pain and the brain. What is pain in the body? You know, one of the things I'd love to think about is how we know what we know. And everyone knows the earth is not flat. Everyone knows the earth is round. And we say, well, how do we know?

Well, you go up in spaceships. We can see the earth is round. It's pretty simple. But people knew the earth was round before. We had spaceships because if there was a boat, I know I'm making a little digression here, but we have a little time. Is that okay? That's the beauty of podcasts.

Please digress. So I love this story. So when a boat was approaching the land from the ocean, you would see the top of the mast before you saw the rest of the boat. Why is that? Because the Earth is curved. If the Earth were flat, you would see the boat. You would see the whole boat at the same time.

you wouldn't see the top first, and then you'd gradually see the rest of the boat. So if people are astute and thoughtful in thinking, they would understand, hey, the earth is round. With pain, we know that not all injuries cause pain. And this is an amazing thing. And we've known this for hundreds of years. There's millions of stories about it. People have had injuries, sometimes severe injuries, and they. nail in their head. There's some guy, famous story, shot a nail in his, he read into his head,

didn't notice, kind of. He thought the nail went up somewhere else, didn't have pain. There's all these things. But the point is, if you can have an injury and not have pain, what that means is that it's not when your finger is hurt, when you cut your finger, it's not your finger that causes pain. It's actually the brain. because what happens is the brain has to make a decision to turn on pain or not turn on pain. And so not all injuries cause pain. Number one. Number two, not all pain is due to injuries.

And we know this for 100%, because we've seen thousands of people, and this is the work that I do, is seeing people have pain, which is real pain, who have no injury at all. And this is extremely common. So when you just take those two things together, what you've come, to is that, number one, all pain is generated in the brain and all pain is real, not imaginary, not fake. There's no such thing as, well, this pain is real because I have an injury, and this pain isn't real because I don't have an injury. Because research shows that stress and emotions activate the exact same parts of the brain as does a physical injury.

And this is mind-blowing. And again, straight neuroscience. And if stress and emotion can activate the same parts of the brain as a physical injury, then the pain that results from stress and emotion and the pain that results from the physical injury are the same pain. It's all real pain. This episode is brought to you by Vivo Barefoot. You know, my journey with Vivo Barefoot started a few years ago. I've always had this weird little kink in my knee and this chronic knee pain that would show up, especially when I'd be walking for long periods of time or even sometimes doing a heavy workout.

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which we're going to be getting into. But before we jump forward, I actually want to talk about why is our current approach to pain management and pain intervention? Why is it a little bit broken? Can you talk about that? Yeah. There's three ways of thinking about pain. three models. One model is, and lots of people believe each of these models. The first model is what I would call the biomedical model, which means that all pain is created by a physical injury.

And a lot of people believe that, and a lot of doctors believe that. And it can't possibly be 100% true, because, as we'll see and we'll talk. But that's one model. And that model works for certain types of illnesses. If you have abscess on your spine that's causing severe back pain and you have surgery, you take it out, pain will be healed. If you have appendicitis with severe abdominal pain, take it out, it will be healed. So this biomedical model is very helpful and useful for certain kinds of illnesses, but it can't possibly apply to all illnesses.

So what then people who became more enlightened in the field of pain back, we're talking about the 60s, 70s, 80s or so, they began to realize, well, the brain plays a role and the spinal cord plays a role. And you can have pain due to an injury, but the brain can damp it down or the brain can make it worse. And so that led to the second model of pain, which is called the biopysysysuco-socicial model. And the biopsychosocial model is the dominant model throughout all of pain management in the world, and all the top centers that do pain management use the biopsychosocial model. I trained in the bioseco-social model. I have a picture of George Engel on my wall up on top there who developed the biopsychosocial models.

There's nothing wrong with that model. It's a great model. But it turns out that that model is really best applied to illnesses that have a physical component and a mind-body component, where you have both. And then that model allows people not just to give medical treatment. So people in this pain management model give medical treatment. They give physical therapy treatment. They give cognitive behavioral therapy type treatments to help cope with the pain better

from a psychological point of view. They use acupuncture. They use medication. So it's kind of a, you know, all hands on deck. Let's approach it from a variety of ways, which, which would make perfect sense. That seems to make perfect sense. We'll do a little bit of everything.

But that model is not working. That model works as pain management. That's what its goal is, pain management. But if you ask, have you ever been in chronic pain? I mean, if you've talked to people who have been in chronic pain, they don't want pain management, really. Yeah. Yeah.

I personally, knock on wood, have not been in chronic pain, but I've had multiple family members who have struggled with chronic pain. Right. And I'm sure if anyone who's listening now, everyone who's listening now knows somebody, as you do, family member, friends, colleagues, business partners who are either suffering or have suffered with chronic pain of some form or another. And I can guarantee they don't really, their goal isn't like, let me just manage it. Yeah, that's great.

And I'm not knocking this field. the field is doing the best it can, but their view of chronic pain is that it has to be managed. Their view of chronic pain is, number one. We don't understand why it's there. It's chronic. It's persistent. We haven't really found exactly why it is, and so we'll try to do everything about it to manage it. Our goal is to manage it. Manage it, and that's the goal of the psychological therapies of cognitive behavioral therapy and acceptance and commitment therapy and mindfulness-based therapies, the three major psychological therapies for chronic pain. And the research on those models for treating chronic pain, chronic back pain, chronic fibromyalgia pain, chronic headache pain, etc. shows that their

treatment is only marginally effective. It's affected to a small degree, you know, one point lowering on average one point lowering on a 10 point pain scale, which is admittedly not that green. So it turns out there's another model, the third model. Are you with me? I'm sorry, I'm going on a little long. No, not at all. This is why people are here. This is why I'm here. We're with you. This is really important. There's a third model. And I'm calling that, and I didn't coin this phrase, but I'm using this phrase from some great researchers called the symptom perception model. And this model is the idea that the brain is generating the pain when that's true. And I've got data.

And we can talk more about this, but I'll just say for the moment that the vast majority of people with chronic pain do not have an ongoing physical injury in their body to be causing that pain. And what I just said, again, is a mind-blowing and revolutionary statement that many doctors, maybe most doctors, would not agree with. Most people in the other two camps would tend not to agree with, but we can talk more about the specific instances of why I think that's true. We have some research data that just came out about why I think that's true. But for the moments, if you take the view that at least some of the people, I say it's a vast majority, but at least some people have real and severe pain in the absence of injury in their body. And for these people, the symptom perception model is going to be more applicable and more accurate and more effective.

Because what we've shown by the emerging treatments that we are using, which we can talk about as well, when you use these treatments for the right person in the right disorder in this model, the results are not just a small decrease in pain, but literally elimination of pain, reversal of pain, or at least dramatic improvement in pain. And no one can claim that 100% of their patients are cured. Nobody. That's not true for anybody. I wouldn't claim that.

But the data that we have is really much more robust and powerful than the other data on pain management. So that's how I see it. And that's why I think the system is a little bit broken because the system is really focused on either the biomedical model or the biocicicicilusory. model, but there's very few people in the medical system who are using the symptom perception model so far. Would it be a fair statement to say then that individuals going down the process, which is something that you write about and research about, the symptom perception model, right, a new approach, a third door, you know, so to speak, that's available, a third way,

that the vast majority of people could see at least, at least. the possibility of a significant improvement, right? Is that a fair statement to say individuals dealing with chronic pain? Yes. For example, we did a study in Boulder, Colorado, with people with chronic acne. The average duration of pain was 10 years. So people have had back pain for 10 years. And in the other models, they'll say, well, that's not curable.

In our study, 75% of the people who engaged in our model, who took our program, and did this form of treatment, the one that's called one of the major two, one is called Pain Reprocessing Therapy, 75% of them were virtually pain-free in one month. I mean, that's astounding. That's astounding. That's astounding. So it's possible. That's what we're saying.

There's hope. There's hope, which is a beautiful thing. And an important message for people to hear today, you know, to understand the solution, sometimes we have to get a better sense of the problem. And you talked about how our system is broken and these three different approaches. The one thing I'd like to touch on just for a moment here is while we're not here to put blame, we are here to highlight incentives. Can you talk about some of the incentives, especially in the United States and the sort of modern

industrial medical complex that we all live in, a lot of it, which is well intentioned, but sometimes is incentivized by the wrong thing. How have these other two models and the incentives that drive them contributed to this broken system that we're in? Well, I, you know, I'm a physician, and I love being a physician. I love our profession. And it's so sad that at least half the patients that I see I'm apologizing for our medical system to them. I'm apologizing to them for how they've been treated by other physicians, by other physicians who don't understand that their pain is real, even when you can't find a physical cause for them,

who tend to dismiss patients and not treat them with the love and compassion and caring that they need and they deserve. And they're being treated like they're drug seeking or they're complaining, or, you know, and especially women and minorities are often treated that way. And it just breaks my heart to see that. Because the people who have chronic pain, as we'll talk about, there's a reason for it. And the reasons have to do with their lives. And what has happened to them in their lives has often been traumatic, difficult, damaging, stressful, things that are outside of their control.

and their brain has responded to that by creating pain. We'll talk about that more as well. But the point is is that the amount of compassion they need should be double or triple what they're getting. So that's one thing that I really see as a horrible problem in our medical profession. The second thing is that people don't know. People are, doctors have not been taught.

This third model, the symptom perception, model. They haven't been taught the neuroscience of predictive processing or how the brain works. They haven't been taught that the brain generates pain, so they don't really understand it. And they're working within their model. And their model tends to be, you get locked into your model, the more you do it over time. And so people are doing, for example, there's an injection therapy for vaccine. There's a variety of different types of injections for chronic low backmen. Those studies, the research studies where they compare those injections versus placebo injections show no difference. I mean, this is a sound, I mean, it's true.

It's right there to read. Anybody can read these data. Why are people still giving them? Because sometimes the treatment is working. If a treatment is working no better than placebo, but it's still working, that means the mechanism by which it's working is a placebo mechanism. And if someone's back pain is coming from their brain and not their back, a good placebo can be curative. I mean, it can make a huge difference. So people are still doing this and they're still making, obviously, money doing those.

Their practice is based on it. And the biotechnical industry is a huge industry because back pain is so big and so much money is in it. and therefore there's a big biotechnical device companies that have been making devices for 50 years or so newer, newer, newer ones to get people to use. And some of these are expensive. But they're expensive. So the device company is making money. The doctor who's doing it is making money.

The hospital is making money. This is all fee for service. It's our system is based on the more you do, the more you get paid, as opposed to the healthier you keep people, the more you get paid, a different system. So there's a lot of incentives in that direction that have to, that range from not understanding and just doing the thing that you know to actual, you know, financial incentives. You know, another item that you have sounded the alarm on in interviews and in your book is helping people understand that often a narrative that they might hear is if they go into a practitioner,

a physician that might be specializing in things like back pain through the biomedical model. They might get a scan. They might get an x-ray. They might get an MRI. And then coming back to them, they'll hear certain themes, which are quite common. hey, you have a bulging disc, you have this structural issue, you have that structural issue. And then the patient feels like, oh, okay, I got it. It's because of X, I have this chronic pain, which is Y. So obviously, I'm going to go and listen to this individual who helped me identify

this issue. Now I know what the root of this situation is, and I can go and address it. Tell us why that often, not always, but often is kind of a story that doesn't add up to the data that's out there. Yeah, yeah, it's misleading. And when people learn about this, they're shocked. And they say to me, how come my doctor didn't tell me all this? And it turns out that if you're in your 30s and you're healthy and you have no back. pain at all. You're in your 30s, about 35 to 40% of people in their 30s are going to have dysdegeneration on an MRI with no pain with them. 30% are going to have disc bulging with

no pain at all. These are 30-year-olds, and their MRIs are going to be abnormal with no pain. Why are their MRIs abnormal with no pain? Because an abnormal, an abnormal MRI for these types of mild findings is normal. is normal. You know, you look very young to me. And I look at your hair and it's like all black, you know. But I'm looking at your beard. There might be a little bit of gray in there.

Oh, yeah, there's a lot of gray on my beard. Yeah, I'm just picking that up. Sorry, I'm not to harp on it or anything. But the point is that gray hair is normal for your age, even though you're young. Right. And that gray hair is not a disease. it's not causing you pain unless, you know, it bothers you emotionally, I guess. But when we look at MRIs of the spine, that's what we're seeing.

We're seeing a little bit of wrinkles. People get wrinkles when they're even in their 30s and 40s, a little bit. They get wrinkles, they get a little bit of gray hair when they're in their 30s or 40s. Now, if you take 50-year-olds and you do MRIs on them who are healthy and have no back pain at all, 60% of them are going to have degenerative discs and 50% are going to have bulging discs. If you take 60-year-olds, 80% of them have degenerated discs and 70% have bulging discs with no pain at all. So if you have back pain and you go to a doctor and you're either 30 or 50 or 70, though there's a high likelihood that an MRI is going to show some of these abnormalities, bulging desk, even hernia.

this, spinal stenosis, the set arthropathy, arthritis. All these things are seen in a healthy normal people. So why would we make the assumption that that's the cause of the pain when that is something that also occurs in unhealthy people with no problem? If you had face pain and the doctor said

it's because you're gray, it's because you're gray, you would laugh. It was ridiculous. But that's exactly what we're doing to people. And so we are very well aware of this, and radiologists need to change. They need to stop reporting these things as being abnormal, as opposed to reporting these things as being part of the normal range of what we expect to see. But in any case, we have developed a second level criteria in back pain and other pains to determine if the pain is actually caused by the brain or the pain is caused.

by the body. And that's what we used in a recent research study we just published that showed that 88% of the 222 people that we evaluated had a non, who had chronic neck and back pain, had non-structural pain, 88%. That's a huge number. And if you have, and obviously, if you have chronic back pain or any back pain and go to a doctor and you get an MRI, 90 plus percent, they're going to tell you it's structural. But it turns out, it's not. It's not. It's actually the opposite, almost 90% is non-structural, because we have developed criteria to look very carefully at the pain to try to figure out what it really is. And we just published that paper in the last month or so. And so we're excited to have it out there so people can argue about it

and fight about it or believe it or tear it up or do whatever they want to, but it's there. And criteria. This episode is brought to you by Aquatru. I've talked to so many experts about the importance of clean water as a foundation for great health. And this makes total sense because our bodies are mostly made up of water. So if we don't get enough, they literally, our cells literally can't function right. But tap water is no longer an option. Most of it is full of toxins like microbes, pesticides, and plastics and PFAs and many of these toxins can cause serious health issues long term. And have you ever heard that cooking off the contaminants from your tap water is a great way to get rid of them? Turns out that contaminants do not boil out, not cool. When I learned how

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That's incredible. And it's all part of helping us as a society. And thank you and your colleagues for the work that you're doing because it's helping us understand the root, true root issues that are there regarding pain. You know, one thing that you've shared a lot about, for example, And you hinted at earlier in the episode, you talked about individuals that have had adverse childhood experiences and how that could be, in some instances, be corresponding to pain that they be, that they're feeling later in life that may not have a structural component to it. So can we talk about that for a second?

If you could explain the ACE study and how it's related to trauma and the narrative of pain and the story that our brain is telling us. Right, right. So the brain has a dangerous signal. When you're driving on the highway, your dangerous signal is on, full blast, ready at any moment. If a car swerves toward you, quick, jump, turn the wheel.

If you're walking down the street, somebody walks behind you, all of a sudden, boom, your danger signal jumps up and you, and you have a reaction to that. And our brain's danger signal is there to protect us, and pain is there. protect us. If you break an ankle, your danger signal will turn on to cause pain until you stop walking on that broken ankle. If so, it's a message. It's an alarm. It's a protective device.

It's like a smoke alarm in that sense, right? And the smoke alarm is just alerting us to an underlying problem. What's the underlying cause? Is it an ankle fracture or not? Now, everyone knows that they've had, you could get a headache when you have a stressful, day at work. You could get a stomach pain when you're trying to speak in front of a large audience. You could, you know, you could, I remember the other day I was at a, I was ready to give a lecture. And I love lecturing. I love talking. But I looked at my hand just before the lecture in my hand was shaking like this. Just like totally involuntarily, my brain was just literally sending me a message, hey, buddy, you know, you're a little anxious now. You need to kind of calm and

compose yourself, even though I didn't feel that consciousness. So this danger signal is in our subconscious brain. It turns on when there's something to alert us, when there's something wrong. And as I said, stress and emotions cause the exact same parts of the brain to light up, as does a physical injury. So we have memories. When you, one of the very first people I saw when I was just starting this work, 21 years ago was a woman who got head pain after getting a new pair of glasses.

She put the glasses on, boom, her head started hurting, and she had pain for 17 years every day, head pain every day for 17 years. She went to dozens of doctors, injections, medications. Nobody could help them. And so she comes to me, and what I want to do is hear your life, hear your story. And so because putting in a new pair of glasses is not going to cause head pain for 17 years. There must be something that that moment was that, that got triggered in that moment. And what got triggering that moment was something in her brain and something that was subconscious.

So her story was when she was young, her mom was fine, her dad was unpredictable. Some days he'd come home, he'd be happy and joking and other days coming home. He'd be in a horrible move and be angry. and mean, and he would grab her by her shirt and yell and scream right in her face. And that would be alternate. She'd never know what kind of dad she was going to get. She grew up. She got married.

She had kids. She was working. Things were going fine. And so that day, she got the new pair of glasses. And I asked her, what was going on in your life? At the time, you got the new pair of glasses. She said, well, my kids were okay. My husband was okay.

My work was okay. Well, I had a new boss. I said, well, what was your boss? She said, well, he was unforegan. sometimes he would be happy and great and other times he would be the cruelest meanest guy and I never know what I was going to get and her head pain was a warning signal from her brain it's so easy to understand when you understand how the brain looks and the brain has a memory and remembers certain remembers the traumas in your life and remembers how to avoid you know

how to avoid that or how to get away from that or what you need to do or whatever. But the brain can't speak English. And, you know, it just caused pain. And she became fine. In three or four months, her headaches were gone after 17 years. And that was just such a mind-blowing experience for me. 21 years ago, understanding this and seeing the results that she could have, that just gave me so much joy and confidence going forward and realizing we're onto something

here. You know, this is somebody nobody else could help. And I could help, but it wasn't anything special that I did. It was just having a different understanding, having a different model, having slightly different tools. You know, for individuals who are listening today who themselves are struggling with chronic pain or know somebody, how do we even take that first step to begin? to know the awareness of how key life events are playing, most likely, a significant role in the existence of chronic pain. What are the modalities? And is it important, and is it something

that people can do on their own? Or typically, would you say they have to work with a practitioner? Well, there's millions and millions of people with chronic pain, not to mention chronic fatigue and anxiety and depression and insomnia and all sorts of other disorders that are brain generated for the most part. So there's not enough practitioners in the world. Certainly now to help everybody. Fortunately, and that's why we've written all the materials that we have to give people the tools to do most of this.

Most people can do this on their own, I believe. And so what are we doing? So there's the treatment steps that we use. Our first step is understanding how the brain moves, not the fact that the brain actually generates what we experience. The brain generates what we see. You don't see with your eyes. If you needed your eyes to see, you couldn't see in your dreams. We don't hear it with our ears.

And there's a lot of stuff on that. I've got a course on the Coursera platform that explains all this. It's free. People want to look at that. But anyway, and our brain generates what we feel. So it's understanding that. Once people understand that, then they can be open. They can begin to open their mind to the possibility that their pain or their other symptoms might be caused by the brain.

Just might be. But that's the first step, being open and understanding that if you have pain generated by your brain, it's not because you're weak. It's not because you're crazy. It's not because you're deficient. It's not because you want it. It's not because it's your fault. it's because that's what your brain is generating. Your response to whatever was going on in your life,

which triggered it in the first place. You're just human. Because also your brain, not to anthropomorphize it, but your brain loves you. It wants to look out for you. It wants to protect you. Exactly. Exactly.

So that's the first step. The second step is this assessment step that we've been kind of talking about. And the assessment step involves a number of things. Again, it's all written in our materials, but it involves things like looking for things like childhood trauma or not necessarily big trauma. Sometimes it's little trauma. Sometimes it's bullying. Sometimes it's illness in the family.

Sometimes it's some amount of overly perfectionism or criticism. So it's looking for that. It's looking for other illnesses that have occurred in your life. So when someone comes to me in their 40s or 50s, and they're. say, well, I've got this neck pain, let's say, well, let's look at what other things. Did you have anything else? Well, I had school phobia when I was a kid. I had an eating disorder when I was a teenager.

I had migraine when I was in my 20s. I had heartburn or irritable bowel when I was in my 30s. Maybe I had some pelvic pain. So you're seeing a story that's being built, right? You're seeing evidence that's coming in. And then we're looking at the symptoms themselves. If you're having neck pain, well, is it always there? Well, it's not always there.

Well, when does it come or when does it go? Well, it's much worse when I'm at work. Okay. It's better when I go on vacation. Okay. It's worse when I, if I even think about it, it jumps up. It's worth when the weather occurs. It sometimes is in the right side of my neck,

but sometimes it's on the left side of my mind. Hmm. And when you begin to put all these clues together, now you're beginning to see, and the MRI doesn't show anything serious other than the normal findings that we were talking about. Now you can be certain. You say, oh, this is coming from my brain.

Why would it be turning on and on? If you have a broken arm, the pain's not going to turn on and off. It's not going to move to a different part of the arm. Right. So we're just using common sense, and that's what we used in that research stuff. that I mentioned with the back pain. So now you have the assessment.

You can have an understanding of that the pain is due to neural circuits in the brain, number one, and number two, what was going on in your life when it started? Did you feel trapped in some way? Was there something at work? Was there something with your child? Was there something with your spouse? Was there something with your parents? A parent gets sick and now needs a lot more help and a lot more attention.

but that same parent maybe was kind of not available when you were a kid. So now you're being loving and caring, being obligated to go help your parent, which you want to do and should do. But on the other hand, there's this kind of underlying resentment that's going on. So there's this conflict of emotions going on in your brain. And guess what happened? The brain's dangerous signal, you know, starts beeping. And as you're driving to, you're driving to,

your mom's assisted living home or you're driving to your dad's apartment all of a sudden you're next door. Wow. Now, what a difference that is to understand that as opposed to, yeah, I've got a bulgy disc in my neck and I have to get injections or take medication. That's a huge change. It's a huge change. And so it's strengthening the connection between how we feel and where our perception exists in that moment. It's always there, but sometimes if we're not zooming in and aware of it, it's so easy to let the trappings of day-to-day life cover it over. From the outside, as you share these examples, it's quite obvious that there's an emotional and an internal perception, deep connection to the pain that's there. But for most of us,

we're so used to our surroundings and our life that it's easy to overlook the history of those things and how they show up for us on a day-to-day basis and are connected to that pain. I mean, we're human beings, and we're so, human beings are social beings and they're emotional beings and they're psychological beings. And to ignore that is to not understand what means to be a human being. We depend on each other. We depend on our relationships for our health and our well-being and our vitality. I mean, people who are lonely, who have few friends, die at an earlier age. We know that.

People who have a lot of great connections, live longer, live healthier. People who think that they're doing well, have a positive attitude in their life. They do better. Your audience knows all this. This has been written about, you know, in the last decade or so to a significant degree. But what we're doing, we're taking it to the next step to really understand how those forces can actually be the most important forces in relation to. to having pain or fatigue or anxiety or depression and so that's the second step,

the assessment and understanding what's going on. Then we have some tools. We've developed some treatments that are specific to this symptom perception model that are different than the tools that are used in the pain management model. Well, I would love to, since you brought it up, I'd love to at least give a little bit of a preview of some of those tools. Yeah. So there's really four things.

The first two are the treatments. One's called pain reprocessing therapy, PRT, and the other is emotional awareness and expression therapy, PAAT. And we and a bunch of my colleagues, I'm certainly not the only one, have developed these over the years. And they're offshoot of a lot of other things. It's not like we just made up something totally new that nobody else had ever thought of. but we've refined these two. And so I'm going to talk about those two in just a second,

but I also want to mention that there's a couple other things that turn out to be really important sometimes, it's for some people. And one of those is how people treat themselves. Because it's amazing how commonly we see, how common it is for people to be seeing us who have chronic pain or other chronic conditions who are overly self-critical,

who have a tremendous sense of guilt, who always put themselves last, who don't stand up for themselves, who don't know how to say none, who feel that they're never good enough, who worry about what everyone else thinks about you. When you live that way every day, that puts a lot of pressure on them. And this is self-imposed pressure that we have control over, we can have control over. And when you have a lot of self-imposed pressure like that,

if you're always beating yourself up, guess what's, going to happen. Your dangerous signal is going to start sending an alarm. And that's one of the things that we identify and help people. And I'm sure I can't, you know, everyone has a lot of these things, obviously. And they're not all bad. It's good to care what other people think of you. But there's got to be a point where you care about yourself, where you take care of yourself. And then the final thing is, what's going on in your life? Like the lady with the headaches, maybe she needed a new job.

So maybe there's something that she needed to do in her life. Maybe if there's a neighbor, maybe you need a fence. Maybe if there's a relative you need to set boundaries with. Sometimes there's things you need to make changes in your life that can make a difference. So those are two other things, right? Those are powerful because, you know,

you gave that example of the woman with the job. It sometimes could be as simple as, hey, here's a new boundary that's there. You know, she has a new boss. That boss might be bringing what he thought was an effective management technique from a previous company and have no awareness. And he himself might be stressed. His own trauma might be driving his behavior. Obviously, it's not our job to necessarily figure that out for that person. But we can set up boundaries for ourselves and be expressed.

know I mentioned at the beginning of the podcast, I've had a few people in my life that have dealt with some version of chronic pain. And for two of those individuals in particular, a huge part of their relief, not that their chronic pain has been completely absolved, but a huge part of their relief seems to have been connected to a major life situation that got so bad that it forced them to finally speak up and say what worked for them and what did. didn't work for them. And immediately after that, again, and of one and of two experience over here, but it follows along the themes that are there. When those individuals finally, it got so bad, and sometimes that is life, you know, it gets so bad that we have to actually do something

with it. It led to a huge sense of almost like a deep emotional sigh afterwards that they didn't feel that they had to deal with this completely without being expressed. And I'm sure you see that time and time again. You see it all the time. Just this week, I saw somebody who changed jobs. Pain was gone. Just like that. And most times people may not even recognize and realize that there's a relationship there.

But it has to do with the idea that the pain is a message. There's a reason for it. And it's a guide. It's not the problem. It's your range solutions, so to speak. And so when people come on the other end of this, at the beginning, you know, all they want is to get rid of this pain because it's so bad and it's so real and it's so severe and so unrelenting often. But at the end, it's kind of like, you know, that pain was a message. In a way, it was kind of a gift.

It led me to do things and make changes in my life that I really needed to make. and I'm a better person for it. I'm a happier person for it. And my pain is going on top of it. That's amazing. That is amazing. You know, I think some of our audiences here, they're listening, they're tracking. They're like, okay, I get it.

Pain is a message. There is a reason. My brain is trying to protect me. And it's not always connected to a specific area of the body that had been injured. Sometimes it happens for the vast majority of people with chronic pain. we're learning from you that it's not the case. It doesn't have exactly a situation or something, you know, that was a trauma to the body physically that has that connection that's there,

especially when it comes to, you know, I think one of the stats I had heard you share in another interview was some high percentage of headaches have no structural connection at all whatsoever. I have no structural connection at all whatsoever. So 95% of people with headaches, tension headaches. migraine headaches, cluster headaches, occipital neuralgia headaches, do not have a structural problem. They're MRIs are normal. Headaches are real.

There's physical changes going on in the brain that cause the pain, but it's the brain that's generating that pain. And that's true for most people with chronic pelvic pain, chronic abdominal pain, chronic widespread pain that we call from neuroalgae and chronic back pain. So it's really important to get, you know, to get the assessment correct. and know what you're dealing with. So, yeah, you're absolutely right. People really need to be open to the idea, I think, to just question and then look carefully, investigate what's causing this pain. And sometimes it's hard to know for sure, and we can help,

and that's why we do have doctors and folks who are trained to do this work. But the two treatments now, if we, I don't know if you want to switch, to the pain reprocess. Yeah. Yeah. So the pain reprocessing therapy is really, at its core, very simple. It relies on the fact that you can't control when the pain occurs because your brain is turning on the pain or keeping the pain going. And that's a subconscious part of your brain. You don't have a switch to just turn that off. But it turns out that we have a powerful way of training the brain out of the pain. And that's by changing how we respond to it. So, and this is very hard for some people, obviously, because what we're saying is that, but we need to stop fearing the pain. We need to stop fearing that it's something damaged or broken, that it'll never get better.

We need to realize it's a message, it's a neural circuit sent by the brain, and it's reversal. There's hope. We need to help people to stop focusing on the pain so much and stop monitoring and stop bowing down to making it their whole life, as opposed to change. taking their brain and putting their brain in a state of contentment and happiness and peace and love and purpose and meaning and doing all the things that make us happy and well and content. I mean, it's hard to have gratitude when you're suffering in pain, but it turns out the more gratitude

you're having your life, the happier you'll be. And the happier you will be, the less pain you will have because now we're training the brain's dangerous signal to turn off the pain. And what we're doing is that if someone's having pain when they're bending over, we teach them to bend over while they're telling themselves, I'm okay, I'm safe, I'm not in danger, counteracting the fear-based messages that they've been given and that they give themselves about the pain. And so we're training the brain because neurons that fire together, wire together. When you bend over with fear, you're getting more and more pain.

You're reinforcing those nerve circuits. But when you bend over with a smile and joy and hope that you're going to be fine and knowing you're okay and knowing there's nothing wrong with your back, all of a sudden, the pain gets less. And it's weird how much power you have over it by changing your mindset and your mental attitude about what the problem is. And the other forms of psychological therapy can't do that because they haven't assessed what the problem is. They're just saying it's chronic pain. You have to manage it. We're saying as we know what's causing it, and we can train the brain out of it. So that's the essence of pain reprocessing therapy.

And for pain reprocessing therapy, is there a framework? If I'm an individual that's dealing with chronic back pain, and I'm wanting to do this, my understanding is that it's something that you do on a regular basis, right? Like in the moment that you might typically have pain, you might be driving to work, and that's when you see maybe it flare up. it may pulse in, it may pulse out. So there might be key moments that you're bringing it in. Are there guided experiences or things that kind of walk you through that to make it easier to be able to do?

Yeah, yeah, I'm glad you brought that up. So if someone's getting pain driving to work, for example, might be foot pain or back pain or neck pain. So what we want them to do is sit in their house, close. their eyes and give themselves messages of safety. I'm healthy and strong. There's nothing more. I'll be fine. Tell themselves they're okay and then then have them put on a really strong mental attitude and a content and a peaceful and happy mental attitude and imagine driving to work with that. It sounds silly, but this is a mental exercise where they're training the brain that driving to work is safe. It's fun. It's joyful. It's fun. There's nothing wrong with driving to

work. It's because their brain is learning that by the imagination of driving to work with joy. And so we have people keep doing that and keep doing that. And then when they get in the car to drive to work, they're doing the same thing. They're doing the same mental exercise. And as they're driving to work, they're doing this mental exercise. And then their pain's moving down. And then it goes up again and then it goes down and it goes up and then they're like yeah my brain is like you know and turning it on and off yeah that's my brain i'm okay do it again tomorrow do it again tomorrow and the brain starts to learn it's like unlearning a habit it's like changing a habit of the brain you know you have the data to show that this methodology works right you have data that's there

that shows it you've cited some of those including the recent paper that you had mentioned It's silly. I mean, I tell people, look, this treatment is going to sound silly, okay? You know, it's going to seem, it's going to seem, because we're just going to play with your brain. You know, we're not going to fight it. We're not going to beat on it. It's not a warrior. Like you said, the brain is trying to protect you. So we're going to treat it like a scared child in a sense. We're just going to calm it and soothe it. And, you know, it works. It's amazing. You know, for me, and I can imagine a lot of my audience who's very sympathetico to this and believe, this inherently knows and maybe even sometimes people have had their own, you know, anecdotal experience

where they were in a good state, like you mentioned, vacation, in a typical setting where they would see their headaches flare up or other things. They were in a safe, comfortable position. They felt secure and they noticed their pain didn't flare up. So I think a lot of our audience is sitting here feeling like this is not silly. What I can imagine them feeling a little bit is, am I doing this right. Of course, they should go through your materials, check out your book, look at some of the free materials that are there on the website. But for those individuals who are concerned that they may not be doing it right or are they doing it right, is it worthwhile for them to try to find a practitioner and maybe have at least some sessions with them? I'm not sure exactly what type

of practitioner is teaching this methodology that's there. But is that a worthwhile endeavor? to at least have a couple sessions to know and feel secure that, hey, look, this takes time, a lot less time than maybe people think in the long term of dealing with the pain that's there. I think you mentioned in one of the studies, some of the back pain of people for 10 years, in one month, was it? Was that the study? That in one month they started to notice a significant difference on the pain scale that's there. So, yeah, is it worth it for them to seek out a practitioner?

And if they did, what kind of practitioner are they looking for? Yeah, definitely. And I want to get to the other main treatment model in a second. But yeah, there's no question that people often need guidance. They often feel alone. They're not sure. Am I doing it right? Will I get better?

They need encouragement. They need a cheerleader. They need hope. And we've got that. Most of it is not in your neighborhood because we've not trained enough people in all the towns and cities across the world. And I get emails from people all of the world. And they say, well, is there somebody in Argentina who can help? Is there somebody in Germany?

Is there somebody in Dubai? You know, I said, well, not that many yet, but we're working on it. But because of the Internet, there's virtual, there's people you can get virtual coaching with, people who are trained in our model. And we're offering for people who want to learn this model, we've got tons of training opportunities in pain reprocessing therapy, in emotional awareness and expression. therapy, which I'll talk about in the second, in this whole model, in how to assess people. We've got trainings in all those areas. And there's people in all those areas who've gone

through our training and are practicing. And most of them are doing it virtually. So yes. And there's lists of that that I can send to you. Great. We'll put them in the show notes so that people can get a chance to reference them. You mentioned the second modality that's there. Could you talk a little bit about it? I believe you said emotional expansion. Is it? Emotional awareness and expression and expression therapy. Mark Lumley and I developed this. It's an offshoot of some work that we learned from Dr. Allen Abbott, who's a brilliant psychiatrist in Canada. And we've tried to make his model a little bit simpler for simple people like us. And so we call it EAET, emotional awareness and expression therapy.

And I'm just going to tell you a story that illustrates me. The idea is that people often hold in emotions instead of letting them out in safe and healthy ways. For example, when you're given, when someone hurts you in some ways, it's normal to feel angry, resentful. But being angry and resentful in the real world leads to violence. We already have enough violence. We already have a lot of polarization and people yelling and screaming at each other. So violence in the real world is just not a good thing. It's not a good way to express anger.

On the other hand, holding your anger in is toxic to you. So what do we do? The same thing happens with sadness. A lot of times people are hurt and they're sad and they don't know what to do with that and just kind of sticks in and they just are living in the sadness and don't know how to get through or people living in guilt. So anyway, a year ago, roughly, the hospital came to me and said, we're not renewing your country. You've been here 20 years.

Thanks very much. We'll see you. You're gone in a month. And, you know, I had worked really hard to be a really good doctor at this hospital. And I was shocked. You know, it's a budget crisis. It wasn't personal. I didn't anything wrong, but it was a budget crisis.

And they couldn't afford me. And I don't make money by talking to people, it turns out. Shockingly. So I was surprised. Three days later, my back started to hurt me. And it kept hurting, and it kept hurting. And I quickly realized I hadn't injured my back. I hadn't done anything to it.

And I started doing this pain reprocessing therapy work for myself. I'm telling myself I was okay. I was safe. It'll go away. Keep moving. Keep telling yourself you're okay. Imagine moving with your own. And I did all that. And two weeks later, I was still having a lot of backpathy. And what it was happening is that I would tell people the hospital let me go. And I would laugh. I would say, isn't that funny? The hospital let me go. Isn't that funny? I'm like kind of a well-known doctor. Why would not? It's funny. And I was in my car two weeks later, and I realized it's not funny. I was having feelings about it. One of the feelings was anger. I was resentful. I was enraged, really, furious. Why would they? How could they do that to me?

Even though I understood why they did it, nevertheless, I was angry. And that was an emotion that was in me, and I needed to do something about it. And so instead of going to the hospital and slashing the tires of all the administrators, which probably not a great option, I started swearing in my car. I started screaming at the top of my lungs, letting out all that anger. F this, F that, F them, just screaming, yelling, all my anger out. And then I imagined blowing up the hospital like in a cartoon with TNT. And then I laughed.

And then I could let go with that anger. Wow. Because it's a safe and a healthy way to deal with a real powerful emotion that needs releasing. It can't hold it in. You shouldn't hold it in. But I didn't want to be violent, obviously. So I let it out in that way. And then I could let it go.

And then I could take deep breath and let it go. And then I went to the hurt, the sadness, getting kicked aside of being unwanted, right? And I allowed myself to feel that sadness because I had blocked that emotion as well. So I'm feeling the sadness. And it led me to think about other times I'd been hurt in my life. My father hurt me when I was a kid, when my basketball coach demoted me, when my, when a girlfriend, you know, dumped me, et cetera. and I was able to take that herd and turn it into compassion because anger is there to protect

you, to fight. Sadness is there to connect to and to be compassionate about it. So I just started really being compassionate to myself. And a friend happened to call me, and he was really being kind and nice to me, Howard, it's okay, they shouldn't have treated you that way, blah, blah, blah. And I came back to my house, I'd expressed the anger and released him. I had felt the sadness and turned it into compassion. And then I began to feel compassion for the hospital too because, you know, they're in a tough spot.

They put up with me for 20-some years and I never made any money for them. And they were good to me. They let me develop this whole mind-body practice all those years. And then I was able to forgive them. And what happened to the pain? Disappeared. Wow. So that's an example of emotional awareness and expression therapy.

And you can also use this therapy for childhood hurts, for things that have happened in the past. So this was an occurrence, current hurt, you know, a current emotionally event. But you can go back in time and do it for events that happened in the past, even all the way back to your childhood. And so what we're doing is we're addressing the pain at the level of understanding it, looking at it as a message. We're using it to help us change how we treat ourselves.

If we need to be kinder to ourselves, we need to stop beating ourselves up. We may use it to change our job or something about relationships, set boundaries or something. And then we're specifically changing the neural circuits in our brain by the gain reprocessing. And we're dealing with the actual underlying emotions which have been causing the pain in the first place. And when you put all that together, that's a model for pain reversal as opposed to pain management. You know, when I think about you in the car and that example that you share, that real life example, I think of you having, you know, in this expression of anger, in this healthy expression of anger, I think of almost a primal response like shouting, yelling, which also when you yell loud enough,

It sort of invokes the body. It gets the breathing going. It's kind of like a full thing. It's not too different than anybody who's spent at least a little bit of time in nature and observed animals. Or if you have a dog, you know that when they go through stressful situations, they'll do things like shake. You can see ducks that get into a fight over who has the right to mate with another duck. And they fight intensely for a period of time. And after it's done, they'll go and they'll shake it out.

You know, they'll have this sort of visceral body reaction where they're actually getting a chance to process, you know, the emotion, the feeling and the sense. Animals know it intuitively, but we as human beings in the society that we've lived in, we've shut a lot of that expression out. And as you mentioned, we don't have healthy ways of releasing that. that anger. So I appreciate that example because that really connects the dots for a lot of people, including myself. And there's, I mean, this is, there's so many ways in different cultures of doing this kinds of work. You know, there's people who do chanting and singing and drumming

and people who do wailing and moaning and all sorts of stuff. I was just reading something yesterday from a book by Jane Goodall where there was a woman in one of the tribal society she was working with who was having a lot of pain and turned out it was grief. The pain was due to grief. And so the treatment was cry the grief out. She cried and cried and cried and cried and cried and cried and cried and the pain went away. Sometimes it's all we need in some situations is somebody who hasn't let themselves, you know, especially men could find themselves in this, you know, group.

They were told their whole life, you have to be a man, don't cry, don't have expression. but there are things and moments in our life. Well, we have that genuine grief, the loss of a parent, the, you know, the morning of a relationship that didn't work out, whatever it might be. And sometimes that expression of the pain through crying, through wailing, through some sort of primal rage, again, in a healthy, you know, healthy expression of it that is not, you know, directly harming somebody else is the modality that's there. Now, with this secondary approach, which is this emotional,

expression approach that you just highlighted, the same practitioners that you have trained and that you and your colleagues have trained, those individuals would also be aware of this modality. Is that correct? In general, yeah. I mean, some people are, some of the practitioners that we refer to are doing more of the PRT, some or the EAET, some are both. You know, but most people are coming to look at this model as being an integrated or holistic model where we have. We can draw. out elements of both of these things, plus the other things that I talked about. So, yeah, yeah, we're, but that's, that's the beauty of this work is that understanding, understanding how the brain works, understanding the relationship between our lives and,

and what's happening in our bodies. And so we put in all that together. We have, we think we have a pretty powerful way of intervening. Now, I'd love to get your hot take on a topic that we discuss a lot on this podcast here. And some physicians have talked about its connection with chronic pain. They're not going to be an expert like you are in this facility, which is why I want to get a chance to ask you. So many researchers, physicians that have been on this podcast who generally are, would be in the loose category of either integrative, functional, holistic, in some capacity, you know,

they're not just looking at the traditional model. of medicine, they talk about the role that inflammation, especially chronic inflammation, inflammation is a good thing, just like pain is a good thing. It's an important part of our healing process. It's chronic inflammation that is largely connected with every single chronic disease that's out there, right? Heart disease, cancer, other things, they all have some link to chronic inflammation. We know that chronic inflammation is something that we don't want occurring. And there's many different root causes of chronic inflammation. but one of the biggest ones that's there is our lifestyles that we are in.

We're extremely sedentary. And in particular in the category of dietary, we as a society, especially in America, and now we're exporting it out to the rest of the world. We're eating foods that are in the ultra-processed category, highly refined, that seem to have some connection based on the literature to chronic inflammation that's there. And generally, when people reduce their ultra-processed food, intake, you know, they notice that their markers of chronic inflammation tend to improve CRP, CRP, interleukin 6. It could be a different, a bunch of different markers that are there.

Do you feel that there's any benefit to people living a low inflammatory lifestyle if they're individuals that are dealing with chronic pain? Not that it is the exact root of their issue, but knowing what we know, is it worthwhile stepping in? to a lower inflammatory lifestyle as a, you know, preemptive measure to at least support the process of these other modalities that you mentioned having a chance to work. Yeah, that's a great question. In terms of disorders like diabetes and heart disease, for example, there's no doubt that chronic inflammation can play a role.

And there's no doubt that that inflammation can build up over time and there may be a tipping point at which there is, the disease occurs. And this is called the allostatic load theory. So that makes perfect sense to me. We do know that processed foods and environmental toxins and stress can cause micro-inflammation in the body, the kind of inflammation that's low-level, that you can pick up on the testing that you talk about, IL-6, CRP, set rates, etc. We also know that stress can cause pain. So it makes sense that inflammation would be involved in pain. But my experience is that this is a small factor,

it may not be a factor at all from many people. We've seen many, many people who've had chronic pain, who've gone the route of detoxifying their whole body, taking lots of supplements. that may cost lots of money, going, you know, getting heavy metals out, getting, you know, stopping eating dairy and gluten and, you know, whatever. And still have chronic pain.

So that's one thing that we know. We see that all the time. We do know that, on the other hand, we know that self-care is a great thing. If people take good care of themselves and they exercise and they have a good diet and they feel good about it. that they're living you're eating for health and well-being that's a great thing and that can be very beneficial in calming the mind and making your mind better but I don't think that

inflammation is actually the cause of pain and the reason that I don't think that's true is that we've seen people get get better from pain using our model and their inflammatory markers are still on and inflammation is not something that turns on and off like that like a switch inflammation is something that comes and goes over days or weeks or months. And so this idea of building up and tipping point doesn't make sense for chronic pain because the chronic pain is the pain is occurring in relation to stressful life events, number one. And number two, it's turning on and off in ways which are related to what's going on in your mind and what's going on in your life. And when you see the pain turn on and off

within seconds due to our exercises, like why I would describe to you with my emotional outburst, and how the pain turned off then. That's not due to change in inflammation. You see? And most of our patients have these episodes where we see the pain turning on and off or switching from one part of another or being in this part of the body

and another part of the body. So I'm not a big proponent of the inflammation theory that relates to. And when we emphasize that it's inflammation, we tend to bring people back to an ear where they think their body's damaged and they need to fix it. And what we've found is our best results occur in people who begin to, who have the understanding that their body's not damaged.

And they don't need to fix it. And they will be okay. And if they do these kinds of exercises and change how they think about their pain and think about themselves, they will get better. And so I don't want to, just like the MRIs, where the MRIs are showing people that there's something wrong in their body and that creates more fear and worry, which actually makes the pain worse. Worrying about inflammation can do the same thing. That's a great breakdown. And I appreciate us taking a moment to talk about that, you know,

while we had a little bit of time here left in the interview, because I think that, you know, you like many physicians that are out there, we want people to lower their risk of chronic disease and a lower inflammatory lifestyle is a part of that. But because what you, you know, you know with pain, it's an important lesson that sometimes people do all those things and their pain doesn't improve. So if we don't get to the root issue of the emotional connection, the story, the trauma that's there, we may not be able to make progress. And that should have and leave people with a healthy level of skepticism for anybody that promises them that there's going to be a solution to their pain through these well-intentioned things.

that might actually make you healthier in other areas, but may not necessarily get to the root of the pain that's there. So having some healthy skepticism, both for the traditional medical industrial complex who might just want to usher you into a back surgery to move forward with things, but also the wellness, you know, big wellness in a way, who is very sometimes can be sensational with their, you know, claims.

There's all sorts of different people in the wellness world and the health world, products that are being sold, et cetera. So to have an awareness that we should have some skepticism on all sides of those equations. Yeah, I love the way you pointed that out. And there's a lot of, you know, there's a lot of other things that I'd like to maybe touch on. But I do want to point out that it's not just pain. The brain can cause fatigue.

Yes. And people with oftentimes severe and chronic fatigue have gotten better, literally all the way better. by using this model because again, when you do, when you take people with chronic fatigue, we haven't found a medical cause for it in the vast majority of people. And again, when you look at the whole story, the whole life and everything, usually you can find the underlying causes. And the brain has a lot, there's a variety of, therefore the brain has a variety of messages it can give. It can't speak, as I said.

But it can cause pain, and it can cause fatigue. And sometimes it might be anxiety, and sometimes it might be depression, and it might be insomnia, or it might be a burning mouth kind of thing, or it might be a dizziness or ringing in the ears, or it might be what they call now they're calling pots, which is part of dizziness, postural orthostatic tachycardia syndrome, which we view as being a mind-body disorder. People are now being diagnosed with hypermobility syndrome, what's called Ellers-Danlos syndrome. And people are being told, again, you need skepticism.

People are being told that the laxity of their tendons and ligaments is the cause for their chronic pain and all their other symptoms, which doesn't make sense to us. People are being told they have something called mass cell activation syndrome, where they have too much histamine in their body, and they're getting allergic to so many things, or they're having multiple cancer, multiple cancer, chemical sensitivity syndrome, where they start to become allergic to more and more

foods and more and more smells and more and more everything. And pretty soon they're wrapped up at home, you know, withdrawn. And Long COVID is the other major one. And we've seen we have research now showing that we can treat lung COVID effectively using this model. All these areas are very controversy, very controversial. you. And you will find people who are adamant and who are, who will, you know, who you get very angry with us for saying that chronic fatigue or long COVID or elders, Danlos, Mass Cell Activation

Syndrome or Pots or mind-body disorders. But the point is, is that mind-body disorders are real. They're real. They're not imaginary. They're not fake. It's not that the suffering isn't there. The suffering is there. And it's just the question of what's causing them. And that's what we're trying to understand and address. And there may be some areas where we're wrong, you know, where things will change over time and medical science will advance. You know, we'll see. But people right now are suffering right now. We have some tools that we know can help a lot of people. And they're very underappreciated, underutilized, under understood. I want to acknowledge you for fighting the good fight to put this out there on behalf of all those

individuals that are suffering from chronic pain. You know, if that person is listening today, their family members send them this podcast. You know, what's the next step from here? Should they go to your book? Should they go to the website? If they're somebody who's like, I want to go through and incorporate these two modalities that you broke down on here and actually start to bring them into my. life on a daily basis. I'm willing to do the work. I want to get excited. I'm willing to get

educated so that I also stay compliant on actually doing it and understand, you know, the story of the brain. What's the first, you know, what's the first second or third step that they take? Well, there's a bunch of free resources. I mentioned I just put out a course on the Coursera platform. It's called Rain of Pain on Coursera.org. And it's free. You can audit the course for no money. It lays all of this out in a lot of detail. It's fun and it's interesting, I think. So that's there. There's a nonprofit website called TMSWiki.org.

TMSWiki.org run a superior group that runs completely free all on a volunteer basis. Tremendous amount of information on this work there. We also have a nonprofit organization called the Psychophysiologic Disorders Association. which is ppdassociation.org, and that's our nonprofit professional group. And anyone can join, actually. And there's a ton of information on that website. And there's a list of practitioners. One of the best list of practitioners is on that website.

There's also the Pain Psychology Center in Los Angeles, started by Alan Gordon. Alan Gordon's book, The Way Out, is really a great resource. And that organization has a list of course. practitioners they've trained in pain reprocessing therapy. And then, as you mentioned, I've written some books. A lot of our other colleagues have written books, including David Hanscombe, Alan Gordon, Georgie Oldfield, David Schechter, David Clark.

And so there's, and I can send all of that information to you. So if you start with a bunch of free resources, and then you have directories of practitioners that you can go to and see on a virtual basis, and then you have some books, all those are pretty, low cost, free or very low cost, ways of getting into this work. So I think there's a lot out there. There's a lot out there. And we're going to put it all in the captions on YouTube, in the show notes, on the podcast. And Dr. Howard Schuvener, I just want to thank you again for going down this journey to have a different approach. There's so many people that are hurting. And there's so many people that have lost. hope, unfortunately, because they've tried a lot of things. They've spent a lot of money on a lot of different solutions that are out there. And they're left feeling like, well, maybe I'm broken. And when I read your work and how you talk about the brain, the biggest reminder is that

the brain loves you. It has your back. And you're not broken. And there's something important that's inside of there, a lesson for us to get a chance to learn. And you guys have I've been highlighting the modalities on the best way to do that and the research that shows that it actually does work. So I want to thank you for coming on the show and sharing your knowledge. Our brains are neuroplastic till the day we've done. You know, our brains are always changing. And new neural circuits and different neural circuits can be more activated or less activated. So that's the science behind this.

There is change. It's not a static thing. It's actually a dynamic thing. and because the brain is dynamic and because the brain can change, even no matter if you're, you know, if you're 20 or you're 100 years old, you really can. And so to me, that's, I just want to emphasize your message. The idea of hope is really critical for folks who are suffering. Well, thank you for giving us to our audience and to me as well today.

Dr. Howard Trubner, thank you again for joining the podcast. It's a pleasure. here now. Bye. Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called Try This

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