Dhru Purohit Show - What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On

Episode Date: April 28, 2025

This episode is brought to you by Cozy Earth and Manukora Honey. Chronic pain affects millions of people, yet traditional approaches often focus only on managing symptoms, without addressing the root cause. Today’s guests share a groundbreaking perspective: that pain is created by the brain as a signal of an underlying emotional issue that needs attention. By identifying and addressing these emotional triggers, lasting relief can be achieved by rewiring the brain. Today on The Dhru Purohit Show, we’re bringing you a special compilation episode featuring Dhru’s conversations with leading experts on getting to the root cause of chronic pain. Dr. Andrea Furlan breaks down the drivers of chronic pain and debunks common myths around treatment. She also highlights the dangers of a sedentary lifestyle in worsening pain and shares her unique, integrative approach to healing. Next, Dr. Howard Schubiner explains why chronic pain is becoming more prevalent and how it’s closely connected to the brain. He outlines why the current model of pain management falls short and introduces Emotional Awareness and Expression Therapy—an evidence-based approach that has been shown to be more effective than traditional treatments. Dr. Schubiner also discusses how adverse childhood experiences can manifest as chronic pain later in life, and how we can retrain our brains to change our perception and experience of pain. In this episode, Dhru and his guests dive into: Top myths in treating chronic pain (01:05) Tier ranking of the top drivers of chronic pain (06:40) Corrective exercises for addressing lower back pain (12:36) Solutions, answers, and advice for lower back pain (15:33) Evidence-based alternative approaches for chronic lower back and shoulder pain (19:26) Do's and don'ts to prevent abuse of the body (22:51) Why back pain has doubled in the last twenty years (29:20) What pain in the body actually is (32:28) Why the current approach to pain and pain management is broken (35:43) The Symptom Perception Model and its effectiveness (43:00) Incentives that contribute to systemic failure (44:32) Why MRIs don’t provide a complete picture of pain (49:11) Adverse childhood experiences and their relationship to pain (54:45) Understanding how the brain generates pain (59:58) Final thoughts (01:07:43) Also mentioned: Full episode with Dr. Andrea Furlan Full episode with Dr. Howard Schubiner This episode is brought to you by Cozy Earth and Manukora Honey. Right now, get 40% off sitewide at Cozy Earth.  From May 2 through May 4th, buy One, Get One Free viscose bamboo pajamas!! Just head over to cozyearth.com/dhru and use code DHRUPBOGO. Upgrade to the creamiest honey, packed with antioxidants and prebiotics. Just go to manukora.com/dhru to get $25 off the Starter Kit and boost your energy, immunity, and digestive health today! Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, Drew Prode here. Millions of people worldwide experience chronic pain, and it's heartbreaking. Yet despite its prevalence, myths about what caused chronic pain are pervasive. And the traditional treatment approach focuses on pain suppression over addressing its root causes. So in today's compilation episode, I dive into some of the most common misconceptions about chronic pain with scientists and physician Dr. Andrea Furling. She talks about many of the main drivers of chronic pain and the tools for managing. it. And I also speak with professor and director of the Mind Body Center at Ascension Providence

Hospital in Southfield, Michigan, Dr. Howard Schubner, about why we're seeing an increased prevalence of chronic pain and the clinically proven treatments and approaches that he and his team use to pain management. But first, let's dive into my conversation with Dr. Andrea Furlin. What are still some of the top myths that you see that are out there when it comes to treating chronic pain. A big one is that it's normal to feel pain with aging. So a lot of people think that aging, getting older, is like a synonym of getting more pain. And people make jokes about this. They say, you know, arthritis comes with age. Everybody has arthritis and arthritis just gets worse. That is not true. That is not true. Okay. So learn something. It's not because you're

old that you must have pain or you are going to suffer more pain. A lot of people, a lot of people, they have arthritis. You can see their bones. They may look horrible. They don't have any pain. So we all know this. Even in MRI, you see people, this has been researched done over and over and over. They MRI people with, you know, who don't have any pain like walking around and doing everything

they want. And they have heart, even discrenation. disc-prolapse, disc prolapses. They have bad arthritis. An example is my grandmother. She was 92 and she had an x-ray of her neck because she had another thing in her head. And I looked at her x-ray. I've never seen the most horrible x-ray in my whole life.

Her teeth is everywhere. She did not have any disc between the vertebra. And then I asked her, grandma, did you ever have neck pain? She said, no, never had. So it's not a synonym, okay? Aging is not a synonym that you have. So that's the first big myth. The second one,

is that because pain is invisible, when people, a lot of people say, I am suffering pain, I am in pain, my pain is terrible. And then the doctors look at them, the friends, the family, the co-workers, the managers, oh, you're fine. You can move everything.

I don't see anything. The doctor said that nothing is broken your bones. You're telling me that you're in pain, that you can't work, you can get out of bed. That is another myth. Because pain is invisible. If the person tells you they are in pain, they are really in pain. So we do need, because again, that pain that centralizes, that I just explained to you and it transforms to chronic pain, it's called nociplastic pain because involves plasticity of the pain system. We cannot see in x-rays or normal MRIs.

We can see in laboratory with some specific tests and some specific physical exam. But another myth is that these people are faking, these people are lazy or they're just depressed and they need to exercise and why don't you exercise more? Why don't you? It's so simple. It's not that simple. If you have an acute pain, let's say a fracture or an inflammation, a toothache, the body heals. We know that the body heals everything and scar. don't hurt. If the pain continues after the period that you expect the tissues to heal,

the fracture is done, the orthopedic surgeon looks at the x-ray side, everything is healed here, why you still have pain? It might be because now your pain has transitioned to chronic pain, which now is becoming a neurological disorder because it's more like a sensitization of the pain system. Drew, if you allow me a few seconds, a few minutes here, maybe I, I like to use the analogy of the alarm system of a house. So the pain is the alarm system of our body. So it's exactly the same thing as an alarm system of a house. You install sensors to detect if there is a danger, right?

A smoke detector, a burglar detector, a breaking, carbon monoxide detector. So those are the sensors that we have for pain. And when you have acute pain, you want them the alarm to, go off and make noise because you need to go to emergency and take care of that problem. So if you have an alarm system of your house that is making noise, you call the ambulance, the fire truck, the police, and they come, they find where's the fire, where's the problem, you fix and the alarm goes down. Chronic pain is when the alarm of this, the alarm of your body, the alarm system of the house

is malfunctioning. And why it is malfunctioning? because it became sensitized. So if a person has chronic pain, they are not going to treat with the same methods that you use for acute pain. You're not going to call the fire truck ambulance police.

You need to call the alarm company. So this is when we see chronic pain transforming from acute to chronic, we need to use different methods. We need to use methods that fix the pain system. So that's what, you know, the analysis, that I use, how do we fix this pain system? Most of them are what you just mentioned. Movement,

mind-body therapies, sleep is essential, good nutrition. I would not say good diet. It's nutrition. I see a lot of people who are malnourished. Those four things are so essential to fix the pain system that that's why you're not going to recommend someone who is having a fracture, you know, to say, oh, you need to meditate, you need to do exercise, movement. No, they need immobilization, they need surgery, they need to fix the fracture. So you see why the treatments are different. Absolutely. If you had to rank, on average, the top drivers of chronic pain, the things that are confusing

are alarm system, even though everybody's unique situation is different, how would you rank some of those things in order of most important as it relates to driving some of this pain to then kind of leased and so on and so forth. Yeah, and we know there's a lot of scientific evidence to say, because we are trying, the scientists are trying to find out what are the drivers, how acute pain transforms into chronic. And we know a lot of things now that we did not know many, many years ago, thanks to a lot of science, especially science looking inside of the brain with function MRI and things that look at where is the system malfunctioning. So one of them drew that is very much important is the danger perception. So stress. We know because in the brain,

the pain is a signal of something broken, something damaged, something injured. You have a disease. You have something. So they activate the areas of the brain that signal danger, danger, danger, danger. So what happens is after that initial injury, lesion disease is healed. Let's talk about a fracture, for example. The alarm system doesn't turn off. The danger signal keeps activated and informing the person that they are in danger. So this is so important that some of the therapies, some of the mind-body therapies,

they act exactly on that. They say if you reduce the danger signals in the brain, the pain will go away, and that's true. And the other things that have, and where does this danger come from? It could be from childhood, early childhood adversities. So people who had adversities when they were growing up, they're more prone to transform acute pain into chronic pain, but also current stress, fears that the person have and that trauma that is maybe not a big trauma, but a small trauma with small teeth like bullying and things that they suffer every day or stress in life. So that's one thing that we know. The second thing that we know that transforms acute pain into chronic pain is bad lifestyle choices. And that will include

putting your body in a situation that it's low resilience. Like the body doesn't have resilience to fight that acute pain, and therefore it will sensitize the pain system. So things like drinking alcohol, smoking nicotine, or any kind of smoke, even cannabis because of the smoke, not sleeping well, not moving the body well, not eating well, working too much or being sedentary, overweight. So lifestyle puts the body well. at a high threshold, like a higher chance of developing chronic pain. And then, of course, there are things that we know related to the pain itself.

If a person has an acute pain that is not well treated, is not well managed, like they are left to suffering pain. People don't give them the proper painkillers. Let's say a surgery. We also know that that stress of the acute pain can also predispose the person to have more chronic pain. So there's a big push for surgeons and esthetists to treat acute pain, especially post-operatively, post-surgical, really well because we know that that principles people to have chronic pain. Let's talk about one of the most common types of chronic pain, lower back pain. I think it's repeatedly mentioned as the number one thing that people are going through. If someone

was going to put together some exercises, exercise snacks, some corrective things, and even maybe some lifestyle issues that they might want to pay attention to. You know, you're not diagnosing anybody. This isn't it medical advice. But just to help people understand what's possible and available to them, how would you approach lower back pain? A few months ago, December 2023, the World Health Organization released guidelines exactly for that for chronic primary low back pain. When we say primary low back pain, pain, it means is this nociplastic pain, is when the pain already transformed from acute to chronic, because we know 90% of chronic low back pain is primary chronic pain. So secondary chronic low back pain would be if the person has a tumor in the spine, like a cancer, a fracture,

or they have an inflammation, there are some inflammatory diseases like ankylosin spondylitis that affect the spine. Or they, or they have a inflammation. They are some inflammatory disease, like ankylosin spondylitis that affect the spine, or they have a neurological impairment. But when you exclude those secondary causes of low back pain, 90% of chronic low back pain is primary, which means it's just a problem of the pain system that is having the sensitization, the muscles are tense, they are aggravated by mental stress, physical stress, sedentary life, all of those. So how do you combat this chronic back pain?

It's lifestyle. Medications will not do the trick. Opioids, anti-inflammatories, analgesics, they are good if you have an acute low back pain for a short period of time. Or if you have a secondary back pain that is secondary to one of those things, okay? But if it is nociplastic pain, like this primary chronic pain, medications, only if the person has some other, like a depressed, they are very depressed, so we need to give them antidepressants, or if they have another inflammatory disease that is affecting other joints we can give anti-inflammatories. But anyway, so don't think medication.

Medication is not going to be the first line of treatment for chronic low-back pain. The first thing that they need to think is about movement. Again, motion is lotion. Let's come back to chronic pain as a bigger picture. We talked about how lower back pain is one of the top things that people complain about regularly. I think you even said in one of your videos that 100% of people will go through some sort of lower back pain in their life, right? Especially if they live long enough. From there, what's the next biggest one that you see people looking for answers, resources, and solutions that you are trying to provide tools for them?

Don't be afraid of it. I think the fear of the pain paralyzes more than the problem itself. We see this a lot. People have an acute episode of back pain. They get very worried. A lot of things start going on in their mind. They start spiraling. Oh, this will happen.

Blah, blah, blah. That's the reaction of a person to the back pain itself is worse than the problem itself. That's the first thing. There is a lot of research saying don't prescribe bad rest anymore. when this is for doctors. Doctors don't prescribe bad rest if your patient has an acute back pain because if you do,

there's a lot of evidence from randomized trials done in the last 40 years showing that if a person rests, they will worse than if the person just try to, you know, take as normal as possible their life. I know some, I had some episodes of really bad,

acute low back pain and I know how hard it is to move. But, and I know, how frightening it is. It's really frightening because it hurts a lot. But the first thing is try not to be afraid of it. Try to move. Try to live your life as normal as possible. You can take some analgesics in the acute phases. Try not to stress too much. You can see a chiropractor, a physiotherapist, a kinesiologist, your doctor, but try to move. The other thing that people need to remember is When they have an acute back problem, seeking like a go to the doctor and demand an image,

I need to see a CT scan or MRI. It's probably not the best thing to do. I am a big educator of doctors. Most of what I do here in Canada is educating doctors, how to treat chronic pain, acute pain, so they doesn't become chronic. Yes, do a good physical examination. Talk to your patient. If your patient has red flags that suggest this could be a.

tumor, a metastasis of a cancer. This could be a fracture. This could be an inflammatory process because my patient is having fever or this could be an infection in the bone because the patient uses IV drugs. They inject drugs and now a bacteria can be growing in their vertebra. So if you don't, if you're not concerned that it's one of those things, don't even order imaging. The guidelines say if you order imaging, MRI, anything, you're going to cause more damage to the person. And that's because we all, we all have some abnormality. Right now, Drew, if I MRI your lumbar spine,

I don't know how old you are, but you're probably younger than I, but I can guarantee I'll find some disc problems because research has been done. We'll find disc problems, facet problem. They're not causing you any back pain right now. These are just incidental findings. The problem is when the patient sees that in the MRI and the doctor sees that, they all go panicking, and now they think they need to treat that thing when that thing is actually not the cause of me. It was just an incidental finding.

Yeah, so it sends them on a wild rabbit chase and they think that this disc or bold is what's driving it. And it could lead to... And it could lead to aggressive recommendations of surgery and other things. which often makes the situation worse. No, that's great advice. You know, this goes into this other larger topic that our audience would love to hear from you on. What are the most evidence-based,

adjacent, alternative, and supportive components that you have seen significantly move the needle forward when it comes to all types of chronic pain, but in particular, lower back, shoulder, sciatica, as being the top ones that people are looking for answers on. Okay. My top one right now has always been my top one, but right now I have seen a lot of success is using mind-body interventions, things that fix that pain.

Remember the alarm system that I mentioned in the beginning. When the alarm system is out of walk, is deregulated, that danger signal is going off all the time, talking to a therapist, doing some counseling, some psychotherapy helps to reduce that fear of pain, helps to regain confidence that you can move, helps them to see stressful situations in their daily life that is aggravating, that muscle tension, helps them to become more self-confident and more positive in reducing the thoughts of catastrophization. Like, oh, this is going to get worse. I'll become paralytic and I'll become in a wheelchair and this only to get worse.

So talc therapy, psychotherapy, mind-body interventions are my top one right now. The other one that are holistic in the complementary field, I would say things that help you to relax overall. So I recommend a lot of massage, acupuncture, because they will help to downplay that stress. I didn't mention here in this interview the importance of the parasympathetic and sympathetic nervous system. The sympathetic one is the fight-flight response, the stress response. The parasympathetic is the heal, digest, the system that you cannot be relaxed and anxious at the same time. So if your sympathetic drive is too high, you do need to activate the parasympathetic. So those things that relax the mind and body, and that could include massage, could include manipulation, it could include music therapy, aromatherapy,

whatever it takes for you to activate your parisimpathic nerve system, because that will eventually lower the sympathetic, and the sympathetic nerve system is driven by adrenaline, not adrenaline, cortisol. So once those substances reduce, because those substances, adrenaline, cortisol, they make the pain more intense. They amplify pain. So then the person will feel better by consequence. And of course, exercise and sleep. But complementary alternative medicines. Also, the person needs to be careful not to become dependent on them. I tell my patients, okay, go to acupuncture, some sessions,

but don't do acupuncture for the rest of your life every week. You do need to stop, to not become dependent on them, and then become self-resilient, self-management. It's learn things for yourself that you can do for yourself, that you don't depend on something. You know, earlier in your interview, you were saying that one of the challenges is we all just sit and we don't move our bodies throughout the rest of the day. What are some of your do's and don'ts and tips for when it comes to many of us that are watching even today on YouTube are sitting down? We're sitting in our jobs.

We're sitting in the car. What are some things that people can be doing to be mindful of how they're sitting, have breaks or other guidelines that could follow so that we don't overabuse our body through all this sitting? First of all, do the exercise, the movement that you enjoy. Don't try to do something that you don't like because you're not going to adhere to that. Find something that you like. It's playing volleyball. It is weightlifting, whatever it is. Find something and adhere to that.

Try to do at least three times a week. So also don't do once a week. Try to do, you know, spread throughout the week. If you can't get a chunk of exercise, because you say, I don't have one hour to do exercise. do snacks. Break down that routine. If it is stretching, aerobics, some weightlifting, resistant exercise, you don't need to do all of them at once, like 90 minutes doing those. You can take snacks, break down into small chunks. So then at least you can achieve those goals. The goal is 150 minutes per week. What about posture of sitting or getting a high-quality chair? Do those things make a

difference? Well, if you see my chair, it's not the most expensive chair. I cannot show you, but it's not an expensive chair, but I bought this backrest. I had bought an expensive chair, and it was horrible. I couldn't, you know, I couldn't work well. It didn't support my back. I like space to move my shoulders, and that was blocking my shoulder. But then I bought a less expensive chair, a back rest to feel that space here of my lumbar spine, and I'm fine. So what I recommend my patients with back problems is it doesn't need to be the most expensive one, but it has to be one. Sometimes it is the most expensive one, who knows, but it has to be one that supports

your back, that you can relax, that when you're sitting, you're not thinking about your back, that you're comfortable. You know, the seat, not too hard, not too soft. And for each person is different. So they do need, go to a store and test some different ones, buy something that you can have a refund if you don't, because that's what I did. I bought one very expensive, many, when I renovated this office.

And then I had to return because I really couldn't use that one. So buy one that you can return and get a refund if possible. And try. The same thing for pillows and mattresses. There is no recipe, Drew, for, you know, you have to buy, this pillow or you have to use this mattress. Each person is different, but they need to find what it takes. And so go to a mattress store and stay there for about two hours and try one, try another

one, try another one to see which one you feel better. Some people like, you know, the harder mattress. Some people like the softer one. There is really no recipe. And we know too that really the mattress, the chair, the pillow. They're not the main drivers of chronic pain. We know now because there has been some trials, they gave the best pillow to people and they compared to a less, you know, exciting one. And there was no big difference to treat people.

So I would say don't spend too much money too on the most expensive thing. You may be surprised that the cheaper mattress pillow or chair might do the thing for you. I further explore the brain pain connection in my conversation with Dr. Howard Schubner. Dr. Schubner's work challenges traditional beliefs that pain is solely the result of physical injuries. And in our conversation, we discuss how the brain often generates pain in response to an unresolved stress or trauma. Let's listen in as Dr. Schubiner details different models for understanding chronic pain and introduces his groundbreaking approach to treatment. 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 see, I see, studied 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 backpack. They're much caring 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 it. 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 be. 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 dramatically soared in young people? in the last 20 years, anxiety and depression. What else has risen is fatigue? And so we need, 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, that I can tell you for sure. Tell us a little bit more about the bank 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 that we'd be around. 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. 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, nail in their head. There's some guy famous story had shot a nail in his, he read into his head, didn't notice, kind of. He thought the nail went out 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 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, 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. It is mind-blowing when you think of it that way and it leads to a whole bunch of questions 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 this 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'll 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 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 Biosyncosocial model. And the Biosyco-Slocial model is the dominant model throughout all of pain management in the world and all the top centers that do pain management use the Biosyco-Slocial model.

I trained in the Biosco-Slocial model. I have a picture of George Engel on my wall up on top there, who developed the Biosco-social 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 for. 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 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 add, 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. 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, retreating chronic pain, chronic back cream, chronic fibromyalgia pain, chronic headache pain, et cetera, 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? 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 moment, if you take the view that at least some of the people, I say it's a vast majority, 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 than part. 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 biocicosocial 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 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 back pain. 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 the style. That's astounding.

That's astounding. So it's possible. That's what we're seeing. There's hope. There's hope, which is a beautiful, 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.

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's, is 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-backman. Those studies, the research studies where they compare those injections versus placebo injections show no difference. I mean, this is the 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 practices 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 is doing it is making money. The hospital is making money. This is all fee for service. 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 range from not understanding and just doing the thing that you. 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. 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 the 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 no pain. 30% are going to have dys bulging with no pain at all. These are 30-year-olds and their MRIs are going to be abnormal with no pain. Why are the MRIs abnormal with no pain?

Because an abnormal MRI for these types of mild findings is normal. Is normal. 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.

You get wrinkles, they get a little bit of gray hair when they're in their 30s or 40s. Now, if you take 50-year-old, and you do MRIs on them who are healthy and have no back pain at all. 60% of them are going to have degenerative this and 50% are going to have bulging discs. 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 this is a high likelihood that the MRI is going to show some of these abnormalities, well, gene desk, even herniated this,

spinal stenosis, just atopathy, arthritis. All these things are seen in 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 healthy 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 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, 90 plus percent, there's a huge number. going to tell you it's structural. But it turns out 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 they're going to come. criteria there, Gene. 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 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 individual. that have had adverse childhood experiences and how that could be, in some instances, be corresponding to pain 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 to 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? 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 to speak in front of a large audience. You could, you know, you could, I remember the other day 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 conscious in short. 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 glass.

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 I, 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 come home, he'd be in a horrible mood, 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 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 unpredictable. 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 works, and the brain has a memory and remembers certain, he remembers the traumas in your life, and remembers 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 and 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. The first step is understanding how the brain works, that 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 thing. 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 people someone comes to me in their 40s or 50s and they say, well I've got this this neck pain, let's say, and I'll 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. 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 neck. 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 talked 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. So we're just using common sense, and that's what we used in that research study 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 are a kid. So now you're being loving and caring, 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 start beeping. And as 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. It's different. 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. We're human beings, and we're so human beings, our social. beings and their emotional means and their 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 died in an early 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 is not, you know, this has been written about 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 having pain or fatigue or anxiety or depression and some manner. And so, so, so that 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. Furthering our understanding of the way that emotions, past traumas, and lifestyle practices all play a role in driving chronic pain offers a profound opportunity. for healing and addressing the true root causes of pain and providing alternatives beyond traditional pain suppression strategies. And this understanding provides alternatives beyond traditional pain suppression strategies which are doing their best, but often falls short for the population. If you're

interested in hearing more from Dr. Schubner and Dr. Andrea Furlin and the specific tools that they like to use to assess in combat pain, you can check out their full-length episodes in the show notes below. And as always, if you've enjoyed this conversation and know someone in your life who might benefit from this information and is navigating the topic of chronic pain, please consider sharing this episode with them. Until next time, Drew Perot, signing off, thank you for tuning in.