Feel Better, Live More with Dr Rangan Chatterjee - BITESIZE | How To Heal Chronic Pain | Dr Howard Schubiner #447

Episode Date: April 25, 2024

CAUTION: This podcast episode contains swearing. Headaches, migraine, back, neck or joint pain, irritable bowel syndrome (IBS), fibromyalgia – they’re just some of the common causes of chronic pain, which is estimated to affect between a third to half of all UK adults, or just under 28 million of us. Feel Better Live More Bitesize is my weekly podcast for your mind, body, and heart. Each week I’ll be featuring inspirational stories and practical tips from some of my former guests. Today’s clip is from episode 310 of the podcast with Director of the Mind Body Medicine Center in Michigan and author of Unlearn Your Pain, Dr Howard Schubiner. Emerging neuroscience tells us our brains actually create what we experience in our bodies, through a process called predictive processing. Pain doesn’t come from the body part where it’s felt, it’s created by our brain, signalling that something needs attention. Howard believes that in many cases of chronic pain your brain has created a neural pathway which remembers the pain and keeps you trapped in a vicious cycle.  In this clip he explains why it’s not ‘all in your head’, your pain is real. And there is something you can do about it.  Thanks to our sponsor https://www.drinkag1.com/livemore Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Show notes and the full podcast are available at drchatterjee.com/310 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Hosted on Acast. See acast.com/privacy for more information.

Today's Bite Size episode is brought to you by AG1, a science-driven daily health drink with over 70 essential nutrients to support your overall health. It includes vitamin C and zinc, which helps support a healthy immune system, something that is really important at this time of year. It also contains prebiotics and digestive enzymes that help support your gut health. It's really tasty and has been in my own life for over five years. Until the end of January, AG1 are giving a limited time offer. Usually they offer my listeners a one-year supply of vitamin D and K2 and five free travel packs with their first order. But until the end of January, they are doubling the five free travel packs to

10. And these packs are perfect for keeping in your backpack, office, or car. If you want to take advantage of this limited time offer, all you have to do is go to drinkag1.com forward slash live more. Welcome to Feel Better Live More Bite Size, your weekly dose of positivity and optimism to get you ready for the weekend. Today's clip is from episode 310 of the podcast with director of the Mind Body Medicine Center in Michigan and author of Unlearn Your Pain, Dr. Howard Schubiner. Chronic pain is estimated to affect between a third to half of all UK adults. And Howard believes that in many cases of chronic pain, your brain has created a neural pathway which remembers the pain

and keeps you trapped in a vicious cycle. In this clip, he explains why it's not all in your heads. Your pain is real, and there is absolutely something that you can do about it. This idea that when we experience pain, most of the time there's nothing actually structurally going on in our body, I think it's quite profound for people because I think we grow up with the understanding

that if we have pain, there's a physical cause of that pain. What we kind of think is every time someone has pain that there must be something wrong with their body. And it turns out the vast majority of people who have chronic pain actually don't have a structural problem in their body. Most people with acute pain probably do. And if you break an ankle, you want pain. It's a message that your brain is giving you to stop. Don't walk on a broken ankle. But it turns out if you have a broken heart, you might get chest pain.

But it might be due to your brain giving you the message that there's something amiss, there's something wrong in your life. The pain is not the problem, it's the solution. It's the solution that our brain has come up with to alert us to a problem. Your brain is saying like, look, I'm worried about you. There's something wrong. There's something amiss. When we can understand that, people can understand that the symptoms they're getting in their body sometimes, and this is really hard for some people to hear, they're a blessing in disguise. They're pointing us towards something that we need to do or we need to take care of.

Help us understand that. What's going on? How does the brain generate this experience of pain and why does it do it as well? Yeah. When you break an ankle, it's not your ankle causing pain. An ankle can't cause pain. When you touch a hot stove, it's not your finger. The impulses go to the brain, but the brain decides,

and this is the craziest thing that's true neuroscientifically, the brain decides whether to actually turn on pain or not. And it's there to protect you. There's a guy in Britain, a construction worker, jumps off a scaffolding onto a nail sticking up in the ground. The nail goes completely through his boot. He can see the nail sticking out on the other side of his boot. He starts screaming in pain. He has severe pain.

They rush him to the hospital. They give him IV pain medication when he gets there. And they take his boot off and the nail is right between his toes. There's no injury at all. Is his pain real? Yes, because all pain is real. All pain is created by his brain and his brain predicted, and the science of the brain is called predictive processing. His brain predicted that he should have pain based on the nail. It just made an error, but it created this pain and the pain is real. Never underestimate the power of the brain to create severe symptoms, severe pain, severe fatigue. Research shows, neuroscience research shows that emotions and stress activate the exact same parts of the brain

as does a physical injury. That's how our brain works. So the pain that occurs due to a fracture is exactly the same as the pain that occurs due to a stressful situation that occurs in our life. It's real pain and it can be severe pain. And that's what people say, how can the pain be so frigging severe

and not be due to a structural injury? It's amazing, but it's true. We see it every day. Yeah, and that's, I think, the power of a lot of your work, a lot of your research is helping to give scientific validity to something that many practitioners have experienced, many patients have experienced, that emotional pain, emotional injury can totally manifest as physical pain. You can't understand pain unless you understand how the brain works

and how the brain can create a cycle of pain due to neural circuits that get activated due to stress and emotions and life situations. And then it continues to get activated by this vicious cycle of pain leading to fear of pain, which leads to more pain. In the US, 25 million people suffer with chronic headaches. And so if you have headaches, you think there must be something wrong. There is something wrong.

You have pain. As physicians, we know there are certain structural problems that cause headaches. But the vast majority, 95-98% of people with chronic headaches don't have a structural disorder. And the pain that is experienced in chronic headache and migraine and irritable bowel syndrome and fibromyalgia and chronic pelvic pain, and we've done research and looking at the causes of these, and most people with neck and back pain, we'll talk more about that in a minute. The pain they experience is real. It's not imaginary. It's not in their head. But it is in their brain because of neural circuits in their brain

when the doctors can't find anything wrong, which is the case most of the time. We did a study on chronic neck and back pain, and we haven't published it yet. But a colleague I have in the States examined 220 consecutive patients coming into his clinic with chronic neck and back pain. He's a physiatrist, physical medicine physician. And he determined that 88% of them

had non-structural pain. I mean, that is shocking. Because if you go to a doctor with chronic neck or back pain or a chiropractor, they're going to say, oh, well, you have degenerative disc disease. Look, it's on the x-ray or the MRI. You have got bulging discs. The vast majority of people have those things on x-ray, as I do in my neck, without pain at all. If you take 30-year-olds, people in their 30s, and you do an MRI, these are people with no pain at all. 40% of them have degenerative disc disease. 30% have bulging discs. These are 30-year-olds. These are normal findings that occur with aging. So what happens when you're 50? 50-year-olds, 80% of people have degenerative disc disease with no pain. 60% have bulging discs with no pain. 30% have herniated discs with no pain. These abnormalities go up to 90% when you're 60 and beyond. But these are people without any pain. It's like saying you've got wrinkles on

your skin and that's the cause of your headaches because you have wrinkles or that your hair is getting gray and that's the cause of your migraines. But it also makes people worse. If you have back pain, the more fearful you are of it, it's going to get worse over time because the neural circuits in the brain, you're getting a positive feedback loop where it's pain leading to fear, focus on it, worry about it, frustration with it.

It actually makes it worse because that's how those neural circuits work. And it's all out of, I don't know how to say this nicely, but not understanding the brain and not understanding the data, the scientific data we have about these MRIs. I have found like you, Howard, I think that many cases, arguably the majority of cases with chronic pain, can be healed. In my experience, at least, I'd love your view on that, without using any medication, if you take time to help the patient understand what's going on, get to the root cause. I mean, what would you say to that?

Exactly. It's 100% true. And we have data now showing that. But the most important thing is that it's not all in your head. When a doctor says or anybody says it's all in your head, it's cruel. And it's ignorant because it implies that it's their fault, that they want the pain somehow. The brain can produce anxiety and depression when we're under stress, obviously. The brain can produce fatigue that can be severe and overwhelming. We see that all the time. The brain can produce eating disorders. The reason that my patients and your patients have these conditions is because they're human.

They're just human. They have a brain. They have a body. They react to stress that occurs in life, and everybody has some of these. Everyone does. I like to say when I started my internship, I was a young doctor.

I got diarrhea for six months. Well, was that diarrhea real? Well, it's real. You can see it. But it wasn't because I had something wrong in my bowel, if I can say this on here. I was scared shitless, you know, being a young doctor and making mistakes and hurting people.

And I was just being human. And so it's amazing how powerful our mental experience is in determining how we function day to day in our lives. Now, was there a pushback on this? It is massive. I mean, prepare yourself for

letters and people, you know, really, you know, misunderstanding the idea of the pain being real, of the symptoms, of the suffering being real. You know, and I've been there and you've been there. You know, when my mom was dying, I had, oh, this horrible upper back and neck pain. And it just lasted and lasted and lasted. And when my dad was dying, I had leg pain shooting down my leg. And I still get pains now sometimes, even for no reason. That's the critical thing that we and physicians and PTs and everyone need to understand, to look carefully, to really listen to people.

What is the history of the pain? Because if the pain is turning on and off, structurally, if you break your arm, the pain doesn't turn on and off. If you go away on vacation, it goes away and you come back to work, it comes back again. That's a neural circuit problem. If the pain is triggered by stress, if the pain is triggered by the wind or cold or the weather, there's all these signs and clues that we have as physicians and other professionals to listen to people intently and make sure that we've ruled out a structural problem.

I'm a physician. We're both physicians. We know that the last thing we want to do is miss a tumor, miss an infection, miss an inflammatory condition, miss something. We desperately want to avoid doing that. Now, I know so many people will be suffering or they'll have loved ones who are suffering with some of the chronic pain symptoms and conditions you've mentioned. You mentioned that it's important to properly evaluate a patient who's suffering with chronic pain because of course there might be a structural

component that is amenable to some sort of treatment. Yes, of course. I would strongly recommend your book, Unlearn Your Pain. I think it's really easy to read. It's got the research. It's got some really great practical exercises. A big theme throughout this conversation is that unprocessed emotions that get stored inside of us that we don't do anything with

can, in some individuals, generate pain. Right. What happens is we respond normally with fear of them. There are six Fs. Fear of them, worry about them, worry about what's going on, focus on them, paying attention, monitoring all the time, fighting them, trying to push back, which gives them so much power, frustrated by them because we're angry and upset,

trying to figure them out, going to all sorts of practitioners and therapies, and then finally trying to fix it. But the harder we do all those things, that gives the brain the message there's a problem and it makes it worse. So this vicious feedback cycle of pain and other symptoms leading to these responses, the six Fs, fear being one of the most important, leading to more pain. So when we interrupt that cycle by giving the danger signal in the brain these calming and safe messages, and that's what pain reprocessing is at its core. And we've got a whole bunch of techniques of how to do that so that people can, you know,

step in, you know, do this, do this, do this, change your relationship to the symptom and see what happens. And then when you start seeing, you start investigating, looking, oh, hey, it hurt then, but it didn't hurt then. Oh my God, it is my brain. Oh my goodness, I'm going to be okay.

And then there's that relief. I imagine even that knowledge alone, even if you do nothing else, even when the penny drops inside you that, wait a minute, this is nothing serious physically, this is not anything structural, I'm okay. Like even that must also help in and of itself, I would imagine. The answer is yes.

Just knowing that you're okay can, and maybe 10, 15% of people just turn off that danger signal. Where do things like journaling and meditation fit in here? off that danger signal. Where do things like journaling and meditation fit in here? Yeah. So once you've done the understanding part of it, and then you start doing this pain reprocessing part of it, of lowering the fear reaction, beginning to start moving again. The pain is not the enemy, it's our message. So if you have a child lying in bed fearful of a monster in the closet, you're not going to be mad at the kid, hopefully.

You're going to open the closet door and say, look, there's no monster. You're okay. Lie down with them. Tell them you love them, that you're okay. Read a story. Get them to laugh.

They'll go to bed. That's how we're treating the brain because the brain is just fearful. It's worried about you in the sense of causing these symptoms. And we do this right in the office. And I've got videos of folks in my office where they're having pain with bending over

and then I have them imagine bending over and then it hurts and say, oh, you're imagining bending over and it hurts. Your brain is afraid of you bending over. Oh yeah, that's what's happening. And now tell, you're imagining bending over and it hurts. Your brain is afraid of you bending over. Oh, yeah, that's what's happening. And now tell yourself you're safe and you're not in danger and smile and bend over five degrees and then 10 degrees and pretty soon they're bending over

because those neural circuits are changeable because it's not a structural problem. That's amazing that we see this happening on a oftentimes really quick basis. Not always, but oftentimes. So this is this pain reprocessing part. Now meditation can fit into that because we use mindfulness meditation type practices in this work. And I've been teaching mindfulness since 1999.

And everyone should learn mindfulness. There's no one who's studied mindfulness who doesn't agree with that. Children, everyone should learn it. But the fascinating thing, Rangan, is that in research studies, mindfulness has not been particularly helpful in reducing chronic pain. Why is that? Because none of them are doing the first step of the assessment of categorizing the pain into a neural circuit problem

as opposed to a structural problem. So when you do mindfulness, you're noticing your sensations in your body, but it hurts, it's painful, it's uncomfortable, and you're interpreting those sensations in your body but it hurts it's painful it's uncomfortable and you're interpreting those sensations as being dangerous because there must be something wrong with you you're not getting better you have to reframe first yes you have to recategorize the symptom into basically and this again i'm doing this'm saying this word with love and compassion, and the reality is that this symptom, this pain or whatever it is,

is basically a thought. It's basically created by the brain. And now if you can observe that, now you can step back from it and observe it and just watch it and not try to fight it and be frustrated by it, but set that aside, and then be with it, and see what happens, and then maybe it shifts, maybe it gets a little worse.

Oh, my brain just made it go up. Oh, that's interesting. What's going to happen next? Oh, it just went down. Oh, that's interesting. Oh, it moved over here. And all of a sudden you see, and then it really, as you said, it drops.

All of a sudden you get it. Then we can get into the emotional side of it because you mentioned journaling. So journaling is part of the techniques that we would use on the second part of the treatment, not the pain reprocessing part, but the emotional awareness and expression therapy, which we've developed and worked on. It has components of intensive short-term dynamic psychotherapy that my friend and colleague Alan Abbas is the foremost researcher and teacher in the world on that, plus some internal family systems work as well. So if you put kind of those things together, you start to deal with the emotions of it. And that's a whole other area that can really lead to healing,

healing on the inside. Not just recovery from the symptoms, but using the symptoms as a way to decide what's important in your life. I feel that what you have done, certainly to me, is help people feel less alone. That actually, no, no, your pain is real. Yes, maybe your doctors haven't found anything structural. Maybe you think you're going crazy with pain.

But you're not. It's just that no one's helped you yet get to the root cause. If you want to solve anything, you need to get to the right cause. And maybe there's other medical paths that you haven't tried yet. Let's sort it out, you know, and let's just take it step by step and let's see what happens and let's investigate. Once you have this kinds of information,

now you can look at what's happening over time. And you can look for those experiences that you can have which show that, oh, the pain, this happened in my life and the pain went up. Or this happened in my life and the pain went down. Yeah. Or it's inconsistent. Why is it happening sometimes and not other times? And now that you have a framework for understanding that, you can say, hmm, maybe it is my brain after all. Wow. Wouldn't that be something? Yeah.

Then it's not for everybody. And I don't expect that everybody who's listening is going to like, oh, yay, you know, we found the way. But some people will. Yeah, some people will. I guarantee that. Hope you enjoyed that bite- will I guarantee that hope you enjoyed that bite-sized clip hope you have a wonderful weekend and I'll be back next week with my

long-form conversation on Wednesday and the latest episode of Bite Science next Friday