Finding Mastery with Dr. Michael Gervais - The Science of Pain: Myths, Truths, and Understanding | Dr. Rachel Zoffness

Episode Date: July 20, 2022

This week’s conversation is with Dr. Rachel Zoffness, a medical educator and disruptor who is revolutionizing the way we understand and treat pain. By trade, Rachel is a trained pain psychologist, a Visiting Professor at Stanford, an Assistant Clinical Professor at the UCSF School of Medicine, and a consultant on the development of integrative pain programs around the world.She is also the author of The Pain Management Workbook, which merges pain neuroscience with psychology – brain with body, physical with emotional – to get to the heart of true pain management. If you or someone close to you lives with any kind of pain or discomfort – which I’m guessing is true for many of us – I think you’re going to find incredible value from Rachel. All of us will experience pain at some point in our lives… it’s part of the human condition. But thanks to Rachel, knowing where that pain comes from – and how to better manage it – no longer has to be a mystery._________________Subscribe to our Youtube Channel for more powerful conversations at the intersection of high performance, leadership, and meaning: https://www.youtube.com/c/FindingMasteryGet exclusive discounts and support our amazing sponsors! Go to: https://findingmastery.com/sponsors/Subscribe to the Finding Mastery newsletter for weekly high performance insights: https://www.findingmastery.com/newsletter Download Dr. Mike's Morning Mindset Routine! https://www.findingmastery.com/morningmindsetFollow us on Instagram, LinkedIn, and X.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Finding Mastery is brought to you by Remarkable. In a world that's full of distractions, focused thinking is becoming a rare skill and a massive competitive advantage. That's why I've been using the Remarkable Paper Pro, a digital notebook designed to help you think clearly and work deliberately. It's not another device filled with notifications or apps.

It's intentionally built for deep work. So there's no social media, no email, no noise. The writing experience, it feels just like pen on paper. I love it. And it has the intelligence of digital tools like converting your handwriting to text, organizing your notes, tagging files, and using productivity templates

to help you be more effective. It is sleek, minimal. It's incredibly lightweight. It feels really good. I take it with me anywhere from meetings to travel without missing a beat. What I love most is that it doesn't try to do everything. It just helps me do one very important thing really well,

stay present and engaged with my thinking and writing. If you wanna slow down, if you wanna work smarter, I highly encourage you to check them out. Visit remarkable.com to learn more and grab your paper pro today. And the problem that I see with pain and the way we talk about pain is either your pain is physical and you see a physician or your pain is emotional and you see a therapist. But what neuroscience tells us is that that's never how pain works. It's never either physical or emotional. It's always both. All right, welcome back or welcome to the Finding Mastery podcast. I'm Dr. Michael Gervais, and by trade and training, I'm a sport and performance psychologist.

Now, the whole idea behind these conversations, behind this podcast, is to learn from people who are challenging the edges and the reaches of the human experience in business, in sport, in science, in life in general. We're going to pull back the curtain to explore how they have committed to mastering both their craft and their mind in an effort to express their potential. Finding Mastery is brought to you by LinkedIn Sales Solutions. In any high-performing environment that I've been part of, from elite teams to executive boardrooms, one thing holds true.

Meaningful relationships are at the center of sustained success. And building those relationships, it takes more than effort. It takes a real caring about your people. It takes the right tools, the right information at the right time. And that's where LinkedIn Sales Navigator can come in. It's a tool designed specifically for thoughtful sales professionals, helping you find the right people that are ready to engage, track key account changes, and connect with key decision makers more effectively. It surfaces real-time signals, like when someone changes jobs or when an account becomes high

priority, so that you can reach out at exactly the right moment with context and thoroughness that builds trust. It also helps tap into your own network more strategically, showing you who you already know that can help you open doors or make a warm introduction. In other words, it's not about more outreach. It's about smarter, more human outreach. And that's something here at Finding Mastery that our team lives and breathes by. If you're ready to start building stronger relationships that actually convert,

try LinkedIn Sales Navigator for free for 60 days at linkedin.com slash deal. That's linkedin.com slash deal for two full months for free. Terms and conditions apply. Finding Mastery is brought to you by David Protein. I'm pretty intentional about what I eat, and the majority of my nutrition comes from whole foods. And when I'm traveling or in between meals, on a demanding day certainly, I need something quick that will support the way that I feel and think and perform. And that's why

I've been leaning on David Protein bars. And so has the team here at Finding Mastery. In fact, our GM, Stuart, he loves them so much. I just want to kind of quickly put him on the spot. Stuart, I know you're listening. I think you might be the reason that we're running out of these bars so quickly. They're incredible, Mike. I love them. One a day, one a day. What do you mean one a day? There's way more than that happening here. Don't tell. Okay. All right. Look, they're incredibly simple. They're effective. 28 grams of protein, just 150 calories and zero grams of sugar. It's rare to find something that fits so conveniently into a performance-based lifestyle and actually tastes

good. Dr. Peter Attia, someone who's been on the show, it's a great episode by the way, is also their chief science officer. So I know they've done their due diligence in that category. My favorite flavor right now is the chocolate chip cookie dough. And a few of our teammates here at Finding Mastery have been loving the fudge brownie and peanut butter. I know, Stuart, you're still listening here. So getting enough protein matters. And that can't be understated, not just for strength, but for energy and focus, recovery, for longevity. And I love that David is making that easier. So if you're trying to hit your daily protein goals with something seamless, I'd love for you to go check them out. Get a free variety pack, a $25 value, and 10% off for life when you head to davidprotein.com

slash finding mastery. That's David, D-A-V-I-D, protein, P-R-O-T-E-I-N.com slash finding mastery. Okay, this week's conversation is with Dr. Rachel Zoffness. She's a medical educator and disruptor who is revolutionizing the way that we understand and treat pain. By trade, Rachel is a trained pain psychologist. She's a visiting professor at Stanford, an assistant clinical professor at the UCSF School of Medicine, and a consultant on the development of integrative pain programs around

the world. She's also the author of the Pain Management Workbook, which merges pain neuroscience with psychology, brain and body, physical and emotional work, to get to the heart of true pain management. If someone close to you lives with any kind of pain or chronic discomfort, which I'm guessing is true for many of us, I think you're going to find this conversation with Rachel incredibly valuable. We talk about frameworks. We talk about ways to think about how pain works. All of that is meaningful as part of the healing process. All of us experience pain at some point in our lives. It is part of the human condition. And knowing how pain works and where it comes from and

typical responses to it. That's all part of the management system. And so thanks to Rachel, she decodes how that works and it's no longer needs to be a mystery. And with that, let's jump right into this week's conversation with Dr. Rachel Zoffness. Rachel, how are you? I'm great. How are you? Fantastic. And I've been looking forward to this conversation for a while because, well, you touch a nerve,

pun intended. Wow. Yeah. Pun intended. Yeah. I'm glad to hear that. I've been getting this really interesting feedback for the last two years, which is, I've been public speaking for a while, but I haven't been doing big podcasts until recently. And the feedback has been so fascinating. Like I never really thought of myself as someone who I'm a, I'm a science communicator. I write, but I never thought of myself as someone who spoke and I've been doing it a lot. And I, I enjoy it because it gets the word out to a broader audience. Perfect. Okay. So that audience, we are craving a deeper understanding of what you've come to understand. Just quickly, background, what's your training? What's your

expertise? How did you come to have a deep opinion about pain? So I'm a nerd with a capital N. I happen to love science and neuroscience in particular, and it's how I make sense of the world. As an undergrad at Brown, I studied the science of pain with a wonderful pain researcher who's no longer with us. I ended up doing my honors thesis on the gait control and neuromatrix theories of pain. I ended up getting a master's at Columbia and a PhD at UCSD in clinical psychology. But I always really wanted to live at this intersection of neuroscience and medicine and clinical work and education and science writing. And I get to do that now and I feel

very fortunate, but I also was a child who had chronic pain in various forms. And as an adult, I've had an episode of chronic pain that lasted about 10 years. But that aside, pain is one of the most ubiquitous human phenomena. It is so phenomenally interesting. None of us are going to escape. And I love communicating the science of how pain works because we've all been fed a lie for so many years. So I just have gone further and further down this rabbit hole. I read everything I can get my hands on. And I'm a consumer of pain science. So one of the first principles in my work as a psychologist, as a performance psychologist, is this. And I think it's going to be jarring for you.

And so I would like to have a thoughtful discussion about this. But you might right out the gate say, that's craziness, you know? So I think one of the greatest mistakes that people and or trained professionals make when helping people become the person that they're working on becoming is to alleviate their pain. There's a purpose for pain and those signals while the chronic pain is a little bit of a different conversation here, but pain is providing signals to change. And if we take away those signals, if we take away or adopt a codependent kind of I'll take care of you lenses on things, even though that that's maybe what people are craving, is to know that they're okay, to know that they belong, to know that they matter, that there's a funny little thing that takes place when we work to take away people's pain with comments like, oh, I understand you'll be okay, or it's okay. It's okay. Like things will change. And so I'm being a little, I don't know, glib when I use those statements. But can you just hit on that axiom that one of the great mistakes that we can make

is relieving people's pain? I both agree and disagree, and I'll say why. I think you're correct with acute pain, which is short-term pain, pain lasting three months or less. Pain is this important danger message that teaches us something. Like you put your hand on a hot stove, you learn not to do that. That's an important message. However, what we know about chronic pain is that the brain has become confused and hypersensitive over time. Sort of, there's like this analogous, much like a trauma response where you have hypervigilance and you're extra vigilant of your surroundings. That's what happens with when the brain has chronic pain. So with chronic pain conditions, I have seen an experience that you can reduce pain and I am all about it. And I do not think the amount of suffering that humans

endure with chronic pain needs to continue. And I think there's this narrative in medicine that there's only one way to treat chronic pain and it's with pills and procedures. And that's a big lie. And I don't think people need to live with pain. And I don't think people need to be exclusively reliant on medication for pain. Okay. So let's, before we get into a big lie that we have swallowed, let's, let's parse out some of the particulars around pain, emotional pain. You already hit acute versus chronic, but let's hit emotional pain as it separates from physical pain. And let's also talk about suffering and the difference between suffering and pain. Dr. Anneke Vandenbroek Gosh, talking to psychologists just

makes me so deeply happy because you frame questions differently. You know, I speak with a lot of physicians who I also appreciate. So, right. So, so I am going to answer your question, I promise. And here's how I'm going to do it. We've all been told that pain is this purely biomedical problem that has just to do with anatomy and physiology, just to do with the body. But what neuroscience says is that that is not correct. Pain does not live exclusively in the body. It does not live just in your back. It does not live in your bad knee. It actually is constructed by your brain, by your brain. Your brain produces pain. Now, the brain works in a funny way. It's not like there's just one place that constructs pain in our central nervous system. Lots of parts of the central nervous system contribute to the experience that we call pain, including the

brain's limbic system. The limbic system, as you know, is our brain's emotion center. So I'm going to say this to you differently. 100% of the sensory messages from your body, whether it's acute short-term pain from a broken ankle or long-term chronic back pain, filter through your brain's limbic system before they become the thing we call pain. Emotions inform the pain experience 100% of the time. Pain feels different when you're stressed and anxious and depressed than when you are not. So your question, pain always is both physical and emotional 100%

of the time. And that's the question I get asked most as a pain psychologist. And maybe we'll talk about what that means and what that is, because no one's ever heard of that before. Why would you go to a psychologist for a physical problem? And what I want to share with everybody is that pain is never a purely physical problem. It's always both physical and emotional. So when people ask me, oh, you're a pain psychologist, do you treat physical pain or emotional pain? Now I just nod my head and I say, yes, because if you want to treat your bad back and your bad knee, it turns out science says, if you're not treating anxiety and depression and untreated trauma and all the things that are

going on in your life, in your toxic interpersonal relationships and environmental stressors, like a pandemic, you're not actually treating pain. So what, okay. I spent a bit of time in, as a partner in a surgical center. So there was 20 plus docs that pulled their money together, built a surgery center. And one of my roles with that organization is to help with selection. And one of the things that we found out quickly is that people that were, there were some candidates that were better suited for surgery, meaning that some were absolutely not ready from a psychological emotional standpoint. And it was a bizarre understanding that I came to learn is that there is a difference between

health candidates that make for good patients and candidates that it's too dangerous for them. And here's what we found out is that candidates that were highly anxious, bled more, had more complicated post-surgery events, and didn't return to full functioning as fast as their counterparts, which were people that didn't suffer from a clinical psychological disorder. So when you say that pain is always emotional and physical, what about pain that doesn't have physical manifestations other than the physicality of emotions? Tell me what that means. So emotions are physical responses and feelings are the way that we interpret that physiological response. So an emotion is when you look at me and

you see that my face is flushed, my hands are shaking, my breathing's changed. There's emotions taking place a la motion. There's a physicality to it. Feelings are private. Feelings are my interpretation of that physiological change that's taking place. And so I feel sad. Um, but the physiological expression of sadness, call it depression, maybe is, uh, like a depressed mood, a low elevation, you know, my pupils do something that I don't have to fill down the lines. So, um, so there are experiences where it is emotional only, but doesn't have what we would normally consider a physiological condition, like an ankle or back or something else. asking. Here's the problem. Emotions are somatic by definition. And what that means is emotions don't just live in your head. They also come out in your body. So if you are anxious, anyone who's ever been anxious knows that your hands will get sweaty and your mouth will get dry and your heart

will race, or you'll get butterflies in your stomach. And those are the, so that's the somatic component of emotions. That's true. So some people with anxiety or who have ever experienced a normal amount of stress or just anxiety or fear before giving a presentation will say, you know, I'll get a stomach ache. I'll get nauseous. I'll get pukey. I'll get the runs or cramps or whatever. And that is healthy and normal. That is normal. Emotions are somatic by definition. For some reason, we pathologize that and we give it all sorts of names, but it is normal for emotions to manifest physiologically. That's not a disorder. That's not weird. And the problem that I see with pain and the way we talk about pain is either your pain is physical and you see a physician or your pain is emotional and you see a therapist. But what neuroscience tells us is that that's never how pain works.

It's never either physical or emotional. It's always both. It's always both. It's always both. So if you're trying to treat someone with chronic stomach aches, which I do all the time, it's very important to find out what their environmental stressors are, what their relational stressors are, how are their interpersonal relationships? Are they dealing with anxiety and in what situations? It's normal and natural for humans to experience anxiety. So I have a different take on this than a lot of therapists. I think a lot of therapists frame anxiety as a mental illness. And I actually think it's a normal part of the human condition. I've never met a human being who hasn't experienced some degree of anxiety and had

that express in some way somatically because that's how the sympathetic nervous system works. So all emotions all the time are physical. They have a somatic component. So, so my, in my, my work, I'm always trying to bridge this gap between like, is it physical or is it emotional? Because it's always both. That's just what science says. When typically in our training, your training, my training, we've been taught that there's cognitive anxiety and somatic anxiety. And then there's a combination of the two. And somatic is like, I just, I'm, you know, I just, my body, you know, I just feel so anxious in my body. And then cognitive is like this excessive worry.

And so it really does have like a more of a psychological bend to it. It's an excessive thought pattern about all the things that could go wrong. So am I hearing you say that you want to up-level that insight based on neuroscience to say cognitive anxiety alone is not ever going to be a full enough picture to talk about this disordered way of thinking? So what I want to do is just what science tells us about anxiety and emotions in general, which is that it's all connected. The brain is connected to the body 100% of the time. There's no such thing as having a thought that doesn't impact your physiology. And there's this great, if you've ever heard of biofeedback, biofeedback is this great treatment for chronic pain. If folks haven't heard about it,

I went to this biofeedback provider. His name is Dr. Pepper, which is of course a great name for any biofeedback provider or any doctor in general. And, which is of course a great name for any biofeedback provider or any doctor in general. And he sat me down in a chair and he said, I am going to teach you to warm your hands to 90 degrees. And I said, I am a neuroscientist and a pain expert, and I don't believe in voodoo. What are you talking about? And he had me, he hooked me up to a machine and the machine was measuring my skin temperature and galvanic skin response, like lie detector tests and muscle tension and heart rate and all these physiological biological processes, which by the way, is why it's called biofeedback because you're hooked up

to this machine and you're getting feedback from the machine about things like skin temperature and heart rate. So you can see in real time what your body's actually doing. And he had me think a host of stressful thoughts as round one. So I started thinking about my list of things to do. And like, I have a million, like I'm teaching at Stanford and UCSF and I'm running a private practice and I'm doing podcasts and I'm trying to write. And I, and my day is like, is really crazy. So I was thinking about my list of things to do. And as I was watching the machine, my skin temperature dropped, my muscle tension spiked, my heart rate ramped up. And, and there's just no denying that the things you think in your head affect your body 100% of the time. So no, there is no such thing as anxiety. That's purely cognitive. That's what science says. There's no such thing. All the things are connected. The brain is connected

to the body 100% of the time. So my job, when I think about treating pain and helping people who are dealing with emotional and mental health issues also is connecting the two. Your brain is connected to your body 100% of the time. Finding Mastery is brought to you by Momentus. When it comes to high performance, whether you're leading a team, raising a family, pushing physical limits, or simply trying to be better today than you were yesterday, what you put in your body matters. And that's why I trust Momentus. From the moment I sat down with Jeff Byers, their co-founder and CEO, I could tell this

was not your average supplement company. And I was immediately drawn to their mission, helping people achieve performance for life. And to do that, they developed what they call the Momentous Standard. Every product is formulated with top experts and every batch is third-party tested. NSF certified for sport or informed sport. So you know exactly what you're getting. Personally, I'm anchored by what they call the Momentus 3, protein, creatine, and omega-3. And together, these foundational nutrients support muscle recovery, brain function, and long-term energy. They're part of my daily routine. And if

you're ready to fuel your brain and body with the best, Momentous has a great new offer just for our community right here. Use the code FINDINGMASTERY for 35% off your first subscription order at livemomentous.com. Again, that's L-I-V-E, Momentous, M-O-M-E-N-T-O-U-S, livemomentous.com, and use code Finding Mastery for 35% off your first subscription order. Finding Mastery is brought to you by Felix Gray. I spent a lot of time thinking about how we can create the conditions for high performance. How do we protect our ability to

focus, to recover, to be present? And one of the biggest challenges we face today is our sheer amount of screen time. It messes with our sleep, our clarity, even our mood. And that's why I've been using Felix Grey glasses. What I appreciate most about Felix Grey is that they're just not another wellness product. They're rooted in real science. Developed alongside leading researchers and ophthalmologists, they've demonstrated these types of glasses boost melatonin, help you fall asleep faster, and hit deeper stages of rest. When I'm on the road and bouncing around between time zones, slipping on

my Felix Grey's in the evening, it's a simple way to cue my body just to wind down. And when I'm locked into deep work, they also help me stay focused for longer without digital fatigue creeping in. Plus, they look great. Clean, clear, no funky color distortion. Just good design, great science. And if you're ready to feel the difference for yourself, Felix Gray is offering all Finding Mastery listeners 20% off. Just head to FelixGray.com and use the code FINDINGMASTERY20 at checkout. Again, that's Felix Gray. You spell

it F-E-L-I-X-G-R-A-Y.com and use the code finding mastery 20 at felixgray.com for 20% off. And you're explaining why if you stub your toe on vacation is very different than when you stub your toe, you know, when you're alone or if you're anxious or, you know, if you're frustrated about something, like it's, it's a very different experience. And do you, have you had that experience as well? Yeah. And I can tell you the science of why. So, so I usually ask my patients who have been in pain for a long time, some for months and some for many years, if anyone has ever explained pain to them and everyone, everyone says, no, no one has ever explained how pain works. So I want to give you a metaphor that will explain the phenomenon of why pain hurts more

sometimes than it does other times. So if you imagine in your central nervous system, which is just your brain and spinal cord, you have something that I'm going to call a pain dial. And there's lots of things that adjust pain volume. So it operates much like the pain, the volume in your car, like on your car stereo, you can turn pain volume up and you can turn pain volume down. So many things adjust pain volume and stress and anxiety is one and mood and emotions is another and attention or what you're focusing on is a third thing that adjusts pain volume. So what science tells us is that when stress and anxiety are high and your body is tense and tight and your thoughts are worried. And as we know, that's all connected. Your brain sends a message to your pain dial,

amplifying pain volume. So pain will feel worse in situations when you're stressed and anxious. That's thing one. Thing two is mood and emotions. So what we know is when emotions are negative, you're miserable and depressed, and you're stuck home in bed, which happens to a lot of people with chronic pain, your limbic system will amplify pain volume. So pain feels worse when mood is negative, you're miserable, you're depressed, you're angry, you're frustrated. And thing three is attention. So when you are focusing on your pain, you're thinking about your pain, you're worrying about your pain, you're stuck in bed, stuck at home, you're not going to work. You're not engaged in

activities. You're not engaged in your life. your prefrontal cortex at the front of your brain will amplify pain volume. It sends a message to your pain dial, raising pain volume. So pain feels worse when you're stressed, when you're anxious, when mood is low, you're miserable and depressed. And when you're thinking about your pain and focusing on it, but the good news about the pain dial is that the opposite is also true. The opposite is also true. So what science says is when you are relaxed and calm, your muscles, your body are relaxed and your thoughts are calm. Your brain sends a message to your pain dial, lowering pain volume. So pain feels less bad when you are relaxed, which is why a lot of pain management treatments, at least the good ones, focus on things like relaxation and mindfulness, even though it

sounds ridiculous. And it's also why muscle relaxants, by the way, are prescribed and effective for pain. Thing two is mood. So we know science says when emotions are positive, we're feeling happy and joyful and engaged in pleasurable activities. Our brain, our limbic system will lower pain volume. So pain feels less bad when we are happy and joyful and engaged in our lives. And thing three is attention. So when we are distracted, when we're outside going for a walk or we're with friends or we're engaged in a pleasurable activity, our prefrontal cortex lowers pain volume. So I always ask my patients, can you tell me about a

time you were so absorbed in some activity, you briefly forgot about your pain and everyone can give me an example. And that is not magic. That's just your brain's pain dial. So to your question, which I promised to answer, when you stub your toe on the day you get fired from work, there's a lot of stress there. There's a lot of contextual factors. There's a lot of emotions and a lot of factors that are going to raise and amplify pain volume versus stubbing your toe when you're on vacation on the beach with friends, you know, drinking Corona and your brain will lower pain volume because of contextual and emotional cues. And it turns out that context and social relationships and

emotions and thoughts always, always matter in the experience of pain. Set and setting is a phrase that, you know, is kind of actually born out of the psychedelic practices. And it holds true here for pain as well as it sounds like what you're talking about is that your mindset and the setting that you're in as a direct relationship to the way you experience pain. Absolutely. Okay. And where do you put purpose? Do you put that into thing three, the like third bucket of attention? Because what I've, what I've noticed is that people that have a very clear purpose, you know, like they, it's almost like pain becomes less important. Like it's the tale of two peas. When purpose is really big, then you like almost dwarfs pain.

Right. So I think in order to talk about that, we have to talk about the big framework of what pain is. So pain is the body's danger detection system, and it exists to tell us that something may be wrong. But the problem with that is sometimes that alarm goes off when it doesn't need to. For example, with chronic pain, that alarm is going off constantly, chronically, because the brain has become sensitive, right? And as we've said, there's a lot of factors that change pain volume and that inform the experience that we call pain. So to get to your question about purpose, we need to talk about what pain is. So we said at the beginning that pain is never a purely biomedical thing. We've all been told this big lie that pain is a purely biomedical problem just to do with your back or your knee. And you should go get 462 back surgeries to cure your pain. And we established that pain actually doesn't live in your back and it doesn't live in your knee, even though things of course can go wrong with the back and can go wrong with the knee. And the reason we know that pain lives in the brain and not the knee is because of this condition called phantom limb pain, right? So phantom limb pain is

when someone literally loses a limb, an arm or a leg, and they continue to have terrible pain in the missing body part. And if you can have terrible leg pain in a leg that isn't attached to your body anymore, that tells us definitively that pain is constructed somewhere else. And that somewhere else is the brain. And as we've established, the brain uses all available information when deciding whether or not to make pain and how much. So again, if we're looking at pain as a biomedical problem, we're just looking at anatomy and

physiology. But what science tells us is that pain is a biopsychosocial phenomenon. And what that means is, yes, of course, there's biological components to pain. There's tissue damage and system dysfunction, diet and sleep and exercise matter, inflammation matters, but that's only one third of the pain problem. And if we're only looking at biological components of pain, we are quite literally missing two thirds of the pain problem. So biopsychosocial means there's biological components of pain. There's also psychological components, and there's a lot of stigma there,

as you know, as a psychologist, if you talk about mental health or anything to do with emotions, a lot of times there's stigma involved with psychology, but in this bubble, in the psychological bubble, we have thoughts, we have emotions, we have memories of past pain experiences. We have coping behaviors, whether you're staying inside and in bed for a year, or whether you're moving your body, you're seeking help, you're using all these relaxation strategies. How are you coping with your pain? There's so many things in there that we need to target if we actually want people to get well. And then we have the social or the sociological domain of pain. And that's really everything else. It's socioeconomic status and access to care

and race and ethnicity and your relationships, your family relationships, and whether or not you have social support or you're isolated, and it's your larger context and environment. So pain lives in the middle of those three domains bio psych and social all the time so your question is what about purpose life purpose so so it's a really good and interesting question so it just depends on how you frame that in my mind um having done a lot of reading about man's search for meaning um and that sort of line um of existential psychotherapy ervin yalom is a friend of mine he wrote a book on existential psychotherapy very Irvin Yalom is a friend of mine. He wrote a book on existential psychotherapy, very cool book. It turns out that not having life purpose and meaning makes people

depressed and anxious. And what we understand about pain volume is that that is going to amplify pain. And conversely, if pain is a biopsychosocial problem, if you have life purpose and your life has meaning and it motivates you and it gets you out of bed in the morning and it gets you doing things and you experience pleasure and you're distracted, you're getting out of bed, you're doing things, pain volume will be lower. So there's a lot of these complex relationships that sort of, in my mind, all roads lead back to the pain dial and pain volume and how we can control that in any given day. Very cool. And my experience with many people is that, you know, when purpose is really big, pain is felt in a different way. And so kind of purpose wins. And when pain is really big,

and the purpose is not quite as clear, pain wins. And maybe a more eloquent way of thinking about it is that many people, their purpose becomes alleviating pain and they become professional in that role. Like they become great at working to alleviate pain, but there's such, and I had chronic pain for two years. It was a surfing injury that compromised C3 and C4 in my back. Wow. And so I know what it's like to try to reorganize myself to not experience pain.

Yes. And if you were to ask me at that time, well, and you say, well, Mike, you know, like, how's your emotional life? I'd be like, it's fine. But this fucking thing is like brutal. And then so there I am agitated and right. And coming right back to the physiological or the physical experience of the pain. And, and yeah, stress was really high.

And I had a thing that you could see, and I want to get into this with you. You could see the abnormality in my spine and it was bad for me. You for me. I could feel it. And finally, I went into a surgeon and he popped up the film. This was before they had digital MRIs. It was a screen of an x-ray. And he goes, oh, now this is a white coat, right? He goes, oh, are you okay? We're both looking at the film. I instantly got worse. Oh, God. I said, what do you mean, doc? You know?

And he goes, well, you've got this really big bulge. Most of them pop out, you know, herniation. This one is pushing in and it's pushing on your spinal cord. Like, are you okay? And I was like, no, I'm not okay. That's why I'm here. I know I got worse. I know instantly from that moment.

Say what that means. Got worse. Say what that means. Got worse. I hyper fixed on the visual and my experience of pain- Amplified. Amplified. Yeah.

So I felt physically more pain. This is me looking back. I'm so sorry. Yeah. This is me looking back. And what I wish, your your training that he had it. And I wish I had the insight that I have now. And obviously you have about like, no, no, no. That, that point of data is, um, is, is co-mingled with expertise and confirming of a something. It was just an amplifier for more pain.

You got it. You got it. You got it. Can I say two things about your experience? And I'm so sorry that you, you know, it's so funny. The more I do this, like none of us are going to escape. Not a single person is going to escape without experiencing pain at some point, whether it's like living in an aging body or the pain of childbirth or, you know, it's just, it's part of being human, which is actually why I liked your question at the beginning.

Like, you know, you can't take pain away. Of course you can't, but there's ways of navigating this that can help people suffer less. And if we can do that as healthcare providers, isn't that our job? Isn't that our goal? So, so just to say, we've all heard this word placebo, right? Placebo, the placebo effect. The placebo effect is when you take a sugar pill and you feel better, you have a real thing. By the way, the placebo effect for Parkinson's disease, that's real. Parkinson's is a real thing. There's brain changes. You can see them.

It's actually thought that 70% of the effect of antidepressants is a placebo effect. There's papers everywhere on that. So placebo effect is when you take a pill or someone says to you, you're going to be fine. You're fine. You're going to be fine. Placebo effect, you magically get better. You have a real problem, a real thing, but you heal. So we think of placebo as sort of this like magical, this it's actually sort of this thing we toss out. When I say that, like when we go and get our degrees, our PhDs, our MDs, they'll say like, you know, uh, but this medication was only a little bit better than the placebo effect. So we're going to discard it. And when I look, knowing what I know now about pain, the placebo effect quite literally is

self-healing. Someone gives you a sugar pill, which is not a medication and your pain goes away or your Parkinson's disease remits your movement is better. You can suddenly walk again. That quite literally is called self-healing. I am not a voodoo practitioner. I'm a neuroscientist. I believe in all the things. There's a guy named Ted Kapchuk at Harvard who's studying all this. There's an abundant amount of research, but there's also the opposite. We've all heard of placebo. Very few people have heard of nocebo. Let's talk about nocebo. Nocebo is the opposite. It's when someone gives you a message or gives you a thing and you get worse. I had a patient, a child with chronic migraine and his neurologist said to him,

oh, your mom has chronic migraine. You're going to have these for the rest of your life. Now, given what we know about pain science, nocebos, quite literally, amplify the brain's danger alarm. Pain is the body's danger detection system. If you give someone a danger message, you are going to amplify the danger alarm. If you give someone a safety message, you're going to lower the pain alarm. So you bet your ass, every single person who comes into my office, I tell them that I can help them. First of all, because I believe it. Second of all, because my patients get better. Like UCSF and Stanford send me the patients that they can't help and God bless. Like I am so glad to get the people who have been on 40 medications because I

know I'm going to help them. So the message that you were given is called a nocebic message. And you're right. You're right. That health care providers do not get trained in pain. Here's a fun statistic for you. I wish we were both drinking bourbon. It would make this go down easier. 96% of medical schools in the United States and Canada have zero, zero dedicated compulsory pain education, which is why we continue to throw pills at pain. Despite the fact that we know that that is not the treatment for chronic pain. It's not the treatment.

Yes. Medication for acute pain. And of course you can feed medications into chronic pain treatment, but that's not the sole treatment ever. And it's not a magic fix. So you were given a nocebic message. I wish that hadn't happened to you. Um, but we need more providers trained in pain. And the funny thing is therapists like you and I get almost zero training in pain. Like it's just not part of the training for most psychologists. And by the way, it's not really part of the training for nurses or physical therapists or occupational therapists. There's just very little training in pain, which is why I go on podcasts like yours, because I am of the mind that every single person deserves to understand pain. And I am tired of nocebos. I am so tired of them. I love it. Your passion is noted and it's,

it's debilitating for people. And because there is a physiological and physical experience of something that is debilitating. And then when you add on top of it that, yeah, I don't know, this is pretty bad. It's a significant spiral from that point forward. And that's right. You know, and this is where, like, when we start to think about pain, I was writing a book with a friend of mine and chapter six was titled making a case for broken bones and it was the importance of getting out on the edge of a tree limb to understand you know kind of the potential and

risk taking and all this kind of activation that comes with exploring and yeah sometimes tree tree limbs are going to break and you're going to fall and you're going to break something on your body and it was we're a bit too callous in the, in the, in the article, which was turning into a book, but we pulled it out long way of saying that the reaction that people have early in life, when, when you fall or your kid falls, let's say, and the parents run over and like, Oh, are you okay? And then you see the toddlers like kind of like, oh, something kind of stings, but then they're trying to sort it out

and they look up and they see panic in the eyes of the adults that all of a sudden they start to cry and they start to like get worse. And then like, it's this thing. And so we have a response that's built in, not lovingly as an intent, but like from a very early age that there's danger

in the world when you fall. So what do we do? And you just, right. We put bubble wrap around people. And this is a constrictor of human performance, human potential that- Totally. Because we don't get out on the edge to understand pain, to understand how to work through it. And I will tell you, when I was in that chronic stage, it was my wife that was like, okay,

so what are you gonna do about it? She's like, listen, like, don't talk to me about it anymore. You're like, whoa, that's cool. Well, I knew flat out we made public vows and we meant it. And she had my back for sure for our whole, we've been married like 30 some years. And like, I knew the love was real, but she's like, right, but what are you gonna do about it? Yeah, okay, I understand it, but what are you gonna do about it?

And it was a great gift. I was like, shit. Yeah. What am I going to do about it? And so it like put me into a proactive mode, which is like, how am I going to become an agent? How am I going to have high agency in my life to be able to solve something that this white coat just, you know, like he didn't have the answers other than get out like, um,

other than danger, danger, danger, hammer and a saw and, you know, right. So anyways, here's what you just beautifully did for me. You just summarized why the social domain of pain is so critical. I use that, that, that study of the children on the playground all the time. You're exactly right. If a child falls on the playground and the parent has a, Oh my God, panic response. Research shows the first thing a child does when they fall is they look at a parent's face. If a parent panics and is very stressed and anxious, the child will cry. If a parent calmly says, Oh honey, you're okay. I'm going to kiss your boo-boo and let's go back to playing. The child will not cry. There is always research

shows a social component to pain. The second example you gave was how your social environment, your relationships respond when you have pain. Are they validating? Do they validate your experience? Are they supportive? Do they help get you back to life? So, you know, there's a, there's a, there's a lot to say there, but what your wife did was to say, I see you, I hear you. I know you're suffering and let me give you your agency back because what pain does is pain takes away power. That's just what it does. It takes away your sense of power over your body and over your life. And I think it's really important to tell people all of this information, because when you teach people about the pain dial, what you're actually doing is giving them their power

back. You're saying there's a lot of things you can do to change your pain. We can target your cognitions about your pain in your body. I'm broken. I'll never get better. We can target emotions. We can target coping behaviors. Like we can stay in bed because it hurts. And understandably, I did that for a year at the beginning of my chronic pain journey. Or we can go back to our lives once we understand the science of pain and learn that just because it hurts, it doesn't necessarily mean your body is in danger. And maybe we can talk about the tale of two nails to sort of elucidate that point. But there's a lot of ways to change the pain experience beyond medications.

And it's very important to feel empowered. So I love that you just described for us, we were talking about how pain is bio psych and social, and that's a great example of the social domain of pain. And by the way, powerful. Yeah. And, and by the way, the nocebo message you got from your physician is also the social domain of pain. When an expert says to you, man, you're effed, your brain of course is going to launch into danger mode. So that is going to also inform your pain experience. So there's all these factors working together all the time. Years of training in the laboratory and from higher education institutions. And that approach that my wife gave me was materially,

it was a game changer. Even my work with other people, it's like, see you, hear you. And what are you gonna do about it? Exactly. See, hear you, what are you gonna do about it? It's like that question. What are you gonna do about it? It's rad. It's really good. Okay. So what are you gonna do about it? Okay. So what's the game plan? Okay. Oh shit. that sounds brutal, but what do you, okay. But like, what are we going to do here? Yeah. We should make that into a t-shirt. I see you. I hear you. And what are we going to do about it? Finding master is brought to you by cozy earth. Over the years, I've learned that recovery doesn't just happen when we sleep. It starts with how we transition and wind down. And that's why I've built intentional routines into the way that I close my day. And Cozy Earth has become a new part of that. Their bedding, it's incredibly soft,

like next level soft. And what surprised me the most is how much it actually helps regulate temperature. I tend to run warm at night and these sheets have helped me sleep cooler and more consistently, which has made a meaningful difference in how I show up the next day for myself, my family, and our team here at Finding Mastery. It's become part of my nightly routine. Throw on their lounge pants or pajamas, crawl into bed under their sheets, and my nervous system starts to settle. They also offer a 100-night sleep trial and a 10-year warranty on all of their bedding, which tells me, tells you that they believe in the long-term value of what they're creating. If you're ready to upgrade your rest and turn your bed into a better recovery zone, use the code FINDINGMASTERY for 40% off at

CozyEarth.com. That's a great discount for our community. Again, the code is Finding Mastery for 40% off at CozyEarth.com. Finding Mastery is brought to you by Caldera Lab. I believe that the way we do small things in life is how we do all things. And for me, that includes how I take care of my body. I've been using Caldera Lab for years now. And what keeps me coming back, it's really simple. Their products are simple and they reflect the kind of intentional living that I wanna build into every part of my day and they make my morning routine really easy. They've got some great new products I think you'll be interested in,

a shampoo, conditioner, and a hair serum. With Caldera Lab, it's not about adding more, it's about choosing better and when your day demands clarity and energy and presence, the way you prepare for it matters. If you're looking for high quality personal care products that elevate your routine without complicating it, I'd love for you to check them out. Head to calderalab.com slash finding mastery and use the code Finding Mastery at checkout for 20% off your first order. That's Caldera Lab, C-A-L-D-E-R-L-A-B.com slash Finding Mastery.

Really quickly, just for color, for folks that are struggling with a loved one or themselves that are listening, is that I know what I wanted. This is with hindsight. I wanted somebody else to heal me. I wanted, I wanted hands on me. I wanted, I was craving when you talk about the power was stripped away. I felt it. I don't know if you felt it, but I would anybody please, you know? And so that John Sarno's kind of foundational book, I'm sure you've read it more than once, but like healing back pain, it just reorganized a way of thinking, which is to your point, which is like, okay, it's the solution is not going to come from him or her or them. That's not where it's going to, it's going to come from the inside out.

And that's why MBSR, you know, Jon Kabat-Zinn's work on mindfulness-based stress reduction, as you're nodding your head like, yeah, okay, that's a really great way to go. And, and, and, and, you know, there's lots of small, thin slices of ways that are very powerful. But I just wanted to hit that note that, that craving for somebody outside of small, thin slices of ways that are very powerful. But I just wanted to hit that note that that craving for somebody outside of me, because my power felt like it was stripped, because all I could think about was avoiding pain and the shitty pain I'm feeling, debilitating in nature. I was seeing other people as being the sources of my healing.

And so physical therapy, this, that, and the other were, were all modalities that just felt like I couldn't get enough of it. Yep. What you're saying of course is absolutely valid and true is that when people have pain, a lot of things happen. Again, your power gets taken away. And of course we want someone to heal us. And part of the reason for that is because there's no training in pain. And I wasn't kidding when I said, I ask every single patient, like I teach now the next generation of physicians at Stanford and UCSF. And I asked them oftentimes how much pain training they've gotten. UCSF and Stanford are a lot better than a lot of the other schools that we've got out there.

It turns out, but it's woefully little. And it's even worse for patients for like, no one has explains how pain works to us either. So of course we want the experts to tell us how to heal. And I think that's the purpose today is to say there are many ways to heal. Targeting the bio alone is not sufficient. It's a biopsychosocial problem that requires a biopsychosocial solution. So we want to target cognitions. We want to target emotions.

We want to target behaviors. We want to target social relationships. And by the way, it's the reason I wrote the pain management workbook. Literally, the reason I wrote that book is because a lot of people don't know what to do about pain. They feel disempowered. The resources are not out there. And also they're very expensive. And honestly, the treatment for pain is not just for rich people. That's like unacceptable to me. And things like mindfulness and cognitive behavioral therapy have been shown to be evidence-based for pain, but they're not reimbursed by insurance. Like that's not okay. So I stuck it all in the pain management workbook to target the

biopsychosocial elements of pain. But the people come to my office and they have been to on average, like 14 different specialists on average, 14. So 14 doctors, 14, you know, and they've been on 40 medications on average. It's just unreal. There is a solution for chronic pain. It is absolutely treatable. And part of it is understanding how pain works because you cannot treat something you do not understand. If somebody has a wrist that they've done in and they, you know, let's say that there's no bone structural stuff, but it's a ligament. And it's just every time they get into a pushup position or they get into some sort of compromised joint,

um, thing, they're like, ah, okay. So what, that doesn't feel like there's a social and, or environment, or I'm sorry, or emotional component to it. It purely is when they put themselves in a compromised position that they have, um, a pinch of pain, but it's kind of always low level under the surface. How do you work with something like that? Great. So I'm going to answer your question by telling the story I've been wanting to tell, and it's called a tale of two nails because I like things that rhyme. So there was this study that was done. I loved your article here. Oh, I'm so glad. Yeah.

I love what you did here because it's something that we all learned in graduate school. And like you nailed it in the article that you wrote. Good one. Like, yeah, it was really good. Good one. Yeah. So I'm a columnist for psychology today. And I put out some articles on pain science.

I haven't had much time to write lately, but it's called the tale of two nails. And you can find that article on Psychology Today. But here's the general gist. The British Medical Journal published a paper saying that there was this construction worker on a job site and he jumped off of a plank straight onto a seven inch nail. And that nail drove straight through his boot, clear through to the other side. And the man was in terrible pain. He was writhing with pain and his colleagues picked him up and they rushed him to the emergency room.

And the good doctors removed his boot and they sedated him with intravenous opioids to help him with his terrible pain. And when they removed his boot, they discovered that a miracle had occurred. The nail had passed between the space between his toes. There was no puncture wound. There was no blood. There was no tissue damage, but his pain was real. How is that possible? His brain, AKA his danger detector, used all available information

to determine whether or not to make pain and how much it used information and knowledge about his dangerous work environment. It used memories of past pain experiences. It used visual information like that seven inch nail sticking out of the top of his shoe. It used emotions like panic and the panic he was absorbing from all of his friends standing around him, freaking out. And because his brain determined that his body was in danger, it made pain to protect him. That's your brain's job. It's your danger detector.

And by the way, as we know, no puncture wound, no blood, real pain. Second story, tale of two nails, number two. Second construction worker, apparently the most dangerous job there is, was on a job site and he was using a nail gun and he saw it. It accidentally discharged and he saw a nail shoot across the room and bury in the wall across from him. But the nail gun backfired and it clocked him in the jaw and he had a headache and a jaw ache and a mild toothache. But he continued on with work and life for about six days. And at the end of six days, he turned to his wife and said, you know, I'm going to go to the dentist to get this toothache checked out. Went to the dentist who did a scan of his face and discovered most much

to both men's surprise, a four inch nail literally embedded in his face. And if you see the picture of it, the tip of the nail is protruding into his prefrontal cortex. So real danger, real damage, but very little pain. How is that possible? His brain, AKA his danger detector used all available information to determine whether or not to make pain and how much it used visual cues, used emotional cues. He saw that nail travel across the room and bury in the wall. He believed, his brain believed he was safe. So it did not make sufficient pain to protect him. So the pain system, like every system in the human body, can and does fail. Now here's the important conclusion. You can have hurt or pain in the absence of harm or damage to your body, like a

nail to the boot, but not the foot. And you can have very little pain and even no pain in the presence of damage to the body, like a four-inch nail to the face. And we all know that's true. For example, if you've ever taken a shower and you found black and blue marks on your body, that is evidence of damage to your body without the accompanying pain. Or if you've ever played a really great soccer game or football game and the end of the game, you're covered in blood and you have no idea how it got there, danger and damage to the body without the hurt. Hurt and harm are not the same. And part of treatment, whether it's ankle pain or whatever, is uncoupling hurt from harm, especially with chronic pain. With acute pain, there's often a more likely relationship between danger and damage.

With chronic pain, we know there's an uncoupling. The brain becomes hypersensitive over time. It gives you a danger message telling you your body's in danger, even in the absence of damage. So there's important messages here for people living with pain. And the first is learning about pain science can lower your pain volume. So to answer your question, the first thing I do with every person who comes to my office is I explain how pain works to them because you bet your ass that everyone who comes to me, a does not want to see a psychologist for pain. Nobody does. There's a lot of stigma there because again, we've been sold the lie that pain is a purely biomedical problem that requires pills and procedures exclusively. But guess what? Chronic pain is on the rise. Chronic pain is on the rise. If our treatments were working, wouldn't they be working? And we have a massive opioid epidemic.

The treatments we have for pain are not actually treatments for pain. Opioids are great for short term acute pain. They are not a treatment for long-term chronic pain. Research shows they sensitize the brain over time. That's what they do. So step one, if you have chronic pain and you want to get better, step one is always learning how pain works because you can only treat something if you understand it first. Okay. Keep going with solutions because it's gold, pure gold. And so if somebody has chronic pain, they understand, let's say they have a decent understanding of how it's working. Yep. And they're looking for strategies that they can employ themselves to be able to

work with the pain. Right. So this brings me back to the pain management workbook. And the reason I talk about it is because I'm very frustrated by the lack of affordable resources for people with pain. It drives me crazy. Affordable, accessible care should be for everybody. So the pain management workbooks on Amazon has everything in it. So the protocol for the actual protocol for treating pain is a multi-step process. Step one is pain education. Research shows my friend, Adrian Lowe, who I happen to adore, has published all these papers that show that when you learn how pain works, it decreases your fear. It decreases your anxiety. It makes you more likely to get out of the house and move your body and distract. And guess what that does to pain volume? It lowers pain volume.

Learning about pain can actually change the pain experience. So step one is always learning about pain. That's step one. Step two, depending on who you are, we want to target all the things in the biopsychosocial pain recipe. So I want to say specifically what a pain recipe is because it helps my patients

and I think it will help your listeners. So do you like to cook or bake by any chance? Yeah, I like to cook. What do you like to cook? I'm not very good at it, but like I'll cook on a regular basis. Like I'd make a mean omelet. Oh, great. Great. Perfect. That's like the extent to my cooking. You and me both, my friend. Okay. So you know that if you want to make a good omelet that requires certain ingredients cooked in a certain order, right? You have to put them in a pan in a certain order for a certain amount of time. And there's a recipe for getting a good omelet. And the same is true for pain. So just as there's a recipe for high pain, there is also a recipe for low pain. Now, a pain recipe is always a biopsychosocial thing.

What do I mean by that stupid word that I keep using? There's biological components to pain. Of course, there are always including tissue damage, inflammation, sleep, diet, exercise, movement, all those things. Those go in a pain. There's also cognitive components to pain, emotional components to pain, coping, social behaviors, social support. So when we talk about a pain recipe, we want to look at everything. Everything matters in a pain recipe. So I ask my patients, tell me about a high pain day. So most of my patients can tell me the ingredients required for a high pain recipe.

So one of my patients, I'll give you an example. High pain recipe is really intense stress at work, crappy sleep, not eating well, sitting in one position, not moving for a really long period of time, not stretching, not going outside, not seeing friends, being socially isolated and home alone. So that's an example of a high pain recipe. I'm not sleeping well. I'm not eating well. I'm not moving my body. I'm not seeing anyone. I'm not going outside. I'm stuck. And by the way, with chronic pain, that is normal and natural. A lot of us get stuck. As I mentioned, I was stuck for about a year on my couch. It's really terrible and not fun, as we all know.

Now, the cool thing about the pain recipe phenomenon is that there is also a recipe for low pain. So if we know that high stress, for example, is on our high pain recipe, to get to a low pain recipe, we have to tackle our stress and our stressors and our negative emotions. So for example, what is contributing right now to my stress? So during the pandemic, what we saw was a massive spike in chronic pain. If we understand how pain volume works, that surprises us. Not at all. The pandemic was a terrible shit show stressor for everybody for a million reasons. We were worried about dying. We were worried about our loved ones dying. We had less access to care. We could some for a period

of time, we couldn't get toilet paper. I mean, some people lost jobs and food security and housing security. I mean, it was just a nightmare. So, so the pandemic for example, was an amplifier. So that would go on our high pain recipe. How do you manage stress and anxiety when you have it? All of those techniques and tools would go in a low pain recipe. So for me, I know my pain recipes now, my low pain and my high pain. I go for a walk outside every day, come hell or high water, even if I can only go for 10 minutes. Great. And, and, you know, my chronic pain was chronic leg pain and I had to get myself off the couch after a year and back to running again. And you asked me at the beginning, and I don't think folks heard this. If I'm a runner, the answer is, I guess, yes, I run like

four or five days a week. I'm not fast and I don't go very far, but I did a 5k. I'm very proud of myself. Um, and that's coming from having chronic leg pain for about 10 years. So, so there's always a high pain recipe. There's always a low pain recipe. Everyone has the power to change their pain volume. Again, you cannot change pain volume until you know your high pain recipe. And that comes from looking at the whole biopsychosocial picture. And most people know about the bio, like you were given by the way, an erroneous message that your pain was just due to a thing you saw on a scan. That was a lie. That is not what your pain. Pain is always, always biopsychosocial. A hundred percent of the time, there was actually a very famous study done.

You're going to love this one, my friend. There was a famous study done on patients with back pain and they compared back scans of people with pain and without pain. That's right. So, so they found all the lumps and bumps and wrinkles and things that happened to the back over time. And there was no correlation between the things they found on the scan and the amount of pain somebody had. The backs of healthy individuals had just as many slipped discs and herniations as the people who had no pain. No pain and pain. Same amount of abnormalities. So, so just to say,

just to really drive home this message, all pain all the time is biopsychosocial. If you want to get well, of course we have to look at the bio, but we have to look at everything in the pain recipe. And there's lots of ways of doing that. I love it. Yeah. Super clear framework at play and with some strategies that will be illuminated in your book. And like the easy one is definitely MBSR, you know, like it's, it's definitely a go-to for me. And then that being said, I've got a family member who's just been debilitated with trigeminal neuralgia. And it's also known as a suicide disease because it is this intermittent intense pain that just kind of rips through somebody's face. That's where the, that, that nerve is in the jaw usually. And so what do you do for that?

Suicide rates and suicidal ideation is 50% higher in the chronic pain population. And that is not a coincidence. And yes, trigeminal neuralgia is a really painful and terrible chronic pain condition where you have chronic pain in your face. I have a good friend who lives with it and I've treated it before. And the answer is pain. All pain has a biopsychosocial recipe 100% of the time. So what I would do with that patient is I would sit down with them and I would explain how pain works, but I would also sit down when I would think through with them what

exactly is on their pain recipe and what contributes to a pain spike. Like it is intermittent. And even with my own chronic pain, I literally would fight people and say, no, it's just random. It's just random. Like my pain flares are random. And what I've learned to do in my work, treating people with pain is there's always, the brain is just responding to your internal and external environments in any given moment. That's what it does. That's what its job is. So we have to figure out what are the inputs? What are the inputs that are contributing to a high pain recipe? So for some

people it's, you know, there's a lot of conflict at home that's going to contribute for a lot of people. It's thinking thoughts like my life is ruined and I'll never get better. And I'm broken and nothing has helped me and nothing will ever help. And that's going to amplify pain too. So there's all these components to a pain recipe, whether it's trigeminal neuralgia or chronic back pain that we have to look at to get well. And again, people with chronic pain already know this. They've gone down the rabbit hole. They've tried the medications and they've gone to all the doctors and they're still

not better. So again, if our treatments worked, they'd be working. If our treatments worked, they'd be working. I imagine you've got a really long waiting list. Do you have, Are you seeing individual clients at this point or are you consulting more in larger projects and writing? What does your professional life look like? So for a long time, you can tell I love what I do so much. I am definitely a helper. And as someone who's lived with pain, I've been inside of it and outside of

it. And I just think it's so nerdy and fascinating from like a neuroscience point of view. So for a long time, I was just doing my private practice and focusing on my patients. And then it became overwhelming. I had a wait list out the door and around the corner because, and I say this like with a lot of humility, like when I say like Stanford and UCF, they were sending me their hardest patients. Like I was seeing children who had been in bed for four years and weren't getting better. And like, I would see them for three months and they would get better. And I do not have magic. I do have training in pain science. That's the effing difference. When I conceptualize pain as a biopsychosocial problem and I go after the pain recipe, my patients get better. When we just do the pills and procedures route, patients do not get well. So I did for a long time have an overwhelming

wait list and I am a bleeding heart. So people would call me and say, here's my story. And so I was just getting everybody in, but I couldn't focus on my life goal. And my life goal, as you know, is getting the word out. I know I was put here to do this and I can't do this kind of work and do things like this with you and really sufficiently and efficiently get the word out unless I make space for it. So I've dialed back on my practice. I wrote the pain management workbook. I also wrote the chronic pain and illness workbook for teens. I'm trying to work on a third book now.

I'm hoping to do that. I have this crazy, huge social media campaign on Instagram and on Twitter. I'm at the real docs off on Instagram. I sort of randomly picked a title, a handle and on Twitter, I'm at Dr. Zofnitz, but, but what I've learned is that in order to change pain, we have to disseminate pain education. So those platforms literally exist to just disseminate information about pain. That's why I, so I'm working on that.

I mentioned I'm teaching at Stanford and UCSF. I want to train the next generation of doctors. Yeah. So, so your answer to answer your question, I love working with patients so much. It gives me so much life and meaning, but I, I I'm tired. My honest answer is I'm like, I'm so tired. Like I happen to love working with teenagers that happens to be my favorite age, but don't tell anyone, but I'm so tired of getting 17 year olds who've been in bed for four years and they've been on opioids and like these crazy antipsychotics like Thorazine for chronic migraine and they

can't function and they've lost their life. And, and, you know, and, and when I work with them and they get out of bed and they go back to high school and they get asked to prom and they go back to playing soccer, it's like such an incredible win. And I feel selfishly so good, but I am tired of that. I don't want that anymore. I don't want to see a single 17 year old with chronic pain ever again, who's only been treated with pills and procedures. I'm just over it. So, so I'm now out in the world trying to spread the gospel because I love it. It's so important. Yeah. You're, you're, I'll say this again, like your passion is noted and it's, and the clarity and precision of your understanding is noted. And the, the obvious that you're working from a framework that can stand up, you know, across

multiple cases is noted. So yeah, it's just science. Yeah, it's really good. So I'm stoked that you have spent your time and energy with us and for our community and is the best place to find you on social. Yeah, I'm at the real docs off on Instagram and I'm at Dr. Zofnus on Twitter. I do have a really nerdy website. It's just my last name, Zofnus.com. And I put together a bunch of workshops actually for people living with pain and for healthcare providers who want to learn more about pain science. Because again, disseminating information is the only way we're going to solve this problem. Literally no problem in healthcare or medicine gets solved without appropriate education. So the goal is just dissemination. So workshops are on the website. There's also a ton of free resources

on the website. There's links a ton of free resources on the website. There's links to podcasts. I'll put this one up there. There's links to books, a million books on pain. There's a zillion journal articles on pain science, including the tale of two nails that I mentioned at the beginning and the psychology today column. There's just like, there's videos, there's guided audio. Like there's more on there than your brain has time to absorb. So if you want to get really nerdy about pain, please come find me. I love it. Rachel, thank you for time and expertise and the talent is obvious. So thank you so much. Thanks for having me today. So nice to talk to you. And I really do appreciate

speaking with a psychologist. It's a really nice framework. Thank you. All right. Thank you so much for diving into another episode of Finding Mastery with us. Our team loves creating this podcast and sharing these conversations with you. We really appreciate you being part of this community. And if you're enjoying the show, the easiest no cost way to support is to hit the subscribe or follow button wherever you're listening. Also, if you haven't already, please consider dropping us a review on Apple or Spotify. We are incredibly grateful for the support and feedback. If you're looking for even more insights, we have a newsletter we send out every Wednesday. Punch over to findingmastery.com slash newsletter to sign up. The show wouldn't be possible without our sponsors and we take our recommendations seriously. And the team is very thoughtful about making sure we love and endorse every product you

hear on the show. If you want to check out any of our sponsor offers you heard about in this episode, you can find those deals at findingmastery.com slash sponsors. And remember, no one does it alone. The door here at Finding Mastery is always open to those looking to explore the edges and the reaches of their potential so that they can help others do the same. So join our community, share your favorite episode with a friend and let us know how we can continue to show up for you.

Lastly, as a quick reminder, information in this podcast and from any material on the Finding Mastery website and social channels is for information purposes only if you're looking for meaningful support which we all need one of the best things you can do is to talk to a licensed professional so seek assistance from your health care providers again a sincere thank you for listening until next episode be well think well keep exploring