Science Vs - Chronic Pain: Can Our Brains Fix It?

Episode Date: October 28, 2021

People with chronic pain often struggle with it for years while doctors scour their bodies for the cause. But are we looking in the wrong spot? For some of us, could an answer — and the solution — actually be in our brains? To find out, we talked with Professor Lorimer Moseley, Dr. Javeria Hashmi, and psychologist Alan Gordon. Here’s a link to our transcript: https://bit.ly/3jHBvYb To learn more about Alan’s therapy, check out his new book, “The Way Out.” This episode was produced by Nick DelRose with help from Rose Rimler, Meryl Horn, Michelle Dang, and Ekedi Fausther-Keeys. We’re edited by Blythe Terrell. Our executive producer is Wendy Zukerman. Fact checking by Erica Akiko Howard. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Emma Munger and Bobby Lord. Thanks to the researchers we got in touch with for this episode, including Professor Akiko Okifuji, Dr. Emma Guymer, Kajal Patel, María Villarreal Santiago, Dr. Massieh Moayedi, Dr. Peggy Compton, Dr. Ramakrishnan Mani, Sheren Gaulbert, and Dr. Yoni Ashar. And special thanks to Joe Cohen, Nolan Gardner, Sarah Nguyen, Liwen Hu and Will Everett. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Rose Rimler, stepping in for Wendy Zuckerman, and this is Science Versus from Gimlet. This is the show that pits facts against feeling pain for years. Today we're talking about chronic pain. And this is something that a lot of people deal with, including someone on our team. My name's Nick Delrose. I work at Science Versus. I'm a associate producer. How long have you been here now? Almost a year.

It just occurred to me recently that we have never met. Right. I mean, the height mystery is just, you are all the same height in my mind. And maybe because I had never met Nick, I hadn't realized that he'd been grappling with pain this whole time. He told me it's actually been going on for years, starting when he was in his PhD program. He was in

New York studying plants, specifically studying how plants grow their roots back after they've been injured. I mean, I love plants, so it was just so exciting to plant seeds and watch them grow. And he says at first he really loved his research, but over time things started to get really hard. Three years in, I was really feeling the stress and just like hunched over my lab bench all the time. And I started noticing that my neck and my shoulders were in just an unusual amount of pain, just throbbing and tensing up. He figured that maybe he was sitting wrong, so he rearranged stuff to try to make it more

comfortable. But that didn't really help. And actually, things got worse. And the pain started to affect other parts of his life. Like, he couldn't even read anymore without feeling pain. It hurt too much. Like, holding a book in front of me and looking down at a book while sitting, like, I... It was so painful.

I'd see people on the subway and it'd be like, you are in the worst possible position, like craning over your little phone screen. How are you not in pain? Because Nick was in pain from everything. And he was trying to be so careful with his posture so that he wouldn't bring it on. By six months on, even sitting in a chair was excruciating. He said it felt like needles poking into his spine. He tried going to a bunch of different doctors, and they gave him some tests, like an MRI, but there was no obvious physical cause for the pain. No smoking gun. At one point, he was diagnosed with fibromyalgia. His doctor told him it basically meant he had unexplained pain.

Doctors had him trying all kinds of stuff, like physical therapy, acupuncture, and even cortisone injections. Everything seemed to help a bit, but nothing seemed to change the situation. Nothing long-term changed the situation. It didn't help. And it's not just Nick. It's estimated that one in five adults has chronic pain in the U.S. That's more than 50 million people. Sometimes the pain is triggered by an injury,

but it sticks around long after you've healed. And very often, the cause of the pain is a total mystery, so it's super hard to treat. According to the Cleveland Clinic, quote, currently, there is no cure for chronic pain. So all you can do is try to tamp the pain down and learn to live with it. And so today, the options for the millions and millions of people living with pain around the world are pretty bleak.

And so when Nick realized he was part of this club, he was feeling pretty helpless. If this is the pain I'm in now, what about 10 years from now? What about when I'm 50 or when I'm 60? I had forgotten what it was like not to have pain. Like, you know, and I couldn't imagine a future without it. It's just like, f***.

But that might all be changing right now. Today on the show, we're going to look at some cutting-edge research that may be pointing to a way out for people like Nick. And it will help us understand how Nick got here in the first place. Because when it comes to chronic pain, It's just like, f***. but then there's science. That's coming up after the break. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist?

And where is Jan Eleven? I'm here, astrophysicist and co-host, ready for anything. That's right, I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan Eleven. I'm Steve Strogatz. And this is Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology and what do they think? I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI.

And don't forget to subscribe wherever you tune in. Welcome back. Today we're looking at chronic pain. We used to think pain was generated by the body. Like if you break your leg, it hurts because your leg is screaming, Hey, I'm in pain down here. But that's actually been debunked. Instead, scientists now believe that pain, no matter where you feel it, is coming from your brain.

Here's what that means. We do have nerves running through our bodies that pick up on all kinds of sensations. But they're just sending that information up to the big boss, the brain. That's actually what decides whether or not you're in pain. The brain makes the final call. For more on this, we called up Lorimer Mosley. He's a professor at the University of South Australia. Lorimer is very familiar with pain, and not just as an academic. What was the worst pain that you ever felt? Oh, wow. Look, the worst pain is probably a bit of a gory and it's a poo-related story. Can't wait. I got to hear this. I used to play football for a living, soccer, and I got

injured and I blew up my coccyx. Is that your tailbone? That's my tailbone, yeah. I was incapacitated for some time, but I didn't poo for a month. And the very first poo I did was excruciating. It truly was, and I burst all the stitches. And Lorimer knows that even though it was a pain in the butt, the pain was coming from his brain. And one of the reasons we know this is because there are times when the brain gets duped. For example, sometimes after

people lose an arm or a leg and it's long gone, they will still report feeling pain in that missing body part. And there are other weird things like this. Take this famous case report about a construction worker who accidentally jumped onto a six-inch nail. The nail went right through his boot. Like in one side and out the other. Obviously the guy was in agony. Even the slightest movement of the nail hurt so much that the doctors at the hospital gave him fentanyl.

They took off his boot. And then they discovered that the nail had gone between two toes and caused absolutely no tissue damage. So wait, the nail hadn't... Through his boot but had gone between two toes and caused absolutely no tissue damage. So wait, the nail hadn't... Through his boot, but had gone between two toes. Yeah, there should have been no pain signals,

no distress call coming from the foot because it hadn't even been touched. And yet the man's brain was ringing the alarm. This is painful. There was very compelling information for his brain to say, your foot is in a world of trouble here, buddy. There's a nail that's gone in the bottom and out the top. This is a highly dangerous situation.

The reason this happened is that the brain is basically playing detective, stringing together clues, and evidence is streaming in from all over the body about what we're sensing. So in the case of the worker with the nail, maybe his brain is sifting through reports from the eyes, oh no, there's a nail going through my boot, and everyone around me is freaking out. Plus, I know nails are sharp and dangerous. And so his brain concluded, ouch, this hurts. And we've all got this organ inside our skull capable of doing this sort of stuff. Like, that's so cool, right, Rose? Well, yeah, it's cool in one way. In another way,

it's kind of a problem. We basically have this detective upstairs who can get tripped up by red herrings, making pain when there isn't any injury. And it looks like this is sometimes what's happening with chronic pain, too. In fact, in 85% of people with chronic back pain, which is one of the most common types of chronic pain, there's nothing really wrong with their backs. When Nick first heard that there might not be anything physically wrong with him, he found it pretty hard to believe. Everything had been taught about pain was that it had to be caused by something in his body, like a broken bone or a torn muscle, or something like that.

I'm feeling pain in my body. It's like the pain is in my back. The pain is in my shoulders and my neck. So I must have done something wrong. I wanted to know, you know, what did I do to my body to be in this pain? Dr. Javeria Hashmi, a neuroscientist at Dalhousie University in Nova Scotia, gets it. She understands that for people with chronic back pain like Nick, it's incredibly frustrating. Because the doctors are not being able to find anything wrong with their backs,

right? They're looking for something like some kind of validation for their experience, which is very severe and debilitating. As a scientist, Jabaria wanted to try to see why the brain might be making this mistake over and over. She decided to compare people who develop chronic pain with people who recover from pain. Okay, so we know from many, many experiments that physical pain shows up in the brain in a signature pattern. If you were to go in an MRI scanner and someone dropped a porcupine on your crotch, your brain would probably light up in a particular way. Going ouch, ouch, ouch, ouch, ouch. Brain regions that would activate, for example, if someone knocks you on your knee or puts something hot on your toe. Javeria wanted to

know if something different was going on for people with chronic pain. So she and her team followed about 40 people with back pain. These were people whose pain had just started. And every few months, Javeria would haul them into an MRI scanner and peek at their brains. We were like scanning like crazy repeatedly for one year. Yeah, they watched them for a whole year. And at first, everybody had that pain pattern. Ouch, ouch, ouch, ouch, ouch.

Eventually, some people felt better. Their pain went away, and their brains calmed down. But then Javeria started to see something strange. When people's pain stuck around, their brains started showing a different pattern, lighting up in regions linked to negative emotions like fear and sadness, alongside memory. So you mean like this was not where physical pain usually shows up? Yes, that's true. That is very true. It shifted from brain regions that are involved in physical pain to brain regions that are involved in processing emotions. That's pretty wild. It was a bit of disbelief. I

couldn't believe that what we had found was like there. And then, you know, like our typical scientist, we just go and like question ourselves. No, this must be an artifact. I need to check it. I need to do this and that. But it wasn't a mistake. For these people, it was like the chronic pain occupied this completely different space in the brain compared to regular pain. And other studies of people with chronic pain also find that their brains are lighting up in this surprising way, which is huge because it suggests that chronic pain is a different beast from other kinds of pain. It's almost like it doesn't matter what's happening in your body. The chronic pain is being fueled by emotions and memory, which is something that was starting to crystallize for Nick. Maybe that's why I can't

find anything. Maybe that's why I'm stuck. I've been looking in the wrong place. He was starting to accept that the answer to his pain wasn't going to come from treating his body. About a year ago, he had a sort of come to Jesus moment with a physical therapist. They'd been working together for six months. And one day when Nick came in, he asked me how I was doing. And I said, terrible. It's just not good. And for the first time, he was visibly frustrated. And he just said, like, you know, structurally you're strong. Like we've worked with you. We've trained your body. We've strengthened your body, but the pain is not responding. Which meant he was at a crossroads.

He had to completely rethink his approach to solving his pain problem. Like this whole time, my body is healthy. You know, usually that's good news. Yeah, yeah. But you know, it's scary because then it's like, okay, my body is healthy. So where am I supposed to, like, what's next? Nick had spent so much time trying to fix his body,

and suddenly he realized that he really needed to fix his brain, which actually sounds a lot more daunting. But it's actually a great thing, because just as your brain could learn this pain, it could unlearn it. Unlearn pain? As in, think your pain away? That's after the break. Welcome back.

We just learned that for people who have chronic pain, it might not be about some injury hidden in your body. It's sometimes about what your brain is telling you, and it seems to get all mixed up with your emotions. And we know how this might come off. We talked about it with Alan Gordon. He's a psychotherapist and founder of the Pain Psychology Center in Los Angeles. Maybe it sounds like you're saying that their pain isn't real. Is that how people sometimes take it? He's a psychotherapist and founder of the Pain Psychology Center in Los Angeles.

Maybe it sounds like you're saying that their pain isn't real. Is that how people sometimes take it, that they're making it up? Yeah, you know, I think the number one question we get is, you know, are you saying the pain is all in my head? Right. Actually, the number one question we get is, do you guys take insurance? But that's probably the second most common question we get is like, is it in your head? Alan says the best way to think about this is that our brains are getting trapped in a cycle. Here's how it happens. So remember the brain as a little detective piecing together clues?

Well, one of those clues is anxiety or fear. When that shows up, the brain might use it as a piece of evidence that something painful is happening. So you feel more pain, which makes you more anxious. When you have a lot of fear around the pain, that kind of energy just further reinforces to the brain that the pain is dangerous. On top of that, people often physically tense up in reaction to the pain. They might stop exercising or stop moving much at all, and that can make things worse. Chronic stress, too, can dial up inflammation, which can increase our sensitivity to pain. All this together is probably why studies find that depression, anxiety, and chronic pain go hand in hand. So a lot of doctors and therapists are seeing this loop of pain, fear, pain, fear,

and realizing that's what we've got to treat. Alan is one of them. He and his colleagues came up with a new therapy to help people with chronic pain. And just recently, they put it to the test. They started by recruiting about 150 people dealing with chronic back pain. These people had pretty much tried everything. On average, they'd been dealing with this pain for 10 years. One group got Alan's therapy, and the others either got a placebo or did nothing new. So first, Alan explains how pain

works, that the brain makes it, and then they really dive into the therapy. So Alan will ask them to sit and feel their pain. And then sitting right there next to them, he talks to them about it. So right now, is the pain moving around or is it stationary? Is it, you know, a burning feeling? Is it a tingling feeling? How would you describe it? And I help them describe it.

And, you know, then I just let them know, okay, so see if you could just pay attention to it. You're not trying to change it. You're not trying to do anything to it. You're just like a passenger in the car. You're along for the ride. You're just watching it and you're noticing what happens and you're just exploring it. The therapy's key lesson is that this pain is not actually a signal that something is going dangerously wrong in the body. And hopefully when people understand this, they can break the pain-fear, pain-fear cycle. To help them, Alan will encourage his patients to let go of the tension that comes with the pain, to relax into the feelings, maybe even laugh at them. You know, I'll try to make jokes, dumb, you know, corny jokes or whatever.

Like what? What are some jokes you might make? Oh my God, this is so embarrassing. Okay. So let's say a patient, you know, I'll be asking about their pain and they'll say, it's kind of like a Bernie sensation in my lower back. And I'll be like, okay, is that like Bernie, B-U-R-N--Y or Bernie B-E-R-N-I-E? Because that would be amazing if your back was like the 1%, you know, and then I'll make fun of myself for, you know, making such a stupid accent. Anything you can to try to get the patient to laugh, to break that state of intensity, to break the state of fear. But to sit with your pain, you have to catch it while it's happening, which means sometimes Alan had to go above and beyond.

You know, I'll tell you, there was one patient in the study. This was unbelievable. She only had pain the first hour of the day. And so finally I said, I'm going to need to come to your house and do an in-person session, you know, in the morning. And I said, okay, so what time do you wake up? And she said know, in the morning. And I said, okay, so what time do you wake up? And she said, 4 a.m. And I was like, oh my God, kill me. I set my alarm. I go over there. I'm so groggy. It was amazing. It worked. She didn't have pain

in the mornings after that. In the study, Allen's team asked the patients to rate their pain at the beginning before the treatment and again after the treatment. And here's what they found. 66% of the people who got his therapy said that their pain was gone or very nearly gone. Yeah, 66%. That's compared to just 20% of those who got the placebo. So it didn't work for everybody. But these numbers are impressive given how crappy a lot of our other treatments are.

Alan and the team also did brain scans in people who did the treatment versus those who got the placebo. And they found that for people who did therapy, their brains showed less of a pain reaction when they were put in an uncomfortable position in the MRI machine. So they said that they felt less pain and their brains were also registering less pain. Exactly. And so, you know, it was great to have that. I mean, really kind of if someone says they're in less pain, that's kind of all you need, but it's great to have that objective evidence as well. Alan figures that this works when his patients learn to recognize the feelings, not as danger, but as something much more innocent. He had a great analogy for us.

Right, so in The Wizard of Oz, Dorothy and the scarecrow and the tin man and the lion are standing there and they're talking to the wizard. And, you know, the wizard is this like floating head and this booming voice and there's flames shooting and they're terrified. And then Toto pulls the curtain back and they see it's just a man behind the curtain and it's not scary anymore, right? There's still the floating head. There's still the booming voice. There's still the shooting flames,

but they know it isn't dangerous. And so they don't have to be afraid, right? So see if you could just pay attention to this pain, knowing that, yeah, you feel something. Yeah, it's scary, but it's not dangerous. It's just a man behind a curtain. It's a false alarm. One year later, Alan's group circled back to these patients and asked how they were doing. Most of the people who responded to the treatment

were still feeling better. We also have another small study from a group in Boston. They tested a different therapy based on the same concept, changing how you think about pain. This therapy was tied to the ideas of another big name in the chronic pain world, Dr. John Sarno. And those researchers also found that about two-thirds of people were pain-free at the end of the study. Both of these studies just came out a couple of months ago, which is exciting. But there are a few caveats here. For one, some people with chronic pain do have a physical cause for it, so this treatment doesn't make sense for them. And since all this is so new, we need more

research to know if it'll work for people in the long run. As for Nick, stuck at home during peak pandemic days, he found an online version of Alan's program and he worked through it. Nick has some experience with this. He actually has gone through your programs. Wow. Yeah, surprise. Wow. This is like the big reveal at the end of the episode. Oh my God, are we half brothers too? So what happened? I was on your program actually by my therapist and everything started to click. Wow. And you know, I think I had run down so many other things

that I realized that there's not something physically wrong with my body. Were you able to get better? Yeah, yeah. Wow. Nick watched videos of Alan walking people through these sessions, and he learned to practice this himself, noticing his pain, sitting with it, and redefining it.

And I'd feel it, but, like, because I could finally accept that there was nothing physically wrong, it didn't spiral, It didn't escalate. It didn't get worse. It just stayed at that kind of like, okay, this is the baseline level of a twinge in my back or something. You kind of broke the pain-fear cycle

and eventually it just kind of fades because you took away its fuel source. Yeah, it's so crazy how it fades. It really is. And that sounds like it was kind of a breakthrough. Yeah. I mean, then I started to get confident, you know? Like, oh, s***, this is it.

And then it just got silly. What do you mean? I just run around my apartment right like I would like just jump and skip and and dance around my apartment this is not something I would have done before right like I was jumping and dancing and laughing just like laughing at how ridiculous I was being, but also laughing because like I was proving it at the same time, you know, like you're strong. I mean, one time I threw myself into the wall by accident. Like I'm talking about like really thrashing around, just like shaking my body, like really just like, you do not need to feel this way.

Like stop it right now. That's Science Versus. Hello. Hi, Nick Delrose, Associate Producer at Science Versus. hello hi nick delrose associate producer at science versus hello how are you how are you feeling i'm doing well um i'm back to swimming i'm now i'm running and finally i'm I'm back to reading. I am reading in the park a lot. Oh, great. What are you reading? Oh, actually, I just read Alan's new book. It's called The Way Out. The Way Out.

He explains his therapy and how it works. Great. How many citations are in this week's episode? It is 110 citations. That's a lot. citations are in this week's episode? It is 110 citations. That's a lot. If people want to see 110 citations, where should they go? You can follow the link in our show notes to our transcripts.

Thanks, Nick. Yep. Bye. Bye. This episode was produced by Nick Delrose with help from me, Rose Rimler, along with Meryl Horn, Michelle Dang, and Aketi Foster-Keys. We're edited by Blythe Terrell. Our executive producer is Wendy Zuckerman. Fact-checking by Erica Akiko Howard.

Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Peter Leonard, Emma Munger, and Bobby Lord. Thanks to the researchers we got in touch with for this episode, including And special thanks to Joe Cohen, Nolan Gardner, Sarah Nguyen, Liwen Hu, and Will Everett.