WEBVTT 1 00:00:00.360 --> 00:00:00.960 Get value. 2 00:00:01.000 --> 00:00:03.439 You can't argue with alt Tesco with their amazing cloak 3 00:00:03.480 --> 00:00:06.200 card prices. Have the perfect night in with their finest 4 00:00:06.200 --> 00:00:09.199 frozen pizza meal deal. Get the finest frozen pizza, chips 5 00:00:09.240 --> 00:00:12.119 and ice cream all for six euro. Like a delicious 6 00:00:12.119 --> 00:00:15.119 spicy salami, hot honey and do ya or Margarito wood 7 00:00:15.119 --> 00:00:18.320 fired pizzas served up with their crispy chunkie chips and 8 00:00:18.440 --> 00:00:21.280 ice cream like sea Salt de caramel or pistachio for dessert. 9 00:00:21.679 --> 00:00:24.480 Can't argue with that shop in store or online. 10 00:00:24.679 --> 00:00:25.120 Tesco. 11 00:00:25.600 --> 00:00:34.000 Every little helps available at most stores. Prices vary in express. 12 00:00:36.119 --> 00:00:39.200 Oh hey, it's that smoothie cup you should have washed yesterday. 13 00:00:39.359 --> 00:00:42.439 Alleyward back with an episode of Ologies you will. Let's 14 00:00:42.479 --> 00:00:47.759 get into it. Dolerology dollar means pain in Latin. Dolerology. 15 00:00:48.000 --> 00:00:51.640 It's the study of the nature in management of pain. 16 00:00:53.240 --> 00:00:55.799 It's a real thing. As it turns out, the folks 17 00:00:55.799 --> 00:00:58.600 who study it are pretty fired up about talking about it, 18 00:00:58.719 --> 00:01:01.079 and it turns out a lot of listeners are like, 19 00:01:01.640 --> 00:01:05.480 I have questions. So this ologist reached out to me, 20 00:01:05.799 --> 00:01:08.640 told me that her mission as a neuroscientist is to 21 00:01:08.640 --> 00:01:10.599 help people feel better. And I was like, well, how 22 00:01:10.640 --> 00:01:12.920 the hell can I turn that down? So I happened 23 00:01:12.920 --> 00:01:16.280 to be in the Bay Area in October following my 24 00:01:16.400 --> 00:01:19.599 new husband's new knee surgery. What's your pain scale on 25 00:01:19.640 --> 00:01:20.760 a pit scale one to ten? 26 00:01:22.840 --> 00:01:23.040 Four? 27 00:01:23.359 --> 00:01:27.719 Four for four, that's kind of a lot. Three. No, 28 00:01:27.799 --> 00:01:31.799 I'm three. I'm not downing. I'm saying that sounds painful. 29 00:01:32.120 --> 00:01:35.239 And after we battled some Friday afternoon traffic, we arrived 30 00:01:35.640 --> 00:01:40.959 at this ologist's Oakland office with Los Angeles style punctuality, 31 00:01:41.799 --> 00:01:44.760 and then we settled into our couch to chat pain. 32 00:01:45.120 --> 00:01:48.359 Turns out she knows her stuff. She has long brown hair. 33 00:01:48.640 --> 00:01:50.680 She was wearing knee high boots. She has a very 34 00:01:50.680 --> 00:01:56.280 youthful exuberance, but a CV that slaps metaphorically speaking. She 35 00:01:56.439 --> 00:02:00.680 is a working pain psychologist and assistant clinical professor at 36 00:02:00.719 --> 00:02:04.079 the UCSF School of Medicine. She is on the Pain 37 00:02:04.280 --> 00:02:07.719 Education faculty at Dartmouth. She's the co president of the 38 00:02:07.760 --> 00:02:12.520 American Association of Pain Psychology. She's a Psychology Today columnist 39 00:02:12.560 --> 00:02:17.080 about pain, and the author of the Pain Management Workbook, 40 00:02:17.280 --> 00:02:20.199 which might be the best twenty dollars you can ever 41 00:02:20.240 --> 00:02:23.759 spend other than ski ball, which is also fun. This 42 00:02:23.879 --> 00:02:26.240 might be better. Well, we will talk about all this 43 00:02:26.319 --> 00:02:28.879 in a minute plus questions from the folks at patreon 44 00:02:28.919 --> 00:02:32.000 dot com Sashologies. I have never received so many questions 45 00:02:32.000 --> 00:02:34.439 for any episode. It's great if you want to submit 46 00:02:34.520 --> 00:02:36.919 questions for guests. It costs a dollar a month to 47 00:02:37.000 --> 00:02:40.159 join at patreon dot com Slashologies, but for zero dollars 48 00:02:40.319 --> 00:02:43.280 you can send this episode to someone. You can mention 49 00:02:43.400 --> 00:02:46.319 ologies to a friend or a date, or you can 50 00:02:46.360 --> 00:02:48.840 subscribe or rate or leave a review that really helps 51 00:02:48.840 --> 00:02:51.000 a podcast. I read a new one each week to 52 00:02:51.080 --> 00:02:53.759 prove that I read all of your reviews. Thank you, 53 00:02:54.039 --> 00:02:56.639 Thelma Burrito for the review you just left that said 54 00:02:57.000 --> 00:02:59.319 I was coming down from a psychedelic high on Wednesday, 55 00:02:59.360 --> 00:03:01.680 and I felt like I needed to hear something comforting 56 00:03:01.719 --> 00:03:04.400 while relaxing in my sweats and fuzzy socks. I put 57 00:03:04.400 --> 00:03:07.159 on the episode on sparkle Botology Fireflies, and I don't 58 00:03:07.199 --> 00:03:09.680 know if it was the sparkly imagery, Ali's voice or 59 00:03:09.680 --> 00:03:11.159 the sheer fact that I live in a world where 60 00:03:11.199 --> 00:03:13.199 someone would make content just so we can learn about 61 00:03:13.199 --> 00:03:15.680 things we would never otherwise learn, but I cried out 62 00:03:15.680 --> 00:03:20.800 of gratefulness. Thanks Ali, Thelma Burrito, Thank you okay, dolerology pain? 63 00:03:20.960 --> 00:03:23.000 What is it? Why does it hurt? How much does 64 00:03:23.039 --> 00:03:26.120 it hurt? Why do some people have more pain than others? 65 00:03:26.360 --> 00:03:29.560 How do pain meds work? Do redheads feel more pain? 66 00:03:29.919 --> 00:03:33.560 How long does it take to change your brain? How 67 00:03:33.639 --> 00:03:37.680 much pain training doctors have? And is there a better 68 00:03:37.800 --> 00:03:42.120 alternative to that placard of miserable emojis that they have 69 00:03:42.319 --> 00:03:44.680 on the walls in the hospital. All this and life 70 00:03:44.759 --> 00:03:50.120 lessons with pain psychologist researcher, professor, author, mental health advocate, 71 00:03:50.280 --> 00:04:16.319 and dolerologist doctor Rachel Softness. We're only forty four minutes late. Okay, 72 00:04:16.759 --> 00:04:19.720 So okay. First name gonna make you do is if 73 00:04:19.759 --> 00:04:21.560 you can say your first and last name in your 74 00:04:21.560 --> 00:04:26.120 pronouns flo. Oh yeah, no, go for it. No, you 75 00:04:26.120 --> 00:04:28.000 can sit on the floor. It's like we're hanging out 76 00:04:28.000 --> 00:04:28.680 in a dorm room. 77 00:04:28.959 --> 00:04:29.959 Rachel's softness. 78 00:04:30.519 --> 00:04:35.319 Rachel's softness. She her got it of dolerology. It's a thing, 79 00:04:35.680 --> 00:04:38.560 it's a thing. Okay, how long have you known this word? 80 00:04:40.360 --> 00:04:42.800 The honest answer is since I decided I wanted to 81 00:04:42.800 --> 00:04:43.600 be on ologies. 82 00:04:44.959 --> 00:04:46.639 I'm not kidding. 83 00:04:48.480 --> 00:04:50.040 I was like, I know there's a word because I 84 00:04:50.079 --> 00:04:53.360 do pain psychology, which is an ology, but I study 85 00:04:53.399 --> 00:04:56.480 pain science and pain neuroscience, which is outside of psychology, 86 00:04:56.519 --> 00:04:59.120 and there's a word for pain science, which is dolerology. 87 00:04:59.639 --> 00:05:01.079 What's the the worst pain You've ever been in? 88 00:05:01.639 --> 00:05:01.879 Oh? 89 00:05:01.959 --> 00:05:04.600 Wow, the worst pain I've ever been in. I had 90 00:05:04.759 --> 00:05:07.759 chronic pain as a kid, and I was always I 91 00:05:07.800 --> 00:05:12.319 had like constant abdominal pain. But as an adult, I 92 00:05:12.399 --> 00:05:14.360 also had a running injury and it lasted for five 93 00:05:14.439 --> 00:05:15.759 years and I was like on the couch for the 94 00:05:15.759 --> 00:05:16.560 better part of a year. 95 00:05:16.839 --> 00:05:18.120 So that was probably the worst one. 96 00:05:18.680 --> 00:05:22.879 What do people say hurts the most. I've heard kidney stones, 97 00:05:22.920 --> 00:05:26.319 I've heard birth, I've heard shingles, I've heard bullet ants. 98 00:05:27.120 --> 00:05:30.519 How do psychologists figure it out? 99 00:05:31.680 --> 00:05:34.680 So the honest answer is this, people are trained to 100 00:05:34.759 --> 00:05:37.279 ask people about their pain on all these pain scales. 101 00:05:37.319 --> 00:05:39.240 And there's a lot of pain scales out there, and 102 00:05:39.279 --> 00:05:42.000 the most common one is out of ten? What is 103 00:05:42.040 --> 00:05:43.720 your pain on a scale of zero out of ten? 104 00:05:44.399 --> 00:05:47.480 Yeah? I just did that to Jarrett outside for probably 105 00:05:47.519 --> 00:05:51.199 the one hundredth time since his surgery two weeks before. 106 00:05:52.120 --> 00:05:54.000 And the funny thing is, and it's actually not funny 107 00:05:54.040 --> 00:05:56.879 at all. Sometimes people will say my pain is a 108 00:05:56.879 --> 00:05:59.240 ten out of ten, and it will be something that 109 00:06:00.000 --> 00:06:02.439 health care provider will think should not be a ten 110 00:06:02.480 --> 00:06:05.120 out of ten. So the health care provider will say 111 00:06:05.480 --> 00:06:08.079 to the patient, well, imagine someone taking. 112 00:06:07.759 --> 00:06:09.360 Off your arm. 113 00:06:09.800 --> 00:06:11.240 That would be a ten out of ten. So now 114 00:06:11.240 --> 00:06:12.959 tell me what your pain number is to try and 115 00:06:12.959 --> 00:06:16.040 get that person to lower the number, like sort of 116 00:06:16.040 --> 00:06:19.040 suggesting to the patient like, oh, you're exaggerating, But in 117 00:06:19.079 --> 00:06:21.600 my mind, what's worse? Like can you do anything worse 118 00:06:21.600 --> 00:06:24.199 to someone who's suffering than say, like the number that 119 00:06:24.240 --> 00:06:26.240 you gave me is inaccurate. The answer is the most 120 00:06:26.240 --> 00:06:29.560 annoying answer in science, which is it depends. So for 121 00:06:29.680 --> 00:06:32.240 one person, post surgical pain might be a six out 122 00:06:32.279 --> 00:06:33.519 of ten, and for someone else it might be a 123 00:06:33.519 --> 00:06:35.240 ten out of ten. So I wouldn't say that there's 124 00:06:35.279 --> 00:06:38.920 like any one thing that is the worst kind of pain. 125 00:06:39.800 --> 00:06:44.079 That's a good answer, okay. And when people are studying 126 00:06:44.439 --> 00:06:47.600 how sharp pain is, how do you even know. 127 00:06:48.199 --> 00:06:51.480 That is all you have? There's absolutely no other way 128 00:06:51.519 --> 00:06:53.519 to measure pain other than what someone tells you. So 129 00:06:53.519 --> 00:06:55.639 if someone says their pain is ten out of ten, 130 00:06:55.879 --> 00:06:56.800 that's what their pain is. 131 00:06:56.879 --> 00:06:57.279 The end. 132 00:06:57.639 --> 00:07:00.360 I mean, that's also why it's really hard to compare, Like, 133 00:07:00.399 --> 00:07:02.399 you can't compare your pain to my pain. Like you 134 00:07:02.399 --> 00:07:05.079 break your ankle, I break mine. But if you're a 135 00:07:05.079 --> 00:07:06.399 ten out of ten and I'm a five out of ten, 136 00:07:06.439 --> 00:07:08.399 it's not like one of us is lying. Yeah, Like 137 00:07:08.480 --> 00:07:10.319 your pain experience is unique to you. 138 00:07:10.839 --> 00:07:13.879 And as a kid is someone who experienced chronic abominal pain, 139 00:07:13.920 --> 00:07:17.439 which I cannot imagine this one in a running injury. 140 00:07:17.199 --> 00:07:18.439 For five years. 141 00:07:18.839 --> 00:07:22.639 Were you in a position to choose your career at 142 00:07:22.639 --> 00:07:24.920 that point when you had a running injury. Were you like, 143 00:07:24.920 --> 00:07:27.040 you know what, I'm going to change my major. When 144 00:07:27.040 --> 00:07:29.319 did you decide I'm going to crack this code? Because 145 00:07:29.319 --> 00:07:32.879 you are super passionate about this, Yeah, you're like, I 146 00:07:32.920 --> 00:07:35.079 looked up the word for this, I wrote a book 147 00:07:35.079 --> 00:07:37.439 about this. I want to talk about it. Yeah, yeah, 148 00:07:37.480 --> 00:07:39.160 where does that passion come from? 149 00:07:39.240 --> 00:07:42.279 So when I was in college, I knew I wanted 150 00:07:42.319 --> 00:07:44.240 to live at the intersection of a bunch of things, 151 00:07:44.279 --> 00:07:48.120 Like I was fascinated by neuroscience and psychology and science 152 00:07:48.160 --> 00:07:51.920 writing and working with kids and medicine, and I just 153 00:07:52.439 --> 00:07:54.279 I wanted to find this thing that would let me 154 00:07:54.319 --> 00:07:57.079 live at the intersection of everything. And I took a 155 00:07:57.160 --> 00:08:00.360 course a neuroscience course in my freshman year brand because 156 00:08:00.399 --> 00:08:02.319 I was a nerd. Like to be clear, I was 157 00:08:02.399 --> 00:08:05.160 like a library mouse, had no friends in high school, 158 00:08:05.560 --> 00:08:09.240 total total nerd. And Inuawan, which is the best class 159 00:08:09.240 --> 00:08:12.120 I ever took, they taught us about pain, and it 160 00:08:12.199 --> 00:08:14.639 was the thing that seemed to live at the intersection 161 00:08:14.680 --> 00:08:17.160 of everything, because, as I'm sure we're going to talk about, 162 00:08:17.600 --> 00:08:20.920 pain is never purely physical. It's also emotional, and it's 163 00:08:20.959 --> 00:08:23.800 not located in the body. Ultimately it's produced by the brain. 164 00:08:24.120 --> 00:08:28.560 So pain is in the brain. Big revelation here. Much 165 00:08:28.600 --> 00:08:29.360 more on that in a. 166 00:08:29.319 --> 00:08:32.000 Bit so, And it's this thing that goes across psychology 167 00:08:32.039 --> 00:08:34.440 and medicine. Effects adults, it affects kids. It had affected 168 00:08:34.480 --> 00:08:36.399 me as a kid. So when I went to do 169 00:08:36.480 --> 00:08:40.000 my honors thesis, my mentor, who's a dear human being 170 00:08:40.000 --> 00:08:43.720 who recently actually not so recently passed from cancer, said 171 00:08:43.759 --> 00:08:46.840 to me, there's this researcher here who studies pain. You 172 00:08:46.840 --> 00:08:48.879 should see if he'll take you on as a mentee. 173 00:08:49.360 --> 00:08:52.559 And he did, and under his tutelage, I did this 174 00:08:52.759 --> 00:08:56.840 long honors thesis on the gate control theory of pain, 175 00:08:57.159 --> 00:09:00.159 and I just thought it was so dynamic and fascinating. 176 00:09:00.200 --> 00:09:03.600 And everyone has pain at some point in their life, right, 177 00:09:03.600 --> 00:09:07.240 and when you're a college student, you're still young. But 178 00:09:07.559 --> 00:09:11.679 as an even younger person, I had already struggled with pain. 179 00:09:11.879 --> 00:09:14.559 So I was so fascinated by this intersection of all 180 00:09:14.559 --> 00:09:15.039 the things. 181 00:09:15.360 --> 00:09:18.360 So Rachel will explain the gait theory of pain in 182 00:09:18.399 --> 00:09:22.960 more detail later and how essentially kissing an Awi does 183 00:09:23.039 --> 00:09:26.080 a sweet neurological sleight of hand, kind of like a 184 00:09:26.120 --> 00:09:30.559 cool button Mitzvah magician. But in terms of her backstory, 185 00:09:30.919 --> 00:09:34.399 doctors Off got her bachelor's from Brown University in brain 186 00:09:34.480 --> 00:09:38.919 and behavior, two masters, one in psychology and education from Colombia, 187 00:09:39.120 --> 00:09:41.879 one in clinical psychology from San Diego State, and then 188 00:09:42.240 --> 00:09:47.039 her PhD in clinical psychology from University of California, San Diego. 189 00:09:47.559 --> 00:09:49.720 Somewhere in there, she took a year long break to 190 00:09:49.799 --> 00:09:53.559 teach science at the Bronx Zoo because she's rad Anyway, 191 00:09:53.720 --> 00:09:55.039 she became a doctor. 192 00:09:54.799 --> 00:09:57.320 And as a post doc after I got my PhD 193 00:09:57.360 --> 00:10:01.000 in psychology, I did my post doc in pain management 194 00:10:01.039 --> 00:10:04.320 and it was non pharmacological approaches to pain, and I 195 00:10:04.399 --> 00:10:06.120 just went back down that rabbit hole and it was 196 00:10:06.240 --> 00:10:10.279 just so interesting to me that there were all these 197 00:10:10.279 --> 00:10:12.519 ways of treating pain that don't really get talked about 198 00:10:12.519 --> 00:10:14.879 in medicine or at all in psychology. Like if you're 199 00:10:14.879 --> 00:10:18.559 a psychologist, you never learn about what we call physical 200 00:10:18.559 --> 00:10:23.759 pain never, and physicians very rarely talk about the psychological 201 00:10:23.799 --> 00:10:26.879 aspect of pain. So when I did my post doc, 202 00:10:27.039 --> 00:10:29.440 I started doing trainings on pain. I just I wanted 203 00:10:29.480 --> 00:10:31.320 to know everything. I read every book I could get 204 00:10:31.360 --> 00:10:34.600 my hand on. Literally, I spoke with a million people, 205 00:10:34.600 --> 00:10:36.799 I took a million classes, and then I decided that 206 00:10:36.840 --> 00:10:39.639 I wanted to start treating pain, and in particular I 207 00:10:39.720 --> 00:10:42.039 wanted to work with kids living with pain. When I 208 00:10:42.080 --> 00:10:43.840 first started that, I really I mean, I was trained 209 00:10:43.879 --> 00:10:48.399 in adult and child psychology, but I felt like, in particular, 210 00:10:48.440 --> 00:10:51.440 teenagers get ignored a lot in medicine. It's just this 211 00:10:51.559 --> 00:10:54.440 really messy, weird age. They're not quite children, they're not 212 00:10:54.480 --> 00:10:56.679 quite adults. So I want to focus on them. So 213 00:10:56.720 --> 00:10:59.480 I went to UCSF and I offered to do some 214 00:10:59.559 --> 00:11:02.679 trainings for free on these non farm treatments for pain 215 00:11:03.159 --> 00:11:05.200 and how pain works in the brain and in all 216 00:11:05.279 --> 00:11:07.519 these departments. For some reason, they let me come and 217 00:11:07.519 --> 00:11:09.840 give a talk to their physicians. Before I knew it, 218 00:11:09.919 --> 00:11:13.559 my practice was full of kids living with chronic pain. Yeah, 219 00:11:13.879 --> 00:11:17.200 but Ali Ward the first, like one of the first 220 00:11:17.240 --> 00:11:18.080 kids they sent me. 221 00:11:18.639 --> 00:11:19.720 Can I tell you a story? 222 00:11:19.879 --> 00:11:21.440 Yeah, yeah, that's what I mean for. 223 00:11:21.519 --> 00:11:23.600 One of the first kids they sent me was a 224 00:11:23.679 --> 00:11:25.559 kid who had been in bed for like four years 225 00:11:25.600 --> 00:11:26.399 with chronic pain. 226 00:11:27.159 --> 00:11:27.440 Yeah. 227 00:11:27.519 --> 00:11:31.519 He had chronic migraine, chronic body pain like diffuse amplified 228 00:11:31.559 --> 00:11:37.919 body pain. He had been on about forty medications, including thorizine. 229 00:11:38.279 --> 00:11:40.559 Okay, I want to do like an hour long aside 230 00:11:40.600 --> 00:11:42.759 on thorizine, but I'm gonna make the snappy instead. I'm 231 00:11:42.759 --> 00:11:44.679 gonna put it in bull of points. Invented by a 232 00:11:44.679 --> 00:11:47.559 French doctor in nineteen fifty two to help with pre surgery, 233 00:11:47.600 --> 00:11:52.200 anesthesia was also used as an anti inflammatory. Now primarily 234 00:11:52.279 --> 00:11:56.759 used to manage hallucinations and mania and some symptoms of schizophrenia, 235 00:11:56.960 --> 00:12:01.360 but it's also been prescribed for everything from behavior problems 236 00:12:01.720 --> 00:12:06.240 ADHD to barfing to hiccups. Now, if you're like, why 237 00:12:06.320 --> 00:12:12.440 does thorizine sound like a superhero made out of electrified muscle, Well, 238 00:12:12.600 --> 00:12:16.240 the lab that marketed thorizine named it after the Norse 239 00:12:16.279 --> 00:12:21.399 god of lightning and hammers thor to reflect the reverberations 240 00:12:21.399 --> 00:12:23.879 that would roll across the medical world as a result 241 00:12:24.000 --> 00:12:27.360 of this revolutionary new drug. Their president said, so yes, anyway, 242 00:12:27.440 --> 00:12:32.360 Thorizine the thunderbolts of psychiatric drugs, sometimes striking where it 243 00:12:32.440 --> 00:12:32.720 was not. 244 00:12:32.799 --> 00:12:36.240 Needed, like knocks them the f out. And this is 245 00:12:36.279 --> 00:12:38.120 a child, and he was on thorisine for his pain, 246 00:12:38.159 --> 00:12:39.879 and it would knock him out for days at a time. 247 00:12:40.159 --> 00:12:42.320 So he wasn't going to school, he wasn't seeing friends, 248 00:12:42.320 --> 00:12:43.240 he wasn't functioning. 249 00:12:43.720 --> 00:12:44.320 It was wild. 250 00:12:44.360 --> 00:12:47.080 He had seen like more than fifteen physicians, and I 251 00:12:47.080 --> 00:12:50.519 had been reading there's all these protocols for treating chronic 252 00:12:50.559 --> 00:12:54.879 pain in both adults and children. And I had worked 253 00:12:54.919 --> 00:12:56.440 with a number of other patients, but I had never 254 00:12:56.519 --> 00:12:57.879 worked with a kid who had been in bed for 255 00:12:57.919 --> 00:13:02.240 four years. And I almost called the referring physician to say, 256 00:13:03.279 --> 00:13:05.480 I can't do it, Like if you guys can't do it, 257 00:13:06.080 --> 00:13:08.440 I surely can't. Like I almost called them to send 258 00:13:08.519 --> 00:13:12.559 him back, but instead, like the kid was so hopeless, 259 00:13:12.559 --> 00:13:14.799 he showed Just to describe him to you, He showed 260 00:13:14.879 --> 00:13:17.600 up at my office. He had like long unwashed hair. 261 00:13:18.159 --> 00:13:20.240 He was like overweight because he hadn't moved his body 262 00:13:20.279 --> 00:13:22.559 in like a number of years, and he was rocking 263 00:13:22.639 --> 00:13:24.639 himself back and forth on my couch with the pain. 264 00:13:25.639 --> 00:13:27.320 I asked him if he had given up hope, and 265 00:13:27.399 --> 00:13:30.200 he said yes. So I made the decision to lie 266 00:13:30.200 --> 00:13:31.039 to him. 267 00:13:31.320 --> 00:13:31.559 Yes. 268 00:13:31.600 --> 00:13:34.320 I know, it's a dubious decision, and I said, I 269 00:13:34.360 --> 00:13:37.519 can help you, but you have to do everything I say. 270 00:13:37.960 --> 00:13:38.600 And I knew. 271 00:13:38.720 --> 00:13:41.960 I mean, especially as a pain psychologist, nobody wants to 272 00:13:41.960 --> 00:13:44.679 go to a psychologist for pain because pain is sold 273 00:13:44.799 --> 00:13:48.120 to us as this purely physical or physiological problem. And 274 00:13:48.159 --> 00:13:51.480 if you go to a psychologist, the popular thought is, oh, 275 00:13:51.519 --> 00:13:53.799 they're saying it's all in my head, or they're saying 276 00:13:53.799 --> 00:13:55.720 my pain isn't real, or I'm faking it right. 277 00:13:55.960 --> 00:13:56.720 But that's not true. 278 00:13:56.720 --> 00:13:59.519 There's all these treatments that are evidence based for pain, 279 00:13:59.639 --> 00:14:02.840 that are non pharmacological. So I said to him, I 280 00:14:02.840 --> 00:14:05.000 can treat you, but you have to do everything I say. 281 00:14:05.360 --> 00:14:09.080 He said okay, and we went through this cognitive behavioral 282 00:14:09.120 --> 00:14:12.360 therapy protocol for pain management, which is now what I 283 00:14:12.399 --> 00:14:16.159 live and die by. And we started out doing very 284 00:14:16.200 --> 00:14:16.919 small things. 285 00:14:16.919 --> 00:14:17.320 At first. 286 00:14:17.320 --> 00:14:19.559 It was like just stand on your porch in the 287 00:14:19.600 --> 00:14:22.120 sunlight every day, and even that was hard for him. 288 00:14:22.440 --> 00:14:23.759 And we did like a lot of work together. 289 00:14:23.799 --> 00:14:25.960 So then it was like walked the corner mailbox and 290 00:14:26.000 --> 00:14:28.600 mail a letter and you know, and he was doing 291 00:14:28.639 --> 00:14:31.200 pt and OT at the same time. And then it 292 00:14:31.240 --> 00:14:32.720 was like, can we get a tutor to help you 293 00:14:32.799 --> 00:14:35.159 catch up in school. It was like small bits of activity, 294 00:14:35.279 --> 00:14:38.639 small goals, and really pacing him to desensitize his brain 295 00:14:38.639 --> 00:14:41.720 and body. Within three months, he was getting back to life. 296 00:14:41.720 --> 00:14:44.240 He was doing jogs around the block. He did get 297 00:14:44.240 --> 00:14:47.159 a tutor, he caught up with friends. He eventually went 298 00:14:47.200 --> 00:14:48.320 back to school in soccer. 299 00:14:48.960 --> 00:14:49.399 Wow. 300 00:14:49.600 --> 00:14:49.960 Yeah. 301 00:14:50.000 --> 00:14:52.480 And the more he did, the more he realized he 302 00:14:52.480 --> 00:14:55.240 could do, the more his brain desensitized, the more his 303 00:14:55.279 --> 00:14:57.639 body was able to function, and he was able to 304 00:14:57.639 --> 00:15:00.279 get back to life and his pain remitted and his 305 00:15:00.320 --> 00:15:04.080 anxiety and depression did too. And he actually graduated from 306 00:15:04.120 --> 00:15:05.600 high school a couple of years ago, and he invited 307 00:15:05.639 --> 00:15:07.879 me to come. My god, Yeah, So I went to 308 00:15:07.879 --> 00:15:10.200 his graduation and this kid he got on stage and 309 00:15:10.240 --> 00:15:12.440 he said, if you had told me four years ago 310 00:15:12.440 --> 00:15:14.279 I'd be graduating from high school, I never would have 311 00:15:14.320 --> 00:15:16.600 believed you. We all cried, and he went off to 312 00:15:16.639 --> 00:15:20.679 college and is like swim Captain. He still has pain episodes, 313 00:15:20.720 --> 00:15:22.519 but he knows exactly what to do, and he's never 314 00:15:22.559 --> 00:15:23.960 going to be that kid who's in bed for four 315 00:15:24.000 --> 00:15:26.320 years ever. Again, no kid ever needs to be the 316 00:15:26.360 --> 00:15:27.679 kid that's in bed for four years. 317 00:15:28.240 --> 00:15:28.480 Ever. 318 00:15:28.840 --> 00:15:31.120 The way we mistreat pain just drives me nuts. So 319 00:15:31.159 --> 00:15:33.279 I think that really drives me. I think I went 320 00:15:33.320 --> 00:15:35.639 on a tangent like maybe a lot on Beautiful. 321 00:15:35.960 --> 00:15:39.320 So before we learn how pain psychology works, let's just 322 00:15:39.480 --> 00:15:44.159 be be back it up and address the fundamental question. 323 00:15:44.960 --> 00:15:45.720 What is pain? 324 00:15:46.960 --> 00:15:48.200 Right? What is pain? 325 00:15:48.279 --> 00:15:52.000 What is it in? How much is it? Yeah, mind? 326 00:15:52.080 --> 00:15:54.759 How much is it body? How much control do we 327 00:15:54.840 --> 00:15:55.559 have over it? 328 00:15:57.080 --> 00:16:00.960 You're asking amazingly hard and awesome question, and I'm going 329 00:16:01.000 --> 00:16:04.039 to answer them. So you can ask forty different people 330 00:16:04.039 --> 00:16:06.279 and you'll get forty different answers. And I'm going to 331 00:16:06.320 --> 00:16:09.519 try and sqush all the things together and make it 332 00:16:09.559 --> 00:16:12.080 as like digestible as possible. So if I don't do 333 00:16:12.159 --> 00:16:13.759 a good job, I'm gonna rely on you to. 334 00:16:13.759 --> 00:16:14.279 Calm me out. 335 00:16:15.559 --> 00:16:19.720 So pain is your body's warning system. By that, I 336 00:16:19.759 --> 00:16:21.960 mean it exists to protect you and save your life. 337 00:16:22.519 --> 00:16:26.039 So I remember learning in this dorky neuroscience class that 338 00:16:26.039 --> 00:16:28.759 there are people who are born without the ability to 339 00:16:28.840 --> 00:16:33.919 feel pain. What Yes, And I remember thinking that sounds delightful, 340 00:16:35.039 --> 00:16:37.919 and then our professor said, yeah, and they don't live 341 00:16:38.200 --> 00:16:38.720 very long. 342 00:16:38.879 --> 00:16:40.759 Oh fuck right, Because if you. 343 00:16:40.679 --> 00:16:44.279 Imagine you put your hand on a stove and you 344 00:16:44.399 --> 00:16:46.799 don't take it off, you go for a run and 345 00:16:46.840 --> 00:16:50.480 you break your leg and you just keep running. Because 346 00:16:50.519 --> 00:16:54.600 pain is actually your body's danger detection system. But like 347 00:16:54.679 --> 00:16:57.639 every system in the human body, the pain system can fail. 348 00:16:58.039 --> 00:16:59.960 So one of the biggest errors we often make is 349 00:17:00.159 --> 00:17:04.559 humans is believing that just because you have pain, it 350 00:17:04.680 --> 00:17:07.960 means necessarily that a body part is damaged or broken. 351 00:17:08.240 --> 00:17:11.480 And that's not always what pain means. You can actually 352 00:17:11.480 --> 00:17:14.880 have pain without damage in a particular body part, is 353 00:17:14.920 --> 00:17:16.880 what we've learned, and that's what chronic pain is, believe 354 00:17:16.920 --> 00:17:20.359 it or not. So pain is also adaptive. Again, it's 355 00:17:20.359 --> 00:17:22.519 this thing that saves your life. It is also this 356 00:17:22.680 --> 00:17:24.880 word that I'm gonna use that I've been told I 357 00:17:24.920 --> 00:17:27.400 shouldn't use because it's confusing, but I'm gonna do it anyway. 358 00:17:27.599 --> 00:17:28.920 Biopsychosocial. 359 00:17:29.240 --> 00:17:32.160 Okay, yeah, what does that mean? Pain is biopsychosocial. So 360 00:17:32.200 --> 00:17:35.440 what that means is one hundred percent of the time, 361 00:17:35.480 --> 00:17:38.039 whether your pain is acute, which means short term, so 362 00:17:38.160 --> 00:17:41.279 any pain three months or less, or chronic pain, which 363 00:17:41.319 --> 00:17:43.920 is pain that's three months or longer or beyond expected 364 00:17:43.960 --> 00:17:47.240 healing time. Your pain lives in the middle of these 365 00:17:47.319 --> 00:17:50.200 three bubbles or domains that I'm gonna call it. So 366 00:17:50.279 --> 00:17:54.440 one is biology biological sources of pain. One is psychology 367 00:17:54.519 --> 00:17:58.200 or psychological sources of pain, and one is social or sociological. 368 00:17:58.640 --> 00:18:00.759 And I want to say what that means. So if 369 00:18:00.759 --> 00:18:03.000 you imagine a ven diagram, so there are these three 370 00:18:03.039 --> 00:18:07.200 bubbles that overlap, and in the middle where they overlap, 371 00:18:07.359 --> 00:18:08.599 that's where pain lives. 372 00:18:09.160 --> 00:18:12.200 Okay, pay attention. So Doctor's off is going to break 373 00:18:12.240 --> 00:18:17.279 down the three sources of pain, starting with biological. 374 00:18:17.000 --> 00:18:18.640 In the middle of these three things. 375 00:18:19.000 --> 00:18:21.720 So the biological components of pain are the things that 376 00:18:21.759 --> 00:18:25.119 you hear about all the time. So it's genetics and 377 00:18:25.240 --> 00:18:29.559 tissue damage and system dysfunction and like immune functioning and 378 00:18:29.640 --> 00:18:32.839 sleep and diet and exercise, and those are all very 379 00:18:32.920 --> 00:18:34.240 important when it comes to pain. 380 00:18:34.759 --> 00:18:35.359 We all know that. 381 00:18:35.960 --> 00:18:38.799 However, if you think about this ven diagram, if you're 382 00:18:38.839 --> 00:18:42.640 only focusing on the biocomponent of pain, you're actually missing 383 00:18:42.640 --> 00:18:45.519 two thirds of the pain problem. Because we know that 384 00:18:45.640 --> 00:18:49.880 pain is this biopsychosocial phenomenon, and I promise I'll explain why. 385 00:18:50.720 --> 00:18:53.480 But then there's this these all these psychological components and 386 00:18:53.519 --> 00:18:56.559 all these social or sociological components. And the problem with 387 00:18:56.599 --> 00:18:59.319 pain management is that we focus just on the bio, 388 00:18:59.440 --> 00:19:02.160 which is and procedures, and a lot of people will 389 00:19:02.279 --> 00:19:06.079 with chronic pain will confirm that it doesn't cure their 390 00:19:06.119 --> 00:19:08.440 pain because it's focusing just on one third of the problem. 391 00:19:08.799 --> 00:19:12.119 So so here is the second source of pain. And 392 00:19:12.200 --> 00:19:13.720 also where I freak out. 393 00:19:14.039 --> 00:19:17.000 In the psychological domain of pain, we've got believe it 394 00:19:17.079 --> 00:19:21.519 or not, thoughts, because neuroscience tells us that how you 395 00:19:21.640 --> 00:19:24.960 think shockingly affects how you feel. 396 00:19:25.519 --> 00:19:29.359 So right, so if you imagine that you have this 397 00:19:29.559 --> 00:19:31.960 like if you imagine. 398 00:19:31.599 --> 00:19:34.319 You have like this pain volume that lives in your brain, 399 00:19:34.759 --> 00:19:38.359 this pain dial when you have anxious, stressed out and 400 00:19:38.400 --> 00:19:42.559 depressed thoughts, pain volume actually gets turned up. So the 401 00:19:42.680 --> 00:19:45.319