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Speaker 3: Oh hey, it's that smoothie cup you should have washed yesterday.
Speaker 3: Alleyward back with an episode of Ologies you will. Let's
Speaker 3: get into it. Dolerology dollar means pain in Latin. Dolerology.
Speaker 3: It's the study of the nature in management of pain.
Speaker 3: It's a real thing. As it turns out, the folks
Speaker 3: who study it are pretty fired up about talking about it,
Speaker 3: and it turns out a lot of listeners are like,
Speaker 3: I have questions. So this ologist reached out to me,
Speaker 3: told me that her mission as a neuroscientist is to
Speaker 3: help people feel better. And I was like, well, how
Speaker 3: the hell can I turn that down? So I happened
Speaker 3: to be in the Bay Area in October following my
Speaker 3: new husband's new knee surgery. What's your pain scale on
Speaker 3: a pit scale one to ten?
Speaker 4: Four?
Speaker 3: Four for four, that's kind of a lot. Three. No,
Speaker 3: I'm three. I'm not downing. I'm saying that sounds painful.
Speaker 3: And after we battled some Friday afternoon traffic, we arrived
Speaker 3: at this ologist's Oakland office with Los Angeles style punctuality,
Speaker 3: and then we settled into our couch to chat pain.
Speaker 3: Turns out she knows her stuff. She has long brown hair.
Speaker 3: She was wearing knee high boots. She has a very
Speaker 3: youthful exuberance, but a CV that slaps metaphorically speaking. She
Speaker 3: is a working pain psychologist and assistant clinical professor at
Speaker 3: the UCSF School of Medicine. She is on the Pain
Speaker 3: Education faculty at Dartmouth. She's the co president of the
Speaker 3: American Association of Pain Psychology. She's a Psychology Today columnist
Speaker 3: about pain, and the author of the Pain Management Workbook,
Speaker 3: which might be the best twenty dollars you can ever
Speaker 3: spend other than ski ball, which is also fun. This
Speaker 3: might be better. Well, we will talk about all this
Speaker 3: in a minute plus questions from the folks at patreon
Speaker 3: dot com Sashologies. I have never received so many questions
Speaker 3: for any episode. It's great if you want to submit
Speaker 3: questions for guests. It costs a dollar a month to
Speaker 3: join at patreon dot com Slashologies, but for zero dollars
Speaker 3: you can send this episode to someone. You can mention
Speaker 3: ologies to a friend or a date, or you can
Speaker 3: subscribe or rate or leave a review that really helps
Speaker 3: a podcast. I read a new one each week to
Speaker 3: prove that I read all of your reviews. Thank you,
Speaker 3: Thelma Burrito for the review you just left that said
Speaker 3: I was coming down from a psychedelic high on Wednesday,
Speaker 3: and I felt like I needed to hear something comforting
Speaker 3: while relaxing in my sweats and fuzzy socks. I put
Speaker 3: on the episode on sparkle Botology Fireflies, and I don't
Speaker 3: know if it was the sparkly imagery, Ali's voice or
Speaker 3: the sheer fact that I live in a world where
Speaker 3: someone would make content just so we can learn about
Speaker 3: things we would never otherwise learn, but I cried out
Speaker 3: of gratefulness. Thanks Ali, Thelma Burrito, Thank you okay, dolerology pain?
Speaker 3: What is it? Why does it hurt? How much does
Speaker 3: it hurt? Why do some people have more pain than others?
Speaker 3: How do pain meds work? Do redheads feel more pain?
Speaker 3: How long does it take to change your brain? How
Speaker 3: much pain training doctors have? And is there a better
Speaker 3: alternative to that placard of miserable emojis that they have
Speaker 3: on the walls in the hospital. All this and life
Speaker 3: lessons with pain psychologist researcher, professor, author, mental health advocate,
Speaker 3: and dolerologist doctor Rachel Softness. We're only forty four minutes late. Okay,
Speaker 3: So okay. First name gonna make you do is if
Speaker 3: you can say your first and last name in your
Speaker 3: pronouns flo. Oh yeah, no, go for it. No, you
Speaker 3: can sit on the floor. It's like we're hanging out
Speaker 3: in a dorm room.
Speaker 4: Rachel's softness.
Speaker 3: Rachel's softness. She her got it of dolerology. It's a thing,
Speaker 3: it's a thing. Okay, how long have you known this word?
Speaker 5: The honest answer is since I decided I wanted to
Speaker 5: be on ologies.
Speaker 4: I'm not kidding.
Speaker 5: I was like, I know there's a word because I
Speaker 5: do pain psychology, which is an ology, but I study
Speaker 5: pain science and pain neuroscience, which is outside of psychology,
Speaker 5: and there's a word for pain science, which is dolerology.
Speaker 3: What's the the worst pain You've ever been in?
Speaker 1: Oh?
Speaker 5: Wow, the worst pain I've ever been in. I had
Speaker 5: chronic pain as a kid, and I was always I
Speaker 5: had like constant abdominal pain. But as an adult, I
Speaker 5: also had a running injury and it lasted for five
Speaker 5: years and I was like on the couch for the
Speaker 5: better part of a year.
Speaker 4: So that was probably the worst one.
Speaker 3: What do people say hurts the most. I've heard kidney stones,
Speaker 3: I've heard birth, I've heard shingles, I've heard bullet ants.
Speaker 3: How do psychologists figure it out?
Speaker 5: So the honest answer is this, people are trained to
Speaker 5: ask people about their pain on all these pain scales.
Speaker 5: And there's a lot of pain scales out there, and
Speaker 5: the most common one is out of ten? What is
Speaker 5: your pain on a scale of zero out of ten?
Speaker 3: Yeah? I just did that to Jarrett outside for probably
Speaker 3: the one hundredth time since his surgery two weeks before.
Speaker 5: And the funny thing is, and it's actually not funny
Speaker 5: at all. Sometimes people will say my pain is a
Speaker 5: ten out of ten, and it will be something that
Speaker 5: health care provider will think should not be a ten
Speaker 5: out of ten. So the health care provider will say
Speaker 5: to the patient, well, imagine someone taking.
Speaker 4: Off your arm.
Speaker 5: That would be a ten out of ten. So now
Speaker 5: tell me what your pain number is to try and
Speaker 5: get that person to lower the number, like sort of
Speaker 5: suggesting to the patient like, oh, you're exaggerating, But in
Speaker 5: my mind, what's worse? Like can you do anything worse
Speaker 5: to someone who's suffering than say, like the number that
Speaker 5: you gave me is inaccurate. The answer is the most
Speaker 5: annoying answer in science, which is it depends. So for
Speaker 5: one person, post surgical pain might be a six out
Speaker 5: of ten, and for someone else it might be a
Speaker 5: ten out of ten. So I wouldn't say that there's
Speaker 5: like any one thing that is the worst kind of pain.
Speaker 3: That's a good answer, okay. And when people are studying
Speaker 3: how sharp pain is, how do you even know.
Speaker 5: That is all you have? There's absolutely no other way
Speaker 5: to measure pain other than what someone tells you. So
Speaker 5: if someone says their pain is ten out of ten,
Speaker 5: that's what their pain is.
Speaker 4: The end.
Speaker 5: I mean, that's also why it's really hard to compare, Like,
Speaker 5: you can't compare your pain to my pain. Like you
Speaker 5: break your ankle, I break mine. But if you're a
Speaker 5: ten out of ten and I'm a five out of ten,
Speaker 5: it's not like one of us is lying. Yeah, Like
Speaker 5: your pain experience is unique to you.
Speaker 3: And as a kid is someone who experienced chronic abominal pain,
Speaker 3: which I cannot imagine this one in a running injury.
Speaker 4: For five years.
Speaker 3: Were you in a position to choose your career at
Speaker 3: that point when you had a running injury. Were you like,
Speaker 3: you know what, I'm going to change my major. When
Speaker 3: did you decide I'm going to crack this code? Because
Speaker 3: you are super passionate about this, Yeah, you're like, I
Speaker 3: looked up the word for this, I wrote a book
Speaker 3: about this. I want to talk about it. Yeah, yeah,
Speaker 3: where does that passion come from?
Speaker 5: So when I was in college, I knew I wanted
Speaker 5: to live at the intersection of a bunch of things,
Speaker 5: Like I was fascinated by neuroscience and psychology and science
Speaker 5: writing and working with kids and medicine, and I just
Speaker 5: I wanted to find this thing that would let me
Speaker 5: live at the intersection of everything. And I took a
Speaker 5: course a neuroscience course in my freshman year brand because
Speaker 5: I was a nerd. Like to be clear, I was
Speaker 5: like a library mouse, had no friends in high school,
Speaker 5: total total nerd. And Inuawan, which is the best class
Speaker 5: I ever took, they taught us about pain, and it
Speaker 5: was the thing that seemed to live at the intersection
Speaker 5: of everything, because, as I'm sure we're going to talk about,
Speaker 5: pain is never purely physical. It's also emotional, and it's
Speaker 5: not located in the body. Ultimately it's produced by the brain.
Speaker 3: So pain is in the brain. Big revelation here. Much
Speaker 3: more on that in a.
Speaker 5: Bit so, And it's this thing that goes across psychology
Speaker 5: and medicine. Effects adults, it affects kids. It had affected
Speaker 5: me as a kid. So when I went to do
Speaker 5: my honors thesis, my mentor, who's a dear human being
Speaker 5: who recently actually not so recently passed from cancer, said
Speaker 5: to me, there's this researcher here who studies pain. You
Speaker 5: should see if he'll take you on as a mentee.
Speaker 5: And he did, and under his tutelage, I did this
Speaker 5: long honors thesis on the gate control theory of pain,
Speaker 5: and I just thought it was so dynamic and fascinating.
Speaker 5: And everyone has pain at some point in their life, right,
Speaker 5: and when you're a college student, you're still young. But
Speaker 5: as an even younger person, I had already struggled with pain.
Speaker 5: So I was so fascinated by this intersection of all
Speaker 5: the things.
Speaker 3: So Rachel will explain the gait theory of pain in
Speaker 3: more detail later and how essentially kissing an Awi does
Speaker 3: a sweet neurological sleight of hand, kind of like a
Speaker 3: cool button Mitzvah magician. But in terms of her backstory,
Speaker 3: doctors Off got her bachelor's from Brown University in brain
Speaker 3: and behavior, two masters, one in psychology and education from Colombia,
Speaker 3: one in clinical psychology from San Diego State, and then
Speaker 3: her PhD in clinical psychology from University of California, San Diego.
Speaker 3: Somewhere in there, she took a year long break to
Speaker 3: teach science at the Bronx Zoo because she's rad Anyway,
Speaker 3: she became a doctor.
Speaker 5: And as a post doc after I got my PhD
Speaker 5: in psychology, I did my post doc in pain management
Speaker 5: and it was non pharmacological approaches to pain, and I
Speaker 5: just went back down that rabbit hole and it was
Speaker 5: just so interesting to me that there were all these
Speaker 5: ways of treating pain that don't really get talked about
Speaker 5: in medicine or at all in psychology. Like if you're
Speaker 5: a psychologist, you never learn about what we call physical
Speaker 5: pain never, and physicians very rarely talk about the psychological
Speaker 5: aspect of pain. So when I did my post doc,
Speaker 5: I started doing trainings on pain. I just I wanted
Speaker 5: to know everything. I read every book I could get
Speaker 5: my hand on. Literally, I spoke with a million people,
Speaker 5: I took a million classes, and then I decided that
Speaker 5: I wanted to start treating pain, and in particular I
Speaker 5: wanted to work with kids living with pain. When I
Speaker 5: first started that, I really I mean, I was trained
Speaker 5: in adult and child psychology, but I felt like, in particular,
Speaker 5: teenagers get ignored a lot in medicine. It's just this
Speaker 5: really messy, weird age. They're not quite children, they're not
Speaker 5: quite adults. So I want to focus on them. So
Speaker 5: I went to UCSF and I offered to do some
Speaker 5: trainings for free on these non farm treatments for pain
Speaker 5: and how pain works in the brain and in all
Speaker 5: these departments. For some reason, they let me come and
Speaker 5: give a talk to their physicians. Before I knew it,
Speaker 5: my practice was full of kids living with chronic pain. Yeah,
Speaker 5: but Ali Ward the first, like one of the first
Speaker 5: kids they sent me.
Speaker 4: Can I tell you a story?
Speaker 3: Yeah, yeah, that's what I mean for.
Speaker 5: One of the first kids they sent me was a
Speaker 5: kid who had been in bed for like four years
Speaker 5: with chronic pain.
Speaker 4: Yeah.
Speaker 5: He had chronic migraine, chronic body pain like diffuse amplified
Speaker 5: body pain. He had been on about forty medications, including thorizine.
Speaker 3: Okay, I want to do like an hour long aside
Speaker 3: on thorizine, but I'm gonna make the snappy instead. I'm
Speaker 3: gonna put it in bull of points. Invented by a
Speaker 3: French doctor in nineteen fifty two to help with pre surgery,
Speaker 3: anesthesia was also used as an anti inflammatory. Now primarily
Speaker 3: used to manage hallucinations and mania and some symptoms of schizophrenia,
Speaker 3: but it's also been prescribed for everything from behavior problems
Speaker 3: ADHD to barfing to hiccups. Now, if you're like, why
Speaker 3: does thorizine sound like a superhero made out of electrified muscle, Well,
Speaker 3: the lab that marketed thorizine named it after the Norse
Speaker 3: god of lightning and hammers thor to reflect the reverberations
Speaker 3: that would roll across the medical world as a result
Speaker 3: of this revolutionary new drug. Their president said, so yes, anyway,
Speaker 3: Thorizine the thunderbolts of psychiatric drugs, sometimes striking where it
Speaker 3: was not.
Speaker 5: Needed, like knocks them the f out. And this is
Speaker 5: a child, and he was on thorisine for his pain,
Speaker 5: and it would knock him out for days at a time.
Speaker 5: So he wasn't going to school, he wasn't seeing friends,
Speaker 5: he wasn't functioning.
Speaker 4: It was wild.
Speaker 5: He had seen like more than fifteen physicians, and I
Speaker 5: had been reading there's all these protocols for treating chronic
Speaker 5: pain in both adults and children. And I had worked
Speaker 5: with a number of other patients, but I had never
Speaker 5: worked with a kid who had been in bed for
Speaker 5: four years. And I almost called the referring physician to say,
Speaker 5: I can't do it, Like if you guys can't do it,
Speaker 5: I surely can't. Like I almost called them to send
Speaker 5: him back, but instead, like the kid was so hopeless,
Speaker 5: he showed Just to describe him to you, He showed
Speaker 5: up at my office. He had like long unwashed hair.
Speaker 5: He was like overweight because he hadn't moved his body
Speaker 5: in like a number of years, and he was rocking
Speaker 5: himself back and forth on my couch with the pain.
Speaker 5: I asked him if he had given up hope, and
Speaker 5: he said yes. So I made the decision to lie
Speaker 5: to him.
Speaker 4: Yes.
Speaker 5: I know, it's a dubious decision, and I said, I
Speaker 5: can help you, but you have to do everything I say.
Speaker 4: And I knew.
Speaker 5: I mean, especially as a pain psychologist, nobody wants to
Speaker 5: go to a psychologist for pain because pain is sold
Speaker 5: to us as this purely physical or physiological problem. And
Speaker 5: if you go to a psychologist, the popular thought is, oh,
Speaker 5: they're saying it's all in my head, or they're saying
Speaker 5: my pain isn't real, or I'm faking it right.
Speaker 4: But that's not true.
Speaker 5: There's all these treatments that are evidence based for pain,
Speaker 5: that are non pharmacological. So I said to him, I
Speaker 5: can treat you, but you have to do everything I say.
Speaker 5: He said okay, and we went through this cognitive behavioral
Speaker 5: therapy protocol for pain management, which is now what I
Speaker 5: live and die by. And we started out doing very
Speaker 5: small things.
Speaker 4: At first.
Speaker 5: It was like just stand on your porch in the
Speaker 5: sunlight every day, and even that was hard for him.
Speaker 4: And we did like a lot of work together.
Speaker 5: So then it was like walked the corner mailbox and
Speaker 5: mail a letter and you know, and he was doing
Speaker 5: pt and OT at the same time. And then it
Speaker 5: was like, can we get a tutor to help you
Speaker 5: catch up in school. It was like small bits of activity,
Speaker 5: small goals, and really pacing him to desensitize his brain
Speaker 5: and body. Within three months, he was getting back to life.
Speaker 5: He was doing jogs around the block. He did get
Speaker 5: a tutor, he caught up with friends. He eventually went
Speaker 5: back to school in soccer.
Speaker 3: Wow.
Speaker 4: Yeah.
Speaker 5: And the more he did, the more he realized he
Speaker 5: could do, the more his brain desensitized, the more his
Speaker 5: body was able to function, and he was able to
Speaker 5: get back to life and his pain remitted and his
Speaker 5: anxiety and depression did too. And he actually graduated from
Speaker 5: high school a couple of years ago, and he invited
Speaker 5: me to come. My god, Yeah, So I went to
Speaker 5: his graduation and this kid he got on stage and
Speaker 5: he said, if you had told me four years ago
Speaker 5: I'd be graduating from high school, I never would have
Speaker 5: believed you. We all cried, and he went off to
Speaker 5: college and is like swim Captain. He still has pain episodes,
Speaker 5: but he knows exactly what to do, and he's never
Speaker 5: going to be that kid who's in bed for four
Speaker 5: years ever. Again, no kid ever needs to be the
Speaker 5: kid that's in bed for four years.
Speaker 4: Ever.
Speaker 5: The way we mistreat pain just drives me nuts. So
Speaker 5: I think that really drives me. I think I went
Speaker 5: on a tangent like maybe a lot on Beautiful.
Speaker 3: So before we learn how pain psychology works, let's just
Speaker 3: be be back it up and address the fundamental question.
Speaker 3: What is pain?
Speaker 4: Right? What is pain?
Speaker 3: What is it in? How much is it? Yeah, mind?
Speaker 3: How much is it body? How much control do we
Speaker 3: have over it?
Speaker 5: You're asking amazingly hard and awesome question, and I'm going
Speaker 5: to answer them. So you can ask forty different people
Speaker 5: and you'll get forty different answers. And I'm going to
Speaker 5: try and sqush all the things together and make it
Speaker 5: as like digestible as possible. So if I don't do
Speaker 5: a good job, I'm gonna rely on you to.
Speaker 3: Calm me out.
Speaker 5: So pain is your body's warning system. By that, I
Speaker 5: mean it exists to protect you and save your life.
Speaker 5: So I remember learning in this dorky neuroscience class that
Speaker 5: there are people who are born without the ability to
Speaker 5: feel pain. What Yes, And I remember thinking that sounds delightful,
Speaker 5: and then our professor said, yeah, and they don't live
Speaker 5: very long.
Speaker 4: Oh fuck right, Because if you.
Speaker 5: Imagine you put your hand on a stove and you
Speaker 5: don't take it off, you go for a run and
Speaker 5: you break your leg and you just keep running. Because
Speaker 5: pain is actually your body's danger detection system. But like
Speaker 5: every system in the human body, the pain system can fail.
Speaker 5: So one of the biggest errors we often make is
Speaker 5: humans is believing that just because you have pain, it
Speaker 5: means necessarily that a body part is damaged or broken.
Speaker 5: And that's not always what pain means. You can actually
Speaker 5: have pain without damage in a particular body part, is
Speaker 5: what we've learned, and that's what chronic pain is, believe
Speaker 5: it or not. So pain is also adaptive. Again, it's
Speaker 5: this thing that saves your life. It is also this
Speaker 5: word that I'm gonna use that I've been told I
Speaker 5: shouldn't use because it's confusing, but I'm gonna do it anyway.
Speaker 4: Biopsychosocial.
Speaker 5: Okay, yeah, what does that mean? Pain is biopsychosocial. So
Speaker 5: what that means is one hundred percent of the time,
Speaker 5: whether your pain is acute, which means short term, so
Speaker 5: any pain three months or less, or chronic pain, which
Speaker 5: is pain that's three months or longer or beyond expected
Speaker 5: healing time. Your pain lives in the middle of these
Speaker 5: three bubbles or domains that I'm gonna call it. So
Speaker 5: one is biology biological sources of pain. One is psychology
Speaker 5: or psychological sources of pain, and one is social or sociological.
Speaker 5: And I want to say what that means. So if
Speaker 5: you imagine a ven diagram, so there are these three
Speaker 5: bubbles that overlap, and in the middle where they overlap,
Speaker 5: that's where pain lives.
Speaker 3: Okay, pay attention. So Doctor's off is going to break
Speaker 3: down the three sources of pain, starting with biological.
Speaker 4: In the middle of these three things.
Speaker 5: So the biological components of pain are the things that
Speaker 5: you hear about all the time. So it's genetics and
Speaker 5: tissue damage and system dysfunction and like immune functioning and
Speaker 5: sleep and diet and exercise, and those are all very
Speaker 5: important when it comes to pain.
Speaker 4: We all know that.
Speaker 5: However, if you think about this ven diagram, if you're
Speaker 5: only focusing on the biocomponent of pain, you're actually missing
Speaker 5: two thirds of the pain problem. Because we know that
Speaker 5: pain is this biopsychosocial phenomenon, and I promise I'll explain why.
Speaker 5: But then there's this these all these psychological components and
Speaker 5: all these social or sociological components. And the problem with
Speaker 5: pain management is that we focus just on the bio,
Speaker 5: which is and procedures, and a lot of people will
Speaker 5: with chronic pain will confirm that it doesn't cure their
Speaker 5: pain because it's focusing just on one third of the problem.
Speaker 3: So so here is the second source of pain. And
Speaker 3: also where I freak out.
Speaker 5: In the psychological domain of pain, we've got believe it
Speaker 5: or not, thoughts, because neuroscience tells us that how you
Speaker 5: think shockingly affects how you feel.
Speaker 4: So right, so if you imagine that you have this
Speaker 4: like if you imagine.
Speaker 5: You have like this pain volume that lives in your brain,
Speaker 5: this pain dial when you have anxious, stressed out and
Speaker 5: depressed thoughts, pain volume actually gets turned up. So the
Speaker 5: things you think affect the way your body feels one
Speaker 5: hundred percent of the time. Then in the psychological bubble,
Speaker 5: we also have things like trauma, because trauma one hundred
Speaker 5: percent of the time also amplifies pain. There's these great
Speaker 5: studies called the ACES studies Adverse Childhood Experiences and and
Speaker 5: they have shown that kids who have had adverse experiences,
Speaker 5: and by the way, adults too who have trauma, it
Speaker 5: also amplifies this pain volume, this pain dial So if
Speaker 5: you are someone who has had pain in childhood or
Speaker 5: in adulthood, chances are you're going to be more susceptible
Speaker 5: to higher pain or end or developing chronic pain. And
Speaker 5: in the psych bubble, also there's memories. So there's a
Speaker 5: part of your brain called the hippocampus, and it stores
Speaker 5: all of your memories and there's a dedicated portion for
Speaker 5: pain memories. So the first time you were held down
Speaker 5: and given an injection as a child, your hippocampus stores
Speaker 5: that information. Why it's adaptive to remember the things that
Speaker 5: are painful because those things might save your life. So
Speaker 5: memories also affect pain. There's also emotions. Emotions also affect pain.
Speaker 5: That seems not even intuitive, but research also shows that
Speaker 5: how you feel emotionally affects how your body feels. And
Speaker 5: we all know that right like when you're depressed, body
Speaker 5: feels heavy, your muscles feel sore. It's just like harder
Speaker 5: to get off the couch, right, Yeah, because emotions affect
Speaker 5: the body too. And then there's coping behaviors also in
Speaker 5: the psych bubble, and coping behaviors just means what are
Speaker 5: you doing to manage your pain?
Speaker 4: When you have pain? What do you do?
Speaker 5: So some people, including me, as I mentioned, for a
Speaker 5: year will stay inside on their couch, not exercising, not
Speaker 5: seeing friends, not moving, But what we know is that
Speaker 5: that's going to amplify pain also.
Speaker 3: Okay, so those first two bubbles were biological and psychological.
Speaker 3: What is the third bubble?
Speaker 5: And then there's the social or the sociological bubble and
Speaker 5: that's everything else. So socio economic status and access to care,
Speaker 5: I mean, if you're not talking about that, are you
Speaker 5: really talking about healthcare at all? Or pain or disease?
Speaker 5: Race and ethnicity and racism in particular, what does that
Speaker 5: do to your stress system and how does that affect
Speaker 5: your pain. There's also friends and family, like do you
Speaker 5: have a support network, do you feel like you're connected
Speaker 5: socially or are you isolated? Being isolated or being socially
Speaker 5: supported affects how you feel all the time. Also, so
Speaker 5: all these things together, as you imagine, like human beings,
Speaker 5: are these complex animals with all these things going on,
Speaker 5: and they interact all of the time to affect your
Speaker 5: pain system. That was a long answer to your question.
Speaker 3: No, it was great. It was visual, oh, and a
Speaker 3: fascinating fact. So the definition of pain has recently been
Speaker 3: changed to reflect those social and psychological components. So a
Speaker 3: twenty twenty piece in the Journal of Orthopedic and Sports
Speaker 3: Physical Therapy explains that the International Association for the Study
Speaker 3: of Pain has updated its definition of pain for the
Speaker 3: first time in four decades, and that the original definition
Speaker 3: of pain was quote an unpleasant sensory and emotional experience
Speaker 3: associated with actual or potential tissue damage, which was criticized
Speaker 3: for being too focused on actual tissue injury. And so
Speaker 3: the shiny new, updated twenty twenty definition of pain is
Speaker 3: an unpleasant sensory and emotional experience associated with or resembling
Speaker 3: that associated with actual or potential tissue damage. So now
Speaker 3: pain does not need to be associated with actual injury.
Speaker 3: So doctor's Oftness says, the new definition leaves much to
Speaker 3: be desired, but it is an improvement upon past Disco
Speaker 3: era definitions, but yes, right in line with her three
Speaker 3: sources of pain and really different from this foggy, jumbled
Speaker 3: mess that I thought pain was, which is now painful
Speaker 3: to listen back to. And I never knew that there
Speaker 3: were three aspects of it. What I picture pain, I
Speaker 3: picture you have this nerve that looks like a thread
Speaker 3: and it has an injury on it, and it sends
Speaker 3: out electrical pulses that make your cells twitch. That is
Speaker 3: what I would think pain was. And that's not accurate
Speaker 3: at all.
Speaker 5: Right, but that that makes sense A and B, Like
Speaker 5: they have done all this research that shows you do
Speaker 5: have receptors in your body that respond to things like
Speaker 5: touch and temperature and like no susceptive input, which is
Speaker 5: like potentially dangerous input. But what they've discovered is here's
Speaker 5: like this really cool, really nerdy fun fact is that
Speaker 5: pain can't possibly live exclusively in the body.
Speaker 4: But we all think that.
Speaker 5: We all think like, well, if I have back pain,
Speaker 5: that means definitely there's something wrong with my back, right,
Speaker 5: Or if I have knee pain, that means that the
Speaker 5: pain lives exclusively in my knee. But here's how we
Speaker 5: know that pain does not live exclusively in the body.
Speaker 5: There's a condition called phantom limb pain, and phantom limb
Speaker 5: pain is when someone literally loses a limb like an
Speaker 5: arm or a leg, and they continue to have terrible,
Speaker 5: excruciating pain in the missing body part. So if you
Speaker 5: can have excruciating leg pain in a leg that isn't there,
Speaker 5: that has to mean that pain is produced somewhere else,
Speaker 5: and that somewhere else is the brain. So you definitely
Speaker 5: have these receptors in your body that are communicating messages
Speaker 5: up to your brain, and your brain is always sending
Speaker 5: messages back down to your body. It's definitely like a
Speaker 5: two way street. They're always working together. But the part
Speaker 5: of your body ultimately that constructs pain has to be
Speaker 5: your brain.
Speaker 3: And how do you know of those three bubbles, what
Speaker 3: is the biggest contributing factor? Like if you have a
Speaker 3: slipped disc in your back and that definitely hurts, versus
Speaker 3: if their X rays show nothing but there is chronic pain,
Speaker 3: how how do you know how to start to address it.
Speaker 4: Here's the answer.
Speaker 5: So the answer is all three things are always contributing
Speaker 5: all of the time, and yes, in any given moment,
Speaker 5: something in any one of those bubbles might be like
Speaker 5: activated or up, but they're always all three are always
Speaker 5: acting all the time. So there's always this like recipe
Speaker 5: for pain, whether it's high or low, and the recipe
Speaker 5: always one hundred percent of the time includes all three bubbles.
Speaker 5: But you're right, right, So with acute pain, which is
Speaker 5: short term pain, it is usually a message that there's
Speaker 5: something going on with your body that you need to
Speaker 5: check out. Right, So like, for example, let's say someone
Speaker 5: has knee surgery, you bet or ask your body's going
Speaker 5: to be giving you all of these messages something's wrong
Speaker 5: like some and yes, someone has just sliced into your.
Speaker 4: Tissue like yeah, and you're healing.
Speaker 5: But so with acute pain, yes, you want to check
Speaker 5: that out and find out what's going on with your body.
Speaker 5: It's a little bit different with chronic pain. And I'm
Speaker 5: going to tell you why. But to go back to
Speaker 5: your original question, if we don't address all three things,
Speaker 5: we're not ever addressing pain. So if you imagine there's
Speaker 5: this like common analogy, if you stub your toe on
Speaker 5: a day you get fired, you've just lost your income
Speaker 5: and you don't know if you're gonna be able to
Speaker 5: afford your rent. When you stub your toe, you're going
Speaker 5: to be cursing and screaming, and it's going to feel awful.
Speaker 4: If you stub your toe.
Speaker 5: When you're out with your friends eating ice cream, you're
Speaker 5: out in the sun, you're having a lot of fun,
Speaker 5: it feels qualitatively different to you. Your brain interprets the
Speaker 5: message differently depending on circumstance, environment, how you're feeling emotionally,
Speaker 5: where you are, who you're with, what's happening, how you
Speaker 5: interpret that the sensation. So the answer is even with
Speaker 5: acute pain all the time, all those things are working
Speaker 5: in concerts. So like if you go to a children's hospital,
Speaker 5: in the ward, you'll see there's like murals on the
Speaker 5: wall and stuffy's on the chairs. And there's a reason
Speaker 5: for that because when you help people feel safe and calm,
Speaker 5: your pain system is going to feel better too. It's
Speaker 5: going to be like less on alert. And that's true
Speaker 5: with adults also, So whether acute pain or chronic pain,
Speaker 5: all the time, all the things are always working together.
Speaker 3: And what about the biological methods that we have right now,
Speaker 3: Like how does aspirin work, how does leave work, How
Speaker 3: does ibuprofen work, How do opiates work, what are they blocking?
Speaker 3: Because sometimes that absolutely blows my mind that I can
Speaker 3: take something and a migrain will go away.
Speaker 5: One hundred percent absolutely, yes, that is totally true. And
Speaker 5: all the medications work in different ways, but they target
Speaker 5: receptors in your brain to block what I'm going to
Speaker 5: call pain messages.
Speaker 3: So yes, chemically it's pretty complex, but just think of
Speaker 3: pain relievers fitting and locking into places and thus just
Speaker 3: ruining the vibe of the pain messages. Real cock blockers.
Speaker 5: But what's really interesting to me about opioids, by the way,
Speaker 5: and all these medications, but opioids in particular, because there's
Speaker 5: so much talk about opioids and pain, is that opioids
Speaker 5: work on an endogenous receptor in your brain. By that,
Speaker 5: I mean you already produce a chemical in your brain
Speaker 5: that opioids imitate, and they're called endorphins. So when you
Speaker 5: if you hear of like a runner's high after you
Speaker 5: go for a run, your brain produces this opioid substance
Speaker 5: called endorphins, and so opioids bind to that receptor. So
Speaker 5: it's true of all medications. Whenever you take a medication,
Speaker 5: it's binding to a receptor in your brain. For a
Speaker 5: chemical your brain already makes.
Speaker 3: In side note, we're going to do a whole episode
Speaker 3: in the future on mechanology, which is the study of
Speaker 3: opium and opiates, including the epidemic of opioid addiction. But yes,
Speaker 3: medicines have pluses and minuses depending on their use.
Speaker 5: And I also need to be very careful and clear
Speaker 5: with so I am in no way anti medication, Like
Speaker 5: I'm like a person who's like, thank God that opioids
Speaker 5: and other analgesics exist for post surgical pain and things
Speaker 5: like migrain and all the other horrible things that happened
Speaker 5: to human beings, like super helpful, super wonderful and very important.
Speaker 5: And simultaneously, because pain is so mistreated in our country,
Speaker 5: and because there's such poor pain education in medical school,
Speaker 5: in psychology programs, and nursing programs across the board, we
Speaker 5: completely and utterly mistreat pain, and people are told that
Speaker 5: medications are the only answer. So people living with chronic
Speaker 5: pain oftentimes feel really helpless and hopeless because either their
Speaker 5: medication is being taken away from them, or there's like
Speaker 5: a lot of controversy around it, or or they feel
Speaker 5: like they don't have other options or alternatives. So so
Speaker 5: thank God for medication, and it is not the only answer.
Speaker 5: And controversially, and like I'm going to get in trouble
Speaker 5: for saying this, but I'm gonna say it anyway. The
Speaker 5: problem with opioids for pain. And by the way, this
Speaker 5: is not like I didn't make this up. This is
Speaker 5: just what research shows over time, opioids sensitize the brain
Speaker 5: to pain over time. Yeah, there's a whole there's it's
Speaker 5: a sensitization syndrome. It's a well known established fact.
Speaker 3: Google opioid induced hyper algesia. It's like a closet just
Speaker 3: stuffed with items, but instead of umbrellas and bowling balls
Speaker 3: falling onto your face, you're just going to be covered
Speaker 3: in studies about pain and opioids, so doctor Zoff explains.
Speaker 5: So, actually, what happens over time is that your brain
Speaker 5: gets more and more tuned in to the sensory messages
Speaker 5: coming from your body. So if you ever try and
Speaker 5: go off, of course, you're going to feel awful and terrible.
Speaker 5: And again, I am not anti opioid, I'm not anti medication,
Speaker 5: but it seems important for people to know that long term,
Speaker 5: their brain is going to get extra sensitive.
Speaker 3: Now, what about someone who is experiencing pain, let's say
Speaker 3: it's chronic, let's say it's ongoing. Where do you even
Speaker 3: start that CBT or something that is non pharmacological, Like
Speaker 3: do you just do like a pain check in? Do
Speaker 3: you just sit and try and figure out like what
Speaker 3: hurts where and why?
Speaker 5: Can I answer your question in a sort of backwards way, yes,
Speaker 5: So chronic pain is its own animal. It's considered its
Speaker 5: own disease process. So here's what happens with chronic pain.
Speaker 5: So to answer your question, the first thing that I
Speaker 5: do is I explain how pain works. And I always
Speaker 5: ask people who come to my office who have been
Speaker 5: in pain for like ten years, Hey, has anyone ever
Speaker 5: explain how pain.
Speaker 4: Works to you?
Speaker 5: And they're like no, One hundred percent of people say no,
Speaker 5: which is so wild to me, Like you've had pain
Speaker 5: for ten years. People will explain how the liver works,
Speaker 5: but they've never explained how pain works. That's crazy pants.
Speaker 5: So we've established that pain is constructed by the brain,
Speaker 5: of course, in conjunction with the body. We've established that
Speaker 5: a cute pain and chronic pain are different. They work differently.
Speaker 5: There's receptors in the body but the brain is always
Speaker 5: working with all of the information to decide whether or
Speaker 5: not to make pain and how much. With chronic pain,
Speaker 5: here's what happens. So I'm going to ask you a question. Okay,
Speaker 5: have you ever practiced anything, like any skill that you
Speaker 5: were bad at and you practiced it and you got
Speaker 5: good at it?
Speaker 3: Absolutely, give me a thing ukulele.
Speaker 4: Oh that's the best one. Yes, great? Great.
Speaker 5: Have you noticed with the ukulele, like eventually your fingers
Speaker 5: sort of know what to do?
Speaker 3: Yeah? Yeah, absolutely, And I can go faster on a song.
Speaker 3: I never have played in front of anyone. It's just
Speaker 3: something I do because it's fun to do alone.
Speaker 4: You know.
Speaker 5: If I had known that, I would have demanded that
Speaker 5: you no, you can't.
Speaker 3: Do it in front of him. But yeah, and I can,
Speaker 3: and I can think about the song before positioning each finger.
Speaker 4: Yeah, so totally right.
Speaker 5: So I'm gonna say it back to you a little differently,
Speaker 5: in like the neuroscience nerd way. Okay, the pathways in
Speaker 5: your brain are like the muscles in your body. The
Speaker 5: more you use them, the bigger and stronger they get.
Speaker 5: So if you said to me, Zoftness, I want huge biceps,
Speaker 5: I would say, Ali, of course you do go to
Speaker 5: the gym and lift weights a lot, or like actually
Speaker 5: be isolated at home. Whatever, Yeah, lift weights a lot,
Speaker 5: and over time your biceps will get big and strong.
Speaker 5: It's the same with the pathways in your brain. The
Speaker 5: more you use them for any particular thing, the bigger
Speaker 5: and stronger they get. So the more you practice ukulele,
Speaker 5: the bigger and stronger the ukulele pathway in your brain gets.
Speaker 5: Like you could hear the notes. Your fingers know what
Speaker 5: to do on the strings, you know how to position
Speaker 5: them instrument. And that's with practice over time. Guess what
Speaker 5: happens when you inadvertently accidentally practice pain over and over
Speaker 5: for weeks and months and years saying, the pain pathway
Speaker 5: in your brain gets really big and strong. And when
Speaker 5: that happens, we say that your brain has become sensitive
Speaker 5: to pain. What does that mean? That took me a
Speaker 5: long time to figure out. How do you explain that
Speaker 5: to someone? What does that mean that your brain is
Speaker 5: sensitive to pain? What it means is that small bits
Speaker 5: of sensory input from your body are interpreted by a
Speaker 5: sensitive brain as very big. So like dogs are sensitive
Speaker 5: to smell, right or sense? So if a dog came
Speaker 5: in here right now and sniffed around, they would pick
Speaker 5: up on the sense that you and I can't even
Speaker 5: detect because their brain is sensitive to smell. So with pain,
Speaker 5: when your brain is sensitive to pain, it means that
Speaker 5: you might have little bits of sensory input coming from
Speaker 5: your body that are not dangerous, that are not dangerous,
Speaker 5: but your brain is going to amplify it and tell
Speaker 5: you that it's dangerous. And that's what pain is. It's
Speaker 5: this big danger response, this big danger warning message that
Speaker 5: actually is inaccurate, and that's chronic pain. So the system,
Speaker 5: one of the systems underlying chronic pain is this process.
Speaker 5: It's called central sensitization, and it doesn't underlie all pain,
Speaker 5: but it explains a lot of chronic pain. And to me,
Speaker 5: it's so fascinating to be able to say to someone, hey,
Speaker 5: the chances are really high that your brain is hyper
Speaker 5: sensitive and it's overreacting and it's not your fault, but
Speaker 5: it's giving you these danger messages when in fact your
Speaker 5: body might not be in danger. So, for example, with fibromyalgia, yeah,
Speaker 5: which is a chronic pain condition, you can go for
Speaker 5: a picnic with your friends and be sitting outside and
Speaker 5: be in terrible pain.
Speaker 4: But it's having a.
Speaker 5: Picnic with your friends dangerous And the answer is no.
Speaker 5: But your brain is producing these danger messages and telling
Speaker 5: you should go home and isolate and be alone and
Speaker 5: not move and not see your friends. And that is
Speaker 5: a big fat lie. And if you listen to your
Speaker 5: brain and you do those things, and you go in
Speaker 5: isolate and you lay on your couch for forty years,
Speaker 5: you are not going to get better. So the treatment
Speaker 5: for chronic pain is the total opposite of what you think.
Speaker 3: It is.
Speaker 5: Your body and your brain are telling you isolate, stay home,
Speaker 5: don't move. And the treatment for chronic pain is like
Speaker 5: my metaphor is like if you've ever been in a
Speaker 5: dark room and someone opens the blinds a little bit.
Speaker 4: And you're like, ah, close the blinds.
Speaker 5: I can't see because your brain is sensitive to light
Speaker 5: when you've been in a dark room. But if you
Speaker 5: sit there for two minutes, your brain desensitizes to the
Speaker 5: light and then you're fine, right, And if they open
Speaker 5: the blinds a little more, you're.
Speaker 4: Like, shit, close the blinds, I can't see.
Speaker 5: And then eventually, two minutes later, your brain desensitizes you're fine.
Speaker 5: Treatment for chronic pain. And that's what cognitive behavioral therapy is.
Speaker 5: By the way, it's helping someone's brain and body desensitize
Speaker 5: to little bits of stimulation a little bit at a
Speaker 5: time until like someone who's in a dark room, suddenly
Speaker 5: you're in a room full of light, gradually, little bits
Speaker 5: at a time, and your brain and body are OK.
Speaker 5: So that's the treatment, but you're you're not going to
Speaker 5: buy into the treatment unless you understand the science. So
Speaker 5: that's why it's so important to me to always lay
Speaker 5: that foundation.
Speaker 3: And is the amygdala it all involved in this? Like
Speaker 3: is anxiety and fear? Is that a big part of
Speaker 3: pain perception?
Speaker 4: Yeah?
Speaker 3: Ah, had a feeling old amy up there? Fucking shit up.
Speaker 4: One hundred percent?
Speaker 3: Yeah help?
Speaker 5: Yeah, okay, So crash course in pain neuroscience, PAINAROS signs
Speaker 5: one or one.
Speaker 4: Here's how it goes.
Speaker 3: Ready, okay, I'm so ready. Let's hear what parts of
Speaker 3: your head are being a literal pain in your ass.
Speaker 5: So there's lots of parts of your brain that contribute
Speaker 5: to pain. With some things, it's like, oh, there's just
Speaker 5: one part of your brain, but with pain, it's a
Speaker 5: diffuse neurological process. And what that means is there's lots
Speaker 5: of parts of your brain that contribute to this experience
Speaker 5: we call pain. So I'm going to tell you a
Speaker 5: couple of parts of the brain.
Speaker 3: Okay.
Speaker 5: One is your cerebral cortex. Okay, your cerebral cortex is
Speaker 5: the part of your brain responsible for thoughts. Thoughts contribute
Speaker 5: to pain all the time. The second part of your
Speaker 5: brain is your prefrontal cortex, and that's the part of
Speaker 5: your brain responsible for executive functioning and attention, what you're
Speaker 5: focusing on, what you're thinking about. And the third part
Speaker 5: of the brain is your limbic system. Yes, your limbic system,
Speaker 5: and your amygdala is a major part of your brain's
Speaker 5: limbic system. And your limbic system, by the bye is
Speaker 5: your brain's emotion center. And here's what this means. That
Speaker 5: means that one hundred percent and I'm not exaggerating one
Speaker 5: hundred percent of the sensory signals that come from your
Speaker 5: body filter through your emotion center before they become this
Speaker 5: experience we call pain. So people always ask me, do
Speaker 5: you treat physical pain or emotional pain? Like, oh, you're
Speaker 5: a pain psychologist. That's so weird, and do you treat
Speaker 5: physical pain or emotional pain? And the answer is always
Speaker 5: necessarily yes, yes, because pain is always physical and emotional.
Speaker 5: It's filtering through your limbic system, it's filtering through your
Speaker 5: emotion center before it becomes this complex experience we call pain.
Speaker 4: So yes.
Speaker 5: So now I want you to imagine we sort of
Speaker 5: touched on this earlier, that you have what I'm going
Speaker 5: to call a pain dial, like the volume knob on
Speaker 5: your car stereo, and you can turn it up and down.
Speaker 5: And it lives in your central nervous system, your brain
Speaker 5: and your spinal cord, which work together to control all
Speaker 5: the shit, including pain. So here's how this works. Lots
Speaker 5: of things can change pain volume, whether it's a cute
Speaker 5: pain or chronic pain, whether you've had it for five
Speaker 5: seconds or ten years. Lots of factors change pain volume
Speaker 5: to turn it up and down. So three things I
Speaker 5: want to tell you about. One is stress and anxiety
Speaker 5: always changes pain volume.
Speaker 4: Oh no, I know. Right during a pandemic.
Speaker 5: During a pandemic, chronic pain during the pandemic went through
Speaker 5: the roof. Opioid related overdoses went up forty percent, Calls
Speaker 5: to suicide hotlines went up eight thousand percent. Oh my god, dude,
Speaker 5: people are suffering. People are really so people in pain
Speaker 5: because of all the snur signs we're talking about. It
Speaker 5: makes sense, right, So stress and anxiety. Thing two is
Speaker 5: mood and emotions always change pain volume, and thing three
Speaker 5: is attention or what you're focusing on. So I'm going
Speaker 5: to tell you specifically how this works.
Speaker 3: So, so again, that was stress, emotions, and attention.
Speaker 5: When stress and anxiety are high and your body and
Speaker 5: your muscles are tense and tight, which is what happens
Speaker 5: when you're stressed and anxious and your thoughts are worried,
Speaker 5: your brain sends a message to this pain dial, turning
Speaker 5: up pain volume. So whatever pain you had before, when
Speaker 5: you're stressed or anxious, like you just lost your job
Speaker 5: or it's a pandemic, or like whatever you're stressed out
Speaker 5: because you're fighting with your partner or whatever, your brain
Speaker 5: is going to amplify pain volume. Pain is going to
Speaker 5: feel worse when stress and anxiety are high. And anyone
Speaker 5: with any chronic pain condition will tell you that stress
Speaker 5: and anxiety can be a trigger or an amplifier of pain.
Speaker 5: Thing two is mood. So again, negative emotions So when
Speaker 5: your mood is low and your mis szeruable and depressed,
Speaker 5: which ironically happens when you have pain, or emotions are
Speaker 5: negative in general, or you're angry or you're very frustrated,
Speaker 5: your limbic system, including your amygdala of course, which is
Speaker 5: implicated in all the will amplify pain volume. So pain
Speaker 5: feels worse when emotions are negative. And Think three is
Speaker 5: attention again, what you're focusing on. So when you are
Speaker 5: sitting in bed or laying on your couch and you're
Speaker 5: focusing on your body and you're thinking about your pain,
Speaker 5: that body part that's hurting, your prefrontal cortex sends a
Speaker 5: message to that pain dial, raising pain volume. So pain
Speaker 5: feels worse when you're thinking about it and when you're
Speaker 5: focusing on the body part that hurts. But the reason
Speaker 5: this is critically important for those of us who have pain,
Speaker 5: which is one hundred percent of us, is that the
Speaker 5: opposite is also true. The opposite is also true, and
Speaker 5: if you think about the implications for pain management, that's
Speaker 5: pretty wild. So let's talk about the opposite. When stress
Speaker 5: and anxiety are low, your body and your muscle are relaxed,
Speaker 5: and your thoughts are calm, your brain sends a message
Speaker 5: to that pain dial, lowering pain volume, so pain feels
Speaker 5: less bad when you are relaxed and calm. Thing two
Speaker 5: is mood emotions, So when your emotions are positive, you're
Speaker 5: feeling happy and joyful and grateful, and you're doing fun
Speaker 5: things with friends, your limpic system lowers pain volume. Pain
Speaker 5: feels less bad when emotions are positive. And thing three
Speaker 5: is attention. So when you are distracted, when you're so
Speaker 5: absorbed in some activity, you briefly forget about your pain.
Speaker 4: We've all had that experience. That is not magic. That
Speaker 4: is your brain's pain dial.
Speaker 5: So your brain, your prefrontal cortex will lower this pain
Speaker 5: dial when you are absorbed in things and you're not
Speaker 5: thinking about your body and you're not thinking about pain.
Speaker 5: So that's why when you go to give a child
Speaker 5: a vaccine, which everyone should do and get an injection,
Speaker 5: you give them a screen and they can watch their
Speaker 5: favorite show and they're distracted and it hurts less. So
Speaker 5: all these things together in my mind help us understand
Speaker 5: that pain again, is this biopsychosocial thing that's regulated by
Speaker 5: mood and thoughts and what you're focusing on and where
Speaker 5: you are and who you're with in your context, and
Speaker 5: all those things are going to matter to your brain
Speaker 5: when it makes this pain decision, whether or not to
Speaker 5: make pain and how much?
Speaker 3: And so what are some of the first steps If
Speaker 3: someone doesn't have the privilege of being your specific patient,
Speaker 3: for example, or maybe they're psychologists or their medical doctors
Speaker 3: don't have this much information and their brains about it,
Speaker 3: where do you start with? People? Do you start with?
Speaker 3: Just like start meditating, go on the porch? Where do
Speaker 3: you even begin?
Speaker 5: So I do this treatment called cognitive behavioral therapy, and
Speaker 5: there's a lot of misunderstanding and misinformation about what that
Speaker 5: is and how it applies to pain. So what it
Speaker 5: is is it's a treatment that was originally developed for
Speaker 5: anxiety and depression that does have evidence effectiveness, and it
Speaker 5: also is a treatment by the way, for sleep and
Speaker 5: family dysfunction and all these other things by the way
Speaker 5: that also contribute to pain, which is so fascinating to
Speaker 5: me because all the things are interconnected, So it makes
Speaker 5: sense to me that this thing might be useful for pain.
Speaker 5: And it teaches us that how you think affects how
Speaker 5: you feel emotionally affects how you feel physically. Affects how
Speaker 5: you behave, or act, So round and round in a circle.
Speaker 5: What you think affects how you feel, affects how your
Speaker 5: body feels affects how you act. And I can give
Speaker 5: you an example of that. So let's say someone invites
Speaker 5: you to a party. They're like, Alley Ward, it's been
Speaker 5: like a year and a half pandemic.
Speaker 4: Come to my house.
Speaker 5: We're going to have a party in my backyard. It's
Speaker 5: going to be really fun. And you have this thought
Speaker 5: in your head. You think to yourself, I am a
Speaker 5: loser and nobody likes me, and if I go to
Speaker 5: the party, no one will talk to me and I'll
Speaker 5: just be standing by myself.
Speaker 3: At this point, I was feeling depressed and ashamed.
Speaker 5: That thought is going to afect your emotions. How might
Speaker 5: you feel if you thought that thought?
Speaker 3: Oh, depressed and ashamed?
Speaker 4: One hundred percent?
Speaker 5: Yes, yeah, right, So you're feeling depressed and miserable and ashamed.
Speaker 5: So how does depression affect your body?
Speaker 3: I think I would have a harder time getting up
Speaker 3: and getting ready for it, that's right. I think I
Speaker 3: would sink into whatever soft fabric I am sitting on
Speaker 3: at the moment.
Speaker 4: One hundred percent.
Speaker 5: Yes, So we know that negative emotions impact the body, right,
Speaker 5: And I'd like to say that negative emotions don't just
Speaker 5: live in your head. They also come out in your body.
Speaker 5: And if you've ever been stressed out or nervous and
Speaker 5: your palms get sweaty and your mouth goes dry and
Speaker 5: your heart races, of course, emotions come out in your body.
Speaker 5: Or if you've ever been depressed, you know that you
Speaker 5: feel heavy and unmotivated. So, right, so that thought I'm
Speaker 5: a loser, nobody likes me, I'm gonna have a terrible time,
Speaker 5: is going to trigger negative emotions and that's gonna affect
Speaker 5: your body. You're gonna feel unmotivated and heavy. So what
Speaker 5: do you do as a result of those thoughts and feelings?
Speaker 5: You already said it perfectly.
Speaker 3: You sink into a couch and then I send a
Speaker 3: text about being on deadline, which is.
Speaker 5: A love right, right, and you like put on your
Speaker 5: fuzzy pajamas and you get a tub of ice cream
Speaker 5: and you binge watch Netflix totally exactly, but the cycle
Speaker 5: spins around. So now you're missing out on the party
Speaker 5: and you're sitting on your couch and you're in your pajamas,
Speaker 5: eating a tub of ice cream, And what are you
Speaker 5: thinking to yourself? Now, I'm a rock star. Are you thinking, I.
Speaker 3: Know I am the lizard that I thought that I was.
Speaker 5: Yes, yeah, And that's what we call the cognitive behavioral
Speaker 5: therapy cycle of how thoughts affect the brain affect the body.
Speaker 4: Right. But now let me give you the opposite. Someone
Speaker 4: says Ali Ward. Come to my house. We're having a
Speaker 4: great party. You can wear whatever dress you want, put
Speaker 4: on your.
Speaker 5: Nice to shoes, and you think to yourself, I am
Speaker 5: a rock star.
Speaker 4: People love me. I'm the life of the party. I'm
Speaker 4: gonna break dance.
Speaker 5: I'm gonna pull out my break dancy moves, and I'm
Speaker 5: gonna like bake brownies and like bring them.
Speaker 4: Everyone's just gonna think, how does that make you feel? Oh?
Speaker 3: I lighter and excited and a little nervous.
Speaker 5: Great love that consolation of emotions, right, excite, totally excited,
Speaker 5: a little nervous.
Speaker 4: So how does that affect the body?
Speaker 5: Usually when you're excited, you have a lot of energy,
Speaker 5: you know, you feel like motivated, And then what's your behavior?
Speaker 4: What do you do?
Speaker 3: Definitely put on lipstick, do some mascara, dig out the
Speaker 3: liquid liner, bake some brownies, eat some of the batter
Speaker 3: if I want to totally yeah, and maybe even leave
Speaker 3: the house on time.
Speaker 5: That's right, So you go to the party, that's right.
Speaker 5: You show up at the party in your dress and
Speaker 5: you bring some brownies. Chances are pretty high some person
Speaker 5: is going to be talking to you. And if you're
Speaker 5: really feeling like if you're thinking I'm a rockstar, I'm
Speaker 5: gonna have fun, chances are high you probably you probably will,
Speaker 5: You'll tract someone to come talk to you. Right, So,
Speaker 5: the things you think affect the things you feel affect
Speaker 5: how you behave always that's always true. And the shit
Speaker 5: of it is, when you're anxious and depressed, you get
Speaker 5: stuck in these thought cycles that contribute to the perpetuation
Speaker 5: of the cycle. And you can see how that would
Speaker 5: easily happen, and it happens with pain.
Speaker 4: Also.
Speaker 5: When you have pain, a lot of the thoughts that
Speaker 5: I hear are I'm broken, I'll never get better. Nothing
Speaker 5: has helped me, so nothing is going to help me.
Speaker 5: Why bother?
Speaker 4: Right? And that makes you feel anxious and depressed.
Speaker 5: And what we already know from pain neuroscience is that
Speaker 5: that's going to amplify pain. So your body's going to
Speaker 5: feel worse, and how are you going to act as
Speaker 5: a result. You're going to stay inside on your couch
Speaker 5: with a tub of ice cream and your snuggie or whatever,
Speaker 5: and it's going to be very hard for you to
Speaker 5: break that pain cycle. So what we do in cognitive
Speaker 5: behavioral therapy or CBT is every individual is unique who
Speaker 5: comes into my office, and my job is to educate
Speaker 5: them about pain in their body because no one ever has,
Speaker 5: and then to figure out what's that person's unique cycle,
Speaker 5: because you bet they're thinking their own unique thoughts and
Speaker 5: feeling their own unique feeling feelings and they are down
Speaker 5: whatever coping rabbit hole they're down, and everyone is doing
Speaker 5: the best they can to manage their pain. Right, this
Speaker 5: is like not a critique. Everyone is doing the best
Speaker 5: they can. And if you really believe that's staying on
Speaker 5: your couch for five weeks is the answer five years,
Speaker 5: that's what you're gonna do.
Speaker 4: Right, So it's like, what is your cycle? How do
Speaker 4: I help you break it?
Speaker 5: And you can break it by going after the thoughts,
Speaker 5: and you can break it by going after the emotions,
Speaker 5: and you can break it by going after the behaviors.
Speaker 5: So what I happen to like to do with my
Speaker 5: patients the best is change behaviors first.
Speaker 3: Oh so you go backwards on the wheel.
Speaker 4: So I should have said this. The wheel can go
Speaker 4: in any direction.
Speaker 5: Because if you think about it, if you just start
Speaker 5: with the behaviors, you're laying in bed for five years?
Speaker 5: Yeah right, what are you thinking? And Harry, you feel
Speaker 5: like you can start. That's what I like about the wheel.
Speaker 5: Everything affects everything. It's multidirectional, it's always spinning in every direction.
Speaker 5: And what I like about behaviors is like, thoughts are
Speaker 5: really complicated.
Speaker 4: It's really hard to challenge your thoughts.
Speaker 5: But with behaviors, it's like, Okay, what's one thing I
Speaker 5: can do today that will get me off the couch?
Speaker 4: Like I want to make fudge?
Speaker 5: Can I send my friend out to help me buy ingredients?
Speaker 4: And like walk to my kitchen? You know?
Speaker 5: So what are small little things I can do to
Speaker 5: break the cycle. And I find that that's often a
Speaker 5: good place to start, because once you change a behavior,
Speaker 5: you can get a little motivation or forward motion going
Speaker 5: so like full circle to the kiddo who had been
Speaker 5: in bed for four years, the first thing we had
Speaker 5: him do was stand on his porch and get a
Speaker 5: little sunlight, and like eventually within a couple of weeks
Speaker 5: he like went and got a haircut, which sounds like
Speaker 5: a small thing, but when you have lung long, unwashed
Speaker 5: hair for four years and you look in the mirror
Speaker 5: all the time, that's reinforcing the wrong, Like you can't
Speaker 5: feel so so great when he wanted went and got
Speaker 5: a haircut, Dude, that kid was a different kid. It
Speaker 5: was a small thing, but it really pushed us forward.
Speaker 5: I know that sounds really weird when you're talking about pain, Yeah,
Speaker 5: but it like really changes the cycle.
Speaker 3: And so do you ever recommend having like an accountability
Speaker 3: buddy or a journal or what's a tool that you
Speaker 3: can use to kind of keep your mind in the
Speaker 3: CBT other than a therapist in a workbook.
Speaker 5: I love accountability buddies definitely. So science shows that social
Speaker 5: support absolutely always changes the brain. So if you have
Speaker 5: someone you can do the things with one hundred percent, Yes,
Speaker 5: I do also like journaling. I think that's very helpful too,
Speaker 5: because when you write stuff down, you're your own accountability
Speaker 5: partner sometimes and when you write stuff down, you can
Speaker 5: track your progress and you can see your change like, oh,
Speaker 5: I did that thing, and then I felt.
Speaker 4: More of what motivated to do that thing.
Speaker 5: I do also think that workbooks are useful for people,
Speaker 5: and they're sometimes really dorky, but it's like a guided
Speaker 5: path toward accomplishing a goal.
Speaker 4: And it's very hard to know what to do.
Speaker 5: Like here I am spouting like I'm making it sound easy.
Speaker 5: It's so hard to live with pain every day. It's
Speaker 5: so discouraging. It's so hard.
Speaker 3: So Doctor's Offness says, working with anyone on this can
Speaker 3: be helpful, whether it's O a friend or a partner,
Speaker 3: an accountability buddy, or you can get a physical therapist
Speaker 3: or an occupational therapist, any therapist who could maybe go
Speaker 3: with you through a workbook, or you could try to
Speaker 3: find a pain psychologist, which is what exactly?
Speaker 4: So what is pain psychology? Again?
Speaker 5: I wanted to live at this intersection of neuroscience and
Speaker 5: medicine and psychology and helping people in science writing and
Speaker 5: pain psychology is kind of that. So pain psychology is
Speaker 5: how do you put together this complicated thing we call
Speaker 5: pain and deliver it to the unique person sitting in
Speaker 5: front of you in a package that they can digest
Speaker 5: and understand that isn't stigmatizing, because that's the worst part
Speaker 5: for me about being a pain psychologist is everyone who
Speaker 5: comes to see me believes that their physician has given
Speaker 5: them this message it's all in your head, or you're
Speaker 5: faking it, or it's just psychological. Your pain is just psychological.
Speaker 5: And that's never true of pain. We know pain is
Speaker 5: always biopsychosocial. It's always like you said, migraines. It's always
Speaker 5: change in blood pressure, changes in blood flow, and it's
Speaker 5: changes in.
Speaker 4: How your brain is working.
Speaker 5: But it's also changes in stress and anxiety and what's
Speaker 5: happening in your environment around you and diet, and it's
Speaker 5: all the things working together, right. Yeah, So a pain
Speaker 5: psychologist looks at this complicated picture and tries to figure
Speaker 5: out what do we need to do to help your
Speaker 5: pain and what does your pain recipe look like? And
Speaker 5: I want to tell you what a pain recipe is.
Speaker 3: Since she explained this to me, I have thought about
Speaker 3: it every single day since.
Speaker 5: So a pain recipe in my mind is like, I
Speaker 5: don't know why I'm talking so much about brownies.
Speaker 4: I must like just really want them.
Speaker 5: But if you're someone who like bakes brownies. You know,
Speaker 5: there's a recipe for awesome brownies, and it's like you
Speaker 5: have to mix these particular ingredients together and particular amounts
Speaker 5: of them, and you have to put it in the
Speaker 5: oven for a particular amount of time, and if you don't,
Speaker 5: the brownies are not going to be cooked, or they're
Speaker 5: going to be burned, or they're going to taste really
Speaker 5: disgusting because you've forgot.
Speaker 4: The chocolate, you know. So, and it's the same with pain.
Speaker 5: There's always a recipe for high pain, like a really
Speaker 5: bad migraine day, and there's always a recipe for low pain,
Speaker 5: like a day I'm feeling awesome. And if you ask people,
Speaker 5: they will all often know what their high pain recipe is.
Speaker 3: Oh. Absolutely. With migrains, I know exactly like not enough sleep,
Speaker 3: not enough water, stressful day and I and I know
Speaker 3: that it's got to have those three usually those three factors,
Speaker 3: and it's like, don't.
Speaker 4: Baby, you got it. Yeah, that's exactly right.
Speaker 5: And so so the trick for me is, if we
Speaker 5: know what the high pain recipe is, how do we
Speaker 5: puzzle out what the low pain recipe is? So you're right,
Speaker 5: like sleep on high pain recipe it's often like this
Speaker 5: combination of sleep and I'm not eating well and I'm
Speaker 5: like fighting with my partner, or there's a lot of
Speaker 5: stress at work or you know whatever. There's like a
Speaker 5: lot of other stressors and things going on in my
Speaker 5: life too, and I'm not exercising and I'm not taking
Speaker 5: care of my body. And so it's like all these biological, psychological,
Speaker 5: and sociological factors all the time interacting. So when we
Speaker 5: think about a pain recipe, I'm looking at all three
Speaker 5: of those bubbles. As a pain psychologist, I'm like, Okay,
Speaker 5: what do I pull from this bubble and this bubble
Speaker 5: in this bubble to make this person's high pain recipe?
Speaker 5: And then what do I need to make a low
Speaker 5: pain recipe? And the thing about a low pain recipe
Speaker 5: is it's just the effing opposite. So it's like getting
Speaker 5: a good night's sleep and taking care of.
Speaker 4: My body and managing my.
Speaker 5: Stress and anxiety and staying hydrated, and you know, putting
Speaker 5: limits on toxic relationships and saying no like I have
Speaker 5: a problem saying no, Like I say, people come to
Speaker 5: me and they're suffering, and dude, it is so hard
Speaker 5: for me to turn people away and say no, or
Speaker 5: like do things where.
Speaker 4: I'm spreading this to me feels so critical this.
Speaker 5: Information about pain, and I have opportunities to do that
Speaker 5: and I want I want everyone to know and to
Speaker 5: have power over their bodies. So anyway, there's all these
Speaker 5: lines we have to draw in the sand if we
Speaker 5: want to have a low pain recipe, like how do
Speaker 5: we take care of our bodies in any given moment
Speaker 5: so that we're going to feel okay? So that is
Speaker 5: my like down and dirty, like what does a pain
Speaker 5: psychologist do?
Speaker 3: Oh?
Speaker 4: I love that.
Speaker 3: I love that thinking of it as a pain.
Speaker 4: Recipe one hundred percent.
Speaker 1: Yes.
Speaker 3: I have so many questions from listeners. Can I fire
Speaker 3: them at you?
Speaker 4: Oh? You do? Yeah? Oh wow?
Speaker 5: Because pain is like that's the thing that's like exactly
Speaker 5: why I want to do stuff like this. It's like,
Speaker 5: pain is this ubiquitous human experience that no one has
Speaker 5: been told anything about.
Speaker 4: It makes me mad, I know.
Speaker 3: But real quick, before we take your questions, we're going
Speaker 3: to give some money away. Each week we donate to
Speaker 3: a charity of the ologist's choice, and Rachel says that
Speaker 3: she sometimes sees kids with medical conditions who come out
Speaker 3: as gay or trans over the course of their treatment,
Speaker 3: and she says she's always so honored to be part
Speaker 3: of their journeys and that more safe spaces need to
Speaker 3: be created in medicine for kids to talk about gender
Speaker 3: and sexuality, especially because suicide rates are so high in
Speaker 3: the LGBTQ youth. So she would like to please donate
Speaker 3: to the Trevor Project to support these brave, strong, amazing kids,
Speaker 3: she says, and the Trevor Project is the world's largest
Speaker 3: suicide prevention and crisis intervention organization for LGBTQ youth. So
Speaker 3: money in their direction. Thank you. Sponsors get value.
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Speaker 3: Okay, let's start by answering your burning curiosities about fiery
Speaker 3: redheads from patrons Mark Heulette, Jason Krauss, Andrea Marsh, Carly Lowe,
Speaker 3: first time question askers Melissa Avignon Redford, Aaron Sorenson, Alyssa Benson,
Speaker 3: self identified smoking hot redhead, Nina Giacab and Okay, Nadine says,
Speaker 3: I've heard that redheads have a different pain tolerance than
Speaker 3: the general population. Is this true? Nadine is a first
Speaker 3: time question asker. Many other gingers asked this as well,
Speaker 3: and as someone who's a fake ginger, I feel like
Speaker 3: I have like dentists be like I know redheads, and
Speaker 3: I'm like, who are we fooling?
Speaker 2: You?
Speaker 3: See my gray roots? So I am not a real reddit,
Speaker 3: but yeah, what's going on genetically with that?
Speaker 4: Here's the honest answer.
Speaker 5: And by the way, you know a good healthcare provider
Speaker 5: when they give you this answer. The honest answer is,
Speaker 5: I don't know what the research says.
Speaker 4: However, I will tell you this if.
Speaker 5: You are someone who is sensitive, and I have absolutely
Speaker 5: no idea if there's any actual data on whether redheads
Speaker 5: are more sensitive than any other person. But if you
Speaker 5: are someone who is sensitive, and by sensitive I mean
Speaker 5: you were a sensitive child smell and touch, and your
Speaker 5: senses are heightened, or you're emotionally sensitive and you pick
Speaker 5: up on things that means by the by friends and listeners,
Speaker 5: your brain is sensitive. When your brain is sensitive, guess what,
Speaker 5: it's more sensitive to sensory input from your body. Also why,
Speaker 5: because a sensitive brain is more likely to amplify warning
Speaker 5: and danger messages from the body and tell you that
Speaker 5: there's danger when there might not be. So I don't
Speaker 5: know about the redhead thing, but the sensitivity thing is
Speaker 5: a thing.
Speaker 3: Okay. I looked up this flim flam this weird myth
Speaker 3: about redheads and anesthesia because it's so annoying that it persists,
Speaker 3: and I found out, get this, it's true. Research backed
Speaker 3: this is real, y'all. So you can see the two
Speaker 3: thousand and four study in the Journal of Anesthesiology titled
Speaker 3: Anesthetic requirement is increased in redheads. They're like, here you go.
Speaker 3: They found that redheads are more sensitive to pain. They
Speaker 3: need significantly in quotes more anesesia than people with dark hair,
Speaker 3: but redheads need fewer opiates. So that was in two
Speaker 3: thousand and four what's changed in seventeen years? Well, we
Speaker 3: know now why. So a more recent study found that
Speaker 3: a certain gene causes melanocytes in red haired mice to
Speaker 3: secrete lower levels of this protein it's called POMC. You
Speaker 3: will not be quizzed. But that protein gets diced up
Speaker 3: into hormones, including one that enhances pain perception so they
Speaker 3: need more anesthesia, and another that blocks pain, meaning that
Speaker 3: they need lower opioid doses. So, Gingers, you're magical mysteries
Speaker 3: and I am honored to pose as one of you.
Speaker 3: But what if you don't have hair the color of
Speaker 3: a chestnut horse in the sunset, Well you could just
Speaker 3: be a highly sensitive person, which is not a disorder,
Speaker 3: it's an attribute, it's a trait. And highly sensitive individuals
Speaker 3: up here in all kinds of species, from humans to fruitflies.
Speaker 3: Scientists say we're all unique little flowers. And some scientists
Speaker 3: at the Queen Mary University of London do call us
Speaker 3: flowers i e. Highly sensitive. Thirty one percent of people
Speaker 3: they call orchids, a low sensitive group twenty nine percent
Speaker 3: of you called dandelions, and then a third group at
Speaker 3: forty percent who have like medium sensitivity, which they say,
Speaker 3: are tulips. I don't know jack shit about botanical robustness,
Speaker 3: but I hope that they asked a flower person first,
Speaker 3: or else things could get pretty thorny. I rose to
Speaker 3: the occasion, and is that like a highly sensitive person? Hsp.
Speaker 3: I've heard of that, but I wasn't sure if that
Speaker 3: was like a thing that was recognized by the medical community.
Speaker 5: You know, being sensitive is recognized as a predictor of
Speaker 5: pain and chronic pain, development of chronic pain. By the way,
Speaker 5: trauma makes your brain more sensitive. Why because trauma, having
Speaker 5: trauma as a child, your brain needs to be sensitive.
Speaker 5: It's adaptive, Like if something terrible has happened to you,
Speaker 5: your brain is always scanning the environment, your internal and
Speaker 5: external environment, like is a bad thing happening?
Speaker 4: What about now? What about now? Is their danger? Is
Speaker 4: their danger? Yeah?
Speaker 5: So if you have had trauma, your brain becomes more sensitive.
Speaker 3: At least Fan Meerbeek wants to know. Is there an
Speaker 3: observed relationship between pain tolerance and genders?
Speaker 5: Ooh, that's so interesting. So what we do know is
Speaker 5: rates of chronic pain are higher in women in Okay.
Speaker 5: The thing about pain tolerance is I don't exactly know
Speaker 5: what that word means. It goes back to that super
Speaker 5: subjective pain scale, that pain rating measurement, where you know,
Speaker 5: you ask two people or twenty five people, you know,
Speaker 5: does this hurt and how much? And everyone's going to
Speaker 5: give you a different answer. So I know that women
Speaker 5: in general are more prone to developing chronic pain, and
Speaker 5: I don't know if that has to do with sensitivity.
Speaker 5: That's a really interesting question.
Speaker 3: Yeah, I wonder if they've done studies too on people
Speaker 3: who are gender nonconforming and how much trauma that they've
Speaker 3: experienced too. I'm sure there's quite a bit of that.
Speaker 5: I'm going to guess there's almost no research on that
Speaker 5: because not enough research has been done on that.
Speaker 4: But should there be definitely?
Speaker 3: Yeah, I wish that this had a name. Oh it does.
Speaker 3: It's called the gender pain gap because for many, many
Speaker 3: hundreds of years, people who were not men were just
Speaker 3: not included in research, which hurts. And I want to
Speaker 3: get real spicy about it. Speaking of America, Caku says,
Speaker 3: can we talk about the TRPV one receptor and pain
Speaker 3: tolerance with spicy foods? Is there any relationship between spice
Speaker 3: tolerance and pain tolerance? And I have myself My brother
Speaker 3: in law, Lee, who's also a heavy metal guitarist, can
Speaker 3: eat the spiciest foods on earth and none of us
Speaker 3: understand how he does it. What's happening with spice? Great?
Speaker 5: So the answer is yes, you have receptors in your
Speaker 5: mouth okay that respond to touch and heat and sensation.
Speaker 5: So you have sensors on your tongue that pick up
Speaker 5: on how hot or spicy a food is, but it
Speaker 5: doesn't become interpreted as pain until it gets to your brain,
Speaker 5: and your brain inputs all the other information also, So
Speaker 5: people who can eat extremely spicy food usually are people
Speaker 5: who have been doing it for a long time, and
Speaker 5: they started with load medium and over time they.
Speaker 4: Worked their way out to super spicy. And guess what's happening.
Speaker 5: Their brain and their tongue are desensitizing over time, like
Speaker 5: being in that room, that dark room, and it gets
Speaker 5: a little bit brighter at a time, So you can
Speaker 5: develop a really high spice tolerance if you want to,
Speaker 5: using this grated exposure a little bit at a time.
Speaker 3: So fun fact, birds can't taste spicy, but squirrels can,
Speaker 3: which is why some bird seed is sold laced with
Speaker 3: hot sauce. So squirrels would be like, fuck this. Who
Speaker 3: am I? Paul Rudd? What is this? A YouTube show
Speaker 3: about hot wings? But birders say better just to get
Speaker 3: a squirrel proof bird feeder and to help prevent the
Speaker 3: spread of bird diseases, make sure to clean your bird
Speaker 3: feeders regularly, even if it's a headache. Speaking of headaches,
Speaker 3: a lot of patrons wrote in about migraines, such as
Speaker 3: rhala Shay Stampluski first time question asker Claire Garden Specialist
Speaker 3: hayfer braa plum turtle, Sarah Carter, Jade Pollard, Paulina Krasinska,
Speaker 3: first time question asker Rachel Shepherd and m Madeline Duke,
Speaker 3: Kelly Simone, Sonia Bird, Kelly King, and Colleen Heather migrain question.
Speaker 3: Why do some people like myself and my grandmothers get
Speaker 3: migraines right before rains? Do you think that's anywhere in
Speaker 3: a pain recipe barometric pressure?
Speaker 5: It's got to be. I don't know the data. I mean,
Speaker 5: these questions are so amazing. I don't know the data
Speaker 5: on migrain and rain, but I have so for me.
Speaker 5: I live with chronic leg pain, and my chronic leg
Speaker 5: pain also changes with weather. Changes, so before rain, my
Speaker 5: leg will also throb. So I've heard people say that
Speaker 5: that's like I hate this phrase, like an old wives
Speaker 5: tale whenever that means. But I've heard people say that
Speaker 5: that's not evidence based, and I've never looked into the evidence,
Speaker 5: but now I'm going to.
Speaker 4: And I don't know if.
Speaker 5: There's sufficient data to show, but it would make sense
Speaker 5: to me that would be part of a pain recipe
Speaker 5: because of course there's barometric pressure. Like if the chain
Speaker 5: environment around you changes, yeah, it seems reasonable that your
Speaker 5: pain would change too.
Speaker 3: I had to look this up and sure enough, there's
Speaker 3: a twenty nineteen study titled Blame It on the Weather,
Speaker 3: The Association between pain in fibermyalgia, relative humidity, temperature, and
Speaker 3: barometric pressure. Someone's out there asking these questions. So the
Speaker 3: short of it is that lower barometric pressure was associated
Speaker 3: with more pain in fibermyologia patients and our right of
Speaker 3: spatients and even people with migraines. But the cause it
Speaker 3: sounds like a still murky. So lower barometric pressure can
Speaker 3: make tissues expand, which might cause joint pain and migraines.
Speaker 3: Scientists say that blood vessel dilation associated with the influence
Speaker 3: of changes in atmospheric pressure can also maybe cause migraines,
Speaker 3: and lower barometric pressure reduces the amount of available oxygen
Speaker 3: the air. But it also usually means shitty weather, which
Speaker 3: contributes to some psychological factors for some folks, and pain
Speaker 3: hurts more so. Apparently weather accounts for twenty percent of
Speaker 3: migraines in Japan. What else triggers migraines not much, just
Speaker 3: like oversleeping, sleep, deprivation, pre menstrual period, stressful life events,
Speaker 3: hot weather, cold weather, relaxation after stress, menstruation, high winds,
Speaker 3: intense emotions, hunger, bright sunlight, red wine, consumption, food additives, msg, nitrates. Also,
Speaker 3: serotonin changes can open and constrict blood wrestles. If you've
Speaker 3: had migraines, you might be chuffed to learn that they're
Speaker 3: the most common neurological cause of disability in the world,
Speaker 3: according to twenty seventeen study, which also taught me the
Speaker 3: ology of migraine pathophysiology. Yeah, future episode, anyone, My brain
Speaker 3: says hell yes, no question. Speaking of this, next question
Speaker 3: about emotional pain was asked by four million of you.
Speaker 3: Scott Sheldon, great question. Is there chemically a difference between
Speaker 3: physical and emotional pain?
Speaker 5: Oh my god, that question makes me so deeply happy.
Speaker 5: There are these wonderful, wonderful researchers who study social neuroscience.
Speaker 5: I'm going to answer your question a roundabout way. And
Speaker 5: they studied the neuroscience of social exclusion and I end
Speaker 5: being ostracized. Oh, the science of ostracization, which is a
Speaker 5: very hard word.
Speaker 4: To pronounce, ostracization.
Speaker 5: And they found that social and emotional pain maps exactly
Speaker 5: onto the parts of the brain that process physical pain.
Speaker 4: So is there a difference?
Speaker 5: Yes, do they overlap and affect each other one hundred
Speaker 5: percent of the time. Yes, does emotional pain hurt physically?
Speaker 4: You know it does.
Speaker 5: Like ask anyone who's going through heartbreak how their body
Speaker 5: feels like you have chest pain when you are heartbroken.
Speaker 5: So emotional pain and physical pain, always, always, always.
Speaker 4: Are connected in the brain.
Speaker 3: It's funny because it's like looking at Instagram, you might
Speaker 3: as well actually be hitting yourself in the face with
Speaker 3: a frying pan. You might as well just do that.
Speaker 4: Amazing, that was amazing.
Speaker 3: It does hurt. So yes, physical and social pain overlap
Speaker 3: in an area of the brain called the anterior singulant quartix.
Speaker 3: And yes, Jade Balcolm Randall and first time question asker
Speaker 3: Carrie Anderson. Pain relievers can soothe broken hearts or at
Speaker 3: least smooth ruffled feathers. So for more on that, you
Speaker 3: can see the very directly titled aceda Menafin reduces social pain.
Speaker 3: fMRIs showed that acidamnifin reduced neural responses to social rejection
Speaker 3: and I don't know how they tested that, but I
Speaker 3: hope they were nice to the volunteers. So yes, pain
Speaker 3: relievers are better. Yet CBT might help when you're feeling
Speaker 3: but heard now, aside from your crack, how about your back?
Speaker 3: First time question asker Jacob Leftwich, Amy Naramatsu, Pixie Muffin,
Speaker 3: Fuzz Goddess, Isle Van Muherbeek and Savannah Bigley all have
Speaker 3: ninety nine problems and a back is one. Now, Michael
Speaker 3: Swords wants to know when it comes to back pain,
Speaker 3: how can we get rid of it? And I feel
Speaker 3: like I know so many people in various levels of
Speaker 3: athleticism and age that have back pain. What's going on there?
Speaker 5: Back pain is one of the most common types of
Speaker 5: chronic pain, and the answer to your question is if
Speaker 5: you're not treating it in a biopsychosocial way, your back
Speaker 5: pain's gonna stay exactly the same. So if you ask
Speaker 5: every single person you know how they've treated their back pain,
Speaker 5: I'm going to bet a bazillion dollars which I don't
Speaker 5: have to give you, but I do have the capacity
Speaker 5: to receive that they have been told to treat their
Speaker 5: pain with medications and potentially surgeries. And check this fact out. Ready,
Speaker 5: there is a new syndrome in medicine called failed back
Speaker 5: surgery syndrome. That's right, they've given it a name, and
Speaker 5: in that's highlight beautiful example of when you treat pain
Speaker 5: purely biomedically, chronic pain in particular, it is not going
Speaker 5: to work. And by the way, that's not to say
Speaker 5: that back surgery doesn't heal people. It surely does, and
Speaker 5: there's lots of things that can go wrong with the
Speaker 5: back totally. But pain, chronic pain is processed by the brain.
Speaker 5: So we have to think about the whole person and
Speaker 5: the whole picture. So if someone's living with chronic back
Speaker 5: pain and then the pills and the procedures have not worked,
Speaker 5: the answer is, let's go after the other things in
Speaker 5: the pain recipe to figure out what's going on.
Speaker 3: Great answer, Tabatha Waite wants to know why do some
Speaker 3: people hold their breath when experiencing high levels of pain?
Speaker 3: Asking for me love that right.
Speaker 5: So if you remember that pain metaphor we were talking
Speaker 5: about this volume knob that operates. One of the things
Speaker 5: that happens when you have pain, believe it or not,
Speaker 5: is that stress and anxiety go up. If you ask
Speaker 5: human beings in general, what are the biggest stressors on
Speaker 5: human beings? Like death of a loved one, moving, but pain,
Speaker 5: Pain is one of the biggest stressors on a human being.
Speaker 5: It's so stressful to be in pain. So we do
Speaker 5: these things, like we clench, even sometimes we don't even
Speaker 5: know we're doing it. So we clench our whole body
Speaker 5: or the part of the body that hurts, and we
Speaker 5: guard and sometimes we limp or we change our posture
Speaker 5: because pain is miserable and you're trying to do everything
Speaker 5: you can not to have it.
Speaker 4: So holding your breath is a pain behavior. It's a clenching.
Speaker 5: It's often involuntary because pain hurts, which is the most
Speaker 5: basic thing I've said, all that pain hurts, So you're
Speaker 5: clenching and you're trying to fight it off, and the
Speaker 5: irony there is, as we know from the pain dial,
Speaker 5: the more you clench and the more tense and tight
Speaker 5: your body is, the higher your pain volume is actually
Speaker 5: going to be. So I know, so somehow finding a
Speaker 5: way to help your body relax and be calm is
Speaker 5: actually one of the things that we're going to need
Speaker 5: to do to help a pain and by the way,
Speaker 5: easier said than done. I'm not just saying like, oh,
Speaker 5: be relaxed, because that's not a thing like oh, just
Speaker 5: I hate that when people are like, oh, just relax,
Speaker 5: you know. So it's not just that it's more complicated
Speaker 5: than that, but the tensing and the tightening, actually it's
Speaker 5: going to make pain worse.
Speaker 3: That makes sense. Quinn west I had a question, if
Speaker 3: you take medication that blocks pain signals, is the pain
Speaker 3: still there? This is kind of a philosophical question.
Speaker 5: Great question, So I'm going to answer that with another question.
Speaker 5: If pain is produced by the brain and you're blocking
Speaker 5: the messages in the brain, are you actually blocking the
Speaker 5: pain messages?
Speaker 4: I think the answer has to be yes.
Speaker 5: Because you're blocking the messages that your brain is interpreting
Speaker 5: as pain. So the sensory signals coming from the body
Speaker 5: are not yet pain. So the sensory message is coming
Speaker 5: from the body, whether it's like a broken foot or
Speaker 5: a bad back, it's not pain until it gets to
Speaker 5: the brain. It's just sensory information. So when you target
Speaker 5: the brain in your treatment, yes, you're blocking the ability
Speaker 5: of the brain to interpret that message as pain.
Speaker 3: Okay, So a lot of folks such as Roberta Amalia
Speaker 3: Kanti Cheese, Leona Schuster, Alice Claire, Dori Kaufman, Brent Mapis,
Speaker 3: Michelle Jacobs, Leela Weller, Lindsay Mixer, Catalina First time question
Speaker 3: askers Kelly Shaver, Andrew R. Cassidy and Arose, Monica Sweet
Speaker 3: and Molly had questions about fiber miyolsha, which is a
Speaker 3: disorder that causes pain and tenderness all over the body.
Speaker 3: It also causes sleep problems and fatigue. In my opinion,
Speaker 3: it sounds not fun. Heather Circle wants to know for
Speaker 3: those experiencing symptoms of fibermyalgia, what are some good tests
Speaker 3: to request from a doctor.
Speaker 5: There are no good tests for fibromyalgia, so diagnosis of
Speaker 5: fibromyalgia has been a shit show. There's like lots of
Speaker 5: different ways of diagnosing. It's like certain number of body
Speaker 5: parts has to be in pain. But as everyone with
Speaker 5: fibromioga knows, different parts of your body hurt.
Speaker 4: In any different given moment.
Speaker 5: So if you only have pain in eight body parts tonight,
Speaker 5: does that mean you don't have fibromyalgia. So there's no
Speaker 5: real great test, is the honest answer. But if you're
Speaker 5: living with fibromyalgia, you absolutely have a biopsychosocial pain recipe
Speaker 5: and we need to figure out what that is. And again,
Speaker 5: I always want to talk about the stigma around recommending
Speaker 5: psychology for the treatment of pain.
Speaker 4: I live with that stigma every day.
Speaker 5: I always recommend psychology for everybody living with chronic pain.
Speaker 5: Why because if you're not targeting the brain, you are
Speaker 5: not targeting pain, and psychology really goes down the rabbit
Speaker 5: hole of what are you thinking, how are you feeling,
Speaker 5: and how are you acting? So I would honestly, from
Speaker 5: the bottom of my heart, recommend a pain psychologist or
Speaker 5: even any psychologist for people living with FIBROMYLDRA.
Speaker 4: In addition to all the other things you're.
Speaker 5: Doing pt and OT and going for walks with friends
Speaker 5: and doing fun things and baking brownies.
Speaker 3: So some pharmaceutical therapies for fibromyalsia are actually also used
Speaker 3: for neurotransmitter balance and the brain's ability to tamp down
Speaker 3: pain signals. And researchers who even tried low doses of naltrexone,
Speaker 3: which is prescribed for alcohol use disorder and opioid use disorder.
Speaker 3: But in many studies, cognitive behavioral therapy provided what researchers
Speaker 3: call worthwhile improvement in pain related behavior and coping strategies
Speaker 3: and overall physical function. And they noted that quote the
Speaker 3: beneficial effects of CBT can be achieved in ten to
Speaker 3: twenty sessions compared with many years required for classical psychoanalysis.
Speaker 3: So CBT has also been shown effective for reducing neuropathy
Speaker 3: pain and improving pain interference and mental health functioning. So
Speaker 3: retraining your actual brain to just tell all those pain
Speaker 3: signals to cool their freaking jets, please and thank you.
Speaker 3: And Rachel says this is so exciting because of neuroplasticity,
Speaker 3: So in an email after our interview, she added the
Speaker 3: fact that the brain is always changing means that the
Speaker 3: brain can change, and if the brain can change, pain
Speaker 3: can change, which is good not only for pain havers,
Speaker 3: but for the people who love them, like Megan Stingle,
Speaker 3: who asked, when someone tells me about an injury, why
Speaker 3: do I sometimes feel a vague sense of pain in
Speaker 3: that part of my body while they're telling me a story?
Speaker 3: And another patron echoed that. Stacy Slowitz asked, is sympathy
Speaker 3: pain real? Do twins feel it more or is it
Speaker 3: more likely for people who consider themselves.
Speaker 5: Impass Oh my gosh, these questions are lighting up my brain. Yes,
Speaker 5: sympathy pain is real. So they do these studies in
Speaker 5: neuroscience where they look at a mother's brain and a
Speaker 5: child's brain, and if the child is suffering and experiencing pain,
Speaker 5: the mother's brain, the pain pathways in the brain light
Speaker 5: up as if she's in pain, which is why moms
Speaker 5: have such a hard time tolerating their children crying. Right,
Speaker 5: It's just it triggers you in that way. So, yes,
Speaker 5: we have mirror neurons in our brain, and we do
Speaker 5: feel other people's feelings. Anxiety contagion and emotional contagion are real.
Speaker 5: And yes, if you are someone who is empathic or
Speaker 5: an EmPATH, I'm going to tell you what that means.
Speaker 5: It means your brain is really, really, really sensitive, and
Speaker 5: you pick on you pick up on things other people
Speaker 5: can't pick up on. So you feel other people's emotions
Speaker 5: when you walk into a room, and I'm going to
Speaker 5: bet a lot of money that you're an unpath allyword. Yeah,
Speaker 5: totally right, right, So it means our brains are more sensitive,
Speaker 5: so we're more likely to pick on other up on
Speaker 5: other things people are feeling emotionally. But the downside of
Speaker 5: it is that we're also more likely to experience chronic pain.
Speaker 3: A lot of people who I will listen to, aside
Speaker 3: Marianna Hulsen, Dene Dryden, and Ashley Home, want to know
Speaker 3: how touch inhibits pain and if scratching or apply pressure
Speaker 3: helps alleviate pain. What's happening there.
Speaker 4: I want everyone to know. I'm doing a dance of
Speaker 4: joy in my chair.
Speaker 5: So I mentioned back in the day when I was
Speaker 5: a nerdy undergrad that one of the things that really
Speaker 5: excited me about pain was this thing called the gate
Speaker 5: control theory of pain. And the gate control theory of
Speaker 5: pain is just this nerdy neuroscience. It's like back in
Speaker 5: sixty five, these guys came up with this gate control
Speaker 5: theory of pain, and they forever revolutionized pain science. And
Speaker 5: it's still evolving there's the neuromatrix theory of pain now,
Speaker 5: and there's all this other cool pain science. However, what
Speaker 5: we know about pain is that touch does actually gate pain.
Speaker 5: So back to our metaphor of this pain dial So
Speaker 5: like for me, I remember this really resonated with me.
Speaker 5: My professor said, you bash your knee, like you're sitting
Speaker 5: under the table and you bash your knee.
Speaker 4: What's the first thing that you do. You rub your knee.
Speaker 5: And the reason you rub your knee is because touch
Speaker 5: messages get up to the brain faster than messages that
Speaker 5: code for the sensory information codes for pain. So touch
Speaker 5: is actually one of the things that can lower your
Speaker 5: pain volume. So one of the things that can be
Speaker 5: on a low pain recipe for people, by the way,
Speaker 5: is getting massages and hugging people and sensory things that
Speaker 5: really make you feel soothed and calmed, like a snuggie
Speaker 5: or a really lovely blanket or a dog. But yes, touch,
Speaker 5: so touching the part of the body that hurts will
Speaker 5: actually help your pain.
Speaker 4: Hah.
Speaker 3: So adopt a dog you got.
Speaker 5: Yeah, or like rub your bashni or get massages, back
Speaker 5: massages or yep.
Speaker 3: Maren Ellis first time question asker asks, why do we
Speaker 3: forget pain? I've had three babies with nomads, but I
Speaker 3: have forgotten the amount of pain I was in with
Speaker 3: each and gladly had the next. What is happening there
Speaker 3: with really really intense pain.
Speaker 5: So there is research on childbirth pain, and that is
Speaker 5: a unique kind of pain. And the research shows that
Speaker 5: after giving birth to a baby, you are flooded with
Speaker 5: all these wonderful, delightful chemicals. It's like a bath for
Speaker 5: your brain. It's like oxytocin and which makes you feel connected,
Speaker 5: and dopamine, which is like this reward chemical, and serotonin
Speaker 5: which makes you feel happy and joyful, and endorphins which
Speaker 5: are your brains, anddogenous natural painkillers. And so your brain
Speaker 5: takes this lovely bath and it feels so good and
Speaker 5: it connects you to your baby. But it also changes
Speaker 5: your memory of childbirth. But why is that adaptive? So
Speaker 5: if childbirth is so aversive or terrible that you never
Speaker 5: want to do it.
Speaker 4: Again, we might go extinct.
Speaker 5: Yeah, so your brain does this like funny trick, but
Speaker 5: that is not true for many other types of terrible,
Speaker 5: terrible pain. And you ask anybody who's been in a
Speaker 5: car accident or like some terrible trauma. They have not
Speaker 5: forgotten their pain and their body has not forgotten their
Speaker 5: pain either.
Speaker 3: Yeah, I guess like with Jared's knee surgery, it's not
Speaker 3: like his knee is gonna suckle for the next year.
Speaker 3: He might who knows, never know. But I thought this
Speaker 3: was a great question from Val McKelvey. How well does
Speaker 3: mara juana work for pain relief as compared to traditional
Speaker 3: pain relief medicines, like all of the CBD that's on
Speaker 3: the market, the THHC, things like that good for pain,
Speaker 3: not good for pain, somewhere in the middle.
Speaker 5: Here's the complicated answer. Okay, I think the thing that
Speaker 5: we know now is like with pain, it's always a
Speaker 5: complicated answer. So here's the complicated answer. Research shows that
Speaker 5: the chemicals in marijuana can actually lower pain volume.
Speaker 4: Righteous they can.
Speaker 5: Here's the problem. Marijuana, and I am not opposed in
Speaker 5: any capacity, also can do funny things to sleep in
Speaker 5: not a great way that can negatively affect pain. And
Speaker 5: the thing that actually is most concerning for me is
Speaker 5: the patients I'm working with who are using it as
Speaker 5: their only pain management strategy and nothing else. So if
Speaker 5: you become if you lean on any one thing, it
Speaker 5: doesn't matter what the one thing is. As your primary
Speaker 5: or only coping strategy for pain, you're targeting only the
Speaker 5: bio domain of pain. And there's a lot of things
Speaker 5: contributing to anybody's pain recipes. So we're just solving it
Speaker 5: with weed. We're not actually addressing that big, complicated problem
Speaker 5: that's contributing to the pain.
Speaker 4: So the answer is yes.
Speaker 5: Sign shows it can lower pain volume, raises pain tolerance,
Speaker 5: whatever that fancy word means. But there's also a couple
Speaker 5: of other complicating factors. I do think it's great for
Speaker 5: things like cancer pain because people can't eat, but that's
Speaker 5: also sort of a problem because with overuse of marijuana
Speaker 5: you can stop eating. There's like an emesis syndrome that
Speaker 5: develops where your stomach doesn't want you to eat any
Speaker 5: more food. So what is my TLDR. Yes, it can
Speaker 5: be useful short term, not all day, every day, and
Speaker 5: not as your only strategy.
Speaker 3: Cool last listener question, Daniell Larman, Alia Myers lux a
Speaker 3: rib want to know. In Alia Myers words, so what's
Speaker 3: up with masochism asking for a friend? Perhaps their friend
Speaker 3: was one of these patrons. Chris Bauman, Piper, Donnielle, O'Neil,
Speaker 3: lux Arib, Mikaela Kwant who asked why does it make
Speaker 3: me so horny? Or the wonderful Scaliborealis who responded to that.
Speaker 3: I spent several minutes trying to type this out in
Speaker 3: a concise way and saw this comment and was like, Yeah,
Speaker 3: that's pretty much what I was trying to say. Also,
Speaker 3: Danielle Lharman, why do I like pain? Please tell me
Speaker 3: why I'm so weird masochism and recreational pain seekers. Probably
Speaker 3: not so weird, not weird.
Speaker 5: Also, such a delightful question, And I'm so glad we
Speaker 5: get to touch on it before the end of this,
Speaker 5: because I really wish I had even said this sooner.
Speaker 5: Pain is a subjective experience, like when we're talking about
Speaker 5: the definition of pain that should have been in there.
Speaker 5: It's always subjective, and like we said, context and environment matter.
Speaker 4: If you're choosing it, it's going to change your experience.
Speaker 5: If someone punches you in the face and you're not
Speaker 5: expecting it and they're stealing your purse, it's going to
Speaker 5: feel very different. Slaps you, it's going to feel very
Speaker 5: different than in the context of sex, or like you're
Speaker 5: turned on, you love your partner, you trust them or whatever,
Speaker 5: or you just you want it. So context, environment, all
Speaker 5: the things are always going to matter when your brain
Speaker 5: is interpreting the message. So, yes, pain can be pleasurable.
Speaker 5: Of course that's super normal and human. It's not weird
Speaker 5: at all that for some people some of the time
Speaker 5: pain is pleasurable. And again back to that thing, like
Speaker 5: you stub your toe on a really bad day when
Speaker 5: you've been fired, it feels very different than you stub
Speaker 5: your toe you're out with your friends eating ice cream.
Speaker 4: So so always the.
Speaker 5: Context in which the messaging happens determines how your brain
Speaker 5: interprets the signal.
Speaker 4: I want to make sure did that make sense? That
Speaker 4: that makes sense?
Speaker 3: Absolutely? Sometimes I just I love the interview so much
Speaker 3: I make sure we're still recording because in my nightmare,
Speaker 3: we've somehow totally it's not the batteries. Now, the thing
Speaker 3: that sucks most about pain?
Speaker 4: What is it?
Speaker 3: What sucks so much about your job? What sucks about pain?
Speaker 3: What's frustrating? Vented out?
Speaker 5: The thing that sucks most about my job is the
Speaker 5: stigma associated with psychology and pain, Like that thing where
Speaker 5: people think you're saying they're mentally ill. That drives me mad.
Speaker 5: The thing that sucks most about pain is the lack
Speaker 5: of agency and control. We feel like we have over it,
Speaker 5: and we feel that lack of agency and control because
Speaker 5: no one has ever explained pain to us. Why has
Speaker 5: no one ever like when I was like a twelve
Speaker 5: year old kid with stomach aches, why didn't anyone ever say,
Speaker 5: by the way this might be mediated by anxiety and stress,
Speaker 5: and by the way it was like I was socially anxious.
Speaker 5: No one ever explained to me I was like poked
Speaker 5: and prodded and blah blah blah.
Speaker 4: No one ever why. So that, as you can tell,
Speaker 4: infuriates me.
Speaker 3: It flame flames, flames on the side of my face.
Speaker 5: Who doesn't deserve to understand pain? It's ubiquitous human experience.
Speaker 5: We are all going to have it. None of you
Speaker 5: are going to get away with not having pain, So
Speaker 5: we might as well know what it is and know
Speaker 5: what to do about it. What also infuriates me about
Speaker 5: pain medicine is the way that nobody gets educated about it.
Speaker 5: So here's a fun statistic. Ninety six percent of medical
Speaker 5: schools in the United States and Canada have zero and
Speaker 5: I mean zero dedicated compulsory pain education. So if ninety
Speaker 5: six percent of our doctors are not learning about pain,
Speaker 5: who then knows about pain? So of course we have
Speaker 5: an opioid epidemic. Of course we're throwing pills at pain.
Speaker 5: Like the people who are treating pain aren't being adequately educated.
Speaker 5: It's nobody's fault. It's just a really broken system. And
Speaker 5: in psychology programs we get zero pain education. Also in
Speaker 5: PT programs and OT programs, a lot of providers will
Speaker 5: tell you insufficient pain education and nursing programs. So it's like,
Speaker 5: if you think about this as a trickle down phenomenon,
Speaker 5: like our providers are the first people we see, and
Speaker 5: if no one's ever explained pain to them in this
Speaker 5: way where it's a biopsychosocial phenomenon, how are they ever
Speaker 5: going to tell us?
Speaker 3: So side note, In addition to being a clinical psychologist,
Speaker 3: doctor's Oftness is also a researcher and a lecturer at UCSF,
Speaker 3: and she and her colleagues there conducted a six part
Speaker 3: pain training with UCSF doctors and in a study just
Speaker 3: published in June, they found that ninety percent of the
Speaker 3: physicians said that the pain curriculum changed the way that
Speaker 3: they conceptualized and approached or managed pain. Ninety percent said
Speaker 3: it changed the way they did it. So the conclusion,
Speaker 3: she said, education matters. Yeah, especially when it comes to doctors.
Speaker 3: You want them to eat books, school up. Thank you
Speaker 3: so much.
Speaker 5: So in my mind, if we're ever going to target
Speaker 5: the opioid epidemic, if we're ever going to target effective
Speaker 5: pain management, we have to start with education, which is
Speaker 5: why I chase people like you, because how do you
Speaker 5: spread the word? Like, how do you tell people by
Speaker 5: the way, there's hope for treating your pain. We just
Speaker 5: have to do it differently.
Speaker 3: Yeah, I think you should be the Brene Brown of
Speaker 3: pain banishment. Okay, great, Yeah. I feel like the typical
Speaker 3: thing we're used to seeing is just a laminated placard
Speaker 3: on the wall with a series of emojis. Yeah, dude,
Speaker 3: like that's that's my god. That's pain education for doctor.
Speaker 3: You got it.
Speaker 5: And so, so what Ali's talking about is it's called
Speaker 5: the pain scale. It's actually called the Faces pain Scale,
Speaker 5: and you've probably seen it before. It's like I think
Speaker 5: it's zero to ten, not one to ten, but I
Speaker 5: can't remember. But it's all these faces that show how
Speaker 5: much pain are you in? And have you ever read
Speaker 5: Hyperbole in a half Yes, Allie brosch Am I saying
Speaker 5: her name right, I don't love her. That girl is
Speaker 5: so brilliant and so talented, and Ali Browch she probably
Speaker 5: listened to this podcast.
Speaker 4: I wo is that is it? Ali brousch Am, I
Speaker 4: saying it right?
Speaker 3: Okay or brush, I've had no idea. Okay.
Speaker 5: So she if you google hyperbole and a half pain Scale,
Speaker 5: you will laugh your ass off.
Speaker 4: She revised, I use.
Speaker 5: It in my lectures. She revised the pain scale. Yes,
Speaker 5: it's I think it's zero to twenty, and twenty is
Speaker 5: like this face like the eyeballs are falling out and
Speaker 5: blood is coming out of the ears, you know. And
Speaker 5: she also redes like this zero to ten pain scale,
Speaker 5: and she's like this, this is just not accurate, Like
Speaker 5: five looks like, you know, I got Ben and Jerry's
Speaker 5: cookie dough ice cream and there just isn't enough cookie
Speaker 5: dough and it, yeah, like the faces don't adequately convey
Speaker 5: what the experience of being in pain. Her pain scale
Speaker 5: is infinitely better, Ali Brosch Hyperbole and a half pain Scale,
Speaker 5: you will laugh and only a pain nerd would really
Speaker 5: know that there's a better pain scale out there. Written
Speaker 5: by the author of Hyperbole and a.
Speaker 3: Half, Well, what about your favorite thing about what you do? Oh?
Speaker 5: My god, so absolutely this is the most addictive work
Speaker 5: I've ever done in my life. And I also feel
Speaker 5: selfish doing it because that kid who had been in
Speaker 5: bed for four years.
Speaker 4: When that kid.
Speaker 5: Stood on stage and went off to college, I felt
Speaker 5: so rad And I am not performing magic. You know,
Speaker 5: this is something I was trained to do. It exists
Speaker 5: in books, that the knowledge is out there. I'm just
Speaker 5: a conduit for the thing that already exists. But when
Speaker 5: people get better and they get their lives back, this
Speaker 5: kid got asked by.
Speaker 4: Two girls, not one, but two, and it's just like
Speaker 4: so delightful to see.
Speaker 5: People re engage in the world, get their lives back,
Speaker 5: and feel like they have power again over their bodies
Speaker 5: and their lives. That is like, I will never do
Speaker 5: anything else. It's like the most addictive thing I've ever done.
Speaker 5: And like people wearing me these crazy emails that make
Speaker 5: me cry, just like yeah, if I start talking about it,
Speaker 5: I will cry. It's just crazy. The work changes lives
Speaker 5: and it's not again it's not me. I didn't make
Speaker 5: it up, but like, this work changes lives, and I
Speaker 5: just want to say the other thing that makes me
Speaker 5: really infuriated about pain is that it's not what I
Speaker 5: do is not affordable to everybody. A lot of people
Speaker 5: can't afford pain psychology because insurance doesn't reimburse it. And
Speaker 5: that's actually why I stuck everything that I do into
Speaker 5: a book for twenty bucks. Because pain education and pain
Speaker 5: medicine should be affordable and accessible to everybody. Why is
Speaker 5: it only affordable by a few people? That's crazy pants.
Speaker 5: So the pain management work book which I gave you
Speaker 5: literally is intended to be like, you don't need insurance coverage.
Speaker 5: It's twenty dollars. Everything I'm talking about is in there. Again,
Speaker 5: it's not magic, and it shouldn't be unaffordable for anybody.
Speaker 4: Is that the word?
Speaker 3: Yeah? Absolutely?
Speaker 5: It makes me so mad. You can tell I just
Speaker 5: I feel like love it. Yeah, Like, why is treatment
Speaker 5: only for people with money?
Speaker 3: It's nonsensical.
Speaker 4: Finances drive pain management? How is that? Okay?
Speaker 3: Bonkers? Any one piece of advice that you want people
Speaker 3: to know to keep them going?
Speaker 5: Yeah, pain is treatable. You do not need to be
Speaker 5: alone on a pain journey. A lot of people are
Speaker 5: suffering alone. There's a lot of support available. Pain psychologists.
Speaker 5: There's not many of them again because just psychology programs
Speaker 5: don't train us in pain, and they should, and it's
Speaker 5: a problem. So this is a call to action for
Speaker 5: anybody in the world of psychology and in medicine to
Speaker 5: up your game when it comes to pain education. But
Speaker 5: a couple of solutions for people who are suffering alone.
Speaker 5: You can google pain psychologists near me. There might be one.
Speaker 5: Ptology today has people on there who list chronic pain
Speaker 5: as one of You want to find out if they're
Speaker 5: trained in cognitive behavioral therapy. If you have a therapist
Speaker 5: you like, or you're willing to find a therapist you like,
Speaker 5: hand them the pain management work book or any pain
Speaker 5: management work book. There's others besides mine out there, doesn't matter,
Speaker 5: and ask them to go.
Speaker 4: Through it with you.
Speaker 5: You don't have to go through the journey alone. It's isolating,
Speaker 5: it's miserable, it's painful, and support is available and help
Speaker 5: is available and change happens. Pain treatment is totally totally possible.
Speaker 3: Thank you for being on.
Speaker 5: Thank you so much for having me. This is so cool.
Speaker 3: Seriously, Forrene bor out of pain, I'm calling.
Speaker 4: It rad.
Speaker 3: H So, for God's sake, ask smart people do feed
Speaker 3: questions because your brain can learn from the things that
Speaker 3: their brains learned from other people's brains. And I hope
Speaker 3: that this episode helps anyone with pain get better care,
Speaker 3: helps loved ones understand that pain is real and give
Speaker 3: some hope and maybe some alternative approaches to turning that
Speaker 3: pain dial down. So doctors Off sells her workbook for
Speaker 3: twenty bucks. It's on Amazon, it's where we get books,
Speaker 3: It's probably in libraries near you, and she wants to
Speaker 3: make it cheap and accessible for everyone. You can follow
Speaker 3: doctors Off at doctor's Offness on Twitter and at the
Speaker 3: Real docs Off on Instagram. Her website is zoftness dot
Speaker 3: com and those are all be linked in the show notes,
Speaker 3: as well as links to the Trevor Project and the
Speaker 3: sponsors you heard about. We are at ologies on Twitter
Speaker 3: and Instagram. I'm Ali Ward with one L on both.
Speaker 3: Please say hi. More links are always up at aliward
Speaker 3: dot com, slash ologies slash dolerology for this one. Thank
Speaker 3: you to Aaron Talbert for adminting the Ologies podcast Facebook group.
Speaker 3: Thank you to new Bride Bonnie and Shannon of the
Speaker 3: podcast You Are That for helping with the merch, Noel
Speaker 3: Dilworth and Susan Hale for all the scheduling and behind
Speaker 3: the scenes business. Thank you to Emily White of the
Speaker 3: Wordery who makes our professionally done transcripts. Caleb Patten who
Speaker 3: bleeps episodes which are up for free on our website.
Speaker 3: Z Thomas Erderbiguez for the Thissmologies episodes which come out
Speaker 3: every other week. They are kid safe, classroom friendly now
Speaker 3: with kids safe ads as well. Thank you to Kelly
Speaker 3: Dwyer for the website. She's available to make a website
Speaker 3: for you if you like her links in the show notes.
Speaker 3: Thank you to Nick Thorburn for the theme music. Thank
Speaker 3: you to Jared Sleeper and Stephen Ray Morris who endure
Speaker 3: the biggest pain of all, which is me, and I
Speaker 3: appreciate them so very much for it. And if you
Speaker 3: stick around to the end of the show, you know
Speaker 3: I tell you a secret. And this week's secret is
Speaker 3: that I like to burn incense sometimes, and I love
Speaker 3: when you're burning an incense stick and then suddenly you
Speaker 3: start smelling the burning stick itself, like the little bamboo
Speaker 3: stem and you're like, oh, that marks the end of
Speaker 3: this incense stick. Thanks nos and that unless you're my
Speaker 3: friend Micah who can't smell anything. Sorry Micah. Okay, bye
Speaker 3: bye pacadermatologe Mammeology, cryptozoology, lithology, zoology, meteorology, the apologies.
Speaker 1: Seriosity get value.
Speaker 3: You can't argue with that.
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