Breakthrough with Healing Chronic Pain | Howard Schubiner | Talks at Google

We are pleased to welcome Power Shooter to all

talks

at Google Seattle Howard is an internist at Providence Hospital in Michigan and also a professor at Wayne State University School of Medicine in Michigan. Oh yeah, we changed Michigan, two books have been published. Now unlearn your

pain

and unlearn your anxiety. and depression and the third book yes, thank you, thank you, that's kind, thank you. I'm going to tell you a story, it's a uniquely American story and, to borrow a phrase from a TV show I've never seen but heard about, it's an American horror story. This is a 41-year-old guy who I saw for lower back

pain

seven years ago.

He started he was 34 years old, so he was running. He didn't have any injuries, but he started having pain in his back while he was running one day. It was a dull pain. In some ways he came and went, it wasn't a big deal, but it gradually got worse over time, eventually becoming constant mainly on the lower left side of his spine in the lumbar area and then but sometimes it was more on the right side . it shot up to his butt I started having trouble sleeping because he was in pain there was no neurological impairment, meaning the reflexes are normal the strength is normal in his legs the sensation is normal there is no evidence of nerve damage, that was well The EMG is a test to test for nerve damage which was normal, so they did an MRI which will tell us what's wrong with him, maybe he had degenerative disc disease and he had a moderate disc bulge at 14 5, so we started receiving treatment, physiotherapy, another course of physiotherapy. therapy does not help pain management specialists spinal injections do not help Botox injections piriformis piriformis injections is in the butt more injections a TENS unit we are going to try to distract your brain from the pain by giving you this electrical stimulation received duloxetine which is an antidepressant that he received gabapentin it's a nerve pill something like lyrica someone gave him opiates it's a good idea, well, but he wasn't getting better, so he said, well, let's go another way, let's try acupuncture.

I'll take yoga two years later, nothing works, so here it goes. surgeon surgeon says we can fix that disc l4 five bulging discs no problem a fusion is done l4 5 it doesn't help the years go by another one year later another doctor says your joint is good IF the joint that connects the sacrum and the pelvis joins type It is like a joint that connects the ribs to the sternum. It's not a big joint, but there is some arthritis. It confuses us because he had that surgery and didn't get better when he was 42 years old. She started having neck pain.

Now we have something else to worry about. um his neck arrived two generations Fassett into space narrowing a small disc lump that doesn't sound right he's going to see the neurosurgeon says well you know you're not really you're not a candidate for surgery on your neck but epidural injections he decided that he had already proven that his lower back didn't want to do that and his pain just continued so he has lower back pain he has neck pain and then in the last year he started getting some sensations in his stomach it's a fluttering sensation in his stomach so now he's going to a pain psychologist and given relaxation exercises.

Basically he doesn't have much hope of improving at this point. That's the horrifying part of the story. We have a problem in this country. There are more people. affected by

chronic

pain now than then, the combined total of diabetes, heart disease and cancer, millions of people suffer from a lot of back pain, headaches, stomach pain, pelvic pain, widespread pain that we call fibromyalgia, certain professions suffer from injuries from repetitive efforts, they suffer tension in the neck. They may have trouble squinting because they're looking at screens all the time, does that sound familiar? We'll talk a little more about that in a minute and the treatment is often completely ineffective.

Pain management is what it sounds like. a good idea, but do you really want to control it? We want to control our pain, that's not what most people want. How many studies have shown that surgery? Randomized controlled trials find back surgery better than exercise or conservative therapy. How many studies have shown that? surgery is better than any non-surgical intervention zero, not a single study showing that what about back injections, a large number of studies, meta-analysis of these studies and when comparing back injections versus back injections placebo, as a result, there is not much difference, what about opioids for pain it is a national disaster so let's work on the brain psychological therapies for pain top psychological therapies for pain cognitive behavioral therapy mindfulness therapy acceptance and commitment neither has been shown to be better than the other and it has not been shown to be better than relaxation therapy, which is what you received, the effects are small and people continue to suffer, so what are the things that are not They taught in medical school and they are still not taught?

They still don't teach me in medical school. I'm working. With three medical schools trying to include more of this in the curriculum, well, the power of the mind and the control that our brain actually has over our experiences, a conversion disorder is when someone has a sudden onset of inability to talk or paralysis of the arm or leg and what happens is that the arm is paralyzed and you say we will try to move it and they can't, it is completely paralyzed, but it can do it. In a conversion disorder, there is no medical cause for this problem, it is a psychologically induced paralysis.

I saw one time, a teenager we had a lot of problems before this and at one point her arm just died. He had a great medical exam and started to improve, but he kept waking up in the morning. His arm was fine even during breakfast. to school he arrives in the parking lot of his high school with his arm dead 3:30 in the afternoon the bell rings he leaves school I'm fine again incredible the power of the brain to induce those symptoms they can be contagious you can catch something from someone called contagion social one of the main symptoms that has been found to have social contagion is repetitive strain injury in the 1980s in australia there was an epidemic of RSI people were writing and it got worse and worse and more and more people got it and at one point the government had to step in and say no more disability for RSI and it started to go down how much you write we had our size from the computers so we are writing let's go like this have you ever typed on a manual typewriter?

I know what that's like, it's a lot more strenuous and we didn't have the sight when we were when people did that. I know a guy who went to grad school, and since he was going to grad school, he was a little tense. of things that were happening and he had this thought I hope I don't understand our ass I hope I don't understand on our side I hope I don't understand on our side Guess what happened he took our side and then his hands hurt and his arms hurt, he His wrists hurt, he goes from one arm to the other and he becomes a little incapacitated and finally he found the job I'm telling you about.

Now it's fine, but for example, I had a woman who had it and she thinks structurally. Everyone thinks we think all pain is structural and this woman who had writing pain writing on Monday Tuesday got worse as the week went on and by Friday it was unbearable so it sounds pretty structural because the more she writes the more it hurts and I asked her if it hurt any other time and she said yes on Sunday night you're writing on Sunday no what's going on in your brain you're anticipating it and that was the moment that's the moment of the house Back in the years 70 the Columbo moment there Sherlock Holmes moment where you go, okay, now we know what this is and she's okay now.

How many of you have regular hallucinations that are not so common? Yes, join the group we don't think about, we think hallucinations are crazy, but how many? Many of you have had the experience of feeling your cell phone vibrate in your pocket when it was not vibrating. There we go, that's a hallucination. One study showed that 90% of college students had that hallucination. The brain commonly creates a wide range of experiences. what I'm going to talk to you about and do you know where stress is located in your body? Do you know when you are stressed where you feel it in your body?

Do you have a feeling that most people know this, but we don't? I don't think we think of that as a different category than this guy I was talking about because his problem is serious, so our brains construct our experience, vision is constructed. Have you ever tried to find an icon on your cell phone when it was in a slightly different place or when you don't expect the color or whatever, you don't know exactly where it is and you look at it but you can't see it, we see it with our visual cortex and approximately 10% of the fibers. that go to our visual cortex come from our eyes from the retina 90% come from our brain I'm sure you've seen this image before What do you see?

It's interesting how what we see is actually a neural pathway of the type you expect to see, you can change it, you know what? Sorry, everyone sees there's a younger woman and an older woman and you can change it. Can you just try to watch one or do you just sometimes get stuck and it often gets stuck in one mode? we get stuck in one mode and we have to say which mode you're stuck in if you're stuck in which one the elder or the younger sees that the older woman's chin is down here and the younger woman's nose is up here and her ear It's there and as soon as you see it, your brain can change when people see an eyewitness when people are eyewitnesses to a crime who they pick out of the line, they pick the person their brain tells them is most likely to be there. committed the crime according to their understanding of crime and criminals and that has been proven, so now we talk about pain.

This seems painful. A friend of mine inadvertently shot a nail into his hand. He had no pain. Pain only occurs if the brain is activated. a danger alarm mechanism no danger alarm mechanism without pain children peel their knees and cry other times they peel their knees and don't cry or they cry when they see a worried parent running our brain has to activate pain in order to experience pain the body can not send pain signals to the brain, it sends signals and our brain has to interpret whether that signal is really a danger or not. Our brain controls pain.

All the pain is in the brain. This guy was written about in the British Medical Journal. from a scaffold to a nail a nail went through his boot they rushed him to the hospital a lot of pain they quickly took his boot off what did they find? The nail was placed exactly between his toes without any injury. His brain had activated the pain as a warning mechanism, but he was completely wrong about the risk. A few years ago I met a doctor who told me this story. He was in the Vietnam War when he was young.

His company was ambushed. One day he received a shrapnel wound in his leg. the pain got medevac he returns home to the United States his wounds heal what happens to the injuries all the injuries heal his brain turned off the danger alarm mechanism and he is now fine approximately 20 years later he is walking down the street and He is startled by the sound of a helicopter approaching behind him and has the same pain in his leg after all those years. How do we snap our fingers? How do we ride a bicycle? How do we do stupid things like that?

These things happen because our brain forms connections, millions of brain cells connect into neural networks. circuits or neural pathway for a specific purpose, this is how we live our lives in your brain, you learned the pain of the injury, remembered it all those years as a neural pathway and then activated it later in life through the mental association of the helicopter , we now know that when someone suffers an emotional injury the parts of the brain that activate are identical to what happens when someone suffers a physical injury. This is the mechanism by which emotional pain can cause physical pain and children who grow up feeling insecure. for any reason parental abuse or neglect or all kinds of things that can happen that show you the feeling of growing up insecure sensitizes that danger and alarm mechanism in the brain that can then be activated later in life by another stressful event of life or from a physical injury like a car accident and So, this whole variety of pain syndromes that are the communist pains in the rooms that we have are all associated with childhood adversity and when you scan the brains of people who have pain from

chronic

back pain, who have back pain, what happens is over, these are people who had back pain that was chronic persistent and the areasSomatosensory areas of the brain dropped to normal, but emotionally charged areas of the brain increased in chronic pain.

It's not particularly a physical problem for most people, which is shocking, so there's this whole range of syndromes that all go together. The possibility that attention or migraine is due to a structural problem in the brain is 2 or 3 percent the vast majority of people attention migraines fibromyalgia irritable bowel most pelvic pain syndromes do not have structural problems inside their bodies and studies show that approximately 85% of people with neck pain or back do not have a clearly identifiable structural cause for that pain (85% and that is shocking, so what happens is that there may be someone who says that their father was me).

You will exaggerate a little, they are not you, I, his father, my father, speaking of Mina, he was a little critical and could be critical, a little harsh, and you have a sensitive young man who grew up in that environment, he certainly was not abusive, but the Danger Path gets a little sensitized and then you get to the internship, so on the first day of my internship I'm a terrified young doctor. I start having diarrhea that lasts six months. Something about being a doctor. I just get really scared and then the danger mechanism is producing a symptom and then I decide oh, here's a good idea.

I will have children. I'll try to get a promotion at my job. I will start researching, I will start working on national committees. Great idea, all of these things are great ideas, but they cause stress. And then the next one starts with her, I wake up in the morning and go to work like this. Have you ever seen someone go? Working like this is quite common and what does everyone say? I slept badly, that's what I said for years and my MRI shows that I have bulging discs and arthritis and all that and I still have these bulging discs in my brain, but in my neck, but I don't have any pain from time to time, do you?

What if I get into a little car accident and then I start having other things or something else happens in your life and then everything can spiral from there because what happens is that the experience of being in pain activates the danger alarm mechanism, which triggers more pain, so having it is a vicious cycle of pain that leads to fear of pain, which creates more pain and that describes why many people with chronic pain get worse over time and their pain tends to get worse. it extends from the lower back to the middle of the back or to the neck or abdomen like the type I told you about and then what I explain to people is that the lesions send signals to the brain and the brain has to decide when I say the brain, these are processes that happen completely outside of our awareness, that's why American horror stories are a suitable analogy because people move into this house that is haunted and everything is out of control, things are happening to them and people are trapped in the spiral like The patient I was talking about feels like things are happening to them that are completely out of their control and it is their brain that is doing it on a subconscious level.

An emotional injury can activate the danger signal in exactly the same way as a physical injury and then pain is learned as a neurological pathway, so when I evaluate patients with pain and there are others, I have to mention other things that are connected to This, for example, with fatigue, insomnia, anxiety, depression or the most common ones, but if we are talking about pain, we are trying. My number one job is if it's a structural problem, like you know, you fell on your wrist, it's broken, you need a cast or it's a neural pathway problem because pain is a message that our brain is giving us, it's It's our job to encode it.

I saw a woman a few years ago who had pain in her butt here and I said well, when did she start? She said well just when my husband retired and if you think about it, you guys aren't thinking about it. Are you thinking about that? That's a very different message, so my first job is to analyze a structural disorder. The guy we're talking about had had everything done that could be done structurally. Nothing had helped him. She had a bulging disc. They already fixed it, they fixed things that weren't even broken, so there's no evidence that it had nerve damage, there was no evidence that it had a structural problem, so now my second job is to say, well, if we can rule it out a structural problem. problem maybe we can rule out a neural pathway or a brain-induced problem well, this is a very important slide a meta-analysis 3,300 people a bunch of studies pooled together if you take completely healthy, pain-free thirty-year-olds and give them MRIs 50 % of them have degeneration, 40% have bulging discs completely without pain, if you take people in their 50s, those numbers are 80% and 60% and if you reach an advanced age like me, we are talking about 90% of the people. have degenerative discs Dedede degenerative disc disease as if it were a disease the vast majority of adults have abnormal MRIs that are not the cause of the pain and doctors don't know what to say doctors know this information is not a secret, it just doesn't They know what to say what to do with it how to interpret it how to apply it in general and what it is what it is what were the messages that this patient I told you about received from his doctors the messages where you are damaged there is a problem here it could be genetic, we don't know, We tried to fix it but we couldn't fix it, which leads to no hope, no hope, which leads to more pain because of the vicious cycle, so what are the clues?

So, we're looking at how many dudu people they have. a variety of symptoms over time were headaches and then stomach pain and then back pain or neck pain or insomnia. Do people have adverse childhood events that maybe triggered that danger alarm mechanism in their brain and two people have this tendency? want to be liked be a perfectionist worry about what other people think of them be overly conscientious and responsible like you like me and that's good for the best people in the world, but when we put more pressure on ourselves they have a greater tendency to activate this mechanism of fear in danger, the danger alarm mechanism, and then we look at what was happening in their life or in their life at the time that symptom A started at the time that symptom B started, etc. and then we are looking at a distribution pattern from a medical point of view someone has pain it starts in the upper left part of the head left side goes to the left torso to the left leg there is no disease that does that there is no disease that has pain from the morning and then it disappears at 2:00 in the afternoon and then it disappears the rest is a there is no disease that does it and then we have to understand that we can evaluate people and the rules in the brain induce pain, so what?

What happens with an injury? An injury occurs, it hurts, and then it gets better in two days or five days or a couple of weeks. Fractures take six weeks to heal, but what we see and you can diagnose people in your family and friends very easily saying oh, I had an injury and it never healed well, what are the chances that probably not, if the pain It continues and gets worse over time after a fairly minor injury, that's not normal, that's not, that's not structurally induced pain, pain. It changes from one area of ​​the body to another Fibromyalgia is classic because the pain is in the arms and then the next day in the legs, it can change in an instant because the neural pathways can be turned on and off, which is the beauty of what I do because people can convey the symptoms better, as I mentioned often bilaterally, the brain shuts down and I say why does my right wrist hurt, my right wrist hurts and now my left wrist hurts, that's a red flag For me, social contagion, we talked about there being a study from Germany. the Berlin Wall fell in 1989.

I think in 1991 they started studying back pain in East Germany and West Germany, these two populations and back pain in West Germany was up here in East Germany. Back pain in East Germany was down here and over time these German back pains. it just rose to the level of West German back pain when those cultures mixed and the conclusion of the article was that back pain is a contagious disorder. Interesting, not all cultures have the amount of back pain that we have in this culture. A friend of mine was a doctor in Iraq and when he came here he said why does everyone have back pain here.

People don't come to the doctor for back pain in Iraq. I know maybe they have other problems, but they did come to the doctor for other problems that they simply didn't have. I don't come for back pain, so that's the kind of work I do. Back to this guy, our friend, he's an engineer, he's from Detroit, so they're all engineers, but not computer engineers, not automotive engineers, of course, a lot of automotive engineers are actually ours. computer engineers his wife now works part-time he had two children he did not have a particularly adverse childhood but he was sensitive he noticed that he had stomach pains before having to give school presentations the onset of his headaches ended and the pain in his buttocks coincided with his first position in his new job, the marriage was difficult at times, but about eight years ago, when back pain began that spread to neck pain, they sold their company, increasing the workload, worried about keeping their job, It was a recession, which puts a lot of pressure.

In things, he started going to work at 7:00 a.m. m. and then at 5 a.m. m. and he started feeling pain because his brain was sending him a message, so here's the trick for him: he goes on vacation, the pain goes away, that's solid evidence that he spent a week camping. on hard ground and his back was fine and that tells me everything I need to know. The other thing you noticed is that you noticed that you didn't notice that your back pain got worse in stressful situations, but you did notice that your stomach pain discomfort was related to stressful situations at work or at home and you also noticed that when your stomach hurt His stomach didn't hurt his back and that is more positive evidence of pain in the neural pathway.

I want to change the subject for a second. This is a study we published for the last time. Last week it's an NIH-funded trial, it was led by an extraordinary colleague, Mark Lumley, from Wayne State University, and we randomly assigned 230 people with fibromyalgia who have severe, chronic pain, but no tissue damage in the body, to three groups and there were three arm study, the first group, the first arm received education about fibromyalgia as a control group, the second arm received the standard cognitive behavioral therapy of pain psychology performed by our excellent colleagues at the University of Michigan, designed specifically for fibromyalgia and the third arm was an arm that marked and I devised it and we based it on the work of one of our colleagues dr.

Alan Abbas and in this group we talked to people about the connection between emotions and pain and asked them to do the difficult work of observing, recognizing, experiencing, expressing and processing emotions that they may have avoided in their life, such as anger, guilt, sadness and compassion. and we didn't know if people were really going to engage in this kind of thing anyway because it's not the standard, it's not cognitive behavioral therapy, the idea is to help you cope better with pain, but we're talking about getting to an underlined point. . mechanism What we found was surprising at a six-month follow-up after treatment, people in the emotional expression and awareness group have significantly higher rates of dramatic pain reduction of more than 50% compared to the other two groups and did not I don't know if you know how much you know about medical statistics, but the number needed to treat was seven, so if you go to your doctor because your cholesterol is high and you've never had a heart attack, your cholesterol is high and your doctors Here I want you to take this medicine to lower your cholesterol.

What is the probability that this medication will actually help you in that situation? The number needed to treat is one hundred, which means one in a hundred is unlikely to have a heart attack. so we make every day this the number needed to treat seven, it's a very powerful effect in terms of medical interventions and we also found that the changes in the generalized pain index in the awareness and emotional expression arm were better than in the CBT arm and in In terms of the percentage of people who still met criteria for the disorder at the end of the study, it was much lower in emotional expression.

This is the first large-scale study, to our knowledge, to show that a psychological intervention for pain is actually superior to any other psychological intervention. So what have we learned? Many people with pain have problems in their lives from childhood and from then on the pain isconnected with emotions and this type of therapy works better than the standard and we believe this is a milestone. I study in many ways and this study does not even include the full range of therapies that I am going to talk to you about and that we give to this man. This is another study, just an outcomes study that we published based on data from my work in my program and in these people with half about half back pain half fibromyalgia the average duration of pain was nine years the average duration of pain in this sample was nine years and these people when they go to pain management clinics generally don't.

There's not much in the way of actual pain reduction, but in our sample two thirds of them had at least 30% of pain reduction and more than half had more than 50% pain reduction, so it's a different paradigm: the paradigm that all pain is due to injury. in the body and is simply reflected in the brain does not work for people with brain induced symptoms, we need a different paradigm and if we are aware of the history of science, paradigms do not change easily, it can take decades to create a paradigm for an idea that initially seems completely contradictory to go to the totally obvious plate tectonics, the idea that the continents were all together and one thing you can see if you look at the map you can see how they fit together like a puzzle, right, scientists find it It took 50 years to agree that that's what happened fifty years and I'm sorry, as you can see the symptoms of this disorder are real but they do not damage the brain, it has been sensitized and the brain has the power to produce even very serious and most people having this at least to some extent is a very common phenomenon we believe that most people with chronic pain have this phenomenon and are being treated according to an old paradigm yes, skepticism continues to abound what do we do interventions They are simpler and cheaper.

The important thing is to understand that this is what is happening because the people who suffer from it understand: "My God, I am not damaged, I am not broken, I can get better," that allows them to do the work of detaching themselves from the symptoms, whereas people who are under the belief that they are actually dead, it's very difficult to do that, so the idea is that people really need to understand and that's why I spend so much time examining people and listening their stories looking for those details that are going to make or break The case, so to speak, is a woman I never met.

She says 21 months after her third back surgery, a three-level fusion doesn't sound right. She spent 21 months trying all the therapies to get out of enormous and relentless back pain, plus 22 years. of chronic limiting back pain without success my doctor sent me a link to your website that's my website six days I considered the possibility that this could apply to me I came back I read it again I said oh my God, that's me I see it , it's obvious paradigm shift, paradigm shift and what happened with your pain, it just subsided, most people don't have that kind of answer, but when you have the answer you actually get it and you see the paradigm shift and you see what's happening, then you have the opportunity to improve to completely improve and she had a dramatic effect just by understanding and learning about this model and then she said, well, I started walking before I could barely walk around the building, but I kept going. telling me what she said to herself.

I can walk I can walk I'm fine I'm not hurt and she starts walking and says well forgive me for being effusive but going from crippled fearful bewildered discouraged on the verge of despair to getting my life back this is kind of a minor miracle so Once I get them If people get the idea and understand what is happening, they can begin to reduce the danger alarm mechanism. They may begin to worry less about pain. They stop anticipating it. They stop monitoring it. They stop allowing pain to dominate their every thought and every action. -engage in physical and social activities despite the pain knowing that they can really do it knowing that they are not damaged knowing that they can get better and then talk about mindfulness in a minute so this is a woman, she said, today I had great success.

Decided to go for a walk but my back was killing me so I told my brain I'm going to go for a walk today you can do it you can make it easy or you can make it hard but come on it's kind of like those old gangster movies where they say you'll talk if you can make it easy or difficult, but you go to PhD and it tells your brain, look, this is how it will be, we have the ability to change our neural pathways. Because the brain is neuroplastic, when we think differently and act differently, we can calm the brain and calm that danger alarm mechanism, which is like calming a child who is really upset and if you keep doing it and keep working In it, what happens is most people get better and then there are the emotion-focused techniques and I don't have time to talk much about that, but one of the simplest things anyone can do is take a piece of paper and start writing.

You can write a letter to anyone. you want it dead or alive and you can shred it so you can say whatever you want and it's a very

healing

process. This is a woman who wrote through this. A woman in Germany who was working on this program and said, "Well, I wrote for the first time." exercise tears running down my face I was done my whole body was screaming in pain no you can't bear to face that so she had activated emotions and her pain went from here to here and then she did something brilliant, she wrote a letter to her brain saying yes I can cope I'm able to do this it's okay I'm allowing myself to feel emotions I was afraid of emotions often and we avoided it at all costs and then his pain just dissipated and he did this work it's amazing and of this type In fact it's very difficult , it's very hard to understand, unless it really happened to you, what happened to you, you're like, oh my gosh, that's amazing, but in the abstract it's like yeah, that's probably true for other people, but those are my real pains and therefore full attention. mindfulness is everywhere.

I have been a mindfulness teacher for 17 years and I am passionate about it. I think everyone should learn mindfulness, but the data on mindfulness for chronic pain shows that it has small effects, it's not particularly effective, and the reason is the same reason cognitive behavioral therapy suffers because we don't look at the underlying cause, so we use mindfulness to better cope with chronic pain instead of understanding that mindfulness can actually be the key to alleviating and resolving it once you know. which is actually a product of the mind, if pain is a product of the mind, then mindfulness works because now you notice it with detachment, now you notice it, you tolerate it, you accept it and it's not like that.

It bothers you, you don't care as much anymore and that turns off the danger alarm mechanism, it is a very powerful intervention and, lastly, sometimes people need to make changes in their life, they need to do something if you are in a you know if Yes There is a difficult situation in marriage, work, neighbor or something, sometimes you have to take action and deal with it as best as possible. So what's up with our friend? Well, at first it was a little difficult, it's like people have been telling me for eight years how damaged I am how bad my back is and it takes time to go over the evidence and explain it and apply it and personalize it and care and show that you really care. matters and that you are doing everything you can and when he sees that he is much more likely to understand that trusting you and believing you, that's why he started doing that work and at first he had his ups and downs, his pain got worse when he started doing this work because it is shaking things up in this danger alarm. like the woman he wrote about, but he persisted in the conviction that he was not damaged and that he could get better and about four months later he was no longer in pain, he was fine after eight years. back pain, neck pain, and stomach pain all caused by the same thing. underlying mechanism and this would repeat itself at strange times every now and then, suddenly he would feel a pain or a twinge or whatever and what was happening in his brain was like Oh Naropa, I remember that flash and then you feel the pain, but he he knows what it is now he doesn't, he doesn't immediately feel fear or frustration or worry you say oh that's my brain nothing much happens disappears or when you have a stressful event in life the pain comes as a message and we need pain the pain It is very important and that is why it serves as a protection mechanism.

Children who grow up without the ability to feel pain often die at a young age, so we need pain, yes, and it is in your case that you have a great barometer whenever your stomach bothered you and you said, "Oh, and so on." "Maybe I should check what's going on in my life because something is bothering me and that's a gift, so research now confirms that all pain is a protective mechanism through neural pathways that can be triggered by a structural disorder." or simply by the neural pathways in the brain and a significant proportion of the pain we have is induced by the brain.

MRI findings often do not correlate with pain and we can make this distinction between structural pain versus non-structural pain or sometimes it is a combination of the two. Because the treatments are radically different and the reversal of this syndrome can occur when the understanding of it is combined, when the cognitive-behavioral and emotional interventions are combined, the results can be dramatic, so, as I said, the paradigms They don't change easily as Sherlock Holmes said. nothing more misleading than an obvious fact: you just hear what you heard today and maybe you knew all this, but you will encounter people with this syndrome frequently, it is that common and it is easy to recognize when you just know what you are looking for and how .

Are most people going to react if you mention it? Disbelief and total rejection, that's what happens, but the more people understand pain like you do now, the more likely it is that the paradigm will change. This website, the TMS Wiki, is a non-profit website information clearinghouse. For information on this, the following URL is for a three minute animated video made by my colleague Allen Gordon and there are a lot of books that explain this and ultimately what happens a lot of times is that people initially reject the idea, but then you find out about this from someone and then from someone else seven I mentioned that someone else happens I mentioned eventually they take a look and finally look at themselves it is difficult to reflect on oneself, but the bottom line is that the rain of pain lies mainly in the brain so thank you for letting me be here and I'll be happy to answer questions yeah yeah you know they have to find their own way well I mean kids reflect what their parents do and if parents have always had a bad back, that will settle in the child's mind like, oh yeah, when I have a problem, my back was the third one that hurt me, so we have to be careful with that, we have to be careful with giving a pill for everything .

There was a woman in Maryland who reached out. with obecalp which is a placebo spelled backwards to give to children when their tummy hurts give them a pill which is a placebo like why would you do that? I have a friend who was on vacation with his son and his parents were divorced and they were doing this hike and the kids' stomachs started hurting and they were like: What did you eat? You know, through every physical thing you can think of and finally say, "Okay, I have a seat," you know, is there something that's bothering you? friend no, no, everything is fine, okay, is there something bothering your friend?, no, everything is fine, something in your mind knows that I miss my mom, so just the idea of ​​understanding that and he says, yes , I miss her, yes, I miss her too, but you will be. we'll see her soon and we'll write her a letter and we'll call her on FaceTime tonight or whatever and then he runs around and he's fine, and the more we understand, the more we can educate our kids to understand other questions, yeah, right ?

Are you saying we can use the mind to help induce pain structurally? The question is, yeah, well you can use the same things, I mean the brain, you know the guy with the nail in his hand, the brain can actually reduce structural pain. and then when someone studies show, for example, that if someone feels pain that week, someone feels pain that is intentional, it hurts much more than if it is accidental and we know that something else that I was going to tell them, we know that they can tolerate the ollar eight intense pain if you think it's for a short time, but it's almost intolerable to tolerate lesser pain if you think it's forever and thus frame how we view pain into how harmful it is and how much we can do and how much we should do.

We want to focus on living our lives instead of letting the pain take over, so at least what we can do with structural pain is to at least hopefully prevent it from falling into the vicious cycle.of getting worse and worse over time due to increased fear, anticipation, and monitoring. and worrying about it, yeah, yeah, yeah, the better the Vietnam vet, yeah, it was just uh, it came and it went, you know, his brain just turned it on at that moment because of that association, so for him it's not It was a continuous process. The pain was short lived, it just showed itself, it's a great illustration of how the brain learns pain, remembers pain, and can then activate it.

A lot of pain is triggered, it becomes a conditioned response, so I say, I know, I know. I have a problem with my back because every time I turn here, but the way the brain works is a model called predictive coding, so if the brain thinks something is going to happen, it will create it, so we used to think that when you stand up, When you stand up, there's a sensor in the carotid artery that sends signals to the brain to say "oh, you're standing up." Send more blood to the brain so you don't, so we don't pass out.

It turns out that when you think about standing. The brain activates that mechanism, so the brain predicts in advance what you are going to do and what you need to do, so every time you bend over, your brain predicts pain and it will, so people who write , the brain predicts. Pain when writing the brain predicts pain when sitting and these are conditioned responses. Pavlovian answers. In reality, we can work to eradicate. I used to have a lot of back pain and every time I bent over it hurt and just when I realized it. I realized it wasn't my back every time I leaned over, I was just telling myself: I'm okay, I'm okay, this won't hurt and you'd do it enough times and your brain eventually gets the message and shuts down. that conditioned response is just fascinating, yes, yes, yes, you can't stop the pain, people feel pain all the time, the main thing is that people always ask me: well how do I know if it's real or not?

Do you know how I know? a lot of common sense, if you fail you get hurt and when it hurts you know and I don't know what it is I go to the doctor and try to make sure but you know with common sense if it doesn't get better or you know Well, you know, just investigate it and then you can figure it out, but the pain does not go away in the short term. That mechanism is pretty cool, so to speak, so I have a couple more things I can tell you, a couple more little stories.

It doesn't matter and then we can finish we will be on time even early so I flew here yesterday from Detroit get up early in the morning get in my car drive to the airport get on the plane everything is fine I'm on the plane I'm walking up and down I grab my bag I get on I get to the car, I get to the hotel, everything is fine, I get out of the car at my hotel and I start walking and suddenly I have this sharp pain in my butt, the big toe of my right foot, it's like a needle was stuck in me, it's a sharp pain and every time it hurts, I wonder what the hell, how could it be wrong, after all day I was fine and suddenly I have this pain like a needle, so my mind, body, doctor, brain, it's and you say, it's fine, what's happening?

You know, you know, you know, you like the hotel or you're giving a talk tomorrow, maybe you're nervous about it, you know what's going on and then the medical side of me says, you know, God, it feels like you have something on your foot. right and then my human side says ding this hurts so I go up and why I go into the hotel I'm at the check in I check in and I'm standing there and then I put a little pressure on my toe and it's okay and I press it harder and it's okay like it was gone, okay, that was my brain because why would it if it was something there?

It wouldn't disappear like that so I grab my key and go up. In my room I'm walking now every step is starting to hurt again and when I get to my room I'm walking on my heels because I don't want to put any pressure on my big toe so I walk into the room. and I get a diaper done for a diagnostic test what the test looked like, so I pull up my shoe, there it is and this is what I found, a shard of glass stuck to my sock, how the hell didn't it bother me in the hole all day until I just got there, but as we say, you have to look, you have to rule out structural causes first.

I was giving a lecture. I was thinking about this the other day. I gave a talk a couple of years ago in London, actually, and at the end this guy. He stood up and said that in my culture pain is seen as a gift from God, what do you think of that? Well, yes, it is how we were formed, we have this capacity to have pain and it is a barometer of our structural body and it is a barometer of our brain and all the experiences that we bring to this moment and when pain or other symptoms that I mentioned occur, when pain occurs, something is happening and it is our job to encode it, it is our job to learn from it and it is a complete experience. gift and people who have been through things like this, you will be much better in your life because now you understand yourself better, you understand what triggers you, what are some of the problems in your life that you can take action on and work on to solve them. deal more effectively with what life brings and sometimes people need to make big changes in their life, but there is an experience that is not as well known and that is post-traumatic growth, not all traumas lead to post-traumatic stress , this or trauma can lead to post-traumatic growth if we know how to use it if we don't interpret it if we have the tools that help us grow as people and I think that's what life is about so I'll leave you with that and thank you very much.