BITESIZE | How To Heal Chronic Pain | Dr Howard Schubiner #447
Dr. Howard Schubiner, Director of the Mind Body Medicine Center, explains that chronic pain is often generated by the brain's neural circuits, not structural damage. He emphasizes that this pain is real and can be unlearned by addressing the brain's fear response and emotional factors.
Deep Dive Analysis
15 Topic Outline
Introduction to Chronic Pain and Brain's Role
Pain as a Brain Message vs. Structural Problem
Brain's Predictive Processing in Pain Generation
Emotional and Stress-Induced Pain is Real
Prevalence of Non-Structural Chronic Pain Conditions
Misinterpretation of MRI Findings in Chronic Pain
The Vicious Cycle of Fear and Pain
Healing Chronic Pain by Understanding its Origin
Brain's Capacity to Produce Diverse Stress-Related Symptoms
Clues for Identifying Non-Structural Pain
The 'Six Fs' Perpetuating Pain and Cycle Interruption
The Power of Recategorizing Pain as Safe
Integrating Mindfulness and Journaling for Pain Management
Emotional Awareness and Expression Therapy for Deeper Healing
Empowering Self-Investigation of Pain Patterns
5 Key Concepts
Predictive Processing
This is the brain's process of creating our physical experiences, including pain, based on its predictions. In chronic pain, the brain might predict pain even without actual structural injury, making an error in its protective signaling.
Non-Structural Pain
This refers to real pain experienced in the body that is not caused by physical damage or injury to tissues. Instead, it originates from neural circuits in the brain that have become overactive or miswired due to stress, emotions, or past experiences, creating a protective pain signal even when no physical threat exists.
The Six Fs
These are common responses to pain (Fear, Worry, Focus, Fighting, Frustration, Figuring out/Fixing) that inadvertently give the brain a danger signal, perpetuating a vicious cycle and making the pain worse by reinforcing the neural circuits.
Pain Reprocessing
This is a therapeutic approach focused on interrupting the vicious cycle of pain by giving the brain calming and safe messages. It involves lowering the fear response to pain and reframing the symptom as a brain-created thought rather than a sign of physical danger, allowing for neural circuit changes.
Emotional Awareness and Expression Therapy (EAET)
This therapeutic approach focuses on dealing with unprocessed emotions that can contribute to chronic pain. It integrates elements of intensive short-term dynamic psychotherapy and internal family systems work to help individuals process and express emotions, leading to deeper healing.
8 Questions Answered
No, the vast majority of people with chronic pain do not have a structural problem. The brain creates pain as a protective message, and it can do so even when there's no physical injury.
The brain decides whether to turn on pain or not, based on its predictive processing. It receives impulses but ultimately creates the sensation of pain to protect the individual, sometimes making an error in its prediction.
Yes, neuroscience research shows that emotions and stress activate the exact same parts of the brain as physical injury, meaning the pain experienced due to stress is real and can be severe, just like pain from a fracture.
No, these are often normal findings that occur with aging, even in people without pain. Attributing pain solely to these findings can be misleading, as the majority of chronic neck and back pain is non-structural.
Fear, worry, and focus on pain create a positive feedback loop in the brain's neural circuits, reinforcing the danger signal and intensifying the pain.
Absolutely not. The pain is real and created by the brain, but it's not imaginary or a sign of weakness. Saying it's 'all in your head' is cruel and ignorant as it implies fault.
Non-structural pain often exhibits inconsistencies: it may turn on and off, disappear on vacation and return at work, or be triggered by stress, wind, cold, or weather, unlike structural pain which is typically constant.
Mindfulness meditation alone has not been particularly helpful in research studies for reducing chronic pain if the pain is not first categorized as a neural circuit problem. It requires reframing the pain as a brain-created thought before observation.
9 Actionable Insights
1. Thorough Medical Evaluation
Ensure a physician has carefully evaluated your pain history and ruled out any structural problems, infections, inflammatory conditions, or tumors before concluding your pain is due to neural circuits.
2. Understand Brain-Generated Pain
Recognize that most chronic pain is not due to structural damage but is a real sensation created by the brain’s neural circuits, often in response to stress or emotions, as a protective mechanism. This understanding is the first step to turning off the brain’s danger signal.
3. Reframe Pain as Signal
Shift your perspective to see chronic pain not as a problem, but as a ‘blessing in disguise’ or a solution from your brain alerting you to something amiss in your life that needs attention or care.
4. Observe Pain Inconsistencies
Investigate your pain patterns by noting when it turns on or off, goes away on vacation, or is triggered by stress or weather, as these inconsistencies are strong clues that your pain is a neural circuit problem.
5. Interrupt Pain-Worsening Responses
Actively work to reduce fear, worry, excessive focus, fighting, frustration, and constant attempts to ‘figure out’ or ‘fix’ your pain, as these responses send danger signals to the brain and intensify the pain.
6. Practice Pain Reprocessing
For non-structural pain, gradually reintroduce movements or activities that typically cause pain while simultaneously affirming to your brain that you are safe and not in danger, allowing neural circuits to change.
7. Mindfulness with Reframing
Practice mindfulness by first reframing pain as a brain-generated sensation or ’thought,’ then observe it without judgment or fighting, allowing you to step back and change your relationship to the symptom.
8. Engage Emotional Journaling
Use journaling as part of emotional awareness and expression therapy to process unprocessed emotions, which can be a significant underlying cause of chronic pain and contribute to inner healing.
9. Read Unlearn Your Pain
Consult Dr. Howard Schubiner’s book, ‘Unlearn Your Pain,’ for practical exercises and research-backed insights to guide you through the process of understanding and resolving chronic pain.
7 Key Quotes
The pain is not the problem, it's the solution. It's the solution that our brain has come up with to alert us to a problem.
Dr. Howard Schubiner
The brain decides whether to actually turn on pain or not, and it's there to protect you.
Dr. Howard Schubiner
Is his pain real? Yes, because all pain is real. All pain is created by his brain.
Dr. Howard Schubiner
Never underestimate the power of the brain to create severe symptoms, severe pain, severe fatigue.
Dr. Howard Schubiner
The pain they experience is real. It's not imaginary. It's not in their head. But it is in their brain because of neural circuits in their brain when the doctors can't find anything wrong.
Dr. Howard Schubiner
When a doctor says or anybody says it's all in your head, it's cruel. Yeah. And it's ignorant because it implies that it's their fault, that they want the pain somehow.
Dr. Howard Schubiner
The pain is not the enemy, is our message.
Dr. Howard Schubiner