How To Heal Chronic Pain with Dr Howard Schubiner (re-release) #519
This episode features Dr. Howard Schubiner, Director of the Mind Body Medicine Center, discussing how chronic pain (like headaches, IBS, fibromyalgia) is often created by the brain due to stress and emotions, not structural damage. He shares revolutionary therapies to reprogram the brain and change the pain narrative.
Deep Dive Analysis
17 Topic Outline
Introduction to Chronic Pain and Dr. Schubiner's Work
Defining Acute vs. Chronic Pain and Brain's Role
Common Chronic Pain Conditions and Medical Challenges
Brain's Predictive Processing in Generating Pain
Misinterpreting MRI Scans and Back Pain Diagnoses
Dr. Chatterjee's Personal Chronic Back Pain Journey
Emotional Weight of Caregiving and Physical Pain Relief
Chronic Pain as a Protective Signal from the Brain
Pain Reprocessing Therapy: Changing the Narrative
Societal and Cultural Influences on Pain Experience
Adverse Childhood Events and Chronic Pain Outcomes
Illustrative Stories of Brain-Generated Pain
Resources and Techniques for Unlearning Pain
Interrupting the Pain Cycle: The 'Six F's'
Role of Mindfulness and Emotional Awareness in Healing
Personality Traits and Chronic Pain Susceptibility
Personalized Approaches to Pain Medication and Hope
7 Key Concepts
Pain as a Protector
Pain is a discomforting experience and an emotion created by the brain as a message to alert us to a problem or danger, telling us to stop or pay attention. It's akin to a smoke alarm, signaling something amiss.
Neural Circuit Based Pain
This refers to pain generated by the brain due to activated neural circuits, often in the absence of a structural problem. These circuits can be activated and reinforced by stress, emotions, life situations, and the fear of pain itself, leading to chronic symptoms.
Predictive Processing
An emerging neuroscience concept explaining how the brain actively creates what we experience, including pain. The brain constantly predicts what it expects to see, hear, or feel, and these predictions can override or generate sensations, even without external stimuli or physical injury.
Pain Reprocessing Therapy (PRT)
A therapeutic approach focused on reversing chronic pain by changing the patient's narrative and perception of it. It involves understanding pain as a neural circuit problem, fostering hope for reversal, and consciously reassuring the brain of safety to turn off its danger alarm mechanism.
Emotional Awareness and Expression Therapy (EAET)
A treatment approach that addresses the emotional roots of chronic pain. It involves processing unexpressed or unprocessed emotions and life events that contribute to the sensitization of the brain's danger signal, leading to deeper healing.
Nocebo Effect
The phenomenon where negative expectations or beliefs about a treatment, medication, or situation can lead to worse outcomes or increased symptoms. For example, fearing the withdrawal of pain medication can intensify the experience of pain.
Granularity in Language
Refers to the specificity with which individuals use language to describe their experiences, both physical (e.g., ache, sharp, hurt) and emotional (e.g., rage, contempt, annoyance). A more granular vocabulary can aid in understanding and addressing underlying issues contributing to pain.
11 Questions Answered
Chronic pain is any pain that has lasted for three to six months or longer. It's estimated to affect around 28 million people in the UK alone and, in the vast majority of cases, does not have a structural problem as its cause.
The brain creates what we experience, including pain, through a process called predictive processing. It decides whether to turn on pain signals based on various inputs, including emotions, stress, memories, and context, even in the absence of a physical injury.
Doctors often struggle because they are trained with tools that don't effectively address chronic pain when there's no structural cause. There's a historical lack of medical education on the mind-body connection and the significant role of emotions and stress in physical symptoms.
No, MRI abnormalities like degenerative disc disease or bulging discs are common findings in people without pain, even in young adults. Attributing pain solely to these scan results can be misleading and worsen a patient's condition by instilling fear.
By focusing on structural abnormalities found on scans and telling patients these are the cause of their pain, professionals can instill fear and an erroneous belief system. This reinforces neural circuits for pain, creating a positive feedback loop that makes the condition worse.
Yes, neuroscience research shows that emotions and stress activate the exact same parts of the brain as a physical injury. The brain can generate real and severe physical pain due to stressful life situations, past trauma, or unexpressed emotions.
PRT is a therapeutic approach that helps reverse chronic pain by changing the patient's narrative about their pain, understanding it as a neural circuit problem, and consciously reassuring the brain of safety. A study showed 75% of chronic back pain patients (with an average 10-year duration) were pain-free in one month using PRT.
Different societies and cultures can have varied outlets for stress, leading to diverse manifestations of physical symptoms. The way pain is discussed and understood culturally can influence its prevalence and expression, as seen with the rise of back pain in teenagers or differences between countries.
Adverse Childhood Events (ACEs) can sensitize the brain, making individuals more susceptible to chronic pain later in life. Studies show that people with more ACEs have significantly lower chances of successful outcomes from treatments like back surgery, regardless of the physical condition of their spine.
Painkillers can alleviate suffering, especially in severe cases, and may be used temporarily while patients engage in therapies like pain reprocessing. However, they are often a 'band-aid' and don't address the root cause, and forced tapering can lead to a nocebo effect, potentially worsening pain.
By understanding that pain is a signal from the brain, not necessarily a sign of structural damage, individuals can change their narrative. Techniques include telling oneself 'I'm okay, I'm safe,' smiling, gradually moving with joy, and challenging triggers, which helps calm the brain's danger alarm.
20 Actionable Insights
1. Understand Brain’s Role in Pain
Recognize that pain is created by your brain, not necessarily the body part where it’s felt, and that emotions and stress can activate the same pain centers as physical injury, which is the first step towards healing.
2. Reframe Pain as a Signal
Understand that pain is not the problem but a solution from your brain, acting as a signal or blessing in disguise to alert you to something that needs attention or care.
3. Avoid Fear-Pain Cycle
Recognize that fear, worry, focus, and frustration about pain create a vicious feedback loop in the brain’s neural circuits, making the pain worse over time.
4. Reframe Pain Narrative
Actively change your internal narrative and self-talk about pain by reassuring yourself that you are safe and not in danger, even smiling, to turn off the brain’s danger alarm mechanism that causes pain.
5. Use Reassurance and Smiling
Give your brain reassurances and smile when experiencing or anticipating pain, as this helps turn off the danger alarm mechanism in the brain that is causing the pain.
6. Practice Graded Exposure
Gradually expose yourself to movements or activities that trigger pain, starting with imagination, while simultaneously telling yourself you are safe and smiling, to retrain your brain’s neural circuits.
7. Control Inner Self-Talk
Be aware of and control your inner self-talk, as negative messages about your body or capabilities can worsen pain, while positive affirmations can improve performance and reduce symptoms.
8. Treat Brain with Compassion
Approach your brain’s pain signals with compassion, understanding that it’s acting out of fear, similar to reassuring a child afraid of a monster, rather than fighting or being angry at the pain.
9. Understand Pain is Not Enemy
Adopt the mindset that pain is not an enemy but a fearful signal from your brain, which allows you to approach it with reassurance and compassion, rather than anger or resistance.
10. Reframe Before Mindfulness
Before practicing mindfulness for chronic pain, first re-categorize the pain as a neural circuit problem (brain-generated thought) rather than a structural issue, then observe it without fighting or frustration.
11. Pair Movement with Joy
Engage in physical movement, like yoga, by pairing it with feelings of calm, joy, control, or peacefulness, to retrain your brain’s neural circuits and associate movement with safety rather than fear or pain.
12. Seek Root Cause of Pain
Believe that chronic pain can often be healed without medication by taking the time to understand what’s going on and getting to the root cause, which is often emotional or stress-related.
13. Use Journaling for Emotions
Employ journaling as part of emotional awareness and expression therapy to deal with unprocessed emotions, leading to inner healing and using symptoms as a guide to understand what’s important in your life.
14. Learn to Set Boundaries
Recognize that personality traits like people-pleasing or perfectionism, often developed in childhood, can put pressure on your system, so learning to say ’no’ and set boundaries is crucial for self-care.
15. Focus on Creating Health
If you have multiple diagnoses and labels, consider setting them aside to focus on creating overall health through addressing emotional well-being, sleep, stress, and movement, rather than solely focusing on what is ‘wrong’ with you.
16. Medication as Healing Bridge
If suffering, use pain medications temporarily to alleviate symptoms while actively engaging in pain reprocessing and emotional work, with the goal of reducing or eliminating medication over time as healing progresses.
17. Re-evaluate Conditions Openly
Approach chronic conditions by stripping away negative labels and the idea of incurability, and instead, carefully investigate your life and symptoms with an open mind to find new avenues for healing.
18. Explore Alternative Paths
Be open to exploring different paths to healing for chronic pain, especially if traditional methods haven’t worked, as there are often alternative approaches that can lead to significant improvement.
19. Validate Chronic Pain Patients
For healthcare professionals, listen to and understand patients with chronic pain, validating their experience that the pain is real and not imaginary, which provides a hopeful message for recovery.
20. Personalize Pain Management
Healthcare professionals should personalize their approach to pain management, meeting patients where they are at, and clearly communicate that medication is for temporary management while offering to help find the root cause.
9 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
It's not all in your head when a doctor says or anybody says it's all in your head, it's cruel and it's ignorant.
Dr. Howard Schubiner
The brain decides whether to actually turn on pain or not, whether to give you the experience of pain or not.
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.
Dr. Howard Schubiner
Our brain creates what we experience.
Dr. Howard Schubiner
The more you're fearful of the diet, every time if you have back pain, the more fearful you are of it, it's going to get worse over time.
Dr. Howard Schubiner
The pain is not the enemy is our message.
Dr. Howard Schubiner
When the mind is ill at ease, the body suffers.
Ovid (quoted by Dr. Howard Schubiner)
When you operate on pain, you get pain.
Dr. Howard Schubiner
1 Protocols
Pain Reprocessing Therapy (PRT) for Chronic Pain
Dr. Howard Schubiner- Change the narrative about the pain, understanding it is a neural circuit problem.
- Cultivate hope that the pain is reversible.
- When performing movements (e.g., lifting, bending), consciously tell yourself, 'I'm okay, I'm safe, I'm not in danger.'
- Smile while performing movements to reassure the brain and help turn off the danger alarm mechanism.
- Utilize graded exposure techniques, starting with imagining movement with joy and then gradually increasing physical movement while maintaining messages of safety.