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How To Heal Chronic Pain with Dr Howard Schubiner #310

Nov 9, 2022 2h 6m 21 insights
Headaches, migraine, back, neck or joint pain, irritable bowel syndrome (IBS), fibromyalgia – they’re just some of the common causes of chronic pain, which is estimated to affect between a third to half of all UK adults. If you or someone close to you is one of them, you don’t need me to tell you it can be physically and emotionally draining. You probably feel like you’ve tried everything – so today’s podcast has the potential to be a life-changing listen for you. My guest is Dr Howard Schubiner, Director of the Mind Body Medicine Center in Michigan and author of Unlearn Your Pain: A 28-day Process to Reprogram Your Brain. Emerging neuroscience tells us our brains actually create what we experience in our bodies, through a process called predictive processing. Pain doesn’t come from the body part where it’s felt, it’s created by our brain, signalling that something needs attention. And as Howard explains, our emotions and stress activate the same pain centres in our brain as an injury. If you’ve ever had a broken heart and experienced chest pain? That’s what’s happening. The same thing occurs with chronic pain. In the vast majority of cases, there is no structural problem – such as injury, infection or a tumour – although of course these must be ruled out. Instead, your brain has created a neural pathway that remembers the pain and keeps you trapped in a vicious cycle. You fear the pain, that causes you stress, and the stress makes the pain real. And that is the absolute key here: it’s not ‘all in your head’, your pain is real. And there is something you can do about it. During this conversation, Howard reveals why the key is changing your narrative on pain. His revolutionary therapies – which you can easily access – have been proven to work not just with chronic pain but in other persistent conditions such as depression and anxiety, chronic fatigue and long Covid. We discuss the role healthcare practitioners can play in these conditions, through listening and empathy. Chronic pain isn’t a subject we’ve covered in depth on this podcast before, so I’m very pleased I have the chance to bring this important conversation to you. Howard is one of the leading researchers in this field and his work represents a game-changing, paradigm shift in thinking about how we approach this epidemic. I hope what you’ll take from this episode is that the power of your brain is immense, and that knowledge is power. I hope you enjoy listening. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore or https://fblm.supercast.com. Show notes https://drchatterjee.com/310
Actionable Insights

1. Reframe Pain as Protector

Understand that pain is not the problem itself, but a solution your brain creates to alert you to an underlying issue or perceived danger. View symptoms as a “blessing in disguise” pointing towards something that needs attention or care in your life.

2. Pain is Brain-Generated

Recognize that pain is primarily created by your brain, not necessarily by structural damage in the body part where it’s felt. Emotions and stress activate the same pain centers as physical injury, meaning emotional pain can manifest as real physical pain.

3. Change Pain Narrative

Actively change your internal narrative about pain, believing it’s a reversible neural circuit problem. When moving or encountering triggers, tell yourself you are “okay” and “safe,” and intentionally smile to turn off the brain’s danger alarm mechanism.

4. Cultivate Self-Compassion

Acknowledge and feel compassion for yourself regarding past or present life stressors and emotional injuries that may be contributing to your pain. Recognizing the link between stress and physical symptoms can be a powerful step towards healing.

Do not feed the vicious cycle of chronic pain by fearing it, focusing on it, worrying about it, or becoming frustrated by it. These responses signal danger to the brain, which can intensify and prolong the pain.

6. Recognize Neural Circuit Pain

Distinguish neural circuit-based pain from structural pain by its inconsistent nature—it turns on and off, shifts, moves, is triggered by innocuous things, or goes away on vacation and returns at work. This helps confirm the brain’s role.

7. Graded Exposure with Joy

Use graded exposure techniques by gradually moving or even imagining yourself moving with joy, calm, and messages of safety. This retrains your brain that these movements are not dangerous, breaking the fear-pain cycle.

8. Move with Calm & Joy

Pair calming practices like deep breathing and reassurance with physical movement, such as yoga. Moving gently with calm, joy, or peacefulness trains your brain that these movements are not dangerous, reinforcing new neural circuits.

9. Journal for Emotional Processing

Utilize journaling as a tool for emotional awareness and expression therapy. This practice helps process unexpressed or unprocessed emotions and life events that may be contributing to physical pain.

10. Mindful Pain Observation

After understanding that pain is a neural circuit problem, use mindfulness to observe sensations without fighting or frustration. Step back, watch the pain, and notice how it shifts, which can help your brain “drop” the sensation.

11. Set Boundaries, Say No

Recognize and address acquired personality traits, such as people-pleasing or perfectionism, that may stem from past experiences and contribute to chronic stress. Learn to stand up for yourself and say “no” to alleviate self-imposed pressure.

12. Knowledge Reduces Pain

Simply gaining knowledge and understanding that your pain is brain-generated and not due to structural damage can, for some, be enough to turn off the danger signal and reduce symptoms.

13. Temporary Pain Medication Use

If suffering severely, use pain medications temporarily to alleviate symptoms while actively engaging in pain reprocessing and emotional work. The goal is to reduce pain through these methods first, making medication tapering easier later.

14. ACEs Impact Chronic Pain

Understand that early life trauma and adverse childhood experiences (ACEs) can significantly sensitize the brain, increasing the likelihood and severity of chronic pain later in life, influencing treatment outcomes.

15. Posture Not Primary Cause

While posture can cause temporary soreness, it is unlikely to be the sole cause of chronic pain. Fear, worry, and stress about posture, combined with life stressors, are more significant contributors to persistent pain.

16. Listen with Empathy (HCPs)

As a healthcare professional, the most important therapy you can offer patients with chronic pain is to listen intently and show genuine empathy. This validates their experience and builds trust, which is crucial for healing.

17. Avoid Misattributing Scan Findings (HCPs)

Do not tell patients that common abnormalities found on MRI scans (e.g., bulging discs in asymptomatic individuals) are the cause of their pain. This creates an erroneous belief system that can worsen fear and hinder recovery.

18. Personalize Pain Management (HCPs)

Tailor your approach to pain management based on the patient’s individual history, beliefs, and current medication use. Meet patients where they are, offering new information and paths to healing without forcing a specific approach.

19. Clarify Medication Role (HCPs)

When prescribing pain medication, clearly communicate that it is for managing symptoms temporarily, not for curing the underlying problem. Offer to help patients investigate and address the root causes of their pain.

20. Focus on Creating Health (HCPs)

Instead of solely focusing on “what’s wrong” with a patient, shift the approach to “creating health” through holistic means like addressing emotional well-being, sleep, stress, and movement.

21. Therapists Treat Chronic Pain

Therapists (psychotherapists, psychologists, social workers) should recognize their crucial role in caring for chronic pain patients, especially since many seeking help for anxiety or depression also have co-occurring chronic pain conditions.