If Your Chronic Pain Does This… It's NOT Coming From Your Body (How To Heal It) | Howard Schubiner

Key Takeaway

Pain isn't always caused by structural damage—your brain creates pain as a protective signal, and it can do this in response to stress, fear, or emotions just as powerfully as physical injury. This revolutionary understanding means chronic pain can often be 'unlearned' by addressing the brain's danger signals through awareness, emotional processing, and reframing your relationship with symptoms. Start today by noticing when your pain changes with stress or context—that awareness is the first step toward recovery.

Episode Overview

Dr. Howard Schubiner explains how most chronic pain is neuroplastic—generated by the brain in response to stress and emotions rather than structural damage. He debunks common myths about pain, discusses why MRI findings often don't correlate with symptoms, and presents a five-part treatment model emphasizing assessment, education, symptom reappraisal, emotional processing, and lifestyle changes to help people unlearn chronic pain.

Full Transcript

Transcript of If Your Chronic Pain Does This… It's NOT Coming From Your Body (How To Heal It) | Howard Schubiner from Feel Better, Live More. Auto-generated from episode audio; may contain minor errors.

What do you think are some of the most common myths that exist out there when it comes to the topic of pain? What I always tell people is you can't understand pain unless you understand the brain. And this is like what? Wait a minute. Cuz everyone understands pain. Everyone knows that your body's damaged when you have pain. So the first myth is that pain always is caused by some structural damage or injury to the body. And we know through the simple fact that you can have an injury and have no pain.

Have you ever experienced that where you had an injury and it didn't actually hurt? And this has been documented thousands of times. So we know that occurs. But if you can have an injury and have no pain, I mean I friend of mine shot a nail in his hand and had no pain. I mean come on. on. on. So the point is the brain determines whether there's pain or not. That is revolutionary and remarkable just that. And so and you can have pain in the absence of injury.

So when you put those two facts together, they're facts. You can have an injury and have no pain. You can have pain without an injury. Now you have to ask yourself the question, when you have pain, what is it? What's going on? And that opens the door to a whole new understanding of what pain is. Yeah. One of the key messages I get from your work and from your latest book, Unlearn Your Pain, is that pain is really a signal. Exactly. Exactly. Exactly. Okay. It's a signal that we need to understand and instead of just looking at the pain as oh I have pain how do I treat it treat it treat it it's also important to understand why am I currently in pain as you say a friend of yours shot a nail into their hand I think if you ask 100 people on the street will that cause you pain they'll say yeah of course it will with your friend for example why would you say it did not cause pain it's a question of what's most important if you're running across the field and you break an ankle, you want pain.

You need pain. Your brain is turning on pain. It's getting signals from your ankle. It's turning on pain to tell you, "Stop. Don't Don't run. Don't walk on a broken ankle. Get help. Get healed." But if you're running and someone's chasing you, you, you, maybe you wouldn't get pain because the fear, the danger of being being chased is greater than than the danger of the injury. And my friend who shot it, he was alone at a construction site. So, he wasn't going to get help if he just stands there in in complete pain.

So, his brain kind of, it sounds weird, I know, made a decision, go to the hospital. Yeah, this is such a key point, Howard, point, Howard, point, Howard, because what you're proposing is fundamentally at odds with how most of the public and most of the medical profession look at pain. Yeah. Yeah. Yeah. And why so many conventional treatments don't work. And in your book you say another myth is that people think that chronic pain is irreversible and incurable. Yes. Why is that a myth? Why that idea exists is because once pain becomes chronic it's defined as 3 months and certainly 6 months a year 5 years you're getting assessments to determine the cause of the pain.

And if you have a kidney stone that's going to be found easily. If you have appendicitis, it's going to be found easily. You know, if you have a ear infection. So the the the medical treatments and certainly, you know, disease, medical tissue damage, pathology can cause pain. We all know that. But once you've passed 3 months, 6 months, a year, now you haven't been able to be diagnosed with something that's easily reparable. So now it's chronic. And the treatments that we've had in medicine for chronic pain like this are managing it, coping with it rather than reversing it because they're viewed as the first myth.

It's that it's structural. So, we'll treat the structural damage, but you can't because you either can't find it or the treatments aren't effective. Yeah. Myth number three, physical findings are always indicative of tissue injury. Yeah. Yeah. Yeah. What does that mean? Well, if you've seen people with fibromyalgia, and all pain is real, okay? We're not saying that the pain is in people's heads, that it's fake, that it's their fault. No one with pain or the other conditions I talk about in the book should be shamed or blamed.

No one. And the point of the book is to have compassion for people who are suffering. Once we understand that that we need to have compassion and caring for people, then we need to look at them in their whole person. Look at their whole life. So we'll talk more about that in a minute. But fibromyalgia is a disorder of often severe pain, pain all over the body, horrible sometimes, often, you know, thought to be incurable by traditional medical reasoning. And but these folks with fibromyalgia often have tender spots.

So they're very tender in the body all over these different tender spots. And you push on them, it's tender. So there must be something wrong there because it's tender. But it turns out the brain can cause tenderness. And uh you're familiar with Laura Mosley, one of the Australian great pain scientists, and he did a study with people with chronic back pain. And he inserted tiny needles in the muscles to um see where there was muscle tension and where there was not muscle tension. So what he found is that there was places where there was pain and muscle tension.

So, oh the the brain can cause muscle tension and can cause pain. But there were places where there was no muscle tension and pain. So the brain can cause pain in the absence of muscle tension. And then there were places where there was muscle tension but no pain. So the muscle tension isn't necessarily indicative of pain. Pain is generated by a decision. It's so weird. A decision made in the brain. A subconscious decision. Yes. 100%. Yes. 100%. Yes. 100%. Why we're perhaps emphasizing this is because for many years patients have often felt that I've got really bad pain, whether that's in my neck or my back or my head or my foot, whatever it might be.

might be. might be. Yeah. Yeah. Yeah. And I go and see the doctor and the test they do, let's assume they come back as normal, right? So if they can't find a structural problem, sometimes patients are left feeling, I think the doctor thinks it's in my head. Yeah. Yeah. Yeah. Right. They feel they've not listened to. They feel disregarded. This is very very common as you well know Howard 100%. 100%. 100%. So that understanding that no wait a minute there are many factors that can lead to the brain wanting to create pain.

pain. pain. Absolutely. It's asking the question. It's just being open enough to ask the question. And people need to be seen and people need to be heard and people need to be validated as suffering. Their suffering is real. And but they also need to have this question asked and answered because maybe we're cutting off hope because so many people I've seen for 23 years now doing this work with pain and other conditions have been told you're incurable. You're going to suffer the rest of your life in pain.

And so one of the stories in the book is a guy named Gary. 25 years of severe pain. 25 years going to the top medical centers in the US getting X-rays and MRIs showing seemingly showing damage. We'll talk about that in a minute. Not all uh MRIs and X-rays show the cause of pain. But any he was told he was incurable. He had injections, medication, nothing worked. Had to quit his job, reduced to to being in a recliner, depressed and suicidal. 25 years. and he sees a physio who says, you know, you're not as damaged as you think you are.

The brain can cause pain. And he's like, you know, come on, give me a break. What do you mean 25 years my brain is causing this severe pain? Pain is horrible. He says, well, that can happen. So he's like, that idea, he gets the question asked. And then one day he's walking into a pharmacy to get a refill of medication and his pain is a five. And he walks into the pharmacy and he sees a long line. Well, he knows when he stands for a long time, his pain is bad.

But his pain jumps from a five to a nine just seeing the line and he's like, "What just happened? What just happened? That was my brain." And that was the moment where the question got answered for him and he started he couldn't walk he couldn't stand but he started walking because his physio said you're not damaging yourself you're not injuring yourself the diagnosis is this is neuroplastic pain not structural pain and he started walking he started giving himself messages of safety and in 6 weeks he's better 6 weeks after 25 years completely better completely better completely better completely and he goes is on vacation to Europe and he's walking 20,000 steps.

I mean, unbelievable. mean, unbelievable. mean, unbelievable. Yeah, it's incredible. I mean, your book is full of incredible case studies. And at the same time, you do acknowledge that and say, listen, not everyone's recovery is as rapid or as complete as this, right? Absol. Absolutely. Absol. Absolutely. Absol. Absolutely. But but many of the times it is. Yeah. And even if it takes longer, there is still hope there. You know, when you were relaying that story, and I do remember reading that story in the book, there was two key things in what you said for me.

One is that the physio beautifully reassured him. I said, "Hey, honestly, I've looked at everything that there's nothing wrong with your back, okay? There's nothing structurally wrong with your back. And did you know that the the brain can actually create pain?" which of course sounds like it's the first time Gary had heard that in 25 years of course. of course. of course. So that's of course really important. But the second thing you said which really stood out to me Howard is the patient. So Gary in this instance realized something that I think is the most important thing that any patient can ever realize when they're trying to make change, whether it's to do with chronic pain or anything else, is to start to really cultivate that self-awareness of how what they do, what they think, how their stress levels are, how that then impacts their symptoms.

Yeah, Yeah, Yeah, that awareness is golden because then you've opened the door for that individual to go, oh, where else in my life might perceptions and stress levels impact my symptoms? And this is real because neuroscience neuroscience neuroscience of predictive processing is now fact. predictive processing mean that our means that our brains generate our experience which sounds like a woo woo concept but in actuality our brains do generate what we see. You can see in your sleep when you're dreaming so you don't need your eyes to see.

Most of the fibers that go to the visual cortex come from within the brain. So all that all that messaging all that understanding of how the brain works is that our brain has to create what we experience. So when you touch a hot stove, it's not your finger causing pain. So understanding that and then understanding the other neuroscience fact is that stress and emotions activate the same parts of the brain as does a physical injury. This is revolutionary. Wow. Wow. Wow. And so we really can understand why this is happening.

It's not like oh it's just stress. stress. stress. It's actually neural circuits and the conditioned responses of how the brain works. Neurons that fire together wire together. Everyone knows that. And so when when Gary would stand up, it wasn't that his body was damaged. It was the standing was causing his brain to turn on pain because of a learned response. And that's the whole point of this work. If pain and we'll talk about anxiety, depression, fatigue. If those sensations can be learned, they can be unlearned.

And and that that hope and that agency that you talk about where people feel like they can do something uh makes all the difference in the world. Yeah. Another myth that you talk about in the book is this idea that an MRI scan will accurately diagnose the cause of chronic back pain for most people. Yes. Yes. Yes. Why is that a myth? It is so big. It is so widpread to know that MRIs can show the inside of the body, which is true. They can. It's revolutionary.

Amazing technology. I was a doctor before there were MRIs and we're like, "Oh my god, you can do the scan. You can see tumors, cysts, bleeds, everything." everything." everything." And you could see degenerative discs. But it turns out that discs degenerate over time just as hair gets gray over time. And grain of hair does not actually cause pain. So we know that normal healthy people starting in their 20s and 30s start to have disc degeneration as seen on an MRI. But people without pain have very high levels of disc degeneration.

So if you're if you're in your 50s you have a 60% chance of having disc degeneration. If you're in 60s you have an 80% chance of having disc degeneration with no pain. So if you and the same is true for bulging disc, spinal stenosis, spondyololisthesis, spondyololisthesis, spondyololisthesis, facet arthropathy or arthritis of the spine, all those increase with age in normal people. So if you have no pain and you get an MRI, you see those findings. If you have pain and you get an MRI, you see the same findings.

Why would you assume that that's the cause of the pain? That's making an assumption. assumption. assumption. And we've seen obviously and this kind of works seen people recover with those findings. When I was in my 30s and 40s, I had neck pain all the time. Uh why? Well, Howard, here's your MRI. You have bulging discs. You have three large bulging discs. You've got facet arthopathy. You're getting old. But then the pain would come and go. If it's structural, why would it come and go? Why would it turn on and off?

It turned out in retrospect that it was stress building up in my life of the pressure to be the best doctor and teacher and researcher and husband and father. Yeah. All those pressures were would just build up and but I didn't realize at the time. Now I have no neck pain but my MRI is still abnormal. So this is so important for people to understand. And in the book there's a chart which shows exactly what percentage of people who have no pain at all have these common MRI findings.

So that is the one of the biggest myths out there. If you have pain and you go and see a doctor, usually usually usually the doctor wants to see if there's a structural element to it, which they should, right? And so they'll, you know, let's say send you for a scan. Even if they don't, you as a patient may want your doctor to send you for something. for something. for something. Sure. Sure. Sure. The problem is when the MRI scan comes back, if it is anything but normal, then one of the most dangerous things I think happens.

I I I don't use the word dangerous to exaggerate. I think it really is dangerous because you get told, oh, that you've got degenerative discs. And we said this on the first podcast when you came on. That word degeneration is not something anybody wants to hear about their body. That in itself is fearinducing for many people. people. people. And then the assumption is made that oh of course now I know why I have the pain. The patient takes on the belief when they're in pain that oh my god at least I know what it is.

I have a degenerative spine. degenerative spine. degenerative spine. Right? So if we understand that the brain creates pain and that fear and danger are massive signals to the brain in order to create the pain, you know, sometimes getting an MRI is not like a neutral thing. It's positively problematic or or the reporting of that MRI could potentially be problematic. There's two studies on this done in the UK both on these exact things which are in the book. One of the studies showed that when you give people the normal reading, oh, the reading is, yes, you've had degenerative, you got bulging disc, you've got spinal stenosis.

Just read that over 6 weeks, people got worse. Just knowing that MRI, they got worse. They were more likely to have injections. They had more pain, more likely to have um more procedures. So, but if you just said, oh, here's your findings, but these findings are also seen in normal people of your age. people didn't get worse. So, the interpretation of the MRI made a huge difference. The other study that showed was that the unfettered use of MRIs, more and more MRIs were causing more and more danger in terms of more procedures, more surgeries, more surgeries, more surgeries, and more pain.

So, people are getting worse. That's one of the factors that causes chronification of pain. People do less and less, and they're more and more fearful. And the more and more fear leads to actually more and more pain. So you mentioned a couple of terms, right? You you've said structural pain a few times. You've also said neuroplastic pain. Okay. I just want to make sure everyone listening has got this absolutely clear before we go any further. Can you just briefly explain what is the difference between the two?

Yeah. Yeah. It's so important. I'm glad you glad you're bringing this up. So structural means there's tissue damage causing the pain. In uh gallbladder, you know, choleic studit is gallbladder infection. You have you have pain in your right upper quadrant. You can see the infection. You have a fractured arm. You can see the fracture. You know, structural tissue damage, injury, pathology. All doctors are good at diagnosing that. diagnosing that. diagnosing that. Would spraining an ankle, having it swollen, swollen, swollen, would that fit here or that's that's more acute pain, I guess.

Yeah. Well, it's still structural. Yeah, structural. structural. structural. Acute pain can also be neuroplastic. You know, on the way here, I was in the Uber getting here and all of a sudden I noticed my head was hurting. What was going on? I don't get headaches typically, but I'm going to see Rangan. I think I made a mistake of looking up how many followers you had. you had. you had. That scared me, you know, and all of a sudden I had this head pain. It was acute, but nothing had happened, you know.

I hadn't injured my head. I was sitting in the car. Yeah. But that was acute pain. That was neuroplastic. Neuroplastic pain means that the brain is turning on pain because of a danger signal. In this case, it was an emotional danger for me coming on this podcast. And uh this is extremely common. Everyone has had this happen in their lives and and neuroplastic pain is just as real as structural pain. When you mentioned um that all pain is created in the brain, the brain, the brain, are you saying that is the same for structural problems as well?

So let's say I sprain my ankle badly and it's hot and it's swollen. People will say or they would think that yeah because it's swollen and there's pressure on the joints. Sure. Sure. Sure. It's those inflammatory mediators that are causing the pain. But you're still saying it's the brain that ultimately is creating the pain, right? Yeah. Those signals are going through the nerves to the spinal cord to the brain. But those aren't pain signals. They're danger signals. The brain has to interpret those. 99 plus% of the time when you have an injury, yes, the brain will turn on pain because pain is a protector.

We need pain. We need pain when we're injured. So, it's a message. Um but it is still the brain and that's the revolution in understanding pain. Yeah. uh and the pain that occurs in the absence of injury like the headache I was having this morning or the neck pain that I had in my 30s uh was caused by the brain in the absence of injury. What's really interesting Howard is that you now through your work which has been decades in this field treating people studying it researching it publishing I think you published over 100 papers so you know you know you know there is proper rigorous scientific research behind the things that you're talking about here today and in your five-part model to treat pain which we're going to get to shortly number four is emotional processing therapies right Now to me it seems that you probably have something that many people don't have enough of these days which is that self-awareness right so in the taxi over to come to the studio today when maybe the pressure of coming on a big show start to give you a headache I would argue that a lot of people would not be aware of their emotions and their stress causing that.

It would be, I've got a headache, right? Oh, I need to start. start. start. Maybe I didn't drink enough. Maybe I didn't sleep well. Maybe uh, you know, it's the air, which could be all those things. These happen. happen. happen. Yeah. Cuz you could be dehydrated. And for some people, when they drink more water, actually the headache goes. So, it's not as if you're saying those things aren't true. But as soon as you became aware that, oh, this is maybe a bit of nerves or pressure, did that start to change the pain?

Absolutely. I could stop, take a moment and give myself the message that I was okay. Give my brain the message because if I on the other hand, you can spiral. You go either direction. You can spiral. I could have spiraled and go like, wait, how many viewers are? I don't know. I don't know what he's going to ask me. I'm not sure I can handle this. Uh, you know, know, know, and and the pain gets worse. Exactly. Exactly. Exactly. Like like with Gary going from a five to a nine.

a nine. a nine. Exactly. yours could start to go up if you start you start you start Yeah. It's almost like there's two paths you can take. One path is fear. Yes. Yes. Yes. And then that will just compound things and make things worse. The other path is pause, reflect, understand yourself and go, "Oh, actually, right." right." right." Yeah. It's, Yeah. It's, Yeah. It's, you know, I've done this before. Yeah. Yeah. Yeah. Or on the other hand, you the thought is like, "Oh my god, what if the pain is how can I do the podcast while I'm in pain?" And then that creates more pain.

Yeah. If there's a skeptic listening who is saying, "Come on, Howard. What? So you're in the car and what your thoughts about a podcast suddenly are giving you a headache." a headache." a headache." Mhm. Mhm. Mhm. What would you say to that sketch that these this is part of being human? It turns out we're human beings need to be connected to each other and need to feel safe. And the brain has this danger signal. And everyone has experienced these kinds of neuroplastic or sometimes we call it mindbody type symptoms.

And if you look at people's lives and you look at your own life, most people will see times when they had that. And the neuroscience is showing this is real. This is exactly what's going on. And we have fMRI studies of the brain showing that showing that showing that emotions and stress and emotions are intimately related to pain. When I was um three, I was almost three, I had a a sister come home from baby sister come home from the hospital and um I started to stutter.

to stutter. to stutter. I mean, what was going on? All of a sudden, you know, I just developed some stuttering problem. Well, I didn't I didn't want a baby sister. I was the king. I was the firstborn. I was the king of the household. And uh my my mother is so smart. She recognized that when I sang, I didn't stutter. And so instead of taking me to speech therapy and medicalizing this problem and making me more aware and more focused on the stutter and making me fearful of it and and feeling embarrassed about it, we just sang and it went away.

And so, you know, children, everybody has these reactions. You know, when a child is having a tummy ache before going to school, uh, you know, it's not there's nothing chances are there's nothing wrong with them. Chances are there's something in their life that they just feel unsafe about. And that's this understanding and compassion that we can have for people uh in these situations. Yeah. I would say the medical profession has a really good awareness in children that stress can cause pain. Yeah. Because you know, you know, even when I was at medical school, I think when you learn about chronic abdominal pain in children, stress and emotions are a huge part of that.

that. that. Of course, it doesn't mean you don't look for a physical cause or what you might call a structural cause, right? But a lot of the time it is emotional, right? not wanting to go to school, stress about something, you know, a repressed emotion, repressed emotion, repressed emotion, parents arguing or feeling, you know, un not feeling smart enough or being bullied or whatever. Yeah. So, so that awareness is there within the profession already. Another way we can look at this if we don't believe that our thoughts can start affecting our physiology is you know many people know the feeling of feeling nervous or before an exam they might feel the need to urinate or use a bathroom right well that it's a similar thing right it's stress in the mind oh my god I'm not prepared enough what might happen or I've got to give a public presentation you know will I do it will I make a fool of myself and people feel the need to go to the toilet Exactly.

And it's subconscious. It's not you're think not necessarily thinking that. It just happens. So I was giving a lecture a few years ago getting ready to give a lecture. I was standing on the podium watching all the people in the audience and I felt cool and I felt fine and collected. I've given lots of lectures. I love lecturing. And I looked down at my hand and my hand was shaking. Mhm. I didn't even realize my hand was shaking, but my subconscious brain was worried at some level about this because it's human to feel worried about being criticized, worried about being rejected, worried about not being accepted.

These are very deep deep uh parts of of our souls, of who we are. Uh and we think, you know, we we have this idea that why would the brain cause pain when there's stress or worry? It it doesn't make sense. You could see, well, it would cause an anxiety or fear. That kind of makes more sense. But we think that Homo sapiens were on the earth at the same time as Neanderthal a long long time ago, right? Neanderthal were bigger, smarter, faster, had bigger brains even.

But they died out. Homo sapiens lived because they worked in clans. They worked together, fought together, defended themselves, you know, raised children, got food. Getting kicked out of the clan is like a death sentence. sentence. sentence. And we all can recognize that being ostracized ostracized ostracized is very, very painful. And emotional pain can cause physical pain. The brain has learned over time to cause physical pain as an alarm signal. It's like a smoke alarm. smoke alarm. smoke alarm. It's just so powerful when you think about it.

And in many ways, it's quite obvious when you think about it, right? But the prevailing norm is so far away from that. It's almost, you know, the book title is unlearn your pain. I I would go further than that. It's unlearn many myths about your body because you don't just stick to pain. Actually, if we have time later, we'll come to this, but you you sort of expand this out to out to out to anxiety, anxiety, anxiety, depression, depression, depression, osteoarthritis, osteoarthritis, osteoarthritis, symptoms like tinitus, right?

Many many other symptoms. There's a there's a whole page of uh there's I think three pages where you list symptoms that could be neuroplastic or have a neuroplastic component. component. component. Yes. And I was thinking as I was reading that these are literally the bulk of the conditions that cause the bulk of the problems in modern medicine, particularly general practice and the conditions that we don't generally have really good treatments for. They're the patients who would come in and in and in and you didn't quite know what was going on.

So you'd end up giving a prescription and say if it's not better in 4 weeks, come back. And again, I'm not criticizing anyone doing that. It's it's an attempt to try and help. But it's very clear that there just isn't a clear understanding of of of neuroplastic conditions. neuroplastic conditions. neuroplastic conditions. Yeah. Exactly. And it's not common sense. It's obvious. Once you once you see this, see this, see this, you can't say it. You can't. And most of the people who do this work have had their own life experiences.

so they could see it in themselves or their family members. Yeah. I want to go into this treatment paradigm that you lay out, this five-part model to treat neuroplastic pain. And you're saying the bulk of pain that people struggle with is neuroplastic, you know, maybe even 90%, maybe more, maybe a bit less. It's in that category, but a lot, right? And there's five components to this. assessment, education, reappraising symptoms, emotional processing therapies, and finally number five, making changes in one's life. I wonder if we could just go through them all sequentially because I think a lot of things will come out as we go through that model.

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See all details at drinkag1.com/live more. more. I mean the first step is as you said it's what doctors need to do. Rule out a structural problem. look for some disease. You know, the last thing any doctor wants to do, last thing I ever want to do is miss a structural condition, miss somebody who has a cancer, who has an infection, who has a a fracture, who has an autoimmune disease, etc. So, that's step one. But is it also worth looking at it the other way, which is if we're trying to rule out something serious, serious, serious, that mentality that mentality that mentality often will lead to a scan.

Yes, of course. Many scans. Many scans, right? But we're also saying that scans in and of themselves can be problematic in many cases. Right. Right. Right. So, if you're not getting any of those red flag symptoms, do you think it's reasonable for a doctor to not go down the route of scanning? At least say, "Look, there's nothing in your history that indicates that. Why don't we try some other things first?" And it's not only trying other things first, but it's a second level of assessment. assessment.

assessment. Okay? Okay? Okay? So, the second level of assessment is first level is ruling out a structural problem. Second level is ruling in a neuroplastic condition. neuroplastic condition. neuroplastic condition. Okay. Okay. Okay. So, how do we do that? Well, that's what I was saying a bit earlier about how if the pain is in the right side, right shoulder, and then it's in the left. Why is that? If it goes away when you're on vacation, then comes back when you come back to work. If it rises up when you go to visit your relatives who you have trouble with.

If it goes away when you're on a boat, there's all these and or it's triggered by the wind or the weather or heat or cold or stress. So all these clues like with Gary walking into the pharmacy that was his click moment. But we have all these things and doctors it's very easy to actually do this kind of assessment to rule in a neuroplastic and then once you see it then you say well gee we probably don't need the scan in that case in this case.

One of the examples you gave there I think it was either back pain or neck pain. Oh it's not there when I'm on vacation but it is there when I'm at work. Yeah. Yeah. Yeah. Of course some people would say that could be to do with sitting posture right? They might they might think, might think, might think, "Oh, on holiday, you know, I'm I'm out walking every day. I'm not sat in front of a laptop. I'm in the pool." Yes. Yes. Yes. Oh, but so so they may not think neuroplastic.

They may think this is a postural thing to do with my um work environments. environments. environments. And I know you do tackle this in the book, right? So that's a possibility. Or would you look at it slightly differently? just look be ask the question, you know, look carefully and take your time and don't jump to conclusions. conclusions. conclusions. Uh and so in the book there's several stories that talk about how over time people kind of figure it out. You begin to see what's going on. One of the amazing things that we've learned to do is if someone says, "Well, I'm worried.

Uh I really think it's probably the computer screen." you know, just looking at it that visual and uh so I you could have someone uh just sit close your eyes imagine you're looking at the computer screen. Sometimes that will cause pain and they go I just I didn't it wasn't the computer screen it was my brain. We we do this all the time and it's another clue. So you're just taking your time. You're doing detailed histories and assessments and looking carefully. Once you ask the question, usually the answer is pretty obvious over time.

over time. over time. Is this where the fit criteria comes in? FIT. FIT. FIT. Exactly. Exactly. Exactly. Yeah. And and can you just quickly go through what what are the fit criteria? Yeah. Functional, inconsistent, and triggered by innocuous stimuli. So this is those three things that help us determine us determine us determine Yes. Yes. Yes. could this pain be neuroplastic? Exactly. Exactly. Uh so functional means that it's in a broad area. Uh it didn't occur with a physical precipitation. Uh it has characteristics that don't fit a structural problem because it's in the whole leg or whole arm.

Um and then inconsistent means it's turning on and off or moving around or shifting. Yeah. And triggered means it's triggered by innocuous stimula like imagining the the situation or um heat, cold, light, sound, etc. sound, etc. sound, etc. Okay. So that's a useful pneummonic to help any clinician or or frankly a sufferer to start figuring out could my pain be neuroplastic? Yeah. Yeah. Yeah. Okay. So So step one is assessment, right? right? right? Step two is education. Yes. Yes. Yes. What's education all about? It's explaining how the brain works.

explaining predictive processing that our brain literally creates what we see, what we hear, and what we feel. So, it's it's validating people to understand again that their pain or other symptoms are real. They're not imaginary. They're not fake. They shouldn't be shamed or blamed at all. And because the brain can produce this level, even very severe symptoms that last a long time, it it can be because the brain gets stuck in a loop, a conditioned loop, a a horrible habit of continuing to turn on pain, you know, every every morning, every evening, you know, all the time.

And so it's really understanding that neuroplasticity means the brain can organize itself and change. So it gives it gives validation. It gives compassion because we're we're linking the stressful situations in their life to the onset of these conditions. So we're understanding them as a whole person. We're seeing them as a whole person, not just seeing their disease. Not just validating their disease, but validating them as a whole person and then offering hope because of because neuroplastic implies neuroplasticity which implies change reversal. You know, Howard, for many years, I've been coming to the conclusion that conclusion that conclusion that the most important thing in our bodies when it comes to health and well-being is the state of our nervous systems.

Mhm. Mhm. Mhm. We literally see the world through the state of our nervous system. You know, the nervous system that's wound up and tight, you're going to see threat and stress everywhere. A nicely relaxed, uncoiled nervous system. You're more compassionate, joyful. You will see the other side of the argument when someone says something and not react, right? And as I was reading Unlearn Your Pain over the last few days, it really reinforced that belief for me that that that the state of your nervous system is everything.

When your nervous system feels as though it's under threat in any way, even mild threats, there are all kinds of symptoms that you will experience that could well be related to that. Mhm. And too often in medicine we look at the symptom and try and treat the symptom. The question for me over the last few days was if someone had a truly calm, relaxed nervous system, which of course is very rare now in the modern world because of the way in which we live. I imagine I imagine I imagine many many seemingly unrelated symptoms would just go.

Yeah. Yeah. Yeah. Because they're there for a reason. Yes. because we're really understanding the whole person and understanding the causes of these things, you know, in in in reality, seeing seeing the truth of what's going on. And so it's on one hand, the symptoms themselves create more and more fear. the symptoms themselves create more and more upsetness and dis you know disease so to speak which makes things worse in and of themselves but at the same time when we look at people's lives to really understand the connection between their lives between what's going on in their relationships what's going on in their work what happened in their childhood in terms of uh traumatizing types of experiences that that have sensitized is the brain to be more sensitive, sensitized this subconscious danger signal to be more likely to react later in life.

And we know, you know, we know for certain that traumatic experiences in childhood, and they don't always have to be the biggest ones, but the hurts of not feeling seen or not feeling heard or being criticized, etc. um have impact or can have impact later in life when other stresses occur. Yeah. I always remember my very first conversation with Gabel Mate I think back in 2018 and Gabell said something to me about childhood trauma. He said it's not only when bad things happen to you, it's also when not enough good things happen.

Yes. And what he's really great about is saying it's not only that the bad thing has happened, but then you weren't attended to, you weren't cared for. And so, you know, many of the stories in my book have to do with that where people and especially women who have who have higher levels of emotional abuse, higher levels of sexual abuse, higher levels of online bullying, higher levels of uh interpersonal interpersonal violence, uh harassment in the workplace, and and higher rates of neuroplastic conditions. conditions. conditions. Exactly.

Exactly. Exactly. Yeah. And again, just to stay on the Gabel matter theme, Gabbor in his last book talks about women as being society's society's society's stress absorbers. stress absorbers. stress absorbers. Yeah. Yeah. Yeah. Right. And they're conditioned to be there for everybody, to be people pleasing, to take care of others first, to make they're the ones who are taking care of the children, they're the ones who are taking care of their parents. Uh they may be in a in a stable relationship, but they're still doing most of the work.

Um, and these are real. You know, this isn't blaming women. You know, this isn't saying that women are weak or that they're deficient in some way. It's just the facts that, you know, I'm not like, you know, I'm not the spokesperson for women, you know, but the facts show that they have higher rates of these of neuroplastic conditions and higher rates of uh, you know, traumatic experiences in their lives. One of the most eyeopening sections in the book for me is when you list out conditions that you say are likely to be neuroplastic.

Okay. Not 100%. You're saying likely. saying likely. saying likely. Everyone needs an evaluation. But I think it's worth reading this list out because I cannot imagine that there are many people listening to this podcast who haven't experienced at least some of these at some point in their life. Okay. Migraine headaches, tension headaches, trigeminal neuralgia, occipital neuralgia. I mean, I I can't go through them all, right? Ben benign positional vertigo, restless leg syndrome, brain fog, memory difficulties, difficulties, difficulties, reo phenomenon, non-cardiac chest pain, pots, postural orthostatic tachicardia syndrome, something that affects loads of people and they struggle to get good treatment for it.

Yeah. tinitus, chronic cuff, chronic back pain, chronic neck pain, sciatic pain, whiplash, pain, whiplash, pain, whiplash, fibromyalgia, purapiforis syndrome, chronic tendinitis, chronic tendinitis, chronic tendinitis, plantto fasciitis. I mean, I could keep going on. going on. going on. Yeah. Yeah. Yeah. The point is is that it's kind of what I was saying to you before about the nervous system. If the nervous system feels feels feels under threat, in danger, the body can express that in a variety of different ways. And some people that's expressed as pain and other people it's expressed as something else.

Yeah. It's an alarm system. And you know, we we realize that smoke alarms are there for a reason and they have to be loud to get our attention. And the symptoms that the danger alarm mechanism in the brain produces are vast and varied. And some people have many of them all in the same person which is so hard to see. But it makes it more obvious that it is neuroplastic when people have so many of these. That's a really key point, Howard. Right. So, a lot of people I found over my career who have situations and conditions like these and are struggling to get help, they often end up picking up lots of labels and lots of diagnosis.

And I always used to have this principle which was if ever I see someone with four, five, six different or seemingly different things, just at the back of my head, I was thinking, are you sure these are all separate or do they all is is there something at the root that's causing all of them? And again, that is not really how we're trained as doctors because we're trained to look at things differently that oh, you know, that's a skin condition, that's a heart condition, that's a lung condition, which again has value.

some of the time. Sure. Sure. Sure. But you see this all the time when people have got 10 diagnosis. I'm like, has this person been really unlucky and they've got 10 different things going on with them or are we missing the root cause? And is there's a story? We all have our stories that that we tell ourselves and their stories define us. And so if the story is I had difficult time in my childhood, there was a lot of stress stress stress and on top of this I was unlucky in that sense.

And then on top of that, I've had other stresses in my life. And on top of that, I got all these different diseases that are all separate. That's really unlucky. And on top of that, I went to the doctors to try to help me. And they really couldn't figure it out. And they tried lots of different things. Nothing works. I'm broken. It's a different story than to say, hm, I did have these stresses in my childhood. I did have these other stresses in my life, but it turns out those stresses actually were the cause of these neuroplastic conditions that are real and I've been suffering.

And the doctors couldn't help me because they didn't understand it. They didn't understand neuroplastic conditions. But the hero of the story is me me me that I can have agency. I can take these things and look at them in a different way and look at my life and put it together so that it makes sense and heal emotional hurts and and change my view of myself as not being broken and crippled and damaged but able to move forward. That is an amazing process for people to go through.

We've done number one, which is assessment. Number two, education. And then we move to step three in the five-part model, which is reappraising symptoms. symptoms. symptoms. And when you describe this in your book, you say something really important. Step three is a pivotal change. We're no longer discussing and identifying the problem, but we're now moving on to working on the solution. Because you make the case in the book that we're not just trying to manage pain, right? Which a lot of treatments are trying to do.

We're just trying to manage your pain. No, no. It's like, well, we want to reduce the pain and if we can eliminate it. Exactly. Which is very different. And we have high quality research showing that that can be done and that it's more effective than the standard models. Uh, and that people's pain can actually if it's neuroplastic can actually be reversed. And so pain reprocessing therapy, reappraising pain is is understanding that the pain or the fatigue, anxiety, depression, whatever symptoms, tenidis, etc. is not actually damaged or you're not damaged or broken.

It's not actually dangerous. And it's calming and soothing yourself and your brain and as you said your nervous system to reduce the threat. And as the threat is reduced, the brain will often turn off or start turning down the symptoms or it'll go up. They'll go up and down. And then you'll see, "Oh my god, it just went up. I'm watching these symptoms. I'm curious about them." And I see all of a sudden they went up. Now they went down. Now they move. Just like, "Oh my god, this is it.

I got it. Now I can expand and do more as I calm and soothe my brain's danger signal." That is a model uh for reversing neuroplastic conditions. conditions. conditions. Is this stage really about self-awareness and reframing things? Yes, absolutely. Yes, absolutely. Yes, absolutely. Yeah, Yeah, Yeah, absolutely. absolutely. absolutely. Uh it's it's kind of like the Bible says you shall know the truth and the truth shall set you free. And it's really knowing this as truth, really feeling it and understanding it. Because what I tell people is like if when your brain gives you a pain or a fatigue or an anxiety sensation, it's also asking you a question.

Are you okay? okay? okay? It's a protector. It's concerned about you. It's fearful. It's worried for you. It's reacting to some potential threat or harm, either emotional threat or harm or obvious potential physical harm. It's asking you the question, are you okay? And most people in chronic symptoms are saying, no, I'm not okay. I've got all these things wrong. I can't do this. I can't do that. My life is a shambles. I'm not okay. And this is changing that paradigm to say I actually am okay.

Which is sometimes hard to do, right? It's hard to make that take that step. Yeah. The symptom is not there just as an annoyance to suppress. It's a signal that we need to understand. understand. understand. Exactly. Exactly. Exactly. Right. So that's the key difference. Exactly. Exactly. Exactly. On page 262 of Unlearn Your Pain was just a beautiful paragraph that you wrote when you're referring to this stage three process of reappraising symptoms. You say, "Here is a description of step three of our treatment, pain reprocessing therapy, which can be thought of as a form of symptom reappraisal recovery therapy." And then you write this, "Your brain is not your enemy.

It is your protector. If your work is a torrent of incessant deadlines and toxic relationships, wouldn't your brain want to create back pain, anxiety, or fatigue, so you have to stay home? If you have a close family member who is making unreasonable demands or threatening you, wouldn't your brain generate headaches, depression, or insomnia, so you'll have to avoid them? If you were constantly berating yourself, pushing yourself to do more than is possible, or feeling guilty or ashamed, wouldn't your brain turn on tinitus, dizziness, or burning sensations to alert you to a problem?

Of course, it would. would. would. That's that makes me like tear up you know because this is the situation of so many people many people many people in their lives and this is the human part of the human condition and thinking about it this way completely different understanding right compassion for people in these situations compassion for ourselves in these situations and understanding understanding understanding that there's a reason for it and if there's a reason and then There's hope. This work is so satisfying. I mean, it's it's incredible to see people change their lives and understand themselves in new ways.

I'm going to bet, Howard, that at least 50% of people who were listening to this podcast when I just read out that paragraph saw themselves somewhere in those lines. And it was probably more like 80 90%. Right. as you say right in the conclusion actually of your book which I found really really remarkable I wasn't expecting this right page 347 right at the end you write most people will develop some form of neuroplastic condition at some point in their lives it is simply a byproduct of being human yes yes yes beautiful yeah I mean it's it's a fact and making that common sense making that common knowledge common knowledge common knowledge is what we're talking about.

That's how you know the last chapter is called transforming medicine one person at a time. Yeah. Because it's just this knowledge that's knowledge that's knowledge that's coming forward by people who who are suffering by the people who need it. Because one of the beauties of the internet is you can search endlessly and eventually and you can find a lot of misinformation. You can find a lot of all sorts of stuff. But you can also find this work online and you can find the stories of other people who have what you have who've recovered.

And when you kind of get to that and you start to look, one of the stories in the book is about a woman, British woman, a young woman who had horrible pain on and on and on. Then horrible fatigue on and on and on. And she was told by the doctors and by the support groups, you will never recover. You will never get better. You will never be able to walk or move or dance or run or travel. You'll never be able to go to school.

This is your fate. and she got a um ad popup ad for an app called Curable. Curable is one of the apps that promotes this work and has a program online program. And she kept getting ads for it. And she got angrier and angrier at them for giving false hope for giving false hope to people because she knew she could never recover. And so she joined the program to prove that it wouldn't work for her. But as she read it, as she read about it, and she learned this material that we're talking about here today, it started to make sense to her.

She saw herself in these stories. She saw herself in this paradigm. And it turned out she had had trauma in her life, all sorts of stuff that she hadn't ever processed or dealt with or understood that this could be related to her pain and her fatigue. And she started getting better. and now she's fine. she's fine. she's fine. Um, you know, but the paradigm shift was just vast. Vast. Tell me about your sister who had an episode of neck pain back in 2016. Oh, yeah. I mean, this this is part of being human, you know.

It it it occurred in the in the time when my mom died. Our mom died. She was very close to our mom and she started getting neck pain. And so maybe not surprising, you know, why wouldn't that happen? Yeah. Yeah. Yeah. You know, why wouldn't it? Uh, and so she goes to the doctor and then she goes to the chiropractor and everyone's looking at it structurally, but you know, it's easy to look at the MRI and see that these are the normal findings that she had and then examine her and make sure that there's no neurologic damage and then talk about her life and then just help her to say give her her her brain a clear message.

Our brains need certainty about what's happening in our lives. When you walk down the street, your brain is constantly there to protect you. And so every person we see, it's friend or foe. Friend or foe. That's how our brain works. And so giving herself the messages of my neck is damaged and broken is going to lead down one path, but the other path she started literally telling herself, I'm safe, I'm healthy, I'm strong, there's actually nothing wrong with my neck, and I'm going to keep moving it.

and telling myself I'm fine and I'm going to move toward joy and I'm going to yes I'm going to mourn our mom but it's okay it's okay it's okay I'll be okay and you know a few weeks she's fine she's fine she's fine because she understood it in a completely different way you talk about her story in quite a lot of detail in the book and as part of her recovery you gave her a set of affirmations and you acknowledged her that I know affirmations can sound ridiculous but they have been shown in functional MRI studies of the brain to change the brain by reducing threats.

Again, Again, Again, these are concepts which a lot of people are going to be skeptical about. Well, Howard, I've got pain. I'm going to tell myself, you know, um know, um know, um I know it sounds crazy. I'm happy. I'm calm. I'm the thing is I know this stuff works, right? But I'm trying to address the skeptic who's going, come on, man. you know to that skeptic again but because I think this work is lifechanging and because millions around the world are suffering I want to make sure that we bring people on board on board on board who might be going wait a minute how does an affirmation help you with your pain pain pain what would you say to them it gives the brain certainty it directly affects the cause of the pain because when the pain is neuroplastic the cause is danger and threat and by giving our and we're always giving oursel messages We're always giving ourselves messages.

The me some a lot of times people's messages they give to themselves are I'm damaged. I'm broken. I'll never get better. Why is this happening? Why is this happening to me? Uh you know I'm a loser. Uh all these messages we give to ourselves. ourselves. ourselves. And when you purposely change the messages, you're giving your brain certainty. You're putting it into a mode of safety. And neurons that fire together wire together. So Gary when he started walking started walking started walking he was it was painful but he started walking telling himself I'm okay I'll be fine there's nothing wrong he was changing the neurosircuits in his brain and if you have a neuroplastic condition all you need to do is change the neuroscircuits in your brain to recover.

Yeah. Yeah. Yeah. Let's go on to step four just to make sure everyone's keeping up. Number one assessment number two education. Number three reappraising symptoms. And there are many techniques within reappraising symptoms that we didn't get to, but they're all there in the book. Step four, emotional processing therapies. therapies. therapies. I loved this section. This is so interesting to me. How our emotions can affect our health. How anger, guilt, shame can potentially cause pain, right? It's incredible. It's incredible. It's incredible. So, you know, let's go through it.

What what's the deal with uh stage 4 emotional processing therapies? Yeah, like you said, Rangan, it's recognizing that emotions are important. They're real. They have major effect on us. And if you're living with guilt, you're living with shame. You're you're you're living with this toxicity of beating yourself up. Most of people with living with shame and guilt is undeserved. They haven't really done anything wrong. anything wrong. anything wrong. And it's very clear and fMRI studies show that emotions are related to pain signals or depression signals or fatigue signals etc.

signals etc. signals etc. Uh if you're living with anger, upset, carrying the grudges that that we do, how's that how's that helping us? you know, it's creating this toxicity in our lives and it's creating the neurosircuits that can fuel these sensations and neuroplastic symptoms. So, So, So, uh, and as I said, uh, traumatic experiences early in life and later in life activate the danger signal and make the danger signal more sensitized as people go through life. So, one of the um first people I saw was a woman who had headaches for 17 years.

And that's a long time. She'd been to three top headache referral centers, injections, medication, everything they tried, nothing worked. And when she asked, "What's the cause of my headache?" They would go, "I don't know." You know, we don't know. But what could I do? Well, I can listen to her and I can talk to her. And her life was pretty straightforward. She didn't have horrible traumatizing experiences in child except that her father was unpredictable. He came home some days from work, he was fine, happy and good.

Other days he was mean and ugly and angry and upset and he would grab her and yell at her and scream at her. her. her. So fearful, but she was fine. She would describe her childhood as being fine. And so when she got the headaches when she was in her 30s, uh, I asked, "What was going on in your life then?" Well, let's see. I had a new boss. Well, what was he like? Unpredictable. Unpredictable. Unpredictable. He was unpredictable, just like her father. He would be fine and happy and good.

And then sometimes he would go into rages and yell at people, demean them, debase them. It was scary. And her brain, like we were saying earlier, her brain was like, "Well, wait a minute. This is not good. and the headaches started and now she understood them in a completely different light and she could change her appraisal of them as we just spoke about. But she could also change her emotions about them and she could allow herself to to feel the emotions of the fear of the anger that she had toward her father toward her boss boss.

And the the method we've used called emotional awareness and expression therapy is to help people express their feelings in safe and healthy ways so that they can resolve them and then they're not hanging on to underlying grudges and anger. They're not hanging on to underlying shame and guilt. And it turns out you can you can purposely change your emotions, change how safe you feel in your life in relation not only to current events that are scary or feeling trapped or hurt or betrayed, but also past events.

So it's actually a treatment for trauma. I'm just wondering how it how people actually do this. So there may be people listening who have realized throughout this last section that yeah you know I'm carrying a bit of resentment or anger or shame or whatever it might be Howard's saying I need to feel it but you know what are people meant to do with that? I mean are they meant to shout, cry, hit the wall, journal, you know or or can all of these things work potentially depending on the individual?

Yeah. Yeah. There's a lot of ways to do emotional processing. There's a lot of different therapies involved or that people have developed over the years. Journaling is certainly one of them and a lot of people have found that to be very useful. Um I uh I lost my job uh four years ago. I was a senior doctor at my hospital for 20 years. But the hospital had budget crisis and they let me go. What doctor loses their job? I mean, it seems like inconceivable. It's the last thing I ever thought would have happened to me.

And my back started to hurt. And I I told people, well, the hospital let me go. That's kind of funny, right? And everyone said, "Oh, I lose jobs. Everyone loses jobs. It's no big deal." So, my back is hurting and it's I'm kind of hobbling around and I do pain reappraisal. I do assessment. I'm not damaged. Nothing happened to me. I had no injury. I do pain reappraisal. I'm telling myself, I'm safe. I'm okay. Keep moving. Everything's fine. Didn't work. I'm in my car 3 weeks later and I realize it's not funny.

I have feelings about this that I haven't expressed that I haven't even recognized these feelings cuz I was just holding them down. And the first feeling was anger. So if you have anger, you can keep it in which is toxic to yourself. You can let it out in the real world which is damaging. Violence is not a helpful solution. Yelling at people in real life. Yelling at the people you care about is not going to be um beneficial to anybody. anybody. anybody. So but I could let the anger out in a safe and healthy way.

I just started screaming. screaming. screaming. I just started screaming and yelling. I was swearing in my car. I was in my car. Okay. Yeah. I was alone. No one could hear me. hear me. hear me. And I just started screaming and yelling all this stuff and swearing and cursing. And then I imagine this is so silly and so crazy and funny. But I imagine blowing up the hospital with TNT like in a cartoon. a cartoon. a cartoon. Mhm. Mhm. Mhm. And then I could relax. And then I could I just let that anger all out and I could just release it and not hold on to it.

and it was safe and healthy and only takes relatively short time. Then I went to the other main feeling which was hurt and sadness. They kicked me aside. They let me go. My god. And all the hurts and sadnesses from my life started coming up. And what do you do when you're hurt or where you're sad for somebody? You care about them. You hug them. You give them compassion. So I started turning that hurt into compassion for myself. a friend of mine called me who was compassionate toward me right at that time and so I could alleviate some of the hurt and then I realized you know what the hospital they put up with me for 20 years I never made any money for them I wasn't a high producer I wasn't making doing injections or anything and I forgave them and I thanked them and I had gratitude for the 20 years I was there and as I forgave them as I processed the anger and the hurt and the forgiveness and the pain just disappeared on the spot.

It's amazing how powerful that can be. Thank you for sharing that story, Howard. Um, Howard. Um, Howard. Um, it's it is incredible to hear that there were so many things that happened there. But there. But there. But your ability or willingness to to to not pretend that you weren't feeling anger and hurt, right? Cuz that's what we do, don't we? We're very good at kidding ourselves. All of us, myself included. You know, you you we can pretend things of, "Oh, yeah, that didn't bother me." You know, everything's fine.

Do you know what I mean? It's And it's uncomfortable. It's uncomfortable to feel our feelings. We want to kind of push them down or push them away. Yeah. But for you to even acknowledge it in your car, shout and even in this cartoon sort of way, imagine the hospital being blown up, right? You would never say that to anyone, right? You would never, A, you would never do it. B, you would never actually probably say that to anyone cuz it's like, well, what will they think of me?

But this is real radical honesty to yourself about what you were actually feeling. So you expressed it, you processed it. It sounds as though what you're saying by processing the anger first, you then were able to experience the hurt that sat underneath the anger. Yeah. Yeah. Yeah. You acknowledge that yeah, I am feeling hurt. I was there for over two decades. You know, you might have been pissed off, frustrated that, hey, you know, but whatever it was, you were honest, expressed it, released it. Yeah. Then you moved on to forgiveness, right?

And you use gratitude to help you do that, which I think is very very powerful. But the key point which fits with the entire conversation is that that was your story. That was your story for this instance of back pain. May not be someone else's, right? Each of us will have our own story about our life. We create our own narratives around these situations that happen, right? So someone else may have lost their job after 20 years and had a different narrative in their head, different emotions, right?

So it's not as if we can say, "Oh, that's the formula to deal with um losing your job in your 60s." No, that was unique to you because we're all unique individuals. We all have our own way of dealing with things. But the key point I'm taking from that is you have to be honest with yourself. You have to start expressing how you're actually feeling and processing it. And if you don't, if you stuff those emotions down, they will express themselves in some way or other in some part of your life.

It's it's hard to imagine how powerful this could be. One of the stories in the book is about a woman who had severe back pain, lower back, and she even had surgery and it didn't help. and she was in a meditative process. And she had this memory of being, and this is horrible to say, but sexually assaulted when she was young, with her back up against a pingpong table where the pain was. And as part of that memory is creating a tremendous amount of hurt and fear and feeling trapped.

feeling trapped. feeling trapped. But what she did as part of that memory was to start to change it, to take agency in her mind, in her imagination to throw this person off, to stop them, to kick them or step on them, to call the police, to get them arrested, to get that young her younger self to safety and giving compassion and caring to her younger self. All in this imagination to change the traumatic memory. And it turns out memories are always changing and we can change memories.

And when she did that whole process, which didn't take that long, the pain went away. And it seems like, again, you're thinking of the skeptic like, how could that possibly, you know, be the cause? How could that possibly make such a difference? But it does. does. does. It does. And if you look at it through a different lens, different lens, different lens, I think most of us understand if you've had a busy week at work and you've not taken lunch breaks, you've been working through, you've been staying late at the office, people recognize on a Friday evening, they may have a bit of a headache.

headache. headache. Yeah. Yeah. Yeah. Right. Or they may feel tense and be reactive with their family. they kind of get that that oh the stress has given me a symptom or changed how I behave. So what you're asking people to do is not really much more of a leap from there. It's not just that stress gives you a bit of a headache. If your brain feels under threat, it can actually generate pain as a protective mechanism. protective mechanism. protective mechanism. Yeah. And you multiply this this danger signal in people who are pushing themselves or being hard on themselves or not feeling good enough, people pleasing, perfectionistic, all the pressure they put on themselves to succeed.

And that can multiply and at some point the brain takes over and says time out, you know, time out. And so sometimes it's people who are very successful, you know, that we see this in who don't recognize that there may be some changes in their life, which is the fifth step, making changes in your life that your brain is alerting you to. It's a message or a guide. It's saying, "Wait a minute. You're you are doing way too much." Yeah. One of the stories in the book is about a woman who was always people pleasing, always doing what everybody said and never said no.

And she was in an interaction with somebody. Somebody asked her to do something she didn't want to do. She said yes. And she's her stomach started to hurt. And then on reflection, she's like, "Wait a minute. What's going on here? Oh, my brain is giving me a message. It's a signal. I wasn't true to myself." So she went back and she had a difficult conversation and she was honest and authentic saying that I can't do that. It's it's it's not good for me. It's not something I can do.

I'm sorry. And her symptoms, you know, the stomach pain went away. But she honored herself. Yeah. Yeah. Yeah. And that was a change for her. Uh that was so powerful because now it's making her her her a better person. It's making her a better version of herself. If you don't say no, the body will say no for you. And there's multiple ways in which it can do that. Exactly. Exactly. Exactly. You're moving on now, as you've mentioned, to the final stage, stage five of this fivepot model to treat uh neuroplastic pain, making changes in one's life, addressing personality traits and life circumstances.

And you just hinted with that example there of someone who's doing that. doing that. doing that. Again, a very powerful couple of paragraphs paragraphs paragraphs in the section of the book where you write about stage five, which I'd like to read to you, Howard, if that's okay. People who grow up with conditional love, high expectations, family secrets, social rejection or not fitting in, anxious or depressed parents, family members who have chronic illnesses or early life medical conditions are also prone to develop the personality traits that are associated with neuroplastic conditions.

Later on in life, our brains will recognize danger not only from the outside world of life stresses, but they will react also to the pressures that we put on ourselves. ourselves. ourselves. Personality traits that have been associated with neuroplastic conditions include people pleasing, perfectionism, self-criticism, guilt, and avoiding anger. It's important to recognize that everyone will have some of these traits and that they can be useful and desirable in moderation. But when they are excessive and tend to rule us, they lay the groundwork for the development and persistence of chronic pain, anxiety, depression, fatigue, and other neuroplastic conditions.

I think I should have got you to read my book instead of me doing this. How that says it all. so beautifully. I mean, again, as I read that, I think there's not going to be many people who are listening who don't identify with one of those things, right? It is, as you say, the process of being human. But again, I I feel sort of stage five and stage four are linked in some way. Stage four is about processing your emotions. I guess you're saying stage five is like with that example you just gave is yes understanding yourself, understanding the emotion, but then importantly taking the step to actually make changes in how you live your life.

Some people need a different job. Some people need to set boundaries for what they will do and won't do. Some people need to set boundaries for how much they see certain people in their lives. Some people need a new spouse and some of these stories are very poignant and very powerful. One of the stories is Cynthia in the book where she just to you know really make it abbreviated she grew up in a in a time and a place where she was not seen not heard.

She was hurt in many ways was all put under the table. She had abusive first husband, abusive second husband, had more and more and more and more symptoms. symptoms. symptoms. But when she realized that she needed to make a change in her life, which took quite a while and through some therapy, as she left the second abusive husband, as she realized she had neuroplastic symptoms, as she started a new life, as she gained agency, everything changed. But it couldn't have happened in the current environment in which she was in.

Do people need to address all five parts of this model in order to get better? Great question. Uh sometimes just the first two steps are enough. A proper assessment and education that it's the brain that's creating pain. Yes, sometimes that is enough because people may not have se severely traumatic things in their life or difficult situations and they have the freedom. If you if you get a a test result saying, "Oh, we just did your biopsy and it's cancer. I'm so sorry." And then the next day they say, "Oh, sorry.

Wrong slide. We mixed the slides up. You're fine. You're fine." There's a liberation there. It's like, "Oh my god, I was so worried, but now I'm fine." That liberation can change the neural circuits in their brain by understanding, having the felt sense of I'm actually okay. So that can be enough for some people and some people need more of the therapy, more of the emotional work, etc. Yeah, it's a very complete model. I can see how not everyone needs all five stages, but some people are going to need to go all the way from one all the way through to five.

Irrespective of that though, the message I get from that model and frankly all of your work and your book is one of hope. It's that even if you've struggled for years with chronic pain in whatever form that shows up for you, even if you've been to multiple doctors and taken multiple painkillers and you have not got better yet, you're basically saying that there is hope. There may be things that you've not tried yet. You may have a belief that only a problem with structure can cause pain.

cause pain. cause pain. And what happens if you live your life with a different belief that actually, wait a minute, my body's not broken. It's my brain that is choosing to create pain. Why is my brain choosing to create pain? It's very empowering. And I and I basically love the idea that you can apply apply apply this thinking model beyond pain. beyond pain. beyond pain. You can apply it to depression. Yeah. And anxiety and fatigue, right? And I write about these in you do in detail.

In detail looking at the science behind it, looking at some of the myths that are there that are out there. I think the section on long co is going to be very insightful for people who are struggling because that is something that a lot of people struggle with but there are common principles right and you know you know you know I think there's a beautiful story about an infectious diseases doctor senior dots here in the UK who might have been skeptical but through his own suffering of long co turned things around cuz it's the science it's really talking about the science here it's not woo woo it's not just, not just, not just, you know, wanting false hope or whatever.

It's really looking at the science of these conditions. And that's why I tried to put there's over 800 medical references, you know, in this book. Yeah, it's incredible. I mean, what I think makes this book unique is that you have literally got a ton of modern scientific references to prove that what you're saying is repeatable and reproducible. And science is a spiral. It's it's good science and the truth will win out over time over time and over time this work I believe will become standard will become common sense will become common knowledge some of it may not turn out to be true there's some parts that may change and as a scientist you have to be humble if I'm not humble about my work I'm not a scientist but we've seen in our research studies that this model does work for many if not most people uh we've seen and we understand how the brain works now.

We understand these conditions much better than we did before. And so as you said earlier, you know, there is hope for people and doing this work is saving saving resources, saving money. It's less invasive, less expensive, uh you know, than some of the current models. And so I'm not saying all medicine is bad. You know, medicine has had major advances in the last couple of decades in cancer treatment, heart disease, stroke treatment. However, these disorders of chronic pain, chronic fatigue, chronic anxiety, chronic depression, so many of these others others others certainly appear to be neuroplastic for most people.

And if that's and when that's the case, there's a chance for recovery. And that is the basic message. Not only recovery, but actually being better, actually being a better version because we're not only getting rid of these symptoms, but we're actually listening to a message that might guide us toward being more authentic. Yeah. uh being, you know, being more real and and being more having more agency and compassion for ourselves. And that's the side effect that is is just is so moving, you know, when you see that it's so poignant.

poignant. poignant. Howard, as I've said, I think one of the best things about your work is that it gives people hope for the future. I think the new book is stunning. Honestly, there's so much great stuff in there that are going to help people whether they have chronic pain or not. It goes far beyond chronic pain into fatigue, anxiety, and depression, and many other things. Thank you so much for writing it. I'd recommend people who are interested in this topic. I definitely recommend they get the book.

If they want to stay in touch with you online, uh, or look at some other resources depending on where they live in the world, are there some places that you can point them to? Yeah, we have a nonprofit in the US and there's um ex other nonprofits around the world that are working together uh peer-to-peer people who just want to help each other. In the US, it's the Association for the Treatment of Neuroplastic Symptoms, neuroplastic.org. In the UK, it's uh living proof nonprofit here. It's amazing work.

in the Netherlands it's shiking emo vera which I'm not exactly saying that ex probably right but uh and all around the world people are beginning beginning uh to do this work and so and they're doing it because they've recovered and they want to help other people and and that is and that's their motivation you know this you know all these nonprofits aren't there to make money money money you know they're there to help well how thank you for your Thank you for the hope you're giving so many people around the world and thank you for coming back on the show.

Thank you so much, Rangan. It is such a pleasure and an honor. Appreciate it. If you enjoyed that conversation, then I think you are really going to enjoy this one that I've picked out especially. When we have an emotion, it changes our posture. When we have an emotion, it stores somewhere in the body. And I've just seen countless times when I touch people in certain parts of their body, certain emotions release. Certain patterns are stored