Building Resilience Podcast

Episode 219: Unlearn Your Pain with Special Guest Dr. Howard Schubiner

Host: Leah Davidson
Guest: Dr. Howard Schubiner
Date: February 26, 2025

Episode Overview

In this episode of Building Resilience, host Leah Davidson welcomes Dr. Howard Schubiner, a leading expert in chronic pain and mind-body treatment. Together, they take a deep dive into the revolutionary science behind pain—what it is, how the brain creates and maintains it, and, most importantly, how individuals can "unlearn" pain that is no longer serving them. The conversation offers profound hope to anyone struggling with chronic pain, anxiety, or related symptoms, emphasizing neuroplasticity, self-compassion, and the latest clinical tools for recovery.

Key Discussion Points & Insights

1. The Science of Pain: Revolutionary Insights

Timestamps: [04:16]–[10:59]

• Traditional vs. Modern Understanding

  • Most physicians avoid treating chronic pain, lacking effective tools and models ([04:16]).
  • Conventional wisdom: “If there’s pain, there must be something wrong in the body.” Dr. Schubiner challenges this, explaining pain as a product of the brain ([05:26]).
  • “It turns out that our brains don’t work that way. Our body doesn’t work that way. It turns out that our brain creates what we experience.” (Schubiner, [05:35])

• Pain as a Brain-Constructed Experience

  • Examples where severe injuries, like a nail in the hand, aren’t felt—demonstrating how the brain can inhibit pain ([08:08]).
  • Emotional situations (e.g., embarrassment, stress) can produce real, physical symptoms: headaches, blushing, stomach pain ([09:08]).

• Danger Signals and the Role of the Brain

  • The brain’s “danger signal” acts like a smoke alarm; it can be triggered by both physical and emotional threats ([10:59]).
  • Emotional issues (rejection, betrayal, pressure) activate the same brain areas as physical injury.

2. Chronic vs. Acute Pain: Understanding the Difference

Timestamps: [12:08]–[15:12]

• The Body Heals:

  • “Millions of people have had a car accident and hurt their neck or their back... and the pain persisted for... a few decades. And we kind of think like, well, the injury didn’t heal somehow.” (Schubiner, [12:40])
  • Most persistent pains are not due to unhealed injuries but learned neural patterns in the brain—neuroplasticity at play ([13:22]).

• Pain as a Learned Response:

  • Brain can associate certain movements or stimuli (e.g., bending over, screens) with pain due to past experience, creating a vicious cycle ([13:33]).
  • “If you’ve learned it, you can unlearn it. This is the name of your book, right?” (Davidson, [15:12])

3. Differentiating Structural vs. Neuroplastic Pain

Timestamps: [15:18]–[21:03]

• Diagnostic Approach

  • Careful medical evaluation to rule out ongoing or static disorders (cancer, untreated inflammation) ([16:04]).
  • MRI findings (bulging discs, degeneration) often not related to actual pain—similar abnormalities found in people without pain.

• The “FIT” Criteria for Diagnosing Neuroplastic Pain

  • Functional: Pain is widespread, starts for no reason, is symmetric ([18:57]).
  • Inconsistent: Moves around the body, can be in different areas at different times.
  • Triggered: Brought on by innocuous stimuli—wind, weather, stress, computer screens ([19:54]).
  • Stories illustrate conditioned responses: A man relives old pain when hearing a helicopter, decades after being wounded ([21:04]).

• Statistic:

  • About 88% of chronic neck and back pain cases Dr. Schubiner studied were neuroplastic, despite abnormal MRI findings ([18:41]).
  • “The vast majority of people with headaches, neck and back pain, stomach pain, widespread pain... are neuroplastic. We’re talking about roughly 90% or more.” (Schubiner, [22:06])

4. The Reality of "It’s All in Your Head"

Timestamps: [22:31]–[23:33]

• Validation:

  • All pain is real, regardless of its source.
  • “People may have told you it’s all in your head... None of that is true. You know that and I know that. And we have to start with that.” (Schubiner, [23:33])

• Hope through Neural Rewiring:

  • Understanding that pain is brain-generated can bring hope for reversal and recovery ([24:30]).

5. How to "Unlearn" Pain: The Road to Recovery

Timestamps: [25:09]–[27:46]

• The Five Key Steps
  1. Accurate Assessment:
     • Confirm pain is neuroplastic, often by examining patterns, associations with stress, and presence of multiple symptoms.
  2. Comprehensive Patient History:
     • Life-long exploration of stressors and links to symptom flare-ups.
  3. Pain Reprocessing Therapy (PRT):
     • Retraining the brain to turn off pain circuits.
  4. Emotional Awareness & Expression Therapy (EAET):
     • Exploring and expressing underlying emotions or conflicts, not always necessary for every patient, but transformative for some.
  5. Self-Treatment & Self-Compassion:
     • Relationship with self is crucial; chronic pain sufferers often excessively self-critical or neglectful ([27:46]).

6. The Emotional Link to Pain

Timestamps: [29:10]–[34:39]

• Evolutionary Perspective:
  • Group membership was survival-critical; emotional threats such as shame, guilt, or risk of exclusion are “danger signals” for the brain ([30:05]).
• Suppressed Emotions:
  • Ignoring or shoving down emotions like anger or guilt can keep the brain’s “smoke alarm” activated, fueling symptoms ([31:44]).
• Safe Expression of Emotions:
  • Expressing emotions doesn’t require confrontation—can be imagined, journaled, or enacted safely at home ([32:08]).
  • Personal story: Dr. Schubiner processed anger about losing his hospital job by “imagining blowing up the hospital with TNT” safely in his car, after which his back pain resolved ([33:54]).

7. Pain Reprocessing Therapy (PRT) and Healing

Timestamps: [36:25]–[39:04]

• Changing the Danger Signal
  • Calm feedback to the brain, reassuring oneself of safety—shifts neural circuits away from chronic pain ([37:20]).
  • “The more you pay attention to something, the more you worry about it, the worse it gets.” (Schubiner, [37:19])
• Clinical Evidence
  • Randomized controlled trials show PRT and EAET are superior to standard therapies like CBT or mindfulness for chronic pain ([37:52]).
• Recovery Stories:
  • Patients with decades of pain experiencing full recovery using these methods ([38:59]).

8. When Recovery is Slow: Addressing Obstacles

Timestamps: [39:07]–[41:40]

• Not All Recoveries Are Immediate or 100%
  • Childhood trauma, difficult life circumstances, and intense symptoms can slow recovery ([40:04]).
  • Sometimes major life changes (leaving an unsupportive marriage/job) are needed for healing ([40:29]).
  • For severe cases, even the smallest steps matter, e.g., bedbound patient started moving fingers to trigger neural changes ([42:02]).

9. The Role of Hope, Belief, and Self-Observation

Timestamps: [42:11]–[45:44]

• The "Click" Moment:
  • Belief in neuroplasticity and the possibility of healing is powerful—most people experience an "aha" moment where they realize their pain isn’t structural ([42:27]).
  • "If there’s time when you don’t have pain, maybe there could be more times of that." (Schubiner, [45:01])
• Tracking Progress:
  • Encouraging patients to notice pain-free moments, not just symptoms, building hope and positive reinforcement.

10. Key Takeaways & Resources

Timestamps: [46:36]–[48:17]

• Final Messages:
  • “Don’t give up hope. Be open and be discerning. Maybe it doesn’t fit for you, it doesn’t fit for everyone. That’s fine. But please don’t give up hope. Be open, take a look and just be kind. Be kind to yourself.” (Schubiner, [47:45])
  • Self compassion is essential at every stage of healing ([48:17]).
• Available Resources
  • Dr. Schubiner’s books (Unlearn Your Pain, Unlearn Your Anxiety and Depression), Coursera course, nonprofit organization for neuroplastic symptoms, and educational videos ([46:36]).

Notable Quotes & Memorable Moments

• On the Brain Creating Pain:
  • “Only the brain can cause the experience of pain.” (Schubiner, [08:23])
• On the Reality of All Pain:
  • “All pain is real. All pain is created by the brain, either in the presence of injury or the absence of injury.” (Schubiner, [10:59])
• On Fear and Avoidance:
  • “The more you avoid the computer screen, the worse we get.” (Schubiner, [13:22])
• On Recovery:
  • “When you see somebody go from 5, 10, 20, 30 years of chronic pain... and get completely better, it’s just mind blowing.” (Schubiner, [38:59])
• On Giving Hope:
  • “The two keys I would try to leave people with is one, don’t give up. Don’t give up hope.” (Schubiner, [47:45])

Resources Referenced

• Dr. Schubiner’s website: kormendihealth.com
• Association for the Treatment of Neuroplastic Symptoms: Professional resources and annual conference.
• Free online course: Dr. Schubiner’s Coursera program.
• Books: Unlearn Your Pain, Unlearn Your Anxiety and Depression, Hidden from View (with Dr. Allen Abbas).

For Listeners:

If you or someone you love is struggling with chronic pain, anxiety, or unexplained symptoms, this episode is a profound call to hope and self-kindness, reminding us that pain is always real—and often, it can be "unlearned" with understanding, the right tools, and self-compassion.