Tana Amen (3:15)

No, not since I was a child.

Dr. Daniel Amen (3:17)

The doctor was like, we should operate.

Tana Amen (3:20)

Yeah. So, I mean, I've had a lot of pain throughout my life just from multiple surgeries and whatever, but I think the worst pain I've Experienced as far as just physical. Acute pain was when I hurt my back. And I mean, it's the kind of pain that is so debilitating. I couldn't walk and I cried. Just walking to the bathroom and forget walking up the stairs, I just broke down crying. And I mean, I've got two black belts, I've broken bones, I've done all kinds of things. This was not the same thing. And it was so awful, you know, I had to get an epidural. They were gonna do surgery. I crushed a disc, it wasn't bulging, it was gone. Bone on bone. And there was no way out of it. And they said, there is no coming back from this. You have to get surgery. You can't. It's bone on bone. And I wanted to try everything else first. And so it was pretty wicked.

Dr. Daniel Amen (4:09)

Well, that brings up a really important point. Bone on bone, bulging discs, MRIs that scare the socks off people. And then I read a study that just floored me that 80% of people my age, so I'm 71, 80% of my of people my age who have no pain at all have abnormal back MRIs. Bone on bone, bulging discs. It's stunning. And I'm like, so what does that mean? 70% of people my age have abnormal necks. 60% of people my age have abnormal joints. When you see the mri, you automatically go to, to fear. And as you'll hear me say, it lights up the suffering circuit of your brain and it smears the pain with dread and fear. And so many people jump to surgery. But there's another study I talk about in the book where they compared conservative care, physical therapy, Pilates, changing your diet, meditation had the same efficacy but 21 times fewer side effects. And for me, when I think of surgery, I think of all the scans I have seen before and after general anesthesia and I'm like, that is not going to be the first thing.

Tana Amen (6:02)

Well, and that's not the only thing. There, there's a high risk to some of those surgeries as far as not so much high risk of, you know, something happening to you, dying, whatever, but with them not being successful or needing a follow up surgery, there's a, there's a high risk. And as a nurse, I had seen a lot of that. So for me, I was in so much pain that I was really, really thinking I was going to follow through with the surgery because I didn't know what to do. But there's that part of my brain that was like, I already know that getting the surgery doesn't guarantee I'm going to feel much better. So that was where I was stuck. And yeah. And I wanted to do everything else first.

Dr. Daniel Amen (6:39)

So you know, I was infantry medic and I saw a lot of suffering up close. But what really intrigued me, why I wrote Change youe Brain, Change, change your pain is in 1991 I started looking at the brain with the study called Brain SPECT imaging. And suddenly I saw that pain actually begins in the brain. And one of my first pain patients, name was Sam, he was a police officer. He came into the hospital where I worked after a serious suicide attempt. He. He had two wicked car accidents, high speed chases as a police officer and ended up with six back surgeries on opiates and alcohol. And he just, he felt like he was a shell of himself. And so one night he's like, I just can't take it anymore. And this is not uncommon in chronic pain patients especially who are suppressing their BR with opiates and alcohol. He went, he got out of bed, went to his garage, turned on his Jeep in a closed garage to kill himself. And his wife just, she was a light sleeper. Ran to the garage, threw open the garage door, screaming, crying. Ended up taking him to the hospital. And when I met him, he. He was a shell. It was almost like not there. And his wife was very upset. And you can imagine. And when I scanned him. Cause it was actually just a couple of months after I started imaging people. His anterior cingulate gyrus, that's the area in the middle of your frontal lobes. I think of it as the brain's gear shifter. It lets you go from thought to thought, move from idea to idea, be flexible, go at the flow. Just on fire. It was the hottest one I have ever seen. And I'm thinking to myself, he gets stuck on the thought of pain. And so.

Tana Amen (9:03)

Well, it's really hard to shift when you are. It's like once you start thinking about it, it's very hard to stop thinking about it.

Dr. Daniel Amen (9:10)

Well, especially if your brain. If the suffering circuits we're going to talk about the three primary pain circuits in the brain is dramatically overactive. And so on supplements to calm that part of the brain along with all the other things we're going to talk about. He got so much better. And he said, you know, I still hurt, but I don't think about it all the time. And it was a huge win for him and ended up going to law school and having really positive life.

Tana Amen (9:49)

So I remember, I remember when I was going through all of that and it was actually a police officer, a SWAT officer who was a friend of mine who had hurt himself on the job. And at the time he sent me. It's actually a much older book now, but he sent me a book on pain and by Dr. John Sarno is an older book. And I remember having a discussion with you about it. When I first got the book, I got very angry. And I think that's a very common thing that happens with people when they have pain and someone sends them something that basically tells them, look, this could be more than just physical. Their first reaction is, you think this is all in my head. Well, that's what I did. I was like, you think this is all in my head? I was so mad at him.

Dr. Daniel Amen (10:27)

I remember that conversation.

Tana Amen (10:28)

Oh, I was furious. I was like, you're such a jerk. Like, I need to have surgery. Why are you like, did you see my mri? Like, I was, I was very upset because I was a very high performing person. I wasn't a person who made excuses for things or, you know, whatever. I wasn't a crybaby. And so he just, he laughed. He didn't even like flinch about it. He goes, just read the book and then call me back and yell at me. And so I'm like, oh, you're such a jerk. But anyways, I read the book and I was like, oh, it is in my head. Just not the way that, that I thought. Not the way that I meant.

Dr. Daniel Amen (11:02)

Not that you're faking.

Tana Amen (11:03)

It was physically in my head. Physically, biologically stuck in my head.

Dr. Daniel Amen (11:08)

Your brain is in your head. And ultimate pain, all pain is felt and processed in your brain.

Tana Amen (11:21)

But what I was going to get at is I had the conversation with you and it was a really good book, but it was really, it was really focused a lot on the psychosomatic, some on the biological. But. But you said at the time, you're like, but there's one piece missing. And so we really talked a lot about that. And you were like, the brain piece is still missing. And he didn't really get into the brain piece. And so I think that's what's special about this, is that you really do a good job of explaining that so people don't feel like it's all in my head. And so I like, no, there's a.

Dr. Daniel Amen (11:51)

Part in the introduction. It's like you're going to feel like I'm saying you're faking it. And it absolutely knows that. No, it's in your head, but in your, in the circuits of your Brain.

Tana Amen (12:06)

Well, and we'll unpack it as we go. But basically what happens is when that happens, it. It then translates to the tightening of muscles, stress hormones, and so then it becomes physical.

Dr. Daniel Amen (12:18)

The doom loop.

Tana Amen (12:19)

Right.

Dr. Daniel Amen (12:19)

We're talking. That's the star of this book. So this book is a battle cry. Pain isn't your destiny. It's a signal your brain needs rewiring. And this is so widespread, chronic pain costs the US 600 billion a year more than cancer and heart disease combined. One in five adults suffer from it. And it's exploding post pandemic. Because Covid activates the suffering circuits in your brain. Women are hit the hardest, twice as likely to develop it.

Tana Amen (13:02)

Do you think that's because our emotional brains are more sensitive or more lit up?

Dr. Daniel Amen (13:06)

They're more. Women are more vulnerable to depression. Women have depression twice as.

Tana Amen (13:13)

And that's because of that emotional.

Dr. Daniel Amen (13:15)

Because their emotional brains are bigger, which is involved in bonding. Which is why there's not one society on the face of the earth where men are primary caretakers for children. You sort of have to go to penguins. And so because it's larger, it's more vulnerable. And then you get the hormone cycling. You know, depression and pain are more vulnerable around the onset of puberty, more vulnerable the last week of your cycle, more vulnerable during perimenopause and menopause. So during a time of significant hormonal shifts. But what I found really interesting is this dance between physical and emotional pain. Pain is in solo. Physical sparks emotional, but it's also vice versa. If you're depressed, you're more likely to have fibromyalgia. If you are depressed, you're more likely to be on pain medications.

Tana Amen (14:30)

So what if you grew up in chaos and trauma?

Dr. Daniel Amen (14:32)

We're going to talk about chaos and trauma for sure.

Tana Amen (14:36)

But does that make you more vulnerable?

Dr. Daniel Amen (14:38)

A score. The more active your pain circuits, the suffering circuit.

Tana Amen (14:46)

Interesting.

Dr. Daniel Amen (14:47)

And the less active your calming circuit is. Wow. Our research shows 70% of chronic pain patients have untreated emotional trauma. It's a tango. Hurt bodies hurt your brain. But hurt brains sense more pain in your body.

Tana Amen (15:14)

Wow.

Dr. Daniel Amen (15:14)

So let's talk about the three pain pathways. I found this to be just so interesting because they're also involved in your mood, in your anxiety, in things like add. That if you have add, for example, that increases your pain because the calming pathway is weak to start. So think of three pain pathways. The feeling pathway that tells you, oh, I heard, and it's here. It actually starts in your spinal cord. It's like A sensory goes to your thalamus, which is the sensory gateway, the brain. Think of it right in the center of the brain, sort of looks like an egg. And that's what sort of initially feels and directs the pain. And if you're depressed, I published a study on this in Translational psychiatry. In depression, it's increased, so it's already vulnerable to feel pain. And then it goes to an area called the parietal lobes, top back part of your brain, which is the sensory cortex. That's where you feel it. So it goes, oh, it's your shoulder, oh, it's your back, it's your elbow, it's your knee. So that's the first one, tells you there's trouble. And then it will activate the suffering pathway. And the suffering pathway, think of the anterior cingulate brain's gear shifter and the insular cortex and basal ganglia. So those are the medial or toward the middle structures. But it's like your emotional brain now activates. So if you've already been vulnerable to anxiety, depression, or trauma, as you said, we published this monster study last year on adverse childhood experiences. And the more you have, the more trauma in your childhood, the more active those three circuits are. And so if the feeling pathway, the suffering pathway, and then the third one is the calming pathway. So your prefrontal cortex, front third of your brain, largest in humans and any other animal by far. If it's healthy, it can damp down the pain. If it's not healthy, say you have add, it tends to be lower, or you've had a traumatic brain injury, it can't turn it off. Does that make sense?

Tana Amen (18:04)

It does. That's really interesting.

Dr. Daniel Amen (18:05)

So it's those three that dance together. So if your thalamus is already overactive because you struggle with depression, or you had post Covid inflammation in your brain, if you've had childhood trauma or you have ADD, pain is going to be harder to control.

Narrator/Announcer (18:29)

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Dr. Daniel Amen (18:35)

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Narrator/Announcer (18:39)

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Dr. Daniel Amen (18:41)

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Narrator/Announcer (18:45)

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Dr. Daniel Amen (18:58)

Gifts at change your brain changeyourpainbook.com.

Tana Amen (19:07)

You said something really interesting, though, about the higher your ACE score, the harder it is for your body to sort of calm down that pain, the more pain you're gonna feel. What I find so interesting about that is, you know, we know that the higher Someone's A score is they're more likely to have seven of the 10 leading, like chronic illnesses that can, like, and they die earlier. Right. So the, the more chronic.

Dr. Daniel Amen (19:27)

So explain it.

Tana Amen (19:29)

So if you. On a scale of 0 to 10, we rate childhood, you know, chronic adverse experiences. I mean, these adverse childhood experiences are called ACE scores. Scale of 0 to 10. So you rate them, you go, you take the test. You can go online, take this test. If you're a four, that's a lot. If you are.

Dr. Daniel Amen (19:49)

So we ask questions about physical abuse.

Tana Amen (19:53)

Right.

Dr. Daniel Amen (19:53)

Emotional abuse, sexual neglect. Neglect. If you witness your mother being abused.

Tana Amen (20:01)

Right.

Dr. Daniel Amen (20:01)

With someone incarcerated, violence, someone incarcerated, someone who had a mental health problem, someone with an addiction, or you just felt unloved. And on a scale of 0 to 10, you're an 8, I'm an 8.

Tana Amen (20:17)

So. And I tried to like, not be an 8, but I'm an 8. I don't want to win this one. Because the reason why is because if you are four or higher, you are at risk for seven of the 10 most common, like chronic illnesses. And that. That really burden our medical system.

Dr. Daniel Amen (20:36)

The leading causes of death.

Tana Amen (20:37)

Right, the leading causes of death. But if you are a six or higher, you actually die 20 years earlier. But what I was going be. And it's really interesting.

Dr. Daniel Amen (20:46)

Wait, wait. So if you have six or more. So if you grew up in chaos.

Tana Amen (20:53)

Right.

Dr. Daniel Amen (20:54)

If you grew up in chaos, the research shows you actually die early.

Tana Amen (21:00)

Yeah, but. Right, but the reason you die early is partially because it actually changes Happy.

Dr. Daniel Amen (21:07)

If you die early.

Tana Amen (21:08)

Right? No, and when I learned this is when I became really interested in it because I'm like, I'm not okay with that. But it changes your brain development and you get stuck in fight or flight. And it flips on that cortisol response. You're always looking for the tiger around the corner. Well, that constant stress, you know, hormone just coursing through your body, it actually triggers all of these processes that lead to chronic illness and early death. So it's not good for you. But what I just was getting at with this, with your book. What I thought was so interesting is you said the higher your score, the harder it is to sort of calm the pain down. And I thought that was so interesting because I don't think pain is one of the things that they talk about with your high ACE score, but it should be.

Dr. Daniel Amen (21:50)

Yeah, no, there's research on aces and pain and the high, but it's not.

Tana Amen (21:55)

One of those 10.

Dr. Daniel Amen (21:56)

It's not one of the 10 for sure. Now when we think about pain on all of our work. So those who follow us know we talk about the four circles, that they're biological causes and solutions to pain, their psychological causes. This is where people go, no, that's not me. I just hurt. Give me my drugs. But it's true. They're psychological causes, they're social causes. One of the biggest causes of pain is emotional instability in a relationship where the attachment is strained or broken, that. That will trigger pain syndromes. And there's spiritual causes to pain. And in the book I write about moral injuries. So, for example, during the pandemic, there were moral injuries. I had patients who were so furious about the government lockdowns, for example, that it. It just didn't fit. Or nurses who were forced to work in the middle of the pandemic.

Tana Amen (23:18)

Whatever your values were, you got. You got pushed on.

Dr. Daniel Amen (23:22)

It was so hard for them. So always think about biological, psychological, social, spiritual causes of pain and solutions to pain. Because people who have a deep sense of meaning and purpose, they do better when they have pain syndromes than people who don't.

Tana Amen (23:51)

Right?

Dr. Daniel Amen (23:52)

And when it's all about me, I'm much more likely to hurt than if my life is not just about me, that it's about other people.

Tana Amen (24:04)

Well, and we've all had those experiences where we're so focused on something like pain in our life. Like, we've got something very painful happening, physical pain. And then something happens that distracts you. That's an emergency. It's, like, critical. I have to focus on this. It's something with your kids. It's something with, you know, there's like, something you have to do and you forget about the pain. I mean, like, I know even in the worst of my pain that has happened where I'm like, I didn't feel the pain for that period. And then all of a sudden that whatever that crisis or situation was is over and I'm back to feeling the pain. And I started thinking, I'm like, well, if I could figure out how to not feel the pain for that moment or those moments, how do I extend that? Like, how do I. How do I make that last longer? And it's a good starting question.

Dr. Daniel Amen (24:48)

And we're going to talk, right? It's a good starting question we're going to talk about. Because where you focus determines how you feel. And one of the big ideas from John Sarno's work, because I'm a huge fan of John Sarno, is that chronic pain is often an expression of repressed.

Tana Amen (25:12)

Rage that was My biggest takeaway from the entire book was that when people are, you know, especially women, we're taught to be polite. Our whole lives, we're taught to be polite, we're taught to be good girls. We're taught to do all these things. I mean, not that I'm actually that good at doing that, but. But I am taught. But we're taught to be polite, right? We don't say the things we really think most of the time. So the. And the more that you have been taught that, the better you are at keeping those thoughts and feelings inside, sometimes the worse it is for you when it comes to feeling pain, because it's gotta go somewhere. All that repressed emotion has to go somewhere. So when I learned how to rage journal, I remember I posted about it a few years ago and people were like, that sounds like a terrible idea. Why aren't you focusing on gratitude? And I'm like, well, I do. After I get all the rage out, I do. But when I really learned how to let that go. And it's not an easy thing to do. When you first start doing it, it feels, it feels very foreign. It's like, I shouldn't be saying this out loud. I shouldn't be writing it. I feel like a bad person. You're looking over your shoulder. Is anybody going to see this? So get it out and then shred it or burn it or whatever, because no one should see those things because those are the thoughts you want out that are awful.

Dr. Daniel Amen (26:24)

And so we're going to talk about this in detail. But since you brought it up, Sarno talks about goodness, right? And this was the profile of people with chronic pain. They tended to be perfectionisms, perfectionists. They he said goodism, feeling that this is a must. Self sacrificing, overly conscientious guilt, low self esteem, feeling responsible for others, not standing up for yourself, putting extra pressure on yourself. So if you think of those things, what do they do to your muscles? They tighten, right? And if they tighten them, they're going to increase your pain. Now, the star of change your brain, change your pain is something I developed called the doom loop. And the doom loop is what gets you into pain and perpetuates the pain. So let me talk about it and then in the beginning of the next podcast, we'll talk about the relief loop. So the doom loop is with an acronym. I like pain hq. So it's pain for any reason. Biological, psychological, social, spiritual. So you got two black belts in karate. And it was probably physical trauma, but also mixed with A high A score.

Tana Amen (28:07)

And there was a lot going on in our lives.

Dr. Daniel Amen (28:09)

Some stress.

Tana Amen (28:10)

Yeah.

Dr. Daniel Amen (28:10)

Having. Yeah. In your family. So there's reasons. But it's so pain for any reason, which activates the feeling pathway, which then will go and activate the suffering pathway. So your thalamus and parietal lobe goes up, and that'll trigger, especially in vulnerable people, their anterior cingulate, insular cortex, basal ganglia. But just think of it as your emotional brain. And if it's already vulnerable, such as you've struggled with depression in the past, you're just more likely. The pain's more likely to hurt. And if you have ADD Your frontal loes are a little bit sleepy. It can't turn it off. So that's the P. A IS Activates the suffering pathway. I Is you get an invasion of ants. Automatic negative thoughts, the thoughts that come into your head automatically. Oh, and anybody in pain knows this when your day. Yeah, I am always gonna hurt.

Tana Amen (29:20)

I'm never gonna be able to do this again. I'm never gonna be able to blah, blah, blah.

Dr. Daniel Amen (29:25)

I lose my independence and high negativity. So this is very important. We just published a monster study on 2, 000 patients on negativity bias. And the more negative you are, the less frontal lobe function you have. Isn't that interesting? So if you're negative, if you have low hope, if you're not happy, all of those things are associated in our research with low activity in the front part of your brain. And why is that a problem? Well, then you can't turn off the pain. And, you know, many people who have high A scores are almost. They wear their negativity as a badge. It's like, well, of course I'm negative. If I'm pessimistic, I'm never disappointed. Did you grow up in the same place I grew up in?

Tana Amen (30:21)

Why are you staring at me when you say that?

Dr. Daniel Amen (30:25)

No, it's what I see with my patients. And you and I talked about it, that negativity is hard on your brain, and then it becomes hard on the brains of the people you care about, which is why in my book, you happier. I quote Dennis Prager that happiness is a moral obligation because of how we impact other people. So pain for any reason activates the suffering pathway, leads to this invasion of ants and negativity, which then the AN is nervous tension is all of these things. Your muscles start to get tense, and if you're holding repressed rage, your muscles are already tense. And so it's like a little poke and all of a sudden, you hurt because you're living with this dynamite, right? And then H leads to harmful habits, whether it's marijuana or alcohol or sugar, you know, a couple glasses of wine at night, the harmful habits drop the calming pathway further. And now you go to Q, which is this quagmire or quicksand of pain.

Tana Amen (31:51)

And.

Dr. Daniel Amen (31:53)

Almost all of my patients who have pain, they go, oh, I'm in the doom loop. But you are not stuck in the doom loop. There is a way out. And that is what we're going to talk about in the next podcast. And you know, I told you about Sam. Tana talked about her pain.

Tana Amen (32:19)

I have a lot of people ask me and we'll talk. I want to actually talk about it more in the next segment, but I have not had surgery. I did everything else first. So people are always like, but I don't understand. I don't understand how you did it. So at some point we should sort of talk, talk through that.

Dr. Daniel Amen (32:33)

Well, and I want to leave you with this one thought. Your body was created to heal. So if 80% of people my age who have no pain have abnormal backs, it could be your body figures out ways around it to heal. And so.

Tana Amen (33:01)

So I want to push back for one second. We obviously know there are people who don't heal from very severe injuries. There are people who are quadriplegics. We know them. My grandfather was one. We have someone dear to us that is one. There are severe injuries that you don't recover from. But what I, and even mine, my disc never came back. It's not like I healed completely. But what I will say is by doing this and by, by really learning these principles, I have figured out that every single day, I can make it better or I can make it worse. And there are like, I could not walk. I could not walk up the stairs. I could not walk to the mailbox. I had to get a zero gravity chair and sleep in it. Like it was that bad. And now I do Pilates every day. I do strength training every day. I'm not doing karate, but I'm doing.

Dr. Daniel Amen (33:52)

A lot have surgery.

Tana Amen (33:53)

I didn't have surgery.

Dr. Daniel Amen (33:54)

The difference is you put your body.

Tana Amen (33:58)

In a healing everything, biopsychosocial, spiritual. I did it all.

Dr. Daniel Amen (34:03)

And some people are going to need surgery, and surgery will change their life in a positive way. The book is really about giving you a different.

Tana Amen (34:13)

And even if you have surgery or even if you aren't going to walk again, you can still make that better or make it worse. That's the point.

Dr. Daniel Amen (34:22)

Every day you're making it better or worse.

Narrator/Announcer (34:25)

Are you a doctor or mental health professional who's tired of one size fits all care? Are you passionate about helping people heal the root causes of their issues, but frustrated by the limitations of standard care? What if you didn't have to guess what's going on with your patients because.

Dr. Daniel Amen (34:47)

You could see it?

Narrator/Announcer (34:48)

At Amen Clinics, we do psychiatry differently. We use brain imaging to improve diagnoses and guide personalized treatment because mental health is really brain health. If you're ready to be a leader in the future of mental health care, we're looking for you. When you join Amen Clinics, you don't just make a difference, you own it. With our employee stock option plan, you become an owner in the mission, a stake in every life. We change. This is your invitation to be a healer, a brain health warrior, a pioneer. Join us. Let's end mental illness by creating a revolution in brain health together.

Dr. Daniel Amen (35:35)

Change your brain. Change your pain is out December 2nd. You can pre order the book and if you pre order the book until the book is out you four free gifts. That starts with an online 30 day course that I do on the book so like five seven minutes every day. Just giving you the big steps to master the relief loop which we'll talk about. You'll also get a supplement from Brain md, one of my favorite ones, brain curcumins that decreases inflammation and one of the best studied supplements to help fight inflammation and pain. Tana talked about journaling. You'll also get my Emotional Freedom Journal to journal your way to release some of the rage and help you with pain. And my hypnosis audios. We'll talk about hypnosis and how much I love it. So if you go to Change your brain ChangeYourPainbook.com you can unlock these gifts just by showing us that you pre ordered the book anywhere great books are sold. Stay with us. Leave us a comment, Question or review subscribe we are grateful for you.