Podcast Summary: "How To Heal Chronic Pain with Dr Howard Schubiner" (Re-release #519)

Feel Better, Live More with Dr Rangan Chatterjee re-released a pivotal episode featuring Dr. Howard Schubiner, Director of the Mind Body Medicine Center in Michigan and author of Unlearn Your Pain: A 28-Day Process to Reprogram Your Brain. This in-depth conversation delves into the complexities of chronic pain, uncovering its roots in brain activity rather than structural bodily issues. Below is a comprehensive summary capturing the key discussions, insights, and conclusions from the episode.

1. Understanding Chronic Pain

Dr. Howard Schubiner begins by redefining pain, emphasizing its role as a protective mechanism devised by the brain. He states:

"The pain is not the problem, it's the solution. It's the solution that our brain has come up with to alert us to a problem."
[00:00]

This perspective shifts the focus from pain as a mere symptom to pain as a signal indicating underlying issues that need attention.

Dr. Rangan Chatterjee echoes this sentiment, highlighting that emerging neuroscience reveals:

"Pain does not come from the body part where it's felt, it's actually created by our brain, signaling that something needs attention."
[02:14]

2. Acute vs. Chronic Pain

The distinction between acute and chronic pain is pivotal. Dr. Schubiner explains:

"Pain is a protector. Pain is something that, it turns out, our brain creates and generates."
[04:00]

• Acute Pain: Typically results from a specific injury (e.g., a broken ankle) and serves as an immediate warning to prevent further harm.

• Chronic Pain: Persists beyond the normal healing period (over three to six months) and often lacks a discernible structural cause. Examples include chronic headaches, migraines, back pain, neck joint pain, irritable bowel syndrome (IBS), and fibromyalgia.

He underscores that most chronic pain sufferers do not have structural abnormalities, leading to frustration for both patients and healthcare providers:

"The vast majority of people who have chronic pain actually don't have a structural problem in their body."
[04:00]

3. The Brain's Role in Pain Generation

A significant revelation from the conversation is the brain's capacity to generate pain through neural circuits, influenced by stress and emotions.

Dr. Schubiner elaborates:

"When you touch a hot stove, it's not your finger. The impulses go to the brain, but the brain decides."
[11:51]

He highlights that emotions and stress activate the same pain sensors as physical injuries:

"Emotions and stress activate the exact same parts of the brain as does a physical injury."
[15:20]

This connection explains why emotional pain can manifest as physical discomfort, underscoring the intertwined nature of mental and physical health.

4. Common Chronic Pain Conditions

Dr. Schubiner lists several conditions often categorized under chronic pain, emphasizing their neural origins:

• Headaches: Including tension and migraine types.
• TMJ Problems: Temporomandibular joint disorders.
• Costochondritis: Chronic chest pain.
• Irritable Bowel Syndrome (IBS): Gastrointestinal discomfort without structural anomalies.
• Chronic Pelvic Pain: Including conditions like pudendal neuralgia and vulvodynia.
• Fibromyalgia: Widespread musculoskeletal pain accompanied by fatigue and tenderness.
• Chronic Neck and Back Pain: Predominantly non-structural, with high prevalence in imaging studies without corresponding pain.

He provides striking statistics from a study on chronic neck and back pain:

"In our Boulder back pain study... 75% of the people we treated were pain free after 10 years of back pain in one month."
[63:10]

5. The Impact of Misdiagnosis and Mismanagement

Misinterpretation of imaging results often leads to incorrect diagnoses, exacerbating chronic pain. Dr. Chatterjee shares a personal anecdote illustrating this issue:

"Increased the Pregabalin by 25 milligrams... all we've got is a specialist letter telling me to increase the dose of a pain medication by 25 milligrams, even though nothing's working anyway."
[02:11]

Dr. Schubiner criticizes such approaches:

"It's incredibly dangerous and maddening because it not only gives them the erroneous diagnosis... but also reinforces fear, making the brain produce more pain."
[26:37]

This cycle of misdiagnosis leads to unnecessary surgeries and prolonged suffering without addressing the root cause.

6. Treatment Approaches: Pain Reprocessing and Emotional Awareness

Dr. Schubiner introduces two primary solutions for chronic pain:

1. Pain Reprocessing Therapy (PRT): Focuses on altering the neural circuits that generate pain by changing the patient's narrative and relationship with pain.

2. Emotional Awareness and Expression Therapy: Addresses underlying emotional issues contributing to pain through techniques like journaling, mindfulness, and intensive short-term dynamic psychotherapy.

He cites a groundbreaking randomized controlled trial:

"Of the 45 participants, 75% were pain free after one month using pain reprocessing therapy."
[63:10]

Dr. Chatterjee relates this to personal healing experiences, reinforcing the efficacy of these therapies.

7. Practical Applications and Techniques

Several practical methods are discussed to facilitate pain reprocessing:

• Positive Self-Talk: Encouraging self-affirmations to interrupt fear-based pain responses.

• Mindfulness and Meditation: Enhancing awareness and reducing the association of pain with fear.

• Graded Exposure: Gradually reintroducing movements or activities associated with pain to retrain the brain's response.

Dr. Schubiner emphasizes the importance of compassionate self-interaction:

"When you can understand that, you can understand yourselves and the people you love and care about."
[46:21]

He shares success stories, including patients who experienced immediate relief upon altering their mindset and approach to pain.

8. The Role of Healthcare Professionals

The conversation highlights a critical gap in medical training regarding the mind-body connection in chronic pain. Dr. Chatterjee remarks:

"We are literally taught zero about that in medical school."

Dr. Schubiner agrees, advocating for a paradigm shift where healthcare providers incorporate pain reprocessing and emotional therapies into their practice to better serve chronic pain sufferers.

9. Societal and Cultural Influences

Chronic pain's prevalence mirrors societal stress and cultural expressions of distress. Dr. Schubiner points out:

"The increasing prevalence of chronic pain has mirrored or certainly followed the increase in anxiety and depression in society."
[74:12]

He discusses how cultural factors shape the manifestation of stress and pain, noting that different societies may express emotional distress through varying physical symptoms.

10. Final Thoughts and Hope for Transformation

Concluding the episode, both speakers underscore the transformative potential of understanding chronic pain's neurological basis. Dr. Chatterjee offers a message of hope:

"Your pain is real. Maybe your doctors haven't found anything structural. Maybe you think you're going crazy with pain, but you're not. It's just that no one's helped you yet."

Dr. Schubiner reiterates the brain's power in shaping pain experiences and encourages compassionate, individualized approaches to treatment.

"The power of the brain is immense. The power of our connection to each other, our social connection, the power of what goes on in our lives is immense and has tremendous impact on how we live day to day."
[96:02]

Notable Quotes

• Dr. Howard Schubiner:
  "Pain is a discomfortable experience, basically, but it's also an emotion."
  [04:00]

• Dr. Rangan Chatterjee:
  "My name is Dr. Rangan Chatterjee and this is my podcast Feel Better Live More."
  [00:32]

• Dr. Howard Schubiner:
  "The brain decides whether to actually turn on pain or not."
  [11:51]

• Dr. Rangan Chatterjee:
  "I wish I could go back and help that lady, because I think she's an example of that patient is struggling and suffering."
  [09:16]

• Dr. Howard Schubiner:
  "The most important thing is that it's not all in your head."
  [16:05]

Conclusion

This episode offers a profound exploration of chronic pain, challenging conventional medical perspectives by highlighting the brain's pivotal role in pain generation. Through compassionate dialogue and evidence-based insights, Dr. Howard Schubiner and Dr. Rangan Chatterjee provide listeners with a hopeful outlook on managing and overcoming chronic pain by addressing its neurological and emotional underpinnings. The conversation serves as a valuable resource for both patients and healthcare professionals seeking to understand and tackle chronic pain more effectively.