The Chronic Pain Experience Podcast

Chronic Pain And Sex: Why Desire Changes—and How to Rebuild Connection

"What Kind Of Pain Do I Have?"

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Living Fully With a Rare Condition: A Story of CPT2 Deficiency

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Part 3 – How to Reduce Stubborn Chronic Pain: A Practical, Science-Backed Roadmap

​​If you’ve been searching for ways to reduce chronic pain and feel like you’ve tried everything—medication, procedures, therapies—but the relief never lasts, this guide is for you. In the final episode of a three-part series from Pain 2 Possibilities, I will walk through why pain becomes stubborn and, more importantly, what you can do about it. Below I’ll summarize and expand on this evidence-based approach so you have a clear, practical plan to reduce chronic pain and reclaim more of your life. 1) Why this matters: chronic pain is not just about tissue Many people assume ongoing pain equals ongoing tissue damage. That’s not always true. To reduce chronic pain we need to understand that pain can be a multi-system problem: structural/mechanical, nervous system sensitization, and psychological/social factors. When treatments only address one area, especially just the structural side, pain often persists.  I see many treatments help briefly but not change the long-term trajectory. This is common and points toward nervous system sensitization as a major contributor to stubborn pain. 2) What changes when pain becomes chronic Decades of research show living with chronic pain changes the body in measurable ways. These are not “in your head” in a dismissive sense; they are changes in neurobiology, perception, and regulation. Here are some examples to watch for if you want to reduce chronic pain: Altered brain maps: People with chronic pain often struggle to rapidly identify left vs. right side or to draw a limb accurately (common in complex regional pain syndrome). Sensory perception shifts: Body parts can feel “different” to the brain—bigger, smaller, fuzzier—because the brain’s representation has shifted. Regulatory dysfunction: Immune, autonomic, and pain systems become overactive producing unpredictable symptoms. Changed movement patterns: Pain and pain anticipation change how you move. The brain learns protective patterns that can reinforce pain long-term.Recognizing these patterns helps you and your clinician decide if the focus should be on retraining the nervous system to reduce chronic pain—not just fixing tissue or reducing immediate intensity. 3) Why many treatments don’t give lasting relief To reduce chronic pain you must understand which part of the problem a given treatment actually addresses. I break these into four categories: treatments that change pain intensity, treatments that address structure/mechanics, mind-body approaches, and nervous-system-specific interventions. Pain intensity tools: Analgesics, injections, nerve blocks, TENS. These can lower the immediate volume of pain—like turning down a stereo—but often don’t fix the faulty wiring causing the noise to return. Structural/mechanical treatments: Physiotherapy for joint stability, chiropractic alignment, surgery, weight loss. Essential when the problem is structural—but not sufficient when sensitization drives pain. Mind-body methods: CBT, meditation, journaling, apps like Curable. Useful for addressing thinking, fear, and stress, but alone can fall short when pain pathways are overactive. Nervous system retraining: Education + graded, neuroscience-based drills that directly target the altered neurobiology of chronic pain. 4) Evidence-backed treatments that target the nervous system When the nervous system is involved, evidence-based interventions focus on changing how the brain processes body signals. These methods are designed to rewire and desensitize the nervous system progressively and safely: Pain education: Understanding pain reduces threat and fear. Knowledge changes perception; when you know what is happening and why, your brain can reduce defensive responses. Graded motor imagery (GMI): A sequence of interventions (left-right discrimination, motor imagery, mirror therapy) proven useful in conditions like complex regional pain syndrome and other sensitized states. Sensory discrimination training: Peripheral “bottom-up” work that refines sensory maps—touch labelling, texture recognition, and precise sensory tasks. Motor retraining: Gentle graded exposure to feared movements, broken down into micro-steps to rebuild confidence. Mirror therapy: Visual feedback to re-align brain representation with actual movement and reduce perceived threat. Top-down approaches: Imagery, visualization, and cognitive tasks that change brain expectation and cortical processing. Combining bottom-up and top-down approaches is more powerful than either alone. The nervous system learns from both peripheral input and central expectation—so to reduce chronic pain we must retrain both directions. 5) What recovery actually looks like Recovery is individual. To reduce chronic pain successfully you should plan for a process, not a quick fix. Outcomes vary—some people become pain-free, others find pain becomes background noise, and many regain function and confidence even while some symptoms persist. Common recovery milestones include: Less fear around movement and activities More predictable day-to-day pain intensity Improved sleep and energy Increased ability to work and participate in valued roles A toolkit you can use for flare-ups for life Change requires time, patience, and daily practice—often only minutes per day. The brain didn’t rewire overnight; it won’t undo overnight either. But consistent, incremental practice creates new neural pathways that reduce chronic pain over weeks and months. 6) The recovery formula: the components you need to change pain longterm Based on the latest research,  The 16 Week Change Pain Academy pulls together these components to form a practical formula to reduce chronic pain: Precursors: Rule out red flags and clarify the type of pain (acute damage vs. chronic sensitization). Pain education: Learn what pain is and why it acts the way it does. Building Your Foundations: Sleep, stress, daily routines, pacing, and a flare plan. Retraining (bottom-up + top-down): Graded motor imagery, sensory discrimination, mirror therapy, and movement reassociation. Coaching: Guidance, accountability, and help tailoring the steps to your unique pain experience. Support & community: People who understand chronic pain and can give and receive help. Accountability: Small, regular check-ins to keep you advancing. All of these pieces together create an ecosystem where recovery can happen. Missing one piece makes the process slower or less effective. To reduce chronic pain, you don’t need every possible therapy—you need the right combination for your situation, applied consistently. 7) Precursors: what to check first Before starting a nervous-system-focused program to reduce chronic pain, make sure you’ve addressed the basics: See a physician to rule out red flags (serious pathology requiring immediate care). Confirm whether imaging or structural problems explain the pain. Before you begin on any pain recovery plan it is wise to ensure you are living/working in a safe environment.  Clarify your goals: what do you want life to look like when your pain improves? Only once those precursors are clear can you safely and effectively focus on retraining to reduce chronic pain. 8) Coaching and community: why they matter Coaching is not a luxury; it’s an active ingredient in many successful recoveries. A skilled coach helps you turn knowledge into daily practice, asks powerful questions, and holds you accountable. Community reduces isolation and provides practical tips, empathy, and the chance to learn from others who have reduced chronic pain. Support—whether from family, clinicians, or peers—affects outcomes. If you feel dismissed by your healthcare team, find supportive people who understand the biopsychosocial model of pain. 9) What to expect from a structured program A well-designed, evidence-informed program to reduce chronic pain will typically be: Structured and incremental—lessons and drills build slowly. Multimodal—education, retraining, sleep and stress foundations, pacing. Interactive—live coaching or group sessions plus peer support. Practical—daily, short brain retraining exercises that fit into real life. The 16 week Change Pain Academy is designed around these principles: science-first, practical, and supportive. They’re not a quick fix but a methodical path that gives you skills to reduce chronic pain long term. 10) Common obstacles and how to overcome them Two common traps slow recovery: “boom and bust” activity cycles and perfectionism. Boom-and-bust creates flare cycles—overdo one day, crash the next. Perfectionism leads to avoidance or all-or-nothing thinking. Both amplify pain by reinforcing threat beliefs and limiting gradual gains. To reduce chronic pain, replace extremes with pacing and compassionate persistence: set small goals, measure progress, and accept that incremental change compounds into meaningful improvements. 11) When to seek professional help If your pain is changing quickly, progressing, or accompanied by red-fl...

Part 1 – Why Do I Hurt So Much? Understanding The Roots Of Chronic Pain

Living with chronic pain is a daily challenge that no one chooses. It brings with it a complex mix of struggle, frustration, and often isolation. If you’ve ever found yourself asking, “Why do I hurt so much?”, you are not alone. Understanding the basic science behind chronic pain is the first step toward reclaiming control over your life. This article dives deep into the essentials of chronic pain, explaining why pain can persist long after an injury has healed and what you can do to begin the journey toward recovery. As a chronic pain recovery coach, I’ve had the privilege of guiding many on this path, helping to bridge the gap between patients and their healthcare providers through experiential learning and science-backed tools. Let’s explore the complexities of chronic pain, its root causes, and the hope that lies in understanding it better. Why Do I Hurt? The Basics of Chronic Pain First, it’s essential to understand that pain is not just a simple message from your body—it’s a highly sophisticated alarm system designed to protect you. Pain serves as a warning signal that something is wrong, prompting you to take action to prevent further injury and promote healing. However, in chronic pain, this alarm system becomes faulty and overprotective, sending signals long after the original injury has healed. Chronic pain is different from acute pain. Acute pain is immediate and directly linked to tissue damage, serving to protect and heal the body. Chronic pain, on the other hand, can persist for months or years and often involves a sensitized nervous system that overreacts to stimuli. The Role of the Nervous System and the Brain One of the most misunderstood aspects of chronic pain is the role of the nervous system and brain. Pain is not merely a sensation in a body part; it is a complex process involving multiple systems. Your brain acts as the “command center” that interprets signals from millions of sensors throughout your body. These sensors are of three types: Mechanical sensors: Detect changes in pressure or posture. Temperature sensors: Detect hot or cold stimuli. Chemical sensors: Detect chemical changes inside or outside the body, such as inflammation or infection. In chronic pain, these sensors become hypervigilant, sending danger signals even when no real threat exists. The brain, interpreting these signals, produces pain as a protective response. This phenomenon is called “sensitization,” and it means that less input is required to trigger pain, and more sensors are produced to meet the demand. The good news? These sensors have a short lifespan and are constantly replaced, meaning your sensitivity can change over time. With the right approach, it is possible to desensitize these overactive sensors and reduce pain. Who Is More Prone to Chronic Pain? Chronic pain does not discriminate, but certain factors increase the likelihood of developing it: Previous injuries, such as car accidents, work injuries, or sports-related trauma. Childhood adversity, measured by the ACE (Adverse Childhood Experiences) score. Living or working in stressful environments. Neurodivergence, including conditions such as ADHD. Long-term anxiety or other mental health challenges. Genetics and epigenetics—the interaction between your genes and environment. Understanding these risk factors is critical because they highlight how chronic pain is not just physical but deeply intertwined with emotional and environmental factors. Essential Pain Facts: What You Need to Know Fact 1: We Are Highly Adaptable and Bioplastic Humans are incredibly adaptable creatures. Our bodies and nervous systems have evolved over thousands of years to respond to demands and protect us. This adaptability, called bioplasticity, means our systems can change in response to experiences—good and bad. Examples of this adaptability include: Muscle growth from weightlifting. Skin calluses from repeated friction. Increased heart rate during exercise. Changes in the nervous system with persistent pain. This adaptability is a double-edged sword. While it allows for healing and growth, it also means the nervous system can learn to become more sensitive to pain, reinforcing chronic pain pathways. Fact 2: Pain Is a Protective Alarm System Pain’s primary function is protective. It is designed to warn us of danger and promote healing. Our pain system is predictive, intuitive, and modifiable. This means it can adjust its responses based on context and experience. There are people born with congenital insensitivity to pain who do not feel pain at all. While this might sound like a blessing, it is actually dangerous because pain is essential for avoiding harm. For example, a child with this condition may unknowingly touch something hot, suffering severe injury without the warning pain signal. Fact 3: Pain Is Complex and Multi-Systemic The old view of pain as a simple signal from injury to brain is outdated. Pain involves multiple body systems, including: Musculoskeletal system Digestive system Immune system Adrenal glands and stress response systems Sympathetic and parasympathetic nervous systems Chronic pain is a learned response, where the brain and nervous system become highly skilled at detecting and amplifying pain signals. This learning process is similar to mastering a skill like riding a bike—the more you do it, the more efficient and ingrained it becomes. Fact 4: Context Matters — Hurt Doesn’t Always Mean Harm One of the most important concepts in understanding pain is that pain does not always equate to tissue damage. The brain’s interpretation of sensory input depends on context, memory, emotions, and reasoning. Consider the story of two men and two nails: A construction worker jumped from a ledge onto a large nail that pierced his steel-toed boot—but caused no injury. Despite this, he felt intense pain because his brain interpreted the presence of the nail as a serious threat. Another man had a nail accidentally lodged in his skull but experienced little to no pain initially because his brain did not perceive immediate danger. This illustrates how pain is not just about physical injury but how the brain evaluates the situation. This explains why sometimes pain persists even after tissues have healed, or why people may feel pain without obvious tissue damage. Fact 5: Our Tissues Have a Remarkable Capacity to Heal Given the right environment, tissues usually heal within predictable time frames. For example, broken bones typically heal in about six weeks. But when pain persists beyond the expected healing period (usually three months or more), it becomes chronic. Supporting healing involves caring for all body systems, including: Ensuring quality sleep Eating nutritious food Creating a safe, low-stress environment Using strategic movement to aid recovery Healing is an unstoppable force, but it requires patience and the right conditions. Overdoing activity or pushing through pain without strategy can prolong or worsen chronic pain. How Understanding Chronic Pain Leads to Hope Chronic pain can feel overwhelming and isolating, but understanding its mechanisms offers hope. Because our nervous system is bioplastic, the very changes that cause chronic pain can be unwound or desensitized. This knowledge empowers you to take an active role in your recovery. It helps shift the narrative from “managing pain” to “resolving pain.” The key lies in education, awareness, and working alongside healthcare providers with a comprehensive approach. Next Steps on Your Path to Recovery Understanding is just the beginning. If you suspect you have overactive pain pathways contributing to your chronic pain, consider taking a self-assessment quiz designed to identify central sensitization. From there, personalized coaching and strategies can guide you toward improved pain control and function. Remember, you deserve answers and a life beyond pain. Chronic pain is complex, but with the right tools and mindset, you can move forward on your recovery journey. Summary: Key Takeaways About Chronic Pain We are adaptable, bioplastic beings built for survival. Pain is a protective alarm system designed to promote healing. Chronic pain results from sensitization and overprotection by the nervous system. Pain involves multiple body systems and is influenced by emotional and environmental factors. Context matters: pain does not always mean harm. Our tissues can heal with the right environment, and chronic pain can be de...

Part 2 – Why Is My Pain Getting Worse?

Living with chronic pain can feel overwhelming and isolating, especially when despite your best efforts, your pain seems to be getting worse instead of better. If you’ve ever asked yourself, “Why is my pain getting worse?” you’re not alone. There are many factors at play that can keep you stuck in a cycle of pain, and understanding these is the first step to reclaiming control over your life. In this article, inspired by insights from pain recovery coach Deana Tsiapalis of Pain 2 Possibilities, we’ll explore why chronic pain can persist and worsen, the gaps in our current healthcare system, the biological changes in your nervous system, and the often overlooked concept of sensitization. Most importantly, we’ll shed light on how you can begin to navigate your path to recovery with clarity and hope. Why Am I Not Getting Better? The Gaps in Chronic Pain Care One of the biggest reasons chronic pain lingers is due to significant gaps in the way chronic pain is currently understood and treated. Often, the healthcare system focuses heavily on structural or mechanical issues—injuries, tissue damage, or anatomical abnormalities. While these are important, they only represent a fraction of what chronic pain is. Many people with chronic pain find themselves overwhelmed by numerous appointments, feeling unheard by providers, and frustrated by a lack of clear answers or support. This can lead to a sense that something must be terribly wrong if recovery isn’t happening, or even fear that pain will be a lifelong sentence. Unfortunately, pain education among healthcare providers is minimal—physicians typically receive only 5 to 10 hours of training on pain management during their entire education. This lack of comprehensive training leads to a medical model that often treats symptoms rather than addressing the root causes of chronic pain. Insurance policies and healthcare systems are also slow to adapt, frequently covering treatments suited for acute pain but not those targeting complex, chronic pain conditions. The Limitations of a Reductionist Model The traditional medical approach is reductionist, meaning it treats symptoms as isolated issues. While this can be effective for acute injuries or clear physical problems, chronic pain is often the result of more complex, overlapping systems. When pain becomes chronic, it may no longer be tied to a single injury but rather involve changes in the nervous system, emotional health, and social environment. Changes in the Nervous System: What Happens with Chronic Pain? When pain persists over time, profound changes occur in your nervous system that can make recovery feel impossible. These changes include: Impaired Sensory Processing: Your nervous system may struggle to accurately sense pressure, temperature, or touch. This disconnect between brain and body can cause confusion and heightened pain responses. Overactivation of the Brain: Chronic pain lights up multiple areas of the brain simultaneously, leading to increased energy use and symptoms like fatigue, brain fog, anxiety, and depression. Difficulty Controlling Pain Signals: Instead of blocking or reducing pain signals from the spinal cord, the brain may amplify them, making pain feel more intense. Hardwired Pain Pathways: Similar to how practicing a skill strengthens neural pathways, chronic pain can create reinforced “pain pathways” in the nervous system that become hard to break. These changes affect multiple body systems including muscular, endocrine, immune, sympathetic, and parasympathetic systems, which all contribute to the chronic pain experience. Obstacles That Sabotage Your Recovery Beyond biological changes, several external and internal obstacles can keep you trapped in pain: Unsafe Environments: Living or working in emotionally or physically unsafe settings can prevent progress. Lack of Support: Feeling unheard by healthcare providers, family, or community can erode motivation and hope. Narrow Treatment Focus: Addressing only biological or only psychological factors limits recovery. Chronic pain requires a holistic approach. Lack of Information: Without clear guidance and understanding, recovery can feel like guessing or “throwing spaghetti at the wall.” Medical System Barriers: Long wait times for specialists and an overemphasis on symptom treatment rather than root causes. Deconditioned Body and Fear of Movement: Pain makes movement difficult, but inactivity worsens pain. Fear around movement can create a vicious cycle. Boom and Bust Cycle: Pushing through pain on good days followed by days of incapacitation creates setbacks. Belief That Only Doctors Can Help: Recovery often requires addressing psychological and social factors alongside biological ones. Financial and Capacity Challenges: Pain reduces mental and physical capacity, making it hard to engage consistently in recovery. Understanding Sensitization: The Underlying Cause of Many Chronic Conditions Sensitization is a key concept in chronic pain that explains why pain worsens and spreads beyond the original injury. It refers to changes in the central and peripheral nervous systems that cause the brain to overreact to normally harmless stimuli, producing intense and widespread pain. Think of sensitization as the nervous system “learning” to be overly protective. Just as learning a new skill involves creating strong neural pathways, chronic pain creates reinforced pathways that amplify pain signals. This process is not your fault—it is a natural but maladaptive response of the nervous system. Examples of Sensitization in Action Watching someone else move in a way that causes you pain can trigger your own pain. Pain that moves around your body rather than staying localized. Feeling pain when thinking about it or anticipating it. Experiencing multiple diagnoses without clear physical causes. Temporary relief from treatments without lasting improvement. Symptoms Associated with Sensitization Digestive issues Sleep disturbances Depressed mood, anxiety, irritability Fatigue and decreased exercise tolerance Memory and concentration difficulties Changes in reproductive health Sensitization plays a role in many chronic pain conditions such as fibromyalgia, osteoarthritis, rheumatoid arthritis, chronic regional pain syndrome (CRPS), migraines, chronic fatigue syndrome, and more. The Biopsychosocial Model: Treating the Whole Pain Experience Chronic pain is not just a biological issue—it is the product of complex interactions between biological, psychological, and social factors. This is known as the biopsychosocial model of pain: Biological: Structural, mechanical, and nervous system changes. Psychological: Thoughts, beliefs, emotions, memories, trauma, and coping behaviors. Social: Access to care, culture, work environment, family, and societal stressors. Effective chronic pain recovery addresses all three dimensions. Focusing solely on biological treatments misses key drivers of pain and limits your chances of long-term healing. Key Takeaways: Moving Forward with Hope and Clarity Understanding why your pain is not improving is empowering. Here are the most important points to remember: There are significant gaps in our current chronic pain care system, especially around education and treatment approaches. Chronic pain causes changes in your nervous system that amplify pain signals ...

Chronic Pain, Insurance Coverage And The Death OF A CEO

In this episode of the Chronic Pain Experience Podcast, host and Chronic Pain Recovery Coach, Deana Tsiapalis, delves into the complexities of chronic pain recovery and the systemic barriers faced by patients. Following the tragic death of United Healthcare CEO Brian Thompson, Deana explores the frustrations many feel toward the healthcare system, particularly issues like outdated treatment models, high rates of claim denials, and prolonged wait times for coverage approvals. Deana also discusses the importance of patient education and self-advocacy, unveiling the top five challenges chronic pain warriors face in securing insurance coverage and offering resources and strategies for navigating these hurdles. 00:00 Introduction to the Chronic Pain Experience 00:43 The Impact of Insurance on Chronic Pain 02:15 Top Challenges in Securing Coverage 02:40 Outdated Insurance Models and Their Consequences 07:50 High Rates of Claim Denials 12:58 Prolonged Wait Times for Approvals 16:54 Limited Coverage for Non-Pharmacological Treatments 19:46 The Financial Toll on Patients and Families 21:59 Empowering Yourself Through Education 22:56 Conclusion and Call to Action Find our free resources Looking for more free resources? Click here to join our unique free community exclusively for chronic pain warriors, access our sought after ‘A Healing Night’s Sleep For Chronic Pain + Checklist’ and more by clicking HERE. Rate, Review, & Follow on Apple Podcasts “I love Deana’s message inside The Chronic Pain Experience Podcast” <– If that sounds like you, please consider rating and reviewing my show! This helps me support more people — just like you — move toward a life well lived despite the pain. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!Have your say! Complete our brief (3 min) survey to help me improve our growing podcast! You can do so HERE.

Chronic Pain And Fascia – What’s The Connection?

In the relentless pursuit of relief from chronic pain, fascia—a vast, connective tissue network—often goes unnoticed. Yet, symptoms like deep aches, stiffness, and tender, sensitive areas may all stem from fascial dysfunction. By understanding how pain works and how our biology responds to it, we can uncover strategies to shift pain patterns and foster healing. In this episode, we explore the profound connection between fascia and chronic pain, while sharing practical techniques to improve fascial health at home. Tune in to learn how understanding your body can be the first step toward reclaiming your life from pain. Find our free resourcesLooking for more free resources? Click here to join our unique free community exclusively for chronic pain warriors, access our sought after ‘A Healing Nights Sleep For Chronic Pain’ and more by clicking HERE.Rate, Review, & Follow on Apple Podcasts“I love Deana’s message inside The Chronic Pain Experience Podcast” <– If that sounds like you, please consider rating and reviewing my show! This helps me support more people — just like you — move toward a life well lived despite the pain. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!Have your say! Complete our brief (3 min) survey to help me improve our growing podcast! You can do so HERE.

Advocating For Integrative Care With Complex Cases

After a catastrophic injury we rely on the brilliance of our allopathic model. When the condition becomes chronic or in the case of a life long disability, our allopathic model falls short. Join Chanda Hinton and myself as we discuss the Chanda Center in Colorado and the amazing work her centre is doing to make integrative care more accessible to those living with spinal injuries, Multiple Sclerosis, chronic conditions and so much more! You can learn more about Chanda and all the amazing work she is doing at chandacenter.org. Find our free resources:Click HERE  for more free resources or to join our community exclusively for chronic pain warriors. You can also rate, review, & follow on Apple Podcasts. “I love Deana’s message inside The Chronic Pain Experience Podcast” <– If that sounds like you, please consider rating and reviewing my show! This helps me support more people — just like you — move toward a life well lived despite the pain. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!Have your say! Complete our brief (3 min) survey to help me improve our growing podcast! You can do so HERE.

The Chronic Pain Project – Illuminating The Invisible

Chronic Headache & Migraine, Alexandria Levin Living with the invisible reality of chronic pain is a challenge many struggle to articulate. Janna Kimel and her team at The Chronic Pain Project are amplifying these voices, using art and storytelling to bring the hidden stories of chronic pain to light. This powerful journey offers deep insights, not just for those enduring the pain, but also for those who wish to understand it on a more profound level. For more information, visit www.chronicpainproject.org. Find our free resourcesLooking for more free resources? Click the link to join our unique free community exclusively for chronic pain warriors, access our sought after ‘A chronic pain warriors guide to better Doctor’s visits’ and more by clicking HERE.Rate, Review, & Follow on Apple Podcasts“I love Deana’s message inside The Chronic Pain Experience Podcast” <– If that sounds like you, please consider rating and reviewing my show! This helps me support more people — just like you — move toward a life well lived despite the pain. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Then be sure to let me know what you loved most about the episode!Have your say! Complete our brief (3 min) survey to help me improve our growing podcast! You can do so HERE.