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If Your Chronic Pain Does This… It's NOT Coming From Your Body (How To Heal It) | Howard Schubiner
Dr Rangan Chatterjee
Overview
This video explores the complex nature of chronic pain, challenging the common myth that pain always stems from physical damage. Dr. Howard Schubiner explains that pain is a signal generated by the brain, influenced by emotions, stress, and learned responses, rather than solely by tissue injury. The discussion debunks several myths, including the irreversibility of chronic pain and the diagnostic certainty of MRI scans. It introduces the concept of neuroplastic pain and outlines a five-part model for healing, emphasizing assessment, education, reappraisal of symptoms, emotional processing, and life changes. The core message is that understanding the brain's role in pain perception offers a path toward unlearning and overcoming chronic pain.
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Chapters
- Pain is not always caused by structural damage or injury; the brain ultimately determines whether pain is experienced.
- It's possible to have an injury without pain, and pain without an injury, demonstrating the brain's active role.
- Pain serves as a signal, and understanding its origin (why it's occurring) is crucial for healing, not just treating the symptom.
- The brain's decision to create pain can be influenced by context, such as the perceived danger of a situation (e.g., running from a threat vs. breaking an ankle).
This fundamental shift in understanding pain from a purely physical phenomenon to a brain-generated signal is essential for challenging ineffective treatments and opening up new avenues for recovery.
A friend who shot a nail into his hand experienced no pain because his brain prioritized his need to get to the hospital over the injury signal, demonstrating context-dependent pain perception.
- Chronic pain (defined as lasting over 3-6 months) is not irreversible or incurable, contrary to a common myth.
- Many conventional treatments fail because they assume pain is solely structural, which isn't always the case for chronic pain.
- Physical findings like tenderness (e.g., in fibromyalgia) or muscle tension do not always indicate tissue injury; the brain can create these sensations.
- Pain is real and valid, even when a clear structural cause isn't found; it should not lead to shame or blame for the individual.
Challenging these deeply ingrained myths is vital for providing hope and directing individuals toward more effective healing strategies that address the brain's role in pain.
Fibromyalgia patients often have tender spots, but research shows the brain can cause tenderness, meaning these spots aren't necessarily indicative of underlying tissue damage.
- Structural pain originates from actual tissue damage (e.g., a fracture, infection).
- Neuroplastic pain is generated by the brain in response to perceived danger signals, even without physical injury.
- Both structural and neuroplastic pain are real experiences, but their origins and treatment approaches differ significantly.
- Acute pain can also be neuroplastic; for example, experiencing a headache due to anxiety about an upcoming event.
Distinguishing between structural and neuroplastic pain is critical because treatments effective for one may be ineffective or even harmful for the other.
Experiencing a headache before a podcast due to anxiety about the interview, even without any physical head injury, illustrates acute neuroplastic pain.
- MRI scans can show degenerative changes (like disc degeneration) that are common in people without pain, making them unreliable as sole diagnostic tools for chronic pain.
- Findings on an MRI that appear abnormal might not be the actual cause of pain; the interpretation of these findings is crucial.
- The word 'degeneration' itself can be fear-inducing and problematic, potentially worsening pain by increasing the patient's fear.
- Over-reliance on MRIs can lead to more procedures, surgeries, and ultimately, more pain, contributing to the chronification of pain.
Understanding the limitations of imaging like MRIs helps patients and doctors avoid misattributing pain to findings that may be incidental, thus preventing unnecessary treatments and fostering more accurate diagnoses.
A person with neck pain might have bulging discs on an MRI, but if the pain comes and goes and isn't present on vacation, the MRI findings may not be the root cause, especially since many pain-free individuals have similar MRI results.
- Step 1: Assessment involves ruling out serious structural problems (red flag symptoms) and then ruling in a neuroplastic condition.
- Step 2: Education focuses on explaining how the brain creates pain, validating the reality of symptoms, and offering hope through neuroplasticity.
- Step 3: Reappraising symptoms involves understanding that pain is a protective signal, not damage, and reframing it as a solvable issue rather than something to be managed.
- Step 4: Emotional processing therapies address underlying emotions like anger, guilt, and shame that can fuel neuroplastic pain.
- Step 5: Making changes in one's life involves actively modifying behaviors, thoughts, and emotional responses to reduce threat signals to the brain.
This structured, multi-faceted approach provides a clear roadmap for individuals to actively engage in their healing process, moving beyond symptom management to true recovery.
The FIT criteria (Functional, Inconsistent, Triggered by innocuous stimuli) are used in the assessment phase to help determine if pain might be neuroplastic.
- Emotions like anger, guilt, and shame can significantly impact physical health and contribute to neuroplastic pain.
- Traumatic experiences, including not feeling seen or heard, can sensitize the brain's danger signal, making it more reactive later in life.
- Many common conditions, such as migraines, fibromyalgia, and chronic back pain, likely have a neuroplastic component.
- The brain's protective mechanisms can manifest as various symptoms, acting like an alarm system when it perceives threat or danger.
Recognizing the profound connection between our emotional lives, past experiences, and physical symptoms is key to understanding and treating many chronic health conditions.
A woman experiencing headaches for 17 years, despite extensive medical treatment, found relief when she recognized her unpredictable boss triggered the same fear response as her unpredictable father in childhood.
- Reappraising symptoms means understanding the brain is a protector, not an enemy, and that symptoms signal a need for safety.
- Instead of suppressing symptoms, the goal is to understand their message and calm the brain's danger signal.
- Emotional processing therapies, such as journaling or safe expression of anger and hurt, help resolve underlying emotional toxicity.
- Affirmations and positive self-messaging can change the brain's neurocircuitry by providing a sense of safety and certainty, directly counteracting the danger signals that cause neuroplastic pain.
This stage empowers individuals by shifting their relationship with their symptoms from one of fear and management to one of understanding and active healing, fostering agency and hope.
Dr. Schubiner's own experience of back pain after losing his job, which didn't resolve with reappraisal alone, was healed after he safely expressed his anger and hurt through screaming in his car and imagining blowing up the hospital.
Key takeaways
- Pain is a complex signal generated by the brain, not solely an indicator of physical damage.
- Chronic pain is often reversible and treatable by addressing the brain's role, not just physical structures.
- Neuroplastic pain, while real, originates from the brain's interpretation of danger signals, influenced by emotions and experiences.
- Imaging like MRIs can be misleading for chronic pain diagnosis, as abnormalities are common in pain-free individuals.
- A comprehensive healing approach involves assessment, education, reframing symptoms, processing emotions, and making life changes.
- Our emotional state and past experiences profoundly influence our physical well-being and can manifest as chronic symptoms.
- By understanding the brain as a protector and learning to calm its danger signals, individuals can unlearn pain and other neuroplastic conditions.
Key terms
Neuroplastic PainStructural PainPain SignalBrain PlasticityPredictive ProcessingDanger SignalEmotional ProcessingSymptom ReappraisalFIT CriteriaChronic Pain Myths
Test your understanding
- How does the brain's role in pain perception differ from the traditional view of pain as solely a result of physical damage?
- What are the key differences between structural pain and neuroplastic pain, and why is this distinction important for treatment?
- Why can MRI scans be unreliable in diagnosing the cause of chronic pain, and what are the potential negative consequences of over-reliance on them?
- Describe the five steps in the model for healing neuroplastic pain and explain the significance of each step.
- How can emotions, past traumas, and life stressors contribute to the development and persistence of chronic pain?