Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Dr. David Clarke: The Approach That Has Helped Over 7,000 Patients
64 Plays1 month ago
In this powerful episode of Pain Coach, Lachlan Townend sits down with Dr. David Clarke, a pioneer in treating chronic pain without a clear visible injury. They dive deep into the world of neuroplastic symptoms — real, often debilitating pain driven by changes primarily in the nervous system rather than structural damage. Dr. Clarke shares groundbreaking insights from decades of work with over 7,000 patients, stories of transformation, and the science behind how our brains and life stresses shape our health. Learn why hope is very real for those feeling lost in the traditional medical system.
DISCLAIMER: This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
RESOURCES:
- Quiz at Symptomatic.me
- Follow Lachlan on LinkedIn and Instagram
- Book a Clarity Call with Lachlan
KEY TOPICS WITH TIMESTAMPS:
- Introduction to Neuroplastic Pain & Dr. David Clark’s Journey (00:00)
- The Scope of Stress-related Illness (07:00)
- Neuroplastic Pain Explained (12:00)
- Adverse Childhood Experiences & Chronic Pain (20:00)
- Boulder Back Pain Study (34:00)
- Gut-Brain Axis and Chronic Pain (49:00)
- Hope and Resources for Chronic Pain Sufferers (1:01:40)
Recommended
Transcript
Introduction to Dr. David Clark and His Approach
00:00:00
Speaker
just absolutely astounded me that you could alleviate a serious physical symptom just by talking to somebody. But I you know decided, you know, if I'm going to be a complete doctor, I should learn something about how to do this.
00:00:14
Speaker
And Harriet gave me a basic framework. And that was the start of it. And today, we're 7,000 patients later that I've helped with this ah approach. Today's guest is Dr. David Clark, a board certified gastroenterologist and pioneer in the diagnosis and treatment of stress-related illnesses.
00:00:36
Speaker
He's the author of the book, They Can't Find Anything Wrong, and president of the Association for Treatment of Neuroplastic Symptoms. With over four decades of experience and more than 7,000 patients helped, he's a leading voice in uncovering the hidden stresses behind unexplained symptoms.
00:00:57
Speaker
This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
00:01:17
Speaker
Dave, thank you for coming on
Dr. Clark's Journey and Career Shift
00:01:18
Speaker
the show. I'd like you to just share a little bit about you and and what you do. Thank you, Lachlan. It's great to be with you. Well, I'm board-certified gastroenterologist and internist physician.
00:01:32
Speaker
And for the last 40 years, my specialty has been people who seem to have nothing wrong with them. They've got pain or illness, um but when they have diagnostic tests done,
00:01:46
Speaker
no disease or injury shows up. And it turns out that ah it's a very real form of illness. It's a very large category of illness. It affects Two out of every five people who go to a physician, one out of every five in the general adult population.
00:02:03
Speaker
And the cause is changes of nerve circuits in the brain um that change how the signals from the body are processed and can produce real symptoms of pain or illness anywhere in the body in the absence of anything being physically wrong.
00:02:20
Speaker
And that's what I do is diagnose and treat that condition. I uncover the stresses in a person's life that they may not fully be aware of, and bring those into conscious awareness, help people to successfully cope with them, and then the symptoms get better, sometimes very quickly, sometimes needs years of psychological treatment, but at least people who are going slowly, they know that they're making progress and they're on the right path. So I've done that with over 7000 patients over the decades.
00:02:53
Speaker
Very rewarding work, wonderful to see people getting better who've otherwise been frustrated in the health care system. Yeah, absolutely. Tell me, because it's it seems that it's a little bit different to traditional gastroenterologist role.
00:03:09
Speaker
Tell me what sort of led you into this area? Well, I was trained as a very traditional gastroenterologist. i am my The first seven years of my training were very much Western-oriented medicine, entirely traditional.
00:03:27
Speaker
I never expected that I was going to be doing this kind of work. And then... In the eighth
The Psychological Approach to Physical Symptoms
00:03:33
Speaker
year, i encountered a patient I didn't know the first thing about diagnosing or treating, which came as a complete shock because by the time you get, you know, seven plus years in, you think you know what you're doing and people are telling you you know what you're doing. I actually got an award in medical school for diagnostic excellence and I was in a, you know very prestigious training program and I was getting high scores on my exams, so I thought
00:04:00
Speaker
hey, i really know what I'm doing. And then I met this patient and she was averaging, she's 37-year-old woman, averaging one bowel movement per month ah for the previous two years, taking four different laxatives every single day in double the usual doses wasn't working. We did all the tests. She came to us from another university where they had done all the tests. We did another very specialized one.
00:04:30
Speaker
It was all normal. And I was doing her exit interview, essentially telling her she was gonna have to live with this. But I was asking her about stress one more time.
00:04:41
Speaker
And in her present day life, she didn't have any. She was happily married. She had two kids. She was working half time in a bank. Everything seemed to be fine, but I asked her about stress earlier, and that's when she told me she had been molested by her father.
00:04:57
Speaker
And the um sexual abuse of children in those days, this was in the nineteen eighty s ah was not thought to be very common. In fact, it was thought to be rare. And so I didn't have any training at all that this could be something important to look into or what to do with the information.
00:05:15
Speaker
I'd never heard of it from a patient before. Nobody had ever disclosed this to me before. But I fell back on basic training for a doctor, got the story, and she's telling me this in a very calm tone of voice about this terrible sexual abuse that had happened to her hundreds of times, as it turned out.
00:05:34
Speaker
And again, I didn't think it was connected to this constipation that she had. I had no training that there could be any relationship there. and But I had heard of a psychiatrist at UCLA where I was in training, ah University of California, Los Angeles.
00:05:50
Speaker
And I sent her off to Harriet Kaplan, the psychiatrist, never thinking for a moment anything would come of it, and went about and my business learning to be a GI doctor. Well, several months later, I ran into Harriet in an elevator.
00:06:04
Speaker
And this was the elevator, or I guess we call it a lift in Australia. the Lyft ride that changed my career because Harriet told me she had cured this patient with less than three months of weekly counseling sessions.
00:06:17
Speaker
Just absolutely astounded me that you could alleviate a serious physical symptom just by talking to somebody. But I you know decided, you know, if I'm going to be a complete doctor, I should learn something about how to do this.
00:06:32
Speaker
And Harriet gave me a basic framework. And that was the start of it. And today we're 7,000 patients later that I've helped with this approach.
00:06:42
Speaker
I just, you know I got better and better at it as the years went by.
00:06:48
Speaker
It's safe to say that that story was sort of a paradigm shift for you in in your thinking. But what's what's amazing and what but I really appreciate about you, Dave, is that you were open to that.
00:07:01
Speaker
You were... you were Despite all your training that hadn't really prepared you for that, you were open to this sort of shift in thinking. Were you were you resistant at the time? Were you trying to explain it away in in other ways?
00:07:16
Speaker
Or were you very accepting that you know the the psychological factors were were playing a role in her condition? Well, you know, I didn't believe it at first, but I couldn't to deny the evidence that Harriet had cured this patient and her bowels were moving normally and she wasn't taking laxatives anymore. And, you know, that was just a shock. But at the same time, i didn't feel comfortable with the idea that after seven plus years of training, that there was a class of patients out there that I didn't know anything about, didn't know how to deal with.
00:07:55
Speaker
um So I thought, you know, this is only going to be a couple of patients a year. i should just learn the basics. And then whenever one of them finds their way to my office, I can send them off to the mental health practitioners and they'll fix them.
00:08:09
Speaker
And I was wrong on both counts. I was
Methods and Success Stories
00:08:13
Speaker
wrong that it was going to be two patients a year. it it was five or six a week. ah for 25 plus years.
00:08:21
Speaker
and And when I sent them off to the mental health practitioners in Portland, Oregon, where I was in practice, well, it turned out there weren't any Harriet Kaplan's out there. It turned out that Harriet Kaplan had some pretty special skills.
00:08:35
Speaker
And the framework that she had given me was not something that was widely known, ah which is terrible because this is, you know, 50 million people in the United States. It's probably 5 million Australians that have this.
00:08:49
Speaker
and And for this not to be a widely understood skill ah is just appalling. And so these patients would go off and they would get cognitive behavioral therapy, which was little more than helping them to live with their condition, whatever it was. Chronic pain was the most common.
00:09:08
Speaker
Constipation wasn't all that common as it turned out. But it wouldn't help them. And they would come back and they would say, Dr. Clark, You know i went to mental health, I got the treatment, but I'm not any better. What are we gonna do?
00:09:21
Speaker
And I said, well, I'm not very experienced with this, but let's try some things and see what happens. And that was how it got started. I would do trial and error with the framework I had learned and they would get better or not. And I would try something new and gradually over time with, you know, 250 or 300 patients a I got slowly better and better.
00:09:43
Speaker
i got slowly better and better And after it took me probably five years where I finally got skilled enough, five or six years that I was had climbed the learning curve ah and was getting decent results on a consistent basis.
00:09:59
Speaker
And it was right at that moment I was working for a big health care organization, five or six hundred doctors. And I was surprised to get voted the Doctor of the Year Award and right at that point.
00:10:10
Speaker
And that was you know such a solid endorsement of how I was practicing that and all the reward of seeing people get better who were otherwise completely frustrated in the health care system. So I had to keep going with it.
00:10:26
Speaker
I'm so glad that you know what was quite new in the field was celebrated because this was back, what year are we talking? 1990 when I got that award.
00:10:39
Speaker
Yeah. So that was a long time ago. yeah And there was nobody else in my community doing this work. So when people found
Challenges and Changes in Healthcare
00:10:47
Speaker
out about this, they started sending me all kinds of patients with and more than just gastrointestinal problems, which is you know, when I was a consultant and people with back pain, one gentleman with come itching of his skin over his entire body, you know all kinds of of unusual stuff.
00:11:08
Speaker
Were you always celebrated for it or was there a lot of pushback? Is there a lot of criticism? Do you still get criticism to this day? The criticism more came from administrators. And when I first started, i was very lucky to have an administrator who saw what I was doing and believed in it and actually gave me longer appointment times to see these patients because it it involved you know a fairly detailed discussion to get the full story of what was going on. So that administrator gave me a lot of support.
00:11:44
Speaker
Unfortunately, he retired and was replaced with somebody who was more numbers oriented. And they were looking at ah the numbers of procedures I was doing. And in the American health care system, you know, procedures are a metric that it gets followed.
00:11:59
Speaker
And if you're in a, you know, a normal fee for service type of situation, your income is heavily dependent on how many procedures you do. So it's ah a number of people follow. And I was doing so many second opinions. And second opinions are where the patient has already been seen by another specialist and they can't find anything wrong. So they would send them to me But those patients had already had their procedures done.
00:12:27
Speaker
There was no reason for me to do another one. So I wasn't doing as many procedures per patient as some of my colleagues were. And I pointed this out to the administrators and and you know they were you know grudgingly accepting that. But there was definitely a little pushback around procedure numbers. I wasn't at the lower end of my department, but I was below average. And so they were kind enough to point that out.
00:12:54
Speaker
a But the other doctors loved it. I mean, like I say, I got the Doctor of the Year Award and that was on a vote from my fellow physicians. You colleagues, yeah.
00:13:06
Speaker
Yeah, it's interesting hear you say that because, you know, I think, I mean, we could talk a while about surgery and the place for it and and there certainly is a place for it. But like in the States, sometimes,
00:13:20
Speaker
there There would be surgeries that happen that I think are sort of driven by biases around financial metrics, um which is what you've you've pointed out there.
00:13:32
Speaker
i don't think that that is uncommon um across all healthcare. It doesn't matter where you are. Sadly not. Although the insurance companies, if once they find out how cost effective this treatment is, and you know because you know they're having to pay the expense for all of these procedures and surgeries and injections and ah on and on,
00:13:58
Speaker
Once they find out there's a much more cost-effective treatment that can actually alleviate pain and illness on a long-term basis in a very large number of patients, you know I think they are going to embrace it because it means they can help more people with the same number of dollars.
00:14:17
Speaker
Do you think they are embracing it in in America? Because in Australia, it seems like it's still a very bottom biomedical model. um And it it can it can be hard. I mean, I talk to WorkCover frequently around clients and it it it can be tricky to explain to them the sort of nociplastic, which will we can discuss a little bit more, nature of pain.
00:14:45
Speaker
they They sort of want to see something on a scan that can um validate it. And they there's a lot of stigma around it for patients that, yeah, they've they they don't feel like they're believed by the insurance companies.
00:15:03
Speaker
Yeah, you're absolutely right. I mean, they yeah coming out of a traditional Western medical education, the assumption about patients who don't have an organ disease or damaged structure to explain their symptoms is that They're neurotic.
00:15:20
Speaker
They're imagining their symptoms. It's all in their head. um They can't handle their own life stresses. There's nothing you can do to diagnose them. and The best you can do is help them to live with their condition or to just treat the symptoms as with opioids and that they're just going to go on with this indefinitely. And turns
Uncovering Hidden Stress and Trauma
00:15:41
Speaker
out not a single one of those assumptions is true.
00:15:44
Speaker
In fact, for most of them, the exact opposite is true. My patients with this condition are actually mentally quite strong. They're just dealing with you very high levels of stress, greater even than they appreciate themselves.
00:15:59
Speaker
I think of them like Olympic weightlifters who are being asked to carry 50 pounds more than the world record for their weight class. Anybody's body is going to break down under that kind of strain.
00:16:10
Speaker
um But they themselves can't see ah the nature of this weight that they're carrying until we investigate it. And it's very hard to believe that just how ill you can get from this. A colleague of mine sent me a magazine article ah via email a couple of weeks ago where an individual who was actually a researcher in this field said you know that these patients ah symptoms, this pain or illness, can't be a mental condition because the symptoms are so real.
00:16:41
Speaker
The symptoms are so severe. um But that's not true. The symptoms generated by the brain in this condition can be every bit as severe as those caused by anything else.
00:16:53
Speaker
but One of my patients had abdominal pain for 79 years, for example. Another one of my patients was, I was asked to see her on her 70th day in the hospital.
00:17:04
Speaker
but She was in there for unexplained abdominal pain. 17-year-old girl getting morphine around the clock in massive doses of 10 milligrams an hour.
00:17:15
Speaker
ah For a slender young lady, ah five or 10 milligrams would be more than enough to alleviate the pain of a fractured leg. And she was getting 10 milligrams every hour.
00:17:27
Speaker
And she had seen six other gastrointestinal consultants over the previous 18 months that she'd been suffering with this. You know you're never going to convince a patient like that that her symptoms weren't real.
00:17:39
Speaker
But all of these patients that I'm describing ah were successfully treated with what I call neuroplastic psychology. You know psychology that plastic means capacity for change in medical jargon, and neuro means nerve and brain.
00:17:54
Speaker
So this new form of psychology, much, much more effective than cognitive behavioral therapy, and can actually physically change the brain according to mag magnetic resonance imaging studies.
00:18:08
Speaker
And you know even the patient with pain for 79 years, even the 17-year-old with morphine around the clock, successfully treated with neuroplastic psychology.
00:18:21
Speaker
Yeah, it's amazing. It's amazing stuff. and and And you were really on the cutting edge. If I think of not, I think it's still on the cutting edge. And in the 1990s to start to to operate this way, it's funny that I use that word operate because you're probably operating less.
00:18:38
Speaker
but But to operate this way back then is yeah, you're you're well ahead of your time. And i'm I'm actually surprised that you didn't get as much criticism, right?
00:18:50
Speaker
Yeah, I would have expected more. what What would your advice be to people who have pain and i have had these endless investigations and there's nothing particularly to see on scans that can be contributed to their symptoms?
00:19:11
Speaker
A great place to start is you know on the symptomatic.me website of my nonprofit. There's a 12-question self-assessment quiz there. Each question has a line or two of explanation about what the question means and what a yes or no answer means.
00:19:28
Speaker
And the more questions to which people answer yes, the more likely it is that their symptoms are neuroplastic in origin. And in More importantly, it gives people some ideas about where to look for sources of stress that they might not be fully appreciating because that's that's a common issue. one One of my patients who was hospitalized at a prestigious university 60 times in 15 years with no diagnosis, um she was completely unaware that her symptoms were triggered by her abusive mother.
00:20:02
Speaker
And her mother had been verbally and emotionally abusing abusing her since she was three or four years old. And she was now 50. Mom was in her 70s and was still mistreating her.
00:20:14
Speaker
But until i made it manifestly clear that her father attacks of dizziness and vomiting that she was having were connected directly to interactions with her mother, either direct or indirect.
00:20:27
Speaker
and Once she saw that, and it was undeniable that the connection was there, I can still remember she looked up at the ceiling and said, oh my God, I can't believe it. But until then,
00:20:39
Speaker
it was completely below the radar. So that's a big part of this is trying to figure out where the stresses are and get a realistic assessment of how big they are.
00:20:51
Speaker
And that
Impact of Childhood Events on Chronic Pain
00:20:52
Speaker
12-question quiz takes less than three minutes is a good place to start. Yeah, awesome. i'll I'll link that one in the in the show notes. on On childhood events, I want you to talk about adverse childhood events and how they seem to be a predictor of of people that will develop uh persistent complex pain problems can you can you speak to that yeah there's there's actually excellent research on that that shows a very strong connection there and in my practice
00:21:32
Speaker
Adverse childhood experiences or ACEs was the single most common reason for why my patients were ill or in pain. But it can be difficult to accurately recognize the magnitude of what happened. A lot of my patients will say, well, yes, a few things were not ideal, but I think I've overcome it or it wasn't that bad or other people have been through worse than me.
00:22:00
Speaker
So none of us has a parallel life to compare ourselves with. So when my patients look back, they're not necessarily perceiving things the way they really were. So my technique for helping people with that is to ask them to imagine themselves a butterfly on the wall of their childhood home.
00:22:20
Speaker
And They are watching a child they care about, either their own or somebody else's. They're watching a child in that same environment they grew up in trying to cope with it.
00:22:33
Speaker
And let's say they're watching them for a week or so. And I ask them, you know, what's that going to be like for you? Are you going to feel sad or angry watching your own child try to cope with everything you had to cope with?
00:22:46
Speaker
And that gives people a completely different perspective and a much more realistic one. And they can start to grapple with some of the emotions around that.
00:22:57
Speaker
Many of them are a lot angrier about what they had to go through ah than they are recognizing. Because to get through that experience as a kid, they had to take their anger and bury it somewhere.
00:23:09
Speaker
So that by the time they get to be an adult, they're very good at burying those emotions. And the emotions then have no choice but to express themselves via the body are in so because they can't come out in the form of of words or actions.
00:23:26
Speaker
Do we have an understanding of the physiological processes behind this? Obviously, we see the phenomena and we see the relationship in terms of adverse childhood events and and developing chronic pain. But do we know sort of the underlying mechanisms behind what you're saying is that days these traumas sort of manifest in the body?
00:23:50
Speaker
Yeah, on the symptomatic.me website, there's a seven-minute long video in which they interview some of the scientists that have been doing this research. And one of the scientists did the boulder back pain study ah where they use neuroplastic psychology to get 75% decrease in chronic pain in one month.
00:24:14
Speaker
And he scanned people's brains before and after they got the neuroplastic psychology and was able to show physical changes in the brain. He also, in the short video, quotes another study of people with acute back pain, meaning short-term, ah you know, injury-related back pain.
00:24:35
Speaker
And what happened is they they scanned the brains and they found out what parts of the brain were active during acute back pain. But then as the in some of the people who didn't fully recover from that acute back pain and it became chronic, which means it lasted for longer than three months, they re-scanned the brains. And now the parts of the brain that were active were in a completely different area, having to do with memory and the making of meaning and emotions.
00:25:06
Speaker
So there was a definite physical change in the brain that was connected to this. Now, have we worked out every last detail of this? No, but it's clear that the brain is the center of this.
00:25:18
Speaker
Another example that people are probably familiar with is what's called phantom limb pain, where somebody's had an amputation and they feel pain in the place where the limb used to be.
00:25:30
Speaker
Obviously, it can't be coming from that limb because the limb is no longer there. So it's an example of pain that's being generated purely in the brain. And this this happens all the time ah in people with no amputations at all.
00:25:47
Speaker
Yeah, it's with when the and with the amputation scenario, it's not like this is a an uncommon phenomena for people with an amputation. It's actually, i don't know the exact stats, you may you may know them, but it's in, I would say, the majority of people at some stage feel some phantom symptoms or pain um in that limb.
00:26:10
Speaker
Some of them don't develop ongoing persistent pain because the the brain must reorganize and and and remap. um But it's just for listeners, this is not like an uncommon scenario.
00:26:24
Speaker
um It's not like these people are crazy or manufacturing this. It's just, it's the it's the nature of... Yeah, I'll find my patients, I think, are mentally stronger than average. I mean, many of them have been carrying loads of stress their entire lives and dealing with it for the most part successfully. And all they need is to have some assistance in recognizing what's going on beneath the surface.
00:26:56
Speaker
I'm so glad you say that because, you know, oftentimes they feel they feel like they're weak, they're fragile, and they feel like no one believes them, they're manufacturing it. And for you to sort of explain how real it is and how strong they are um as people is, I'm sure, music to many people's ears oh on On the childhood events, adverse childhood events, and we could, it shows me, it demonstrates to me the importance of morality.
00:27:32
Speaker
And look, I don't want this to be a full conversation around morality, but but the importance of morality. a family dynamic that's healthy and an environment where people can flourish and a society where people can flourish just seems so important for the prevention of this this kind of thing.
00:27:54
Speaker
do you have any thoughts on that? Yeah, I mean, so often in my patients, when I am able to learn about previous generations, what I hear is that the trauma in those families, the adversity in those families has been going from one generation to another.
00:28:15
Speaker
And what i try to help my patients do is if they can understand this ah well enough, they can break that cycle. They can raise their own children in a way that is far superior to what they went through themselves. Many of my patients have been very concerned about having children of their own because they think they're gonna do a terrible job and they're gonna continue the generational cycle of trauma.
00:28:41
Speaker
And i try to reassure them that Once they have awareness of what they went through, once they can see ah certain assumptions that they absorbed about themselves that are simply not true, um they can make changes.
00:28:57
Speaker
If they can see where those assumptions came from, and then they can, that will facilitate making changes. For
Changing Self-Perception and Breaking Cycles
00:29:04
Speaker
example, many of my patients were made to feel like they were second-rate human beings or never measuring up or frankly completely worthless or that they were or that it was their purpose in life or their job in life to take care of the needs of everybody else in their world without ever putting themselves on the list of people they take care of.
00:29:26
Speaker
but Just those two ah false assumptions alone are responsible for huge amounts of stress in my patients that contributes to their illness. But if they can see that this dates back to how they were treated as kids,
00:29:41
Speaker
and that these assumptions are completely false and that they should instead think of themselves or admire themselves for the heroic perseverance they showed in getting through those experiences, that's a complete flip in their self-image.
00:29:57
Speaker
It gives them a foundation going forward for understanding a completely different relationship with themselves and how they think about themselves and in what kinds of personal relationships they're willing to tolerate.
00:30:10
Speaker
ah You know, they're not going to be so accepting of toxic people in their lives anymore, for example. And that sets them up to not pass this toxicity on to the next generation.
00:30:23
Speaker
Yeah, yeah. i have I have two sisters. i don't have kids myself yet. I have and two sisters. ah ah They're beautiful people. They have amazing families, amazing kids.
00:30:36
Speaker
But they're already they already have a lot of pressure on them to be, you know, quote unquote, the the perfect person. the perfect parent. And now if they're listening on to this, they're probably thinking, oh no, it's even, it has even more effects than we can imagine. What would your advice be? Because what I say to them often and,
00:30:58
Speaker
It's hard because i'm not i don't I'm not a parent, so I don't know what they're going through. um But I say to them, the stress of of you trying to be this, you just got to be mindful that, you know, if you're trying too too hard to have everything perfect, the stress that that caused causes is detrimental in and of itself.
00:31:20
Speaker
What would your advice be to parents that are listening going, oh, my goodness, how are we going to fill these shoes? Yeah, it's it depends a little bit on where the drive for perfection is coming from, if it's coming from a healthy place or if it's coming from a toxic place.
00:31:39
Speaker
If it's coming from a toxic place, as it often does, I mean, kids who are grew up under adversity will often react to that adversity by trying to be better kids.
00:31:51
Speaker
And when that doesn't solve the problems, they try to be even better than that. And they get really self-critical whenever things are not working out. They're much more critical whenever they make a mistake, ah critical of themselves than they ever would be of somebody else who made the same mistake.
00:32:08
Speaker
So if that's where the drive for perfection is coming from, we we need to help people understand that it's not coming from a healthy place. And we need to flip the self-image so that people recognize that they overcame a lot when they were kids that they had to have heroic perseverance to make it through that and to start thinking of themselves in those positive terms.
00:32:33
Speaker
And when they are successful in doing that, then it's a lot easier to tolerate when you fall short, for example, because parenting is such an impossible task. I've had two boys myself and now five grandchildren. and None of us does it perfectly.
00:32:50
Speaker
You know, you're always going to mess up because it's just too darn difficult. If the perfectionism is coming from a healthier place, you know, you're just trying to ah to do your best and you're responding more to society's pressure than to ah toxicity when you were growing up.
00:33:09
Speaker
um That's, I think, a little more important. readily accessible to making change. That what I encourage people to do, wherever the drive for perfection is coming from, is to put themselves on the list of people they take care of. It turns out to be an essential human skill.
00:33:29
Speaker
to take regular time that has no purpose but your own joy. And what I'm
Neuroplastic Psychology and Pain Perception
00:33:36
Speaker
looking for there is ah for people to to have an activity that ah is the moral equivalent of finger paints for a four-year-old. I don't know if you call them finger paints in Australia, but if you've ever seen a four-year-old just messing with the paint on a piece of paper, they just know they're having fun.
00:33:52
Speaker
They don't care how many pictures per hour they produce. They don't care if it's a perfect picture. they just know they're having fun. And it turns out we still need that as adults.
00:34:03
Speaker
And people who aren't getting that, people who are always focused on what um others around them need, they're they're living as if on a treadmill, they never step off.
00:34:16
Speaker
And sooner or later, the body is going to protest. A lot of chronic fatigue, for example, comes out of that, where your body just simply won't let you function, until you learn how to play.
00:34:30
Speaker
ah It's awesome to hear that from you and giving the people the guilt free ability to to do those things is is awesome. I want to shift gears. Actually, before we do, I want you to unpack the Boulder back pain study. Lots of people have back pain.
00:34:46
Speaker
As you know, it's the world leading cause for disability. um Tell us what the treatment was. Well, firstly, just give us a snapshot of the results. And then and then if you can unpack what the treatment actually entailed for the people in the study.
00:35:05
Speaker
if If you're aware of it, I understand that you you may not you may have been one step removed from that study. But if you can unpack that, that would be great. Yeah, i'm I'm very familiar. In fact, the the lead researcher is a friend of mine. So I'm very familiar with the study and ah my nonprofit actually helped raise some of the money for it.
00:35:26
Speaker
But after we gave him the money, we said, you know, you guys go and do your thing and see what what happens. And they were actually skeptical. You know, they, ah this gentleman who is now my friend, I just met him and he said, you know, just talking to people,
00:35:42
Speaker
with 10 years on average of back pain? You think you're going to alleviate this? I don't know. i mean, we're we're going to do your study. You guys put money up for it, so we're going to do it, but we're going to collect the data and we're going to see if this actually works or not.
00:36:02
Speaker
Well, they were shocked. I mean, the these are people, 10 years of pain, and in one month of pain psychology, they two sessions a week for four weeks, pain came down by 75%.
00:36:15
Speaker
And in the two control groups that they had, one with their usual care and the other with a big injection into the spine, and very little change at all. so this This was a huge shock. I mean, there's a statistic, ah you know, for anybody in your audience that enjoys statistics, there's one called effect size.
00:36:36
Speaker
It's a very simple concept. It's just how much of an effect did you have on your experimental group? And the numbers come out to be 0.2 is small, 0.5 is a medium effect, and 0.8 is a large effect.
00:36:53
Speaker
In this study, the pain psychology effect was 1 and 1 half. So it was almost double what's considered a large effect. The researchers were shocked.
00:37:04
Speaker
it It shocked the the guy who became my friend so much that he is now devoting his career to this. He was previously going in a different direction, but when he saw these results, he said, you know, I've got to get, you know, do this, you know, for my my entire career. And he's now got half a dozen follow-up studies going, ah including one that where he went back to these same patients after five years to see how they were doing.
00:37:31
Speaker
and the The original study, they followed them for a year, and they and the pain scores stayed down 75% for the whole year. They only got treatment for a month, but the pain scores stayed down. It was just a shock. So now he's out five years, and he's telling me that his preliminary data is pain scores are still down.
00:37:50
Speaker
um So... Just a tremendous result. And it unlocked lots of funding for studies around the country. The results have been corroborated in studies, some of which were actually came out before the Boulder Back Pain Study, but studies from Halifax, Harvard, Detroit, UCLA, confirming these these same results.
00:38:14
Speaker
Just remarkable outcomes. What was the treatment? Oh, sorry. Obviously, no, no, no, that's great. That gives us this really good snapshot of how fantastic the results were.
00:38:26
Speaker
But I can just think of people that are listening going, what exactly did they do? i want some of that. Yeah, actually, it was a fairly simple approach.
00:38:37
Speaker
What I liked about what they did is that it wasn't as complicated as what I've been talking about with you earlier in this interview. They just persuaded people that their medical evaluations had not shown a conclusive structural reason ah for why they were having back pain.
00:38:58
Speaker
they They didn't take people into the study if they had nerve damage, for example. if If you had muscle weakness or you lost your reflexes or you had numbness of the skin in an area that corresponded to what we call a dermatome or a nerve pathway.
00:39:16
Speaker
you know That indicates nerve damage, and they weren't including that. But it turns out in another study, if you take everybody with back pain, only 12% have the nerve damage. The other 88%, it's just non-structural back pain or neuroplastic pain that we call it.
00:39:36
Speaker
So what did they do? they They said, okay, this is not your back. um You know, if you're if you're focusing your brain on your back, it's like focusing on the little indicator light on your dashboard that says that your engine has a problem.
00:39:49
Speaker
You know, focusing on that light is not going to solve the problem. What you need to do is go to the the source and start thinking about what's happening in your brain that is changing the the circuits up there.
00:40:02
Speaker
And that means thinking about stresses that are going on in your life and not thinking about what's happening in the pain and being aware of the pain, you know being able to just notice it, but without the the fear and the worry about ah disability and all of the emotions that go with it, just that it's a sensation, it's a signal from the brain, it's a a way that the brain is trying to communicate with you.
00:40:32
Speaker
So that's how it's the treatment starts, is we're just recognizing that a completely different way of thinking about this kind of symptom, that it's ah almost a form of language,
00:40:43
Speaker
that your brain is trying to communicate with you that it it is distressed, just like the indicator light on your dashboard is indicating that there's something going on in the engine. So then people shift their attention and they start thinking about, well, what is happening in my life that might be distressing to me?
00:41:02
Speaker
And the the actual um psychology that they used in this study didn't get too deeply into that. there were There were definitely discussions around it. People would start in the sessions to speculate about what those stresses might be.
00:41:18
Speaker
But the actual treatment itself, not hugely delving into emotions or traumas or um issues that people had in their present day lives.
00:41:31
Speaker
And people could figure these things out. They could make a lot of progress once they shifted their attention to where the real problem was. Yeah, the it's crazy that the importance of reframing the problem of pain.
00:41:48
Speaker
And Lorimer Mosley, his some of his research down at the University of South Australia is saying the same things. It's saying it most of the effects of of that and also Peter O'Sullivan's studies on on cognitive functional therapy, most of the effects seems to be coming from this reframing of what the problem is, which is which is really powerful and really, really hard for people to believe.
00:42:17
Speaker
So that's the hurdle that we have to jump. But, yeah you know, the work that you're doing is fantastic in in hopefully hopefully jumping that hurdle. Yeah, I can relate because i had trouble believing it myself. Another one of my patients had a completely paralyzed stomach, and not the abdomen, not the belly, but the the stomach organ.
00:42:40
Speaker
It was completely paralyzed. we We had a specialized test where we get a nuclear tracer and the patient swallows it and we watch where it goes. And there's a normal amount of speed with which the stomach will empty the tracer and we can follow that with a scanner.
00:42:56
Speaker
And the scanning people called me and said, we've been scanning your patient for two hours and it hasn't moved an inch. Do you want us to keep scanning him? And I said, no, you know, after two hours with nothing emptying, he's got a paralyzed stomach.
00:43:11
Speaker
But it was 100% from a neuroplastic process because once I uncovered what the stress was, he got, he became well.
00:43:21
Speaker
um But beforehand, I never would have guessed that the brain could do that to the stomach. Yeah, yeah, it's it's um it's amazing when you think about it. It really is. And it it is a paradigm shift for ah society to come across to this new new research and new way of thinking.
00:43:41
Speaker
With the Boulder Back Pain Study, wi because like obviously when it comes to and MRI findings, this may not be ah obvious to everyone listening, but to to you and I, we know that there's always these abnormal, what they call abnormal findings that really are probably normal because most people have them, even if they don't have back pain.
00:44:04
Speaker
were Were those people with any sort of finding excluded or was it only those that um that we can really pin it down to a structural problem?
00:44:15
Speaker
yeah Yeah, that's a great question, Lachlan. I should have mentioned that. But you're absolutely right. There are studies that did MRIs or x-rays of people who feel fine of all age ranges, who have no back pain at all.
00:44:33
Speaker
and they x-rayed or MRI'd their spines just to see, you know, how did they look? And they didn't look good. More than half the people over the age of 40 and a large fraction of people under the age of 40 had abnormalities in their spine, and they felt perfectly fine.
00:44:52
Speaker
So it's you know very easy when you develop pain, especially neuroplastic back pain, and you go to a physician and they image your spine one way or another, and they see these abnormalities to point to them and say, this must be the cause of your pain. So what they did in the study was they took everybody, no matter what their spines looked like, as long as they didn't have physical evidence of neuroms nerve damage.
00:45:22
Speaker
So this this, you know, they there were all kinds of disc abnormalities and vertebral abnormalities and going on in people's backs because those are those are common. And yeah in the other study that was done and that I mentioned where they did very careful evaluations of of people with all kinds of of spine abnormalities, they found that 88% of them, the pain was not structural.
00:45:48
Speaker
And of the remaining 12%, half of them, it was a mix of structural and neuroplastic. So at least in the spine, it's the majority that that have neuroplastic pain, regardless of what is found on the imaging.
00:46:07
Speaker
I want you to speak to whether for those mixed presentations, so for for people listening, we sometimes when we're coming into, we're investigating what's going on, we we sort of put these categories to them. We get nociplastic, which is, you know, the nocipline, nervous system is playing a big role in it.
00:46:28
Speaker
And then nociception, which means there's structural problems that that may be contributing to it in a major way. um Or neuropathic, which means there's nerves contributing to someone's pain. Those are the sort of broad ones.
00:46:43
Speaker
There may be more. But what happens when there's a mixed presentation and you feel like there probably is some nervous system related changes that are contributing, but also say a neuropathic presentation.
00:47:00
Speaker
How do you go about managing those clients? Yeah, it is fairly straightforward for me. I just treat people for both. ah You know, if you find that you think there's ah combination of neuroplastic. and Neuroplastic is the term that my colleagues use for nociplastic. It means, you know, brain generated.
00:47:23
Speaker
um But since few people know what the noce means, we decided to go with neuroplastic. But yeah, a common example is in rheumatoid arthritis where, you know people have clear joint abnormalities and rheumatoid arthritis causes pain.
00:47:39
Speaker
um But sometimes the pain seems to be much greater than you would normally expect from the degree of arthritis that is present. And so it's appropriate to investigate and see if there could be a neuroplastic contribution and assess people for, you know, how much stress is going on in your life.
00:47:59
Speaker
Do you have a ah manifestation of, say, depression or anxiety here that is manifesting in your body in the form of a greater amount of pain than arthritis would normally produce, and treat people for both. And sometimes you can't even tell and the what the relative contribution is, that you know maybe 30% of the pain is structural and 70% is neuroplastic or vice versa, and you may not necessarily know until you've treated the patient for both.
00:48:31
Speaker
In my specialty of gastroenterology, many patients so with inflammatory bowel disease, so ulcerative colitis or Crohn's disease, for example, ah can have irritable bowel syndrome, which is a neuroplastic condition at the same time.
00:48:46
Speaker
And they only get better um when you treat them for both. Hmm.
The Gut-Brain Connection
00:48:53
Speaker
Yeah, that's it that's a great way to look at it. And i I think sometimes in hindsight, you can, looking back in the rear view mirror, you can work out what the sort of contributions contributions were.
00:49:04
Speaker
But in in sometimes in the moment, it it can be hard to know which which is contributing to it in a greater way. I want to get to your specialty in terms of terms of gastroenterology. And I know that that looks different to what we would traditionally look at, but you you may also do some traditional stuff as well.
00:49:29
Speaker
I'm interested in the role of the, what they call the gut brain access, especially in some of these complex problems like fibromyalgia, there seems to be some good research surrounding it, or at least new research.
00:49:44
Speaker
What are your thoughts on on that area and the way that the gut and and the health of the gut microbiome can affect pain? Yeah, two-thirds of my practice was normal gastroenterology involving you know ulcers and gallstones and tumors and things of that nature. and Only one-third of my patients had these neuroplastic conditions. So I was very comfortable moving back and forth and in both worlds, so to speak. And there has been some interesting research about the microbiome, which is the
00:50:20
Speaker
collection of microorganisms that live in our guts. And actually, the number of those organisms is greater than the number of cells in our body by a but factor of three or four. So from their perspective, we as human beings just exist to carry them around. So they're they are actually quite important in a number of different dimensions.
00:50:44
Speaker
But the problem has been determining the direction of the effect. If you have irritable bowel or if you have fibromyalgia and you have changes in your gut microbiome, as some of the research has shown, ah well, what's causing what?
00:51:02
Speaker
ah Is it the change in your microbiome that's causing the irritable bowel or the depression or the fibromyalgia? Or is it the fibromyalgia, of the depression and the irritable bowel that are causing the problems and or the changes, at least, in your gut microbiome.
00:51:20
Speaker
And it's very possible that it's in the direction of ah the brain changing the muscle contractions of the gut, which then leads to changes in the microbiome. There's a something called a migrating motor complex, which is a wave of muscle contraction that goes from your stomach all the way through your large your small intestine down to your large intestine, which is you know probably five meters and in a lot of people.
00:51:51
Speaker
And it sweeps out the bacterial contents and pushes them all down into the large intestine. And it's something that happens when you've been You haven't had any food in your gut for a while.
00:52:06
Speaker
And that motility, we call it, can absolutely be affected by what's happening in your brain. There are very strong nerve connections from your brain down to your gut.
00:52:18
Speaker
And your gut has, you know, approximately as many nerves in it as your spinal cord. ah So lots of communication going on in both directions. And if your brain is coping with massive amounts of stress, you it can affect the muscle contractions of the gut, which then affects the microbiome.
00:52:38
Speaker
It's like that that patient I mentioned whose stomach was completely paralyzed, or the woman with the one bowel movement per month. You know, just profound effects going from brain to gut.
00:52:50
Speaker
And there's no question that the microbiome will react to those changes. Yeah, wow. So you're saying that the brain and the stresses that that we're under affects the the gut microbiome. Are there other things that affect it? Like what's the role of diet in this?
00:53:10
Speaker
Yeah, it's you know it's a very complex system. I mean, you're talking about 100 trillion organisms of something like 5,000 different species, and they're all you know competing for nutrients, and some of them like oxygen, and some of them, oxygen is poisonous to them, and ah it's... um I think of it like the Amazon jungle down there. And so, you know, what you're putting down there, you know, has an effect. You know, what kinds of nutrients you're putting down there.
00:53:50
Speaker
you know, the the gut has been evolving for over 500 million years. I mean, the the intestinal tract that went from mouth to anus first appeared in a little worm 550 million years ago, and it has been evolving ever since.
00:54:08
Speaker
And it did not evolve to to deal with crisps and soda. You know, it it evolved to deal with much healthier types of food. And it's only been in the last century or so that the gut has been asked to cope with um all these, you know, manufactured, highly processed foods, high fructose corn syrup and whatnot that is being, you know, thrust upon us today. So I don't.
00:54:40
Speaker
I can't tell you from from research what's what kind of ah food is actually going to be ideal for your gut microbiome, but I absolutely have faith that the closer we get to ah the diet that the gut evolved to manage, ah the better off we're going to be. You know whole grains and lean meat and lots of, you know, vegetables and legumes and foods of that nature are going to be what we evolve to take advantage of.
00:55:15
Speaker
Yeah, it's a fascinating area for me because, you know, especially people with very complex pain systems, obviously the nociplastic thing is is one element to it oftentimes, as we've discussed, but what other options do we have in terms of treatment? And it seems like For some of these, the gut may be an area to target. And like you say, targeting the stress of that can also be a part of that, but but perhaps what we what we put into our stomach. So yeah, that's that's fascinating to me.
00:55:48
Speaker
Tell me the research about... Sorry, just one point about the research on on dietary manipulations. you know We go back to that statistic called effect sizes.
00:55:59
Speaker
And you can sometimes see an effect size, ah you know remembering that 0.2 was a small effect size and 0.5 was a medium effect size. Some dietary manipulations, you there are studies that get you to about 0.3.
00:56:13
Speaker
So they're not you know all that powerful. ah They are a little better than nothing in some cases. But not hugely powerful, especially when compared to the one and a half effect size that the neuroplastic psychology achieved with the back pain.
00:56:31
Speaker
So you're saying at the moment, it
Resources and Education on Neuroplastic Symptoms
00:56:33
Speaker
seems like the target is more the the brain and the stresses then than the gut in terms of effectiveness. I think that's where the research is showing we have the most leverage.
00:56:46
Speaker
Yeah, yeah. Yeah, interesting. It's good to hear. tell Tell us about your non-for-profit. You sort of mentioned it, but tell us the role of the non-for-profit, what the goal, the mission of it is, and and how it all started.
00:57:01
Speaker
Yeah, the Association for Treatment of Neuroplastic Symptoms, was launched in 2011. And the goal is to educate both the public and healthcare care professionals about neuroplastic symptoms and their successful treatment.
00:57:19
Speaker
And we've been growing steadily ever since. ah Personally, I give speeches all over North America and Europe. and We've got a video-based courses for professionals that are jargon-free so that the public can take them and benefit from them as well.
00:57:37
Speaker
We just launched one a year ago called Challenging Cases, which has got some of the more difficult and fascinating patients that I've seen over my career and we We hired actors to play those roles so that it would be a more realistic depiction of um what it was like for those patients and for me to try to diagnose them.
00:57:59
Speaker
It's a fascinating course. We have um a new podcast that just started last week ah where I'm interviewing a patient ah most of whom have recovered from neuroplastic symptoms, but some of whom have not, about all of the psychosocial issues that are responsible in their lives for producing their symptoms.
00:58:22
Speaker
and We have an annual conference that is happening next at the end of September ah in Boulder, Colorado, for anybody that fancies a trip to the United States. So, yeah, and lots of resources, videos and the self-assessment quiz on symptomatic.me, which is our website.
00:58:43
Speaker
Yeah, awesome. I'll ah put put those links if you can share them with me. I'll i'll pop them into the to the show notes for anyone listening. They can they can go and check
Understanding Pain as a Brain Signal
00:58:52
Speaker
it out. I want to ask a question that we've sort of been talking around, but I want you to just give us your best summary of why we hurt.
00:59:03
Speaker
Like, why do we feel pain? Well, it's a danger signal. It tells us that there is something that needs to be paid attention to. And usually it's damage to our bodies. If if I whack my thumb with a hammer, and there's going to be tissue damage there. And that doesn't cause the pain itself.
00:59:26
Speaker
It just causes tissue damage. And then that signal from the tissue damage goes up to my brain And my brain has to decide, is it going to give me a pain signal there in my thumb so that I will not injure the thumb even more?
00:59:39
Speaker
But it's a decision the brain is making about whether that pain signal is a good thing. For example, ah ah if I sprain my ankle while I am running from a gaiter, I'm probably not going to feel pain in that ankle until I get to a safe place.
00:59:58
Speaker
So it's a decision that the brain is making about whether to ah send me that pain signal or not. And there are people who, because of a genetic abnormality, don't feel any pain.
01:00:11
Speaker
And they end up with long-term structural damage in their bodies because they don't know when their body needs protection. And the the same thing happens in... ah when there's danger or damage from an emotional cause.
01:00:27
Speaker
um The brain is is trying to communicate to us that there is something it is distressed about. And if it can't do it by bringing that issue into conscious awareness, it'll sometimes send signals into the body instead.
01:00:45
Speaker
As a very succinct way of of putting it, Dave, it sounds like you've had a lot of practice over the years and a lot of peef a lot of people will be able to grasp that really clearly. And I think that one of the key things that I i keep trying to drive home is that pain is more than tissue damage or body damage.
01:01:05
Speaker
Sometimes not less than, sometimes you know that that is involved, um but it's certainly more than. And waste yeah you know as a clinician, you see this with people with with structural problems that ah that seem awful and they they have very little pain, if any.
01:01:25
Speaker
And then you see people that have very, very good looking scans. and and no structural damage with with a lot of pain. It just doesn't seem to relate. So yeah, I appreciate that, how succinct you were then.
01:01:40
Speaker
um I think
Hope for Those with Unexplained Pain
01:01:41
Speaker
that'll be great for the listeners to hear. Lastly, and this is a little bit of a tradition on on this show, i want you to speak to someone that is listening, that is struggling with pain, that's feeling that there is no hope and they're,
01:02:00
Speaker
there Yeah, they're just they're just in a dark place. Can you speak to them? Yeah, absolutely. There is tremendous hope in this approach. And the the problem in the traditional healthcare care system is that pain from a neuroplastic process this hasn't been recognized, it hasn't been validated.
01:02:25
Speaker
And then when people look elsewhere for answers, they get confronted with Various companies that are exploiting people with this condition to make a profit and they are selling devices or manipulative therapies or supplements.
01:02:45
Speaker
Supplements are are huge in the United States where they're largely unregulated. And none of them have any more than placebo value. And so people go on suffering and wondering if if they must be crazy because they have this real symptom and nobody seems to know what to do about it.
01:03:06
Speaker
And i so many of my patients have reached a place of of hopelessness. you know, that patient who was hospitalized 60 times at a prestigious university and I don't know if I mentioned that when I first met her, she said, don't waste your time with me.
01:03:23
Speaker
ah You'd be better off seeing your other patients. ah Just such despair. And yet, i she was successfully treated in a very short space of time. And So there's there's tremendous hope when this approach is um is followed.
01:03:41
Speaker
And that's that's my message is look into this, look at the resources. We've got books, videos, self-treatment course ah for members. We've got online Zoom Q&A.
01:03:54
Speaker
Every three months, we do an online Zoom that's for free. You don't have to be a member to access it. And um we schedule it weekly. at a time when it's you know in the morning. I think it's approximately 7 or 8 in the morning in Eastern Australia so that Australians can look in on that and get questions answered there too.
01:04:17
Speaker
The next one's going to be, I think, June 24th or something close to that. So lots and lots of hope, Blackland. Awesome. Well, thank you so much for for coming on the show. Thank you for giving up your time and sharing your wisdom. We really appreciate it.
01:04:36
Speaker
Thank you very much. I appreciate you getting this information to your viewers. If you found this podcast helpful, please click follow.
01:04:47
Speaker
This simple action can help us reach more people and spread hope for those living with chronic pain.