Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
The Missing Two-Thirds Of Pain Treatment + Find Your Pain Recipe | Dr. Rachel Zoffness (PhD)
131 Plays2 months ago
Dr. Rachel Zoffness (PhD) is a pain psychologist and author who has devoted her career to understanding why we suffer with pain and what we can actually do about it.
We discuss:
- The childhood experience with chronic pain that sparked her obsession with understanding suffering.
- The "biopsychosocial" truth about pain that medicine has known for 65 years but never tells patients.
- Why the healthcare system only treats one-third of the pain problem.
- The "pain dial" in your nervous system and the three factors that turn it up or down.
- How she learned to warm her hands to 90 degrees using only her thoughts.
- The difference between a "high pain recipe" and a "low pain recipe" – and how to craft yours.
- If there is an off switch for pain and whether you would want one.
And much more...
Rachel's new book Tell Me Where It Hurts is out March 24th and is available for pre-order on Amazon.
RESOURCES
- Pain Coach: Find Lifestyle Targets for Treating Pain
- Tell Me Where It Hurts
- Rachel's Website
- Book an appointment to see Lachlan
KEY TOPICS
00:00 The lie medicine has sold you about pain
01:24 Why Rachel devoted her life to studying pain
03:02 Chronic pain as a child & what she wishes she'd known
05:28 What is pain? The biopsychosocial model explained
08:05 The three domains: Bio, Psych & Social
09:05 The missing two-thirds of pain treatment
11:32 Why pills and procedures aren't working
12:13 Central sensitization: How pain becomes chronic
15:01 The piano analogy: Your brain practices pain
17:50 Is there hope? Can the pain pathway shrink?
25:52 The Pain Dial: How to turn your volume up and down
26:15 Factor 1: Stress and anxiety
26:40 Factor 2: Mood and emotions
27:25 Factor 3: Attention and focus
28:16 The good news: The opposite is also true
30:18 Is there an on/off switch for pain?
32:04 Why opioids work (and it's not just physical)
33:39 Can chronic pain ever fully disappear?
35:32 The Pain Recipe: High pain vs low pain ingredients
38:35 Crafting your low pain recipe
41:51 Habit change & lasting pain relief
45:08 Biofeedback: How Rachel learned to warm her hands to 90 degrees
51:42 Your thoughts literally change your biology
53:16 Biofeedback is as effective as migraine drugs
54:16 This isn't "manifesting" – it's science
55:55 How to reduce fear during a pain flare
58:24 What surprised Rachel while writing the book
01:00:26 About "Tell Me Where It Hurts"
01:02:10 Rachel's parting advice: Write your pain recipe
Recommended
Transcript
Understanding Pain Beyond the Biomedical Model
00:00:00
Speaker
Pain is not a purely biomedical or biological phenomenon. That is the lie we've all been sold. But we have 65 plus years of science that tells us that so many more things go into pain production and also pain reduction. And and like this is not new and it isn't news. The problem is that when we only focus on the bio domain of pain, we're missing two thirds of the pain problems. Just as there is a recipe for brownies, there is always a recipe for pain. Tell me the ingredients that go into making a high pain day.
00:00:35
Speaker
I want you to think about it because I'm going to ask you in a second. Like for me, it's... Dr Rachel Zofnus is a pain scientist and thought leader revolutionising the way we understand and treat pain. She's an assistant clinical professor at UCSF, lectures at Stanford and consults on the development of pain management programs around the world.
00:00:56
Speaker
Her new book, Tell Me Where It Hurts, drops March 2026 and will be translated into more than 25 different languages. This podcast is for educational purposes only.
00:01:08
Speaker
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.
00:01:23
Speaker
So, Rachel, you've devoted a significant portion of your life to pain and this field of pain treatment. Yeah. You know, you're a clinical psychologist ah that specializes in pain. You're an authored writer in this area with, I think, two or maybe three books on chronic pain. You've devoted a significant amount of time and effort into this field. Why? What is the reason that you have dove into the pain field?
00:01:56
Speaker
I originally started studying pain as a complete nerdy undergrad at Brown University because I was scared of it. That's why. I took an introduction to neuroscience class and my professor was telling us about the science of pain and how it worked. And I, you know, the natural human response is to be scared of pain.
00:02:16
Speaker
That's standard. It's an aversive human experience. And I found that as he explained pain to me, my fear of pain started abating a little bit. And so for my honors thesis, I was matched with a pain neuroscientist at Brown. He really took me under his wing. And I learned so much over the course of that study. Um, But the the honest answer is that I started studying pain because I was scared of it. And for me, knowledge has always been power. The more I understand something, the less scared of it I am.
00:02:47
Speaker
why Why was it that you were scared of pain? Like, I mean, we all naturally are to some degree, but was there some sort of personal experience that you've had or something that had led to you being fearful of pain?
00:03:01
Speaker
um I would say it's sort of just a general fear of pain, just the way anyone's scared of pain. But as a kid, I had had chronic pain episodes. So I think that probably amplified it for me. m What is it that you know now that you wish you had of known back then when you were dealing with chronic pain as a kid?
00:03:21
Speaker
Oh my, there's so many things to say about that. But I think most revelatory was the fact that pain is not a purely biomedical phenomenon, like something to do just with bones and body parts. What I would have appreciated knowing at any point in life before becoming a pain expert is that pain is actually a biopsychosocial phenomenon and that emotions adjust pain volume and your social health adjust pain volume and even your environment and even your parents and you know everything happening around you adjust pain volume too. That would have been So empowering for me if I had had that information. And I remember when I first learned about it in college, it was really one of those like your head is exploding emoji moments. You know, I couldn't believe it. I had this i had this sense of like, why did no one ever tell me this before?
00:04:17
Speaker
Why is this the first time I'm hearing it? And then, you know, of course, if you're an adult who's engaged in any sort of sport or activity, you probably will have more pain episodes as you age. And of course, I had multiple. And with every injury, I learned more and more about what pain really was as I continued my studies, which sort of occurred in parallel with what was happening to my body. And, you know, as I learned that, for example, emotions are physical,
00:04:47
Speaker
That was really a game changer for me too. So for example, you know, we're told that emotions are this psychological event that occur occur in the space between your ears. But, you know, any doctor will tell you that every emotion has a somatic component. And that word has become this stigmatized bad word in in medicine. And I hate that because the somatic aspect of emotions is part of the emotional experience. Like when we're sad, saltwater leaks from our face, you know, like, Every emotion is somatic by definition. And I wish I had known, you know, when I was younger that emotions are physical. They're part of the pain experience. The parts of your brain that make emotion also make pain.
00:05:28
Speaker
That would have been such a game changer for me at at any stage of my life. Fascinating. Yeah. So, yeah. Okay, so there was sort of a a shift over your life from a biomedical pain understanding to more of a more complex biopsychosocial understanding. what For those that are sort of going, what do you mean, like how did you shift your understanding of pain? Because people experience pain and so experience. They feel and they are in in some ways an expert in it because they they know how they feel it. They've experienced it. And they haven't probably put a lot of thought into what is pain, although many people listening would have.
Pain as a Biopsychosocial Phenomenon
00:06:10
Speaker
So what what is pain? How does it work?
00:06:13
Speaker
can you Can you teach us? Yeah. I mean, I can give you the language that I like to use, which has sort of been honed over time. um And the reason it's been honed over time is, as you know, there's a lot of stigma around any suggestion that pain has an emotional component. Like for some reason, not for some reason, I can tell you the reason. What we have done in medicine is we've separated out physical pain from emotional pain so completely that any mention of combining them creates this sense of like, oh, you're saying it's all in my head. So like,
00:06:44
Speaker
here in the States, you know, either you have physical pain and you're sent to a physician or you have emotional pain and you're sent to a psychologist, you know, or psychotherapist. And that's not how pain works at all. So um I've sort of have had to over time sort of create some language around this. So Pain, by definition, is the body's warning system. It's our danger detection system. And I like to think of it that way because when I first learned about pain, the same professor who I keep talking about, who I should probably call and tell him I'm talking about him all the time,
00:07:16
Speaker
told us that there are people who are born with a very, very high pain threshold. In fact, it's so high that they don't really get these warning messages or danger messages. And I remember thinking, that sounds so nice. Who doesn't want a life without pain? And of course, he followed that up by saying, and those people don't live very long. And it it was really, it drove home for me this idea that pain is adaptive. It's this Very important message from your body, often, not always, that something is happening.
00:07:52
Speaker
So, of course, there's a difference between acute pain and chronic pain. So just to define terms, acute pain, pain lasting three months or fewer. chronic pain lasting three months or longer. There's other definitions of chronic pain also, which I sort of hate because they're so fuzzy, like biomedical thing to do just with bones and body parts, anatomy and physiology. But we have 65 plus years of science that tells us that so many more things go into pain production and also pain reduction. and And like this is not new and it isn't news. And as neuroscience has evolved, we've been been able to get gather so much more data on this. So we know that, you know, pain is this, when I say biopsychosocial, I want to say what I mean by that. If you imagine a Venn diagram with three domains or three overlapping bubbles, pain lives in the middle of these three domains. So there's the biological domain of pain, and that's the one we've all been taught the most about. And the biological domain of pain is genetics and tissue damage, system dysfunction, inflammation, diet, exercise, sleep. I put those in there. So all of these things we know, of course, are very, very important for pain.
00:09:05
Speaker
The problem is that when we only focus on the bio domain of pain, we're missing two thirds of the pain problem. So I want to say what the psych domain of pain has and the sociological domain of pain. So the psych domain of pain has all these other things that we also intuitively know affect the pain we feel. For example, our thoughts, believe it or not, The things we think affect our bodies 100% of the time. Of course, we know that's true. if you start thinking, I'm going to be in pain forever, I'm broken, your brain will bump out. Your brain and body will bump out. Stress hormones, cortisol will go up. Muscle tension will go up. Your thoughts affect your body. Those things, of course, are going to amplify pain volume.
00:09:52
Speaker
Emotions also live in this psychological domain of pain. And what I mean by that, and hopefully we'll get into it more, is that science shows us that negative emotions like stress and anxiety and depression and anger will amplify pain volume and that positive emotions, relaxation,
00:10:14
Speaker
happiness, joy, gratitude will lower pain volume. And also in the psych domain of pain, we have coping behaviors. And I love thinking about and talking about coping behaviors because that's something that we all have so much control over more than we even realize. So by coping, I mean, when we have pain, how are we handling it? What are we doing about it? So many people with chronic pain, as you well know, will stay home, stay inside, stay in bed, stop exercising, stop moving. And science tells us that that that is very bad for our body and our brain and is ultimately going to amplify pain over time. Our muscles get tighter, our joints get stiffer, our brain and our brain gets more sensitive, so these pain messages get amplified. So coping actually changes the pain we feel too. And then we have the sociological domain of pain. And I like to call that the everything else domain of pain because so much is in there. You know, socioeconomic status and access to care and race and ethnicity and social support or lack of it and isolation. You know, there's there's so much in that final domain of pain, including environment and context. So together, all of these things create the pain experience. And I...
00:11:32
Speaker
I get so frustrated on behalf of my patients because that word is never used. Patients are never told and all they're ever given for their pain is a pill or a procedure. And we know it isn't working because rates of chronic pain
Chronic Pain Mechanisms and Management
00:11:46
Speaker
aren't going down. They are on the rise.
00:11:49
Speaker
a Yeah. so pain is multifactorial. There's lots of things that contribute, which you've sort of outlined.
00:12:00
Speaker
And there's ah there's a key function that they all go through, which is this sensitization. Can you explain this process, how that works in simple terms?
00:12:12
Speaker
Yes, I'll do my best. So when scientists have poked around and tried to understand why pain becomes chronic, they've come up with a lot of really interesting and important discoveries that are relevant for us as people living with pain. you know And I always like to say this upfront, I think it's There's this sort of myth in medicine that there's providers on the right and patients on the left. And that's not true about pain. Like pain is coming for all of us. None of us are going to escape. We are all pain patients. So one of the processes by which pain becomes chronic is this process called central sensitization. And the way I like to think about it is...
00:12:57
Speaker
When we think of something that's sensitive, like dogs have a sensitive sense of smell. And what that means is if my dog came trotting into this room right now with his sensitive sense of smell, he would detect and pick up all these faint scents that I and smells that I could not detect. So we think of sensitivity as maybe a bad thing. It's not a bad thing. It's a wonderful thing. and A seismograph, I live in the Bay Area, seismograph is this machine that detects earthquakes. And a sensitive seismograph is a superior machine. Why? Because it picks up small bits of sensory data and it amplifies them before any other machine that's less sensitive. So what we've discovered with the human brain is that the pathways in the brain are like the muscles in the body. The more we use them, the bigger and stronger they get over time. So like if you said to me,
00:13:51
Speaker
Hey, Zofniss, I want really big biceps. I would say, of course you do. Who doesn't want huge biceps? I recommend you go to the gym and lift lots of weights, and over time, with repetition and experience, your bicep muscles will get big and strong.
00:14:07
Speaker
It turns out the same is true with the pathways in the brain. The more we use them, the bigger and stronger they get. So I like to ask people, is there like a skill or something that you were bad at and you practiced over time and you got good at?
00:14:23
Speaker
Give me one. Oh. It can be an instrument or a sport or like anything you were bad at, you practiced it over time and you got good at it. This is an extremely strange one, but I never used to be a reader as a child. So like growing up through my teenage years, it wasn't until about 15, 16 that I started just consuming lots of books. And now, you know, I i consume probably on average 12 per year. And that's actually a little bit of a recurring New Year's resolution to consume 12 books. So that is very strange, but I got better at reading and enjoying reading. So yeah, that's one that I've got. Good.
00:15:01
Speaker
I like that one. So for me, it's piano. Like when I was a kid, my mom was like, you should take piano lessons. They're good for your developing brain. And I was like, don't have to. I have to. And she was like, look, the more you practice, the easier it will get. Turns out, lo and behold, she was right. I would sit down at the piano, practice, practice, practice. And I noticed over the weeks and months and years that the more I practiced, I could just like sit down at the piano and my fingers magically knew what to do. I didn't even need to read the seat the sheet music. And there's a reason for that. The longer I practiced playing the piano, the bigger and stronger the quote unquote piano pathway in my brain
00:15:40
Speaker
became to the point where I would hear the songs in my head. i could just hear them. I could hear the music. And you know we've all had that experience where we practice something over time and we become so good at it that it almost feels like it's become automated. And that's because the pathways in our brain, again, are like the muscles in our body. And what we've learned is that what happens over time is that the longer we practice pain, the bigger and stronger this so-called pain pathway in the brain becomes. And I want to say clearly, there is no one single pain pathway in the brain. That's not how pain works.
00:16:16
Speaker
Pain is this multi-system experience in the human body, but for our purposes, the bigger and stronger your pain system becomes over time. And when that happens, we say that your brain and your pain system have become sensitive. And again, back to the way we described what sensitive means,
00:16:35
Speaker
When your brain and body have become sensitive to pain, what that means is your brain is now detecting small bits of sensory input from your body and amplifying it. So your brain is telling you that there's danger when, when it comes to chronic pain, usually there is not. And these loud danger messages, of course, are interpreted as pain. So central sensitization is one of these driving forces behind why pain becomes chronic. Hmm. I find that incredibly hopeful for people that are living with pain, but it's also quite scary. And I'm i'm thinking from personal experience. This idea of um the the pathways of pain get stronger, you know, the more you live with it, it can be a very daunting or scary idea.
00:17:26
Speaker
yeah what would you do to alleviate some of those fears that I have around that? I'm glad you said that. So what I really love about it actually is that just as the brain and body can become more sensitive, they can also become less. And we know that that's true. So if you've ever gone to a movie theater, and I hope you have because movie theaters are really fun, and the lights go off and you're in the dark for a couple of hours, you'll notice that your eyes adjust and adapt to the light and become more sensitive to light over time. What do I mean? What I mean is
00:17:58
Speaker
Of course, you know, in the dark, your eyes, your pupils get larger and the photoreceptors in your eyes become more sensitive and they start collecting more light. The longer you're in the dark, the more sensitive your eyes become. Now,
00:18:13
Speaker
If you walk out of that movie theater into the bright, blinding sunlight of the daytime, you're like, oh my God, oh, that's terrible. And for me, that analogy is like asking someone with chronic pain to go outside and run run a marathon. Like that is unrealistic. And to a sensitive brain and body, that's a disaster. And that's not what we ask our patients to do at all. In fact, what we want to do with our patients is desensitize their brains and desensitize their bodies. So to keep the analogy going, if you've been in a dark room for a really long time, what I'm gonna ask you to do is slowly open the blinds just a little bit. I want you to let in just a tiny bit of light. And you know, having done this probably before,
00:18:56
Speaker
that your eyes and your brain will slowly adapt to that little bit of light. And then when they've adapted, you open the blinds a little bit more, brain and body desensitize a bit more, open them more until suddenly you're in a room flooded with light, you're not in the dark anymore, and you are okay, you're not in pain. So
Strategies for Pain Management
00:19:13
Speaker
one of the most important tools I love to teach patients is this tool called pacing.
00:19:17
Speaker
And pacing for pain is much like pacing for a marathon. I am not going to ask you again to run outside 26 miles tomorrow. you Your body will fail. i mean, like, I would be a mess. What we want to do is gradually titrate you up.
00:19:34
Speaker
Like, you want to start at whatever is tolerable now. And if that's 20 seconds of activity, great. You know, and then I'm going to gradually help you work your way up. you know, to whatever your goal is. And as far as I'm concerned, one of the most important parts of pacing is asking people, tell me one thing that pain has taken from you that you wanna take back. Like one activity, what bit of real estate do you wanna take back from pain? Is it fudge making? Is it walking? Is it, you know, rolling around on the floor with your grandkids? Like what is the thing that pain has taken? And once I have a thing that's personally meaningful,
00:20:13
Speaker
to the people I'm working with. I know they're going to be motivated to do the pacing protocol, like those little bits of activity and stimulation that will help their brain and body adjust and and help lower pain volume.
00:20:25
Speaker
a lot Did I answer your question? Yeah, absolutely. i love I love your analogy because, well, I've definitely experienced it. I don't know if some of the listeners have experienced it when you when you're in the cinema and you come out and if you you've got lack of sleep as well. You're hit with this like headache behind the eyes. It feels like it's it's very intense. I do wish that pain would desensitize as quick as I do when I come out of a cinema. but and And I love pacing and it's something that I use clinically all the time in the physical sense.
00:20:55
Speaker
But sometimes it is complicated because there's lots of factors that can contribute. And it's not just the physical things that you'd like to do that can flare up pain, but also sometimes it's the cognitive load or your work capacity or um your your capacity to handle stress and all of those things. And I think, you know, I would love to talk to you about that aspect.
00:21:19
Speaker
side of pacing, more of the psychological slash cognitive side. Yeah, being a psychologist, I think you'll be able to speak to that well.
00:21:29
Speaker
Yeah. So I want to back up for a second and say, by necessity, I am simplifying some extremely complex concepts. And and the reason I'm simplifying them is because they're so complex and because they're really scary. And I think it's really important to be able to take these super complex phenomena and make them really digestible. So as, since we're going big picture, I also want to say, I said before that pain is biopsychosocial. And what that means is there's a bazillion ingredients that are affecting your pain volume in every given moment of every day. So yes, sensitivity is part of the picture, but so is sleep and so is diet. And so is, you know, how much you've been moving and whether you haven't been moving. And So is whether you have social support or you've been isolated and you know what and how negative your thoughts have been and your emotional state and your mental health. So there are a million ingredients. And so just to say, like I recently wrote a book. It's called Tell Me Where It Hurts. and And the reason I wrote the book was because I really wanted to go down the rabbit hole with the research of all these different domains of pain. Like I wanted to know how many studies are out there, how compelling are they, what do they say? And I amazingly, like it was such an amazing and challenging experience. I don't think I've ever done anything so hard. Like this book took me three years and I'm a nerd and I love nerdy stuff, but this was head and shoulders, the heart. I i read hundreds of papers a week. I mean, it's it was crazy. But I learned so much about the data we've collected about pain's complexity. And and I want to just clarify and say, while I have really absorbed and accepted the fact that pain is really complex on this journey, I also learned, and it really concretized for me, that pain is also so much simpler than we ever imagined. Because if you can figure out with hopefully a trusted provider what your pain recipe is and all the ingredients that go into making pain, you have the power to change the recipe and change pain volume. So I just, I wanted to make sure I wasn't, you know, being one of those people who's suggesting that, oh, it's the simple, easy thing and your brain's sensitive and you just desensitize it. It's it's not, it's not. But that is one of the processes.
00:23:49
Speaker
So back to your question. You asked, tell me again what you want to know. You said cognitive factors. Tell me more specifically what you're asking. Yeah. So I guess, you know, we we talk about pacing and graded exposure as physical therapists, as you call them in the States, or physiotherapists here in Australia.
00:24:09
Speaker
we We talk about that from a physical point of view, the graded exposure, pacing, work. where it be running marathons or whatever it is that you want to achieve and how to do that slowly and gradually so that the pain system doesn't yeah overwhelm you with pain flares and those kind of things. So I wanted to hear your, because for me personally, it's, there is an aspect of that, but it's also probably, you know, the cognitive load. I'm a very ambitious individual. um i
00:24:43
Speaker
yeah You know, I own a clinical business and then I'm the founder of Pain Coach, which interestingly overlaps amazingly with some of the things I've been discussing. But I'm very ambitious and I know that when I am highly stressed and I've taken on too much, that my pain flares. And I also know that when i go on a holiday, it generally seems to settle a lot.
00:25:10
Speaker
Great. And so for me, like that pacing from more of those aspects is actually probably more important. Like I i would probably prefer to do a 70-kilometer bike ride than then have a really stressful week at work when it comes to pain.
00:25:25
Speaker
Totally. Okay. So as you can tell, I'm really big on metaphors and analogies because, again, this is a complex topic. It's a scary topic. And knowledge is power, and it helps reduce fear around pain, which is always my job and always my goal. So I want to offer another metaphor that I use to talk about some of these cognitive and emotional components. So I want you to imagine in your central nervous system, which is your brain and your spinal cord, that you have what I'm going to call a pain dial. And And this pain dial operates much like the volume knob on your car stereo. Like you can turn pain volume up and you can turn pain volume down. And there's many things that adjust pain volume. And of course, one of those things, thank God, is pain medications. But there are many other things that change pain volume also. And I want to tell you about three things in particular.
00:26:14
Speaker
One of those things is stress and anxiety changes pain volume. So, When your thoughts are worried and your body is tense and tight, your muscles are tense, your brain sends a message to this pain dial amplifying pain volume. So pain, as we all know, feels worse when we're stressed and when we're anxious.
00:26:39
Speaker
thing two is mood and emotions. So we know from science that when our emotions are negative, we're miserable, we're depressed, we're angry, we're frustrated, the brain sends a message to the pain dial amplifying pain volume. And specifically, people have heard of the amygdala and the limbic system. Those are the parts of the brain that will ratchet pain volume up when our mood is low and emotions are bad.
00:27:09
Speaker
And of course, you know, when you're stressed, that's connected to your mood. When we are really stressed out and cognitive load is too intense, mood tends to crash. And thing three that I want to mention is a cognitive factor called attention.
00:27:25
Speaker
We know that when we focus on pain and think about pain and talk about pain all the time, our prefrontal cortex sends a message to the pain dial amplifying pain volume. Pain feels worse when we focus on it. In fact, if I sit here and, you know, you ask me to, like, focus on pain in my body, I will suddenly, my brain will zoom in on the body parts that hurt, like my right leg and my jaw, you know, like...
00:27:51
Speaker
You think about it, focus on it, the brain will amplify it because the brain is like a magnifier. You know, the second you focus on something, the brain will magnify the sensations. But here's the good news. And with everything that I explain, I always want to have good news that is critical. Like hope and agency are critical for healing. So here's the good news.
00:28:16
Speaker
All of everything I just explained with the pain dial, the opposite is also true. The opposite is also true. So I said stress and anxiety is a factor.
00:28:26
Speaker
We know that when our thoughts are calm and our body and our muscles are relaxed, the brain sends a message to the pain dial lowering pain volume. There is a reason that doctors prescribe muscle relaxants When it comes to pain, there is a reason, even though we all roll our eyes, that mindfulness-based stress reduction and you know belly breathing and Lamaze breathing for women who are giving birth actually changes pain.
00:28:56
Speaker
That is science. Thing two I said was mood and emotions. We know that when our emotions are positive, we're happy, we're joyful, we're experiencing gratitude, we're and we're engaged in pleasurable activities, our limbic system, our amygdala will lower pain volume and turn it down. And thing three I said is attention. We have all experienced this one.
00:29:22
Speaker
When we are distracted, We're so absorbed in some activity or hobby that we briefly forget about our pain. That is not magic. That is our brain's pain dial. We know that when we distract our prefrontal cortex away from the thing that's hurting, pain volume is going to go down. And what I love about this pain dial thing is that it really reminds us that we have so much more power over pain than we realized. Like we every day get to put our hands on that dial.
Controlling Pain Without an Off Switch
00:29:51
Speaker
We can adjust our thoughts. We can adjust our emotions. We can adjust our coping behaviors. We can change attention. And like that puts power into the hands of people with pain.
00:30:02
Speaker
Yeah, it's amazing. It's amazing to know that. I wonder, well I've heard this, you know, the pain volume um metaphor has been spoken about a fair bit ah and previous people on the pod have also spoken about it.
00:30:18
Speaker
i wonder what your thoughts are around, and this is a bigger question that I have, but around, okay, so there's a pain dial that turns the volume up and down, but is there an on-off switch?
00:30:32
Speaker
And is there, yeah, well we'll start there. Is there an on off switch? Okay. So I I answer questions confidently and I want to say with complete humility that like no one knows everything about pain. Like we all have gathered a lot of data and experience and wisdom. Like I am someone who lives with pain and I'm someone who treats pain. So i you know, and I've devoted my life to it. So yes, I know a lot about it, but I don't want to pretend to be some like, you know, No, no at all. But I will say this.
00:31:01
Speaker
It would not be evolutionarily adaptive to have an off switch. We don't want one. You don't ever want to feel no pain because God forbid you've turned on your off switch and you go for a run and you step on a nail and you like are at risk of contracting tetanus and your foot's at risk of infection. You don't want an off switch. Pain is adaptive. Pain helps you survive. Like we already established that chronic pain means the brain has changed in this not great way where it's amplifying pain messages and telling you you're in danger even when you're not. So with chronic pain, we really need to retrain the brain and body so that we can lower pain volume and help you become functional again and get your life back, you know. And yeah and so in my mind, like, you know, it's more of a danger warning system when it comes to acute pain messages and we really wanna pay attention to those. But I do not think it's adaptive for any of us to have an off switch. So I would say, no, there's probably not an off switch for pain. Can we lower pain volume? Yes. Do do drugs do a great job of doing that?
00:32:03
Speaker
They sure do. You know, like people on high doses of opioids will report they feel very little physical and emotional pain. That one kills me. Like opioids are effective not because they go after just physical pain. They dull the pain of isolation and loneliness and depression and anxiety also. And there's a reason for that. The reason for that is that the parts of the brain that make emotion also make pain. So we can definitely dull pain volume, you know, to a dull roar sometimes and sometimes even less than that. But no, there's not an off switch, I don't think, for pain, no.
00:32:39
Speaker
So I understand what you mean when you say like there's not a permanent off switch, but what if there was an off switch that could be triggered by some of these events? You know, like so for someone that is dealing with chronic pain, be nice for that particular switch to be off, at least for the time being while prior to some sort of an event that you need to know that you're in danger, you need to go to the hospital, get the tetanus shot as your example. Yeah.
00:33:06
Speaker
I guess that's where... So I actually, by the way, I'm a massive, I love what you do. And I'm just thinking about all of the questions that someone that would be listening and I have the beauty and so do you of having like that personal experience as well. And so I'm like always trying to think, what are they what are they asking right now? Yeah. is Does that mean if there's no off switch, does that mean there's no ah hope of permanently
00:33:38
Speaker
ah removing chronic pain. Ah, I see. Okay, so I'm someone who has had to train myself over time to not be black or white. Like my brain wants to be black or white, on, off, good, bad, black, white. think we all do.
00:33:53
Speaker
Right. yeah and And that's not how the human body works. No. we We exist on a spectrum. Literally every effing thing about humans exists on a spectrum, like aggression, the size of our nose, you know our ability to hear. like Everything's on a spectrum. That's true for pain too. So what I love about the pain dial analogy is like, yeah, you can dial pain down to zero. like Right now in this moment, I have zero pain.
00:34:18
Speaker
Zero, none, absolutely none. And again, I'm someone who lives with chronic pain. So Yes, of course we can dial pain down to zero. Does that mean there's an off switch and it's gone for good? I would say no. i would say my dial's down at zero. I've been really diligent about taking care of my pain and self-care and all the things i know I need to do to make sure that pain volume is dialed low. But I also know, you know, just because of what's going on with my body that like it could also dial back up again. So I'm always sort of careful about what do I need to do. That's not true of everybody. Like I have plenty of patients and there are plenty of stories of people who had chronic pain and now they don't anymore. Like that is a thing. And there were, you know, certain pain things that I used to have that I don't have anymore. Right. So, um I think there's always hope for treating chronic pain. I think there's always hope for making pain go down to zero. I think there's always hope for making pain disappear. But I think it's different in my mind than this like off switch because to me that's like the danger of a black white thing. And I do want to also add to that and say, at the risk of overwhelming your lovely listeners with metaphors and analogies, I want to offer another one that was life changing for me and is life changing for my patients. And that is this concept of a pain recipe.
00:35:32
Speaker
And I want to say what I mean by that. Just as there is a recipe for brownies, there is always a recipe for pain. um Are you someone who likes to cook or bake? I am not. I am like the worst. Thank God my husband is best cook of all time. I do i prefer cooking than cleaning. um My wife and I have a deal because she she doesn't like cleaning after. And so and i I, no, su sorry, she I don't love cleaning after cooking.
00:35:59
Speaker
But she She does she doesn't mind. She prefers the cleaning part than the cooking part. So I usually cook. So, yeah, actually I'm fond of cooking. So I'm with you. Yeah. So I am someone who hates cooking. Thank God my husband is like the best cook of all time. But but as someone who who cooks, you know – that there's always a recipe of ingredients that go into making whatever it is you want to make. And you also know that if you leave out certain ingredients, you'll get a different end product. Like if you want to make brownies and you leave out the cocoa powder, you will have really gross brownies. Or we also know with a recipe that environment matters. Like if the temperature of the oven is wrong or the oven is broken and there's no heat, that matters. The pan that you put the brownies in, that matters too. So environment matters, ingredient matters.
00:36:51
Speaker
The same is true for pain. Again, just as there's a recipe for brownies, there is always a recipe for pain. We all know this intuitively. Like if I ask people, Tell me the ingredients that go into making a high pain day.
00:37:06
Speaker
Like, I want you to think about it because I'm going to ask you in a second. Like for me, it's being sedentary for too many hours, sitting in front of my computer without taking breaks and standing up, not exercising, being isolated. Like I wrote a book for three years and, you know, that was really bad for my pain. I wasn't, you know, engaged enough socially. i know that eating a crap diet is going to amplify pain for me. Part of my recipe, you know, I know that poor sleep is part of my high pain recipe. So all of these ingredients together, I call your high pain recipe and everybody has one. Do you know, do you know some things that are in yours? Yes.
00:37:45
Speaker
Yeah, for sure. And interestingly, this ah this is kind of my was my motivation for creating Pain Coach, which is a lifestyle tracker that finds lifestyle targets for the treatment of pain. So for me, my Pain Coach data shows me that psychological distress is moderately linked. So I know that when I have a really stressful week at work or there's a lot of things going on and my mood's a bit low, I know that those things can certainly influence it.
00:38:14
Speaker
do we Should we talk about the positive side as well? I guess the opposite. Oh, I will. i'm I absolutely will. That's my next. Okay, cool. And then the other one that shows- just want to know if you know like the factors that go into a high pain day. Yeah, yeah. And then the other one that shows is that- when i When I exercise and I move, I feel better that day.
00:38:35
Speaker
okay Obviously, i i can also overdo that. um But yeah, in general, more exercise means a better pain day. Okay, so what I heard you say is like psychological factors, stress, cognitive load, and like maybe exercising too much will will go into your high pain recipe. yes And what I love about this concept of a recipe is that if I can help you figure out your high pain recipe, and what I mean by that, of course, is the biopsychosocial ingredients that go into pain amplification and a bad pain day, then I can help you craft your low pain. recipe. You bet your ass I can. So your low pain recipe, like for me, I know, again, I said poor sleep, crap diet, you know, being isolated, being sedentary for too long. So I know for me, for my body, that I need to stand up every hour if I have like a long day of meetings or patients or, you know, I have to stand up every hour. I need to build in and protect time to move my body and exercise.
00:39:36
Speaker
I know that I need social support. So I have to reach out to my community, make sure I'm seeing friends. I'm going out. I'm doing fun things. I know I have to monitor my diet. I'm very careful with that. Like if I have a day where...
00:39:49
Speaker
I'm so busy that I like skip lunch and I eat a bag of chips or like whatever. I grab whatever. I know that my pain is going to feel worse. I know that I also have to be careful with sleep. So I implement what's called a sleep hygiene protocol. And of course, I put that in Tell Me Where It Hurts. Why? Because everyone deserves to understand how to lower pain volume. So for me, I have a sleep hygiene protocol, and that means that I'm going to bed and waking up at approximately the same time every day. If I can't fall asleep, I'm getting out of bed. I'm making sure I'm not lying there stressing out about not sleeping because I know stress will go up, and as stress goes up, sleep gets worse. So I know that when I map out on a piece of paper for my patients their high pain recipe, and we work together to do that, that together we are going to be able to map out a low pain
Lifestyle Changes for Pain Relief
00:40:39
Speaker
recipe. Like to me, it's so straightforward and it's also so mind bending because what happens is as you map out the ingredients, you see that they're biopsychosocial. And then you also have antidotes to each one. And it's so empowering. And my patients walk out of my office with their low pain recipe, and they're like, okay, you know, of course there's a missing step, right? Which is like, how do I get from this high pain ingredient to this low pain ingredient? Like most of my patients don't intuitively know, like what is the nutritional plan I should be on for low pain? Or like what is sleep the sleep hygiene protocol for low pain? Or like what are some really great
00:41:18
Speaker
hacks for stress that will help me lower pain volume. So that's my job as a provider. Like I'm going to help you figure out all the techniques between the high pain recipe and the low pain recipe to help you get there. But it is eminently doable and I find it so optimistic. For sure, for sure. At the end of the day, this is all about habit change, really, or changing lifestyle habits. I have this idea that I tell people a lot, which is that you're one lifestyle change away from lasting pain relief.
00:41:51
Speaker
Now, that doesn't mean, you know complete pain relief necessarily, but lasting pain relief, one habit change. Habits are hard, though. Do you have any tips or tricks that maybe channel your atomic habits. I don't know if you've read that book, but it's it's it's one that I've read and reread um because I think this is so important when it comes to pain treatment, especially yeah obviously chronic pain.
00:42:15
Speaker
Yeah. how do How do we form a good habit? Yep. So a couple of thoughts on that. I mentioned this before. The first thing I ask my patients is, tell me something you miss and that pain has taken away from you that you want to get back. Because I'm not going assign people a thing to do. That's not going to work. Like, it can't come from me. It has to come from you. So I had a patient... who really wanted to get back to soccer. It was his passion. And he had been in bed for four years.
00:42:44
Speaker
Like, you know, I had a patient who wanted to get back to Irish dance. That was her passion. I had a mom who was, she ran her own catering business. She wanted to get back into the kitchen, especially so she could like bake with her grandkids. So everyone has their own goal. So first things first for me is like, what is your goal and how can I help you achieve it, right?
00:43:06
Speaker
So for changing habits, small, they have to we have to break your big goal down into small, digestible, tiny bites. And then we have to have a very concrete plan for getting you there. So I want to know when, so like once I break it down into small steps, like say your goal is fudge making, right?
00:43:27
Speaker
So like, what is the, what are the steps that are required to get you from the couch to start making fudge again? Right. So like maybe step one is going into the kitchen and looking at the recipe that like, maybe that's step one blessings. That's great. That's where we start. Maybe step two is like,
00:43:45
Speaker
Writing out the ingredients list and making sure you have the car. Maybe step three is asking a friend to get in the car with you because, you know, social support is real and having an accountability buddy, as we all know, makes it more likely you're going to do the thing.
00:44:01
Speaker
And maybe step four is driving with a friend to the grocery store and having her help you go grocery shopping. And then step five is lining up all the ingredients in your kitchen. shes So like, obviously that's, you know, sort of like a simplified example, but, but we, I also did this with soccer. Like step one was standing in your backyard with a soccer ball, even though your body is in pain and you feel like crap, you know, and you'd want to be inside in bed and you're standing outside with a soccer ball for 10 minutes. And that's what you can do. And that's great. And that's where we start. And by the way, this was a 16-year-old kid who had been in bed for four years. And that kid not only went back to soccer, but he went back to high school and got asked to prom by two girls. And it was like the coolest thing ever. So like this plan that we have of of changing habits, I think really starts with the most important thing, which is what do you want? What do you want to get back? What has pain taken from you where you're like, no, I want to take my power back and and that I can help you craft a plan for doing that?
Mind-Body Connection and Pain Education
00:45:03
Speaker
Yeah, that's huge. Yeah. i You've spoken about biofeedback and I found it fascinating. i was very interested. can you Can you speak about that?
00:45:14
Speaker
Yeah. And then we'll talk about the power of the mind, which is what that really demonstrates. Yeah. So when I first started treating chronic pain a million years ago, i had some provider colleagues say to me like, oh, do you send your patients to biofeedback? And I said, you know, actually no, because I don't send my patients to anything I don't really understand. And I don't really know what that is. So I, of course, I did some reading. I've already disclosed that I'm a big nerd.
00:45:42
Speaker
And then I went up and found a biofeedback provider. He's a professor at San Francisco State University, and his name is Dr. Pepper, which is the best name for any doctor ever. And Dr. Pepper sat me down in a chair, and he said, i am going to teach you to warm your hands to 90 degrees.
00:46:03
Speaker
and I said, listen, doc, with all due respect, like I don't believe in magic. I'm a chronically cold-handed person. and how are you going to teach me to do that? Like, are you going to give me hand warmers or what? And he explained to me something that has really changed my understanding of this connection between our thoughts and our emotions and our body.
00:46:25
Speaker
He explained to me that when we are in a state of stress, like we're thinking stressful thoughts, we're experiencing stressful emotions, our body goes into fight or flight. Our sympathetic nervous system gets activated. And when that happens, there's many physiological things that happen to the body. One of the things that happen when we're in fight or flight is that all the blood goes rushing from our extremities, our fingers and our toes, to our core.
00:46:54
Speaker
Why? Because you can live without your fingers and toes if there's an emergency. And our body, of course, goes into fight or flight when there's an emergency. You're being chased by a lion. You know, there's something terrible is happening. And you can live without your hands and you can live without your feet, but you cannot live without the vital organs in the center of your body. So your blood... your blood your blood rushes to your core to make sure your heart has what it needs to be strong, to pump, to fight or flight. Like you're either going to run for your life or you're going to fight the lion and everything in your core is working as it should. So what that means is when your blood rushes away from your hands and your feet, your hands and feet get cold. So I don't know if they have this saying in Australia, like people who are about to get married, get cold feet. Have you heard this before? Yeah.
00:47:42
Speaker
Yeah. Yeah. So in that moment, I realized like, oh, that's a real thing. Like, that's not just a saying. When you're nervous and anxious and stressed, your feet actually get cold because your blood is rushing to your core and away from your extremities. So he said...
00:47:58
Speaker
I'm going to teach you to use biofeedback. I'm going to define what that is. Biofeedback is a technique whereby we learn to harness the power of these sort of like unconscious running in the background biological processes that like heart rate and galvanic skin response and skin temperature. And there's a machine in front of us and sensors attached to our body, our skin, that's giving us feedback in real time of those biological processes. So...
00:48:32
Speaker
Dr. Pepper had me sit in a chair and he hooked me up to these sensors, this machine and all these sensors. So like on my finger, there was something reading my galvanic skin response and there was something reading my skin temperature. There was a sensor that was collecting data about my muscle tension and my heart rate, my respiration rate. And I was looking at a machine and it was giving me feedback from in real time about these biological processes. He said, i want you to close your eyes and tell me some stressful things that are happening in your life. So like, you know, I told him about my patients who weren't getting better. And I told him about my very long to-do list and how I had to pay my taxes and whatever, like interpersonal conflicts. And as I watched the machine, heart rate went up, respiration went up,
00:49:20
Speaker
Skin temperature plummeted as I was talking. And like, you can't deny it's happening because you're watching the stupid machine. So just my thoughts, just my thoughts, like my stressful thoughts were changing my physiology. So that's happening in every moment of our lives. Like our thoughts are changing our bodies. And like, by the way, of course they are. The brain is connected to the body 100% the time. So like, of course, the things we think are connected to our biological systems. So then he had me walk through this protocol for relax for relaxing my brain and body.
00:49:57
Speaker
So he had me close my eyes and he walked me through like a guided relaxation And I was doing belly breathing, which I'm doing now, diaphragmatic breathing, where you breathe low and slow into your abdomen. And he had me use visualization. So I was like visualizing warm blood, running down my arms and into my hands, and I was using gravity to help.
00:50:22
Speaker
All of these techniques we were using and my eyes were closed. And after I would say about 10 minutes, 15 minutes, he had me open my eyes And I looked at the screen, which was giving me biofeedback, feedback about my biology. And lo and behold, heart rate was significantly slower.
00:50:42
Speaker
Respiration was slower. And my hands were approaching 90 degrees. They weren't quite there. It took me like two or three sessions to do it. But now I can do it on command. Like as soon as I start thinking about warming my hands, I've done it so many times, I've The hand-warming pathway in my brain has gotten really big and strong, so I can really do it on command. And I love to like you know do this trick on hikes when we go for hikes in the snow. like I'm the only one not wearing gloves, and I'm like doing hand-warming. It's amazing. So biofeedback is this process by which... We teach people how to have control over biological processes that affect pain. Because does muscle tension affect pain? You bet your ass it does. Does circulation and blood flow and respiration affect pain?
00:51:28
Speaker
Of course it does. Again, back to muscle relaxants. That is a drug that is prescribed for pain management. And if you can learn to do that with your brain, what incredible power you have over your body and over your pain.
00:51:42
Speaker
You know, that's crazy. And people aren't going to believe me. But when you as you were describing that visualization, my hand started to warm up. And for 10 seconds, I kind of lost you because I kept going doing the visualization and I could literally i could literally feel the change. i think Yeah, you feel tingling.
00:51:59
Speaker
what What I love, though, I'd be interested to hear if any of the listeners had the same experience. Yeah. um what i What I really love about that is how he's proved to you in that moment that your thoughts actually change your biology, what's happening in your body. And I think it's a really it's actually something that I was just thinking there, man, I need to bring that into my practice. Because, you know, we all have like the little ah the heart rate monitors that you can and the oxygen
00:52:31
Speaker
sats and it's easy to get and it would be a cool little trick to show people that when they're talking about stressful things or or pain or what triggers their pain that their heart rate goes up. Absolutely. an example of how the the mind and the body are so interconnected.
00:52:48
Speaker
Yeah. And we're such visual creatures. Of course we are, right? It's like, prove it. Yeah. like you i think we all intuitively know that the things we think affect our bodies. like If I sit around thinking about stressful things for too long, I'll get a stomach ache. So like I think we all know there's this connection, but when you see it happening in real time, there's no denying that it's really just your thoughts that are changing your body so profoundly. You know, and you know of course, they again, like I want to go back and acknowledge that there's a lot of stigma around this and say, i am not saying you can think your way out of pain. You can't think your way out of pain, but you can use this as a tool to lower pain volume really profoundly. Like one of the data points I love about biofeedback, the American Migraine Foundation posted on their website, and this is true, I've gone down the rabbit hole and looked at the studies they were citing, that biofeedback is as effective a pain management tool for migraine as the most powerful migraine drugs.
00:53:51
Speaker
I mean, i think imitriptyline and God, there's Elevil maybe are the two I think that they were comparing it to. and And biofeedback was equally as effective at lowering, you know, the the intensity of and and longevity of migraine in these patients. So It has real evidence of effectiveness for a bunch of different diagnoses.
00:54:16
Speaker
I'm so glad you sort of said, you know, you can't think your way out of pain ah because my mind went to sort of – ah what do they call it? a Manifesting.
00:54:27
Speaker
And that like sort of like, it's a little bit too woo woo for me. It actually kind of irks me a little bit. I'm very data driven and science driven, which is kind of why I created pain coach in part.
00:54:39
Speaker
But yeah, yeah and and I was like, I ah hope people aren't hearing that out of what we're discussing. So I'm really glad that you've No. Yeah. That's not what we're saying. Like my goal is to always just offer people ingredients that they can use to create a lower, pain like a low pain recipe and lower pain volume. And like, it's why I spend so much time writing books. It's like pain. I think pain education should be accessible and affordable to everyone. And it bugs me to no end that when people go for biofeedback or come to see someone like me, insurance often won't reimburse it. Like the U is,
00:55:14
Speaker
healthcare care system is an absolute disaster. And so like for me, like putting all this stuff in books is a way to make it affordable and accessible for everybody. So yeah I hope people will check out Tell Me Where It Hurts. I'm really proud of it. Yeah, I want to come to that in a second as well. I just want to ask a question that a patient, I reached out to a patient of mine and she's actually ah read your workbook. Oh, cool.
00:55:38
Speaker
and Yeah, the pain management workbook? Which one? The pain management workbook? Okay, there's two. Yeah, yeah the pain management workbook. And and she she asked the question, when pain flares or she has this new symptom, how can she reduce her fear response?
00:55:55
Speaker
Yeah. I'm going to think about it while I'm talking about it. So my my initial gut response is pain is aversive by definition.
00:56:05
Speaker
Pain's job is to grab your attention. Like I love Laura Mermosley. I listened to his stuff obsessively and that was something I got from him. Like if pain doesn't grab your attention, it hasn't done your job. Like think about it. Like, you know, if you eat...
00:56:20
Speaker
bad food and you are having like an alert, like an allergic response because you, you know, been poisoned or whatever, and you don't pay attention to the abdominal pain, you're going to get real sick. Or like if you hurt your leg when you're on that run and you keep running, you're going to damage your body. Like you are supposed to pay attention to pain. And one of the ways pain gets your attention and is by activating your sympathetic nervous system and your fear response. So that's sort of supposed to happen and it's not a bad thing. So my antidote is always reminding myself in the moment, like cognitive strategies that I use that are so critical is like, oh yeah, I'm having a flare.
00:57:00
Speaker
And I've had 80 of these and I've managed every single one of them and they've gone down. So my mantra is like pain is always changing. So that means pain can change. This is not permanent. I have the tools that I need to lower pain volume. I'm getting better at this every day. This is going to pass. So like my best hack for the fear around a pain flare is to have a couple of you know, statements or mantras or whatever you want to call them. Like I have patients write them out and stick them on their fridge or next to their bed or like carry it in their wallet and you pull it out. Cause in the moment of a flare, sometimes you're so activated, you don't have access to it. So like, I want you to look at it and be like, okay, I've had 106 of these, they've all passed.
00:57:47
Speaker
Pain is always changing. That means pain can change. I have strategies for managing my pain. In this moment, I am going to do my relaxation strategy. I'm going to go for a walk. I'm going to eat something. I'm going hydrate. I'm going to call a friend. like Whatever your strategies are in that moment for soothing, I'm going to take my medication. like Whatever it is, you have like your pain plan. and It's all written out.
00:58:07
Speaker
You know exactly what the F to do and When you know what to do, it really lowers fear because when you feel empowered, you know that you know what to do, it really sort of explodes the the terror of having a pain flare. That's a great answer. I love it.
00:58:24
Speaker
With your all the research that you did on the book, um I was wondering if you had any paradigm shifts or things that you've changed your mind on about pain while you were going through the process of researching for the book.
00:58:40
Speaker
Oh my God, what a good question. I haven't thought about that. Anything I changed my mind on, I'm sure I'll think of something as soon as we're done, but but what really happened as I was writing the book was I sort of became impressed by the human body and how incredibly complex and incredible the brain is at using all available information to determine whether or not to make pain and how much. Like the brain doesn't just use data from the body part and damaged tissues. Of course, it uses that also. but it also incorporates your emotions and where you are and who you're with and it incorporates memory memories of past pain experiences. And what I really became enamored with is you know this process whereby your brain just gathers like this big prediction machine and it's gathering all of this data to make a prediction. like Do I need to make pain and how much? like What has happened in the past and what is going to save this body? What's going to save my life in this moment? So I think if anything, I just became sort of like more incredulous and impressed by how complex and beautiful the system is, you know, and like, I'm still scared of pain. Like I am someone who, you know, I'm not going to ever pretend I want pain. I don't want to be in pain. I'm still scared of pain, but but I feel like a different kind of agency over it and a different sort of like respect for it than I ever did before.
01:00:13
Speaker
It's like everything, hey, the more that you learn about it, the more all you have for that particular subject just because it's so, yeah, it's it's kind of beyond us in a sense, even though you're trying to put that into words in your book. Yeah.
01:00:26
Speaker
So the book is available on Amazon for pre-sale and yeah and its release is is it March 24 from memory? Yeah. Yeah, it's March 24th. And I'm so nervous for people to read it. It's like, i i just have this sense of what will people think? And is it good enough? And did I do a good enough job? And was the research thorough enough? And, you know, I hold myself for to a very, very high standard and very few people have read it. Like I was supposed to keep it under wraps. And so I did. So I have this like...
01:00:56
Speaker
nervousness about about it, but I'm very excited for colleagues like you to read it. And I'm most excited for people who have been living with pain for a long time to read it because I feel like my goal is to share hope and a sense of agency and empowerment for people who have been suffering for a long time and have like only been given, again, like pills and procedures and nothing else and feel really hopeless. Or maybe they've tried a few things or a few therapy sessions and they're like, this doesn't work. So, you know, what I really wanted to do with the book was say, here is a manual. Here is an operating manual. Like, part three is an entire pain protocol. Here's everything you need to know to absolutely positively adjust pain volume on your own terms, on your own time, you know. And, like, my hope, of course, is that... people will find trusted healthcare care providers that they can walk through the protocol with, whether it's like a physio or an occupational therapist or a doctor or a nurse. That's my hope. but
01:01:52
Speaker
But I really wanted to give tools to those of us who are suffering. Like it's just, I'm sick and tired of pain treatment being unaffordable or inaccessible or, you know, in in a form that doesn't actually really make sense for the pain problem we have.
01:02:10
Speaker
um ah it's awesome I'm keen to order that so I'm going to jump off here and go and go and grab it in a second I have a traditional question and I'm nearly tempted to skip it because your answer might be get the book which is a fair answer but the question is if there's someone listening uh feeling down feeling helpless and they don't see a way out of their current pain experience what would your words be to them My words would be, i want you to write on a piece of paper what your high pain recipe is. And by that I mean, i want you to take a moment or even ask your partner, ask a friend, you know, what do you notice makes my pain days, like when I have a bad pain day, what's going into that? Most of us know. Most of us like have a sense of that. I want you to write it down and then I want you to, on one side of your piece of paper, and then on the other side of the piece of paper, like a, you know, I want you to make a table with two columns. And in the other column, I want you to look at every single one of those ingredients and I want you to think about its effing opposite, just the opposite. So if poor sleep is a high, sorry, I'm a New Yorker, i have a cursing problem. So if, if, if sleep, you know, if poor sleep is a high pain recipe, then good sleep is part of your low pain recipe. And that is your starting point. And I want you to bring that to whomever your healthcare provider is and say, poor sleep is part of my high pain recipe. Do you have any tips for improving my sleep? And of course, I do want to say yes. Like there's a sleep hygiene protocol in Tell Me Where It Hurts. But that's not the only place to find it. Like there's a million sleep hygiene protocols all over the place. So I want you to feel empowered. That's what I want.
01:03:49
Speaker
So, you know, go think about your high pain recipe, write it down and and, you know, you can email me and let me know, did you discover any ingredients in your low pain recipe that you feel like you might be able to control?
01:04:00
Speaker
That's, that's my, my parting tip. Yeah. Awesome. Awesome. I have many more questions that I'd like to ask, but for the sake of time, we'll we'll leave it there. Maybe we'll do a part two in the future. sure thank Thank you so much. It's been an absolute pleasure and I've learned a lot and I've enjoyed the conversation.
01:04:20
Speaker
Thank you so much for inviting me. It's so nice to meet your listeners. Thanks, Rachel.