pain is a normal human experience but
living in pain is not take a moment and
look at the person sitting on your left
now look at the person sitting on your
right chances are at least one out of
the three of you is living with some
form of chronic pain that’s right one
out of three Americans has chronic back
pain neck pain knee pain pelvic pain
migraines nerve pain you name it
chronic pain cost the United States over
six hundred and thirty five billion
dollars a year that’s more than heart
disease diabetes and cancer together
starting at age 26 I myself spent the
deccan the better part of a decade as a
reluctant inhabitant of pain land I
hadn’t planned to go there and I tried
my best to leave but nothing worked
after a few months of my initial efforts
with no improvement
I did the next logical thing I sought
care from a doctor over the next seven
years I was medicated manipulated
massaged MRIs CT and injected all with
pretty much no improvement I became
obsessed with pain fixated on it hating
it fearing it and fighting it the author
Sonya Huber writes that pain is
prehensile something about its nature is
to twist like the delicate but tenacious
shoots of a vine so that it can embed
and grab on it
IVs itself into the brick of my
structure weakening it pain twists me
like the ends of a halls cough drop
wrapper this is how it was for me but
here’s the thing like a Chinese finger
trap the more you fight pain the worse
it gets the more you fear pain the more
threatening it becomes pain is a fire
and fear is fuel people with chronic
pain are standing in front of a fire
holding two buckets full to the brim
with fuel and what we need to learn how
to do what the medical system should be
teaching us but isn’t is how to stop
thrashing and set the buckets down for
many years we’ve thought about pain
using the biomedical model of pain which
assumes that tissue pathology and pain
are the same problem so the thinking
goes that if you have
or pain that must mean that there’s
increased tissue pathology and an
increased tissue pathology must
necessarily lead to more pain therefore
we treat the tissues with things like
injections manipulations surgery and so
on and when that fails we dull the pain
with pills since the mid-1990s we have
unleashed a devastating wave of heroin
like compounds on the world narcotic
painkillers like oxycontin and Norco all
based on the morphine molecule this
little molecule contains both heaven and
hell within it it can be merciful and
life-saving in the case of acute pain
like injury surgery or for people dying
of cancer but numerous studies show that
when used for chronic pain opioids don’t
really help long term and in fact they
often make people more sensitive to pain
and they don’t improve function that’s
not even to mention the side effects
which can be quite extreme up to and
including overdose and death about
ninety Americans every day are dying
from opioid overdose the problem is that
the biomedical model of pain is
incorrect or at least incomplete and
beyond that very few health care
providers get much training and pain
management let me ask you this if the
tissues at the site of the chronic pain
are the problem then why do our tissue
based treatments for chronic pain so
often fail why are one out of every
three of us still living with pain
despite all of our fancy scans
injections surgeries and so on why don’t
the abnormal findings that we see on our
scans like x-rays and MRIs correlate
with levels of pain or distress why are
ninety people every day dying from drug
overdose sounds pretty dire right so
just kidding we do actually know what to
do it turns out that pain is much more
complex than we used to think pain is
not a stimulus it’s an emotional
experience here we see the
biopsychosocial model which shows us
some of the many other factors besides
the tissues that contribute to the pain
experience these factors are some of the
reasons that purely treating the tissues
has failed so miserably we basically
have been treating the tissues and
ignoring the rest but complex problems
like pain require complex solutions the
good news is that if you are living in
pain land like I was it’s possible to
chart your own way out of it with
dedication hard work and some coaching
along the way it may not be possible or
even desirable to eliminate all pain
because pain is a useful stimulus about
the world and the state of our tissues
but we can certainly decrease suffering
the basic process works because the
brain and the nervous system are
extraordinarily plastic that means
changeable the nerves change on a
minute-to-minute basis and the entire
brain rewires itself about every three
weeks first in this process comes
education we know that or we have a
saying that no pain equals no gain this
is because research shows the more
people know about pain the less pain
they experience and anyone can learn
about pain neuroscience even kids as
young as fifth graders over the next few
slides will go through some pain
neuroscience education just like we
teach it to people suffering from
chronic pain now keep in mind this is
not information specific to your own
medical conditions so those questions
are best addressed to your doctor this
is just general information pain is an
experience created by the brain in the
brain if you didn’t have a brain you
couldn’t feel pain nerves can just tell
us about danger by increasing their
level of electrical excitement they can
tell us about threat such as stepping on
a rusted nail how does that process work
this here is a representation of your
body’s nervous system it contains over
400 individual peripheral nerves and all
of them are connected like highways if
we put them all into end
that would add up to about 45 miles all
400 nerves have a little bit of
electricity flowing through them all the
time this is normal and it shows that
you’re alive nerves are like alarm
systems designed to tell us about danger
when you step on a nail which I don’t
recommend by the way nociceptive nerve
fibers in your foot danger nerve fibers
increase their level of electrical
excitement up to a threshold that’s the
dotted line once they get to that
threshold they fire off a danger message
to the brain and the brain takes action
usually in the form of creating pain to
get you to notice the problem and take
care of it after you take out the nail
bandage your foot get a tetanus shot and
so on the system is designed to slowly
come back down to its resting level over
the next few days and the pain will ease
did you know the brain actually creates
its own pain medicine as well the brain
has the most powerful drug cabinet in
the world 50 times more potent than the
most potent narcotics known to man we
call this a wet brain a wet brain has a
lot of good healthy chemicals floating
around that the brain can use to dampen
down the incoming signals danger signals
that are coming up the cord a good
example of that is stubbing your toe
when you stub your toe also not
recommended it really hurts right for
how long months years no maybe a few
seconds a minute or two and then it gets
much much better that’s because the
brain turns on the tap and flushes down
on the incoming danger signals and eases
the pain experience why does the brain
do that basically the brain understands
that toe stubbing is not a big deal and
it tells the system calm down you’re
making a scene everyone is watching now
this is key in about one out of every
four people who develops pain the nerve
system the nervous system doesn’t
completely calm back down to its
baseline level but it stays extra
sensitive closer to that firing
threshold for a danger messages we know
that tissues themselves have very
predictable stages of healing most
tissues in the human body will be here
within three to six months so ongoing
pain after that point is more likely due
to an extra sensitive nervous system
than it is to an ongoing tissue problem
an extra sensitive system impacts life
considerably before pain there’s lots of
room for movement and activities without
setting off an alarm and experiencing
pain after developing persistent pain
there’s a very little room for movement
and activities before an alarm is sent
and pain is experienced that little room
for movement and activities is not
necessarily due to tissue injury or
damage but just to an extra sensitive
system why do some people systems stay
extra sensitive lots of reasons for one
thing living with pain every single day
adds stress and it can create issues at
home at work at school many people with
chronic pain have been given different
explanations for their pain which
creates confusion and that creates
stress and treatments for the pain
aren’t working otherwise it would be
gone so all of these things combined and
as long as somebody remains stressed
confused afraid etc the alarm really has
no incentive to turn down the brain
still thinks there’s something wrong but
knowledge really is the first step in
the journey out of pain land here we see
the brain scan of a patient with chronic
back pain who’s been given multiple
explanations for her pain but treatments
aren’t really working in the top row row
one the patient is resting calmly in the
scanner and the brain is calm no red
blobs in the middle row the patient
moves her painful back and all the red
blobs show us her brain’s processing the
pain experienced in the bottom row the
patient’s doing the same movement as in
the middle row the difference is it’s
after a 30-minute educational session
kind of like this one and her pain has
eased we see this over and over in
research in addition education there’s a
lot of other things we can do to get the
nerves calmed down that’s a huge topic
while outside the scope of this talk but
I’ll give you the broad overview here
for one thing sleep is really important
for nerve
brain function getting eight to nine
hours of sleep is very important
meditation and relaxation are ways to
increase body awareness and get the
nerves to calm down diaphragmatic
breathing is one of the most powerful
tools we have to get the nerves calm
down what that does is it stimulates the
vagus nerve from the diaphragm and helps
to calm the whole system down and
basically decrease the fight-or-flight
response
aerobic exercise pumps blood and oxygen
around the nerves which they like and
physical therapy it can particularly be
useful for people who have had pain for
a long time they’re not very active and
PT can help get them moving again
without reinforcing their pain cycle you
might be thinking this all sounds fine
and good but you don’t understand I have
a bulging disc or I have arthritis in my
back and that’s why I have pain let’s
think about bulging discs did you know
that forty percent of people over the
age of thirty almost half with no back
pain have bulging discs on their scans
if we scan someone with a bulging disc
two months later the Bulge is 50%
smaller and if we scan them nine months
later it’s completely gone if we scan
someone lying down as opposed to
standing we’re gonna see more disc
bulges because gravity pulls the disc
material backwards into the spinal area
and if we scan someone in the morning as
opposed to the afternoon we see more
bulges because the discs are $0.24
plumper in the morning with water so
what we see on scans just doesn’t really
correlate with levels of pain let’s
think about our thright Asst we know
that a human being starts to develop
some arthritis in the spine in their 20s
that’s the green curve the blue curve
shows when low back pain is experienced
most throughout life you can see that
it’s possible to have very little
arthritis and significant low back pain
or you can have a lot of arthritis and
very little low back pain the fact that
these two curves don’t even have close
to the same shape tells us that our
thright as’ and the spine really isn’t a
cause of back pain you might be thinking
okay fine Liz I’ll take your word for it
on the bulging discs and the arthritis
but I was in a
car accident and that’s why I have
persistent pain well think about
demolition derby drivers these people
have about 50 car accidents per demo
derby event and they go through about 30
events in their lifetime that’s an
average of 1,500 car crashes with an
average speed of 24 miles per hour not
insignificant but only two to three
percent of demo derby drivers go on to
develop long-lasting pain there’s much
much more but time is limited so some
take-home points persistent pain longer
than three to six months is more likely
due to an extra sensitive nervous system
than to an ongoing tissue problem the
nervous system is extraordinarily
plastic that means changeable everything
gets rewired and just as it’s possible
to change for the worse and develop a
chronic pain cycle so it’s possible to
change for the better and get out of one
we see this every day working with
patients who have pain form a team
including a physical therapist if you
have persistent pain find health care
providers that really understand
persistent pain not all of us do if
you’re not getting what you need with
one health care provider find someone
else ask for physical therapy and
participate diligently it can really
help get you moving again and teach you
techniques to cope with pain try to
avoid imaging like MRIs and CT scans and
less explicitly advised by your doctor
we use these things way too much in our
society given that we know that they
really don’t help improve outcomes and
that the findings on the scans correlate
very poorly with pain so unless there’s
a really good reason for scans try to
avoid them avoid narcotic painkillers
for chronic pain whenever you can that’s
not to say these drugs are bad or that
they should never be used but we do know
that for chronic pain they usually end
up making pain worse because of how they
affect the central nervous system if
you’re on narcotics for chronic pain ask
your doctor for help getting off of them
it is possible it’s a long road but many
people I know including myself have
experienced that pain gets better once
you’re off the medications
manage environmental psychological and
social factors that affect pain
experience sleep is so important manage
your stress manage your diet make sure
you’re getting exercise even if it’s
five minutes a day make sure you’re
getting that and manage your social
networks maintain those we know that
loneliness is a huge cause of stress and
stress is a huge cause of pain as for
myself I still visit pain land most days
but I view myself as more of a tourist
there than a permanent resident I view
the landscape with curiosity and an open
mind the difference is I don’t fear my
time there I know what to do to improve
my suffering even when I still feel pain
so for those of you who are affected by
chronic pain or suffer with chronic pain
just know that the tools for improvement
are there and a tribe of people waiting
and ready to help is forming thank you [Applause]
living in pain is not take a moment and
look at the person sitting on your left
now look at the person sitting on your
right chances are at least one out of
the three of you is living with some
form of chronic pain that’s right one
out of three Americans has chronic back
pain neck pain knee pain pelvic pain
migraines nerve pain you name it
chronic pain cost the United States over
six hundred and thirty five billion
dollars a year that’s more than heart
disease diabetes and cancer together
starting at age 26 I myself spent the
deccan the better part of a decade as a
reluctant inhabitant of pain land I
hadn’t planned to go there and I tried
my best to leave but nothing worked
after a few months of my initial efforts
with no improvement
I did the next logical thing I sought
care from a doctor over the next seven
years I was medicated manipulated
massaged MRIs CT and injected all with
pretty much no improvement I became
obsessed with pain fixated on it hating
it fearing it and fighting it the author
Sonya Huber writes that pain is
prehensile something about its nature is
to twist like the delicate but tenacious
shoots of a vine so that it can embed
and grab on it
IVs itself into the brick of my
structure weakening it pain twists me
like the ends of a halls cough drop
wrapper this is how it was for me but
here’s the thing like a Chinese finger
trap the more you fight pain the worse
it gets the more you fear pain the more
threatening it becomes pain is a fire
and fear is fuel people with chronic
pain are standing in front of a fire
holding two buckets full to the brim
with fuel and what we need to learn how
to do what the medical system should be
teaching us but isn’t is how to stop
thrashing and set the buckets down for
many years we’ve thought about pain
using the biomedical model of pain which
assumes that tissue pathology and pain
are the same problem so the thinking
goes that if you have
or pain that must mean that there’s
increased tissue pathology and an
increased tissue pathology must
necessarily lead to more pain therefore
we treat the tissues with things like
injections manipulations surgery and so
on and when that fails we dull the pain
with pills since the mid-1990s we have
unleashed a devastating wave of heroin
like compounds on the world narcotic
painkillers like oxycontin and Norco all
based on the morphine molecule this
little molecule contains both heaven and
hell within it it can be merciful and
life-saving in the case of acute pain
like injury surgery or for people dying
of cancer but numerous studies show that
when used for chronic pain opioids don’t
really help long term and in fact they
often make people more sensitive to pain
and they don’t improve function that’s
not even to mention the side effects
which can be quite extreme up to and
including overdose and death about
ninety Americans every day are dying
from opioid overdose the problem is that
the biomedical model of pain is
incorrect or at least incomplete and
beyond that very few health care
providers get much training and pain
management let me ask you this if the
tissues at the site of the chronic pain
are the problem then why do our tissue
based treatments for chronic pain so
often fail why are one out of every
three of us still living with pain
despite all of our fancy scans
injections surgeries and so on why don’t
the abnormal findings that we see on our
scans like x-rays and MRIs correlate
with levels of pain or distress why are
ninety people every day dying from drug
overdose sounds pretty dire right so
just kidding we do actually know what to
do it turns out that pain is much more
complex than we used to think pain is
not a stimulus it’s an emotional
experience here we see the
biopsychosocial model which shows us
some of the many other factors besides
the tissues that contribute to the pain
experience these factors are some of the
reasons that purely treating the tissues
has failed so miserably we basically
have been treating the tissues and
ignoring the rest but complex problems
like pain require complex solutions the
good news is that if you are living in
pain land like I was it’s possible to
chart your own way out of it with
dedication hard work and some coaching
along the way it may not be possible or
even desirable to eliminate all pain
because pain is a useful stimulus about
the world and the state of our tissues
but we can certainly decrease suffering
the basic process works because the
brain and the nervous system are
extraordinarily plastic that means
changeable the nerves change on a
minute-to-minute basis and the entire
brain rewires itself about every three
weeks first in this process comes
education we know that or we have a
saying that no pain equals no gain this
is because research shows the more
people know about pain the less pain
they experience and anyone can learn
about pain neuroscience even kids as
young as fifth graders over the next few
slides will go through some pain
neuroscience education just like we
teach it to people suffering from
chronic pain now keep in mind this is
not information specific to your own
medical conditions so those questions
are best addressed to your doctor this
is just general information pain is an
experience created by the brain in the
brain if you didn’t have a brain you
couldn’t feel pain nerves can just tell
us about danger by increasing their
level of electrical excitement they can
tell us about threat such as stepping on
a rusted nail how does that process work
this here is a representation of your
body’s nervous system it contains over
400 individual peripheral nerves and all
of them are connected like highways if
we put them all into end
that would add up to about 45 miles all
400 nerves have a little bit of
electricity flowing through them all the
time this is normal and it shows that
you’re alive nerves are like alarm
systems designed to tell us about danger
when you step on a nail which I don’t
recommend by the way nociceptive nerve
fibers in your foot danger nerve fibers
increase their level of electrical
excitement up to a threshold that’s the
dotted line once they get to that
threshold they fire off a danger message
to the brain and the brain takes action
usually in the form of creating pain to
get you to notice the problem and take
care of it after you take out the nail
bandage your foot get a tetanus shot and
so on the system is designed to slowly
come back down to its resting level over
the next few days and the pain will ease
did you know the brain actually creates
its own pain medicine as well the brain
has the most powerful drug cabinet in
the world 50 times more potent than the
most potent narcotics known to man we
call this a wet brain a wet brain has a
lot of good healthy chemicals floating
around that the brain can use to dampen
down the incoming signals danger signals
that are coming up the cord a good
example of that is stubbing your toe
when you stub your toe also not
recommended it really hurts right for
how long months years no maybe a few
seconds a minute or two and then it gets
much much better that’s because the
brain turns on the tap and flushes down
on the incoming danger signals and eases
the pain experience why does the brain
do that basically the brain understands
that toe stubbing is not a big deal and
it tells the system calm down you’re
making a scene everyone is watching now
this is key in about one out of every
four people who develops pain the nerve
system the nervous system doesn’t
completely calm back down to its
baseline level but it stays extra
sensitive closer to that firing
threshold for a danger messages we know
that tissues themselves have very
predictable stages of healing most
tissues in the human body will be here
within three to six months so ongoing
pain after that point is more likely due
to an extra sensitive nervous system
than it is to an ongoing tissue problem
an extra sensitive system impacts life
considerably before pain there’s lots of
room for movement and activities without
setting off an alarm and experiencing
pain after developing persistent pain
there’s a very little room for movement
and activities before an alarm is sent
and pain is experienced that little room
for movement and activities is not
necessarily due to tissue injury or
damage but just to an extra sensitive
system why do some people systems stay
extra sensitive lots of reasons for one
thing living with pain every single day
adds stress and it can create issues at
home at work at school many people with
chronic pain have been given different
explanations for their pain which
creates confusion and that creates
stress and treatments for the pain
aren’t working otherwise it would be
gone so all of these things combined and
as long as somebody remains stressed
confused afraid etc the alarm really has
no incentive to turn down the brain
still thinks there’s something wrong but
knowledge really is the first step in
the journey out of pain land here we see
the brain scan of a patient with chronic
back pain who’s been given multiple
explanations for her pain but treatments
aren’t really working in the top row row
one the patient is resting calmly in the
scanner and the brain is calm no red
blobs in the middle row the patient
moves her painful back and all the red
blobs show us her brain’s processing the
pain experienced in the bottom row the
patient’s doing the same movement as in
the middle row the difference is it’s
after a 30-minute educational session
kind of like this one and her pain has
eased we see this over and over in
research in addition education there’s a
lot of other things we can do to get the
nerves calmed down that’s a huge topic
while outside the scope of this talk but
I’ll give you the broad overview here
for one thing sleep is really important
for nerve
brain function getting eight to nine
hours of sleep is very important
meditation and relaxation are ways to
increase body awareness and get the
nerves to calm down diaphragmatic
breathing is one of the most powerful
tools we have to get the nerves calm
down what that does is it stimulates the
vagus nerve from the diaphragm and helps
to calm the whole system down and
basically decrease the fight-or-flight
response
aerobic exercise pumps blood and oxygen
around the nerves which they like and
physical therapy it can particularly be
useful for people who have had pain for
a long time they’re not very active and
PT can help get them moving again
without reinforcing their pain cycle you
might be thinking this all sounds fine
and good but you don’t understand I have
a bulging disc or I have arthritis in my
back and that’s why I have pain let’s
think about bulging discs did you know
that forty percent of people over the
age of thirty almost half with no back
pain have bulging discs on their scans
if we scan someone with a bulging disc
two months later the Bulge is 50%
smaller and if we scan them nine months
later it’s completely gone if we scan
someone lying down as opposed to
standing we’re gonna see more disc
bulges because gravity pulls the disc
material backwards into the spinal area
and if we scan someone in the morning as
opposed to the afternoon we see more
bulges because the discs are $0.24
plumper in the morning with water so
what we see on scans just doesn’t really
correlate with levels of pain let’s
think about our thright Asst we know
that a human being starts to develop
some arthritis in the spine in their 20s
that’s the green curve the blue curve
shows when low back pain is experienced
most throughout life you can see that
it’s possible to have very little
arthritis and significant low back pain
or you can have a lot of arthritis and
very little low back pain the fact that
these two curves don’t even have close
to the same shape tells us that our
thright as’ and the spine really isn’t a
cause of back pain you might be thinking
okay fine Liz I’ll take your word for it
on the bulging discs and the arthritis
but I was in a
car accident and that’s why I have
persistent pain well think about
demolition derby drivers these people
have about 50 car accidents per demo
derby event and they go through about 30
events in their lifetime that’s an
average of 1,500 car crashes with an
average speed of 24 miles per hour not
insignificant but only two to three
percent of demo derby drivers go on to
develop long-lasting pain there’s much
much more but time is limited so some
take-home points persistent pain longer
than three to six months is more likely
due to an extra sensitive nervous system
than to an ongoing tissue problem the
nervous system is extraordinarily
plastic that means changeable everything
gets rewired and just as it’s possible
to change for the worse and develop a
chronic pain cycle so it’s possible to
change for the better and get out of one
we see this every day working with
patients who have pain form a team
including a physical therapist if you
have persistent pain find health care
providers that really understand
persistent pain not all of us do if
you’re not getting what you need with
one health care provider find someone
else ask for physical therapy and
participate diligently it can really
help get you moving again and teach you
techniques to cope with pain try to
avoid imaging like MRIs and CT scans and
less explicitly advised by your doctor
we use these things way too much in our
society given that we know that they
really don’t help improve outcomes and
that the findings on the scans correlate
very poorly with pain so unless there’s
a really good reason for scans try to
avoid them avoid narcotic painkillers
for chronic pain whenever you can that’s
not to say these drugs are bad or that
they should never be used but we do know
that for chronic pain they usually end
up making pain worse because of how they
affect the central nervous system if
you’re on narcotics for chronic pain ask
your doctor for help getting off of them
it is possible it’s a long road but many
people I know including myself have
experienced that pain gets better once
you’re off the medications
manage environmental psychological and
social factors that affect pain
experience sleep is so important manage
your stress manage your diet make sure
you’re getting exercise even if it’s
five minutes a day make sure you’re
getting that and manage your social
networks maintain those we know that
loneliness is a huge cause of stress and
stress is a huge cause of pain as for
myself I still visit pain land most days
but I view myself as more of a tourist
there than a permanent resident I view
the landscape with curiosity and an open
mind the difference is I don’t fear my
time there I know what to do to improve
my suffering even when I still feel pain
so for those of you who are affected by
chronic pain or suffer with chronic pain
just know that the tools for improvement
are there and a tribe of people waiting
and ready to help is forming thank you [Applause]
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