Can you tell me a little bit about your background? How did you become interested in the chronic pain field and mind-body medicine? 

 I became interested in meditation and mindfulness in the late 90s and mainly for personal uses. I found it really great and helpful to me. I began teaching it and then about two or three years after that, I read a book by Doctor John Sarno who was working in the mind-body medicine space during the 1980s. He was starting this work and as a back pain specialist he began to see that some people with back pain had a lot of pain, but with normal X-Rays and MRIs while other people had very little pain with abnormal X-Rays and MRIs. He couldn’t figure out why that would be the case, so he started looking more deeply into it, and he concluded that sometimes the pain wasn’t coming from the back. It was coming from the brain. It was coming from stress and emotions and neural circuits in the brain that can cause pain.

This is an idea that sounds crazy and weird and makes no sense to anybody, but he helped a lot of people. He wrote books on this and a lot of people were helped by his ideas of changing the brain to turn off the pain. In 2002, I read one of his books and I became interested in it then.

I started a practice at my hospital and I started seeing people and talking to them, taking time with them, and listening to them and looking for clues about their pain. I’ve been doing this for 20 years now.

It’s really incredible. I had no idea what I would find and where I’m at now is understanding that the brain is what generates pain. Who would think of that? It makes no sense to anybody, but it turns out that if you touch a hot stove, it’s not your finger that causes the pain. It’s actually the brain. We know that because people can have injuries and not have any pain. The brain either turns on pain or doesn’t turn on pain. This leads us to be able to help people with many chronic pain conditions.

There’s a new science of the brain called predictive processing and we have randomized, controlled research trials that show that our methods are very effective in helping people not only cope with chronic pain but reverse it.

I learned that you are the founder and director of the Mind-Body Medicine Center at Providence Park Hospital. Could you tell us a bit about the Mind-Body Medicine Center and how you’re treating patients there?

It’s really just me in my practice there. I have people come in and I sit and talk with them, ask them a lot of questions, and I find out not only where the pain is, not only what their tests show, but also what their life has been like.

For example, one of the first patients I saw was a woman who was in her late 40s and she had been having headache pain for 17 years. She had daily severe headaches every day, all day on the side of her head. She had been to many doctors, headache clinics, and specialists. She had been on many different medications. She did everything she could think of and nothing could stop this pain.

While talking with her, I learned that as a child, her father was decent and fine, but he was very unpredictable. Sometimes he would come home from work and be nice and kind, and other times he would come and be mean and nasty. He would yell and scream and it was really scary.

She grew up, got married, had kids, got a job, and things were going fine in her life. Then one day she got a new pair of glasses and as soon as she put those glasses on, she got a pain in her head that lasted for 17 years. Now a pair of glasses can’t make your head hurt for 17 years. They tried changing the lens and the glasses, but nothing helped. I asked her what was going on in her life at the time she got the pair of glasses. She said, “I had a new boss and he was very unpredictable. He was nice most of the time, but sometimes he was just really unpredictable and he would start yelling and screaming at me for no reason”. When she got the new pair of glasses, her brain was in a state of danger. This boss reminded her of her father. The pain started when she got the pair of glasses because her brain was actually sending her an alarm signal. When there’s enough danger in your life, the brain will turn on some mechanism to alert you. Maybe it’s anxiety or maybe it’s a stomach ache.

If you have a lecture in front of a lot of people, your stomach might hurt. If you get really embarrasses, your face might turn red. So we know that the brain can affect the body due to stress and feeling uncomfortable.

I explained to her that because all her testing was normal, there wasn’t anything damaged or wrong in her head or brain, but her brain was producing these neural circuits of pain and she could learn to turn them off.

I gave her exercises on how to turn off the neural circuits which is to meet the sensations of pain with safety and calm. Over time, in about four months, the pain went away. She was completely fine. We see this in people who have headaches, migraines, neck pain, back pain, and chronic stomach pain. We even see it with people who have chronic fatigue, anxiety, and depression. These are the main causes of disability in the United States and all around the world.

I’m not saying that all pain is due to the brain. I mean that all pain is actually created in the brain. If you get an injury, it’s your brain turning on pain.

Not all pain is due to neural circuits. Some pain, of course, is due to structural damage in the body. Everyone needs a careful evaluation to determine if the pain is caused by an ongoing structural problem in the body or if it’s due to these neural circuits in the brain. Our research shows that the majority of people, not all but the majority of people with chronic pain, do have pain due to neural circuits in the brain. That pain is real. It’s not imaginary, it’s not fake, it’s not because they want the pain, and they’re not crazy. It’s because their brain has turned on pain and continued pain for a variety of reasons having to do with stress, emotions, fear, and worry.

These neural pathways and circuits were learned. Sometimes people hear me talk and they say, “Oh, you’re saying that I’m imagining my pain or the pain is all in my head”. That’s the last thing I’m saying. People who say that the pain is all in your head are being dismissive, judgemental, cruel, and they’re certainly ignorant about the role of the brain in pain. What we’re trying to tell people with chronic pain is that there may be hope for a reversal of chronic pain, even though their regular doctors may have told them that they’re incurable or that the only options are surgery or injections and pain medications that haven’t worked. It’s so frustrating and such a horrible position to be in.

This approach is revolutionary and even though it’s not for everyone, we have found that people can have dramatic results. We’ve shown that in research studies.

You mentioned that patients have to learn how to feel safe and stop fearing the pain. How do you help patients get to that point?

It’s not always easy, but the first step is knowing what the problem is. If you know that the pain is real and you also know that the pain is not damaging you, that is an important step. People have to learn little by little. We want them to gradually start changing their focus on the pain, change their fear of it, and change how they relate to it. I have them start talking to themselves. Everyone talks to themselves and people in chronic pain are constantly talking to themselves, not out loud most of the time. But they tend to give themselves messages like, “This hurts”, “This is terrible”, “I’ll never get better”, and “Why is this happening to me?” There are thousands of negative messages every day that people are feeling and are hearing from themselves and from other people as well. We need to replace those messages and gradually start to replace fear and focus on the pain. We want to give the pain less power over them so they can begin to reclaim their life and do more. Chronic pain causes people to withdraw in on themselves, they become more socially isolated, less happy, less involved, less active, and less purposeful. All these things make pain worse. It’s a vicious cycle. Most people with chronic pain actually get worse over time and the pain tends to spread over time as well.

It takes courage to decide that you will be the one who will help yourself. Sometimes it takes quite a while and it’s not an instantaneous thing because it’s hard to do. Most people expect a doctor to be the hero.

In chronic pain and these other associated conditions that we see such as chronic fatigue syndrome, anxiety, depression, insomnia, irritable bowel syndrome, interstitial cystitis, POTS, chronic Lyme disease, Ehlers Danlos, and even people with long Covid- all of these conditions are actually caused by neural circuits in the brain. Understanding the cause is really the first step and then shaking off the negative story and the negative thoughts that people have had. Then they can move forward and reclaim their life.

Some people benefit from emotional processing work because stress and emotions are often underlying these conditions. They usually don’t just happen out of the blue. If people look carefully at their life and are open and honest about it, they usually will find there is some amount of stress and emotional situations that have come up in their life.

Now sometimes the symptom will start because someone gets an injury and then the pain doesn’t go away. The injury sent nerve signals to the brain, the brain turned on pain, and then the injury healed because that’s what injuries do. But when people have pain in an area of an injury that has already healed, then that’s indicative of the neural circuits in the brain causing that pain.

For example, some people have pain in an incision where a scar was made for surgery. In women who have had a cesarean section for childbirth, only 3-5% of them have persistent pain in the incisional site where they had the surgery. Women who have had a mastectomy for breast cancer, 30-50% of women have pain that persists in the incisional site. Both are incisional sites. The difference is that childbirth is a very happy and exciting time whereas getting breast cancer and having a mastectomy is the opposite. That simple data shows how stress and emotions can play a role in the brain either turning pain on or not turning pain on.

A lot of times, people don’t want to hear that. They think somehow that we’re blaming them or it’s their fault, or they’re weak or deficient. We’re not saying that at all. We are just describing how the brain works. Research shows that when you give someone a physical injury and do an fMRI, certain parts of the brain light up. If you give a person an emotional injury, the exact same parts of the brain light up. Emotional injuries and stress cause the same thing to happen in the brain as a physical injury would. The pain from stress and emotions is exactly the same as the pain from an injury.

It’s really hard to believe that severe pain can be due to neural circuits in the brain, but it’s 100% true. It’s really hard to believe when other doctors are not telling patients about this stuff.

Why do you think that the majority of doctors don’t talk about the psychology and the neuroplasticity behind chronic pain?

They weren’t taught this stuff. They are doing what they have been taught. The education on pain is very limited and the education on chronic pain is even more limited. They weren’t taught it, they haven’t learned it, and they’re not aware of it. Even the doctors who are aware of it often have a hard time talking about or explaining it to people. People often take offense if they don’t hear it the right way.

 I saw that you wrote a book on depression and anxiety. Can you explain how depression and anxiety can lead to chronic pain?

Anxiety and depression are caused by something that’s missing in a person’s life. If something is going wrong in their lives and they get anxiety and depression, then their brain reacts to their life situation with symptoms of anxiety or depression. People like this can easily get chronic pain because that is just another way for the brain to send them an alert message.

Conversely, if someone has chronic pain, it is often so devastating, debilitating, and frustrating that anxiety and depression can occur because of the pain itself. 

My books are “Unlearn Your Pain” and “Unlearn Your Anxiety and Depression”. They’re talking about different problems, but the problems are coming from the same place.

 Mind-Body Medicine is often described as a treatment for people who no longer have structural abnormalities. Can this form of treatment be applied to patients who do have a structural problem?

Everyone needs a very careful evaluation to determine if their symptoms are due to a structural problem or not. Someone may have an autoimmune disorder and they may also have pain. What if the autoimmune disorder specifically affects joints, but they are also experiencing headache pain and muscle pain? The autoimmune disorder doesn’t cause muscle pain or headache pain, so in that case the pain may be due to a Mind-Body condition.

Autoimmune disorder can be affected by mind-body work because the brain can control the immune system. Endometriosis is similar. Endometriosis can cause pain, but not all people with endometriosis have pain. In fact, there are studies that show many women have endometriosis, but have no pain. Sometimes someone is having pelvic pain and they get a laparoscopy showing endometriosis. The doctors say that endometriosis has to be the cause of the pain, but that may not be true because a lot of people have endometriosis, but no pain.

To sort this out, we talk and we take a detailed history and talk about the pain. Endometriosis pain is going to be in one place. If the pain is on the right side of the abdomen on one day and another day it’s on the left side of the abdomen, that wouldn’t be due to endometriosis. If the pain goes away when you’re on vacation, then we know the pain is not due to endometriosis.

I ask the patient, “Is the pain worse with stress?” or “Is the pain worse when the weather changes?”, or “Is the pain worse when there’s heat or cold or light or sound or certain foods?”

All those things suggest that the pain is being triggered in the brain as a conditioned response. I have all these criteria outlined in my books and on my website to help determine if the pain is due to a structural problem or not. I never assume that it is structural or non-structural without getting all of this detailed history.

What advice would you give to someone who’s been newly diagnosed with chronic pain? What advice would you give someone with chronic pain for 20 years?

If it’s a new onset of a condition, people need to see their doctors and make sure there’s nothing structurally wrong. They need to get routine testing to make sure that they’re okay. If they have neck or back pain, they should be aware that most people with no pain have abnormalities on MRIs of the neck and back. About 40% of 30-year-olds have degenerative discs in their back and they have no pain at all. 30% of 30-year-olds have bulging discs and they have no pain. 80% of 50-year-olds have degenerative discs and no pain. 

You want to get an MRI to rule out fractures, an infection, a tumor, or something like ankylosing spondylitis. If you have these other findings that are what I would call normal abnormalities of the back, you shouldn’t assume that those are the cause of your pain. You should get educated on the criteria that I was talking about. We want to look for pain that is turning on, turning off, shifting, and moving, and the triggers of the pain to determine if it is structural or not.

In terms of people who have had pain for many years, even though they may have tried everything, they may not have tried this particular approach. As I said, most people with chronic pain have a mind-body type disorder. Even though the pain has been there for a long time, like the woman who had headache pain for 17 years, it can be reversed. I want people to not give up on hope.

Is there anything else that you would like to talk about? 

Most importantly, people with chronic pain are treated with compassion and care. They must be believed that their pain is real and that they’re not faking or imagining it. Doctors and medical professionals need to make sure that they’re treating chronic pain patients with compassion, and that their families are treating them with compassion as well. Most importantly, patients need to treat themselves with compassion. 

In addition to that, I would ask that they be open to looking at this mind-body approach. I’m not saying this mind-body approach is right for everyone, but we have found over the years that most people with chronic can benefit from this approach. I ask people to be open to it, understanding that we’re not saying their pain is fake. We’re saying it’s real. We are seeing that the brain can cause severe and chronic pain and our research is showing that the pain is reversible.

Takeaways:

• The brain can cause severe chronic pain. Research shows that this pain is reversible.

• Everyone needs an evaluation to determine if their pain is structural or psychological.

• It’s important to recognize that the pain is real, but it is not causing any actual damage.

• Chronic pain is often related to underlying stress and emotional problems.