- [Roberts]: More than 100 million Americans suffer from chronic pain.
- [Smith]: All of the evidence suggests that we're going through an epidemic of chronic pain, and it costs the United States and the world an incredible amount of suffering.
- [Darnall]: We have got to re-engineer not only the way that we think about treating pain, but the way that we deliver pain treatment.
- [Sanders]: Chronic pain affects so many different facets of a person's life, not just their physiology, but their psychology, and how you live, and how society sees you.
- [Roberts]: This everyday pain can ruin lives, but you don't have to suffer in silence.
The latest research reveals an incredible connection between pain and the brain.
- [Lumley]: We know the brain changes in response to ongoing input from the body and on ingoing input from life and from one's history.
So the brain becomes this organizing entity that can create the perception of pain.
-[Scott-Ward]: The pain-brain connection is that there is a physical impact which impacts our emotional awareness, and we can break that loop.
- [Roberts]: The pain-brain connection shows that we have a way that we can manage and in many cases relieve pain.
-[Ocasio-Turk]: You can disconnect that pain, and that's what I did.
- [Roberts]: Everything you thought you knew about pain is wrong.
The latest research reveals that there's hope.
You can get your life back.
Learn how to put advances in pain science to work for you in "Pain Secrets, The Science of Everyday Pain."
Hi, I'm Deborah Roberts, and you might not guess it from looking at me, but I've got a Pain Secret.
For years, I've dealt with knee pain and an occasional migraine.
With so many of us, everyday pain is just something we learn to live with.
But it doesn't have to be that way.
The latest research shows that there are three steps to reduce and potentially alleviate chronic pain.
Number one: understand the pain-brain connection, number two: harness your own mind-body pathways for active relief, and number three: harness the body-mind pathways for direct interventions.
We're going to detail these critical steps, what we're calling the secrets of pain.
And we're also going to explore many different treatment modalities within each Pain Secret.
Finding relief for chronic pain takes a multilayered approach, so you're likely going to need to research which options work best for you.
Together, these Pain Secrets could help turn your pain journey into a healing journey.
But before we get started on that journey, let's get a better understanding of pain.
-[Rossman]: Pain is usually defined as a noxious stimulus or an experience.
So acute pain, you know, pain that's resulting from an injury, which is also called nociceptive pain, it's transmitted on particular nerve fibers.
It's like what you get when you sit on a tack or you put your hand on the hot stove.
-[Atlas]: Nociception describes the actual signals that come in and cause your body to react to a potentially damaging stimulus, but pain is what you actually perceive.
-[Darnall]: The International Association for the Study of Pain actually defines pain as being both a noxious sensory and emotional experience, so what that means is that psychology is baked into the definition of pain.
-[Roberts]: And that's where that everyday pain, chronic pain, can come into play.
-[Rossman]: Chronic pain is a complex phenomenon that involves not only the nerves and the nervous system, but the emotions, the emotional reaction, the traumatic reactions, the thoughts we have about pain, the narrative that we create about pain.
-[Zeidan]: The constellation of these interactions also are the reason that chronic pain is so difficult to treat.
So in reality, when someone is suffering from chronic pain, you're not only treating the symptoms of the feeling of pain, but you're also having to treat and consider the whole individual.
-[Roberts]: The researchers we spoke with had a common theme: pain is complex.
So in order to treat it, we need to start with the first Pain Secret: understanding the pain-brain connection.
-[Lumley]: Pain is felt in the body.
What's the brain got to do with it?
If I could use a analogy, where do we see?
You might think we see with these things, but actually, we perceive vision with the back of our brain.
We have sensory receptors in our body for tissue damage, but the signal which comes up the spinal cord to the brain is organized into a perception called pain and then experienced in the body.
-[Roberts]: Pain is linked to our own perception and psychology, which makes it a subjective experience.
How we think about our pain is critical.
-[Atlas]: It is something that represents so many things to us.
It's important for our survival.
It is something that is necessary in order for us to know we need to communicate to somebody else and ask for help.
And so I think that all of those different types of functions, as well as your basic need to escape the thing that could be causing you harm, they can be shaped by our prior experiences.
-[Rossman]: There's pain, and then there's the suffering.
And the suffering is the emotional and narrative aspect of the pain, what it means to the person, how they interpret it, and what they do with it emotionally.
-[Scott-Ward]: Maybe some people think that I experience this pain because I deserve it.
So we need to understand all those stories so that we can decouple the actual physical reality of the pain and the emotional reality of the pain.
- [Roberts]: Chronic pain can even occur within the brain without external stimulation.
-[Smith]: There are these chronic impulses coming up to the brain, and the brain, instead of properly analyzing them and saying, well, we can live with that, amps 'em up.
Most of the time, the inhibitory system in the periphery the inhibitory system in the spinal cord and the inhibitory system in the thalamus inhibit these impulses so they don't cause chronic pain.
Sometimes, that just doesn't work or work well enough.
So instead of the brain inhibiting this pain impulse, the brain gets wound up and so used to feeling pain that that's all it feels.
-[Roberts]: That might sound like one of the most pervasive and damaging myths of chronic pain: the idea that it's all in your head.
-[Crespo]: Am I doing this to myself?
And so you go through a cycle of sadness, anger.
That's why I kinda compare it to grieving, 'cause you go in this cycle of emotions while you're going through the pain.
-[Roberts]: But contrary to that cliche, the experts we spoke with were adamant: the pain is very real.
It's not a figment of our imagination.
-[Laliotis]: You have to think about it as an exquisite form of communication.
Our tasks is to listen and to understand what the communication is about.
-[Roberts]: Listening to your pain and understanding the pain-brain connection opens up a toolkit of options to target the relationship between your brain and your body.
As with any treatment, consult with your healthcare provider.
Building a trusted team for your journey is critical.
-[Darnall]: We always recommend that people seek a medical evaluation, and particularly in this case, you would want to rule out that there is a recurrence of a disease, always want to speak with your doctor about those circumstances.
-[Roberts]: One option in the pain management toolkit which works with secret number one, understanding the pain-brain connection, is called Empowered Relief.
-[Darnall]: What Empowered Relief does is integrate many different tried-and-true, evidence-based pain management principles, but it integrates them into a single session so people can put this into action quickly.
-[Roberts]: Empowered relief incorporates lessons from a number of other well-tested therapies: mindfulness, neuroscience education, and cognitive behavioral therapy.
-[Rossman]: CBT, cognitive behavioral therapy, can be very, very useful to people with chronic pain because it addresses those thought patterns that may be dysfunctional, and we can be feeling it right now in our bodies all the time.
We need to learn how to at least interrupt that.
Take a break from that.
-[Roberts]: Empowered Relief can help interrupt the dysfunctional thought patterns with its approach to education and building a personalized plan.
It helped Linda Ocasio-Turk with her fibromyalgia.
-[Ocasio-Turk]: Fibromyalgia is painful.
It causes arthritis symptoms, as well as just pain, terrible, terrible, constant pain.
You're not living when you're in that much pain every single day, straight through the whole day.
-[Darnall]: People learn what pain is, how it's processed in the nervous system, and why psychology matters within the context of pain.
-[Ocasio-Turk]: Empowered Relief is different because you're putting everything together.
I was walking around thinking that I was doing so great with meditation and the CBT that I learned, and the relaxation techniques until I went to this Empowered Relief seminar and learned that I can actually do more.
And once I was able to use that and I saw that, wow, it really works.
-[Darnall]: Within our central nervous system, and within our brain, we have the ability to modulate certain aspects of our experience.
We can actually de-amplify some of the pain and its distressing affects.
People will often say one of the worst aspects of pain is feeling at the mercy of it.
This is why it's so important for people to learn various pieces of information and skills that focus on increasing their control over their experience of pain.
-[Ocasio-Turk]: Being able to control my pain, um, I mean, I go right into a smile.
(laughter) It's, it's everything.
It's, it's given me my life back.
Having control over your pain will allow you to live.
-[Roberts]: Gaining control over pain will change your life.
That's what the pain-brain connection can do.
It's a phenomenon based on brain change or neuroplasticity.
-[Chiba]: That's what the brain does: neuroplasticity.
I mean, it's changing on an ongoing basis.
It changes to adapt to what's going on on a moment to moment basis.
- [Moskowitz]: Neuroplasticity is the common denominator between everything that we do with our brain, with information that's coming from the body and from our brain with information that tells the body how to change.
-[Roberts]: Dr. Moskowitz had his own experience with chronic pain resulting from a leg injury.
The pain lasted nearly four years after he healed.
He used his understanding of brain change as the basis for his own treatment Self-directed neuroplasticity.
As with Empowered Relief, understanding the pain-brain connection was critical.
- [Moskowitz] I made a simple graphic of the brain in pain and the brain not in pain, and just thought about if my brain looked like the picture of the brain out of pain, I couldn't have any pain.
And I kept thinking, make it look like the picture without pain.
And sure enough, it started turning down my pain after about five weeks, but I had to be relentless.
Every time the pain started really breaking through consciousness, I had to do something to push back.
It didn't just have to be visual.
You could use all your senses to do that.
Regardless of the stimulus, you can teach your brain to shut it down.
That's what the brain normally does.
But what you have to do is take over for some of these unconscious processes consciously because they're not working right.
And you have to push the brain in that direction.
-[Roberts]: Repetition was also key.
- [Moskowitz]: Every time you do it, you're putting another brick in that wall to prevent that pain from winding up.
The reward is your brain's unconscious processes will start to take over and you'll get to be a lot less conscious about this because you'll have less pain.
-[Roberts]: The tools of self-directed brain change are customizable.
Dr. Moskowitz found that his patients could create their own visualizations to help them change their brains.
- [Moskowitz]: One of my favorite things that a patient came up with was the, we have this picture of the brain all lit up in the areas where chronic pain is processed.
And he came up with the idea, he would visualize himself snowboarding past each of the lit up areas of the brain and splashing it with snow and putting it out.
And this guy, I treated him for five, six years, all he could do is lie down on a couch and he couldn't function.
He had nothing going on in his life.
And the last few times I've seen him over the last few years, he's had no pain, he sits up, he can do anything, he's fully functional.
And he did all that using that pain visualization process.
-[Roberts]: It's not quite thinking yourself to health, but it is using the power of the pain-brain connection for your benefit.
Connecting more with visualizations is at the heart of another powerful treatment approach with Pain Secret number one -- biofeedback.
It uses technology to amplify the effect of your imagination, and allows you to learn to use it most effectively for pain relief.
-[Zeidan]: With biofeedback, the individual is trained to condition a certain response with another response, and over time can learn through conditioning how to feel better by turning on brain area X.
-[Perlin]: What you often find with pain is that the brain is over-activated.
I think biofeedback spoke to me because it was very concrete.
You could measure something about your body and then learn to control it.
- [Scott-Ward] There are definitely multiple types of biofeedback.
And the one that I use with my clients is based on heart rate variability.
The heart is connected to the amygdala.
That is the part of the brain that is the threat detector, which tells you that there's danger.
Not only does the physical pain tell the body that it's in danger, but also negative emotions and negative thoughts.
People think that the heart kind of beats like a metronome, like very even beats and time between our heartbeats, but what we know is that when we're dysregulated or upset, or even just walking around our day, it's really variable.
Biofeedback is retraining the body and the brain to be in a more relaxed state, that you don't always have to be on edge that it's okay to settle into the present and settle into the body.
-[Roberts]: One type of biofeedback is called neurofeedback, which works by measuring the electrical activity in the brain.
-[Crespo]: Neurofeedback, um, helps my brain learn how to respond better to situations, um, to pain, and helps me control my reaction.
So I'm not hyper-sensitive or just overreacting to a simple situation.
-[Perlin]: What's really great about any kind of biofeedback is that you get all sorts of side effects that are positive.
So you may be working on your pain, but you lower your blood pressure, and you feel less anxious.
-[Crespo]: The pain almost took my life, but I believe neurofeedback has given me the tools to manage.
Neurofeedback has given me my independence.
It's given me hope that I can do this, that I can manage my conditions, and still function and be there for my family.
-[Roberts]: The first Pain Secret shows us that we can put our hands on the steering wheel of our health.
We can use the power of neuroplasticity, self-directed or with technology like biofeedback, to gain greater control over our pain experience.
And when we come back, we're going to share some more tools to help you manage and even relieve your pain.
You're not going to want to miss that, so please stay with us.
-[Roberts]: Welcome back to Pain Secrets.
I'm Deborah Roberts.
We've already learned the first Pain Secret that can help turn a pain journey into a healing journey by understanding the pain-brain connection.
Well, now we're going to see how continuing to build a portfolio of treatments helps provide opportunities for relief.
-[Darnall]: We really need a bio-psycho-social treatment approach to treating chronic pain.
A broader toolkit, so that we can harness the power of the brain and behaviors and daily choices and self-regulatory skills, to be able to reduce pain and its negative impacts.
-[Roberts]: Giving yourself a multi-layered approach toward pain management is at the heart of the second Pain Secret.
You can continue to build your own pain relief toolkit and harness the power of mind-body pathways.
Take advantage of the ability of our mind to influence our brain and body.
-[Rossman]: We want to help people find how to turn that mind-body healing effect on, on purpose.
If you have a certain amount of pain from anything, if you're frightened of it, if you're anxious about it, if you're kind of telling yourself certain stories, it amplifies the pain to a great degree.
And it becomes chronic, sets up a loop, sort of a circular track of neurons.
The story sets itself up as a kind of repetitive loop.
-[Roberts]: Because of the pain-brain connection, researchers are finding that there are ways we can intervene and interrupt that loop in the brain.
The first modality of Pain Secret number two, mindfulness meditation.
-[Zeidan]: Chronic pain is heavily involved in the self narrative of the experience of pain.
People develop a lot of fear of movement, a lot of depression and anxiety, and as well as a lot of social embarrassment from not being able to do the things that they used to be able to do.
-[Chiba]: Our brain is getting slammed with a lot of information all the time.
We need a way to calm our system down also, and we do so through the autonomic nervous system.
And believe it or not, breathing and meditation actually calm the brain down.
-[Roberts]: Calming down the brain sounds great about right now, doesn't it?
I would definitely want to add that one to my toolkit.
But how do you do it with mindfulness?
-[Zeidan]: What an individual is taught to do is to acknowledge that distracting thought, feeling and emotion, without judgment on themself or the experience, and to let it go, by gently bringing the attention back to the breath.
This can be quite effective for a chronic pain patient, because they're taught to let go of the emotional reactions that arise from their chronic pain.
-[Sanders]: I was always aware of the pain in my body, but before, it just led to tension and tightness and stress and just, oh gosh, here we go again.
But after learning mindfulness tools, it's, okay, that's happening.
-[Zeidan]: We were able to discover that mindfulness meditation modulates the thalamus in many different ways to reduce the experience of pain.
The thalamus is considered a relay center for the body.
All information from the body has to go through the thalamus, which is almost like a gate, before it enters the brain, except for the sense of smell, which of course goes through the nose.
What we proposed was that mindfulness meditation is essentially shutting down the gate of the thalamus to reduce the elaboration of pain processing throughout the brain.
-[Roberts]: There are different types of mindfulness meditation, too.
Guided imagery, for instance, is an approach that uses new sensory input to interrupt the cycle of pain and fear.
-[Rossman]: We can use imagery to affect the way that the body responds.
And the guided part of it is that there are certain images that may be more effective than others, especially if we're moving into areas that have emotional charges.
-[Sanders]: For me, guided imagery, it takes the onus off of me on trying to figure out how to process this or do this.
And it's really, really, really, really helpful.
-[Zeidan]: We have found that mindfulness meditation doesn't necessarily take someone's pain symptomology away, but rather changes the relationship one has with the feeling of pain.
-[Roberts]: Mindfulness is changing the brain, even with small amounts of practice.
-[Zeidan]: We have found that 60 to 80 minutes of mindfulness-based mental training can significantly reduce behavioral and neural mechanisms of pain.
What we have seen in our research is at least a 95% response rate.
That is, even individuals that don't think that it's going to work for them still report significant reductions of pain.
-[Sanders]: If I do a session of mindfulness and meditation, I might be able to lower my pain a score or two.
So I might go down from a five to a four or three.
Anything I can use that doesn't require taking a pill is success to me.
- [Roberts]: Sounds like success to me, too.
Mindfulness meditation isn't the only way we can intervene with a mind-body pathway.
The next strategy of Pain Secret number two is called EMDR, or Eye Movement Desensitization and Reprocessing therapy.
Whew, that's a long title for a treatment that can interrupt those pain pathways in the brain.
-[Rossman]: We talked about that circulating pathway in the brain that may be re-stimulating pain.
If you can lower the emotional valence or the emotional charge in that network, which EMDR seems to do for many people, then you have a better chance of altering it.
-[Laliotis]: When we have a disturbing life experience, it gets encoded in the brain.
And when it's overwhelming, we're not able to metabolize it at the time that it happens.
What EMDR therapy does is it allows our neurobiology to do now what it couldn't do at the time and reprocess the way it's encoded in the brain, so then it gets encoded differently.
So that what we know about what happened and how it feels are the same.
-[Roberts]: EMDR can also have an impact on that chronic everyday pain we've been learning about.
- [Scott-Ward]: When we're talking about chronic pain, we're also really talking about trauma, whether it's the trauma of the actual pain or early life trauma.
Because early life trauma, developmental trauma is actually a risk factor for experiencing chronic pain later in life.
-[Laliotis]: It's not about what happened then, it's about what comes up now in the present as we bring the memory to mind.
So for example, if you had a car accident five years ago, back then probably the most disturbing part was how you almost died in that accident.
That moment of just before the collision where your life is flashing before your eyes.
And so, maybe five years later, it's less about that moment where you almost died and more about the fact that it took your partner, your spouse, your best friend hours to get to the hospital.
And there you were alone, in pain, frightened.
And that that's what remains disturbing in the present.
-[Scott-Ward]: With EMDR, we can help a person in a state of calm, address those memories, address those bodily experiences, address those beliefs in a non-threatening way, make more sense of them in a way that's adaptive.
We can be aware of the traumas that have happened to us in a way that doesn't make us feel dysregulated.
-[Roberts]: EMDR takes place in a trained therapist's office.
One of the unique ways that therapists can help their clients access those emotionally charged memories is through something called bilateral stimulation.
This requires focusing on an external stimulus, such as hand tapping or therapist directed eye movements.
-[Scott-Ward]: With EMDR, some people believe that that bilateral stimulation or the eye movement kind of forces a very similar process to when you are in REM sleep, the phase of sleep where you're processing emotions, processing maybe some difficult events that have happened throughout your day.
-[Laliotis]: The client's neurophysiology is being activated so they can reprocess the experience.
And then the therapist checks in periodically.
And as long as the process is moving and the quality of the client's experience is shifting, we just keep going until it's over, there's no distress, and the body is calm.
- [Scott-Ward]: After 12 sessions of 90 minute sessions, people have a significant reduction in pain, they have a significant reduction in depression and anxiety.
-[Laliotis]: By the time people come to us, they're distraught, they're exhausted, and are looking for hope.
And so part of what we offer is hope.
There may not always be a cure, but there is always healing.
-[Roberts]: And healing is what we're really looking for.
Clinical studies have shown that EMDR can lead to the elimination of post-traumatic stress disorder in as many as 70-90% of patients.
The success of this therapy demonstrates that there's a strong link between stress, trauma and pain.
-[Lumley]: If we think about pain as an experience, a perception of the brain, which is constructed in response to danger, then anything we can do to decrease the sense of danger can actually turn off the neural circuitry that's generating the pain.
That kind of pain based largely in the brain is changeable.
With the right sort of brain changing experiences, that pain can be reduced and sometimes even eliminated.
-[Roberts]: Another approach in Pain Secret number two, aims to create those brain changing experiences.
Emotional awareness and expression therapy, or EAET and tension myoneural syndrome or TMS therapy.
Both of these strategies target the emotional underpinnings of pain.
Then with the help of a skilled therapist, they show a pathway to confront the emotion-based root causes.
- [Lumley]: There's a number of steps involved in emotional awareness and expression therapy.
We ask patients to disclose some of the conflicts they've had.
Oftentimes these are experiences that involve some degree of anger.
And so we help patients then move towards finding their voice, recognizing their feelings and giving it some expression in a safe place, like a therapy room, not in public or not towards the person directly involved.
To help them overcome the inhibitions or their fears about expressing their feelings, finding the courage to tackle those feelings and those relationships that have been tying them up in knots that actually can turn off the pain generator.
-[Roberts]: Stephen Connena suffered from a sudden onset of debilitating pain that would come and go throughout his life.
Then one day the pain came and didn't go.
-[Conenna]: A couple of days passed and a couple of weeks passed and a couple of months passed and the pain did not go away.
I went to see chiropractors, physical therapists, surgeons.
They said that I had a herniated disc.
They said that there were disc abnormalities and that probably I needed surgery.
I remember breaking down and crying in my apartment to my mother.
We were in my kitchen table and I just in desperation, I was like, "Mom, I don't know why God is doing this to me."
I'm a good guy.
I never hurt anybody.
Why is this happening to me?
And I just broke down and sobbed.
-[Roberts]: Determined to find another way out, his research led him to a book by Dr. John Sarno, a rehabilitation medicine specialist.
- [Conenna] What I read knocked me out.
Dr. Sarno speaks about a very specific relationship between the pain and our emotions.
The purpose of the pain is to distract your attention from painful emotions.
So if the pain is saying, look over here, you don't want to look down over here at these shameful emotions of rage, emotions of anger, emotions of deep sadness.
So the pain keeps distracting you.
I always thought the world of emotions was one world and the world of the physical body was another.
I didn't understand any kind of relationship between them.
- [Roberts]: That relationship can be complicated.
Researchers have found that the physical body can show abnormalities in structure that are unrelated to the pain.
- [Lumley]: We have to be careful when some physical problem is found on a scan because it might not be the cause.
People's pain moves around their body.
It moves up and down in intensity and it's not that the body's structural disease triggers are changing as much as it is their psychosocial triggers.
- [Sherman]: Ultimately, the goal is, in treatment, to enable people to develop other ways of responding to their feelings, other than developing pain.
-[Conenna]: I was able to discover that I had pockets of emotions that I wasn't aware of.
For example, I discovered that I had deep emotions of anger toward my father.
With my therapist, Eric, I learned that it was okay to have all those emotions.
In that moment where I didn't have to change how I felt about my dad, I didn't have to change how I felt about myself.
I just needed to confront it and accept it.
The pain no longer served the purpose and disappeared.
-[Roberts]: The experience of pain is subjective.
So not all treatments work the same for all people.
As they say, results may vary.
But following the multi-layered toolkit approach can help you find something tailored for you.
And then hopefully you, too, can find freedom from pain.
When we come back, we'll hear more of the latest science of everyday pain and see some incredible ways that technology is helping change the pain journey for so many people.
Don't go away.
-[Roberts]: Welcome back to Pain Secrets, The Science of Everyday Pain.
I'm Deborah Roberts.
So far, we've seen how pain is created in the brain and how understanding and influencing the pain-brain connection can steer us toward better health and pain relief.
We've already learned about many treatments that can be part of your own pain relief toolkit.
Well, now we're going to explore the third Pain Secret, harnessing the body-mind pathways for greater healing.
These modalities leverage the power of physical interventions.
The first approach that works this way is one you no doubt know, nutrition.
And in particular, the anti-inflammatory diet, which has a surprisingly powerful impact on pain.
-[Feller]: Pain can be an inflammatory response.
The idea with an anti-inflammatory pattern of eating is to engage in consuming foods the majority of the time that are rich in antioxidants.
Good sources of fiber, good sources of phytonutrients, some type of omega-3.
Those are our heart healthy fats.
They're also great in terms of anti-inflammatory properties.
- [Roberts]: Plant-based foods are rich in all of these anti-inflammatory compounds.
-[Feller]: We always hear everyone say, eat your vegetables, eat your vegetables.
Well, rightly so.
They're filled with phytonutrients, antioxidants that act as free radical scavengers and have the potential to reduce systemic inflammation.
And with that reduction in systemic inflammation, there's the possibility that we can reduce some of the adverse outcomes or side effects that come along with certain types of pain.
-[Winckler]: I think that I notice when I eat poorly, the next day my whole digestive system is off and my hands hurt more.
-[Feller]: It's not about perfection.
It's about what are the behaviors that we can replicate over and over again that are supportive that you can do today and tomorrow, and also the things that have great clinical outcomes.
When I think about what nutrition can do for someone, I say that the possibilities are endless.
-[Roberts]: One of those possibilities is that the anti-inflammatory diet can reduce blood pressure and even improve your mood.
Relieving chronic inflammation and pain would certainly improve my mood.
That's what helps make this a great foundation for other strategies of Pain Secret number three.
Before we get to some of those strategies, it's important to understand a key principle of all Pain Secrets.
It's something called the Placebo Effect.
You may have heard of that, but it's one of the most misunderstood concepts in pain research.
- [Atlas]: A lot of people have heard of placebos in the context of drug trials, where you have the treatment when you compare it to a placebo.
But if you compare the placebo to a group of patients who get no treatment, you can actually see that the placebo itself can reduce pain.
What placebos do is harness your body's own pain inhibition mechanisms to reduce pain.
-[Rossman]: Placebo doesn't mean it didn't happen.
It was the effect of doing something with your mind that gave you the pain relief.
And it's the most highly researched intervention in all of medicine.
We compare everything to placebo.
And very few things work better than placebo.
-[Darnall]: The Placebo Effect is real, it's potent, and it alters our response to medications.
It can determine even whether a pharmaceutical helps us or not.
So, I personally think that it's this latent often untapped aspect of human psychology that we can optimize.
-[Roberts]: Pain Secret number three can engage that internal pain relieving system.
The first approach we'll explore has been practiced around the world for centuries.
That's right, we've been able to manipulate the pain-brain connection before even knowing what the pain-brain connection was with acupuncture.
- [Moy]: Acupuncture is the physical act of inserting thin hairlike needles into the body.
And it's not just any point.
These are acupuncture points that have been studied and documented in manuscripts for thousands of years.
-[Rossman]: If your brain is like the central processing unit that's keeping track of what's going on, you can imagine your skin as a keyboard.
When we stimulate certain areas of your skin, we're sending messages to the brain that can alter the pattern of a discharge in the brain.
And that's what we want to do with chronic pain.
- [Moy]: Acupuncture handles pain, anxiety, depression, insomnia.
It's not a cure-all for everything, but what it is, it sends a signal to the brain that there's something going on with this body part or with this person's imbalance.
So it's my job to figure out what is the right point combination that works for them.
- [Roberts]: Many of us are familiar with the needle-based acupuncture, but there are many kinds of acupuncture being practiced around the world, including cupping, acupressure, electrical stimulation, and even cold laser acupuncture.
-[Rossman]: If it's knee pain, or back pain, or neck pain, or headaches or irritable bowel pain, or central sensitization pain, all that's gonna go into how we pattern the stimulation of the points, whether we're using needles or laser, or other forms of acupuncture, that's gonna go into the pattern.
- [Volpe]: I am an avid knitter.
So having pain down my arm was not a comfortable thing.
Looking at facing injections in my neck, under an MRI, and then possibly surgery, this really led me to look for other solutions.
And the solution that I wanted to try was that acupuncture.
- [Moy]: There is definitely a pain-brain-body connection.
It's been shown in MRIs and various medical studies, science-based studies, where when you're performing acupuncture on a patient, that message, that signal, where you're putting the points on the body goes to the brain and endorphins are released.
-[Sanders]: I noticed when I did acupuncture and massage therapy right after, I had double the benefit.
So that was really helpful for me.
It really helped in lowering my pain.
-[Rossman]: In the same way that some people do respond really well to certain medications and others can't tolerate them, certain people respond gangbusters to acupuncture and there's other people who don't respond at all to it.
As you get repetition and reinforcement of treatment, if it's working for them, they get longer and longer periods of relief.
And we spread the treatments farther and farther apart.
So it looks to me like that's a learning process going on in the brain.
- [Burford]: This is your body doing the work.
The acupuncture is just the start of a process.
And the needles start it going, then they are taken away and the process continues.
And in my case, that process has been major-league relief of pain.
The results show.
It really, really works.
- [Roberts]: So why does acupuncture work?
- [Rossman]: Well, we don't completely know.
And that's not very different than most drugs that we use.
We know a lot about most drugs, but we don't know definitively how most drugs even work.
But we do know that acupuncture is a very potent stimulator of the release of endorphins and related chemicals in the brain that are very powerful pain relievers.
- [Roberts]: While we may not know why it works, it has been shown to be effective for chronic pain.
A recent systematic review of studies on acupuncture for low back pain found strong evidence that combining acupuncture with usual care helps more than usual care alone.
-[Damner]: I've had this experience of acupuncture.
I feel my body has taken control of itself and it's working in the correct fashion.
And I really know that my body is in such a better, better place because of the peacefulness it feels when I've been treated for acupuncture.
It's much better than any drug.
And a drug is really a temporary fix, whereas this has been, I think, a permanent fix.
- [Roberts]: And isn't a permanent fix for pain what we're all searching for?
While acupuncture offers the promise of that fix with an ancient practice, researchers have also tackled this problem with modern technology and electricity.
-[Smith]: I knew that it's possible to stop pain electrically.
The brain and the spinal cord are a heck of a lot more plastic than anybody ever thought, particularly the brain.
Trying to capitalize on that has been extraordinarily difficult.
-[Roberts]: In 2009, Dr. Smith got a call about a device that leverages the nervous system's inherent plasticity for pain relief.
It's called Calmare or Scrambler Therapy.
It's a therapy for treating neuropathic pain.
-[Smith]: Chronic neuropathic pain is just demoralizing.
It just takes your energy away and keeps you from living a normal life.
-[Uretsky]: What I feel like was all the joy of life was taken away, because basically, I was in pain 24/7.
- [Roberts]: Scrambler Therapy works through a series of electrodes on the skin near an area that is experiencing pain.
The electrodes send a signal along the entire nerve pathway back to the brain.
-[Smith]: Electrodes on the skin send a non-pain signal up your native nerves to your spinal cord, connect to that second cell in the spinal cord, and then up to the third cell in the thalamus and over to the other side of the brain.
And it would replace the pain information with non-pain information.
And it sends what a signal that to me, feels like being bitten by electrical ants.
(mimics electrical noise) It's constantly shifting.
-[Cooney]: So you'll never get one sequence repeated.
Now the importance of that is that the brain can't accommodate to it.
The brain gets that message and it allows the brain to break that pain pattern.
-[Roberts]: Dr. Smith's first Scrambler Therapy trial studied 18 people with typical chemotherapy induced neuropathy.
-[Smith]: The pain scores went from six on day one down to two at day 10.
These people had had no relief from anything else, so we thought we were actually onto something.
-[Roberts]: Scrambler Therapy is not widely available yet.
When faced with debilitating complex regional pain syndrome, Cal Uretsky did his own research and decided to give it a try.
-[Uretsky]: I did research.
I had nothing to lose by trying it.
Our nervous system has memory.
So what happens from this is you can get an injury to the nerve system and you'll feel the pain initially and now your body remembers it.
What things like Scrambler Therapy is designed to do is it sets your pain system's memory in your nervous system back to zero.
As long as you've gotten that therapy and it's worked for you, if you maintain the therapy, it keeps that complex pain from coming back.
- [Smith]: What we've seen is sometimes you put this on and 15 minutes later, people'll say, "You know, this doesn't feel as numb anymore "and I can actually press my finger.
"I haven't been able to do that for three years.
"What did you do to me?"
(chuckles) -[Roberts]: Dr. Smith told us that not everyone is wired the same way.
This is why having a toolkit approach is essential, because pain is subjective.
Not every person responds the same to every therapy.
But each therapy gives you another pathway, another shot at relief.
-[Smith]: About 10 or 20% of people, when I put the machine on, absolutely nothing.
There are another 20% who get some relief, but not a whole lot.
The other 60%, I think, get pretty substantial relief.
-[Uretsky]: In the first session, Dr. Cooney said, "How does that feel?"
I said, "I feel like I just put my finger in the socket, "but I feel it moving through my leg "I feel there's a change there."
-[Cooney]: Pain is a warning signal that's important.
There are instances though, where it can malfunction.
What we want is to re-establish to the brain and allow all the functions to be predicated upon real information.
Because when you get that type of loop in the brain, it's not predicated upon real information.
-[Uretsky]: By the time Dr. Cooney got through the third or fourth session, I started to feel relief.
And then, by the time I did the 10th session, the relief was in place and I felt great.
-[Smith]: Some of our patients had their pain go to zero, literally to zero, and stay that way for weeks or months at a time.
- [Roberts]: The results were astonishing.
Even Dr. Smith was surprised.
- [Smith]:The best medical management pain scores went down by 28%.
Our group, the Scrambler Therapy group, went down by 91% at a month.
- [Uretsky]: On a scale of one to a hundred, this is at least an 85% improvement in my life.
But the pain's gone, and that's what Scrambler Therapy does.
- [Roberts]: An 85% improvement in life sounds incredible for anyone suffering from chronic pain.
Substantial relief is within reach when we work with all the Pain Secrets.
-[Darnall]: If we're treating the full definition of pain right at the beginning, then we are setting up patients to have best response to all of the medical treatments that their doctors will try.
-[Roberts]: Because our experience of pain is so subjective, the multi-layered approach with the three Pain Secrets helps give us all a broader set of tools toward achieving relief.
It all starts with Pain Secret number one, understanding the pain-brain connection.
-[Darnall]: Because all pain is processed in the central nervous system and in the brain, it's also influenced by a whole host of factors, such as our mood, how much attention we give pain, our thoughts, our feelings, even the context in which we experience pain.
All of these different factors can influence the intensity of the pain that we feel and the amount of suffering that we experience from pain.
-[Roberts]: Pain Secret number two, harness the mind body pathways, gives us more ways to leverage the ability of our brain to change our pain.
-[Zeidan]: What we found through mindfulness practices, the individual, through mental training, can disentangle the appraisal, the judgment, and our reflexive reactions.
While we can't remove their pain, we can change the way that they react to their pain, which can then lead to reductions in depression, anxiety, and improve overall wellbeing.
-[Roberts]: And Pain Secret number three, with physical interventions, we can harness the body-mind pathways.
- [Rossman]: How do we use the mind-brain-body connection to do the same thing as a placebo relief of pain, which is very real and accounts for a large amount of all relief by other means?
-[Roberts]: The amazing thing about the Pain Secrets is that these modalities are complementary approaches.
Find what works for you, but always check with your doctor.
The toolkit approach means you can use multiple treatments at the same time to maximize your opportunity for relief.
- [Laliotis]: Where there's physical pain, but there's also an emotional component, then combining it with an acupuncture treatment or mindfulness practices all bodes very well for the progression of the treatment.
- [Darnall]:Various treatment approaches that are shown to be low risk and also have an evidence-base behind them, biofeedback -- all of these different treatments, there's little downside and potential huge benefit if an individual is a responder to that treatment modality.
- [Roberts]: But perhaps the greatest Pain Secret is that when you take advantage of strategies that work for you, they can have an incredible impact on your life and they can give you hope.
- [Darnall]: What's important for people to know is that there is hope.
There is great evidence showing that some of these types of treatments can really and truly help you gain control over a variety of symptoms that are related to pain, that may be impacting your quality of life and your relationships and your enjoyment.
- [Rossman]: To find something that you can do that brings you some comfort is a huge step for people.
They start to feel more empowered, they start to get interested in other things that they can do to modulate their pain.
-[Sanders]: There's so many options out there, ask a lot of questions, and make sure you have the right people on your team.
-[Ocasio-Turk]: Pain might come and go, but it's not controlling me anymore.
I can control it.
There is hope and it's real.
And it's something that anyone, anyone can do.
Not just me, anyone, it's-- Oh my gosh, it's just so simple.
It's very simple.
-[Roberts]: There is real power in hope because there's real power in the pain-brain connection.
I hope that Pain Secrets has opened the door to some new approaches, different strategies, and a new way of thinking about pain.
Wishing all of you a healing journey.
I'm Deborah Roberts.
Thanks for joining us.