Living with Pain

[00:00:02] Speaker A: It's the youe Life Lived well podcast with Dr. Kevin Payne, a better way of seeing the life that you want to live. Welcome. [00:00:14] Speaker B: Just a note. My apologies if my voice is sometimes difficult to understand. It still comes and goes, but I'm working with it the best I can. Thanks for bearing with me. [00:00:24] Speaker A: So here goes. [00:00:25] Speaker B: All of us have some lived experience with pain. Our primal brains have knitted together an understanding of pain that is absolutely convincing. And that entirely mistaken story of our pain seems so overwhelmingly and unquestionably true that we do not doubt it. It's hard to wrap our minds around how it could even be questioned or or why we should do so. To understand our contemporary context for pain in the United States, we need to wind things back to 1996. In that year, two catastrophic trends came to a head, and like many eventual train wrecks, they seemed like good ideas at the time. First, a truly shortsighted and devastating idea took hold in the American medical community. I'm speaking, of course, about the Pain is the fifth vital sign movement introduced by the American Pain Society. The idea stemmed from the fact that at least half of all initial medical visits are motivated by pain. We hurt and then we go to the doctor. So this idea seemed logical. But there are two problems. Pain is not a medical sign, nor is it vital. What do I mean? Medical data comes in two varieties, signs and symptoms. Medical signs can be empirically measured by an outside observer. The results can be standardized and scaled for direct comparison across instances and populations. Medical symptoms cannot be observed or compared in this way. They are self reports. My report not only cannot be compared directly to yours, my report now also cannot be directly compared to my report in the past or or the future. Pain is a symptom. Pain is also not vital. The classic vital signs included in a medical consult are temperature, blood pressure, heart rate, and respiration. Notice these are truly signs in that they are externally observable and comparable according to a shared standard. They are also vital in that all four are unambiguous indicators of of healthy biological functioning and that when any one of them is out of range, they directly signify an emergent life threatening problem that must be urgently addressed. Pain is not vital in this same way. A lot of pain won't directly kill you. Under some conditions it might signal a condition in urgent need of treatment, but but more often, as we will see, it does not. A great deal of pain might also, under very rare circumstances, induce one kind of shock and eventual death. But it's far more likely to cause you to pass out, not die. Although as someone who's lived with pain for decades, I understand that pain can certainly make you feel as if you want to die. But this is only half the equation for the slow motion disaster that began in 96. At the same time that physicians were being encouraged to ramp up their treatment of pain and to tolerate nothing less than pain free lives for their patients, more Americans were being covered by health insurance plans that included more generous prescription drug benefits. Prominent physicians in the pain treatment community, optimistically citing bad research downplaying the likelihood of opioid addiction, argued that pain would not be sufficiently treated until we all lived pain free into this perfect storm of circumstance. Purdue Pharma developed, patented and aggressively marketed their painkiller OxyContin. Their hook was that because it came in slow release pills, it was less likely to become abused. Odd other pharma conglomerates rushed after them into this new and lucrative market. We look to our physicians to protect us, but they were out of their depth and failed us as a profession. Most physicians don't actually know that much about pain. At best, most receive two to four hours of pain education and for many, what they learned is outmoded by 21st century research. Some of us are old enough to remember that only a few decades ago we used to think quite differently about pain. This movement effectively changed both our cultural expectation for pain and professional norms for how medical professionals treated pain. That led to two devastating trends. First, it set us up with unreasonably high expectations that would always be failed in practice. And second, it distracted medical professionals from pain treatments that actually work long term in substituted pain treatments that will fail and that come with additional harms. This is not an episode about the whys and wherefores of the opioid crisis. Rather, I begin here to provide some explanation for why our perspective on pain and what to do about it has become so harmfully skewed even among a large proportion of well meaning professionals. With that, we'll take a quick breather before we jump into a critical examination of what the research says is really going on with our pain. [00:06:14] Speaker A: I'm Dr. Kevin Payne. Just jump with me into your life lived well. Half of us now live with chronic illness. Mine is multiple sclerosis. It's your life. Live it well. A chronic diagnosis doesn't mean goodbye to the good life you wanted. You don't have to feel overwhelmed or hopeless. I'll show you how to save yourself. Take your first step at justjump life. It's the youe life Lived well. Podcast don't forget to like, share and subscribe. [00:06:57] Speaker B: All pain is an experience. Technically, it's a medical symptom or subjective experience. It's not a medical sign because it can't be externally observed and measured. Even under an mri, we can see. [00:07:12] Speaker A: That something's going on, maybe some rough idea of intensity. But hundreds of brain's areas light up and they're a little different based on your personal experience, because all of this is true. It kind of flies in the face of many things that the medical establishment is telling you about your pain. It's flying in the face of things that our unreflective experience is telling us about our pain. We're going to dive into that in this episode. It's going to be one tiny little toad dipped into a really, really big pool of the topic of pain. All of this is this big, complex, layered nuance set of processes your body and your brain and your mind are doing to try to protect you. That's what all of this is about. So one of the ways that we try to quantify pain is to use what's called a pain scale. Many of you have probably been exposed to one or more of these over the years. They'll ask you, well, how does your pain feel on a scale of 0 to 10? Now, of course, the problem is your 3 might be my 5 or my 7 or something else. And your 3 today may be different from your 3 a week from now or a year from now. So out of the many pain scales that are out there, there's one that I like a little better than the rest of them. It's called the Defense and Veterans Pain Relief Rating Scale. And the reason why I like it is because it's behaviorally anchored. In other words, it's functionally anchored. It's anchored in an idea of how much is pain getting in the way of you living the life that you would otherwise be living. Zero is no pain. One is, yeah, I've got pain there, but I hardly notice it. Two is I notice the pain, but it doesn't interfere with my activities. Three is where the pain sometimes is distracting me from what I want to do. So not a lot, but occasionally it just kind of breaks through and it's hard for me to focus. Four is where it's definitely distracting me, but I can still do my usual activities. Five, now we're at the midpoint of the scale, and this goes from mild to moderate pain. Now, this is interrupting some of your activities. At 6, you're saying that pain is hard to ignore. And it often prompts you to avoid some of your usual activities. Now at 7, we're kind of crossing the boundary into severe pain. 7 pain has now become the focus of your attention and it prevents you, not just distracts you, it prevents you from doing some of these daily activities. At 8, your pain is awful and it is hard to do anything. So this is you are almost non functional. At 9, you can't bear it and you are unable to do anything functionally. Again, pain is kind of taken over your entire experience. 10 is as bad as it could be. And literally nothing else matters in your life other than dealing with that pain. But. So I like that because it's not about subjective experience. It's about how is the pain impacting how you're trying to live. That makes it easier for other people to comprehend the functionality, how pain is operating in your life. You can't directly share with someone how your pain feels. We just don't have a way of doing that right now. If you can convey to someone this is how much pain is getting in the way of what I'm trying to do, well, that can be useful. So I've had a long and colorful history with pain. As a young man, I had the typical accidents and pains. I broke a foot once at a bachelor party. I almost sliced the end of my finger off. I got an abscessed tooth. And conveniently that happened on a Friday night. So I had to live with it the entire weekend. And this is how most of us judge pain. Pain is a transient experience associated with some kind of physical trauma. And that's how we think of it. Pain is an acute experience and we think of it that way until we live with persistent pain and we realize that these are different. I'll give you another example. When I was a teenager, I was in the first car accident that should have killed me. And I was driving a little Toyota and she was in a 79t bird and. And she T boned me and didn't even bother hitting the brakes. Crushed the passenger side into the center column. If I would have had a passenger, they would have been dead after all of the rending and the noise. And she pushed me way down the highway and I managed to crawl out of the wreckage and I'm severely concussed. Probably everything that I have is bruised and all of the glass shattered and went into my head. So head wounds bleed profusely. I'm now covered in blood. I'm just oozing blood, I'm spurting blood everywhere. And I'm pretty dazed because I'm pretty concussed. I'm staggering through the intersection through all of these pieces of broken car, heading to the convenience store. On instinct. I reach into my pocket and I pull out a quarter and I'm headed to a payphone to call someone. The woman who is the clerk at the store runs screaming out of the store. Oh my gosh, are you okay? Obviously I wasn't okay. Here's the thing. I felt no pain at that point. I felt no pain because when we have catastrophic injuries, we tend to feel no pain. And we'll get into why that's the case here in a moment. What I do remember vividly is as I'm stumbling toward the payphone by the convenience store, I tripped over the curb and I stubbed my toe. And that hurt. I remember the pain from the stubbed toe. The rest of my body is completely mangled and I have no pain. So the ambulance gets there, they immobilize me, they put me on a spine board, they rush me to the hospital. I didn't start feeling pain until about half an hour later. And that's pretty typical. So this is our first clue to what's going on with pain. Pain isn't the directly related to physical damage kind of mind boggling when you think about it, but it's not now. In 1989 I started itching all the time. And what I didn't know was that this was probably the first blush of my Ms. Showing itself. But this is a second clue to pain that I want you to think about. Pain signals are not necessarily painful. Itch is related, gastrointestinal distress is related. All kinds of ways that our body demonstrates discomfort are related. [00:14:18] Speaker B: And for me, the real pain started in 2002. That's when I started getting some parts. [00:14:24] Speaker A: Of my body disappearing, being numb, not just the itching that had been around for by that point over a decade. Pins and needles, like you'd hit your funny bone in all sorts of places and then also pull pain always. This was kind of weird because there were no injuries that anyone could see. And this gives our third clue to what pain is actually doing. Pain is an experience and the pain we experience is related to everything in our lives, related to all sorts of stressors going on in our lives or good happy things going on in our lives. It's intimately tied to our overall well being and quality of life. So like 75% of those people with MS, pain is part of the symptoms that I regularly experience. One of the many, many, many, many Many forms of chronic pain. Now, a decade ago, I was living day to day in that six to seven range every day, often gusting up to eights. And. And on a handful of occasions, the pain became so overwhelming that I blacked out, which is an unnerving experience. Chronic pain is the world's most pressing health challenge. Full stop. More Americans have chronic pain than stroke, diabetes, heart disease, and cancer combined. Pain is the reason for 60% of all initial physician visits. Pain is the most common source of lost work, lost productivity, lost wages. And this isn't true just for the United States. It's increasingly true all around the world. So here's the frustrating thing about all this. We actually know how to best prevent and treat pain, but we're not doing it. Our mismanagement of pain in the last couple of decades has created this overwhelming opioid crisis that we're still trying to get a handle on. The reason why we're not doing what actually works for pain, what a mounting pile of research over the last decade or two keeps saying we should be doing for pain is because those best practices don't make sense to most people, not even to medical professionals. You realize the average MD only has about 4 hours of pain science training coming out of medical school. That's about it. By the time you get through this one meager podcast, you will have 1/4 the education that they do. And the missing link is pain education informed by the latest research consensus. I'm going to say some things that you won't believe, but I swear everything I'm going to tell you is backed by the latest research. If you can wrap your mind around this and put it into action, your life, your pain, will be better. So I'm going to start with one that's probably going to hack you off. You're not going to like this, and I'm going to tell you before I even say this that you will misinterpret what I'm going to say. Pain is created and interpreted in your head, but it isn't a matter of choice. So when people say pain is all in your head, well, okay, it's 90, 95% in your head, but it's not a matter of choice because it's being created subconsciously by bodily and brain systems that are outside your conscious control. And they are so deeply seated and they are so hell bent on protecting you that they create these loud, screamy signals because they need you to do something. Now, my pain had reached its maximum sometime around a decade ago so, by 2015. I'd been living with the pain for a long time. I'd gotten really used to it, and I had gone through retraining myself. So by this time, what used to be maybe in that 6 to 8 range was for me subjectively in that 1 to 3 range now. Had my condition changed? No, it hadn't really changed, but I had educated myself. I had used exercise and nutrition and meditation and lots of these other tools to reframe the way my brain was processing those pain signals, which are really danger signals. So I was pretty used to it. In 2015, I went into my general practitioner for a checkup. He has my shirt off and he's looking at my stomach kind of funny. He kind of gets a quizzical look and gets in close and he takes it and index finger and kind of poke, poke, poke at a spot a couple places. And so then he did more examination, and he said, how are you walking? And I gave him a curious look in return. And he said, you've got three really well developed hernias. I had both inguinals and an epigastric. He said, most people are not even walking with the pain this bad when thinking about it. I live with pain all the time, so I just kind of dismiss it. So this brings us to our fourth clue about pain. We've got to become better observers of ourselves and interpret our pain properly. Think about it this way. We have what's called nociceptors, these little nerve fibers that are all through our skin and joints and some of our internal organs, but not all of them. And these scents, what are called noxious stimuli, painful, dangerous stimuli, more flames, more pain, more crushing, more pain, more cuts, more pain, more chemical burns, more pain, et cetera. That kind of pain nociception is largely signal. This is a danger signal that your body is sending you in that moment because you're detecting some kind of noxious stimuli, and you need to do something about it right now so that you are not damaged or damaged even further. And this is generally how we think of pain. Pain as signal, as an important danger message. But when you're living with chronic pain, pain becomes noise because it's not giving you a valuable signal, because whatever it is that's causing the pain isn't going to change. And it's not that it's presenting an immediate danger to you. In my case, I have a wacky central nervous system. It's not gonna kill me. It just makes things really difficult. There's nothing I can do about it. I can't get away from it and let it heal. Because it's my own immune system that's attacking. The pain is not a signal for me. It doesn't spur any kind of useful health promoting activity on my part. It's noise. And for most of us living with chronic illness, it's mostly noise because we already know something screwed up. Thank you. Stop screaming about it. This idea of nociception, nociceptors come from nosare to hurt or harm. This is sending us a signal to deal with a specific immediate danger. And it is the oldest form of pain, A form of pain that we share with lots and lots and lots of other critters. We felt pain this way long before we were human. Even with this simple, direct, acute pain, there's more going on. [00:22:02] Speaker B: And so we've got this standard view of pain, the biomedical model of pain, or the postural structural biomechanical model, it's called the PSB model. [00:22:13] Speaker A: And this model says that pain is directly associated with damage. And if you cure the damage, the pain will go away. But it's not true. And there are a couple of things that we can take out of this one. From all of the studies out there, we know this really well. We start feeling pain before we are damaged. Otherwise pain would be a really crappy signal, wouldn't it? Because the whole point is trying to get you to back off from some kind of activity that is going to damage you. So you can think of it this way. Pain is our oldest protective signal. A little newer than that is fear, which is doing the same thing, but the associations are a little more sophisticated and it's got a longer warning. Like maybe a few decades ago we'd know maybe 15 minutes before a tornado touched down. And now we know that a tornado, maybe an hour, two hours, is coming. So fear is an old, old system that is telling us about danger. Pain is an even older system that's doing the same thing. But we start feeling pain before we're damaged. You can try this experiment if you want. Grab a sensitive part of your body, like your earlobe, or like the skin between your index finger and thumb, and squeeze it and you will start feeling pain. If you squeeze hard, just increasingly, squeeze, squeeze, squeeze, and then stop whenever you feel pain. Are those parts damaged? No, they're not damaged because you started getting pain before the damage occurred. You can take this a step further, but you need a friend. Squeeze their earlobe or that, or a finger or that flap of skin there between their thumb and their index finger. The same amount and they will report a higher level of pain than if they did it themselves because they're not in control of it. Now go find a stranger on the street and they're going to look at you funny. But don't worry, it's for science. And if you have them squeeze one of those parts, you'll report a higher level of pain sooner than you reported when your friend did it. Because there's a bigger unknown. They're a stranger. You don't know them. So what I'm telling you here is that the amount of pain that you feel is associated with the amount of distress, the amount of threat that you perceive. If you did the same experiment in a darkened room where you couldn't see anything, you would report a higher level of pain sooner than if it was a fully lighted room. So. So if we try those experiments ourselves, we realize that the amount of pain we feel is A not going to be directly related to the damage and B, it's going to be related to a lot of other factors that we can identify. How much information is coming in, whether we're controlling it or somebody else, is whether we know somebody is doing it or not. The point is that our mind and our brain are taking in all of the possible information they're bringing to bear all of the information from our experience. Oh, have we been in this sort of circumstance before? Do I know my friend is a practical joker and is going to inflict a little more pain than I would otherwise? Like, have I been through an experience like this in the past that didn't turn out very well or that did turn out very well? We're going to take all that information and we will start feeling pain before we are damaged. We will also, as I mentioned with my story of my car accident all those years ago, when the injury becomes really severe, when it's really serious, there's little to no pain. And there are dozens and dozens of stories of this guy with a railroad spike through his head. And the point here is our body is intelligent enough to know that when there's a light to moderate amount of damage, the best strategy for us is to get distant really quick and then protect it for a while. But if we are so screwed up that we are covered in blood and concussed and stumbling through the streets, then we have to have a little more of our wits about us so that we can act and move and think and process. And then when we start to feel more safe, the pain will start from the trauma, from the damage, so we can have physical Damage and no pain. Like most adults with back pain. Yeah. With rheumatoid arthritis, with lots of other conditions, we can have pain and no physical damage. A huge proportion of amputees still feel pain in the amputated limb. They're not getting any pain signals there because there's nothing to send them pain signals. They still feel it. With my ms, I get pain sensations from lots of body parts, and I know good and well that there's no damage going on there. What I'm trying to do is to convince and educate you that the link is not between pain and damage. The link is not between pain and damage. The link is between pain and danger, perceived danger. That's what your system is trying to do. And then we get into all of the other layers that are happening, because we know that PSB model, that biomechanical model is incomplete. It's saying that there's this direct relation between damage to your body and the pain signal you're getting. By the 1960s, we start getting something called gate control theory. In the 70s, we got this biopsychosocial model of pain. In the 90s, we got the pain neuromatrix and all of these. They're discovering in pain science that pain depends on not just the biological factors, but on what's going on with your thoughts and your feelings, what's happened in your experience up to this point, what's going on with your social and cultural and physical environment, all of these things. If you don't know how you're going to make your mortgage, you will feel more pain from the same incident. And as someone who is physically stable, it's as simple as that. The pain that we feel is reflecting lots of other factors in our overall life circumstances, in our overall quality of life. So what this means is during this time, pain scientists were figuring out what we social and behavioral scientists have known for decades and decades and decades. And that is pain is just like every other human thought and feeling or sensory experience. All of those have mental and emotional layers of interpretation that are slathered on top of the direct physical experience. All pain is mediated by social, cultural, environmental, and contextual and historic and biographical factors. And once we know that pain does not equal damage, pain equals perceived danger, we can start training ourselves to respond differently. It's tripping to that understanding. First, that's the step that we have to take. And that's really difficult to take, because if we are convinced that pain equals damage, what are we going to do? We're going to withdraw from the world. We're going to try to protect ourselves. We're going to try to get distant, just like we did with fear. Pain is just misunderstood. And I hope that that's the first thing that you've taken out of this episode. Pain is sending us a really valuable message and we're misunderstanding it. Even when pain is wrong or when pain gets. We haven't talked about pain windup yet or central sensitization or any of these other things that tend to happen with chronic pain over a long period of time. How after you've experienced pain, once you've recovered, your pain buffer has increased, so you're starting to feel the pain, that sense of danger, even earlier than you did before. And that's a pretty common response many of us get. So all of those are not pain as signal, but pain as noise, or pain like I live with every day. That's pain as noise. It's not useful. It's not an informative signal that's coming to me. Yes, I know my system is screwed up, thank you very much. So all of this is important because, you know, I said this at the very beginning of the episode, and I'm going to say it again right now. All pain is real. All pain sucks. No matter where it starts or what causes the pain. Pain is pain. If it's nociceptive or neurogenic or psychogenic or neuropathic or, you know, any of those things, it's still pain. Pain is pain. Your pain is what you say it is. And we also don't get to dismiss one another's pain. We don't get to hold ours up as somehow worse than everyone else's pain. Pain is never a contest. It's just not. There is no way to directly compare or rank your pain and mine. I don't know what you would do with my pain. I know my pain is a lot for me to deal with and I don't care what you would deal with with my pain because that, thankfully, it's not yours to have to deal with. You have to deal with your own pain. Pain is pain. And it's all just as real as any other pain. And it all has all of these different layers going on. And the good news out of all of this is because pain is not just a direct signal about damage. That means that with some time and some effort and some patience, we can retrain and relearn what some of those layers are doing through that process, improve our experience with pain. And I know this works because I've done it myself and I know it works because there are multiple studies now who've done it. You know, one of these really fascinating studies, an Australian study from. It was about 2016 or so. 1400 people in the study, so pretty large. And the average duration of pain in this study was seven years. People have been living with it for a good long time. And their average reported pain on a scale similar to the one I talked about was 5 out of 10. And they educated these people about what pain is really doing. A lot of material similar to what I've talked about in this episode, that research, and some other stuff as well. It didn't have an immediate effect, but three months out, you've got the control group that is just doing standard pain meds and relevant physical therapy for their pain. Three months out, their pain level is still at a 5 on average. The group who had been educated about what pain is really doing were down to a three on average. One year out, the control group still using only the standard methods, pain relievers still at a 5. The people who had been educated and were practicing down to an average of 1. Was the pain gone? No, still there. They just didn't care. Kind of like me. Pain's still there. I don't care. It's not getting in my way. Around the turn of the 21st century, we got on this kick about pain being the fifth vital sign and we should have no pain. That change happened just before the opioid crisis started taking off. We reset people's expectations to something completely unattainable. And we reframed how people thought of the pain in their life and whether they thought they had to do something about it or not. I'm not saying you should be in pain. What I'm saying is sometimes pain is an important signal for us, and sometimes it's noise, but we can learn to put it in its place. You are changing the way that your body has learned to deal with pain. Pain is a danger signal trying to protect you. Pain is not a signal about how much damage your body has experienced. Two, again, all pain is pain. Nociceptive, radicular pain, inflammatory pain, neuropathic or neurogenic pain, psychogenic pain, all of it. It uses the same systems. Number three. The brain draws on every available bit of information and experience in the moment and from your past to interpret what should be done with that nociceptive signal or with the painful concepts or feelings or whatever they are. It's always taking in all that information to try to interpret how best to deal with this to keep you safe. Because pain's a danger signal. Number four, we learn how to experience pain. We learn, when you were a little kid, if your parents freaked out when you scraped your knee. That's what you learned. You, if your parents smiled at you, said, oh, that's not so bad, jump up, shake it off, it's going to be okay. That's what you learned. And those really early baselines frame the way we each deal with pain. Now, they're still in there. So we learn to experience pain, we learn to provide a bigger buffer. Once we have experienced pain, we learn to become more sensitive to pain. Once we've experienced pain, our pain becomes less precise Once we've experienced more pain. So rather than having a localized pain, it may travel through different parts of our body, it may spread out. We can actually see the changes in the brain when this happens. We learn pain rapidly, effectively and well. But we deal with a lot more kinds of pain now than our ancient pain system was adapted to deal with. So we've got to help. We've got to get our smarty pants frontal cortex involved to help our pain system understand everything that's going on. Number five, we have a natural drug cabinet of analgesics in our brain. Dopamine, serotonin, oxytocin, endorphins, more than 20 kinds of endorphins, including natural opioids, noradrenaline or norepinephrine, glutamate, and gabo. We dismiss how powerful our internal drugs are, even though the man made drugs that we're taking are attempting to artificially reproduce what these substances naturally do. And these work better in the long term than anything we've come up with in a lab. What opens the natural drug cabinet? Positive information and experiences, which is again, one of the reasons why I jump out of airplanes, because I immediately get that endorphin and adrenaline rush followed by a dopamine and serotonin chaser. I come down and my brain's neurochemistry is automatically reset. I am alert and focused and happy and comfortable. I'm not saying skydive therapy for your pain, but, you know, you can choose some worse things. But my point is that we do these things naturally in our brains, and we need to take advantage of that. Number six, movement is key. Some people say motion is lotion. Pain wants to restrict us. But we've already established that pain isn't telling us damage. Pain is telling us danger. And we know that the more we move, that can be formal exercise, or it could just be getting out and being more Engaged. The more we do that, the better our system responds and the better we learn to deal with pain. And eventually pain reduces because we're building those capacities back up in our body. Only got two choices. Living systems either grow or they atrophy. If you are not doing things to actively grow, your system is atrophying, which means more pain. Number seven, most pain is noise, not signal. Can't emphasize that enough. And number eight, neuroplasticity. This has become a really popular term right now. Everybody's talking about it. It's like, oh, our brains rewire themselves. Well, yeah, duh. We're living systems. It's not neuroplasticity, it's bioplasticity. It's all of our system. Every single part of us, as long as we're living, adapts full stop. If you don't see that you're adapting, you're not paying attention. If you're not changing, then you're actively working not to change. And if you're not growing, you're atrophying. Life has no stasis. Activity is the enemy of pain. Go out, think good thoughts, actually do things. Talk to your pain signals, soothe them, comfort them, don't dismiss them. They're real and they're trying to help you be better. You need to help them be better at their jobs. That's all. We all have challenges. Mine is multiple sclerosis. We each have this one life, and. [00:39:11] Speaker B: We didn't choose to be saddled with chronic illness. [00:39:15] Speaker A: But there's a better way. So I choose to just jump. And you can, too. It's your life. Live it well. Justjump life. It's the youe Life Lived well podcast. Don't forget to, like, share and subscrib. [00:39:44] Speaker B: I want to emphasize one thing I am not saying in this episode. I'm not saying that there's no place for the standard approaches to pain management historically favored by mainstream Western medicine. Pharmacology, surgery, physical therapy, and manipulation. They all have their place. But there are four caveats to this conventionally received wisdom. One, we expect too much of them. Two, we turn to these methods too quickly. Three, we fail to look beyond them for other solutions. And four, we try to apply them beyond their best effectiveness. This traditional approach is more likely to be useful for acute transient pain because that pain is much more likely to be caused by postural, structural and biomedical dysfunctions or by exposure to noxious stimuli that are physically damaging our bodies. These pains are more likely to be reliable danger signals associated with physical damage that must be treated and protected. But even when accurate, this approach only explains part of the pain we experience and never accounts for all the treatments we might use to ameliorate the pain we experience. This approach is also increasingly inaccurate and incomplete the longer a pain persists. Physicians and researchers at the cutting edge of pain study and therapy overwhelmingly recognize that our dominant perspective on pain in the west is at worst wrong and at best limited and biased. Most of us believe A short List of Myths and misconceptions about pain 1. Pain equals damage. But pain usually begins before physical damage occurs, and pain is a signal of perceived damage danger, not damage. 2. Pain is cured with a pill or surgery. But pills mask symptoms. They cure nothing, and surgery is often irrelevant to the real cause. 3. Each pain can be traced directly and solely to a localized and recognizable physical problem. But pain, especially chronic pain, is really complex, multifaceted and dynamic. 4. Every physical problem causes a pain, but physical problems often carry no symptoms. Like, for example, if you are middle aged, you likely have structural issues in your spine that some associate with back pain, even if you do not. 5. When pain stops, the problem is fixed, but the severity and character of pain varies with all of your life circumstances. Number six for all these reasons, pain is a clear, honest signal. But only some pain is signal, and all pain carries a varying degree of noise, that is pain that is not conveying a useful and actionable protective message. And 7 all physicians accurately understand pain. But most physicians have very little pain education, and their education is often dated or biased. What does all of this mean? Pain is not a direct physical sensation. It's a social psychological phenomenon, just like everything else we sense, perceive, remember or imagine. Pain is complex, layered and variable. We've only touched the surface of pain in this episode. I promise we'll return to this important topic in another episode and focus on the different kinds of pain, especially chronic pain. And that is more than enough for today. If you live with pain. Well, I don't exactly understand your pain because all pain is unique, but I understand my own pain and I know that this isn't a contest. Pain is pain, and all pain sucks. So show yourself a little more compassion, make a great week for yourself, and I'll look forward to meeting you again in our next episode where we'll revisit another misunderstood stress. But for now, go forth, be well, do well, and do good. [00:44:23] Speaker A: If you've enjoyed today's topic and want to join the conversation with Dr. Kevin Payne, find your life lived well on all of your favorite social media sites. Patreon and of course, yourlifelivedwell co.