Dr. Joe Tatta: Welcome to the Healing Pain Summit 2.0 I am your host, Dr. Joe Tatta. It’s great to have you here for the second year of the summit. If you are new to the summit, welcome. If you are returning from last year, it’s a pleasure to have you back in helping me support this really important mission and turning around our nation as well as our global chronic pain epidemic. Um, I’ve got a bunch of new speakers this year as well as some fascinating and interesting speakers returning. So you start off the summit this year. I have Dr. David Butler. He is a physiotherapist, um, from Australia. He also has a doctorate degree in education. He’s a professor and he’s written a number of books on pain. He’s actually a well known, um, international pain expert. His books are the mobilization of the nervous system, the sensitive nervous system explains pains. One of his big ones, uh, the graded motor imagery handbook and the explain pain handbook protecting me.
He has a new book coming out called Explain Pain Supercharged, which we’ll hear about in his interview. He is well known and respected as a lively speaker. As you will see, he is capable of transforming some of the more complex pain, neuroscience or neurophysiology concepts into really easy digestible concepts that whether you’re a clinician or whether you are someone who is looking for pain relief, you can kind of understand these concepts and see how it relates to healing pain in your life. Um, he is a founder of the NOI group, the neuro orthopedic Institute group. You can find [email protected]. The link is also below his bio there on the homepage. New for the summit this year is that I’ve created a healing pain support group. So make sure you click on that link, make sure you go to the support group and join it. You’ll be able to interact not only with me in that support group, but also with others and share their kind of experiences around pain, their pain story as well as what has worked for them.
So without further ado, welcome to this year’s Healing Pain Summit 2.0 and I want to welcome Dr. David Butler, Dr. David Butler. Welcome to the healing pain summit. It’s great to have you on the summit this year. It’s, I’m sure you’re going to have a lot of tools and strategies to share with both clinicians as well as those looking for questions about their pain. Thank you, Joe. Great to be here, man. Best gradings to everybody from Australia. Yeah, thanks for joining us. I know gross has a bit of a time difference, but I’m, you know, it’s really, uh, you know, a real pleasure to have you here. You have probably a 40 year, um, quite a steam career of actually explaining what cane is to people or, or trying to develop systems around explaining what pain is. Can you tell us about how you came about this concept of explaining the pain and how it relates to, uh, people who have pain? Yeah, thank you.
Dr. Butler: Um, and yes, it has been nearly 40 years and, uh, um, and I just like to say I’m not quite retired yet, but I’ve had a real boost in the last few years with this world of, uh, understanding Brian plasticity, immunology, and I think we’re really onto something. But, um, I’ve been, um, playing with them, experimenting and trying, um, education therapies and merging education therapies in with my traditional manual therapy base now for quite a few years. And I think it just came about because the realization that people want to know and there’s a science out there, which if we really take a look at this, some wonderful stories, I call it the gifts of neuroscience, that if you can take the patients, they’ll really begin to move. And I think in the last, uh, probably 10 to 15 years now, I think there’s probably 15 randomized controlled trials that show that explaining pain with quality movement enhancement is the best thing out there. The chronic pain far better than any medication or anything else. Mankind’s and bandit.
Dr. Joe Tatta: Excellent. So just to, just to give our listeners and viewers a, an idea, you are a physical therapist trained first, eventually went on to pursue advanced training and a doctoral degree. And how did you come about this explaining pain? How did you start to develope it?
Dr. Butler: I started to develop it. Um, as I said from a need and I’ve got a, um, say I was lucky in my career to, to link up, um, early on with um, uh, people like, uh, professor Patrick Wall and the guy control work who was really supportive of physiotherapy or physical therapy. And um, he used to call us the sleeping profession and I’ve always taken that on as it gets out there and does something. And so many of you, you’ve got the patient license, the license to touch people, you’ve got some great skills already. Just merged some of the neuroscience into it. And the best way to merge it was um, this, uh, explaining the stories to patients as part of, as part of therapy. But it’s interesting because our profession or many professions don’t really think of education therapy yet.
Dr. Butler: We’ve done really quite tight that on. And um, I certainly found when I went and did an educational doctorate that there’s like these two big silos. One was health and one was education and H didn’t really mix, but there was so much that could be done. And I was probably self taught early on or with a voice like talking to patients and telling stories and then then mixing up and meeting with some colleagues. I’m really Gifford and then Laura Mosley was particularly particularly helpful. So I guess I um, I probably developed a of pain stories now that I’ll be publishing with shortly of a hundred or so little stories and nuggets that can be taken to patients sometimes as emergency analgesia but other times for longer stories that can help them develop significant and durable conceptual change.
Dr. Joe Tatta: Excellent. So you brought up the point of education and how education can really impact people have pain so you, cause I think as people watch this they start to think, well he’s really talking about maybe something like a cognitive behavioral therapy or almost how does, how does something like CBT differ than explaining pain that a, let’s say traditional physical therapist would use? That’s a great question. Joe. CPT.
Dr. Butler: Um, it’s obviously the most well known, one of the psychological methods and I actually think, um, explained pain and CBT both offer a lot to each other that there is still to merge. Um, there are some issues with CBT though I believe because uh, um, one of the features of CBT is, um, that is taught here in, in the U K perhaps in the U S as well, is that, um, if you have pain then CBT can help you function better. But then I don’t think can you change pain? And one thing we believe firmly in the data shows is that we believe that not only can you function better, but pain can also change. And there’s a fundamental term that I think is linked to that to take it on. And that is we should be considering pain treatment, not pain management. We think the word, I think the word my colleagues think the word pain management is a copper finds a biological event. Everything in biology changes. If we’re good enough, pain can change too. And with CBT if thoughts and beliefs can take you to a pain state, then surely thoughts and beliefs can take you out of it as well.
Dr. Joe Tatta: Excellent. I think that’s, that’s a great point cause I, and I think it’s fascinating to talk to another physical therapist about this cause I think when you hear physical therapists, most people are thinking, well, they’re going to talk to me about exercise or movement or strengthening muscles or something like that. But you’re talking about actually how your thoughts, your beliefs, your emotions affect your brain and how it can affect your
Dr. Butler: and how they can affect your pain but not only pain, but um, if we can take on a fundamental concept that pain is an output of the brain and that a construction of the brain homeostatic system if you want, there are, there are a number of other homeostatic systems as well, which it can affect and that’s going to be not any pain but immune and the crime, sympathetic respiratory, motor emotions, cognitions among others. There’s a big field there. And I guess this is part of what keeps me so excited after 14 years in the game. Yeah. Well
Dr. Joe Tatta: you just pretty much named almost every system in the body. So
Dr. Butler: that’s right. And we need to know that these systems that Joe I have, Oh, they all bring a remarkable narrative with them by bringing an understanding and understanding with them and uh, and it just powers up everything else we do in physical therapy, which is evidence based.
Dr. Joe Tatta: Yeah. So let me, if I can, let me just pull one of those systems. I that you mentioned just pull endocrine for a minute. Yup. When traditional physicians or traditional practitioners hear endocrine, they think of hormones and to a traditional physician you would say, well to affect hormones I might have to give you hormone replacement therapy or some kind of drug left side. How planing pain affects are actually a neuroendocrine system cause it’s really two combined is one. Correct? Yeah. Well the endocrine system, it’s an output system which obviously helps us cope, adjust and, and learn. And it will still be, be turned on if there’s what we call, um, if I might use the language, uh, Mosley, NYSE and others use names out there, a lot of danger in me, which can arise from many, many, um, sort of mines.
Dr. Butler: Um, it’s not only whether you’re injured, how you’re traded all ISIS elections in America, there’s a lot of danger out there. Um, so the circumstances or the context can create as we know. Well, I a stress response and you know what I mean, the crime response, which is part of that, uh, which will lead to altered glucocorticoids, which have an effect. But you know, this has been known for ages and there’s lots of stories out there. And if I was just to take that to a simple story, it would be, uh, when you’re in trouble, one of the systems which can come in and help you use the neuro endocrine system and what it does for acute stress. It powers up systems you need and shuts down systems.
Dr. Butler: You don’t need what you need when you’re stressed. If you’re being challenged or mud or whatever, you don’t need digestion, your dad, they reproduction you that need healing you that need high level thoughts, that’s okay. But if the stress persists for a long time, then you will start to get these changes that we say. So common in pic with chronic painter of cognitive changes, of slow tissue healing, of uh, of the beta changes of gut changes, et cetera, and otherwise been interested in as a therapist because, because for example, in chronic back pain, one of the most common co-morbidities is gut problems. And I’ve always been into this two different things, but very often again, arise from the one essentially stressed state, which is causing
Dr. Joe Tatta: two different sort of systems. I mean that give you one. Yeah. There are a lot of people who talk about gut health and nutrition on my, on my summits, I like talking about it myself. I’m trained nutrition, I’m a certified nutritious. I think it’s really important and there are some people, I think you can go to the gut first to start the healing, but for a lot of people, especially people with chronic pain, you don’t have to go to the other areas first. And I think your point of the brain and people’s thoughts of rude, the place where you have to go to to start the healing process and that the gut is secondary to it.
Dr. Butler: Yeah. I, I’m certainly not trained as you are there, but we certainly would see what they did with people with got pain and um, our view here and indeed the signs that we type the explain from would be that we’d say chronic gut pain is as broadly similar to chronic sort of back pain that can be processes in the target tissues that got other back processes in the neurology, changes in the central nervous system and changes in the other output systems which can come back and create a cycle and kick the gut and, or the God issues going. But, um, you know, still in explained pain and I still feel just been thinking the will was being slow to take the trip up the effort and year end or the glory above and see what one does in majesty that he’s there to enhance therapy and to do educational strategies.
Dr. Joe Tatta: Excellent. So the nervous system is, is you’re actually, you’re an expert in the nervous system. Can you explain to us how someone with chronic pain, you guys paying more than six months, what are some of the changes that begin to happen in the nervous system and why is it that a sensitive sensitive nervous system is more likely to cause of their pain versus let’s say a joint, a muscle attendant?
Dr. Butler: You know, other things we can think of? Yeah, that’s a great question. And, and, and um, quite a long one. I think it’s fairly well accepted in science that over time the essential pathophysiological processes for a pain state move up into the end of the representation of the muscle, the tissue, the injury, so got, could occur at, um, spinal cord or through a ganglion. But certainly in the, in the representation in the brain as well. And this is broadly, um, a way in which the human tries to protect itself. I think it calls upon more higher level protected to sort of defend and depending if you want to use a, uh, Jane analogy to pass on your genes to survive and, and uh, and live and if protection in a bowl, things like, well expanding the representation of a body part in the brain then so be it.
Dr. Butler: That’s uh, that is sort of a bright thing. As long as that doesn’t stifle too long. Um, we have many ways to protect ourselves and of course it could be, um, more useful or which could ultimately lead to perturbations of any of the homeostatic systems. Um, changes in, in respiration, changes in cognitions, changes in the sympathetic system, change in the endocrine system, all of these protective systems which are bright for, for, um, more acute trauma. But if they kept turned on, if they kept aging, they only have 30 patients in those sort of systems that we see later on. If it’s a perturbation in the sympathetic, I mean immune, you might see complex regional pain syndrome, perturbations in the motor system, you could all sorts of muscle imbalances and the like. But the same is I start from um, human protective elements against a range of dangerous out there in society.
Dr. Joe Tatta: So essentially what you’re saying is they all start from the brain basically, and then the brain can send a different kind of output to the body depending on who you are and what’s your, let’s say physiology or geo or genetics or, because you mentioned some of those motor outputs and so it’d be more sympathetic outputs I think motor people get, so they’re saying, well I guess motor means I could have a weakness or I could have a muscle on balance or one, one muscle is tighter. One muscle is let’s say more flexible. What does sympathetic really mean though? Oh, that’s quite, that’s quite complex because it gets complex because these homeostatic
Dr. Butler: systems that we say perturbed will never be turned on. Um, alone. If you’ve got a sympathetic alteration, which could be more or less adrenaline being bought out or could also involve a change in the amount and kind of adrenaline receptors in the excellent neurons. Um, but you’ll nearly always see it linked to endocrine and immune changes as well. But in the simplest sense, um, in the more acute sense, we say the sympathetic nervous system, um, perturbed and turned on, um, probably one of the fastest, um, of the system’s turned on to help us deal with, uh, with stress. Uh, you see the initial blushing and the redness. But of course, if our brain, why is the world and decides if I can use that language that the sympathetic nervous should system should be used as a prime defender. And that uses that so hard and so long, then that system itself, its apparatus can become putted and you start to get blood pressure changes, skin changes, um, POC and entrees, um, anxiety and sort of panic attacks.
Dr. Butler: So, but, but there’s story in that too that explained the pain story of why, why that might’ve happened. Um, if they go back a step because, um, to the, uh, to the motor system and we see, for example, a characteristic sort of motor change after a persistent threat of a forward head posture and these muscles get tight and all sorts of hotspots in them. And this is weak and a decent sort of therapist shouldn’t start to strengthen and stretch that and do other sorts of strategies. But if they take it a step further and then go deeper and try and work at what was it that made that person adapt, that posture, what was the, what was that person trying to protect from? Then they’re getting into a deeper biopsychosocial approach and they’re also getting into the need for narrative or story to explain that.
Dr. Butler: Excellent. So you’ve been up to two points I want to kind of touch on briefly. Um, the first is what is a biopsychosocial approach and how does it differ from what many versions have been practicing for the past? I’ll say five decades. Yeah. The bar is like a, it’s a big word, isn’t it? It’s a big clumsy word, but I’m afraid we don’t have anything better at the moment and it’s become a bit trendy. I don’t live in the U S but here it’s quite trendy to sound bias, like essential and look very few people I think understand what it is and the true strength of it. I must admit it, I did a doctorate in it or not, I still quite understand it, but if I could briefly have a couple of minutes. The bio in bio, it’s like a social is not biomedical, it’s big bio and that includes the biology processes within the tissues of the body, within the brain, within the mental frameworks and the interactions between them.
Dr. Butler: The psycho obviously includes the psychological components which interestingly are increasingly being biology and by that I mean for example, catastrophize ation. We now know some of the immune changes catastrophization which by the way makes it really good to help explain catastrophization and the social side, which is often missed in our health profession, but I always tell people if you’re with a client, a patient and that patient is telling you about their pain state, if you can suddenly realize, hang on, this is not a problem just with this person. This is a problem in society as a whole. Then you’ve really got the social part of bio-psycho-social. Of course there’s the other framework, the biomedical framework, the find it and fix it if you want that, by the way, we’re never going to let go cause there’s some fabulous pieces in biomedical thinking and I would say that many of your listeners, there will be some who would not be alive today if somebody didn’t have a really detailed biomedical hunt for some sort of pathology.
Dr. Butler: But the key thing is, just as I’m sure most of your listeners will know, is that when something becomes chronic and when the pain state has multiple causes and also depends on what a person thinks and does about it, then the biomedical singular hunt for a hunt for something will not work. And you need to go to a more bio-psycho-social, a wider framework to actually address that. And it’s not just chronic pain, it’s chronic obstructive airways. Disease is chronic diabetes. It’s a whole range of the chronic States and often say biomedical thinking. We’ll fit into bio, psycho social thinking, but the biocycle social will not fit into biomedical. So we buy a psychosocial us, welcome the biomedical, we say, come in, join our club, give us your tablets, your good bits, and we’ll help enrich, enrich your own practice with boss’ Soka socialism. Sounds like Max’s doesn’t advise.
Dr. Butler: Yeah, it’s a very complex word, but you know, to kind of boil it down, what do you really say is that there is no one way to necessarily treat or cure pain. It may be different and um, unique for a particular individual. That’s right. It’s got to be absolutely. Um, it’s, um, there’s no recipe. It’s gotta be reason, um, to get the best out of the person. Yeah. It’s an individual experience and that’s the first thing we have to respect. So that brings me to the next, my next question, which um, I think it kind of ties into your book, explain pain and I know you have your version of that will come out, which is called explain pain supercharged. Yeah. How is it that every person’s pain experience is unique to them? So if two people have the same injury, let’s say, or disease process or trauma or whatever it is that is causing their pain, ultimately pain and the pain experience is unique to you as an individual.
Dr. Butler: Yeah, it is. I would say it will never, ever be the same for each person. And I think that’s it because everybody has an injury in a different context. Everybody has an injury with different memories, concepts, experiences, predictions for the future at that time. So I would say that when a person, apparently when we see two people with the same injuries, it will never be the same injury because of these other processes which has occurred, the framework with that in the framework that the injury has has occurred on. And of course, um, it then goes on. It also depends on a whole range of things. Who you meet, who you, who treats you. Um, does that person have adequate skills in relation to your own, your own concepts about your pain state? So everybody, everybody is different from the moment their region. I think everybody’s different from the moment before they’re injured.
Dr. Butler: You know, I’ve always said that I look at this chronic pain epidemic. We realize, what is it? 100 Americans have an ongoing pain state. We realize that chronic pain in America costs I think something like five times what it does to run the Wars America’s involved in. And Australia too. It’s a, it’s a horrendous, it’s a horrendous epidemic. And I sometimes think, um, what’s the answer and the may, it’s almost a preemptive hit back in, back in, uh, in schools back before people have pain education in industry and schools about pain that it’s usually not a damaging thing that will nearly always get better. That we always have pine in lot, that it’s a normal, a normal part of life. But, um, that’s a long winded way of answering your last sort of the question. We’re all different, but we need to get back I think early on in our lot experiences to actually do something about this epidemic.
Dr. Butler: So if there are, there are a lot of people log on to my summit. I mean, physicians, physical therapists, chiropractors, health coaches. Um, some of them are very familiar with their concepts and some of them are just starting to hear them. What are the key principles that practitioners need to be successful for explaining pain to, to patients? Yeah, thanks. That’s, that’s um, first of all, that’s something my colleague Lorimer Moseley, some of your listeners would have surely heard of. We work together a lot and when we write explained pain, we were essentially telling the story of the neuroscience in a language that patients and therapists and health professionals would get. And then we realized a little bit lighter that, um, uh, we needed to do more on how to translate that information, which is the same. So conceptual change theory, how do we change concepts in our patients as well?
Dr. Butler: So that’s merging the education element in with the, in with the neuroscience and there’s a few things there to be good at it. I first of all think you’ve got to have a bias, like a social approach, right? That’s the first thing that nice wide bias, like a social approach, but there’s also competencies that, um, um, uh, health professionals need. I think you need to be, first of all, biologically literate and biologically literate these days means, um, first of all, an understanding that neuroscience is changing at an incredible rate. Our all systems we’ve, we learned about nosy set this and stuff is changing. We have to be neuro immunologists. I think if you don’t take on the immunology and realize that at least 50 to 80% of the brain of the brain cells are, have gotten immune function, that we’re really sort of missing something. The glial cells have an immune function and a critical in, in learning health and sensitivity.
Dr. Butler: I also believe that a health professional to be good at it needs to have what we call an emergent schema in their brain, an emergent neuro tag in their brain and said another way. The person rather, if I can contrast that with a linear way of thinking, which someone who’s thinking linear a, B, C, D will often have a singular blame for something. So that happened. I was in utero work. This happened, this happened and this happened. But if the professional has an emergent framework, which means if I can think collectively and realize that many things come together at the same time to construct this app for the pain, if I haven’t got that, I think need a little bit of trouble, it can be taught. And indeed, one of the things we teach our patients is, um, is that, um, uh, to try and give them this ability to think collectively.
Dr. Butler: So I’ve given just an example. Um, someone’s side has been badly burned. Um, and then three is lighter. They have a chronic pain state. I can fully understand how that person would want to just blame the burn for it and what happened at the burn. But of course three is lighter. There’ll be many, many other things that are coming in to help construct this pain state. So they’re coming in together, working together collectively to create the pain state. So this emergent framework is thinking collectively as I think is a real, a real necessity for thinkers. There’s lots of others I think. Um, um, now in common Todd therapy too, I think if I was to list some of the common concept targets for education, um, first of all, the difference between nociception and pain that’s a nosy section is a far and wide Delta and other fibers.
Dr. Butler: But nociception doesn’t have to hurt. Pain is a Brian construction. I think key concept targets at Bryant that pioneer is distributed in the brine so that when we have pine that could be, I don’t know, maybe a thousand areas of brain engaged at the same time, which sort of says there’s many things which can come in from that come and influence it. And it underlies a pair of context. I think, um, a key thing is that web, we are bioplastic is the word we use that underlies incredible changeability and potential that we, that we have. Um, I think that there are many coping strategies to, to, for people to where that, that there are many coping strategies and I’m sure many of your learners will, we’ll have some wonderful uh, sorry, not your learners, your, your, um, your code contributors will have many ways to deal with the pain state and please link it all together.
Dr. Butler: It will be absolutely wonderful. So yes, there are competencies that I think, um, people need to have. And finally, I think we could all do with a little bit of educational psychology. I think, um, you know, teachers are taught how to teach and here we are pushing education as therapy. And uh, if I can summarize that in one, a few sentences for, for your listeners. Um, the kind of education we’re after here is not the education that we all had when we were young, since when we learned new things. The kind of educational psychology we need here is the conceptual change world because people with pain come in with a lot of existing beliefs and knowledge ideas and the educational strategies, uh, essentially come from the research field of conceptual change. And there is one there sometimes with conceptual change it requires a little bit of conflict and many of our colleagues don’t want to engage in conflict. It can be done nicely, it can be done beautifully, can be done with stories. It can be done implicitly with people reading. But to really get to this epidemic in society, um, the conceptual change philosophy with a bit of conflict, um, is often necessary.
Dr. Joe Tatta: Yeah, I think it’s a great point. The conflict part. I mean I have had conversations with other practitioners, um, couple of examples that come to mind, mind or you know, well, if someone has an autoimmune disease, how explain pain or pain education or pain, neuroscience, whatever you want to call it, how can it help that? Or if someone has, you know, a fractured vertebrae, they were in a car accident, they fractured their spine. How, you know, how did, how is your, you know, conceptual model gonna change that base. And there they’re valid questions that I think
Dr. Butler: questions and I think that what’s that done? It’s led to a philosophy that I’m explaining. Pain is something for the person with chronic pain and not acute pain or even sort of sub acute. But our view is that explaining pioneers for all pain. In fact, I don’t really like to divide, um, acute and chronic. I don’t know where that came from really. I find it difficult. So we say that, um, education is for both acute and also as I’ve commented before, even as a preemptive, um, hit on pain. Now obviously if someone’s got a fracture, you’ll be doing other things as well. Of course, but there’s no harm and certainly would be advantageous to discuss the pain they’re experiencing too. Two, why up, um, why they’re hurting and if I might just expand on that a little bit. Um, there’s a fundamental, the thing that I feel that’s really kept me going in the last few years, it’s the ability along with my colleague Mosley to put a lot of complex neuroscience under a simple formula and it’s called the same formula.
Dr. Butler: So if I may say, we feel competent to say that a person will have pain when their brain, why is the world but can use that language. So judges everything and works out that there’s more danger out there than safety. Equally, a person will not have pain when a brain, why is the world and judges this more cited at the thin danger? The trouble is of course, danger and safety hide in hard to find places. So that giant just out there, which could be constructing a pain state, could be ranging from smells, memories, the things people say that things they say their own injuries to the body. And people I hang around with the places they meet. So indeed, if there are let’s say a thousand pieces of Brian engage in a pain experience, you can understand there could be many dangers coming in and constructing that. I will still be there and around in an acute pain stay. And I believe you can deal with that early. You may will be preventing or sort of minimizing the chances of a more chronic time sort of lighter. Rolling.
Dr. Joe Tatta: Excellent. So really what you’re saying is when we’re talking about the experience of pain, you can bring in a smell or a sight or something that you heard or syncing. Those are all receptors that come into your brain. Basically the brain has to take in all that information, do something with them to figure out whether there is safety or whether there’s danger.
Dr. Butler: That’s that’s correct. And, and I think a lot of my therapy now with the explained kind world, it’s, we call it trying to demolish the Dems, the dangers out there, which are often explaining things which could even arrange, uh, from, uh, letting a person know that the language they are using is actually danger enhancing. But we also help them find the safeties to and and safety. It hides in hard to find places. It could be looking at, uh, uh, it could be in music, it could be in a pitcher unit you’d like, it could be, and going to a safe place. It could be meeting up with someone on Facebook again and as well as it could be with the gratitude exercise and activity, meeting with your best friend at the gym, etc. Losing a bit of white, getting off the fried food or whatever. So it’s a big, broad, big, broad, bought a psychosocial look. Some people side say to me, you’re trying to be a psychologist. I said, no, no, no. I’m a physical therapist who’s, who’s using all avenues I can to help somebody in an ongoing pain state with education and movement. As my fundamental banks.
Dr. Joe Tatta: Yeah, I think it’s great. I mean, one of the things I tell my patients is that ultimately pleasure mutes pain. So if you can find a way to increase the pleasure in your life, lot of times, as you say, those dangerous signals start to really kind of die down basically. And what you’re, you know, if those dangerous signals die down, you really can’t have babies.
Dr. Butler: That’s right. So a story would tell my patients would be that when I do these fancy Brian maps of people in pain and people in pleasure, it looks reasonably similar. So we could say Krave, that pleasure uses a similar networks as pain does. So you could argue it’s exercising areas of brain use in pain. So it takes it away from what we call the pain. So the a day, yeah, that would be an example of a very simple explain time. Yeah.
Dr. Joe Tatta: So where do you see us going in the next 20 years regarding paint treatment?
New Speaker: I mean, you know, in the U S right now, the last, I would say six months or so, we’ve had a, you know, pretty good awareness around opioids and the fact that we have an opioid addiction problem in our country and it’s over prescribed and we finally have the government saying, look, they may have their place, but they don’t really have such a great place for those with chronic pain or persistent, I don’t like to use the word chronic, I like to use the word persistent. Look, we can stop persistent pain. Um, but where, where do you see pain treatment going the next 20 years? Yeah, that’s a really interesting question and I often have that discussion with my colleagues over a few Australian shirazes and civilians late at night. First of all, I think I like how you use the word pain treatment. That’s lovely. Um, I think that is just great that this, uh, opioid abuse is really come to life. It’s not only in your country, it’s here as well too, that we have more deaths from the prescription pad than there are illegal opioids. Um, and surely there will be some more that’s a responsibility taken for, for, um, the opioid overuse. But then again, I think there’s, there’s those of us who are out there, um, presenting a different thing. For example, if there’s no heavy drugs, well then you know, what is there and it’s up to us. It’s up to your, your listeners. I think disabled, hang on. There’s a hell of a lot of other things that we can do that are gaining it, that are really guiding it and don’t have the same sort of side effects.
Dr. Butler: And I’d obviously put education and movement and all of your other, other contributors, diet, et cetera in that as well. So I think we need to stand up and be an and, um, and be heard. Um, I’ve got a little bit more confident now. I must met 10 years ago. I was thinking, well, that’s going to happen. But then again, you know, you see, you say big pharmacology is actually moving out of research and development for chronic pain. And because the last big one, he was Gabapentin, I think it’s called Lyrica day or whatever. And then Ben says, well, who’s next? Who’s going to take, who’s going to take the take the place? And, uh, I, I must admit, I get really confident when I see, for example, um, it’s getting a bit easier to get research money for education and non pharmacology, um, based, um, by specifics from, from a government basis.
Dr. Butler: And, uh, I still recall the fist explained pain course I ever did in Sydney in 2003 with Rama Mosley and we publicize it, but I need nine people turned up and I say it to alarm, Oh, this is not going to guide very far. And he said, I’d stick with it. I think they’ll get it. And uh, we now have the, the grade, some honors, quite a humble to go around. We might go around a small Australian sort of city and a hundred people will turn up, but there’ll be from all professions, all professions coming in. So it’s long now gone out of the physical therapy world. And it’s a very multidisciplinary thing, which I really love.
Dr. Joe Tatta: Yeah. I mean, I, I took your explain pain course and it’s a, it’s a wonderful course. Um, and I think it’s really starting to, you know, pick up more momentum in the United States. And I’m sure it will, it’ll continue. Um, can we just talk about the physical therapy profession just for a second and this whole kind of pain? Uh, you know, epidemic and I had done a lot of, let’s say, phone calls and emails and some urging of the, of, of the American physical therapy association, the, our professional association here in the U S to really say, Hey, I really do think that physical therapists probably are the key clinicians for attorney are persistent pain epidemic around. I realize that there’s no one source of pain and there a lot of different reasons for it, but why are physical therapists uniquely trained and to, to really take this epidemic head on and probably really changes. So when I look back, you know, I think 50 years from now when we look back, I really do think that, you know, physical therapists, doctors, physical therapy here and who has really probably would be the ones that turned that epidemic around.
Dr. Butler: I think you’re right there with some sort of, um, yeah, with a few provisors I do think our education has to change. Um, for example, that at undergraduate level there should be full one, two long subjects on chronic pain, acute pain treatment. I don’t know that that’s that prevalent out there. Um, I know it took me a long time to get our university here to take on a 190 hour, um, clinical pain sciences course 10 years ago. And I know there were a few others that had things set up so that that has to happen at the undergraduate level first. Um, secondly, of course we have this uh, problem out there where, um, explained pain is attempted to be delivered at the same time as more biomedical approaches. Um, without picking on one in particular, I’ll say a dry needling. Okay. Now I don’t have any problem with dry nailing or, or Graston technique or, or, or anything, as long as it’s put in a big framework of Baba boss, like the social approach.
Dr. Butler: And that that is just part of an overall and overall recovery. But explained pain becomes quite difficult if it’s not putting that big sort of framework. Because if you’re explaining pain, you’re essentially saying to somebody, a lot of your pains in the brain, right? And then you go on to do something which is more biomedical. It is left by itself. That’s just say a needle or some technique and it’s a bit confusing for the patients. It’s a bit of a problem and I probably won’t quite get it. So this is the way bias, a social philosophy and thinking I think has to come in very, very early in our education, very early in our education, um, to make this actually actually work. Um, I’d also say too, for our profession, we are really only just getting a grasp of the power of education too. So, um, I know Laura and I’ve just sat down and we’ve written a taxonomy of nine stories, a hundred sort of strong and each Tommy Layton took the suggestion that we, I wish I was using that story five years ago or eight years ago.
Dr. Butler: I wish I could use that. Um, so yeah, I think we’re still growing, growing with, um, with um, explained pain and that also leads to a problem because anything a little bit new is a little bit, can easily be knocked off. So people say yes, I tried that. Guess I gave him a few stories that didn’t work, so I went down and did this. So, so I guess I asked people to be careful with it. I think there’s 16 randomized controlled trials now showing its efficacy. 16 and probably four. I’m aware of still being done. Uh, we’re not works in different populations in different ages, um, for different problems. States as well too. But it still needs, it still needs a lot more. The good news from it though is that, um, all the RCTs show that it works. And, um, if you look at the number needed to treat statistics, they’re certainly far, far better than any of the heavy medications which are currently still the mainstay for pain treatment in your country in mind.
Dr. Joe Tatta: Great. So Dr. Butler, if people want to learn more about you and, and some of the courses you offer or if they’re looking for, you know, more information about exactly what explained pain is. Can you tell me one on the summary where they can find you
Dr. Butler: and your website show? They can come to the website, www.NOIgroup.com. Um, and there’s lots of links there and lots of video clips. Um, they can come on to NOI, jam.com where we post the explain pain stories, uh, nearly every week. And I’m coming over the U S at the end of the year around election time, which I’m a little bit scared at election time because the world is not sure what’s going to happen, but I’ll be there doing some big seminars in Philadelphia and Seattle. And I always loved coming over the U S and, uh, getting inspired again and just seeing what people are doing. So yeah, I’m around. I might’ve been here for 40 years, but I’m still pretty excited about it all and I think I’ll be here for quite a while yet.
Dr. Joe Tatta: Great. So we will, of course, if you’re in the U S please check out, um, Dr. Butler, I think you’re in Philadelphia and Seattle you said?
Dr. Butler: That’s right. Yes, please. In December, is that correct? Bill is in December. I’m doing it. I’m doing a course there and this is another advanced to explain pain. I’m doing it with Laura Mosley, but also with Mark Jensen of somebody might know I’m professor of psychology in, uh, San Francisco and of course he’s a world expert in hypnosis. So one of the things we’re doing in our strategies to develop, explain tinies whether it will be better if we can induce a state of hypnosis first and then use LH occasion, but there’s a number of other strategies, um, um, motivational interviewing that can be used to help nurses, CVT, etc. So I’m looking forward to that.
Dr. Joe Tatta: Fascinating. Okay. So maybe we’ll check you out on www.NOIgroup.com
Dr. Joe Tatta: yeah, and you can also find the appropriate link under dr Butler’s bio on the summit page, so please check it out there to link right to his site. And if you enjoyed his video, which I’m sure he did, there’s lots of great strategies and tips, tidbits. Please hit the link below this video so you can share it out on Facebook or you can share it out on Twitter. And I want to thank Dr. David Butler for joining us on the Healing Pain Summit 2.0 this year. It’s been great to have him and we will see you on the next interview.
Dr. Butler: Right. Thank you very much, Joe. And thanks for all the work you’re doing.
