How To Live With Less Pain With Afton Hasett, PsyD

Welcome back to the Healing Pain Podcast with Afton Hasett, PsyD

How exactly do we deal with chronic pain? The state of the science suggests that the answer may be different for different people. In this episode, Afton Hassett, PsyD, a renowned expert from the University of Michigan, delves into the complexities of chronic pain and the safe, effective ways to manage it. Drawing from her extensive research and her recently published book, Chronic Pain Reset, Dr. Hassett offers profound insights into the physical, emotional, and social aspects of pain. She emphasizes the importance of addressing the affective component of pain and the significance of behavioral activation in the recovery process. Her innovative approach combines neuroscience, behavioral therapy, and positive psychology to empower individuals living with chronic pain. Discover actionable strategies and practical solutions that can truly make a difference. Tune in to this episode to learn more and unlock a path toward thriving despite chronic pain.

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How To Live With Less Pain With Afton Hasett, PsyD

Our featured guest in this episode is Dr. Afton Hassett, a licensed clinical psychologist and Director of the Pain and Opioid Research Center at the University of Michigan. Dr. Hassett’s work in the Chronic Pain and Fatigue Research Center has made her a prominent figure in the field of pain management. With over 100 articles published in scientific journals, Dr. Hassett focuses on exploring the profound impact of positive emotions on people living with chronic pain while also developing interventions to enhance pain self-management.

Dr. Hassett’s contributions go beyond her research. In addition to her academic accomplishments, she’s the author of a new book called Chronic Pain Reset: 30 Days of Activities, Practices, and Skills to Help You Thrive. Without further ado, let’s begin and let’s meet Dr. Afton Hassett and learn about effective strategies for pain self-management.

Afton, thanks for joining me on the show.

I’m so happy to be here. Thank you for the invitation.

I’m excited to speak with you a little bit about the psychology of pain and all the things that are connected to that. That’s the biological piece, the sociological piece, the environmental piece, what’s happening in our healthcare system, new developments that you’re working on, and things that we may or may not be focusing on that we need to focus on more.

I know we’re going to touch on lots of topics. A lot of what you do revolves around researching pain. At the University of Michigan, I know you and your team work on that on a daily basis. You have a number of research investigations going on. A good place to start is what’s the one thing you’re working on as far as research goes that you’re most excited about?

I love so many things, so it’s hard to pin one down. Maybe the one that may have the biggest impact and really will hopefully impact physical therapists is a study that we’re conducting under the NIH HEAL funding initiative. That’s Help End Addiction Long-term. It’s the congressional money that was put forward to support, hopefully, some innovative research in substance use but also in pain.

The grant that we had gotten is what they call a mechanistic research center grant. It means it’s a big bunch of money to dig into a topic. What our group does phenomenally well is mechanistic work. That’s understanding and teasing apart the brain mechanisms of things, how inflammation works in the body, how treatments impact brain function, and other biological changes.

What we are doing is looking at four effective treatments that are commonly used in chronic lower back pain and trying to tease out two key questions. The first question is who responds to what therapy? Given therapies that are evidence-based and generally effective, because they only work for about 1/3 of people in many cases, who responds best to what therapy? Can we learn anything about ordering? For example, would we want to get patients on duloxetine before sending them to physical therapy, or do we want them in physical therapy before we have them do talk therapy? Those are some of the questions we can answer.

Since we’re a mechanistic center, we can also dive into how these are working. Is physical therapy changing connectivity in the brain? Is duloxetine affecting different systems than we thought in the brain or inflammatory systems? Are behavioral therapies different in how they impact the overall physiology compared to physical therapy? It’s exciting. We almost are overwhelmed by the data that we’re getting already on how to best tease out these key relationships.

The focus there is pain mechanisms, so to speak. Maybe for people tuning in who may not know what a pain mechanism is, distill that down. What’s the difference between research that looks at pain mechanisms and why that’s important versus research that maybe looks at outcomes of the research?

I struggle with this. Why would we care how something works in the body? Why is that important? Isn’t it important that it works? When we understand the mechanisms, it helps us make it clear that this behavioral treatment, whatever it might be, is changing body and physiology. It becomes even more compelling to physicians. If physical therapy is changing connectivity in the brain, wow. Those are the types of things that give us a little bang for the buck.

If physical therapy is changing connectivity in the brain, those are the types of things that give us a little bang for the buck. Share on X

The research that we spend a lot of time on is the mechanisms of pain itself, so understanding the differences amongst types of pain. Inflammatory pain is quite different than mechanical pain which is bone-on-bone osteoarthritis versus pain that is predominantly driven by dysfunctions in the brain. Those are changes in the function and structure of the brain, so a nociplastic pain. All of those require different types of treatment approaches. When the pain types overlap inflammatory pain that also has nociplastic, so somebody has rheumatoid arthritis and fibromyalgia, how that is treated so differently? Being able to tease apart some of the biology of these things does give us some important information.

A review of the four groups that you were looking at, what you mentioned were?

Physical therapy, which is a mindfulness-based stress reduction, and an online group or a setting. We are looking at acupressure delivered by mHealth. It’s a self-acupressure regimen. Lastly, duloxetine.

I’m curious about this. A lot of physical therapists follow this show. One group is “physical therapy.” To me, physical therapy is a profession, not an intervention. I’m wondering what that particular treatment looks like and how physical therapy is standardized.

That was our hardest arm. We spent the most time talking about it. It’s exactly what you’re saying. It’s many things. Almost like psychology or many interventions, one size doesn’t fit all. How do you come up with a plausible intervention that is tailored to some degree but also meets the needs of conducting a clinical trial?

We worked very closely with a number of DPT-level individuals who gave their feedback. We also left a lot of latitude. Unlike most of the clinical trials that we conduct that are pretty to letter, we left physical therapy to be more flexible, because that is the requirement. The physical therapist has to make this assessment and truly use different tools and the toolbox to be able to best treat a patient. We left that pretty loose, so one person’s physical therapy may not look like another one in this study. We’re very clear about that.

Since it’s a mechanistic study and not an efficacy trial, meaning that we want to understand how stuff works, we wanted to represent what happens in the wild. You guys aren’t following one treatment manual. You are adjusting. We’re doing long visits, too. They’re doing 30-minute or longer visits and they’re getting 8 sessions. It is what I hope is a reasonable dose of physical therapy. What we’ve asked them not to do is something that you guys probably do regularly and do very well. It is to add a lot of the psychological aspects to it. That’s for the study. In a separate study, we are allowing that.

You did piece out the psychological aspects. It’s interesting though. Physical therapy is a profession. We do a lot of different things like psychologists “do a lot of different things in therapy.” Some people look at movement as a behavior. It’s almost like its own behavioral therapy. When I think about it like that and I reflect back on the research that has been done in neurological physical therapy with people recovering from strokes and Parkinson’s, we know that there are changes happening in the brain and nervous system. It’s neuroplasticity. It’s motor learning. It’s motor control and those aspects of things. Are you starting to see that? Can you share a little bit of early data with us in that area?

We don’t have it yet. I would love to scoop some of it to you, but we’re still in the early days. We’re still cleaning our neuroimaging data. We have made good progress though. We want to randomize a total of 400 individuals, so 100 in each arm of the study. We’re at 300, so we’re not all that far away. We’ve made great progress. Hopefully, we’re going to have some preliminary results for you in 2024.

I know you also are working on some neuroimaging. I know it’s probably part of that study, but is there a neuroimaging study that has come out of your group that you’d like to share with us that is important with regard to what we’re seeing happen in the brain with pain?

I don’t know if I want to stay close or go all the way back. I’ll do both. Our group is very known for a study that was published back in 2002. It was the first study that showed using neuroimaging that there are differences in the brain amongst people who have chronic pain compared to those who do not. In the study, they compared people with fibromyalgia to a non-chronic pain control group.

What was seen in that study was that the individuals with chronic pain required far less pressure pain to have a very seminal neural pattern to the people who had chronic pain. We’d put six times greater pressure pain on the healthy controls to get this same level of brain activation. That was the first time. It was shown in a real, clear fashion that something different was happening. There is this amplification process.

HPP 323 | Chronic Pain
The individuals with chronic pain required far less pressure pain to have a very seminal neural pattern to the people who had chronic pain.


A second study I wanted to tell you about is something we published not long ago. It’s using the ABCD data. I don’t know if you talked about that before, but it’s fascinating. It’s another NIH initiative to study a large cohort of children over time. They’re studying these children in very in-depth ways. They’re studying, I believe, at eight years old all the way through the end of the teen years. They’re looking at questionnaire data but also do neuroimaging every year. You can map that data on.

The study was initiated to understand substance abuse. Which children are particularly vulnerable to developing substance abuse? In it, they also ask questions about pain. We are able to use those data to ask someone questions about given pain-free children in an early stage, what predicts the onset of new pain down the road as a teenager? We see many of these pain conditions begin quite early and then last into adulthood.

What we found was quite surprising in a pair of papers. With the one paper that looked at the questionnaire data, it was not depression and anxiety that was predictive of who got chronic pain. We may think or might hypothesize that could be a predicting process, but it was sensitivity to the body, being aware of the body, feeling, smell, senses, having a few symptoms, sleep problems, and cognitive problems. The kids with the greatest cognitive complaints and fogginess were the ones most likely to develop chronic pain.

In the brain, what we saw was exciting. It was the children who had intense or over-connectivity between the default mode network and the salience network, these two networks in the brain are overconnected in chronic pain adults, were the ones that eventually developed chronic pain. This brain connectivity is a vulnerability. It isn’t necessarily caused by the experience of chronic pain because we didn’t know. That’s some exciting work that helps us think about these conditions a little differently.

Opioids are a sensitive topic. We’ve talked about opioids over the years. Sometimes, I’ve done entire episodes on them. I oftentimes receive very positive feedback, and then I oftentimes receive feedback from people who are concerned, scared, and angry. Those are all very understandable reactions to opioid use and misuse at times in our nation and how all of us, and I include myself when I say that, have approached this topic and how we’re still trying to figure out what this topic is and how to help people directly.

Especially within 2022, some of the restrictions around opioids have been slowly pulled back a little bit so that prescribers would have a little bit more flexibility that was taken away from them. Probably like yourself, I have mixed feelings about some of these things. Some of the 2030 Healthy People data shows that emergency visits for opioid misuse are down, which is good. I’m concerned that if we roll this back, might we see that go up? What’s your general opinion, and this is a professional opinion, about where we are as far as opioids and what we should be communicating to the public about the use of opioids?

It’s a sticky subject because part of it is the data aren’t that good with the definitive clinical trials that have not been conducted. What we are left with is what we see clinically. Our research team is embedded in a very large outpatient pain clinic for the Department of Anesthesiology at the University of Michigan. We see 2,000 new patients a year. It’s a busy clinic with many individuals. A large number of individuals come into our clinic on opioids. The question is, “What do we do? Do we continue these? Do we discontinue them?”

It’s hard because what I know from talking to physicians and talking to patients is some patients that with chronic pain do well with opioids. You take them off of opioids and they’re miserable. It started a panic, a lot of fear, and a lot of anger, and rightly so. To have a medication taken away from me, that really works. We also see a group of patients that the opioids are not helping. Their lives could be disrupted by addiction. That’s almost rarer than when we see that they’re not benefiting. People are coming in on a large dose of opioids and their pain is a seven.

Some of the work that we’ve done is also trying to understand the phenomenon of opioid-induced hyperalgesia, which is the notion that your body acclimates to whatever’s put into it and changes. In the case of opioids being taken for too long a time, it can make pain worse. The use of opioids is elevating pain. We don’t have a great way of knowing that by looking at the patient. We often think, “You’re taking opioids. You’ve been on them a long time. You probably don’t remember what it was like to be off of them, but what might be happening now?”

We talk to them and say, “A large subset of patients do as well or better off opioids, but we won’t know what patient you are. If you do terrible off of opioids, we will figure out how to get you back on opioids in the same way.” The opioid experiment is amazing because most people are afraid to do it because they can’t believe that their pain could possibly be better. How could it? It’s going to be a 62 if it’s a 7 on opioids.

What we find is that as they’re weaned off of opioids, often using the help of buprenorphine or other types of weaning medications, after a few weeks off of opioids, a large subset of patients are shocked that their pain is better. They’re sleeping better. Their emotions are feeling more stabilized. They’re thinking more clearly. They’re able to go to the bathroom. Life has gotten better. A sane way is for each patient to meet with their physician and decide if an opioid experiment makes sense for them and see where they’re at. We need to be sane. We need to recognize that some people do benefit. It’s a disservice to stop giving people opioids. It’s dangerous.

We need to recognize that some people do benefit from opioids. It’s a disservice to stop giving people opioids. It's dangerous. Share on X

What we do know is that it can be dangerous. That’s for certain. I appreciate your point. I’m sure people tuning in who are on an opioid or have taken one in the past and benefited from it know that some people do show beneficial effects from it and other people don’t. Talk to me about how important in that process choice is with regard to the conversation around tapering.

It’s critical. It’s like anything else. Unless somebody is at that inflection point where they want to explore something different, you can’t make people do things. It is so difficult because they’re going to have a bad outcome. If we educate and people think, “On the other end of this, I might be better,” isn’t that worth seeing? It is like, “You’re cracking open that door that I might be better. If not, I can go back.” That’s it.

The choice is critical. In studies that we often conduct, the more choices we give to patients in what they do or when they do it, the better off they are. It’s a huge piece of my book. When I talk to other clinicians about, “What behavioral therapy or what therapy in general works best for patients that you treat?” we all come to the same conclusion. The treatment that works best for almost any given patient is the one they’re willing to do. It’s because if something makes sense to people, if it feels like it’s something that they can do or it’s doable, then you’re much more likely to have a good outcome. I’m a terrible patient. If I don’t understand why something is being asked of me by my physician, I won’t do it.

Most of us in healthcare like that. We want a lot of information first, and then we want to make an informed decision. For some reason, in our busy healthcare system, we, at times, don’t afford that luxury to people. People with pain, especially, have been through 2, 3, 5, or 10 different providers and they want to know, “What’s different about this particular encounter? How’s it going to help me?”

To talk about a little bit of the data around the tapering, do we have an idea? I’ve seen slow tapering schedules. I’ve seen fast tapering schedules. I’ve seen some data about tapering with giving people different types of tools. That could be anything from exercise to mindfulness to pain coping skills, etc. Do we have any idea how we should approach safe, effective, and comfortable tapering for people? There’s a comfort level here that has to happen as well.

I don’t know what the actual data are. I know what my observations are. I don’t think you can take anything away from somebody and not give them something else. It’s critical that we offer, “We’re going to give you some other tools. We’re going to give you some other medications. We’re going to provide for you some additional behavioral things that you can do to unlock your own.”

That was a problem in the early opioid crisis, probably back around the 1800s. We pulled the rug out.

Pull the rug out and, “Take some Tylenol.” You’re like, “That doesn’t work. I got nothing else.” It’s critical. The data will eventually catch up because even the CDC said, “Let’s rethink what we’ve stated here.”

Looking back, we don’t have a lot of data on certain topics. The idea of pulling people off opioids rapidly in many ways was done with good intentions for the most part. I wonder how much or how many people we inadvertently traumatized through that experience and how important that is from the trauma-informed lens of working with people who have pain.

That’s so cool. I haven’t thought about that from that perspective, but it would be traumatic. The very people that you trust, your healthcare providers, perpetrated this trauma. Is this something you’ve observed? That’s an insightful thought.

A lot of my interest is around not how we educate people because we’ve gone down that road. Especially in the world of PT and pain education, we have “used” education as an intervention. My question is with the particular person in front of you, because pain is contextual or specific to the individual, what do they need so that they feel empowered?

It is knowledge but also choice. It’s both of them. It’s true for most big decisions that sometimes, if you lay things out there and let people chew on them for a little bit, let them talk to people, and let them think about it a little bit, you can then give them the list of, “What are the potential symptoms? Let’s talk about this together. What are your concerns?” It could be cognitive fogginess, constipation, or whatever it could be. You’re like, “How do you weigh those? What would you give to get them back?” This motivational interviewing approach can be effective in figuring out what are the barriers and the facilitators. Also, sometimes, people need a little time.

The other piece as far as the trauma component there which we hear in pain all the time is this idea of safety. I’m always thinking, “Does this person feel safe in their body? Do they feel safe in their mind? Do they feel safe in the living environment that they’re embedded in?” Potentially, what’s important is, “Do they feel safe with us as clinicians engaging in that therapeutic encounter?”

When we take an intervention and pull it away, this happens with insurance companies, too. All of a sudden, insurance companies are like, “We’re sorry. There are no more psychological services for you. There’s no more physical therapy for you.” It’s an abrupt change in someone’s life as they were starting to build that sense of empowerment, that sense of safety, that sense of self-efficacy, and that sense of, “This can get better.”

How do we restore that? Often, it is by acknowledging that’s a big piece of it to put on our little psychology hats and realize that there probably was something there. There probably is a little bit of trauma there. It is acknowledging how hard that must have been for them and how hard it must be for you to trust me. You’re not even initiating anything until the patient has a greater sense of trust in you, too. The last thing we want to do is to yank out the rug again from them.

It is also helping them determine the other pieces that they need to feel safe. Is it having a rescue medication? Is it having a plan for what might happen if they develop other types of side effects? Is it a group that they can talk to? Do they need more humans in their lives to help support them through this? Identifying what it is that’s going to help them feel safe is important.

That’s well said. As a psychologist, cognitive behavioral therapy is something that interests you, that you use, and that you’ve been researching. A lot of other professionals are using cognitive behavioral techniques and skills as well. There have been a number of large-scale meta-reviews on cognitive behavioral therapy for pain. Pretty much anything you look at helps about 1/3 of the people. The other 2/3 is not so much. It’s low-impact. Tell us how you view cognitive behavioral therapy for pain. What do you see is missing? How can we bolster that in a way that could potentially be more effective?

CBT for pain has strengths. I love that it’s very portable. Many people can deliver this to their patients. A lot of it’s behavioral. It’s clear. Many of the techniques are evidence-based. That is a big pro. As a practitioner, in the past, what I’ve also found is it’s lacking something. There’s a little bit less emphasis on the emotional aspects of living with pain and what that’s done to people’s relationships, lives, self-esteem, and safety. Sometimes, there are deeper issues that need to be addressed to help the person. It might not necessarily be impacting the pain. It could very well be impacting their overall mental health. That sometimes is missed in cognitive behavioral therapy for pain.

One of the major things that we tend to see in research and clinical practice is that many people with chronic pain are leading lives that aren’t feeling terribly fulfilling. They’re surviving and getting by. They are doing the things that they have to do, addressing the must-dos in life, and missing what Lois Verbrugge called valued life activities. Those are the things that make life sparkle and the things you care about. Those get set aside.

Many people with chronic pain are leading lives that aren't feeling terribly fulfilling. They are doing the things that they have to do, but they’re missing out on the things that make life sparkle. Share on X

An element that I really care about in making cognitive behavioral therapy more effective is getting at some of these affective elements by predominantly decreasing negative emotions but building positive emotions in an effort to build resilience and even think about how we deal with reward processing deficits. There is this brain pattern that we see where there are deficits in the reward-processing areas of the brain. Those are reversible as some new data are starting to show that by doing simple positive reinforcing activities regularly, these systems start popping back online.

The tact I take is to integrate some of what we’ve learned in positive psychology that also has an evidence base to it. Not only make the CBT richer and perhaps hit more targets, but also makes it more engaging. What we all struggle with is how to get people to continue to do these things we introduce them to and maintain them over time so that they can continue their emotional fitness over time.

I want to unpack a couple of things there for the clinicians mostly, but for people who are interested in CBT as well. When you and I are talking about the data behind CBT, usually, we’re talking about a package of 8 to maybe 10 or 12 sessions. In the beginning, you said that you’re a proponent of CBT except you feel that there’s the affective component that’s missing. We’re talking about CBT specifically for pain, which typically has a focus on negative thoughts and working with negative thoughts. Sometimes, when you work with negative thoughts, it does have an effect on emotions. You’re saying, “How can we be more intentional about someone’s effect of response to the way they’re living?”

How do we identify what are this person’s priorities and how do we help them integrate more of this in their life? Not only do we find that when people are engaged in things they enjoy, they’re moving. One of the real secrets of positive psychology interventions is that they have behavioral activation at their core. Getting people to do pleasant activity scheduling, which is part of CBT for pain, is valuable because it’s activating people to move and do things.

HPP 323 | Chronic Pain
The individuals with chronic pain required far less pressure pain to have a very seminal neural pattern to the people who had chronic pain.


When we do studies of CBT, that’s the one thing that we find people do the most. If we assign all these other types of activities, that’s the one thing people get all in on because it’s like, “Finally, somebody’s giving me permission to take time for myself and do things that I value.” Keying on that and giving people the space and the opportunities to have some joy again does help with people’s experience of pain.

CBT delivered with a strong behavioral activation, lean into it, if you will, right?

Yeah. Lean into it and lean into the resilience aspects of it.

When you say behavioral activation, what does that mean to you? What’s the definition? What are you saying with that piece there?

We see a lot of restricted movement in chronic pain. There is often fear of movement, but there’s also a lot of fear around doing things. It is like, “If I get out there in the world and I have and I have to sit down, are my friends going to be disappointed?” or, “I don’t know if I am in a space where I can start this hobby or take up my hobby again.” Their world shrinks and they withdraw. Their worlds become very small. The behavioral activation part of it is beneficial in as much as it gets people moving again physically and emotionally and engaging in life again. It’s different than the real, true definition of behavioral activation. It is more broadly getting people moving again and re-engaged in things that matter to them.

Behavioral activation came out of the depression research and then has been modified and molded a little bit for chronic pain in a certain way. It’s interesting because when I read the behavioral activation research, sit back, and think about it, a lot of this fits into what I would consider good physical therapy where you’re not giving someone an exercise for the sake of an exercise.

You may be giving them an exercise, but you’re talking to them about, “How do we apply this movement to your life? Where would you use this type of movement? How is movement important to you in the sense that it’s going to help you re-engage with something that is important, meaningful, and maybe has a sense of purpose to you and value in your life?” All those things are rich in the emotional and affective component of things.

I love that. That is so key. Part of what I talk about frequently when I’m working with patients and what I talk about in the book is that team is so important. In working with the physician, the physical therapist, and potentially, behaviorists, it is so important that we can all come together. I love your interpretation. That is so key. This movement is not just a movement for movement’s sake. Strengthening and being able to do this might open the door to you taking a pickleball again or whatever it is that you adore. It clicks for them that, “I’m willing to do this. Now I get it.”

Pickleball is a great example. Everyone’s doing that.

It’s so social, too. That’s an important piece of building resilience and helping people get behaviorally activated and re-engaged.

I know you’ve wrapped up a lot of this research in a new book you have that educates people about chronic pain and the safe and effective ways that they can manage it and eventually overcome it. I’m sure you’ve read many books in the past. When you start to look at some of the trade books that are out there on pain, what did you find that was missing in them that you included in your book?

There are a lot of good actionable books out there. Rachel Zoffness has a lovely book out there. There are a number of them depending on where we’re going. For me, the key was how to help a person maintain the changes. A big problem that we see in many self-help books is you read and think, “That’s cool and interesting,” and then the person reading it never takes a step towards practicing what they learn. They have that knowledge. Maybe someday, they’ll come back to it, but it’s not terribly actionable.

I try to make a really actionable book. I start with a series of chapters that talk about some of the neuroscience in, hopefully, a very accessible way, but also the neuroscience that underlies thoughts and emotions, the data, and the support for the importance of things like gratitude, our social relationships, and having a sense of purpose in life. All of these things are valuable and have benefits for chronic pain at the behavioral, psychological, social, and also behavioral at the brain level.

Hopefully, I’ve set the foundation for why I’m going to ask people to do some weird stuff over the next 30 days. The meat of the book is 30 activities, skills, and practices. It is like speed dating. Each day, I say, “Read two pages.” The two pages are a new skill, activity, and practice. It’s evidence-based. Read about it and give it a try during the day. At the end of the day, think, “Did I like this? Is this something I could do in my life? Maybe.”

HPP 323 | Chronic Pain
The individuals with chronic pain required far less pressure pain to have a very seminal neural pattern to the people who had chronic pain.

Maybe the next day is the one that they love. They can start that and say, “This is so much better. I’m all about mindful breathing.” To another person though, mindful breathing is going to seem like a bunch of hooey. They’re going to say, “That’s stupid. I don’t want to do mindful breathing. Thank you very much.” Each of these is different not necessarily from the other but they tap into different categories.

There’s a lot of emphasis on moving. I love people to start a walking program. I love people to get into nature. That’s some of the things. At the end of the 30 days, they’ve read about and tried different interventions for thoughts, emotions, and relationships. At the end of the 30 days, they come back and take stock. They are like, “What were the activities, skills, and practices that felt like I really liked? These speak to me. They make sense in the content text of how I understand my pain. I’d be willing to do them.”

The last part of the book helps them build a real incremental plan. Try one at a time. Give it a couple of weeks to see if they want to make it a habit. How do you make it a habit? When do you introduce something new like another practice? Maybe somebody starts with a walking program but also likes being in nature. They can combine those two things.

Maybe they also want to start a gratitude practice a week. That’s okay. We try and do things incrementally. They’re hopefully building a richness in our lives that hits a number of domains. We want people to sleep better. We want people to move. We want people to have ritual relationships. We want people to feel that they have some stress-coping techniques.

There are a lot of good things I want to point people. One is always thinking about hitting a number of different domains. That doesn’t necessarily mean interventions. That means that there’s got to be something physical to what you’re doing. There should be something that has an emotional and psychological component to it. There should be something that’s social. There should be something that’s lifestyle-based. Those are typically the domains that we’re looking at.

Like yourself, I’ve read a lot of self-help books on pain. What I find is they’re huge. They’re 300-plus pages. My question always is who’s reading this and doing this whole book? Most of us with advanced degrees probably would have a hard time picking that up. There is the idea of one little thing a day. You have two pages in your chapter, which I did the same thing in my book, Radical Relief. It has two pages a chapter. It’s something small. Where you’re going with that to connect to neuroscience is how neuroplasticity works. When you have something that’s achievable, it’s small, but you can do it frequently.

You hit it right on the mark. I want it to feel doable. I had a lovely editor. He kept shortening my writing. I was like, “You’re going to help me write this briefly.” For people with chronic pain, it’s hard for them often to read. The audiobook is going to be out soon, so I’m so excited about that. Xe Sands is a fabulous narrator. She’ll be doing that. That’ll be helpful too because some people with chronic pain find it hard to read. It can spark a migraine. It can feel fatiguing. To hear the spoken word is often superior.

We’ll point people to your website. Tell people what your website is and the name of the book.

The website is The book is called Chronic Pain Reset: 30 Days of Activities, Skills, and Practices to Help You Thrive.

I want to thank Afton for joining us to talk about chronic pain, both the research behind it as well as the practical solutions that you can implement into your life. You can find her book where all books are sold online or in a store. You can go to her website, I want to thank Dr. Hassett for joining us in this episode with some wonderful information about how to treat chronic pain safely and effectively. Please share this episode with your friends, family, and colleagues on your favorite social media handle. Hop on over to the Integrative Pain Science Institute and join our mailing list so you can receive the latest episode. We’ll see you in the next episode.


Important Links


About Dr. Afton Hassett

HPP 323 | Chronic PainDr. Hassett is a licensed clinical psychologist who is an Associate Professor and Director of Pain and Opioid Research in the Department of Anesthesiology at the University of Michigan. She is a principal investigator at the Chronic Pain & Fatigue Research Center where she conducts interdisciplinary research related to exploring the role of positive emotions in people with pain, as well as developing novel interventions to promote resilience and better pain self-management. She has published over 100 articles in peer-reviewed scientific journals and is a leader in the field of resilience and pain. Dr. Hassett is a Past President of the Association of Rheumatology Professionals – a division of the American College of Rheumatology. She is also the author of the new book, “Chronic Pain Reset – 30 Days of Activities, Practices, and Skills to Help You Thrive,” an innovative pain self-management book written for patients and clinicians.



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