Welcome back to the Healing Pain Podcast with Dr. Melissa Farmer.
I am so happy that you’re here for another week where we talk about integrated strategies for healing chronic pain naturally both for the practitioner and for those who are struggling or suffering with chronic pain. Each week, I spend a lot of time finding really interesting, fascinating people to talk about how to heal chronic pain, so make sure when you listen to the podcast that you share it out with your friends and family on social media. Of course, go to iTunes and leave a five-star review for us. We would so appreciate that.
You can catch me at the PT Next Conference and Expo on June 21st to 24th in Boston Massachusetts. I want to give a big shout out to PT Next and the American Physical Therapy Association for inviting me to speak there.
I want to introduce my wonderful guest this week. Her name is Dr. Melissa Farmer. A couple of weeks ago, I met Dr. Farmer at an incredible Pain Science conference. I attend a lot of pain science conferences where we talk about how to heal chronic pain naturally. I know a lot of information about pain but every once in a while there’s somebody who gets on stage that I am completely blown away by. I quickly ran up to Dr. Farmer, I said, “I really need to talk to you further. I need to have you on the podcast.”
Dr. Farmer is an Assistant Professor in the Physiology Department of the Northwestern University School of Medicine in Chicago. In addition to being a licensed psychologist, she is also a neuroscientist, who loves the study of pain and loves to decipher unexplained pain, as well as the emotions that underlie the chronic pain experience. Dr. Farmer will share her thoughts on the role of learning and brain plasticity in establishing—and ultimately treating—the emotional memories that underlie chronic pain. As a form of emotional memory, chronic pain is perpetuated by counterintuitive physiological rules that distort how an individual perceives and interacts with the environment. Every individual creates a different “pain logic” to make sense of these experiences, and uncovering this logic is key in challenging these pain memories. Dr. Farmer will discuss the relationship between pain perception and the quirky mechanisms that establish chronic pain, how this learned association can drive maladaptive behaviors and beliefs, and how the controlled, therapeutic manipulation of emotional memory may potentially alleviate chronic pain.
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Chronic Pain Mechanisms for Maladaptive Pain Learning with Dr. Melissa Farmer
Dr. Melissa Farmer, welcome to the Healing Pain Podcast. It’s great to have you here.
Thank you. It is a pleasure to be here.
You have a really interesting background. You’re a licensed Psychologist. You obviously studied the brain in neuroscience and you teach at a university level. I believe you still see patients part time involved in research studies. I’m interested to hear your story and how you got involved in pain.
I became involved in pain through sex, interestingly enough. When I was an undergrad, I was looking for some research opportunities and I fell into this female sexual psychophysiology lab, which is the mind-body relationship of women’s sexuality at University of Texas at Austin. I fell in love with research. I thought I would be a female sexual help expert. I knew information about desire, arousal, orgasm. The only thing I didn’t know about was pain. A lot of the sexual dysfunctions have to do with pain. I decided to go to McGill University and work with Irving Binik and Jeff Mogil to pursue pain research. I ended up falling in love with pain research, a little bit more than sex research. Female sexuality, it’s incredibly complex and yet still, chronic pain, it’s just more rewarding because the amount of suffering that you when you interact with people to get better, it has a different effect.
As a clinician, there’s nothing more rewarding to help someone who has struggled for, let’s say, months or years or sometimes even decades finally find the relief they get. I totally understand why helping someone live the life of less pain and helping someone live a pain-free life can be very interesting for us as clinicians and researchers. There’s also the aspect of the pain puzzle. As a clinician, you always like to learn and you always like to apply what you learn. With pain, we’re still just really skimming the surface out of all the chronic disease and how to cure it naturally, basically. It’s a great introduction.
When we talk about pain, those of us who work in pain science and the chronic pain space, we know that acute pain exists for a reason. There’s a reason why there’s acute pain. With chronic pain, that could be debatable. Oftentimes the signal is maladaptive. Can you maybe start by explaining to us why the human brain is so primed to pay attention to and remember pain?
One way I’m going to answer this is to talk about cake. Whenever you have a bite of cake, like your birthday cake, the first bite of cake, it’s delicious. You have your friends around you and it’s just a very positive feeling. Toward the end of the cake or maybe after it’s been in the fridge for a few days, you have the same cake, the same exact cake. It’s good but it’s not as good. Our taste habituates to certain flavors, the same thing with noises, the same thing with a visual display when your eyes just habituate to how bright a room is. This is called sensory specific satiety. The only sense that doesn’t demonstrate this is pain. If you think about it, it makes sense. Why would you ever want to get used to having pain? Because what does pain mean? It means that most likely you have either actual injury or potential injury somewhere in your body and you don’t want to get used to that. Instead, your body is primed to withdraw, defend against that, remember the circumstances so you can avoid it in the future. Our bodies are organized to amplify pain signals so that we can survive.
You mentioned pain being sensory. A lot of people of course realize that when you have pain, your attention is drawn to the part of your body that hurts, or your attention is drawn to your lower back pain or the potential lower back pain that you have or it’s drawn to the headache pain that you have. Can you talk about maybe pain from the emotional context and why that’s so important for both the clinician, who helps someone with pain, as well as someone who has been struggling with pain to try to solve their pain puzzle?
Pain is called a primary reinforcer. That means that without any learning at all, any human being will have a negative response to pain. One of the reasons that happens is that, in addition to the sensory processing, that information fast tracks to some of the regions in the brain that mediate fear and the salient situations. You can also think of it in terms of reward. The lack of reward is painful or harmful, and lack of pain is pleasurable. Those systems are very closely intertwined in the brain. They have the same circuitry, they use the same circuitry. There is something inherently emotional about the meaning of the signals that are evoked whenever we’re in pain.
Does that apply to every single type of pain that there is out there? Does that apply to whether you actually fall, let’s say you break an arm, or whether let’s say you have a pain processing condition like fibromyalgia and you have pain for, let’s say, maybe three years or some? Does the emotional component apply to both acute and chronic states of pain? Why is it important that we realize the emotional component when we work with patients?
Obviously, your emotions and your attention to the stimulus, it colors your experience with acute and chronic pain. However, with acute pain you know it’s going to end soon. You know your tissue is going to heal. That sustains a different psychological response as opposed to, “Whatever I do, this pain is not going to leave me.” The chronic pain state has been likened to a state of emotional suffering, where there isn’t going to be relief. Whatever you do, it won’t be enough to really dramatically reduce the pain, so you start to develop feelings of helplessness. Therefore, that recruits some of the depression and anxiety. Depending on what kind of person you are, depending on what kind of emotional learner you are, I think, depending on past experiences, you’re going to handle that information in different ways.
There are some people who will notice it, will decide not to focus on it and move on. Maybe they still feel pain, I don’t want to say this in an accusatory way, they don’t let it ruin their lives. These aren’t things that you can necessarily choose, it’s just how your brain works. If you take that same brain and you put it on a research project, that’s a fantastic research brain, that obsessing, ruminating brain. In the case of a chronic pain, it isn’t helpful. For instance, there’s a primary emotional dysfunction but then there are all of the consequences. That’s where the suffering comes in; losing friends, not being able to see people on a consistent basis, the depression, the sense of loss of self whenever you can’t do what you used to define yourself by. There are so many creations of this.
What you’re articulating is the difference between pain and suffering. Because when I think of pain, like you said, it’s that number. It’s that two out of ten or five out of ten pain. The suffering is more attached to the emotional component. Buddhism actually teaches this on a more simplistic level where they separate the pain from the suffering. In some ways, that’s what we’re learning to do, slowly but surely, in pain science, in pain psychology and physical therapy; to look at patients as a whole and start to treat not only their pain, but also their suffering and their emotions around the pain experience.
You talked a little bit about the factors that influence pain. You talked about the laws of relationships. You talked about someone has lost their identity. Let’s say they’re an athlete, they can no longer be an athlete, or they were the super mom who now needs help around the house, so to speak. I think it’s so important with many women who struggle with chronic pain. Talk to me about early life and what we know about early life and how it affects our emotions and how it affects really the brain’s ability to create pain later in life.
That is a very complex question, and there is no answer but I will speculate a bit in terms of what evidence is out there. Early life is a time of rapid development of the different brain systems. You can even see different brain systems evolve over time. It isn’t until mid-adolescence to late adolescence that the prefrontal region starts to really organize. Even the machinery that can handle different types of trauma or stressors, it’s shifting across time. What that also makes for is a very plastic, very labile system. The brain is just naturally geared to do this if the pathway is used very frequently. Our brains naturally have mechanisms that amplify and make that signal easier to access and easier to process. We’re very efficient in that way. That’s the principle underlying neuroplasticity, where whenever you use a connection often enough, there are anatomical changes that make it easier to use that connection.
One of the clearest examples of this is prenatal pain. For instance, whenever children are born prematurely, there are lots of painful procedures they undergo. Many different painful experiences have been linked to proclivity to develop chronic pain later in life, fifteen, twenty years later. This is data that was only emerged in the past ten years or so. Interestingly, one of the things that they’re trying to do to counter this is to increase holding of children. C fibers, which transmit pain, there’s a subset of them that transmit pleasant touch. That’s the natural analgesic counter to pain. Even just holding a baby and having non-painful sensations is enough to counter that shift to the child’s system.
Remember, we were talking about what are the pain pathways, they overlap with reward pathways. That means that the system that is up-regulated overlaps with the brain regions that you’d use to cross this emotion. Those pathways are already up-regulated. They’re primed and ready to process new information. If you have a stressor that is introduced afterwards, it will have an optimized response to that stressor. In the brain logic, it isn’t a bad thing. It’s adapting properly to your environment and to the threats that you encounter. As far as your brain is concerned, being able to optimize processing of a trauma is ensuring that you’re going to remember it so you don’t encounter that again.
Because it’s very important to remember traumatic experiences, whether they’d be emotional or physical, because part of your brain’s job is to learn what could be potentially harmful. It stores that. It stores those potential harmful experiences. If you encounter that next time, it has a warning system to let you know about it, and that warning system is pain. You mentioned that before the age of seven, we’re using less of our frontal cortex, so that’s the front part right in front of our forehead, which is the part that’s involved in decision-making and higher cognitive abilities. In essence what you’re saying is we’re using the more primitive parts of our brain early in life and that’s where many of those memories are being stored. Is that correct?
Yes, very much so.
The question I would then ask, especially from a psychological perspective, is as we get older and we’re not adults and we realize that maybe our previous life experience is causing our pain or is amplifying our pain, how do we tap in to the use of our prefrontal cortex to help change some of those memories and emotions that have been stored there?
The beautiful thing about emotional learning is that it’s optimized to be able to adapt to new emotional learning. Any emotional memory can be fundamentally changed given certain circumstances. This is somewhat the case with other types of learning, although there isn’t as much evidence behind it. It’s called memory reconsolidation. Consolidation is memory formation and reconsolidation is memory revision. The idea is that whenever you fully conjure up an emotional memory, meaning you draw on every single bit of the experience you can remember, the more emotional the better. Essentially the more upset you become the better, because you’re pulling together all of the different parts of the memory that are stored in different parts of your brain and you’re trying to change their interrelationship with one another.
If you react to this memory in an effective way, you have about a four-hour window to change it. You can change the emotional intensity. You can almost change the content. For instance, false memories have been implanted this way. Technically, you can implant a false memory that trauma didn’t happen or that it wasn’t as bad. I don’t mean to be flippant about that, but I do think it’s a powerful feature of our bodies, especially in pain, we can take advantage of. But there are certain rules to optimize that.
In essence, we’re starting to learn to almost hack our painful emotional experiences. I don’t want to use the word “hack” but I think it comes in uniquely in this circumstance. I’ve had patients who I’ve referred to psychologists because they’re having a hard time with their emotions or the pain experience overall in their life. They say, “I really don’t want to go to psychotherapy twice a week for six months,” like my friend did who had depression. Oftentimes, I say that’s typically not the way it works. With pain, oftentimes you can work through it a little bit faster, especially if you’re working with someone who really understands pain. There are psychologists who, like yourself, study and understand pain.
What you’re saying in that four-hour window is that if you’re working with a skilled clinician, no matter who it is, that you’re working with them or if you’re working at home on your own, sometimes people read my podcast notes and they try things on their own, is that you’re bringing back an emotion that is painful. Let’s say, it was the divorce that you’ve had a couple of years ago. Around that time, a divorce is when pain happens. To try to put yourself in a state where you get back to that exact experience and bring up as best as you can the intensity of those emotions in the moment. Is that correct?
That’s correct.
People don’t like to bring up emotions that are painful. People like to leave their pain in their past often. We are learning that as we reframe certain experiences, that people can have tremendous benefit from it and they can of course alleviate their pain. When I bring up this emotion, what do I do with it then?
First, I’d say have a plan. Have a plan in terms of ideally about an hour after you bring up the emotion, that’s the prime time, an hour after the emotion is first conjured up. Have a plan in terms of, if you’re going to do it by yourself, who would you call in case you need support, just because it is upsetting. If you have someone, a professional with you who knows how to deal with pain, have a plan with them in terms of, what we will do if I can’t relax or if I can’t wind down? Because one of the critical aspects of this not only is building yourself up but making sure your sympathetic nervous system is wound down enough to where, specifically, your amygdala doesn’t encode the situation with the same intensity as it did before.
I’d also like to suggest that even though it will be very emotionally upsetting, the emotion are actually epiphenomenon. What you’re looking for and what you can do as a preparation exercise for this, you’re looking for the belief, the modelling you have about reality and how things work that is underlying your pain. That’s often difficult. It isn’t just emotional pain, it’s more existential pain. What is the worst case scenario in terms of dealing with your pain? What will happen? What are you afraid of most? What is your biggest fear related to your pain? That will be an individual response for every single person. By bringing that belief up explicitly, either talking about it or just purposely thinking about it if you’re on your own. Pairing that with the emotions and then ideally introducing some information that counters that core belief. That’s where a clinician comes in handy because we’re trained to do this very strategically. Not just psychologist but it’s just a level of objectivity where it isn’t just providing rational against the belief. It’s sometimes even orchestrating an experience that disproves the belief as you’re there together. That would be optimal.
Sometimes patients go through this on their own in life where in some ways they work through this, whether they’re talking to a friend or somehow they changed it in their own brain, their own cognition. Sometimes it comes up in physical therapy and you wind up talking about it inadvertently, you wind up talking about these situations. I remember years ago, I had a patient who had chronic pelvic pain. She came up for a couple of sessions. She was doing well. We were doing some exercises and some manual therapy. But somewhere in the treatment session, one day she said, “I never would have had this pain if my husband didn’t force me to go for IVF treatments and have a baby at the age of 44. My body wasn’t able to handle it.”
I said, “That’s really interesting. Your body can handle it. Your body is very strong. We’re going to get through this. I’m going to show you how you can be stronger, and maybe you should talk about this with your husband. Talk about some of that experience that you went through and the fact that maybe you didn’t want the kid 100% although you love him right now and you love caring for him.” These things come up in conversation with many types of practitioners. I think they’re important to articulate.
When we look at people with past trauma and past experiences, is there a framework of people who don’t fall into that category where they develop chronic pain? Is there a model for someone who is more likely to live or develop a chronic pain syndrome? If you’re a primary care physician, this may be someone you want to look out for who’s in your practice, let’s say.
This follows the idea that some people might be predisposed to develop pain or emotional problems, for example, or with an adequate event, a stressor, people who would be more or less likely to carry that with them. Or if it’s already set, if you already have chronic pain, there are some people who are more or less likely to suffer. I suggest that there are probably subcategories within each of those and that there are some people who are just resilient. I’m very jealous of those people. They’re resilient. They take things in stride. It’s interesting to see them have pain and how they don’t overreact to it. It’s a fantastic model.
I have a friend who is in the process of developing CRPS, but he didn’t really believe in that. He did a few courses of PT and then went to Europe to do some talks, came back and it was fine. He wasn’t really bothered. That’s the type of brain right there that is primed to not develop chronic pain. Then there are perhaps individuals who maybe their parents have a history of depression, maybe their parents have history of addiction. What we’re finding in the research we do is that the changes in the brain that occur with addiction are very closely related to the ones we see in chronic pain. It’s almost addiction to an immersive state.
If you have an addictive prone brain, that would also be someone who’d you want him to watch more closely. I like saying emotional learner just because everyone knows what an emotional learner is, but it also doesn’t place blame on that person who naturally experiences emotions. An emotional learner is a great candidate for chronic pain because they are readily accessing all of these negative emotions, maybe they’ve already primed those to process information, emotional information efficiently. As opposed to someone who isn’t very emotional, during their panic experience they probably wouldn’t access those same circuits and so on and so forth. In most cases I think it’s probably more dependent on how you react or how you interpret the pain at the moment that determines your trajectory.
You mentioned belief. You mentioned your friend had a certain belief, that he didn’t believe in CRPS or Complex Regional Pain Syndrome. Some people know it as RSD. How important are our beliefs in modulating our pain experience? What beliefs do those that have pain typically struggle with?
Beliefs are so critically important, especially beliefs that occur early in life, the models that you create based on your interactions with how people work, how the environment works. These are your underlying truths that you fit new facts into. It’s your filter as you move through your world. Beliefs related to chronic pain include something that you mentioned, “My body is not strong enough.” Or one of the best ones is, “If I do this, I’ll hurt myself more.” By definition, chronic pain is past the period of actual injury. The tissue is healed. You aren’t really hurting anything but you’re still getting a message that there’s a potential to. It’s because I don’t think our bodies previously in evolution were ever in the position to have chronic conditions like this. Our minds don’t know how to interpret chronic pain. It’s just pain.
One of the most heartbreaking beliefs I’ve ever heard had to do with a woman who was trying to conceive, very similar to your story. She developed chronic back pain where she couldn’t practice anymore. She couldn’t do anything and she’s bedridden. She was afraid that, essentially just like her mother, if she couldn’t produce a son for her husband she was a failed human being. I’m saying that very lightly just because the words she used were heartbreaking. Culturally specific belief in terms of, what is your worth as a woman? What is your worth as someone who has a business degree? Why are you not fulfilling your potential? You’re a failure. There are a million of definitions of failure. Again, those core beliefs are part of what is driving the suffering.
When you peel back the layers of the onion and you started looking at someone’s beliefs, it’s not only what they currently believe in their life but it also draws in their memories about what they’ve been told about not only pain, but also what they’ve been told about really life in general. That all starts to come into this web, if you will, of the pain experience for that person. Is that why pain is so unique to the person and no two people feel pain exactly the same?
I would say yes. That’s an excellent way of putting it. It actually reminds me of some interpersonal discrimination exercises part of your therapy, we have a patient described there each of their family members and also the beliefs, the lessons about life that they learned from that person. You can see those lessons played out throughout their lives. I think in many cases, especially with the more critical self-appraisals, the root of that is often in early relationships with your parents or with loved ones. That means that all of those things need to be discussed whenever you’re talking about pain.
One of the questions I always like to ask clinicians who work with people in pain is, what is your response to someone who says, “I have chronic pain. I’m always going to have it. It’s going to be there forever.” Because in essence, when we give someone with the label and the diagnostic code, if you will, of chronic pain, on some level we’re actually telling someone they’re going to have this problem for a long time. Because the word chronic means that it’s always going to be there. It’s not a word I’m very happy to use. I really think the word “persistent” is better because we can stop something that persists, whereas something that’s chronic has a different identifier, if you will. What do you say to people who say, “I have chronic pain, that means I’m always going to have it”? Then, two, what is your recommendation for someone who has chronic pain right now who wants to heal it naturally and not take, let’s say, anymore drugs or have a surgery or another injection that we have in entrenched in our biomedical model of pain?
What I would first tell the individual who’s slapped with this lifelong diagnosis of chronic pain is I would say that it’s possible that pain might persist, but the meaning of the pain can change. How much the pain affects you can change. How much it disrupts your life can change. I know what you’re saying, it’s dissatisfying. At the same time, you could argue with people with chronic depression. They also need to live with that if it won’t respond to treatment. They’re living with that for the rest of their lives. They can still find pleasure. What I would probably suggest is that, given what we know about chronic pain, I would suggest a couple of things. I would suggest increasing the amount of positive experiences, increasing rewarding experiences. If there’s a part of your body that’s painful, to touch it just in a non-painful way because I think that there’s something critically important in persistent pain where knowing where the boundaries of our bodies are helps our brain conceptualize what the pain is or even where it is.
It reminds me of a study in chronic regional pain syndrome or complex regional pain syndrome where whenever you have your vision blocked and you take the painful limb, you cross it over to the opposite side, that limb takes on characteristics of the better or the healthy limb and vice versa, to where the with the happy limb it starts to have a temperature drop, increased sweating. It’s almost as if your mind has encoded that area of space as painful. It’s not even your body. It’s that space, which means that perhaps were not taking advantage of treatment options because we’re limiting pain to the person’s body; peripersonal space, how close a threat is, all these things come into play. It definitely creates positive feedback with non-painful touch, ideally pleasurable touch. So for instance if someone has pelvic pain, keep on masturbating. If you have pain out of ejaculation for example or orgasm, don’t break it there. Don’t forget what it feels like to have pleasure there. That’s not just psychological, it’s so that that information from those nerves is not branded as painful.
I would also suggest, if possible, to try to explore the core belief that might help sustain someone’s pain. It will work as long as you’re more relaxed at the end than you began. Even if you do it in smaller bits, like over ten sessions rather than one big upsetting session. As long as you’re more relaxed, your amygdala is encoding it as less threatening, which is exactly what we want. We have evidence in a drug that you can change amygdala receptor activity and change the emotional content of the pain independent of the sensory content. They aren’t necessarily united. You can reduce the suffering in it. You can do it perfectly naturally, as we’ve discussed.
The touch component that you talked about, having someone touch themselves in a way that’s pleasurable or non-threatening or non-harming, helps them reintegrate this amount of sensory part of their experience and their brain and their body. When you talk about getting to the point where you feel relaxed, that’s when we go back to earlier where if you’re bringing up those emotions or those memories that are distressing and painful, that’s okay. But after that experience where you’re attempting to bring them up and resolve them, you want to wind up in a more relaxed state in whatever way that could be. That could be during progressive relaxation exercises. That could be deep breathing. Even things that are pleasurable to people, some people just love music or they love singing, anything that you could really do to bring some joy and happiness after that experience is beneficial.
The mechanism is ultimately norepinephrine, but usually stress increases cortisol, which is the hormone that changes norepinephrine levels. That’s the key pathway. Essentially, whatever will reduce cortisol is what you want to do.
High levels of cortisol lay down painful memories in essence.
They strengthen the encoding. You have, again, a three to four-hour time window. After that, whatever you do it’s not so useful, but you should keep on relaxing.
At some point in your life, you should make relaxation part of your life because all of us need to get into a state of relaxation at some point.
If there’s a way that someone with pain can use visual imagery to counteract the qualities of the pain. For instance, if someone has burning pain, it’s a neuropathic pain most likely. First, deep breathing and then imagining a cool blue light washing down through the body and neutralizing that burning sensation. That’s something else that you can tweak per individual.
Tons of great tips and strategies today. We’ve covered everything from neuroscience and brain science probably to psychology and some of the behavioral aspects of pain. I want to thank Dr. Melissa Farmer for being on the Healing Pain Podcast this week. It’s a great podcast to share with people. It’s got lots and lots of wonderful new information that can help with practitioners and people struggling with pain. Make sure you share that with your friends and family on social media.
Dr. Farmer, can you tell everyone how they can learn more about you, where you teach and your website and all the activities that you’re involved, because you do some wonderful research?
Right now, the easiest thing would be VisceralMind.science. It’s my website. Also my Twitter handle is @Farmer_mindbody. I’m very active on that. I love to talk about pain all the time.
Please check her out. She teaches at Northwestern University. You can always find her there, but please check out her website. It’s a wonderful resource of some great information, especially for those who have sexual pain, because that’s a lot of what her research focuses on in addition to chronic pain.
I want to thank you for joining me this week. Each week, make sure you stay tuned to me on DrJoeTatta.com. You can sign up for the podcast and you’ll get free updates as well as all the great information that I’m sharing on how to heal chronic pain naturally. Thank you very much and we’ll see you next week.
About Dr. Melissa Farmer, PhD
Melissa Farmer is a sex researcher turned neuroscientist. During her clinical psychology training in sex therapy and chronic pain management at McGill University in Montréal, she vetted her clinical hypotheses by developing mouse models of the clinical populations she assessed and treated. Dr. Farmer’s unique knowledge of chronic pain physiology emerged from her daily interactions with McGill’s prominent group of pain researchers, who modelled basic science-clinical translation and multidisciplinary collaboration. Dr. Farmer’s research spans several disciplines and currently focuses on the use of sensory testing and neuroimaging to guide clinical phenotyping of “wastebasket” pain diagnoses like vulvodynia, chronic prostatitis/chronic pelvic pain syndrome, interstitial cystitis/bladder pain syndrome, and irritable bowel syndrome, as well as low back pain and phantom limb pain. She loves to decipher unexplained pain.
Dr. Farmer is a Research Assistant Professor in the Physiology Department of the Northwestern University Feinberg School of Medicine in Chicago.
Website: VisceralMind.science
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