Welcome back to the Healing Pain Podcast with Alan Gordon
If you have followed this podcast and studied pain for any period of time, you know that pain has sensory, cognitive and affective components. The sensory component is of course the thing that is the most obvious. It’s what you feel on your body. It’s the aching, the burning, the sharpness, the stabbing. The cognitive components is what you think about pain, what the cause of your pain is and whether or not you believe it’s temporary or permanent, controllable or curable. The affective component consists of your feelings and emotions about pain: fear, worry, anger, anxiety, guilt. In order to eliminate chronic pain, all the components need to be addressed and treated. The ways in which people think about their pain and their feelings are connected and have a great impact on the severity of pain and your ability to completely reverse it.
Joining me on the podcast this week is Alan Gordon, who is a Psychotherapist and the Director of the Pain Psychology Center in Los Angeles. He’s also an Assistant Adjunct Professor at the University of Southern California, has authored publications on the treatment of chronic pain and has presented on the topic of pain at many conferences and trainings throughout the nation.
The Mind Body Connection: Overcoming Chronic Pain with Alan Gordon
Alan, welcome to the Healing Pain Podcast. It’s great to have you here.
Thanks for having me, Joe.
I’ve really been wanting to connect with you. I heard about your work and the institute through Dr. Howard Schubiner. I love that you integrate really more the Mind Body Syndrome aspect into treating those with chronic pain. I’d love to hear about how you got started with working with people with chronic pain.
I got started because I was a chronic pain patient myself when I was in graduate school about twelve years ago. I was a second year grad student and I came down with really terrible low back pain. I couldn’t sit in the chairs in my classroom. I actually had to go to Office Depot and buy one of those big puffy chairs on wheels and wheel this chair around from class to class. I actually ran into a fellow grad student about three to five years ago and he says, “I know you. You’re the chair guy.” I was the chair guy in grad school. I went to the best doctors in Los Angeles and one of them said, “You have a disc herniation.” Another one said, “You have pain because you have disc degeneration.” The third one said, “You’re just too tall.” I was literally getting every diagnosis possible. After just dozens of different treatment approaches, I learned about the neural pathway component to chronic pain and I was able to eliminate all of my symptoms relatively shortly after that. Since then, I was in graduate school for Psychology, I started practicing it from this perspective having experienced it myself.
It’s interesting because you were in school for Psychology but at that time, were you learning about the neural pathways about how pain is produced? Was that something was being taught on the graduate level?
It’s not really something that’s taught in the graduate level for Psychology or for Medicine. If you think about chronic pain, it seems like it’s something that would be a specialty for physicians, not psychotherapists. Given what we’re learning now about the real nature of chronic pain and that much of it is caused by the mind, it’s something that really should be in the wheelhouse of Psychology. It isn’t something that’s really addressed too much at any level.
Even in physical therapy school, there’s still a ton of education around the biomechanics and the physical body, anatomy, physiology and all that’s important. Even the physiologic aspects are more important when we talk about the psychology of pain. But they really don’t teach you too much about the psychology of pain. It’s starting to seep its way into the university level, a little bit more around fear avoidance. Really going deep into some of the issues we’re going to talk about today really is still not talked about, so I’m excited to have you here. TMS or Tension Myositis Syndrome is something that Dr. John Sarno coined many decades ago. Now it’s talked about as far as Mind Body Syndrome. Can you explain what Mind Body Syndrome is and what the basic psychology of Mind Body Syndrome entails?
This is a syndrome that goes by many different names: TMS, Mind Body Syndrome. David Clarke refers to it as stress illness, psychophysiologic disorder. I pretty much just call it neural pathway pain or learned pain, but they all generally refer to the same phenomena. Many forms of chronic pain are not caused by structural pathology in the body but rather learned neural pathways in the brain. This pain is very real but it is not generated by some sort of structural anomaly. They actually did a study in Northwestern a few years ago where they took about 50 patients who had initial episodes of back pain. They wanted to see if they could predict what percentage of them were going to go on and develop chronic pain. They didn’t take any X-rays. They didn’t take any back MRIs. They just took scans of their brains. They were able to predict with 85% accuracy who was going to go on to develop chronic pain. More and more they’re finding that most of chronic pain is not caused by what most people think that it’s caused by. It’s caused by neural pathways in the brain. Just as this pain could be learned, it can be unlearned.
When you say it’s not what most people think it is, what comes up with me and my patients quite often are working on people’s beliefs or faulty beliefs really about what pain is. I think we’re moving away from the cause of pain just being physical and moving rapidly more and more towards that as both the sensory and an emotional component. How deep does someone’s core beliefs about what pain is affects their ability to cope with pain?
Your thoughts about pain, your beliefs about pain, very directly could either reinforce the sensations or the symptoms of the pain, likewise it could cut off the vessel of reinforcement. The belief over whether or not your pain is structurally caused, essentially whether or not the pain is dangerous is everything. It determines whether or not the pain perpetuates, the pain exacerbates or the pain essentially decreases or becomes eliminated.
In this mind body syndrome or neural pathway, the way you mentioned it, I know it’s hard to put a number on this but how much of your time do you spend working on modifying or helping someone change those core beliefs to prevent this priming of pain that happens in the brain?
I would say 64%.
That’s huge. That’s probably the most I’ve ever heard. I’ve interviewed a lot of psychologists on the podcast. I think in the traditional psychology world, I would say right now there’s so much emphasis on pain catastrophizing but not so much an emphasis on working on those core beliefs, which I think are really key for people.
Pain is a danger signal. If you injure yourself, the pain is essentially letting you know, it’s a warning signal not to cause additional tissue damage. Our brains are not able to perfectly distinguish a physical threat, like the idea of accumulating additional tissue damage, or a psychological threat. Oftentimes, it’s the belief that the pain is dangerous that keeps the danger signals activated. I was being tongue in cheek when I said 64%, but really it is the majority of the treatment actually involves helping the patient to recognize that these unpleasant physical sensations that they’re feeling and that they’re interpreting as pain are actually non-dangerous; assuming of course that the pain is not dangerous.
Some people do have structural injuries. Some people have autoimmune. Some people have acute injuries and the pain is dangerous. For people who have neural pathway pain, the majority of chronic pain patients, the pain is actually non-dangerous and getting to a point where you can wrap your mind around the fact that this pain that I feel is not actually dangerous, is the thing that can cut off the vessel reinforcement. It is the most important part of eliminating pain.
I like the word vessel reinforcement because I think that so often that when people don’t get the help they need that they keep having this pain pathway reinforced where we know there are ways to prevent that. Are there certain personality traits that are more likely to develop something like neural pathway pain?
Yes. Pretty much everybody who develops chronic pain and it is neural pathway pain, a strong majority of people have an underlying sense of hypervigilance. I think of the best way of describing hypervigilance is if you’re giving someone your phone number, do you repeat it a second time or do you trust that they got it? It’s the kind of thing where you’re always making sure of things that there’s this undercurrent of anxiety. If you imagine a zebra out in the jungle constantly looking over its shoulders to scan the environment for lions, that’s what hypervigilance is. Because neural pathway pain actually involves these danger signals and keeping these danger signals active, having that personality trait of anxiety, of hypervigilance, is the number one predictor of whether or not someone is going to develop neural pathway pain. There are other characteristics: having a tendency to be very hard on yourself, self-critical, perfectionistic, that I think all stem from this hypervigilance that are very common in neural pathway pain.
Sounds like those are many traits that a lot of people encounter just in daily modern life where we have pressure on us: where we are pressured to perform, we are pressured to pay the bills. We are pressured to do a good job at work and be a good husband and wife. It sounds like a lot of these personality traits are things that people can identify with.
I just read something recently. You know Curt Schilling, the pitcher for the Boston Red Sox who retired about five years ago?
Yes, I do.
He’s a Hall of Fame pitcher or I don’t know if he’s made the Hall of Fame yet but he’s this great pitcher who won Boston their first championship in 86 years. I recently read an article about him and he said when he got to the Minor Leagues, all that mattered to him was breaking into the Majors. When he got to the Major Leagues, all that mattered to him was crashing the starting rotation. After a year or two, he cracks the starting rotation and then all he cared about was making the All-Star team. Finally, after a few years, he’s an All-Star and all that mattered to him was working hard and winning a World Series. Then he won a World Series and at a certain point he realizes, “I’m 38 years old and I have not enjoyed playing baseball,” because there’s constantly that pressure and that drive to get to the next level. For the last two years, he’s like, “This is great.” He actually enjoyed it. I think that is one of the detriments of living in this capitalistic society is there isn’t an emphasis on mental health, on inner peace. There’s an emphasis on more achievement, on ambition. It’s great in terms of external success, but it actually leads to a lot of people existing in a state of fight or flight. That’s what activates a lot of those danger signals, and that’s why you have 25% of Americans in chronic pain. It doesn’t need to be that high.
Of course, that chronic pain exists across all different types of groups. You don’t have to be young or old. It doesn’t matter whether there’s more female typically than male but I think that is one that needs to be looked into actually further. We realize this is a problem across all different types of ethnicities as well. When someone comes into your practice and you start to treat them for this neural pathway pain, what does it look like? Can you give us a framework of what treatment looks like for your patients?
Yes, it’s essentially a three-pronged approach. Obviously, the first thing we do is we assess to make sure that this pain is due to neural pathways. In fact, whenever anyone calls in, I always do all of the intakes myself. I just want to make sure that they’re a good candidate for treatment. You don’t want to treat someone who has a ruptured disc as if it’s neural pathway pain. There’s a big distinction between someone who has an autoimmune and someone who has fibromyalgia. We’ll rule out for an actual structural or pathological cause for their pain. Assuming that it is neural pathway, the first thing we want to do is we want to help them wrap their mind around the fact that the pain is not caused by a structural problem in the body, that the pain is actually caused by neural pathways in the brain, which is not as easy as it sounds. We’re evolutionarily wired to associate physical pain with physical injury.
The first goal is to help someone wrap their mind around that inherent contradiction. “It feels like the pain is coming from my back but it’s actually coming from my brain.” The second thing we do is we help someone fundamentally change their relationship with the fear around the pain. “This pain is scary, sitting is scary, walking is scary, but I know that there’s nothing wrong with my back.” Really changing your relationship with the fear helps deactivate those danger signals. The third thing that we do is we work on whatever is going on that’s underneath the surface that brought the pain up in the first place. Maybe you’re always putting a ton of pressure on yourself. Maybe you’re constantly scaring yourself. “Is this going to happen? Is that going to happen? Is my kid going to be okay? Is my husband going to leave me?” Maybe you have a tendency to repress emotions and anytime an emotion comes up, you’re unconsciously sending it away. The third part is to really get underneath the surface and explore, why did these dangerous signals get activated in the first place? That really prevents the pain from either coming back or being manifested in some other form.
It’s a great three-part framework you have out there. I think that’s very beneficial. I think a lot of practitioners could definitely benefit from that. I think a lot of people who hear that will be able to see themselves in that framework as well. How does this differ from traditional CBT or Cognitive Behavioral Therapy or does it?
Specifically with regard to pain?
Yes. When you’re treating someone and we’re looking at really more Mind Body Syndrome or neural pathway pain, is there a difference in what you do in practice versus someone who goes through a traditional eight-week of CBT?
Absolutely there is. It’s based on an entirely different premise. The premise that most pain management practitioners use is this pain is structurally caused. This is something that you have to deal with. Let’s try to make it as little of a life impairment as possible. Let’s try to hone a sense of empowerment around your pain. Let’s really increase your ability to do activities even though you feel pain and you’re going to feel pain. The premise is this pain is structural. Let’s try to not let it take over your life, which I’m totally on board with assuming the pain is structural. The premise that we work from, assuming that it’s neural pathway pain, is you don’t have to have this pain. The real difference is, it’s pain management versus pain elimination. Assuming that it is an actual structural injury, there’s literally no difference between our treatment approach and that of the average pain management specialist. It’s just that distinction.
The word pain management is always a bit interesting to me. We talk about nocebos a lot and I’m not sure that the concept of pain management isn’t in some way a nocebo to patients where they look at “Now, I have to manage this pain for the rest of my life.” Most people don’t want to manage their checkbook let alone obviously manage chronic pain.
That’s really interesting, I never thought about that but you’re right. I did go to a pain management psychologist myself early on before I even learned about neural pathway pain. It was just yet another thing that you have on your responsibility list and it really did seem like this overwhelming task. I remember the pain management specialist said, “I wonder if part of this pain is a way to get attention from other people like secondary gain.” I was like, “Maybe but I don’t tell anyone about it.” It’s not a very good strategy. Again, it’s a faulty premise for most chronic pain patients, so it’s relatively limited.
Alan, can you share with us a success story of a patient? We don’t have to mention their name, just an example of maybe a patient who came into your practice that was struggling with chronic pain and through this approach, you helped them to alleviate or cure it.
Yes. Howard Schubiner and I did a conference about a couple of months ago and it was really amazing. There was this woman, a nurse practitioner named Felicia. We actually have a video of this up on our YouTube page. It’s something that is in a public domain and she’s given us permission to talk about it. She’s had chronic neck pain for twenty years. During the conference, she actually came up to do a live demonstration. We did a live demonstration of having her turn her head back and forth. For twenty years, every time she’s turned her head, she’s had pain associated with it. For a long time, she believed, “There’s something wrong with my neck. There’s something physically or structurally going on with me.” Dr. Schubiner was able to asses her and determined, “No, there’s nothing wrong with your neck. You’re structurally sound. This is neural pathway pain.”
We did an exercise with her where we essentially had her turn her head back and forth. We just had her reinterpret these unpleasant sensations she was feeling as non-dangerous. Over the course of about seven to ten minutes, the pain just gradually started to fade as she started to reinforce the idea, “The sensation that I’m feeling right now is not dangerous. This pain is just my brain misinterpreting these sensations as dangerous when in fact they are.” Over the course of ten minutes, the pain completely disappeared. I reached out to her a few weeks ago and she said, “I had a few flares in the first couple of weeks after that but I’ve had no pain for the last three or four weeks.” This was the case of a woman who simply by communicating to her brain that this pain was non-dangerous, was able to eliminate twenty years of pain in about ten minutes.
I’m sure people listening to us they’re saying, “I would love if that happens to me because I’ve been to every physician and therapist in the entire city and I still haven’t been able to find that.” Where can they find that YouTube video?
If they go to the Pain Psychology Center YouTube page, it’s up there. It’s titled Woman Overcomes Chronic Pain or something like that. Just as a caveat, I know that a lot of them or someone will read one of Dr. Sarno’s books and feel frustrated because it seems like every case that he cites overcomes their pain just from reading one of his books. It’s really frustrating for them if they’re still experiencing pain after reading the book. Just as a caveat, not everyone overcomes their pain in ten minutes. That was an incredibly great success story but some people, it can take a couple of months to get pass this thing, but most people do. Most people are able to overcome their pain.
It is amazing that once you start to give some positive reinforcement and change people’s beliefs so they don’t feel like they’re being harmed anymore that things can change much more rapidly than we think. I know you and Dr. Schubiner are working on a great project where you’re doing some brain imaging work. Can you share that project with us?
We’re actually going to be taking part in a brain imaging study in Boulder in conjunction with Tor Wager who is one of the world’s leading pain researchers. It is a huge randomized controlled brain imaging back pain study where there’s going to be 90 patients, three different groups. One of them is a weightless group, one of them is a placebo group and then one of them is getting our Mind Body Treatment. We’re going to work with every one for eight sessions treating them from this perspective. Everyone in all three groups is going to get scans of their brain taken both before and after treatment and the groups are going to be compared. We’re hoping, we’re optimistic that this is going to be the landmark study that can really validate in the scientific community the effectiveness of this Mind Body Treatment Approach.
There has not been a study like this today, is that correct?
Yes, this is the first one for sure.
How many participants are you aiming for?
There’s going to be 90 participants total. There’s going to be 30 participants solely in the Mind Body Treatment group. They’re going to be compared to a group that’s getting a placebo injection and then another group that’s getting no treatment at all.
It sounds like a great study. How can people learn about that and support you around it?
We did a crowdfunding campaign. It was a lot of firsts here. It was the first crowdfunding campaign for a large scientific study, so nobody knew what to expect. We actually met our goal in three weeks. It was pretty amazing. What we’re doing is we’re actually putting together a stretched goal so that we can try to get a documentary around the study made. We feel like studies are great but there are a lot of numbers, there’s a lot of statistics. If we are able to put together a documentary, we have an award-winning documentarian named Mitch Dickman who has offered to oversee the documentary process of the study, follows several patients, strive to overcome their chronic pain. We feel that could really give meaning to the results of the study on a more emotional level.
We’re continuing to try to raise funds over that through the end of July. It’s over Indiegogo. If you just go to the Indiegogo website and then in the search engine, type Mind Body Study. It is the first thing that comes up. We’re giving away rewards in exchange for people who contribute along the lines of Howard Schubiner’s Unlearn Your Pain book and recordings of people overcoming their symptoms and classes of how to get out of pain to really try to generate enthusiasm around the campaign.
That’s a great study. I think crowdfunding is such an interesting way to start that. I’d love to see more studies done around crowdfunding actually because I think so much of our research is in the hands of practitioners. I think involving the public, people who are interested on this and having them put their dollars toward things, a needle mover for them would be really fascinating. Alan, it’s been great chatting with you. Can you tell all the listeners of the podcast how they can learn more about you?
If you go to PainPsychologyCenter.com, you can learn about me, you can learn about our center. We have all kinds of information about this treatment approach as well. There are sample sessions, there’s talks, there’s examples on how to get over pain and there’s obviously information on how to be connected with a therapist who treats that if that’s what you’re interested in as well.
I want to thank Alan Gordon for being on the Healing Pain Podcast this week. You can of course find him at the Pain Psychology Center in Los Angeles, California. The website for that is www.PainPsychologyCenter.com. With every podcast, please make sure to share this with your friends and family. We know there are millions of people who are struggling with chronic pain but there is a way to overcome it and there is a way to alleviate it and even reverse it in many cases. Please share this with your friends and family. Stay tuned and we’ll see you next week on the Healing Pain Podcast.
About Alan Gordon
Alan Gordon is a psychotherapist and the director of the Pain Psychology Center in Los Angeles, CA. Alan is an Assistant Adjunct Professor at the University of Southern California, has authored publications on the treatment of chronic pain, and has presented on the topic of pain treatment at conferences and trainings throughout the country.
He’s currently helping to oversee a large brain imaging study, comparing a mind body approach to a placebo in the treatment of chronic back pain.
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