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87:: The science of pain (how your brain creates & can rewire pain)
Episode 1038th December 2025 • Wellness Big Sis: The Pod • Dr. Kelsy Vick
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What is pain, really? Is it simply tissue damage or something much more complex? In this episode, I’m breaking down the fascinating science of pain, from how our brains process “danger signals” to why past experiences can completely change the way we feel pain today.

As a physical therapist, I’ve heard pain described in a hundred different ways: burning, sharp, aching, sore. But here’s the thing: pain isn’t actually something our bodies sense. Instead, it’s an output of the brain designed to protect us.

We’ll cover:

  • Why pain is not an input, but an output.
  • The role of nociceptors in detecting potential threats (mechanical, chemical, and thermal).
  • How the brain integrates past experiences, stress, emotions, and cultural beliefs to create pain responses.
  • The difference between acute pain and chronic pain, and why the brain can sometimes produce pain without any new injury.
  • Central sensitization, hyperalgesia, and allodynia (and what they mean for chronic pain).
  • Groundbreaking pain science research, including Dr. Lorimer Moseley’s famous snake story and the protectometer tool.
  • Hopeful news: the brain is plastic, meaning pain pathways can actually be rewired and reversed.

By the end of this episode, you’ll understand why two people can experience the same injury so differently, why chronic pain feels so overwhelming, and how we can start to regain control over our pain experience.

✨ Pain is real, but it’s also adaptable. Your brain and body are capable of healing, and understanding the science behind pain is a great first step.

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Research Articles:

https://www.abdn.ac.uk/news/24440/

https://neurosciencenews.com/mindfulness-pain-placebo-27618/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11559515/ 

https://www.explorationpub.com/Journals/em/Article/1001282

https://pmc.ncbi.nlm.nih.gov/articles/PMC5799128/ 

https://www.physio-pedia.com/The_Protectometer 

https://pubmed.ncbi.nlm.nih.gov/15827919/ 

00:00- 00:17 Intro

00:18- 01:21 Introduction to Pain Science

01:22- 03:44 Understanding Pain: Types and Descriptions

03:45- 04:10 The Brain's Role in Pain Perception

04:11- 06:27 Case Study: Dr. Lorimer Moseley's Snake Bite

06:28- 09:48 How Our Bodies Sense Pain

09:49- 10:24 Safely

10:25- 12:56 How Our Bodies Sense Pain

12:57- 16:55 Acute vs. Chronic Pain

16:56- 22:24 Research Insights and Tools for Managing Pain

22:25- 22:59 Neap

23:00- 26:24 Conclusion and Empowerment

Mentioned in this episode:

Neap

Live Safely Sidekick

Transcripts

Speaker:

This topic is super fascinating

to me and one that I feel like not

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a lot of people truly understand.

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So let's chat about the science

behind pain and how our brain

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actually creates and can rewire pain.

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Welcome back to Wellness.

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Fix the Pot.

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I'm your host, Dr.

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Kelsey Vic, a board certified orthopedic

doctor of physical therapy and a

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pelvic floor physical therapist.

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And I have this conversation a lot

with patients, but I feel like it's

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very clinical where a lot of the times

people don't truly get this sort of

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education unless they're going to see.

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Honestly, a physical therapist or an

allied health provider in general, where

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their primary care, the physician that

they typically see, usually doesn't have

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time to get into this super in depth.

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So a lot of the time, this is the

conversation that I'm having with patients

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and I wanted to share it with you guys.

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So my hope is that by educating and

understanding pain on a deeper level,

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it can either help you as someone

going through pain or maybe even a

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loved one of yours who's also going

through a situation where their brain is

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perceiving threat or danger and giving

that output of pain in their body.

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So let's start from a high level.

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What even is pain?

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Have you ever wondered what

the mechanisms are behind pain

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and how we experience pain?

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I know a lot of us, we say something's

painful, but if we're able to get a

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little bit more descriptive, maybe

it's sharp, maybe it's hot, maybe

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it's a surface that's burned us.

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Maybe it's a pressure thing.

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Maybe it's a muscle soreness

or strain sort of pain.

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Maybe it's more of an

instability type of pain.

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There's all sorts of different words

in the English language that we use

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for pain, but pain can be this umbrella

term that when we dive in a little

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deeper, we can see that there is sharp,

there is hot, there is mechanical, like

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stretchy pain, there's instability, pain.

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So pain can mean a wide range

of things to different people.

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As a pt, I've heard pain described

in a lot of different ways.

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I have a really good PT friend of

mine, and he started writing down funny

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things that patients would say to him.

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And he has his ongoing list.

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But I feel like the way that patients

and people describe pain and the way

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that I describe pain when I'm going

through pain, it can be very descriptive.

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Like authors and writers would be super

impressed with the descriptive adjectives

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that people use to describe their pain.

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Even something like, it feels like a

rubber band is just slapping me every

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time, like I'm stretching it and slapping

my skin every time I've heard that.

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There are so many ways that people, and

patients specifically describe pain to me.

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But one commonality between a lot of

people who experience pain is that

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we always relate pain to physical

damage in the area that is associated

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with that pain, or in the area that

supplies that area associated with pain.

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For example, if you have pain in

your low back, a lot of people

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assume their low back is damaged,

or the structures in their low back.

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Are damaged and are causing that pain.

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If you have a burning sensation in

your arm or in your hand, a lot of

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people sense that the nerves supplying

that hand are damaged or the nerves

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in the arm are damaged in some way.

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so typically people associate the

pain they feel in a certain region

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with physical damage of the structures

in that region or the structures

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that actually supply that region.

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and this can definitely be the case.

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If you sprain your ankle or there

is some sort of physical damage to

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your ankle or a broken bone, you are

going to feel pain because structures

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in that area are sending danger

signals to the brain, and the brain

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is integrating a lot of different

signals to create that output of pain.

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So there is some correlation,

but it's not always the case.

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There are more complex networks

involved in how our brain eventually

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tells us that we're in danger.

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The brain has to integrate a whole lot

of inputs, not only the physical damage

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from the structures, if that's the

case, but also our cultural beliefs,

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our past experiences, our visual inputs.

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It's constantly integrating

a lot of different inputs in

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order to create that output.

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That tells us that we are in pain.

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So one of my favorite examples to

talk about this phenomenon is actually

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a researcher out of Australia, Dr.

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Lo Mosley, and he is one of the top

researchers in this field of pain science.

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And he has such a wonderful way of

explaining pain To where people can

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really understand what their body is

going through, what their brain is

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going through, and how the two mix

together to create this responsive pain.

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So one of the stories he utilizes That

I feel like is a perfect example, and

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I might paraphrase it a little bit, but

there's one day where he's walking to the

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river, maybe with his friends and he's

out of Australia, so you can only imagine

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the terrain that he's going through, but

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His leg ends up touching a blade

of grass or a shrub of some sort.

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Ends up rubbing against his

leg and he kicks it off and

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continues walking to the river.

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He gets to the river,

gets in, starts swimming.

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He gets bitten by a snake.

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then he sent to the ER to take

care of this poisonous snake bite

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that he just got in the river.

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He's all fine.

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He survives the snake bite.

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He survives the ER visit, but the next

time he's walking to the river, his leg

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again feels that blade of grass, that

shrub, and he is in agonizing pain,.

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Just the most intense pain he's

experienced from that same sensation,

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that same brush against the leg of

that shrub or the blade of grass.

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I can't say it's the same

one, but you get the picture.

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It's the same intensity of signal,

but a completely different output

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because of his past experiences.

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How can that same blade of grass

trigger a completely different response?

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His brain used past experiences as

a way to protect him in the present.

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His brain had a previous experience

of brushing against a blade of

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grass and then a subsequent ER

visit after getting bit by a snake.

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So his brain takes that information and

says, okay, next time that happens, I'm

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going to remember that experience and

that er visit, and the poison and the

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trauma that was from that experience.

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I'm going to create a response that

is going to elicit pain and let

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the body know that I'm in danger

so that it doesn't happen again.

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So it wasn't just the input that

created that sensation of pain, but it

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was also the brain integrating a lot

of different components, especially

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his past experience of having that

blade of grass brush against his

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leg and then ending up in the er.

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So when we talk about the basics of

pain in our nervous system, pain is not

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actually a sensation that we can sense.

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Our brains do not actually sense.

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Pain.

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There is nothing that happens in our

body that says, oh, that was painful.

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What we have within our bodies are

receptors and sensors that sense

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potential threat, and these are

called nociceptors and they sense

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a variety of potential threats.

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So we have receptors that sense

mechanical threats, like pressure

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or cutting, like slicing the skin.

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We have chemical threats, so acid

or an inflammatory substance.

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We have thermal threats,

too hot, too cold.

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And then we also have of course, potential

tissue damage like a broken bone.

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So if you experience low back pain,

your low back alone cannot sense pain.

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It can only sense possible threat

signals that are sent to the brain,

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where the brain can integrate

a lot of different inputs in

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order to create a certain output.

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And sometimes that output is pain,

so if you experience low back pain,

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your back alone cannot sense pain.

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It can only sense possible threats to

be sent to the brain for the brain to

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decide what that response is going to be.

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Rather than thinking of pain as

an input oh, I have low back pain.

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That pain signal is sent to the brain.

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Think of it as an output where,

okay, I've injured my low back.

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The nociceptors, the receptors, that

sense potential threat in my low back are

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sending signals and inputs to the brain,

and the brain has to decide what to do

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with it so after the signal is received

your brain actually integrates the signal

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with a variety of other brain areas and

past experiences to create a response.

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The response doesn't have to be pain.

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It can be pain, but sometimes

that signal is ignored.

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Imagine if you sat on your wallet, right?

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Your wallet is pressure.

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We have sensors within our skin

that helped to sense that pressure.

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If we sat on our wallet and it was painful

every single time, that would be an issue.

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I know that's more of a guy thing

to have wallets in their pockets,

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but girls you have those little

metal things in your jeans.

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that's pressure that our body senses.

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And if our brains sense that

as pain every time, we would be

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not able to sit down in jeans.

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So instead, some of those signals

are ignored, which is a good thing.

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Sometimes the brain also

creates another response, like

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a muscle spasm, inflammation.

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It creates an altered movement pattern,

like a limp or a compensatory pattern.

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If you roll your ankle, maybe you also

walk a little funny to protect that area.

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Same with heightened

awareness of that area.

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I'm sure if you sprain your ankle,

moving that ankle in and out of bed,

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you're a little bit more aware of those

movements to not move the ankle in a

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certain way that might cause you pain.

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So we can think of pain as one of

the possible responses that our

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brain can help carry out based on

the signals it is receiving from all

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of the receptors within our body.

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This should actually feel super

empowering Because it actually means

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that we can help to change those outputs.

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Our brain is sensing potential threats

and danger, and its job is to protect us.

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But if it gets to that

overprotective state, like in Dr.

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Lore or Mosley's example of

that blade of grasp brushing

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against the leg and creating.

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Agonizing pain response, even though

there really was no threat from the blade

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of grass, it was what happened after.

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If we can think about that,

we can understand that.

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We can actually help our brain

decipher what is true and

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what is a potential threat.

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What is not threatening, and

what is threatening, what

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actually puts us in danger.

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So from a higher level, the brain

actually evaluates what inputs

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it's receiving from those various

receptors across our body with past

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experiences in similar situations.

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So going to the river, brushing up against

a blade of grass, getting bit by a snake.

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That past experience, the brain

is definitely going to remember

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next time that same thing happens.

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It's also gonna integrate with

cultural beliefs and influences current

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knowledge about the injury, emotional

state, social context, stress levels,

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visual input, it integrates with.

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So many different inputs in order

to create the appropriate response

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that is going to protect us.

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' cause that's all that pain is.

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That's all that it's trying to

do, is to protect us from what

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the brain is sensing as danger.

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So this is why the same injury or

experience can produce a drastically

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different response in the same

person or even in different people.

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so to sum it up, your tissues can

send danger messages, but it's the

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brain that decides whether those

messages warrant the creation of pain.

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As a fun fact, the brain doesn't

actually have nociceptors.

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So the primary organ involved in sensing

danger cannot itself send danger messages.

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So we've talked a lot about the signals

being sent to the brain, but let's talk

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about how the brain actually integrates.

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and when I say integrate, I used to

be super confused when this word was

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used in some of my courses because I

was like, what does that even mean?

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I think about it as it's compiling a lot

of information from around the body, and

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then I picture like my hands doing like

this, like it's calculating and computing

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what the output should actually be.

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I know the visual is not gonna help over

audio, but if you're watching on YouTube,

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you could see, I don't know I picture

things, I'm a very kinesthetic learner,

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so a lot of my demonstrations I use

my hands for, because as a kinesthetic

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learner, I have done so much like body

movements to help me learn things.

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And so when I picture integration

and computing, I picture almost like

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my fingers, just coming together

and doing a crazy mess and then

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creating this like solid output,

whether that's pain, inflammation,

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muscle spasm, whatever, the brain.

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Census is the right response for

those inputs and that integration.

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So there's six key brain regions that

help to process those danger signals

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or those potential threat signals.

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For those of you guys who do

enjoy the little bit of like

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neuroscience brain stuff.

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There's the thalamus, the

anterior cingulate cortex.

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The insula, the primary and secondary

somatosensory cortex is the prefrontal

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cortex and the motor cortex.

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So these areas of the brain combined

are in charge of sensory processing.

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So where are we sensing that

threat and what does it feel like?

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Emotional processing.

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How threatening is it?

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Memory systems.

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So linking it to past experiences,

cognitive evaluation, so cultural

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beliefs and influences, and

then motor planning regions.

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So the protective responses,

some conscious, some unconscious.

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We've talked about reflexes, but you.

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I don't know if you guys have

ever touched like a hot tool

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or a hot iron or a hot stove.

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Your hand immediately pulls

away and that signal actually

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doesn't have to go to the brain.

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It goes into the spinal cord to

actually coordinate that motion.

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So there's certain things that

our body does that help to protect

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us with conscious awareness, but

also without conscious awareness.

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Let's demo this with

an acute pain example.

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So acute pain is different

from chronic pain.

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Acute pain is like your ankle

sprain, your deadlift, where

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you have a low back injury.

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It is short and sweet where

chronic pain is long-term pain.

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Usually patients who have chronic pain

have either had an injury that has lasted

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super long and they start to feel pain

in other areas They're going through.

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Some sort of treatment for cancer

or some sort of disease process.

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Autoimmune condition.

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So chronic pain can be a wide

range of things, and acute pain

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can be a wide range of things, but

it really comes down to timing.

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So acute pain is quicker

and more immediate.

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Chronic pain are those who

have been experiencing pain

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for a longer period of time.

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So in acute pain, you sprain your ankle.

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A dangerous signal is

then sent to the brain.

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Too much stretch on that

ankle, on those ligaments.

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So that can be one of

the signals that's sent.

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Those mechanical receptors that are

sensing my ankle's been stretched in a

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funny way that's potentially threatening.

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Send that signal to the brain.

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The brain integrates that

signal, and then it might.

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Create the response of altered movement

patterns, swelling, pain, and inflammation

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to protect the region from more damage.

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So by sending the output of pain, of

inflammation, of swelling, of altered

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movement, Your brain is helping you to

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protect that area where that

dangerous signal came from.

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In chronic pain, it's a little different

because some of the time the brain

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doesn't actually need any input in

order to create the output of pain.

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So we have what we call central

sensitization, and it's where the central

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nervous system becomes hyperexcitable.

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So the brain and the spinal cord

are the central nervous system.

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It becomes hyperactive and the person

might start to experience things like

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hyperalgesia, where their painful

stimuli becomes even more painful.

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You might prick your finger

and have an amplified response

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way out of what's normal.

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They also might experience

allodynia, which is non-painful.

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Stimuli become painful, so things

like a hand towel rubbing against

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your hand, that might be excruciating

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they also might experience overall

hypersensitivity to different stimuli.

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So think of light like too much light.

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people with chronic pain might be

oversensitive to light, to sound, to

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smell, to taste to any of the senses.

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They might experience those at a higher

intensity, even compared to a normal

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person because they are centrally

sensitized and their central nervous

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system is just a little bit hyperactive.

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The longer someone experienced

pain, the more structural brain

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changes that can actually occur.

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so as soon as that acute pain turns

to chronic pain and that chronic pain

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turns to even longer chronic pain,

the more the brain actually changes

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in response to that chronic pain.

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This means decreased

connectivity, so People can't

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turn off pain focused thinking.

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The brain becomes hyper activated and

hyper connected with dangerous signals.

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So it senses those inputs at a larger

and greater scale compared to someone

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who's not experiencing chronic pain.

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They also experience reduced cognitive

control over that pain experience, so they

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have reduced top-down control, reduced

logic when it comes to their own pain.

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This is all a little bit doom and gloom,

especially when it comes to chronic pain.

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Chronic pain is so hard.

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People who are in pain for prolonged

periods of time, it is hard to work

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against your brain's natural wiring.

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But on the bright side, you actually can.

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As soon as we understand that the brain

is what's creating this output, the

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brain is actually trying to protect us.

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It sometimes just goes a little

bit too far in that protective.

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Overbearing way that it continues

those pain signals when in reality

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bright lights aren't gonna harm us.

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loud noises aren't gonna harm us.

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A little prick on our

finger is not life or death.

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There are certain things our brain tells

us when we experience chronic pain, that

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we can start to introduce a little bit

of truth and logic to help rewire our

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brain to not be so alert when it comes

to those signals of potential threat

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that are sent from throughout our bodies.

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so a little bit of cool research

and tools for anyone to utilize for

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themselves if they're in pain or for

their loved ones who are in pain.

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But Dr.

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Laura Mosley's teams have done a study

on visual inputs and the pain output,

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and they found that when patients

touched an extremely cold plate, their

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responses were different based on

the visual cues that they received.

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So if patients were presented

with a hand on a cold plate and

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a visual input of red light.

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They experienced more pain and

sensations of burning and pulled

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their hands away more quickly.

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Compared to patients who had that

same exact cold plate with blue

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light as their visual stimuli.

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Those patients experienced less pain

and didn't pull away as quickly.

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So their results were that pain is

not just about what is experienced

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at the tissue level, but it also

integrates things like, again,

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past experiences that we've talked

about, but also visual inputs.

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This next study's been super applicable

to me as a physical therapist, but

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it's by Sims and Shin, and they.

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Researched 40 demolition Derby drivers.

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So their average was 30 career events

with 52 collisions per event with each

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of those collisions happening at 26

miles per hour to 45 mile per hour

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for demolition Derby drivers, their

job is basically car accidents, but

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they reported their worst neck pain

in the history of that neck pain.

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And most drivers had pain

that lasted less than 21 days.

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One driver had pain that lasted greater

than one year, and two drivers had pain

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that lasted greater than three months.

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So out of all of those 40 demolition

derby drivers, most of them had neck

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pain that lasted less than 21 days.

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Compared to the general population

following a single rear end collision,

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over 50% reported neck pain at one year.

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So basically when the brain's prior

experience tells it, I've survived this

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before, it downregulates the protective

pain response and greatly reduces

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both pain, severity and duration.

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So the fact that these demolition derby

drivers had gone through these car

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accidents multiple times in the past and

have survived it, their pain experience

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was lessened compared to people like me

and you or most of you guys, I'm guessing,

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where if we get an AR rear end collision.

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We're gonna experience neck pain at a

greater intensity compared to those who

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experience it all the time for their

jobs and have survived in the past.

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So Dr.

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Er Mosley also created a tool

that he calls the Protect Oter.

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And this is a tool that you can

use if you're in pain or share

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it with one of your loved ones.

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You can access it online as well, but

it helps people establish the seesaw.

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So the balance between what they sense as

dangers and what they sense as safeties.

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So he calls them dangers

in me and safeties in me.

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So Dims and Sims, so this Pro Exometer

looks at a few broad range of categories

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and helps people decide what in

that category is a danger to them,

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and what do they sense as safety.

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So for things you hear, see, taste,

touch, or smell, a dim or a danger in

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me might be looking at an X-ray that

might feel harmful or as a potential

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threat to you compared to a safety

in me or a sim, a gentle massage.

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Things you do.

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A danger in me might be staying home

all the time and a safety in me might be

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gentle exercise or laughing with a friend.

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Things you say, A danger in me or a dim.

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I have pain everywhere.

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A safety in me or a sim is I believe

my brain and body will heal things

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:

you think and believe a danger in me.

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Pain is forever.

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Insurance is out to get me a safety in me.

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I believe my brain and body

will heal and my faith.

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The places you go.

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A danger in me might be the

doctor's office in the hospital.

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You might feel potential threats in

those places, but a sim might be your

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library at home, the people in your life.

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:

A danger in me might be

the insurance companies.

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:

And believe me, you are not the

only one that is experiencing that.

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:

And a safety in me might be your

friends, a spouse or loved one.

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And the last category is

things happening in your body.

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A danger in me might be

depression or anxiety.

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A safety in me might be healing

and more optimistic feelings.

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So we wanna basically go through that

thought exercise and have those sims.

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The safety in me outweigh the

danger in me, but this allows us to.

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Take those subconscious processes,

that subconscious integration that's

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happening within our brains, typically

outside of our control and put a

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:

little bit more control over it.

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:

So a little bit more of that top-down

approach where we're actually being a

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:

little bit more logical with our brains

and being like, Hey, just because

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my leg brushed against that blade of

grass doesn't mean that I'm in danger.

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It's actually okay that I do that.

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So it's really just.

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Reframing and rewiring some of

those pathways that our brain is

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doing for us at a subconscious level

so that we are not experiencing

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pain on this heightened scale.

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So if you experience pain in your

life, or you have someone who is going

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through pain right now, or chronic pain.

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I hope you share this episode with

them in education with them, and I

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hope that it helps them just truly

understand what's actually happening in

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:

their body, especially when it comes to

pain, because pain really is an output.

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It's our brain's way of protecting us.

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It's a good thing to experience

inflammation and swelling and all of

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:

these different responses that our brain

comes up with, but we need it to be in a

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:

healthy range, not to an extreme range.

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And then we can also try and rethink

how we can add a little bit of logic to

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:

what our brain is trying to integrate.

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:

If we see a red light and a blue light

and touch the same cold plate, we can

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be like, oh my gosh, this is wild.

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That because my brain senses

red light is dangerous.

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It is creating this greater pain output

for me with the same temperature of

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:

the cold plate compared to the people

who are sensing the blue lights.

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So basically grabbing hold of some of

those thoughts and inputting it with

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truth and logic to help rewire our

brains and help our brains understand

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that some things are not pain and are

not potential threats, and some things

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:

are, and we still wanna keep those.

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But if you're in this chronic pain cycle,

a lot of the time, our brains can run wild

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:

with potential threats and without our

actual conscious input into those thoughts

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and that integration, it can run even

more haywire and just start compounding.

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So to end on pain is very real.

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How we experience pain is very real.

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Our brains rewire because of pain.

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However, pain is in our control.

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Our brains are very plastic and adaptable,

and we can reshape how we experience pain.

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Pain is protective.

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Pain is our body's way of protecting

us, and pain is necessary,

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but pain can be temporary.

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And there are tools that we can use

to rewire our brains to make pain

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not a normal part of our lives,

especially if you're someone who's

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lived with chronic pain for a long time.

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:

So I hope you guys enjoyed this episode.

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This is one of those topics that can

truly help us and our loved ones.

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:

So I hope you guys enjoyed this episode.

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:

I know I've been through a lot of

different sorts of pain in my life.

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I know loved ones of mine especially,

who have gone through so much pain

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:

and so much chronic pain where

they are stuck in this cycle and

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:

their body's stuck in this cycle.

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:

And I'm not here to tell you that is fake

at all because I know that can be a hard

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:

line to draw where people are like, oh,

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:

it's just in my head.

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No, it is in your head, But it is your

brain, which is a very powerful organ

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:

that is helping to decide that output.

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:

And you actually do have control over

that organ and over that part of your

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:

brain and all of those different parts of

your brain that help to decide what those

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:

potential threats actually mean to us.

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:

So I hope you learned a lot about pain

this episode, and I hope that it can

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help either empower you if you're going

through pain or be a resource for those

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:

of you guys who have loved ones who are

going through a lot of pain to understand

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:

how they can grasp that pain and how they

can actually change and rewire their own

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:

brain so that pain does not have to be

a normal part of their day-to-day lives.

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The more we understand pain, the more

we can actually keep it in our control.

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So I hope that's the overarching message

that you guys all take from this, and

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I hope you guys enjoyed this episode.

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I know it's a very touchy subject.

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Pain is not something that we

typically enjoy talking about,

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but I think it's super important

to understand and learn about.

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So I hope you guys enjoyed this episode

and I'll see you guys again on the next

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:

episode of Wellness Books is the pod.

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