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:
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:
This topic is super fascinating
to me and one that I feel like not
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:a lot of people truly understand.
3
:So let's chat about the science
behind pain and how our brain
4
:actually creates and can rewire pain.
5
:Welcome back to Wellness.
6
:Fix the Pot.
7
:I'm your host, Dr.
8
:Kelsey Vic, a board certified orthopedic
doctor of physical therapy and a
9
:pelvic floor physical therapist.
10
:And I have this conversation a lot
with patients, but I feel like it's
11
:very clinical where a lot of the times
people don't truly get this sort of
12
:education unless they're going to see.
13
:Honestly, a physical therapist or an
allied health provider in general, where
14
:their primary care, the physician that
they typically see, usually doesn't have
15
:time to get into this super in depth.
16
: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
20
:loved one of yours who's also going
through a situation where their brain is
21
: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
27
: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.
32
:There's all sorts of different words
in the English language that we use
33
: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
35
: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.
142
:It can be pain, but sometimes
that signal is ignored.
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:Imagine if you sat on your wallet, right?
144
:Your wallet is pressure.
145
:We have sensors within our skin
that helped to sense that pressure.
146
:If we sat on our wallet and it was painful
every single time, that would be an issue.
147
: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.
150
:And if our brains sense that
as pain every time, we would be
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:not able to sit down in jeans.
152
:So instead, some of those signals
are ignored, which is a good thing.
153
: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.
158
: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.
166
: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.
231
: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.
245
: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.
247
:So acute pain is quicker
and more immediate.
248
:Chronic pain are those who
have been experiencing pain
249
:for a longer period of time.
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:So in acute pain, you sprain your ankle.
251
:A dangerous signal is
then sent to the brain.
252
:Too much stretch on that
ankle, on those ligaments.
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:So that can be one of
the signals that's sent.
254
:Those mechanical receptors that are
sensing my ankle's been stretched in a
255
:funny way that's potentially threatening.
256
:Send that signal to the brain.
257
:The brain integrates that
signal, and then it might.
258
:Create the response of altered movement
patterns, swelling, pain, and inflammation
259
:to protect the region from more damage.
260
:So by sending the output of pain, of
inflammation, of swelling, of altered
261
:movement, Your brain is helping you to
262
:protect that area where that
dangerous signal came from.
263
:In chronic pain, it's a little different
because some of the time the brain
264
:doesn't actually need any input in
order to create the output of pain.
265
:So we have what we call central
sensitization, and it's where the central
266
:nervous system becomes hyperexcitable.
267
:So the brain and the spinal cord
are the central nervous system.
268
:It becomes hyperactive and the person
might start to experience things like
269
:hyperalgesia, where their painful
stimuli becomes even more painful.
270
:You might prick your finger
and have an amplified response
271
:way out of what's normal.
272
:They also might experience
allodynia, which is non-painful.
273
:Stimuli become painful, so things
like a hand towel rubbing against
274
:your hand, that might be excruciating
275
:they also might experience overall
hypersensitivity to different stimuli.
276
:So think of light like too much light.
277
:people with chronic pain might be
oversensitive to light, to sound, to
278
:smell, to taste to any of the senses.
279
:They might experience those at a higher
intensity, even compared to a normal
280
:person because they are centrally
sensitized and their central nervous
281
:system is just a little bit hyperactive.
282
:The longer someone experienced
pain, the more structural brain
283
:changes that can actually occur.
284
:so as soon as that acute pain turns
to chronic pain and that chronic pain
285
:turns to even longer chronic pain,
the more the brain actually changes
286
:in response to that chronic pain.
287
:This means decreased
connectivity, so People can't
288
:turn off pain focused thinking.
289
:The brain becomes hyper activated and
hyper connected with dangerous signals.
290
:So it senses those inputs at a larger
and greater scale compared to someone
291
:who's not experiencing chronic pain.
292
:They also experience reduced cognitive
control over that pain experience, so they
293
:have reduced top-down control, reduced
logic when it comes to their own pain.
294
:This is all a little bit doom and gloom,
especially when it comes to chronic pain.
295
:Chronic pain is so hard.
296
:People who are in pain for prolonged
periods of time, it is hard to work
297
:against your brain's natural wiring.
298
:But on the bright side, you actually can.
299
:As soon as we understand that the brain
is what's creating this output, the
300
:brain is actually trying to protect us.
301
: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
303
:bright lights aren't gonna harm us.
304
:loud noises aren't gonna harm us.
305
:A little prick on our
finger is not life or death.
306
:There are certain things our brain tells
us when we experience chronic pain, that
307
:we can start to introduce a little bit
of truth and logic to help rewire our
308
:brain to not be so alert when it comes
to those signals of potential threat
309
:that are sent from throughout our bodies.
310
:so a little bit of cool research
and tools for anyone to utilize for
311
:themselves if they're in pain or for
their loved ones who are in pain.
312
:But Dr.
313
:Laura Mosley's teams have done a study
on visual inputs and the pain output,
314
:and they found that when patients
touched an extremely cold plate, their
315
:responses were different based on
the visual cues that they received.
316
:So if patients were presented
with a hand on a cold plate and
317
:a visual input of red light.
318
:They experienced more pain and
sensations of burning and pulled
319
:their hands away more quickly.
320
:Compared to patients who had that
same exact cold plate with blue
321
:light as their visual stimuli.
322
:Those patients experienced less pain
and didn't pull away as quickly.
323
:So their results were that pain is
not just about what is experienced
324
:at the tissue level, but it also
integrates things like, again,
325
:past experiences that we've talked
about, but also visual inputs.
326
:This next study's been super applicable
to me as a physical therapist, but
327
:it's by Sims and Shin, and they.
328
:Researched 40 demolition Derby drivers.
329
:So their average was 30 career events
with 52 collisions per event with each
330
:of those collisions happening at 26
miles per hour to 45 mile per hour
331
:for demolition Derby drivers, their
job is basically car accidents, but
332
:they reported their worst neck pain
in the history of that neck pain.
333
:And most drivers had pain
that lasted less than 21 days.
334
:One driver had pain that lasted greater
than one year, and two drivers had pain
335
:that lasted greater than three months.
336
:So out of all of those 40 demolition
derby drivers, most of them had neck
337
:pain that lasted less than 21 days.
338
:Compared to the general population
following a single rear end collision,
339
:over 50% reported neck pain at one year.
340
:So basically when the brain's prior
experience tells it, I've survived this
341
:before, it downregulates the protective
pain response and greatly reduces
342
:both pain, severity and duration.
343
:So the fact that these demolition derby
drivers had gone through these car
344
:accidents multiple times in the past and
have survived it, their pain experience
345
:was lessened compared to people like me
and you or most of you guys, I'm guessing,
346
:where if we get an AR rear end collision.
347
:We're gonna experience neck pain at a
greater intensity compared to those who
348
:experience it all the time for their
jobs and have survived in the past.
349
:So Dr.
350
:Er Mosley also created a tool
that he calls the Protect Oter.
351
:And this is a tool that you can
use if you're in pain or share
352
:it with one of your loved ones.
353
:You can access it online as well, but
it helps people establish the seesaw.
354
:So the balance between what they sense as
dangers and what they sense as safeties.
355
:So he calls them dangers
in me and safeties in me.
356
:So Dims and Sims, so this Pro Exometer
looks at a few broad range of categories
357
:and helps people decide what in
that category is a danger to them,
358
:and what do they sense as safety.
359
:So for things you hear, see, taste,
touch, or smell, a dim or a danger in
360
:me might be looking at an X-ray that
might feel harmful or as a potential
361
:threat to you compared to a safety
in me or a sim, a gentle massage.
362
:Things you do.
363
:A danger in me might be staying home
all the time and a safety in me might be
364
:gentle exercise or laughing with a friend.
365
:Things you say, A danger in me or a dim.
366
:I have pain everywhere.
367
:A safety in me or a sim is I believe
my brain and body will heal things
368
:you think and believe a danger in me.
369
:Pain is forever.
370
:Insurance is out to get me a safety in me.
371
:I believe my brain and body
will heal and my faith.
372
: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.