Episode 72: Rewiring the Pain Response: How the Brain, Body, and Mind Work Together

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode of the Beyond Pain podcast, hosts Joe Gambino and Joe LaVacca delve into the complex nature of pain, emphasizing the mind-body connection and the importance of compassionate communication in healthcare. 

They discuss how pain is often misunderstood as being 'all in your head' and explore the implications of this perspective on patient care. The conversation highlights the significance of listening to patients, understanding their experiences, and providing them with options to empower their healing process. 

Through a compassionate approach, the hosts aim to restore hope and clarity for those struggling with chronic pain.

Takeaways

• Pain is a perception and an emotion.
• The words we use in healthcare have a significant impact.
• Compassion is essential in managing pain effectively.
• Pain can be both in the mind and the body.
• Listening to patients is crucial for effective treatment.
• There are often unseen pathways to pain that imaging cannot detect.
• Empowering patients with options can restore hope.
• Pain sensitivity can increase over time due to prolonged stress.
• It's important to educate patients about their pain responses.
• Healthcare providers should avoid disempowering language. 

Transcript

Joe Gambino (00:44)
Welcome back to the Beyond Pain podcast. I am one of your hosts Joe Gambino and I am here with our other host Joe LaVacca You can find us on Instagram at Joe Gambino DPT for myself at strength and motion underscore PT for Lavaca over there podcast on Instagram Beyond Pain podcast and on YouTube cups of Joe underscore PT. Welcome back.

Joe LaVacca (01:06)
Good to be back. I'm excited to chat with you again. I am obviously a big fan of the topic that we're going to be speaking of. So it comes up constantly and I'm sure we've touched on it a little bit, but it'll be nice to give it its own ⁓ space, Mr. Gambino. So good job picking the topic today. And the topic is, is pain in your head.

Joe Gambino (01:07)
Yes.

Joe LaVacca (01:33)
And I think this is definitely, especially with the clients that we have found ourselves, you know, more and more connected to, probably people who have gone to other clinicians, have been struggling with persistent or problematic pain for some time. And then sooner or later, you're going to meet a healthcare provider who probably just gets frustrated. And we've all been there and I've been there and I'm sure I'll be there again.

I do my best to limit my frustration, but it still happens. And I think when I hear stories from clients and they've been told this idea that pain is all in their head, it usually comes up after, Hey, well, nothing was working. Injections didn't help the surgery didn't do this. My exercises weren't going good. And then I have a healthcare provider blurt out, well, this is all in your head and we have to kind of, you know, either get past it or ignore it.

Joe Gambino (02:14)
Mm-hmm.

Joe LaVacca (02:28)
keep moving forward in some way shape or form. So when you've had that happen, what are your first thoughts? How do you try to handle it?

Joe Gambino (02:36)
Yeah, it's, it's, think a frustrating process because I think people in healthcare, doctors, physical therapists, chiropractors, you name it. We, don't, I don't know if providers don't understand the impact our words have, but the things that we say, especially when someone's coming to us in a place of vulnerability, they have a lot of pain. They're not sure what to do.

There's a lot of uncertainty for them that saying something like, there's nothing wrong with you. The imaging is clear. There's, you know, we can't reproduce your pain in the clinic, whatever it is. And, you know, movement looks okay. Like it means the pain is in your head, right? And when you start to tell somebody that there's nothing wrong with you, when they come in and they're telling you that they've had pain for all this time.

Well, now you're not listening to that person. The patient is going to feel misunderstood. They're going to feel misheard. It's going to create more confusion. And then you're telling them that it's in their head. And now they're like, well, you know, some people might think, it? Um, you know, I've had people come to me and they're like, Oh, well, I don't know if the pain's all in my head. I'm like, well, I mean, the nervous system can kind of like,

Determine that your alarm system it can ring off a bell and that can be for a number of different reasons and it may not be anything specific to what you've done or or an actual Diagnose II or something that pops up on imaging right you can have a escalated alarm system or more sensitive alarm system and then when people are telling them this and It can just make that alarm system even more sensitive, right? So frustrating to hear I think that is a

you know, from that that person or that provider standpoint, I think they're doing a disservice to somebody by not addressing or listening. Right. Like I think it goes a long way with us just listening to that person to educate that person and, you know, kind of almost be on their team versus like you just put a divide here. Right. Like I think once you say something like that, there's a zero percent chance that you're to be able to help them from there.

Joe LaVacca (04:36)
Yeah, it definitely gets a lot harder when you break that trust for sure. I think it's, you know, the way that we've talked about pain or the way that I've sort of expressed it is, you know, the way that it makes the most sense to me is to sort of consider it an emotion, right? Or just a perception. So yes, it absolutely is in your head. And let's just talk about the podcast for a second. And whoever's listening to the podcast right now, where is my voice?

Is my voice coming from the speaker? Is my voice in your ear? Is my voice in your head? And the answer is yes, it's coming out of the speaker into your ear and your brain is processing it. So yes, my voice right now is existing in three different places or maybe four or five, six different places all at once. So while pain is in your head, it is also in your body. It is a part of the tissues that are telling you they hurt.

So if your elbow hurts or your back hurts, but your x-ray is clean, your MRI is clean, the thing I tell people is, well, just because we can't see a pathway doesn't mean that one isn't there. We just might not have the ability to detect it with an x-ray or an MRI. And this is typically where I would tell them a little bit about, you know, feeling sick. You can go get an x-ray or an MRI when you have a cold, and even though your head hurts or your chest is maybe congested,

your X-ray and your MRI are gonna be completely clear, right? We can't see your sickness, but we know that you are actually sick. So how do we handle it? Well, just like what you said, we listen to you, we give you some advice, we help you with maybe some lifestyle modifications, things that are gonna make you feel better, right? Maybe it's eating soup, maybe it's going to bed early, maybe it's taking a day off from work. So we do the same things as physical therapists when we're listening to these people in pain.

Hey, I'm understanding you. Here's what we can do as far as movement or exercise goes. Here's what we can do to maybe help you with your sleep hygiene. And here's just some things that maybe make you feel better. Maybe it's the foam roller, maybe it's the heat, maybe it's the ice, maybe it's the Advil, the Tylenol, whatever the case is. But just because we can't see something, I don't think we should be not believing or not listening to our clients.

Instead, trying to work with ways that will help them make sense of things rather than just throw out the sort of ending result of a it's in your head, get over it. Cause that's typically the connotation is that, Hey, I can't help you unless you do something, which is probably true for the most part, but they are coming to us to be that something to be that guy. Right. And I think that that's.

sort of the way I've tried to explain it ⁓ more recently when people feel kind of a little bit stuck. And that's sort of what helped me, I guess, repair some of these relationships again.

Joe Gambino (07:34)
Yeah, I like that. I mean, I think it's a really great way to kind of break that down. And I think I kind of always from like a education point and I don't have the ability to maybe I do have the ability to draw here. I just don't know how. But, know, the envelope of function just kind of having like that graph of, you know, like pain and, you know, time and essence, right? Where

You know, you could have like a large level of force, so to speak, right. And, know, that breaks your arm, right. You fell off a ladder and landed on your arm and you broke it, right. It's like a large level of force that kind of goes in there. And then, you know, you can also have these like, you know, longer duration forces, like sitting for a long period of time, that kind of build up. We all have this kind of like neurological safe zone, right? If we walk, we're going be generally okay, right? That's not really high level.

If we have a certain amount of force that acts on our body, if we do that way too often, right? That can push off our nervous system, right? So I started to kind of give this educational standpoint. The more you spend time in this zone where, you know, we're above this kind of like, you know, there's a gap right between our neurological level of what our body feels safe and what the anatomical breaking point where I'm going to break my wrist is. And if we spend a bunch of time in that area there, right?

then pain can start to happen. And when pain starts to happen, that initial threshold starts to come down. So now forces that our body feels safe with are less and less and less over time if we don't kind of address these things. So I think that also kind of helps people understand like, there's an actual explanation for why my pain is so sensitive a little bit and things like that. And now we say, well, what we do now is same way we were strength training somebody in a case of things were normal.

We want to train you as close to that neurological safe zone, right? We want to like, if we're as close to that as possible without going over, we're going to avoid overtraining. We're going to be able to create that strength stimulus. We're going to be able to take that level of whatever it was and move it higher, right? And that builds robustness and helps you feel like you're more resilient. And now when we're injured, all we're doing is we're taking whatever that current threshold is. you can walk for, you can walk, but when you start to run for.

30, you know, a half a mile, your pain starts to come on. Well, now we can train you at 20 minutes, which gets us close to that barrier. We can give you a running stimulus and over time that's going to help your body feel more comfortable there. And that threshold should come up. So now maybe you can run for 40, you know, three quarters of a mile or a mile without pain. And now we can bump you up and say, let's run at three quarters of a mile and then a mile. Right. And so we can get you back to that running distance that you want. So I think that also kind of gives them a kind of a more of a

you know, like a concrete, not really concrete, but like a more concrete example. This is kind of what's happened. This is what their approach looks like. And I think that starts to help people kind of process this better because otherwise, you know, when we just say, ⁓ it's a nervous system response, it's, you're, know, there's still a lot of uncertainty. And I think that giving somebody as much certainty as possible around it can really help them find that path forward, so to speak.

Joe LaVacca (10:34)
Yeah. And what you and me and what you were just highlighting and sounded to me, it's like compassion, right? You know, you, just said that being told pain is all in your head is, you know, kind of disempowering to some degree. It kind of maybe makes you lose, you know, a path forward or, what do I do if it's all in my head? I mean, I'm not creating the pain. I don't want it to be there. I'm not trying to make myself miserable. And then you just lay out this wonderful idea of.

Hey, well, this is what we can do. Right. And then that's compassion that's going to restore hope. think coming back to that idea though of, ⁓ and I think you said it before, you know, the words that we speak have impact. I think we so often highlight placebo, in the medical field. And that's basically using an inactive substance or an inactive treatment to cure or alleviate people's symptoms.

Right and that's what a placebo does it doesn't cure disease, but it does really help with symptoms So if a nocebo or a now actively harmful sort of like idea ingredient or word is gonna be thrown into the mix Well, okay, maybe it doesn't necessarily make the pain worse but it will make suffering and potentially all those other factors that we've talked about coming along with it a lot

more difficult to manage. Cause now I have this six, seven, eight, whatever number out of 10 pain. ⁓ and it's all in my head. So there's nothing that Joe, me no Joe Lovaca or any doctor can do to help me because this is my fault. Right. And when you take that blame on yourself, it makes it a lot harder to take action. So I think that's why we work so hard and you know, we do the podcast and we try to

Joe Gambino (12:13)
Hmm.

Joe LaVacca (12:25)
give out as much good information as possible to people because we've seen it and we've seen it really harm people's outcomes and prevent them from being where they want to be. So if you've been told pain is in your head, rejoice, because that is true. It is also in your body. It is also in your mind. You know, because when we say head, I mean, are we saying the brain or because that's a very specific structure? Are we saying the mind because that's a construct or

Just the whole head, right? mean, like now even more semantics have to come up into like, what do we actually mean by head? Right? Cause I also can't touch the mind because the mind is an idea, right? So your mind is your body, your body is your mind, your brain is your nervous system, your nervous system is your brain. There is no separating all of these things. And I think the more people can learn that then I think it becomes.

many options do we have to work with you? And then you could tell me which options haven't worked and then you just using that running example, you can't run for 30 minutes, okay that's no problem. Has anyone ever told you to run six minutes ⁓ five times? Has anyone ever told you to just do intervals up to 20? Has anyone ever told you to split your workout into two workouts? I mean and just right there you're giving people options again. ⁓ So I think that's what you really highlighted.

Joe Gambino (13:47)
Yeah, I like that. think what you're the you're trying to say here is, you can't, I don't think you, can't think you're weighing the pain, right? It's not like a, you know, my back, I'm just thinking about my back and I'm making the pain happen. Right. And you can't do the opposite, right? You can't just like, well, well, it's in my head. Right. So I don't have pain anymore. And it goes away. It's a lot more complicated than that. And, know, technically it's in there somewhere, right. But it's not of any fault of your own. It's, it's, it's a response more than, than a thought.

Joe LaVacca (13:55)
Mm-hmm.

Joe Gambino (14:16)
so to speak.

Joe LaVacca (14:17)
Yeah, for sure. 100%.

Joe Gambino (14:19)
You got anything else for us, Joy Boy?

Joe LaVacca (14:20)
No, I think that was it. I know we wanted to try to, you know, keep this one a little shorter and sweeter. And I think we both, ⁓ hit the points that I was hoping that we would touch on. So I hope it was helpful for everyone. Listeners, we love you. Joe, I love you. And don't forget to come back. double love. Don't forget to come back next week for another exciting episode of the Beyond Pain podcast.

Joe Gambino (14:32)
Love it.

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