Chronic Pain and the Brain with Dr. Jeff Axelbank

I’ve been experiencing chronic pain in my arm very recently which I attributed to overuse from playing tennis.  This conversation got me really thinking about what this injury could mean on a deeper level.  In this episode my expert guest and I explore: 

• Can negative thoughts such as “unspeakable anger" manifest as pain in our bodies?
• Why is it that two people can show the same exact damage from an injury on an MRI but feel the pain in two very different ways?
• What are some steps we can take to help our chronic pain go away?   
• Can working through our past and present anger prevent chronic pain from emerging?

My guest for this episode, Dr. Jeff Axelbank, is a psychologist and expert on chronic pain.  Dr. Axelbank is a recipient of the New Jersey Psychological Association (NJPA) Psychologist of the Year Award and the Rutgers University Graduate School of Applied and Professional Psychology (GSAPP) Peterson Prize for outstanding contributions to professional psychology.    Learn more about his work and practice at www.jeffreyaxelbankpsyd.com.   Dr. Axelbank practices the Sarno approach to addressing chronic pain, of which more information can be found at www.tmswiki.org. 

An additional “fun fact’ about chronic pain that I learned while preparing this podcast but didn’t have a chance to mention was the relationship between norepinephrine and pain.  Norepinephrine is a neurotransmitter we produce in the brain that regulates our mood.  Certain  antidepressant medications  work by accessing  more norepinephrine. Norepinephrine travels from the brain  and through the body and inhibits pain in areas where it’s not useful for us to have pain, such as the stomach, joints and back.  When the body is constantly shooting messages of pain to the brain this is a stressor.  If, as a result of stress, we produce less norepinephrine to be distributed to the body, we will feel more pain in our back, joints and stomach.  This explains why antidepressant drugs like SNRIs that attempt to access more norepinephrine can be helpful for syndromes which cause joint pain and chronic pain, such as in Fibromyalgia.  

This episode is dedicated to Ginnie’s House, a non profit organization which provides100% free therapy for abused children. Learn more at GinniesHouse.org.  

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Transcript

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SPEAKER_00 0:04

To love learning. To laugh. To love. To be love. To see beauty. To understand.

SPEAKER_01 0:13

To bring grace to the things that matter most.

SPEAKER_00 0:17

This is Psychology America with Dr. Alexandra. Welcome to my show. For every life stage, we have questions. Let's enhance our lives together as we explore the things that matter most. Hello, listeners. The intention of this podcast is to help people that have chronic pain or people that know someone who has chronic pain. But in addition, it's to prevent chronic pain because we are going to learn from our expert about how our repressed emotions, especially negative emotions, can manifest in our body, can lead to pain in our body. And I have most definitely experienced this myself and seen this in my practice and in those that I love. We have with us Dr. Jeff Axelbank, psychologist, who is an expert on chronic pain, a recipient of the NJPA Psychologist of the Year Award, and also the Rutgers University Graduate School of Applied and Professional Psychology Peterson Prize for outstanding contributions to professional psychology. Congratulations, Jeff.

SPEAKER_02 1:40

Thank you so much.

SPEAKER_00 1:42

Jeff, you had a story to tell about a train trip that you missed.

SPEAKER_02 1:47

Yeah, uh the train trip I was on, it was the station at the end of the train trip that I missed. Um this goes back about 10 years when my daughter was a new driver. She was 16, and she was just so excited that I asked her to pick me up at the train station. Um and um so we made this arrangement that I was gonna be on such and such a train at such and such a time, and she was gonna pick me up. She was real excited. And I'm on the train coming back from New York, and I got very engrossed in something I was reading. And so I missed the stop. And I realized it like as the doors were closing of the train, and I, oh my God, what am I gonna do? And so I called her up and I said, Oh, you know, you're gonna have to drive down the rail line to the next stop and I'll meet you there. So she was all excited because this meant she could drive even further, you know, and longer. And um, so uh at the next stop, I made sure to get up, and I was in like the last car of the train, and I had missed the announcement that said, if you're in the last two cars, please walk up because those two cars won't make the platform. And so I waited at the door for the door to open, and it never opened, and the train started pulling out of the station, and I was like, So I missed the second one. So now I'm calling her again and saying, Now meet me in Princeton, which was the next stop, which was really much further. And again, she was very excited because now she got to meet me in Princeton, and also her father was had screwed up, and and she was also excited about that.

SPEAKER_00 3:23

You guys must have been laughing.

SPEAKER_02 3:25

We were we were laughing. I was I was a little embarrassed. Um but when I got to Princeton, I don't know if you're familiar with the Princeton train station, but there's this um uh second train, you get off the main New Jersey transit train, and then there's this dinky train, they call it the Dinky, and it goes from Princeton Junction into Princeton Town, and I didn't know where it was, and so I got off the train in Princeton and I'm like looking around where where is this dinky? And as I'm looking, I see the dinky pulling away. So I missed that one too. So it's like three in a row. And um, then I had to call her again.

SPEAKER_00 4:08

How did she do?

SPEAKER_02 4:09

She so we ended up meeting uh I had to call it taxi, and uh got a taxi into Princeton and met her at a at a coffee shop in Princeton, and uh it all worked out okay, but it was uh it's gone on a sort of a legendary story in our family about uh when when dad missed three stops on the train.

SPEAKER_00 4:32

Yeah, it was worth it for the story that you got to keep forever.

SPEAKER_02 4:35

Exactly, exactly. And she just uh, you know, again, loved the extra driving she got to do.

SPEAKER_00 4:39

Aaron Ross Powell My daughter is 16 and she has her permit to learn how to drive. So we've done it once and there was a lot of laughing and this topic today is very relevant also given the opioid crisis that we have here in the United States.

SPEAKER_02 5:00

Yeah, often uh opioid use begins with people who have chronic chronic pain and they're trying to alleviate that, and then the the opioid epidemic or the opioid use uh piles on an extra added uh complication of addiction. And so part of why chronic pain and chronic pain treatment is so important is to try to avoid uh opioid use in the first place, and also it makes it easier to break the addiction if there's actually a way to deal with the chronic pain other than opioids.

SPEAKER_00 5:34

Today we're gonna talk about different ways to deal with chronic pain that are natural. And it certainly touches a lot of families, right in my own community. We in my own county, we had 38 suspected deaths from opioids last year. Jeff, as I read about chronic pain, I was really fascinated to learn about how it works in our body. I I want to begin with a story about my friend Jeanette, who I was chatting with her about this upcoming podcast, and she told me a story about her chronic pain. And just before coming over here to Ponderosa Studios, I said, Jeanette, can you tell me that story again so I get it right? So she texted it to me. I'm gonna read you her text, Jeff.

SPEAKER_02 6:25

Great.

SPEAKER_00 6:26

So here it is. Jeanette. When I was about 20 years old, I was cleaning houses and self-employed. My parents were selling the house that I grew up in, and I developed severe back pain that went down my legs, and I spent so much time in modes of anxiety and panic attacks, fearing that I would no longer be able to clean houses, and I had nowhere to live, and I hadn't finished college. My mother, whom I wasn't particularly in tune with during that time, gave me a book and suggested I focus on a connection between my anxiety and my back pain. My mother was a dean of students at a community college at the time, and she said these years were very difficult for many kids leaving their home and feeling like they had no financial support and nowhere to turn. I was pretty hostile and dismissed her, and I got an MRI. When the doctor looked at the MRI, he pointed out that yes, I did have a disc that was herniating, but that this was very normal for people my age, and that the pain I was describing to him was in no way related to the disc he was discussing. I'd really been focused on the herniated discs in general, and I'd heard they were these horrible, uncontrollable causes of pain, and he backed up my mother and suggested that I go about my life and look into some muscle relaxing techniques and deep breathing. So I picked up the book that my mom suggested and started to really make the connection between when I was in physical pain versus when I was in emotional pain. Pretty much as soon as I read this book, combined with getting the clearance from a professional, my pain disappeared. It's been too long to remember if it disappeared overnight, but it disappeared pretty quickly. So that was her text. Okay.

SPEAKER_02 8:46

And it actually is very familiar because it kind of parallels my own story um and how I got into chronic pain care in the f in the first place. Um so um uh this goes back to uh 2002. So uh in fact it involves the daughter who was a new driver in in the uh the other story that I told. Um so um I had been through my um pretty much since an adolescent, I had had episodic uh back pain and neck pain, and you know, my mother used to tell me, Oh, it's because you slept wrong, you must have uh got a crick in your neck overnight, and and I went to chiropractors and and uh you know, sometimes heat and sometimes cold. That's something that, you know, people uh there's a kind of controversy about do you do heat or do you do you do cold?

SPEAKER_00 9:40

Yes.

SPEAKER_02 9:40

And um but it was sort of a chronic episodic uh problem that I had. And then in 2002, in the fall of 2002, I had what I call the mother of all back spasms, and I was really laid up and I went to uh chiropractor f you know, like three times a week, and I did, you know, my my um heat and cold, uh depending on how I was feeling, and um it didn't work, and in fact it seemed to get worse, and I s I started to get shared.

SPEAKER_00 10:12

I've had that where it spreads. You get a spasm in one part of your back, and then it spreads and spreads and spreads, takes up your whole back.

SPEAKER_02 10:20

And then I had this this scary thing where I had this shooting pain going down my arm, and it was a different kind of a tingly, very I guess nerve pain.

SPEAKER_00 10:29

Yes.

SPEAKER_02 10:29

Um and I went to my doctor and he um had me take off my shirt and he s said with great concern, Oh, you know, looks like your back muscles are already atrophying. Um we should go get an you know an MRI. And I got the MRI and it showed like um three discs herniated and um protrusions. Um and uh it was very scary. And he warned me that if I wasn't careful, I might lose the use of my arm because he'd seen that happen.

SPEAKER_00 11:00

That's terrifying.

SPEAKER_02 11:01

It was pretty terrifying. And uh he warned me not to uh uh swim because if you do the breaststroke, it puts pressure on your neck, and if you do the freestyle of crawl, you're turning your head, and that puts pressure on your neck. And also I was a pretty avid bicyclist, and I used I shouldn't ride the bicycle because that was gonna put my my neck uh out of out of whack and be careful about running because uh that's too jarring on the spine. And um I should do muscle relaxance and chiropractic and physical therapy and non-steroidal anti-inflammatory. And I did all of that because I'm a good boy, and uh uh none of it helped. And it was went on for a couple of months.

SPEAKER_00 11:48

Mm-hmm. And this is uh before you continue, reminding me of what happens to a lot of people with chronic pain because it leads them to stop activities.

SPEAKER_02 11:57

Exactly.

SPEAKER_00 11:58

But go on.

SPEAKER_02 11:59

Yeah. So uh uh about two months in, my sister-in-law calls me and she says, So, Jeff, uh, how are you doing? And I said, I'm doing okay. And she says, How can you say you're doing okay when and I thought she was gonna say, how can you say you're doing okay when you're in such pain? But what she said was, how can you say you're doing okay when your daughter just got diagnosed with type 1 diabetes? And it sort of stopped me right in my tracks. And I was like, wait, what do you what do you mean? And she said, Well, uh your mind and your body are connected. Which seems now like such an such an obvious thing. But I said, Yeah, but but I but I have the MRI, and I I can look at the the image on the MRI. It's so clear. These her these discs are clearly, you know, protruding and and um ruptured and and um herniated. And she said, Well, that's not what's causing your pain. And she sent me uh two books written by Dr. John Sarno, um, one called Um Healing Healing Back Pain, and the other is called the Mind-Body Connection. And um I read those books and I was a little skeptical at first because I had this MRI that showed so clearly what was wrong with me. But it started to make sense because Dr. Sarno identifies some um personality traits that tend to um correlate with these kind of problems, and it's about uh people who l like to do good. I said before I'm a good boy, and uh that's people who work very hard at being good and taking care of other people and uh are perfectionists, um tend to uh develop problems like this.

SPEAKER_00 13:48

They are more likely?

SPEAKER_02 13:50

More likely, yep. Uh Dr. Sarner calls it the the the type T personality. Um and uh he coined this um syndrome, uh the tension myoneuro syndrome, and um basically tension having to do with s with stress and myo having to do with muscles and neuro having to do with neurons. Um and it's a syndrome, and one of the things he says that's so wonderful about his books that this is basically uh normal for healthy people. There's it's uh part of the universal human condition, there's nothing to be embarrassed or ashamed about. And he talks about in the book his own his own struggles with with um this syndrome. And there are three pillars to what he recommends. He recommends, first of all, think psychological, not physical. In other words, it's not what you lifted or how you moved or or um you know sleeping wrong, but uh think psychological, what's going on in your life at this at this time. That's number one. Number two is um stop all medical treatments. And number three is resume normal activities as soon as possible. And so I took those three pillars and I said, hmm, um I can see thinking psychological because certainly I just had this pretty major thing happen in my family. I was very upset about m my daughter's diagnosis with diabetes at age age 10 and worried about her and worried about that and how we were going to manage this. And um, I could see that could be upsetting. And uh then I thought about, well, stopping the medical treatments. That was a little tougher because I thought I was depending on these things to relieve my pain. Um but I I think I let go of the muscle relaxants first and the chiropractic and the physical therapy, and um I realized I wasn't getting worse when I let go of those those things. And um, so then the third pillar was resuming normal activities, and the first thing I went back to was my swimming. And I remember the first time I dove into the pool, it was excruciating pain. But over the course of even that first day swimming, the pain got less and less the more I moved. Um and um over the next two weeks, the pain basically went away entirely. And um I would since then, so this now is um eight um 16 years later, I have had um no limitations on my activities. I run, I rake leaves, I shovel snow, I I bike, I ski, I swim, um, and really have had no problems at all.

SPEAKER_00 16:51

Aaron Powell It's remarkable. As I hear it, I have to tell you, I had a similar reaction to what you had about the stop medical treatment part because I do have a respect for the progress that we've made in science and in medicine.

SPEAKER_02 17:07

So I don't know if there's a part of me that's protecting um the work uh, you know, the body of work of all of the Yeah, it's very interesting because I think that um the medical community has kind of missed the boat in this particular area. And um, you know, we can speculate about why that might be. Um and there's probably multiple reasons, but um it's um kind of like we've missed the boat, not uh because of evidence, but in spite of evidence, because there's there's a lot of evidence that the mind and the body are connected. There's a lot of evidence that there's very little correlation between what shows up on an MRI or in um scans of different types and people's experience of pain. Um I did find a study on that.

SPEAKER_00 18:02

Yeah, there was a seven-year study um looking at you know what did MRIs find and what did they find seven years later, and how did that correlate with actual pain? And it it didn't.

SPEAKER_02 18:17

Yeah, the severity of what uh showed up on the MRI does not correlate with the severity of pain. There's a there's a classic study of um uh I think it was 92 people who did not have pain, and they gave those people MRIs, and I think it was something like 60 percent or so, 65 percent of the people with no pain had significant herniations, uh ruptured discs. Um and so again, uh it um even though they had those structural anomalies, um they did not have pain. So one of the things uh uh Dr. Sarno says is these are normal abnormalities.

SPEAKER_00 19:03

Uh yeah. Yeah, so those a as my friend Jeanette had.

SPEAKER_02 19:09

Yeah, exactly, exactly. So yeah, the other thing um uh about Jeanette's story that rang a bell is how um sometimes just knowledge it can be the cure. Um just knowing that it's not a physical problem that's causing your pain um can release it. Uh and uh you know, as you said, resuming normal activities then can reinforce the idea that it's not the physical um uh activity that's uh or the physical problem that's causing the pain.

unknown 19:48

Yeah.

SPEAKER_00 19:49

As I did the research into this area, I was fascinated with it, Jeff. Um first of all, learning that pain can come from three different areas of our body, meaning there's the peripheral area where you might touch something and get burned, right? So the pain can start there and then it leads to your spinal cord, and the pain can also begin and end from there, not necessarily from the peripheral areas, and then it goes up into your brain and splits into two different directions where um it touches the somatosensory cortex of your brain, which is asking the question, how much tissue damage is there and how big is this? And then it also goes up to the emotional centers of your brain, which are going to decide what does this feel like and how do I interpret this? And then when those two things combine, the ouch comes out.

SPEAKER_02 20:54

Right. You know, one of the things that I've that I've learned is that all pain really sort of um r uh resides in the brain or in the mind, whether it's acute pain from when you sprain an ankle or um chronic pain that you've had for years and years, that it's the brain's interpretation of signals that it's getting. Um there's some great stories. There's a story of um uh I think it was a soldier who stepped on a spike, and the spike went through his foot, and he passed out from the pain. It was excruciating, and they brought him to the hospital and they cut off his shoe, and they found that actually the spike went between his toes and didn't even go through his foot at all. But his brain interpreted the brain looked down and and saw the spike coming out of his shoe, and he probably felt a little bit of something on the side of his toes. And um basically there was there was no there was no injury, and yet he had experienced such uh you know. Excruciating pain that he passed out. The other thing that's so interesting about what you said about the two different regions of the brain is that a lot of times chronic pain originates as acute pain, like someone will be in a car accident, let's say, and and have some injury. And long past the time where the physical injury heals, the person will continue to have pain. And that's like a shift from acute pain to a chronic pain. And what you find, what they have found is when they do functional MRIs of the brain and they see what part of the brain lights up from the pain, during the acute pain phase, it's in uh the part of the brain that is sensing uh pain from from the body, and they actually can track the movement of the part of the brain that lights up as it shifts to chronic pain and it shifts to the emotional uh centers of the brain. So it really is another piece of evidence that chronic pain is is about emotions. Uh it's really a powerful finding.

SPEAKER_00 23:07

It's so powerful. And as I studied it, I was learning that when you can sometimes if we don't treat pain, it can become chronic as well. And all of that firing in the brain can actually make the prefrontal cortex shrink. And you can correct me because I I'm more new to this information than you are, but my understanding is that it can lead to disruption in the norepinephrine from the brain coming down. So go ahead.

SPEAKER_02 23:45

Yeah. The way I the way I think about it is about neural pathways. So, like for instance, when you ride a bike, when you learn to ride a bike, you are learning, you're teaching your nerves to fire in a certain sequence to uh you know contract your quadricep muscles and then your hamstrings on either side and they kind of alternate to make the pedals go around and around, and then you you've learned it, and your neural pathway is a kind of set. And similarly, when you have chronic pain, the neural pathways that that um you know send the signals from, say, your your back or your neck into your spinal column and then up your spinal column into your brain. That there's kind of a it gets to be a habit for your for your neurons.

SPEAKER_00 24:31

Yes.

SPEAKER_02 24:32

And and so um basically, you know, the treatment ends up being ways of breaking those neural pathways and relearning new ones. Um and that's partly why resuming n normal activity is so important, because that will help break the old neural pathways. Because if you if you have pain and you stop moving, then that neural pathway of the pain just keeps firing and firing and firing, and it gets more solidified. Kind of like if you're if you're taking a walk in the woods and you keep walking on the same path, eventually that path is is a path.

SPEAKER_00 25:09

Right.

SPEAKER_02 25:10

Uh and if you don't, if you stop walking on the path, then it starts to That's all that's left, too. Uh right. And then if you stop walking on that path, it starts to grow back and then it's no longer a path. So similarly, if you have pain and you resume your normal activities, then eventually that neural pathway will go away, the one that was causing your pain.

SPEAKER_00 25:34

What do you think about the gate theory of pain, where the idea that there's almost like a master switch that can open it up and amplify it or create it.

SPEAKER_02 25:49

You know, honestly, it's not um a theory that I'm that familiar with.

SPEAKER_00 25:54

So Okay. It's um it's the idea that from the input of chronic pain, this switch is opened at the spinal cord level. And it can be open and it can be closed. And some people would say that negative thoughts could even amplify it.

SPEAKER_02 26:14

Right. Well, it's interesting about negative thoughts. One of um the the pillars or kind of um uh foundations of uh Dr. Sarno's theory, which I've seen over and over again, is that the pain acts as a distraction from negative thoughts. And so, you know, people whose uh lives are disrupted by chronic pain are often um preoccupied with their pain. They're worried about your your friend Jeanette talking about um being a being afraid that it was gonna um wreck her life and her future and what what was she gonna do? This is so so common. And people will um orient their whole lives around avoiding the pain, dealing with the pain, compensating for the pain. But in doing so, they are distracting themselves from from other issues. Um and so, for instance, in your friend's case, she was distracting herself from the change in her life that was happening with her parents selling her house, which was very upsetting to her, um I'm sure. For me, in my in my case, um I was my pain was a great distraction from this very upsetting thought about my daughter getting diagnosed with this chronic illness, which was was going to be an issue.

SPEAKER_00 27:36

It's the concept that you would rather not think about that. Aaron Powell Exactly. You don't want to think about that. So you you would focus on this pain instead, which is easier to deal with.

SPEAKER_02 27:48

Right. And there's there's not as much conflict about. Um this is uh something that I see over and over in my patients, that um sometimes the thing you don't want to think about is a feeling that you have that you feel is unex unacceptable.

SPEAKER_00 28:04

Unacceptable to talk about or to face.

SPEAKER_02 28:06

Right. Right. Like um uh one of my patients I'm thinking about, he uh he developed chronic pain right after the birth of his first child. And it was uh affected you know everything about his family life and his ability to care for the child and all that. And I said to him, you know, I think I think that's why you have chronic pain. And he said, Why? What do you mean? I said, I think I think you hate your son. And he said, No, of course. I love my son. What do you mean? I said, Well, I know you love your son, I know that. But I also think that a part of you, it's not all of you, but a part of you is kind of aware that you are uh now have to sacrifice yourself. And maybe there's a part of you that's kind of angry about that, and you have an inner conflict about that. And I think you know, all of us as parents have had times where we, you know, we just uh we're sick and tired of of of parenting. And if and that's a perfectly normal um emotion to have. But if you find that emotion unacceptable, that it's not okay to have sometimes or a part of yourself that is angry with your children or angry with your needs having to be sacrificed, then um pain is a great way to resolve that that that that conflict. But if you can accept the conflict or accept these feelings that you have, then you don't need the pain as you know as a distraction.

SPEAKER_00 29:38

It's really it's fascinating.

SPEAKER_02 29:41

Yeah. And I've again I've seen that, you know, over and over again. Um and I've seen some really dramatic, really dramatic um examples. Um I'm thinking of a uh actually this was a uh another psychologist I know.

SPEAKER_00 29:57

Yes.

SPEAKER_02 29:58

Who when he was uh 22 years old, he was um healthy, healthy young man. And um one day he woke up and he was exhausted and um started over the over a few months uh pain all over his body, and he was diagnosed with uh chronic fatigue and fibromyalgia and Epstein Barr virus. Um and uh he actually um told me that he kept track that he saw over 30 doctors over a couple of years and uh 30 30 doctors of various different specialties and and nothing was really helping. And he was actually at the point where he was transported in a wheelchair. He was confined to a wheelchair for uh for quite a while. And then someone um I guess I think it was one of his parents, uh found uh Dr. Sarno's book and uh gave it to him. And over time, over a couple of weeks or a couple of months, I don't I don't remember the time frame, he got out of the wheelchair and he started to walk more. And um now I know him now. He's uh he's perfectly mobile, uh active guy. He's got children of his of his own now. And he would say that, you know, part of what was going on was he was too uh perfectionistic, too uh demanding of him of him himself. He couldn't accept some of his um uh some of his weaknesses and his imperfections, and once he accepted those and uh thought psychologically rather than physically and didn't keep pursuing the medical um uh solutions, which weren't helping anyway, he was able to lick it. Uh it's a great great answer.

SPEAKER_00 31:52

Did he do that after just reading the book, or did he do that through psychotherapy? Do you remember?

SPEAKER_02 31:58

Well, I think uh this goes to another question. Um some people get better just by reading one of one of the books. And some people need to go to a doctor who either is, you know, familiar with or trained trained by Dr. Sarno. And um there are some lectures which um doctors like that can do, and some people get get help with that, and some people need to take it a further step and go for th for th for therapy. And um it's uh it's pretty variable. And you know, people ask me, you know, how long will this take? And I say, well, let's not worry about how long it's gonna take. Let's just get down to work on it. And um usually when you take that that attitude and you take the pressure, the time pressure off yourself, that actually makes things go faster than if you uh if you pressure yourself.

SPEAKER_00 32:54

The good news is that I do think a lot of medicine is getting this as far as the value of integrating psychology into medicine. And once a week I work in a medical clinic that uh brings in behavioral health through integrated psychology. And we are right there with the medical doctors checking it out with patients to s to check out the psychological component of how they're feeling. So they they see it in this clinic.

SPEAKER_02 33:25

And it also helps the patient. It's kind of a one-stop shopping uh experience too.

SPEAKER_00 33:30

Yes, it is that way.

SPEAKER_02 33:33

Yeah, yeah.

SPEAKER_00 33:34

How can this oh I want to ask you something else before I saw something about journaling.

SPEAKER_02 33:42

Yeah, it's really an interesting thing. Um uh I was talking just before about the the unacceptable emotions you may have. And um one of the things that we tell people is if you can write down some of the things that you you know you might want to avoid, or some of the things you're angry at.

SPEAKER_00 34:02

What do you think about the unspeakable things?

SPEAKER_02 34:04

The unspeakable things, exactly. And some people find it helpful to make an index card that's just like lists, you know. I'm angry at, you know, ABC. And some of these things may be from the present, things you're angry about now, your spouse, your kids, your work, uh your f your friends, but some of them also may be historical. Um I'm I'm angry at the way my parents treated me when I was young, or I'm angry at uh how I was abandoned, or I'm angry at um abuse that may have happened, physical abuse or sexual abuse, and um that when they get into pain, they get into a pain cycle, they can take out the index card and actually look at it and try to get in touch with the feeling that's the uns unspeakable or unfeelable feeling. And even though that may not be the most pleasant feeling, it doesn't tend to make the pain, the physical pain, go away. And so taking it a step further, a journaling uh is a way to get those feelings out and get them onto paper. And it's really remarkable that that that itself can can be healing and can make the pain reduce and even go away entirely.

SPEAKER_00 35:16

Aaron Powell I noticed that you are suggesting that they not only write it down, but they try to feel the feeling.

SPEAKER_02 35:23

Right. It's not this is a uh um a common um thing I hear from my patients. They say, Oh, I've I've already talked about that. I've I I know about those things. And I always say, well, you know them, but do you feel them? And and um usually not. They they maybe have told the story about the the abuse that happened, but they haven't really felt what it was like as as a child to go through that. And that that inner child lives on. Um sometimes say is, well, I don't want to live in the past, you know. But I counter and say, well, actually the past is living in you. And uh we need to find a way to heal that inner child uh and and that will actually, by healing the inner child, that will actually also make your pain go away.

SPEAKER_00 36:19

This could probably save a lot of money in the workplace.

SPEAKER_02 36:24

Aaron Powell Yeah, it's amazing. Um I don't know the numbers right offhand, but the cost of lost productivity, disability payments, uh health insurance costs skyrocketing, absenteeism in companies and corporations due to chronic pain is really astronomical. It's billions and billions of dollars. Um I know that it's the cost is um it exceeds the sum of of um all the other uh many of the other uh problems like cancer and and s and such. And so um I'm reminded your question reminds me of a s of a study that was done a few years ago at a um an a an airplane plant where they studied um they followed about 3,000 um workers who were at risk of having back problems. And over the course of the, you know, some number of years, I think it was three years that they s they studied them, um there was uh actually I have the paper right here. There was um 279 people reported having back pain. And they looked at those uh 279 people and saw, well, what were the physical aspects, the physical predictors that um correlated with their pain? And the only physical thing that correlated with their pain was having previous medical treatment. But what did correlate with their pain was job task satisfaction and emotional stress. And so it wasn't about how much they had lifted at work or whether their job was particularly physically demanding. It was more about their emotional satisfaction at work. And so, you know, there's an opportunity here for companies to reduce their costs by um looking at the emotional factors rather than the physical factors. Now, of course, you know, I mean, uh safety comes comes first, and you know, real injuries are you know, you don't want to drop a heavy item on your foot. I know you're not saying that. But but um but if you really look at at the numbers and the the correlations, it's really emotional factors. And so there's a there's a there's a huge opportunity for companies to to um take a look and prevent chronic pain and also nip it in the bud when it when it happens. Because as I said before, it is a kind of universal human uh experience.

SPEAKER_00 39:06

Aaron Ross Powell And I also remember there have been some studies of how chronic pain can catch in a society. It's not that it's catching, but that people will direct their pain to certain areas of the body in certain regions of the world.

SPEAKER_02 39:24

Aaron Ross Powell Yeah. As you said, it's not catching like in the sense of um um viral contagion or a bacteria, but there is definitely emotional contagion, and there's some really fascinating examples of that. Um for instance, one of my favorite uh things is that in Lithuania, the country of Lithuania, they do not have whiplash. And it's not like they don't have rear-end car accidents. That's pretty much you know happens anywhere in the world. But because it's not a thing that um, you know, is reimbursable by insurance and and uh and known by the medical establishment there, then people don't actually have whiplash. They don't get the pain. Whereas here, like for instance, in this country, you know, you know, you get rear-ended and people say, Oh, did you get whiplash? You know, and so that plants the seed in your brain, and that becomes like a contagious thought that that uh you know can happen. Uh another favorite uh cultural um thing that I that I I love to to uh tell people is in the U.S., if you have a back problem, they say, oh, you need a harder mattress. You need a you need a firm mattress. If you're in the UK and you have a uh uh problem with your back, they say, oh, you need a softer mattress. You need you need to really have a softer mattress. So, you know, I don't think this this the spines in um across the pond in the UK are any different from the spines here in the the U.S. uh we're all human human beings, but there's a cultural piece that that has grown up. Um so yeah, things are and I there we really are in an an epidemic now of chronic pain, and I think that is about what you're what you're talking about. It's kind of a catchy idea. You know, nowadays um, you know, it used to be that that ulcers were the were the the epidemic uh chronic condition. And um nowadays if you said to someone, you know, I have an ulcer, they'll think or they'll say to you, so you know, are you under stress? But if you have a back problem, they'll say, Oh, have you had an MRI? Um and hopefully we'll get to a point where people will say, um, you know, I have a you have a a back pain, and they'll say, well, what's going on in your own. What else is happening? Yeah, exactly.

SPEAKER_00 41:57

Jeff, I know that you have a mission to help people with chronic pain and to prevent chronic pain. Right. And I wonder how people can find you uh so that you can be of service.

SPEAKER_02 42:11

Yeah, well, I have a website. Um it's uh www.jeffreyaxelbankps y d dot com, and I'm gonna spell that out because that's kind of a mouthful. Uh J E F F R E Y A X E L B A N K, P as in Peter, S is in Sam, Y, D as in David.com. That's that's a lot of letters. Um and I know on um um the listening for this show you'll have that written out.

SPEAKER_00 42:44

Um I'll put it in the write-up so people can just click on it.

SPEAKER_02 42:49

Yep, yep. And um man, I'm happy to to help out. And I'm in particular, I'm also um really interested in this last thing we were just talking about about organizations and how we can help um companies both reduce their costs and therefore improve their bottom line, but most importantly to to keep their employees healthy, healthy, and happy, uh both in their work life and their f and their family life.

SPEAKER_00 43:14

Aaron Powell So you will make yourself available as a speaker.

SPEAKER_02 43:17

Sure.

SPEAKER_00 43:18

Or for lunch and learns.

SPEAKER_02 43:20

Absolutely. Workshops, speaking opportunities, sure.

SPEAKER_00 43:24

I am so happy to have had this conversation. Thanks for coming in today.

SPEAKER_02 43:28

And I am so uh honored to be here and thank you for the invitation to come.

SPEAKER_01 43:33

If you enjoyed this episode of Psychology America with Dr. Alexandra, show your support by leaving an awesome rating on iTunes. If you'd like to share your comments or ideas about this podcast, follow us on Facebook under Alexandra Miller. Lastly, Dr. Alexandra has written an inspiring children's book entitled There's Always Hope, a story about overcoming, which is beautifully illustrated by Brianna Giasula. There's always hope, a story about overcoming, teaches children about finding joy and gratitude even when things don't go exactly as planned, and can be found at Psychology America.com or Amazon.com.