Secret #54: The Reign of Pain (Lies Mainly in the Brain) with Howard Schubiner
Chronic pain, anxiety, depression, and fatigue are some of life’s most stubborn challenges—but what if the true cause, and the path to lasting relief, lies not in your body, but in your brain? In this eye-opening episode of Life’s Dirty Little Secrets, we uncover the groundbreaking science of pain with renowned mind-body physician Dr. Howard Schubiner.
Learn how cutting-edge neuroscience reveals that most chronic pain and related conditions aren’t the result of structural damage, but are instead generated by the brain’s protective mechanisms—often triggered by stress, trauma, or emotional injury. Dr. Schubiner shares powerful, research-backed techniques including pain reprocessing therapy, emotional awareness and expression, and practical life changes that can help you break free from the vicious cycle of pain and fear.
From Emma Waddington’s personal healing journey to astonishing real-life recoveries, this episode will transform your understanding of pain—and give you hope that recovery is closer than you think. Don’t miss this essential conversation for anyone living with persistent pain, unexplained symptoms, or looking to reclaim their wellbeing!
Highlights:
Neuroscience of predictive processing in pain
Emotional injury activating danger signals
Chronic pain and structural diagnosis myths
Mind body conditions in women
Pain reprocessing and emotional awareness therapy
TIMESTAMPS:
00:00 "Mystery of Rising Chronic Conditions"
05:03 "Brain Controls Pain Perception"
10:04 Rethinking Chronic Pain Diagnosis
12:46 Cycle of Fear and Pain
16:45 Psychologist's Chronic Pain Journey
20:30 "Brain's Pain and Safety Switch"
24:06 Trapped by Pelvic Pain
25:00 Imagination-Based Neurocircuit Testing
30:28 Mind-Body Connection Revelation
32:59 "Escape from Lifelong Pain"
36:45 Self-Compassion and Honest Expression
39:06 "ACT: Limited for Chronic Pain"
42:26 "Pain Education Nonprofit & Resources"
44:10 "Appreciation for Meaningful Dialogue"
More about Dr. Howard Schubiner
Take the Reign of Pain Coursera course
Learn more about ATNS nonprofit
Visit the Peer run free website
Visit Howard’s website unlearnyourpain.com
Lastly, if you have benefitted from the mind body work that Dr. Schubiner does, and you want to be counted, please go to https://unlearnyourpain.com/unlearn-your-pain-book-experience-entry/ add your name (or a fictional name if you prefer) to those who will be listed at the end of his new book, to be published by Penguin/Random House Press in 2026.
Dr. Howard Schubiner is an internist and a Clinical Professor at the Michigan State University College of Human Medicine and has authored more than 100 publications in scientific journals and books. He lectures regionally, nationally, and internationally. Dr. Schubiner has consulted for the American Medical Association, the National Institute on Drug Abuse, and the National Institute on Mental Health. Dr. Schubiner is the author of three books: Unlearn Your Pain, Unlearn Your Anxiety and Depression, and Hidden From View, written with Dr. Allan Abbass.
Dr. Schubiner has collaborated extensively with colleagues such as Mark Lumley, Tor Wager, Yoni Ashar and Alan Gordon to develop two novel psychological treatments for chronic pain: Emotion Awareness and Expression Therapy (EAET) and Pain Reprocessing Therapy (PRT), which have been shown to be highly effective in randomized, controlled trials. EAET is now listed as a treatment option in the U.S. Department of Health and Human Services Pain Management Best Practices Inter-agency Task Force Report.
Dr. Schubiner sees patients virtually from anywhere in the world at cormendihealth.com and lives in the Detroit area with his wife of forty years. They have two adult children.
Follow us on Facebook @lifesdirtylittlesecretspodcast and on Instagram @lifesdirtylittlesecrets
Reach out and let us know you are listening and what you would like to hear on the show - email:lifesdirtylittlesecretspodcast@gmail.com
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Secret #54: The Reign of Pain (Lies Mainly in the Brain) with Howard Schubiner
[00:00:00] We are all very human and fallible, and yet we live in a society that rewards pretending we're not fallible or the range of acceptable fallibility is narrow. We are constantly comparing our insides to other people's outsides and feeling inadequate and guilty, even ashamed. Trying to blend in means parts of ourselves will disappear, and we must then live in fear that we will be found out here together.
We will create a space where we can. Laugh, cry and carry our suffering and hurts lightly in the service of being deeply human. This is life's dirty. Little secrets.
Introduction and Guest Introduction
Emma Waddington: Welcome to Life's Sturdy Little Secrets. I'm Emma Waddington.
Chris McCurry: And I'm Chris McCury, and today it is our great privilege and honor to have Dr. Howard Schuur here with us today. He's a clinical professor at Michigan State University College of [00:01:00] Human Medicine. As a fellow in the American College of Physicians and the American Academy of Pediatrics, he is authored more than a hundred publications in scientific journals and books and lectures regionally, nationally, and internationally, and has consulted for the American Medical Association, the National Institute for On Drug Abuse, and the National Institute on Mental Health, his clinical practices health.com. He has website, MINDBODY Medicine for the 21st century, several books. All of this will be in the show notes and he will mention his newest book that will be coming out shortly, at some point here today. So, without further ado, Dr. Schuur.
Dr. Howard Schubiner: Yeah. Thanks for having me the, on uh, the Secrets, the Dirty Little Secrets
Chris McCurry: The dirty little secrets.
Dr. Howard Schubiner: That's exciting. I haven't been on a Dirty Little Secrets show before.
Chris McCurry: [00:02:00] We try to make the most of it. The secret ear, the better. So your life's work has largely been around pain, chronic pain, other kinds of pain, but you've also written about anxiety and depression and other sorts of. Conditions and situations that flag a lot of people in our society. And you've got some very interesting and powerful ideas and strategies for dealing with these situations. So I'm just gonna let you jump in at where you think are listeners would best be informed in terms of being introduced to the topic and your work.
Dr. Howard Schubiner: Yeah. Thanks so much. there's diseases. As I, as a physician, I know there's diseases that cause mortality, cancer, stroke, heart attack, dementia. And and these, and cancer of course, and these disorders have clear pathology in the body. They kill people. They occur equally in men and women. They're pretty [00:03:00] stable in society. Medical treatment has advanced, there's decent medical treatment for a lot of these disorders, and they occur higher. The older you get, the more likely you are to get one of these diseases. Now the problems that I deal with are the morbidity conditions.
The ones that don't kill you, the ones that are rising dramatically in society. All of them that occur more in women than men that occur in younger people, not in older people. And that don't kill you, but they cause tremendous suffering. Modern medical treatment for them is generally not that great. And this is a huge chasm, huge divide, and people have been unable to explain that I. Unable to explain any of those things. Why are they rising? Why are they in young people? Why are they more in women? You know why? And we can't find clear pathology or [00:04:00] medical EV evidence of disease in the body for all of these conditions.
Chronic headaches, migraine, chronic back pain, abdominal pain, irritable bowel syndrome, chronic pelvic pain, syndromes, widespread pain, fibromyalgia, chronic fatigue, syndromes, anxiety, depression. All these go together and many of the. People who have one of these, have many of them, they all they flock together.
There's something that they all have in common, and that's the secret right there. That's it.
That's the question. Why?
Chris McCurry: yes, exactly. And so what have you and others found? What is the common denominator in all these things?
The Neuroscience Behind Pain Perception
Dr. Howard Schubiner: The common denominator is we now understand the neuroscience of how the brain works. That doctors don't know that I wasn't taught in medical school. And the neuroscience of how the brain works is called predictive processing, [00:05:00] which sounds like a woowoo concept because it posits that the brain creates what we experience.
I. So that sounds like, okay, gimme a break. Just like, yeah. Oh yeah. I wanna be a millionaire. My brain will create wealth. Right. You know, that's, there's been that kind of positive thinking out there, but our brain creates what we see. We don't see with our eyes. You can see in your sleep, in your dreams. our brain creates what we hear. We mishear things all the time. Our brain fills in the gaps. when you touch a hot stove, it's not your finger causing pain. It's actually the brain. And this is a very difficult concept for people to grasp, but we know it's true because thousands of people have had injuries. Like a guy, you know, shot a nail in his hand and had no pain. Everyone knows people have had injuries and had no pain. If you have an injury and you have no pain, what does that mean? It means the brain is in control of [00:06:00] whether you have pain or not. The brain is in control of whether you have fatigue, anxiety, or depression or not, and the brain can be triggered to produce these sensations with physical injury.
With medical disease, of course it can, but. Secret number two, the brain can also produce these syndromes, these sensations, these symptoms, pain, anxiety, fatigue, depression the absence of physical injury. Secret three. Most people who have chronic pain, chronic anxiety, chronic depression, chronic fatigue, do not have a physical injury in their body to account their symptoms. I just said things that are so counterintuitive, so different than what most people think and what most doctors think, but we know it's true [00:07:00] because of the neuroscience, because of our clinical experience and because of our research. Emma, have you had any experience with this?
Emma Waddington: Wow. I'm I feel like we have to sort of take each one of those and think of examples. I mean, that's phenomenal. I think for me, thinking that the brain creates pain, I. It isn't what we're taught. Like you said, you know, we, you're talking about medical school, but I'm thinking even in just common parlance, right?
We don't talk about that. We talk about, you know, you touch the stove, like you said in the example, and the pain is felt in the finger where it's that you touched it. The fact that it's the brain that creates that pain.
Dr. Howard Schubiner: Yeah.
Emma Waddington: It's crazy.
Dr. Howard Schubiner: research shows,
Emma Waddington: Yeah.
Dr. Howard Schubiner: the fourth secret.
Emotional and Psychological Triggers of Pain
Dr. Howard Schubiner: Research shows that stress and emotional injury activates the same parts of the brain as does a physical injury. So [00:08:00] now we have a reason. Now we can begin to understand that our brain has a danger alarm mechanism like a smoke alarm. If someone has an emotional injury. This relates to all sorts of emotional injuries from childhood, traumatic experiences, later life traumatic experiences. You know, children who are problematic, parents who are problematic bosses, who are problematic neighbors, society that's problematic and justice. those things feed into our brain, and when the brain feels endangered, it sends a warning signal and the warning signal is not in. Language, it's not in English. A warning signal is in sensations. And so when someone is starting to feel overwhelmed, even if they don't recognize, they're feeling overwhelmed consciously, subconscious brain is there to protect them and send them a message.
And it may give them some anxiety. They may have trouble [00:09:00] falling asleep at night. saw a woman who was having trouble falling asleep at night and a young woman, and she goes to the doctor and they say, oh, you need some, you know, sleep medicine, you have trouble falling asleep. Well, it turned out she had been, she had a date rape month before that and she didn't have any, no.
Any idea that was connected to her lying in bed, not being able to fall asleep with her heart racing, but likely that's what it was. The brain can produce headache pain. If you're under a lot of pressure, all of a sudden your head feels pressure. Maybe you know someone's a pain in your neck and you have neck pain.
You know, there's the brain creates these experiences as guides, as messages, as protectors, and. It's just true. That's what it does. When I started my internship, I was a scared young physician, scared of making mistakes, scared of hurting people, not knowing what I was doing in a city hospital where I had way too much [00:10:00] responsibility and every morning I had diarrhea out of the blue.
I'd never had it before in my life. You know, what was going on? I was scared shitless, So what our brain does. when we fail to recognize that, what happens is the next secret is that you go to a doctor with your symptoms, your back pain, your headache pain, your stomach pain, your fatigue, and the doctor's running all sorts of tests.
And maybe finding things,
Emma Waddington: Yeah.
Dr. Howard Schubiner: not finding things, but treating everything as a physical ailment. And if it's, if it is a physical ailment, great, you need medical treatment. of the time it isn't. And we've, we have a back pain study we did. evaluated 222 people with chronic neck and back pain. And when you use our criteria, careful detailed history to determine is it really a structural problem or not, we found that 88% of them did not have a structural problem to [00:11:00] account for their chronic back pain. But when you treat it as a medical problem, you can actually make it worse. you're doing procedures, you're doing injections, you're giving medications, and you're scaring people thinking that there's something wrong and that they're never going to get better. The message the medical profession gives to people with chronic pain, chronic anxiety, chronic depression, chronic fatigue, is you're never going to get better, which actually makes it worse.
Emma Waddington: Can I ask about the structural damage piece, because that's pretty key, right? That's kind of stage step one in this journey is to understand that the source of your pain isn't structural and that. A huge shift for many people. So if we think of people who've had chronic pain for decades and they've gone down the route, the medical route, and you know, some of them, let's say if we're thinking about pain from, you know, in the back, the neck they'll have had MRIs and like you talk about, most [00:12:00] MRIs will find something as you get older.
What the stats are quite staggering actually.
Dr. Howard Schubiner: 40,
Emma Waddington: Is it?
Dr. Howard Schubiner: of people in their thirties will, who are, have no, no back pain at all. 40% of people in their thirties with no pain will have an abnormal MRI.
Emma Waddington: That's incredible. Yeah.
Dr. Howard Schubiner: So 50% of people in their forties, 60% of people in their fifties have an abnormal MRI,
Emma Waddington: Wow.
Dr. Howard Schubiner: no pain. And then 90% of people in their sixties have an abnormal MRI bulging disc, degenerative disc, spinal stenosis, facet arthropathy, spondylolisthesis, all these what we call normal abnormalities. And when you have this high rate of those things on MRIs in normal healthy people.
Emma Waddington: Yeah.
Dr. Howard Schubiner: we assume that those are actually the cause of pain?
Emma Waddington: Right.
Dr. Howard Schubiner: assume that shouldn't, but we do it every single day.
Emma Waddington: Yeah.
Dr. Howard Schubiner: Which creates more fear, more worry, and it [00:13:00] turns out one of the things that causes persistence of chronic pain, chronic anxiety, chronic fatigue, chronic depression, the persistence is caused by two major things.
One, ongoing stress. Emotional issues may be related to early childhood trauma or not, but ongoing. the second thing is the fear and the worry and the focus on the symptoms themselves. So the message that you're never going to get better a powerful effect that sends feedback to the brain, which tells the brain danger, the brain creates more symptoms. Which is a very negative, vicious cycle of pain, leading to fear, leading to more pain or anxiety, leading to more fear of the anxiety, leading to more anxiety and the loop that you feel like you can't get out of.
Emma Waddington: And
Dr. Howard Schubiner: medications don't help and injections don't help, and massage doesn't [00:14:00] help, and physical therapy doesn't help, and alternative medicine doesn't help, what are you left with?
Emma Waddington: yeah.
Dr. Howard Schubiner: just so devastated, so demoralized. Your life is broken. You're losing your friends. Your life is caving in on yourself. You can barely get out. all of these symptoms are real. They're not imaginary, they're not in people's heads.
Emma Waddington: Yeah.
Dr. Howard Schubiner: not fake. They're not their fault. They're not 'cause they're crazy or defective or weak. Why
Emma Waddington: Yeah.
Dr. Howard Schubiner: have higher rates of these mind-body conditions? The answer that, the best answer that I can come up with after consulting with a lot of women and feminist theorist is that women have higher rates of sexual assault than men. They have higher rates of emotional abuse than men. have higher rates of and social conditioning to be good and and don't speak up.
They have higher rates of what's called self [00:15:00] silencing. When they are attacked, if when they've had sexual assault, they're more likely to keep a secret out of shame. Mother's secret they're more likely to have sexual harassment in the workplace. in the workplace. Mean girls bullying, social media issues, single parenting of children carrying avail, older adults,
Emma Waddington: yes.
Dr. Howard Schubiner: is a lot of stuff
Emma Waddington: Yeah.
Dr. Howard Schubiner: signal is just more likely to be turned on when you're in that kinda situation. A lot of men, obviously a lot of men have these conditions as well, the fact is women do have higher rates and I think there's good reason for it, and I think if we recognize that, we begin to see that we actually need some changes in society. It's not women's fault that they have these things. It's our society is structured.
Emma Waddington: Yeah, that's quite striking, isn't [00:16:00] it? And I'm. I just wanted to touch back on the structural piece. I know it's, it just feels so important because people get so stuck. There. Is there, given that the rates of it being structural as in when we're thinking about chronic pain, the mind body syndrome, we're thinking about those people who, it's not structural.
There are some people that it is structural.
Dr. Howard Schubiner: Of course. Of
Emma Waddington: The small, a small group.
Dr. Howard Schubiner: Of course.
Emma Waddington: and I guess just being in a place where we can say it's not structural feels quite radical for some people because exactly that people think it's in your head, Ben, which is not what we're saying here.
Dr. Howard Schubiner: 99% of the people of structural pain are gonna be found out to have structural pain in an evaluation within a month, within a couple months. It's not hard to do. Doctors know how to do this. They know how to find abscesses, fractures, tumors, cancers. We know how to do [00:17:00] that. how to find inflammatory conditions, but when those are not found, and the pain or the anxiety or depression, et cetera, continues and goes on, on and on, chance of it being structural goes lower and lower.
Emma Waddington: Yes. And that's one that gets chronic and chronic and the sort of anxiety.
Personal Experiences and Case Studies
Emma Waddington: So I thought I would share a bit about my journey just because I'm hoping it'll be useful to listeners, but also because as a psychologist, as. At different points through the journey. I was told I should know better because I'm a psychologist.
And so my gosh, I think probably over the span of on and off, probably 20 years I've had pain. And actually it's through this work that I came across thanks to my fabulous physio. I came across your work not that long ago and it was. Radical. So I had my [00:18:00] first back injury probab. I was in my early twenties.
And as I was researching for our conversation today I saw the story, the narrative is so aligned with everything we're talking today, more so than I'd realized prior to our conversation. So, IF my first back injury, I was backpacking with my husband, my now husband. We were caught in a cyclone in the middle of Botswana.
Dr. Howard Schubiner: I hate when that happens.
Emma Waddington: I isn't it so inconvenient?
Dr. Howard Schubiner: He got
Emma Waddington: And I was terrified. I was terrified he wasn't, this just shows a difference in perception. He was fine, but I was terrified and we were in the middle of nowhere and just a handful of people. Anyway, I got quite scared. A few days later I was doing yoga and. Having done yoga for years, I felt my back and we were sort of traveling in a truck and I felt my back and I felt uncomfortable, but mostly I was sort of riddled with anxiety
What had [00:19:00] happened.
We got back to the uk well, he went, he continued traveling, but I, my anxiety took me back to the UK back. I couldn't continue my trip and my back. Kind of got progressively worse, as did my anxiety. And eventually I had sort of PTSD from that incident and I got my treatment and then I also saw physio and my back got worse.
And then it seemed to get better. And then it seemed to get worse with stress, but at the time I didn't realize it was stress. And I remember somebody once saying, I wonder if it's the weather. Which is something that I hear people say since then. And so that was my early twenties, up and down with stress preparing for our wedding.
My back got worse. And then eventually it seemed to settle. No, really not really clear why it settled. It just did. It went, and then a few years later I got pregnant and then I got pelvic pain. During my pregnancy, [00:20:00] and it was really bad. It got to the point with my eldest where I was in crutches and even wheelchair, I couldn't walk much at all because of my pelvic pain.
And nobody understood it, why it got so severe. And everybody said, the postnatally, you'll be fine. As soon as you give birth, you'll be fine. It'll go. And of course, I gave birth. It didn't go. And that created immense anxiety. In fact, I couldn't carry my son for a long time 'cause because of this physical pain,
Dr. Howard Schubiner: It's so scary.
Emma Waddington: it was so scary.
Dr. Howard Schubiner: Yeah.
Emma Waddington: Nobody could tell me what was happening. And physios didn't know, doctors didn't understand I was wearing a brace. I was eventually, I started running
And. Running sink to help, and it makes no sense. I can't carry my baby, but I can run.
Dr. Howard Schubiner: Right, right.
Emma Waddington: And so I got [00:21:00] well enough to get pregnant again, and
Dr. Howard Schubiner: one
Emma Waddington: yes.
Dr. Howard Schubiner: think about when the brain can turn on neuro circuits for pain and it
Emma Waddington: Right,
Dr. Howard Schubiner: off
Emma Waddington: right.
Dr. Howard Schubiner: it can turn 'em on when there's more danger or feeling more stress, or your
Emma Waddington: that's right.
Dr. Howard Schubiner: danger. Maybe your brain was perceiving danger with the pregnancy for a whole variety of reasons.
To do with your physical. Of being pregnant, but some about having a baby and having a child and all sorts of things that relate to your childhood and what your mom was like, et cetera.
But, and running can put the brain into a sense of safety sometimes,
Emma Waddington: yes.
Dr. Howard Schubiner: the brain is in a sense of safety, it will turn off pain.
And so when we see this pattern of pain turning on and off. Shifting or moving, coming and going, occurring with the weather being triggered by innocuous things, that's our clue. That's the medical clue. And that's what we did in that research study I was telling you about. [00:22:00] That's the clues that we make so that we can figure out is the pain you know, a mind body type pain or not, or is it structural? So
Emma Waddington: Yes.
Dr. Howard Schubiner: a huge clue and I just really wanted to.
Emma Waddington: Yes,
Dr. Howard Schubiner: you know, was clear to people.
Emma Waddington: absolutely. And I didn't, I couldn't make sense of that. I noticed that, and I could not make sense of it. And people couldn't explain it to me. And we fast forward my second pregnancy. I moved to Singapore soon after. And my pain was better. I mean, my, my second child was eight weeks old when we moved to Singapore, and I was still on crutches when we moved with a 2-year-old and a six week old or eight week old.
But my pain seemed to be better until we moved, and of course it got much worse when I got here and I. Again, and we couldn't, I couldn't make sense of it. Physios didn't know. We tried everything, nothing was getting better. And eventually I went to a pain specialist who [00:23:00] said to me as a psychologist, you know, don't you think you should be able to handle this better?
Which added immense shave to the whole
Dr. Howard Schubiner: Do you
Emma Waddington: thing.
Dr. Howard Schubiner: to women?
Emma Waddington: Yeah.
Dr. Howard Schubiner: This is a perfect example. Of how women are dismissed, gaslit, mistreated, not heard. Not seen. I mean, it's a perfect example of that. I hate to
Emma Waddington: Yeah,
Dr. Howard Schubiner: it.
Emma Waddington: it was horrible. It was horrible. He did help me in a way.
Chris McCurry: I was just gonna say from, for the men, they probably wouldn't even go to the doctor. They would probably just try to suck it up and be like,
Dr. Howard Schubiner: could be. Yeah.
Chris McCurry: manly about it or something. So it's not like the guys are getting off easy here. Or we wouldn't be, we wouldn't be dying how many years younger than typically for females.
But
Emma Waddington: yeah. We're better at help seeking.[00:24:00]
Chris McCurry: there. But please con,
Dr. Howard Schubiner: longer.
Chris McCurry: Emma.
Emma Waddington: yes. Just the final bit because that's where it all sort of gets better, thankfully. It took me a while, but I started to know to work with a physio and I noticed that one of my biggest fears, which is so bizarre, was stepping over things. So I had this pelvic pain and stepping over things used to really trigger my pain.
And then in a therapy session with my physio, I said to him, you know, even if I think of an iPad on the floor, a toy on the floor, I get pain.
Dr. Howard Schubiner: Yeah.
Emma Waddington: And he, and that's when he started to tell me about this work because it was insane. I could stand there, have no pain, and I could close my eyes and go. I imagine a toy and I could feel the anxiety, and I could feel the pain because the thought of lifting my leg because my pain was in my pelvis [00:25:00] terrified me, and I felt I was in prison.
During this period in my life, I very much felt like I was in a prison with this pain. Trapped. Nobody could tell me exactly what it was. They told me at best I could get 50% better. I then went on to have a third child and she's fabulous. And I was paying free
Dr. Howard Schubiner: Wow.
Emma Waddington: during this pregnancy having been in, in a wheelchair in my first, like, it was crazy.
And I ran through my third pregnancy. Running was always my thing. But.
Understanding Provocative Testing
Dr. Howard Schubiner: You describe what you described as what I call provocative testing.
Emma Waddington: Yes.
Dr. Howard Schubiner: provocative testing is a procedure we use to help demonstrate the neuro circuits of the brain. And so we have people close their eyes and imagine a triggering situation for pain or anxiety or fatigue. It might be walking, standing, bending, moving.
In your case it was stepping over something and often the imagination. Feels like, feels to the brain as if it's you're actually doing it. And then the brain creates the fear, [00:26:00] the anxiety, and the sensations. Often, not all the time, but most of the time. And then that can become a click moment where you realize.
I think that's what really happened with you in your physio world. You had that moment where it just kind of clicked in and all of a sudden you realize this is something different,
Emma Waddington: Yeah.
Dr. Howard Schubiner: you realize either consciously or unconsciously that it was your brain and then that. Might have propelled you to worry less, to be more active and to that when you ran, you were good.
And that kind of created a positive spiral toward you know, toward resolution.
Emma Waddington: Yeah, it is. It really is, and it still happens. I'll get moments where I'm scared that it's gonna come back
Dr. Howard Schubiner: Sure.
Emma Waddington: and I feel the fear in my body. Like that's something that I've come to realize, that I feel fear physically, like sensations, like body sensations. I'll, I've had, you know, [00:27:00] bouts of back pain since then, and it's always been.
Moments of high stress, like there'll be an injury. I said I might do something during exercise and I'll get. But then it persists because I start to get scared. I'm like, oh no, here we are again. I'm gonna be trapped in this for X number of months or years. And you start to think about what you're doing and you restrict your behavior.
And then I become very self-conscious, as in I'm monitoring my pain. Does this hurt? Does that hurt? What's going on here?
Dr. Howard Schubiner: Right.
Emma Waddington: and I get stuck in that fear cycle that you described where. I start to fear the pain, and so I am monitoring more, and so I'm restricting my exercise. So my emotions, you know, I feel like I get stuck in that prison, and that makes me anxious and worried, which triggers the pain.
It's just [00:28:00] heartbreaking, but so real.
Dr. Howard Schubiner: That feeling of trapped or being in prison, just that. Is that take you back to something in an earlier time in your life where you felt a similar situation to that?
Emma Waddington: I don't know. I don't know.
Dr. Howard Schubiner: Frequently.
Emma Waddington: yeah, I'll have to think about that.
Dr. Howard Schubiner: not, may or may not resonate for you, but frequently that happens. Paint emotions are physical events. Emotions are felt in the body. And it can be felt as a tightening electrical, a numbness, a tingling heaviness fatigue you know, and we tend in our society, tend to teach people to their emotions down and in. To not speak them, to suppress them, to not get [00:29:00] angry, to not express themselves. We teach people, we teach, you know, boys, it's not good to cry. You know, you should hold your emotions in, we teach girls you shouldn't get angry, you know, which it's not, you know, it's not nice. We teach people to be people pleasers always. Everyone else first. you know, those kind of things can build up over time. And sometimes you get in a situation where it just hits, you know, hits a breaking point and that's when that danger signal goes off. And it can feel like you injure yourself. You know, because, oh, I was doing yoga, or I was, you didn't really injure yourself.
You were just doing yoga.
Emma Waddington: Yeah. Yeah. And it was a sensation. I think that's pretty crazy,
Dr. Howard Schubiner: Yeah.
Emma Waddington: as in to think that emotions cause physical sensations. I don't think I, I, until I've experienced it myself, I didn't, [00:30:00] I. Really believe it. Like I thought it was independent physical sensations. Physical pain is one thing, emotions is a different thing.
But now I see how emotions can feel, like physical pain. My felt like I notice it. Like one of the things that helped me with my pain and I remember my pain specialist gave me were muscle relaxants. And I remember thinking, I was like, give me whatever you've got. All of it. I'll take whatever you have. And and he gave me muscle relaxers.
I thought, why are you giving me muscle relaxers? It worked a dream.
Dr. Howard Schubiner: Yeah,
Emma Waddington: Why?
Dr. Howard Schubiner: those actually work on the brain.
Emma Waddington: Exactly. Exactly. And I was so calm and doing so well. But they're not, you know, they're not they're dealing with that exactly on that neurological level. They're calming my nervous system down. 'cause that's what needed to quieten.[00:31:00]
Dr. Howard Schubiner: Exactly. Yeah. It's the, it's so counterintuitive, you know, the situations seem outta this world like couldn't possibly be true most of the people who work in this field. Work in this field because they've had their own personal experience with having pain, anxiety, depression, or fatigue that they couldn't figure out. they finally figured it out because they found this mind-body connection. And they found the role of emotions and they found the role of stress and fear and feeling trapped. Then they got better and then they're going, oh my God, I've gotta tell other people about this. You know, I've gotta try to help other people.
And so they become a therapist. They make a movie. They write a book. Become a coach. They, you know, they do all sorts of things because they really wanna help others to see this. And the people who've never experienced this [00:32:00] find it very hard to believe.
What's
Emma Waddington: yes.
Dr. Howard Schubiner: to believe is how frequently, not all the time, but how frequently the solution to these chronic type symptoms is relatively simple, is relatively straightforward. Because you don't have to fix the body 'cause the body's not broken. So that takes the load off. You can learn that it is the brain, which takes another load off. You can have hope and optimism that you're going to get better, which takes another load off. of a sudden you're taking these loads of worry off of the brain you start to treat the sensations that you have with curiosity rather than fear. You start to notice when they go up and down, you start to notice that they're related to stress. Maybe you start to deal with some of the emotional situations in your life [00:33:00] and all of a sudden your brain goes, okay, nevermind. We're okay. We're good, and the symptoms turn off and maybe they only turn off for a day, but then when they turn off for a day, you, then you really realize, oh my goodness. Look at that. It just went away, and then you have more understanding and more hope, and then it turns off for a couple days. I saw a guy yesterday, okay. He started getting headache and neck pain when he was eight years old. He's 73 now,
Emma Waddington: Wow.
Dr. Howard Schubiner: so 61 years. Of pain and it started when he was a boy in school. He was reading a book, an unauthorized book in class. The teacher came up behind him, whacked him in the neck, scared the crap out of him, whacked him in the neck, and he's had headache and neck pain for 61 years.
Emma Waddington: Wow.
Dr. Howard Schubiner: was also being bullied [00:34:00] at school, bullied by a father, bullied by a brother. There's a lot of stuff going on in his life at the time as well. had a long and successful career, and when I saw him yesterday, the first thing he said to me is, I have been headache free for the last 10 days. the first time I've been headache free in 61 years. Because he started this work after all those years, and he was so happy. So happy.
Chris McCurry: So what does the work entail? The, I know you've got brain reprocessing therapy. I'm sure our listeners at this point are saying, so what do I do?
Dr. Howard Schubiner: I can't tell you.
Chris McCurry: Okay, well, I, this, we're just gonna have to buy your books.
Dr. Howard Schubiner: I'm joking. So, so there's a five parts to the model [00:35:00] One, making the assessment, making sure there's not a structural problem.
Therapies for Chronic Pain
Dr. Howard Schubiner: Number two, educating about the brain, explaining predictive processing, how the brain creates what we experience, helping people see that's what they have, and that there's a, there's a. You know, a path for recovery, not just living with and coping with your symptoms, but recovery. So then we have three types of treatment. One is called, pain reprocessing therapy. The second one is called emotional awareness and expression therapy. And the third one has to do with changing your life and changing how you treat yourself and others. The first one, pain reprocessing therapy is. Is called, I call it a fear reappraisal therapy. what you're doing is you're, instead of fearing the symptoms, focusing on them, fighting them, being frustrated with them, trying to fix them, trying to figure them out. What you're doing is you're just noticing them. You're stepping back, you're observing them, you're watching them, they're, you're [00:36:00] letting them be. You're telling yourself you're okay. You're starting to move with less fear. You're running or you're walking, or you're doing yoga, doing something you love. Without fearing the sensations, that helps to turn off the dangerous signal in the brain. The emotional awareness and expression therapy has to do with dealing with emotions, and so that has to do with recognizing emotions come up. Oh, I started to get this pain in my neck. What's going on? Let me think. Oh my goodness, someone was treating me poorly. I don't like it. Oh my goodness. I'm actually I'm actually resentful.
I'm actually angry. I'm gonna allow myself to be angry and I'm gonna, and I'm gonna go in my car and I'm gonna cuss him out for a minute and I'm gonna go, wow, that felt good. And then I'm gonna let it go. And maybe I'm sad. Maybe I'll need to allow myself a little tear. Maybe I need to [00:37:00] myself permission to cry. So you're allowing these emotions to come up in safe and healthy ways. You can also use this therapy to go back to heal childhood hurts and childhood trauma. And the final part of it, it has to do with the, these, way that we've adapted, so the people pleasing, the perfectionism the self-criticism that people have. people need to change how they treat themselves. People often need to be kinder and more caring to themselves. People often need to have compassion for themselves. sometimes need to stake a stand in their lives. Sometimes they need to speak their mind. I had a man who had headaches for 12 years, very severe headaches. Really disabling. one of the things he had never done, he had never spoken honestly to his wife about things that had bothered him. [00:38:00] And he had never, he, I can't do that. I can't, you know, it's wasn't even part of he even thought was And when I helped him to figure out ways to speak to her with civility and honesty and authenticity, and with love and caring, I. Their communication improved and she could see what he needed and he could see what she needed. And he was like, that's amazing. And his headaches went away. Some people need to change their job. You know, I. Some people need to get divorced. You know, I mean, I had I, a woman who was in an abusive marriage and she was having a lot of pain, one of, one of which was migraine. And when she finally decided to leave, she drove her car out of the town she lived in and on the way out of the town as she drove away, was the last migraine she had. It was amazing. [00:39:00] So those are the three areas of therapy that we use. And, you know, they're inexpensive, they're relatively simple. You know, it's amazing.
Chris McCurry: I mean, it, it sounds very much like the. Therapy that Emma and I were trained in acceptance and commitment therapy, which has a lot of that mindful noticing with curiosity,
Dr. Howard Schubiner: Yeah.
Chris McCurry: allowing that's the acceptance part. And then, you know, toward having the best life that you can. Even if from time to time thoughts and feelings show up.
Dr. Howard Schubiner: Acceptance and commitment therapy is a great therapy. It has not been shown to be particularly effective for chronic pain for three reasons. One, I. People do it in the absence of doing that structural evaluation. people are using it for pain that they think is structural [00:40:00] because what else are they gonna think?
They've never had that evaluation. Number two act is geared toward helping people cope with pain better, and it's good at that, but what people don't want just to cope with pain. Our work is geared toward reversing pain. So it's a different the techniques are quite similar, but the intent the direction is toward reversal rather than coping. And the third thing is our method also has a heavy emphasis on emotional, the emotional part, which act has less of. And you know, one of the, our research, you know, in our PRT research studies, two thirds to three quarters of patients have been pain free or virtually pain free within a month or two. That's phenomenal for chronic back pain and in our EAET studies, have compared, we've compared in several of the studies, EAT to cognitive behavioral therapy. Cognitive behavioral therapy is a great therapy, but it is also is a [00:41:00] coping therapy. It has very small effects on pain itself, on pain reduction. It has the same effects on pain reduction as ACT and as mindfulness based therapies. In our studies that Brandon Yarns did out at UCLA with veterans, older male veterans with chronic pain, average duration of pain, 26 years, very difficult to treat. that sense, EAT was way superior CBT in these studies. Amazing. I can send you all those studies.
Emma Waddington: EAT is the emotional awareness therapy. Wow,
Dr. Howard Schubiner: Exactly. And so what we do clinically, we combine the pain reprocessing, the fear reappraisal part with the EAET, the emotional awareness and expression part with the making changes in your life. So we do it all instead of in the research studies, it's just studying one, you know?
'cause research has to be more like. Boxed in, do[00:42:00]
Chris McCurry: Yeah.
Dr. Howard Schubiner: manualized,
Hope and Resources for Recovery
Chris McCurry: So in the interest of time what should we leave our listeners with?
Dr. Howard Schubiner: you know. The main things from my point of view are the symptoms are real. They're not in people's heads. They're not because they're crazy or defective. It's because of being human. Everyone gets mind-body conditions. It's part of being human. the fact that women have higher rates is because women have harder lives. That's just a fact in general. Number one. Number two, don't give up hope. There is hope for these chronic conditions. Please keep an open mind. Look at our literature. Look at the books. There's not just my books. There's a lot of people in our community have written books. There's free, there's an, the tms wiki.org, a free.
Peer Run website. There's the [00:43:00] Atns Symptomatic Me is a nonprofit organization that we founded that has tons of information, has courses on it. We teach a lot, of course on my website, on linear pain.com. There's a list of all the courses that we teach. I have a course on Coursera, that's free, coursera.org/learn/reign of pain, R-E-I-G-N, reign of Pain. that's a free course that has all this information on it. There's hope and the most important thing that people can do. Is realize that they're worthy, they're deserving. They're worthy of getting better. They don't deserve to be in the, with these chronic symptoms the compassion that they take for themselves can lead to action, that can have hope for recovery.
Chris McCurry: Wonderful. Thank [00:44:00] you so much. This has been amazing, and I know it's gonna be very helpful and inspiring and hopeful
Listeners.
Emma Waddington: Yes, thank you. And I've, I mean, I've personally benefited from your work and feel immensely grateful that there is a way out of paying because
Dr. Howard Schubiner: it's amazing. Yeah. I'm collecting names of people who wanna stand up and they add their name to a list that I'm gonna be publishing in my next book. And we'll send you that link. If
Emma Waddington: Yes.
Dr. Howard Schubiner: to add their name to the list, we would welcome it. 'cause
Emma Waddington: Yeah.
Dr. Howard Schubiner: list, you know? And it's really amazing to see people
Emma Waddington: Yeah,
Dr. Howard Schubiner: you know, doing this work.
It makes you feel like you're not alone.
Emma Waddington: I agree. I'll be putting my name on it. Thank you. Thank you. This has been amazing. Incredible. It's taken us a while, which is just a sign of how important this conversation needed to be.
Dr. Howard Schubiner: Thanks so much guys. I
Emma Waddington: Thank you.
Dr. Howard Schubiner: Take
Chris McCurry: take care.
Emma Waddington: you too.
