00:00:14.800 --> 00:00:16.850
I have back pain every day.

00:00:16.850 --> 00:00:18.430
Some days worse than others.

00:00:18.430 --> 00:00:20.520
And it's there all day, every day.

00:00:20.520 --> 00:00:22.890
Pretty much general,
chronic, low back pain.

00:00:22.890 --> 00:00:26.150
I couldn't walk more than about 100 feet
without sitting on the sidewalk.

00:00:26.150 --> 00:00:28.860
You bend over to get something
and you just can't move.

00:00:29.110 --> 00:00:31.400
A world of pain
that just keeps continually increasing.

00:00:31.400 --> 00:00:32.780
Couldn’t stay on my feet

00:00:32.780 --> 00:00:36.910
to do the exercises and didn't
find them to be terribly beneficial.

00:00:36.990 --> 00:00:40.120
When I lie down, I have to put my head
on the pillow and just get my head right.

00:00:40.120 --> 00:00:41.950
I'm afraid to go dancing.

00:00:41.950 --> 00:00:44.120
You know, I just--
it doesn’t feel like I should.

00:00:44.160 --> 00:00:45.040
I used to love to dance.

00:00:45.040 --> 00:00:47.790
Being unable to sit for any meaningful

00:00:47.790 --> 00:00:51.630
Length of time.
- And it felt like somebody hit me with a two by four.

00:00:54.800 --> 00:00:56.680
Sometimes walking around all day

00:00:56.680 --> 00:00:59.970
would just, like, put me on my floor
for hours when I would get home.

00:00:59.970 --> 00:01:03.310
I would just freeze up.
I’d be able to lie on the ground for days

00:01:03.310 --> 00:01:06.690
and just hardly able to move.
-It affected everything and just made me

00:01:07.810 --> 00:01:09.060
just grouchy.

00:01:09.060 --> 00:01:10.440
And kind of after 15 years

00:01:10.440 --> 00:01:14.070
of being in pain, kind of exhausted
from trying things that don't really work

00:01:14.240 --> 00:01:17.820
or that work for a little bit
or are really high maintenance,

00:01:17.860 --> 00:01:20.910
it's hard for me to keep up
and have like a normal work/life balance.

00:01:20.910 --> 00:01:24.250
I stopped exercising, I stopped
working out, I stopped even walking.

00:01:24.250 --> 00:01:25.370
It was even hard to walk.

00:01:25.370 --> 00:01:28.170
And it was hard to stand, it was hard
to sit, it was hard to do anything.

00:01:28.460 --> 00:01:30.500
So I pretty much stopped moving my body.

00:01:30.540 --> 00:01:31.670
And I was like, Well,

00:01:31.670 --> 00:01:34.300
some people have other things to deal with
and this is my thing.

00:01:34.590 --> 00:01:37.260
And I just figured, okay, well,
this is my thing and that's it.

00:01:38.470 --> 00:01:40.470
So I just came to terms with

00:01:41.640 --> 00:01:43.640
that it was how it was.

00:01:47.480 --> 00:01:49.100
There's 70 million people

00:01:49.100 --> 00:01:51.480
in this country alone with chronic pain.

00:01:52.520 --> 00:01:55.360
Probably 50 million of them
don't have to be.

00:01:55.650 --> 00:01:59.610
The way that chronic pain is
currently, generally, looked at in

00:01:59.610 --> 00:02:03.450
the medical community is
fundamentally based on a flawed premise.

00:02:03.450 --> 00:02:05.120
You know, if you learn that two plus

00:02:05.120 --> 00:02:09.120
two equals five early on, all your future
math equations are going to be wrong.

00:02:09.460 --> 00:02:12.750
The medical community looks at things
through a biomechanical lens.

00:02:13.000 --> 00:02:15.210
That's the paradigm
that they look at things through.

00:02:15.840 --> 00:02:20.300
Surgeons, physical therapists,
chiropractors, acupuncturists,

00:02:20.510 --> 00:02:24.850
the Laser Spine Institute,
all of these different places are founded

00:02:24.850 --> 00:02:27.930
on treating pain
from a structural perspective.

00:02:28.390 --> 00:02:33.020
but there aren't that many effective
treatments for chronic pain.

00:02:33.400 --> 00:02:37.650
That's why there's this massive
opioid epidemic, because there's this

00:02:37.820 --> 00:02:40.910
fundamental misunderstanding
of chronic pain in the medical community.

00:02:41.740 --> 00:02:44.490
We're trying to literally affect
a paradigm shift

00:02:44.490 --> 00:02:50.920
where the majority of chronic pain
is not biomechanical but is psychogenic.

00:02:51.370 --> 00:02:53.460
I think it makes sense to be skeptical.

00:02:53.790 --> 00:02:57.960
We're evolutionarily wired to associate
physical pain with physical injury.

00:02:58.380 --> 00:03:01.550
I've had this thing and I was resistant.

00:03:10.980 --> 00:03:12.940
When I was in pain.

00:03:12.940 --> 00:03:18.900
I remember waking up and just thinking
14 hours till I get to go to sleep again.

00:03:18.900 --> 00:03:20.200
Waking up and just thinking like,

00:03:20.200 --> 00:03:23.530
this is not a life worth living,
this is a life that you're just kind of

00:03:24.530 --> 00:03:27.410
managing.

00:03:28.080 --> 00:03:32.290
I saw three of the best back
specialists in Los Angeles.

00:03:32.580 --> 00:03:35.960
One of them said that I had pain
because I had a disc herniation.

00:03:36.210 --> 00:03:36.960
One of them said it was

00:03:36.960 --> 00:03:40.420
because I had disc degeneration,
and one of them said I was just too tall.

00:03:41.550 --> 00:03:46.260
I had 18 different
MRIs between 2003 and 2005.

00:03:46.970 --> 00:03:50.680
I had procedure after procedure,
medications, physical therapy,

00:03:50.680 --> 00:03:53.270
I mean, more diagnostic tests
than you can imagine.

00:03:53.980 --> 00:03:58.360
And I was in my mid-twenties
thinking like, how did my genes survive

00:03:58.360 --> 00:04:01.320
throughout evolution?

00:04:02.110 --> 00:04:06.070
My mom's friend's son had back pain

00:04:07.120 --> 00:04:08.910
and he had read a book

00:04:08.910 --> 00:04:11.830
and his pain went away
from reading this book.

00:04:12.710 --> 00:04:14.830
My mom, you know, she got the book for me.

00:04:15.750 --> 00:04:18.750
I remember
literally throwing it across the room

00:04:18.960 --> 00:04:21.130
just thinking like, mom,
I have herniations to the point

00:04:21.130 --> 00:04:23.380
where the physical therapist looked at
my MRI

00:04:23.630 --> 00:04:26.010
and asked me if I fell off a third story
balcony.

00:04:26.010 --> 00:04:29.430
Like, a book isn't going to get me better.

00:04:29.430 --> 00:04:31.270
And then it was maybe a year later

00:04:31.270 --> 00:04:35.060
that I picked it back up and I read it
and it made sense.

00:04:35.520 --> 00:04:39.690
I was able to get rid
of all of my symptoms.

00:04:40.780 --> 00:04:42.820
My insurance company
spent about one and a half

00:04:42.820 --> 00:04:45.530
million dollars on me
over a span of three years.

00:04:46.160 --> 00:04:48.160
A million and a half dollars.

00:04:48.160 --> 00:04:50.700
And I got better from this approach.

00:04:51.330 --> 00:04:53.910
Well, this is. A real physical disorder

00:04:55.120 --> 00:04:58.880
that your
brain thinks it has to create in order

00:04:58.880 --> 00:05:03.130
to protect you from some very powerful,
dangerous emotions.

00:05:03.760 --> 00:05:08.050
I generally don't even mention John Sarno,
even though he literally saved my life.

00:05:09.220 --> 00:05:11.430
The book didn't make me better,

00:05:11.430 --> 00:05:13.680
but it helped me see that

00:05:13.980 --> 00:05:17.520
my problems weren't
caused by the disc herniation that I had

00:05:17.850 --> 00:05:21.690
and that there was the potential
to get better.

00:05:22.820 --> 00:05:25.280
Pain is a danger signal, essentially,

00:05:25.320 --> 00:05:28.200
like the purpose of pain is to warn us.

00:05:28.610 --> 00:05:31.530
If you put your hand on a hot stove,
the pain is letting

00:05:31.530 --> 00:05:34.290
you know you've got to move your hand
or you can cause additional damage.

00:05:34.700 --> 00:05:37.750
Sometimes the brain could
actually activate these danger signals

00:05:38.170 --> 00:05:40.670
when there is no actual injury

00:05:40.670 --> 00:05:43.630
and that's what's happening
in most cases of chronic pain.

00:05:43.920 --> 00:05:45.970
The person has pain.

00:05:45.970 --> 00:05:51.220
Their brain is actually amplifying
just a safe and neutral sensation.

00:05:51.220 --> 00:05:54.930
But the pain patient
is believing that there's danger.

00:05:55.180 --> 00:05:59.230
So they're living their life
as if they have a problem with their back.

00:05:59.600 --> 00:06:01.690
You know, they're avoiding
certain activities.

00:06:01.980 --> 00:06:03.980
They're avoiding certain positions.

00:06:04.230 --> 00:06:07.700
They're reinforcing this idea of danger.

00:06:07.900 --> 00:06:10.320
And that keeps these
danger signals activated.

00:06:12.870 --> 00:06:15.620
There are a few doctors who practice
this, and

00:06:15.620 --> 00:06:19.330
I went around and just met with them
and learned what they did

00:06:19.670 --> 00:06:23.540
and then we created a center
to treat patients who have chronic pain.

00:06:24.210 --> 00:06:26.340
We've been doing this for years.

00:06:26.340 --> 00:06:30.220
We've seen patients who have had chronic
back pain or neck pain or headaches

00:06:30.470 --> 00:06:34.600
for years or decades get to a point
where they don't have pain anymore.

00:06:36.350 --> 00:06:39.850
There are other patients I work with where
we help them bring their anxiety down

00:06:40.060 --> 00:06:42.900
and their pain goes from a five out of ten
to a one out of ten.

00:06:43.770 --> 00:06:47.110
This nurse practitioner,
she's had chronic neck pain for 20 years

00:06:47.530 --> 00:06:49.650
and we had her
turn her head back and forth

00:06:49.650 --> 00:06:53.070
and 20 years of pain
she got rid of in 7 minutes.

00:06:53.620 --> 00:06:57.290
I want everyone, all of you guys I want
you guys to turn your heads 20 degrees.

00:06:57.500 --> 00:06:59.870
How’re you feeling right now?

00:07:00.870 --> 00:07:02.290
I feel like I want to cry.

00:07:02.290 --> 00:07:05.920
We put this on YouTube and promoted it,
and it has like 3000 views.

00:07:06.550 --> 00:07:08.300
What do we have to do, you know?

00:07:08.300 --> 00:07:11.180
Welcome Casey,
along with his parents, Diane and Dan,

00:07:11.180 --> 00:07:14.010
as well as Alan Gordon from the Pain
Psychology Center.

00:07:14.850 --> 00:07:17.010
We go on TV, we get this kid

00:07:17.220 --> 00:07:20.020
who's literally passing out from pain.

00:07:20.020 --> 00:07:21.600
Like, the best doctors

00:07:21.600 --> 00:07:24.110
at the best hospitals in the world
couldn't do anything with him.

00:07:24.900 --> 00:07:26.770
We get him completely out of pain.

00:07:26.770 --> 00:07:29.030
We prove it by showing it in his brain.

00:07:29.400 --> 00:07:32.820
We literally got the first ever fMRI case
study

00:07:32.820 --> 00:07:34.780
of someone who's eliminated chronic pain.

00:07:34.780 --> 00:07:36.200
I love this story.

00:07:36.200 --> 00:07:38.910
From my perspective, it's so endlessly
frustrating.

00:07:38.910 --> 00:07:42.870
Like, what do we have to do
to get this thing out there?

00:07:43.500 --> 00:07:45.630
I don't know what it's going to take.

00:07:45.630 --> 00:07:48.050
We spent $25,000

00:07:48.340 --> 00:07:51.760
working with one of the biggest
PR marketing firms in California,

00:07:52.090 --> 00:07:55.390
and they literally couldn't even get us
a write up in the Scranton Times.

00:07:56.220 --> 00:07:58.560
I think that we need someone
who could kind of promote it from

00:07:58.560 --> 00:08:02.560
this scientific perspective and is willing
to, like, really give themselves to it.

00:08:04.690 --> 00:08:05.150
Tor is

00:08:05.150 --> 00:08:08.190
the biggest there is in terms of fMRI
pain researchers.

00:08:08.980 --> 00:08:11.940
We've been trying to get Tor’s
attention for years.

00:08:12.490 --> 00:08:16.160
Once we got the fMRI of the kid
from this TV show,

00:08:16.530 --> 00:08:21.290
we got this huge back pain study
and this is an opportunity for us

00:08:21.580 --> 00:08:25.630
to prove it in an evidence based way

00:08:25.880 --> 00:08:30.050
with three different groups
and fMRI studies to validate it.

00:08:30.380 --> 00:08:33.420
This is legit.

00:08:37.760 --> 00:08:39.930
Yoni works under Tor

00:08:39.930 --> 00:08:43.480
and he is overseeing the entire study.

00:08:44.850 --> 00:08:47.310
My role in the study
is not to get people out of pain.

00:08:47.770 --> 00:08:52.240
My job is to run the study with
the highest scientific integrity possible

00:08:52.490 --> 00:08:54.030
so that we know
when we're looking at the answer,

00:08:54.030 --> 00:08:55.200
it's like the best answer

00:08:55.200 --> 00:08:57.910
we could have gotten, the best way
we could have answered the question

00:08:57.910 --> 00:08:59.950
and gotten the clearest answer
we could get.

00:08:59.950 --> 00:09:02.450
They're talking about curing back pain.

00:09:02.450 --> 00:09:05.080
Cure someone of their back pain
by talking with them?

00:09:05.870 --> 00:09:08.170
Y’know it's kind of like it's- it's crazy.

00:09:08.170 --> 00:09:10.380
I'm totally dubious and totally skeptical.

00:09:10.380 --> 00:09:11.000
At the same time.

00:09:11.000 --> 00:09:15.130
I'm like, I'm bought in enough
that I'm running this study.

00:09:17.050 --> 00:09:20.260
There's some work from Northwestern,
from the lab of Vania Apkarian

00:09:20.300 --> 00:09:24.680
has implicated a whole other
set of brain regions in chronic pain.

00:09:25.980 --> 00:09:27.020
Such as the ventromedial

00:09:27.020 --> 00:09:29.110
prefrontal cortex
and the ventral striatum.

00:09:30.060 --> 00:09:32.400
And that's really interesting
because those two brain regions

00:09:32.480 --> 00:09:37.410
are also really related
to emotion and learning.

00:09:37.410 --> 00:09:40.700
So there’s acute or evoked pain,
think about stubbing your toe,

00:09:40.870 --> 00:09:43.450
cutting your hand,
something just like, “Ow!”

00:09:44.160 --> 00:09:48.500
That lives in these brain circuits
that process kind of nociception,

00:09:48.500 --> 00:09:53.130
which is a fancy word for signals
of damage coming up from the body.

00:09:53.840 --> 00:09:56.670
But this amazing study
followed people immediately

00:09:56.670 --> 00:09:59.470
after a back injury
and then their back pain chronified.

00:10:00.090 --> 00:10:03.100
And as an injury became a chronic injury,

00:10:03.430 --> 00:10:06.640
the brain activity
related to that pain changed

00:10:07.140 --> 00:10:10.610
such that the beginning, immediately
after an injury, the pain was associated

00:10:10.610 --> 00:10:14.230
with activity in these kind of standard
pain processing networks.

00:10:14.530 --> 00:10:18.490
And, over time, the pain
then shifted into a learned circuit.

00:10:20.200 --> 00:10:21.570
The simple interpretation from

00:10:21.570 --> 00:10:26.540
you would be that
the brain learned the pain, and that's in

00:10:26.540 --> 00:10:29.290
some ways the premise of the study,
because if the brain can learn pain,

00:10:29.710 --> 00:10:32.790
then the brain can unlearn pain.

00:10:38.630 --> 00:10:42.010
We’re comparing psychotherapy treatment
to what's called a waitlist control group

00:10:42.010 --> 00:10:44.600
so people who keep doing the usual
for a month.

00:10:46.140 --> 00:10:48.310
The standard in the field is managing back
pain.

00:10:48.310 --> 00:10:52.560
Bring someone down from a six to a three
and that's a victory.

00:10:52.560 --> 00:10:54.860
You know, Alan's talking about
going from a six to a zero.

00:10:55.150 --> 00:10:56.480
I mean, total cure.

00:10:56.480 --> 00:11:07.620
And if that happens,
how does that work in the brain?

00:11:08.410 --> 00:11:10.830
A major focus of our work over the past

00:11:11.170 --> 00:11:14.250
five years has been developing
brain markers.

00:11:15.670 --> 00:11:20.220
So the first thing we did was find
a brain marker for chronic back pain.

00:11:20.470 --> 00:11:23.470
We want to know,
did the treatment really work?

00:11:25.140 --> 00:11:28.220
We measure people's pain before
and after treatment,

00:11:28.220 --> 00:11:32.270
and we also scan their brains before
and after treatment.

00:11:39.990 --> 00:11:42.150
You know,
we only have a month with this treatment.

00:11:42.780 --> 00:11:46.330
There are going to be a series of battles
and victories.

00:11:46.580 --> 00:11:49.870
The first one is getting these patients
better, right?

00:11:50.080 --> 00:11:54.170
The second one is, are we able to validate
that with the fMRIs?

00:11:54.630 --> 00:11:57.210
For Alan, I think this study is just
about proving something

00:11:57.210 --> 00:11:58.420
he already knows.

00:11:58.420 --> 00:12:01.380
He really thinks it's
going to be a turning point and

00:12:02.880 --> 00:12:04.640
I don't think
these things can be predicted.

00:12:04.640 --> 00:12:05.970
I think we're going to have

00:12:05.970 --> 00:12:09.390
the greatest results in the treatment
of chronic pain in the medical literature.

00:12:09.770 --> 00:12:12.060
Alan is

00:12:13.980 --> 00:12:15.560
a bit obsessed with the study.

00:12:15.560 --> 00:12:19.480
This will inevitably be the biggest study
in the history of chronic pain.

00:12:19.530 --> 00:12:23.200
So, you know, we'll look at the data
and we'll see what the answer is.

00:12:23.200 --> 00:12:25.910
And it's about knowing the truth,
as it were.

00:12:26.030 --> 00:12:29.120
I want to know the truth, the data are
the data are the data that's-- Y’know

00:12:29.120 --> 00:12:32.580
we'll look at the data
and we'll see what the answer is.

00:12:32.710 --> 00:12:36.170
My goal
for this study in terms of outcomes

00:12:36.540 --> 00:12:40.840
is a 70% overall reduction in back pain

00:12:41.090 --> 00:12:46.180
and maybe 10 to 12 patients
being pain free or completely pain free.

00:12:46.470 --> 00:12:48.800
I am confident
that that's going to happen.

00:12:48.800 --> 00:12:50.680
We're doing a new set up.

00:12:50.680 --> 00:12:54.350
We've never worked with people
for a month, twice a week.

00:12:54.770 --> 00:12:57.940
I'm not sure
if the frequency is lined up right...

00:12:57.940 --> 00:13:00.150
No. You know what? I'm hedging.
Yeah, I'm confident.

00:13:00.150 --> 00:13:01.150
I'm confident.

00:13:01.480 --> 00:13:03.030
We're going to get somewhere
in that range.

00:13:03.030 --> 00:13:04.700
Maybe it'll be 60%.

00:13:04.700 --> 00:13:07.740
Maybe it'll be 6 to 8 people
all the way better.

00:13:08.530 --> 00:13:11.950
So I had an injury back in 2014 and it's
been relatively consistent since then.

00:13:12.160 --> 00:13:14.080
The disc had come out of place.

00:13:14.080 --> 00:13:15.250
I was out for four months.

00:13:15.250 --> 00:13:18.420
I previously had a herniated disc close

00:13:18.420 --> 00:13:21.960
to 20 years ago.
-My back pain was actually diagnosed or assessed

00:13:22.300 --> 00:13:26.840
as being spinal stenosis.
-and then it just progressively

00:13:28.220 --> 00:13:30.100
got worse with time.

00:13:30.100 --> 00:13:33.220
It's been off and on since 1998.

00:13:33.600 --> 00:13:37.100
As long as I can remember,
probably at least six years.

00:13:53.240 --> 00:13:57.040
Was there ever an acute injury
where it was just like one

00:13:57.040 --> 00:14:01.250
physical, traumatic thing where you felt
an enormous amount of pain afterward.

00:14:12.720 --> 00:14:14.220
And you've done

00:14:14.220 --> 00:14:17.850
lots of different treatments, yoga,
physical therapy, everything like that.

00:15:17.580 --> 00:15:18.250
Oh, wow

00:15:27.960 --> 00:15:29.510
Oh, wow!

00:15:30.760 --> 00:15:34.180
ALAN: When you say it varies from day
to day or there’s some days when it’s really bad

00:15:34.180 --> 00:15:38.970
and some days when it’s pretty good
is it pretty consistent?

00:15:59.290 --> 00:16:02.210
Do you have any history of anxiety
or depression, Lindsay?

00:16:07.920 --> 00:16:12.220
Is there any positions that make the pain
in your back better or worse,

00:16:12.470 --> 00:16:15.010
or is it independent of physical position
or activity?

00:16:26.480 --> 00:16:28.980
ALAN: Does your mind
go to fear thoughts pretty easily,

00:16:29.270 --> 00:16:32.530
or would you consider yourself
not like hypervigilant in that way?

00:16:40.910 --> 00:16:41.910
Okay...

00:16:45.000 --> 00:16:46.960
All right. Well, that's that's actually

00:16:48.000 --> 00:16:48.340
yeah,

00:16:48.340 --> 00:16:51.510
that's the best thing that you've told me
so far on this call.

00:16:51.510 --> 00:16:53.880
So pain is essentially a danger signal...

00:16:54.010 --> 00:16:58.260
My emotions on that call
I was like terror, despair, a little hope.

00:17:00.350 --> 00:17:02.100
I didn't like that

00:17:02.100 --> 00:17:04.940
three different physicians
told him that he needed surgery.

00:17:04.940 --> 00:17:07.520
That scares me.
When he said he played football,

00:17:07.520 --> 00:17:09.110
I was like,
maybe he stopped after high school.

00:17:09.110 --> 00:17:11.320
Like, college is serious.

00:17:11.320 --> 00:17:15.360
There are some serious collisions.

00:17:15.360 --> 00:17:17.280
When someone says
they have a structural injury,

00:17:17.280 --> 00:17:19.780
the first thing I say is talk to Howard
Schubiner.

00:17:20.080 --> 00:17:24.000
Let's see if that structural injury
is really just normal wear and tear

00:17:24.200 --> 00:17:27.920
or if it's really causing what's going on.

00:17:27.960 --> 00:17:29.500
[PHONE RINGING]

00:17:29.670 --> 00:17:31.210
Hello this is Greg, how can I help you?

00:17:31.210 --> 00:17:33.210
Greg, it's Howard Schubiner. How are you?

00:17:34.050 --> 00:17:35.130
I'm doing great, how are you, Howard?

00:17:35.130 --> 00:17:36.260
I am well.

00:17:36.260 --> 00:17:38.890
You're up and about this morning?

00:17:39.680 --> 00:17:40.180
Yes I am.

00:17:40.180 --> 00:17:43.180
ALAN: What Howard does is
he makes an educated guess

00:17:43.600 --> 00:17:48.310
based on a lot of criteria,
but it's not a definitive diagnosis.

00:17:48.310 --> 00:17:50.230
We're continuing to gather evidence.

00:17:50.230 --> 00:17:52.690
Headaches on and off.
When did those start, would you say?

00:17:55.150 --> 00:17:56.070
College?

00:18:00.490 --> 00:18:02.990
So I'm going to ask you a favor.
-Sure.

00:18:03.240 --> 00:18:05.620
And all my patients do this.
Everyone does this.

00:18:05.620 --> 00:18:08.670
This may sound-- Don't

00:18:08.670 --> 00:18:11.170
take it personally,
but let me be the doctor here.

00:18:11.790 --> 00:18:12.670
Oh, sure.

00:18:12.670 --> 00:18:15.800
Okay.

00:18:15.800 --> 00:18:17.720
Because we're not going to assume

00:18:17.720 --> 00:18:21.680
cause and effect relationships are true
because that's not being a good doctor.

00:18:22.720 --> 00:18:25.390
And so I'm looking at your MRI

00:18:26.140 --> 00:18:29.900
and your MRI shows some slippages.

00:18:29.900 --> 00:18:30.980
-Correct.

00:18:30.980 --> 00:18:34.570
And there's disc degeneration,
particularly at the L5

00:18:34.570 --> 00:18:36.650
S1 area.
-Yes.

00:18:37.690 --> 00:18:41.530
If you do MRIs in people
who are pain free and healthy

00:18:41.530 --> 00:18:46.200
and they've never had back pain in their
life, 80% of them have disc degeneration.

00:18:47.080 --> 00:18:50.580
The MRI of my neck shows three
large bulging discs

00:18:50.580 --> 00:18:55.130
pushing on nerves on both sides of my neck
and I have zero neck pain.

00:18:55.920 --> 00:18:57.170
-That's amazing. That's wonderful.

00:18:57.170 --> 00:18:58.630
Now, I have had neck pain

00:19:00.550 --> 00:19:00.930
and my

00:19:00.930 --> 00:19:04.220
doctors told me it was due to
what was found on the MRI.

00:19:05.060 --> 00:19:07.270
But my doctors didn't tell me

00:19:07.270 --> 00:19:09.810
was that those findings are normal

00:19:09.810 --> 00:19:13.610
for large amounts of the population.

00:19:13.980 --> 00:19:17.110
I'm looking at your exam
from the orthopedic

00:19:17.110 --> 00:19:19.440
physician from 2014

00:19:20.200 --> 00:19:24.240
and his exam says your strength is normal
in your legs.

00:19:24.780 --> 00:19:26.910
-Yes.
Your reflexes are normal.

00:19:27.580 --> 00:19:29.710
-Yes.
There's no loss of sensation.

00:19:30.540 --> 00:19:30.910
-Correct.

00:19:30.910 --> 00:19:34.170
You have pain in the back and in the groin.
-Yes.

00:19:36.210 --> 00:19:40.420
but these things all indicate to me

00:19:40.420 --> 00:19:45.890
that there's no nerve damage,
because if there was nerve damage,

00:19:46.600 --> 00:19:50.560
you would have decreased reflex
or decreased muscle strength

00:19:50.770 --> 00:19:52.060
or decreased sensation.

00:19:52.060 --> 00:19:56.230
Something that's showing that the nerves
coming out of the back are damaged.

00:19:57.690 --> 00:20:00.690
All these factors are providing evidence,

00:20:00.740 --> 00:20:04.110
not just the story,
but evidence for a different story.

00:20:05.240 --> 00:20:08.200
-I like that because that's everybody's
got a story.

00:20:08.410 --> 00:20:10.790
Exactly.
- And how do you interpret that story?

00:20:10.830 --> 00:20:13.210
You said earlier
you only see what you want to see.

00:20:13.210 --> 00:20:15.330
How do people see eye to eye?

00:20:15.330 --> 00:20:17.090
How am I seeing, how am I living my story?

00:20:17.090 --> 00:20:18.300
Exactly.

00:20:18.300 --> 00:20:20.460
-And how can I change
and live that in a different manner?

00:20:20.460 --> 00:20:23.470
And the story is powerful
because predictive coding

00:20:23.470 --> 00:20:26.010
your brain creates
what it expects to create.

00:20:26.510 --> 00:20:29.560
And that's all you're going to be doing
in this pain thing you're-- You're going

00:20:29.560 --> 00:20:32.640
to be changing the story, changing
the messages that you give yourself,

00:20:33.190 --> 00:20:35.900
and you're going to turn around
these pathways in your brain.

00:20:35.900 --> 00:20:38.320
-You got me excited.

00:20:38.400 --> 00:20:40.650
Cool. That’s my job.

00:20:40.650 --> 00:20:41.900
-Well, where do we go from here, then?

00:20:41.900 --> 00:20:43.610
So Alan will be contacting you.

00:20:43.610 --> 00:20:46.280
He’ll be setting up meetings
with you on a twice weekly basis.

00:20:46.280 --> 00:20:47.370
-Gotcha.

00:20:57.210 --> 00:21:01.000
This study is unusual
in a few different ways.

00:21:01.510 --> 00:21:07.390
First, there's never been a study
that's tested a psychotherapy

00:21:07.430 --> 00:21:10.720
treatment for chronic back pain with brain
imaging before and after.

00:21:11.560 --> 00:21:14.810
And another piece is
the collaboration is unusual.

00:21:15.480 --> 00:21:19.230
Neuroscientists,
psychologists, medical doctors.

00:21:19.690 --> 00:21:21.480
You know, Alan's a social worker.

00:21:21.480 --> 00:21:25.610
Dr. Knight is a pain physician.

00:21:25.610 --> 00:21:29.070
Dr. Knight: No, I don't think most of
my colleagues are sitting down

00:21:29.070 --> 00:21:31.990
with primary researchers like this.

00:21:32.830 --> 00:21:35.750
My specialty
is the neuromuscular skeletal system.

00:21:36.160 --> 00:21:40.000
My focus and my practice over
the last 10-15 years has been

00:21:40.670 --> 00:21:43.960
almost exclusively pain management.

00:21:43.960 --> 00:21:47.800
I wish that there was more natural ways
that this was occurring

00:21:48.430 --> 00:21:50.970
where these types of basic scientists

00:21:50.970 --> 00:21:54.430
were speaking to physicians

00:21:54.430 --> 00:21:57.690
and then physicians were having
an opportunity to reach back and say,

00:21:58.230 --> 00:22:00.900
Do you understand
this is what I'm seeing in the clinic?

00:22:01.730 --> 00:22:04.690
A little bit of that happens
in the university

00:22:05.320 --> 00:22:09.110
setting, but us doctors out here
in the trenches who are just trying

00:22:09.110 --> 00:22:12.160
to keep up with their patient load
and meet

00:22:12.160 --> 00:22:17.580
our meaningful use requirements,
people are always on a treadmill

00:22:18.330 --> 00:22:21.040
racing to kind of get through their day.

00:22:21.420 --> 00:22:26.300
There needs to be more opportunity
for research to come out and touch

00:22:27.760 --> 00:22:31.300
ordinary clinicians’ lives and vice versa.

00:22:31.300 --> 00:22:34.890
They need to see what we're doing
in our patients and what's going on.

00:22:35.390 --> 00:22:39.190
This type of research
can really help us understand

00:22:39.600 --> 00:22:43.900
this brain-body connection
and how to actually

00:22:44.480 --> 00:22:47.190
move the needle
in getting people to feel better.

00:22:47.860 --> 00:22:52.370
My goal is to get people better,
whatever way I can

00:22:52.370 --> 00:22:56.500
and if it is through less invasive

00:22:56.950 --> 00:22:59.080
options, wouldn't that be wonderful?

00:23:00.540 --> 00:23:04.210
Traditionally, people in health care

00:23:04.210 --> 00:23:08.170
look for a tissue-based reason
why someone's experiencing pain.

00:23:08.670 --> 00:23:11.260
Some people do have
simple mechanical problems

00:23:11.260 --> 00:23:14.470
that haven't been diagnosed
and we can treat those out.

00:23:15.220 --> 00:23:19.520
But then there's a group of people
who seem to have this persistent pain,

00:23:19.940 --> 00:23:23.520
even when we can't find tissue

00:23:23.730 --> 00:23:27.320
that is inflamed or broken or torn.

00:23:28.190 --> 00:23:32.490
And those people have real
persistent pain.

00:23:32.490 --> 00:23:36.870
Sometimes it's called fibromyalgia,
sometimes it's called chronic widespread

00:23:36.870 --> 00:23:37.950
pain.

00:23:38.200 --> 00:23:41.160
It's pain
that lasts longer than three months.

00:23:41.160 --> 00:23:43.630
That's our definition
of chronic pain right now.

00:23:45.420 --> 00:23:46.590
Chronic pain

00:23:46.590 --> 00:23:49.760
is something that doctors
don't like to deal with

00:23:49.970 --> 00:23:54.680
because they're sort of helpless
with the current medical model.

00:23:55.260 --> 00:23:58.850
They can throw physical therapy at it,
they can throw medications at it,

00:23:59.140 --> 00:24:03.400
they can send them to a pain doctor
who may or may not help them,

00:24:03.730 --> 00:24:05.310
or they can send them to a surgeon

00:24:05.310 --> 00:24:07.440
and then they come back
and they still have pain.

00:24:08.110 --> 00:24:12.450
Doctors are daunted by these patients.

00:24:18.910 --> 00:24:21.830
GREG: So was that Dr. Schubiner behind you?

00:24:21.870 --> 00:24:23.580
-Yeah. Kind of hovering in the back.

00:24:23.580 --> 00:24:25.750
-Am I over here?
-Yes.

00:24:25.750 --> 00:24:26.710
-So you already got Kleenex?

00:24:26.710 --> 00:24:28.630
Am I supposed to cry, too?

00:24:28.630 --> 00:24:30.710
-Just in case.

00:24:33.090 --> 00:24:36.760
ALAN: So the best way-- First of all,
are you on board with the fact

00:24:36.760 --> 00:24:40.220
that from a structural perspective,
you don't have to have pain?

00:24:41.060 --> 00:24:43.810
I would say I'm probably 90% in agreement.

00:24:43.810 --> 00:24:44.850
That's amazing.

00:24:44.850 --> 00:24:49.190
ALAN: It's not always easy to kind of buy into
that right off the bat because it's like

00:24:49.730 --> 00:24:52.900
sometimes you need to experience
something before you can believe it. But

00:24:53.860 --> 00:24:56.620
the idea that there isn't anything
structurally wrong with you,

00:24:56.620 --> 00:24:59.490
what are your thoughts about that
as it applies to you?

00:24:59.950 --> 00:25:02.830
For me, I just think, reflecting on
when I feel like

00:25:02.830 --> 00:25:05.710
I experience the most pain and things
that I do to try and alleviate it.

00:25:06.040 --> 00:25:07.830
I feel like there's some relation in that.

00:25:07.830 --> 00:25:11.250
Like I was describing like particular
like yoga stretches and different

00:25:11.590 --> 00:25:13.050
manipulations I've done to myself.

00:25:13.050 --> 00:25:14.800
I'm like, Oh man, that was a relief.

00:25:14.800 --> 00:25:18.090
But I don't know if that's an association
of this is how I receive relief is

00:25:18.090 --> 00:25:21.180
by like the sounds that come from my back
when I crack it.

00:25:21.220 --> 00:25:22.560
Now I feel better.

00:25:22.560 --> 00:25:25.440
You're saying you're saying
is it possible that

00:25:25.890 --> 00:25:29.730
I'm actually getting relief
because I'm stretching--
-of the tension.

00:25:29.730 --> 00:25:30.320
Yeah, and it’s releasing.

00:25:30.900 --> 00:25:34.110
Or is it just kind of a learned
association, like a placebo?

00:25:34.860 --> 00:25:35.570
I don't know.

00:25:35.570 --> 00:25:39.660
I don't know if it's my posture
or if the fact that as I've aged,

00:25:39.660 --> 00:25:43.080
I've let my body go a little bit
in terms of physical strength,

00:25:43.410 --> 00:25:45.660
and it's not holding itself
in the right way.

00:25:45.660 --> 00:25:50.000
So maybe when it's relaxing, it's
pinching, is I guess what's going on.

00:25:50.000 --> 00:25:52.960
-That is a logical explanation.
-right?

00:25:53.380 --> 00:25:55.380
-Based on the evidence.
-Right.

00:25:55.380 --> 00:25:58.090
There's something structurally

00:25:58.470 --> 00:26:00.850
or from a musculoskeletal perspective.

00:26:01.350 --> 00:26:04.980
That is causing you pain
when you stand because of your position.

00:26:05.270 --> 00:26:05.770
Correct.

00:26:05.770 --> 00:26:08.020
Let me provide an alternate explanation.

00:26:08.310 --> 00:26:11.860
We have the capacity
to generate musculoskeletal tension.

00:26:12.270 --> 00:26:14.820
So take your fist and squeeze it.

00:26:14.820 --> 00:26:17.360
Squeeze it like really squeeze it
until like it hurts.

00:26:17.400 --> 00:26:20.160
Can you feel any tension there?
-I can.

00:26:20.660 --> 00:26:21.990
-That doesn't have anything
to do with anything.

00:26:22.990 --> 00:26:25.000
I'm just kidding. So.

00:26:25.000 --> 00:26:27.120
So you can see when you squeeze it,
it hurt.

00:26:27.120 --> 00:26:29.290
It was tight. It was tense. Right?

00:26:29.290 --> 00:26:31.540
But there's nothing
structurally wrong with it.

00:26:31.540 --> 00:26:34.420
Sometimes
when we're in a state of fight or flight,

00:26:34.880 --> 00:26:37.260
we have a tendency
to unconsciously clench.

00:26:37.970 --> 00:26:40.680
Was there anything growing up

00:26:40.680 --> 00:26:44.430
that had you feeling maybe like,
not perfectly safe?

00:26:44.720 --> 00:26:48.940
No. My parents rarely fought
and actually work together,

00:26:48.940 --> 00:26:51.520
kind of a very model,
in a way, to get along.

00:26:51.610 --> 00:26:55.360
My dad was in charge
and my mom was kind of subservient

00:26:55.360 --> 00:26:57.740
to my dad
and not necessarily in a negative way.

00:26:57.780 --> 00:26:59.950
Maybe it was more the era. Maybe it was.
-Yeah.

00:26:59.950 --> 00:27:02.240
My dad's a very strong personality.

00:27:02.240 --> 00:27:03.580
Did we butt heads? Sure.

00:27:03.580 --> 00:27:05.160
-You and your dad?
-Yes.

00:27:05.160 --> 00:27:07.830
Was your dad's energy ever intimidating?

00:27:08.290 --> 00:27:09.870
Oh, he was very intimidating.

00:27:09.870 --> 00:27:12.380
Oh, very, very much so.
-Tell me about that.

00:27:13.340 --> 00:27:15.880
If you have a tendency
to put a lot of pressure on yourself,

00:27:16.420 --> 00:27:19.090
if you are perfectionistic,

00:27:20.550 --> 00:27:23.760
you know, if you're always--

00:27:23.760 --> 00:27:25.640
-Just yes to all of those questions.

00:27:25.640 --> 00:27:29.890
-Everything, I mean, could you imagine
the state of fight or flight

00:27:29.890 --> 00:27:31.060
You’d be in--
-Yeah.

00:27:31.060 --> 00:27:32.980
-With that much pressure
all the time.

00:27:33.190 --> 00:27:35.440
I hope that I'm not, like I say,

00:27:35.440 --> 00:27:39.900
doing those mental things to my son,
who is an amazing, wonderful kid.

00:27:40.490 --> 00:27:42.950
And yet I have high expectations for him.

00:27:44.700 --> 00:27:46.370
Yeah he sent me a text
the other day

00:27:46.370 --> 00:27:47.950
that kind of broke my heart.
And I'm like...

00:27:48.950 --> 00:27:51.670
dumb ass, what are you doing to your kid?

00:27:52.120 --> 00:27:54.420
You know, and that frustrates me.

00:27:55.090 --> 00:27:58.090
So you almost see yourself kind of like

00:27:58.510 --> 00:28:01.930
putting a level of pressure on him.
-Yes.

00:28:01.930 --> 00:28:04.590
To the point where he actually feels
like he's not deserving.

00:28:04.930 --> 00:28:07.760
Yes. That tears me up.

00:28:10.390 --> 00:28:12.730
You know, it isn't you.

00:28:12.730 --> 00:28:14.270
It's the dad in your head.

00:28:14.270 --> 00:28:16.730
Right? Could be, you know, very much.

00:28:16.900 --> 00:28:18.360
-Your dad,

00:28:18.360 --> 00:28:21.280
You know, made you feel like

00:28:21.280 --> 00:28:23.110
I mean, he loved you.

00:28:23.110 --> 00:28:25.450
And I'm sure that he was--
-very much so.

00:28:25.450 --> 00:28:29.290
Yeah, but I think he had
you feeling like you needed to do

00:28:30.120 --> 00:28:32.660
this or that in order to be enough.

00:28:32.710 --> 00:28:37.090
In order to be successful,
in order to earn his approval.

00:28:37.670 --> 00:28:41.590
And I think that you've kind of
internalized a part of your dad.

00:28:41.920 --> 00:28:44.130
Yeah, I don't ever.

00:28:44.130 --> 00:28:46.890
It's not that I don't want

00:28:46.890 --> 00:28:48.680
it's not that I don't respect
and love my dad.

00:28:48.680 --> 00:28:50.470
I don't want to be my dad.

00:28:50.470 --> 00:28:55.350
It seems like your anxiety
and your pain follows similar tracks.

00:28:55.400 --> 00:28:56.230
-Mm hmm.

00:28:56.600 --> 00:29:00.230
So it's like your pain is just
a physical manifestation of anxiety.

00:29:00.280 --> 00:29:00.900
-Mm hmm.

00:29:00.900 --> 00:29:03.950
So our goal
isn't just to get rid of your pain.

00:29:04.030 --> 00:29:04.490
-Mm hmm.

00:29:04.490 --> 00:29:09.160
It's to get rid of the need for the pain,
to really kind of teach your brain

00:29:09.160 --> 00:29:10.410
a feeling of safety.

00:29:10.410 --> 00:29:10.870
-Mm hmm.

00:29:10.870 --> 00:29:14.290
So, about 90% of people
who have this neural pathway pain

00:29:14.620 --> 00:29:17.830
have a tendency to develop conditioned
responses.

00:29:18.380 --> 00:29:21.710
Conditioned responses
are when certain physical positions or

00:29:21.710 --> 00:29:24.300
activities become linked with the pain.

00:29:24.590 --> 00:29:26.340
Standing seems to be a trigger.

00:29:27.340 --> 00:29:29.680
It isn't
the standing that's causing the pain.

00:29:29.850 --> 00:29:30.430
-Right.

00:29:30.430 --> 00:29:32.680
It isn't the sitting
that's causing the pain.

00:29:32.970 --> 00:29:39.230
These are all learned associations
that your brain has come to interpret

00:29:39.230 --> 00:29:41.230
These positions as dangerous.

00:29:41.690 --> 00:29:45.280
We're going to teach your brain together
that these things

00:29:45.280 --> 00:29:48.870
that you're interpreting are
dangerous are actually safe.

00:29:49.530 --> 00:29:51.910
Does that make sense?
-Makes sense.

00:29:51.910 --> 00:29:53.200
This is the hard part.

00:29:53.200 --> 00:29:58.210
You know, you're you're trying
to introduce a new way of looking at pain,

00:29:58.500 --> 00:30:03.420
to someone who's looked at it
the same way for years.

00:30:04.380 --> 00:30:06.550
So I'll ask them questions to see

00:30:06.550 --> 00:30:09.300
if it reflects what we see a lot.

00:30:09.760 --> 00:30:11.550
Do you have a history of anxiety?

00:30:11.550 --> 00:30:14.390
Do you have pain
in more than one place in your body?

00:30:14.430 --> 00:30:16.180
Do you think about the pain a lot?

00:30:16.180 --> 00:30:18.440
Do you have an enormous
amount of fear around it?

00:30:19.020 --> 00:30:21.190
Are you preoccupied with your symptoms?

00:30:21.480 --> 00:30:25.490
All of these things are ways
to teach their brain that

00:30:25.900 --> 00:30:29.320
this sensation that they're interpreting
as dangerous is actually safe.

00:30:29.570 --> 00:30:30.570
You know, the part of the brain

00:30:30.570 --> 00:30:33.990
that we're trying to educate
is not the logical part of the brain.

00:30:34.540 --> 00:30:37.080
It's the unconscious part of the brain.

00:30:37.500 --> 00:30:40.880
And even if, logically,
they believe that there's nothing

00:30:40.880 --> 00:30:42.460
structurally wrong with them,

00:30:42.460 --> 00:30:45.510
We really need to sell it
to this part of the brain that they don't

00:30:45.510 --> 00:30:48.340
necessarily have conscious control over.

00:30:48.510 --> 00:30:52.550
Once you get them on board,
that's when, you know,

00:30:52.600 --> 00:30:55.600
you start doing the work.

00:30:57.850 --> 00:31:00.520
The relationship between sports

00:31:00.520 --> 00:31:03.940
and therapy, for me, is so integrated.

00:31:05.230 --> 00:31:09.280
The way I do therapy
and the way I shoot a basketball...

00:31:09.650 --> 00:31:11.820
very similarly.

00:31:14.080 --> 00:31:16.120
ALAN: So how have you been over the past
few days?

00:31:16.330 --> 00:31:17.540
GREG: Very good.
-Yeah?

00:31:17.540 --> 00:31:18.620
Very good.

00:31:18.870 --> 00:31:21.330
Last two nights, I slept in the bed,
I normally sleep in a chair.

00:31:22.000 --> 00:31:23.420
-You sleep in a chair?

00:31:23.420 --> 00:31:24.790
I have for years.

00:31:24.790 --> 00:31:26.920
Let's get you sleeping back in a bed.

00:31:26.920 --> 00:31:28.130
-That’d be nice!

00:31:28.130 --> 00:31:30.340
Well, and based on our little

00:31:30.720 --> 00:31:34.510
breathing, you know, feel the breath
instead of breathe deep.
- Look at what you just did.

00:31:34.510 --> 00:31:36.850
When you crossed your legs like that.

00:31:37.270 --> 00:31:40.140
That's an indication
that on some unconscious level,

00:31:41.190 --> 00:31:43.770
There was like a little spike of fear.

00:31:44.230 --> 00:31:47.110
I’m not doing these like crazy shots,

00:31:47.110 --> 00:31:49.990
like hook shots, layups,
like fall away or whatever.

00:31:50.190 --> 00:31:53.490
I’m literally just practicing
shooting the exact

00:31:53.490 --> 00:31:56.990
same way every time to kind of train
my brain to do it.

00:31:57.910 --> 00:32:01.500
Anxiety is like this giant roadblock.

00:32:01.500 --> 00:32:06.880
If you're able to regulate your anxiety,
it opens you up to all kinds of feelings.

00:32:07.300 --> 00:32:10.090
And feelings
inherently aren’t bad, even sadness.

00:32:10.090 --> 00:32:12.130
It's not bad.

00:32:13.050 --> 00:32:16.180
It can be fun,
but you're not out there to have fun.

00:32:16.390 --> 00:32:18.220
You're out there to learn a skill.

00:32:19.560 --> 00:32:21.730
So what are you feeling right now
as we're talking?

00:32:22.020 --> 00:32:24.310
Now, let's call it a sensation
and it feels hot,

00:32:26.110 --> 00:32:27.610
but it's not bothersome at all.

00:32:27.610 --> 00:32:28.650
-It's not pain.

00:32:28.650 --> 00:32:30.150
Not at all.
-Yeah.

00:32:30.150 --> 00:32:31.440
Now, I still have pain in my heel.

00:32:31.440 --> 00:32:32.740
And I notice that.

00:32:32.740 --> 00:32:34.780
ALAN: Getting feedback from what's happening,

00:32:34.990 --> 00:32:37.660
trying to integrate
with all of the information that you know,

00:32:37.660 --> 00:32:40.620
what's the best direction to go,
what could happen if you do this?

00:32:40.620 --> 00:32:42.870
What could happen if you do that?

00:32:43.290 --> 00:32:46.710
If you're, you know, scared
about something happening psychologically,

00:32:46.960 --> 00:32:50.170
your brain could mistake
that as a physical threat.

00:32:50.170 --> 00:32:53.130
And that's when you could have
either anxiety or pain.

00:32:53.420 --> 00:32:55.930
So if you end this study
and you have no back pain

00:32:56.220 --> 00:32:59.850
and your anxiety is up here,
we haven't done anything.

00:32:59.850 --> 00:33:01.720
I think you've really come a long way

00:33:01.720 --> 00:33:04.480
with regard to teaching your brain
that these sensations are safe.

00:33:04.810 --> 00:33:07.400
But I think there are still some
things that you're scared of.

00:33:08.770 --> 00:33:10.360
Standing, for Instance.

00:33:10.360 --> 00:33:10.900
-Still.

00:33:10.900 --> 00:33:14.610
Yeah. So what I want to try is
see if we could

00:33:14.820 --> 00:33:19.740
have you stand up for short instances
of time and just kind of practice

00:33:20.330 --> 00:33:23.040
when you're ready, just stand up
and we're only going to have you do it

00:33:23.290 --> 00:33:25.250
for like 30 seconds.

00:33:25.250 --> 00:33:27.540
All right,
the back pain is going to come up.

00:33:27.580 --> 00:33:29.340
-It already has.
-It already has? Great.

00:33:29.340 --> 00:33:32.090
All right, we want it to
because this is an opportunity.

00:33:33.210 --> 00:33:37.840
Your goal is to try to get the person
a number of corrective experiences

00:33:38.050 --> 00:33:40.850
to teach their brain
that the sensation is non-dangerous.

00:33:41.680 --> 00:33:44.600
All we want you to do right now
is see if you can just kind

00:33:44.600 --> 00:33:47.980
of practice paying attention
to the physical sensation in your back.

00:33:48.440 --> 00:33:50.110
See what's going on.

00:33:50.110 --> 00:33:51.900
And now sit down again.

00:33:52.900 --> 00:33:55.780
Good.

00:33:55.780 --> 00:33:57.780
So what are you feeling in your back?

00:33:57.780 --> 00:33:59.620
-Sharp pain.
-Okay.

00:33:59.620 --> 00:34:01.910
And was it scary for you?
-Yes.

00:34:01.910 --> 00:34:03.910
Were you relieved to sit down again?

00:34:03.950 --> 00:34:04.500
Yes.

00:34:04.540 --> 00:34:06.830
ALAN: There is a process.

00:34:07.750 --> 00:34:10.420
Don't forget to bend your knees,
use your legs

00:34:11.170 --> 00:34:13.590
and follow through.

00:34:13.590 --> 00:34:15.840
All right. So stand up again.

00:34:15.840 --> 00:34:17.220
And you're doing great.

00:34:17.220 --> 00:34:18.630
The pain’s going to come on.
-Right.

00:34:18.630 --> 00:34:19.930
But let the pain come on.

00:34:19.930 --> 00:34:22.850
Because all we know is that
this is just a condition response.

00:34:23.010 --> 00:34:24.930
So right now,
is there still some residual?
-Yes.

00:34:24.930 --> 00:34:27.850
Right under here.
-Try again.

00:34:27.890 --> 00:34:30.810
And this time, see if you can actually
feel a little bit empowered.

00:34:31.190 --> 00:34:34.820
It seems like you're
just kind of like in the flow, but really

00:34:34.820 --> 00:34:38.610
what you're doing is
you're making like a thousand decisions.

00:34:39.700 --> 00:34:41.410
And how are you feeling right now?

00:34:41.410 --> 00:34:43.120
-Fine.
-Great! K, sit back down.

00:34:43.120 --> 00:34:46.080
-Again, a little tense in the back,
honestly, I feel that.

00:34:46.080 --> 00:34:47.160
-That's good.

00:34:47.160 --> 00:34:48.460
-But it wasn't pain.

00:34:48.460 --> 00:34:50.330
-It wasn't pain.
-Wasn't pain.

00:34:50.330 --> 00:34:52.460
-Let's try it again, I’ll stand with you.
-We’re doing reps.

00:34:52.500 --> 00:34:53.920
-Yeah we're doing reps.

00:34:53.920 --> 00:34:56.800
We're doing brain reps,
neural pathway repetitions.

00:34:57.420 --> 00:34:59.720
Just being so detail oriented,

00:35:00.340 --> 00:35:03.260
working on something over and over
and over.

00:35:03.260 --> 00:35:05.890
You've been standing
for three straight minutes without moving

00:35:06.100 --> 00:35:07.350
and you have no pain in your back.

00:35:07.350 --> 00:35:08.100
-Isn’t that amazing?

00:35:08.100 --> 00:35:10.650
I mean,
how do you get excited about standing?

00:35:13.060 --> 00:35:15.780
ALAN: You know, there are times
when the pain is going to be really bad

00:35:16.110 --> 00:35:20.240
and if you follow the process,
you will get out of pain.

00:35:20.320 --> 00:35:23.830
There have been moments
where, yeah, the pain will rise.

00:35:23.830 --> 00:35:25.910
But then again,
I feel like I'm just saying bring it.

00:35:26.200 --> 00:35:28.830
-Because you know that it isn't dangerous.
-Yeah.

00:35:29.830 --> 00:35:31.830
I know that you had a
little bit of a setback.

00:35:32.170 --> 00:35:35.380
-I had a setback that one day
and then...

00:35:35.380 --> 00:35:37.460
Did it throw you back into a
state of fear a little bit?

00:35:37.710 --> 00:35:39.340
-No, I don't. I don't think so.

00:35:41.010 --> 00:35:42.300
How are you doing?

00:35:42.300 --> 00:35:43.510
-I'm okay.

00:35:43.550 --> 00:35:44.850
How is your back pain?

00:35:44.850 --> 00:35:46.180
-Totally fine

00:35:47.560 --> 00:35:48.520
What’s going on?

00:35:49.350 --> 00:35:53.690
-I mean, not the best
I could possibly feel.

00:35:54.060 --> 00:35:55.730
ALAN: You want to tell your brain it's safe.

00:35:55.730 --> 00:35:58.190
This is just temporary.
You're going to be okay.

00:35:58.230 --> 00:36:00.280
Trust the process.

00:36:00.280 --> 00:36:04.240
If you train your brain
to shoot the same way every time,

00:36:04.570 --> 00:36:09.370
it could be
almost impossible to miss.

00:36:16.880 --> 00:36:18.750
Hm.

00:36:18.840 --> 00:36:22.180
While I was in the lab in the past eight
years, my interests have kind of morphed.

00:36:22.180 --> 00:36:23.800
And I got very interested
in placebo effects.

00:36:23.800 --> 00:36:27.100
And then in the past year,
these three studies came out

00:36:27.100 --> 00:36:29.850
about heart pain, shoulder
pain, knee pain.

00:36:30.140 --> 00:36:31.930
They did the surgery as appropriate

00:36:31.930 --> 00:36:34.980
in the part of the body
and they compared it to placebo surgery.

00:36:34.980 --> 00:36:38.940
So the doctor kind of goes
in, clinks around a little bit, pulls out,

00:36:39.400 --> 00:36:42.900
you wake up the patient if they're under
anesthesia, say you just got surgery.

00:36:43.320 --> 00:36:45.990
And the sham surgery
did just as well as the real surgery.

00:36:45.990 --> 00:36:49.870
I mean, so just the the mirage,
the illusion of surgery was sufficient

00:36:50.080 --> 00:36:52.960
to get all the benefit
of the real surgery.

00:36:53.500 --> 00:36:57.250
And in fact, the knee pain
one was steroid injections into the knee.

00:36:57.250 --> 00:36:59.800
And the placebo group actually did better
because over time,

00:36:59.800 --> 00:37:02.630
the steroid injections into the knee
were eating away cartilage.

00:37:02.800 --> 00:37:05.640
And so you'd rather
be in the placebo group than actually

00:37:05.640 --> 00:37:07.550
getting the injections.

00:37:07.550 --> 00:37:09.930
I think the essence of the psychotherapy,

00:37:10.260 --> 00:37:13.850
the way it works, is
a reappraisal of your symptoms.

00:37:14.560 --> 00:37:17.650
Imagine your car alarm's going off
and you think it's a burglar breaking

00:37:17.650 --> 00:37:18.150
into your car.

00:37:18.150 --> 00:37:21.480
So you're, like, flipping out
and having a huge reaction.

00:37:21.820 --> 00:37:25.490
But imagine your car alarm’s going off and
you know it just the wind and who cares?

00:37:26.070 --> 00:37:30.120
And that kind of attitude,
I think, is the essence of the treatment.

00:37:31.830 --> 00:37:33.620
YONI: In terms of how the
Study’s going,

00:37:33.620 --> 00:37:35.750
they're pretty remarkable results.

00:37:36.460 --> 00:37:41.340
YONI: About 16 or 17 people have finished
the therapy.

00:37:41.340 --> 00:37:45.470
Alan's been telling me
that all these people

00:37:45.470 --> 00:37:47.680
he's treating are getting out of pain.

00:37:47.680 --> 00:37:49.390
Like zero pain.

00:37:49.390 --> 00:37:51.640
Yeah, we have been talking about this.
I know.

00:37:51.640 --> 00:37:54.230
Was that on camera when Alan
just said you're right, I wanted that.

00:37:54.810 --> 00:37:55.940
DR. KNIGHT: Yeah, was that on camera?

00:37:55.940 --> 00:37:57.980
ALAN: You’re right, it’s the stimulus.

00:37:57.980 --> 00:37:59.730
The therapy Alan's doing

00:37:59.730 --> 00:38:03.280
has been very effective for the people
that have been coming into this study.

00:38:03.320 --> 00:38:05.570
We'll have to see if they hold up. Maybe.

00:38:05.570 --> 00:38:06.150
I'm secretly

00:38:06.150 --> 00:38:06.820
hoping that

00:38:06.820 --> 00:38:07.860
in the second half of the

00:38:07.860 --> 00:38:10.780
of the patients, they're all going to be
total non-responders.

00:38:11.120 --> 00:38:15.040
And they'll just blow you off and tell you
you're out of your mind and walk out.

00:38:15.330 --> 00:38:16.160
-That could happen.

00:38:16.160 --> 00:38:19.210
Because the results have been almost,
almost too good.

00:38:19.210 --> 00:38:20.250
You know, to believe.

00:38:20.250 --> 00:38:24.130
Yeah, I think even for you,
you're even like, what is going on here?

00:38:24.130 --> 00:38:25.760
How is this even working so well?

00:38:25.760 --> 00:38:27.930
-It is like almost kind of a little scary,

00:38:28.590 --> 00:38:32.140
but I think one of the reasons
why the results are so much better

00:38:32.140 --> 00:38:35.270
is because the majority of chronic back

00:38:35.270 --> 00:38:40.270
pain is not structurally caused
and it was just learned.

00:38:41.610 --> 00:38:45.820
I'm really excited about what you're doing

00:38:47.110 --> 00:38:50.700
because if we can get better tools on

00:38:50.740 --> 00:38:55.240
managing that part and we can actually
convince insurance companies, etc.,

00:38:55.240 --> 00:39:00.920
to pay for different types of treatment,
there's a huge component of chronic pain

00:39:00.920 --> 00:39:04.130
that has to do
with the psychological part of it.

00:39:04.880 --> 00:39:09.970
And obviously mindfulness types
of training can be extremely helpful.

00:39:09.970 --> 00:39:14.390
And from a medical perspective,
if it's not physiologic pain,

00:39:14.390 --> 00:39:16.890
the doctor tells you to go away.
-Right.

00:39:16.890 --> 00:39:19.560
And that is not very thoughtful

00:39:19.560 --> 00:39:22.480
or compassionate
or very helpful to patients.

00:39:23.110 --> 00:39:25.570
I didn't necessarily

00:39:25.570 --> 00:39:28.940
I, I don't agree with you,

00:39:29.570 --> 00:39:32.280
but I'm so fascinated

00:39:32.570 --> 00:39:35.490
about the implications.

00:39:36.240 --> 00:39:40.620
So the way that you
intellectually structure this,

00:39:40.620 --> 00:39:46.300
I think can be very negative
to people who have chronic pain

00:39:47.250 --> 00:39:49.720
from a medical perspective.

00:39:49.970 --> 00:39:51.840
That's really interesting
that you say that

00:39:51.840 --> 00:39:54.180
because I feel the same way about you.

00:39:54.850 --> 00:39:55.390
-What?

00:39:55.390 --> 00:39:59.060
I feel like letting someone know
that there's something

00:39:59.060 --> 00:40:03.190
physically wrong with you
is incredibly damaging

00:40:03.730 --> 00:40:08.070
because it reinforces to their brain
this danger.

00:40:08.280 --> 00:40:10.240
That's only part of what I say.

00:40:10.240 --> 00:40:12.280
-I know.
-And what if it's true?

00:40:12.280 --> 00:40:14.780
I think, if it's true...

00:40:15.280 --> 00:40:16.870
You know, I agree with you.

00:40:16.870 --> 00:40:19.950
I think letting someone know
there's nothing

00:40:19.950 --> 00:40:22.790
structurally wrong with you
if there is, is incredibly damaging.

00:40:22.790 --> 00:40:24.000
But likewise,

00:40:24.000 --> 00:40:25.670
I think letting someone know

00:40:25.670 --> 00:40:27.420
there is something
structurally wrong with you

00:40:27.420 --> 00:40:30.880
if there isn't, is just going to
perpetuate the perceived danger.

00:40:31.380 --> 00:40:34.800
But I'm really, really thorough

00:40:34.800 --> 00:40:39.310
and vigilant to not do that
because you never,

00:40:39.680 --> 00:40:41.850
ever want
to treat someone from this approach

00:40:42.140 --> 00:40:44.310
if there's something
structurally wrong with you.

00:40:44.310 --> 00:40:49.530
The difference between us is our belief
of what percentage

00:40:49.530 --> 00:40:53.200
of chronic back pain patients
have something physically wrong with them.

00:40:53.450 --> 00:40:57.490
But here's
where I think we differ, is that

00:40:57.490 --> 00:41:01.410
I think that you can have
these structural things going on

00:41:01.790 --> 00:41:06.250
and you can also tell them that
they don't have to have pain from them.

00:41:07.210 --> 00:41:08.380
-But that is what I tell them.

00:41:08.380 --> 00:41:11.420
You know, I say--
-But you’re saying there's nothing

00:41:11.420 --> 00:41:12.170
structurally wrong with them.

00:41:12.170 --> 00:41:15.260
-I'm saying that there's--
they’re normal abnormalities.

00:41:15.260 --> 00:41:18.220
Saying there's something
structurally wrong with you implies

00:41:18.550 --> 00:41:21.140
that the structural abnormalities
are causing the pain.

00:41:21.430 --> 00:41:23.520
There's something structurally wrong
with all of us.

00:41:23.520 --> 00:41:26.440
I mean, the only people
who don't have structural--

00:41:26.440 --> 00:41:27.060
-Oh, really?

00:41:27.100 --> 00:41:28.730
So there is?
-Of course.

00:41:28.730 --> 00:41:32.740
-So we can't educate people about
their actual body that they're living in.

00:41:32.940 --> 00:41:36.200
I let people know, you know,
you have a disc

00:41:36.200 --> 00:41:38.950
herniation, you have disc desiccation,
you have arthritis.

00:41:39.240 --> 00:41:40.530
But that's totally normal.

00:41:40.530 --> 00:41:42.750
And it isn't the cause of your pain.

00:41:42.750 --> 00:41:43.580
When we say there's.

00:41:43.580 --> 00:41:46.620
nothing--
-But when I'm saying what
their pain is, I'm saying it's a complex

00:41:46.620 --> 00:41:52.090
phenomenon and maybe, er--
this thing could be contributing to it.

00:41:52.090 --> 00:41:56.800
But your experience of pain, you’re
saying that--
-I think it's very simple.

00:41:57.180 --> 00:41:59.550
You know, I think that it's like
if someone's sick,

00:41:59.890 --> 00:42:03.430
you're not like it's 70%
bacterial and 30% viral.

00:42:03.430 --> 00:42:05.310
It's usually one or the other.

00:42:05.310 --> 00:42:07.940
And generally speaking, I think that it's

00:42:07.940 --> 00:42:10.860
either entirely structurally based.

00:42:11.110 --> 00:42:14.570
It's structurally based,
but the brain is exacerbating it

00:42:14.780 --> 00:42:18.280
or it's entirely generated by the brain.

00:42:18.280 --> 00:42:23.700
And I think the majority of people--
-And that is not my experience
that many, most people who are suffering

00:42:23.700 --> 00:42:29.250
from very significant
chronic pain have both components to it.

00:42:29.250 --> 00:42:30.460
-How could you know, though?

00:42:30.460 --> 00:42:32.710
-Because that’s what I do for a Living,
-What are you basing that off?

00:42:32.710 --> 00:42:35.050
-No, until you get them out of pain,

00:42:35.050 --> 00:42:37.300
you can't know what was causing
their pain.

00:42:37.300 --> 00:42:40.970
You know, of the 16 patients
that we've seen in the treatment group

00:42:40.970 --> 00:42:43.970
who've completed it so far, 13 of them

00:42:43.970 --> 00:42:46.680
are either completely pain
free or nearly pain free.

00:42:47.100 --> 00:42:51.690
Right? And you can't know
what was the cause of their pain for sure,

00:42:52.190 --> 00:42:54.900
until you've treated it

00:42:54.900 --> 00:42:57.740
and made that determination.

00:43:00.160 --> 00:43:02.200
GREG: Not going to call it
an out of body experience, but...

00:43:03.530 --> 00:43:04.870
walking down this corridor at

00:43:04.870 --> 00:43:08.370
the Bellagio,
and that's when it’s like, “oh, this is...

00:43:08.870 --> 00:43:10.580
what's going on, this is..?”

00:43:10.580 --> 00:43:12.670
And then, when it hit and I stumbled,

00:43:13.090 --> 00:43:15.880
That moment...

00:43:15.880 --> 00:43:17.260
was...

00:43:18.380 --> 00:43:19.220
so intense.

00:43:19.220 --> 00:43:21.550
It was so powerful and yet so quick.

00:43:22.390 --> 00:43:25.680
No pain this weekend until this morning
and I just leaned into it

00:43:25.930 --> 00:43:28.850
and just thought of it
more as a novelty rather, as you describe.

00:43:28.930 --> 00:43:31.560
-Yeah.
-Oh, yay, this is an opportunity.
-It’s an opportunity.

00:43:31.560 --> 00:43:32.730
-Yeah.

00:43:32.730 --> 00:43:33.480
And same thing.

00:43:33.480 --> 00:43:37.990
I think it happened midday and, yeah, it
came up and just seeing it for what it is.

00:43:38.320 --> 00:43:39.240
-Good!

00:43:39.320 --> 00:43:42.490
ALAN: Being a therapist is the one job

00:43:42.570 --> 00:43:45.200
where your goal is to get fired
by your client.

00:43:45.580 --> 00:43:48.750
You know, you want to help them to a point
to where they don't need you anymore.

00:43:49.250 --> 00:43:55.090
I'm glad it happened because it allows me
to know that I'm going

00:43:55.090 --> 00:43:59.130
to have sensations and it doesn't mean
I have to go back in the same rut.

00:43:59.130 --> 00:44:00.630
-And it...

00:44:00.630 --> 00:44:03.340
It doesn't mean it's going to last
each time--

00:44:03.340 --> 00:44:05.010
-It hasn't.

00:44:05.010 --> 00:44:07.600
ALAN: Our goal
is to teach them how to feel safe.

00:44:09.020 --> 00:44:11.560
There's them
and then there's their primitive brain.

00:44:11.850 --> 00:44:14.650
I kind of think of like
the primitive brain as like a five year

00:44:14.650 --> 00:44:17.520
old kid during like a lightning
and thunderstorm.

00:44:18.070 --> 00:44:22.200
Your job is to take that little kid
and let him know that he's safe.

00:44:24.160 --> 00:44:25.410
15 years.

00:44:25.410 --> 00:44:27.370
That is so long.

00:44:27.370 --> 00:44:28.540
So long.

00:44:28.540 --> 00:44:29.950
Oh, my God.

00:44:29.950 --> 00:44:32.830
I'm 25. That's way over
half my life.

00:44:32.830 --> 00:44:34.500
Oh, this makes me want to cry.

00:44:34.500 --> 00:44:36.500
-You’ve had pain
since you were nine years old.

00:44:36.540 --> 00:44:37.500
Yeah.

00:44:37.630 --> 00:44:38.420
-It's really funny.

00:44:38.420 --> 00:44:42.680
Like, I feel like you got everything
out of this treatment

00:44:43.010 --> 00:44:44.930
so that the last two sessions.

00:44:44.930 --> 00:44:48.060
We just kind of hung out. It's funny
because I'm just kind of like writing

00:44:48.060 --> 00:44:48.970
notes.

00:44:48.970 --> 00:44:52.230
Lindsey, seventy seven, hung out.

00:44:53.140 --> 00:44:57.310
I think the one thing to continue
applying these lessons to...

00:44:58.320 --> 00:45:01.740
Teaching your brain that
emotions are safe, too.

00:45:01.740 --> 00:45:02.740
-Right.

00:45:02.740 --> 00:45:06.160
What percent would you--
Do you think you improved?

00:45:06.620 --> 00:45:08.280
Well, I would say 100%.

00:45:08.280 --> 00:45:12.870
I mean, I mean, it's without...
I feel like I've gotten my life back.

00:45:13.000 --> 00:45:14.710
I really do.

00:45:14.710 --> 00:45:16.920
-Do you really feel like you're--

00:45:17.080 --> 00:45:18.880
I mean, you talk about-- I feel healed.

00:45:18.880 --> 00:45:20.750
I really do feel healed.

00:45:20.750 --> 00:45:21.210
-All right.

00:45:21.210 --> 00:45:21.760
Give me a hug.

00:45:21.760 --> 00:45:22.550
-All right. Yeah.

00:45:22.550 --> 00:45:24.760
I appreciate it. Thank you, sir.

00:45:24.760 --> 00:45:25.260
I do.

00:45:25.260 --> 00:45:27.640
I do appreciate everything.
more than you know.

00:45:49.990 --> 00:45:53.160
Science just progresses like molasses.

00:45:54.870 --> 00:45:58.000
The entire last 12 months of my life
have just been analyzing the data

00:45:58.500 --> 00:46:01.840
and then sharing it,
how amazing the results are.

00:46:03.130 --> 00:46:06.800
I am 95% pain free.

00:46:07.180 --> 00:46:11.720
They, through just talking to me about why
I'm having this pain and what it is,

00:46:12.470 --> 00:46:15.390
kind of helped me to understand

00:46:15.390 --> 00:46:19.270
what was going on in my body
and therefore be able to control it.

00:46:19.480 --> 00:46:20.150
I was

00:46:21.230 --> 00:46:24.030
surprised that the study

00:46:24.030 --> 00:46:26.400
was going this way,
that I didn't think it was going to go.

00:46:28.070 --> 00:46:30.570
YONI: After treatment,
People who are treated with PRT

00:46:31.240 --> 00:46:36.580
had less response
in several brain regions,

00:46:36.580 --> 00:46:39.830
including the anterior insula, mid
cingulate, and prefrontal cortex.

00:46:41.340 --> 00:46:44.380
What we know is that those regions

00:46:44.380 --> 00:46:49.800
are all really involved
in assigning the threat

00:46:49.800 --> 00:46:54.180
level to a stimulus and making
meaning of how threatening something is.

00:46:55.100 --> 00:46:59.650
Their brains were in less pain.

00:46:59.650 --> 00:47:04.070
Two thirds of patients randomized to PRT

00:47:04.690 --> 00:47:09.490
were pain free or nearly
so after treatment.

00:47:09.490 --> 00:47:12.870
Usually the pain,
you know, it's a couple of minutes.

00:47:12.870 --> 00:47:14.990
I kind of think about it
and then I go about my day.

00:47:15.330 --> 00:47:16.580
It usually doesn't come back, so...

00:47:16.580 --> 00:47:18.910
Well, most days I have no pain at all.

00:47:19.000 --> 00:47:21.000
I still have maybe a little stiffness

00:47:21.000 --> 00:47:23.590
if I've been sitting in a chair
and working for an hour.

00:47:24.380 --> 00:47:26.380
It definitely, like I said, makes me

00:47:26.840 --> 00:47:29.470
look at pain totally, totally differently.

00:47:29.880 --> 00:47:33.050
You know, after a couple of months of
talking to Alan it was pretty much gone.

00:47:33.680 --> 00:47:37.810
YONI: Before treatment, Basically
everyone believed their pain was due

00:47:37.810 --> 00:47:42.770
to injuries or sitting or bad posture
or degenerative disc disease.

00:47:42.770 --> 00:47:45.400
After treatment,
suddenly people were telling us

00:47:45.400 --> 00:47:49.030
a totally different story
about what was causing their pain.

00:47:49.030 --> 00:47:52.200
They were saying it
was due to stress,
to neural pathways,

00:47:52.200 --> 00:47:55.160
to anxiety, to their life history.

00:47:55.950 --> 00:48:01.920
And what we found
is that the more people shifted in what

00:48:01.920 --> 00:48:06.460
they believed to be causing their pain,
the more they had a pain reduction.

00:48:07.090 --> 00:48:10.590
What I found was really interesting was
it wasn't just helping me with the pain,

00:48:10.590 --> 00:48:13.720
but it felt like it was helping me
with other things that I was dealing with,

00:48:13.720 --> 00:48:17.430
like anxiety or stress
or things like that.

00:48:17.760 --> 00:48:21.270
It was a dramatic
Reconceptualization of pain.

00:48:21.810 --> 00:48:24.560
I mean,
I think Alan really had to work hard

00:48:24.560 --> 00:48:27.190
those first four sessions
to kind of chip away

00:48:27.730 --> 00:48:31.780
at my kind of--
the grip that I had on this belief.

00:48:32.280 --> 00:48:37.330
He kept saying, “pain is an opportunity
and your emotions are an opportunity.”

00:48:37.330 --> 00:48:38.870
And at first that used to piss me off.

00:48:38.870 --> 00:48:44.170
It doesn't anymore because I'm realizing
they are absolutely an opportunity.

00:48:45.750 --> 00:48:46.920
LINDSAY: Please rate your pain

00:48:46.920 --> 00:48:49.500
by choosing the one number
that best describes your pain.

00:48:50.300 --> 00:48:52.630
At its worst this week?

00:48:52.630 --> 00:48:55.640
Zero. On average? Zero. Right now? Zero.

00:48:56.090 --> 00:48:57.970
Pain dictated

00:48:57.970 --> 00:49:00.970
the way that I lived my daily life.

00:49:01.140 --> 00:49:05.310
It was giving it more power
by just feeding into it.

00:49:05.310 --> 00:49:07.610
And I feel like that

00:49:07.610 --> 00:49:10.360
was not beneficial and that I had never

00:49:10.360 --> 00:49:14.320
really talked to a therapist about it
being something not physiological.

00:49:14.450 --> 00:49:18.200
I felt ready to not be in pain anymore
for sure, but I felt like also attached

00:49:18.200 --> 00:49:20.200
to my story
because it's defined me.

00:49:20.870 --> 00:49:23.370
GREG: Sitting. I can sit in a
chair as long as I like.

00:49:24.290 --> 00:49:25.750
Standing.

00:49:25.750 --> 00:49:28.500
I can stand as long as I want
without extra pain.

00:49:29.710 --> 00:49:34.170
I could never imagine,
14 months ago, a life without back pain.

00:49:35.800 --> 00:49:39.180
I was resigned, the fact that I had a dad
bod and I would not be active

00:49:39.180 --> 00:49:42.890
and I was just going to be growing old,
and I didn't like that.

00:49:43.270 --> 00:49:47.850
And now, today, I don't even think about
back pain because it's not there.

00:49:48.150 --> 00:49:49.480
It's not even like I worry.

00:49:49.480 --> 00:49:51.400
Is it coming? Is it not coming?

00:49:51.400 --> 00:49:54.240
That thought doesn’t even cross my mind
because I don't have back pain.

00:49:55.110 --> 00:49:57.280
And I've essentially gotten my life back.

00:49:57.280 --> 00:50:05.160
It's absolutely amazing.

00:50:05.160 --> 00:50:10.290
Everybody has a story
and it may or may not be the truth,

00:50:10.290 --> 00:50:15.090
but it is their story
and it is what they make true.

00:50:20.470 --> 00:50:22.640
YONI: Our study highlights

00:50:23.140 --> 00:50:27.810
that the mind and brain
are often at the center of chronic pain

00:50:28.190 --> 00:50:31.360
and that treatments that target
the mind and brain

00:50:31.820 --> 00:50:36.320
can eliminate chronic pain
for many people.

00:50:36.950 --> 00:50:41.120
And this opens up a lot of fascinating

00:50:41.120 --> 00:50:44.830
future directions.

00:50:44.830 --> 00:50:50.750
DR. KNIGHT: I think working on this study
reaffirmed to me how important it is

00:50:50.790 --> 00:50:55.510
to break this paradigm.

00:50:55.510 --> 00:51:00.470
The whole process has given me courage
to try to do that within the confines.

00:51:00.470 --> 00:51:03.640
Of traditional biomedical practice.

00:51:07.060 --> 00:51:11.270
YONI: I'm basically a believer
that chronic pain can be unlearned.

00:51:11.650 --> 00:51:16.690
What I'm not a believer in
is how robust it is, how reliable it is.

00:51:17.030 --> 00:51:20.700
Can you get like, you know,
like 70% of the people, you know,

00:51:20.740 --> 00:51:24.830
60, 70% of people out of pain reliably,
which is what we saw in the study.

00:51:25.040 --> 00:51:26.830
I have no idea if that's reliable.

00:51:26.830 --> 00:51:30.290
That needs to be,
you know, more studies, more therapists.

00:51:30.960 --> 00:51:32.250
But that this is possible?

00:51:32.250 --> 00:51:35.050
It's possible to unlearn chronic pain
using these specific

00:51:35.590 --> 00:51:37.840
strategies and approaches,
maybe other ones?

00:51:38.130 --> 00:51:39.840
Yes, I believe.

00:51:39.840 --> 00:51:40.720
I've been convinced.

00:51:40.720 --> 00:51:44.890
The data to me is so compelling
just looking at that is so compelling.

00:51:50.980 --> 00:51:55.110
ALAN: What we showed in the study
is that we can get

00:51:55.110 --> 00:51:58.570
the majority of people out of chronic pain
in a short amount of time.

00:51:59.610 --> 00:52:01.820
There were 50 people in this treatment
group.

00:52:02.070 --> 00:52:07.790
Every single one of these patients
represents a million people.

00:52:07.790 --> 00:52:11.040
Literally,
there's tens of millions of people

00:52:11.080 --> 00:52:15.670
who are suffering
and many of them are suffering to a point

00:52:15.670 --> 00:52:20.130
where one thing could kind of
change the course between someone

00:52:20.130 --> 00:52:24.760
having a miserable existence
or having a joyful existence.

00:52:25.140 --> 00:52:27.390
Like, this is the barrier for that.

00:52:27.390 --> 00:52:32.020
If you think of like one single person
who you've known who is just miserable

00:52:32.230 --> 00:52:35.650
and if you could imagine flipping a switch
and all of a sudden

00:52:35.810 --> 00:52:39.690
the next 50 years of their life
are like really nice and pleasant

00:52:39.690 --> 00:52:40.690
and they're happy.

00:52:40.690 --> 00:52:42.530
And it's like that.

00:52:42.530 --> 00:52:44.610
But like times 50 million.