661: Rachel Zoffness | Managing Pain In Your Body and Brain

661: Rachel Zoffness | Managing Pain In Your Body and Brain

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[00:00:06] Coming up next on The Jordan Harbinger Show. 

[00:00:08] Rachel Zoffness: Pain is one of the biggest stressors on the human body. Like moving cross-country is stressful, and death of a loved one is stressful, but being in pain day in and day out is a huge stressor. So not only are we facing pain, but our brain is in this state of fight-or-flight emergency. And we know that amplifies the pain alarm. So it's just so important for people with pain to know that part of what's happening for them is that their brain has become extra sensitive. And it is alarming when it doesn't need to.

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[00:01:33] Today, we're going to learn about pain from my friend and pain genius, Dr. Rachel Zoffness. She's a really amazing pain psychologist and pain neuroscience expert, focusing on kids and pain, which is both noble and heartbreaking to think about. It's a big reason why I've got such a soft spot for her and for this topic here today. We're talking not only about acute but also chronic pain, what pain really is, where it exists in our body, and its effects on the brain. I've never learned about this stuff. It just occurred to me — I know nothing about pain or at least I didn't until this episode. It turns out it's all pretty fascinating. We'll also discuss pain treatment, what modern medicine gets wrong, and what we can and should do instead. Hey, even if you don't have pain, this episode will teach you about something that millions of people have to live with every single day. And if you do have pain, what this episode will do is offer you hope and a better path forward. 

[00:02:25] Here, we go with Dr. Rachel Zoffness.

[00:02:29] So I almost got bit by a bullet ant in the Amazon. 

[00:02:34] Rachel Zoffness: Almost doesn't count.

[00:02:35] Jordan Harbinger: No, but it counts enough for the story — so that's my point. I almost had a really good story for this episode, but I'm also really glad that I don't have a really good story for this episode. Because it was the last day of a two-week-long Amazon hiking trip. And it came out of my backpack where I had my wallet and we were paying the bill for the hotel at the end. And I was like, "I brought cash," and I pulled my wallet out and there was a bullet ant on my wallet and I've never thrown so much money so far away in my whole life. 

[00:03:06] Rachel Zoffness: I'm not actually sure which to react to first, the fact that there was a bullet ant in your backpack or that you were paying for an expensive hotel in cash, but all of those things are— 

[00:03:15] Jordan Harbinger: There are very few hotels in the jungle, so you don't have much choice and they also don't have much Internet. So it's kind of like if you don't bring cash, I'm not really sure what happens to you at the end. 

[00:03:26] Rachel Zoffness: Fair. I'm glad you didn't get bitten, by the way. 

[00:03:28] Jordan Harbinger: Yeah. That's a memory I don't really need. And also anything that causes that much pain, if you Google bullet ant and bullet ant pain, it sounds truly awful. Like it comes in waves of unstoppable pain and there's like, no way to get rid of it. There's no antidote for it. You just have to deal with it, which thinking about it gives me a lot of sympathy for some of the people that you've talked about in your work, because these are people that didn't go on a silly hiking trip to the Amazon and have worse or similar pain to what a bullet ant could do to you, but it's coming from inside their body. And there's nothing they can do about it, seemingly or at least that's what they think. 

[00:04:07] And so we're going to talk about a little bit of that today, but I wanted to start off on a little commonality here, which is that I also had some stomach pain as a kid. 

[00:04:15] Rachel Zoffness: You did?

[00:04:15] Jordan Harbinger: Yeah. And I'm like I had that, but I just really didn't want to go to school. And I kind of knew that was what was going on. But I was like, but also my stomach hurts. But also when I think about how much I don't want to go to school, my stomach hurts more. So they're probably connected, but whatever, I just don't want to go to school. That's as far as I thought about it. 

[00:04:31] Rachel Zoffness: That's as far as most people think about it.

[00:04:33] Jordan Harbinger: Yeah. And you had that, right? This is something you struggled with, but were you aware also that it was kind of like, "Okay. I just really—" 

[00:04:40] Rachel Zoffness: Totally, no, no. 

[00:04:42] Jordan Harbinger: No? 

[00:04:42] Rachel Zoffness: I went to stomach aches — they run in my family, but I was not aware that my stomach aches were due to stress and anxiety at all because I went to a million doctors. I was scoped, I was prodded. I got all the tests. I was even put on medications and nothing worked, but at no point did any doctor or specialists say to me, "Hey, guess what? Anxiety and stress are somatic because emotions don't just live in your head. They also come out in your body. And it turns out that serotonin — this brain chemical, that everyone talks about all the time that's related to depression and stress and anxiety — it doesn't just live in your head. 90 percent, 90 percent of the body's serotonin lives in your gut. Your gut is actually one of your body's emotion centers. So when you get sick to your stomach, watching the news, or when you get butterflies, when you're nervous or you have a gut instinct, there's a reason for that. And if someone had said that to me, I think I would have made the connection that you so intelligently made when you were a kid that I did not make. 

[00:05:44] Jordan Harbinger: Well, my mom also said after a while, "I think this is psychosomatic." And after I looked up psychosomatic, I was like, maybe, right? My mom is a speech therapist, but she's also my mom and knows me really well. And she's like, "I'm pretty sure you just really hate school because it's super boring. You're in middle school, which is hell for everyone. Some of your teachers are horrible people by all accounts. My mom was a teacher, so she wasn't like, "I'm going to blame the teacher," but some of the teachers were just absolute crap and mean and stuff. And also, my mom was going through all this crap with her brother who was like stealing from my grandma and my grandpa was in a nursing home. So my mom was depressed and my dad was really stressed out at work. So he'd be like yelling a lot and my dog was dying. So I was having a time and it was like, "I just want to stay home and play on the computer and if I say my stomach hurts—" but then it was like, my stomach did hurt. And it was like, well, you can't just magically give yourself a stomach ache. And the truth, what you're saying is now, "Hey man, that's not magic. That's you having the worst years of your life and finding out that pain comes out in other ways." 

[00:06:46] Rachel Zoffness: What you just described to me actually is what I would call a perfect pain recipe, because what we know is there's always a recipe for pain, always. And the recipe isn't just to do with your body, it's also to do with your social environment and everything happening around you and your emotional state and the thoughts happening in your head. And it's always a million different things. But I just also want to say this word you use psychosomatic— 

[00:07:10] Jordan Harbinger: Yeah. 

[00:07:11] Rachel Zoffness: —has become — first of all a really bad word in medicine, because when you say something psychosomatic, what you're saying to someone is— 

[00:07:19] Jordan Harbinger: You're crazy in your head. 

[00:07:19] Rachel Zoffness: —I don't think this thing is real. It's just in your head. That's right. Or, you know, you're just anxious or it's just depression. It's not really pain. And what I'm hoping to do is sort of flip that script and instead say, literally, the word somatic means of the body. That's what it means in Greek and Latin. Soma means body. When you say that emotions are somatic. Yes, of course. They are, of course, emotions — what are emotions? Emotions are a biological cascade of things. Emotions are neurotransmitters and hormonal changes and changes in muscle tension and blood flow and immune functioning. And emotion by definition, of course, is physiological. And if it's physiological, it is, of course, somatic. I'm trying to reframe this language that we use. Like when a kid has stomach aches, those stomach aches are real. Like their enteric nervous system, this bundle of neurons connecting brain to gut gets disrupted. Serotonin is part of that system. So it is physiological. Stress and anxiety, we all know our physiological and it's different for everyone. 

[00:08:20] So for me, stress and anxiety, I now know because I'm down this rabbit hole so far, I know what stress and anxiety does to my body. Like I know my heart rate starts going really fast. I noticed that my shoulders and my back are really tight. Sometimes my mouth gets dry. I'll get like jaw tension or I'll clench my jaw sometimes at night. I know my sleep sometimes gets messed up. I will get stomach aches, but I look now, I'm like, "Okay, what is my body doing because of my emotional state?" And in Western medicine, for reasons I do not understand, we separate it out. So far, it's like either you have physical pain and you see a physician or you have emotional pain and you see a psychologist or a therapist, but guess what? That is not how the brain works. 

[00:09:02] The brain in humans is connected to the body. 100 percent of the time, all of the things are connected. Emotional health and mental health are connected to your physical health, always. There is no divide. It's a false divide, which is why it bothers me so much. This thing you said before, most physicians don't get trained in pain. 96 percent of med schools in the United States have zero dedicated compulsory pain education. That is a statistic from a 2018 study, 96 percent. So we're saying that physical and emotional are separate. And then even then, if you're saying pain is physical and you send someone to the doctor, even then 96 percent of our medical schools are not adequately training doctors in pain. 

[00:09:46] Jordan Harbinger: That's so — you'd think doctors would know more about pain than anyone. And that pain would be like a first year of medical school class, like contracts are for a lawyer in the first year. It's like you have to have a good foundation in pain and know all about how it works and how the mechanisms in the body. And it's just not the case, huh? 

[00:10:06] Rachel Zoffness: I get in trouble when I talk about this — and by the way, I'm just reporting literature. This isn't an opinion. I just read everything I can get my hands on. And there's abundant literature actually on the lack of pain education in medical schools. What we also know is that the med ed, the medical education that does exist on pain is very biomedical. And I'll say what I mean by that, what people are trained in if doctors are trained in pain or — it's not just physicians, by the way, it's also nurses or PTs or OTs, or, you know, any kind of therapists were trained in the biomedical model of pain. And what that means is we tell people that pain is purely to do with physiology, like parts of the body and brain chemicals. And that therefore the treatment for pain is also biomedical, so like pills and procedures. 

[00:10:54] So people with back pain probably know this. You probably have been sent for a million different procedures and maybe a spinal cord stimulator and probably some medications, but a lot of people with chronic pain will tell you that it isn't sufficient and it isn't working. And we know that that's true because chronic pain is on the rise. There's a hundred million Americans living with chronic pain and that number exploded during the pandemic and it continues to go up. Not only that, more evidence that what we're doing isn't working, we are in the midst of an opioid epidemic— 

[00:11:28] Jordan Harbinger: Yeah. 

[00:11:28] Rachel Zoffness: —which everyone is sick of hearing about but that also is exploding. Like if our treatments worked, they would be working. So there's a metaphor that I like to use to explain how pain works in the brain and also what we can do about it. 

[00:11:41] So I want you to imagine that in your central nervous system, you have what I'm going to call a pain dial, and it operates much like the volume knob on your car stereo. Like you can turn pain volume up and you can turn pain volume down. And there's a lot of things that change pain volume in any given moment of every given day. And I want to tell you about three things in particular, that will be useful when we're talking about all the rest of this stuff. 

[00:12:05] So one of the things that changes pain volume is stress and anxiety. And I'll say specifically how that works when stress and anxiety are high and your body is tense and tight, and your thoughts are worried, neuroscience tells us that pain volume is amplified. That pain volume, that pain dial is turned up. And the opposite is also true, when stress and anxiety are low, your muscles are relaxed and your thoughts are calm, your brain turns pain volume down. That's thing one. 

[00:12:36] Thing two is mood. Mood, and by mood, I mean emotions, positive or negative. And what science tells us is that negative emotions like depression and sadness and frustration and anger, your limbic system when you're depressed and when you're angry and when emotions are negative, your limbic system will turn up that pain dial and amplify pain volume. But the opposite again is also true. So emotions matter to pain a lot when emotions are positive, you're feeling joyful and happy and you're engaged in pleasurable activities, your limbic system — again, that part of your brain responsible for emotions — will lower pain volumes. So pain feels less bad when emotions are positive. And thing number three — I know it's counterintuitive so when emotions are hot positive and good, pain volume is low. 

[00:13:27] Jordan Harbinger: I mean, that makes sense. 

[00:13:28] Rachel Zoffness: Yeah. 

[00:13:28] Jordan Harbinger: It's like if I crack my toe when I'm at home alone and I just got a nasty email from somebody and had a cancellation on something that hurts. But if I crack my toe, when I'm like drinking Coronas at the beach with my friends, I'm like, "Oh, that's annoying."

[00:13:44] Rachel Zoffness: You don't even notice. 

[00:13:45] Jordan Harbinger: Yeah, barely. 

[00:13:46] Rachel Zoffness: That's a perfect example. That's exactly right. Because emotions change pain volume. And thing three is attention, potential processes. So again, when we are stuck at home, stuck in bed, thinking about our pain or you're trapped in the hospital, or, you know, your body's been hurting for so long, you feel like you just can't get off your couch, your prefrontal cortex will send a message to that pain dial amplifying pain volume. Pain feels worse when we think about it, when we focus on it, when we ruminate about it, which is why part of our treatment is distraction strategies. 

[00:14:17] So the opposite is also true. Neuroscience tells us that when we distract from pain — sometimes I ask my patients, "Hey, tell me about a time you were so absorbed in some activity, you briefly forgot about your pain," and everyone can give me an example. And that forgetting is not magic. It's your pain dial. So being absorbed and distracted in activity, your prefrontal cortex will lower pain volume. So pain feels less bad. And by the way, It's during the last couple of years, when we were giving kids vaccines, we stuck a screen in front of their faces because distractions can really help gate and control your experience of pain.

[00:14:56] Some kids don't even notice they're getting a shot in the arm when they have a screen in front of them and others if they're staring at are screaming, bloody murder and they have to be held down, which is an absolute disaster and no one should ever do that. 

[00:15:06] Jordan Harbinger: That's why we play Baby Shark when we cut my kid's toenails. 

[00:15:10] Rachel Zoffness: Perfect. See— 

[00:15:11] Jordan Harbinger: Yeah. 

[00:15:11] Rachel Zoffness: —you just got pain psychology 101. That's it that's the science of pain, but we don't talk about it in this way explicitly. The neuroscience of pain is not discussed. So people don't know this metaphor I just gave you, the neuroscience of pain tells us that the thoughts we think change the pain we feel, the emotions we're feeling in any given moment control pain volume, and distraction or what we're focusing on matters intimately. So pain, whether it's in your leg or your knee or your back or your tooth always is biopsychosocial all the factors always matter to your brain when it's deciding whether or not to make pain and how much. 

[00:15:50] Jordan Harbinger: We can get into that in a bit. I do have questions about that as well. Before I forget, I want to go back to pain recipes because that was interesting. We kind of glossed over it. What are pain recipes? Because whenever there's a recipe, usually there's what like a counter recipe, right? There's like a remedy for the recipe. I guess this is a crap analogy, but I'll let you take over. 

[00:16:09] Rachel Zoffness: Okay. Well, so to tell you what a pain recipe is, I sort of need to go backwards and tell you what pain actually is. Can we do that? 

[00:16:18] Jordan Harbinger: Yeah. Tell me what it is. 

[00:16:19] Rachel Zoffness: It's really nerdy, pain science, but I am nothing. 

[00:16:22] Jordan Harbinger: You're in the right place. 

[00:16:23] Rachel Zoffness: I'm not a nerd. 

[00:16:24] Jordan Harbinger: Yeah. 

[00:16:24] Rachel Zoffness: Yeah, I feel like I'm in good company. So again, we've been trained to believe that pain is this purely biomedical problem, something to do with anatomy and physiology, but neuroscience tells us that that's not actually true. Pain does not live exclusively in the body. And one of the reasons we know this is because of this condition called phantom limb pain. And phantom limb pain is when someone loses a limb like an arm or a leg and they continue to have terrible pain and the missing body part. Now, if you can have terrible leg pain in the leg that you don't have anymore, that tells us that pain must be constructed somewhere else and that somewhere else— 

[00:17:07] Jordan Harbinger: In the brain.

[00:17:08] Rachel Zoffness: That's right. And here's the funny thing about the brain — and by the way, neuroscience is my jam. It just helps me make sense of everything and especially pain. And this is a thing that doesn't get talked about ever. 

[00:17:18] Jordan Harbinger: This totally makes sense, right? Because we've heard of people that are blind that can see things in their brain because the brain constructs reality based on input from the eye — well, from the senses, but also from the eyes. So if you don't have eyes, it's impossible to see. Well, not really. You just can't see using your eyes because you don't have any, but if you can feel pain in a leg you don't have it. Then you can see with eyes that you don't have as well, as long as there's another form of sensory input, like these tongue grids with electrical stimuli and stuff that people are experimenting with. This all checks out and seems like we should have sort of applied these principles across the body a long time ago, but I guess it's all new.

[00:17:52] Rachel Zoffness: Yeah. But guess what you and I are doing today, we're revolutionizing pain. We're telling everybody how it actually works because guess what? None of us are going to escape without having pain. Pain is part of being human. All of us at some point, if we haven't already are going to experience pain. It seems about time we understood it, knew how it worked and knew what to do about it. So that's why this whole conversation is even happening. 

[00:18:16] So the thing about the brain is that there's no one single pain center in the brain. That's not how it works. There's multiple parts of your central nervous system, that process pain, including your spinal cord and all these other parts of your brain. So I'm going to tell you about three in particular. One is your prefrontal cortex processes pain, and that's the part of your brain responsible for attentional processes or what you're focusing on. There's a reason I'm telling you that. Part of the brain number two is your cerebral cortex. That's the part of your brain responsible for many things, but also thoughts, thoughts, because the things you think affect the way your body feels always. 

[00:18:55] And part of the brain three is your limbic system, your brain's limbic system. And that is your brain's emotion center. Your limbic system processes your emotions. Now, I want to be more clear about what that means. 100 percent of the signals, the sensory messages from your body filter through your brain's limbic system, before they become the thing that we call pain. So all of the time, all of the time, pain is both physical and emotional. 

[00:19:26] So I am what's called a pain psychologist, which no one has ever heard of. You know, people are like, "Well, you're not an MD." "No, I'm a pain psychologist." Here's why that's important. People say, "Oh, well you must treat emotional pain." The answer to that is no. Pain is always both physical and emotional. That's what neuroscience says. And in fact, what we know is that negative emotions like stress and anxiety or depression or anger or frustration, turn up pain volume in the brain. We think and are trained, and our doctors are trained, that pain lives in the body, like in your back or in your knee. It is, of course, true that things may be going wrong in your backer in your knee, but that isn't where pain lives. Pain lives in the brain.

[00:20:13] Jordan Harbinger: And so the pain recipe then is this cocktail of stress and anxiety, also your knee pain, also the fact that your family support sucks because your parents are breathing down your neck about how you should just try not having pain and being depressed, and get your act together and go to school like your brother or whatever, right? It sounds like that's what happened to this kid who was in bed for four years. As a parent, that was so horrifying to hear that story and you saved that kid's life. Can you tell me about this? 

[00:20:43] Rachel Zoffness: Yeah. So thank you for circling back around to pain recipes. So can I get more clear on what that is?

[00:20:48] Jordan Harbinger: Yes. Sure. 

[00:20:49] Rachel Zoffness: I went down a tangent of pain neuroscience. 

[00:20:51] Jordan Harbinger: That's all right. That's why I'm here. 

[00:20:52] Rachel Zoffness: Yeah. So there's always a recipe of things that can amplify pain volume. And again, we have established that pain lives in the brain. We have established that pain is not biomedical, but we haven't said what pain is. Pain is biopsychosocial. Biopsychosocial, and all that means is, of course, there are bio components to pain like genetics and tissue damage and system dysfunction and sleep and exercise and diet. Of course, all of those things are part of what we're calling a pain recipe that will lead to high pain, but pain also has cognitive components and emotional components and behavioral components. 

[00:21:29] And they live in this psychological, which has so much stigma around it, but the psychological component of paints, we've got bio, we've got psych, which are thoughts and emotions and trauma, past trauma lives with pain and behaviors, the things we choose to do — I promise I'm getting to your pain recipe — and then we've got the social or the sociological domain of pain, which is quite literally everything else. So it's socioeconomic status, race, and ethnicity, and access to care. And it's social environment, its parents and friends, and whether you're lonely and isolated. It's a million things. 

[00:22:01] So a pain recipe is the sum total of all of those different domains of pain, the factors in the bio bubble. That can amplify pain like tissue damage and system dysfunction and lack of sleep and lack of moving your body and poor nutrition. It's all the things in the psych domain of pain, like thinking scary, catastrophic thoughts. And when you're a kid in eighth grade, you know, there's a lot of horrible things going on in your life. Those happen in your head also. It's your emotional functioning — again, negative emotions amplify pain. If you're stressed or anxious or depressed, pain volume is going to be amplified. And if behaviorally, if you're staying at home and inside, which is a lot of people with chronic pain do. They don't move their bodies. They don't leave their house. Pain will also be amplified. And then we have all this stuff in the sociological bubble. 

[00:22:48] So a pain recipe, for me, when someone comes to my office, I'm always looking at those three big domains and I want to pick out the things in each of those domains that are contributing to a pain recipe. So for you, I should have written it all down, but death of a dog, angry parent, a lot of family conflict at home, you know, having some social stuff going on at school, maybe some academic stress, you know, or some social anxiety, all of that stuff will contribute to pain volume being amplified in the brain.

[00:23:19] Jordan Harbinger: You're listening to The Jordan Harbinger Show with our guest Dr. Rachel Zoffness. We'll be right back. 

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[00:26:04] Now back to Dr. Rachel Zoffness. 

[00:26:08] And so can we do like the inverse of the pain recipe? I mean, that's harder to do of course, but as the cure for that, then instead of just going on pain meds for your knee pain is that maybe I start exercising, even if it's just a walk around the block. And maybe my family gets a freaking therapist for God's sake. And maybe we end up with another type of pet that is, you know, my dog hadn't died, but let's say that he did like, maybe we get another pet that I can take care of that I care about. That keeps me company when I'm home alone all day. And maybe I opened the curtains in the morning instead, or leave the curtains open. Like, can we do the George Costanza method where we're like, "What's the opposite of what I'm doing right now?" And then do that, and then the pain gets better. Is that a thing?

[00:26:52] Rachel Zoffness: Yes. So the answer is yes but the caveat is it's not quite that simple. It's not like, oh, just do the opposite and everything will get better because there's— 

[00:26:59] Jordan Harbinger: Of course. 

[00:26:59] Rachel Zoffness: —a number of complicated processes, usually maintaining a chronic pain cycle, but you are on it a hundred percent yes. That's right. So we look at the things that are maintaining a pain cycle. So that's actually why I wrote The Pain Management Workbook. The reason I wrote The Pain Management Workbook was because I want everyone to understand their pain recipe and to know how to hack it. And it can be hacked. 

[00:27:18] The first part is the stuff we're doing right now, which is just pain education. Like if we don't understand pain, we can't treat — how do you treat a thing you don't understand? So first we have to locate pain to the brain. We have to understand all the little bits of pain neuroscience that help us lower pain volume. And then exactly what you're saying. We have to put together this recipe, this cocktail of things, that's going to hack our pain recipe and lead to a lower pain volume.

[00:27:41] So moving your body, if you've been sedentary, going outside and connecting socially, treating your depression and anxiety, which by the way, by the way, the last two years of the pandemic have been a sh*t show for everybody. Like our definitions of anxiety and depression are just really bad and wonky. If you've experienced some anxiety and depression in the last two years, that's what we call a situational trigger. It does not mean that everybody has been mentally ill in the last two years. Like obviously, if the entire world is mentally ill, our definition of abnormal is clearly wrong. It is a normal response to an abnormal situation, but that's true with chronic pain too. 

[00:28:19] A lot of people with chronic pain live with some anxiety and some depression. And I will say that is not what I call mental illness. That is again, a normal response to an abnormal situation. The human body is not built to be in pain for like months and many years. So yes, the answer is yes. To hack a pain recipe, you first have to understand what's happening and use tools. So like The Pain Management Workbook can be used by anyone like anyone with pain and also any provider. Like for me, what pisses me off is that the stuff that I do, these like biobehavioral treatments aren't reimbursed by insurance. You can get seven back surgeries, but things like cognitive behavioral therapy, which have evidence for treating pain and biofeedback, they're not reimbursed.

[00:29:02] Jordan Harbinger: You need to like cut people open and then give them cognitive behavioral therapy and saw them back up and then you'll get reimbursed for it. That's ridiculous. 

[00:29:09] Rachel Zoffness: It's insane. 

[00:29:09] Jordan Harbinger: That's actually insane. 

[00:29:11] Rachel Zoffness: You asked before about a kiddo that I mentioned. Are you talking about the kiddo that I mentioned on a different podcast?

[00:29:16] Jordan Harbinger: I am talking about the kiddo you mentioned on a different podcast. Yeah. 

[00:29:19] Rachel Zoffness: Okay. 

[00:29:19] Jordan Harbinger: Thank you for using the word kiddo. I love that. People who care about kids use that word like that is that is like a— 

[00:29:25] Rachel Zoffness: It's so funny. I actually really don't like that word and I try not to use it because I usually just call my kids, my kids, but then people say, "Well, are you talking about your own children?" And I don't know. Yeah, I haven't yet found a better way of doing that. 

[00:29:37] Jordan Harbinger: Yeah. It's a little bit of a generation above in terms of your and I age, but— 

[00:29:41] Rachel Zoffness: I actually hate the word kiddo. 

[00:29:43] Jordan Harbinger: Do you? That's so funny. 

[00:29:44] Rachel Zoffness: So teenager, this teenager came to me with chronic pain. He had multiple diagnoses. He had been diagnosed with chronic migraine and chronic abdominal migraine, and he had diffused amplified body pain of unknown etiology. People weren't sure why he was in pain or what was happening. And he had missed a lot of school. He had been in bed for about four years. He had seen 14 physicians and he had been on 40 medications, including some narcotics and also Thorazine. Thorazine is an anti-psychotic that — it's an old-school anti-psychotic.

[00:30:21] When I worked on an inpatient unit, if there was an adult having an aggressive, psychotic outburst, he would be held down and injected with Thorazine, Thorazine knocks people out, but that's still what we do for children in pain. You can tell I have some feelings about that.

[00:30:37] He had no life. He had no friends. He had no hope. When he came to my office, he had like long unwashed hair. He was walking, bent over and hunched holding his belly. He was really pale. He hadn't really gone outside. So I asked him if he had given up and he said, "Yes." I told him I could help him but only if he did everything I said. 

[00:30:55] And I should say, I never know, of course, whether or not I can help one of my patients. I believe very strongly in what I do. And like, the results are insane. Like I'm addicted to this work. And I go out here, even though I have public speaking anxiety and I do things like this because it's so important to me to spread the word because I see how many lives are changed and how profoundly they're changed by this work. So I want everyone to understand pain and what to do about it. 

[00:31:21] So I told him that we could do this thing together, but he had to do every single thing. So we started really slow. When someone's been in bed for four years, their brain and body have become very sensitive. And I want to explain what that word means before I explained to you what we did with him. What happens with chronic pain? Chronic pain is known as its own disease process. And there's a process that happens with chronic pain called central sensitization. And I want to explain in layman's terms what that means. 

[00:31:51] So I'm going to ask you a question. Can you tell me a skill that you practiced over time and got good at? You were bad at it. You practiced it. You got good at it over time.

[00:32:01] Jordan Harbinger: Yeah. I mean, any language. Like, does that count? 

[00:32:04] Rachel Zoffness: Yeah. 

[00:32:04] Jordan Harbinger: I mean, this language I'm speaking right now, for sure. I mean, everybody has done this right, but also like German or Chinese or something. 

[00:32:10] Rachel Zoffness: Great. Wonderful languages. Perfect. So you've noticed that the more you practice speaking German or writing German or reading German, the easier got the better you got at it.

[00:32:20] Jordan Harbinger: Sure. 

[00:32:20] Rachel Zoffness: And for me it was piano. So when I was a kid, I had to play piano and I practiced all the time. And it turned out that over time, what would happen is I could sit down at the piano after 10 years of playing and my fingers just magically knew what to do. I didn't even have to look at the sheet music and I could hear in my head the notes before I played them. 

[00:32:40] Jordan Harbinger: Ooh.

[00:32:40] Rachel Zoffness: Is that magic? 

[00:32:41] Jordan Harbinger: That's cool. 

[00:32:42] Rachel Zoffness: Not magic. It's your brain. So the more you practice a thing, the pathways in your brain are like the muscles in your body. The more you use them, the bigger and stronger they get. So the more you practice the German, the bigger and stronger the German pathway in your brain gets. The more I practiced piano, the bigger and stronger the piano pathway in my brain got. And I can still sit down even now and access that pathway and my fingers know what to do. It's very weird. 

[00:33:10] Now, guess what happens when you inadvertently accidentally practice pain over and over for months and years, the pain pathway in your brain gets very big and strong. And when that happens, we say that your brain has become sensitive to pain. 

[00:33:28] That's horrible. 

[00:33:28] That's right. But that is how the brain works. 

[00:33:31] Jordan Harbinger: Right. No, totally makes sense. 

[00:33:33] Rachel Zoffness: Right. 

[00:33:33] Jordan Harbinger: But that's like the worst thing — there's a lot of things I would want to be sensitized to and pain is like the last one on the list. 

[00:33:39] Rachel Zoffness: Well said, sir, well said. I couldn't agree more. And so what happens when our brains become sensitive to pain? It took me a while to figure out how to explain what that means. What that means is that small bits of sensory information from the body that are not dangerous are interpreted by your brain as dangerous because pain is your body's danger detection system. Pain is your body's danger alarm. 

[00:34:06] Jordan Harbinger: That's what I remember learning about the definition of pain and like middle school science, right? It's like the body's way of telling us something is wrong. And you hear about kids that feel no pain. And have you heard about this? I'm sure you have, of course. This is horrifying, right? The kids will like jump off the roof of the house and break both of their legs and then do it again the month after like staying in the hospital for six weeks because it doesn't hurt. But when they are in the hospital, their parents who are crappy and fighting all the time are giving them non-stop attention. They don't have to go to school, they can eat whatever they want or — and this is like the same kid that I've read about — he would pull out all of his teeth with pliers because it was kind of fun, made a weird noise.

[00:34:46] Rachel Zoffness: Okay. I've never heard that story. I don't know if I want to hear any more about it. 

[00:34:49] Jordan Harbinger: Yeah. 

[00:34:49] Rachel Zoffness: Can I tell you about those kids? They don't live very long. 

[00:34:53] Jordan Harbinger: Yeah. They don't live very long. It's really — yeah. 

[00:34:55] Rachel Zoffness: And that's exactly right because pain is your body's danger detection system. And if you either don't have it or it's not working well, or you're ignoring it, you're not going to survive. However, the caveat is like every system in the human body, the pain system can fail and pain does not always indicate danger. That's the most important thing I'm going to say all day. Pain does not always indicate danger. When you have chronic pain and your brain has become sensitive, small bits of non-dangerous input from the body are being interpreted incorrectly as dangerous.

[00:35:33] And so your brain is telling you to stop doing all the things, to stay inside, to not move, to not exercise, to not go out, to not see friends, because it believes that your body is in danger erroneously, incorrectly. So when we have chronic pain, our brains have become like that car alarm. You've seen that car alarm like you're looking out your window and that car, the lights are flashing and the horn is beeping. And you're like, "Bruh, no one's breaking in. You're safe. The glass isn't even broken, but the car is alarming." It's like, "Help me, help me." And that's a brain on chronic pain. Your body is safe, but your brain believes you're in danger. 

[00:36:13] So the treatment is the opposite of what you think is learning to desensitize a sensitive brain. Now, to be clear, that's not to say that things can't go wrong with the body. Of course, they can. And of course, they do. And back to that thing, where pain is always, biopsychosocial, always, always, always. So we're always looking at the three parts of the puzzle, the bio pieces, the cognitive and emotional and behavioral pieces, and the social and the sociological pieces.

[00:36:41] So I don't want anyone to think that I'm saying that I'm missing out on the bigger picture of pain, but the most important piece to know is with chronic pain, our brains flip into this state of chronically being in a state of alarm and stress because pain is one of the biggest stressors on the human body. Like moving cross-country is stressful and death of a loved one is stressful, but being in pain day in and day out is a huge stressor. So not only are we facing pain, but our brain is in this state of fight-or-flight emergency. And we know that amplifies the pain alarm. So it's just so important for people with pain to know that part of what's happening for them is that their brain has become extra sensitive and it is alarming when it doesn't need to. 

[00:37:25] Did that make sense, the way I said that? 

[00:37:27] Jordan Harbinger: Yeah, no, that's really interesting. And the analogy with the car alarm makes perfect sense. And it also is really enlightening that we can strengthen our pain pathway or make it so easy for pain to flow down that channel, that everything registers as pain. Like, you know, we've heard that pain is sort of subjective. And some people feel like a good workout feels good and other people are, and they're like, "I'm sore." And other people are like, "This is horrible. I hate every second of this." It also makes perfect sense that somebody would feel something and say, "This hurts a lot," and the other person, like — you know, what drove me freaking crazy is whenever I would get hurt as a kid, my dad would go, "Gah, that doesn't hurt." And I'm going to be like, "No, it does hurt. I separated my shoulder. You POS," and then he'd be like, "Oh, sorry," you know? Because the doctor would be like, "Yeah, your kid's shoulder ripped out of the joint, like that hurts."

[00:38:15] And then what was interesting about that was when I went to the ER, it didn't hurt that much because no one was there to sympathize. So I was like, "Actually the pain, the physical part is like, not that bad." And the ER doctor was like, "Yeah, do you want an injection of something for that? Because that looks really bad." And I was like, "I'm fine." And he's like, "No, no, don't be a tough guy. That's a bad injury." And I was like, "I really don't feel like this hurts that much." And he's like, "Sure, okay," thinking that I was just like straight up in shock, but it turned out that I'd probably done nerve damage or whatever, and it didn't hurt that much or it was all the way out and didn't hurt that much. But it was so interesting that me scraping my knee and crying to my dad and having him blow me off, definitely. I remember that hurt way more than separating my shoulder later on in my life, which is an actual injury. 

[00:39:01] Rachel Zoffness: I mean, that's so profound for so many reasons. Honestly, what you just highlighted very well is that context matters to the brain. The brain is always taking in all available information when it decides whether or not to make pain and how much. All available information matters, including context, including the reactions of people around you. And there's this famous playground study of these little kids — It's different than what you just told me because what you just told me is like a little bit more layered. It's like being dismissed and like being told that your experience is invalid, which, of course, is triggering in a whole other way. 

[00:39:37] But there's this famous playground study where there are these kids running around on the playground and they would fall. And the first thing a child does — as you know, you have a small child — they look at their parent's face to see how their parent is reacting. And if a parent on the playground after the child fell went, "Oh my god, are you okay?" and was really anxious and activated, the child would cry. If the parent was calmly like, "Oh, sweetie, let me kiss that booboo but you're okay," and distracted and was like loving and nurturing, but also very calm and distracting, the kid would not cry because context matters very much in the brain's interpretation of the sensory messages from the body. 

[00:40:19] Jordan Harbinger: Yeah. 

[00:40:19] Rachel Zoffness: So that story is great. I also want to get back to the kiddo that I started talking about. 

[00:40:23] Jordan Harbinger: Yeah, please. 

[00:40:23] Rachel Zoffness: The teenager, not kiddo. 

[00:40:26] Jordan Harbinger: Ugh, stop using the word kiddo. 

[00:40:27] Rachel Zoffness: I know. 

[00:40:28] Jordan Harbinger: Come on. 

[00:40:28] Rachel Zoffness: Sorry, sorry. Yeah, I've been trained to use that word because people tell me it's inappropriate to say kid — teenager, so again, I told them we were going to walk through this treatment protocol. It's called cognitive behavioral therapy for pain. People have heard of CBT for anxiety and depression. CBT for pain is different. Very few people are trained in it which is again, why I've stuck it all in a workbook, because it really pisses me off that I don't have anyone to refer to and that it isn't reimbursed by insurance. It bothers me a lot.

[00:40:55] So we walked through this whole protocol. And so week one, I always sent him home after our sessions with some homework and week one, his homework was to go outside and stand on his porch in the sun. 

[00:41:06] Jordan Harbinger: I liked that. 

[00:41:06] Rachel Zoffness: And week two, it was to walk to the corner mailbox. And by the way, the goal again, how do you desensitize a sensitive brain? We've established that with chronic pain, the brain has become very sensitive. How do we desensitize a sensitive brain? The analogy that I make, which explains why this treatment was happening for him is like, if you've ever been in a really dark room, you know that if someone pulls open the blinds, all of a sudden you're like, "Oh, I'm blind," and it feels terrible. But if someone opens the blinds, just a tiny little crack, a couple of seconds later, your eyes and your brain desensitize, and you're fine. And if they open up just a little bit more, let a little more light in and wait for like 30 seconds, your brain and your eyes desensitize, and you're fine. And all of a sudden, you know, you're in a light-filled room and your brain and your eyes are okay. You can tolerate it. 

[00:41:55] And the treatment for chronic pain is the same. How do we lead someone out of a very, very dark room? You have to desensitize their brain little bits at a time. So with this teenager, we first just had him standing on his front porch because he had been in bed, again for four years. Then we had them walking around the block. And his goal, by the way, was to get back to soccer. He told me that he wanted to play and I was like, "We're going to get you back to soccer. You are going to play soccer again." Then he walked his dog to the dog park and talk to a couple of strangers, which was terrifying for him as you might imagine. 

[00:42:27] Jordan Harbinger: That's hard for people that don't have chronic pain. 

[00:42:29] Rachel Zoffness: Yeah. 

[00:42:29] Jordan Harbinger: So props to him for doing that. 

[00:42:30] Rachel Zoffness: Totally. And he had— 

[00:42:31] Jordan Harbinger: That's not easy. 

[00:42:32] Rachel Zoffness: He also had social anxiety and he was also— 

[00:42:34] Jordan Harbinger: Yeah. 

[00:42:34] Rachel Zoffness: —depressed and suicidal as a lot of people with pain like suicidality in the chronic pain population is 50 percent higher. 

[00:42:41] Jordan Harbinger: I'm sure. 

[00:42:42] Rachel Zoffness: That's right because a lot of hope is lost and here's what started happening. The more he started doing physically, the more he started doing cognitively, the more he started doing emotionally and socially, the lower and lower his pain alarm started becoming. The more functional he started becoming. And the more he did, the more he realized he could do. He went and got a haircut. He went and bought a backpack. That was like a game changer. When he did that, it was like, all of us were like, "Something really good is happening." Like by the way, he was still having pain flares, but they were not laying him out. And he was not taking Thorazine anymore. So he wasn't like drugged for four days without being able to function. 

[00:43:21] So there were a lot of other things happening too. He was gradually not only moving his body, but he got a tutor. He was catching up in school. He was catching up with his friends. He started seeing them in real life. This was years before the pandemic and that walk around the block, turned into a jog and then it turned into running a mile. And when he went back to school, he was like this tall fit, handsome kid. He got asked to prom by two girls, that kid. And he got onstage when he graduated because he did graduate.

[00:43:50] And he said, "If you had told me four years ago, I'd be graduating high school. I would not have believed you." And I was there. And his mom and I, of course, cried. And like the crazy thing about this work is that it absolutely changes lives. And I would love to take credit and say that I made it up. And there are people who are writing books even today. With this treatment, calling it something after themselves like as if they've made it up. It's been around for effing ever. We've known, science has known for decades that pain is biopsychosocial and it requires a biopsychosocial treatment. But here's the problem, it doesn't make the kind of money that surgeries and pills do— 

[00:44:27] Jordan Harbinger: Right. 

[00:44:27] Rachel Zoffness: And big pharma owns pain medicine. So they will tell you all day— 

[00:44:32] Jordan Harbinger: Yeah. 

[00:44:32] Rachel Zoffness: —that the answer for your pain is a pill, but science shows that is wrong, wrong, wrong all day long for acute pain, short-term pain, oh yeah, thank God for morphine for short term, but for long-term chronic pain, ain't the thing. 

[00:44:46] Jordan Harbinger: I want to get to that for sure. But also, there was another point you'd said about how pain is constructed in the brain in context matters. Tell me the tale of two nails, because this is one, gross, which I kind of dig, and also so freaking interesting because of what it says about pain in our brain. 

[00:45:01] Rachel Zoffness: I love that you've done your research, Dr. Harbinger. 

[00:45:03] Jordan Harbinger: Look, I'm not an MD. All right. But I know a lot of stuff about podcast. 

[00:45:07] Rachel Zoffness: Totally. So I kind of feel like a used car salesman. As you know, no one wants to go to a psychologist for pain. No one like zero people want to go to a psychologist. 

[00:45:15] Jordan Harbinger: We're practically giving them away over here at Zoffness store. 

[00:45:19] Rachel Zoffness: Right. Because we think of pain as a biomedical problem. And if someone says you should see a pain psychologist, you think, of course, they're saying it's all in my head. They're saying my pain isn't real. So I'm constantly having to think of ways to prove basic pain neuroscience that I started studying as an undergrad at Brown that I have been studying for the last 20-something years of life, by just using all of this information that I've gathered over time. 

[00:45:44] So there's two papers from the medical literature, that report on two different construction workers. So construction worker number one was on a job site and he jumped off of a plank straight onto a seven inch nail. And it went clear through his boot— 

[00:45:59] Jordan Harbinger: Ow. 

[00:46:00] Rachel Zoffness: Straight through to the other side. And he was in terrible pain and he was rushed to the emergency department and all of his coworkers were horrified and he was screaming with pain. They gave him fentanyl, I believe, an intravenous opioid for his pain. 

[00:46:14] Jordan Harbinger: Right. We all unfortunately know what fentanyl is now. Like that's like a very 2021, 2022 thing that unfortunately has hit our zeitgeists. 

[00:46:21] Rachel Zoffness: Yeah, I'll say it, by the way. I am not anti-fentanyl. I am not anti-opioid. Like thank God for those drugs. Thank God for modern science, but for long-term chronic pain, it's a disaster, but for short-term pain — blessings. 

[00:46:33] Anyway, so they gave him IV opioids and the good doctors removed his boot and they discovered that a miracle had occurred. The nail had passed between the space between his toes. There was no puncture wound. There was no blood, there was no tissue damage, but his pain was real. How did that happen? 

[00:46:55] Jordan Harbinger: He expected it. 

[00:46:56] Rachel Zoffness: His brain— 

[00:46:57] Jordan Harbinger: Because I would expect it. 

[00:46:58] Rachel Zoffness: Right. That's a right. 

[00:46:59] Jordan Harbinger: It looked like it went through his foot. 

[00:47:00] Rachel Zoffness: That's right. His brain aka his danger detector used all available information to determine whether or not to make pain and how much. So his brain used knowledge — again, cognitive and our psych bubble of pain, knowledge of the dangerous work environment, memories of past pain experiences. It used the visual input of this giant seven inch nail sticking through the top of his boot. It used the visual of his colleagues facing. It used all available information to determine whether or not to make pain and because his brain decided that his body was in danger, it made pain to protect him. And guess what? That pain did exactly the right job. It got him to the emergency room. 

[00:47:44] Jordan Harbinger: Yeah. 

[00:47:44] Rachel Zoffness: And if that nail had gone through his skin, the emergency room is exactly where he needed to be. So pain did its job. But again, reminder, the pain system, like every system in the human body can fail. Pain is not always an indicator that there is damage to your body. And I love that example because it really shows us that you can have pain in the absence of danger and damage to the body. 

[00:48:08] Jordan Harbinger: So interesting. 

[00:48:12] This is The Jordan Harbinger Show with our guest Dr. Rachel Zoffness. We'll be right back. 

[00:48:17] This episode is also sponsored by Justworks. Lots of businesses are remote these days, including our entire team. We're spread out from California to Canada to Prague. Whether your team is remote or in person, Justworks makes it easier for you to start, run, and grow a business. But how you ask? Justworks is basically a one-stop shop for everything involving taking care of your team from onboarding to giving your employees access to large group health insurance plans, handling payroll, PTO requests, and figuring out state by state rules and regulations. Everything is in one easy-to-use platform. And Justworks also comes with expert 24/7 support for you and your team. Across the country, small businesses with big dreams love Justworks for it's simplicity, intuitive platform, and time-saving features. Sure, you could do it all, but let the experts handle it so you can use your valuable time growing your business.

[00:49:04] Jen Harbinger: Find out how Justworks can help your business by going to justworks.com. That's just works.com for more info. 

[00:49:12] Jordan Harbinger: This episode is also sponsored by Progressive insurance. Let's face it sometimes multitasking can be overwhelming. Like when your favorite podcast is playing — ahem, ahem — and the person next to you is talking your car fan is blasting, all while you're trying to find the perfect parking spot. But then again, sometimes multitasking is easy, like quoting with Progressive insurance. They do the hard work of comparing rates so you can find a great rate that works for you, even if it's not with them. Give their nifty comparison tool, a try, and you might find getting the rating coverage you deserve is easy. All you need to do is visit Progressive's website and get a quote with all the coverage you want, like comprehensive and collision coverage or personal injury protection. Then you'll see Progressive's direct rate and their tool will provide options from other companies all lined up and ready to compare. So it's simple to choose the rate and coverage you like. Press play on comparing auto rates. Quote at progressive.com to join the over 27 million drivers who trust Progressive. 

[00:50:01] Jen Harbinger: Progressive Casualty Insurance Company and affiliates. Comparison rates not available in all states or situations. Prices vary based on how you buy.

[00:50:08] Jordan Harbinger: This episode is also sponsored in part by Nissan. The future will be great, but today is just as incredible. Meet Nissan's most advanced lineup. If you can't get enough adrenaline, there's the all-new 400-HP Nissan Z, or for your off-road adventures, check out the all-terrain Nissan Frontier. If you're a more of a spontaneous road trip type of person hop in the Nissan Pathfinder. So let's enjoy the ride. 

[00:50:28] Jen Harbinger: 2023 Ariya and Z not yet available for purchase. Expected availability this spring for 2023 Z and this fall for 2023 Ariya. 

[00:50:37] Jordan Harbinger: Thank you so much for listening to this show and for supporting the show, you guys are the best. Your support of our advertisers is what keeps the lights on around here and allows us to have these amazing conversations. By the way, all of these URLs and the codes and all that stuff — I know that's hard to memorize — we put them all in one place. This is a new mobile responsive page, jordanharbinger.com/deals. We're also working on the search function for that page. By the way, you can also search for any sponsor using the search box on the website as well. So please consider supporting those who support us. 

[00:51:08] Now for the rest of my conversation with Dr. Rachel Zoffness. 

[00:51:13] I will give a little appetizer to number two. When I was a kid, somebody blew up a mailbox with a pipe bomb in my neighborhood because of white trash and we had nails all over through wood pieces in the yard. And I went out with my friend, Tim, who I'm still friends with. Shout out to Tim Gideon. And we were playing and I was like, I have a rock in my shoe. And then I looked down and I had a rusty nail that went all the way through the sole of my shoe, through my foot and came up a little bit to where you could see a bump in my foot. And I, obviously, had to go to the hospital and get a tetanus shot, but the thing is, it didn't hurt that bad because I really didn't notice it, but I will tell you once I noticed it, it hurt a lot. And once my mom was like, "Oh honey, oh my gosh," it hurt way more than that. 

[00:52:01] Rachel Zoffness: You got it. 

[00:52:02] Jordan Harbinger: And having this conversation with you, looking back at all these examples as a kid, I'm like, I almost didn't have that much pain unless somebody was watching. And also I saw how gross the wound was. It's like, if you just ignore those things, your level of pain, my level of pain would have been so much more manageable and easy to deal with. And probably, I would be dead from tetanus because I'd be like, "Eh, it's nothing, right? It's a little tiny hole in my foot. I'm just going to pull this out and keep riding bikes. 

[00:52:27] Rachel Zoffness: You remember how we talked about the parts of the brain? That process pain include your prefrontal cortex, the part of your brain— 

[00:52:32] Jordan Harbinger: Yes. 

[00:52:32] Rachel Zoffness: —responsible for attention. Science shows that attending to pain, amplifies pain volume. So if you're thinking about your pain or you're staring at it or you're home missing work and missing out on life and feeling miserable. It's going to amplify pain volume. Pain is going to feel worse. So exactly what you said, attending to pain— 

[00:52:51] Jordan Harbinger: Ruminating. 

[00:52:52] Rachel Zoffness: And definitely ruminating about pain will make pain worse. That is exactly right. That is a great lead into tale of two nails number two. 

[00:52:59] Jordan Harbinger: Yes. Let's do it. 

[00:53:01] Rachel Zoffness: Let's do it. 

[00:53:01] Jordan Harbinger: Don't eat — if you're eating right now, take a little break or pause this. 

[00:53:05] Rachel Zoffness: It's not that gross. 

[00:53:07] Jordan Harbinger: I think it's pretty great. 

[00:53:08] Rachel Zoffness: All right. It's pretty gross. I wish I could show you the pictures. Maybe I can send them to you and you can show them.

[00:53:13] Jordan Harbinger: You can send it to me and we'll link them in the show notes. 

[00:53:15] Rachel Zoffness: So second construction worker, because obviously, that's the most dangerous job a person can possibly have was on a job site somewhere in Breckenridge, Colorado. And he was using a nail gun and the nail gun accidentally backfired and it ricocheted backwards and it clocked him in the jaw and he saw a nail shoot across the room and bury in the wall across from him. But he had this like injury on his chin, and it really hurt. And he had jaw pain and tooth pain. He had a headache, but he went home after work, hung out with his wife, ate dinner. He had this headache and this toothache for six days. At the end of six days, he said to his wife, "You know, I'm going to get this toothache checked out." And he went to the dentist and the good dentist did a scan of the gentleman's jaw and face and much to both men's surprise. They discovered a four-inch nail embedded in his face. That's right. There was a four-inch nail embedded in his face, protruding into his brain. 

[00:54:13] Jordan Harbinger: For seven entire days, well, at this point, seven days, right? Because six days had gone by where he's like, "Man, eating cereal hurts. I should probably have somebody look at this." 

[00:54:22] Rachel Zoffness: That's right. Now, minimal pain, maximal damage. No one would argue that that's very significant and dangerous, but pain stayed very low. How did that happen? His brain again, his danger detector used all available information to determine whether or not to make pain and how much. So it used the visual of the nail shooting across the room into the wall. And because his brain believed his body was safe, it did not make sufficient pain to protect him. Thank God, there was some pain from where that thing backfired. 

[00:54:59] Jordan Harbinger: Yeah. 

[00:55:00] Rachel Zoffness: But just to say, just to say, pain or hurt is not the same as harm or damage to the body. They are not the same. And the mistake we make in Western medicine is assuming that pain means the body is in danger. And that's why when we have chronic pain, we stay inside and stopped doing all the things. It's the reason why we have 4,200 surgeries because we think we assume that there's something dangerous happening with the body.

[00:55:29] And I will say with back pain, hundreds of studies have come out showing that when you take scans of normal people's backs, who do not have they look just as bad or worse as people who do have back pain and have these wonky-looking scans with bulging discs and all the language that sounds so terrifying. The studies are up on my website. I have a nerdy website with all this pain research. It's zoffness.com. It's just my last name. 

[00:55:57] Jordan Harbinger: We'll link it in the show notes, of course. 

[00:55:58] Rachel Zoffness: So if people want to read these papers, they're up there on back pain. So I want to say again, you might get messages that there is damage or structural stuff going wrong with your body. And yes, that, of course, can be true. No one is saying that isn't true, but long-term back pain is not necessarily — chronic back pain is not necessarily a sign that your back is in danger of harm. It does not necessarily mean that you need surgery. There is something in medicine called failed back surgery syndrome. 

[00:56:28] Jordan Harbinger: Failed back surgery syndrome?

[00:56:30] Rachel Zoffness: You got it, sir. 

[00:56:31] Jordan Harbinger: Wow, how interesting. 

[00:56:32] Rachel Zoffness: It tells us that back surgeries often fail for pain. I think the statistic is like surgery for back pain is only successful 20 percent of the time or something like that. It's because we're not treating pain as a biopsychosocial problem. We're not looking at the whole pain recipe. We're only looking at the bio domain of pain. And by the way, if we're only looking at the bio domain of pain, we are missing two-thirds of the pain problem. 

[00:56:53] Jordan Harbinger: Right. Yes, exactly. I was going to say, you're treating one-third of the problem. Of course, you're going to have two-thirds of the pain, at least still left over.

[00:57:00] Rachel Zoffness: You got it. So if we really want to treat back pain, we have to do the things that nobody wants to do. We have to talk about your past trauma. Trauma lives with chronic pain up to 80 percent of the time. That is not a coincidence because trauma also sensitizes the brain. Trauma sensitizes the brain. If trauma makes the brain more sensitive, literally what that means is it's going to amplify any potential danger message from the body.

[00:57:23] So we want to look at past trauma. We want to talk about your toxic relationships and the divorce you're going through. We want to talk about the fact that your parents are dying. We want to talk about your history of illness. We want to talk about how you got fired and how there's economic stress. We want to talk all about what just happened in the last two years with the pandemic and how anxious you've been because anxiety amplifies pain. If we really want to treat pain, we have to talk about all the hard things. And I know that's bad news. And I know that listeners will think I'm saying it's on your head or it's all psychological. I am not saying that. I'm saying that in the human body, all of the things are connected all of the time. The brain is connected to the body 100 percent of the time. That's just how humans work. 

[00:58:03] Jordan Harbinger: I know we're running short on time, so I want to do some quick ones and then we can go longer if you have time. It's so funny to hear that you think — you call this public speaking anxiety. Nobody listens to this podcast. You have nothing to worry about. I think it's funny that you consider this to be public speaking. Like I'm the only one here. 

[00:58:19] Rachel Zoffness: Right. So I have — during the last two years, I was like, I need to get pain education out into the universe. And I wrote this book and it had no marketing budget. And I'm like, I need to tell people that I wrote a pain management workbook because no one can afford what I do. So how do I do that? I reach out to people who have really rad and awesome platforms. If no one's listening to this podcast and we should just turn this off right now. Let's just, let's just go. Okay, bye. 

[00:58:39] Jordan Harbinger: Yeah, nobody's listening.

[00:58:40] Rachel Zoffness: But this is public speaking anxiety, Dr. Harbinger because I have in my mind this awareness that people might listen.

[00:58:47] Jordan Harbinger: Yes. 

[00:58:47] Rachel Zoffness: It makes me very nervous and sweaty. You can't tell, but I am sweaty right now and I'm talking fast because I am nervous. When we say emotions manifest physiologically, that's a perfect example, sweating and talking fast, but I am really moved by this message. And again, I have kids and adults who have been in bed for four years and they get out of bed and they go back to life. And they get asked to prom by two pretty girls and this sh*t works and everyone deserves to understand pain. We've all been lied to for the last bazillion years, but the neuroscience is out there. It exists in the literature. So nothing frustrates me more than watching the way we continue to treat pain.

[00:59:25] Jordan Harbinger: Why do I feel pain when I see other people get hurt or embarrassed? 

[00:59:29] Rachel Zoffness: Because in your brain you have a really cool thing called mirror neurons. And it's actually adaptive for humans to react to other people's emotions. I'll tell you why. 

[00:59:38] Jordan Harbinger: Yeah. 

[00:59:39] Rachel Zoffness: Back in the day, of course, we were hunters and we would be hunting animals, but guess what? Animals also were hunting us. So if there was a lion approaching and you saw people running and screaming, you have a couple of options. You can either sit down and think, "Hmm, I wonder what I should do in this situation? It seems people are fleeing for their lives. Here's my menu of responses," or your mirror neurons can just mirror or mimic the response of people around you. So you've noticed probably that if people around you are panicking, you feel panic. Even if you look around and you're like, "Why am I panicking?" That happened during the pandemic. Anxiety contagion in the last two years was absolutely insane. 

[01:00:21] So mirror neurons in your brain will mirror the emotions of people around you. It's called emotion contagion or anxiety contagion. And that's real. And by the way, empathic pain or sympathy pain is also real for the same reason, you will feel sometimes physically the pain of people that you love. And by the way, I am in the wrong profession because I feel sympathy— 

[01:00:44] Jordan Harbinger: Yeah, I know you're so sensitive. 

[01:00:46] Rachel Zoffness: I am sensitive, and I feel a lot of my patient's pain. Like I sometimes work with kids who are amputees. And then I can't function for a few days because I just absorbed that and I have to become better at that, but it's not a bad thing. It also makes me better at what I do. 

[01:01:00] Jordan Harbinger: I was going to say, it makes you awesome at your job. Imagine if you were just like, "Oh, your phantom limb hurts? Come on, you crazy, little munchkin. That's not real. 

[01:01:08] Rachel Zoffness: Munchkin is worse than kiddo. 

[01:01:09] Jordan Harbinger: It is. I was trying to avoid saying kiddo and I just made it worse. 

[01:01:14] Why do I rub my knee when I crack it against a table? And why does that actually work? 

[01:01:19] Rachel Zoffness: There is a really cool theory of pain from many years ago called the gate control theory of pain Melzack and Wall in 1965, one, a pain neuroscientist and one, the first-ever pain psychologist, and they forever revolutionized pain medicine. And everything we know about pain today has grown out of the gate control theory of pain. And what they showed is there's a lot of things that can gate or change pain volume. Many things can do it. 

[01:01:47] So it turns out that like you said when you bash your head or bash your knee, one of the first things that you instinctively do is you reach to touch it or rub it. And the reason for that is because you have very, very skinny pathways connecting your knee up to your spinal cord, up to your brain, that code for the sensory messages that tell your brain that something bad has happened that maybe it needs to make pain. You also have very fat or thick pathways leading from your knee up to your spinal cord, up to your brain, that code for touch and touch messages get up to the brain faster than sensory messages from the body, that code for possible pain. So touch reaches the brain faster and the spinal cord faster. 

[01:02:30] So what it does is if you touch your knee, that message gets up to the spinal cord quicker and it closes the gate and it prevents that pain message from getting up to the brain. So it gates it. So touch will actually lower pain volume. And by the way, there's a million things that will gate or control the experience of pain. Touch is one of them, positive emotions is another, social support is another, treating trauma is another, but touch is one of them. So massage really helps. There's something called a TENS machine that will vibrate on the part of you that hurts. That is effective for pain— a lot of things. 

[01:03:05] Jordan Harbinger: My wife used that when she was giving birth, the TENS machine. It really helped a lot— 

[01:03:09] Rachel Zoffness: Exactly. 

[01:03:09] Jordan Harbinger: —because those muscles are just like going through some serious stuff. And that you turn this thing up a little and it's like, oh, this is pulling in another place— 

[01:03:17] Rachel Zoffness: That's right. 

[01:03:17] Jordan Harbinger: —instead of— 

[01:03:18] Rachel Zoffness: That's exactly right. So touch interrupts the pain messages that are trying to get up to the spinal cord and brain. 

[01:03:23] Jordan Harbinger: You've mentioned social pain a few times. So that's similar to physical pain in that they're all types of pain. And I've always wondered if the types of pain are similar if it's just like pain is pain and you've answered that here on the show. But does that mean that I can like take a Tylenol for not getting invited to prom, hypothetically? 

[01:03:39] Rachel Zoffness: Of course, the answer is a complicated one and I love your question. Yes, there are studies that show that things like Tylenol and other pain relievers will treat the pain of a broken heart or the pain of social rejection and ostracization. It's pretty wild because again, the parts of the brain that process physical pain are the parts of the brain that process emotional pain because pain is both physical and emotional 100 percent of the time. So yes, there have been studies that show that emotional pain can also hurt physically, which shocks no one.

[01:04:14] If anyone has ever had a broken heart, you tell me that you didn't have chest pain or that your body didn't hurt. We all know that social and emotional pain also can hurt physically. Because again, as we said at the beginning, emotions don't just live in your head. They also come out in your body. So because those two things are connected by the way, is why opioids are so magical for pain. Because opioids also alleviate anxiety and depression and the trauma of past traumas. Opioids knock out everything. That's why they're so addictive and why we don't use them for chronic pain, or we shouldn't use them for chronic pain. 

[01:04:51] And again, I am not anti-opioids. Opioids are great for acute pain, but what research shows for long-term chronic opioid use — by the way, and a lot of people who have been taking these for years don't know this is that they sensitize the brain to pain over time. I can get a lot of trouble for talking about opioids. So I want to say this carefully, I am not in favor of ripping opioids out of the hands of people living with chronic pain, because they haven't been given other options, but there are ways of ethically tapering and giving people replacement tools to manage pain.

[01:05:25] But I do think it's critical for people to know that opioids are a very powerful medication because they target not only physical pain but emotional pain too. And that over time, they make the brain more sensitive. So again, small sensory messages from the body are going to feel even more terrible to you if you've been on long-term opioids. So we are actually harming, we are harming our pain patients. We're hurting them. 

[01:05:49] Jordan Harbinger: Right. We've been taught that medication is the only answer. And like you said before, a big pharma hoodwinked us by convincing us that all of it is a chemical issue that can only be solved by other chemicals, which is not the case at all. In the sense opioids actually are making our brain more sensitive to pain, totally makes sense. Because, of course, when you try and get off them, you're just like, "Well, wait a minute, everything sucks even more than I remember. It's sucking before. Of course, I'm not going to quit this. Like, it was bad enough to make me go on this before. And now that I'm taking a break, it's twice as bad, screw this. I'm going back in the hole," right? Like I totally get that. That makes complete sense. 

[01:06:23] Rachel Zoffness: But people in pain have just been screwed because first of all, Nine times out of 10 or more than that, their doctors actually haven't been trained in this biopsychosocial neuroscience. It's not their fault. We have a flaw in our educational programs like doctors, by the way, thank God for doctors. It's like, everyone just wants to help. Everyone just wants to heal. It's not like some malicious terrible thing. I mean, big pharma is pretty malicious. That's just all like money-focused crap. Doctors want to heal. But the patients haven't been told, they weren't told upfront that their pain is biopsychosocial and therefore requires a biopsychosocial treatment, including cognitive-behavioral therapy and biofeedback and dealing with trauma and all these other things.

[01:07:03] And they were told the opposite. They were told their pain is purely biomedical and therefore requires just pills and procedures. It's not their fault either. It's just — this is the cycle we're trying to break. This is the system we're trying to fix. This is why you and I are doing this thing today. Who doesn't deserve to understand how pain works?

[01:07:22] Jordan Harbinger: What about people who like super spicy food? You know, what's the deal with those freaks that love just crazy heat. And they're inhaling this like crazy hot ramen that would give me blisters what's going on there? 

[01:07:32] Rachel Zoffness: Yeah. It turns out that people can desensitize to things like heat as well. So you have sensors on your tongue, of course, that correspond to sensors in your brain. Over time, gradually with small bits of sensory input, your brain desensitizes. So you could become desensitized also to really hot, spicy food if you want it to. It's sort of like what we do with chronic pain, sort of the metaphor I gave before of opening the blinds slowly one at a time. We would do that with spicy foods and you would start with just a little bit, and then you would increase the spice and you would just increase the spice. And yeah, people love it. Also, listen, by the way, I should say, there are people who love pain. 

[01:08:09] Jordan Harbinger: Yeah. I was going to say, what about kinky stuff, man? Like the people who are into, you know, asking for a friend. 

[01:08:13] Rachel Zoffness: Yeah, of course, you're asking for a friend. That is totally normal. It is not weird. It is not weird. Because again, when we talk about pain, context matters. If you're with a partner you like and trust, and you want them to do a thing, it will feel good in that context. It wouldn't feel good if a stranger on the street grabbed you by the hair and slapped you across the face. But like, if you like that— 

[01:08:37] Jordan Harbinger: For example. 

[01:08:38] Rachel Zoffness: If you like that in bed with a trusted partner, it's going to feel differently to your brain. Your brain is going to interpret that sensory input differently, depending on context, that's a perfect example of why social context and your emotional state matters a lot. So again, it's not weird to enjoy things that can be painful in other contexts because in certain contexts, they can be pleasurable and exciting. And again, that's just further proof to all of us that all pain is biopsychosocial all the time and that your brain uses all available input when it decides whether or not to make pain. 

[01:09:14] Jordan Harbinger: I know there are lots of practicals in the workbook. I checked some of it out. Definitely seems like something that if you have pain or somebody, you know, has pain, this is well worth the purchase. We'll link to the book in the show notes, but if you cannot afford the book, email me, and I will buy it for you. And I will send it to you because I think a lot of people who are in this situation might also not have a lot of disposable income or the person won't buy it because they're like, "Nothing works. Stop talking to me about this. I hate every second. I'm thinking about it," and you want me to send it to them. I will pay for it using the ad revenue from this episode. 

[01:09:51] Rachel Zoffness: Has anyone ever wept on your podcast before that was overwhelmingly kind? I don't even know what to say. 

[01:09:57] Jordan Harbinger: It would be — what is it? 20 bucks.

[01:09:59] Rachel Zoffness: Yeah. 

[01:09:59] Jordan Harbinger: It's got to be 20 something. It's 20 bucks, well spent — can you imagine that somebody's life has changed by 20 bucks? 

[01:10:05] Rachel Zoffness: Oh, Jordan, you're my new hero. Like officially you're my new hero. That was so rad. That was so rad. I'm going to talk about this for like years. I want to tell you I get messages, sometimes I post them. Sometimes I sit around and read my social media and I get these messages that just make me, they bowl me over, like— 

[01:10:24] Jordan Harbinger: I'm sure. 

[01:10:24] Rachel Zoffness: "I've had pain for 40 years. And finally, my pain is changing for the first time," or like, "I have hope," or, you know, "My body is changing for the first time." I cannot tell you like the response to this work has just bowled me over. Like you can tell. I'm passionate about it. I believe in it. I have had pain as an adult also. Like it has changed my life too, but when I read these messages, it's just like — I mean, we are starting a revolution. There's no way around it. We are going to change pain medicine and thank you for helping me do that. And for believing in this resource, that means a lot. 

[01:10:56] Jordan Harbinger: It's my pleasure. This conversation has really been super fascinating and I really appreciate your time. Thank you so much. 

[01:11:02] We've got a trailer of our interview with Jack Barsky, former KGB spy, who posed as an American and a truer-than-life version of a Hollywood movie. This is one of our most popular episodes of the show. Jack not only dodged the FBI for decades but also defected from the Soviet Union, secretly becoming a real American. We'll learn how spies were recruited and trained during the Cold War and what skills Jack used to assimilate seamlessly into American culture.

[01:11:29] Jack Barsky: I was untouchable. I was above the law. I was always bypassing customs and passport control. So for a young person that really feels good because I never liked rules. 

[01:11:40] Jordan Harbinger: How did you flip to eventually becoming full American? I know they tried to call you home. Can you take us through that? 

[01:11:45] Jack Barsky: They called me back as an emergency departure. They've done this in the past. They've called back in the agent, and as soon as they step on Soviet soil, they are jailed or even executed. I was stalling the Soviets, and then one day they send one of their resident agents and he said to me, "You got to come home or else you're dead." It was a threat. I decided I would defy them and tell them that, "I'm not returning. I will not betray any secrets. And please give the money on my account to my German family." 

[01:12:16] Jordan Harbinger: Wow. 

[01:12:17] Jack Barsky: End. 

[01:12:17] Jordan Harbinger: Tell us how you got caught because the story is just not complete until you — like you said — had to face your past. 

[01:12:24] Jack Barsky: I was stopped on the other side of the toll gate. It was a state trooper. He says, "I just like to check your license and registration. And could you step out of the car?" I stepped out of the car and still not having a clue what was going on. Out of the corner of my eye, somebody approached me from the back. The fellow introduced himself, he says, "Joe Riley, FBI." And he showed me his badge. "We would like to talk with you." The first question I asked, "Am I under arrest?" And the answer was no. Then I said, "What took you so long?" 

[01:12:53] Jordan Harbinger: For more from Jack Barsky, including how Jack was finally caught by the FBI and what happened after that, check out episode 285 of The Jordan Harbinger Show. 

[01:13:04] I learned so much about pain from Dr. Rachel Z. There's a lot in her workbook as well. Something called the pain voice. Basically, it's a voice that tells us the pain's never going to go away. She'll teach us how to recognize that voice. The pain voice doesn't want to be out of a job, right? We got to catch it, check it, change it. You can't identify with it and let it become your reality or let it become you, right? The pain voice thinks it's protecting you, but it's really just causing you to identify with the pain. And there's a lot of questions like this in the book. There's a lot of techniques in the book as well. And remember this isn't as simple as thinking the pain away or being like Dr. Spock and saying, "I refuse to feel the emotions or the feelings of the pain." This is real stuff.

[01:13:41] I am serious about buying the workbook for people who need it but cannot afford it. All you need to do is reach out and say the word. I think if I could help somebody get rid of or manage their pain, it's just the best money I've ever spent, frankly. 

[01:13:56] Thank you to Dr. Rachel Z. Again, the book is linked in the show notes. Links to everything, always in the show notes at jordanharbinger.com. Please use website links if you do buy the books from the guests. It does help support the show. And it lets me buy other books for people who need them, that can't afford them. That's what I use a lot of that money for. Transcripts are in the show notes. Videos are on YouTube. Advertisers, deals, and discount codes, all at jordanharbinger.com/deals. Please consider supporting those who support the show. I'm at @JordanHarbinger on both Twitter and Instagram or connect with me on LinkedIn. 

[01:14:29] I'm teaching you how to connect with great people and manage relationships using software, systems, and tiny habits. The same stuff I use every single day folks. It's our Six-Minute Networking course. The course is free. It's at jordanharbinger.com/course. Dig that well before you get thirsty. And most of the guests you hear on the show subscribe and contribute to the same course. Come join us, you'll be in smart company where you belong. 

[01:14:50] This show is created in association with PodcastOne. My team is Jen Harbinger, Jase Sanderson, Robert Fogarty, Millie Ocampo, Ian Baird, Josh Ballard, and Gabriel Mizrahi. Remember, we rise by lifting others. The fee for this show is that you share it with friends when you find something useful or interesting. And if you know someone who is dealing with pain, this is a great episode to share with them. And I will happily get them this book if they need it. The greatest compliment you can give us is to share the show with those you care about. In the meantime, do your best to apply what you hear on the show, so you can live what you listen, and we'll see you next time.