How to Combat Pain
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What myth about pain does Hidden Brain open the episode with?
This is Hidden Brain. I'm Shankar Vedantam. It happens in an instant. You move too fast and you feel a wrench in your back. That first sharp pain is followed by a persistent ache, bothersome enough to send you to the doctor. A scan reveals a problem. A specialist recommends surgery. You go under the knife, trusting that once the damaged tissue is repaired, the pain will disappear. The story makes intuitive sense. Diagnose the problem, fix the bone or ligament or tendon that is not working properly, and you'll make the pain go away. But for many of us, that's not how pain unfolds. Aches persist even when scans look normal, or they vanish without any medical intervention. Treatments that promise relief fail to deliver.
We also notice something puzzling. The pain we feel changes with other things happening in our lives. When we're feeling calm or absorbed in something else, the pain subsides. When we feel isolated or sad, the pain gets worse. Today on the show and in a companion episode on Hidden Brain Plus, we examine why our culture gets so many things wrong when it comes to understanding the true nature of pain. What's really happening when we experience pain and how to address it?
This week on Hidden Brain.
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Pain feels like a simple message from the body If your elbow hurts, there must be something wrong with your elbow If your back is painfully stiff, you need some work done on your back The brain in this model is an observer. It registers signals of pain sent in by nerves from the far reaches of the body. But is that really all there is to it? At the University of California, San Francisco, psychologist Rachel Zofnes studies the nature of pain. She has found that our minds play a much larger role in our experience of pain than many of us realize. And they also play a much larger role in how we need to deal with pain. Rachel Zofnes, welcome to Hidden Brain.
One of my favorite ever podcasts. I'm so honored to be here.
Rachel, as you began your own research training, you were taught a one-dimensional biomedical model of pain. Can you describe that model for me?
Absolutely. The biomedical model is an antiquated way of looking at disease and pain that focuses primarily, if not exclusively, on anatomy and physiology and bones and body parts and what that means in the biomedical frame of things. is that when we talk about treating pain, we also talk primarily, if not exclusively, about biomedical solutions, and that takes the form of pills and procedures. So here's what I observe as a clinician and pain researcher. What I observe is that if you have chronic knee pain, you will be sent to 762 knee specialists, but we never talk about your brain at all.
So early on in your own training, Rachel, you encountered a pair of clinical cases documented in the medical literature, which got you thinking about pain in a different way. One was about a 29-year-old construction worker who got injured. Can you set up the scene for me and describe what happened to this worker?
I love these two stories, and I call them a tale of two nails, because who doesn't like rhymes? So, yes, the first story, the first tale of nails, is a construction worker who was working on a job site when he jumped off a plank straight onto a seven-inch nail. And that nail drove through his boot clear through to the other side. Oh, my God. Yes.
So the pain must have just been excruciating.
It was excruciating. And his colleagues rushed him off to the emergency department. And he was sedated with a lot of good drugs like, you know, fentanyl and other opioids. And when the good doctors removed his boot, they discovered that a miracle had occurred. The nail had passed between the space between his toes.
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