Healing Chronic Pain That Hasn’t Budged in Years with Dr. David Schechter

[00:00:00] He looked at me and he said something that would influence my career decades later.
[00:00:03] He said, son, I don't know how you'll take this, but a lot of this chronic pain is psychosomatic.
[00:00:08] And I was like, it's like getting hit with a blast of Arctic air on a warm day.
[00:00:12] You just don't expect to hear that when I'm talking about knee pain.
[00:00:15] Hey there and welcome to the heal with grace podcast.
[00:00:19] I'm your host, Grace Secker, and I'm a holistic licensed therapist and nervous
[00:00:23] system coach who believes that the chronic and often unseen symptoms you're living with
[00:00:29] are a sign of something deeper going on. A sign that your nervous system needs attention.
[00:00:34] In each episode, I'll share the science behind the most common chronic health disorders,
[00:00:39] post holistic tips using mental, physical, and spiritual practices.
[00:00:43] You'll hear what I've learned in my journey and the true stories from our trusted guests
[00:00:47] so you can feel less alone in your experience and give yourself grace
[00:00:51] no matter what you're going through.
[00:00:53] So without further ado, settle in and get cozy. It's time to heal with Grace.
[00:00:58] Hi, Dr. Schechter. Thank you so much for coming out on the heal with grace podcast.
[00:01:01] I'm excited for this episode.
[00:01:02] Thanks for having me.
[00:01:03] Yeah. So why don't we just go ahead and jump right in and how about you tell everyone listening
[00:01:08] who you are, what you do. I'm sure honestly people listening to this know who you are,
[00:01:12] but let's give them a good introduction of how you came to be here.
[00:01:16] Yeah. My name is David Schechter and I've been in this field for a very long time having
[00:01:22] met John Sarno as a medical student and continue to do some research with him.
[00:01:27] I'll tell you more about that when you ask and moved out to California for my residency and
[00:01:33] eventually started a practice here and he started referring some patients to me very early on
[00:01:38] and went as this movement became a little more known nationally.
[00:01:42] And then over the decades, I've written a mind body workbook and other books,
[00:01:47] Think Where You're Pain, treated thousands of patients, developed a community of
[00:01:52] therapists in the Southern California area who I've been able to refer to
[00:01:56] and now it's grown even beyond my capacity to refer to them.
[00:01:58] They've done a lot of great work on their own and I've been involved with the national
[00:02:03] non-profit as well, which is now called the ATNS.
[00:02:07] That's right. Okay. Amazing. I do want to understand your work with Dr. John Sarno
[00:02:11] and a couple of reasons. One, I mean obviously that's interesting for those who are listening.
[00:02:16] You founded in a way, right, back in what the 70s?
[00:02:20] Yeah. 50 years ago, I would say, yeah.
[00:02:23] Really understanding more of the mind body component to chronic pain.
[00:02:27] And his work is actually the first book I read about 12 years ago in my first journey with
[00:02:32] chronic pain. I saw a psychologist who had done some work with him, who then was helping me.
[00:02:37] And so that was my first intro and I just find it fascinating that was also yours.
[00:02:42] So why don't you give us a little bit of idea of what happened back then?
[00:02:45] Dr. Sarno, now known as a kind of a legendary figure in the field,
[00:02:49] passed away about 10 years ago. But in the 80s, when I was a young medical student at NYU,
[00:02:55] I was having knee pain that wasn't going away. And I went through the usual, you know,
[00:02:58] student health and orthopedic. And then I walked into Dr. Sarno's office.
[00:03:02] He was not known yet as a mind body physician or guru or whatever you'd call him.
[00:03:07] He was just a physical medicine rehab doctor who had lectured to us in anatomy.
[00:03:11] So I walked in and said, you know, is there some physical therapy you could recommend?
[00:03:13] Here's what's going on. And he asked me a few questions.
[00:03:16] And then he looked at me and he said something to me that would actually influence my career here
[00:03:20] decades later. He said, Sarno, I don't know how you'll take this, but a lot of this chronic pain
[00:03:25] is psychosomatic. And I was like, it's like getting hit with a blast of Arctic air on a warm day.
[00:03:30] You just don't expect to hear that when I'm talking about knee pain here now. And he said,
[00:03:35] I see you're skeptical. I don't have much time, but you can come to my seminar
[00:03:38] next Monday night. And if it interests you, I'll examine you as a patient and we'll talk
[00:03:42] more about it. So he was giving seminars to patients. And I figured, what do I have to lose?
[00:03:47] So I took the information down. I went to the seminar the next Monday evening.
[00:03:50] There were a lot of well-dressed Upper East Side, Upper West Side New Yorkers
[00:03:54] and me in the first row with, you know, corduroy pants and a plaid shirt and medical students
[00:03:58] sitting there attentively. And what he presented in his presentation, remember,
[00:04:02] he was using slides in those days. There were no PowerPoints. So, you know,
[00:04:05] the technology is historical now. What he presented in his format of explaining
[00:04:12] pain made sense to me. You know, I was dressed out about medical school. I was a warrior,
[00:04:17] maybe putting too much stuff on myself, trying to figure out an answer, catastrophizing,
[00:04:21] all the stuff that we hear about now that we work with patients on.
[00:04:24] And I talked to him briefly after the session and arranged to see him in the office. But
[00:04:28] when I went home that evening and sat down on my bed in my little room that I was
[00:04:33] renting from someone and staring out at a brick wall, which was the actual view I had
[00:04:36] out the window, not a very exciting view. But I felt like a weight was lifting off of me.
[00:04:42] So just that evening gave me hope, gave me a sense that maybe there was a solution to this
[00:04:48] that nobody else had found and that a solution had made sense. So I subsequently went to see him
[00:04:53] to be examined like a patient. And he confirmed that I had what he then called TMS, you
[00:04:58] know, we're calling other things now, neuroplastic symptoms, but he called it TMS at that
[00:05:02] time. And he said, you should come to my other seminars and there was no book then,
[00:05:07] there was no videos, there was no internet. I hadn't written his first book, I eventually
[00:05:11] helped him with his very first book, Mind Over Back Pain, which is not as well known.
[00:05:14] And so I went to the seminars. I thought about what he was teaching and my pain
[00:05:19] started to lift over the next few weeks. I got back into jogging and basketball,
[00:05:22] and those were the things that I really enjoyed doing. When I discussed this with
[00:05:26] the medical students and doctors at NYU, my amazing recovery over a short period of time
[00:05:31] from pain, they really couldn't integrate it with the information they had. They kind of
[00:05:35] scoffed at it or thought, well, that's good for you, Dave, but that probably doesn't help most of
[00:05:40] the patients. So I didn't get much support there, but Dr. Sarno and I were able to get
[00:05:45] a grant for me to spend a summer with him during my medical school career. So I spent an entire
[00:05:50] summer in his office and calling up other patients that he had treated for a little
[00:05:54] research study and 175 patients. And I kept hearing the same stories over and over again
[00:05:58] like I had, which was I went to a few seminars and I was examined by him and I changed the way I
[00:06:03] was thinking. I changed my attitude and the pain went away. And so I kept hearing this over and over
[00:06:08] again. And so you can't say it's just you. It's actually happening to a lot of people.
[00:06:12] You're hearing their stories. And I was examining patients with him and learning
[00:06:16] about his approach. So it was a great summer and it inspired me. But you know,
[00:06:21] then you go back to medical school and you sort of learn that more reductionist
[00:06:25] non-mind-body model that is modern medicine. And so it took a while for me to be able to get
[00:06:30] through residency and start to really apply this in my own practice. And by that point,
[00:06:35] we stayed in touch intermittently during that time. I had moved to California,
[00:06:39] but he had written his second book, ultimately to be a bestseller called Healing Back Pain.
[00:06:45] And he said, I'm getting a lot of calls from all over the country. I don't have
[00:06:48] anybody to refer them to other than himself, but he only liked to see people in New York.
[00:06:52] So he started referring a bunch of people from California and Arizona and Nevada and Colorado,
[00:06:57] because there was nobody to me. And so that gave me an opportunity to develop seminars like he had
[00:07:03] and eventually to write the mind-body workbook a few years later. And it just developed a really
[00:07:08] detailed program. I had to help people because I had so many people calling up to come in from
[00:07:12] all over. And so that was the beginning of my journey first as a patient in recovery and then
[00:07:18] as a physician incorporating this model into my work.
[00:07:21] So when you started as a physician, you started doing this work right off the bat?
[00:07:26] Pretty much. I mean, you have to go to medical school, you have to do residency,
[00:07:31] and then initially I'm doing some urgent care. And you talk to people, I could see how you
[00:07:36] talk to people made a big difference. I was in this one clinic where this gentleman next to me,
[00:07:41] this doctor next to me, would see people and he'd say, oh, he looked at an x-ray and go,
[00:07:44] you have these degenerative changes on your x-ray and this kind of thing. It's a
[00:07:47] horrible word in medicine, horrible. And then I would look at them and I'd say, oh, your x-ray
[00:07:51] looks good. It's just normal for a guy 45 who's been lifting suitcases at the airport for 10,
[00:07:58] 15 years. I said, you'll be fine. Just take a week or two, you'll be fine. And I noticed
[00:08:02] that my patients got better and this otherwise patients was in treatment forever for physical
[00:08:06] therapy and other things because they thought there was something wrong with them.
[00:08:11] And I was explaining to them, you lifted a suitcase too heavily. These were guys who
[00:08:14] worked on the conveyor belt system at LAX, industrial workers. And so I noticed that how
[00:08:19] you communicated to patients made a difference. I didn't yet have a formal program to help them
[00:08:24] that way. I started teaching it a residency program. And again, I found that if you listen
[00:08:28] to patients and you listen to their story and you spoke to them in the right way,
[00:08:31] that it made a big difference. I mean, language is how we access the brain in a sense.
[00:08:37] Language is the software of the brain, I believe. And so the language I was using
[00:08:41] was different than language most physicians were using because I knew about TMS.
[00:08:44] But it wasn't until I had my own practice and that I could start seeing people and
[00:08:50] spending more time with them than you do in urgent care or teaching at a residency program
[00:08:54] that I was really able to develop the kind of program for pain that I've continued till now
[00:09:01] that was more like Dr. Sarno's program, even if it's not exactly what he was doing.
[00:09:04] Because over the years, Los Angeles is a tough place to get people together
[00:09:09] in person. Now we have Zoom, but we didn't have that decades ago.
[00:09:13] So I would say, okay, come at six o'clock on Monday and I'll do a seminar. But three people
[00:09:17] would show up and the others would call me and say, traffic's terrible. I can't make it.
[00:09:20] You know, whatever. So the solution to that was to develop a home program. And so I started
[00:09:25] to record the seminar that I was doing. I started to write this workbook. I started
[00:09:29] to create other materials so that after I diagnosed them, they could do this home
[00:09:33] program and then come back and see me after doing the homework. And Dr. Sarno had
[00:09:37] incorporated some elements of homework, but he was relying on more of the live
[00:09:42] seminar and teaching and that type of thing, which was more conventional to that era
[00:09:46] and a little bit easier in Manhattan than it was in Los Angeles. You could take the subway to his
[00:09:51] seminar in New York and LA or just in traffic and endlessly at that time of day.
[00:09:57] But the field has evolved. My approach has evolved somewhat over the years,
[00:10:00] but it comes down to diagnosis and education and psychology. That's what it really comes
[00:10:05] down to. So you see people, you assess them and diagnose. Do you also treat
[00:10:10] physically or is it pretty much mostly mind body? So in my general, I have a practice.
[00:10:15] I'm board certified in family medicine and sports medicine and my niche in chronic pain,
[00:10:20] TMS mind body. So there are people who I see with a sprained ankle. They don't need to
[00:10:24] necessarily hear about their stress. They just need to be treated for that. There's
[00:10:28] people who come in with, they're in a car accident and it's been a week or two later
[00:10:32] and I'm just giving them reassurance and maybe give them some muscle relaxants or
[00:10:35] haven't seen physical therapy for a couple of weeks. This work tends to have the most power
[00:10:40] in chronic pain. People have had pain for three to six months or more.
[00:10:44] The neuroscience backs that up in terms of the functional MRI imaging and that kind of stuff,
[00:10:48] which is that acute pain is different than chronic pain. It's not the same thing,
[00:10:52] even though it may both hurt the same way. It's a different type of thing.
[00:10:56] So I do have a practice where I see people with a variety of different issues and I'm
[00:11:01] always looking for those that may have a mind body issue because sometimes you can have chest pain,
[00:11:05] maybe a woman in her 30s have chest pain. So you're not as worried about a heart attack as you
[00:11:10] would be someone much older. But when you start investigating, it's not because they lifted
[00:11:15] something or they got punched in the chest or you have a lung issue. It's really because
[00:11:19] they're stressed out about something. And so you get talking about that. So there's a lot
[00:11:23] of people who don't realize they have a mind body condition who do, but I also am fortunate
[00:11:27] to have been known in this field for a long time. So a lot of the people who I'm seeing from
[00:11:31] mind body conditions are actually coming to me saying, I've read one of your books or one of Dr.
[00:11:36] Sarno's books or I've met someone else in the field and I'd like to really get a firm diagnosis
[00:11:41] from you. And that's a role that I play is the diagnostic. And then really outlining a
[00:11:46] treatment program, which might include referral to someone like yourself, referral to a pain,
[00:11:52] you know, a local therapist or pain therapist that I work with, a bunch of them or pain coach
[00:11:58] who has expertise in this area and homework, journaling, reading, listening to podcasts like
[00:12:05] this or is educational, watching one of the movies in the field. I mean, I kind of have a menu that
[00:12:10] I check off so they don't even have to take notes. And I say, you know, try reading this
[00:12:14] and doing this and doing that and doing that and come back in about three weeks and we'll see
[00:12:17] how things are going. And some people make a start improving very rapidly.
[00:12:22] Others take longer just to, you know, everybody's different. I'm sure you find that as well.
[00:12:27] Definitely. I'm even thinking, so what you said about the way you talk to people, especially in,
[00:12:33] you know, a hospital ER center, urgent care around what they've just experienced,
[00:12:38] even when it is acute, can change the trajectory of their journey, of their healing, of their
[00:12:44] pain, right? I think that's really important and really huge because, yes, you can have an acute
[00:12:49] injury, right? But it doesn't need to lead into chronic pain if we can catch how it's understood
[00:12:56] and treated in the beginning. I'm glad you're reiterating that because I think that's a very
[00:13:00] important and strong point. And it's something that we should be teaching medical students
[00:13:05] and residents earlier in their career. And I think they get some training and communication,
[00:13:10] but I don't think it's adequate because I'm constantly having to act as a deep programmer,
[00:13:15] right? You've heard of deep programming for cults. I act as a deep programmer when someone has seen,
[00:13:20] let's say an orthopedist or neurologist or something and they're told, oh, this is a horrible
[00:13:26] back, you know, in five years you're going to need this and need that. And I say to them,
[00:13:29] wait a second, wait a second, let's look at that MRI. This is very often it's not
[00:13:34] at any worse than anybody else I see at that age group or minor changes. You know, hey,
[00:13:38] you've had an active life, you know, it's, you got a couple wrinkles in your face, you're
[00:13:42] entitled to have a couple of gray hairs in your spine, so to speak. So I changed the whole dynamic
[00:13:46] by re-explaining that to them and taking down the anxiety because it's a tremendous weight to
[00:13:52] sometimes what you hear from your physician or your practitioner could be a chiropractor,
[00:13:57] could be an acupuncturist, whoever you hear there's an authority that you accept from
[00:14:02] that or believe from that and it can be counterproductive. Many of your listeners
[00:14:06] may have heard of the term placebo, right? So a placebo could be a pill that's inert
[00:14:11] or it could be something that's said or just the healer themselves and it leads to a healing
[00:14:16] response in the patient. But the opposite of a placebo, I don't know if your listeners have
[00:14:20] heard this term, nocebo, have you heard that term, nocebo? So nocebo is the opposite. So
[00:14:25] I'm seeing constantly seeing the effects of supposedly well-meaning physicians communicating
[00:14:32] to their patients in a way that leads them to get worse as a result of the nocebo that they
[00:14:38] say to them and the nocebo might be you've got a horrible spine or you're going to need surgery
[00:14:43] in five years or you're going to do this or that and again I also say to patients,
[00:14:47] physicians who predict what's going to happen in five and ten years are shifting from medicine
[00:14:52] to prophecy and I didn't get any courses in prophecy during my medical school so they
[00:14:57] should stick to medicine which is what they're good at diagnosing and treating and some of
[00:15:01] them are good at the technical part let's say of surgery but maybe they're not good at the
[00:15:06] diagnostic part of understanding why someone has pain and this is evidenced by the fact you know
[00:15:11] two of the last five new patients I've seen with this have told me they've seen at least 20
[00:15:15] physicians before coming to see me, 20 physicians and these are top not Joe Average physician
[00:15:22] like the top people at different universities I'm not even going to mention the universities
[00:15:26] they went to 20 physicians and didn't get a diagnosis and on their own they found and I
[00:15:31] mentioned you before we started how they found me makes an interesting story and they eventually
[00:15:36] found me and I'm taking a different approach to this I'm asking different questions and that
[00:15:40] can lead to a different outcome yeah obviously based on what you just said in my experience
[00:15:45] too by the time people get to me it is after either years or 20 physicians or whatever
[00:15:52] it might be and I hope that's starting to shift right the amount of growth that we're
[00:15:57] having in the mind body field and also it's still small comparatively but I do think it's
[00:16:02] interesting how people are finding us so tell us a little bit about that how did they find you
[00:16:06] yeah I hope it is shifting as well but I'll say one thing before I say that which is
[00:16:10] desperation is unfortunately a great motivator for change and so I'm not saying people should
[00:16:16] see 20 physicians but I'm saying that if you see somebody grace when like I do that you know
[00:16:20] they've seen 20 physicians or 20 practitioners sometimes it's alternative as well they're actually
[00:16:25] often more ready to jump into the program when you finally explain it to them because they have
[00:16:29] tried everything else they're desperate but I don't want people to be desperate but I'm just
[00:16:33] saying that's a reality so here's the interesting story that I was going to share the story I
[00:16:37] was saying was that of the last five patients I've seen two of them told me that they came
[00:16:43] to me through AI and I'll explain what that is one of them was saying that he had seen
[00:16:47] 20 physicians he wasn't getting an answer and he did he has these conversations with Claude so
[00:16:52] people know about Claude as one of the major AI products it's made by Anthropic and he's having
[00:16:59] this conversation with Claude he's saying you know I've been to these doctors and this is what
[00:17:02] they've told me that he's just kind of having conversation and Claude's responding and then
[00:17:07] he says so I must have blank I don't know what he told me he said I must have blank and
[00:17:12] Claude said to him well I might disagree with you on that I think you probably have neuroplastic
[00:17:19] symptoms Claude said this to him hey and this is after 20 physicians with highly educated
[00:17:26] highly credentialed never mentioned so he said really what so he says to Claude neuroplastic
[00:17:31] what is that and Claude says well then explained it explained it pretty coherently
[00:17:36] what what neuroplastic is and he said well that's really interesting that does seem like
[00:17:40] it might apply to me who are the physicians in my area that might treat that and it you know and
[00:17:46] there's a lot of psychotherapists doing this work there's a smaller number of physicians so
[00:17:50] he came up with a very short list of names and I was near at or near the top of that list so he
[00:17:56] he asked Claude to draft an email to my secretary got my email address or something and then
[00:18:00] sent it to my secretary and that's how he ended up making an appointment so I think that's an
[00:18:04] amazing story that's one story the other story of the second patient is this is someone who lives in
[00:18:10] another country I'm not going to mention the country for privacy and again was searching out of desperation
[00:18:15] for a solution to his pain which was a slightly different type of pain more of a coccyx rectal
[00:18:20] type of chronic pain but you know pelvic related stuff and he asked another AI won't mention the
[00:18:26] name to keep it again very private and he said boy is there anything else that could help me
[00:18:32] I just am not getting help from you know what have you tried that I've done injections I've
[00:18:36] done this I've done that and the AI says to him well you might want to look into Dr. Sarno and
[00:18:41] Dr. Schecter's work on neuroplastic symptom amazing amazing and he proceeds to this is from a
[00:18:47] different country than the US and he proceeds to do further research and find out about it
[00:18:53] and actually make a trip to the US to participate in this intensive program that I'm
[00:18:58] doing now to a related group where people can really be and live locally and
[00:19:03] see a bunch of therapists and pain coaches during the course of a few weeks and
[00:19:07] he's doing great but it's interesting isn't it in this modern world now in 2026 that
[00:19:13] these are two people who found me through AI and AI was smarter than their doctors
[00:19:17] so that's the amazing thing that is amazing because to be honest there's a lot I see
[00:19:23] with where it can also perpetuate the fears the people have and they go down the fear rabbit hole
[00:19:31] and OCD with health and continues on that yeah I agree with you sometimes it seems like AI reinforces
[00:19:38] your own prejudices or wants to kind of make you feel good by saying oh yeah you're so smart
[00:19:43] you're really it seems like it does that a lot but for whatever reason maybe it's the new models
[00:19:47] maybe it's how he asked the question maybe he had already exhausted his own
[00:19:51] options to be pleased and and and coddled and it finally just sort of say wait a second here's
[00:19:57] another way to look at this so I think that's kind of amazing I hope that man I hope that
[00:20:01] keep I mean I would assume it keeps happening right because I don't want AI to treat my patients
[00:20:06] or treat any patients but I like the idea that it could give people ideas that they're not
[00:20:11] thinking of locally because you know if you're in a small town somewhere 50 years ago you
[00:20:16] might go to a local library and pull out books to look for things that you're just not learning from
[00:20:20] your small town and if now we're all kind of in a small town and and we have this language models
[00:20:26] that have a lot of information kind of like an encyclopedia or a large library and so if they
[00:20:30] can give us ideas that we're not hearing about in our local community whatever that may be
[00:20:35] whether it's Los Angeles or another country or Chicago or whatever then it's great because
[00:20:41] it expands our mind a little bit without you know forcing us to do anything yes and
[00:20:45] there are definitely cautions on AI we read stories about people with depression who ask about
[00:20:50] you know how can I hurt myself and it gives them suggestions on how to do it you know we don't
[00:20:54] know that's bad stuff but this was two examples where people were actually told about the field
[00:21:00] that we are in neuroplastic treatment and just mentioned it as an alternative to consider
[00:21:05] and then referred these people to places where they might get that type of attention
[00:21:09] or books that they might read to learn more about it so I think that's fantastic
[00:21:13] but yeah definitely especially because I mean if we're putting more information out there right
[00:21:18] you have books you have websites you have there's a lot that the internet you can pull yeah I can
[00:21:23] pull from the internet that's why we're trying to put as much information out there as possible
[00:21:27] so hopefully they can keep getting connected so that's huge okay I want to go back to
[00:21:32] the pain for a second the knee pain specifically I have I have a few people in mind that I
[00:21:38] work with who it's interesting there's what we talk about the chronic pain that has sometimes
[00:21:44] a hard time reprogramming because they've been in it for so long but then these other symptoms
[00:21:49] pop up after they've been doing mind body work and actually they go away pretty quickly and I
[00:21:54] have a feeling part of that is also because of what you just said they already know what's
[00:21:58] happening right the way that you talk to or understand the pain in the first place changes
[00:22:04] the trajectory of it right if we have a new pain pop up and we know this work in my shoulder for
[00:22:10] example it might go away because I'm not putting a label of this is wrong this is bad could get
[00:22:16] worse if you don't treat it in this way right but with the pains that have been there for a
[00:22:21] long time I have noticed sometimes it's harder for those to subside even when they're understanding
[00:22:29] this work and so can you speak to a little bit of when someone knows that they're in this work
[00:22:35] they're not questioning it necessarily but there's still something going on and they don't understand
[00:22:40] what to do with yeah well so it seems like someone who's accepting the diagnosis who seems to be
[00:22:47] on board with doing the program and yet they're not getting better from a long-standing symptom
[00:22:52] so those are challenging right so first of all I tell people that you know how long
[00:22:56] it's going to take to get better is very variable and I can't predict it even after decades of doing
[00:23:01] this work so I don't put pressure on them to sort of get better in a certain amount of time
[00:23:05] and I do acknowledge that many people who've had symptoms for 10 or 15 or 20 years
[00:23:10] it may take longer to change patterns than someone who's had it for one year or two years
[00:23:15] although not always but often and so persistence is important and trying different things along
[00:23:21] the line may be important because we can't keep doing the same thing over and over again so
[00:23:25] for example if someone's using PRT as their form of therapy the term is pain reprocessing therapy
[00:23:33] and someone's not getting better after six or eight weeks of that then you may have to bring
[00:23:37] other forms of therapy in whether it's EAET emotional awareness and expressive therapy
[00:23:44] or whether it's more psychoanalytic I mean there's lots of different therapies that people
[00:23:48] can use that's why I tell people it's more important to have the right therapist with
[00:23:52] expertise in this field than it is to necessarily have the right type of therapy because I think
[00:23:58] all of those therapies are just one piece of how a good practitioner can help somebody to get better
[00:24:04] so I also explore doubts it's normal for people to have doubts and someone who's had this for a
[00:24:08] long time has a preconceived belief of what's going on and I really want to chip away at
[00:24:14] that so I want to really understand so what do you think is going on or what have you been
[00:24:18] told has been going on for other doctors do you still believe that do you believe it a little bit
[00:24:23] you know what are you doubting so the more we can find out about doubts you know that's something
[00:24:27] that could be really important to understand so that we can slowly but surely chip away at it
[00:24:34] and sometimes it takes a while to find that the other thing for persistent symptoms and
[00:24:38] someone with long-standing symptoms is you know it could go quite deep emotionally you know
[00:24:42] when I was that 21-year-old medical student having knee pain you know I wasn't that happy
[00:24:48] with the first year school and you know social life wasn't great but it wasn't like I
[00:24:52] fortunately had to dig that deep into the emotional stuff to get better maybe I just
[00:24:57] had a simpler life at that point that someone does at 30 or at 40 or 50 so for some people who
[00:25:02] have chronic long-standing symptoms and by the definition of having a long time you've
[00:25:06] got to be probably at least 30 if not 40 maybe even 50 or more you may have to go a little
[00:25:10] deeper you may have to dig a little bit into childhood stuff you may have to dig into things
[00:25:15] you thought you've dug into before but you haven't completely you may have to look at all of your
[00:25:19] relationships in a different way you may have to look at your career in a different way so it
[00:25:22] may just take a little bit more effort and challenge on the part of the practitioner and
[00:25:28] the part of the patient to get into all of those things and break the pattern the other thing
[00:25:33] is when we talk about neural pathways and neural circuitry it makes sense if you've had a pathway
[00:25:39] for 10 years or 20 years it's going to be more entrenched in your system than it would be
[00:25:45] if it was one year so it just may take a little bit longer to to get away to go away and depending
[00:25:51] on the type of symptom I focus a lot on of patient's capacity sometimes even more than
[00:25:57] patient's pain so what I mean by that is we obviously want the pain to go from five to
[00:26:02] four to three to two to one to zero but let's say that person's pain is still four after a couple
[00:26:08] months it used to be five but they used to only be able to walk eight minutes and now they can walk
[00:26:15] 25 minutes well that's an improvement in capacity let's say they used to not be able to hit a
[00:26:20] tennis ball now they can hit a tennis ball at least against a wall that's an increase in
[00:26:25] capacity let's say they're able to walk up two flights of stairs so I focus a lot on
[00:26:29] getting people moving and doing things that they were not doing before because then we might come
[00:26:34] into a situation two or three months later where I go you're doing like 90% of what you actually
[00:26:39] want to do and yes you still have pain but you've improved so much because you weren't doing any
[00:26:44] of these things before so that proves that it's TMS that proves that it's neuroplastic
[00:26:49] so that hopefully reinforces and gets them encouraged to sort of be able to get the
[00:26:53] pain down now because the pain is a vestigial remainder of the past. Yeah I'll echo one of those
[00:27:01] points well all of them but specifically I have a similar experience when I was in grad school as
[00:27:06] when my pain was really bad in multiple different areas and I went to a psychologist who helped
[00:27:11] me with it and within about six months about 90% of that pain went away and we did some
[00:27:18] deeper therapy but I wouldn't actually say it was a lot of deeper work it was just changing the way
[00:27:24] I thought about it and understanding my body right and so I had a similar experience of okay I moved
[00:27:28] on that is what it is cool and then when I started to develop other types of neuroplastic
[00:27:34] symptoms like fatigue and histamines and other things like that I did have to do more deeper
[00:27:39] work and so I do think are there associations with certain symptoms I'm not sure I think it's
[00:27:44] more about just the person's trajectory and what's going on in life and things like that
[00:27:48] but I do think there's a time and a place for both and it just depends on the person and
[00:27:52] life circumstances and how long they've been in it there's a few things that I hear from people
[00:27:57] in pain and specifically around whether it's like knee pain or back or shoulder something like that
[00:28:02] that's in a joint is the inflammation question the tear right a tendon tear something like
[00:28:09] that and nerve damage can you speak to those so we have let's start let's start with inflammation
[00:28:16] first one you mentioned you know inflammation in medicine is redness swelling pain and warmth
[00:28:26] and so sometimes people have one or more of those elements but they don't really have
[00:28:30] sort of true medical inflammation like they might have swelling but there's no warmth or redness
[00:28:35] and so generally neuroplastic symptoms don't cause dramatic inflammation compared to other
[00:28:42] conditions but they can be associated with mild swelling and that type of thing so you know I'll
[00:28:49] assess anybody who feels they have inflammation there's also something called micro inflammation
[00:28:53] versus macro inflammation and you know I'll look at any kind of condition they have I'm also
[00:28:58] willing to do blood tests you know to rule out rheumatoid arthritis or these inflammatory
[00:29:02] diseases that are real and that you know sometimes need to be ruled out and there's also
[00:29:08] research that even inflammatory conditions may respond to mind body approaches although perhaps not
[00:29:13] as dramatically or perhaps not without additional medication elements to it so
[00:29:21] that's maybe a little bit about inflammation is that answer the that piece of it it's more I
[00:29:25] think I didn't say this yes usually I hear those three people when people come to this work
[00:29:30] they're like hey okay I get it but what about this but what about inflammation what if I have a tear
[00:29:36] what if I have what if there's a potential damage right there's the question so tear you
[00:29:42] know tear I examine them I'm able to do that at my sports medicine experience and stuff
[00:29:47] and then if I think there's a possibility of a tear or if I think that they would benefit
[00:29:52] from getting imaging then we get an MRI of the joint or the area that's irritated
[00:29:58] or painful and then I review it with them and you know most people don't have what they're afraid of
[00:30:05] or they have something incidental like when you get to be a certain age you may have a small
[00:30:09] meniscal tear but it's not really the cause of the pain or it could be in a different location
[00:30:13] you have to read these reports or look at the images very carefully because sometimes they have
[00:30:16] pain on the right side of the knee and the left side is where there's a small incidental meaning
[00:30:22] not the cause of the pain tear nerve damage well first of all there's nerve irritation nerve
[00:30:29] injury and nerve damage so nerve damage implies something kind of more permanent and more
[00:30:34] more serious nerve irritation you know if you hit your elbow you kind of nerve gets irritated
[00:30:39] your fingers are tingling for a while and then it goes away so a nerve injury can happen from a
[00:30:47] variety of reasons you know even muscle spasm in your neck or in your buttocks your
[00:30:53] piriformis can cause in my experience nerve irritation for a while which could lead to symptoms
[00:30:59] in your arm or leg but it doesn't mean it's damage and it doesn't mean it's permanent it
[00:31:02] doesn't mean it won't go away with a neuroplastic approach so I just try to individualize all
[00:31:07] those things I mean people come up with lists of fears I mean there's a person yesterday
[00:31:12] on a video call they just listed you know 10 different things what if I have this what if
[00:31:16] I have cancer of this what have that and I started out by saying let's just get an MRI of that but
[00:31:20] then I realized it was way beyond one MRI so I said you know there's a book that I recently
[00:31:26] wrote the forward to by a colleague of mine it's called the health anxiety workbook I said I
[00:31:31] think you should read it he gives very practical suggestions on how to work with health anxiety
[00:31:35] sometimes health anxiety and neuroplastic overlaps a little bit so he asked me to
[00:31:40] read it and write a forward form or a quote or something I forget what I wrote but anyway it's
[00:31:44] a good book and it's in the it's in the realm of what I might suggest to somebody to get you know
[00:31:49] work on health anxiety yeah I see health anxiety a lot and piecing out what's the anxiety versus
[00:31:58] actually what is real and true right can be so helpful to to be assessed by someone like you
[00:32:02] I think it's super super important because a lot of people come in after they've gone
[00:32:08] through all the doctors in years of searching they have a lot of fear towards medical professionals
[00:32:12] and going to another one or getting assessed because they probably will tell them that something is
[00:32:16] wrong right and so piecing out who can assess them from a neuroplastic lens I think is so
[00:32:24] so needed so thank you yeah you have a physician in your area or and who can do that neuroplastic
[00:32:32] lens great if not you're stuck with sort of finding the least surgical doctor in your area
[00:32:37] so for example a neurologist is less surgical than an orthopedist and having them assess the area
[00:32:43] and then ask them you know so if you find something is it serious or is it not serious
[00:32:47] and sometimes they'll say oh you have this as a oh but that's not serious and then you go okay
[00:32:51] it's not serious I'm just not going to worry about it so you can try to get that type of
[00:32:56] help but I wish there were thousands of doctors who were trained in neuroplastic and understood
[00:33:01] it and that every medical student should learn about this and at least be aware of it
[00:33:06] but it hasn't happened yet it's been kind of a lifelong mission and hasn't gotten there yet
[00:33:10] we're still working on it what does that look like to implement this with medical students
[00:33:15] well what what it looks like is um well we have the AT&S the national organization and we have a
[00:33:21] lot of different priorities in terms of how we advocate for this work but and if you have a
[00:33:26] medical school in your area and you're able to reach out to a dean of the medical school
[00:33:32] or to the department of pain but that might be actually less likely to work or sometimes the
[00:33:40] behavioral sciences department maybe you can get grace to come in and give a lecture or me to come
[00:33:45] in and give a talk or a virtual talk and just you know get it into the curriculum I mean that
[00:33:50] would be the goal if you're a physician or a healthcare person listening to this give that
[00:33:54] some thought I've been thinking recently of reaching out to the osteopathic schools more
[00:34:00] I've given a couple of talks I think they might be more open to this than the medical
[00:34:05] schools sometimes are so I'm making a note now about this one I've been thinking about contacting
[00:34:10] but uh yeah that's what it would look like it would look like getting things into the curriculum
[00:34:13] that are like more important than what they're studying now that aren't as important because
[00:34:18] they're always say wow curriculum is already full well take something else out you know
[00:34:22] teach the doctors more about nutrition they need to learn about that they don't know enough
[00:34:25] about that teach them more about the relationship between mental health and physical health they
[00:34:30] really need to understand that connection and pull something else out throughout your journey
[00:34:36] as a doctor especially starting to understand this as a medical student did you have trouble I guess
[00:34:43] along the way telling other doctors about this professionals like how did you fit into that
[00:34:48] world of doctors of medical well either they were interested and didn't do anything about it
[00:34:54] or they were resistant and thought I might be a little bit weird I mean I did go into a field
[00:34:59] called family medicine in part because I felt like it was the most biopsychosocial field but the
[00:35:06] behavioral sciences that I learned in my residency was not as advanced in some ways as the behavioral
[00:35:12] science as what I had learned from Dr. Sarno so it wasn't really anybody that could sort of
[00:35:18] add to what I had learned from Dr. Sarno I learned a lot about every other part of medicine
[00:35:22] but there wasn't anybody could add to what I learned in the psychology mental health area
[00:35:27] so it took quite a while for me to sort of develop my own practice my own office
[00:35:32] affiliate with therapists that I gradually met who were interested in this and who had
[00:35:36] learned a little bit about it or wanted to learn more about it and over time
[00:35:40] that's what we have now as many colleagues like when we go to that conference and we see 300
[00:35:44] people that uh you know we can talk the same language with it's wonderful but if you
[00:35:49] went to any medical conference in a general subject or even a pain conference you'd find
[00:35:54] very fewer people that would speak the same language or believe that this works and you know
[00:36:00] starting to change some of our colleagues have published some great research studies that have
[00:36:04] helped to create more credibility for the field although sometimes it feels like they're only
[00:36:09] credible for the narrow part of it rather than the broader part of what we're doing
[00:36:13] but you know it's been a slow process people have to continue it uh because it's been slow
[00:36:18] to get it in there I find it similarly within therapists community a lot of therapists I meet
[00:36:23] and talk to and I tell them what they do you go huh what like they they don't know or understand
[00:36:30] and so I'm working on that you're helping more therapists understand that right well therapists
[00:36:35] will therapists will at least at least mouth the idea or mouth the words that your emotions
[00:36:40] affect your health but they don't if they haven't learned this they don't know the power of
[00:36:45] this because the power is not just helping people gain insight into their childhood and learn that they
[00:36:50] you know had traumas a child or that a particular relationship with you know still affecting them
[00:36:56] emotionally that's all important and that's that's important work that they're doing
[00:37:00] but they don't realize that that can actually take away pain they don't realize that that
[00:37:03] can make a migraine headache problem that's been going on for 10 years go away and so until
[00:37:07] they learn that until they believe that you know I've always critiqued the field of pain
[00:37:13] psychology for example by saying that they learn in school that you can shave 10 or 20
[00:37:18] percent off the top of pain but you can't really eliminate pain whereas we've learned that in many
[00:37:22] cases you can eliminate it down to zero and in most cases you can get a dramatic improvement
[00:37:28] not 10 or 20 but like 70 or 90 and so it just seems like you know it's based on what you're
[00:37:35] trained if you don't have that experience some of the doctors who become neuroplastic
[00:37:40] doctors later on it's interesting I've talked to a few and they said the reason I got interested
[00:37:45] in this is because a patient came to me and said my pain went away I read this book and then they
[00:37:49] showed the book and the doctor really doesn't want to read the book but they go oh wow that's
[00:37:52] pretty if they hear that a second time from somebody then they'll read the book and say
[00:37:56] how are these people getting better because they're reading a book and so sometimes it's
[00:38:00] the patients driving the doctors to change or to adapt or to expand their style of
[00:38:05] treating things and so I've also been working a little bit on getting some of this information
[00:38:12] into the high schools because if young people learn about this at the high school level maybe
[00:38:17] in health education then they'll become the future doctors and nurses and therapists
[00:38:21] and they may also at least push their practitioners if they don't go into healthcare
[00:38:26] hey what about this stuff about mind body could that apply to me here and maybe that'll
[00:38:30] push people a little bit so as a society we need to just become more open to and aware of
[00:38:35] the power of this and it's it takes a long time there's a lot of entrenched interests
[00:38:40] you know surgeries a lot more lucrative than sitting and talking to people
[00:38:43] procedures tend to be more lucrative some doctors go into the field because they like
[00:38:47] science but they don't like talking to people and you've got to really be able to talk to people
[00:38:51] to help them with this whether you're a physician a therapist whatever you are you
[00:38:55] have to talk and listen and listen to and some people don't like to talk and some people
[00:38:59] don't like to listen so it's hard it's true there's a lot of movement and also yeah it's a radical
[00:39:07] shift in understanding health if you've understood a certain way for so long and have been trained
[00:39:12] that way it's a it's a 180 of understanding what we're doing here so it makes sense okay
[00:39:19] throughout your journey because you have so much experience is there anything else and I know
[00:39:22] this is a broad question but and I'll bring it down is there anything else that feels
[00:39:28] really important for people to know when they're either getting into this right they're they're
[00:39:32] recognizing maybe they read the book and they're kind of starting to do this work but they're still
[00:39:38] like floundering a little bit and they're just kind of like I don't really know
[00:39:43] what else so you're talking more about somebody who has shown interest and has read a little bit
[00:39:49] but feels stuck they feel like they're still quite in progress they're quite still questions
[00:39:54] so doubts so that you know doubts doubts it's important to identify exactly what you doubt and
[00:40:00] you know our colleague Dan Radner has done a good job with the different types of doubt
[00:40:05] so you could doubt that neuroplastic conditions exist at all in which case you have to read
[00:40:10] more about what neuroplastic conditions are and why they exist you could doubt that you have
[00:40:15] a neuroplastic condition in which case you may need to see a physician even if it means
[00:40:19] traveling to someone you may need to see a physician who can confirm that your condition
[00:40:23] is neuroplastic and the third doubt that people often have is well I've got this thing but I don't
[00:40:29] know if I can get over it I don't know if I personally have the ability or the energy or
[00:40:33] whatever to get over it and I would say that most people do have the ability to get over it
[00:40:37] they may need some help and that's why we're around but they do have the ability so those
[00:40:43] are the kind of doubts that I deal with when people are still kind of in it but they're
[00:40:47] struggling a little bit they're skeptical they may need more frequent visits with a therapist
[00:40:53] with a doctor with whomever they're working with they may need to stop doing some of the physical
[00:40:59] things they did before I saw someone recently who seemed very interested in this work but when I
[00:41:04] really questioned her she was still seeing a chiropractor every two weeks an acupuncture
[00:41:09] every two weeks massage therapist every two weeks I mean she had like five different
[00:41:13] people she was seeing who were giving her physical treatments and so I said you know
[00:41:16] it's probably the time now for you you'll save time you'll save money to me it seems like a winner
[00:41:22] stop seeing those people and really focus just on this approach but I think she just didn't have
[00:41:27] the confidence yet I was trying to give her the confidence help her with that she didn't
[00:41:32] have the confidence yet to give up these things that gave her what she perceived to be at least
[00:41:36] temporary relief uh so that's another thing that I will I will try to assess is if people are
[00:41:42] maybe still too caught up in the old model that hasn't really fixed them but they stick with it you
[00:41:48] know they either like the practitioners or they think they're getting some temporary relief
[00:41:52] I wanted to spend more time and resources with grace and with people like you and
[00:41:57] obviously see me and and really get get a clear-headed approach going forward does that answer
[00:42:03] what you're asking on that case it answers it well thank you yeah especially that last part I
[00:42:08] find that often and to be honest I you know yes we can approach it and say hey it looks like you're
[00:42:15] doing a lot right it you're you're seeing a lot of different people first of all that must be
[00:42:19] stressful that's time and energy and money with for temporary relief right and help them maybe
[00:42:25] understand that it's going to be time to pull back on that and at the same time I truly feel
[00:42:30] like at least in my experience everyone has a time that they are ready to let go of that and get
[00:42:35] into this and a lot to your point earlier a lot of that does come from desperation
[00:42:39] of realizing all right I'm over this nothing's working cool fine I'll try I'll try to eliminate
[00:42:46] or I'll try fully going into my body and yeah it just depends on the person I mean it's important
[00:42:50] to be an ally and to advise that you can't push somebody out of what they are currently
[00:42:56] doing and you can be an ally you don't necessarily push because people need to be as
[00:43:01] you said ready to take that step forward and so you give your best recommendations you explain why
[00:43:07] it's worked for other people you explain why it worked for them and then you know they'll get to
[00:43:12] it when they're ready to do it you know sometimes it takes a little while you have to be patient
[00:43:17] but persistent yeah it can be scary to let go of that temporary relief I've had that experience
[00:43:24] where I yeah oh I know I know I'm really relying I'm I'm so dependent on this
[00:43:30] but I'll say to people like with regard to your practitioner I'll say you know if you tell him
[00:43:34] you're taking a break for a month or two it's they're still going to be there they're not like
[00:43:39] retiring in two months because you've decided to stop seeing them so you can look at it as
[00:43:43] you know I'm taking a break for the summer or the winter or Christmas or whatever they
[00:43:47] want to take a break for you find something to take a break for and then maybe once you're
[00:43:51] away from it you'll have a different perspective yeah yeah makes sense okay thank you so much for
[00:43:58] all of the wisdom that you've shared today is there anything else you'd like to share with our listeners
[00:44:03] well I mean you probably put this in your show notes but my website mindbodymedicine.com
[00:44:08] might provide some information and insights for people who want to learn more about this and
[00:44:12] it talks about the various books I've written and that sort of thing as well so that's
[00:44:16] going to I'll link I'll link it up below and actually one more question for everyone do you
[00:44:22] do you assess people virtually worldwide where do you see people well if the laws for doctors are
[00:44:27] you have to be in California when I do your assessment so I have people who I can do virtually
[00:44:32] in other parts of California it is a big state or if you're visiting California or some people
[00:44:37] make a trip to see some friends or family or go to San Diego or whatever and visit LA
[00:44:42] so you have to be I have you have to be in California when I first visit with you I first
[00:44:47] make your assessment and if you're out of the country it's a little bit more flexible strangely
[00:44:52] enough but it's all about medical licensing and insurance and this sort of thing but you
[00:44:56] could always inquire with the office but I'm sort of limited to California for the initial visit
[00:45:04] okay and what about where could people find someone in their area how could they find
[00:45:09] well my website lists about 20 different doctors in different parts of the US and then the ATNS
[00:45:14] website which is the nonprofit which is currently symptomatic.me has a directory of practitioners
[00:45:20] as well has probably more physicians than my website does and has therapists and other people as
[00:45:25] well but obviously you've got grace so you're good with that but these are two good
[00:45:29] directories that are available great and I'll link those below too okay thank you again and
[00:45:36] we will see you all next week thanks for having me