Join Dr Rachel Zoffness discussing One Thing she wants people challenged by pain to know about. Explore the current state of pain science research and clinical practice in this straight-to-the-point interview with Rachel.
About Rachel Zoffness
Dr. Rachel Zoffness is a leading global pain expert and thought-leader revolutionizing the way we understand and treat pain. She is a pain and health psychologist, Assistant Clinical Professor at the UCSF School of Medicine, lectures at Stanford University, and is a Mayday Fellow. Find out more about Rachel here.
Transcript
JOSH: What’s the one thing that you want people challenged by paying to know?
RACHEL: There are so many things that I want people with pain to know. I would say the most important thing is that pain is never ever a purely biomedical problem. And by that I mean it’s never exclusively due to anatomy and physiology, no matter what you’re told. And people in pain, including me, get told that all the time, but that is a big fat lie. Pain is actually a biopsychosocial phenomenon, which is a big word that’s actually easy to distill down. And what that means is pain lives in the middle of these three big domains of life as everything to do with human health does. So of course, there’s biological and biomedical components of pain like tissue damage and system dysfunction and inflammation, and that’s very important, of course, to pain. But there’s also the psychological domain of pain, and that has a stigma around it, understandably. Because when you talk about psychology with people living with pain, understandably we hear like it’s all in your head, or this is just stress or anxiety, and that’s very dismissive of pain.
But when we talk about biopsychosocial, we’re not talking about that. We’re never saying that pain is all in your head. What we’re saying is that neuroscience shows that the things you think and the things you feel affect your pain 100% of the time. So neuroscience says that cognition and beliefs, and intentional processes can adjust pain volume. The more stressed out and anxious and sad and depressed we are. The higher pain volume goes and the worse we feel, and the opposite is also true. The more positive emotions, the more relaxed and calm we are. The happier and more joyful we are, the lower pain volume will be. And also in this psych bubble we have coping behaviors. So how we respond to our pain also matters. So people with, often, including me, stay inside and stay in bed and don’t move and don’t get off the couch and don’t see friends, and don’t get outside because we think that that’s what pain is telling us to do. But it turns out that that also makes pain feel worse, and the treatment for chronic pain is counterintuitive. It’s doing the opposite of that. To get your life back and actually turn pain volume down, we need to start doing things like pacing for pain. So little bits of activity at a time seeing. Moving our bodies, engaging in pleasurable activities.
So all these things are important to pain. And then we have the social bubble or the sociological domain of pain, and that in my mind is like the everything else domain. So we’ve got socioeconomic status and access to care and race and ethnicity and family and friends. And if you’re a kid, parents matter. There’s a huge parent component we know in pediatric chronic pain and also context and environment matter a lot to your brain when it’s deciding whether or not to make pain and how much.
So my message always to people living with pain is it’s more simple and more complex than we’re usually told when we go to the doctor. Pain is this very, um, integrated experience, like everything to do with human health and everything matters when it comes to.
JOSH: Fantastic, so I guess just for someone practically, like if they’re watching this and they’re like, oh, I’ve never heard this before. What do you recommend they should do about that?
RACHEL: Yeah. So I like to think about this as a recipe. So just as there’s a recipe for baking brownies, right? Like we all know you have to have certain ingredients in a certain amount, in a certain order, in the oven, and a certain amount of time. Otherwise, the recipe doesn’t come out. So this, the same is true for pain. So there’s always a recipe for high pain and there’s always a recipe for low pain, and it’s always a biopsychosocial recipe. And what I mean by that, Like when I think about my own pain, I think about the things in the bio bubble, but I also think about, now that I know about pain, what’s in the psych bubble?
So I notice that my high pain recipe, my pain often flares when I’m really stressed out, when I haven’t moved my body, and I’ve been sitting for long periods of time when I’m not eating well, when my sleep is crap, you know? So I’m always thinking, I’m not seeing my friends in the social bubble and I’m not engaging in my life. So I’m always thinking about, what are the ingredients that are in my high pain recipe? And the reason that’s so important if people wanna change pain is because changing your pain to a low pain recipe is quite literally the opposite. So if I’m thinking about it, and I recognize that my pain flares are correlated with poor sleep and poor nutrition and high stress and not moving my body.
Then what that means is for a low pain recipe, I have to actively engage in the opposite and, and usually we need support with that. Like everyone with chronic pain deserves support. I feel very strongly about that and there’s lots of ways of getting support. Like PTs and OTs and pain psychologists do a lot of these things where they target the biopsychosocial recipe and there’s no shame in this game. There’s a lot of stigma around seeing someone like me. I’m a pain psychologist. But, but once we understand pain as a biopsychosocial problem, we know that it requires a biopsychosocial solution. And that means that PT and OT and biofeedback and pain psychology are part of creating a low pain recipe.
JOSH: Yeah, fantastic. And, and in terms of just expectations on when these things will have an effect, like they all sound nice, but someone might go out and try it today and then their pain’s actually worse. What do you say to that? Like, is this a long-term strategy or does this start working today?
RACHEL: Um, if there was a magic pill, I would be giving it to everybody. Um, the answer is every brain is different and everybody is different. So, you know, I see patients and in six sessions true story, their pain is gone. Like that happens sometimes. And then I see people for longer periods of time. Like for me, it probably took like a year before I saw real change. My pain is like 99% under control now. And, but it’s different for every person who comes into my office. Everyone is different. Everyone’s brain is different. It’s like, we know that that’s just whether it’s, you know, your diet or any sort of disease, the process is different across people. So I wish there was sort of one answer, but, but it is, it always is an investment of time. Um, and I think, you know, we all sort of want a quick and easy answer. Who doesn’t? Everyone wants pain to go away. It’s such an aversive, unpleasant experience. But in my mind, you know, the, the more wide we cast our net and the more resources we have, the more likely it is to go away quicker.
JOSH: Fantastic. Well, thank you so much Rachel. We really appreciate hearing your one thing, which was just mind blowing.
RACHEL: Thanks, Josh.