Below, Dr. Rachel Zoffness shares five key insights from her new book, Tell Me Where It Hurts: The New Science of Pain and How to Heal.
Rachel is a leading global pain expert, clinical psychologist, and teaches pain science at Stanford and UCSF School of Medicine.
What’s the big idea?
Pain has been mistreated and misunderstood for decades. We’ve long treated it as a purely physical problem, but science now shows it’s much more complex—and much more changeable—than we thought.
Listen to the audio version of this Book Bite—read by Rachel herself—in the Next Big Idea App, or buy the book.
1. Pain is more than we think it is.
We’ve been sold the lie that pain is purely biomedical, something to do just with bones and body parts, something to be treated just with pills and procedures. But our treatments aren’t working.
Pain remains the number one reason we go to the doctor, and rates of chronic pain are going up. Thanks to recent medical advances, we now understand more about pain than ever before. It turns out that pain is biopsychosocial, meaning it is a product of biological, emotional, cognitive, social, and environmental factors. We must treat it from all angles to truly heal.
2. Pain is constructed by the brain.
It’s easy to believe that pain lives exclusively in the body part that hurts—our aching back, our bad knee—but neuroscience reveals that pain extends beyond that. It is ultimately constructed by the brain.
“Pain remains the number one reason we go to the doctor, and rates of chronic pain are going up.”
One reason we know this is because of a syndrome called phantom limb pain. Phantom limb pain occurs when someone loses a limb but continues to experience severe pain in the missing body part. If you can have leg pain in a leg that is no longer attached to your body, that must mean that pain is constructed somewhere else, and that somewhere else is the brain.
In fact, we now know that the brain uses all available information from our bodies, our histories, our emotions, and our environment to decide whether to trigger pain and how much.
3. Pain is emotional.
In Western medicine, we have a myth that either our pain is physical, in which case we should see a physician, or our pain is emotional, in which case we should visit a therapist. But this is a big fat lie.
Neuroscience tells us that the parts of our brain that construct emotions also construct pain. That’s why pain feels worse when we’re stressed, depressed, or anxious. Emotions don’t just live in the space between our ears. Emotions are physical. In medical terms, emotions are somatic.
Each emotion triggers a biological cascade of physiological events: changes in our hormones, neurotransmitters, muscles, respiration, and digestion. If I ask you to tell me how your emotions manifest physically, I bet you could give me a list. For me, stress typically manifests as a stomachache. And when we’re sad, saltwater leaks from our face.
“Emotions don’t just live in the space between our ears.”
Emotions are common pain triggers, pain amplifiers, and pain exacerbators. It’s an important reminder of something we all already know intuitively: pain is both physical and emotional 100 percent of the time.
4. Chronic pain is treatable and we have the power to control the dial.
If pain is multifactorial, so is its treatment. There are a zillion ways to change pain beyond pills and procedures, although those can certainly help.
5. Our bodies have a built-in pharmacy that we can activate.
Our brain and body already produce many of the chemicals needed to lower pain volume, such as:
- Serotonin – a chemical involved in mood.
- Dopamine – involved in reward and motivation.
- Endorphins – our body’s homemade opioids.
Several inputs activate our body’s pharmacy, including movement and exercise, laughter, friends, and even certain foods, like chocolate. There are a million ways for us to activate our body’s pharmacy and lower pain volume.
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