Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Chronic pain is very misunderstood. Whether we're experiencing it in the form of migraine, irritable bowel syndrome, or fatigue, many of us who experience these symptoms know that it has a huge impact on our quality of life as well as on our emotional health.

And when we're told to just live with it or just deal with it, it can feel like we're being dismissed, like our experience is not being taken seriously, and we can become hopeless about our options. So today, we want everyone to know if you are experiencing chronic pain, you are not alone. It's estimated that tens of millions of Americans live with chronic pain, often after years of tests, treatments, and specialist visits that don't offer relief.

Today, instead of saying, "Just deal with it," we're diving in, taking a step-by-step approach to chronic pain and asking different questions.

What if we realize that the brain itself is keeping the pain switched on long after the structural injury has gone away?

And what if understanding that could open a new path to feeling better? In this episode, we'll explore what neuroplastic pain means and how to tell the difference between a structural injury and an injury where our brain is continuing to give us pain signals that we can manage in other ways, and why none of this ever means that your pain is all in your head.

We'll talk through practical steps you can take alongside your current care regimen, and how to spot our own aha moments about what makes our pain better and what makes it worse. And we'll also discuss ways to support loved ones who may be suffering. Our goal is to help everyone feel validated, informed, and more hopeful about what's possible in our lives if we're living with chronic pain.

But first, let me introduce my guest, Dr Howard Schubiner. Dr Schubiner is an internist, pediatrician, researcher, and educator. He's clinical professor at the Michigan State University College of Human Medicine. He's played a major role in the development of innovative treatments for chronic pain and associated conditions.

Dr Schubiner is the author of the recently released book, "Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression." Welcome to the WebMD Health Discovered podcast, Dr Schubiner.

Howard Schubiner, MD: Thank you so much. I'm happy to be here.

Pathak: I am so, so happy and thankful to be able to talk to you about our topic for today. But before we jump into it, I'd love to ask about your own personal health discovery that brought you to the work that you're doing.

Schubiner: It's funny 'cause I talk in my work a lot about these aha moments, or these click moments when something becomes clear. And what happened to me, I was a full professor at Wayne State University Med School. I was there for 18 years. I switched hospitals. A good friend of mine said, "Oh, you should read this book."

I'd been studying and teaching mindfulness meditation at the time, among other things. He said, "You should read this book by this guy, Dr John Sarno." And my good friend had chronic pain, horrible pain. She read the book, and she recovered fully. And I'm like, "Okay. Well, that sounds weird. Like, who--how does that happen?"

But I'm, what the heck? I read the book, and I had this little aha moment, like, "Could this be real? Could this be true?" This guy, Dr Sarno, had thousands of people who had recovered using his model of changing how you think about your pain, basically. So anyway, I went to work with him for a few days.

I came back and I said to my boss, "I'd like to try this out, see if it works, see if it works for me, see if it works in science." And we could eventually do research on it. Anyway, so one of my first patients was a woman who was scheduled for a back surgery because of bulging discs and degenerative discs on her MRI.

But what Dr Sarno taught me is that most adults have bulging discs and degenerative discs even if they don't have pain. Okay, so she didn't have any neurologic findings or cauda equina syndrome or anything. Anyway, so I started treating her using his model, and three weeks later she was pain-free and canceled her surgery, and I was like, "Holy goodness."

That was an aha moment that I could see it working in front of me for me, and that just set me on this course. That was 23 years ago.

Pathak: Wow. Amazing, amazing story.

And so let's define what we mean by chronic pain. Help us understand how that's defined and how it's different from the type of pain we might feel right after an injury or an illness.

Schubiner: Yeah. Well, pain is pain. All pain is real. And it turns out, I don't know if we have time to really get into this today, but it turns out that all pain is actually generated in the brain. When you get an injury, the injury causes your brain to turn on pain. And we know that simply 'cause many people have had injuries and had no pain.

And I'm sure people can relate to that. But if you can have an injury and have no pain, and we know you can have pain in the absence of injury, now we've understood that the brain has a danger alarm signal, and that is what causes pain. It also causes other sensations in the body like fatigue, anxiety, depression, et cetera.

But the pain is real. It's not imaginary. It's not fake. It's not in people's heads. It's not 'cause they're crazy. This is so important to understand. And acute pain is usually due to an injury, but not always. And chronic pain is usually not due to an injury once the usual medical, significant medical conditions, cancer, fracture, severe arthritis, inflammatory conditions are ruled out.

But chronic pain is simply defined as more than three months of pain, which we're talking about 50 to 100 million Americans have.

Pathak: And is that pain something that's located in a specific area, or is it sort of global generalized pain when we're thinking about that large population of chronic pain sufferers? What are we kind of thinking about?

Schubiner: Well, the most common cause of chronic pain is neck and back pain. After that, it's headaches, facial pain, abdominal pain, pelvic pain, and other musculoskeletal pains and joint pains. And so what we're saying is that in order to get good treatment, you need to have the right diagnosis.

It's, it's so elemental. That's what doctors do. That's what we've been trained as, as doctors. And if you ask the question, "Could my back pain... Is my back pain 100% due to the damage that's seen on an MRI?" We did a study. We took 222 people with chronic neck and back pain, and we evaluated them carefully and closely, and we looked obviously for some structural problem, fractures, tumors, inflammatory conditions.

98% of those people, they were all adults, had abnormal MRIs, bulging discs, degenerative discs, et cetera. But the fact is, is that 90, roughly the same number of adults that age will have those same findings even if they don't have pain. So we didn't assume that that was the cause of their pain. And then we investigated, does the pain shift or move or turn on and off?

Is it triggered by the wind or by stress or by the weather? We're looking for these clues, and I'll, I'll give you an example of one of those aha clues in just a second, that can help define, is the pain purely structural? It's always there, it's consistent, or does it shift and move, turn on and off? Is it more likely to be what we would call neuroplastic and brain-generated?

What we found was shocking, and we published this two years ago now. 88% of the 222 who had chronic neck and back pain, we defined after this careful evaluation, 88% had what we would call non-structural or neuroplastic pain. An amazing example, there's a guy named Gary who I write about in my book.

He had severe back pain, severe leg pain, severe foot pain. So bad he couldn't sit, he couldn't stand. 25 years of this. He had been to two of the top medical referral centers in the country. Medications, injections, even surgery, nothing helped. His life was over. He was literally suicidal. And he met a physical therapist who said, "You know what?

I think your injuries have healed from 25 years ago, 10 years ago. I think th-this could be neuroplastic pain." And Gary said, "Well, how would I know?" And he said, "Well, look for the clues." So the next week, Gary walks into a pharmacy, his pain is a five. He sees this long line. As soon as he sees the line, the pain jumped from a five to a nine. And that was a click moment for him.

Oh my goodness. His brain... He didn't s- he wasn't standing. He was anticipating standing, which would cause pain, but he realized his brain was doing this. And in six weeks, his pain was gone, Neha. His pain was gone because he totally changed his view of it, and he used the kinds of treatments that we recommend.

And it is just astounding. But if you never ask the question, could it be neuroplastic or not? If you just assume it's always structural, well, you're gonna be wrong some of the time.

Pathak: Yeah. No, your story's so powerful for a couple of reasons, and I'd love to pull on a few threads because you gave us such a good definition of trying to figure out whether or not an issue is structural versus talking about neuroplastic pain.

But I'd love for you to dig into this sort of concern that patients often have is being told by their doctor or someone that this just means it's all in their head.

Schubiner: Almost every person I've seen for the last 23 years has been told at some point by doctors, by family members, by friends, by their boss, "You're-- just can't possibly be that bad." It can't possibly... Because we can't see it. It's invisible. So how do we know how much you're suffering?

And they've been told, "You could get better if you wanted. It's all in your head. It's psychological. It's just stress. Snap out of it." And that is so hard for people. It's so invalidating and really demeaning and ignorant of the understanding that all pain is real, and severe pain can be real. Pain that is 9 out of 10, 10 out of 10, 11 out of 10 can be caused by the brain and can be caused by structural damage, and we just need to sort it out.

But if people aren't treated compassionately and with caring, they're not gonna get better in-- no matter what, what the diagnosis is. And, what happens is, is that sometimes people will have an injury, say a car accident, and they get injured, and then the pain starts, and then normally the body heals, pain gets better, they recover.

But over time, in some people, the pain will actually get worse over time, or it will spread over time. And then we have to be aw- aware of could this possibly be something else going on? What was going on in this person's life at the time of the injury? Was there stress? Was there a problem at work? Was there a problem with their son or their daughter?

What, who's, what happened to the person who hit them? Were they apologetic or they were blaming them? And it turns out research shows, hard neuroscience research shows that emotional injury causes the same parts of the brain to light up or activate as does a physical injury. So when someone is under a stressful situation and they get an injury, the injury will heal because injuries heal.

But when the pain persists or gets worse or spreads over time, it's likely neuroplastic. And then we have to help them understand that the injury has healed. And we also have to think about were they validated? Were-- How were they treated with compassion? What's going on in their life? What ongoing thing might be happening?

I saw this woman a couple months ago who had pelvic pain, and she had endometriosis. And her doctor said, "You need surgery." Well, she's a doctor. So she looked up endometriosis, and she found, yes, some women need surgery for endometriosis, but many women have endometriosis without pain. How was she to know?

Well, again, she had to look for the clues. So she was, she's, she saw a therapist. The therapist said, "Well, you're the kind of person who's people-pleasing. You want to please everybody all the time. You, you tend to neglect yourself." She said, "Okay. Well, what does that have to do with it?" Well, she was at lunch with a friend, and after lunch, her pain spiked really high. It turned out her friend had asked her to do something, and she said yes because she always says yes. But in her heart of hearts, she didn't want to do it. She had betrayed herself. And she took the courage to call her friend and say, "I can't do that. Sorry." And the pain disappeared on the spot.

Not forever, but it disappeared.

It turned off at that moment, and that was her click moment. And she could see the connection between emotions and how she treated herself and how she thought about herself and physical pain. This is a revolutionary concept that most people and most doctors, frankly, are not really aware of. I certainly wasn't.

Pathak: And you write about this sort of process once you've had that click or that aha moment as an opening to unlearning when it comes to chronic pain. So can you help walk us through what that process looks like, and how does the brain change over time as you're working towards unlearning?

Schubiner: Yeah, great question. So I think about this in five steps. The first step is making a good medical diagnosis. We do not wanna miss structural damage, structural injuries. We do not wanna miss diseases, number one. Every doctor-- But most doctors are pretty darn good at that. Secondly, we wanna explain the brain and understand neuroplasticity and understand that the brain does have the power to create even severe symptoms.

I saw a guy the other day who's completely recovered now, but in the midst of his chronic fatigue syndrome. For eight months, he was not only bedbound but unable to eat. He had to be spoon-fed by his grandfather. That's how severe his energy depletion and fatigue was, and he's completely recovered now.

That was due to his brain. So the second thing is truly understanding the power of the brain and what is going on in people's lives. Then there's three treatment, treatment processes. The first we call pain reprocessing therapy. I'll talk about that in a second. The second we call emotional awareness and expression therapy.

And the third has to do with what changes does one need to make in your life? The woman I just mentioned, she started to make changes in her life to be more authentic, to speak her truth, to stand up for herself, to speak her mind, and, and that can make all the difference. The two therapies, the pain reprocessing and the emotional awareness and expression therapy, have been studied in randomized controlled trials showing that they're effective and more effective than standard talk type therapies for chronic pain.

So we have that data now. Pain reprocessing therapy is once you recognize that the pain is not structural, it's to step back from it. It's to stop fearing it and stop monitoring it all the time, and to start to expand your life even though you're having discomfort. It's difficult sometimes, but if you really know it's neuroplastic, it's not injuring you.

That's what happened to Gary, the guy in the pharmacy. He started walking. It hurt, but he kept walking and he kept telling himself, "I'm safe. I'm not in danger. I'm not injuring myself." And his brain learned to turn off those neural circuits. I mean, it's so simple. It sounds way too good to be true, and people are saying, "Well, I've done that. I've done that." But it's literally the power of truly understanding this neuroplastic model and understanding and having the hope for recovery, not just for coping with pain.

Pathak: And so when it comes to pain reprocessing therapy, is that something that you should be doing or pursuing with someone who is trained in this type of therapy? How does one go about doing this in a way that is actually evidence-based?

Schubiner: Yeah, that's a great question. It's a spectrum. As I mentioned at the beginning, some people read the book and their brain just goes, "Oh yeah, I'm fine. Oh my goodness." Boom, they get better. Not a, not a majority, but you know, 10% maybe, but some people do that. Some people read the book and get a workbook and start doing some of the exercises and start, using the model based on from reading about it.

There's some apps. There's a bunch of apps out there. There's AI apps and there's coaching apps and that people can use and we'll give you all these references. And then, then beyond that, there's coaches and there's therapists that you can work with on a, once a week or once a month, whatever.

And some people need a little bit more even than that. So it's a spectrum. But we just try to match, what the dose of the intervention is to what they need.

Pathak: And I imagine that many of the people you work with, whether it's fibromyalgia, chronic migraine, IBS, chronic fatigue, they've spent years probably seeing many, many different specialists. They haven't found relief. They may have felt like their symptoms have been minimized. What are some of the patterns that you've noticed amongst these patients, and what is it that you see happening to them when they sort of start to turn the corner and start to improve?

Schubiner: We see that frequently there's some adversity in childhood, going back to childhood or their teen years. And I wanna just touch on, later—in a minute—on the emotional awareness and expression therapy component of this work, because sometimes that is necessary or helpful. We see people who've been through stress and difficulties in their life at the time of an accident or the time the symptoms started.

We see people who have learned to be, as I mentioned before, people pleasers and doing everything for others and not being able to be assertive or stand up for themselves. And we see that people who do this work well are really open-minded to say, to look at it in a different way, and to be able to say, "You know what? What I was doing, I tried my best, the doctors tried their best, but they didn't really understand this." And we've seen people with what we would call medical trauma, and this is so sad. I love being a doctor. I love our profession. Well, we've seen a lot of people who've been either minimized by physicians or PTs or other healthcare providers, or given invasive treatments that maybe they didn't need.

And this is hard. And so, so this kinda gets back to the idea of dealing with some of the emotional stuff, which again, most doctors may not be comfortable with or not aware of how important it might be. But emotional awareness and expression therapy, as I said, has been studied in our hands. I developed it with Mark Lumley, my excellent colleague at Wayne State University, and it's been shown in randomized controlled trials to be highly effective, and not in just coping with pain, but in reversing it.

And the idea is to help literally access the feelings that people have. If someone's angry about what somebody did to them, they can hold the anger in, but that hurts them. Or they can let it out in the real world in violence, and that hurts the world. That's—And you go to jail. That's not good. So, but the idea is to honor that anger.

Anger is there for a reason, and to express it in a safe and healthy way in our mind with a therapist or in writing, and then move through that anger and approach ourself with sadness and kindness and caring. A lot of people who've been hurt have learned not to literally care for themselves, and self-compassion can be a critical component of this work.

And then oftentimes they can move to letting go, setting boundaries, moving away, or forgiving so that these, these things can then—the mind can be freed. Three years ago, I was let go by my hospital. I was an esteemed senior doctor at the time, 20 years at my hospital. It was a financial issue, and I didn't make money for the hospital 'cause I was talking to people.

But what doctor loses their job? I was, I was astounded. And my back started to hurt. And I started doing the pain reprocessing, and I was telling myself, "I'm fine. I'm safe. There's nothing wrong." I kept moving, all that stuff. Didn't work. And then a few weeks later, I'm in my car and I realize, you know what? I have some feelings about this. I have some anger about being let go, and I expressed that anger in my mind just to, just like imagine just like yelling and screaming when I was alone and getting all that anger out. And then I went to the hurt and the sadness of being kicked aside, and I allowed that sadness, and I turned that sadness into self-compassion.

And then I forgave the hospital because they put up with me for 20 years. I never made any money for them. And the pain went away that day.

Pathak: Hmm.

Schubiner: So really understanding this whole concepts can make a big difference. It's a quiet revolution in medicine that you can't really see until you've seen it.

Pathak: I absolutely want to thank you for sharing that very powerful story. I think we probably, if we reflect back, we can all think of examples where sometimes when it comes to pain, I know for myself, I injured my back at one point, and I was so focused on what I couldn't do and being fearful and being scared that when I saw a physical therapist who tried to make me focus on things that I could do and movements that didn't bring me pain, that completely shifted how I was thinking about the pain, and I was able to sort of move through it.

So, I really want to honor your story, and I want to thank you for sharing that. I'd like to shift us to really thinking about women specifically because women disproportionately are affected by many chronic pain conditions, the ones that you mentioned as well, particularly chronic pain and chronic pelvic pain, et cetera.

Why do you think that is? And is there a health system fix that we need to also be thinking about at a systems level to better support women when they are trying to come to the healthcare system for care?

Schubiner: When I started writing this book, "Unlearn Your Pain," the new version of it, I came across these data, and I didn't know what to do with them. Do I talk about that? As soon as there's this old white guy talking about women's pain, women have been diminished, have been demeaned, have been neglected in medicine and in society for centuries.

And women's pain hasn't been taken seriously. They're more likely to have been told it's all in your head. So all that is true, and all that is real. And yet, women do have higher rates of these conditions. How do we reconcile that? And how do we do that in a way that's caring and supporting and compassionate?

That was what I tried to accomplish in writing this book. And we don't know the answer of why it is. There may be some variety of immunologic and hormonal and a variety of things that we don't really understand yet, but we haven't really found those when you look at the data carefully. But we do know that women do have higher rates of certain situations in life.

Girls have higher rates of emotional trauma and abuse than boys, higher rates of sexual assault, intimate partner violence, higher rates of caring for the older generation and the younger generation that you talked about. They have higher rates of harassment in the workplace, and they have higher rates of online bullying.

And all these things, could that be part of the reason? I sort of think so. We can't say for sure, but if we're looking at it that way... A good friend of mine just finished reading this book, and she said, "I didn't have the pain conditions you talked about, but reading about it made me reflect on my life and what I went through in my life."

And she said, "It gave me more compassion for myself." That is the goal.

The goal is to treat people compassionately and understand them and recognize that life situations can lead to these conditions. And basically what's happening, the brain is acting as a danger signal, like a smoke alarm, and it's sending out a message.

And the message might be, the brain can't talk English and say, "You're going through all this stuff. We need to, we need to deal with that." So on a system level and a structural level, we need to take care of children. We need to treat people who are going through stressful times with getting good care and getting compassion and helping them to be empowered to, to have agency in their lives as much as possible.

And to me, that is part of the lessons that I've learned through writing this book.

Pathak: It's a very powerful approach and an important way for us to think about the complex interplay between structural disease, hormonal, immunologic, psychologic, mental health, the interplay that leads to a lot of these conditions, and then being minimized within the healthcare system.

So that brings me to another piece. You, you discuss conditions like long COVID. I'm curious about chronic Lyme. A lot of things that are in the sort of zeitgeist of today, and people are recognizing, I think rightfully so, within the healthcare community as well, now that we're identifying potential biomarkers that actually may signify that these conditions are, quote-unquote, "real" to the biomedical system, and yet people have had symptoms, fatigue, chronic pain for so long and may not have been taken seriously by the healthcare system.

So how do patients know whether a neuroplastic approach like the one you describe might be appropriate for them?

Schubiner: These conditions have skyrocketed in the last decade or so. More and more people [are] being diagnosed with hypermobile Ehlers-Danlos, mast cell activation syndrome, chronic Lyme, EBV reactivation syndrome, long COVID, chronic fatigue syndrome, and they're all real. I mean, they're not imaginary.

People are suffering, and sometimes they're suffering for years or even decades. And I had to decide in writing this book, Unlearn Your Pain, am I gonna tackle these and how to tackle them? Because again, the first goal is to be compassionate and caring and understanding of people and validate who they are and what they have and what they're going through.

And the second thing is to look at the medical data and help decide how much of the biomedical markers that are there are actually causative, or are they correlative? And this is one of the most important things in medicine. Is something correlated with an illness, or is it causing the illness?

Because if it's causing the illness, then a purely biomedical approach might be necessary. But for these conditions, there is no biomedical approach. We have not found effective treatments either in the traditional biomedical model nor, I would argue, in the alternative medical model. And this is very controversial, but I decided to take it on because people are suffering.

And what I'm saying is we just need to ask the question. You need to ask the question: How will you know? Investigate. Each person needs a detailed and careful investigation. As I mentioned, that's what we did in that back pain study, and that's what I do every day in the people I see. Did the symptoms start with [a] stressful situation? Do they come and go? Do they shift? Do they turn on and off? Have they spread over time?

Oftentimes, people in this situation have been diagnosed with not just one of these conditions but three or four or five of them. And we've seen, and we're doing research, there's a couple long COVID studies that have been done in Europe and the US showing that people can have reversal of these symptoms using this mind-body approach.

So if you never ask the question, you can't get an answer. And we honor if someone decides that the neuroplastic approach is not for them, that's what—then they shouldn't take it. It's not for them.

Pathak: So if someone's interested in exploring this approach, what are some of the first steps that they can start taking today alongside the care that they're receiving?

Schubiner: Yeah. The first step is education. It's education and reading the stories and listening to podcasts and looking at some of the websites that are out. There's so much out there now all over the world on this work, and just seeing if it fits, if it resonates. How does it sound to you? Do you fit into that?

We've seen so many people, they read a story in my book or other people's books or online, they hear a podcast, they go, "Oh my God, that's my story. I can see myself in that story, in that person's story," and that can make all the difference in the world. So the first step is education. The second step is evaluation.

Looking carefully, there's a whole chapter in my new book on evaluation, how to determine if the condition is neuroplastic or not. And then the third step is like, "Well, what can I do? What are steps that would—if I think this is truly neuroplastic, what are my next steps?"

And there's a lot of resources out there for that as well.

Pathak: So help us understand what the expectation should be as someone is embarking on this journey.

Schubiner: The brain is in charge of our symptoms, and it can turn them on and turn them off and shift them and move them around. And sometimes people get really better quickly, and then their pain comes back or their fatigue comes back, and then it goes away again. It comes back again.

Or they get 50% better, but they're not getting all the way better. And the understanding of the fact that the brain can do all this can help us step back and not get too focused and worried about the path. Because, and you kind of mentioned it before, you were with your back, you were focusing on, "Am I gonna get better? When am I gonna get better? How soon?" And those questions just weigh on our brain and make our brain a little more afraid.

And what I tell people is when your brain gives you pain or fatigue or anxiety or depression, it's also asking you a question. And the question is: Are you okay? How you doing? Are you okay? Tell me. Give me feedback. It sounds so weird, but I believe this is true.

And when we get the symptom, if we're able to say to our brain, "Thank you very much for alerting me. Thank you for your concern. I'm actually okay. I'm gonna be all right," that simple model can be so powerful. And it's just really understanding.

The other day I was in the gym and I was having this pain in my upper shoulder. And a friend of mine said, "Hey, are you excited about your new book coming out?" And I said, "Yeah, I'm really excited, but I'm also very fearful of it." And as soon as I said that, I realized, oh my goodness, I think this pain was due to this concern that I'm having, this fear.

And I just—it just hit me. And then as soon as I noticed that and recognized it and put it together, this pain started going away. Within a week, it was gone.

So it was just having this understanding can make all the difference in the world.

Pathak: That brings me to my next question around how can family members or loved ones support someone who's living with chronic pain? Most of our conversation has been around how can we talk to ourselves and provide self-compassion to ourselves. What are ways that we can support loved ones if they're the ones living with these types of symptoms?

Schubiner: It's so hard. It's hard on the whole family. Moms who have feel like they're abandoning their kids when they're in pain or in bed a lot of the time. Dads feel they're not living up to their role or not making as much—not working as hard as they should, et cetera. And so [the] whole family can be affected.

And so the whole family hopefully can rally around the person with caring and love and belief and understanding and helping them to be normal, treat them as normal, but also treat them with the caring that, yeah, they may need to do less for a while, but that's okay. We'll pick up the slack. You're going to get better.

You're going to be okay. We'll work together. And we just don't want people to start blaming each other or carping at each other or doing things which will actually make it worse.

Pathak: This has been such a powerful conversation, and in our last few minutes together, I'd love to cede the floor to you. And if you can speak directly to the person who's listening who might really resonate with what you've said today and who's been told that they just have to live with their chronic pain, what message would you like them to hear?

Schubiner: My message to people who are suffering is your suffering is real. I'm with you. I'm not feeling your suffering, but I know it's real. I know you have it, and I'm with you. I care about you. You can give yourself the kind of caring and compassion that you deserve.

Secondly, don't give up. Don't give up. Keep looking. Keep looking for something that will work for you or fit for you, and explore and just ask the question: Could this possibly be mind-body related? Could this possibly be neuroplastic? Maybe it is, maybe it isn't, but ask the question and just look into it. Give yourself the benefit of the doubt.

You deserve to have every avenue explored, and usually this avenue is not the first one. It's often the last one, but it can often be the key that can really help. And so I think my message is caring, validation, compassion, not giving up, searching and looking, and educating yourself about this approach.

Pathak: I want to thank you so much for that very powerful closing message and for sharing resources, which we will add to our show notes so that people can go and find out more information and start the process of education.

Schubiner: Thank you so much for having me. It's really a pleasure.

Pathak: I'd like to share my three key takeaways from this discussion. First, and this is the most important, I think chronic pain is real, brain-driven, and frequently misdiagnosed.

Hearing someone respond to your pain with a dismissive statement like, "It's all in your head," can feel deeply invalidating. But as we discussed in this episode, careful evaluation often shows that a large share of chronic neck and back pain and conditions like migraine, pelvic pain, irritable bowel syndrome, and chronic fatigue are neuroplastic rather than purely structural.

So while the pain is technically generated in your brain, it's not all in your head. It just gives us a different avenue to try to treat it.

Second, there's hope. Again, because neuroplastic pain can improve by retraining our brains and processing emotions, that gives a whole new spectrum of treatment options.

And Dr Schubiner outlines a five-step approach: Make a solid medical diagnosis to rule out structural or serious disease, educate ourselves about neuroplasticity, and then use pain reprocessing therapy, emotional awareness and expression therapy, and life changes like setting boundaries and increasing self-compassion to help our brain unlearn the pain signals.

And finally, compassion and validation are central to recovery. Today, we emphasized that trauma, stress, life pressures, and medical dismissal all shape chronic pain. The people in our lives suffering from chronic pain need their experiences validated, not minimized.

So, to find out more information about Dr Schubiner and his work on chronic pain, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.