(audience applauding)
- Thank you.
(audience applauding)
Teaching is what I love.
It's what I think I do the best.
And reflecting on this work that I've been doing
for 20 years now,
I realise that we can do more research, which are,
we're planning,
we have two new brand new research studies
starting this year that I'm very excited about,
that I'll tell you about.
But research doesn't really change what people do,
what changes what people do is stories.
And the opportunity to talk and teach,
is to tell stories
and to connect to people at a heart level
because that's what changes things.
And the people who understand the work
that we've been doing,
almost all of them understand it.
Not from their head, not from reading,
not from reading research.
Almost all of the people who understand what we're doing,
understand it from the heart because they've experienced it.
They've had experiences in their life,
or their friends, or their family's lives who
open their eyes to something that they couldn't see before.
And it's amazing how I do a lot of lecturing
and I speak to a lot of doctors and physicians,
and psychologists, and social workers,
and most people kind of, yes, they nod their head,
but they don't really understand
the depth and the breadth of this work
because they haven't experienced it.
And it's sometimes it's hard to see something
that you haven't experienced.
The main topic for today is how the brain works
and why, and how the brain would cause pain,
or anxiety in the world.
There's a certain things we know cause people to die,
cancer, heart disease, stroke, diabetes,
suicide, homicide, things that cause death.
But if you take that aside
and you take the other things
that cause suffering in the world,
suffering and disability, it's back pain,
neck pain, headache pain, stomach pain,
joint pains, anxiety, depression, trouble sleeping.
Those are the things, the major things that cause suffering
and disability in the world.
And all those things are,
from my point of view, misunderstood.
They're treated in the same category
as cancer, and heart disease, and stroke,
and things that Arnold was saying,
well what about when there's a physical cause?
And it turns out,
and this is a revolutionary statement to say that
the vast majority of the things in this category
are not due to structural damage.
And so the most common ones,
the most common of the pain conditions,
our back pain, headache, pain, neck pain, irritable bowel,
facial pain called trigeminal neuralgia.
And have you heard of this disorder, trigeminal neuralgia?
It's a disorder where the pain is like sharp and severe
and the pain can be triggered by a light wind.
Go outside and there's a light wind
and (groans) horrible pain.
And when people write me about this disorder, they say,
well, I've been reading about it
and I read about this disorder.
And do you know what that, do you know what it's called
in common language, this disorder?
The suicide disease, how horrible is that?
Oh, you've got this condition.
It's called trigeminal neuralgia,
by the way, it's called the suicide disease.
How do you feel about that?
What a horrible, horrible language.
Once you see this work, as I was saying,
once you know that young woman who's pain from nine to 23,
you know her and you see her and you know her story.
You see that, you understand it,
you get it, she gets it.
She'll never unsee that.
But when someone tells you you have a suicide disease,
that the pain is so severe, it makes people commit suicide.
How can you unsee that?
How can you unhear that?
What harm does that do?
And what does that portend?
What does it tell you is gonna happen?
What's your future gonna be like?
And is that gonna help somebody?
It turns out that's gonna make them much, much worse.
The name, the language is gonna make them worse.
This is in the United States.
This pain report just came out last week.
Chronic pain is pain that's lasted over three months.
That affects you on most days.
High impact pain is pain that you've had over three months.
That causes you disability on most days.
Inability to work, or function,
or do the things that you do.
Male and female, it's kind of the same, not much difference
by age it goes up.
This is really important.
Younger people have only 7.5%,
of young people are having pain, 13%, 14%
and young middle age, 26%,
65, 30, 34.
It goes up. But it only goes up just a little bit
gradually, gradually going up.
It's not a major incline.
These numbers are fairly similar by ethnicity.
The region of the country, there's no difference.
There's a higher in rural areas,
higher in people who have less money.
Rural areas, poverty,
more stress, more anxiety, more worries,
more problems, more pain.
And then by education,
higher and less education.
The most common pain condition is low back pain.
They say in a lifetime 85% of people get low back pain
at some point, it's common.
And so when we treat, when we think of low back pain,
is it in this category of something
that's caused by the brain,
or is it something that's caused by some problem
in the body or some of each?
Well, you can certainly twist your back, hurt your back,
you know, have some physical problem in your back.
But when it becomes chronic, it's much more likely
that it's gonna be not due to the physical problem.
And I'll tell you about that.
But when you treat all back pain
as if it's purely structural, well you wanna do injections,
pain medications, you do more testing, MRIs,
you do some more surgery.
And over the past couple decades,
we've had major increases in the US
and in the world of all the interventions for low back pain.
And what has happened to low back pain over these 20 years?
Has it gone down
because we have all these treatments for it?
No, it's gone up.
Why don't we have more and more scientific treatments
for something and the problem gets worse.
Is it possible that somehow the scientific treatments
are making the problem worse?
Is that possible? Of course it is.
Just like telling someone they have a suicide disease
is making them worse.
Getting an MRI will make people worse,
because it'll show them things that are scary,
which makes things worse,
because fear is what causes the brain to.
And so what about surgery?
Well, there are hundreds of thousands
of surgeries done on people's backs for pain.
And why would we do that?
Well, there must be a scientific reason for it.
Why would doctors do something
if it wasn't based in science?
There's never been a single
randomised controlled research study to show that
back surgery for back pain
is better than exercise for back pain,
or physical therapy for back pain,
or just watching and doing nothing for back pain over time.
There's not a single research study showing that.
So what's the justification for it? I don't know. (laughs)
I mean, is it money?
You know, I mean cynically, we would say,
if you're sceptical, you would say,
well, people want money.
Yes, everyone wants money.
But sometimes about a third of people
who get surgery for back pain get better.
About a third are unchanged. About a third or worse.
So it's a very invasive and expensive procedure.
So getting it.
Now, there's some people who can benefit from back surgery
if you have a fracture,
or some kind of tumour, not a fracture,
but if you have some kind of tumour,
if you have some kind of infection, an abscess,
yeah, you need surgery on your back.
If you have a disc that's really, really big
and it's pressing on the nerve
and it's causing pain down the leg and it's clear that,
and the foot is starting to weaken
and the nerves are starting to damage,
yeah, surgery can help that.
But the vast majority of back surgeries are not for that.
They're for pain in the back.
And if you're getting surgery
and then they say, well, two thirds of the people,
it doesn't help.
Would you do it?
The odds are not that great.
Two thirds are not helped.
One third gets better.
Okay, if the problem is due to the brain,
why would one third get better?
- They believe. - What?
- [Audience member] They believe.
They believe the placebo effect. Yeah.
So it does work some of the time.
And when it works, the patient's happy, the doctor's happy,
and then the doctor says, oh good, I'm doing a good thing.
So then they keep doing it.
If it never worked, I think they would stop doing it.
Does that make sense?
I think they would stop doing it, I really do.
So we don't have a sham surgical trial.
You know what a sham surgical trial
is when you take half the people randomly
and you give them the surgery
and the other half, you give them the sham surgery,
meaning you put them in the operating room,
you do all these things and the lights and you wash, wash
and sterilise and you do all that
and then you make a incision and you sew it up,
but you don't do the surgery.
That's a sham surgery.
Is that a good idea to do a research study like that
where you do the sham surgery on half the people?
That seems wrong ethically, but we've done it.
And it is ethical.
If you don't know, if you don't know
if the surgery actually helps or not,
how would you find out?
The only way to find out really
is to compare the actual surgery to the sham surgery.
So that's been done in knee meniscal tears.
And it's been done also in knee surgery
for like cleaning out the joint for arthritis.
And what they found in those studies
is that the average pain was about six outta 10
prior to the procedure.
And the people who got the meniscus repaired or removed,
whatever they do,
went down to three, 50% pain reduction.
It's pretty good. Six to three on average.
And so what about the group that got the sham surgery?
Six to three, it's the same.
So what was the value of the surgery?
Placebo effect.
Belief that it could get better.
Belief that it could get better is changing the brain.
Placebo is real. It's important, it's dramatic.
It can be anything anybody needs.
If somebody just has
what I would call a mind-body condition,
all they need is a good placebo treatment.
All they need is some magic
and it can work and it's amazing.
But that's great.
I'm a, you know, you could say I'm a placebo doctor.
I help people change their brain,
marshal the power of their brain
to change their brain to get better.
So my brother's orthopaedic surgeon,
he looks at their research, he said, see, it works.
Why I keep doing it, because it's working.
I'm happy, the patient's happy spending money invasive.
But we don't have that kind of study
with low back surgery.
We should do that a hundred percent.
We need to do that.
Somebody needs to do that study.
But it probably never happened.
What about injections for back pain?
$20 billion in the US spent on injections for back pain.
The research shows when you,
do the injections work? Yes.
Do they work better than placebo injections? No.
$20 billion on that.
$20 billion on surgery per year in the US.
$20 billion on injections
that are no better than placebo injection.
But again, we keep doing them
because we're thinking that the pain is due to death.
There's a spinal cord,
even more invasive spinal cord stimulation.
Put this thing in with the battery
and it has leads into the spinal canal.
Stimulating the spinal cord.
We've been doing this,
this has been going on for 10, 15 years,
doing these procedures.
About six months ago,
somebody in Scandinavia somewhere, I forget Norway, maybe
they did a research study.
Let's see if it actually works or not.
Well, no better than placebo. Amazing what we're doing.
So if the physical treatments
for these chronic pain conditions aren't effective,
what about the psychological treatments?
If this is a,
if back pain is quote a psychological problem,
or a mind-body problem,
or it's due to neuro circuits in the brain,
as I'll try to convince you of that.
How about psychology, psychological therapy.
So what's the most common psychological therapy
in the world?
Cognitive behavioural therapy, right?
Are you familiar with that?
So cognitive behavioural therapy is,
has been adapted specifically for pain.
That makes sense. That should help.
And so what happened,
the psycho, you know there was the psychoanalytic literature
and Freud and all of his followers
and young and all that stuff.
And then they got pushed out
by cognitive behavioural therapy,
'cause it's simple, you can study it,
you can teach it, everyone can do it.
So if you're doing cognitive behavioural therapy
for chronic pain and there's been thousands
of studies showing that this type of therapy
is helpful or is effective for chronic pain.
Literally thousands of studies. And this is the most common.
But how effective is it? It's effective.
But how effective is it?
So if you have pain on a 10 point scale from one to 10,
your average pain of,
if you take a thousand people,
their average pain is this.
How much do you think their pain would go down
by doing cognitive behavioural therapy?
Would it go down by one point?
Two points, three points on average?
Do you think?
- Two points. - Two points.
Any other thoughts?
- Three. - Three.
- One. - One.
Four, half?
So we have one, two, three, or four. Okay, let's see.
The effect size is 0.4.
Well effect size, it's a research term.
It doesn't really mean anything, you know,
so on a 10 point scale, the answer is 0.5.
That's the average. Not that much.
Again, if you tell somebody,
well we have this treatment for your pain,
great, thank you so much.
I'm not sure I want psychological treatment,
but I'll do anything to get rid of my pain.
I know the injections didn't work.
I didn't want surgery.
The medications aren't working.
I'll try this psychological therapy.
What's the chance that it'll help me?
Oh, it'll help you.
Thousands of studies showed it'll help.
Well, how much on average will people benefit?
Well, about half a point.
Oh, not so good.
So why would that be?
It's not a bad therapy.
Cognitive behavioural therapy is good.
It's got a lot of great things in it.
Why are the effects so small?
In addition, there's the newer,
the newer one, acceptance and commitment therapy.
Are you familiar with that?
Acceptance and commitment therapy is a newer wave,
supposed to be better,
it focuses on living your life
and what's important to you and all these great things.
It's great, great stuff in ACT, great stuff.
It's the same when you compare CBT versus ACT.
Exactly the same, no difference.
And the effects are not,
even this effects that are small are not sustained.
How about mindfulness?
Are you familiar with mindfulness? Right?
Everyone should learn mindfulness.
I've been a mindfulness teacher since 1999.
It's helped me dramatically.
And children should learn it.
Everyone should learn it.
So let's apply mindfulness to chronic pain.
Seems like a good idea.
Well, research has been done on that.
And it's the same.
It's just as effective or ineffective,
as effective but small effects
that are not sustained over time
in back pain studies
and many studies of mindfulness for chronic pain.
Why would that be?
If this great technique doesn't seem to help,
maybe nothing can be done for chronic pain.
That's another, that's a conclusion that one could draw.
Because if mindfulness, if the surgery doesn't work,
and injections don't work, and the medications don't work,
and CBT doesn't work and ACT doesn't work
and mindfulness doesn't work.
What, I mean, so if you go,
if you have chronic pain and you go in the US
to the best medical centre in the country,
which is let's say Mayo Clinic, what do they tell you?
You have chronic pain.
We don't know why you have chronic pain.
It may have something to do with your brain.
We can't cure you of it, but we can help you cope with it.
How does that make you feel?
Not that great. I don't wanna cope with it,
please, I want to cure it.
Well, chronic pain can't be cured.
That's just like saying suicide disease.
Is it not? Right?
Do you see what I'm saying?
Cleveland Clinic, same thing.
Stanford University, I've been to all these places.
I know these folks.
They're great people. They're smart people.
Can we do better?
Same mindfulness for low back pain,
no difference from the CBT and the mindfulness.
Short-term, small benefits,
and over time the benefits are gone.
The small benefits don't last.
So have we reached the limit?
Is that the best we can do?
Is it lifelong?
Can we not eliminate it?
Can we not cure it?
Should we focus only on improving function? No. (laughs)
So when you take low back pain,
the most important thing to understand is this slide,
this data has been around the percentage of people
who have these problems.
Disc degeneration, disc bulging, disc herniation,
fissures, facet.
This is arthritis of the spine,
slippage of one vertebrae over the other.
This data has been around for decades, it's not new.
And these are all numbers
and people who have no back pain at all.
Grey hair, no offence.
Grey hair, (laughs) grey hair, does it hurt?
Only when you look in the mirror, right? (laughs)
(audience laughing)
It's normal to have grey hair.
It's normal to have disc degeneration as you age.
And it starts in young people, 20 year olds, 30 year olds.
These findings are in people who have absolutely no pain.
Remember I showed you the data
on how much pain there is by age.
It goes up with age, but only a little bit goes up by age.
If disc degeneration cause back pain,
then 80% of 50 year olds would have back pain,
but they don't.
90% of 70 year olds would have back pain, but they don't.
So all doctors know this, they should know this.
But when you have somebody who actually has back pain
and then you get an MRI or X-rays,
and you see these changes,
there's a question of attribution.
Is this causing the pain or is this just there
because like grey hair?
Thinning of the skin,
wrinkles of the skin, bags under the eyes,
okay, enough about me.
So they assume that that's the cause of the pain
because they can't conceive, can't possibly conceive
that the pain could be caused by their brain
as opposed to something wrong in their back.
How common is it that back pain is caused
by something in the brain versus something in their back?
I'll tell you that in just a moment.
And the same thing is true in other disorders.
Women who have pelvic pain, you get a laparoscopy,
they look inside, look for what's wrong.
And then you say, well you have this,
you have endometriosis,
that must be the cause of the pain.
But when you do laparoscopies in people,
in women who don't have any pain,
you find endometriosis as well.
So is the endometriosis the cause of the pain?
Maybe, but maybe not.
Same thing when looking in the bladder.
There's a condition called interstitial cystitis.
And when people look in the bladder inside,
they say, oh, there's these red spots.
That must be the problem. You have these red spots.
So you have this disease that's causing pain
and that's why you have pain.
So it's a physical problem, we can't cure you.
We can give you a variety of things that are often invasive,
but we don't know.
Well, if you take normal people
and you put all, extend their bladder with all the fluid
and look inside, you see similar things,
you can see the same spots.
And of course when you look at people
with chronic pelvic pain, people with migraine,
people with fibromyalgia, they have higher rates of ACEs,
higher rates of adverse childhood events,
higher rates of stress, and anxiety,
and trauma in their life.
And again, everyone knows this, but what does it mean?
What do we do with that?
Can we do anything about that?
And the model that we have is, yes, this is very important
and we can do something about it.
But if you ignore it and you just say, well, it's too bad,
and what does that have to do with this,
then you're not helping people understand themselves.
What about depression?
So it's not just pain.
The other major causes
of disability in the world are anxiety and depression.
So we have these medications
and we have this idea that depression
is caused by low serotonin in the brain.
Have you ever heard that?
Depression is caused by low serotonin in the brain.
Everyone knows that.
And medications that increase serotonin
can be helpful for depression.
SRIs, serotonin and reuptake inhibitors.
So it turns out, if you give medication for,
if you give these medications for depression,
about 75% of people have benefit
in about a six week time period.
75%, that's pretty good.
How effective is the placebo treatment? 72%.
Kind of the same.
And there's reasons why
that even difference is probably not that meaningful.
So if 72, if more virtually the same people
can get better by placebo.
And here's the thing,
there's a new drug somebody came out with a while ago
that lowered serotonin, okay?
Didn't raise it, it lowered it.
So they tried that for people with depression.
75% got better,
has nothing to do with serotonin.
This idea of the serotonin hypothesis was created
by a pharmaceutical company,
not based on research on the brain.
This is that surgery I told you about with the knee.
Migraine headaches.
When you do say Botox for migraine headaches,
well Botox for migraine headaches, think about that,
you're giving Botox, are you giving it into the brain?
Not really. (laughs)
Botox is in the skin, right, in the soft tissue.
Botox, it's good for wrinkles.
I should try it again.
So we research on migraine headaches.
Migraine is caused by the brain.
There's something in the brain that's causing pain.
Everyone knows that that's true.
So Botox, okay, well whatever sounds like a good idea.
And in the treatment Botox group had six,
six fewer days of migraine pain per month,
that's a big change.
Six fewer days per month
of migraine pain in the placebo arm,
five fewer days of migraine pain, kind of the same.
Okay, so what it is, is that chronic pain is presumed
to be biological and psychological.
So the idea of mind-body is that the mind affects the body,
but it's also the body affects the mind,
it's a two way street.
And most people will say, well,
you can't separate the mind and the body.
I mean you're, if you separate the mind and the body,
you're engaging in dualism, which is really bad.
So I'm accused of engaging in dualism
because I'm saying, look, is it a structural problem
or is it a brain problem?
I wanna know the difference.
If I have stomach pain, I wanna know,
should I go to the hospital and get surgery for my appendix,
or should I think about it differently?
To me, those are a big difference.
Or should I do both?
Should I always do both?
So chronic pain is presumed
by everyone in the field to be both.
It's biological and psychological.
So we have something called
the biopsychosocial model of illness.
Have you heard of that?
Biopsychosocial model of illness?
So, which is brilliant, it makes perfect sense.
It was developed,
the credit for it goes to a guy named George Engel.
I have a picture of him on my wall. I love him.
I love what he's done.
But when people hear the biopsychosocial model,
when they hear those words, bios, psychosocial,
the psycho, psychological
and the social kind of get pushed to the side.
And the bio is like this, 'cause I have a problem.
There's some biological problem in my body
that I need to fix.
And when you think you have
a biological problem in your body,
and if you think that your disc are bulged,
or your disc surgery degenerated,
or you think you have the suicide disease,
or whatever people have told you,
you think your serotonin is off.
You think it's genetic disease with migraine,
it's deemed to be a genetic disease,
but it's actually an epigenetic disease.
Do you know the difference?
An epigenetic disease means that the genes are changed
by life, by what happens.
Your genes are changed when you laugh, when you smile.
Your genes are changed
when you learn to play the violin.
Your genes are changed when you have a stressful day,
they change all the time.
So the treatment there for us, we'll do some of everything.
You go to the Mayo Clinic, the Cleveland Clinic,
you'll get psychological therapy, you get physical therapy,
you get medications, you get injections,
you get acupuncture, you get tai chi, you get everything.
And we'll think that that'll help
because we'll do everything.
But when you do everything,
the message that you're giving to somebody
is you're pretty broken
for to need all these interventions.
You are really broken. You are really messed up.
And that message makes things worse,
'cause it affects how the brain works.
And they haven't been effective in really reducing
or eliminating pain.
So the difference between what I would call the coping model
for chronic pain and anxiety, depression, insomnia, fatigue,
chronic fatigue, very important versus the curing model.
So this is what we're talking about is the curing model.
Okay, so what are the limitations?
Well, if you don't make a specific assessment,
if you say, well the pain is
we don't know why you have pain.
It's chronic and we'll help you cope with it.
But why is it in this category or this category?
Well, we can't tell, it's gotta be both.
Now you don't have anything.
I'm gonna teach you tomorrow how to assess,
to determine is it this category or this category?
And it's not that hard. And anyone can do it.
Anyone can do it.
You don't have to be a physician
to distinguish the two 90% of the time.
There's a few where you need a physician
because it's complicated.
And I'll show you some of those cases
where it's complicated,
but most of the time it's not that complicated.
It's very straightforward, it's very easy.
Secondly, the methods that they use are geared toward coping
or functioning better rather than actually curing
rather than eliminating the problem.
And finally, the coping model doesn't deal with the stress,
the trauma, the emotions.
Just yesterday, my wife sent me an article
from the New York Times headlines, "Emotions aren't bad."
God, thank goodness, it's about time.
The New York Times said so. So it must be true.
That's true, emotions aren't bad. We are emotional beings.
And if we don't deal with the emotions of our life,
then we're not really dealing with our lives.
So if you have anxiety or depression,
is that a structural problem, a physical problem?
Or is that a kind of a mind-body problem?
Well, most of the time it's a mind-body problem.
Psychologists, social workers,
therapists treat anxiety and depression all the time.
But there are some people who have anxiety
because of a structural problem.
Their thyroid is very high, that can make you anxious.
We would wanna know that,
'cause then that's a medical problem. Treat the thyroid.
You have arrhythmia of the heart,
your heart's going like that,
and it's due to a heart problem, a disease in the heart.
We would wanna treat that, you'll feel better.
Depression if you have a low thyroid,
if you don't treat that.
If you have a very low pituitary adrenal gland hormones,
testosterone hormones, those can cause depression.
We would wanna know that, right?
But 99% of the time, that's not the cause of people
who have anxiety, depression,
anxiety, depression is in this category 99% of the time.
Fibromyalgia, chronic, widespread pain.
We have not found any disease process in the body
to cause that disorder.
So if you rule out an inflammatory condition,
fibromyalgia is not an inflammatory condition,
it is not an autoimmune condition,
it is not a structural or physical condition.
It's a mind-body condition.
Good, we can treat that, simple.
Irritable bowel syndrome. What is that?
It's a disorder where there's stomach pain,
cramping, diarrhoea, constipation,
variety of those things turning on, turning off
related to stress.
Worse in people with trauma,
or more likely in people with trauma.
And the tests are all normal.
All the blood tests, all the GI tests, they're all normal.
Good. It's not a structural problem.
See how simple it is?
Headaches, migraine headaches.
If it's migraine headaches, it's not a structural problem.
Tension headaches, not a structural problem.
Occipital neuralgia, not a structural problem.
So now you've we're just, we're like racing through.
We're getting to the 90% that anybody can figure out.
If the doctor, if you've had medical testing
and you've been found to have those disorders,
those are mind-body problems.
Pelvic pain syndromes, 90% of those are mind-body disorders,
vulvodynia, coccydynia, pudendal neuralgia,
interstitial cystitis,
pelvic floor dysfunction, all mind-body conditions.
They're just given different names.
What about chronic neck and back pain?
So we did a research study two years ago
and a friend of mine who's a physical medicine
and rehab doctor in Louisiana,
he learned about this work and he said,
wow, this is amazing.
I see it, I see it. And I said, good.
Let's see how common it is in your patients.
Just regular people coming to the doctor
for chronic back pain, no screening.
Not like the people who come to see me,
who is like Dr. Schubiner I wanna see you.
I know it's in my brain. Good.
These are people who are like, I have back pain, help me.
And he screened 220 people.
But he screened them using the methods
that I'm gonna teach you tomorrow
of how to distinguish this category versus this category.
So he used those methods,
which most doctors don't use.
And he determined that 88% of the people
with chronic neck and back pain were in this category.
Purely a mind-body category.
88% of people with chronic back pain or neck pain.
That's amazing.
We're trying to get that article published
in a medical journal right now.
It's not going so well. (laughs)
We're having problems,
but we'll get it published sooner or later.
Somebody's gonna believe us, we'll see.
But that's amazing, right?
And one of his patients was a man
who was a labourer working with his back
for many, many years.
He had very severe back pain.
It didn't change, it didn't move, it didn't vary.
And he had a severe spinal stenosis on his MRI.
So my friend Bill Lowry is his name.
He said, this must be structural. Okay fine.
We put him in the structural category, the 12%.
We didn't know it was 12% until the end of the study.
But he put him in the structural category
and then they go to treat him.
So they give him injections, epidural injections
in the spine because the nerves were being pressed on.
Well, if the nerves were being pressed on,
the pain would actually be in the legs.
But he didn't have any pain in his legs.
He only had back pain. So that didn't really fit.
But anyway, whatever.
So they do the injections
where it should help based on the MRI didn't help at all.
No benefit. So they said, well, hmm, what can we do now?
Well, we'll do injections in the facet joints.
The facet joints are the little connections
between one vertebrae and the next.
They're floating on each other, little facet joints.
So they injected those both sides.
That wasn't where the problem was on the MRI,
but you know, they did it.
Total cure, completely cured for one day.
Well the injection only lasts for one day,
'cause it's a lidocaine and a steroid.
But the next day he's still cured.
The next week he's still cured.
The next month he's still cured.
The pain didn't come back six months later. Why is that?
It was a placebo effect.
It's like giving you a, you know, an injection that,
a painkiller that lasts one day,
but the pain goes away for six months.
Somehow that injection changed his brain,
made the pain go away.
And so my friend Bill Lowry is like, geez,
I was wrong on that one.
I thought it was, even I thought it was structural,
but it turned out it wasn't.
We left him in the structural category
for the purposes of the research study.
But that's a science thing.
So what we're gonna do next when we come back
after the break,
is talk about how the brain works
and hopefully and we'll show you some magic.