(Howard laughing)
- He said it's not science, it's magic.
It is science.
That is science.
That's the power of the brain.
'Cause our brain creates what we experience.
And if you show this to people, they'll see it.
And once you see it, it's a little hard to unsee it.
And we're trying to open people's minds
to create something that they can see
that they couldn't see before.
Not everyone will experience that.
You can't take a hundred people and all a hundred
will have that response, by the way. (laughs)
So pain.
Do we need pain?
Yes.
Children who are born without the ability
to experience pain, which occurs rarely,
often die at a young age
'cause they're always hurting themselves
and they don't know that they're getting injured.
Pain is a protection.
We need pain.
It's very important.
If you're running and you break an ankle
while running across a field,
you want pain because you need to have pain
in order to stop running.
So you stop, you don't run on a broken ankle.
But if you're running from a lion and you break an ankle,
do you want pain then?
Probably not because you'll die.
So your brain has to make a decision,
pain or no pain, run or don't run.
And there's many, many times
where the brain has completely ignored pain,
just like you saw in that video
where the guy had the needle in his actual arm
and his brain couldn't feel it
because his brain was focused on,
that's not your arm, this is your arm.
And that happened in a very short time.
This neuroplasticity is always there.
Neuroplasticity means the brain
is always changing over time.
And it can always change.
And it doesn't matter if you're 9 years old or 90 years old.
It doesn't matter 'cause your brain is always neuroplastic.
It always has the ability to change.
So my wife has the same breakfast every morning,
sliced apple, yoghourt, granola.
One morning, she had an extra slice.
She came up the bedroom and she fed it to me.
I didn't see it 'cause it was dark.
I didn't touch it.
I just bit on it.
And I got a rotten taste in my mouth.
And I'm thinking like,
I haven't done anything wrong today yet,
you know, to justify poisoning.
But it wasn't an apple, it was a peach.
But my brain was expecting apple.
It was predicting crunch.
And when it didn't get crunch, my brain, in an instant,
had to make a decision.
Sweet peach or rotten apple.
It didn't know.
And it didn't have time to think about it.
These are instant things, you have to protect yourself.
If you're standing next to a bush
and you hear a rustling,
you can say, well, it's probably the wind.
But if it's actually a lion, you'll die.
So wouldn't it be safer to just assume it's a lion and move?
And we've been living in that way
for tens of thousands of years,
with our brain erring on the side
of protecting us of from danger.
And eating a rotten thing is dangerous.
This is an interesting fact I just learned last month.
When women get pregnant,
their immune system has to down-regulate a bit
because the immune system, you don't wanna reject the baby
with your immune system.
Make sense?
And so the immune system is down-regulated a bit.
And what they found, that women who are pregnant often
are more likely to be more sensitive to taste.
Or if a taste is off, they're more likely
to be aversive to bad smells or bad taste.
And bad smells or bad tastes are like getting an infection,
getting rotten food.
Makes sense.
So your brain is sensitive.
It doesn't want you to eat something rotten.
So I got the softness of the peach,
my brain said, that's bad.
And I felt a rotten taste in my mouth.
My brain literally made a rotten taste in my mouth
when the peach was sweet.
The exact opposite.
The exact opposite sensation of what is really there.
Is that a hallucination?
Yeah.
In a way, right?
It's just how the brain works.
Our brain creates what we experience.
I have this patient who,
she had back pain, and it hurt when she walked.
But she found, after a while,
if she went out of her house
and if she walked this way around the block, she had pain.
If she walked that way around the block, she had no pain.
That's amazing.
It's magic, right?
But it's just simple neurology.
For whatever reason,
her brain was turning on pain to the right,
turning off pain to the left.
But that tells us what's going on.
That's why it's not hard to determine when a symptom,
when a sensation is neuroplastic,
'cause you can look at,
you know, what's happening around it, its characteristics.
I had a patient with long Covid,
and she couldn't smell or taste.
Well, lung, or Covid, the virus,
appears to cause people to not smell or taste.
It's very common in people who get Covid.
So I assume, like most doctors would,
that this inability to smell and taste
is due to the actual virus causing a physiologic problem
in the ability to smell and taste.
Makes sense.
But why does she continue not to be able to smell or taste
after three months or six months or nine months?
I don't know.
Why would that happen?
Well, this woman saw me with long Covid,
headache, fatigue, ring in the ear,
can't think straight, a lot of symptoms
after about nine months.
And then I saw her, and I explained everything that I do,
which you're gonna learn everything that I do this week.
And I saw her two weeks later, and she was 80% better.
It was amazing.
She was like so much better.
Fantastic, I was so happy.
And I said, "Well, what about your smell and taste?:
She said, "It was really funny
'cause I saw you on a Tuesday,
on Wednesday, I still couldn't smell or taste.
Thursday, I could smell or taste fine.
Friday, I couldn't smell or taste again."
What? (laughs)
"Saturday, I could smell or taste.
Sunday, it went away, and then I was fine."
Turn on, turn off.
Wipe on, wipe off.
Turn on, turn off.
That's amazing that this sense, ability to smell or taste,
could be determined purely by neural circuits in the brain?
Incredible.
Not all injuries cause pain.
This is a guy who had a nail in his hand.
He had no pain at all.
Why?
I don't know why.
The brain just didn't create pain.
It happens all the time.
There's thousands of cases.
And there's a study from Henry Beecher, World War II.
Soldiers who were injured in World War II
get to this, the area of the safety.
And they asked them, are you in pain?
And two thirds of them said no.
Two thirds of them said no.
They're head injuries.
This guy was alone at a construction site.
Maybe his brain said it's better to drive to the hospital
than just be alone in pain.
I don't know why.
We don't know why our brains do what they do,
but he had no pain at all.
This guy, you've probably seen this thing,
he had severe pain, a nail all the way through his boot.
They rushed in the hospital.
He was screaming in pain.
They gave him IV pain medication.
They took the boot off, the nail was between his toes.
There was no injury at all.
I tell these stories to every single patient I see,
every single patient.
I tell them the stories about
the apple.
I tell 'em the stories about the pain running
or pain running from a lion.
I tell 'em that pain is necessary,
that children without pain often die.
I tell them about the nail in the hand.
I tell 'em about the nail in the boot.
And when the person I'm talking to smiles or laughs
when I tell them that there was no injury
with the nail in the boot, that he had severe pain,
when they smile or laugh,
it's a very positive sign. (laughs)
I don't know, I've just noticed.
When they smile or laugh,
I know, like, okay, they're hearing me.
They're getting it.
That's funny.
If you can think of this as a little more funny,
as you'll see in the work that we do,
'cause humour, when a child skins their knee
and if you can get them to laugh,
they can forget about their pain.
And we're doing the same with the brain.
Anyway, I just noticed that.
It's interesting.
This is the third story I always tell
to every single patient.
There was a doctor I met, he was a doctor later,
but he was in the Vietnam War when he was a young man.
He got injured one day, his company got attacked, ambushed,
a lot of people died, a lot of gore.
He got shrapnel wound to his leg.
He had a lot of pain.
He got medevacked out.
What happened to his injury?
His injury healed.
Why?
'Cause all injuries heal.
This is the simplest three words.
All injuries heal.
Have you ever had a cut that didn't heal?
And yet you see hundreds,
thousands of people who had an injury,
and there's still pain three months later, six months later,
a year later, five years later.
Why is there pain?
And the answer is, well, the injury didn't heal.
That is highly unlikely.
All injuries heal.
There's a study that was done
by a colleague of ours in Norway.
And they were studying post-surgical pain,
so pain in a scar.
When you have a surgery, you get a scar usually.
And that scar means that tissues have healed.
And when you think about our lives,
we haven't been in the world
for all these tens of thousands of years
to have injuries that don't heal.
It wouldn't make sense.
It wouldn't be good for our survival.
Anyway.
So they studied people,
women who have caesarean sections,
have a baby, brand new baby, you have to have a caesarean,
what percentage of women who have babies by caesarean section
have pain many months later?
It's about 3 to 5%.
Some, but not that high.
Now they also took women who had mastectomies
for breast cancer with a scar.
What percentage of them have pain
that lasts six, three, six, nine months, a year later?
30 to 50%.
A big difference in having a caesarean and a new baby
or having a surgery and having cancer.
What's the difference?
It's not the scar, it's not the healing, it's not their age.
It's what's going on in their life.
Having cancer, having a baby.
So pain is a dynamic process.
It can turn on, it can turn off.
All pain is real.
There's no such thing as real pain or imaginary pain.
All pain is real.
All pain is generated in the brain.
So when you have an injury, it's not your finger.
Your finger can't cause pain.
You can cut your finger, the finger,
the nerves from the finger go to the brain.
The nerve sends signals to the brain.
But the signals have to be interpreted by the brain.
The brain has to decide,
pain or no pain?
The brain has to decide that.
And usually, it decides it within a millisecond.
And it decides it one way or the other.
If you cut yourself, 99.9% of the time, you will have pain,
but not 100% of the time.
Because the brain is deciding.
Pain is generated in the brain.
And pain can be triggered by tissue damage
or pain can be triggered by neural circuits
in the absence of tissue damage.
And just knowing that is a revolutionary idea,
knowing that you have to decide, you have to choose.
You have to think about it, right?
When I woke up in the middle of the night
with stomach pain a few weeks ago,
I had to decide, am I dying, you know?
Should I go to the hospital
or was I, whatever, my brain turned on pain
the middle of the night.
Maybe I was dreaming about something.
Maybe something was bothering me.
I don't know why, but I had to decide.
So I just waited.
And then it went away.
okay, I guess I'm not dying.
Good, I'll go back to sleep.
But you have to ask the question.
That's all I'm saying.
So this is the model that we use.
Injury can activate the danger signal to turn on pain,
or fatigue, or insomnia, or tinnitus,
or anxiety, or depression, or irritable bowel, or whatever.
There's a million ways, a million messages or alarms.
It's like a smoke alarm, as I tell people.
If there's enough smoke, the brain will go off.
And when the brain's going off, why is it doing that?
It's a message, it's an alarm.
Something's wrong.
Of course something's wrong,
but the question is, what's wrong?
Good, now you're asking the question.
You have the right question.
Is it something wrong in the body, an injury,
or is it something because of stress and emotions
and something that's going on in our life that's causing it?
And people's brain, people who have stress
or trauma in their life are much more likely,
their danger signal is set to be more sensitive often.
Not always.
Not everyone with trauma.
A lot of people have trauma and do okay, do fine,
lots of people.
Lots of people have trauma.
Everyone has some trauma, we'll talk more about that later,
but the point is that it's a tendency
for that danger signal to be set
to be a little more sensitive.
We'll talk about that.
The symptoms that occur, the pain, or the fatigue,
or the anxiety, don't feel good.
It feels bad, it's unpleasant.
And that unpleasantness leads one to react to it.
And we react with fear of it, focus on it, worry about it,
frustration about it, trying to figure it out.
We'll talk more about that.
And those things tend to make the danger signal go back
and make it worse in a vicious cycle, a spiral.
And most people with chronic pain,
or many people with chronic pain, get worse over time.
The pain gets worse.
I had an injury and then the pain got worse
and worse and worse.
When you have an injury and the pain
gets worse and worse and worse, what does that tell you?
It's the brain.
It's not complicated.
'Cause an injury will heal.
And if the injury heals, then the pain
will tend to go down over time.
But if it's getting worse, something else is going on
that doesn't have to do with the injury, right?
Capiche?
So can the brain create pain?
Here's a great study.
It shows that when you do physically induced pain,
certain parts of the brain light up.
Hypnotically induced pain, same parts of the brain light up.
Hypnotically induced pain, not physically induced pain,
it's the same.
All pain is the same.
All pain is generated by the brain.
And it doesn't matter if it's caused by an injury,
or it doesn't matter, it matters, but, I mean,
the sensation, the output of what you feel is the same
if it's caused by an injury
or if it's caused by neural circuits in the brain.
So people always wanna know, how can the pain be so severe
and be caused by my brain?
Because all pain is caused by the brain.
10 outta 10 pain, 12 outta 10 pain,
100 outta 10 pain can be caused by the brain,
'cause the brain can create the same level of pain
for an injury, right?
You with me?
It's very important.
Even imagined pain has the same thing.
And we'll get back to that on Wednesday.
We'll talk about how we can use this idea of imagination
to help people, people with fybromialgia.
The pain is real.
There's nothing wrong in the body, but the pain is real.
And it's critical that people understand that.
And people with chronic back pain and fybromialgia
have the same areas of the brain lighting up
because most chronic back pain is caused by the brain,
like about 88% in our study.
Social exclusion, just in the laboratory setting,
where you exclude people,
like you're playing catch with them
and then you stop playing catch with them.
Oh, I feel socially excluded.
Not a big deal.
But when you scan their brain,
the part of the brain lights up
that makes you more sensitive to pain.
Emotional pain can cause physical pain.
Here's another study.
This is from one of my universities, in Michigan.
Social rejection.
They showed people, college students,
a picture of an ex-romantic partner who had dumped them
in the past six months.
And they showed them their picture.
It's cruel, I know, but they did it.
And they scanned their brain.
And then they gave them an injury, a little mild injury,
heat to their arm, and they scanned their brain.
It's the same.
Emotional pain, physical pain, it's the same.
Why would the brain cause pain
because of an emotional trauma?
We don't know.
I mean, that's speculation.
Why would the brain do that?
It might be nice if the signals
were completely different, right?
It would be a lot easier if emotional pain
caused, you know, pain in your right arm
and physical pain is your left arm.
I don't know.
But that's how it is.
The speculation is, I think,
and a speculation purely,
but when you think about our past,
the Neanderthal people were on the Earth
at the same time as homo sapiens, us humans.
They were together on the Earth at the same time.
We know that.
Neanderthals were stronger, they were bigger,
they had bigger brains, they were smarter,
and they all died out.
Humans survived,
probably because humans banded into groups.
They learned language.
They helped each other.
They hunted together, whatever, right?
So the group was protective.
The group was life or death.
And the speculation is if you got kicked out of the group,
it was like a death sentence.
So if you get bit, you know, get injured,
it's a death sentence.
You get injured, pain, rest and recover.
Your brain is helping you to rest and recover
if you get bit by a lion.
If you get kicked out of the group,
your brain is like, pain!
It's telling you, don't get kicked out of the group!
That's a bad thing for you.
I don't know.
Does that make sense?
I just think it's interesting to think about,
but we don't know.
Recently they were able to take a male mouse, in fact,
and expose them to a smell
that they never experienced before,
like, you know, rutabaga or something, some smell.
And then they shocked him.
So they make him afraid of that smell.
And then the mice has babies, and they have babies,
and the babies' babies are afraid of that smell.
That's incredible
that a smell, that a memory,
could be passed down epigenetically,
that this memory could be created in a mouse
and then passed down to other mice.
And it opens up the door to a lot
of really weird and interesting ideas about trauma,
not only about our trauma, but even past trauma,
and can that be passed down?
And so it's really an interesting and brand new area
that not everyone really knows what to do with.
But we do know that PTSD, and fybromialgia,
and irritable bowel, and migraine headache,
they're all the same.
I mean, really, what is PTSD?
It's stress and trauma that causes a reaction in the body.
We call it PTSD when it's anxiety or flashbacks.
What if it's pain?
Well, we call it fybromialgia.
We call it irritable bowel or migraine headaches.
But the mechanism is the same.
Stress and emotions activate neural circuits in the brain
that can turn on these different circuits.
And why would the brain choose migraine headaches
in one person, and back pain in the next person,
and, you know, irritable bowel in the next person,
and anxiety in the next person,
and fatigue in the next person,
and the other person, all the above?
You know, we don't really know.
One explanation is that it's symbolic.
I had a friend of mine who had a pain
right here in his side, just bothering him.
And he had this employee that was just causing,
there was so many problems.
And finally, the employee left, and his pain went away.
And I said, "Well, he was a thorn in your side."
And he goes, "Oh, good point."
Symbolic.
You know, someone who's a pain in your neck
and you get neck pain, right?
Something you can't stand.
You just can't stand it, and you're having foot pain.
Something that makes me sick,
and you have stomach pain.
So sometimes pain is symbolic,
but not always, I don't think.
It can be contagious, like the TikTok tics.
It can be contagious, like the Havana diplomats.
It can be due to an injury.
So you had an injury to your back, let's say,
and then it heals, and you're fine.
And then you're in a stressful situation here,
and now your back starts hurting in the same place
as when it hurt when you had the injury.
'Cause your brain learned
the neural circuits from the injury.
Can the brain learn neural circuits from an injury?
Remember the, oh, did I, oh I forgot,
I didn't finish the story about the guy in Vietnam War.
That's silly.
He got medevacked out, and his brain, he was fine.
His injury healed.
His brain turned off the danger signal.
And he was fine, pain gone.
20 years later, he was startled
by the sound of a helicopter in the sky,
and the pain came back in his leg,
the same pain that he had 20 years earlier
emerged at that moment
'cause the brain had learned the pain as a neural circuit,
and remembered it, and then it activated it
by triggering the sound of a helicopter.
And so when you have people with pain
that's triggered by an innocuous stimuli,
like a sound, or the weather, or the wind,
you can say, oh, that's the brain.
So simple, so obvious.
So where will, oh, so it's an injury.
So an injury can be triggered
'cause the brain will remember it.
It can be mechanical.
If you're typing a lot and you're stressed,
guess what, your brain will make your hands hurt.
What's the message your brain is giving you?
Don't type so much. (laughs)
You're working too hard.
Maybe you hate what you're typing.
Maybe you hate your job, you know?
I don't know, whatever's going on.
But your brain will use the fact
that you're using your hands a lot
or it'll give you eye strain
'cause you're looking at a computer so much.
So childhood victimisation associated with fybromialgia,
stress and trauma associated with migraine headaches,
interstitial cystitis, pelvic pain, irritable bowel,
these are all research studies
showing this connection that we talked about.
Research shows that if you have someone with low back injury
and you scan their brain
when they come into the emergency room
with a low back injury, you can predict,
based on what you see in the brain,
if they're more likely to develop chronic back pain or not,
based on the connection between the NAc,
the nucleus accumbens, and the prefrontal cortex.
That's an emotionally laden connection.
Think about somebody getting an injury,
which is triggering pain,
but their brain has been more sensitised
because of trauma, stress, prior injury, whatever.
Those are people are more likely for those neural circuits
to make the back pain chronic.
Does that make sense?
So predicting persistence of chronic pain
by what's happening in the brain on an emotional level,
that's amazing.
More scientific proof for what we're doing.
Here's a study where they took people who had low back pain
and they asked them to write about something
that made them angry or upset.
And they measured the muscles of the neck.
Nothing changed.
They measured their blood pressure, didn't change,
their heart rate, didn't change.
They measured their skin response, didn't change.
They measured the tension in their low back, went up.
Linking emotions to tension in a specific,
it wasn't like emotions are causing,
you know, the whole autonomic nervous system
to be activated.
No change in heart rate, blood pressure, et cetera.
The emotion's changing
a very specific neural circuitry
related to pain in the lower back, okay?
More scientific data linking the mind and pain.
And if you look at people
at the start of a back injury, the area,
the red diamonds are high.
This is the somatic portion of the brain.
Over a year, it goes down.
But in people with persistent back pain,
the emotional part goes up over time.
So at a year later, people have persistent back pain.
The somatic areas of the brain are low,
the emotion laden areas are high.
Chronic back pain is more of an emotional problem
than a physical problem.
What a weird, and bizarre, and revolutionary idea that is.
And in the United States, after 9/11,
they could measure kind of stress in the society.
Stress went up in the society after 9/11.
What happened to back pain?
It went up, the same.
Interesting.
We wrote a paper recently on racial discrimination
as a source of pain.
And this guy, Tim Brown,
a friend of mine from Berkeley, California,
an economist and scientist,
did some studies where he suggested that discrimination,
not only, like, the internal stresses of our lives
but external stresses coming from the world,
more likely to cause pain.
So what do I tell people?
Anybody who said this fatigue, or this pain, or this anxiety
is all in your head is either being judgmental,
ignorant, dismissive,
invalidating, downright cruel.
That's how they're treating you.
It's the worst thing you can tell anybody,
that it's all in your head, that it's not real,
because it suggests that it's fake or imaginary.
You're making it up, you're crazy.
It's your fault, you want this.
And none of that is true.
You know it's not true, I know it's not true.
I have to say this.
You have to really help people see
that you care about them, that you love them,
you wanna help them,
and you understand that their suffering is real.
It's very important.
I can't imagine what kind of suffering you've been through.
I can't imagine it.
And I know it's real.
And I'm sorry for that.
And it's hard.
But I think there's hope.
I think there's a chance for being optimistic.
I think there's a chance that we can make things better.
Because the brain
can cause real pain.
The brain can cause real fatigue, real tinnitus,
real everything,
realness that is real, and can be severe,
and can last a long time.
And I don't know if that's the case with you,
but maybe it is.
If it is, wow, that would be incredible
'cause we have these ways of helping people with that
that can really make a huge difference.
And I've seen dozens, hundreds,
thousands of people get better.
Not just cope with it better, not just deal with it better,
but literally get better.
Resolve, eliminate all these horrible things
by methods that we have shown to be scientifically valid
and proven, which I'll show you guys.
Would you be interested in hearing more about that?
Would you? (laughs)
You might.
So there are certain signals in what you're telling me
that suggest maybe the brain
might have something to do with this.
If that's the case, I've had other people
have remarkable results.
It's not for everybody.
You have to decide.
If you're trying to convince somebody of something,
what's the best way to convince them?
Tell 'em, no, it's not for you. (laughs)
Really.
Because the more you sell, the more you're pushing,
the more they're saying no.
That's how we are.
So it's all up to them.
You can present information.
And the reason I'm giving you this information this morning
and more of this information this afternoon
on how to talk to people,
what we're gonna practise this afternoon after lunch
is how to talk to people, what to say, to use these stories,
and I'll lay it all out for you,
and you can practise doing that,
and play with it, and learn different ways,
then it's up to them.
You know, we can only do the best we can do.
But the suffering is so great.
There's a lot of people who will literally do anything
if it means looking into their brain, yeah.
Everybody who comes to me is willing to do it.
So we're just trying to spread this idea,
spread this knowledge so that more and more people,
because at some point, it becomes a tipping point.
You know, at some point, there's enough change
in the thinking of a society that makes things shift.
And it comes from lots and lots of different ways.
We'll talk about that later.