- Okay, so you're ready for a quiz?
- [Audience Member] Yes. - Ready for a quiz?
- Yes. I like it. Okay.
This is fill in the blank and I'll give you a,
but I'll give you a clue.
I'll give you some clues, okay?
Ready? The brain creates what we?
- [Audience Member] See. - see.
The brain creates what we see.
Let's try this one.
The brain creates what we?
- [Audience] Hear.
- Oh, you're catching on.
(everyone laughs)
The brain creates what we?
- [Audience] Feel. - Feel.
We've learned a lot already.
Let's try this one. This is a variation.
All pain is created by the?
- [Audience] Brain. - Brain, good.
Not all injuries cause?
- [Audience] Pain. - Pain.
Not all pain is due to?
- [Audience] Injury. - Injury.
Here's a hard one.
What percentage, in my opinion, I'm not asking your opinion.
I'm asking my opinion now.
(audience laughing)
What percentage of chronic back pain
is caused by the brain, roughly?
Eighty-five, 90, 88, yeah, in that neighbourhood.
There's a guy named Richard Deyo, D-E-Y-O,
was a American doctor-scientist written
for back pain for many, many years.
And he wrote an article in 1991
where he estimated that 85%
of all back pain is not structural
that we came up with based on our research.
He just wrote it, so I looked up his paper.
Where was the reference for that?
There was no reference for that. He just said it.
And then two years ago, or a couple,
two, three years ago in the Lancet,
there was a research, not a research paper,
a review paper of back pain, chronic low-back pain.
And it said, "85% was undetermined
or unclear or not structural."
Again, where did that number?
That number came from the other paper.
But the other paper came from who knows where?
So now for the first time, we actually have the data.
It's the same number They were right.
I don't know how they knew they were right,
but they were right.
Okay. So what we're gonna do now is I'm gonna just review
one simple way of calling is pain, neuroscience, education,
explaining in common language
to yourself, to your friends, to your family,
to your clients, to your patients,
to whoever you come in contact with.
I'm gonna give you my way of explaining that.
And then we're gonna break into groups of two, pairs of two.
And you can practise explaining it
to each other in whatever language you want.
You can use some of my language,
all of my language, I don't care.
A little bit of it. Use your own language.
But the idea is to just have practise explaining this.
So this is what I say.
I say, you can't understand pain,
unless you understand how the brain works.
And it turns out the brain works
by something we call predictive processing
which means that the brain generates everything
that we experience.
This is a wild and seemingly counterintuitive idea,
but it's what neuroscientists
have determined how the brain works.
The brain predicts what it should experience,
and then it actually creates it.
Vision is created in our brain. We don't see with our eyes.
Light comes in our eyes,
but our brain is what generates the images.
If I gave you glasses that were prism glasses,
prism that turned the world literally upside down,
you would see everything upside down,
but only for a few, a couple days.
And then your brain, even though you're still wearing
those glasses, the light coming in is upside down.
Your brain would turn things right side up,
just like your brain turns the nose
of the mask pointing toward you in the rotating mask.
Our brain's determined by what we hear.
Yani and Laurel.
Some people hear Yani, some people hear Laurel.
If you say in your mind, brainstorm, you hear brainstorm.
If you say in your mind, green needle,
then you hear green needle.
Our brains determine what we hear,
and our brains determine and generate what we feel.
For example, my wife had an apple
that I thought was an apple,
but when I bit on it, I got a rotten taste in my mouth.
That's how the brain works.
And all pain is generated by the brain.
When you touch a hot stove,
it's not your finger causing pain.
It's actually the brain.
Pain is a decision that the brain makes to protect us.
Pain is a protector. We need pain.
If you run across the field and break your ankle,
you want pain because your brain
is telling you stop running on a broken ankle.
It's a message, it's an alarm. It's like a smoke alarm.
And when there's enough signal,
the brain will turn on a message,
which is telling us something.
But it turns out that your brain
doesn't have to turn on pain.
If you're running from a lion
and break an ankle, maybe your brain won't give you pain.
And that is the power of the brain
to determine what you experience.
And then I tell them about the guy
who shot a nail in his hand
and had absolutely no pain,
despite having a nail his hand.
Maybe because he was all alone at a construction site.
But the point is, the brain decided
to not have pain even though there was an injury,
so not all injuries cause pain.
And there was a guy who jumped off a scaffolding.
The nail went clear through his boot and he had severe pain,
and they rushed him to the hospital,
and he was screaming the whole way.
But when they took his boot off, there was no injury at all.
And he was fine, and it was his brain creating pain
out of a prediction, out of the idea that this should hurt
and you should get pain.
You should go to the hospital
because the brain has to decide.
And sometimes the brain is not always accurate
because it's doing the best it can to protect us.
And if it errs on the side of producing pain,
when there's no injury, at least you went to the hospital.
And research shows that stress
and emotion activate the exact same parts of the brain,
as does a physical injury.
The stress and emotion of seeing a nail
through your boot activates pain
that is real, not imaginary.
That can be severe.
And that is generated by the brain.
And that's how our brains work.
That's how our brains were designed or created by God,
or evolved, or however you think about it,
but that's how they work.
And there was this guy who was in this war,
and he had a shrapnel wound.
And the shrapnel wound caused a lot of pain.
And he got medevaced out, and his injury healed
'cause all injuries heal.
And his brain turned off the danger signal and the pain,
and he was pain-free.
And 20 years later,
the sound of a helicopter activated
his brain to turn on pain
'cause the brain can learn pain as a neural circuit.
It can remember it,
and then it can activate it at the sound of a trigger.
And a trigger might be bending over.
A trigger might be the wind.
A trigger might be getting in a car.
A trigger might be typing.
A trigger might be a computer screen.
A trigger might be a certain food.
And we see all of these kinds of triggers
that are triggering the brain to turn on pain.
And those can be reversed.
And pain is fueled by fear of the pain.
So when pain occurs, it activates us to action.
A smoke alarm activates us to action,
and a smoke alarm has to be loud.
If it's not loud, it's not doing its job.
If your brain wants to activate you to action,
it's gotta be loud.
It's gotta be loud enough, so to speak,
or painful enough for you to take action,
to move your hand from the stove,
to stop running on the broken foot.
Or maybe, it's to change your relationship
with your neighbour who's keeps driving on your lawn.
That's a big thing in America.
(everyone laughs)
Your neighbour drives on your lawn. That's a problem.
Or maybe it's your boss, or maybe it's your child,
or maybe it's something else.
But there's a message there and there's a meaning.
And our failure to listen to that,
to understand that tends to,
the misinterpretation of pain being a structural problem,
which causes us to do something,
go to the doctor, get shots, get surgery,
get medication, versus the differentiation,
which we'll talk about tomorrow,
of how to do this of the pain,
being a message, having to do with your life
or your family, or your past,
or whatever is a totally different message.
But the reaction that we have frequently is fear of it,
worry about it, focus on it, frustration with it.
All these things that we'll talk about more,
which actually teach the brain that this is a problem.
We're giving feedback to the subconscious brain,
this brain part.
When I say brain,
I'm talking about the subconscious part of our brain, right?
But consciously, we're saying, oh my God, this is horrible.
This is weird. I gotta get outta this. It's fight or flight.
And then that causes the brain to see more of a problem
because neurons that fire together wire together, right?
And when you're having pain and your reaction,
our reaction to it, the normal human reaction
of those fear, focus, fighting, freezing.
That's teaching the brain it's worse.
But if we change our reaction,
we have a way of interrupting that.
So there's lots of ways that we can help this.
We can stop this.
And if you're interested, we can evaluate you.
We can see what's going on here,
and we can try to figure it out together.
Would you be interested in that?
And this finally, the most important part
that I forgot to mention, anybody who says this pain,
or this symptom or this sensation is all in your head,
is being either ignorant or judgmental,
or dismissive, or even cruel.
Because what they're implying when they say it's all
in your head is that it's not real.
It's imaginary. You're making this up.
You want this. It's your fault.
And that's completely untrue. We know that's untrue.
And that's one of the worst things someone can tell you
because we know this is real.
And the suffering that you have is real.
And there may be opportunity to help, to fix, to change it.
Because there's this emerging science of the brain
that tells us that real sensations, even severe sensations,
can in fact be caused by the brain.
And we can sort out if that's true or not in your situation.
And we'll see. Maybe it will, maybe it won't.
But if it is, we can help.
And if you're interested, we can look at that together.