- Okay, so let's just take a peek at this,
there's a couple minute segment
of me talking to a woman
and demonstrating this work a little bit.
So, Maggie, you've been having this pelvic pain
for some time now, right?
- Yeah, it's been on and off,
but it's been pretty prevalent the past,
I'd say few months for sure.
- Yeah.
And it's obviously, you know, pretty unpleasant.
- Yeah.
I mean, it varies,
some days are worse than others, of course,
but the bad is pretty bad, yeah.
- Yeah.
And it's been kind of,
just kind of takes over sometimes, or on your mind a lot,
you think about it a lot, that kind of thing?
- Yeah, I do.
I find that usually when it acts up the most
is in the evenings, like before bed,
and it stops me from falling asleep.
I just, I can't focus on anything else but the pain.
Once I finally do fall asleep,
I even like wake up because of how bad the pain is.
- Oh, that sounds horrible.
- Yeah.
And you kind of have tried a variety of things
to figure it out or, you know.
- Yes.
Oh my God, I've tried anything you can think of,
I've done, you know, acupuncture,
I've done physical therapy, I've had MRIs done,
I've just, I've done pretty much anything
and everything in the book.
I've tried, you know, even like yoga and exercise,
and it doesn't really seem like-
- Yeah.
- Anything helps no matter what I do.
- Nothing's helped, yeah.
- Mm-mm.
- And have you been told,
given any definitive answers about,
you know, what might be going on, or?
- No, doctors, whenever I go to the doctor
to get it checked out, and I've been to like a regular PCP,
I've been to an OBGYN, you know, or, wait, gynaecologist?
Might have messed that up.
(Maggie laughing)
- That's fine.
- I've been to, you know, my gyno about it,
and they can't really find anything wrong like within,
you know, my pelvic region, but-
- Oh.
- I feel like something is obviously going on,
because it's so pervasive.
- Yeah, I mean, how frustrating.
I mean, the good thing is that
if they would have found something wrong,
they could have addressed it.
You know, if they had found an infection,
if they had found a tumour, you know, God forbid,
if they had found some structural problem then, you know,
at least you'd be validated of what it is,
and maybe they could figure something out.
But it's pretty darn frustrating to, for them not to know.
- Mhm.
- And, you know, kind of throw up their hands
or send you here or there, right?
- Exactly, yeah.
They basically just tell me to take some Advil
or ibuprofen and move on with my day,
but I don't think they understand the severity of it.
And it makes me wonder then if there is something, you know,
wrong that they haven't caught.
- Right, well let's look into it more deeply.
But, you know, I've looked at the results of your MRI
and your CAT scan,
and the results of the pelvic examinations you've had.
- Mhm.
- And even the ultrasound too, and they're normal.
I mean, they haven't found a disease process,
which to me is really good.
- Mm.
- Right, because we have a model that demonstrates
and validates that real pain can be caused by the brain,
in the absence of structural damage.
- Mhm.
- And it doesn't mean it's all in your head,
it means that it's real,
it means that the brain can cause real pain,
not because you're imagining it, or you're weak,
or it's your fault, or you want it, or anything like that.
- Mhm, yeah, I hope so,
I mean I'm hopeful that that's the case.
- Yeah.
- We'll see.
- Well, let's look into it more deeply
and if we could get little more detail
on when exactly did this pelvic pain first start in you?
- Mhm.
Yeah, so in my early 20s when I was in undergrad,
I was in a pretty serious long-term relationship,
and I don't know if there's any correlation to it or what,
but I started having these
just kind of sharp stabbing pains,
again before going to bed usually.
And so I kind of just attributed it to, I don't know,
just my body being a body, or maybe something hormonal,
or my period.
But you know, it's interesting,
because it started in this relationship in my early 20s,
and then once I graduated from undergrad
and broke up with my boyfriend,
the pelvic pain slowly went away after the breakup, so-
- Wow.
- Sometimes I wonder if there is a correlation there, but-
- Yeah.
- I dunno.
- Well, I mean, we've talked about the fact
that stress and emotions can cause the brain
to activate a danger signal, which can cause real pain.
And that certainly may have been happening to you then.
The fact that it went away without any medical intervention
suggests that the fact that you were in
a difficult situation,
where was the pain at that time?
- So it was still in my pelvic area,
it kind of almost felt similar to like menstrual cramps.
It was just kind of this stabbing,
kind of dull feeling like right, yeah,
like where my pelvic line would be.
And that was where it was mainly.
Sometimes it would gravitate towards
the tailbone area in the pelvic region, but-
- Yeah.
- Mainly kind of front and centre, if that makes sense.
- So it was mainly in the front,
but then sometimes it would spread to the tailbone area.
- Yeah.
- Did it kind of turn on and off?
Would it come and go?
- It would definitely come and go.
And looking back on it, it would come a lot more
during the darker moments of my relationship or,
you know, during finals.
I remember it always happening during finals week,
which was so, so annoying.
- Yeah, yeah.
- But it definitely came and go,
and varied kind of day to day overall.
- Right, exactly.
And was it triggered by anything else?
Anything that would trigger it other than stress?
- I mean, not that I can really think of.
The relationship, I mean-
- Yeah.
- It was definitely kind of tumultuous,
it had its up and downs, but-
- Sure.
- I can't necessarily pinpoint an exact moment
that might have triggered it all.
- Got it.
And the fact that it would also be worse in the evening,
or when you were lying down, is really telling,
because pain that comes and goes turns on and off,
pain that's worse with stress,
pain that occurs when you're just lying there
and not doing anything.
Those are all very characteristic of mind-body pain, or-
- Mhm.
- Neural circuit type pain.
- Mhm.
- Which is good.
And the fact that it went away shows that it can go away.
- Yeah, yeah.
- What's the situation now with the pain now?
Is it similar to that or are there some differences as well?
- Yeah, so I would say it's pretty similar.
You know, that all happened in my early 20s,
and I'm in my late 20s now,
and it's kind of just come back within the past few months.
And when it does come back,
it is kind of that same sharp stabbing feeling,
like front and centre of the pelvis area.
- Yeah, is it ever in different areas?
Is it always in the same area,
or does it sometimes more on the right, or the left,
or in the back, or?
- Yeah, definitely it seems to hit
more on the left side, for some reason.
And some days it'll kind of
gravitate towards the right side,
but it predominantly is in either the left side,
the right side by itself, or kind of just that entire area.
- So sometimes it can be more on the right,
sometimes on the left, sometimes both.
- Right, yeah-
- Right, yeah, exactly.
Okay, well that's pretty helpful.
What else, is it being activated at certain times of day,
or certain things that you do?
- Yeah, so you know, how I mentioned earlier,
it used to act up primarily in the evening,
it still does that, it definitely still wakes me up when I,
I wake up in the middle of the night
thinking I have to go to the bathroom because of the pain
and just kind of that frequency feeling-
- Yeah.
- Like that stress feeling.
- Yeah.
- But it stabs me right before I go to the bathroom
and afterwards, so I don't know.
And then it also acts up, you know, when I,
I'm planning a wedding right now,
and it also acts up when I go to meet my,
when I'm on the way to meet my wedding planner.
So, I've noticed that kind of pattern too-
- Wow, wow.
- Yeah.
- Well pain waking someone up at night
is almost always a mind-body or neural circuit pain.
- Mhm, mhm.
- But also you said that it can be activated
when you go to urinate, but before you're urinating
and after, but not while you're urinating,
is that what you're saying?
- Correct, yeah.
- Yeah.
And is it every time that you're going to pee,
- It definitely, it varies
and I think it varies on how intense the pain is
but definitely not every single time, no.
- Yeah, so it's not actually due to the act of urinating,
it's not actually due to a problem
with the bladder or the urethra
because if it was a structural problem,
it would be much more consistent than that.
- Mhm, right.
- And we also see that pain that occurs
before or after urinating is more likely to be
neural circuit pain as well.
- Right.
- And, but you've also noticed that
it may have to do with something about the wedding,
I mean, we see that a lot,
I mean, weddings are pretty stressful, obviously.
Is there something in particular
that you think might be bothering you?
- You know, I can't pinpoint anything,
and that's what's so frustrating,
because I mean, I'm marrying a wonderful guy,
we're having a great wedding-
- Yeah.
- And it's supposed to be, you know,
this really exciting time in my life, but-
- Yeah.
- There is something just holding me back in the whole,
you know, wedding area in general, and I-
- Yeah.
- I dunno if it's just kind of jitters or what, but-
- Yeah.
- I can't pinpoint anything specifically right now.
- Yeah, okay.
Well let's talk about some of your past a little bit,
because on the form,
you had some symptoms when you were young,
in your like elementary school years, right?-
- Right, yeah.
- What was that about, can you tell me?
- Yeah, so when I was in elementary school,
I had like chronic stomach aches, really.
They would happen, you know, especially at nighttime,
there's this huge like evening theme in my life,
so especially at nighttime.
You know, multiple times throughout the school day.
It was never, I mean, I remember my mom
taking me to the doctor,
and there was never really anything found,
like no inflammation, no, you know, dietary restrictions,
anything like that.
- Yeah.
- But as I kind of like recollect on my past
and my childhood, I, you know, wonder if it has something
to do with my dad actually, because he was,
you know, very combative, very loud, verbally abusive, and-
- Mm.
- I just wonder if there's a connection there.
- Yeah.
And did that often happen in the evenings, then,
in your home?
Those kind of situations?-
- Yeah.
Right, yeah, my mom worked in the evenings,
so my dad was the primary caregiver at night-
- Oh.
- So it kind of makes sense now that I say it out loud.
But yeah, my stomach pains would definitely
act up in the evening time,
but even if he wasn't having a bad night,
it would still act up.
- Could he be critical or, you know,
was his anger directed at you in any way?
- Yeah, so he would verbally abuse me,
and physically abuse my siblings-
- Oh.
- And so I received a lot of the verbal anger,
and he would always say like, you know,
"You're so stupid, why aren't you doing this right?"
"Why can't you take care of yourself?"
Kind of things like that.
And I was like, you know, seven, eight years old,
so I didn't fully understand,
but there was definitely a sense of
constant criticism from him, yeah.
- Oh, I'm so sorry, that just, that's horrible.
Imagining a young person, you know, having to endure that
from their own father, I mean.
- Mhm.
- Yikes.
- Yeah, thank you.
- I mean, would be pretty obvious in a lot of ways that,
you know, your brain might say, "This is not right."
"There's something wrong here."
You can't stand up to him, you couldn't do anything, but,
but your brain was giving you pain.
And we see this all the time,
that stomach pain in kids is often related to something
that's going on in their life.
And this was a pretty big thing for you.
Did that get better over time with him?
- Um, yes and no, I think he went through phases definitely
where things would be okay, but,
you know, I think once I hit my teen years
things might have calmed down a bit.
But I also randomly started getting like headaches
and migraines in my teen years, so I don't know.
Things kind of just shifted at that point.
- The stomach pains kind of went away after awhile,
is that correct?
- Right, yeah.
Once I hit about high school or so-
- Yeah.
- The stomach pain started to go.
- And you started, but you started getting headaches then?
- Yeah, yeah-
- Yeah.
And if you, looking back at it,
is there anything that was particularly,
if your father wasn't quite as, you know, difficult-
- Mhm.
- Was there maybe something else going on
when the headache started that you can think about?
- Um.
I guess as I think about it now, as we're talking about it,
I can see that, you know,
just obviously the regular pressures
of being a teenager in high school
and trying to fit in, get good grades.
- Yeah.
- But I also had my first boyfriend during that time,
and you know, being young and kind of naive,
I didn't always understand
what a healthy relationship should have looked like.
So I can see now that, you know, that relationship,
which is very similar to that of me and my father's,
maybe that could have kind of perpetuated the headaches,
I dunno.
- Yeah, wow, wow.
Are you the kind of person
that puts a lot of pressure on yourself?
- Definitely, yeah.
Especially because my two older siblings aren't seen like,
successful in our family,
so I remember feeling like an immense amount of pressure
to get into the best college and to, you know,
have kind of my whole future set up by like-
- Yeah.
- Age 16, yeah.
- Yeah, headaches are often a pressure feeling even,
it feels like pressure,
and sometimes when there's a lot of pressure on you
for a variety of reasons, the brain can create
that symptom, that pain.
- Mm.
- And also, was there anything in particular,
now that you think about it, going back to the boyfriend
that kind of reminded you of your father, possibly?
- Yeah, I can see he would have like
pretty big anger outbursts,
but I kind of just attributed it to, at the time,
of just like being a teenage boy, like he would-
- Mhm.
- Get really mad over the kind of smallest things.
But he never really directed his anger at me,
which is why it's confusing.
But, I guess I would still witness it in the same way that,
you know, I would witness or experience
the anger that my dad elicited, for sure.
- Yeah.
And then you said when the pelvic pain
started in your college years.
- Mhm.
- You were also in another relationship
that had some amount of difficulty and, you know,
it may be that your brain was primed to be sensitised
and sensitive.
- Mm.
- To being criticised, to being yelled at, to anger-
- Mhm.
- And then when it's such a major way from your dad,
and then these other relationships can trigger
that reaction in the brain,
because your brain is going into danger mode.
- Mhm.
- And somebody treats you that way, as it should, of course.
But, you know, particularly in you, that would make sense
that even a small amount of danger or anger
could trigger your brain given your prior history,
if that makes sense at all.
- Yeah, it makes total sense.
And it's interesting to hear that, for sure.
- Yeah.
And when we think about now where you're at,
you know, going into the wedding, I've seen a lot of people,
women in particular,
who had difficult relationships in the past,
and now they're getting married, the guy is great,
and on the surface everything is fine,
but their brain, so to speak,
might be a little worried for them-
- Mhm, mhm.
- Because your brain is there to protect you
and help you and warn you, you know, "Is this really right?"
"Is this really good?"
"Should you be doing this?"
"Maybe he'll turn out to be like your father."
"Maybe he'll turn out to be like one of your boyfriends."
Or something, I don't know if that makes any sense to you.
- Yeah, and I've definitely kind of
had those bleeding thoughts,
I think I have those bleeding thoughts
with like every partner that I have, like-
- Yeah.
- "Are they gonna be like so and so?"
But it just, it really sometimes confuses me,
because all things considered, this guy is truly amazing,
and I just, yeah, I just don't know why my brain-
- Yeah.
- Would activate that-
- Yeah.
- But it makes sense.
- Yeah, do you have any doubts,
or has he done some things that you can think of
that actually have given you pause, or not really?
- Um, yeah, a couple things.
You know, sometimes the way he talks about other people
is a bit-
- Hm.
- Disturbing to me, like he'll be like,
"Oh wow they're, you know, a fucking idiot."-
- Right.
- And that kind of resembles by dad a bit.
But he never says it about me.
- Yeah.
- And there's been like a couple like anger outbursts
that he's had, but they're far and few between, and-
- Yeah.
- They're, again, never really directed at me.
- Right, exactly.
- But I'm there for them.
- Right.
But you know, that may be enough
for your brain to activate pain
when you go to the wedding planner.
I've seen that, that could absolutely happen.
- Mm.
- And I'm convinced that we can help you with this.
- Mm, yeah, I hope so, that's good.
- Yeah.
- That's really good to hear, yeah.
- I mean, everything points toward a mind-body,
neural circuit type pain problem, everything.
The history from your childhood, the stomach pain,
the headaches, the other pelvic pain you had in the past.
- Mhm.
- The relationship to situations, the relationship to,
you know, emotion or anger,
the fact that the pain comes and goes,
it's worse when you lie down at night
for no particular reason,
sometimes it hurts in one part of the abdomen,
sometimes in the other part of the abdomen-
- Mhm.
- Sometimes hurts when you urinate, sometimes it doesn't.
- Mhm.
- These are all inconsistencies
and triggering effects that show us
that your brain is telling you, and telling me,
I guess, in a way, like, "Hey, it's me, I'm doing this."
- Mhm.
- Do you want to, which is all good,
it's all really positive and I'm optimistic
for you getting better.
- Good, yeah.
If you're optimistic, I trust that, so I'm excited.
- Easy, right?
(audience laughing)
No, really.
(Howard laughing)
When you have a model, you have a paradigm,
you have an understanding of how this can work.
And then you just listen to the story,
and you reflect on the story
to see if the story fits with the model that you have.
And it turns out the model that we have is extremely common,
extremely powerful, extremely easy to see,
if you just know what it is, and you know what to look for.
Any questions about that?
Did you see me doing everything that we just talked about?
Right, looking for the functional, the inconsistent,
the trigger, looking for the linkages,
looking for the situations,
and how the brain more likely to be,
obviously what's causing something earlier in life,
and then later in life, it may take a smaller thing
to trigger the brain, but especially if it's similar
to what had triggered the brain in the past.
Yeah, Lakshmi.
- [Lakshmi] That one seemed particularly obvious scenario.
- Yeah.
- [Lakshmi] Are you saying that many of these
are that obvious?
- Yes, exactly.
(Howard and audience laughing)
It's amazing, I'm not kidding,
90 percent of the time they're just so,
patient after patient that I see
and I keep saying, "Oh, you're making it easy on me."
Oh, so easy.
It's like rolling off a log.
Really.
- [Lakshmi] Hm.
- It's usually not that hard,
if you listen, if you know what to listen for.