Getting To The Root Cause Of Chronic Pain With Dr. Afton Hassett

Chronic pain does not need to be something we "just live with".  There are healthy alternative ways to reduce and even remove chronic pain and Dr, Afton Hassett talks about how in this episode.

Please share this episode around and make sure to rate/review, I will be forever grateful!

In this episode Dr. Afton talks about

• Her background and why she got into working with clients with chronic pain
• What is chronic pain, the different kinds and the causes
• How the mind plays a role in chronic pain
• How what we love to do will help with chronic pain
• Other alternative methods/strategies to remove chronic pain
• Talks about her book “Chronic Pain Reset”

And so much more…

Dr. Hassett's bio:

Dr. Afton L. Hassett is an Associate Professor and Director of Pain and Opioid Research in the Department of Anesthesiology at the University of Michigan. She is a principal investigator at the Chronic Pain & Fatigue Research Center who has over $14M of research funding from the National Institutes of Health (NIH). Viewed as a leader in the field of chronic pain and resilience, she recently gave the Keynote address at the 2023 Pain Consortium Symposium on Advances in Pain Research for the NIH. While studying established treatments for chronic pain and developing new approaches is her passion, her frustration is that exciting research discoveries rarely make it to the people who could benefit the most. Thus, Afton’s mission was to write Chronic Pain Reset to bring evidence-based strategies from research and academic medical settings directly to people who live with chronic pain with the hope that they will gain new tools to lead more rewarding lives with less pain.

Dr. Hassett's links:

• Website: https://aftonhassett.com/
• Instagram: https://www.instagram.com/aftonhassett/
• Twitter/X: https://twitter.com/AftonHassett

Transcript

 I mentioned that, you know, when you're more panicking, anxious or stressed, the pain is worse. But when you're distracted, doing something you love, when you're feeling joyful, when you're with friends that you adore, the pain after this experience is less intense. And that's not because your mind is making it, it's just how the signals being processed. 

 U2 

 0:31 

 Hello and welcome to another episode of The Root of Our Health podcast. I am your host, Elizabeth, a National Board certified health and wellness coach, a certified social medicine health coach, and also currently working as an employee wellness coach. Each and every other week, I'll be talking about topics that has to do with alternative health and wellness for women. As we celebrate the second half of our lives, these episodes will range from solo to interviewing professionals in the space, as well as getting to know everyday people like you, and how we can implement simple, bite sized habits in our daily lives that will help us thrive. Today's episode is an interview episode that I had the pleasure to sit down with. Afton Hassett. Afton is an associate professor and director of Pain and Opioid Research in the Department of Anesthesiology at the University of Michigan. She is a principal investigator at the Chronic Pain and Fatigue Research Center, who has over 1.4 million of research funding from the National Institute of Health, or NIH. Viewed as a leader in the field of chronic pain and resilience, she recently gave a keynote address at the 2023 Pain Consortium Symposium on Advances in Pain Research for the NIH. While studying established treatments for chronic pain and developing new approaches is her passion. Her frustration is that exciting research discoveries rarely, rarely make it to the people who could benefit the most. Thus, Athens mission was to write chronic pain reset to bring evidence based strategies from research and academic medical settings directly to people who live with chronic pain, with the hope that they will gain new tools to lead more rewarding lives with less pain. Now, in this episode, I asked it talks about her background and why she got into working with clients with chronic pain. She also described really what chronic pain is and I did not notice or know this. That there are different kinds of chronic pains and then the causes of chronic pain. She also talks about how the mind plays a role in chronic pain, how what we love to do will help with chronic pain. Also touches on other alternative methods and strategies to remove the chronic pain. And also talks about her book Chronic Pain Reset. Everything will be linked up in the show notes, so you can go ahead and check that out. Uh, once you can. 

 U1 

 3:33 

 If you can actually spread this word around there have I know, I know, there's a lot of people out there and you, my listeners, have some chronic pain and would love to find out, you know, what to do. Right? So if you know somebody that is going through this along with you or know somebody who is just going through it, you think alone, tell them that they're not alone. Share this with them. Let them know that there is hope to remedy this chronic pain. Also, if you can, please hit that subscribe button or follow wherever you are listening to this podcast. And if you are watching it on YouTube, please do hit that subscribe button. Would love to see the YouTube subscribers increase as well. And last but certainly not least, I would love for you to rate and review this podcast or this episode and or this episode if you want to do both that quite all right. Um, it's not only for me to hear from you, which I would love to do, but it's also a free way to support this podcast. If you truly are one fan and just want to, you know, keep listening to these episodes or want to spread this far and wide rating. Uh, you don't have to put a review. You can just rate. And when the, uh, ratings and reviews happened, they actually spread out more widely and this podcast gets in to many more ears. So this is my hope for this year, is that I expand and not only in, um, so many other people's household or, you know, earbuds, all of that fun stuff. But just to understand what you want and what you are, my listeners are looking for and loving. So, uh, if you can do all of those things, I greatly, greatly, greatly appreciate it. And, uh, now without further ado, here is my interview with 

 U2 

 5:34 

 Afton Hassett. 

 U1 

 5:39 

 All right. So welcome, Afton, to the route of our house. It is such a pleasure to have you on the show. Thank you so much for being here. Thank you again. 

 U2 

 5:47 

 Oh, Elizabeth, I'm so happy to be here. Thank you for the invitation to talk to you and to talk to your audience. 

 U1 

 5:52 

 Yes. And we are definitely going to be digging in to an important topic. Um, but before we do that, you know, I am not just fascinated with the topic, but I want I'm fascinated to know you. It's probably my audience as well. So if you could get a little give a little bit of backstory, as well as why you decided to get into helping people with chronic pain. 

 U2 

 6:14 

 Yes. So, um, I'm a clinical psychologist, and when I was doing my training at an out place, an outpatient placement, I was working with these women who had pretty significant psychiatric illnesses depression, anxiety, PTSD. And I found that as I worked with them, um, we would make some progress in our therapy, but then they would have these incredible pain flares, flare ups, and their pain would preclude them from coming back to therapy. And it was really frustrated. So I went to my supervisor and I said, you know, can you help me understand what's happening here? And she said, I would like you to go to the UCSD Medical School Library. It's the University of California, San Diego, and I'll look up fibromyalgia, irritable bowel, um, you know, interstitial cystitis, just look up some of these chronic pain conditions and see what you can find about the relationship between thoughts, pain and emotions like that. Okay. And so I did that and I came across an article written by someone named Dan Clore who wrote about the neurobiology of chronic pain, meaning that how the brain processes pain and what role thoughts and emotions play, that thoughts and emotions don't cause the pain. They don't. They're not what it's not like psychiatric conditions are masked. Um, the pain is a psychiatric condition. It's that they all interrelate very powerfully. They're all processed by similar areas of the brain. And so there is this need to understand the overlap. And at that point I was hooked. This is what I wanted to do. I changed my dissertation. I, uh, focused on chronic pain and wrote my dissertation in pain and depression, in fibromyalgia, rheumatoid arthritis, and just kind of teased out the differences in the role that it played. Nice. Yeah. And it's sometimes, you know, that's how the path goes. Right? So when you start in one thing, you start to see the issues and the problems really at the root cause. So it is just making sure, you know, to get to that. And so then yeah, that was your transition. Awesome. Thank you for sharing. Um, so before we get into. 

 U1 

 8:34 

 Treatment of chronic 

 U2 

 8:36 

 pain. If you could let us know. Like, I mean, it's kind of maybe 

 U1 

 8:42 

 very, um. 1s You know, very, uh, you know, 101 ish. But if you could kind of go into what chronic pain is really like a definition and what usually causes chronic pain, you know what I thought if there was just one or many, you can kind of go into that and then we'll go into the 

 U2 

 9:01 

 treatment. Yeah. So pain is fabulously complex and it isn't one thing. There are many types of pain. And so, um, the things that typically cause pain, um, are injury. And that is a function of our pain system. Our our pain system is really important. People who don't have pain receptors don't live very long. So our pain makes us back away from danger. It makes us perceive carefully, um, you know, and it's very protective and very important. But chronic pain is pain that is occurring that isn't helpful. Right? So it's considered pain that takes place for greater than three months. And that, um, that we're in often where the pain really kind of exceeds the explanation for it. Right? So if somebody, um, say, injured their back and they went through physical therapy and rehab and, and the, you know, the fancy MRIs all look fine. And yet the person has tremendous pain still there. That to us is chronic pain. And what we understand to that point is the nature of pain is probably changed. So what I say, the nature of pain there is the acute pain we get when we twist an ankle or have surgery. And that's all useful, right? So the ankle twist keeps us off that ankle. So to heal the surgical pain, that surgical side pain keeps us steady so that we don't if our institutions. Right. So it serves a purpose. So acute pain is very um very specific and is treated using specific medications. Right. So this is the one place where opioids are really useful cancer pain and where this type of acute especially post-surgical pain. But a more chronic pain is something like we might see with osteoarthritis, right. So that we've got bone on bone going, probably knees or hips that are grinding together and creating this tremendous pain. That is kind of what we call mechanical pain. And that's a specific thing that signal it. Pain signals shooting down from that hip and up into the up into the brain. Then there's also inflammatory pain like we might see with rheumatoid arthritis where people have no swelling their joints. And the greater the swelling, the greater the pain. That's you know, that's really a strong correlate. And that requires different treatment to. Right. So if it's an autoimmune disease it's causing the pain like lupus or righties. Then you use, you know, a biologic therapy very steroid to try to cut back that, that inflammation. Then there's also neuropathic pain. This is a pain that occurs because there's impingement on a nerve. And that's where you get that pain that shoots down the leg because usually there's another thing impinged on. So that's a different type of pain that's treated differently. And then there's one more type of pain. That is what we in our research group and really, really kind of across the pain research world find the most fascinating. It's something we call no C plastic pain, no C for nociceptive. There's a little little receptors that pain. So no seek and then plastic meaning that there is great plasticity in the brain. The brain changes. And what we see that happens is when a pain signal is emitted too many times over and over and over and over again, perhaps from a low back of the knee, the brain actually starts to learn that pain signal and wire that in. And so this pain signal can exist even in the absence of pain that's coming from the knee or the back that's stimulating it. It's actually pain kind of for its own sake. It's kind of brain created or brain amplified pain. And no. So plastic pain is something we see predominantly fibromyalgia and chronic low back pain, but we see it in arthritis and lupus and rheumatoid arthritis and just about any other pain condition where the pain signals emitted for a long period of time in the brain starts to change. 

 U1 

 12:39 

 Interesting. So is this kind of what people say, that they have a high threshold of pain because basically their brain or their mind is like it's used to it. So then they're able to kind of move through the pain easier than others. Is that is that the correlation or am I kind of off? 

 U2 

 13:01 

 Yeah. Well, you've actually brought up a couple of interesting points. So this is the first point is that we all kind of have a set point for how sensitive we are to external stimuli, being that pain or lights or sense. And some of us are just real sensitive okay. Many people who have chronic pain will experience something painful that is not necessarily painful to another person, but they also are sensitive to sense of smell and lights. It's just like the nervous system is a little higher tuned. Okay. And so they have a very kind of a low, um, a low sensitivity or tolerance for pain because they just experience it much more powerfully. We see this in our neuroimaging studies. I mean, it's observable in the brain. We know this is a thing. And then other people, just for whatever reason, they nothing really bugs them. I mean, they have a very high pain tolerance. You can really squeeze pinch them or squeeze a finger or whatever else. Like it just doesn't really bother them. And they're also probably not bothered by smells and light and stuff like that. Yeah. They just they just are set point is, is different than someone who is prone to having chronic pain who has chronic pain. 

 U1 

 14:02 

 Okay. All right. Thank you for clarifying that. So sure. Uh, but you know, going back to the brain, right. So you are a psychologist of chronic pain. So I personally I've never heard of a such but I understand it, you know, um, so you obviously focus a lot on, um, either behavior or brain patterns. Um, so how does the brain or the mind can I know that they're kind of like two separate things. So how does the mind play a role in our clapping? 

 U2 

 14:35 

 Oh, the mind is so important. So we know that she can be made worse when we're angry or panicky. We're really, really afraid. You might picture a time that maybe you fell and twisted an ankle or something like that, and and were really frightened or angry, and that pain was probably overwhelming. Or maybe a similar ankle twist that happened in a really silly way with a bunch of friends. And everybody laughs. And you laugh isn't necessarily detected as this painful. Right. So the way we think about pain, the way that our emotions are layered on top of pain, really affects actually how the pain signals processed. It's not necessarily that our mind is making it better or worse or making up it really. It's just how the brain is processing signals and those upset signals or angry signals or happy signals all getting mixed up in that same brain processing pod. And and it can affect it. So, you know, like I mentioned, that, you know, when you're more panicking, anxious or stressed, the pain is worse. But when you're distracted doing something you love, when you're feeling joyful, when you're with friends that you adore, the pain often is experiences less intense. And that's not because your mind is making up, it's just how the signal is being processed. 

 U1 

 15:45 

 Interesting. I never really thought it 1s play on words. I never really thought about that. So that that's a great yeah, I could see that happening because a lot of times and I think this kind of goes into flows into the next sort of question as well. Um, you know, a lot of times when we do. What we love when we're again in that happy state, when we're in that joy. Um, it kind of. Sometimes they say like, um, mind over matter, meaning like when our mind is not thinking about the pain, so it's not creating the pain. And you alluded to neuroplasticity earlier and I, I yes, I 100% believe our brains or our minds are, you know, plastic and they can change. Um, so whatever we feed it literally like food and our thoughts could, um, kind of reverse, uh, you know, these, these outcomes. Um, so. Can you actually. 1s You know, if you can kind of go into really, um. 1s In a detail about, like, you know, the chronic pain and the mind and how, um, you know, how do me something that we love if I didn't touch on it. And if you can go into further detail at any time, have, um, anything else to say about it? But yeah, if you can get to, you know, what we love to do in our lives and how we could kind of maybe that's one tip people could, could take 

 U2 

 17:24 

 away. Oh, I love that question. And I think it's so important because let me just kind of share a couple thoughts for so when we're stressed and we are feeling anxious, we have kind of an alarm system in our brain that goes off. Right. And so it could be even something that is just you're just worried about a relationship or something or the next day or whatever. Your brain can interpret that as an actual threat. And the more that we experience these threats. So if we're thinking about work the next day and we're really kind of freaking out about it, and we're starting to catastrophize about what's going to happen at work, and now we're jacking up the part of our body that processes stress and threat. And so when the brain starts doing threat, it makes pain worse immediately. It's just kind of part of the process. The more that we can do through being mindful, being relaxed, focusing on things we love and things that are pleasant, the more we can ratchet down that stress response, the less severe pain is. And so that's kind of one notion that the stress response system is really important. Another notion is that our brain is a marvelous tool that we don't really understand as well as I think we would like to. But one thing we do know is that it's marvelous at screening information at any time, tens of thousands of bits of information coming into your brain from what's going on internally in the body, from your breathing to an itch you might have on your body, to how close feel to your shoes, to you have a hangnail on your on your thumb, um, how your hair feels. You know, I mean, all of this stuff is happening in your brain. It's not paying attention anyway. And spreading that all out and focusing on what you put your attention to. And in doing that, that's kind of the route of mindfulness that we put our attention to our breath, and then we just kind of feel our breath, and then we just kind of funneled out all this other wildness there. But also if we put all of our attention in our pain and that's all where we're feeling, then we experience so much more pain now when we're doing things that we enjoy and being with the people we love and stuff like that, that pain starts to recede into another part. It's just another piece of stimuli, and it maybe it's being offset by laughing with a friend, or watching a great show together, or eating some fabulous piece of fruit or whatever it is that you're doing, though, putting these other positive inputs and just kind of pulling the attention away from paying the bully can be really, really helpful. 

 U1 

 19:50 

 Got it. And so I mean, that's amazing. You know, obviously the, 

 U2 

 19:56 

 um. 1s The, you know, the happiness, I guess the the the chemicals definitely help to alleviate that. But am I correct in saying that it doesn't really get rid of the pain? It just. 

 U1 

 20:12 

 It kind of makes you not focus on it. Is that is that what I'm hearing? Okay. 

 U2 

 20:18 

 I think that's important. And and the the and the less you focus and the more you focus on other things. You start building other neural connections. You're building new bridges, I mean, even or learning another language or picking up an instrument. Anything you can do to start building additional and other pathways. Got it. Helpful. Yeah, yeah. And you know, and that. It's just. And you know, this that's what this podcast is. Is alternative ways. Yeah. Yeah. So when we're talking about medication, you know, you said the opioids and and everything else that people, the doctors tend to kind of over prescribe. Right. So and so having something like this understanding, um, the psychology of, you know, the ways that we can have. 1s Just, you know, move through our pain in that to where we don't have to take medication. Yeah. Um, now I'm going to give an anecdote, and I it's not pain related, but I just want to kind of it's a little bit of a correlation just because, um, some people looked at me crazy when I, I just had oral surgery a couple of weeks 

 U1 

 21:31 

 ago, and, and I opted out of having, um, antibiotics and any heat medication. Wow. Yeah. So I think exactly. That's what I mean. That's what the reason, you know, I just did it because. I know our bodies and what you're, you're, you're talking about today in terms of. I know that my mind. 1s If I take these, it's just going to be a sedative, right? It's just going to be something to to mask it. And I understand, you know, 

 U2 

 22:05 

 I am one of those. And there are those out there that are kind of like me that we're like, you know, we need to feel the pain to, to move to, to understand, um, you know, we can't always feel comfortable in life. You know, we have to kind of feel the pain a little bit. Um, there was a point I am going to say, like, probably five days in, I was feverish, I was discomfort still. And I'm sitting here like, maybe I should have, but, uh, I never did. Actually, it's funny because once I realized that literally the next day, I was fine, I was like, so is this more or less like, okay, you know what they say when you get to that very last, that's when you want to break, but keep going. So and I kind of want to give that little anecdote again, it's not chronic pain obviously. But yeah, you know it's something to wear. We can't always rely on pain medication, especially for things that um. 

 U1 

 23:10 

 You know, again, we can we can overcome in an alternative way by 

 U2 

 23:15 

 mindfulness. Um, I'm going to throw in there, if that's okay with you. Like meditation, you know, kind of like, you know, being centered and focusing really on something else versus unpaid. Because, yes, once we focus on that, whatever we focus on grows. So as you mentioned, um, is there any other way, like tips that you can get in terms of moving through chronic pain? Um, or do you is there do you have any also like tips or, you know, things that we can do to minimize or even eliminate the chronic 

 U1 

 23:54 

 and I, I yeah, yeah. Well, I mean, you went through in the beginning the different tightness. So chronic pain. So I don't know if you just want to cover one. Um I would say that a few of my, um, clients that I have have rheumatoid arthritis and a lot of I interviewed somebody that had had rheumatoid arthritis and reversed it. So I don't know if they focus on that or other things. Um, other, uh, 

 U2 

 24:23 

 chronic thing. Yeah. Great. Great questions. And actually it's kind of multiple questions. So maybe, maybe 

 U1 

 24:29 

 start with this. So starting with this, this first notion that, um. There are strategies that are non medicine, non-pharmacological strategies that can make pain go away sometimes for good. And some of the strategies that we're the we're testing right now in our in our clinical trials in University of Michigan, um, one of the approaches is called pain reprocessing therapy. And this pertains to people who have chronic pain. It's actually chronic pain. It's in an area that comes and goes. So some people will say I've got very severe back pain. It absolutely cripples me. And then the next day it's gone. And then the next day it's back and it's crippling. Right? So this pain that kind of has it comes and goes often tells us that the pain is not structural. If it's a structural thing, frequently the pain does not abate. You might get a little better. Right. But for these types of pain, what is happening is this really appears to be truly top down, brain driven pain, right? The brain is driving this pain process. It's recognizing, it's thinking that there should be pain. There are a lot like the case where somebody has phantom limb pain, right? You heard about the person will lose a limb and have tremendous pain in that missing limb. And it's like, what is this? It is. The brain still has a representation of where that pain should be, and it knows nothing different. So you're thinking, why is this like this out here hurting? Well, why is this back hurting the way it is? Because that representation is there and it's admitting to pain. And what the brain isn't doing, in effect, is trying to protect you. That's really what our brain does. Is is in the case of chronic pain, it's a little bit of an overprotective nanny. And it's telling you, no, no, no, don't don't do that. Don't move. Don't go. Oh you can't go that way. Yeah. And what we do in the physical therapy and what we do in pain for processing, um, therapy is teach people that they can move in those places. Right. And it's a process. It's kind of what we call proprioception, which is how our brain understands our place in space. And as we slowly start to extend that, the brain is like, okay, oh, okay, okay. Oh, yeah, you can move that way. 1s And it is a process of kind of retraining. And so with pain reprocessing therapy, it's very much that we're telling patients that there's nothing structural that's causing her. Hey, a physician has told you this, so he wants you to do movement. So let's start slowly. If you cannot move your neck, just talk to your brain, talk to your pain and say, it's okay, I am safe. This is safe pain. I can move and move a quarter of an inch. And then we get people just moving slowly and all this, oh my God, I can move. Because again, it's it's kind of what it's really kind of rewiring tape. Not all pain is like that. But that is one example of a, you know, a pain. And it doesn't mean a person made up the pain is truly the brain is driving this pain. The person didn't make up the pain and it is the brain driving a pain process. So that's kind of one thing. Uh, another thing is that frequent in people with rheumatoid arthritis, they can have, um, really good treatment and get the best biologic therapy, and they'll go to their labs back. The physician says, hey, your rheumatoid arthritis is in remission. You look great. And the person says, yeah, but I have incredible pain. I cannot move my arms or my, my, um, my hands and my back now hurts. And what they've probably developed is now more than no. So plastic pain is on top of the inflammatory pain. So that explains that. And so then we require different types of treatment for that. Ideally we get people moving. We get people um decreasing their stress. We give people breathing mindful meditation. Um, and. We are the biggest drivers of our own stress as humans. Pretty much. 

 U2 

 28:16 

 Yeah. We're yeah, we're wired to look for a threat. And so we will do that. But we look for it in the craziest places. We look for it in our relationships and our work in our house. And, and, you know, and these things become things that we worry about, and we worry about our friendships, worry about this stuff. But the brain doesn't know much better, knows that it's experiencing threat. And so, you know, again, we've jacked up our stress responses. And so really the goal is a lot of what you talk about is, you know, is bringing this all down, kind of bringing this homeostasis, this internal healing, you know, understanding what the causes of these things are, not just medicating and covering over, but understanding the root cause. And by getting at that. So with us and pain is understanding, the brain is driving it. So now how do we wrestle with the brain? We're not going to operate on it. But there are ways we can influence brain diet, exercise, movement, nature, getting out and breathing fresh air, warm loving relationships, doing things you love. I mean, all that stuff stimulates and changes how your brain is processing information. 

 U1 

 29:20 

 Yes. Yeah, all of that. Because, um, and I was just thinking, as you were, you know, listening. I'm listening. But as you were talking, I was also kind of going into, you know, the, the everything that plays a role. So the nutrition, the fitness, the, the mindfulness, all of those things kind of play a role where your brain, you're feeding, you're literally feeding your brain. You're literally I um, because without good proper nutrition, you know, they're not able to think right. Without sleep, good sleep, sleep, you're not able to to think um, or to to function. Your mind is not function correctly. So again, we're we're and I say this at nauseum but we're a process. We're we're a whole being. All right. So every night if one thing is off. The other thing, right? Oh. So. Yeah. That's awesome. Um, you wrote a book that's just came out of my career that just came out? Yes. When you talk about 

 U2 

 30:23 

 what's it been about? The 5th of September has only been out a little bit more than a month. 

 U1 

 30:27 

 Nice. Congratulations, by the way. It was a year for 

 U2 

 30:30 

 you. Thank you. This is my first year. 

 U1 

 30:32 

 Oh, wow. I've 

 U2 

 30:34 

 written about 110 scientific articles, but I've never written a book. But it was the pleasure and joy of my life. Awesome. Yeah. You know, I, I can just imagine how hard it was, but yet how rewarding it must be. So. Yeah. Um, but yes, the book is called The Chronic Pain Reset. So I don't know if you can kind of go a little bit more detail or maybe, you know, some snippets in the book that he would like to, um, kind of tell me and my audience, I know that we talked a little, uh, well, a lot about chronic pain. So I don't know if we covered a lot in the book, but if there's something new that you would like to kind of maybe 

 U1 

 31:15 

 give a little bit about the book, I'd love to hear it. 

 U2 

 31:18 

 Thank you. So this thing the goal was that we use researchers do a tremendous amount of work. I mean, I have about $15 million from the NIH to do pain research, and nobody gets it in their hands. Nobody gets us. So we know things at work. We know things that are helpful, and it just doesn't get to the people who need it. So I decided during the pandemic that I needed to do something with my time. And so I decided to write this book for patients and also for clinicians. And what I wanted to do is I work with one of the most talented and, and, um, well known, uh, pain research groups in the country. The Chronic Pain and Fatigue Research Center is physician psychologist, physical therapist, um, and a bunch of neuroscientists that all work together to try and understand the brain workings of chronic pain with therapies, work with therapies, work for who? Um, I mean, you know, what are the mechanisms that underlie healing? And, um, I wanted to create a book that just kind of summarizes. So so the book itself is about, uh, 15 chapters shortly, four pages that talk about kind of a lot of the principles that we've talked about today and of the neurobiology of chronic pain, but also because I study resilience, I'm very much of the field of positive psychology. I work. I've done research with my cell admin and, uh, and, uh, and just such a proponent of thinking about. About resilience and people's strengths. And so in those chapters, I also talk about, um, the, the neuroscience kind of underlying positive emotions and the importance of purpose in life and gratitude and friendships and healthy relationships and, um, yeah, just and just wellbeing and meditation and mindfulness. How what we understand about these things from the research perspective, but written in a way that I hope anybody can say, oh yeah, I get it. Oh, wow. That's interesting. It's that's how it changes your brain. Wow. And after people kind of hopefully get this knowledge and I, and I try to do so in an amusing way, I tell stories. I have, um, people with lived experience share their really beautiful reflections about about things they've learned and, and stuff. But then we have the meat of the book, which is 30 days of activity skills and practices. And so these are all things that are evidence based that are helpful for people with chronic pain or more chronic illness more broadly, and which with the with the reader does is every morning they wake up and there's a little two pages and there's a description of an evidence based practice. And it could be mindful breathing. It could be creating a walking program. It could be pacing your activity so you don't induce a pain flare. It could be sorting through your relationships to pick out the toxic ones. I mean, there's all these different things that people can do. And each day you look at the you look at the activity, you read a little bit about it and then it tells you how you can do that. So try it, try it for today. And then you go and you try it. It can be acts of kindness. And then there's, you know, doing the visual arts. I mean there's a jillion different things that we know are helpful. So you try that thing that day, then you come back at the end of the day and you say, I like that. I actually think I could do that. I'm actually kind of excited to do that. And so you color in the little star and that becomes something that you'll revisit on the next day. You might read about something that seems incredibly stupid and like a waste of time. You'll try it anyway that day and you say, okay, that's not for me. And then you do this for 30 days, and at the end of the 30 days, you take stock, you know, what are the things that you really liked. And then he sort through them. He kind of prioritize them by domains. You know what will help me with my physical health or help you? My sleep will help me, um, with my inner building, my relationships, my happiness. And you kind of place these little activities in the domain it belongs. And you pick one and you start with the one you're most excited to do. And he tried for two weeks. If you like it, we work on making it a habit. There's kind of instructions how you do that. Um, and then you just kind of keep adding because ideally this is a thriving plan, meaning that you're not just going to learn one thing. Ideally, you're going to learn a series of things over time that will eventually become really just a different way that you lead your life. Because once things are but you don't even notice them anymore, you just doing them. So if you're doing kind of a daily gratitude or if you're doing, you know, a daily positive reflection, or if you're doing your daily walk in nature, you know, all that just becomes part of who you are. And you're starting really to change the system from within. 

 U1 

 35:43 

 Yeah. Yeah, that that's amazing. That is amazing. I'm probably going to be picking that that book up because you you. Touched on so many things there. And not only do I resonate because, you know, the positive psychology, I mean, that's that's the basis of being a health coach. Um, but yes, behavior change and also activities. Um, as, as we talked off camera are off, uh, the recording. Yeah. My my job, I do a lot of activities and I do read on your website that you also kind of do some corporate. Um, am I correct in saying that you do some corporate, uh, like, work and stuff like that and in corporations. Do you want to talk about that a little bit or not? 

 U2 

 36:35 

 Yeah. So I'll kind of tell you two things. So so the first thing, I love that this is resonating with you because I wrote this book also for clinicians with patients. So ideally, I think I think some patients, some, some readers will be incredibly motivated to do this themselves. I think other readers will want to do this in groups. They can kind of do it together. 

 U1 

 36:51 

 Yeah. Each other motivated. Yeah. But I really 

 U2 

 36:53 

 see health coaches, physical therapists, other psychologists, social workers actually using the book and working with patients because, yeah, all of these evidence based things, you you probably know a bunch of them already. They're all kind of there, but they're all explained in a really easy way, in a way to try them. And then and then the best way I think, to this work is to have somebody like yourself that would help coach them, that, you know, over time, hey, you've developed a thriving plan. What are you doing here? And then maybe you say, hey, they're following up with us or whatever it is you then helping them really create these new habits, you know, create this behavior change. So so that's kind of the first thing. So my work with corporate America, um, was always kind of doing the same thing. So, um, I've done a lot of outcomes research, meaning that when a pharmaceutical company kind of comes to a point that they're like, okay, we don't want you just to say the patient has pain or not. We want more interesting outcomes. And so we help. Think about how do you measure quality of life? How do you measure well-being? How do you measure, you know, is a perceived well-being. What does that mean? And so how do you do family life. And so that's the type of work that I've done. It's always been just to kind of support richer patient outcomes that some of the work that I've done, Martin Seligman to and understanding how it is that well-being can be impacted by, you know, by, uh, by a drug compound, but also because that's important to have these richer, um, outcomes in our lives. Yeah, 

 U1 

 38:15 

 yeah. And, you know, it is definitely very important. So thank you for putting all of that together. Because, you know, we can definitely use resources, tools. I mean there's it's. 1s The more variety that we give. I mean, it's at the end of the day, obviously it's the same thing, you know, in terms of similar, um, outcomes. You know, the kindness, the, uh, what we love to do. Like, you know, one person loves crafting. I have a client that loves crafting. Crafting. And that's how, you know, she could, um. And then another person just loves to go to the gym, so it's it's. But, you know, also, you know, the different things that we can do, um, that makes us, uh, I don't want to say happy, but we'll bring joy in our lives. I mean, obviously, happiness is is tied in there, but also the joy, the purpose. Um, I won the purpose. I did association a few of probably maybe a couple of months ago. Purpose and meaning. I mean, uh, you know, that important is so important. So important because that is really essentially what gets us up in the morning, right? Yeah. 

 U2 

 39:31 

 It's so important. Yeah. Now? Yeah. Go ahead. Oh, please. I was gonna say no. It didn't. Actually, I could have saved it towards the end of my book. I think it's probably the last chapter said the last chapter that I talk about because it is such a rich, um, such a rich concept. But the data are so good for health outcomes. So people who have strong sense of purpose in their life really have much better health outcomes, including longevity. It's, you know, it's so powerful. I just think, you know, it helps people that are able to weather the storm. You know, it really is centering. And I think that is such an important piece of, of our overall health is as human beings. Yes. And you mentioned resiliency as to kind of the first word that comes to mind when you are weathering the storm. You are able to be more resilient and, you know, keep going, keep moving forward with things are up against you. So, yeah, um, yes. All the good things in this. And, you know, again, a really, um, interesting because we don't always when we talk about positive psychology, we don't always correlate that with chronic pain. 

 U1 

 40:40 

 So this is a different, um, you know, correlation. And that's why I wanted you on this show and loved that you came on the show because there is a correlation. Um, and thank you again for explaining, uh, everything in detail. Um, is there a question that I didn't ask that you wanted to touch on or anything, any topic that you wanted to talk a little bit more about? Oh my goodness. You did such a wonderful job asking questions. Overall, I really appreciate it. Um, and I just think, uh, the work that, um, that, you know, people who do functional medicine is so important because one of the problems that we see so often in medicine, I mean, I'm in a traditional medical school. Uh, the problem that we see is how chronic conditions are treated, and I do I am a fan of interdisciplinary care, but it means really interdisciplinary. It means a physician, a physical therapist, potentially an occupational therapist, a behavioral coach. I mean, just people coming together to really address a person as a whole. We've really moved beyond medication only, and I think our patients are much more sophisticated now and want to know what can they do in their health. And I think that's a really great place for health coaches, because you can really help the person tap into what is their ability, you know, what, what can they bring to the table. And it's really empowering because I think unfortunately, our medical system often is not empowering. So I say, oh, you just stay still and let us fix you. Yeah. 

 U2 

 42:08 

 And we all know it's different. Yeah. And that's exactly it. You hit the nail on the head. You know it's empowering. And that's what this podcast is for. That's what we do. Um, as practitioners and in, in our own right is we empower the patients or the clients with knowledge and education because, you know, at the end of the day, yes, I would love everybody to go see a functional medicine doctor. And, you know, all everybody in terms of alternative wellness. But again, at the end of the day, that's not going to happen. So how can we arm them with the knowledge of okay, well, you know, your doctor is telling you what to do. Um, he's giving you these medications. He or she I'm not going to generalize, but he she is going to give you these medications and they're going to tell you, you have to take this, but not not kind of go anywhere else around it, not touch on anything else in terms of how can we fix it. Um, and I don't know, I'm not going to again. 

 U1 

 43:12 

 You know, the doctors are. Well, you know, they mean well, right? It's just the system, the the health care system, which really, again, is sick care. Um, so it's just in general of. 

 U2 

 43:25 

 The patient coming to them and asking those questions or say, hey, I learned about this. What do you think about that? Yeah. So and then I'm hoping that then doctors will open their eyes and say, wow. Yeah, they know a lot more than you know. We let the you know. Yeah. 

 U1 

 43:46 

 And so yeah, 

 U2 

 43:48 

 I agree with you. But I also I also want to defend some of my doctors because they, they, they, they have the same frustration and exactly and the time with their patients and they want to delve into cause and you can't do that in ten minutes. So I think, you know, I mean, they're just lovely warm good people too. And so I think yeah, there's just a lot of frustration. So you know, so I guess with that being a limitation that we fill in the blanks and so we can use fog to build a therapy. We use coaches. We can use different, you know, ways to help our help empower our patients. 

 U1 

 44:19 

 I agree I agree I agree I agree. Yeah it's amazing. Thank you afternoon for being on here. Um where can people find you and pick up your book and all of that? 

 U2 

 44:30 

 Yeah. Um, I'm at the University of Michigan in the Department of Anesthesiology. I'm not easy to find there, but I also have an author website. It's apt. antacid.com. My name often sitcom. The book is available there with links. And it's also to just go right to Amazon or Barnes and Noble and it's and it's available there as well. And um, I'm, you know, I'm really excited to hear what people think of the book and, and what's helpful. And so please feel free to drop me a line. I'd love to hear what you, what you, what you think of the book when you had a chance to to to read it. 

 U1 

 45:02 

 Yes. And I will put your website in the show notes so that people go to your website and not okay. 

 U2 

 45:12 

 Just 

 U1 

 45:12 

 to be able to go to your website and not hearing that. So, um, I'll definitely link up everything in the show notes. And yes, um, I will will most likely buy the book as well. Uh, I think it'll be a great resource in general and to an understanding as well. So, um, last question that I have for you is what is your favorite quote or any words of inspiration that you can leave us with? 

 U2 

 45:40 

 Oh my gosh. Let's see. Um. 3s I have many, but I think, um, my words of inspiration really came from another patient who told who has chronic pain and told me that there are some days that are so awful that it feels like a day has been lost. And she said, but if she just does one thing that makes her feel a moment of joy, something that feels valuable, just that one thing that day will make the day not a loss. So that's that's a loose quote from her. But it is. It's a you know, it really is along the line to make each day matter. And sometimes it's just one small action. So. Pick action. 

 U1 

 46:24 

 That's beautiful. Yeah. And that I it sounds like it correlates with gratitude. Like she should realize that there is something, you know, to be grateful for, no matter how small, um, that they may be, and that that's what she's attaching to, um, for that day. So that's beautiful. Thank you so much. And it's a pleasure to have you on here. Um, and everybody else, you know, everything's gonna be linked in the show notes. And until next time, have a good one. 1s Thank you.