Stuck in Chronic Pain? Here's How the Brain Can Turn It Back Off | Dr. David Schechter, M.D

Show Notes

Millions of people living with chronic pain turn straight to scans, injections, or surgery for answers. Yet the clinical data reveals a striking mismatch between what shows up on an MRI and what a patient actually feels.

In this episode, Dr. Ravi Kumar sits down with Dr. David Schechter, a sports and mind-body medicine specialist, to examine how the brain regulates, amplifies, and can even fabricate physical pain. As a neurosurgeon trained to look for a structural cause, Dr. Kumar presses on the mechanism, the evidence, and the limits of this approach, and the two of them work through where pain is a signal of damage and where it has become a self-perpetuating loop in the nervous system.

Dr. Schechter shares his own path into the field, recounting how he overcame chronic knee pain as a medical student under Dr. John Sarno and went from skeptic to one of the leading voices in mind-body medicine. Together they dismantle the idea that chronic pain must come from an anatomical defect, introducing the concept of neuroplastic pain, historically known as Tension Myositis Syndrome. They explore why standard diagnostics can create a nocebo effect, where a doctor’s careless words trap a patient in years of fear and restriction. Dr. Schechter then walks through his evidence-backed framework, which combines psychoeducation, targeted emotional journaling, and graded return to activity to help patients retrain their nervous systems.

Episode Resources

• Dr. Ravi Kumar on LinkedIn
• Dr. Ravi Kumar’s Website
• Dr. David Schechter on LinkedIn
• Dr. David Schechter’s Website
• Dr. Schechter’s book: Think Away Your Pain

In this episode, you will discover:

• The chronification of pain: Why pain that lasts longer than three to six months often shifts from a peripheral tissue issue to a centralized loop in the nervous system
• The brain’s two-way street: How the brain constantly modulates incoming sensory signals, with the ability to turn pain down or amplify it
• The asymptomatic scan myth: What the clinical data shows about healthy people walking around with large, painless disc herniations and bulges
• The broken signal model: How to reframe chronic pain as a malfunctioning traffic light that can be safely overridden once it is understood
• The danger of nocebos: How negative pronouncements from trusted medical authorities can install decades of fear, restriction, and pain
• The Type T personality: Why perfectionists, high achievers, and people-pleasers are especially vulnerable to psychophysiological pain syndromes
• The science of rewiring: The functional MRI data from clinical trials like the Boulder Study, which shows that successful mind-body therapy can change pain processing in the brain
• Dr. Schechter’s protocol: A step-by-step home framework built on emotional awareness, expressive journaling, and a graded return to normal activity

Key Takeaways

• Chronic pain is real, but it does not always mean ongoing tissue damage. Long after the body has healed, the nervous system can keep the pain signal switched on
• Imaging findings do not equal pain. Many people with large disc herniations have no symptoms, while others with clean scans hurt badly, so a scan alone rarely explains chronic pain
• Words from a doctor carry weight. A frightening or careless diagnosis can act as a nocebo and lock a patient into years of fear and avoidance
• Personality is part of the picture. Perfectionism, high achievement, and people-pleasing raise the risk of neuroplastic pain
• The Boulder trial and functional MRI work suggest that mind-body therapy can shift how the brain processes pain and produce lasting relief for the right patients
• Much of the treatment costs nothing and has no side effects: learning that the pain is real but not dangerous, gently returning to activity, and addressing the emotional drivers underneath it
• This approach does not replace a careful medical workup. Dangerous structural causes of pain still need to be ruled out first, which is exactly why a surgeon and a mind-body physician are having this conversation together

Transcript

[00:00:00 –> 00:03:32] Dr. Ravi Kumar: Welcome to the Dr Kumar Discovery podcast. My name is Dr. Ravi Kumar. And on today’s episode, I’m sitting down with Dr. David Schechter, one of the leading voices in mind body medicine in the treatment of chronic pain. Now when most of us hear chronic pain, our minds go straight to some structural problem in the body, like a worn out disc, a pinched nerve, something torn, something degenerating, something that shows up on a scan and probably needs a pill, an injection, or a surgeon like me. Well, that’s how I was trained to think too. But not surprisingly, a huge amount of chronic pain is not coming from ongoing damage in the body at all. It’s being generated and amplified by the nervous system itself. The pain is completely real, it just isn’t always pointing at a broken part of our body. Our guest today, Dr. Schechter, has spent his career chasing this question. Why does some pain refuse to leave long after the body has healed, and how do we actually help those people get better and break the cycle? He trained directly under Dr. John Sarno, the godfather of this whole mind body medicine field, and he became a believer in mind body medicine the hard way as a patient himself. He’s now treated thousands of patients with this approach, and he wrote a book called Think Away Your Pain, which I listened to and I loved. So, by the end of this episode, you’re gonna understand the difference between pain that signals damage in the body, and pain that is self perpetuating and generated in the brain itself. You’ll learn how fear can lock pain in place for years, long after the body has healed. We’ll talk about the clinical trials focused on psychosomatic therapies and the spectacular results that they’ve reported in chronic pain, and we’ll talk about what you can start doing right now if you’ve been hurting for a long time and have no clear answers. It’s a fantastic episode and very applicable to all of our lives. So before we do all that, I have to give you a quick disclaimer. Dr. Schechter and I are doctors, but we’re not your doctors. This show is for informational purposes only. Everything you learn from my conversation with Dr. Schechter is meant to empower you. So take this knowledge, ask better questions, and work with your own doctor to build a more informed, healthier life. That is what I want for you. And just to be clear, this show is separate from my role as assistant professor at UNC. Okay. Let’s get into it. My name is Dr. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Dr Kumar Discovery. Dr. Schechter, thanks so much for joining us on the show today. I’m really excited to talk to you because we’re talking about something that most people have never heard of called tension myositis syndrome or neuroplastic pain syndrome. And can you just start off this conversation by telling us what that is and why it might apply to a bunch of us in the audience and in the world?

[00:03:33 –> 00:04:51] Dr. David Schechter: Okay. Chronic pain is really the category that I mostly focus upon, and so let’s just differentiate. Acute pain is typically described as less than six weeks, might be spraining your ankle or falling down or some other thing. And most of those cases improve and some of them of course are more serious than others. Subacute pain is described as six weeks to three or six months depending on how you define it. Chronic pain is more than three to six months. Some of some people I see with five years of pain or seven years of pain. Some of them just have a year or six months. But in the category of chronic pain, that’s always been a challenging area for for medicine and alternative practitioners to treat. And at some point my mentor, Dr. John Sarno, began to formulate a concept which he initially called TMS, which we’re now calling neuroplastic pain or neuroplastic symptoms, which is that in chronic pain, the nervous system is actually stuck on pain rather than with acute pain where it’s typically some part of your body that’s injured. Now to the patient it feels the same. And it’s real pain. Not saying any of this is imaginary, it’s not malingering or faking. It’s real pain, it’s just what is the ultimate cause of this pain and how should it be treated?

[00:04:51 –> 00:05:27] Dr. Ravi Kumar: Okay. So that that is very interesting because when we think of pain, and you know when I have always thought of pain, I’ve always thought of there’s some tissue injury, some problem in the body that’s sending a signal to the brain that, hey, there’s a problem, deal with it, stop moving or splint this or or take protective measures. But you’re telling me in pain that lasts longer than three to six months, there might not be actually a problem in their body, but the brain is anticipating that there should be, and there’s literally no sensory difference for the patient. Is that kind of what you’re saying?

[00:05:27 –> 00:07:23] Dr. David Schechter: Well, anticipating is a great term that we can actually come back to further because it relates to the issue of prediction, and there’s a whole concept in terms of predictive models of the brain. The thing that we didn’t learn in medical school, or certainly wasn’t emphasized, is the research of Howard Fields at the UCSF, and and elsewhere, that the brain is also sending signals in the other direction. So we learned that the sensory or afferent fibers are coming from the periphery to the brain and and being perceived as pain. But what was not emphasized, and I think at least the time when I went to medical school I don’t think it was known, was that the brain is constantly sending signals in the opposite direction to modulate those symptoms, those signals. And I give the example to my patients in the office that when they first sit down at the chair, and I have a comfortable chair for them to sit in, they notice the chair briefly. They’re aware of the chair. And maybe they’re making a judgment about the chair or whatever. But in a few seconds their brain literally turns off those sensory signals, and there’s no conscious awareness that you’re sitting in the chair because you’re having a conversation with your doctor, maybe you’re looking at the art on the wall or whatever. Maybe six or eight minutes later, people typically notice the chair again because you get that sort of feeling of squirming, like you wanna readjust your your position in And the so your brain has allowed those signals to become into your awareness because you needed to take an action based on those signals. And then of course it turns those signals off again, and you’re back to your conversation with your doctor or whatever else you’re doing. You’re not thinking about the chair. This is just one very simple example of how our brain is in a sense determining, and this is occurring at a preconscious or unconscious level in the nervous system as to whether or not signals that are being sent up are important or not. And then there’s a whole other issue of how signals can start in the brain and go down to the body. And I can give you examples of that as well without any pathology in the body at all.

[00:07:23 –> 00:07:38] Dr. Ravi Kumar: So are you saying that just like our brain churns off this sensation of sitting in a chair where we don’t recognize it or we don’t realize or we don’t feel it or give notice to it, our brain can also churn off signals of pain in the body.

[00:07:39 –> 00:07:42] Dr. David Schechter: Can turn it off or can amplify it.

[00:07:42 –> 00:07:43] Dr. Ravi Kumar: Okay.

[00:07:43 –> 00:09:01] Dr. David Schechter: Can choose to focus on it or can choose to ignore it. We also believe that as you get into chronic pain, there are circuits that are becoming solidified. You know, there’s a term in neuroscience, it’s somewhat controversial, but those circuits that fire together wire together. And you know, it’s related to the concept of if you’re constantly getting signals for a certain number of months to your brain, then the perception that it’s still a problem can be left in your nervous system, in your brain, in your awareness. Use the broken signal model with some patients. So I’ll say to them, have you ever driven down a road and it was a red light? So you stop. But it’s rural road. You’re waiting. It’s thirty seconds. It’s a minute. The light doesn’t turn. You realize at some point the signal is broken and you drive, you look both ways carefully and you drive through. So some of the chronic pain that patients are experiencing is a broken signal. And I teach it in that way and that helps them to look at it in a different way. And then when you look at it in a different way, amazingly enough, and this is truly amazing, but I’ve seen it happen thousands of times so it’s no longer as amazing to me as it is to the patient for the first time or those listeners who are hearing it, is that it goes away. Stop experiencing the pain at all.

[00:09:02 –> 00:10:01] Dr. Ravi Kumar: Very interesting. So let me posit two types of patients that I have in my neurosurgical practice to you and see what you think about them. I have some patients that come in with fairly large lumbar disc herniations. I mean, disc herniations in the back are most of the time extraordinarily painful. But they’ll come in because their PCP, you know, they were in an accident or something, got a CT scan, they saw maybe a disc, or they said, okay, let’s get an MRI. They get the MRI, and they say, have a big disc herniation, you need to see the the neurosurgeon right now. Yeah. They come into my clinic, and they they have no pain. They’re like, I don’t know why I’m here. They said I better come quick, though, I have this big disc herniation. And I’ll do an exam on them, and I can’t find a single neuro deficit. They have no pain. They have no sensory abnormalities. Then I’ll get another patient who has a tiny disc herniation, and their life is falling apart. I mean, they they can’t function, they’re in so much pain. Is that in the realm of this mind body pain syndrome that you’re talking about?

[00:10:01 –> 00:13:15] Dr. David Schechter: I I’d I’d love to address both of those cases and and try to, you know, bring some of my own insights into that. So in the first case, the primary care physician or whoever referred you, the patient, ordered an MRI. Perhaps the MRI wasn’t indicated. Maybe it was indicated. But it showed something, a fairly large disc. But I’m presuming that the disc probably wasn’t pressing on a nerve when you looked at it on the imaging, and there were no neurological deficits. There was no weakness or any other and in fact the patient at the time that they saw you had no pain. It would really be considered an asymptomatic disc bulge. So that would go along with the extensive literature, first identified forty years ago, much more thirty years ago and into the last couple decades of if you take a 100 people on the streets of Boston between thirty five and 55 and you offer them a $100 to lie in an MRI machine and get an MRI who don’t have any symptoms. That somewhere between thirty five and fifty of them will have bulging discs depending on their age. And it goes up a little bit as you get older. And a few of them will have herniated discs. And this is a group of asymptomatic patients, right? And they’ll have other findings. So MRI imaging in general is extremely sensitive but doesn’t always clarify, but sometimes can confuse rather than clarify by showing things that are asymptomatic or incidental. Now the second patient you mentioned had a small disc, and again we didn’t discuss the particularities of whether it was in fact in a bad location, in a foramina, or pressing against a nerve. You know I’m up on all of these structural things as I should be, but in this particular patient it is ruining their life. I’m presuming there’s leg pain with this rather than back pain. So it falls into a different category. It points out that the size of the disc is not the only factor. And it points out perhaps, and this is what you were alluding to in terms of the mind body, is that the patient’s perception of what’s happening is also a factor. So perhaps that first person doesn’t have a lot of fear about it, or maybe primary care physician said, well it’s really, it’s not uncommon for people to have bulging discs and you’re not really symptomatic, but I just feel more comfortable with a neurosurgeon looking you over. And maybe the second patient was frightened by the first physician, possibly a primary care physician, who saw them and says, you know, this disc could really cause problems and boy, your reflex is down and boy, there’s a high chance you’re gonna need surgery. Where fact, even with a herniated disc, you know, ninety five percent of people can improve with conservative care over the first few months. And as a neurosurgeon you know the indications on when to operate such as progressive weakness, progressive neurological deficits, etcetera. So I think that in my practice I see fear being a big driver. I see emotional issues in general, depression, anxiety. You know, there’s been a lot of literature on job dissatisfaction and how that pertains to chronic pain. Some of those studies go back decades to the Boeing Corporation in Seattle. So it’s a fascinating subject. Why does one person have a different experience than the other? And how much of this chronic pain could be intercepted at the primary care level if people were better educated as to how to diagnose and treat at that level.

[00:13:16 –> 00:14:27] Dr. Ravi Kumar: Hey guys, I created this podcast because there’s too much confusion out there. There’s too much noise, too many conflicting messages about our health. My goal was simple when I made this podcast. I wanna cut through all of that and give you information that you can actually use. If that resonates with you, here’s how you can help. Leave a rating and a review on Apple Podcasts. Share an episode that resonated with you with someone else that you care about, and that’s how this show grows. That’s how we reach more people who are searching for answers. Thanks for being a part of this, and I appreciate your help. Okay, so that’s all very interesting. Can you kind of describe to us a classic patient who has TMS? And by the way, to the audience, I just want to say we’re going to say TMS, neuroplastic pain syndrome, they’re the same thing. Sometimes they say psychophysiological pain syndrome. But the TMS that we’re talking about here is tension myositis syndrome. We talk all the time about transcranial magnetic stimulation, and we call it TMS too, so it’s totally different. But in a patient with TMS, which are the type of patients that you see, what is the classic presentation, and how are you able to help these people?

[00:14:27 –> 00:20:13] Dr. David Schechter: Well, the classic presentation would be somebody who has had a long history of pain, and it could be a year, it could be three years, it could be thirteen years. I mean I’ve seen people with very long durations. They’ve typically seen both conventional alternative practitioners, because when people have pain that persists, they don’t just go to their primary care doctor, they don’t just go to an orthopedist, they don’t just go to physical therapy, they’ll see chiropractic, acupuncture, all types of treatments. And again, if they got better, they don’t end up in my office with chronic pain. So these are the people that haven’t improved despite multiple treatments, including medications, sometimes injections. I’ve even seen people who’ve had surgery and have not improved. And we could talk about some interesting cases in that category as well. So they come in, and nobody has mentioned to them the possibility that they could have neuroplastic symptoms, that they could have this condition also known as TMS. The newer term is tension myoneural syndrome. Myositis kinda got dropped some years ago as well. Okay. It’s been hard to find a good terminology for this. And of course transcranial took over the TMS category with its marketing. I call that transcranial actually instead of TMS in my own work. But anyway, so they’ve come in with this history, and maybe there’s two possibilities. One is that they have somehow found through a practitioner, through a book, through a website, through a podcast like this, through any number of sort they somehow found out a little bit about this subject and maybe they’re reading up on it. And they’re intrigued and they’re in California, so they come to my office in Los Angeles and they wanna see could this apply to them. So that’s a group of people who have some knowledge of this, and I’m gonna get more into the detail on that. The other group of people come to see me because I’m a sports medicine certified as well as family medicine doctor, and they don’t know anything about this. But I’m seeing them, I’m saying they’ve already been through physical therapy, they’ve already been through core strengthening, they’ve done training, they’ve had an injection, they’ve done all the things that you could otherwise do, And I start interviewing them. So I’m asking perhaps, for both categories, I’m asking more psychosocial questions. I’m asking more about here’s a question most doctors don’t ask them. What’s going on in your life? And I pause, and a lot of times a lot of stuff spills out. Not a psychologist, but a lot of stuff spills out. And sometimes I’ll say to them, well what was going on in your life at the time of the onset of this problem? And I pause, and a lot of times stuff spills out here too, including some tears and some other thing. And I’ll also ask a little bit about their childhood because I’ve now reached the comfort level and people start getting comfortable talking to me about emotional issues as well as physical issues. And sometimes there’s trauma in childhood. Sometimes it’s big t traumas, which you can imagine are the most difficult things to deal with, childhood abuse, sexual abuse, etcetera. And then sometimes it’s small t traumas, just a misfit in terms of their parents and their personalities or a sibling who was a bully with them, but not a big big t trauma. All of those things can contribute to a higher likelihood, and this is proven by data, a higher likelihood of chronic pain and a higher likelihood of poor surgical outcomes. So these are things that I believe should be looked into in cases of borderline cases where elective surgery type cases as well. So I take a very detailed history compared to many of the physicians they’ve seen. I do an exam. I do the range of motion like any doctor would do in the musculoskeletal field. I check reflexes. I check sensation. I also look for six tender points on the back, which are marker spots for TMS that Dr. Sarno first identified forty five years ago, and I’ve continued, as have others, to look for these spots. And having two or three of them or more can be indicative. It’s not diagnostic by itself, and they’re different although they overlap slightly with the fibromyalgia spots. They’re different than that. And I’m putting all this information together. I’m putting the pattern of pain together. Does it fluctuate? Does it get better on vacation? Is it better when they’re distracted? Is it worse on vacation? What’s going on in their life? I’m putting all of these pieces together. Is pain sometimes provoked by stress or by pressure at work? And then I’m obviously reviewing imaging. I often have the actual imaging. Sometimes I have the reports. I’m reviewing imaging to see if there’s anything impressive. Many of them have minor findings on MRI, but they don’t typically have the kinds of things that Dr. Kumar would rush into the Operating Room to fix. You know, they have the couple of bulging discs, or they have some degenerative changes that are, I hate that word, but wear and tear changes that happen as we get older. And so that leads me, that whole constellation of history and the physical and the exam, to making a diagnosis of you have a neuroplastic condition. Let me explain what that is and how you can get better from it. So that would be the typical patient. It could be a 30 year old, it could be a 70 year old, it could be any I’ve seen 18 year olds with this. And when we get into the personality, which I do ask about as well, many of them are what we call a type T personality, T being for tension or TMS. So they might be very hard on themselves. They’re perfectionists. They’re high achievers in some cases. They’re very responsible for others. They might be what we call goodists, which are people that are trying to change the world. And look look, it’s hard enough to change ourselves or the person next to us, much less change the world. So it can be very frustrating. These personality features are important because these can often drive the pressure or tension that is driven into the body in a sense in terms of physical symptoms, but which if you turn it down a little bit or you get a little bit of therapy or you get a little bit of coaching, can help you to take a little bit of pressure off yourself, and in my experience help the pain to improve or resolve.

[00:20:14 –> 00:20:18] Dr. Ravi Kumar: Okay. So what kind of results do you get, when you start working with these patients?

[00:20:19 –> 00:21:36] Dr. David Schechter: Well, you know, first of all, Rome wasn’t built in a day, and I explained that to them, so it doesn’t happen overnight in all cases. There are people who make very dramatic improvements. As I did as a medical student, you know, if you asked me later about my own experience, was a patient of Dr. Sarno’s to learn about this stuff, didn’t know anything about it. And I made a rapid recovery I think because I was 21 and open to it and all of that. But how do people do? Most of them do very well, and that’s proven in my own published study, which was a cohort study. It’s proven in some randomized controlled trials that some of my colleagues have published over the last five years. Doesn’t mean everybody is a success. And this does involve the patient playing a very active role. So it’s not only dependent on how good my hands would be or Dr. Kumar’s hands are in terms of doing an operation, It’s also dependent on my ability to guide them through a healing journey, but it’s also dependent on the patient’s willingness to take on a little responsibility and to be active in the change process. And some of them are excited by this, and for some this is very difficult for them to do. So that’s one of the variable elements in recovery. But in general, I’ve had great outcomes. I’ve treated 4,500 patients over the last thirty plus years, and have had very good outcomes with this approach.

[00:21:37 –> 00:21:40] Dr. Ravi Kumar: Yeah. We’ll talk a little bit more about the BOLDER trial in a little bit

[00:21:40 –> 00:21:41] Dr. David Schechter: Yeah.

[00:21:41 –> 00:22:04] Dr. Ravi Kumar: That shows how well this actually works. But tell us about who Dr. Sarno is, because you keep mentioning him. And I know he was in your book, I, you know, looked him up, and he’s kind of the the godfather of this this whole field. And then tell us about Dr. Sarno, and then tell us about your initial experience and how you got better, and how this launched you on this into this field.

[00:22:04 –> 00:28:45] Dr. David Schechter: Yeah. Dr. Sarno had developed a, career in aphasia, which is stroke rehabilitation, at the Rusk Institute of Rehabilitation Medicine at at NYU. So he was a full tenured professor, and they asked him to run the outpatient rehab clinic for back pain and related conditions. And he began to see a lot of back pain patients. And he found that when he talked to them, when he educated them, when he asked them about how they were doing and how they were feeling, that they seemed to improve more. So he began to think maybe there’s more to the psychological part of back pain than he had been taught in his training as a rehab doctor. And he began to do seminars and he began to sort of develop a theory over a period of years, around fifty years ago or so, began to write some papers on this about chronic back pain being more of a myoneuralgia, he called it, a muscle and nerve condition that was triggered by psychological and emotional factors or perpetuated by that. So you can have an injury that maybe should have gone away in four weeks, but it keeps going on and on and on where again the brain is playing a big role in this, TMS neuroplastic model. So that’s what Dr. Sarno was doing, and he had been treating thousands of patients as the director of rehab and developed a reputation in New York City as someone who could help people with back pain that other doctors weren’t helping. I didn’t know any of this when I walked in into his office as a first year medical student who had played a lot of basketball, done a lot of running, and was developing knee pain. Not back pain, but knee pain. And I had been to the student health physician at at NYU Medical. They had referred me to an orthopedist, a knee specialist who was the New York Yankees team physician at the time. They didn’t fool around with sending you to the average doctors, they sent you to the top people when you were in medical school. But you know these guys couldn’t, they said nothing much wrong with your knee, let’s just strengthen it up. So I did the strengthening exercise, I had the strongest quads, for a skinny guy, I’m a slim person, but I had the strongest quads you could imagine, and I still had knee pain. So I walked into Dr. Sarno’s office because he’s a professor of rehabilitation medicine, so I figured physical therapy maybe. And also he had lectured to us in anatomy, so I knew he I knew that he knew a lot about the musculoskeletal system, lower extremity, etcetera. I walked in and I said, Dr. Surgeries, could I bother you? And he said, I have a couple minutes. So I gave a very brief, you know, very brief presentation of what I was dealing with. And he kinda turns around in his chair and he says, I don’t know how you’ll take this son, but a lot of this chronic pain I have found is psychosomatic. And it was like getting hit with a blast of cold air because I’m going in there for physical therapy and he’s telling me to think about my my stress intention as a medical student. So he said, can see you’re a little bit skeptical. That’s okay. I I do these seminars for patients on Monday night. Can you come next week? And I figure, what do I have to lose? So I go to a seminar at Rusk Institute. There’s about 30 or 40 people. There’s well dressed Upper East Side, Upper West Side New Yorkers, and 21 year old me in the first row with corduroy pants and a flannel shirt. You know? And he presents this concept and this conceptualization of pain, and it made a lot of sense to me. You know, had gone from college, having a lot of fun, living out in more of a countryfied atmosphere to New York City, sharing an apartment with an artist. I was subletting a room from her, and I was staring out at a brick wall when I wasn’t on the street. It wasn’t an upbeat environment at that point. And medical school first year, as you may remember, there’s a lot of memorization. There’s a lot of stuff that’s not the clinical stuff that we get into. There’s a lot of memorization. You may have enjoyed anatomy. But I mean the courses were important but not always fascinating and they involved a lot of memorization. So it wasn’t a great year for me. I wasn’t that happy with my social life. So it kinda made sense to me. Wait a second. You’re you’re sort of a sensitive person. Maybe you’re internalizing this worry into your body. And I again, he presents this very effectively at that point. So I I go home. I thanked him for the lecture, I said I’ll come back next week, and he offered to see me in his office as a patient, pro bono. And then I go home to my little bed on my and looking out at the brick wall, and I felt like a weight was lifting off of me. There was like a pressure that I wasn’t I felt lighter that day after hearing him explain my pain in a way, as so many of my patients now report, they worry about permanence. They worry about the pain not going away. And Sarno was able to convince me that there was a path out of this that was different from what I had been doing, that wasn’t working. And so I felt lighter, I started to walk a little bit faster the next day I noticed, and went to what was examined by him. He confirmed the diagnosis with his examination and history. I started shooting a few free throws, it felt okay. You know, I started doing a little light jogging. And you know, over the course of a month I’m back to my activities and things. It was amazing. I shared this with medical students, I shared this with attendings, and they scoffed. They said, well, all right, worked for you, but that’s not typically what we do for knee pain or for other types of pain. And there wasn’t a lot of enthusiasm, let’s say, among the people I shared this with. Was many years before I would say the the openness to mind body or the openness to neuroscience, which has gotten a little bit better over the decades, was many years before that happened. But I was a believer, and I spoke to Dr. Sarnoy after getting better, and eventually was able to get a grant, I think for the following summer, to spend the summer in his office and do a research follow-up study with his patients, and also clinically see all the patients he saw that summer and go to his seminars, that kind of thing. So I was able to call up a 175 of his patients and do a a questionnaire type of interview, and I kept hearing the same types of stories that I had experienced. So it wasn’t just me. It was all of these people say I mean, these were just charts pulled off Iraq. That was, of course, the before electronic records. So it was a bunch of charts we pulled off of the shelf, and I called them one after the other, developed a questionnaire, and they kept telling me these amazing stories of their back pain getting better, usually back pain, sometimes migraine headaches, mostly back pain, some knee pain. And so I was convinced this was a very powerful thing that more doctors should know about. Ultimately the study was not published in the medical literature, complicated reason for that, but he ended up using it in the first book that he was writing at that time called Mind Over Back Pain. And I helped him a little bit with that book and and was mentioned in the acknowledgments to that book. He subsequently wrote several other books as I moved on through medical school and into residency on the West Coast and all of that. And then we we we stayed in touch lightly, and we reconnected as when I opened the practice, And that that led to, referrals to the practice and, you know, really developing my own program. So that’s how

[00:28:45 –> 00:29:48] Dr. Ravi Kumar: it That’s a great story. I’m just gonna sum it up for the audience right now up to this point. So you had this initial experience with mind body medicine, what we’re calling TMS or neuroplastic pain syndrome, and it was with your knee. You reframed the way you basically perceived that pain through some kind of psychological phenomenon that you basically changed. And your pain got better, you returned to activity, and you were shocked that something that modern traditional medicine hadn’t been able to touch was basically fixable by a mental reframing. And you’ve gone on to build a career around this concept, treating patients who have chronic pain. It can be pain anywhere in the body, and you basically teach them how to rewire the habituation of chronic pain to where they’re not getting aberrant signals. Is that is that a good summary, or what do you

[00:29:48 –> 00:32:36] Dr. David Schechter: think about that? Very well stated. You should you should have a podcast. Okay. Very well stated. Yeah. I mean, it’s really amazing that a psychoeducational approach and for me, I didn’t see a therapist. They didn’t even have groups or other things at that point. You know, again, it was the very early stages. There was no Internet. There were no videos of this to to teach people. There’s a lot more information now to educate people about this. I’ve written books. Dr. Sarno obviously wrote books during his career. My colleagues have written books. There’s videos and websites and all kinds of none of this was available. And so that was the interesting thing that I sometimes come back to in my work today is how did Sarno fix people, or help them to heal, I should say, without all of the modern conveniences and without all the educational materials. And it was really about attitude and belief. You called it reframing, is very accurate. Attitude. My attitude was I wasn’t getting better. I was discouraged. I was a little bit depressed by it. And he helped me to get out of that by seeing a pathway forward. Belief, I believed there was something structurally wrong with my knee that had not yet been detected. There was no clear meniscal tear. But patellofemoral syndrome, this sort of tendonitis, I mean they didn’t really have diagnostic, the MRI wasn’t used in clinical medicine for the knee until the following year, because you know I’m a bit older than you are. So they didn’t do an MRI on my knee. And if they had they might have seen nothing, they might have seen a trace of inflammation, I don’t know. It ultimately didn’t matter because I didn’t need surgery. What I needed was a different attitude and a different belief in what was wrong with me, and then to gradually, and then graded exercise. I didn’t jump back in and start playing full court basketball the first week. I started shooting some free throws. I started walking faster. I started jogging a little bit. It’s the same type of approach I use with my patients, except we have a lot more educational materials to work with. We have a we have a bigger team if we needed in terms of psychotherapists, coaches, both in Los Angeles, nationally, internationally. There’s people that do this. And so the field has obviously grown a tremendous amount over the last thirty, forty years. I was a young medical student at the time. But what you’re saying, the core principles are the same, which is that if you don’t have a structural or biochemical cause for your pain, and there clearly are structural and biochemical causes, I don’t in any way deny that. If you have rheumatoid arthritis, you should be treated for inflammation of rheumatoid arthritis. If you have a meniscal tear that’s that’s locking or causing your knee, you should have that meniscal tear treated. There’s lots of structural problems that cause pain, but there are also neuroplastic causes that cause pain. There’s also pain that gets stuck in these neural circuits or is perpetuated or amplified by your brain and by your emotional responses to it. And that was the experience I had as a medical student that I’ve been able to guide patients through the recovery of.

[00:32:36 –> 00:32:54] Dr. Ravi Kumar: Very cool. So let’s talk about the evidence because, you know, we can talk about, hey, this is my empiric experience and it’s been great, but there’s actually some really good science on it. I mean, it started off with that survey you did of Dr. Sarno’s patients where I think you found like seventy five percent of their pain people’s back pain was completely gone.

[00:32:55 –> 00:32:56] Dr. David Schechter: Correct. Correct.

[00:32:56 –> 00:33:16] Dr. Ravi Kumar: Is that is that right? And then Yeah. You did your own observational study Right. And then there’s even been the BOLDER trial, is was a clinical trial Right. And the follow-up study Correct. And it’s all just confirming what you’ve been saying for the last multiple decades Right. And seeing in your personal practice. So can you kind of talk us through the evidence on this and and what kind of results they’re seeing?

[00:33:16 –> 00:35:11] Dr. David Schechter: You could say in a sense that Dr. Sarno built a beautiful house but for but didn’t build the foundation. So the foundation in modern medicine is the research. Right? So usually you have the research done, and then you build the house on top of that, the clinical treatment program or the or he did it the other way around. He was a great empiricist in terms of observing and noticing patterns in people, and he developed a treatment program based on that rather than based on a clinical trial or a research hypothesis. But as you mentioned, there were earlier efforts at doing some follow-up studies by myself, by Dr. Sarno, and by a few other people. But more recently some of my colleagues including Howard Schubner and Mark Lumley in Michigan, including Yoni Ashar and Alan Gordon from Colorado and Los Angeles, and a gentleman by the name of Donino in Massachusetts have done randomized controlled trials. So these are considered to be the highest standard of clinical evidence, RCTs they’re also known as. And they’ve received some funding, etcetera. And what they’ve seen in these trials, and they’ve used different treatment modalities, similar to this. For example, the Boulder study you mentioned was an initial assessment online by a physician. And then the treatment was primarily provided by psychotherapists, I think 10 sessions. Not a lot, 10 sessions of fifty minutes each. People with chronic back pain. And in this case they excluded leg pain, which is back pain. And remarkable success, I mean in terms of the percentage of people whose pain went to zero, and not even also including patients whose pain went to 20% of what it was before, which again is a very functional lifestyle, etcetera. So we’re talking sixty to eighty percent results in these studies. I, you know, I have the studies on slides, but from the top of my head I don’t remember all the exact numbers, and I don’t wanna quote them inaccurately. Numbers were so good, I wish I could have

[00:35:11 –> 00:35:12] Dr. Ravi Kumar: that in my surgical practice.

[00:35:13 –> 00:38:37] Dr. David Schechter: Yeah. I mean, they’re really remarkable remarkable. And then they did a five year follow-up recently on the same group, or three year follow-up. I forget, Yoni did this, follow-up, Shar. Yeah. And the results have persisted, which has been my experience too, that results persist. Now I can also say that some people can have a recurrence or a flare up, and we can get into that if you ask. And then Denino Brigham and Women’s or Mass General, he’s an emergency room doctor who got interested in this approach and decided to create a clinical trial, again, around people with back pain and an educational model. He didn’t use psychotherapy. He used group classes as the model. And again, seventy percent long term success, tremendous, you know, results, people lot of people’s pain going to zero. And again, these are not people who just walked in off the street. These are people with chronic pain. So these are people who have been treated by other doctors and practitioners over a period of time. Karnes at the Veterans Hospital in Los Angeles. So he took a very complicated group of patients, and I’m sure you if in your training if you worked with VA populations, not an easy group to work with. These are older veterans. And he compared sort of standard CBT, which is cognitive behavioral therapy, which you think might be effective for chronic pain, to EAET, emotional awareness and expressive therapy, which is kind of the psychotherapy that Dr. Sarno and I have been recommending for decades. But they’ve now standardized it. Dr. Mark Lumley and Howard Schubiner created a model to standardize that. So they gave this approach in group sessions again to older veterans. And they found that CBT was not really effective, and EAET was incredibly effective for this older veteran group. Again, not as effective in a younger group and with longer sessions, etcetera, but dramatic improvements in pain. So this is occurring again and again. We’re seeing a number of clinical trials being performed by different people in different cities using similar models and getting similar results, excellent results. So we’re beginning to put together the and you know, people are talking about this now in the medical world. I’ve had people say to me, oh, so do you do pain reprocessing therapy? Which is the term that Gordon and Ashar used in Colorado. And I go, I do that plus more, but that’s part of what I do. Because I’ve been doing this so long that all of these things are part of what I do. They decided to sort of take one piece that they’re very good at and use that as the therapeutic treatment, and it was extremely effective. And it wasn’t even the whole gamut of what we can bring to people if we need to. So people are starting to talk about this. Hospitals are starting to get interested in this. And there are very few physicians, although there’s more than there used to be doing this. There’s a lot of psychotherapists though. There’s a lot of psychotherapists who’ve taken training from Lumley and and Schubert and others. They’ve been trained and and gone to their communities that are doing this work. You might be able to find one in yours. And that’s really exciting, and it’s happening internationally as well. There’s there’s a group in The Netherlands. There’s a group in England. And there’s groups in other Australia, other country, Israel, that have been doing this work and are getting closer to publishing clinical trials and all of that. So it’s an exciting thing to have been in for so long and finally to see it catching on a bit. But you know, I still feel like, and I’m doing these podcasts because I feel like there’s a lot more people that need to know about this because most of your physicians don’t know about this. Most of your physicians don’t. More people probably know about this from reading one of the books and all of that over the years than do your physicians, which is really troubling. And Yeah. Not singling any one physician out, but it’s true.

[00:38:38 –> 00:39:18] Dr. Ravi Kumar: Yeah. Yeah. I mean, I agree with that. I didn’t know anything about it until I read your book or listen I listened to your book on Audible, and I had so many moments as I listened to that book, you know? And not just in my clinical practice, which I recognize the patterns in my practice, but with myself. Mean Yeah. You know how many times I’ve you mentioned this term in the book called catastrophizing. Think that’s what you called it. Yes. Yes. I mean, my wife would be like, Ravi does that all the time, you know? And Okay. It’s only in a point of high tension, you know? I’ve got something big coming up, and all of a sudden, oh, man, I’m screwed. Got this pain. I’m not gonna be able to operate all day tomorrow. And you know But somehow you get

[00:39:18 –> 00:39:20] Dr. David Schechter: through it and you operate, right? You do.

[00:39:20 –> 00:39:22] Dr. Ravi Kumar: And then when you’re done, it’s all better.

[00:39:22 –> 00:39:22] Dr. David Schechter: It’s gone.

[00:39:22 –> 00:39:23] Dr. Ravi Kumar: It’s better.

[00:39:24 –> 00:42:43] Dr. David Schechter: No. Our significant others know us often better than we do ourselves. And I’ll sometimes say to patients, well, say you’re not hard on yourself, what would your wife or husband say about that? And often they say, yeah, they would say I’m pretty hard on myself, you know, as a driving force in this. So catastrophizing is something that is a common psychological strategy or response that people do who have a tendency toward this condition. I got an interesting one for you. You know Okay. Physicians probably have this condition at a higher percentage of the general population, but still don’t know about this condition. So there’s a condition called benign fasciculation syndrome. Have you heard of it in your neurological Yes. Training? Yes. There So was a published this is a con people get worried if they have fasciculations, which are Yeah. Wiggling and hearing about ALS. Because there’s a very bad disease that you could have with that condition, although many people have fasciculations without ALS. Right? So if you have fasciculation, don’t run to your doctor tomorrow, take your time, etcetera. But the interesting thing I wanted to bring up was that there was a published study from a neurological clinic that treated fasciculations and ALS, but ALS is the Lou Gehrig’s disease, the condition. And they found that half of their patients with benign fasciculation syndrome were nurses and doctors. So why would that be? Well first of all nurses and doctors know that if you see something wiggling in your muscle it could be bad. Then they start catastrophizing it and don’t say, oh yeah, feel otherwise fine, my muscles are strong. ALS is not just the fasciculations. You develop weakness, you develop other symptoms as well. But it’s interesting that doctors and nurses were half of the study in this particular group. Getting back to the general population, catastrophizing and worrying is a common thing that people do, and we worry about our And you’re mentioning different symptoms. So I’ve had TMS since I’ve been cured. I’ve had it many times in different things, but I’m able to get on top of it now because I understand it and try to understand. So this is a thing we ask patients to do, and of course I do it myself, which is what am I worried about right now? What’s making me anxious? What’s going on here? And when I am able to identify that, it goes away very quickly. I’m not able to identify it, which sometimes you’re not able to, but if I talk to myself and say, it’s distress. I don’t have to worry about this, it also goes away. It may take a little bit longer. It also goes away. So that’s what we call acknowledging the emotions or acknowledging the cause. And if you can link it to the emotional thing, it often goes away very fast. I was once having dinner with my wife, and I I got paged. I was on call for a residency program at that time where I was teaching. And, you know, I took the call from the resident, and it was a stupid question if you could say so. Mean, doctors sometimes, young doctors sometimes ask stupid questions. And I answered it, and I hung up, and I said to my wife, boy, that was not one of the brighter questions I’ve had. And I said to her, you know, my neck is hurting. And five minutes later, said to her, my neck is hurting. And we were just sitting there waiting for dinner. I think we were sitting having a drink before dinner. And she said to me, do think it has anything to do with that call you took five minutes ago? And I said, of course it does. That’s what it is. And it literally dissipated in thirty seconds, you know, my neck hurting. I didn’t injure my neck. It just was hurting. So

[00:42:44 –> 00:42:46] Dr. Ravi Kumar: so powerful. That’s powerful, right?

[00:42:46 –> 00:43:07] Dr. David Schechter: So that’s why I came with the title Think Away Your Pain because I didn’t believe this when I was a medical student, but I learned it, and I’ve seen it in thousands of other people that you can learn to. It’s not an innate ability of humans, but you can learn to think away your pain if your pain is a neuroplastic pain and structural pain.

[00:43:08 –> 00:43:08] Dr. Ravi Kumar: So

[00:43:08 –> 00:43:11] Dr. David Schechter: Think Away Your Pain is the title of my book. Yeah.

[00:43:11 –> 00:43:59] Dr. Ravi Kumar: So Think Away Your Pain is Dr. Schechter’s book. It’s one of his books, and it’s a fantastic book. I listen to the whole thing. And yeah, if anyone’s interested in diving deeper into this, that’s a good place to go. I’ll put a link to in the show notes for that. So, okay. Let’s now move on to application of this. So right now, I bet there’s thousands of listeners thinking, oh my gosh, I think I have this. Mhmm. I think, you know, my foot pain or my TMJ or my back pain or my shoulder pain or my headaches, maybe they’re TMS because they’ve been to doctors, they’ve been to chiropractors, they’ve been to counselors, and no one can find a real problem, but they still have this pain, and it’s very, very real to them. What can they do? Where should they start?

[00:43:59 –> 00:45:27] Dr. David Schechter: Yeah. So it’s interesting. You used the term real problem. This is a real problem, and you kind of pushed it back because, you know, it is real to them. No. It’s actually a real problem. I mean, it’s a it’s real pain. It’s not it’s not imaginary at all. It’s real pain. So where should they start? Well, first of all, you pointed out you do have to be seen by a physician or you know, have something serious excluded if you have some type of persistent pain. I wouldn’t ignore any chest pain. I wouldn’t ignore pain shooting down my leg. I mean get yourself checked out. But if you’ve been checked out and you’ve been examined and you don’t have a clear structural or biochemical cause for your pain, then it certainly is worth exploring. I mean it’s it involves reading a book or looking at some websites. My website is mindbodymedicine.com, that’s pretty easy to remember. Looking at some websites, looking at a book, and just, you know, ask yourself, be open to it. Ask yourself if this seems to apply to you. And then if it does, you can try self treatment. Many people do that through reading, and I have a workbook that helps you to sort of talk about journaling as one of our treatments. I have a workbook that helps you with that. There’s also a directory of physicians and psychologists on my website that can potentially be a source, and there’s other websites that have other lists of physicians and therapists and coaches that help can help you with it. So I think the first step of course is to make sure you don’t have anything medically seriously wrong, structural we call it rather than real, or biochemical. And then this may be the path that you need to heal because it is for many people.

[00:45:28 –> 00:45:44] Dr. Ravi Kumar: So how many of these folks out there that might think they have TMS or neuroplastic pain need to actually see a professional once they’ve been checked out and they know there’s no big problems? Can they do it on their own with your work using your workbook or by reading your book?

[00:45:44 –> 00:47:03] Dr. David Schechter: Or do they do it on their own. Many people do it on their own. Dr. Sarno initially called that the book cure, that people can read a book and get better. Now there’s more resources available than just one book or three books or whatever. There’s quite a lot of resources. But sometimes a human being needs guidance from another human being. Mean when a person comes into my office with my decades of experience and my thousands of patients treated and they get the diagnosis from me and I look them in the eye and I say you have neuroplastic symptoms and you can get better from it, I think it makes a big difference in terms of their recovery. And when somebody talks to a therapist, when they realize they’ve got some deeper sources of stress that maybe they haven’t dealt with till now, when someone deals with a therapist or talks to a therapist either virtually or in person who is an expert in this field, not just a general therapist, they’re helpful too, of course, for depression, anxiety, and other stuff. But when it when you’re talking about neuroplastic symptoms, it helps to see somebody who’s an expert in this field. I mean, there’s there’s clearly their ability to help you to understand your emotional drivers for this, your personality, etcetera, is at a level beyond your own ability to help yourself. So Yeah. I would say that if you get a great response from the online materials or books, my books, etcetera, fantastic. And if you don’t, there are resources, human resources to help you.

[00:47:04 –> 00:47:26] Dr. Ravi Kumar: Okay. So let’s say we have Jane Doe. She’s 42 years old. She’s had back pain for a decade, literally. And she’s gone had MRIs. She’s even had a back surgery. Nothing’s helped. And she comes to you. How are you gonna take her through a full treatment? Like, tell us all the steps that you would go through on this

[00:47:26 –> 00:51:52] Dr. David Schechter: this week I mentioned before, I I don’t think I have to completely reiterate, that I take a very detailed history, and the history is psychosocial as well as medical. Right? It’s not just how long has the pain been there, does it get better when you cough, It’s also about what’s going on in your life and what kind of what pressures you’re dealing with. And sometimes there’s divorce, there’s grief, there’s you know, so I deal with this. I’ll try to open that up, And then I examine them and I review imaging. I already mentioned that. I review any lab tests that they’ve had that are relevant. What they leave with at that point, which I’ve developed my process over the years, but my process now is I have a sort of a two sided menu, if you will, of treatment. I’ll circle for them. I’ll say, okay, based on what you’ve told me so far, and I see you’ve read my book, so I’m gonna suggest you also read and I circle them. I don’t want them to have to take notes or make it difficult. I also would like you to read this book. I’d like you to start journaling ten or fifteen minutes a day, and you can do that in a blank notebook, journaling about your feelings, because that’s helpful. Or you could get my workbook. I have two workbooks I’ve written that volume two is the newer one. I’d recommend that one. So I circle that. There’s an app or two on this field now that people have developed an app. Curable developed an app. I was one of the consultants for it. I have no ongoing involvement with them, but some people find it helpful to download an app. For some people I’ll say to them, there’s a movie you can watch with your spouse because they might be a little skeptical about this, is a movie called All the Rage. And there’s another movie called Pain Brain about the Boulder Back Pain Study. So I might recommend one or both of those movies which you can stream for an hour and ten minutes, make some popcorn, etcetera. And then I decide in that first visit along with the patient, should I involve a coach? Should I involve a therapist? And if we don’t do it at that session, then I might say to them, okay, this is your homework, and let’s see you back in about three weeks. We’ll also discuss briefly, because it’s all spelled out in books and workbooks and other things, but we’ll also discuss what to do if they have pain, how to start the process of thinking it away, how to reduce the fear, reduce the catastrophizing. But you know, you can’t do all of that in one session, so we do some of that at the follow-up. And some of that I’ve written down or put in my materials. So I give them kind of a directed program, a home educational program. I used to do it as a seminar, as I mentioned Sarno did fifty years ago or forty years ago seminar. But I found that people in LA and elsewhere have a hard time being in the same place at the same time. Zoom can make that easier. But I found that people work at their own pace. You’ll give them a home educational thing, follow-up in three weeks, and sometimes they’ll follow-up in two weeks, sometimes in four weeks. And I’m sort of seeing what kind of progress they’re making. Some people have made a huge amount of progress in that amount of time. Other people are just scratching the surface and I have to give them more guidance. Other people will come back and say, you know thing that chiropractors said five years ago sticks in my head. Can you please address that? Or the thing that that neurologist said. So I have to begin to address, okay, I understand you had this or he found this or he saw that, but let me explain why I don’t think that that’s continuing to cause you pain. So I have to sometimes deprogram them, if you will, from misinformation or inaccurate information. So that’s a role that I continue to play at initial visits and at follow ups. And there’s this systematic program with education and with you know, some of them benefit from psychology. I don’t really determine in advance, does everybody need a therapist? No. Does everybody need a coach? No. But some people benefit from it. And people like a coach can be with you every week. It’s a little less expensive than my time, and they can spend more time with you than a doctor typically does. So some people benefit from that. A coach is someone who has training in this field but is not a licensed therapist. And a therapist is either a LCSW social worker, MFT therapist, or a PhD psychologist. And they, you know, they do the the therapy piece but from this perspective. And they use techniques like the PRT and the EAT and other acronyms that we’ve used on this podcast that are documented to work in clinical trials. And they also use their own experience in acumen because humans have to be treated on an individual basis, not just a protocol. So that’s very important to me and to I think all the practitioners I work with. Yeah. Does that help to understand Yeah, it a little

[00:51:54 –> 00:51:59] Dr. Ravi Kumar: it does. I mean that that was a really good description of how you take them through. How long is that that course that you would expect?

[00:52:00 –> 00:52:06] Dr. David Schechter: People funny, people ask that question. That’s one of their favorite questions to ask. How long will it take me to get better?

[00:52:07 –> 00:52:07] Dr. Ravi Kumar: Yeah, As

[00:52:08 –> 00:53:13] Dr. David Schechter: you know, doctors are much better at treating than we are at being prophets or prognosticators. So I’ll say to them, you know, it’ll take as long as it’ll take. It’s not gonna take years, and it may take months. It may take less. Let’s just take it a step at a time. And a lot of these people are hard on themselves. Some are type a, although we consider type t to be different than type a. And so they’ll they’ll they’ll you know, I’m smart. I’ll get better quickly. I I often say to them, it’s not based on your intelligence. It’s not based on how many hours a day you study these materials. The nervous system is complicated. I mean as far as we know it, the human brain is the most complicated structure we know of in the universe. There’s nothing more interconnected and wired that we know of. And so it takes a little while for the brain to sort of like rewire itself, the nervous system to do so. And I’ve seen it happen in weeks, and I’ve certainly seen it happen in months. And different people take different amounts of time. I can’t always predict that. I have a very good feel for who’s going to get better, but I don’t have a feel for how long it’s gonna take you.

[00:53:13 –> 00:53:25] Dr. Ravi Kumar: Yeah. That makes a lot of sense to me because you think about it, a lot of these patients they I’ll I’ll use the term learned. Maybe you’re gonna disagree with that, but they learned to be in pain over many years.

[00:53:25 –> 00:53:26] Dr. David Schechter: Yes.

[00:53:26 –> 00:53:41] Dr. Ravi Kumar: And now they’re de learning or unlearning those neural processes, and that’s actually a physiological and neuroanatomical change that’s being made. In fact, I think in the Boulder study, didn’t they do functional imaging and showed different neural networks being activated in the

[00:53:41 –> 00:55:43] Dr. David Schechter: people who watching? That the function that the Boulder study, in addition to having clinical outcomes also did functional MRI imaging. So that’s where you look at blood flow rather than looking at a structure per se. So on functional MRI imaging they found that different parts of the brain were activated when people recovered versus when they had pain. Acute pain, functional MRI studies have been done repeatedly on acute pain, and it’s experienced mostly in the somatosensory cortex where you would expect it to be But as pain persists, and this is really interesting, and this is one of the things I mentioned in my my book on chronification, as pain persists three or six months, if you’re put in a functional MRI scanner, and studies have been done with this, a lot of these came out of Northwestern in Chicago. I’m I’m blanking on the doctor’s name. Like to mention them if I could think of it, give them credit. But anyway, when you get to chronic pain, three to six months or more, a year, the somatosensory cortex is not the primary structure that’s lighting up. It’s prefrontal cortex, it’s areas closer to the amygdala, and it’s areas that are associated with the emotional centers. So this provided in a sense neuroanatomical and neuroscientific confirmation that we should be treating acute pain different than chronic pain. And that chronic pain is more linked to the emotional centers of the brain than it is to simply a sensory experience like acute pain is. Yeah. Alright. So that’s I’m glad you brought that up because not only did the Boulder study show a change when you treat patients successfully, but previous studies, Apkarian is the doctor who led the team in Chicago. By the way, these people initially did not know anything about TMS, this Chicago group. But they were just looking at pain. They said is acute pain the same as chronic pain? And they found no, it’s not. And neuro scientifically it’s not. So that was exciting information when I discovered that prior to writing my book Think Where You’re Pain some years ago.

[00:55:44 –> 00:57:22] Dr. Ravi Kumar: Yeah, makes sense. Solidifies all the basically clinical data, the empirical data. Because, you know, if you think about your for the audience, if you think about your sensory strip, it’s like right behind your ear, it goes up to your head, and it it it receives sensory input from your body that usually travels through the spinal cord in the in the the back of the spinal cord called the dorsal columns, and the right side of your brain will sense the left side of your body and and vice versa, and there’s a little bit of crossover, but that’s kind of how it works. The sensory strip is pretty much just a sensor. It’s a sensor that tells the brain, hey, you’ve got pain, pull your hand away from a hot surface, or don’t step on that spiky thing. So it’s how we survive in the world to prevent ourselves from getting injured. You know, what Dr. Schechter’s talking about is that in chronic pain, you’re not just getting a signal from the body through the spinal cord to the sensory somatosensory cortex, you’re actually getting an input from the anterior cingulate and the basal ganglia and the prefrontal cortex that are actually generating pain signals, sending it back to the somatosensory cortex that makes you feel actual pain, even though it’s not coming up the spinal cord. And so this is like neuroanatomically described using functional MRI MRI, which is completely fascinating, that we are actually able to generate pain, the perception of pain in the brain. So I I know it’s more complex than that, but it’s fascinating. And this is something that we didn’t really have objective evidence for until that those studies.

[00:57:22 –> 00:59:16] Dr. David Schechter: Until functional MRI was available. Yeah. Dr. Sarno had none of that when he hypothesized these models. I wanted to discuss what you mentioned about learning because that’s a really important concept in this field as well. So if you wanna learn how to get better at tennis, you have to hit hundreds of backhands, hundreds of backhands, hundreds of forehands. When you do, there’s wiring that goes on in your nervous system that to your cerebellum and other parts of your brain that allow you to become unconsciously fluid in hitting a backhand or hitting a forehand. So you can, as Dr. Kumar said, you can learn unfortunately to have pain. But the good news is you can unlearn it too. You can develop other pathways, other ways of thinking about your pain, other ways of formulating a response to the pain. And I believe that those pathways that are developed to create the pain wither. I don’t think they ever go away completely, which is good and bad. I’ll tell you why I don’t think they ever go away completely because several experiences. I’ve been in restaurants where I’ve run into a patient I hadn’t seen in seven years. They’re in Los Angeles so they run into them at a restaurant. It’s a big city but occasionally you run into people you know. And they’ll say to me, thank you for helping me. You know, I’ve been great the last seven years since I saw you with back pain. May not even remember them. I am good at faces. I don’t remember the name usually, but I’m very good at faces. But sometimes they’ll come back to me during the dinner and say, you know, I haven’t thought about my back for years, and I’m having pain now in my back during the dinner. So why is that? And I’ll explain to them, it’s probably because you met me again and sort of reactivated some old withered pathways. Don’t worry, I’m sure by the end of the dinner it’ll be gone, and you’ll be fine, completely fine tomorrow, etcetera. And they always tell me they are. So it’s possible for these memories, if you will, of pain to be reactivated. So I think that’s a powerful concept. Very interesting. Learning, unlearning, and pathways that wither other pathways that develop. Very important concepts in this area.

[00:59:16 –> 01:00:21] Dr. Ravi Kumar: Okay. So I highly recommend that anyone and everyone actually read your book Think Away Your Pain because you know you talk a lot about these type T personalities, which are doctors and nurse nurses, it sounds like, and and a lot of other people who basically hold tension in their body because of expectations and worries that they place on themselves. But honestly, this was my perception, Dr. Schechter, is that everyone gets some degree of this. Everyone. Like, even my kids. You know? Because I recognize patterns that you described, and I so I really think that just like you said, identifying or linking these sensory perceptions to actual things in our world that affect us is in itself massively powerful, but you first have to know about it. You know? And and then you’re not gonna learn it in medical school, so don’t just go be a doctor to to learn about this stuff. But so I think everyone should really listen to your book because it’ll help you. It’s like a almost like a magic wand. I I don’t want I don’t want people to think that it’s a magic cure, but it it feels like it, honestly.

[01:00:21 –> 01:02:40] Dr. David Schechter: I’d love to get this into the school system. I’ve been working on some pro bono projects because just like you said, your kids sometimes have symptoms that are related to tension, stress, school stuff, pressure, bullying, hopefully not, but different things that they go through as kids. I’d love to get this into, you know, the middle school, high school level of health education because it’s hard to train doctors in this because we can’t get into the medical schools yet. We will soon, hopefully. But maybe if we could train the the lay public or educate the lay public more at a younger level, it would help. And one more thing I wanted to add which was you mentioned having a symptom that just was brief. That before you, maybe the day before you were operating something was going on and you got a little sensation or pain. So you could say, well isn’t that acute pain? Isn’t that the thing you say is not mind body? Well yeah, lot of acute pain is a sprained ankle or it’s infectious diarrhea that’s causing a stomach cramp or whatever. But some acute symptoms can also be mind body. I don’t want to ignore that part. The other thing I was gonna say is that you know the brain can basically and I use this as a teaching thing for patients. The brain can basically create any symptom that a disease can create. I’m gonna give you a couple of examples. So you can get diarrhea from a parasite or something that you ate bad food in a restaurant. You can also get diarrhea because you’re nervous about a date or an exam the next day or something else. You can get a headache because you got jostled playing basketball and you got whacked a little bit and it caused a headache. Your brain got shaken around, might have even been a mild concussion. You can also get a headache because you’re tense about something, maybe a job interview or something else, right? Some of these are physiological from an injury or biology, and some of these are brain based. You can also get chest pain, and it can be from the heart, especially in a middle aged man or woman, especially as we get older, chest pain, squeezing chest pain could be a heart attack. But I also see people in my office 25, 30 with squeezing chest pain from a panic attack or from anxiety. The same exact symptom. The same exact sensation that the patient experiences in the diarrhea, the headache, and the chest pain, but it can be caused by a physiological process that’s pathological, but hopefully will go away, or it can be caused by a mind body reaction. So I think that’s really powerful information that people should know.

[01:02:40 –> 01:03:01] Dr. Ravi Kumar: The mind is so powerful. Every part of our body, every symptom we experience cognitively and perceptually can be created or is at least gated by the brain. I had to learn that the hard way in my own health, but as soon as I realized it, things got better, and that’s why when I read your book because you talk a lot about pain. Right?

[01:03:01 –> 01:03:01] Dr. David Schechter: Yeah.

[01:03:01 –> 01:03:42] Dr. Ravi Kumar: But I mean, there’s other other things too. I mean, it it like, you can have even, like, full on disease processes that can be measured by labs that I believe are being caused by psychosomatic processes. You know, there’s there’s a lot a lot to be proved out there, but just think about this. The placebo effect is more effective than most drugs, and there’s whole departments of research and fields of research that are just trying to figure out how to harness placebo and even amplify it. Because what we’re doing there is we are taking control of the power of the brain to positively influence our health.

[01:03:42 –> 01:04:57] Dr. David Schechter: Well your audience probably knows placebo what is, but how about this word, nocebo. That’s a word that most Yes, people blame don’t Right? So a nocebo is when something that typically a doctor says to you or does to you leads to you getting worse even though they didn’t actually do anything biochemical. So for example, you go to a doctor, white coat, respect, all of that, and they go, boy, spine looks awful. Your x-ray is awful. Just are you 40 or 60? Some doctors will say stupid stuff like this. That’s a nocebo that leads to people having twenty years of like worrying about their pain and not playing tennis and all the things they could have enjoyed. So there’s unfortunately, doctors are not always as careful with their mouth as they are as they should be. And they say things that they don’t realize have a huge impact because patients will come to me five or ten years later and say, I saw this doctor who said I said, that’s a horrible thing for them to say. They don’t know the future. Last time I checked they didn’t study prophecy, they studied medicine, so they can’t know the future. And you actually were given a no SIBO. You were given a negative influence that has led to fear and worry. So I think placebo is important, and then avoiding no SIBO or understanding it if it happens to you is also important.

[01:04:58 –> 01:05:31] Dr. Ravi Kumar: Yeah, definitely. I mean for all the doctors in my audience, and most of them are probably pretty aware of this because you know, they’re here learning how to make patients better without the traditional dogma that surrounds our field. But your words can be more powerful than any prescription you write and sometimes more powerful than any surgery you do. So, yeah, think about bedside manner and and the psychological and somatic condition of your patients because your words can cut them down or build them up. And I think about that all the time, and I still make mistakes. I still do.

[01:05:31 –> 01:05:32] Dr. David Schechter: We’re not perfect.

[01:05:32 –> 01:05:50] Dr. Ravi Kumar: No. Dr. Schechter, this has been awesome. I think you’ve blown a lot of minds today, honestly, with the information you’re putting out there. And if people want to get ahold of you, first off, I recommend read your book, Think Away Your Pain. How else can they see what you’re doing, get ahold of you if they want to?

[01:05:50 –> 01:06:52] Dr. David Schechter: Yeah. My website, mindbodymedicine.com, will allow you to learn more about this subject, and it also links to the books I’ve written. There’s actually more than than one or two. And it does have a contact page if you wanted to contact us. I I’m not able to do virtual visits on people out of state. People always ask me that. Although I have a little more leniency, strangely enough, in people in other countries. But for malpractice reasons, I you have to come to Los Angeles to see me, especially for a first visit. I wish it were different, but, you know, licensing in in The United States is state by state, as you know. Yeah. And I try to follow that. During the pandemic, the laws had changed, and it allowed us to see people out of state more easily. But in any event, I can’t see everybody, but I can refer you to people in other states. On my website there’s links. And obviously my materials hopefully will help you educationally and sometimes therapeutically. And, if you are able to come to Los Angeles, I look forward to to meeting you and hearing that you heard me on Dr. Kumar’s podcast.

[01:06:52 –> 01:06:54] Dr. Ravi Kumar: Thanks a lot, Dr. Schechter. Cheers.

[01:06:55 –> 01:06:56] Dr. David Schechter: I enjoyed it. Thank you.

[01:06:56 –> 01:08:14] Dr. Ravi Kumar: Okay. I hope you enjoyed my conversation with Dr. Schechter. I thought it was a fantastic conversation, and here’s what I want you to walk away with. Chronic pain is not a sign that your body is broken. It’s a signal that got stuck in the on position, and that means it can be turned back off. And the beautiful part is, a lot of what makes a big difference here in turning off that signal costs you nothing and has no side effects. These include understanding that the pain is real, but not dangerous, which reduces fear around it. Gently returning to activities that you’ve been avoiding, evaluating what was happening in your life when the pain started, and what still may be bothering you, and easing up on that internal pressure, the perfectionism that so many of us self impose. None of that requires a prescription or a procedure. It just requires a different way of seeing the problem. If you want to go deeper, Dr. Schechter’s book is Think Away Your Pain. And you can find it on any major book platform, and it’s available in audiobook as well. And you can also find him and other resources at his website, mindbodymedicine.com. I’ll put the links in the show notes. Okay, folks. Until next time. Stay curious, stay skeptical, and stay healthy. Cheers.