Pain Management Specialist in Austin

00:00 Hey there, Jessica here. Um, so you have ended up on my website. You're reading about pain reprocessing therapy and how I work with chronic pain.

00:12 And maybe you're still wondering, is, is this right for me? What is this going to look like? And so I thought I would record a session, like a mock session of me going over the kind of stuff I typically go over in session one, um, just to kind of give you another piece of information to help you make

00:29 the decision and help you decide if this is worth investing in. So, session one of pain processing therapy is really all about pain science education, um, which in and of itself can be a great help, has been shown to be helpful in, in reducing pain.

00:53 So even this first session is, um, even though I'm providing information and it may seem like we're not really doing anything, um, even this has been shown to start making a little changes that lead to people being in less pain.

01:08 So I really like to talk about, like, identity and loss of identity due to pain. Um, so I want you to think about how has pain changed your sense of yourself?

01:24 Or how has it impacted your identity? Because it probably has, it's probably changed the way you view yourself, maybe the way you view the world, the way that you, yep, the way, the way you think about yourself, like all, all kinds of things.

01:41 And so I always like to pose that question, you may or may not have a ready answer to it, but something to, something to think about, maybe something to, to jot down some notes if, if you're a journaling type of person.

01:52 But pain reprocessing therapy believes that your nervous system has learned the habit of pain, and so this is a little different way of looking at pain, so instead of attributing pain to some kind of injury or a structural cause, pain reprocessing therapy believes that your nervous system has, has learned

02:17 this habit of pain. So the more practice you get in doing any habit, the easier it that symptom is to get activated in the future.

02:27 So I like to use the example of, uhm, Oh, my camera froze. Okay, I think we're back. Uhm, so I like to use the example of stop lights.

02:40 So we all stop at red lights, uhm, because that's just what we do. That's fine. That's what we've done, uhm, that's what we've done for years, and I just realized I should have put my phone on silent, so, uhm, we stop at red lights because that's just what we, that's what we were taught to do is what

02:57 we've done for years, and so let's say that we changed the traffic laws and decided that now everybody is gonna stop on green and go on red.

03:07 Stopping on red is a habit, going on green is a habit. It's something you do without having to think about it because you've done it so many times.

03:14 We could change the habit of stopping on red and going on green. It would just take some time and some practice and people would have to really think about what they're doing when they approach an intersection.

03:26 They couldn't go on autopilot. We could change that habit. Pain is kind of the same way. So as pain becomes chronic, your brain gets more and more and more protected.

03:39 So what this means is that your brain, it kind of gets hypervigilant. Um, so it, it detects danger much more readily and then tries to triggers the pain response, even in the absence of danger.

03:54 And we know that it's possible for humans to feel like scared when there's no danger. For example, um, horror, like horror movies, there's a whole industry built on the fact that humans can feel pain.

04:05 You can scared, even if there is no real danger and you can feel pain, even if there is no, um, tissue damage.

04:15 So chronic pain, of course, impacts every aspect of your life. This is not news to you. I'm not telling you anything.

04:21 You don't already know, um, but I just kind of want to highlight all the different, um, changes and, and just pose the question to you.

04:30 If, if you relate to this, you're the level of physical activity that you're able to tolerate your social life and your relationships.

04:37 Your relationships get impacted, your identity, kind of like we talked about earlier. Um, your mental health, of course, gets, gets impacted.

04:47 And even just your daily routine and the way you sort of go about doing things. And all of this, all of this, just gives your brain more fuel for the pain response.

04:56 And rinse and repeat. I also like to think of like a car alarm. If you've ever heard a car alarm go off, even when no one's trying to steal the car.

05:06 Usually no one's trying to steal the car. Usually somebody bumped it or a kid. Rolled their ball into it or something like that, but the alarm doesn't know the alarm just perceives that the car is in danger of being stolen.

05:20 And so it activates the alarm, um, because that's what it's programmed to do. Um, it's trying to be helpful. Your brain is trying to be helpful.

05:28 So I like for people to start thinking about who are they besides a person with chronic pain. So, yes, you are a person with chronic pain.

05:39 It's part of your story. It's part of your experience. Um, but who else are you? What else, what else is there to, to know about you?

05:47 Um, because my guess is that that's not the whole story. A couple of things I also like to talk through is that everybody has some form.

05:57 of neuroplastic pain. So I'll define that really quickly. I define it as brain malleable and it's the type of pain that is, um, that we think the brain is playing a very big role in it.

06:13 And it's a lot of the time it's that, it's that they can't find anything wrong type of pain. Um, sometimes there is a diagnosis or a structural problem, but a lot of the time it's people who are in pain and nobody can figure out why.

06:27 And nothing shows up on any scan or any test that any lab work. So we all have some neuroplastic pain at some point in our lives.

06:37 So for example, a lot of people have chest pain when they're nervous. Doesn't mean they're having a heart attack, doesn't mean there's anything structurally wrong with their chest, but we can have chest pain.

06:45 Or nausea. Uhm, it's not pain, but I've seen neuroplastic pain take the form of chronic nausea. Where, you know, the purpose of nausea is if you ingest something bad, you throw it up so it doesn't kill you.

07:01 But you can, You feel nauseous when you haven't ingested anything bad. So we all have the capacity to feel pain without any actual tissue damage.

07:09 Uhm, there's actually a pretty famous, uhm, case out of England. This construction worker, uh, stepped on a nail on the construction site.

07:18 And the nail went up through his boot. And he was in unbelievable pain. They took him to the emergency room.

07:26 They actually had to sedate him. Because he was just so, uhm, dysregulated from being in this pain. So from that finally, the doctor is able to remove his boot and come to find out that the nail didn't actually go through his foot.

07:41 It went between his toes. So the nail didn't actually pierce his foot. But here's the thing. This guy was in pain.

07:48 He was legit in pain. He was in pain. not making it up. He was not faking it. He was feeling pain.

07:55 He was feeling the same pain that you would feel if you stepped on a nail and the nail went through your foot.

08:01 Because his brain saw that the nail was sticking up out of the boot. And filled in the gaps. Because our brains will fill in the gaps.

08:10 So we all have the capacity to feel pain without any actual tissue damage. Even further, there's some research actually looking at scans and people's, like, subjective report of how much pain they're in.

08:23 And we've actually found that there's not as much correlation between, like, what somebody's scan looks like and how much pain they're in.

08:31 Somebody could have a normal looking scan and be in a ton of pain or somebody can have a scan that looks really messed up and they're not in a lot of pain.

08:40 So it's a lot more complicated than just what's going on with like the bones and the muscles and stuff like that.

08:46 25% of the world's population, more or less, uh, we think has chronic pain. So that's about. About 1.5 billion people.

08:56 It's a lot of people. I like to point out to people, um, you know this, but I'll, I'll go ahead and share it. You're not doing, you're not doing this intentionally.

09:06 It is an unconscious process. It's just like when you pull up to a. Red light, your foot hits the brake and you stop the car.

09:13 You're not thinking about it. You're not thinking, Oh, the light's red. What do I do? What should I do? What's that?

09:18 No, we just red light. Boom. Stop. Foot hits break. You're stopped. You don't have to think about it. This is really similar.

09:25 It's an unconscious process. But as we start to make it more conscious, a lot of the time, people find that they gain better control over it. 09:36 Again, just like the stoplight example, you just have to really think about it and think it through and figure And then finally, your pain is no less real or valid than pain that would show up on a scan.

09:58 or lab, you know, lab work, whatever. Your pain is no less valid than pain that a doctor can see on something.

10:06 So pain is always an output of the brain, no matter the source. And then, uhm, there's a slight, there's a there's actually a little slide show presentation that I'll, I'll show at this, at this point.

10:19 Uhm, I'm just, I'm not able to, to pull that out, but I'm going to kind of talk through it. So we tend to assume that pain is an input into the brain.

10:30 think, okay, I, I injure myself, there's pain in my knee that is feeding pain into my brain. That's why I feel pain.

10:39 So if you cut your arm, that's kind of what you think. You think that the area that got cut is sending messages to the nerves of pain to your brain.

10:47 Which would mean pain is an input into the brain. But that's not how the nervous system works. If you look at a red Coke can, it feels like the red is going into your eyes.

11:02 And you experience, you see the color red, uhm, so we think, oh, vision is an input of the brain. But that's actually not how the nervous system works.

11:13 So what's going on? If you cut your arm, there are what are called nociceptive neurons. Neurons that are near the cut, they feed information back to your brain, and they say, hey brain, there's some tissue damage going on here.

11:26 There's something going on. And then the brain kind of makes a judgment call about what's going on, should I sound the alarm?

11:34 So it takes the information from those neurons and makes a decision about should I create the experience of pain. And it'll decide to create the experience of pain if it believes that you have been injured or if you're in danger.

11:50 Same with looking at a red Coke can. So there is tissue, optical neural tissue in our eyes. It's relaying the red color.

11:59 It's relaying the information related to the color, to the back of our brain, the occipital lobe, which is back here.

12:06 And then, again, the brain kind of makes a judgment call about, is this can red? What's going on? Uhm, and if it decides, yes, that's what's going on, it creates the experience of seeing a red Coke can.

12:19 So, vision and pain, are outputs of the brain. Uhm, and there's a picture, I, I think what I, I think I might try to make this PDF, uhm, available to people.

12:32 So, I'm still thinking this through. Uhm, but there's this, this picture that I like to show people, that looks like a picture, but it's a of a red cocaine.

12:39 And it looks red. You look at it, it looks red. And then you zoom in, and you see that there is no red in that picture.

12:47 Like, there's no red. But it looks red. And what's going on is our brain sees the coca-cola logo. And we just, we know, because of branding, that coca-cola is red.

12:59 Their cans are red. So our brain fills in the red. But there's actually not any red. Uhm, our brain can be mistaken, both in terms of vision and color, and in terms of taste.

13:10 So I then kind of like to, uhm, pose some questions to people. Uhm, so we, we start having the conversation about what, what do you think is causing your pain?

13:24 What's, what's your hypothesis? What do you think is, why do you think you have, I mean, maybe we don't know for sure, but what do you think?

13:32 What do you think is causing your pain? Uhm, what have doctors told you? Uhm, it's, you know, interesting to kind of consider, uhm, what they've said.

13:41 They, you know, they, they don't know. I don't always get it right. Uhm, and then finally, what have other people in your life told you?

13:50 So what's sort of like the messaging that you've gotten around the cause of your pain? So, pain and processing therapy, uhm, is really a big, it's a big shift, it's a big shift in how we think about pain.

14:04 Historically, the focus, and this is typically how it is if you go to a physician, go to the emergency room, and you say, my knee hurts.

14:13 They're going to focus on your knee. Right? They're going to x-ray it, they're going to scan it, they're going to examine it, they're going to really focus, and if they don't find anything wrong with your knee, then a lot of the time, they're kind of out of options.

14:27 And so, pain reprocessing therapy, is positing that what's going on is actually in your, more so in your brain, than in your knee.

14:37 Your brain thinks your knee is injured. So, to reverse this cycle of pain, really what we need to do is target your brain.

14:48 So, we need to convince your brain both logically and emotionally that you're safe, and pain reprocessing therapy is going to tackle both.

14:58 So, just learning more about the brain's role in pain, can start to help you overcome it. So, this session and then the second session, the session that we would be doing after this, really speak to your logical brain.

15:13 So, this session and the next session are all about, like, facts and data, research, statistics. Uhm, there's been a lot of research into this, which I'm happy to share.

15:24 Some people are really interested in the research. Some people are just like, eh, I don't, I don't really care. I just want to know if this will help me.

15:31 Uhm, but please let me know if you are super interested. If you're interested in the research, I'm happy to share that stuff with you.

15:38 So pain's a danger signal. Um, pain is a danger signal regardless of, of what's going on. So if you touch a hot stove, then you feel the pain to let you know, to move your hand so you don't burn yourself.

15:55 So you may, and you, I don't know if you've ever had this happen where you reach toward like a hot stove or something in the oven and you don't quite touch it because you realize, oh, that's hot.

16:06 I shouldn't touch that. But you don't actually make contact with it, but you actually kind of feel the burn just a little bit as your brain is filling in those gaps.

16:15 So the pain lets you know, hey, I need to pull my hand back. Um, so I don't burn myself. So I don't have tissue damage.

16:25 So sometimes the danger signal of pain gets activated, even if there's no structural damage. Um, this happens. This, this, this, this can happen can happen with anybody.

16:36 So your brain just sometimes misinterprets safe signals as if they're dangerous. This is often the case with chronic pain. Um, I'll, I'll give another example.

16:46 So I remember one morning, um, I think we, uh, my husband and I forgot to, um, disalarm, disarm the alarm system in our house.

16:53 Um, after waking up and I, I think I shut the fridge too hard. Um, and it, it started going off.

17:00 Like the alarm system thought somebody was trying to break into our house because there must've been like the way I shut the fridge must've caused.

17:10 Vibration that made the window shake. I don't know. I'm piecing this together, but it thought the alarm system thought somebody was trying to break into our house.

17:19 And so it went off to alert us to potential danger. It was wrong. There wasn't any danger. Um, but. It, that's what happened.

17:28 And that's what can happen with pain and the brain. So chronic pain also want to say that chronic pain and acute pain are really different.

17:37 So chronic pain is really complex. There's so much pain. There's so more to it than just a simple structural abnormality that might show up on an x-ray.

17:48 So chronic pain goes beyond there just being a physical problem. Maybe there is a physical problem. Some people have been given a diagnosis.

17:58 And other people will have been told there's nothing wrong with you. Uhm, but regardless, chronic pain, as opposed to acute pain, chronic pain is more likely due to these learned neural pathways than a physical problem.

18:14 So there's something called the pain-fear cycle. I'm doing, I'm doing the circle because it goes in a circle. So if you're feeling pain, that's gonna, you're gonna feel some kind of a way about that.

18:29 That's gonna trigger a feeling. It could be a feeling of fear. Uhm, maybe it's fear that there's something wrong, that there's some problem.

18:39 Or it could be a different feeling. Sometimes pain triggers frustration, or annoyance, or anger. Uhm, it could trigger despair, it could trigger sadness, despair, depression, or sometimes, uhm, with pain, people also get triggered into preoccupation.

19:01 So, meaning they'll just go kind of think in circles about, uhm, God, I used, I used to be able to do this, I used to be able to, to do that, or this is never gonna get better, or they just kind of get in this loop.

19:13 Or problem solving. You feel pain, and you're like, okay, what's wrong, what's wrong, I need to fix it, I need to fix this, I need the problem, maybe I need to take a medicine, maybe I need to change positions, maybe I need to stretch, maybe I need to not stretch, maybe I need, I don't know, I just need

19:25 to fix it. So pain triggers an emotion, uhm, and that emotion puts your brain on high alert. So if you're scared, if you're angry, if you're anxiety, if you're preoccupied, if you're trying to problem solve, if you're annoyed, if you're frustrated, that is going to put your brain on high alert.

19:43 And when your brain is on high alert, you're now more vulnerable to feeling pain. Because it's all, it's all danger, it's all a danger signal.

19:53 So if your brain is on high alert, you're, it's going to be more inclined to generate that pain response. So now you have more pain, well that leads to more fear, or frustration.

20:06 Frustration or anger or despair. And then more fear or frustration or anger or whatever leads to more pain. So we've got this cycle of pain plus fear plus more pain, pain plus more fear, and it just feeds on itself.

20:26 So with pain reprocessing therapy, what we're actually targeting is the fear. We're not actually targeting the pain directly. Now is the goal to get you out of pain?

20:35 Yes, absolutely. That is the goal. That's the goal with the treatment. That is what they found in the research, but we don't directly try to stop the pain.

20:48 We're trying to stop or address the fear of the pain. So, this is usually where I'll ask people, when your pain comes on, or maybe when your pain is really bad, if it's chronic, I have some people that it comes and goes, I have other people that it's just constant.

21:06 So when the pain comes on or when the pain's really bad, where does your mind go? What are you thinking?

21:11 What are you saying to yourself? How are you feeling? Are you frustrated? Are you scared? What's going on? And then also think about, and you know, if you're sitting on the other side of the screen from me, we're having a conversation.

21:26 How do you think that response could perpetuate that, that pain for yourself? So our goal is not to immediately get out of pain.

21:37 Ultimately, that is the goal, is to get you out of pain. But, where we start, is to change your relationship to the pain, change your relationship with the pain.

21:49 Uhm, because it does, and I've seen it, like, I know what the research says, and I've also seen it with people.

21:58 you are responding to it differently, you cut off that fuel source, you cut off the fuel source of the fear, the anger, whatever that is.

22:10 So I want to just, I'll talk a little bit about, there was a, there's been at least one, you know, um, randomized clinical trial, just kind of considered like the, the goal, like the best way to, um, to, to do research.

22:25 And it's called the Boulder Back Pain Study. If you want to, if you want to Google it, um, it's called the Boulder Back Pain Study. So at the end of the study, what they found was that 98% of everyone that participated saw improvement.

22:40 98% improved. 66% of people were pain-free. Or nearly pain-free. So just about everybody saw improvement, and about two-thirds were out of pain, or just about out of pain.

22:56 Uhm, so the beliefs about what, and what, what they worked on, what changed, was people's beliefs about the pain. So if you believe that there is some kind of structural damage in your body, then it's going to be really hard to not feel scared, angry, want to problem-solve all the that kind of stuff.

23:20 So what they found with these people in the vulvar back pain study is that their beliefs about the pain had changed a lot.

23:28 And what really happened was that there was a lot less fear and a lot less of what's called catastrophic pain.

23:34 I should have a link on my website and a um, that I'll pull up a PDF that's got all the different, all the different site pages.

23:55 Um, so that's a lot of what I typically go over in the first session, okay, you're processing therapy. And then I, um, I like to assign some homework.

24:06 Not, not a lot, but I, I, I, I'm a, I'm a homework therapist. I'm a skills and tools and teaching and, and how work therapists.

24:16 So my assignment, usually from the first session, is now knowing that That's it. Pain is a combination of sensation plus fear.

24:27 So sensation plus fear equals pain. If we're using that equation, I ask people to start thinking about what fears must you have.

24:38 What fears are start this process? Like, what's, what's the fear? What are you, what's, what are you afraid of? What fears are going to need to be overcome to start that recovery journey?

24:53 And then I also like for people to start. Thinking about what are their most, what are the most significant barriers?

24:59 Like, what do you think is going to get in the way? What's going to make challenging? Um, because then we can start to talk about that sort of problem solver around it.

25:09 So, um, that's a lot. But of what I like to go over in the first session of pain and processing therapy, um, the session itself, typically, I do a 45 minute session.

25:21 Um, so it takes a little bit longer because I'm, you know, asking questions and answering questions and things like that.

25:26 But, Umm, anyway, I hope this was helpful. I hope it just gave you another data point in trying to make your decision.

25:36 So, from here, if you found this useful, if this sounds like something you'd like to try, um, You can go back to my website, JessicaFinktherapy.com.

25:46 You can fill out my contact form. Or, you can email me. Umm, it's JessicaFink at JessicaFinktherapy.com. That's F. Like, Frank, I.N.K.

25:57 Umm. Or you can call me, 512-5227291. Umm, we'll set up an initial free phone consultation. We'll take about 15 to 20 minutes. We'll just kind of get to know each other. Umm, give me a little bit of an overview of kind of what to expect. It's like just enough. To, to feel like it's worth moving forward

26:18 . Umm, and then if everything sounds good on the phone, then we schedule your first session while you're off phone. Umm, a hundred percent, I'm a hundred percent virtual so I can see anybody as long as you are located in the state of Texas.

26:30 Alright, well I think that's it. I think I'm gonna wrap this up, but umm, yeah, thanks, thanks so much for watching and I hope to hear from you.

26:40 Bye.