Chronic Pain Reset - Interview with Dr Afton Hassett

welcome back to another episode of

Christian Natural Health today I'm very

excited to have Dr Afton hassette with

us Dr hassette is an associate associate

professor and director of pain and

opioid research in the department of

anesthesiology at the University of

Michigan she's a principal investigator

at the chronic pain and fatigue Research

Center who has over 14 million of

research funding from the National

Institutes of Health viewed as a leader

in the field of chronic pain and

resilience she recently gave the keynote

address at the 2023 pain Consortium

Symposium on advances in pain research

for the NIH while studying established

treatments for chronic pain and

developing new approaches is her passion

her frustration is that exciting

research discoveries rarely make it to

the people who could benefit the most

thus Acton's mission was to write

chronic pain reset to bring

evidence-based strategies from research

and academic medical settings directly

to people who live with chronic pain

with the hope that they will gain new

tools to lead more rewarding lives with

less pain welcome Afton thank you for

joining us oh thank you so much for

having me it's such a pleasure to join

you yeah yeah absolutely so okay let's

start with some definitions chronic pain

what is it how is it defined right so

the way that we Define it for research

is it's pain that is present frequently

for most of the last three months so

people can often have an injury they

kind of lingers maybe a month or so we

don't necessarily call you're consider

that chronic at that point it really is

pain that has lasted longer than we

should anticipate is necessary for the

healing process to take place got it

okay and so your book kind of focuses on

the fact that chronic pain even though

we feel it in parts of our bodies it

actually originates in the brain how

does that work

you know it's so exciting we have about

30 years of really fascinating Cutting

Edge pain research and I feel the

Neuroscience that really has helped us

understand how it is that the brain

processes pain what parts of the brain

process process pain and how it's

different how pain is processed

differently in people with chronic pain

compared to people who don't have

chronic pain and what has become very

very apparent to us is that without the

brain of Consciousness pain is not

experienced so if you think about maybe

um the patient who undergoes surgery and

they're anesthetized and so certainly

there's painful things being done to

them including a large incision but no

pain is experience because the brain is

not connecting and making making pain

possible to perceive and then when the

patient wakes up it's acutely painful

right because they're conscious now and

they're processing right what we have

learned is that um you know without that

processing without that enhanced

processing um everything is with crime

that is observed in chronic pain that um

we need to think about new ways to treat

that because that is so different than

people who don't have chronic pain sure

absolutely so and before I get into some

of like the techniques and strategies

and whatnot just because the opiate

crisis is so enormous can you give us a

little bit of like what's your

perspective since this is kind of your

wheelhouse what do you have what's your

perspective on what's going on with that

so you know the opioid crisis is really

multifactorial and you ask you know is

it possibly just kind of a sign of a

greater malaise amongst Society but

really

um that might have set the stage for how

the epidemic got so out of control but

really the heart of the opioid epidemic

was people with chronic pain who needed

to have treatment and needing to treat

people on a massive scale having a pill

with a godsend to pain providers or to

pay you know to Physicians who are who

are caring for pain patients and to have

one pill that has so much promise and

hype coming with it you know feel like

wow we've got the Panacea really

difficult problem and a simple solution

but you know we all know some how many

years 30 years later what um what that

brought us and how upside down so many

lives have been turned

um people with chronic pain people

without chronic pain the parents of

children you know children and their

parents it's you know it really has

abandoned things and so our goal as as

researchers is to find the best possible

alternatives to opioid therapies for

people with chronic pain and some people

benefit from opioids some people do not

most actually do not according to the to

the data yeah very interesting so what

do our thoughts and emotions have to do

with our perception of pain

this is a thorny subject because so long

people with chronic pain were thought to

have a psychiatric condition and it was

like oh dismiss this woman she's clearly

she's cray-cray you know yeah yeah

litter aside but um but what we really

know is that chronic pain isn't hard a

psychiatric illness many people with

chronic pain have never had a depressive

episode or anxiety and the high

functioning outside of the chronic pain

and and so that's just not the answer

but what we do know that's really

fascinating is that the parts of our

brain the many parts that process pain

also overlap with or it can connect to

next to the parts of our brain that um

process thoughts and emotions and so

maybe you've experienced this yourself

that you know you've um fallen and

injured yourself and if you could

panicky and fearful and angry often the

pain feels worse but if you kind of

laugh at it because it's kind of silly

kind of Shake It Off the pain often

isn't as bad so we kind of either

amplify or dampen the signals depending

on our thoughts and our emotions and

that gives us a way in to improving

chronic pain yeah because we can adapt

our thoughts so that they're a little

healthier a little less fearful in our

emotions so there that we've invited

some positive emotion into the mix we

actually can dampen down pain and

actually see how the brain can start to

rewire itself

fascinating and so give us some examples

of maybe some healthy activities or lack

thereof that can affect our perception

of pain well you know your grandma

probably was right I mean my grandma

always said you just need to eat healthy

drink a lot of water exercise

yes yes yes

you know it's like what is good care for

our bodies is good care for our brains

so the first thing is sleep so the best

tool I have for sleep is go to bed at

the same time every night get up at the

same time every morning no matter what

weekends right because your body loves

predictability your body's built on

circadian rhythms or just these kind of

natural processes that run up by on a

biological clock and the more

predictable you are in your lifestyle

the easier it is for your body to adjust

and thus going to bed and waking up at

the same times the best thing we can do

for sleep

eat healthy you know the more fiber the

more healthy vegetables the less

processed food all good for your brain

and they'll certainly stay hydrated that

helps us feel less fatigued helps us

think more clearly but really beyond

that exercise and that doesn't mean

going to the gym and and having to you

know to you know break on a tremendous

sweat lift huge weights it means get

outside with your friends and go for a

brisk walk it means um go to a dance

class something that you really really

enjoy take up take up dance

um if there's some sort of sport pickle

ball or tennis that you can play in a

modified fashion do that so do

that's fun move your body right and then

most importantly is what we do for our

mind body Health that are we thinking

thoughts that are really

self-destructive are we ruminating and

driving ourselves nuts are we um are we

feeling shame all those things by pain

worse and just to become aware of them

doesn't mean we want to get rid of all

these emotions all of our emotions are

valuable but it doesn't mean we need to

really dwell in them and then also

opening up the door for positive

emotions too that people with chronic

pain often think how do I have the time

or ability my life is so bad how do I

experience positive things but they can

and we can and it's just opening

yourself up to the possibility of you

know of emotional spiritual friendship

things that bring joy into your life

absolutely so and with all of these

things in place I mean this is going to

dampen down the signal to the brain or

does it actually cause things to resolve

like what do we need to do to get that

reset button to occur yeah so it depends

on the person it's very individualized

so for some people there are some of

these cognitive and exposure activities

that'll take away their pain so what

happens is frequently pain is a signal

that there's some sort of danger okay so

if you've injured yourself the pain

signal says whatever you're doing stop

right

and so pain is a natural cue to your

stress response system to be on alert

something bad is happening oh my God am

I pain and so the more chronic pain that

people have their lead alert system is

often activated and so by beginning to

deactivate

firefighter flight system we can do that

through meditation through exercise

through changing kind of our thought

patterns we can start to dampen that

down

another thing is our brain can become

like an overprotective Nanny that don't

don't move your neck is bad you've heard

your neck don't move and the physician

will have looked at you and said you

know what I think it's time for you to

move your neck I think you can start

doing some exercise but your brain is

telling you don't you dare move your

neck and what we do through some

therapies is we just help the person

realize once the doctor says it's okay

that let's start moving your neck and

now how about if you tell yourself that

tell your brain brain this might be

uncomfortable but I'm safe I know I can

do this and slowly start moving and we

get people to do this and they're

stunned to say oh my God because they're

simply just telling your brain it's safe

I can do this I'm not my no the unit is

not in danger because that's your

brain's function is to keep the unit

keep you alive and by telling your brain

oh I guess that's all right so our brain

just does these amazing things to try

and preserve us and sometimes we just

need to do that exact thing yeah to

teach the brain that it's okay it's okay

to move yeah and that itself is

potentially going to shift you from the

fight or flight to the pathetic

feeling safe absolutely yeah so I mean

what was what would your perspective be

on somebody who does Imaging and they

find like they've got chronic back pain

for example but the image finds nothing

and then they're in the position of

wanting to go get surgery because they

see maybe this little maybe there's like

a slight little bulge bulging disc and

it could be impinging on the nerve but

maybe not I mean I know that the

statistics for surgery are sometimes not

the best if you can't identify the cause

would that necessarily fit into this

category or could it fit into this

category oh I'm so glad you asked this

it's actually right on the mark so

there's actually multiple studies

um that show us that what happens on an

MRI what we see there is not really a

direct correlate to what the patient is

telling you so for example somebody

could have really lousy knees so they

have osteoarthritis all over this is me

but I have no pain and so the doctor

will look at you like seriously yeah how

does this not hurt but it's a little

stiff but they don't hurt well another

person can have

um absolutely no osteoarthritis of the

knees and everything all the ligaments

and tendons are fine but have tremendous

pain and it's and there's nothing on the

MRI to show it and so that poor person

often gets told ah well you know there's

nothing we can do for you we don't see

anything so I don't know maybe send you

to physical therapy which could help but

they you know it it is what we see on

our MRIs and what people's experiences

are rarely matched and we're actually

conducting one of the largest studies

today to really really test that with

with about 400 people okay to get a

really good sense of where they are with

their pain and every other and all these

other aspects of there being what we

call a phenotype and then we've got two

Radiologists reading a very very um

intensive set of radiographs or MRI and

and we will hopefully do the definitive

study saying yeah there's not a great

match up here it's not to say though

that your doctor is wrong if they see

something on MRI you know they might not

be wrong they may you know you've got

pain this is here fix it and it's fixed

it's just not that clear though and so

often people will get something fixed in

a knee replaced your hip replaced or

back surgery and say I feel the same

babe why do I feel the same yeah that's

so discouraging absolutely so and your

book goes through this 30-day series a

cognitive behavioral therapy approaches

for decreasing pain perception can you

give us an example of a few of them and

kind of why they work I mean you sort of

have told us why they work but

of course of course so the wave kind of

structured my book is to you know the

first like 12 chapters give a really

good overview kind of what we understand

in pain science but in really playing

English and just kind of explain what

have we learned in Neuroscience why is

this why does this work and to some

degree it's you know what I've been

saying here that pain is in the brain

it's due to these neural networks and

because it's predominantly doing done to

how the brain amplifies the pain signal

and due to that poor wiring that we can

unwire and so there are many things that

do do that so in the book I kind of Step

people through all these things that

could potentially help life-changing

thoughts changing emotions improving our

social relationships

um living life that feels purposeful or

meaningful people being kind and

volunteering so all these things that

generally help us feel like happy

meaningful fulfilled people are the very

things that help rewire our brain so

that we don't experience pain yeah as

much pain so what what we do once we get

to these 30 days is we have so many

great evidence-based interventions that

we have studied really well in academic

settings and published in our fancy

scientific papers that often never make

their way to to patients to people who

have chronic pain and so that was the

thought of my book is that you know what

I'm going to bring 30 of my favorites to

people and let them consider them and so

the 30 days is a little bit of a

challenge I ask people to just spend 30

days and each day pop open a little

two-page insert and look at the

technique and so I got a little

background about the technique what it

is how to practice it for that one day

and then maybe if they like it how to

practice in the future but for that

moment you're just you're supposed to

think about that and then try it

sometime during the day and then at the

end of the day you come home you pop

open your book again and you think about

it okay so I tried that I kind of liked

it but not really or I tried that and I

love it I can so see how I put that in

my life and then so you pass judgment on

each of these and they're very very

different types of things that are

straight you know go right at the pain

things to things that are like breathing

or changing your sleep or considering

your your social relationships or

thinking about

um our spirituality or purpose in life

and each of these little bits are very

very different because all of us are so

different and what feels like it would

be great to one person might seem nuts

to another but it's like we all

understand our bodies and we have a

sense of what our pain is and somehow

even intuitively we kind of feel like

once we see it we know it might work and

so once people do these 30 days they

kind of I walk them through the last

couple chapters of kind of building a

step-by-step kind of slow thriving plan

but ideally they may already be

experiencing some improvements by trying

some of the things just along the way

right yeah and they pick and choose and

figure out what works for them

regular basis that's awesome so where do

you see the science of pain management

going in the future where would you like

it to go and where do you see it going

so

um

well it it is the science of pain

management also the science of treatment

so what we knew before the opioid crisis

is the best way to care for people with

chronic pain was to give him a really

rich interdisciplinary treatment setting

right so they get a really good

evaluation by a physician by a um by a

physical therapist by somebody in the

behavioral sciences to help them you

know identify things that they can do

better

um uh I'm just nursing just a whole

group of people occupational therapy and

just to say okay this is kind of where

you are we get a sense of where you're

telling us where you want to go let's

work on this and so this really good

team that adds many different pieces

from the behavioral things getting

people exercising again and maybe

dealing with a depression if it's there

getting people into a fresh medication

starting something new getting people

into physical therapy so all these

things happen that's what used to work

then the opioids came along and most of

these programs were no longer

sustainable they you know they they

stopped being insured they stopped being

covered and so the Panacea was to give

people pill and send them on their way

what was missed is that sometimes the

chronic pain was due to so much more

sometimes it was due to stressors and

our situations or you know everything

from persecution to Childhood trauma to

um to to an injury that was intrigued

rights I mean so many things and in each

really meeting a very personalized

approach and so that's where I hope we

go again everything new is old again

getting really multi-disciplinary

getting a really good take on the person

setting them on a really good course and

then giving them what we call pain

self-management which is basically what

my book is is okay we've done all this

these are things you're going to do for

your health and it's just like all the

things that we should do for our health

anyway that you know we should get a

little exercise we should eat well we

should try and meditate a little bit or

be peaceful

um yeah yeah absolutely I love it what

have I not asked you that you want to

make sure you leave about audience

oh my goodness you know we we haven't

talked about something that is that is

so important to to many people with

chronic pain as we're talking about the

kind of the opioid question so

um

it you know it's thorny for people with

chronic pain because many people with

chronic pain have benefited from taking

opioids and then the CDC came in and

changed the recommendations and then

people lost access

and many people suffered and so

I worry about those people I think a

more sane approach is having each person

who's been on chronic long-term opioid

therapy with chronic pain do an opioid

experiment which consists of with your

physician

slowly tapering off opioids you may be

using some other medications to help and

some other modalities to help and then

give yourself a month to see where

you're at and what we see frequently is

some patients have terrible pain and

need to get back on their opiate spine

but most patients will say after about a

month oh my gosh I am so much better my

pain is better I think I had a seven out

of 10 on on pain and opiates I thought

I'd be at 22 or something but it's

better and I can think and I can I can

my emotions are back and I just feel so

much better and so the opiate experiment

I think has been a really great a great

novel thing to do so we can see where

we're at and if you get to the other

side and then can start exercising and

hopefully do some self-management

practices so that's something I think is

important for us to talk about I love

that I love how integrative your

approach is that you're really looking

at all aspects of the case and so try to

bring it all together yeah well we're so

unique absolutely absolutely where can

people go to learn more about you and to

find your book oh thank you for asking

um my book is available on Amazon Barnes

Noble Target every place including

independent bookstores please ask for it

but Afton hassett.com my name

a-f-t-o-n-h-a-s-s-e-t-t.com is my

website

um you can get access to the book there

but I also have a podcast which is

really fun we just started that and we

have

um all sorts of resources that support

the book like mindfulness and breathing

and and other things so please please do

visit I'm always delighted to welcome

more people to our website into reading

the book awesome very cool I will link

to that in the show notes thank you

often this has been fantastic really

appreciate your time thank you I've

really enjoyed speaking with you and

getting to know you a bit too I'm sure

are you looking for a holistically

minded Healthcare practitioner who truly

treats root cause rather than symptom

suppression unfortunately even in the

alternative healing professions this

isn't a given that's why I've created

wholehealthdoctor.com a resource to help

connect patients to healthcare

practitioners in their area who share a

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of the practitioners listed also

practice Telehealth so if there isn't

anyone local to you you can still find a

great practitioner to help you regain

Optimal Health go to

wholehealthdoctor.com that's

wholehealthdr.com type in your location

or adjust the specialty that you're

looking for and find the practitioner

who's right for

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