Full Transcript Introduction to chronic pain and the guest 0:10 Hey friends, I'm your host, Dr. 0:13 Elizabeth Samana, the intuitive psychiatrist, and you're listening to Stepping Into Soul Power. 0:18 Friends, here in the United States, we are going through it. 0:22 As far as chronic pain is concerned, about one in four adults struggle with chronic pain here. 0:32 And people are turning to all kinds of things, opiates, cannabis, like there's a lot of stuff out there. 0:39 We're so quick to jump to a medication, but what if our chronic is asking us to dig deeper. 0:49 What if there is a message to hear? 0:51 And our next guest is our board certified physician in internal medicine and gastroenterology. 0:57 He is the founder of Association for the Treatment of Neuroplastic Symptoms. 1:03 Has more than three decades of experience where he has been helping to revolutionize how we understand pain. 1:11 Dr. 1:11 David Clark, welcome to the show. 1:14 Great to be with you, Dr. 1:16 Samantha. 1:16 Thank you. 1:18 There's a story. 1:19 Somehow you got here. 1:21 How did you get to this point where you are really standing out in medicine and helping to change the way that we're thinking about treating pain? 1:34 Yeah, it started a long time ago, actually, when I was still in my formal training years. 1:40 And like you, I learned that when there's pain or illness, that must be from an organ disease or structural damage. 1:48 That's what we were taught to look for. 1:50 But it turns out there is a huge category of people that have pain and illness with their bodies being structurally sound with no disease.
How brain-generated symptoms changed Dr. Clark's career 2:01 Those symptoms which are completely real are generated by the brain. 2:06 There are actual physical changes in the nerve pathways in brain that are producing real pain or illness anywhere in body, 2:15 literally from head to toe. 2:16 Migraines, ringing in ears, visual disturbances, dizziness, pseudo seizures, trouble swallowing, certain kinds of rashes, 2:26 fibromyalgia, irritable bowel, pelvic pain, bladder spasms. 2:30 A joint pain, pain in the spine, I should have led with that because that's one of the numerically largest numbers. 2:37 Chronic fatigue, certain cases of long COVID, brain fog, the list goes on and on. 2:43 The only common denominator is that people tend to have more than one symptom at a time. 2:48 According to our recent national survey, The average was almost three symptoms at at time These people go to the doctor and they get diagnostic tests. 2:57 No organ disease or structural damage is found and typically the physicians are throwing up their hands and there telling the patients or at least thinking 3:05 that the patient have this all in their heads and their imagining it and or their neurotic or mentally weak or though it turns out none of that is true. 3:14 These symptoms are real. 3:16 The patients themselves are atleast as mentally strong as anybody else. 3:20 They're just carrying a burden of stress that is significantly greater for most of them than even they realize themselves. 3:29 I didn't know any of this through the first seven years of my training. 3:33 It was very traditional, Western-oriented. 3:36 And I was successful in that world and two-thirds of patients, that's exactly what they had. 3:44 The other one third were initially medical mysteries. 3:47 It was very surprising to me to get to my eighth year of formal training. 3:52 As you know, you've been through this. 3:54 The training goes on for a long time. 3:58 Year eight, I encountered a patient I didn't know the first thing about diagnosing or treating. 4:03 which you're not supposed to encounter somebody like that when you are eight years in. 4:07 But she was averaging one bowel movement per month, despite taking double the usual doses of four different laxatives every day. 4:17 She'd already been evaluated by another university. 4:20 They couldn't find anything wrong with her. 4:22 they sent her to us at UCLA for an additional highly specialized test. 4:27 That was normal also. 4:29 So it was left to me to do her exit interview. 4:33 Essentially, I had to tell her she was going to have to live with this. 4:36 We didn't have anything else to offer, but the conversation continued for a while and eventually she trusted me enough to share that she had been sexually 4:46 abused as a girl by her own father numerous, numerous times. 4:50 That had stopped happening when she 12. Now she's 37 and she has had this condition for two years. 4:59 It's embarrassing to admit this as a physician, but I had no training in what to do with that information. 5:04 I'd never been told that it might be relevant to uncover it. 5:07 But at least it gave me the idea of getting her an appointment with a psychiatrist who happened to be also certified in medicine and had an interest in 5:17 these brain to body conditions. 5:19 And I thought, okay, well, maybe the psychiatrist can help this patient live with her condition a little more successfully. 5:26 And I forgot all about her after that until I ran into Harriet Kaplan, the psychiatrist, in an elevator three months later. 5:35 And this was the elevator ride that changed my career because between the ground floor and the fifth floor, I found out that she had cured this patient 5:45 with basically 10 sessions of weekly counseling. 5:48 And that just shocked me that you could alleviate a serious physical condition just by talking to somebody. 5:55 You psychiatrists can't do that, can you? 5:58 She did. 5:59 So I thought, okay, if I'm going to be a complete doctor, I should learn a little bit about how this was done. 6:05 Next year and a half, I learned from Harriet a basic framework. 6:08 I started using it when I got into private practice in Portland, Oregon. 6:12 There wasn't anybody else up here doing that work. 6:16 I was getting good outcomes with patients, patients who were being failed by the rest of the healthcare system. 6:22 They were improving when I used this framework and I learned more and more by doing it. 6:28 And today it's now, you know, 40 years later, 7,000 plus patients.
What treatment looks like for neuroplastic symptoms 6:33 Tremendously rewarding work for me personally. 6:36 I spend my time now teaching all over the world for other physicians and the public how to do this. 6:43 It's been very successful. 6:44 And there's now research too. 6:46 We've got randomized trials published in prestigious journals like JAMA Psychiatry and coming from leading research institutions that show that this can 6:58 be dramatically successful even when rigorously studied. 7:02 So, sorry, long-winded answer, but it was quite a turnaround for me early in my career. 7:07 For our audience members who don't exactly know what that entails, can you give us a brief description of what treatment looks like? 7:17 Yeah, absolutely. 7:18 For people that are curious about whether their own pain or illness is connected to this, at Symptomatic.me, the website, 7:25 we have a 12-question screening quiz that comes with some explanatory information about it so people can get insight into their personal conditions. 7:35 But when we don't find organ disease or structural damage, I start looking for sources of stress in a person's life. 7:42 It could be anything bad that's happening to them right now, whether it's domestic violence or stress in the workplace or any of a range of other possibilities. 7:51 I want to make sure also that we don't have a hidden case of depression, anxiety or trauma going on. 7:58 Some of my patients have been through really bad traumas right before their symptoms began and they've got PTSD symptoms that nobody is aware of in connection 8:07 with this and you have to know to go looking for those things. 8:10 So all of that can be treated. 8:12 Once you see the connection between a stress in somebody's life or depression or anxiety or trauma, we can address that directly. 8:20 The more challenging ones are people who had adversity as children, like my very first patient. 8:26 I asked my patients to imagine a child of their own or another child that they care about growing up exactly as they did. 8:34 And if you imagine that happening, are you going to see anything happening to that child that you care about that would make you sad or angry to witness? 8:42 Because if did, that might still be having an impact on you today. 8:46 It can lead to stressful personality traits like perfectionism or people pleasing or neglecting your own needs or choosing relationship partners who are toxic. 8:57 It can also lead to strong negative emotions that are largely unrecognized and that can be manifesting in your body as symptoms. 9:06 And it can lead also to triggers, people, situations or events that is highly stressful for you because they are in some way connected to the past. 9:15 So by identifying all of these issues, bringing them into conscious awareness, usually the treatment from there is pretty standard, 9:23 you know, something that you do in office every day. 9:26 So that's not the challenge. 9:28 The challenge is uncovering which of the many mental health stresses are connected to the person's symptoms. 9:35 And sometimes it's very simple. 9:37 One of my patients, the only time he got his pain was when he was driving to work. 9:41 When he driving home from work, he fine. 9:45 So we investigated what was happening in his workplace and he had a huge stress going on there that had been happening for the same period of time as his pain. 9:55 And as soon as he saw that connection, he hadn't put it together before then. 9:59 As soon he as saw it, went to his supervisor, said we got to make some changes and symptoms initially just got better and then eventually went away. 10:07 So in the world of psychiatry, you see a lot of pain, a LOT of PAIN. 10:14 But in our culture, if they don't take a med, they feel like they're getting treated. 10:20 So what do you have to say to those people? 10:24 Yeah, a lot of the patients have come to me and they're already taking pain medication and I'm perfectly happy to have them keep taking it, 10:32 but I am also identifying the sources of stress, past or present, that are responsible for their condition and we begin treating those issues and helping 10:42 people make changes in their lives to bring the stress level down. 10:46 And as they do that, their pain is going to improve and their going be able to taper down the medication that they are using. 10:53 And I don't force people to do that. 10:57 They just do it naturally when they start feeling better. 11:00 One of the more dramatic examples was a 17-year-old girl with unexplained abdominal pain for two years. 11:07 I was asked to see her after six other gastrointestinal specialists had seen her and not been able to find a cause for her pain. 11:15 This was on her 70th day in the hospital. 11:19 She was getting 250 milligrams of morphine by PCA pump around the clock, which is for your listeners who are not familiar with morphene doses, 11:29 five or 10 milligrams would be enough to alleviate the pain of a fractured leg.
Medication, trauma, and real-world recovery examples 11:33 And she was giving 10 mg every hour. 11:37 And it was all connected to stress. 11:40 I was able to identify an issue in the family that, you know, everybody in this family was doing the best they could, but there was a major stress happening 11:50 that they just weren't dealing with in a best way. 11:55 And by helping them to change how they were managing it, the patient was able to start turning down her own morphine dose. 12:03 And she went home from the hospital on opioid tablets after a week and started weaning those down. 12:11 30 days after we met, she was not taking any medication at all. 12:16 Now that's, I remember that story because it's a very dramatic improvement. 12:20 There's another patient of mine after 20 years of therapy, her morphine dose went from a 200 milligram equivalent down to about 60 after twenty years psychotherapy. 12:31 So that was a measure of just how traumatized a person she was. 12:36 She was doing her best, she getting good therapy but it was just a long slow process for her. 12:41 It sounds like you're saying the results can vary depending on whatever the individual's situation is. 12:48 Yeah, the level of trauma they went through, their own resilience abilities, lots of factors that come into play there. 12:56 But many of my patients, they weren't really taking much in the way of medication. 13:01 They were just simply looking for answers and hadn't found them from the traditional biological approach to pain and illness. 13:10 But when we start talking about sources of stress, frequently they were quite obvious. 13:16 A patient that was described to me by a colleague in Arizona, she was going from doctor to doctor for six months and he was the one who found out that 13:25 right before she became ill, that she had been a hostage during the robbery of a store. 13:29 And for 40 minutes, she had a handgun pointed at her neck. 13:33 And she has all kinds of post-traumatic stress symptoms after that, one of which was the physical symptoms. 13:40 But she never thought to mention that she'd gone through this trauma. 13:44 He knew specifically to ask about events like that in people's lives, and that's when the story came out. 13:52 There's this huge delay in people getting the health that they need. 13:56 Why do you think that it's so hard for people to make that link? 14:01 That's a great question. 14:02 I think as a society and I include the healthcare profession as part of that society. 14:10 We have a belief that pain and illness are linked to organ disease or structural injury. 14:16 And the idea that your brain can do this to you as well can create real symptoms in your body. 14:22 It's just a foreign concept. 14:26 generally known to the public, just how prevalent this is. 14:32 25% of the general public is 40% percent of everybody who goes to see a physician. 14:38 So it's on the order of 60 million people in the United States alone that have this. 14:44 And there just is a lack of awareness and a lot of training by medical and mental health professionals. 14:52 We medical professionals don't learn the questions to ask of somebody when their organs and structures turn out to be fine. 15:00 And mental health professionals don't learn what kinds of questions of people who are physically ill. 15:06 Mental health professional know about all the mental issues, but when they're client also has physical symptoms, they kind of draw the line, 15:16 and they are not crossing that line. 15:17 They are leaving that to the medical professionals. 15:21 When the medical professionals have ruled out a disease or injury, then that's when the mental health professionals can step in and they can say, 15:29 look, this is brain generated, and that means that it's coming from stress or trauma or emotions or adversity in childhood or other challenges in life. 15:38 And that is absolutely in your wheelhouse. 15:43 issues that are a little different than you would get in a patient who's got primarily a mental health concern that they're coming to see you about. 15:51 But the physical symptoms in these patients, they are kind of a form of communication. 15:56 The mind is trying to stay something here. 15:59 And if you can learn to read what that message is, you're going to understand your clients a lot more deeply. 16:07 Yeah, you mentioned a couple of different things. 16:10 Culture also plays a big part in this. 16:14 In the United States, for some people, it can be very difficult to even admit to any sort of mental health issue. 16:23 It's tough. 16:25 Yeah. 16:25 And it absolutely is. 16:26 I see that the most in my male patients who have come from a childhood adversity environment that Those environments very often have the effect of making 16:38 people feel like they're second rate or that they are not measuring up or they were worthless. 16:43 And if you are a person who is different in any way from the majority of people around you, that can contribute to that. 16:54 So if you're a person of color or you are LGBTQ or your neurodivergent or a large person, all of that can contribute to this wounding of your self-esteem. 17:05 So that when you then try on top of, that to tell somebody they've got a mental health issue, my male patients in particular are fighting against that. 17:15 That's the last thing that they want to hear that, they got an additional problem or issue on, top everything else that there. 17:23 feeling about themselves. 17:24 So I try to reassure people that if you've been through these challenging adverse experiences, that you have actually demonstrated heroic perseverance
Why chronic pain is misunderstood in medicine and culture 17:35 in many cases. 17:37 If you imagine a child of your own growing up like that, you'd be telling them, wow, look at what you overcame. 17:44 It's as if you were parachuted into a dangerous jungle as a toddler and you somehow found your way out of there. 17:51 You deserve tremendous credit for that. 17:53 My patients are like in many cases, in most cases they're like Olympic weightlifters who've been asked to carry 50 pounds more than the world record for 18:03 their weight class. 18:04 Anybody's body is going to break down. 18:07 under that kind of a load. 18:08 But we as mental health professionals can teach them how to put that load down. 18:15 And when they do, not only do they feel a heck of lot better, but they realize how strong they have been all along. 18:21 So beautiful. 18:22 Because in many ways, you are helping them reframe the story that they're telling themselves to tell a more empowered story. 18:31 Yep, that's absolutely right. 18:34 Stepping into soul power, as you might say. 18:37 People who've been taught the opposite, their failures. 18:42 A simple example, a patient of mine Age eight, she is trying to treat her father's alcoholism by hiding his liquor bottles. 18:50 And of course she fails. 18:52 He finds the liquor bottle, he gets drunk, loses his temper, and she feels terrible because she has failed yet again to successfully treat his alcohol. 19:03 She grew up feeling close to worthless from that. 19:07 I had to try to teach her that in fact through no fault of her own she had found herself in this highly challenging environment and she has coped with 19:18 it extraordinarily well and should think of herself as heroic for having done that. 19:23 Completely 180 degree flip in the way it was framed. 19:29 Yes, that is powerful. 19:31 I do want to go back to something that you said. 19:33 You said male patients, like they fight against, they're fighting against it. 19:42 And what are the things that need to change so that there's less of a fight? 19:49 Yeah, it's so important. 19:51 And men really struggle with this. 19:54 In our society, they are asked to feel strong. 19:59 They're asked feel like their emotions are not going to bother them. 20:06 Asked to be tough under extraordinarily difficult circumstances. 20:13 What I try to do is help them realize the reality of what they went through. 20:20 I recall speaking to a man earlier this year, just went through absolute hell as a kid. 20:28 Just one example was that his father used to make he and his brother fight with each other all the time just to see them fight. 20:37 Obviously a horrible situation, but he wasn't fully recognizing the magnitude of it. 20:42 He was trying to tell me it wasn' that bad. 20:44 It was just one of those things that happened. 20:47 That didn't affect me that much. 20:49 So, I asked him to imagine if his own daughter was growing up, he had a 10-year-old daughter, asked them to image her in that environment and what it would 20:58 be like if he was a butterfly on the wall of his childhood home and had to watch her try to cope with that. 21:05 He was horrified. 21:06 You could see his facial expression change, the idea that he wouldn't leave his daughter in the home for five minutes, let alone for 18 years that had 21:16 been through there. 21:18 really gave him a different perspective on the difficulties he'd been forced to overcome. 21:23 The purpose of his imagining this was not to re-traumatize him, it was to help him see, as I mentioned earlier, the heroic perseverance that it took to 21:33 survive in that and to give himself some credit. 21:36 Because when you can give yourself that foundation of self-esteem, it changes so many other things. 21:43 It takes the pressure off you to be perfect. 21:45 it alleviates the tendency to to extremely self critical. 21:49 Reduces the possibility that you're gonna be in relationships with toxic people. 21:54 Because you gonna feel like, you know what, I deserve not to in relationship with people who who think I showed heroic perseverance back in the day. 22:07 And it's going to give you the strength to set boundaries.
Reframing childhood adversity and setting boundaries 22:09 You know, his father was still in his life. 22:11 His father were still toxic and causing problems. 22:14 But this floor and foundation for his self-esteem gave him the power to say, I am not going put up with this man to the extent that I have in past. 22:25 And all of those things helped him to feel physically better, to alleviate the physical symptoms that he was suffering, which were numerous and severe. 22:34 So it sounds like you're saying, like, in addition to reframing how you look at the story, this particular individual started to maintain healthier boundaries. 22:47 Yeah, absolutely. 22:48 That so many of my patients, somebody who mistreated them when they were kids is still in their life as an adult. 22:54 And they've never had the ability to set boundaries with that person because when we were growing up, they we're dependent on that. 23:02 So they had to interact with them and try to cope as best they could. 23:07 Now, as adults, if I can empower them to say, look, you deserve better than this. 23:13 You deserve to have this person be so toxic towards you that they're making you physically ill and to set some boundaries so that you don't have your physical 23:23 pain or illness anymore. 23:24 Yes. 23:25 And it strikes me that not only does there need to be change as individuals, but we may need what it means to be a man, that you are allowed to have feelings. 23:42 Yeah, absolutely. 23:43 So many of the feelings, both by men and women, get buried. 23:47 When you're in a toxic environment as a kid, you don't have much choice. 23:51 If those emotions start coming up, they're not going to help you if you are in toxic or adverse environment. 23:57 And so kids learn to take the emotions and bury them. 24:01 Part of that treatment process, as you know, is to connect with those emotion. 24:08 That exercise of imagining yourself watching your own kid try to cope with your childhood environment, that can bring up the anger or fear or shame or 24:20 grief or guilt or all of the above and you can finally start to feel some of those things. 24:28 the child you care about that you're imagining and then transfer those feelings to where they're really coming from, which is yourself. 24:36 And then you can begin to put them into words. 24:38 You can speak them to your psychiatrist or write them in a journal or speak to a loved one. 24:44 The more you put those feeling into the words, the less they need to go into your body in the form of symptoms. 24:56 Many people struggle with, there's a book in psychiatry that a lot of people read that the body keeps score. 25:05 People suppressing their emotions is very common. 25:11 I think sometimes the hardest thing to do is to let go of these emotions. 25:18 And you described using writing or talking as types of release. 25:25 Yeah, absolutely. 25:27 Putting them into words is, to me, a necessary step before you're able to move beyond them. 25:34 You have to first feel them, and then you have express them in words. 25:39 And then once you've got it all out there on a piece of paper or a computer screen, then it's possible to potentially, not always, 25:51 but potentially to forgive the person or people who created the emotions in the first place. 25:58 Something else that comes up in a lot of patients who struggle with chronic pain is this feeling of being powerless. 26:07 And I wonder for you as a physician, are there practical mindset shifts that you think will help people who just feel like I've tried everything, 26:20 these people aren't listening to me, I give up? 26:24 Yeah, if you're focused on other people, then yes, very often the other, people are not going to change. 26:33 They are. 26:33 Going to reconcile with you, they are, not, going, to apologize for the transgressions they've committed. 26:41 That's the usual outcome. 26:42 they, are dealing with their own issues that are too powerful for them to enable them, Patient, you have to recognize that that is part of the burden that 26:58 you've been carrying around. 26:59 When I was talking about Olympic weightlifters carrying more than the world record around on their shoulders, that's part that weight. 27:08 And part recovery from the physical symptoms is taking that wait and putting it down, which when it comes to other people is recognizing that they were 27:18 part the jungle that your parachuted into as a toddler. 27:21 and that you should give yourself tremendous credit and recognize your own power of having made your way out of that jungle. 27:29 And you're just going to have to leave certain people behind in the jungle as you move on. 27:35 Well said, well said. 27:38 Dr. 27:38 Clark, I know that our audience is going want to connect. 27:42 Can you tell us how they might go about doing it? 27:47 Well, we have wonderful resources available at the symptomatic.me website, starting with that 12-question self-assessment quiz.
Resources and closing remarks 27:57 But we've got a podcast of my own called The Story Behind the Symptoms, where I interview patients, much as I used to do in my office for many years. 28:07 We've got recorded conferences. 28:09 We have got courses that have been recorded. 28:12 If you become a member of the AT&S, you can attend monthly Q&A sessions where experts will answer your questions. 28:20 And we've one coming up for the general public that anybody can come to, whether they're a members of AT & S or not. 28:27 I believe that's on December 8th. 28:29 and you can find out the details there on symptomatic.me. 28:33 So lots and lots of resources to help people with this condition. 28:38 Well, Dr. 28:38 Clark, it was a pleasure having you on the show. 28:42 Thank you so much for being a beacon of light in the field of medicine. 28:49 It was an honor to have you. 29:02 If you haven't heard it yet today, I appreciate you. 29:06 The soul in me honors the soul and you if you'd like to see more episodes like this, please subscribe or click here. 29:14 And friends, if this spoke to you, leave a comment below. 29:19 We would love to hear from you
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