Trailer: About this podcast
Automated transcripts of the episodes are below in chronological order.s
Episode 1 (aug 8, 2021) : Explaining the pain (solo)
Explaining the pain
[00:00:00] Pain is some serious business. It ain’t everyone who knows what to do about it. Now I hear there’s a podcast just about this. It doesn’t talk of pain alone, but other interesting things distracting the mind from it. So I suggest you tune into Outsmart the pain and listen to what Karsten has to say about it. Get ahead, get it done. Listen to the podcast and maybe change your life or someone else’s.
Karsten: Hi, and welcome to outsmart the pain and this episode explaining the pain. I’m Karsten Ahlbeck a pain physician who wants to share my knowledge and experience with you. You know, one in five people have persistent pain. So if you have pain and feel alone with this ,because many people do, you are not. In [00:01:00] Sweden there would be 2 million people with persistent pain .In the U S that would be like 60 million? Most people call long-term pain chronic. Since the word chronic often says that it is irreversible, we would rather like to call it persistent pain .In Swedish it is långvarig smärta instead of kronisk smärta. The thing is many professionals I talk to say it should be called persistent and they persist in calling it chronic. But I will call it persistent throughout this podcast. And it is the same thing as chronic. So now, you know, I will get back on this persistent thing, but for a better understanding, I will now go through the pain system we have as a whole.
It will be explained in the same way I explain it to my patients. And since the feedback has been only positive, I will stick to it. Now a part of this [00:02:00] explanation would be to draw a very simple image of the brain. It’s hard to draw it in a podcast. And I can’t expect that every listener bought my book either.
I will do my very best to explain it accordingly. But for your support, I have included it on my webpage karstenahlbeck.com under the podcast menu .Here, I will add some useful stuff to my talks. And if you´re driving. Please do not look that up right now, but do it later as a repetition or something. Now just relax and listen. You will now get three types of pain explained. Let’s say you fall from a bike and hurt your knees. Scraping them, real bad. The pain you get tells you either not to get back on the bike immediately, or to be a better biker next time. If you break a leg have had surgery [00:03:00] or just got muscle soreness after exercising, you can get that type of pain, which in jibberish is called nociceptive pain.
It’s also called tissue pain. And when I explain it to my patients, I simply call it muscle skeletal and joint pain to make it easier to grasp. This definition of my own does not really include other forms of tissue pain, like inflammatory pain, but it’s good enough to use for my patient meetings. So one type of pain is the muscle skeletal and joint pain. Another type is neuropathic or nerve pain.
This can be a little bit trickier to understand. First of all, since nerves transmit all senses we have, would not all pain be considered being nerve pain?. Well, no. Because we are not talking about working nerves, doing their job but nerves which are damaged in some sense. And this damage could be central or peripheral [00:04:00] .Central meaning inside the brain, for instance, after a stroke or during an MS disease. Peripheral meaning any nerve outside the brain. Could be a completely cut nerve after an amputation or badly functioning nerves along with diabetes, where you may be also don’t feel your feet properly. A so-called polyneuropathy. It can be hard to diagnose nerve pain because there is no imaging which can prove you have pain coming from a nerve.
An MRT scan can look perfectly normal and someone is still describing a typical nerve pain, very accurately. And sometimes a doctor might wander how much pain this person must have with a back showing all those changes on an x-ray. And there is actually no pain at all. A lab test can show if you have a vitamin B deficiency or that you drink too much alcohol. [00:05:00] Two conditions we know can worsen nerve pain. But it does not prove that you have pain.
The characteristics of your pain does not prove anything either. Even if you describe your pain as shooting burning fire, walking on glass, running ice cold water down your leg or something else, it is not proof. It comes from a defective nerve. For example, if you have a soccer player falling on the ground due to muscle cramp, although I think they sometimes fall just because the referee is close enough, but that’s not really important is it .Anyway they might describe it as burning like fire, but in this case we know it is 100% muscle pain, right? Since nerves have a distinct area of the body they are in charge of ,a defective nerve can make pain in that whole area. Often the nerve has a so-called representation of the skin, meaning [00:06:00] that if you have, for instance, a disc hernia affecting the lumber disc number four, you would have pain or numbness below your knee on the same side as your big toe.
Not your arm, not your hip, not the outer side of your leg, but then you could have a pain in this area because of other reasons, too. So it can be a bit harder to know exactly where the pain is coming from as opposed to tissue pain. If you are interested in seeing which areas of the skin that are represented by these nerve levels, you can go to my webpage and look for the notes on this episode of Outsmart the pain.
So now we have talked about two types of pain, the nociceptive pain also called tissue pain, or in my words, muscle skeletal and joint pain. The other type is [00:07:00] neuropathic or nerve pain. Why should we know the difference then? I mean, pain is pain, right? Of course not. What did you think. I will only touch on this very briefly in this episode.
But if we talk pharmacology that is like pills, the medication for the tissue pain is something completely different than for nerve pain. For tissue pain you have, for instance, paracetamol or acetaminophen, anti inflammatory drugs, muscle relaxants, and opioids like morphine, which could work. None of these meds will help for nerve pain and for nerve pain, not too many drugs have actually been developed against pain, but science found out that some substances worked for pain too.
Therefore, it might seem a bit odd, but the best drugs we have against nerve pain are antidepressants and anti epileptics. That means that medicine, which was made for [00:08:00] depression also might work for nerve pain, regardless of you being depressed or not.
I have many patients who said they were offered an antidepressant, but said I did not take it because I’m not depressed. Well, dear listener now, you know, more than many why these tablets are being offered. Also, there are anti-epileptics, which originally were made against epilepsy, but work against nerve pain.
Also, if you use TENS, trans cutaneous electrical nerve stimulation, which is small patches put on the skin and a weak electrical, current is being sent through them. If you have a tissue pain in the thigh, you probably put the patches right onto the hurting area. If you have the same thigh with pain, but now a nerve pain, putting an electrical current in the middle of it may make things a bit more hurtful.
You do not destroy anything, but it hurts. So you do not [00:09:00] want to use that method again. But what you should have done is to put the patches a bit away from that area, or maybe on your lower back or even on the opposite thigh. So before you get pain treatment, You really need to know which type of pain it is . Now here comes something really important.
Listen carefully with explaining these different types of pain. It really means that intensity has nothing to do with treatment. Listen, again, intensity has nothing to do with treatment. Let’s say you go to the doctor and you say, doctor, I have a sore throat. And the doctor examines you and sees that you have a bacterial tonsillitis, so you will get antibiotics.
And then you tell the doctor, but doctor my throat really, really hurts a lot. And the doctor says, okay, [00:10:00] I will give you a lot more antibiotics and stronger too. Now, you know, it doesn’t work that way, but in pain, many people, including doctors tend to think that the more pain, the stronger medication you need.
But like I said, if you have tissue pain, anti-inflammatory drugs can help. They will not help in nerve pain and not even morphine will do unless you really get high doses, which has other side effects so to speak. In the nerve pain case you need antidepressants. Unfortunately many people have seen the pain ladder, which is just that: more pain, more medication, but it is not accurate.
Please forget the pain ladder. First, find out which type of pain you have.
So the two types of pain I’ve talked about are tissue pain [00:11:00] and nerve pain, and they are more or less working in an acute or emergency system. Now we turn to the third and last type of pain, persistent pain. Now we are actually moving away from the tissue and nerve and talking time. Strange, right? But it has its reasons.
If you are looking at the brain picture on my webpage, we have now left the left side and gone to the brain in the middle and later on, we will go to the right side If you don’t understand what I’m talking about. Uh, bear with me. The definition of persistent pain is having a pain more than three months.
The reason for this is not that something happens after ninety days, but when you want to compare groups in research, you need to have clear cut limits. So someone having had pain for at least three months has a persistent pain and someone who has had pain for [00:12:00] three weeks has not. Although there are many good theories out there we are not completely sure why some people develop persistent pain. Some never get pain free after surgery, regardless of its being successful or not. So in that case, something probably happened early on in the pain system and not after three months. Others of course have multiple surgeries and never develop a persistent pain.
It’s really an enigma, isnt it. Why did I draw the brain in the middle of the picture? Well, just like the eye, just letting in light, which is converted to electrical signals, transmitted through the optical nerve, to your brain where the image actually is processed and produced the same goes with pain.
The pain is not created in your fracture. It is created in your brain. In a very biological sense, do not confuse this with making up the pain or some other rubbish. [00:13:00] So now we’re getting into some really interesting brain mechanics, let me tell you. Let’s say you have a tissue or nerve pain in your foot. Of course, there is not one single cable running from your foot to your brain.
The signal is transmitted via your spinal cord and finally ends up in your brain. Here it passes many different areas which have other functions than processing pain. We do not know why pain needs to pass these areas, but it does these areas are for instance called the limbic system the periaqueductal gray and hypothalamus.
If the brain is fed with this pain day in and day out, sometimes it will just be too much for it to process. It needs to prioritize what it’s supposed to process and what not [00:14:00] I think that a hundred thousand years ago, the pain system was really, really important. If we got hurt, it was important we got away to a safer place or that animal would eat us.
Maybe we didn’t even have persistent pain because we did not live that long. The brain was not made for long-term pain, but was on high alert for the acute pain. Nowadays, if we get hurt, we can call an ambulance or make a call to get some good advice from a health care line. But the pain system is still as active as it always has.
And now it can continue for longer time because we did not die being food for the lion. So even if , we logically can understand that the pain I have today does not differ from the pain I had yesterday or last week, our primitive part of the brain does not understand this. If it feels like a knife, it probably is a knife and you need to get alerted.
[00:15:00] This means that when the brain needs to prioritize what to handle when it gets overwhelmed, it will not downgrade pain. It will keep pain right at the top where I think it should be. Always ready to tell you it hurts. Instead, it will downgrade other function that these different areas in the brain have.
Therefore just because of a biological priority in the brain, some functions will not work as before. And someone with persistent pain will change. The most common things they discover is that they have problems concentrating. They forget things, they get less sex drive, they can’t sleep and their mood changes . They more easily get angry or even depressed. I will have a separate episode talking about persistent pain, how it works and how to treat it. So here I will just touch on it very briefly. But the thing is persistent pain can change your [00:16:00] personality and this is not imagination or you’re getting crazy, although your surrounding and finally you yourself think so. It’s a real biological change thats occuring in your brain. It’s not destroying anything. It’s just prioritizing. When your pain gets better, these things will get better too. But if these changes also persist for some time, they can actually become bigger issues than pain itself. Many times when I ask patients who come for pain treatment what their biggest problem is, it’s not pain anymore.
It’s sleep, or maybe an anger issue. It can be economical problems because of not being able to work and so on. So even if I could make the pain go away with a Harry Potter wand, These other things will not. Therefore you also understand that there is no magic pill against persistent pain because of its complex nature.
Many people can start their path to a [00:17:00] better life just by knowing what to do, but some need help from the health care system, what we usually call a pain rehabilitation. So even if your pain started with a very obvious reason, a tissue or nerve damage, for example, if the pain has become persistent, the characteristics of the pain become more….. foggy.
It can feel just like in the beginning. The thigh hurts just like when you first hit it in the car accident, but now the medication does not help anymore. How is this possible?
Well, now we’re turning to the third part of the pain system. But first, a 20 second repetition. We have an acute pain system being tissue or nerve pain. We have a brain which processes pain that might need to prioritize [00:18:00] different functions if it’s being overwhelmed and pain will unfortunately be prioritized.
The brain wants to warn you, but it actually wouldn’t need to The third part, the right side for you who are following my drawn image is actually a system called the pain filter. It’s something we all have, and it’s supposed to filter out unnecessary pain. Let’s say your cordially invited to one of my lectures.
Suddenly I slap you because I’m crazy. You get the pain, look at me understand that I’m kind of strange and you leave the lecture after doing that eye for an eye thing. The brain has warned you about me, but you do not need to keep the pain to get reminded after a year or so on my somewhat dubious lecture techniques.
So the pain filter takes care of that. Now then, if you have pain, which is there constantly every day, this system can become fatigued. It cannot [00:19:00] withstand all pain signals, like in nets, not catching herrings anymore because they can escape through the mesh, which has become larger. How is this noticed by the person having persistent pain?
First of all, the pain is spreading. It can start in a knee, but then goes to the hip, the hip on the other side, other joints, maybe muscles, and maybe finally the whole body. I quite often see that healthcare tries to explain this by some kind of uneven load on your body. You have pain in your knee, so you’ll walk strangely and get pain in your hip.
Okay. But does this explanation work when you get pain on the upper part of your body, your elbows finger joins your neck, et cetera. How awkwardly do you actually walk Monty Python silly walk? I think our human body has been developed quite well to withstand small changes in posture actually .Another thing I [00:20:00] sometimes hear is that you measure the length of your legs and find out that one is longer than the other.
And this is the cause of your pain. And how long have you had this difference in bone length? Did one side suddenly grow or the other side shrink and therefore giving you pain? Hm, I don’t think so. The reason pain is spreading is that the overall pain inhibition system in the body does not work. The pain has started with something very real.
Sometimes, you know what happened and sometimes you don’t. The pain has weakened the pain filter and when the tissue or nerve is working properly, again, strangely enough, you still have the same pain. This means that the medication or treatments you used in the beginning will not work at this time. And you will not even find the reason since has all been healed. The problem is in the brain and it has nothing to do with imagination. [00:21:00] It is a weak pain filter we’re dealing with. So, what is the pain filter then? Well, the substance, is nor adrenaline also named nor epinephrin. It is not possible to measure this in humans. So there is no way at this date to find out the levels of pain filterin your body. Again, a short repetition, since you’re listening and not reading. An acute system can be divided into tissue and nerve pain.
The brain processes, the pain signals. And if you have had pain for a long time, the brain works a little bit differently due to prioritization. You may have problems concentrating you forget things, get worse sleep, and your mood can get affected too. When you have had pain for three months or longer, it is called persistent pain.
One of the things changing too is what I call the pain filter. This is a nor adrenaline driven system, which is supposed to protect [00:22:00] us from unnecessary pain. If pain is there long enough, this system can weaken making pain persist although everything in the body has been healed. This means the pain can spread your old medication don’t work and examination will not reveal anything that’s wrong. Another thing with a weak pain filter apart from getting a pain which is spreading is that you experience that it’s jumping .One day, you have pain in your right shoulder. The next day, the left leg, although you haven’t really done anything special.
If your health care professional is not familiar with the system I am telling you about he, or she might think that there is something wrong with you because there are no nerve systems that change sides overnight. But as you understand, this is not strange at all for anyone being familiar with pain and the pain system, and who has met lots of patients with persistent pain. The longer time with pain, the less use you have of working [00:23:00] with the acute side of pain, that is the ordinary medication like anti inflammatory drugs or even opioids. They will not help with the pain. This is the reason why the world health organization, WHO, classifies persistent pain as a disease of its own and not only a symptom of something else. Pain is the disease and needs to be treated accordingly.
So then how do you treat persistent pain then? I will have a separate podcost well, actually more than one, taking a look at treating persistent pain, but I can give you two ways right now. The first one is an excellent treatment with no side effects. It’s also inexpensive might even increase your social skills.
Hmm. It’s called exercise. Don’t worry that it hurts a bit in the beginning. [00:24:00] It´s like opening an old creaking door for the first time in a long time or a car that hasn’t been started for a while. It will hurt in your body in the beginning. But please trust me. In the long run, it will be much, much better.
There are studies showing that the pain threshold gets higher for people with persistent pain when they exercise. There is even some evidence showing that the closer of the hurting part of the body that you exercise, the better. That is, if your knee hurts, this is actually the thing you should use more. But actually I would not use the word exercise, because it brings so many feelings about something being overwhelming. And if you start with high expectations, buying a membership at the gym and so on and then fail, it will be much harder to start again. No, instead of exercise, I would [00:25:00] simply call it activity. Start really slow with something which might even feel silly.
If you walk 10 minutes each day. Try 15 and don’t overdo it. If you decided on 15 minutes, then stop after 15, don’t do 30 or 45 and get so much pain you regret everything? No, the key here is daily consistency. It is much, much better to do five extra minutes everyday than 30 minutes extra once a week. There are some suggestions for activities on my webpage as well.
And don´t forget, , that activity is not only physical. You need to socialize, you need to use your brain being mental active. That is also activity. And it also helps persistent pain. Activity is the first thing which will strengthen your pain filter. The other thing I will tell you about today, s medication, which increases the noradrenaline.
[00:26:00]Now don’t fall into the trap. That medication is the easy way out. It can help, but during the time you are better, you must change the rest of your behavior to get better, get more active. Otherwise you will get your pain back after a while, even though you are taking your medication. So if you use it, start using the medication and while you have less pain start the activity.
So when you taper down the medication, you will still have a functioning pain inhibition system in your body. the medication which increases nor adrenaline is, guess what antidepressants the same sort, which helps against nerve pain if you remember. Not all antidepressants help some only to increase a [00:27:00] substance called serotonin, but we need to increase nor adrenaline. And again, this has nothing to do about depression or anxiety, but it’s a pain killer. I would really like to call them nor adrenaline increasing pain medication instead. So there you have a very simple but effective way to understanding the pain system, making it easier to know what happens with the body and brain during persistent pain and what to do about it.
I will come back in later episodes and talk about this more in detail. If you have any questions, please drop me a line at firstname.lastname@example.org. And I will do my best to answer. If you want to know more about my podcasts and other pain related activities from my side, please visit karstenahlbeck.com and join my email list.
No spam I promise. And of course, make sure to subscribe, to Outsmart the pain. Be well and prosper.
Episode 2 (Aug 30, 2021) : the burned out brain (talk with Hedvig Söderlund)
[00:00:00] ..Pain is some serious business. It ain’t everyone who knows what to do about it. Now I hear there’s a podcast just about this. It doesn’t talk of pain alone, but other interesting things distracting the mind from it. So I suggest you tune into Outsmart the pain and listen to what Karsten has to say about it. Get ahead, get it done. Listen to the podcast and maybe change your life or someone else’s.
Karsten: It is a great pleasure, and I’m really excited about this podcast episode, because I have the great opportunity to talk to you Hedvig Söderlund professor in psychology. Very, very welcome to this show today.
Hedvig: Thank you so much. It’s really fun to be here. I have not done a lot of work myself on pain, [00:01:00]
Hedvig: so its a new angle for me. So it’s a lot of fun for me too.
Karsten: Some of the episodes actually don’t talk about pain at all. We just distract the mind from it. Talking about psychology would be great. But to start actually, you are a professor in psychology and for people who don’t know it : what does a professor do?
Hedvig: a professor is someone who has spent a lot of time at the university. And it takes a lot of things to become a professor. There are several things you do research and that means that you’re doing different kinds of studies to examine various questions that you have scientific questions and related to this you apply for grants to get money, to do the actual research. It’s key to know how to do that. That’s a big part of the work.
And then you’ll also teach, you teach classes and tell the students about various things in psychology, for example. Also supervise students on different levels. So as part of the research, you usually [00:02:00] have grad students that are training to get a PhD in psychology. You can also have undergrad students do administrative as part of the department,you usually take part of making decisions for the department making decisions for the university as a whole.
Also it’s important to spread knowledge that you have to, the bigger public .
Karsten: So we’re looking into the academic part of psychology where you know a lot about current research what’s actually been proved to work and what’s not and all those things.
So, apart from being a professor, you started a company called Brain of Sweden – excellent name! What does this company do?
Hedvig: What I’m doing is to write books on one hand, I’ve written one so far, and I’m hoping to write [00:03:00] others. To give talks and lectures . My focus in my research is the brain and memory. Various aspects of memory, like how alcohol impacts memory, how aging impacts memory, sex differences in memory and the brain, various things like that. And also to write journal articles, not necessarily scientific articles, but you know, little pieces focused on aspects of psychology and memory.
Karsten: So it’s a fantastic, really interesting subject. I mean, the brain is very, very big. It contains a lot of different subjects that you could actually talk about. I have a short podcast about alcohol and pain. Do you have anything to say about alcohol and your research?
Hedvig: in memory research, we talk about encoding and retrieval. So encoding is when you learn something, something happens and you encode it in your memory, in your brain. And then there is the retrieval [00:04:00] which is remembering your troubles . One thing that we know now in memory and alcohol research is that for example, people say sometimes that they drink to forget about all their troubles but alcohol mostly effects encoding. it’s not that we don’t usually have trouble remembering things that happened while we were sober . Instead, we have problems, you know, encoding the things that happened, while we were intoxicated or drunk. And the extreme obvious thing is blackouts so much that you don’t remember a single thing and how on earth did I get home and why am I wearing a rabbit suit?
Karsten: Another thing that you often hear is that we only use 10% of the brain, is that true?
Hedvig: Well, no, absolutely not true. And it’s [00:05:00] even laughable almost for brain scientists. And here I have a little anecdote . When I studied neuroscience at the Karolinska Institutet, like 20 years ago, long time ago, there was a famous brain scientist who was teaching a class and one of the students asked this very question, is it true?
And then the, brain scientists said to him, “maybe it’s true for you”. It was mean. It was clever. And funny, but it was very mean anyway, very salty. So no, our whole brains. When you scan someone in the MRI scan, and you can look at the activity while the person is doing something or not doing anything.
people aren’t supposedly doing something in the scanner, still the whole brain is lighting up, the whole brain is active all the time.
I’m exaggerating, but pretty much. Of course you can train your brain, you can become better and use it more efficiently, but is not like we have [00:06:00] 50% of the brain in a hidden closet and just like “oh my goodness, I’m not even using this. And I’m going to study Chinese now and I’m going to use this “
Hedvig: You know, use it or lose it, for example .sorry, I’m getting excited showing you now with my hands, which isn’t very useful in a pod, but I’m doing it anyway. All the body parts are represented in the brain. The more you use it, the larger it gets, There is a classical study on violinists where they’ve seen that professional violinist have larger areas of the various fingers in their brain like the index finger and the larger it has become in these violinists players in the brain. So the more you use it, the larger it gets, there’s also results in the other direction. Not that you’re losing it, but that the brain is becoming more efficient.
when you’re performing a task and you see an area in the brain light up, if you practice this task over and over and over the area and the brain sometimes gets smaller because you’ve learned to do it more [00:07:00] automatically, you could say, and you don’t need to recruit as large of an area anymore.
Karsten: We will actually have podcast with professional classical musicians.
Hedvig: No way! Oh wow!
Karsten: And they will talk about their field and some have connections with pain and some not.
I heard a neurologist say that they had done some study about the myelinated nerve fibers, they have a sheath that makes the nerve signal go faster and that professional musicians had a thicker sheath. Have you heard about that?
Hedvig: I haven’t. I haven’t, but that’s amazing.
Karsten: that could actually be true.They don’t know if they’re born with it and therefore become better violinists or if they work it up.
Hedvig: Huh. That’s fascinating. I think they work it. up, but I don’t know. It’s not hopeless, it’s not because you don’t have a hidden stash of brain tissue that you can’t learn new things.
On the contrary, the brain is extremely plastic. You can increase the size and you can change the connections in the brain. Not hopeless at all on the contrary.[00:08:00]
Karsten: You said that you have published a book and maybe more are coming. Of course I know the Swedish title of the book, and it will probably be translated to English. I hope. Tell me what would be called in English you think?
Hedvig: So my working title for the book is “Burnout! My life as a female brain scientist- facts, data, the path to healing.” it’s my personal story of burnout. Being a scientist because that’s the part of the whole thing. also being a female scientist because the book has a, maybe a feminist angle is a strong word, but it’s a very much about why it’s so many women amongst the people who are burnt out in Sweden, 80% are women. Why is that? that’s a big part of the book. It’s my personal story, [00:09:00] but then I’ve also looked up studies and data and, statistics . This was actually a lot of fun for a scientist. As you know, when we publish scientific papers, it has to be very and strict and no emotions. Now I’ve actually taken stuff from the internet, from Twitter, stories I’ve read about in the newspaper. They’re all true. I verified all of them, it’s been a lot . so it’s been a very creative, process in a way. been a lot of fun to write that.
Karsten: We have talked about interesting things so far with the brain and memory and even alcohol. Now it’s getting really, really exciting because you are like the brain scientist, you know about stress, you educate people and you get burned out. How is that possible? Tell me.
Hedvig: big sigh.Well, sometimes life happens and there are certain things that you can’t do anything about that you can’t control. So I had a very busy [00:10:00] life. I had my own lab, my own research group with several grad students, assistants. I was teaching giving classes, this and that. Both of my parents are a bit older. they were both getting sick in various ways. My dad actually passed away last year . I was taking care of them a lot, like a lot. And, I lived in Uppsala at the time and my parents lived in Stockholm. So there was a lot of driving back and forth and exhausting.
So I never really got to rest and I never really got any time for me.
And in combination with all of these stressful things, the board or the leadership at work, weren’t very, what do you want to say? I want, do you want to call that they weren’t, they weren’t very understanding they certainly didn’t care about me very much.
When you’re a professor you’re supposed to teach and we’re all supposed to teach a certain amount, I was told to take on this new thing, this new thing, this new thing. I said to him like, I’m sorry but, I’m on my knees here. Like I was falling down, you know, I was [00:11:00] halfway there.
And I said, I can’t take anymore this because he knew that my parents were unwell. And he said, well, that’s your problem, your parents aren’t getting any better.
I was going to give this new course graduate course. So it was supposed to be on a high level biological psychology. And normally that wouldn’t be a problem. I know this topic and it’s what I love. Now when I was already down on my knees, it felt impossible. And one day. I just, it all just burst .You know, like I was walking in the street in Stockholm. I was talking to my cousin on the phone and she asked me how I was doing, you know, like you do. And I just, boom, started crying like crazy. Things have been going against me so to speak I’m getting goosebumps here when I talk about it, because it’s all coming back to me now,
I couldn’t control things. Even though I told them, I’m hitting the wall here. They didn’t care about me. They were treating people very differently, depending on whether you were [00:12:00] close to them and a friend, or if you weren’t. There was a lot of nepotism going on and I wasn’t part of the crowd.
Karsten: I don’t think that there’s a genetic predisposal that women get burned out, but it’s surrounding environmental cultural thing. Do you have any figures on male burnout? Do we know anything about that?
Hedvig: We know that 20% of the people that are burnt out are men. We also know that men who live in more equal relationships where they’re doing more household work than other men who don’t, they tend to get more burnt out.
And I almost started laughing there because I don’t want to tell men, like, doing the housework guys. Like you don’t want to get burned out. So if people who are doing a lot, a lot, a lot of work, both at home and at work, get burnt out.
Then maybe we’re not supposed to work as we do. I mean, that’s the only conclusion I can come to.
And I do think [00:13:00] however that women are treated more poorly in many situations, like we get worse treatment. I don’t want to say that to you. You’re a doctor, but …
Karsten: Just hit me I will edit it out. It will never be aired.
Hedvig: Yeah, that’s good. No, but there are studies that show that women have to report higher levels of pain for it to be noticed in their files men have to do. So I think it’s not genetic, I think it’s societal.
Karsten: I was thinking, there are a lot of courses and there are articles in magazines where it says, this is how you become a better boss. I have always thought that the people who read those are people who already know what’s going on and the people who we really want to stick that article under their noses, they don’t, they don’t think it belongs to them.
[00:14:00] Do you have any suggestions to either the boss who thinks that he or she is just a Superman or a -woman or, the person who feels that they’re not treated right. Well, can we help someone out there? That’s my question. I think,
Hedvig: In this case, obviously I’m, I’m relating it a bit to myself. I think it’s really important to listen to your staff and take them seriously. If it’s someone seems to be a high-performing person, who’s working hard an engaged person, and that person tells you, this is my limit, I can’t do anymore. I think you should listen to that person and take them seriously. They’re probably telling the truth because the thing with burnout is that usually the people who get burnt out are the people that really don’t want to be on sick leave.
Because they’re working so hard important for them to perform well or a lot. Overall, I think it’s important to let your staff feel free as can, obviously they [00:15:00] can’t do whatever they want, not to micromanage them. And to say like, you have to do this.. they’ve seen in studies that the more liberty that the employees feel at work the better their health. They will feel more productive, more creative, instead of the boss coming in, and micromanaging everything that they do.
I think that’s important. I also think another thing that I did not experience at my work was to get some positive reinforcement for the good things that you do. I don’t want to brag, but I have to. No, but I’m good at writing grants.
I know that that’s my kind of skill and I did get several big grants, but my employer didn’t care at all about all.
All she wanted me to do was to teach like that was the only important thing for me to do. But when other people got grants, it was like, “Bravo, that’s amazing. Look at this guy.”
Like he’s so talented. I think it’s important to encourage your staff and show appreciation for their work. We’re children in [00:16:00] the end, we want our parents to tell us that we did good. It sounds a little childish but I think it’s important even for adults, to get recognized for what they’re doing. I think that’s a very, important thing.
Karsten: For someone who does not understand this at all, a manager or someone who is in charge, I can say this, look at this in a very pragmatic view. If someone tells you that they can’t work any harder, if you keep them working, they will quit and you will need to get a lot more job done on finding a new one.
So it’s less work for you if you try to make it easier on them right now.
Hedvig: true. That’s a very good point. it’s finance, like it’s a short term. financial loss maybe, but it’s a long-term gain because like you say, you have to put down time and money.
Karsten: Sometimes I think about women getting pregnant and right after they have gotten a new place to work, because now they have like a safe place to work and everything.[00:17:00] Maybe you hear that “oh, that was so typical that they got pregnant now”. And I think, well, that’s, that’s just a proof that it’s a very good workplace that you feel safe and you will get someone back who has another experience in life with children, for instance, if that’s it.
Hedvig: Oh, my goodness. Yes, we do. You’re warming my heart. The kind of workplace that I had, was really toxic and bad. So I did try to go to my or at least the person who was handing out the teaching and say that I couldn’t do more than I was already.
And that didn’t work obviously. I just got burned out instead. When you’re a professor, theoretically you do have a boss, I’m not used to asking my boss for advice or anything like that.
So I think you need to try and talk to your employer about all of this and if they don’t listen or don’t care and you notice that the situation is just unbearable, it’s just going to get worse and worse. You have to consider quitting. That might be really hard and it was extremely [00:18:00] hard for me in the academic setting, getting,a tenure job, like a permanent position, It’s so hard.
so it took me years to come to that decision that I was actively going to quit. Cause I did quit. I think you have to think about that. Is this workplace going to change? Is my work situation going to change? If it isn’t life is too short to have a bad time at work and life is too short to get stressed out by your work. So you have to really think about yourself and listen to your body. If your body is going at work with stress,
Karsten: We hear a lot of interesting things and maybe you think that, I don’t remember everything and do I need to listen to this many times? I do have something I called Insights where I take episodes and think about my own thoughts about our conversation.
And I would really [00:19:00] suggest that you listen to that it comes one week after the episode. So listen to the Insights with Hedvig. And I will tell you in conclusion, what we talked about and what I think about it. So head on to that episode, right?
Who should read your book?
Hedvig: I’m obviously biased because I think that everyone should read it, but I have several readers who did read it and they say that everyone should read it. And I think it’s true because like the title only sounds like it’s about burnout, but it’s actually about lot more it’s about our society how it treats men and women and how some of this differential treatment actually leads to women getting burnt out talk about microaggressions in the book, which is when we’re being, talked to in a certain way, treated a [00:20:00] certain way, maybe touched a certain way.
Each thing in itself is tiny, small and micro aggression. when you have a lot of these, every day, every week, every month a while, you’re like, you know, you’ll go crazy. Cause there are so many I have a neighbor at my summer house. an older male professor and he has read my book twice he said he learned a lot from this and I was so happy to hear this because I was thinking that some men will get angry when they read it, not that I’m complaining, I’m pointing out things that are unjust, and are affecting men’s and women’s health. I think it’s an important book for a lot of people who are interested in human behavior society, the world . Is that modest enough for you?
Karsten: What have the reactions been on your book?
Hedvig: They have been really good. I have to say several people have written to me thanking me for the book they’ve said that it’s helped them to not feel alone in all of this. some [00:21:00] people have said that it’s an eye-opener to several things.
I’ve been talking about how meetings often work with men and women. A lot of women experience that they’re saying things, no one cares, no one listens. And then a man says exactly the same thing and everyone´s like “Bravo, Bravo” to this guy. And we’re like, “I just said that” .
Karsten: Did you get any bad reactions on your book?
Hedvig: I thought that I would get hate letters. So far nothing. I’m pleasantly surprised.
Karsten: I need to tell you a short story, which is true. I was working at a place as a general physician, and have this, person who wanted sick leave. She was a writer and after the book, she needed to go to a lot of different places and have lectures and travel a lot. It was really bad and she got really burned out and this is ages ago. She did get the sick leave. And after I had worked, I went to a bookshop. And I saw her name and she had a book called “how to avoid [00:22:00] burnout with yoga”.
How do you cope with this now with, because I can see how energetic you are you are really burning for the subject. How will you not get into the burnout phase again?
Hedvig: Yes. You know, that’s such a relevant question. I mean, getting emotional again, because you’re really touching like, you’re so correct here. This is my first book. I thought writing the book would be the hard part. I thought that would, be draining, so to speak, but actually the work afterwards, just like she said, it’s like giving interviews, being on TV, it’s been exhausting.
It’s been a lot of fun cause I love it, but it has actually taken a lot of energy out of me. I’ve noticed that I have, I have to monitor myself I have to monitor my schedule, sure that I don’t have things every day. I’m not that into them high in demand, but, another thing you have to realize that even fun things take energy, especially if you’re on the verge of burnout, if [00:23:00] you’re not then they might just give you energy. But if you’re already exhausted, you don’t have a lot of resources left. You don’t have a big margin or a buffer,even some fun things are going to be very demanding.
Remember that, sometimes I feel guilty when I don’t have the energy to be social, with friends. Cause they’re like, well, I should be fun to hang with. And I’m like, yes, you are fun to hang with but it’s exhausting for even, even social interactions can be exhausting, you know? So that’s important to remember.
Karsten: So what is your Oasis?
Hedvig: The big thing is nature. I really would say nature, I have bought myself a sup board, you know, stand up pedal board. , it’s a sit down paddleboard in my case.
So I sit down on my paddleboard and I go out in nature, on the water and I have my phone and I take photos. So that’s another thing that I do. take a lot of photos and I live in my own little bubble, you know, if someone calls, I don’t answer it .
I want to be in my own head. Here and now, so that’s something that I bring up in the book, [00:24:00] this mindfulness technique, when you try to focus on here and now don’t think about the past don’t ruminate on bad things that have happened to you, or don’t worry about the future and whatever is coming up there, be here now enjoy the music.
I play the piano myself. I like piano music, and I like Regina spectra. I used to like Tori Amos. Bruce Springsteen is wonderful. Then I listened to classical morning on P2 every morning. Swedish radio and it’s wonderful. It’s so, so relaxing. I love it. Some opera is good too. I like a lot of music by that. I don’t want to say what I don’t like.
Karsten: The brain is powerful.
Hedvig: It’s amazing.
Karsten: Hedvig, it has been such a pleasure to talk to you. Really, I do think that many, many people can change some things or maybe get enlighted by what you have said today. And by reading your book, if you know, Swedish, I would recommend that you actually, get to read Den Utbrända Hjärnforskaren, and whenever the English [00:25:00] title comes, I’m sure that people buy that one too. because it it’s a important in our lives to, understand ourselves and not get burned out. Really.
Hedvig: a good investment in yourself and it’s good investment for society.
Thank you so much. It was a lot of fun.
Karsten: So Hedvig and everyone else out there – Be well and Prosper!
Episode 8 (Sep 19, 2021) : Pain self management! (talk with Pete Moore)
[00:00:00] ..Pain is some serious business. It ain’t everyone who knows what to do about it. Now I hear there’s a podcast just about this. It doesn’t talk of pain alone, but other interesting things distracting the mind from it. So I suggest you tune into Outsmart the pain and listen to what Karsten has to say about it. Get ahead, get it done. Listen to the podcast and maybe change your life or someone else’s.
Karsten: So I have the great opportunity to actually talk to the first English native speaking guest in this Outsmart the pain, series. And that is Pete Moore from the UK . Welcome to this show.
Pete: Thanks Karsten for inviting me along. I’m really keen to do this podcast interview because, that’s what it´s all about [00:01:00] pain becomes overwhelming. But we need some tools and skills to get confidence back. So that we get ourselves back in the driver’s seat. I love the title of the book Outsmart the pain. (refererar till boken Överlista smärtan)
Karsten: And for all the listeners out there, you can go to my website and see the transcript of this pod. If you don’t understand everything that Pete says or that I say…
We will not go too deeply into your own story, but since you actually are a person with pain, you’re just not a lecturer or author – you are someone who experienced pain. What was your turning point? When and how did you decide that “I need to do something about this”?
Pete: It’s a question I get asked quite frequently and sometimes I get fed up talking about it, but I think it’s important because other people out there listening to this who are struggling with their pain will identify.
Back in the early nineties, my back [00:02:00] was prolapsed, I went to the doctor and got pills and it wasn’t getting any better. Days went into weeks, weeks into months and months went into years.
I was really struggling and my lowest point where I think I had to take action was on my birthday 31st, December 94. Actually, I was thinking about ending my life because, then I was mid forties, and I just couldn’t see what’s the future.
There was no future. It was just – every day melted into the next one. Pain was just going on every day. I just woke up and said “how much pain am I going to be in today?”. Looked in the mirror and I saw myself and I thought “this is the guy that’s going to get me out of this mess”. So it was about me taking action. There were no computers. There was no such thing as email. A lady in Norfolk was telling me about this pain management program she’d been on in London. I contacted them – “I’ve got to get myself in this program”. It was 25 years ago, actually, [00:03:00] 1996, I went on there on the program and what that program gave me Karsten: it gave me the tools or skills. I was stretching, exercising on a daily basis. But more importantly, it gave me the confidence to manage my pain myself. I’m doing more things now.
Karsten: You’re saying something very important because you started with saying that you had three prolapsed discs. I know that there are people out there who has a pain where they can’t really see anything that is related to their pain. And that is still a real pain, but you did actually have prolapsed discs, but I don’t hear you say anything about surgery ? Many people I meet, they start by thinking, “oh, this is the way I have it now, three prolapsed disc at this age, this is just going downwards”.
I can’t hear anything like that. Didn’t [00:04:00] you think that these discs really need some repair or, or how did you manage that ?
Pete: Well, you know, I become a doctor shopper. I was therapy shopper. I’d had an x-ray and MRI scans . I’m not pain free, but my pain levels are such low frequency, they don’t really bother me and as I’ve become an older person with, osteoarthritis in joints it keeps all that down as well.
That’s a really negative message they said to me back in a day one orthopedic surgeon. He said “your spine is like a digestive biscuit”.
Pete: Your spine is like a digestive biscuit.
Karsten: Oh, I have someone where the radiologist said that “your spine looks like a rotten flagpole”. How do you get these people to start mobilizing? If they know that their whole body is supported by a rotten flagpole or crumbling digestive biscuits?
Do you think that healthcare workers have a responsibility on how to communicate with people with pain?
Pete: They have a massive responsibility. They’re just repeating what they’ve been told in med school, you know? That sort of language frightens people it frightened me because my spine is crumbling, digestive biscuit. I was very careful. So I stopped. I was walking around, holding on to things. I was very careful how I moved because I wasn’t moving around. And I was still eating, I put a massive amount of weight not moving all my joints started to, um, I’ll call them, get rusty, you know and unused muscle will feel more pain than that than an exercise one.
Karsten: We hear a lot of interesting things and maybe you think that, I don’t remember everything and do I need [00:06:00] to listen to this many times? I do take episodes and think about my own thoughts about our conversation. And I would really suggest that you listen to that it comes one week after the episode. And I will tell you in conclusion, what we talked about and what I think about it. So head on to that episode, right? (“Insights”)
I sometimes hear that the pain is in your head and I say, do you see the painting over there? And they’d say, yeah, well, sad to tell you, but it’s all in your head because the vision and the sounds and feelings, everything is in your head. And just because pain is processed in your brain, then it’s not real.
So it is in your head, but it’s not the way that people usually understand is it.
You were here some years ago and actually had some lectures in Stockholm here in Sweden. And two things that really caught my eye were that, first of all, [00:07:00] between the lectures, you did exercise and stretch because that was really a way for you to make the lectures work.
You were really persistent in your own treatment, and you always took the stairs and you just looked at me when I took the escalator and I kind of got a bad conscience. The second thing was that someone asked from the audience that “now when you´re pain free or have less pain” or something like that, “of course, it’s easy for you to travel around and have lectures” and you answered, well, actually I have more pain now than I had before, but I know how to deal with it or, or something like that.
That was really revealing for us that you could have a better life. And not even thinking about pain more and treating it. So you talk about self-management, that’s like your big deal. You are the beacon of light for self-management. [00:08:00] Could you just tell us what is that? What does that have to do with pain treatment?
Pete: Yeah, self management. Doing collaboration with the healthcare professional. What they’re doing is actually working more closely, in their circle of support. It could be to healthcare professionals. Friends, family work colleagues, et cetera, I’ve never yet met anyone who’s had long-term pain and solve their own their own.
It’s not a marriage. It’s not “till death to you part“. At some point I got to let you go because we have to work out things for ourselves. I’ll go and see the physio, the osteopath, chiropractor, wherever, and they will sort out, well, you know, I’ll get problems, but I sort it out.
Karsten: Don’t get dependent on other people.
Pete: no, obviously, no, When was the last time I saw a doctor about pain
um, there’s gotta be 20 plus years ago. Okay.
Karsten: How many years?
Pete: But 20 plus [00:09:00] years,
Karsten: And what about painkillers? How many do you take a week?
Pete: I dont take any dont take any painkillers since 1997, 20 – 26 – 24 years ago.
Karsten: Wow. In the same breath that you talk about your self management, you often talk about, people with pain needing to be responsible themselves for their treatment. Coming from someone who actually is so to speak on the other side and can speak neutrally about this, what do you have to say about own responsibility in pain treatment ?
Pete: We need to be more responsible and take more responsibility. Self management is about taking action. It’s about being more responsible. When I’m doing my workshops I’ll start to talk about self management.
What is it?
-Did you brush your teeth this morning?
-Yeah, yeah, of course I brushed my teeth.
– Well, why did you brush your teeth?
– Well, it keeps my brush fresh and you know, help you from staying away from the dentist.
[00:10:00] They’re brushing their teeth twice a day, so they don’t have to have any unnecessary visits to the dentist.Thats self managing. And it’s the same thing with pain. Its about our responsibility.
Karsten: So you have the website paintoolkit.org. And that’s your organization. Could you tell us what do you do there?
Pete: Yeah. It’s become quite a popular resource now, not only for people with pain, but also healthcare professionals. Being able to supply information in a format that people like to learn from.
Karsten: I think about all the manuals I really want a list, how to do things. And nowadays you always have to watch a video on how, and it’s like seven minutes and I want to read a list and just do it and not talk about four minutes on how to prepare to do those last two minute things.
But the younger generation, they always look on the [00:11:00] videos, how to do things and learn that way. They probably don’t want the lists that I want. So that’s really important.
Pete: I’m looking at how people would want their information perhaps in the future, but people told me they liked that VR (virtual reality) concept even now, you know? We’re doing VR for educational purposes, it’s about having fun as well. And I think that’s what we’re missing in self management or pain, self supporting self management is it’s pretty dry.
Karsten: I had a patient who said that in all other medical conditions, the physician asks how you feel and your symptoms.
And then they talk about, treatments and decide on something to do. But when it comes to persistent pain, It seems like the physician already made up his or her mind that it doesn’t matter what you say. [00:12:00] They already know what to think about this. Is that true or was that just one patient saying that?
Pete: No, no, I true but it’s not the consultant or the doctor’s fault
once you’ve had pain for longer than three months, other things start to kick in like, low mood, depression, relationship worries, work problems, you get tired, annoyed, easily. Lose your fitness. Get depressed, and these things, they’re become more, more of a problem than the actual pain itself.
It’s like teaching someone to drive, but don’t bother telling them, that its something you’ll have to learn yourself.
You know, you just can’t do that. So focused on the medical model that there’s no, the long term strategies is – when the next appointment?
Karsten: But let’s say that someone is listening and they have back pain, maybe nothing has been seen on x-rays or maybe they even had surgery which didn’t help very much, they mostly [00:13:00] lie in bed. They need their pain killers because they can’t even get out of bed if they don’t start with the painkillers.
Now they’re listening to this episode. What would be your first suggestion for someone who is in that situation, which you actually were in many years ago?
Pete: Yeah, I was just laid around all day long. I was lying on the floor, which I would get out of bed then going down the floor so I’ll be watching a TV, put the TV on the wall. I put the TV up, it is so it was near the ceiling. So I didn’t have to crank my neck over.
There is a way out of it! For me it was via the pain management program, you got to come to that conclusion, start changing, and people change at different ways. A lot of people listening today, theyre going to think “Yeah, but thats alright for him”.
But trust me, I’ve been there and that’s why I’m still doing it after 25 years because, I don’t [00:14:00] want anybody to be in that position, I was back in 94.
I’ve spoken to people and I can see their eyes – they’re not ready to change yet. They’re still, still looking for that “fix”.
Karsten: So, actually the first thing that you said was when you were looking into the mirror and said that I am going to do this myself, in that moment, you actually put yourself in the driver’s seat.
Karsten: So that must be like the first step that “don’t depend on someone else to fix this.”
You might need help, but you are the one who needs to fix this. Is that a conclusion you would agree on?
Pete: Yeah, but you don’t have to wait that you’re down to the level where I was, when you want to think about harming yourself.
You could do it before. You can get out the lift at any floor, you dont have to wait until you’ve got to sort of the bottom floor before we went to get out and do take action.
You can get out the lift now, but you’re going to need some help and youre going to choose a health care professional[00:15:00] as a team who is familiar with pain management as you are, but remember you got to do the work. They’re going to help you build the plans together, but you’re going to have to do the work. “I’ve read your book, now send me the muscles” – but it aint gonna happen. You know, you gotta put the work in.
Karsten: Can anyone become better or are there people that will never get better?
Pete: That’s a really tough question. I’m going to be honest with you. I got a brother-in-law he had back pain longer than me.
So ask me He’s becoming an old person and because of all the pills he’s been taking, he’s now got severe stomach problems. But he ain’t ready. He still isnt ready. He is in that medical model and aint coming, coming out of it.
Karsten: So what would you say is the biggest obstacle for people who do [00:16:00] not get better in your view?
Pete: first off, you’ve got to come to that conclusion that you want to move on. “I´ve become sick and tired of being sick and tired”. I don’t think a healthcare professional can decide that for you, accepting that pain is going to be with you for a long period of time.
Karsten: But if someone says, oh, I want to move on, but I can’t because I have too much pain.
Pete: So much pain now, but teaming up with the right health care professional an experienced healthcare professional, who is familiar with pain management and then work together.
Karsten. I’m not an academic man. I’ve never been in a university. I’ve got no medical qualifications whatsoever, but all I can really say to you and the listeners there is that:
if I can do it, you can do it.
Karsten: That’s really great. I’m very happy to talk about these issues with someone who is not a physician, because I think that many people can relate better to you than to me, because I’m [00:17:00] still a doctor who tries to, tell people how to do. I really think that reading the book outsmart the pain (överlista smärtan) would be a good start because we use patients’ experiences what have worked for them. My coauthor is also experiencing pain.
So you could start there.
Pete, it’s been such a pleasure to talk to you. I hope it won’t end here because probably many listeners will actually surf into paintoolkit.org. And I hope that we have been able to give them some sort of advice in this episode.
Pete: thank you very much.
Karsten: For everyone out there: be well and prosper..