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The Ezra Klein Show

This Book Changed My Relationship to Pain

The Ezra Klein Show

New York Times Opinion

Society & Culture, Government, News

4.6 • 11K Ratings

🗓️ 21 February 2023

⏱️ 64 minutes

🧾️ Download transcript

Summary

Physical pain is a universal human experience. And for many of us, it’s a constant one. Roughly 20 percent of American adults — some 50 million people — suffer from a form of chronic pain. For some, that means having terrible days from time to time. For others, it means a life of constant suffering. Either way, the depth and scale of pain in our society is a massive problem. But what if much of how we understand pain — and how to treat it — is wrong? Rachel Zoffness is a pain psychologist at the University of California, San Francisco, School of Medicine and the author of “The Pain Management Workbook.” We tend to think of pain as a purely biomechanical phenomenon, a physical sensation rooted solely in the body. But her core argument is that pain is also produced by the mind and deeply influenced by social context. It’s a simple-sounding argument with vast implications not only for how we experience pain but also for how we treat it. She points to numerous underused tools — aside from pills and surgeries — that can help lessen our pain. We discuss Zoffness’s surprising definition of how pain serves as “the body’s warning signal”; how our mood, stress levels and social environment can amplify or dial down our pain levels; what phantom limb syndrome says about how the brain “makes pain”; how our emotions and trauma influence our pain levels; the crucial difference between “hurt” and “harm”; why studies on back pain have yielded such bewildering results about the sources of perceived pain; how to figure out and improve your personal “pain recipe”; the roots of our chronic pain crisis and how our health care system could be better set up to treat it; why she says, “If the brain can change, pain can change”; and more. Mentioned: “Neuroimaging of Pain” by Katherine T. Martucci and Sean C. Mackey “Targeting Cortical Representations in the Treatment of Chronic Pain” by G. Lorimer Moseley and Herta Flor “Psychological Pain Interventions and Neurophysiology” by Herta Flor “Sham Surgery in Orthopedics” by Adriaan Louw, Ina Diener, CĂ©sar Fernández-de-las-Peñas and Emilio J. Puentedura “Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations” by W. Brinjikji, P.H. Luetmer, B. Comstock et al. “A Biological Substrate for Somatoform Disorders: Importance of Pathophysiology” by Joel E. Dimsdale and Robert Dantzer “Undergraduate Medical Education on Pain Management across the Globe” by Nalini Vadivelu, Sukanya Mitra and Roberta L. Hines “Lifestyle medicine for depression” by Jerome Sarris, Adrienne O’Neil, Carolyn E Coulson, Isaac Schweitzer and Michael Berk Book Recommendations: Why Zebras Don’t Get Ulcers by Robert M. Sapolsky The Body Keeps the Score by Bessel van der Kolk Pain by Patrick Wall Thoughts? Guest suggestions? Email us at [email protected]. You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs. “The Ezra Klein Show” is produced by Emefa Agawu, Annie Galvin, Jeff Geld, Roge Karma and Kristin Lin. Fact-checking by Michelle Harris and Kate Sinclair. Mixing by Sonia Herrero and Isaac Jones. Original music by Isaac Jones. Audience strategy by Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Carole Sabouraud and Kristina Samulewski.

Transcript

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0:00.0

I'm Mr. Clive. This is the Ezra Conchell.

0:23.4

So maybe it's that I'm in my 30s now. Maybe it's that I have kids and I'm always picking

0:27.5

them up in pole motor car seats, bending down. Maybe it's my constant habit of emotional

0:33.2

repression. I'll come back to that one. But for the past couple of years I've had a

0:37.9

lot of nasty neck and back pain and I've sought all the normal remedies and experts, doctors

0:44.0

and sports medicine doctors and chiropractors and x-ray technicians and physical therapists

0:49.4

and the sauces. I got an ergonomic chair for the day, the standing desk and I got a neck

0:55.4

bolster at night and what I'm totally certain of is none of these people have any idea what

1:00.6

is going on with me. And I'm not telling you this because it's interesting. Although

1:06.4

I appreciate it because I want your theories. I'm telling you because it's been all roughly

1:11.3

20% of American adults, about 50 million people suffer from chronic pain. For most people

1:17.8

that just means bad days now and again, a couple of days laid out in bed. For some it

1:22.7

means constant suffering and narrowing of the horizons of life. And for too many it's

1:28.5

meant opioids, it's meant addiction, it's meant overdoses. And spend even a few minutes

1:35.2

talking to people about their pain experience or for that matter as I have looking at the

1:40.0

studies tracking treatment success and you'll realize that when it comes to chronic pain

1:44.4

we do not understand what is behind all this and we are not good at treating it. So

1:49.5

I've become interested in what we understand about pain, what is happening at the frontiers

1:53.4

of pain research and pain thinking. And somebody who's sitting there is Rachel's

1:58.3

offness who is a pain psychologist at the University of California at San Francisco

2:02.9

in their school of medicine. And she's the author of the pain management workbook which

2:07.2

I would recommend to anybody dealing with chronic pain. I found it revelatory. But her

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