Understanding Pain with Dr. Rachel Zofness

Pain psychologist Dr. Rachel Zoffness joins Forrest and Dr. Rick to explore what pain is, why it can persist long after an injury has healed, and what actually helps. Rachel explains why the brain, rather than the body part that hurts, is what constructs pain, the difference between acute and chronic pain, and the distinction between hurt (what you feel) and harm (what's damaged). They get into the biopsychosocial model, the "pain dial" that stress, sleep, mood, and social connection can turn up or down, the disappointing response rates for most pain treatments, why pain is absolutely not “just in your head,” what sham surgery and open-label placebo studies reveal about how pain works, and why the research is so hard to interpret.  This is not medical advice. Please do not start, change, or discontinue any medication based on this episode. All decisions should be made with your doctor. About our Guest: Dr. Rachel Zoffness is a pain psychologist, assistant clinical professor at the UCSF School of Medicine, and the author of Tell Me Where It Hurts.  Key Topics: 0:00 Introduction 1:42 Acute vs. chronic pain 3:41 What is pain? 9:20 The biopsychosocial model 11:11 Hurt vs. harm: the tale of two nails 19:10 The pain dial 23:10 Nociception vs. pain 26:46 Your pain recipe 29:46 The "all in your head" stigma 31:23 Central sensitization 35:53 Pushback from pain patients 40:42 Loneliness and pain 46:51 Pacing 50:48 Reducing distress vs. reducing pain 54:26 Does anything work? 1:00:07 What placebo actually is 1:03:19 Acupuncture, sham surgery, and open-label placebo 1:09:42 Why the research is such a mess 1:14:10 Hopelessness, and trying one more thing 1:17:46 Mindfulness and attention 1:23:02 Advice for friends and family 1:30:22 Recap Support the Podcast: We're on Patreon! If you'd like to support the podcast, follow this link. Sponsors Go to https://Zocdoc.com/BEINGWELL to find and instantly book a top-rated doctor today. Check your health the way I do with 160+ lab tests and access to scans through Function, all for only $365 a year. Learn more at https://functionhealth.com/BEINGWELL and use code BEINGWELL25 for a $25 credit. Learn more about your ad choices. Visit megaphone.fm/adchoices