Stop Managing Your Chronic Pain and Start Curing It

Delaware Hospice Family Support Center

Dr. Judith Pierson, judithpierson@juno.com

The material presented here comes from the book Unlearn Your
Pain by Dr Howard Schubiner with Michael Betzold, Mind
Body Publishing, 2019.
Pain and the Brain
 Dr. Schubiner focuses on pain which is chronic, which
means it continues long after the tissue or bone that
was injured has healed. He is talking about pain that
can't be linked to pathological developments such as a
tumor in someone with cancer, damaged heart tissue in
someone with heart disease or bacteria in someone with
an infection.
 Schubiner contrasts these pain-causing physically
identifiable conditions to the conditions he labels Mind
Body Syndrome (MBS). MBS is the focus of his work. He maintains that MBS
conditions are very real physiological conditions that give rise to very real pain and very
real symptoms.
 It is not "all in your head." It is actually all in your brain and, fortunately, this makes
it very treatable and reversible. "The fact is that all pain is experienced in the brain. We
cannot have pain without activation of the pain pathways in the brain." The brain can
turn off pain when a body is injured and turn it on when it isn't. This means pain can be
independent of injury. Dr. Schubiner gives these two examples:
"A friend of mine told me about a man he saw
diving in the ocean for conch shells. When he
merged with the conch shell, he showed it to his
wife on the beach and was beaming. He had no
pain until he noticed that his legs were bleeding
due to cuts from the coral reef. A construction
worker in Britain jumped off scaffolding and landed on a large exposed nail, which
pierced his work boot. He immediately began screaming in pain and was rushed to
the hospital. Pain and sedation medications given through an IV were necessary to
try to lessen his pain. When doctors removed the boot, they found that the nail was
lodged between two toes and had not injured him at all." (Schubiner, 2019, pg. 37)
 Another example, which shows the complexity of the relationship between the brain
and the body, is "phantom limb" pain. People who have had an arm or a leg removed
sometimes report severe pain in the missing limb. Clearly this is not being caused by
actual damaged tissue - there isn't any tissue. It is, however, real pain which is created by
"sensitized nerve connections and the creation of neural pathways in the brain." "Pain
begins when neural pathways from the brain to the body are stimulated or 'fired.' Over
time, these pathways can become 'wired' into the brain's circuity."

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  Chronic pain can develop from an injury that has actually healed. Pain results as the
nerves in that area become overly sensitive and, in turn, make the brain overly
sensitive.
"It is well known among neuroscientists that when the nerves that carry danger
signals from the site of an injury to the brain are activated for some time, the nerves
become 'sensitized,' meaning they are more likely to fire and send more danger
signals with lesser amount of tissue activation…This is how, over time, acute pain
can become chronic, although the tissues have healed from the acute injury. The
small nerves learn to react to even minor changes, such as tense muscles…These
sensitized nerves that carry pain signals to the brain gradually affect the brain as well.
The areas of painful sensation in the brain also become sensitized and continue to
experience pain. This is another way that chronic pain caused by Mind Body
Syndrome becomes engrained. As the neurological systems of the brain and body
learns these pain and other symptom pathways, these nerve fibers very quickly start to
get wired together. The more often nerves fire, the longer the pain occurs, and the
more likely these fibers will continue to create this viscous cycle of pain." (Schubiner,
2019, p. 28)
 So chronic pain after a condition has healed is caused by a persevering neural
connection between the brain and the body. Persisting neural pathways become
learned by the brain and can create a host of other very real physical symptoms as well.
 Neural pathways are made up of thousands of brain cell that are organized for a
specific purpose. Children learn to walk by practicing and as they acquire this new skill,
a neural pathway is created and they know just what to do. We use neural pathways all
the time when we learn how to ride a bike or a computer. When we develop neural
pathways, they become stored as memories. Like they say "you never forget how to ride
a bike."
 Following an injury, we develop neural pathways related to the pain associated with
those injuries and sometimes these pathways continue even after the injury has healed.
"The good news is that the brain and the nervous system can be retrained to get out of
ruts that produce pain." (Schubiner, 2019, p 3)
 Stress and feelings, in general, and those that develop in reaction to pain (fear, anger,
anxiety, frustration and worry) also increase pain through an amplification process
in the brain. Furthermore, traumatic experiences in childhood leave an imprint on the
brain which makes it more likely for someone to experience a vicious pain cycle.

Why Medicine Often Doesn't Help with Chronic Pain and Other Symptoms
 Despite advancements in medicine, few effective treatments exist for chronic pain
and other chronic illnesses. Schubiner would argue this is because they don't get to
the root of the problem. When doctors can't find an identifiable cause, they either
suggest a nebulous "syndrome" or they doubt the patient's claims of pain and discomfort.
Being told you have a syndrome or condition that appears to be untreatable, generates
feelings and responses that, in all likelihood, only exacerbate your symptoms. Not being
believed creates an additional source of stress, frustration and anger.

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 Schubiner examines a number of common experiences that can result in chronic pain.
 Whiplash, he writes, is a disorder everyone "knows" is a physical condition. Whiplash
causes a strain or sprain of the neck. This should heal within a relatively short period of
time. But some people report neck pain and headaches that last for months, years and
even decades. He suggests that what happens in these instances is that neural
connections that get fired by the injury become set and, in a sense, "learned" by the brain.
Neurons in the neck continue to fire and become wired, causing pain that continues long
after the initial injury is healed.
 He cites a study comparing rates of disability from whiplash among people from
Norway versus those in Lithuania. He said doctors in Norway, like those in the U.S.,
recommend rest, heat and anti-inflammatory medication. In Lithuania most doctors
advise similar patients to simply go back to work. The researcher found that those in
Lithuania who had been in car accidents were no more likely to have headaches or neck
pain than a group of people who had not been in a car accident. (Schrader et al., 1996)
This was true for Lithuanians who weren't wearing seat belts and didn't have head rests
and whose cars were severely damaged.
 In another study (Castro et al., 2001) researchers put fifty people in simulations of car
accidents that could cause whiplash. And even though their necks never moved 10%
said they were still having neck pain four weeks later. The people most apt to develop
persistent neck pain were those who had the most stress and emotional distress in their
lives at the time of the experiment.
 Schubiner writes, "Without the mind at work, very few accidents and injuries would
cause chronic, lasting pain. A study of demolition derby drivers revealed that almost
none had chronic neck pain, even after more than 150 collisions (Simotas & Shen, 2005)
Why? Because demolition derby drivers love what they do, and therefore don't think of
the collisions as traumatic." (Schubiner, 2019, p. 9)
 He also challenges the notion that all back pain is due to abnormalities of the spine
that can be confirmed with an X-ray or CT scans and MRI. Jensen, Borenstein and
Boos, in three separate studies, found that in people without any back pain, MRI's
revealed that 60-90% of them had bulging discs, degenerative discs, arthritic changes,
spinal stenosis and other back "conditions." He asserts that if you took 100 people with
back pain and 100 people without back pain and looked at their MRI's, doctors would not
be able to guess who had back pain and who didn't.
 He also mentions a more recent study of over 1,100 people with acute back pain that
found only 1% of them turned out to have a physically identifiable problem
(Hensche et al., 2009). He still thinks people with back pain should have physical exams,
especially to find out if there is a tumor, infection, fracture or evidence of nerve
compression or damage.
 Dr. Scubiner's four-week (28 day) program can be done in a group, on-line or via
his workbook. It helps people get to the source of their pain which could be overly
sensitized nerves or an overactive autonomic nervous system driven by stressors or
unresolved emotions and retrain their brain to stop sending out very real pain signals or

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 other symptoms. I will give you an overview of his program as part of this presentation.
You will find it in his book Unlearn Your Pain.
 Schubiner tells the story of 65-year-old Helen who suffered with back pain for 9 years.
It started in her lower back one day as she was working on the assembly-line. The pain
was so bad, she was carried out of work on a stretcher. She was diagnosed with, among
other things, compressed, flattened and bulging discs and narrowing of the outlet for her
spinal nerves. She was treated with physical therapy, acupuncture, electrode nerve
stimulation and got no relief. She was about to undergo lumbar fusion surgery when she
decided to take Dr. Schubiner's program. She had marked pain relief after two weeks,
and by the end of the fourth week, "she was pain free and canceled her back surgery. Her
joy was incalculable, and she felt in control of her body and her life for the first time in
nine years." (Schubiner, p. 12-13)
 He also tells the story of Katherine, a 42-year-old, who'd had pain for four years when
she entered the program. It started during a short run, when she experienced pain in a left
hamstring. She went from being a very active person who ran, hiked, skied and mountain
biked, to someone who spent significant parts of her day in bed or lying on the couch.
Nothing she did made it better. In the program, she was able to identify stressors from
her childhood and many in her current life. Within two weeks she was running twice a
week. After four weeks she reported, "I am so happy to say that I now have the ability to
recognize that my pain is caused by an accumulation of anger and guilt in my mind and
that it uses my body as its outlet and that I no longer allow it to do so. This has taken
work on my part; however, I am thankful that I am able to now let go and be pain free."
(Schubiner, p. 14)
 The pain these two women experienced was real. But the cause of it wasn't the
bulging discs and other physical explanations they were given. Doing the program
helped them get to the deeper roots of the pain and reverse it. I will talk about the role of
stress and trauma in pain and other medical conditions later, but, like the overly
sensitized nerves near a former physical injury, it has to do with triggers that activate the
autonomic nervous system and cause it to over-react.
 Dr. Schubiner talks about fibromyalgia as another condition that is likely rooted in a
problematic link between the mind and the body. Because doctors have found it
difficult to identify a structural cause for it, patients have often been treated poorly by
the medical system. The implication is often "it is all in your head." This makes
sufferers understandably reluctant to approaches that suggest a psychological component.
According to Gracely and colleagues (2002) "brain imaging studies have shown that the
pain is real and is felt as much as pain from a bone fracture."
 There is significant research, however, that found people who suffer from fibromyalgia
"have much higher rates of stressors and victimization (physical, sexual, or emotional
abuse) compared to people with other physical disorders…There is also a large overlap
between those with fibromyalgia and those experiencing anxiety, depression, and post-
traumatic stress." (Schubiner, p. 15)
 In his program, 25% of participants with fibromyalgia have gone into remission.
Another 25% reported a moderate reduction in pain. While these numbers aren't high,

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 they represent more success than any other treatment currently available, including
medication.
 He tells the story of Janet a 41-year-old woman who grew up with a mother who was
emotionally distant. "The mother was very busy with her own life and was usually gone,
often playing bridge and tennis. Janet had no illnesses or symptoms of MBS, until she
was in her thirties. She was happily married, with two small children, for whom she was
determined to be the best mother possible. She was having a new home built and trying
to make it perfect. At this time, she began to develop widespread pain in her muscles and
tendons, which was diagnosed as fibromyalgia. When I asked her what her mother was
doing at the time she and her children needed her help, she replied, 'Playing bridge and
tennis.' She then began to sob over the loss that she experienced as a child and that her
children were now experiencing. Her mother was being as distant with her grandchildren
as she had been with her own daughter. At this stressful point in her life, that separation
was enough to trigger severe pain in her body. Once she realized that she was not
physically ill and that her pain came from unexpressed emotions, her pain totally
disappeared." (Schubiner , p. 17)
 Finally, Schubiner tells the story of 55-year-old Vickie who suffered from constant daily
headaches for 17 years. She had been on over 20 medications and through multiple
treatments even surgery. The headaches began the day she tried on a new pair of glasses.
Digging a little deeper, Schubiner learned she grew up with an abusive and bipolar father
who would often grab her by the collar and yell at her. At the time she tried the new
glasses, she had a boss she described as "mean and nasty" who would frequently yell at
her. "Vicki quit her job a few months later, but by the time the vicious cycle of nerve
connections had been formed, and her headaches continued on a daily basis. She started
this program, and her headaches gradually began to decrease. After the program, her
headaches continued to improve, and after six months she became free of them all
together." (Schubiner, p. 18)
 Schubiner argues that as long as traditional, and alternative, medicine insist that real
and painful symptoms can only be caused by underlying pathology in the body, they
will either dismiss people's symptoms or label them as a condition for which there is
no known treatment. "The medical profession has unwittingly created a form of mental
imprisonment, called medicalization, when diagnosis and treatment causes an increase in
pain and suffering. The false belief that one has a serious and intractable condition
causes activation of more stress and emotional reactions, such as depression,
hopelessness, helplessness, fear and anxiety, that can exacerbate the problem."
 Understanding the reversible physiological changes to the brain and nerve pathways
offers true hope for recovery from pain and other symptoms.

The Role of Trauma and Stress in Medical Conditions

 We all know that stress can cause physical reactions. We get up to speak in public
and we begin to blush, we see someone we are attracted to and we get butterflies in our
stomach, or we have a stressful day and develop a headache. The symptoms are real –
our face really is red, our stomach really is churned up and we really do have a headache.
They are very real physical reactions but they can be reversed and are usually temporary.

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 "What is not common knowledge is that stress and emotions create the neural
pathways that can cause chronic and often severe physical symptoms." (Schubiner,
p. 24)
 Understanding how the brain works can help us understand how the stresses of life
and even past traumas turn into bodily pain and other symptoms.
 "Emotional memories are imprinted in our brains…They are imprinted in a network
of the brain that registers and stores emotions, which includes several structures such
as the amgydala, hippocampus, insula, anterior cingulate cortex and prefrontal
cortex. These areas are closely connected to the hypothalamus, the center for the
autonomic nervous system (ANS)…The ANS controls our breathing, heart rate, blood
pressure, temperature, and many other automatic and involuntary functions – the things
our body does without our conscious mind being aware of them." (Schubiner, pp. 24-25)
 During times of stress, the emotion-based network sends signals that activate the
autonomic nervous system and produce hormones such as cortisol and adrenaline
which then set off the fight or flight response.
 During a fight or flight response, blood flows to our muscles so we can run or do battle.
We often react before we are even conscious of what is going on. For example, you see
something squiggly moving across the ground, it is our autonomic nervous system that
causes us to jump back to be safe. We don't stop and reach out to it. Our protective
system kicks in before we even process what is going on.
 "In fact, research shows that when emotions arise quickly, the blood flow in the brain
shifts away from the frontal lobes, the conscious thinking part of the brain, to the
limbic system, which is the emotional, reacting and subconscious part of the brain, which
includes the amygdala and the autonomic nervous system." (Schubiner, p. 25)
 The autonomic nervous system controls the nerve fibers that shape responses in
virtually every area of the body. Strong emotions can cause increased tension in any
muscle.
 Research actually has shown that anger and anxiety will create tension in the back
muscles of people with chronic back pain (Burns et al., 2006; Quartana & Burns,
2007). That tension, even without our conscious awareness of it, can cause real and
significant physical pain. (Nerve fibers in the back which have become overly
sensitized trigger a signal to an overly sensitized brain which in turn creates pain.
 The autonomic nervous system can impact muscles and blood flow but also the entire
nervous system, the heart, the gastrointestinal (GI) system and the genito-urinary
(GU) systems.
 "The ANS can produce a much greater variety of symptoms in response to stress and
emotional reactions in humans. Activation of the muscles can produce pain in almost
any part of the body. Nervous system activation can produce tingling, numbness, or
burning sensations as well as dizziness, tinnitus, and anxiety. Activation of the GI
system can cause abdominal pain or bloating, heartburn, nausea and vomiting, diarrhea or
constipation. When the GU system is activated, one can experience pain, itching,
burning, and urinary frequency. Cardiovascular (CV) activation can produce

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 palpitations and a rapid heart rate. Alternations in blood flow can produce migraine
headaches." (Schubiner, p. 26)
 While everyone has heard of the fight or flight response to danger, there is also the
freeze and submit responses to danger. Schubiner suggests that freeze and submit
responses to danger may lead to fatigue and/or depression.
 "When the brain is in an ongoing state of warning and danger, it will continue to
produce pain with movement, fatigue with activity, disordered thought processes,
and many other sensations designed to enforce rest and inactivity. And the more the
accompanying neural pathways are activated, the more they become normalized as
default pathways." (Schubiner, p. 30)
 As we have already noted, the brain can turn pain on and off. It usually decides this
based on the many regions of the brain that make up the "salience network." The
salience network determines what is salient (or important) and must be tended to and
what can be ignored. So, if you were a caveman and you were running from a lion and
twisted your ankle, the brain would probably block the sensation of pain so you could
keep running. If you were running from a deer however and twisted your ankle it would
turn on the pain. This is because you don't need to keep running to avoid being eaten by
a deer. And if you keep running you may cause damage to your ankle which could cause
a long-term disability. The brain decides when to turn pain on or off based on the
salience network that is commonly thought of as the danger/alarm system.
 One part of this network is the anterior cingulate cortex (ACC). Emotions increase
activity in the anterior cingulate cortex (ACC) which causes pain to be amplified.
 "When you feel pain, this may cause worry about what it is; when you go to the doctor
and you're told you have a problem in our back or neck, this may cause fear; when your
doctor tells you that he or she doesn't know what is causing the pain, this may cause
resentment; when the pain becomes chronic and you don't know if you'll ever get better,
this may cause frustration. All of these emotional reactions activate the ACC. MRI
studies show that when the ACC is activated, pain is greatly increased…In addition,
when the ACC is activated, it turns off the dorsolateral prefrontal cortex (DLPFC)
area of the brain, a part of the brain that acts to decrease pain." (Schubiner, pp. 26-
27)
 Research suggests that children exposed to abuse or other forms of trauma or adversity
can become adults with overly responsive autonomic nervous systems. In Bessel Van
Der Kolk's book The Body Keeps the Score he documents the long-term impact of
adversity in childhood. He writes " Trauma produces “a re-calibration of the brain’s
alarm system, an increase in stress hormone activity…” (van der Kolk, 2015).
 "The emotional imprinting from early experiences is stored in the brain, and when a
similar experience occurs later in life, the ANS reaction can start a painful process."
(Schubiner, p. 27)
 The brain can also learn to associate a particular physical response with a trigger.
Pavlov classically taught dogs to associate a buzzer with eating by always pairing food
with the buzzer. Later they would begin to salivate whenever they heard the buzzer.

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  In one study mice were given a drug that suppressed the immune system in a bowl
with saccharine, which has a distinctive taste. The drug did in fact suppress the immune
system. But weeks later after their systems recovered, drinking just the saccharine
water (without the drug) led to the suppression of the immune system. This same
study was replicated with people. (Goebel et al., 2002)
 The body can also be "primed" for pain by previous experiences. You can probably
ride a bike or throw a ball again after years of not doing so because those neural
pathways became deeply engrained. Injuries can also create neural pathways between
the brain and the body that can lie dormant until situations of stress or strong
emotions awaken them.
 Schubiner tells the story of Dr. Lorimer Moseley who is also a leading pain researcher.
As a young boy he took hikes into the country and often came home with nicks and
scratches. His mother was alarmed but they never bothered him. At the age of 25 he was
hiking and got nicked in the leg again. He kept walking, thinking nothing of it. When he
got home, he discovered the fangs marks of a very poisonous snake and realized his leg
was very swollen and painful. He spent several days in the hospital. Five years later he
was walking in a park and noticed a nick on his leg. He immediately fell to the ground
and experienced severe pain that was all the way up and down his leg. He was rushed to
the hospital and learned he really only had a rather insignificant scrape. When he was
younger, he ignored scrapes because he believed they were not dangerous. But after his
life-threatening snake bite, the brain interpreted a small scrape as very dangerous and
"and activated the same pain pathways that were leaned five years earlier." Further, the
pain from that scrape lasted two weeks. (Schubiner, p. 35.)
 Stress, overly sensitized areas of previous injury, strong emotions, experiences that tap
childhood traumas, and associated triggers cause the brain to turn on pain. This is caused
by the activation of the anterior cingulate cortex (ACC) and the autonomic nervous
system (ANS) and deactivation of the dorsolateral prefrontal cortex (DLPFC). The
exercises utilized in the program designed by Dr. Schubiner and others aim to decrease
the ACC and the autonomic nervous system (ANS) and increase the DLPFC.

The Power of the Subconscious Mind

 Now you may be thinking, I'm not aware of having strong feelings or even stress when
my back pain or headaches flair up. In many cases the strong emotions or internal
conflicts driving pain or physical symptoms are too dangerous, too disturbing or too
unacceptable to be consciously experienced. As a result, they are usually stored
outside our conscious awareness in our subconscious.
 Wilson (2002) in his book Strangers to Ourselves: Discovering the Adaptive
Subconscious estimates that approximately 95% of our thoughts, feelings and memories
live in our subconscious. The human brain can absorb about 11,000,000 bits of
information a second, the conscious mind can only process about 40 bits a second.
 Most of our day-to-day actions such as driving a car, talking, walking, doing dishes are
automatic and don't require a lot of conscious thought. These routine actions are the
product of learned neural patterns in the subconscious part of the brain. (Wegner,
2002; Wilson, 2002)
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 Schubiner (p. 43) cites a number of studies that manipulated behavior using subliminal
messages that registered in the subconscious but were flashed so quickly they were
below the threshold for conscious perception. In one study people who were subliminally
presented with words like "old," "wise," "retired" and "grey" walked more slowly from
the room than those shown random words.
 In another study people subliminally shown aggressive words interpreted the behavior of
others as being more hostile than the control group shown random words. Finally,
people given a cold cup of ice coffee to hold, rated a stranger as being less friendly than
a group that held a warm cup of coffee.
 As children we are exposed to a host of stressful or traumatic events. The memories
associated with these experiences are stored in the amygdala, hippocampus and other
parts of the brain. Just as our brain reacts quickly to physical danger, it also responds
just as quickly and often unconsciously to things we experience as emotionally or
interpersonally dangerous.
 Schubiner cites the book The Emotional Brain (1996) in which LeDoux "points out that
the nerve pathways that sense a dangerous situation will send signals to the
amygdala within twelve milliseconds. It takes twice as long for the signals to get to the
conscious part of the brain." Schubiner refers to this as "emotional speed dial," because
the body responds to emotional triggers before we are even aware of them.
 When we encounter something that caused fear, anger or guilt earlier in our life, it
can set off the alarm system in our brains. For example, you hear someone yelling in a
store, the anger isn't aimed at you but it takes you right back to when your mother or
father yelled at you and your body may well react as if it were happening all over again.
 Referring to these kinds of experiences, Schubiner writes: "In these situations, our
subconscious mind will try to alert us to a problem or protect us from something it
perceives as harmful. Unfortunately, our bodies do not use words to tell us that there is a
perceived danger. Our bodies just react, often with pain. When we are faced with very
real stressful situations, especially when we feel trapped and unable to find a solution, our
bodies react as if we were in grave danger. The brain will activate the danger/alarm
mechanism, and it can cause tension in certain specific muscles – tension that creates real
pain. Over time, the pain can worsen or become widespread. I often use this metaphor to
describe this process: 'Your body was knocking to let you know that something was
bothering you. But you didn't understand it. So, it knocked louder and louder, by
creating more pain or new symptoms. When you didn't listen, it rang the doorbell, and
finally it threw a rock through a window to get your attention.'" (Schubiner, p. 44)
 He gives as an example the fact that whether someone does well with back surgery can
be predicted by their job satisfaction. He believes this is because the body creates
backpain in people who are in jobs they hate but don't feel they can leave as a way to
protect them. In another study women who had high workloads, little control over
their work and experienced bullying in the workplace were more likely to develop
fibromyalgia than women happy in their jobs.
 He also tells the story of Barry a 35-year-old firefighter who had an accident on the job
and developed neck pain he couldn't get rid of. He told Dr. Schubiner he'd had similar

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 injuries in the past but always bounced back. When Dr. Schubiner asked him what was
different about this fire, he explained one of his friends died in the fire. He had been on
disability for 9 months when he came to Dr. Schubiner. "I explained consciously he
wanted to return to work but that his nervous system had become sensitized as
subconsciously he had feelings of fear, anger, and guilt caused by his friend's death."
He told him his pain was real but curable. He participated in the doctor's program and he
was 80% better in three weeks and he was back to work in 6 weeks.
 He suggests the location of pain or problems can give a hint about what is driving it.
He said difficulties swallowing might be reacting to a situation that is hard to swallow.
He says he treated a woman with pain on the bottom on her feet who realized she was
dealing with a situation "she couldn't stand."
 Dr. Schubiner talks about a man who grew up with a father who never had time for him
and when the father remarried, sent him to live all of his adolescence in a youth home. In
spite of this adversity, the man did well and had a family of his own. He had little
contact with his father but when he knew he was in the area he invited him to come visit
and meet his grandchildren. His father arrived in a drunken state and stayed only briefly.
Within a few days his patient developed severe stomach pains, back pain and anxiety.
For years he sought medical treatment and endless medications which did little to help.
Dr. Schubiner told him "Your father had poured the gasoline for all those years of
your childhood, and when you asked him to something for your children, he lit a
match which ignited all the anger and resentment that had built up in your
emotional memory. You could handle him neglecting and abusing you, but when he did
a similar thing to your children, you had so many strong subconscious feelings that it
erupted in your body." (Schubiner, p. 48)
 He says he has interviewed hundreds of people with mind-body symptoms and so far
has only had a handful of people for whom the source of their symptoms didn't become
clear with an in-depth interview.
 "One of the most difficult things to understand about MBS is that the symptoms can
be very severe. It is extremely difficult for people with severe pain, anxiety, depression,
or fatigue to grasp the idea that their condition is not caused by some kind of physical
damage or injury…Consider the role that pain plays as a protective mechanism…This
mechanism has been in place in our brain for many centuries. Since emotions and
stress activate the exact same mechanisms as does a physical injury, we often get very
severe pain…Therefore, do not be fooled by how severe or how frequent your symptoms
are. The pain or other symptoms are not imaginary or simply, 'in your head.' Your brain
has learned them, and you can reverse them." (Schubiner, p. 78)
 If you would like to take a more in-depth look at childhood experiences, stressors or
other factors that might contribute to your physical pain or other symptoms, see the
list of questions at the end of this handout.

The 28 Day Program to Cure Chronic Pain

 You can guide yourself through this program using the book Unlearn Your Pain. You
can also enroll for an on-line program. The online program has video instruction, an
online forum for help and ongoing access to Dr. Schubiner by email for questions or
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 concerns. This might be a more effective alternative to just working through the book on
your own. https://www.unlearnyourpain.com/moodle/login/index.php
 There are 6 major components: reading about MBS (Mind Body Syndrome);
repudiation of physical explanations for your symptoms; writing exercises; verbal
expression of deep emotions' reflecting with meditative exercises; reprogramming your
mind; and, rebuilding your life.
 Describing the program in detail is beyond the scope of this presentation. I will just
provide a general overview. You can do the program on your own or look for a group. I
am considering offering a group. If you are interested, send me an email –
judithpierson@juno.com
 It is also important to have already had the appropriate tests and other diagnostic
procedures completed to make sure you don't have a physically identifiable, and
treatable, condition.
 You who are listening to this program have already "started" the program because you
have learned about what the mind-body syndrome is. The first week of the program
involves identifying past traumatic or stressful events as well as personality traits that
might be linked to ongoing pain or other symptoms. It also involves giving expression to
feelings such as anger, guilt, sadness, and grief. It also involves writing about your pain
using a variety of exercises. It also introduces a mindfulness meditation and other
techniques to use when your pain is triggered.
 Week Two focuses on "reclaiming your past." It has participants focus on feelings of
guilt and shame. It also involves examining memories and the lessons learned from those
experiences and writing unsent letters. A meditation that involves revising the past is
introduced along with exercises to reprogram the brain and to rebuild your life.
 Week Three introduces the tools of dialogues and internal family systems. There is also
a focus on forgiveness and gratitude. And, there is a continuation of meditations and
exercises to reprogram your brain and rebuild your life.
 Week Four focuses on creating the new you. Activities include becoming open to and
accepting of yourself; finding new responses to stressors and difficult situations; facing
your fears and choosing a new life; and, writing your life story in a new way.
Dr. Schubiner shared the words of a young woman who wrote:
"Strange as it may sound, I am thankful for my experience with Mind Body Syndrome. Without
the incentive from that wretched pain, I would never have looked inside myself for the answer.
In doing so, I was forced to confront old demons and begin the path towards healing, both inside
and out." (Schubiner, p. 328

References
Boos, N., Semmer, N et al. (2000). Natural history of individuals with asymptomatic disc
abnormalities in magnetic resonance imaging: Predictors of low-back pain-related medical
consultation and work incapacity. Spine, 25: 1484-92.

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Borenstein, D.G., O'Mara, J.W. Jr. et al (2001). The value of magnetic resonance imaging of the
lumbar spine to predict low-back pain in asymptomatic subjects: A seven-year follow-up study.
Journal of Bone and Joint Surgery, 83-A: 1306-11.
Burns, J.W. (2006). Arousal of negative emotions and symptom-specific reactivity in chronic
low back pain patients. Emotion, 6:309-19
Castro, W.H., Meyer, S.J., et al. (2001). No stress – no whiplash? Prevalence of "whiplash"
symptoms following exposure to a placebo rear-end collision. International Journal of Legal
Medicine, 114: 316-22.
Goebel, M.U., Trebst, A.E., et al. (2002). Behavioral conditioning of immunosuppression is
possible in humans. Federation of American Societies for Experimental Biology Journal, 16:
1869-73.
Gracely, R.H., Petzke, F., Wolf, J.M. & Clauw, D.J. (2002). Functional Magnetic Resonance
imaging evidence of augmented pain in processing in fibromyalgia. Arthritis and Rheumatism,
46: 1333-43.
Hensche, N., Maher, C.G. et al. (2009). Prevalence and screening for serious spinal pathology in
patients presenting to primary care settings with acute low back pain. Arthritis and Rheumatism,
60: 3072-3080.
Jensen, M.C., Brant-Zawadski, M.N., et al. (1994). Magnetic resonance imaging of the lumbar
spine in people without back pain. New England Journal of Medicine, 331: 69-73.
LeDoux, J. (1996). The Emotional Brain: The Mysterious Underpinnings of Emotional Life.
New York: Touchstone Books, Simon and Schuster.
Quartana, P.J. & Burns, J.W. (2007). Painful consequences of anger suppression. Emotion, 7:
400-14.
Schrader, H., Obelieniene, D. et al. (1996). Natural evolution of late whiplash syndrome outside
the medicolegal context. Lancet, 347: 1207-11.
Simotas, A.C. & Shen, T. (2005). Neck pain in demolition derby drivers. Archives of Physical
Medicine and Rehabilitation, 86: 693-6.
van der Kolk, B. (2015). The Body Keeps the Score. New York: Penquin Books.
Wegner, D.M. (2002). The Illusion of Conscious Will. Cambridge, MA: Bradford Books, The
Massachusetts Institute of Technology Press.
Wilson, T.D. (2002). Strangers to Ourselves: Discovering the Adaptive Subconscious.
Cambridge, MA: The Belknap Press of Harvard University Press.

Resources
Dr. Schubiner's website: unlearnyourpain.com. Here you can watch videos and listen to
podcast related to his unlearn your pain. I thought a two-minute video was an accessible and a
good quick overview. - https://www.youtube.com/watch?v=D36yy63CHq4
You can enroll for his on-line program via this page. The online program has video instruction,
an online forum for help and ongoing access to Dr. Schubiner by email for questions or concerns.

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This might be a more effective alternative to just working through the book on your own.
https://www.unlearnyourpain.com/moodle/login/index.php
The PPD/TMS Peer Network is a network for people dealing with pain not explained by
traditional physical causes. It is loaded with information including practitioners who work with
this. It also has a community forum for support between members.
The Pain Psychology Center is a facility in LA specializing in the treatment of chronic pain that
works worldwide over Skype to help reduce or eliminate their symptoms. -
https://painpsychologycenter.com/index.html
The Psychophysiologic Disorders Associations (PPDA) – "Psychophysiologic Disorders (PPD)
is the clinical term for mindbody symptoms. PPD are physical conditions and pain symptoms in
the body that develop in response to stress, trauma and other psychological factors. These mind-
body symptoms can affect almost any structure, organ system or region of the body." -
https://ppdassociation.org/
Curable app: See curablehealth.com. This is an application you can download on your phone.
Built on a Proven Approach - The "biopsychosocial" approach to pain has shown significant
results across clinical studies. Curable's unique design translates this approach for people, to help
address pain from multiple angles - physical, emotional, and psychological. Dr. Schubiner is
affiliated with this program.
Freedom from Chronic Pain – " Effective neuroplasticity treatment for most chronic pain
conditions." - https://www.freedomfromchronicpain.com/
Reading List
Unlearn Your Pain: A 28 Day Process to Reprogram Your Brain, Howard Schubiner and
Michael Betzold. Mind Body Publishing, 2019.
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, Bessel van der
Kolk. Penguin Books, 2015.
WORKBOOK For The Body Keeps the Score: Brain, Mind, and Body in the Healing of
Trauma, Bessel van der Kolk. Go-Get Publishing, 2020.
Fierce Self-Compassion: How Women Can Harness Kindness to Speak Up, Claim Their
Power, and Thrive, Dr. Kristin Neff. Harper Wave, 2021.
The Mindbody Prescription: Healing the Body, Healing the Pain, John E. Sarno. Warner
Books, 1999.
The Divided Mind: The Epidemic of Mindbody Disorders, John E. Sarno. Harper Perennial,
2007.
How Emotions Are Made: The Secret Life of the Brain, Lisa Feldman Barrett. Mariner Books,
2018.
The Illusion of Conscious Will, Daniel M. Wegner. M.I.T. Press, 2017.
Strangers to Ourselves: Discovering the Adaptive Unconscious, Timothy D. Wilson. Belknap
Press, 2004.

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Self-Compassion: The Proven Power of Being Kind to Yourself, Dr. Kristin Neff. William
Morrow Paperbacks, 2015.
Lives Transformed: A Revolutionary Method of Dynamic Psychotherapy, David Malan and
Patricia C. Della Selva. Routledge, 2007.
Reaching Through Resistance: Advanced Psychotherapy Techniques, Allan Abbass. Seven
Leaves Press, 2015.

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 Investigating Your Childhood
(taken from Unlearn Your Pain, Schubiner, H. & Betzold, M. Mind Body Pub. 2019)
What words would you use to describe your father? (Substitute another caregiver if you
didn't grow up with your father.)
What kind of work did your father do? Was he successful in his career?
Was your father loving? Did he hug you or tell you he loved you? Was he supportive?
Were you particularly close to your father? Did he confide in you?
Was his love conditional? (Did you have to earn it or was it given with no expectations?)
Did your father have high expectations of you?
Was he critical or judgmental?
Was he a perfectionist?
Did he yell at you?
Did he hit or punish you?
Were you afraid of him?
Was our father aloof, neglectful, or self-centered?
Were some children given preferential treatment or treated more harshly than others? If so, how
did that make you feel? How did that affect the relationship between you and any of your
siblings?
Did your dad drink or use drugs? If so, how did that affect him, the family, and you?
Did your father have any mental health issues?
Was he anxious, worried or insecure?
How did your father treat your mother?
Did you identify with your father?
Did you attempt to be like him or to be different from him?
What words would you use to describe your mother? (Substitute another caregiver if you
didn't grow up with your mother.)
What kind of work did your mother do? Was she successful in her career?
Was your mother loving? Did she hug you or tell you she loved you? Was she supportive?
Were you particularly close to your mother? Did she confide in you?
Was her love conditional? (Did you have to earn it or was it given with no expectations?)
Did your mother have high expectations of you?
Was she critical or judgmental?
Was she a perfectionist?
Did she yell at you?

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Did she hit or punish you?
Were you afraid of her?
Was our mother aloof, neglectful, or self-centered?
Were some children given preferential treatment or treated more harshly than others? If so, how
did that make you feel? How did that affect the relationship between you and any of your
siblings?
Did your mother drink or use drugs? If so, how did that affect her, the family, and you?
Did your mother have any mental health issues?
Was she anxious, worried or insecure?
How did your mother treat your father?
Who was in charge of the house?
Who handled disciplinary issues?
Did your parents argue?
Did you identify with your mother?
Did you attempt to be like her or to be different from her?
Did anyone other than your mother and father have responsibility for you or care for you as a
child? If so, who? Repeat the above questions for these individuals if they had significant roles
in your upbringing.
Think of the relationships you had with your siblings while you were growing up.
Were there resentments or jealousies?
Was there any cruelty, meanness, or abuse?
Did any of your siblings have any illnesses, psychological problems, or drug abuse problems?
Did any of your siblings rebel, act out, or behave in ways that were upsetting to our parents or to
you?
How did you react to these situations?
How was money handled in your family?
Did you feel that money was a scarce resource?
Did your parents use money as a controlling agent?
Were they generous with money or not?
Did you work as a child or teenager?
Finally, consider if there were any particularly stressful or traumatic events in your
childhood. Describe any of the following: deaths, moves, bullying, taunting, teasing, emotional
or physical abuse, changes in school situations, conflicts with teachers, or changes in family
situations?
Have you ever been subjected to any episodes of unwanted sexual activity or sexual abuse?

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