Brain Circuits Drive Chronic Pain--Beyond Physical Sensation

Deep Dive

The discussion begins by introducing Dr. Daniel Amen, a double board-certified psychiatrist and founder of Amen Clinics, known for his pioneering work in brain imaging and his new book, "Change Your Brain, Change Your Pain." His clinics have performed over 200,000 SPECT brain scans, allowing him to map blood flow patterns related to behavior, mood, and cognitive symptoms. This approach aims to demonstrate that struggles are rooted in biology rather than being solely "in one's head." The episode highlights the prevalence of chronic pain, affecting one in five adults according to the CDC, and sets the stage to explore the brain's pain circuits, the cycle that perpetuates pain, and potential therapeutic tools.

The conversation then delves into the nature of pain, positing that while pain is experienced in the body, its circuits reside in the brain. This is illustrated by the use of antidepressants like Cymbalta for chronic pain and supplements like SAMe for both depression and arthritis. The source explains that the brain circuits involved in emotional pain are the same ones that process physical pain, suggesting that an unhealthy brain makes one more susceptible to suffering. Repressed emotions, particularly rage, are identified as factors that can amplify suffering. The discussion touches on the use of Tylenol for emotional pain and Advil's differential effect on females versus males, hinting at hormonal influences.

The concept of the "doom loop" is central to the discussion, describing how the brain perpetuates pain once it begins. Automatic negative thoughts (ANTs) are presented as a key driver, increasing muscle tension and pain while diminishing the brain's calming circuits. A study on 2,000 people is cited, showing that negativity bias activates the emotional brain where pain circuits are located and deactivates the thoughtful brain responsible for calming. Low hope, low happiness, and low frontal lobe function are linked to increased pain, as they impair the ability to turn off pain signals.

The episode explores the impact of stress and certain conditions on pain susceptibility. Individuals experiencing higher stress levels are deemed more prone to negativity bias and thus more likely to experience pain if injured. Those with ADHD are noted to have lower activity in their prefrontal cortex, leading to impulsivity, and also lower cerebellar activity, which is involved in coordination. This reduced cerebellar function can increase the likelihood of minor accidents that lead to pain.

Regarding treatment, the source expresses concern over the long-term effects of opiates, citing a study showing they can increase inflammation by affecting white blood cells. For antidepressants, while not the first choice, the discussion pivots to supplements. Omega-3 fatty acids, saffron, zinc, and curcumin are highlighted for their potential benefits in managing depression and inflammation. A review of 192 studies on 17,000 people indicated saffron as highly effective for depression, with SAMe also showing promise. Zinc and curcumin are noted to enhance the effectiveness of saffron or antidepressants, with zinc aiding serotonin production and curcumin reducing inflammation.

A new study is mentioned that suggests SSRIs may increase vulnerability to dementia, a concern given that 25% of adults are on psychiatric medication. The reasoning provided is that SSRIs, by increasing serotonin, can cause cognitive problems if initiated at low doses, and depression itself is a risk factor for dementia, doubling the risk in women and quadrupling it in men. This leads to a critique of current psychiatric practices, advocating for a focus on identifying the root cause of depression rather than solely treating symptoms.

The source proposes a shift in psychiatric practice, advocating for three key changes: the use of imaging to understand brain function, honesty about the brain's condition, and a move away from symptom-cluster diagnoses without biological data. The current system, with millions of antidepressant prescriptions issued without brain scans, is described as "insanity." The influence of a half-trillion-dollar industry is suggested as a factor resisting this change, leading to critics labeling those who advocate for brain imaging as "quacks."

The discussion addresses the scientific consensus that depression is not solely caused by a neurotransmitter imbalance, with studies showing SSRIs performing no better than placebo in large groups. An anecdote is shared about a wife experiencing significant behavioral changes, including risk-taking, after being prescribed Prozac for depression following thyroid cancer, highlighting how medication can alter personality and decision-making. The conversation also touches upon birth control pills, noting their potential to alter a woman's attraction patterns and that 40% of women experience depression while on them, underscoring the importance of knowing the risks associated with medications.

The episode then pivots to a more holistic approach to brain health, emphasizing the need to address the root causes of depression. Dr. Amen's "BRIGHT MINDS" acronym is introduced as a framework for preventing or treating 11 major risk factors for brain health, applicable to depression, pain, and Alzheimer's prevention. These factors include blood flow, retirement/aging, inflammation, genetics, head trauma, diabetes, emotional stress, and sleep.

The role of psychological and social factors in depression is explored. A viral post suggesting that a vacation lifting depression indicates a "shitty life" is discussed, with the host agreeing that external circumstances can significantly impact mood. Dr. Amen outlines four circles of influence: biology, psychology (how one thinks), social circle (isolation, pandemic effects), and spirituality (belief in God, sense of meaning and purpose). He notes that not believing in God triples the risk of depression, and a lack of meaning and purpose, prevalent in 58% of young people, contributes to rising depression rates, exacerbated by a social media culture focused on self.

The potential for chronic pain to become akin to an addiction is raised. The case of Sam, a police officer with chronic back pain after accidents and multiple surgeries, is presented. Sam's overactive anterior cingulate gyrus, described as the brain's "gear shifter," led to a repetitive "I hurt" loop. Supplements aimed at calming this area provided relief. This illustrates the "doom loop," which begins with pain from any source (biological, psychological, social, or spiritual) and activates suffering circuits, leading to negative thoughts, nervous tension, bad habits, and a cycle of increased pain.

The "healing loop" is presented as the antidote to the doom loop. This involves approaching pain with curiosity rather than fury, asking questions about diet, sleep, and emotional state. "Havening," a technique involving bilateral hemisphere stimulation, is introduced as a method to calm the amygdala and reduce distress. The host shares a personal experience of using havens to process the grief and anger after his father's death, finding significant relief. This technique is compared to EMDR, noting its shared principle of processing difficult emotions.

The importance of mental discipline is emphasized as a key lifestyle lever. The source argues that the mind can be trained like a muscle, and education should include how to manage one's thoughts. A children's book, "Captain Snout and the Superpower Questions," is mentioned, promoting the idea of questioning negative thoughts, categorized as "ants" like all-or-nothing thinking, fortune-telling, and guilt-inducing thoughts. Giving one's mind a name is suggested as a technique to gain psychological distance and observe thoughts without attachment.

Repressed rage is identified as