Control Pain & Heal Faster With Your Brain | Huberman Lab Essentials

welcome to hubman lab Essentials where we revisit past episodes for the most potent and actionable science-based tools for mental health physical health and performance I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford School of Medicine let's continue our discussion about neuroplasticity this incredible feature of our nervous system that allows it to change itself in response to experience and even in ways that we consciously and deliberately decide to change it most people don't know how to access neuroplasticity and so that's what this entire month of the huberman Lab podcast has been about

we've explored neuroplasticity from a variety of different perspectives we talked about representational plasticity we talked about the importance of focus and reward we talked about this amazing and somewhat surprising aspect of the vestibular system how altering our relationship to gravity and in addition to that making error as we try and learn can open up Windows to plasticity but we have not really talked so much about directing the plasticity toward particular outcomes and thus far we really haven't talked yet about how to undo things that we don't want and so today we are going to explore

that aspect of neuroplasticity and we are going to do that in the context of a very important and somewhat sensitive topic which is pain and in some cases injury to the nervous system we as always here on this podcast are going to discuss some of the science we get into mechanism but we also really get at principles principles are far more important than any one experiment or one description of mechanism and certainly far more important than any one protocol because principles allow you to think about your nervous system and work with it in ways that

best serve you so let's start our discussion about pain and the somata sensory system the somata sensory system is as the name implies involved in understanding touch physical feeling on our body and the simplest way to think about the somata sensory system is that we have little sensors and Those sensors come in the form of neurons nerve cells that reside in our skin and in the deeper layers below the skin we have some that correspond to and we should say respond to Mechanical touch so you know pressure on the top of my hand or a

pinpoint or other sensors for instance respond to heat to cold some respond to vibration we have a huge number of different receptors in our skin and they take that information and send it down these wires that we call axons in the form of electrical signals to our spinal cord and then up to the brain and within the spinal cord andin brain we have centers that interpret that information that actually make sense of those electrical signals and this is amazing because none of those sensors has a different unique form of information that it uses it just

sends electrical potentials into the nervous system pain and The Sensation of pain is Believe It or Not A controversial word in the Neuroscience field people prefer to use the word no acception noors are the sensors in the skin that detect particular types of stimuli it actually comes from the Latin word noera which means to harm and why would neurosci does not want to talk about pain well it's very subjective it has a a mental component and a physical component we cannot say that pain is simply an attempt to avoid physical harm to the body and

here's why they actually can be dissociated from one another and there's a famous case that was published in the British Journal of Medicine where a construction worker I think he fell is how the story went and a 14inch nail went through his Boot and up through the boot and he was in excruciating pain just beyond anything he'd experienced he he reported that he couldn't even move in any Dimension even a tiny bit without feeling excruciating pain they brought him into the clinic into the hospital they were able to cut away the boot and they realized

that the nail had gone between two toes and it had actually not imp impaled the skin at all his visual image of the nail going through his boot gave him the feeling the legitimate feeling that he was experiencing the pain of a nail going through his foot which is incredible because it speaks to the power of the Mind in this pain scenario and it also speaks to the power of the specificity it's not like he thought that his foot was on fire he thought because he saw a nail going through his foot what it was

going through his boot but he thought it was going through his foot that it was sharp pain of the sort that a nail would produce it really speaks to the incredible capacity that these top down these you know higher level cognitive functions have in interpreting what we're experiencing out in the periphery even just on the basis of what we see so why are we talking about pain during a month on neuroplasticity Well turns out that the pain system offers a a number of different principles that we can leverage to a ensure that if we are

ever injured we are able to understand the difference between injury and pain because there is a difference that if we're ever in pain that we can understand the difference between injury and pain that we will be able to interpret our pain and during the course of today's podcast I'm going to cover protocols that help eliminate pain from both ends of the spectrum from the periphery at the level of the injury and through these top- down mental mechanisms believe it or not we're going to talk about love a colleague of mine at Stanford who runs a

major pain clinic um is working on and has published quality peer- rreview data on the role of love in modulating the pain response so what we're talking about today is plasticity of perception which has direct bearing on emotional pain and has direct bearing on trauma so let's get started in thinking about what happens with pain and I will tell you just now that there is a mutation a genetic mutation in a particular sodium Channel a sodium channel is uh one of these little holes in neurons that allows them to fire Action potentials it's important to

the function of the neuron it's also important for the development of certain neurons and there's a particular mutation there are kids that are born without this sodium Channel 1.7 if you want to look it up those kids experience no pain no pain whatsoever and it is a terrible situation um they don't tend to live very long due to accidents it's a really terrible and unfortunate circumstance in fact it's reasonable to speculate that one of the reasons not all but one of the reasons why people might differ in their sensitivity to pain is by way of

genetic variation in how many of these sorts of receptors that they express people who make too much of this receptor experience extreme pain from even subtle stimul so let's talk about some of the features of how we're built physically and how that relates to pain and how we can recover from injury so first of all we have maps of our body surface in our brain it's called a homunculus that representation is scaled in a way that matches sensitivity so the areas of your body that are most sensitive have a lot more brain real estate devoted

to them your back is an enormous piece of tissue compared to your finger finger tip but your back has fewer receptors devoted to it and the representation of your back in your brain is actually pretty small whereas the representation of your finger is enormous so the how big a brain area is devoted to a given body part is directly related to the density of receptors in that body part not the size of the body part you can actually know how sensitive a given body part is and how much brain area is devoted to it through

what's called twoo discrimination you can do this experiment if you want I think I've described this once or twice before but basically if you have someone put um maybe take two pens and put them maybe 6 Ines apart on your back and and touch while you're facing away and you they'll ask you how many points they're touching you and you say um two but if they move those closer together say 3 in you're likely to experience it as one point of contact whereas on your finger you could do play that game all day and as

long as there's a millimeter or so spacing you will know that it's two points as opposed to one and that's because there's more pixels more density of receptors this has direct bearing to pain because it says that areas of the body that have denser receptors are going to be more sensitive to pain than to others so just as a rule of thumb areas of your body that are injured that are large areas that have low sensitivity before injury likely are going to experience less pain and the literature shows will heal more slowly because they don't

have as many cells around to produce inflammation and you might say wait I thought inflammation is bad well one of the things I really want to get across today is that inflammation is not bad inflammation out of control is bad but inflammation is wonderful inflammation is the tissue repair response I thought it might be a nice time to just think about the relationship between the periphery and the central maps in a way that many of you have probably heard about before which will frame the discussion a little bit better which is Phantom limb pain now

some of you are probably familiar with this but for people that have an arm or a leg or a finger or some other portion of their body amputated it's not uncommon for those people to feel as if they still have that limb or appendage or piece of their body Inta and typically unfortunately the sensation of that limb is not one of the limb being nice and relaxed and and you know and just there the sensation is that the limb is experiencing pain or is contorted in the specific orientation that it was around the time of

the injury so if someone has a you know a blunt force to the hand and they end up having their hand amputated typically they will continue to feel pain in their Phantom hand which is pretty wild and that's because the representation of that hand is still intact in the cortex in the brain and it's trying to balance its levels of activity normally it's getting what's called proprioceptive feedback proprioception is just our knowledge of where our limbs are in space it's an extremely important aspect of our somata sensory system and there's no appropri receptive feedback and

so a lot of the circuits start to ramp up their levels of activity and they become very conscious of the Phantom limb now um before my lab was at Stanford I was at UC San Diego and one of my colleagues was a guy everyone just calls him by his lap last name ramachandran who is famous for understanding this Phantom limb phenomenon and developing a very simple but very powerful solution to it that speaks to the incredible capacity of top- down modulation and top- down modulation the ability to use one's brain cognition and senses to control

pain in the body is something that everyone not just people missing limbs or in chronic pain could learn to benefit from because it is a way to tap into the our ability to use our mind to control perceptions of what's happening in our body so what did ramachandran do ramachandran had people who were missing a limb put their intact limb into a box that had mirrors in it such that when they looked in the box and they moved their intact limb the opposite limb which was a reflection of the intact limb because they're missing the

opposite limb they would see it as if it was intact and as they would move their intact limb they would visualize with their eyes the the limb that's in the place of the absent limb so this is all by mirrors moving around and they would feel immediate relief from the phantom pain and he would tell them and they would direct their hand toward a orientation that felt comfortable to them then they would exit the mirror box they would take their their their hand out and and they would feel as if the hand was now in

its relaxed normal position so you could get real time in moments remapping of the representation of the hand now that's amazing this is the kind of thing that all of us would like to be able to do if we are in pain because if you do anything for long enough including live you're going to experience pain of some sort and this again I just want to remind you isn't just about physical injuries and pain this has direct relevance to emotional pain as well which we of course we'll talk talk about so the ramachandran studies were

really profound because they said a couple of things one plasticity can be very fast that it can be driven by the experience of something just the visual experience and so this may come as a shock to some of you and by no means it might trying to be insensitive but pain is a perceptual thing as much as it's a physical thing it's a belief system about what you're experiencing in your body and that has important relevance for healing different types of injury and the pain associated with that injury now this brings up another topic which

is definitely related to neuroplasticity and injury but is a more General one that I hear about a lot which is traumatic brain injury many injuries are not just about the limb and the the lack of use of the limb but concussion and head injury but I want to talk a little bit about what is known about recovery from concussion and this is very important because it has implications for just normal aging as well and offset setting some of the cognitive decline and physical decline that occurs with normal aging typically after TBI there's a constellation of

symptoms that many people if not all people with TBI report which is headache photophobia that lights become kind of aversive sleep disruption trouble concentrating sometimes mood issues there's you know a huge range and of course the severity will vary Etc it's very clear that regardless of whether or not there was a skull break and regardless of when the TBI happened and how many times it's happened that the system that repairs the brain the adult brain is mainly centered around this lymphatic system that we call for the brain the glymphatic system it's sort of like a

sewer system that clears out the debris that surrounds neurons especially injured neurons and the glymphatic system is very active during sleep and the glymphatic system is something that you want very active because it's going to clear away the debris that sits between the neurons and the cells that surround the connections between the neurons called the glea those cells are actively involved in repairing the connections between neurons when damaged so the glymphatic system is so important that many people if not all people who get TBI are told get adequate rest you need to sleep and that's

kind of twofold advice on the one hand it's telling you to get sleep because all the good things happen in sleep it's also about getting those people to not continue to engage in their activity fulltime or really try and Hammer through it the glymphatic system has been shown to be activated further in two ways one is that sleeping on one side not on back or stomach seems to increase the amount of wash out or wash through I should say of the glymphatic system the other thing that has been shown to improve the function of the

lymphatic system is a certain form of exercise and I want to be very very clear here I will never and I am not suggesting that people exercise in any way that aggravates their injury or that goes against their Physician's advice however there's some interesting data that zone 2 cardio for 30 to 45 minutes three times a week seems to improve the rates of clearance of some of the debris after injury and in general injury or no to accelerate and improve the rates of flow for the lymphatic system it could be fast walking it could be

jogging if you can do that with your injury safely could be cycling and this is really interesting outside of TBI because what we know from aging is that aging is a nonlinear process it's not like with every year of Life your brain gets a little older it's a has sometimes it follows what's more like a step function you get these big jumps in in a in markers of Aging I guess that we could think of them as jumps down because it's a negative thing for most everybody would like to live longer and be healthier in

brain and body and so the types of exercise I'm referring to now are really more about brain longevity and about keeping the brain healthy than they are about physical fitness so I think this is really interesting and if some of you would like to know the mechanism or at least the hypothesize mechanism ISM there's a a a molecule called aquaporin 4 that is related to the gal system so Gia are the it means glue and Latin are these are these cells in the brain the most numerous cells in the brain in fact that in sheath

synapses but they're very Dynamic cells aquaporin 4 is mainly expressed by the gal cell called the astroy Astro looks like a little star incredibly interesting cells and the the thing to remember is that the asites bridge the connection between the neurons the synapse the connections between them and the vasculature the blood system and the gimatic system so this glymphatic system and the gal asroy system is a system that we want chronically active throughout the day as much as possible so low-level walking Zone 2 cardio and then at night during slow wave sleep is then really

when this lymphatic system kicks in so that should hopefully be an actionable takeaway provided that you can do that kind of cardio safely that I believe everybody should be doing who cares about brain longevity not just people who are trying to get over TBI now I'd like to return a little bit to some of the subjective aspects of pain modulation because I think it's so interesting and so actionable that everyone should know about this our interpretation our subjective interpretation of a sensory event is immensely powerful for dictating our experience of the event the molecule adrenaline

when it's liberated into our body truly blunts our experience of pain we all know the stories of people you know walking you know miles on stumped legs um people doing all sorts of things that were incredible Feats that allowed them to move through what would otherwise be pain and afterward they do experience extreme pain but during the event often times they are not experiencing pain and that's because of the pain blunting effects of adrenaline adrenaline binding to particular receptors actually shuts down pain Pathways people who anticipate an injection of morphine immediately report the feeling of

loss of pain their pain starts to diminish because they know they're going to get pain relief and it's a powerful effect now all of you are probably saying placebo effect Placebo effects are very real Placebo effects and belief effects as they're called have a profound effect on our experience of noxious stimul like pain and they can also have a profound effect on positive stimuli and things that we're looking forward to one study that I think is particularly interesting here from my colleague at Stanford Sean Mackey they did a neuroimaging study they subjected people to pain

in this case it was a a heat pain people have very specific thresholds to heat at which they cannot tolerate any more heat but they explored the extent to which looking at an image of somebody in this case a romantic partner that the person loved would allow them to adjust their pain response and it turns out it does they could tolerate more pain and they reported it as not as painful that response that feeling of Love internally can blunt the pain experience to a significant degree these are not small effects and not surprisingly how early

a relationship is how new a relationship is directly correlat with people's ability they showed to use this love this internal representation of love to blunt the pain response so for those of you that have been with your partners for many years and you love them very much and you're obsessed with them terrific you have a pre-installed well I suppose it's not pre-installed you had to do the work because relationships are work but you've got a installed mechanism for blunting pain and again these are not minor effects these are major effects and it's all going to

be through that top down modulation that we talked about not unlike the mirrorbox experiments with Phantom limb that relieve phantom pain or some other top- down modulation in the opposite example is the nail through the boot which is a visual image that made the person think it was painful when in fact it was painful even though there was no tissue damage it was all perceptual so the pain system is really subject to these perceptual influences which is remarkable because really when we think about the somata sensory system it has this cognitive component it's got this

peripheral component but there's another component which is the way in which our sensation our somatos sensory system is woven in with our autonomic nervous system independent of love we're going to talk about something quite different which is putting needles and electricity in different parts of the body so-called acupuncture something that for many people were it it's been viewed as a kind of alternative medicine but now there are excellent Laboratories exploring what's called electroacupuncture and acupuncture and I think what you'll be interested in and surprised to learn is that it does work but sometimes it can

exacerbate pain and sometimes it can relieve pain and it all does that through very discrete Pathways for which we can really say this neuron connects to that neuron connects to the adrenals and we can tie this all back to dopamine because in the end it's the chemicals and neural circuits that are giving rise to these perceptions or these experiences rather of things that we call pain love ET Etc there are actually a lot of really good peer-reviewed studies supporting the use of acupuncture for in particular GI trct issues in recent years there's been an emphasis

on trying to understand the mechanism of things like acupuncture and acupuncture itself but as a way to try and understand how these sorts of practices might actually benefit people who are experiencing pain or for changing the nervous system or brain body relationship in general what I want to talk about in terms of acup puncture is the incredible way in which acupuncture illuminates the cross talk between the somata sensory system our ability to feel stuff externally exteroception internally interoception and how that somata sensory system is wired in with and communicating with our autonomic nervous system that

regulates our levels of alertness or calmness so this takes us all back to the homunculus we have this representation of our body surface in our brain that representation is what we call somatotopic and what somatotopy is is it just means that areas of your body that are near one another are represented by neurons that are nearby each other in the brain the connections from those brain neurons are sent into the body and they are synchronized with meaning they Crosswire with and and form synapses with some of the input from the viscera from our guts from

our diaphragm from our stomach from our spleen from our heart our internal organs are sending information up to this map in our brain of the body surface but it's about internal information what we call interoception our ability to look inside or imagine inside and feel what we're feeling inside so the way to think about this accurately is that our representation of our self is a represent ation of our internal workings our viscera our guts everything inside our skin and the surface of our skin and the external World those three things are always being combined in

a very interesting complex but very seamless way acupuncture involves taking needles and sometimes electricity Andor heat as well and stimulating particular locations on the body and if somebody has a gastrointestinal issue like their their guts are moving too quick they have diarrhea you stimulate this area and it'll slow their gut motility down or if their gut motility is too slow they're constipated you stimulate someplace else and it accelerates it and you know hearing about this of it sounds kind of to a Westerner who's not thinking about the underlying neural circuitry it could sound kind of

wacky but when you look at the neural circuitry the neuro Anatomy it really starts to make sense intense stimulation of the abdomen however with these electroacupuncture has a very strong effect of an increasing inflammation in the body body and this is important to understand because it's not just that stimulating the the gut does this because you're activating the gut area it activates a particular nerve pathway for the afficionados it's the splenic spinal sympathetic axis if you really want to know and it's pro-inflammatory under most conditions if for instance the person is dealing with a particular

bacterial infection that can be beneficial and this goes back to a much earlier discussion that we had on a previous podcast that we'll revisit again and again which is that the stress response was designed to combat infection so it turns out that there are certain patterns of stimulation on the abdomen that can actually liberate immune cells from our immune organs like our spleen and counter infection when you stimulate these Pathways that activate in particular the adrenals the adrenal gland liberates norepinephrine and epinephrine and the brain does as well it binds to what are called the

beta noradrenergic receptor okay so this is really getting kind of down into the weeds but the beta nuragic receptors activate the spleen which liberate cells that combat infection that's the short-term quick response the more intense stimulation of the abdomen and other areas can be pro-inflammatory because of the ways that they trigger certain Loops that go back to the brain and Trigger the sort of anxiety Pathways that exacerbates pain so one pathway stimulates norepinephrine and blunts PL the other one doesn't what does all this mean how are we supposed to put all this together well there's

a paper that was published in nature medicine in 2014 this is an excellent Journal that describes how dopamine can activate the Vegas peripherally and nor norepinephrine can activate the Vegas peripherally and reduce inflammation what this means is that there are real maps of our body surface that when stimulated communicate with our autonomic nervous system the system system that controls alertness or calmness and thereby releases either molecules like norepinephrine and dopamine which make us more alert and blunt our response to pain and they reduce inflammation but there are yet other Pathways that when stimulated are pro-inflammatory

one of the things that bothers me so much these days and I'm not easily irritated but what really bothers me is when people are talking about inflammation like inflammation is bad inflammation is terrific inflammation is the reason why cells are called to the site of injury to clear it out inflammation is what's going to allow you to heal from any injury chronic inflammation is bad but acute inflammation is absolutely essential remember those kids that we talked about earlier that have mutations in these receptors that for sensing pain they never get inflammation and that's why their

joints literally disintegrate it's really horrible because they don't actually have the inflammation response because it was never triggered by the pain response so I think that the data on acupuncture turning out to be very interesting before I continue I just thought I'd answer a question that I get a lot uh which is what about Wim Hoff breathing Wim Hoff also called AKA The Iceman um has his breathing that's similar to uh Tumo breathing as it was originally called involves basically hyperventilating and then doing some exhales and some breath holds a number of people have asked

me about it in uh in relation to pain management the effect of doing that kind of breathing it's not a mysterious effect it liberates adrenaline from the adrenals when you have adrenaline in your system and when the spleen is very active that response is used to counter infection and stress counters infection by liberating killer cells in the body you don't want the stress response to stay on indefinitely however things like Wim Hoff breathing like ice baz anything that releases adrenaline will counter the infection but you want to regulate the duration of that adrenaline response today

we've talked about a variety of tools but I want to Center in on a particular sequence of tools that hopefully you won't need but presumably if you're a human being and you're active you will need at some point it's about managing injury and recovering and healing fast or at least as fast as possible it includes removing the pain it includes getting Mobility back and getting back to a normal life whatever that means for you I want to emphasize that what I'm about to talk about next was developed in close consultation with Kelly starett who many

of you probably have heard of before Kelly can be found at the ready State he's a formally trained so degreed and educated exercise physiologist he's a world expert in movement and tissue Rehabilitation so I asked Kelly I made it really simple I said okay let's say I were to sprain my ankle or break my arm or injure my knee or ACL tear or something like that or shoulder injury what are the absolute necessary things to do regardless of situation so the first one is a very basic one that now you have a lot of information

to act on which is sleep is essential and so we both agreed 8 hours of sleep would be ideal but if not at least 8 hours inmobile so that's a non-negotiable in terms of getting the foundation for allowing for glymphatic clearance and tissue clearance Etc the other is if possible unless it's absolutely excruciating when you just can't do it a 10-minute walk per day of course you don't want to exacerbate the injury at least a 10-minute walk per day and probably longer this is where it gets interesting I was taught I learned that when you

injure yourself you're supposed to ice something you're supposed to put ice on it but I didn't realize this but when speaking to exercise physiologists and some Physicians they said that the ice is really more of a placebo it numbs the the environment of the injury which is not surprising and will eliminate the pain for a short while but it has some negative effects that perhaps offset its use it actually can create some like clotting and sludging of the of the tissue and fluids which is bad because you want the macras and the other cell types

phagocytosing eating up the debris and and injury and moving it out of there so that it can repair so that was surprising to me which made me ask well then what about heat well it turns out heat is actually quite beneficial the major effects seem to be explained by heat improving the viscosity of the tissues and the clearance and the profusion of of fluid blood lymph and other fluids out of the injury area so all of this might sound just like Common Sense knowledge I always just thought it's ice it's non-steroid anti-inflammatory drugs it's things

that block block prostag gland and so things like aspirin ibuprofen acetam Menin those things generally work by blocking things like the the they're called Co the Cox uh prostag gland in blockers and things of that sort things in that pathway those sorts of treatments which reduce inflammation may not be so great at the beginning when you want inflammation they may be important for limiting pain so people can be functional at all but the things that I talked about today really are anchored in three principles one is that the inflammation response is a good one it

calls to the to the sight of injury things that are going to clean up the injury in bad cells then there are going to be things that are going to improve profusion like the glymphatic system getting deep sleep feet elevated sleeping on one side low-level Zone 2 cardio three times a week many people ask me about platelet rich plasma so-called PRP they take blood they enrich for platelets and they re-inject it back into people here's the deal it has never been shown whether or not the injection itself is what's actually creating the effect the claims

that PRP actually contains stem cells are very very feeble and when you look at the literature and you talk to anyone expert in the stem cell field they will tell you that it's the number of stem cells in PRP is infinim small stem cells are an exciting area of Technology however there's a clinic down in Florida that was shut down a couple years ago for injecting stem cells harvested from patients into the eye for immaculate degener ation these were people that were suffering from um poor vision and very shortly after injecting uh these stem cells

into the eyes they went completely blind and I'm not here to tell you that you should or shouldn't do something but I do think that anything involving stem cells one should be very cautious of the major issue with stem cells that I think is concerning is that stem cells are cells that want to become lots of different things not just the tissue that you're interested in so if you damage your knee and you you inject stem cells into your knee you need to molecularly restrict those stem cells so that they don't become tumor cells right

a tumor is a collection of stem cells one needs to approach this with Extreme Caution even if it's your own blood or stem cells that you're re-injecting so I'm going to close there I've talked about a lot of tools today I've talked a lot about somea sensation about plasticity about pain about acupuncture some of the Nuance of acupuncture inflammation stress we even talked a little bit about high-intensity breathing so as always we take kind of a whirlwind tour through a given topic lay down some tools as we go hopefully the principles that relate to pain

and injury but also neuroplasticity in general today in the context of the somata sensory system will be of use to all of you I don't wish injury on any of you but I do hope that you'll take the information do with it what you will once again thanks so much for your time and attention today and as always thank you for your interest in science [Music]