Tired of Living with Pain? A Pain Expert Gives Advice
Updated: Jul 2
This article is a transcribed edited summary of a video Bob and Brad recorded in March of 2020. For the original video go to https://www.youtube.com/watch?v=0pxenGYuCgs
Bob: And once again, it is our extreme pleasure to have with us today Dr Adrian Louw. Dr Adrian Louw is a pain expert, and I’m going to let you talk as to what your qualifications are, what makes you that. Brad?
Brad: This is a real treat for us. I mean this is like going to one of the world’s leading experts.
Bob: Right! Just listen, you’ll find out.
Brad: You’ll be on the edge of your seat.
Bob: So, Dr Louw if you could maybe just give a little bit on your background.
Dr Adrian Louw: Yeah, like I said, I’m a physical therapist, trained as a physical therapist, and I got very interested with the pain and decided to study it. And then I was very fortunate to be surrounded by some of the smartest pain people on the planet, and they were very kind to me. I just started studying, doing PhD work, and now we’re doing an enormous amount, we’ve got about 23 studies right now ongoing.
Bob: Oh, fantastic, wow.
Dr Adrian Louw: Big research team and just trying to get the world a better place.
Bob: That is so awesome!
Brad: So you got your PhD and he’s from South Africa.
Brad: He’s written all these books; we have 13 or 14 books that he authored.
Bob: Books on pain, and what you going to want to do is check these books out. Because if you have a specific problem, it probably is in one of these books. So if you’re having trouble with back pain or if you have pelvic pain or fibromyalgia, check out the book links at the end and we’ll get into those specifically. If you’re a therapist, you may want to check out this book, “Integrating Manual Therapy and Pain Neuroscience.” There are also classes they put on, and it’s going to be in https://evidenceinmotion.com/ if you check that out.
Bob: So I guess, again, we’re talking here, we’re going to kind of talk about examples of some of the education you give. Why don’t you talk about why the education is important?
Dr Adrian Louw: We have just found out several years ago when we interviewed people with pain and asked, what do you want from us? And the clear message is they want more information. The current, even though people get internet and all, the information currently isn’t, it’s not clear. It doesn’t explain things really well.
Bob: I think it’s even scarier on the net.
Dr Adrian Louw: It is actually scary, there’s recent studies that showed 90% of the information on the internet about back pain isn’t bad, it is disastrously bad. Because it drives fear and all those things. And so we went to study pain, what is pain, how pain really works, and we found out people are better for it when they learn about pain from a neuroscience perspective. What I mean is if they understand the underlying biology. Now, the problem is, I cannot just sit with you like a textbook and say, “this is how pain works.” It doesn’t make sense. So we’ve taken this and put theem in stories. We learn through stories. Everybody listening right now probably cannot remember what they were taught about history in the fifth grade. We could lie, right, we could lie and say Lincoln, Hitler, we could say anything of those. But we remember stories like “The Tortoise and the Hare”, right, stories. Through the history of mankind, we transferred knowledge through stories. And so we took this information, put them in stories, and it works, it makes peoples lives better. To be honest, one of the coolest things we’re working on, we built a middle school pain neuroscience program that’s now in middle schools in nine states.
Bob: No kidding!?
Dr Adrian Louw: In the United States, so we’re teaching kids about pain and we’re tracking them now through school. They experience less pain, they take less medicine when they hurt, all the things we want them to do.
Bob: Which I imagine decreases stress too.
Dr Adrian Louw: Absolutely, they have less fear too. So we’re tracking them, and bottom line is if people know more about their pain and know how it works, our lives are better for it. And for us as therapists, it means they’ll move, and movement is the biggest pain killer on the planet. Bar none.
Brad: Absolutely. Motion is lotion.
Bob: You had mentioned in the other video some of the other things that can help decrease pain too, in addition to education.
Dr Adrian Louw: Yes, there is a bunch of stuff we have now looked at. I mean if you look at things like sleep hygiene. Sleep calms the nervous system down. There’s different types of nutrition, mindfulness, relaxation, goal setting. Different forms of exercise. I may call it manual therapy, some people call it yoga, Pilates, etc. Movement, all those different movement styles. There’s so many different things that can calm the nervous system non-pharmacologically, because that’s a safer alternative for what we’re doing right now.
Brad: You’ll see people that are on pain medications with a primary goal of reducing that. Is that something you deal with on a regular basis?
Dr Adrian Louw: Absolutely. And as we always say, you cannot take the pain medicine away. If I was a patient listening right now, I would say, don’t take my medicine, I don’t know what else to do. We should think about it as a scale, if we build this side so powerful and my physician can take the medicine down, they don’t freak out. And what we have now built, especially in the VA, what I’m showing you right now, there’s 22 things we’re doing as part of, in many VA’s right now, as part of their anti-opioid initiative. If you build this side up, the brain turns on it’s own chemistry. Your brain right now has the most powerful medicine known on the planet, between your ears. When you hurt yourself, our brain has this incredible capacity to shut that down. We are sitting here right now, a farmer in Nowhere, MN, today is putting up a fence. Auger pulls his arm and cuts his arm off in the middle of the field, the brain turns open the faucet, the tap, and produces these fancy chemicals: endorphins, enkephlanins, serotonin, where the guy feels nothing. Puts a tourniquet on him, he drives 20 miles to the emergency room, he probably stops for a coffee. We’ve heard these stories right?
Dr Adrian Louw: And then he shows up at the emergency room,
Bob: Or like with a nail in his head.
Dr Adrian Louw: Then we ask him, what’s your pain rating? I’m good, I’ll wait. How cool is that? When we hear our soldiers coming back and they’ve been shot, they’re not aware of it, our brain has incredible chemistry. When you’re in pain, the brain dries that up to make you more sensitive. So we almost have to ask today, how do we take a dry brain, less chemical, and make it wet again? All the happy chemicals, and that’s that stuff you guys do and I do, all that 22 things. Let’s turn the brain on so we can take that medicine, over time, away.
Brad: So you’re saying the brain physically can produce pain medicine?
Dr Adrian Louw: Yes, yes, medicine. Are you guys runners?
Dr Adrian Louw: We talked about running and dogs, and we talk about it in a great way. A six mile run produces 10 milligrams of morphine in the human brain.
Photo by Jenny Hill on Unsplash
Bob: No wonder I’m so high after.
Dr Adrian Louw: So think about it, if you break your arm today and you go to the emergency room, they’re going to give you two or three milligrams of morphine to set your arm. You get two to three times more then that by just going on a run. That’s why this is that “runner’s high”. And this is so much our brain produces to dampen the system, but It dries up when we’re in pain because the brain is worried about us. So we have to enhance that again.
Bob: So, would you say of the 22 things, the first thing and the cornerstone of it, is education?
Dr Adrian Louw: There’s four. We’ve tested it. And trust me, we didn’t sit up one night with my buddies with a couple of beers going, yep, yep, no, yep, yep, no. This is statistical modeling. There are four things you gotta get right. 1) You have to know why you hurt. The most dangerous brain we have is one that doesn’t know what’s going on because we all make up our own reality. And I mean no disrespect here today, but all of us have been there, all of us have found something on our body and like, ooh, what’s that bump? And two minutes later you’re thinking worst case scenario. So the brain must know what’s going on.
Bob: It’s taking those leaps.
Dr Adrian Louw: Yes, number one, check. Number 2) you have to move. Motion is lotion, as you guys always preach. Like, motion is lotion. When we pump blood and oxygen through the human body, the nervous system calms down. And I know our patients right now are watching this going, “I know he’s going to go there. We gotta run marathons, climb Mt Kilimanjaro,” no, no, no. A nice brisk walk and very simply is you gotta get your heart rate up a little bit, pump some blood through your body. How cool is that? Buy a leash, take your dog for a walk. How cool is that? And then 3) is sleep. It’s one of the biggest cornerstones we have. The minute somebody can get meaningful sleep, but it isn’t as simple as just, saying go to sleep. We have to change your biology, we gotta get your system to dampen down. We gotta get healthy sleep habits. And then number 4) you’ve got to have a reason to get out of bed, that’s goals. There’s got to be a reason to get out of bed. And unfortunately, our system right now does not incentivize people to go back to work or to go back to activity and we have to find that thing. And that’s where we talk to our patients about deep beliefs and thoughts and goals. If those four things are right, we tested it, people had meaningful shift in their life.
Bob: It’s funny, I just read the book, “Why We Sleep.”
Dr Adrian Louw: Yes, yes, yes, absolutely, Bradley Walker.
Bob: I was telling Brad; it’s a fantastic book.
Dr Adrian Louw: Oh, it’s mind blowing.
Bob: But it scares the heck out of you if you don’t get enough sleep. I mean I’ve changed my life now making sure that I’m going to get enough sleep. I mean we go to bed earlier…
Dr Adrian Louw: I would tell you, if you can get a person of chronic pain to sleep, you’re halfway there. But it isn’t that simple.
Bob: It’s not simple.
Dr Adrian Louw: Your system has to dampen a little bit. But mind-blowing, it’s amazing.
Bob: So we thought we’d start the education process, maybe, with a story. You use a lion because you’re from South Africa. We might use a barking dog, or a Cujo. You probably don’t know the movie Cujo?
Dr Adrian Louw: No, no I don’t. He made it up, didn’t he?
Bob: A Stephen King movie, Cujo is this huge dog that starts attacking a family and its kind of like the one example of a bad dog.
Dr Adrian Louw: I think he made it up.
Brad: We’ll go with the lion.
Bob: Look it up. Okay, we’re going to use lion.
Dr Adrian Louw: So one of the ways we often, as I said, we tell stories to patients, it resonates with them. And so what we find with people in chronic pain, for example, they have problems, they’re fatigued. I have so many patients come and see me, “I don’t know what’s going on. Since I developed pain I’m so tired. 2:00 in the afternoons”, they say “I’m wiped out.” Or they say things like, “I cannot sleep at night.” Either they cannot fall asleep or they’re so exhausted, even though they sleep. So we understand the underlying biology, there are stress chemicals running through our body. But sitting with them and just saying, let me tell you how stress works, is a little too academic. So we tell a story, and you guys are going to be my fifth graders. There’s a TV show, “Are You Smarter then a Fifth Grader?” so don’t let me down, don’t let me down.
Bob: We’re gonna be perfect. All right.
Dr Adrian Louw: If a lion jumped in this room right now, right, a big roaring African lion, what would you do?
Photo by Francesco De Tommaso on Unsplash
Bob: I’m going to try to maybe, I don’t know, run or fight or flight.
Dr Adrian Louw: Yeah, and most people are familiar with fight and flight, right? So we would run and so, you’d probably shove me in front of him. This is a classic.
Bob: That’s right, we don’t have to run fast, we just have to run faster than you.
Dr Adrian Louw: Faster than the last guy, that’s me, yeah. So we would say to the patients, if a lion jumps in the room, what would you do? They’d say, I’d scream, I’d run, whatever, fair enough. But then we run through scenarios. If the lion jumps in the room, are you going to take a nap? I’ve never had a patient say yes, they say, “No, I’d be awake.” Exactly. The lion jumps in the room, are you gonna mobilize all your energy, or are you going to store some for the winter? “No, I’m going to mobilize.” They’re smart, right. If the lion jumps in the room, which muscles do we need? The big ones or the small ones? It’s the big ones…
Bob: The big ones.
Dr Adrian Louw: So I can punch the lion, shove Adrian in front of the lion, right? They understand this. If a lion jumps in the room are you worried about the food in your stomach? No, we shunt blood away from it. Everybody understands the system. The local zookeeper at Winona, MN, I don’t know if you have a zoo here? He comes and takes the lion out of the room and you sit back in your seat and go, “whew, that’s the third lion attack in Winona this week, this better stop,” right? We have this fight or flight. The system ramps, calms, ramps, calms. What does this have to do with someone in pain? Pain is a stressor. Pain is a normal thing. All of us experience pain, but living in pain is not normal. I think we need to understand if you wake up in the morning and from the moment you wake up you experience pain, that assumes you slept, and that lion is in your life not for a day, not for a week, not for a month, not for a year, but for 20 years, your system shunts but never comes back. That’s why when you wake up in the morning, guess what? You burn through fuel by 2:00 and you’re wiped out. And again, it seems simple, but patients go, “Wow, that makes sense.”
Bob: And that’s why you might have an irritable stomach for 20 years because it’s not adjusting like it should.
Dr Adrian Louw: Exactly, so the bowel and bladder is a little bit suspect, we don’t sleep at night because the lion could be in the room, all these things change. They understand, that’s why I fun out of fuel. When you lay in that room at night in bed, you can’t go to sleep because where’s the lion? You don’t fall asleep. By the way, since you’re in sleep you don’t go do the deeper restorative phases you need –
Bob: Exactly, which is REM.
Dr Adrian Louw: So you never really rest. And so these things, I’m sure people are looking at this going, “This is silly, but it makes sense.”
Brad: I wanna know how to get rid of the lion.
Dr Adrian Louw: Well there’s ways of getting rid of the lion, right? But the point is simple, we, then the question comes and this is actually coming back to you Brad, is then we ask somebody, now what would you do if a beautiful small little baby lion cub walked into this room? And the classic answer is “Aaaww”, right? So we need to take this lion and let’s identify the lion. What is the lion, we have different explanations for our pain? Treatments aren’t working. I’m not sleeping. And what about my job, my kids, my family? You make this monster list. And we just start attacking each one of these. Okay let’s start with sleep? Now we’re going to go to the sleep program. And we work through a sleep hygiene. Good, check. Let’s talk about this. And we slowly start making this lion smaller and smaller and smaller so when we do wake up with that lion you go “Aaaww”. Notice what we’re doing here. It’s not everything nothing, but we can slowly shift it. Or as we often say, and I mean no disrespect, but we gotta turn the Titanic around. It’s a big turn. We’re not gonna overturn it, it’s not like a quick little boat, but we’re gonna turn this turn. And the minute we start turning with better movement, better sleep, better nutrition, all these things, the boat can turn. Takes a little time, but it can do it.
Bob: It’s funny, I just used this example last night. I was talking to a family member; I won’t mention who it was. But, she has been under a fair amount of stress and the stress has been calming down, and she thought she had irritable bowel syndrome. And I said, “How’s your stomach doing?” And she’s like, “Well, it’s been doing better.” And I go, “You know, I think it may be stress related.” I gave the example of the lion, how your digestive system slows down when the lion’s in the room, and she goes, that just is so calming to me, because she kept thinking it was something serious, something really bad. That alone can be so helpful. And I said, that is true and that’s what they have found.
Dr Adrian Louw: And we need to understand, obviously we do due diligence by screening, right? I have a practice like you guys, patients walk off the street, we go through a very thorough medical screening before we jump into this. I don’t want people to think all we do is sit and tell stories.