Approximately 1.5 billion people worldwide suffer from chronic pain, including 100 million adults in the United States, according to multiple national studies. Chronic pain affects more people than cancer and heart disease combined, and its prevalence continues to rise, particularly among young people.
Over the past several decades, physicians have sought to treat chronic pain through medication, injections and surgery. In 2021, chronic pain accounted for an estimated $722 billion in annual economic cost in the U.S., according to The National Library of Medicine. Yet in many cases, traditional medicine approaches have failed to provide lasting relief.
According to Dr. Howard Schubiner, a leading expert in mind-body medicine, the key to understanding — and potentially healing — chronic pain may lie in viewing it not only as a structural problem, but also a learned, modifiable process in the brain.
In his newly released book, “Unlearn Your Pain,” Schubiner — a physician, researcher, author, speaker and clinical professor at Michigan State University College of Human Medicine — details decades of his work researching and redefining how we can view chronic pain.
“Unlearn Your Pain” highlights the link between emotional stress and physical pain, suggesting that some chronic conditions are neuroplastic, meaning they arise when the brain generates pain as a warning signal in response to perceived danger.
“The brain can be triggered to generate pain either in the presence of physical injury or in the absence of physical injury when there’s particular life stress or emotional situations going on,” Schubiner said. “And research shows that when you give someone a physical injury and you scan their brain, certain parts light up. When you give them an emotional injury, the same parts of the brain light up.”
Chronic pain is not always an irreversible condition, the book suggests. It argues that conditions such as headache, migraine, irritable bowel syndrome, fibromyalgia, chronic neck and back pain, anxiety and depression may be neuroplastic — and therefore potentially reversible.
In “Unlearn Your Pain,” Schubiner presents research and outlines methods for unlearning pain and treating neuroplastic conditions, including using pain reprocessing therapy and emotional awareness and expression therapy, which he co-developed.
“People should read this book to get a completely different viewpoint of what pain, anxiety, depression, and fatigue are,” Schubiner said.
“It’s for people who want to explore other ideas that might help them or a loved one,” he continued. “There are so many people with chronic pain, anxiety, depression, and fatigue that virtually everyone who picks up this book will themselves be someone who might benefit from the book, or they will have a friend or a loved one who could benefit from it.”
The global scope of chronic pain
Over the past decade, chronic pain has been increasing in prevalence across the world. According to the National Center for Health Statistics, over 24% of U.S. adults suffer from chronic pain and 8% have pain that frequently limits their daily activities.
Rates of chronic conditions are higher among veterans, minorities and individuals with lower incomes and lower levels of education. Chronic pain is also significantly more common in women than men.
There are now more than 50 million people in the U.S. with chronic back pain, 40 million with chronic anxiety, 25 million with chronic headaches, 20 million with irritable bowel syndrome, 20 million with depression, 5 million with chronic fatigue and 5 million with fibromyalgia.
Those numbers are rising, and according to Schubiner, not simply because people are aging or living longer. Increasingly, individuals are being diagnosed with chronic pain in their teens, 20s, 30s and 40s, and these trends appear to correlate with rising rates of anxiety and depression.
About 20% of youth globally experience chronic pain, per a study from the National Library of Medicine.
“It’s huge numbers,” Schubiner said, adding that because so many young people are affected by chronic pain, physicians in treatment need to “look more carefully, more deeply in each person to see what are some of the situations in their life that might be triggering the brain to turn on pain as a warning signal.”
‘Unlearn Your Pain’ in action
One case of chronic pain, described in “Unlearn Your Pain,” follows a middle-aged woman who had been living with chronic and severe headaches for 17 years.
In a last-ditch effort to find relief, the woman turned to Schubiner. She had tried multiple medications, injections and cutting-edge headache treatment at three different specialized headache centers, but nothing eased her pain.
In an effort to treat the woman, Schubiner asked not only about her headaches, but also about her life. He asked her about her childhood, which she initially described as happy.
But as he posed more targeted questions aimed at uncovering experiences that may have primed her brain’s danger signals, the woman revealed her father was unpredictable and would sometimes come home from work angry and yelling — experiences she remembered as frightening.
Schubiner and the woman then traced her headaches to beginning at the same time she got a new boss, who was encouraging at times but occasionally erupted into rages, yelling at people. In that moment, Schubiner believed the connection between the woman’s father and her boss could be the key to understanding her chronic headaches.
The woman began to understand her chronic pain as a learned neural circuit rather than an incurable disease, and that shift in perspective led to a major change in how she viewed her symptoms. Using an emotional expression technique along with other methods outlined by Schubiner in “Unlearn Your Pain,” her headaches eventually disappeared.
In “Unlearn Your Pain,” Schubiner shares dozens of similar examples from his clinical work, describing people who have recovered from chronic pain by unlearning neural circuits in the brain that trigger pain signals.
“Everyone knows that when you have pain, there must be something wrong in your body. Everyone knows that. And it turns out it’s not necessarily true. It can be true. But it turns out from a neuroscience point of view, you can have pain without an injury. You can have an injury without pain. When you put those two facts together, that shows that the brain is actually in charge of pain,” Schubiner said.
All pain is real pain
To help illustrate how pain is generated in the brain, Schubiner shared a few examples.
While at work, a construction worker in England accidentally jumped onto a large nail, which punctured the sole of his boot and appeared to pierce through the top. He immediately screamed in pain and, upon arrival at the hospital, required IV pain medication.
When his boot was taken off, he was stunned to discover the nail had passed cleanly between his toes, causing no actual injury.
In another case, a man accidentally shot himself in the hand with a nail gun. He was alone, and felt no pain at the time— his brain likely suppressed the neural circuits for pain — and he was able to drive himself to the hospital.
These examples demonstrate that not all injuries cause pain, and not all pain is caused by injury, Schubiner explains, but all pain is real.
“Our brain generates pain. And so what this book is saying at its most basic level is that most people don’t understand that all pain is real. It’s not in people’s heads,” Schubiner said. “When people have pain, it’s a very intense, often overwhelming, (and) can be a debilitating personal experience.”
Many people who suffer from chronic pain have no visible injury or structural cause. But, as Schubiner emphasizes, chronic pain is still very — even when it occurs in the absence of a detectable physical cause.
In cases of neuroplastic conditions, the brain may generate pain or other symptoms as a warning signal to protect us from perceived danger. These symptoms are very real and should be validated, but can be unlearned through effective therapeutic methods.
“People with (chronic) pain are often diminished. They’re often not taken seriously. People thinking their pain isn’t real. They’re imagining it. They’re making it up, et cetera. It’s all in their head. It’s just stress,” he said. “The reason that’s so important to say that all pain is real is that chronic pain needs to be taken seriously.”
Treating neuroplastic conditions
The first step in treating chronic pain is a thorough medical assessment to rule out any treatable physical abnormalities or autoimmune diseases.
“Everyone needs good and careful examinations, histories and physical exams and lab testing and imaging testing from their doctors,” Schubiner said. “We want to make sure someone is not, we’re not missing a cancer, a fracture, an infection, an autoimmune disease, et cetera, hormonal disease. But most of the time, those aren’t found in these chronic pain conditions because most of the time, those are relatively easy to find with going to getting routine testing.”
In neuroplastic conditions, individuals are typically suffering for years, even decades, and have undergone multiple medical examinations that turn up no structural cause for their pain, Schubiner said.
Also, symptoms in neuroplastic conditions often turn on and off, worsen with stress, disappear on vacation and shift to different locations in the body.
Cases of neuroplastic conditions can be treated through pain reprocessing therapy, which works to alter neural circuits by sending corrective feedback to the brain and retraining it to stop generating pain in response to learned triggers.
Individuals can further alter these neural circuits by addressing underlying emotional issues through a method known as emotional awareness and expression therapy.
Both methods, which Schubiner co-developed, are outlined in “Unlearn Your Pain.”
Through these treatments, “you’re giving your brain the sense of hope and calmness and relief and even smiling a bit. And when you do all that, the brain will say, ‘Oh, you’re not in danger. I get it. Turn off the alarm,’” Schubiner said.
A study published in Biological Psychiatry, found that pain is influenced not only by physical injury, but by emotions and expectations. Researchers found that mindfulness reduced pain more effectively than placebo treatments, sham meditation or no treatment at all.
Brain scans showed mindfulness meditation works differently than placebo treatments, and could be a unique way to manage pain.
“The mind is extremely powerful, and we’re still working to understand how it can be harnessed for pain management,” said Fadel Zeidan, PhD, a UC San Diego anesthesiology professor and researcher on the study.
He added, “By separating pain from the self and relinquishing evaluative judgment, mindfulness meditation is able to directly modify how we experience pain in a way that uses no drugs, costs nothing and can be practiced anywhere.”
Looking ahead, Schubiner believes the medical system will eventually embrace these ideas about healing chronic pain, as research increasingly shows these treatments can be effective for neuroplastic conditions.
But doing so would require providers to reduce their reliance on injections, surgeries and prescription medications, he said. It would also require providers to spend more time with patients and hear their stories, rather than limiting care to the typical 15-minute visit.
“We believe that these techniques that we’re using, the pain reprocessing therapy and the emotional awareness expression therapy, will continue to evolve and get better,” Schubiner said.
“It we’re correct that the that the vast majority of people with chronic pain, not to mention anxiety, depression and chronic fatigue have a neuroplastic condition, there’s hope for millions of people with these conditions.”
When does ‘Unlearn Your Pain’ come out?
“Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression” releases on Tuesday, May 26 through Maria Shriver’s The Open Field imprint at Penguin Life.