Overview of The Model Health Show with Shawn Stevenson
In this episode, Shawn Stevenson interviews Dr. Howard Schubiner about the science of chronic pain, the brain’s role in generating pain, and how many cases of long-term pain may be “neuroplastic” rather than caused by ongoing tissue damage. The conversation centers on a major study published in JAMA Psychiatry showing that Pain Reprocessing Therapy (PRT) helped about 66% of chronic back pain patients become pain-free, dramatically outperforming standard care and placebo. Dr. Schubiner explains how pain can be learned, reinforced by fear and stress, and then unlearned through validation, reappraisal, and emotional processing.
Key Topics Discussed
What pain actually is
- Pain is a brain-generated warning signal, not simply a direct output of injured tissue.
- The brain can create pain with or without physical injury.
- Emotional stress can activate the same pain-related brain circuits as physical injury.
Why chronic pain persists
- Chronic pain often becomes a fear-pain cycle:
- pain leads to fear,
- fear increases attention to pain,
- increased attention amplifies the pain experience.
- Many chronic pain sufferers are misled by imaging results, especially MRIs showing “abnormalities” that are often also found in people without pain.
The Boulder Back Pain Study
- The study compared:
- Pain Reprocessing Therapy
- placebo injection
- usual care
- Many participants had suffered chronic back pain for an average of 10 years.
- After treatment, a large portion of the PRT group became pain-free, showing that even long-standing pain can improve dramatically.
Emotional causes and the mind-body connection
- Pain can be linked to:
- anger,
- guilt,
- sadness,
- fear,
- stress,
- unresolved emotional injury.
- Dr. Schubiner emphasizes that this does not mean pain is imaginary or “all in your head.”
- Instead, it means the brain may be using pain as a protective alarm.
Pain reprocessing and emotional expression
- Pain Reprocessing Therapy helps people reinterpret pain as safe and non-damaging.
- Emotional Awareness and Expression Therapy helps people identify, feel, and safely express emotions that may be fueling symptoms.
- Validation and compassion are essential first steps.
Main Takeaways
1. Not all pain means damage
- Many structural findings on scans are present in people without pain.
- MRI abnormalities do not automatically explain symptoms.
2. The brain can learn pain
- Pain can become conditioned by past injury, stress, or emotional trauma.
- Learned pain can also be unlearned.
3. Emotional suppression can worsen symptoms
- Repressed anger, sadness, or fear may contribute to chronic pain, fatigue, anxiety, or depression.
- Healthy emotional expression can reduce symptom intensity.
4. Standard biomedical treatment often misses the root cause
- Modern medicine is excellent for clear structural problems like fractures, infections, and tumors.
- It is often less effective for chronic conditions such as:
- back pain,
- headaches,
- fibromyalgia,
- IBS,
- chronic fatigue,
- anxiety,
- depression.
5. Recovery begins with validation and curiosity
- People need to feel seen, heard, and understood.
- Curiosity about triggers, patterns, and life stressors can reveal the real drivers of pain.
Practical Steps and Recommendations
How to assess whether pain may be neuroplastic
- Get a proper medical evaluation first to rule out serious structural issues.
- Look for patterns such as:
- pain that moves or shifts location,
- pain that comes and goes,
- symptoms that change with stress, weather, or attention,
- pain that worsens with fear or anticipation,
- symptoms that seem disproportionate to imaging findings.
How to begin healing
- Reframe pain as a possible brain-generated safety signal.
- Practice telling yourself:
- “I am safe.”
- “This sensation is not dangerous.”
- “My body is capable of healing.”
- Increase gentle movement instead of avoiding all activity.
- Explore emotions honestly:
- What am I angry about?
- What am I sad about?
- What am I afraid of?
- Use compassion instead of self-blame.
What Dr. Schubiner wants listeners to do
- Read Unlearn Your Pain
- Learn more about Pain Reprocessing Therapy
- Consider the role of emotion in chronic symptoms
- Share the information with others who are suffering
Notable Insights
- “Pain is a function of the brain.”
- “The brain can cause pain without injury, and injury can exist without pain.”
- “Validation is step one.”
- “There are no bad emotions — emotions are signals that need to be understood.”
- “Nothing is more powerful than a good idea whose time has come.”
Resources Mentioned
- Dr. Howard Schubiner’s book: Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression
- Pain Reprocessing Therapy (PRT)
- Emotional Awareness and Expression Therapy
- Association for the Treatment of Neuroplastic Symptoms (nonprofit educational organization)
Bottom Line
This episode argues that a significant portion of chronic pain is not driven by ongoing tissue damage, but by learned brain circuits shaped by stress, fear, and emotional injury. The encouraging message is that these patterns can be reversed. With the right education, validation, and therapeutic tools, many people may be able to reduce or even eliminate chronic pain and reclaim their lives.