Chronic Pain Reset: Unmasking the Brain's Role in Processing Pain with Dr. Afton L. Hassett

Welcome to the Living to 100 Club Podcast.

Greetings to everyone joining us today on our podcast. You're listening to one of our Successful Aging episodes this month on the Living to 100 Club program, and I am your host, Joseph Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. And remember, you'll find this podcast and our complete library of podcasts on our sponsoring platform, seniorresource.com. Today we discuss strategies for changing how someone experiences chronic pain. Our guest is Dr. Afton Hassett, the author of a just-released book, Chronic Pain Reset: 30 Days of Activities, Practices, and Skills to Help You Thrive. The book helps readers evaluate your pain and its triggers and offers straightforward and often fun strategies to improve chronic pain. How can a seemingly disconnected set of activities like sleep patterns or exercise actually work to reduce pain? And we answer an important question: Why the cause of acute pain experienced 5 years ago Is not the cause of today's chronic pain. Our listeners will greatly benefit from this conversation about developing our own personalized pain management toolkit. Be sure to tune in. First, a little background. Dr. Afton Hassett, PsyD, is an associate professor and director of pain and opioid research in the Department of Anesthesiology at the University of Michigan. She is a principal investigator at the Chronic Pain and Fatigue Research Center, who has over $14 million of research funding from the National Institutes of Health. Viewed as a leader in the field of chronic pain and resilience, Dr. Hassett recently gave the keynote address at the 2023 Pain Consortium Symposium on Advances in Pain Research for the NIH. While studying established treatments for chronic pain and developing new approaches is her passion, her frustration is that exciting research discoveries rarely make it to the people who could benefit the most. Thus, Dr. Hassett's mission was to write Chronic Pain Reset to bring evidence-based strategies from research and academic medical settings directly to people who live with chronic pain with the hope that they'll gain new tools to lead more rewarding lives with less pain. Dr. Hassett, welcome to our program today. Thank you.

So good to be here, Dr. Joe. Good to see you again.

Oh, you're so welcome. Glad to have you with us. I always like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today, maybe the highlights or the touchpoints that brought you to where you are today?

Oh, thank you. That's such a generous question. My road was kind of long and circular. I don't think that many psychologists decide they want to focus on pain. And so it was quite by accident that I ended here. It was back when I was in my doctoral program in San Diego, and I was at a training site where I was treating a lot of women who had depression, anxiety, post-traumatic stress disorder, you know, a number of clear psychiatric conditions, but they also had chronic pain. And it was so fascinating that as we started to make a little progress on their depression and anxiety and other symptoms, their chronic pain would often flare. And it felt like it flared just about the time we were about to get to something important in the person's history. So most psychologists that are listening to this are kind of nodding their heads, yes, of course. But certainly I didn't know when my supervisor sent me to the University of California in San Diego Medical School Library. And she said, pull some articles on fibromyalgia and chronic pain conditions and read a little bit about kind of what's the current neurobiological thinking. And I thought, I'm not sure why I'm doing that, but I did that. And this is in the olden days when we used to walk up and down the old cold libraries and pull big stacks great big huge books off the shelves and you walk to the copier and print them. But there was something very satisfying about curling up in that cold library and reading these articles. And one of them was written by this physician researcher named Daniel Klawe, Dan Klawe. And I was so taken by how he and his colleague at the NIH wrote about pain and how pain was such an integrative process that could not be thought of without thinking about one's psychosocial circumstances, that just the way that pain is processed in the brain, that our thoughts, emotions, and behaviors play a really big role. And once I read that article, I was hooked. I went right back to my supervisor and I said, I'm a PsyD. I was just going to do clinical work. I'm going to change my degree. I want to study this. I want to be a researcher. And I went, I went back to my program leads. They said, you know, keep your PsyD because It's too hard to reclassify you, but we'll have, we'll have you do a dissertation and give you the extra stats classes. And so I kind of sideways got into this. It's not to say that I didn't do clinical work. I did. But really the last 20 years of my life have been dedicated to pain research.

So that really planted the seed and you've gone on to develop a real specialty in this area.

Yes.

Yeah. You've become quite an authority on the subject. So I'm really Glad to have you with us on our program today. Let's jump right into it. Tell us about the difference between acute pain and chronic pain. How are they the same and how do they differ?

Yeah, they're the same in as much as the brain is needed to interpret the pain signal. When somebody has acute pain, there usually is some damage, something that's generating the pain signal. So it could be a twisted ankle. And the little pain generators are sending a message up. It could be a surgical incision that's creating the pain. It could be inflammation, as if somebody has rheumatoid arthritis and has inflamed joints. So that is kind of the acute pain process, that there is usually something somewhere in the periphery that's causing pain, and then the brain interprets that pain. In chronic pain, we see kind of a combination of things where somebody might have, say, osteoarthritis of the knee, so they constantly have bone-on-bone grinding, and so there is something that's sending that signal. But that over time, that pain signal now is different. It's not just the bone-on-bone grinding that's sending the message. The brain itself, over receiving that pain signal for so long and so many instances, has now kind of wired so that it is sending that signal really quite on its own. And this brain-amplified or brain-created pain is gotten a name in the last few years. We call it nociplastic pain. And this is kind of an internationally accepted term that describes pain that is either A, greatly amplified by the brain, or B, completely generated by the brain.

So the acute signals have lapsed or they're not so strong anymore, and the continuing pain now is carried on through new signals, new processes in the brain. NoC plastic? NoC-I-P-L?

Yes.

Okay.

Yes. Yeah, noC is kind of the root of the word for nociception, for pain perception. And plastic just refers to the brain's plasticity to rewire and reform. And we do think that most chronic pain really is due to just changes in the networks, in the structure and function of these networks in the brain, and that they are malleable. We can see them become worse and more interconnected, or we can see changes. And often we'll see in an intervention study, when we do neuroimaging before the study and then after it, we'll actually see different areas of the brain functioning differently. There'll be different connectivity. There may be different areas that are speaking to each other. There may be areas that are less lit up, that there's less activity in them after the intervention. So we do see this kind of this, these changes in responses to therapy and how the brain networks work. And that's why we're pretty sure that's how it works.

Yeah. So I was really struck by that when we had our earlier conversation that the acute pain episode is not any longer triggering the chronic pain. There's almost a— is there a disconnect? Can you go that far to say there's a disconnect between the acute pain episode and the new onset of chronic? Wow.

Yeah. So the way that we kind of talk about it more colloquially is that we'll say that there is bottom-up pain. So bottom-up pain just means somewhere in the body there's some disturbance. There's an injury or a pain signal. So it's coming from somewhere else in the body. And then there's top-down pain. There's a pain that really truly is generated by the brain. So there, you know, so this evolution of the pain signal has taken place. It's gone from a back injury that may have healed reasonably well and now become this very amplified. So maybe there's some stimuli coming from that lower back injury, but most of it is just the brain's overreaction. Now it's learned this signal too well and now emits pain quite on its own. And it can be exacerbated by stress, anxiety, fear, tiredness, lack of exercise. I mean, all these things can make the pain experience worse.

Wow. OK. So are there different types or classes of chronic pain? Yeah, there are.

We do think about them differently. And this is really important. This is where we spend a lot of time talking to our physician providers about being really clear about the type of pain, as clear as we can be. Because, for example, if somebody has inflammatory pain, like, say, due to rheumatoid arthritis, we treat that very differently than we would with somebody who has, say, pain from osteoarthritis, which is more the bone-on-bone grinding. So with the rheumatoid arthritis, we might use a really strong biologic or steroid type of medication to put that, you know, to quell that inflammation. With the osteoarthritis, we could treat that quite differently. We want to, you know, perhaps rebuild some of the synovium, get people moving. So there's these different treatment plans and different medications that are used. And then in contrast, somebody who has fibromyalgia, where we don't really have an understanding of what could have started the process, right? There is no damage that's observable across the body, but the pain is felt in a widespread way. It's felt throughout. And thus, that's a very different condition. That is very much in that nociplastic pain category. And different medications are used for that. So it is useful to understand. Oh, and then lastly, neuropathic pain, too. So somebody has an impingement on a nerve, that's also very different, and often that's treated with surgery, which is very different than how we would, say, treat rheumatoid arthritis or fibromyalgia.

Oh, I see. Okay, so the type of chronic pain will dictate or steer the practitioner towards a specific type of treatment. Yeah. So what is— this is a hard one, but what role does brain play in sustaining or exacerbating the chronic pain? Is there a role that, you know, so the role in the background that is sustaining it?

Well, the brain plays a huge role. I think the question we're trying to really untangle is what role does the mind play? So, you know, so Chronic pain really is this neural change, right? These changes in the structure and function of the brain, changes in the networks. But the mind, what we think about, and our emotions have a powerful impact on the experience of pain. So if, you know, you could think about this yourself, even if you've ever twisted an ankle or been injured and something kind of frightening happened and you were fearful or angry, the pain is often much worse. But if you twist that same ankle and you, and you know, you're embarrassed because you fell down and your friends are laughing and you're laughing, the pain often is not so bad, maybe until you get home later. But, you know, truly what, how we think about it and our emotions really, really dictates how that pain is experienced. It's very pliable.

Yeah. So the emotions will activate the chronic pain in different ways.

Yes.

Interesting.

Yeah. And it's mostly due to the fact that we understand very clearly kind of what structures are involved in processing pain. And quite interestingly, the same structures are often involved in processing thoughts and emotions. So that starts laying the groundwork for how this works. So it's not that you've made up your pain, but certainly feeling terrified is going to activate or co-activate areas of the brain that can make your pain worse.

Well, yeah, when I speak about, um, kind of our thinking styles or thinking patterns, and I am in front of groups, I often talk about, um, kind of the positive thinking style or negative thinking style. Yeah, how we interpret an event, how we explain it to ourselves, is really going to color how well we cope with it, how well we manage it. Like tripping as we step off a curb and what we're saying to ourselves. So Sounds like that's pretty consistent with your, your take as well. It's, yes, it's our kind of cognitive appraisal that's fitting into that event.

Yeah. Oh no, you're— yeah, yeah, you know, you're 100% right. That it is— the event is less important than what we make of it, right? That, um, how we react to something, someone, or, or some, you know, new, new thing in our lives is really critical. And if we see this new event as a threat to ourselves, that activates all of our stress response systems. That's very, very intensely activating to people with chronic pain, right? Because those systems kind of overlap. So the more sympathetic activation we have because we're frightened or worried, the more pain we experience. The sympathetic nervous system is very tightly tied to how pain is experienced. So if somebody is feeling very panicky— conversely, and what I spend my time studying is how powerful positive emotions are that, like, I used the example before, when somebody kind of laughs, you emit different chemicals. I mean, there's an entirely different set of hormones that are released— endorphins, dopamine, serotonin— and these are all analgesics, which is incredible that, you know, just laughter is an analgesic process to some degree. You're releasing endorphins. So, you know, again, how we think and how we feel is so important. So what we do in the book is we talk about this just in a very frank way about how we as humans are set up to look for threat. That's what we do. It's our survival. You look for everything bad out there. If somebody pays you one compliment and says, you know, or somebody pays you 5 compliments and says one negative thing, you're going to hear the negative amongst the 5 compliments. It's what we do. So being positive takes a little bit more work, but it's worth it. And so we spent some time talking about these negative thoughts and really how to catch yourself in them, catch yourself when you're being overly critical, when you're not being very compassionate, when you're experiencing rumination or other negative, catastrophic types of thinking. And to think, oh, well, that's a negative thought. And then we have 2 or 3 different ways, kind of based on kind of the different behavioral and cognitive behavioral schools of thought of how to think about our thoughts and how to think about our emotions. And to, and to reframe.

So how can we tease out those negative thinking patterns from the experience of pain? That's kind of the, the treatment approach. Um, we'll talk more about the book in a few minutes. I think it must be invaluable for, for the reader. So, um, is this where we come into Chronic Pain Reset? Is this is what we're talking about? Yeah, tell us about Yeah.

Yeah. So the, the thought is that these brain networks are rewired and dysfunctional. And we used to think that once we are older, that there's very little that we can do to change the structure and function of our brain. And now we know that's so wrong that, you know, even as you age, even in elder adults, that there is still plasticity in the brain. And so the goal then is we know that we have a disturbed network. So now we need to reset it. And so what does that take? So it takes decreasing the problematic thoughts, emotions, and behaviors and increasing the ones that are more conducive to having less pain. And what that does in effect is it actually leads people to leading a life that is much more enjoyable and rewarding by getting people away from very, very, you know, fright, you know, kind of fear-based and negative thinking and moving more towards purpose. And what really matters in life. And when we kind of rejigger our view of what is happy for us in the context of what is rewarding and purposeful to us, everything kind of falls into place. And that's a big piece of what we want to do in this book is to help, you know, individuals start shedding some of the unhelpful thoughts and views and invite more positive and rewarding exchanges with ourselves.

So it sounds like that's, uh, the treatment in itself. You're, you're treating the chronic pain with these positive experiences, and that makes the pain subside.

It makes the pain better. And so we know a number of things make pain better. So the first is activity. So, just getting folks moving again, getting off the sofa and outside for a short walk, getting some sunshine in the face and exposure to some greenery, all of that has healing properties too. Having people reconnect with people with their supportive and positive relationships, also incredibly gratifying and other ways to build resilience. And then having people lead, Do things in life that don't just feel like they're doing only the things they have to do. And that's what happens to many people with chronic pain is their lives shrink because they just start doing the things they have to do. They do the bills, they do the housework, they go to work, they deal with the kids or the elders and give up everything else. And living life like that is really depressing. And I think that's one of the main reasons we see a lot of depression and anxiety and chronic pain is that's a horrible way to live. And so what we do with the book and what we do with a lot of our therapies is give people permission and actually make it part of their prescription to do things they enjoy in life again, for these very reasons, to get you engaged, to get you moving, to get you reconnecting.

You know, I'm noticing the picture you have on your wall, the painting on your wall, and I'm just having this thought, beautiful painting. Thank you. And what you're doing with The treatment is you're taking an old picture with an old frame, maybe rusty, broken down, scratched picture, and you're helping the person— let's put this experience into a brighter, more positive, more uplifting view and perception. And taking that old image, old setting, old, uh, sensation of pain, and let's get rid of that image and put it in a new place. And it really creates this whole positive experience, kind of re-experiencing the pain from a very different perspective.

Yeah, exactly. And then, Mark, and you're really the first person that made mention of it, but what this is— I love this artist because she takes really standard views. This was kind of a, just a standard marsh. And so she does these natural things, and then she just does them in wild colors, unexpected. And it is really getting at the heart of what you're saying. It's like, you know, you take something that is maybe not that engaging and just let it be and grow and do something different with it, right? Just imagine, reimagine.

Yeah, well, going from stick figures to a beautiful painting, colorful painting. Oh yeah, that's great. That's good. So you mentioned some of these activities like increasing the physical activity. And I can surmise, I haven't worked with a lot of patients with chronic pain, but I can surmise that people gradually kind of inhibit their movement because it becomes so painful. And the more pain, the more inhibition of that behavior. And that's probably going in the wrong direction. But what do you, what do you say to that person?

Yeah. So, you know, fear of reinjury is one of the biggest things that we contend with when we're working with people, especially people earlier in their chronic pain, because often, you know, it may have been maybe 6 months ago 8 months ago that they had an injury. And we consider chronic pain after 3 months. 3 months is kind of what we say, hey, by now it should have healed itself. And then we think the brain is doing something here. This is kind of a brain thing. And so when people have fear of movement, it's totally expected. And I know that. And I actually broke my knee at one point, and I went to physical therapy, and my physical therapist was having me do all these motions. It's like, oh my God, I'm afraid to do that. I now get it. And he's like, this is your brain. This is actually part of it. Oh my God, this proprioception. Is that what it is? That my brain doesn't think I can do that movement. And so I need to teach. And he goes, that's it. You need to reteach your brain that you can do these things. And so I think that's what often makes fear of movement so difficult is because our brains are telling us, no, no, no, no, no, you can't. You don't even know how to move the way. Don't do it. And so, you know, the longer people go without doing certain motions, the harder it is for them to strike out and do them.

Mm-hmm. So that it's kind of a protective, um, kind of survival mode almost to, to not reinjure yourself. So we inhibit, we contain, we restrain. And that's, uh, that's going in the wrong direction. So we're teaching our brain, let's take those tiny steps and yes, see that it's rewarding. There is a positive response to that. Yeah, that's great. Yeah, that's great. So what are, what are some of the activities that you rec— you touched on them, but what are some of the activities you recommend in your book?

Well, I'm going to riff a little bit on what you were just talking about because we talk about kind of this notion that the brain is this overprotective nanny. It's like, don't do things. There is one of the things that people try in the book is something called pain reprocessing therapy. And this has become really well studied, becoming more well studied, but really anecdotally amongst clinicians who work with patients, including myself, experiences I've had, is really powerful. And what this is really based on the notion that whatever injured your, say, your neck, um, 5 years ago is no longer causing the problem. So the way that this therapy is delivered is the person will go to the physician. The physician says, no, no, no, there is nothing structural that I can see here that should be causing this pain. This is muscular. This is something else. And then once they have that reassurance, they go to the therapist and the therapist says, okay, this is what we're going to do. Your brain now is an overprotective nanny. And so every time you think about moving, it screams, don't, danger, don't do it, and gives you pain. So you don't move because that's what freezes us in place. So what we're going to do is we're going to tell your brain that it's okay, that it's safe. And in Pain Processing Therapy, that's what's done. It's just like you start talking to your brain and say, what I'm doing is safe. This is a safe movement. I'm going to do this movement safe. And brain, you're going to see it's going to be okay. And this is not all that different. That's kind of what's done in physical therapy, that we just slowly tell the brain brain that a movement is okay. And so in pain reprocessing therapy, while the patient is thinking, this is okay, I can do this, we get them to slowly, in the case of a neck, slowly start moving the neck again. And usually about halfway through the exercise, the patient bursts into tears because now they can move. They can do this movement they haven't done in 8 years because they've been able to kind of break that fear that the brain has that, yeah, don't do it. And then once it's broken, it's quite amazing. It's like it's gone. It may move someplace else, which it often does, which is the weirdness of pain is she may not have it in her shoulder, but it's the same thing too. It's just like, you know, this, this, I have nothing here that's structural. You're just trying to take care of me, brain. I have nothing here. And the movement can actually loosen up. So that's one of the, uh, one of the more dramatic things that we discuss in the book.

Yeah. So reprocessing, almost reprogramming.

It's reprogramming and it's quick. And for those, yeah, for those that, for whom it works, it's like a miracle. It's crazy. And we don't know how many, we have a sense of who might benefit, but that's just kind of one of the things. Most of the other skills are more skill-like, more like things that you can do to kind of better pace yourself when you have chronic pain. But about two-thirds of the skills in there are just human being skills. These are just evidence-based activity skills and practices that lead to a better life, helping our sleep practices, helping our social connections, helping us cope better with our thoughts, helping us be better able to understand and deal with our emotions. And it's kind of based on cognitive behavioral therapy, ACT, mindfulness-based stress reduction, dialectical behavioral therapy. So all of these treatments, but each of them has these wonderful skills within. And so that's kind of what we offer here for people to explore.

Oh, that sounds great. You made a comment a minute ago about the medical workup or the physician is saying, well, we can't identify any damage that would cause us to think there's acute pain. Can I infer that you cannot identify chronic pain on medical workups, MRIs or X-rays?

Yeah, this is such a great question because I'd say the evidence is really robust that there isn't a real great correlation between between the damage we see on MRIs and what the patient experiences. So we are in the process right now of conducting one of the largest studies today. We'll have close to 500 individuals that have undergone significant MRI and, and had their scans read by 2 radiologists, and then having a really rich phenotyping, just a really good understanding of what the person reports as far as pain that they experience. So we hope to conduct a definitive study, but really the data are pretty good that there is a real mismatch. So for example, I tell a story in my book about breaking my knee. So I fell and I fell on my kneecap and I broke my kneecap. And I had, I went in for MRIs. They did both knees. And when I was sitting with my physician's assistant, he said, yeah, you broke it. Your right knee's broken. But, and you got a little bit of osteoarthritis in it. Has it been bothering you? I said, no, I have no problem with it. And he says, but how does your left knee feel? I said, what, the one I didn't break? He says, yeah, he says, your osteoarthritis is terrible. And I said, oh, it's fine. It doesn't hurt at all. Sometimes it's a little stiff, but it never hurts. It's totally fine. And I'm very athletic and I do my thing. And he's like, that's really weird because it's bad. So we see this over and over again. And so it's hard to know. So there'll be some MRIs of somebody with a back injury that clearly there is a disc that needs to be corrected. Other times it's like, ah, I don't know, can that be causing it? Other times we'll take MRIs of a person who is totally pain-free and their back your back looks terrible. You've got discs doing all sorts of crazy stuff. So it's hard. Yeah. It's hard to really, to tease out what's causing what.

Well, it's very similar to the Alzheimer's picture where you have plaques and tangles in normal subjects and you don't have as many in the Alzheimer's patients. So that in and of itself doesn't mean you have the diagnosis.

Exactly right.

Interesting. Yeah.

Yeah.

We are complex beings, aren't we?

We are, and we, and we understand so little.

That's right. So, um, you mentioned the Thriving Plan where you can help customize one's, you know, curative approach to adopt activities that make a difference. So how does that work? What's the Thriving Plan?

So the way that the book is structured is there's a series of short chapters that give the background about the neuroscience of pain, but as well as what we understand about pain and thoughts and pain and emotions, and even some of the neuroscience of our friendships and relationships, gratitude, thriving positive emotions. So just kind of setting the stage for how doing some simple things might actually improve your pain by helping you reset your brain. And then once you get through kind of that background tutorial, and hopefully that's happy and fun and written— I try to write light with a lot of humor and some wonderful stories from patients. But then there's a real exploratory period. And it's not all that different than what we do in cognitive behavioral therapy. With chronic pain, where we introduce an activity skill or practice every week. And then the people try it and they come back the next week and they tell us, hey, yeah, that worked really good. I think I want to do that in the future. And then we make a note and then they try another one the next week and they try that out and come back. So anyway, it's not that different though, but I have people do it in a day. It's like a speed dating thing, right? So every day you wake up for 30 days and you read a little 2-page summary. About an activity, skill, or practice. It could be anything from activity pacing to sleep hygiene to keeping a gratitude journal to considering the toxicity of your relationships. I mean, there's a little bit of everything in there. But you look at each one each day, and you read through, and you think, huh, interesting. I do need to do something with my sleep, and this seems like kind of a good approach to do that. So I'm going to give it a try today. Perhaps you tried. At the end of the day, you're supposed to come back and say, Yeah, that's good. I'm going to make a note of that. And so you just kind of start, but then you go on, right? So we just make a note that that might be a keeper. Then the next day you have something else and maybe it is conducting random acts of kindness or some darn thing to build positive emotions and get you moving. But do you think that's just stupid? So you try it that day and you're like, I'm not going to do this ever again. Fine. The goal is 30 evidence-based things that people just try all these different things. And by the end, ideally, people have identified 5 or 10 maybe that they like. They're like, oh my gosh, this fits with how I understand my pain. This fits with what I'm willing to do and willing to try and actually might be kind of fun. And so the goal is that these things should be things that people are willing and wanting to do. And so that's the goal. So at the end of the thriving plan then is just how then now that you have these groups of activities that you already like, you've checked these all down. What do you do first? And then we spend some time in a Thriving Plan. You know, what is your, what is your top target? You know, what makes the most sense? Do you really need to want to get your sleep going first? You know, or maybe your mood is very poor and we need to kind of think about your depression or anxiety, or, you know, maybe you just need to get moving again. You just need, you know, you need to just start a walking program. And so we, you know, we kind of help the patient kind of walk through their— the reader kind of walk through that and identify, you know, how to stage these. And then they're suggested just to do try one at a time and just try for 2 weeks, give it a real try. And if it's something that works, sometimes it just goes right in the schedule. And then we talk about habit formation and habit stacking and how to make, you know, these new habits. And then the goal is that you're now creating something that is long-term, that this, you know, that ideally you're gonna, you're gonna have 1 or 2 of these things that really work, that become part of what you do. And you may even have an epiphany. And what I'm hearing from people who are doing it now is like, actually, I feel better. I'm 4 days in, I'm trying these things one at a time, but I actually feel better. And some of that is just taking time for self-care, for being, you know, for, you know, just setting up time. I'm taking care of myself. And then maybe one of them, you know, often I try to do things that make, you know, people have a little spark of happiness that can make a big difference, you know, and just having a little bit of positive emotion has been highly associated with better sleep and more activity. So that can help explain why people will even do it in the 30 days are feeling better.

Yeah. Well, I love that. I think that's great. What you're really doing is you're giving people a whole range of choices, and what works and what doesn't work, take off the list, and continuing to refine that list. Almost what, what's the best return on your effort? Yeah, what's giving you the best return? And then you have that plan. I can imagine that that plan could change over months, or for sure, yeah, it's going to be re-customized.

Yes, exactly.

That's great. Sounds like a great book. Sounds like a great book, Afton. Yeah, I love that. So you touched on CBT and positive psychology. Where does positive psychology come into the picture for treating chronic pain?

Yeah, so kind of more serendipity. I was at this time, it was early in my career, and I was at Rutgers Robert Wood Johnson in New Brunswick, New Jersey. And I was working there for a fabulous rheumatologist named Lance Siegel, who was very psychologically minded. And he had eventually left academia and went to work in a pharmaceutical company. And while there, they brought me in to help with some outcomes. They wanted to think, hey, you know, we're doing a lot of great work with rheumatoid arthritis. Is it possible that we can do a better job of assessing quality of life? And they asked me to kind of come in and do that because I was very interested in psychometrics and measurement. And what they showed me, though, was beyond my knowledge. And what it was is it was videos before and after treatment with a really novel biologic. This is a B-cell modulator in the early days of these new exciting drugs for autoimmune disease. And the patient baseline videos were, as one would expect, people were very kind of wiped out and dissatisfied with their lives and a lot of pain and a lot of frustration. And then, you know, 5 months later when they completed the trial, these new set of videos, the people look like different people. You know, they, you know, so many had responded so well to this, to this novel medication. And they asked me at the pharmaceutical company, well, what's going on here? And I said, well, that's happiness. And I have no idea how to study it. So I reached out and not knowing any better again, I reached out to Martin Seligman, who was then still at the University of Pennsylvania. And he kindly agreed to teach me about the world of positive psychology that helped me study these patients. And so that's kind of how I ended up there. And it was just a better fit for my personality. Personality. I'm just, you know, I tend to be a happy person and I like positive things, so it just was a real natural.

Yeah, great. I had a guest on my podcast several months ago and she has a program in Hawaii and she has a company called Happiness University. They have faculty teaching them courses on happiness and how to smile and whatever, because it is, it's very therapeutic. And as you said, Laughter is one of the better ways as an analgesic. So I think that's great. Yeah.

Oh, it's incredibly— so I did eventually, years later, after meeting Marty like 20-some-odd years ago, we actually did a study together. We had the opportunity to look at Army data. And we looked at like over 10,000 soldiers who did a series of questionnaires pre-deployment and then deployed. And the question that they asked is that, is there some way to predict who comes back with new chronic pain? Because chronic pain is a gigantic problem. In post-deployment soldiers. And they just wanted to know, is there some way that we can understand this? And so we had some factors that we had looked at. And what we found out is that the most optimistic soldiers were like 7 times less likely to develop new chronic pain compared to the least optimistic soldiers. So something as simple as just kind of being an optimistic person. And what was fascinating is when we actually kind of dug down into the data and actually controlled for things like number of deployments, whether or not they were injured, whether or not they saw combat, whether they were injured themselves in combat, whether they saw really grisly, horrible things. All of those, even when they occurred, did not dampen the effect of optimism. So it just was so protective. And so that tells us so much about our thoughts, our attitudes, and the power of our emotions.

Yeah. Wow. That's great. That's great. Well, we've covered a great number of topics, very important topics, and we touched on your book again, Chronic Pain Reset: 30 Days of Activities, Practices, and Skills to Help You Thrive. I love that title. I'm sure it's got to be a great resource for people that are struggling or learning to improve their chronic pain situation. So what's the, what's the main takeaway? For our listeners today? What would you hope they really remember from our conversation?

Oh, that, you know, medicine over the years has often made us recipients of care. There is a new wave where we are active agents in our care. And I think this is an important element of aging, that the more we take kind of control of our health and our lives and know that we do have power, that the better off we're going to be. And so, you know, Chronic Pain Reset just really puts the power in the patient's hands. Yes, work with your physician. Yes, work with your physical therapist. Yes, work with your psychologist, social workers. But man, there's so much that you can do too. And we're really, really trying to capitalize this in all disease care, diabetes, heart disease, hypertension. You know, there's so much that the patient themselves can do to take control of their life.

Yeah. Yeah, that's a perfect message. That's a perfect message. I, I agree. I mean, when I, when I speak, I talk about longevity, and, uh, NIH has said, uh, 30% of our longevity is due to genes. That means 70% is up to us. It's up to our lifestyles and things that are under our control. And that's exactly what you're saying. Yeah, we don't want to replace— you're not trying to replace the medical approach, the physician, but where it's a supplement, it's a, it's an additional additional tool in the person's hands. Yeah, that's great. That's great. So, um, looks like we're out of time for today, Naphton. Um, before I wrap up, I just wanna remind my listeners to visit my website, livingto100.club, sign up for my email list, and download a free copy of my 9 Tips to Make Living Longer Enjoyable. You also see an option to contact me with your questions and comments. I welcome your feedback. Dr. Hassett, thanks so much for being a guest on our show today. For those who might want to contact you or learn more, how would you, um, how would you direct them?

Oh, please feel free to visit my website. It's aftonhassett.com. A-F-T-O-N-H-A-S-S-E-T-T.com. Um, the book is available on Amazon, Barnes Noble, and the audiobook is coming out, um, October 31st. So we're very excited about that.

Great. Congratulations. That's great.

Thank you.

Well, I, I really enjoyed our conversation today. I think it's great. I, you know, I like being a messenger for this, these good messages.

So great. Well, thank you. You're doing great work out there, so I really appreciate it. It was great of you to have me. Thank you.

Thank you. And thanks to all of our listeners for tuning in. Hope to see you next time.