What Science Says About Mental Fitness and Pain Relief

I don't believe that anyone creates a health nightmare intentionally. I think a lot of it is a lack of knowledge and awareness. And so, you know, some people might get judgmental of somebody who eats fast food every day. However, we can't really hold them responsible when they don't know the impacts of fast food on their body.

Hello and welcome to Beyond Diagnosis, a podcast to raise your awareness, decisions and voice for alternative practices so you can take back control of your health. I'm Rita De Michele, your host, a mindset and empowerment coach, and the founder of the Onus platform. Join me each week so you can create the health of your dreams. If you're wanting to resolve pain in your body or develop a healthier habit along with a positive mindset, then today's interview has the answers you've been looking for. Jen Ashhold is a physical therapist, a certified health and wellness coach, positive intelligence coach for mental fitness, and a fellow of pain science. Welcome, Jen, to the show.

Thank you so much. I am thrilled to be here.

Oh, it's so good. This is going to be a really fun talk because— an interesting and educational talk because so many people are suffering with chronic pain. I know my mother did. My mother just lived a life of chronic pain, and it is really debilitating and also affects our mental health and how we just are in life. So can we start by tell us, tell us about you, how you got into this work and what you do?

Sure.

I will say that you are correct. We do have an epidemic of chronic pain, about 1 in 4 people in our country, America. And also it's a similar statistic worldwide. So you are absolutely correct. Um, I am Jen Uschold. I have been a physical therapist for almost 33 years, and I've always really desired helping people help themselves, empowering them to— I always joke with my clients, the goal is for you to fire me, not because you don't like me, but because you are doing well and you have the goals and the strategies that you need. And I developed a love for health and wellness coaching because a client asked me to come home with him. And I said, I don't think my clients are my— I don't think my kids would be happy with that. And so then I started to get my coach training. And from there, as I fell in love with understanding pain, I remember as a new grad not knowing how to help these people that had longstanding pain. And what we have learned about pain in recent decades is mind-blowing and so helpful to helping people that are suffering with pain to make a change in their function and their pain as well. And out of that, I got into lifestyle medicine, which is harnessing the power of lifestyle choices to all— to prevent and also treat and reverse up to 80% of lifestyle-related diseases. So that is really powerful how much we have available to us that's easy and no side effects. And then my most recent passion is mental fitness. And my one-sentence summary is this is the work of Shirzad Shamene and positive intelligence. It is harnessing your brain to be your friend. more often than your enemy, and that helps everything.

Absolutely. And what I love about what you said is what you do is the prevention, to prevent, because that's the key, isn't it? We can go down the path of managing, curing, or whatever, but to prevent is the best, is the best. So for our listeners who have chronic pain, how would you specifically help them? And what's the commitment on their part to, you know, heal, or even if you can't heal, manage their pain?

That's a really good question.

What's the client commitment? Because I like to tell my clients, you're with me for an hour a week. There are whatever, 7 times 24 plus 23 other hours in the week that you have to be really contributing to moving yourself forward in your process. And, um, you had talked about prevention. Well, it's true. We do know the best way to prevent chronic pain is to properly address acute pain or pain early on. So those are 2 very important components. However, we still need to be able to help the people that are experiencing chronic pain.

Exactly.

And it is all evidence-based, the work that I do. And our base program is called Pain Neuroscience Education. And there are 4 very well-researched pillars. And we know that Education. Understanding pain helps reduce pain, which sounds crazy, but when I explain a little bit more, it makes more sense. Exercise, along with understanding pain. This is a gold standard. If there's only 2 things you're gonna do, this is what we would recommend. And then sleep is an essential component of healing from pain, as well as having goals, knowing where you're going and where you're headed. In addition to that, we have the PNE Plus program, which is 22 additional evidence-based strategies that we can use to help people in pain. We like to say we treat pain rather than manage pain, and all of these are non-surgical and non-pharmacological.

That's brilliant. I love it that people won't be reliant on medication. Because that comes with a whole set of side effects. If you're a lifelong, you know, need for pain medication, you may get the relief, but then you've got a whole lot of other symptoms down the, down the track.

That's about 10 other podcasts.

Yeah.

One of your questions before was, what's the commitment by the client? And I love that question because I cannot want the client to get better more than they want to get better. So someone who is Curious, ready to learn about themselves, learn about their symptoms, learn about different contributing factors. And it is in this curiosity that we can then learn the strategies that are going to work best for them moving forward.

And what I love about what you said before is that normally people wouldn't associate exercise and chronic pain in the same sentence, you know, like, or the same thought process. Because when you're in chronic pain, the last thing that you want to do is go and exercise. It's like they say, when you have arthritis, you need to exercise, otherwise you're going to stiffen up. So that is really fantastic that, you know, that is one of the things that you address in helping people to understand that exercise and, and, um, diet and mental, you know, fitness, like you were saying, is so important. Which brings me to my next point, is what are some of the habits or some of the common habits that can negatively impact people's health that you see quite common in, you know, what people are doing regularly?

I think we live in a society where we want information now, and so I am often asking my clients, did you get this information from Dr. Google? Because Dr. Google can have some value. However, We are also a very quick-fix society. So someone who's experiencing pain, it is the process to learn and find the strategies to come out of it. And part of understanding how pain works allows them to try and be a little bit more patient. There's a great story I can tell you if you're interested to help people understand a very basic framework of how pain works. So we can get to that. Some other behaviors. I don't believe that anyone creates a health nightmare intentionally. I think a lot of it is a lack of knowledge and awareness. And so, you know, some people might get judgmental of somebody who eats fast food every day. However, we can't really hold them responsible when they don't know the impacts of fast food on their body. And so I think coming in with curiosity and compassion is really important because everyone's story is unique. And so I don't like to really say people are doing negative things, but once they learn about it, then they're like, oh, hey, you know what? Sleeping 7 to 8 hours a night, this is going to help me heal. This is going to help my memory. It's going to help everything. Now, then it becomes a choice. If they still choose 4 hours a night, I can't do anything about that. And I let them know. I'm like, Are you willing to accept the consequences of that choice? The answer is yes. The answer is no. Then we can get curious together about how they want to improve their sleep.

Absolutely. Absolutely. So thinking positively has huge benefits on our mind and body. Can you tell us what you mean by mental fitness?

Yes, I would love to.

So it sounds like that's your passion project right there.

It is my passion. I actually describe mental fitness as the stitches on a quilt because I have learned so much great information from so many powerful and important people in the fields of study that I've been in. And I feel like this positive intelligence has found a way to bring it all together in a very beautiful, cohesive manner.

Mhmm.

So positive intelligence is, again, the work of Shirzad Shamene. And what he has done is he has synthesized 4 areas of research— positive psychology, performance science, neuroscience, and cognitive behavioral therapy. And so out of that, we have positive intelligence. And positive intelligence is the ability to recognize the impact of negative emotions and learn the exercises to shift our brain, to literally, literally shift ourselves from negative to positive. And in that, we are able to be more empathetic with others. We are able to be more creative. We are able to step out of tunnel vision that so often we have. And then we're also able to kind of reflect on what is important now. You know, is it important that I run through this red light so I get to the meeting on time? Or big long-term picture, maybe it's okay that I'm 2 minutes late to the meeting. And lastly, being in that positive side of our brain that allows us to activate Can we be successful in the negative side of our brain? Yes, at the sacrifice of happiness and peacefulness. Many people are very high achievers, but they're miserable. When we function from the right side of our brain or using this positive intelligence framework, we can achieve probably even more and also be happy and peaceful.

So you're saying that the positive intelligence side comes from the right side of the brain.

So broadly, all of our negative emotions are housed on the left. There are other structures, but just for simplicity, yes. And then all of our positive emotions are housed on the right, in very broad terms. Yeah.

So you can see how the, the, the wave, um, the global wave towards, um, mindfulness and being more flexible thinking all comes into this positive, this positive mindset and mental fitness. So being mentally fit, are there particular things that someone can do at home to help them become mentally fit? You know, like we know about all the brain gym exercises and all the apps and all of that sort of thing. What are things that we can do? Because the brain can— we can rewire the brain.

We can rewire the brain.

We can rewire the brain. So, you know, and I find that there's a little bit of thinking that you can rewire the brain up to a certain age. Say you get a little bit older, a bit mature in life, and they say, oh, it's too hard, it's too hard to rewire the brain, your habits are set in stone. What would you say to that mentality?

I would say we blame a lot of things on aging that are actually not based in science. And it is true that learning can be harder as we age. However, neuroplasticity— this is one of our more recent discoveries in recent decades— is the ability for the brain to continue to form and change and create new connections and neurons. And so, yes, we absolutely can continue to learn. They have tested the positive intelligence into people into their 80s, and we've seen it into children in elementary school. I have an amazing anecdotal story about a 5-year-old, a kindergartner. She broke her arm, and her teacher had been doing these mental fitness exercises with her. And while she was waiting for the principal with her mom and the teacher, the Principal couldn't get her to calm down. They were trying breathing exercises. And the teacher said, let's try our mental fitness exercises. And very quickly, the little girl was not crying. She was attending to the teacher. And the principal leaned in and said, what are you doing to her? And the answer was the mental fitness exercises. So across the ages, we can use these mental fitness exercises. And that neuroplasticity is a really important part of pain science as well. So now I'm kind of crossing them over. So you start to see why I'm so passionate about both. And a framework— because you had asked for something practical— a framework for both of them is the importance of education. So I often will ask my clients what they do for a living. And if they are an accountant, I ask them, what would it be like if we switched places? Well, it would be very difficult for me to be an accountant. And it would be very difficult for them to be a physical therapist. The reason why is they have education. Training and lots of experience and repetitions. If we want to understand how to impact our pain, we need to understand how pain works. If we want to understand how negative emotions impact our ability to function and thrive, we need to understand that operating system. And then from there, within that awareness, then we can choose something different. So in the mental fitness framework, one of our 3 key muscles is to intercept those negative thoughts when you feel them, when you experience them. Stop. And then one of our other muscles is called self-command. It is really tapping into that part of the brain. You had mentioned mindfulness. Mindfulness and meditation, they are forms of peak But however, the PQ or the positive intelligence, we can get this done in as little as 10 seconds. So I wonder, would you and your audience like to experience a short PQ session?

Absolutely. Let's go for it.

Alright.

You can choose the time. You're the one with the clock over there. Um, how long would you like? 1 minute, 2 minutes? I can kind of guess what you'd— what would work best for you and your audience.

Let's do 2 minutes.

2 minutes. Okay. So I invite you, if you're comfortable, to close your eyes. I will close my eyes. And let's start by just feeling the weight of your body on your seat and the weight of your thighs and your feet on the floor.

If you feel or experience a thought or an emotion, that's okay. Come back to the sensation of weight.

See if you can find all of your toes and bring awareness to them.

Wiggle them if you need to. And now we'll move to some hearing PQs. What is the farthest away sound in your environment? Again, if a thought or an emotion comes in, come back to the awareness of sound. What is the closest sound in your environment? And can you hear your own breathing? Feel the air As you breathe in, and the air as you breathe out. Notice the difference in the temperature of the air. And to finish up, rub 2 fingers together so lightly and with such intention That you can feel the ridges on each fingertip. And when you're ready, open your eyes.

That was fabulous. I just felt so centered in my body. That was great. I'm, I'm a person who definitely can be too much in her head. But that really just— it really calmed the nervous system. And just, I felt grounded. I felt grounded in my body.

And if we had a fancy fMRI brain scanner, we can see the activation of the left side quieting and the right side getting more activated. So it's fascinating how we can measure these things. And the same is true with pain science. We have very cool research studies showing somebody's brain scan. And then they've done something that causes them pain. And their whole brain lights up. And then they have a short education session on how pain works. And they redo the scan. And their brain quiets down beautifully. And that's just from a short education on how pain works. Very powerful.

That's amazing. That's amazing. Because yeah, I've read and I've heard on podcasts and TV, etc., and I'm not sure if I'm interpreting this correctly, that the, the brain doesn't actually understand pain. It's The memory of us having pain. Is that correct?

That is a piece.

Oh, interesting.

So our previous experiences around pain will inform our brain about what happens when that comes around again. So an easy way to understand this is Food poisoning. Have you ever had food poisoning?

I have.

It's unpleasant, right?

It's very unpleasant.

I don't know what the food was. Do you remember what the food was?

I think it was fish, actually.

Yeah. Fish.

Okay, so you had fish, you had a very poor reaction to it, and it's not uncommon for someone who has had food poisoning, if they smell that same fish again, They can start to feel nauseous. That is their brain going into a protective mode because it remembers what happened in the past. And then it's up to us to say, no, we're safe now. Somebody else is eating that fish. We're okay. And so the same is true with pain. What would you think about a short story about pain? And I think that will pull that statement in a little bit more broadly. There's truth to it. There's so much Okay. So my first question for you is, if you stepped on a rusty nail, would you want to know about it? Yes. Why would you want to know?

Because mainly because it's rusty and I feel I may need an injection because it's rusty.

Exactly. Yeah. And you might want to clean up the area, you know, who knows?

Exactly.

Wear shoes when you're in that area. So there's reasons. And so Can you see how pain is protective?

Mm-hmm.

So often people think pain, all pain is bad. However, pain is really protective. So you've stepped on the nail. It's not yet pain. We have 400 nerves in our nervous system, and they are all connected like a big crazy highway. It's about 45 miles in length. So I'm in the DC area. I usually say it's about the distance to get to Baltimore. I don't know what 45 miles is from you.

Neither do I. We're in kilometers.

Oh, oh, yeah. Good point. 45 miles. I don't know what the translation is. So all of those nerves are interconnected. So when you step on that nail, we do not have pain sensors. We do not have pain nerves. It is on a danger sensor. It has a fancy name, nociceptor, and it goes up to your spinal cord. It gets on another neuron, it goes up to your brain, and then your brain has to decide what to do with this danger information it's received from your foot. So, in this case, you feel pain so that you take care of your foot and make sure that your tetanus is up to date. So, that is fantastic. Now, can we agree that your foot might be sore for a few days afterwards?

Absolutely.

Every time your foot feels sore, are you causing more damage in your foot?

No, I don't think so. Right.

That is an important thing for people experiencing chronic pain, because they feel pain does not— and more often it means there is no damage and there's nothing going on with the tissues or something small. And the nervous system, it went off really quickly, so you felt that nail in your foot. It takes longer for it to get back to its baseline than to go off in the first place. So that's important for people with chronic pain to understand that it does take time for that system to get back to its baseline. And along the way, people have some peaks and valleys. And so one of the phrases we use is no freakouts over flare-ups. They may have an increase in symptoms, but part of understanding how pain works is then they know, oh, this can happen. What are the factors that might be contributing? And most importantly, what are my tools that I can do to get myself out of it? So the challenge that we have is that 1 in 4 people, it doesn't come back down to baseline. So we have this threshold. The fancy word is action potential. If we cross that action potential line, That's when we'll experience pain. If our nerves are really running down here, we'll just say 1 out of 10. We've got all this room to do whatever it is we want. People with chronic pain, they might be running at an 8. So now they have very little room to do what they want to do down here. This might be running 10 miles up here. It might be walking a quarter of a mile. Before the alarm gets tripped. Does that make sense?

Absolutely makes sense. So that now I have such a shorter threshold.

Yes. And another way that's really tangible, because sometimes I use pictures, but we don't have pictures, is if you have an alarm on your house, we would want that alarm to go off if a brick went through the window. However, what if somebody changed the sensitivity of your house alarm And your house alarm went off when a leaf hit the window.

What a great antidote. Yeah, what a great example.

Is your house okay? Yes. Your house is okay. And so I ask my clients, can your body be okay? And we need to address the sensitivity of your alarm system. And the answer is yes. And sometimes we need to be treating some of the tissues as well. So then we wonder, why do I have chronic pain? My neighbor had surgery and he or she is fine. I have pain 3 years later, 10 years later. We've done research on this, and this kind of comes back to your question. Is there are things in our lives that can raise the sensitivity level? It may not get us to cross the threshold, but it may get us closer to the leaf rather than the brick. Things such as different explanations for pain. People that go to provider after provider and someone says it's a strain, someone says it's all in their head, someone says it's IBS. This is very confusing for the nervous system.

Yeah.

And the pain is a protector. The brain is doing its best to protect you. Other things that can cause these yellow flags. Ongoing pain is a stressor. Family situations, job situations, financial situations— all of these things are contributing factors, and they're things the brain considers when it gets the information from the body. So when you had mentioned that about the memory, yes, sometimes pain is partially based on a memory. However, not always, because if you break your arm and you've never broken your arm before, your brain doesn't have that memory, right?

Right, exactly.

So it's a piece of it, but it's not all of it.

That is so informative, which brings me to ask you, when you mentioned about people going to different practitioners and someone says it's a sprain or it's all in your head, can you give 3 tips to help our listeners better advocate for their needs if they're not being heard. If they know— if someone's saying, oh no, it's only a pain at this level, but they feel like the pain is at a 9, and someone's going, how can it be a 9? Or they just don't know how to put words to their pain. They don't— they really— pain is something hard to describe because— A practitioner many times may ask you, what type of pain? Does it tingle? Does it burn? Does it whatever? People find it hard sometimes to explain and then to advocate for themselves and get the correct help. What are some things, some tips, at least 3 tips that you can help our listeners with?

Well, one is a little blunt. If ever— if anyone ever tells you that your pain is in your head or you're making up or you can't have a pain higher than 10 out of 10 Politely get up and leave because that is not the right provider for you.

Love it. Love it.

I would like—

You love it.

I would like to believe that we as providers are doing the best we can. However, our knowledge of pain and how it works has exploded. The challenge we have is disseminating this information. So finding a provider that is trained in pain science is important. And remembering this provider works for you. You don't work for them. So even many people in my own family, they are very hesitant to ask questions of the provider because they figure, oh, he or she is the doctor. I got to do what they say. But the reality is you are your own best expert. You may not have the language to describe the pain in the words they're asking for. You do have language to describe it in a way that fits you. How does it impact your life? And so that's another way to really remember that you are in the driver's seat. And if they don't want you to be in the driver's seat, again, that might not be the right provider for you. So that's 2. And the 3rd one is, I would say, be prepared as best you can. Be prepared with the information you want to share with the provider because An unfortunate reality, at least in the United States, is that many providers are tight on time. And so you're gonna have more time to garnish their expertise if you are able to come in prepared and efficient and concise. I'm lucky I'm able to treat— I'm able to see my clients for 45 minutes. Um, but for people that are in a different environment, I think that can be a very helpful tip.

Absolutely. I love, love those tips because that's what we're all about here is education, awareness, and self-advocacy.

Yes.

And I say to so many people, if you're not getting the answers, if you're not happy with the provider, find another one. That is actually the point of the podcast. The point of this podcast is to raise awareness of what else and who else is available If you're not getting the answers you need. So to finish off today, I always like to ask, what are some simple actionable steps that you can give our listeners today if they're in pain and feel unmotivated and just mentally and physically unmotivated to help themselves? What are some simple things they can do today?

Movement is your best friend. It seems a bit counterintuitive.

Mm-hmm.

However, we talked about how the sensitivity of the nerves is elevated. Nerves are very happy when they have lots of blood flow and movement. And so when people can take a short walk, if you're not able to walk because the pain is too much, do some exercises with your arms. Do anything to get your blood moving. And that physiologically calms down the electrical signals in the nerves. And when those electrical signals are calmer, then you will have less pain. Get curious about pain. Dr. Google is a challenge. However, for the most part, there are some good resources on the internet now if you're searching pain science. And I'll tell you, some of the leading pain science people come out of Australia.

Thank you.

So there are amazing resources in Australia. Yeah, if I could think of— Pain in Motion, I think, is one of them. paininmotion.com. Anyway, some brilliant, brilliant minds that we have learned so much about pain science from come from Australia. So the idea of the resources, appropriate resources, Getting some movement, and finding a provider that works for you and understands that the goal is for you to fire them.

Fantastic! I love that, Jen. It has been such a pleasure and incredibly informative, and I hope all our listeners who are struggling with thinking positively or with chronic pain or some form of chronic condition that causes pain will book in with you. Do you work globally, Jen?

I can do coaching a lot. I can do my coaching globally. I cannot do the physical therapy. However, there's so much that I can integrate into that coaching model. So yes.

Fantastic. Jen's— all her details will be in the show notes, so please click on them. Learn from her and connect. Thank you so much, Jen. It was a pleasure having you on the show.

Thank you. So much fun.

I appreciate it.

Thank you. I would love to know what was the biggest insight or aha moment you got from this interview so you can now speak up, take action, and make informed decisions for your health. And if you like this episode, get instant access to your free ebook, Alternative Wisdom: Taking Back Control of Your Health, at life-onus.com.