The New Science of Pain: It's Not Just Physical with Dr. Rachel Zoffness

Pain psychologist Dr. Rachel Zoffness joins Forrest and Dr. Rick to explore what pain is, why it can persist long after an injury has healed, and what actually helps. Rachel explains why the brain, rather than the body part that hurts, is what constructs pain, the difference between acute and chronic pain, and the distinction between hurt (what you feel) and harm (what's damaged). They get into the biopsychosocial model, the "pain dial" that stress, sleep, mood, and social connection can turn up or down, the disappointing response rates for most pain treatments, why pain is absolutely not “just in your head,” what sham surgery and open-label placebo studies reveal about how pain works, and why the research is so hard to interpret.

This is not medical advice. Please do not start, change, or discontinue any medication based on this episode. All decisions should be made with your doctor.

About our Guest: Dr. Rachel Zoffness is a pain psychologist, assistant clinical professor at the UCSF School of Medicine, and the author of Tell Me Where It Hurts.

Key Topics:

0:00 Introduction

1:42 Acute vs. chronic pain

3:41 What is pain?

9:20 The biopsychosocial model

11:11 Hurt vs. harm: the tale of two nails

19:10 The pain dial

23:10 Nociception vs. pain

26:46 Your pain recipe

29:46 The "all in your head" stigma

31:23 Central sensitization

35:53 Pushback from pain patients

40:42 Loneliness and pain

46:51 Pacing

50:48 Reducing distress vs. reducing pain

54:26 Does anything work?

1:00:07 What placebo actually is

1:03:19 Acupuncture, sham surgery, and open-label placebo

1:09:42 Why the research is such a mess

1:14:10 Hopelessness, and trying one more thing

1:17:46 Mindfulness and attention

1:23:02 Advice for friends and family

1:30:22 Recap

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