Ep. 10: David Butler – How Your Brain Shapes the Experience of Pain

0:00 – intro
1:45 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

02:20
Dr. Maya Novak:
In this interview, I’m joined by David Butler who is an associate professor, physiotherapist, clinician, and a world-leading pain educator. He is globally recognized as an expert in the treatment of acute and chronic pain, and he’s taught this to over 30,000 health professionals around the world. He has written many publications on the topic, and the book he co-authored called Explain Pain is the go-to resource for helping people understand the complexity of pain, and how to treat it. David, thank you so much for being here.

02:56
David Butler:
Maya, thank you so for inviting me, and a big Good Morning from Australia to all of your listeners!

03:02
Dr. Maya Novak:
Thank you. So, educating people about pain is important because is the first step towards resolving it. Now, before we got into depth, can you share a bit about yourself and why did you decide to first become a physiotherapist, but then also what got you into pain and being an expert in that area?

03:28
David Butler:
Thank you, Maya. Well, I have to admit, I started off studying law and accounting and found it terribly boring and I got out of that and I went and worked in outback Australia looking after sheep and cattle, and that got boring too. I was always interested in biology and people’s health, and then somebody said to me, why don’t you become a physiotherapist, there’s 96 women in the class and four men! So, off I went to the university in Brisbane and studied physiotherapy, and I’ve loved it ever since!

04:06
Dr. Maya Novak:
Oh my goodness. This is absolutely a funny story and the first that I’ve heard it explained that way. So many women, so I went!

04:15
David Butler:
Oh, yes!

04:17
Dr. Maya Novak:
And what about pain? So, what then led you to pain?

04:22
David Butler:
Yes, pain – I think I had a really good grounding in my undergraduate work and I did a lot of manual therapy, a lot of hands-on work, and I still do that. Then I got interested in and started researching the nervous system and how it’s moved through our body as we’ve moved. And then, this repeated clinical questioning, Maya. People weren’t quite getting better with chronic pain and the things I was doing wasn’t really helping enough. So, it was a personal journey, and I was lucky enough to join up with I call the pain revolution, that incredible new knowledge out there emerging, and to link up with some really good researchers. I think I’m part of the way through this journey yet, but there’s been a progress made. If I reflect now, I think probably 10 or 15 years ago, there would have been patients who had rather severe problems who I would have thought, oh, I can’t really help you. But now, I’m happy to try and help everybody who comes in the door, and that’s part of this revolution.

05:31
Dr. Maya Novak:
This is a very exciting time. I mean, so many things are now known that just a few decades ago we did not know about, and especially about pain and how it works. That’s why I’m so excited to be talking to you today. Now, what kind of role does the brain play in pain because usually, it’s like, oh, I fractured my leg or ankle or knee. And then it’s, yes, it’s there, pain is there. But can you explain a bit more about this?

06:05
David Butler:
Well, the brain’s obviously the boss. You could say the only known total cure for chronic pain is decapitation, but we don’t want to do that! So, the brain is the boss. But we have to be careful here because I think it’s important that it’s a brain in a body, in a person, in a world, in an environment. So, I tend to hold what’s called an embodied thinking view, how our world comes into our brain and our bodies. For example, with this virus around now, people are more tense. People are talking differently, speaking differently. Also, the language we use, someone who might say I’m worn out, I’m finished. Well, your body and your brain sort of takes that on. So, the brain is boss, but I like to think of it in a body, in a world.

06:58
Dr. Maya Novak:
Yes, this is a very interesting thing because how we are explaining things and what we are saying to ourselves and to others, this absolutely can affect and is affecting our physical bodies. Is that correct?

07:12
David Butler:
Absolutely. Very, very powerful and indeed in my work now I think it’s important to try and help somebody have a new or different or healthier linguistic expression of language. I think that’s as important as having healthy movement and healthy activity.

07:30
Dr. Maya Novak:
Mhm. Since we started talking about the brain, can you explain what brain smudging is and why is it important when it comes to pain?

07:40
David Butler:
Brain smudging, well, first of all, the word smudging is not a very nice word is it, Maya? But I must admit, I’m probably guilty for putting it out there, and it’s stuck so we’ll have to bear with the word smudging. We originally came up with the word – if you think of a pencil, you make a pencil line and your rub your finger over and it becomes smudged. But what smudging really means is that the territory in our brains that look after a body part or look after a body movement change. So, I prefer the word brain change or brainpower, essentially. I think it’s a better word than smudge. And this is part of the revolution. Since we’ve had these wonderful brain mapping experiments we’ve been able to see this incredible change in the brain. So, smudging means brain change, and this happens normally. I think that’s a key thing. It happens in us all the time.

08:42
Dr. Maya Novak:
Mhm.

08:43
David Butler:
If you were to go and learn darts, for example, you would have far better pathways or hi-ways between your hands and your eyes. Or a person who is blind and is using braille – not many people still use braille – but they have much bigger fingers in their brain than a person who doesn’t use braille.

09:04
Dr. Maya Novak:
Mhm.

09:05
David Butler:
So, it’s kind of a real ‘use it’ type of thing. The thing with pain though, of course, say you have a really painful knee for some time, it’s highly likely that the brain territory looking after knee becomes wider, it becomes bigger, and this is a fabulous protective thing. It’s looking after you. It helps make you more sensitive. But the problem is, if that keeps persisting, keeps staying there and doesn’t change, then that is likely to be part of the chronic pain state.

09:37
Dr. Maya Novak:
So, when we start treating pain or when we want to become free of pain, do we have to think about how to make that thing smaller in my brain? Or how do we go with that?

09:54
David Butler:
Okay, that comes back to one of the – I’ll drop back. One of the key findings of this neuroscience revolution that really excites me is the idea of a network in the brain, all right. So, when I trained, a long ago, we were taught that things like pain and love and anger, that there was one area in the brain looking after it.

10:18
Dr. Maya Novak:
Mhm.

10:19
David Butler:
But, of course, part of the pain revolution is that’s nonsense. When I‘m in pain or experiencing love or anger, there’s a whole network up there which lights up. It’s kind of like the lights on the Christmas tree light up. Or, as I often tell people, when you get in an airplane – remember those days when we used to fly in airplanes – that you looked at the book and they had the airline route in the back, and there’s all these links marking and linking – Chicago to New York and Los Angeles.

10:54
Dr. Maya Novak:
Yes.

10:54
David Butler:
That’s kind of like how the brain works, it’s a network. And the key thing is that if there’s these changes – I mentioned there’s little bits of smudging, that’s just going to be part of the whole network. So, within that network, there will be all sorts of things – your thoughts, your beliefs, your memories, your actions, your future goals. Everything is in the network there, and part of the network will be areas that are a little bit bigger, smudged, and looking after you. But Maya, this is so exciting. The idea of network is so exciting because if there are so many things coming in, contributing to a pain state, then there’s so many things you can do for it.

11:38
Dr. Maya Novak:
Yes.

11:39
David Butler:
And that’s the key thing of the joy of network. I’ve just got to say, when we first – I think it’s been the most liberating thing in my work, is to understand this notion of network. Many things coming together to contribute a pain state, not just one thing, but therefore many, many things that you can do to help.

12:00
Dr. Maya Novak:
So, do we here then talk about just the physical things? Because many times when we are in pain, when we are experiencing pain, we think of it as, oh, it’s a physical thing. Or maybe I have to go from one doctor to another, to a physiotherapist, or to an osteopath, and search for the physical solution of why, perhaps months after the accident, I’m still in pain. Is that how we should do it? Or what are the other things that we should look into?

12:34
David Butler:
Yes, that’s a really great question, Maya. First of all, we still hear or you still read people talk about physical pain and emotional pain, you hear this all the time. But that’s not true, they’re all the same thing. So, in somebody who has a lot of physical change, it could be severe injury, there will always be emotional components. But even someone who has a pain that is more, let’s say emotional, the pain of losing someone or losing out or whatever, there will still be a physical element in there. You can see it in their posture, and if you looked in deeply, you’d see it in some of the chemicals and the cell activity. So, this physical and mental thing must merge and I see them as one. The output of pain, the production of pain, is a combination of physical elements and these mental elements merged together.

13:32
Dr. Maya Novak:
Yes. Sometimes I explain this as that sometimes the body screams with you. So, if you are in a lot of emotional pain – this is my experience, I’m talking from my experience. When I was in a lot of emotional pain, sometimes my body responded with pain in the back, in my hips, in my ankle, and so on.

13:57
David Butler:
That’s right, and that comes back to the notion of the network. Someone might have an old injury or an old problem area in their body. If the network, the pain network becomes extra sort of sensitive, then that area can be brought back into consciousness, and that’s where it aches. I’ve always liked the singer Leonard Cohen. Leonard Cohen used to sing this song, ‘It aches in the places where I used to play’. I’ve always loved that line.

14:28
Dr. Maya Novak:
Yes. So, when we talk about pain, often we talk about painkillers –painkillers as in pharmaceutical painkillers. So, pills that we can get and it’s the easiest thing. But can you also talk a bit about those painkillers that produce ourselves?

14:51
David Butler:
Yes, but I’m going to drop back a moment because I don’t like to use the word ‘painkiller’ anymore because the word painkiller makes us think pain is the enemy.

15:01
Dr. Maya Novak:
Yes.

15:02
David Butler:
And pain is not really an enemy we need to kill. Pain is a protector. So, instead of painkiller, I say pain softener. Or instead of anti-inflammatory medications, which is also got this warlike thing, I like to say movement-enhancing medicines. To even dampen the language because I want to try and change this notion that pain, horrible as it is when it’s chronic, is actually in us to protect us. It’s just that humans, when they weigh the world and judge everything going on, often make a little bit too much than is really required. But we do have, in our own brains – this is important knowledge because, as we all know, there are problems with the opioid medications out there, there’s far too much done. And opioids, while they’re wonderful drugs that humanity needs, and could be particularly useful for acute problems, in chronic pain, they actually make things worse. But for people coming off opioids, for changing, it is really reassuring to know that you have your own drug cabinet in the brain. I’ll tell you about it. It’s in there between your ears, okay. It’s a little group of neurons – it’s quite a bit group of neurons, about as big as the end of your thumb. It’s your own internal drug cabinet. It produces drugs like opioids. It produces stuff very similar to morphine, endorphins, encephalins. And do you know what, Maya, the one in here is open 24/7. You don’t need a prescription. It’s natural. There’s no side effects. And it’s even open on Christmas Day! It’s fabulous, hey?

16:57
Dr. Maya Novak:
It is fabulous.

16:59
David Butler:
What it does, it pours out these – I call these chemicals the happy hormones. They’re like the endorphins and the morphine that pours out all over your body. If we think about it, there’s so much evidence that this – we have our own drug cabinet. I tell the young people look, you might have gone out for a big party last night and you woke up the next morning and there’s a big bruise on your leg. You think where did that come from? I can’t remember being hit. That’s because your drug cabinet was open because you were happy and in a safe place and enjoying yourself.

17:33
Dr. Maya Novak:
Mhm.

17:35
David Butler:
So, this cabinet opens and closes. Maya, the message that it opens up to, or the key is for someone’s brain to think is it worth me having pain now. So, is it worth me having pain now? For example, if you’ve just got back in your car for the first drive after an accident and you’re quite tense, it might be worthwhile having pain when you passed the place where you had the accident, and the drug cabinet will close. It will close. If you were playing a game of sport, and you were in the grand final and you’d almost finished and you thought, oh, I’ve really hurt my leg but I want to finish the game, you won’t have pain. Your drug cabinet can open and pour out these wonderful powerful happy hormones, that in chronic pain, are far more powerful than any kind – anything that mankind has ever produced. So, people always say to me, well, how do I open up? How do I open up this drug cabinet? How do I get it going? Well, it comes back to the network. There’s lots of ways in which this can be opened. We call them ‘SIMs’ finding Safety In Me, and just to go through some now because I will cover some more later, it could exercise, it could be laughter, it could be socializing, it could be understanding, it could be having goals, it could be changing diet, it could be using different words. There’s a whole range of things. With the network, the more you put together, the more power you’re going to have. So, it’s just nice to have our own drug cabinet.

19:17
Dr. Maya Novak:
Yes, and this is very empowering because truly have the power to change things. It’s not that the solution is somewhere out there, but it’s actually what we are doing, the in and the out, that we can actually do a lot on our own, right?
19:37
David Butler:
That’s right. You’re so right. To take back our own power, to be our on treater, to use the resources out there, but healing’s within.

19:51
Dr. Maya Novak:
So, you mentioned that opioids and with chronic pain, that they cause more problems than not. Can you talk a bit more about this? Because this is a huge problem after accidents, people are then on pain ‘softeners’…

20:12
David Butler:
Yes!

20:13
Dr. Maya Novak:
… and they are using them a lot. So, how does this cause problems if actually, it is sort of helping the body not to feel that much pain?

20:22
David Butler:
Okay. So, first of all, the opioids, as I’ve already said are a great drug. The World Health Organization recognizes them as one of the 12 or 15 key drugs for mankind. And you couldn’t do some of those enormous surgeries, like cutting the chest, without opioids. So, they’re great. However, the best evidence from the United States now, is that around about after three days or four days on opioids, it starts to get addictive qualities. There’s euphoria, but it starts to get addictive qualities. We know now in treating so many people with chronic pain, that people need more and more of the drug to get some sort of relief. But an opioid is a foreign agent. It’s not part of you. It’s a synthetic thing. So, over time, our bodies, our immune system, sees the opioids as a foreign invader and starts to produce its own immune reaction to kind of reject it. What happens, is you get this opioid hypersensitivity. So, people who have been on opioids for too long, and if there’s been too a high a dose, become too sensitive. Now, it’s very hard to get off that. You have that grade it off carefully, guided by a skilled medical practitioner. But still, if you knew that in your brain you had your own drug cabinet and ways to access that and open it and let your own natural opioids flood out, that would be the first step.

22:03
Dr. Maya Novak:
Fabulous. Now, I’m going to ask you something here because I have a feeling that some listeners are right now questioning this because we are used to that when take a pill something magical is going to happen, or something is very powerful. Now, when we sort of understand that no, that we also can produce this, there is nothing tangible. So, is it really true? Or how do we then perhaps also convince ourselves that this can be as powerful as taking a medication?

22:41
David Butler:
Well, actually you are taking a medication. You’re taking it internally.

22:46
Dr. Maya Novak:
Okay.

22:47
David Butler:
All right. So, that’s the first thing. One of the most powerful things in changing viewpoints is what I call the moments of stillness where you stop and just reflect. Reflect on your own stories, reflect on other people’s stories, and read. You will find, as you read, one of the key things that can help change that is simply stories of people who have had incredible injury but no pain. People who’ve had minor injuries, but heaps of pain. You start to see this disconnect out there between the amount of pain somebody experiences, and injury. Even when you reflect on your own life, there would have been times when things have hurt but you had a different mental framework out there and you managed to either walk or do things. I just had a patient recently with a chronic foot pain. She was a friend of mine, and I took her out fishing. She was hobbling on the boat, but she caught this most beautiful fish. I said was your foot hurting when you caught that fish? She said, no, it didn’t hurt at all. Huh? That’s not just simple distraction. That is the brain in that moment pouring out a flooding of these incredibly powerful chemicals. I’d also like to tell people that in our pain systems, for every one message coming up in nerve cell, coming up that might be saying to the brain ‘danger, danger, danger, it’s worth having pain’, there’s two hundred coming down. And that’s the real power of our brains to actually alter things. So, again, my message comes back to self-reflection, reading, and understanding that this has a really strong science background.

24:43
Dr. Maya Novak:
Since you mentioned your friend and your fishing expedition, when we are experiencing pain or when we are not experiencing pain while being distracted, does that mean that the pain might not be physical? Meaning that perhaps there is not a physical problem in that tissue and perhaps the pain is connected to something else? Because if we can sort of ignore it or if we can be flooded with positive hormones – do you know what I mean?

25:25
David Butler:
I think I know what you mean. The first thing I would comment though is that it is still real. It is still real and can be nasty and horrible.

25:35
Dr. Maya Novak:
Mhm.

25:36
David Butler:
So, a human experiencing pain, whether it is some physical damage that’s quite clear or somebody who doesn’t appear to have some physical damage, the pain’s still going to be equally horrible and nasty, all right.

25:52
Dr. Maya Novak:
Yes.

25:52
David Butler:
Secondly, the body producing pain in a chronic pain state – somebody might have had an injured back, but over time the brain, the nervous system looking after the back, in the spinal cord and brain, become changed. So, you could say it’s still real and physical, although the mechanism for producing it has moved to a different part of the body. That’s quite complex, but the key thing is they’re still real, and for both pains, when there’s a physical element or a more emotional element, treatment is fairly similar. Come back to the network. You can do so many physical things, but you can do so many educational, reflective, mental, self-compassion things as well.

26:50
Dr. Maya Novak:
So, a positive learning here is since the brain can change itself to experience more pain, which means that it can change itself not to feel pain.

27:05
David Butler:
Correct.

27:06
Dr. Maya Novak:
So, the brain is not static. So, if we were able to start experiencing more pain, we are basically capable of experiencing less pain.

27:15
David Butler:
Perfect. Right on. I’ve already said one of the key things from the neuroscience revolution that I’ve picked up and taken into my life and my work is number one, the network. But the second thing is you touch on something that we call bio-plasticity, which is the incredible potential that we all have in us for change. So, yes, if a brain can change to protect us, to make more territory to look after a body part, yes, it can go back to what it was before if the things that caused it to go bigger are taken away. Which is often if you get back and move better, take away some of the fears, the emotions, the anxieties, it will go back. That’s this incredible thing that we have in us called bio-plasticity. But I would give one word of warning that there’s a lot of neuro hype out there, I call it, that we can really super change, but it can be hard work. It can be enormous amount of self-reflection, of movement, of time, of patience, of guidance. But we do have it within us if we give it a go.

28:27
Dr. Maya Novak:
Yes, this is very important. I absolutely agree with you because I experienced it on my own. So, I suffered with chronic pain for a couple of years. And at the end, yes, it took a while, quite a few months to change my brain, to start seeing things differently. But I completely agree with what you said. So, it is possible, but it’s not always easy. It’s not an overnight thing.

28:56
David Butler:
It’s not always easy and I often go back to the network because many of the things that are contributing to a person’s pain state we’re not aware of. You’re not aware of what you read in the news is contributing to your pain state. Or what somebody did five years ago is also contributing. Or your fear of a particular movement is also contributing. So, sometimes there’s a lot of unraveling to do, but it’s worth it.

29:28
Dr. Maya Novak:
So, what are your thoughts – because sometimes I hear, well, I tried everything and nothing works. So, I’m still pain. Nothing works. I tried everything. What are your thoughts about that?

29:42
David Butler:
Oh, I love – well, I don’t like hearing that – but when somebody says that, I say come on in, come on in. Have you tried yourself - the power within yourself? Because that usually means, oh, I’ve tried a bit of acupuncture, manipulation, drugs, they’ve tried everybody around. We call it the nightmare of choice! Rather than coming in – let’s face it, Maya, if you’ve got a back pain out there – I think I counted the other day you could go to something like 33 professions who say they can help your back pain.

30:15
Dr. Maya Novak:
Mhm.

30:16
David Butler:
Sometimes that relentlessly searching for an answer can also make things worse. So, we have a formula that I use, and with my colleague, Lorimer Moseley, and it’s a simple formula about pain. That is this – that you and I, and your listeners, will hurt. When our brains weigh everything going on in the world, and the brains make a decision – if I can use that strange language – brains make a decision that there’s more danger out there than safety.

30:52
Dr. Maya Novak:
Mhm.

30:53
David Butler:
Equally, we will not hurt when our brains weigh the world and compute, or whatever brains do, that there’s more safety out there than danger. Now, that is a really, really powerful formula that we use in our Protectometer booklet. People will say to me, well, that’s usually quite interesting. And this is where we get to this idea of DIMs and SIMs – the network. We’ve talked about the network. A DIM – Danger In Me network and SIM – Safety In Me network. For some of you like Asian food, dim sims, they’re very popular in Australia. So, a DIM is a danger in me, and a SIM is a safety in me. But the key thing is, going back to network, for somebody with a chronic pain there could be so many DIMs. We categorize them. A DIM could be – and I’ve even made a list here of what the last 20 patients have said. It could things you hear, see, smell, taste, and touch. So, for somebody, the DIM could be a creaky joint, a cracking. Or looking at an x-ray. Or hearing someone say there’s no cure. But the SIM could be something like just blue skies. Touch. A kiss. A cuddle. I must admit, Maya, I sometimes find myself thinking I’m a bit of an old hippy saying this because I used to be very much a whack and crack and twist and really aggressive on people. And now, I find myself, for this category, I might say to a patient in chronic pain I want you to go to the local market. Walk through. Find three different smells, three different colors, and touch three different textures. They’ll look at me a bit a weirdly, and I say if you do that, your brain will construct new pathways in there that will, over time, overcome some of the pain pathways. You construct. Our brains love novelty. So, there’s a scientific explanation. Others could be the things you do. The DIM could be just a limp, repeated limping. A limp is always a reminder that there’s something going on. Do you know the best way to change a limp?

33:19
Dr. Maya Novak:
Please share.

33:21
David Butler:
Walk backward! The limps, the things you do, the doctor hunting and always seeing somebody else. That’s a DIM. The brain is picking up danger pathways. But the things you do that could be safe – right a bike, laugh, go back to your family. Gradually exercise. There’s plenty of ways to exercise gradually, carefully, with context, out of pain. The things you say, Maya, could also be DIMs and SIMs. I’ll talk a little bit about that after this because I want to pick one area to just focus a little bit on if there’s time.

33:59
Dr. Maya Novak:
Yes.

34:00
David Butler:
So, the things you say that could be really good, and the things you say that could be troublesome. The things you think and believe too is another category. If you think, they should have fixed me…

34:09
Dr. Maya Novak:
Mhm.

34:10
David Butler:
… or why haven’t they fixed me. Or the world is stuffed. Or pain is forever. If that is your belief structure, that’s a danger in here. But if you can have a SIM, which might be, hey, there’s new neuroscience out there, which can explain or give me direction out, there is understanding. Hang on, I’m more bio-plastic than I ever thought. The places you go could be a DIM, couldn’t they.

34:36
Dr. Maya Novak:
Mhm.

34:37
David Butler:
It could be seeing mum in a nursing home. I could be the cold scary places out there. It could be where you injured yourself. But equally, the places you go could be SIMs. Like, climb a tree. Go back to a church, if you’re religious. Your back shed. These are all SIMs, and so much of my work I’m trying to get my patients to find the SIMs. Get out, walk on the beach with your favorite music with your best friend and that will give your body an incredible immune blast. The people in your life could be DIMs. Sometimes it’s nice just to reflect. It could be the neighbor. It could be a health professional. It could be certain politicians, we won’t mention any names.

35:19
Dr. Maya Novak:
No.

35:20
David Butler:
But equally, they could be SIMs. And it doesn’t have to be people in your immediate family. It could be the Para Olympians or some sports star, or someone who has overcome incredible adversity. You might see it in a movie. People always say, well, why do I do that? I say, you go to a movie and see or read a story about someone who is really uplifting, your brain takes that on too and you live their life and there’s mirror neuron cells in there will come alive and also help you, and so it goes on. And then the things happening in your body could also be DIMs. If there’s creaks or crackles or things that need getting fixed, a fluttering heart, etc. dietary changes, they’re also DIMS but they can be turned into SIMs too. Move better. Get a bit fitter. Get your muscles up. Love your body parts again, etc. But I’m getting a bit excited here, Maya, I’m just raving on a little bit and I should hand back to you!

36:20
Dr. Maya Novak:
No, no, no. This is fantastic. One thing that I would love to ask you, since you mentioned stories and watching movies, so would you say that it’s advisable when you are recovering or when you are healing this chronic pain, that it’s better to watch positive movies, comedies, instead of horror movies and something really terrifying?

36:47
David Butler:
What a great question that it is. I’m going to answer it by saying it should be graded. So, I’ve often advised people as part of their therapy, and of course, they’re also getting exercises and a whole range of other things, let’s go to the movies. So, that for some people could be actually a physical thing, and they might say, but oh, I can’t sit more than half an hour, say. Well, go on a quiet day and sit up the back so you can stand up. Oh, okay, I’ll give it a go. Then, what kind of movie would you like to go and watch? So, for somebody’s who’s quite sensitive, it might be a nice gentle – not quite Snow White and the Seven Dwarves, but something pretty gentle before you get into Blade Runner or some horrendous thing. I would use in the movies, for people just to watch a movie, you get one that is appropriate to their mental framework at that particular time, but you might say, in the movie, just watch those legs move. Watch various aspects move. But, you know, Maya, life is a movie. I’ve often told people to go and sit in the mall. Find a comfortable spot, and just watch people walk by, okay. And watch the body part that’s hurting you because I know that’s activating all these mirror cells in the brain. And just might be one little part of the overall puzzle in the network.

38:15
Dr. Maya Novak:
I love this because it’s a different kind of take on also if you are watching something, a scary movie, let’s say, you can actually focus oh, they are running, so if they can run, I can run as well. They are walking. If they can walk, I can walk as well. So, this is a great change of perception.

38:34
David Butler:
That’s right, and the neuroscience behind it is quite strong. There’s a neuroscience reason for doing it. Again, it comes back to – I talk about it so many times, it’s the power of the network. There’s so many things people can do for pain. Put them all together and you’ve got a really powerful treatment tool.

38:55
Dr. Maya Novak:
Yes. Fabulous, David. Now, can we do some more hands-on work, and can you guide us through something that we take and implement in our lives to start resolving chronic pain and start healing in the best possible way?

39:15
David Butler:
Okay. Well, there’s so many places we could go, but I’m going to ask your listeners to do a little bit of self-reflection. So, this comes down to a treatment perspective I have, and it’s basically this, we can do lots of things that revolve around what I call stillness, which is just self-reflection, sometimes self-compassion, contemplation, and mediation. They’re the stillness things. But at the other end of the spectrum, there’s the movement things. That’s quality movement, exercise, stretch, contextual movement. What I’ve picked here is something to do with the stillness side, and it comes back to language as a DIM and a SIM. The first thing is I would like to ask your listeners, and you, to contemplate do the words you use, suggest that you’ve given up on yourself?

40:14
Dr. Maya Novak:
Mhm.

40:16
David Butler:
So, I ask people to reflect and it’s worth asking friends and family around. For example, words might be things like, in Australia, they say ‘I’m stuffed’, ‘I’ve got one foot in the grave’, ‘I’m on my last leg’, ‘I’m past help’. Or they use the word – it starts ‘I can’t…’. So, on you this just to reflect for five or 10 seconds, can they hear themselves saying some of those words. ‘I’m too old’, ‘My x-ray’s a mess’. Because, Maya, if people are saying these things or thinking these things, there are three key things – number one, they’re making their own prognosis. So, what you’re actually thinking and saying could become you. That’s that you embody your thoughts, they become you. Someone who says here ‘I’m riddled with arthritis’, it doesn’t sound good. I often laugh in this one, you know the great runner, Usain Bolt.

41:31
Dr. Maya Novak:
Yes.

41:32
David Butler:
He wouldn’t run as fast if his name was Usain Plod, would he?

41:37
Dr. Maya Novak:
Probably not!

41:39
David Butler:
The language or the words you use. Secondly, Maya, in this thinking, it’s usually not true. Those words people are saying, suggesting they’ve given up on themselves are not true because we grow new neurons until our last breath. The pains we have don’t necessarily relate at all to x-rays and other changes. There’s many, many other things gone on in the network that can be changed. And thirdly here, ‘oldies are goldies’. So, I’m sure some of your listeners might be a bit older, like me. But I want to tell them, that oldies are goldies. Sixty is the new 40, yes? Eighty is the new 60. And there are three myths out there. Pain is not inevitable with aging. In fact, older people have less pain than younger people, particularly headaches. Go the oldies! Secondly, if you have pain now, it doesn’t mean you’re going to get it when you’re older. It comes and goes like in younger people. Thirdly, toughing it out, as many older people do, is not a good thing. There are many, many ways that you can actually treat it, it goes back to the network. And, Maya, I have to say, it’s great being old. We use less shampoo. Older people don’t smell as much as younger people. Did you know that? They don’t need to buy combs and shampoo, and they have less allergies. So, go oldies! And then this final comment here, about reflecting on whether you’ve given up on yourself is something, which is very dear to me. I believe we often need to love our bodies again. Have some self-compassion to think this body has carried you through so many years. It’s done so much service for you. Don’t reject it. Don’t hate it. Take it back, it’s yours. Give it a bit of love.

43:42
Dr. Maya Novak:
Yes. May I ask something here because I absolutely hear you. You talk about the older generation, but this – the last one with loving your body is so important for also those who are younger, but when you have serious injury, your body changes, and many times it’s, oh, but I don’t like how I look right now, and so on.

44:07
David Butler:
Yes, that’s a very good pick-up there, Maya. You’re absolutely right. I could talk about that for ages because I think it’s really, really important. And if somebody leaves me and say, oh, well you’ve just taught me to love my body again, I reckon that’s – oh, I’ve done my job!

44:31
Dr. Maya Novak:
Yes.

44:32
David Butler:
The second thing, is I liked to get your listeners to reflect on are you using words suggesting your body is fragile and about to break, and this is DIM language. So, you might say ‘Oh, I’m always weak at the knees’, or ‘there’s degeneration’, or ‘it’s all wear and tear’, ‘my back goes out all the time’, ‘crumbling’, ‘disc slips’. These words, so I’ll get them to just reflect because they’re very common, and I’d like your listeners to begin to reflect that these words themselves are keeping the network sensitive in the brain.

45:19
Dr. Maya Novak:
Mhm.

45:21
David Butler:
Sometimes they will need to talk to a good health practitioner to fully explain it. So, I’m going to give you some examples now that are linked to the knee – osteoarthritis of the knee. So, that are SIMS. For example, instead of wear and tear – which is a really common term used here. I’m sure it’s common in America too, wear and tear.

45:47
Dr. Maya Novak:
Yes.

45:47
David Butler:
It’s a rhyme, isn’t it? It’s a rhyme, and rhymes are very memorable in the brain. So, what we do is we break the rhyme. First of all, it’s very unlikely, and I’ll use the knee as an example, that there’s something torn. So, get rid of the tear. Wear can be quite normal, quite natural. We all wear a little bit. And the good news is, that if you exercise appropriately, and understand what’s going on, osteoarthritis doesn’t have to get worse. So, I say ‘wear and repair’ rather than ‘wear and tear’.

46:26
Dr. Maya Novak:
Yes.

46:29
David Butler:
Other words, I love the little phrases like ‘motion is lotion’, ‘bend and mend’, ‘the more you know, the better the knee juices will flow’. So, in your knee, you’ve got about a teaspoon of this lovely fluid and it’s got a compound in it called lubricin, and that lubricin will flow and caress the knee joint surfaces much more when you move, but it’s also much more fluid and flows when you’ve got more SIMS in your life. The less stressed you are, the more you understand, the more you can see a future. Beautiful. And I always like to say with movement and knowledge, the knee cartilage will gleam and glisten and glide. So, it’s giving a new language here, but that’s quite a job, and I hope your listeners can find someone who can help them along with this language story. The third thing I’d like to talk about or get people to reflect on, is grunts, squeals, and grimaces, all right?

47:38
Dr. Maya Novak:
Mhm.

47:38
David Butler:
So, what I mean by that is to think what sounds do you make when you move? Do you ooh, ah, eh? Does your face turn into a lemon? Reflect on that because that little sound you make is actually a DIM, and what it’s doing, if you keep doing it, it’s priming the brain that you’re going to have pain. It’s like you’ve turned on the first switch in the network. For example, some of our work now is looking at people with stroke who have chronic pain. It’s very common in stroke. There are some people who may have the same grunt – ee, ah, oh – when they get up to 20 years. We try and change that because we now realize with the network, that that’s actually a little signal going into the brain that it’s going to hurt. So, that’s three reflections. If I could go over them again, and maybe later people might start to think. Is the language you’re using suggesting you’ve given up on yourself because it shouldn’t. Secondly, are you using language that is more suggestive that your body is fragile because your body’s not fragile. And thirdly, just to reflect on the little grunts, squeals, and grimaces, because they may be priming the brain that pain is going to hurt. Try and change them. Find a different grunt or squeal or have a giggle or do something different when you move.

49:09
Dr. Maya Novak:
David, this is fantastic because it really is about becoming conscious of what we are doing unconsciously.

49:17
David Butler:
Correct. Yes, and that’s a really good point, Maya, because so much of what – or the vast majority of human brain activity is unconscious, of course, but the more you become conscious of it, the more you reflect on it. Yes, I believe it gives humans what we call a greater – what would you call it – a free will, I think, to actually change.

49:42
Dr. Maya Novak:
True. Now, I do have a question in regards to this. We talked a bit about acute pain and chronic pain, and changing the brain and language. Now, does treating CRPS differ from, so to say, normal chronic pain? Or is it very similar?

50:04
David Butler:
What a lovely way to put it – normal chronic pain!

50:05
Dr. Maya Novak:
[laughs]

50:06
David Butler:
I don’t know that our listeners would like that one very much!

50:10
Dr. Maya Novak:
You know what I mean!

50:12
David Butler:
I know exactly what you mean. CRPS is Complex Regional Pain Syndrome and look, it’s an example of a really nasty chronic pain state that 15-20 years ago we didn’t really know what to do with. We didn’t understand this. And indeed, there’s been a lot of research recently on Complex Regional Pain Syndrome. Very broadly, the treatment for it doesn’t differ that much from so-called normal chronic pain, in that there’s a lot of education, a lot of graded movement. But the thing, I think, which is changing is that the initial treatment needs to go back deeper into a super-sensitive network in the brain. So, the work that we’ve been doing with Lorimer Moseley and colleagues, is using Graded Motor Imagery for Complex Regional Pain Syndrome. That is a combination of, first of all, making sure that you know your lefts and rights. It’s a really common thing. Say somebody has a Complex Regional Pain Syndrome and all that swelling and redness in the hand, that if you show them a picture of a left hand, they can’t identify it as left or right.

51:29
Dr. Maya Novak:
Mhm.

51:30
David Butler:
Or I’ve had some patients/clients, when you ask them to say is this the left or right hand, they actually feel ill. Now, Maya, this is a really deep brain protective thing. The brain is computing, oh, I’m not going to let this person move. I’m even going to shut down whether they pick lefts or rights. But you can train back lefts or rights by repeated use of cards or online programs. The next step would be to go onto imagery, to do imagined movements. And it often has to be imagined movements in safe places and then graduating up into imagined movements in less non-safe places. For example, you wouldn’t imagine doing a hand movement next to an instrument that might also damage the hand, you’d have to grade it. The third step is using mirrors to give a reflection of the image. So, you’re kind of tricking the brain a little bit. You’ve got the problem hand hidden away, and then you’ve got your so-called good hand outside moving, but the brain, of course, is seeing that the one that’s hidden is actually moving. That’s called Graded Motor Imagery. Again, it sounds fun, but again, it’s a lot of hard work, and it’s got to be linked in, Maya, the most precious thing is that if you’re doing that, you’re actually subconsciously saying to someone it’s in your brain, it’s in your brain. So, you need these stories of changing the smudging, activating mirror neurons in the brain. But if it’s done well, if it’s done with education, the scientific studies show this is a worthwhile treatment for Complex Regional Pain Syndrome.

53:18
Dr. Maya Novak:
Now, this is actually – what you were explaining here, you have an amazing app, right? The Recognize App, which is these types of things inside of the app. Am I correct?

53:32
David Butler:
Yes, that’s right. The Graded Motor Imagery program and there is a Recognize App where people can use it and train their lefts and rights, whether it’s feet or hands or knees, also the back too.

53:48
Dr. Maya Novak:
Mhm. Now, this so fun, and I know that I could be talking with you for hours, and hours, and hours.

53:56
David Butler:
Yes, Maya, it’s the questions. You’re asking me the most useful questions. These are really questions for the moment. They’re really good. Thank you very much.

54:06
Dr. Maya Novak:
Well, thank you for being here and sharing this because I am learning so much, and I know that participants are learning so much as well. Now, I know that there are also people out there who are listening to this right now and they are losing hope about their healing, about their pain. What would you say to someone is down that road, losing hope about their recovery?

54:30
David Butler:
That’s a hard question because it might depend on the availability of health practitioners who are up with the new stuff. So, somebody may need to reflect on are they getting what is best from a health practitioner. That is the first thing. But the broad answer would be, Maya is that there is always somewhere to go, and that’s something I’ve said to be people. It comes back to the network. With so many things contributing to a pain state, there’s always somewhere to start. Whether it’s just that first step of moving differently, thinking differently, reading something, getting a new pair of shoes to go for a walk, or anything, making that first step. There’s always somewhere. I am going to – and I actually apologize to the public, and say that health professionals have sometimes been a little bit slow to pick up on the pain revolution.

55:32
Dr. Maya Novak:
Mhm.

55:33
David Butler:
But we are catching up and the best hope I can say is that with this revolution, there are people with pain states, like amputees or Complex Regional Pain Syndrome or post-concussion or failed surgery, this whole range of pain states out there that, in the past, I and my colleagues would have said we can’t help. But now, we realize that we can help. We realize that we can help them on two things. Number one, it’s the incredible bio-plasticity we all have within us, and sometimes it just needs a little bit of help to be unleashed, and that might be a good health professional. And secondly, the studies now show – I think there’s probably 25 big trials would now show that combinations of education about the brain linked into quality movement and the skills that many practitioners can use will help chronic pain states. I, and my colleague Lorimer Moseley, we used to talk about this thing pain management. We don’t say it anymore. We now say pain treatment. And although it’s a hard thing to say, we do say to people now based on our knowledge of change and the scientific studies, that recovery is on the cards.

56:55
Dr. Maya Novak:
This is fabulous. We covered so much in this hour. Now, what is your number one advice? Perhaps one thing that we already covered or perhaps something else completely, what is your number one advice that you would give someone who is right now injured and in the process of healing?

57:18
David Butler:
In the process of healing, okay. As long as that hasn’t been a super severe trauma, it would be to rejoice and marvel at the enormous potential we have within us, and how much you can learn from that particular experience. It would come back, for me – to answer that question – it is yes, the incredible bio-plasticity, again, that we have within us. And that’s not just for healing of skin, muscle, joint, ligament, bone. That’s for healing and change within the nervous system and the immune system, which is representing our body part as well.

58:06
Dr. Maya Novak:
Yes.

58:07
David Butler:
And I ask people to seek something within. The answer is not ever going to be just within a number of health practitioners out there. You’ve got to a stage in life where you’ve got there, and you’ve been through injury, you’ve been through trauma, you’ve been through many life adventures. Reflect back and marvel at what a human you are.

58:32
Dr. Maya Novak:
This is incredible advice. So, it’s not jumping from one health professional to another, to another, to another, but actually really taking the power back. Go inside and search for that answer that you already have inside of you.

58:47
David Butler:
Go inside, search for the answer. When you go to a health practitioner, have your questions answered too, which is really important. Why am I on this medication? What is the next step? How safe is it? Take back the power within.

59:04
Dr. Maya Novak:
Great. David, I do have one last question that is a fun and bit of an out of the box question.

59:11
David Butler:
I can imagine there’d be an out of the box question with you, Maya!

59:16
Dr. Maya Novak:
So, the question is if you imagine right now being injured and you know that the recovery is going to take you a while, and it’s not going to be easy all the time, but right now in this moment, you have an option to choose one of two gifts or one of two options. Now, option number one is that you go through your recovery and do the necessary work, everything that you can to recover in the best possible way, and when you are done, you will have a gift of not being injured anymore in the future. Option number two is that go back in time, prevent the accident, but then you are also taking your chances, and you don’t know if you’re going to be injured in the future or not. So, my question here is what do you choose, and why?

1:00:08
David Butler:
What do you think I’ll choose?

1:00:11
Dr. Maya Novak:
I don’t know – gift one.

1:00:12
David Butler:
Gift one. I’m gift one, and as long as it’s not a super severe injury. Because, I think I’ve already said this, life is about learning. And I do know there have been patients and colleagues who – with injuries, they’ve said aren’t you lucky? You can learn about this. You can learn about your body, your healing, you can pass it onto your children and your family, and you’ve got a memory bank already in there which will help you in the future with other injuries. So, I’m going for number one because, for me, life is about learning. Life is about learning, unlearning, and relearning. For me, self-education is the most precious thing. And for me, education and knowledge is the most renewable energy on this planet.

01:01:02
Dr. Maya Novak:
Beautiful. David, where can people find more about you and your work?

1:01:08
David Butler:
Sure, they can go to the noigroup.com site if they’re interested in the DIMs and SIMS. They may be interested in the little Protectometer book, and there’s lots of resources there. There’s clips and resources and ask a question. There are always people there to answer questions. That’s noigroup.com. We’re here in Australia and we have groups and teachers around the world. It’s all about chronic pain and our message that recovery is on the cards.

1:01:44
Dr. Maya Novak:
Yes. I wish one hour would be longer because I would love to talk to you even more, but for now, thank you so much for being here, for sharing your knowledge, and for helping people get off medication and becoming pain-free. So, thank you, David, for being here.

1:02:05
David Butler:
Maya, thank you very much. Thank you so much for your great question, and thanks to all the listeners out there from your friends down here in Australia! Keep safe.

1:02:17
Dr. Maya Novak:
Thank you for tuning into today’s episode with David Butler! As you could hear at the beginning, this episode was recorded in 2020 as a part of The Mindful Injury Recovery World Summit. These life changing events contain 48 in-depth interviews and you can discover invaluable information from Physicians, Researchers, Surgeons, Physiotherapists, Chiropractors, Yoga Teachers, Pain Specialists, Psychiatrists, Nutritionists… you name it – I interviewed them all. All these conversations are still available and can be yours at mayanovak.com/summit.