Andrew Huberman· PhD
What I eventually realized is that, well, it's this disk bulge. It just so happens that the nerves that emit from that region, they branch out to a bunch of different areas. And so you think the pain is in your leg, but the issue is someplace else. And occasionally indeed I feel the pain elsewhere in my body as well. It's sort of like a matching of regions for pain that seem unrelated. Is that a way to think about reference pain? SEAN MACKEY: Perfectly. The examples also I referred to of a heart attack causing referred pain or also the pelvic region associated with back pain as a way of referred pain. What you're describing is the fact that pain doesn't have to start with an injury or a stimulus in the periphery. You could damage the nerves anywhere along the way and that will be perceived as pain. We refer to that as neuropathic pain. So that's another distinction you brought up nicely. Good segue into there's thought to be several different types or categories of pain. We have been talking through much of this time about somatic pain, injury out here. We talked about visceral pain. And when you have damage to a peripheral nerve, damage, injury to a peripheral nerve or the central nervous system, we refer to that as neuropathic pain. It frequently has different qualities, different characteristics. People will refer to it as shooting, stabbing, shock-like, burning. It can frequently when there's a damage to a nerve or damage to certain regions of the brain be incredibly challenging to treat. By the way, the good news is with that light disk bulge is the vast majority of time, the disks reabsorb. ANDREW HUBERMAN: Yeah, I have to be careful to not do too much spinal flexion, like sit ups and stuff. I thought that would help. But that actually doesn't strengthen the back. It was actually a asymmetry between the abdominal muscles and the lower back muscles. So provided I do a lot of back extension type training, then that bulge more or less stays in. I just have to be a little cautious, not too cautious fortunately. As long as we're talking about referenced pain, somatic, visceral, and all the rest, what about associative or referenced pain where it's psychological? And I don't want to get too abstract here, but more and more these days I hear from people who say, I was in this job and the job sucked. Or I was in this relationship and the relationship sucked. And I had terrible back pain, really acute, localized back pain or chronic headaches or migraines. And then they go on vacation or they change their circumstances and lo and behold, the pain goes away. Does that surprise you as an expert in pain? SEAN MACKEY: Not at all. Not at all.