Hi, I'm Quinn Carmighi. Welcome to Manifestation, Motivation and Passion. If you're looking
to transform by delving into brain science, sacred inner wisdom and want to heal and feel
great about your life and live in your powerful loving centre, whilst bringing affluence into
your world, then tune in and let's evolve together.
Jen Ashold grew up in Western New York and has been a PT for over three decades. Has
worked in multiple treatment environments including travel PT. Out of her love for PT
and helping others to empower themselves, she was drawn to both pain science and health
coaching. Jen has completed a fellowship in pain science with evidence in motion and
is an eager learner and has also studied lifestyle medicine and positive intelligence. Jen loves
and has been teaching since 1998 with companies in Chicago, Virginia, Colorado and internationally.
Jen has owned a small private practice since 2007. Outside of PT and coaching, Jen is a
passionate mum to three, mostly grown kids, I understand that one, while seeking laughter
and connection with others. As the saying goes, laughter is good medicine and Jen wholeheartedly
agrees. Let's connect and get ready for some learning, smiles and even laughter today.
Hi Jen, thanks for joining us. Thank you so much for having me, Quinn. I'm excited. Thank
you for joining me. Perhaps we can jump straight into it. We're going to discuss chronic pain
today and how does that differ, please, from acute pain? What a very good question. Well,
I'll start by saying that pain is a universal experience. All of us experience pain and
there's a very, very small segment of people that are born with the inability to feel pain.
Most of us do not like pain, however, it is protective and those who have this condition
where they don't feel pain, they actually don't live very long and an easy way to understand
that is if you put your hand on a hot stove and you don't feel it because you have this
condition, then this is going to very quickly turn into a problem for you. That's usually
an aha moment for my clients who would think not having pain would be the most wonderful
experience ever. The reality is pain is protective and if we go to this difference between acute
pain and chronic pain, acute pain is more closely related to when we've had an injury
or a surgery and a sprained ankle is a great place to start. So if you're hiking on a trail
and you sprain your ankle and you feel pain, we would put that in the category of acute
pain. We know that the way tissues heal, our muscles, our ligaments, these are very, very
well researched and documented and we know that the bulk of those tissues are going to
heal in generally three to six months. And so when we have people that have pain for
a prolonged period of time, this could be months, years and even decades, we have to
get a little bit more curious about pain beyond the physical, musculoskeletal tissues. All
pain also has a component of the tissue health and also psychology and sociology and the
framework that we work from is something called a biopsychosocial model. And what that means
is that all pain has some biology to it, some psychology to it and some sociology to it.
And when somebody has an ankle sprain or they just had a tooth removed, the piece of the
biology pie is going to be much bigger and that's what we see with people who have acute
pain. And then the longer people have pain, after we know the tissues are healed, then
we have to get more curious about the psychology piece and the sociology piece. That might
be a good overview and then I'm curious as to how I can dive deeper with you.
Wow, that's a lot of information. So then how does I guess chronic pain impact a person's
daily life and overall wellbeing?
Wow, the answer is it is a unique experience for everyone and I have seen people who have
been in pain for 30 plus years. Pain impacts all areas of your life and it impacts it differently
for each of us. We have FMRI studies which are fancy brain scans that show us that there
are nine different parts of the brain that are potentially involved in any pain experience
and for each person that's going to be unique. And for somebody who it's the part of their
brain that handles digestion, this may be somebody who shows up with more irritable
bowel symptoms. And for somebody who's really having trouble remembering doctor's appointments,
this might be affecting the memory and concentration part of their brain. And we can kind of go
on and on in that area. And so the way I like to describe this is if you think about one
of your favorite foods, so what's one of your favorite foods?
Custard or chocolate.
Custard?
Yeah. I have a sweet tooth.
Homemade custard?
Pardon? Oh, I'm not fussy.
Homemade custard?
I don't mind.
You're not fussy. Well, we're going to say homemade custard because it will make my metaphor
be easier to understand.
Okay.
So there are many ingredients in custard. There are eggs, there's sugar, there's milk,
there's vanilla, there's other spices. And what is it that makes custard amazing?
Oh, it's warm liquid ooziness. It's sweetness. It's homely. It reminds me of my Nana.
Oh, I love how you just brought in your Nana. So you have a very emotional connection to
custard and people have an emotional connection to their pain experience. Someone who sprains
their ankle on a job that they hate and they're poorly treated is going to have a different
pain experience than someone who sprains their ankle on their honeymoon and they're having
the time of their life and they happen to sprain their ankle. So that is a great thing
that you highlighted.
The other piece of our custard example is that the custard isn't amazing because of
one ingredient. We need all of those ingredients to create that custard. And for you, we need
the emotional connection and the love of your Nana. And so pain is no different. Everyone's
pain experience is unique. How it shows up in their brain will be in these different
parts, but how it shows up is going to be different to them because all of us have had
different experiences and exposures and beliefs and education that got us to this point. And
that can be helpful because sometimes it's really frustrating for people to say have
had a back surgery and really struggle and wonder, well, my sister had back surgery and
she's fine, my neighbor had back surgery. And that's because it's much more complicated
than merely the health of the musculoskeletal tissues.
I really like that you've said that it is different for everyone and it depends on your
psychosocial status at the time. So my question is how, given that you can't, pain is something
that you feel. So how do you study that? How do neuroimaging techniques help researchers
study and visualize chronic pain in the brain because we can't see it? Do you know what
I mean? Like we can't, like, well, you might be able to because, I don't know, like neuroscientists
and that might be able to, but how do they see it? How do they research it? Because it's
not something that is seen. Well, to my knowledge.
It can be seen and the reason we know so much more about the way pain works now since the
nineties then before is because of fMRI scans and spec scans and all of these fancy scanners.
Prior to this, we've been working on a model that goes back literally three and a half
centuries. Rene Descartes told us pain is either physical or psychological. We now know
from these fMRI studies that pain always has a physical and an emotional component. And
we know that pain is not derived from the tissues. We require the tissues to feel it.
However, it's actually an output of the brain. So I'm going to slow down a little bit with
this because this can be hard for people to kind of grasp. Never are we saying people
are making up pain. All pain is real. That's the most important bottom line. And the way
we get to pain is I often use a story of stepping on a nail. Do you want to go through this
story with me? Oh, absolutely. All right. So let's just say that you're walking and
you step on a rusty nail. Do you want to know that you've stepped on a rusty nail? It would
be painful. Let's go there. It would be painful and you'd look at it and this would provide
valuable information. Oh, I've stepped on a rusty nail. I need to check for nails in
the area. I need to make sure my tetanus is up to date. I need to clean the wound and
maybe put a band-aid on it. Now, if you hadn't felt that pain, you wouldn't have known. You
wouldn't have received that information to do those other things. So when you look at
it that way, can you see how pain is valuable and protective? Absolutely. Absolutely. And
have a friend that works in the disability sector and has someone that can't feel heat.
They don't have that sensation so they need someone with them to make sure they don't
burn themselves. So I understand from that perspective that the pain is a very needed
sensation to alert us to danger. Exactly. So let's keep going. So now you've received
that information. How do we get to the experience of pain? People know what pain feels like
but it's very hard for people to define pain. We do not have pain nerves and we do not have
pain sensors. What we have and to use your word is we have danger sensors and the fancy
science name is a nociceptor. This takes the information to the spinal cord and then it
takes it up to the brain and then the brain will decide, yes, this is important. Quinn
needs to know what's going on and then you will feel pain. So does it make sense? Oh
sorry. Are there specific areas of the brain then that are associated with chronic pain?
No, there are nine different parts of the brain that have the potential to participate
in any particular pain experience. And the challenge we have is when someone shifts from
more that acute pain into the chronic pain, then those parts of their brain are busy,
we call that being in a pain meeting. So instead of taking care of digestion, that part of
your brain is busy in pain and so this shows up as somebody with irritable bowel symptoms.
If the musculoskeletal part of your brain is busy in the pain meeting, then this shows
up as sore muscles, tired muscles, fatigued muscles. It's similar to when we are in meetings
all day, people aren't getting things done in the meeting because they are not able to
focus on their regular job. And so with chronic pain, we want to get those parts of the brain
out of the pain meeting so to speak so that they can get back to their regular job. How
does one go about doing that? Ah, great question. Can we go back to our nail story because that
would make more sense. Absolutely. Okay, great. So now we know that the information travels
on a danger sensor up to the brain and the brain says, Quinn, you stepped on a nail.
Now does it make sense that it's going to take longer for our foot to heal and for that
messaging to calm down than to ramp up? I'm not sure I understand what you mean. Are you
going to use me? Sorry about that. Your foot might be sore for a couple of days. Can we
agree on that? Oh yeah, absolutely. Sorry, did you want to grab a drink? Yeah, I'm good.
I have a drink right here so I apologize. Oh, okay. All right. So it will take longer
to calm down than to ramp up and that's just the way the nervous system works. So that's
good. We know that it's going to take longer to reach its baseline. And if your foot feels
sore in the few days afterwards, you're not damaging the foot anymore. It's just that
the sensitivity is still a little bit elevated. So in our nervous system, we have 400 nerves
and they're all connected like a big crazy highway and it's about 45 miles in length.
All of these nerves have a little bit of a low buzz all the time and it lets us know
we're alive. So maybe your listeners can just imagine a scale of one to 10 or zero to 10
and the nerves are buzzing along at a one all the time. When we step on the nail, we've
crossed the threshold at 10 and then we expect it to come back down. The problem about one
in four people, not only in the United States, but it's a similar statistics worldwide. The
alarm never gets back to baseline. Really? So maybe it's staying at a seven or an eight.
Right. So how does this impact us? This was your question. How does this impact us day
to day? So if our nerves are buzzing at a one and we have from one to nine or 10 before
we cross that threshold, that gives us so much room to do what we want to do and need
to do every day. If someone has their nerves buzzing at seven or eight, the image, mental
image, we have so little room to play and do and be before we cross that threshold.
Sometimes it's easier to understand it with the example of an alarm on your house. If
you have your alarm set and the alarm goes off, if a brick goes through the window, this
is good, right? We want to know. We want the alarm to go off. Does that make sense? Yeah,
sure. Okay, great. Now, if the sensitivity of the alarm is elevated or changed and a
leaf hits the window and your alarm goes off, is that helpful? That would scare the bejesus out of me.
No. I'm like that. So you know what? Pain does scare the bejesus out of people. And so
oftentimes it's not the state of the body. It is the state of the alarm. And so I'll tell
my clients, I'm like, so if your alarm goes off, when a leaf hits the window, is your house okay?
I would say it depends on how bad the damage is. If a leaf hits the window. Oh, sorry. If a leaf
hits the window. Sorry. No, I would say the house is fine. Right. And so then I also ask my clients,
I'm like, is it possible that your body, your house is okay? And we need to address the
sensitivity of your alarm. And this is where we start to have differentiation. The longer
people have had pain, our treatment strategies are different because it is still about the body
and the brain. However, the way we go about it is different. And we have four main very well
researched pillars and they are the power of education. We have amazing fMRI scans of showing
people and the way the brain is responding. For those who don't know, what is the fMRI?
FMRI stands for functional MRI. And it is a scan that people have. And in this case, it's of the
brain. So people are able, the scientists are able to see in real time what's going on in the brain.
Perfect. Sorry, keep going. Yes. Sorry about that. Yes. That's all right. And so they have scans of
people and before the education, you can see the brain's response to the painful motion. And then
they do the education and you can see how beautifully the brain calms down after a small
amount of education. So the power here is that one of our key treatments is helping people
understand pain. And it is very, very powerful. Our other three main pillars are sleep. Sleep is
essential because sleep is when we heal and many other amazing necessary things happen in sleep.
I'm kind of a sleep geek. That's really difficult though. Oh, sorry. That's really difficult though
when you're in pain to try and get to sleep. Yes. And that is a topic that I talk with my clients
about. Many people think that because of their pain, it's impacting their sleep. And it's true,
it's a two-way street. Pain impacts sleep, but the research actually shows that the quality of our
sleep impacts pain a little bit more. And there are many different things we can do to address sleep.
The three main areas that I address with my clients is looking at sleep hygiene, sometimes some very
simple hygiene changes can make a world of difference. Looking at their airway, how efficient is
their airway? Because if we're not breathing through our nose at night, we are impacting the
quality of our sleep. And then the third area is nutrition and supplementation. Vitamin D is very
important for sleep. We know that the microbiome or the environment of our gut, gut health is
really important for sleep, as well as things like magnesium. So these are all areas that I address
with my clients to help improve their sleep. Gosh, you're just a wealth of information. Sorry, keep
going. Oh, say that again? I said you're a wealth of information. Yes, absolutely. And then the final
area is having goals. So we know that for our clients, this is no different than any coaching
scenario. Having goals helps us get to our final destination with little goals along the way.
And in addition to those four, we also have 22 other areas. We call this PNE plus. PNE stands for
pain, neuroscience, education, using these stories like we just talked about to help people understand
the complexities of pain. The 22 plus are other areas that are evidence-based reading. We have
research to support them to help reduce pain. This really puts the client in the driver's seat.
They get to choose, oh, this sounds great. Oh, I already like doing arts and crafts and this can
help my pain. Amazing. I already love to do yoga. I already love to do journaling. And so we're then
taking these additional strategies to create the best plan for each client. So can chronic pain be
overcome to a point where it reaches sort of that acute pain or you do eventually get over it? Are
there ways to rewire the brain so that you're no longer in pain? We are able to rewire the brain.
It takes understanding of pain, the willingness to get curious about their pain, the willingness
to get curious about things in the environment that may influence their pain and what can we do
to reduce the pain experience? Pain management is a very common term. However, we pain science geeks,
we like to say that we are treating pain rather than managing pain. We don't want to get rid of
pain. We want to get their pain to a place where it is helpful and protective. Absolutely. And
Adrian Lowe is one of my pain science mentors and he says pain is normal. Living in pain is not.
And so that's what we're trying to get people back to. I have one client as you asked that question,
she came to mind. I saw her a few years ago. I was her 27th provider in 10 months. That is a lot of
physical therapy and other interventions. And she and I worked together for a while and she did have
this goal of going on a trip to Budapest. When we started, she was only walking one to two minutes
and just this past summer or spring, she sent me a picture of her in Budapest. And it was amazing
because I didn't work with her for the whole time, but she had the tools and the strategies and she
kept working at it even after we finished our work together. And I think that mental aspect is
really important, having those tools to then be able to continue on, which it sounds like what
you're providing. Right. Yes, it is about empowering the client for sure. And at the same time,
if we have these, we know that the gold standard is combining education and exercise. So if someone
is only going to do or willing to do two things, it is those two that are an amazing combination.
And so I don't know if your listeners are familiar. Okay. Oh, sorry. From that PT perspective,
how do you go about getting that motivation up so people not only do it with you, but then
continue to do it at home? Because I think that's really one of the key factors is helping people to
empower themselves. But I think when you're in chronic pain, you might not always see those
benefits straight away. So how do you keep that motivation up? You are absolutely right. That's
part of the reason why we use the stories to help people understand the complexity of pain.
For a lot of people who really think the main source of pain is in their shoulder or their knee
or their back, understanding that story of how the sensitive alarm can be responsible for a bulk of
their pain experiences helps them to be willing to try something different. And we also use a lot of
coaching and motivational interviewing when working with chronic pain clients, because you're right,
it really doesn't matter how much knowledge I have, unless they are willing to learn these
learn these concepts and then apply them themselves, we're not going to get anywhere. And so the
importance of coaching and meeting the client where they are is so very important because if I
tell them they need to walk 20 minutes a day, because that's what research says, that doesn't
matter if they're not going to do it. And I had one client once and she was very well aware that
exercising 30 minutes a day was the recommendation. And we started talking and I said, Are you willing
to exercise 15 minutes a day? And she said, No. I said, Okay, 10 minutes. No, we got all the way
down. I said, Are you willing to exercise one minute a day? And she's like, Yeah, of course I am.
And I was like, Okay, that's where we start. And that's exactly where she started. And this idea of
working with the client, utilizing the tools and skills of motivational interviewing helps them
shift and show up for themselves. Because that's really what's important is them showing up for
themselves. Well, you just packaged that so well. That's been absolutely amazing. Thank you for all
your information. We are going to have to wrap it up because we've got to that point already. It
seems to come around too quick. And I have all these questions I haven't had the chance to ask
you. But for anyone else that is wanting to perhaps get in contact with you, what's the best way for
someone to find you? For information on the physical therapy and the pain science, my website is
180therapyandwellness.com therapy and wellness is spelled out. Another compliment that we haven't
talked about is mental fitness. And that website is iriseforeme.com I R I S E F O R M E.com.
And anyone that's interested in emailing me, I would love to hear from you and answer questions.
And my email is Jen at iriseforeme.com. Wow, perfect. Thank you again. That has been
an absolute pleasure. And like I said earlier, you're an absolute wealth of knowledge. I just
wish we had more time. So perhaps we can schedule another one down the track. I would love to
schedule another one because there's so many other concepts that we can help people understand.
Because the more people understand, the less pain they will have. And we will treat each other
better. Absolutely. Absolutely. Thank you again for talking to you again.
I'm Quinn Carnegie and I hope you enjoyed this week's episode of Manifestation, Motivation and
Passion. I'm so thrilled you chose to spend time listening and would be even more grateful if you
left a positive review. And if you found value, no doubt your family and friends will too. I'd
love it if you share it with them. Thanks again.