[00:00:00] Speaker A: Welcome to the Heart Rate Variability Podcast. Each week we talk about heart rate variability and how it can be used to improve your overall health and wellness.
Please consider the information in this podcast for your informational use and not medical advice. Please see your medical provider to apply any of the strategies outlined in this episode. Heart Rate Variability Podcast is a production of Optimal LLC and Optimal HRV. Check us out at optimalhrv.com Please enjoy the show.
Welcome friends to Heart Rate Variability Podcast. I am back here today with one of my favorite guests. It is never boring when this man shows up on the show.
I'm so excited to talk about his recent article, but Dr. Eric Pepper, welcome back to the show. I know it's been a little while since we've had you, so maybe for those that didn't haven't listened to every episode that we've had, maybe just a quick introduction of yourself before we dive into one of your amazing pieces of work that you gifted to the world.
[00:01:03] Speaker B: Well, Matt, thanks so much for this very generous introduction. It's much too generous. It always reminds me in a way of going to a funeral and then you know, where people know the disease and they all give these very kind comments. Except we know the person. Anyway, thanks anyway. I'm Eric Pepper. As Matt explained, I'm a faculty member at San Francisco State, the Institute for Holistic Health Studies, where we really are intrigued in developing strategies to optimize health for people they can do by themselves, which is really an individualistic approach with the awareness in fact, that health is not individualistic at system and we are really a system embedded into the culture. The other part is I run a practice called Biofeedback Health in Berkeley, which we do all kinds of biofeedback for people, probably psychosomatic or somatic issues.
Again, the focus is more on self regulation and as many of you know, you have read probably my blog, it's pepper perspective.com that's pepper von P pepperperspect.com, which has many of these articles.
Search in the search box and you can find it. So that's probably my background in terms of hrv, which this is. I'm totally persuaded, which is probably makes me unique among most, but that breathing is much more than HRV or HRV is only very limited. It's great, but there are many things it misses when only one looks at hrv and maybe I'll think of that in a moment because so many people look at HRV using a photoplaphysmograph, which would be on the finger. Very few clinicians use the ekg, which would make it a very accurate one. But overall the BVP as it would be called the photoplithysmagraph is, is basically for clinical purposes just as accurate and works just as well. There's a problem with using just HRV and that is that HRV measures the heartbeat, the time in between. As you know, everybody knows what it misses and you usually don't see that unless you're using a polygraph or some form of equipment that can show the raw signal of the heartbeat is that the amplitude of the heartbeat is maybe even a more meaningful signal or just as meaningful.
So when the amplitude, because the amplitude really represents the vasoconstriction in the periphery or cardiac output and they are much more responsive for some people to emotional reactivity at times than even the HRV as a measure. And so that is, you know. So I would really recommend for anybody who does HRV to look at the pulse amplitude simultaneously. That is especially true if you're looking at post traumatic stress or, or people who have that because when people evoke that memory, their HIV probably will change. It will come back fairly quickly. However, their pulse amplitude will often stay very low for a long time because they're being captured. So we are missing a lot of information now that.
[00:04:01] Speaker A: Can I just ask you a quick question for our long term listeners? We've talked about max min before.
Are we hitting any of what you're talking about with that metric?
[00:04:14] Speaker B: I think what you're seeing probably in the don't know the answer. It is clear to me that sometimes you can get a max min. If you really inhaling your chest and exhale, then you get a really big high and a low and that gives the max min. That is not how I would think about it. It reminds me really that, that we often use a breathing pacer to stabilize or to enhance hrv, which I think is great. However, breathing is much more than hrv. Let me give it a couple of examples. One, I can breathe just in and out from my nose and do hrv. I can breathe in and out from my mouth and do hrv.
The experience, however, the long term experience is totally different because people who breathe mainly through their nose tend to have less allergies. Their breathing is smoother, they have less airway irritation. Well, if you tend to breathe mainly through your mouth, you're much more at risk for sleep apneas, you name it. And I'm not saying that one causes the other. They may be concurrent with each other. That's just the most simple one. Or if you think where you're breathing, you know, am I breathing mainly in my chest? You can get great HRV in a controlled way. Superb. I happen to think that is not quite the right way, because breathing is much more than gas exchange.
People think of breathing mainly in terms of oxygen or carbon dioxide. However, breathing in terms of the body movement is a whole pulsing pattern and a rhythm. And so when you breathe, the diaphragm ideally would go down when you inhale. That means the abdomen must expand when you, or a better way to say it, the abdomen expands, allowing the diaphragm to descend. And then with the abdomen slightly constricts again or comes in, forces the diaphragm back up. You can see this probably very easily when you look at your dog who's sleeping on its side. You see the movement all in the abdomen. And then the question is, even if you're monitoring the strain gauge of that breathing pattern of the abdomen, it still doesn't quite get to the subtlety of it. And that was reminded me when I was working with a client last week. A young man who has severe anxiety, has severe rap recurrent abdominal pain.
A lovely young, very sensitive young man. And so we're starting to teach him to really to focus on heart rate variability. That follows the findings by Dick Gertz and his colleagues that recurrent abdominal pain can be well treated, probably 80% success rate, doing essentially HRV training.
But when we were doing that, it was very interesting because we're monitoring his strain gauges. He had a hard time breathing, letting the abdomen expand. That makes sense. If you habitually have pain, you tend to curl in and hold it. So that makes sense. But what was very interesting is when he finally started to breathe diaphragmatically, he still didn't quite get it because what he was using was a kind of will to almost. When you inhale, you almost push your diaphragm down, expanding your stomach. And then finally, near the end, magic happens. I would say it followed almost the work of autogenic training where it says, it breathes me.
And for that moment after he exhaled, he could feel he allowed his abdomen to relax inside deeply. Just when you feel really safe, when your stomach can just go out, the pelvic floor drops, the lower ribs widen, but not with work, it allowed it. And that deep internal relaxation is what you want. And allow then the breathing to move in and out anyway. So that is. So there's much more to it than what we think, at least from My sense as I look at and I can keep going for a long time.
[00:08:05] Speaker A: Well, there's Nothing like a Dr. Pepper introduction that takes us down a rabbit hole before I even ask my first question. This is why I love whether I'm in the room with you, in person at a conference or these conversations. I always learn so much.
I got to get us a little bit focused though on the latest.
And again, while we're not officially the APB podcast, I gotta push their biofeedback. I guess you might call this a magazine more than a journal with this. But I always love reading Dr. Pepper's work and pain. There is hope you covered some of the stuff I think we introduced the show with.
But as I was sharing with you before we hit record here, the most roller coaster article I think I have ever read in a scientific publication.
I'll just give the audience a brief overview. It starts with a beautiful story of your daughter blowing back your hair to kind of distract her from a shot to a few pages later seeing some pictures that I just brought pain to me and I was like, what a wow. What? What what? I didn't know what the next page, what the next picture was going bring. So skewering your tongue or your bicep or your chest from your daughter's story, it was a roller coaster ride, but it was a great read both from intellectually and emotionally with that experience. So I, I would love to hear you introduce to our audience from your vast expertise what, what is pain? Because we're going to get into the article about ways to help manage pain and there is hope. But you know, from your perspective, with all your knowledge, what, what is pain?
[00:10:08] Speaker B: Well, pain is always a subjective experience and I think that's the most important part. We don't quite know if someone has pain unless their body is reacting and it's just by self report.
And so the moment you look at that, it can be some form of damage or stimulation to the body which then the brain interprets as pain.
Sometimes pain is almost just a novelty experience which has been conditioned, I would say, to the experience of pain. And I often give give the examples to mothers when they have little babies or little children, you know, toddlers, when a toddler falls or hurts itself not too badly, it's more like a shock. I would say it isn't yet totally pain. It's more like a startle internally quality and then nothing is happening. But then the child looks at the mother and when it sees the mother, then it cries. But it depends because then it Gets the feedback, positive feedback. Ah, oh, what's wrong Versus saying, you know, it's just information. It always reminds me of a Milton Erickson story about children. When a child cuts themselves or is bleeding badly, you instead of giving this panic and you say, oh my God, you know, it's okay. What he says is something totally different. Look at this gorgeous blood flowing. Gosh, it's. You are so lucky. You have this great blood. Look how it's healing, how it's flowing out, washing all the germs and it's notice it's a reframing of the experience.
And if you can do that more, then instead of getting the panic. So we have a combination of the automatic, almost like a defense reaction, alarm reaction to the stimulus, which is also very useful. But that is just one. So you have actual pain. A big part also, especially from a chronic pain or situation where pain can reoccur, is really anticipation of pain. We've all been conditioned that certain events will be painful. Therefore even thinking about that event will prime the body to evoke more pain.
And so, you know, the analogy I use in there, which many people have experienced at one time or another, is being at the dentist when they get their Novocaine.
It hurts almost before the needle is inserted because we anticipate it so much. And what is so nice, if you monitor people with biofeedback, you can really see that when we imagine re experience it, the body reacts the same way. So people forget that mind is body and therefore if you can think differently about it, the experience may be different.
And that is really a part which we really observed in the yogi. That's Kavakami, who we studied a number of times, who essentially in the lab, both in public for a setting a study and the laboratory inserted skewers, non sterilized by the way, through his cheeks and through part of the flesh on his throat.
And then we did a qeeg on him and we found his brain, you know, and Jay Gunkelman did the analysis of that. And the brain does not show that pain of response, which is the most interesting part.
But really you can ask how is he doing it? And that was the most interesting part. And we did this research also with Jim Johnston together and so others. So I want to give everyone credit. And he also presented at the California Biofeedback Society and did it live.
And what he first did is pass the needles around to the audience he could contaminate with their germs and only then did he stick it through himself.
In a cell. Okay, but what did he really do? And I think that's the important. That's the part I wasn't totally. I didn't know till we looked at the physiological data. So we looked at his muscle tension, we looked at his skin conductance, we looked at his heart rate, we looked at his QEEG in another study.
But basically, what you could see him doing, you can even see it on the film, the video clip that is embedded, the link is embedded in the article.
What you can see is when he inserts the needle, before he inserts, he starts exhaling. It makes a difference. Even if you breathe in your chest or stomach, you take a breath, you could say at this moment, your HRV goes up. You're pulling parasympathetic system out.
You're not yet sympathetically activated. You're just pulling it out. Now you start exhaling.
And during the exhalation phase, he keeps exhaling while he skewers his body. And it's quite hard, it's quite hard to push through the skin. If you ever tried it, do it sometime. And he did that.
[00:14:42] Speaker A: That's Dr. Pepper's advice, not the advice of the podcast.
[00:14:46] Speaker B: That's right.
[00:14:47] Speaker A: And later on here at the podcast, don't skew yourself.
[00:14:52] Speaker B: But you know, I'm agreeing totally. And especially don't do it with non sterilized needles, please, please. But then he skewered himself through his chi. And every time near the end of exhalation, he would stop movement, he would inhale and then move again just after exhalation started. Not at the same time. Because what many people do is they inhale and then they do it at the same time. No, that's still the startle. So he is already moving to decreasing his heart rate. You could say he's already exhaling and then he pushes, he continues the pushing of the needle or in the withdrawal the same way. So during the phase when pain would occur, he would be in the exhalation phase.
And that was a very useful lesson. I think that's the one big lesson I learned, even though I knew some of this before. But, you know, seeing it live is really different.
And we have also done this in a kind of informal recommendation and studies with people that do check it out next time. If you take a shower, turn the shower on cold water.
And now you stand there and just walk into it. And most of us will do a gasp.
If on the other hand, and as if you could think about in the gas, what are you doing? You're anchoring the experience with this increase decrease in parasympathetic activity and getting ready to activate the sympathetic activity.
But it's anchoring it now the opposite way. And you do it at home and let us know, you know, send us a note how your experience is with practice. Now, the next time you do this, you have the same cold water. You stand at the edge. Now you take a low diaphragmatic breath.
And then as you are exhale, let the exhale already go. Be sure you relax your shoulder and keep exhaling while you enter the cold water.
And if you do that, you'll find that the experience is less painful in a way you probably still won't find it pleasant. I'm not recommending that. But that was the. That was one piece. The second piece was the framing.
[00:16:53] Speaker A: Yeah.
[00:16:54] Speaker B: Remember when. When you watch that video of him skewering himself or the other video of the Sufis, you go, you. The whole audience goes, ah, yeah, vicariously.
[00:17:04] Speaker A: Like everybody's in pain.
[00:17:06] Speaker B: And distinction is he didn't do that. Yeah, and the Sufis didn't do that. I'll talk about that later. And so the key is, for him, he had no anticipation of pain. He really felt the needle would just go through his skin. It would be cool, it would pass up. And he had. There. You can't say don't feel pain. Although it's not the language he used in some ways, maybe translated from Japanese, but basically it meant I. There's no such association. There is no anticipation. So he could allow himself to already relax. And if you think about it metaphorically, maybe when he really relaxes, then when the skewer goes through the tissue, it's more likely to bypass the blood vessels and all. It goes almost in between the cellular spaces. A little hypothesis.
And then when he pulled it out, which was very interesting, you could see there was no bleeding. But you don't expect much bleeding in puncture wounds anyway.
And it healed basically almost, you know, in a little while. And so that. So the real key is.
And people can really apply this, I think, to many things. If you are really.
And you have hip pain when you get up, you can just see people getting up.
You know, they're holding their breath, they're tightening up.
Explore the following. Take it. Sit down really brief diaphragmatically, not in your chest, which is what you do automatically, almost. And then you lift your chest, you feel your back already tightening, but now feel yourself exhaling. And then when you inhale, feel your lower back almost loosening. Now, as you Exhale, then lean forward and then get up while you're exhaling. And you'll find usually the pain will be less.
And if you. We have also done that work with people of emphysema. And then people have emphysema so quickly run out of air in movement. If they can keep remembering, even exhaling that little bit because they have problems exhaling in a way, then they find also their endurance is much better.
And the key is you need to feel safe.
[00:19:06] Speaker A: Yes.
[00:19:07] Speaker B: And if you feel safe, you can regenerate more quickly. And that is the analogy of my daughter, which we use when we were there, but also for the Sufi, he felt totally safe. He didn't see any danger. So this was just interesting.
[00:19:21] Speaker A: Yeah.
[00:19:21] Speaker B: You know, and then, and then for other people, you can use, you can call that the breath is also a distraction technique. Instead of focusing on the pain, you're now focusing on exhaling, making a sound or imagine the air going down your arms or whatever. And that already reduces it as well. And finally, I think what is the meaning of pain?
You know, And I think we forget that quality as well. Pain can be just a signal. I get injured, I need to do something about it.
Pain can be almost conditioned, but if I think of it, that pain leads to more danger or harm, it's hard to let go.
[00:19:59] Speaker A: Yeah.
[00:20:00] Speaker B: And the classic example of that with soldiers who are, as you know, these are studies also in World War II, it's a whole part of the, you could say placebo responses, understanding. But basically what you find with many soldiers is that and even athletics. The same way they get injured, they may not even know the. How painful it is. But in a soldier, when they now get to the hospital, all of a sudden they're no longer in danger. So in that sense, pain is beneficial. I don't mean it in, in a derogatory way at all that they tried to get injured, not at all. But at least they're now out of danger. And so they may need less narcotics, paradoxically, because they feel safe for healing.
So there are many factors.
[00:20:41] Speaker A: The key, if I, if I could like, because pain is such a.
A fascinating complex thing to. Especially with chronic pain and you know, the opiate epidemic in the United States, you know, is it in your head? Because I think some people feel like they hadn't been hurt historically. Then we made it this vital sign with the capitalist, you know, let's prescribe medication for. So are. I think societies relationship with pain is complex. The individuals experience the pain. Because I think a lot of people Got told, and there's cultural and racist stuff going on here is that their pain wasn't taken seriously.
So I'm just curious about. Because I know the message you're sending is it's not all in your head. That's not by any.
[00:21:33] Speaker B: I would say it differently. Okay, yeah, I would say pain is always in your brain.
You know, the signals may come from your body, how you interpret the signals, how do you process it, that makes a difference. So sometimes chronic pain in a purely almost mechanistic sense, maybe less, but it's the anticipatory phenomena.
And also we have been conditioned. If you use opiates to stop the pain, we become more sensitive to pain over time. We need more opiates and it's an escalating cycle. It's very interesting if you look at the history of pain, chronic pain treatment in the United States, that in the 1960s and 70s, she developed these pain management programs which were intensive programs where people still learned a lot of self regulation techniques and others which were expensive because the people had to. They were often in the setting for two weeks or something like that, or three weeks. They would learn massive number of skills.
But then their pain often became significantly less and they became more functional. Sometimes you cannot easily get rid of pain. You have to be pragmatic. The question is, can you make your life meaningful?
And so, I mean, I remember one woman we was not, I wore, I didn't work with, but one of my colleagues who knew her, she was an artist who had truly horrible pain, you know, intractable pain. However, she focused on her art and that was her joy of living.
And so if you do work with others, it may be better. The challenge is that when you have pain, you're exhausted and people forget how much exhaustion pain gives you. Then we demand at the same time, he may just then not do anything, but not do anything, get you involved with your own awareness of the pain. And we also know that if you really get captured by something, you may not become less aware of the pain. If you have pain, whether it's knee pain, hip pain or whatever, and now you're all of a sudden watching a movie and ray and you're totally captured by it, the pain often drops to the background that tells you there is a kind of relationship how much I attend to it. And it's almost impossible to ask the person not to attend to the stimuli. I mean, I can talk about this, but the moment you go to the dentist and they work in your mouth or something like that, you know, if you're trying to just use control by yourself. Good luck in most cases.
And you see the same thing in childbirth.
[00:24:01] Speaker A: Yeah.
[00:24:01] Speaker B: You know, so, I mean, as a male, obviously I'm an expert on childbirth, but I come from a different culture, from the Netherlands, so where there were more home births than in the United States. And childbirth historically was seen as a healthy phenomenon, not a medical procedure kind of perspective.
But if you look at childbirth, for a number of people, childbirth can be very painful. I am not disagreeing, however, the key of it, and that's why a doula or a midwife can be so useful, because, yes, you get captured by the pain, but then the doula helps you distract afterwards, come back again. And if you can do that, the birth is quicker for many women, not all. And, you know, it's great that we have medicine, you know, medical procedures in case we do need a cesarean or something. But in the us, Cesareans are way over prescribed, overdone, but going back to pain and equality. So the final one, I think, which in our article we looked at, which was the most interesting experience, was studying Sufis in Amman, Jordan, and then later at the BiofeedBA AAPB meeting in Portland, and also at the BFE meeting in Russia, Poland.
What these Sufis did as part of their spiritual tradition is that they would do deliberate harm. That's their terminology almost. They wouldn't just do a simple skewer. They would take a knife going through their pectoralis or through the bottle, you know, a fairly thick skewer through the bottom of their. Their chin, you know, underneath their tongue, or hammering knives in their head. I have all those videos we did, and they're hunting knives hammered through, and then they asked me to pull it out.
But what was interesting is when I had the opportunity to study them and I went to Amman, Jordan for that, there was a kind of spiritual meeting where they did the chanting. We had a great meal beforehand. Then the chanting. The people were not on drugs or anything else, but what they did have is a total faith and trust.
And we underestimate the power of that. They knew that their, you know, their sheikh there is almost their almost equivalent to a pope in Catholicism. This is for the Sufis, that their sheikh had this power of healing, and they were totally in awe of him. And it's a remarkable group of people. Very caring. They were not discriminatory.
And so it was really rare. I was very honored to be able to work with them. And what happened is that when we were there, they were chanting and Then one person after the other did deliberate harm and including cutting their tongue with a knife, including, you know, putting the picture, I think you see the person doing a skewer through the, the bottom of their mouth. And then also for the pectoralis, the ones I did not point in here are the. The hammers hammered into the skull.
And all of them, they really showed no pain behavior when we did it there. When they did it there for me in this meeting, you know, we did not record them, but we did record them in the other meetings. And again, you could say that the QEEG really showed no pain. Which is the most. That's really the work of Thomas Calura, who helped with that in that work.
And they showed no pain behavior. Moreover, when they pulled it out the knife, the wound just closed very quickly.
And by the next day, basically the damage was not visible, as you could see in that picture.
What was most interesting, I should point out, that if you sit there and you see one person after another doing this and nobody gives the reaction like you did when you saw the pictures or when I tell my students this, something like this, for them this is normal.
It was totally normalized behavior. This is part of the spiritual tradition.
So at the end, after I saw about 15 people doing these different things, they turned to me and asked, you want to do it? And I said, sure, why not?
So I'm on video, in fact, you see me skewering myself being skewered with a skewer going through my cheeks and then pulling it out later. And again, basically no bleeding. And I kept making pictures of it, of the healing. It healed very quickly. And all these people, their healing was very quick. I thought that was very remarkable.
[00:28:20] Speaker A: Yeah, almost.
[00:28:21] Speaker B: No, you don't expect much scarring or from a puncture wound anyway, because that's really what they are. But when you put a knife through the pectoralis, you would expect some. The tissue really did heal very quickly. Or in the skull. When we hammered it, they hammered. I didn't hammer it, I only pulled it out. And then I pulled out the hammock, but not the knife yet, because it stuck so much. It's just like a nail in wet wood.
They reported no pain. And this was for them a confirmation. And there's a long tradition in many cultures of doing some form of self inflicted pain as a demonstration for, for spiritual connectiveness. And even the su. Even my yogi going all the way back.
Why did he ever do this in the beginning? Because he wanted to show to himself that his power that his meditation, that he really could do the yogic meditational practice, that meant I could hold my focus on the task and not focus on the skewer inserting. And that is a final test. And for them, it was different. So what the Sufis really taught me more than anything else is the importance of trust, that you need to feel safe and trusting. And that is a part that is so often now missing in our digital medical world. There's nothing new about this. That's the rule of medicine, I would say the rule of psychology. You need to. The patient needs to feel cared for and trusted. And if that is not there, you inhibit healing process. And I think that's really what the Sufis taught me more than anything else.
[00:29:59] Speaker A: I love that. So one of the things I haven't talked to you or heard you talk about, because I've heard you. I always try to get to your workshops when I can, is interoception. Because, I mean, part of this is we talk a lot about this on the podcast. Probably had more episodes on that topic than any other single topic you know of.
I would almost. And I think I'm wrong about this, so I'll put that out there. But I'd love to get your. Is if I was going to school myself through my pectoral muscle, I would prefer to disassociate from that experience.
But I don't think that's what's going on. But I also hear you talk. Maybe I'm not present with the experience I like. I just love.
[00:30:46] Speaker B: It's a very good question. What actually happens in the brain or in the person's thought patterns? I think for my yogi, I mean, if I go back, I think he was aware he was pushing it through his skin, but he didn't. He. He was totally aware of sensation, but the sensations felt cool, not pain. So it was a reframing of the sensation because he had no anticipation. For the Sufis, they were totally present. I don't think they. They spaced out. They felt they had this infinite trust. They had the blessing of their sheikh, who was present in that room. They had the blessing so they could now truly relax and maybe not focus on the sensation in here on their head. When the knife was put in, they showed no reactivity. But we know that many people have the ability to use their covert awareness or their manipulating of their own interoception to not feel pain. That's the very old work on hypnosis, where the old work of hypnosis in the 19th century showed that about 20% of people who can with a good hypnotic induction can even get abdominal surgery without anesthesia. And we know that a number of women, if they use the skill of hypnosis, they may have a delivery, somewhat painless delivery, which often is then quicker. The challenge is that that has not tended to be built. That has not tended to be incorporated in medicine very much for multiple reasons. You need to be skillful to be. To do the guidance. You need to have, you know, a lot of trust. And it may not and possibly not reliable. So anesthetics are much more reliable for everybody. So why do that? Why do hypnosis when the anesthetic will work very well? The outcomes may be different because often people bleed less in hypnotic inductions techniques.
Are they not present?
You know, it's a very good question. We do know that if you dissociate in a sense focus on something. What is dissociation?
It's almost.
I don't like the term per se because that feels almost like pathology kind of. I dissociate.
It may be more that I now focus my attention on something else and just hold my attention there. And therefore I don't react to other stimuli. It's a little bit like my daughter when she went for her vaccination injection that she blew on my hair. She was so captured by that phenomena that the other information never really penetrated upwards. And I think I like that better than the term to dissociate completely.
[00:33:27] Speaker A: Yeah, I love that. So I'm also curious about, you know, because, you know, a lot of our, I guess Western, for lack of a better word, spiritual. You know, pain is, I mean, fasting is one that might be there. Self flagellation was one that came to mind. Did you think that self flagellation, like pain as punishment would be interpreted different? It seems like I was trying to throw this in like kind of my Catholicism upbringing and self flagellation was the. Not. Not that most Catholics practice that at least physically. Mentally we do, but not physically.
[00:34:06] Speaker B: Well, you know, you're talking about. You really talk about the meaning.
[00:34:09] Speaker A: Yeah, that, that struck me about.
[00:34:11] Speaker B: It is clear that pain can be used to, you know, it's often used to get arousal and arousal may increase sexual activity. It may, you know, the many factors of pain. Yeah, it's interpretation of it what it is in many spiritual traditions, like you're talking Catholicism, you do a kind of flagellation. I don't think the person is really doing it, that it is more than doing it for Christ or something like that. So it has a positive meaning in doing is most people who would do that kind of flagellation, I have not studied them. I was going to study them in Fasalonica where they carried a cross and all that stuff, but I did not have the opportunity to do that.
I don't think they do it as much for self punishment as more as a spiritual practice.
And that gives a different perspective.
If I can, you know, then the pain becomes a meaningful signal of my devotionalness.
That's my interpretation of that.
I would say that in terms of pain, it's an interesting phenomenon to what extent our perception makes. It causes interpretation, you know, how we interpret it. And I remember a story which was told to me by Rachel Zoftness, who's writing a great new book being published next year on brain is in the. I don't know the title of it, but look up Rachel Zofnus. She has a great presentation on, I think YouTube presentation or something on pain. One of the best I know. And she tells the story of this worker in the construction industry who had his boots on and then a nail gun went right through his foot.
And he was in excruciating pain.
The nail, you know, his big nail went right through his foot.
And the nail went right up through the. For the bottom. So the nail was. He was rushed to the emergency room. He was excruciating. Well, the medical staff was very worried. They very carefully cut the leather away and they found out, in fact, the nail went right between his toes.
She tells the story. She tells the story much better. But the key is that was our perception. I saw the nail going through. It's real. It hurts. It evokes all those memories. We forget that much of what we experience is not only experience, is how we pull it, how we pull our past experience onto that.
I love that.
[00:36:39] Speaker A: I love that.
[00:36:40] Speaker B: And you know, if. If I can even reframe some pain. And that's what you try. That's really. I go back to labor again. For some women, that's the advantage. Having a an coach and doula, but especially someone who has gone through labor herself successfully, that then you give. This is safe, this is normalized. But so many of us now live in a world where we have never seen these phenomena, you know, and I think now shifting from the birth process. So how many of us and women have seen other women give birth?
Almost none in our culture today. But in traditional cultures, that was just part of the culture. You knew what happened, right? You know, it's just like, child, you're raising children. Right now we're almost all, you know, nuclear families, but we have a very little experience hanging around with other little kids. So for us, it's all new experiences.
[00:37:33] Speaker A: Yeah.
[00:37:34] Speaker B: And that to me, when I saw the yogi doing it, when I saw the Sufis doing it, but for the Sufis, remember, this was just part of their culture, so there was nothing strange about it. Anybody can do it. Their children would do it. It was just normal. And if something is normal, we do it.
And so if you can normalize some phenomena, then we realize it may have different meaning. I love that.
[00:38:00] Speaker A: I love that.
[00:38:00] Speaker B: And so I think in summary, for pain, I would recommend don't get too much pain and avoid it as much as possible. I have no disagreement.
But pain there, you know, but pain has two pieces. One is, you know, crisis alcohol crisis pain and chronic pain. And they are really different. And crisis pain is like a trauma. You know, the pain is there, it's a signal and. And then it goes away. But I use the example again in the paper about getting a. Having a heart disease. If I got a heart attack, I get this massive, maybe sharp pain in my chest. If you're a man, for women, it may be totally different.
And then you're terrified anytime you feel any pain in the chest, however small, I'm going to die almost or something like that. But most interestingly, after you've had your bypass surgery, it's much more painful, basically. But now the pain has a new label. The pain is now I have made it. I, there's hope. And now the pain is a positive reframing.
And so that makes a big difference in trauma.
When people have chronic pain, what happens is the first time you have pain, oh, they'll go away. Then after a week, well, and then slowly but surely, you start changing your perspective. And that makes it so hard.
Yeah, because then you. And then after about before you even wake up, you already anticipate the pain.
[00:39:24] Speaker A: Yeah.
[00:39:25] Speaker B: And so the final piece, I would say that has been very helpful. And we wrote it up in a totally different article, not about pain, but about an eye problem.
It's also my blog about a woman. And that is a useful practice is to say if you have pain instead of being pissed off, because that's probably we're pissed off. I have hip pain. No shit. You know, you really are slightly almost angry at yourself.
I think a useful practice is a kind of acceptance and gratitude to the area of all it had done for you all these years while you have abused it.
So in a way if I think of my hip and my hip, I have hip pain, you know, instead of saying, oh, whatever language you would use inside, say, gosh, thank you, you know, you know, I want to really, I want to just thank you anyway for all you have done. The many times I've abused you, how many times didn't I jump inappropriately, I did whatever and try to do that kind of acceptance and forgiveness or thanking the hip. And when you can thank the hip for what it all has done for you, some people find and then just say, okay, this is what is now.
It sometimes makes the pain much less. And I would argue that there are a number of lovely visualization techniques which you can incorporate with breathing to reduce the pain. Because pain has multiple dimensions. We wrote an article with one of my students who had a severe neck pain, unbelievably or back pain. And it's real. She had a motorcycle accident. She broke her back in multiple places. She had to put a metal brace in instead of the vertebrates that were totally scattered. She broke her jaw into place. She broke her shoulder. Good motorcycle accident, right? Not recommended. She was in my class a year later. I had no idea she was there. She did all these kind of self healing practice, including breathing, including self healing imagery and many other techniques.
But after. And she was on pain medication.
But what she observed in one of the things she observed and she had to monitor our pain very carefully for this self study is that pain had at least two qualities.
It was both tension and like almost thorns in our body, in our back.
And notice when we have pain, we tend to say just. It's just a global concept. If I can break it apart, the sharpness and tension or the sharpness and coldness or coolness, whatever it is, I can work at the place where I can have control.
And she started to do that. She worked out on the place that she could have the tension. Then she used imagery techniques to change the image, mental image of it and also to bring warmth in it. Because she had learned how to warm her hands, which happens often that people do learn slower effortless breathing or hrv. Their hands warm up. You can combine it with imagery. And now she could do that by imagery. She could warm her hands and bring that warmth to her back.
Halfway through the class over the five weeks, she stopped all the pain medications. It was mind boggling. I did not know any of this, I would never recommend that. But she did and she basically became pain free. It's one of the more remarkable little case reports.
It's One of the blogs that's listed on pepperperspective.com and it describes these techniques. So I think for pain it's multidimensional. The pain is always in the brain.
By definition, it's also in the body and they interact together.
So we are the same. So I would say check your.
How do you anticipate it? What do you think about, can you reframe the pain? It's very challenging to do that.
[00:43:06] Speaker A: Absolutely. Well, I think that that is a beautiful way to wrap up our conversation. I feel like I have 20 more questions, but they would all lead to a new podcast. So Dr. Pepper, I appreciate you. I appreciate your work. Again, if you're not a member of aapb, the journals they put out, the biofeedback I think is worth the membership in of itself. And like I said, I.
There's been some articles in my life that have like changed my perspective on things. I have never been on a roller coaster ride both intellectually and emotionally as the seven or eight pages of your article in this. So I highly recommend folks check that out and we'll put information. I do recommend Dr. Pepper's blog as well. It's a great read and I've learned so much from you over the years. So Dr. Pepper, thanks so much for joining us again. I always love to have you on the show.
[00:44:03] Speaker B: Well, Matt, thank you so much. And for the article, you can also go to the blog. As I said, that's pepperperspective.com read through it and click on the link and you can see the actual demonstration of the yogi or the Sufis. I have many more of those videos. We only put in two.
I have other ones where you see me do it and what is so surprising. But it's an interesting part because when we showed. I'll end with this. When I show the videos of the SU feature yogi to my students, you know, they, they give this body reaction but they're basically saying in their brain that doesn't apply to us because those are strange people, you know, yogi, the Sufis. And then when I ended and I showed a video of me doing it, then they really believe it because then they have, you know, they identified more or less with me, oh, he's just a college professor or something like that, or a clinical practitioner.
Oh. And then it gives, it shifts the experience.
But you know, do it yourself. As I said earlier, combine the breathing and, and let me know for those who have discomfort when you really do your movements in the middle of the exhalation Let me know how it changes or what you experience. I'm very intrigued. So, Matt, thanks so much.
[00:45:14] Speaker A: Thank you. We'll put all that information in our show
[email protected] thank you so much for joining us and we'll see you next week.
