In this Huberman Lab Essentials episode, I explain how to manage pain and accelerate injury recovery by leveraging protocols to modulate pain perception. I discuss how pain interpretation is a complex experience, shaped by both internal factors like emotions and genetics, as well as external factors, such as context. I explain how practical strategies like acupuncture, breathing techniques, exercise and temperature modulation can influence the body’s pain response and accelerate recovery. I also discuss topics like phantom limb pain, recovering from traumatic brain injury and the crucial role inflammation plays in the healing process. Huberman Lab Essentials are short episodes (approximately 30 minutes) focused on essential science and protocol takeaways from past Huberman Lab episodes. Essentials will be released every Thursday, and our full-length episodes will still be released every Monday. Read the full show notes for this episode at hubermanlab.com. Thank you to our sponsors AG1: https://drinkag1.com/huberman Eight Sleep: https://eightsleep.com/huberman David: https://davidprotein.com/huberman Timestamps 00:00:00 Huberman Lab Essentials; Neuroplasticity 00:01:58 Somatosensory System, Pain 00:05:22 Pain vs Injury; Genes 00:07:38 Sponsor: Eight Sleep 00:09:09 Touch, Sensitivity, Pain, Inflammation 00:11:24 Phantom Limb Pain, Top-Down Modulation 00:15:31 Traumatic Brain Injury, Aging & Glymphatic System; Tools: Side Sleeping, Zone 2 Cardio 00:20:36 Sponsor: AG1 00:21:49 Pain Interpretation, Adrenaline, Emotion & Love 00:25:03 Acupuncture; Somatosensory System, Pain, Gut & Inflammation 00:32:15 Sponsor: David 00:33:31 Tool: Wim Hof Method, Tummo Breathing, Pain 00:34:29 Tools: Injury Management, Ice or Heat? 00:38:10 Platelet-Rich Plasma (PRP), Stem Cells 00:39:43 Recap & Key Takeaways Disclaimer & Disclosures Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is the main topic of this episode?
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
Let's continue our discussion about neuroplasticity, this incredible feature of our nervous system that allows it to change itself in response to experience, and even in ways that we consciously and deliberately decide to change it. Most people don't know how to access neuroplasticity. And so that's what this entire month of the Huberman Lab Podcast has been about.
We've explored neuroplasticity from a variety of different perspectives. We talked about representational plasticity. We talked about the importance of focus and reward. We talked about this amazing and somewhat surprising aspect of the vestibular system, how altering our relationship to gravity.
And in addition to that, making errors as we try and learn can open up windows to plasticity, but we have not really talked so much about directing the plasticity toward particular outcomes and we really haven't talked yet about how to undo things that we don't want.
And so today, we are going to explore that aspect of neuroplasticity, and we are going to do that in the context of a very important and somewhat sensitive topic, which is pain, and in some cases, injury to the nervous system. We, as always here on this podcast, are going to discuss some of the science, we get into mechanism, but we also really get at principles.
Principles are far more important than any one experiment or one description of mechanism and certainly far more important than any one protocol because principles allow you to think about your nervous system and work with it in ways that best serve you. So let's start. about pain and the somatosensory system.
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Chapter 2: How does the somatosensory system relate to pain?
The somatosensory system is, as the name implies, involved in understanding touch, physical feeling on our body. And the simplest way to think about the somatosensory system is that we have little sensors and those sensors come in the form of neurons, nerve cells that reside in our skin and in the deeper layers below the skin.
We have some that correspond to, and we should say respond to mechanical touch. So, you know, pressure on the top of my hand or a pinpoint or other sensors, for instance, respond to heat, to cold, some respond to vibration.
We have a huge number of different receptors in our skin and they take that information and send it down these wires that we call axons in the form of electrical signals to our spinal cord and then up to the brain. And within the spinal cord and brain, we have centers that interpret that information that actually makes sense of those electrical signals. And this is amazing because
None of those sensors has a different unique form of information that it uses. It just sends electrical potentials into the nervous system. Pain and the sensation of pain is, believe it or not, a controversial word in the neuroscience field. People prefer to use the word nociception Nociceptors are the sensors in the skin that detect particular types of stimuli.
Chapter 3: What is the difference between pain and injury?
It actually comes from the Latin word nocera, which means to harm. And why would neuroscientists not want to talk about pain? Well, it's very subjective. It has a mental component and a physical component. We cannot say that pain is simply an attempt to avoid physical harm to the body. And here's why, they actually can be dissociated from one another.
And there's a famous case that was published in the British Journal of Medicine where a construction worker, I think he fell is how the story went. And a 14 inch nail went through his boot
and up through the boot and he was in excruciating pain just beyond anything he'd experienced he reported that he couldn't even move in any dimension even a tiny bit without feeling excruciating pain they brought him into the clinic into the hospital they were able to cut away the boot and they realized that the nail had gone between two toes and it had actually not impaled the skin at all
His visual image of the nail going through his boot gave him the feeling, the legitimate feeling that he was experiencing the pain of a nail going through his foot, which is incredible because it speaks to the power of the mind in this pain scenario. And it also speaks to the power of the specificity. It's not like he thought that his foot was on fire.
He thought because he saw a nail going through his foot, it was going through his boot, but he thought it was going through his foot. that it was sharp pain of the sort that a nail would produce.
It really speaks to the incredible capacity that these top-down, these higher level cognitive functions have in interpreting what we're experiencing out in the periphery, even just on the basis of what we see. So why are we talking about pain during a month on
Well, it turns out that the pain system offers us a number of different principles that we can leverage to A, ensure that if we are ever injured, we are able to understand the difference between injury and pain, because there is a difference. That if we're ever in pain, that we can understand the difference between injury and pain. that we will be able to interpret our pain.
And during the course of today's podcast, I'm going to cover protocols that help eliminate pain from both ends of the spectrum, from the periphery, at the level of the injury, and through these top-down mental mechanisms. Believe it or not, we're going to talk about love. A colleague of mine at Stanford, who runs a major pain clinic, is
and has published quality peer reviewed data on the role of love in modulating the pain response. So what we're talking about today is plasticity of perception, which has direct bearing on emotional pain and has direct bearing on trauma. So let's get started in thinking about what happens And I will tell you just now that there is a mutation, a genetic mutation in a particular sodium channel.
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Chapter 4: How can thoughts influence pain perception?
more slowly because they don't have as many cells around to produce inflammation and you might say wait i thought inflammation is bad well one of the things i really want to get across today is that inflammation is not bad inflammation out of control is bad but inflammation is wonderful inflammation is the tissue repair response i thought it might be a nice time to just think about
between the periphery and the central maps in a way that many of you have probably heard about before, which will frame the discussion a little bit better, which is phantom limb pain.
Now, some of you are probably familiar with this, but for people that have an arm or a leg or a finger or some other portion of their body amputated, it's not uncommon for those people to feel as if they still have that limb or appendage or piece of their body intact. And typically, unfortunately, the sensation of that limb is not one of the limb being nice and relaxed and just there.
The sensation is that the limb is experiencing pain or is contorted in the specific orientation that it was around the time of the injury. has a blunt force to the hand and they end up having their hand amputated, typically they will continue to feel pain in their phantom hand, which is pretty wild.
And that's because the representation of that hand is still intact in the cortex, in the brain, and it's trying to balance its levels of activity. Normally it's getting what's called proprioceptive feedback. Proprioception is just our knowledge of where our limbs are in space. It's an extremely important aspect of our somatosensory system. And there's no proprioceptive feedback.
And so a lot of the circuits start to ramp up their levels of activity and they become very conscious of the phantom limb. Now, before my lab was at Stanford, I was at UC San Diego. And one of my colleagues was a guy, everyone just calls him by his last name, Ramachandran, who is famous for understanding this phantom limb phenomenon and developing a very simple, but very powerful solution to it.
that speaks to the incredible capacity of top-down modulation. And top-down modulation, the ability to use one's brain cognition and senses to control pain in the body is something that everyone, not just people missing limbs or in chronic pain can learn to benefit from because it is a way to tap into our ability to use our mind to control perceptions of what's happening in our body.
So what did Ramachandran do? Ramachandran had people who were missing a limb put their intact limb into a box that had mirrors in it such that when they looked in the box and they moved their intact limb, the opposite limb, which was a reflection of the intact limb, because they're missing the opposite limb, they would see it as if it was intact.
And as they would move their intact limb, they would visualize with their eyes that's in the place of the absent limb, so this is all by mirrors, moving around and they would feel immediate relief from the phantom pain. And he would tell them and they would direct their hand toward a orientation that felt comfortable to them. Then they would exit the mirror box. They would take their hand out.
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Chapter 5: What is phantom limb pain and how is it treated?
Now, this brings up another topic, which is definitely related to neuroplasticity and injury, but is a more general one that I hear about a lot, which is traumatic brain injury. Many injuries are not just about the limb and the lack of use of the limb, but concussion and head injury. But I want to talk a little bit about what is known about recovery from concussion.
And this is very important because it has implications for just normal aging as well and offset setting some of the cognitive decline and physical decline that occurs with normal aging.
Typically after TBI, there's a constellation of symptoms that many people, if not all people with TBI report, which is headache, photophobia, that lights become kind of aversive, sleep disruption, trouble concentrating, sometimes mood issues. There's a huge range and of course the severity will vary, et cetera.
it's very clear that regardless of whether or not there was a skull break and regardless of when the TBI happened or how many times it's happened, that the system that repairs the brain, the adult brain, is mainly centered around this lymphatic system that we call for the brain, the glymphatic system. It's sort of like a sewer system that clears out
the debris that surrounds neurons, especially injured neurons. And the glymphatic system is very active during sleep. And the glymphatic system is something that you want very active because it's going to clear away the debris that sits between the neurons and the cells that surround the connections between the neurons called the glia.
Those cells are actively involved in repairing the connections between neurons when damaged. So the glymphatic system, is so important that many people, if not all people who get TBI are told, get adequate rest, you need to sleep. And that's kind of twofold advice. On the one hand, it's telling you to get sleep because all these good things happen in sleep.
It's also about getting those people to not continue to engage in their activity full-time or really try and hammer through it. The glymphatic system has been shown to be activated further in two ways. One is that sleeping on one side, not on back or stomach, seems to increase the amount of wash out or wash through, I should say, of the glymphatic system.
The other thing that has been shown to improve the function of the glymphatic system is a certain form of exercise. And I want to be very, very clear here. I will never, and I am not suggesting that people exercise in any way that aggravates their injury or that goes against their physician's advice.
However, there's some interesting data that zone two cardio for 30 to 45 minutes, three times a week seems to improve the rates of clearance of some of the debris after injury and in general, injury or no, to accelerate and improve the rates of flow for the glymphatic system. It could be fast walking, it could be jogging, if you can do that with your injury safely. It could be cycling.
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Chapter 6: What role does the glymphatic system play in recovery?
And that's because of the pain blunting effects of adrenaline. Adrenaline binding to particular receptors actually shuts down pain pathways. People who anticipate an injection of morphine immediately report the feeling of loss of pain. Their pain starts to diminish because they know they're going to get pain relief. And it's a powerful effect. Now, all of you are probably saying placebo effect.
Placebo effects are very real. Placebo effects and belief effects, as they're called, have a profound effect on our experience of noxious stimuli like pain. And they can also have a profound effect on positive stimuli and things that we're looking forward to. One study that I think is particularly interesting here is from my colleague at Stanford, Sean Mackey. They did a neuroimaging study.
They subjected people to pain. In this case, it was a heat pain. People have very specific thresholds to heat at which they cannot tolerate any more heat, but they explored the extent to which looking at an image of somebody, in this case, a romantic partner that the person loved would allow them to adjust their pain response. And it turns out it does. They could tolerate more pain.
And they reported it as not as painful. That response that feeling of love internally can blunt the pain experience to a significant degree these are not small effects and not surprisingly how early a relationship is how new a relationship is directly correlates with people's ability they showed to use this love this internal representation of love to blunt the pain response
So for those of you that have been with your partners for many years and you love them very much and you're obsessed with them, terrific. You have a pre-installed, well, I suppose it's not pre-installed. You had to do the work because relationships are work, but you've got a installed mechanism for blunting pain. And again, these are not minor effects. These are major effects.
And it's all going to be through that top-down modulation that we talked about, not unlike the mirror box experiments with phantom limb that relieve phantom pain or some other top-down modulation in the opposite examples, the nail through the boot, which is a visual image that made the person think it was painful when in fact it was painful, even though there was no tissue damage.
It was all perceptual. So the pain system is really subject to these perceptual influences, which is remarkable because really when we think about the somatosensory system, it has this cognitive component, it's got this peripheral component, but there's another component, which is the way in which our sensation, our somatosensory system is woven in with our autonomic nervous system.
independent of love, we're going to talk about something quite different, which is putting needles and electricity in different parts of the body, so-called acupuncture, something that For many people, it's been viewed as a kind of alternative medicine, but now there are excellent laboratories exploring what's called electroacupuncture and acupuncture.
And I think what you'll be interested in and surprised to learn is that it does work, but sometimes it can exacerbate pain and sometimes it can relieve pain. And it all does that through very discreet pathways for which we can really
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Chapter 7: How can exercise improve brain health?
The connections from those brain neurons are sent into the body and they are synchronized with, meaning they cross wire with and form synapses with some of the input from the viscera, from our guts, from our diaphragm, from our stomach, from our spleen, from our heart.
Our internal organs are sending information up to this map in our brain of the body surface, but it's about internal information, what we call interoception, our ability to look inside or imagine inside and feel what we're feeling inside. So the way to think about this accurately is that our representation of ourself
is a representation of our internal workings, our viscera, our guts, everything inside our skin and the surface of our skin and the external world. And those three things are always being combined in a very interesting, complex, but very seamless way. Acupuncture involves taking needles and sometimes electricity and or heat as well, and stimulating particular locations on the body.
And if somebody has a gastrointestinal issue, like their guts are moving too quick, they have diarrhea, you stimulate this area and it'll slow their gut motility down. Or if their gut motility is too slow, they're constipated, you stimulate someplace else and it accelerates it.
Hearing about this, if it sounds kind of to a Westerner who's not thinking about the underlying neural circuitry, it could sound kind of wacky. But when you look at the neural circuitry, the neuroanatomy, it really starts to make sense. Intense stimulation of the abdomen, however, with this electroacupuncture has a very strong effect of increasing inflammation in the body.
And this is important to understand because it's not just that stimulating the gut does this because you're activating the gut area, it activates a particular nerve pathway for the aficionados, it's the splenic spinal sympathetic axis, if you really want to know, and it's pro-inflammatory under most conditions.
If for instance, the person is dealing with a particular bacterial infection, that can be beneficial. And this goes back to a much earlier discussion that we had on a previous podcast that we'll revisit again and again, which is that the stress response was designed to combat infection.
So it turns out that there are certain patterns of stimulation on the abdomen that can actually liberate immune cells from our immune organs like our spleen and counter infection. When you stimulate these pathways that activate in particular the adrenals, the adrenal gland liberates norepinephrine and epinephrine, and the brain does as well.
It binds to what are called the beta-noradrenergic receptors. Okay, so this is really getting kind of down into the weeds, but the beta-noradrenergic receptors activate the spleen, which liberates cells that combat infection. That's the short-term quick response.
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Chapter 8: What are the key takeaways for managing pain effectively?
My favorite flavor is chocolate chip cookie dough, but then again, I also like the chocolate fudge flavored one and I also like the cake flavored one. Basically, I like all the flavors. They're incredibly delicious. For me personally, I strive to eat mostly whole foods.
However, when I'm in a rush or I'm away from home, or I'm just looking for a quick afternoon snack, I often find that I'm looking for a high quality protein source. With David, I'm able to get 28 grams of protein with the calories of a snack, which makes it very easy to hit my protein goals of one gram of protein per pound of body weight each day.
And it allows me to do that without taking in excess calories. I typically eat a David Barr in the early afternoon or even mid-afternoon if I want to bridge that gap between lunch and dinner. I like that it's a little bit sweet, so it tastes like a tasty snack, but it's also giving me that 28 grams of very high quality protein with just 150 calories.
If you would like to try David, you can go to davidprotein.com slash Huberman. Again, the link is davidprotein.com slash Huberman. Before I continue, I just thought I'd answer a question that I get a lot, which is what about Wim Hof breathing?
Wim Hof, also called AKA the Iceman, has this breathing that's similar to TUMO breathing, as it was originally called, involves basically hyperventilating and then doing some exhales and some breath holds. A number of people have asked me about it in relation to pain management. The effect of doing that kind of breathing, it's not a mysterious effect. It liberates adrenaline from the adrenals.
When you have adrenaline in your system and when the spleen is very active, That response is used to counter infection and stress counters infection by liberating killer cells in the body. You don't want the stress response to stay on indefinitely, however.
Things like Wim Hof breathing, like ice baths, anything that releases adrenaline will counter the infection, but you want to regulate the duration of that adrenaline response. Today we've talked about a variety of tools, but I want to center in on a particular sequence of tools that hopefully you won't need, but presumably if you're a human being and you're active, you will need at some point.
It's about managing injury and recovering and healing fast, or at least as fast as possible. It includes removing the pain. It includes getting mobility back and getting back to a normal life, whatever that means for you. I want to emphasize that what I'm about to talk about next was developed in close consultation with Kelly Starrett, who many of you probably have heard of before.
Kelly can be found at The Ready State. He's a formally trained, so degreed and educated exercise physiologist. He's a world expert in movement and tissue rehabilitation. So I asked Kelly, I made it really simple. I said, okay, let's say I were to sprain my ankle or break my arm or injure my knee or ACL tear or something like that, or shoulder injury.
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