Beyond Pain: Biopsychosocial Approach with Jen Uschold

Julia Borgan: 00:00:03

Welcome to Beyond Possible Club podcast. This is a space for dreamers, achievers and anybody who wants to transcend their limitations.

I am Julia Borgan, your host and I believe that nothing is truly impossible, no matter what obstacles and challenges you face in life. And you might already be living your epic dream life, but still have a list of things that you really, really want but you think are impossible.

Or maybe you feel really stuck in your situation in a relationship, in your body and you feel like even like having a normal life would seem out of reach right now. So wherever you are, this podcast is for you. So let's get started. This is season one, episode one.

It's all brand new and I'm so happy to start with a very, very juicy topic of pain science. And welcome my guest today, Jen Uschold.

And we will talk about biopsychosocial approach to pain management that will help people both heal and achieve peak performance. So welcome Jen.

Jen Uschold: 00:01:20

Thank you. I am so excited to be your first guest.

Julia Borgan: 00:01:24

I know, I know. And it's happened completely by coincidence.

I posted something on LinkedIn, tagged you because it was my contemplation about pain and we started talking and here we are. I had the dream of starting this podcast for a couple years and talking to you just made it happen.

And then I realized what the perfect topic because talking about going beyond pain, both physical, emotional, it's such an obstacle for getting to the life that we want to live. So let me just start. I'll. I'll read your. I have your bio introduction here.

I might stumble through so many certifications that you have so you can correct me or add anything that I missed. So Jen Ashold is a physical therapist first of all with over 30 years of experience and she special specializes in pain science.

Jen is a national board certified health and wellness coach and she completed a fellowship in pain science as a certified positive intelligence coach as well. She integrates mental fitness techniques with lifestyle medicine and empowers clients to achieve holistic well being.

Now she's also a program director for certification at Lifestyle Medicine and in Lifestyle Medicine Evidence in Motion. So she is a very passionate educator and advocate for patient centered, centered care.

Outside her professional roles, Jen is a proud mom of three and she brings laughter, connection and curiosity to all aspects of life. Thank you. Welcome Jen.

Jen Uschold: 00:03:19

Thank you. That's my goal. That was a fine intro.

We can leave it at that and probably other things will just come out organically as we're chatting with other things I've done. But that probably isn't as interesting. To your crowd as our topic of pain.

Julia Borgan: 00:03:36

Yeah, we have so much to dive in. I think I expect we're gonna have part two, part three.

So there will be some things that we will be double clicking on and some things we'll put a pin on and come back later because we can easily be here for three hours. So I think the best way to start is actually for listeners, for viewers, to hear the definition of pain, because everybody experiences pain.

But if you ask people, what is pain? Define it, that will be pretty impossible to define what pain actually is. So give us.

I want to say your definition of pain, but I don't know if it's your definition of pain or it's the definition of pain and perspective that you're taking as part of the job that you're doing.

Jen Uschold: 00:04:26

Okay. I'm going to combine the kind of three main definitions of pain.

The first comes from the International association for the Study of Pain, so they have the official definition, which they just changed and revamped a couple of years ago. And then there's another one from Lorimer Moseley, who is a big pain scientist. I think he's in Australia.

And then combining that just with the pain science that I have learned through my mentor, Adrian Low, and evidence in motion, a very simple definition of pain is. Pain is an output of the brain 100% of the time based on input from the tissues, your body, as well as your environment.

And it is in response to the level of real or perceived threat. It's a mouthful, and people get a little edgy when I say it's 100% an output from the brain.

This is by no means suggesting that your pain isn't real, because all pain is real. Pain scientists have never scanned fake pain.

However, the complexity of pain, it is sourced as an output from the brain rather than an output from the tissues.

Julia Borgan: 00:06:01

And you talk about pain also as an experience.

Jen Uschold: 00:06:07

I talk about pain as an experience because that is what it is. It is information. And then we need to decide what to do with that information. And sometimes we want to respond right away.

Maybe we put our hand on the hot stove. Yep, let's take our hand off right away. Maybe we feel a cramp, and we are just five minutes from crossing the finish line of a marathon.

Maybe we can table that sensation, that experience, until we cross the finish line. So it is an experience, it is information, and then we have to decide what to do with it.

That's the hard part, because there are so many factors to consider.

Julia Borgan: 00:06:49

I also heard you talk about that we don't have pain receptors.

Jen Uschold: 00:06:54

That is correct.

Julia Borgan: 00:06:55

And what, maybe give us example, what receptors we do have, like in comparison. And what does it mean we don't have pain receptors.

Jen Uschold: 00:07:04

Okay, I'm going to start with what the types of receptors we do have. And then you and I have talked about how important stories are.

And so I'd actually like to tell you and your listeners a story and help them understand a little bit more about the nervous system. So what type of receptors do we have? We have receptors in our body that tell us that it's 50 degrees out or it's 100 degrees out.

So things that respond to temperature, we have receptors that respond to stress, Stress and immunity and position and blood flow. So there are many, many, many types of sensors or receptors. However, we do not have pain nerves, nor do we have pain sensors.

Do you want to understand this a little more?

Julia Borgan: 00:07:52

Yes, please. I'm like clicking, click, click. I want to know, like, chat GPT and I'll ask, do you want me to tell you more? It's like, yes, please, tell me more.

Jen Uschold: 00:08:02

There you go. Okay, so it starts. Julia, if you stepped on a rusty nail, do you want to know?

Julia Borgan: 00:08:11

Yes, I definitely want to know.

Jen Uschold: 00:08:14

You might be surprised how many people say no. Why do you want to know that you stepped on a rusty nail also.

Julia Borgan: 00:08:20

I can deal with it. Well, actually, maybe I'm a little bit cheating. I heard the story before and I heard that people saying, I better not know.

I was like, no, damn it, I want to know.

Jen Uschold: 00:08:31

But you want to know because you want to deal with it, right? Exactly. So that pain that you felt is information. It got you to stop and look and say, oh, I've stepped on a nail. I need to do something about this.

So now your nervous system is made up of nerves and your spinal cord and your brain. That's a very simple nervous system description. It's 400 nerves. That's a lot of nerves. And they're all connected like a crazy highway.

So for you and your listeners, what is 45 miles from where you are? Maybe about 60 kilometers. If we stretched all those nerves end to end, that's how far we'd get. So we've got a lot of crazy nerves.

Now all of those 400 nerves, they have a little bit of electricity in them all the time. It lets us know that we're alive. So that's really good. Now we're going to go back to the nail.

So again, when you step on that nail, it's not yet pain. What we have is A danger sensor. The fancy word is a nociceptor. And that takes the information up to the brain for processing.

And if you remember our definition, it's processing based on information from the body as well as the environment. And if it crosses a particular threshold in the brain, that is when you'll feel pain.

So do you think that your foot will be sore for a few days if you step on a nail?

Julia Borgan: 00:10:05

Definitely.

Jen Uschold: 00:10:07

And when you feel that soreness, are you causing additional tissue damage?

Julia Borgan: 00:10:13

When I feel. Oh, those are hard questions. No.

Jen Uschold: 00:10:19

Correct. So you can feel the soreness in the pain. You're not causing additional damage.

It's just still that this alarm is a little extra sensitive and your nervous system is doing the work of getting back to that baseline little buzz. So we talk about your nervous system as a super high tech alarm.

Julia Borgan: 00:10:40

Yeah. And I also think that it's almost. It's protective that if the heart is sore, I'm also not gonna overuse it too much, you know? Right.

Is it also not just healing like there is pain that probably there because of healing process? And also I guess it's kind of useful to know that something there is not 100% okay, so I'm not gonna dance on that leg.

Jen Uschold: 00:11:15

That gets us into different topics. So yes, we do want to be giving it the environment to heal efficiently.

However, too often people think nothing, doing nothing is the way we heal efficiently. However, movement is actually one of our most important strategies.

So the, the physiology of the healing of that soreness on your foot is it's bringing inflammatory chemicals to the area so that it can heal the tissues and inflammation and pain do go together. So it's not necessarily that you need to be doing nothing.

Julia Borgan: 00:11:57

It's.

Jen Uschold: 00:11:57

It's just information. It's still information. So the problem we have is that about 1 in 4 people in, in the US and it's really not that different worldwide.

The alarm doesn't come back down to baseline. So I like to describe this with a house alarm. And I think if a brick went through your window, do you want your house alarm to go off?

Julia Borgan: 00:12:21

Yeah.

Jen Uschold: 00:12:22

Now what if somebody messed with the sensitivity of your house alarm and your house alarm went off? If a leaf hit the window, is your house okay?

Julia Borgan: 00:12:33

My house is okay. I might be very annoyed. I might be in emotional pain at this point.

Jen Uschold: 00:12:38

You might be annoyed. However, it's not the house that's the problem.

So I ask my clients, is it possible that your house, that your body's okay and our focus needs to be the sensitivity of the alarm? Versus the state of the tissues where you feel pain.

Julia Borgan: 00:12:57

And what is the statistic again? You mentioned that the percentage of people that have that sensitive.

Jen Uschold: 00:13:02

Almost one in four.

Julia Borgan: 00:13:06

Yeah, yeah. Okay, you know what? And I just want to actually just jump in into practical tool, insect. What, what is there to do for those people?

And how do they know that they're 1 in 4? And, and now what that they are, I don't want to say overreacting, but their nervous system is overreacting to the pain.

Jen Uschold: 00:13:26

Yeah, they are definitely not overreacting because I will say this as many times as I need to in the world. I All pain is real.

Their nervous system, if we go back to that definition, it is an output of the brain based on the level of real or perceived threat.

So people who have a highly sensitized nervous system and they have chronic pain, they have a nervous system that is perceiving a threat that is not there. Their nervous system is responding to a leaf rather than a brick. And so your question is about what do we do about this? That's a huge question.

And broadly we divide pain experiences into three basic categories. And depending on what the dominant piece is for the client, our treatments will be different.

So let's take an ankle sprain, if you're a runner, and you did that three days ago, that we would call more of a, I'm not going to name the buckets, we're just going to call that the, that bucket. And we do much more traditional physical therapy for those people. We want to get the swelling down, we want to get their mobility back.

We need to get their strength up. So those people, they're going to, they're going to recover in two to four weeks.

Now sometimes those people can then turn into more of a chronic situation.

Our middle bucket, this is somebody who's had a particular nerve injury or they've had a crush injury to their nerve, maybe even somebody that's had the diagnosis of carpal tunnel. We treat that differently than we treat this first bucket and then the third, the most complex bucket is the third one.

These are the people, the one in four that have chronic pain. And we have a program called P and E plus Pain. Neuroceptive Pain. Pain. Wow. Why am I forgetting pain? Neuroscience, education, too many neuro words.

So the plus program is it's 22 evidence based approaches to help people ease their pain. So this bucket, you talked about the word biopsychosocial. There's much more of a dominant psychosocial aspect in the third bucket.

So we treat them very different than the person who had an ankle sprain three days ago. The other truth is that every single client has something of all three buckets.

But the amount of each of them is different and also varies during recovery.

Julia Borgan: 00:16:12

Okay, so I want to describe what's happening in my brain right now, what experience I'm having. My very curious brain just really wants to know what the names of those buckets are.

Jen Uschold: 00:16:25

Okay.

Julia Borgan: 00:16:27

So I won't be able to sleep. Tell us the name of the buckets.

Jen Uschold: 00:16:31

So the first bucket is nociceptive pain. Remember we talked about the danger sensors?

Julia Borgan: 00:16:36

Right.

Jen Uschold: 00:16:37

So that's nociceptive. That's more. That is more tissue driven. That has predictable things that ease and aggravate pain. That's bucket number one. Bucket number two.

This is the peripheral neuropathic bucket. And this is more that nerve crush injury.

Each nerve has a particular pattern we can see like anatomical and neurological patterns to the pain that these people are experiencing. And then the third bucket, this is called central sensitization. This is where the brain is in a hyper, hyper vigilant, hyper aware state.

It is doing its job too well.

The changes in the brain are significant and so this is why we treat them differently, because we want to shift their brain back to a place of safety.

Julia Borgan: 00:17:27

Okay. So I will trust you going forward when you don't want to name something. Because I regret asking this question.

I understand why you chose to omit the names. They are not sexy names. Okay. And so I want to come back, we'll kind of to, you know, what would. What would what.

What is generally your approach to helping anybody to deal with the pain, to go beyond pain. What, what is your basically almost wish for general population to know about pain? And I'm hinting at the four pillars.

Basically trying to ask a question. Tell us about the four pillars. I know about the four pillars. They're pretty cool.

Jen Uschold: 00:18:19

Yeah, I'm going to, I'm going to actually zoom out from that.

So the way I approach pain is first I have to know the client's story and I need to know what it is they want because that may you talk about four pillars. We'll get into that in a moment. But that's going to inform me of.

Well, this pillar is a non discussion at this point or they're really excited to dive into this particular pillar. And so it all starts with the client.

And so for people that are listening, my suggestion is to find a clinician or a coach or a therapist who is really going to put you in the driver's seat of your career as opposed to mandating what you do, being all die hard about things. So that's my one little side. So the four pillars, these are our main, well researched areas to help people reduce pain.

And the first one is education. It is fascinating. We have FMRI studies showing people's brains calming down after they receive education about pain.

And when you think about it, it's really not that weird. You know, if we go into a math test and we're wholly unprepared, we're probably going to be stressed and anxious.

If we go into a math test and we have studied and we know the information and we've done it repetitively, we're going to be much more likely to have success. The same is true for pain. When people understand pain, they have less pain. It's not a standalone treatment.

That's super important because some people think, oh, I could just learn about it. And we're good. No, because we also need, what are the treatments we need to create safety and calm in the nervous system.

Exercise is a huge, super important piece. If we were to choose only two things, it would be exercise and education.

And the reason that exercise is so important, one of the reasons is because when we exercise we are creating blood flow and nerves love blood flow and movement. So if they're getting that, then they start to calm down. Sleep is huge for pain.

I was just having a conversation with a client earlier today and I'm like, how's your sleep? And she's like, I want to sleep more. She's taking these different meds. And then she said, I said, well, what about some of your sleep hygiene?

She's like, yeah, you know, I do what I want. And I was like, okay. And like, check the box of all the things we wouldn't recommend.

And I said, well, are there areas that you're interested in considering changing? She's like, no. And I'm like, all right. So I'm tabling that conversation because it's not important to her.

And at the same time, sleep is a huge driver of pain. And then our last one is having goals.

Julia Borgan: 00:21:17

I, yeah, I just, I wrote it down. Nerves love blood flow, you know, and just thinking about those new compression type boots that, you know, you know, endurance athletes are using.

It's just like getting, getting the blood flow. And I think that. But it's so hard for people to get back to exercising because, yes, we think something is wrong.

We don't know if we can be exercising. So unless, I guess, maybe when we're working with the specialist that can guide us. No, it's okay to do this type of exercises. How?

What would be your advice? How can we learn to discern for ourselves? Yeah, I can exercise through this pain. I can still.

I doesn't feel good, but I need to keep moving versus like, no, I have to chill.

Jen Uschold: 00:22:08

Well, here. If we have a fracture, please don't exercise. You can exercise another body part and still calm the nervous system down.

So you have a broken wrist and you're in a cast or a splint, you can walk to your heart's content. You could probably even do elbow planks and do some leg things that way. So movement is key.

And if you can't move one particular body part because of a fracture, where can you get creative and still get movement to promote healing and decreasing that sensitivity? Now, a common problem that we have with many athletes in particular is that they push through pain. They go, go, go, go, go. Weekend warrior.

Have you heard of that description? Right, so the weekend warrior, they go, go, go, go, go, and then they crash.

And then they recover in time for the next weekend and they go, go, go, go, go, and then they crash. Well, the reality is that's not really good for anyone.

But if you have a sensitized nervous system, that's going to really actually make your system more sensitive. Because remember, pain is information. Your brain is giving you that experience to get you to pay attention and it wants to alert you.

So if you continue to ignore it, it's going to keep giving you that message. So the opposite is also true. Some people are like, well, I can't do anything until all my pain is gone. So now we have the opposite extreme.

Well, we also know when people stop moving and stop doing, it also increases the sensitivity of their pain. So the beautiful middle ground is my favorite word, which rhymes with fudge, and that is nudge.

So when you experience pain, we want you to get clear, okay, did I just get hit over the head with a baseball? Then maybe I need to stop. But if I'm feeling a little pain in my ankle and I'm running, well, what happens if you run for another 10, 20, 30 seconds?

Maybe it's just going to go away. And maybe if it continues, then you're going to walk and see how that goes. And then maybe if it continues, maybe then you're going to take a pause.

And so rather than just doing this all or nothing approach, we really want to nudge it. It's no different than training.

If you can run five miles, you're not going to go run 25 miles, you're going to go five to six to nine, you're going to do it progressively. The same is true for increasing function and decreasing pain.

Julia Borgan: 00:24:46

Yeah, yeah, yeah.

Well, I learned through endurance sports that as soon as I start feeling the pain while exercising, in many cases if I kind of stop or back off or start thinking about the pain, it definitely gonna get worse. But if I kind of say, no, it's fine, I'll just continue, it's fine.

In 99% of the cases, it goes away like as if, like the alarm went on because, you know, the body knows, okay, she's kind of pushing it. And then I was like, no, it's fine. And something happens. Like the brain kind of whatever, whatever was trying to stop me.

It's like I was like, oh, it's fine. Or you know, you know, my hip plexus starts kind of like pulling at the end of long run, I was like, it's going to heal tomorrow.

And all of a sudden, as soon as I say it's, oh, it's going to be fine tomorrow. Yeah, I know it hurts, but it's fine. It disappears like, or it subsides. It doesn't get worse. I can, you know, continue, continue running.

Jen Uschold: 00:25:52

You want a potential explanation for that?

Julia Borgan: 00:25:54

Yes.

Jen Uschold: 00:25:55

All right, so the first thing you said is you feel the pain because the body knows. I'm gonna, I'm gonna word shift that to okay. You feel pain because your brain is creating that experience. Okay, that's number one.

And your brain is creating that experience based on a real or a perceived threat. You give good, healthy input into your nervous system. It's going to be okay tomorrow.

And your brain's like, oh, okay, I guess this isn't a five alarm fire after all. And then you don't have pain.

Julia Borgan: 00:26:30

Okay.

Jen Uschold: 00:26:32

And there are times where we do need to stop. So it's not super clear, it's not black and white and is so many variables.

However, what you talked about is saying, oh, I'm going to be fine tomorrow. That's tapping into our mirror neurons. Have you ever heard of mirror neurons.

Julia Borgan: 00:26:51

But more in the context of social environment and mimicking kind of what's happening around us. Not in, I don't think, not in the context that you're referring to right now.

Jen Uschold: 00:27:02

Yeah. So you unintentionally mentioned how mirror neurons help you or harm you in that last conversation.

So about 25% of the 80 billion neurons in your brain are mirror neurons, which means they respond to what you think, what you say, what you feel what you do. So in your example, you felt pain and you're like, oh, if I start to think about that pain or if I stop, it gets worse.

Your mirror neurons are responding to that. Oh, when you feel pain, you think, oh, it'll be gone tomorrow. 25% of your neurons are responding to that as well.

So for my clients, if they get into that deep, dark hole of the pain's never going away, I'm getting worse, they're actually reinforcing that with 25% of their neurons. Mantras are so important. If they shift, they find a statement that makes them feel calmer and safe.

There's some that we give clients, hurt doesn't equal harm. Alliteration is helpful exercise. My favorite is motion is lotion. I can feel sore, but safe.

So we want clients to have these mantras that they can interrupt those experiences of pain when they are safe. When they're not safe. We need them to heed those experiences of pain.

Julia Borgan: 00:28:28

Yeah, I can think right now that actually a year ago, I started training for a race that I realized, like, I didn't feel like I signed up, but I realized I over committed. I don't want to train and usually love training, but I couldn't back off. Like, I was just like, no, I'm gonna do it. And then I had an accident.

I fell and I cracked my rib. And typically, if I crack my rib while I was training for a raise that I really want to do, I would be like, this is not a problem.

You know, we're gonna heal. It's gonna heal. I literally felt relief. I was like, oh, great, I don't have to train.

Jen Uschold: 00:29:08

Isn't that fascinating?

Julia Borgan: 00:29:10

And I was like, I can't tell this to anybody. This is my dirty secret. I'm like, oh. And on top of that, I can miss some work because I don't feel like working either.

Jen Uschold: 00:29:20

But isn't that fascinating, Julia? A fractured rib is a fractured rib. And in case one, you're like, no, no, no, I'm going to keep running.

And in case two, you're like, oh, no, this is an excuse to stop the race and stop working. It's just a fractured rib. So this is an indicator helping people understand that tissue damage is not the only driver of pain.

And in fact, it's a very small piece of it.

Julia Borgan: 00:29:49

Yeah, it's like that decoupling of, yes, there is a tissue damage and there is an experience. Right. It's of having a pain experience that our healing experience.

Jen Uschold: 00:30:03

Well, and 30% of people who have Chronic pain have never had an injury or a surgery and they still have debilitating pain.

Julia Borgan: 00:30:13

What's the percentage again?

Jen Uschold: 00:30:15

30%. Okay, so we really have to disconnect tissue damage and pain.

Julia Borgan: 00:30:23

So is that kind of that another story of another nail?

Jen Uschold: 00:30:28

Oh, you'd like to hear the two nails? Yes.

Julia Borgan: 00:30:30

I think that makes, I love stories. I want as many stories as we can share with people.

Jen Uschold: 00:30:36

Yes, absolutely. So the first nail is a construction worker who in South Korea, he went to the emergency room with a headache or wherever he went.

And they took an X ray and they said, hello and they said, where did you get this 4 inch nail? Straight through his forehead.

And he thought, well, maybe like the best he could remember was that four years earlier he was on a job site and he was working with his nail gun and it jammed. So he looked at his nail gun and felt a puff of air and he's like, whatever. It goes back to work, end of story.

Four years later they find this nail in his forehead. I think that a nail through your skull counts as tissue damage. But he had no pain. That's story number one.

Story number two, also a construction worker. We can learn so much from them. So this guy was walking on the.

Julia Borgan: 00:31:34

Job site because they have access to a lot of males.

Jen Uschold: 00:31:37

Yes. And he stepped on a nail and the nail went all the way through his boot and all the way out the top of his boot. And he was screaming in pain.

And so they took him very carefully to the hospital. They took the boot off so carefully because they didn't know the extent of nerve or blood vessel damage. You know what they found?

Not even a scratch because the nail went right between two toes. Was his pain real?

Julia Borgan: 00:32:14

Yes.

Jen Uschold: 00:32:17

A little more confidently. All pain is real.

Julia Borgan: 00:32:23

All pain is real based on the.

Jen Uschold: 00:32:26

Level of real or perceived threat.

Julia Borgan: 00:32:29

So so basically like he would be example that somebody would say this was in your head, right? Like, because you know, there was no. It was really his perception, that perception of the thread.

But when you say the pain is real because you put it on the functional MRI and all whatever lights up in the brain indicating it's pain will light up. Is that.

Jen Uschold: 00:32:51

Yeah. And he felt it. He felt that.

Julia Borgan: 00:32:53

He felt it. Yes, of course he felt it.

Jen Uschold: 00:32:56

Yes, he felt it. You cannot. So I often have this happen. People like, well, I just don't feel it anymore. Well, pain is always a physical and an emotional experience.

It's always both together. We can't separate them. So if you don't feel something physical, then you don't have pain. People, like, I have it, I just don't feel it.

That's not a thing. Because pain is physical and sensory and emotional.

Julia Borgan: 00:33:30

Yeah.

So I guess when, before we were trying to have a conversation on LinkedIn about physical versus emotional pain, my context for that was more that if the thread, real or perceived, is physical threat to my physical body in terms of, like, it's a childbirth or I'm jumping off the, you know, bungee jumping, like there is a physical activity or physical sensation, like that affects, you know, the visible thing of my body versus an emotional danger.

Like, you know, and I would say, like, one of the scary things, like, for example, like, going through separation and divorce would be, you know, and, you know, like, it's. I'm not going to die. I know. Like, I talked to my therapist at that time. She's like, you know, and I was like, but I feel I'm going to die.

And she's like, you are not going to die. And I was like, you're right. Like, it's. I know I'm not going to die physically, but it feels I'm going to die. And so what did you feel when.

Jen Uschold: 00:34:48

You felt you were going.

Julia Borgan: 00:34:48

Oh, they're the same panic if somebody is, like, holding a gun and just gonna shoot me. You know, like in the life, like, it's. It's kind of in once feeling the body. Well, that anxiety that it's. It's that, you know, like that panic.

Shortness of breath.

Jen Uschold: 00:35:08

Shortness of breath is a physical experience.

Julia Borgan: 00:35:11

Yes.

Jen Uschold: 00:35:12

So your emotional experience, the fear of separation.

Julia Borgan: 00:35:16

Hmm.

Jen Uschold: 00:35:17

One of the ways it showed up physically for you was shortness of breath.

Julia Borgan: 00:35:24

Okay. My mind is jumping somewhere else right now because that's actually.

It's a good point that all the emotions we're feeling, or we technically can, if we able to place it somewhere in our body, there is a physical.

You know, as a coach, when I work with clients, and if I ask them where they feel it in their body, that specifically, if we want to go specifically to that emotion, not everybody can name. And some even say, I never feel things in my body I can know. Don't even ask me that question.

So is it just the way people, their connection to the body, or is it different way if they're feeling. Somebody is feeling an emotion? And I typically can easily say it's, you know, it's in my throat, it's in my chest, it's in my, you know, like any.

Any sort of part. And a lot of people can name where if they zone in to their Body where they're actually feeling that but some can't.

And is it just a matter of interception kind of being able to connect or it just. People feel things differently on the emotional side. I'm totally jumping into the emotional side right now.

Jen Uschold: 00:36:38

I don't often ask my clients where in their body they're feeling an emotion.

I know that's valuable in some frameworks, which is fine for me it's more about helping them understand that we cannot disconnect physical and emotional because pain is always both. So for them to understand that I feel pain in my back and it makes me scared I'm going to lose my job. There's a physical and an emotional connection.

I feel nervous about to get off the high dive and my legs are shaking. Then we have the emotional and the physical. So. Yeah, I don't get into that a lot.

Julia Borgan: 00:37:26

Yeah, no, I understand. It's a different type of like we, it's you work, you, you always start. Yeah, it's. I just felt, I just had to share.

Jen Uschold: 00:37:36

I'm aware of it and I'll be honest with you, I was one of those people until like two or three years ago. They always. Where you feel like I have no idea what you're talking about. Drop into your body, like I have no idea what you're talking about.

Can you just feel it in your body? Like no idea what you are talking about. And so I think probably a lot of my clients aren't able to do that either.

They are able to connect that physical pain and emotional pain go together.

Julia Borgan: 00:38:05

Okay. Okay.

Jen Uschold: 00:38:06

And think about this. This is another example I like. So say you sprain your ankle on a vacation. You've got two days left.

It's the most glorious vacation you've ever been on. And you want to enjoy those last two days. Think about the pain you might or might not experience.

Now let's have you do the exact same ankle, ankle sprain, the exact same tissue damage. In a job you hate, where you are abused, you are one hour into a 14 hour shift.

Do you think your pain might be different because emotions impact pain?

Julia Borgan: 00:38:47

Yeah. So what is it like? Is it when we're in stress, already is our nervous system is already. What.

What exactly is it's kind of different from my experience is like, oh, I don't want to train and I don't want to work, so I'm just going to, you know, take some time off, which probably contributed how long it took me to recover.

But in, in the cases that people are stressed, in a stressful job Environment versus a vacation and how they experience the pain, what is it actually that affects. Like, is it their positive emotions or the nervous system?

Jen Uschold: 00:39:25

That's part of the biopsychosocial model, is that we know that our environment can influence the experience of pain. Where we grew up, how we grew up, even different cultures experience pain differently. The Japanese culture, I think it's their tradition.

Don't quote me, that men are not to express pain even to a healthcare provider. So that's their culture. So we need to know how we're going to help somebody if their culture limits their ability to express it.

And then there are some cultures where they're much more expressive and emotive. Does that mean that this man in Japan is not having pain and this person, this other culture, is over the top and ridiculous?

No, it means we need to pay attention to environmental influences as well as whatever's going on with their tissues. So it's.

Julia Borgan: 00:40:21

Yeah, that's why it's so important. When you say you need to know the client's story.

Jen Uschold: 00:40:26

Right?

Julia Borgan: 00:40:27

You know, like, not just the story, what they believe about the current pain and the story about the current pain, but it's also like, what is their general, I guess, experience, you know, like, in terms of their environment. I remember you sharing something about kids that play competitive sports. They have different. They have different rates of chronic pain.

Jen Uschold: 00:40:53

They're less likely to develop chronic pain because they learn that they get hurt and they heal. They get hurt, they heal. Tissues get damaged, they heal because our bodies are really amazing.

So, yeah, when kids learn that they can experience pain and tissue damage, whether or not they're the same at that moment, and they heal, this is a great, growing opportunity for them.

The toddler who falls on the sidewalk, often they're ready to just get up, but then they look, mom, babysitter, dad, and they get that overreactive face. That's when the kid cries, when they've gotten input from their environment that, oh, this is dangerous, versus, hey, let's go, let's get up.

Let's get you to the playground. And if there's really something we need to address, we're going to figure it out.

But let's help them recognize that a fall and a scrape on the knee is not the world's worst experience.

Julia Borgan: 00:42:01

Yeah, yeah. So. So everything we talked about today, there is a lot of insight that will help people who had injuries or any.

Any, you know, surgeries, you know, like any.

Any accidents, and they are recovering from the tissue damage, and they know, oh, how, I think My environment, maybe even type of movie I'm gonna watch, you know, funny movie versus some scary frightening movie. You know, they know that they are.

They have agency over their healing, you know, an experience of their healing while, you know, they can, you know, maybe.

Maybe even the tissue will take the same time to heal, but their experience will be different in terms of how they going to be dealing with that pain and more likely to exercise.

And, you know, what I'm curious about is that you mentioned, was it 30% of people that didn't have a tissue damage or surgery and they are in pain like that? It's. To me, it's that physical manifestation of emotional pain or trauma or like, what in. Is. Is it part of the work that you're doing as well?

Is it what. Comment. Comment on that?

Jen Uschold: 00:43:28

Yes. So I'm going to say again that all pain is physical and emotional. Emotional pain doesn't.

Julia Borgan: 00:43:36

I'm going to chew it on my forehead.

Jen Uschold: 00:43:40

This is my mission to help people understand pain better.

Julia Borgan: 00:43:43

If you can convince me and I believe it, you know, we're good. Okay.

Jen Uschold: 00:43:48

That might be my challenge, Julia. So they've had an emotional experience, trauma, and it's showing up in different ways. So for one person, it might show up as digestive issues.

For somebody else, it might be mood and concentration. For somebody else, it's sore muscles. For somebody else, it's fatigue or chronic fatigue syndrome. For somebody else, it might be chronic Lyme.

For somebody else, it might be Ehlers Danlos. There are so many of these chronic experiences that people have that we can now tie to a sensitized nervous system as being a piece.

And sometimes it's a big piece, and sometimes it's a small piece. So someone who has not had an injury or a surgery can have hardcore debilitating pain that is 100% real.

So I'm going to try and help you disconnect a little bit more. This is actually. We call this the Hean theory. Nerves that fire together wire together.

But what we want to do is we want to break apart that belief that it's physical or emotional, because nerves that wire apart, fire apart. So, darn it, I forgot my example.

Julia Borgan: 00:45:15

Okay, well, for now, I'm just going to give you my excuse. I grew up in the Soviet Union talking about, okay, I blame everything on my Soviet upbringing, if there is any.

Jen Uschold: 00:45:27

All right.

Julia Borgan: 00:45:30

No, we're tough and stoic.

Jen Uschold: 00:45:33

Right. So that. That is your cultural upbringing. Right. So that. That has become a part of your fabric. And so that influences how you experience pain.

Julia Borgan: 00:45:46

Yeah. And Also, it's on the one hand, stoic and tough is part of it. And also almost like being happy was not okay.

Like, if you smiling and always happy people like, what's wrong with you? Are you dumb? You know, like, if you were smart, you knew how tough that life is.

So if you, if somebody asks how you doing and you're like, I'm doing great, they're like, what, you know, what, what's happening? So it's so again, it was, you know, a long time ago and. But it took me a while to like, oh, it's okay to show, like, it's okay to be happy.

And it's okay when I'm happy to actually tell people I'm happy.

Jen Uschold: 00:46:31

Right. And so your culture and your environment influence how you deal with pain. Now, is it necessarily right, wrong, better, worse?

No, it's, it's information that is valuable as you are navigating and valuable for you when you're with somebody who is more emotive about pain rather than, you know, a judgment of, oh my gosh, why are you expressing pain more? That connection and curiosity of, okay, I know that all pain is real. What can I do to help you? That makes sense.

Julia Borgan: 00:47:08

Do you remember your example now?

Jen Uschold: 00:47:09

No.

Julia Borgan: 00:47:10

Okay, so I going to bring in as an example of emotional and physical pain. One pain, maybe. Is it like chocolate milk? You know, remember I remember you talking about.

Jen Uschold: 00:47:27

Exactly. You can. Chocolate milk, you can't separate. That wasn't my story. But you cannot separate the chocolate from the milk once you've put it together.

Pain is always emotional and physical. There are nine different parts of your brain that participate in any pain experience.

And that includes the emotional part of our brain as well as all the other parts of our brain too. It's always connected.

Julia Borgan: 00:47:53

Yeah. So, okay, I'll give you another example to comment on. Like, I am typically a very high energy person. Like, I always, I have energy.

I have, I'm like energize a bunny or tigger from Vinnie the Pooh. Like, I'm typically like, I'm, I'm high energy. So for me to be like, you know, tired, like, I have to do a lot of things to wear myself out and.

But then I had an experience of loss, grief, you know, like a loss of a person. And I, for the first time in my life, I couldn't get out of bed and like, well, I could get up enough to like, do something for my child.

But then as soon as she goes, you know, somewhere, I lie down and like, I just can't I. I can't get up. Like, I physically, like, cannot. I have no energy. And.

And I also, at that time, I also possibly realized, like, I was like, okay, I lost people before. I had a lot of losses. How come I never felt. It is if, like, it was maybe not allowed. Don't feel, don't. The Soviet thing. Don't fail. It's fine.

And it felt like it hit me, like, everything, everything that I. But again, like, I was like, what is this? What is happening to me? And I ended up working with a grief recovery coach.

Actually, just coincidentally, I. I met somebody that was like, perfect. I was like, I am in so much grief, I can function. And it's like, for me not to function. It was.

So what was that?

Jen Uschold: 00:49:32

What's the actual question? What is grief? What was the energy?

Julia Borgan: 00:49:35

Yeah, like, it was like. Again, like, we're on the topic of convincing me there was only one pain.

Jen Uschold: 00:49:44

Okay, well, so my pain was.

Julia Borgan: 00:49:46

Nobody hit me. I was not run over by a truck or bus, that I'm injured, that I cannot get up, but I felt like I was hit by bus. Like, I can't get up.

Jen Uschold: 00:49:55

Okay, so you have experienced that emotional pain is also physical, and yet it's hard to recognize that they always go together.

Julia Borgan: 00:50:16

Yeah.

Jen Uschold: 00:50:22

Something you've experienced it. You know it. You know it from experience. But cognitively, you want them to be separate.

Julia Borgan: 00:50:33

Yeah. Yeah. Because I guess maybe because I'm tying it in with. If it's a physic, physical thread. If it's a physical.

I mean, physical danger versus emotional danger.

Because maybe, maybe, you know, maybe it comes from, you know, you know, when we're learning about managing fear, there is a lot of stories about how, you know, like, yes, we have this fear response because we needed to pay attention. Like, we have naturally negativity bias, you know, in wired, in our force, in us for survival. That's like, yeah, I'm not.

I'm supposed to pay more attention to dangerous snake versus pretty butterfly because snake can kill me. So we kind of so many times, like, work that we do, we didn't even get to it.

Today might not be positive intelligence and like, coaching that teach people that you're not in physical danger, you know, that, yes, your brain reacts and pays, you know, three times, 10 times more attention to a perceived thread of, you know, negativity rather than what's going well. So maybe that's, for me, where it's coming from. Like learning that to decouple. You know, maybe like, it was like, I'm not in Physical danger.

So I'm fine.

Jen Uschold: 00:52:06

Yes. And we can. It's not 50. 50. Maybe that will help. It's not 50% physical and 50% emotional. It's whatever is needed.

Whatever the brain perceives is in the best interest of you because the brain's job is to protect you. And I describe it in the case of chronic pain. It's like a helicopter parent. It's just doing its job too well.

Julia Borgan: 00:52:33

Okay.

Jen Uschold: 00:52:34

So, you know, we go back to that ankle sprain on the glorious vacation. Maybe it's 95% physical and 5% emotional.

Julia Borgan: 00:52:44

Okay.

Jen Uschold: 00:52:45

And then in the job where you're being abused, maybe it's 98% emotional and 2% physical. It's always both.

Julia Borgan: 00:52:56

I like the part, you know, like, what really resonated with me is what's useful, like, what is needed, what's best for you, like that. Like, what is. It's like pain is a data point, right? Like, it's. It, it's. And now it's like, I guess it's, you know, back to that, interpreting.

Like, what is the data? What is the information? Right, Right.

Jen Uschold: 00:53:23

So pain is information. We get to decide what to do with it.

And in our positive intelligence world, negative experiences are information and we get to decide what to do with it. So another example is say you sprain your ankle just, you know, walking on your sidewalk. It's probably going to hurt, right? Yeah.

So what if you're crossing a really busy road and you don't wait for the light to turn green and you sprain your ankle in the exact same manner and out of the corner of your eye you see a bus hurling at you? Is your ankle gonna hurt?

Julia Borgan: 00:53:57

Yeah. No. Yeah. I mean, no. Yeah. Jen, why don't we just. For our kind of like, last topic.

Jen Uschold: 00:54:06

Can I finish that sentence?

Julia Borgan: 00:54:08

Yeah. Sorry. Yes, go ahead.

Jen Uschold: 00:54:09

So your brain is always going to prioritize your survival. And so in the case of a sprained ankle versus the threat of the bus, the bus is a bigger threat to your survival. So you likely will not feel pain.

Now you get to the other side of the street, then your brain will be like, hey, can you take care of this sprained ankle? And then you'll likely feel it.

Julia Borgan: 00:54:36

Yeah.

I had relatively recent example when I was in some distress personally, and all of a sudden my daughter needed me in a way that I had no luxury being in my distress. And all of a sudden my distress was not important. I just kind of. I was like, okay.

I quickly put myself together, healed my, you know, emotional ankle.

Jen Uschold: 00:55:05

Your emotional Ankle. Emotional ankle. I like it.

Julia Borgan: 00:55:12

So that's a new term introduced on this podcast. Emotionally explain my emotional angle.

You know, I really want to maybe bring this home with an introduction of positive intelligence framework, because I also know this is something you've been integrating more and making the work that you do on all fronts, both with the pain, with the pain management clients and lifestyle medicine more effective. So maybe explain to our listeners what is positive intelligence and what is.

And yeah, and how are you integrating that framework, how it powers now, these services that you provide to your clients?

Jen Uschold: 00:55:54

I'm just going to say this feels like pressure because you are a former Positive Intelligence employee. Positive intelligence.

Julia Borgan: 00:56:03

You know, the pressure is on me because I was like, oh, am I going to explain what positive intelligence is? Oh, I have to do it perfectly.

Jen Uschold: 00:56:09

Oh, that's so funny. I should know how I explained it to people. I explain it as harnessing your brain to be your friend far more than your enemy.

And we learned that broadly negative emotions are housed in the left side of your brain, and broadly positive emotions are housed in the right side of your brain. And so what we're doing is we're really helping people to first become aware and then create new neural patterns.

The word is neuroplasticity, which is just a glorious thing for people going through pain as well. And so, yes, I am integrating them. There are so many amazing crossovers between both of them. But we have.

We have left side of the brain negative, right side of the brain, positive. We have nine parts of the brain that participate in the given pain experience.

So in both cases, we are trying to shift and create safety, whether it's pain, science, or mental fitness. Create safety with new patterns so we can soar in whatever it is we want to do.

Julia Borgan: 00:57:17

Very good. How do you feel? Do you feel safe?

Jen Uschold: 00:57:24

Like you're going to write to Shirzad? Jen has no idea what PQ is.

Julia Borgan: 00:57:29

Well, but the thing is that it's what I like about positive intelligence, that it's. It's like we refer to it as operating system. Right. Like what? It's so universal. How simple? Radically simple.

It explains the brain to the mass population and teaches that those negative, like, emergency.

I now started calling them emergency emotions, you know, can be calm down, you know, so we don't hurt anybody and ourselves with, you know, staying in them too long. But the application of positive intelligence is endless.

You know, like, if you're applying it in health, you're applying it, you know, like in, you know, team, team collaboration or conflict management, you know, it's it's endless. Endless. Or with kids, with parents, like, anywhere.

So obviously everybody will explain it differently based on the audience and based on the context that they are applying it to. So, yes, you can. There's many ways to explain what Mental fitness, Positive intelligence.

Jen Uschold: 00:58:32

Revoked. You're not going to get my certification revoked.

Julia Borgan: 00:58:39

No. Good. All clear.

Jen Uschold: 00:58:40

All right, good.

Julia Borgan: 00:58:42

Okay, so I thought, you know, I want to, like, first of all, before I go to closing, I have a couple of questions for us to close off today, but I just want to, for myself and for the listeners to highlight the importance of stories, because I know it came up couple times, you know, like when you were describing, you know, when you were educating me and others and giving examples of educating your clients. You know, telling stories is such a powerful way to get people to understand such a complex. This topic that. Thank you. Don't.

Don't ever tell those three names of the buckets to anybody. Just tell stories.

Jen Uschold: 00:59:33

That was so funny.

Julia Borgan: 00:59:35

I want to know. I was like, my eyes are blazing over.

And also the importance of stories that we tell ourselves about our pain or based on our, about our current pain or based on our previous experience that we had, or bringing story that we tell, which basically our beliefs, you know, believes about ourselves, about what pain is, the importance of that in our experience, in our healing, in our ability to, you know, like, overcome, you know, and get back. Back to, you know, having a normal life or having a peak performance life, depending on where we're coming, what, what our goals are.

Once again, you mentioned the importance of goals as well.

Jen Uschold: 01:00:26

Right?

Julia Borgan: 01:00:26

Yeah. So thank you for being a powerful storyteller and, and using stories so effectively. And I.

You'll have a chance to maybe, maybe tell us a couple more stories because I have a couple questions for you.

Jen Uschold: 01:00:43

I have no doubt that you have more questions. I like questions.

Julia Borgan: 01:00:48

And so I want to know, because the name of the podcast is Beyond Possible, and I want to know what other things in your personal life that you're willing to share with our listeners that you overcame and you thought they were not possible, they were impossible, but you went beyond those limitations that you thought you had and what they were, and maybe some tips about how you went, how you did it. That's question number one.

Jen Uschold: 01:01:23

Okay. One is a little more fun and one's a little more heavy. So I'll give you the quick, fun one first.

In: 2020

And so he had gone and he scaled up like Spider Man. And then there I was, you know, I slammed into the wall a few times, and then I was. At this point, I was stuck. And I'm like, I'm not going anywhere.

And I look up and the two of them are just chatting. And I'm like, why aren't they helping me? Like, why aren't they pulling me up?

And all of a sudden I realized, well, if they're not concerned about my safety and my ability to get up, then maybe I need to buck up and figure this out. And I did. And I'll tell you what, I was so proud that I got up that cliff or whatever it was, and I didn't have to have their help.

It was really a cool moment and it was really emblazoned in my brain, like, wondering why they weren't helping me. Looking up, seeing them having no care in the world that had to do with me at all. And realizing they believe in you, so start to believe in yourself.

So that was all just thought in mind. That's the only reason I got through that.

Julia Borgan: 01:02:43

So that's basically just hang out with people who think, are you fine? You can handle. They're not helicopter. You know what?

Jen Uschold: 01:02:51

They need help. Exactly, exactly. Yeah, that's a good point. Yeah. Never really thought of it that way. Yeah, I like that. Yeah.

So the second one, I did not think I would survive my divorce of a couple of years ago. It was a intense, contentious divorce. It took two and a half years from start to finish. I was very concerned I was going to be living in a house.

And I told my bookkeeper that. And she's a wonderful human. She said, jen, I will. I said, I'm going to be living in a cardboard box.

She said, jen, I'll make sure it's a very nice cardboard box and I will bring you dinner. Okay? But I will say there were some very, very, very, very dark moments in the divorce. How did I get through? There are a lot of ways I got through.

I would say the two things that got me through the most were support and actually allowing myself to let others help me and the existence of my kids because they kept me from going to the darkest place. That's how I did it. Told you. One was people.

Julia Borgan: 01:04:16

I feel like there is a theme having the people having the reason.

Jen Uschold: 01:04:23

And it's hard to reach out for people like I. I am described as being fiercely independent, and then somebody Close to me, he's like, you know, it's a trauma response. And I'm like, oh.

Julia Borgan: 01:04:37

Yeah, I heard that recently that inability to ask for help could be in some cases a trauma response. You know, like we brought up divorce twice today.

So I think that will be part two or three will have to do on because I think that a lot of the times, you know, being stuck in the relationship or being, or being stuck and getting out of relationship and rebuilding life is such a big part of so many people can relate to it and it's life defining for sure. So. Well, we'll pin it for another time.

Jen Uschold: 01:05:14

All right, we can.

Julia Borgan: 01:05:15

So I have last question is, is there is anything right now that you really, really want but you think is impossible?

Jen Uschold: 01:05:26

I'm really trying to believe it's possible.

My mission, I actually have an LLC called the Beacon of Kindness because I want to really educate the world about the power of pain, science and mental fitness and create a ripple of knowledge, empowerment and kindness. And that feels like a big mission but I really want to believe it's possible. Some days it feels more possible than others.

Julia Borgan: 01:05:58

Well, today you took one.

It's not the first domino I know for sure, but it's one of the dominoes, one of the, one of the steps of, you know, educating and making a difference.

And yeah, so I think that we, yeah, there's I, I talking to you, you know, know, knowing you prior to this conversation, having this more in depth conversation and preparing for it, I realized how little we know about pain and I considered myself like an expert on pain because of my endurance sports. I was like, I go for pain. I know pain.

We're friends now and at the same time, so far from really understanding what pain is and what role we can play in our experience.

Jen Uschold: 01:06:48

Absolutely.

Julia Borgan: 01:06:50

Of the pain and when to really allow it to protect us and save us from ourselves and from our daring adventures and when to actually say that no thanks, I'm fine.

Jen Uschold: 01:07:06

Right. Exactly.

Julia Borgan: 01:07:07

Yeah. Well, so now I just, I, I want to tell the listeners where they can find you the best way to connect if they listen to this, what's.

Where should they head to reach out to you?

Jen Uschold: 01:07:20

Yes.

So my physical therapy website is 180 therapy and wellness all spelled out.com and then the irise for me that is where I have the mental fitness as well as they have a six month pain to gain coaching program. And then I, I also do help people navigate divorce using these same strategies. Oh, that website is irise for me.com.

Julia Borgan: 01:07:49

So that.com excellent and we will put all your social media links. I know you're on LinkedIn. That's where we usually talk. We put it in the show notes and so people can access it easily.

So they can also find you on LinkedIn. Are you on Instagram as well, or.

Jen Uschold: 01:08:08

I pounded Instagram for a long time and I got no traction, so I'm not on Instagram anymore.

Julia Borgan: 01:08:16

Okay, Jen, thank you so much. Is there is anything else that you really want to say before we we close this, this first episode?

Jen Uschold: 01:08:29

I would like to say that pain is normal. Living in pain is not. And my broad mission is that pain is not a life sentence.

Julia Borgan: 01:08:42

Thank you. Thank you so much. Thank you for being with us today. Thank you for being launching me, making my dream possible. And definitely to be continued.