70% of Your Chronic Pain Starts in Your Brain | Dr. Daniel Amen
In this episode of The School of Greatness, Dr. Daniel Amen explains how brain health plays a crucial role in chronic pain, with 70% of chronic pain cases linked to brain function rather than physical injuries alone. He introduces the concept of a "doom loop," where pain and negative emotions create a cycle of increased suffering, and discusses how therapeutic approaches like ISTDP and EMDR can help break this cycle.
The conversation explores how an integrated approach to health—addressing biological, psychological, social, and spiritual aspects—can improve brain function and reduce pain. Amen shares research on how lifestyle factors such as cell phone use and diet affect brain health, while also examining the connection between spirituality and recovery from illness. The discussion includes practical techniques for managing negative thoughts and understanding how mental patterns influence physical well-being.
This is a preview of the Shortform summary of the Dec 8, 2025 episode of the The School of Greatness
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1-Page Summary
The Connection Between Brain Health and Physical/Emotional Pain
Daniel Amen explores the intricate relationship between brain health and pain, revealing that 70% of chronic pain is connected to brain function rather than physical injuries alone. He explains that medications like SAMe and [restricted term] can effectively treat both depression and arthritis because they target the same brain circuits.
Breaking the Pain Cycle
Amen introduces the concept of a "doom loop," where pain triggers negative emotions that activate the brain's suffering pathway. This creates a cycle of increased negative thoughts and tension. He emphasizes the importance of addressing brain health before considering surgical interventions, noting that therapeutic methods like ISTDP and EMDR can effectively process trauma and soothe the nervous system.
The Importance of a Holistic Health Approach
In his discussion, Amen advocates for an integrated approach to health that encompasses the brain, body, mind, relationships, and spirit. He presents his "Whole Four" program, which addresses biological, psychological, social, and spiritual domains simultaneously. Lewis Howes joins the conversation to discuss how health choices can influence future generations through epigenetics.
Mindset, Lifestyle, and Spirituality's Impact on Brain Health
Amen explains how thoughts affect every cell in the body, potentially leading to physical stress and pain. He suggests practical techniques for managing negative thoughts, such as psychological distancing and writing down negative thoughts to challenge them. The discussion extends to lifestyle factors, with Amen warning about the negative effects of excessive cell phone use, ultra-processed foods, and artificial sweeteners on brain health.
Regarding spirituality, Amen references an MRI study showing larger temporal lobes in believers and cites Harold Koenig's research demonstrating that regular churchgoers recover faster from illness and experience better mental health outcomes. He shares his experience with Teen Challenge, where faith-based programs showed high success rates by focusing on relationships with God and others.
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Counterarguments
- The claim that 70% of chronic pain is connected to brain function rather than physical injuries alone might be an oversimplification, as pain is a complex experience influenced by a multitude of factors including but not limited to physical, psychological, and social aspects.
- While medications like SAMe and [restricted term] may target brain circuits involved in both depression and arthritis, individual responses to these medications can vary, and they may not be effective for everyone.
- The concept of a "doom loop" is a useful model, but it may not capture the full complexity of the pain experience or the variety of coping mechanisms individuals use.
- While addressing brain health is crucial, surgical interventions may still be necessary and the best course of action for some types of pain and conditions.
- Therapeutic methods like ISTDP and EMDR are effective for some individuals, but they may not work for everyone, and other therapeutic approaches may be more suitable depending on the person's specific needs and circumstances.
- A holistic health approach is beneficial, but the "Whole Four" program may not be universally applicable or effective for all individuals, as people have diverse needs and may respond differently to various treatment modalities.
- The impact of health choices on future generations through epigenetics is an emerging field, and while there is evidence to support this, the extent and mechanisms of such influence are still being researched.
- The idea that thoughts can lead to physical stress and pain is supported by some research, but it is also important to recognize that physical conditions can exist independently of mental states.
- Psychological techniques for managing negative thoughts are varied, and what works for one person may not work for another; it's important to have a range of strategies available.
- The negative effects of lifestyle factors like excessive cell phone use, ultra-processed foods, and artificial sweeteners on brain health are areas of ongoing research, and conclusions may evolve as new evidence emerges.
- MRI studies showing larger temporal lobes in spiritual believers may not necessarily imply causation, and other factors could contribute to these findings.
- The faster recovery and better mental health outcomes among regular churchgoers could be influenced by a range of factors, including community support and lifestyle choices associated with religious participation, rather than spirituality alone.
- The success rates of faith-based programs like Teen Challenge may not be solely due to the focus on relationships with God and others; other elements of the program or selection biases could also contribute to their outcomes.
Actionables
- You can create a "brain-healthy" meal plan that avoids ultra-processed foods and artificial sweeteners, focusing instead on whole foods known to support brain function. Start by researching foods rich in omega-3 fatty acids, antioxidants, and vitamins that are linked to brain health, such as wild-caught salmon, blueberries, and leafy greens. Plan your meals for the week around these ingredients, ensuring you're nourishing your brain with every bite.
- Develop a daily "mind-body bridging" routine that combines physical exercise with mindfulness practices to address both physical and mental aspects of well-being. For example, after a 30-minute walk or yoga session, spend 10 minutes meditating or practicing deep breathing exercises. This routine aims to strengthen the connection between your physical state and mental clarity, potentially reducing stress and improving pain management.
- Engage in a "spiritual exploration" activity once a week to nurture your spiritual domain, which could involve attending a community religious service, exploring nature, or volunteering for a cause you're passionate about. The goal is to find a practice that resonates with you and contributes to a sense of purpose and connection, which may enhance your overall well-being and resilience against illness.
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The Connection Between Brain Health and Physical/Emotional Pain
Daniel Amen delves into the critical connection between brain health and the experience of physical and emotional pain in his new book.
Chronic Pain Links to Brain Health and Function
Amen discusses that 70% of chronic pain is linked to the brain, not just physical injuries. He explains how substances like SAMe and [restricted term] can treat depression and arthritis effectively because they target the same brain circuits. A healthy brain helps to balance these circuits and can thus reduce pain.
Improving Brain Health Can Reduce Pain
Negative Emotions Amplify the Brain's Pain, Creating a "Doom Loop" Of Suffering
The book introduces the "doom loop" concept, where pain activates the brain's feeling pathway, which then turns on the suffering pathway. This increases automatic negative thoughts, nervous tension, and harmful habits, creating a cycle of pain and suffering. Amen also mentions that due to the negativity bias, these negative thoughts can decrease activity in the prefrontal cortex, leading to a decreased ability to control judgement and impulses and making it harder to turn off pain signals. Overcoming pain involves breaking this "doom loop" to heal chronic physical and emotional pain.
Pain Treatments Target Brain Processing
Addressing Brain-Body Connection Crucial for Long-Term Pain Relief
Amen emphasizes the importance of brain health before considering surgery for issues like abnormal backs or necks shown in MRIs. He reflects on studies showing that 80% of people with no pain have abnormal back MRIs and cautions against the risks of general anesthesia. Instead, he highlights the body's natural healing abilities and the potential to heal or adapt to abnormalities w ...
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The Connection Between Brain Health and Physical/Emotional Pain
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Clarifications
- SAMe (S-adenosylmethionine) is a naturally occurring compound in the body that supports mood regulation and joint health by influencing neurotransmitter activity. [restricted term] (duloxetine) is a prescription medication that acts as a serotonin-norepinephrine reuptake inhibitor (SNRI), used to treat depression, anxiety, and certain types of chronic pain. Both work by altering brain chemistry to improve mood and reduce pain signals. Their effectiveness in pain and depression highlights the brain's role in these conditions.
- The brain circuits involved in pain include the limbic system, which processes emotions, and the prefrontal cortex, which regulates pain perception and mood. Depression and arthritis share overlapping pathways involving neurotransmitters like serotonin and norepinephrine that influence both mood and pain signals. Medications like SAMe and [restricted term] work by modulating these neurotransmitters to reduce inflammation and improve mood, thereby alleviating pain. This overlap explains why treating brain chemistry can help manage both emotional and physical pain conditions.
- The brain's "feeling pathway" involves regions like the insula and anterior cingulate cortex that process the emotional aspect of pain. The "suffering pathway" includes areas such as the prefrontal cortex and limbic system, which interpret pain as distress and contribute to emotional suffering. These pathways interact, amplifying the perception of pain beyond physical signals. Negative emotions can strengthen this connection, making pain feel more intense and persistent.
- Negativity bias is the brain's tendency to focus more on negative experiences than positive ones. This bias evolved to help humans quickly detect and respond to threats for survival. The prefrontal cortex, responsible for decision-making and impulse control, becomes less active when overwhelmed by negative thoughts. Reduced prefrontal cortex activity impairs judgment and self-regulation, making it harder to manage pain and emotions.
- The prefrontal cortex is the brain region responsible for complex cognitive behaviors like decision-making, judgment, and controlling impulses. It helps regulate emotional responses and suppresses inappropriate or harmful behaviors. In pain regulation, it modulates how pain signals are perceived and managed, reducing the intensity of pain experience. Damage or decreased activity in this area can impair self-control and increase sensitivity to pain.
- The "doom loop" is a cycle where pain triggers negative emotions, which then increase the perception of pain. This cycle involves brain areas that process feelings and suffering, reinforcing each other. Negative thoughts reduce activity in the prefrontal cortex, weakening self-control and pain regulation. Breaking this loop requires interventions that calm the brain and shift focus away from pain.
- ISTDP is a form of psychotherapy focused on rapidly accessing and resolving unconscious emotional conflicts. It uses intense, focused sessions to help patients confront and process deep-seated feelings causing psychological distress. The therapy aims to reduce symptoms by breaking through emotional barriers and promoting emotional awareness. It is often used to treat anxiety, depression, and trauma-related issues.
- EMDR is a psychotherapy technique used to help people process and heal from traumatic memories. It involves guided eye movements or other bilateral stimulation while recalling distressing events. This process is believed to help rewire the brain's response to trauma, reducing emotional distress. EMDR is often used to treat PTSD and other trauma-related conditions.
- The microbiome consists of trillions of bacteria and other microorganisms living mainly in the gut. These microbes ...
Counterarguments
- While the text suggests that 70% of chronic pain is linked to brain function, it's important to recognize that pain is a complex experience influenced by a multitude of factors, including tissue damage, inflammation, and individual pain thresholds. Other experts may argue that the brain's role, while significant, is just one aspect of a multifaceted issue.
- The effectiveness of SAMe and [restricted term] may vary among individuals, and while they target brain circuits, their efficacy is not guaranteed for all patients. There is also a risk of side effects that can sometimes outweigh the benefits.
- The concept of a "doom loop" is a useful metaphor, but it may oversimplify the complex interplay between emotions and pain. Some might argue that it doesn't fully capture the individual variability in coping mechanisms and resilience.
- The idea that negative emotions can decrease activity in the prefrontal cortex and thus impair judgment and impulse control is a generalization. Different individuals may experience varying degrees of this effect, and some may not experience it at all.
- The recommendation to prioritize brain health over surgery in cases of abnormal MRIs may not apply to all situations. Some conditions may indeed require surgical intervention, and the decision should be made on a case-by-case basis, considering the patient's specific circumstances and the advice of medical professionals.
- While ISTDP and EMDR are highlighted as effective therapeutic methods for processing trauma, it's important to note that not all patie ...
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The Importance of a Holistic Health Approach
Daniel Amen advocates for a comprehensive perspective on health, emphasizing the inextricable connection between the physical, mental, emotional, and spiritual components of well-being.
True Health Requires Addressing the "Whole Self" - Brain, Body, Mind, Relationships, and Spirit
Outdated and Ineffective: Separating Physical, Mental, and Emotional Health
Daniel Amen stresses the importance of a health approach that encapsulates the brain, body, mind, relationships, and spirit. He argues against the traditional separation of physical, mental, and emotional health, suggesting that what might seem like distinct disorders are often various manifestations of an unhealthy lifestyle and exposure to toxins. Amen proposes an integrated approach to address not only the brain’s health but also the mind’s thought patterns, the quality of personal relationships, and an individual’s spiritual alignment.
Integrated Approach Targeting "Whole Four" for Lasting Improvements in Pain, Mood, and Quality of Life
Neglecting one Domain Can Undermine Others
To further underline the interconnected nature of whole health, Amen introduces the "Whole Four" concept, which dovetails the biological, psychological, social, and spiritual domains. His 18-week "Amen Hole 4" program, which is faith-based, is crafted to simultaneously optimize all these areas. This program underlines Amen’s belief that by modeling daily behaviors that promote health, not just individuals but future generations can benefit.
Lewis Howes joins the discussion emphasizing t ...
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The Importance of a Holistic Health Approach
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Counterarguments
- While Daniel Amen's holistic approach is comprehensive, some critics argue that it may lack sufficient empirical evidence to support its efficacy compared to more conventional medical treatments.
- The integration of faith into the "Amen Hole 4" program may not appeal to or be appropriate for individuals with different religious beliefs or those who prefer secular approaches to health.
- The concept of epigenetics is complex, and while lifestyle can influence gene expression, the extent and mechanisms by which this happens are still under scientific investigation. It may be an oversimplification to suggest that health habits directly affect gene activation or deactivation in a predictable and significant way.
- Some health professionals might argue that while the interconnectedness of health domains is important, there is still a need for specialized care in cases of serious physical or mental health issues, which might not be adequately addressed by a generalist holistic approach.
- Critics may also point out that the "Whole Four" concept, while valuable, might not be entirely original, as it resembles other holistic health models that have been discussed and implemented in various health and wellness comm ...
Actionables
- You can create a personal "Whole Four" journal to track your daily activities and reflections in the four domains of health. Start by dividing the journal into four sections: Biological, Psychological, Social, and Spiritual. Each day, jot down what you did to nurture each area. For example, under Biological, you might note your exercise routine or a new healthy recipe you tried; under Psychological, a positive affirmation or a mental challenge you overcame; under Social, a meaningful conversation or an act of kindness; and under Spiritual, a moment of meditation or a passage that inspired you.
- Develop a "Family Health Tree" to visualize the impact of health habits across generations and to encourage family-wide wellness practices. Gather your family and draw a tree together, with branches representing different family members. On each branch, write down health habits, conditions, or traits that run in the family. Use this as a starting point to discuss how you can collectively adopt healthier behaviors, like planning weekly family hikes or cooking healthy meals together, to potentially influence your shared genetic expression positively.
- Initiate a "Community Health Buddy" syste ...
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Mindset, Lifestyle, and Spirituality's Impact on Brain Health
Daniel Amen and Lewis Howes discuss how a person's thoughts and lifestyle choices, along with their spiritual beliefs, can have significant effects on brain health and pain management.
Negative Thoughts Like Anxiety, Depression, and Self-Doubt Impair Brain Health and Cause Pain
The conversation begins with the acknowledgment that every thought can impact every cell in the body, affecting physiological responses and potentially leading to physical stress and pain. Amen highlights an epidemic of negative mental states, such as anxiety, depression, and ADHD, which impair brain health and well-being, worsening after the pandemic. He notes that chronic negativity increases the risk of dementia and is associated with two-thirds of psychiatric symptoms.
Training the Mind to Be Positive, Grateful, and Present Calms the Brain's Pain Response
Amen discusses the harmful effects of the negativity bias on the brain and how training the brain to be more positive, present, and grateful can calm the brain's pain response. He introduced techniques to manage the mind, such as not believing every negative thought, and recommends psychological distancing by giving one's mind a playful name, like his suggestion of visualizing a mischievous raccoon. He also encourages writing down negative thoughts and talking back to them to combat negative thinking patterns.
Key Lifestyle Habits Like Nutrition, Exercise, and Stress Management Are Essential for Brain Function and Resilience
Amen touches on lifestyle habits by associating [restricted term]-destroying activities, like excessive cell phone use and social media, with an increased risk of depression and suicidal ideation. He explains that ultra-processed foods, video games, and negative news can wear out the pleasure centers of the brain. Amen highlights the relationship between physical health and brain health, sharing how his father improved his brain health by losing weight and working out effectively.
Unhealthy Behaviors Harm Brain and Increase Pain
Amen critiques the over-prescription of SSRIs and the negative effects on the brain of substances like alcohol and artificial sweeteners such as aspartame and Splenda. These are implied to be behaviors that harm the brain and increase pain.
Spirituality Linked To Better Mental Health, Pain Tolerance, and Well-Being
Amen emphasizes the link between spirituality and better mental health, mentioning an MRI study which found that believers had larger temporal lobes. He infers that a healthy brain can experience a positive reception of consciousness, which can be disrupted by factors like inflammation.
Using Faith-Based Pr ...
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Mindset, Lifestyle, and Spirituality's Impact on Brain Health
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Counterarguments
- The assertion that every thought impacts every cell in the body may be an oversimplification, as the relationship between thoughts and physiological responses is complex and not fully understood.
- While negative mental states can impact brain health, it is important to recognize that conditions like anxiety, depression, and ADHD have multifactorial causes, including genetic, environmental, and biological factors, not just negative thinking or lifestyle choices.
- The claim that chronic negativity increases the risk of dementia could be misleading without acknowledging other significant risk factors such as age, genetics, and cardiovascular health.
- Techniques for training the brain to be positive may not be universally effective, as individuals respond differently to various psychological interventions.
- The role of [restricted term] in depression and suicidal ideation is complex, and while certain activities may influence [restricted term] levels, they are not the sole contributors to these mental health conditions.
- The critique of SSRIs and other substances like alcohol and artificial sweeteners may not fully consider their benefits or the nuances of their effects on different individuals.
- The link between spirituality and brain health is an area of ongoing research, and while some studies suggest benefits, it is not conclusive that spirituality directly causes better mental health or pain tolerance.
- The association between larger temporal lobes and spirituality may not imply causation, and other factors co ...
Actionables
- You can create a "positivity playlist" with songs that evoke gratitude and happiness, playing it during moments of stress to shift your mindset. Music has a profound effect on emotions, and by curating a playlist with tracks that have positive lyrics or uplifting melodies, you can counteract negative thoughts and foster a more positive mental state.
- Develop a "brain-friendly" meal plan by incorporating foods rich in omega-3 fatty acids, antioxidants, and vitamins known to support brain health. For example, you might start your day with a smoothie that includes spinach, blueberries, and flaxseed, or plan dinners featuring baked salmon with a side of quinoa and steamed broccoli.
- Engage in a weekly "digital det ...
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