In part one of this two-part experimental series, patient David undergoes a full neuroplastic pain assessment with Dr. Matt McClanahan, DO — a board-certified physician and expert in chronic pain. Join John Gasienica, LCSW, as he explores the nuanced diagnostic process, how emotional and historical factors play a role in chronic symptoms, and what it means when pain has no clear structural cause. This conversation will shift your understanding of pain and recovery.
This special episode captures part one of an innovative two-part series, following a patient's full neuroplastic pain journey — from diagnosis to treatment.
What you'll hear in this episode:
– A live neuroplastic pain assessment from Dr. Matt McClanahan, DO
– Discussion of "FIT criteria" (Functional, Inconsistent, Triggered symptoms)
– The impact of trauma and historical context on pain
– David’s candid account of how conflicting diagnoses made recovery harder
– A breakdown of why nervous system safety is essential for healing
Part two of this series will feature a treatment session with David and legendary insights on how to begin retraining the brain.
Podcast 4
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[00:00:00] Welcome to the PRT Podcast, brought to you by the pain rep processing therapy Center, a training center where thousands of doctors, therapists, nurses, and coaches have learned how to treat and eliminate their patients' chronic conditions. My name is John Seneca and I'm the director of Clinical Research and Development at the Pain Psychology Center in Los Angeles, where I team up with medical schools, healthcare companies, and government agencies.
To conduct research and improve the treatment of chronic conditions with psychology. Today's episode is part one of a two part series. That was a bit of an experiment. The idea was to have a patient, see an expert doctor who specializes in neuroplastic pain diagnosis, and then have that same patient do a session with me to see if we could show the whole journey from assessment through treatment.
I wanted to show the process we see all the time in our clinical trials where a patient discovers the underlying cause of their symptoms. And that actually learns how to change the patterns that keep them in pain. I honestly wasn't totally sure it was gonna work out in a podcast format, but once it was [00:01:00] all recorded, I was really glad we took the chance.
So in this first episode, you'll hear a patient named David getting a full neuroplastic pain assessment and diagnosis from one of the Best Mind Body doctors around Dr. Matt McClennan. You'll also hear Dr. Matt answer some of the most common questions patients have for doctors about their symptoms. This episode is about gaining more confidence in the neuroplastic pain diagnosis and finding the underlying causes of a sensitized nervous system.
Even if you're a hundred percent sure you have neuroplastic pain, I'm confident you'll benefit from the wisdom Dr. McClanahan shares about some of the blind spots people have in their recovery. The second part of this series features a legendary guest as well as the treatment session I conducted with David, where we'll show you how to actually start changing some of the trauma patterns that chronic pain is caused by.
So be sure to subscribe to the podcast to stay up to date on the next episode, or follow me on Instagram at john g dot therapy where I also answer questions and provide information on the tools we introduce before we get started. A brief disclaimer. [00:02:00] This podcast is presented solely for general information and entertainment purposes and is not intended as a substitute for the advice of a physician, psychotherapist, or other professional healthcare service.
If you have specific medical concerns or questions, please contact your personal healthcare provider. Now let's meet my guest for today's show. So joining me today is Dr. Matt McClannahan. He's a board certified physician in neuromuscular skeletal medicine and family medicine. He's the founder of the Center for Insight Medicine and an expert in chronic pain and central sensitization syndromes.
I first met Dr. Matt on a clinical trial for chronic pain, and I truly learned something from him. Each time we interact. He's a constant source of wisdom, not only in medicine, but in fields like psychology and philosophy. Welcome, Dr. Matt. How you doing? Uh, I'm doing really well. I feel welcome. Thanks. Glad to be here.
You know, one of the things I, I first learned about you through the studies that we did is that. You're just incredibly thorough in your assessments of patients and you take [00:03:00] this really holistic view of the client, um, before you arrive at a diagnosis. Why do you think that thoroughness and that holistic approach is important for chronic symptoms?
I am in this privileged place to really like zoom out or explore other areas. And as we've talked in the past, uh, you know, there's, it's one thing to. Determine the cause of something, but another thing. Determine the cause of the cause of that thing. And so that's where we can really put into context, uh, these symptoms in a whole person's life.
Neuroplastic symptoms most fundamentally operate on the nervous system's perception of safety and threat. And it takes a certain kind of questioning and inquiry to access. Where has safety and threat been? And is it in balance now? What about the past? What about their personality traits that help to either facilitate or resist, uh, certain.
Components of this, [00:04:00] and especially it's the threat. It's, it's usually the unpleasant stuff and the, and the negative danger signals. We don't get danger signals from contentment. Um, the contentment itself is the signal that, that your needs are being met. I like to say like, it, it just takes time and, and some finesse and just some experience in being able to kind of fare it out.
Where are these signals coming from and why are they there and why now I'm always struck by. Doctors who work in this MINDBODY field, because most of the stuff you weren't taught in medical school. So it means you have to learn more and be very curious. You're also bucking trends, so you are either starting your own business or kind of going against the typical paradigm.
I know you've worked with Dr. S Shuber before who, who's a disciple of John Sarno. Who are some of the other influences you've had that have inspired you to take this kind of more difficult route? That's a great question. My, my whole link to this whole world is Dr. Shuber. Um, and I encountered him about halfway through my [00:05:00] residency in 2012 and worked with him.
Yeah, that was life changing on the one hand to see that and on the other, it's just the pain I've experienced. I. Pain that didn't get better as a kid or a younger man always had this fantasy of like, what superpower would you want? And, you know, being able to fly would be pretty cool and, and all of that.
But I always had this idea that like, I would want to be like the Wolverine 'cause he always heals from things and I never feel like I can heal. Wow. I had a real distrust of my body. And then when I started to get introduced to this, I didn't even apply it to myself. I, I'd see a cardiologist about my palpitations and he wouldn't ask me about.
My life, um, or about what musculoskeletal complaints I have. And I went on acid reduction medication, but nobody was talking about my relatively lifelong, uh, sleep difficulty. And so these are the kinds of questions that I was to wrestle with myself. So it's been like a progression of, uh, continuing to more deeply inhabit this space.
I was [00:06:00] listening to this talk, Alan Gordon gave, it was a talk on accepting the diagnosis. Hmm. And I really applied it to myself for the first time, even after, I don't know, four-ish, three and a half, four years of, of being exposed to the model and knowing I had some of these stress induced symptoms. But I was working with a, a back injury as I, in quotes, that I thought I had, and just really applied it to that experience and got better.
And then after that I just, I couldn't not do this. I get to do this for a living now, so it's like amazing. I'm really excited for people to hear you. I. Pass this growth on forward to the client we have today. Who's David? Just to give a little background for the listener at home, David was in the ocean and cut his foot open on a piece of sheet metal and he received treatment, including stitches and a walking boot and thought he was on the road to recovery.
But like so many chronic pain sufferers, his recovery didn't go quite as planned. And let's take a listen as Dr. Matt asked David about his recovery.[00:07:00]
After the initial injury, you were in the boot and the pain was big and then got better and better and better. The stitches came out eventually, um, because they were, you know, not needed anymore. The wound held together and, and then you got better. Once I came outta the boot, it was, I, I slowly reintroduced myself back into like, boxing, things like that.
Um, after being off for, for so long and yeah, basically no pain. The pain had had decreased. It felt like nothing for about a year. It was pretty much the next summer, COVID restrictions had gotten tighter, so I wasn't able to do the things I'd usually do. I all I could do was run. Mm-hmm. Uh, it was something I'd never really done too much of before, but I, yeah.
So I started running and gradually I could feel this, this lump in my foot where the injury was the, the bigger it felt, the sort of tighter it felt. And the more of a grip around my foot, it seemed to have. Um, so it's pretty localized [00:08:00] to where the foot was cut open, where the scar tissue is, and then the like toes that were affected by potentially the scar tissue wrapping around the nerve in the foot.
Yeah. And that's the kind of operating diagnosis right now. This is a scar tissue problem. Yes. Well, this is where it gets a little bit, I've, I've. It really was affecting my day to day. So I, I, I went to gps, I went to specialists, nerve specialists, physiotherapists, and I've got about four or five different diagnosis of what the problem is.
Oh, can you, can you rattle those off or is that hard to do or do? Absolutely. No, absolutely. So scar tissue around the nerve is one of them. Scar tissue wrapping around the nerve is one of them. Okay. Uh, nerve damage, uh, where the, where the metal. Just chipped the nerve, not even severed. It just, they said it chipped.
And what, what that doctor told me was if you even opened up the skin and just [00:09:00] blew on the nerve, it would take like a long time for the nerve to sort of regenerate. And like I've been told, within a month of appointments, I was told one that it'll. It'll heal itself naturally. And the next month I was told it'll only get worse and worse as time goes on.
Um, so it was very exactly the opposite. Yeah. Yeah. And I thought it was interesting looking retrospectively at those diagnosis when I was told it was it was gonna get worse and worse over time and that it was permanent. Uh, that's when it, for me, it became permanent and I felt it ever since then.
So Dr. Matt, when you hear a, a patient like David who's gotten a lot of different explanations for their pain, what does that tell you about their case or what kind of alarms start going off in your brain when you hear this? The main thing that goes off for me is that there's a lack of clarity in the diagnosis.
It doesn't mean that all [00:10:00] diagnoses or all structural conditions are super clear cut from the beginning and. You know, you order these tests and then it's a, b, c. When you incorporate that someone has gotten multiple diagnoses for the same condition, that's the gray area that we can start to enter into to actually provide maybe a little bit of clarity.
We're we're going through the gray to provide a clarity or a story or, or some meaning. Um, rather than just like resisting the gray or knee jerking our way out of it. David even had, yeah, too contradicting. Things that the nerve will heal or no, the nerve won't heal and you're screwed. Both of those things can't exist.
Okay. At the same time. And it's, it's reasonable for us to enter in and especially the, the perception and the, the mindset that he had that this is a structural thing, so let's use structural treatments. Well, okay, so let's let that diagnosis be there. It's a structural diagnosis. Well. [00:11:00] How's that working for you?
Well, Dr. Phil question there, um, and it does, it wasn't working very well. I mean, he, he did a lot of work to, with rehab and his own kind of fitness and lots of, uh, injected and topical treatments. All of this after a time of complete resolution of symptoms. So all of that, uh, continues to point to this like gray area in which neuroplasticity lives.
I look at that in a. In a good way because it, it's, it's sort of like, has so much potential for us to probe, inquire a little more deeply even into that. So often the next part of the neuroplastic assessment is also checking in on some of the testing that's been done in the patient. So let's take a listen as Dr.
Matt hears about some of the testing David's had,
you've had. Some testing done on this, including imaging tests, right? Yes. And I, I, I would like to actually hear just a little bit about that, um, what you've had done and what was told to you and how, [00:12:00] how that's affected you. Yes. So before any of the injections, uh, I was told I had to get what's called nerve, nerve conduction.
Okay. Nerve conduction test, which was like. I believe electrodes sent through the nerves just to Same. Yeah. They stick 'em in your skin and zap you. Did you have that? Yeah. Yeah. So I had that and they said, yeah, there was definitely some nerve damage. Like just on that side. On that one foot? Just on the one.
Okay. They just on it. Uh, along that did they say, say there's severe or like no mi mild. They said mild. Okay. Uh, from there I was told I'd get Botox injections or there was a way that they could Wow. Sort of know, uh, put a blocker on the, the nerve, but those surgeries never came about. And like I'm still waiting on those surgeries.
The steroid injections did very little, like it was more, the anesthetic they put in, it was more helpful than the actual how long OID injections. How did the steroid injections help? The first one was [00:13:00] I. I think around a month and then the second one a week maybe tops. Okay. And I was, I was talking to my physio and said they should be six months.
They should be li like a minimum. Yeah. Every six months. Yeah. Mm-hmm. So I'm just kinda iffy then about Botox. So kinda like, I, you know, is it worth potentially risk and damage from more injections in, you know, into the ligaments? Like, um. Yeah, I mean with steroids especially, that kind of thing. I mean, well steroids for more injections, but it, you know, if you get a procedure to go back in there, it could damage the nerve further.
You know, I, I'm looking at all this in, in the right setting. People can have, like you said, uh, transient, uh, changes to like a nerve conduction study, but it actually doesn't make sense to me that. You would've damaged the nerve and then had, you know, six months or something of no symptoms at all. Right.
When, when you really, when you first had re were recovered from the initial [00:14:00] acute tissue injury. Um, yeah. And then for it to start, like kind of coming back like that just doesn't make medical sense to me from that standpoint. Or that there's scar tissue wrapping around the nerve or, and just the variety of, of symptoms.
You kind of indicated at least on, on one thing that even like. That the symptoms still like being 24 7, but they, they're still like a, a ver a variability. Yeah. Like you said, you know, they can get down to a two, but get up to a seven. That's a high level of pain to have constantly. But like that, there's still variability.
Like that's, that's all good news in all evidence for neuroplasticity, irrespective of a nerve conduction study. Those things can have false positives. We'll get a lot of people that are diagnosed with something called small fiber neuropathy. Or a lot of people with mild changes. Um, it's funny, I'll, I'll get people that were looking for one thing and they got another, like, they were looking for, I don't know, like carpal tunnel syndrome and instead that, that seemed, that was normal [00:15:00] or whatever, but they, uh, they found like mild damage somewhere else in, in, in that same upper extremity.
They're not having any symptoms there at all.
So I was talking with this great doctor, another doctor that I work with, and she teaches at a medical school, and she was saying one of the problems she sees in the medical community is doctors using tests as a basis for their diagnosis rather than something that's confirming a diagnosis. Why do you think it's important to, to look at the context of a patient's situation rather than looking at something like a nerve conduction test and, and making a diagnosis?
Just s basing it on that. We have a few instances where this is really relevant. Most notably we see this in the people with, uh, changes on MRIs, but they're asymptomatic. Lots of degenerative disc disease, disc bulges, [00:16:00] a number of different. Age related arthritis and degeneration related sim signs. Okay.
Actually objective evidence on MRIs. But these people have no pain. And yeah, maybe they were getting some scan for a, a kidney stone and, and the radiologist, because they're obligated to, were reports on degenerative changes in the spine and these people start having back pain. Sometimes this is life saving.
We'll, we'll scan for a kidney stone and find a, and find a an adrenal. Tumor. So it, it's not that these are all bad in one sense, but how much fear it adds to this. Mm-hmm. Um, so there's another. Uh, instance in, in the gynecologic world like endometriosis, that's a severe, it can be a really debilitating condition.
Um, but they've done laparoscopies on people with no pain and we find endometriosis in there and they find these people with, um, terrible, horrific pain and have been diagnosed clinically, uh, just manually as endometriosis. And we go in and find nothing. [00:17:00] In carpal tunnel syndrome. Uh, one study in from 2019 found that that 43% of people, um, with no pain, no symptoms of carpal tunnel syndrome, had a positive nerve conduction study.
Wow. The idea is simply that we want to situate our diagnostic testing in the setting of. History and physical. I mean, this gets back to old school medicine and we're all taught this. We just have sort of stopped doing that or we don't do it quite as much. We really have to start to say, okay, well yeah it said this, but because of this and this and this piece of evidence, all of which indicate like a neuroplastic pattern, we have to question the validity.
You know, I have gray hair in my beard more so since uh, my two and a half year old was born. Um, and that doesn't mean my face hurts. Um, my ego might a little bit, but you know, we talk about some of these degenerative findings as just like gray hair of [00:18:00] the spine or wrinkles on the inside. And, um, so we, we wanna just take it in context.
In this next clip, Dr. Matt starts to put together some of the context for David so that he can understand some of the reasons why he's getting toward a, a diagnosis of neuroplastic pain. Let's take a listen.
I dunno if you've heard of that. FIT FIT testing or FIT criteria for neuroplasticity. Have you ever heard that term fit? Mm, I actually don't think I have. Oh, okay. That's great. So tho those letters mean functional, inconsistent, and triggered. FIT Then these are, these are Hallmark symptoms or we would call these like confirmatory criteria for, uh, considering neuroplasticity.
And it doesn't mean that like, if you have one of these, that definitely can't be something else. But once we've, uh, gone through the ringer, uh, of diagnostic and treatment, uh, you know, protocols and we still have symptoms, we start to really look for this. [00:19:00] A functional change would be that your pain started af long after normal tissue healing.
And you had had tissue healing and no symptoms for a time. Great. That's a, that's a functional thing. Another functional piece of it. And this is functional or inconsistent, but like that the quality of your pain is so different at times. Sometimes it's a pulling and other times it's aching and sometimes it's itching and sometimes it's burning.
It does one, one day or, or multiple shifts around it within a day. Uh, and in a, in a nerve person or a chiropractor or even a neurologist might say, well, that's just what nerves do. Um, but that, that doesn't exactly make sense. Like certain nerves do certain things and so, um, uh, but that would be a kind of a, a functional thing.
The inconsistency at the beginning, um, would be, uh, that you would have good days and bad days, right? The intensity of it would change. You said there were times where certain stretches or doing activity would help it some days earlier on, and then an exercise, and then after that it would like the same exact thing would make it worse.
Yeah. [00:20:00] That, that inconsistency is a big piece. And the last part is triggered, uh, triggered by stress. Sometimes it's triggered by weather. Sometimes it's triggered by a certain kind of shoe, right? I'm not saying that there aren't variables, okay. Or that every shoe is the same, but the idea is like the forces on the area are relatively the same.
Regardless of the kind of chew, um, and that, that you would have like, you know, a market increase in pain with one and not the other. That's, that, that would be this sort of a triggered. Or inconsistent even, um, factor that, that we look at.
So in that section, I hear you breaking down for David, his history and his symptoms under this fit criteria that comes from Dr. S Shuber. In my experience, it helps the client see the cause of the cause. This is a phrase that you've used to me. When a patient says, well, my pain is being caused by this, and you ask them, well, what is the cause of the cause?
Can you expand on that a little bit? Help people understand what you mean by that? [00:21:00] So, the cause of the cause is, is something that, uh, another practitioner actually functional medicine talked about in looking for the reason behind the reason, and I'll give you some examples of that. So let's say that someone has diabetic neuropathy, which is a structural, you know, neuropathic type pain, not neuroplastic, and it shows up in this or that way.
And what, what is the cause of that? Well, it's. High blood sugar over too long of a time. Okay, great. Well, what's the cause of that? Cause? Well, I ate, you know, too many carbohydrates. I've got a genetic predisposition to this. I have a sedentary job and lifestyle. Um, I. Okay, good. Well, what's the cause of that?
Um, we're at a third of, cause now we find out then, you know, ask them questions like, well tell me about like, why do you eat and when do you eat and, uh, how do you eat? And we find out that there's a stress mediated component to eating comfort foods or stress eating or eating your feelings or whatever we want to call it.
Okay. So we're, we're way a different thing now. And all of these things [00:22:00] are not irrelevant hormones and such, and bad choices for foods and all of that. But, um, when food is also a comfort. That becomes something that a, an an uncomfortable nervous system will turn to more and more frequently, which leads to all these like metabolic dysfunctions down the road.
And so the cause of the cause I'll get people then with back pain and they'll say the back pain's causing is caused from my tight muscles. Or they'll say that, you know, I've got spinal misalignment or subluxations is what my chiropractor told me, or their osteopath said they have some dysfunctions.
These are all words that we use and those are not unuseful words. Um, but what moves? Bones? Muscles, well, mire muscles get tight. Look at tight for all sorts of reasons. And yes, uh, you know, inactivity or, or deconditioning and, and that kind of thing. I is part of it. And sitting all day long. This is not like ideal for.
What we're built for on the one hand, but another thing that tightens muscles is [00:23:00] stress. Mm-hmm. Chronic stress, repeated stress. We found that there are autonomic nervous system fibers that fight, flight, freeze. Part of our nervous system embedded into these trigger points that we can get, and that muscle relaxers sometimes don't reduce these trigger points, but sympathetic blockade like fight flight energy blockade.
Will actually reduce and relax these trigger points. So it's very interesting to me that, uh, we can start to look at the cause of the cause and we just have to keep asking a few questions, you know, why now or, uh, what, what else was going on at the time when this began? Or tell me about your childhood, or tell me about what don't you like about your life?
Where do you feel the most powerless or stuck right now outside of your health? And when people can start to. Zoom out and look inward. Both. That's where we start to put together this picture and we can start to see a cause of a cause rather than just bad posture or too much food or whatever we're [00:24:00] told or assume, or some well-meaning healing practitioner has, uh, foisted upon us in our belief system.
It might not translate for the podcast as we had to cut down a two hour session you had with down to 20 minutes, but. Just your insistence on specificity. Mm-hmm. It wasn't just asking about certain things, it was asking follow up questions, pushing the patient upstream. In this next section, you'll hear Dr.
Matt focus a little bit more on the psychological factors in the patient.
Do you have any other triggers? I mean, you kind of identified stress. It's, it's, it's a bit of an odd one that, that it's kind of a chicken and an egg situation with. Sort of mental health. It's like I could be having a very low day and then that in fact, impacts my pain. Mm-hmm. Or vice versa, if, if the pain's very bad one day, that that can bring my mood down a lot.
Yeah. Yeah. And so it's, it's just the constant feeding cycle in my, um, reading of this, that the anxiety and depression are longer [00:25:00] lasting. Are they predated this, or, uh, they would, they would long, long predate to be, yeah. To be fair, um, since I was about. Yeah. You said 14. That's right. Yep. Yeah, so it wasn't any trigger really of these mental health issues always kinda existed.
But my father actually passed away from suicide when I was Yeah, I read that. I'm really sorry. God, thank you. I think
it would've, yeah, it definitely just changed the way a lot of my problems would've manifested and, and how I dealt with them and things. Um, yeah, but I suppose in, in a way, it also led me to, to take counseling for, for them as well. Uh, the most recent time I was back in counseling would've been, uh, the past year just gone, and it was related primarily to the pain because the pain got to the point where it was 24 7.
Yeah, [00:26:00] yeah. My, my, my thoughts were based on the pain. Like, yeah. First thing I'd wake up and like, check in with. The pain was, and it would keep me up at night. So it was pretty much became my whole cycle of life at that stage. I guess I'm curious then, otherwise like. At the time of the injury, uh, at the time of a year later ish when the symptoms kind of went from pretty much fully recovered to like kind of niggling, and now you're noticing it when you're running and now you're noticing it more, and now it's like all the time.
And now it's 24 7, and now it's like, uh, crippling your life. Tell me about safety and threat. And this might be a list for you to make on your sheet there on your note. Yeah. Like list of threats and I'll just put at the top, uh, global Pandemic. Yeah, absolutely. I mean, that was a, um, a major one like before Covid.
And then during Covid, actually right as I was leaving my undergrad, um, I started to have panic attacks mm-hmm. Towards the end of my finals. [00:27:00] Um, and they were very, very sparse. I have won, I'd have like around major life events, um, so I'd had. I don't know, maybe three or four big ones that I can think of.
Definitely two that I was hospitalized over. They, they were seen as, um, they were perceived heart attacks. Oh, yeah. Came with chest pain and that kind of thing. Yeah, sure. I, yeah, that there was definitely those, and then post the injury, I started to have regular panic attacks. Have you considered that panic attacks or just a neuroplastic symptom too?
That's a, that's a very interesting, uh, little things, insubstantial things, who knows what. Yeah. Sometimes it's stress, sometimes you can't figure it out. Um, I mean, panic attack itself, like it feels like you're dying of a heart attack, et cetera. Mm-hmm. And everything's one a hundred percent fine. I mean, it doesn't feel fine, but Right.
You out the labs, you rule out heart damage. Uh, [00:28:00] they give you some medication in the, uh, after hours clinic and or whatever, and you're. Back to basically normal or the next day. And so it's kind of interesting, right? Well, the weirdest thing that you've put those two sort of together now, and when we were talking about both things, one little thing in my brain kept ticking over and over, and it's something that I had in common for both and for both the pain in my foot and the panic attacks, I always class them as fear.
Do you know the acronym Fear? False Evidence appearing real. Oh, I've not heard that. That's great. I might use that. No false evidence appearing real. Okay. Thanks. Appearing real. And I've, I've, I've noticed, I guess retroactively and now that you're saying that, that, that both really fall under that purview of there's nothing physically causing it, it's all mentally Yeah.
Sort of exacerbated. Yeah. I, that's it just takes sometimes someone else saying these things mm-hmm. To like, mm-hmm. For you to make that link in the mind.[00:29:00]
So we hear David kind of have this aha moment or this click in his brain. Why do you think understanding that his panic attacks and his pain were in the same category was, uh, was a big deal for him? I think that legitimizes both of them. I hope it does and provides even a, a greater strength of evidence that.
One, he has a strong mind body connection. And two, that there are unrecognized threat states inside of him and for reasons that he even acknowledged, right? These panic attacks come around, uh, life circumstances, et cetera. And when you can start to put together this very real experience of his, in the context of very real.
Conflict or stress or trauma, if you will. Then it, it makes so [00:30:00] much more sense. And when things are clear, when they make sense, that is a form of safety. And when you can start to write this down, man, it, it like puts together, you start to paint yourself a picture or listen to the story for the first time that your nervous system is telling you like, oh my goodness.
Like it's, in a way it's been trying to help me. Or it's the one thing I'll listen to, to, to assert boundaries or to ch make changes in my life or, or just take care of myself in a new way that is more than just a, my busted, broken, fragile self. So, so far, we've heard in this session with David, Dr.
Gathered some evidence, he's helped David understand the connection between the mental health and the physical health. And now, as Dr. Matt has been explaining, we're gonna start going into looking for the meaning of the symptoms. So let's take a lesson.[00:31:00]
There's a, um, there's a quote I like, I, I heard it. It comes out of like addiction and recovery, sort of, um, language and programs. But it says, uh, if it's hysterical, it's historical. And hysterical is kind of an overdone word. I don't, I don't mean like overly dramatized, but like, if it's really intense, that means it's, it, it's, it's got connections to the past.
And so a lot of times, like panic attacks starting like this really intense and overly intense, uh, false evidence appearing, real appearing like, I'm dying and, and you're not dying. But the idea being there's probably something historical. It can be of use. Now you can pour yourself back into like all the Gabor mate books that are there out there in the world, which I read all of them and they're awesome.
Um, you could obsess about like this naval gazing and, and self dissection to, as a way to, to cope with that. That is one way of dealing with it versus gentle patient accepting inquiry. Why is my body in mind in this threat state? It's funny you were saying, uh, if it's [00:32:00] hysterical, it's historical. I can remember quite vividly like the days of panic attacks, you know, from the last however many years.
I can remember the worst days that were happening, but not too much of the details of what was where I was in life at the time or what. Interesting. You remember the symptoms, but not the context. Yeah. Yeah, absolutely. Yeah.
What does this tell you? When a patient focuses on the symptoms, but the context just kind of fades away? Yeah, that tells me the symptoms are serving a purpose. They are, in fact the lesser of the pains. You know, it's really. Easy to talk about, you know, what new anti-inflammatory diet or supplement you're taking and which Pilates instructor you're working with, and what you learned in PT last week, and much more difficult to talk about how difficult your children are or the traumas in your life that are, that [00:33:00] have happened or that are being triggered.
Again, I recently heard. Somebody described this as trying to, you know, swim in the deep end while holding a beach ball underwater. Mm. Like the beach ball has all this pain and emotion and, and the trauma that wants to come up inside of us. And, um, just be processed, be digested, be witnessed, uh, be brought safety and power and connection and meaning to all of this, and yet we resist it.
When we can start to embrace or just have this curiosity, just essentially bring safety to all of our unpleasantness, unpleasant physical sensations, unpleasant emotions, whatever pain we've been through, past or present, or even our personality traits, everything's here to help because it's pointing to something that's not working.
It's a check engine light. I hate when my check engine light goes off in my car. Because it means I gotta do something and I'm too busy and I don't want to go to the shop and I don't wanna spend money on this kind of thing. [00:34:00] Like, I don't wanna look at this right now. And David, his father committed suicide at age 18.
Well, that's really devastating. But I would guess that like it wasn't an overnight, he was a great person and dad and totally integrated. And then, then this happened one day. I would guess there were years of depression or anxiety or other symptoms preceding that. He talks about age 14 is when some symptoms started and he doesn't know what happened.
Well, I would guess that if we have enough time and patience and gentleness and we're trauma informed, and that's kind of a buzzword, but what that means is like we are aware and compassionate and curious, and also providing enough safety to witness what. Needs attention, and I love the way you frame this of the examination, being gentle, being kind as you approach these things often is the cure.
It's not [00:35:00] this thing where you need to solve all these problems in your life, right? So often it's just you need to change the way in which you're perceiving reality, which is a lot easier of a fix. Uh, than having to change the external world. Yeah, I, there's this other quote. This comes from, uh, a poem by this guy Jeff Foster.
A patient sent me this, um, I'll kind of skip around. It's, it's not really long, but it starts, stop trying to heal yourself. Fix yourself, even awaken yourself. Let go of letting go in quotes. Healing is not a destination. Your pain, your sorrow, your doubts. Your longings, your anger, your fearful thoughts, they're not mistakes and they aren't asking to be healed.
They're asking to be held here now lightly in the loving, healing arms of present awareness. And I love that because everything in my training and everything in my character formation says it's not okay to feel bad. It's not [00:36:00] okay to struggle. You need to succeed. Failure is not an option. When like every great teacher, and even people like Tony Robbins, you know, our gurus and like life coaches, and the most awesome of us say failures are the greatest teachers.
Mm-hmm. If we can listen to our pain and if we can hold it rather than just fix it. If we can do this in our relationships and in our marriages, I don't need you to fix it, honey. I just need you to listen. Like we can be the, the conduit for, for bringing safety to our, uh, patients and to their pain. This is not our job to lift or fix it for them to do the heavy lifting.
We're not their Sherpas, but we're their guides. We are pointing the way and walking with them ways, uh, on a path of safety and power and connection and meaning, and that those [00:37:00] things are how your nervous system. Know that it's safe. So in this next section, Dr. Matt does exactly that. He helps put the picture together for David and helps give him a nudge on the way toward.
This meaning getting some of this power, getting some of this confidence back. So let's take a listen.
I, I actually talk about something called shift criteria, the S and the H stand for sensitization and historical factors. You filled out something called an adverse childhood experience questionnaire. Do you remember that? Ace Adverse child? Mm-hmm. It was 10 questions that has someone had, you know. Uh, inappropriate sexual contact with you?
No, thank God. You know, did someone beat you around as a kid? Did you, you know, did you, somebody, did somebody go to prison? You know, that, those kinds of questions, he said, no, no, no. But you said yes to three of those questions, right? Um, and so we would say your ACE score is three out of 10. And that other question then on, on my neuroplastic symptom questionnaire, you know, if a, if a child that you care about was growing up the [00:38:00] same way you did, how would that make you feel?
You said very, very sad or very angry. Um, between maybe some of these familial things. You also said some bullying, which I, I also experienced that as a child. And, um, those factors in addition to variability of symptoms and a long time between injury and then real, the onset of the, of the, the cyclical kind of nature of this.
Um, a, a lot of those things in addition to the anxiety and depression, which is related to everything, it's just, it's very clear to me that these are neuroplastic symptoms you're having. I'm confident that it's a hundred percent. Neuroplastic, like, it's not a, it's not a thing where you, well, maybe there is that scar tissue.
Um, because the, the variability and, and the, the, the difference even in the quality, uh, of, uh, of what happened just doesn't hold water with the structural. Explanation. I just wonder how that, how that lands for you. How, how does that make you feel? Yeah, I mean, weirdly it's, it's kind of a relief, you know, a huge relief because the more you go after the structural, [00:39:00] the more you try and tackle that, it's like you, you're ended up down dead end roads and you're just set back.
More and more every time the surgery mm-hmm. Wears off, like that was probably one of the lowest points, like mm-hmm. Maybe the second time I'd gotten the injection and, um, it wor it, like, it, it essentially don't maybe work for a week and then it wasn't providing any relief at all. And it just like, well, you know, what is, what is how discouraging.
Yeah. Yeah. So, you know, it's a relief to know that it's. It's, it's most likely neuroplastic or is, you know, is definitely neuroplastic. Uh, yeah. And I think retroactively and the more we've been talking, all of those things are sort of clicking together now of, of how they feed into one another. Panic Yeah.
Know. Yeah. Everything, it, it's, it's sort of making sense and it's one of those things, it'll take a while for it to click together in my brain. Mm-hmm. Sure. Like looking back, it's all sort of, yeah. I can see the sort of connections already. Forming, I guess in my mind I would say, [00:40:00] yeah. How was this experience?
I mean, did it feel, feel good, natural, like really, really helpful. And I, I didn't want to jinx it, but at a certain point when we were talking, um, I just couldn't feel my foot anymore. Oh. Oh, great. Yeah, sure. Yeah. You know, I think when we were talking, forget specifically what part of we were discussing, but I just.
Yeah, it, it, I have a shoulder injury as well that only, like we were saying about the pants, you only feel them when you think about them. I have a shoulder injury that's exactly the same. Yeah. I only feel it when I think about it. Uh, the foot went to like that. It went to like the, oh, well I don't feel it right now.
If I think about it, it's back, but, you know. Yeah. Um, definitely very, that's a piece of evidence to write down by the way that your symptoms went away. When we were talking or engaged, or you were really considering or thinking deeply about Yeah, that, that's actually what I was gonna say is that, um, that gave, when that started to go away, that gave me like great evidence that it was neuroplastic.[00:41:00]
This has just been absolutely wonderful. And, and, uh, before we leave, I just want to give you an opportunity if you had anything final to say to people listening, any, any message that you'd wanna give out. Yeah, thanks. I would just say trust your pain and turn towards it. Um, these pains you feel are messengers.
Listen to them. If it's hysterical, it's historical. I said that to, uh, David as well. And I have gotten so much mileage out of that, um, because in a way, every one of my symptoms has been hysterical, not crazy fabricated. Um, but if it reaches the level of, of a symptom for me, it means that like something needs attention.
And that might just mean like I need to pause and breathe and, and reintroduce some safety. Um, but it almost always means that some old part of me that is mad, sad or scared is being poked at. And I've got [00:42:00] other parts of me that are rising up to push it back down and, um, yeah, the way out is through. So.
Amazing. Well, thank you so much for your time today, Dr. Matt. Yeah. John, it's been a real pleasure and I just have real admiration for your work and your approach and your gentle, but also courageous like love and approach to patients. It is. It's a thing to behold, so keep it up. That means a lot. Thanks a lot.
Thank you for listening to the PRT podcast, brought to you by the Pain ing Therapy Center. I wanna thank our guest, Dr. Matt McClanahan for joining me today. You can visit his website at center for insight medicine.com. Finally, I wanna give a special thank you to David for allowing us to broadcast a piece of your journey.
To stay up to date on the next episode, please be sure to subscribe to our show. And if you'd like to partake in a [00:43:00] session for the podcast, message me on Instagram at John g Therapy where I answer questions and provide information on the tools we cover in the episodes. Thank you again for listening.