Becoming Pain-Free: Dr. Amy Baxter Of Pain Care Labs On How to Alleviate Chronic Pain

So many people suffer from chronic pain. Often people believe that they have tried everything, and that there is no real hope for them to live pain-free. What are some things these individuals can do, to help reduce or even eliminate their pain? In this interview series, called “Becoming Pain-Free: How to Alleviate Chronic Pain” we are talking to medical professionals, pain management specialists and authors who can share their insights and strategies about how to alleviate chronic pain. As a part of this series we had the pleasure of interviewing Dr. Amy Baxter.

Neuroscientist Amy Baxter MD FAAP FACEP is CEO of Pain Care Labs (PCL) and is an Associate Clinical Professor at Augusta University. After Yale, Emory Medical School, and fellowships in Child Abuse, Pediatric Emergency Medicine and clinical research she invented her first device to biohack pain. Federally funded for needle fear, pain relief and opioid reduction research, she publishes and lectures internationally on how options retrain the brain to give power over pain.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you share your “backstory” with us?

As a pediatrician, my research was always in different types of suffering — PTSD, scald burns in children, liver injuries, nausea. I grew up poor, so anything unnecessary or wasteful also bothered me. In particular, I was always annoyed at unnecessary pain — we doctors have ways to block pain, why weren’t we using it more often? I invented a device to block needle pain and began using it for my kids’ vaccinations. Since it wasn’t proven or FDA registered, of course I couldn’t use my little prototype to help the kids in the emergency department where I worked. I knew that there was a way to stop pain on contact, but unless I went through the process of getting a grant and researching it and learned how to create medical devices my invention was never going to do anyone any good. To be honest, I was both scared and resentful in a way — why can’t someone else take this idea and do it? I don’t want to change my job or my life! But my family and I talked about it, and we thought “how hard can it be? Take a year to see this through.” With my first NIH grant, I discovered that blocking pain wasn’t enough — you had to deal with fear as well. That was 2008!

The last 10 years of practice, I was doing sedations for kids with broken arms or MRIs. I started realizing that how I spoke to kids while giving the medicine and the environment I created dramatically impacted how well those medications worked.

Can you share the most interesting story that happened to you since you started your career? What were the main lessons or takeaways from that story?

Fast forward to 2015 and one of my colleagues used my Buzzy needle pain device to not take opioids after a knee surgery. This was when I decided to quit practicing and really dig into how Physiology focus and fear were related for all kinds of pain. When I began trying to figure out how vibration worked in 2017, there were a lot of new articles that explained how the science we thought we knew about gate control, TENS units, and that kind of thing were wrong. Most importantly, the opioid crisis had hit, and I began to understand that what I had always learned about opioids — and taught in lectures! — was wrong.

One day I was reading a chapter on pain perception and vibration by an Italian researcher. It was like the Usual Suspects — all the clues I’d been reading about over the years came together with new studies. All at once I understood why Buzzy worked when it did, why it didn’t when it didn’t, how to change it for better pain relief, what studies were needed to go further — it was a moment of nerd bliss.

It has been said that our mistakes can be our greatest teachers. Can you share a story about a mistake you made when you were first starting? Can you tell us what lesson you learned from that?

My first study on teenagers with Buzzy didn’t work. When we dug into the numbers, Buzzy only worked if patients weren’t afraid of needles, but 67% of our teenagers were afraid. I was devastated- not because it didn’t work, but because that incidence of needle fear was three times higher than had been previously reported. Clearly, I figured, I had somehow messed up my questionnaire or the way we presented the question to kids that caused them to be more afraid. After sulking for about a year worried that my science was bad, another researcher published a survey of kids in a Science Museum and guess what? 67% of them were afraid of needles. Coincidence? I went back into my data and found that what both of us were seeing was true- there was a real increase in needle fear vastly higher than had been previously shown.

What I learned from this was that if something doesn’t look right you can’t accept it on face value but have to really understand the why rather than accepting the what. The why was that fear is one of the volume knobs for pain, and because of the new way we started giving boosters in the late 80s a whole generation has now become afraid of needles.

When it comes to health and wellness, how is the work you are doing helping to make a bigger impact in the world?

Since I’ve quit practicing medicine I realize the huge skepticism that all physicians have against anything that’s not a pill. Physicians fear looking foolish or believing something before everyone else. We have a very monocular view of medicine- we’re trained with multiple choice tests and they’re always one right answer to a problem. At the same time, in the last decade doctors have less and less time to explore new information. With pain there is never one right answer. The way our brains are wired, even after the structural problem in the body is resolved the structure of our brain can change to keep feeling pain. And medications can’t remodel your brain back to its pre-pain state.

While I think my vibration frequency devices have a role to play, I think the most important thing I can do is explain that being in control of pain and being able to reduce fear and ignore pain are two of the biggest contributions that any intervention can make. In 2013 I published three overlapping circles with physiology, fear, and focus. Pain is the experience in the middle. When we’re overwhelmed or feel that there are no options, pain is increased. When we fear damage, we stop moving and make pain worse. My best purpose is to be a physician who absolutely supports opioids in the hospital, but understands and can communicate that the next phase of pain management leverages options, and the way back from chronic pain doesn’t use medications at all.

Let’s jump to the main focus of this series. For the benefit of our readers, can you please tell us why you are an authority on the subject of chronic pain?

First, I have a huge accumulation of suffering-related knowledge from my child abuse/emergency/needle pain/sedation background. Second, I was lucky enough to be NIH-funded during the most productive pain research granting period in history. The Help End Addiction Longterm, or HEAL program, gives me the luxury of learning more new pain science than physicians working in a hospital ever have. Serving on scientific review groups of new grant applications gives insight to potential breakthroughs. When you have 15 or 20 unrelated applications that you review in a year you start making connections that you wouldn’t see otherwise. It’s the synthesis of these new areas of science that have led to a more unified understanding of pain perception.

The cool thing is that all of this research has just validated the experience of what a Child Life specialist taught me about pain a decade ago. Child Life specialists are highly trained to be able to explain procedures to any age child in a hospital, and use multiple techniques to help them tolerate pain and not become traumatized. When I was speaking at a hospital in Wisconsin about pain relief, a woman in a wheelchair offered to tell me about her perspective on pain. She had juvenile arthritis but was now an adult, and had more surgeries than she could count. I had just finished a huge talk about how and when to use specific pain drugs, and she said, “the thing is, that’s always the smallest source of options. When you can’t take another pill or do another surgery, then what? There are lots more over the counter medications and supplements than prescriptions. There are lots more physical options than supplements. And there are SO many more things to do to take your mind off pain. The combinations are infinite, you just have to start creatively thinking about ways to feel better rather than thinking about pain.”

Can you please share with us a few of the most common causes of chronic pain?

Well by the numbers, 65 million people in the US have had a recent back injury, and16 million have chronic back pain at any given time. Arthritis and knee pain come in second as causes of pain that stick around. There are other kinds of chronic pain that aren’t related to injury or wear and tear, but inflammatory conditions like auto-immune diseases. Multiple sclerosis is the top here, and fibromyalgia, chronic fatigue syndrome, and now long COVID are situations where the body attacks itself just enough to cause pain all the time. Finally, there are “come and go” chronic pains that flare up, like migraines, Crohn’s and ulcerative colitis. Most chronic pain started as an acute issue, then became chronic over time. Acute pain goes through a path in the brain that reduces pain perception — endorphins, inhibition from the thalamus, reduction of impact and fear by the ACC. Chronic pain is processed almost completely differently — it bypasses the endorphins, gets ramped UP in the thalamus, and goes to the fear, memory, and catastrophizing areas.

There are many different types of pain that people struggle with. Which specific form of pain would you like to focus on in this interview? Why that one?

The pain I’m most expert with is the kind of pain I have personal experience with, and the pain that I think we have the best answers for. I have broken 8 or 9 bones in my life through a mix of impulsivity and clumsiness, including ribs and a neck injury that had me intubated for 5 days. The recovery after an injury often leads to chronic pain but doesn’t have to. By understanding how the brain processes and creates pain, this kind of acute to chronic is most familiar. These techniques can help people with chronic pain as well, but ongoing rheumatologic issues are a somewhat different situation. Hopefully we’ll learn more about the inflammatory kinds of autoimmune pain as we understand long COVID better. For now, though, I want to talk about how to live life better despite musculoskeletal chronic pain, and how to avoid it after surgery or injury.

Here is the main question of our interview. Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey toward becoming pain-free? Please give an example or story for each.

First, I think it’s a mistake to frame anything in terms of being pain-free. This means you have to draw your attention to pain to constantly assess how much you have. That’s a cognitive error we reinforced with the “pain is the 5th vital sign” sort of stuff. It was well intentioned, and is appropriate in a hospital, but life is pain. The goal is to be able to tolerate discomfort and do the things we want to do.

1 . Think in terms of goals, not grievances. This is an adaptation of something called Acceptance and Commitment Therapy. When the structural cause of pain can’t be found or is no longer there, the brain still keeps the counterproductive pain responses designed to protect you. The fastest way to dismantle it is to accept that there is pain, decide what you value most about life and commit to doing it more. You love swimming but your arm hurts? After you’ve done as much physical therapy as is needed to strengthen and retrain the muscles, you commit to swimming and use that as the outcome metric, not how many faces of hurt you have. Studies in adults and kids both show this is a more effective method of reducing pain than pharmaceuticals, which are notoriously bad at brain reshaping.

2 . Movement reduces pain. Motion may be the best way possible to reassure your brain that you’re safe. Small movements or standing on a vibrating plate can overcome minor stiffness pain, and increase strength which reduces pain. Walking and moving release pain-reducing endorphins and stop the pain signals from registering as worry. In addition, pain has to go through two processing centers before it passes to the areas of the brain that register pain as worry and memory. By moving deliberately with concentration — dancing, playing a sport — you prevent pain signals from passing from these processors, reducing your perception of pain. Finally, new research shows that muscle signals are actually connected to sensation signals and reduce pain.

3 . Fear is a volume knob for pain: consciously decide not to fear pain. Pain is the brain’s opinion of how safe you are, so fear naturally makes pain worse. Recently, I fell off an electric bike, cracking a few ribs and pushing my shoulder too far forward. Over the next two months, I didn’t have a chance to get evaluated by a physical therapist, and was worried I had a shoulder tear that needed surgery that I might make worse. By trying not to move the arm, I ended up engaging all the stabilizing muscles and neglecting the strength muscles. Stabilizers that are overused can hurt a LOT, and routinely woke me up. After a therapist determined I didn’t have a tear, the pain was immediately better. By concentrating on moving the muscles normally, and a few days of strengthening, I was moving normally despite soreness and sleeping through the night. Categorizing the feelings as “soreness” rather than “potentially dangerous pain” reversed the cycle that got me hurting in the first place.

4 . Have a pain reduction plan. One of the pain processing areas, the anterior cingulate cortex or ACC, will direct pain sensations to the fear center, the memory center, and the “previous options” center, among others. These connected areas are part of the pain perception “connectome”, and are why you’ll see someone start to wince before a needle touches them: their brain has started reacting to what it expects, not what it feels. To counteract the expectation part of pain, make a comfort plan if pain starts increasing after a surgery or injury. Magnesium for reducing inflammation, aromatherapy to relax, tea, a cold-vibration device for an overused stabilizing muscle, watching a favorite comedian…. The point is that, like Ikea products, you like things better because you made them. By having a plan of ways to get more comfortable that you made, it’s more likely to work. Multiple options engage the ACC to make choices and evaluate if it is time, pain doesn’t pass through. The perception in the connected areas is blocked, reducing pain.

5: Sleep — Feeling irritable increases inflammation and the sensation of pain. Everything you can do to make sleep better, like reducing alcohol and opioids that disrupt deep restorative sleep, will help. Eating at least 3 hours before going to sleep, not risking a full bladder, and if necessary melatonin.

Bonus! . Quick tricks: if there are situations where you have a procedure or sharp pain, do a combination of physiologic trics and a brain engagement: First, the feeling of ice water cold is evaluated by the brain as annoying but not dangerous, so is suppressed. Putting your hand in ice can make it easier to tolerate pain anywhere else. Second, we now know that the nerves that sense position in space don’t get tired, and are the most effective at blocking pain. This is why shaking a banged thumb makes it better. The frequency that stimulates these nerves is in the VibraCool devices, which can be coupled with ice. Third, fast relief comes from visually activating the ACC, which is most strongly engaged with cognitive conflict. Optical illusions, counting things out of context, or sorting tasks work best. For example, count how many circles are in the letters in a sentence you see: “It’s going to be fine” has 7, for example. These things together can reduce sharp pain, and you’ll be too busy to be afraid.

If you could start a movement that would bring the most amount of wellness to the most amount of people, what would that be?

Movement is such a strong concept. I’d love to teach people that there’s no one change that brings wellness. Just as with pain, there is no one right answer. Instead, collect and practice ways that make you feel healthier and that work for YOU. Do you like lifting weights or walking or swimming or dance? Find your favorite movement. Do you like massage or yoga or heat or cold? Do you like meditation or singing or making tea? What are rituals that work the best for you to fall asleep? Having options is the secret to power over pain — start curating activities and interventions that work for you before you need them.

What is the best way for our readers to further follow your work online?

I put my pain relief blogs on PainCareLabs.com, sometimes do youtube updates when there’s news, linkedin essays when I’m mad at the system amybaxtermd and signing up for our emails will get the updates on pain relief whenever we get them!

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.

About The Interviewer: Maria Angelova, MBA is a disruptor, author, motivational speaker, body-mind expert, Pilates teacher and founder and CEO of Rebellious Intl. As a disruptor, Maria is on a mission to change the face of the wellness industry by shifting the self-care mindset for consumers and providers alike. As a mind-body coach, Maria’s superpower is alignment which helps clients create a strong body and a calm mind so they can live a life of freedom, happiness and fulfillment. Prior to founding Rebellious Intl, Maria was a Finance Director and a professional with 17+ years of progressive corporate experience in the Telecommunications, Finance, and Insurance industries. Born in Bulgaria, Maria moved to the United States in 1992. She graduated summa cum laude from both Georgia State University (MBA, Finance) and the University of Georgia (BBA, Finance). Maria’s favorite job is being a mom. Maria enjoys learning, coaching, creating authentic connections, working out, Latin dancing, traveling, and spending time with her tribe. To contact Maria, email her at angelova@rebellious-intl.com. To schedule a free consultation, click here.