Becoming Pain-Free: David D Clarke On How to Alleviate Chronic Pain

An interview with Maria Angelova

Stressful personality traits can develop when a child is trying to cope with adversity. Low self-esteem, excessive self-criticism, caring for others to your own detriment, continually trying to be seen as “good,” lack of assertiveness, repeatedly choosing relationship partners who take more than they give, and perfectionism are some of the common ones. Try to understand who taught you to be this way and how they did it. Then you can start to unlearn these traits and replace them with a healthy self-respect and a caring tolerance for yourself.

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 David D. Clarke, MD.

David Clarke, MD is President of the Psychophysiologic Disorders Association (EndChronicPain.org) and Clinical Assistant Professor of Gastroenterology Emeritus at Oregon Health & Science University in Portland, Oregon. He is board-certified in gastroenterology and internal medicine and has successfully treated over 7000 patients whose pain or illness were not explained by diagnostic tests. His ideas are described in his books They Can’t Find Anything Wrong! (praised by a president of the American Psychosomatic Society as “truly remarkable”) and Psychophysiologic Disorders. He lectures across North America and in Europe, has appeared on over 100 television and radio broadcasts, and has produced three documentary films.

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?

I thought I was doing well during my medical education and training. I had won an award for excellence in medical school. I was in a top residency program, and I passed my exams with flying colors. Then, in the 8th year of my formal training (1982), I was asked to see a patient that I didn’t know the first thing about how to help. That shocked me.But this patient’s serious medical condition was caused by her brain and cured by a psychiatrist who knew that the brain could cause real pain or illness. The psychiatrist taught me the framework for her approach, and I have built upon that for the last 40 years.

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?

The first story in my first book took place in the 1980s. I was asked to see a patient in the hospital for severe dizziness and vomiting. The first thing she told me was not to bother trying to help her. It turned out she had been hospitalized at a famous university 60 times in 15 years for the same problem. A dozen specialists, including a psychiatrist, still had no idea what was wrong with her. But I knew what to look for, found the stress that was linked to her attacks, explained to her how that caused her illness, and she was cured on the spot. That was when I knew I had found a truly effective approach that could help millions of people.

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?

Early in my career I arranged for six of my most ill patients to meet as a group because they were not getting better, and I didn’t know what else to do. We met one afternoon a week for two months with a senior psychiatrist in attendance. I still had a lot to learn at that time and after the two months of listening, neither the psychiatrist nor I had any idea what was wrong. But I had absorbed a tremendous amount of information from those patients. Slowly the pieces of the puzzle became clear, and I realized the mistake I had been making. These patients all had powerful emotions linked to maltreatment as children. But the emotions were not visible on the surface. I had missed seeing this because of my lack of experience. But I began working to help these patients recognize and put into words their anger, fear, shame, grief, or guilt. It was only then that they began to feel better.

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

Stress-related, brain-generated pain or illness afflicts 20% of all adults and 40% of people who visit a primary care doctor. This is tens of millions of suffering people who could be successfully treated with Pain Relief Psychology. This treatment has now been validated by several scientifically rigorous randomized controlled trials. My non-profit is helping to bring this approach to everyone who can benefit.

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?

Since 1982 I have conducted detailed interviews with over 7000 patients whose pain or illness was not caused by disease or injury but instead was due to stress-related changes in the circuits of the brain. These interviews led to successful diagnosis and treatment even for people with severe symptoms that had endured for decades.

In addition, I have:

• Co-founded and led as President the non-profit PPD Association since 2011.
• Taught courses in three graduate schools.
• Lectured extensively in North America and Europe for over 15 years.
• Written/edited three books.
• Led two international conferences that presented 24 hours of accredited lectures.
• Produced three documentary films.
• Produced two online courses (suitable for patients or professionals).
• Appeared on over 100 TV & radio broadcasts and numerous podcasts.
• Co-led the funding campaign for the Boulder Back Pain study that was published in JAMA Psychiatry in 2021.
• Authored a dozen published papers about PPD.

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

1. Brain-generated pain linked to stress causes the majority of chronic pain which can occur literally from head (migraine, facial nerve pain) to foot, with spine pain and fibromyalgia being particularly common.
2. Organ disease caused by tumors, infection or inflammation.
3. Structural injury that fails to heal (uncommon).

Most people assume, and physicians are trained, that organ disease or structural damage are the only cause of pain. But pain (and many other symptoms) can also be generated by the brain. This pain is just as real as pain from any other cause. Why does this occur? Studies have shown that the anatomy of the nerve circuits in the brain is different. This change has developed because of past or present psychosocial stress. The good news is that when the stress is identified and treated, the pain can be relieved.

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?

Brain-generated pain linked to stress is just as severe and can last even longer than other forms of pain. It afflicts millions of people, but few healthcare professionals have had formal training in how to diagnose or treat this condition. Consequently, this has become the largest single source of unnecessary suffering for patients. The good news is that this cause of pain can be successfully relieved by identifying and treating the underlying past or present stress.

Can you share your top five “lifestyle tweaks” that you believe will help support people’s journey toward becoming pain-free?

For pain that is not due to disease or injury, the key is to uncover sources of stress in the past or present that you might not fully recognize. Until you see these issues for what they are you can’t make progress with brain-generated pain. The 12-item screening test at EndChronicPain.org can provide patients with insight into this; here are some additional examples:

1. Imagine watching a child you care about growing up exactly as you did. Would you feel sad or angry about this? Many of my patients look back at their own childhood and don’t recognize the magnitude of the difficulty they endured. I will always remember one young woman who was the peacemaker between her constantly battling parents. She told me, “It wasn’t as bad as it sounds.” Then I asked her to imagine her beloved niece in the same situation. “What would it be like for you to watch your niece cope with your parents for a week?” I asked. The young woman stared at me for a few minutes while she processed this thought experiment and then said, “At the end of that week, I would shoot myself.” This was a key insight that helped her appreciate the heroic perseverance needed to endure her parents. If a thought experiment like this resonates for you, consider writing an unmailed letter to the perpetrators of your childhood adversity that expresses all your feelings (good and bad) about them.

2. Many of my patients focus on the needs of others in their lives so much that it becomes detrimental. Often they never learned to play as children, so as adults they aren’t really sure how to put themselves on the list of people for whom they care. One of my patients was a champion athlete as a girl. But she practiced and competed before school, after school and on weekends from age 4 onward. She never truly had the chance for carefree self-indulgence. In her early 30s she was a working mother and part-time coach who never took time for herself. Eventually this became too much, and she developed unexplained abdominal pain. It was only when she set aside regular time for her own enjoyment that the pain went away.

3. The patient described earlier who told me not to bother trying to diagnose her dizziness and vomiting was ill because her abusive mother was still very much in her life. Are there people, events, or situations in your life that trigger pain or emotions (or both) for you? Are these triggers reminding you of adversity in childhood? Convince yourself that after all you have endured, you deserve to set boundaries that limit the harm from these triggers.

4. Stressful personality traits can develop when a child is trying to cope with adversity. Low self-esteem, excessive self-criticism, caring for others to your own detriment, continually trying to be seen as “good,” lack of assertiveness, repeatedly choosing relationship partners who take more than they give, and perfectionism are some of the common ones. Try to understand who taught you to be this way and how they did it. Then you can start to unlearn these traits and replace them with a healthy self-respect and a caring tolerance for yourself.

5. Ask yourself if you have had any traumatic, terrifying, or horrifying experiences that occurred just before your pain began or that are linked to a triggering event that happened just before your pain began. One of my patients had pain in the right lower corner of her abdomen that began soon after she unexpectedly encountered the man who murdered her brother. She did not know he had just been released from prison. Years earlier, she had seen this man shoot her brother in the right lower corner of his abdomen.

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

I already have! Since 2011 the Psychophysiologic Disorders Association has taught science-based concepts that, as one doctor told me, “put the joy back into my practice.” This is because she can now cure patients with pain or illness that formerly left her in despair. That doctor and three colleagues have since taught 70 other doctors in their city to use the same ideas. Through our courses, conferences, textbooks, videos, and lectures, he PPD Association is teaching more healthcare professionals and patients every month. Our goal is to help tens of millions who are currently suffering.

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

The website for my book They Can’t Find Anything Wrong! is Stressillness.com.

We are always adding new resources to the Psychophysiologic Disorders Association website EndChronicPain.org including:

• A 12-item Self-Assessment Quiz.
• Courses that professionals and non-professionals can learn from.
• Monthly Q&A webinars with experts (for PPDA members).
• Recorded and live conferences.
• Videos of patients describing their path to success including “Dynasty” actress Catherine Oxenberg.
• Recommendations for resources produced by others.

Thank you for these fantastic insights! We wish you continued success and good health.

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.