Good Life Project

How to Unlearn Pain: Groundbreaking Research Offers Hope | Yoni K. Ashar

February 2, 2026

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  • Pain is an output, not an input, created by the brain based on its perception of threat, which can be influenced by emotions, narratives, and learned neural patterns, rather than solely by structural injury signals from the body. 
  • Chronic pain often transitions from a bottom-up, injury-driven signal to a top-down, learned neural pattern, evidenced by a shift in pain-related brain activity from typical pain processing areas to regions associated with emotion, learning, and memory (like the medial prefrontal cortex and amygdala). 
  • Pain Reprocessing Therapy (PRT) aims to break the pain-threat cycle by fostering safety through cognitive reframing (understanding pain as neuroplastic/a false alarm), gradual behavioral exposure to feared activities, and addressing deeper emotional or life meaning issues that signal threat to the brain. 
  • Due diligence for chronic back pain should be reasonable and not automatically require extensive testing like MRIs or X-rays, as current guidelines often advise against them without red flags. 
  • To live a good life, one must be honest about their feelings and embrace their own agency to be an agent of healing in their life. 
  • The episode concludes by promoting the next week's conversation on 'Good Life Project' with Harry Reis about why love sometimes fails to land. 

Segments

Guest’s Personal Pain Journey
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(00:03:57)
  • Key Takeaway: The guest experienced chronic back pain that only manifested when standing still, proving it was a learned neural pattern, not constant structural injury.
  • Summary: The guest, Dr. Yoni Ashar, experienced chronic back pain that paradoxically disappeared while hiking but returned upon standing still, leading to the realization that his brain had learned to associate standing still with pain. He successfully unlearned this connection during a three-day meditation retreat by intentionally standing and observing the rising waves of fear and pain without reacting. This personal experience provided proof that standing was not inherently damaging and led to the eventual disappearance of his pain.
Scope of Chronic Pain Crisis
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(00:07:13)
  • Key Takeaway: Chronic pain is the leading cause of disability in America, costing more economically than heart disease and diabetes combined.
  • Summary: Chronic pain is the number one leading cause of disability in America and among the top three worldwide, affecting an estimated 50 million Americans. The combined economic impact from medical procedures and lost workdays surpasses that of heart disease and diabetes. Furthermore, rates of chronic pain have been increasing over the past few decades, worsening the societal burden.
Limitations of Biomedical Approach
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(00:09:21)
  • Key Takeaway: The typical biomedical approach focuses treatment below the neck, often leading to ineffective treatment cycles based on incidental imaging findings.
  • Summary: The predominant healthcare approach assumes pain source lies in the specific body part, leading to reliance on imaging, medications, and procedures. Imaging studies frequently reveal incidental findings like disc degeneration or tears, which are highly prevalent in pain-free adults, yet these findings are often incorrectly identified as the pain source. This focus on structural issues below the neck often results in patients bouncing between providers without achieving lasting relief.
Ineffectiveness of Spinal Surgeries
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(00:12:29)
  • Key Takeaway: Randomized trials show spinal surgeries for pain are often no more effective than sham surgeries, suggesting relief is driven by placebo, not structural correction.
  • Summary: Studies comparing real spinal surgeries to sham surgeries (superficial incision only) show no difference in outcomes, indicating that the perceived success is due to the placebo effect, belief in being fixed, and feeling cared for. A meta-analysis in the British Medical Journal found no evidence that 13 common spinal procedures for pain were superior to their fake counterparts. This highlights that the physical intervention itself is often not the mechanism for pain reduction.
Pain as a Brain Output
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(00:15:16)
  • Key Takeaway: Pain is an output generated by the brain based on its interpretation of the situation and body input, meaning it is always real but not necessarily indicative of ongoing injury.
  • Summary: The pain experienced is always real, but the concept of ‘making it up’ stems from misunderstanding pain as a direct input signal. Instead, pain is an output created by the brain to protect the person based on perceived threat. Neuroplastic pain occurs when the brain, being smart and adaptive, overprotects by creating pain even when the actual level of threat is low or resolved.
Acute to Chronic Pain Shift
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(00:21:38)
  • Key Takeaway: Chronic pain often starts acutely but shifts mechanisms from bottom-up (body-driven) to top-down (brain-driven) processing over time.
  • Summary: In the acute phase, pain is typically bottom-up, driven by signals accurately interpreted by the brain as injury, prompting necessary care. As time passes, if pain persists after healing, the mechanism shifts to top-down, driven by brain signals that maintain the pain loop, independent of the original injury. Brain imaging confirms this shift, showing pain activity moving from typical sensory areas to meaning-making regions like the medial prefrontal cortex.
Identifying Neuroplastic Pain
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(00:29:21)
  • Key Takeaway: Telltale signs of neuroplastic pain include pain that moves around the body, fluctuates substantially day-to-day, or correlates with high life stress or multiple prior symptom conditions.
  • Summary: Pain that moves location (left to right) or fluctuates wildly (e.g., 7/10 one day, 2/10 the next) is inconsistent with a fixed structural injury. The onset of pain coinciding with high life stress, such as a divorce, is another indicator of a neuroplastic component. Having multiple, seemingly unrelated chronic conditions (stomach issues, back pain, headaches) strongly suggests a single underlying mechanism in the brain amplifying symptoms.
PRT’s Three Domains of Intervention
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(00:36:01)
  • Key Takeaway: Pain Reprocessing Therapy (PRT) intervenes in the pain-threat loop using cognitive, behavioral, and emotional/meaning-based strategies to establish safety.
  • Summary: Cognitively, PRT helps patients adopt a new narrative, viewing pain as a false alarm from a healthy body, thereby reducing fear. Behaviorally, it involves gradual, slow re-engagement in feared and avoided activities (exposure therapy) to prove to the brain that the body is safe and strong. Emotionally, PRT addresses deeper life messages, recognizing that pain can signal a need to address misaligned relationships or purpose, which, when resolved, allows the system to feel globally safe.
PRT Study Outcomes
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(00:49:42)
  • Key Takeaway: A randomized control trial showed PRT led to large, lasting pain reductions (down to 1/10 on average) in chronic back pain sufferers, sustained five years later.
  • Summary: In a trial of 150 people with chronic back pain averaging 10 years duration, the PRT group reported pain dropping from an average of 4/10 to 1/10, significantly outperforming control groups. Five-year follow-up confirmed these reductions were largely maintained, with brain imaging showing decreased threat response to back sensations post-treatment. The primary drivers of pain reduction were decreases in fear of pain and reduced avoidance of activities.
Chronic Pain Imaging Diligence
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(01:00:48)
  • Key Takeaway: Guidelines advise against routine X-rays or MRIs for chronic back pain without specific red flags.
  • Summary: Patients should confirm with providers if imaging like MRIs or X-rays are truly necessary for chronic back pain, adhering to current medical guidelines. Due diligence does not necessitate these tests if no acute issues or red flags are present. This prevents unnecessary procedures that might distract from brain-driven pain mechanisms discussed in ‘How to Unlearn Pain: Groundbreaking Research Offers Hope | Yoni K. Ashar’.
Defining a Good Life
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(01:01:27)
  • Key Takeaway: Living a good life involves self-honesty and embracing personal agency for healing.
  • Summary: The definition provided for living a good life centers on being truthful about one’s feelings. It emphasizes recognizing and utilizing one’s own ability and agency to drive healing within one’s life. This aligns with the episode’s theme of taking an active role in recovery from chronic pain.
Next Episode Preview
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(01:01:55)
  • Key Takeaway: The subsequent ‘Good Life Project’ episode will address relationship dynamics concerning unreceived affection.
  • Summary: The next conversation on the podcast will feature Harry Reis discussing why love sometimes fails to connect, even when the feeling is genuine. Listeners are encouraged to follow the show to ensure they receive this upcoming episode.
Podcast Production Credits
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(01:02:07)
  • Key Takeaway: The production team for this episode of ‘Good Life Project’ is acknowledged.
  • Summary: Executive producers for this episode include Lindsey Fox and Jonathan Fields. Editing assistance was provided by Alejandro Ramirez and Troy Young. Christopher Carter created the theme music for the podcast.
Sponsor: Peloton Promotion
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(01:03:09)
  • Key Takeaway: The Peloton Cross Training Tread Plus offers real-time coaching and form correction via Peloton IQ for versatile workouts.
  • Summary: The Peloton Cross Training Tread Plus is designed for busy lives, featuring Peloton IQ for guidance during running, lifting, and stretching. Its movement tracking camera corrects form and suggests weights, making workouts purposeful. The swivel screen allows easy transitions between different exercise modalities.
Sponsor: Capital One Banking
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(01:04:10)
  • Key Takeaway: Capital One banking features include no fees or minimums on checking accounts and weekend cafe availability.
  • Summary: Capital One checking accounts are promoted for having no fees or minimum balance requirements. Additionally, most Capital One cafes are open seven days a week to assist customers with their banking needs. This segment concludes with the tagline, ‘What’s in your wallet?’
Sponsor: Babbel Language Learning
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(01:04:40)
  • Key Takeaway: Babbel uses conversation-based techniques and native speakers to quickly teach practical language skills.
  • Summary: Babbel focuses on teaching useful words and phrases through conversation to enable quick speaking ability in real-world contexts. Lessons are created by language experts and voiced by native speakers, simulating a private tutor experience. A special offer of up to 55% off a subscription is available via a specific link.
Sponsor: Sleep Number Bed Benefits
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(01:05:19)
  • Key Takeaway: Sleep Number smart beds allow independent side adjustment for firmness and offer rapid cooling capabilities.
  • Summary: Sleep Number smart beds allow users to adjust their side to be softer or firmer, setting their individual Sleep Number setting. The bed can cool up to eight times faster than standard options, ensuring personalized comfort. A limited edition bed is currently available at 50% off during the President’s Day sale.