Episode 314 | Pain & Pleasure: Decoding the Dopamine and Chronic Pain Connection with Anna Lembke, MD
Jun 28, 2023
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Dr. Joe Tatta is joined by Dr. Anna Lembke, MD to discuss the connection between dopamine and chronic pain. They explore the role of dopamine in addiction, the addictive nature of exercise, and the effects of our brain's wiring for scarcity and danger. Embracing discomfort and resetting reward pathways are emphasized. Check out Dr. Lembke's book 'Dopamine Nation' for more insights.
Dopamine plays a role in both pleasurable and painful experiences, affecting our motivation and reinforcing certain actions.
Understanding the balance between exercise and pain can guide practitioners in pain management and physical therapy.
Deep dives
The Role of Dopamine in Addiction and Pleasure
Dopamine is a neurotransmitter that plays a crucial role in pleasure, reward, and motivation. It is the final common pathway for all reinforcing drugs and behaviors. The more dopamine released in the brain, the more likely a substance or behavior is to be reinforcing. Different substances and behaviors can release varying amounts of dopamine, leading to different levels of pleasure and addiction potential. This understanding of dopamine can help inform addiction treatment and interventions.
Exercise and Hormesis
Exercise has both toxic and beneficial effects on the body. In the right amounts, exercise triggers the body's healing mechanisms and increases the production of feel-good neurotransmitters like dopamine. This is known as hormesis. However, excessive or extreme exercise can lead to overtraining syndrome or exercise addiction. The concept of pleasure-pain balance plays a role here, as moderate discomfort and effortful mind-body work can help reset pain thresholds and promote resilience. Understanding the balance between exercise and pain can guide practitioners in pain management and physical therapy.
Pleasure-Pain Balance and Addiction
Pleasure and pain are intimately related in the brain, working as opposite sides of a balance. The brain constantly seeks a state of balance, called homeostasis, between pleasure and pain. Addiction occurs when the brain is overwhelmed by the excessive release of dopamine from highly reinforcing substances or behaviors. This imbalance leads to craving, anxiety, and depression. The intervention for addiction involves abstaining from reinforcing substances and behaviors long enough for the brain to restore balance. Additionally, intentionally engaging in difficult, challenging, and psychologically/emotionally uncomfortable activities can help reset the pleasure-pain balance.
The Effects of Shame, Social Pressure, and AA
Shame can be both a motivator for change and a perpetuator of addictive behaviors. Alcoholics Anonymous (AA) is a social movement that effectively leverages shame to create a supportive environment for individuals facing addiction. By embracing the identity of an addict and participating actively in AA, people can overcome the shame associated with their behaviors and work towards positive change. AA provides a social context that understands the dopamine addiction cycle and helps individuals navigate their addictive behaviors. This understanding of shame and social pressure can inform mental health and addiction treatment approaches.
Dopamine is a chemical formed in the brain that allows us to experience pleasure, reward, and motivation. The more of it that is released in the synapse, the more likely it can reinforce us to do a specific action all over again. In this episode, Dr. Joe Tatta is joined by Anna Lembke, MD, who discusses how dopamine is not only released through pleasurable activities but also relatively painful ones. She discusses how to achieve a complete pain-pleasure balance in today’s world that keeps bombarding us with dopamine hits left and right – and most of the time, even at our own command. Dr. Anna also explains why pain can become addictive and what must be done to secure a healthy dose of pain in our lives.
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