Biofeedback for Chronic Pain: How the Mind-Body Connection Can Help You Heal | Cindy Perlin

Leigh Brandon (00:01.28)
Cindy, welcome to Beyond the Pain. It’s great to have you on the show. It’s great to have you here, and I just want to thank you for being so patient with me. for the audience, I’ve had a 24 hours from hell, which meant I arrived extremely late for this interview. So thank you very much for being so patient.

Cindy PERLIN (00:15.803)
Thank you for having me.

Leigh Brandon (00:32.79)
So I always like to start at the beginning. So can you take us through your own journey with chronic back pain, the the difficulties you faced finding effective treatment and how discovering biofeedback eventually changed your life?

Cindy PERLIN (00:46.973)
Okay. So this was almost fifty years ago. when I Well I’m seventy four and this happened when I was twenty five, so

Leigh Brandon (00:53.976)
So you must have been about two years old, yeah?

Leigh Brandon (00:59.276)
Wow.

Cindy PERLIN (01:02.925)
I was pretty active physically. I was going to graduate school to become a social worker and I decided that I would take up running to get in better shape. And as I, you know, tried to run every day my back started bothering me more and more.

And so I went to the doctor, you know, primary care and he said, Stop running. So I stopped running. But then it seemed like everything else I tried to do made things worse. Like he gave me back exercises to do and I hurt my back more trying to do the back exercises and then I went to a yoga class trying to help my back and it wasn’t a very good yoga class. The instructor was just do this, do that without any of

appropriate cautions or anything else and that was kind of the straw that broke not the camel’s back but mine. So I was just in agony 247 and I was going to doctors and getting X-rayed and they couldn’t find anything wrong with me. And they gave me drugs that just turned me into a zombie and didn’t help the pain at all.

And this went on. I had to drop out of graduate school. I was in so much pain I couldn’t sit through a class or concentrate. I was in pain twenty-four seven and it was pretty severe. And nobody knew what was wrong with me. And I went to an osteopath who told me to do nothing but come to see him and the rest of the time stay in bed basically. so I got very weak and then eventually an appointment I made with North

Surgeon came up and he spent 45 minutes with me examining me, talking to me, looking at my x-rays, and said, I don’t know what’s wrong with you. you may be like this for the rest of your life. just live as best you can. And I really wasn’t living because I couldn’t do anything. And the idea that that was going to be the rest of my life when I was at that point twenty-eight years old, was pretty upsetting.

Cindy PERLIN (03:15.049)
And to pass the time while I was in bed doing nothing else, I was watching the Holocaust mini series and I was reading books a friend had given me just to keep me occupied and they were all about World War Two and the Holocaust.

and then another friend suggested that I read a book called Anatomy of an Illness by Norman Cousins. And this was a long time ago. The book had just come out. And basically he was diagnosed with a degenerative crippling joint disease and he was told he had virtually no chance of recovery and he’d just get more and more crippled until he died. And he was a very intelligent, very well known man. He was

the editor of the Saturday Review, which was a literary magazine. And he just didn’t want to take that prognosis lying down. So he did his own research, which I always like to say has become a very negative term, you know, during the COVID epidemic. But he did his own research, which I which I strongly urge everybody to do. And he found that the will to live was really important. And he

He decided that what really made life living for him was being able to laugh. So he he surrounded himself with funny people. He got himself out of the hospital where they used to let you stay for years if you were sick. But he, you know, got himself out of the hospital, got a movie projector. This was in the fifties.

So and he watched Charlie Chaplin movies and W. C. Field’s movies and discovered that if he could get ten minutes of belly laughing, he could get a couple of hours pain-free. So he kept that up. The only other thing he did was vitamin C therapy, because he read that was good for joints, and he completely recovered. And he also mentioned in his book that he talked about biofeedback.

Cindy PERLIN (05:18.457)
So I stopped watching the Holocaust mini series. I had no idea that what was in my mind would affect my body. And this was before mind-body approaches were really being talked about at all. So I didn’t have a clue. My doctors didn’t have a clue. Most doctors still don’t have a clue. but I changed what I was focusing on.

Leigh Brandon (05:28.099)
Mm-hmm.

Cindy PERLIN (05:44.622)
And then I found a biofeedback practitioner, a local psychologist. And at this point I had like no money. I mean I was pretty broke ’cause I hadn’t worked for a few years. I’d been going to graduate school before that. I didn’t have savings, I didn’t have an income, but I took the few pennies that I had and I went to this psychologist. And he he told me that, you know, worrying about the pain would make the pain worse, that what was in my mind was important.

And he took me through a temperature biofeedback set session. So temperature biofeedback is hand temperature, and the colder your hands are the more stressed you are. And he taught me a little technique, you know, for relaxation, and he gave me this little strip of plastic that was a liquid crystal diodes. Like a sophisticated mood ring. If anybody remembers mood rings, they change color depending on your mood. So this was a little more sophisticated.

Sophisticated, it would give you a temperature readout. And I went home and I practiced relaxation diligently. I like to think of myself at that point as a very highly motivated patient. You know, it was just so intent on getting well. And by the next day, literally, my pain was 50% less.

And what I attribute that to is everyone was telling me there was nothing I could do to control this. And this person said, If you do this, it’ll help.

So that took a lot of the fear, that sense of being out of control, that sense that my body was just attacking me and I couldn’t do anything about it. That really shifted within a day from that appointment. And I kept working with my hand temperature. whenever it would go low, I would do some relaxation and bring it back up till I got pretty f proficient with that. I was eventually able to I started doing some, you know, I did an exercise class at the

Cindy PERLIN (07:46.39)
IMCA for people with bad backs to get my strength back because I was so weak at that point from staying in bed for so long I could barely walk around the block. And I eventually got back to work and being physically active and and all of that.

Leigh Brandon (08:03.318)
Excellent. You know, it’s your your story is so common in my experience. People coming to me and saying I’m I’m in pain, I’ve been in pain for a long time. Doctors don’t know why I’m in pain. In fact it they kind of suggest that there’s nothing wrong with me, but then why am I in pain? And again that old saying of, yeah, you’re probably gonna have to live with this forever

You know, and those words can have such a negative effect on people. You know, the more the more you you’re in a state of fear, the more you you’re likely to feel pain, right? Because pain pain is a reaction to a fear response, right? Your body creates pain to protect you, right? And you normally need protecting from things that are fearful, right? You know, whether it’s whether it’s a lion or whether it’s a piece of sharp glass or

Cindy PERLIN (08:48.709)
Right, right.

Cindy PERLIN (08:56.495)
Right. Right. So

Leigh Brandon (09:01.454)
a hot fire, you know, y you wanna you wanna be fearful of those things, otherwise they’re gonna hurt you, right?

Cindy PERLIN (09:06.883)
Right, right. And your body is saying, protect that area, you know, whatever it is because it’s vulnerable, or protect yourself because you’re vulnerable, be on the alert, so it ramps up your physiology in ways that create more pain. And if you don’t know how to shut that down when it’s no longer necessary, it’s usually only necessary for a very short time. if you don’t know how to shut that down, then it’s just going to keep it’s like

Fear is like an anger and and are like and negative thoughts are like putting gasoline on a flame. You know, it just makes it worse. And it’s not the external circumstances, it’s how we interpret them and how much we focus on them that causes the problem. So I had to learn that and once I learned that, you know, I I was able to have a lot of control over it. So but I did have another situation, I have to mention this

two, which is after I started feeling better for my back and I was back at work, I started having a foot problem and it I had a bone spur in my big toe joint and I had surgery for that. And after the surgery my foot pain got worse and worse and worse and nobody could figure that one out. And the mind body approach did not work at all. And

I went 14 years barely able to walk without agony. And then I found out that it was a structural problem, that while my foot was healing, I was holding it and walking on it differently because I didn’t want to stress the incision that was in the joint and everything in my foot and leg, you know, tightened up and shortened, and then I could no longer put my foot normally on the ground. So some pain is structural.

You know, I had to learn that myself. You know, I was people were saying I was reading, you know, pain in the foot is about fear of moving forward in life. So I’m working with that, I’m working with relaxation. And none of that would work ’cause the pain was from a structural problem that was, you know, compensating for an injury basically. And the fact that none of the doctors could diagnose that was pretty damning too.

Leigh Brandon (11:24.213)
Yeah. Yeah, it’s interesting. You know, when I when I started helping people in pain twenty five years ago, yeah, I was only three at the time. it’s interesting because I all the only tool in my toolbox then was corrective exercise and and high performance exercise for the first few years.

But understanding mind body medicine, I think I was doing that without even realizing it. Because I think like like y the person that finally helped you, they said, I can help you with this, right? So straight away your mindset changes, right? Because now you’ve got a little bit of belief and hope back. And looking back at my career, those first two or three years when I when I was pretty much only doing corrective exercise with people.

I was probably giving people the confidence that they could move again. And I and I had never really thought of that until probably earlier this year, that although it seemed like that was the only tool in my toolbox, I was actually doing mind body medicine without actually realizing it. I was because I was getting really, really good results with clients just using exercise. So I had that confidence in my abilities and I guess

I was portraying that to people when they were coming to me. So yeah, I’ve helped someone you know, helped someone with the same thing and this is what we did and you know, straight away this I th okay, this this guy can help me, even though, you know, I’ve seen ten people already and they they didn’t know what to do. So I think you can work on that level even even without realising it sometimes.

Cindy PERLIN (12:44.025)
Mm-hmm.

Cindy PERLIN (12:57.21)
What?

Cindy PERLIN (13:01.017)
Yeah, I mean now there’s something called pain reprocessing therapy and part of that is about paced movement and teaching your brain that you can safely move again. You know, so you were doing that. You know, none of this stuff was available when I was going through this. In fact, Norman Cousins, who wrote that book I read that was so helpful, he eventually became the first non-physician to ever teach at UCLA medical school. and it was about

the mind-body connection and he did research that found that when people left they produced more of the body’s natural opioids which are called endorphins. You know, so there was a physiology to it that nobody knew at the time.

But you know, he happened upon it, he had this experience. And that’s happening with a lot of things in terms of people found they were working and it’s only now that we’re beginning to understand how the brain connects to the body and how that all works. So more and more therapies are coming up that are very new, that are really helpful for pain and chronic illness.

Leigh Brandon (14:10.794)
Yeah. No knowing that you’re from the New York area, I’m guessing you’re familiar with Doctor John Sarno. Mm.

Cindy PERLIN (14:17.829)
Yes, I almost mentioned his name a couple a couple of seconds ago. So, you know, his book, Healing Back Pain, he’s now deceased. but he wrote this book and I forget when it came out, maybe twenty years ago. And I read the book because I was really looking for something to refer people to that, you know, would be helpful to them about the mind body connection. But I found he was so

Leigh Brandon (14:22.858)
Yeah.

Leigh Brandon (14:28.203)
Yeah.

Cindy PERLIN (14:46.295)
ignorant in my opinion. He didn’t really understand the mechanism he was mechanism he was dealing with or how the mind-body connection worked. And he was very arrogant, like I have the answer for everybody. Just come to me, I’ll fix everybody. It’s all this simple your brain’s trying to distract you from what’s, you know, really going on. So he really didn’t understand the mechanism, but he helped a lot of people. And now the mechanism is much better understood. So and Dr

Howard Schubiner, who’s a psychologist, I believe, he kind of took his principle but you know made it more scientific and more based in reality, I think. And I his book on learning back pain, I think is a much better book than than anything Dr. Sarnos has written.

Leigh Brandon (15:38.273)
Yeah, it’s interesting because Dr. Sarno has a video mean it would have been shot a long time ago looking at looking at the video where he’s got an audience of people with back pain and he’s standing at the front kind of saying, Look, there’s nothing physically wrong with you, but the reason you’re in pain is because you’ve got some unprocessed, unconscious emotions. And it’s interesting that when I watch that

And also he’s you know, I’ve read I’ve read all of his books as well. I kind of felt like the underlying not not necessarily concepts, but the underlying angle that he’s coming from, it there’s there’s a lot of truth in it. But then there was a lot of things I disagreed with as well. And I think and he do you know, he he doesn’t say sometimes structural issues don’t cause pain. He doesn’t say that, but he does dismiss a lot, which you know, again

Coming from a structural background initially, I know that I’ve helped a lot of people with using a more structural approach. but you know, I think I think his work’s great, you know, and it’s just that people since then have built on his work. And I think rather than the concept of you know, la just just the lack of blood flow to the area causing pain, I think the whole concept of central sensitization has kind of kind of taken over and

I I I guess it’s more of a scientific understanding and explanation of of persistent pain rather than, you know, it’s just it’s just a lack of oxygen to the tissues.

Cindy PERLIN (17:16.175)
Yeah, well I also think there’s something about you know, holding emotion in.

you know, not expressing how you feel, sometimes not even being aware of how you feel, but even if you are, you know, your muscles emotions are flow of energy through your body. And if you suppress them consciously or unconsciously, your muscles have to kinda hold that energy in. And that can cause pain. So that’s emotional awareness and expression therapy is part of that. But you know, I kinda picked up on that, you know, in my journey towards

feeling myself with somebody who I did some hypnosis with. She taught me how to do self hypnosis and said, You’ve got all this stuff you’ve had in your life you’ve never processed and you need to just spend some time feeling your emotions. And that that was kind of a breakthrough for me.

Leigh Brandon (18:13.598)
Yeah.

Cindy PERLIN (18:13.605)
But you know, in terms in terms of biofeedback, because I do wanna spend some time talking about biofeedback itself, what biofeedback is, and most people have heard the word, they don’t know what it is, is that you’re measuring your biology, something about your physiology, and then you’re getting information about that, so that you can see the effect of what you’re thinking, what you’re doing in real time, and learn to adjust it so that you improve.

things. So for me I was measuring hand temperature which is a measure of autonomic arousal level.

So, you know, I run into a lot of people all the time who say I have cold hands all the time, I have bad circulation. But if you teach them relaxation techniques, they can see that their hands warm. Nothing changed circu you know, structurally. it’s just a matter of part of the fight or flight response when you’re stressed is that your body withdraws circulation from extremities to concentrate it in your heart and lungs and large muscle groups so that you have this sometimes superhuman

energy, you know, when you’re in a dangerous situation. And that happens no matter what the stressor is. So learning to control your hand temperature is about learning to control your arousal level.

And at the time the so you’re using some kind of electronic instrument usually to measure things. So you can measure hand temperature, you can measure muscle tension, you can measure skin moisture, which also changes with stress, you can measure heart rate, and you can measure brainwave activity. That’s called neurofeedback as opposed to biofeedback, or sometimes it’s called brainwave biofeedback. And so you’re you’re taking the measurements.

Cindy PERLIN (20:09.427)
And you’re showing them to the patient. And then you’re practicing, with everything but brainwave biofeedback, you’re practicing relaxation or some kind of conscious process. With brainwave biofeedback, you’re just giving the brain yes or no feedback. This is good, this isn’t so good. And you let your brain figure out what it has to do because consciously, our conscious control of the brain is very limited compared to what the unconscious brain.

Does for itself. So for me, I was just learning to warm my hands. Even though muscle tension was a part of what was going on with me. When you relax one system in the body, it tends to have an impact on everything else. So I had this little strip that I put around my finger that they no longer make. It’s called the biotic band. And it cost five dollars at the time. And it changed my life. So what I it’s no longer available, so I want to show you what I.

often start my patients with this is a little thermometer and I’m holding it you usually tape it to your finger or hold it and it’s taking my hand temperature in the 90s is considered relaxed. People’s hand temperature can be in the 70s when they’re really stressed. I once had a hand temperature 64 in a 70 degree room. I couldn’t believe that was possible but I was very very concerned about something and my

hands just got freezing cold. But the good news is you can change that. So I have very sophisticated instrumentation in my office that’s computer computerized that will take hand temperature to one hundredth of a degree. It will measure it. And then you know a movie plays if you’re warming and you get all sorts of graphs and whatever. And that’s thousands of dollars for that instrumentation. It does other kinds of biofeedback too. This is

2995. And it will give you some very important information. It measures hand temperature to the tenth of a degree.

Cindy PERLIN (22:19.243)
And you can just pick it up and most people don’t know how stressed they are. people notice stress when it’s worse than what they usually carry around, but they’re usually unaware of their default mode in terms of stress. And people who are in chronic pain often are at a high level of stress without even realizing it. So just learning to measure their hand temperature and control it can be very, very effective.

Leigh Brandon (22:23.487)
Mm.

Cindy PERLIN (22:49.307)
in terms of lowering their pain levels. I mean that’s what I discovered. And I get much more sophisticated than that now. But you know, for people who don’t have a lot of funds to spend on therapy or biofeedback, I send them home with this thirty dollar device and they have something that they can use that can be really, really, really helpful.

Leigh Brandon (23:15.443)
Yeah, you can also get oxymeters now, can’t you, that go on your finger and they measure your heart rate and what else do they meet measure? temperature. So they’re I mean they’re I think they’re even cheaper. I think in the in the UK they’re like less than ten pounds. Like eleven twel eleven, twelve dollars. Yeah.

Cindy PERLIN (23:19.671)
Uh-huh. Mm-hmm.

Cindy PERLIN (23:25.553)
Mm-hmm. Yeah.

Cindy PERLIN (23:33.147)
okay.

Which would be what, about twelve dollars? Yeah. Yeah. So, you know, those are biofeedback devices. You know, people say a scale is a biofeedback device. You know, when you weigh yourself, it tells you about your physiology and how you’re doing. But having this, you know, moment to moment feedback and being able to see how what you’re doing it works, you know. for instance I had this woman who called me years ago and she was in really severe

pain and she said on the phone to me, I meditate three hours a day and it’s not helping. so she came in and I’m thinking, what can I do for her? She’s measu you know, meditating three hours a day. But I measured her her muscle tension and her hand temperature and I said, you know, do what you usually do.

And what we discovered was that the longer she meditated, the more tense her muscles became. She would sit there and she would, you know, tense her shoulders and whatever. So I did biofeedback with her and taught her to meditate without doing that. And then, you know, her meditation practice was helpful for her pain. You know, so I had another woman who came in and her problem was high blood pressure and she was she was terrified because

because her father had died at her age of a stroke and so she was very concerned about her blood pressure. And she she had practiced meditation years ago but just gave it up ’cause she didn’t think it was doing anything for her.

Cindy PERLIN (25:14.091)
And so, I just, you know, connected her to hand temperature and I said, Do what you used to do. And she could see that it was it was changing her physiology. She didn’t have that internal sense, which a lot of us don’t, of yeah, I’m a little more relaxed. I may not be like really chilled out, but I’m a little more relaxed. Some people just don’t have that internal awareness, so they they try techniques and they don’t think it’s doing anything for them.

But even if it changes a tiny bit in the right direction, you know what you’re doing is having an effect. So she happened to be a social worker and at the end of the session she said, I don’t know my schedule, I’ll have to get back to you about another appointment. And I didn’t see her again. I ran into her six months later at a conference and I said, How’s your blood pressure? And she said, it’s great. You know, after that session I just went back to meditation and

My blood pressure’s great now. So just having that information on top of, you know, whatever else you might be chang you know, trying to do is valuable.

Leigh Brandon (26:24.022)
It’s interesting, before we started recording, I’m I mentioned to you that I I was in Northern Ireland last week. I was actually on a on a course, a manual therapy course that’s active release techniques. We were specifically learning about nerve entrapments. And the guy that I worked on the most, or he worked on me as well, had the coldest hands I’ve ever felt in my life. And I’m wondering if he was stressed up I mean it was a very very intense, very, very intense course.

But he did say I he his his hands were always cold, so ma maybe he’s just a very stressed person. But don’t doesn’t the like a underactive thyroid generally also cause like cold hands and feet?

Cindy PERLIN (27:06.843)
Well, you know, I’m hypothyroid myself. that has to do more, I think, with core temperature. So, you know, the average core temperature is supposed to be around ninety eight point six. People vary. My core temperature is usually ninety seven point three, so I’m way below normal. That’s just even when I think I have a fever and I take my temperature it’s ninety seven point three. So but

Peripheral temperature, which is what you’re measuring, is very different. So that has to do with whatever your core temperature is, your body is withdrawing circulation from your periphery, your hands and feet, so that it can use that blood supply for other places and that cools your hands and your feet. So yeah, so it’s

It’s a little bit related probably in terms of how high you could get your peripheral temperature if you try. You know, if you have a fever you could probably get your peripheral temperature a little higher than if you’re, you know, at normal temperature.

But but you can go down as low as, you know, seventy degrees. Whatever the room you’re in is, you know, at some point your peripheral temperature could be so restricted that it’s only the, you know, ambient temperature in the room that’s keeping your your hands and feet warm and not that blood supply to the tissues. And I think that has a lot to do with neuropathy too. There are some studies that show that if people learn to warm their hands.

in their feet, depending on where the neuropathy is, that that’s helpful.

Cindy PERLIN (28:54.915)
I had a friend who he was a very avid hiker and he went out in the middle of winter at night and got lost in the woods and he developed a frostbite on his feet so bad that he was in the burn unit of a local hospital for three weeks and they considered amputating his toes. And they told him that he’d probably never be able to do winter hiking or skiing again because you know he just damaged his feet so

badly and I taught him to warm his feet and he fully recovered.

Leigh Brandon (29:30.906)
Interesting. Now I would say that I generally have warm hands and feet. What does that suggest? I say I I I would I would say I I I generally have warm hands and feet.

Cindy PERLIN (29:37.809)
I’m sorry, what’s that?

Cindy PERLIN (29:44.37)
So I would say that either you’re more relaxed you’re a relaxed person generally or

So the thing about we we we’re somewhat individualized in our physiology. So we all react in all our systems to stress ’cause our body’s preparing to fight or flee basically. So all those changes that we have are our body gearing up. But we’re individualized to some extent in terms of which systems react in most strongly. So it could be that you react more in your

you know, in your muscle system, you know, your musculoskeletal system when when you’re stressed. So but ev but everybody and the most variation I’ve seen is in skin moisture. There’s a measure, skin conductance measure in biofeedback. And some people, you know, are very, very reactive in that and other people are not.

So but there is some individual variation. But you know, if your hands are always warm, would you say you’re generally a kind of laid back kind of person?

Leigh Brandon (30:50.941)
Yeah. Yeah. Most most people that know me would say I’m I’m horizontal. I’m so laid back. I generally don’t stress about things. A apart f apart from the last twenty four hours, but that even even then I didn’t get that stressed about it.

Cindy PERLIN (30:55.845)
Cindy PERLIN (31:05.541)
Well, you weren’t measuring your hand temperature, so

Leigh Brandon (31:08.041)
True, true. But I mean it yeah, I mean it they didn’t I I’m quite in tune with my body. And they certainly I mean to be honest, I was I was my body was warm. But that might have been ’cause I was because we’re obviously we’re we’re just going into winter now, so I had I didn’t even have a big coat on, I had a thin coat on, but I was still I was very warm. I need I needed to take my coat off, but yeah. so something you mentioned was neurofeedback.

Cindy PERLIN (31:37.602)
Mm-hmm.

Leigh Brandon (31:38.023)
So can you can you describe perhaps what the differences are between neurofeedback and biofeedback?

Cindy PERLIN (31:44.732)
So you know the main difference is what you’re measuring.

So th at some point the field split, which I wish it never had because it makes it much more complicated to explain things, but when brainwave biofeedback or neurofeedback first came on the scene, which came b after the other types of biofeedback, there was an in very entrenched group that was very resistant to brainwave biofeedback. So the brain wave biofeedback people went and, you know, did their own thing

and kind of established it as a separate thing. But basically you’re doing the same thing. You’re measuring physiology, in this case the electrical activity of the brain, and you’re feeding that information back to the patient so that they can learn to improve it. And before computers the the feedback was very simple, like you know, a light would go on on the instrument when the brain was doing better, whatever threshold they set for it.

Now it’s much more complicated in terms of we use computers, there’s audio visual feedback. I like to use DVDs. you take any DVD, you put it in your DVD player of your computer, if it has one, because now they’re making a lot of computers without them, but you can get an external DVD player. or you could use a streaming service now. Some of the software uses streaming like Netflix or whatever. So you’re playing a movie.

And when your brain is doing better, whatever better is defined as the way you set up the biofeedback software. So the movie is playing through the biofeedback software. So when your brain is doing better, the movie plays more smoothly, it’s brighter, the picture’s bigger, the volume is a little higher.

Cindy PERLIN (33:41.242)
So the brain is is getting the message, that’s good, that’s not so good, that’s good, that’s not so good. The brain wants the movie to play better.

So the brain says, well if I do this, that works. That you know, that makes it better. So and when we s when you know, the field first developed, we would try coaching people. You know, a lot of the initially it was being used for attention deficit disorder. So, you know, we were saying, you know

concentrate better basically. But now we don’t do that. We just let the brain figure it out because it’s the brain is just so complex that it’s better at figuring itself out than we are telling it what to do. You know, the brain runs our physiology without us thinking about us, responding to our environment all the times in ways we’re not aware of. It’s a very sophisticated, very powerful computing device, let’s say.

And so just giving it information about how it’s doing. because it doesn’t give good feedback to itself. So over time the brain learns that

this means working better, this gets better results, and that becomes its default mode. That becomes the way that it functions. So if you’re talking about focus, your brain learns to focus better. If you’re talking about hyper arousal that’s making pain worse, the brain is learning how to turn down its arousal by doing that. And because it’s a complex process, it’s not just teaching conscious skill, you need to spend a lot more time

Cindy PERLIN (35:26.952)
connected to the instrument.

you know, to learn how to do it. So you’re generally talking, you know, at least twenty sessions using the biofeedback device, but generally more forty, fifty. And if you’re if you’re doing something very complex, like treating autism, for instance, you might want to do two hundred sessions. So depending on, you know, what needs to be corrected. I’ll just give you an example of someone that I work with. He

He had been in accident at work where a piece of heavy equipment fell on him and crushed his back. And that was twelve years before I saw him and he had had multiple surgeries on his back and twelve years later he was still in pain. And we did twenty sessions of neurofeedback and he was out of pain.

Leigh Brandon (36:24.169)
Amazing. If if you want to, if you want to send me some links where people can stream that kind of stuff or even buyer DVDs, feel free to send that info to me and I can put that in the show notes if if if you want to.

Cindy PERLIN (36:39.107)
Okay, I’m trying to think of I mean I have I have articles on my website which is Paintreatment Directory dot com about biofeedback and neurofeedback and I might have a a video interview or two about it so I I can do that.

Leigh Brandon (36:55.965)
Yeah, happy to put those on the show notes. Absolutely. So as we mentioned earlier, many people with chronic pain have been told that their scans and medical tests are normal, there’s nothing wrong with them, yet their pain continues. How how is it that bow feedback and neurofeedback help address the heightened pain sensitivity, the central sensitization that I mentioned earlier, and the patterns of nervous system activity that may contribute to that ongoing pain?

Cindy PERLIN (37:26.191)
Okay, so you know, like

So as I was saying earlier about my own experience, just learning consciously to relax the body is very helpful because when you’re in the stress response, your muscles are tense, your peripheral blood flow is reduced, your your your maintenance functions and healing functions of the body are suppressed. And the reason for that is, you know, the stress response is for fight or flight to save you from imminent danger. And it’s not

meant to be there chronically.

So using relaxation techniques that you can learn to, you know, hone and figure out which ones work best for you by measuring, you know, peripheral hand temperature or muscle tension or whatever, that’s very, very helpful. So you could go through your day and this is what I did when I was recovering. my first job when I got back to work was at the child abuse hotline for New York State where we took reports of child abuse. Not

What relaxing environment.

Cindy PERLIN (38:36.503)
a lot of pressure to keep moving because a lot of calls were coming in all day long, people were on hold, you know, so it’s a very stressful environment. Not hearing good things, you know, if you want to focus on positive things to feel good, this was and what I did was I had my hand temperature device and I just made sure that I stayed in that relaxed range using my relaxation techniques, no matter what I was hearing, what I was doing. And it took a lot of

conscious work to do that. But I was able to do that. I was able to get through a work day without my pain increasing from you know what I was being exposed to. So that’s one way is just to learn how to consciously relax.

when you’re dealing with central sensitization, which is like chronic, you know, overreactivity of the brain, if you do brainwave biofeedback and you you teach the brain to change its default mold, you know, it’s going deeper than conscious relaxation techniques. It’s when you’re not paying attention, your brain is just programmed to just be in a better place. So you’re shutting down that overreactivity.

Not that your brain doesn’t react when it needs to, but it’s not it’s not chronically in a hyper aroused state and constant re constantly reacting to any stimulation as it as if it’s a dangerous thing. I have someone I’m working with right now and

He got hurt at work and he had surgery on his shoulder and they botched the surgery. And for thirteen years no one would believe him that you know there was something really wrong and that they needed to really look at it because something was still out of whack even though he had surgery on the injury. And for thirteen years no one would believe him. And then finally he had the surgery, he had more surgery and they discovered

Cindy PERLIN (40:42.003)
that something was connected wrong that his doctor had missed. Whenever he moved, it was getting pulled on and they fixed it. And so a lot of his pain went away, but he was still overreactive to everything. Bright lights, sound, people around him, you know, whatever. So I’m doing neurofeedback with him to calm him down. He would take a walk of a few blocks and his system would get so over aroused, he’d just be so overwhelmed.

tired. Now he’s walking seven miles without a problem. You know, so we’re just calming his brain down from being chronically just hypersensitized to everything.

Leigh Brandon (41:24.998)
Yeah, I I often use analogies to describe that. You know, one analogy is, you know, the smoke alarm in your house. You know, if it if it goes off every time you make toast, it’s overly sensitive, right? There’s there’s not really the house isn’t burning down. You you just made some toast, right? And what what you’re doing is you’re taking that oversensitized smoke alarm and you’re turning down the dial so it’s not so sensitive. Yeah.

Cindy PERLIN (41:41.231)
Right.

Cindy PERLIN (41:52.41)
Right, right.

Yeah, and the effects of it if you do enough neurofeedback and the rule of thumb is twenty sessions and you get a significant change that will stick, you know, ’cause your brain has learned enough that it can hold on to what it’s learned so far. but it that’s usually not optimized. Usually you want to do more than that. Once you do enough and get to the level you want, it should last like the rest of your life basically.

Yeah, unless something else comes along that, you know, really dregulates you. But, you know, I rarely ever see people again once they’re done with treatment. They’re usually, you know, good to go. I might check in with them a year or two later and say, How’s it going? And, you know, generally the the results last.

Leigh Brandon (42:25.032)
Yeah.

Leigh Brandon (42:45.128)
Yeah, I’m I’m guessing in terms of the actual relaxation techniques, I guess almost anything that helps someone relax will work, right? But but I’m also guessing you use specific ones and maybe slightly different ones for different people, would that be correct?

Cindy PERLIN (43:00.547)
Yeah, you know, I’ll take people through a few different things like a meditation technique, a body scan, a visualization, anything they’ve learned on their own breathing technique, you know, I’ll always check with them what do you already know? And let’s see if that works for you, even though you haven’t been using it and even though you don’t think it’s doing anything. And I’ll start from there and then I’ll and then we see what works best. Like for me what works best is a body scan where I just consciously go through

my body from head to toe and and pay attention to it and tell that part of my body to relax. And that generally works really well. But with the neurofeedback you’re not telling people to do anything. You’re just saying, let’s pick a movie you’d like to watch, you know, let’s hook you up. Just watch the movie and let your brain do its thing. And the brain will say, you know, why is that getting why is the screen getting small?

like that. it just got bigger. what did I do that made it bigger? I want to do more of that is the process is going on unconsciously, but you’re just watching the movie. I mean I work with kids as young as four years old who, you know, you’re not really teaching them anything. You’re not instructing them. They’re just we’re gonna put some sticky things on your head to measure your brain. You just watch the movie. And that’s basically what I tell adults too. I’m just gonna put these things on your head. We’re gonna take

measurement, you know, pick a movie you like to watch. I have like five hundred DVDs in my collection at this point, you know, where they can or now I can on some of my programs I can use Netflix or YouTube, you know, so just something that you’re interested in watching. Hopefully not anything that’s

gonna be too dysregulating ’cause it’s violent or, you know Yeah, you know. Now some some providers would say, you know, that’s teaching somebody to relax even in the face of something fearful or stressful. There’s something to that, but I prefer not to, you know, start with triggering people when they’re, you know, dysregulated and hurting enough. so, you know, down the road that might be a more useful strategy.

Leigh Brandon (44:53.637)
Yeah, horror movie.

Cindy PERLIN (45:20.557)
usually I just let people pick what they want to watch and if they’re picking something I don’t think is gonna be that useful I’ll I’ll say I don’t think that’s

corre a good choice for you right now. But but it’s an amazing technology and when people get exposed to it they’re just really pleasantly surprised at you know how it’s to me it’s you know I call it the best kept secret in in medicine. You don’t need a drug to change your anxiety level, to get better sleep, to lower your pain, to you know, jumpstart your immune system. I mean all of that is you

learn how to control your body. And most of the things you’re doing with neurofeedback historically were thought to be out of a person’s conscious control. But if you have the information you can learn how to control it. You know if you can take those measurements, see how they respond to what you’re doing, then you can learn to do what you need to do consciously or unconsciously to change your physiology so that it just functions better. So it’s very very

powerful and yet mostly unknown. It’s been around since the sixties.

Leigh Brandon (46:36.325)
Right, wow. Interesting. So are there particular types of chronic pain that perhaps tend to respond best to biofeedback or neurofeedback?

Cindy PERLIN (46:49.595)
Well it would be, you know, I talked earlier about the difference between my structural issues and my foot pain and my back issues that were, you know, apparently more triggered by stress. So, you know, if you’re dealing with any kind of pain that gets worse with stress, so that could be, you know, back pain, neck pain, fibromyalgia, neuropathies, complex regional pain syndrome, arthritis.

even. I remember when I was starting my practice, which you know, I’ve been in practice as a clinical social worker for thirty-three years and at the time I was starting my practice there was a great program at a local rehab hospital for people in chronic pain. They check into the hospital for two weeks and they get this complete mind body program with with biofeedback and psychotherapy and physical therapy and

medication management, which the US healthcare system stopped paying for like thirty five years ago when opioids came on the scene. But it was a very comprehensive program and I’ve never forgotten the story that one of the providers there told me, which is they had this elderly woman and she was very crippled with rheumatoid arthritis. And she went to a class where they told people that you know, anger would

you know, would ramp up their pain and if they learned to express their anger appropriately, of course, that it could help with pain. And at the end of the class she said, You you mean to tell me that, you know, if I expressed my anger I’d have less pain? And they said, Yes. So this was before cell phones, they had pay phones. She goes to a payphone in the lobby or whatever, and she starts calling family members and telling them often I’m not gonna do this for you and blah blah blah. And at the end of her phone calls,

is pain-free for the first time in years. So even something like rheumatoid arthritis, autoimmune diseases, you know, they they can be, you know, positively impacted. And because your stress level affects your healing capacity, you know, it can really potentially affect any kind of pain. But most directly, you know, things like fibromyalgia and back and neck pain and things like that.

Leigh Brandon (49:16.859)
Yeah. So someone listening to this, if they are struggling in pain, how can they determine whether things like biofeedback or neurofeedback would be applicable for their particular condition and how important is it to combine them perhaps with other approaches when addressing the underlying causes of persistent pain?

Cindy PERLIN (49:44.006)
Well, you know, I think that pain is usually complex and you really need to address the whole body. So you need to look at movement. You know, when I was getting better, as I mentioned earlier, I’d gotten so weakened by inactivity because of the pain that I really needed, you know, a guided exercise program to get back my range of motion and my strength. so you know, that’s always important.

Diet is always important, you know there’s inflammatory diets and anti-inflammatory diets. when I’m working with people, even when I’m doing biofeedback to calm their nervous system down, I also like to find out if there’s anything in particular like a past trauma.

or a current situation that especially, you know, triggers them and that really upsets them. And I target those things with something called energy psychology, which is a trauma resolution technique where you’re working with the person works with their own energy, acupuncture energy points while they’re thinking of the trauma and that diffuses the stored emotional energy from that. So I combine that. I think just a bit

that anybody who’s dealing with chronic pain can benefit from at least something like temperature biophibia, you know, where they just learn to calm their body down.

Leigh Brandon (51:16.422)
Yeah, it’s interesting. Y you just summarized my my book. So, you know, I I I I suggest that chronic pain, and you can probably say almost every human condition can be caused by structure. So you mentioned movement, metabolic, you mentioned diet and inflammation, nervous system regulation, and then emotional trauma. So they’re the four things that I suggest.

Cindy PERLIN (51:20.41)
Exactly.

Leigh Brandon (51:45.198)
other causes of of pain. There might be others that I don’t know of or anyone doesn’t know of as yet. Yeah. Yeah, so that would be in metabolic for me. Yeah.

Cindy PERLIN (51:50.534)
Well, there’s things like allergens or toxins, you know, also

Yeah. So on my website which is the Alternative Pain Treatment Directory at Paintreatment Directory dot com, there’s some recent articles on root causes of chronic pain. And there’s also I just did a webinar series and it was four parts. September was pain awareness month, so I did this four-part webinar and the recordings are on my website. The first one is you know, why people need to

look beyond conventional medicine for pain relief because medications and you know invasive procedures do not get at the root causes. The second one is about the root causes of pain. So it goes through diet and nutritional deficiencies and structural imbalances and mind-body, those kinds of things. And then there’s the third one is about body-based treatments. So you know things like massage and chiropractic and acupuncture and movement therapy.

And fourth one is all about mind-body therapies. So, you know, between those four videos, people can kind of get a whole picture of I have an older book, so this would be my newer book that someday I’ll write. You know, that just covers the whole gamut. Because really, conventional medicine has really failed when it comes to chronic pain. It’s done more harm than good for just about everybody. So people really need to

you know, stop going to their doctors. I know you’re in the UK. In in the US there was a survey done of US medical schools and how much time they spent teaching doctors about pain, not just diagnosing it but treating it. And the average among medical schools was less than two hours in their four years in medical school. And then when they get out in the world and they read the journals, they’re all funded by pharmaceutical companies.

Cindy PERLIN (53:56.452)
So they don’t cover that and then they go to continuing ed that’s also heavily funded by the pharmaceutical companies. So they never see

they never see the other side of it and you go to them and then they might refer you to pain management and those doctors are usually anesthesiologists and they’re taught to numb the pain, not diagnose it and get to the root of it. So it you know, it’s really important if you’ve got a chronic issue to go beyond just D’s. At least in in the US it is

Leigh Brandon (54:29.488)
Yeah. it’s no different here. It’s no different here. Yeah, I mean people have the perception that it’s free here. It’s not free, you still pay for it, it’s just taxation rather than insurance. That’s the only difference. You know? I mean we have something called national insurance. That’s what pays supposedly pays for our medical system. But then people in their mind, because they don’t have to pay per treatment, they think it’s free. But of course it’s not.

Cindy PERLIN (54:58.287)
Well, the difference is here people hesitate to go to a doctor because of the out of pocket cost. where there, you know, you don’t have that initial thing. You’re paying for it but you pay whether you use it or not. Here, you know, there’s an additional cost. But as I understand it in the UK there are providers who are outside the national health system that you can pay out of pocket. So, yeah.

Leigh Brandon (55:22.276)
Yeah, it’s private as well, yeah. Yeah.

Cindy PERLIN (55:27.451)
So

Leigh Brandon (55:27.482)
Yeah, so you pay you pay the tax and then you pay privately on top, yeah.

Cindy PERLIN (55:31.023)
And that happens here too, you know, you’re paying enormous amounts of money for your health insurance and then they don’t cover things like me and what I do. So, you know, it’s the same kind of thing except it’s a double immediate out of pocket whammy.

Leigh Brandon (55:48.89)
Yeah, absolutely. Cindy, this has been amazing. I’ve really loved talking to you. What what what’s next for you?

Cindy PERLIN (55:55.757)
well I wanna encourage people to go to my website. As I said it’s paintreatment directory dot com and sign up for my newsletter.

And eventually I will be coming up with another book. I do have one book, but it was published in 2015. It’s still good, but I’ve learned a lot since then. That’s called The Truth About Chronic Pain Treatments. It’s available on Amazon and other online sellers. So but mainly the most up-to-date information is at Paintreatment Directory dot com. There’s over 400 blogs. There’s natural pain relief products. There’s US based providers.

on that website. So I keep developing it, expanding it and I’d love to see more traffic to it. So tell everybody you know about it.

Leigh Brandon (56:47.344)
Do. Yeah, I’ll make sure all all the links are in the show notes so people can find find your website and your and your book as well. Cindy, this has been amazing. I mean it’s always good to hear that someone’s on the same page as me. But yeah, I really enjoyed talking to you and I want to thank you again for being so patient with me. I’ve had a not the best day, not the best day, but yeah, I really want to thank you for your patience.

Cindy PERLIN (56:54.661)
Okay, thank you so much.

Cindy PERLIN (57:05.906)
you I’ll

Well, you’ve recovered quite well and as far as I could tell. And thank you for having me. I appreciate it.

Leigh Brandon (57:17.092)
Yeah, it’s been a pleasure. So that’s it from Cindy and me for this week. But be sure to tune in, same time, same place, next week on Beyond the Pain.

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