Why Pain Doesn’t Always Match the Injury | Chronic Pain & Concussion Explained | E54

Pain isn’t a simple “damage equals symptoms” equation. Sometimes your nervous system turns the volume down so far you barely notice serious wear and tear, and other times it turns the volume up until every small sensation feels like an alarm. That difference matters if you’re living with chronic pain, fibromyalgia, or persistent symptoms after a concussion, because the right treatment depends on how your brain is regulating threat and sensation.

I sit down with Dr. Norm Hoffman to unpack the neuroscience of chronic pain in plain language, including the two common patterns he sees: persistent local pain that never fully resolves and chronic widespread pain that spreads with fatigue, headaches, and sensory overload. We talk about top-down pain inhibition from the brainstem, why cortical body maps can shrink or distort, and how changes in pain receptors can leave people feeling like their natural pain relief system is no longer doing its job. If you’ve ever wondered why pain can “move around” or why one big injury can temporarily mask another, this conversation connects the dots.

From there we get practical. Dr. Hoffman explains how he looks for hidden local drivers that often get written off, and why addressing nerve sensitivity, mobility restrictions, and other subtle inputs can reduce the overall noise in an amplified system. We also cover options like PRP and focused shockwave therapy, plus supportive nutrition and supplements that can improve tissue repair. For widespread pain, we dig into why graded exercise is so important and how tools like whole body vibration, music, and gentle dance can help you move without triggering days of flare-ups. Finally, we layer concussion and post-concussion syndrome on top of all of it, including how brain injury can disrupt pain control and how dual-task testing can guide rehab.

If this helped you think differently about chronic pain and concussion recovery, subscribe, share this with someone who feels stuck, and leave a review so more people can find the show. 

Dr. Norm Hoffman: website. 

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Transcript

Pain Signals Before You Feel Them

Dr. Norm Hoffman 0:38

And its job is to send a signal down to your spinal cord at the various levels and say, I don't want to feel that. Okay, so it will either amplify or quiet the signals before they ever get to the level of consciousness. So those two people won't uh experience the same level of pain to the same level of injury, uh, if you will. So somebody who has had a chronic pain situation, they won't necessarily even deal with it because it's a two to them or it's a one to them, even though their body is in a state of what we call no suception, negative signaling going up towards the brain. It's being squashed before it hits the level of consciousness. They're not that aware of that pain, right? Contrast that with the fibromyalgia patient, their pain is being amplified.

Two Types Of Chronic Pain

Dr. Ayla Wolf 1:39

Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolfe, and I will be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information, whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing, treatments, and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology, and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless, or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr. Norm Hoffman has been in practice for 28 years with a special focus on neurological issues, complex health problems, and challenging cases. He incorporates an integrative approach to care, utilizing a wide variety of techniques and technologies, including traditional chiropractic care, low force techniques, neurologic rehabilitation, balance retraining, hand-eye coordination training, photobiomodulation, nutrition, and more. His compassionate approach to patient care stems from the fact that his drive to learn has been motivated by his desire to improve the lives of his own family members afflicted with various chronic health challenges. After graduating Summa cum lauda from Palmer College of Chiropractic in 1994, Dr. Hoffman returned to the central Alberta area to establish his practice in his hometown of Red Deer. His deep roots in the community have spurred countless charity fundraisers and donations. He then established the Hoffman Outreach Family Foundation as a charitable giving organization to help families with disabilities receive the care they might not otherwise be able to afford. Enjoyed this conversation with Dr. Hoffman. Dr. Norm Hoffman, welcome to Life After Impact. How are you today? Wonderful, thanks. Excellent. Well, our topic today is on chronic pain. This is something that, well, I've lived with chronic pain for I don't know how many years. At first it was low back pain, and then it was a brachial plexus injury. And I had a very interesting experience where I had low back pain for many, many years, had tried, you know, everything under the sun for it. And once I injured my shoulder and I was in excruciating pain, I felt like I was walking around with a broken collarbone. This was on top of several concussions. My low back pain disappeared during the year and a half that I had excruciating left-sided collarbone pain. After I tried, again, so many things for that, I did uh platelet-rich plasma injections and it got about 95% better. But I swear to you, the moment this pain went down by 95%, my low back pain was suddenly there again. And I was like, okay, brain, why? Why do you have to do this? I was so happy about having no low back pain. Now it's back. So talk to us about what is going on with chronic pain that makes it different from acute pain. And then eventually we're going to get into the role of when you layer a concussion or a traumatic brain injury into this mix, that just makes it that much harder to treat. So I'm going to give you the floor here.

Ignoring Pain Versus Amplifying Pain

Dr. Norm Hoffman 5:28

Okay, so let's talk about the brain and pain. Brain basically kind of sees it doesn't really know the difference between acute pain and chronic pain, but it treats them differently. Um, chronic pain as a whole comes in two flavors. So chronic pain can be local pain that has simply remained unresolved, such as your low back or your shoulder, right? And it just persists and persists and persists, but it stays more or less where it is. And then there's a second flavor, which is chronic widespread pain, which is I started off with a low back pain, now my knee also hurts and my shoulder also hurts, and I get headaches all the time, and now I've got gut problems and I've got fatigue and I've got all these other things that go along with it, right? So if you don't um manage that pain, or if you don't have the right answer, shall we say, to that pain, um then it can amplify. But there's also specific things that will increase the likelihood that a painful episode will turn into a chronic pain or chronic widespread pain. And yeah, so again, the depth of this is a lot. But so sp people people's brains are kind of set into uh one of a couple different patterns when it comes to chronic pain. Pattern number one, you might say, is the um sort of ignorer, the the person has some sort of a bias towards ignoring the pain. And therefore the brain actually starts to diminish its maps according uh towards that area. So you'll see um, you know, cortical maps um where, again, if you were just to imagine that somebody was sticking a needle in the brain and you would say, okay, well, why are you feel that, where you feel that, where you feel that. Um, a good cortical map would say you've got a large area to cover a small amount of the body, which is to say I can feel a lot of detail around that area. So we would have a larger map for our hand than we would have for our entire back, right? When you have chronic pain, that map can shrink. And that shrinking is part of that particular individual's process of not noticing the pain anymore, right? And so this is one strategy for if I'm not going to get rid of the pain, I can become numb to the pain to a certain extent. And this is the people who have had, and maybe you've seen them in your practice, they come in and they've got horrible, horrible problems that, and they're like, Yeah, I didn't feel anything till last week. And you see an x-ray of their spine and they're absolutely obliterated, they're completely, you know, turned into a big melted candle. Their spine is just destroyed. And I, yeah, I was fine till last week. No, you weren't. These are the people whose brains have been wired such that ignoring that is the bias, if you will.

Dr. Ayla Wolf 8:48

And I imagine that that pattern is seen very often with elite-level athletes that have gotten very good at just ignoring pain and continuing on with their training and their sports.

Brainstem Pain Control Explained

Dr. Norm Hoffman 8:59

Absolutely, elite athletes or or industrial athletes. You know, you see the concrete worker, you see the person who's, you know, in construction, or they just they just sort of beat their body for a living. And these are the people that are generally, you know, insensitive to things like, you know, their hands look like their feet, right? Like they just, you know, they're just one big cow is from one end to the other. That's that's the general gist, right? And of course that can come in different in different shapes and sizes, but that's the sort of the bias, is that, you know, you just don't uh deal with that. And they would likely have an early life uh uh, shall we say, set up that is that sort of favors that um that bit. Maybe they were always, you know, in a safe kind of an environment where they where it was just never, you know, considered to be, you know, uh a big deal where things were. And there's could gonna be genetic factors with these things as well. And then the other version is uh well gonna be the opposite upbringing, usually. Maybe there's been early life traumas. They, you know, they were never really in a safe space growing up. Um, these are gonna be far more likely, you know, either there was financial traumas or there was physical traumas or there was, you know, there's just always a threat, right? There's always always something to look out for, always something to watch for, kind of an idea. And these ones have a far more likelihood of developing fibromyalgia, chronic fatigue syndrome, chronic widespread pain, because their brains amplify the pain so that they can have a greater radar dish, if you will, for threats. So uh they're constantly on the lookout for, you know, what is the threat in my environment? What is the gonna, what should I not do? What should I do to avoid this? They are their brain is in a threat avoidance pattern. So this threat avoidance pattern says, I am smart enough, these are generally bright people, they don't smart enough to figure out that if I don't do this, then I don't hurt. So I'm not gonna do that because I don't want to hurt. The other group, they're like, I'm gonna do it anyways, I don't care. Yeah. The important part of this is that the brain has a massive top-down pain regulatory module in the base brainstem, comes through uh a lot of the cortex, comes through, but it comes down through some major aspects in the brainstem. And I know you didn't want me to get into the big name, so we'll stay away from the thick uh words, but in these areas there are massive, what we call top-down pain control mechanisms. So imagine that in the brainstem, still inside your skull, it's not in the spinal cord, it's still in the brain, but it's you know tucked up inside the skull. We've got an area, and its job is to send a signal down to your spinal cord at the various levels and say, I don't want to feel fat. Okay, so it will either amplify or quiet the signals before they ever get to the level of consciousness. So those two people won't uh experience the same level of pain to the same level of injury, uh, if you will. So somebody who has had a chronic pain situation, they won't necessarily even deal with it because it's a two to them or it's a one to them. Even though their body is in a state of what we call no seception, negative signaling going up towards the brain. It's being squashed before it hits the level of consciousness. They're not that aware of that pain, right? Contrast that with the fibromyalgia patient, their pain is being amplified. So there are receptors on the cells in your brain stems for uh signaling for pain. These are generally glutamate receptors, and there are opioid receptors. So opioids are for blocking pain, cannabinoids for blocking pain, and these receptors should turn off the sensitivity, right? So we have amplifiers and we have trissures. So if we take and we have this person who has chronic widespread pain, they will generally amplify the action of the amplifiers. So those glutamate receptors will become more sensitive. They'll have more of them. Instead of having three, they'll have 30. They'll have way more receptors for being able to detect pain. At the same time, their opioid and cannabinoid receptors become what we call internalized, meaning that they go inside the cell. So if the cell is like this, and on the outside surface, there's a little thing that is supposed to detect opioids when they're natural painkillers in your blood. That opioid receptor has now been turned to the inside. And you it's not on the surface anymore, so the opioid comes along and it can't see the opioid because the receptor has been internalized to this ins inside of the cell.

Dr. Ayla Wolf 15:07

Wow. So those receptors just basically go into hiding so that the opioids, which would normally block pain, they've got nothing to bind to, and then they can't do their job. You got it. Wow. Okay. So how do you fix that?

Finding And Clearing Hidden Local Pain

Dr. Norm Hoffman 15:24

Wow, there's a question, right? So it isn't a simple mindset thing. So just to be very, very clear for anybody that's listening, that's living with chronic diamonds saying, well, just change your mindset, you'll be fine. That doesn't work. Okay. We have a very specific approach that we teach in my courses. We have a very specific approach that we use in my office. But let's explore some of that and see we'll see what we have time to kind of cover. I mean, my pain course is 100 hours, so we don't have time to cover it, but we will do our best. Um, so first things first is to eliminate any local pain. So I teach a couple of courses on how to um identify and eliminate sort of hidden sources of local pain. So in in many people, let's again speak about our fibromyalgia patients or our chronic widespread pain patients, they'll go to their doctor and they'll say, um, my shoulder's really hurting, or I I hurt down into my arm, right? And then the doctor will say, Well, that's your fibromyalgia. And they get the same, you know, gabapentin, you know, pregablin, whatever kind of drug that they were going to get, anyways, and it really doesn't solve the problem. Or they go to the chiropractor, they go to a physiotherapist who does the same thing that they wouldn't necessarily do with every other patient, or or also says, you know, you've got, you know, you've got fibromalgia, and and, you know, there's only so much I can do. Um, as a rule, most doctors um cringe when they see a patient with fibromyalgia because they don't understand how to handle them. Um, so there is there is a way to be successful with that. Um, and I'm hoping that that becomes more popular. Um, but, anyways, what I do, what my approach is, is to assess that area using a very specialized sort of set of uh uh assessments to look at everything that I can look at with that shoulder, like look at it one way uh backwards, forwards. And I use a uh a lot of motor testing with that to determine where there might be a it's not exactly preclinical, but like very subtle aspects that are that are associated with that. So for example, I might have somebody come in and I had them yesterday and had them the day before, where they have, say, a blood flow that's restricted up here in a in an area that you know we call a thoracic outlet, but it isn't bad enough that most doctors would recognize it as thoracic outlet syndrome, and yet it's intermittently there. It's it's there when they're sleeping and it goes away when they're up, and unless they have their hands over their heads for too long, it doesn't really bother them. But if you hit the right set of circumstances, it does. Okay, I'm gonna eliminate that. And I'm gonna eliminate that by moving that rib off of the collarbone and uh making more room for the subclavian arteries and making that space wider. I don't need to do surgery, I just need to open that space. Okay, now we've got more blood flowing in there. At the same time, the same person, because they have an amplified system, they feel every little thing that's going on. So, okay, in the back of the room, there's a mild restriction associated with the radial nerve. So they've got if the uh you're gonna be familiar with like a tinal tap test. So when you're doing testing for nerves, you can tap on the nerve, and if it creates more tingling, oh, you've got carpal tunnel kind of the same. Well, one of the little tricks that I teach is to use a motor test, like so for a radial nerve, you're looking at at finger extensions, right? I might tap over that radial nerve, and if it makes that muscle weak when it was otherwise strong, it's too sensitive. And we might decompress that nerve, and oh, now it's strong. And even if I tap, it's still strong. So this gives us a tool to be able to look for subtle things that are being amplified in the body, gives us a way, a window into seeing where are the problems that are affecting this person, causing things, and that have some potential for amplification. And then for my chronic widespread patients, I just do it for the whole body. So we check the entire back, the entire neck, the entire skull, the jaw of the sinuses, the chest, the abdomen, both arms, both legs. And I do it in about five minutes because I have a very, very uh efficient system. And we release all of the restrictions, all of the fascia, all of the nerve entrapments, all of the joint mobility issues, all of that stuff. And with widespread pain patients, we do it from head to toe. Now that's different than what we would do in, say, your case where you're talking about your low back, and then your shoulder was bothering you, and then your shoulder went away, then your back was bothering you. So you were having a wonderful aspect of top-down brain-based control of that low back pain, because something that is more closer to the brain, something more proximal to the brain, was was the signal. And it was so loud that when your brain sent down the signal to the opioids to say, it worked. It worked very well. Your opioids worked great.

Dr. Ayla Wolf 21:02

And they wow, something was working back then. Amazing.

Dr. Norm Hoffman 21:06

It was working. You were having so many opioids that the low back pain couldn't get to the top because it was being blocked closer to the brain.

Dr. Ayla Wolf 21:14

Okay. Okay, gotcha.

Dr. Norm Hoffman 21:15

So in your particular case, everything that I would care about would be about restoring function and making sure there's no nerve component, making sure the nerves are being regenerated, everything I could do to get that brachial plexus injury to restore. And at the same time, since I don't charge by the body part, I would also be looking at this chronic low back pain that you have because I would assess everything and I would look at that and I would say, okay, well, that's something else we should deal. While you're in the office, let's deal with this other thing as well. And hopefully by the time one resolved, the both would be better and a way you'd go.

Dr. Ayla Wolf 21:53

Well, one of my discs completely disintegrated and was basically gone.

Shockwave Therapy And Regeneration Tools

Dr. Norm Hoffman 21:58

Yeah, and you know what? That's so that's where there's some neat technologies that we can use. So when you used a PRP to do that, what you're basically saying is I'm gonna take my regenerative chemicals called gross factors, and I'm gonna take them from my blood and I'm gonna spin them and concentrate them, and then I'm gonna stick them into that area, right? We use in our office, because I don't do all the needles and stuff that uh some other people do. We use in our office, we use a focused shockwave to do that sort of thing. So a regular shockwave is called a radial shockwave. It's basically a tool about yay big. It has a hammer on the end of it, and the metal plate strikes the other metal plate, and that creates a sound wave that travels through the tissue. Okay. That shock wave, as it travels through the tissue, um, it compresses the cells. And when the cells get squashed a little bit, they'll release their growth factors into the surrounding interstitial fluid. So that and then you hit it again, and it does more. And then because you have to space the treatments apart, if you're gonna do this properly, you space the treatments apart, you let the growth factors build back up in the cells, and then you squash them and let them out. Then you let them build back up again, then you squash them and you let them out. Okay. We do that with the focus shockwave, and then it's essentially the same thing where we're taking these growth factors in the tissues right there and allowing that the opportunity to make all of the osteophytes and the grasp and the other, and everything to kind of work fast. And if you whether you do it with a stem cell, whether you do it with a PRP, whether you do it with a focus shockwave, you're basically coming after the same essential mechanisms. We usually add laser to the focus shockwave to increase the productivity of the cells because it's going to increase cellular activity and multiply the effects of whatever you're getting, right? So we use focus shockwave because of two main things, and then a really important third thing. So the two main things is that it has a smaller, like a shorter shockwave that's higher. So it has greater amplitude with a shorter. So the wave on a normal shockwave might be something like this. The wave on a focus shockwave is shorter and higher. So it has more ability to compress. It's a sound wave, right? So every time you hit it, so that sound wave is smaller, it has greater ability to compress. Okay. That greater ability to compress is also focused. So if you will think about the thing that emits the shock wave is a parabola. It's like a satellite dish, right? And because of that, it focuses it to a point that is a certain depth away from that. And it's always a fixed point away from the speaker. So the focus shock wave is it as a literal sound wave emitted by a speaker. Okay, this is a really cool speaker, right? And so we're smacking against another metal plate. So that focus is always at a depth, which means that we can get really, really deep with it. So a radial shockwave has its greatest impact at the skin, and then it bec it dissipates as it comes out away from the skin. So the deeper you want to get, if you want to get to a hip, you've got to go through a lot of tissue. It can only penetrate the the standard thing that we know right now is it probably will only penetrate about one to three centimeters on a radio shockwave. That's being generous. And that's if you turn it way up. So if you've ever had shockwave, you know that it's excruciatingly painful. If it's not painful, you're not doing it right. It has to be painful in order for it to give enough energy to go past the skin and get to the stuff underneath of it. So people do it all the time for plantar fascitis and elbotendinitis and things of that nature, which are chronic pain syndromes, but they're local, and so we're treating them locally. But they are very talkways, very effective for it. But it's excruciating. And I'll have somebody come in and they had their right foot done with the plantar fascitis with the shockwave, and they really don't want to have the other one done because it was so painful. And then ours is not painful. So the focus shock wave doesn't hurt. And it doesn't hurt because it the energy is happening inside the tissue. If the skin level is set here and the focus level is there, you set an exact depth. And so what these things have is they have a little sponge, a little jelly pack on the outside. And different depths of jelly pack make it so that the depth that you are penetrating the skin is one centimeter or four centimeters or seven centimeters. And depending on the depth of the tissue you want to get to, you can get really deep into a hip or really superficial into a superspinatus tendon or something, or the sole of your foot. And so you can set the depth with the little jelly sponge so that you get, but it's always the same distance from the speaker, but it's always going to be past the skin, which means the skin doesn't get hurt, and so it doesn't hurt like a regular fuck would. The downside is that it's $40,000 for the machine instead of $4,000. So the doctor has to buy this $40,000 monstrosity. But I have. I've bought them, I love them, they work, they work better than the other stuff, and uh it makes me happy because people get better. We've done thousands and thousands and thousands of these, and we have an 85, 95% success rate with them. In people have knees that are destroyed. I mean, I got guys with knees that they're 75 years old, they golf every day, but they can't golf now because their knees are destroyed and they look like a horse. You know what a horse's knee looks like? It looks like that. And you're like, what have you done to these? There's no cartilage left, they're absolutely bone-on bone. It's just just horrible to look at.

Dr. Ayla Wolf 28:11

I've got lots of patients with those kinds of knees.

Supplements That Improve Tissue Repair

Dr. Norm Hoffman 28:14

Yeah. So we do that, we do the focus shockwave on him, and he's out golfing and he's doing everything he wants to do. And he's happy to pay for the treatments because they work so very well and he can live his life, and he doesn't want the surgeries, and this is how he this is how he wants to live. So he'd rather pay for the the focus shockwave sessions and be able to go out and do what he wants. Is he going to get all the cartilage back in his knees? No. But it doesn't need all of it. He needs just enough to create a layer where there's no pain. Right? So we get all of these all the time and and we do really well with those. So if you, if we were treating you with that shoulder, I would be looking for any of my little impingements, finding anything that I could find there, making sure there's nothing that's that's grabbing and pushing onto anything that shouldn't be pushing on. And I'm not just saying, okay, we're gonna go and crack stuff. We're gonna be very, very diligent in looking all that stuff. And then we're gonna probably use that if we know that that disc is gone, we're gonna use that focused shockwave and we're gonna get that nice and deep and get that disc and get that thing starting to come back. And not only that, when you hit it with the shockwave, it was originally designed to get rid of kidney stones. So you get rid of some of these little bone spurs, not a not a ton. Like you're not gonna say, you know, I did five treatments and it's gone off the x-ray. But you're gonna get some of the calcium to resorb and you're gonna get some of the sharp edges off, and you're gonna get some of that stuff to kind of clear out. And it's gonna start to do better. I got ladies that are 82 years old, and you adjust them and you do this and you do that, nothing helps at all. And you do this machine and it works really, really well. So that's, and again, this is one of about a hundred tools that I have. So it's it's not the be all and end all for everybody, but it in your case, what you're talking about with with your disc being gone in your neck, that plus laser would be at the top of my list. I would also combine that with supplements for regrowing cartilage, because I found a nice little paper that, well, I didn't, it wasn't a paper, it was a review of papers. It was a meta-analysis. And so it showed all the different studies that we're using. Uh, in this particular case, it was uh post-electromagnetic field therapy for regenerating cartilage. So they they they looked at post, because that's another tool we have in our office. So we we I looked at this paper for post-electromagnetic field, and it's okay, these guys got um, I mean, unbelievable results. They're like 200% better and everything, and everybody's at, yeah, it's good, it's 20% better. And I'm like, okay, well, what are these guys doing that these guys aren't doing? Why are the results so dramatically different? Usually they're not, I mean, unless they're cheating on their research, then it's it's usually not that dramatic. He's saying, is this person biased on his results or whatever? So I looked at his paper, and what they were doing that was different is they were they injected them with an intravenous, well, not injected, but they had an intravenous, they had a bag that they would do with their um post-electromagnetic field sessions. And the in the bag was because they were an um osteopathic doctor, they had prescription rights and stuff like that. So they had ibuprofen, they had um like a glucosamine sulfate in there, they had um some vitamin D in there, and they had uh some other, I can't even remember the there's other drugs that were in this concoction, but they were for um anti-inflammatory kind of aspects and and so on and so forth. Can't remember. No shark cartilage. No shark cartilage. But there was there was always a sulfur donor for sure, right? So that you're like that chondroitin sulfate kind of an idea. And and and some anti-inflammatory aspects, and um I think some blood thinning aspects or something like that, if as I recall. In any case, because I haven't looked at the paper for a while, I just can't I just know what I use in my office to kind of mimic it. So I I said, okay, well, I'm gonna, I was using my machines for a while, for probably a year before I found this paper. Since we've added the supplements, our results have gone up from about 85% to about 95%. We're really pretty on the mark successful with these things. And it is no small part due to the fact that I read this paper and it had to do, and and we add in with the patient takes a joint supplement, a broad-based joint supplement with chondroitin, glucosamine, MSM, yada yada yada. And we give them a curcumin with um uh boswelliana as the sort of the herbal anti-inflammatory kind of mix, and we give them a vitamin D and a vitamin K. And that was my research on what was the natural thing that was the closest to the to the cocktail that this guy was using. Right. Yeah, yeah. And when we add that in, I mean, it's pretty rare that we fail these days. So it's it that's been really helpful because then the what you're doing again, you're you're compressing cells, you're releasing growth factors with the shock wave. You're asking the body to make more connective tissue. Well, if you have the raw ingredients to do that and you're controlling the inflammatory response, you're actually getting better results. Right? All of those vitamin D, vitamin K, all of that stuff is gonna have its effect. And you're asking the body to heal. You're you're you're you're sort of saying just deuce, well, it's gonna do better when you add these things in. So that's been the sort of secret sauce to getting that that result to be even better than we got it before.

Dr. Ayla Wolf 33:56

And then it sounds like um, going back to our initial conversation on the difference between localized, isolated pain versus widespread pain. Um, when you do have the patient that comes in and says, I hurt everywhere, then what changes?

Dr. Norm Hoffman 34:12

Yeah, so that's a completely different approach. Now, we will always identify local pain factors first, right? Like, okay, yes, you hurt everywhere. What's the worst? And target in on those and make sure there aren't any treatments and make sure there aren't anything that's local. But then we're gonna add a level to try to get them from having that big giant radar dish that is sensory overload and convert. So the brain balances out between motor and sensory. Okay. So if you add more sensory, the motor comes down. Okay, so pain, chronic pain, decreases motoricity, it decreases the excitability of the motor cortex, in fancy words, right?

Dr. Ayla Wolf 35:04

So the more pain you have, the less you want to be moving around.

Vibration Music And Safer Exercise

Dr. Norm Hoffman 35:09

Correct. Absolutely. Right? And that's just because the brain's being depressed in an area that would otherwise move you, right? So um we use that what they what we do in research to to to look at this is you use a transcranial magnetic stimulation and you see how excitable the cortex is. When you hit it with the magnet, how much does it take before the thing moves? This is how you determine the excitability of the cortex. And we know that when people are in chronic pain and there's a lot of sensory noise, that cortex is not very excited. It's not it's not easy to move, it's not easy to do, right? It's not easy to think, it's not easy to create action. On the other hand, when you move, you decrease sensory. Okay? So we were generally taught in school when you did your anatomy that the motor side of things goes down to the alpha motor neuron in the cord, and that's what allows you to move, right? And then the sensory, that's you know, that's the information coming up. There's also branches from the motor cortex that go down and block the sensory signals from ever coming up the cord. So there is a very distinct connection in the spinal cord through the internals and the spinal cord that block a certain amount of pain when you move. So we know that the research for the last 15 years has been that the number one treatment, if you will, for fibromyalgia is exercise for widespread pain. Exercise. What's the number one thing that fibromyalgia patients don't want to do? Exercise. Exercise. Why? Because it hurts. Not only does it hurt, but they they suffer for days afterwards, right? But when they can do movement and they can do it regularly, and they can do it at the right amount, they get less pain. All the research says is this is this is just standard operating procedure. But because they're smart, they know that if they exercise, they're gonna hurt for two or three days afterwards. So they're not gonna do it because they're gonna avoid that because they're smart people. And they are. They're not wrong. That's exactly what happens. So what we do is we try to find ways to bypass some of the mechanisms that would um uh create more long-standing pain from exercise by increasing the output of the motor cortex and decreasing the sensory cortex in addition to just the exercise. So some of the tools that we use, but one is whole body vibration, because whole body vibration sends a different type of signal up the the um sensory system that is more, shall we call it, proprioceptive. It's more body aware than it is pain signal. It's a generally pleasant enough sensation. This whole body, it's not, it doesn't hurt. Uh, you know, my mom is 80-something and has had fibromyalgia for 40 years, 50 years. Um, she can stand on a whole body vibration plate and she doesn't suffer as a result of doing so. So it's generally tolerable quite quite nicely. And that allows for us to add some movement into the system without having to overly exert the individual to start with. So it's a nice way to start that. Then if we layer music on top of that, music increases motor output. So what happens when you listen to something that's got a pretty good beat?

Dr. Ayla Wolf 39:02

Yeah, you want to move to it.

Distal Needling And Brainstem Reset

Dr. Norm Hoffman 39:04

Right? That is using a different pathway to increase motor cortex output. So you're getting that sensory. So there's something called music in um music-generated inhibition. So there's a when you have music, you will reduce pain, right? So this is a thing where they put music in the operating rooms, they put you know, listen to music while you're getting your dental work done, you know, this kind of thing, because music can reduce pain to a certain amount, right? I mean, it's not morphine, but I mean it does reduce pain to a certain amount, right? So, but it always, and part of the reason is because it helps with that motor cortex going up, that the desire to move, and then that reduces the sensory cortex. So we put them on whole body vibration, tell them to bring their own music, listen to the music while they are on the whole body vibration plate. Now we've got now this desire to move while they're on that, and then we try to get them to dance on the whole body vibration plate. So they're just kind of doing, you know, this right on the whole body. That movement, it's very safe. When it's enjoyable, there's far less likelihood to be a consequence afterwards. Okay? So my fibromyalgia is I'm like, she's like, what should I do for exercise? Dance in your living room. I love dancing. Great, do that, right? That's gonna be wonderful for you because you're gonna increase that. You're not, you know, gonna go beyond what your capacity is for doing that, and it's it's nice and safe. It's not like you cleaned out your garage. That's not the same thing, right? Those things are unpleasant, the brain doesn't like them and it fights against them. There's a whole aspect with that. Or, you know, who likes, you know, exercising, right? I mean, it's uh the after-effect is wonderful for the people to get that, but these people don't get that, right? They don't get that buzz afterwards, they just hurt for days afterwards. So dance, music, whole body vibration, those are wonderful ways. I just teach whole classes on vibration therapies and stuff like that that we can use. And that allows them to get into a safer environment associated with movement. Now we combine that in our office with whole body treatment. This is what I was saying before. Whole spine, whole chest, whole abdomen, both arms, both legs, all we get, a myofascial joint, any kind of anything released that I can find everywhere in about four minutes, five minutes, something like that, if I know the patient well enough. And it allows me to change the sensory signaling throughout. It takes and it makes the whole system go on a global scale. And that's what you need. A simple spinal adjustment does almost nothing. The and it's and a and a and a full-body manipulative does almost nothing, and maybe you will make them worse for most fibromyalgia patients. But dry needling works, right? What what do you want to do? You want to do it as wide as you can do it. You want what's I don't know, you know, I know nothing about acupuncture, but I I know that when it comes to the research on dry needling, you want to be as do as much as you can with what you think the patient can handle because you want the entire body to reset. You want the entire body to have a different view of itself rather than be stuck in this. What's going on there? Oh, look, you see that, that, that, you see that thing? That's that's right. I wonder what that is. I wonder if I'm, oh, I wonder if I'm getting arthritis in that knee. Or I want, oh, I wonder if that's a tumor, right? Like there's this threat that is constantly going on in the brain, whether it's conscious or not, in a lot of these patients, because they are extremely threat aware, right?

Dr. Ayla Wolf 43:02

Right. Well, I really feel like the needling is such a great way of remapping those cortical maps of the body. Yes, for sure. And then there's a really fascinating uh fMRI study where they were looking at the, I know we're we we're trying to get away from all the the technical turns, but the rostral ventral medial medulla, this this part of the brain that's so important in the top-down inhibition of pain. And I didn't think you did. That's not I know. I know. But what I think was really cool was that this study was looking at the um the amplitude of amplitude of low frequency fluctuations, the kind of neuronal activity in this part of the brain that's so important for shushing pain. And they did acupuncture at distal points. They did not do anything on the head or the neck, it was all hands and feet, 20 sessions, and it completely changed this one very specific part of the brain in the brainstem. And I just thought that it was such a cool study because it was on people that had migraines. And so the the fact that there was no points done locally on the head, and it still had that effect on these key. That's exactly, exactly my point. Yeah, yeah. Key brainstem structures change their behavior with distal acupuncture.

Dr. Norm Hoffman 44:24

You got it. And since I don't do that, I just I adjust the feet and I adjust the hands and I adjust the wrists and I adjust the shoulders and I make sure all that stuff's going on, right? So different approaches to accomplishing the same thing, which is to say, reprogram that brainstem.

Concussion Changes Pain Recovery Plans

Dr. Ayla Wolf 44:38

Yeah, absolutely. Um, so then when you layer a brain injury on top of all of this that we've already talked about, uh, you know, that brain injury by itself interferes in some cases with this top-down inhibition of pain. So now when you have a patient coming in with uh either widespread pain or localized pain, I mean, again, so often I get the patient that was in the car accident, right? They've got an injury to their knee, they've got injuries to their back, they've got injuries to their neck, they've got seatbelt injuries across their torso, they've got the concussion. And so now they do have widespread pain and a brain injury, and now we have to deal with this.

Dr. Norm Hoffman 45:22

So you weren't sure you had to fix that in a couple minutes, right?

Dr. Ayla Wolf 45:25

No, no, no. I uh maybe just uh, you know, does your approach change?

Dr. Norm Hoffman 45:31

Absolutely. So we're gonna do the same thing from a Body standpoint if we're dealing with widespread pain. Okay. But we're going to layer in a brain recovery. We're going to, so my efference essentials course is that motor dual tasking course. So we're looking at do a motor activity, ask the brain to do a second task at the same time, see if that activity that you had them do in the first place falters. And so do we have a problem with the ability of the brain to do this task and this task at the same time, this task and this task at the same time, this task and this task at the same time? And if it can't do that, then you say, okay, well, that's not a very efficient brain. And we should probably make that better. And the rule of thumb, and you probably know this from all of the work that you've done, is you generally work from the back of the brain forward. So we've tried to identify the most posterior, inferior aspects that we possibly can and make sure that those are stable first and then work forward. So brain sem cerebellum and then work our way forward into the various lobes until we get to frontal and prefrontal aspects and so on and so forth. So pretty hard to target, you know, very specific things. You say, okay, I'm going to target the, you know, uh anterior cingulate cortex. Well, that's not something that has a wide receptor field to go into, but there are things you can do that will affect it, but you can't say, I'm only affecting that one area. It doesn't really work that way. But you can affect the left temporal lobe with high degree of specificity because of, you know, sound smell aspects associated with what side of the cerebellum you're going to activate. So we would do that. We would just say, okay, based on our dual tasking, it looks like you have problems here and here. Let's work this set of receptor-based activations into that part of the brain, see if it makes it better. Oh, it does. You can now do that dual task saying, okay, so now that becomes your exercise, that becomes your therapy. And we're now going to repeat and repeat and repeat until that area becomes stable. Now that area is stable. Now we can work on the next part of the brain and the next part of the brain until we run out of brain. When we hit the prefrontal cortex, we run out of brain and we say, okay, we've got everything as good as it possibly can be. The brain is as good as it can be. Let's continue to do this because we're still having these other issues, but the brain has recovered. And we use tools in our office to measure all of this stuff. Um, I have eye mapping tools, I have balance tools, I have all of the, you know, hand mapping tools, I have everything that I could possibly do. My staff spends two hours doing an exam uh with all of my tools so that it's objectified. And then I spend 45 minutes with the patient and refine all that stuff down to make a pathway for that particular individual patient. And then if they have to do therapies, then they get a prescription for the different therapies, and they go to my therapist and I take care of them and put them into whatever routines that I have developed for them. And then they come to me and I get their whole body put back together and away we go. So that is how I can kind of efficiencize my time. Um, because otherwise I'd be spending an hour with one patient, and where I live, that's hard to um get anybody to sort of, you know, cover, if you will. Um really do that around here.

New Research Questions And Microclots

Dr. Ayla Wolf 49:08

Yeah, well, that is a great answer. I love it. What would be your ideal research study if you could design one? Oh, oh my goodness.

Dr. Norm Hoffman 49:22

Um, I mean, I actually uh I'm actually very excited right this exact second about a lot of the research that's being done on what are called micro clots. Um so what they're finding is that people with long COVID and people with um uh chronic fatigue syndrome and people with POTS have high propensity to these micro clots. And so instead of your platelet aggregation being like that, the platelet aggregation is more like that, and it's not big enough to block the artery. You don't get strokes from them, but it gums up the whole works, and so we have these blockages that are temporary and they carry through and but you know, the stuff's not dying, but it becomes ischemic a little bit or hypoxic a bit, and then when you move and you do stuff, then it blasts these things loose, and then they start circulating around again, and there's this massive uh free radical uh storm that comes as a result of this, you know, mixing of, you know, oh, we found this, oh, and we blow up all of this free radical activity, so on and so forth. And so um I'm working with like an enzyme kind of based treatment for that. And I want to see more research being done in terms of how can we, you know, keep these clots from becoming a big deal in these particular cases. So that's where I'm getting excited about some things.

Dr. Ayla Wolf 50:46

Okay. Awesome.

Dr. Norm Hoffman 50:48

Tomorrow it'll be different, right?

Dr. Ayla Wolf 50:49

But today that's well, I can't wait to uh hear more about that when you start talking more about it in your courses. I I you know what? I always share everything.

Dr. Norm Hoffman 50:59

I got uh I I I'm I'm also really, really looking at uh microbiome stuff and how can we, you know, make bigger, more specific um pushes at changing the microbiome. That's kind of a big deal for for a lot of things. So these are all on my radar.

Where To Find Dr Hoffman

Dr. Ayla Wolf 51:17

Yeah, yeah. Love it. Awesome. Well, where can people find you in Canada?

Dr. Norm Hoffman 51:23

Um Well, I'm in I'm in Red Deer, Alberta, so that's you know, maybe a bit uh farther away than maybe a lot of your listeners are. Um my website.

Dr. Ayla Wolf 51:32

What is the population there?

Dr. Norm Hoffman 51:34

The population for Red Deer is 100,000.

Dr. Ayla Wolf 51:36

Okay. Half of which have been your patients.

Dr. Norm Hoffman 51:39

Yeah, I I've I've seen uh probably 40,000 people over the last 32 years that I've been with. Amazing. Um I mean, we have a trade area of, you know, probably 250,000, 300,000 at this point. Um, but I get people that come to me from out of province. I get people that come to me from the States. I get people that come from across Canada to come to me because they heard something and they they want to go to the person that helped their friend or whatever it happens to be, right? And so they'll they'll drive a ways to get that work done. But yeah, my website is Hoffmanwellness.com. They can email me. It's dr norm, dr-n-o-r-m at hoffmanwellness.com. And that's that's probably the best way to contact me.

Dr. Ayla Wolf 52:21

Excellent. I will add all that in the show notes. Well, thank you so much for your time. You're a wealth of information and an absolute expert when it comes to the neuroscience of pain and doing the world such a great favor by sharing all your information with clinicians so that they have better tools to help these patients with complex pain disorders. So thank you so much. My pleasure. Thanks for having me. Yeah, have a great rest of your day. Medical disclaimer. This video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis, or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.