Rachel Zoffness (on pain)

Rachel Zoffness (Tell Me Where It Hurts: The New Science of Pain and How to Heal) is a psychologist, pain scientist, and author. Rachel joins the Armchair Expert to discuss why she was drawn to pain in her early neuroscience studies, the most pressing question regarding pain being made in the brain, and how a pain psychologist is like a used car salesman. Rachel and Dax talk about the biopsychosocial factors that contribute to pain, definitive psychological origins of phantom limb syndrome, and the sensory map on our brain called the cortical homunculus. Rachel explains the tale of two nails, compelling evidence that pain and physical damage are not the same, and why data we give the brain that amplifies danger will also amplify pain. Take printer ink off your to-do list with HP Smart Tank | hp.com/SmartTank Check Allstate first for a quote that could save you hundreds: https://www.allstate.com/ See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dax Shepard?

  Welcome, welcome, welcome to Armchair Expert Experts on Expert. I'm Dan Shepard. I'm joined by Lily Padman.

• 0:05Speaker 01

  Hi.

• 0:06Dax Shepard?

  We have a guest today with the cutest last name perhaps we've ever had, Rachel Zoffness.

• 0:12Speaker 01

  Yeah, this was a great episode.

• 0:14Dax Shepard?

  I just love that last name.

• 0:15Speaker 01

  It's a good last name. It's a little misleading because this isn't a Zoff episode.

• 0:21Dax Shepard?

  Although it is in also another way.

• 0:24Speaker 01

  I guess.

• 0:25Dax Shepard?

  She is a leading pain psychologist and neuroscientist. You guys, this episode is so incredible. I think it's one of the best of the year. It's so many of us know, as you learn in here, there's 1.8 billion people in the world suffering from chronic pain and there's 100 million Americans. And we don't understand how we experience pain, truly.

• 0:45Speaker 01

  Yeah.

• 0:45Dax Shepard?

  And this is an incredible explanation of how it actually works. And it's quite an empowering take on it.

• 0:52Speaker 01

  It is.

• 0:52Dax Shepard?

  Yeah, so her book is called Tell Me Where It Hurts: The New Science of Pain and How to Heal. I have already sent it to two people who I know who suffer from chronic pain. This is a great one. Please forward it to anyone in your life who's experiencing chronic pain. Please enjoy Rachel Zoffness. We get support from AG1. Fall is that time when your body and mind are getting ready for the winter. You're settling in, bracing for the cold. Your body's already running a deficit from the shorter days and broken sleep patterns. You don't want a nutrient deficit stacked on top of that, too.

• 1:28Speaker 01

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• 1:41Dax Shepard?

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• 1:55Speaker 01

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• 1:59Dax Shepard?

  It's an easy, everyday thing. I've added it to my morning routine and I'm gonna tell you, I actually love the taste of it. It's like Pavlovian. I drink it and I know I'm gonna get that little vitamin buzz.

• 2:10Speaker 01

  That's also the thing. When you do it first thing in the morning, you already feel kind of self-esteem because you're like, I already did something good for myself.

• 2:16Dax Shepard?

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• 2:57Dax Shepard?

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• 3:40Dax Shepard?

  Try today at superhuman.com.

• 4:01Speaker 02

  Hi.

• 4:02Speaker 03

  It's such a pleasure to meet you. Are you a hugger?

• 4:03Speaker 02

  Yes, let's do it.

• 4:06Dax Shepard?

  Monica, you must know how this started.

• 4:08Speaker 03

  This is terrifying for me. I'm like a library mouse bookworm. I'm like not a public facing person.

• 4:13Speaker 01

  Okay, well, you're already so warm feeling.

• 4:16Dax Shepard?

  Well, listen to what happened. I saw Rob by the staircase when I left the house. So by the time I got out and went up the stairs to grab my drink, I saw that he was in the bathroom. And I go, Jesus, what are you taking a shit in there? It was Rachel.

• 4:30Speaker 03

  I was like, don't you wish I was?

• 4:33Speaker 01

  Oh, no.

• 4:35Dax Shepard?

  Is that terrible?

• 4:36Speaker 03

  It's funny.

• 4:37Dax Shepard?

  Oh, my God.

• 4:38Speaker 01

  Did you get really scared?

• 4:42Speaker 03

  Good lord. I know where I am. Come on.

• 4:46Dax Shepard?

  Even for me.

• 4:47Speaker 01

  Yeah, even for you, you would not do that.

• 4:49Speaker 03

  We have a friend in common also.

• 4:51Dax Shepard?

  Who?

• 4:51Speaker 03

  Do you see the person who wrote the endorsement on the top of the book?

• 4:54Speaker 01

  Who did? Who did it?

• 4:55Dax Shepard?

  Oh, I did see that. Yes.

• 4:56Speaker 03

  Anna Lemke.

• 4:57Dax Shepard?

  I'm obsessed with her.

• 4:58Speaker 01

  Oh, yes.

• 4:59Speaker 03

  She's the reason I teach at Stanford. Because addiction, medicine, and pain are best friends.

• 5:03Speaker 01

  Yeah, that's right.

• 5:04Dax Shepard?

  So you're down presumably from San Francisco. Do you live there?

• 5:07Speaker 03

  Yeah, I'm in the Bay Area. But I'm originally a New Yorker, which is why I have an attitude problem. And I wear too much black and I curse all the time.

• 5:13Dax Shepard?

  Uh huh.

• 5:13Speaker 03

  I feel like I'm in good company.

• 5:15Dax Shepard?

  Those are good attributes.

• 5:16Speaker 01

  I thought you said you were like a church mouse.

• 5:18Speaker 03

  Library mouse? Very, very different than church mouse. Yeah, super different.

• 5:23Dax Shepard?

  People are pervs.

• 5:24Speaker 01

  Oh dang.

• 5:26Dax Shepard?

  They're like in the nurse category.

• 5:27Speaker 03

  What's happening? Tell me what's happening. Yeah, no, I was like the kid who was shy and quiet. Shy and quiet. Quiet and shy. And was in the library reading all the time. Books were my friends.

• 5:40Speaker 01

  Oh.

• 5:40Speaker 03

  Different than a church mouse.

• 5:42Speaker 01

  That is different. You're right.

• 5:43Dax Shepard?

  How has teaching been for you? Because that requires a ton of get up in front of people and speak.

• 5:48Speaker 03

  What's funny is that during the pandemic, this thing happened where I was supposed to give all these talks. And I was actually doing that because it was partially a treatment for my own performance anxiety and public speaking anxiety. The treatment is exposure therapy, right? Like, if you never do it, you never get through it. So I had all these talks planned and then everything got canceled.

• 6:05Dax Shepard?

  Hmm.

• 6:06Speaker 03

  I was like, okay, what do I do now? So I started planning virtual talks and I started cold pitching podcast hosts. And I pitched a couple of people who actually had really big platforms and I didn't realize it at the time. As I started doing more and more podcasts, I think I did like 42 of them.

• 6:21Dax Shepard?

  Wow.

• 6:21Speaker 03

  And Ezra Klein came calling. And by the time I did that one, I had done so many that I felt pretty secure in what I wanted to say. And I feel very passionate about the topic and I keep my patience in my mind when I talk about the topic. So I'm sweating through my clothes.

• 6:36Speaker 01

  Well, that's also because it's

• 6:37Speaker 03

  For sure.

• 6:38Speaker 01

  500. I'm so hot.

• 6:40Speaker 03

  It's also 90 degrees.

• 6:41Dax Shepard?

  Oh my god, that never happens.

• 6:42Speaker 03

  But you can also take off your sweater.

• 6:43Speaker 01

  I'm considering it.

• 6:44Dax Shepard?

  It's not gonna happen.

• 6:45Speaker 01

  It's a cute outfit.

• 6:46Dax Shepard?

  Yeah, it's not gonna happen. She would be dying of heat exhaustion. We'd say, can we remove the sweater? I don't know.

• 6:51Speaker 03

  No, it's a cute color.

• 6:52Dax Shepard?

  I'll die doing what I love.

• 6:53Speaker 01

  It's layered.

• 6:54Dax Shepard?

  Being in this cute sweater. Okay, so you're originally from New York. You really could write a book on universities of America, probably.

• 7:02Speaker 03

  You mean because I've been to so many?

• 7:03Dax Shepard?

  Yeah, you've been to so many.

• 7:04Speaker 03

  Did I tell you I was a nerd? I think I did, coming in here.

• 7:07Dax Shepard?

  You started at Brown, yeah?

• 7:08Speaker 03

  Yeah, yeah.

• 7:09Dax Shepard?

  You were biology?

• 7:10Speaker 03

  Yeah, I was brain and behavior. I couldn't decide what I wanted to study when I was at Brown. I loved neuroscience. I loved human biology. I thought psychology was so interesting. I couldn't decide if I wanted to do research or clinical work or teach kids. So human biology, brain and behavior was sort of an amalgamation of everything. And then when I learned about pain in my first neuroscience class, it lived at the intersection of everything I thought was so rad.

• 7:34Dax Shepard?

  Because why?

• 7:36Speaker 03

  Because why? It just depends on how far down the rabbit hole you want to go.

• 7:39Dax Shepard?

  I mean, I've heard you say that you were drawn to it because you were so afraid of pain.

• 7:43Speaker 03

  Yeah, and that's another reason. Pain scares the shit out of me. And it should, right? Pain is designed to be aversive. It's designed to save your life. If it doesn't grab your attention and get you to stop doing the thing you're doing, there's a chance you could hurt yourself slash die.

• 7:55Speaker 01

  Yeah.

• 7:56Speaker 03

  So that's pain's job. But I always found pain to be very scary.

• 7:59Speaker 01

  Physical pain.

• 8:00Speaker 03

  Well.

• 8:01Speaker 01

  Oh.

• 8:02Speaker 03

  My friend.

• 8:03Speaker 01

  Oh.

• 8:04Speaker 03

  Well, my friend.

• 8:05Dax Shepard?

  Fasten your seatbelt.

• 8:06Speaker 03

  That's the number one question I get, especially because I study pain psychology. So to answer your question very briefly, guess where pain is made? It's not in your bad back and it's not in your aching knee.

• 8:15Speaker 01

  In the brain.

• 8:16Speaker 03

  And the parts of your brain that make emotions Also, make pain. Like, your amygdala and your limbic system are a critical part of the pain machinery. And we all know that our bodies feel worse during times of stress and duress. Of course, they do. But does anyone ever tell you that at any point in your effing life?

• 8:34Dax Shepard?

  Yes. And we're gonna march through that granularly. But her question still stands because prior to you understanding that there is no difference between psychological pain and physical pain in one regard. Were you someone that was afraid you were gonna get physically hurt? Or were you afraid you were gonna get emotionally hurt?

• 8:50Speaker 03

  It is a fair and good question. And yes, physical pain is what I was scared of. But of course, no one likes emotional pain either.

• 8:56Dax Shepard?

  Yeah.

• 8:57Speaker 01

  I don't know. Some people...

• 8:58Speaker 03

  And some people like physical pain, too. Like, there's a whole BDSM community where pain is pleasurable and there's a reason for that. And maybe we'll even get to that. But it all goes back to pain being made in the brain.

• 9:08Dax Shepard?

  Were you sheltered? Were they very nervous kind of parents?

• 9:10Speaker 03

  I would say I had very overprotective parents and, by nature, I was shy, quiet...

• 9:18Dax Shepard?

  Indoor cat.

• 9:19Speaker 03

  Library mouse. So, I was self-protective. Like, my sister and brother would be running around, playing sports, hitting each other with lacrosse sticks. I was in the backyard, reading books by myself. Self-directed. No one told me to do that. It wasn't because my parents were like, "You're gonna get hurt."

• 9:32Dax Shepard?

  Were you the older?

• 9:33Speaker 03

  I'm the oldest.

• 9:34Dax Shepard?

  Yeah, yeah, yeah. Because they get crazier. We can't have the library mouse at the end.

• 9:39Speaker 01

  Yeah, no.

• 9:40Dax Shepard?

  It's gotta be at the beginning.

• 9:41Speaker 01

  The library mouse is at the beginning.

• 9:43Dax Shepard?

  Yeah, yeah. This is ticks the party off. Okay, so after Brown, you go to, is it San Diego State?

• 9:49Speaker 03

  Columbia.

• 9:50Dax Shepard?

  Columbia next. And we do teaching masters there.

• 9:54Speaker 03

  I got a masters in psychology. I was interested potentially in education, like, teaching psychology or maybe being a professor one day. Like, I really couldn't decide what direction to go. I mentioned I was a science teacher at the Bronx Zoo. I was like, "I love biology. I love animal behavior. Do I go that route where I'm a science educator?" I was a science writer at Natural History Magazine.

• 10:17Speaker 01

  Oh, cool.

• 10:17Speaker 03

  Out of the Museum of Natural History in New York City. I was like, "That's rad. You're science writing. You're learning so much stuff. You're translating complicated science for the lay public. Do I want to do that?" I realized it was just me with my... My computer and that wasn't satisfying enough. So for me, the education piece, I am also a glutton when it comes to information, especially science. So I was like, what can I do where I could consume the most amount of science over the course of my life? So I just went to school for as long as I could.

• 10:45Dax Shepard?

  Yeah, were your parents at all getting frustrated like, we got to figure out what direction or they were just supportive?

• 10:51Speaker 03

  No, I was working really hard and I'm very self-driven. They were not at any point worried about me.

• 10:56Dax Shepard?

  Okay.

• 10:57Speaker 03

  I think they were probably worried because I was so stressed out. Figuring out your life path is not a casual thing and it can feel scary and intimidating for as long as you're wondering that. And you can be on this journey for forever. Hopefully we'll all have different points in our career where we pivot and do different things. But for me, I've been on this path from the beginning. Like I knew I wanted to help people. I knew I thought neuroscience was amazing. I knew that I want to do something with medicine. It really just naturally led me here. I did my honors thesis at Brown on the neuroscience of pain and I studied with a pain neuroscientist there. We studied endogenous neurochemicals that regulate pain.

• 11:32Dax Shepard?

  Okay, so those are ones that emanate from your body. They're not exogenous, right? It's your body's pharmacy kit.

• 11:37Speaker 03

  You got it.

• 11:38Dax Shepard?

  Yeah.

• 11:38Speaker 03

  It's the chemicals that are made by your body's pharmacy.

• 11:41Dax Shepard?

  And what was the most fascinating aspect of that? I love telling people that, like, when you take a drug, the drug itself isn't the thing that's giving you this sensation.

• 11:49Speaker 03

  That's right.

• 11:49Dax Shepard?

  It's either regulating uptake or down. It's just letting the chemicals in your body go crazy.

• 11:54Speaker 03

  And it's binding to receptors that your brain has because your brain already makes those chemicals.

• 11:59Dax Shepard?

  Yeah.

• 12:00Speaker 01

  Which is why you adjust. It's in you, it's not whatever you're putting in.

• 12:03Speaker 03

  Right, so like if you're taking a drug for a very long period of time, your brain does a thing where it down-regulates. You probably have heard this term from the other science nerds you've had on, where your brain stops producing as much of that thing. So if you're taking chronic opioids, for example, your brain doesn't need to produce as many because you're giving them from an external source. So you down-regulate, you don't have as many. Now, neurotransmitters in your brain and the receptors are just picking up what you're giving it instead of like the homemade ones.

• 12:29Dax Shepard?

  Take me to San Diego State.

• 12:30Speaker 03

  Oh, right.

• 12:31Dax Shepard?

  Take me there.

• 12:32Speaker 03

  We're on the education journey. This is hard for me, by the way. I hate talking about myself.

• 12:35Dax Shepard?

  I guess what I'm trying to figure out when I asked about your parents and you, I guess there's two versions of this. One is, I have anxiety, I'm afraid to pick, I don't really know what my Calling is I'm scared. Another one is I'm at this salad bar and I just can't stop going up to it and trying something new.

• 12:53Speaker 03

  It was that.

• 12:53Dax Shepard?

  It was the latter.

• 12:53Speaker 03

  Yeah. And also, I really wanted to make sure I was going in the right direction because it's a lot of time when you go to school for that long. Like, you really want to be sure as shit that this is the right direction. So I just kept honing it and honing it. So San Diego State, UCSD was where I went for my PhD. And I studied clinical psychology because I decided I wanted to work with patients. And I really was fascinated by the brain-body overlap. I still feel this way. I felt like if I had gone to med school, I would have gotten like one slice of the pie. And if I went for my PhD in psychology, I would get another.

• 13:25Dax Shepard?

  Yeah.

• 13:25Speaker 03

  And I wanted the intersection. And I had to kind of go get that on my own, to be perfectly honest.

• 13:31Dax Shepard?

  Yeah, we just had Michael Pollan on last week.

• 13:33Speaker 03

  I just saw him at a diner. He lives in my neighborhood.

• 13:36Speaker 01

  Oh, my God.

• 13:36Speaker 03

  I almost went up to him and I was like, that's rude. I'm not going to do that.

• 13:39Speaker 01

  Oh, he probably would have liked it.

• 13:41Speaker 03

  That must be so annoying.

• 13:42Dax Shepard?

  Oh, I don't think so.

• 13:43Speaker 01

  It's only annoying if you go and tell them about your shroom trip.

• 13:45Speaker 03

  Like how people come up to me and tell me their pain stories.

• 13:48Speaker 01

  Yeah, exactly.

• 13:49Speaker 03

  I actually don't mind that much because I'm like, oh, my God, tell me everything.

• 13:51Dax Shepard?

  Right, more data.

• 13:52Speaker 03

  Yeah.

• 13:54Dax Shepard?

  Okay, so at what point do you start seeing patients and specialize in pain psychology?

• 14:00Speaker 03

  I wanted to hang up a shingle right away. I did the PhD because I wanted to get really good at research. Like, if you're a real nerd, you want to make sure that the papers you're reading are high quality, the data's good data. So in my PhD program, I got that. I got what I was looking for. But I really wanted to work with patients and I was obsessed with the science of pain. People think I'm a masochist when I talk about how much I'm interested in pain. But I'm not saying that I enjoy inflicting it or receiving it. Just the science is mind-blowing. So I wanted to treat patients right away. And, you know, I had been teaching a bit at UCSF and at Stanford. And I just told my colleagues, like, I'm opening my doors. I want to specialize in chronic pain. I got the hardest patients. I want to say this clearly.

• 14:41Speaker 03

  Absolutely no one wants to see a psychologist for pain. I am like the used car salesman of pain medicine, right? Of course not. The stigma attached is like, you're saying it's all in my head, you're saying it's just emotional, it's psychosomatic. It's not real.

• 14:54Dax Shepard?

  Yes.

• 14:54Speaker 03

  I just want to see a medical doctor. 96% of our medical schools have zero dedicated compulsory pain education. I'm gonna say that one more time. Wow. 96% of med schools in the United States and Canada have zero dedicated compulsory pain education. The real pain science is out there and it exists. It's just not being taught in med school.

• 15:13Dax Shepard?

  And of the 4% that have it, the total is in the four to six hour range or something, right? It's very small.

• 15:21Speaker 03

  And check this shit out. We're gonna talk about this, I'm sure. The current model of understanding and treating pain is the biomedical model. It means when we talk about pain and when we treat pain, we talk about anatomy and physiology and bones and body parts. And yes, that's important. But neuroscience has known for 65 effing years that pain is this word. It's bio-psychosocial, which means yes, there's bio-components. There's also cognitive and emotional components. There's also social components. But it makes me crazy. I had to study pain on my own for 700 years to really distill down like, what is this? And what are we getting wrong? And how has this happened in pain that we've created an opioid epidemic? And we're still doing it today?

• 16:04Dax Shepard?

  So Michael Pollan was in, and his new book is on consciousness. And similarly, it's riddled with the same challenges in that Rene Descartes broke the mind and the body into two things for us 300 years ago. And we are stuck in that paradigm where there's two different things. There's your thoughts and emotions and then your physiology or your physicality. More and more, we now know there's no such thing as a division in any one of these components. This is one complex system that's talking at all times with itself and it's integrated. And there's no division that can be made. And to put a super fine point on what you're saying, because I'm currently dealing with it with a loved one, to say that it's more than just the physical pain is not to say it's not real.

• 16:49Dax Shepard?

  It's 100% real. And the question is, what's contributing to it? Right? It's very relevant. How are we getting to this pain, which is 1,000% real? And anyone who's listening to preventing the defensiveness, it's real, real, real. No one is suggesting that the pain is not real. So to your point, the patients you're getting have generally gone through years, in some cases, of exploring every single medical option. For their pain, what are some examples, MRIs?

• 17:20Speaker 03

  That was sort of what triggered when you asked me about opening the private practice. I was getting the patients who weren't getting better. So I have this patient who lives in my brain. And of course, I'm changing names and personal details because that's what you're supposed to do. And it's very important for patient privacy. But I have this patient in my mind and I still see him all the time when I talk about pain. One of the chronic pain patients that really sticks in my mind is Sam.

• 17:42Dax Shepard?

  It was really Samuel.

• 17:45Speaker 03

  Sammy. He had been in bed for four years and he had been on 40 medications. He had seen 14 specialists. And I want to describe him to you because I see him in my mind's eye every time I talk about him. He had long unwashed hair and his skin was pasty and pale. And he was rocking himself back and forth on my couch with pain. What's funny is I remember thinking to myself, who do I think I am? This kid had been to Stanford.

• 18:13Dax Shepard?

  So the punchline is this person who's been bedridden for four years.

• 18:17Speaker 03

  Yes.

• 18:17Dax Shepard?

  Is only 17?

• 18:19Speaker 03

  Correct.

• 18:19Dax Shepard?

  Oh, my God.

• 18:20Speaker 03

  And at 17, when you've missed four years of life, that is really significant. Like, those are all the milestones. You really only get those once. But I did have imposter syndrome. I absolutely was like, who do I think I am? So we talked about my training and how I'm a nerd and studying pain neuroscience and endogenous brain chemicals that make pain and pain psychology and biology. But I really think of myself as a pain detective. And when someone comes to my office, it's my job to figure out all of the factors that are contributing to the pain, that are amplifying the pain and are perpetuating the pain cycle. So when I assessed Sam, I had his records, like, yes, family history of migraine. Diagnosed with migraine and diffuse amplified body pain of unknown etiology. Meaning, he was riddled with pain all over his body.

• 19:04Speaker 03

  No one knew where it was coming from. He had had a million tests. He had been on all the drugs. So when I assess my patients, yes, I want to know your medical history. If you haven't had all the tests and the scans, I'm going to send you. I want to know that your blood and body parts are OK. Then I want to know about the rest of you. We use this word bio psychosocial. That means that there are a lot of factors contributing to pain in any given moment, all the time. Sam was depressed and suicidal. Shocking, he had been in bed for four years. He had no friends, no life, no hope.

• 19:35Dax Shepard?

  He left in seventh grade. He detaches from playing soccer, from having friends.

• 19:40Speaker 01

  But what happened? The first thing is he had a migraine?

• 19:43Speaker 03

  He had crippling migraines.

• 19:44Speaker 01

  OK, in his seventh grade, he had crippling migraines?

• 19:47Speaker 03

  Yes, diffuse amplified body pain. So severe body pain, all the tests, no one knew what was going on. He couldn't go to school. His loving parents were like, what are we supposed to do? He was like, I can't go to school. So he stopped going, and that just never ended.

• 20:02Speaker 01

  Oh, my god.

• 20:03Speaker 03

  You would be surprised by how common this is in the pain world. So I started getting all those patients. But I want to tell you what happened with Sam.

• 20:11Speaker 01

  Yeah, yeah.

• 20:12Speaker 03

  He was depressed and suicidal. He was socially anxious, like crippling social anxiety. Couldn't talk to kids. His pain was always worse Sunday nights and Monday mornings. So there's a pattern to the pain.

• 20:22Speaker 01

  Of course, yeah.

• 20:22Speaker 03

  He was on a white food diet.

• 20:24Speaker 01

  Oh, like rice and bread?

• 20:26Speaker 03

  He didn't like fruits and vegetables.

• 20:28Dax Shepard?

  Pasta and fries. I doubt he was.

• 20:30Speaker 03

  Pizza, pasta, chips, bread.

• 20:32Speaker 01

  Oh.

• 20:32Dax Shepard?

  You would pray for rice, I think, for Sam.

• 20:34Speaker 01

  Rice is white.

• 20:35Speaker 03

  I mean, like, that's not uncommon for a big chunk of the American pediatric population. Like, she just don't like fruits and vegetables, and so don't eat them.

• 20:43Speaker 01

  If they're saying they can't eat, or they're too sick to eat, then yeah, your parents can be like, fine, just eat these chips, I guess. Eat something.

• 20:50Dax Shepard?

  And his only activity at this point?

• 20:52Speaker 03

  Was reading books.

• 20:54Dax Shepard?

  And playing video games.

• 20:55Speaker 03

  Playing video games. So he's up till four in the morning, playing video games. His sleep hygiene was off. So in order to help Sam, I knew I needed to help him look at the whole recipe and fix the whole recipe. So we changed his nutrition, had a come-to-Jesus talk with mom and dad. We were like, how is his body supposed to fight this thing if he's not getting appropriate nutrition? Put him on a sleep hygiene protocol. He had to wake up at like 10 instead of like 2 in the afternoon.

• 21:20Speaker 01

  Oh, this is so.

• 21:21Dax Shepard?

  Peeling it back.

• 21:21Speaker 03

  Exactly.

• 21:22Dax Shepard?

  I like how small you started. You had really tiny steps for him to take. I think the first one was to go outside.

• 21:28Speaker 03

  It's called a pacing protocol. It's one of the most fundamental parts of a pain plan for people with chronic pain. So week one, he was standing outside in the sun on his porch. And texting just one friend. Week two, he was walking to the corner mailbox and mailing a letter. His mom would actually give him bills she had to pay. Week three, he was taking his dog to the dog park and having a conversation. And we scripted it. Cute dog. Remember, paralyzing social anxiety, isolated, stuck at home. By the way, that will amplify pain. All of these ingredients. He got a tutor, started catching up in school, went for his first haircut. When that kid came to my office after his first haircut, he also had gone and bought a backpack. He was a child transformed. That was like one month in, one month in. Some sunlight, some social exposure.

• 22:12Speaker 03

  By the way, the more he did, the more he realized he could do. Mood started going up, stress and anxiety started going down. And oh shit, the brain's connected to the body. When stress and anxiety started going down and mood started going up, all these things started changing, his pain started changing too.

• 22:27Dax Shepard?

  The virtuous cycle or the destructive cycle is spinning. So the one he was in was just gonna get worse and worse and worse until probably suicide or something else was on the table. And just the notion that one thing's feeding into another and then slowly it's all gaining momentum. And the fact that he was happy when he came to your office with a haircut and a backpack.

• 22:45Speaker 03

  His face was shining.

• 22:46Dax Shepard?

  Yes. And he spoke at his graduation, he returned to school.

• 22:50Speaker 03

  I love that he had an impact on you. I still think about him. He graduated from high school and he walked across the stage and he said, if you had told me four years ago I'd be graduating high school, I never would have believed you. I maybe cried. That kid got asked to prom by two girls, not by one, when he went back to school.

• 23:05Dax Shepard?

  And he went with both somehow. I would love to talk to him how he juggled that.

• 23:09Speaker 03

  They were two different schools.

• 23:10Dax Shepard?

  Oh, okay. I thought it was at the same prom. I'm like, how did Sam?

• 23:14Speaker 03

  I still hear from his parents.

• 23:15Speaker 01

  Oh.

• 23:16Speaker 03

  I have to tell you.

• 23:17Speaker 01

  You saved his life.

• 23:18Speaker 03

  Very selfishly.

• 23:19Speaker 01

  You did.

• 23:19Speaker 03

  It changed my life. I'm not joking. That kid, I was like, I'm never doing anything else. When I met that kid, he was on opioids and Thorazine. I also worked on an inpatient psych unit. If you're homicidal or suicidal, you will go to an inpatient psych unit where they lock the doors. And if someone's having an acute psychotic episode, they will shoot you full of Thorazine and knock you the F out. This child was on opioids and Thorazine for his pain because we tell people that pain is a Purely biomedical problem that requires a purely biomedical solution. I want to say clearly, I am not a magician. But that kid got out of bed and back to life. He will never again be the kid who's in bed for four years. That will never happen to him again. What are we doing to people in pain? It makes me crazy.

• 24:03Speaker 01

  Yeah.

• 24:04Speaker 03

  Like, it's not beyond anybody's understanding.

• 24:06Dax Shepard?

  Yeah, so let's talk about, first of all, the subjectivity of pain. You've got a lot of different, great examples of how we can illustrate that it's not just the broken bone, although that is definitely part of it. But I think a good place to start is amputee phantom limb pain.

• 24:24Speaker 01

  I'm obsessed with phantom limb.

• 24:25Dax Shepard?

  Explain.

• 24:26Speaker 03

  You are?

• 24:26Dax Shepard?

  Explain phantom limb pain.

• 24:28Speaker 03

  Only if I got to hear after my Monica's obsessed with phantom pain. Or before.

• 24:32Speaker 01

  I'm kind of obsessed with pain. Well, not pain.

• 24:35Dax Shepard?

  Oh.

• 24:35Speaker 01

  But I'm a little bit of what Dax would say a hypochondriac. I don't identify that way, but he identifies me that way.

• 24:42Dax Shepard?

  Dax would say.

• 24:43Speaker 01

  So, you know, I am hyper-aware of what will cause distress and pain. I avoid those things pretty much at all costs. So, in a psychology class, when I learned about phantom limb, I was like, "What? That's horrifying."

• 24:55Speaker 03

  Okay, so, we have all been sold a big, fat lie about pain and what it is. So, pain is the body's warning system. It's our danger-detection system. However, we have been told that pain lives exclusively in our body, in the part that hurts. You have back pain, you see 762 back doctors, and you probably get back surgery, and maybe you get a prescription. You have chronic knee pain, you see 40 million knee specialists. Maybe you have surgery, maybe you take medications. Now, I want to say clearly, surgeries are important and useful. Medications are important and useful. They are not the only treatment for pain, and they are not the best treatment for chronic pain, not by a long shot.

• 25:37Dax Shepard?

  It's really important, because we're gonna primarily be talking about chronic pain. And acute pain is pain that lasts

• 25:42Speaker 03

  Three months or fewer.

• 25:43Dax Shepard?

  Three months or under, and that is your stomach hurts, you might have gotten food poisoning. So, great.

• 25:47Speaker 03

  Broken bone, acute illness, yes.

• 25:50Dax Shepard?

  So, anything that persists for longer than three months. Now, we're into the chronic pain category. And this is where we really want to focus.

• 25:57Speaker 03

  So I am going to be talking about the definition of pain across the board. But you are right. Generally speaking, god, my language is so bad. The fuckery comes when we talk about chronic pain. So sorry for people who are listening, but I know where I am. So hopefully the audience is okay. But the chronic pain world is where we really screw people. But this is true for acute pain, too, just the basic signs of pain. So we've all been told pain lives just in our body part that hurts. One of the reasons we know pain isn't constructed just by the body part that hurts is because of this thing called phantom limb pain. Phantom limb pain is when someone loses a limb, an arm or a leg, and they continue to have terrible pain. Monica's knocking on wood. They continue to have terrible pain in the missing body part.

• 26:40Dax Shepard?

  Debilitating pain.

• 26:42Speaker 03

  If you can have terrible leg pain in a leg that is no longer attached to your body, that tells us pretty definitively that pain cannot live exclusively in the body part that hurts. I had a patient with phantom hand pain who had lost his hand and his arm in a terrible firework accident.

• 27:01Dax Shepard?

  Mateo, another young boy.

• 27:03Speaker 03

  Mateo. He felt like his hand was constantly spasming, cramping. Sometimes it was picking things up. So if you can have hand pain in a hand that is no longer attached to your body, that tells us pretty definitively that pain is constructed somewhere else and that somewhere else is the brain. And we said before that the parts of the brain that make emotions also make physical pain.

• 27:27Dax Shepard?

  Yeah, so the nervous system is kind of mapped in your brain. You have a neural network that knows where all the nerve endings are, and it's communicating. And it's interesting, this phantom limb pain is an outgrowth of the fact that your brain believes you still have this same nervous system you had before some of it was removed. And it takes a while to update it.

• 27:47Speaker 03

  That's right.

• 27:48Dax Shepard?

  I mean, that's mind blowing, isn't it? It's like it has a map of what it's supposed to have, and it hangs on to the map long after a piece has been removed. So Mateo, what did you do with Mateo?

• 27:58Speaker 03

  Yeah, what you're talking about is you have a map of your body that lives in your brain. It's called the homunculus. Actually, when I teach this, I see patients of all ages, adults and kids. But when I teach kids, I ask them what they think a homunculus might look like. And they draw me pictures. And I used to have a whole wall full of drawings.

• 28:14Dax Shepard?

  I see like triceratops with an elephant's trunk.

• 28:16Speaker 03

  See?

• 28:17Speaker 01

  Oh, yeah, definitely.

• 28:18Speaker 03

  Homunculus.

• 28:19Dax Shepard?

  It's a pachyderm.

• 28:20Speaker 01

  Sure. No, I'm wet hippo, but that's because of the...

• 28:22Dax Shepard?

  Yeah, that's a pachyderm. Yeah, you're good.

• 28:24Speaker 03

  Yeah, right. And it's a really cool map. So like if I tell you right now, without doing anything, to sense into your right foot, like what is your right foot doing? Can you feel it? Can you feel it on the table?

• 28:35Dax Shepard?

  Yeah, yeah.

• 28:35Speaker 03

  Is it warm or cold? You can do that. And the reason you can do that is because of your homunculus. It's like a sensory and motor map. With phantom patients, there's a treatment called mirror therapy. And with mirror therapy, there's a lot of books on this, so interesting. You erect a mirror. So they have their functional arm and the damaged arm. And you put a mirror up. They hide the damaged arm. The good arm stays up and there's a mirror reflecting back to the brain, the undamaged arm, doing things. So they engage in activities and exercises. And it feeds back to the brain an image of two healthy arms. And it helps update the out of date brain map.

• 29:12Dax Shepard?

  It's kind of counterintuitive.

• 29:14Speaker 03

  Your left arm's hidden. Your damaged left arm sits behind you. But your brain sees your left arm and your right arm doing things together. Like Dak said, the map in your brain just hasn't caught up with the damage that has occurred. That arm is gone. Like, it's not in danger anymore. But pain is the body's danger system. So your brain is going to continue making...

• 29:33Speaker 01

  To fix the pain.

• 29:34Dax Shepard?

  Yeah, yeah, yeah, yeah.

• 29:35Speaker 01

  Not to trick your brain into thinking...

• 29:36Dax Shepard?

  It's like unplugging the association with your left damaged arm by seeing your right damaged arm in its place.

• 29:44Speaker 01

  Yes, yes, that makes sense.

• 29:45Speaker 03

  It's quieting the danger alarm. That's the whole trick with pain, is pain is the body's danger system. So credible evidence of danger will amplify the alarm. Credible evidence of safety will lower the alarm. So like, one of my favorite examples of this is if you get slapped and bitten when you're having sex with a hot partner and you want it, it will feel good. If you get slapped... Lapsed and bitten when you're getting mugged? You bet your ass that is going to feel completely different to your danger alarm. Because pain is biopsychosocial, which means it takes into account bio-information, but also contextual and social information, and also emotions, and where you are in the moment, and who you're with, and what's happening.

• 30:24Dax Shepard?

  And intention.

• 30:25Speaker 03

  And intention.

• 30:26Speaker 01

  Safety.

• 30:27Dax Shepard?

  Yeah.

• 30:27Speaker 03

  Safety.

• 30:28Dax Shepard?

  Yeah, think of a massage, there's so many great examples. A massage, which would otherwise be painful, is like euphoric because you have put it in this framing.

• 30:38Speaker 03

  You're there on purpose.

• 30:40Dax Shepard?

  Yeah.

• 30:40Speaker 03

  You desire it, you're paying the person to do this to you.

• 30:43Dax Shepard?

  You have some notion that it's medicinal. I mean, I always think, oh, they're getting the knot out. No, I don't know physiologically that's even true, but I think we're making progress towards my health.

• 30:52Speaker 03

  Yes.

• 30:52Speaker 01

  Some control over it.

• 30:54Speaker 03

  That is huge. When you think about safety, control is a big part of that, right?

• 30:58Dax Shepard?

  Yeah, enjoying capsaicin, like eating hot, hot foods.

• 31:01Speaker 03

  The winner of the hot ones.

• 31:03Dax Shepard?

  Yeah, we enjoy that pain.

• 31:05Speaker 03

  Tattoos, MMA fighting, what are you kidding? There's a million examples of enjoying pain on purpose. It's expectations, it's your context, it's emotions, it's predictions.

• 31:18Dax Shepard?

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• 32:02Dax Shepard?

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• 32:59Speaker 04

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• 33:18Speaker 05

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• 33:36Dax Shepard?

  We want to think it's a subjective thing. It sends a signal. The signal itself is pain. No, the signal's not. It goes into the computer, and the computer interprets and comes to a conclusion.

• 33:47Speaker 03

  If I could give you a grade, you would get A+.

• 33:48Dax Shepard?

  Oh, thank you.

• 33:50Speaker 03

  But that's the thing we don't know. Even now, if you Google what a nociceptor is, a nociceptor are the neurons that live in your body, in your tissues, in your skin, your organs, and they feed information about potential danger to your brain. Potential danger. But if you look it up, you're going to be told that it's a pain receptor. It makes me crazy. That is sensory data. Sensory data isn't pain until it reaches the brain, and the brain uses all available information to decide whether or not to make pain and how much. Yeah. So it isn't a pain receptor. It's like temperature, it's touch.

• 34:26Dax Shepard?

  It's reflex. Such a flame.

• 34:29Speaker 03

  Yes.

• 34:29Dax Shepard?

  A hot burner. Noception makes your body move before you even think about it or process it. You have an instinctual reaction to that. And I learned all this from Ed Yong's book, Immense World. So all these different animals have noception.

• 34:43Speaker 03

  Yes.

• 34:43Dax Shepard?

  But they don't necessarily have pain. Some do, some don't. We're figuring out which ones do. But all animals have this.

• 34:49Speaker 03

  Noception.

• 34:50Dax Shepard?

  Yes.

• 34:50Speaker 03

  So what happens is those danger detectors in your skin, organs, ones. Send data first to your spinal cord and your spinal cord initiates that automatic instant response.

• 34:59Dax Shepard?

  Again, there's a lot of animals that demonstrate constantly they have these survival reflexes.

• 35:05Speaker 03

  Yes.

• 35:06Dax Shepard?

  But they don't have any of the other signatures for pain. So we are somewhat unique in how sophisticated our interpretation is.

• 35:15Speaker 03

  Yeah, it's true.

• 35:16Dax Shepard?

  OK, I think now's a great time to talk about a tale of two nails. Sometimes things are so interesting that I'm reading about that they make it to my dinner table. So last night I had to tell my daughters about this. So let's talk about our first construction worker.

• 35:30Speaker 03

  So I was reading these great papers. There was this one from, I believe it was like 1995 in the British Medical Journal. And they wrote about this construction worker who had been on a job site. And he jumped off a plank straight onto a seven inch nail. So he was in terrible pain. They rushed him to the emergency room. They gave him really good drugs. He was in terrible pain. They gave him a bunch of opioids and fentanyl was one of them. He got all the good stuff. And when the good doctors removed his boot, they discovered that a miracle had occurred. The nail had passed between the space between his toes. No. There was no puncture wound. There was no tissue damage.

• 36:06Dax Shepard?

  Everything's groovy.

• 36:07Speaker 03

  No blood, but his pain was real. How is that possible? His brain, AKA his danger detector, used all available information to decide whether or not to make pain and how much. Pain is your body's danger alarm. It exists to save your life. So it used knowledge of his dangerous work environment, memories of past pain experiences and injuries on the job site. It used the horror of the construction worker's face. His friends around him, the visual data of this crazy nail and his brain perceived potential danger and it made pain to protect him. Tale of nails number two.

• 36:48Speaker 03

  Second construction worker, most dangerous job apparently ever, on a job site using a nail gun. Nail gun misfires. He sees a nail shoot across the room, bury in the wall across from him. Nail gun ricochets backwards, clocks him in the jaw.

• 37:02Dax Shepard?

  He hits himself in the chin with the nail gun, which hurts.

• 37:05Speaker 03

  Shoot across the room and he has mild jaw pain, mild toothache, mild headache, continues on with work and life for six days. At the end of six days, he says to his wife, you know, maybe I'll check out this tooth.

• 37:18Dax Shepard?

  Yeah, I can still feel this tooth a little bit.

• 37:21Speaker 03

  Goes to the dentist, scans his patient's jaw.

• 37:25Dax Shepard?

  And Rob, please put up the x-ray of him. Okay, so listener.

• 37:28Speaker 03

  Much to both men's surprise, they discover a four inch nail embedded in his face. I spoke with Dr. Seth Rinear on the phone. That's how big of a nerd I am. I was tracking down this photo. I wanted it so bad for the book. He said, this is the luckiest guy ever.

• 37:43Dax Shepard?

  And for the listeners, so the nail has entered the top of his jaw and it has passed all the way through his zygomatic, everything, all the way up into the frontal lobe. The brain is spanning from his upper jaw into his brain.

• 37:56Speaker 03

  Yes, and the whole story and the picture is also in the book for people who can't see it.

• 38:00Dax Shepard?

  Yes, yes, yes. This guy has enormous chunk of metal in his face.

• 38:05Speaker 03

  And I want to say clearly, very real damage, very little pain. Now, if pain were a reflection of how much damage we have to our body, gentleman number two with the giant nail in his face should be in crippling, excruciating pain. Gentleman number one, who has a nail in his boot, but not his foot, should actually be fine. We have all had experiences like this. This is a stark example. If you've ever gotten into the shower and you have black and blue marks on your body, you're like, how did those get there? That's evidence of damage to your body without the pain. We know that pain and damage are not the same thing, but we continue to get sold that lie.

• 38:46Dax Shepard?

  Okay, so now, and this is the area that I'm constantly saying on here out loud because I heard it from Layne Norton, but I'm relieved to hear-

• 38:54Speaker 03

  Layne Norton is a buddy of mine.

• 38:55Dax Shepard?

  Oh, he's the greatest. I talk about this one often, but you have two examples of it, but now I have the precise numbers, which I'm grateful for, which is, there's been two incredibly compelling studies, because back pain's among the most common pains.

• 39:09Speaker 03

  Like 80 to 85% of people develop chronic back pain at some point.

• 39:12Dax Shepard?

  Chronic back pain, yeah. So, they scanned 3,000 healthy individuals, meaning people who have zero back pain, no reported back pain. And nearly all of the individuals scanned, 90% of subjects ages 60 to 69, and 80% of subjects aged 50 to 59, had bulging discs, disc degeneration, and other anatomical abnormalities, with no accompanied pain.

• 39:40Speaker 03

  I want to reiterate that.

• 39:41Dax Shepard?

  Yeah.

• 39:41Speaker 03

  Almost all of us with no back pain are wandering around with slipped and bulging discs, and we don't know it. You want to know why we don't know it? We don't have pain, so we've never gotten our backs scanned. However, if you have chronic back pain, and you go to get your back scanned, and they find a bulging disc, guess what you will be told is causing your pain?

• 39:59Dax Shepard?

  They think they have a smoking gun, but you can't have a smoking gun if 90% of us have the same smoking gun.

• 40:06Speaker 01

  But then that's why when they do those full-body scans, what's it called?

• 40:09Dax Shepard?

  Pernuvo's the brand of one I got.

• 40:11Speaker 01

  That's tricky to do, because it will tell you, "Oh, you have a bulging disc here," and then you might be like, "Oh, fuck," and then your brain will probably-

• 40:19Speaker 03

  Have you done that? Please don't do that.

• 40:20Dax Shepard?

  Hold on, I did.

• 40:21Speaker 03

  I don't want her to do it.

• 40:22Dax Shepard?

  No, that'll be my third argument I have about this. I want to hit the second one, though.

• 40:25Speaker 03

  Yeah, yeah.

• 40:26Dax Shepard?

  So there was another study, too. 1,200 healthy subjects who had no pain. Nearly 90% of them had bulging discs. So, this is enormous. Less than 5% of back pain is from structural issues.

• 40:38Speaker 03

  Right.

• 40:38Dax Shepard?

  And that is not unique to back pain. Those are similar results when you study the hip, the pelvis, the jaw, the uterus, the wrist, the knee, and neck pain.

• 40:48Speaker 03

  I went so far down that rabbit hole. There are study after study after study showing that pain and damage, the things we find on scans, that's what we're blaming pain on. But there seems to be very little relationship between the abnormalities found on scans and chronic pain.

• 41:05Dax Shepard?

  It's the ultimate correlation, not causation.

• 41:08Speaker 03

  Yes, but are people listening going to be like, oh, OK, well, when I have chronic back pain, I'm not going to go? That's the thing. Because of this thing we're sold, which is that pain and damage are the same, it's a really, really hard relationship to break. So I'm going to tell you a quick story. 30 years ago, there was a little kid growing up in Jamaica, and he loved to run. He was really fast. And as he grew, something strange was happening to his spine. It started twisting into an S shape.

• 41:35Speaker 01

  Scoliosis.

• 41:36Speaker 03

  And he was diagnosed with scoliosis. But it didn't stop him. He didn't get surgery. He wasn't in terrible pain. He kept running. He was faster and faster and faster until he was fast enough to qualify for the Olympics. And by the time he qualified for the Olympics, his body was so twisted, his spine was so abnormal, and his body was so asymmetrical, that his right leg was, I believe, half an inch shorter than his left.

• 42:04Dax Shepard?

  And his left leg could only put down 14% as much power as the right leg.

• 42:10Speaker 03

  He won not one Olympic gold medal, but eight of them. Do you want to guess the name of this gentleman who has extremely severe scoliosis, but has never been treated for it and has very little pain?

• 42:21Dax Shepard?

  Usain Bolt. And still holds the world record in the 100, the 200, and the 4x100.

• 42:26Speaker 03

  Usain Bolt is the fastest man alive. You should see this man's spine. It is absolutely gnarly.

• 42:33Dax Shepard?

  It's a bowl of spaghetti.

• 42:34Speaker 03

  And so if the lie was true, that damage and pain are the same, that gentleman should be relegated to a hospital bed. He should not be the fastest man alive. And in fact, we are often told that asymmetry is the cause of our pain.

• 42:49Dax Shepard?

  Yeah, yeah.

• 42:50Speaker 03

  I will say again, he's so asymmetrical that his right leg is half an inch shorter than his left.

• 42:57Speaker 01

  You would think that would affect a run.

• 42:59Speaker 03

  Well. Check this out.

• 43:01Dax Shepard?

  He's running like lightning.

• 43:02Speaker 03

  The scientists who study his biomechanics have discovered or believe that it is his very asymmetry that helps him go faster.

• 43:12Speaker 01

  Listeners, do not chop off some of your leg just to be faster.

• 43:15Dax Shepard?

  Yeah, it's not gonna make you a single. Now, here's where we get to my own personal story, which is I did the Prunovo scan.

• 43:20Speaker 03

  Yeah.

• 43:21Dax Shepard?

  And I'm going through the different categories. They do heart, they do lungs, all this stuff. And I get to skeletal system and I have abnormalities. I'm like, oh, what's this? And yeah, I have significant scoliosis.

• 43:36Speaker 03

  Oh, yeah.

• 43:36Dax Shepard?

  At the top of my back, my spine curves to the right pretty dramatically. I went, oh, my God, all the times my mom was yelling at me like, you always drop your left shoulder in photos. And we had no explanation other than it was my laziness, I guess. Come to find out, oh, yeah, I've had scoliosis significantly. It's visible in photographs now that I have seen the X-ray. But yeah, I have zero issues up there. I've had lower back pain, but nothing where the scoliosis is at all. No issues.

• 44:03Speaker 03

  Wild.

• 44:04Dax Shepard?

  And the same thing, I'm like, oh, yeah, if I were in pain and I went and got the X-ray, it would be definitive.

• 44:09Speaker 03

  I think this is the complexity of it is, yes, biological factors matter. Yes, of course, you can have pain with scoliosis. It's just not the only factor that matters. Bio-psychosocial, it means biological factors matter, cognitive and emotional factors matter, social and environmental factors matter too. And together, those create the pain we feel.

• 44:28Speaker 01

  Does it work the opposite way, though? So often do people go and they're like, oh, wow, oh, my God, I have scoliosis. Yeah, my back. Then does the brain start sending the signal because you're aware now of it?

• 44:40Speaker 03

  There's a story in the book called How Cancer Cured a Kidney Stone. I should say, should I say that I wrote a book? I wrote a book. It's called Tell Me Where It Hurts.

• 44:46Dax Shepard?

  Yeah, yeah, yeah, yeah.

• 44:47Speaker 03

  That's why I'm here. It's called Tell Me Where It Hurts. I took sort of like the most fascinating patient stories and put them in because pain is gnarly and it generates these incredible and counterintuitive stories. So one of the stories I put in the book is called How Cancer Cured a Kidney Stone. So I had a patient who had regular kidney stones and they appeared like clockwork. She would have a six out of 10 pain, abdominal pain. There would be a host of accompanying symptoms and the stone would pass within, I can't remember exactly, I think a max of like a couple of weeks and then the pain would go away. She would be fine. So she was having the normal constellation of symptoms. Her pain was a six out of 10. Her father had recently died of cancer. She was having a pain flare and her husband said to her, are you still having pain?

• 45:33Speaker 03

  It has been like six weeks. Are you sure this is a kidney stone and not something else? And she immediately thought to herself, shit, I have cancer too. Right.

• 45:44Dax Shepard?

  I think we all think we have cancer at least once a week. If you're a normal, healthy human being.

• 45:48Speaker 03

  Thank you for that validation.

• 45:50Dax Shepard?

  Yeah, yeah.

• 45:50Speaker 03

  And I think her dad had died of maybe abdominal cancer, something like this. So she, yeah, the knocking on the wood. I understand. I didn't want you to see it. Sorry, I won't call it out next time.

• 45:58Dax Shepard?

  You need your own little.

• 45:59Speaker 03

  You should do it, do it, do it.

• 46:00Dax Shepard?

  You know your handle is wood on your chair.

• 46:02Speaker 03

  I did it on my handle. I did it small, but you still got it. Sorry, I can't help it. I observe behavior all day. So she had the thought, maybe this is cancer pain. And she shared that with her husband. They both freaked out. Her pain went to an 11 out of 10, per report. She fell to the floor screaming. Oh my God. Her husband called 911. She got rushed to the emergency room. They did a scan. They found the kidney stone. Her pain went back down. Oh my God. Don't remember the number, three out of 10. And she went home and the kidney stone passed. Pain is the brain's danger alarm. It's subjective. It thrives on data. Any data we give the brain that amplifies danger will amplify pain.

• 46:45Speaker 03

  Data we give the brain that makes us feel safe will lower the brain's danger alarm. So that story to me was so revealing. The things we think, the images our brains feed us, the images we get from our doctors, they are going to affect the brain's pain alarm. And of course they should. It is adaptive and evolutionary for our brain to use all available information. Why should we only use data from the body part? We should use all available data, right?

• 47:10Dax Shepard?

  Now let's explore these three pillars that attribute to our experience of pain. So the first one's biometric. We understand that one. I think we all understand. Your bones broken, you have

• 47:22Speaker 03

  The biological

• 47:22Dax Shepard?

  The flu.

• 47:23Speaker 03

  Yes.

• 47:23Dax Shepard?

  Yeah, so let's talk about the psychological and how it impacts.

• 47:28Speaker 03

  Can I add to the bio domain of pain?

• 47:30Dax Shepard?

  Yeah, yeah.

• 47:30Speaker 03

  Okay, so, like you said, it's the obvious stuff. It's like tissue damage, system dysfunction, genetics, like Sam's family history of migraine. It's also diet, sleep and exercise. And I like putting them there because those are biological imperatives. The reason I'm going to go into this is because what I want everyone listening to remember is that you have so much more control and agency over pain in your body than anyone has ever told you. If sleep and diet and exercise affect your body, you maybe can't change your genetics. You can change your sleep, you can change your nutrition protocol, you can change your sleep hygiene. I'm always sort of keeping in mind, like, pain is terrifying, it's overwhelming, it feels unmanageable and uncurable.

• 48:14Speaker 03

  So if I can help people feel like, oh, there's actually 72 things I can do, maybe starting today, if I can seed some hope, I have done my job. So that's the bio domain.

• 48:25Dax Shepard?

  That's the bio domain, and let's talk about psychology now.

• 48:28Speaker 03

  Yeah, so I want you to imagine that there's a Venn diagram with three overlapping circles, and I should have said this at the very beginning. Of course, the first circle is the bio circle, the one we just talked about. Then we've got the psych circle, psychological factors, and the social or the sociological domain of pain. So pain lives in the middle of these three circles in our Venn diagram. Okay, so you asked about bio, covered. In the psych domain of pain, this domain of pain is so full of stigma and misunderstanding, so I really front-load with just the science. So in the psych domain of pain, we have emotions. We said at the beginning, the limbic system, our amygdala, the parts of our brain that make emotions, also make physical pain.

• 49:11Speaker 03

  So our bodies hurt more during times of stress and duress, we know that's true. Anxiety and depression will amplify the brain's pain alarm, there's like 4,000 papers on that. Our emotional health affects our physical health.

• 49:26Dax Shepard?

  And we're in a broken paradigm, which is It's either physical or mental.

• 49:32Speaker 03

  Oh, my gosh.

• 49:33Dax Shepard?

  So if it's physical, go see a doctor. If it's mental, go see a psychologist.

• 49:35Speaker 03

  Yes.

• 49:36Dax Shepard?

  That's not a real distinction.

• 49:39Speaker 03

  I feel so much gratitude. Like, this is the line that I go around repeating. In Western medicine, we're told either your pain is physical and you need to see a physician, or your pain's emotional, you should go see a psychotherapist. But pain is both physical and emotional 100% of the time. You can't separate them out. That's just not how the brain works.

• 49:56Dax Shepard?

  Right.

• 49:57Speaker 03

  When we're treating chronic pain, I actually want us to be thinking about our emotional health. And I am not saying it's all in your head. I am not saying it's all psychological. You just can't deny that the brain is connected to the body. Yeah, it's part of the recipe.

• 50:09Dax Shepard?

  I want to talk about some of the specific things within the psychology domain, which would be thoughts, attention, distraction, and emotion. So we said emotions. Let's talk about thoughts, attention, and distraction.

• 50:19Speaker 03

  Yes. We tend to think that thoughts are just these air bubbles that appear in our head, you know, in the space between our ears. But thoughts trigger a neurobiological cascade of events in the human body. Right now, I want you to think about your to-do list. All the things you have to do and haven't gotten done. Maybe your taxes. That's true for me. How does your body feel? When we think stressful thoughts, our body has a physiological response. Our muscles get tense. We bump cortisol and other stress hormones.

• 50:51Dax Shepard?

  Heart rate goes up.

• 50:52Speaker 03

  Heart rate goes up.

• 50:53Dax Shepard?

  Inflammation goes up.

• 50:54Speaker 03

  Thoughts don't just live in your head. Thoughts affect your body 100% of the time. And then we have in there also, like you said, attention. That's a cognitive factor. So what we know about pain is that when we think about pain and talk about pain and focus on pain, what happens to the brain's danger alarm? It magnifies the pain response. And of course, the opposite's also true. So if you have to give a kid a shot, for example, you shove a screen in front of their face, and they will be distracted and laughing, and they will not cry, and they will not scream. We all know this, even as grownups. If you've ever been so absorbed in some pleasurable activity that you didn't notice your pain, or you briefly forgot about your pain, which happens to everyone, that's not magic. That's just your brain's danger alarm. Right? So attention changes. Pain to.

• 51:39Dax Shepard?

  Yeah, maybe even think about why opiates work.

• 51:43Speaker 03

  Oh dude.

• 51:43Dax Shepard?

  As I was reading all this because I have a very well-known issue with opiates at one point. They certainly cure the physical pain, but I think for me, they're only curing the physical pain because they distract me from the mental pain.

• 51:58Speaker 03

  By the way, that is a known thing.

• 52:00Dax Shepard?

  Yeah, it's like, it's not sending anything that's making the inflammation go away like NSAID would or something.

• 52:05Speaker 03

  That's right. It's binding to the opioid receptors and you have a disproportionate amount in your brain's emotion centers. And opioids medicate not just physical pain, but emotional pain. And that's why they're so dangerous and that's why they're so addictive.

• 52:17Dax Shepard?

  Yeah, you think they're addressing this physical pain. For me, they're not. They're affecting the angst and discomfort of my emotional life. Yeah, they're muting everything.

• 52:26Speaker 03

  By the way, what are we doing to people in pain, especially people with a history of addiction? It's like handing people a loaded gun when they already have a genetic loaded gun. To me, it feels unfair and unsafe and I hope we'll talk about that.

• 52:36Dax Shepard?

  Yeah, I was curious in this psychological pillar, I often think of identity as having a lot to do with this. So my identity is that I'm indomitable. I have reasons why I've made that my identity. I believe if I appear to be indomitable, you will not try to take advantage of me. And so in order to service this identity I have, Monica will tell you, that's why I had no business on opiates. My shoulder's in four pieces. I gotta wait a week to get the surgery because I'm still filming and I go film an episode in a sling racing a rally car with one hand and jumping. And I can do that. I don't know why I can do that. I don't have an explanation. I don't think I was born with that thing where I don't feel pain,

• 53:20Dax Shepard?

  but it's not on the table for me to be outwardly vulnerable. And so I do think I've willed my way out. I've been yelled at by my wife for carrying things while I just had surgery, right? And I'm like, you know, I can still fucking carry it. The notion that I can't carry it is the most painful thing. The pain's not the painful thing. And so I just feel like I have really reformatted my relationship with pain. And my only explanation is that it's this identity thing that I will not threaten my identity by experiencing this pain. Or if I get tattoos, I don't give a fuck. So what do we think about our identity? And how can that play a role in there?

• 53:52Speaker 03

  I feel like every once in a while, someone brings an ingredient to me that I haven't thought about before. So the way I frame this is like a pain recipe. Like, there's a recipe for brownies. There's always a recipe for pain. And there's biological ingredients in there. There's psychological ingredients. There's sociological ingredients. And I feel like I spend a lot of time with each one of my patients, like, mapping out the ingredients. Like, what are the things in this recipe of yours that's amplifying your pain? And what can I do to help change those ingredients to help you lower pain volume? And one that I have absolutely, till this moment, never thought of is identity.

• 54:24Dax Shepard?

  Anecdotally, it's so present in my best friend from childhood, Erin Weekly, who also grew up around a lot of violence and being vulnerable is not an option. I see it in my sister and my brother. My mother has it. We don't give a fuck about that. And then somehow, some magic happens where I'm not experiencing it.

• 54:42Speaker 03

  Yeah, yeah.

• 54:42Dax Shepard?

  So I think I'm lying to myself or fighting it. It's like, I don't care.

• 54:45Speaker 03

  I don't think you're lying to yourself. I think it's adaptive for you in some way. It's like a survival tool for you. I don't know you well enough to know why, but it has been adaptive for you throughout your life, and that's why you've been using it. And that's not a flaw. That's not a character flaw. It has helped you get where you are.

• 54:59Dax Shepard?

  I think it's fascinating.

• 55:01Speaker 01

  It has a tail to the head of that coin. It does go somewhere. It goes into emotional distress that then needs medication, whatever that medication is, whether it be drugs or whatever it is.

• 55:13Dax Shepard?

  Or adrenaline.

• 55:14Speaker 01

  It's not just like it's magically, oh, I don't have pain. It's that it gets funneled into somewhere else where people don't see it necessarily.

• 55:21Dax Shepard?

  Yeah, it has pros and cons.

• 55:23Speaker 01

  And then that's not good either.

• 55:24Dax Shepard?

  Yeah.

• 55:25Speaker 03

  I hear you.

• 55:26Dax Shepard?

  OK, so let's talk about sociological, because I think you probably have a lot of interest in statistics. And I'm sure things differ in these different categories of sex, gender, race, ethnicity, socioeconomic status. How are these factors evident in people's experience with pain?

• 55:42Speaker 03

  Yeah, so when I was first studying pain as this little library mouse, not church mouse, at Brown, with this pain neuroscientist, I was like, yeah, pain's biological. It feels pretty intuitive that there's an emotional component. But what is this social shit? Like, pain is social? What does that even mean? So I really went down that rabbit hole, and I wanted to examine that. So I'm going to give a couple of examples, and I hope they're resonant, and you can ask me questions about it. So among the worst punishments you can give a human being? Is solitary confinement. What does it say about human beings that one of the worst things you can do to us is isolate us from others? Being social is biologically adaptive. It helps us survive.

• 56:22Speaker 03

  It's so fundamental to our very survival that our brains evolved a mechanism to reward us for engaging in it. When we are social, our brains bump out serotonin, which bumps our mood, dopamine, pleasure and reward and motivation, and endorphins, our endogenous homemade painkillers. When we are with other people, pain volume goes down. The opposite is also true. When we are isolated and lonely and alone, especially in solitary confinement, all of those good chemicals crash and we feel terrible, not just physically, not just emotionally, but both because it's connected.

• 57:03Dax Shepard?

  This made me think of the weirdest thing while I was reading about this. When I worked for my mom and I worked with all of my friends in my early twenties and we would drink way, way too much on work nights and we'd stay up till three in the morning and we'd be out in the parking lot at 6:00 AM to fucking wash cars. But because all eight of us were hungover, there was some bizarre joy in sharing that state. And I think people can relate to this on vacation with friends. When you're with a group of people and everyone's hungover versus you're by yourself in your apartment, dealing with a hangover, those are totally different experiences, aren't they, Monica?

• 57:40Speaker 03

  Yeah, that's true. I think so.

• 57:41Dax Shepard?

  I never cared about a hangover when I was with my friends. And when I was a solitary drinker, they were insufferable.

• 57:46Speaker 03

  And there's this old saying that when you share your joy, you double it. When you share your pain, you cut it in half. And that is definitely true for me. Like if I'm suffering, my friends will tell you, I will burden them. And for them, they seem to be able to carry it. You can tell me your stuff all day, I'll be fine. You know, like I can carry anyone's stuff. When I share my stuff, it definitely reduces my pain. Yeah. So that's one example of how pain is social.

• 58:09Dax Shepard?

  So when people are isolated in their pain, obviously that's going to make it go up exponentially. It's gonna feed that.

• 58:15Speaker 03

  So that was another data point that was so fascinating to me. So former US Surgeon General Vivek Murthy. Yes, we love him.

• 58:21Dax Shepard?

  We've had him. Yeah, he's all about ending loneliness.

• 58:24Speaker 03

  He did that amazing study, like hundreds of thousands of people where he showed, by the way, he wasn't the first to show this, but he gathered all the scientific data to show. That when we are lonely and isolated and alone, it actually is a predictor of a whole host of chronic illnesses and also chronic pain.

• 58:45Dax Shepard?

  That are worse outcomes than smoking a pack a day, which is the craziest comp. We all know how bad smoking a pack a day is, but being alone is worse.

• 58:54Speaker 03

  Not just emotionally, just to make that clear. Loneliness is bad for our physical health. It is a predictor of disease and pain.

• 59:03Speaker 01

  Yeah, that's so wild.

• 59:04Speaker 03

  I know. So like all of these data points to me, I was like, oh yeah, pain is social. Social medicine is real, but that's not being prescribed. And most of us roll our eyes like, yeah, I have chronic pain, blah, blah, blah. Don't tell me to just hang out with more friends. And I want to say clearly, it's not that simple.

• 59:18Dax Shepard?

  It's one of the things, one of the levers you can pull.

• 59:21Speaker 03

  It's one of the ingredients in the recipe.

• 59:23Dax Shepard?

  Yeah.

• 59:23Speaker 01

  We should probably be done with timeouts, right? For kids.

• 59:26Dax Shepard?

  There are a lot of psychologists who are anti timeout.

• 59:29Speaker 01

  For that reason.

• 59:30Dax Shepard?

  Although there is a version of it, which is it is our baked in learning mechanism. Because we're a social primate, being excluded from the group is insanely powerful.

• 59:39Speaker 03

  Yeah.

• 59:40Dax Shepard?

  So is there a version of it that is?

• 59:43Speaker 03

  Not too terrible, right?

• 59:44Dax Shepard?

  Yeah, like it's all about degrees of it, I think.

• 59:47Speaker 03

  Yeah.

• 59:47Dax Shepard?

  But yes, in general, when your kid is dysregulated and you send them away to deal with their dysregulation by themselves, maybe not a great idea, right?

• 59:54Speaker 01

  Yeah, it's just like not gonna work, really.

• 59:56Dax Shepard?

  Yeah, and the goals should be probably to first regulate, then teach the lesson. I think that's also a good order of events. So I wasn't a big timeout person, but there were a couple of occasions where it felt appropriate.

• 1:00:08Speaker 03

  Totally.

• 1:00:09Dax Shepard?

  What do we see with pain? Is it applies to gender? How is it differ with socioeconomics? I have my guesses, but what do we know about?

• 1:00:17Speaker 01

  And redheads.

• 1:00:19Dax Shepard?

  That's physiological, though.

• 1:00:21Speaker 01

  What is that?

• 1:00:22Speaker 03

  I had to look that up. Someone asked me that on a previous podcast. I was on this podcast called Ologies, which is a science podcast and she has red hair. And she was like, is that true? So there is some data to suggest that redheads do experience more pain. It's still very new science and I would not say it's definitive, but there is some research suggesting that it is tied to like our sensitivity. This is the most fascinating thing. So all of us, as part of our recipe, have pain thresholds. And some people, and this may be true for you, have higher pain thresholds than other people. And like everything else to do with humans, it is on a spectrum. Some of us are very sensitive. And some of us are less sensitive.

• 1:01:02Speaker 01

  Don't look at me like that. I can handle a good amount of pain.

• 1:01:06Speaker 03

  Yeah, yeah, yeah.

• 1:01:07Dax Shepard?

  Well, it's very, very clear to me. If you choose it, you can, you can endure a ton. So your role as a cheerleader, you endured pain that you wouldn't otherwise be able to endure because you wanted to be a cheerleader. But you also cut your finger and it is a very, very big deal.

• 1:01:24Speaker 01

  Well, hold on.

• 1:01:26Dax Shepard?

  Both things are true.

• 1:01:26Speaker 03

  I opened a can of worms.

• 1:01:27Speaker 01

  You did. Listen, the finger cutting is not a big deal because it hurts. It's a big deal because I'm

• 1:01:37Dax Shepard?

  Alone.

• 1:01:38Speaker 01

  That's a huge part of it. Then I'm calling people and sending pictures like, is this okay? And as soon as they're like, oh no, whatever they say. The connection with another person is helpful.

• 1:01:48Speaker 03

  You're saying that loneliness amplifies the pain alarm and social support lowers the pain alarm.

• 1:01:52Speaker 01

  And it's like, oh, what if I bleed out? It's about that. It doesn't hurt.

• 1:01:56Speaker 03

  You just proved the point. When we are alone, we feel, like this is just biological. We're more at risk of death because we don't have people. We're more vulnerable. That's the word. And the second you have social support.

• 1:02:08Speaker 03

  I love that example. I thought that was beautiful.

• 1:02:10Dax Shepard?

  I wonder if your proximity to us is gonna lower or up your pain threshold? Because you're now across the street.

• 1:02:15Speaker 01

  Well, I have a good example. This isn't really pain, although sort of, I guess. But my parents were in town recently and the alarm went off in the middle of the night.

• 1:02:24Speaker 03

  Oh, so scary.

• 1:02:25Speaker 01

  Yes.

• 1:02:26Dax Shepard?

  Normal.

• 1:02:26Speaker 01

  If I was by myself, oh my God, I would have been so panicked. Cut to a week later, my doorbell rang in the middle of the night. I was by myself and I was like, oh, I'm dead. I'm dead. I don't know what to do. Do I call? Like, I didn't know. But when I was with my parents, I was just like, it's fine. I had no idea what was going on. Someone could have literally been burgled.

• 1:02:47Dax Shepard?

  A door blew open.

• 1:02:48Speaker 01

  Yeah.

• 1:02:48Dax Shepard?

  But she didn't even care. But if you're by yourself, it's definitely a guy with a huge knife entering in a ski mask.

• 1:02:53Speaker 01

  I assumed it was some

• 1:02:55Speaker 03

  It's scream. One through four.

• 1:02:56Speaker 01

  Fine when there were people around and I assumed it was something bad when I was by myself.

• 1:02:59Speaker 03

  I know, but we forget about how that affects our bodies.

• 1:03:02Speaker 01

  Yeah.

• 1:03:02Speaker 03

  We just forget.

• 1:03:03Dax Shepard?

  This is like one of the many ingredients in these why married people live longer. This is a one component of it. You're not having the cortisol dump. It's easier on your body.

• 1:03:11Speaker 03

  Yes.

• 1:03:26Dax Shepard?

  Did we interrupt your mid-thought?

• 1:03:27Speaker 03

  I don't really, I actually have no idea and I don't care.

• 1:03:29Dax Shepard?

  I keep asking how-

• 1:03:31Speaker 03

  This is so much fun and so interesting.

• 1:03:31Dax Shepard?

  How sex and race and socioeconomic, I'm curious how those-

• 1:03:35Speaker 03

  Oh, yeah, yeah.

• 1:03:36Dax Shepard?

  We've got loneliness covered.

• 1:03:37Speaker 03

  So there's a lot of data on socioeconomic status and gender and race and ethnicity. So something that comes to mind is a disproportionate number of people living with chronic pain are women. However, this one really got me. Eighty percent of pain research has been conducted on men and male mice. But there's also been a lot of pervasive racism in medicine. Like, this is well-known, this is not my opinion, this is just what the research says. In general, over the years, there has been this myth, and there's a name for it, I'm forgetting the name of it. It's like the hero myth or something. It's like that black people feel less pain than whites because they have thicker skin.

• 1:04:12Dax Shepard?

  Oh, my God.

• 1:04:13Speaker 03

  Yeah, it's a holdover from the slave trade.

• 1:04:16Dax Shepard?

  Yes.

• 1:04:16Speaker 03

  And so, in general-

• 1:04:18Dax Shepard?

  Justifying.

• 1:04:18Speaker 03

  Blacks are prescribed something like 50% less pain medications in the emergency room. And like, it's still happening.

• 1:04:24Dax Shepard?

  And the women are believed the least amount about their pain assessment. Black women, if they tell you it's an eight, the person immediately cuts that in half.

• 1:04:32Speaker 03

  Right, and that leads to this other thing that happens with women and minorities is not being believed, or the suggestion that you're histrionic. That word has somehow just found its way into modern medicine, or it's psychosomatic. So that's still happening.

• 1:04:44Dax Shepard?

  But let me ask you this, we're gonna try to punch from every angle-

• 1:04:47Speaker 03

  Yeah, yeah.

• 1:04:48Dax Shepard?

  At the risk of offending someone. Is it not conceivable that women in general are more vulnerable physically? You're going to die by the hands of a man more than I'm going to, unless I go to war. There's an objective threat because of the sexual dimorphism that feeling vulnerable- You get in an elevator with a guy that's 6'2", you have a different experience than when I get in an elevator, right? So the feeling of vulnerability, if we're acknowledging that that's part of pain, couldn't that be in the recipe?

• 1:05:17Speaker 03

  It sure could, but there isn't data to suggest in general that women are more sensitive to pain than men at a biological genetic level.

• 1:05:27Dax Shepard?

  Oh, I don't think they are at all. They're giving birth. I would argue they have a higher threshold.

• 1:05:30Speaker 03

  Yeah, exactly. That's what makes it so complicated is like because there's all these ingredients and they're always interacting. Is it cultural? Is it sociological? Is it learned? Is it biological? What is the recipe that's creating this thing?

• 1:05:43Dax Shepard?

  And then are poor people experiencing more or less pain?

• 1:05:45Speaker 03

  Yeah, also, access to care is in this recipe, too. We talk about insurance companies. So many of the treatments we're talking about aren't affordable. So like you can have 42 surgeries and take 72 medications, but like if you want to come see me, it's not reimbursed by insurance companies. It's really crazy. So access to care, being able to afford treatment, access to healthy foods. There's a lot that's stacking up against people who are economically disadvantaged. And so, of course, that affects their pain, too.

• 1:06:14Dax Shepard?

  Okay, so we have a sense of all the things now that are contributing to this, again, phenomenological experience of pain.

• 1:06:22Speaker 03

  Yes.

• 1:06:23Dax Shepard?

  But you don't stop there, luckily. The last third of the book, Tell Me Where It Hurts, is dedicated to addressing these things. Other than the three you mentioned in the bio under that umbrella, not a lot you're going to do about your genetics or your tendon strength.

• 1:06:39Speaker 03

  No.

• 1:06:39Dax Shepard?

  But there's a ton of stuff that you can do in the pain protocol. So how do you identify and track your pain recipe?

• 1:06:48Speaker 03

  Yes, part three is a pain protocol. And my mission in life is not only to change the way we talk about pain and the way we understand it, but also the way we treat it. Because we are completely effing people living with chronic pain by telling them that the only solution is a pillar procedure. So if you came to my office, part three is the pain protocol, and it's exactly what I would do with you. And you'll see in the pain protocol that we walk through, like, what are the things in the bio domain of pain that you have the power to change? And what are the strategies and tools that I can offer you to help walk you through that in a very approachable, digestible, not overwhelming? Way because it can feel so overwhelming.

• 1:07:29Dax Shepard?

  A quick part of a lot of people's pain recipe will be like, the pain starts when I've been sitting for a while.

• 1:07:35Speaker 03

  Yeah, totally.

• 1:07:35Dax Shepard?

  Right? Like, so what are some common examples?

• 1:07:37Speaker 03

  I'll say my pain recipe. My pain recipe is like, sitting for too many hours staring at my screens, not getting up and stretching and moving my body, not drinking water and just like being extremely dehydrated, eating a crap diet.

• 1:07:52Speaker 01

  Sure.

• 1:07:52Speaker 03

  When I'm hungry, eating chips or something. Poor sleep. Thank you so much. I really appreciate you very much as I talk about my pain recipe.

• 1:07:59Speaker 01

  Do you have chronic back pain?

• 1:08:00Speaker 03

  I don't, thank God, but I'm aging and so like my body.

• 1:08:04Speaker 01

  It hurts.

• 1:08:04Speaker 03

  Yeah. So crap diet, sitting too long, not moving my body, poor sleep. Like I am someone who has insomnia on and off. So like if I have a bad night of sleep, my body will hurt more. Not protecting time to exercise. I don't exercise to lose weight. I exercise because if I don't, my body feels terrible. My mood is shit. Those things for me are sort of like fundamental. Oh, and stress. Stress is so fundamental to my pain recipe. Like if I have too many things to do, which is all the time, and I'm not protecting that and I'm not like managing my stress well and I'm doomed scrolling at night or watching the news.

• 1:08:37Speaker 01

  Yeah.

• 1:08:38Speaker 03

  So all those things together will come together for me and create a high pain recipe.

• 1:08:41Dax Shepard?

  Yeah, you gotta be aware of what your self-medication is because it's often a part of why you're suffering.

• 1:08:47Speaker 03

  Right. You mean like scrolling.

• 1:08:49Dax Shepard?

  We all have a lot of ways to regulate ourselves and many of them make us worse in the same way that drugs do. It's like they temporarily relieve your discomfort, but at a much bigger cost.

• 1:09:00Speaker 03

  Like I'm a workaholic. That's one of my.

• 1:09:02Dax Shepard?

  And that's a distraction and distraction is a good tool.

• 1:09:05Speaker 03

  But when you overwork, you're overstressed, you're sitting too long, your body feels worse. But so just as there's a recipe for high pain, there is always a recipe for low pain. And like this high pain recipe I just outlined, the cool thing is that it has an opposite. I know poor sleep. Is going to mess up my body, make my pain feel worse. So I know I have to put myself on a sleep hygiene protocol. I have been doing this for like 25 years now. My sleep hygiene protocol is like dimming my lights a couple hours before bed. Not doom scrolling. Sometimes that means I have to put my phone in another room and I will do it because insomnia messes me up. It means getting out of bed after about 20 minutes if I'm not sleeping so that I'm not lying in bed being like, why aren't I sleeping? This is so annoying.

• 1:09:50Speaker 03

  And then stress goes up, anxiety goes up, likelihood of sleeping goes down. So I know what my high pain recipe is. I know what my low pain recipe is and I know how to get there. That's actually what part three is.

• 1:10:02Dax Shepard?

  So sleep, nutrition, movement, activity, functioning. How about strategies targeting emotional health, including brain-based treatments known to adjust pain volume?

• 1:10:12Speaker 03

  So can I ask, what are things that you guys do for emotional health that's helpful?

• 1:10:16Dax Shepard?

  I have a bonkers, I'm like the most creature of habit-y. I have such a routine every single day. And mine is like, exercise is number one. Meditation's very important. Journaling's very important. My diet's very important. Sauna's very important. It's embarrassing how much time I put in to prevent me from being in pain. Embarrassing in that I can't believe it takes this much shit. But I don't care because I am not in pain. I've had a bunch of motorcycle accidents. I work out like crazy and I am not in pain. And I am generally very stable emotionally and mentally. And these are, I know, because I've lived without these routines and I've lived in flaring my arthritis with the foods I'm allergic to.

• 1:11:01Dax Shepard?

  And I've done all the things that were miserable. And now I am just very, very regimented about my schedule.

• 1:11:09Speaker 03

  Great. So you have figured out your low pain recipe?

• 1:11:11Dax Shepard?

  Other than I can't hack sleep, but whatever. There's going to be some categories that suck. I have forgiveness for myself.

• 1:11:16Speaker 03

  Yeah, good. So you're taking care of your emotional health and by the way, also your physical health with that routine. Can I ask you too? You don't have to answer.

• 1:11:23Speaker 01

  Yeah, of course. Yeah. I think for me, the main thing is being Social. I like really make time for that. I try to do that daily, like hang out after work with people. There was one period of time where two of my friends who I hang out with a ton were both gone. And I was like, I'm gonna die.

• 1:11:40Dax Shepard?

  Yeah.

• 1:11:41Speaker 01

  I don't know what to do. I need these people.

• 1:11:44Speaker 03

  Social medicine is real.

• 1:11:45Speaker 01

  Yes. Obviously, if I exercise, I feel better. I'm not as regimented as that.

• 1:11:49Dax Shepard?

  That's okay.

• 1:11:50Speaker 01

  Is that at it?

• 1:11:51Dax Shepard?

  I'm also 12 years older.

• 1:11:52Speaker 01

  If I'm in a good routine, I use to exercise all the time. So if I'm in a good routine, yes, but I think the social medicine is a huge one.

• 1:11:59Dax Shepard?

  I want to add, I don't want to pat myself on the back. You do what you have to do.

• 1:12:04Speaker 01

  Yeah.

• 1:12:05Dax Shepard?

  You're humming along. Again, you're 12 years younger than me. I do what I have to do to not be miserable. If I got to do less and not be miserable, I would do it. I had to go to AA because I was gonna die. I didn't go because I wanted to go. Like, I also think you can look at someone else's routine and feel some kind of shame that you're not executing all this stuff. But you should only be doing what you have to do. This is what I have to do.

• 1:12:28Speaker 01

  That's true. Like, there are moments where I'm like, I have to go on a walk. My body and brain know, but I just want maybe need to do it on the same frequency or I don't know, whatever. But yeah, mainly that.

• 1:12:40Dax Shepard?

  Fanatical schedule.

• 1:12:41Speaker 01

  Well, no, I didn't say that.

• 1:12:43Speaker 03

  I found your low pain recipe and I think it's really amazing. And you guys listed all the things that I would put, like taking care of emotional health, other than when I think of emotional health support, I actually think it's great to talk to someone. And there's so much stigma around that. Still, it's like 20, 20,000. And here we are and we're still talking about like, it's so shameful to have to see a therapist. So like, I want to see if I can frame this differently.

• 1:13:05Speaker 01

  Sorry, I can't believe I didn't say that. I can't believe I didn't start with that. I'm in therapy.

• 1:13:09Speaker 03

  Yeah, yeah.

• 1:13:10Speaker 01

  And it's everything.

• 1:13:11Speaker 03

  It's hard to find someone who's available at the times you want, who's qualified, who you like and trust and want to talk to. So I'm not saying it's easy, but research shows it can be extremely, extremely helpful. Just as we go to the gym all the time to exercise our bodies and make our bodies stronger, why would we not engage in some form of brain exercise for our emotional health? When I think of therapy, that's what I think of. We're going to a trained professional who's helping us with our emotional health, with our history of trauma, with our fucked up relationships with our families. Doesn't everybody need that just as much as we need to go on a jog? How much better a place would the world be if we were all engaging in as much brain exercise as body exercise? So I think about that also.

• 1:13:54Dax Shepard?

  Yeah, I think my reservation there a little bit is I am always conscious, I think, because of where I came from, with how lofty a lot of these are. If you have two jobs and you have two kids and you're a single parent, A, I don't have the money for therapy. And I don't have the free time to exercise, like you're saying. These are all real, real pressures. But even to that, I would argue, like, AA is free. There's a lot of different groups that are free. You can actually engage in group therapy in a lot of ways for free. I would also argue that to prioritize 20 minutes of movement in the day.

• 1:14:31Speaker 03

  You could go for five.

• 1:14:32Dax Shepard?

  You'd really be shocked how much time that buys you the rest of it. Because you're no longer in that destructive cycle. You're in the virtuous cycle. So you might be shocked with how taking more time for that thing ends up adding time.

• 1:14:44Speaker 03

  I think it's a fair and a good point. And the affordability piece is a really huge one. And I think there are a lot of resources out there. There are even workbooks that can help with certain things like depression.

• 1:14:54Dax Shepard?

  That's why I like your book. Someone can get your book and go through this.

• 1:14:57Speaker 03

  The purpose of writing the book was sort of like to put the power into hands of anybody who wants to understand it and treat it.

• 1:15:02Dax Shepard?

  You have techniques for modifying negative thoughts?

• 1:15:05Speaker 03

  True story.

• 1:15:06Dax Shepard?

  That's great. Social medicine, we just talked about that. Some things that could help that weirdly downriver affect pain is like better boundaries, creating healthy social connections, healing trauma. These things all impact your experience with pain.

• 1:15:19Speaker 03

  Yep.

• 1:15:19Dax Shepard?

  My other curiosity was, again, I brought up AA. AA has abysmal success numbers.

• 1:15:26Speaker 03

  Is that true?

• 1:15:26Dax Shepard?

  Oh, yeah, it's in the like 30%. But.

• 1:15:29Speaker 03

  I did not know.

• 1:15:30Dax Shepard?

  Relative to the other treatments, it's an absolute miracle. You can look at it one of two ways. If you want to just go like, well, only 30 some percent of people who go there end up getting long-term sobriety, sure. But versus the alternative is like, single digit. People don't just quit. I mean, very few people just white knuckle it for the rest of their lives. So I'm curious, we know how abysmal the outcome of chronic pain treatment is with doctors. It's in the low, you know, it's under 50%. What kind of success would you say you were experiencing with this more holistic?

• 1:16:04Speaker 03

  Sound like a jerk.

• 1:16:06Dax Shepard?

  Okay.

• 1:16:06Speaker 01

  Like a brat.

• 1:16:07Dax Shepard?

  Let's be a brat.

• 1:16:08Speaker 03

  Here's why I'm sitting here on your couch despite performance and public speaking anxiety. My patients get better. They get out of bed and they go back to life. I am not saying that their pain disappears completely all of the time. That would make me a liar. Sam continued to have pain flares, but he knew what to do. They didn't paralyze him and they didn't keep him bedridden. He knew what to do. If he needed to rest, he would rest. But he wasn't on the white food diet. He wasn't socially isolating. He wasn't not moving his body. The treatment for chronic pain is known. There is always hope for treating chronic pain. It just isn't told to our doctors. It's not told to us.

• 1:16:50Speaker 03

  The treatment for chronic pain is identifying your pain recipe with all of the ingredients and mapping them out, hopefully with someone else. But you can also do it on your own. And then figuring out what you need to do to change the ingredients in your pain recipe. There is always hope for treating chronic pain. And it makes me crazy because if you Google the treatment for fibromyalgia, it will tell you there is none. I can't tell you how many of my patients were told that there's just no treatment for their pain. They've been through all the medications. In fact, in medicine, if you've had four back surgeries and you still have back pain, you will get diagnosed, check me, with failed back surgery syndrome. As if you failed the treatment instead of the other way around. There is always a treatment for chronic pain. The treatment exists.

• 1:17:35Speaker 03

  It's looking at the recipe and figuring out what we can do to lower pain volume. And there's a million things we can do.

• 1:17:40Dax Shepard?

  The great challenge to me still seems like asking patients for behavioral modifications versus pills or procedures is a tall order. Getting people to change their behavior is really, really hard.

• 1:17:55Speaker 03

  I agree with you. I would say it's a combination of things. I am not telling people to go off their pills. Absolutely not. Pain medications are a godsend. We're no longer biting on wooden spoons. Thank God for good drugs.

• 1:18:07Dax Shepard?

  Think of Ulysses S. Grant dying of throat cancer for months. Like, what was that experience like?

• 1:18:12Speaker 03

  I can't even imagine.

• 1:18:14Dax Shepard?

  Yeah, I mean, crazy.

• 1:18:15Speaker 03

  And I want to say also that opioids are appropriate for post-surgical pain and end-of-life care and cancer pain. I just feel like we are screwing people. Can I ask a question?

• 1:18:24Dax Shepard?

  Oh, yeah, you can ask.

• 1:18:25Speaker 03

  Did it start with an injury?

• 1:18:28Dax Shepard?

  Yeah. So I had been eight years sober. When I had a motorcycle accident, I was prescribed. I asked my sponsor, am I allowed to take this?

• 1:18:37Speaker 03

  Oh, boy.

• 1:18:38Dax Shepard?

  I took it. It was completely fine. Very misleading. I filed it as a mental note. I'm like, oh, that's weird. That was a drug that I was fine. I didn't take them all. Still did my shit. So that was a very bad data point. And then, over the years, I had more injuries. And then, what really set it off to the races was, yeah, I had back-to-back hand shoulder surgery. And this bullish arrogant view that this was a drug that didn't seem to affect me in the way that cocaine or alcohol did. And that this was kind of a manageable thing. And then, yeah, I was off to the races. But, I mean, I want to take 90% of the responsibility for it.

• 1:19:18Dax Shepard?

  I also was open to the idea that there was still something I could do. That wasn't the other things I had admitted I couldn't do.

• 1:19:27Speaker 03

  I ask a question.

• 1:19:28Dax Shepard?

  Yeah.

• 1:19:29Speaker 03

  Would it be fair for me to say, like, I don't prescribe, but I observe and I see patients with pain all day. It makes me angry that this is what we're doing to people who have a history of addiction. So my question for you is, do you feel like it's inappropriate for me to say, like, maybe we can recommend different pain medications for people with a history of addiction than opioids? Do I have a leg to stand on?

• 1:19:52Dax Shepard?

  It's tricky because, I'll give you an example. Like, what screamed bullshit to me about the James Frye book, which I loved, was he did not have all that dental work without anesthetic. That doesn't happen. No one does that.

• 1:20:07Speaker 03

  Yeah.

• 1:20:07Dax Shepard?

  No one should be expected to do that. Addicts shouldn't be expected to do that. I don't love putting the responsibility on the doctors, if I'm being honest. But I'm in an addict community. The responsibility is mine to say to the doctor, hey, I'm an addict. The pills should go to my wife. This happens in the program all the time. People are responsible for other people's pills. As long as you take it as prescribed and as you're supposed to, you're fine. So that's on me going in to go like, I should never be holding pills. If there's some range of how long someone should be on these pills, I should be on the shorter end of these pills. But I don't think it's fair for the surgeon to take on and understand your level of addiction. My dad died 28 years sober. He had many different bouts of being on opioids. It never got him. There wasn't a thing for him. They were in a

• 1:20:52Dax Shepard?

  His house, he didn't care. He self administered. He never abused them. I don't know why. That's what version of addict he was. And then I was this version. So. I think it's too much to ask the person that's supposed to be really great at reassembling your bones to also be somehow an addiction. Specialists who can evaluate. I think that's on us addicts, to be honest.

• 1:21:11Speaker 01

  I totally disagree.

• 1:21:12Speaker 03

  I want to hear your opinion.

• 1:21:13Speaker 01

  Well, for one, we know that the doctors were part of the whole opioid epidemic to begin with. So. They do have a responsibility, in my opinion. I agree with you that ultimately it's the addict's responsibility, but when you're in your addiction.

• 1:21:29Dax Shepard?

  Yeah, that's the problem. Soon as I had the pills in me, the game plan went out the window.

• 1:21:32Speaker 01

  Exactly. When you're sober, you can say, hey, so my wife needs the pills. If you're in your addiction, you're not doing the whole point is to get hot. So I do think doctors should have to ask before they prescribe, what's your history with addiction? Ask you straight up. They still might lie, but at least it's there. And if the answer is, oh, I have a history, then I think they need to say, well, what's our plan then?

• 1:21:56Speaker 03

  That's correct. I agree with you a million percent.

• 1:21:57Dax Shepard?

  We're also in a different era, we need to acknowledge, because I've had surgeries in all the years, right? So when the Sacklers were running, I mean, if there is a true villain in it, it is the Sackler family who had a very well financed campaign to convince doctors who hadn't studied pain.

• 1:22:13Speaker 03

  Less than a 1% chance of addiction.

• 1:22:14Dax Shepard?

  Yeah, yeah. So they don't know. And then they're, and they're, and they're seeing all this data that was bullshit data that the Sacklers had come up with. So again, I can't expect them to like go specialize in pain medicine if they're a thoracic surgeon. They have to rely on studies and stuff. So. They were the victims of a very good campaign by a very well funded, dark ass family. And so there was a period, I talk about this, most of my friends are stuntmen. They all have crazy injuries. Most stuntmen have a kit of opiates at their disposal. That doesn't exist anymore. The dam's shut.

• 1:22:49Dax Shepard?

  It's not what it was, so I also don't think we need to overreact to a situation that no longer exists to a large degree.

• 1:22:56Speaker 01

  Well, because of that.

• 1:22:57Dax Shepard?

  You're not walking in with a toothache and walking out with two weeks of Percocet anymore.

• 1:23:00Speaker 01

  But I think a lot of that can be reaction. So that's good.

• 1:23:03Dax Shepard?

  Oh, yeah. But they've slammed the door on it, so I don't know that it's the same issue as it was 10 years ago.

• 1:23:10Speaker 03

  I respect both of your positions. I find myself landing in the middle because I feel like, as a provider, you bet your ass it's my responsibility to assess my patient, and I absolutely need to educate myself about my patient's history. That is my job. My oath is to do no harm. Every doctor takes that oath. And I, having studied pain for like 35 years, I am doing harm if I am prescribing opioids to someone with a history of addiction, because what happened to you could happen to anyone. It didn't happen to your dad and bless, but why would I put you in that position? If I'm a good doctor, I am trained to ask that question. You don't have to be trained in addiction medicine to ask.

• 1:23:47Dax Shepard?

  We also might lie to you.

• 1:23:49Speaker 03

  That is 100% on you, that's 0% on me. But I did my job.

• 1:23:52Speaker 01

  Yes, exactly.

• 1:23:53Speaker 03

  I asked you, do you have a history of addiction? Am I putting you in harm's way by giving you this particular medication? Because as a doctor, a trained MD knows, there are alternative painkillers out there. It doesn't have to be the most addictive one. So someone could have given you a friendlier, less dangerous drug, and could have saved you the fuckery that you found yourself in. Wouldn't that have been nice for you? Just to say.

• 1:24:15Dax Shepard?

  You're not gonna like this answer, but I mean, I had to go through that.

• 1:24:18Speaker 03

  You had an important life experience, and I'm not, and I am in no way discounting it or minimizing it.

• 1:24:23Dax Shepard?

  But had I died, yeah, had I OD'd.

• 1:24:25Speaker 01

  You came out on the other end, a lot of people don't.

• 1:24:27Dax Shepard?

  I didn't end up shooting dope downtown. A lot of people end up shooting dope downtown.

• 1:24:31Speaker 03

  So like, I think there's definitely the responsibilities on the patient to be honest, to disclose, and even to bring it up if you feel comfortable. For people who don't feel comfortable, the onus is on the doctor. We, as healthcare providers, have to do our due diligence. We have to get to know our patients just a little bit. Can we do that? If you're a healthcare provider and you're listening, spend three minutes. I literally just did this. I put like a pain assessment on my website, because I don't think we assess pain properly. And one of the questions we need to be asking... Do you have a history of addiction? It's very simple. You don't have to be trained in addiction medicine. You don't have to do anything. You have to treat the person for addiction. Just ask.

• 1:25:07Speaker 01

  I would expect every doctor to ask that.

• 1:25:09Speaker 03

  I feel so strongly about that. Having seen so many nightmares. I was really honored when you invited me on because I have listened to your episodes where you talk about opioids and pain. And I teach the addiction medicine fellows at Stanford, the next generation of M.D.s, because they don't learn very much about pain. And pain and addiction in America are best friends. Our mutual friend Anna Lempke runs like a pain and addiction center.

• 1:25:34Dax Shepard?

  Well, this is really great. It's in the book. We are, I think, 4.5% of the world population. And this country consumes 80% of the opioids on planet Earth.

• 1:25:44Speaker 01

  Crazy. That is crazy.

• 1:25:46Dax Shepard?

  I mean, that number's probably fallen in the last couple of years, but still.

• 1:25:50Speaker 03

  Yeah.

• 1:25:50Dax Shepard?

  There was a point where 4% of the population was consuming 80% of the opioids.

• 1:25:54Speaker 03

  And I think it was specifically like OxyContin.

• 1:25:56Dax Shepard?

  Yeah, yeah, yeah.

• 1:25:57Speaker 01

  It's like similar numbers, probably to guns. Two things that kill everybody.

• 1:26:01Dax Shepard?

  Yeah, yeah, yeah, yeah.

• 1:26:02Speaker 03

  I think we could just do a better job.

• 1:26:04Speaker 01

  Yeah.

• 1:26:04Speaker 03

  I think we can all agree that we can just like do a better job.

• 1:26:07Speaker 01

  You know?

• 1:26:07Dax Shepard?

  Well, Rachel, this was awesome. The book is called Tell Me Where It Hurts: The New Science of Pain and How to Heal. It's awesome. It was worthy of a conversation at dinner. I think you'll find that to be the case as well. And the cutest last name ever, Zofnis. It's almost softness. It's like softness with a speech impediment.

• 1:26:25Speaker 01

  With the hardest letter to explain.

• 1:26:27Dax Shepard?

  Yeah, Zof.

• 1:26:28Speaker 01

  Mixed messages.

• 1:26:29Dax Shepard?

  X might have been a little harder, but yeah, yeah. Zofnis, what a cute name. Okay, thanks for coming. I enjoyed this.

• 1:26:35Speaker 03

  Thanks for having me. Thanks to you both. I really appreciate it.

• 1:26:37Speaker 01

  Thank you.

• 1:26:39Speaker 01

  Stay tuned for the fact check. It's where the party's at.

• 1:26:48Dax Shepard?

  So I think I have a fun and ironic update.

• 1:26:50Speaker 01

  Okay, let's hear it.

• 1:26:51Dax Shepard?

  About our debate.

• 1:26:53Speaker 01

  Oh. About skin marks?

• 1:26:56Dax Shepard?

  No, my arms.

• 1:26:57Speaker 01

  Oh, okay.

• 1:26:59Dax Shepard?

  With waving the flag.

• 1:27:00Speaker 01

  Okay.

• 1:27:00Dax Shepard?

  If you recall.

• 1:27:01Speaker 01

  I think you need to tell people.

• 1:27:02Dax Shepard?

  Yeah, so I was saying I was in a bit of a pickle because I wanted to both work my arms out in case I waved the flag at the MotoGP race. And also my arms don't fit in my suit.

• 1:27:13Speaker 01

  Exactly.

• 1:27:14Dax Shepard?

  So I was really, Sophie's Choice didn't know what to do.

• 1:27:17Speaker 01

  Uh huh.

• 1:27:18Dax Shepard?

  You were really urging me to skip arm day.

• 1:27:20Speaker 01

  Yes, I was.

• 1:27:21Dax Shepard?

  For the safety of the riding.

• 1:27:23Speaker 01

  Yes, I was.

• 1:27:24Dax Shepard?

  Big debate. Uh, red carpets came and high heels got invoked.

• 1:27:29Speaker 01

  What did I mean?

• 1:27:30Dax Shepard?

  I was pointing out that you're uncomfortable on high heels. Yes, yes, yes, yes. Just bring back all the details.

• 1:27:35Speaker 01

  Yes, yes, yes, yes, yes.

• 1:27:36Dax Shepard?

  So I went to Austin with that, uh, on the table.

• 1:27:41Speaker 01

  Mm hmm.

• 1:27:42Dax Shepard?

  And the question was, what was I gonna do? Heed your advice? Be responsible? Or be vain?

• 1:27:49Speaker 01

  But you made very clear to me that it wasn't a safety hazard.

• 1:27:52Dax Shepard?

  No, it wasn't.

• 1:27:53Speaker 01

  You could move. That I was overreacting.

• 1:27:56Dax Shepard?

  Just uncomfortable. So I chose vanity.

• 1:27:58Speaker 01

  Okay.

• 1:27:59Dax Shepard?

  Definitely worked my arms out on Saturday. And they did not ask me to wave the flag.

• 1:28:05Speaker 01

  Right. So.

• 1:28:07Dax Shepard?

  So that's funny. So that right there is a win for you. That's like a win.

• 1:28:11Speaker 01

  No, it's not.

• 1:28:12Dax Shepard?

  Well, it is in a, it is in a funny way, which is like I did this thing, which I shouldn't have done. And then I didn't even get to do the thing. Maybe I won't use the word win. I'll just say that's a funny mark in your category. And then we'll get to the mi- mine. Which was, so I did, I, I got my arms all pumped up.

• 1:28:28Speaker 01

  Yeah.

• 1:28:28Dax Shepard?

  And vascularized.

• 1:28:29Speaker 01

  Yep.

• 1:28:30Dax Shepard?

  Didn't wave the flag. They didn't even ask me.

• 1:28:32Speaker 01

  Yeah. Who did?

• 1:28:34Dax Shepard?

  I don't know. I don't know. It's funny you don't pay as much attention when you're not the one waving the flag.

• 1:28:39Speaker 01

  Which then goes to show how many people aren't paying attention when it's you.

• 1:28:42Dax Shepard?

  I did have someone last year text me and go, oh my God, you were waving. I mean, another MotoGP fan.

• 1:28:47Speaker 01

  Sure.

• 1:28:48Dax Shepard?

  Noticed I was waving the flag. Anyways, I did not wave the flag, wasn't asked to wave the flag. I was like, well, I was for nothing. But then, and here's the irony, the ironic twist.

• 1:28:58Speaker 01

  Yeah.

• 1:28:58Dax Shepard?

  Went to the track on, on Monday. I don't know if it's because it was so hot in Austin, whatever. Arms weren't tight.

• 1:29:04Speaker 01

  You were fine.

• 1:29:05Dax Shepard?

  No issue.

• 1:29:06Speaker 01

  I know.

• 1:29:07Dax Shepard?

  So both things happened in reverse.

• 1:29:09Speaker 01

  That's right.

• 1:29:10Dax Shepard?

  That's how I feel like it's a win for both of us.

• 1:29:13Speaker 01

  It's a win for me if you're safe. That's all I care about. I'm not against you having big arms on a flag wave.

• 1:29:22Dax Shepard?

  Yeah.

• 1:29:23Speaker 01

  Only if it comes at the risk of your safety, which you assured me it didn't, but I didn't believe you. And also you.

• 1:29:29Dax Shepard?

  It was just a hilarious outcome.

• 1:29:31Speaker 01

  Yeah.

• 1:29:32Dax Shepard?

  Harrison Barnes waved the flag this year. He's a NBA player.

• 1:29:37Speaker 01

  Oh.

• 1:29:37Dax Shepard?

  For the San Antonio Spurs. Okay, great.

• 1:29:40Speaker 01

  Okay.

• 1:29:40Dax Shepard?

  So we had a San Antonio Spurs and good because presumably he was very tall. Six, seven. Six, seven, get that flag up in the air.

• 1:29:47Speaker 01

  Seven.

• 1:29:48Dax Shepard?

  In fact, I might have to go back on my DVR and watch him wave the flag.

• 1:29:51Speaker 01

  That's nice.

• 1:29:52Dax Shepard?

  And I want to see how his arm, you know, these NBA players have really nice arms. I'd probably like to check out his arms.

• 1:29:56Speaker 01

  Okay.

• 1:29:57Dax Shepard?

  Yeah.

• 1:29:58Speaker 01

  Okay.

• 1:29:59Dax Shepard?

  I was just talking side note. Oh, yeah, great.

• 1:30:02Speaker 01

  Really nice arms.

• 1:30:03Dax Shepard?

  Great, great, great, great.

• 1:30:03Speaker 01

  Rob just put a picture up.

• 1:30:04Dax Shepard?

  And great delts and he's got some vascularity in his delts or in his left.

• 1:30:08Speaker 01

  He looks handsome.

• 1:30:09Dax Shepard?

  Yeah. He looks like he's screaming in that photo.

• 1:30:12Speaker 01

  Yeah.

• 1:30:12Dax Shepard?

  Yeah.

• 1:30:12Speaker 01

  Of happiness.

• 1:30:14Dax Shepard?

  Hmm. Victory was his.

• 1:30:16Speaker 01

  Yeah.

• 1:30:16Dax Shepard?

  I think it says that's when he found out he was going to wave the flags. Oh, that probably makes sense.

• 1:30:20Speaker 01

  Oh, yeah.

• 1:30:21Dax Shepard?

  They probably just told him.

• 1:30:21Speaker 01

  Okay.

• 1:30:22Dax Shepard?

  Okay. So I was talking to Ricky Glassman yesterday.

• 1:30:25Speaker 01

  Great.

• 1:30:25Dax Shepard?

  And it was ostensibly he called for advice, which is always so flattering. I love this role I get to have in Ricky's life. It's very, uh, yeah, I really cherish it. So we're talking about business stuff and everything. And then I don't know how we got on the topic of muscles. But we just went off and he's like, yeah, I don't know how to explain it. I guess because I grew up watching Schwarzenegger and Sylvester Stallone. I'm like, I, that must be it too. And he's like, I just love them so much. And then we were talking about like, to what extent do we love them? And I'm like, you know, I want to squeeze them and stuff.

• 1:31:03Speaker 01

  Mm hmm.

• 1:31:04Dax Shepard?

  Like, where is this line? This is very weird.

• 1:31:07Speaker 01

  Homorotic.

• 1:31:08Dax Shepard?

  Where is that line?

• 1:31:09Speaker 01

  You're attracted to it in a.

• 1:31:12Dax Shepard?

  I think there's layers in an aspirational way.

• 1:31:14Speaker 01

  Yeah.

• 1:31:14Dax Shepard?

  Like, oh, I'd like to look like that.

• 1:31:15Speaker 01

  Exactly, yeah.

• 1:31:16Dax Shepard?

  But I also want to feel them, like I want to squeeze.

• 1:31:20Speaker 01

  But you don't want to feel their dick, do you?

• 1:31:23Dax Shepard?

  No. We went through like, well, how far does it go? I would definitely want to squeeze, uh. Schwarzenegger's biceps and I'd like to feel, I'd even like to run my hands across Brad Pitt's abs in Fight Club.

• 1:31:36Speaker 01

  Okay.

• 1:31:36Dax Shepard?

  Right? I'd like to feel that.

• 1:31:38Speaker 01

  What do you wanna feel?

• 1:31:39Dax Shepard?

  All the definition and the ridges.

• 1:31:42Speaker 01

  Uh huh.

• 1:31:42Dax Shepard?

  Yeah. Can you relate to that?

• 1:31:44Speaker 01

  Um.

• 1:31:45Dax Shepard?

  Would you like to run your hand over his?

• 1:31:47Speaker 01

  No, but I'm straight.

• 1:31:49Dax Shepard?

  Yeah, yeah.

• 1:31:50Speaker 01

  You know what I don't wanna do is rub my hands over like Kristen's arm muscle.

• 1:31:56Dax Shepard?

  Right.

• 1:31:56Speaker 01

  I have zero.

• 1:31:57Dax Shepard?

  I know. This is why it was worth us discussing. It's like we're, we're on some traject- we're on some spectrum.

• 1:32:05Speaker 01

  I think.

• 1:32:06Dax Shepard?

  On the Kinsey scale.

• 1:32:07Speaker 01

  I don't think it's.

• 1:32:07Dax Shepard?

  Where we like wanna touch and feel. That's like, that's interesting.

• 1:32:10Speaker 01

  Well, because I think it's still like, you wanna touch and feel it so you can kinda see like.

• 1:32:16Dax Shepard?

  What it would feel like if I could rub my arms.

• 1:32:18Speaker 01

  It's still about you guys.

• 1:32:20Dax Shepard?

  You think so?

• 1:32:21Speaker 01

  Yeah. I mean, I mean, women have, I have this all the time, like with other women.

• 1:32:26Dax Shepard?

  Do you wanna feel any of women's boobs or anything?

• 1:32:28Speaker 01

  No.

• 1:32:29Dax Shepard?

  But I do hear that from other women that are straight. Yeah, they're like, oh, I wanna squeeze those boobs and they're straight.

• 1:32:34Speaker 01

  Okay, well, I've never ever wanted to.

• 1:32:36Dax Shepard?

  You've never had a friend of yours ask if they could touch your boobs?

• 1:32:40Speaker 01

  No.

• 1:32:40Dax Shepard?

  Never? Even drunk?

• 1:32:43Speaker 01

  No.

• 1:32:44Dax Shepard?

  You could wanna squeeze them without being sexually attracted?

• 1:32:47Speaker 01

  No, I guess, but like, I, whatever. I, I don't know. I can't speak on behalf of anyone other than me.

• 1:32:52Dax Shepard?

  We've got to sidetrack.

• 1:32:53Speaker 01

  Yeah.

• 1:32:53Dax Shepard?

  Okay.

• 1:32:53Speaker 01

  I, um, have no desire to touch any, uh, squeeze anyone's boobs or touch their.

• 1:33:01Dax Shepard?

  How about a butt?

• 1:33:02Speaker 01

  Genital parts. Touch?

• 1:33:04Dax Shepard?

  Yeah. Like if you saw a big, buoyant butt, you don't wanna squeeze it to see what it feels like in your hand?

• 1:33:09Speaker 01

  No.

• 1:33:09Dax Shepard?

  Oh, wow.

• 1:33:10Speaker 01

  I might wanna be, I might wanna say like, a, a female.

• 1:33:13Dax Shepard?

  Yeah, yeah.

• 1:33:14Speaker 01

  Yeah. I might be like, oh my God, that person has such a nice body. Like, I wish my body looked like that.

• 1:33:19Dax Shepard?

  Uh huh.

• 1:33:20Speaker 01

  But I don't need to touch it. No, I don't need to touch it to know that. I just like, I'm like. Oh, they have like great X, Y, or Z. I wish I had that. And then, you know, then you hate yourself for a little bit.

• 1:33:32Dax Shepard?

  Okay.

• 1:33:33Speaker 01

  And then, um.

• 1:33:34Dax Shepard?

  What are you chomping on over there?

• 1:33:35Speaker 01

  Oh, I have some lozenges.

• 1:33:36Dax Shepard?

  Oh, okay.

• 1:33:38Speaker 01

  I'm still sick. Oh, and I have an, I, I have a sick spray.

• 1:33:42Dax Shepard?

  Oh, fine.

• 1:33:43Speaker 01

  I almost brought it since we're both have sprays. No, it's like natural.

• 1:33:47Dax Shepard?

  Oh, okay. So it's pageantry for show?

• 1:33:51Speaker 01

  I mean, I'm not better, so.

• 1:33:53Dax Shepard?

  It's just an activity to do.

• 1:33:54Speaker 01

  Well, yeah.

• 1:33:54Dax Shepard?

  Yeah, yeah. Okay, so no desire to touch?

• 1:33:56Speaker 01

  Okay, I, I have no desire to touch, but I definitely have admiration, a lot of admiration for a lot of, uh, female bodies. But it's still about me. That's, it's still like, I wish I looked like that.

• 1:34:07Dax Shepard?

  Hmm.

• 1:34:08Speaker 01

  It's never outward really towards them.

• 1:34:11Dax Shepard?

  Yeah.

• 1:34:12Speaker 01

  It's like, how can I look like that? And I think, I think that's what's happening with you guys too, but maybe the feeling is like, is still, it's still about that. It's like, hey, what does it feel like to have that?

• 1:34:24Dax Shepard?

  I wanna feel the heft of things too, you know? The weight of things and the heft.

• 1:34:29Speaker 01

  Right.

• 1:34:29Dax Shepard?

  Mm-hmm.

• 1:34:31Speaker 01

  Yeah. But let me ask you something.

• 1:34:33Dax Shepard?

  Yeah, ask me.

• 1:34:35Speaker 01

  So you wanna, you wanna feel it.

• 1:34:37Dax Shepard?

  Squeeze and prod?

• 1:34:38Speaker 01

  Yeah. Touch. You wanna get your physical hands on it.

• 1:34:41Dax Shepard?

  Mm-hmm.

• 1:34:42Speaker 01

  Um, with their consent.

• 1:34:44Dax Shepard?

  Yeah.

• 1:34:44Speaker 01

  And, um, but do you wanna do that for females? Like, when you see abs on a female, are you like, ooh, I wanna, I, I like, I wanna touch that? Not really.

• 1:34:56Dax Shepard?

  No, but I regularly see butts in spandex or something, or boobs, and I do wanna like, I wanna squeeze it.

• 1:35:06Speaker 01

  Sexual. Those are the sexual parts. Like, that's different than what you're feeling towards these men and, and their abs.

• 1:35:14Dax Shepard?

  That's true.

• 1:35:14Speaker 01

  Goes to show, if you're not wanting to touch the female abs, it's not about.

• 1:35:18Dax Shepard?

  Muscles.

• 1:35:19Speaker 01

  Exact, no, it is, it's about actual muscles.

• 1:35:23Dax Shepard?

  Okay.

• 1:35:23Speaker 01

  On, on the men and how you can get them.

• 1:35:26Dax Shepard?

  Hmm.

• 1:35:27Speaker 01

  Or like how you can relate to them or something, but.

• 1:35:30Dax Shepard?

  Yeah.

• 1:35:30Speaker 01

  I think most people out in the world are aware of other people's faces and bodies and whatever, sexually or not.

• 1:35:40Dax Shepard?

  Yeah, they're probably seeing the ones, whatever one they want.

• 1:35:42Speaker 01

  Exactly. That's my whole point.

• 1:35:44Dax Shepard?

  That is your point.

• 1:35:45Speaker 01

  Or if, if whatever they feel sexually, their sexual orientation, they might see.

• 1:35:54Speaker 01

  You know, like if you're straight, you're gonna see the opposite sex a little with more curiosity sexually.

• 1:36:01Dax Shepard?

  Of their erogenous zones.

• 1:36:03Speaker 01

  Exactly. Cause when you're attracted to someone, it could be really random things you're attracted to on their, on their body.

• 1:36:12Dax Shepard?

  Absolutely.

• 1:36:13Speaker 01

  Not just their erogenous zones, you know?

• 1:36:15Dax Shepard?

  Mon's pubis, a shoulder blade.

• 1:36:18Speaker 01

  That's the clear erogenous zone. But you know, I really like hands.

• 1:36:24Speaker 01

  And so I do tend to look at men's hands a lot.

• 1:36:28Dax Shepard?

  This is so fascinating. Again, very anecdotal. I have no idea what the granddad would say. But certainly I'm aware of so many men who have foot fetishes.

• 1:36:38Speaker 01

  Right.

• 1:36:39Dax Shepard?

  I don't really know any women that do. I've never heard a woman talk about.

• 1:36:42Speaker 01

  This is so interesting. This just came up on Elizabeth and Angie's.

• 1:36:45Dax Shepard?

  Oh, really?

• 1:36:45Speaker 01

  Uh huh.

• 1:36:45Dax Shepard?

  But I know many women who are super into hands. And I don't know a ton of guys who are super into hands.

• 1:36:52Speaker 01

  Right.

• 1:36:53Dax Shepard?

  What is going on? Why would one?

• 1:36:56Speaker 01

  Well, I know why women do. Hands are a huge part of sexual.

• 1:37:03Dax Shepard?

  Interaction?

• 1:37:03Speaker 01

  Interaction.

• 1:37:04Dax Shepard?

  Cause they're gonna be all over you.

• 1:37:05Speaker 01

  Yeah, they're all over you, they're in you potentially.

• 1:37:09Dax Shepard?

  Sometimes they're in you, they're on you, they're in you.

• 1:37:11Speaker 01

  Yeah.

• 1:37:12Dax Shepard?

  They're in charge of all the action.

• 1:37:13Speaker 01

  Exactly.

• 1:37:14Dax Shepard?

  Yeah.

• 1:37:14Speaker 01

  So that's why I think women can be attracted.

• 1:37:17Dax Shepard?

  So do you think these guys with foot fetishes want to be manhandled by their feet?

• 1:37:22Speaker 01

  Well, that's what I don't.

• 1:37:23Dax Shepard?

  I've seen pornography where guys are getting jerked off with a woman's feet.

• 1:37:27Speaker 01

  What?

• 1:37:28Dax Shepard?

  Yes, I have seen that.

• 1:37:30Speaker 01

  That seems very hard to do.

• 1:37:32Dax Shepard?

  For her, yeah. Yeah, you gotta really be coordinated.

• 1:37:36Speaker 01

  Like gracefully, it feels like you'd look so weird, the woman.

• 1:37:39Dax Shepard?

  Yeah, also, how do you gently bring up like, hey, are you coordinated with your feet? Like, that's a huge thing for you. That's like your ultimate, like the guy we interviewed for Armchair Anonymous.

• 1:37:51Speaker 01

  Yeah, Kinks.

• 1:37:52Dax Shepard?

  Who liked his toes played with. So it's like, it's, he, he want, this is an important thing to have.

• 1:37:59Speaker 01

  Yeah.

• 1:38:00Dax Shepard?

  Is this foot job we'll call for sake of time.

• 1:38:03Speaker 01

  Okay.

• 1:38:04Dax Shepard?

  How do you suss out whether that partner is gonna be able to do that? Cause I bet, I imagine there'd be a lot of gals that were fully up for it.

• 1:38:13Speaker 01

  And they just can't do it.

• 1:38:14Dax Shepard?

  And can't do it.

• 1:38:14Speaker 01

  Yeah, I feel like most people can't do that.

• 1:38:16Dax Shepard?

  It's so corny. If I try to, man, yeah, forget that. I mean, also, the amount of leg strength you'd have to have.

• 1:38:22Speaker 01

  That's what I'm saying. It's actually a lot more than the foot. You also have to be flexible depending on.

• 1:38:27Dax Shepard?

  Those guys should be, they should be more generous and just be like, can you lay down on your back and I'll hump your feet?

• 1:38:32Speaker 01

  Hmm, okay, so are they putting the penis?

• 1:38:35Dax Shepard?

  Between their feet.

• 1:38:36Speaker 01

  This, like, like this?

• 1:38:39Dax Shepard?

  Yeah.

• 1:38:40Speaker 01

  Oh, okay, I imagined it like.

• 1:38:41Dax Shepard?

  That requires a lot of, um, quad and add the core.

• 1:38:46Speaker 01

  I imagined it like that.

• 1:38:48Dax Shepard?

  That could be fine.

• 1:38:49Speaker 01

  But that's hard.

• 1:38:50Dax Shepard?

  That, yeah, that would work too. Actually, I'm not even sure of the way I said the first one. I think that feels more natural what you just did. Whereas the inside of your feet.

• 1:38:59Speaker 01

  That also is hard on the legs.

• 1:39:01Dax Shepard?

  On the IT band.

• 1:39:02Speaker 01

  Yeah, you have to be like out of one of these, you know?

• 1:39:05Dax Shepard?

  Yeah, yeah, yeah.

• 1:39:05Speaker 01

  Okay, I hope nobody asks me to do that, cause I just, I'm gonna look, I'm just gonna look bad.

• 1:39:10Dax Shepard?

  What if you say, give me a, give me a couple of days of practice on a banana or something to see if I can even do that?

• 1:39:16Speaker 01

  Yeah.

• 1:39:17Dax Shepard?

  Thing, concept, I'm fine with it. And I, like, there's nothing wrong with that in theory, thank you.

• 1:39:22Speaker 01

  Uh huh, uh huh, uh huh.

• 1:39:23Dax Shepard?

  Um.

• 1:39:24Speaker 01

  Um, but I think, well, in this.

• 1:39:28Dax Shepard?

  Circle, so we gotta circle back?

• 1:39:29Speaker 01

  No, this like is more evidence to it. Like why the hand and the foot fetish, and like I said, I think the hand makes sense.

• 1:39:37Dax Shepard?

  Sure.

• 1:39:37Speaker 01

  Um, I think foot, I think people who have foot fetishes, I think women's feet like remind them of the vagina. I don't understand why.

• 1:39:47Dax Shepard?

  Really?

• 1:39:47Speaker 01

  Maybe because the bottom part's so soft.

• 1:39:49Dax Shepard?

  What are you basing that on? Have you heard someone say that?

• 1:39:52Speaker 01

  I just know it.

• 1:39:52Dax Shepard?

  It's just you're leaping to that.

• 1:39:54Speaker 01

  No, I just know it in my heart.

• 1:39:55Dax Shepard?

  Oh, you do? Should we call Eric?

• 1:39:57Speaker 01

  Yeah, we can. Remember, we've talked to him about this, though, and his is weirder. His is not like.

• 1:40:03Dax Shepard?

  It doesn't, it's not as conventional?

• 1:40:05Speaker 01

  I don't think so.

• 1:40:06Dax Shepard?

  Also, we should say, Eric's not the kind of person who's buying photos off the internet.

• 1:40:09Speaker 01

  Exactly.

• 1:40:10Dax Shepard?

  Yeah, yeah, I think it's like, I think he's a low grade.

• 1:40:12Speaker 01

  He just.

• 1:40:13Dax Shepard?

  He just appreciates.

• 1:40:13Speaker 01

  Appreciates the aesthetic a lot, and especially because he worked in women's shoes.

• 1:40:18Dax Shepard?

  As a young boy.

• 1:40:19Speaker 01

  But he does, he's never said like, he wants to like suck any toes or anything. So I don't, so his is.

• 1:40:24Dax Shepard?

  He didn't suck your toes at one point?

• 1:40:26Speaker 01

  No, he just cheese grated them.

• 1:40:28Dax Shepard?

  Oh, okay.

• 1:40:29Speaker 01

  He just manicured them, you know, like, again, like, he wanted aesthetically.

• 1:40:34Dax Shepard?

  Suck your toes.

• 1:40:34Speaker 01

  No, oh my god, that would.

• 1:40:37Dax Shepard?

  But if anyone, if we would let anyone, it'd be Eric.

• 1:40:39Speaker 01

  Yeah, but like, I don't think, I, I don't, I don't know, that seems, that is intimate. Well, by the way, toe sucking is a sexual thing.

• 1:40:49Dax Shepard?

  Sure, standard biz.

• 1:40:50Speaker 01

  Yeah, and, and I think it's because it's sensitive, your feet are very sensitive, just like your vagina. I think there's some similarities.

• 1:40:59Dax Shepard?

  Okay.

• 1:41:00Speaker 01

  I think that's what it's about.

• 1:41:01Dax Shepard?

  Having no draw to the feet, I can't begin to figure out what's going on.

• 1:41:07Speaker 01

  I think I.

• 1:41:08Dax Shepard?

  Can't relate.

• 1:41:08Speaker 01

  I think I did. I really do think I cracked it.

• 1:41:10Dax Shepard?

  I just think it's interesting that you think the foot looks like the vagina.

• 1:41:13Speaker 01

  And not looks, no.

• 1:41:15Dax Shepard?

  If that's the argument, then I think people would be way more into armpits.

• 1:41:18Speaker 01

  Not looks. There's just something about it that I think for these people. Yeah, like the softness, the sensitivity. Well, if you have, if you have good feet, they're soft.

• 1:41:31Dax Shepard?

  Uh huh, uh huh.

• 1:41:31Speaker 01

  But if you have bad feet, they're great for you.

• 1:41:33Dax Shepard?

  The toenails.

• 1:41:34Speaker 01

  They're ma, they're like, yeah, they're manicured in a way that like a lot of vaginas are, like, kempt, as we talked about last time. Kempt or unkempt.

• 1:41:44Dax Shepard?

  Sean Kemp?

• 1:41:46Speaker 01

  Yeah, so I just, I, I think that's what it is, and if you have a foot fetish, please. Way in.

• 1:41:53Dax Shepard?

  Let us know.

• 1:41:53Speaker 01

  On whether or not I'm right.

• 1:41:55Dax Shepard?

  Although you might not want to do it in public on the comments, but.

• 1:41:58Speaker 01

  People also, they don't know what it is. Like, I just decided that about hands, and I think that's right.

• 1:42:03Dax Shepard?

  Mm-hmm.

• 1:42:04Speaker 01

  But that's not what's happening when I'm like at the grocery store and I see someone have nice ha- men with like a strong hand. I'm not like, oh, I like, I want that on me.

• 1:42:13Dax Shepard?

  Uh-huh.

• 1:42:13Speaker 01

  It's just like, I, it's a visceral thing. Where I'm just like, oh, that's hot.

• 1:42:18Dax Shepard?

  Yeah.

• 1:42:18Speaker 01

  Something about that is a PQ.

• 1:42:20Dax Shepard?

  Yeah, you get a PQ, you get a, a little bolt of electricity.

• 1:42:23Speaker 01

  And some people, I think I actually don't get it from a lot of things that a lot of people get it from.

• 1:42:30Dax Shepard?

  Like?

• 1:42:30Speaker 01

  Well.

• 1:42:31Dax Shepard?

  Like, what do you hear friends talking about, and you're like, oh, I can't even relate? For me, it's like, I have a friend that's like, talks about ankles and talks about feet.

• 1:42:38Speaker 01

  Oh, really?

• 1:42:39Dax Shepard?

  And I'm like, what are you talking about? About the ankles, like, since it's.

• 1:42:42Speaker 01

  Cause it's skinny? What is that?

• 1:42:44Dax Shepard?

  I, I don't even want to go into it, but there are guys with things with ankles, and I'm just like, how could, of all the things to look at, why is that even where you would be focused on? You've got eyes, lips.

• 1:42:57Speaker 01

  The obvious ones.

• 1:42:59Dax Shepard?

  Different body parts. Origin of zones.

• 1:43:02Speaker 01

  I'm okay, just, I'm, I'm on fire.

• 1:43:05Dax Shepard?

  Wow, you're really solving a lot of mysteries, age-old mysteries.

• 1:43:08Speaker 01

  I think I now understand the ankles.

• 1:43:10Dax Shepard?

  Okay.

• 1:43:10Speaker 01

  Because conventionally, you don't really, they're covered up.

• 1:43:16Dax Shepard?

  Mm, okay.

• 1:43:17Speaker 01

  Mine are.

• 1:43:18Dax Shepard?

  Yeah.

• 1:43:18Speaker 01

  People are wearing socks, people are wearing pants, shoes, whatever. So it's kind of like, oh, I'm seeing something I'm not really supposed to be seeing. And I have that, like, with certain things if I see that normally are cou- like, okay, like, I really like necks.

• 1:43:34Dax Shepard?

  Okay, those are always on display.

• 1:43:36Speaker 01

  Not always, cause people have jackets and shirts.

• 1:43:40Dax Shepard?

  You think everyone's wearing turtlenecks?

• 1:43:41Speaker 01

  Jackets and shirts and like hats. Eh, okay, that one's a little more of a.

• 1:43:46Dax Shepard?

  Pretty.

• 1:43:47Speaker 01

  On display.

• 1:43:48Dax Shepard?

  Yeah.

• 1:43:49Speaker 01

  Okay, that's probably right. Um, but it's still just.

• 1:43:52Dax Shepard?

  You just like necks.

• 1:43:53Speaker 01

  No.

• 1:43:53Dax Shepard?

  It's not that they're not on display, you just like them.

• 1:43:55Speaker 01

  Well, it feels like. It's not like right in front of me. It's not eyes or lips or something.

• 1:44:01Dax Shepard?

  But do you mean specifically the back of the neck?

• 1:44:02Speaker 01

  Back, back of the neck.

• 1:44:03Dax Shepard?

  Oh, that's different.

• 1:44:04Speaker 01

  Yeah, back of the neck.

• 1:44:05Dax Shepard?

  Okay, I'm with you. Front of the neck, you're you're getting as much front of the neck as you are face.

• 1:44:10Speaker 01

  I don't care about front of the neck. No, back of the neck.

• 1:44:13Dax Shepard?

  Back of the neck?

• 1:44:14Speaker 01

  Yes, and it's like.

• 1:44:15Dax Shepard?

  And what are you looking for in the back of a neck?

• 1:44:16Speaker 01

  I don't know. It's just like, I just know, I know when I see it, that I like it. And I do think it's like, oh, I'm not really supposed to be looking at that.

• 1:44:25Dax Shepard?

  Oh.

• 1:44:25Speaker 01

  Cause like, they can't see me looking at it, maybe. Like, there's some stuff, there's some stuff in there.

• 1:44:30Dax Shepard?

  Okay. Now, back to the what your friends, do you find that you hear your friends talking about specific body parts?

• 1:44:38Speaker 01

  Um.

• 1:44:39Dax Shepard?

  In men? That you're like, I don't get it?

• 1:44:41Speaker 01

  Well, I'm never like, I don't get it, because no one is saying anything weird. But like, yeah, like, if you're like at a grocery store, this, all this stuff's happening at the grocery store.

• 1:44:52Dax Shepard?

  It's hilarious, cause you, you order all your groceries, but, yeah.

• 1:44:59Speaker 01

  Oh my god, um.

• 1:45:00Dax Shepard?

  It's like you're doing an improv about it. It's like, we need a location. Grocery, you're always going, grocery store.

• 1:45:06Speaker 01

  No, because when I.

• 1:45:06Dax Shepard?

  Can we get a location that these brother and sister would be in? Grocery store!

• 1:45:10Speaker 01

  No, it's just where most like strangers are all together. Yeah.

• 1:45:14Dax Shepard?

  And you're in lines and you're.

• 1:45:15Speaker 01

  Exactly, you're behind people. So, if someone's at the grocery store, oh, Jess calls this something, okay? So, whenever he sees anyone wearing a shirt that's like kinda cropped, or like, right at the pants.

• 1:45:31Dax Shepard?

  Yeah.

• 1:45:32Speaker 01

  He calls that marinara.

• 1:45:34Dax Shepard?

  Oh, interesting.

• 1:45:35Speaker 01

  Because when you go to grab, in his, when you go to grab the top of of the shelf, you grab the marinara.

• 1:45:42Dax Shepard?

  Which in his mind isn't always marinara, is it?

• 1:45:44Speaker 01

  Okay. It exposes the stomach.

• 1:45:47Dax Shepard?

  Yeah.

• 1:45:47Speaker 01

  And the arrows, and like the abs.

• 1:45:49Dax Shepard?

  Arrows are really powerful.

• 1:45:50Speaker 01

  Arrows are powerful.

• 1:45:53Speaker 01

  They are powerful.

• 1:45:54Dax Shepard?

  Yeah, I feel like they're of the many things a man could have, arrows are like really high up on the list.

• 1:46:00Speaker 01

  Now, do you like arrows on a woman?

• 1:46:01Dax Shepard?

  Yeah.

• 1:46:02Speaker 01

  Yeah, well, arrows are literally arrows, they're pointing to your genitals.

• 1:46:06Dax Shepard?

  Yeah, yeah. Yeah, it's funny, and it's not that I'm like an ab person, so it's not like I need a six pack, but yeah, even arrows on a, on a gal, you're like.

• 1:46:16Speaker 01

  Definition.

• 1:46:16Dax Shepard?

  I think, I think there's something that we know that we don't know about the arrows. And this goes for a lot of different fitness things. Which is like, arrows are really hard to get, you're really athletic if you have arrows.

• 1:46:29Speaker 01

  Oh.

• 1:46:30Dax Shepard?

  And so somehow your body knows, evolutionarily, like, that person's very fit.

• 1:46:36Speaker 01

  Oh, interesting.

• 1:46:37Dax Shepard?

  And then there's other things where it's like, every guy does bench press and has a big chest, you're just like, yeah, yeah, yeah, the guy's a big, it's like, doesn't really say anything.

• 1:46:44Speaker 01

  I think it's more that it's pointing to the genitals.

• 1:46:46Dax Shepard?

  I think that's why butts too are, are really powerful.

• 1:46:49Speaker 01

  So I don't have a thing for butts.

• 1:46:52Dax Shepard?

  At all.

• 1:46:52Speaker 01

  Mm-mm.

• 1:46:53Dax Shepard?

  Really? When you watch like an NFL game, you're not like mesmerized by?

• 1:46:56Speaker 01

  I'm not a butt girl.

• 1:46:58Dax Shepard?

  Yeah.

• 1:46:58Speaker 01

  Um, but anyway, marinara.

• 1:47:00Dax Shepard?

  Yeah.

• 1:47:00Speaker 01

  Okay, so if someone is marinara, uh, I, sometimes it's, sometimes it's intriguing to me, but from, I think most women, that's very intriguing.

• 1:47:13Dax Shepard?

  Okay, there you go.

• 1:47:14Speaker 01

  I'm like, hit or miss, hit or miss, not always, even if it's like really nice.

• 1:47:20Dax Shepard?

  Okay.

• 1:47:21Speaker 01

  Um, I'm just like, mm.

• 1:47:23Dax Shepard?

  Yeah.

• 1:47:23Speaker 01

  I like more, I like more random things.

• 1:47:26Dax Shepard?

  Uh-huh, hands, necks, earlobes.

• 1:47:29Speaker 01

  Sometimes I just like, I'll see something random on someone's body, like their forearm or something, and I'm like.

• 1:47:35Dax Shepard?

  And you get a jolt.

• 1:47:36Speaker 01

  I get PQs.

• 1:47:37Dax Shepard?

  Wow, wow.

• 1:47:53Dax Shepard?

  Uh, kneecap ever?

• 1:47:55Speaker 01

  Um, no. I've never been attracted to anyone's kneecap.

• 1:47:58Dax Shepard?

  Me either.

• 1:47:59Speaker 01

  But you know, I remember we had, we had Hussin on.

• 1:48:02Dax Shepard?

  Uh huh.

• 1:48:03Speaker 01

  And he said, and I thought this was interesting. He said like, he's really attracted to like, specifically Indian women.

• 1:48:12Dax Shepard?

  The little hairs, that one?

• 1:48:13Speaker 01

  He did talk about, he did talk about that. But he talked about the, in, in a woman's arm, an Indian woman specifically, like armpit.

• 1:48:22Dax Shepard?

  Mm-hmm.

• 1:48:22Speaker 01

  There's often like, extra fat right here.

• 1:48:25Dax Shepard?

  More folds.

• 1:48:25Speaker 01

  I have it. I do, and I like, I despise it.

• 1:48:28Dax Shepard?

  Oh, you hate it?

• 1:48:28Speaker 01

  Oh my God, I hate it.

• 1:48:29Dax Shepard?

  Okay.

• 1:48:30Speaker 01

  But I remember him specifically talking about that.

• 1:48:33Dax Shepard?

  That he loved it.

• 1:48:34Speaker 01

  And that he liked it. And I was like, oh, you know, there really is like, there is a lid for every pot.

• 1:48:40Dax Shepard?

  And ass for every seat.

• 1:48:41Speaker 01

  There really is, like, you, you never know what people are attracted to.

• 1:48:46Dax Shepard?

  And you just decide, oh, no one likes this. And then, and then, and then you will confirm that.

• 1:48:51Speaker 01

  Exactly.

• 1:48:52Dax Shepard?

  And you're missing out on like, you, you see it all the time. We see people that are paired up and you're like, wow. That person clearly has all the options in the world and that's who they picked. That's so, that's interesting.

• 1:49:04Speaker 01

  Mm-hmm.

• 1:49:05Dax Shepard?

  And it should be comforting.

• 1:49:06Speaker 01

  Yeah.

• 1:49:07Dax Shepard?

  Yeah.

• 1:49:08Speaker 01

  Yeah, it should be. It should be comforting. It's like, someone will like this.

• 1:49:13Dax Shepard?

  Yeah.

• 1:49:13Speaker 01

  But also it's like, I don't know, I go back and forth, I guess, because, you know, I don't like that skin, fleshy, uh, fatty part of my arm.

• 1:49:23Dax Shepard?

  Armpit?

• 1:49:24Speaker 01

  Armpit. It's like, it's not really the pit. Well, I guess it is the pit, sort of, but it's more like on the side. Anyway, um, I hate it. And I guess I could be like, well, somebody will like this. Like, that's.

• 1:49:35Dax Shepard?

  Mm-hmm.

• 1:49:35Speaker 01

  But I don't like it. And I think it's so, uh, it's like, I should probably just care about what I like. I don't like it, so.

• 1:49:42Dax Shepard?

  Yeah, I mean.

• 1:49:43Speaker 01

  Find someone who likes.

• 1:49:44Dax Shepard?

  It's a better rule of thumb to be making decisions for yourself and know what others will like about you.

• 1:49:49Speaker 01

  Yeah.

• 1:49:49Dax Shepard?

  In general.

• 1:49:50Speaker 01

  Yeah.

• 1:49:51Dax Shepard?

  But then you really gotta ask yourself, well, why don't you like it? My hunch is you don't like it because you think other people don't like it.

• 1:49:56Speaker 01

  Probably.

• 1:49:57Dax Shepard?

  You know?

• 1:49:58Speaker 01

  Because it's not on the bodies of the women that I look at. And I'm like, oh, I want to look like that.

• 1:50:02Dax Shepard?

  Yeah, but don't want to touch.

• 1:50:04Speaker 01

  I just don't want to touch. I don't want to touch like their armpit.

• 1:50:07Dax Shepard?

  You don't ever want to poke a big butt to see like what the consistency is?

• 1:50:10Speaker 01

  Never.

• 1:50:10Dax Shepard?

  Wow.

• 1:50:11Speaker 01

  The thing is, we talked about this with Nikki, whoever you're attracted to.

• 1:50:14Dax Shepard?

  Yeah. They like it, man.

• 1:50:16Speaker 01

  You like, you like all the parts.

• 1:50:18Dax Shepard?

  Yes, totally.

• 1:50:20Speaker 01

  You like it all.

• 1:50:21Dax Shepard?

  Yep.

• 1:50:22Speaker 01

  So great.

• 1:50:22Dax Shepard?

  He's gotta have a little confidence.

• 1:50:23Speaker 01

  That's why, that's why personality is real, like having a good personality and being someone, somebody wants to be around and hang, hang out with, like, once you're that person, I mean, I say this to someone with no boyfriends, once you're that person.

• 1:50:39Dax Shepard?

  And a pretty strict.

• 1:50:40Speaker 01

  God, does that mean I have a bad personality?

• 1:50:42Dax Shepard?

  Why?

• 1:50:43Speaker 01

  Because I'm saying if you have a good personality, you can get people.

• 1:50:46Dax Shepard?

  No, I think this is the, what's funny is I think you're giving yourself this advice.

• 1:50:50Speaker 01

  What do you mean?

• 1:50:51Dax Shepard?

  I think you might be a little too, what's the word? I, picky's the word, I guess. You gotta go with who's got a good personality and then see if you would get attracted to them after that. You don't know anyone with a good personality?

• 1:51:04Speaker 01

  The people I know who have good personalities are my friends.

• 1:51:07Dax Shepard?

  Right.

• 1:51:08Speaker 01

  And they're all married or they're Jess.

• 1:51:11Dax Shepard?

  Yeah, you're not at the grocery store.

• 1:51:12Speaker 01

  I don't go to the grocery store, no.

• 1:51:13Dax Shepard?

  Yeah.

• 1:51:14Speaker 01

  I'm not gonna get, I'm not gonna get their personality really from the grocery store.

• 1:51:17Dax Shepard?

  It's funny, you're out a lot.

• 1:51:19Speaker 01

  I am out a lot, yeah.

• 1:51:20Dax Shepard?

  I know you're out a lot, so I'm, I'm a little confused.

• 1:51:24Speaker 01

  Can I be, I not to be this, good personalities are few and far between.

• 1:51:28Dax Shepard?

  Are they?

• 1:51:29Speaker 01

  Yeah, they really are, across the board, women and men. Good personalities.

• 1:51:34Dax Shepard?

  I'm so misled.

• 1:51:36Speaker 01

  Well, I'm misled, that's the problem. My friends, the people in my life have great personalities.

• 1:51:42Dax Shepard?

  Well, I was gonna say, we interview insanely interesting people all week.

• 1:51:46Speaker 01

  Yes.

• 1:51:47Dax Shepard?

  And then generally if I hang out with somebody, it's one, someone in our friendship group, so I probably don't have a great read.

• 1:51:54Speaker 01

  Uh huh.

• 1:51:55Dax Shepard?

  On the general options personality wise. Other than when I'm in Nashville, I'm just hanging with my neighbors and stuff and out at restaurants.

• 1:52:03Speaker 01

  Right. I do think that Jess being my best friend.

• 1:52:09Dax Shepard?

  Is problematic.

• 1:52:10Speaker 01

  Is a hindrance.

• 1:52:11Dax Shepard?

  Yeah, big time.

• 1:52:12Speaker 01

  He is the most, he has the most special personality of anyone I've ever met my entire life and I spend all my time with him.

• 1:52:20Dax Shepard?

  Uh huh, I know.

• 1:52:22Speaker 01

  Even Marinara, like, who am I gonna meet that is, that is, is Marinara? Like, no one.

• 1:52:29Dax Shepard?

  Yeah.

• 1:52:30Speaker 01

  And so, this is where I really think sometimes, I'm like, look. I got so lucky.

• 1:52:35Dax Shepard?

  You should send him to conversion camp.

• 1:52:37Speaker 01

  No, we're not attracted to each other and that's what's great about us. He has a incredible personality and I get to spend, I get, I get free access to that personality and it's, it's so lucky.

• 1:52:49Dax Shepard?

  That is a problem. If you're, if you're deciding, you meet a guy, you've been on a date with him and then you're deciding the next night, do I hang out with Jess or do I hang out with this guy? That's, yeah, this is interesting. This is a problem, kinda.

• 1:53:02Speaker 01

  It is. I, I, that is what goes through my head. Of course it is. Like, okay, I have two hours to hang out tonight. Am I gonna go on a date? Or am I gonna hang out with this person that's gonna make me laugh for two hours?

• 1:53:14Dax Shepard?

  Yeah.

• 1:53:15Speaker 01

  I'm prob, I'm always gonna pick that?

• 1:53:17Dax Shepard?

  Yeah.

• 1:53:17Speaker 01

  So sometimes I think like, oh, maybe I should just, in fact, most days I think I think this, like, I'm just so lucky. I have these incredible people in my life. A mul, multiple incredible people.

• 1:53:30Dax Shepard?

  Uh huh.

• 1:53:30Speaker 01

  That I think if anyone would be so lucky to have one of these people in their life and I have so many.

• 1:53:36Dax Shepard?

  Yeah.

• 1:53:36Speaker 01

  Maybe I should just be lucky and grateful for that and like, that's enough.

• 1:53:41Dax Shepard?

  How about this? If, if I said there's this new breakthrough, AI figured this out.

• 1:53:46Speaker 01

  Okay.

• 1:53:46Dax Shepard?

  You and Jess could take this pill. They took your DNA and they engineered it. And when you, after you wake up tomorrow morning, you're gonna be insanely attracted to Jess and he's gonna be insanely attracted to you.

• 1:53:55Speaker 01

  Oh. Would I do it?

• 1:53:57Dax Shepard?

  Yeah, why?

• 1:53:58Speaker 01

  I know, but what if it ruined everything? This is a Black Mirror episode. This should be a Black Mirror. It could ruin everything.

• 1:54:05Dax Shepard?

  Yeah.

• 1:54:06Speaker 01

  I think you just gotta be grateful for what you have.

• 1:54:09Dax Shepard?

  Alright.

• 1:54:11Dax Shepard?

  Yeah, let's say you're both attracted to each other, but now all of a sudden he wants to have sex with you more than you want to have sex with him.

• 1:54:15Speaker 01

  Or what if he's like selfish in bed or something like, then like, you know, bad parts of personalities can come out when these things get involved. Jealousy, like, there could be a lot of things.

• 1:54:26Dax Shepard?

  Jealousy, when he's making other people laugh, all of a sudden it bothers you.

• 1:54:29Speaker 01

  Oh, hundred percent, hundred percent.

• 1:54:31Dax Shepard?

  Yeah, cuz right now you don't care.

• 1:54:33Speaker 01

  No, I feel.

• 1:54:33Dax Shepard?

  But if he was making some girl just laugh uncontrollably and he was your boyfriend.

• 1:54:37Speaker 01

  And he was straight?

• 1:54:38Dax Shepard?

  Yeah, you'd be.

• 1:54:39Speaker 01

  No, I, I.

• 1:54:40Dax Shepard?

  You'd tell him to shut up.

• 1:54:41Speaker 01

  Well, no.

• 1:54:42Dax Shepard?

  Your, your comedy's only for me.

• 1:54:45Speaker 01

  I, I know, it is funny cuz now, when we're out places and he's making people laugh and, and he's my, you know, buddy, I'm like, so, I, I feel so.

• 1:54:54Dax Shepard?

  Proud.

• 1:54:54Speaker 01

  Yeah, I'm like, oh my god, yeah, Jess is my best friend.

• 1:54:57Dax Shepard?

  Yeah, yeah, yeah.

• 1:54:57Speaker 01

  I'm so lucky.

• 1:54:58Dax Shepard?

  Yeah.

• 1:54:59Speaker 01

  And, but yeah, if he was into girls.

• 1:55:03Dax Shepard?

  Uh huh, he's making some hot chick laugh uncontrollably. And you could see she was looking at him like, I wish this guy was my boyfriend.

• 1:55:10Speaker 01

  Yeah, and then she's like, pulling her shirt down. And I'm like, fuck you.

• 1:55:15Dax Shepard?

  Get outta here. I break up with you, Jess.

• 1:55:19Speaker 01

  Yeah, see, it could go badly.

• 1:55:21Dax Shepard?

  So maybe we wouldn't. We wouldn't take it.

• 1:55:23Speaker 01

  Yeah, I'm gonna leave it.

• 1:55:24Dax Shepard?

  Alright.

• 1:55:24Speaker 01

  Hey, should we do that?

• 1:55:25Dax Shepard?

  One is a fact, yeah.

• 1:55:27Speaker 01

  Okay, this is for Rachel, Zoffness.

• 1:55:30Dax Shepard?

  What a name.

• 1:55:31Speaker 01

  Great name.

• 1:55:31Dax Shepard?

  Yeah, Zoffness. I wish my name was Dak Zoffness. It'd be too many weird letters, but it does soften everything.

• 1:55:39Speaker 01

  God, do you wanna hear something embarrassing?

• 1:55:41Dax Shepard?

  Yeah.

• 1:55:42Speaker 01

  I can't believe I'm gonna admit this.

• 1:55:44Dax Shepard?

  Oh, God, it's a day of admissions.

• 1:55:46Speaker 01

  So, when I was young, I would like, you know, write a lot of fiction stories on my computer. And I would, um, create, and I was basically like, writing what I wish my life was, kind of. Uh, the main character. And I was always like, thinking about what na, what I would like, name the characters and stuff. And I did really like the last name Shepherd.

• 1:56:12Dax Shepard?

  Really?

• 1:56:13Speaker 01

  Yes, I did.

• 1:56:15Dax Shepard?

  Where did that come from?

• 1:56:16Speaker 01

  I don't know, I must've heard it, and I was like, oh, I really wish that was my last name.

• 1:56:20Dax Shepard?

  Ah, very white.

• 1:56:21Speaker 01

  Yeah, but it's like, it sounds nice. It sounds really nice.

• 1:56:26Dax Shepard?

  I'm grateful for Shepherd.

• 1:56:27Speaker 01

  Yeah.

• 1:56:27Dax Shepard?

  Don't get me wrong.

• 1:56:28Speaker 01

  It's good.

• 1:56:29Dax Shepard?

  Yeah, it's, it's a good name. And then, of course, I like that it's not spelled the way, so I still have some uniqueness, you know? I love uniqueness.

• 1:56:36Speaker 01

  I don't like that. It's annoying.

• 1:56:38Dax Shepard?

  You would want H E R D.

• 1:56:39Speaker 01

  Actually, no. I, I like the way yours is spelled aesthetically.

• 1:56:43Dax Shepard?

  Yeah, it looks better, right?

• 1:56:44Speaker 01

  Yeah, it looks better.

• 1:56:45Dax Shepard?

  Yeah, we don't even have H in there.

• 1:56:46Speaker 01

  But it bothers me when people spell it wrong, like when they're like reaching out.

• 1:56:50Dax Shepard?

  Oh, it's almost exclusively wrong. I get offers or I get these, these ones that are kind of like, they're very flattering letters.

• 1:56:57Speaker 01

  Exactly.

• 1:56:58Dax Shepard?

  Begging me to be a part of something. And I'm like, but you didn't even look up.

• 1:57:01Speaker 01

  You don't even.

• 1:57:02Dax Shepard?

  You're acting like a super fan, but you don't know how to spell my name.

• 1:57:04Speaker 01

  Yeah.

• 1:57:05Dax Shepard?

  But I don't get that, but on the shape of, Rob McElhenney famously.

• 1:57:08Speaker 01

  Oh, well, his is so hard.

• 1:57:09Dax Shepard?

  He's let people go over it, yeah.

• 1:57:10Speaker 01

  Oh, wow.

• 1:57:11Dax Shepard?

  Yeah, yeah.

• 1:57:12Speaker 01

  I get it. It's like, just take a second. But I've made the, I've also made that mistake.

• 1:57:18Dax Shepard?

  I don't care. Thank God. It's one, I mean, I care about so many dumb things, but that, I don't, I don't happen to care too much. I just, it's ironic. I see the irony of like, I'm your biggest fan.

• 1:57:30Speaker 01

  I know. It would happen with Kristen too.

• 1:57:33Dax Shepard?

  D A C K S. S H E P H E R A R D.

• 1:57:37Speaker 01

  Yeah.

• 1:57:37Dax Shepard?

  Yeah, yeah, yeah.

• 1:57:38Speaker 01

  I, when, when I was Kristen's assistant and people would reach out asking for things and they would misspell her name, I was like, no.

• 1:57:44Dax Shepard?

  Yeah, yeah, yeah.

• 1:57:45Speaker 01

  You're not getting it. You can't even take the time.

• 1:57:51Speaker 01

  So, um, anyway, so I wanted it to be, I wanted that as a last name.

• 1:57:56Dax Shepard?

  Monica Shepard.

• 1:57:57Speaker 01

  No, it wasn't Monica. I hated that.

• 1:58:00Dax Shepard?

  It was gonna be Gal Shepard.

• 1:58:01Speaker 01

  No, it was like Sky or like Ansley.

• 1:58:05Dax Shepard?

  Ansley Shepard. That's cool.

• 1:58:07Speaker 01

  I know.

• 1:58:08Dax Shepard?

  Yeah.

• 1:58:09Speaker 01

  It is cool. Um, okay.

• 1:58:12Dax Shepard?

  You never wanted Hollis?

• 1:58:14Speaker 01

  Sorry, I didn't know about it.

• 1:58:16Dax Shepard?

  With a bunch of crazy letters slammed in there.

• 1:58:18Speaker 01

  I would have written a character in my story.

• 1:58:21Dax Shepard?

  No one spells my name right, so don't worry. Well, Rob, we've been working together for eight and a half years and honestly, every time I have to write your last name, I get a sharp pang of anxiety. I'm like, I'm never doing this right.

• 1:58:30Speaker 01

  Yeah, how dare, how dare you complain about yours?

• 1:58:35Dax Shepard?

  I'm gonna try. I think it's Hollis. H O L Y.

• 1:58:42Dax Shepard?

  C Z?

• 1:58:43Speaker 01

  No, S Z.

• 1:58:45Dax Shepard?

  Yep. Okay.

• 1:58:46Speaker 01

  Wow.

• 1:58:47Dax Shepard?

  I thought it was C Z for a second. You can definitely see where there'd be a C in there, right?

• 1:58:51Speaker 01

  Hollis? No.

• 1:58:54Dax Shepard?

  I don't normally get a C in the wrong.

• 1:58:56Speaker 01

  You get, do you get H O L L I S?

• 1:58:58Dax Shepard?

  Well, phonetically, yes.

• 1:59:00Speaker 01

  Yeah.

• 1:59:01Dax Shepard?

  Could we, you ever thought about?

• 1:59:03Speaker 01

  No. Rob, you be you.

• 1:59:06Dax Shepard?

  I think it was already changed technically from like the real Polish.

• 1:59:10Speaker 01

  Oh, probably.

• 1:59:12Dax Shepard?

  Pronunciation at least. Okay, so I blew it in public. Yeah, so it's a tough one for me. I know there's a Y and a Z in there.

• 1:59:18Speaker 01

  Oh, having a Y and a Z in your name is tough.

• 1:59:21Dax Shepard?

  It's gonna be tough.

• 1:59:22Speaker 01

  Yeah.

• 1:59:22Dax Shepard?

  Yeah.

• 1:59:23Speaker 01

  Speaking of names that someone could mispronounce, Usain Bolt, just some-

• 1:59:30Dax Shepard?

  That's a tough one, yeah.

• 1:59:31Speaker 01

  Yeah, uh, so just some stuff about his back.

• 1:59:35Dax Shepard?

  Scoliosis, yeah.

• 1:59:36Speaker 01

  To manage his back issues and protect his spine, Bolt focused heavily on core strength, sometimes doing up to 700 sit-ups per day.

• 1:59:44Dax Shepard?

  Hmm.

• 1:59:46Speaker 01

  At age 15, he became the youngest male world junior champion ever in the 200 meter, running at under 20 seconds.

• 1:59:54Speaker 01

  During the 2008 Beijing Olympics, he ate roughly 1,000 McNuggets over 10 days because he was picky about the food.

• 2:00:01Dax Shepard?

  What? 1,000 McNuggets? That's a, that's a scientific experiment.

• 2:00:08Speaker 01

  Yeah.

• 2:00:08Dax Shepard?

  Like, what would happen if someone ate 1,000 nuggets in two weeks? They would set all the world records.

• 2:00:14Speaker 01

  That pink sledge video is one of the best mark- I, I don't know what they were marketing. I get, Burger King probably was behind that. Like, and I cannot hear the word McNugget and not think of that pink sledge.

• 2:00:30Dax Shepard?

  Oh, thank God I don't. I have no association.

• 2:00:32Speaker 01

  It is, it is permanent. It's cemented. I mean, I'll still maybe eat it.

• 2:00:37Dax Shepard?

  They're delicious.

• 2:00:38Speaker 01

  Oh, yeah. They're delicious.

• 2:00:40Dax Shepard?

  Oh, they're fucking delicious.

• 2:00:41Speaker 01

  By the way-

• 2:00:42Dax Shepard?

  I wish I had an excuse to eat 1,000 of them in two weeks.

• 2:00:45Speaker 01

  Well, you could.

• 2:00:47Dax Shepard?

  I wouldn't look like Usain Bolt.

• 2:00:49Speaker 01

  If you do 700 sit-ups a day, you might.

• 2:00:52Dax Shepard?

  I think I'll also have to be running very fast for, oh, very frequently.

• 2:00:57Speaker 01

  Probably. Um, at what margin do women experience chronic- Pain more than men. Data suggests that approximately seventy percent of chronic pain cases are women. And they suffer from higher pain sensitivity, more severe pain and higher rates of conditions like fibromyalgia and migraines. Fibromyalgia. Remember?

• 2:01:16Dax Shepard?

  Classic.

• 2:01:17Speaker 01

  Classic. There used to be so many commercials about fibromyalgia.

• 2:01:21Dax Shepard?

  Yeah, especially on sixty minutes.

• 2:01:22Speaker 01

  Yeah.

• 2:01:23Dax Shepard?

  Yeah.

• 2:01:23Speaker 01

  The old, older person programs.

• 2:01:25Dax Shepard?

  Older demo, yeah.

• 2:01:26Speaker 01

  Yeah.

• 2:01:27Dax Shepard?

  Which I am out of officially.

• 2:01:28Speaker 01

  You're what?

• 2:01:29Dax Shepard?

  I'm not in the demo anymore. It's eighteen to forty-nine. I'm not a valued viewer anymore.

• 2:01:35Speaker 01

  Oh, no.

• 2:01:36Dax Shepard?

  Yeah.

• 2:01:36Speaker 01

  But you're in the fibromyalgia.

• 2:01:39Dax Shepard?

  Yeah. That's why I said the older demo, but this is kind of a throwaway demo. It's not what advertisers care about. They care about eighteen to forty.

• 2:01:45Speaker 01

  That's silly. They should care about the older people because the older people.

• 2:01:51Dax Shepard?

  They have more money, but they spend less.

• 2:01:53Speaker 01

  Right.

• 2:01:53Dax Shepard?

  Yeah, they're done, they're done buying crap.

• 2:01:56Speaker 01

  Hmm. How much of the world's opioids does the US consume? The US has less than five percent of the world's population, but consumed roughly thirty percent of the world's opioids in two thousand nine, including more than ninety-nine percent of the world's hydrocodone. Woo, and eighty percent of the world's oxycodone.

• 2:02:18Dax Shepard?

  Hmm.

• 2:02:18Speaker 01

  As of two thousand seventeen, that was a long time ago, the US and other affluent nations, Canada, Western Europe, consume roughly ninety-five percent of the global opioid supply, leaving only five percent for the rest of the world.

• 2:02:31Dax Shepard?

  Hmm.

• 2:02:31Speaker 01

  Some Sackler family fun facts.

• 2:02:34Dax Shepard?

  Oh, great.

• 2:02:34Speaker 01

  Owners of Purdue Pharma made approximately thirty-five billion dollars in revenue from OxyContin sales. In twenty twenty-five, family agreed to a seven point four billion settlement as part of a bankruptcy deal, which required them to give up control of Purdue Pharma and ban them from selling opioids in the US of A. Okay, this, so this is some stats on AA and its success rate. But like.

• 2:02:59Dax Shepard?

  Before you read them, I'm gonna, um, I'm just gonna say us, uh, something very cool, uh, smart and astute that Drew Pinsky said about the success rate of AA. AA is a very hard thing to evaluate because you can evaluate a cancer medication. Because you take the one pill, they took it or they didn't, and then you measure the outcome. Whereas AA is advise, go to meetings, get a sponsor, work the steps, sponsor someone else, do service, right? So there's a lot of components. So it's hard to measure.

• 2:03:34Speaker 01

  I know.

• 2:03:34Dax Shepard?

  If someone has the full dosage, if they do all five of those things.

• 2:03:38Speaker 01

  Yeah.

• 2:03:39Dax Shepard?

  Consistently, you're gonna get one outcome.

• 2:03:41Speaker 01

  Right.

• 2:03:42Dax Shepard?

  And then a person who does one meeting a week and never gets a sponsor, doesn't do the steps. You know.

• 2:03:47Speaker 01

  That's why I don't really agree with this. I don't wanna read this. I don't think that's.

• 2:03:51Dax Shepard?

  What does it say? 10% or something?

• 2:03:52Speaker 01

  This is, this is 2014. Well, yeah, this says is 7%.

• 2:03:57Dax Shepard?

  Yeah. And then also, how are you defining it's like relapse within the first year?

• 2:04:01Speaker 01

  Right, then, okay, so it says addiction specialist cites success rate slightly higher between 8 and 12%. But then it says 27% of the participants were sober for less than a year, 24% were sober. From what? Oh, a 2014 study conducted by AA found the following among over 6,000 members. 27% of participants were sober for less than a year, 24% were sober 1 to 5 years, 13% were sober 5 to 10, 14% were sober 10 to 20, 22 were sober for 20 or more years. The eight-year follow-up showed that 46% of those who chose formal treatment were abstinent, while 49% of individuals who attended AA were abstinent. Those are actually.

• 2:04:42Dax Shepard?

  Some more.

• 2:04:42Speaker 01

  Yeah, but they're saying these are AA studies.

• 2:04:46Dax Shepard?

  Yeah, what's success? If someone drinks once within a year versus they drank seven days a week.

• 2:04:52Speaker 01

  Right.

• 2:04:52Dax Shepard?

  That's pretty successful.

• 2:04:53Speaker 01

  Yeah.

• 2:04:54Dax Shepard?

  Uh, you know, over the course of 20 years, if they have eight relapses, does that mean it's not successful? That, no, to me, that, that person used eight times in 20 years. And they used to. Use 365 days a year?

• 2:05:08Speaker 01

  I know, it's hard, it's really, I don't know, it's hard.

• 2:05:10Dax Shepard?

  It's almost impossible to evaluate.

• 2:05:12Speaker 01

  I agree.

• 2:05:12Dax Shepard?

  Yeah.

• 2:05:13Speaker 01

  Um, that's it.

• 2:05:14Dax Shepard?

  Okay, great. Well, I enjoyed Rachel. I've been telling so many people about The Tale of Two Nails is so fun at a Durn party.

• 2:05:21Speaker 01

  Ah, it is, yeah.

• 2:05:21Dax Shepard?

  Especially if you have the, um, x-ray on your phone like I do.

• 2:05:25Speaker 01

  Yep.

• 2:05:25Dax Shepard?

  Um, and then the back data is fascinating.

• 2:05:28Speaker 01

  The back data is really fascinating.

• 2:05:32Dax Shepard?

  Yeah.

• 2:05:32Speaker 01

  Just pain in general. I mean, it relates to the other episode we have on over We had on over diagnosis where there's phantom seizure, you know. See, there's, people can have seizures that are Not caused by epilepsy, you can have, you know. It's similar, like your body is still reacting.

• 2:05:54Dax Shepard?

  Yeah, it's in a high alert survival mode and it doesn't need to be.

• 2:05:58Speaker 01

  It just every, you know when people will ask, like, Ah, you've had so many experts on in the past eight years, what have you learned? Or like, what's the, your biggest takeaway? I always kind of like trip on that because we, there's so much.

• 2:06:10Dax Shepard?

  Yeah.

• 2:06:11Speaker 01

  But I think the main takeaway is just The brain is so powerful.

• 2:06:18Dax Shepard?

  Yeah.

• 2:06:19Speaker 01

  It can do anything. It can kill you and it can, it can, um.

• 2:06:23Dax Shepard?

  Take you to another, uh, it take you out of the, this planet to another place.

• 2:06:28Speaker 01

  Yes.

• 2:06:28Dax Shepard?

  Yeah.

• 2:06:29Speaker 01

  It can save you, it can, I mean, it's, it's like, it's all a fucking here.

• 2:06:34Dax Shepard?

  Yeah, yeah, yeah. No, it's, uh, it's the great enigma still.

• 2:06:38Speaker 01

  I know.

• 2:06:39Dax Shepard?

  Yeah. We all got one.

• 2:06:41Speaker 01

  Some of us didn't get one. That's my diss. Did you even get a brain?

• 2:06:47Dax Shepard?

  Yeah, when God was handing out brains, you must have went, "Apsenpapda."

• 2:06:52Speaker 01

  Did you miss that day?

• 2:06:54Dax Shepard?

  There was a thing in, when, when, when God was handing out somethings, you thought he said somethings. Do you, does that ring a bell? Like shirts and you thought he was saying shits. It's not that, but it's like, It's a burn. Yeah, I was like, oh, oh, it's, when God was handing out brains, you thought he said stains and said, no, thanks.

• 2:07:13Speaker 01

  That's a thing?

• 2:07:15Dax Shepard?

  That's a third grade thing and.

• 2:07:16Speaker 01

  That's a Christian diss?

• 2:07:18Dax Shepard?

  No, that's a, um, what's the name of my elementary school? Spring Mills Elementary diss on third grade. When God was handing out brains, you thought he said stains and said, no, thanks.

• 2:07:27Speaker 01

  Be honest, did you invent that?

• 2:07:29Dax Shepard?

  No, I can barely remember it.

• 2:07:31Speaker 01

  Okay, okay, but I.

• 2:07:32Dax Shepard?

  I never forget something I create.

• 2:07:36Speaker 01

  All right. All right, love you.