If the Brain Can Change, Pain Can Change | Dr. Rachel Zoffness

WEBVTT

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You're listening to the P.T.

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Pinecast,

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where smart people in healthcare come to

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make noise.

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Here's your host, Jimmy McKay.

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Thanks, Voice Guy.

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She asks if I need a bio.

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We'll get to the guest.

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Do you want to say thanks to Sarah

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Health First,

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the remote care platform helping clinics

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boost revenue without adding staff?

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If you're going to be at CSM in

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Anaheim, look for Stephen Cohen.

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He's the guy behind Sarah Health.

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He always wears a tennis ball colored

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track suit to conferences.

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Ridiculous?

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Yes.

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Does it help him stand out?

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Also, yes.

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Sarah essentially automates daily patient

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check-ins via text, which means no app,

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no logins.

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God bless.

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Love it.

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Just better outcomes.

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It's a simple way to meet RTM requirements

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that improves follow-through and actually

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gets reimbursed for care between visits.

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SarahHealth.com.

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That's Sarah without the H.

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I know a lot of Sarahs out there

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when they order their lattes,

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it's like Sarah without the H.

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But there is an H because it's also

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health.

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So SarahHealth.com.

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Now we'll get to the big fancy intro.

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She's been called a pain psychologist,

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a pain scientist, a pain educator.

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I'm sure a few other pains,

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but her real title might be Myth Slayer.

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What do you think about that?

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For decades,

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our health system has taught pain all

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wrong.

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And today our guest is back.

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A return guest is back to here to

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flip that script.

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She's treated patients like a six year old

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kid whose life was swallowed by migraines

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and mixed diagnoses and then helped them

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reclaim their lives with science.

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empathy, and zero magic pills,

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which is good because magic pills are

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expensive.

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She's written bestselling books.

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We're going to talk about that.

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Taught at Stanford and UCSF.

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We're going to talk about that.

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And her work sparks more viral clips than

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your average TikTok doc.

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For a while there,

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she was on my Instagram feed every eleven

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minutes.

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She's on a mission to radically reeducate

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both patients and providers about the true

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nature of pain.

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And you're going to want to take notes

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or just read the transcript because I'll

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provide that.

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Welcome back to the show, Dr.

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Rachel Zoffness.

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What an intro.

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That was awesome.

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Just as we're hitting record, she's like,

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do you need a bio for an intro?

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I'm like, yeah.

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Listen,

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I am not great at a lot of

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things, but reading intros is one of them,

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right?

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No, that was pretty... I am impressed.

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Also,

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I sort of miss all that fun podcasting,

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Instagram stuff that used to be happening,

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but I have been in a book writing

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hole for three effing years.

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Excuse my language.

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I will not do that again.

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That was brutal.

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I was literally going to ask.

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That was going to be one of my

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first questions.

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Where did you go?

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Where have you been?

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I walk around with my chest out when

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I have read a book.

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I'm like, I don't want to brag,

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but I just read all these books.

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And it's not a picture book.

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It's a chapter book.

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And I do that and I am

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It's like the difference between climbing

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a mountain and building a mountain.

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I've climbed a hill,

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but I'm building a hill.

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So before we get to the insides of

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the book, why?

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How did it go?

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Three years?

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Did you want to quit?

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What does writing a book look and feel

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like?

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I still want to quit.

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Like,

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I'm supposed to be doing a book tour.

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I'm like,

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can I just lay on the floor for

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six months now?

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I'm so tired.

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OK, I know.

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What's the honest answer?

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The honest answer is like, as you know,

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I'm a nerd.

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I'm a real nerd.

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And I always wanted to write a science

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book.

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So forever.

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Yeah.

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But so Oliver Sacks was sort of my

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hero in college.

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Do you know that guy, Oliver Sacks?

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is a neurologist he's no longer with us

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but he wrote a bazillion books one was

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called the man who mistook his wife oh

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i've seen that one yeah i know that

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one right and there's a movie called

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awakenings based on a book he wrote that

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you know starred robin williams you've

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seen it yeah

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yeah i loved the way that oliver sachs

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would take complicated science concepts

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and use patient stories and distill the

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science down and suddenly you were like

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wow i didn't realize i was interested in

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aphasia but now i am you know and

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and so this was sort of a passion

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of mine for forever like how do i

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take the science of pain you know i've

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been studying pain neuroscience and pain

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biology for the last thirty five years

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you know and for me i was like

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how do i take this and you know

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i mean you're down this pain rabbit hole

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you know how complex it is how do

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you take this incredible science like

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these sixty five years of neuroscience and

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and translate that yeah for like the lay

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public because in my mind

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Pain isn't just a thing that affects pain

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patients.

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I'm using hard air quotes there.

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We are all pain patients.

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Pain is coming for every single one of

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us,

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whether it's back pain or childbirth or

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living in an aging body.

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So we should all understand how it works.

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So that's how the book originally was

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born.

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It took forever to get a literary agent,

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my dude.

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That is a non-casual undertaking.

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So do you...

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Do you pitch, I got an idea?

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Do you pitch, here's who I am,

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let's come up with an idea?

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How does that work?

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I've never done that.

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Right.

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So for anyone interested in writing a

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book, it is not a casual undertaking.

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You have to first query literary agents

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and you have to find the right literary

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agent.

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Because if you want to write a fiction

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book, it's a different set of people,

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right, than represent nonfiction books.

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And you want like a badass nonfiction

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literary agent.

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And when I pitched literary agents

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originally, they were like, well,

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you seem smart and interesting,

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but you don't have a platform.

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And I was like, what is a platform?

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I'm seven hundred Instagram.

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Dude, at the time, I didn't know.

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I was like, I'm seven hundred years old.

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I wasn't using social media at the time.

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I was like,

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are you telling me I have to teach

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myself?

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So, yeah,

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I went and taught myself how to use

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like Twitter back when med Twitter was a

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thing and Instagram.

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We've we've all left.

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Right.

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I've I've left.

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Right.

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I'm just making sure.

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I'm not the person who just left the

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party and is still going.

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Yeah, I left.

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No, I mean, I know.

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I want to say this carefully because

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Twitter is still there.

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X is still there.

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But Med Twitter,

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where all the doctors were hanging out,

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migrated over to Blue Sky.

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So I kind of followed the pack.

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I was like,

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I'm on this thing because I want medical

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education and pain science and all that

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stuff.

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So everybody left.

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Yeah.

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So I migrated too.

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So let's say you find Ballpark.

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How many literary agents did you pitch?

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Oh, gosh, I don't know.

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Fifteen to twenty, probably.

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And then are you like walking and you're

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pitching because they're the ones sort of

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in the driver's seat?

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Like, are you shark tanking?

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Yeah, you're pitching.

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You're pitching them.

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You're querying them.

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And then they say yes or no.

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And then ultimately,

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when all of the podcasts I was doing

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were for some crazy effing reason,

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we're all going viral.

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Don't ask me why.

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I still don't know why.

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I mean, there's so many.

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And you distill things down.

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We already discussed this.

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Working on that.

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I'll say it so you don't have to

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because you're smart and you take this

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thing that touches not just pain patients

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and you help people understand it in a

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myriad of ways.

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That's why it goes off.

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So I'll say it.

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You don't have to brag.

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I will.

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Here's hoping.

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But it was when those things were going

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viral that finally agents started paying

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attention.

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So then I got a book deal.

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And so I've spent the last three years

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writing a book and it's called Tell Me

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Where It Hurts.

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And it comes out in March.

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And I'm so nervous for people to read

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it.

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I'm like disproportionately nervous.

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Good title.

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You like it?

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Tell me where it hurts.

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I mean, how many times, I mean,

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that's relatable to any medical provider,

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but also any person has heard that.

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You've either said that or heard,

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this book is for people who have heard

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or said, tell me where it hurts.

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Like, ta-da, that's across the top.

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I'll take my nickel now per episode.

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So who is this book?

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Who do you hope reads this book?

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We'll get to other things inside the book.

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But when you were like three years old,

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Is not a short time.

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It is roughly.

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Nine hundred plus days.

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I'm not a math guy.

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When you were sitting there,

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who were you hoping this like was who

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was who?

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What does success look like when you hear

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back from someone after you've hit the New

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York Times bestseller list and people like

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this book did X?

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Who is it for and what do you

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hope it did for them?

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um when you write a book and when

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you pitch a book to the publishing houses

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you have to give them your main audiences

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so i'll give you my top three audiences

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good good good good that's a good exercise

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thank you so much and also i really

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i'm jealous you're drinking bourbon it's

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eleven thirty a.m here i sort of want

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to for folks listening jimmy and i had

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like a happy hour together during the

00:08:33.173 --> 00:08:35.072
pandemic the pandemic happy hour that was

00:08:35.092 --> 00:08:36.374
a fun thing i sort of wish we

00:08:36.394 --> 00:08:37.073
were doing that again

00:08:37.793 --> 00:08:39.174
Yeah, maybe we'll do that again.

00:08:39.215 --> 00:08:41.195
We'll do that next pandemic,

00:08:41.235 --> 00:08:42.235
but who are your three audiences?

00:08:42.255 --> 00:08:43.515
Next pandemic.

00:08:43.576 --> 00:08:44.395
Three audiences.

00:08:44.576 --> 00:08:46.256
One is healthcare providers because there

00:08:46.277 --> 00:08:48.798
are healthcare providers across all

00:08:48.857 --> 00:08:51.359
disciplines who want to understand pain

00:08:51.619 --> 00:08:52.818
and who have had a dearth of pain

00:08:52.859 --> 00:08:54.240
education and they want it.

00:08:54.639 --> 00:08:56.460
I mean, I'm talking PT, OT, nursing,

00:08:56.721 --> 00:08:57.461
pharmacology.

00:08:58.041 --> 00:09:00.082
Physicians across all physician

00:09:00.102 --> 00:09:00.663
disciplines.

00:09:00.962 --> 00:09:01.823
Lord knows, you know,

00:09:01.844 --> 00:09:03.485
there's so many anesthesiology,

00:09:03.544 --> 00:09:04.285
cardiology.

00:09:04.625 --> 00:09:05.206
I mean,

00:09:05.265 --> 00:09:08.207
is there one domain of medicine that pain

00:09:08.268 --> 00:09:08.928
doesn't affect?

00:09:08.969 --> 00:09:09.208
Right.

00:09:09.288 --> 00:09:10.750
And then, of course, psychology.

00:09:10.850 --> 00:09:12.831
So all health care disciplines.

00:09:13.432 --> 00:09:15.614
Also, my second audience was patients.

00:09:15.653 --> 00:09:16.774
So people living with pain.

00:09:17.475 --> 00:09:18.054
And that's again,

00:09:18.075 --> 00:09:18.875
that's sort of all of us.

00:09:19.196 --> 00:09:20.618
And then my third audience is people who

00:09:20.658 --> 00:09:21.437
just love science.

00:09:21.457 --> 00:09:23.640
Like we know right now there's a big

00:09:24.160 --> 00:09:25.422
wave in the healthcare world.

00:09:25.442 --> 00:09:27.705
Like people are listening to- That's

00:09:27.904 --> 00:09:28.184
right.

00:09:28.284 --> 00:09:28.905
Let's go.

00:09:28.946 --> 00:09:29.125
Yeah.

00:09:29.145 --> 00:09:30.748
And we're all interested in what's going

00:09:30.807 --> 00:09:31.729
on with the human body.

00:09:31.788 --> 00:09:33.510
So I really wanted people who were

00:09:33.551 --> 00:09:34.971
interested in science to think this book

00:09:34.991 --> 00:09:36.332
was interesting.

00:09:36.514 --> 00:09:37.094
How do you...

00:09:38.322 --> 00:09:41.743
do that because those are not like if

00:09:41.763 --> 00:09:43.224
your base of support here,

00:09:43.563 --> 00:09:45.264
if you were trying to like tow both

00:09:45.303 --> 00:09:45.865
lines, those are,

00:09:45.904 --> 00:09:47.725
those are why like talking to both of

00:09:47.764 --> 00:09:49.265
those audiences at the same or all three

00:09:49.285 --> 00:09:50.346
of those audiences at the same time,

00:09:50.785 --> 00:09:52.807
couldn't have been easy.

00:09:52.907 --> 00:09:53.206
Right.

00:09:53.506 --> 00:09:54.027
Well said.

00:09:54.346 --> 00:09:54.427
Um,

00:09:54.967 --> 00:09:57.467
the answer is for me when I'm writing

00:09:57.908 --> 00:09:59.129
and when I'm talking, um,

00:09:59.428 --> 00:10:00.870
I'm always trying to think about like the

00:10:00.970 --> 00:10:02.370
lowest common denominator.

00:10:02.490 --> 00:10:03.971
And what I mean by that is like

00:10:04.051 --> 00:10:05.552
obviously not dumbing it down and not

00:10:05.572 --> 00:10:06.792
talking to people at all.

00:10:06.831 --> 00:10:07.032
Right.

00:10:07.371 --> 00:10:08.913
I just want to take the most important

00:10:08.952 --> 00:10:11.614
stuff and use easily digestible language

00:10:11.653 --> 00:10:13.174
because pain neuroscience is gnarly.

00:10:13.254 --> 00:10:13.815
It's just gnarly.

00:10:13.914 --> 00:10:16.115
And I know that like the level of

00:10:16.515 --> 00:10:18.157
understanding of science for a health care

00:10:18.197 --> 00:10:20.357
provider will probably be different than

00:10:20.378 --> 00:10:21.899
the level of understanding for like.

00:10:22.859 --> 00:10:24.201
Joe walking down the street with back

00:10:24.240 --> 00:10:24.461
pain.

00:10:24.640 --> 00:10:25.701
So I have to sort of find a

00:10:25.741 --> 00:10:28.264
happy medium where I'm using legitimate

00:10:28.304 --> 00:10:29.145
scientific terms,

00:10:29.186 --> 00:10:31.067
but I'm also explaining it in very

00:10:31.087 --> 00:10:32.649
approachable language.

00:10:32.690 --> 00:10:33.650
So just finding that.

00:10:34.244 --> 00:10:34.904
I'll reiterate,

00:10:34.924 --> 00:10:37.206
because I love science communication.

00:10:37.366 --> 00:10:38.587
It is not dumbing it down.

00:10:38.947 --> 00:10:41.110
I need to hone this down a little

00:10:41.130 --> 00:10:42.251
bit, but I tell people,

00:10:42.272 --> 00:10:45.514
if you've ever resized a picture on an

00:10:45.794 --> 00:10:46.034
app,

00:10:46.775 --> 00:10:48.096
if you sort of do it and you

00:10:48.136 --> 00:10:49.538
made it out of proportion,

00:10:49.719 --> 00:10:50.659
that's dumbing it down.

00:10:50.899 --> 00:10:51.900
What you want to do is you want

00:10:51.921 --> 00:10:52.902
to keep it in proportion.

00:10:52.961 --> 00:10:53.221
You're like,

00:10:53.302 --> 00:10:55.024
I'm going to keep it as smart as

00:10:55.104 --> 00:10:55.563
I can

00:10:56.384 --> 00:10:57.125
but just bring it,

00:10:57.164 --> 00:10:58.546
make it more digestible.

00:10:58.625 --> 00:10:59.947
Like I love that word for some reason,

00:10:59.986 --> 00:11:01.788
digestible, which is simple,

00:11:02.327 --> 00:11:03.808
just not easy to do.

00:11:03.828 --> 00:11:06.951
Cause sometimes science is complicated.

00:11:07.010 --> 00:11:08.152
So it's like simple to do.

00:11:08.211 --> 00:11:09.172
It's just not easy to do.

00:11:09.211 --> 00:11:10.552
That's why when someone does it well,

00:11:11.113 --> 00:11:12.134
it typically lands.

00:11:12.614 --> 00:11:14.955
So now let's get into the book, right?

00:11:15.216 --> 00:11:16.375
Well, let's get into the concept.

00:11:16.495 --> 00:11:19.618
What do we typically get wrong about pain?

00:11:19.937 --> 00:11:20.918
And I'll frame it for you,

00:11:20.958 --> 00:11:22.460
for our audience in healthcare,

00:11:23.277 --> 00:11:24.162
And why does that matter?

00:11:24.243 --> 00:11:25.811
What do we get wrong in healthcare about

00:11:25.851 --> 00:11:26.133
pain?

00:11:26.556 --> 00:11:27.057
Why does it matter?

00:11:28.105 --> 00:11:30.748
Where do I start?

00:11:31.467 --> 00:11:32.869
Wherever you want, you're in charge.

00:11:32.969 --> 00:11:33.149
I mean,

00:11:33.188 --> 00:11:34.330
what do we get wrong in healthcare?

00:11:34.350 --> 00:11:34.909
First of all,

00:11:36.010 --> 00:11:37.932
healthcare remains rooted in the

00:11:38.091 --> 00:11:39.993
antiquated biomedical model.

00:11:40.293 --> 00:11:41.394
And what do I mean by that?

00:11:42.094 --> 00:11:42.934
For forever,

00:11:42.975 --> 00:11:45.096
we have labored under this erroneous

00:11:45.135 --> 00:11:48.557
belief that pain is a purely biomedical

00:11:48.597 --> 00:11:49.158
problem,

00:11:49.599 --> 00:11:51.519
something to do just with bones and body

00:11:51.539 --> 00:11:51.899
parts,

00:11:52.441 --> 00:11:55.062
that requires a purely biomedical

00:11:55.101 --> 00:11:55.582
solution.

00:11:56.482 --> 00:11:58.783
We have known for literally sixty five

00:11:58.823 --> 00:12:01.605
years of neuroscience that pain is a

00:12:01.686 --> 00:12:03.366
biopsychosocial problem.

00:12:03.767 --> 00:12:06.489
And what that means is a whole person

00:12:06.528 --> 00:12:09.110
problem requires a whole person solution.

00:12:09.850 --> 00:12:12.751
And what we have seen in medicine is

00:12:12.792 --> 00:12:15.994
that our treatments aren't working like if

00:12:16.033 --> 00:12:16.774
they were working.

00:12:17.414 --> 00:12:19.535
wouldn't they be working chronic pain

00:12:19.615 --> 00:12:22.557
isn't going down it is on the rise

00:12:22.878 --> 00:12:24.578
like rates of chronic pain today are

00:12:24.620 --> 00:12:27.120
higher than they've been ever before and

00:12:27.160 --> 00:12:28.922
we have this opioid epidemic that we're

00:12:29.081 --> 00:12:31.082
all sick and tired of hearing about you

00:12:31.104 --> 00:12:33.004
know we know the science on opioids like

00:12:33.544 --> 00:12:35.725
great for acute pain not so great for

00:12:35.765 --> 00:12:38.528
chronic pain i mean we we have known

00:12:38.567 --> 00:12:40.668
the science of this for so many years

00:12:40.749 --> 00:12:40.889
so

00:12:41.850 --> 00:12:43.171
I think there's a lot of problems in

00:12:43.211 --> 00:12:43.672
healthcare.

00:12:43.711 --> 00:12:44.552
And I think to me,

00:12:44.653 --> 00:12:47.254
one of the most glaring and egregious is

00:12:47.316 --> 00:12:48.817
the lack of pain education.

00:12:49.177 --> 00:12:51.840
So there have been a zillion papers

00:12:51.879 --> 00:12:52.299
published.

00:12:52.340 --> 00:12:54.022
My favorite one is from twenty eighteen,

00:12:54.142 --> 00:12:57.846
showing that ninety six percent of medical

00:12:57.885 --> 00:12:58.285
schools.

00:12:58.866 --> 00:13:00.128
Good thing you're drinking bourbon for the

00:13:00.168 --> 00:13:01.048
statistic, by the way.

00:13:01.668 --> 00:13:04.591
Ninety six percent of medical schools in

00:13:04.611 --> 00:13:05.173
the U.S.

00:13:05.212 --> 00:13:06.313
and Canada have

00:13:06.474 --> 00:13:09.475
have zero dedicated compulsory pain

00:13:09.515 --> 00:13:11.378
education i'm going to say that again

00:13:12.259 --> 00:13:14.080
that's a lot six percent of our medical

00:13:14.120 --> 00:13:16.042
schools have zero dedicated compulsory

00:13:16.501 --> 00:13:19.644
pain education and yet the first person we

00:13:19.683 --> 00:13:23.187
go to obviously when we have pain is

00:13:23.226 --> 00:13:24.927
our doctor i'm not saying doctors aren't

00:13:24.947 --> 00:13:27.129
important doctors are very important but

00:13:27.210 --> 00:13:29.052
my physician colleagues are very

00:13:29.091 --> 00:13:31.293
frustrated because they haven't received

00:13:31.393 --> 00:13:33.475
adequate pain education and it's not their

00:13:33.514 --> 00:13:34.475
fault they want it

00:13:35.241 --> 00:13:36.383
And one of the first things that they

00:13:36.423 --> 00:13:37.604
hear when they're with a patient is,

00:13:38.924 --> 00:13:39.586
it hurts right here.

00:13:39.625 --> 00:13:40.405
Or one of the first questions.

00:13:40.426 --> 00:13:40.927
Tell me where it hurts.

00:13:40.947 --> 00:13:41.726
Tell me where it hurts.

00:13:41.847 --> 00:13:43.528
See, you went upstream.

00:13:43.589 --> 00:13:44.250
You knew exactly.

00:13:44.850 --> 00:13:46.051
It's not a good title.

00:13:46.270 --> 00:13:46.971
It's a great title.

00:13:46.991 --> 00:13:48.633
I'm so glad.

00:13:48.673 --> 00:13:51.115
So you mentioned, and I agree,

00:13:52.035 --> 00:13:55.038
that statistics alone or lessons alone

00:13:55.078 --> 00:13:55.639
don't land.

00:13:56.259 --> 00:13:58.140
But in the book, you don't do that.

00:13:58.160 --> 00:13:58.761
You tell a story.

00:13:59.081 --> 00:13:59.682
Kid named Sam.

00:14:00.782 --> 00:14:03.645
What did his case teach you about the

00:14:03.686 --> 00:14:04.966
brain-body connection?

00:14:05.048 --> 00:14:07.591
Because stories are the driver.

00:14:07.791 --> 00:14:07.971
Like,

00:14:08.272 --> 00:14:09.874
I need all my colleagues to hear this.

00:14:10.254 --> 00:14:10.715
We know this.

00:14:10.754 --> 00:14:11.875
This is why we have fairy tales.

00:14:11.916 --> 00:14:13.457
It's a story with a lesson.

00:14:13.678 --> 00:14:14.659
Story, lesson, right?

00:14:15.019 --> 00:14:16.743
So let's talk about Sam.

00:14:16.783 --> 00:14:18.304
What did Sam's case teach you about the

00:14:18.345 --> 00:14:19.186
brain-body connection?

00:14:19.837 --> 00:14:20.177
Rad.

00:14:20.357 --> 00:14:20.638
Okay.

00:14:20.717 --> 00:14:22.678
So let me practice telling the Sam story.

00:14:22.739 --> 00:14:24.139
I'm really rusty on the Sam story,

00:14:24.159 --> 00:14:24.360
but man.

00:14:24.379 --> 00:14:25.620
You're going to be on your book tour

00:14:25.700 --> 00:14:27.000
and I'm glad to kick it off.

00:14:27.081 --> 00:14:27.600
Yeah, I know.

00:14:27.681 --> 00:14:29.302
And I just want to say like Sam,

00:14:29.322 --> 00:14:30.501
that's obviously not his real name.

00:14:30.602 --> 00:14:31.903
I anonymized my patients.

00:14:31.942 --> 00:14:34.323
The stories in this book are anonymized

00:14:34.403 --> 00:14:37.164
amalgamations of multiple people by

00:14:37.225 --> 00:14:37.745
necessity.

00:14:37.806 --> 00:14:39.186
Like I would lose my license.

00:14:39.346 --> 00:14:41.586
The patients would lose their privacy.

00:14:43.087 --> 00:14:43.327
Right.

00:14:43.427 --> 00:14:46.408
So Sam, when I first met him,

00:14:46.609 --> 00:14:47.909
was seventeen years old.

00:14:48.710 --> 00:14:51.932
He had been in bed for four years.

00:14:52.432 --> 00:14:55.312
He had been on forty medications.

00:14:55.974 --> 00:14:58.014
He had seen fourteen health care

00:14:58.034 --> 00:14:58.514
providers.

00:14:58.595 --> 00:15:00.015
And I want to describe what he looked

00:15:00.056 --> 00:15:02.677
like to you.

00:15:02.736 --> 00:15:04.057
I'll literally never forget when Sam

00:15:04.077 --> 00:15:04.798
walked into my office.

00:15:04.817 --> 00:15:06.278
He had like long, unwashed hair.

00:15:06.818 --> 00:15:08.179
He was pasty and pale.

00:15:08.559 --> 00:15:10.020
And he sat on my couch and he

00:15:10.120 --> 00:15:11.620
rocked himself back and forth with the

00:15:11.640 --> 00:15:11.981
pain.

00:15:12.422 --> 00:15:14.423
And I legit remember thinking to myself,

00:15:15.182 --> 00:15:17.184
if Stanford and UCSF couldn't heal this

00:15:17.225 --> 00:15:18.647
kid, like, who do I think I am?

00:15:18.726 --> 00:15:20.629
And I almost emailed his neurologist to be

00:15:20.668 --> 00:15:23.773
like, yeah, I can't do this.

00:15:23.832 --> 00:15:24.774
But like, I did not do that.

00:15:25.595 --> 00:15:27.076
He had been diagnosed with chronic

00:15:27.116 --> 00:15:29.740
migraine and diffuse amplified body pain

00:15:29.840 --> 00:15:31.041
of unknown etiology.

00:15:31.120 --> 00:15:33.224
So he had, you know, pain all over.

00:15:33.323 --> 00:15:35.426
No one really knew what was causing it.

00:15:35.547 --> 00:15:35.706
Now,

00:15:38.264 --> 00:15:39.105
By training,

00:15:39.605 --> 00:15:42.168
I have studied pain neuroscience,

00:15:42.249 --> 00:15:43.049
human biology,

00:15:43.090 --> 00:15:45.232
pain psychology for like a bazillion

00:15:45.273 --> 00:15:45.573
years.

00:15:46.094 --> 00:15:48.256
But I actually think of myself as a

00:15:48.356 --> 00:15:50.760
pain detective and I like thinking of

00:15:50.821 --> 00:15:52.923
myself that way because really at the end

00:15:52.943 --> 00:15:53.344
of the day,

00:15:54.264 --> 00:15:56.727
My job is to try and figure out

00:15:56.888 --> 00:15:58.629
all the ingredients that are going into

00:15:58.690 --> 00:16:01.472
maintaining and amplifying my patient's

00:16:01.513 --> 00:16:01.773
pain.

00:16:02.114 --> 00:16:04.096
So I did an assessment of Sam.

00:16:04.535 --> 00:16:05.476
Here's what I learned.

00:16:05.636 --> 00:16:07.298
And this will get to your question of

00:16:07.359 --> 00:16:08.519
what did Sam teach me?

00:16:09.581 --> 00:16:12.221
I quickly learned that Sam had been living

00:16:12.261 --> 00:16:14.743
with debilitating social anxiety,

00:16:15.263 --> 00:16:17.724
depression, and suicidality.

00:16:18.063 --> 00:16:19.004
And like, P.S.,

00:16:20.044 --> 00:16:22.605
suicidality is fifty percent higher in the

00:16:22.645 --> 00:16:23.926
chronic pain population.

00:16:24.186 --> 00:16:25.907
And that is not a coincidence.

00:16:25.966 --> 00:16:27.586
And I'm happy to come back to that.

00:16:27.667 --> 00:16:27.966
Okay.

00:16:29.087 --> 00:16:32.548
I also learned that his emotional health

00:16:32.568 --> 00:16:35.049
had been discarded as unrelated to his

00:16:35.110 --> 00:16:35.429
pain.

00:16:35.730 --> 00:16:36.490
His body hurt.

00:16:36.950 --> 00:16:38.270
What did emotions have to do with it?

00:16:38.971 --> 00:16:39.191
Right.

00:16:39.530 --> 00:16:41.711
I also learned that Sam was on a

00:16:41.831 --> 00:16:42.731
white food diet.

00:16:42.871 --> 00:16:44.172
A lot of American kids are on this

00:16:44.192 --> 00:16:45.251
diet, the white food diet.

00:16:45.292 --> 00:16:45.832
You do know it.

00:16:45.873 --> 00:16:46.173
Ready?

00:16:47.373 --> 00:16:49.033
It's called I don't like fruits and

00:16:49.052 --> 00:16:49.552
vegetables.

00:16:49.592 --> 00:16:53.433
So I subsist on pizza, pasta, chips,

00:16:53.754 --> 00:16:56.394
ice cream, popcorn, bread.

00:16:56.554 --> 00:16:57.054
Yeah, dude.

00:16:57.154 --> 00:16:57.355
I mean,

00:16:57.375 --> 00:16:59.135
like he didn't like fruits and vegetables,

00:16:59.155 --> 00:17:00.135
so he wasn't eating them.

00:17:01.135 --> 00:17:02.356
Lots of things to unpack there.

00:17:02.856 --> 00:17:05.138
And he also, his sleep was a disaster.

00:17:05.199 --> 00:17:06.400
So he was staying up till four in

00:17:06.420 --> 00:17:08.020
the morning playing video games.

00:17:08.060 --> 00:17:09.241
He was not going to school.

00:17:09.682 --> 00:17:10.481
He had no life.

00:17:10.682 --> 00:17:11.442
He had no friends.

00:17:11.722 --> 00:17:12.923
He was miserable.

00:17:13.525 --> 00:17:15.605
So I quickly realized if I was going

00:17:15.625 --> 00:17:16.586
to treat Sam,

00:17:17.426 --> 00:17:19.429
I had to treat all of the ingredients

00:17:19.469 --> 00:17:21.750
in his recipe that were hijacking pain

00:17:21.770 --> 00:17:23.392
volume and keeping pain high.

00:17:23.731 --> 00:17:26.714
Like he had been on forty meds.

00:17:27.055 --> 00:17:28.135
He was getting worse.

00:17:28.355 --> 00:17:29.356
He was not getting better.

00:17:29.936 --> 00:17:32.538
So had a come to Jesus talk with

00:17:32.619 --> 00:17:33.640
Sam and his parents,

00:17:34.280 --> 00:17:35.842
changed his nutrition plan,

00:17:36.442 --> 00:17:37.584
started getting him eating fruits and

00:17:37.604 --> 00:17:39.845
vegetables, taught him sleep hygiene.

00:17:40.766 --> 00:17:43.146
a million tools for improving sleep put

00:17:43.186 --> 00:17:46.268
him on a pacing plan wherein we're slowly

00:17:46.367 --> 00:17:48.407
and gradually getting him out of bed and

00:17:48.448 --> 00:17:50.669
back to life so like week one he's

00:17:50.709 --> 00:17:52.569
standing on the porch in the sun and

00:17:52.609 --> 00:17:55.049
texting just one friend week two he's

00:17:55.109 --> 00:17:57.510
walking to the corner mailbox and like

00:17:57.711 --> 00:17:59.951
meeting a friend for i don't know ice

00:17:59.991 --> 00:18:00.172
cream

00:18:00.592 --> 00:18:01.373
Week three,

00:18:01.653 --> 00:18:04.296
he is walking around the block with his

00:18:04.355 --> 00:18:07.417
dog and he is reconnecting with his soccer

00:18:07.438 --> 00:18:07.838
coach.

00:18:08.239 --> 00:18:10.020
Week four, he hired a tutor.

00:18:10.260 --> 00:18:12.502
He mixed in like thirty minutes of jogging

00:18:12.923 --> 00:18:14.265
with his walk around the block.

00:18:14.585 --> 00:18:16.906
And like slowly but surely,

00:18:17.607 --> 00:18:20.911
as Sam's mood improved and stress and

00:18:20.951 --> 00:18:22.132
anxiety went down,

00:18:23.586 --> 00:18:25.667
pain started going down too,

00:18:26.008 --> 00:18:28.429
which is actually no surprise because pain

00:18:28.528 --> 00:18:30.148
is both physical and emotional.

00:18:30.670 --> 00:18:32.509
One hundred percent of the time,

00:18:32.830 --> 00:18:34.590
the parts of the brain that make emotions

00:18:34.750 --> 00:18:35.672
also make pain.

00:18:35.872 --> 00:18:37.051
They are intimately connected.

00:18:37.551 --> 00:18:39.333
And when Sam finally went back to high

00:18:39.373 --> 00:18:39.653
school,

00:18:40.032 --> 00:18:41.993
he got asked to prom not by one

00:18:42.034 --> 00:18:43.394
girl, but by two.

00:18:43.654 --> 00:18:44.855
And he said yes to both of them.

00:18:45.055 --> 00:18:46.675
And like, I love that detail so hard.

00:18:46.796 --> 00:18:47.435
I just love that.

00:18:48.155 --> 00:18:49.696
And when he finally graduated high school,

00:18:51.106 --> 00:18:52.228
He walked across the stage.

00:18:52.268 --> 00:18:54.108
He invited me, which was amazing.

00:18:54.189 --> 00:18:56.770
He walked across the stage and he said

00:18:56.790 --> 00:18:57.471
to the audience,

00:18:57.551 --> 00:18:59.512
if you had told me four years ago

00:18:59.853 --> 00:19:01.394
that I would be graduating high school,

00:19:01.515 --> 00:19:02.634
I never would have believed you.

00:19:02.875 --> 00:19:04.156
I'm like, of course we all cried.

00:19:04.517 --> 00:19:04.876
And look,

00:19:04.977 --> 00:19:06.557
Sam is out in the world now and

00:19:06.878 --> 00:19:08.119
he still has flares,

00:19:08.559 --> 00:19:10.580
but he knows how to manage them and

00:19:10.601 --> 00:19:12.303
they will never lay him out ever again.

00:19:12.782 --> 00:19:13.824
And the message here is,

00:19:14.403 --> 00:19:18.105
is that pain need never be treated as

00:19:18.145 --> 00:19:21.126
a purely biomedical phenomenon while

00:19:21.207 --> 00:19:23.127
missing two-thirds of the pain problem.

00:19:23.388 --> 00:19:25.349
Like, it's biopsychosocial always,

00:19:25.390 --> 00:19:27.391
and we are failing our patients if we

00:19:27.411 --> 00:19:31.192
are only focusing on the bio.

00:19:31.452 --> 00:19:31.932
Woof.

00:19:32.452 --> 00:19:33.353
That is a story.

00:19:33.753 --> 00:19:34.193
Yeah, I know.

00:19:35.663 --> 00:19:36.804
How does that make you feel to go?

00:19:36.824 --> 00:19:38.003
I want to go with you now because

00:19:38.044 --> 00:19:38.604
Sam's not here.

00:19:38.644 --> 00:19:39.684
I can't ask him any questions.

00:19:39.724 --> 00:19:41.164
But how does that make you feel going

00:19:41.224 --> 00:19:43.486
from why did you send this patient to

00:19:43.526 --> 00:19:43.747
me?

00:19:43.787 --> 00:19:46.107
Who the heck am I to graduation day?

00:19:46.448 --> 00:19:48.209
That's got to feel good for you, right?

00:19:48.608 --> 00:19:50.829
That patient changed my life.

00:19:51.069 --> 00:19:51.569
Like I mentioned,

00:19:51.589 --> 00:19:52.369
there's a couple in there,

00:19:52.390 --> 00:19:53.550
but I have one in mind when I

00:19:53.590 --> 00:19:54.411
tell that story.

00:19:54.530 --> 00:19:55.971
Like the one who got asked to prom

00:19:55.991 --> 00:19:57.653
by two girls said yes to both.

00:19:57.673 --> 00:20:00.374
Good problem to have.

00:20:00.493 --> 00:20:01.513
Listen, two prom days.

00:20:02.194 --> 00:20:02.615
Sticky,

00:20:02.815 --> 00:20:04.096
solve the problem before the problem,

00:20:04.115 --> 00:20:05.056
but good problem to have.

00:20:05.256 --> 00:20:05.556
But like,

00:20:05.596 --> 00:20:06.875
especially if you're a kid who's been

00:20:06.955 --> 00:20:08.777
stuck in bed inside for four years,

00:20:08.876 --> 00:20:09.576
I mean, look,

00:20:09.616 --> 00:20:11.758
that that that that particular patient

00:20:11.778 --> 00:20:12.478
changed my life.

00:20:12.518 --> 00:20:16.338
Like I had this revelatory moment of this

00:20:16.419 --> 00:20:18.299
actually has nothing to do with me.

00:20:18.759 --> 00:20:21.621
It has everything to do with the science

00:20:21.661 --> 00:20:22.181
of pain,

00:20:22.580 --> 00:20:25.221
which has been known for sixty five years.

00:20:25.521 --> 00:20:26.521
It's not being taught.

00:20:27.102 --> 00:20:29.364
we are ignoring the rest of the human

00:20:29.384 --> 00:20:29.644
being.

00:20:29.664 --> 00:20:31.066
Like it's a whole person problem.

00:20:31.547 --> 00:20:34.229
We're treating our kids with forty pills

00:20:34.509 --> 00:20:36.070
and we're ignoring their emotional health.

00:20:36.351 --> 00:20:37.772
We're ignoring their social health.

00:20:38.053 --> 00:20:39.795
We're ignoring their environmental health

00:20:39.934 --> 00:20:41.155
and like adults too.

00:20:41.497 --> 00:20:42.498
So what it taught me

00:20:43.238 --> 00:20:44.238
was that this myth,

00:20:44.298 --> 00:20:47.539
this lie that people are sold that chronic

00:20:47.559 --> 00:20:50.340
pain is untreatable or it's only treatable

00:20:50.361 --> 00:20:52.201
with a pill or a procedure is a

00:20:52.300 --> 00:20:53.142
big fat lie.

00:20:53.221 --> 00:20:53.981
It's not true.

00:20:54.301 --> 00:20:55.583
And as healthcare providers,

00:20:55.942 --> 00:20:57.703
we fail our patients if we believe it

00:20:57.983 --> 00:21:00.304
and we fail ourselves if we don't get

00:21:00.404 --> 00:21:02.424
educated in the full picture.

00:21:02.484 --> 00:21:04.026
Like if we don't start learning about the

00:21:04.066 --> 00:21:05.145
whole pain recipe,

00:21:05.346 --> 00:21:06.906
like all of the factors,

00:21:07.067 --> 00:21:09.347
all of the ingredients that go into making

00:21:09.387 --> 00:21:11.909
pain and amplifying it and also reducing

00:21:11.969 --> 00:21:12.068
it.

00:21:12.449 --> 00:21:13.750
Because as providers,

00:21:14.590 --> 00:21:16.113
there is so much we can do.

00:21:16.173 --> 00:21:17.513
We have so much power.

00:21:18.153 --> 00:21:19.935
We can provide so much hope and so

00:21:19.955 --> 00:21:20.656
much agency.

00:21:20.836 --> 00:21:22.218
And I want to do that all day.

00:21:22.278 --> 00:21:23.038
And that's why I'm here,

00:21:23.159 --> 00:21:24.400
even though I have public speaking

00:21:24.440 --> 00:21:25.721
anxiety.

00:21:25.761 --> 00:21:26.281
Do you really?

00:21:26.883 --> 00:21:27.723
Oh, it's crippling.

00:21:28.023 --> 00:21:28.364
Terrible.

00:21:28.463 --> 00:21:30.306
Is this public to you?

00:21:30.385 --> 00:21:30.726
Oh, yeah.

00:21:30.826 --> 00:21:31.807
There are people listening, right?

00:21:31.948 --> 00:21:33.348
If people are listening... Not right now,

00:21:33.368 --> 00:21:34.569
but later.

00:21:34.630 --> 00:21:34.950
Right.

00:21:35.351 --> 00:21:35.490
Yes.

00:21:35.510 --> 00:21:37.152
It's private speaking and we're just

00:21:37.172 --> 00:21:37.673
recording it.

00:21:37.932 --> 00:21:38.452
No, no.

00:21:39.054 --> 00:21:40.755
Podcasts are really hard for me.

00:21:40.775 --> 00:21:41.974
Can I ask some things based on what

00:21:42.015 --> 00:21:42.476
I was hearing?

00:21:42.695 --> 00:21:43.695
Yeah.

00:21:44.036 --> 00:21:45.376
I just asked a question and didn't wait

00:21:45.396 --> 00:21:45.836
for your answer.

00:21:45.896 --> 00:21:46.917
I just went right to the question.

00:21:47.877 --> 00:21:50.480
When you were talking about his

00:21:50.940 --> 00:21:53.882
progression back to socialization,

00:21:55.221 --> 00:21:56.202
you were like, Hey, week one,

00:21:56.222 --> 00:21:57.523
we're going to make one text message.

00:21:57.584 --> 00:21:58.064
And week two,

00:21:58.084 --> 00:21:59.104
we're going to walk around the blocks.

00:21:59.545 --> 00:21:59.704
Yeah.

00:22:01.163 --> 00:22:03.326
a few things hit me one that sounded

00:22:03.346 --> 00:22:06.188
like james clear where he was like okay

00:22:06.788 --> 00:22:08.348
week one you're gonna go touch the

00:22:08.368 --> 00:22:10.790
doorknob on the gym seven times that's it

00:22:10.810 --> 00:22:11.791
you're not gonna go to the gym you're

00:22:11.811 --> 00:22:13.113
gonna go to the gym and then leave

00:22:13.373 --> 00:22:14.614
and then week two you're gonna go inside

00:22:14.634 --> 00:22:15.674
you're gonna hang out for five minutes and

00:22:15.694 --> 00:22:17.715
you're gonna leave and then week three

00:22:17.776 --> 00:22:20.077
you're gonna go five times and you're

00:22:20.097 --> 00:22:22.920
gonna do one exercise and leave and then

00:22:22.960 --> 00:22:24.501
week five because you're not building

00:22:25.740 --> 00:22:27.942
strength at first it's the goal is to

00:22:27.961 --> 00:22:30.182
build the habit that strength comes after

00:22:30.202 --> 00:22:32.825
the habit yes so by the way that

00:22:32.845 --> 00:22:35.747
is exactly what that is yeah that's I

00:22:35.767 --> 00:22:37.167
mean I was like oh look at that

00:22:37.528 --> 00:22:38.949
a book I told you I told you

00:22:38.969 --> 00:22:40.630
I walk around like I like I got

00:22:40.750 --> 00:22:41.810
with my chest when I read a book

00:22:42.010 --> 00:22:44.053
I read a book Rachel write a book

00:22:46.934 --> 00:22:48.536
but what like sort of makes me mad

00:22:48.635 --> 00:22:49.636
is um

00:22:51.481 --> 00:22:52.663
That would be hard.

00:22:52.763 --> 00:22:54.185
Like myself included,

00:22:55.166 --> 00:22:56.588
I would probably jumped ahead way too.

00:22:56.628 --> 00:22:57.971
I would have been like, hey man,

00:22:58.191 --> 00:22:59.753
let's get you and ten buddies together.

00:23:00.153 --> 00:23:01.516
Like I think I would have jumped too

00:23:01.536 --> 00:23:03.519
many steps and I would have lost them.

00:23:03.618 --> 00:23:04.180
Do you know what I mean?

00:23:04.680 --> 00:23:04.980
I do.

00:23:05.020 --> 00:23:05.521
And I think...

00:23:06.721 --> 00:23:08.162
We do need to hear stories like this

00:23:08.201 --> 00:23:09.343
to say like, hey, listen,

00:23:10.104 --> 00:23:10.824
we needed to move.

00:23:11.105 --> 00:23:12.605
We needed to go to the gym and

00:23:12.625 --> 00:23:13.606
touch the doorknob and go home.

00:23:13.946 --> 00:23:14.928
No lifting occurred.

00:23:15.367 --> 00:23:16.409
But then nothing was done.

00:23:16.449 --> 00:23:19.731
It's like a lot was done.

00:23:19.951 --> 00:23:21.593
Five doorknob touches at the gym was done.

00:23:22.034 --> 00:23:25.436
And so I think what I think I'm

00:23:25.477 --> 00:23:27.117
getting at is sometimes we overthink it.

00:23:27.377 --> 00:23:29.079
It's like we needed a lot of little

00:23:29.119 --> 00:23:31.721
steps, not five big, huge steps.

00:23:32.551 --> 00:23:33.432
So well said.

00:23:34.894 --> 00:23:35.635
So well said.

00:23:35.816 --> 00:23:39.339
And James Clear understands psychology and

00:23:39.359 --> 00:23:40.060
human behavior.

00:23:40.441 --> 00:23:41.903
And that's at the crux of all of

00:23:41.923 --> 00:23:42.123
this.

00:23:42.663 --> 00:23:44.885
If you want to help your patients get

00:23:44.925 --> 00:23:46.067
out of bed and back to life,

00:23:46.548 --> 00:23:48.431
we sure as shit need to understand human

00:23:48.451 --> 00:23:49.270
behavior, don't we?

00:23:49.352 --> 00:23:51.013
Because that's part of healing.

00:23:51.054 --> 00:23:51.954
Part of healing is like,

00:23:52.674 --> 00:23:55.757
what's my motivation and do I believe my

00:23:55.777 --> 00:23:58.238
healthcare provider and how am I gonna do

00:23:58.278 --> 00:23:59.778
this thing when I'm living with pain and

00:23:59.818 --> 00:24:01.180
I haven't been able to go to school?

00:24:01.259 --> 00:24:03.240
So our goals need to be small,

00:24:03.580 --> 00:24:04.981
they need to be measurable,

00:24:05.321 --> 00:24:07.522
they need to be achievable, achievable,

00:24:07.583 --> 00:24:09.064
like capital A achievable.

00:24:09.124 --> 00:24:10.904
So like I will ask my patients,

00:24:11.545 --> 00:24:13.465
Tell me a thing you miss and want

00:24:13.506 --> 00:24:15.306
to get back to for Sam.

00:24:15.346 --> 00:24:16.346
And I left this out of the story

00:24:16.366 --> 00:24:17.707
because otherwise it gets too long.

00:24:18.146 --> 00:24:20.167
His goal was soccer, by the way.

00:24:20.428 --> 00:24:21.768
Like I want to reiterate again,

00:24:22.067 --> 00:24:23.588
that kid came into my office,

00:24:24.028 --> 00:24:25.028
pasty and pale,

00:24:25.528 --> 00:24:27.710
hadn't gotten his haircut in four years,

00:24:27.769 --> 00:24:29.431
was rocking himself back and forth and was

00:24:29.451 --> 00:24:30.790
like, I want to play soccer again.

00:24:30.971 --> 00:24:31.330
Oh my God.

00:24:31.371 --> 00:24:32.152
He did.

00:24:32.192 --> 00:24:32.652
He did.

00:24:33.071 --> 00:24:33.311
Right.

00:24:33.551 --> 00:24:35.952
But like, so I always, I'm, I'm,

00:24:36.732 --> 00:24:37.673
I'm getting somewhere with this.

00:24:37.712 --> 00:24:39.614
I promise we, I always ask,

00:24:40.253 --> 00:24:42.237
What's a thing pain has taken away from

00:24:42.297 --> 00:24:44.319
you that you want to get back?

00:24:44.359 --> 00:24:47.625
And I ask that question because who cares

00:24:47.644 --> 00:24:49.647
what my goal for my patient is?

00:24:50.248 --> 00:24:51.269
I want you to go to the gym.

00:24:51.650 --> 00:24:52.111
Who cares?

00:24:52.211 --> 00:24:53.113
If you don't want to go to the

00:24:53.133 --> 00:24:55.195
gym, you're not going to go.

00:24:55.215 --> 00:24:55.516
Yeah.

00:24:56.636 --> 00:24:57.857
So I had a patient who wanted to

00:24:57.877 --> 00:24:59.038
get back to Irish dancing.

00:24:59.357 --> 00:25:00.378
I had a patient who wanted to get

00:25:00.398 --> 00:25:02.099
back to like making fudge in the kitchen

00:25:02.140 --> 00:25:02.900
with her grandkids.

00:25:02.920 --> 00:25:04.340
Like, what's your goal?

00:25:04.661 --> 00:25:06.842
So then we break down that big goal

00:25:07.142 --> 00:25:09.803
into tiny little goals a la James Clear.

00:25:09.883 --> 00:25:10.923
So what can I get?

00:25:11.483 --> 00:25:13.384
What is realistic for you week one?

00:25:13.565 --> 00:25:15.445
Week one, you are not okay.

00:25:16.286 --> 00:25:17.586
But I have to get you to do

00:25:17.626 --> 00:25:20.107
something that is achievable so you feel a

00:25:20.167 --> 00:25:22.249
sense of accomplishment and you feel

00:25:22.409 --> 00:25:24.869
optimistic and positive that change is

00:25:24.930 --> 00:25:25.390
possible.

00:25:25.690 --> 00:25:27.391
So if you can stand outside in the

00:25:27.451 --> 00:25:29.011
sun for one day,

00:25:29.571 --> 00:25:31.031
like just for a couple minutes,

00:25:31.472 --> 00:25:33.032
one day a week for one week,

00:25:33.553 --> 00:25:35.534
that's big because you did just one thing.

00:25:35.834 --> 00:25:36.414
If week two,

00:25:36.454 --> 00:25:37.994
you can walk to the corner mailbox,

00:25:38.536 --> 00:25:39.096
blessings.

00:25:39.236 --> 00:25:42.217
If you have paralyzing social anxiety and

00:25:42.237 --> 00:25:43.557
you can text one friend,

00:25:44.298 --> 00:25:45.398
That's pretty big.

00:25:45.558 --> 00:25:47.119
Like when you're, when you're isolated,

00:25:47.480 --> 00:25:49.261
you haven't used that social muscle in a

00:25:49.301 --> 00:25:50.482
long time and now you're using it.

00:25:50.742 --> 00:25:51.222
That's big.

00:25:51.564 --> 00:25:53.184
So I actually think this,

00:25:53.325 --> 00:25:55.286
this is called a pacing protocol and a

00:25:55.346 --> 00:25:57.528
pacing protocol in my mind is at the

00:25:57.667 --> 00:26:00.410
center of treating chronic pain.

00:26:00.549 --> 00:26:01.911
A pacing protocol is like,

00:26:02.352 --> 00:26:04.153
if you wanted to run a marathon McKay,

00:26:04.393 --> 00:26:05.913
I would not say to you, Hey,

00:26:05.994 --> 00:26:07.935
go outside and run twenty six miles

00:26:07.955 --> 00:26:08.415
tomorrow.

00:26:08.916 --> 00:26:09.576
You would die.

00:26:09.757 --> 00:26:09.978
Actually,

00:26:09.998 --> 00:26:11.318
you're probably fit and you'd be fine.

00:26:11.338 --> 00:26:12.479
But like, I would die.

00:26:12.640 --> 00:26:12.759
Yeah.

00:26:13.400 --> 00:26:13.519
So,

00:26:13.680 --> 00:26:14.701
so if you want to pace for a

00:26:14.721 --> 00:26:15.340
marathon,

00:26:15.800 --> 00:26:18.541
you gradually increase your activity so

00:26:18.582 --> 00:26:20.782
that you can, you know,

00:26:20.883 --> 00:26:23.624
grow your capacity, your lung capacity,

00:26:23.864 --> 00:26:24.845
your muscle capacity.

00:26:25.125 --> 00:26:25.505
Also your,

00:26:25.744 --> 00:26:27.806
your brain needs to get used to that

00:26:27.846 --> 00:26:28.586
activity too.

00:26:29.625 --> 00:26:29.967
Right.

00:26:30.027 --> 00:26:30.707
So it's small,

00:26:30.747 --> 00:26:32.748
gradual bits of increasing activity.

00:26:32.807 --> 00:26:34.468
And that's what pacing for pain is too.

00:26:34.587 --> 00:26:35.888
And I think it's fundamental.

00:26:38.419 --> 00:26:39.980
I'm pausing because I'm like, yeah,

00:26:40.279 --> 00:26:41.980
I'm like digesting everything.

00:26:42.020 --> 00:26:43.321
Yes, the answer is yes.

00:26:44.321 --> 00:26:47.663
You have said that pain treatment must be

00:26:47.763 --> 00:26:48.724
multidisciplinary.

00:26:48.805 --> 00:26:50.445
You sort of mentioned it a few seconds

00:26:50.465 --> 00:26:50.625
ago.

00:26:50.645 --> 00:26:53.207
You're like, it's not for anybody.

00:26:53.426 --> 00:26:54.147
This is everybody.

00:26:56.044 --> 00:26:57.045
Why?

00:26:57.546 --> 00:26:58.528
I agree with you.

00:26:58.788 --> 00:27:00.369
This is a set up question.

00:27:01.230 --> 00:27:01.592
Why?

00:27:02.212 --> 00:27:03.835
Why must it be multidisciplinary?

00:27:04.095 --> 00:27:04.655
Yeah, yeah.

00:27:04.736 --> 00:27:07.339
So if pain is a whole person problem

00:27:07.539 --> 00:27:09.563
that requires a whole person solution,

00:27:10.344 --> 00:27:12.086
I want everyone at the table together

00:27:12.125 --> 00:27:12.547
talking.

00:27:13.406 --> 00:27:14.807
The next question is how to make that

00:27:14.827 --> 00:27:15.167
happen.

00:27:15.428 --> 00:27:19.611
But I want the physician and the PT

00:27:19.691 --> 00:27:21.372
and the OT and the psychologist.

00:27:21.811 --> 00:27:26.535
I want interdisciplinary coordinated care.

00:27:26.595 --> 00:27:28.236
Patient care coordination is very

00:27:28.316 --> 00:27:28.736
important.

00:27:29.355 --> 00:27:31.016
What I see with my patients,

00:27:31.036 --> 00:27:33.257
they come to my office, they have like,

00:27:33.817 --> 00:27:36.057
seventy-five health care providers.

00:27:36.678 --> 00:27:38.057
None of those health care providers are

00:27:38.097 --> 00:27:39.057
talking to each other.

00:27:39.377 --> 00:27:40.238
So oftentimes,

00:27:40.317 --> 00:27:41.798
I have patients who are being prescribed

00:27:42.179 --> 00:27:43.759
this thing for their emotional health,

00:27:44.138 --> 00:27:45.598
this thing for their physical health,

00:27:45.858 --> 00:27:46.558
and then, you know,

00:27:46.700 --> 00:27:48.119
other people are prescribing these

00:27:48.160 --> 00:27:48.660
activities,

00:27:49.200 --> 00:27:51.480
but no one's talking to each other.

00:27:51.500 --> 00:27:53.320
What are these things doing to each other?

00:27:53.340 --> 00:27:53.881
Right.

00:27:54.240 --> 00:27:55.362
It leads to confusion.

00:27:55.422 --> 00:27:56.021
First of all,

00:27:56.382 --> 00:27:58.823
it leads to like people aren't adhering to

00:27:58.863 --> 00:28:00.423
the protocols because it's confusing and

00:28:00.443 --> 00:28:02.325
they have like sixteen different

00:28:02.345 --> 00:28:02.765
protocols.

00:28:02.825 --> 00:28:03.305
It's too much.

00:28:03.404 --> 00:28:03.644
Right.

00:28:03.684 --> 00:28:06.906
So so in my mind, in my mind,

00:28:06.946 --> 00:28:08.906
like one of the biggest problems in my

00:28:08.946 --> 00:28:11.868
mind in Western medicine is that we have

00:28:11.989 --> 00:28:12.588
this myth.

00:28:12.648 --> 00:28:13.690
I love that you called me a myth

00:28:13.710 --> 00:28:14.990
buster because I feel like I talk about

00:28:15.089 --> 00:28:15.911
myths all day.

00:28:16.050 --> 00:28:18.731
Like we have this myth in Western medicine

00:28:19.112 --> 00:28:20.853
that either your pain is physical

00:28:21.653 --> 00:28:23.873
you see a physician or your pain is

00:28:23.893 --> 00:28:26.173
emotional and you like need a therapist or

00:28:26.193 --> 00:28:28.934
whatever you know or you know drugs

00:28:29.414 --> 00:28:32.434
medications for your mental health and

00:28:33.055 --> 00:28:35.556
science tells us that pain is both

00:28:35.635 --> 00:28:38.056
physical and emotional one hundred percent

00:28:38.076 --> 00:28:39.757
of the time like the parts of your

00:28:39.817 --> 00:28:42.156
brain that make emotions your limbic

00:28:42.196 --> 00:28:45.458
system your amygdala also make pain and to

00:28:45.498 --> 00:28:48.098
say that better one hundred percent of the

00:28:48.159 --> 00:28:49.818
sensory messages from your body

00:28:50.499 --> 00:28:52.140
Filter through your brain's emotion

00:28:52.180 --> 00:28:54.682
machinery before they become the thing we

00:28:54.721 --> 00:28:55.261
call pain.

00:28:55.281 --> 00:28:56.042
And we all know that.

00:28:56.343 --> 00:28:58.763
We know our bodies feel worse in times

00:28:58.804 --> 00:28:59.904
of stress and duress.

00:29:00.224 --> 00:29:01.967
We know that stress Fs with our

00:29:02.007 --> 00:29:04.167
musculoskeletal system and tenses our

00:29:04.208 --> 00:29:07.829
muscles and boosts cortisol and Fs with

00:29:07.869 --> 00:29:08.651
our immune system.

00:29:08.730 --> 00:29:09.490
I mean,

00:29:09.510 --> 00:29:11.011
there are a million ways that our

00:29:11.051 --> 00:29:12.653
emotional health affect our physical

00:29:12.692 --> 00:29:14.114
health, but we separate them out.

00:29:14.414 --> 00:29:15.714
And then we don't have everyone at the

00:29:15.734 --> 00:29:16.476
table talking.

00:29:16.576 --> 00:29:18.757
And that creates a lot of confusion and

00:29:18.797 --> 00:29:19.298
chaos.

00:29:19.958 --> 00:29:22.480
And what we're also seeing with most of

00:29:22.500 --> 00:29:24.761
our patients is that they're only going to

00:29:24.781 --> 00:29:25.281
the doctor.

00:29:25.803 --> 00:29:27.344
They're not even... Like with Sam,

00:29:27.904 --> 00:29:29.846
the emotional pain is completely ignored

00:29:29.885 --> 00:29:30.946
because it's, quote unquote,

00:29:31.086 --> 00:29:32.248
unrelated to their pain.

00:29:32.347 --> 00:29:34.349
So we're ignoring it as part of the

00:29:34.390 --> 00:29:35.069
pain recipe.

00:29:36.530 --> 00:29:37.972
To throw myself under the bus,

00:29:37.992 --> 00:29:39.173
because I won't throw my colleagues under

00:29:39.193 --> 00:29:40.354
the bus, I might have said...

00:29:40.634 --> 00:29:42.096
Let's say Sam ever got to me in

00:29:42.115 --> 00:29:42.536
a clinic.

00:29:43.557 --> 00:29:44.357
I do think...

00:29:45.318 --> 00:29:47.740
before I listened to you and read James

00:29:47.800 --> 00:29:49.643
Clear and would have understand in the

00:29:49.682 --> 00:29:50.683
current model, I would have been like,

00:29:51.263 --> 00:29:53.026
we got to do twenty things to justify

00:29:53.066 --> 00:29:54.527
you coming here to check a box for

00:29:54.547 --> 00:29:55.807
an insurance company to make sure this

00:29:55.847 --> 00:29:56.868
visit was paid for.

00:29:57.869 --> 00:30:00.692
And that jumps over what Sam actually

00:30:00.711 --> 00:30:01.272
would have needed.

00:30:02.471 --> 00:30:03.732
Greatly.

00:30:03.873 --> 00:30:04.873
I might have been like, well,

00:30:05.113 --> 00:30:06.193
let's get on the treadmill, man.

00:30:06.213 --> 00:30:07.234
And you're like, whoa, whoa, whoa.

00:30:07.255 --> 00:30:08.095
This is day one.

00:30:08.134 --> 00:30:09.895
This is day zero.

00:30:09.915 --> 00:30:10.776
That's too much.

00:30:11.396 --> 00:30:13.238
But myself, I'm including,

00:30:13.317 --> 00:30:14.337
this is just me for me.

00:30:14.857 --> 00:30:16.118
I think I would have skipped ahead too

00:30:16.138 --> 00:30:17.380
fast, too far,

00:30:17.420 --> 00:30:19.181
too fast because of how the system is

00:30:19.221 --> 00:30:19.560
set up.

00:30:20.143 --> 00:30:20.864
Yeah, that's fair.

00:30:20.943 --> 00:30:22.546
And I also want to say in fairness

00:30:22.566 --> 00:30:26.131
to my PT colleagues, like, I need you.

00:30:26.571 --> 00:30:27.532
I want you part of the team.

00:30:27.613 --> 00:30:28.054
I need you.

00:30:28.094 --> 00:30:28.714
Don't go anywhere.

00:30:28.815 --> 00:30:30.016
I always refer to PT.

00:30:30.115 --> 00:30:31.478
I feel like it's a critical part of

00:30:31.518 --> 00:30:33.039
the puzzle because when I get patients

00:30:33.079 --> 00:30:34.162
like Sam, and by the way,

00:30:34.281 --> 00:30:35.523
I did send them to a PT and

00:30:35.564 --> 00:30:35.963
an OT,

00:30:36.044 --> 00:30:37.165
and I left that out of my list.

00:30:37.685 --> 00:30:38.886
I need to remember that for future

00:30:38.926 --> 00:30:41.328
tellings of the story.

00:30:41.388 --> 00:30:45.093
He needed help getting out of bed.

00:30:45.393 --> 00:30:47.094
He needed support.

00:30:47.153 --> 00:30:48.935
He needed a structured plan.

00:30:49.056 --> 00:30:50.356
So I put him on a pacing plan,

00:30:50.376 --> 00:30:51.897
but I was also working with his PT.

00:30:51.938 --> 00:30:54.339
And we were together talking about what's

00:30:54.359 --> 00:30:56.342
the level of activity?

00:30:56.801 --> 00:30:58.523
How do we increase his strength and his

00:30:58.564 --> 00:31:01.326
endurance without taking it too far?

00:31:01.425 --> 00:31:03.508
So for me, collaboration is really key.

00:31:03.768 --> 00:31:05.209
I'm not sitting here on some...

00:31:06.289 --> 00:31:08.913
thrown like I'm doing this all by myself

00:31:09.032 --> 00:31:11.595
no like multidisciplinary care is like I

00:31:11.654 --> 00:31:13.497
need my colleagues I want us all working

00:31:13.517 --> 00:31:15.818
together like PTs have skills and

00:31:15.838 --> 00:31:17.420
knowledge about the human body that I

00:31:17.500 --> 00:31:21.123
absolutely do not have how does what's

00:31:21.182 --> 00:31:22.924
bringing someone else then how does Usain

00:31:23.025 --> 00:31:24.707
Bolt prove

00:31:25.577 --> 00:31:28.040
that structure doesn't equal pain.

00:31:30.103 --> 00:31:31.243
Did I send you that story?

00:31:31.284 --> 00:31:32.085
Did you read that one?

00:31:32.865 --> 00:31:33.145
Okay.

00:31:33.306 --> 00:31:34.867
So to people who are listening,

00:31:34.907 --> 00:31:37.911
I'm going to tell the story because this

00:31:38.270 --> 00:31:40.272
fascinates me so hard, right?

00:31:40.653 --> 00:31:43.455
So we know those of us who have

00:31:43.516 --> 00:31:44.416
studied pain science,

00:31:44.436 --> 00:31:45.679
which is everybody listening because you

00:31:45.719 --> 00:31:46.419
listen to McKay.

00:31:47.200 --> 00:31:49.201
We know that hurt,

00:31:49.742 --> 00:31:51.523
which is the subjective experience of

00:31:51.604 --> 00:31:52.065
pain,

00:31:52.664 --> 00:31:55.407
is not actually the same as harm or

00:31:55.607 --> 00:31:56.929
damage to the human body.

00:31:57.209 --> 00:31:58.230
And I like to talk about it that

00:31:58.250 --> 00:31:58.410
way.

00:31:58.470 --> 00:32:00.192
Hurt and harm are not the same, right?

00:32:00.912 --> 00:32:02.213
And, you know,

00:32:02.253 --> 00:32:05.056
this myth persists that they are the same,

00:32:05.135 --> 00:32:05.395
right?

00:32:05.455 --> 00:32:07.858
So, like, if you have back pain,

00:32:08.338 --> 00:32:08.598
you will...

00:32:09.559 --> 00:32:11.181
quite likely go to the doctor and get

00:32:11.221 --> 00:32:12.122
a scan of your back.

00:32:12.142 --> 00:32:13.644
And if there's an abnormality found on

00:32:13.663 --> 00:32:14.344
your back scan,

00:32:15.505 --> 00:32:16.846
you will be told that that is the

00:32:16.885 --> 00:32:17.886
cause of your pain.

00:32:18.027 --> 00:32:21.650
And the more abnormal the scan, you know,

00:32:21.869 --> 00:32:24.492
the more severe it is predicted your pain

00:32:24.653 --> 00:32:25.413
is or will be.

00:32:25.574 --> 00:32:27.055
Now I'm going to tell you a story

00:32:27.154 --> 00:32:28.996
and you already know the outcome of the

00:32:29.016 --> 00:32:29.217
story,

00:32:29.237 --> 00:32:30.317
but I'm going to tell your listeners the

00:32:30.337 --> 00:32:31.538
story anyway, because it's so great.

00:32:32.680 --> 00:32:34.040
About thirty years ago,

00:32:34.560 --> 00:32:35.622
there was a little kid,

00:32:35.981 --> 00:32:37.143
and he loved to run.

00:32:37.584 --> 00:32:38.644
And he was living in Jamaica.

00:32:38.984 --> 00:32:40.506
And he was really fast.

00:32:41.406 --> 00:32:42.728
And as he grew,

00:32:43.067 --> 00:32:44.970
something really odd was happening to his

00:32:45.069 --> 00:32:45.609
spine.

00:32:45.930 --> 00:32:48.251
It was twisting into an S shape.

00:32:48.593 --> 00:32:49.953
And as he grew and grew,

00:32:50.433 --> 00:32:52.715
his spine started twisting more and more.

00:32:52.756 --> 00:32:55.238
And he was diagnosed with a very serious

00:32:55.258 --> 00:32:57.140
condition called scoliosis.

00:32:58.253 --> 00:32:58.775
However,

00:32:59.194 --> 00:33:01.877
it wasn't causing him significant pain.

00:33:02.577 --> 00:33:04.980
And so he continued to train and he

00:33:05.020 --> 00:33:07.103
trained and he trained until he was fast

00:33:07.143 --> 00:33:10.405
enough to qualify for the Olympics.

00:33:10.826 --> 00:33:12.127
And by the time he got to the

00:33:12.167 --> 00:33:12.769
Olympics,

00:33:13.169 --> 00:33:13.769
this kid

00:33:15.211 --> 00:33:19.013
His spine was so twisted and his body

00:33:19.374 --> 00:33:21.234
was so asymmetrical,

00:33:21.355 --> 00:33:23.576
and I'm using that word on purpose,

00:33:24.576 --> 00:33:26.618
that his right leg was a quarter inch

00:33:26.679 --> 00:33:30.240
shorter than his left.

00:33:31.061 --> 00:33:32.923
And he did run in the Olympics,

00:33:33.403 --> 00:33:36.224
and that mofo won not just one gold

00:33:36.265 --> 00:33:37.665
medal, but eight.

00:33:38.105 --> 00:33:40.468
And his name was... Usain Bolt.

00:33:41.282 --> 00:33:42.964
His name was Usain Bolt.

00:33:43.045 --> 00:33:45.287
He is the fastest effing man alive.

00:33:45.467 --> 00:33:46.147
I'm a New Yorker.

00:33:46.268 --> 00:33:48.769
I'm so sorry about the like, but like,

00:33:49.210 --> 00:33:50.811
but like if that story,

00:33:51.051 --> 00:33:52.173
you know how I learned about that?

00:33:52.513 --> 00:33:53.894
He posted on Twitter,

00:33:54.634 --> 00:33:56.837
scoliosis couldn't stop me with a picture

00:33:56.917 --> 00:33:57.657
of his back.

00:33:57.698 --> 00:33:59.319
And if you Google scoliosis,

00:33:59.640 --> 00:34:02.701
if you google usain bolt you can see

00:34:02.761 --> 00:34:05.503
through the skin this s shape and like

00:34:05.644 --> 00:34:08.085
scientists have studied him and they have

00:34:08.126 --> 00:34:11.307
determined that his asymmetry which is the

00:34:11.407 --> 00:34:13.208
other thing that pain is always blamed on

00:34:13.289 --> 00:34:16.150
and it drives me crazy his asymmetry

00:34:16.411 --> 00:34:18.793
doesn't slow him down it in fact makes

00:34:18.833 --> 00:34:21.934
him go faster it makes him go faster

00:34:22.014 --> 00:34:22.235
now

00:34:22.936 --> 00:34:25.456
if hurt which is pain and harm or

00:34:25.496 --> 00:34:28.958
damage were the same thing then usain bolt

00:34:28.978 --> 00:34:31.259
should be debilitated in a hospital bed

00:34:31.579 --> 00:34:34.039
because he has so much damage to his

00:34:34.079 --> 00:34:37.179
spine he has so much asymmetry and instead

00:34:37.460 --> 00:34:41.442
he remains in the fastest man alive so

00:34:41.461 --> 00:34:43.663
like we are obviously getting something

00:34:43.722 --> 00:34:46.583
wrong about this relationship between

00:34:46.844 --> 00:34:47.744
abnormalities

00:34:48.543 --> 00:34:52.351
and asymmetries and tissue pathology and

00:34:52.391 --> 00:34:52.751
pain.

00:34:52.972 --> 00:34:55.938
They are not the same.

00:34:55.978 --> 00:34:57.541
Hard stop.

00:34:57.581 --> 00:34:58.003
Mic drop.

00:34:59.079 --> 00:34:59.759
He's also like,

00:34:59.800 --> 00:35:00.940
there was other stuff that when you slow

00:35:00.960 --> 00:35:03.282
down how he runs, like it was great.

00:35:03.342 --> 00:35:04.722
I watched this video a while ago and

00:35:05.202 --> 00:35:06.284
these expert runners,

00:35:06.304 --> 00:35:08.025
these expert running analysis guys were

00:35:08.045 --> 00:35:09.025
like, Oh, that guy,

00:35:09.045 --> 00:35:11.106
he's that they were just shown like, uh,

00:35:11.726 --> 00:35:14.548
the, the scan, like the three D scan,

00:35:14.568 --> 00:35:14.768
you know,

00:35:14.789 --> 00:35:16.090
when they put the little dots all over

00:35:16.130 --> 00:35:17.311
you and they play and they're like,

00:35:17.490 --> 00:35:18.592
tell us who's fast then.

00:35:19.431 --> 00:35:20.893
Tell us who's fast and tell us who's

00:35:20.992 --> 00:35:21.773
injured or not injured.

00:35:21.833 --> 00:35:22.994
And they were like, this guy, no.

00:35:23.014 --> 00:35:24.014
And they were like, well, actually,

00:35:24.034 --> 00:35:25.355
that was Usain Bolt.

00:35:25.394 --> 00:35:27.135
But he's got the valgus angle.

00:35:27.175 --> 00:35:27.815
It's too much.

00:35:27.835 --> 00:35:29.615
And they go, here's the problem.

00:35:29.956 --> 00:35:32.317
He is the fastest person on the planet.

00:35:32.376 --> 00:35:35.898
So correlation causes your feelings don't

00:35:36.119 --> 00:35:36.659
come here.

00:35:36.878 --> 00:35:37.179
Right.

00:35:37.219 --> 00:35:38.280
So he wasn't in pain.

00:35:38.460 --> 00:35:39.420
He wasn't debilitated.

00:35:40.101 --> 00:35:40.740
He was fast.

00:35:41.382 --> 00:35:41.583
Right.

00:35:42.224 --> 00:35:42.884
And like, by the way,

00:35:42.943 --> 00:35:44.324
we all know that hurt and harm are

00:35:44.344 --> 00:35:44.925
not the same.

00:35:44.985 --> 00:35:47.367
Like if you've ever taken a shower and

00:35:47.387 --> 00:35:49.068
discovered black and blue marks all over

00:35:49.108 --> 00:35:49.688
your body,

00:35:50.208 --> 00:35:52.369
that is evidence of damage to your body

00:35:52.409 --> 00:35:53.030
without the pain.

00:35:53.050 --> 00:35:54.391
You're like, how'd that even get there?

00:35:54.690 --> 00:35:54.931
Or like,

00:35:54.952 --> 00:35:56.231
if you're an athlete and I think you

00:35:56.291 --> 00:35:56.972
are, I'm not,

00:35:56.992 --> 00:35:58.574
I'm like a library mouse nerd,

00:35:58.954 --> 00:36:01.215
but like athletes will tell you that they

00:36:01.235 --> 00:36:03.336
will play a spectacular game of football.

00:36:03.817 --> 00:36:05.557
And it is only after the game is

00:36:05.699 --> 00:36:07.960
over that they discover they're covered in

00:36:08.039 --> 00:36:08.960
blood, right?

00:36:09.260 --> 00:36:11.362
Because we know biopsychosocial factors

00:36:11.382 --> 00:36:12.864
will keep pain at bay.

00:36:12.903 --> 00:36:14.565
Like you're distracted, you're having fun,

00:36:14.585 --> 00:36:15.485
you're enjoying yourself.

00:36:15.846 --> 00:36:18.387
You know, your adrenaline is high,

00:36:18.447 --> 00:36:19.128
you're bumping.

00:36:19.409 --> 00:36:22.791
So we know that damage and pain can't

00:36:22.831 --> 00:36:24.172
possibly be the same thing.

00:36:24.452 --> 00:36:25.313
But for some reason,

00:36:25.353 --> 00:36:26.934
that's not trickling down into clinical

00:36:26.974 --> 00:36:27.434
practice.

00:36:27.494 --> 00:36:30.117
We still have this issue wherein if you

00:36:30.197 --> 00:36:31.978
have pain in a body part,

00:36:32.219 --> 00:36:33.159
if you have the hurt,

00:36:33.900 --> 00:36:35.824
we are told we should go looking for

00:36:35.884 --> 00:36:36.244
harm.

00:36:36.724 --> 00:36:38.246
And we do go look for harm,

00:36:38.547 --> 00:36:43.576
and then we blame the tissue abnormality.

00:36:43.615 --> 00:36:45.018
We say that that's the cause of pain.

00:36:45.438 --> 00:36:46.938
We're surprised when we find a thing that

00:36:46.958 --> 00:36:47.599
we're looking for.

00:36:47.880 --> 00:36:49.221
You're told there's a red herring,

00:36:49.240 --> 00:36:50.202
you go find it, and you're like,

00:36:50.342 --> 00:36:51.983
and now I have done my job.

00:36:52.043 --> 00:36:52.963
I've found the red herring.

00:36:52.983 --> 00:36:53.364
There it is.

00:36:53.425 --> 00:36:53.684
Right.

00:36:53.965 --> 00:36:55.286
And this is what I love about all

00:36:55.326 --> 00:36:56.688
these studies that are being done by

00:36:56.728 --> 00:36:58.028
doctors who are like, hmm,

00:36:58.409 --> 00:36:59.989
it does seem like hurt and harm are

00:37:00.030 --> 00:37:00.590
not the same.

00:37:01.010 --> 00:37:02.371
I am going to scan the backs of

00:37:02.413 --> 00:37:03.253
healthy people.

00:37:03.594 --> 00:37:05.735
And lo and behold, I discover that like,

00:37:06.096 --> 00:37:07.396
eighty to ninety percent of us

00:37:07.797 --> 00:37:09.757
are walking around with spinal

00:37:09.838 --> 00:37:12.960
abnormalities and slipped discs and all

00:37:13.000 --> 00:37:13.639
the thing, you know,

00:37:13.659 --> 00:37:15.961
compressed discs and absolutely no pain,

00:37:16.141 --> 00:37:17.242
zero pain, right?

00:37:17.561 --> 00:37:17.902
So like,

00:37:18.143 --> 00:37:19.322
thank God I don't have back pain,

00:37:19.362 --> 00:37:21.344
but if you scanned my back right now,

00:37:21.465 --> 00:37:23.306
you will probably find abnormalities

00:37:23.346 --> 00:37:25.547
because our backs age just like our faces.

00:37:25.567 --> 00:37:26.047
Like, hey,

00:37:26.106 --> 00:37:28.047
I have wrinkles on my face and also

00:37:28.088 --> 00:37:28.608
on my back.

00:37:29.028 --> 00:37:30.469
Why aren't we talking about that more?

00:37:30.489 --> 00:37:32.791
Maybe you can tell me.

00:37:32.931 --> 00:37:33.650
No, you wrote,

00:37:33.670 --> 00:37:34.731
you spent three years writing,

00:37:34.751 --> 00:37:36.072
but the answer is we should be and

00:37:36.112 --> 00:37:36.452
we're not.

00:37:38.978 --> 00:37:39.358
It drives me batty.

00:37:39.518 --> 00:37:40.918
Thanks to Empower EMR.

00:37:40.998 --> 00:37:42.378
If your clinic is stuck in an EMR

00:37:42.398 --> 00:37:44.878
that slows you down, you need Usain Bolt.

00:37:45.498 --> 00:37:47.300
Empower gives you speed, clean workflows,

00:37:47.320 --> 00:37:49.300
and features PTs actually ask for.

00:37:49.360 --> 00:37:50.900
Better notes, faster documentation,

00:37:50.920 --> 00:37:51.740
smoother operations,

00:37:52.201 --> 00:37:54.141
all wrapped in customer support that

00:37:54.201 --> 00:37:55.001
doesn't ghost you.

00:37:55.780 --> 00:37:58.181
Using a slow EMR is a choice, people.

00:37:58.481 --> 00:37:58.961
Don't do it.

00:37:59.202 --> 00:38:00.581
EmpowerEMR.com.

00:38:00.621 --> 00:38:01.981
Kick the tires and see if it's right

00:38:02.021 --> 00:38:02.282
for you.

00:38:02.422 --> 00:38:04.543
EmpowerEMR.com.

00:38:05.443 --> 00:38:07.447
uh i think it was the third day

00:38:07.467 --> 00:38:09.371
of pt school they taught us this pain

00:38:09.411 --> 00:38:13.378
scale zero to ten what's wrong with that

00:38:13.498 --> 00:38:15.581
and what should we not just what's wrong

00:38:15.601 --> 00:38:15.902
with it

00:38:16.806 --> 00:38:19.507
what should we be doing instead?

00:38:19.608 --> 00:38:20.527
So not just poo-poo,

00:38:20.547 --> 00:38:21.969
but also a better plan.

00:38:22.188 --> 00:38:23.289
What's wrong with it and what can we

00:38:23.309 --> 00:38:24.849
do instead instead of zero to ten?

00:38:24.949 --> 00:38:25.311
Right.

00:38:25.570 --> 00:38:29.032
So I want to say I am glad

00:38:29.353 --> 00:38:31.713
we have a way to rate pain.

00:38:31.934 --> 00:38:34.534
Like it is useful for me to get

00:38:34.695 --> 00:38:37.036
to collect your subjective experience of

00:38:37.077 --> 00:38:37.396
pain.

00:38:37.516 --> 00:38:39.338
Like if you tell me your pain is

00:38:39.358 --> 00:38:40.878
an eight out of ten, that's good data.

00:38:40.918 --> 00:38:41.838
If you tell me it's two out of

00:38:41.878 --> 00:38:42.699
ten, that's good data.

00:38:43.280 --> 00:38:46.523
So I don't want to dismiss entirely the

00:38:46.543 --> 00:38:47.085
pain scale.

00:38:47.224 --> 00:38:47.985
I'm glad we have it.

00:38:48.385 --> 00:38:48.827
However,

00:38:49.487 --> 00:38:52.452
it is a subjective rating of a subjective

00:38:52.552 --> 00:38:53.192
experience.

00:38:53.293 --> 00:38:56.115
There is no such thing as an objective

00:38:56.175 --> 00:38:56.976
measure of pain.

00:38:57.318 --> 00:38:58.920
If you line up ten people with the

00:38:58.960 --> 00:39:00.201
exact same injury,

00:39:01.137 --> 00:39:02.759
the exact same injury,

00:39:03.119 --> 00:39:05.221
they will all give you different pain

00:39:05.260 --> 00:39:05.681
numbers.

00:39:06.061 --> 00:39:06.442
Why?

00:39:06.902 --> 00:39:08.744
Because pain is a biopsychosocial

00:39:08.784 --> 00:39:09.384
experience.

00:39:09.684 --> 00:39:12.407
So those ten people all have different

00:39:12.467 --> 00:39:14.628
ingredients that are affecting their pain

00:39:14.668 --> 00:39:16.269
number in any given moment.

00:39:16.630 --> 00:39:18.331
Emotional health, social health,

00:39:18.391 --> 00:39:20.432
environmental health are all changing

00:39:20.472 --> 00:39:22.275
their pain experience in every given

00:39:22.315 --> 00:39:22.594
moment.

00:39:23.074 --> 00:39:24.976
So I think what the pain scale misses

00:39:25.398 --> 00:39:25.898
is that.

00:39:26.318 --> 00:39:28.099
Like pain is like an iceberg, right?

00:39:28.179 --> 00:39:30.021
There's like the subjective experience of

00:39:30.061 --> 00:39:31.764
pain or maybe like the tissue damage,

00:39:31.784 --> 00:39:33.726
the things you can see on the top.

00:39:34.286 --> 00:39:35.748
And then there's everything else you can't

00:39:35.788 --> 00:39:37.510
see under the surface.

00:39:37.849 --> 00:39:39.652
So in my mind, the pain scale,

00:39:39.692 --> 00:39:40.472
while useful,

00:39:40.893 --> 00:39:42.635
really misses the whole bulk of the

00:39:42.715 --> 00:39:43.576
iceberg, right?

00:39:43.615 --> 00:39:44.956
So what I want to do with my

00:39:44.996 --> 00:39:45.978
patients is

00:39:46.677 --> 00:39:47.898
as we talked about with Sam,

00:39:48.360 --> 00:39:49.721
is conduct a better assessment.

00:39:49.760 --> 00:39:51.483
Like, what are the things I can't see?

00:39:51.882 --> 00:39:53.605
I can see you're rocking yourself back and

00:39:53.625 --> 00:39:54.405
forth with pain.

00:39:54.786 --> 00:39:55.047
You know,

00:39:55.646 --> 00:39:57.409
I can see the diagnoses that you've been

00:39:57.449 --> 00:39:58.630
given by all of your doctors.

00:39:58.670 --> 00:39:59.570
I've read your charts.

00:40:00.072 --> 00:40:01.793
What don't I know?

00:40:02.414 --> 00:40:04.996
What parts of the pain recipe am I

00:40:05.056 --> 00:40:05.476
missing?

00:40:05.817 --> 00:40:07.059
And I want to say clearly what I

00:40:07.079 --> 00:40:08.981
mean by pain recipe because it will answer

00:40:09.001 --> 00:40:09.481
your question.

00:40:10.481 --> 00:40:12.403
Just as there's a recipe for brownies,

00:40:12.985 --> 00:40:15.748
there is always a recipe for pain.

00:40:16.228 --> 00:40:16.628
Always.

00:40:16.909 --> 00:40:17.009
Now,

00:40:17.268 --> 00:40:18.811
I don't like to cook or bake at

00:40:18.891 --> 00:40:19.090
all.

00:40:19.190 --> 00:40:19.612
Do you?

00:40:19.632 --> 00:40:21.233
Not so much.

00:40:21.313 --> 00:40:21.914
No,

00:40:21.954 --> 00:40:23.416
but like there are people listening who

00:40:23.456 --> 00:40:23.655
do.

00:40:23.755 --> 00:40:26.137
And anyone who is listening knows that if

00:40:26.217 --> 00:40:27.719
you want, I don't know,

00:40:27.800 --> 00:40:28.800
let's stick with brownies.

00:40:29.161 --> 00:40:31.143
You have to have certain ingredients.

00:40:31.704 --> 00:40:33.166
You have to add them in a particular

00:40:33.286 --> 00:40:33.606
order.

00:40:34.027 --> 00:40:35.628
You have to put them in a particular

00:40:35.688 --> 00:40:36.550
size pan.

00:40:37.050 --> 00:40:38.371
And then you have to bake them at

00:40:38.391 --> 00:40:40.554
a particular temperature for a particular

00:40:40.614 --> 00:40:41.396
amount of time.

00:40:41.677 --> 00:40:42.697
The ingredients matter.

00:40:43.259 --> 00:40:44.320
So does the environment.

00:40:44.820 --> 00:40:47.023
The same is true for pain.

00:40:47.344 --> 00:40:48.505
So if you ask me,

00:40:49.286 --> 00:40:50.927
What is your high pain recipe?

00:40:50.947 --> 00:40:52.068
I'm going to ask you this too,

00:40:52.110 --> 00:40:53.070
so I want you to think about it.

00:40:53.490 --> 00:40:55.873
Your high pain recipe is all the

00:40:55.914 --> 00:40:58.617
ingredients that go into making a bad pain

00:40:58.637 --> 00:40:58.918
day.

00:40:59.297 --> 00:41:00.039
So for me,

00:41:00.559 --> 00:41:03.302
a bad pain day means I'm sitting at

00:41:03.322 --> 00:41:05.365
my computer for too many hours without

00:41:05.405 --> 00:41:05.965
taking a break.

00:41:06.706 --> 00:41:07.847
I have high stress.

00:41:08.268 --> 00:41:09.869
I'm eating a crap diet.

00:41:10.269 --> 00:41:12.211
My sleep has been really poor.

00:41:12.813 --> 00:41:13.893
I'm not getting enough sleep.

00:41:14.634 --> 00:41:17.717
I'm not saying no to incoming requests

00:41:17.737 --> 00:41:18.858
like that's happening to me now.

00:41:18.898 --> 00:41:20.358
Like my publishers are like, do this,

00:41:20.378 --> 00:41:20.840
do this, do this.

00:41:20.860 --> 00:41:22.101
And I'm not setting boundaries.

00:41:22.141 --> 00:41:23.342
So I have too much on my plate.

00:41:23.762 --> 00:41:25.903
So I know what's going to make my

00:41:25.963 --> 00:41:27.144
body hurt more.

00:41:27.965 --> 00:41:30.007
Do you know what your high pain recipe

00:41:30.027 --> 00:41:30.068
is?

00:41:30.666 --> 00:41:30.826
Yeah,

00:41:30.885 --> 00:41:32.807
I'd say a lot of those things close

00:41:32.847 --> 00:41:33.608
to it, right?

00:41:33.728 --> 00:41:35.889
If I don't move something in the day

00:41:36.150 --> 00:41:38.112
and I'm not a morning exerciser,

00:41:38.231 --> 00:41:39.632
but so if it hits like five o'clock,

00:41:39.693 --> 00:41:41.074
six o'clock and I haven't, I'm like,

00:41:41.094 --> 00:41:41.855
it's too late.

00:41:41.894 --> 00:41:42.795
What do I do?

00:41:43.175 --> 00:41:44.697
And that makes me feel like poo.

00:41:45.742 --> 00:41:46.181
Exactly.

00:41:46.302 --> 00:41:46.521
Right.

00:41:46.641 --> 00:41:48.163
So most of my patients can tell me

00:41:48.202 --> 00:41:50.264
at least a couple of things in their

00:41:50.284 --> 00:41:51.184
high pain recipe.

00:41:51.643 --> 00:41:53.143
And the cool thing about this recipe

00:41:53.184 --> 00:41:55.525
concept is that just as there's a high

00:41:55.545 --> 00:41:56.284
pain recipe,

00:41:56.746 --> 00:41:58.865
there is always a low pain recipe.

00:41:59.106 --> 00:42:00.706
And it's really just the opposite.

00:42:00.786 --> 00:42:04.288
So if poor sleep is amplifying my pain,

00:42:04.987 --> 00:42:06.168
I know that I have to help my

00:42:06.228 --> 00:42:08.248
patient go on a sleep hygiene protocol.

00:42:08.289 --> 00:42:10.489
I need to give them some regimented,

00:42:10.829 --> 00:42:13.371
structured protocol for helping with their

00:42:13.411 --> 00:42:13.670
sleep.

00:42:14.391 --> 00:42:16.692
I know if eating a crap diet is

00:42:16.751 --> 00:42:18.192
making my body feel badly,

00:42:18.311 --> 00:42:19.311
and it usually does,

00:42:19.351 --> 00:42:20.851
like Sam's white food diet,

00:42:21.492 --> 00:42:23.713
I need to change their nutrition protocol.

00:42:24.432 --> 00:42:26.092
I know that if they're sitting for too

00:42:26.112 --> 00:42:28.293
many hours a day where they can't get

00:42:28.333 --> 00:42:28.853
out of bed,

00:42:29.273 --> 00:42:30.494
I need to put them on a pacing

00:42:30.534 --> 00:42:30.994
protocol,

00:42:31.114 --> 00:42:32.815
or I need to help them schedule time

00:42:32.855 --> 00:42:34.474
outside, time moving,

00:42:34.855 --> 00:42:36.456
social time so they're not isolated.

00:42:36.795 --> 00:42:38.396
So to go back to your question,

00:42:38.996 --> 00:42:39.876
The pain scale,

00:42:40.235 --> 00:42:42.757
it measures a very useful subjective

00:42:42.797 --> 00:42:43.416
measure of pain.

00:42:43.717 --> 00:42:44.496
What is it missing?

00:42:44.956 --> 00:42:47.197
Sleep, nutrition, social health.

00:42:47.277 --> 00:42:48.137
Are you isolated?

00:42:48.458 --> 00:42:49.597
You know, how's your mental health?

00:42:49.657 --> 00:42:50.657
Are you getting outside?

00:42:50.677 --> 00:42:51.579
Are you getting out of bed?

00:42:51.659 --> 00:42:52.559
Like, you know,

00:42:52.998 --> 00:42:55.719
what are all the missing ingredients that

00:42:55.739 --> 00:42:57.860
are going into making and maintaining and

00:42:57.960 --> 00:43:00.219
amplifying your pain?

00:43:00.239 --> 00:43:01.300
So it's a good tip of the iceberg,

00:43:01.320 --> 00:43:02.181
but you got to dig deep.

00:43:02.260 --> 00:43:03.141
You got to say, okay,

00:43:03.221 --> 00:43:04.041
how do we get there?

00:43:04.894 --> 00:43:06.016
We have to go wider.

00:43:06.536 --> 00:43:07.597
I might have done everything right,

00:43:07.617 --> 00:43:09.039
but haven't slept in two days.

00:43:09.199 --> 00:43:10.722
And now everything sucks.

00:43:10.922 --> 00:43:14.405
Or I slept okay, but I've eaten poorly.

00:43:14.846 --> 00:43:16.288
So an eight could be an eight,

00:43:16.327 --> 00:43:17.769
but what's the reason for the eight?

00:43:17.809 --> 00:43:19.311
The eight is a good starting point,

00:43:19.351 --> 00:43:20.293
it sounds like you're saying,

00:43:20.333 --> 00:43:21.273
but it's not the whole picture.

00:43:21.976 --> 00:43:22.456
That's right.

00:43:23.257 --> 00:43:24.559
An eight is a good starting point,

00:43:24.579 --> 00:43:25.880
but why are you at an eight?

00:43:26.239 --> 00:43:28.320
Are you at an eight in part because

00:43:28.340 --> 00:43:29.242
you haven't been sleeping,

00:43:29.262 --> 00:43:30.342
you haven't been eating well,

00:43:30.643 --> 00:43:32.003
you've been socially isolated,

00:43:32.023 --> 00:43:33.644
you're depressed and anxious and stressed,

00:43:33.684 --> 00:43:34.965
and your body is freaking out?

00:43:35.525 --> 00:43:37.226
What are all the other ingredients that

00:43:37.246 --> 00:43:38.507
are contributing to that eight?

00:43:38.907 --> 00:43:40.668
And that's very empowering for us as

00:43:40.748 --> 00:43:41.389
providers,

00:43:41.789 --> 00:43:43.891
and it's very empowering for our patients.

00:43:44.170 --> 00:43:46.893
Because as soon as we identify the high

00:43:46.932 --> 00:43:47.833
pain ingredients,

00:43:48.393 --> 00:43:51.215
I can help you identify and achieve

00:43:51.715 --> 00:43:53.376
those low pain ingredients and I can help

00:43:53.396 --> 00:43:55.297
you create a low pain day.

00:43:55.436 --> 00:43:56.597
And what a gift that is.

00:43:57.077 --> 00:43:58.376
Well, my next question was going to be,

00:43:58.777 --> 00:44:00.597
you hit us with that statistic of ninety

00:44:00.637 --> 00:44:02.318
six percent of med schools, you know,

00:44:02.577 --> 00:44:04.139
offering zero pain ed.

00:44:04.159 --> 00:44:06.259
So I guess the idea is I was

00:44:06.278 --> 00:44:07.478
going to say what needs to change about

00:44:07.679 --> 00:44:09.860
change about how we train health care

00:44:09.900 --> 00:44:10.340
providers.

00:44:10.360 --> 00:44:11.960
I wouldn't I won't limit it to one

00:44:12.380 --> 00:44:12.900
discipline.

00:44:12.920 --> 00:44:16.940
I guess the answer is add pain education.

00:44:16.981 --> 00:44:17.382
Right.

00:44:17.422 --> 00:44:18.822
I mean, that has to be the answer.

00:44:18.842 --> 00:44:19.121
Right.

00:44:19.222 --> 00:44:19.282
Or

00:44:20.483 --> 00:44:21.744
yeah i mean look if i could have

00:44:21.804 --> 00:44:23.945
my way i want more pain education but

00:44:24.025 --> 00:44:28.829
i also want to shift away from biomedical

00:44:28.869 --> 00:44:30.550
pain education because the four percent of

00:44:30.590 --> 00:44:32.791
med schools that do offer pain education

00:44:33.331 --> 00:44:35.333
are offering pain education from a purely

00:44:35.753 --> 00:44:37.594
biomedical perspective so like

00:44:38.215 --> 00:44:40.637
Folks are learning about tissue pathology

00:44:40.717 --> 00:44:43.260
and surgery and medication and chemistry,

00:44:43.641 --> 00:44:47.143
but we are more than just body parts.

00:44:47.405 --> 00:44:49.427
Like we are a whole person.

00:44:49.507 --> 00:44:51.469
So like what I want is biopsychosocial

00:44:51.509 --> 00:44:53.710
pain education in like every healthcare,

00:44:54.492 --> 00:44:56.233
every healthcare training program across

00:44:56.434 --> 00:44:56.713
America.

00:44:56.733 --> 00:44:57.215
That's what I want.

00:44:57.335 --> 00:44:58.836
So I'm not an academic.

00:44:58.856 --> 00:45:00.159
So there's probably terms for this.

00:45:00.239 --> 00:45:01.460
And I apologize for people who are

00:45:01.480 --> 00:45:02.661
listening who are in academics.

00:45:02.702 --> 00:45:05.125
But would you make this one class or

00:45:05.204 --> 00:45:07.027
is this a thing that needs to be

00:45:07.588 --> 00:45:08.168
salted?

00:45:08.449 --> 00:45:10.351
Is this a we salt bang into every

00:45:10.472 --> 00:45:11.172
this needs to be?

00:45:11.733 --> 00:45:12.353
Is this a horror?

00:45:12.434 --> 00:45:13.996
Is this a vertical like it's a class

00:45:14.275 --> 00:45:15.577
or does this need to be sort of

00:45:15.737 --> 00:45:16.199
everywhere?

00:45:17.753 --> 00:45:19.755
um gosh what's my answer so when i

00:45:19.914 --> 00:45:22.297
look like so i'm a clinician like at

00:45:22.317 --> 00:45:23.697
the end of the day what motivates me

00:45:23.757 --> 00:45:25.458
to do all this public speaking even though

00:45:25.478 --> 00:45:27.059
it terrifies me and i hate it is

00:45:27.079 --> 00:45:28.639
that i am sick and tired i am

00:45:28.800 --> 00:45:30.601
sick and tired of having

00:45:30.661 --> 00:45:32.422
seventeen-year-olds come into my office

00:45:32.802 --> 00:45:34.583
and they've only ever been on pills for

00:45:34.603 --> 00:45:36.123
pain and they've been in bed for four

00:45:36.164 --> 00:45:36.784
years i am

00:45:37.344 --> 00:45:38.847
tired like I treat adults too by the

00:45:38.867 --> 00:45:40.469
way but the kids just like get me

00:45:40.748 --> 00:45:42.731
they get me like you don't get you

00:45:42.771 --> 00:45:44.492
just don't get thirteen fourteen fifteen

00:45:44.532 --> 00:45:45.713
back you don't get that back you get

00:45:45.733 --> 00:45:47.835
that one time you know so they just

00:45:47.876 --> 00:45:50.378
kill me and I'm tired of it I

00:45:50.398 --> 00:45:52.181
am tired of it and it seems to

00:45:52.240 --> 00:45:54.083
me I was thinking to myself like

00:45:54.603 --> 00:45:57.106
originally years ago how do you make

00:45:57.166 --> 00:45:59.588
change in a very broken health care system

00:46:00.009 --> 00:46:00.889
What is the answer?

00:46:00.989 --> 00:46:03.733
How do you shift the needle on a

00:46:03.813 --> 00:46:05.414
system that's been rooted in this

00:46:05.514 --> 00:46:09.619
biomedical profit-driven system for

00:46:09.679 --> 00:46:10.641
forever?

00:46:10.661 --> 00:46:12.163
Who do you target?

00:46:12.182 --> 00:46:13.704
Do you target the insurance companies

00:46:13.724 --> 00:46:15.246
because they're not reimbursing a lot of

00:46:15.286 --> 00:46:15.606
things?

00:46:16.949 --> 00:46:17.668
Everyone knows that.

00:46:17.710 --> 00:46:19.251
We could talk about Luigi Mangione all

00:46:19.291 --> 00:46:19.492
day.

00:46:20.773 --> 00:46:22.753
but I don't want to.

00:46:23.414 --> 00:46:25.235
Do we target universities?

00:46:25.255 --> 00:46:26.536
Do we target med schools?

00:46:26.617 --> 00:46:28.057
Am I targeting PT schools?

00:46:28.318 --> 00:46:30.219
Am I targeting people living with pain?

00:46:30.579 --> 00:46:32.420
Am I targeting the general lay public?

00:46:33.041 --> 00:46:34.722
Do we need to go to the government?

00:46:34.882 --> 00:46:36.302
Where do you start?

00:46:36.543 --> 00:46:37.724
Do you change policy?

00:46:38.844 --> 00:46:39.746
Where do you make change?

00:46:39.806 --> 00:46:41.226
So for a while,

00:46:41.306 --> 00:46:42.728
I sort of was trying to do everything.

00:46:42.887 --> 00:46:43.668
I was like, okay, well,

00:46:44.568 --> 00:46:45.809
I'm going to start with my patients

00:46:45.929 --> 00:46:47.250
because that's where I have the most

00:46:47.570 --> 00:46:48.110
agency.

00:46:48.130 --> 00:46:49.871
You know, they're coming to me.

00:46:49.891 --> 00:46:50.610
They want the help.

00:46:50.630 --> 00:46:51.371
They're motivated.

00:46:51.931 --> 00:46:53.751
And I was seeing the fruits of that.

00:46:53.791 --> 00:46:56.333
And I was watching people get out of

00:46:56.373 --> 00:46:57.512
bed and go back to life.

00:46:57.552 --> 00:46:59.213
And I'm like, this is odd.

00:46:59.393 --> 00:47:00.574
I'm certainly not magic.

00:47:00.634 --> 00:47:01.813
Like what's going on here?

00:47:02.054 --> 00:47:03.494
There must be some science to this

00:47:03.554 --> 00:47:04.054
madness.

00:47:04.514 --> 00:47:06.815
So then I started writing workbooks like

00:47:06.835 --> 00:47:07.916
the pain management workbook,

00:47:07.936 --> 00:47:09.336
which is why I came on last time,

00:47:09.896 --> 00:47:10.157
you know,

00:47:10.197 --> 00:47:12.878
and then I started doing podcasts and, um,

00:47:13.757 --> 00:47:15.878
I also started pitching med schools to

00:47:15.918 --> 00:47:16.438
your question.

00:47:16.478 --> 00:47:17.239
Like I was like, okay,

00:47:17.420 --> 00:47:18.480
I am an academic nerd.

00:47:19.101 --> 00:47:22.101
I want to train the next generation of

00:47:22.141 --> 00:47:22.641
doctors.

00:47:23.003 --> 00:47:25.364
So like I started teaching at UCSF, like,

00:47:25.664 --> 00:47:27.525
you know, their incoming med students,

00:47:27.565 --> 00:47:28.764
but also their residents.

00:47:29.146 --> 00:47:30.286
And then I pitched Stanford.

00:47:30.545 --> 00:47:31.266
Like, why not?

00:47:31.387 --> 00:47:31.927
I was like, hey,

00:47:31.967 --> 00:47:33.847
y'all need a little bit more pain

00:47:33.907 --> 00:47:34.347
education.

00:47:34.367 --> 00:47:35.889
So now I teach the addiction medicine

00:47:35.929 --> 00:47:37.869
fellows at Stanford because it turns out

00:47:38.690 --> 00:47:39.369
Lo and behold,

00:47:39.469 --> 00:47:42.311
addiction medicine and pain are now best

00:47:42.331 --> 00:47:42.652
friends.

00:47:42.771 --> 00:47:43.672
And isn't that great?

00:47:43.811 --> 00:47:45.813
What we have done to pain patients is

00:47:45.853 --> 00:47:48.293
just like mind blowing to me.

00:47:48.313 --> 00:47:50.114
How's that received from the students?

00:47:50.594 --> 00:47:50.755
I mean,

00:47:51.396 --> 00:47:52.255
maybe they don't know any different,

00:47:52.295 --> 00:47:52.456
right?

00:47:52.476 --> 00:47:53.856
Because they're just going through for the

00:47:53.896 --> 00:47:54.356
first time.

00:47:54.416 --> 00:47:55.617
So they're probably just like, okay,

00:47:55.657 --> 00:47:58.097
but how is that received maybe in a

00:47:58.177 --> 00:48:00.800
system where they might not have

00:48:00.840 --> 00:48:01.659
previously done that?

00:48:02.876 --> 00:48:03.936
For the most part,

00:48:04.496 --> 00:48:06.217
I have students at the end of the

00:48:06.277 --> 00:48:06.516
course.

00:48:06.536 --> 00:48:08.458
So to answer your original question,

00:48:08.898 --> 00:48:10.858
sometimes I teach one standalone class.

00:48:10.878 --> 00:48:12.300
Sometimes I teach a whole course,

00:48:12.320 --> 00:48:13.340
like a whole series.

00:48:13.659 --> 00:48:14.981
And it just depends on what the school

00:48:15.021 --> 00:48:17.041
will let me do and what the department

00:48:17.061 --> 00:48:17.661
will let me do.

00:48:18.001 --> 00:48:18.961
What do I think we need?

00:48:19.121 --> 00:48:20.043
I think we need like,

00:48:20.342 --> 00:48:22.523
absolutely we need standalone pain science

00:48:22.563 --> 00:48:23.623
courses for sure.

00:48:23.684 --> 00:48:25.304
Like multi-discipline, like taught by,

00:48:25.844 --> 00:48:27.166
I want PTs in the room.

00:48:27.266 --> 00:48:28.686
You know, I want everybody in the room.

00:48:28.905 --> 00:48:30.606
Like this is not an exclusive thing.

00:48:31.266 --> 00:48:31.827
Um,

00:48:31.847 --> 00:48:33.829
but the response most of the time is,

00:48:34.628 --> 00:48:35.309
oh my God,

00:48:35.389 --> 00:48:36.871
why didn't I learn this sooner?

00:48:36.891 --> 00:48:36.971
Yeah.

00:48:37.050 --> 00:48:39.132
Like nine times out of ten.

00:48:39.152 --> 00:48:39.893
I have a student at the end of

00:48:39.913 --> 00:48:40.572
the class, like,

00:48:40.992 --> 00:48:42.293
especially when I teach the fellows.

00:48:42.313 --> 00:48:43.795
So the fellows are at the very end

00:48:43.815 --> 00:48:44.916
of their medical training and they're

00:48:44.956 --> 00:48:46.396
like, wait a minute.

00:48:46.416 --> 00:48:46.617
Yeah.

00:48:46.657 --> 00:48:47.757
Yeah.

00:48:48.038 --> 00:48:48.318
Yeah.

00:48:48.378 --> 00:48:49.478
Where was this when I was in med

00:48:49.498 --> 00:48:49.699
school?

00:48:49.739 --> 00:48:51.358
This should have been like mandatory first

00:48:51.398 --> 00:48:52.199
year med school.

00:48:52.980 --> 00:48:54.181
Like I would say that this should be

00:48:54.221 --> 00:48:56.202
like undergrad, like pain science.

00:48:57.101 --> 00:48:57.822
I'm going to say this again.

00:48:58.443 --> 00:49:00.123
Every single one of us is going to

00:49:00.143 --> 00:49:01.983
have pain one day if we don't already.

00:49:02.264 --> 00:49:03.804
Like this is not just for med school.

00:49:03.844 --> 00:49:05.346
We all need to understand pain.

00:49:05.585 --> 00:49:07.806
Who doesn't deserve to understand the

00:49:07.847 --> 00:49:08.507
science of pain?

00:49:08.907 --> 00:49:12.168
Who doesn't deserve to be told how to

00:49:12.208 --> 00:49:13.469
figure out their pain recipe?

00:49:13.489 --> 00:49:13.849
I mean,

00:49:13.889 --> 00:49:17.210
it seems to me so important to spread

00:49:17.231 --> 00:49:17.490
the word.

00:49:18.465 --> 00:49:22.309
Your episodes tend to go pretty viral and

00:49:22.329 --> 00:49:22.931
pretty well.

00:49:23.110 --> 00:49:25.413
Why do you think this topic hits so

00:49:25.452 --> 00:49:25.773
hard?

00:49:25.833 --> 00:49:26.893
You explain it well,

00:49:26.934 --> 00:49:28.735
but why does the topic hit so hard

00:49:28.775 --> 00:49:29.215
for people?

00:49:29.255 --> 00:49:30.077
Is it what you just said?

00:49:30.137 --> 00:49:31.297
We've all experienced it.

00:49:31.639 --> 00:49:34.722
Will have or treat people who are or

00:49:34.762 --> 00:49:34.961
will?

00:49:36.387 --> 00:49:37.188
So to correct that,

00:49:37.228 --> 00:49:38.949
they did go viral like four years ago

00:49:38.989 --> 00:49:40.090
back when I was doing a lot of

00:49:40.130 --> 00:49:40.409
them.

00:49:41.271 --> 00:49:42.811
I haven't done it in a really long

00:49:43.052 --> 00:49:43.532
time.

00:49:44.793 --> 00:49:46.755
But yeah, I don't, you know, people,

00:49:47.614 --> 00:49:49.295
I used to try and explain that and

00:49:49.376 --> 00:49:51.057
I don't actually have an explanation for

00:49:51.097 --> 00:49:51.717
that phenomenon.

00:49:51.818 --> 00:49:53.219
I have no idea why they went viral.

00:49:53.298 --> 00:49:54.840
I think if I had to guess,

00:49:54.900 --> 00:49:56.300
I would say there's something about this

00:49:56.380 --> 00:49:58.041
intersection of physical and emotional

00:49:58.083 --> 00:49:58.342
pain.

00:49:58.382 --> 00:50:00.523
Like I think we all, whoa, why,

00:50:00.664 --> 00:50:01.425
what are the balloons?

00:50:01.644 --> 00:50:02.224
What are the balloons?

00:50:02.264 --> 00:50:02.766
What was that?

00:50:03.126 --> 00:50:03.585
I don't know.

00:50:03.867 --> 00:50:04.987
Are you on like a Microsoft?

00:50:05.407 --> 00:50:06.648
When you say a certain word on like

00:50:06.708 --> 00:50:09.070
Teams or something, balloons go across.

00:50:09.090 --> 00:50:09.831
I'm not sure how that worked.

00:50:10.831 --> 00:50:11.193
All right.

00:50:11.333 --> 00:50:12.713
So I'm not going to do that hand

00:50:12.733 --> 00:50:14.414
gesture again because it activated

00:50:14.454 --> 00:50:14.956
balloons.

00:50:17.137 --> 00:50:18.918
So I think there's something about the

00:50:18.938 --> 00:50:20.320
intersection between physical and

00:50:20.340 --> 00:50:21.041
emotional pain.

00:50:21.280 --> 00:50:23.702
I think all of us intuitively know that

00:50:23.722 --> 00:50:26.045
our emotional health affects our physical

00:50:26.085 --> 00:50:26.824
health always.

00:50:26.925 --> 00:50:27.385
And of course,

00:50:27.606 --> 00:50:28.927
the brain is connected to the body a

00:50:28.967 --> 00:50:29.987
hundred percent of the time.

00:50:30.068 --> 00:50:30.909
Of course, that's true.

00:50:31.389 --> 00:50:32.090
But for some reason,

00:50:32.130 --> 00:50:33.610
that intersection isn't really getting

00:50:33.650 --> 00:50:34.490
talked about enough.

00:50:34.851 --> 00:50:35.931
And I think the science of it is

00:50:35.992 --> 00:50:37.233
actually really compelling.

00:50:37.313 --> 00:50:38.693
So I don't know if that's what it

00:50:38.773 --> 00:50:38.974
is,

00:50:39.034 --> 00:50:41.954
but it strikes me that that is hitting

00:50:41.974 --> 00:50:42.815
a nerve with people,

00:50:42.936 --> 00:50:45.918
that this intersection between physical

00:50:45.938 --> 00:50:47.418
and emotional seems to be very resonant.

00:50:47.579 --> 00:50:48.719
But I actually don't know.

00:50:49.360 --> 00:50:49.900
I have no idea.

00:50:49.920 --> 00:50:50.000
Well,

00:50:50.039 --> 00:50:52.101
we're recording this in early February.

00:50:52.541 --> 00:50:53.681
What's the deal?

00:50:54.143 --> 00:50:55.722
Wherever books are sold,

00:50:55.764 --> 00:50:57.244
let's make sure we... What is it?

00:50:57.304 --> 00:50:57.585
You know,

00:50:58.849 --> 00:51:00.472
sell me on like make sure people when

00:51:00.512 --> 00:51:02.014
they hear this and when do you want

00:51:02.134 --> 00:51:04.456
me to drop this like let's drop it

00:51:04.496 --> 00:51:05.577
like the day it's out I want to

00:51:05.617 --> 00:51:07.280
drop I don't like dropping these before

00:51:07.681 --> 00:51:09.623
because like when people are like yes I

00:51:09.643 --> 00:51:11.103
want them to be like click click got

00:51:11.164 --> 00:51:12.365
it like I don't want to tease them

00:51:12.405 --> 00:51:13.567
I want to give it to all right

00:51:13.646 --> 00:51:15.409
okay well so okay where are they getting

00:51:15.429 --> 00:51:15.730
the book

00:51:16.195 --> 00:51:19.076
So Tell Me Where It Hurts comes out

00:51:19.456 --> 00:51:20.996
March twenty fourth and it will be

00:51:21.097 --> 00:51:21.478
everywhere.

00:51:21.538 --> 00:51:21.697
I mean,

00:51:21.717 --> 00:51:23.458
it's a ready for preorder on Amazon right

00:51:23.498 --> 00:51:24.958
now, but whenever this comes out,

00:51:25.039 --> 00:51:25.679
perhaps it will.

00:51:25.980 --> 00:51:27.199
Yeah, no, it's already available.

00:51:28.240 --> 00:51:29.822
And I want to say quickly what the

00:51:29.862 --> 00:51:30.362
book does.

00:51:31.222 --> 00:51:33.282
I wanted to put out something that would

00:51:33.342 --> 00:51:34.184
help people.

00:51:34.903 --> 00:51:36.804
know how to reduce pain volume,

00:51:37.326 --> 00:51:38.827
know how to increase functioning,

00:51:39.487 --> 00:51:41.527
know how to create their own pain recipe.

00:51:41.907 --> 00:51:43.268
And like, if you're a provider,

00:51:43.329 --> 00:51:44.630
help your patients get out of bed and

00:51:44.650 --> 00:51:45.291
get back to life.

00:51:45.630 --> 00:51:48.472
So part three is an entire pain protocol.

00:51:48.532 --> 00:51:49.853
Like if you came to my office,

00:51:50.213 --> 00:51:51.655
part three is what I would do with

00:51:51.675 --> 00:51:51.914
you.

00:51:52.394 --> 00:51:52.614
You know,

00:51:52.655 --> 00:51:54.076
parts one and two are sort of like,

00:51:54.416 --> 00:51:56.416
how do I prove to you as someone

00:51:56.456 --> 00:51:58.699
living with pain or as someone who likes

00:51:58.739 --> 00:52:00.500
science or as a healthcare provider that

00:52:00.639 --> 00:52:02.179
how do i prove to you this thing

00:52:02.239 --> 00:52:04.900
i'm saying that pain is biopsychosocial

00:52:05.061 --> 00:52:06.601
like you know there needs to be a

00:52:06.641 --> 00:52:08.382
lot of science and evidence behind that so

00:52:08.422 --> 00:52:10.443
how can i tell you patient stories and

00:52:10.503 --> 00:52:11.802
actually give you the data and the

00:52:11.822 --> 00:52:15.704
research to support it um so that's what

00:52:15.824 --> 00:52:17.405
that's what it is and yeah and it

00:52:17.425 --> 00:52:18.085
comes out in march

00:52:18.797 --> 00:52:20.077
And if you pre-order a copy,

00:52:20.117 --> 00:52:21.878
I got this information from your

00:52:21.918 --> 00:52:23.958
publisher, if you pre-order the copy,

00:52:24.018 --> 00:52:25.798
Rachel will record your voicemail greeting

00:52:25.858 --> 00:52:26.838
on your cell phone.

00:52:26.858 --> 00:52:29.099
So she's offering that as a cameo,

00:52:29.119 --> 00:52:31.239
which is a good offer.

00:52:32.000 --> 00:52:33.521
Did you not know that?

00:52:33.561 --> 00:52:34.420
That was in the fine print.

00:52:34.460 --> 00:52:37.922
You said you will record any pre-order's

00:52:37.961 --> 00:52:38.702
voicemail greeting.

00:52:38.722 --> 00:52:40.543
So think up some funny voicemail greetings

00:52:40.563 --> 00:52:41.503
for all the providers.

00:52:41.782 --> 00:52:41.862
Yeah.

00:52:42.003 --> 00:52:42.744
Okay, I'll do that.

00:52:42.784 --> 00:52:43.224
I'll do that.

00:52:43.244 --> 00:52:43.684
Thank you so much.

00:52:43.704 --> 00:52:43.844
Yeah.

00:52:43.864 --> 00:52:44.184
All right.

00:52:44.806 --> 00:52:45.867
We have a tradition on the show.

00:52:45.887 --> 00:52:47.007
You did it last time you were here.

00:52:47.027 --> 00:52:50.072
We call this the parting shot.

00:52:50.132 --> 00:52:52.134
This is the parting shot.

00:52:52.693 --> 00:52:54.096
One last mic drop moment.

00:52:54.775 --> 00:52:55.556
No pressure.

00:52:56.018 --> 00:52:58.119
Just your legacy on the line.

00:52:59.630 --> 00:53:00.672
No pressure there.

00:53:00.751 --> 00:53:02.192
Parting Shot brought to you by U.S.

00:53:02.231 --> 00:53:03.012
Physical Therapy,

00:53:03.612 --> 00:53:06.114
a national network of clinics focusing on

00:53:06.173 --> 00:53:07.155
developing clinicians,

00:53:07.574 --> 00:53:08.275
not burning them out.

00:53:08.335 --> 00:53:09.695
Leadership tracks, mentorship,

00:53:09.735 --> 00:53:10.297
career growth.

00:53:10.317 --> 00:53:12.538
It means stability to build your future in

00:53:12.577 --> 00:53:12.958
PT.

00:53:12.998 --> 00:53:15.699
If you want a place that supports you

00:53:16.519 --> 00:53:18.760
and how you want to practice, that's USPH.

00:53:18.840 --> 00:53:20.681
Visit them online at USPH.com.

00:53:20.702 --> 00:53:23.083
That's USPH.com.

00:53:23.163 --> 00:53:25.405
So what's the mic drop moment?

00:53:25.425 --> 00:53:26.045
What's the thing?

00:53:26.304 --> 00:53:27.925
I mean, what is it?

00:53:29.155 --> 00:53:29.335
All right.

00:53:29.356 --> 00:53:29.597
Here it is.

00:53:30.976 --> 00:53:33.298
You as a provider or as a patient

00:53:33.858 --> 00:53:36.179
may have been told or you will be

00:53:36.219 --> 00:53:39.621
told that chronic pain has no treatment or

00:53:39.702 --> 00:53:40.123
cure.

00:53:40.802 --> 00:53:41.963
That is a lie.

00:53:42.623 --> 00:53:45.465
And the way to change that starts with

00:53:45.925 --> 00:53:47.286
you and me.

00:53:47.407 --> 00:53:48.967
Like we are the change makers.

00:53:49.367 --> 00:53:50.527
This is the revolution.

00:53:50.849 --> 00:53:51.648
The time is now.

00:53:51.748 --> 00:53:52.809
Like what we know is...

00:53:53.929 --> 00:53:56.211
Pain is constructed by the brain and the

00:53:56.251 --> 00:53:57.793
brain is always changing.

00:53:57.873 --> 00:53:59.273
And if the brain can change,

00:53:59.713 --> 00:54:00.634
pain can change.

00:54:02.315 --> 00:54:03.056
It even rhymes.

00:54:03.096 --> 00:54:03.896
It must be true.

00:54:04.856 --> 00:54:06.097
Things that rhyme are usually true.

00:54:06.677 --> 00:54:07.197
There we go.

00:54:08.119 --> 00:54:09.099
Thank you for doing this.

00:54:09.320 --> 00:54:10.440
Let's make sure it's not, you know,

00:54:10.541 --> 00:54:12.061
another three years before you come back

00:54:12.101 --> 00:54:12.382
on the show.

00:54:12.402 --> 00:54:12.862
You know what I mean?

00:54:12.882 --> 00:54:13.442
It's been a while.

00:54:14.083 --> 00:54:14.282
Yeah.

00:54:14.302 --> 00:54:15.282
We'll have you back before that.

00:54:15.322 --> 00:54:16.543
But you go do your book tour,

00:54:16.983 --> 00:54:17.885
sell a million copies,

00:54:17.905 --> 00:54:19.465
then we'll come back and we'll celebrate

00:54:19.485 --> 00:54:20.085
with bourbon,

00:54:20.487 --> 00:54:21.867
not at eleven o'clock in the morning where

00:54:21.887 --> 00:54:22.208
you are.

00:54:23.697 --> 00:54:24.838
If someone wants to contact you,

00:54:24.858 --> 00:54:25.398
where do you send them?

00:54:25.418 --> 00:54:26.659
Do you have a big fancy website?

00:54:26.699 --> 00:54:27.420
Where do you want them to go?

00:54:27.440 --> 00:54:28.179
Yeah, I have a website.

00:54:28.199 --> 00:54:29.041
It's just my last name.

00:54:29.081 --> 00:54:30.101
It's softness.com.

00:54:30.161 --> 00:54:31.583
And I'm putting together communities.

00:54:31.682 --> 00:54:33.583
In my mind, change happens in community.

00:54:33.603 --> 00:54:34.625
So what I want to create,

00:54:34.925 --> 00:54:35.905
and you and I did this during the

00:54:35.945 --> 00:54:37.266
pandemic with our happy hour,

00:54:37.567 --> 00:54:39.168
but I'm trying to create communities for

00:54:39.188 --> 00:54:40.849
healthcare providers and also communities

00:54:40.869 --> 00:54:41.409
for patients.

00:54:41.449 --> 00:54:44.130
Because I think if change wants to happen,

00:54:44.170 --> 00:54:45.271
it's going to have to happen from the

00:54:45.311 --> 00:54:46.172
bottom up and not the top.

00:54:46.193 --> 00:54:46.592
Not in isolation.

00:54:46.612 --> 00:54:47.954
Yeah, it's usually not in isolation.

00:54:47.974 --> 00:54:48.893
It's going to have to be in isolation.

00:54:48.994 --> 00:54:49.434
Exactly.

00:54:49.454 --> 00:54:49.715
Exactly.

00:54:49.905 --> 00:54:50.447
All right.

00:54:50.467 --> 00:54:51.568
And the bottom right-hand corner of

00:54:51.608 --> 00:54:53.030
Rachel's website is where you can click,

00:54:53.070 --> 00:54:53.331
click,

00:54:53.351 --> 00:54:55.012
and then put that request in for to

00:54:55.032 --> 00:54:56.175
get her to record your own,

00:54:56.215 --> 00:54:57.115
your voicemail reading.

00:54:57.155 --> 00:54:57.896
And she'll do that for you.

00:54:58.538 --> 00:55:00.019
Dr. Rachel Zoffness, everybody.

00:55:00.099 --> 00:55:00.960
Thanks for coming on the show.

00:55:00.981 --> 00:55:01.822
Thank you, McKay.

00:55:03.873 --> 00:55:04.934
That's it for this one.

00:55:05.414 --> 00:55:06.896
We're just getting warmed up.

00:55:07.356 --> 00:55:09.257
Smash follow, send it to a friend,

00:55:09.478 --> 00:55:11.159
or crank up the next episode.

00:55:11.659 --> 00:55:12.541
Want to go deeper?

00:55:13.021 --> 00:55:15.163
Hit us at pgpinecast.com.

00:55:16.422 --> 00:55:18.425
Or find us on YouTube and socials at

00:55:18.445 --> 00:55:19.666
pgpinecast.

00:55:20.085 --> 00:55:22.367
And legally, none of this was advice.

00:55:22.447 --> 00:55:24.750
It's for entertainment purposes only.

00:55:24.829 --> 00:55:25.831
Bulls**t!

00:55:25.851 --> 00:55:26.431
See, Keith?

00:55:26.630 --> 00:55:27.711
We read the script.

00:55:27.992 --> 00:55:28.652
Happy now?