Full Transcript Introduction and Background 0:09 And good evening. Um, hi Xavier. Thank 0:09 And good evening. Um, hi Xavier. Thank you so much for joining me uh on the 0:11 you so much for joining me uh on the 0:11 you so much for joining me uh on the Amelio podcast. 0:14 Amelio podcast. 0:14 Amelio podcast. Could you share with our audience uh a 0:17 Could you share with our audience uh a 0:17 Could you share with our audience uh a little bit about your background and 0:18 little bit about your background and 0:18 little bit about your background and your passion in [music] chronic pain 0:20 your passion in [music] chronic pain 0:20 your passion in [music] chronic pain management? 0:22 management? 0:22 management? >> Yes, thank you so much Kathy. It's good 0:24 >> Yes, thank you so much Kathy. It's good 0:24 >> Yes, thank you so much Kathy. It's good to see you. Um, thank you for having me 0:26 to see you. Um, thank you for having me 0:26 to see you. Um, thank you for having me on. Um, [music] so for those who don't 0:30 on. Um, [music] so for those who don't 0:30 on. Um, [music] so for those who don't know me, my name is Dr. Javier Jimenez. 0:32 know me, my name is Dr. Javier Jimenez. 0:32 know me, my name is Dr. Javier Jimenez. Uh, some people call me Dr. X. The 0:34 Uh, some people call me Dr. X. The 0:34 Uh, some people call me Dr. X. The Javier [music] spelled with an X, so 0:35 Javier [music] spelled with an X, so 0:35 Javier [music] spelled with an X, so it's a little confusing. Um, I'm um I'm 0:39 it's a little confusing. Um, I'm um I'm 0:39 it's a little confusing. Um, I'm um I'm basically I'm a physician in the New 0:42 basically I'm a physician in the New 0:42 basically I'm a physician in the New York area that specializes in about 0:45 York area that specializes in about 0:45 York area that specializes in about three areas, [music] uh, psychiatry, 0:47 three areas, [music] uh, psychiatry, 0:47 three areas, [music] uh, psychiatry, pain medicine, and addiction medicine. 0:49 pain medicine, and addiction medicine. 0:49 pain medicine, and addiction medicine. And the way that I ended up with those 0:52 And the way that I ended up with those 0:52 And the way that I ended up with those specializations uh, is still a surprise 0:55 specializations uh, is still a surprise 0:55 specializations uh, is still a surprise to me, a pleasant one. I love what I do, 0:57 to me, a pleasant one. I love what I do, 0:57 to me, a pleasant one. I love what I do, but I [music] did not know that I'd be 0:59 but I [music] did not know that I'd be 0:59 but I [music] did not know that I'd be doing this. Um, I uh I'm a CubanAmerican 1:04 doing this. Um, I uh I'm a CubanAmerican 1:04 doing this. Um, I uh I'm a CubanAmerican kid from Miami, Florida, and was always 1:07 kid from Miami, Florida, and was always 1:07 kid from Miami, Florida, and was always very restless and [music] 1:09 very restless and [music] 1:09 very restless and [music] um you know, interested in philosophy 1:11 um you know, interested in philosophy 1:11 um you know, interested in philosophy and ethics and topics of that sort. But 1:14 and ethics and topics of that sort. But 1:14 and ethics and topics of that sort. But I decided I wanted to go into medicine 1:15 I decided I wanted to go into medicine 1:15 I decided I wanted to go into medicine when one of my aunts was a physician. 1:18 when one of my aunts was a physician. 1:18 when one of my aunts was a physician. She's now [music] retired and she 1:19 She's now [music] retired and she 1:19 She's now [music] retired and she influenced me. And when I was in 1:21 influenced me. And when I was in 1:21 influenced me. And when I was in medicine, I was fascinated by every 1:23 medicine, I was fascinated by every 1:24 medicine, I was fascinated by every topic. Uh particularly surgery and 1:27 topic. Uh particularly surgery and 1:27 topic. Uh particularly surgery and physiology and all of these topics, but 1:30 physiology and all of these topics, but 1:30 physiology and all of these topics, but I really fell in love with psychiatry. 1:32 I really fell in love with psychiatry. 1:32 I really fell in love with psychiatry. Um I [music] thought, you know, the mind 1:34 Um I [music] thought, you know, the mind 1:34 Um I [music] thought, you know, the mind as the next frontier was just so 1:36 as the next frontier was just so 1:36 as the next frontier was just so fascinating. So I specialized after 1:39 fascinating. So I specialized after 1:39 fascinating. So I specialized after becoming a physician, I specialized 1:40 becoming a physician, I specialized 1:40 becoming a physician, I specialized [music] in psychiatry, but I never 1:43 [music] in psychiatry, but I never 1:43 [music] in psychiatry, but I never really felt comfortable being only quote 1:47 really felt comfortable being only quote 1:47 really felt comfortable being only quote unquote a psychiatrist. [music] I really 1:49 unquote a psychiatrist. [music] I really 1:49 unquote a psychiatrist. [music] I really kept one foot in the medical and 1:51 kept one foot in the medical and 1:51 kept one foot in the medical and surgical space. 1:53 surgical space. 1:53 surgical space. Uh, and as a result, I I did some extra 1:56 Uh, and as a result, I I did some extra 1:56 Uh, and as a result, I I did some extra training in what what's [music] called 1:58 training in what what's [music] called 1:58 training in what what's [music] called consultation psychiatry or medical 2:00 consultation psychiatry or medical 2:00 consultation psychiatry or medical psychiatry. 2:01 psychiatry. 2:01 psychiatry. My training was at the University of
How Chronic Pain and Psychiatry Intersect 2:03 My training was at the University of 2:03 My training was at the University of Pittsburgh Medical Center for psychiatry 2:05 Pittsburgh Medical Center for psychiatry 2:06 Pittsburgh Medical Center for psychiatry and then after went to the Harvard 2:07 and then after went to the Harvard 2:07 and then after went to the Harvard system at Mass General for [music] a 2:09 system at Mass General for [music] a 2:09 system at Mass General for [music] a year to specialize in medical settings, 2:12 year to specialize in medical settings, 2:12 year to specialize in medical settings, psychiatry in medical settings or 2:14 psychiatry in medical settings or 2:14 psychiatry in medical settings or consultation liaison [music] psychiatry. 2:16 consultation liaison [music] psychiatry. 2:16 consultation liaison [music] psychiatry. That's actually the first place I became 2:18 That's actually the first place I became 2:18 That's actually the first place I became interested in pain management. It was 2:20 interested in pain management. It was 2:20 interested in pain management. It was accidental. I think uh I was actually in 2:23 accidental. I think uh I was actually in 2:23 accidental. I think uh I was actually in a burns unit, a trauma and burns unit. 2:26 a burns unit, a trauma and burns unit. 2:26 a burns unit, a trauma and burns unit. Horrible stories of individuals with 2:28 Horrible stories of individuals with 2:28 Horrible stories of individuals with [music] severe injuries requiring skin 2:31 [music] severe injuries requiring skin 2:31 [music] severe injuries requiring skin grafts, uh various interventions, 2:34 grafts, uh various interventions, 2:34 grafts, uh various interventions, surgical [music] 2:35 surgical [music] 2:35 surgical [music] interventions. And my mentor who was a 2:39 interventions. And my mentor who was a 2:39 interventions. And my mentor who was a psychiatrist himself said, "Don't be 2:41 psychiatrist himself said, "Don't be 2:41 psychiatrist himself said, "Don't be afraid [music] of managing and helping 2:43 afraid [music] of managing and helping 2:43 afraid [music] of managing and helping people with pain." Uh so you know that 2:46 people with pain." Uh so you know that 2:46 people with pain." Uh so you know that was my introduction uh after years of 2:48 was my introduction uh after years of 2:48 was my introduction uh after years of specializing in psychiatry go back to 2:50 specializing in psychiatry go back to 2:50 specializing in psychiatry go back to the basics of medicine and help 2:51 the basics of medicine and help 2:51 the basics of medicine and help individuals who are in pain and [music] 2:54 individuals who are in pain and [music] 2:54 individuals who are in pain and [music] from there on I never looked back. I've 2:56 from there on I never looked back. I've 2:56 from there on I never looked back. I've only worked as a psychiatrist in medical 2:58 only worked as a psychiatrist in medical 2:58 only worked as a psychiatrist in medical settings. After that training I went to 3:01 settings. After that training I went to 3:01 settings. After that training I went to the Cleveland Clinic and [music] was 3:02 the Cleveland Clinic and [music] was 3:02 the Cleveland Clinic and [music] was there for about eight years and 3:04 there for about eight years and 3:04 there for about eight years and specialized in a number of areas medical 3:07 specialized in a number of areas medical 3:07 specialized in a number of areas medical areas with [music] psychiatric uh 3:10 areas with [music] psychiatric uh 3:10 areas with [music] psychiatric uh dimensions. So for instance I worked in 3:12 dimensions. So for instance I worked in 3:12 dimensions. So for instance I worked in an epilepsy monitoring unit for a while. 3:14 an epilepsy monitoring unit for a while. 3:14 an epilepsy monitoring unit for a while. I worked uh with rheumatology with 3:17 I worked uh with rheumatology with 3:17 I worked uh with rheumatology with orthopedics [music] 3:18 orthopedics [music] 3:18 orthopedics [music] with anesthesia 3:20 with anesthesia 3:20 with anesthesia neurology and the area that I spent 3:23 neurology and the area that I spent 3:23 neurology and the area that I spent [music] the most time in which is 3:25 [music] the most time in which is 3:25 [music] the most time in which is germanine to today's discussion was 3:27 germanine to today's discussion was 3:27 germanine to today's discussion was chronic pain. I uh had a mentor who was 3:31 chronic pain. I uh had a mentor who was 3:31 chronic pain. I uh had a mentor who was running a program there [music] at the 3:32 running a program there [music] at the 3:32 running a program there [music] at the Cleveland Clinic called the chronic pain 3:35 Cleveland Clinic called the chronic pain 3:35 Cleveland Clinic called the chronic pain rehabilitation program. This was a 3:37 rehabilitation program. This was a 3:37 rehabilitation program. This was a multidisciplinary 3:39 multidisciplinary 3:39 multidisciplinary entity where we had doctors, [music] 3:41 entity where we had doctors, [music] 3:41 entity where we had doctors, [music] nurses, psychologists, physical 3:44 nurses, psychologists, physical 3:44 nurses, psychologists, physical therapists, occupational therapists, 3:47 therapists, occupational therapists, 3:47 therapists, occupational therapists, music therapists, everyone working 3:49 music therapists, everyone working 3:49 music therapists, everyone working together in a very dynamic way to help 3:52 together in a very dynamic way to help 3:52 together in a very dynamic way to help individuals with chronic [music] pain 3:54 individuals with chronic [music] pain 3:54 individuals with chronic [music] pain that was very lasting and disabling. And 3:57 that was very lasting and disabling. And 3:57 that was very lasting and disabling. And in that space, I became the medical 3:59 in that space, I became the medical 3:59 in that space, I became the medical director. I became certified, board 4:01 director. I became certified, board 4:01 director. I became certified, board certified in pain medicine. And I also 4:05 certified in pain medicine. And I also 4:05 certified in pain medicine. And I also became very interested in sort of 4:07 became very interested in sort of 4:07 became very interested in sort of related topic of addiction medicine and 4:09 related topic of addiction medicine and 4:09 related topic of addiction medicine and became board certified in [music] that 4:11 became board certified in [music] that 4:11 became board certified in [music] that as well. All of this was somewhat 4:14 as well. All of this was somewhat 4:14 as well. All of this was somewhat accidental. I I went into medicine 4:16 accidental. I I went into medicine 4:16 accidental. I I went into medicine really thinking about what every kid 4:19 really thinking about what every kid 4:19 really thinking about what every kid thinks about, right? Let me fix a broken 4:21 thinks about, right? Let me fix a broken 4:21 thinks about, right? Let me fix a broken bone. Let me transplant an organ. Save a 4:24 bone. Let me transplant an organ. Save a 4:24 bone. Let me transplant an organ. Save a life. That kind of stuff, right? The the 4:26 life. That kind of stuff, right? The the 4:26 life. That kind of stuff, right? The the flashy stuff. And then I realized 4:28 flashy stuff. And then I realized 4:28 flashy stuff. And then I realized actually when you're in medicine, you 4:29 actually when you're in medicine, you 4:30 actually when you're in medicine, you see enormous suffering, you see enormous 4:33 see enormous suffering, you see enormous 4:33 see enormous suffering, you see enormous [music] pain, enormous chaos, and I 4:36 [music] pain, enormous chaos, and I 4:36 [music] pain, enormous chaos, and I wanted to help bridge some of those 4:38 wanted to help bridge some of those 4:38 wanted to help bridge some of those [music] gaps. So that's what got me 4:40 [music] gaps. So that's what got me 4:40 [music] gaps. So that's what got me eventually to where I am. I'm currently 4:42 eventually to where I am. I'm currently 4:42 eventually to where I am. I'm currently working for Northwell, which is a large 4:44 working for Northwell, which is a large 4:44 working for Northwell, which is a large health system in and around [music] 4:46 health system in and around [music] 4:46 health system in and around [music] uh New York City. And I continue to see 4:51 uh New York City. And I continue to see 4:51 uh New York City. And I continue to see individuals who have chronic pain, 4:53 individuals who have chronic pain, 4:53 individuals who have chronic pain, mental health concerns, addiction or 4:56 mental health concerns, addiction or 4:56 mental health concerns, addiction or some combination of those [music] both 4:57 some combination of those [music] both 4:58 some combination of those [music] both in the hospital and in clinic. I have a 5:01 in the hospital and in clinic. I have a 5:01 in the hospital and in clinic. I have a clinic also where I see individuals 5:03 clinic also where I see individuals 5:03 clinic also where I see individuals >> [music] 5:03 >> [music] 5:04 >> [music] >> um in in the ambulatory space and I 5:06 >> um in in the ambulatory space and I 5:06 >> um in in the ambulatory space and I continue to strategize with the rest of 5:08 continue to strategize with the rest of 5:08 continue to strategize with the rest of Northwell growing health system to 5:10 Northwell growing health system to 5:10 Northwell growing health system to deliver integrated care models so that 5:12 deliver integrated care models so that 5:12 deliver integrated care models so that we [music] can really fill in these gaps 5:15 we [music] can really fill in these gaps 5:15 we [music] can really fill in these gaps that are inadvertently created by our 5:17 that are inadvertently created by our 5:18 that are inadvertently created by our massive [music] health care systems. 5:20 massive [music] health care systems. 5:20 massive [music] health care systems. That's kind of how I got here. 5:23 That's kind of how I got here. 5:23 That's kind of how I got here. >> Wow, that's an amazing journey [music] 5:25 >> Wow, that's an amazing journey [music] 5:25 >> Wow, that's an amazing journey [music] and it's really interesting uh that you 5:27 and it's really interesting uh that you 5:27 and it's really interesting uh that you sort of fell into chronic pain 5:29 sort of fell into chronic pain 5:29 sort of fell into chronic pain management. Um I can really relate to 5:32 management. Um I can really relate to 5:32 management. Um I can really relate to this. I I myself [music] 5:33 this. I I myself [music] 5:34 this. I I myself [music] came from uh acute pain management 5:36 came from uh acute pain management 5:36 came from uh acute pain management background a role in nursing [music] uh 5:39 background a role in nursing [music] uh 5:39 background a role in nursing [music] uh which led me to pain management and then 5:41 which led me to pain management and then 5:41 which led me to pain management and then psychology which is you know very 5:43 psychology which is you know very 5:43 psychology which is you know very [music] similar journey isn't it and uh 5:46 [music] similar journey isn't it and uh 5:46 [music] similar journey isn't it and uh um it's really interesting uh where I 5:49 um it's really interesting uh where I 5:49 um it's really interesting uh where I was working in um [music] you know 5:52 was working in um [music] you know 5:52 was working in um [music] you know trauma and uh acute pain and ICU and uh 5:59 trauma and uh acute pain and ICU and uh 5:59 trauma and uh acute pain and ICU and uh [music] anesthetics recovery those sorts 6:02 [music] anesthetics recovery those sorts 6:02 [music] anesthetics recovery those sorts of areas and then also working in a 6:05 of areas and then also working in a 6:05 of areas and then also working in a [music] multi-disiplinary pain clinic 6:07 [music] multi-disiplinary pain clinic 6:07 [music] multi-disiplinary pain clinic like yourself and we could actually see 6:09 like yourself and we could actually see 6:09 like yourself and we could actually see that you know the people [music] would 6:12 that you know the people [music] would 6:12 that you know the people [music] would come from that acute phase and then into 6:16 come from that acute phase and then into 6:16 come from that acute phase and then into the chronic pain clinic and you think 6:17 the chronic pain clinic and you think 6:17 the chronic pain clinic and you think [music] 6:18 [music] 6:18 [music] wow I've just seen this from beginning 6:20 wow I've just seen this from beginning 6:20 wow I've just seen this from beginning to end and I can see where these cracks 6:24 to end and I can see where these cracks 6:24 to end and I can see where these cracks are that's just phenomenal that you 6:26 are that's just phenomenal that you 6:26 are that's just phenomenal that you you're uh you're talking about that 6:28 you're uh you're talking about that 6:28 you're uh you're talking about that [music] 6:28 [music] 6:28 [music] can you tell me your thoughts on the 6:31 can you tell me your thoughts on the 6:31 can you tell me your thoughts on the link links between mental ill health and 6:35 link links between mental ill health and 6:35 link links between mental ill health and mental wellness and [music] chronic 6:37 mental wellness and [music] chronic 6:37 mental wellness and [music] chronic pain. I know it's a you know we we often 6:40 pain. I know it's a you know we we often 6:40 pain. I know it's a you know we we often talk about um mental health, but I think 6:44 talk about um mental health, but I think 6:44 talk about um mental health, but I think we're me missing the point here. We're 6:46 we're me missing the point here. We're 6:46 we're me missing the point here. We're actually missing the fact that it's 6:48 actually missing the fact that it's 6:48 actually missing the fact that it's mental ill health [music] and chronic 6:51 mental ill health [music] and chronic 6:51 mental ill health [music] and chronic pain. 6:52 pain. 6:52 pain. >> It's a great topic and we can go on on 6:55 >> It's a great topic and we can go on on 6:55 >> It's a great topic and we can go on on on these relationships for hours. uh the 6:58 on these relationships for hours. uh the 6:58 on these relationships for hours. uh the the the relationship between mental 7:00 the the relationship between mental 7:00 the the relationship between mental health or ill health and chronic pain 7:03 health or ill health and chronic pain 7:03 health or ill health and chronic pain [music] is rich uh it's birectional 7:07 [music] is rich uh it's birectional 7:07 [music] is rich uh it's birectional uh in the sense that each domain [music] 7:09 uh in the sense that each domain [music] 7:09 uh in the sense that each domain [music] influences the other and is what is 7:12 influences the other and is what is 7:12 influences the other and is what is perpetually fascinating in my work. 7:14 perpetually fascinating in my work. 7:14 perpetually fascinating in my work. [music] I will start with a disclaimer 7:17 [music] I will start with a disclaimer 7:17 [music] I will start with a disclaimer because some individuals who have 7:18 because some individuals who have 7:18 because some individuals who have chronic pain will react to somebody from 7:21 chronic pain will react to somebody from 7:22 chronic pain will react to somebody from mental health like a psychiatrist, 7:23 mental health like a psychiatrist, 7:23 mental health like a psychiatrist, psychologist, a therapist, uh trying to 7:27 psychologist, a therapist, uh trying to 7:27 psychologist, a therapist, uh trying to quote help them with their pain and some 7:29 quote help them with their pain and some 7:29 quote help them with their pain and some individuals react to that poorly and 7:31 individuals react to that poorly and 7:31 individuals react to that poorly and [music] think this is a purely medical 7:34 [music] think this is a purely medical 7:34 [music] think this is a purely medical issue. There's no space for for those 7:37 issue. There's no space for for those 7:37 issue. There's no space for for those kinds of discussions. I obviously 7:39 kinds of discussions. I obviously 7:39 kinds of discussions. I obviously disagree, especially in chronic 7:41 disagree, especially in chronic 7:41 disagree, especially in chronic disabling pain. to get to your point, 7:45 disabling pain. to get to your point, 7:45 disabling pain. to get to your point, when we have somebody who is [music] uh 7:47 when we have somebody who is [music] uh 7:47 when we have somebody who is [music] uh especially exhausted conventional 7:49 especially exhausted conventional 7:50 especially exhausted conventional medical interventions, hasn't [music] 7:52 medical interventions, hasn't [music] 7:52 medical interventions, hasn't [music] responded to them, continues to 7:54 responded to them, continues to 7:54 responded to them, continues to languish, um is disabled by their 7:57 languish, um is disabled by their 7:57 languish, um is disabled by their chronic pain, that's really where we we 8:01 chronic pain, that's really where we we 8:01 chronic pain, that's really where we we have to incorporate a a broader what's 8:04 have to incorporate a a broader what's 8:04 have to incorporate a a broader what's [music] called biocschosocial approach, 8:06 [music] called biocschosocial approach, 8:06 [music] called biocschosocial approach, which includes psychological dimensions. 8:08 which includes psychological dimensions. 8:08 which includes psychological dimensions. It's not the only factor. We have to 8:10 It's not the only factor. We have to 8:10 It's not the only factor. We have to continue to balance the biological and 8:12 continue to balance the biological and 8:12 continue to balance the biological and the social [music] too, but the 8:14 the social [music] too, but the 8:14 the social [music] too, but the psychological is part of it. And I think 8:16 psychological is part of it. And I think 8:16 psychological is part of it. And I think to answer your question more more 8:19 to answer your question more more 8:19 to answer your question more more generally, [music] the relationship has 8:21 generally, [music] the relationship has 8:21 generally, [music] the relationship has a lot to do with what we call the pain 8:23 a lot to do with what we call the pain 8:23 a lot to do with what we call the pain experience. 8:25 experience. 8:25 experience. I think most people really fixate on I 8:28 I think most people really fixate on I 8:28 I think most people really fixate on I [music] have pain or I have chronic pain 8:31 [music] have pain or I have chronic pain 8:31 [music] have pain or I have chronic pain and and yet don't really get as curious 8:34 and and yet don't really get as curious 8:34 and and yet don't really get as curious as maybe they need to be about their 8:36 as maybe they need to be about their 8:36 as maybe they need to be about their pain experience. What does that even 8:38 pain experience. What does that even 8:38 pain experience. What does that even mean? That means how somebody in 8:40 mean? That means how somebody in 8:40 mean? That means how somebody in totality is experiencing their pain. Not 8:44 totality is experiencing their pain. Not 8:44 totality is experiencing their pain. Not not just that it hurts. The physical 8:46 not just that it hurts. The physical 8:46 not just that it hurts. The physical component of it is very important. 8:48 component of it is very important. 8:48 component of it is very important. [music] Sometimes the most important 8:49 [music] Sometimes the most important 8:50 [music] Sometimes the most important part. But in other situations, there's 8:52 part. But in other situations, there's 8:52 part. But in other situations, there's the physical component, the sensation of
Resilience, Wearables, and Pain Tracking 8:55 the physical component, the sensation of 8:55 the physical component, the sensation of pain and [music] 8:57 pain and [music] 8:57 pain and [music] additional layers of experience. And 9:00 additional layers of experience. And 9:00 additional layers of experience. And those layers of experience can be 9:02 those layers of experience can be 9:02 those layers of experience can be psychological. They can be anger, 9:05 psychological. They can be anger, 9:05 psychological. They can be anger, sadness, [music] 9:06 sadness, [music] 9:06 sadness, [music] fear, panic, depression, all all sorts 9:09 fear, panic, depression, all all sorts 9:10 fear, panic, depression, all all sorts of experiences that [music] come with 9:12 of experiences that [music] come with 9:12 of experiences that [music] come with and around related to etc. the pain that 9:15 and around related to etc. the pain that 9:16 and around related to etc. the pain that pain experience [music] is squarely a 9:18 pain experience [music] is squarely a 9:18 pain experience [music] is squarely a psychological phenomenon. And that's 9:20 psychological phenomenon. And that's 9:20 psychological phenomenon. And that's where you start to see that individuals 9:22 where you start to see that individuals 9:22 where you start to see that individuals with mental [music] 9:24 with mental [music] 9:24 with mental [music] ill health versus mental health issues 9:29 ill health versus mental health issues 9:29 ill health versus mental health issues vary widely in their pain [music] 9:30 vary widely in their pain [music] 9:30 vary widely in their pain [music] experience. you ran an experiment or 9:34 experience. you ran an experiment or 9:34 experience. you ran an experiment or even just did a population study on 9:36 even just did a population study on 9:36 even just did a population study on [music] everyone who has very similar or 9:39 [music] everyone who has very similar or 9:39 [music] everyone who has very similar or identical medical injuries, diseases, 9:42 identical medical injuries, diseases, 9:42 identical medical injuries, diseases, [music] uh concerns and then plot them 9:44 [music] uh concerns and then plot them 9:44 [music] uh concerns and then plot them out over time and see how many of them 9:47 out over time and see how many of them 9:47 out over time and see how many of them even have chronic pain to [music] start 9:49 even have chronic pain to [music] start 9:49 even have chronic pain to [music] start with. Secondly, of those with chronic 9:51 with. Secondly, of those with chronic 9:51 with. Secondly, of those with chronic pain, what is their degree of disability 9:53 pain, what is their degree of disability 9:53 pain, what is their degree of disability [music] and pain experience? You will 9:55 [music] and pain experience? You will 9:55 [music] and pain experience? You will see variability. you'll see differences 9:57 see variability. you'll see differences 9:58 see variability. you'll see differences which points at individual again pain 10:01 which points at individual again pain 10:01 which points at individual again pain [music] experience. So to get back to 10:03 [music] experience. So to get back to 10:03 [music] experience. So to get back to your point and how you phrased it, 10:05 your point and how you phrased it, 10:05 your point and how you phrased it, mental health, mental ill health is huge 10:08 mental health, mental ill health is huge 10:08 mental health, mental ill health is huge in uh ascribing some variability to how 10:12 in uh ascribing some variability to how 10:12 in uh ascribing some variability to how individuals [music] navigate their pain. 10:15 individuals [music] navigate their pain. 10:15 individuals [music] navigate their pain. And of course we have lots of research 10:17 And of course we have lots of research 10:17 And of course we have lots of research to suggest [music] that more 10:18 to suggest [music] that more 10:18 to suggest [music] that more specifically. There's the granular stuff 10:20 specifically. There's the granular stuff 10:20 specifically. There's the granular stuff about well if somebody [music] for 10:22 about well if somebody [music] for 10:22 about well if somebody [music] for instance has a very negative pain 10:25 instance has a very negative pain 10:25 instance has a very negative pain experience with fear-based cognitive 10:29 experience with fear-based cognitive 10:29 experience with fear-based cognitive patterns [music] 10:30 patterns [music] 10:30 patterns [music] catastrophizing which is worst case 10:33 catastrophizing which is worst case 10:33 catastrophizing which is worst case scenario thinking or other distortions 10:35 scenario thinking or other distortions 10:35 scenario thinking or other distortions they're going to have poorer prognosis 10:38 they're going to have poorer prognosis 10:38 they're going to have poorer prognosis they're going to cycle into disability 10:41 they're going to cycle into disability 10:41 they're going to cycle into disability at much greater rates than somebody who 10:43 at much greater rates than somebody who 10:43 at much greater rates than somebody who doesn't have that thinking pattern. So 10:46 doesn't have that thinking pattern. So 10:46 doesn't have that thinking pattern. So that's a a a clear example that has been 10:48 that's a a a clear example that has been 10:48 that's a a a clear example that has been studied many times. On the flip side, 10:52 studied many times. On the flip side, 10:52 studied many times. On the flip side, alternatively, we have [music] positive 10:55 alternatively, we have [music] positive 10:55 alternatively, we have [music] positive thinking patterns like increased 10:57 thinking patterns like increased 10:57 thinking patterns like increased self-efficacy [music] or optimism, 11:01 self-efficacy [music] or optimism, 11:01 self-efficacy [music] or optimism, a sense of agency and mastery. These 11:03 a sense of agency and mastery. These 11:03 a sense of agency and mastery. These kinds of tendencies [music] tend to 11:05 kinds of tendencies [music] tend to 11:05 kinds of tendencies [music] tend to portend very very well for the 11:07 portend very very well for the 11:07 portend very very well for the individual with chronic pain and [music] 11:09 individual with chronic pain and [music] 11:09 individual with chronic pain and [music] rarely will they have significant 11:13 rarely will they have significant 11:13 rarely will they have significant crippling disability. So, [music] those 11:15 crippling disability. So, [music] those 11:15 crippling disability. So, [music] those are just two micro examples of what I 11:17 are just two micro examples of what I 11:17 are just two micro examples of what I think you're referring to in terms of 11:19 think you're referring to in terms of 11:19 think you're referring to in terms of mental health or mental ill health 11:21 mental health or mental ill health 11:21 mental health or mental ill health impacting [music] 11:22 impacting [music] 11:22 impacting [music] the total chronic pain experience. 11:26 the total chronic pain experience. 11:26 the total chronic pain experience. Yeah, this is exactly what we found uh 11:28 Yeah, this is exactly what we found uh 11:28 Yeah, this is exactly what we found uh in our online chronic pain [music] 11:30 in our online chronic pain [music] 11:30 in our online chronic pain [music] program and this is why we use 11:33 program and this is why we use 11:33 program and this is why we use behavioral scores [music] and combine it 11:36 behavioral scores [music] and combine it 11:36 behavioral scores [music] and combine it with wearable data so that we can 11:38 with wearable data so that we can 11:38 with wearable data so that we can actually see that [music] impact of 11:41 actually see that [music] impact of 11:41 actually see that [music] impact of these uh you know sleep, mood behaviors 11:44 these uh you know sleep, mood behaviors 11:44 these uh you know sleep, mood behaviors and resilience [music] on how they're 11:47 and resilience [music] on how they're 11:47 and resilience [music] on how they're actually coping uh with their chronic 11:49 actually coping uh with their chronic 11:49 actually coping uh with their chronic pain. How do you think resilience uh and 11:53 pain. How do you think resilience uh and 11:53 pain. How do you think resilience uh and chronic pain [music] are intertwined? 11:59 >> Yeah, it's a great question. Firstly, I 11:59 >> Yeah, it's a great question. Firstly, I want to say that you guys in Amelio 12:02 want to say that you guys in Amelio 12:02 want to say that you guys in Amelio Health are ahead [music] of the curve 12:03 Health are ahead [music] of the curve 12:03 Health are ahead [music] of the curve from what I can tell and and even 12:05 from what I can tell and and even 12:05 from what I can tell and and even thinking about these dimensions of 12:07 thinking about these dimensions of 12:07 thinking about these dimensions of chronic pain and measuring them and and 12:09 chronic pain and measuring them and and 12:09 chronic pain and measuring them and and and being data driven in that regard. 12:12 and being data driven in that regard. 12:12 and being data driven in that regard. So, I commend you for that. Most of 12:14 So, I commend you for that. Most of 12:14 So, I commend you for that. Most of healthcare really isn't set up for that 12:16 healthcare really isn't set up for that 12:16 healthcare really isn't set up for that unfortunately. [music] 12:18 unfortunately. [music] 12:18 unfortunately. [music] As far as resilience, resilience is 12:21 As far as resilience, resilience is 12:21 As far as resilience, resilience is really the the the counterpoint to 12:23 really the the the counterpoint to 12:23 really the the the counterpoint to vulnerability, right? And individuals 12:27 vulnerability, right? And individuals 12:27 vulnerability, right? And individuals with high default resilience are [music] 12:29 with high default resilience are [music] 12:30 with high default resilience are [music] going to meet challenges very 12:31 going to meet challenges very 12:31 going to meet challenges very differently than somebody with very low 12:34 differently than somebody with very low 12:34 differently than somebody with very low resilience or high vulnerability. 12:36 resilience or high vulnerability. 12:36 resilience or high vulnerability. [music] And so resilience is a very 12:38 [music] And so resilience is a very 12:38 [music] And so resilience is a very protective kind of element. individuals 12:41 protective kind of element. individuals 12:41 protective kind of element. individuals with a lot of support, a lot of [music] 12:44 with a lot of support, a lot of [music] 12:44 with a lot of support, a lot of [music] frontloading of knowledge and health 12:46 frontloading of knowledge and health 12:46 frontloading of knowledge and health literacy, a lot of incentives [music] to 12:49 literacy, a lot of incentives [music] to 12:50 literacy, a lot of incentives [music] to be well for these individuals have a 12:53 be well for these individuals have a 12:53 be well for these individuals have a resiliency package, [music] if you will, 12:55 resiliency package, [music] if you will, 12:55 resiliency package, [music] if you will, that will buffer against severe 12:58 that will buffer against severe 12:58 that will buffer against severe disabling effects of chronic pain. Uh 13:02 disabling effects of chronic pain. Uh 13:02 disabling effects of chronic pain. Uh there are other psychological factors 13:04 there are other psychological factors 13:04 there are other psychological factors too, not just the environmental ones 13:05 too, not just the environmental ones 13:05 too, not just the environmental ones that I just listed [music] that would, 13:07 that I just listed [music] that would, 13:08 that I just listed [music] that would, you know, be incorporated into 13:09 you know, be incorporated into 13:09 you know, be incorporated into resilience. So this is the other side. 13:10 resilience. So this is the other side. 13:10 resilience. So this is the other side. These are the individuals we don't see 13:12 These are the individuals we don't see 13:12 These are the individuals we don't see in our chronic pain clinics [music] uh 13:15 in our chronic pain clinics [music] uh 13:15 in our chronic pain clinics [music] uh because they're they're they're thriving 13:17 because they're they're they're thriving 13:17 because they're they're they're thriving despite horrible diseases, injuries, 13:20 despite horrible diseases, injuries, 13:20 despite horrible diseases, injuries, surgeries, and other 13:21 surgeries, and other 13:21 surgeries, and other >> [music] 13:21 >> [music] 13:21 >> [music] >> uh pain conditions. Uh but I will say 13:24 >> uh pain conditions. Uh but I will say 13:24 >> uh pain conditions. Uh but I will say the good news about resiliency is that 13:26 the good news about resiliency is that 13:26 the good news about resiliency is that it can be built up. [music] It's not a 13:28 it can be built up. [music] It's not a 13:28 it can be built up. [music] It's not a static phenomena. Individuals even with 13:32 static phenomena. Individuals even with 13:32 static phenomena. Individuals even with some vulnerabilities can develop quite a 13:35 some vulnerabilities can develop quite a 13:35 some vulnerabilities can develop quite a bit of resiliency. [music] It's it's a a 13:37 bit of resiliency. [music] It's it's a a 13:37 bit of resiliency. [music] It's it's a a dynamic issue that can be manipulated if 13:40 dynamic issue that can be manipulated if 13:40 dynamic issue that can be manipulated if you will by the individual in healthcare 13:42 you will by the individual in healthcare 13:42 you will by the individual in healthcare and we can team up to actually bolster 13:44 and we can team up to actually bolster 13:44 and we can team up to actually bolster that like a muscle that has been [music] 13:46 that like a muscle that has been [music] 13:46 that like a muscle that has been [music] weakened or underdeveloped. It can be it 13:49 weakened or underdeveloped. It can be it 13:49 weakened or underdeveloped. It can be it can be developed and that's I think an 13:50 can be developed and that's I think an 13:50 can be developed and that's I think an important optimistic [music] take on 13:53 important optimistic [music] take on 13:53 important optimistic [music] take on this. It's not about only focusing on 13:55 this. It's not about only focusing on 13:55 this. It's not about only focusing on individuals and their vulnerabilities, 13:58 individuals and their vulnerabilities, 13:58 individuals and their vulnerabilities, their weaknesses. It's about also 14:00 their weaknesses. It's about also 14:00 their weaknesses. It's about also boosting [music] up that resilience. And 14:03 boosting [music] up that resilience. And 14:03 boosting [music] up that resilience. And by the way, I'll just add this. I I 14:05 by the way, I'll just add this. I I 14:05 by the way, I'll just add this. I I don't think of resiliency as simply 14:07 don't think of resiliency as simply 14:07 don't think of resiliency as simply [music] an attitudinal 14:09 [music] an attitudinal 14:09 [music] an attitudinal or or psychological phenomenon. 14:11 or or psychological phenomenon. 14:11 or or psychological phenomenon. Individuals [music] tend to think it's 14:13 Individuals [music] tend to think it's 14:13 Individuals [music] tend to think it's soft and it's all about optimism. It's 14:17 soft and it's all about optimism. It's 14:17 soft and it's all about optimism. It's actually also about neurobiology. You 14:19 actually also about neurobiology. You 14:19 actually also about neurobiology. You know, individuals can beef up, if you 14:22 know, individuals can beef up, if you 14:22 know, individuals can beef up, if you will, [music] their resilience 14:24 will, [music] their resilience 14:24 will, [music] their resilience physically too through conditioning and 14:28 physically too through conditioning and 14:28 physically too through conditioning and being able to withstand more. [music] 14:30 being able to withstand more. [music] 14:30 being able to withstand more. [music] And furthermore, even at a at a at the 14:32 And furthermore, even at a at a at the 14:32 And furthermore, even at a at a at the level of analesia, the the [music] term 14:34 level of analesia, the the [music] term 14:34 level of analesia, the the [music] term for pain control, we see that 14:36 for pain control, we see that 14:36 for pain control, we see that individuals who, for instance, now I'm 14:39 individuals who, for instance, now I'm 14:39 individuals who, for instance, now I'm going to get very technical, get beef up 14:41 going to get very technical, get beef up 14:41 going to get very technical, get beef up their descending pain pathways and their 14:43 their descending pain pathways and their 14:43 their descending pain pathways and their [music] inbuilt endogenous painkillers, 14:45 [music] inbuilt endogenous painkillers, 14:45 [music] inbuilt endogenous painkillers, their endorphins, all of that. When they 14:48 their endorphins, all of that. When they 14:48 their endorphins, all of that. When they beef that up and condition that up, they 14:50 beef that up and condition that up, they 14:50 beef that up and condition that up, they also develop a form of resilience 14:52 also develop a form of resilience 14:52 also develop a form of resilience [music] that is neurobiological that 14:54 [music] that is neurobiological that 14:54 [music] that is neurobiological that arguably is medical. So there are 14:57 arguably is medical. So there are 14:57 arguably is medical. So there are medical and psycho behavioral and social 15:00 medical and psycho behavioral and social 15:00 medical and psycho behavioral and social elements that can be woven into the 15:03 elements that can be woven into the 15:03 elements that can be woven into the enhancement of resiliency. I think it's 15:05 enhancement of resiliency. I think it's 15:05 enhancement of resiliency. I think it's an a critical target [music] for us in 15:08 an a critical target [music] for us in 15:08 an a critical target [music] for us in chronic pain management. 15:10 chronic pain management. 15:10 chronic pain management. >> Yeah, we what we found is that we've now 15:12 >> Yeah, we what we found is that we've now 15:12 >> Yeah, we what we found is that we've now got a marker for it. So [music] 15:15 got a marker for it. So [music] 15:15 got a marker for it. So [music] uh looking at um the wearable device, we 15:18 uh looking at um the wearable device, we 15:18 uh looking at um the wearable device, we can now see [music] that difference uh 15:20 can now see [music] that difference uh 15:20 can now see [music] that difference uh in the heart rate variability between 15:23 in the heart rate variability between 15:23 in the heart rate variability between the sympathetic [music] and the 15:24 the sympathetic [music] and the 15:24 the sympathetic [music] and the parasympathetic nervous systems. And uh 15:28 parasympathetic nervous systems. And uh 15:28 parasympathetic nervous systems. And uh uh that is our marker now for [music]
Opioids and Safe Discontinuation 15:30 uh that is our marker now for [music] 15:30 uh that is our marker now for [music] uh people actually gaining resilience. 15:33 uh people actually gaining resilience. 15:33 uh people actually gaining resilience. And it's really really powerful when we 15:35 And it's really really powerful when we 15:35 And it's really really powerful when we can actually share this information with 15:38 can actually share this information with 15:38 can actually share this information with the person that's uh going [music] 15:40 the person that's uh going [music] 15:40 the person that's uh going [music] through our pain program. 15:42 through our pain program. 15:42 through our pain program. [clears throat] Sorry. And uh and we can 15:45 [clears throat] Sorry. And uh and we can 15:45 [clears throat] Sorry. And uh and we can [music] see they can start to see, you 15:47 [music] see they can start to see, you 15:48 [music] see they can start to see, you know, you know, I had this [music] the 15:50 know, you know, I had this [music] the 15:50 know, you know, I had this [music] the worst night's sleep. I I really didn't 15:52 worst night's sleep. I I really didn't 15:52 worst night's sleep. I I really didn't get any sleep. You know, I feel like 15:54 get any sleep. You know, I feel like 15:54 get any sleep. You know, I feel like crap. 15:56 crap. 15:56 crap. And you know, well, that's pretty 15:58 And you know, well, that's pretty 15:58 And you know, well, that's pretty obvious. [music] I can see it on your 15:59 obvious. [music] I can see it on your 15:59 obvious. [music] I can see it on your your wearable. You know, you you 16:01 your wearable. You know, you you 16:01 your wearable. You know, you you literally had 300 minutes of sleep and 16:04 literally had 300 minutes of sleep and 16:04 literally had 300 minutes of sleep and then it was only light sleep. You didn't 16:06 then it was only light sleep. You didn't 16:06 then it was only light sleep. You didn't get any REM or deep sleep. 16:08 get any REM or deep sleep. 16:08 get any REM or deep sleep. [clears throat] 16:09 [clears throat] 16:09 [clears throat] So any wonder you know you're feeling 16:11 So any wonder you know you're feeling 16:11 So any wonder you know you're feeling pretty bad [music] 16:13 pretty bad [music] 16:13 pretty bad [music] and if you take a look now at your heart 16:15 and if you take a look now at your heart 16:15 and if you take a look now at your heart rate variability you can actually see 16:17 rate variability you can actually see 16:17 rate variability you can actually see [music] that um you're not you're not as 16:20 [music] that um you're not you're not as 16:20 [music] that um you're not you're not as resilient today. So, you know, it's a 16:23 resilient today. So, you know, it's a 16:23 resilient today. So, you know, it's a very real bof [music] feedback for them 16:26 very real bof [music] feedback for them 16:26 very real bof [music] feedback for them and they go, "Oh, that's why I can't 16:28 and they go, "Oh, that's why I can't 16:28 and they go, "Oh, that's why I can't cope with the kids screaming and you 16:30 cope with the kids screaming and you 16:30 cope with the kids screaming and you know, [music] you know, being 16:33 know, [music] you know, being 16:33 know, [music] you know, being uh, you know, annoying to each other and 16:35 uh, you know, annoying to each other and 16:36 uh, you know, annoying to each other and you know, I just I just snap and I I uh, 16:39 you know, I just I just snap and I I uh, 16:39 you know, I just I just snap and I I uh, you know, take it out on them and then 16:41 you know, take it out on them and then 16:41 you know, take it out on them and then they feel guilty and you know, it's just 16:43 they feel guilty and you know, it's just 16:43 they feel guilty and you know, it's just [music] this sort of cycle, isn't it?" 16:46 [music] this sort of cycle, isn't it?" 16:46 [music] this sort of cycle, isn't it?" Um 16:47 Um 16:47 Um so [music] it it's really really 16:49 so [music] it it's really really 16:49 so [music] it it's really really powerful uh information I think is is 16:53 powerful uh information I think is is 16:53 powerful uh information I think is is [music] being able to give that now back 16:56 [music] being able to give that now back 16:56 [music] being able to give that now back to the individuals [music] and be able 16:58 to the individuals [music] and be able 16:58 to the individuals [music] and be able to say this is why this is happening. 17:01 to say this is why this is happening. 17:01 to say this is why this is happening. You know this is um you're not a nutter 17:05 You know this is um you're not a nutter 17:05 You know this is um you're not a nutter and the fact that you're a psychiatrist 17:07 and the fact that you're a psychiatrist 17:07 and the fact that you're a psychiatrist I think is really uh pertinent to that 17:10 I think is really uh pertinent to that 17:10 I think is really uh pertinent to that because you know that's what people 17:11 because you know that's what people 17:11 because you know that's what people think the doctors are saying to them. 17:13 think the doctors are saying to them. 17:13 think the doctors are saying to them. I'll send you to a psychiatrist [music] 17:15 I'll send you to a psychiatrist [music] 17:15 I'll send you to a psychiatrist [music] because we actually think you're a 17:17 because we actually think you're a 17:17 because we actually think you're a nutter. And they actually start to think 17:20 nutter. And they actually start to think 17:20 nutter. And they actually start to think they are a [music] nutter themselves. 17:22 they are a [music] nutter themselves. 17:22 they are a [music] nutter themselves. You know, that that they're going out of 17:24 You know, that that they're going out of 17:24 You know, that that they're going out of their mind. And [music] uh I guess 17:28 their mind. And [music] uh I guess 17:28 their mind. And [music] uh I guess opioids play a really big role in this, 17:31 opioids play a really big role in this, 17:32 opioids play a really big role in this, you know, these feelings [music] 17:33 you know, these feelings [music] 17:34 you know, these feelings [music] um of, you know, not coping and um the, 17:38 um of, you know, not coping and um the, 17:38 um of, you know, not coping and um the, you know, the levels of fatigue, [music] 17:40 you know, the levels of fatigue, [music] 17:40 you know, the levels of fatigue, [music] the interference in sleep. uh and then 17:43 the interference in sleep. uh and then 17:43 the interference in sleep. uh and then exacerbating this problem with 17:45 exacerbating this problem with 17:45 exacerbating this problem with resilience. [music] Um how do you see 17:47 resilience. [music] Um how do you see 17:47 resilience. [music] Um how do you see opioids play a role in this particular 17:50 opioids play a role in this particular 17:50 opioids play a role in this particular mix? 17:52 mix? 17:52 mix? >> Yeah, it's a great and loaded uh 17:54 >> Yeah, it's a great and loaded uh 17:54 >> Yeah, it's a great and loaded uh controversial topic. Uh opioids uh sadly 17:59 controversial topic. Uh opioids uh sadly 17:59 controversial topic. Uh opioids uh sadly [music] claimed the lives of many and 18:01 [music] claimed the lives of many and 18:01 [music] claimed the lives of many and it's been a huge issue in the United 18:03 it's been a huge issue in the United 18:03 it's been a huge issue in the United States in particular. I did want to say 18:05 States in particular. I did want to say 18:05 States in particular. I did want to say briefly [music] that I love the BOF 18:07 briefly [music] that I love the BOF 18:07 briefly [music] that I love the BOF feedback uh example you were offering 18:10 feedback uh example you were offering 18:10 feedback uh example you were offering about [music] our sympathetic nervous 18:12 about [music] our sympathetic nervous 18:12 about [music] our sympathetic nervous system. It's just another physical 18:15 system. It's just another physical 18:15 system. It's just another physical dimension to resiliency that you can 18:18 dimension to resiliency that you can 18:18 dimension to resiliency that you can modify [music] and and enhance and 18:21 modify [music] and and enhance and 18:21 modify [music] and and enhance and empower the individual to feel more in 18:23 empower the individual to feel more in 18:23 empower the individual to feel more in control. This is all about individuals 18:25 control. This is all about individuals 18:25 control. This is all about individuals managing their pain as [music] opposed 18:26 managing their pain as [music] opposed 18:26 managing their pain as [music] opposed to the pain managing them. And back to 18:29 to the pain managing them. And back to 18:29 to the pain managing them. And back to opioids. [music] Um you know opioids are 18:33 opioids. [music] Um you know opioids are 18:33 opioids. [music] Um you know opioids are important in analesics for certain 18:36 important in analesics for certain 18:36 important in analesics for certain situations. [music] They are needed for 18:38 situations. [music] They are needed for 18:38 situations. [music] They are needed for acute pain for terrible you know uh 18:41 acute pain for terrible you know uh 18:42 acute pain for terrible you know uh medical processes at times. [music] If 18:43 medical processes at times. [music] If 18:43 medical processes at times. [music] If you recall my introduction into pain 18:45 you recall my introduction into pain 18:45 you recall my introduction into pain management was acute pain management 18:47 management was acute pain management 18:47 management was acute pain management with with burns and trauma and the 18:50 with with burns and trauma and the 18:50 with with burns and trauma and the peroperative [music] space. So clearly 18:52 peroperative [music] space. So clearly 18:52 peroperative [music] space. So clearly opioids have a role. The mistake that I 18:55 opioids have a role. The mistake that I 18:55 opioids have a role. The mistake that I think we made with our [music] uh 18:57 think we made with our [music] uh 18:57 think we made with our [music] uh approach to chronic pain is just 19:00 approach to chronic pain is just 19:00 approach to chronic pain is just extrapolating lessons from acute pain 19:02 extrapolating lessons from acute pain 19:02 extrapolating lessons from acute pain onto something called chronic pain that 19:05 onto something called chronic pain that 19:05 onto something called chronic pain that is vastly different. Chronic [music] 19:07 is vastly different. Chronic [music] 19:07 is vastly different. Chronic [music] pain you know as defined 3 to 6 months 19:10 pain you know as defined 3 to 6 months 19:10 pain you know as defined 3 to 6 months beyond its original uh you know acute 19:13 beyond its original uh you know acute 19:13 beyond its original uh you know acute pain [music] progenitor is is a very 19:16 pain [music] progenitor is is a very 19:16 pain [music] progenitor is is a very different phenomenon and I think opioids 19:18 different phenomenon and I think opioids 19:18 different phenomenon and I think opioids there have a diminishing role. It's not 19:21 there have a diminishing role. It's not 19:21 there have a diminishing role. It's not a zero role. There are some individuals, 19:23 a zero role. There are some individuals, 19:23 a zero role. There are some individuals, although very rarely, that may need 19:25 although very rarely, that may need 19:25 although very rarely, that may need opioids, [music] but time and time 19:28 opioids, [music] but time and time 19:28 opioids, [music] but time and time again, we have learned that there are 19:30 again, we have learned that there are 19:30 again, we have learned that there are more cons than pros to continuing 19:32 more cons than pros to continuing 19:32 more cons than pros to continuing opioids in chronic pain. They may 19:36 opioids in chronic pain. They may 19:36 opioids in chronic pain. They may restore function in a few individuals, 19:38 restore function in a few individuals, 19:38 restore function in a few individuals, but by and [music] large, they 19:40 but by and [music] large, they 19:40 but by and [music] large, they contribute to a host of other problems. 19:42 contribute to a host of other problems. 19:42 contribute to a host of other problems. And I won't even focus on [music] the 19:44 And I won't even focus on [music] the 19:44 And I won't even focus on [music] the highly publicized ones like addiction or 19:47 highly publicized ones like addiction or 19:47 highly publicized ones like addiction or overdoses. Those are extreme examples. 19:50 overdoses. Those are extreme examples. 19:50 overdoses. Those are extreme examples. Even though they're very important, even 19:52 Even though they're very important, even 19:52 Even though they're very important, even within pain management, opioids [music] 19:55 within pain management, opioids [music] 19:55 within pain management, opioids [music] actually are known to cause 19:58 actually are known to cause 19:58 actually are known to cause paradoxically worse pain [music] through 20:00 paradoxically worse pain [music] through 20:00 paradoxically worse pain [music] through opioid induced hyperalesia or 20:03 opioid induced hyperalesia or 20:03 opioid induced hyperalesia or upregulation, if you will, strengthening 20:05 upregulation, if you will, strengthening 20:05 upregulation, if you will, strengthening of pain pathways. [music] And so, 20:08 of pain pathways. [music] And so, 20:08 of pain pathways. [music] And so, paradoxically, this tool that we have 20:10 paradoxically, this tool that we have 20:10 paradoxically, this tool that we have all hoped would be, you know, very 20:13 all hoped would be, you know, very 20:13 all hoped would be, you know, very effective in chronic pain can be uh 20:15 effective in chronic pain can be uh 20:15 effective in chronic pain can be uh backfiring in a number of individuals. 20:17 backfiring in a number of individuals. 20:17 backfiring in a number of individuals. And I see time and time again that 20:20 And I see time and time again that 20:20 And I see time and time again that [music] you know either diminishing or 20:21 [music] you know either diminishing or 20:21 [music] you know either diminishing or detoxing eliminating the opioids safely 20:24 detoxing eliminating the opioids safely 20:24 detoxing eliminating the opioids safely and judiciously can be a huge component 20:27 and judiciously can be a huge component 20:27 and judiciously can be a huge component of the recovery [music] process for 20:29 of the recovery [music] process for 20:29 of the recovery [music] process for individuals with chronic pain. Not 20:31 individuals with chronic pain. Not 20:31 individuals with chronic pain. Not always the only one but a big [music] 20:33 always the only one but a big [music] 20:33 always the only one but a big [music] part of it. Um in in that in that space 20:37 part of it. Um in in that in that space 20:37 part of it. Um in in that in that space we have to of course educate patients 20:39 we have to of course educate patients 20:39 we have to of course educate patients [music] as to why this is you know 20:41 [music] as to why this is you know 20:41 [music] as to why this is you know necessary or important to think about. 20:43 necessary or important to think about. 20:43 necessary or important to think about. We also educate going back to the 20:45 We also educate going back to the 20:45 We also educate going back to the descending pain pathway and our own 20:47 descending pain pathway and our own 20:48 descending pain pathway and our own endogenous pain relieving [music] 20:49 endogenous pain relieving [music] 20:49 endogenous pain relieving [music] pathways. We have to educate about how 20:51 pathways. We have to educate about how 20:51 pathways. We have to educate about how that pathway has been weakened actually 20:53 that pathway has been weakened actually 20:53 that pathway has been weakened actually by chronic opioids. If you're taking 20:56 by chronic opioids. If you're taking 20:56 by chronic opioids. If you're taking opioids [music] from the outside, your 20:57 opioids [music] from the outside, your 20:57 opioids [music] from the outside, your own endorphins are going to take a 20:59 own endorphins are going to take a 20:59 own endorphins are going to take a backseat. Let's get [music] those 21:01 backseat. Let's get [music] those 21:01 backseat. Let's get [music] those indogenous endorphins back online. So, I 21:04 indogenous endorphins back online. So, I 21:04 indogenous endorphins back online. So, I talk about all of this neurobiology 21:06 talk about all of this neurobiology 21:06 talk about all of this neurobiology to make it clear this is a medical 21:09 to make it clear this is a medical 21:09 to make it clear this is a medical intervention. This isn't about, you 21:11 intervention. This isn't about, you 21:11 intervention. This isn't about, you know, [music] 21:11 know, [music] 21:12 know, [music] being afraid of the government and 21:13 being afraid of the government and 21:13 being afraid of the government and policy and and preventing addiction. 21:16 policy and and preventing addiction. 21:16 policy and and preventing addiction. It's more it's more about helping 21:19 It's more it's more about helping 21:19 It's more it's more about helping somebody's actual pain condition. And so 21:22 somebody's actual pain condition. And so 21:22 somebody's actual pain condition. And so [music] to answer your question, I think 21:23 [music] to answer your question, I think 21:23 [music] to answer your question, I think opioids have a diminishing role in
Trauma, Nervous System, and Chronic Pain 21:26 opioids have a diminishing role in 21:26 opioids have a diminishing role in chronic pain next to or near zero. 21:29 chronic pain next to or near zero. 21:29 chronic pain next to or near zero. [music] Uh but I I I don't want to say 21:31 [music] Uh but I I I don't want to say 21:31 [music] Uh but I I I don't want to say zero. There are some outliers and and 21:34 zero. There are some outliers and and 21:34 zero. There are some outliers and and [music] so we need to think about 21:35 [music] so we need to think about 21:35 [music] so we need to think about everything else that can be entertained 21:37 everything else that can be entertained 21:37 everything else that can be entertained and not just other medications. [music] 21:39 and not just other medications. [music] 21:39 and not just other medications. [music] Of course, there are other strategies 21:41 Of course, there are other strategies 21:41 Of course, there are other strategies through physical, psychological 21:43 through physical, psychological 21:43 through physical, psychological rehabilitation [music] 21:44 rehabilitation [music] 21:44 rehabilitation [music] and and so on and so forth. 21:48 and and so on and so forth. 21:48 and and so on and so forth. >> Wow, that's that's amazing. You recently 21:52 >> Wow, that's that's amazing. You recently 21:52 >> Wow, that's that's amazing. You recently shared [music] 21:53 shared [music] 21:53 shared [music] uh a video on YouTube and Instagram. I 21:56 uh a video on YouTube and Instagram. I 21:56 uh a video on YouTube and Instagram. I love your videos and you know, keep 21:59 love your videos and you know, keep 21:59 love your videos and you know, keep going, Dr. X. It's [music] great. 22:01 going, Dr. X. It's [music] great. 22:01 going, Dr. X. It's [music] great. um about helping people discontinue 22:05 um about helping people discontinue 22:05 um about helping people discontinue [music] 22:06 [music] 22:06 [music] opioids uh utilizing a biocschosocial 22:10 opioids uh utilizing a biocschosocial 22:10 opioids uh utilizing a biocschosocial lens. Can you [music] 22:11 lens. Can you [music] 22:12 lens. Can you [music] enlighten us about this approach? I I 22:14 enlighten us about this approach? I I 22:14 enlighten us about this approach? I I know that it's very similar [music] to 22:15 know that it's very similar [music] to 22:15 know that it's very similar [music] to what to what we're looking at as well 22:18 what to what we're looking at as well 22:18 what to what we're looking at as well and uh I'm really really fascinated to 22:21 and uh I'm really really fascinated to 22:21 and uh I'm really really fascinated to see you know how you bring that about. 22:24 see you know how you bring that about. 22:24 see you know how you bring that about. >> Sure. Thank you. Um, I I encourage 22:27 >> Sure. Thank you. Um, I I encourage 22:27 >> Sure. Thank you. Um, I I encourage anyone who's interested to see the 22:30 anyone who's interested to see the 22:30 anyone who's interested to see the videos, but essentially, as I just 22:32 videos, but essentially, as I just 22:32 videos, but essentially, as I just alluded to, stopping chronic opioids in 22:35 alluded to, stopping chronic opioids in 22:36 alluded to, stopping chronic opioids in chronic pain is is not a [music] a 22:38 chronic pain is is not a [music] a 22:38 chronic pain is is not a [music] a simple task. It requires some careful 22:41 simple task. It requires some careful 22:41 simple task. It requires some careful consideration of all of the factors 22:43 consideration of all of the factors 22:43 consideration of all of the factors involved. What I alluded to earlier in 22:45 involved. What I alluded to earlier in 22:45 involved. What I alluded to earlier in terms of pain experience, 22:47 terms of pain experience, 22:47 terms of pain experience, um, [music] other 22:49 um, [music] other 22:49 um, [music] other >> thought processes, comorbid or you know, 22:52 >> thought processes, comorbid or you know, 22:52 >> thought processes, comorbid or you know, accompanying conditions. So it needs to 22:55 accompanying conditions. So it needs to 22:55 accompanying conditions. So it needs to be taken very seriously and carefully. 22:56 be taken very seriously and carefully. 22:56 be taken very seriously and carefully. [music] 22:57 [music] 22:57 [music] There are no shortcuts. They say 22:59 There are no shortcuts. They say 22:59 There are no shortcuts. They say famously with opioid discontinuation. 23:02 famously with opioid discontinuation. 23:02 famously with opioid discontinuation. And it what I say as a very first thing 23:05 And it what I say as a very first thing 23:05 And it what I say as a very first thing [music] to individuals who are grappling 23:07 [music] to individuals who are grappling 23:07 [music] to individuals who are grappling with this question, should I continue? 23:08 with this question, should I continue? 23:08 with this question, should I continue? Should I not? Is I say to them, you 23:10 Should I not? Is I say to them, you 23:10 Should I not? Is I say to them, you know, you've been on chronic opioids for 23:12 know, you've been on chronic opioids for 23:12 know, you've been on chronic opioids for [music] four years, 10 years, 15 years, 23:15 [music] four years, 10 years, 15 years, 23:15 [music] four years, 10 years, 15 years, whatever the duration is. is [music] the 23:17 whatever the duration is. is [music] the 23:17 whatever the duration is. is [music] the question I pose to them is would you be 23:19 question I pose to them is would you be 23:19 question I pose to them is would you be willing to entertain something much 23:22 willing to entertain something much 23:22 willing to entertain something much shorter than that a couple of [music] 23:23 shorter than that a couple of [music] 23:23 shorter than that a couple of [music] months maybe even less as a process to 23:26 months maybe even less as a process to 23:26 months maybe even less as a process to get off of these opioids. It took a long 23:29 get off of these opioids. It took a long 23:29 get off of these opioids. It took a long time to get us here. [music] Would you 23:30 time to get us here. [music] Would you 23:30 time to get us here. [music] Would you be open to something briefer than four 23:34 be open to something briefer than four 23:34 be open to something briefer than four years, 10 years, [music] 8 years? And 23:36 years, 10 years, [music] 8 years? And 23:36 years, 10 years, [music] 8 years? And and most patients, you know, agree with 23:38 and most patients, you know, agree with 23:38 and most patients, you know, agree with that. And to get back to the 23:40 that. And to get back to the 23:40 that. And to get back to the biocschosocial meat of the matter, it 23:42 biocschosocial meat of the matter, it 23:42 biocschosocial meat of the matter, it really is attending to the biological, 23:44 really is attending to the biological, 23:44 really is attending to the biological, psychological, [music] and the social 23:46 psychological, [music] and the social 23:46 psychological, [music] and the social all at once. It's a balancing act. And 23:49 all at once. It's a balancing act. And 23:49 all at once. It's a balancing act. And we have to hold all of these at once. So 23:51 we have to hold all of these at once. So 23:51 we have to hold all of these at once. So the biological part would be of course 23:53 the biological part would be of course 23:53 the biological part would be of course [music] safely discontinuing the 23:55 [music] safely discontinuing the 23:55 [music] safely discontinuing the medications over time, thinking about 23:58 medications over time, thinking about 23:58 medications over time, thinking about alternative medications either 24:00 alternative medications either 24:00 alternative medications either transiently, temporarily or long-term 24:02 transiently, temporarily or long-term 24:02 transiently, temporarily or long-term [music] 24:03 [music] 24:03 [music] that have less effects than than opioids 24:06 that have less effects than than opioids 24:06 that have less effects than than opioids and and helping manage that pain 24:08 and and helping manage that pain 24:08 and and helping manage that pain appropriately, biologically, if you 24:11 appropriately, biologically, if you 24:11 appropriately, biologically, if you will. And by the way, I I've also 24:12 will. And by the way, I I've also 24:12 will. And by the way, I I've also trained in interventionals, [music] 24:14 trained in interventionals, [music] 24:14 trained in interventionals, [music] you know, anesthesia, nerve blocks, all 24:16 you know, anesthesia, nerve blocks, all 24:16 you know, anesthesia, nerve blocks, all of that. So I also incorporate that when 24:18 of that. So I also incorporate that when 24:18 of that. So I also incorporate that when [music] the time is is is right for 24:20 [music] the time is is is right for 24:20 [music] the time is is is right for that. Psychologically there's quite a 24:23 that. Psychologically there's quite a 24:23 that. Psychologically there's quite a bit of work that needs to [music] be 24:24 bit of work that needs to [music] be 24:24 bit of work that needs to [music] be done around the individual's again pain 24:27 done around the individual's again pain 24:27 done around the individual's again pain experience, their fear of discontinuing 24:29 experience, their fear of discontinuing 24:29 experience, their fear of discontinuing opioids, [music] their fear of pain 24:31 opioids, [music] their fear of pain 24:31 opioids, [music] their fear of pain returning. These variables cannot be 24:34 returning. These variables cannot be 24:34 returning. These variables cannot be ignored. You have to anticipate [music] 24:36 ignored. You have to anticipate [music] 24:36 ignored. You have to anticipate [music] them and say they're going to come up, 24:39 them and say they're going to come up, 24:39 them and say they're going to come up, but also educate individuals in ways 24:42 but also educate individuals in ways 24:42 but also educate individuals in ways that they're prepared. [music] For 24:43 that they're prepared. [music] For 24:43 that they're prepared. [music] For instance, one important uh dimension for 24:46 instance, one important uh dimension for 24:46 instance, one important uh dimension for individuals to think about 24:47 individuals to think about 24:47 individuals to think about psychologically is [music] they need to 24:49 psychologically is [music] they need to 24:49 psychologically is [music] they need to understand that sometimes when something 24:50 understand that sometimes when something 24:50 understand that sometimes when something hurts, it doesn't actually mean that it 24:53 hurts, it doesn't actually mean that it 24:53 hurts, it doesn't actually mean that it is harming them. [music] That hurt and 24:55 is harming them. [music] That hurt and 24:55 is harming them. [music] That hurt and harm distinction is critical. That's a a 24:58 harm distinction is critical. That's a a 24:58 harm distinction is critical. That's a a very important [music] 24:59 very important [music] 24:59 very important [music] psychological 25:01 psychological 25:01 psychological space to reside in for a moment so that 25:03 space to reside in for a moment so that 25:03 space to reside in for a moment so that individuals don't get paralyzed by the 25:06 individuals don't get paralyzed by the 25:06 individuals don't get paralyzed by the fear [music] 25:07 fear [music] 25:07 fear [music] of something harming them. Um, and 25:10 of something harming them. Um, and 25:10 of something harming them. Um, and remember harm has connotations to 25:13 remember harm has connotations to 25:13 remember harm has connotations to [music] trauma, injustice, other things 25:15 [music] trauma, injustice, other things 25:15 [music] trauma, injustice, other things that scare really anyone, but in 25:18 that scare really anyone, but in 25:18 that scare really anyone, but in particular individuals who might have 25:20 particular individuals who might have 25:20 particular individuals who might have been harmed before. [music] 25:22 been harmed before. [music] 25:22 been harmed before. [music] So hurt alone, although it's unpleasant, 25:25 So hurt alone, although it's unpleasant, 25:25 So hurt alone, although it's unpleasant, doesn't equate to harm. So [music] 25:27 doesn't equate to harm. So [music] 25:27 doesn't equate to harm. So [music] that's you know the the beginning if you 25:29 that's you know the the beginning if you 25:29 that's you know the the beginning if you will or one major component of 25:31 will or one major component of 25:31 will or one major component of understanding the psychology [music] of 25:34 understanding the psychology [music] of 25:34 understanding the psychology [music] of coming off of of opioids and the rebound 25:36 coming off of of opioids and the rebound 25:36 coming off of of opioids and the rebound pain and withdrawal and things of 25:38 pain and withdrawal and things of 25:38 pain and withdrawal and things of [music] that sort. And then the social 25:40 [music] that sort. And then the social 25:40 [music] that sort. And then the social part is very important too. You know 25:42 part is very important too. You know 25:42 part is very important too. You know individuals really need to feel 25:43 individuals really need to feel 25:43 individuals really need to feel supported through this not just through 25:44 supported through this not just through 25:44 supported through this not just through our healthc care connections but family 25:48 our healthc care connections but family 25:48 our healthc care connections but family community [music] 25:48 community [music] 25:48 community [music] friends. They may have developed all 25:51 friends. They may have developed all 25:51 friends. They may have developed all sorts of social patterns over the years 25:53 sorts of social patterns over the years 25:53 sorts of social patterns over the years that are now being challenged [music] 25:55 that are now being challenged [music] 25:55 that are now being challenged [music] and disentangled. 25:56 and disentangled. 25:56 and disentangled. Their life may have become quite small 25:59 Their life may have become quite small 25:59 Their life may have become quite small uh due to chronic pain and chronic 26:01 uh due to chronic pain and chronic 26:01 uh due to chronic pain and chronic [music] pain disability. And now instead 26:03 [music] pain disability. And now instead 26:03 [music] pain disability. And now instead we're actually inviting individuals to 26:05 we're actually inviting individuals to 26:05 we're actually inviting individuals to get out in the world and be more active 26:06 get out in the world and be more active 26:06 get out in the world and be more active [music] and make social connections. So 26:09 [music] and make social connections. So 26:09 [music] and make social connections. So these are just a few examples of the 26:11 these are just a few examples of the 26:11 these are just a few examples of the biological, [music] 26:12 biological, [music] 26:12 biological, [music] psychological, and social elements that 26:14 psychological, and social elements that 26:14 psychological, and social elements that are needed for individuals that are 26:16 are needed for individuals that are 26:16 are needed for individuals that are going to come off of chronic opioids. 26:18 going to come off of chronic opioids. 26:18 going to come off of chronic opioids. [music] But of course, each case is 26:20 [music] But of course, each case is 26:20 [music] But of course, each case is individual. Some may need different 26:23 individual. Some may need different 26:23 individual. Some may need different medications. [music] Some may need 26:25 medications. [music] Some may need 26:25 medications. [music] Some may need cognitive behavioral therapy, 26:27 cognitive behavioral therapy, 26:27 cognitive behavioral therapy, motivational interviewing, things of 26:29 motivational interviewing, things of 26:29 motivational interviewing, things of [music] that sort in the psychological 26:31 [music] that sort in the psychological 26:31 [music] that sort in the psychological bucket. And then socially, of course, uh 26:33 bucket. And then socially, of course, uh 26:33 bucket. And then socially, of course, uh you know, family interventions and 26:35 you know, family interventions and 26:35 you know, family interventions and social interventions. [music] 26:37 social interventions. [music] 26:37 social interventions. [music] >> Yeah. It really needs to be tailored to 26:38 >> Yeah. It really needs to be tailored to 26:38 >> Yeah. It really needs to be tailored to the individual, doesn't it? 26:42 the individual, doesn't it? 26:42 the individual, doesn't it? >> Yeah. and and I guess too [music] 26:45 >> Yeah. and and I guess too [music] 26:45 >> Yeah. and and I guess too [music] um you know they've got to start to gain 26:48 um you know they've got to start to gain 26:48 um you know they've got to start to gain confidence that um they can actually 26:51 confidence that um they can actually 26:51 confidence that um they can actually start to reduce these medications and 26:53 start to reduce these medications and 26:53 start to reduce these medications and that's something that [music] we do um I 26:56 that's something that [music] we do um I 26:56 that's something that [music] we do um I think quite well in that we we find a 27:00 think quite well in that we we find a 27:00 think quite well in that we we find a medication because they're usually on 27:02 medication because they're usually on 27:02 medication because they're usually on multiple [music] different medications 27:05 multiple [music] different medications 27:05 multiple [music] different medications and usually very high doses. Uh what we 27:09 and usually very high doses. Uh what we 27:09 and usually very high doses. Uh what we found is that if [music] you can find a 27:12 found is that if [music] you can find a 27:12 found is that if [music] you can find a medication that they might have uh 27:14 medication that they might have uh 27:14 medication that they might have uh missed at some time and found that it 27:17 missed at some time and found that it 27:17 missed at some time and found that it didn't really make much difference, 27:19 didn't really make much difference, 27:19 didn't really make much difference, uh that's what we we tend to start with 27:22 uh that's what we we tend to start with 27:22 uh that's what we we tend to start with and they they [music] it might be 27:24 and they they [music] it might be 27:24 and they they [music] it might be something like uh you know the 27:26 something like uh you know the 27:26 something like uh you know the gabapentenoids or even um uh 27:29 gabapentenoids or even um uh 27:29 gabapentenoids or even um uh anti-inflammatories. 27:31 anti-inflammatories. 27:31 anti-inflammatories. So, uh, we know that anti-inflammatories 27:34 So, uh, we know that anti-inflammatories 27:34 So, uh, we know that anti-inflammatories aren't very effective for, [music] you 27:36 aren't very effective for, [music] you 27:36 aren't very effective for, [music] you know, for chronic pain because there's 27:38 know, for chronic pain because there's 27:38 know, for chronic pain because there's really no, um, tissue inflammation at 27:41 really no, um, tissue inflammation at 27:42 really no, um, tissue inflammation at that time. Um, and so what we get them 27:47 that time. Um, and so what we get them 27:47 that time. Um, and so what we get them to do is to start reducing one slowly 27:51 to do is to start reducing one slowly 27:51 to do is to start reducing one slowly that uh that [music] hasn't been very 27:54 that uh that [music] hasn't been very 27:54 that uh that [music] hasn't been very effective for them and see that it's not 27:56 effective for them and see that it's not 27:56 effective for them and see that it's not really making much difference as they're 27:59 really making much difference as they're 27:59 really making much difference as they're going off and they start to get quite 28:01 going off and they start to get quite 28:01 going off and they start to get quite confident of being able to do that and 28:03 confident of being able to do that and 28:04 confident of being able to do that and then they can work on the more difficult 28:05 then they can work on the more difficult 28:05 then they can work on the more difficult [music] medications afterwards with that 28:08 [music] medications afterwards with that 28:08 [music] medications afterwards with that support around them that you were just 28:11 support around them that you were just 28:11 support around them that you were just talking about. I think this re really 28:14 talking about. I think this re really 28:14 talking about. I think this re really leads straight into my next [music] 28:16 leads straight into my next [music] 28:16 leads straight into my next [music] question. Um, and that is, you know, 28:19 question. Um, and that is, you know, 28:19 question. Um, and that is, you know, emotional trauma. Does this really set 28:22 emotional trauma. Does this really set 28:22 emotional trauma. Does this really set our nervous systems up for chronic pain? 28:24 our nervous systems up for chronic pain? 28:24 our nervous systems up for chronic pain? [music] Especially in childhood and, you 28:27 [music] Especially in childhood and, you 28:27 [music] Especially in childhood and, you know, this sort of um physical and 28:30 know, this sort of um physical and 28:30 know, this sort of um physical and emotional trauma. You know, the the mind 28:32 emotional trauma. You know, the the mind 28:32 emotional trauma. You know, the the mind and the body, we we [music] just can't 28:35 and the body, we we [music] just can't 28:35 and the body, we we [music] just can't separate. 28:37 separate. 28:37 separate. >> Yeah. I I I love this topic. It's a 28:40 >> Yeah. I I I love this topic. It's a 28:40 >> Yeah. I I I love this topic. It's a complex one and yet not at the same time 28:43 complex one and yet not at the same time 28:43 complex one and yet not at the same time because you're right, the mind and the 28:44 because you're right, the mind and the 28:44 because you're right, the mind and the body can't be separated. [music] 28:46 body can't be separated. [music] 28:46 body can't be separated. [music] The short answer to that question, my 28:49 The short answer to that question, my 28:49 The short answer to that question, my visceral reaction is not exactly but 28:52 visceral reaction is not exactly but 28:52 visceral reaction is not exactly but sort of. 28:53 sort of. 28:53 sort of. >> Yeah. 28:53 >> Yeah. 28:53 >> Yeah. >> So, [music] um, clear as mud, right? Um, 28:56 >> So, [music] um, clear as mud, right? Um, 28:56 >> So, [music] um, clear as mud, right? Um, >> yeah. 28:57 >> yeah. 28:57 >> yeah. >> Emotional or physical trauma, early 29:01 >> Emotional or physical trauma, early 29:01 >> Emotional or physical trauma, early development, [music] 29:03 development, [music] 29:03 development, [music] childhood, etc. These adversities that 29:05 childhood, etc. These adversities that 29:05 childhood, etc. These adversities that we sometimes refer to as adverse 29:07 we sometimes refer to as adverse 29:07 we sometimes refer to as adverse childhood experiences, etc. 29:09 childhood experiences, etc. 29:09 childhood experiences, etc. absolutely [music] shape the nervous 29:11 absolutely [music] shape the nervous 29:11 absolutely [music] shape the nervous system and by that I mean the central 29:14 system and by that I mean the central 29:14 system and by that I mean the central nervous system primes the central 29:17 nervous system primes the central 29:17 nervous system primes the central nervous system [music] to be on high 29:19 nervous system [music] to be on high 29:19 nervous system [music] to be on high alert. Um it shapes our autonomic 29:22 alert. Um it shapes our autonomic 29:22 alert. Um it shapes our autonomic nervous system, our fight-flight 29:23 nervous system, our fight-flight 29:24 nervous system, our fight-flight pathways. Absolutely. [music] This has 29:26 pathways. Absolutely. [music] This has 29:26 pathways. Absolutely. [music] This has been shown 29:28 been shown 29:28 been shown numerous times and there are downstream 29:30 numerous times and there are downstream 29:30 numerous times and there are downstream health consequences from this and this 29:32 health consequences from this and this 29:32 health consequences from this and this is where 29:33 is where 29:33 is where >> the causing of chronic pain is where it 29:36 >> the causing of chronic pain is where it 29:36 >> the causing of chronic pain is where it gets complex. There are some individuals 29:38 gets complex. There are some individuals 29:38 gets complex. There are some individuals who have had adverse childhood 29:40 who have had adverse childhood 29:40 who have had adverse childhood experiences, trauma, 29:41 experiences, trauma, 29:41 experiences, trauma, >> [music] 29:41 >> [music] 29:41 >> [music] >> etc. and don't develop chronic pain. 29:44 >> etc. and don't develop chronic pain. 29:44 >> etc. and don't develop chronic pain. >> And then there are others who have 29:46 >> And then there are others who have 29:46 >> And then there are others who have [music] quite a bit of that and it seems 29:48 [music] quite a bit of that and it seems 29:48 [music] quite a bit of that and it seems to be an important ingredient in the 29:50 to be an important ingredient in the 29:50 to be an important ingredient in the development of chronic [music] pain. Um 29:53 development of chronic [music] pain. Um 29:53 development of chronic [music] pain. Um the chronification of pain is an is a 29:56 the chronification of pain is an is a 29:56 the chronification of pain is an is a fascinating area of study. When [music] 29:58 fascinating area of study. When [music] 29:58 fascinating area of study. When [music] we crack that nut, if you will, and 30:01 we crack that nut, if you will, and 30:01 we crack that nut, if you will, and figure that out, then we'll really be 30:03 figure that out, then we'll really be 30:03 figure that out, then we'll really be able to [music] prevent, you know, 30:05 able to [music] prevent, you know, 30:05 able to [music] prevent, you know, chronic pain hopefully. But what we have 30:07 chronic pain hopefully. But what we have 30:07 chronic pain hopefully. But what we have seen is enormous rates, sadly, enormous 30:10 seen is enormous rates, sadly, enormous 30:10 seen is enormous rates, sadly, enormous rates of developmental trauma [music] 30:12 rates of developmental trauma [music] 30:12 rates of developmental trauma [music] and childhood adverse experiences in 30:15 and childhood adverse experiences in 30:15 and childhood adverse experiences in those with severe chronic disabling 30:17 those with severe chronic disabling 30:17 those with severe chronic disabling pain. It's not the only thing or the 30:20 pain. It's not the only thing or the 30:20 pain. It's not the only thing or the only factor involved, [music] but it 30:22 only factor involved, [music] but it 30:22 only factor involved, [music] but it certainly sets up the central nervous 30:24 certainly sets up the central nervous 30:24 certainly sets up the central nervous system to be on high alert 30:26 system to be on high alert 30:26 system to be on high alert >> [music] 30:27 >> [music] 30:27 >> [music] >> uh to recover uh poorly or not at all 30:30 >> uh to recover uh poorly or not at all 30:30 >> uh to recover uh poorly or not at all sometimes to stimuli and to have fight 30:33 sometimes to stimuli and to have fight 30:33 sometimes to stimuli and to have fight orflight reactions that just [music] do 30:35 orflight reactions that just [music] do 30:35 orflight reactions that just [music] do not help with the ultimate pain 30:37 not help with the ultimate pain 30:37 not help with the ultimate pain experience we were describing earlier. 30:39 experience we were describing earlier. 30:39 experience we were describing earlier. So somebody without trauma, somebody 30:41 So somebody without trauma, somebody 30:41 So somebody without trauma, somebody [music] with trauma, they they both go 30:44 [music] with trauma, they they both go 30:44 [music] with trauma, they they both go through the same car accident, have 30:47 through the same car accident, have 30:47 through the same car accident, have whiplash, let's say, [music] or same 30:49 whiplash, let's say, [music] or same 30:49 whiplash, let's say, [music] or same surgery. 30:50 surgery. 30:50 surgery. You know, the one with trauma is going 30:53 You know, the one with trauma is going 30:53 You know, the one with trauma is going to be in heightened sense of of [music] 30:55 to be in heightened sense of of [music] 30:55 to be in heightened sense of of [music] vigilance and have downstream problems 30:57 vigilance and have downstream problems 30:57 vigilance and have downstream problems from that, the other one, while it was 31:00 from that, the other one, while it was 31:00 from that, the other one, while it was unpleasant as well, uh may not have that 31:02 unpleasant as well, uh may not have that 31:02 unpleasant as well, uh may not have that experience. And that alone can make the 31:04 experience. And that alone can make the 31:04 experience. And that alone can make the [music] difference in terms of recovery. 31:07 [music] difference in terms of recovery. 31:08 [music] difference in terms of recovery. >> Yeah. Yeah. And we've seen that um you 31:10 >> Yeah. Yeah. And we've seen that um you 31:10 >> Yeah. Yeah. And we've seen that um you know published over and over again and I 31:13 know published over and over again and I 31:13 know published over and over again and I [music] think uh professor um Michael 31:16 [music] think uh professor um Michael 31:16 [music] think uh professor um Michael Sullivan from Canada uh has published on 31:19 Sullivan from Canada uh has published on 31:19 Sullivan from Canada uh has published on this quite a lot in particular uh the 31:22 this quite a lot in particular uh the 31:22 this quite a lot in particular uh the learned [music] catastrophizing 31:24 learned [music] catastrophizing 31:24 learned [music] catastrophizing behaviors that that people develop when 31:27 behaviors that that people develop when 31:27 behaviors that that people develop when [music] they've been through these sorts 31:28 [music] they've been through these sorts 31:28 [music] they've been through these sorts of trauma but also the way that they've 31:32 of trauma but also the way that they've 31:32 of trauma but also the way that they've um you know maybe grown up in their 31:34 um you know maybe grown up in their 31:34 um you know maybe grown up in their their uh 31:36 their uh 31:36 their uh >> [music] 31:36 >> [music] 31:36 >> [music] >> um you know social environment. ment uh 31:39 >> um you know social environment. ment uh 31:39 >> um you know social environment. ment uh as well. So those learned behaviors of a 31:43 as well. So those learned behaviors of a 31:43 as well. So those learned behaviors of a copic um [music] responses, but also to 31:47 copic um [music] responses, but also to 31:47 copic um [music] responses, but also to um perceived injustice is something that 31:50 um perceived injustice is something that 31:50 um perceived injustice is something that he talks about as [music] well. And uh 31:52 he talks about as [music] well. And uh 31:52 he talks about as [music] well. And uh that's something that we measure in our 31:54 that's something that we measure in our 31:54 that's something that we measure in our program to [music] 31:56 program to [music] 31:56 program to [music] just see how much of the epistemic 31:59 just see how much of the epistemic 31:59 just see how much of the epistemic injustice plays a role [music] in this 32:03 injustice plays a role [music] in this 32:03 injustice plays a role [music] in this uh you know continuation of the 32:05 uh you know continuation of the 32:05 uh you know continuation of the heightened sensitiv [music] sensitivity 32:08 heightened sensitiv [music] sensitivity 32:08 heightened sensitiv [music] sensitivity of the nervous system. 32:10 of the nervous system. 32:10 of the nervous system. Wow. It gets very deep, doesn't it? It's 32:13 Wow. It gets very deep, doesn't it? It's 32:13 Wow. It gets very deep, doesn't it? It's just incredible. And um you know, this 32:16 just incredible. And um you know, this 32:16 just incredible. And um you know, this has just been [music] a truly 32:18 has just been [music] a truly 32:18 has just been [music] a truly inspirational conversation. And thank 32:21 inspirational conversation. And thank 32:21 inspirational conversation. And thank you so much, Savia. Um or Dr. X. I think 32:24 you so much, Savia. Um or Dr. X. I think 32:24 you so much, Savia. Um or Dr. X. I think that's a really really good uh [music] 32:27 that's a really really good uh [music] 32:27 that's a really really good uh [music] um analogy. And then I hope you will 32:30 um analogy. And then I hope you will 32:30 um analogy. And then I hope you will join us again for further insight uh 32:33 join us again for further insight uh 32:33 join us again for further insight uh into chron chronic [music] pain 32:35 into chron chronic [music] pain 32:35 into chron chronic [music] pain management. Thank you so much for 32:37 management. Thank you so much for 32:37 management. Thank you so much for talking with us today. Thank you so 32:39 talking with us today. Thank you so 32:39 talking with us today. Thank you so much. Each of these topics can go on for 32:41 much. Each of these topics can go on for 32:41 much. Each of these topics can go on for an hour and it's a delight. [music] 32:43 an hour and it's a delight. [music] 32:43 an hour and it's a delight. [music] Thank you so much, Kathy. 32:45 Thank you so much, Kathy. 32:45 Thank you so much, Kathy. >> I think we'll be uh we'll be joining 32:47 >> I think we'll be uh we'll be joining 32:47 >> I think we'll be uh we'll be joining forces again and and really digging some 32:50 forces again and and really digging some 32:50 forces again and and really digging some deep into some of these 32:52 deep into some of these 32:52 deep into some of these >> [music] 32:52 >> [music] 32:52 >> [music] >> um other topics. I think there's so much 32:54 >> um other topics. I think there's so much 32:54 >> um other topics. I think there's so much more that we can we can talk about that 32:56 more that we can we can talk about that 32:56 more that we can we can talk about that is valuable for uh for our our [music] 32:59 is valuable for uh for our our [music] 32:59 is valuable for uh for our our [music] participants that are uh going through 33:02 participants that are uh going through 33:02 participants that are uh going through both, you know, both of our programs. 33:04 both, you know, both of our programs. 33:04 both, you know, both of our programs. >> Sign me up. We're allies and I love what 33:06 >> Sign me up. We're allies and I love what 33:06 >> Sign me up. We're allies and I love what you guys are doing with Alio Health. 33:08 you guys are doing with Alio Health. 33:08 you guys are doing with Alio Health. It's very data driven. It's very [music] 33:10 It's very data driven. It's very [music] 33:10 It's very data driven. It's very [music] powerful. Again, you guys are on the 33:13 powerful. Again, you guys are on the 33:14 powerful. Again, you guys are on the sort of on the cusp of something really 33:16 sort of on the cusp of something really 33:16 sort of on the cusp of something really [music] 33:17 [music] 33:17 [music] uh fantastic and empowering individuals. 33:19 uh fantastic and empowering individuals. 33:19 uh fantastic and empowering individuals. And if this can help even one individual 33:21 And if this can help even one individual 33:21 And if this can help even one individual out there, then I've done my job. 33:24 out there, then I've done my job. 33:24 out there, then I've done my job. >> Me [laughter] too. [music] Thank you so 33:27 >> Me [laughter] too. [music] Thank you so 33:27 >> Me [laughter] too. [music] Thank you so much. 33:28 much. 33:28 much. >> Thank you.
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