WEBVTT 1 00:00:00.160 --> 00:00:03.480 The topics and opinions expressed on the following show are solely those of the hosts 2 00:00:03.480 --> 00:00:07.280 and their guests, and not those of W FOURWN Radio It's employees or affiliates. 3 00:00:07.400 --> 00:00:11.119 We make no recommendations or endorsements for radio show programs, services, or 4 00:00:11.160 --> 00:00:15.320 products mentioned on air or on our web. No liability, explicit or implied 5 00:00:15.400 --> 00:00:19.719 shall be extended to W FOURWN Radio It's employees or affiliates. Any questions or 6 00:00:19.719 --> 00:00:23.399 comments should be directed to those show hosts. Thank you for choosing W FOURWN 7 00:00:23.519 --> 00:00:46.759 Radio. Hello and welcome to Fearless Fabulous You. I am your host, 8 00:00:47.039 --> 00:00:51.240 Melanie Young, and you're listening today on the Women for Women Network W four 9 00:00:51.359 --> 00:00:55.439 w N Radio. You can hear all my shows anytime anywhere on your preferred 10 00:00:55.479 --> 00:00:59.520 podcast channel. I'm happy to be in my tenth season and my mission is 11 00:00:59.560 --> 00:01:03.960 to get inside people's heads, particularly for women, to help them make informed, 12 00:01:03.120 --> 00:01:07.599 comfortable choices about their lives and every aspect of it. Today we're going 13 00:01:07.640 --> 00:01:14.280 to talk about a four letter word, and it's used very loosely, as 14 00:01:14.400 --> 00:01:17.719 in, don't be a pain in the you know what, he's such a 15 00:01:17.799 --> 00:01:23.200 pain. I'm in pain. This pains me. It's pain p ai N. 16 00:01:23.959 --> 00:01:29.599 Pain is used very loosely in a lot of ways and a lot of 17 00:01:29.920 --> 00:01:34.400 you know, dialogues, But it's serious business and a lot of people are 18 00:01:34.439 --> 00:01:37.640 in pain. There's physical pain and there's emotional pain. But get this. 19 00:01:38.159 --> 00:01:42.239 According to the Centers of Disease Control the CDC, which I refer to, 20 00:01:42.359 --> 00:01:48.439 always roughly over twenty percent of adults have chronic pain. Okay, so twenty 21 00:01:48.680 --> 00:01:55.680 that's like fifty million people chronic pain. I also notice non Hispanic white adults 22 00:01:55.680 --> 00:02:01.040 were more likely to have chronic pain compared to non Hispanic blacks, and women 23 00:02:01.519 --> 00:02:06.959 have a higher percentage of pain, and women adults are likely more likely to 24 00:02:07.000 --> 00:02:13.039 have about twenty one percent high impact chronic pain pain compared with men. So 25 00:02:13.080 --> 00:02:15.240 again, women get the brunt of it. You know what's going on. 26 00:02:15.719 --> 00:02:20.639 So we're going to talk about pain. Hopefully you are not in pain, 27 00:02:20.960 --> 00:02:23.560 if you are, but if you are, I'm hoping that the show will 28 00:02:23.599 --> 00:02:28.360 help you. I have a pain expert joining me today. She's a PhD 29 00:02:28.439 --> 00:02:32.400 in m d Doctor Andrea Ferland, an Associate professor in the Department of Medicine 30 00:02:32.400 --> 00:02:38.199 at the University of Toronto and a staff physician and senior scientists at the Toronto 31 00:02:38.280 --> 00:02:43.319 Rehabilitation Institute. She's a pain specialist with a YouTube page. It has more 32 00:02:43.319 --> 00:02:46.520 than four hundred and eighty seven thousand subscribers in more than forty two million views, 33 00:02:46.639 --> 00:02:53.680 so she has a following. She's also author of a book just out 34 00:02:53.680 --> 00:02:59.879 called Eight Steps to Conquer Chronic Pain, A Doctor's Guide to long time, 35 00:03:00.120 --> 00:03:05.360 Long life long sorry, long life, long backwards. I'll do that again. 36 00:03:05.400 --> 00:03:10.319 Eight Steps to Conquer Chronic Pain, A Doctor's Guide to life long relief, 37 00:03:12.000 --> 00:03:15.319 lifelong relief. So we're going to cover pain in all its forms, 38 00:03:15.319 --> 00:03:19.800 and also what's not pain, and also why you shouldn't be using that word 39 00:03:19.879 --> 00:03:23.199 so loosely, because it really there are a lot of people feeling pain. 40 00:03:23.319 --> 00:03:29.280 Doctor Ferlin, Welcome to Fearless Fabulous. You. Thank you so much Malanie 41 00:03:29.360 --> 00:03:32.280 for inviting me. Well, I have been reading an e copy of your 42 00:03:32.319 --> 00:03:37.280 book. There's a lot of interesting information in here because I don't think I 43 00:03:37.360 --> 00:03:42.080 know anyone who doesn't have pain of some kind, and we're going to explain 44 00:03:42.159 --> 00:03:46.039 that of some kind. So I want to get to the you know, 45 00:03:46.120 --> 00:03:49.199 the basics, what is pain, how do you define it? What is 46 00:03:49.199 --> 00:03:52.360 pain? And what is not pain? As you note in your book. 47 00:03:53.719 --> 00:03:59.599 Yeah, I think we all know what is pain. It's an unpleasant sensation. 48 00:04:00.759 --> 00:04:05.319 And we all know acute pain from you know, a toothache, earache, 49 00:04:06.439 --> 00:04:13.400 bruise, a fracture, and inflammation and that hurts. So that is 50 00:04:13.520 --> 00:04:18.879 pain. It's it's defined as an unpleasant sensation that is interpreted in the brain, 51 00:04:20.240 --> 00:04:27.240 and that's mostly acute pain, which is not all humans experienced this, 52 00:04:27.439 --> 00:04:32.199 believe it or not. There is a genetic hereditary condition very rare that the 53 00:04:32.279 --> 00:04:36.759 person is born without the ability to a few pain. And those people they 54 00:04:36.959 --> 00:04:43.600 die in young age because they can't protect themselves from harms and diseases and injuries, 55 00:04:45.160 --> 00:04:48.079 physical pain. And we're talking mainly about physical pain, correct, Yes, 56 00:04:48.319 --> 00:04:50.680 this is a lot of emotional pain, which is a whole other thing. 57 00:04:51.959 --> 00:04:57.560 Now you know they are connected. They are connected. We can't separate 58 00:04:57.639 --> 00:05:00.399 the mind from the body, especially in pain. Well, I want to 59 00:05:00.399 --> 00:05:03.600 get to that because that was my name. You know, how does the 60 00:05:03.720 --> 00:05:06.839 mind and body interact with pain? Because you know, a lot of people 61 00:05:06.879 --> 00:05:12.279 say, oh, it's all on your head, you know, sometime always 62 00:05:12.279 --> 00:05:15.360 on your head, can you you know? But you're very clear it's not. 63 00:05:15.720 --> 00:05:18.439 So why don't you delve in that a little bit more. Yeah, 64 00:05:18.519 --> 00:05:24.920 where when we say the pain is a sensation, it means that it is 65 00:05:25.040 --> 00:05:29.120 interpreted by the brain. So it is in the head in some sense, 66 00:05:30.040 --> 00:05:35.000 because you need the brain to interpret and to tell you that it is pain 67 00:05:35.199 --> 00:05:41.639 or not. But when I think when people are gas lighted or they are 68 00:05:43.120 --> 00:05:46.759 not believed, is when a person has chronic pain, which is different from 69 00:05:46.759 --> 00:05:50.199 acute pain. I will explain that in a minute. But they go to 70 00:05:50.519 --> 00:05:55.480 a healthcare professional and they can't find what is wrong, and they do all 71 00:05:55.600 --> 00:05:59.480 kinds of tests, or they are still they're taking a lot of medications, 72 00:05:59.519 --> 00:06:02.399 they're still pain. That's when you know they hear, oh, you must 73 00:06:02.439 --> 00:06:05.800 be imagining this. It must be psychological. It must be in your head. 74 00:06:06.319 --> 00:06:11.600 That's what it's not. Because nobody imagines pain and say I will be 75 00:06:11.680 --> 00:06:15.279 feeling pain today. I want to feel pain, and then they start imagining 76 00:06:15.360 --> 00:06:17.800 pain. Thought, that's not true. That's the main difference. If they 77 00:06:18.000 --> 00:06:24.399 feel pain. If they say I am in pain. Even if we can't 78 00:06:24.439 --> 00:06:28.720 find anything wrong with the body part that is hurting, they are in pain. 79 00:06:28.800 --> 00:06:33.759 So the pain is always real. You talk about chronic pain and acute 80 00:06:33.800 --> 00:06:41.360 pain, right yes, they're different. So how are they different. They 81 00:06:41.360 --> 00:06:46.759 are different in a sense that there are two different conditions. Acute pain is 82 00:06:46.800 --> 00:06:50.600 a signal that you have an injury. For example, if you have a 83 00:06:51.759 --> 00:06:57.920 if you put your toe on fire, and then the inflammation and damage to 84 00:06:58.199 --> 00:07:01.600 this skin because it will be a burn that will hurt, that's a huge 85 00:07:01.680 --> 00:07:08.279 pain. Now, a person may be feeling pain for a long time in 86 00:07:08.399 --> 00:07:12.600 a part of the body. Usually it's the back muscles. It could be 87 00:07:12.800 --> 00:07:17.240 migraines, it could be abdominal pain, it could be an undefined pain that 88 00:07:17.360 --> 00:07:24.439 nobody knows where it's coming from. That is different because chronic pain is constant, 89 00:07:24.759 --> 00:07:29.160 ongoing pain all the time. They feel the pain a part of the 90 00:07:29.279 --> 00:07:33.519 body. But the pain is different now because the thing is the disease. 91 00:07:33.720 --> 00:07:36.439 Let me let me explain this. I talk about this in the book. 92 00:07:36.600 --> 00:07:40.480 It's the alarm system of the house. I think when I explained the alarm 93 00:07:40.560 --> 00:07:44.839 system, people understand better. So when you install an alarm system in a 94 00:07:44.920 --> 00:07:49.199 house, you wanted to alert if there's a fire, burglar, a leak 95 00:07:49.279 --> 00:07:54.839 in the basement, something wrong. So you install sensors and the sensors can 96 00:07:54.920 --> 00:08:01.079 be like a smoke detector or burglar breaking detector. So acute pain is that 97 00:08:01.399 --> 00:08:07.720 the sensors are working normally and if the aligm makes noise goes off, it's 98 00:08:07.720 --> 00:08:11.360 because something's broken, damage or lesions. There is a problem there. You 99 00:08:11.439 --> 00:08:16.360 need to call the fire truck, the police, or the ambulance. Now, 100 00:08:16.360 --> 00:08:22.560 when a person has pain, chronic pain, it's similar to the alignming 101 00:08:22.600 --> 00:08:28.079 system is malfunctioning. So there is a problem because it needs to be fixed. 102 00:08:28.319 --> 00:08:33.200 They're not imagining there is a real noise. The problem is not that 103 00:08:33.799 --> 00:08:35.200 they don't need to call the ambulance, firetruck, the police. Now they 104 00:08:35.279 --> 00:08:41.279 have to call a different person. They need to call the alarm company to 105 00:08:41.519 --> 00:08:46.120 fix the pain system. In the majority of cases of chronic pain, that's 106 00:08:46.120 --> 00:08:50.360 where the problem is. Because the initial injury has healed, the disease is 107 00:08:50.440 --> 00:08:54.399 gone, it's treated, but they continue feeling pain. It's because the pain 108 00:08:54.519 --> 00:08:58.840 system is sensitized and they need to really train the pain system. So that 109 00:09:00.000 --> 00:09:03.799 that's why we say the treatment for a cute pain is different from from chronic 110 00:09:03.679 --> 00:09:09.679 and some things that work for a cute doesn't work for chronic. It's interesting 111 00:09:09.960 --> 00:09:13.960 and it is a big misconception. I was looking at her. I do 112 00:09:13.039 --> 00:09:16.320 a little research for every show, and I looked at the biggest misconceptions at 113 00:09:16.879 --> 00:09:22.360 pain. That was one of them, because yeah, a lot of people 114 00:09:22.399 --> 00:09:26.159 also think that pain is a thermometer, that something is wrong. And I 115 00:09:26.279 --> 00:09:31.720 think when you ask me what pain is not thing is not a good thermometer 116 00:09:31.799 --> 00:09:35.759 because a person may have a lot of injury not feel any pain and a 117 00:09:35.840 --> 00:09:39.200 lot of another person may not have any injury and feel a lot of pins, 118 00:09:39.200 --> 00:09:43.360 So it's not a good thermometer. That how the amount of damage. 119 00:09:45.159 --> 00:09:50.039 Are sensitivity to pain hereditary or I mean some I know some people like my 120 00:09:50.159 --> 00:09:52.960 mother was sensitive to pain. God loves you know. Other people are not 121 00:09:54.039 --> 00:09:56.559 sensitive to pain. And some people say you have to grin and bear it. 122 00:09:56.720 --> 00:10:00.639 Let's talk about pain sensitivity and when you really it's not called the Grand 123 00:10:00.639 --> 00:10:05.399 and Barret. Yeah, there's a lot of research in this area. It's 124 00:10:05.559 --> 00:10:11.720 very interesting. Women is more Usually women is more sensitive to pain than men. 125 00:10:13.279 --> 00:10:20.080 So we know this in female animals. In humans, it's consistent women 126 00:10:20.279 --> 00:10:22.759 is more sensitive. We don't know why. We don't know if it's because 127 00:10:22.799 --> 00:10:26.960 of these sexual hormones, if it's because of the genetic composition. Actually we 128 00:10:28.039 --> 00:10:31.519 don't know why, but all the laboratory studies they come to the same conclusion. 129 00:10:31.960 --> 00:10:39.360 But there is also big variability in the population in general. They do 130 00:10:39.120 --> 00:10:45.240 some laboratory studies where they provoke pain. Imagine, I don't know who would 131 00:10:45.279 --> 00:10:48.720 come to laboratory to be, you know, subject to pain, but they 132 00:10:48.799 --> 00:10:52.879 do. And they bring these people men, women, all kinds of ages, 133 00:10:54.120 --> 00:10:58.159 and all kinds of background, and then they apply the same painful stimulation 134 00:11:00.360 --> 00:11:05.159 in a laboratory, so they know it's the same thing, but people respond 135 00:11:05.399 --> 00:11:07.879 very differently. Some people will say, wow, this is a one out 136 00:11:07.960 --> 00:11:13.720 of ten. Other people say this is a nine out of ten with the 137 00:11:13.840 --> 00:11:20.120 same simulation. Yes, and as pain get worse as you age, well, 138 00:11:20.159 --> 00:11:22.720 it doesn't get worse as we age. It's just that as we age, 139 00:11:22.759 --> 00:11:30.360 we just accumulate more diseases, more injuries, more lesions to your body. 140 00:11:30.919 --> 00:11:35.960 So the tendency yes, older people. Among older groups, the incidents 141 00:11:37.120 --> 00:11:41.039 prevalence of chronic pain is one in three all the adults. When you mentioned 142 00:11:41.080 --> 00:11:45.120 one in five adults, but it's one in three all the adults. And 143 00:11:45.200 --> 00:11:52.360 that's just because people accumulate during lifetime more conditions health conditions. Diabetes is a 144 00:11:52.639 --> 00:11:56.240 very important cause of chronic pain because diabetes can cause lesion in the nerves, 145 00:11:58.120 --> 00:12:05.519 and the artried is fibrom alga and your pathic pain surgery, surgeries and other 146 00:12:05.600 --> 00:12:09.360 things. That is a very good starter for chronic pain. And so if 147 00:12:09.440 --> 00:12:13.840 people start having more surgeries during a lifetime, they will have a tendency to 148 00:12:13.960 --> 00:12:18.600 have more chronic pain. You know, I didn't think fibro fibro my alga 149 00:12:18.799 --> 00:12:22.559 was as common as it is, and I didn't realize it was like your 150 00:12:22.720 --> 00:12:26.360 entire body and it's just chronic. It's like chronic pain throughout your body. 151 00:12:28.240 --> 00:12:31.240 Yeah. Sometimes I feel like, you know, the weather. I think 152 00:12:31.279 --> 00:12:33.360 weather effects, Like it's raining, where am today? Doctor frown and I 153 00:12:33.720 --> 00:12:37.960 feel more pain today. It's cold and wet, and I'm like, oh, 154 00:12:37.159 --> 00:12:41.960 every little tendon in my body hurts. Not bad. Yeah, but 155 00:12:43.279 --> 00:12:46.440 yeah, I think weather it doesn't make it worse, right, Yeah. 156 00:12:48.000 --> 00:12:54.360 They say the researching this area is very vague because it's hard to prove. 157 00:12:54.600 --> 00:12:58.919 It's hard to pinpoint where the problem is. But we hear this a lot, 158 00:12:58.039 --> 00:13:03.519 especially in people who have a joint problems like our tritees rhumatoried trities. 159 00:13:03.559 --> 00:13:07.120 They tell us that they can be a good forecaster. They know when to 160 00:13:07.279 --> 00:13:11.159 change. The weather is going to change, and it's it seems to be 161 00:13:11.279 --> 00:13:18.679 more related to pressure, biometric pressure than temperature itself. My mother was that 162 00:13:18.720 --> 00:13:24.080 way. My mother acute acute rheumatori arthritis, the worst ever, and she 163 00:13:24.200 --> 00:13:28.799 couldn't you know when it rained. It was a disaster here and it you 164 00:13:28.919 --> 00:13:33.399 know, I feel for people who are in pain because it really affects your 165 00:13:33.399 --> 00:13:37.519 ability to function well. You talk about so if somebody's experiencing pain, they 166 00:13:37.559 --> 00:13:39.919 should seek help. I mean, you know, that's number one message to 167 00:13:39.960 --> 00:13:43.720 everybody out there. Don't just you know, grin and bear it and hide 168 00:13:43.799 --> 00:13:46.039 it, because there could be an underlying condition that has to be addressed. 169 00:13:46.639 --> 00:13:52.639 You have to talk about. You use a method called the Socrates method to 170 00:13:52.960 --> 00:13:56.960 work with your patients and understand the pain and diagnose it. Tell me about 171 00:13:58.000 --> 00:14:03.240 that. Yeah, So when I see people with chronic paining, it's interesting 172 00:14:03.360 --> 00:14:09.840 that they come to my clinic and then they have like a twenty year history 173 00:14:11.000 --> 00:14:16.279 to tell me in thirty minutes. So I want to listen and I want 174 00:14:16.320 --> 00:14:20.879 to give them, you know, all the attention that I can, but 175 00:14:22.120 --> 00:14:26.000 sometimes I have to tell them thieves. Help me help you. I need 176 00:14:26.120 --> 00:14:31.240 to I need to know the details of what is that you're feeling? How 177 00:14:31.320 --> 00:14:35.519 long did it take? And don't tell me everything would started twenty years ago. 178 00:14:35.759 --> 00:14:41.799 And so I help them. And I have this in my book saying 179 00:14:41.879 --> 00:14:46.159 when you go to a doctor or a physiotherapist or a clinician that will help 180 00:14:46.240 --> 00:14:52.120 your paying, try to be objective, try to be give them the details 181 00:14:52.159 --> 00:14:54.799 that they need to help you. And so that's what I talk in my 182 00:14:56.000 --> 00:14:58.159 book. I say, you know, the socratist is just a message of 183 00:14:58.440 --> 00:15:05.000 remembering this. The s is for tell them what is the site? Where 184 00:15:05.080 --> 00:15:09.039 does it hurt? Precisely? And if you can paint a body diagram. 185 00:15:09.120 --> 00:15:15.159 I give my patients a body diagram and I ask them paint here where are 186 00:15:15.200 --> 00:15:20.360 the areas that hurt? And then all of the socaches is the own set. 187 00:15:20.799 --> 00:15:24.320 So tell me how did this pain started? Was this an accident? 188 00:15:24.120 --> 00:15:28.399 Was this a surgery? Or there was no apparent cause that you can remember. 189 00:15:30.240 --> 00:15:33.000 The c is for the characteristics of the pain. So tell me is 190 00:15:33.039 --> 00:15:39.600 this burning? Is this jingling? There is numbness? How would you describe 191 00:15:39.639 --> 00:15:43.000 this with words? Because it can tell me if this is a nerve injury, 192 00:15:43.080 --> 00:15:48.519 if it's more inflammatory or not. They are is for radiating. Tell 193 00:15:48.600 --> 00:15:52.919 me does this pain radiate somewhere else where does it go? Because that will 194 00:15:52.000 --> 00:15:58.600 help me also to make the diagnosis. The A is for associated symptoms. 195 00:15:58.720 --> 00:16:00.840 Tell me what else do you have when you have this pain? Does it 196 00:16:00.960 --> 00:16:06.639 come with a swelling with change in color for example, or redness? And 197 00:16:06.799 --> 00:16:11.039 what makes it better? So ameliorating factors. So if you put a hot 198 00:16:11.080 --> 00:16:14.720 pack doesn't help, if you put an ice pack doesn't help, because those 199 00:16:14.799 --> 00:16:18.759 will give me some hints. This is inflammatory. This is a nerve damage. 200 00:16:18.399 --> 00:16:22.200 The G is for time, So tell me when do you feel pain 201 00:16:22.600 --> 00:16:26.559 most chase it in the morning, Is it in the middle of the night, 202 00:16:26.840 --> 00:16:30.720 is in the end of the day. E is for exacerbating What makes 203 00:16:30.759 --> 00:16:34.720 it worse or better? Because also I need to know if you take a 204 00:16:34.799 --> 00:16:38.399 pain killer, an anti inflammatory medication in your pain is a lot better. 205 00:16:38.759 --> 00:16:44.320 It tells me this is probably inflammation. And as is for the severity, 206 00:16:44.440 --> 00:16:48.159 give me a sense. It gives me a sense of how severe this is. 207 00:16:48.360 --> 00:16:51.639 Are we talking about a pain that is like a one two out of 208 00:16:51.720 --> 00:16:53.720 ten or are we talking about a pain that is like eight? Nine, 209 00:16:53.799 --> 00:16:57.039 ten out of ten. I know it's hard for people to give a number 210 00:16:57.080 --> 00:17:02.240 to that pain, but we have no other way to measure intensity of pain. 211 00:17:02.440 --> 00:17:04.720 If it's not by numbers that they give choice, well, I think 212 00:17:04.720 --> 00:17:08.640 another indicator would be how does the pain impact your ability to do day to 213 00:17:08.759 --> 00:17:14.279 day activities and giving some examples of the impact, like does it hurt to 214 00:17:14.359 --> 00:17:17.279 lift? Does it hurt to use a fork a knife? Does it hurt 215 00:17:17.319 --> 00:17:22.799 to swallow? You know, I'm a cancer surf where I went through chemotherapy, 216 00:17:22.920 --> 00:17:29.720 and I find I find the communication between doctor and patients could be very 217 00:17:29.759 --> 00:17:34.519 tenuous. Many patients don't know how to communicate effectively, and many doctors don't 218 00:17:34.519 --> 00:17:41.880 know how to communicate effectively. And it's important to ask questions, but to 219 00:17:41.039 --> 00:17:45.400 bring to to come in ready to ask questions, and then the doctor also 220 00:17:45.480 --> 00:17:48.400 needs to be ready to ask questions. And somehow everybody has to be honest 221 00:17:48.480 --> 00:17:56.000 with those questions. Because some people don't know how to describe what they're feeling 222 00:17:56.079 --> 00:18:00.920 and experiencing. I always do the context what does that feel like? Give 223 00:18:00.000 --> 00:18:03.480 me an example, um, because I've never been you know, when I 224 00:18:03.519 --> 00:18:07.480 get the one to five, one to ten, it's all yeah, that 225 00:18:07.680 --> 00:18:11.519 is all mad because some people see a pain is a ten you know, 226 00:18:11.799 --> 00:18:14.599 I'm dying, and somebyle's okay, it's that big deal. And I never 227 00:18:14.720 --> 00:18:17.680 know whether I'm being truly honest about pain or not when I put it down, 228 00:18:17.759 --> 00:18:22.400 because it's it's what I think it is. Um. It's very interesting. 229 00:18:22.720 --> 00:18:26.400 Um. You outline in your book eight steps title of your book, 230 00:18:26.400 --> 00:18:32.880 to Conquer Chronic Pain. Uh, and you go through them. Why don't 231 00:18:32.920 --> 00:18:37.799 we touch on them and to give my listeners a sense of what this what's 232 00:18:37.880 --> 00:18:41.839 involved in your book? Yeah? Yeah, So, as I mentioned, 233 00:18:41.920 --> 00:18:48.240 the chronic pain is, um is this chronic disease and I it's a chronic 234 00:18:48.359 --> 00:18:53.039 disease that will probably not go away. So I never tell the patients will 235 00:18:53.240 --> 00:18:57.759 cure your chronic pain and your pain will disappear, although that is possible. 236 00:18:59.000 --> 00:19:03.160 I've seen people they don't have pain anymore, so they don't feel anymore, 237 00:19:03.640 --> 00:19:07.559 but they may have like a relapse here and there, and so they live 238 00:19:07.680 --> 00:19:10.799 really well and they're not feeling pain, but once in a while they might 239 00:19:11.119 --> 00:19:15.920 have a flare app But most people is a chronic disease, and what they 240 00:19:15.000 --> 00:19:19.720 can do is when they say conquering means that they will be able to manage. 241 00:19:19.839 --> 00:19:23.119 They will be able to self manage their thing. They will learn what 242 00:19:23.319 --> 00:19:26.880 works for them, they will learn what their disease is. They will not 243 00:19:26.960 --> 00:19:30.759 be fearful of pain, because another thing that we see a lot is the 244 00:19:32.000 --> 00:19:37.359 fear of being paralyzed. As people, the fear of thing itself has to 245 00:19:37.519 --> 00:19:41.079 be treated. The fear of thing is what's one of the main barriers that 246 00:19:41.160 --> 00:19:47.039 I have in my clinic to get people moving to do the things that I 247 00:19:47.160 --> 00:19:51.759 want them to move to do that will I know will help them to live 248 00:19:51.799 --> 00:19:56.079 a fulfilling life. So conquering pain means you can live a fullfeeling life feeling 249 00:19:56.200 --> 00:20:00.960 something, but that pain doesn't need to dictate what you So the steps, 250 00:20:00.079 --> 00:20:06.039 let's talk about the steps. So the first step is retraining the pain system. 251 00:20:06.880 --> 00:20:10.079 So again that is similar to the alarm system of the house that I 252 00:20:10.160 --> 00:20:15.640 mentioned before. It is let's call the alarm company. Let's call the alarm 253 00:20:15.720 --> 00:20:19.640 company and retrain and fix our pain system. Because the pain system may be 254 00:20:19.839 --> 00:20:26.319 sensitized. The paining system in a person with chronic pain will be telling them 255 00:20:26.519 --> 00:20:29.759 a lot of things that they don't need to hear. For example, the 256 00:20:29.839 --> 00:20:34.400 pain is excruciating. Today I did something wrong to myself. I cannot do 257 00:20:34.680 --> 00:20:38.319 that movement again. So you have to retrain your pain system. You have 258 00:20:38.559 --> 00:20:45.680 to learn that your pain system is just telling you something different today that is 259 00:20:45.759 --> 00:20:49.640 not true. It's almost like an illusion that your paining system is doing. 260 00:20:49.799 --> 00:20:55.680 You know, optical illusions means you see something, but your brain tells something 261 00:20:55.759 --> 00:21:02.160 different. I think we all know. Optical illusions means sometimes a darker shade 262 00:21:02.440 --> 00:21:04.240 in a picture, but when you look closely, oh, it's not darker, 263 00:21:04.319 --> 00:21:08.440 it's actually the same color. That's because the brain is telling you things. 264 00:21:10.119 --> 00:21:12.400 So that's the first step. We're training the pain system. So learning 265 00:21:12.480 --> 00:21:17.279 that you can move, you can do the activities, You're not going to 266 00:21:17.400 --> 00:21:22.799 harm yourself. You can keep going and leaving with this. So that's the 267 00:21:22.920 --> 00:21:26.839 first step because if we stick the pin system, if we regulate the pain 268 00:21:26.960 --> 00:21:33.039 system, it's much easier to treat a like a knee arthritis or a low 269 00:21:33.119 --> 00:21:40.119 back pain because now they are not supersensitive. The second step is about emotions. 270 00:21:41.079 --> 00:21:47.359 Emotions have a big component in pain sensations. They come handing hinge and 271 00:21:47.519 --> 00:21:52.559 why is this Because in the brain they are connected, they are linked the 272 00:21:52.720 --> 00:21:56.599 sensation comes from a body part, let's say from a knee or from a 273 00:21:56.799 --> 00:22:02.519 back, but then in the brain they activate the emotional areas of the brain. 274 00:22:02.799 --> 00:22:07.839 So if a person is such on a day or they are having a 275 00:22:07.920 --> 00:22:11.359 bad day emotionally, they will feel more pain on that day. We know 276 00:22:11.519 --> 00:22:17.799 that there are a lot of laboratory studies showing that if they do the same 277 00:22:17.839 --> 00:22:23.960 pain for stimulation, showing the person like a sad movie or such pictures or 278 00:22:25.039 --> 00:22:30.440 telling them a sad story, and then they measure pain. After the laboratory 279 00:22:30.599 --> 00:22:34.400 people did the thing stimulation, they will feel much more pain. Now, 280 00:22:34.480 --> 00:22:38.640 if you show them a happy movie, tell them a happy story and they 281 00:22:38.640 --> 00:22:42.039 are in a happy mood, they do the same thing for stimulation, they 282 00:22:42.119 --> 00:22:48.039 feel less pain. So we know that emotions have a big component in the 283 00:22:48.240 --> 00:22:52.599 volume of thaying how much pain the person will feel. So of course nobody 284 00:22:52.680 --> 00:22:57.000 wants to feel more pain that you need. So that's what the step number 285 00:22:57.079 --> 00:23:03.640 two is. Let's control or emotion. Let's do an inventory of our emotions. 286 00:23:03.480 --> 00:23:08.920 Are you having did you have a discussion with your children? Are you 287 00:23:10.079 --> 00:23:12.359 mad at someone, are you angry? Are you frustrated? Are you lonely? 288 00:23:12.599 --> 00:23:17.640 Loneless as a big has a big impact on pain. People who are 289 00:23:17.720 --> 00:23:22.200 lonely, they feel pain more intense than people who have some supports people around 290 00:23:22.240 --> 00:23:26.960 them. Holding hands. We know that people who hold hands with another person 291 00:23:27.039 --> 00:23:30.920 they feel less being. So there are a lot of things that you can 292 00:23:30.079 --> 00:23:36.440 just do an inventory of emotions doing journaling. I recommend people to journal their 293 00:23:36.480 --> 00:23:41.400 emotions because once they start putting things on a paper, they realize, oh, 294 00:23:41.319 --> 00:23:45.680 I think because of this arguments that I had with my husband that is 295 00:23:45.720 --> 00:23:49.319 affecting my muscles, I'm feeling more paying my muscles, and that's why my 296 00:23:49.400 --> 00:23:55.279 pain is worse to them. Because again, Melanie, this kind of pain, 297 00:23:55.319 --> 00:23:59.759 emotional pain, we can't treat with medications. We can't take appeal to 298 00:24:00.039 --> 00:24:04.599 treat to them, so you have to treat with emotional support. Step number 299 00:24:04.640 --> 00:24:12.079 three is about sleep. It's very neglected. Sleep quality is so neglected in 300 00:24:12.200 --> 00:24:18.240 the general population. But in my patience, they usually say, well, 301 00:24:18.400 --> 00:24:21.920 I sleep bad because I am in pain. I wake up because I am 302 00:24:22.000 --> 00:24:25.559 in pain. But I tell them, sometimes you are having pain because you 303 00:24:25.640 --> 00:24:29.119 are not sleeping well. So you need to take care of your sleep and 304 00:24:29.240 --> 00:24:32.759 then your sleep quality will be better. And then you will not be waking 305 00:24:32.839 --> 00:24:36.319 up by pain. Pain will not disturb your sleep. There are a lot 306 00:24:36.359 --> 00:24:42.119 of medications that affect sleep and a lot of medications that cause them side effects 307 00:24:42.279 --> 00:24:47.720 that affect sleep. Like we use a lot of untidepressants and unti convulsants to 308 00:24:47.839 --> 00:24:51.759 treat chronic pain, and they may have interference with sleep. Some of them 309 00:24:51.880 --> 00:24:55.160 help, some others don't help. So we need to be careful how we 310 00:24:55.279 --> 00:24:59.640 do this. So that's the step number three. The step number four is 311 00:24:59.640 --> 00:25:03.559 about diet, and I'm not talking here about it just you know obysity. 312 00:25:03.640 --> 00:25:07.039 People think that I'll be talking about the miracle diet that will fix all of 313 00:25:07.079 --> 00:25:11.680 their things. No, I'm talking here about malnourishment. A lot of people 314 00:25:11.799 --> 00:25:17.400 are normal wage or maybe overwege, but they don't know that they are malnourished 315 00:25:17.480 --> 00:25:23.440 because they might be lacking essential ingredients, especially vitamins or omega three. Omega 316 00:25:23.519 --> 00:25:29.359 three is very important to fight inflammation. Also, the way we eat, 317 00:25:30.200 --> 00:25:33.200 we need to eat mindfully. We need to, you know, pay attention 318 00:25:33.319 --> 00:25:37.279 to when we are eating, with whom we are eating, not just put 319 00:25:37.359 --> 00:25:44.000 something our stomach to survive. Eating mindfully is so important human thing. Also, 320 00:25:44.039 --> 00:25:48.000 a healthy diet, what we buy, the habits that we have cooking 321 00:25:48.039 --> 00:25:53.160 at home instead of buying fast food or eating out. The first step is 322 00:25:53.680 --> 00:26:00.319 what about the other people around us? Because pay is a cycle, it's 323 00:26:00.319 --> 00:26:03.440 a biological phenomenon, but alse it's a psychological as we talked about, but 324 00:26:03.519 --> 00:26:10.200 it's also a social phenomenal. We know the pain depends on who is around 325 00:26:10.359 --> 00:26:15.119 us, and also pain affects people around us. A person with conic thing, 326 00:26:15.799 --> 00:26:19.079 they tell us this a lot, that their relationships might be broken, 327 00:26:19.680 --> 00:26:26.680 relationships with their spouses, with their children, with their doctors. Sometimes they've 328 00:26:26.920 --> 00:26:32.599 lost the trust from their doctors, friends, family, for workers, oh 329 00:26:32.680 --> 00:26:38.119 my god, job for workers, bosses, managers at work. Those relationships 330 00:26:38.160 --> 00:26:45.720 are broken and confused, and because of this, they will affect how the 331 00:26:45.839 --> 00:26:52.240 person feels pain. Because if they feel misunderstood, if they have to explain 332 00:26:52.400 --> 00:26:55.319 all the time, all the time that they go to a party like a 333 00:26:55.400 --> 00:26:59.480 family reunion, if they have to explain how they are, what they're feeling, 334 00:26:59.599 --> 00:27:02.200 they maycasions they are, why they're not feeling well, why they need 335 00:27:02.240 --> 00:27:07.599 to leave the party earlier. It's stirring, it's really exhausting. So in 336 00:27:07.680 --> 00:27:12.240 this chapter I talk about how people communicate with others, how they can get 337 00:27:12.279 --> 00:27:15.799 help with others, and how they can communicate their pain with those that are 338 00:27:15.880 --> 00:27:22.759 around them, because that will affect them. The start number six is about 339 00:27:22.000 --> 00:27:27.160 medications. So I talked in this chapter about medicine, the medicine cabinage. 340 00:27:29.079 --> 00:27:32.640 What do you have at home? How do you use those medications? How 341 00:27:32.680 --> 00:27:37.039 do you use pain killers? We talk about opioids, We talk about antiflammatories, 342 00:27:37.079 --> 00:27:45.279 injections, I talk about topical queens. I talk about cannabis, steroids, 343 00:27:45.519 --> 00:27:49.240 anti the presence, and convulsants. Because people are confused to they sometimes 344 00:27:49.240 --> 00:27:52.759 they don't even know why they're taking some medicases. They say, why am 345 00:27:52.799 --> 00:27:56.960 I taking to the present for pain? I'm not depressed. But we use 346 00:27:56.000 --> 00:28:00.359 them to the persons, especially if the person has neuropath pick pain, which 347 00:28:00.519 --> 00:28:04.039 is a kind of chronic pain that affects the nerves, the nerve system. 348 00:28:06.000 --> 00:28:10.400 So it's important for them to understange why they are taking what they're taking and 349 00:28:10.559 --> 00:28:15.839 also discussed with their doctors, pharmacist nurses, the side effective these medications. 350 00:28:15.880 --> 00:28:19.079 Why really need can I stop taking them? You know? Manly? Because 351 00:28:19.160 --> 00:28:25.359 some people are on these medications for decades and they are taking a soup from 352 00:28:25.440 --> 00:28:30.599 medications. It's amazing that we call this polypharmacin and nobody ever questioned them, 353 00:28:32.400 --> 00:28:34.359 why are you taking this medication? Do you still need it? Maybe some 354 00:28:34.519 --> 00:28:38.960 doctor started this fifteen years ago, but maybe you don't need this anymore. 355 00:28:40.039 --> 00:28:45.039 So it's important to talk about them and the medications. Step seven is about 356 00:28:45.599 --> 00:28:49.720 what other things you have in your tool box, the toolbox. I talk 357 00:28:49.759 --> 00:28:52.960 a lot about the tool box in my videos in the book, it's all 358 00:28:53.039 --> 00:28:56.680 the other things that you have to self manage your pain. So medications is 359 00:28:56.759 --> 00:29:00.720 one of them. The pills, the injections. You know, the queens, 360 00:29:00.759 --> 00:29:04.480 the topical queens, but they're not the only one. When you talk 361 00:29:04.480 --> 00:29:10.200 about the emotions, we talk about relaxation, mindfulness, meditation. Those are 362 00:29:10.240 --> 00:29:15.319 excellent tools to retrain the pain system. But there are other things that they 363 00:29:15.319 --> 00:29:18.599 can put in their toolbox. And I talk about the five MS for them 364 00:29:18.680 --> 00:29:25.319 to remember, and the five ms are movement, mind, body interventions, 365 00:29:25.720 --> 00:29:32.039 manual therapies, modalities such as heat code, electrotherapy. And then the medications 366 00:29:32.119 --> 00:29:37.160 of course, the antiflammatories and allgetics must relax and opioids, cannabis based compounds 367 00:29:37.200 --> 00:29:42.640 et cetera. And then the step h The last one is the focusing on 368 00:29:42.759 --> 00:29:48.519 their goals because goal setting is really important, especially for people who have a 369 00:29:49.000 --> 00:29:53.359 long term condition. Chronic pain is a chronic condition, so when you have 370 00:29:53.559 --> 00:29:57.599 a chronic condition, you need to have goals in your life. You need 371 00:29:57.640 --> 00:30:03.640 to have smarter goals things that you can achieve. So for example, going 372 00:30:03.720 --> 00:30:07.960 back to school, getting a job, getting married, those are goals that 373 00:30:08.039 --> 00:30:11.799 people have in life. So we talk about now that you are conquering or 374 00:30:11.880 --> 00:30:15.400 mountain you're conquering, or chronic pain, how you're going to achieve those goals, 375 00:30:15.960 --> 00:30:21.119 and we help them to set smarter goals. For example, if you 376 00:30:21.160 --> 00:30:26.559 want to go back to school, you have to start by creating a routine 377 00:30:26.680 --> 00:30:30.359 that you're going to study one hour a day, maybe five days a week. 378 00:30:30.960 --> 00:30:33.599 That's a small step for you to start, you know, because once 379 00:30:33.640 --> 00:30:37.039 you go back to school, you're going to study a lot. You have 380 00:30:37.119 --> 00:30:41.680 to have a routine. So we have them to reorganize their lives because I 381 00:30:41.759 --> 00:30:45.960 see it's really sad. I see people with chronic pain that they lost a 382 00:30:47.039 --> 00:30:52.559 lot of years lived because of this chronic pain and their dreams. Their goals 383 00:30:52.680 --> 00:31:00.559 were not fulfilled. It's sad, you know. I thank you for the 384 00:31:00.799 --> 00:31:03.920 great explanation of each of date steps. You mentioned medication, and I want 385 00:31:03.960 --> 00:31:08.559 to zoom in on that because doctors are very quick to prescribe medication all the 386 00:31:08.640 --> 00:31:11.240 time, and I always when I see my doctors, I say, what 387 00:31:11.319 --> 00:31:15.000 are my other options besides medication? And you mentioned and tell me if I 388 00:31:15.240 --> 00:31:18.759 missed this, you said something that you don't necessarily need medication, because I 389 00:31:18.839 --> 00:31:25.039 always hear about people becoming addicted to pain medication. Yeah, and you know, 390 00:31:25.240 --> 00:31:29.440 I'm curious, first of all, at one point, you know, 391 00:31:29.680 --> 00:31:33.359 what are some ways to mitigate pain without medication? And at what point do 392 00:31:33.400 --> 00:31:38.319 you really say you need medication? Yeah, so let's go back to those 393 00:31:40.039 --> 00:31:45.880 analogies of the Alliance system. Okay, So if the some people have chronic 394 00:31:45.920 --> 00:31:52.119 pain because they have an ongoing injury to their body, we call this no 395 00:31:52.279 --> 00:31:56.799 susceptive or neuropathic pain. So it's almost like having once in a while you 396 00:31:56.920 --> 00:32:00.640 have a fire in the house and then you do have to call the fire 397 00:32:00.680 --> 00:32:05.960 truck because they will have to come and you know they need to put up 398 00:32:06.000 --> 00:32:09.759 the fire. So in these cases that a person continue to having injuries to 399 00:32:09.880 --> 00:32:15.160 their body, or if they have neuropathic pain, medications are used. So 400 00:32:15.279 --> 00:32:20.480 for example, an anti inflammatory. They have an inflammation in their body like 401 00:32:20.599 --> 00:32:24.880 romatoriatritis is a good example. They do have some time to time those joints 402 00:32:24.920 --> 00:32:31.119 that will inflame and will hurt, and we don't want this inflammation to sensitize 403 00:32:31.160 --> 00:32:36.799 the pain system. And now the aligned system of the body is sensitized. 404 00:32:37.480 --> 00:32:44.079 So before before the pain system gets sensitized, we treat this pain from an 405 00:32:44.160 --> 00:32:52.480 inflammation with at inflammatories or biologics. So they need medications and opioids in acute 406 00:32:52.559 --> 00:33:00.319 pain, all surgical pain are really important because one thing that's sensitized the pain 407 00:33:00.440 --> 00:33:05.480 system and make the alarm system of the house dysfunctional is a cute pain. 408 00:33:06.119 --> 00:33:08.720 So if a person goes to surgery, they're going to feel pain. We 409 00:33:08.839 --> 00:33:15.440 need to treat that ping aggressively. Doesn't mean opioids all the time, but 410 00:33:15.559 --> 00:33:21.200 it means antifomatories, it means eyes. It may mean opioids, but then 411 00:33:21.480 --> 00:33:25.039 we need to stop those medications after the scar is formed and they don't have 412 00:33:25.160 --> 00:33:31.160 the pain from the surgery anymore. When I say we don't need opioids, 413 00:33:31.279 --> 00:33:36.960 we don't need pain medications for a lot of chronic pain is because that initial 414 00:33:37.119 --> 00:33:40.880 injury is healed and they don't have that initial injury anymore. They don't have 415 00:33:40.920 --> 00:33:45.720 that inflammation anymore. That is healed. For chronic pain. If we keep 416 00:33:45.839 --> 00:33:50.559 giving them opioids, it's not going to treat the origin of the pain. 417 00:33:50.880 --> 00:33:54.759 It's only going to mask their pain for a few hours. It's not treating 418 00:33:54.839 --> 00:33:58.799 the origin of the pain because they don't have that injury anymore. That thing 419 00:33:58.960 --> 00:34:02.920 is healed. But then they start having the side effects and they develop tolerance. 420 00:34:04.079 --> 00:34:08.800 We know that opioids creates a tolerance in our body. Tolerance means if 421 00:34:08.840 --> 00:34:14.079 you take let's say three tablets a day of opioids for a couple of days, 422 00:34:15.239 --> 00:34:19.239 then your body will become tolerant to that, and now you need four 423 00:34:19.320 --> 00:34:22.960 tablets a day to have the same effects. And then your body becomes dependent 424 00:34:22.679 --> 00:34:27.400 tolerant to four, and now you need five and they need six. So 425 00:34:27.559 --> 00:34:31.039 you need a higher dose to get the same effects. And that's why people 426 00:34:31.159 --> 00:34:37.920 start increasing the dolls. They may become a dependent on that medication. Dependence 427 00:34:37.280 --> 00:34:44.360 is a very physical thing. Dependence is not psychological. Dependence means if they 428 00:34:44.440 --> 00:34:47.360 stop taking that medication, or if they miss a dose of the opioids, 429 00:34:47.440 --> 00:34:55.320 they get horrible withdrawals. And interesting enough, Melanie withdrawals of opioids caused pain. 430 00:34:57.280 --> 00:35:00.840 So a person. It's really terrible because then the person uses a dose 431 00:35:00.920 --> 00:35:05.800 of the opioids or they try to stop the opioids just to see how their 432 00:35:05.880 --> 00:35:10.320 body responds. But now they have pain, which is confusing because they say, 433 00:35:10.360 --> 00:35:13.679 well, if I am in pain, it needs that I need the 434 00:35:13.840 --> 00:35:17.639 opioid. No, but your pain is just because of the withdrawals. So 435 00:35:17.800 --> 00:35:22.960 that's why opioids is not a good term a good solution for a long term 436 00:35:22.039 --> 00:35:28.320 pain. Yeah, and unfortunately we're just reading more and more about people who 437 00:35:28.320 --> 00:35:30.280 are addicted to pain. I don't like I hate pain, pain medication. 438 00:35:30.400 --> 00:35:34.000 To be very honest, when I have my surgeries, I don't like them 439 00:35:34.000 --> 00:35:39.280 because they can't to pay you. And that's person a lot of things. 440 00:35:42.519 --> 00:35:45.000 You know. There's you know, I'm a big believer, as you mentioned 441 00:35:45.039 --> 00:35:51.199 in your steps, you know, the mind, body finding, meditation, 442 00:35:51.679 --> 00:35:55.159 mindful eating. I think you made a point, well, it touches on 443 00:35:55.280 --> 00:36:00.840 pain. I think it's an important point in general about malnutrition because I think 444 00:36:00.880 --> 00:36:07.000 a lot of people erroneously or mistakenly think malnutrition is because being somewhat is starving, 445 00:36:07.360 --> 00:36:15.000 they're not eating enough. But malnutrition, bad nutrition mall like Latin and 446 00:36:15.159 --> 00:36:21.880 nutrition means poor nutrition. You can be overweight, you can be underweight, 447 00:36:22.559 --> 00:36:28.599 you can be a relatively okay weight, but you can still be malnutrition because 448 00:36:28.639 --> 00:36:30.760 you don't have the proper nutrients in your body. If you live on a 449 00:36:30.840 --> 00:36:37.079 diet of fast food or sugar, or a strange diet because people, you 450 00:36:37.159 --> 00:36:40.840 know, there's this way too many strange diets out there right now, that's 451 00:36:40.880 --> 00:36:46.280 poor nutrition and it will impact your ability to handle pain. It also picked 452 00:36:46.639 --> 00:36:51.920 your whole body. I think that's important to point out because it all goes 453 00:36:52.000 --> 00:36:55.519 hand in hand with your overall health. Right absolutely, you just said, 454 00:36:55.639 --> 00:37:02.599 You just said exactly what I was going to say. Malnutrition means they don't 455 00:37:02.639 --> 00:37:10.440 have the nutrients in their body to create those neurotransmitters that will fight pain, 456 00:37:12.119 --> 00:37:20.679 to fight chronic inflammation, to fight them to give them energy to get up 457 00:37:20.719 --> 00:37:25.480 from bed and do movement and exercise. It's also related to depression. Depressed, 458 00:37:27.280 --> 00:37:31.320 so people need to pay attention a lot what they eat because if they 459 00:37:31.440 --> 00:37:37.039 put a lot of sugar and unhealthy fast in their diet. They will feel 460 00:37:37.400 --> 00:37:40.679 full, they will feels saciated, and then they will say, why do 461 00:37:40.760 --> 00:37:45.079 I need to eat that fish? Why do I need to eat that olive 462 00:37:45.119 --> 00:37:47.000 oil? Why do I need to eat that vegetable if I'm feeling full? 463 00:37:47.960 --> 00:37:53.480 But you know that extra virgin olive oil contains a lot of omega threes that 464 00:37:53.639 --> 00:38:02.400 you need to fight inflammation. And they if they don't buy mindfully. Grocery 465 00:38:02.480 --> 00:38:07.280 shopping is where you start to have a good nutrition. I tell them, 466 00:38:07.400 --> 00:38:12.360 if you would you be able to show me your grocery bills for the home 467 00:38:12.400 --> 00:38:15.599 month, and if I look at your grocery bills, would you be proud 468 00:38:15.719 --> 00:38:19.000 of what you show me? If they say, well, not really, 469 00:38:20.159 --> 00:38:23.559 I know they're not having a good nutrition because they're buying only junk food, 470 00:38:24.239 --> 00:38:31.360 fast food, package food, ready made food, frozen pizzas that I'm not 471 00:38:31.440 --> 00:38:36.000 against those, I love those things, but you know, maybe once a 472 00:38:36.079 --> 00:38:38.639 week, one meal a week, because you can have a junk food, 473 00:38:39.360 --> 00:38:45.400 but the rest of your meals should be really nutritious, should be very well 474 00:38:45.559 --> 00:38:47.719 thought while you're put in your mouth, or how you're feeding your family, 475 00:38:49.360 --> 00:38:53.400 how you are preparing your meals, and people. I don't know what's going 476 00:38:53.480 --> 00:38:58.480 on with our culture. People people want fast and easy is what it is. 477 00:38:58.599 --> 00:39:01.039 I spend a lot of time I try level quite a bit to Europe, 478 00:39:01.119 --> 00:39:04.880 thankfully, and back, and it's a different attitude over there on how 479 00:39:04.920 --> 00:39:08.400 they approach food. Everything is fast and easy and convenient. And I look 480 00:39:08.440 --> 00:39:12.760 at a lot of grocery carts. I'm currently in the Deep South. I 481 00:39:12.960 --> 00:39:17.280 watch a lot of grocery carts and most of them were filled with packaged, 482 00:39:17.719 --> 00:39:22.679 poor, empty, empty calories. And as you get older, it gets 483 00:39:22.719 --> 00:39:28.039 harder. Many my mother died of malnutrition. As a food professional, just 484 00:39:28.280 --> 00:39:32.840 know that my mother died of self induced malnutrition, and I know what it 485 00:39:32.920 --> 00:39:37.920 did to her, and it was because she only wanted each sugar and and 486 00:39:39.719 --> 00:39:45.559 forty. It is a common problem with the elderly, and it has and 487 00:39:45.679 --> 00:39:47.079 it's very hard. You just want them to do anything, and you know 488 00:39:47.239 --> 00:39:51.039 they all eat and you know, I won't say the brand, but there's 489 00:39:51.199 --> 00:39:52.840 you know, protein shakes as we're just going to call them poaching nicks, 490 00:39:52.840 --> 00:39:59.000 and they just filled with sugar. It's something you got to think about because 491 00:39:59.000 --> 00:40:04.679 it all helps keeping the body hopefully, So I'm curious about two things. 492 00:40:04.800 --> 00:40:10.280 We've got about eight minutes left. First, what are your thoughts about the 493 00:40:10.440 --> 00:40:17.199 natest greatest research in the frontiers of pain management? What are you excited about? 494 00:40:17.280 --> 00:40:22.880 Are seeing ahead? Oh? Yeah, I'm glad you asked that, 495 00:40:22.000 --> 00:40:29.039 because there's a lot of things coming in the pipeline. And what I would 496 00:40:29.079 --> 00:40:31.559 say is, I've been doing this for thirty years, Melanie. But I 497 00:40:31.960 --> 00:40:37.440 graduated from medical school and I did choose a specialty that was able to treat 498 00:40:37.440 --> 00:40:42.039 people with chronic pain. So I've been researching and treating people with chronic pain 499 00:40:42.079 --> 00:40:45.119 for thirty years, and it has been a shift. What we were doing 500 00:40:45.199 --> 00:40:50.599 thirty years ago is very different from what we're doing now, and that's because 501 00:40:50.639 --> 00:40:57.360 there's a lot of advances in imaging of the brain of people with chronic pain. 502 00:40:57.440 --> 00:41:02.079 We're understanding much better what happens what brain, what pain does through our 503 00:41:02.159 --> 00:41:08.079 body, because thirty years ago, we always thought that pain is something that 504 00:41:08.239 --> 00:41:16.000 is happening in our body like kneeds hips back head, and then it's just 505 00:41:16.119 --> 00:41:20.760 a sensation that comes through brain and you need to stop that sensation and the 506 00:41:20.840 --> 00:41:24.480 brain. We always thought that the brain is just a passive with seeping of 507 00:41:24.599 --> 00:41:30.480 these information and there could be nothing that you could do at the brain level. 508 00:41:30.679 --> 00:41:36.000 But oh my god, things are changing in this area a lot because 509 00:41:36.119 --> 00:41:39.679 now with a lot of functional MRI and the studies of the brain, because 510 00:41:39.719 --> 00:41:45.920 of the technology that has a brand so much, we can see what pain 511 00:41:45.000 --> 00:41:50.519 does through the brain, and then what the brain does through pain, which 512 00:41:50.679 --> 00:41:55.039 is amazing, amazing. I'm so excited about this because the brain has this 513 00:41:55.280 --> 00:42:04.960 plasticity, this amazing ability to change itself to respond to stressors, and pain 514 00:42:05.119 --> 00:42:09.360 is a strong stressors. The brain has the ability to modify the meaning that 515 00:42:09.519 --> 00:42:15.920 we give to things, to suppress some sensations, to even to create some 516 00:42:16.079 --> 00:42:20.800 sensations. I don't know if you ever heard about phantom pain. A person 517 00:42:20.880 --> 00:42:24.360 has alciated, so the brain is able to create pain. So a person 518 00:42:24.480 --> 00:42:30.679 has an entutated leg, but they continue feeling pain, cruciating pain, very 519 00:42:30.719 --> 00:42:34.880 intense pain in that body part doesn't exist anymore. So the same way that 520 00:42:34.960 --> 00:42:40.320 the brain can create pain, the brain can eraise pains. So that's where 521 00:42:40.400 --> 00:42:45.079 I think we're going to see a lot of advances in the future is using 522 00:42:45.920 --> 00:42:49.199 these areas of our brain. We have an inner pharmacy in our brain, 523 00:42:50.000 --> 00:42:53.920 We have an ability to create our own opioids, cannobinoids, sell toning, 524 00:42:54.199 --> 00:43:00.639 dopamine. It's a potent pharmacy that we have inside of our brain. And 525 00:43:00.760 --> 00:43:04.280 now we are learning how we can stop a coupuncture, for example, is 526 00:43:04.320 --> 00:43:07.719 a way that we can tap into this pharmacy. When a person does a 527 00:43:07.800 --> 00:43:13.000 coupuncture, they stimulate the brain to release those pain killers. So we are 528 00:43:13.079 --> 00:43:16.280 learning more about what the brain can do, and I think the future will 529 00:43:16.920 --> 00:43:22.239 open up to a lot of how we can train or brain, how we 530 00:43:22.360 --> 00:43:28.960 can use these strategies to improve the lives of people with chronic pain. Well, 531 00:43:29.000 --> 00:43:34.719 that's encouraging. And I'm a big believer in holistic approaches to managing all 532 00:43:34.840 --> 00:43:37.480 aspects of your health because, as I said straight on, I'm not big 533 00:43:37.519 --> 00:43:43.760 on medication. I think that eventually, I you know, other than addiction. 534 00:43:43.840 --> 00:43:46.719 I think at some point, don't people become immune to their medication and 535 00:43:46.840 --> 00:43:51.760 we can't be of medication forever. It seems like, yeah, yeah, 536 00:43:51.800 --> 00:43:54.280 we use the term tolerance. We don't use but we call this tolerant. 537 00:43:54.280 --> 00:43:59.559 They develop tolerance, right, and then you got to switch it and whatnot, 538 00:43:59.599 --> 00:44:02.719 and that be dangerous. I've seen that can be very dangerous. As 539 00:44:02.800 --> 00:44:07.920 well, and I think we have to caution my listeners on claims. There 540 00:44:07.960 --> 00:44:12.639 are a lot of supplements. I'm not big on the supplement industry because unregulated 541 00:44:12.920 --> 00:44:15.679 CBD. You know, everybody's promoting CBD. When my mother, my mother 542 00:44:15.760 --> 00:44:22.360 had chronic matory arthritis, people were bringing her so many CBD CBD salves and 543 00:44:22.840 --> 00:44:29.480 I have a drawer of salves for her. You know, my my edits 544 00:44:29.519 --> 00:44:32.119 savir money. I don't really know what's in your head or not with all 545 00:44:32.199 --> 00:44:36.599 that, but it's expensive and I don't see where it helps. Of course, 546 00:44:36.760 --> 00:44:38.880 you know there are people out there, be very famous people promoting them. 547 00:44:39.039 --> 00:44:43.880 What are your thoughts? Yeah, I have not In the beginning, 548 00:44:43.920 --> 00:44:46.639 I think that was a big push for us to try this thing. I 549 00:44:46.719 --> 00:44:52.159 saw a lot of my patients excited with thhc CBG. I have been seeing 550 00:44:52.280 --> 00:44:57.639 a lot of good success stories, and the evidence of scientific evidence is also 551 00:44:58.400 --> 00:45:05.719 kind of getting. The excitement is dying regarding the use of cannabis because they 552 00:45:05.760 --> 00:45:08.639 were not able to achieve like all this pain really especially for pain. Maybe 553 00:45:08.679 --> 00:45:15.800 for other things they may have other uses, but for chronic pain they were 554 00:45:15.880 --> 00:45:21.039 not so successful as we initially thought. Although for neuropathic pain, which is 555 00:45:21.079 --> 00:45:23.960 a kind of pain from the nerve injuries and diseases. For neuropathic pain, 556 00:45:25.119 --> 00:45:31.159 THHC seems to have some effect reducing pain sensations, but for the majority of 557 00:45:31.320 --> 00:45:37.440 chronic pain, they don't have neuropathic pain, so actually doesn't do much for 558 00:45:37.599 --> 00:45:40.599 pain. Well, that's interesting because neuropathic pain is very different. I have 559 00:45:40.719 --> 00:45:45.239 neuropathic pain because I had a double massectomy, so I've had phantom pain. 560 00:45:45.840 --> 00:45:51.719 Neuropathic pain. It's a strange. It's a strange sensation, a much stranger 561 00:45:51.800 --> 00:45:53.920 than like the pain from the stub toe I have right now. Yea, 562 00:45:55.440 --> 00:46:01.039 and as you said, has to be managed very different. So I have 563 00:46:01.239 --> 00:46:06.760 enjoyed it talking to you again for my listeners, We've been talking with doctor 564 00:46:06.920 --> 00:46:10.960 Andrea Farland, Associate professor at the Department of Medicine at the University of Toronto 565 00:46:12.000 --> 00:46:16.760 and a staff physician at the Toronto Rehabilitation Institute. The book is called Eight 566 00:46:16.840 --> 00:46:22.559 Steps to Conquer Chronic Pain, A Doctor's Guide to Lifelong Relief. What is 567 00:46:22.559 --> 00:46:25.599 your YouTube channel that has all this followers. Yeah, it's just my name, 568 00:46:25.679 --> 00:46:30.320 doctor Andrea Bland. I you r l I am well, congratulations, 569 00:46:30.639 --> 00:46:34.119 you know that's that's a pretty nice amount of following, and thank you for 570 00:46:34.199 --> 00:46:39.239 all the work you're doing to help improve people's health and well being. Pain 571 00:46:39.480 --> 00:46:45.400 is an insidious thing to live with because it can, in fact, every 572 00:46:45.480 --> 00:46:49.199 aspect of your life, how you work, how you have relationships, how 573 00:46:49.280 --> 00:46:53.000 you function. And I've witnessed it myself watching my mother deal with pain. 574 00:46:53.079 --> 00:46:59.480 I've witnessed it many times. And as I said, to be careful when 575 00:46:59.480 --> 00:47:02.079 you say the words I feel your pain, because you know you don't. 576 00:47:02.679 --> 00:47:07.760 Most of the time you don't. Everybody's pain is very individual, so you 577 00:47:08.199 --> 00:47:12.639 be considerate when you use that term, because there are people who are in 578 00:47:12.760 --> 00:47:15.679 pain and they need help. And the most important thing always, if you 579 00:47:15.760 --> 00:47:21.639 are experiencing a condition that is making you feel uncomfortable, unhealthy, unwell, 580 00:47:21.760 --> 00:47:27.119 or unable to function normally, seek help. It's a sign of strength to 581 00:47:27.199 --> 00:47:30.920 say I need help, not weakness. Don't grin and bear it, bear 582 00:47:30.960 --> 00:47:35.239 it all. I'm Melanie you. You've been listening to Fearless, Fabulous You, 583 00:47:35.559 --> 00:47:38.000 And as always I like to say, you have the choice and how 584 00:47:38.079 --> 00:47:42.719 you live your life and what you want to do with it. Choose fearless, 585 00:47:42.840 --> 00:47:45.960 choose fabulous, and make an impact on yourself and those around you. 586 00:47:45.639 --> 00:47:49.960 Thank you for joining me, and thank you doctor Furlough. Thank you Melanie. 587 00:48:00.320 --> 00:48:05.920 After time casts used between B