In this episode, we are discussing how to use functional nutrition to treat and alleviate chronic musculoskeletal pain. My guest is Aparna Natarajan. She is a Certified Nutrition Specialist with a Master's degree in Nutrition and Functional Medicine. She is a clinician, a researcher, and an educationist who has contributed to the Institute for Functional Medicine's Meal Planning Program as a subject matter expert. She's cultivated an understanding of the mind-body connection and combines both the science, as well as the art of nutrition, Reiki, and emotional freedom technique.
We will discuss the importance of nutrition and overcoming chronic pain, as well as the benefits of an elimination diet for those living with chronic pain. If you enjoy this episode, make sure to stay tuned because I have a perspective paper that is being published in PTJ, the Journal of Physical Therapy, on the topic of nutrition and chronic pain, specifically for the physical therapy professional, though it relates to other professions as well.
That's moving through the peer-review process. For those of you that have published before, as you know, sometimes that can be a bit of a slow process but it will be out, rest assured, hopefully, sometime in early 2022. For now, let's begin and meet Aparna and learn about the importance of nutrition for chronic pain.
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Welcome back. We're discussing how to beat cancer holistically with Chris Wark. Chris is a cancer survivor, a best-selling author, and a patient advocate. He was diagnosed with Stage 3 colon cancer at the age of 26. After surgery, Chris made the decision to go against his doctor's advice, opted out of chemotherapy, and chose to use nutrition as well as other natural therapies to heal.
Chris has become one of the most well-known cancer survivors on the planet and reaches millions of people per year as a blogger, podcaster, speaker, as well as a global health coach. In this episode, we'll discuss how to beat cancer primarily by using nutrition and other lifestyle-based interventions. Without further ado, let's begin and let's meet Chris Wark.
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In this episode, we're talking about pain education and specifically asking the question, "What do patients value learning about pain?" Our expert guest is physiotherapist and pain researcher Hayley Leake. After working clinically for six years, Hayley embarked on a PhD mission at the University of South Australia with Professor Lorimer Moseley's research group. Her research aims to optimize pain education for adolescents and adults living with chronic pain.
Pain education is a popular treatment approach for treating persistent pain that involves learning a variety of concepts related to pain and is thought to be an important part of recovery. In this episode, we discussed targeted concepts and themes that seem to be the most important of value to those living with chronic pain when delivering a pain education intervention. Without further ado, let's begin and meet Physiotherapist and Pain Researcher, Hayley Leake.
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We have an important episode. We're discussing the association between chronic pain and suicide. The information you'll learn in this episode may help you screen for the risk of suicide more effectively. It may help you effectively treat suicide, and by learning and sharing this information, you may save a life. According to the American Foundation for Suicide Prevention, suicide is the tenth leading cause of death in the United States.
In 2019, approximately 48,000 Americans died by suicide. In that same year, there were an estimated 1.4 million suicide attempts. Chronic pain is a risk factor for suicide, and research indicates that chronic pain is present in about 10% of those who die by suicide. It's important as licensed healthcare professionals and loved ones of those who live with chronic pain that we learn how to ask the right questions, assess for risk factors, and intervene to help prevent suicide rates.
In a few moments, you'll meet Clinical Psychologist, Dr. Joan Rosenberg, who has conducted research in the field of suicide, as well as treated patients in her clinical practice. Before we begin, I wanted to provide you with some information to effectively ask, assess, and intervene in those you feel may be at risk for suicide, especially those who live with chronic pain. First, I'd like to provide you with a shortlist of factors that may increase the risk of suicidal behavior among people living with chronic pain.
If you're a healthcare professional, these might surprise you because we see common risk factors almost every day when we treat people with chronic pain. The first one is insomnia. Insomnia is common among people living with pain and also associated with an increased risk of suicide. The next is an over-reliance on passive coping strategies when you recognize or observe that someone is hoping their pain will go away from these passive coping strategies, increasing their risk of suicide.
The next is pain catastrophizing, a topic we've talked about in-depth on this show. All of us are well aware of the catastrophizing pain scale, and there are also other scales and self-report measures that identify catastrophizing. It's very important that we include that in our initial paperwork. The next is prescription pain medication access when other factors are present.
We're talking mostly about opioids here. It's not just if someone is taking opioids. There have to be several other factors. The factors that you learned about now present. As we're talking about prescription medication, always be on the lookout for what they call the triple threat, which is opioid, anti-anxiety medication, and alcohol use disorders. Those three together, people oftentimes overdose as well as an increased risk factor for suicidality.
There are specific pain diagnoses that have been associated with an increased risk, specifically chronic lower back pain. The diagnosis of psychogenic pain, which is medically unexplained pain or medically explained physical symptoms as well as migraine, those three, chronic lower back pain, psychogenic pain, and migraines.
Feelings of helplessness or hopelessness, individuals who will feel that they can do nothing to change or impact their pain and believe that positive outcomes are not possible for them may be at an increased risk for suicide, and then finally isolation or perceived burdensomeness. Oftentimes these go together. If you recognize or identify distressed and interpersonal relationships where someone feels like they are a burden to others or express feelings of not belonging, these are associated with an increased risk of suicide.
Suicide can look and sound a lot like depression. It's important that we screen for depression. We all know that depression rates are high in those living with pain. There's a simple way that you can screen for depression in your clinical practice, no matter what type of health professional you are. That's with the PHQ-9, Patient Health Questionnaire-9. It's readily available online if you google Patient Health Questionnaire-9.
This is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. It includes nine questions. What's great about this is not only does it screen for depression but question number nine is a single screening question on suicide risk. A patient who answers yes to question nine needs further assessment for suicide risk by an individual who is competent to assess this risk that may or may not be you. Hopefully, by the end of this episode, you will realize that screening for suicide is possible.
What I also like about the PHQ-9 is it gives you a couple of different cutoff points for mild, moderate, moderately severe, and severe depression. With those cutoff points, it recommends proposed treatment action for each cutoff point. It's Patient Health Questionnaire-9, super simple, nine questions to screen for depression. Question number nine is specifically for suicide risk.
With some of that background information, let's bring in our expert guest, Dr. Joan Rosenberg. Dr. Rosenberg is a cutting-edge psychologist known globally as an innovator in the field of mental health. She is a two-time TEDx speaker and serves as a blogger for Psychology Today and has been a featured expert in multiple documentaries on television and radio.
As a licensed psychologist, Dr. Rosenberg speaks on how to build emotional strength and resilience, psychotherapy, and suicide prevention. She's a Professor of Psychology at Pepperdine University in Los Angeles, California, as well as maintains an active clinical practice. This episode aims to create a roadmap or a blueprint for assessing and intervening with suicide. Without further ado, let's begin and learn about this important topic and meet Dr. Joan Rosenberg.
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We explore how overweight and obesity are linked with persistent pain and the importance of physical therapists promoting combined nutrition, exercise, and weight loss programs when treating chronic pain syndrome. Joining us as an expert guest is Anneleen Malfliet. She is an Assistant Professor, Postdoctoral Researcher, and a member of the Pain in Motion international research group. Research in clinical investigations centers on chronic pain with a special interest in spinal pain, central sensitization nutrition, and diet.
In this episode, we will explore the broader lifestyle perspective when considering the link between obesity and chronic pain, how a clinician can assess the presence of obesity or be overweight. Finally, how to approach weight reduction and organize a weight management program in clinical practice. There is a lot packed into this episode. You will gain a lot from the information and data that Anneleen has around the impact of obesity on chronic pain. Let's begin and meet Anneleen Malfliet.
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In this episode, we're exploring the concept of interoception, and how it impacts both physical and mental well-being. Interoception can be defined as one sense of their internal state of the body. This is a full-body sensory experience that has both a conscious as well as a subconscious or semi-conscious layer to it. As practitioners, we're able to train the sense just as we would train balance or proprioception. Interoception includes the brain's processing of signals relayed up from the body into specific sub-regions of the brain, such as the brainstem, the insula and the somatosensory cortex. This felt a sense of our body, its organs, and all of our physiologic processes allow for specific, as well as subtle or nuanced representation of our emotional and physical state.
Interoception is important for maintaining homeostasis in the body. It improves one’s self-awareness or body awareness. It's a critical component of mindfulness training, especially when you're working with body-based conditions, such as reversing chronic pain or releasing trauma. Both have important ties to interoceptive processing. Training interoception, which we can also term as this eighth sense, is often left out of both physical and mental health treatment for chronic pain.
Joining us to speak about interoception is Occupational Therapist Kelly Mahler. She an Occupational Therapist, serving school-aged children and adults and is a winner of multiple awards, including the 2020 American Occupational Therapy Association Emerging & Innovative Practice Award. Kelly is a principal investigator in several research projects pertaining to interoception, self-regulation, trauma, and autism. In this episode, we'll further define interoception, how it can be used in clinical practice and how interoception has an influence on chronic pain and other chronic disease conditions. Without further ado, let's learn about this eighth sense of interception and let's meet Dr. Kelly Mahler.
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I had the opportunity to speak on a panel for the development of a new chronic pain app. There were three of us that were practitioners on that panel. It was myself, a social psychologist and our guest, Dr.Natalie Dattilo. We were fielding questions both from people living with pain as well as practitioners. I had the opportunity to get to know Natalie and I wanted to share her with you and introduce you to her because I found her approach to be very refreshing. For me, it was refreshing even though we know that mental health is finally getting the attention it deserves both in pain care and other aspects of illness.
What I like about her approach is that she focuses on well-being and resilience. Instead of focusing on what's wrong, she's focusing on what can we improve and how can we improve someone's resiliency so that they can cope and overcome whatever physical or mental health challenge that they're facing.
She is a licensed Clinical and Health Psychologist who specializes in the treatment of depression, anxiety, stress as well as insomnia. She provides psychological evaluation and treatment at Brigham Women's Hospital and is an Instructor of Psychiatry at Harvard Medical School. In this episode, we discuss the intersection between self-care and resiliency, when it comes to living with chronic pain or another challenging health condition.
We discuss why self-care is important and how self-care is related to resiliency, how to build resiliency, as well as the barriers that might show up as you start to engage in a self-care routine. The rates of depression, anxiety as well as chronic pain skyrocketed during the COVID-19 pandemic. This is an important episode to share with your friends, family as well as the patients that you treat. There's no time like a depressant to take stock of how you're doing mentally, physically as well as emotionally and to develop a self-care routine that will contribute to resiliency. Without further ado, let's begin and meet Dr. Natalie Dattilo.
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Professor Annette Willgens is going to be sharing some amazing information about mindfulness. I want to share her bio with you before we begin. She is a Clinical Associate Professor at the Doctor of Physical Therapy Program at Temple University. She has over 30 years of experience in both clinical practice as well as educating students and professionals.
Her scholarly agenda, which is what makes me excited, includes studying mindfulness and how it relates to resilience and stress management. Why I love her work so much is because she's working from the inside. She's working inside an active DPT program to educate future DPTs, future physical therapists, and oftentimes other health professionals that she works with on an interprofessional basis in the university setting.
Mindfulness is important for lots of different physical as well as mental health conditions. It is not being taught so much in PT school. We're excited to share this information with you. I'm personally excited to share her with you. I love her and her work. She's going to have lots of great tools, techniques and tips that you'll learn from her. With that, I'm going to turn it over and we'll begin our show.
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This was a fun episode for me for lots of different reasons. The first reason, I spent a lot of time over past episodes talking about cognitive-behavioral therapies, in essence, if you will, the more top-down approaches for the treatment of chronic pain as well as other health conditions. Being a physical therapist, I work with both the mind as well as the body. I want to turn some attention toward more of the embodied therapies, more of the bottom-up approaches, and how they can have a very positive influence and impact on someone's pain and their overall health.
In this episode, we are going to discuss awareness through movement and how the Feldenkrais Method can be used as a tool for pain management. My guest for this episode is Professor Teresa Miller. She is the Founding DPT Program Director at St. John's University, a graduate of the American Physical Therapy Association Educational Leadership Fellowship, and a Guild Certified Feldenkrais Practitioner.
She is an Associate Professor Emeritus from State University of New York Downstate Medical Center in Brooklyn, New York, where she taught physical therapy for years. Dr. Miller received her PhD in Physical Therapy from Temple University, her MS in School Psychology, a BS in Physical Therapy, and AIS in Physical Therapy Assisting.
In this episode, we discuss what is the Feldenkrais Method, how it is developed, what are the guiding concepts of a Feldenkrais lesson, how Feldenkrais can help those managing chronic pain and how to find a Guild Certified Feldenkrais Practitioner. A little FYI before we begin this episode, Dr. Miller was one of my professors of Physical Therapy at the State University of New York Health Science Center, Brooklyn way back from 1995 to 1997.
I consider her a colleague, a mentor, as well as a friend. It was lots of fun for me to do this episode with her. It takes you back in time a little bit too when I was a student and reviewing some of the work that she did, which is groundbreaking. Feldenkrais was not so popular in 1995 when I went to PT school. She was one of the first people to introduce me to more of the mind-body as well as embodied approaches to treating pain.
I want to thank her for her time and for joining us for this episode. I know you are getting a lot out of it. I especially want to thank her for her leadership and bring some of these mind-body approaches into my personal practice as a PT but also into the profession and providing evidence for it. Without further ado, let's begin and meet my good friend, Teresa Miller.
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Friends, thanks for joining me on this episode. I am speaking with Physical Therapist Zachary Stearns about how to screen for psychological factors when treating patients with chronic pain. Zachary is a physical therapist in Durham, North Carolina. He's board-certified in Orthopedic Physical Therapy and has worked in outpatient clinics, which have a focus on musculoskeletal pain management. He's currently working on a large research study, which is called the AIM-back program. This is a collaborative effort between Duke University and the U.S Department of Veterans Affairs. He's also a PhD student in Health Sciences.
In this episode, we discuss the benefits of screening for psychological factors or what we call “yellow flags” in chronic pain management. What types of screening tools can you use? Self-report measures that you can use in your practice. As physical medicine professionals, should we be screening for suicidality? If we do have a positive screening, how do we approach that? How do we follow through with that? Finally, the barriers to implementing and screening psychological factors in clinical practice. I want to thank Zachary for joining me on this episode.
If you're a clinician, this is a content-rich episode where we go deep into how to screen for psychological factors, which are important. We also touch on the topic of suicidality. We have a little bit of a healthy discussion on, “Should we be screening for suicide and what do we do after we screen for suicide?” Zachary also just finished writing a paper in the Journal of Orthopaedic & Sports Physical Therapy. I did mention that at the beginning of the episode. It's great. It's really useful and it would help you. Without further ado, let's begin and let's meet physical therapist, Zachary Stearns.
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In this episode, we have two incredible guests. I'm excited to bring two guests with some incredible experience and research behind them to talk about an important topic, which is bringing ACT to a multidisciplinary pain clinic setting. My guests are Physical Therapist Corinne Cooley and Psychologist Heather King. First, I'll tell you about Corinne. She is a Physical Therapist at the Stanford Pain Management Center and a Clinical Residency Faculty Member in the Stanford Orthopaedic Clinical Residency Program in California. She works with pain physicians and pain psychologists to help optimize complex patient care plans, and leads the exercise and movement portion of interdisciplinary outpatient programs.
Psychologist, Heather King, is a Clinical Associate Professor in the Department of Anesthesiology and Peri-Operative Pain Medicine. She also serves as the Director of the Pain Psychology Fellowship at Stanford. Her areas of expertise are Cognitive Behavioral Therapy for pain as well as insomnia, and Acceptance and Commitment Therapy. In this episode, we'll discuss an investigation that Corinne and Heather were both involved in.
This study included an outpatient interdisciplinary approach with pain psychology using ACT as well as physical therapy, and compared that to traditional Cognitive Behavioral Therapy. In essence, this was an ACT plus PT intervention compared to a Cognitive Behavioral Therapy intervention alone. They got some interesting data and some results to share. They share how they went about investigating this topic and some of the outcomes as well as the patient population, and how ACT flowed through the psychology as well as the physical therapy part of care.
As you know, I'm a little biased toward mindfulness and acceptance-based approaches, to living life to the fullest, especially with chronic pain. That's why I'm so excited to share Corinne and Heather with you. They also use ACT as their primary form of Cognitive Behavioral Therapy in their treatment. Just a reminder, if you want to learn more about ACT for chronic pain, there are two great resources for you. The first is my book, which is called Radical Relief. The second is our course, ACT for Chronic Pain, here at the Integrative Pain Science Institute.
Take the time to read about some of the topics we're talking about with regard to chronic pain, both on how ACT can help the psychological aspect as well as the physical aspect of pain. Also, how Heather and Corinne worked together as this tight interdisciplinary team, which is important in the study they created. Hopefully, we can see more of this in healthcare settings. I highly recommend if you're a professional to download the paper. It’s open access. You can read either the paper and follow along with the show or read the paper after. Without further ado, let's begin and meet Physical Therapist Corinne Cooley and Psychologist Heather King.
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In this episode, we're tackling the important but often times not spoken about the impact of trauma and PTSD on the experience of chronic pain. We're going to be sharing a masterclass that was delivered by a physical therapist, Dr. Jeremy Fletcher, on the topic of trauma-informed pain care and why all of us as healthcare professionals should be more sensitive to the needs of people living with trauma and PTSD. Jeremy does share a number of slides. It's got some great data and some beautiful slides to share with everyone.
Let me tell you a little bit about Jeremy before we begin this episode. Jeremy is a Physical Therapist and serves as the Director of Community Integration for a company called Veterans Recovery Resources. This is a non-profit mental health organization, which is located in Mobile, Alabama. He is a former Professor of Physical Therapy. He's also presented at state, national, and international conferences on the topic of chronic pain, health behavior trauma, as well as community health. He's a Major in the US Army Reserve and holds several leadership positions for non-profit organizations throughout Alabama. His service in the Afghanistan war earned him a Bronze Star for working in a combat zone. He's also a veteran, a father, a coach, as well as a husband. I know you'll gain a lot from this episode.
Jeremy talks about the topic of trauma from a clinician's perspective. He also talks about it from his own perspective, as far as being in a war and suffering from his own PTSD. He's also leading our Trauma-informed Pain Care Course at the Integrative Pain Science Institute. That course is open for registration now. It's a five-week course with a mentor and learning session at the end of the course. You can find out more about the Trauma-Informed Pain Care Course that Jeremy is leading on this episode. You can also go over to the website at IntegrativePainScienceInstitute.com. Scroll over to the Courses tab and scroll down, and you'll find the Trauma-Informed Pain Care Course page.
We would love to see you in that course. It is so important that all of us mental health providers oftentimes receive some trauma-informed pain care, but those of us who are physical medicine professionals, PTs, OTs, oftentimes, we need to reinforce that training. This is an incredible course to do that. Without further ado, I welcome you to read this episode of this masterclass. If you have any questions, you can reach out to us at the Institute. Our email is Support@IntegrativePainScienceInstitute.com. Without further ado, let's begin to learn about Trauma-Informed Pain Care with Dr. Jeremy Fletcher.
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The month of September is Pain Awareness Month. In years past, I've done lots of different things for Pain Awareness Month. I've held online summits, which hosted 30 plus experts. I've done courses for professionals and people with pain. In 2021, I was trying to figure out, "What are we not talking about in the chronic pain space that we need to bring more awareness around? What should we be talking about? What can we bring some more disruption around to disrupt our pain care world out there that isn't always as effective for people with chronic pain?"
As I started to reflect on my practice and the patients I've seen over many years I've been treating patients looking at research, I said, "We need to talk more about the link between trauma and chronic pain." This September, I've done a couple of different things to raise awareness around the trauma-pain connection. The first is I've done lots of different posts on my Instagram handle. If you can head on over to Instagram and find me, my handle is easy. It's @DrJoeTatta. You can find me on Instagram. Like and follow me. I have lots of great posts and sliders that are perfect for you if you're a practitioner or someone with chronic pain and you want to learn more about the trauma-pain connection.
The second is I partnered with a physical therapist this September. His name is Dr. Jeremy Fletcher. He is teaching our first Trauma-Informed Pain Care Course. You can find that by going to IntegrativePainScienceInstitute.com. Head on over to the Courses tab and scroll down and you'll find the Trauma-Informed Pain Care course. That's open now and you can register. It's available for CEs as well as CEUs for physical therapists and other licensed health professionals. It's about seven hours long and has lots of great content.
Jeremy is a physical therapy educator. He works for a company called Veterans Recovery Resources, which is a not-for-profit organization, which helps veterans with both their physical well as mental health needs. He is a dad, coach and also a survivor of trauma himself. He is a veteran of the Afghanistan War. He brings lots of professional as well as personal input to this topic. I've learned so much from Jeremy. He and I lectured in 2020 at Combined Sections at the APTA National Conference. I'm going to lecture again in 2021 at the national conference, which is in February. You can meet both of us there if you're around.
Finally, I've reached out and partnered with people like our guest, Dr. Robyn Walser, who is an ACT-trained clinical psychologist. She is one of the world's leading experts in treating trauma and PTSD. She is the Director of TL Psychological and Consultation Services. She is also an Assistant Professor at the University of California, Berkeley and works with the National Center for PTSD. As a licensed clinical psychologist, she maintains international training, consulting as well as therapy practice.
Robyn is well-known as an expert in Acceptance and Commitment Therapy, specifically for the treatment of trauma and PTSD. She has co-authored seven books, including a book on Learning ACT. Robyn's work spans traumatic stress, depression, substance use and chronic pain. She has written research articles, chapters and books on these topics. She has been doing ACT training and workshops since 1998.
Robyn is incredible. I've seen her in action at a couple of national conferences through ACBS. I've also read a couple of her books. They're great. Head on over to Amazon and make sure you check out all of her books. Dive into this episode, read the topics that she and I are talking about around chronic pain and trauma, see if it resonates with you and think to yourself, "How much do I understand about trauma, PTSD, adverse childhood experiences and the social-political contextual aspects of trauma?" All these are important factors when it comes to treating people with chronic pain. Let's begin this episode and meet Dr. Robyn Walser.
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As always, it's an honor and a pleasure to be spending this time with you. Before we begin, there are a couple of thank yous as we move forward. I wanted to thank OPTP Products for hosting me on their webinar, which was on September 16th. I conducted a webinar for them on mindfulness and acceptance-based approaches for the treatment of chronic pain. Also, I talked about some information from my latest book, Radical Relief, which you can find on their website as well. Thank you for all the great people at OPTP. Make sure you check them out on their website, which is OPTP.com.
On October 21st, I'll be giving a two-hour session on mindfulness and acceptance-based approaches for the treatment of chronic pain at the New York Physical Therapy Association Annual Conference. I hope to see you there. I also want to thank the NYPTA for inviting me. Finally, you can catch me and our guest in this episode at The 2021 Educational Leadership Conference in Atlanta, Georgia. The Excellence in Physical Therapy Education Conference highlights excellence in physical therapy, as well as innovation. It's a collaborative effort by the APTA Academy of Education and the American Council of Physical Therapy.
If you're a PT or PT educator and you're going to be at the 2021 ELC Conference, make sure to visit me and my colleague. We're presenting a session called Mindfulness and Acceptance-based Interventions in Physical Therapy Education. It's time to address the cycle of distress using evidence-based practice. Also, if you're attending the conference, make sure to catch the keynote by our guest, Dr. Nicole Piemonte. It's on Friday, October 22nd at 8:00 AM. She'll be speaking about cultivating the habits of the heart of patient care, including compassion, vulnerability and imagination.
Let me tell you about Dr. Nicole Piemonte before we begin. She is the Assistant Dean for Student Affairs and a faculty member in the Department of Medical Humanities at Creighton University School of Medicine. She earned her PhD in Medical Humanities, where she focused on Philosophy and Medical Ethics. Her teaching and research focus on incorporating the humanities into medical education in order to cultivate future practitioners who are tuned to suffering, vulnerability and social justice.
In this episode, we discuss the benefits of confronting suffering and vulnerability, both in healthcare education, as well as its impact on patient outcomes. Once again, I want to thank the New York Physical Therapy Association and the Educational Leadership Conference for inviting me to speak. It's a great honor. I look forward to meeting all of you and without further ado, let's begin. Let's meet Dr. Nicole.
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We have an incredible guest and we're discussing ways to heal and prevent common childhood diseases. Our guest is an ear for parents, a voice for children, a resource for other healthcare professionals, and she's on a mission to help one million children get off meds. They may not need it if they were eating the right food for their health system. My guest is Dr. Sheila Kilbane. She is a board-certified pediatrician. Who's also trained in integrative medicine. She practices medicine in Charlotte, North Carolina, and consults with physicians around the globe using her holistic strategies to help parents resolve eight chronic recurring health conditions. Dr. Kilbane, welcome to the show.
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By now, you know that I'm a big fan of mindfulness and acceptance-based approaches for the treatment of chronic pain and I'm pretty sure I'm not the only one. If you look at studies, an increasing number of Americans are using some type of integrative or contemplative practice on a daily or a weekly basis to improve upon their physical health, as well as their mental health.
One of the reasons why I love mindfulness and acceptance-based approach so much is because, as practitioners, we're faced with an increasingly complex, more chronic, and more disease professional landscape. The other reason is I believe we've arrived at a place where we can no longer separate the brain from the body or the mind from the body, however you'd like to look at it.
Consider for a moment that there's a well-known, backed by evidence and science, strong positive association between living in a state of stress, which then turns into emotional distress and then finally, on to mental illness. There's a bi-directional relationship between mental illness and physical illness that's inseparable.
Currently, 1 in 5 Americans lives with a mental illness, that's about 52 million people and there have been surveys of physical therapists working in the general orthopedic practice where 75% report treating comorbid mental health problems on a daily or weekly basis. Mindfulness and acceptance-based interventions are a family of methods that emphasize a present moment awareness, nonjudgmental stance, and employ values-based living.
The techniques and exercises embedded in these methods teach you how to cope with stressful thoughts, stressful emotions, and even painful physical sensations. The goal is not to clear the mind or to prevent difficult emotions or thoughts from occurring. We don't have a great way to do that. It's about learning how to relate differently to all your experiences, even the distressing ones as part of our human experience.
These methods are useful in clinical practice, especially if you're aiming for health promotion, improving physical function, injury prevention, pain management, modulating the immune system, alleviating noncommunicable disease, and even improving sports performance. Mindfulness is much more than meditation. These are thoroughly investigated, science-backed, and proven methods of health behavior change.
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Thanks for joining us. My guest is Mathew Embry. Mathew has a great story of overcoming adversity and a chronic condition. Mathew was diagnosed with a debilitating form of progressive MS where he was offered no cure and few if any solutions. He and his father, who is a PhD trained researcher, set out on a quest to find answers. They dove into the peer-reviewed medical literature and discovered natural ways to halt and reverse the progression of multiple sclerosis.
His entire journey can be found in the Amazon documentary called Living Proof, where Mathew shares his story of halting the progression of MS. The documentary also explores the relationship between MS charities and the pharmaceutical industry, their lack of transparency with regard to medical funding, as well as their power, influence, and sometimes their ability to avoid opportunities to raise awareness around lifestyle-based treatments such as nutrition and exercise therapy for the treatment of MS. We discussed this story and how potential conflicts of interest affect those in need of chronic disease treatment. Without further ado, let's begin and meet Mathew Embry.
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In this episode, we are discussing the impact of the health insurance industry on the effective treatment of chronic pain. This is a topic I have been wanting to create some content around for some time. When I look back at the evolution of the show, the episodes typically fall into two buckets. I'm either talking about effective treatments, trying to build, spread awareness around conservative effective treatments for chronic pain or I'm talking about the latest, or some new research that I feel is innovative.
In those two buckets, I'm also always looking for where are the problems and the barriers for us as professionals and for people living with pain to access effective pain care. When I look at the problems, there's one big problem that is like a big flashing red light, the elephant in the room. That's the health insurance industry.
I asked myself, "How has this changed throughout my career?" As a physical therapist, I started practicing or treating patients in 1997. In 1997, I can't think of too many barriers for me treating a patient. When do I say that I'm talking about how much it costs a patient to access conservative pain care and then is that treatment covered? Those are the two big issues, "How much does it cost? Is it covered?" I can tell you back in 1997, I don't remember any patient having a deductible. If there was a copay or something moderate, it's maybe $5 or $10.
I'm not saying as citizens, professionals and people living with pain that we shouldn't be fiscally concerned about the delivery of healthcare because that's important, especially in the United States of America. However, I can tell you in 2021, the average American contributes to their health insurance. Meaning there's typically an employee portion each month as an employee that contributes to your monthly premium. There's also an annual deductible and then there are copays on top of all of that.
As people in the United States of America, this may be the most important for those of us who live in the United States but I know this impacts all of us around the world, we are paying a lot of money into our health insurance. We have to ask the question, "What are we getting back? What is the benefit that we are receiving?" The average deductible in New York City, the place where I live, is somewhere between $5,000 and $10,000 for a family plan. I have seen family plan deductibles upwards of $20,000. It's clear that premiums have increased.
The second thing for us to consider is copays. When I first started in 1997, copays were maybe $5 or $10. It's not uncommon now. I have seen copays that equal the cost of the PT visits. Copays that run anywhere between $40, $50, $60 and $70 upwards to $100 to receive physical therapy care. We are paying more.
However, at the same time, I have also seen visits decrease. In the United States of America, this varies depending on the diagnosis and where people live, the average length of stay for a PT session is about twelve visits. Consider you have to treat someone who has fibromyalgia and you only have two visits per week for six weeks for a total of twelve visits before the insurance company terminates care.
Effectively, what large insurance companies have done is have contracted or hired third-party medical management companies, which come in. It's what they call they manage health insurance claims, which I would like to call what it is the aggressively deny claims for conservative care. This includes things like physical therapy, occupational therapy, speech, mental health services, as well as addiction treatment.
Not only do they manage that care but oftentimes, insurance companies will not approve a patient seeing multiple providers. For example, insurance companies often regulate if a patient is seeing both a physical therapist and chiropractor or a PT and OT. Any combination of those, they don't like when patients are using their insurance to the fullest extent.
Let's carry that over into what is identified as the gold standard for the treatment of chronic pain, which is multidisciplinary or interdisciplinary care. That's when the patient can access multiple providers. In the United States of America, we have one interdisciplinary chronic pain clinic for every million people that focus on chronic pain management.
Why do we have that? Insurance companies have identified this as expensive care. It's too expensive to pay multiple providers, at the same time, they have severely cut back on those programs probably since the early '80s somewhere. That's when that trend started. That has come back somewhat but we haven't seen a revitalization of interdisciplinary chronic pain treatment programs in the United States of America specifically because insurance companies won't pay for the care.
Lastly, I don't want to just focus on private health insurance companies in the United States. We have things like Medicare and Medicaid, which are government-sponsored plans. Those two have been cut every year it seems. Some emails go out by organizations, such as the American Physical Therapy Association. It's called Stop The Cut. That's where the Medicare fee schedule is reduced.
Each year or every couple of years, the national government tries to reduce payments to outpatient physical therapy services. When payments are reduced, it often has an impact on the number of visits that we can see patients for and the quality of care that we can provide in an outpatient setting. The question is, "How does the health insurance industry perpetuate the chronic pain crisis?"
Joining me is Dr. Michael Schatman. He is a clinical psychologist who spent many years working in multidisciplinary chronic pain management. He is on the teaching faculty of the Department of Public Health and Community Medicine at the Tufts University School of Medicine in Massachusetts and serves as Director of Research and Network Development for Boston PainCare. He has authored more than 100 journal articles and book chapters on chronic pain management and lectures regularly at the international level. He is also the Editor-in-Chief of the Journal of Pain Research.
In this episode, we are going to talk about the health insurance industry and how it impacts the treatment of chronic pain. This is an important episode. Make sure you share this with your friends, families and colleagues all over social media so we can raise awareness on this topic. Let's begin and meet Dr. Michael Schatman.
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We're talking about analgesic medications and how they can have both a positive and a negative impact on how your muscles function. Analgesic medications are simply medicines that are used to alleviate pain. You may have seen them marketed as painkillers or pain relievers. Technically the term analgesic refers to any medication that provides pain relief without putting you to sleep or causing you to lose consciousness. There are many different types of medications that have pain, relieving properties. Some people tend to lump these all together, but they're different groups or types of medications.
Some common names you might have heard of are non-steroidal anti-inflammatory medications, such as NSAIDs. These include things like Aleve and Advil. Another group is narcotic opioids, like oxycodone and morphine, and then another common group or non-opioid analgesics typically falls into that category are things like acetaminophen or Tylenol. In many cases, the effect of treatment of chronic pain may include one or more of the analgesic medications I previously mentioned.
However, the use of analgesic medications can be potentially challenging for physical therapists because they're faced with a paradox. On the one hand, an analgesic medication may alleviate pain, which you may think makes it easier for people to move and function. Yet, on the other hand, these medications may negatively impact the physiology of your muscles, nervous system and other parts of your body. Here to talk to us about analgesic medication is Dr. Bahar Shahidi.
Bahar is a physical therapist and a researcher investigating how analgesics impact muscle physiology, pain as well as physical function. She is an assistant professor in the Department of Orthopedic Surgery at the University of California at San Diego. Her academic background includes a Bachelor's in Chemistry, a Doctorate Degree in Physical Therapy and a PhD in Neurophysiology. Her research focuses on muscle physiology changes in the presence of chronic spinal pain.
In this episode, we discuss how analgesic medications impact clinical outcomes in people with chronic low back pain, exercise responsiveness, how to time the use of analgesic medication relative to physical therapy treatment, and balance medication use and exercise for optimizing patient outcomes. Let's begin and meet Dr. Bahar Shahidi and learn about how analgesics impact muscle physiology.
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In this episode, we're discussing how to bridge the gap that exists between a person and pain, their ability to move beyond suffering and back to life through applying both modern pain science principles, and the ancient wisdom of yoga. Yoga is a practice that is more than 5,000 years old, and the field of pain science is probably more than 40 years old. However, when brought together, both of these methods and techniques offer each other enormous resources and wisdom for the treatment of pain and many other chronic health conditions. Joining me to discuss the combination of pain neuroscience with yoga for effective pain care are physical therapists Niamh Moloney and Marnie Hartman. Niamh is a physiotherapist, pain researcher, and yoga teacher. Marnie is a physical therapist, a certified strength and conditioning specialist, and a registered yoga teacher.
Both have a special interest in pain neuroscience and how to use yoga for effective pain care. In this episode, we discuss how to apply modern pain or science to yoga and yoga therapy, the similarities between yoga and a modern pain science approach, how to optimize both the mind and the body for effective pain relief, and whether or not mindful movement is more effective than general physical activity for pain management. Together, Niamh and Marnie wrote a great book called Pain Science-Yoga-Life, you can find that on Handspring Publishing, make sure to check that out. Without further ado, let's begin this episode and learn about pain neuroscience and yoga for effective pain care.
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On this episode, we're discussing patient adherence to treatment as a foundational aspect of pain management. The evidence-base and research in this era tell us that high levels of adherence to things like physical activity or perhaps an exercise program are highly correlated with positive health outcomes, but what about when a patient does not adhere to the agreed upon treatment plan? Do we know how to increase patient adherence? Do we know how to promote the maintenance of pain self-management behaviors? Joining me to discuss adherence to and the maintenance of self-management behaviors in people with musculoskeletal pain is Dr. Anne Soderlund. Anne is a Professor of Physiotherapy in Sweden with a special interest in behavioral medicine.
Her research area is on prevention, treatment and evaluation of health problems from a behavioral medicine perspective embedded within a physiotherapy framework. This includes a strong focus on an individual's behavior, behavior change, and the ability for functioning in everyday life at different ages. On this episode, we discuss the important topic of helping patients adhere to exercise programs and other self-management techniques for the treatment of chronic pain. As a leader in this area, it has some great research with regard to physiotherapy and behavior change. She's definitely someone's work I recommend that you follow. Without further ado, let's begin and let's meet Dr. Anne Soderlund.
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