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Published: March 14, 2022, 9:30 a.m.

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Episode Summary

In this episode, Co-Founder of Aivo Health, Melissa Farmer, talks about the mind-body approach to treating chronic pain.

Today, Melissa talks about the mind-body approach, getting patients to be more receptive to the mind-body approach, and how practitioners can recommend psychological care for chronic pain. How can psychology work to treat people with chronic pain?

Hear about the gaps in chronic pain measurements, the psychology behind farming pain out, the Aivo Health App, and get Melissa\\u2019s advice to her younger self, all on today\\u2019s episode of The Healthy, Wealthy & Smart Podcast.

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Key Takeaways

• \\u201cThe body and mind aren\\u2019t separate. They work together, they interact, and that impacts the experience of someone who lives with chronic pain.\\u201d
• \\u201cJust because we can\\u2019t measure it with an existing tool, doesn\\u2019t mean it doesn\\u2019t exist.\\u201d
• \\u201cA patient saying that they\\u2019re in pain is all the proof that you ever need to believe that they\\u2019re in pain.\\u201d
• \\u201cWe all have a collective responsibility to empower people who have been living with chronic pain.\\u201d
• \\u201cOne of the most powerful tools for pain relief is between peoples\\u2019 ears.\\u201d
• \\u201cYour identity is not your accomplishments.\\u201d

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More about Melissa Farmer

Melissa Farmer is a veteran chronic pain researcher-turned-entrepreneur. During her graduate studies at McGill University, she trained with a world-class multidisciplinary team at the chronic pain center founded by pain research legend, Ronald Melzack. She earned a doctorate in clinical psychology and neuroscience. Dr. Farmer went on to pursue postdoctoral training with neuroimaging pioneer Vania Apkarian at Northwestern University, where she specialized in brain imaging of hard-to-treat chronic musculoskeletal and pelvic pain.

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In 2018, she left academia to co-found Aivo Health, a startup with Vania Apkarian and a chronic pain patient/entrepreneur. Their mission is to bring insights from the top tiers of pain science directly to people living with chronic pain.

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On twitter, Dr. Farmer has an international following of influencer physiotherapists who appreciate her ability to translate basic pain science research into understandable language.

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Suggested Keywords

Healthy, Wealthy, Smart, Healthcare, Physiotherapy, Chronic Pain, Psychology, Treatment, Mindfulness, Meditation, Therapy, Trauma, Pain Relief, Mind-Body,

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To learn more, follow Melissa at:

Email:\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 melissa@aivohealth.com

Website:\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 https://aivohealth.com

LinkedIn:\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 Melissa Farmer

Twitter:\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0\\xa0 @Farmer_MindBody

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Read the Full Transcript Here:\\xa0

00:02

Hey, Melissa, welcome to the podcast. I am so happy to have you on I have heard raving reviews from Sandy Hilton and Sarah Haig about you. So it\'s great to have you here.

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00:15

Thank you so much, it is a pleasure to be here with you. And today we\'re going to talk about treating patients living with chronic pain from a mind body approach. So before we get into the meat of the interview, can you define what a mind body approach to the treatment of chronic pain is? Sure, a mind body approach to the treatment of chronic pain acknowledges that we are embodied in these, you know, this skin, muscle bone, that we feel emotions in our bodies, that sensations have emotions that are attached to them. And it also acknowledges that all of these conscious experiences like pain and chronic pain arise from the brain. So they\'re conscious perceptions that are shaped by our thoughts and emotions and feelings and past experiences. So it\'s an acknowledgement that the body and mind are separate, that they work together they interact. And that impacts the the experience of someone who lives with chronic pain. And now here\'s here\'s the hard part as clinicians, what can we do to help our patients be more receptive to this approach when it comes to pain management, because chronic pain, any clinician will tell you is not an people living with chronic pain, excuse me, it\'s not a it\'s not an easy road. So what can we do to allow our patients to be more receptive to this? Because oftentimes people will say, so you\'re saying it\'s all in my head? And that\'s not hopefully not what we\'re saying. So got it? Oh, not at all. So one of the most powerful things I think, that we as clinicians can start with is a simple statement, I believe you, which is something that many people with pain don\'t ever hear. And it can be such a powerful statement, because then instead of coming to an appointment with, you know, evidence that they\'ve prepared to prove that their pain is real, you know, tests, scan results, etc. You push all that off the table, you say, I believe that you\'re in pain right now, and I\'m ready to help you. That\'s, that is, I think, one of the first pieces of resistance that we can remove, just by validating their experience.

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02:53

And I think especially whenever people have lived with chronic pain, and have seen many, many, many, many doctors, they get used to this feeling that they need to

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03:08

convince the person in front of them that their suffering is real. And if we just if we

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03:19

if we get up that out of the way, just by acknowledging that common humanity, I think there\'s there\'s one level of resistance that\'s removed quite quickly. And what about providers, or medical professionals who our education, whether it be formal education school, our clinical rotations, has sort of trained us to look at scans and say, Oh, this is it. This is what\'s causing it. So what can we do as providers to? To break us out of that, if it\'s in the scan, then that\'s, that must be what it is. Do you know what I mean? Mm hmm. I think getting in touch with some humility. So crepe is a great way to start. Because one of the issues with scans and test results is that these are things that

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04:14

scientists and the medical professional has decided these are measurable, objectively accessible, indices that we\'ve all sort of mutually agreed, indicate that something you know, there\'s some sort of structural abnormality or whatnot. In other words, we\'re testing to look for what we know might exist. Another way of saying that is that we\'re only testing for the things that we\'ve thought about before, and that we know how to measure and there\'s a lot of things that we don\'t know about and we don\'t know how to measure. And just because we can\'t measure it with an existing tool, doesn\'t mean it doesn\'t exist. And, you know, from a basic science perspective, right

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05:00

My background is in basic science of chronic pain, we do not know a lot about chronic pain mechanisms. And so having sort of the humility to recognize that

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05:18

the nervous system is incredibly complex, the brain is incredibly complex, there are many things we don\'t know how to measure, and it doesn\'t mean that they aren\'t there,

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05:30

we tend to cling to tests that reflect our particular training. And from a patient perspective, what that means is that they get different types of snapshots. For instance, if someone has

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05:45

lower back pain, they may get MRI scan to one, you know, from one doctor, if there\'s comorbid, visceral pain, which could be referred, for example, they might get a colonoscopy from another doctor, each of every every, you know, we\'ve talked about silos before, you know, in the general field.

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06:06

Each of these silos have their preferences for these different tools, and they all provide small snapshots. And it\'s sort of like the, you know, the blind men feeling on different parts of the elephant, you know, that really handy metaphor, just because you\'re a trunk expert, or you\'re a, you know, a, an, an elephant foot expert doesn\'t mean that you\'re able to see the entire picture. So Humility is a great attribute. Yeah. And where do you think this kind of false dichotomy between the body and mind originates from? Is it that, you know, Decart Deyan? Theory, you know, that happened centuries ago that we continue to accept? Or is it that we put more weight to the objective and less weight to the subjective? Or is it both? Or is it all the above and more,

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07:06

all of the above, for sure, especially in the pain field, Decart has, he said, really strong influence, and he suggested that the body is like a machine. And you can sort of causally identify almost like a, you know, knocking down a line of dominoes. A cause effect, cause effect cause effect. And that\'s how you understand a more complex organism. But

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07:34

what he, he sort of, it\'s interesting, he, he essentially said that, you know, like the body, the material, it works on different rules than consciousness. And he sort of made this blanket statement that we all accepted. So in a sense, relying on the words of a philosopher 400 years ago, is the basis for our logic today is a little a little surprising. But it\'s something that many people haven\'t questioned. And, unfortunately, in the, in standard medical training,

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08:09

I\'m sure you\'re familiar that like, especially in Northern America, in medical school, they receive anywhere between four and 11 hours of pain education,

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08:21

there isn\'t enough time to go into the depth, the proper depth that this subject deserves. So I think that it\'s a, unfortunately, a reflection of these overly simplistic heuristics that medical professionals and other practitioners receive.

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08:40

That that just doesn\'t do justice, to pain at all. Yeah, and like you said, because pain is so complex, because pain is an emotional and

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08:54

physical state

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08:57

that I think people are always looking for the answer. I know, patients are always looking for that one doctor, that one test that one scan that will say, Oh, this is it. This is the problem because people like logical things, right? People like well, point A, here\'s the problem. I can do B and I will end up with C feeling better. But when it comes to chronic pain, we can\'t look at the body and mind as separate. And I think a lot of people do and that does really is a recipe for some really ineffective treatments for pain. So what what can we do if a patient comes to us and they have sort of accepted that their mind body and mind are totally separate? And their kindness I must have done something I\'ve got I\'ve had this pain. I you know as a practice, I\'m sure you\'ve heard it. I hear it all the

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10:00

Time, I\'m sure I did something again, or I must have done something to flare it up. So how can we respond to that in a way that\'s accurate and helpful.

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10:12

One of my beliefs, and this may not be a popular belief is that

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10:19

the body has done nothing wrong, whenever it creates chronic pain, the body and mind it that chronic pain isn\'t a mistake.

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10:29

And I say that from a scientific perspective, because whenever I\'ve studied the mechanisms from the nerve ending on the skin, you know, whenever pain signals or nociceptive signals are transmitted from the surface of the skin, to the spinal cord to the brain, the body is naturally designed in a way that amplifies pain signals. So amplifying pain is how nature works. And it works that way. Because pain is a really important thing to notice. Pain is a primary reinforcer. And that means, by definition, it\'s aversive, you don\'t need to condition or to pair it with anything for an animal or for a person to try to avoid something, it\'s painful. And that\'s why it\'s always sensory and always emotional. It\'s always aversive.

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11:23

And whenever, you know, as I\'ve studied chronic pain populations over the years, and I\'ve looked and really considered and reflected on the biological changes that I see all of these, these mechanisms that sort of turn up the volume of pain, whether it\'s at the nerve and the surface of the skin, or in the spinal cord, or in the brain, they\'re all there for a reason. And it\'s because the signal is incredibly evolutionarily important to respond to.

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11:55

And the division happens in the brain where once it gets to the brain, and creates a emotional memory, or a fear memory. That\'s whenever the brain adapts and changes in response to that incoming signal. So in a sense, that\'s the point where the brain begins to adapt to accommodate the pain in someone\'s life, rather than just being passively responding to the environment. And that\'s one of the

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12:31

one of the main features of chronic pain, where it\'s no longer just a, you know, whenever you see a patient to

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12:42

has pain that still increases and decreases in response to external stimuli. That\'s a great sign because it means that the nervous system is still really closely linked with the environment. Once pain fluctuations start to vary independent of the environment, that means that it\'s become

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13:01

more hard coded into the nervous system.

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13:05

So that whenever I see patients who you know, who do have pain that\'s responsive to seeing the environment, I congratulate them.

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13:15

But again, the idea that

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13:19

it\'s adaptive to remember what causes pain means that it\'s also adaptive to create pain memories. It\'s also adaptive to change how you move in relation to pain. And it\'s adaptive, to feel depressed, and to feel anxious. Those are all completely normal, understandable responses to pain. And the

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13:44

thing that isn\'t as natural and healthy is the inability to go back to baseline after you\'ve hit that new state. And one of the reasons is that whenever you have chronic pain, so many experiences during your daily life, reinforce that cycle that you don\'t have many opportunities to learn what the lack of pain is like.

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14:07

And something this is something I call relief learning. So it\'s natural for us to pay attention to periods of escalating pain. It\'s something it\'s a skill that can be learned to pay attention to periods of pain relief. And that\'s something that a lot of patients don\'t naturally do. And it\'s something that

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14:31

if you don\'t come at it from a brain perspective, you might not see the importance of it. But anytime pain is decreasing, or it\'s lower than it normally is. That\'s the time that you should be focusing on positive emotions, relaxing the body, learning new skills, that\'s optimal learning time. So of that, one of the reasons I bring that up is that the the brain even though it\'s responsible for creating this chronic state

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15:00

It\'s also the key to changing it and shifting back and reversing to the pain free state. The plasticity of the brain is is just a never ending thing of beauty. Absolutely. Absolutely. Well, now let\'s talk about, because it sounds like, and I love what you just said, it sounds like we\'re really focusing on sort of psychological care, which is part of care for chronic pain. And I love something that you wrote in that if mind based treatment helped my pain, then my pain must not be real. Hmm. Right is maybe something that might be in the back of someone\'s mind someone living with chronic pain are in the forefront. So how, how can

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15:45

psychological care? Whether that be CBT, or mindfulness, or you know, there\'s a million different kinds of, I\'m sure scientists, psychological care. So

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15:58

how can people use psychological care, but not D legitimize their pain experience, not make them feel like, well, if, if this helped, then

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16:10

my pain wasn\'t real, because if it were real, then that injection would have taken it away, or that movement or that stretch, etc, etc.

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16:20

One of the things about trading

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16:25

one of the things about psychology is

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16:30

that sort of inherent in this illusion that the mind and body are separate

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16:37

is that

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16:40

whenever you have a new experience, there are measurable neuronal changes in the brain, there is a physical change that occurs, there is a measurable change that occur that occurs, even if you know we don\'t have the tools right away to measure it.

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16:58

psychological changes are biological changes. And there\'s what 4050 years of science that reinforces that. So just because a psychological treatment can help doesn\'t mean that it isn\'t biological, it just reinforces that this source of the biological change is different from what you expected it to be. So I know that a lot of people with pain

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17:27

you know, if for instance, their lower back hurts, or if a certain limb hurts, they assume that the source of the pain must be in that body part.

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17:38

And although this is getting a little high up,

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17:44

in terms of mechanisms, one of the reasons why we can even tell where our body parts are, is that there are maps in the brain. For instance, you know, one of the examples of this is the homunculus. But there are actually four different maps in different parts of the brain, that help us understand where our body is in space, and where our hand is where our lower back is. So you don\'t know where your lower back is, unless your brain helps you decipher where in the body map it is. So, you know, in multiple levels, this this idea of separation is really artificial, it really doesn\'t serve the experiences of people with pain.

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18:25

I understand that.

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18:28

Also, that one of the reasons why patients may adopt this kind of thinking is because they\'re

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18:37

trying to work with the perspective of the provider who\'s treating them. If the provider has these assumptions, patients naturally, just to adapt, they have to play the same bowl game they have to in you know, they might do this through Google searches, or educating themselves on the web, or looking into pain, neuroscience education.

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19:03

In order to be heard, I need to study the way that this is described online and in the literature, I need to be able to talk to my doctor in a way that they can understand.

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19:16

And even that

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19:19

even even that point where it\'s like I need to interpret my internal experience into something else so that someone else will believe me, I feel is sacrificing their internal experience of pain. No doctor

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19:35

I almost think that like

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19:38

a patient saying that they\'re in pain is all the proof that you ever need

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19:45

to believe that they\'re in pain. You don\'t need a test. I really believe this. And so much the point that you know, I\'ve I\'ve I worked with Dr. Vani up caring for many years. The reason why his research

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20:00

has been replicated so many times and has been published in such higher to high tier papers is because he looked at the patient\'s perception of pain and mapped brain signals to that perception.

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20:17

He listened to the patients from the very beginning, he didn\'t say, Well, you have to finish the standardized questionnaire. And that\'ll tell me, that\'ll be the way that I measure whether your pain is there or not. He had a moment by moment, measure of pain intensity that he used to extract the signals from the brain during these brain scans. And that\'s how he found his fantastic findings that have been replicated again, and again, by different by different groups. And those are the findings that reinforced that as pain becomes more chronic, the brain regions that are correlated with the perception of pain change from sensory related regions early on, to emotional related regions within a year. In other words, after a year of living with pain, emotional brain regions are correlated with the sensory perception of pain.

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21:15

Another way of saying that is that the sensation becomes emotional.

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21:21

And that isn\'t saying that it\'s not real that saying that it\'s so real, you can measure it on a brain scan, you can see the pictures, you can replicate it across studies. It\'s that real?

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21:34

So I feel like I\'ve sort of No, no, gone in a few directions to answer your question. But

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21:44

all all patients,

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21:47

all we need to do is take patients word for their pain, we don\'t need any extra evidence that it exists, we just need to take them seriously. And to reinforce that, it\'s not your fault that you have this pain, you did not cause your illness, your body was doing exactly what it was designed to do exactly what we would expect a healthy person\'s body to do. It\'s not your fault. So let\'s, let\'s work together and find

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22:19

your own path to pain relief learning. Right. And obviously, everyone\'s path is different and individualized. And I think we can all agree on that. There was something that you had said,

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22:31

as you were speaking, that popped something that caused me to think that sometimes I don\'t know if you\'ve seen this, but is it easier for patients to sort of farm their pain out to sort of third person their pain, versus first person their pain, meaning they may describe it, or they may listen to the way the doctors describe it, and not think of it as their first person pain, but think of it more as third person. And I\'ll give you an example of what I mean by that. So I have a long history of chronic neck pain

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23:07

during my 30s, like, literally, the decade of my 30s For the most part. And I had I was giving a keynote talk a couple of years ago. And so I joined a speaker salon, or speaking group to help with this talk. And it was about they wanted me to talk about my experience with pain. So I went out there and I started it like imagine a patient walked in and had all these symptoms, right. And the woman who is not a clinician, a health care practitioner in any way. She is a writer, director and speaking coach, her name is Tricia Brooke. She said, Well, hold on a second. I\'m gonna I\'m gonna stop you for a second. I said, yeah, yeah. What is it? She\'s like, Is this about you? And I said, Yes, it is. And she\'s like, Well, why are you talking about it in the third person?

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23:57

I said, Oh, well, because at the end is the big reveal that it was me and she\'s like, people know, it\'s you. You\'re up there talking about it. Like so why don\'t we change it to the patient and change it to me. And I started and within five minutes, I was crying so much I couldn\'t continue.

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24:15

And I was like, This is why it\'s not first person because it was so hard. For me it was a lot easier to sort of third person it out or farm it out. And then going through this for eight weeks, I was finally able to get through the whole talk and someone came up to like, you know, I really liked those parts when we were first doing it when you were crying a little bit. I\'m like, that wasn\'t part of the bit. That wasn\'t a bit that was me not being able to talk about my experience with pain, because it\'s emotional and sensory. So the although at this point now I had not had pain in years. To the extent I had it when I was speaking about it right, but to your point

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25:00

The emotional attachment was still there.

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25:04

So what do we do with that?

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25:10

That\'s such a great

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25:13

question.

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25:18

I think it\'s self protective. Initially, whenever just just as you described, it\'s self protective and that you live with the pain every day.

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25:30

It\'s a way to distance yourself from the suffering.

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25:36

So on one hand, I understand 100% Why people do that. And in a lot of the patients that I\'ve seen, over the years have done that too.

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25:50

I think that

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25:58

something that comes up for me right now, is that the words that one person uses for their own pain are the most therapeutic words that they could

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26:10

use.

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26:12

In that, engaging in the pain memory, from a psychological perspective, is one of the things that allows you to change that memory.

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26:23

And I kind of wasn\'t planning on going here. But it\'s, it\'s an opportunity.

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26:29

One of the reasons why psychological approaches to

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26:34

chronic pain care have the potential to be so effective is that if pain is an emotional memory,

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26:45

we know from 20 years of basic science, neuroscience, that emotional memories can be fundamentally change. There are rules, there are very clear rules.

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26:59

The rules are you revoke the memory, on purpose as fully as possible.

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27:07

You ideally introduce some type of contradictory experience something surprising, because that really makes the

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27:20

the brain state more salient, it makes the brain pay more attention to what\'s happening. And then within three hours, you induce relief, psychological relief, deep breathing, I\'ve worked with patients where we administered propranolol under the guidance of their you know, their doctors, but deep breathing is enough. And that if you are able to induce in sort of controlled conditions, these experiences where you fully experience pain, how it is for you, using your words, the emotions that come up in your body. That is how you fundamentally changed the memory structure of chronic pain.

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28:06

Fascinating, you can do that in little bits across time.

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28:12

Under more controlled conditions, you can do it in one big whammy exposure session.

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28:17

Interesting, I think I did it in little bits over an eight week period in front of an audience

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28:23

in front of a very safe audience of 14 amazing women. And you were also in a sense, potentially reshaping your pain narrative, as you\'re going through this, too. So you know, per Gillette Abelton.

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28:38

You know, working with the pain narrative, and changing the meaning of the pain story over time is one of the another way that

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28:48

that your pain story itself can be really therapeutic. Yeah, yeah, it was. It was wild. But it\'s it\'s a good example, I think of how even though I had not had pain for years, but the emotional attachment to it was so strong that I couldn\'t even get through a paragraph of this talk without crying. I was like, I think I need to come off the stage. And then each time it got, you know, it took more and more time, I guess before I would have like a really emotional response. But I have to say since then it was like,

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29:28

like a weight off my shoulder. You know, and this is years after not years, maybe like six years after I really had more consistent chronic pain. So it was years and it was it was years after the pain had the chronic pain had subsided.

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29:45

That\'s interesting too, because it suggests that there\'s a larger memory structure underneath there that even if the sensory aspects have been remodeled, the emotional attachment can still remain. And so in a sense, perhaps

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30:00

that experience helped to heal the entire memory structure in a way that it you know, it wasn\'t quite complete just with the sensory pain being gone. Yeah, yeah, maybe it closed the circuit a little bit, so to speak. But anyway, it was it was highly, that\'s fantastically effective. But it just goes to show and again, I wasn\'t working with a professional perhaps if I were maybe I would have closed that circuit a little earlier. Or maybe not. Maybe this was the time, we don\'t know, too many questions to answer. So it\'s just right, you didn\'t just write for us at the right time. So, you know, just goes to show that when we\'re when we are treating chronic pain, we need to target the brain. Right? I think you need to have psychological care. So what do treatments look like? Obviously, reminding the audience that everyone is different, and everyone is individualized. But what are some examples of how psychology can work with people with chronic pain?

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30:57

Well, so there are a number of evidence based approaches.

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31:01

So cognitive behavioral therapy is one that everyone knows about Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, even pain, neuroscience education for some people. And whenever I think about these things that I typically look at the biases of the person in front of me, is the person in front of me a highly logical, rational type of person, I\'ll direct them to cognitive behavioral therapy, are they more embodied emotional person, they might be more open to mindfulness meditation approaches, or Acceptance and Commitment Therapy.

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31:38

I think, especially people who have been in the healthcare system, go around for years and years and have some trauma related to being a chronic pain, patient benefit from pain, neuroscience education, just because it helps them get a better understanding of what they\'ve been working with. So in a sense, you know, we have sort of a number of different tools that we know of in the literature, and adjusting each tool based on the the worldview of the patient is the best way to go. I think that\'s such a great way to look at it. And what advice do you have for let\'s say, physical therapists, occupational therapists who are working with patients with chronic pain? What is your advice to us to recommend psychological care? How, how can that conversation initiate?

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32:36

And what is the best way for us to refer out?

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I think that one of the best ways to initiate the conversation is by expressing empathy, and compassion, it looks like you\'re really having a tough time with this.

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And from what you\'ve described, it seems to impact many areas of your life, I see that you feel anxiety, I see that you\'ve experienced some depression, I see that this stresses you out,

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have you thought about support some sort of psychological support? To help you through this, that\'s, I think one of the most open ways that that this can, this can happen and a lot of physical therapists that I\'m that I\'ve interacted with, have taken it upon themselves to learn some of the psychological purchase, because it\'s almost

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because they\'ve sort of found themselves in the position of being the psychologist whether they liked it or not, or whether they had the training or not. And I\'ve really admired a lot of the physical therapists that I\'ve interacted with, because they\'ve gone extra steps to learn what it is that they might need to know in order to provide better psychological care, as you know, as a physical therapist.

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However, there are lots of times whenever the degree of distress or the degree of suffering, it is beyond training, you know, the training that you might have as a, as a physical therapist. So that\'s whenever it\'s time to bring in a professional

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in terms of identifying

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the optimal type of treatment or making referrals. That\'s very tricky of because there aren\'t a lot of pain psychologists in North America.

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Even if I were to come up with a list of them, a lot of them that I know of are in academia and the people that

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are in sort of the private sector. They have that specialization just

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because they have lots of experience there. So it\'s, I kind of, I don\'t have, I don\'t have many suggestions. In this case, I do have a suggestion of a tool that I\'ve helped to develop, that could supplement that in a way.

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But in terms of finding the optimal,

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as per the optimal psychologist, I think it would come down to therapeutic alliance. And that\'s something that each person has to feel out for themselves. And that, okay, you have a person who\'s highly rational, logical CBT might be the thing for them, have them talk to three different suggests they talk to three different people who feels right.

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Because I\'m a firm believer of therapeutic alliance, in the larger sense. And the the foundation of therapeutic alliance was best articulated by drum Frank, in his book, persuasion in healing. And one of the things he described is the healer suffer relationship. And one of the core tenants of the healer separ relationship, the healer believes that they can heal, the suffer, believes that the healer can help them. And they come together and interact with a number of rituals together, that are intended to relieve the suffering. So if you have someone who\'s on your side, even if they don\'t have the right training, but you trust them, you feel like they get you, that\'s more therapeutic than their training proper.

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And that\'s, it\'s it\'s tricky. But for instance, even just talking on the phone for 15 minutes, to three different practitioners is enough to be able to get that feeling. Yeah, that\'s great advice. Thank you for that. And now, as we wrap things up here, what would you like the listeners to take away from this conversation? If you could wrap it up in a bow? What would that what would that present look like?

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I think

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we all have a collective responsibility to empower people who have been living with chronic pain.

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And I think that,

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you know, based on our conversation, one of the most powerful tools for pain relief is between people\'s ears. And I really think that that\'s the most empowering approach as well. And that I, at my core, I don\'t believe that we, that people need to rely on

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doctors or medications or even approaches nearly as much as their own brains.

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I, I know that it\'s difficult to get access to tools and psychological approaches that enable that. One of the things I\'m doing,

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you know, just from a, from an entrepreneurial background, is working on tools that will help people with that. But the key to long term pain relief, is teaching people to attend to patterns of pain relief, and what really feels like even if it\'s just a few moments every day. So my overall bold statement would be the key to your pain relief is paying attention to whenever the pain is less whenever you have time, to enjoy things in life to engage in positive emotional learning. Those are the keys to pain relief, because the more you focus on those moments during the day, and the more we encourage our patients to focus on those moments, the better they\'ll get, and the more quickly they\'ll get better.

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I love that. And now where can people find you? What do you have going on? What\'s coming up? Let us know. Yes. So one of the things that I\'ve done in the past few years after leaving academia, thank goodness, is I co founded a startup with Vanya, up Korean and a chronic pain patient, make Mika Michalak. So he\'s an entrepreneur, finished entrepreneur who has had chronic pain himself. And we

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created a tool that is essentially insights from Bonniers research in an app form.

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And it contains Mindfulness Based CBT exercises and tools that I wrote, and pain neuroscience education that I wrote. So in a sense, it is a expert created tool that is designed to give all of these insights directly to a patient without them having to rely on doctors or any formal care.

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Because one of the apps Oh, the app is

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Ava health app.

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So if you go to www dot Evo health.com, you can learn more about it. And one of the one of the things that I it\'s a real conviction of mine, the science that\'s needed to heal chronic pain exists today.

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You know, this is work that Vanya has been doing for years. And the time that it takes to sort of for that knowledge to trickle down to clinicians and to, you know, clinical guidelines, is 10 to 15 years. And one of the reasons why we decided to do this was because if it exists today, patients deserve to have it today.

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So it\'s, it\'s a labor of love.

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And I invite anyone listening to this podcast, to recommend to check it out yourself, to recommend it to your patients. And to contact me directly at Melissa at Ava health.com. If you\'d like some more information about how to use it to help your patients. I\'m very open to that. I love it. And we\'ll have the link to that in the show notes at podcast dot healthy, wealthy, smart, calm. And again, that website is www dot A i V as in Victor Oh health.com Just so people have the spelling of that.

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And now one last question that I asked everyone and knowing where you are now in your life and in your career, what advice would you give to your younger self, let\'s say a fresh face out of grad school or maybe undergrad wherever you want, wherever you want to take that starting point.

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I would say Melissa,

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you\'re either identity is not your accomplishments.

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Think about what

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drives you what creates the most passion in you. It\'s to help people get better. And to support people while they\'re healing.

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instead of chasing after the shiny ego cries that other people applaud you for take a step back and focus instead on what makes people feel better now make choices to help people heal.

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Now, don\'t worry about long term research because long term research won\'t help people now.

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I love that advice. Thank you so much. This was a wonderful conversation. I always learn such I always learned something new. And this was a lot of new so I want to thank you for coming on. Thank you so much for having me. And I really appreciate it was wonderful and everyone thank you so much for tuning in. Again. If you have any questions for Melissa you can reach her at a vo help calm and have a great couple of days and stay healthy, wealthy and smart.

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