Perspectives on Pain

Dr. Scaperato and CRNA Nick Angelis talk about the causes and treatments for pain. How much of it is psychological, and if so, what’s the best treatment if a patient hears, “It’s all in your head?” Many diseases have cultural origins, and pain is rapidly becoming a uniquely American problem. This is not to say chronic pain doesn’t exist in other countries, but it isn’t endemic with all-or-none approaches leading to neglect or further hardship from the side effects of opioids. We also recommend programs such as “Unlearn your Pain” and “Tame the Beast.”

[Music] hello and welcome to the Ascend Health show I’m your host Nick Angelis I’m a nurse anesthetist and one of the owners of Ascend Health Center and I’m here with Mike scoparado doctor of chiropractor how are you how you doing Nick thanks for having me on today so we’re supposed to talk about custom orthotics and Quantum integration we might get around to that but both of us were like you know what let’s talk about pain and the reason I thought of it was I went to the dentist today and I don’t mind the dentist because when I was five they let me get into the treasure box and I got a free toy so ever since then even though I’m 14 now I’m like it’s not a big deal I get a toy out of it and you know something that is a very good way to get people to come in and you know it’s amazing what will make people come in when they’re in pain whether it’s with their teeth or with their spine or any other aches and pains they may have yeah and it ends up being psychology in fact I do have my toy from the dentist which is a really good one I don’t think it’s going to work though because it’s a it had to bend in because I felt a little bad about taking kid toys if uh right happy Friday get some bubbles going right this is the reason also why I need to have these shows here in the studio because otherwise I’d be complete nonsense all the time so we’ll put that down so I don’t get distracted right so my main point was that because I associate something painful with something good it never became that oh I have to go to the dentist and I read an article saying that chronic pain is a uniquely American condition that other countries don’t really suffer from this which I thought was ridiculous I was like well no when I was growing up uh in the late 90s anorexia was everywhere like any time a teen was troubled that’s what they would do they would not eat and eating disorders are still a thing but it’s not quite the focus that it was then then there’s other cultures where like some of the Latin American cultures were in Pacho were having like a a bolus of food that you can’t digest is an actual disorder that they treat with various maladies so I’m not saying for the show today that hey your Pain’s in your head relax but still there’s an intense psychological component to the way that we feel things I agree now that it seems like you touched on most areas and regions of the world tend to have their own things that they they deal with as a culture and as a whole and pain seems to be one of the biggest ones and is a big problem here in the United States right so and sometimes it seems to be gender specific where uh obviously women have a higher pain tolerance if they’re the ones that create all of us but at the same time most of the guys that I see at my clinic I send Health Center that come in for pain you know someone dragged them there and they should have come years ago while a lot of times the psychological physical manifestations of fibromyalgia or some of those nerve disorders are almost exclusively women so again not to make this show controversial for the sake of being controversial but there’s so many different facets of like what is pain how do we interpret it so what do you do when someone comes and says oh I have maybe I have back pain it just feels weird like how how do we make that step of let’s start with a conservative approach and see what we can do for you yeah that’s a great question so what I like to do is obviously start off with taking a very thorough history and exam because that helps me to get the patient to tell me more about what’s going on rather than just I have pain here you know it’s important to know not only where the Pain’s at but also what type type of pain is being felt is it sharp is it dull is it achy is it knife like does it travel from one spot to the other does it involve also painful or non-painful numbness and tingling so finding that out is really crucial to knowing exactly what could potentially be the cause and is there a difference for whether it’s new onset pain or someone has waited years and years to come to as far as a prognosis or what you can do with it yeah absolutely obviously you know my recommendations all my patients is if you feel pain for more than five days that usually is your body trying to tell you hey there’s something more serious going on than just maybe a sore muscle or you may have you know pulled something especially this time of year doing yard work or you know in the pool something like that there’s something deeper going on now as far as long-standing pain compared to short-term pain so it can actually go either way sometimes that long-standing pain gets worse over time other times it just stays pretty constant but that’s been your body’s way of saying hey I’m really trying hard to get your attention here and I haven’t seen it time and time again where they’re like yeah it comes and goes and it feels okay but then they’ll be in my office because they suddenly had everything just blow up right when it blows up like that usually it takes longer to reserve to resolve the pain rather than shorter right well a lot of times too I’ll have patients who say well everyone has stupid advice for me like eat better be active and then at the debilitating pain and why I tell them I was like well I’m sorry but Medical Science we also have stupid therapies for you you’re going to have to visit a chiropractor all the time you’re going to have to have expensive Medicaid medicines you’re going to perhaps need opioids where everyone’s going to judge you it’s hard to get your refills your in pain management which is really strict like we don’t have great ways to treat pain so you might as well start with all the stupid methods of having an anti-inflammatory diet maybe adding some supplements staying active so because I do feel there are some disorders where you take a pill you’re better there’s no judgment that’s fine like we’re done here we don’t have to earn our way to health but there’s other than pain is one of them where there aren’t really easy methods so you you do have to do whatever you can whatever is on you to get better I completely agree with that and sorry that I called going to the chiropractor too often stupid yeah right

I heard a lot worse believe it or not so and you you hit on a very good and important topic you know a lot of people when they feel pain their first instinct or their first method of treatment is take a pill you know taking the pill to numb the pain to numb the senses a lot of times it’s a physical problem that is causing the pain whether it’s a misline with a spine it could be traumatic like from a slip or a fall or a car accident it could be you know from sleeping incorrectly or doing picking something up incorrectly as well so the the first inclination is to take that pill which is a chemical solution for what tends to be a physical problem so it should really be reversed in over 90 percent of the cases fix the physical problem assess things physically and then if that doesn’t resolve or it gets worse that’s when a chemical solution may help to get rid of the pain or at least help further it a lot help further the healing along right the other thing and usually I 140 for me in the opposite where I’m like no I have to earn my health so you know I’ll play basketball for two hours at church every Saturday morning and I made an agreement with my wife as long as they don’t complain about the pain I can do this to my body if I don’t do any other exercise and then I realize well if I take a Motrin beforehand I’m fine so then it was that issue of like well do I need to earn my health I’ve got plenty of supplements and then I was like nope this takes care of it and I take one motor in about once every month or so so I’m fine but of course those aren’t the people that we see because they’re not fine otherwise they wouldn’t come to see us that’s true so again that’s where I think the lifestyle changes have to come in if you tried one specialist recommendation and it didn’t work well you better start doing everything you can in your power so I think that’s a fair way to do it because again all of us are humans so we want to do a lifestyle change if as a first option most of us don’t honestly but that’s a good way to think of it as like okay the very easiest solution did not work I better do everything that I can I like where you hit on that too you know the words lifestyle and change really go well together and yes it is a change and you and I both know how hard sometimes it is to change those long-standing habits that have been going on for years and years we also have a good point that there is a level of responsibility that the patients have to take for themselves you know us as you know Clinic clinicians and practitioners we can only do so much you know within our office there has to be a level of that responsibility that the patient needs to take on themselves to help make sure that the care that we’re giving them is the most effective right and there’s no judgment with it it’s simply that with Lifestyle Changes you’ll need to see Specialists less often so just more of your own time and money and I think we all make those value choices every day so and I think those value choices are best done without shame or judgment sort of like if you’re at a so I had a friend who was a gluten-free so they went to this Christmas cookie exchange they’re like I’m gonna have some gluten but you know what I’m gonna have the best gluten so I’ve got to decide which of the these cookies are worth it and which of these are trash I was like that’s actually a really interesting philosophy yeah you know one of the things that I learned growing up from my chiropractor and some of my mentors was you know you got to be able to enjoy life so they said try your best to follow the 80 20 rule 80 of the time make the right choices do the right things get a healthier diet if you can you know do exercise if you’re able to 20 of the time hey have fun if you know if you’ve been doing really really good reward yourself with a with a treat or you know a slice of pizza even though it has gluten or something like that that can just make you feel like you’re not this robot you’re not stuck inside this box all the time yeah because otherwise you’ll make them better with your chiropractic care and they’ll have to come to Ascent Health Center for mental health care because of that singular focus on I must be 100 my worth comes from being a healthy physically and that sort of thing because I have those conversations all the time like look we could do this and it’ll get you another 10 percent better but honestly I don’t think it’s worth your time or money so and I think that’s important conversations you have because that’s a big part of self-worth and value valuing yourself at you know I’m fine and this is uh you know I’m healthy enough to do what I need to do and that’s where I’m going to go so absolutely great

I really should stop doing three shows in a row value myself a little bit better but uh my last thought of pain is so we’ve already said okay you’ve you know you might just see me we might see you uh there’s some mental health things you can do for yourself too even counseling and therapy which sounds ridiculous like no it’s physical pain a lot of times that can unlock you to some hidden trauma or again um I guess I can’t say this enough times the Medical Solutions for pain are stupid so you have to do everything you can even if it sounds stupid before you start having rfas or I’ve done a lot of anesthesia work for pain management and absolutely sometimes it’s needed that’s all it is to it just go get your surgery and stop being in pain but because the ways of treating pain are difficult even if something sounds silly you do need to investigate it and when you investigate it you also have to find out well maybe this isn’t the path because I’ve had patients you’ve had patients where it’s like nope you’re not better this isn’t the pathway to get better you need to try something else so sometimes those failed attempts whether it’s a ketamine infusion or getting your back adjusted that that’s useful too because it tells us okay this is a road we don’t need to travel let’s back up and try this path I agree and you know that’s why it’s important to also have a clinician or a clinic that has you know multiple therapies so that way it’s not just a a One-Shot and all and we don’t know what to do at that point so like how you touched upon how you know the the mind can actually affect or cause pain in the body which is known as the psychosocial or psychosomatic aspect of pain so you touched upon you know the the ketamine effusion there’s something to do at your office right so my office we do a form of biofeedback where it measures the pitch of your voice and it finds where the voice is Out Of Tune or out of alignment like your spine can get on a musical scale it actually can find either a current or past stressful or traumatic events and then you listen to audio clips which the op has the opposite tone really nice overlaid music too it’s very gentle very soft a lot of people liken it to meditation music and that is a good way of just helping that you know those stressful events helping your body work through it I’m more of a subconscious level I’ve had really great results with patients have come in to use it that’s absolutely and I think again the main I wonder if we can name this show like pain treatments are dumb or something correct treatments because I’ve looked at so many of those and you’re talking about Quantum integration and the first one’s gonna be like well that sounds dumb I was like well you know what else sounds dumb being on the toilet all day because you’re on opioids and you’re really constipated so again you have to look at the Alternatives of okay what do I have to lose and um I’m sorry that every single show talks about this but we all have limited amounts of time and money and so we don’t want to waste them on things that aren’t going to work and so sometimes it is as simple as this isn’t expensive it sounds dumb if it’ll if it’s going to help me and I don’t do it I’m going to feel really dumb so where do we find that limit for patients so look you can’t try every single thing but how can we focus on the things that certainly aren’t going to make you worse so really good question there so sorry again all my questions are so long that’s all right you know my take is you know that’s where I think also the the history taking the exam making sure that none of the bases are missed is going to help keep them or even direct them onto that path of this is the proper treatment for you this is one that’s going to be the best and again just like you have at your office as well as mine having multiple methods to try should one fail or not produce results that the patient should be seeing so they should be progressing as well as the way that we feel they should be too yeah I get that question a lot like how are you as a nurse anesthetist working with psychotherapists and a psychiatrist and that’s why I tell them like well sometimes it’s one of our turns it’s like you’re up and because we have very separate Lanes it allows a lot of crosstalk that’s usually not possible so yeah absolutely and I think you you kind of hit the nail on the head where again it’s sometimes it is just having your back checked out or doing your typical chiropractic care and other times it’s like well no especially for someone who’s had a lot of surgery on their back that’s where something like Quantum integration might be more useful it’s like no everyone’s already worked on your back and you’re still in pain so maybe that’s not the key here sure you know there’s multiple different Avenues I mean there’s so many different alternative treatments out there that even I lose track of them or I’ll go over you know here’s somebody mention one or go through a list of seeing ones like oh yeah I totally forgot that one was available so and that sometimes is the one that is missing in a patient’s care that I’ve been thinking about recently yeah and and to finish up that talk too uh I think it is important to try to get some Clues on well what if a treatment is really stupid how can I tell and obviously we’re not going to have great answers here because the whole point is it is very patient specific so you can Google some options for yourself but certainly you need to talk to provider about which ones might be right for you for me a lot of it is if it’s too glamorous honestly if it’s uh you see this in supplements all the time where there’s some gold foil wrapped supplement bottle that’s MLM and it’s like wow 50 and then like I saw these agreements that these ingredients at the Great Value brand for the same thing so sometimes it is if there’s too much marketing spent then maybe like they spent all their time on marketing and not on Research so that’s one way for me at least that I can sort of tell you know what this this just looks too good to be true or it’s too fake or uh or it might be something I’ve never heard of but it’s packaged as if like everyone in the country needs this and they’re going to get better from it so agree with you on that too especially touching on supplements you know it seems like everywhere you turn around people are talking about supplements or trying supplements and you know we’re constantly seeing you know try this and vitamin shop you know and other grocery stores and you touch upon you know one of the one of the brands and when things of the chiropractor that I have found is not only is brand important but the quality is important so a lot of supplements they get things either from overseas where they may not have as much or as strict of a protocol for testing to make sure that the right things are in there so and that’s why you know finding a practitioner that is really knowledgeable on supplements not just from them taking themselves but has had seen success in their patients with certain brands and certain you know high quality supplements is super important because you know I have a saying you know garbage in garbage hour and that goes with not only food but also supplements when you put into your body your body’s going to utilize and it’s going to incorporate that into all your cells so if you’re taking in something that isn’t High quality I want to actually produce you know low quality results when you take it and sometimes too if an office offers you something right away like before you even trust them like for example when we do ketamine infusions it’s a very intense experience and what we prefer is to have a patient for a while and then over time like okay you know what this medicine failed it’s time to try this so if somebody comes in uh like oh you really need this expensive program this is going to fix you like you barely know my name you just met me so sometimes it is uh wait until there’s a trusting relationship and the way Healthcare is today like it won’t take you long to figure this out like you’re not going to need a year worth of business but okay I trust you we’ll go ahead and do the quantum integration now but and this has to do of course with you know if you find something on the Internet too if you have a trusted relationship with a provider if you feel that you’re on the same page you’re not in it for the money they really want you to get better then it’s more like like okay I will give this a try so and sometimes like I said it’s perfectly fine like well wait let’s try something conventional let me get used to you and then over time we’ll see if all those get exhausted if I’ll try the exotic flavor of the day or whatever it is all right do you have a lot of patients also come to you asking you know hey have you heard about this even though it’s something you don’t offer in your clinic just to get your opinion on it yeah and so and I usually tell them like oh I’m really smart about this or like I did a Google search just like you did and here’s my opinion so they have a sense of how wise my opinion is going to be and then I think now with the addition review of course I have about 800 different providers in uh just Northeast Ohio so it’s like well this is a specialist on this because I think that’s a challenge too because both of us deal with um kind of confusing diagnosis while someone is at fibromyalgia is a PTSD what exactly is going on here is it mental health physical health it does help to have a long list of of people that they could see and some of it does depend on okay you’ve you know they’ve let’s say they go to you and they’re not using Insurance well if you’re going to come to me then let’s try something that is Insurance based again because sometimes if you split all your resources between multiple Specialists it’s almost like going to a buffet and just having like one bite of everything it’s not really going to work right you touch on the point you know it’s great for your you know for your practitioner whatever you’re seeing for whatever ailments whatever pain whatever health condition you know it’s important to know that they have a long list or at least a good list of other practitioners to do in conjunction with care or if like we touched on this whole show saying hey you know this this may not be the right fit either right now or you know we may need to do it later down the road but I need you to try this Avenue you know to make sure that but we’re still staying on the right path to get any better and the freedom for patients to come and go I have some patients who like I won’t see for a year and a half and they’ll come back put them right in we fix them back up send them on their way and that’s perfectly fine because otherwise to expand on my terrible analogy of the buffet like so you have one bite from all the different uh troughs at Golden Corral you’re still going to get food poisoning if you choose one wrong so the challenge with multiple Specialists is that you could still get your back jacked up you still could have the deleterious effects of someone who doesn’t know what they’re doing and you’re widening the scope so much that any potential benefits you could get are so deluded from all these different Specialists that all have given you different diagnoses like like I said earlier I went to the dentist today I’m sure most problems that I have they would attribute to my oral health or my teeth you know if I go to you you’re a chiropractor there’s going to be something with those joints or bones so it does take a grain of salt with that too sure you know more than one way to skin a cat right that’s an age-old saying and that involves you know not only um multiple areas of life but also when it comes to your health and health care too yeah well Kathy chiropractic care too I’m sure absolutely this is probably a good place to end the show since we’re about to talk about chiropractic care for cats they do have spines and nervous systems so yeah even even there are animal chiropractors out there oh I bet that’s awesome well I mean if you have an organic okay let me Focus if you need mental health you can come to me at ascenthealthcenter.com we will set you up with a counselor or a psychiatrist if it looks like something that works with my expertise as a nurse anesthetist you’ll see me as well afterwards if on the other hand needs of chiropractic care how can they reach you so one of the best ways to reach me obviously is to you know tried and true giving the office a call because that number is

234-334-770 highly recommend anybody looking for chiropractic care to see if I’m a good fit to check out my website which is integyro.com they’ll be able to see a list of things that I can help with and more on there plus they can get more information about the quantum integration about the biofeedback that I offer they also found that I do custom orthotics where I take a mold of the feet because the foundation of the body is off well the rest of it is going to be off just like in a house so making sure that from the ground up everything is Sound Outside the office the spinal decompression is great for disc issues whether herniated or bulge or that sciatica pain it can help with that too as well as many other methods that I offer great well thank you all for joining us for the ascent Health show [Music]

thank you

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