Welcome back to the Healing Pain Podcast with Dr. Peter Abaci
The technology that modern medicine possess is so powerful that it can change the life of a patient with a push of a button. The danger is that the medical community needs to be aware how to harness this technology appropriately and judiciously, because otherwise, more problems for the patient may occur. Author of Conquer Your Chronic Pain Dr. Peter Abaci believes that integrative pain care can help in chronic pain management with core principles like function, independence and social connectivity. Find out why the medical community is at a crossroads in health and pain as patients start to look for other paths of the healing process.
If you listened to my podcast and my summits over the course of the last two years, you’ll know and have heard me say that pain really is a major and significant public health problem that really affects us all. I believe it’s a challenge that we can really tackle and one we can remedy. Just recently, we’re beginning to see the opening up, the reengagement, the renewing of interests in integrative or multidisciplinary pain care. What’s interesting to me is that this is not a new concept. It’s not something that’s experimental and in many ways, the evidence for multidisciplinary and integrated pain care had been around for years. It’s undeniable that when patients enter into multidisciplinary pain program is to get better outcomes. Their pain goes away faster. They were able to cope and get back to the life that they love and deserve.
Here to speak with us about interdisciplinary pain is Dr. Peter Abaci, who is one of the world’s leading experts on pain and integrative medicine. As the Medical Director and Co-Founder of the Bay Area Pain and Wellness Center in California, his innovative strategies for integrative pain management have helped restore the lives of thousands struggling with pain. Dr. Abaci has also written two books and he is known as a trusted resource for patients, family members, doctors and other practitioners like psychologists and physical therapists as well as insurance companies who really come to him to find out about these integrative strategies and what he is really doing in practice.
Conquer Your Chronic Pain: How To Save Integrative Pain Care with Dr. Peter Abaci
Dr. Abaci, welcome to the Healing Pain Podcast.
Thank you for having me.
It’s great to talk about integrative pain care because I do see this as the way of the future. You’re an anesthesiologist by training. Take me back a little bit as to what your early practice was like and how that evolved and how that came to be?
I would like to say enlightened anesthesiologist. It’s interesting I got into pain in the ‘90s and at that time, it was a new specialty and I was an anesthesia resident. It was a break-off or a subspecialty of anesthesia. It was really based on interventional treatments and manipulating medications because as an anesthesiologist, you’re trained to make people feel a certain way or make them feel nothing at all. That’s how pain management started to grow and that’s how I got into it. I thought it was really cool to be able to do all these great things and the special injections and procedures and prescribe medicines or do things with medications that no one else could do. It wasn’t really until much later on in my career that I really discovered what treating pain and chronic pain in particular was really all about and how it was much more than exercise and fancy procedures of pharmacology and really was much more about helping people heal at a much deeper level. How I spend my days now is so different from how I originally started when I got into this field in the world of anesthesia.
What’s interesting is that it can be cool to give people a pill and their pain goes away. In many cases, people who listen to my podcast know that I’m not anti-opioid and I’m not anti-intervention, that there are times when those interventions are needed and still help people. Somewhere in the ‘90s, we took one road into those interventions as the only treatment for pain. Do those interventions in and of themselves work for pain or does it take other factors to help people?
You’re probably like me. I’m not anti-medication but I’m pro-health and I want to do whatever is best for my patient’s health and well-being and wellness both today and tomorrow but also near their future looking ahead five to ten years down the road. I think that the choices and the decisions that we make have to be with the big picture and mind for our patients, for their benefit. One of the examples that I use in my first book is the story of King Midas. King Midas is this story of everything he touched turns into gold and what powerful tool that is. The reality is it was a curse for King Midas. I think in modern medicine, we have such technology and can do so many powerful things, but if we don’t know how to harness it and use it appropriately and use it judiciously, we can actually end up causing our patients more problems than actually help them. Really a lot of what we treat in our clinics, a lot of it is created by the healthcare system and the doctor visits or the healthcare treatments people get which is really unfortunate. Having a pain problem could be bad enough or challenging enough and then you just make it worse and worse by misguided treatments or other things, and we’re not really getting to where we want to go for folks. It’s not what we want to do.
You really have a wonderful integrative practice at Bay Area Pain and Wellness Center. What has been the reaction to some of your peers? It’s not every anesthesiologist or every physician for that matter that works with people with pain. There are a lot of types of doctors or physicians that treat pain. It’s not a lot of them that are going to really embrace some of the things that you’ve embraced and practice.
It really took a number of years to get people to buy into certain things. I remember in the ‘90s, when I first started private practice, there was a lot of pushback and not really a place for the psychology side of pain management, seeing a psychologist, doing psychological based treatments. That was still a little bit foreign and suggestive that you’re implying the person was crazy or something like that when really you’re just trying to develop a care plan that speaks to all the different layers to the end including the emotional sides of the pain problem. We had to get past that.
In the early 2000s, we started introducing more alternative things like art therapy and bringing in some of the Eastern things like yoga, TaiChi, Qigong, things like that and then getting people to buy into that and to have a blue collar truck driver tell you, “I’m not doing art therapy. I don’t play with crayons,” when it really is a much deeper form of processing and healing in therapy. We had to go through all these iterations, challenges and pushbacks both in the medical community, in the patient community, in the insurance world. We’re still climbing up that hill in a lot of ways but I think we’ve made a lot of progress. It’s interesting now something like art therapy, which we started using in 2001 and that we really are the first group to do that in the chronic pain setting. People thought it was strange that we would bring it out into what we were doing. Nowadays, I think you see the military using that with veterans and using it to treat PTSD. It’s quite a common place now. I think even the vice president’s wife has been promoting art therapy now. If you stick with what you’re doing and if you show good outcomes, I think eventually people start to buy into it. It just takes a long time.
It’s so true and it’s interesting for me because my first job in 1996, I worked in a small community hospital here in New York City and in the adult rehab department. Most adult rehab departments are integrated in some way. There’s multidisciplinaries treating patients with conditions like a stroke or joint replacement. Then I went into private practice and I saw this silo that really is the mainstay still to this day in care where practitioners are in their silos and they’re doing their thing. What do you recommend as a way to get practitioners to start to talk to each other and to share ideas and maybe even partner together?
I think for the model that we have, we make it easy in our own practice because we have everybody working under one roof as much as possible. The physical therapist, the psychologist or the medical doctors or other specialties are collaborating under one roof, one team approach, which I think is the optimum. Outside of that, it’s not easy to get two doctors to communicate, to pick up the phone. They have to go through the phone tree. It’s hard to get through. It’s just really hard to communicate out in the real world of healthcare. I think it really only happens when the patients really push for it. When they say, “I really need you to talk to another doctor or I need you to talk to my psychologist.” When patients advocate for that, I think the providers are more likely to be quite honest to do that otherwise, they have their head down in their work in their busy day.
The collaborative communication is really lacking when it comes to any chronic disease management model. With what we saw with Obamacare, when that came in the ACO model with healthcare, there was a recognition that this is important with disease management. The different specialties working in a coordinated way was going to give us better outcomes. It hasn’t really translated yet into mainstream medicine where you see people having that done well for them, and your point we need to do that a lot better.
On top of that, I guess we have the challenges of insurance which ultimately a lot of times drives the way we practice. Even if we don’t want it to, it just does it inadvertently.
It’s a huge barrier really, and not just private insurance but also the Medicare system. We talked about how people need integrative programs, they need interdisciplinary care and that we get better outcomes for our patients with it, but Medicare doesn’t cover things like that. Private insurances often don’t cover things like that very well. How do you expect doctors or chiropractors or physical therapists to provide great care for the patients if there’s not a payer system in place to help them do that? We’ve got to overcome that challenge.
There’s one thing though when some of the new opioid rules went in a couple of years ago, I was like it’s great for sending the message that opioids are not the fix but it’s really bad because we’re pulling drugs away from people, but we’re not giving them anything in their place. That caused a lot of fear in patients, obviously people with chronic pain especially. We know that fear oftentimes can lead to more pain. What are the core principles of effective pain management as you see it?
There are a couple of important objectives that you want to bring in as a patient, that you want to bring in to working with your doctor and what you get out of it. I think function is super important. I think that can be broken down into your mobility. How you can get around whether it’s walking, crossing the street, visiting your friends, driving your car. Things that your doctor or your provider team or your treatment can help you do that make you more mobile is going to really increase and improve your quality of life. It’s going to help you interact with more people, work, do meaningful activities, have fun, all those important things. Mobility is a really important part of a good pain management plan and I think promoting independence. Nobody wants to be dependent on somebody else for taking care of them, going to the bathroom, bathing, whatever you want to be able to do to get through your day in an independent and successful way.
Focusing some of the treatment on improving your independence I think is an important one and I think social connectivity is really important. We know now from a lot of interesting research being done that how long we live, how well we live, and how happy we live is directly correlated to the quality of our social connections and how well we bond with others. We know that when we’re hurting or when we’re in pain, it changes our social connections in sometimes a lot of negative ways. We experience mood changes. We don’t relate to our family as well or get along with our spouse as well. We’re not able to get out and get around. We don’t see as many people. We’re not able to go to work because we’re on disability and you think about how many hours you spend at work everyday and all the different people you talk to and all of a sudden, that’s gone. We know those types of things are really important. When you’re working with your provider team, you want to try to bring in those important elements because regardless of the pain problem, it’s going to improve your quality of life. At the end of the day, you can have a very challenging pain problem but you can still have a great life and that’s what you want to get out of your healthcare provider.
The social part more and more I find interesting. I do think you’ve gone through this wave of different things. We’ve understand that movement is very important to people with pain. I think the current wave is to understand how someone’s mindset or their psychology is important. Those are three lines that are going to permeate really whatever type of pain rehabilitation you choose. The social part is really interesting to me because people are isolated if you’re at home and you’re not mobile, a lot of times you’re home. You’re not going to work or you’re not engaging with friends and family or other activities. I wonder we have social media which does add a layer of social connectivity although the pain groups I’ve seen online sometimes are not very supportive. There are more places for people to list their complaints really if you will. In your practice, how do you address the social aspect of it and how do you bring people together so that they talk and communicate and share in a way that helps them really resolve what they’re going through?
Positive social interaction is a powerful healing tool that I come to learn over the years. One of the things that we do in the center is we have a day program where our patients are here for several hours everyday and they’re in small groups. As opposed to being isolated or one-on-one with their provider trained team, they’re working with a small group of other folks many of which have some similar experiences or things that they share and so that often has a positive effect. We’ve also learned that when a new person comes into the group for the first time and they’re working with somebody else who maybe has been in the program for a couple of weeks already, maybe they both have back problems, one’s been doing the program for about three to four weeks and is doing well, has very positive influence on the new person. They start to see what’s possible. What they can create or accomplish for themselves. I think people can really help motivate other people, provide good examples, and really help the healing process. One of my patients may have a much bigger impact than something I would tell. It’s very interesting. The social dynamic part of it is really great.
Then another thing that we’ve done is we have ongoing support groups that meet on a regular basis especially after they’ve completed the six-week program. Some of them meet regularly and do art projects. We have crochet group that meets. We have some exercise groups that meet. Different things depending on what people are interested in. It allows those social bonds and positive social energy to continue. We have to be careful when it’s negative, it changes the experience for the other people in the group.
You mentioned movement earlier. You mentioned physical therapy. You mentioned other things like Tai Chi and yoga, which are all really wonderful and incredible. I’m sure a lot of your patients probably cycle through some form of physical therapy first before going on to those other groups. It can be really challenging when you have pain to start to move again and there’s a lot of fear behind that. What do you say to your patients to put them at ease so they can feel a little more confident going into a physical therapy session?
Physical therapy can be a big challenge because a lot of people with pain problems try it, many times they have a bad experience. I think a lot of physical therapists are trained in the more acute entry model, the sports injury acute rehab model, where a lot of pain problems are more chronic and more complicated problems. A lot of times, their traditional physical therapist is not attuned or experienced or trained to treat chronic pain problems and then we ran into some issues. I think having the patient find or seek out movement experts whether they be physical therapist, chiropractors, yoga teachers, whatever they may be, but movement experts who really understand the mind-body connection, understand the complexities of chronic pain really puts them in a much better chance to win. Recognizing for patients, if you’ve got a pain problem, that means that there’s going to be all kinds of musculoskeletal imbalances in your body. We have to work through those and recognize that the hip bone is connected to thigh bone. What’s going on in one part of your body is going to affect everything else. We like to align people with healers and providers who get that as opposed to the more acute model that’s just focusing on an inflamed knee or something like that. Just a very more limited scope. That makes all the difference in the world.
I think it’s interesting to see how we’re starting to look at movement as a powerful way to affect someone’s plasticity versus just about strength and range of motion. Those things are of course important but when you look at how movement affects your nervous system, your brain, the function of your brain, plasticity, hormones and neurotransmitters, I think other than diet and nutrition which is probably my second love, but movement of course is essential for everyone.
I want to take you to the flipside of this now and you seemed like a pretty enlightened physician, so I think you’re going to enjoy this question. How do you handle it? I know you have psychologists on staff that will deal with this but I’m assuming that you’ve had patients who start to look at their pain from a more spiritual level and wonder why this has happened to them. Why it’s persisting? Why they’ve been trying things and nothing has worked? People start to think, “What is it about me or my life or maybe things I’ve done or not done?” Those can be really challenging questions. If you look at the research around spirituality, most patients want their practitioner to be informed on some level about what spirituality is and how it affects pain. Right now, I think spirituality only exists in your last few weeks in healthcare. We haven’t really brought it into modern medicine. What might pain care be the place to really do that?
I love the whole topic of spirituality. I agree with you. It gets way undersold in traditional medicine. I actually gave a lecture on spirituality and healing to our patients. I’m pretty into it and I think it’s a very powerful part of our lives. You can approach it from a scientific standpoint in some ways. You mentioned the neuroplasticity and we’ve learned about all the structural neuroplastic changes that take place when we’re experiencing pain. We start to see what ways can we undo that? Can we heal our nervous system? The spiritual world has a huge powerful healing effect on that and why not embrace that and bring it into our lives. The ‘why me?’ situation, that comes up. I had my own experience with a bad back injury about three years ago where I was in excruciating pain and it was the sciatica and a lot of physical disability associated with that for a period of time while I was trying to recover. You really do have to connect at many different levels, but definitely on a spiritual side and recognize that you’re going to get through this and it’s going to make you better on the other side of this.
It certainly made me a more enlightened physician, a better doctor who understood back problems and recovery a lot better. It made me a better person. A couple of lessons that I learned from that, one is being in pain is a very humbling experience. If you’re the practitioner or the doctor and you treat people and you have this feeling of you’re all powerful but to be the person, to be the patient, to be in those shoes, is a very humbling experience to be in. At the end of the day, none of us are better than anyone else and suffering and pain is unfortunately a part of the walk in this Earth. We have to handle it the best way that we can.
With your own pain experience, what kind of treatments did you find to be most helpful for you?
What happened was I had this 9 millimeter extruded disc that popped out at L5-S1 and had pinned my S1 nerve root against my facet joint which is the bones that are in my back. At first, I couldn’t move. I couldn’t sit in a chair and I couldn’t drive a car and I was having a hard time walking and I was having severe pain and weakness. I needed to do a lot of rehab work over a period of really many, many months, more than a year to get the strength back in my left foot and my left leg. I wanted to do what I could to help my body. I wanted to maximize my body’s own inherent healing mechanisms. We’ve learned that if we have a herniated disc, our immune system can go in there and start to clean that out. I wanted to give myself the best chance to do that. I experimented with some acupuncture and I responded pretty well to that. I kept doing that. I wanted to have good hydration and good nutrition to give my body a good chance to heal while I was doing that.
Finding the right movements, the right rehab plan, some acupuncture, a lot of prayer, it’s how you get through it and you just take it one day at a time. I think the great lessons from all that and it was the title of the last chapter of my book is, “Two steps forwards, one step back.” We try to recover from our devastating injuries or challenges in life. We progress but we never progress and don’t slide back. We always have some setbacks. It’s important to just know that that’s just part of the natural process and not to freak out and think that we’re going back to square one again, but to actually take advantage of all the things that you’ve learned to get you to where you are and then use that to get you over the next hump again. One of the many things you learn when you’re in that position.
When you’re injured and you’re in pain, that’s true especially when you’re a practitioner because you know so much but it can affect you just like we see in our patients. Your recent book is called Conquer Your Chronic Pain: A Life-Changing Drug-Free Approach for Relief, Recovery, and Restoration. How was that different from your first book called Take Charge of Your Chronic Pain?
My first book Take Charge of Your Chronic Pain is really an easy to understand introductory guide on chronic pain and how to recover from it that I think anybody can understand and hopefully benefit from. It’s a real basic starter guide for the pain patient. The Conquer Your Chronic Pain, my second book, actually goes a lot deeper. It goes into more of the science, more of the neuroscience, a deeper understanding of the brain and neuroplasticity. I go a lot deeper into that. I think a bit deeper into some of the psychological aspects, talk more about trauma, trauma therapy and recovery. It’s a little bit more of advanced version of the second book. I think they’re both helpful and for some folks, it might help to read the first one first, but it really depends on what a person is looking for.
There was an article in the Journal of Orthopaedic & Sports Physical Therapy a couple of months ago and the title of it is A Call for Saving Interdisciplinary Pain Management. In that article, it says that there’s one multidisciplinary pain clinic for every 1.7 million Americans. Obviously, that’s not a lot. Imagine squeezing 1.7 million Americans into your clinic, which is interdisciplinary. What’s your advice to you patient who is out there saying, “I’d like to find a place like that but I don’t know if there’s one in my neighborhood or I don’t know how to go about finding that?”
I think we’re at a crossroads in healthcare and pain with the opioid crisis and people looking for other paths. As people start saying no to patients, I think they have to figure out, what are you going to say yes to? You can’t take things away and not offer people better care or better treatments and that’s what we need to do. For patients who are struggling to find the right places to go, it’s really hard especially in certain parts of the country. Probably a good starting point if you have no idea where to start is to look at an academic center if there is one in your geography or your state or county and see what they have to offer. That might be a good starting point. If it doesn’t exist, then I think what the person is looking at is piecemealing different providers or different practitioners in their community. Finding a good psychologist who treats pain, finding a good physical therapist who can treat complicated pain conditions, finding maybe an acupuncturist or a good yoga class or a Tai Chi in the park. Starting to put those pieces together. I think a lot of folks in their communities, that’s what they’re going to have to do until more structured programs are available and we have the insurance and the resources to make that more readily available.
I agree and I would say that practitioners are going to become multidisciplinary in and of themselves. You’re going to see practitioners like a physical therapist for instance adapting nutrition and understanding principles of mindfulness-based stress reduction and pain psychology that really can be through lines no matter what type of practitioner you are. There are a lot of different types of practitioners that treat pain. Like you said, the most important thing is if you don’t have access to it, then start to develop your own program. You can do that either by picking up books, the kinds that I’ve written, the kinds that Dr. Abaci have written that explains to you what works, and then finding the practitioners that support you. To summarize, can you tell us how people can find out more information about you, your books, your clinic, everything?
You can learn more about me in my website PeterAbaci.com. Both of my books, Take Charge of your Chronic Pain and Conquer Your Chronic Pain can be ordered on Amazon. I also have a blogsite called PainReliefRevolution.com. If folks want to catch up on what’s going on in the world of pain management, that’s one resource we have. If they’re in California and they’d like to see us in our office, it’s the Bay Area Pain and Wellness Center. I’m also doing blogs right now for some other places like WebMD and some of the other healthcare sites out there. Plenty to keep people busy with.
I want to thank Dr. Peter Abaci for being on the Healing Pain Podcast. You can find him at PeterAbaci.com. Like every podcast, I ask you to share this information out with your friends and family because it’s vitally important. Go on to iTunes and give us a five-star review. If you are someone who is suffering with pain, you can check me out at DrJoeTatta.com with these great products and programs and services there. If you’re a clinician, please go over to the IntegrativePainScienceInstitute.com. We are working on training integrative practitioners and many of the strategies that we talked about on the podcast. I’m Dr. Joe Tatta. It’s been great being with you. We’ll see you next week.
About Dr. Peter Abaci
Peter Abaci, MD is one of the world’s leading experts on pain and integrative medicine. His newly released book, Conquer Your Chronic Pain, A Life-Changing Drug-Free Approach for Relief, Recovery, and Restoration, is considered a must read for anyone dealing with chronic pain. He is the author of Take Charge of Your Chronic Pain: The Latest Research, Cutting-Edge Tools, and Alternative Treatments for Feeling Better, host of Health Revolution Radio, and regular contributor to WebMD, The Huffington Post, and PainReliefRevolution.com. As the Medical Director and Co-Founder of the renowned Bay Area Pain and Wellness Center, his innovative strategies for integrative pain treatment have helped restore the lives of thousands struggling with pain. Dr. Abaci’s publications on pain treatment have become a trusted resource for patients, family members, doctors, psychologists, physical therapists, and insurance companies, alike. He resides with his family in Los Gatos, California.
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