Dr. Joe Tatta: Welcome back to the Healing Pain Summit. I am your host, Dr. Joe Tatta. Thank you for being here once again for another expert interview. Today we have Dr. Karen Litzy. She’s the host of a weekly radio show called healthy, wealthy, and smart. The aim of her show is to provide the latest and best information on health and wellness from leading experts. Dr. Litzy empowers her listeners. Each episode will be a healthy and pain-free life. The show promotes the physical therapy profession and provides a channel to get the most accurate information out there for both practicing physical therapists and the everyday person. Dr. Litzy’s mission is to show people how physical therapy can improve their lives and help them live a pain-free life. Dr. Karen Litzy, welcome to the Healing Pain Summit. It’s great to have you on as an expert speaker this year.
Dr. Litzy: Oh Joe, thank you so much. I am so honored to be here. You have such a great lineup of people.
Dr. Joe Tatta: Thank you. So I know people obviously know you from your um, radio show, which is a big success called healthy, wealthy, and smart. Obviously you’re a doctor. Physical therapy and you know, as, as a physical therapist, pain is probably the number one thing we treat. Not too often people come to us and say, Oh, I feel stiff or tight. Obviously it’s always pain, but I guess let’s get started. How did you get kind of more, you know, involved in the chronic pain treatment and epidemic, so to speak?
Dr. Litzy: So the, how I got involved as a very personal reason. So about 10 years ago, maybe it might even be longer than 10 years ago, I woke up one morning and I couldn’t move. I couldn’t get out of bed. I had, I was in complete pain through my entire neck and shoulders and, and literally couldn’t lift myself out of bed. I had to log roll onto the floor, climb myself up and, and I thought, well, I’m a physical therapist. Yeah, I’m in a lot of pain. I’ll go to work because there are other physical therapists there and my pain subsided a little bit, but then it never really went away. And I sort of lived with chronic pain in some capacity. Sometimes it was bad enough that I couldn’t go to work and sometimes it, but it was always at a low. It was always there.
Dr. Litzy: And that was like that for the better part of my thirties. So for almost eight or nine years, I lived with chronic pain to some degree. And when you live with something, you really want to know more about it. And then about five or six years ago, I met Dr. David Butler, who is also part of this summit. And he completely changed my life. I heard him speak, I heard him talk about the neuroscience behind pain, um, which was something I knew a little bit about, but not enough. And from then he was a mentor. He helped me with some graded activities and, and things like that. And within about a month, 90% of my pain was gone. And a couple months after that, 99%. Um, and at this point, if I wake up where it used to be, I would wake up and be in pain. That was my normal, you know, and when you have pain it’s you’re like you, you kind of resign yourself to the fact that this is it. I’m going to have pain and now I wake up and if I have pain, it’s abnormal.
Dr. Joe Tatta: Right. So did you have pain beyond that three month period of time where everyone kind of says if you have pain beyond three months and it starts to turn chronic basically?
Dr. Litzy: Oh no, it was for like eight years, eight years of chronic pain of, you know, not being able to maybe do the things I wanted to do. Feeling like your life is put on hold because of the pain, you know, fearing a lot of fearing a lot of activities, fear, avoidance behaviors. Catastrophization you name it. I so I can really, not only can I really empathize with this population, but I can truly sympathize with them because I know what it’s like to feel like I have pain, therefore I’m damaged.
Dr. Joe Tatta: No, I think what’s interesting about your story is that there was an article, I think it was in the journal of physical therapy probably about two months ago, where they did a study on physical therapy students and they showed that the vast majority of them, I think 75 plus of PT students actually have current parents have had chronic pain themselves. So I think, you know, people think that obviously we know a lot about pain, so it means that we don’t have pain. I think we know how to get out of it faster, but pain is something that we all experience probably at some point in their life.
Dr. Litzy: Oh, a 100%. I mean, I think to go through life and never experienced any pain. I think you have a genetic disorder, that group of people that don’t experience pain. Um, I think everyone’s going to experience pain at some point in their life. And as physical therapists, like you said when we started, that’s why people come to see you. And it is rare. I’ve had maybe two people come to see me to say I’m running a marathon. I would really love for you to evaluate me. And there’s nothing wrong with me. I feel great. So that’s why people come to see us.
Dr. Joe Tatta: So let’s talk about the average patient who comes to see you. How many treatments have they been through or how many treatments have they sought and you know, maybe it, it worked a little bit or maybe they fail totally before they actually hit a physical therapist, let’s say.
Dr. Litzy: I mean, I think they’re seeing a lot. They’re oftentimes they’re seeing multiple doctors. It may be multiple neurologists, it may be multiple orthopedics, it may be the endocrinologist or the podiatrist, or you know, the neurosurgeon. So they’re seeing multiple doctors. A lot of times they’ve already seen multiple other healthcare practitioners, whether it be the chiropractor, the acupuncture, and massage therapists. So I think they’re going through a lot of different practitioners and seeking out that passive answer to their pain problems. And then by the time they come to see me, typically it’s been, they’ve had the pain for years. No, it’s not even that they’ve had the pain for a month or two. They’ve been in pain for many years, and so then we start, we start the process.
Dr. Joe Tatta: Yeah, I think that that’s a common scenario. Take a history. Obviously people have been through many types of treatments that you mentioned, the passive treatments, and I think there’s a place for passive treatments. So things like opioids may be at the right time and the least dose for the shortest period of time or acupuncture or dry needling may have a place. But what’s your opinion on kind of the passive strategies versus the more active strategies for pain?
Dr. Litzy: Well, and I think you’re right. I think that the passive strategies can be good because perhaps they can open the door to a little bit of pain relief in the short term and get the patient moving. But the active techniques, uh, getting, getting the patient moving, getting the patient to understand what’s going on from a neurophysiological perspective, I think that’s where the understanding and the treatment of people with chronic pain really comes into play. Because if, if you’re constantly sort of seeking out the passive answer, if you are not as a patient, if you are not willing to take control of your situation and if you’re not willing to say, well I just want someone to help me but not willing to help yourself, I think it’s, it makes it very, very difficult for you to kind of move forward with your, with your pain.
Dr. Litzy: Because there has to be some acceptance. Like, okay, I have this pain, I have it, I realize it, but I feel like perhaps there’s something I can do about it. And taking that ownership over that is, is very powerful. And knowing that you can do small things and like, so for instance, for me, I would say I can’t carry anything. I can’t go grocery shopping because I can’t carry anything because if I carry something that’s going to hurt my neck. And what I started to do was I went to the grocery store and I got like a bag of chips and a loaf of bread, put it in a bag, carried it home. And I was like, Oh I can do that. And that’s hugely empowering to know that you can do that. And then every time I went, I would just add a little bit more to the bag. Now I can carry two bags home from the grocery store, you know? So I think unless you’re taking an active approach to your pain situation, it’s really going to be very difficult to move forward,
Dr. Joe Tatta: you know? And on the summit, I mean, I, I’m a certified nutritionist, so nutrition is a huge component of people’s pain and helping them alleviate their pain. There’s a lot of things people can kind of grab toward, but I always tell people ultimately to get out of chronic pain, you have to start to move you up to such a re-engagement healthy movement. Yup. Start to reengage a functional movement. So, you know, I think there’s a place in the beginning for people like you and I, and maybe some of the pain psychologists like dr Darnell, who we have on the summit where maybe two to maybe five sessions where we explain you what pain is on a physiologic basis. But then like you said, we slowly start to get your moving basically.
Dr. Litzy: Yeah. Yeah. I mean, what did they, I don’t know if it was David Butler or, uh, who had said, you know, motion is lotion, so you have to move. I mean, plus you have to move to get through life, you know, if you don’t, you have a whole cascade of other, uh, maladaptive behaviors, you know? So I think it’s really important to empower the patient and to let them know that they can do these things and it’s not gonna it’s not going to set them back. It’s not going to make them exponentially worse.
Dr. Joe Tatta: Right. So in addition to obviously treating patients, I know you work with a lot of new physical therapists, either in their internships or residency or they’re just starting to practice and you help them. Um, you know, integrating some of the paint science into their work is, it’s so important. I know one of the things you focus on is that patient intake or that patient’s initial evaluation. Why is that important for clinicians to really get, you know, get correct when they start to interview people?
Dr. Litzy: Sure. And the interview process, you know it, when we’re in physical therapy school, we learn all about the object of exam, right? We learn how to take range of motion and strength and all these special tests and things like that. And, and we spent some time on the subjective, but a lot of times that subjective exam can be dictated by, unfortunately by an insurance company. So what’s your pain zero to 10 what makes it worse? What makes it better? These are all certainly important questions, but the interview is so much more. So the interview is really your way into this patient. So you have something coming to you in chronic pain. Odds are they’re depressed, they’re anxious, they’re not happy, they don’t feel good about themselves. You have a lot of issues swirling around a patient with chronic pain. So in that initial interview, it establishes rapport between you and the patient and is the beginning of that therapeutic relationship.
Dr. Litzy: And we know that the therapeutic relationship, a lot of studies have shown that that really has a difference with when it comes to outcomes, right? You can be the best therapist. And have the best technique. But if you don’t get that therapeutic relationship or that quote unquote buy in from the patient, boy, it’s gonna make your treatment a lot harder. So I think the initial evaluation helps to establish that rapport, establish that therapeutic relationship, and then it helps you to direct your objective exam. So you’ll find everything you need to know in what direction your exam needs to go in. During that initial evaluation, the patient is telling you what’s wrong with them. They’re telling you what path to go down. They’re giving you hints as to maybe what special tests you need to use. Um, it also helps you to find out what the patient thinks is going on with their own condition.
Dr. Litzy: And, and we can talk a little bit more about that and kind of the questions that I always ask. And it’s a way to detect these. He flags he flags, uh, it’s in the explained pain book by David Butler and Lorimer Moseley. And that is you’re interviewing the patient and they’re saying to you, for an example, uh, it’s this slipped disc. I have a slipped disc. Uh, my father had a slipped disc, my grandfather had a slipped disc. We all have pain. That’s why I have pain. So you’re thinking, okay, I’m going to write this down. This is an E-flat cause this is definitely something I’m going to go watch. I want to go back and explain, you know, I may want to explain to them, well boy, you know, I saw your MRI and yes, maybe you have a slipped disc. But if I were to take 20 people off the street, a lot of them would have a slipped disc and no symptoms.
Dr. Litzy: And let’s look, it doesn’t really look like that disc is pushing up against a nerve that can possibly be causing this pain. So let’s try and explore some other options. And then you can also pick up on what Louis Gifford calls your pink flags. So your pink flags are flags that are highlighting the positive things that are going on with that person. So they may say, I have all this pain, but you know, I still go to work every day. I still pick up my kids. So let’s focus on that. Let’s focus on, wow, it’s so great that even living with this pain, you can hang out with your children, you can watch some at a soccer game, you can go to work, you can provide for your family. So really pointing out the pink flags or the positive flags because not everything is doom and gloom.
Dr. Joe Tatta: So should we try to focus evenly on the E flags and the pink flags during the initial intake? Or should we let the patient kind of steer us in which direction to kind of go?
Dr. Litzy: I mean, I think the PA, I think you let the patient steer you, but, and this was an interesting question that I actually just got today over social media, is how do you redirect the patient back to the back to the information you’re trying to grab to take into that objective exam. So the oftentimes, and, and hopefully they do, the patients will tell you their whole story. So a lot of times we have to kind of gently redirect them. So I always make it a point of if they do say something positive, wow, that’s great. That’s awesome. You know, and you write down that pink flag and maybe two weeks from now you reinstate that or you reiterate that flag back to them and say, Hey, are you still going to work? How is it going? Is it getting easier? You know, kind of pushing the positive and with the, the flags you want to say the person’s telling their story and you want to say them.
Dr. Litzy: You know, you said something really interesting a couple of minutes ago you said X, Y and Z. Is that correct? And is, you know, is that what you believe? And they may say yes or just say, okay, well let’s talk about that for a second because I want to make sure that you understand the neuro neurophysiology behind it. You know, you can make, you can say it in a different term, but I think the best way to sort of redirect and to yes, you wanna focus on the flags and yes, you want to focus on the pink flags. It depends on what the patient’s giving you, you know? But I think you always want to circle around. You want to restate what they said and then I’ll always say, is that correct? You know, or I’ll say, you know, if I’m hearing you correctly, this is what you said. And then they’ll say, so I’ll have some patients say, yeah, that is right. Or, or they’ll say, Oh, I can’t believe I that, that’s what I said. So it’s a really great way to kind of get your foot in there and, and show the patient that you’re really actively listening to them.
Dr. Joe Tatta: So one of the things I’m thinking of is obviously when you’re, um, taking an intake or initial evaluation with a chronic pain patient that’s obviously different from just a basic ankle sprain, let’s say, or basic acute injury. I think most clinicians really want to rush to the treatment aspect. So they want to get their hands on someone they’d want to, you know, do the exercise, the modality, the mobilization, whatever it is that they’re, they’re choosing. How important is it for people to really get their, their full story out and can then just kind of telling their story and hearing their story can not be therapeutic to them. On some, you know, brain level cause we know that the brain is the actual cause of pain.
Dr. Litzy: Oh 100% yes. How important is it vitally important? Does it have to happen all in one day? No. Can you listen, I know that some people don’t have the luxury of having a full hour to do an evaluation on someone. Oftentimes people have a half an hour, you know, but you can get, you can gain a lot of insight from someone in 20 minutes of an interview and then because you’ve listened and now you know where to hone in on your objective exam, you can give a small treatment and exercise and the patient can go on their way so that the patient still feels like they’re getting the full advantage of that physical therapy treatment that day. Do you want to get the whole story? Yes. Does it have to happen in one day? God, no. You know, sometimes, and you know you’ve been treating patients for for some time, you know that four or five treatments in, they’ll say, Oh you know, I forgot to tell you this.
Dr. Litzy: And it was so vitally important, you know, so, and again, that that comes with maybe the patients feel more comfortable with you now, you know? So are you going to get everything on the first try? No. Do you want to get as much as you can to kind of push your objective, uh, examination in the right direction? Yes. Do you want to get the information needed, uh, from the patient to, like you said, maybe I’ve had people start crying. It’s cathartic, but in a good way, you know, and, and oftentimes they’re going from practitioner to practitioner to practitioner and no one’s listening. You know, I think that there’s a study that shows that oftentimes when patients go to health care practitioners, they’re interrupted at second 12 to 18, 12 to 18 seconds into them telling the person their entire story. They are interrupted.
Dr. Joe Tatta: Yeah. And that’s, that’s if they get, you know, six to 12 minutes with their, you know, usually their primary care provider basically. So when you pick at an hour with a physical therapist, that’s, that’s kind of a, you know, a luxurious, but actually probably what’s needed in many ways.
Dr. Litzy: Yeah, absolutely. And so just by sitting back, like I’ll have the person come in, I say, well go ahead and tell me your story. And I just sit back. I listen, I make notes, I go back and revisit things. I redirect. Um, and so if I can get, I mean I’m lucky I get to see patients for an hour for an evaluation. So sometimes my initial interview could be 30 to 40 minutes,
Dr. Joe Tatta: right? Yeah. So we have a lot of health coaches, physical therapists, chiropractors are going to be watching this. What are the, what are the important questions that we should start to ask on the initial intake with your patients?
Dr. Litzy: So the first question I always ask is, tell me your story. And then I sit back and I allow them to talk and tell me their story. Um, and then one of the, so a couple of powerful questions that I think are vitally important, especially with this chronic pain population, is people say, if only I could be better, I could do X, Y, and Z. So one question I think is vitally important and it’s one that Sandy Hilton says, I got this from her, so I can’t take credit for this one. Um, but it’s what does better look like for you because better for you is far different than better for me and better for your neighbor and better for the next patient. So what does better look like for you? That’s a really powerful question. Um, another one is what are your goals for physical therapy?
Dr. Litzy: Because are sometimes as a therapist, like our goal is to be zero out of 10 pain. We want the patient to be going back to the gym. And the patient may say, you know, a goal for me is maybe my pain is, is a one to three out of 10 I can live with that. You know, and again, that’s a very big pink flag, you know, knowing that, Hey, I can deal with this, this is, this is something I can deal with. So knowing specifically what their goals are. And another question I always ask is, what is valuable to you in your life? So we may think what’s valuable to this patient is getting them exercising and doing all this stuff. Whereas I had a patient once who said, you know, I just want to be able to walk to dinner with my husband. I’ve never exercised my entire life.
Dr. Litzy: I’ve done yoga. I’m happy doing that. But I really just want to be able to walk to and from dinner with my husband. I want to be able to drive to our house in the country and not have to stop every half an hour to get out of the car. So again, you’re really trying to find what’s valuable to that patient. Um, another one that I like to ask is what would you be doing right now if you didn’t have your symptoms? And that’s a great question. What would you be doing today? What would you be doing tomorrow if you didn’t feel these symptoms? And then again, I’ve kind of mentioned this before as I always ask. So, so what do you think is going on? What do you think is happening? Why do you think you have this pain? And this is a great way to get a little bit more into the psyche of this patient.
Dr. Litzy: You know, are they fearful, are they catastrophizing? And you know, there’s a Tampa pain scale and the pain catastrophizing scale that you can use in conjunction with your interview to really gauge where is this patient at and where do I need to be to meet them where they’re at. And then at the end I always say, is there anything that I haven’t asked that you feel like you’d like to tell me? Is there anything relating to this to your symptoms? And you would be shocked at what patients, like I had a patient say she had a lot of pelvic pain and hip pain and back pain. And as it turns out, she had some pregnancy issues that I, my bad didn’t ask, which is another thing. If you have a woman, a patient, you should probably always ask about that, but say, is there anything I’ve asked? She said, you know, I’ve had these pregnancy issues and, and all of a sudden she started crying and she said, wait a second, I never put it together. That maybe that’s why I have this pain, you know? So I saw her once we had a 40 minute interview, gave her some exercises, checked up the next week. She was like, I feel great. You know? So sometimes that’s all it takes is that person coming to the realization of, wait a second, if, if we didn’t have this conversation, I never would’ve put this together.
Dr. Joe Tatta: Yeah. So really powerful connection she made between her past experience and how it connects with our current, you know, pain today, basically.
Dr. Litzy: Yes, exactly. Exactly. Um, and, and those are pretty much, and listen, there’s a ton of other questions that I think, uh, you’re going to be having people, uh, people can download from you. Um, there’s probably 15 other questions, but those are the ones that I think are really important that you want to ask with every single patient.
Dr. Joe Tatta: So Dr. Litzy has a great download that’s free on the, um, summit homepage. When you logged in. You can download a load that for yourself, obviously your clinician, you can use it. And even even if you’re a patient’s right to look through and start to answer some of those questions for yourself, you may make some breakthroughs.
Dr. Litzy: Yeah. And, and even if you’re the patient, it’s great to kind of have this in your arsenal so that when you go in to see the, the practical health care practitioner and they asked you these questions, you’re not like, Oh I’m, um, and getting all stressed out because we don’t want you to be more stressed out coming to us cause we’re there help you feel better not to make you more stressed.
Dr. Joe Tatta: How does a, we have a lot of people talking about the biomedical model versus the bio-psycho-social approach that hopefully we’re trying to move our, you know, nation and, and you know, globe toward, if you will, to try to help people in pain. How does a thorough intake and initial evaluation that, that pain discussion, that pain story, really fit into that model?
Dr. Litzy: Well, I think, you know, you have bio which is, or the biomedical psycho, which is this more of the psychological and social, which is what does the person do every day. So all of those must ask questions. You’re finding out all those answers just from those few questions. What do you think is going on with you? Well that can give you, are they really highly entrenched in a biomedical model? You know, like the example of the slipped disc. Um, from a psychological standpoint, well, what are your values? Where, what would you be doing? What does better look like for you? These are very deep questions to ask someone. And then from the social aspect is what would you be doing if you didn’t have this pain? Let’s talk about things you like to do. You know, and I think like you said, the bio-psycho-social model is definitely gaining steam. You know, if you look at the iPhone, which is a manual therapy conference that was just held in Glasgow a couple of weeks ago, a lot of the talk was about the biopsychosocial model of care. Lorimer Moseley was one of the big keynote speakers, you know, and this is a manual therapy conference that you think the whole thing would just be biomedical. So I think there is a big shift because they’re finding that that in many cases this is a really great path to recovery and whatever that recovery is for that person.
Dr. Joe Tatta: So let’s, let’s talk about a kind of a hypothetical, cause we have, you know, you and I practice in New York city and we, you know, the United States is obviously a big country in there, you know, different regions and healthcare systems all over the country, a little bit different and, and, you know, function differently. Um, what do we really need to do as a a nation and what do we need to do as practitioners to try to create a system that actually supports people in pain? Um, you know, the NIH and the CDC made some big statements this year around opioids saying that they should not be your GoTo with chronic pain, that they actually don’t work, which is powerful. I think where they kind of missed the boat a little bit is they didn’t really say what does work and what we should really do to kind of, you know, reshape our, our healthcare system around a more supportive system for people with chronic pain. So what do you, what are some of your suggestions toward that?
Dr. Litzy: Well, I think as, as a physical therapist and the physical therapy profession, boy, we are uniquely qualified to, to step into this role, especially for musculoskeletal, uh, chronic pain conditions or, well, I shouldn’t say for neuro musculoskeletal pain conditions. I think physical therapists, we have the education, we understand movement. Uh, more and more physical therapists are our adoptive and bio-psycho-social model of care and learning more about the neurology and the neurophysiology or the neuro immune system behind pain. And I think we’re uniquely qualified to be that frontline practitioner, to be that, uh, first practitioner to see these, these patients. And, and luckily there is direct access in all 50 States. Now that direct access is certainly depends on the state as to how far after the initial evaluation you can see that PT. But no, as the patient that you can go directly to a PT without a PA without a doctor referral.
Dr. Litzy: Um, that’s not to take away from the doctor. I think of it as we’re so lucky to augment the physician’s treatment. You know, we can triage these patients and say, you know, I know the perfect doctor that you can go to or you know, let’s try some physical therapy for four weeks. Let’s try it for six weeks. And then if we’re not seeing any changes, I know the perfect person to send you to. And then we’re sending that patient to our partner physician armed with a lot of education, giving the physician a lot of information about this patient so that when they go to see the, the physician, it just creates a better team environment. And I think that’s what chronic pain patients need. They need a nice, strong solid team behind them. And that team can be anyone from the physical therapist to their medical doctor, a massage therapist, a nutritionist, um, a yoga instructor.
Dr. Litzy: You know, this team can be everyone with that patient in the center with the patient taking, like we said in the beginning of of the interview, an active approach to their care being part of dictating the direction in which they want their care to go. And I think unless patients know and people know in general that these resources are available, they’re going to go, of course they’re going to go to what they think is the easy way out. And that’s taking a pain. Medicine is taking an opioid. You know, even though studies show it doesn’t work with chronic pain, but this is what is so deeply entrenched due to decades of misinformation really.
Dr. Joe Tatta: Yeah. And pharmaceutical companies, you know, probably pushing that message, you know, potentially a little stronger than they, they really should. That, you know, in, in our country, in the United States, um, at the Cleveland clinic, there’s a pilot study, I’m sure you know about it going on, where when someone comes in with a chronic lower back pain, they’re actually seeing a physical therapist first in conjunction with a pain psychologist. And they’re kind of, you know, triaging them. If they feel like they need that medical management, they’re moved on to the primary care physician. Um, do you think that physical therapists can be the first line of pain care for our, for our country is that, you know, a solid solution to reverse our chronic pain of DEMEC?
Dr. Litzy: I think it’s part of the solid solution. Absolutely. And, and I’m confident that physical therapists can step into that role very easily. Um, and, and you know, now there are a lot of physical therapists in emergency departments so that when they have, because emergency departments, guess who they see a lot of low back pain patients, right? People with chronic pain or going to the emergency room. So instead of saying, okay, here’s your medication, those patients are being triaged by the physical therapist now and then are kind of, so yes, the PT is the entry point and then they are treated accordingly. But yes, I think that physical therapists can certainly step into that role. And, and I think that the team approach, like you said with the pain psychologist that they’re doing at the Cleveland clinic is, is such a step in the right direction and away from this dependency on medication.
Dr. Joe Tatta: Oh, what do you think the big insurance companies need to do as far as supporting people with chronic pain? It’s a, it’s a huge topic. Um, you know, when I first started practicing in 1996, um, I had to do very little paperwork and I could probably get about 40 visits for a patient. Today if you’re working in insurance-based model, you have a ton of paperwork. Cause even maybe you can get nine visits for a patient. So is that model or the model we currently have, is that really appropriate for our chronic pain patients?
Dr. Litzy: I don’t think that model is appropriate for any patient to be quite honest. I don’t think that the insurance company should be the one dictating the care. I think that the care should be dictated by the therapist and the patient. I think it should be patient centered care, not insurance centered care. So I don’t think it’s appropriate for anyone. Is it appropriate for someone with chronic pain? God, no. You know, and I think a lot of the problems when it comes to insurance is that they’ll say, Oh, you know, we’ll give you four visits, but you have to use them in a month. Well, a chronic pain patient, you know, maybe you only have to see them once a month, you know, maybe you only have to see them twice a month. And so it’s just this redundancy of paperwork and overload that’s going to have the potential to burn out the therapist for sure.
Dr. Litzy: And then the therapist and has to be a little wishy washy with the patient. And well, I don’t know. We have to see if we can get more visits. I think you need it, you know? And so then the psyche of the patient who is in chronic pain coming to you for help is now thinking or do they think I’m not bad enough to warrant more visits? I mean it’s, it’s a huge, huge problem. And the solution is, I don’t know, I don’t know what the solution is. I know that perhaps if more people, and I’m sure this goes to more of the legislators in our country, if more patients and more practitioners continually write their legislators, perhaps something can be done, you know, but I think it probably needs to start there and then it might trickle down into the insurance companies. But you know, when you think about an insurance company, their number one priority is to not pay.
Dr. Litzy: So I think if, if there are ways, and I think that dr Darnell out at Stanford, they’re working on a lot of a great cost effective solution for people. Um, if there are ways that physical therapists, and maybe this is through telehealth or maybe it’s through group classes, uh, to at least get the education side of things and the movement side of things for, to see multiple patients at one time at a much, much lower cost. I think physical therapists, again, are uniquely qualified to be able to do that. So there you’re still giving good, good quality care at a much lower cost. I think that of course, you know, you need to kind of study these things like what they’re doing at Stanford, but I really think that that could be a, an interesting alternative for a lot of these patients.
Dr. Joe Tatta: Yeah, I do think telehealth is probably going to be the one way we, I mean with a hundred plus million people in pain, I think even in every single physical therapist, you know, through their doors open as wide as possible. We probably couldn’t take all those people. So tele-health and things like this summit is a way to reach people and try and get the message out there in a broader way. Um, I want to thank you from one DBT to another DBT. It’s great to have you on the healing pain summit this year. Um, you have a wonderful podcast and some other things out there that people can access for free. Can you tell everyone where they can find out more about you?
Dr. Litzy: Sure. So if you wanted to listen to the podcast, you can go to podcast dot healthy wealthy, smart.com and it’s on iTunes and SoundCloud and Stitcher and Google play. And iHeartRadio and all that fun stuff. Um, and if you are, uh, a chronic pain patient in the New York city area, uh, you have a ton of choices. You can find out more about firstname.lastname@example.org.
Dr. Joe Tatta: Excellent. So I want to thank Dr. Karen. Let’s see, for being on the healing pain summit this year and given us some great information about the chronic pain revolution that we’re experiencing and how to turn it around, as well as how to interview, which is super important when you’re working with people with chronic pain, you have an opportunity to help Karen. So make sure you hit the share button. You can show this video out on Facebook and on Twitter so we can help spread the message and stay tuned for the next interview and we’ll see you next time. Thank you so much.