Chronic Pain: Learning Steps to Prevention and Recovery

Welcome to the Living to 100 Club Podcast.

Here's our host, Dr. Joseph Casciani. Greetings to everyone joining us today for our podcast. You're listening to the Living to 100 Club, and I'm your host, Joe Casciani. You can find this conversation and all past conversations on our website, livingto100.com. In addition to my podcasting, I'm a public speaker, and I present to community organizations and senior groups on topics related to aging well and managing setbacks. And on my website, you'll see options to sign up for one-on-one resilience coaching for anyone wanting more personal time to talk. I also provide consulting and training on clinical topics like depression and dementia. Now on to our podcast where we discussed successful aging, staying positive, and making more informed decisions. Our guest for today is Sam Wisnik. Sam is a healthcare provider and fitness instructor who shares his perspective on managing chronic pain and learning steps to prevention and recovery. We'll be discussing the factors that contribute to creating and maintaining chronic pain and how our mindset can significantly change one's experience of pain. A little background on Sam. Sam has spent his life studying the fundamental aspects of human health with a focus on movement and clinical massage therapy. In a world of specialists, surgical procedures, drugs, and quick-fix remedies, he's committed to finding and developing strategies that help people stuck at the gap. Sam has studied dozens of methodologies for uncovering the root cause of aches and pains, some of which include pain science, hands-on soft tissue massage techniques, myofascial release, and coaching movements. Understanding the various elements that contribute to conditions and the power of communication and education makes his Release Muscle Therapy program unique from other hands-on therapy approaches. Dan, welcome to our program today.

Thank you so much for having me. I'm excited to, uh, have this chat.

Great, glad to have you with us. I always like to open by asking our guests to tell us a little bit about the the journey that you took to get you where you are today?

Well, mine was not a straightforward path, but I'll put it that way. Sure. In some regards it was, maybe perhaps when I first started doing this work, I was always the kid that was hanging out in the weight room and, you know, needed to, really needed to lift weights because it was kind of classically the skinny kid. So for me it was, and I wasn't a naturally kind of gifted physical athlete, So for me, it was a lot of work and, and having to go to the gym and so forth. And, uh, for me, because it didn't come so naturally, I was naturally a little bit more inclined to go to the bookstore. I know these were— Barnes Noble were available and we could actually go and sit and read books because you didn't have online like that— and, uh, learn. And in particular, scientific aspects of fitness and lifting weights and so forth. So very early, I kind of was into that left-brain kind of approach to doing things. And so when I graduated high school, the most logical thing for me to do was become a personal trainer, because to me I knew so much about these things already and I wanted to apply them with other people. And this was happening at kind of a weird time in the fitness industry where, coming out of the '80s where everything was about aerobics fitness and, you know, weightlifting was still kind of a generic, more bodybuilding kind of thing. And in the '90s, it started to kind of move into a direction where more ideas that had bled over from physical therapy, which is looking at posture and looking at, you know, quality of movement and getting people up and off of machines and doing more things standing and moving, was now kind of becoming something that was more popular. And I got swept up into that, uh, that realm. And of course, that kind of work really did emphasize or work toward, uh, helping individuals in our population. Classically, of course, so many people dealing with some kind of achor pain, low back pain, they had hip pain, anything like that. And these approaches were starting to get the personal trainer to start thinking a little bit more about the needs of the individual and how to help them with some of these issues by modifying exercises and so forth.

Sure. More custom, more individualized programs.

Yeah, not getting hurt. I mean, that's the real key. How do we help people move more without injuring them, right? And we have to be a bit more knowledgeable about what's going on. So that realm kind of opened up to me. I became very interested in it, and I had really good mentors early on. One of my mentors was, um, he was a rehabilitation expert for the U.S. Army boxing team, had a lot of experience in clinical massage therapy, which was more aimed at helping people with pain. And of course, I just followed his path and went to massage school and did a lot of hands-on therapy. And from there, it was all about just mastering my craft and over time adding little things in there to continue my education and help individuals even as much as I can, um, with lots of different types of conditions.

Sure. Yeah. A long road, a lot of training, a lot of self-learning, and a lot of developing your own skills based on what you've learned and what you picked up from others. Yeah, so the subject of chronic pain, that's a huge topic. Books have been written. We could spend hours. There have been courses on— we could take on chronic pain. So let's just jump into it quickly. How do you differentiate chronic from acute pain? And why is it important to know the difference?

Well, of course, and there's going to be— within the upper echelons of any profession, there's going to be some disagreements on terminology and so forth. But I think generally most people would be satisfied agreeing with this explanation, which is that whenever there's something that occurs in the body, some kind of injury, whether it's a pulled muscle or maybe an injured tendon or a broken bone, there is a certain amount of time that is expected that we know it's going to take for that issue to generally heal. So if you break a bone, you put a cast on, we know the cast is going to take X amount of time, let's say 6 to 8 weeks, then you take it off, it's going to be healed. So when we have pain that's associated with that healing time, we classically just see that as a normal process, right? So people have pain when they get an injury, and it goes away when the tissue heals. The challenge is here now that when everything in the body, for the most part, if we just look at this from a broader perspective, is going to heal in about 6 months. Most people will agree to that. And after 6 months of time— and of course, you know, depending on the kind of injury, some things are much shorter than that— If an individual is experiencing pain from that earlier stage through and past the time where the tissue or whatever, the bones or whatever, have healed, if they're continuing to experience pain, the pain now is not associated with the tissue healing. So now it is actually its own entity. So the pain now is persisting even though the tissue has healed. And that tissue or that pain has now moved into what we would refer to as chronic pain. It's important to know this because addressing chronic pain is very much, in many ways, a completely different animal than addressing acute pain. Certainly, when you look at medical treatments for acute pain, that's the case, right? So you wouldn't— if somebody came in with the bone was still at the area where the bone break, was, was still hurting, the doctor would not, after, you know, 6 months to a year, put a cast on it at that point, right? So there are certain things that we would not do. But in chronic pain, there's oftentimes a misunderstanding of what chronic pain is. And sometimes there is oftentimes therapies and treatments that are used in chronic pain, which generally are ineffective because they really should be reserved for people with acute pain. So there's a mixing of using the wrong treatments for the wrong time. And that becomes— for obvious reasons, it's going to lead to a lack of results because you're using the wrong tool for the job.

Sure. So different approaches depending on which condition it is. So that's helpful description. So basically, the acute pain should subside with proper treatment and casts and whatever. After 6 months, plus or minus. And what you're saying is when it doesn't subside and there's— the healing is done but there's still pain, that's what evolves into chronic pain.

Exactly.

There's no more healing to be expected during the chronic phase?

Well, not in the, in the classic sense of— in particular, we're talking about, let's say, tissue damage, you know, where there's been an injury, a car accident or something occurs, right? So that tissue is pretty much done at 6 months. And again, there's some flux there depending on what you're talking about.

So if it is delayed, it could still be acute pain. I mean, if the healing is not completed.

Yes. And it depends on what it is. If somebody comes in and says, I pulled a muscle, and it's been a year and a half, well, that pain doesn't serve the function anymore of protecting a muscle that was pulled over a year ago. And, you know, we could bring this to something that's very common, which is, um, you know, a large chunk of our population is dealing with chronic low back pain, for example. And sometimes at, you know, one time or another, I'll have clients who will come in and they— when their initial bout of back pain had been, you know, diagnosed 6 years ago, 7 years ago, and they had an MRI done, for example, and the doctor said, well, we have— you have a disc bulge in your spine. But then the narrative is that the person comes in after all of these years and they will tell me that their back still hurts because the disc hasn't healed. And we know that that is not true. Um, the research is pretty clear on discs that basically can bulge and reabsorb all on their own in a matter of months. So an individual is not dealing with an active disc bulge type of pain years after it initially occurred. Now they can re-aggravate the disc bulge or it can re-bulge, right? But the initial issue, provided that that is done and gone, the individual's pain is not coming from that unless there is a re-emerging problem with that disc.

Hmm. Okay. Yeah, that's helpful. So can chronic pain develop without an acute event? Yeah.

And that's what's really fascinating. And I think the statistics are about 25% of people that develop chronic pain have never had any kind of initial injury or insult that had generated it. So this can present in a lot of different ways. You know, people wake up and they start to feel some kind of ache or pain, and then it just continues to some— for whatever reason— get worse. And this is a common story when I talk to people and say, hey, well, did you have any incident or episode where this just happened? And some people go, no, one day I just feel like it just came on. I didn't do anything to it. And now my back or my neck hurts all the time.

Mm-hmm. Conceivably there could have been some incident. Maybe we twisted or, um, kind of reached the wrong way and we're not even aware of that. That could contribute to that, but there's no identifiable tissue damage in these kind of chronic conditions or, uh, Is that not so?

Well, that's the interesting part, is that, you know, I've seen so many cases over the years of people dealing with chronic pain with a clean MRI or X-rays, and nothing really shows. And that's one thing that is interesting and a whole topic in and of itself to discuss, which is diagnostic imaging and its relationship or usefulness in chronic conditions. In particular, there's been a big movement for many years now, especially as the literature on pain, the pain education, the pain science and research that's come out is showing the clear lack of correlation between some of these diagnostic images that are being performed and what the person is experiencing. So a lot of times that people will develop some kind of ache or pain. And again, that is a perfect example of the presumption that there was an injury. Maybe the person didn't— know it. So let's say that, you know, that person does have back pain, trip to go to the doctor and say, well, this came out of nowhere. Well, of course the clinician is going to want to clear underlying pathology. Let's make sure there's not underlying organ disease or spinal disease that we didn't know about. But they're oftentimes not going to find those things for the most part, most of the time. But what they will find is naturally occurring phenomenon that we see as a process of aging. So we're going to see arthritis. We're going to see degeneration. We're going to see these natural things that may occur. And then the unfortunate thing is that the symptoms that the person is presenting with may not directly correspond with what the findings are on the imaging. But yet the two things become now intertwined. The reason why you have pain is because you have arthritis in your spine. Never mind the fact that virtually everybody has some degree of arthritis in the spine or whatever typical finding. I think that right now, the last statistics on our research report I saw showed that one study in particular showed that about 60% of MRIs, even on people that have pain, no pain, just a random assortment of people, will show some type of abnormality on the scan. 60%. So we get a challenge here where it is a challenge for everybody is to determine whether or not what you're finding on that scan is really the reason why that person has pain. And one thing that I do note that I do find interesting is that most of the time, even when therapy is successful, the, the MRIs are not rerun. So we don't run the MRI again. So let's say the person, the back pain, their pain was a 6, you know, on a 10 scale, it goes down to a 1 or 0, and it's a 6 successful treatment, the MRI is not rerun at that point because most of the time, for good reason, people would say, well, why would we do that? We don't need to know. But we do need to know because if that disc bulge is the exact same size after the successful treatment as it was before, we have to start questioning the validity of the, of the disc diagnosis.

Hmm. Okay. So the chronic pain can develop without any external events like an accident or a fall or whatever. So you're saying maybe arthritis or some degenerative condition could contribute, could kind of precipitate that onset of chronic pain. And sometimes the MRIs and the diagnostics will pick it up, sometimes it won't. So you get false positives, you probably get false negatives as well. So there's not necessarily the correlation between those metrics, those exam results, and what the person is experiencing. That's got to be really frustrating for the individual patient. I can see that. And then when you add the mix of, as you've developed your, your approach to mindset and helping the person understand, I mean, chronic pain is very prevalent, as you say, and we don't always have a good way to treat it other than working with the individual's mindset and kind of pain reduction approaches?

Well, there is a lot that's available if we start to move away from that structural mechanical narrative of chronic pain. So almost always the assumption is, is that pain and orthopedics are connected, you know, so almost as if the fields are the same thing. And in fact, there is a difference between experts on pain and experts on orthopedics, experts on neurology. They're all different fields, but we oftentimes marry these disciplines together as if they are like a one and one. They work together that way. So that's where the, the great change is occurring here is a narrative that is moving away from this, I guess, would say slight excessivism over structural diagnostics as being the causes of pain and moving more toward a neurological understanding of pain about how the brain is perceiving information from the body. So when we start to move into this different narrative, it really opens up the opportunities of the different ways that we can start addressing pain by not getting cornered or stuck in a diagnostic model that purely looks at the structure of the body without looking at all of the other elements. So that is where I'm excited about things, uh, is giving so many more options.

I see. Yeah, that's good. So don't rely on these other measures, but we're really looking at subjective experience.

Yes, and pain itself is another area of debate, which is pain itself is not necessarily— some authors believe is not a sensation. Pain is an experience. And the difference between these things is a sensation is something we can feel, such as pressure, stretch, hot, cold, etc. But pain doesn't really operate in the same way. What pain is, is almost a collective decision or meaning that is assigned to the experience of the information that we're feeling in our bodies in combination with how our brain is processing that information. So pain as a metaphor, the way we think about it metaphorically, functions as an alarm system for our nervous system. So the way I like to explain it is, is that imagine you have an alarm system on your house. You have the central processing box where the main, you know, brain is of the alarm system, and you have all those wires that go to all the windows and the doors and so, so forth. Now really, the job of the wires on the doors and the windows is not the alarm. The job of those sensors are to send information to the main box the main box has been put together in a way with a computer system in it that takes all of that information and decides whether or not it's time to trigger the alarm. So if we're getting information that windows are opening and that's going to the, to the box, then that algorithm gets triggered. And the purpose of the alarm is to signal you to pay attention and to take action. That's really what its job is. And an alarm is supposed to not be a gentle sound that sounds soothing. It's meant to be noxious. It's meant to be loud because it's supposed to get your attention and to tell you something is wrong, go investigate, or to take some kind of action. And fundamentally, our nervous system with pain is the same. Pain is noxious for a reason because it has to grab your conscious awareness and your attention so that you can do something. So if you're stepping on a nail, It— pain should be noxious to take your foot off the nail or to do some kind of activity. So it's— its sensitivity goes up and down. So pain is never, never, uh, counter to what most people believe is a bad thing. Pain is doing its job from a biological standpoint to protect us. The problem is when the alarm is constantly being triggered by information that's coming from the body which may not indeed be threatening, but the nervous system is perceiving it to be threatening. So we have that happening in the background with chronic pain. And then the complexity here is, again, now we have another element to that, which is our conscious brain and how it copes with that system. So if the alarm system is going on all the time, imagine the alarm is going off in your house. It's very loud. It's very obnoxious. You want it to stop, but you go over to the unit, the panel, and the computer, but you don't know how to turn the alarm off. So now you're getting frustrated at the alarm, and now you're trying to figure out what's going on. So it's like, you've got multiple factors that are going on here that we have to interact with. And I think that's where we have to figure out for the individual how that experience is playing out. Is the alarm too loud? Is the person's over-response to the alarm, and they're getting very aggravated with with it, how much is that contributing to the problem? And so there's multiple pieces to juggle at the same time to try to understand that person's subjective pain experience.

Yeah. Well, that's complicated. I mean, that's a beautiful description. So sometimes the sensors that are going through all of the windows and doors kind of short circuit, and the alarm may trigger, and really there's nothing to be alarmed about. So to speak. Correct.

Or maybe, yeah, they're just— maybe the door is— the window is rattling because of the wind and the alarm sensors are so sensitive that even when the window is rattling, the alarm is getting the information that the window is opening and it's not. And so if you imagine it like that and we think about where would arthritis or something like that play in, We don't dismiss those things, but maybe we see that that's a sensor that's starting to get old and maybe it doesn't— the magnet doesn't align just perfectly on the window. But that doesn't mean that it's the problem because we also have multiple other parts in that mechanism that can also be co-contributing to that.

Yeah. So it may not be a threat, may not be someone trying to break in. It really is just the wind or storm that's triggering that sensor.

Exactly.

Fascinating. So with aging, does that automatically accompany chronic pain?

That's another interesting piece because the assumption right away is that aging is associated with degeneration, right? So degeneration in the physical body always, you know, from the day we're born, we actually, as we kind of hit our peak in growth, we actually start our decline from a bone perspective and so forth. But arthritis continues to rise over time. But when you look at most of the charts on the age ranges that people show up to the doctor in for chronic pain, the ranges are not correlative with the increase in the arthritis over time. So most of the people that are showing up for chronic pain generally might be in the range of age 35 to 55 or to 60. And so this is a different time period. And then as we start to look at pain presentations and people showing up with pain issues to the doctor, they actually start to decline after those ages, but yet arthritis continues to rise. So the correlation is not there. So I think that that implied assumption is wrong and it's erroneous because increased arthritis is not associated with increased chronic pain. Because if that was the case, as you age, every single person would be dealing with chronic pain. And that is not true. But what I do think occurs is, number one, our nervous system's ability to cope with these types of stressors actually reduces over time. And we see that with, for example, as we get older, we might see more disruptions in our ability to sleep deeply and to sleep really well. And that is one factor that is highly correlated with, um, your ability to cope with chronic pain, keeping nerves healthy and so forth. We see other factors that are associated with aging, and namely things like, uh, deconditioning, lack of fitness. And this is kind of part of a a larger discussion over why, as people get older, they're oftentimes less active because they're also try to— are conditioned by health systems, for the most part, that you have increased likelihood of getting injured and having far more problems by being active. So that you have this loop of people being afraid to exercise and to do things that will sustain their bone health and their muscle mass, and they were not doing them, and that is increasing their likelihood of developing problems. So we've got a couple of factors there. The natural course of, yes, degeneration, lack of mobility, you know, of not having good flexibility in the joints and so forth. We have loss of muscle mass and lack of exercise and fitness that might set one up for the incidences that we oftentimes would see. Um, having to do an activity— I used to refer to this as the snow shoveling syndrome. So if you live in an area where there's a lot of snow, you may not be an active person for 6, 7 months out of the year, and then all of a sudden you've got to go out for 2 hours and shovel your driveway. Now your back hurts because— was it the shoveling the snow, or was it the deconditioning and not being prepared for that activity?. And that can be a trigger for pain and ongoing pain. So that's the thing. And the narrative that we use for that and say, well, you're getting too old to be doing that. That's bad for you. Well, that's not true, because if you were active most of the time, we know lots of people that can do these activities. One of my clients from many years ago, I remember, who was in her late 70s, was a downhill, like, alpine skier. She was amazing. And she just was on the go nonstop. And her just immense level of fitness, I believe, kept her vital. And, and she had aches and pains, but she was so much easier to work with when she did have an ache or pain because of the level of fitness that she had. So, and she never stopped, you know, so she just kept doing that over the years. So I think that is a good way of looking at it.

That's good. Yeah, I've heard from other fitness experts who say the same thing. If you're physically healthy and you do some regular working out, you're much less vulnerable to any of these events, a fall or tripping up on a downhill. Yes. But yeah, so here's what the interesting thing is. What you're saying is that chronic pain is not inevitable with advancing age. It's these intervening variables that come into the mix that contribute to it. I mean, there may be some decline in our muscle strength or endurance or our balance, but that doesn't necessarily trigger chronic pain. It's whatever else kind of comes in to muddy the picture, kind of like shoveling snow every 6 months.

Well, those things can be triggers. And I think about it this way, because a large assortment of people develop chronic pain from some kind of initial issue. They're pulling their back or whatever it is that is going on. And then they start to engage with the system about what happens at that point. And that's where there's increased likelihood of developing ongoing pain. And one of those things is having a strong concern. So I think that I would imagine that 30, 40 years ago, when you show up to the doctor with a minor backache, I mean, it was probably a relatively simple process. You were reassured. That you're going to be okay, maybe to take it easy for a little while and then get, get back out there and start doing your thing. These days, I feel a lot of times there is excessive cautioning, um, of, you know, again, the overdiagnostic model and saying, you have a disc bulge, you better be careful, or you have a disc bulge, there's nothing we can do for you. And what this does is we consider what that does in the mind of the individual who is concerned about their body, they may now, through those incomplete statements or incomplete, uh, explanations of not knowing what that information means or how to process that data, start to negatively impact their behaviors. They may recede from doing activities. They may be more afraid to do things. And now it's increasing a level of anxiety And maybe, you know, that might mean for the person they can't go out and play 18 holes of golf on the weekend, which is their favorite thing to do. And now that anxiety builds toward over the long run, if this pain hangs around, feeling a little more disabled. And we can easily see how that can turn into mild amounts of depression depending upon what that person has going on in their life. And maybe that sport or that activity is so important to them and it's a release. So those, that soup, that collection of kind of story that can go in there are all factors that can contribute to that chronic issue hanging around.

Yeah, even exacerbating it because we, we restrict ourselves more when that's just contrary to what we should be doing. And the more we pull back, the more difficult it is to even take the routine steps and physical movement. And the more we restrict ourselves, the more limited we become. And I'm triggered thinking that that would trigger the onset of some pain when we're doing things that we would normally do.

Yes. And that said, it has that exact effect of the way that the brain works is we perceive or let in information from our body to our brain through the spinal cord. And imagine it has a little gate on it. And that gate controls how much information we perceive in our body. We've all had that experience where we had a bump or a bruise that we look down and we go, where did we get that from? So somehow you got bumped or bruised and there was legit, uh, tissue damage, a bruise, and you didn't even feel it. But then there are times where you get something small or a paper cut and there's an immense amount of discomfort from it. We're getting almost so much information about it. Now that process is determined by the weight of our brain putting an importance level on what it is that's happening to us. So if you were— and one of those things is a lack of understanding, which makes us more concerned about something. And when we're more concerned about something, we allow more information from that body part into the brain. So if you're concerned that you have a bad back, you're going to pay more attention to any little nuanced sensation that you feel in your lower back. And therefore what that does is creates a feedback loop that the more we pay attention to something and we get concerned about it, that little gate at the spine opens up and we further pay attention to it. So now it becomes a focal point for us is to pay attention always to any information that comes in from that one area where the pain is. And there's a problem with that because that information most of the time is deleted. We don't pay attention to that. And therefore we get little aches and pains. They come and they go. But now imagine being hooked on neurologically, only paying attention and feeling any little discomfort you have from that area and having an emotional response to it. That is bad. So that serves a purpose in the short run when you have acute pain, because you should pay attention so you don't irritate anything. But in chronic pain, it has the reverse problem, is that we pay too much attention to it, and it now becomes a significant contributor to the ongoing cycle of chronic pain.

Yeah, yeah. It's a hyper-alertness to that event, and it gets bigger in our own minds. So how do you address chronic pain with your methods? You approach your patients?

So for me, I use the things that— in the toolkit that I use, and namely, I'm used to working with people that predominantly definitely have a fear of movement for those exact reasons that we talked about. They're afraid to move because maybe they think that their back is going to go out and they don't know which types of exercises to do. So they seek out a professional like me to educate them and say, look at my posture, look at my body and my movement and tell me what I need to do. And so we're going to seek out those muscles that, that are associated. If somebody has a pain in their back, we may find certain stretches for their hips loosen up their back, or certain exercises when they work on certain muscles, it loosens them up. So it gives them a new sensation. It gives them something to feel differently and improve their ability to move in non-threatening ways. So when they learn how to move in non-threatening ways, the belief comes from, I can't do anything without my back bothering me, to Hey, I could do a bunch of exercises and my back doesn't bother me. That's good. So we're starting to expand the scope of what the individual can do. We also will use massage therapy and extra, uh, some types of hands-on therapies to relax tissues, areas that have too much nerve sensitivity. We'll desensitize them so we can get them to calm down and functionally what I call, call the brain to reset. To give the brain new information, non-threatening information, so it has the opportunity to change its behavior. And of course, using home exercises and helping the individual be able to continue doing these activities to train their nervous system on how to move without that excess sensitivity. And of course, what ends up happening, the more you do things that you thought were threatening in non-threatening ways, The nervous system goes, hey, I guess this isn't so much of a problem anymore. And it starts to downregulate. It starts to reduce the amount of information it's receiving from those body parts because it's feeling safer.

Yeah.

There's lots of other things that I'll do. I'll look at people's sleep. I'll look at their lifestyle and find out what else we can do because there's only so much exercise you can do. There's only so much massage. If you can get somebody to sleep a little bit better, to adopt better behaviors, change their diet a little bit more, to maybe reduce things that inflame or agitate their digestion. These things will all contribute to reducing the amount of threat on the alarm system and will have a global effect on improving the person's mood and their ability to tolerate stress. And therefore, that will help the situation. And of course, last but not least, certainly, because the thing that I spend the most time on with people is pain education. I teach them about a lot of things that we're talking about to identify those beliefs that might be getting in our way and ask people things like, do you even know what a disc bulge looks like? And they go, well, no. Well, let me bring my skeleton over here and let's talk about this. I know this sounds terrifying and you're probably playing terrifying movies in your head about what this is doing, but let me show you what it actually is so that we can start to clean out any misinformation which might be altering that person's behavior in ways that is not supporting their goals. So mindfulness techniques are really good as well, teaching people how to self-regulate with relaxation and to understand when their nervous system is kind of getting too amped up or carried away, and to learn how to self-adjust.

Yeah, it's really a beautiful integrated medicine, lifestyle medicine approach where you're doing a lot of different paths to this kind of recovery. Yeah, that's great. And you didn't mention hypnotherapy. Recall you do some hypnotherapy with your patients. Is that helpful?

Yeah, I've been a long-term advocate of hypnotherapy and it's a long-forgotten discipline, it seems. But lately, I'm very happy to say, as with everything, tends to have a reemergence from time to time. In particular, hypnotherapy was very, very potent, and a lot of people— was, it was very popular 30, 40 years ago, kind of fell out of favor because I think for the most part people didn't understand why it works. And for many years there wasn't much information, and now technology is changing so much where now we have functional MRIs and different types of ways to scan the brain So a lot of new research is being done on the brain to understand what these things are doing. Mindfulness, cognitive behavioral therapies, and hypnosis. And we're actually learning a ton about what is going on. And it's, believe it or not, of course, thankfully, it has further solidified that what hypnosis thought it was doing is indeed doing what it was thought to do, which is changing what the different areas of the brain are perceiving when it comes to pain. And for a long time, hypnosis— what I always used to look at with that was how do people get relief doing hypnosis with no touch, no exercise, and they can get people pain relief by talking. And if that's the case, there has to be something there. But yet the field continued on its merry way looking at structural biomechanics And, and because it was hard to explain that, it was like putting blinders on and just dismissing it because they don't know how to deal with that. And now it's come back around where the fields are now sharing information because of the internet. A lot of research is available, and you're starting to see practitioners like me going out and wanting to talk about it a lot more and to say, why aren't we using these things in conjunction with each other rather than keeping all of these fields so separate when there's common elements that actually bring the fields together and we can get better results and hopefully at a lower cost to the consumer and, uh, help with this, this epidemic of chronic pain.

Sure. Yeah. That's exciting. Instead of all of these approaches being divergent, you're saying we are now seeing that they're all coming back together and they overlap and there's a lot of interconnectedness among these different approaches. Which is the way medicine should be. I can see that.

Yeah.

If you think about that for a second, you know, you've got massage therapy and you have hypnotherapy. Why isn't there hypno-massage? You know, like there's no reason why you can't combine things together or, you know, have these integrated clinics and so forth where, you know, day one you see a mechanical practitioner, day two you see somebody who supports your diet and your lifestyle. Day three, you see a therapist who will help you with the anxiety, the depression, which is almost always associated with chronic pain. And this is all natural. It's normal to do this rather than it being, again, disjointed and where the practitioners don't all kind of work together under the same philosophy. It's not the discipline, and that's where we're stuck, is the disciplines, when we should really be coming together under the philosophy based upon what the science is showing us about pain. And I think that's where we need to make headway on, on pulling all of that together in a sensical way.

Yeah, having the specialties work together instead of multi-specialty. Formerly they were diverging and now they're converging, so they're coming back together. And we are seeing that interconnectedness. That's good.

It's getting there. Yeah, a lot, a long way to figure out because I could tell you it is difficult even with the multiple things that I do to not overwhelm and to confuse people with so much information that comes in, but also having to do too much in the lifestyle at once. So that is the challenge, which is also maintaining the patience in the process of resolving chronic pain. It— you can only go so at a rate so fast. The body and the nervous system has to do its thing, but your practitioners also need time to help flesh out the things that you need to do without trying to change everything overnight, which just creates more stress.

Sure. Yeah. And when I was working in nursing homes, we always talked about the importance of integrated care instead of in, you know, individual specialties. When you have the dietitian and when you have the activities therapist and the physical therapist and the physician and nursing and mental health, when they're all integrated, you can come up with a more solidified, really customized, individualized program for the given patient. And that's what you're talking about is we can incorporate all of these different approaches and everyone kind of adopt and understand the give and take and respect one another's specialty. That's the key to, I think, treating these folks.

Yeah, absolutely. 100% agree.

Yeah. So is this the release muscle therapy program you've been describing? Is this what's, what you've put together, you've crafted this approach.

Yeah, and I think that, yeah, for me it's always about the working philosophy. Techniques will come and go, uh, different types of therapeutic modalities are going to come and go, but what keeps everything together is the overall viewpoint and the goal of keeping up with what the research says and science shows and trying to take the things that kind of seem like they're in the cloud from the research and try to bring them into an actual day-to-day practice. So how does that look when somebody comes in to do massage therapy, or how does a communication look when we're starting to talk about these things, and try to blend those things from the research to the actual practice. And that leaves behind lots of techniques, lots of things that I might do— massage therapy, different types of massage, different types of fitness programming, or different types of recommendations for lifestyle. And those are always ever evolving to try to be more concise, to be more precise to the individual needs. And the better that is, you streamline the process and you can streamline the process. You can help more people and, um, and you can help them faster at a reduced cost. Right. So that's really what I'm always after is trying to do more with less perception on the individual to seem that they're overwhelmed, but everything seems so easy. And that's my job, is to compress all of that and then make the end user's experience simple. Uh, they don't need more stress. Uh, what they do need is to know exactly what is going on, education, and know how to apply things to, to make the changes to get them away from thinking about pain and to doing other things. I want people to go do the things that they want to do. I don't want them to be a habitual therapy patient or client.

Well, you've done a great job explaining this approach, Sam. I think, I think it's helped our listeners. But what, what would you, uh, hope our listeners take away from our conversation? What's, what's the big takeaway?

The big takeaway, I would say, number one, is, uh, you are not hopeless. You know, I think that we oftentimes, through that limited scope of that old narrative which we had initially talked about in early on in our discussion, it seems limited because the options are surgical procedures. They are things you cannot change, and that is a dead end. But instead, shifting over to this new mentality and narrative of understanding the brain's interpretation and the— and pain being an alarm system, and what we have to do is desensitize nerves. And a little bit goes a long way in terms of, first of all, shifting your focus in that direction, and acquiring some more knowledge and resources on a little bit more about how that might work is going to open up the doorway to hope, which is one of the things that is the first step, is developing a sense of hope that there's a lot more out there for you that you can do to help yourself. And that kind of gets your foot moving forward into that direction where you can start pursuing avenues to find more resources, education, and actually things that you can do to help yourself. To move yourself away from chronic pain.

Yeah. Well, thanks. You've done a great job explaining that and giving hope to those individuals who need some direction and offer that education. I'm really appreciative of your sharing this. It looks like we're out of time though for today. Before we wrap up, I want to remind our listeners about a co-sponsor for our program, A Mighty Good Time. Are you looking for ways to engage and stay active? Check out almightygoodtime.com. It's a one-stop shop for events and activities for those 50 and over. It's free to search and it's free to post. almightygoodtime.com. And be sure to visit the Living to 100 Club website to sign up for our weekly podcast announcements and monthly newsletters. And while you're there, be sure to download a free copy of my 9 tips for living longer. Lastly, pick up a copy of my book, Living Longer Is the New Normal, all about maintaining a positive mindset in all we do. It's available on Amazon as an ebook or hard copy. We've been talking today with Sam Visnic. Sam, for those who might want to contact you, what's the best way for them to do that?

Directly on my website at releasemuscletherapy.com. On there, you'll also find some resources and remind people that if they wonder where they can get information on pain education and some of those courses, I have a free membership area that you can access where I put in loads of content. So you can get direct access to exactly what we were talking about today in an expanded format right inside of there.

That's great. Great resource. Thanks very much for sharing that. ReleaseMuscleTherapy.com. Many thanks again, and thanks to everyone for tuning in. Hope to see you all next time.

Thank you.

Hi, this is Suzanne Newman, host of the Answers for Elders podcast and radio show. We are the North Star that guides you through the complicated journey of senior care with trusted experts in money, law, living solutions, and more. So join us on this station, your favorite podcast channel, or just go to answersforelders.com. Meet the wayshowers who will help your journey go a lot easier.