June 17, 2025 • 40 mins
In this conversation, Dr. Paul Lynch shares his journey into pain management, highlighting the critical connection between physical and mental health. He discusses the origins and consequences of the opioid epidemic, the role of Suboxone in treating addiction, and the emerging fentanyl crisis. Dr. Lynch emphasizes the importance of education, a holistic approach to pain management, and offers advice for young doctors and patients alike. Wellness Unmasked is part of the Clay Travis & Buck Sexton Podcast Network - new episodes debut every Tuesday & Friday.
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Episode Transcript
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Speaker 1 (00:02):
Welcome to Wellness on MASS. I'm doctor Nicoll Saffhire. Today
we are diving into a conversation that intersects two national
health emergencies, the opioid epidemic and chronic pain. In twenty
twenty four, over eighty thousand Americans lost their lives to
drug overdoses. Now, this is a twenty seven percent decline
from the previous year, and that's the steepest drop that
we've seen in decades. This is absolutely encouraging, but we
(00:26):
still have a long ways to go. Overdose remains a
leading cause of death in adults among those aged eighteen
to forty four now. But I don't want to get
into the weeds of the opioid epidemic right now, because
that is its own episode in itself, and to be honest,
it is more than just one episode. We have to
talk about the history of it, where we are now,
in the future of it. We're not doing that today.
(00:48):
Here's what we're doing today. What's often left out of
the conversation is the fact that more than fifty million Americans,
roughly one in five adults, are living with chronic pain,
and of those that, nearly seventeen million are experiencing high
impact chronic pain that actually limits their daily lives. Now,
this is not just a personal burden, It's actually a
(01:09):
national crisis. I wrote about it in my first book,
Make America Healthy Again, which came out in twenty twenty.
Chronic pain costs the US economy and estimated five hundred
and sixty to six hundred and thirty five billion dollars
a year. Now, this is direct medical expenses, but it's
also from lost productivity, more than the combined costs of
(01:30):
heart disease, cancer, and diabetes. Yet we rarely hear people
talking about chronic pain, and I guarantee people listening to
this podcast there are some of you who are dealing
with it. I'm dealing with it. I've talked to you
about the fact that I suffer from an autoimmune disease,
and I do everything I possibly can to fight that inflammation,
(01:52):
whether it's taking my biological injections, to living a clean lifestyle,
to exercising and doing other things that are targeted for
decreasing inflammation. What some of you may not know about
me is deep During COVID December twenty twenty, I also
fell down my stairs. Yeah, that's right, I wasn't doing
anything fun. I wasn't dancing or doing anything crazy. I
(02:13):
was going down to grab some laundry and I was
wearing socks on my wooden stairs, and yep, my foot
went out right from under me. I to protect my
head because I'm married to a brain surgeon and I've
heard total nightmare stories about people falling downstairs and hitting
their head. I instinctively threw my arm behind my head
and protected my head. The good news is I did
(02:34):
not hit my head, but I sacrificed my arm to
protect it. By the time I got down to the
bottom of the stairs, I knew that something was terribly
wrong with my arm. I immediately had to have two
surgeries to put the pieces of my arm back together again.
But I found myself several months after that second surgery,
in still in chronic severe pain. And I found myself
(02:58):
I was back at work, I was going back to
my daily life, but every evening I was in such
severe pain. I was taking motrin to get through the
day tile and all, and then I was also taking
pain medication in the evening time because I still needed
to get on with my life. I have children, we
have laundry, I have driving, we have to make dinner,
and I needed to get some rest. And I found
(03:19):
myself realizing that without taking pain medication at night, I
wasn't sure I was going to make it. It was
affecting me physically, it was affecting me mentally. So my
husband and I decided that I needed to seek the
help of a pain specialist, and that pain specialist decided
to take me off of the pain medication and he
injected my joint with some medications to decrease the inflammation.
(03:44):
And it took a few injections, but all of a sudden,
I got my life back again. I was able to
get through the day without feeling severe pain. I was
back to exercising, and I wasn't needing to take any
more medication. Now, not everybody is able to go and
find a pain medicine doctor. They don't even realize they
and some pain medicine doctors will just continue to prescribe
opioids and other medications. So how do we balance effective
(04:07):
pain relief with responsible prescribing. How do we treat pain
without fueling addiction. It was the treatment of pain that
got us into this problem of the opioid epidemic. In
the first place. To help answer these questions. I'm joined
by doctor Paul Lynch, a double board certified pain management physician.
He's the founder of multiple national pain clinics and a
(04:29):
fierce advocate for safe non opioid alternative. You're listening to
Wellness unmass. We'll be right back with more well I
am happy to have on my friend, former colleague, doctor
Paul Lynch, who has dedicated his career to treating pain.
He's also founded us Pain with a clear mission in mind.
So Paul, thanks so much for being with us on
(04:50):
Wellness Unmasked.
Speaker 2 (04:52):
Dr Stapfire, thank you so much for having me.
Speaker 1 (04:54):
Oh, we're going to be formal, Okay, I'll be Doctor Lynch.
Take us back to what initially drew you into pain
management in the first place.
Speaker 2 (05:05):
Yeah, if you will allow me, I'll go all the
way back to being nine years of age and my
dad is a therapist, he's a licensed clinical social worker,
and he was on the phone in the kitchen and
he called me over to him, and he wrote on
a piece of paper to go next door and called
nine to one to one, and my dad's patient had
called him to say goodbye. He was a therapist, and
(05:27):
she said he was the only person that ever listened
to her and cared about her. He was the only
one that would miss her, and so he kept her
on the phone while nine year old Paul ran next door.
We called the police and my dad was able to
save her life. But I felt like I was part
of that, and I said that I've been kind of
chasing the dragon to mix our metaphors here today, of
saving lives. Since I was nine years old, I always
(05:50):
wanted to be like my dad. I wanted to be
a psychiatrist, and all the way through school, I majored
in psychology. In college, I matched in psychiatry. I'm not
sure you even remember this story, or Nicole, we used
to talk about it, but I matched in psych I
was supposed to go to New York City, right to
kind of like you. I was supposed to be in
New York for psychiatry. And I was about a month
away from graduating and my mother in law was diagnosed
(06:14):
with a severe form of cancer. It was pancreatic cancer,
which I know you have a lot of experience with
in your practice, and it spread to her spine and
so she had like seven fractures in her spine and
she had a lot of tumor in her belly. The
family asked me to help with pain control. I knew
nothing about pain as a medical student, right, and so
I just started researching and I would talk to the
(06:36):
doctors in the hospital and I would use Google, and
in the process I realized a couple of things. Once
she needed these fractures repaired in her spine, and I
learned about a procedure called kyphoplasty, where we could blow
up a balloon and restore height to the bones and
take away pain. And I read about a procedure called
celiat plexus block where we could literally block these nerves
(06:57):
that went to her belly. And as I was reading
about it, I realized that this was the specialty that
I was always supposed to be in, and I didn't
know it. You know, I always wanted to treat mental health,
growing up watching my dad and wanting to be like him.
And then I realized that there was this specialty where
I could treat mental health and physical health at the
(07:18):
same time, and that was pain. And so I literally
dropped out of my psych residency. I had no idea
what I was going to do. It was a scary time,
but I have a strong faith in God, and I
just prayed and I asked God to open the doors.
And I won't tell you the rest of the story now,
but I got into surgery in New York and then
I did anesthesiology at NYU and became a pain doctor.
Speaker 1 (07:39):
I mean, isn't that interesting that you learned early on
in the career, because usually it's not until you've been
in practice five, ten, even twenty years that you see
how intimately connected physical health and mental health really are.
But pain is the forefront of that connection, because chronic
pain is one of the most debilitating things and affecting
(08:00):
mental health so much. And obviously you have now dedicated
your professional life to treating acute pain but also chronic pain.
Speaker 2 (08:09):
Well, that's exactly right. And I think that for better
or for worse, God gave me these experiences and I
learned from them. You know. I like to talk about
justifying the suffering. You know, the suffering that my mother
in law went through was vast, and what my wife
went through and seeing that, but I feel like out
of that there was a silver lining that, you know,
I think I learned what true suffering is, and it's
(08:32):
not just physical suffering, but it's mental suffering. And I
think I probably I learned the mental suffering part for
the first fifteen years of you know, believing I was
going to be a psychiatrist, and then I learned the
physical suffering probably over the last fifteen or twenty years.
And the thing that I really want to talk about
today is that there's there's a third part of it,
which is, yes, you can treat the physical suffering, and
(08:52):
yes you can treat the mental suffering. And as a country,
we're getting a little bit better at talking about mental suffering,
but we're really bad when it comes to addiction.
Speaker 1 (09:01):
Well, well, let's talk about that, because when our quest
to focus on pain, we thought we had the magic pill,
the opioids, I mean, right, which you know, decades ago
when they first came to the market. All of a sudden,
we were finally seeing something that was helping people with
their pain. And now we're still in the middle of
an opioid epidemic. You've obviously been very vocal about non
(09:24):
opioid interventions.
Speaker 3 (09:26):
But in your view, let's go back a little bit.
Speaker 1 (09:28):
How do you think we ended up in this opioid
epidemic in the first place. You know, what did the
medical community do, right?
Speaker 2 (09:35):
Well, I think it actually comes from the good side
of us. The positive side of being a physician is
you want to help your patients. When I saw my
mother in law suffering in the hospital, dying in pain,
of course I wanted to give her opioids. She was
dying with cancer. We wanted to take away that pain.
And people came along, you know, multiple times over the
(09:57):
last hundreds of years, saying that there was a new
opioid that's not addictive, right, Like, I'm not sure if
you know this or if your viewers do, But when
they released Heroin. It came out in about the eighteen eighties. Morphine,
we were learning was very addictive. We started using morphine
a lot during the Civil War, and by the eighteen
eighties we had, you know, thousands of people that were
addicted to morphine. So they released Heroin. The same people
(10:20):
that make bear aspirin made Heroin, and they said it's
just like morphine, but without the addiction. That was the advertising,
and of course we found out that heroin is very addictive,
and then we thought the same thing was shocking, right,
And then we thought the same thing about oxycoda and
the same thing about fyking in. And we went through
this period in the nineties where the entire healthcare system
(10:41):
came together and basically said, we can treat people with
opioids and they're not going to get addicted. And it
was a slippery slope, but it accelerated by the time
I went to medical school in nineteen ninety eight. I
had a lecture on a Monday, and the pharmacology teacher
said that opioids are a perfect molecule that won't damage
one cell in the human body if used at the
right doses. That's what they told me in nineteen ninety eight.
(11:03):
And the next day I went to a lecture in
behavioral health and they brought in a heroin addict to
talk to us. And he said he brought the pharmacy,
sat down the floor, set off the alarm, and knew
that he could get away, but he chose to shoot
up one last time because the opio was more powerful
to him than anything, including his family and his God.
He said that to us, and I said, how could
this reconcile with the lecture that we got yesterday? And
(11:25):
this was nineteen ninety eight. And so we went through
about a twenty year period, call it nineteen ninety five
to about twenty thirteen, where we basically told people that
these meds were safe, and they are safe when used
in the operating room by nanastesiologists, they're safe when used
at the end of life for someone who has cancer.
They're not safe for people that just have low back pain.
(11:45):
And that doesn't mean we don't use it. There are
some patients I say low back pain. I had patients
that you know were blown up in Iraq and had
shratton on their spine and were paralyzed. And there is
true suffering that we see every day in our pain clinics.
What we need to be very careful about is putting
someone who doesn't need to be on opioids on opioids,
because the addiction problem really is real.
Speaker 1 (12:05):
Well, so what I mean there are still many people
who are addicted. What are your thoughts on subox owne,
you know, widely used for opioid addiction treatment. You know,
what are your thoughts on some of those medications?
Speaker 2 (12:17):
Yeah, So my goal with US pain Care is I
want to save a million lives, And people say, how
are you going to save a million? Lives, and the
answer is to do what I talked about earlier. I
call it try diagnosis for these patients that have mental
health issues, in mental suffering, they have physical suffering, but
they also become addicted to the very pills that we're
(12:37):
giving them to treat their physical suffering. Sometimes they get
addicted to the pills that we give them to treat
their mental suffering. I listened to one of your podcasts
earlier this month on anxiety and ADHD, and like you
talk about these medications, there's the flip side of it,
which is we always are battling the side effects, which
sometimes could be dependents and addiction. So for me, the
way that I save a million lives is number one
(12:59):
is we have to get really big market share, which
I'm working on going into all fifty states and working
with some of the best doctors around the country. But
once we have market share, I want to influence, if
not change, the standard of care that if someone becomes
addicted to the pills that we're giving them right now,
what we do is we kick them out of our clinics.
I'm an anesthesiologist, I'm not an addictionologist, and so someone
(13:20):
would come in I would write them percoset because they
just had knee surgery. At week two or three, they're
still hurting. Let's say I keep writing it. At six weeks,
Let's say it becomes clear they're totally addicted to the METS.
What most doctors will do is just cut them off
the pills and kick them out or send them to
an addiction psychiatrist, which typically takes about ninety days to
get in to see, and a lot of the people
are out of network, you can't afford it. My goal
(13:44):
is to train antestesiologists across the country and physical medicine
rehab docs and neurologists or radiologists or whoever I'm working with,
that if that person becomes dependent, you just treat it
like a side effect. You don't act like it's a
big deal. And the treatment is subox you know, you
asked about suboxone. If you take someone who has opioid
(14:05):
use disorder, not just someone that's been on for four
six weeks, that's not a great example. What about someone
that's been on for four or six years and they're
taking ten pills a day, and they're going to the street,
and maybe they're getting fentanyl, which is widely available now
in every city. If you put that person who's opioid
use disorder on suboxone, you reduce their death rate by
fifty percent.
Speaker 1 (14:25):
And so, how does suboxone work for people who don't
really know what it is? Peope, you have heard a
lot about in the loxo, but not necessarily suboxide.
Speaker 2 (14:33):
Sure. No, it's a great question. And I know your
viewers probably can't see me, but I'm going to use
my hand to demonstrate. So there's like a receptor in
your brain called a MEW receptor. And if someone's taking fentanyl,
let's just use fentone example, because it's the drug that's
killing so many people, eighty thousand dead from fentanyl in
twenty twenty three. So fentanel comes along and it sticks
in the receptor and it's a perfect fit. It fits
(14:56):
perfectly in the MEW receptor. We call that an agonist
it agoni, or it stimulates the receptor and you get
pain relief. Sometimes you get euphoria, and you can get
respiratory depression where you stop breathing. You also get other
things like itching and constipation and stuff that no one
cares about. But it's thinkinting perfectly inside this receptor. If
someone overdoses, you can give them narcan or in the lozone,
(15:18):
which a lot of people have heard about. I worked
with the White House sit between twenty fourteen and sixteen
to get education out there about how we can use
narcan throughout the country. This wasn't a thing like even
ten or fifteen years ago. But now we have narcan
in the back of every ambulance. We have it widely available,
and we know that it saves lives. And so where
you have that fentanyl stuck in that me receptor, narcan
(15:39):
comes along. It's called an antagonist, and it's stronger than
the fentanyl is, so it kicks it off. And now
I'm putting my hand kind of partially in the receptor.
The narcan only partially stimulates the receptor, so and I'm
not saying that well, I'm sorry, it completely blocks the
receptor and it kicks off the fentanyl. And so if
you look at suboxone, there's actually two molecules in it.
(16:00):
One is bupernorphine, which is called an agonist antagonist, and
so it partially agonizes the receptor. So if you give
it to a patient who has severe pain, they will
get some pain relief, which is a nice benefit of suboxone.
Not as much as fentanyl, but it might work sixty
percent as well, or even seventy percent. But here's where
it gets interesting. It also blocks the receptor, so we
(16:21):
call it an agonist antagonist. It will partially bind to
the receptor, but it blocks it. And here's the part
that most people don't know. It is seventy times stronger
than fentanyl seven zero. And so when people are afraid
of like this fentanyl crisis, I tell them, listen, I'm
not afraid of fensanel. We literally need more suboxone or
more bupernorphine, because it's like Godzilla is bupernorphine and fentanyl
(16:44):
is this little baby bunny at a molecular level when
you're talking about how it stimulates that receptor. And so
what we do with suboxone is we combine these two
molecules bupernorphine, which will partially agonize the receptor and block it.
And then narcndis there. And a lot of people don't
realize this. The narcan, the naloxone that's part of suboxone,
is not even biologically active when you take it sublingually,
(17:08):
so you take it under the tongue, it goes into
the bloodstream and the buper and orthhene is working. But
if you take it and shoot it up, because sometimes
when you have opioid use disorder, people start doing ivy drugs.
If you try to shoot up the bupernorthene, it keeps
you from overdosing because the narcan is released and it
blocks the receptor. So it's a brilliant drug and when combined,
like I said, it's a fifty percent reduction immortality because
(17:29):
it's so much more strong than the opioid.
Speaker 1 (17:31):
So you're using the sevoxone to treat the chronic pain
as a means of someone who has already been addicted
to it, or you're starting with savoxone to begin with.
Speaker 2 (17:40):
So it's kind of a loaded question there. We don't
use suboxone typically if it's just pain, we'll use a
different a different way to get the buper and orthene
into the body. So one's called a bu trans patch.
You can just put a patch on and it gives
you bruperorphene. It blocks your receptor and it gives you
pain relief. But you don't you don't get addicted and
you don't ow. It's almost impossible to overdose on bupern
(18:02):
orphine unless you combine it with like alcohol or benzodiazepines
or other sedative hypnotic agents. So for someone who comes
in that just has chronic low back pain, a lot
of my community is going towards bupernorphine as a treatment
because it's so low risk. But if someone comes in
and they have terrible, serious pain and they've become addicted,
and they have full on opiud use disorder, this is
(18:23):
a very easy diagnosis to make. There's eleven questions in
the DSM five they have low, mild, moderate, and severe.
And if you take someone like my younger brother, by
the way, was a heroin addict, and I can tell
you a little bit more about that, you know, maybe later,
but he has severe opiod use disorder, and he started
(18:43):
helping me tell the story of kind of what he
went through. He started on perkos at and then within
about ninety days he got addicted to heroin and it
lasted about ten years where he was full on severe
opiod use disorder. And so for someone like him, he
has chronic pain. He had an overdose that was so
bad in two thousand and six that he spent about
(19:04):
ninety days in the ICU. We had about twenty six surgeries.
He was paralyzed from the waist down. It was terrible,
Nicole and when he came out, yeah, took us back.
Speaker 3 (19:12):
For those who don't know the story.
Speaker 1 (19:14):
So what most people don't understand is they think of, well,
we take pergose, maybe wisdom teeth got taken out.
Speaker 3 (19:19):
They had the ACL from a ski injury.
Speaker 1 (19:22):
Most people can't comprehend how you can go from just
taking post procedural opioids to getting heroin on the street.
Like they can't fathom that that happens to everyday people.
Speaker 2 (19:32):
Yeah, so thank you Boyd's. You know, the data shows
that if you smoke even one cigarette when you're in
junior high or high school or as an adult, sixty five
percent of people will get addicted for at least a
short period of time. Think that's crazy, right, sixty five percent.
It actually happened to me. My brother took me and
we smoked a cigarette when I was nine years old
(19:54):
behind a train station, and I smoke for a week.
Every time every chance I got, I'd sneak away and
go smoke with my brother. Other smoke for almost ten years.
He got addicted as a child and smoke all the
way up through college, and then he finally stopped. If
you look at the lifetime prevalence of smoke in the
United States, I think it's not about fifteen or twenty percent.
Those people are addicted. They can't stop right and so alcoholism,
it's about seventeen to twenty percent of Americans will get
(20:16):
addicted to alcohol at some point during their life. So
if you take just those same numbers and said seventeen
to twenty percent of people who take percoset might get addicted,
that's probably not too far off the reality. There's some
data showing it's as low as four percent or ten percent.
There's some data showing as high as forty but I
think the numbers somewhere between ten and twenty percent. Of
people are like my brother. They take the percoset and
(20:37):
they love the way it makes them feel. Listening to
your podcasts and stuff, you're very into mental health and
you understand depression and anxiety. You take an opioid for
the right person or the wrong person, it might make
them feel calm for the first time in their life.
It might make them feel pleasure when it stimulates that
receptor that I talked about, it releases endorphins, right, and
so this person finally feels good and they feel pain
(21:00):
and they feel happy, and then they take a bigger
dose and a bigger dose and a bigger dose over time,
and before you know it, someone becomes addicted.
Speaker 1 (21:08):
But then how does that transform to going and getting heroin?
Why you know they shop around.
Speaker 3 (21:13):
To the doctors or I want to know how to
go get heroin?
Speaker 2 (21:17):
Sure, So I'm gonna answer that through the story of
my brother. So interestingly, the story I told you about
my mother in law that was in the spring summer
of two thousand and two. I had what I call
about a three or four month honeymoon period with the
pain space where I was like, these procedures are great,
these drugs are great, these opioids help people. I mean
I was a little suspicious because, like I said, I
(21:38):
saw the guy in medical school telling me rob the
pharmacy to get opiates. I was a little bit suspicious.
And my dad ironically was a drug and alcohol counselor
at the time, and so I didn't know a little
bit about drugs. But I had like this four month
honeymoon period in New York City, and this was kind
of like ground zero writing a bunch of opioids. You know,
I worked under a guy named Russell Portnoy at Beth
Israel Hospital who was of some of this. My brother
(22:02):
hurt his back and in Oklahoma, where you know where
I was going to medical school, he went to a
doctor in the game percocet and immediately took away my
brother's pain. But my brother had, you know, a long
history of probably you know, mental health issues as well,
including depression, anxiety, on other things, and so I think
for him he felt he felt good for the first time.
(22:25):
But what happens is you get tolerance, right, and so
you're a doctor, you understand this. But for your users,
what tolerance means is that receptor that I talked about,
Once it gets filled with a percocet, your brain makes
two more and now you have three receptors, and so
you go back to the doctor and say I need
a bigger dose. So they give you a bigger dose,
and then you get six receptors, and then ten and
then one hundred. And they've done lots of research on this,
(22:46):
but it's called opioid hyper algesia where they actually start
having worse pain because they have more receptors. And so
you get to the point where the doctor says, no,
you can't have anymore. This is crazy. You can't take
twenty oxycode on a day. And if you've ever had
like you know, if you ever go out drinking with friends,
you might have that one guy that can drink twenty
drinks and it just doesn't affect them. That person will
get cut off by the doctors say I can't give
(23:08):
you twenty oxy cotos today, and then they go to
the street and you you start buying pills, and then
the pills aren't enough and someone's like, hey, I can
give you heroin. You can shoot it up and you
feel better immediately, and you slip into it. And that's
exactly what happens in the old days. When I first
started looking at this data, when my brother first overdosed
in my bathroom, there was about five hundred thousand Americans
(23:29):
that were addicted to heroin. Today it's nine million that
are addicted to fentanyl or opioids or pills. Nine million.
This has all happened during my career.
Speaker 3 (23:39):
Well, so you keep.
Speaker 1 (23:40):
Bringing up fentanyl because there is a relationship between you know,
medical opioid dependents, but also fentanyl, and the new FBI director,
Cash Forttel, has said that it is going to be
a priority to him to get the fentanyl off our
streets because it's being imported in from other countries and
he's working on this very hard. What kind of impact
do you think that we'll actually have of on the
(24:00):
opioid crisis that we are seeing here in the United States.
Speaker 2 (24:04):
Well, I think it's I think it's very important. I
think that Fentanel I like to teach this to people.
We have two separate epidemics going on at the same time,
and it's almost like a ven diagram where they overlap
a little bit. There is an opioid prescribing epidemic. There
has been an epidemic in the way we've prescribed since
nineteen ninety five. Probably we've got better at it, but
we continue to write more opioids than any other country
(24:25):
in the world, and we have an epidemic of people
becoming dependent on the very pills we're writing, which is
a big part of my campaign to educate pain doctors
use less pills and if you get someone who's addicted,
you treat their addiction. Like that's how I make an
impact in my space. In the fentanyl space, it's a
totally different epidemic. You have a molecule that is micrograms, right,
not milligrams. Like when we had our cocaine crisis in
(24:46):
the eighties. You remember you'd watched the shows with Pablo
Escobar and they were shipping in plane loads of cocaine,
and like you could see the plane coming and you
know it's got cocaine, and it was actually very easy
to fight. In the big picture, fentanel is totally It's
sold not milligrams, but micrograms. It's very very tiny. You
can overdose on enough. Fentanyl can sit on the tip
of a pencil, right, the tip of a pencil can
(25:09):
kill you. You can sneak it in in diapers and
dolls and food and whatever you want. It is coming
across our border. I live in Arizona and we're one
of the primary access points for fentanyl into our country,
and so we need to have strong policies on fentanyl,
whatever that is. And I think that our government can
make a really big impact by focusing on fentcannel. From
my perspective as a doctor. The biggest thing I can
(25:31):
do is educate, like our kids need to know about fencanel.
Like the good old days of going to a party
and doing some pills in the seventies or eighties are gone.
Any pill that you take could kill you one pill
because they put fentanel in pills, right, and so you
can literally take it and one pill can kill you.
And so it's important for us to educate our high
school students, our college students to have narcan widely available.
(25:53):
We talked about narcian earlier can reduce and or can
reverse an overdose. And certainly our federal government needs to
be looking diplomacy with China and Mexico to cut down
the distribution of fentchannel across our borders, to go after
cartels that are selling it. But yes, I think that
cash betells you to make a big impact with as policies.
Speaker 1 (26:12):
You know, it's interesting you said overdose, and I hear
a lot of people say, you know, we do talk
about overdose and when we find people unconscious or when
they die because they've taken too much of a dose
of a medication that's caused the respiratory depression and being
unconscious or even death. But the reality is with a
lot of these young people who are taking these medications,
they don't even know that they're spent andel in it,
(26:33):
so they're not overdosing on it, they're being.
Speaker 3 (26:36):
Poisoned with it, and it's killing them.
Speaker 1 (26:38):
And so I wonder if changing even the verbiage that's
used to just remind people that these kids who are
going out and are overdose quote unquote overdosing, they are
taking something which they don't even realize what it is.
Speaker 3 (26:51):
One they're not asking questions.
Speaker 1 (26:52):
They're taking like unlabeled pills, because that's what people still
do apparently, and you know, the mindset needs to change.
Speaker 3 (27:00):
But I think it's really interesting with us pain.
Speaker 1 (27:02):
You know, you're talking about how patients shouldn't just be
cut off, So we're already saying we have an overprescribing
situation of opioids. It's much better now than it was
a couple of decades ago, but it's still happening.
Speaker 3 (27:15):
You obviously know more than anyone.
Speaker 1 (27:17):
But the problem is when a physician gets uncomfortable thinking
someone may be addicted to pain, as you said, they
get cut off and they get just kind of sent
out into the world. And do you think that that's
kind of what pushes them to then go and find
street level opioids because they can no longer get it,
you know from a medical professional. And is that perpetuating
(27:39):
and making this opioid crisis even worse.
Speaker 2 (27:41):
It's very insightful what you're saying. It's one hundred percent true.
And there's been multiple papers written on this. The CDC
has acknowledged this. We had guidelines that came out in
twenty sixteen, and states across the country started making laws
on how much you could get and started shutting people off,
and doctors started getting in trouble getting sanctioned, and the
CDC came out with another report four or five years
(28:03):
later saying, hey, you guys way overreacted. Is if we're
not saying that you that you're going to lose their license? Yes, yes,
it's exactly what happened. And our federal government, I think
did a bad job of navigating this entire thing. And
I don't know if your viewers know this, but up
until a year and a half ago, you had to
have a special license just to treat addiction. There were
(28:26):
two million providers, doctors, nurse practitioners, and pas in the country,
but only fifty thousand people could give you suboxone if
you got addicted. And I have fought against that for
ten years, worked with a government, educated everything I could.
They finally changed that about a year and a half ago,
and so now every single provider in the United States
can actually write suboxone. So part of what I'm advocating for,
(28:47):
I mean, I'm an anesthesiologist. Like when we put someone
to sleep, we might give them twenty five different drugs.
We tight trade them off or tight trade them on.
We tight trade them off, like we know how to
use these medications. Someone comes in and they're addicted to
an opioid, I can help that. I know how to
get them off with them. One of the things that
we're teaching is called a suboxone micro induction, where you
give them four percent of the final dose the very
(29:08):
day you meet them. I call it treat them when
you meet them. And so if someone looks at me,
if you said, hey, doc, I'm I'm addicted to these opioids.
I feel like I'm out of control. I want some help.
You could literally stay on your purpose at and I'd say, here,
you're going to take four percent of your stable dose,
and that's about zero point five milligrams of suboxone. You
actually have to cut the strip and it gets a
little bit complicated. The next day you take eight percent,
(29:29):
the next day you take twelve. It's not that different
from me on what I do putting someone to sleep
or waking them up. I can tytrate on this life
saving molecule, and once you get to about fifty percent
of the dose, you can just stop your opioids and
you're good. I'm encouraging every anesthesiologist in the country. By
the way, about fifty percent of pain doctors are anesthesiologists
like me. I'm saying, listen, if you put someone to
sleep and wake them up, you can put them on
(29:50):
the suboxone and treat their addiction. And by the way,
I'm not asking every anesthesiologist and every pain doctor to
become a full on addiction psychiatrist. I'm asking them to
stabilize their patient, get him into behavioral health, get them
into a psychiatrist. But fix the problem. Treat them when
you meet.
Speaker 1 (30:06):
Them, especially fix the problem that they may have caused
in the first place.
Speaker 2 (30:10):
Exactly.
Speaker 1 (30:11):
Here's my question, and I'm sure you're going to get
you get it from critics is are you just replacing
one addiction for another?
Speaker 3 (30:17):
I mean, are people ever going to get off the
subox up?
Speaker 2 (30:20):
It's a great question. I'm glad you asked it. So
when we first realized that methodone could save lives, there
were methodone clinics in the nineteen seventies. It was massively
controversial because methodone is a full agonist, right, methodone is
a very long acting opioid, and especially like the twelve
Step crowd. I grew up with my dad, who was
an addiction counsel. I used to go to twelve Step
(30:40):
meetings and listen and learn, and they were all about abstinence, right.
It was like God is going to help you your
higher power, you don't have any substances, and that became
the standard of care in treating alcoholism. But then they
had this molecule called methodone. They realized if you showed
up every day at a clinic, you could take methadone
once a day and you wouldn't go do street hair.
(31:00):
And it was very, very controversial, and that continues to
be fought for years and years and years. When suboxone
came out, it kind of changed the narrative because suboxone
is not a pure agonist. It kind of blocks the
receptor like I talked about, it does stimulate the receptor
a little bit. It is a scheduled drug, so there's
a little bit of what you're talking about. But now
the data started coming out, and the data is that
(31:21):
if you're on suboxone, there's a fifty percent reduction in
death rate. There's not another drug that I can think of,
and I've asked maybe one hundred doctors now I cannot
think of another drug that has a fifty percent reduction
in mortality. The chemotherapy drugs aren't even close, right, so
the heart drugs aren't even close. You're not reducing someone's
death rate by fifty percent when they have heart failure
with any drug. And so as we look at the data,
(31:42):
it is clear that abstinence does not work with opioids.
If you have severe opid use disorder like my brother,
he will never come off of this drug. And he
should never come off of this drug because if he does,
more than likely he'll be back doing drugs within days,
if not weeks. And so when I talk to people
like that, I understand the idea of abstinence. I think
it works really well with alcoholism. But in the opioid space,
(32:05):
when you're addicted to opioids, the data is very clear
if you look at an abstinence group versus a suboxone
group at five years, if you put someone on suboxone
and leave them on, eighty percent are not doing drugs.
The abstinence group is like twenty five percent success. And
so I lean on the data, which is suboxone save
lives and it works better than abstinence.
Speaker 1 (32:23):
Well, I'm always all about the data. Show me the data. Well,
I think it's great. I think that you know, we're
still in the middle of an opioid crisis. I think
people don't talk about it as much. It's not getting
as much media attention. But you know, what you're doing
with us pain is making sure that you know, we're
trying to stop causing even more problems and potentially helping
(32:44):
those who are on it and not giving them the stigma,
and making sure that you're taking their physical and mental
health into account.
Speaker 3 (32:50):
I think it's great. You know, the world of pain
is extremely exciting.
Speaker 1 (32:54):
You know, as an interventional and breast radiologist, I love
the idea of you know nervablys and some non you know,
medication pain relief items. Do you still talk about some
of this stuff or do you do this stuff or
are you kind of just focusing on this right now.
Speaker 2 (33:10):
Well, my goal is to reduce suffering, and I am
a pain doctor to my core. I love the procedures
that we do. Like the procedure that my mother in
law needed, the kyphoplasty. It was so close to my
heart that you could literally, and like a ten minute procedure,
take away someone suffering by fixing a fracture. It blew
me away that was even possible. Like that procedure made
(33:32):
me want to become a pain doctor. My approach to
pain is all about holistic care. Though right I think
that we've gone way too far with interventions, way too
far with surgery, way too far with pills. And I
think I think you agree with me. I think it's
a holistic approach. I think the best thing I can
do for my patient is to get them mentally healthy
(33:53):
right to I encourage all my patients to talk to
a therapist. I talk to a therapist. I want them
to talk about, you know, what makes them happen, what
makes them sad? What are their goals. I want them
to lose weight. I want them to have appropriate diet.
I want them to look at their supplements and how
are they doing with vitamins. I want them to do
physical therapy. If they get addicted, I want to treat
their addiction. And yes, we have all these crazy cutting
(34:14):
edge technologies now where we can take away suffering. I
just what I want us pain care to be is
that we're not just an interventional based practice. We're not
just we give you pills. I want us to treat
the whole person. And I think that's where we really
will help human suffware.
Speaker 3 (34:29):
So two part question.
Speaker 1 (34:31):
You know what advice would you give to Let's say,
start with young doctors who want to help people who
are in pain without feeding into this broken system.
Speaker 2 (34:39):
Yeah, that's great. Number one. If you want to be
a pain doctor, I suggest that you go to a
fellowship and you learn these procedures you're talking about, because
some of these procedures really blow me away, Like it's
spinal corese stimulation. That data and the research on it
has gone to the next level. There was a study
published in jama about two years ago that if you
(35:00):
have severe painful diabetic neuropathy. Placing a very small electrode
behind the spinal cord. It sounds crazy, but we can
place a small little electrode in the epidural space that
that has ninety percent reduction in pain from diabetic neuropathy,
and it does it by blocking the pain signals on
the way to the brain. And so if you want
to be a pain doctor, I think number one is
(35:22):
you do a fellowship and you learn these advanced techniques
that you talked about radio frequency of blation and spinal
cord stimulation. Number two, I encourage doctors to really become
a good pharmacologist. Like again, I'm an anesthesiologist. We use
medications all day. I love the pharmacology of how a
muscle relaxant works and a neuropathic medicine works, and how
to interdepressant works, and to really understand those medicines, not
(35:44):
to lean too heavily on opioids, to look at all
the other type of medications. And then I really encourage
doctors to understand mental health. I'm trying to make a
lot of changes in the system, but one is I
want all pain physicians to have obligatory training and mental health.
They need to understand depression and anxiety. Every patient that
I've ever met who's had pain, you know, for five
(36:06):
years or ten years, they have some sort of depression
or anxiety, and we don't focus on that enough. We
don't focus on the mental health. So for young doctors,
I just want them to understand a holistic approach which
includes the procedures and includes the meds, but a lot
of it is mental health and diet and exercise and
all the other stuff.
Speaker 1 (36:23):
And the second part of the question is what about
for the everyday person, you know, myself, anybody else listening
who deals with some sort of pain, whether it's a
cute pain from an injury that just happened, or some
form of chronic pain, Like, what do you suggest.
Speaker 2 (36:35):
That they do activity? I know it sounds it sounds crazy,
but when you're hurting, what I want people to do
is get active. I want them to go to physical
therapy first, and I want them, within limits to understand
how bad is the injury and how much can I
be active range of motion? Right, you hurt your shoulder,
the best thing you can actually do is start to
(36:57):
do shoulder exercises and to build up the muscles right
to get a good doctor. When pain persists beyond two
or three or four weeks, imaging right, like you're a radiologist.
I like to do imaging early and often.
Speaker 3 (37:11):
Because sure companies don't always agree with this.
Speaker 2 (37:15):
I agree and I fight them all day long because
I think that early diagnosis is key and I think,
you know so, imaging is a big part of it
when I teach my doctor, and I'd say the same
thing to my friends, like it's a five finger approach,
my first finger, my thumb is diagnosis. We have to
make a good diagnosis and that's usually imaging and a
good physical exam and sometimes neuro studies. Number two is
(37:36):
I want to find out what medication is right for you,
and I'll tell you. As a pain doctor, I always
start with dietism medication, right, like what are you eating?
Are you eating vegetables and fruits? And you know your
gut health and all this. Number three for me is
is there some sort of physical therapy that I can
do for you? And that includes massage? Will send people
for massage, physical therapy, chiropractic care. Number four, I start
(37:57):
talking about mental health, right, I say, hey, you know,
are you depressed or you anxious? If my patients say no,
I'm like, I still want you to talk to someone.
I think you might actually have I just it's okay,
Like we want to destigmatize mental health. And then the
fifth thing is is there some sort of intervention? Is
there something we can do to change the tissue or
radio frequency or smile forstem or a surgery? But I
try to do that. Fifth, I start with the first
(38:18):
four things.
Speaker 1 (38:20):
Well, doctor Paul Lynch, you are the founder of US
pain Care. It is a bold endeavor. I am grateful
that you've included me on your advisory board, and I
am so excited to see what you do with this.
Speaker 2 (38:32):
I am too, doctor Sapphire, you have been a wonderful
friend for many, many years. I love the work you do.
I'm a big fan, and thank you for having me
on today.
Speaker 3 (38:39):
Thanks for joining us.
Speaker 1 (38:41):
More coming up on Wellness Unmasked with doctor Nicole Sapphire.
Thank you, doctor Paul Lynch for your insight, your compassion,
and your relentless pursuit of solutions that heal without harm.
As we heard today, this is not just about reducing
overdose deaths. It's about transforming how we understand and treat
pain in America. Doctor Lynch's goal is nothing short of bold,
(39:05):
to save one million lives by revolutionizing pain care, expanding
access to innovative non opioid therapies, and advocating for policy
change that puts patients first. For me, I am eternally
grateful for pain physicians like doctor Lynch, who is able
to get me off pain medications. I wish I could
say that the trouble with my shoulders in the past,
(39:26):
but the reality is I will be undergoing a third
shoulder surgery here in the next.
Speaker 3 (39:31):
Couple of weeks.
Speaker 1 (39:32):
But I already have a pain plan mapped out because
I do not want to find myself again being reliant
on pain medications. I will keep you informed as I
go through this next chapter with this next surgery. I'll
keep you up to day all along the way. If
you are someone you know lives with chronic pain, or
you felt the impact of the opioid epidemic, know that
(39:54):
there are people like doctor Lynch working every day to
bring relief, hope, and a better path forward. If you
are someone you love is living with chronic pain, or
if you felt the impact of the opioid epidemic, know
that there still are people like doctor Lynch working every
day to bring relief, hope, and a better path forward.
Thanks for listening to Wellness Unmass on America's number one
(40:15):
podcast network, iHeart. Follow Wellness on Mass with doctor Nicole Sapfire,
and start listening on the free iHeartRadio app wherever you
get your podcasts, and we will catch you next time.
Welcome to Wellness on MASS. I'm doctor Nicoll Saffhire. Today
we are diving into a conversation that intersects two national
health emergencies, the opioid epidemic and chronic pain. In twenty
twenty four, over eighty thousand Americans lost their lives to
drug overdoses. Now, this is a twenty seven percent decline
from the previous year, and that's the steepest drop that
we've seen in decades. This is absolutely encouraging, but we
(00:26):
still have a long ways to go. Overdose remains a
leading cause of death in adults among those aged eighteen
to forty four now. But I don't want to get
into the weeds of the opioid epidemic right now, because
that is its own episode in itself, and to be honest,
it is more than just one episode. We have to
talk about the history of it, where we are now,
in the future of it. We're not doing that today.
(00:48):
Here's what we're doing today. What's often left out of
the conversation is the fact that more than fifty million Americans,
roughly one in five adults, are living with chronic pain,
and of those that, nearly seventeen million are experiencing high
impact chronic pain that actually limits their daily lives. Now,
this is not just a personal burden, It's actually a
(01:09):
national crisis. I wrote about it in my first book,
Make America Healthy Again, which came out in twenty twenty.
Chronic pain costs the US economy and estimated five hundred
and sixty to six hundred and thirty five billion dollars
a year. Now, this is direct medical expenses, but it's
also from lost productivity, more than the combined costs of
(01:30):
heart disease, cancer, and diabetes. Yet we rarely hear people
talking about chronic pain, and I guarantee people listening to
this podcast there are some of you who are dealing
with it. I'm dealing with it. I've talked to you
about the fact that I suffer from an autoimmune disease,
and I do everything I possibly can to fight that inflammation,
(01:52):
whether it's taking my biological injections, to living a clean lifestyle,
to exercising and doing other things that are targeted for
decreasing inflammation. What some of you may not know about
me is deep During COVID December twenty twenty, I also
fell down my stairs. Yeah, that's right, I wasn't doing
anything fun. I wasn't dancing or doing anything crazy. I
(02:13):
was going down to grab some laundry and I was
wearing socks on my wooden stairs, and yep, my foot
went out right from under me. I to protect my
head because I'm married to a brain surgeon and I've
heard total nightmare stories about people falling downstairs and hitting
their head. I instinctively threw my arm behind my head
and protected my head. The good news is I did
(02:34):
not hit my head, but I sacrificed my arm to
protect it. By the time I got down to the
bottom of the stairs, I knew that something was terribly
wrong with my arm. I immediately had to have two
surgeries to put the pieces of my arm back together again.
But I found myself several months after that second surgery,
in still in chronic severe pain. And I found myself
(02:58):
I was back at work, I was going back to
my daily life, but every evening I was in such
severe pain. I was taking motrin to get through the
day tile and all, and then I was also taking
pain medication in the evening time because I still needed
to get on with my life. I have children, we
have laundry, I have driving, we have to make dinner,
and I needed to get some rest. And I found
(03:19):
myself realizing that without taking pain medication at night, I
wasn't sure I was going to make it. It was
affecting me physically, it was affecting me mentally. So my
husband and I decided that I needed to seek the
help of a pain specialist, and that pain specialist decided
to take me off of the pain medication and he
injected my joint with some medications to decrease the inflammation.
(03:44):
And it took a few injections, but all of a sudden,
I got my life back again. I was able to
get through the day without feeling severe pain. I was
back to exercising, and I wasn't needing to take any
more medication. Now, not everybody is able to go and
find a pain medicine doctor. They don't even realize they
and some pain medicine doctors will just continue to prescribe
opioids and other medications. So how do we balance effective
(04:07):
pain relief with responsible prescribing. How do we treat pain
without fueling addiction. It was the treatment of pain that
got us into this problem of the opioid epidemic. In
the first place. To help answer these questions. I'm joined
by doctor Paul Lynch, a double board certified pain management physician.
He's the founder of multiple national pain clinics and a
(04:29):
fierce advocate for safe non opioid alternative. You're listening to
Wellness unmass. We'll be right back with more well I
am happy to have on my friend, former colleague, doctor
Paul Lynch, who has dedicated his career to treating pain.
He's also founded us Pain with a clear mission in mind.
So Paul, thanks so much for being with us on
(04:50):
Wellness Unmasked.
Speaker 2 (04:52):
Dr Stapfire, thank you so much for having me.
Speaker 1 (04:54):
Oh, we're going to be formal, Okay, I'll be Doctor Lynch.
Take us back to what initially drew you into pain
management in the first place.
Speaker 2 (05:05):
Yeah, if you will allow me, I'll go all the
way back to being nine years of age and my
dad is a therapist, he's a licensed clinical social worker,
and he was on the phone in the kitchen and
he called me over to him, and he wrote on
a piece of paper to go next door and called
nine to one to one, and my dad's patient had
called him to say goodbye. He was a therapist, and
(05:27):
she said he was the only person that ever listened
to her and cared about her. He was the only
one that would miss her, and so he kept her
on the phone while nine year old Paul ran next door.
We called the police and my dad was able to
save her life. But I felt like I was part
of that, and I said that I've been kind of
chasing the dragon to mix our metaphors here today, of
saving lives. Since I was nine years old, I always
(05:50):
wanted to be like my dad. I wanted to be
a psychiatrist, and all the way through school, I majored
in psychology. In college, I matched in psychiatry. I'm not
sure you even remember this story, or Nicole, we used
to talk about it, but I matched in psych I
was supposed to go to New York City, right to
kind of like you. I was supposed to be in
New York for psychiatry. And I was about a month
away from graduating and my mother in law was diagnosed
(06:14):
with a severe form of cancer. It was pancreatic cancer,
which I know you have a lot of experience with
in your practice, and it spread to her spine and
so she had like seven fractures in her spine and
she had a lot of tumor in her belly. The
family asked me to help with pain control. I knew
nothing about pain as a medical student, right, and so
I just started researching and I would talk to the
(06:36):
doctors in the hospital and I would use Google, and
in the process I realized a couple of things. Once
she needed these fractures repaired in her spine, and I
learned about a procedure called kyphoplasty, where we could blow
up a balloon and restore height to the bones and
take away pain. And I read about a procedure called
celiat plexus block where we could literally block these nerves
(06:57):
that went to her belly. And as I was reading
about it, I realized that this was the specialty that
I was always supposed to be in, and I didn't
know it. You know, I always wanted to treat mental health,
growing up watching my dad and wanting to be like him.
And then I realized that there was this specialty where
I could treat mental health and physical health at the
(07:18):
same time, and that was pain. And so I literally
dropped out of my psych residency. I had no idea
what I was going to do. It was a scary time,
but I have a strong faith in God, and I
just prayed and I asked God to open the doors.
And I won't tell you the rest of the story now,
but I got into surgery in New York and then
I did anesthesiology at NYU and became a pain doctor.
Speaker 1 (07:39):
I mean, isn't that interesting that you learned early on
in the career, because usually it's not until you've been
in practice five, ten, even twenty years that you see
how intimately connected physical health and mental health really are.
But pain is the forefront of that connection, because chronic
pain is one of the most debilitating things and affecting
(08:00):
mental health so much. And obviously you have now dedicated
your professional life to treating acute pain but also chronic pain.
Speaker 2 (08:09):
Well, that's exactly right. And I think that for better
or for worse, God gave me these experiences and I
learned from them. You know. I like to talk about
justifying the suffering. You know, the suffering that my mother
in law went through was vast, and what my wife
went through and seeing that, but I feel like out
of that there was a silver lining that, you know,
I think I learned what true suffering is, and it's
(08:32):
not just physical suffering, but it's mental suffering. And I
think I probably I learned the mental suffering part for
the first fifteen years of you know, believing I was
going to be a psychiatrist, and then I learned the
physical suffering probably over the last fifteen or twenty years.
And the thing that I really want to talk about
today is that there's there's a third part of it,
which is, yes, you can treat the physical suffering, and
(08:52):
yes you can treat the mental suffering. And as a country,
we're getting a little bit better at talking about mental suffering,
but we're really bad when it comes to addiction.
Speaker 1 (09:01):
Well, well, let's talk about that, because when our quest
to focus on pain, we thought we had the magic pill,
the opioids, I mean, right, which you know, decades ago
when they first came to the market. All of a sudden,
we were finally seeing something that was helping people with
their pain. And now we're still in the middle of
an opioid epidemic. You've obviously been very vocal about non
(09:24):
opioid interventions.
Speaker 3 (09:26):
But in your view, let's go back a little bit.
Speaker 1 (09:28):
How do you think we ended up in this opioid
epidemic in the first place. You know, what did the
medical community do, right?
Speaker 2 (09:35):
Well, I think it actually comes from the good side
of us. The positive side of being a physician is
you want to help your patients. When I saw my
mother in law suffering in the hospital, dying in pain,
of course I wanted to give her opioids. She was
dying with cancer. We wanted to take away that pain.
And people came along, you know, multiple times over the
(09:57):
last hundreds of years, saying that there was a new
opioid that's not addictive, right, Like, I'm not sure if
you know this or if your viewers do, But when
they released Heroin. It came out in about the eighteen eighties. Morphine,
we were learning was very addictive. We started using morphine
a lot during the Civil War, and by the eighteen
eighties we had, you know, thousands of people that were
addicted to morphine. So they released Heroin. The same people
(10:20):
that make bear aspirin made Heroin, and they said it's
just like morphine, but without the addiction. That was the advertising,
and of course we found out that heroin is very addictive,
and then we thought the same thing was shocking, right,
And then we thought the same thing about oxycoda and
the same thing about fyking in. And we went through
this period in the nineties where the entire healthcare system
(10:41):
came together and basically said, we can treat people with
opioids and they're not going to get addicted. And it
was a slippery slope, but it accelerated by the time
I went to medical school in nineteen ninety eight. I
had a lecture on a Monday, and the pharmacology teacher
said that opioids are a perfect molecule that won't damage
one cell in the human body if used at the
right doses. That's what they told me in nineteen ninety eight.
(11:03):
And the next day I went to a lecture in
behavioral health and they brought in a heroin addict to
talk to us. And he said he brought the pharmacy,
sat down the floor, set off the alarm, and knew
that he could get away, but he chose to shoot
up one last time because the opio was more powerful
to him than anything, including his family and his God.
He said that to us, and I said, how could
this reconcile with the lecture that we got yesterday? And
(11:25):
this was nineteen ninety eight. And so we went through
about a twenty year period, call it nineteen ninety five
to about twenty thirteen, where we basically told people that
these meds were safe, and they are safe when used
in the operating room by nanastesiologists, they're safe when used
at the end of life for someone who has cancer.
They're not safe for people that just have low back pain.
(11:45):
And that doesn't mean we don't use it. There are
some patients I say low back pain. I had patients
that you know were blown up in Iraq and had
shratton on their spine and were paralyzed. And there is
true suffering that we see every day in our pain clinics.
What we need to be very careful about is putting
someone who doesn't need to be on opioids on opioids,
because the addiction problem really is real.
Speaker 1 (12:05):
Well, so what I mean there are still many people
who are addicted. What are your thoughts on subox owne,
you know, widely used for opioid addiction treatment. You know,
what are your thoughts on some of those medications?
Speaker 2 (12:17):
Yeah, So my goal with US pain Care is I
want to save a million lives, And people say, how
are you going to save a million? Lives, and the
answer is to do what I talked about earlier. I
call it try diagnosis for these patients that have mental
health issues, in mental suffering, they have physical suffering, but
they also become addicted to the very pills that we're
(12:37):
giving them to treat their physical suffering. Sometimes they get
addicted to the pills that we give them to treat
their mental suffering. I listened to one of your podcasts
earlier this month on anxiety and ADHD, and like you
talk about these medications, there's the flip side of it,
which is we always are battling the side effects, which
sometimes could be dependents and addiction. So for me, the
way that I save a million lives is number one
(12:59):
is we have to get really big market share, which
I'm working on going into all fifty states and working
with some of the best doctors around the country. But
once we have market share, I want to influence, if
not change, the standard of care that if someone becomes
addicted to the pills that we're giving them right now,
what we do is we kick them out of our clinics.
I'm an anesthesiologist, I'm not an addictionologist, and so someone
(13:20):
would come in I would write them percoset because they
just had knee surgery. At week two or three, they're
still hurting. Let's say I keep writing it. At six weeks,
Let's say it becomes clear they're totally addicted to the METS.
What most doctors will do is just cut them off
the pills and kick them out or send them to
an addiction psychiatrist, which typically takes about ninety days to
get in to see, and a lot of the people
are out of network, you can't afford it. My goal
(13:44):
is to train antestesiologists across the country and physical medicine
rehab docs and neurologists or radiologists or whoever I'm working with,
that if that person becomes dependent, you just treat it
like a side effect. You don't act like it's a
big deal. And the treatment is subox you know, you
asked about suboxone. If you take someone who has opioid
(14:05):
use disorder, not just someone that's been on for four
six weeks, that's not a great example. What about someone
that's been on for four or six years and they're
taking ten pills a day, and they're going to the street,
and maybe they're getting fentanyl, which is widely available now
in every city. If you put that person who's opioid
use disorder on suboxone, you reduce their death rate by
fifty percent.
Speaker 1 (14:25):
And so, how does suboxone work for people who don't
really know what it is? Peope, you have heard a
lot about in the loxo, but not necessarily suboxide.
Speaker 2 (14:33):
Sure. No, it's a great question. And I know your
viewers probably can't see me, but I'm going to use
my hand to demonstrate. So there's like a receptor in
your brain called a MEW receptor. And if someone's taking fentanyl,
let's just use fentone example, because it's the drug that's
killing so many people, eighty thousand dead from fentanyl in
twenty twenty three. So fentanel comes along and it sticks
in the receptor and it's a perfect fit. It fits
(14:56):
perfectly in the MEW receptor. We call that an agonist
it agoni, or it stimulates the receptor and you get
pain relief. Sometimes you get euphoria, and you can get
respiratory depression where you stop breathing. You also get other
things like itching and constipation and stuff that no one
cares about. But it's thinkinting perfectly inside this receptor. If
someone overdoses, you can give them narcan or in the lozone,
(15:18):
which a lot of people have heard about. I worked
with the White House sit between twenty fourteen and sixteen
to get education out there about how we can use
narcan throughout the country. This wasn't a thing like even
ten or fifteen years ago. But now we have narcan
in the back of every ambulance. We have it widely available,
and we know that it saves lives. And so where
you have that fentanyl stuck in that me receptor, narcan
(15:39):
comes along. It's called an antagonist, and it's stronger than
the fentanyl is, so it kicks it off. And now
I'm putting my hand kind of partially in the receptor.
The narcan only partially stimulates the receptor, so and I'm
not saying that well, I'm sorry, it completely blocks the
receptor and it kicks off the fentanyl. And so if
you look at suboxone, there's actually two molecules in it.
(16:00):
One is bupernorphine, which is called an agonist antagonist, and
so it partially agonizes the receptor. So if you give
it to a patient who has severe pain, they will
get some pain relief, which is a nice benefit of suboxone.
Not as much as fentanyl, but it might work sixty
percent as well, or even seventy percent. But here's where
it gets interesting. It also blocks the receptor, so we
(16:21):
call it an agonist antagonist. It will partially bind to
the receptor, but it blocks it. And here's the part
that most people don't know. It is seventy times stronger
than fentanyl seven zero. And so when people are afraid
of like this fentanyl crisis, I tell them, listen, I'm
not afraid of fensanel. We literally need more suboxone or
more bupernorphine, because it's like Godzilla is bupernorphine and fentanyl
(16:44):
is this little baby bunny at a molecular level when
you're talking about how it stimulates that receptor. And so
what we do with suboxone is we combine these two
molecules bupernorphine, which will partially agonize the receptor and block it.
And then narcndis there. And a lot of people don't
realize this. The narcan, the naloxone that's part of suboxone,
is not even biologically active when you take it sublingually,
(17:08):
so you take it under the tongue, it goes into
the bloodstream and the buper and orthhene is working. But
if you take it and shoot it up, because sometimes
when you have opioid use disorder, people start doing ivy drugs.
If you try to shoot up the bupernorthene, it keeps
you from overdosing because the narcan is released and it
blocks the receptor. So it's a brilliant drug and when combined,
like I said, it's a fifty percent reduction immortality because
(17:29):
it's so much more strong than the opioid.
Speaker 1 (17:31):
So you're using the sevoxone to treat the chronic pain
as a means of someone who has already been addicted
to it, or you're starting with savoxone to begin with.
Speaker 2 (17:40):
So it's kind of a loaded question there. We don't
use suboxone typically if it's just pain, we'll use a
different a different way to get the buper and orthene
into the body. So one's called a bu trans patch.
You can just put a patch on and it gives
you bruperorphene. It blocks your receptor and it gives you
pain relief. But you don't you don't get addicted and
you don't ow. It's almost impossible to overdose on bupern
(18:02):
orphine unless you combine it with like alcohol or benzodiazepines
or other sedative hypnotic agents. So for someone who comes
in that just has chronic low back pain, a lot
of my community is going towards bupernorphine as a treatment
because it's so low risk. But if someone comes in
and they have terrible, serious pain and they've become addicted,
and they have full on opiud use disorder, this is
(18:23):
a very easy diagnosis to make. There's eleven questions in
the DSM five they have low, mild, moderate, and severe.
And if you take someone like my younger brother, by
the way, was a heroin addict, and I can tell
you a little bit more about that, you know, maybe later,
but he has severe opiod use disorder, and he started
(18:43):
helping me tell the story of kind of what he
went through. He started on perkos at and then within
about ninety days he got addicted to heroin and it
lasted about ten years where he was full on severe
opiod use disorder. And so for someone like him, he
has chronic pain. He had an overdose that was so
bad in two thousand and six that he spent about
(19:04):
ninety days in the ICU. We had about twenty six surgeries.
He was paralyzed from the waist down. It was terrible,
Nicole and when he came out, yeah, took us back.
Speaker 3 (19:12):
For those who don't know the story.
Speaker 1 (19:14):
So what most people don't understand is they think of, well,
we take pergose, maybe wisdom teeth got taken out.
Speaker 3 (19:19):
They had the ACL from a ski injury.
Speaker 1 (19:22):
Most people can't comprehend how you can go from just
taking post procedural opioids to getting heroin on the street.
Like they can't fathom that that happens to everyday people.
Speaker 2 (19:32):
Yeah, so thank you Boyd's. You know, the data shows
that if you smoke even one cigarette when you're in
junior high or high school or as an adult, sixty five
percent of people will get addicted for at least a
short period of time. Think that's crazy, right, sixty five percent.
It actually happened to me. My brother took me and
we smoked a cigarette when I was nine years old
(19:54):
behind a train station, and I smoke for a week.
Every time every chance I got, I'd sneak away and
go smoke with my brother. Other smoke for almost ten years.
He got addicted as a child and smoke all the
way up through college, and then he finally stopped. If
you look at the lifetime prevalence of smoke in the
United States, I think it's not about fifteen or twenty percent.
Those people are addicted. They can't stop right and so alcoholism,
it's about seventeen to twenty percent of Americans will get
(20:16):
addicted to alcohol at some point during their life. So
if you take just those same numbers and said seventeen
to twenty percent of people who take percoset might get addicted,
that's probably not too far off the reality. There's some
data showing it's as low as four percent or ten percent.
There's some data showing as high as forty but I
think the numbers somewhere between ten and twenty percent. Of
people are like my brother. They take the percoset and
(20:37):
they love the way it makes them feel. Listening to
your podcasts and stuff, you're very into mental health and
you understand depression and anxiety. You take an opioid for
the right person or the wrong person, it might make
them feel calm for the first time in their life.
It might make them feel pleasure when it stimulates that
receptor that I talked about, it releases endorphins, right, and
so this person finally feels good and they feel pain
(21:00):
and they feel happy, and then they take a bigger
dose and a bigger dose and a bigger dose over time,
and before you know it, someone becomes addicted.
Speaker 1 (21:08):
But then how does that transform to going and getting heroin?
Why you know they shop around.
Speaker 3 (21:13):
To the doctors or I want to know how to
go get heroin?
Speaker 2 (21:17):
Sure, So I'm gonna answer that through the story of
my brother. So interestingly, the story I told you about
my mother in law that was in the spring summer
of two thousand and two. I had what I call
about a three or four month honeymoon period with the
pain space where I was like, these procedures are great,
these drugs are great, these opioids help people. I mean
I was a little suspicious because, like I said, I
(21:38):
saw the guy in medical school telling me rob the
pharmacy to get opiates. I was a little bit suspicious.
And my dad ironically was a drug and alcohol counselor
at the time, and so I didn't know a little
bit about drugs. But I had like this four month
honeymoon period in New York City, and this was kind
of like ground zero writing a bunch of opioids. You know,
I worked under a guy named Russell Portnoy at Beth
Israel Hospital who was of some of this. My brother
(22:02):
hurt his back and in Oklahoma, where you know where
I was going to medical school, he went to a
doctor in the game percocet and immediately took away my
brother's pain. But my brother had, you know, a long
history of probably you know, mental health issues as well,
including depression, anxiety, on other things, and so I think
for him he felt he felt good for the first time.
(22:25):
But what happens is you get tolerance, right, and so
you're a doctor, you understand this. But for your users,
what tolerance means is that receptor that I talked about,
Once it gets filled with a percocet, your brain makes
two more and now you have three receptors, and so
you go back to the doctor and say I need
a bigger dose. So they give you a bigger dose,
and then you get six receptors, and then ten and
then one hundred. And they've done lots of research on this,
(22:46):
but it's called opioid hyper algesia where they actually start
having worse pain because they have more receptors. And so
you get to the point where the doctor says, no,
you can't have anymore. This is crazy. You can't take
twenty oxycode on a day. And if you've ever had
like you know, if you ever go out drinking with friends,
you might have that one guy that can drink twenty
drinks and it just doesn't affect them. That person will
get cut off by the doctors say I can't give
(23:08):
you twenty oxy cotos today, and then they go to
the street and you you start buying pills, and then
the pills aren't enough and someone's like, hey, I can
give you heroin. You can shoot it up and you
feel better immediately, and you slip into it. And that's
exactly what happens in the old days. When I first
started looking at this data, when my brother first overdosed
in my bathroom, there was about five hundred thousand Americans
(23:29):
that were addicted to heroin. Today it's nine million that
are addicted to fentanyl or opioids or pills. Nine million.
This has all happened during my career.
Speaker 3 (23:39):
Well, so you keep.
Speaker 1 (23:40):
Bringing up fentanyl because there is a relationship between you know,
medical opioid dependents, but also fentanyl, and the new FBI director,
Cash Forttel, has said that it is going to be
a priority to him to get the fentanyl off our
streets because it's being imported in from other countries and
he's working on this very hard. What kind of impact
do you think that we'll actually have of on the
(24:00):
opioid crisis that we are seeing here in the United States.
Speaker 2 (24:04):
Well, I think it's I think it's very important. I
think that Fentanel I like to teach this to people.
We have two separate epidemics going on at the same time,
and it's almost like a ven diagram where they overlap
a little bit. There is an opioid prescribing epidemic. There
has been an epidemic in the way we've prescribed since
nineteen ninety five. Probably we've got better at it, but
we continue to write more opioids than any other country
(24:25):
in the world, and we have an epidemic of people
becoming dependent on the very pills we're writing, which is
a big part of my campaign to educate pain doctors
use less pills and if you get someone who's addicted,
you treat their addiction. Like that's how I make an
impact in my space. In the fentanyl space, it's a
totally different epidemic. You have a molecule that is micrograms, right,
not milligrams. Like when we had our cocaine crisis in
(24:46):
the eighties. You remember you'd watched the shows with Pablo
Escobar and they were shipping in plane loads of cocaine,
and like you could see the plane coming and you
know it's got cocaine, and it was actually very easy
to fight. In the big picture, fentanel is totally It's
sold not milligrams, but micrograms. It's very very tiny. You
can overdose on enough. Fentanyl can sit on the tip
of a pencil, right, the tip of a pencil can
(25:09):
kill you. You can sneak it in in diapers and
dolls and food and whatever you want. It is coming
across our border. I live in Arizona and we're one
of the primary access points for fentanyl into our country,
and so we need to have strong policies on fentanyl,
whatever that is. And I think that our government can
make a really big impact by focusing on fentcannel. From
my perspective as a doctor. The biggest thing I can
(25:31):
do is educate, like our kids need to know about fencanel.
Like the good old days of going to a party
and doing some pills in the seventies or eighties are gone.
Any pill that you take could kill you one pill
because they put fentanel in pills, right, and so you
can literally take it and one pill can kill you.
And so it's important for us to educate our high
school students, our college students to have narcan widely available.
(25:53):
We talked about narcian earlier can reduce and or can
reverse an overdose. And certainly our federal government needs to
be looking diplomacy with China and Mexico to cut down
the distribution of fentchannel across our borders, to go after
cartels that are selling it. But yes, I think that
cash betells you to make a big impact with as policies.
Speaker 1 (26:12):
You know, it's interesting you said overdose, and I hear
a lot of people say, you know, we do talk
about overdose and when we find people unconscious or when
they die because they've taken too much of a dose
of a medication that's caused the respiratory depression and being
unconscious or even death. But the reality is with a
lot of these young people who are taking these medications,
they don't even know that they're spent andel in it,
(26:33):
so they're not overdosing on it, they're being.
Speaker 3 (26:36):
Poisoned with it, and it's killing them.
Speaker 1 (26:38):
And so I wonder if changing even the verbiage that's
used to just remind people that these kids who are
going out and are overdose quote unquote overdosing, they are
taking something which they don't even realize what it is.
Speaker 3 (26:51):
One they're not asking questions.
Speaker 1 (26:52):
They're taking like unlabeled pills, because that's what people still
do apparently, and you know, the mindset needs to change.
Speaker 3 (27:00):
But I think it's really interesting with us pain.
Speaker 1 (27:02):
You know, you're talking about how patients shouldn't just be
cut off, So we're already saying we have an overprescribing
situation of opioids. It's much better now than it was
a couple of decades ago, but it's still happening.
Speaker 3 (27:15):
You obviously know more than anyone.
Speaker 1 (27:17):
But the problem is when a physician gets uncomfortable thinking
someone may be addicted to pain, as you said, they
get cut off and they get just kind of sent
out into the world. And do you think that that's
kind of what pushes them to then go and find
street level opioids because they can no longer get it,
you know from a medical professional. And is that perpetuating
(27:39):
and making this opioid crisis even worse.
Speaker 2 (27:41):
It's very insightful what you're saying. It's one hundred percent true.
And there's been multiple papers written on this. The CDC
has acknowledged this. We had guidelines that came out in
twenty sixteen, and states across the country started making laws
on how much you could get and started shutting people off,
and doctors started getting in trouble getting sanctioned, and the
CDC came out with another report four or five years
(28:03):
later saying, hey, you guys way overreacted. Is if we're
not saying that you that you're going to lose their license? Yes, yes,
it's exactly what happened. And our federal government, I think
did a bad job of navigating this entire thing. And
I don't know if your viewers know this, but up
until a year and a half ago, you had to
have a special license just to treat addiction. There were
(28:26):
two million providers, doctors, nurse practitioners, and pas in the country,
but only fifty thousand people could give you suboxone if
you got addicted. And I have fought against that for
ten years, worked with a government, educated everything I could.
They finally changed that about a year and a half ago,
and so now every single provider in the United States
can actually write suboxone. So part of what I'm advocating for,
(28:47):
I mean, I'm an anesthesiologist. Like when we put someone
to sleep, we might give them twenty five different drugs.
We tight trade them off or tight trade them on.
We tight trade them off, like we know how to
use these medications. Someone comes in and they're addicted to
an opioid, I can help that. I know how to
get them off with them. One of the things that
we're teaching is called a suboxone micro induction, where you
give them four percent of the final dose the very
(29:08):
day you meet them. I call it treat them when
you meet them. And so if someone looks at me,
if you said, hey, doc, I'm I'm addicted to these opioids.
I feel like I'm out of control. I want some help.
You could literally stay on your purpose at and I'd say, here,
you're going to take four percent of your stable dose,
and that's about zero point five milligrams of suboxone. You
actually have to cut the strip and it gets a
little bit complicated. The next day you take eight percent,
(29:29):
the next day you take twelve. It's not that different
from me on what I do putting someone to sleep
or waking them up. I can tytrate on this life
saving molecule, and once you get to about fifty percent
of the dose, you can just stop your opioids and
you're good. I'm encouraging every anesthesiologist in the country. By
the way, about fifty percent of pain doctors are anesthesiologists
like me. I'm saying, listen, if you put someone to
sleep and wake them up, you can put them on
(29:50):
the suboxone and treat their addiction. And by the way,
I'm not asking every anesthesiologist and every pain doctor to
become a full on addiction psychiatrist. I'm asking them to
stabilize their patient, get him into behavioral health, get them
into a psychiatrist. But fix the problem. Treat them when
you meet.
Speaker 1 (30:06):
Them, especially fix the problem that they may have caused
in the first place.
Speaker 2 (30:10):
Exactly.
Speaker 1 (30:11):
Here's my question, and I'm sure you're going to get
you get it from critics is are you just replacing
one addiction for another?
Speaker 3 (30:17):
I mean, are people ever going to get off the
subox up?
Speaker 2 (30:20):
It's a great question. I'm glad you asked it. So
when we first realized that methodone could save lives, there
were methodone clinics in the nineteen seventies. It was massively
controversial because methodone is a full agonist, right, methodone is
a very long acting opioid, and especially like the twelve
Step crowd. I grew up with my dad, who was
an addiction counsel. I used to go to twelve Step
(30:40):
meetings and listen and learn, and they were all about abstinence, right.
It was like God is going to help you your
higher power, you don't have any substances, and that became
the standard of care in treating alcoholism. But then they
had this molecule called methodone. They realized if you showed
up every day at a clinic, you could take methadone
once a day and you wouldn't go do street hair.
(31:00):
And it was very, very controversial, and that continues to
be fought for years and years and years. When suboxone
came out, it kind of changed the narrative because suboxone
is not a pure agonist. It kind of blocks the
receptor like I talked about, it does stimulate the receptor
a little bit. It is a scheduled drug, so there's
a little bit of what you're talking about. But now
the data started coming out, and the data is that
(31:21):
if you're on suboxone, there's a fifty percent reduction in
death rate. There's not another drug that I can think of,
and I've asked maybe one hundred doctors now I cannot
think of another drug that has a fifty percent reduction
in mortality. The chemotherapy drugs aren't even close, right, so
the heart drugs aren't even close. You're not reducing someone's
death rate by fifty percent when they have heart failure
with any drug. And so as we look at the data,
(31:42):
it is clear that abstinence does not work with opioids.
If you have severe opid use disorder like my brother,
he will never come off of this drug. And he
should never come off of this drug because if he does,
more than likely he'll be back doing drugs within days,
if not weeks. And so when I talk to people
like that, I understand the idea of abstinence. I think
it works really well with alcoholism. But in the opioid space,
(32:05):
when you're addicted to opioids, the data is very clear
if you look at an abstinence group versus a suboxone
group at five years, if you put someone on suboxone
and leave them on, eighty percent are not doing drugs.
The abstinence group is like twenty five percent success. And
so I lean on the data, which is suboxone save
lives and it works better than abstinence.
Speaker 1 (32:23):
Well, I'm always all about the data. Show me the data. Well,
I think it's great. I think that you know, we're
still in the middle of an opioid crisis. I think
people don't talk about it as much. It's not getting
as much media attention. But you know, what you're doing
with us pain is making sure that you know, we're
trying to stop causing even more problems and potentially helping
(32:44):
those who are on it and not giving them the stigma,
and making sure that you're taking their physical and mental
health into account.
Speaker 3 (32:50):
I think it's great. You know, the world of pain
is extremely exciting.
Speaker 1 (32:54):
You know, as an interventional and breast radiologist, I love
the idea of you know nervablys and some non you know,
medication pain relief items. Do you still talk about some
of this stuff or do you do this stuff or
are you kind of just focusing on this right now.
Speaker 2 (33:10):
Well, my goal is to reduce suffering, and I am
a pain doctor to my core. I love the procedures
that we do. Like the procedure that my mother in
law needed, the kyphoplasty. It was so close to my
heart that you could literally, and like a ten minute procedure,
take away someone suffering by fixing a fracture. It blew
me away that was even possible. Like that procedure made
(33:32):
me want to become a pain doctor. My approach to
pain is all about holistic care. Though right I think
that we've gone way too far with interventions, way too
far with surgery, way too far with pills. And I
think I think you agree with me. I think it's
a holistic approach. I think the best thing I can
do for my patient is to get them mentally healthy
(33:53):
right to I encourage all my patients to talk to
a therapist. I talk to a therapist. I want them
to talk about, you know, what makes them happen, what
makes them sad? What are their goals. I want them
to lose weight. I want them to have appropriate diet.
I want them to look at their supplements and how
are they doing with vitamins. I want them to do
physical therapy. If they get addicted, I want to treat
their addiction. And yes, we have all these crazy cutting
(34:14):
edge technologies now where we can take away suffering. I
just what I want us pain care to be is
that we're not just an interventional based practice. We're not
just we give you pills. I want us to treat
the whole person. And I think that's where we really
will help human suffware.
Speaker 3 (34:29):
So two part question.
Speaker 1 (34:31):
You know what advice would you give to Let's say,
start with young doctors who want to help people who
are in pain without feeding into this broken system.
Speaker 2 (34:39):
Yeah, that's great. Number one. If you want to be
a pain doctor, I suggest that you go to a
fellowship and you learn these procedures you're talking about, because
some of these procedures really blow me away, Like it's
spinal corese stimulation. That data and the research on it
has gone to the next level. There was a study
published in jama about two years ago that if you
(35:00):
have severe painful diabetic neuropathy. Placing a very small electrode
behind the spinal cord. It sounds crazy, but we can
place a small little electrode in the epidural space that
that has ninety percent reduction in pain from diabetic neuropathy,
and it does it by blocking the pain signals on
the way to the brain. And so if you want
to be a pain doctor, I think number one is
(35:22):
you do a fellowship and you learn these advanced techniques
that you talked about radio frequency of blation and spinal
cord stimulation. Number two, I encourage doctors to really become
a good pharmacologist. Like again, I'm an anesthesiologist. We use
medications all day. I love the pharmacology of how a
muscle relaxant works and a neuropathic medicine works, and how
to interdepressant works, and to really understand those medicines, not
(35:44):
to lean too heavily on opioids, to look at all
the other type of medications. And then I really encourage
doctors to understand mental health. I'm trying to make a
lot of changes in the system, but one is I
want all pain physicians to have obligatory training and mental health.
They need to understand depression and anxiety. Every patient that
I've ever met who's had pain, you know, for five
(36:06):
years or ten years, they have some sort of depression
or anxiety, and we don't focus on that enough. We
don't focus on the mental health. So for young doctors,
I just want them to understand a holistic approach which
includes the procedures and includes the meds, but a lot
of it is mental health and diet and exercise and
all the other stuff.
Speaker 1 (36:23):
And the second part of the question is what about
for the everyday person, you know, myself, anybody else listening
who deals with some sort of pain, whether it's a
cute pain from an injury that just happened, or some
form of chronic pain, Like, what do you suggest.
Speaker 2 (36:35):
That they do activity? I know it sounds it sounds crazy,
but when you're hurting, what I want people to do
is get active. I want them to go to physical
therapy first, and I want them, within limits to understand
how bad is the injury and how much can I
be active range of motion? Right, you hurt your shoulder,
the best thing you can actually do is start to
(36:57):
do shoulder exercises and to build up the muscles right
to get a good doctor. When pain persists beyond two
or three or four weeks, imaging right, like you're a radiologist.
I like to do imaging early and often.
Speaker 3 (37:11):
Because sure companies don't always agree with this.
Speaker 2 (37:15):
I agree and I fight them all day long because
I think that early diagnosis is key and I think,
you know so, imaging is a big part of it
when I teach my doctor, and I'd say the same
thing to my friends, like it's a five finger approach,
my first finger, my thumb is diagnosis. We have to
make a good diagnosis and that's usually imaging and a
good physical exam and sometimes neuro studies. Number two is
(37:36):
I want to find out what medication is right for you,
and I'll tell you. As a pain doctor, I always
start with dietism medication, right, like what are you eating?
Are you eating vegetables and fruits? And you know your
gut health and all this. Number three for me is
is there some sort of physical therapy that I can
do for you? And that includes massage? Will send people
for massage, physical therapy, chiropractic care. Number four, I start
(37:57):
talking about mental health, right, I say, hey, you know,
are you depressed or you anxious? If my patients say no,
I'm like, I still want you to talk to someone.
I think you might actually have I just it's okay,
Like we want to destigmatize mental health. And then the
fifth thing is is there some sort of intervention? Is
there something we can do to change the tissue or
radio frequency or smile forstem or a surgery? But I
try to do that. Fifth, I start with the first
(38:18):
four things.
Speaker 1 (38:20):
Well, doctor Paul Lynch, you are the founder of US
pain Care. It is a bold endeavor. I am grateful
that you've included me on your advisory board, and I
am so excited to see what you do with this.
Speaker 2 (38:32):
I am too, doctor Sapphire, you have been a wonderful
friend for many, many years. I love the work you do.
I'm a big fan, and thank you for having me
on today.
Speaker 3 (38:39):
Thanks for joining us.
Speaker 1 (38:41):
More coming up on Wellness Unmasked with doctor Nicole Sapphire.
Thank you, doctor Paul Lynch for your insight, your compassion,
and your relentless pursuit of solutions that heal without harm.
As we heard today, this is not just about reducing
overdose deaths. It's about transforming how we understand and treat
pain in America. Doctor Lynch's goal is nothing short of bold,
(39:05):
to save one million lives by revolutionizing pain care, expanding
access to innovative non opioid therapies, and advocating for policy
change that puts patients first. For me, I am eternally
grateful for pain physicians like doctor Lynch, who is able
to get me off pain medications. I wish I could
say that the trouble with my shoulders in the past,
(39:26):
but the reality is I will be undergoing a third
shoulder surgery here in the next.
Speaker 3 (39:31):
Couple of weeks.
Speaker 1 (39:32):
But I already have a pain plan mapped out because
I do not want to find myself again being reliant
on pain medications. I will keep you informed as I
go through this next chapter with this next surgery. I'll
keep you up to day all along the way. If
you are someone you know lives with chronic pain, or
you felt the impact of the opioid epidemic, know that
(39:54):
there are people like doctor Lynch working every day to
bring relief, hope, and a better path forward. If you
are someone you love is living with chronic pain, or
if you felt the impact of the opioid epidemic, know
that there still are people like doctor Lynch working every
day to bring relief, hope, and a better path forward.
Thanks for listening to Wellness Unmass on America's number one
(40:15):
podcast network, iHeart. Follow Wellness on Mass with doctor Nicole Sapfire,
and start listening on the free iHeartRadio app wherever you
get your podcasts, and we will catch you next time.
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