October 21, 2025 • 28 mins
On this episode of Five to Thrive Live, anesthesiologist and pain specialist, Dr. Rosanne Sheinberg will be sharing why and how she incorporates anti-inflammatory strategies into her approach to pain management. She will tell us why effective pain management depends on incorporating key anti-inflammatory strategies.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:14):
And Hello, Welcome to five to Thrive Live, a podcast
(00:44):
about thriving for those who have been affected by cancer
and chronic disease. I'm doctor Lisau Schuler and I co
host with my good friend and colleague, Carolyn Gazilla. You
can find all of our past show podcasts on every
major podcast outlet, and you can also find schedule of
the shows on I thriveplan dot com. Well, I'm very
(01:05):
excited because this show I will be talking to doctor
Roseanne Sheinberg about how and why she incorporates anti inflammatory
lifestyle recommendations into her pain management practice. Doctor, I'm so
used to calling you Rosie, but I will try to
be professional here. Doctor Roseanne Sheinberg is an Associate professor
(01:26):
of anisysiology and pain Medicine at the University of Washington.
Her areas of clinical expertise include cardiac anisysiology, perry operative
trans esophagial echo cardiography and integrative Perry operative and pain management.
And prior to receiving her undergraduate degree in biochemistry from
(01:48):
the University of California Davis, she was a member of
the Jeoffrey Ballet in New York City, and she toured
as a member of the Phantom of the Opera and
danced for Carnival cruise lines. So she's a renaissance woman
to be sure. She completed her medical training at the
Johns Hopkins and then pursued a fellowship in integrated medicine
through the Andrew Wild Program of Integrative Medicine at the
(02:10):
University of Arizona. And she's also trained in medical acupuncture.
And I've had the great honor and privilege of knowing
doctor Sheinberg for some time. She's a delight and welcome
to the show.
Speaker 3 (02:23):
Thank you so much. I'm thrilled to be here.
Speaker 2 (02:26):
Well, good, We're going to have a very interesting conversation.
But before we start that, I do want to thank
our sponsors that make this conversation possible. So we have Cetria,
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so that's one of the body's primary defenses against free
(02:49):
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learn more at Cetria Glutathion dot com. We also have
Cognizance citicoline, which is nature's way of key being the
brain firing on all cylinders. So if you want to
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you can learn more at Doctororherprobiotics dot com. Okay, can
(03:51):
I call you Rosie?
Speaker 3 (03:52):
Oh? Absolutely.
Speaker 2 (03:54):
Oh good well, Rosie, it's a delight to talk with
you again. And you know, pain, pain is a big deal.
So many people suffer with pain, and I think it's
probably one of the highest or most prevalent unmet needs
for people with other health conditions because it accompanies so
many health conditions, and even if their condition gets treated appropriately,
(04:17):
they can still be left with pain. And of course
pain is part of a lot of illnesses. So what
is chronic pain? Why does it happen?
Speaker 3 (04:27):
You know, the what is a lot easier to answer
than the why. But you know, in essence, acute pain
chronic pain, that transition happens somewhere around three months, and
so that becomes the definition. It's kind of pain that
is stuck around longer than three months, which means longer
than we would have suspected for some kind of process
to heal itself. But you know, they just define it
(04:51):
as it's some constant sometimes intermittent, but it interferes with
daily life, has a lot of causes. The why is
a little harder, right, you know, I think we are
seeing a rise in most chronic illnesses, a lot of
which I think is preventable. I mean, all the way
(05:11):
from obesity rising in children to diabetes, pre diabetes, cancer,
autoimmune issues. I think modern life has really just evolved
to not supporting kind of resilience building at its basis.
Our plates are too full, humans who are busy, stressed,
not sleeping enough, We don't have time to cook an exercise,
(05:31):
not connecting in meaningful ways. That's just modern life. And
I think that when we're vulnerable, then we become more
vulnerable to things like chronic pain and other diseases.
Speaker 2 (05:41):
Very interesting, I've never heard it described quite like that.
So in some sense, you're suggesting that chronic pain is
a consequence of, or a symptom of modern life.
Speaker 3 (05:54):
You know, I think modern life predisposes us to illnesses,
issues that we may not have faced before, or at
worsens things that we may have faced to a small degree.
Speaker 2 (06:06):
Yeah. So the opposite then would be a what we
call anti inflammatory life. So what does that mean to you?
Speaker 1 (06:17):
Yeah?
Speaker 3 (06:18):
To me, you know, I think this goes back to
kind of this whole origins of this sort of field
of what has become now integrated medicine. I mean, we're
looking at root causes and at a as a primary motive.
We're seeking to support, build, enhance health and resilience. And
I think we're finding a common sort of theme or
(06:39):
root cause underneath a lot of our chronic illnesses in
this country. Underneath heart disease, cancer, immune issues, chronic pain,
and I think that is chronic systemic low grade inflammation,
and how we live our lives contribute significantly to that
burden of inflammation. So anti inflammatory lifestyle focuses on things
(07:02):
that are under our control, because not everything is right
that we're exposed to in life, but it focuses on
things that we can adapt and change to lower that
systemic burden of inflammation. And to me, the biggies that
contribute to that are food, movement, stress, and sleep. And
this is where science helps us biohack ourselves to optimize
(07:24):
these areas and understand how to make each of these
broad areas as anti inflammatory as possible.
Speaker 2 (07:31):
Love that and you've connected a lot of dots there.
So I want to take us into the world of
pain for a moment, because you know, somebody who is
in chronic pain, their brain is functioning a little bit
differently once pain settles in, so some circuits are bypassed,
others are accentuated. So people interact with even information a
(07:54):
little bit differently when it's through the filter of pain.
So I imagine that makes your job of teeing up
the idea of an anti inflammatory lifestyle as an important
component of their pain management somewhat challenging. So how do
you introduce this to your chronic pain patients?
Speaker 3 (08:13):
Yeah, I think I always start where the patients are
by validating their frustration with, you know, what they've been
through the medical system, how they've been treated in it.
I mean, most patients who end up in sort of
a university affiliated academics specialized chronic pain clinic have felt
(08:33):
at some point dismissed, disbelieved, demeaned by providers. And I think,
you know, our Western system does support the idea that
if our treatments, medications, injections, surgeries don't resolve all of
your problems, sort of we've done everything we can in
our toolkit and now it just becomes a you problem,
(08:54):
meaning the patient. So a lot of patients almost feel blamed,
like they're somehow at fault by not resolving their condition
with sort of you know, our available treatments. But many
patients come to me thinking that there must be a
relationship between their pain and some of the other symptoms
and comorbid diseases. But they never really had this idea
(09:16):
of root causes validated, but they had some kind of
gut sense. In fact, some patients now come to me
saying they think they have an inflammation problem. Oh my god,
I love it. I can't tell you. But next I
explain this kind of root cause idea using the analogy
of an iceberg poking out of the water. So I
(09:39):
tell them the western approach targets the tip of that
iceberg that you can see outside of the water, but
it often ignores the vast ice underneath the surface. And
I tell the integrative approach where that is seeking to
kind of create resilience and works from underneath the water
to chip away at that large underneath portion, because gets,
what if we can take care of that, Yeah, the
(10:00):
tip of the iceberg won't be supported by anything and
it just disappears on its own. So that's kind of
how I introduce it to patients.
Speaker 1 (10:06):
Love it.
Speaker 2 (10:07):
I love that metaphor. It makes a lot of sense
and I think is very true. So let's chip away
at the iceberg. You know, one of the things that
is under the water, there is stress. I mean for sure,
chronic stress chronic inflammation are joined at the hip, so
to speak. And so I'm wondering if you could dive
into that connection a little bit and then talk maybe
(10:29):
about some of the ways that you help your patients
to manage stress.
Speaker 3 (10:34):
Yeah, oh, you are speaking my love language. I love
talking about the stress response. And I can't tell you
how impressed I have been in the vast clinical connection
I see between people with chronically elevated stress responses and
in particular those who have experienced adversity during childhood. I
(10:56):
think there is a giant link, and that link is
through the autonomic nervous system. When the sympathetic and parasympathetic
nervous system are not balanced and the sympathetic is chronically activated,
we know that the mind and body are connected, and
so that creates its own cascade of inflammatory chemicals and
(11:16):
that inflammatory soup. Plus the impact the sympathetic nervous system
has on the brain's perception of pain. It's just this
one two punch that makes the experience of pain much worse.
In my view, I would agree. And so for tools,
what do I do? So you know, we're not so
(11:37):
advanced with precision medicine, yet that we can look at
someone's genetics and determine which approach to augmenting parasympathetic tone
will work best or be preferred by the patient. I mean,
maybe one day that would be amazing. However, my goal
is to give a small range of tools for patients
to explore. I start with the basics. Lower deeper breathing.
(12:01):
We know that activates the parasympathetic tone either four seven
eight breath, a box breathing. I also like a technique
taught by James Gordon, who is a trauma psychiatrist who
heads the Center for Mind Body Medicine in Washington, DC.
He teaches a technique called shaking and dancing, and I
find that great for kind of moving some that stuck energy.
(12:25):
You know, of people's past, things that have happened to
them in a way that other things don't. Next, I
like to add something objective, So here's where we get
a little more scientific. Stress in the autonomic nervous system
can be a bit nebulous when we're talking about it
is it's something you can't see. However, you know, we're
(12:45):
a society that likes data. Kind of that's prove it
to me idea. And so for reducing stress, what we
want to know with what is whatever intervention we're taking
the time out of our day to do, whether that's
actually making an impact or a change on our nervous system.
So I want something that definitively tells me that piece
(13:07):
of information, and I for that, I like to use
heart rate variability. And so you know, when I was
taught an EKG, it was like, if it's a normal
sinus rhythm, that there's like a metronome, like your heart
beat's going to beat one beat every second and it's
you know, really regular. But actually that's not true. While
(13:28):
one beat maybe one second, the next one might be
point nine to six seconds, and then one point oh
four seconds, and then point eight six seconds and then
one point two to three seconds. So there's a little
variability between each heart beat, and that variability is completely
under the control of the autonomic nervous system. So we
(13:49):
can use that when we're doing, say a breathing exercise.
We can track that by different wearable devices nowadays, to
see if our system is actually shifting from a sympathetic
to parasympathetic dominance. That's where I start that is definitely
not you know, a complete toolkit for sort of stress management.
But that's where I start with patients.
Speaker 2 (14:11):
Yeah, it's great. I mean I love the combination of
things that just we know reset and can shift somebody's
perspective very quickly, for example, breathing. And then I think
that biofeedback type of technique with heart rate variability and
all the wearables that people have is really helpful because
that's where it gets very individualized. What works for one
(14:34):
person may not work as well for somebody else, so
they can kind of adjust and figure out what their
secret sauce is in their pain management or their stress management.
Speaking of which I have a question for you. Do
you think that it's possible for somebody who's been in
chronic pain to get out of chronic pain without addressing stress?
Speaker 3 (14:58):
You know, I think pain is complex and it takes
a many faceted approach to chip away at the entire
picture of contributors that create this burden of inflammation and
that erode resilience. Look, if you know, if it were
a simple pain, then simple interventions, you know, even just
the passage of time would have cured it and patients
(15:20):
wouldn't bother to wait the six to eight month waiting
list just to get into our university pain clin clinic
and stress is a relative term, right. If a person
has faced adversity since childhood, they grew up, for example,
with an alcoholic parent, with divorce, with neglect, with abuse,
they now have they have developed olympic strength in their
(15:40):
sympathetic nervous system and that will contribute to that picture
adversely contributing to their health in a number of ways
over time. So you know, it's a little bit of
a it depends.
Speaker 2 (15:53):
Yeah, fair, I mean, that's that's a reasonable answer for sure.
And I think actually kind of is a hopeful message
because one of the things I've noticed and people who
are in chronic pain is that there's a bit of
hopelessness that can sneak in and that itself can be
a cause of stress. So I think just the recognition
that the path for everybody out of that place is
(16:15):
quite different, and as you said, multifactorial, which means there's
a lot of options, a lot of ways, a lot
of levers that can be pulled along the way, one
of which is group visits. And I'm really interested to
hear why you use this model of care in your
pain management clinic.
Speaker 3 (16:33):
Oh yeah, I'm loving it. So the data behind group
medical visits or shared medical appointments is the other name
that they're called, is positive on a number of fronts.
Not only does it decrease sort of wait times, it
increases access to a provider for an extended period of time.
These you know, visits are ninety minutes two hours with
(16:56):
a group of patients, and so it's increasing access to
care and education can be done in this format that
all patients need. You know, they are doing group medical
visits for patients with diabetes, patients with hypertension, you know,
all sorts of different things. Now in addition, pure support
that they can get through this interaction with each other,
(17:17):
with the patients with each other has been shown to
benefit those in the group. So I do it for
all of those reasons. But also I'm in the operating
room most of the time and in a pain clinic
one day a week, so I can get this information
to many more patients in need if I talk to
them in groups. And the great to me is we're
such a specialty clinic that they already have a medical
(17:39):
team in place for all of their individualized Western management
of their pain and comorbidity. So I get to focus
on adding these integrative elements and this integrative information, and you.
Speaker 2 (17:51):
Know, I think that it's pain is also tends to
be isolating for the person who's in pain. So I
think just being in a group with the other people
who are kind of dealing with suffering with pain can
be itself somewhat healing. Just knowing it out alone.
Speaker 3 (18:08):
Yeah, it can be incredibly validating that they are not
the only one they're and knowing other people or sort
of struggling and troubleshooting the same things they are.
Speaker 2 (18:16):
Yeah. Okay, So one of your group visits, you have,
you know, topics that you cover in these visits, and
one of them is about diet and specifically kind of
I guess, well, you mentioned anti inflammatory lifestyle, but I
think a big component of that is diet. So can
you just talk a little bit about the nutritional component
(18:39):
of the anti inflammatory lifestyle.
Speaker 3 (18:42):
Absolutely, I think it is easy to say you need
to eat healthy. However, you know, I think in this journey,
understanding the why, going back to inflammation and how foods
contribute in an ongoing fashion to inflammation is key. You know,
I all my patients kind of upfront jokingly, I'm going
(19:02):
to take all the joy out of their life and eating.
It's in jest, but you know, in truth, we do
delve into foods and how they can hit the reward
centers of the brain, and how for patients and chronic
pain they don't get many things that make them feel
good anymore, and sometimes food is the only thing that
gives them pleasure. We know, foods like sugar hit the
(19:23):
reward and the addiction pathways of the brain hard, and
I go into the science of that. I even talk
about animal studies that compare choices of mice or for
sugar sweetened beverages versus cocaine, and how sugar is likened
to the addiction potential of you know, something like cocaine,
and I talk about how our food industry doesn't have
(19:45):
their best interest in mind. You know, they may be
hiring food chemists to add ingredients to food products that
hit the reward centers of the brain, so we as
consumers want more and more of it. I mean that
helps the bottom line of manufacturers. So next, after all
the science, then we get into the weeds about Okay,
(20:06):
how do we actually make this happen, you know. I
tell people, Look, this is one problem that could get
easier if you have Oprah money and you can just
instruct your personal home chef to have anti inflammatory meals
and snacks available all the time. Great, do that, But
for the rest of us, we really need to sort
of talk about strategies, hacks, grab and go options, cheap options,
(20:29):
backup options, backup to backup options when you're really stressed
and tired and overworked. So we've spent a lot of
time sharing information, question and answers about how to make
sort of an anti inflammatory diet doable. And then I
also dive besides sort of this whole food you know,
anti inflammatory eating, then I really dive into glycemic control
(20:53):
because I think between those two things, talking about whole
food options, glycemic control, I think that is really the
powerhouse of creating sort of your internal ideal pharmacy, your
chemical soup on the inside for building health and helping
resolve disease.
Speaker 2 (21:10):
Love that love how you've really drilled it down, and
you clearly have lots of strategies that you can share
that will make this workable for anybody wherever they're at,
which is amazing. So can you share an anecdote for
your practice that just gives us a little bit of
an idea of what can happen to somebody when they
engage with some of these strategies.
Speaker 3 (21:32):
Yeah. Sure. In fact, my first sort of integrative clinic
experience that I was working with was cancer patients. But
guess what. Cancer patients have pain as well, whether it's
related to their cancer or not related to their cancer,
they have both. But I worked with metastatic breast cancer
women mostly, and they're an amazing population who are seeking
(21:56):
information like crazy and so interesting in doing whatever they
can to help themselves and skew things in their favor.
So in my cancer population, they would hear this information
about anti inflammatory whole food's diet and guess what the
next day done. They were doing it, They were walking
that walk. They were so motivated, and guess what they
(22:19):
would come back to me. And I think my chronic
pain patients here hate this because almost as an aside,
they would be like, oh, by the way that pain
that I was talking about last time, by the way
it's gone. So it was so interestingly, you know, it's
incredibly impressive at how it's almost I tell them it's
(22:39):
annoyingly impressive how well even just anti inflammatory eating works
to lower pain signals or in some cases eliminate them
at all.
Speaker 2 (22:50):
But this is amazing. I just want to pause you
for a second and just stress what you're saying, because,
like in seemingly intractable cases of pain life, like you
mentioned with people who have cancer, sometimes even the pains
coming from literally tumors pressing on nerves, which in the
medical world is considered very difficult pain to address. Even
(23:12):
in those patients, I've seen a combination of strategies that
their physician provides along with diet, stress management, all the
things you've been talking about. It's only when those things
are combined that the effect is felt. So it's really
I mean, these things sound very sort of nice, you know,
it sounds great, but it is so impactful.
Speaker 3 (23:35):
It is it is, and it's a lot of work
we're asking people to do. And so that's why I'm
appreciating more and more this, you know, constant connecting with
patients regularly during the group medical visits so that they
can all kind of share this, because it is we're
asking them to change a lot of habits and a
lot of things on a lot of different fronts, and
that's not always easy, right exactly.
Speaker 2 (23:55):
So what do you think the barrier is in kind
of getting this information into the Western mindset? I mean,
this is not rocket science, there's data behind it. Why
is it so difficult for patients to hear this information?
Speaker 3 (24:11):
Yeah, I think the way medical providers are reimbursed by
insurance and insurance companies, time with patients isn't valued. Hearing
more than one patient complaint isn't valued. So we try
and chop up all the little symptoms they're experiencing, you know,
this little tip of the iceberg, all the symptoms, and
(24:31):
we divide those up into all the specialties. So they
maybe go into a sleep clinic for their sleep disruption,
a headache clinic for their headache, the neurosurgeon's office for
their spying, pain rehab medicine, pain medicine, and you know,
and indocrinologists for their diabetes, maybe their primary care doctor
for their ozempic. But no one's stepping back to the
bigger picture and addressing this vast ice under the water,
(24:55):
so the real cause in the first place. So we're
just not doing patients justice this way, and we're not
getting to know our patients in that model, knowing their stressors,
how they live their lives, to be able to make
these valuable and kind of complete recommendations.
Speaker 2 (25:11):
Yep, that makes sense to me. Okay, So in our
last few minutes, what final thoughts would you like to
leave our listeners with?
Speaker 3 (25:22):
Yeah, you mentioned hope upfront, and I like to give
my patients hope. You know, they don't have to give
their autonomy to doctors and health providers. They have the
power in their own hands to be proactive and make
a real difference in their own outcomes. Too many patients
come discourage after seeing ten fifteen different providers about their
(25:47):
pain and not finding answers or relief. So one of
my favorite slides when I speak at conferences or to
providers and patients is this pigraph with the heading where
does health come from? And this comes from a study
that showed about ten to fifteen percent of our health
comes from medical intervention. Now I will not argue that
(26:07):
that is not an important ten to fifteen percent, but
that leaves the other eighty five ninety percent comes from
a combination of these life daily habits. Do you smoke,
do you drink? Are you sleeping, stress, exercise, food, and
socioeconomic factors, so there is a big chunk that the
patients can have autonomy over.
Speaker 2 (26:28):
Yeah. Absolutely, fantastic, love it well as usual. You are
fantastic as well, and this has been a great show
and I really want to thank you for taking the
time to join me on five to five Live. So
where can our listeners find more about you and your work?
And if they're lucky enough to be in the state
(26:48):
of Washington, how can they find your clinic? Any websites
you'd like to share?
Speaker 3 (26:54):
Yeah, I mean, sadly, I'm not the biggest one out there.
I've been thinking about, you know, create my own website
just so I can share some of this information on
a bigger scale. I please. I'm at the University of
Washington in the Center for Pain Relief, so I'm happy
to see anybody there.
Speaker 2 (27:15):
Yeah, okay, well that sounds good. I'll look forward to
your website. I'm going to hold you to it. And
that wraps up this episode of five to Thrive Live.
We thank our sponsors pro Thrivers Wellness, Sleep Formula, Cetria Glutathion,
the superior glutathion to support liver and immune health cognizance
andicoline to help enhance memory, focus and attention. And doctor
(27:39):
Ohira is award winning Shelfsdale Probiotic and thank you again
Rosie for your wonderful insights. Thank you all listeners for
joining us. May you experience joy, laughter and love. It's
time to thrive everyone, have a great night.
Speaker 3 (28:23):
Sh
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
Always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:14):
And Hello, Welcome to five to Thrive Live, a podcast
(00:44):
about thriving for those who have been affected by cancer
and chronic disease. I'm doctor Lisau Schuler and I co
host with my good friend and colleague, Carolyn Gazilla. You
can find all of our past show podcasts on every
major podcast outlet, and you can also find schedule of
the shows on I thriveplan dot com. Well, I'm very
(01:05):
excited because this show I will be talking to doctor
Roseanne Sheinberg about how and why she incorporates anti inflammatory
lifestyle recommendations into her pain management practice. Doctor, I'm so
used to calling you Rosie, but I will try to
be professional here. Doctor Roseanne Sheinberg is an Associate professor
(01:26):
of anisysiology and pain Medicine at the University of Washington.
Her areas of clinical expertise include cardiac anisysiology, perry operative
trans esophagial echo cardiography and integrative Perry operative and pain management.
And prior to receiving her undergraduate degree in biochemistry from
(01:48):
the University of California Davis, she was a member of
the Jeoffrey Ballet in New York City, and she toured
as a member of the Phantom of the Opera and
danced for Carnival cruise lines. So she's a renaissance woman
to be sure. She completed her medical training at the
Johns Hopkins and then pursued a fellowship in integrated medicine
through the Andrew Wild Program of Integrative Medicine at the
(02:10):
University of Arizona. And she's also trained in medical acupuncture.
And I've had the great honor and privilege of knowing
doctor Sheinberg for some time. She's a delight and welcome
to the show.
Speaker 3 (02:23):
Thank you so much. I'm thrilled to be here.
Speaker 2 (02:26):
Well, good, We're going to have a very interesting conversation.
But before we start that, I do want to thank
our sponsors that make this conversation possible. So we have Cetria,
a patented form of glutathione which is clinically proven to
raise blood glutathione levels, and goone is a master antioxidant,
so that's one of the body's primary defenses against free
(02:49):
radicals and it also helps respiratory health and you can
learn more at Cetria Glutathion dot com. We also have
Cognizance citicoline, which is nature's way of key being the
brain firing on all cylinders. So if you want to
enhance your brain function, memory, focus, and attention, look for
Cognizant on the label or you can learn more at
(03:09):
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(03:51):
I call you Rosie?
Speaker 3 (03:52):
Oh? Absolutely.
Speaker 2 (03:54):
Oh good well, Rosie, it's a delight to talk with
you again. And you know, pain, pain is a big deal.
So many people suffer with pain, and I think it's
probably one of the highest or most prevalent unmet needs
for people with other health conditions because it accompanies so
many health conditions, and even if their condition gets treated appropriately,
(04:17):
they can still be left with pain. And of course
pain is part of a lot of illnesses. So what
is chronic pain? Why does it happen?
Speaker 3 (04:27):
You know, the what is a lot easier to answer
than the why. But you know, in essence, acute pain
chronic pain, that transition happens somewhere around three months, and
so that becomes the definition. It's kind of pain that
is stuck around longer than three months, which means longer
than we would have suspected for some kind of process
to heal itself. But you know, they just define it
(04:51):
as it's some constant sometimes intermittent, but it interferes with
daily life, has a lot of causes. The why is
a little harder, right, you know, I think we are
seeing a rise in most chronic illnesses, a lot of
which I think is preventable. I mean, all the way
(05:11):
from obesity rising in children to diabetes, pre diabetes, cancer,
autoimmune issues. I think modern life has really just evolved
to not supporting kind of resilience building at its basis.
Our plates are too full, humans who are busy, stressed,
not sleeping enough, We don't have time to cook an exercise,
(05:31):
not connecting in meaningful ways. That's just modern life. And
I think that when we're vulnerable, then we become more
vulnerable to things like chronic pain and other diseases.
Speaker 2 (05:41):
Very interesting, I've never heard it described quite like that.
So in some sense, you're suggesting that chronic pain is
a consequence of, or a symptom of modern life.
Speaker 3 (05:54):
You know, I think modern life predisposes us to illnesses,
issues that we may not have faced before, or at
worsens things that we may have faced to a small degree.
Speaker 2 (06:06):
Yeah. So the opposite then would be a what we
call anti inflammatory life. So what does that mean to you?
Speaker 1 (06:17):
Yeah?
Speaker 3 (06:18):
To me, you know, I think this goes back to
kind of this whole origins of this sort of field
of what has become now integrated medicine. I mean, we're
looking at root causes and at a as a primary motive.
We're seeking to support, build, enhance health and resilience. And
I think we're finding a common sort of theme or
(06:39):
root cause underneath a lot of our chronic illnesses in
this country. Underneath heart disease, cancer, immune issues, chronic pain,
and I think that is chronic systemic low grade inflammation,
and how we live our lives contribute significantly to that
burden of inflammation. So anti inflammatory lifestyle focuses on things
(07:02):
that are under our control, because not everything is right
that we're exposed to in life, but it focuses on
things that we can adapt and change to lower that
systemic burden of inflammation. And to me, the biggies that
contribute to that are food, movement, stress, and sleep. And
this is where science helps us biohack ourselves to optimize
(07:24):
these areas and understand how to make each of these
broad areas as anti inflammatory as possible.
Speaker 2 (07:31):
Love that and you've connected a lot of dots there.
So I want to take us into the world of
pain for a moment, because you know, somebody who is
in chronic pain, their brain is functioning a little bit
differently once pain settles in, so some circuits are bypassed,
others are accentuated. So people interact with even information a
(07:54):
little bit differently when it's through the filter of pain.
So I imagine that makes your job of teeing up
the idea of an anti inflammatory lifestyle as an important
component of their pain management somewhat challenging. So how do
you introduce this to your chronic pain patients?
Speaker 3 (08:13):
Yeah, I think I always start where the patients are
by validating their frustration with, you know, what they've been
through the medical system, how they've been treated in it.
I mean, most patients who end up in sort of
a university affiliated academics specialized chronic pain clinic have felt
(08:33):
at some point dismissed, disbelieved, demeaned by providers. And I think,
you know, our Western system does support the idea that
if our treatments, medications, injections, surgeries don't resolve all of
your problems, sort of we've done everything we can in
our toolkit and now it just becomes a you problem,
(08:54):
meaning the patient. So a lot of patients almost feel blamed,
like they're somehow at fault by not resolving their condition
with sort of you know, our available treatments. But many
patients come to me thinking that there must be a
relationship between their pain and some of the other symptoms
and comorbid diseases. But they never really had this idea
(09:16):
of root causes validated, but they had some kind of
gut sense. In fact, some patients now come to me
saying they think they have an inflammation problem. Oh my god,
I love it. I can't tell you. But next I
explain this kind of root cause idea using the analogy
of an iceberg poking out of the water. So I
(09:39):
tell them the western approach targets the tip of that
iceberg that you can see outside of the water, but
it often ignores the vast ice underneath the surface. And
I tell the integrative approach where that is seeking to
kind of create resilience and works from underneath the water
to chip away at that large underneath portion, because gets,
what if we can take care of that, Yeah, the
(10:00):
tip of the iceberg won't be supported by anything and
it just disappears on its own. So that's kind of
how I introduce it to patients.
Speaker 1 (10:06):
Love it.
Speaker 2 (10:07):
I love that metaphor. It makes a lot of sense
and I think is very true. So let's chip away
at the iceberg. You know, one of the things that
is under the water, there is stress. I mean for sure,
chronic stress chronic inflammation are joined at the hip, so
to speak. And so I'm wondering if you could dive
into that connection a little bit and then talk maybe
(10:29):
about some of the ways that you help your patients
to manage stress.
Speaker 3 (10:34):
Yeah, oh, you are speaking my love language. I love
talking about the stress response. And I can't tell you
how impressed I have been in the vast clinical connection
I see between people with chronically elevated stress responses and
in particular those who have experienced adversity during childhood. I
(10:56):
think there is a giant link, and that link is
through the autonomic nervous system. When the sympathetic and parasympathetic
nervous system are not balanced and the sympathetic is chronically activated,
we know that the mind and body are connected, and
so that creates its own cascade of inflammatory chemicals and
(11:16):
that inflammatory soup. Plus the impact the sympathetic nervous system
has on the brain's perception of pain. It's just this
one two punch that makes the experience of pain much worse.
In my view, I would agree. And so for tools,
what do I do? So you know, we're not so
(11:37):
advanced with precision medicine, yet that we can look at
someone's genetics and determine which approach to augmenting parasympathetic tone
will work best or be preferred by the patient. I mean,
maybe one day that would be amazing. However, my goal
is to give a small range of tools for patients
to explore. I start with the basics. Lower deeper breathing.
(12:01):
We know that activates the parasympathetic tone either four seven
eight breath, a box breathing. I also like a technique
taught by James Gordon, who is a trauma psychiatrist who
heads the Center for Mind Body Medicine in Washington, DC.
He teaches a technique called shaking and dancing, and I
find that great for kind of moving some that stuck energy.
(12:25):
You know, of people's past, things that have happened to
them in a way that other things don't. Next, I
like to add something objective, So here's where we get
a little more scientific. Stress in the autonomic nervous system
can be a bit nebulous when we're talking about it
is it's something you can't see. However, you know, we're
(12:45):
a society that likes data. Kind of that's prove it
to me idea. And so for reducing stress, what we
want to know with what is whatever intervention we're taking
the time out of our day to do, whether that's
actually making an impact or a change on our nervous system.
So I want something that definitively tells me that piece
(13:07):
of information, and I for that, I like to use
heart rate variability. And so you know, when I was
taught an EKG, it was like, if it's a normal
sinus rhythm, that there's like a metronome, like your heart
beat's going to beat one beat every second and it's
you know, really regular. But actually that's not true. While
(13:28):
one beat maybe one second, the next one might be
point nine to six seconds, and then one point oh
four seconds, and then point eight six seconds and then
one point two to three seconds. So there's a little
variability between each heart beat, and that variability is completely
under the control of the autonomic nervous system. So we
(13:49):
can use that when we're doing, say a breathing exercise.
We can track that by different wearable devices nowadays, to
see if our system is actually shifting from a sympathetic
to parasympathetic dominance. That's where I start that is definitely
not you know, a complete toolkit for sort of stress management.
But that's where I start with patients.
Speaker 2 (14:11):
Yeah, it's great. I mean I love the combination of
things that just we know reset and can shift somebody's
perspective very quickly, for example, breathing. And then I think
that biofeedback type of technique with heart rate variability and
all the wearables that people have is really helpful because
that's where it gets very individualized. What works for one
(14:34):
person may not work as well for somebody else, so
they can kind of adjust and figure out what their
secret sauce is in their pain management or their stress management.
Speaking of which I have a question for you. Do
you think that it's possible for somebody who's been in
chronic pain to get out of chronic pain without addressing stress?
Speaker 3 (14:58):
You know, I think pain is complex and it takes
a many faceted approach to chip away at the entire
picture of contributors that create this burden of inflammation and
that erode resilience. Look, if you know, if it were
a simple pain, then simple interventions, you know, even just
the passage of time would have cured it and patients
(15:20):
wouldn't bother to wait the six to eight month waiting
list just to get into our university pain clin clinic
and stress is a relative term, right. If a person
has faced adversity since childhood, they grew up, for example,
with an alcoholic parent, with divorce, with neglect, with abuse,
they now have they have developed olympic strength in their
(15:40):
sympathetic nervous system and that will contribute to that picture
adversely contributing to their health in a number of ways
over time. So you know, it's a little bit of
a it depends.
Speaker 2 (15:53):
Yeah, fair, I mean, that's that's a reasonable answer for sure.
And I think actually kind of is a hopeful message
because one of the things I've noticed and people who
are in chronic pain is that there's a bit of
hopelessness that can sneak in and that itself can be
a cause of stress. So I think just the recognition
that the path for everybody out of that place is
(16:15):
quite different, and as you said, multifactorial, which means there's
a lot of options, a lot of ways, a lot
of levers that can be pulled along the way, one
of which is group visits. And I'm really interested to
hear why you use this model of care in your
pain management clinic.
Speaker 3 (16:33):
Oh yeah, I'm loving it. So the data behind group
medical visits or shared medical appointments is the other name
that they're called, is positive on a number of fronts.
Not only does it decrease sort of wait times, it
increases access to a provider for an extended period of time.
These you know, visits are ninety minutes two hours with
(16:56):
a group of patients, and so it's increasing access to
care and education can be done in this format that
all patients need. You know, they are doing group medical
visits for patients with diabetes, patients with hypertension, you know,
all sorts of different things. Now in addition, pure support
that they can get through this interaction with each other,
(17:17):
with the patients with each other has been shown to
benefit those in the group. So I do it for
all of those reasons. But also I'm in the operating
room most of the time and in a pain clinic
one day a week, so I can get this information
to many more patients in need if I talk to
them in groups. And the great to me is we're
such a specialty clinic that they already have a medical
(17:39):
team in place for all of their individualized Western management
of their pain and comorbidity. So I get to focus
on adding these integrative elements and this integrative information, and you.
Speaker 2 (17:51):
Know, I think that it's pain is also tends to
be isolating for the person who's in pain. So I
think just being in a group with the other people
who are kind of dealing with suffering with pain can
be itself somewhat healing. Just knowing it out alone.
Speaker 3 (18:08):
Yeah, it can be incredibly validating that they are not
the only one they're and knowing other people or sort
of struggling and troubleshooting the same things they are.
Speaker 2 (18:16):
Yeah. Okay, So one of your group visits, you have,
you know, topics that you cover in these visits, and
one of them is about diet and specifically kind of
I guess, well, you mentioned anti inflammatory lifestyle, but I
think a big component of that is diet. So can
you just talk a little bit about the nutritional component
(18:39):
of the anti inflammatory lifestyle.
Speaker 3 (18:42):
Absolutely, I think it is easy to say you need
to eat healthy. However, you know, I think in this journey,
understanding the why, going back to inflammation and how foods
contribute in an ongoing fashion to inflammation is key. You know,
I all my patients kind of upfront jokingly, I'm going
(19:02):
to take all the joy out of their life and eating.
It's in jest, but you know, in truth, we do
delve into foods and how they can hit the reward
centers of the brain, and how for patients and chronic
pain they don't get many things that make them feel
good anymore, and sometimes food is the only thing that
gives them pleasure. We know, foods like sugar hit the
(19:23):
reward and the addiction pathways of the brain hard, and
I go into the science of that. I even talk
about animal studies that compare choices of mice or for
sugar sweetened beverages versus cocaine, and how sugar is likened
to the addiction potential of you know, something like cocaine,
and I talk about how our food industry doesn't have
(19:45):
their best interest in mind. You know, they may be
hiring food chemists to add ingredients to food products that
hit the reward centers of the brain, so we as
consumers want more and more of it. I mean that
helps the bottom line of manufacturers. So next, after all
the science, then we get into the weeds about Okay,
(20:06):
how do we actually make this happen, you know. I
tell people, Look, this is one problem that could get
easier if you have Oprah money and you can just
instruct your personal home chef to have anti inflammatory meals
and snacks available all the time. Great, do that, But
for the rest of us, we really need to sort
of talk about strategies, hacks, grab and go options, cheap options,
(20:29):
backup options, backup to backup options when you're really stressed
and tired and overworked. So we've spent a lot of
time sharing information, question and answers about how to make
sort of an anti inflammatory diet doable. And then I
also dive besides sort of this whole food you know,
anti inflammatory eating, then I really dive into glycemic control
(20:53):
because I think between those two things, talking about whole
food options, glycemic control, I think that is really the
powerhouse of creating sort of your internal ideal pharmacy, your
chemical soup on the inside for building health and helping
resolve disease.
Speaker 2 (21:10):
Love that love how you've really drilled it down, and
you clearly have lots of strategies that you can share
that will make this workable for anybody wherever they're at,
which is amazing. So can you share an anecdote for
your practice that just gives us a little bit of
an idea of what can happen to somebody when they
engage with some of these strategies.
Speaker 3 (21:32):
Yeah. Sure. In fact, my first sort of integrative clinic
experience that I was working with was cancer patients. But
guess what. Cancer patients have pain as well, whether it's
related to their cancer or not related to their cancer,
they have both. But I worked with metastatic breast cancer
women mostly, and they're an amazing population who are seeking
(21:56):
information like crazy and so interesting in doing whatever they
can to help themselves and skew things in their favor.
So in my cancer population, they would hear this information
about anti inflammatory whole food's diet and guess what the
next day done. They were doing it, They were walking
that walk. They were so motivated, and guess what they
(22:19):
would come back to me. And I think my chronic
pain patients here hate this because almost as an aside,
they would be like, oh, by the way that pain
that I was talking about last time, by the way
it's gone. So it was so interestingly, you know, it's
incredibly impressive at how it's almost I tell them it's
(22:39):
annoyingly impressive how well even just anti inflammatory eating works
to lower pain signals or in some cases eliminate them
at all.
Speaker 2 (22:50):
But this is amazing. I just want to pause you
for a second and just stress what you're saying, because,
like in seemingly intractable cases of pain life, like you
mentioned with people who have cancer, sometimes even the pains
coming from literally tumors pressing on nerves, which in the
medical world is considered very difficult pain to address. Even
(23:12):
in those patients, I've seen a combination of strategies that
their physician provides along with diet, stress management, all the
things you've been talking about. It's only when those things
are combined that the effect is felt. So it's really
I mean, these things sound very sort of nice, you know,
it sounds great, but it is so impactful.
Speaker 3 (23:35):
It is it is, and it's a lot of work
we're asking people to do. And so that's why I'm
appreciating more and more this, you know, constant connecting with
patients regularly during the group medical visits so that they
can all kind of share this, because it is we're
asking them to change a lot of habits and a
lot of things on a lot of different fronts, and
that's not always easy, right exactly.
Speaker 2 (23:55):
So what do you think the barrier is in kind
of getting this information into the Western mindset? I mean,
this is not rocket science, there's data behind it. Why
is it so difficult for patients to hear this information?
Speaker 3 (24:11):
Yeah, I think the way medical providers are reimbursed by
insurance and insurance companies, time with patients isn't valued. Hearing
more than one patient complaint isn't valued. So we try
and chop up all the little symptoms they're experiencing, you know,
this little tip of the iceberg, all the symptoms, and
(24:31):
we divide those up into all the specialties. So they
maybe go into a sleep clinic for their sleep disruption,
a headache clinic for their headache, the neurosurgeon's office for
their spying, pain rehab medicine, pain medicine, and you know,
and indocrinologists for their diabetes, maybe their primary care doctor
for their ozempic. But no one's stepping back to the
bigger picture and addressing this vast ice under the water,
(24:55):
so the real cause in the first place. So we're
just not doing patients justice this way, and we're not
getting to know our patients in that model, knowing their stressors,
how they live their lives, to be able to make
these valuable and kind of complete recommendations.
Speaker 2 (25:11):
Yep, that makes sense to me. Okay, So in our
last few minutes, what final thoughts would you like to
leave our listeners with?
Speaker 3 (25:22):
Yeah, you mentioned hope upfront, and I like to give
my patients hope. You know, they don't have to give
their autonomy to doctors and health providers. They have the
power in their own hands to be proactive and make
a real difference in their own outcomes. Too many patients
come discourage after seeing ten fifteen different providers about their
(25:47):
pain and not finding answers or relief. So one of
my favorite slides when I speak at conferences or to
providers and patients is this pigraph with the heading where
does health come from? And this comes from a study
that showed about ten to fifteen percent of our health
comes from medical intervention. Now I will not argue that
(26:07):
that is not an important ten to fifteen percent, but
that leaves the other eighty five ninety percent comes from
a combination of these life daily habits. Do you smoke,
do you drink? Are you sleeping, stress, exercise, food, and
socioeconomic factors, so there is a big chunk that the
patients can have autonomy over.
Speaker 2 (26:28):
Yeah. Absolutely, fantastic, love it well as usual. You are
fantastic as well, and this has been a great show
and I really want to thank you for taking the
time to join me on five to five Live. So
where can our listeners find more about you and your work?
And if they're lucky enough to be in the state
(26:48):
of Washington, how can they find your clinic? Any websites
you'd like to share?
Speaker 3 (26:54):
Yeah, I mean, sadly, I'm not the biggest one out there.
I've been thinking about, you know, create my own website
just so I can share some of this information on
a bigger scale. I please. I'm at the University of
Washington in the Center for Pain Relief, so I'm happy
to see anybody there.
Speaker 2 (27:15):
Yeah, okay, well that sounds good. I'll look forward to
your website. I'm going to hold you to it. And
that wraps up this episode of five to Thrive Live.
We thank our sponsors pro Thrivers Wellness, Sleep Formula, Cetria Glutathion,
the superior glutathion to support liver and immune health cognizance
andicoline to help enhance memory, focus and attention. And doctor
(27:39):
Ohira is award winning Shelfsdale Probiotic and thank you again
Rosie for your wonderful insights. Thank you all listeners for
joining us. May you experience joy, laughter and love. It's
time to thrive everyone, have a great night.
Speaker 3 (28:23):
Sh
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