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It starts with being seen like if someone says they feel a pain, and how many people have gone and been dismissed instead of giving that one-on-one, hands-on care.
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There's a lot of systemic issues, but when you just keep that patient forward, you can give them the care they need.
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If you want to break the mold of traditional pharmacy and healthcare, you are in the right place.
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Welcome to the Pivoting Pharmacy with Nutrigenomics podcast, part of the Pharmacy Podcast Network.
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Here's a little truth bomb.
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We're all unique, down to our DNA, so it's no wonder we react differently to the same medications, foods and environment.
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Here's a million dollar question how can you discover exactly what your body needs?
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How can you discover exactly what your body needs, which medication, what foods or supplements and which exercises are right for you?
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How can you manage chronic conditions like diabetes without more medications?
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How can you lose weight and keep it off?
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How do you tap into your genetic blueprint so you can stop surviving and start thriving in health and life?
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That is the question, and this podcast will give you the answer.
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I'm your host, Dr.
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Tamar Lawful, Doctor of Pharmacy.
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Let's pivot into genomics and bring healthcare to higher levels.
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Hello, welcome back to Pivoting Pharmacy with Nutrigenomics.
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I'm your host, Dr.
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Tamar Lawful, Doctor of Pharmacy and certified nutritional genomic specialist.
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Today's episode is one that I think so many of us need to hear, whether you're a provider, a patient or someone who's just tired of being told the only answer to pain is another pill.
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We're diving into the world of chronic pain, but from a completely fresh angle.
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We're going to explore what happens when you stop treating pain like a problem to numb and instead start listening to what the body's trying to say.
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Joining me today is someone who's made it his life's work to do just that Dr Jordan Barber.
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Dr Barber is a doctor of acupuncture and oriental medicine, a healthcare consultant and an educator with over 20 years of experience helping both patients and practitioners.
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He's a clinic partner, a former institutional review board chair and the upcoming author of Realigning Medicine, a book that speaks to the soul of every healthcare provider who's ever felt stuck in a system that doesn't match their values.
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Jordan's specialty reimagining in pain, especially chronic pain, through the lens of integrative and evidence-based care.
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He brings a deep understanding of the fascial system, trigger points, dry needling, biomechanics and beyond.
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But what makes him truly unique is his heart for helping others, both the people in pain and the clinicians treating them.
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So if you've ever felt like there has to be a better way to manage chronic pain, this episode is your sign.
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Listen in.
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Well, I would like to welcome Dr Jordan Barber to the show.
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Thank you so much for joining us on Pivoting Pharmacy with Nutrigenomics today.
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I'm super excited to speak with you.
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Likewise Now, jordan.
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Chronic pain.
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You know I want to talk about that.
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It carries so much weight for so many people.
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But before we dive into your reimagined approach to pain management, can you take us back to where it all started for you, you know, was there a specific patient, a moment or even a personal experience that made you realize that the current system needed a shakeup?
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There's multiple points.
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How far do you want to go back?
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Because I started in IT and went through 9-11 and had a complete change and I think that would be my first point of realizing just what psychological pain can do to a person.
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I was too young, I think, at that point to understand it, because I had no clinical experience of systems engineer in IT, so it didn't really play out.
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But as I started seeing patients, over time I started seeing the weight of chronic pain.
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So it's not necessarily that one patient, although I can speak of a few but it's the weight of chronic pain not just on the patient but on family dynamics and social dynamics.
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Because when a person's under pain and pain comes in many different flavors, right, there's the actual perceived pain, but there could be emotional pain, it could be many other types of pain, but a person's not operating at their best.
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They may not be able to give the affection they need to their kids, they may not be able to be the best father or best mother, they may not perform well at work, which leads to all these other issues or, worse, they, you know, wind up into substance abuse or other things like that.
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So when we can't address chronic pain in its largest definition, it becomes a major issue.
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So it became something I'm very interested in.
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And then, secondarily, I've always been a very like hands-on person and pain is something very palpable that you could see change almost immediately, especially if someone comes in and their shoulder doesn't work or they can't lift their shoulder and next thing you know they can.
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Well, that's an immediate gratification.
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So for me that's like a dopaminergic win, so I get like really excited just from those things.
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So it's kind of a two phase thing.
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Whereas long chronic care, sometimes it takes a long time to see a person progress, but pain is very tangible.
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It is.
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It's very tangible.
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Now, when it comes to chronic pain, traditional medicine defaults to what pill should be given or what pill can I take.
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Now your approach.
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It goes way outside the box.
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Can you walk us through what it means to treat pain without relying on medication, what it means to treat pain without relying on medication.
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Yeah, you know, and first I I tend to be maybe a little different than people of my background, where I'm not anti-standard care.
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There's a time and place for everything.
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So the definition first is like if you're in acute pain, I think pharmacological approaches is the number one approach, right, get you out of pain immediately, interrupt the inflammatory cycle.
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But what is that long-term?
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Eventually you go to subacute and you wind up in a chronic pain.
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So that's where I feel integrative modalities shine.
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Having you know, as a background in Chinese medicine, you know my biases tend towards.
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Well, acupuncture is very good, which acupuncture is phenomenal, and the subset of it called dry needling, which is the treatment of trigger points, using acupuncture needles to release them and change their effect on the system.
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But you know, even larger, the therapeutic touch, manual therapies, craniosacral therapy, massage therapy, and that even falls into physical therapy, which is the standard of care you know, using all those to reduce and titrate down pharmacological approaches for the benefit of the patient and the benefit of society.
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That's kind of my overarching approach and I feel that working in care teams and collaboratively is the best way for patients and collaboratively is the best way for patients and that's kind of part of my message is to get integrative approaches that work, to be crossing the aisle, so to speak, with other practitioners, medical doctors etc.
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To raise awareness that there are alternatives for people, to titrate them down and to get them back to whatever normal life is.
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I don't like the word normal these days, but you know whatever's normal to them.
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Yeah, Exactly, Perception, perception of normal.
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Now I like that you said really working together with the team, because it takes you know that phrase it takes a village to raise a child.
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It's the same thing in healthcare it's not just one specialty, it's multiple for certain patients and if they can all work together, communicate together, so we can actually take care of that patient as a unit, that is the best welfare for the patient in general, that we can all work together.
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And I mean that's actually been the AMA's position.
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They put out that paper for systems-based medicine.
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Maybe it's a decade now, I don't remember.
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Of course, it very rare does the social worker get to talk to the neurologist, so there's really no communication between these two things.
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Right, and we can say that about everything.
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Right, it's not working in application and you see, the NIH's direction focus on the whole person health.
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Right, that being the new kind of view of what is health.
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It has to be, you know, a systemic approach, but I think it's just new branding looking at more integrative approaches of systems-based medicine.
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I just always, I think at the academic level we have great ideas, but in application and in hospital-based systems and everything else, it's very hard to change systems.
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And it's not that even people don't want to change it, it's usually just behemoths, right to be able to make change.
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Yeah, it is On paper.
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It sounds great, it's a great plan, but the healthcare system is so complex.
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So to get everybody on board to really execute what the plan is can be a challenge indeed.
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What the plan is can be a challenge indeed.
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And when we along the lines of having that connection, not just among the practitioners, but for the patient to feel a connection to their doctor or the person that's taking care of them I've heard you use the phrase redefining patient engagement and you know that feels so human and hopeful, but what does that actually look like in clinics?
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So this is something that we can have a thought of having on paper.
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We want to redefine patient engagement, but how do we actually execute that so that the patient can feel less like a case and more like a whole person in the pursuit of that healing process for them?
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So I mean I have complex answers for everything.
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I spend too much time thinking about these things because I think it's important.
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I have four integrative offices focused on pain and then I have a boutique clinic in Brooklyn where I reside.
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So I see it play out in many different things, both my insurance-based clinics and my cash-based clinic.
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But I like to use the word patient journey and I actually stole that the idea of journey from Apple when Steve Jobs was around, the idea that the.
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You know, if you remember when Apple was kind of exciting and you would go in there and everything was always like you felt special and when you got the new thing it was exciting, and in some ways it still plays out, but not as much.
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So when we talk about a patient journey, from the moment they hear about you to the moment they're discharged is the journey, and that means that every encounter, everything they hear about you right, every time that you know the, the front desk staff reaches out, should always be congruent with that message that you're planning on giving to that patient.
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If your message is positive and attentive, everything should be positive and attentive, including your online branding, your online messaging and everything else, because when that starts shifting and there's incongruencies and I write at length about congruencies in clinics there becomes these nonverbal, subtle, mixed messages that patients receive and the trust values go down.
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When trust goes down, compliancy goes down, right.
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So I think when we want to look at connecting with patients, we have to think about what connecting really means.
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It's not a transaction and medicine is very complex because it's not a standard.
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You go to the store and buy the widget, whatever that thing is, and then the transaction's done.
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You're affecting a person's life and when you think of that transaction lifecycle, if you want to stay in a business mindset, that transaction lifecycle is very long, which means that you have to keep that communication going and it has to be on brand.
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But my position always is if you come from a place of authenticity, you don't really have to worry about things being on brand, because it's going to be on brand and you can always apologize.
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Nothing ever goes right.
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I'm sure you know that, right.
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You know, like you know, someone's appointment goes off or something went wrong in the calendar or whatever.
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Nothing always goes right, but you're able to own up to it and it stays on brand, right?
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I?
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I think that message is missing.
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I used to teach practice management at graduate level.
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It's missing in all schools and in all disciplines because we're, you know, focused on jurisprudence and the basics that you get in practice management how not to lose your license but we don't actually think how do we care for patients, which is the act of practicing?
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Yeah, it definitely is.
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You're on point with that.
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The that patient journey, not just the authenticity that we as practitioners and healthcare providers need to to have with our patients that journey, that relationship that we're building with them, is continuous, is continuous.
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So we have to always lead with authenticity and in doing that, I know that makes them feel like they're being heard, they're being seen and not just another name on a paper or a number to be seen for 10, 15 minutes that day.
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So that makes a huge difference.
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You know, being heard and seen is like the number one thing for patients, and I mean when we're talking about chronic pain especially, you know it starts with being seen, like if someone says they feel a pain, and how many people have gone to a doctor of any discipline, integrated or otherwise, and been dismissed or got just average care?
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Or the insurance model in PT doesn't really allow PTs to flourish anymore, is they're?
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They're well-trained, but they're stuck seeing, you know, six people an hour and having assistants and aides do most of the work, instead of giving that one-on-one, hands-on care to be able to truly do a differential diagnosis and assessment and treatment.
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Because you know they're getting paid $20 a visit and you know you're in California or I'm in New York.
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The $20 doesn't go far, doesn't pay for even the electric bill for that hour, right, so it's.
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There's a lot of systemic issues, but when you just keep that patient forward and think about that journey entire time, especially when treating them for pain or anything else, you can hear what they're saying, you can give them the care they need or you can find a way of making sure that they get what they need, maybe because you're still stuck in an insurance model, but you can make sure that they're getting videos or other assistive things that they can reference to do at-home care or other stuff.
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We can still function in this model, but we have to think about the patient first, not just I got paid for the 15-minute modality, whatever that procedural code was, and that's it.
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Because that's why people don't get better.
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We don't pay attention to them, and it's part because the system forces us to think that way.
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That is so true.
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I agree with that and part of that as well.
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If the patient is feeling like that, that ties into their emotions, right, their stress levels, and many people when they have chronic pain they feel like it's a life sentence or that it's just purely physical.
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But I know you've talked about how pain can also sit in emotions.
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Yes, even those habits that they have, even those stress levels that can come, whether it's from doctor, they feel like they're not being heard or whatever's going on in their personal life.
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Can you share an example of how addressing someone's mental or emotional health can actually relieve that physical pain they have?
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Yeah.
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So I'll give you two.
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One just staying on the patient journey thing.
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You know, imagine a person is suffering, they're in pain and had a negative front office experience while waiting for you.
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That's going to increase cortisol, it's going to increase their stress hormones.
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They're going to put them more into a sympathetic state.
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The more sympathetic they are, or sympathetic locked, it's going to be more difficult to get them into a parasympathetic state which is going to cut down pain right off the bat.
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Additionally, there's been numerous studies, and you know, last week they were in my head and they've escaped me Now I would have been able to quote the statistics.
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But there is repeated over and over in the studies that people who are suffering from emotional pain have increased perceptions of physical pain.
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That's documented multiple, multiple ways.
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So we have that when we can reduce a person's mental and emotional pain, we then can get them closer to a parasympathetic state and we can begin to get them to begin to heal.
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It's very hard to make someone relax, to soften a muscle or to get someone to feel hope for the future when they're stuck in fight or flight.
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I mean, that's the crux of it, right, you know, for for acupuncture and dry kneeling it.
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You know it stimulates gaba.
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It works on the endocannabinoid system, um, you know it works on multiple, multiple pathways.
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But all of those don't really work well if we're stuck in this extreme sympathetic lock, right, the sympathetic system is just stuck there and can't relax.
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And if you can't sleep, what does the lack of sleep do to the body and the perception of pain?
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It's going to amplify it, right.
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And if your cortisol levels are high, you get crappy sleep for lack of a technical term and then your hormones go off.
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So it's a positive feedback loop.
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But the problem with positive feedback loops is that they're really actually negative, right.
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So it's a negative reinforcement.
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That is, I think, the crux of emotions and pain right there, because if your hormones are awful, then it's all over, right.
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Yeah, I agree with that.
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That's a good uh analogy or high point to highlight, with that positive feedback loop, which is actually a negative feedback loop because the things that are happening are producing, having your body produce things, release those hormones and enhance that perception of pain for that patient as well.
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So they're not getting better, but just showing that the importance of having or taking a holistic approach, an integrative approach, when it comes to that management of pain and management and health in general, well, think about this difference in an integrative approach, right.
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Anything you can do to interrupt that cycle puts them in the pathway or a new position to start healing.
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For example, as strange as it sounds, there's numerous, numerous studies that show morning sunlight resets the circadian clock and decreases pain.
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It decreases pain because it resets the circadian clock.
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It's not magic, that's free.
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Decreases pain.
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It decreases pain because it resets the circadian clock.
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It's not magic, that's free.
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But people who are in pain aren't out outside in the morning to get that morning sunlight and they're not even told that that is something that can help them.
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There's so many other kind of just natural, simple hacks that have been around forever that can start interrupting it.
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You still need your pharmacological approaches, you still need your physicians and your allied professionals, but there's so many simple things that we can educate people on to break them out of these cycles and to take at least the emotional drag off and to start improving sleep and these other things that are affecting them, depending on the individual, that are just not in the awareness of the people treating them.
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But it's in the database, it's in PubMed, we know this and it's free and no one's going to die by accidentally trying to get the sunlight, unless they live in Siberia, because it still frees, so there's no harm.
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So why not try it?
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You know, even if you look at grounding and earthing strange as it sounds, but there's tons of studies.
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There's like, I think, 157 peer-reviewed studies that showed that it decreases pain.
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I don't know, go put your feet on the earth, it's not going to kill you.
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Try it, see what happens.
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Right, these are simple things, but if that can interrupt the autonomic nervous system and bring them closer to a parasympathetic state the autonomic nervous system and bring them closer to a parasympathetic state you know it's huge for even the Western practitioners using medications.
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They can start titrating them down or they can go on different medications that may be no longer opiates.
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We may go on gabapentin or something else and start bringing them down, but we just, without having cross dialogue and raising awareness, we're stuck in the same thing.
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You know the stuff that we've been seeing people getting caught addicted to opioids and everything else.
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Right.
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And I think it's a tragedy.
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Yeah, it is definitely a tragedy when we have something that's so simple and free.
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That could help in that process.
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And I'm not saying the morning sunlight is going to cure everything, right, but I will say, I get up and I go on my roof I live in Brooklyn, we don't have grass, but I go on my roof and I watch the sunrise, you know, for at least 10 minutes, usually 20, 30.
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And I do my meditative practice as well, doing that, but that's a me thing, but I actually see the value of it.
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I as well doing that, but that's a me thing, but I actually see the value of it.
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I'm not up there in the winter this New York is brutal, you know but the moment spring is warm enough, I'm there because I feel the value, my day is better, my sleep gets better.
00:21:20.497 --> 00:21:23.819
So, trying it, what do you got to lose?
00:21:23.819 --> 00:21:24.441
Why not?
00:21:24.441 --> 00:21:25.541
Why not?
00:21:25.541 --> 00:21:43.402
And then using things like acupuncture, craniosacral therapy is something that I think you know has impacted my life and I've trained in it and I've seen it do phenomenal things for people, especially on how it almost directly puts someone in such a deep parasympathetic state.
00:21:43.402 --> 00:21:52.730
It's wild and so subtle and you know, it's been around forever and it came from the osteopaths, but it just doesn't have as much awareness.
00:21:52.730 --> 00:21:56.828
But what could that do for people, you know, with migraines and everything else.
00:21:58.292 --> 00:22:02.307
Yeah, yeah, why not try it Now, jordan?
00:22:02.307 --> 00:22:09.929
Your work, you know it's not just with patients, but you also work with clinicians and teams on building value-driven practices.
00:22:09.929 --> 00:22:15.436
What's the hardest mindset shift that you've seen providers have difficulty with?
00:22:16.238 --> 00:22:20.346
It's the individual, it's the provider.
00:22:20.346 --> 00:22:26.818
Right, we have perceptions, limiting, belief systems, set points that are in our way.
00:22:26.818 --> 00:22:29.329
What we believe is what we're capable of.
00:22:29.329 --> 00:22:31.556
How far can we go with things?
00:22:31.556 --> 00:22:43.699
And you know these are varied from how we grew up to you know, our own traumas, to just systemic issues, right, that create all these sort of belief systems.
00:22:43.699 --> 00:22:51.169
Right, the hardest part is getting a person to know that they can do things right and that they are empowered and they have agency.
00:22:51.169 --> 00:22:54.260
There's nothing that prevents anyone from doing anything.
00:22:54.260 --> 00:22:59.315
Yeah, there's actually a lot of things out there, but there's nothing that stops you from trying, right.
00:22:59.315 --> 00:23:02.009
It's when you give up before you try.
00:23:02.750 --> 00:23:10.676
And I noticed that with people it's like oh well, I don't want to charge the going rate because people won't come to me, especially like for new, new clinicians.
00:23:10.676 --> 00:23:12.300
You know I'm like well, you're charging.
00:23:12.300 --> 00:23:17.875
What I teach a class on the treatment of orthopedic diseases and one day I'm known for going off on weird tirades.
00:23:17.875 --> 00:23:20.107
This is what I do when I teach is my teaching stuff.
00:23:20.107 --> 00:23:26.330
And I asked someone how much they were going to charge when they graduated and they said something absurd for New York area.
00:23:26.330 --> 00:23:36.912
I was like cool, let's, let's work this out and I I multiplied it, you know, and I was like great, by the time you're done, once we reduce your overhead and everything else, you're going to make 30,000 a year in New York city.
00:23:36.912 --> 00:23:46.432
And they stared at me because the only reason why you're charging that is because you emotionally believe that's what you're worth, where the going rate was double that.
00:23:46.432 --> 00:23:51.381
But they thought they can get people and it's not a new person discount, this was how they were going to start.
00:23:51.381 --> 00:23:55.796
So that's just like a minor example that I see people deal with.
00:23:55.796 --> 00:24:07.551
And you know, within my book I have a lot of exploration exercises and ways to look at those things and I encourage people, you know, to use therapy and everything else to work through them, depending on where they come from.
00:24:07.612 --> 00:24:11.616
Sometimes you're just like, oh wow, I'm just not valuing myself and that's good enough and you can move forward.
00:24:11.616 --> 00:24:24.028
That's like the number one thing I see people deal with is their own belief systems, because everything else is possible.
00:24:24.028 --> 00:24:24.789
You don't have enough money.
00:24:24.789 --> 00:24:26.771
It's either you don't have time or you don't have money.
00:24:26.771 --> 00:24:30.215
You don't have money but you probably start getting enough money.
00:24:30.215 --> 00:24:32.298
Then you can pay consultants to do those things.
00:24:32.298 --> 00:24:44.358
There's always a way, but you know, I have someone that I coach and it's always excuses, and they're in demand, but there's always excuses of why, oh, I didn't get to update that website.
00:24:44.358 --> 00:24:46.226
Oh, I didn't get my Google profile up yet.
00:24:46.226 --> 00:24:47.769
Oh, I'm waiting on this person.
00:24:47.769 --> 00:24:50.777
Okay, well, you're waiting on money.
00:24:51.305 --> 00:24:53.817
And do you think that's tied to the mindset as well?
00:24:53.817 --> 00:24:56.166
Like, maybe they're not really believing that they can.
00:24:56.166 --> 00:24:58.814
They can do this, you know it's mindset.
00:24:59.035 --> 00:25:00.606
But you know what is mindset?
00:25:00.606 --> 00:25:02.151
Right, it's, it's an individual.
00:25:02.151 --> 00:25:06.346
So you know, is that tied to that person's upbringing?
00:25:06.346 --> 00:25:16.866
Is it tied to the fact that you know they came from a point of struggling, they're actually doing pretty decent now, but like they just don't think effort's gonna do anything anymore?
00:25:16.866 --> 00:25:18.770
You know I failed.
00:25:18.851 --> 00:25:24.268
I won at least five times like rock bottom, lost all my money.
00:25:24.268 --> 00:25:29.307
But I believed in what I was doing because I was like, well, I really like this, I have to find a way to make money doing this.
00:25:29.307 --> 00:25:29.608
So I didn't give up.
00:25:29.608 --> 00:25:30.636
But I know in what I was doing because I was like, well, I really like this, I have to find a way to make money doing this.
00:25:30.636 --> 00:25:32.049
So I didn't give up.
00:25:32.049 --> 00:25:42.015
But I know the third, fourth and fifth times it definitely rang like a very loud bell in my head that I'm probably going to fail and maybe I should give up.
00:25:42.565 --> 00:25:54.374
And there was even one time that I had a six figure offer to go back into IT and I ho and hummed on that for a good two months and then I'm glad it never happened.