S03_E17 - Beyond Medication - Effective Strategies for Pain Management

Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilden, your host of the Healthy Matters podcast. And welcome to episode 17. Today we are gonna focus on chronic pain and ways to manage it in your life that don't always include medications. To help me out, I've invited Dr. Catherine Justice. She is a doctor of physical therapy and a repeat guest on our show. We did an episode a while back about a ways to manage pain at work with Catherine and now she's come back to talk to us about pain in general and ways to management. Thanks for being back on the show.

Speaker 3: 0:48

Catherine . Thanks so much for inviting me. I'm really happy to be back.

Speaker 2: 0:51

So let's start out by just framing the conversation about chronic pain. First of all, what does chronic mean? And then if you could talk to us about how you think about people who are living with chronic pain. Yeah.

Speaker 3: 1:01

Well it's a really good question to ask what does chronic pain mean? Because it's kind of a complicated question. So sometimes we even call it persistent pain rather than chronic pain because it's pain that persists for longer than you think it should or longer than is manageable in your life. Chronic pain and in chronic pain itself becomes its own diagnoses. So someone can have back pain and their problem is in their back, but when back pain becomes chronic, chronic pain becomes its own diagnosis, its own condition outside of where in your body you feel it.

Speaker 2: 1:36

It can be due to lots of different things. Oh yeah.

Speaker 3: 1:38

Lots of different things. And in fact, sometimes when I talk to people about pain, that they're experiencing pains that that is persisting usually longer than three months. Um, let me do that again, sorry. When I talk to people about pain, that's persisting pain that goes on usually longer than three months, but it's different for different folks of where they hit that point where it starts to really interfere with their life. Sometimes I tell them, think of your body like a house. And it's kind of a weird house because it has a ton of doors, not just a front door and a back door. It's filled with doors. So you're the house and one door is a different way that pain can enter your body. So one of those doors, we call it the biological or the body pain that's in our body. Another door, however, is the psychological kind of mental health and how that influences pain. We have emotional health, that's another door. Then we have our spiritual health, like our sense of meaning and purpose in our life. So that's another way that pain can enter our body. And then we have our social self and that's another way that pain can enter in our body. And then we have the environment that we live in. We have the social determinants of health, we have the social structures around us, experiences of marginalization or racism. That's another way that pain can physically enter our body. And so when we think of all these different doorways and all these different places that pain can enter our body, if we only think about getting pain out of the body through that biological door through medication, we're really cutting ourselves off. So all of these doors, pain can come in, but we gotta remember pain can also leave through all these doors.

Speaker 2: 3:12

Yes. And oh , so that is a absolutely fantastic way to think about this. And I have not heard it put like that before. So when we're giving medications for pain, we're only looking at one of those doors.

Speaker 3: 3:22

Yeah, yeah. You're just looking at the one door. And if we can expand our treatment plans, expand the way that we manage pain in our patients and in our communities and in our families, we can look at all these other doorways and there's plenty of evidence to show that these doorways are really connected. So they've done studies where they've looked at how an experience of holding someone's hand that you care about, how that decreases your experience of pain. So there we're opening that social door and even if pain is entering in our body, we can exit it through that social door and we can look at two of people who feel a deep sense of meaning and purpose in their life. And it allows them, if there's meaning and purpose behind an experience, you can manage a lot , a pain, a lot better than if there's no meaning or purpose. So that's that spiritual door opening up to allow for pain to exit or pain to decrease the suffering around pain to decrease.

Speaker 2: 4:16

How do you think we've got to the point in much of healthcare, not all of it, but in much of healthcare where we have ignored all those other sources of pain and we've got to just thinking about neural receptors in the body and give a medication that blocks those receptors? Yeah,

Speaker 3: 4:31

Well that's probably a whole nother podcast in and of itself. Looking at some , uh, external drivers of healthcare and why medication tends to be the go-to for a lot of our healthcare system. But I feel like we're shifting and we're changing that we're recognizing that actually the evidence doesn't back up that approach a hundred percent. And even if we're looking at just pain receptors, that even doesn't do necessarily a great job of even just that biological door because a lot of pain that we feel in our body is stuff that's caused by say, muscle tension or stuff that's caused by a condition within our tissues, within our joints, that the medication might mask the sensation, but it's not gonna actually fix it. It's not gonna actually deal with the tissues themselves that are experiencing the dysfunction that leads to the pain. Could

Speaker 2: 5:17

You lead us down a little bit about the neuroscience behind pain? Yeah.

Speaker 3: 5:21

So that, I love this topic and I love to nerd out on it as much as possible. So I really appreciate the question.

Speaker 2: 5:27

I don't know anything about being a nerd, Dr. Justice , I don't know anything about that. Ha ha ha .

Speaker 3: 5:33

<laugh> . Um, so one thing that's cool I think about pain, you know, is that it's very personal and pain is very personal. It's very complex. And even within one person, your experience of pain can be totally different from one context to another. And sometimes I like to share an example with my life about how our body can rewire our pain mechanisms and how we experience pain through my own experience of childbirth. So when I had my first kid, it was very painful, <laugh> , and I had experienced pain in my life before then, but not that kind of pain. And maybe an hour or two after I delivered, the nurse came into the room and she asked me like, on a zero to 10, what's your pain? And I looked at her and I said, well, I have a new 10. And so I'm in a lot of pain right now. I would give myself a four. I'm

Speaker 2: 6:20

In a lot of pain . Okay . 'cause childbirth was the new 10.

Speaker 3: 6:22

Childbirth was the new 10. So my current state, I was in a lot of pain. I didn't feel great and I gave it a four. So that was like, whereas

Speaker 2: 6:29

Prior to childbirth, that maybe was eight or a nine. Oh yeah. Yes ,

Speaker 3: 6:32

Totally. Yes. It would've been at least , at least a seven, if not an eight, what I

Speaker 2: 6:36

Was experiencing. You reset your scale . Yeah . My own mother, I, I'm convinced, doesn't feel pain. And she says, I've given birth

Speaker 3: 6:42

<laugh>. Yeah. So her 10, it reset everything. It

Speaker 2: 6:45

Reset everything. Yeah. Yeah ,

Speaker 3: 6:46

Yeah. And so that's like we, we do that in our bodies and we do it usually not that quickly. Usually our body resets pain, it takes longer. And this is where this phrase comes in, that nerves that fire together wire together. And so usually change actually happens slowly through repetition. So we don't like reset our pain mechanisms in our brain overnight generally. Usually it's more from repeat practice that we can really reset how we experience pain. So

Speaker 2: 7:14

People living with persistent pain over time, does their perception of pain differ?

Speaker 3: 7:21

Yeah. Oh it absolutely does. And there are practices that we can do that will help to encourage our pain system to reset so that we suffer less from pain and maybe even experience less pain. And then there are practices that we can do that will actually increase it. And it, it's a sticky subject to talk about because no one likes to be told that your pain is in your head. No one likes to hear that. No one likes to feel like their provider is telling them that it's belittling and it kind of erases people's experience and it's not good. And yet on a neurobiological level, all pain is in some way, shape or form in our heads because we don't actually experience the suffering due to pain until that signal, that stimulus that causes the pain reaches our higher level of our brain. And so we have to interpret the signal and that interpretation happens in our minds. And I'm not saying that the pain that people experience isn't in their body 'cause it's absolutely in their body, but the brain interprets what the body is experiencing. It's

Speaker 2: 8:23

A great way to frame that, I think. Yeah , that's, so is it possible on all those doorway entries of pain, is it almost always or always there's a biological body pain that is exacerbated by your spiritual, your mental, your environment? Or are they all equal contributors?

Speaker 3: 8:40

I think the individual, I

Speaker 2: 8:41

Didn't state that well. Yeah . But do you know what I mean?

Speaker 3: 8:43

I do. Yeah. And I think the individual mix is where it leaves kind of the science behind and the art comes into it. And where we can't make sort of assumptions or judgements about people we really don't know all the time where the pain, what the size of their doors are, you know, they might have like big body doors and small like social doors or things like that. Like that their more, their pain is coming from their body, less from their social experiences. But we really don't know. So it's really, that's where as a clinician and as a patient you get to kind of work together and customize where the right treatment plan is that's gonna really address it from a very personal point of view.

Speaker 2: 9:21

So you talked about resetting your, your 10, your your pain scale. Mm-Hmm . <affirmative> . Uh, how do opioid medications work or other pain medications affect that scale?

Speaker 3: 9:30

I'm so glad you asked because this is sort of the shadow side of that. When your pain gets reset because you experience extreme pain, you get a new 10, everything changes opioids and particularly chronic use of opioids. Something that people don't always hear or know about them is that they actually make us more sensitive to pain. They found that over time people who take opioids chronically, they tend to become more sensitive to pain. And what ends up happening, I think, is that opioids reset their zero. So childbirth gave me a new 10. Opioids give people a new zero because the experience of being without pain in our bodies is not actually normal. Like if you right now thought about your body, I bet you could scan through and you could find some place in your body that doesn't feel great someplace that's, you know, a little sore or achy or something like pain is information and it's there for us to tell us things about our body so that maybe we, you know, adjust our posture. Or if our hand touches a stove, we pull it away. Like pain is actually quite important. And when you have the experience, especially the repeat experience of having no pain, of being pain-free, zero outta 10, that actually resets our zero. So suddenly after having a new zero, when you experience what would've been a four outta 10, now suddenly that's an eight that resets your system so that you become more sensitive to pain and you suffer more because of those sensations that you're feeling. So it does the opposite of what we want it to do. I bet

Speaker 2: 11:01

That's a message not many people have heard and I absolutely resonate with that . Resonate so much. Is there a role at all then, in your opinion, for opioids or other pain medications for chronic pain?

Speaker 3: 11:14

I mean, I think there is a role when we're talking about palliative care. Mm-Hmm <affirmative> , there's a role in people who suffer from addiction who are already victims of the opioid crisis that we don't wanna just cut people off cold Turkey. So there is a role for opioids and we have to be thoughtful about it and we have to be careful with it. And again, individualize it that every person and their experience is unique and their needs are unique. So one person might be very afraid of taking opioids, might not want them, would prefer to suffer pain than take opioids. And maybe is so averse to them that you're like, Hey, come on, like <laugh> , you don't have to suffer this much. And others might be so afraid of suffering that they are drawn towards numbing that sensation at all costs. And so you really have to be very individual in how we approach it with people and very sensitive to their needs as well.

Speaker 2: 12:08

Thank you for that. And listeners, that's all we're gonna talk about for pharmacologic or otherwise known as medications for pain. And I appreciate your comments about opioids because they're in our public consciousness a lot. When we come back from a short break, we're gonna talk about other non-pharmacologic modalities for managing chronic pain. I would like to call listeners attention to two of those that being chiropractic and acupuncture. These are wonderful treatment and management modalities for persistent pain, but we covered them in some depth that previous podcast episodes. So I will refer you to the episodes from acupuncture with Jessica Brown and chiropractic with Rick Printin from previous podcast episodes. So when we come back from the short break, I'll rejoin Dr. Katherine Justice and we're gonna talk about other non-medication pain treatment modalities. Stay with us. We'll be right back

Speaker 4: 13:00

When Hennepin Healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and that their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 13:39

And we're back with Catherine Justice . She's a doctor of physical therapy at Hennepin Healthcare here in downtown Minneapolis. And now we're gonna get to the heart of the conversation about management of chronic pain. Talk to me about physical therapy, if you could, to manage chronic pain.

Speaker 3: 13:53

Well, yeah, I, I consider myself an integrative physical therapist, which is sort of a new title and it's not an established specialty yet, but I am hoping that eventually it will be. But what it basically means is that instead of as a physical therapist, just focusing on function and getting people moving again, which of course is important and I love to do that with integrative physical therapy, we focus on allowing people to reestablish this connection between their body and their mind and their spirit and feeling more connected to their bodies, more in love with their bodies. And we use a tool set that's a little bit broader than conventional physical therapy, which has a wonderful tool set. So conventional physical therapy, we'll use manual therapy approaches with their hands. They'll use exercise therapy, they'll use what they call neuromuscular reed where they sort of retrain your body how to move and how to move thoughtfully. And in integrative pt we do all of those things as well. And we use other modalities like yoga or tai chi, Qigong , mindfulness and breathing practices and really focusing on kind of this whole person approach to physical therapy. While a lot of conventional physical therapists will also have this whole person approach, they often don't necessarily have that sort of full range of complimentary and integrative health modalities that go along with it.

Speaker 2: 15:11

Before we get into some of those other things you just mentioned, movement itself and exercise. Mm-Hmm . <affirmative> . And how does that work for patients , uh, with persistent pain?

Speaker 3: 15:20

That is really tricky. It hurts . It is. I know. So you're cruel.

Speaker 2: 15:24

You're making me move more. I

Speaker 3: 15:26

Know. Well, exactly. So there's oftentimes these cycles that people get into when they experience persistent pain. And one cycle is it hurts to move. And so then I move less and then I become stiffer and weaker because I'm not moving as much. And then I try and move and it hurts even more to move. And then I move less and I get stiffer and weaker. So that is just gonna make things worse. But there's another pattern that people often do, which is, it hurts to move, but I don't care. I'm gonna do it. And then they overdo it and then they pay for it and then they spend the next day or two just miserable. And then they are just pushing and pushing and they overdo it again and then they're miserable. So again, these two cycles are not helpful for our bodies and not pleasant either. So the, the antidote to those is something we call pacing, which means you do a little bit of movement and then a little bit of rest, a little bit of movement and a little bit of rest. And it's up to the physical therapist and the patient to work together to figure out what's that right special sauce of that formula of pacing for you. How much movement can you do that's not gonna set you back and also gonna get you moving again and feeling stronger and more supple in your body. And so finding that that special balance is part of the joy of what we get to do with people. 'cause it's actually quite fun to figure out. It's like a little puzzle. Like how, how can we get creative about your life and the movement that you wanna do and bringing joy back to your life through movement, through the body in a way that's not gonna make you miserable. So

Speaker 2: 16:57

I take it you would not agree with those who say you have to work through the pain, play through the pain if you're an athlete or pain is weakness, leaving the body, you gotta work through it, all that stuff. No guts, no glory, all that kind of stuff.

Speaker 3: 17:11

Yeah, I am , I'm not a fan. I will admit that. Yes . Shocking. No, I know. Um , so I, I think of, I try and help people rethink of pain as information. Pain is there to tell you something about your body and then how you determine how you listen to it and what you do about it is up to you. So, because there are some forms of what we experience in our body is pain, soreness, achiness. If we haven't moved in a while , everyone's gonna feel a little stiff and achy. And then you get moving and you feel better. So that's what we wanna get is to that place where like, how can we figure out that movement that actually makes you feel better? Not the movement that you feel worse and worse and worse and worse. And so sometimes getting through that stiff achy period when you're haven't moved in a while , that is, is tricky. But that's where we can really scale things back, do smaller movements, pace the movements, and eventually almost everyone is able to find some form of movement that helps 'em feel better rather than worse. So

Speaker 2: 18:07

We weren't meant to be stationary, were we?

Speaker 3: 18:10

No, no, no, no.

Speaker 2: 18:11

<laugh> . I one time had a a a a fitness instructor talk about fuzz, you know, in quotation mark what's fuzz? Fuzz is like that achiness or soreness from too much inactivity. And the same fitness instructor said, motion is the lotion. Yes.

Speaker 3: 18:25

Motion is lotion. Yeah. <laugh> .

Speaker 2: 18:27

So we do need to move.

Speaker 3: 18:28

We do need to move. Not ,

Speaker 2: 18:30

Not all achiness should be a contraindication to

Speaker 3: 18:33

Moving . No, no. And in fact, you know, and this gets back to the neuroscience of pain a little bit too, because some people, I experienced this in part of my life, I'm also a yoga instructor. And especially when I first started teaching yoga, I would notice that sometimes, and I'm making a generalization, but people who appeared male would come to class, they'd be less flexible than some of the people who appeared female. And they would just grimace, just make these painful faces .

Speaker 2: 18:56

Were you watching me at , I was not at my first yoga class . That's totally me . I can't straighten my hamstrings. Yeah . I look like, I , like I'm in agony out there. <laugh>. Well

Speaker 3: 19:05

It's, you know, when people experience like, oh I'm stretching and I feel stiff and they're , it hurts. They say it hurts like it doesn't feel good. And I'll say, you know, back off, I'll teach them to breathe. Which we can talk about too as far as breathing and how that can help pain. 'cause that's a big one. Listen to the sensation. Notice what your body is telling you and you can start to ease back into that stretch in a way that eventually you might look around the room and suddenly realize now my face is not grimacing. It's actually enjoying the sensation and the stretch sensation might not have even changed. It's just our perception of it has changed. Rather than it feeling like our body is the enemy where we're stretching and it's gonna like feel like we're fighting against it. When we can make our body our friend and say, no, I'm gonna ease into this and find the sensation. You can feel this stretch. And it's not actually painful. It actually starts feeling good and it's the same sensation. So it really

Speaker 2: 19:56

Does feel good. Yeah. Because so many people I have heard over and over, oh, doesn't that stretch feel good? And I'm going like, oh heck no, <laugh> . It does <laugh> .

Speaker 3: 20:04

Yeah, you need to probably, I

Speaker 2: 20:06

Mean it does . I'm not there yet on the stretching. Feels good. Section <laugh>, talk to us more about yoga if you could, Catherine . Um, the benefits of it and maybe segue into Tai Chi because I have actually read tons of medical literature that Tai Chi is good for things all the way down to arthritis.

Speaker 3: 20:21

Oh, Tai chi is fantastic. And I think yoga and Tai chi have a very similar approach. And again, they're about kind of reconnecting the body, the mind, our emotions, our breath, like all these things, like they're kind of opening lots of doors. They're getting with one intervention, Tai Chi, yoga, Qigong , all these things. They can really start to help us experience the full spectrum of how we can relieve pain and stay connected to our bodies and our spiritual selves. Again, that idea of meaning and purpose, that tai chi, qigong , and yoga can kind of really ignite in us this feeling of connected to each other, connected to the universe. So they, they're all forms of movement, but they're movement where you're training your body to tune into the sensation, training your body to breathe, maybe even slow down a little and connect deeper with yourself. So the word yoga itself is a Sanskrit word which comes from ancient India, which is there where yoga comes from and it means union. So it's this idea of bringing together, of uniting. I've

Speaker 2: 21:20

Never known that. Yeah,

Speaker 3: 21:21

It means union . What

Speaker 2: 21:22

Is Qigong and Tai Chi for those who maybe aren't quite as familiar with those.

Speaker 3: 21:26

So those come from China and are part of, when we think of acupuncture too, which I know you mentioned, that's all part of traditional Chinese medicine, which is a whole system in and of itself. So most of us think of acupuncture and traditional Chinese medicine as kind of the same thing. But acupuncture is just one tool in the toolbox of traditional Chinese medicine. And Tai chi and Qigong are other tools. So they're part of that same system and they're a form of moving meditation. And meditation And mindfulness practices again are another really fantastic way of managing pain. And again, we're talking about this, about tuning into the body, tuning into the sensations. So mindfulness itself, the practice of mindfulness is anything that has three ingredients to it. So it has to have intention, meaning you're doing it on purpose, attention. So you're paying attention to the present moment as it happens. And then the tricky one is non-judgment. And again, when people start to have a mindful approach to their pain, it's kind of counterintuitive. 'cause normally we think of distracting ourselves.

Speaker 2: 22:28

Yeah . Shouldn't you forget about it? Yeah . You're supposed to , you put it on your mind. Yeah.

Speaker 3: 22:31

But they've actually found that when we start to actually tune into the sensation and really locate it in our body and understand it, sometimes we'll say, does your pain have a color? Does it have a texture? Does it have boundaries? Like really zoom into it. We start to actually realize it's, it's different than I thought it was and it's changing. And that's one of the biggest things for people who experience persistent pain is that if we can change what you're experiencing, even if we're not erasing the pain, but if we can change it, that's gonna provide some relief. 'cause really a big part of where we suffer in chronic pain is the feeling of being stuck. So mindfulness helps us realize that these sensations are changing and that they're changeable and suddenly now we feel like we have a little bit of power over it that we can manage it in a different way. Catherine ,

Speaker 2: 23:16

Earlier you mentioned breathing and deep breathing. Mm-Hmm. <affirmative> . And its, its role in pain management. Could you say more about that please?

Speaker 3: 23:23

Yeah, so breathing actually takes us back again to the neuroscience. So sorry for getting nerdy again. Part of why breathing is such a powerful way to manage pain is because breathing is a direct link to our stress response. And anytime our body is under a state of stress, our pain signals are gonna be amplified because it's our kind of danger system in our body saying, danger, warning, pain. You know , you think of that like a red alarm, like flashing. That's what's happening. And when we can do things that dampen that stress response, it's gonna also dampen the pain response. Sometimes I tell people, think of pain and stress like two like unruly children that are constantly riling each other up and wrecking your house. Like again, we're coming back to the house. So we've got lots of doors and now two crazy kids running around,

Speaker 2: 24:07

Running around, wrecking stuff there . Stress and pain. Stress

Speaker 3: 24:09

And pain. So we gotta calm

Speaker 2: 24:11

It sounds positively dick, like from a Charles Dickens thing, <laugh>.

Speaker 3: 24:15

So we gotta calm down our stress response and that's gonna help calm down our pain response and actually vice versa. Because we know that the experience of being in chronic pain, that's a stressful experience, that's a stress in and of itself. So if we can use our breath to help decrease that stress response, then that's gonna also help to dampen that pain response.

Speaker 2: 24:35

Probably also good for a whole bunch of other things in your overall wellbeing. Yeah . Ranging from your blood pressure to your pain control.

Speaker 3: 24:41

Absolutely. And it's all connected, which is why it's like these systems like mindfulness, like yoga, like breathing, I mean they're, they're so great because they're so holistic. They with one modality, again, you get lots of those doors opening up. I'll

Speaker 2: 24:53

Bet there's a whole bunch of listeners right now who are resonating with what you've said or a loved one in their life is experiencing chronic pain or they personally are. And I'll bet you a whole bunch of them wish they could talk to you. One-on-one personally right now, but they all can't <laugh> . So what tips might you give to people listening for next steps, whether it be on a mindfulness or a meditation practice or, or yoga or , uh, seeing an integrated physical therapist? What tips would you leave us with?

Speaker 3: 25:21

Well, I would say tip number one would be slow down your breathing. Like rather than even thinking of deep breathing, think of slow breathing. Like that is one of the things that's really gonna have an immediate effect on your nervous system. An immediate calming effect, particularly slowing your exhalation. So it's spending a little longer time exhaling, slowing the breathing down that's gonna dampen that stress response. So that would be tip number one. And

Speaker 2: 25:48

You can do that any, every day ,

Speaker 3: 25:49

Anytime , anywhere. Mm-Hmm , <affirmative> , just slow the breath down. And then tip number two would be asking around to find the right fit for you with what modality is gonna resonate most with you. So that might mean saying you have to try a couple things. Maybe you ask some friends and family or ask around on social media, does anyone know an acupuncturist who might be experienced with what I'm experiencing? Or a chiropractor or a physical therapist or a massage therapist, you know, music therapy, art therapy. Again, these are all modalities that could be really beneficial, which is why we have a group medical visit program here at Hennepin Healthcare where we explore a lot of these different modalities in a group setting with patients in order to give them a taste and then they can leave the group with some more ideas of like, oh, the acupuncturist, that was interesting to me. Maybe I'll try that. Or some of the yoga, the breathing, the massage, like all of of these things, people can take a little test of them and then decide if it's something that they wanna pursue

Speaker 2: 26:48

More . That's a wonderful resource. Mm-Hmm . <affirmative> , if I could just uh , chime in on that one. If you happen to live in, in the Twin Cities of Minnesota at Hennepin Healthcare, our integrative health division has these group visits that are very well received in run by experts like Dr. Justice here. But if you live elsewhere Mm-Hmm. <affirmative> I , I'll bet they could seek those out in other places

Speaker 3: 27:08

As well. Yeah. And if you live in the state of Minnesota, you can always find a provider too by going to no pain amen.org . And there we have listed all of the, that we could find evidence-based, non-pharmacological pain management practitioners throughout the whole state of Minnesota. So it includes PTs, OTs, massage therapists, chiropractors, acupuncturists, even , um, mental health providers who specialize in treating chronic pain. 'cause again, that is a specialty in and of itself is the mental health burden of chronic pain.

Speaker 2: 27:39

Another amazing program. Mm-Hmm . <affirmative> that grew out of Hennepin Healthcare and Catherine , you and your team. Uh , the no pain mn.org is that website.

Speaker 3: 27:47

If you're really interested in nerding out on chronic pain, like uh, you really wanna get deeper into it, you could join. We have a project ECHO that's happening here at Hennepin. That's gonna be the first Tuesday of the month. What's that ? From 12 to one. So Project Echo, ECHO stands for extension of Community healthcare outcomes. And it is an online learning platform where anyone around the world can join us and learn more about this topic of integrative pain care. And so learning about the full spectrum from conventional care to what we consider that complimentary and integrative approaches to pain care, the full spectrum of care approaches for chronic pain and for pain in general. I would say too that when we look about movement and ways of moving our body for pain, I think the most important thing is find something you actually enjoy doing. 'cause there's a lot out there that can help. Walking, swimming, dancing, all of these things can be really beneficial. And they're very low to no cost . They're open to all of us to just move our body in a way that brings you joy. What

Speaker 2: 28:50

A wealth of information about managing persistent and chronic pain. Catherine , thank you so much.

Speaker 3: 28:56

Oh, thank you. This was so much fun to be here.

Speaker 2: 28:58

It's been great having you on the show. We've been talking with Dr. Catherine Justice. She is a doctor of physical therapy and an integrative physical therapist at Hennepin Healthcare. And as you have heard, she has so much wisdom around managing your chronic pain. So it's been a joy having you on the show. Listeners, I hope you'll join us in a couple of weeks for our next episode. And in the meantime, be healthy and be well.

Speaker 1: 29:22

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.