How alternative therapies could be the key to ending the pain care crisis [PODCAST]

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We dive into the pain care crisis in the United States with Cindy Perlin, a social worker and chronic pain expert. We explore the epidemic of chronic pain, the limitations of conventional treatments, and the risks of opioid addiction. Cindy shares insights on alternative therapies, including mind-body approaches, nutritional medicine, and emerging technologies that offer hope for those suffering from chronic pain.

Cindy Perlin is a social worker.

She discusses the KevinMD article, “Why physicians need to become more educated about alternative pain treatments.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at kevinmd.com/podcast. We welcome back today Cindy Perlin. She’s a social worker. Today’s KevinMD article is “Why physicians need to become more educated about alternative pain treatments.” Cindy, welcome back to the show.

Cindy Perlin: Thank you.

Kevin Pho: So, for those who didn’t listen to some of your prior episodes, let’s briefly again share your story and journey.

Cindy Perlin: OK. Well, I’m seventy-two now, and when I was twenty-five, I hurt my back running, and doctors didn’t seem to have any solutions. That got worse and worse until I ended up disabled for three and a half years, stumbling around, and just happened to find a solution, which was biofeedback.

Since that time, I’ve explored lots of different kinds of treatments. I tend to be somebody who does get a lot of muscle aches and injuries and things like that. So everything that I’ve learned, I’ve kind of been putting into a book I wrote, The Truth About Chronic Pain Treatments: Best and Worst Strategies for Becoming Pain-Free. And then I also have a website, the Alternative Pain Treatment Directory, paintreatmentdirectory.com, and that has, at this point, over 360 articles about alternative pain treatments.

Kevin Pho: All right. So this most recent KevinMD article, “Why physicians need to become more educated about alternative pain treatments.” Before talking about that article, what led you to write this particular one in the first place?

Cindy Perlin: Well, just hearing from so many chronic pain patients that they weren’t getting help from their doctors, that they were only being offered medications that weren’t working or surgical procedures that didn’t help or that they didn’t want to do. And there’s just so much more out there.

One of my biggest frustrations and disappointments is that when I was going through my own episode of chronic pain, I saw an orthopedic surgeon who seemed very compassionate and kind and spent a lot of time with me. And then, at the end of it, said he didn’t know what was wrong with me, he couldn’t help me, and just to go on with my life as best I could. And I had no life at that point.

And so many years later, when I had recovered and was helping other people, I contacted him and said, “I appreciated your kindness and all of that, but you couldn’t help me, and I’ve discovered things that do help people. Will you meet with me so I could talk to you about it?” And he refused to talk to me. And I thought that was very disappointing, that he wouldn’t be open-minded. I know that I wasn’t the only person in that situation he ever saw.

Kevin Pho: You wrote in your article that chronic pain affects up to 56 percent of Americans, and high-impact pain disables about 7 percent. Now, talking among yourselves in a chronic pain community, do you think that’s a typical experience in terms of the medical profession not adequately addressing pain?

Cindy Perlin: Yes. And there was even a survey of physicians at academic medical centers a few years back, and 66 percent of the physicians who responded said that they didn’t feel competent treating pain. So that tells me it’s not just one-sided.

And I think physicians are terrified because they know that if they prescribe opioids, the DEA can come after them. So they’ve been told that’s the most effective tool they have. I don’t believe that, but that’s the tool they feel they have, and they’re afraid to use it.

And so they see a pain patient come in the door, and they’re very uncomfortable. And I think the patients pick that up, and they don’t feel heard. They don’t feel welcome. If somebody loses their physician because of retirement or moving out of the area or, in a few cases, loss of license, they can’t find another physician to see them because physicians don’t want to treat pain patients.

Kevin Pho: And what is the perspective from the chronic pain community about the potential DEA overreach that prevents a lot of physicians from comfortably prescribing opioids?

Cindy Perlin: Well, I think a lot of patients are very, very upset about that, and a lot of them have been harmed by being abruptly cut off their opioids or abruptly tapered. And they’re suffering, and they haven’t been offered alternatives. And generally, what you see in terms of any kind of advocacy with patients is, “Give me my opioids back.” And I think that’s unfortunate because there are better things.

The reality is that opioids cause a lot of problems even besides addiction. They increase the risk of falls in the elderly. They contribute to traffic accidents. If you prescribe opioids for acute pain, it’s more likely to turn into chronic pain. So there’s a lot of other things about opioids that are not good for people. They have a lot of side effects that are unpleasant. Quality of life tends to go down because of sedation and not being able to be that actively involved.

And there are a lot of other things out there that I hope to educate patients and physicians about so that there’s not as much suffering on both sides.

Kevin Pho: So let’s take a look at some of these alternative pain treatments that you’re talking about. What are examples of those?

Cindy Perlin: So there are things that are pain-relieving that are natural. The biggest one would probably be an anti-inflammatory diet that doesn’t have processed foods, because that contributes to widespread pain. Nutritional deficiencies, particularly vitamin D and magnesium. Sedentary lifestyle.

But the biggest, most ignored one in my mind is the mind-body connection. People who are chronically stressed or have a history of trauma, their nervous system is chronically overaroused, and that contributes to many different kinds of pain and inflammation in many different ways. And I’ve met many people in my journey who spent even decades going to every kind of conventional and alternative treatment and didn’t get any relief until they finally looked at what was going on in their brain.

Kevin Pho: So when you talk about mind-body connection and anti-inflammatory diets, what are some specific things that they can do? What are some modalities that they can adopt?

Cindy Perlin: OK. So there’s a really great book out there, The Body Keeps the Score, that talks about how the brain changes with trauma and how it can’t really be accessed by talk therapy. The treatments that work tend to be neurofeedback, which is a feedback of brain activity; EMDR, eye movement desensitization and reprocessing, which is a nonverbal treatment that gets the patient to make eye movements, and that seems to make brain connections.

There’s something called energy psychology. The most well-known one, it’s a tapping therapy called emotional freedom technique. It frees up the energy that’s stuck in the body from the freeze response from trauma and clears it out. And it’s interesting because it not only helps people physiologically, but it gets people past PTSD symptoms like flashbacks of trauma.

And a lot of people say, “I didn’t have any trauma.” Well, there’s something called small-t trauma, which is growing up in a home where you don’t feel safe, where you’re criticized, where you don’t feel loved. And there’s just daily insults that affect people physiologically, and that can have as much impact as a big trauma, like sexual abuse or physical abuse or being in a natural disaster or something like that. So getting that stuck energy, that chronic muscle tension, that overarousal that’s in the body, out of the body is really helpful.

There’s also something called central sensitization, which is, if you’ve been in pain for a long time, your brain sort of gets stuck. It just keeps sending pain signals. And there’s two things that I know that help with that. One is neurofeedback, as I mentioned earlier, brainwave biofeedback. And the other is something called Calmare, which isn’t widely available. But what it does is it sends what they call a “no pain” signal to the brain and confuses the brain. And after about ten treatments over two weeks, the brain just stops sending the pain signal. So some people’s brains just get stuck. The tissues are healed, but the brain keeps sending the alarm.

And then there’s things like acupuncture, physical therapy, massage that can be very helpful. The biggest problem for people in accessing these techniques is that insurance doesn’t cover it.

Kevin Pho: So you’re right that a lot of physicians, they don’t get a lot of pain management education, let alone some of these alternative pain medicine educations that you’re talking about. So if I were interested in exploring some of these modalities, where can I send patients to find them?

Cindy Perlin: Well, that’s why I have my website. So it’s paintreatmentdirectory.com, and people can search by condition. They can search by treatment. They can find articles. They can find products.

Some of the most interesting interventions that I found that are most helpful have to do with devices that work with electrical stimulation or light or magnetic pulses, magnetic fields. And there’s home treatment devices that people can get that are relatively inexpensive, where they can treat themselves.

The light therapy, it’s also known as photobiomodulation or low-level laser therapy, that facilitates healing. It actually changes the cell, makes it more permeable so that nutrition and oxygen can get in, so that it enhances ATP in the cell, which is the cell’s energy.

So there’s a lot of things that I mention on my website that people can learn about because there’s just so much on the internet, you don’t know where to go or what to believe. My articles tend to have citations from research. So if people want to dig deeper and not just believe me, they can.

Kevin Pho: Now, you’re more in touch with the chronic pain community. Now, are they interested in some of these alternative pain modalities? Are they open to some of these suggestions in the Alternative Pain Treatment Directory?

Cindy Perlin: Most of them are. As I said, there’s a subset that’s just, “Give me my opioids back.” I think some of that is brainwashing. When Purdue Pharma came in with their aggressive marketing, it was all about, “This is the most effective thing that we have.” And a lot of patients and physicians have bought that.

But there are a lot of people who are receptive, who, when they learn about it, they’re willing to try it. And as I said, the main problem is financial, the lack of insurance coverage. And as you probably know, people who’ve been in chronic pain for a long, long time, they might have been on disability for a long time. So they’re very financially constrained, which is why we want to get to people early before they go too far down that path.

Kevin Pho: And just give us a sense, in terms of the most common alternative pain treatment modality, what kind of monthly cost are we looking at?

Cindy Perlin: Well, that’s really a hard question to answer. If you go for an acupuncture session, let’s say, or a massage session, you might go once a week, and it might cost you between $60 and $100. The good news about that is it’s time-limited. Hopefully, you heal or recover from that. You don’t need it forever. Unlike, take an opioid, you might take it for life. So there’s those kinds of costs.

Obviously, a healthy diet can be more expensive than an unhealthy diet. Processed foods tend to be cheaper than fresh organic foods, which is your best bet. I spend a ton of money on supplements because I will do anything to stay healthy. Having lost my health at the age of twenty-five, I know how important it is to stay healthy.

So I personally spend probably close to $200 a month on supplements: magnesium supplements, herbal supplements, vitamin D supplements, omega-3 fatty acid supplements. That’s just me. So I think the most important supplement that people could take is vitamin D. Most people are vitamin D deficient, and I think there’s four hundred processes in the body that use vitamin D. And one of the problems with vitamin D deficiency is widespread chronic pain. And that’s very inexpensive. You could probably do that for $10 a month.

Kevin Pho: Are there any types of pain that are more amenable to some of these alternative therapies, musculoskeletal versus neuropathic?

Cindy Perlin: Well, so it really depends. You have to match the right treatment to the right condition. So I think all of them are. There’s a possibility of recovering from any of them. Some of them are more intractable.

For instance, CRPS, complex regional pain syndrome, is a very painful, debilitating condition that’s very intractable with conventional medicine. But Calmare scrambler therapy that I was talking about earlier, ten sessions over two weeks will get most people out of pain, and they might need occasional boosters.

When you’re talking about musculoskeletal pain, that won’t help that at all. You need something. You need to look at muscle imbalances, chronic muscle tension. Using something like light therapy can really help, or magnetic therapy, EMF therapy, can help. So you have to match the right treatments to the right conditions.

I do pain consults, 90-minute sessions, virtual sessions on the phone, where I just go through people’s history of their condition, treatment history, and then I make recommendations on the best match for their condition, what’s going to help the most.

Kevin Pho: We’re talking to Cindy Perlin. She’s a social worker. Today’s KevinMD article is “Why physicians need to become more educated about alternative pain treatments.” Cindy, as always, we’ll end with some take-home messages to the KevinMD audience.

Cindy Perlin: OK. Well, you just reminded me of something. So in terms of my pain consults, I am very open to talking to a physician, consulting on cases. And I’m asking physicians to keep an open mind, get educated, because a referral to something that will help someone is just as valuable as a prescription and doesn’t really take more time.

Kevin Pho: Cindy, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Cindy Perlin: Thank you for having me.

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