Conquer Chronic Pain with guest Dr. Andrea Furlan

Table of Contents

• Dr. Andrea Furlan's Experience With Chronic Pain
• 3 Types Of Pain
• 8 Steps To Conquer Chronic Pain
• Retraining Your Brain To Heal Chronic Pain
• How To Talk To Your Doctor About Chronic Pain
• How To Talk To Your Family About Chronic Pain
• Chronic Pain Support Groups
• Can Opioids Make Chronic Pain Worse?
• Conclusion

Episode Transcript

Dave Candy: Welcome to the St. Louis Pain expert podcast, I'm your host Dr. Dave Candy. Today we're going to be talking about the topic of chronic pain and I have a very important specialist in the topic of chronic pain. Dr. Andrea Furlan, she's a pain specialist scientist and researcher at the University of Toronto and I'm very grateful to have her here today. So welcome Andrea.

Andrea Furlan: Thank you so much, Dave, for inviting me to be here today.

Dave Candy:  So, before we get started, talking about this very in-depth topic of chronic pain. Can you just tell me how you came into specializing in this? That's not a topic that a lot of people just choose to specialize in.

Dr. Andrea Furlan's Experience With Chronic Pain

Andrea Furlan: Yeah, I know. Well, my story with paying started a long time ago. I was a teenager. And I was having terrible very debilitating. Monthly menstrual cramps.

Andrea Furlan:  And that's not chronic pain, that is acute pain, but it was recurring every month for years and years and I had to miss school. I know medications was helping me, they were giving me more stomach pain. So I decided to do medicine because of that to help people with pain. So when I did my medical school in Brazil, I, I couldn't find a special team that could treat people with chronic pain and I chose physiatry physical medicine rehabilitation because I thought this is the best. A special team to help people who have acute and chronic pain. Chronic pain is an invisible disability and physiatry is the specialty of the person with disabilities. 

Andrea Furlan:  I found over the last thirty years that I graduated from medical school, I've been doing a lot of research. I do metanalysis. I did many Cochran reviews for chronic pain and I did. I was the team leader that developed the Canadian opioid guidelines telling physicians how to prescribe opioids for chronic pain. So that's my involvement in, in my pain clinic where I work, I see all kinds of people with chronic pain, but mainly muscular fibromyalgia low, back pain, neck, pain, shoulder hips, and knees. So I do have the science and the clinical background

Dave Candy: Yeah, that's pretty much the same demographic that I see in my clinical practice as well.

Dave Candy: Now you mentioned when you were talking about your own pain history that that's not chronic pain, that's a acute pain. And in your book, 8 Steps to Conquer Chronic Pain. You actually describe three different types of pain....

Dave Candy: Can you briefly mention what those are, what the difference is between the three are, and how that's applicable to people who may be dealing with pain.

3 Types Of Pain

Andrea Furlan:  yeah, and I think that's very important for people to understand because the treatments are different Although, sometimes they come together, but the three types are nociceptive, neuropathic, and nociplastic, and I'll explain what they are. So, nociceptive. Pain is pain. That is a signal. That something is broken damage. Lesions, there's a disease. So that's the normal pain that we all feel. If you have a toothache, there's an inflammation in the tools, that's nociceptive. Being nociceptive is an inflammatory joint and arthritis or a bruise or tendon that is rupture fracture.

Andrea Furlan:  and that is because the pain system is functioning normally, we need pain to survive and all human beings need to feel pain, because there is a genetic disorder that a person is born without the ability, to feel this nociceptive pain, and they can die in early age because they can't protect themselves from danger, so that's nociceptive. And then the other type of pain and nociceptive pain is mostly acute because the body will heal and go back to baseline where they don't feel any more pain. Neuropathic, pain is, when there is a illusion and damage or a disease of the, the pathways that conduct the pain impulse. So the pain, the lesion can be in the nerve, in the spinal cord, or in the brain. So, examples are people who have post-herpetic neuralgia, this is after they have herpes zoster.

Andrea Furlan:  Or people who have diabetes and then they just the diabetes damage, the nerve endings. So they feel like a burning pain, their hands or feet or people who had a stroke. And then now they have opposed stroke being or spinal cord or people with multiple sclerosis. So those are lesions in the nerve system. Now the third type of paying is not simplistic which is involves plasticity of the pain system so it's a malfunctioning of the pain system. Let me give an example, practical example, imagine that you have an alarm system of a house. And you install the alarm system because you wanted to go off when there is something wrong. And so, if there is a fire, a smoke, a burglar, an intruder. The alarm will go off because those sensors are working perfectly.

00:05:00

Andrea Furlan:  And you call the ambulance, the fire truck or the police they come and fix everything and the noise stops. So, that is nociceptive pain, the normal pain. That if you have a toothache, you need to treat the tooth and then the pain goes away. If the wires of the house are cut or if there's a short circuit and that would be equivalent of neuropathic pain. So you need to fix the wires you need to fix. You know, Where's the short circuit? Now imagine that the wires are normal. There is no fire, no smoke, no nothing but the alarm is going off or the volume of the the sound of the siren is very loud. That's not plastic pain, like everything is everything looks normal. There's no fire, no burglar. The wires are not in short circuit, but you are still hearing a lot of noise.

Andrea Furlan: So you have to call the alarm company, you have to fix the alarm system so that's what nociplastic pain is. And that is what the majority of chronic pain is.

Dave Candy: And that was a great analogy that you gave about the house.

Andrea Furlan: It's a malfunctioning of the pain system, the pain system is sensitized for those are the three types of me.

Dave Candy: And you mentioned at the end when talking about nociplastic pain that everything looks normal. The wires are attached, there's no burglar, there's no smoke but yet there's still a problem and I think that leads to the stereotype of people with fibromyalgia or other types of chronic pain. Saying Well you're just making it up, your MRI looks normal, your x-rays, look normal. There's nothing wrong. You speak to that a little bit.

Andrea Furlan:  So because the ping system, this abnormalities of the ping system are very real, the person is not inventing, they're not making up all of this. They don't show up in the regular MRIs of the spine, for example, because the problem is not in the spine anymore. Like if they're having fibromyalgia, they're hurting, you know, the lower back, the neck, the shoulders, their arms, the legs, you can't, if you MRI everything or blood tests or X-rays, you're not going to see anything. I'm normal there. You should do some tests of the pain system but unfortunately we don't have machines, we can do this in laboratory the pain laboratories. We can see those changes But they are so variable. If the reason we are not doing those brain functional MRIs in clinical settings, is because

Andrea Furlan:  They vary from person to person and we are afraid of you know doing a function MRI on a person that is saying I have fibromyalgia and then showing that at that time there is no problems going on with the pain system because those things are very variable. But in laboratory, we know that those changes happen in the in how the pain system is functioning. So we try to there's another analogy that we're saying, fibromyalgia, nociplastic, pain is a problem of a software. If you have a laptop, a computer and not susceptive in neuropathic means a hardware problem. So, again, if your computer is not working, it could be because you, you know, you let it drop on the floor. It broke, you know, something is broken inside. So you need to go and change that, that piece.

Andrea Furlan:  So that would be the equivalent of the nociceptive in neuropathic pain, but if your computer, you know, is stop working, but there is no broken pieces. But is this, you're not working. It's a problem of the software. And you, if you open the computer and look at all the pieces, you will say. Everything is normal. But you need to reinstall the software. So that's what nasty plastic pain is. Is a problem of the software. There's nothing broken, nothing. That is really damage.

Andrea Furlan:  But the computer is not working, so your pain is not working. So what the people with nosy, plastic being feel an examples of nociplastic pain are fibromyalgia, is the main one but we also have chronic back pain. Can be nociceptive, we have irritable bowel syndrome. Chronic migraines, Chronic pelvic pain People, call this bladder, painful, bladder painful, prostate people who have chronic pain, Chronic CRPS complex regional pain syndrome. Or even Fenton pain. So a person being me amputated that body parts doesn't exist anymore but they feel pain in that body part. So this is not the plastic pain because the changes are in the pain system. Like the the brain is still processing that memory of praying and the person feels real pain.

00:10:00

Andrea Furlan:  So the problem is they are not visible. You can detect with imaging or laboratory study or blood tests, but we can detect some abnormalities when we examine the patient, like the sensations can be a normal. Like we can touch this key and a few pain or sometimes. We do some stimulation with painful impulses and they don't feel the pain in the skin. So there are some Exams that we can do at the bedside to detect if this is more nausea plastic or not.

8 Steps To Conquer Chronic Pain

Dave Candy: And in your book, you get into some steps of how to treat some of those invisible pains eight steps actually and…

Andrea Furlan:  Yeah.

Dave Candy: I noticed that I was going through that the typical things that we think of as treatment, like medication is step, six, physical therapies and manual therapies are step seven. So, basically what you do and what I do, don't come to a way down the continuum and…

Andrea Furlan:  Yeah.

Dave Candy: you describe why it's so important to have those foundational pieces in place, in order for the more traditional treatments to have a better chance of working.

Andrea Furlan: Yeah absolutely. And the order, the steps I on purpose, put the step one, retraining European system before you do anything else because a lot of people just by doing that they don't need the other seven steps. That's why I put that in the beginning. So what does it mean retraining the pain system? 

Retraining Your Brain To Heal Chronic Pain

Andrea Furlan:  It is using all of this knowledge that we have about nasioplastic pain. What it is. It's this problem of the malfunctioning and if the person can retrain, how they dispensed system is deregulated. So like it's calling the alarm company to your house and say You know what? The volume of this space the volume up. This noise is too high and you can lower this volume. Then you don't need medications, you don't need the everything else that you and I we do right the physical modalities because they're paying now is either gone or very low that they don't even need to take medications or apply anything to their body. So how do how do someone regulate the pain system? Dave, I'd say it's so simple, but Because it is so simple. I have a very hard time to sell this.

Andrea Furlan:  Message to my patients because they say, no, it's not possible. It is so simple like that. They want something more complicated, I think patients They want something that is. Injectable or requires a lot of effort and requires a lot of visits to the physiotherapist chiropractor. Doctors injections, they can't believe that something so simple could work. But I can tell you my most successful patients. Are the ones who retrain their ping system control. Their emotions which is step two. Took good care of their sleep, which is step three and started eating healthy, which is step 4. Then they don't need anything else, but so let me explain to you what is with training, the paint system. So, if we

Andrea Furlan:  and this would work if a person has nociplastic pain again, if someone has not susceptive pain like my my menstrual cramps that were every month, an inflammation of the uterus, probably would not work so much retraining, my pain system, But if a person has passed that face, and now they're having constant pain. That is not responding to an inflammatories. It's not responding to acetaminophen is not even responding to opioids. Because opioids are great for not susceptive and neuropathic pain. So if the person is taking opioids and they're steering thing, probably it is not simplistic pain. so, the way that they can retrain the pain system is, thinking differently about their pain because they're paying is basically

Andrea Furlan:  Telling the brain that there is a danger in their body, when there is no more danger, whatever, cause the pain is gone, it's healed. So if they had a tendonitis in their shoulder, well, the tendonitis takes we know you and I we know it takes exercise and inflammatories. But within three, four months that tendonitis is healed. That inflammation is gone. We all heal athletes the injured, their bodies a lot and they heal. We know they heal. The body is designed to heal but if they're still feeling that shoulder pain for three, four, five, ten years. That thing is is healed, the body already adapted to that. And what they're feeling is a memory of that thing.

00:15:00

Andrea Furlan:  It's not their fault again, it's real. I'm not saying that you are imagining this, you're making this up. No, we can see if we do bring images, we can see that their memory is there. The problem is now that that pain is ongoing and it's a stressful and you are in Hyper-vigilance all the time. Everybody that you every time that you move your shoulder, that thing lights up in your brain. So your brain, says, Oops danger again, danger, again, danger again. And so those messages of danger, they tire your brain, you are in hypervigilance and if you are stressed by that thing, now you can't be attention to anything else. You can concentrate, you can sleep. Well, you're fatigue doing the day. And then what happens is,

Andrea Furlan:  Start becoming depressed because feeling that pain every day is depressing. And so you are reducing the amount of physical activity that you do, you're more deep conditioned, you're not eating well, so, all of those cascades, we call that the fear avoidance cycle because you feel that pain in the shoulder. Your brain lights up all danger again and then everything else happens. You, you become the condition, more fearful, more stressed. And when you are more stressed, more adrenaline, more cortisol are released in the brain and then you feel the pain even more. So you have to revert all of that and you reward those by using that body part. So the physiotherapists are essential because they need to show the person, you know, you can move your shoulder. Let's move your shoulder but at the same time give the person messages of safety. Look, your shoulder is not broken damage. It's not illusion, it's good.

Andrea Furlan:  Functioning well. And then the more you do the more you bring starts believing that. So it's less fearful of the pain. And if you can reduce the fear of being they start building confidence that they can use that body part and that's when once they realize that, Oh my God, that's a big change because they believe that they can do things and they start improving and the pain starts getting less. Intense. So, that's the retraining of the pain system. And then emotions, the second step is essential because we know a lot of things that happen around us, that's the bio cycle. Connection Biology in psychology. We can't separate the mind and the body we can't. So the pain is not only in the body, it's not just a biological phenomenon. The body sends impulses to the brain, but the brain will interpret that pain.

Andrea Furlan:  So we we know from research that. If the person is having a good day, a happy day, less stress, more relaxed, they feel pain less, the pain is less intense.

Andrea Furlan:  If there are extremely anxious and paying itself, creates anxiety, then they feel more pain. We know that if they are angry with someone, if they think that they are victim of some injustice, if they have a tendency to be more pessimistic, we call this catastrophizing characteristics. People who always see the worst in any situation, we call this catastrophizing tendency, they feel more pain, they do feel the pain is more intense. So all of this can be retrained, They can learn to think differently about being justices that they suffered, the catastrophizing thoughts, the fears that they have the anger that they have. So

Andrea Furlan:  Those two things are extremely important and as I said, most people with chronic pain, nausea plastic pain, they do these two things and then they take care of their sleep nutrition. They may not need all of the interventions that we apply.

Dave Candy: Yeah it's amazing how often people get better after going on vacation, just because their stress is less. They're moving more.

Andrea Furlan:  Yeah.

Dave Candy: So that psychological connection is one. I think is really important to touch on and…

Andrea Furlan:  Yeah.

Dave Candy: then you mentioned the biology like, how you treat the nociceptive pain? Treating the tissues. But then there's another part of the biopsychosocial mark model of pain which is the the social part. And I think that's the part that oftentimes makes people suffer like well, other people think of me as my spouse or my children gonna think I'm a burden or my friends gonna judge me for not being able to do things with the kids? How do you how do people talk to their family and their friends and even their doctors about their pain without fear of what others will think?

00:20:00

How To Talk To Your Doctor About Chronic Pain

Andrea Furlan: Yes, that's really important because we know too from a lot of research. That. Isolation. For example, if a person feels isolated or they may have a perception that they are invisible and they may not be isolated but they have a perception that they are. Useless that they are invisible that they don't matter anymore, they will feel pain more. So, a pain that would be like, a level of one, two or three, you know. We like to give those scales to your patient zero to 10. Zero is no pain, and is the worst. I don't agree with this game, but we don't have anything better. but a pain that could be one, two or three, if the person feels isolated alone, neglected stigmatized labeled

Andrea Furlan:  We know the brain will alert saying You know you are in danger and again every time that the brain feels danger, it amplifies, those that suffering. Again, if a pain is one, two, three, but the brain is sensitized. The person will feel the pain like a seven, eight, nine or ten. And then what happens is, this person goes to emergency, they go to their doctor, their physiotherapist, and they say I'm suffering. I And so, suffering and pain. Maybe two different things because suffering is much more than just the pain. Suffering is all of this together is all of this frustrations.

Andrea Furlan:  And if they show up to a doctor and this doctor say, I don't know what to do with you, but I can see you're suffering. I can see you're in pain because you know, you're not doing anything with your life and then they give opioids. Which don't work for nociplastic pain. But the problem is how you communicate this to people. like in my book, I have the chapter that talks about How all of this? Social networks Influence or pain. So we feel more. If you are isolated, cultural perspectives, also change, we know that there are some cultures that they are more expressive. They're more allowed to express their pain, others are more suppressed. Mayo and females. They also express paying differently.

Andrea Furlan:  And how you communicate. So, in the book, I tell them, it's a really important that you use objective words with your families. They need to know what it means to be suffering. Your coworkers, people who are working their managers, they need to know what's happening to you. So instead of seeing you as a complainer You need to explain to them that what chronic pain is that is this disease of the pain system and is unpredictable? You never know when you're going to have a good day, a bad day. So you may need acommodation some days.

Andrea Furlan:  Also talking to the doctor, the doctors usually have very little time to listen to people and I have a privilege that I can spend an hour and a half with my patients because I'm a specialist being specialist but you know, family, doctors nurse practitioners. They have five ten minutes and then you bring a history of 15 years, 20 years of paying and you want to tell everything in those 10 minutes. So you need to be really precise and conscious about what you're going to say and you may bring a lot of X-rays MRIs and tests and once them to see everything, So it is really important, especially, especially if the person needs to use opioids, which some people need.

Andrea Furlan:  I'm not against opioids, Please don't take me wrong. Opioids are great for nociceptive neuropathic pain, not so good for nociplastic pain, they can make it worse for nausea plastic paint. But the problem is some people have all three types of pain and they may have a mix of neuropathic in osteoplastic. Which makes it difficult to treat. And in this case, they may need some opioids. And when you bring opioids to the conversation with doctors then they would think Oh you are drug seeking. You are addict, you're faking this pain just to get your opioids So it's important to explain that you. You understand your condition that you can even teach your physicians and nurse practitioners, about what this condition is because all those connections, all those relationships affect your mood, your sleep, your stress levels. And we know those things make pain worse.

00:25:00

How To Talk To Your Family About Chronic Pain

Dave Candy:  And then how about talking to family and friends that may not necessarily understand what you're going through.

Andrea Furlan: Yes. So for example, I mentioned this in my book that People with chronic pain. They sometimes they feel they are victim and they play the victim. So I tell them in the book, you know, it's think about this. Forgive be grateful for what you have and move on with your life. Don't be, don't play the victim a long time because your family Notice that and you need to be there for them and they need to be there for you. So when you're talking to family close to you about your pain, it is okay to say I'm in pain today but be very objective what you need from them. Don't don't think that they will read your mind.

Andrea Furlan:  I think a lot of people expect that if they stay quiet or locking their bedroom in the dark room, people will understand what they want. So please use words and use words saying I, I I just want you to be sitting by my side and hold my hands. That's all I need from you today. I just need you to be, you know, make me laugh. I am having a bad day. Can you just, you know, let's just watch some funny movie or show me some cat videos, or just tell me some jokes, but tell them what you need explain. What are your needs that you're having a bad day and you just want to, you know, light up your spirits, but some people don't and they expect their relatives children's spouses parents sisters brothers to read their mind,

Andrea Furlan: And see what they need. Sometimes they don't even know what they need, sometimes, they don't know, they're just feeling bad and horrible and miserable frustrated tired. And they don't know what they need. So sometimes what they need is someone to Encourage them. Tell them that they're going to be okay.

Dave Candy: Yeah.

Andrea Furlan: That they're doctors are doing the best that they can, it's not their fault that they are in pain. Sometimes even reading something for them, like open a book or we, you know, play your podcast to them and encourage them to get more knowledge about paying chronic pain.

Chronic Pain Support Groups

You know, Dave, another thing that helps a lot, I found my patients. If they connect with a group of peers people with lived experiences of chronic pain.

Andrea Furlan:  But people who have conquered their mountain, I tell them don't connect to groups, could be Facebook groups or personal in-person groups community centers. Don't connect with groups that they only complain and they don't have solutions that will not be healthy to you. But there are excellent peer groups that they deserve, people who want to help others to, because they conquered, that chronic pain, they want to help others to conquer to. So, find out in, on the websites, I have some resources in my book at the end that I list some groups of people across the world, United States, Canada, UK, where they can connect and find groups. Because sometimes telling another person who understands what you're going through, helps you to, you know, be understood and how you overcome the daily challenges.

Dave Candy: Yeah, I think it is important. What you said with the groups to find groups that build each other up and not just sort of commiserate and say, Boy life's really bad boy, was all of us. So I think that it was a really good point to bring up.

Andrea Furlan: Yeah.

Can Opioids Make Chronic Pain Worse?

Dave Candy: Now, you did mention the topic of opioids before and how that can actually harm someone who's having nausea plastic pain or can make it worse. Can you describe how that works with sort of your internal opioid system? And the role that opioids play with chronic pain?

Andrea Furlan:  Yes. so, when the pain system is sensitized. We call this central sensitization. It happens in the spinal cord.

Andrea Furlan: So the pain system is sensitized basically by pain. So if a person had acute pain, neuropathic pain, and that being sensitize, the pain system and there are a number of predisposing factors that put a person at a high risk of becoming sensitized for example, early childhood experience adverse, try it would experiences so,…

00:30:00

Andrea Furlan: Once the base system becomes sensitized, This means that changes have happened in how the pain is processed. And these changes can be in the receptors, in the periphery, like the muscles joins the skin in the spinal cord went where that neuron enters in the brainstem and in the brain itself.

Andrea Furlan:  We know that when the pain system is sensitized if you, There is a, there is also an imbalance on how this neurotransmitters are produced. so, they lack serotonin in some synapses in some parts of the brain, which is a neurotransmitter And the the endogenous opioids are also in balance. They have some areas that they lack receptors for opioids in their brain. And there are other areas that the opioid receptors are active activated by what we call NMJ receptors. So when those imbalances happen in the pain system, if you give opioids, the opioid will activate some NMDA receptors. I know I'm talking some hard names here but I don't have another better name for them.

Andrea Furlan:  The NMDA receptors. I usually activated by glutamate. But in this case, they can be open and the opioids that the person is taking by prescription will activate the receptor and then it will amplify the pain. We call the name, the scientific name for this is called opioid induced hyper algesia Which means, hypergesia means more pain. And it's induced by opioids. We know this is a very real phenomenon. It's not imaginary it happens.

Andrea Furlan:  And so we need to be really careful for whom we give opioids if they have nausea plastic pain, not everybody will develop opioid induced hypogeysia. But we see this. For example, if a person, the pain is spreading to other body parts, if the pain is still present, even if they're taking opioids, they still have, you know, some intensity of pain. And sometimes we touch the skin, we touch their, you know, their muscles or skiing, and they feel a little bit of pain. So that's hyper allergies. Yeah. We know that the opioids are not doing a good job and we need to lower the dose, We call this tapering opioids. And when we taper the opioids, the pain either gets better or the pain doesn't change. But we I have been able to taper opioids from a lot of patients and they don't feel worse. They

Andrea Furlan:  To the point that some patients were taking opioids for 15-20 years and now, they're taking zero and they come back to me and they say, I don't know, I was taking those opioids. They were just giving me a lot of side effects. And my pain is the same, I still have pain because they have that chronic pain, my pain is the same or sometimes, it's even better my pain now, but the process Dave to taper, the opioids may be really hard on people. Especially for those people who have been taking opioids for a long time.

Dave Candy: Yeah, and so definitely something to do under medical guidance. If you've been taking them for a long time.

Andrea Furlan:  Yeah. Yeah.

Conclusion

Dave Candy: Now you gave a lot of good information today if people listening want to find some more of your resources, what other resources do you have available?

Andrea Furlan:  So I I have a lot of videos that I posted on YouTube. I open a YouTube channel four years ago and people can find me doing demonstrations of exercises. I have also demonstrations of how to activate the passing pathetic nerve system because that is to reduce the stress and I do have videos about diet nutrition. So, I have a YouTube channel. It's just my name, @drandreafurlan. And then I have the book where I kind of summarize, a lot of those messages that I have in my videos. My book has keyword codes, linking to some of my videos, not all of them, but just the main videos that I have in my channel, I have QR codes in the book. 

Andrea Furlan: So the book basically is  a manual, a guide on steps that the person can take. Not everybody with chronic pain. We need to do all the steps, but they are there for people to read and try to apply the principles in the book. And I have testimonials also on my channel people who have conquered their chronic pain mounting. I have a lot of cases in the book of patients that I've seen in the pasta, 30 years things, that worked things that didn't work. I have lots of stories to tell. I couldn't put all of the stories in my books. So I put some of them, not all of them. and I think it's a practical guide if people want to have an idea like a map where to go, With their chronic pain. And because it's not easy. Chronic pain is a chronic disease.

00:35:00

Andrea Furlan:  It's almost like a diagnosing. Someone a diabetes. Imagine Dave, if I diagnose, someone with diabetes and the person had never heard about diabetes, let's say that a person never heard about the disease diabetes. And then I say, Okay, you have diabetes. And I want you to do insulin injections many times during the day, many injections, every day, I need you to change your diet, I need you to lose weight. I need you to exercise more. They will say, you're crazy. You're just telling me that I have this disease. That is just a few letters and telling me that I need to do all of this. They will not adhere. To my treatment. What I offer. But if the person goes and they study get a little bit of knowledge. What is diabetes? All of those recommendations will make sense.

Andrea Furlan:  So I think that's what I hope. The book will do, give them the knowledge about, what is chronic pain. And then when they understand what is, chronic pain, mainly nausea plastic pain. They will understand why they need to do exercise because they are actually doing exercise to retrain their pain system. Why they need to do the meditation mindfulness, brain relaxation is because they are fixing their pain system. Why they need to exercise, it's sleep. Better do nutrition because all of this contribute to fixing that alarm system of our body. So I think, if they understand what is chronic pain, they will adhere to the recommendations. We we give to them like you are the expert in exercises modalities. But if you just tell a person oh you have current pain, go into exercises. If they don't understand why they need to do, I don't think they will adhere with excitement.

Dave Candy: Yeah, I agree. If you just tell someone what to do, it feels like an order. But if they understand the reasons behind doing it, then they're more likely to choose to do it for themselves. So just kind of wrapping up here,…

Andrea Furlan:  Yeah.

Dave Candy: what's the final closing thought that you give to someone who maybe suffering with chronic pain right now?

Andrea Furlan:  Yeah, first of all I'd like to say your pain is real. You're not imagining this. You're not faking it. I know some people don't believe in you. but, The things are changing. We are training the next generation of healthcare professionals. And we hope that they will understand that chronic pain is a disease of the pain system. It's not just a symptom and your pain is real and the second message is this hope don't give up.

Andrea Furlan:  You don't need to take this alone. There are professionals that are trained to help you. There are groups of people who have conquered a growing pain and they're there to help you. You just need to find them, don't lose, hope don't give up. There are a number of different things you can do lifestyle, changes modifications. They're not easy to make, but if you choose one by one by one and you make those changes in your life, you're going to see that you can have a better quality of life. Fulfill your dreams your goals in life. Do the things that you like, despite having chronic pain, it is possible. I've seen David has seen this. And there are many patients that could be giving you testimonials that it is possible. So don't give up.

Dave Candy: Well, thank you so much Andrea for taking the time to share your information today. And for those people listening at home, if you are interested in getting more of Dr. Furlan's information. I'll put the links to her book as well as her YouTube channel in the show notes here and if you did enjoy the information that you heard today, please subscribe to the podcast so you get notified of our future episodes. Thanks for listening.

Want To Learn More?

Check out Dr. Furlan's Book 8 Steps To Conquer Chronic Pain

And Dr. Candy's Book Chronic Pain: You're Not Just Getting Older, You're Not Crazy, And It's Not All In Your Head