Welcome back to the Healing Pain Podcast with Dr. Melissa Cady: Live The AntiPAIN Lifestyle.
I am so excited this week to be speaking with Dr. Melissa Cady. She’s the author of a book called Paindemic. She’s also known as The Challenge Doctor, who is driven to champion the cause of living the antiPAIN lifestyle and minimizing the current paindemic that is so rampant today. With the help of her website, PainOutLoud.com, her dream is to deliver information that empowers and guides people with pain relief. Her goal, really, is to reach more people than she could in her practice, which I love that because it’s another reason why I started the entire Healing Pain Podcast.
She’s a physician, trained in osteopathic medicine, followed by allopathic, post-graduate training in surgery, internal medicine, anesthesiology and pain medicine. Upon beginning her career, she realized that she had some reservations about going into a traditional pain practice in light of the current biomedical model we have that’s transitioning to a biopsychosocial model. She really believes that education is the way to empower those with chronic pain.
Live The AntiPAIN Lifestyle with Dr. Melissa Cady
I want to welcome Dr. Melissa Cady to the Healing Pain Podcast.
Thank you, Joe. I appreciate being here.
I read through your book, it’s a really wonderful book. It’s a great read. Everyone should pick it up. It’s called Paindemic. What I find with the book, and I know it’s difficult when you go to author a book and talk about it, but it’s got a pretty straightforward, frank opinion about what’s going on in the world of pain medicine, pain care today. I commend you on it because it can be a little uncomfortable to stick your neck out there. It’s one of the things that I do with this podcast, and say, “Look, we’re treating people with pain wrong. Here’s the direction we should move.”
Talk to me about maybe what the response has been around your focus, because you’re a physician. Sometimes, as a PT, you’re at the end of the food chain and the patient comes to see you last. I understand your frustration a little bit. A lot of physicians have yet to develop the insight and the level of attention you really have to this topic. Talk to us about your journey so far.
I think I was expressing my opinion so much that people got a pretty clear idea that I thought differently than them. I wouldn’t say I was considered an outcast, but people knew I was fairly vocal about it. I’m still part-time in the anesthesia world, which does give me a good view what’s going on, but at the same time I feel a dilemma of why is this person really having this. It’s really hard for me to still just do my job with doing anesthesia.
I had some people, even surgeons, they were so excited to read my book, and I think mainly because they’re hoping to get some insight. I think they probably did. It also made them face the fact that there are plenty of studies out there that show that what they’re doing themselves may not really benefit the patients. For instance, knee scopes, there are plenty of studies. There is always that occasional person that would benefit, whether it’s a foreign body locking up the knee or whatnot, some real obvious when you associate with the clinical history. There are so many people. They just think just because something looks not pristine and perfect like they were when they were five years old, that that’s the reason for their pain.
Most people that are very supportive in the community are already in their own life trying to be conservative and be thoughtful on how they take care of themselves. The ones that have read it that were thinking that they’d be excited and talk to me about it, they just went silent. I expect that. I’m not surprised by that. You’ll notice how I write it. It’s not just like I’m talking to the patients or the people out there with pain. It’s a little bit passive-aggressive with the physician population, hoping at some time, these patients will say, “I just read this book. Do you mind reading this and see what you think?” so that maybe they start getting an eye-opener.
It was really written for both people because the hard thing about physicians is that if you don’t integrate it into the initial medical curriculum, you’ll typically scoff at it. Not so much that you’ll 100% disagree. It’s just that it’s hard for you to prove to the people that are colleagues of yours that have definitely haven’t been trained in it either. I think it’s really hard for them to defend themselves. We know there are plenty of things in the medical school curriculum that over time have evolved. Even physicians smoked in the hospitals in the 1950s or whatever. We’re influenced by a lot of factors too.
The interesting part of that is that you are definitely not alone. I think that not only are there physicians that are coming forward, but also even within the physical therapy world, we’re looking at what we’ve done for the past 20-50 years. We’re saying, “Some of the treatments we’ve done as physical therapists don’t work for chronic pain.” We need to start to reeducate ourselves. We need to start to retool ourselves. We need to be open to other integrated strategies that may or may not be within our scope of practice, so to speak.
I just spent the last three months working with the American Physical Therapy Association around nutritional guidelines for a nutritional scope of practice for PTs, which traditionally PTs have never even talked about nutrition. Now, very, very slowly, we’re starting to change our perspective. We’re starting to change our approach. Because let’s face it, if someone comes in, they are 350 pounds and they have diabetes and metabolic syndrome, that we can move them and give them exercise and manual therapy and pain science education all we want. But ultimately, they need to work on healthy nutrition. They need to work on weight loss.
My question for you is you went through osteopathic school, which is not quite like medical school. It’s actually a little bit more holistic, so to speak. At what point did you say to yourself, “I really want to help people with pain, but what I’m seeing is not making me fulfilled,” so to speak? That happened in medical school? That happened during your first job? When did that occur?
Actually, I think there are pieces that happened. Before I went to medical school, I actually was working for a physical therapist. I actually woke up with a crick in my neck and some various things. It was just a real subtle, a little bit of distraction of the neck. It was not a huge mobilization, but they made me participate in it and told me what to do. It went away immediately. Of course, that was just a little bit of my history where it was almost miraculous. I didn’t understand it at all.
I actually was accepted into University of Texas at Houston to be an MD, at the same time be in Texas College of Osteopathic Medicine to be a DO. Now it’s all one application from what I understand. But I had to choose. I was just in the middle of trying to decide after working with physical therapists and being a personal trainer, did I want to go to massage therapy school? Because I just love the musculoskeletal system. As a DO, we’d learned hands on assessments and treatment with the hands, so I was like, “Why not have an extra tool?” I went to school there in my third year. I ended up getting back pain. I finally realized what had happened. We always don’t know for sure, but I’m pretty sure that when I was a doing a hot press in one leg and doing three plates, that it was too much for my hips and my low back to sustain. I felt a twinge. It didn’t really hurt so bad until the next day.
For a whole year, I was trying to figure out what this back pain, to the point where it was incapacitating me to actually be able to tie my shoes. I’m in my 20s. That situation, it took me multiple people. Finally, it wasn’t necessarily that I had a diagnosis, but I was taught the things that helped it and what made it better and what my body preferred. Over a course of a month to a year, it was definitely a lot better right away, but then it came and went a lot more, then it died off. It’s very rare that I have this. I put that in the back of my mind because when I get into all of my training, even though osteopathic school is more holistic in the sense of the philosophy, most of it is integrated with the same things that MDs learn. You’re still siphoned down this pathway of pharmacology.
When you think about anatomy, if it weren’t just for my hands-on and a little bit of perception of how the body moves. Physical therapists have a better perception of that than MDs. But as a DO, we still get a perception of functionally how the body moves, while the MDs, you’re working on dead people. That gives you no clue on how these people move. The tissues aren’t the same. I gained an appreciation for the variety of feeling of tissues. It’s really hard to just say that to an MD. Some people, even as DOs who are in medical school, they don’t get into it as much. They don’t just really enjoy it. Some people are just a little bit more physically-oriented.
When I go through the osteopathic school, I didn’t really think anything too much of it when it came to pain other than the fact that I was very grateful that an osteopathic physician helped and guided me. I did a year of general surgery, all these things you said. You’re just trying to survive. A lot of your notes that you write about patients are three alphabets long because you fell asleep on the keyboard. I really wasn’t thinking about a lot of that.
In my anesthesiology residency, I saw there was a pain service. A lot of it was acute pain. Epidural sounds cool. I love working with my hands during procedures. That was very fulfilling. Then, I was like, “I don’t know if I want to do another year of training. I can just go out and work. I’m not going to go back and go back to get trained later. I’m just going to do another year, get that under my belt.” When I got into the pain service, I started seeing what other people were doing in private practices. I realized a lot of these things were dealing with the symptom. Nobody was addressing the biomechanical evaluation of the patient.
However, I was very fortunate in my Pain Fellowship, of all things, we had a physical therapist that trained with DOs and chiropractors. He had this array of things that he helped patients with. Some people get better. Some people wouldn’t. The people that got better, really, the MDs, their eyes were like, “What? How did that happen?” They had these little epiphanies. The thing was, I was always the one that did the fewest injections. No one got mad at me because I probably saw maybe four to six patients a day just because I knew that I cared. Not that they don’t, it’s just that I had a different way that I looked at things. The patients, most of the time, appreciated that I was giving a lot of education.
Whether it was right or wrong, I think I learned more and more that what we see can be just like an MRI, that it can deceive us. That you have to keep in mind that it may not always be what you think it is. That uncertainty is really hard for a lot of patients and people who are just trying to help the patients. I think I realized that the most things were not right. I know it’s a long-winded answer, but this has been a progression. When I see people change a procedure, not necessarily my fellowship, they didn’t get the results or this gets reimbursed better, so why in the world would you change something for a patient if it’s just reimbursed better? Just changing even what you’re doing, it didn’t make logical sense to me.
To me, I’m always trying to think root cause. There’s so much complacency with just picking something that you get paid for that addresses the symptom. It’s not that I believe in bad mouthing our profession, but I do believe that you need to make patients more savvy and understand that if you don’t have a physician that’s trying to discuss what you can do and/or maybe the root cause. You got to be patient enough to work with them. If they’re showing some genuine interest in trying to understand what’s going on and not just getting moved on into the physician assistant lineup and they never see you again. No offense, I know sometimes that’s the only way they can serve lots of people in a certain population. We just have to be honest with ourselves.
I just went down to Australia, met an orthopedic surgeon who just wrote a book. I told him some of the things that I’m telling you that made me think, “Why on God’s green earth are we doing all these things when there are so many other ways that we can help people, or at least give them tools.” You can’t just make them so dependent on you. It’s not serving them. I told him all these things. He’s like, “That’s just wrong. That’s not the way you’re supposed to do things.”
He was saying it’s wrong that our population of physicians are doing all these procedures. He’s actually of the mindset that a lot of surgeries are being done that shouldn’t be done. He’s been in practice and probably will be retiring in the near future. He was of strong conviction, I’ll put it that way. Had no problems putting his neck out there and telling a physician who convinces themselves that what they’re doing is right, that they’re wrong. I respect that. It’s not always easy.
I like the position that you take because you’re really straddling the traditional pain medicine world, which you probably interact with a lot of orthopedic surgeons and pain medicine physicians, and physiatrists and primary care physicians. You also probably have contact with physical therapists and nutritionists and functional medicine practitioners. Like me, you’re talking to both sides. If you could bring out your crystal ball, what do you think the pain care world or the treatment of pain, what do you think it would look like in, let’s say, twenty years? What is it going to look like? The last 50 years, we have seen that we’ve gone through surgery, medication and injections as a way to treat chronic pain. Both you and I are cognizant that sometimes people need those things. What you and I are both agreeing on is that there are too many procedures basically. What could it look like in twenty years?
One thing I wanted to mention is that I feel that one of the bad trends in medicine, including opioids and other things, is we create a pendulum swing that’s too strong. We go to one side and then we reverse it all the way to the other. The one thing that bothers me is there’s great value in all kinds of practitioners. If we isolate ourselves completely from traditional medicine, there’s a time and a place, that advancement in medicine has its time. It’s mainly red flags when it comes to pain. It’s usually where you need the traditional medical system. I think there’s a danger too when you have someone that’s not privy to understanding those red flags that’s only caring for you and they miss something that’s life-threatening.
For the patients in our audience, can you explain what a red flag means in medicine?
To me, it’s more of an emergency. It could be an urgency, but to me, an emergency. Maybe you had an epidural injection or all of a sudden there’s a bleed and you just had back pain. If someone doesn’t think there are changes in their legs or maybe they’re not able to control their bowel or bladder and suddenly things are rapidly changing. You have to be astute enough to understand that these are things that can be emergent. If you don’t, then they can end up being paralyzed or an infection.
Those are the things you have to think. It’s very easy for any of us, and I’ve been guilty of it, you have a certain tool and you get so fixated on it. You just keep trying and trying within your own realm of knowledge and you never consult anybody else or you don’t collaborate with anybody else. You can actually be harming that patient. I say all that because the future is obviously a collaboration of efforts. When you look at the technology, we’re using a video right now. There are a lot of follow-ups that can be done after you’ve initially consulted and evaluated the patient. You feel like you know them well enough.
You can have all sorts of people, you talked about functional medicine physicians. You have chiropractors, physical therapists. You can have your physician. You can have someone who’s pain-trained physician. You can have someone who’s a behavioral therapist, cognitive-type of therapy. You can have all of them be able to witness maybe a dialogue that happens once. You collaborate maybe in one screen. There are different ways of doing it. When you look at the cost of healthcare, who knows what’s going to happen in the next year. There were problems before even Obama. It’s a medical problem. It’s insidiously been getting worse and worse. It’s just not been magnified as it has now.
The problem is that patients are starting to see that there’s not transparency and that they’re having to pay $3,000 or $6,000 deductibles. If they’re not spending beyond that anyway per year, essentially they’re paying cash. My view is that if you take out the middle man, and I am all for this, get back to the care. If you can create that transparency and people are already paying cash in the current way, they’re going to have to put their cash in somewhere. Why would you want something of less value than if you can just know where all your money is going, you know exactly what you’re going to spend and you know what you’re going to get. You have a supportive environment that you can go to. You won’t be changing doctors every month because you’re unsatisfied with the value of the care.
The future, I see, is one that patients become savvier. I already know there are plenty of unhappy physicians. There are 400 suicides a year for physicians. That tells you something. The system has victims treating victims, meaning physicians treating patients when it comes to pain. That seems really harsh, but they’re just trying to survive too. The people that pull out of that system that want to create good care are going to collaborate with other people, be humble enough to realize that they don’t know everything, that they reach out to patients that really want to get better.
There’s always going to be those people in life that are not willing to help themselves. Without naming names, I have plenty of people in my family who battle with morbid obesity and pain, that I’m pretty convinced that pain would not have been there, just because it’s been so insidious. It is a struggle with those that don’t want to help themselves. I feel like a third of the population is definitely ready to take the bull by the horns and do what they can for themselves. If you start migrating to that population, then the ones that aren’t as savvy will start picking up on that. I feel like it’s a ripple effect.
I think showing people value is extremely important and I also think leading by example, whether you’re a practitioner or whether you’re the head of the household, this is how we live our lives basically. This is how we eat. This is how we move. This is how we work on stress. This is how we love. This is how we sometimes create steam in the house, so to speak, to get rid of a little bit of anger and that’s okay at times. Ultimately, you come back to a healthy place. In your book, you talk about the antiPAIN Lifestyle. Can you tell us what that is?
There’s definitely a detailed definition. You can read it in the book. Essentially, it’s what we’ve talked about. We can challenge ourselves in multiple ways. We can use our own internal pharmacy, so to speak, too. In fact, I’m reading another book that’s great. Spark is a great book. It talks about exercise in particular and how it changes the brain and how it affects everything that processes there. That’s just one of many ways you can influence your pain. Sleep to me is the best way to start your new life. If you want to start new habits, just pick a day to have the best sleep ever. The next day, you start this new habit that you know you should be doing, maybe just eating something that’s not processed and creates inflammatory response in the body.
The other thing is that not everything’s inflammatory. Things can be a biomechanical thing, which is a huge gap in physicians out there. They don’t even rule that out. I’ve learned a lot about the McKenzie that has a place. I think it is a great rational approach to things too. There are a lot of people doing great approaches. The antiPAIN Lifestyle is just a philosophy. It’s not a definitive thing that I’m trying to trademark the actual lifestyle. This is a way for you to challenge yourself, do the things you can do for yourself, and then use the medical system appropriately so that if you’ve tried everything, you’ve got multiple opinions. It’s just like us curb siding anyone in the medical profession. We’re not always just going to take one person’s opinion. We’re going to get a few different opinions. The same thing for patients. It is a struggle. It costs money. It takes a lot of time. But when you get into a multidisciplinary or interdisciplinary place, you hit the jackpot a lot of times if they really work well together, if they can help you. Those are hard and they can be expensive.
The whole emphasis on antiPAIN Lifestyle is your lifestyle to move in a direction away from pain, and to use the medical system appropriately. If something’s happened that your pain’s so intense, that you really want and you’re struggling and you’re making your pain worse and you know that you need to do these things, then the medical system might be able to just bridge you. But you have to go in with the mindset that they’re juts bridging you. They’re not going to be able to live your life.
I tell people, I jokingly say, “You may know that walking is good for you, but if someone made you like a marionette and walked for you, it doesn’t have the same benefits.” You can’t be passive for too long. That’s essentially what I’m trying to get across there. You can add probably multiple things to what I even have there, but it gives people a starting place.
Ultimately, we know that when you engage with things, whether it’s exercise or positive cognitive behavioral changes, or nutritional changes or stress relief or sleep, anything that you actively engage with is going to alleviate your pain faster and probably more permanently than anything passive, other than those red flags that we’ve mentioned earlier. Red flags are things like infection and cancer, things that we all want to avoid at all costs basically. Tell me about your average day in the office right now, because you still work in a clinic.
It’s a surgery center. A lot of people, they assume, because I’m talking about pain, that I’m in the clinics. What happened is that my anesthesia world has transitioned to, half the time, we’re providing sedation for other pain physicians. I’m seeing a lot of high volume pain procedures, which is what’s escalated my voice to create this book. It’s not something I see myself doing the rest of my life. I think my boss knows that. For me, it’s an early morning and I take care of patients doing big procedures. It’s usually elective cases. I do nerve blocks to help them with post-op pain, which I get to educate them about how to manage their pain a little bit afterwards. The most disconcerting for me is when I see pain procedures and I’m being told to do heavy sedation for a lot of things that I don’t feel like always need heavy sedation.
It’s a little bit of a theory of mine. I haven’t proven it yet. I feel like the more you make people passive to the extent of always putting them under nearly a general anesthesia for an injection, you don’t train the brain to learn how to deal with a little discomfort. I feel like there’s more fear of pain. They can’t feel anything. They don’t want to sense even a little poke. I understand it’s uncomfortable. But I do believe that a lot of the preparation, how you educate patients, which is usually not happening a lot of times in these high volume practices.
The more you educate them and let them feel more reassured and help them understand what pain is and that it’s trying to tell you something, first it’s always obliterating it and not even wanting to get near it. We’re setting these patients up for lower tolerance, potentially lower threshold for anything in life. I don’t mean just physical pain. You’d find that they’re more sensitive to everything. Whether it’s because of the opioids, with the opioid-induced hyperalgesia, which is things that are painful but they’re excessively painful to people, it’s out of proportion to what you’d expect, or if it’s just because they are avoiding it.
I’m seeing a lot of this and it’s driving me right now to create a lot of thoughts to put into educational digital products. Like what we said earlier, if I can reach more people that way and not have the overhead on top of dealing with the whole medical system, you don’t want to work half your week just to pay your overhead. It’s running your wheels a lot. When you talk about the future and the clinics, that’s another reason that people are going to try to be more part-time in the clinic or share an office and do a lot of things, video-wise, to carry on that relationship. I think it makes a lot of sense.
With 116 million people with chronic pain, that’s a lot of people that we have to try to treat. Even if every practitioner jumped and said, “I’m going to treat chronic pain the way it should be treated,” the truth is you really don’t have enough practitioners. That’s why I wrote my book, Heal Your Pain Now. That’s why I have a program called Heal Your Pain, Heal Your Life. I love talking to practitioners like you who are really trying to weed through all these problems as fast as possible. Obviously, first, for the people who have pain, and then next for how do we wrestle our medical system to the ground and reshape it.
My last question for you today would be, if someone came to you today and said, “I live in Maine, which is far from both you and I, and I’ve had chronic back pain for ten years almost, comes and goes, but it’s there almost every single day. Plus, I have Lupus, which may or may not be contributing to it.” What would your recommendation be for them? Right now, this person has some ideas in their mind about the direction they’re going to take as far as treating their pain. Probably most of it is allopathic, which involves drugs and surgery and medications and possibly injections. How do you start to have this conversation?
Maybe my ultimate question for you is, where do we start educating people? Do we start with the physicians first in medical school? Do we start with the public first? Do we start with trying to get the pharmaceutical companies to not be as aggressive, which between you and I, I don’t think will ever happen? Where do we really start educating people on pain?
I guess the question is, if they’re establishing a relationship with me to get information or is it just a liaison and I’m just directing them? There are two layers here. I want biomedical, just assess that there are no red flags, especially with Lupus, if there’s any major laboratory abnormalities, just rule out that obvious stuff. Then someone that can curate the information to make sure that maybe she’s not seeing as being important that could be important. There are some therapists, like physicians too, who are really good at just weaning out or deciding or making sure that there’s no biomechanical thing that’s reversible. To me, that’s one of my biggest pet peeves about our system. Why are we not biomechanically evaluating? Rule out the red flags by biomechanically evaluating this patient to see if there’s something that is reversible and give them some strategies, which might take some reassessment and whatnot. I think that should always be the frontline when it comes to helping a patient.
I would try to, if I had the time and this is the situation, but reaching out to a primary care physician that’s open to a physical therapist. I do think with low back, McKenzie has some ways that they can reverse things fairly easily. There’s a certain percentage that are tougher. If there’s something really easy to reverse, why would we go through the million-dollar workup?
It’s not that I’m saying no to anybody’s abilities. If we just get a basic frontline. I’m actually considering going to the Functional Medicine Training this year. They know a lot of stuff that we don’t learn in our typical medical school either. Everything’s important, but rule out the red flags, try to do the reversible stuff first before you start tapping into symptoms and dealing with all that and letting our eyes fool us into thinking they need surgery. The injections themselves can be harmful too. It’s a lot of money and time. I see what people do. They come every two weeks. It doesn’t make sense. We’re not fixing it. It boggles my mind that people, as patients, don’t recognize this is not fixing you.
There is so much more from getting on the frontline. I do agree that physical therapists or biomechanically trained people should be on the frontline to capture those quickly reversible things that could be chronic pain later. Even just posture, people don’t recognize simple things like that. People don’t need a diagnosis when they’ve been out the garden for four hours and the next day they’re sore. They know what did it. The cause and effect is very clear, especially if every month they go out there one day a month and it’s always the next day. You could put that story together. It’s a little bit clearer to them. But people want a diagnosis. It’s not always easy to put a precise diagnosis on things.
If that’s not the case, if we can’t put a good diagnosis, we need to learn about the patient and what they favor, what they don’t, what works, what makes it better. You’ve got to guide the patient because they don’t always read things like that. It’s not going to be the case for every patient, but there are so many. The percentages of be being able to help people like that are higher than an MD.
We’ve learned so much as far as what works for chronic diseases. The more we look at chronic diseases, we figure out probably most of the medical things we’re doing may have its place. But really, the chronic diseases, we want to teach them the lifestyle factors. We want to give you some motivation. We want to give you some education. We want to really give you the support on how you can change your health, how you can change your family’s health, and how you can change your own individual, really, the body you live in on a daily basis.
I want to thank Dr. Melissa Cady for being on the Healing Pain Podcast. It’s been a great interview. Please check out her awesome, awesome book. It’s called Paindemic. You can check her out on her website at PainOutLoud.com. As always, check out my brand-new book, Heal Your Pain Now: The Revolutionary Program to Reset Your Brain and Body for a Pain-Free Life. Check out my online program, Heal Your Pain, Heal Your Life. It’s a six-week integrated program to help heal from chronic pain naturally. Until next week, I’ll see you all. Take care.
About Dr. Melissa Cady
Melissa Cady is a physician trained in an osteopathic medical school followed by allopathic postgraduate training in general surgery, internal medicine, anesthesiology, and pain medicine. Dr. Cady is currently board-certified in anesthesiology and fellowship-trained with a board certification in pain medicine. She currently practices anesthesiology in Austin, Texas while developing an online community, PainOutLoud.com and other educational products including her recent book release, PAINDEMIC.
Acknowledging that medical interventions have their time and place, Dr. Cady believes strongly that education is essential for chronic pain patients. In fact, her initial desire to become an author originated from the realization that one of the greatest needs within the medical system is education, which is undervalued, underpaid, and therefore, under-delivered. Whether educating the general public in a book or online, Dr. Cady wants to empower and direct people toward better choices and less pain while avoiding unnecessary medical interventions.
- More information can be found at www.MelissaCady.com.
- PAINDEMIC is available in paperback, audiobook, and ebook at www.paindemicbook.com or can go directly for purchase at Amazon.
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