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Keep Moving Pod Transcripts

Episode 8: Pain Relief or Healing?

All right, welcome back everyone. On this episode, we are going to be talking about pain relief and healing, the difference between those two things, where they overlap and how the distinction becomes very important when you're discussing treatment options, either with your doctor or researching for yourself. So the reason why this is an important distinction to make is because it's often not made, meaning I believe there's a blind spot between even recognizing it in conventional medicine, a blind spot of even recognizing that there is a difference between these two things. And we'll get to more of that as we go through, but let's start with just some definitions.
So what are we, what are we going to be talking about here? So pain relief is the alleviation of a symptom, right? So pain is a symptom. It generally, but not always, is associated with something called nociceptive input. So you have, you don't quite have pain receptors in your body. You have nociceptive receptors, which are receptors signaling tissue damage. Now, sometimes that results in the conscious output of pain. Sometimes it doesn't. A lot of that has to do with psychological stimulation and context. There's an idea called the, the biopsychosocial model of pain that really is comprehensive in describing this, which we won't get into in full detail. but the the bottom line is pain is generally associated with Nociceptive stimulus, but not always it can be overridden by really heightened states psychologically it can be Flipped on its head and you can have pain in the absence of nociception However in most people most of the time, you know, you burn yourself you cut yourself That's a nociceptive input your your brain outputs pain So pain relief is the alleviation of that phenomena Pain is a symptom of an underlying process of damage in most cases pain relief is the alleviation of that symptom healing in this context that we're going to be talking about and we'll be talking about on different levels, but my definition of healing is going to be an an improvement damage or dysfunction.
So healing is not the full resolution necessarily, although it can be, but just the improvement of damage or dysfunction. So this can be damage in the tissue, dysfunction, dysfunctional nerves, dysfunctional movement patterns, but it's the improvement or resolution of damage and dysfunction. Now healing is a term that generally is gonna lead to the alleviation of pain, because pain is the symptom of damage and dysfunction. And so the distinction here, just kind of off the bat before we get into the specifics, pain relief versus healing. Healing should result in pain relief. And as we'll get through, there's some differences in the dynamic or the timeline, but healing is addressing the cause and pain relief is addressing the symptom. So those are the definitions and that's what we're talking about.
Now you can already see the distinction between these two things is an important one. And knowing if you do have joint pain, for example, or any pain in your body, understanding the difference between these two things and what it is that you're actually seeking and and what it is that you are, what your goal is with treatment becomes a very important one, because there's lots of things that can relieve pain that don't do any sort of healing. There are some things that are healing that don't have any short -term effect on pain. In the best case scenario, the thing that you do both heals you and relieves your pain sort of in parallel. are often on different timelines and so understanding that there is a difference between these things, the simplest way to think about it is the symptom versus the cause. So this can be also sort of more broadly generalized to just the difference between kind of allopathic medicine which is sort of your conventional medicine approach which is really just countering symptoms. You know if you have inflammation, you give an anti -inflammatory, if you have a fever, you lower the fever. If you know you have an infection, you give an anti -microbe medication, it's opposite medicine. You're countering, you know, you're countering symptoms with primarily medications that address each particular symptom. which is how you get people, you know, taking a medication and then you take a medication for the side effect of the first medication and then a third medication for the side effect of the second medication and I don't know, because it's, it's, it's a symptom sort of chasing approach. Again, not always, not all the time. There's obviously always exceptions, but philosophically it's, it's focus is alleviation of symptoms in a more naturopathic or integrative medicine approach where we are more oriented toward the cause of whatever the issue is, right? So if you have this kind of a non -orthopedic example, right? So if you have high blood pressure, you could give a medication that just lowers your blood blood pressure number, uh, which would be the, you know, the high blood pressure as a symptom, or you could say, look, you could probably eat less processed foods and, you know, increase your physical activity even slightly, thereby addressing the cause, which is cardiovascular conditioning and reduce blood pressure through that route. So they're both reducing blood pressure. They're both reducing the number that you see when you measure your blood pressure. One is directly oriented at a symptom. The other one is directed at the cause of the blood pressure in the first place. Um, so philosophically speaking, obviously, you know, with, with a lot of this discussion, we're going to be by definition, uh, kind of painting with, with a broad brush. Um, there's going to be exceptions to what I say. The exceptions basically prove the rule. They don't, uh, mean, you know, they don't invalidate the, the, the broader claims. And as we, you know, I'll provide as many specific examples as I can. Um, because there's some really interesting ones and we can talk about this on different levels.
So let's just start with the most basic. situation and example, you come in with joint pain. Let's just say the joint pain is from knee arthritis, right? A lot of people, it's the most common cause or the most common form of arthritis. It's a super common cause of pain in general. The pain relief approach for knee arthritis is going to be first stop moving, right? So if it hurts, don't do that thing. Second, it's going to be take ibuprofen, which is to say just reduce the inflammatory cause. That's sort of one step prior to the pain itself. And then a third option may be cortisone injections, which is another type of anti -inflammatory. All of these things, right? Stopping, moving ibuprofen and cortisone are Kind of your main kind of go -to options, conventionally speaking, when you have arthritis. And they are all explicitly symptom relievers, right? So the cause of pain when you have knee arthritis is degradation of the tissue inside the joint, which leads to inflammation, which leads to pain. So by stopping moving, you are feeling better in the short term, right? If you don't use it, it doesn't hurt. Great. But by stopping moving, you're also reducing and eliminating the anabolic impulse for your body to build back stronger, right? You're getting worse functionally in the long term, right? So again, the namesake of this podcast, the only way to keep moving is to keep moving. Stopping activity completely when you have pain is probably the worst thing you can do. Now, it depends on the dose and what type and all those things. But in general, we know well beyond the shadow of a doubt that when you stop moving, everything else gets worse. It's about finding what the right movement is for you. Okay, so ibuprofen or NSAIDs, but ibuprofen being an example of that, is another approach. First line therapy for arthritis pain does absolutely nothing to help the joint, right? It's suppressing the reaction that your body is having to the damage in your joint, right? It is addressing the symptom of pain without doing anything to help the joint itself. And actually, we know that ibuprofen inhibits glycoaminoglycan synthesis, which is one of the main components of cartilage. So you're actually suppressing a symptom. and harming the the process by which your body is trying to heal itself. And then cortisone is sort of the like the upper level or higher level version of ibuprofen where you're still an anti -inflammatory. This one is a steroidal anti -inflammatory injected directly into the knee. This too right is addressing the symptom of pain while undercutting the the quality of tissue in the joint. So it's addressing your symptom while making the actual problem worse. And that's why when we say or I shouldn't say we when when they when when a you know conventional sports medicine doctor. It says, oh yeah, cortisone helps with arthritis. It is patently false. It is bad communication. It's not informed consent. It's inaccurate, right? The correct way to explain this is that cortisone helps alleviate the pain of arthritis in the short term, while at best doing nothing and at worst, damaging the underlying joint and the underlying condition. That's the most evidence, I know obviously that's wordy, but that's the most evidence -based way to explain what cortisone is doing. It's a short -term symptom reliever that makes the underlying joint problem worse. So, let's go through, so that's an example with just joint pain as kind of a template now for what we'll do. So cortisone is anti -inflammatory that addresses the symptom.
In contrast, platelet -rich plasma, microfragmented adipose tissue, prolotherapy, the regenerative therapies that I specialize in are aimed at improving the tissue quality, right? They're improving the damaged areas, which is the problem, right? That is what osteoarthritis is, is the degradation of the connective tissue and cartilage surfaces in the joint. So, the cortisone is relieving the symptom, the PRP, platelet -rich plasma, the MFAT, the microfragmented. microfragment adipose tissue and to some extent, prolotherapy or regenerative therapies that are addressing the tissue quality in the joint and thereby over the longer term, resulting in pain relief. NSAIDs like ibuprofen and Aleve and aspirin, opioids, painkillers, right, are a symptom reliever. Physical therapy, for example, would be the opposite of something that is anabolic, constructive, health -promoting, better in the long term, actually addressing the cause. You could loop in things like nutrition, general care, like general lifestyle habits, getting good sleep. These things like taking care of your body, of which sort of physical therapy and training and strengthening and fitness, you know, being functionally fit. healing like movement is healing and it's I would argue probably the most sort of it's not it's not necessarily a competition but if we're if you had to pick one thing right it's either sleep or movement that are the most healing things for our being for our body so painkillers are pain relief movement in the form of PT or fitness lifestyle nutrition and sleep are healing they're improving damage and dysfunction you have ice and heat that's kind of a superficial one ice is numbing the area right so it's relieving the pain just through numbing it but reducing blood flow and actually making it harder for your body to heal and this is like you're sort of after an acute injury heat on the other hand is going to have a beneficial effect as far as circulation and eventually getting healing in the tissues in terms of foot and ankle health which I'm you know very intimately involved in and have a lot of experience with you have things like orthotics and arch supports which for most people most the time feel better in the short term like if you put in an art if you have some issue whether it's plantar fasciitis or or you know any any number of common foot issues and you're given an orthotic you tend to feel better in the short term like within you know the first month right like oh you could you know you had heel pain and now you have less heel pain and you can walk a little bit more or walk with a little less pain with your orthotic now that's addressing a symptom which is without getting too much into the specifics of foot health in this podcast Yeah, you should listen to my previous one about the kind of diving deep in here But the orthotics are addressing a symptom which is improper Function improper alignment and improper strength or or deficiency and strength in the foot It's propping the foot up Which is gonna and in a lot of people have a short -term benefit while Undercutting the health of the foot over the long term making it weaker making it more dependent on increasing support So orthotics are a short -term pain reliever and this has been proven in studies right there has never been a study Published on orthotics and arch supports that show a long -term benefit Whereas proper alignment and strengthening of the foot is healing Right, that's gonna be actually healing your foots gonna be improving the health of your foot not just addressing the symptom Now The other distinction we can make in the general, this is not, again, this is not always true, but one sort of thing or facet of this dynamic is the timeline. I think this is really important because people tend to not be sort of fully informed of these dynamics where symptom relievers, so pain relief tends to be a short -term, short -acting, short -term solution. I hesitate to call this a solution, a short -term strategy. Whereas healing and measures that actually heal us take longer. Sometimes longer can just be a week or two, sometimes it can be a month or two, longer than the short -acting symptom reliever, but it tends to be, cortisone's gonna help you feel better tomorrow, PRP's gonna help you feel better next month, and it's gonna help you feel better and better the longer the timeline is for you. So if you say, well, I'm really concerned with six months from now, then regenerative medicine versus cortisone, there's no question. But if you're saying I have a race next week or in three days or I have a vacation next week and I just don't want the pain, forget about healing, I just don't wanna feel this thing anymore, then cortisone's probably the way to go because it's short, it's gonna act in the short -term and you're gonna be worse in the long -term potentially, but short -term, long -term is another good distinction. Most people that I meet in most of my patients when I explain the difference say, look, you could probably feel better tomorrow if we do cortisone, right? But if you're concerned with resolving this thing over the long -term, like resolution, healing, like putting this behind you, then... what we want to do is is deprioritize the short term you're in this for the long run right we only get one body and you know take a month or two do rehab we'll do treatment and you'll come out the other end of it you know whether it's one month or three months or whatever the timeline is for different people depending on their condition you'll come out the other end of this with with some healing right with some actual improvement of your condition not just symptom relief and then two months later more symptom relief and then two months later more symptom relief and then you look up and your joint in this example your joint or whatever it is you're treating your tendon is worse than it would have been had you done nothing right because the symptom relievers are have a have a side effect of making the underlying condition worse Now, what I find also interesting about this conversation is that it works on multiple levels, right? So I mentioned the biopsychosocial model of pain. One of the reasons I love doing what I do is because pain is so interesting to me in terms of it's not a straightforward physiological response, right? It's an output of consciousness and we can modulate our pain response depending on you know what our conscious experience of things are. A good example is like if you were to work out, you know, you feel the burn of like muscle failure. You know, you do push -ups or pull -ups or whatever until you can't do anymore, right? Like failure mode. You do as many as you can and that sensation that you have in your body is not exactly what you'd call comfortable, right? It may be actually painful. However, in the context of working out, the burn of your muscles is a positive one, right? It's it is the like that is the sensation of growth, right? That is the sensation of of change, of improvement, of you know of whatever, of discipline, right? And that's we associate that psychologically with a positive valence. If you were to just have the pain that you have when you work out, I shouldn't say pain, the sensation that you have when you work out but you just woke up one day with it and your muscles were just burning, this would be a negative valence, right? That you would not feel good about that, right? But because of the context of pushing your body on purpose, right? We we can adjust the interpretation of our sensations. And so pain relief and healing can be talked about in that psychosocial realm as well, right? So pain relief right, or the addressing of a symptom or the addressing of pain psychologically, right, you can distract yourself, right, you can engage in diversions, right, you can binge watch a show and just and just really like kind of disconnect from your life and from your thoughts. Right. And that would be an example of pain relief, right, you're using a diversion to relieve in the short term, the pain or discomfort that you're feeling, whereas the healing of that psychological discomfort or pain is generally going to come through as opposed to distraction and diversion is going to come through introspection or examination or write the the the facing it the moving through it right not avoiding it and being averse to it from a substance perspective right we have alcohol alcohol is a really great example right a socially acceptable substance that is used to you know as a social lubricant to relieve tension to relieve anxiety to relieve discomfort to relieve pain but obviously in the in the abused situation right with alcohol abuse you're really making the underlying pain worse because you're not addressing it right and so you have on the flip side you have things like psychedelics which are you know with with the with the enormous caveat here of you can have very different experiences all this is very context -dependent just like with alcohol you can use it well or you use it unwisely but in contrast to alcohol which is going to be a short -term reliever of some symptom psychedelics provide an opportunity to in some cases feel much worse in the short term right if you have a really intense experience on a psychedelic substance right it's not that it's like all you know smiles and rainbows but it can be really extraordinarily intense uncomfortable painful but the research and evidence shows at this point really very very strongly that the use of psychedelics is associated with long -term healing and we and the the contrast here between alcohol and psychedelics is a really apt one because actually the use of psychedelics has been shown to greatly influence and be a very good treatment for alcoholism and for addiction and so here you have right not necessarily at all having to do with any sort of physical pain, but very much having to do with psychological pain or emotional pain or social pain, um, mental, emotional, whatever, there's different words for it. But alcohol is a pain reliever in psychedelics or are a healer, right? You're going to feel better in the short term on alcohol, which is how you become addicted because you just could chase the short term alleviation, right? While making the underlying cause of your pain worse by not addressing it or the healing power of something like psychedelics is that, yes, maybe you feel worse or more intensely in the short term while again, in the ideal scenario, while in the long term or over a longer stretch of time, the underlying cause of your pain begins to heal and your pain relieves as a function of healing, not. as a function of suppression, right? And so suppressing your symptoms allows the underlying cause to fester by engaging in a healing process that may create a short -term setback, but that is geared more towards the long -term. We are actually addressing the underlying cause of the pain and thereby creating much more long -term success. And success in this context, meaning, actual alleviation of the issue at its root, not just suppressing the downstream effect that it's having. So I think that's a really useful thing. Again, it's not just about physical pain. And I think our society in certain aspects, Western or American society, right, is really good at seducing people into the short -term alleviation of discomfort, right? That's basically what hedonism is at its root, right? You're feeling stressed, you're feeling anxious, you're feeling depressed, you're feeling lonely, you're feeling worthless, you're feeling shame. The solution to all of that is to consume, to buy, to subscribe to a streaming service, to eat bad food, to drink alcohol, right? To do these things that are all short -term distractions or short -term relievers of an immediate symptom as opposed to getting to the root of why it is you're anxious, why it is you're stressed, why is it that you're depressed or lonely? you can choose to address the cause or you can choose to just continue to chase the symptom relief. The other so just another example right is going to be with with the sort of weight loss phenomena that's happening right now which I don't it's I hesitate even saying this as an example but it's the the Wagovii or osempic the use of these drugs the weight loss drugs as a way to address a symptom right so being overweight as a symptom of something versus developing healthy habits essentially right and I think there's a big distinction between you know just labeling people who are overweight as unhealthy I think that's not constructive and certainly not judging people based on their appearance because you have no idea what other people are going through so I'm not making the distinction of you know, overweight people are unhealthy and skinny people are healthy But that's part of that's part of the the facade here is that the osempic wagovi craze is conflating Thinness with healthiness and it's it's a very common thing that people conflate and it's a very dangerous idea because People just want to have an aesthetic as opposed to the habits Right, you can look Skinny in clothes and be profoundly unhealthy, right? And you can eat well and move well and sleep well and still be a little overweight, right? And and the outward appearance of different people Is it can make it very hard to tell which is why you shouldn't judge people based on their appearance, but This also fits into this box of the osempic craze is addressing a symptom Which is excess weight as opposed to the promotion of things that address the underlying cause And I think that the big distinction is like the the outward appearance versus the hat and I think the aesthetic versus the habits It's kind of a good way to think about but it's just another example of this symptom relief versus root cause so Hopefully all those examples are are helpful I think when we get down to it clinically, there's some important points to for everyone to understand Number one is that there is no Absolute right or wrong here. There are reasons to want short -term pain relief or short -term symptom relief There's there's simply good reasons to want those things And obviously Like I said, most people that I talk to when I explain these kind of things to my patients They're like, oh, well, I want the healing thing. Like I don't care if I feel better next week Like I want to be I want to I want this to be resolved, right? Okay, so most people I think when they given the choice want healing right they want to be they want the tissue to be healthier right they want to be healthier they want resolution of the damage they don't want to just cover it up right another analogy that I like to use with patients is you know the short -term symptom relievers especially like cortisone is you know you you have pain imagine pain like feeling pain in your knee or whatever in your back whatever feeling pain is your smoke alarm going off in your house cortisone is you hearing the smoke alarm and being like man that is really annoying and then you reach up and you take the batteries out of the smoke alarm and you go man that noise is gone I feel way better I'm glad I'm glad it's not making that beeping sound anymore Meanwhile, obviously, you know, there's smoke filling the room and you haven't done anything to put out the fire Whereas doing regenerative injections again, we're in the kind of going back to the example of neo osteoarthritis Instead of taking the batteries out of the smoke alarm. We're hearing the smoke alarm and we're saying, okay Where's the smoke coming from? Let's go put out the fire And these are fundamentally different approaches. And so there is no Right or wrong necessarily. I think the big thing is that You have to simply know what you're doing and why you're doing it And in my experience, most people get a really bad Park you a park Park you is a medical acronym. It's a term. It's basically the informed consent So Park use an acronym for procedure alternative risks and questions parq So when you're going over treatments Like a treatment that a doctor is recommending. They should explain the procedure. They should explain the alternatives They should explain the risks and they should allow time for questions, right? That's sort of this basic template for like good medicine like very basic, you know, like low Low bar kind of good medicine in my opinion but most people That I talked to have gotten very very poor par cues They have not gotten informed consent and I know this because I asked them about what their view of for example Cortisone is right and they were in there and then they're they're not Told and they're not communicated to that. Cortisone is only a short -term answer They're not communicated to that. Cortisone will make their joint worse in the long term. They're not communicated to that. There are alternatives to Cortisone They're not communicated to that. There's risks to Cortisone, right? People especially with foot and ankle or I see this on foot and ankle patients where people get Cortisone for neuromas which is a nerve condition between your toes essentially and They've had three four five Cortisone injections, right? The doctor has stopped to be like hey this fourth and fifth one like there's quite a bit of a risk here because we've done so many and by the way the skin over your foot where we've been injecting is now purple because we've atrophied and thinned the skin by doing so much cortisone right and that's a risk and it's a risk that most people aren't told about and that maybe they sign informed consent but again it's bad medicine if your doctor is not going over these things with you verbally and so it's not about that net you know that that choosing the healing modalities always better right as we'll talk about there's reasons to want the short -term benefits and as an aside to you know I drink alcohol occasionally I watch Netflix I watch sports like I I get the the sort of I'm not immune to these sort of the allure of the short -term relief like You know, I engage in all of these things that I'm criticizing and to some extent or another I mean, I think I can get into you know Alcohol I've you know, it's it's in a lot of a lot of moderation, especially as I get older I drink Remarkably less than I used to when I was younger in terms of distractions and diversions, right? Like you can like watch a show right now. I'm watching the Americans. It's a great show I'm you know, I watch one episode at a time probably, you know a few times a week, right? So 45 minutes, I'm never watching You know two three four in a row right the binge watching right is this sort of socially acceptable way Culturally socially acceptable way of kind of just zombifying your mind Which which I don't find useful and even with sports like I'm I legitimately enjoy watching sports And I hate commercials and so I've just I've adapted to ways of watching sports now like I'll record a game that I want to watch in and Start it, you know an hour after it actually starts and then fast -forward through the commercials or I'll do that Plus I'll only watch the second half so that I'm not sacrificing so much of my time Right. So anyway, the point is I'm not perfect. I get that, you know short -term you want to be diverted You want to have some short -term relief? Sometimes you just want to relax. I get it. It's all it's all a matter of dosage but Getting back to the joint pain conversation People are not informed at all well enough with these kind of conversations, so The the where I think this really kind of rubber meets the road is where people are told That Such and such works for arthritis, right? So they'll say Cortisone helps with your arthritis, which is what we said before it's it's not accurate Cortisone helps alleviate the pain of arthritis in the short term while making your joint worse in the long term. That is the evidence -based correct statement to make about cortisone. So again, it's not about one being bad and one being good. It's simply about knowing what you're doing and why you're doing it. I call this doing it, doing things on purpose, right? And this is just what informed consent is, right? It's not just enough to know like, oh this will help. It's like, okay, but at what cost? What else is there, right? Is there a better thing than cortisone for my grade 2 arthritis? And the answer is absolutely yes. Properly made, image -guided, precise, platelet -rich plasma is better than cortisone for grade 2 osteoarthritis. So And if you're not getting that, right, if you're not getting that kind of explanation, um, from your doctor, then they're not doing their job. Um, and they're, they're doing a poor job of even understanding the landscape. I think a big issue is that this distinction is rarely made and, and, and maybe even rarely recognized, right? So a lot of conventional doctors won't even realize the distinction that I'm making at all, right? They actually will think like they're not lying to you, right? They're, they've been fooled themselves, right? They actually think that cortisone is the only thing for arthritis, right? They actually think that cortisone won't damage the joint, right? Or that it's your only option, you know, you're 45 with grade two arthritis. Let's just start with cortisone and basically sign you up for a knee replacement. Like, you know, it's coming down the pipe anyway, right? That kind of thinking, which is, which is completely ludicrous. Like it's, it's completely nonsensical, right? It's not evidence -based it's defeatist, right? It's, it's really just completely succumbing to the sort of drug surgery model, um, which is a very narrow and myopic view of medicine and health. So the distinction is rarely made. It's rarely recognized by professionals just because there's a blind spot. There's a significant blind spot to there being a distinction at all. And I think the confusing thing or the thing that perpetuates itself is that we do a thing like cortisone and your symptoms get better and you go, okay, well, Hey, like allopathic medicine, we're here to suppress symptoms. We did a thing. The thing got better. That must mean that you are better, right? And that's the sleight of hand. That's the trick is that like your symptom getting better does not mean that you got better, right? And we don't have to just say this in terms of like philosophy or linguistics. Like we, we know this as a consequence of long -term controlled evidence -based studies, right? There's been studies. published in JAMA, the Journal of the American Medical Association, one of the top three journals in the world, doing a two -year follow -up period head -to -head between cortisone and PRP, and PRP is better. It's placebo, or I'm sorry, cortisone is no better than placebo, and it makes the cartilage worse. And this has been confirmed by MRI studies. And so there just shouldn't be as much confusion around this. And then the whole another aspect is my article that I've written on the website that you should check out about PRP quality. So even if a doctor recognizes maybe cortisone's not the best thing for you, but hey, we have this thing that we do on the side, PRP, we can do that for you. And then what they're actually doing is some really crappy version of it, where they're not. drawing enough blood, they don't, they don't do it enough to know what they're doing. They're not, they're not recording their platelet counts. Um, they don't know what they injected. They're depending on a kit to make it for them. So they don't really have any idea about the quality of the product, right? And then when that doesn't work, they say, Oh, well, PRP must not work, right? But it's actually the whole thing is just confused because the, they're not really understanding the distinction in the first place. And then when they do, they're delivering a bad product or bad medicine to, which sort of proves the underlying point. So how do I park you my patients? I think that's a good way to kind of make a distinction. So when I talk to my, we're just going to keep using the knee osteoarthritis example, though this is, this is really transferable to really any condition. And I'll, I'll give another example to illustrate that, but with knee arthritis, all right, it's like, okay, you have grade two, which is moderate. Grade two, arthritis, you have cartilage, it's a little worn down. Um, but you're not end stage. You're not guaranteed to have a knee replacement. You're, you're fine. If you have this amount of cartilage for the rest of your life, you're going to be just fine. That's, that's like the perfect kind of sweet spot for people grade two, three. So what I tell people is, look, we could do cortisone. That's one option. That's what your, you know, what your sports med doc at OHSU or at Kaiser or at Providence is going to probably recommend for you. If we do that, you're going to feel better, uh, you know, tomorrow or, or next week, are you going to feel better in the short term? Maybe, or probably maybe not. There's a lot of people who fail cortisone injections, but saying everything works well, right? You'll feel better in the short term. You can, you know, you can, you can walk again, start running again. Now the risk is that you actually feel so good that you do too much and you do further damage to the joint. Right. We also know that. injecting cortisone into the joint and suppressing all of your inflammation is synonymous with suppressing all of your healing response. And so what you're actually doing is suppressing your body's ability to heal itself, which when taken too far becomes inflammatory pain, but when completely suppressed, is undercutting your body's ability to build healthy tissue. And so the risk of doing cortisone while you may feel better next week is that in two months, three months, four months, six months, you're gonna be worse than you would have been had you done nothing. Okay, questions, risks, there's always a risk of infection. That doesn't happen with me. We're very diligent. Alternatives. So alternatives to cortisone would be PRP, platelet rich plasma. Platelet rich plasma is a blood product made from your own blood where we spin down and concentrate the platelets that are naturally occurring in your plasma. The platelets are envelopes or packages of growth factors. The growth factors are cell signaling molecules that tell your body to heal. They switch on anabolic healing processes that improve the quality of the tissue, that resolve damage or improve damaged tissue. And also reduce inflammation over the longer term. Via, instead of anti -inflammatory compounds through pro -resolution compounds. With PRP, the risks are that you feel worse in the short term. So that you're gonna feel worse for three to five days. You know, stiff, achy, sore afterwards. And that you may not feel any improvement for a few weeks. And then obviously the risk with cortisone and PRP is that it just doesn't work. Like it doesn't do what we think it will do, right? So the cortisone doesn't provide relief. The PRP doesn't provide relief, right? The risk is with anything is that it doesn't work as intended. The risks with PRP are again, anytime we're injecting anything, an infection. But it's from your own body. There's no immune reaction or reduction there's no, you're not worse off because of it because it's not gonna be degrading your tissue or making anything, the underlying problem worse. And that's the kind of the full explanation. Any questions? So you can see there that that explanation. involves two different treatments. We're talking about the virtues of each the, oh, I know one, I know what I was going to say. The last thing with PRP is if, you know, assuming that it does work well, right? What we'll, what we'll see is that over time that you're going to have more significant pain relief over the longterm than you would if we were to do cortisone and your joint is going to be at least as good as it is now, if not better over the longterm. And so the pain relief happens, right? But it happens as a virtue of your joint being healthier, not as a virtue of taking the batteries out of the smoke alarm. So that's a full par -q on cortisone versus PRP. I don't think that most doctors do that. I don't think that most patients hear that, which is why you should see someone like me. but it's a good example of how that distinction between pain relief and healing is a very important one because I think if most people get that explanation that I just said, people are gonna pick PRP most of the time because it makes more sense, right? If you're concerned, if you're 55 and you're like, well, I don't care how I feel next week, like I wanna keep walking for the next 20 to 30 years. And it's like, okay, that's an easy decision then, right? And maybe it doesn't work as well as we thought. There's always failures, there's always reasons why maybe things don't work perfectly. But again, the general thrust of this is that if you want better joint health, you need to be concerned about healing. Healing can take a little bit more time, but it's fundamentally different than just being concerned with, make the pain go away as soon as possible. So that's with osteoarthritis, with something like a tendon tear, right? So maybe a bad tennis elbow, a rotator cuff tear, a plantar fascia tear. The Park U is a little different because the Park U goes something like, look, you have a tear in a tendon. Cortisone, I would not recommend at all because while it could make you better, again, while it could make you feel better in the short term with a tear, the risk is that it fully tears, right? That the cortisone chemically degrades the tendon and also shuts off your nociceptive inflammatory response so that you do more than what the tendon is physically able to do and it snaps. I actually saw this a couple of months ago. I had a patient who had a biceps tendon tear. They did not want to do PRP partially because of the cost and partially because they just wanted to play tennis as soon as possible. Again, I gave them this. exact park you ultimately it's not my job to tell people what to do it's to give them the the fun of fully informed consent and to do it we injected cortisone into the biceps tendon sheath she felt really good about a week later playing tennis for I believe six one to two months six weeks one or two months and then felt like a pop in her arm one day she came back and I scanned her and the little kind of partial tear tendonitis of the long head of her biceps had turned into a complete rupture and so you know that's a totally overcomeable issue you know it's not necessarily painful but it just it was a situation where she made a choice and the choice had a consequence and it's exactly what I warned Was the Like the downside is look if you do this thing with a tendon tear, you're not gonna feel your body's feedback of saying hey, we should not do this because we can't handle it and then Snapped off so Tendon tears. I'm much more adamant. I would just be like I would not do this whereas with joint stuff They've never had cortisone before. I'm like look, this is an option, right? You know, there's downsides to it, but it's it's up. It's up to you Which gets us into you know, the special cases basically athletes and Well athletes in particular tend to have shorter term time frames for their goals, right? It's like they I need to compete next week like we need to be better now, which is different Obviously generally athletes are younger by definition But I think those are totally legitimate reasons to do short -term symptom relievers Again, I think with athletes because there tend to be younger people There tends to not be a huge amount of long -term thinking in general and like maybe you regret it later in your life As far as you know doing damage to your body when you're 20 that maybe when you're 50 you were you kind of wish you wouldn't have done but That's a legitimate reason to want short -term relief, right? The other thing that can be a good example of this is like Important events or vacations or things where if someone's going on a trip You know a trip that they've had planned for nine months and you know two weeks before they get a you know planner fasciitis You know flare up. It's not the end of the world to just do cortisone And say have a great trip We'll see you when you get back and like heal this thing right when we have the time and the space and the in the runway to do so, but If you were to insist on doing like regenerative therapy when someone has a short -term goal like a trip coming up I mean the regime risk is that they feel worse during their trip than they did when they saw me. And so, you know, that's where just being careful with the parq and with the informed consent makes a huge difference. And I mean, one of the things I think sets myself apart, and that I really put a lot of intention and effort into is just communication, right? I mean, one of the naturopathic principles is doctor's teacher, I think the doctor's teacher, ethic in me, manifests itself a lot in just how I speak to people, both in educating them about their bodies, but also educating them about their choices and kind of going through all of this type of conversation tailored to each person's individual condition and circumstance, so that people understand what they're doing and why they're doing it, right? It's not what you do, it's why you do it, right? There's no good or there's no good or evil medicine, right? There's just there's just inappropriate use of certain tools. And actually, with athletes. You know, more and more athletes now are just using PRP because athletes understand also that like, like, you know, maybe, maybe there's a small difference in short -term relief, but ultimately like, if I want to keep playing this game, I need, I need my joints to like stay in one piece. Right. And so I, I don't want to, uh, you know, I don't know for sure. But for example, NBA playoffs just started Kawhi Leonard, um, has had chronic knee problems. He's a player, a very, very good player for the Los Angeles Clippers. He just had a knee injection. Uh, he's going to miss about a week, uh, I believe, and then, and then hopefully play, um, soon, but I'm pretty sure from what I can tell from reading about it, that he got a PRP injection. He's had knee surgeries. He's had issues with his knees for a long time doing cortisone in his knee. I assume, again, I don't know anything about his medical details other than what's been publicly, you know, um, Given, but it's very, it's the point is it's very popular, like in the NBA, golf, NFL, all sorts of different sports to do PRP now in season and certainly between seasons for the specific reason, right? You want to, you want to play, you want to keep playing, um, long term, right? And that, and that requires joint health, not just taking the batteries out of the smoke alarm. So, um, I hope that, that how to keys you all in on a, on an important distinction. I hope that this is, um, making some intuitive sense. And I hope that the, the physician that you're seeing is, is giving you this level of explanation. Um, if they're not, you should come see me, uh, joint pain from head to toe, foot and ankle specialty, musculoskeletal ultrasound expert, regenerative medicine, specialists, um, I really have the tools to really serve all of your orthopedic needs, uh, non -surgically. So. pain relief or healing know which one you're after know which one is the goal of your treatment and if you're not getting these explanations please schedule the visit with me today cascade from general medicine thank you all take care thanks for listening everyone if you are curious to learn more please visit our website at cascade regenmed .com you can follow us on instagram at cascade underscore regen underscore med And you can schedule with us today if you or anyone you know has joint pain arthritis sports injuries We'd be happy to answer your questions and help you out. Thanks a lot and we'll see you in the next episode 

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