Chronic Pain Needs Shared Expertise—not a Hero Clinician

Mark Kargela: ​[00:00:00] to give space to a person's story and all those things that sit below water that you speak of that takes, you sitting in front of a person and just, I always say, shut your mouth and listen. What they've been going through and all the things that you spoke of that your pain groups talk about and that jives with what the research is saying.

Everybody, welcome back to another episode. This week's episode a little bit different. I had Pete Moore, my friend from the Pain Toolkit. He does a monthly q and a in his academy. We do some great work over there, so we'll link his stuff in our show notes. But we're gonna do a little bit of a shared podcast where Pete's gonna share it with his group. We're gonna share with you all, these are basically questions from his audience, from the folks that are in the Pain Toolkit Academy.

Oftentimes lived experiences, but I do believe they have some clinicians in that group as well. So they posed some questions to me, and we talked a lot about things that are really all about really our mission and vision at Modern Pain Care, and also a shared vision and mission of what Pete's trying to do in his Pain Toolkit group.

So that obviously gets to really rethinking pain, getting beyond the tissues where we're treating humans and not [00:01:00] scans. We talk about listening as an intervention where really we just need to shut up and listen to our patients to let their story have a stage so we can make sense of their story with them.

We also talked about how sensitization flourishes when life gets small, and how we as clinicians can help widen life again, through helping share that expertise with the patient in front of us. We also talked about , this hero clinician role that we need to swap for a shared expertise where the patient is the greatest expert on their unique pain experience.

I think you're gonna like the episode. I'd love to hear your comments and if you're not subscribed, I'd love if you could subscribe to the podcast so we can get this message reaching more people. Enjoy the episode.

This is the Modern Pain Podcast with Mark

Pete Moore: , Hi everyone. It's Peter for the Pain Toolkit. And listen, look at this. I'm with Mark. I'm flipping the tables. I'm daring doing to flip the tables with Mark.

Hi, mark. How you doing?

Mark Kargela: I'm doing great, Pete. Always good to talk with you.

Pete Moore: Yeah, mate. Likewise man. Hey, listen, I'm flipping the tables a little bit because Mark's been doing a load of recordings with, people I know in the pain [00:02:00] management world and people I don't know.

And I find him super interesting. If you haven't seen them go to go and track down Mark on his I think I've taken it there on YouTube. I,

Mark Kargela: yep. Modern pain podcast on YouTube is where we're at.

Pete Moore: So whether you are a person liver pain or a healthcare professional. Then go check out Mark's interviews that he's been doing because you're about to increase your skills et cetera.

But anyway, I've I reached out to Mark a couple of weeks ago because we over at the Pain talk, getting myself Keith Meldrum and Dave Oxley, who we do the pain talk, get q and a. I thought it'd be fun to flip the tables.

Let's let's get cracking on the questions and I've had some interesting ones come through. First one's from a guy called George from the uk and he asked it's a Rethinking Pain, and he says, you emphasize the importance of rethinking pain, but can you explain what do you, what does that actually mean to you and how it influences your approach to treating patients?

Mark Kargela: Yeah, I think it goes back to [00:03:00] how I was taught pain, and I think in school and physio school, it was like we got to the gate theory, but was still very peripherally driven around. The tissues were really the determinant of what pain you felt, and there's some truth to that, right? There are situations where you break a bone and that.

That message pretty much is very clear with the pain experience that you feel is very almost proportional often. Although, you'll hear stories of veterans in battle who've had amputated limbs and carried them off the battlefield and with minimal pain 'cause there's so much adrenaline and other competing things going on.

So even then, situations aren't pain, isn't as neat and tidy as we'd think it was. So I think for me, rethinking pain means. Understanding pain is so much more than the tissues, and I think that was. Evidence in my career of failing with people when I'd only looked tissue deep at what was going on with them.

I just had 10, 20, sometimes 30% of my practice who weren't responding when I only focused on their tissues, and I would have a lot of difficult emotions coming into my treatment room. I'd have difficult. [00:04:00] Life experiences coming to my treatment room and different things that I didn't know how to process and understand much.

'cause I was like, well let's just talk about your tissues 'cause that's what I'm here to figure out and fix with you. I, people were like that whole body and machine narrative that permeates healthcare still to this day where people are like these mechanical beings that are just needing to be fixed.

And that's how I looked at pain for a while and then it, it was. Couple instances where I was ready to quit. 'cause I just felt like I'm just not good at physio. I can't these 10, 20, 30% of people just, I can't figure 'em out. I read Louis Gifford's work who's a pioneering physio over there in the uk, who unfortunately passed away too soon from cancer.

But I, he was probably one of the more turning point situations where I realized, and along with having some pain science introductions and. Just hearing stories of people, it was a big aha moment for me to realize that yes, if I just strictly focused on the tissues with people, I was doing 'em a disservice.

Because we know pain is a sensory and emotional experience as IAP defines it. Our big body of pain knowledge across the [00:05:00] world that people's experience and distress around their pain and how it interacts with our stress systems, our autonomic systems, our hormonal systems, our HPA access.

I'm not gonna get too nerdy into the science. Creates an environment where pain can flourish, where sensitization of the body and dysregulation of your gi, your, and your migraines and all these different things coalesced to create a very complex experience. And it takes much more than an interrogation of tissues to understand that you have to understand the unique human in front of you, their unique story.

Their unique experience, the unique things that have them distressed and worried about what they're losing in their life and how life has gotten small with them. So I guess that's the big picture way of how I look at rethinking pain as far as rethinking it more broadly from a whole person perspective, not just what their x-ray and their MRI looks like.

Pete Moore: When I'm talking to whether I'm coaching or just talking to healthcare professionals. Or patients in general. Really, I, after three months pain, we become co, I call it. We've become very complicated people because after three [00:06:00] months, when it's like pain's become persistent.

All over there. I know you may say chronic over there. When I, especially when I talk to patients, like, when you say, well, what are your problem? They never mention pain. They start talking about all the other stuff, sleep problems, money worries, and worry, just overthinking and stuff like that that, and that actually supersedes the pain itself.

So. I have to say after three months, like we've become super complicated, and and some, when I always say that we've gotta perhaps deal with those factors first before you can, I think the pa managing the pain will slot in. I remember being on our pain management program back in 96 that, when they went round the room, they was talking to, people very rarely talked about their pain.

They talked about how they can't sleep, they lost their mobility, their confidence, et cetera. They lost their job having problems with their family and whatnot, so, yeah, it's it's the thing I like, what I like about your work. Is, that you've had a bit of a re as you say, like, well bit rethink really, that is dealing with all the other stuff is really important but I [00:07:00] think most, I suppose a little bit of an add on question to that is how do we get your colleagues in, they're so anchored into the medical model, they're, so, it's like, oh, you're trying to get, I dunno if it's a, like when I say to him, what about doing? He say, well, we ain't got time, yeah. That's all that mumbo jumbo stuff like, and, but the thing is, unless you do deal with that stuff, I always liking it to that. One of the slides I used that the iceberg, where you've got paint at the top of the iceberg and then a below, you see a third of the iceberg, and then underneath the waterline two, the extra two thirds of it.

And paints a little bit like that is, is at the top, but all the other stuff be, the bigger stuff is below the waterline, and a bit we, what I found over the years is that. If you deal with that stuff below the waterline, then that will wind the pain down. Like, but what have you, what would you say to your colleagues who a bit stuck still in and not rethinking pain?

Mark Kargela: That is a question I toil with every day of how to reach them because I think there's a couple things at play there. I think there's systemic barriers. [00:08:00] That our healthcare systems don't give us the time, unfortunately.

And space to, to give space to a person's story and all those things that sit below water that you speak of that takes, you sitting in front of a person and just, I always say, shut your mouth and listen. What they've been going through and all the things that you spoke of that your pain groups talk about and that jives with what the research is saying.

Like Camper did a study on what people in chronic pain wanted out of an encounter, and 60% of them wanted to talk about issues in their life. It wasn't just. You know what their x-ray looked like. Some of that was Of course. Yeah. And that's fine. So I think, again, there's systemic barriers where we make it hard to give people's story, the time and stage it deserves.

And it requires if you're gonna really help somebody who's dealing with some complex pain situations. And then I do think there's some clinician barriers as well of. I've just recently had these discussions. I think clinicians feel the need to feel like they belong and there's that they have the knowledge and expertise to the point they want to be controlling the expert on this pedestal where we really try to [00:09:00] train clinicians that you need to understand that there is a shared expertise in the room.

That you are on the same level as the patient. You're both humans, right? And the person who has the most expertise on a pain experience is the person experiencing the pain. Right. And what uniquely it feels like with them. What things in their life affect it.

Yeah. How it's changed their life, what struggles it's brought about in their life as a result of that. And then that gives us the space to then help patients put pieces together. But how do we get clinicians to change systemic change is tough. I part of why I do the podcast and.

Social media content. I'm not a huge fan of social media on its own, but it's a vehicle to get this message across. 'cause I'd really try to put things out there 'cause I know if people are honest with themselves, clinicians, they know there's these people in their practice that require more than the what our systems are allowing and we need to give, those clinicians tools.

To be able to get a story to take a person's story in and validate it and help people make sense of that story and how it relates to their pain. So I tried [00:10:00] to put content out there that helps clinicians question what they're doing. 'Cause I was one of those clinicians who just felt like I needed more expertise so I could dictate and fix these people in pain.

There was, it was a and it was a me problem, but it wasn't more techniques. It was a approach of being able to. Suspend my need to be the expert in the room and really understand the true expert in the room is the person with the pain, not the person. And my expertise needs to fit in with that person where I can definitely throw physio and neuroscience expertise and things in there, but if it doesn't resonate with how it's gonna move somebody back towards their life, then it's not as much meaningful information.

I think that Switch is trying to help push clinicians to. To make that switch. It's not easy. I'd love to say I have all the answers for that, but it's part of why we do our coursework too. And I just got off a call with one of our students who's really feeling like, they've, they're making some big strides in their practice.

So I think we do it at a grassroots level to help clinicians start making a change. And then we highlight those changes with, sharing the stories of our clinicians who feel like their practice is much more meaningful, much more [00:11:00] impactful when they take this type of approach.

Pete Moore: Yeah, it's like we see like, like I sort to Keith about this and and other self managers and it's, like I was stuck, like, but it's like where it's like the healthcare professional gets stuck and the patient's stuck and they're they were missing each other sort of along the way, so. Bit bonkers, but I think he's gotta start, well, we've gotta do the work. But also I think healthcare, I think that the starting point is with the healthcare professionals because we're the guys that, the patients go and see for a little bit of guidance.

So I think it's gotta start from there. Okay, number two. So we've got Gwen from Australia and this is quite an interesting one, Gwen asked, the type loaded question is humanity and pain care you advocate for, bring you advocate for bringing human humanity back into pain care.

But what are some of the specific practices or philosophies you implement in your work to ensure that patient feels understood and supported through their treatment journey or management journey?

Mark Kargela: It piggybacks off of what we just spoke about, but I think. It's respecting the expertise of that [00:12:00] patient and the humanity of their experience.

Right? I think too often we get caught in the biomedical components of their experience where, their lab tests and their x-rays and all these things, which can have a place. I'm not here to say that those things aren't important, but the human story that revolves around pain is often what drives it to become persistent.

It's the loss. It's the not able to do the things that are meaningful to them. It's their life shrinking around their pain, yet medicine still gets so stuck on wanting to interrogate tissues and blame everything, and nobody just listens to a patient. It seems easy, but I can't tell you how many people I talk to that have.

Navigated a healthcare system where they're dismissed. The doctor wants to get to the next appointment. And I don't want to come across that I'm, I realize that there's physicians who are, have all the best intentions in the world. I was probably operated in some of these settings in my past where they just simply don't have the resources to give the appropriate amount of time and things.

And they're under pressure, they're burning out they have compassion fatigue. There's a lot of issues that create maybe healthcare interactions where. It's not the ideal [00:13:00] situation for the humanity, the experience to come out. Yeah. So I think understanding, just I think getting, that's why I love having interviews with people like you and Joletta and Keith and Trevor and Tom and others who are people that have been through it.

Because I think it's important for us to not lose sight of that human story that accompanies pain. And it's one that, as I talked to you all, who are lived experiencers, it's one that I'm dedicated to keeping front and center when we have events, when we have conferences, when we have things.

Because honestly, I've learned more from that. I've, I definitely have learned from continuing education within my profession, but honestly I've learned more from talking with people who've navigated their journey of how to better help them than what next technical skill I'm gonna learn in my craft.

So I think I tell my students, be a good human if that's the way you approach. Your care. Yeah. You're gonna probably do well. Like and what does that mean? This looks like it's been hard for you. Like, I'm so sorry you've been through this situation. How's this impacting your life? Like, pretend it's your mother or your aunt like and you, and it's not that we don't genuinely care, but I think we have this [00:14:00] like, I'm the clinician and you're the patient.

No, we're two humans in the same room. Yeah. I have my own struggles as a human. I've had pain in different things, not to, I'm not there to compare to patient's pain. 'cause obviously oftentimes they've navigated a much, much more difficult journey. But I think if you can take that approach of like, we're two humans trying to come together to make.

An encounter that moves them towards something that's meaningful for them. And I think too often we have a clinician agenda versus a patient person in front of us agenda that can get us stuck and struggling.

Pete Moore: To me it's I also have healthcare professionals that, that we got the fact, we've got two of these.

And one of those gives the, gives game ride really. And I would say learn to listen, learn learn to listen and listen to learn. Absolutely. At the end of the day, we are we do, I think what happens is we, like, like as I mentioned earlier in the other question that we get, patients get stuck in a med medical model and and we don't want to, we don't wanna be in it.

We want to get on with our lives sort of thing, but we're so anchored into it. And, but it's and we need to, we, so at the end of the day, we're the ones that have gotta be [00:15:00] doing all the work, most of the work really. So we're looking to the healthcare professional for, but it's a little bit, can I keep going back to learning to drive, do you drive? Do you drive still? Do you drive?

Mark Kargela: Certainly,

Pete Moore: yeah. So did you take driving lessons?

Mark Kargela: I did have to take some lessons with,

Pete Moore: yeah. Are you still taking them now? I am

Mark Kargela: not.

Pete Moore: So see, the thing is once the one people take learning the drive sort of scenario, they get up to require standard and then off we go.

But when you was learning, you was in the driving seat, driving, and the instructor sit beside you. He or she was giving you the guidance and information on how to go forwards or backwards and turning left and turning right. And you got up to required standard. You passed a test and bush off your, off your wing.

But, and that's it. And I will say it's not. It's not a relationship all death to your part, but as long as we've got that information, that self management information, we can get back on calls as well. Like, that's my old boss in when I worked in the NHS so Jane Thompson to remind me, we, we will learn more from our mistakes than we do. Our [00:16:00] success is like,

Mark Kargela: a hundred percent.

Pete Moore: We've got Harrison from Canada. How do you balance your responsibilities? What role do you believe education plays in helping patients and healthcare professionals? Understand and manage pain more effectively.

Mark Kargela: I think education is huge. I think another reason we produce a lot of the episodes where patient stories are there is to help patients. It's, I find it more powerful for patients to hear it from people that have walked in their shoes. I think it's the most powerful learning experience that.

Can happen for some patients. And often that comes with those people who've experienced it in our lived experiences, reflecting their understandings of pain and different things. So helping educate patients. I think I, I've, my approach to educating patients is a little bit more of a invitation, not just, I'm gonna.

Slam the patient with information whether they want it or not. I think I try to be a little bit more selective with, yeah, where the person's at, what they're ready to hear, what kind of things are in their way that might benefit from maybe a, [00:17:00] some education that might help them consider a different perspective and then help them work themselves through that perspective.

But. As far as education of students and even fellow clinicians. 'cause we do post-professional education and I work with students in the clinic. So my favorite thing, like I, today after I'm done with you, I'll get ready to go to work and then I have two students at are university who are with me full-time and they are working with my caseload and I'm helping them start to learn these skills.

And I'm it's, I practiced a bit differently than I practiced when I was early in my career where I was much more. Driving, like you said, I was the driver instructor who was not even letting the student drive. I was just driving and this is how you drive student. And I was just taking the wheel and driving and not letting them get the experience.

Right. I think my care is much more 'cause I like your analogy is much more in that guide as the driving teacher where the student or the patient is behind the wheel. I just try to help them find what destination's gonna be worthwhile for them. To move them in a direction of life that's [00:18:00] meaningful for them, not for me.

And then we can find, well, what's the roadblocks? What's the detours we have to take? Or what's the different things along that path that get them to those? Because every, we all have, every human has their own unique challenges and unique parts of their story that make their travel or their journey on that road to be different.

So I think. Having those skills. I wish I had somebody who helped me. 'cause I spent years trying to chase clinicians who were the people who were just, it was something in my hands I didn't have senses to, to feel what's in their tissues that was keeping this pain persistent. And that almost had me quit the profession twice.

Because it's a failed pursuit. You're not gonna find it in the tissues. There's things you can, information you can find in the tissues. Don't get me wrong, tissue-based interventions can have their place as long as they're positioned as like at most, a supporting cast member. For the real work of getting people back in the driver's seat of their lives and getting back to the things that are important to them.

So, a roundabout thing, but I think education to help, students be this, the driving teacher and patients [00:19:00] be the driver. I think that's where the education needs to go is and getting skills to make sure that's the way we drive pain care.

Pete Moore: I talk to Keith Meldrum quite a bit, we have a chat most weeks on a weekend,

but funny enough, we was talking about this last weekend about education. Education seems to be the key and because, and good education. Sort of thing, like, not it's a tick box thing, it's, but if people are received the right education a and also healthcare professionals, there's only, they're both, everybody's a winner.

I think those who you mentioned like healthcare professionals get, perhaps get a bit of burnout. Bit disenchanted with it because of they don't feel they're making a difference. When they're when they see when they're coming from a coaching point of view, or, driving instructor point of view they see people getting on,

It puts a, it's job satisfaction as well, really. So, yeah, it's maybe tough, but, and we also have cookies. I no doubt about eggs. I find I find, talk to people like me really tough as well. Like, and I get frustrated. But the thing is, it's if they get good education good [00:20:00] guidance, et cetera, there's the, both, both the patient and the healthcare professional were both winners.

Like, I be, I've give you a heads up, I was be driving instructor, so that's why I come help a lot of yeah, back in the day, that's when I had hair actually. And yeah, I used to I started teaching people to drive. Then I become a staff instructor and teaching people to become instructors and whatnot.

So I've ended up being all these sort of scenarios like, yeah. But great stuff. Thanks for that. One from the uk someone called Charles. Charles. They say they ask about modern, the modern pain. Podcast. As a host of the Modern Pain Con podcast, what are some of the key topics or expert insights you have uncovered that challenge to additional views on pain management?

Mark Kargela: Yeah, I think to just reiterate, I think the patient expertise component is one that I don't think has enough stage in conferences in continued education courses. In situations where professionals are getting together and discussing, well, these are what patients, these are the things patients should be doing, and there's not a patient within a square [00:21:00] mile of that discussion.

So to me, I think that voice needs to be front and center when we're having these discussions. If it's gonna be shared expertise, we should embody it by how we. Have these discussions and there's been positive movement, right? Keith? Meldrum is doing amazing stuff. Gillette belt and yourself are involved with discussions with professional knowledge and are being included in discussions, which I think is a positive first step.

As far as other topics, and I think just trying to bring out the human component of pain. 'cause I just think that's the big missing piece that I, the humanity piece. And there's research to support where we translate. Life experience and this massively distressing scenario when your life's shrinking around pain and you're losing some things that are so vitally important to you, and feeling lost, feeling small, feeling, just where life's got us on the sidelines.

I think when we can help translate that experience, so this is not just your life experience, this translates into your biology, right? This is when you're in perpetual stress or you're really dealing with understandable depression, anxiety, and all the normal [00:22:00] emotions that humans experience when they're going through such a distressing experience.

That has a significant impact on your biology and how your physiology, I usually give the analogy of the haunted house versus the beach at sunset. I put patients in a scenario where, how does your body behave? Same body. Let's drop you in a haunted house. Let's talk about what does your blood pressure look like?

What does your tension look like? What does your heart rate looking like? Yeah. And all those things. And then you can talk about the beach at sunset or the most serene environment, let's look at the same body, put it in that situation. I'll often share like his, a lot of patients I work with chronic pain, deal with IBS, irritable bowel stuff, they have dysregulated GI and we're realizing.

Our GI and our immune system and pain are very much correlated. And when I'd have to make big speeches and I always say this is my TMI speech for my patients and things, but when I'd have to make big speeches or toxic conferences, I was in and out of the restroom all the time. My, I was like extremely dysregulated 'cause it was a massively stressful thing for me.

The lovely thing and [00:23:00] the fortunate thing for me is that talk would be done and my system would calm right down. The problem is that talk never ends for people that stress of to have it. Yeah. 'cause it's life. It's the financial troubles, it's the loss of relationships, it's the, yeah. Loss of who they are.

It's the loss of their role in life and feeling loss of who they're gonna be, hence forth when they're not the person they were prior to this pain situation. So I think that's one of the big things is trying to help. 'cause there is so much horrid narratives out there on pain. That get people feeling more and more broken, right?

There's, there is no shortage of people on YouTube and Instagram and TikTok and all these places that will convince you that there is some faulty structure that is at play here. And if you read that as a patient or you go into, I don't know how, you don't come out of that feeling like a more broken, failed human.

And I think there's just a lot of hope for people if we can help these topics and help them understand that. Maybe I don't need to search for the next tissue based fix. Nothing wrong with having some things that help our tissues along and maybe help them become healthier, but sometimes it's just starting to learn [00:24:00] how to control the distress around their experience and start clawing back some things that bring a smile to their face, that bring a laugh.

Bring a relationship back in their life that can start re reregulating systems to not be in such a situation where sensitization and all these processes that we know physiologically neurobiologically happen. Those topics, I think from helping clinicians make those connections, but most, most importantly, helping patients be able to make the connections of their story.

Yeah. And their body's behavior. Because I think those two yeah, have been traditionally put in two different buckets and they're not brought into the same encounter. And I think. The most powerful clinical encounters for patients are the ones that can take their story and connect it to their biology, and I think that's a skill we need to continue to develop.

Pete Moore: Yeah. Mark. I always remember how we met. I think that there was a conference where I think we all ended up attending in, over in Boston, over in the States. And where people with I, I say I'm not lived experience, I'm living experience 'cause I'm not dead. [00:25:00] So. All people with a living experience of pain.

So, like myself Keith Joe Belton, and we was invited to do workshops, et cetera, at their, at the I International Association of Study Pain at our Congress there in Boston. And we all met there. We, I think we knew each other vaguely on social media. But that but and Bonnie Thompson from New Zealand, she was there and I think Keith.

Keith Carol Carol, he was there. And it's like, it was like like a springboard. I dunno what happened from there, because out of that being invited to that congress there and meeting each other, et cetera it felt like, well for me anyway, I felt like I wasn't alone anymore because I always felt I was a bit.

Thinking I'm whistling in the wind sort of thing, but after meeting Joe, Keith the two, Keith, Brian and whatnot, yourself, it was like a turnaround really. And and now I think this, listening to each other, I learned so much from all the other guys, like, but I think that was an, a massive influence for us to go off and do stuff like, and, but and why? But since then we it [00:26:00] hasn't been a, there has been, hasn't been a similar con congress like conference. And it's why, couple years ago, or it'll be four years ago in February myself and Keith was having a chat and I said, we, well, why don't we get invited to these gigs?

Like, why are we there? And I said, well, I said to him, Hey, what do you think? Should we do our own thing? Like, but we're a role model. So what we did, we started we organized the it pain support, self management con conference online, of course. And and, but what we do is we invite, by the way, you are gonna get invited.

Not, you can't get you in this year or next year in February, but we're definitely gonna have you in, 20 27. That'll be, yeah. So keep that clear. I amen. It will be in February. But so what we do is we role model you, us, because support yourself management, it's a great team work, so we have three self managers and three healthcare professionals like yourself.

And so there's that balance there, like, and so we're doing the fourth one I think in, on the 21st. I think in North America it'd be on the the 20th. But in Europe and New Zealand, Australia be the 21st. And [00:27:00] we started also now initiating a pain self-management week as well.

So like on the 16th on that Monday, all throughout the week, we inviting people. Share about things about all things, all matters related to pain, self management. So we're trying to keep that momentum going. Keep it nice, refresh, et cetera. But it, to me it's ed, going back to that other thing, you, the education bit, where we can educate each other and, swap ideas, et cetera. I love it.

Mark Kargela: Yeah.

Pete Moore: That's yeah. Thanks. Okay. Near nearly near the end now. From Penny, from the UK she says or asked her about future of pain care. This is this one always interests me lot 'cause I like to hear about, well, what's going, what's everybody like? He allowed to hear what you are doing, what Joe's doing.

Keith Keith had just kicked off something and in, in Canada, any he action on paying for his podcasts and whatnot. And everybody's be super busy around the planet. But the future of pain care. So in your experience, what do you see as the biggest challenge you facing pain care today?

And how do you envision the [00:28:00] future of pain management evolving to better meet the needs of the patients? I'd like to include healthcare professionals in that if I can as well.

Mark Kargela: Yeah. The future of pain care. I think where I see it going, and there's a couple things I'm, there's some concerns.

I'm all for AI and tech and leveraging it in a way that serves us in the best way possible. I do fear sometimes that. Furtherly strips the humanity out of the experience when you're trying to have AI interact with the human, I think there's some helpful, maybe triage things or different things that maybe can set up a clinician to be able to be more present in a interaction and not buried in their laptop, typing in their electronic medical record.

So I think there can be helpful ways with that. So I think the future of pain care, there's so much going on in the biomedical space, which I think, AI and other models can hopefully help us. Better have treatments. 'cause I don't think we can discourage, 'cause I've sometimes been accused, well you just wanna talk to people.

No, I still think there's [00:29:00] helpful ways to treat pain, be it, medical approaches. If we can help people with fibromyalgia or chronic fatigue or various of these chronic overlapping pain conditions. Have a better ability to manage pain. And then also still having them connected with somebody who's also on a, let's get you back to your life components too.

So where it's all working in a synergistic, not like, where it gets so disjointed and people are putting their little siloed buckets where nobody's putting the story together. So, and that's where my dream would be is true health pain care. That helps. Form a story in a narrative for a patient where they can understand how their unique journey has impacted their unique pain and how they can have strategies to impact their unique story to start getting back to the life they wanna live.

So I think some of the advances in technology are great. I do think AI that allows us to be more present in a conversation and an interaction with person can be something very helpful. Again, I just fear sometimes of us getting less human by getting too enamored [00:30:00] with technology. And you're talking to somebody who, my wife has declared me a technology junkie, so, I'm all for it.

But I think again, we have to put it in perspective to make sure we don't lose the humanity of what we're doing. And I think that to me, those are the advances I think we can make is how do we better understand how the mind body. Influences each other. 'cause too often in healthcare, we've put those two in two separate buckets.

You're gonna talk to somebody about what's going on in your head and somebody who's gonna go on talk to you about what's going on in your body. They're one and the same. You can't cord those two off because what goes on in your head influences your biology. When that head is in a haunted house, it trucks out a lot of distress.

Stress and different things. So I think we need to have a future of pain care that it helps. Patients better have information to connect their unique story to their unique biology and how their body's expressing pain. And then have some medical advances that can help support that as well. I'm not saying, again, medicine doesn't have its place, it's just.

Often patients are so stuck in the I need to find the next tissue or medication or next [00:31:00] procedure that's gonna fix it. And nobody's helping them understand their life around their pain. That's probably driving the situation more than their x-ray or their MRI or whatever tissue-based variable that, and again, they can have importance.

I'm not saying we strip tissues out of the equation, but when people have been chasing tissue based fixes for sometimes decades. Life still isn't getting better for them. I think we need to take pause both as patients and as clinicians. Like we need to do something different. And I think that difference is helping connect them to their story and how they can rewrite their story and take control of that driver's wheel to start charting a different path with it.

And it doesn't have to just be a healthcare system that isn't listening, that's failing more and more procedures to fix their pain, where they can start getting the wheel and starting to. Fix themselves, I guess you would say.

Pete Moore: Yeah, I agree. Mark. It's getting, it's about balance again, isn't it?

With using the technology? I, I started getting into the, a little bit technical side of it a few years ago with vr, virtual reality, so [00:32:00] is like, I put, I started because I was, how I looked at it was trying how do we engage patients? How do we engage healthcare professionals? I started funny.

I found a link from a Japanese doctor who used this, a virtual reality platform. And so I built like, rooms there, like, where there was lots post I, I was able to post things on the walls, et cetera. And so people could go onto the, what I liked about that program.

I've still got it now, our platforms, because you don't need a, I've got the headset and everything, but, you can use your phone or your laptop is what we've got now, or your computer or whatnot. And, so people can drop in and out. I'll drop in from time to time, and see what's happening.

I'll see people in there, they're just chatting away with each other, say, well, that looks interesting, blah, blah, and then I've got in I've been working with university and from the Northeast, and they found some money to make me into an ai. Person and I had to sit in a room for two days asking questions about the pain talk, self management and my life, et cetera, like, and so that was quite interesting.[00:33:00]

I sit in the same position for two days, so there's anything. And so, but it's about balance, and you can't beat that human contact, like, whether it's in face-to-face or, even just like this really, but it's about balancing it. Especially 'cause if there's another COVID thing, like, we've got, everybody's gotta shift back to this again, like, but I think most Oma was always wary of the techn technology favors those that live in rural areas. Over there in the States it's a massive area, like, and not everybody can, get to a. Clinical, a practice, if they're living out in the countryside, et cetera.

But it's about balance and how do we do that? It's that's the interesting bit, like, but I use with technology, so how are, how can I grab someone's attention? Really, especially the younger people because it's no good giving 'em a booklet, like a paying toolkit booklet, because where I lived in.

Account, if I've given them a booklet, they'll roll it up and try and smoke it, yeah. So that it is pretty pointless. So it's but it's how do we engage people, especially the younger people, like, what, how are they using technology to get their [00:34:00] information?

But it's all about balance. Yes, absolutely. Okay. We done all the. I'm gonna go into a bit of fun stuff. Ready? Just there's a couple of questions. Two, two more questions and then I'll let you get on to work or get to work. So, a superhero for pain relief. So if you could have any superpower to help your patients with pain management, what would it be and how would you use it?

Mark Kargela: I would give people the ability to see their own potential to impact their own pain experience. I would be able to help people be able to look inward. 'cause I think too often people have surrendered the steering wheel of, not by choice, but because healthcare kinda takes it from them. And I think I would help patients in pain understand that.

They have the capacity to drive their experience in a much better situation. If they give themselves some grace, some self-compassion and some patience to start taking control and get guidance and be able to be confident to take the steering wheel of their experience, even though healthcare will make them feel like there's, and it will feel probably [00:35:00] as scary.

Unsure. Uncertain. 'cause it is a journey where it's not a clear cut. We don't have Google maps that's gonna navigate you perfectly always to the destination. It can be met with, all sorts of detours and things. But I do think within our patients lies the capacity to live well again. And I think healthcare, we need to get out of the way in a lot of cases and help patients understand that's superpower.

Lies within them to get that. Now there might be some supportive things we can do as healthcare people to help them better, steer better, clear the windshield better, get shocks on the car and all those things that help support their car's journey on the self-management. But to me it's, I that's been the number one transformational thing I've seen with people is when they.

I no longer feel they're beholden to a pain physician or a physio, or a chiropractor, or a massage therapist, and none of these folks are not, they can sit in the backseat. That's nothing wrong with it, but they shouldn't be driving. The patient should be driving. And I think the more we can help patients recognize that they [00:36:00] have the capacity to, even though it's gonna feel scary, it's gonna feel uncertain that within them they have the way to drive.

It's they've driven a bike before. It's it's gonna feel scary. It's like they haven't ridden a bike in decades, but the ability to live well is within us all. It's just sometimes it gets very much. Limited and restricted by a very distressing, massively life altering experience. But if we can help them start reclaiming the steering wheel, I think we can make people, I think that would take healthcare a heck of a lot further.

Yeah. When it comes to pain,

Pete Moore: I've just come across a lovely lady over in the west side of the county unit. I live in Essex in the uk and we had a meeting the other day. She's an illustrator. I'm gonna ask her if she can do an illustration of you with your superpower. Nice. I love it. Perfect. My tape or something like that.

And I dunno. Hey listen. Last question. So listen I've organized a dinner party. And of people like ourselves that work in the in the pain management field, et cetera. So who would be your three what your, and you had the opportunity to invite three [00:37:00] guests. Who would those guests be?

They can be still living or they've sadly passed on.

Mark Kargela: That's a great question. It's probably gonna be interesting, and this may change day to day depending on what I'm reading and what I'm consuming in my own life. But as I think about it now, a person that I would love, love, love to have the chance to sit down and have dinner or coffee with would be Louis Gifford.

He's probably been he's no longer with us unfortunately. But such a transformational figure as far as physio. That was probably on the leading edge. Us really questioning how we look at pain and why a traditional physiotherapy approach. And this translates beyond just physiotherapy, chiropractic, osteopathic, all these different professions could learn from him.

And he just shares such a, I saw myself in his journey because I very, there's a lot of parallels in what he went through and what I went through in my career that felt like it resonated and he just was such a forward thinker. And he was talking about things decades ago that were just still, doing much better.

I think hopefully he would be happy to see where we're moving, but I, there's still not enough. So he'd [00:38:00] be definitely one of the people strangely. One of my big things I've pursued is, as we've talked a little bit out in this interview already, is how do we get this message? To people in a way that resonates and gets them to take action and make a change in how they look at pain.

So, somebody who I think is probably one of the leaders in doing that in marketing is Gary Vaynerchuk. He's a pretty bombastic doesn't always have the best language, but. Truly, I think, is out there to help humans in his own way as far as to help them spread a message and be able to put positivity in the world.

I think he just, I think we owe it as healthcare people who are trying to make the change of patients trying to consider something differently. To learn how to message and put themselves out there and help, improve the human condition through social media content. So, and marketing messages that meet humans where they are right now.

And that is on TikTok and on Instagram and on YouTube. So I do think I'd love to just have a day with him to say, and have him just go through my messaging. And here's how you [00:39:00] start reaching these people to the best of your ability. 'cause I think there's a degree that we're not taught that as healthcare people.

So how do you market the message that competes with all the garbage out there around that has people disa, disabled and believe in they're broken. So he'd be one last person I'd probably have. I've really had interest in Buddhist philosophy. I think that just a lot of what we look at with.

Self-management and acceptance, commitment. A lot of psychological principles come outta that a little bit. I think obviously he's had traditions of generations of wisdom and the Buddhist mindset passed out down to him. So, and I just, he has quotes that just always resonate with me as far as like, how man's endless pursuit of finances to the parallel of his health is something that's a mystery that we still.

To fight in modern society. So he'd be a, just an amazing person to sit down and talk to. I'd love to have those folks at a dinner table. It'd be an interesting dynamic for sure, with those three, but I think a great dinner party nonetheless.

Pete Moore: Yeah. I'd like to check him out as well. Get a, yeah. I started following another what's the video used about?

A guy by [00:40:00] Tibetan Monk and he talks about the monkey mind. How to, to. So, so, we're always overthinking it, but, it gets very busy. Yep. He said, you work, with the monkey mind. Like, you have to keep, gives this, give it something to do.

You can't give it a banana, so you gotta give it something to do. So just breath in, breathe out, just concentrate, breathing in, breathing out. And to me, like you, I've I'm really into all that sort of stuff as well. Mark, absolutely. Absolutely. Well, listen Mark's been fantastic flipping the tables on you, and I'll tell you I've been, I've, I can't wait to see the the video, et cetera.

And, thanks very much for giving up your time and has really appreciated. And so, well, we're definitely gonna get you in February 27th, me and myself and Kate and, so thanks everybody for watching. As I said do you wanna give you, give your channel a couple of plugs,

Mark Kargela: mark?

Sure. You can find me on Instagram and X and all these at m Illa dpt. We, I'll put a link in the show notes if you're watching this on my channel and I'll send it to Pete. Modern Pain Podcast is the podcast where we try to start helping this type of. [00:41:00] Content and patient facing things and clinician facing things where again, we're all on a shared expertise journey together.

That's where I try to make sure we're having some good conversations that keep that stuff front and center. So that would be where to hang out and hear more from me. I'd love message me on social media. I love hearing people who are, trying to navigate these struggles themselves. And if I can help in any way, I'm happy to do so.

Pete Moore: Again, mark, thanks very much. Have a nice day. And listen stay safe, look after yourself. Thank you for all you do to support the pain self-management message. And we'll see you again soon. Take care. Have a great day, mark. Ciao.

Mark Kargela: You too, Pete. Great talking.