Dr. Andrea Furlan
Appearances
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
They're not causing you any back pain right now. These are just incidental findings. The problem is when the patient sees that in the MRI and the doctor sees that, they all go panicking and now they think they need to treat that thing when that thing is actually not the cause of pain. It was just an incidental finding.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Okay, my top one right now has always been my top one, but right now I have seen a lot of success is using mind-body interventions, things that fix that pain. Remember the alarm system that I mentioned in the beginning. When the alarm system is out of walk, is deregulated, that danger signal is going off all the time,
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Talking to a therapist, doing some counseling, some psychotherapy helps to reduce that fear of pain, helps to regain confidence that you can move, helps them to see stressful situations in their daily life that is aggravating that muscle tension, helps them to become more self-confident. and more positive and reducing the thoughts of catastrophization. Like, oh, this is going to get worse.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I'll become paralytic and I'll become in a wheelchair and this is only to get worse. So talk therapy, psychotherapy, mind-body interventions are my top one right now. The other ones that are holistic in the complementary field, I would say things that help you to relax overall. So I recommend a lot of massage, acupuncture, because they will help to downplay that stress.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I didn't mention here in this interview the importance of the parasympathetic and sympathetic nervous system. The sympathetic one is the fight-flight response, the stress response. The parasympathetic is the heal, digest, the system that you cannot be relaxed and anxious at the same time. So if your sympathetic drive is too high, you do need to activate the parasympathetic.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
They MRI people with, you know, who don't have any pain, like walking around and doing everything they want. And they have even disc herniation, disc extrusion, disc prolapses. They have bad arthritis. An example is my grandmother. She was 92 and she had an x-ray of her neck. because she had another thing in her head. And I looked at her x-ray.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So those things that relax the mind and body, and that could include massage, could include manipulation, it could include music therapy, aromatherapy, do whatever it takes for you to activate your parasympathetic nerve system, because that will eventually lower the sympathetic And the sympathetic nervous system is driven by adrenaline, not adrenaline, cortisol.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So once those substances reduce, because those substances, adrenaline, cortisol, they make the pain more intense. they amplify pain. So then the person will feel better by consequence. And of course, exercise and sleep. But complementary alternative medicines. Also, the person needs to be careful not to become dependent on them.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I tell my patients, okay, go to acupuncture, some sessions, but don't do acupuncture for the rest of your life, every week. You do need to stop Should not become dependent on them and then become self-resilient. Self-management is learn things for yourself that you can do for yourself, that you don't depend on someone else.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
First of all, do the exercise, the movement that you enjoy. Don't try to do something that you don't like because you're not going to adhere to that. Find something that you like. It's playing volleyball. It is weightlifting, whatever it is. Find something and adhere to that. Try to do at least three times a week. So also don't do once a week. Try to do, you know, spread throughout the week.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
If you can't get a chunk of exercise, because you say, I don't have one hour to do exercise, do snacks. Break down that routine. If it is stretching, aerobics, some weightlifting, resistance exercise, you don't need to do all of them at once, like 90 minutes doing those. You can take snacks, break down into small chunks. So then at least you can... You can achieve those goals.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
The goal is 150 minutes per week.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Well, if you see my chair, it's not the most expensive chair. I cannot show you, but it's not an expensive chair. But I bought this... Backrest. I had bought an expensive chair and it was horrible. I couldn't, you know, I couldn't work well. It didn't support my back. I like space to move my shoulders and that was blocking my shoulder.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
But then I bought a less expensive chair, a backrest to fill that space here of my lumbar spine, and I'm fine. So what I recommend my patients with back problems is it doesn't need to be the most expensive one, but it has to be one. Sometimes it is the most expensive one. Who knows?
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
But it has to be one that supports your back, that you can relax, that when you're sitting, you're not thinking about your back, that you're comfortable. You know, the seat, not too hard, not too soft. And for each person is different. So they do need to go to a store and test some different ones. Buy something that you can have a refund if you don't, because that's what I did.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I bought one very expensive when I renovated this office. And then I had to return because I really couldn't use that one. So buy one that you can return and get a refund if possible. And try the same thing for pillows and mattresses. There is no recipe, Drew, for, you know, you have to buy this pillow or you have to use this mattress. Each person is different.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I've never seen the most horrible x-ray in my whole life. She did not have any disc between the vertebra. And then I asked her, grandma, did you ever have neck pain? She said, no, never had. So it's not a synonym, okay? Aging is not a synonym that you have. So that's the first big myth. The second one, Drew, is that because pain is invisible, right?
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
But they need to find what it takes. And so go to a mattress store and stay there for about two hours and try one, try another one, try another one to see which one you feel better. Some people like, you know, the harder mattress. Some people like the softer one. There is really no recipe. And we know, too, that...
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Really, the mattress, the chair, the pillows, they're not the main drivers of chronic pain. We know now because there has been some trials, they gave the best pillow to people and they compared to a less exciting one. And there was no big difference to treat people differently. So I would say don't spend too much money too on the most expensive thing.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
You may be surprised that the cheaper mattress, pillow or chair might do the thing for you.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
When people, a lot of people say, I am suffering pain. I am in pain. My pain is terrible. And then the doctors look at them, the friends, the family, the co-workers, the managers. Oh, you're fine. You can move everything. I don't see anything. The doctor said that nothing has broken your bones. You're telling me that you're in pain, that you can't work, you can't get out of bed.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
That is another myth because pain is invisible. If the person tells you they are in pain, they are really in pain. So we do need, because again, that pain that centralizes, that I just explained to you and it transforms to chronic pain, it's called nociplastic pain because it involves plasticity of the pain system. We cannot see in x-rays or normal MRIs
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
We can see in laboratory with some specific tests and some specific physical exam. But another myth is that these people are faking, these people are lazy or they're just depressed and they need to exercise. And why don't you exercise more? Why don't you? It's so simple. It's not that simple. If you have an acute pain, let's say a fracture or an inflammation, a toothache, the body heals.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
We know that the body heals. Everything. And scars don't hurt. If the pain continues after the period that you expect the tissues to heal, the fracture is done, the orthopedic surgeon looks at the x-ray site, everything is healed here. Why you still have pain?
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
It might be because now your pain has transitioned to chronic pain, which now is becoming a neurological disorder because it's more like a sensitization of the pain system. Drew, if you allow me a few seconds, a few minutes here, maybe I like to use the analogy of the alarm system of a house. So the pain is the alarm system of our body. So it's exactly the same thing as an alarm system of a house.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
You install sensors to detect if there is a danger, right? smoke detector, a burglar detector, a braking, carbon monoxide detector. So those are the sensors that we have for pain. And when you have acute pain, you want the alarm to go off and make noise because you need to go to emergency and take care of that problem.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So if you have an alarm system of your house that is making noise, you call the ambulance, the fire truck, the police, and they come, they find where's the fire, where's the problem, you fix and the alarm goes down. Chronic pain is when the alarm of your body, the alarm system of the house is malfunctioning. And why it is malfunctioning? Because it became sensitized.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So if a person has chronic pain, they are not going to treat with the same methods that you use for acute pain. You're not going to call the fire truck ambulance police. You need to call the alarm company. So this is when we see chronic pain transforming from acute to chronic, we need to use different methods. We need to use methods that fix the pain system. So that's what, you know,
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
The analogies that I use, how do we fix this pain system? Most of them are what you just mentioned. Movement, mind-body therapies, sleep is essential, good nutrition. I would not say good diet. It's nutrition. I see a lot of people who are malnourished. Those four things are so essential to fix the pain system. That's why you're not going to recommend someone who is having a fracture.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
You know, to say, oh, you need to meditate, you need to do exercise, movement. No, they need immobilization, they need surgery, they need to fix the fracture. So you see why the treatments are different.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Yeah, and we know there's a lot of scientific evidence to say because we are trying, the scientists are trying to find out what are the drivers, how acute pain transforms into chronic. And we know a lot of things now that we did not know many, many years ago, thanks to a lot of science.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Especially science looking inside of the brain with functional MRI and things that look at where is the system malfunctioning. So one of them, Drew, that is very much important is the danger perception. So stress. We know because in the brain, the pain is a signal of something broken, something damaged, something injured. You have a disease, you have something.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So they activate the areas of the brain that signal danger, danger, danger. So what happens is after that initial injury lesion disease is healed, let's talk about a fracture, for example, the alarm system doesn't turn off. The danger signal keeps activated and informing the person that they are in danger.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So this is so important that some of the therapies, some of the mind-body therapies, they act exactly on that. They say if you reduce the dangerous signals in the brain, the pain will go away. And that's true. And the other things that have, and where does this danger comes from? It could be from childhood, early childhood adversities.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So people who had adversities when they were growing up, they're more prone to transform acute pain into chronic pain, but also current stress, fears that the person have and that Trauma that is maybe not a big trauma, but it's small trauma with small teeth, like bullying and things that they suffer every day or stress in life. So that's one thing that we know.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
The second thing that we know that transforms acute pain into chronic pain is bad lifestyle choices. And that would include putting your body in a situation that is low resilience. Like the body doesn't have resilience to fight that acute pain and therefore it will sensitize the pain system. So things like drinking alcohol, smoking nicotine or any kind of smoke, even cannabis because of the smoke.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Not sleeping well, not moving the body well, not eating well, working too much or being sedentary, overweight. So lifestyle puts the body at a high threshold, like a higher chance of developing chronic pain. And then, of course, there are things that we know related to the pain itself.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
If a person has an acute pain that is not well treated, is not well managed, like they are left to suffering pain, people don't give them the proper painkillers, let's say a surgery, We also know that that stress of the acute pain can also predispose the person to have more chronic pain.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So there's a big push for surgeons and anesthetists to treat acute pain, especially post-operatively, post-surgical, really well, because we know that that predisposes people to have chronic pain.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
A big one is that it's normal to feel pain with aging. So a lot of people think that Aging, getting older is like a synonym of getting more pain. And people make jokes about this. They say, you know, arthritis comes with age. Everybody has arthritis and arthritis just gets worse. That is not true. That is not true. OK, so learn something.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
A few months ago, December 2023, the World Health Organization released guidelines exactly for that, for chronic primary low back pain. When we say primary low back pain, it means it's this nociplastic pain. It's when the pain already transformed from acute to chronic. Because we know 90% of chronic low back pain is primary chronic pain.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
So secondary chronic low back pain would be if the person has a tumor in the spine, like a cancer, a fracture, or they have an inflammation, there are some inflammatory diseases like ankylosing spondylitis that affect the spine, or they have a neurological impairment. But when you exclude those
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Secondary causes of low back pain, 90% of chronic low back pain is primary, which means it's just a problem of the pain system that is having desensitization, the muscles are tense, they are aggravated by mental stress, physical stress, sedentary life, all of those. So how do you combat this chronic back pain? It's lifestyle. Medications will not do the trick.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Opioids, anti-inflammatories, analgesics, they are good if you have acute low back pain for a short period of time. Or if you have a secondary back pain that is secondary to one of those things, okay? But if it is nociplastic pain, like this primary chronic pain, medications, only if the person has some other... Like a depressed, they are very depressed, so we need to give them antidepressants.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Or if they have another inflammatory disease that is affecting other joints, we can give anti-inflammatories. But anyway, so... Don't think medication. Medication is not going to be the first line of treatment for chronic lower back pain. The first thing that they need to think is about movement. Again, motion is lotion.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
Don't be afraid of it. I think the fear of the pain paralyzes more than the problem itself. We see this a lot. People have an acute episode of back pain. They get very worried. A lot of things start going on in their mind. They start spiraling. Oh, this will happen, blah, blah, blah. The reaction of a person to the back pain itself is worse than the problem itself. That's the first thing.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
There is a lot of research saying don't prescribe bed rest anymore. This is for doctors. Doctors, don't prescribe bed rest if your patient has an acute back pain, because if you do, there's a lot of evidence from randomized trials done in the last 40 years showing that if a person rests, they do worse than if the person just tried to take as normal as possible their life.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
I know I had some episodes of really bad acute low back pain, and I know how hard it is to move. And I know how frightening it is. It's really frightening because it hurts a lot. But the first thing is try not to be afraid of it. Try to move, try to live your life as normal as possible. You can take some analgesics in the acute phases. Try not to stress too much.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
You can see a chiropractor, a physiotherapist, a kinesiologist, your doctor, but try to move. The other thing that people need to remember is when they have an acute back problem,
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
seeking like a go to the doctor and demand an image i need to see a ct scan or mri it's probably not the best thing to do i am a big educator of doctors most of what i do here in canada is educating doctors how to treat chronic pain acute pain so it doesn't become chronic yes do a good physical examination talk to your patient if your patient has red flags that suggest
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
It's not because you're old that you must have pain or you are going to suffer more pain. A lot of people, a lot of people, they have arthritis. You can see their bones. They may look horrible. They don't have any pain. So we all know this. Even in MRI, you see people, this has been research done over and over and over.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
This could be a tumor, a metastasis of a cancer. This could be a fracture. This could be an inflammatory process because my patient is having fever. Or this could be an infection in the bone because the patient uses IV drugs. They inject drugs and now a bacteria can be growing in their vertebra. So if you're not concerned that it's one of those things, Don't even order imaging.
Dhru Purohit Show
What is Your Body Trying to Tell You? The Top Causes of Chronic Pain and How to Tackle Pain Head On
The guidelines say if you order imaging, MRI, anything, you're going to cause more damage to the person. And that's because we all have some abnormality. Right now, Drew, if I MRI your lumbar spine, I don't know how old you are, but you're probably younger than I, but I can guarantee I'll find some disc problems because research has been done. We'll find disc problems, facet problems.