HEALTH," Dr. RICH AND COMPANY DISCUSS CHRONIC PAIN.

HOW PHYSICAL ACTIVITY CAN SUPPORT PAIN PREVENTION AND THE LATEST IN NON-SURGICAL TREATMENT OPTIONS PLUS THE TEAM VISITS UPSTATE'S REGIONAL REHABILITATION CENTER IN CLAY TO EXPLORE HOW PATIENTS ARE LEARNING HOW TO MANAGE CHRONIC PAIN AND REGAIN THEIR INDEPENDENCE AND ON THE NEXT MEDICAL STUDENT MINUTE, HOW THE BRAIN DOES NOT FEEL ANY PAIN.

THAT'S COMING UP ON "CYCLE OF HEALTH."

DON'T GO ANYWHERE.

HELLO AND WELCOME TO CYCLE OF HEALTH.

I'M YOUR HOST, DR. RICH O'NEILL.

TODAY'S TOPIC: PAIN!!!

8 OUT OF 10 OF US WILL HAVE BACK PAIN IN OUR LIFETIME.

FOR EXAMPLE.

WHAT TO DO TO GET RID OF IT?

HOW TO KEEP ACUTE PAIN FROM TURNING CHRONIC?

WHAT'S THE LATEST ON MEDS AND OVER-THE COUNTER DRUGS INCLUDING CANNABIS?

AND SURGERY?

DOES IT EVER WORK?

FOR WHOM?

AND HOW TO KEEP PAIN FROM COMING BACK OR FROM EVER GETTING IT IN THE FIRST PLACE?

AND WHAT DO ”EFFORT-AVERSE” AND “NO PLEASURE, NO TREASURE” HAVE TO DO WITH IT?

ALL THIS AND ME IN MY COOL WALKING / BIKING OUTFIT ON THE NEXT CYCLE OF HEALTH!

JOINING US TODAY TO ANSWER ALL OF OUR QUESTIONS ARE DR. MELISSA PATNELLA, PHYSICAL THERAPIST AND THERAPEUTIC PAIN SPECIALIST AT SYRACUSE ORTHOPEDIC SPECIALISTS; AND DR. JOSEPH CATANIA, ANESTHESIOLOGIST AT NEW YORK SPINE AND WELLNESS CENTER.

WELCOME, FOLKS.

>> THANK YOU.

>> I KNOW EVERYBODY REALLY WANTS TO SEE MY RED JACKET.

I WANT TO HOLD IT UP FOR ANOTHER SECOND.

IT'S THE COOLEST RED YOU EVER SAW.

ANYWAY, THE REASON I'M WEARING MY OUTFIT IS BECAUSE OH LIKE 30 YEARS AGO I WAS A SERIOUS RUNNER AND AT ONE POINT I SUDDENLY DEVELOPED BACK PAIN, WITHOUT ANY CLEAR PRECIPITATING EVENT.

NOW, IF I CAME INTO YOUR OFFICE AND SAID JUST THAT, WHAT KINDS OF THINGS WOULD YOU BE CURIOUS ABOUT?

WHAT WOULD YOU GUYS BE ASKING ME?

>> SURE.

SO FOR ME, THE FIRST THING I WOULD BE LOOKING AT IS HOW LONG HAVE YOU HAD THE PAIN FOR, WHAT THE PAIN FEELS LIKE.

DOES IT COME AND GO?

IS IT THERE ALL OF THE TIME?

DO YOU HAVE A HISTORY OF BACK PAIN?

YOU KNOW, WHAT IS YOUR ACTIVITY LEVEL?

WHAT IS YOUR JOB?

WHAT IS YOUR FAMILY SITUATION?

THOSE ARE KIND OF FIRST PARTS OF THE PUZZLE I WOULD WANT TO PUT TOGETHER.

>> JOE, ANYTHING TO ADD?

>> I HAVE SIMILAR SORT OF QUESTIONS AS WELL.

I WOULD GO ONE STEP FURTHER AND DIVE A LITTLE MORE INTO YOUR ACTUAL INCITING EVENT, THE RUNNING, HOW MUCH YOU RUN.

HOW OFTEN YOU RUN.

DO YOU ENGAGE IN CROSS TRAINING WHERE YOU CHANGE WHAT YOU DO, ALLOW ADEQUATE REST IN BETWEEN.

TO ME, RUNNING HAS SOME TRAUMATIC EVENTS AND TRA TRAUMATIC PRESSURE IN YOUR LOW BACK, SO WE WOULD LOOK A LITTLE BIT MORE INTO THAT.

CERTAINLY LOOK INTO YOUR SMOKING HISTORIED, OTHER METABOLIC HISTORY.

DIABETES, IF YOU HAD PREVIOUS INJURIES, SURGERY.

THINGS LIKE THAT.

AGAIN, THE QUESTIONS ARE VERY IMPORTANT TO LEAD US TO KNOWING WHAT IS GOING ON AND TO WHAT IS THE BEST SORT OF TREATMENT OPTIONS FOR YOU.

>> AS YOU ARE TALKING ABOUT THAT, ONE OF THE CONCLUSIONS I CAME TO WHEN I WAS BACK THEN, WAS THAT I WAS SITTING TOO MUCH BECAUSE I'M A PSYCHOLOGIST IN MY DAY JOB, RIGHT?

AND I SIT A LOT, RIGHT?

AND I THOUGHT WELL, I'M RUNNING.

THAT'S NOT, YOU KNOW, I HADN'T CHANGED ANYTHING RECENTLY THAT WOULD PROBABLY ACCOUNT FOR THAT ALTHOUGH I WAS ALWAYS RAMPING UP HOW MUCH I WAS DOING, WHICH, YOU ARE LAUGHING.

THAT'S A PRECIPITATING EVENT.

>> DEFINITELY.

>> BUT ONE OF THE OTHER THINGS WAS SITTING A LOT.

AND I NOW HAVE A SIT-STAND DESK AND I DID FOR A LONG TIME.

BUT LET'S TALK ABOUT THE IDEA WHY I'M WEARING MY OUTFIT, WHICH JUST, THE BEST BLUE EVER SAW IN YOUR LIFE, TOO.

I GOT IT FOR A PRESENT.

AND I LOVED IT SO MUCH I SAID WILL YOU PLEASE SELL ME THE BLUE ONE.

IN ANY EVENT, MOTION IS LOTION.

TELL US ABOUT THIS IDEA.

>> YEAH, SO REALLY, WHEN IT COMES TO TAKING CARE OF YOURSELF, I MEAN ONE OF THE MAIN WAYS YOU CAN DO THAT IS BY BEING ACTIVE.

ONE OF THE MOST IMPORTANT THINGS YOU CAN DO TO PREVENT INJURY IN GENERAL.

THE PHRASE MOTION TO LOTION OR MORE OFTEN IS MOVEMENT IS MEDICINE.

KEEPING YOURSELF ACTIVE AND IT DOESN'T HAVE TO BE THE MOST INTENSE OR AGGRESSIVE WAY TO BE ACTIVE.

DOING IT IN A WAY THAT YOU ARE MOTIVATED, CONNECTED TO IT AND WILL DO IT CONSISTENCY.

THAT'S HOW YOU STAY HEALTHY.

>> JOE?

>> I CERTAINLY AGREE.

THE PLACE WHERE I DIVERGE A LITTLE BIT IS I WILL GET MANY PATIENTS WHO WILL STATE WELL, I'M VERY ACTIVE.

I WORK, I DO LAUNDRY, I'M UP AND DOWN THE STAIRS.

I RAKE MY YARD.

AND I TELL THEM WHAT YOU ARE DOING IS WORK.

EXERCISE IS A COMMITMENT TO YOURSELF.

SO IF I HAVE A TASK-ORIENTED JOB WHERE I'M GOING TO RAKE THE JARRED YARD AND I HAVEN'T BEEN ACTIVE FOR A LONG TIME AND DO EXCESSIVE LAWN WORK FOR EFERL HOURS, THE GOAL IS TO COMPLETE THE TASK, NOT TAKE CARE OF PIE BODY.

EXERCISE TO ME IS A DEVOTION OF TAKING CARE OF MY BODY... >> SWITCH THE GOAL.

>> EXACTLY.

NOT IGNORING THE PAIN IN LIEU OF GETTING THE TASK DONE.

SO PROPER EXERCISE IS WARMUP, A LITTLE STRETCHING.

YOU DO THE EXERTION, MAYBE SOME COOL DOWN AND THEN YOU MOVE ON TO YOUR NEXT PART OF YOUR DAY.

IT ISN'T BEING OVERWHELMED BY THE TASK AT HAND.

>> SO NOT TOO MUCH TOO SOON.

YOU DON'T WAB TO BE DOING THAT-- YOU WANT TO EASE YOUR WAY IN.

SO LET'S GO BACK TO ME AND MY HISTORY.

SO I COME INTO YOUR OFFICE, JOE, AND I SAY, WELL I WENT TO SEE MY PHYSICAL THERAPIST, MELISSA AND SHE GAVE ME SOME EXERCISES AND I STILL HAVE THE PAIN.

WHAT WOULD YOU BE CURIOUS ABOUT AT THAT POINT?

>> SPECIFICALLY WHAT EXERCISES.

I'M CERTAIN THE EXERCISES THAT MELISSA WAS FOCUSING ON IS AND WILL BE CORE STRENGTHENING.

SUPPORTIVE STRUCTURE TO YOUR LOW BACK AND ABDOMEN.

CERTAINLY THAT'S WHAT WE FEED FOR LOW BACK STRUCTURE.

WE WANT TO MAKE UP AS MUCH SUPPORT TO THE SKELETON AS YOU CAN.

BUT CERTAINLY IF THERE IS RADIATING PAIN WHERE WE ARE CONCERNED THAT THERE IS SOMETHING PRESSURING A NERVE, IF THERE IS CERTAIN POSITIONS THAT ELICIT PAIN, THE PELVIS RING HAS A CERTAIN MOBILITY TO ALLOW TO YOU WALK OR RUN AND THAT COULD SUFFER AN INJURY.

SO AT SOME POINT, WE NEED TO DELVE A LITTLE DEEPER INTO THE PAIN SPECIFICS TO KNOW IF WE NEED TO ORDER ANY KIND OF TESTING, X-RAYS, MRI SCANS, NERVE TYPE STUDIES.

SO THERE IS-- WE DON'T WANT TO IGNORE PAIN AND SAY HEY, JUST EXERCISE MORE.

THAT'S NOT FAIR.

BUT WE NEED TO COMBINE WHAT YOU TELL US WITH MOBILITY AND THEN ARE WE LEARNING SOMETHING IN TERMS OF YOUR SYMPTOMOLOGY FROM THE CERTAIN EXERCISES YOU ARE DOING.

>> HOW OFTEN DOES IT HAPPEN THAT YOU PRESCRIBE A SET OF EXERCISES FOR PEOPLE?

AND THEY DON'T REALLY DO THEM?

WHAT IS THE HIT RATE WITH THAT?

>> THAT'S A GREAT QUESTION.

I THINK THAT'S A TOUGH QUESTION TO ANSWER, ONLY BECAUSE FULLY COMMITTING TO AN EXERCISE PROGRAM LOOKS DIFFERENT FOR EVERYBODY.

BUT I WOULD DEFINITELY SAY IT'S NOT 100%.

BUT THERE IS REASON FOR THAT AT TIMES.

SOMETIMES IT IS AN INTERNAL JUST NOT MOTIVATED, NOT CONNECTED GOING TO P.T.

BECAUSE SOMEBODY TOLD ME TO RATHER THAN UNDERSTANDING WHY YOU ARE SENT THERE.

>> I DON'T WANT TO DO IT FOR MYSELF.

>> INTERNAL DRIVE IS A BIG PART OF IT BUT WE CAN'T IGNORE EXTERNAL THINGS, TOO.

LIFE STRESSORS, LIFE HAPPENINGS, JOB, CHILDREN, THINGS LIKE THAT CAN AFFECT IT AS WELL.

>> WHEN I HAD THE BACK PAIN, IT WAS HARD FOR ME.

I HAD TO STOP RUNNING, WHICH WAS VERY UNPLEASANT TO ARE ME BECAUSE I WAS REALLY DEVOTED TO RUNNING.

BUT ALSO IT WAS EVEN LIKE IF I TIED MY SHOE, IT WAS PAINFUL TO TIE MY SHOE.

SO DOING EXERCISES WAS HARD.

SO WHAT ABOUT THAT?

IF SOMEBODY SAYS TO YOU, YOU GIVE ME THIS EXERCISE TO DO AND I COME BACK AND I SAY YOU ASKED ME, WELL DID YOU DO THEM.

I SAY WELL, DOC, IT HURTS.

WHAT DO YOU SAY?

>> THAT REALLY, AGAIN, IT'S HARD TO ANSWER THAT ONLY BECAUSE PART OF IT IS OUR PLAN CHANGES OVER TIME.

WE ARE MOLDING WITH THE PATIENT AS WE UNDERSTAND HOW THEY RESPOND TO WHAT WE ARE GIVING THEM.

THAT'S ONE.

BUT IN THE BEGINNING, USUALLY THERE IS A PROTECTIVE PHASE WHERE WE ARE INTRODUCING MOVEMENT THAT IS SAFE, BUT WE ARE ALSO LIKELY AVOIDING THINGS LIKE BENDING DOWN, TYING YOUR SHOES 20 TIMES A DAY.

WE DON'T WANT YOU IN THAT POSITION.

EVENTUALLY WE'LL GET BACK TO THOSE EXERCISES THAT REINTRODUCE THAT MOTION BUT GENERALLY SPEAKING, WE ARE GOING TO START WITH EARLY PROTECTION, EARLY SAFE MOVEMENT AND THEN BUILD INTO THAT FROM THERE.

>> AND IS IT FAIR TO SAY THAT YOU MIGHT HAVE TO TOLERATE SOME PAIN IN ORDER TO, YOU KNOW, SHORT-TERM PAIN FOR LONG-TERM GAIN?

IS THAT FAIR?

>> DEFINITELY.

WITH THE IDEA THAT YOU ARE DOING IT WITH A PROVIDER ALONGSIDE YOU.

I WANT A PATIENT REPORTING TO ME HOW THEY'RE FEELING.

THEN I CAN DECIDE BASED ON THEIR REPORT WHETHER OR NOT IT'S TIME TO TURN TO OTHER SOURCES, HAVE THEM SEE OTHER PROVIDERS.

OR IF IT'S THE TYPE OF PAIN YOU ARE TALKING ABOUT WHERE IT'S JUST THAT INTRODUCTORY WE GOT TO FIGHT THROUGH IT TYPE OF SYMPTOM.

>> ANYTHING TO ADD TO THAT, JOE?

>> I THINK MELISSA AGAIN IS RIGHT ON THE MARK.

BUT I THINK ONE THING SHE IS ALLUDING TO IS WE ARE VERY COLLABORATIVE.

WE INTERESTINGLY ARE A SEPARATE PRACTICE BUT FROM A PHYSICIAN PERSPECTIVE, I'M OFTEN INTRODUCING THE IDEA TO THE PATIENT THAT LOOK, YOU HAVE SIGNIFICANT ATROPHY-- >> DISUSE ATROPHY.

I LOVE THAT TERM.

WHAT DOES HAT MEAN.

>> THE PATIENTS HAVE BEEN IMMOBILE FOR QUITE SOMETIME AND DUE TO PROTECTIVE MEASURES, THE IDEA OF PAIN VERSUS HARM.

IF I HURT AND I DO SOMETHING, I'M GOING TO MAKE IT WORSE, WHERE, IN OUR MIND SET, YOURS, MIND, MELISSA'S, A LITTLE PAIN SORT OF THAT NO PAIN NO GAIN HAS MERIT ALSO BUT IN THE RIGHT CONTEXT.

IF I GET SOMEONE WHO HAS BEEN SEDENTARY FOR A LONG TIME OR THEY HAVE AN ALMOST OVERLY SUPPORTIVE HOUSEHOLD, WHERE THE HUSBAND OR THE WIFE IS DOING EVERYTHING FOR THAT SPOUSE, TO SOME DEGREE-- >> THAT'S ME.

EVERYTHING I DO FOR MY WIFE.

BACK TO YOU.

>> IT CAN BE HEALTHY IF IT'S IN THE RIGHT CONTEXT BUT IT CAN BE COUNTERPRODUCTIVE IF IT'S CAUSING PROGRESSIVE WEAKNESS, DISUSE ATROPHY AS WE SAY.

SO IT ISN'T FAIR FOR ME TO SAY GO TO PHYSICAL THERAPY AND MELISSA CRACKS THE WHIP.

OF COURSE WE ARE GOING TO DO MORE HARM THAN GOOD.

IN THAT SETTING, I WOULD PRESCRIBE SOME MEDICATIONS THAT MAYBE ANTIINFLAMMATORY MEDICATIONS THAT ARE MILD ANALGESICS, MAY RECOMMEND MUSCLE RELAX ANTS, IMPROVE THEIR SLEEP QUALITY SO THEY CAN GET IMPROVED DELTA WAVE SLEEP.

>> SLEEP IS AN IMPORTANT PART OF GETTING RID OF PAIN.

>> VERY SIGNIFICANT COMPONENT TO EVERYTHING.

IT HELPS WITH MOOD ELEVATION, MUSCULAR PAIN.

IT HELPS WITH MOTIVATION.

AS I TELL PATIENTS, IF PAIN GOES UNTREATED, IT WILL WIN SO WE NEED-- WHEN YOU GET THE STOIC PATIENT WHO SAYS DON'T WORRY, DOC, I'M FINE.

BUT THE REALITY IS I CAN SMIRK AND SAY I'M HERE WHEN YOU ARE READY BECAUSE I KNOW THAT WHO IS GOING TO WIN THAT BATTLE.

PAIN IS GOING TO WIN.

SO WE TRY TO WORK IN A WAY THAT WE ARE GOING TO HELP PROVIDE THAT PERIOD OF PAIN FREE INTERVAL OR CONTROLLED PAIN INTERVAL SO MELISSA CAN HELP RESTORE MUSCLE FUNCTION AND GENERALLY MOTIVATE THE PATIENT IN A MORE POSITIVE WAY.

>> SO YOU ARE GETTING YOUR EXERCISE IN THERE TO DEVELOP MORE FLEXIBILITY, MORE STRENGTH, MORE STABILITY AND THOSE THINGS AND HOPEFULLY ALL OF THAT WILL REDUCE THE PAIN.

>> YES.

>> ABSOLUTELY.

>> SHORT-TERM.

NOW WHAT ABOUT PREVENTING SHORT-TERM FROM GOING TO LONG-TERM?

CHRONIC ACUTE TO CHRONIC.

IS THAT WHAT WE ARE TALKING ABOUT.

>> YEAH AND HE STARTED TO TOUCH ON THAT AS WELL.

A HUGE PART OF THAT IS LOOKING AT THE BROADER PICTURE NOT JUST THE SPECIFIC EXERCISES OR SPECIFIC MEDICATION THAT YOU ARE ON.

IT'S LOOKING AT WHAT IS YOUR ACTIVITY LEVEL IN GENERAL.

WHAT IS YOUR SLEEP LIKE ON A CONSISTENT BASIS.

WHAT IS YOUR HYDRATION AND NUTRITION.

WHO IS YOUR SOCIAL SUPPORT?

WHO IS WITH YOU AT HOME, YOU KNOW, GIVING YOU THE PUSH TO SAY HEY YOU GOT TO GO OUT AND DO IT.

ARE THEY SAYING NO, YOU CAN'T DO THAT.

LAY DOWN.

WHAT DOES THAT LOOK LIKE IN THE WORKPLACE FOR YOU.

IT'S A WHOLE PICTURE THAT PAINTS OFTEN THE BRIDGE THAT TAKES PEOPLE FROM ACUTE TO CHRONIC PAIN.

>> WELL, OUR "CYCLE OF HEALTH" TEAM IS INVESTIGATING WAYS PEOPLE ARE MANAGING PAIN AND GETTING BACK ON THEIR FEET, WITHOUT LETTING IT SLOW THEM DOWN.

LET'S TAKE A LOOK.

BUT WHILE WE ARE DOING THAT, WE ARE GOING TO BE A GOOD MODEL.

WE ARE GOING TO STAND UP AND ACTUALLY MOVE A LITTLE BECAUSE SITTING IS THE NEW SMOKING.

IT'S NOT GOOD FOR YOU RIGHT?

WE ARE GOING TO STAND UP AND THIS IS WHAT WE ARE GOING TO HAVE TO MOVE AROUND GET A LITTLE MUSIC?

DANCE.

AND HERE COMES THE PIECE.

>> MY NAME IS CHELSEA TORRES, OCCUPATIONAL THERAPIST.

I WORK FOR UPSTATE THIS FACILITY IS OUR BRAND NEW CLAY LOCATION.

THIS IS WHERE WE SEE A LOT OF OUR OUTPATIENT THERAPIES.

AND MY JOB AS AN OCCUPATIONAL THERAPIST IS JUST TO SEE WHAT IS STOPPING YOU FROM DOING DAILY ACTIVITIES AND OFTEN THAT IS PAIN.

SO MY AREA IS INCLUDING NEURO, NEUROLOGY STROKE, BRAIN INJURY, SPINAL CHORD.

THERE IS CONCUSSION.

THERE IS ALSO GENERAL ORTHOTICS SO PEOPLE WHO COME IN WITH BROKEN BONES, TORN ANKLES SO ON AND SO FORTH.

WE SEE VISION AND PEDIATRICS.

IT'S A LOT OF DIFFERENT PEOPLE HERE AND WE HAVE O.T., P.T.

AND SPEECH SERVICES AS WELL AND ON THE OTHER SIDE YOU SEE OUR CONCUSSION CLINIC.

WE HAVE A LOT TO OFFER HERE.

THIS GIVES PEOPLE AN OPPORTUNITY WHO MIGHT NOT HAVE THE LUXURY OF GOING DOWNTOWN TO OUR BIGGER LOCATION AND GENERALLY INCREASE OF ACCESS AND IT'S VERY PRIVATE, TOO.

THIS IS MY FAVORITE TOOL.

A GRABBER, A REACHER.

ESSENTIALLY LIKE A TRIGGER, YOU USE THAT TO GRAB THINGS.

YOU DON'T HAVE TO BEND I TELL MY PATIENTS YOU CAN USE THIS TO GRAB YOUR TV REMOTE, GRAB YOUR SHOES?

GO FOR IT.

AND I WILL TRAIN THEM HOW TO USE THE EQUIPMENT.

IF I CAN SAVE YOU THE UNNECESSARY NEED TO BEND ALL THE TIME, WHY NOT.

WHAT I NOTICE WHEN I TEACH PATIENTS THIS PAIN PROCESS.

THE POWER IS TAKEN AWAY FROM THEIR PAIN.

IT'S NOT THIS GIANT MONSTER THAT WE DON'T KNOW ABOUT.

THEY'RE MORE EMPOWERED.

SOMEBODY IS LISTENING TO THEM FINALLY.

THEY CAN ACTUALLY MANAGE THEMSELVES.

I NOTICE AN INSTANT CONFIDENCE BOOST AND GETTING AWAY FROM THE MIND SET THAT IT ALWAYS GOING TO BE LIKE THIS.

I NOTICE THAT PATIENTS MORE WANT TO TRY THINGS AND EVEN I NOTICE PEOPLE ARE DOING MORE.

PAIN MANAGEMENT STARTS WITH TALKING TO THE PATIENT AND UNDERSTANDING THIS IS A REAL EXPERIENCE FOR YOU AND GIVING YOU THE TOOLS AND THE EDUCATION TO HAVE HOW TO HANDLE IT RATHER THAN JUST SAYING IT'S MADE UP.

MAKING UP IT IN YOUR HEAD.

TAKE THIS MEDICATION.

NOT THAT MEDICATION IS BAD BUT I FIRMLY BELIEVE THAT WE COULD HAVE TRIED MANY DIFFERENT THINGS BEFOREY WITH RESULT TO SOME MEDICATION SOMETIMES.

I THINK FOR THE LONGEST TIME IN THE HEALTHCARE CULTURE, WE RELIED SO MUCH ON IMAGING, RESULTS.

WE SAY THE IMAGES WERE FINE.

THE X-RAY WAS GREAT.

YOUR MRI FINE OF YOUR ANKLE OF YOUR BACK, BUT THOSE DEVICES DON'T SEE PERCEPTION.

THEY DON'T SEE HOW THE BRAIN IS PERCEIVING THE SIGNALS THAT ARE COMING FROM THE BODY AND WE OFTEN DISMISS IT.

WE'LL TELL PATIENTS.

IT'S IN YOUR HEAD.

SO I THINK,000 THAT WE ARE AS A RESULTING TO SEE THAT WE ARE NOT ADDRESSING THE PROBLEM, THERE IS A CONSEQUENCE TO SAY JUST SUCK IT UP BUT I THINK NOW, I MEAN THE TEAM I WORK WITH HERE, FABULOUS, VERY UNDERSTANDING.

WE LIKE TO HEAR PEOPLE, WE WANT THEM TO KNOW THAT THEY'RE HEARD.

>> THAT WAS FUN.

THANK YOU VERY MUCH.

I HAVE NEVER DANCED ON THE SHOW BEFORE.

THAT WAS ENJOYABLE.

WHOOPS, I GOT TO GET MY PILLOW HERE.

SO WE TALK A LITTLE BIT ABOUT MEDS.

WHAT ABOUT THE IDEA THAT CHRONIC PAIN, WHEN YOU HAVE PAIN, YOU CAN GET NEURAL PATHWAYS IN YOUR BRAIN SENSITIZED AND THEN THINGS THAT YOU DIDN'T USED TO BE PAINFUL BECOME PAINFUL?

>> SO THAT'S DEFINITELY A REAL THING.

THERE IS DIFFERENT TERMINOLOGY FOR IT.

CENTRAL SENSITIZATION IS ONE OF THEM.

ESSENTIALLY WHAT IS HAPPENING IS THAT THIS REPEATED PAIN STIMULUS IS MAKING THE BRAIN ESSENTIALLY BE ON HIGH ALERT.

I WAY I TALK TO PATIENTS ABOUT IT, THINK ABOUT HEARING A NOISE IN THE MIDDLE OF THE DAY VERSUS HEARING A NOISE IN YOUR HOUSE IN THE MIDDLE OF THE NIGHT.

OR ONE SOUNDS A LOT SCARIER AND THREATENING AND YOUR BODY GOES INTO THE NIGHT MODE ALL OF THE TIME.

SO EVEN THINGS THAT SHOULDN'T BE PAINFUL, YOU KNOW, CAN BECOME PAINFUL IN THAT SENSE.

>> SO WE JUST HAVE A COUPLE MORE MINUTES.

WHAT ABOUT PREVENTION?

WHAT IS THE BEST WAY, LIKE IF YOU WANT TO BE ONE OF THE TWO PEOPLE OUT OF 10 THAT DOESN'T HAVE BACK PAIN IF YOUR LIFETIME, WHAT WOULD YOU GUYS PRESCRIBE FOR PEOPLE.

I KNOW YOU ARE A BIG BIKER YOURSELF.

IS ONE OF THE THINGS-- >> I WOULDN'T-- YES, AS WE TALKED EARLIER, I THINK THE KEY TO A WELLNESS LIFESTYLE IS HAVE YOU TO LOVE WHAT YOU ARE PLAYING WITH AND TO ME, I LOVE CYCLING.

I FEEL THERE IS JUST TONS OF BENEFITS IN TERMS OF IT BEING VERY LOW STRESS ON YOUR BODY, WHICH IS KEY, IT ALSO BUILDS A FAIR AMOUNT OF MUSCLE AND ENDURANCE SO THERE IS CARDIAC HEALTH.

THERE IS MUSCLE HEALTH BUT I ACTUALLY ENJOY WEIGHT TRAINING AS WELL.

SO TO ANSWER YOUR QUESTION, FOR ME, I JUST FEEL THAT SORT OF THE OLD SAYING, I THINK IT'S SOMETHING TO THE EFFECT THAT THE SOUND BODY BUILDS A STRONG MIND.

I THINK YOU NEED TO HAVE THE WHOLE PACKAGE.

AND TO ME, EXERCISE IS MY-- IS PART OF MY DAILY ROUTINE AND SO DO I GET HURT?

I SEEM TO GET HURT ALL THE TIME.

BUT THE REALITY OF IT IS I HEAL VERY WELL AND I HATE THAT WHEN THE DOCTORS THAT ARE MY PEERS AND MY DOCTORS BECAUSE I'M A DOCTOR AND A PATIENT, THEY'RE CONFIDENT I'M A GOOD HEALER.

YOU ARE MISSING THE POINT.

I DON'T WANT TO BE THE GUY GETTING HURT BUT THEY'RE CONFIDENT I HEAL WELL BECAUSE I KNOW THE KEY IS BACK TO EXERCISE SO GETTING TO MOTION IS LOTION, THAT'S MY GOAL EVERY TIME.

>> AND YOU ARE NOD AGO LONG.

>> I AGREE-- YOU ARE NOD AGO LONG.

>> MOVEMENT IS MEDICINE, MOTION IS LOTION.

FINDING SOMETHING YOU YOU CONNECT TO AS A PERSON THAT YOU CAN BE CONSISTENT WITH ACTIVITY.

WHETHER IT'S BIKING, WEIGHT LIFTING OR JUST WALKING, DOING SOMETHING TO MOVE YOUR BODY ON A REGULAR BASIS, TAKE CARE OF YOURSELF, TAKE CARE OF YOUR MIND.

THAT'S THE BEST THING YOU CAN DO.

>> SO MY SIT-STAND DESK IS A GOOD IDEA.

KEEP MOVING.

>> TWO THUMBS UP.

>> OKAY.

I'M A WEIGHT GUY, TOO, SO AFTER THE SHOW, WE ARE GOING TO HAVE AN ARM WRESTLE.

WE'LL SEE WHO HAS THE STUFF.

BASICALLY YOU GUYS ARE SAYING YOUR GOAL FOR BOTH OF YOU IS TO GET PEOPLE BACK SO THEY CAN BE ACTIVE, SO THEY CAN START MOVING AGAIN AND THAT WILL PREVENT ACUTE TO GO INTO CHRONIC IN MOST CASES?

>> I THINK EVERY PATIENT IS DIFFERENT AND SO SOME PEOPLE, FOR A VARIETY OF REASONS, AS MELISSA MENTIONED EARLIER, NEVER WILL DEVELOP CHRONIC PAIN BASED ON WHATEVER IS THEIR INTERNAL DRIVE AND THEIR MAKEUP BUT FOR BOTH MELISSA AND I, OUR VOCATION IS TRYING TO HELP THE PEOPLE THAT HAVE SORT OF DEVELOPED CHRONIC PAIN.

AND THAT'S A CHALLENGING POPULATION.

SO THAT'S WHERE LIKE MEDICATIONS, AND IF THAT'S NOT ENOUGH, TO GET THEM MOVING WITH PHYSICAL THERAPY OR PHYSICAL MODALITIES.

THAT'S WHERE I MIGHT DO NERVE BLOCKS OR MINIMALLY INVASIVE PROCEDURES WHERE EVERYONE ISN'T BACK PAIN PATIENT.

MEDICATION, NERVE BLOCKS, SOME OF THE MINIMALLY INVASIVE PROCEDURES WHERE WEEK DO SMALL THAT SENSITIZATION CAN DESENSITIZE AND GET THE PAIN DOWN.

>> I'M COMING TO YOU GUYS NEXT TIME I GET INJURED.

BEFORE WE WRAP OUR SHOW TODAY.

I WANT TO INTRODUCE MS. MARGARET LOVIER, THIRD YEAR MD STUDENT AT UPSTATE MEDICAL UNIVERSITY, WITH A SURPRISING FACT: THE BRAIN DOESN'T FEEL ANY PAIN.

LET'S TAKE A LOOK.

BEALE STAND UP AND DO SOME MORE MOTION.

>> HI EVERYONE.

I'M MEG, A THIRD YEAR MEDICAL STUDENT WITH MY MEDICAL STUDENT MINUTE.

HERE IS AN INTERESTING FACT I'VE LEARNED AS A MEDICAL STUDENT.

THE BRAIN DOES NOT FEEL PAIN SURPRISING RIGHT?

IF YOU ARE ONE OF THE MILLIONS OF PEOPLE WHO EXPERIENCE HEADACHES ON THE REGULAR, YOU MIGHT WONDER WHERE THAT PAIN COMES FROM IF NOT FROM YOUR BRAIN.

I MEAN WHAT ELSE IS THERE UP IN YOUR HEAD?

WELL, ACTUALLY, A LOT.

HEADACHES CAN CAN COME FROM MANY OF THE LAYERS IN AND AROUND THE SKULL.

LIKE THE THIN LINING AROUND YOUR BRAIN, THE ARTERIES AND VEINS IN YOUR HEAD, YOUR SINUSES OR ANY OF THE MUSCLES AND NERVES AROUND YOUR FACE.

AND BRAIN FREEZE.

THE PAIN DEEP IF YOUR HEAD WHEN YOU EAT ICE CREAM TOO FAST?

ALSO NOT YOUR BRAIN.

THAT'S FROM A CLUSTER OF NERVES UP BEHIND THE ROOF OF YOUR MOUTH .

SO WHY IS ALL OF THIS IMPORTANT?

IF THE BRAIN CAN'T FEEL PAIN, WE CAN'T USE PAIN TO TELL US HOW BADLY THE BRAIN HAS BEEN HURT WHEN WE EXPERIENCE HEAD TRAUMA.

INSTEAD, DOCTORS AND FIRST RESPONDERS LOOK FOR OTHER SIGNS LIKE CHANGES IN VISION OR PASSING OUT.

SO IF YOU HIT YOUR HEAD AND SOMETHING FEELS OFF, TAKE IT SERIOUSLY.

EVEN IF THE PAIN ISN'T ALL THAT BAD.

THIS HAS BEEN A MEDICAL STUDENT MINUTE.

I'M MEG LOVIER.

REMEMBER, EAT YOUR ICE CREAM SLOWLY.

>> OKAY, BACK WE GO.

WELL, THAT'S ALL THE TIME WE HAVE.

I WANT TO THANK OUR GUESTS DR. MELISSA PATNELLA, PHYSICAL THERAPIST AND THERAPEUTIC PAIN SPECIALIST AT SYRACUSE ORTHOPEDIC SPECIALISTS; AND DR. JOSEPH CATANIA, ANESTHESIOLOGIST AT NEW YORK SPINE AND WELLNESS CENTER.

TO HEAR OUR COMPANION COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM.

AND IF YOU WANT TO SEE THIS EPISODE AGAIN AND PAST SEASONS, VISIT WCNY.ORG/CYCLEOFHEATH.

FOR ‘CYCLE OF HEALTH', I'M PSYCHOLOGIST DR. RICH O'NEILL.

AND REMEMBER: WE'LL ALWAYS HAVE YOUR BACK.

THANKS FOR WATCHING, AND WE'LL SEE YOU NEXT WEEK!

ON THE SEASON FINALE OF "CYCLE OF HEALTH," Dr. RICH BRINGS IN AN EXPERT PANEL TO DISCUSS DIETS FROM MEDITERRANEAN, VEGAN AND KETO TO THE DRAW BACKS OF THE AMERICAN DIET AND HOW TO MAKE HEALTHIER NUTRITIONAL CHOICES.

AND ON THE NEXT MEDICAL STUDENT MINUTE, LINDSAY SWAN SHARES OW PICKLES AND VINEGAR CAN KEEP YOUR BLOOD SUGAR IN CHECK.