Can you tell us how you got into the field of pain medicine?

I did exercise science as my undergrad degree and I went to UC Davis. Coming out of school I thought that I was going to be a physical therapist. For my first job out of school, I worked as a personal trainer for a clinical obesity facility partnered with microsoft. Through that I worked with physicians, mental health therapists, nutritionists, and all of the above to do this multidisciplinary weight loss program. Through that process I discovered that I really liked the team atmosphere and all the team components to treating chronic disease. It led me to make a jump from going to physical therapy school to going to medical school.

I got into medical school and learned what physiatry was. Physiatry is basically a short name for physical medicine and rehabilitation. We do a lot of different stuff. We treat everything from brain injuries to spinal cord injuries, to musculoskeletal conditions, to chronic pain, strokes and more. I did a residency in physiatry because I liked a little bit of everything and then I did another year of training in pain medicine. The reason I went and did another year is because I could learn procedures which is super valuable in treating pain and I liked the concept of pain in the sense that it is a very personal experience. What someone is going through with pain, that is unique to them. As a practitioner, it gave me an opportunity to connect with patients on a very different level and then help them try to improve along the way. That journey is what led to me starting Pogo Health.

When you worked as a personal trainer for a clinical obesity facility, did you ever notice a correlation between a person’s weight and the amount of pain that they experienced?

We know that there is a bidirectional relationship between obesity and chronic pain. This means that chronic pain contributes to obesity and obesity contributes to chronic pain. In this relationship between obesity and chronic pain, it is what we call “dose dependent”. If a person has more obesity, they have more pain. We know that one will contribute to the severity of the other. That’s why something I focus on a lot with patients is weight management and nutrition because it is such a large contributing factor.

Based on my research, it looks like you’re the CEO of Pogo Health, a clinical advisor for Neura Health, and you work with the Orthohealing Center in Los Angeles. Can you tell us a little about each organization and how they approach chronic pain treatment?

They’re each a little different and I have different roles in each company. Neura Health is specifically addressing chronic migraines. They have done a fantastic job of bringing together a virtual platform to help manage chronic migraines. They do it all remotely and they have a great group of neurologists and other specialists that help with headache management. 

The Orthohealing Center is a little different in the sense that it specializes in the use of things like platelet rich plasma and stem cells to address joint disease, arthritis, and tendon injuries. Pogo Health is another virtual platform that brings together health coaches, mental health therapists, and pain physicians to put together chronic pain programs for people dealing with different types of chronic pain.This is the company that I am most involved in because I co-founded it and I am an active provider in it.

As I started to grow and develop my practice in chronic pain, I came to realize the mental health component with chronic pain is crucial to address. We know that individuals with chronic pain are three times more likely to have anxiety or depression. It’s my belief that addressing mental health in the context of chronic pain is essential for managing and helping individuals thrive in the setting of chronic pain. That’s why with Pogo Health, we try to bring a support team to each individual.

What led you to realizing that mental health plays such a huge role in chronic pain?

You see it with a high percentage of patients in general. A lot of patients who walk through the door are struggling with an injury, pain condition, or something that is impacting their ability to live their life. At some point you have to bring in resources to provide the best level of care for patients. It was something that I saw a deficiency in the management of chronic pain and I felt strongly about adding it to my practice.

What do you believe are the best approaches to take when treating the mental health aspect of chronic pain?

The method of psychological support is really dependent on the patient. It’s kind of like choosing which colors you want to make a painting. The principles of cognitive behavioral therapy (CBT), pain reprocessing therapy (PRT), and acceptance and commitment therapy (ACT) all have useful components that may resonate more with different individuals. The philosophy of Pogo is to take aspects of each of those and bring them together to create more of a tailored and customized treatment plan. All of our mental health therapists are trained in those principles

When someone first signs up with Pogo Health, what does the overall process look like for them?

It depends on which program they are in because we have multiple programs. We have a clinical liaison or patient coordinator that anyone who is interested in Pogo Health can become connected with. We find out some basic information and then set up a consultation with a treating provider. I think it’s really important that every patient meet with a pain provider. I like to establish what treatments they have already tried because that determines the next steps. Then depending on what their goals are, we can put them in whichever program is most applicable.

For example, patients who are in a crisis state or a very significant pain flare, they may benefit from our most intensive program which is 12 weeks. In that program we may address sleep hygiene, nutrition, exercise pacing, and more on a weekly basis. In some of our other programs, this would be done on a monthly basis. 

We don’t push things on patients. The patient has to dictate what they want. We have something called Pogo doses which deals with goal setting and exercise and other things I have talked about. It really depends on what the patient is looking for. If someone says that they are having trouble exercising because of their knee pain then we can start with exercise and a training program. We can help them set more goals geared towards fitness. If someone says that their chronic pain is really affecting their mental health, then we need to start with a mental health program which would deal with mindfulness, progressive muscle relaxation therapies, and some other topics.

Another thing I would like to talk about is the use of stem cell treatments in chronic pain. You had mentioned that the Orthohealing Center does this treatment. 

There are stem cells in some of these injectable therapies, but you can also use things like your blood, bone marrow, or your fat tissue to address painful regions. You can use something in your blood called PRP to address joint pain and tendinopathy. The Orthohealing Center utilizes some of these alternative treatments to address chronic joint pain and things like that.

Stem cell treatments have been around for a while. I think it’s really important for each individual to meet with a provider and talk about the risks, benefits, and alternatives. The reason I say that is because there are other things that can be done prior to interventions which may provide better and longer term benefits.

Oftentimes when people are in pain for a long period of time, they are looking for an answer and the reality is that they’re going to need a combination of things. It starts with the foundations which are mental health, exercise, and those types of things.

When you first meet with a patient through Pogo Health, what is your starting approach for treating chronic pain?

I really like to understand with each patient “where are you now, where have you been, and where do you want to go”. You have to take a past, present, and future approach to it. Every person’s pain journey has a different end point. Some people want to be able to play with their grandkids more, some people want to get back to playing soccer, and some people want to learn to surf. What the patient wants is the most important question to ask. My goal is to get them to where they want to be.

What is your advice for someone who is newly diagnosed with chronic pain?

100% see a doctor. If it just started happening and they haven’t received treatment, then they probably need a work up. The doctor may say, “Let’s just see if it goes away” and if it doesn’t go away, we can do some imaging and try some medications. They need to be evaluated to see if it’s something deeper that needs to be addressed.

What is your advice for someone who has had pain for over 10 years and they have tried physical therapy, medications, and surgery and nothing has worked?

In these situations, doing more is not necessarily the answer. That’s not what everyone wants to hear. Getting more medications and trying more aggressive therapies is not necessarily the answer. Sometimes patients need to come back to the basics. That’s kind of how Pogo Health was born. It was created to help establish that foundation and help individuals who have had pain for 10, 20, or 30 plus years. These individuals who have had pain for so long have lost the foundational skill set. We want to re-establish that foundation in a way that is beneficial to individuals with chronic pain.

Do you often see patients who regress from the progress that they made? How do you approach treating these individuals?

It’s very common. An individual that has chronic pain has a “dial” like the control on a radio. Some days the dial is going to be turned up and we have the ability to turn it down. I focus on teaching individuals how to turn the volume of their pain down. We know that there are going to be bad days. The road to recovery is not lineary. It’s going to have ups and downs. Knowing that, how can we learn all the coping skills? Whether it’s mentally, emotionally, or physically.

We want the pain to be done forever. I get that and I want that too, but the reality is that it may not be. We need to be prepared for the bad days and know how to ground ourselves and turn that dial down when your spiraling and things are escalating. It’s different for everyone.

Would you say that there are certain types of people or personality types that are more prone to developing chronic pain?

There are mental health conditions that can predispose people for chronic pain. People with chronic pain are 3x more likely to have anxiety and depression. I can’t really comment on a personality type because people who are type A or type B in their personalities are at an equal risk for developing depression and anxiety. We do know that depression and anxiety can significantly contribute to chronic pain. PTSD is also a very large risk factor.

Where do you see chronic pain research taking us within the next five years? 

Our philosophy for treating chronic pain from a medical standpoint has changed drastically. If you go back 15 or 20 years, chronic pain was being managed with a high volume of opioid prescriptions. We now know that chronic opioid use can contribute to significantly more pain. Now we have changed the prescribing guidelines for treating chronic pain patients with opioids.

As we have transitioned, other medications that are non-opioid based have been used to treat pain. We now have methods and programs for weaning people off of opioids.

The stigma of mental health is changing in the U.S. More and more people are identifying mental health as a major public health crisis. I’m hoping this trickles into the chronic pain space and that we start to address it more. Many of the medications that we use to treat chronic pain are antidepressants. 

Does Pogo Health offer treatments for weaning off of opioids or do you find that people tend to wean themselves off the opioids once they see that other treatments are working?

I always recommend that an opioid wean be done under the supervision of a physician because there are side effects and risks to coming off of the medication too quickly. At Pogo Health, we try to help patients with the weaning process and we incorporate other modalities. The goal is to make it easier to get them off of the opioids.

Is there anything else that you would like to talk about and make people more aware of?

One of the things that I am particularly interested in is the prevalence of chronic pain in the workplace. The chronic pain journey can be very isolating. There are around 60 million people in the U.S. that have chronic pain and a vast majority of those individuals are working. Chronic pain is in the workplace and it is not addressed because no one wants to talk about it. A lot of times it goes unaddressed, it’s not discussed, and it’s not handled appropriately in the workplace. 

If I could change anything, I would change how chronic pain is addressed in the workplace. With Pogo Health, we have created programs to try and help employees. We want to help employers help their employees by offering programs that they can do on a flexible timeline. This can help employees be more productive and engaged at work.

When you have a chronic pain flare, your productivity is naturally going to go down. How do you combat that? I think the answer is that it takes a village. It takes multiple people supporting each individual along their chronic pain journey. 

There are also 8-10% of chronic pain patients who have what is called high impact chronic pain. This is pain at such a high level that it impairs their daily living and often their ability to work. There are many missed opportunities to intervene before it gets there. There is a complete lack of support for this specific percentage of employees. There are things that we can do to keep these people in the workforce and feeling better. Things need to change in the system. We need to improve access to resources which is one of the benefits that came out of the pandemic. We developed virtual care to get resources to individuals more easily.

Takeaways:

• Chronic pain contributes to obesity and obesity contributes to chronic pain.

• People with chronic pain are more likely to have anxiety and depression.

• The road to recovery is not linear. There are going to be ups and downs.

• Mental health needs to be addressed in the treatment of chronic pain.

• Chronic pain is not handled appropriately in the work space and this needs to change.

Thank you so much to Dr. Hunter Vincent for doing this interview with me. He has helped the chronic pain community so much and Pogo Health is an amazing and easily accessible resource. Here is the website for Pogo Health if you are interested in learning more: https://pogo-health.com

Hang onto Hope!!