Hello everyone! I recently had the opportunity to interview Jennie Shulkin, the CEO of Override Health. Jennie has experienced years of chronic pain herself and she created this organization to provide effective care and treatments that our healthcare system currently fails to offer to people with chronic pain. After reading this interview, check out Override Health so you can use it as a resource in your chronic pain journey.

Takeaways: 

• Finding interdisciplinary comprehensive pain programs (healthcare programs with different healthcare providers of different specialties working together) can be incredibly difficult in the United States. Override Health is one of those few programs because it incorporates pain physicians, physical therapists, pain psychologists, and more.
• Override Health is one of few comprehensive pain programs that accepts insurance.
• Override Health is entirely virtual, making it easy to have appointments with pain physicians, physical therapists, and pain psychologists.
• Research shows that as we can learn pain, we can also unlearn pain.

Can you tell us your personal story with chronic pain?

Yeah, I was twenty years old and I had just recovered from the second of two traumatic brain injuries that had occurred within a year and a half of each other. I developed pain starting in my neck and that spread to my lower back. Over the past 10 years, the pain has spread to many other parts of my body and I have a more general chronic pain syndrome.

What did your healing journey look like once you started experiencing chronic pain?

My pain started in my neck and my lower back which seemed like normal musculoskeletal pain. I was going to physical therapists, doing dry needling, massages, and getting scans done. It was pretty normal musculoskeletal treatment at the start, but this was a weird time for me because I was studying abroad in Tel Aviv at the time. I hardly spoke Hebrew. I didn’t even have a smartphone with GPS on it so that I could use it to find doctors. I was getting lost on buses in Tel Aviv when I was trying to go to different doctors and physical therapists to get help for this problem. I felt pretty alone.

Wow that sounds incredibly difficult being in a foreign country where they don’t speak the same language and dealing with your health.

So at some point you came back to the United States and started pursuing further healthcare options here. Tell us about that experience.

As soon as I got back, I got worked up at the hospital that my father was running in New Jersey and I was sure that I would be well on my way to recovery. I probably spent the first three or four years thinking that my cure was coming soon. If you had told me that I would still have this 10 years later and that I might have this for the rest of my life, I would have been shocked and so sad.

Looking back on your journey with chronic pain and knowing everything that you know today, is there anything that you wish you could go back in time and do differently with your health journey?

There’s this idea with chronic pain that the longer you’re in pain, the harder it is to reverse. This is a hotly debated topic. Some people in the profession say that is not true and you can get out of pain even if you have been in pain for decades. Other people say that it is true because the repetition of being in pain makes the cycle harder to break. I think there’s some truth in the latter philosophy so I wish that I could back in time and find something that would have worked and broken the cycle when it was earlier and easier to break. I wish I knew some of the things I knew now, which would’ve been helpful then.

How would you describe your experience with doctors and the healthcare system at the time?

I have had terrible experiences with doctors, but I have not experienced nearly as much gaslighting and doubt that other chronic pain patients, especially female ones, have experienced. I think that is for a couple of reasons. I went to college at a top university and then continued on to being well-educated and professionally successful. I was articulate. I also came to appointments usually with one of my parents who are medical doctors themselves, so I wasn’t doubted in the way that many patients are. 

There are doctors that will tell patients they have pain because they are depressed or that the pain is all in their head. I didn’t experience much of that because of what I just mentioned, but I still experienced providers who were nasty and not empathetic and who said horrible, pessimistic or stupid things. They could be unhelpful at best and harmful at worst.

Unfortunately, it is very common for patients with chronic pain to have negative experiences with doctors. So you have created this organization called Override Health that treats people with chronic pain. When you were in the process of creating Override Health, what flaws did you notice within the healthcare system that you have tried to address within your organization?

The biggest thing that I noticed was that if you wanted a comprehensive experience – meaning providers of different specialties working together – it’s very difficult to find. Interdisciplinary comprehensive pain rehab programs exist in just a few places in the country and many of them are only open to pediatrics or veterans. They require you to disrupt your life by moving to another state, signing a lease or paying for a hotel, taking time off from work, etc. It’s completely disruptive to a person’s life.

The alternative was seeing your doctor once a quarter and going to regular physical therapy, which for many chronic pain patients isn’t enough to even make a dent in their condition. The reason why Override is a virtual interdisciplinary care program with a team of pain doctors, physical therapists, pain psychologists, and certified pain coaches individually working with the patient and working together as a team is to fill that void in the market. Override Health provides a way to get a comprehensive, interdisciplinary pain rehab experience, but it’s virtual, it’s on your own time, and it’s affordable because it is covered by most insurance plans. You can keep living your life while getting the type of comprehensive care and support that you need to actually start making a difference.

I’d like to know about the beginnings of Override Health. What inspired you to create Override Health and how did you get started?

It started as just a couple hours of work a day. Originally we wanted to make it even more comprehensive than it is now and we were calling it the Global Pain Center at the start. We wanted it to be a one-stop shop for all of your needs such as disability consultations, genetic counseling, you name it. We eventually narrowed it down to our core offering which is pain doctors, physical therapists, pain psychologists, and pain coaches. 

Like any start-up, we went through ideation phases and business plan proposals and then narrowed it to what we thought the market would want. Then of course you find out the market doesn’t really want that and wants something else instead, so you make changes. \

The process of creating a startup is just constantly editing and refining. Since then we have not deviated from our core mission of when we first raised money over two years ago. We have stayed true to our vision of interdisciplinary comprehensive chronic pain services.

Do you see Override Health changing or do you have any future plans for where Override Health will be going in the future?

What we’re trying to do is break up our offering to make the “comprehensiveness” less intimidating to patients and providers alike. Some people like that, and others don’t. Our Comprehensive Pain Program is a lot of care because it’s often 5-8 visits per month and some patients think that is too much of a time commitment. Some providers don’t refer their patients to our program because they think the patient is not in bad enough shape for it. 

What we’ve made clear over the past few months is that we’re able to do individual appointments. We’re able to see someone for just pain psychology, or just virtual physical therapy, or even to provide quick access to a pain physician that you can see within a week. We want to spread the word that we can be flexible and meet the patients where they are.

What would you say differentiates Override Health from other organizations that are treating chronic pain?

There are not a lot of organizations that combine all the different specialties that need to be involved in chronic pain recovery. There are certainly a few different organizations that are focusing on pain reprocessing therapy or through a pain psychology lens. Unfortunately, those organizations tend to be all cash pay so they’re only available to the top 1% of people who can afford that.

These organizations focus on the pain psychology piece and for some people that may be the key to unlocking their pain. But for a lot of people, it’s not going to be that simple. It may need to be combined with medication and physical therapy and more.

For example, people with chronic pain can develop kinesiophobia, the fear of movement. That’s something a psychologist can work on, but you also need implementation and practice of that movement, which can be done through physical therapy. The patient may need someone to guide them through healthy and safe ways to move to help them with their fear of movement.

Could you describe the overall program and what the process looks like?

I typically describe it as a virtual chronic pain clinic where we have teams of pain doctors, physical therapists trained in chronic pain, pain psychologists, and certified pain coaches. They all work individually with the patient and together as a team. 

Our first differentiator is that we have chronic pain specialists who know how to treat chronic pain differently from acute pain or just general conditions. 

Our second value proposition is that we have these chronic pain specialists working together as a team, which is very difficult to find. 

We make it easy to direct message these specialists and have multiple appointments with your providers throughout the month. It feels different to be able to communicate with your providers and to feel like they care about you in a way that you have not experienced in the traditional pain medicine system.

The third aspect that makes us unique is that we’re entirely virtual. There is no driving to appointments, waiting in waiting rooms, and the exhaustion that comes with all of that. We have a mobile app with pain education, goal setting, meditations, and all sorts of things that wouldn’t be included in any sort of traditional care.

#4 is that we incorporate pain neuroscience research and education, pain reprocessing therapy, and nervous system calming techniques. 

A lot of people with chronic pain are familiar with pain doctors and physical therapists, but not as familiar with pain psychologists or pain coaches. Can you explain the role that pain psychologists and pain coaches play in the treatment of chronic pain?

I think we should probably start with a brief explanation of chronic pain and the brain and neuroplasticity. It’s important to understand that while most people think of chronic pain as a body part problem, pain neuroscience research has made it clear that if you have lived in a sustained period of chronic pain, it becomes ingrained in the nervous system (or the brain). I sometimes compare it to riding a bike. When you first learn to ride a bike, you stumble and fall, but after enough practice and repetition, it gets to the point where it is ingrained in your mind. It’s actually really hard to forget how to ride a bike.

Unfortunately, the same thing is true with chronic pain. It’s hard for the brain to forget the pain that it has learned and it becomes like a broken record or an error loop. The research shows that just as we can learn pain, we can also unlearn pain. We can break the cycle of pain through all sorts of techniques like desensitization, graded motor imagery, and meditation.

We have seen in the research that psychology and coaching by extension on the behavioral side of things are very important in breaking the cycle of pain. That’s through techniques like pain reprocessing therapy and reframing. It’s about shifting perspectives. One example is that just saying the word “pain” sends signals in your brain that reinforce pain neural pathways. So a pain psychologist might tell you to say a silly word like peanuts or pillows in place of the word pain. So you would be saying things like, “My peanuts are less comfortable today” instead of saying “My pain is really bad today”. You might laugh or smile when you say “peanuts,” and even if you don’t, it is softer to the brain. A professional might even tell you to limit talking about pain to a certain number of times per day.

Can you explain why learning the neuroscience behind pain can help with the healing process?

Pain education has been studied to be very effective in helping patients take control of their pain. Pain is scary especially when you don’t know why something is hurting. Pain education helps us to understand what pain is and how you can calm your nervous system to quiet symptoms. 

We have a pain neuroscience education curriculum that we have built at Override and is housed within the app. It has video clips, text snippets, audio segments, meditation, quiz questions, and journal entries on everything from the role of nutrition and sleep to why managing anxiety and depression matters in the experience of pain. A patient can learn through the app, but then they are also given the opportunity to attend a live group session each week that is led by a coach, who reviews a specific topic. The third way we use pain neuroscience education is that it’s infused into every session with their Override providers. It can be about the fear of movement, reframing thoughts, nutrition, or anything that the patient is struggling with.

Do you often find patients who are resistant to pain psychology and want to hold onto the belief that their pain is purely physical?

There are probably very few of us who have not had a point in our pain journeys where we felt that only physical modalities were the only thing that could help us. I do believe that everybody is entitled to be at that point in their journey. I don’t blame patients if they feel like Override or the psychological parts of Override are not for them.

At the same time, pain neuroscience education itself is pretty persuasive because it’s rooted in science and makes sense on a rational level. This isn’t an emotional or spiritual philosophy. When people go through our curriculum and they understand the science, it’s fairly eye-opening.

What advice do you have for someone who is newly diagnosed with chronic pain?

I feel for that person, thinking of myself six months into chronic pain and not knowing what to expect. Heck, I still don’t. The advice that I’d have is to find chronic pain specialists as quickly as possible. Waiting isn’t good. It’s your life, it’s your body, and it’s so valuable so don’t waste time and money on a generalist or someone that you don’t really trust.

Then we have someone on the opposite end of the spectrum who has been struggling with chronic pain for decades and they have tried so many things. What advice do you have for that person?

I’d say come to Override and give it a try. Someone like that has probably been through so much treatment and medical trauma and has maybe reached the point of giving up. That’s a hard place to be in, but we have talked to a lot of patients who say they have given up, but you can tell there is still something in them fighting because they’re still calling us and they’re still open to the idea that one day things could be better. I relate to that as well. Holding on to that little bit of hope is so important especially if you’re going to try something new like Override.

If you had the opportunity to speak with the healthcare community and tell them how they can better treat people with chronic pain, what advice would you have for them?

First, I would implore them to listen better to their patients. Most people with chronic pain feel like they’re not being heard or that they’re being ignored. 

Second, I would ask them to be humbler and to admit when they have not been trained and that they may not be able to handle more complicated cases. I’d ask them not to blame or abandon the patient when what they’re doing doesn’t work.

I’d also suggest that they need to know when they should refer out to resources with chronic pain specialists, whether it’s Override or elsewhere – a place where they can send chronic pain patients who they don’t know how to help. I’m amazed that when I call a health system to get an appointment in person, I’m often told that there’s nothing for 3 or 4 months. I wish that health system would say, “In the meantime, you could try going to Override, which has much better access to appointments.” 

Check out Override Health using this link: https://www.override.health/