Understanding Chronic Pain: And Its Role in the Opioid Epidemic

Chronic pain affects millions of people around the world. Yet many patients are still told that if scans look normal, the problem must be “in their head.”

In reality, chronic pain is far more complex. It involves the brain, the nervous system, emotional regulation, and the way the body responds to stress and trauma.

In this episode of Living a Life in Balance, Abdullah Boulad is joined by Dr. Mel Pohl for a deep conversation about chronic pain, addiction medicine, and the mind-body connection.

Drawing on decades of clinical experience, Dr. Pohl explains why traditional medical models often struggle to treat chronic pain effectively. The discussion explores how addiction medicine intersected with pain treatment during the opioid epidemic, and why a deeper understanding of the nervous system is essential for long-term recovery.

The conversation also examines how trauma, stress, loneliness, and emotional regulation influence pain perception. Dr. Pohl discusses the role of the vagus nerve, Polyvagal Theory, and why safety and co-regulation are critical factors in healing.

Rather than focusing on quick fixes, this episode looks at the gradual process of restoring balance within the nervous system and helping individuals regain agency over their lives.

Topics explored in this conversation include:

• The evolution of addiction treatment and lessons from the opioid crisis
• Why high-functioning professionals are not immune to addiction
• The relationship between chronic pain, trauma, and the nervous system
• How thoughts, stress, and attention shape the experience of pain
• Polyvagal Theory and the role of the vagus nerve in healing
• Why integrative approaches are changing how chronic pain is treated

This conversation offers a thoughtful perspective on one of the most misunderstood conditions in modern medicine.

About Dr. Mel Pohl: Dr. Mel is a physician specializing in addiction medicine and chronic pain treatment. With decades of clinical experience, his work focuses on the intersection between substance use disorders, pain management, and the nervous system, emphasizing integrative approaches that address both the biological and psychological dimensions of healing.

00:00:00 — Dr. Mel Pohl’s Path into Addiction Medicine
00:01:05 — Why Doctors Specialize in Addiction Treatment
00:01:29 — Early Addiction Treatment and Aversion Therapy
00:04:57 — The Opioid Epidemic and Chronic Pain
00:05:35 — Addiction Among High-Functioning Professionals
00:08:21 — Recovery Models and Alcoholics Anonymous
00:10:27 — The Evolution of Addiction Treatment
00:13:10 — Why There Are No Quick Fixes in Addiction Recovery
00:13:41 — Dr. Mel Pohl’s Personal Experience with Chronic Pain
00:16:06 — Why Back Surgery Often Fails Chronic Pain Patients
00:18:29 — What Chronic Pain Really Is
00:21:16 — How the Brain Influences Pain Perception
00:25:07 — Psychological Approaches to Chronic Pain
00:28:16 — The Vagus Nerve and Polyvagal Theory
00:32:29 — Trauma, Co-Regulation, and the Nervous System
00:34:28 — Placebo, Nocebo, and the Power of the Doctor-Patient Relationship
00:39:19 — Integrative Medicine and the Mind-Body Connection
00:42:50 — Self-Regulation Tools for Chronic Pain
00:49:18 — Trauma, Stress, and Chronic Pain
00:57:38 — The Future of Chronic Pain Treatment

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https://www.linkedin.com/in/mel-pohl-4b104914/

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Transcript

0:00

I began my career in addiction medicine. Two years later, I got sober, showing up, telling people how to get sober and me going home and taking all sorts of drugs on the weekend and blacking out and driving. I used to give really good lectures on cocaine. On cocaine. Wow. Denial keeps you from seeing the truth until you can't deny anymore. How did you get out of it? I went to AA. We stopped using the substance. And life does not get better. My life did not get better. My life got worse. What's your own experience with pain? I developed some very severe pain. 80% of the experience of chronic pain is in the brain. Anxiety. Fear. Anger. The medical profession doesn't do justice to people's chronic pain. Traumatized brains are more sensitized to pain for people with chronic trauma. Safe isn't safe. I want to encourage people to have a better life in the face of their experience of chronic pain, and it can be done. Be open to the possibility that there's more to your chronic pain than you've thought. Welcome to the Living a Life and Balance podcast. My guest today is Doctor Mel Paul, a board certified family physician and addiction medicine specialist internationally recognized for his work in chronic pain and the opioid crisis. I hope you will enjoy. Mel, what motivated you to do what you do today? Well, I think it was the journey was guided. We could say, uh, I was I'm a family physician and went to medical school in Buffalo, New York, did my residency there, and in the middle of residency, I got a little interested in addiction. I don't know why. And I did a month rotation in specialty, and I went to an Alcoholics Anonymous meeting and then I was moving out of Buffalo, was very cold, and I ended up moving. To Las Vegas, Nevada. The opposite. Yes. And I moved there because my partner got a job. So that was the motivation. I didn't want to go to Vegas, and the job I got was a family doctor, and the owner of the practice who employed me said, by the way, I run an addiction program and you're going to cover every other weekend. You know, it was out of I mean, I had no clue that that was going to happen. So I moved a few months later and became the assistant medical director of this treatment program. And he 5 or 6 months later, he ended up getting ill, and I became the medical director of an addiction program. It was called Raleigh Hills Hospital. Very. This was 1979? Yes. The method of treatment there is, uh, aversion therapy. We gave people injections of medicine to make them throw up. Yeah, gave them alcohol to drink. And they coupled the sight, smell and taste of alcohol. It was very primitive. Okay. That's crazy. And so that's where I began my career in addiction medicine. Two years later, I got sober. So in that two year period, I struggled with my own addiction, which became more and more, more and more of a serious problem, but hadn't yet been arrested, hadn't yet, uh, lost anything really. But my it was it was wearing on me the, you know, showing up, telling people how to get sober and me going home and smoking marijuana and, you know, taking all sorts of drugs on the weekend and blacking out and driving. And, you know, at some point it was just I'd had enough and, uh, got sober, stopped drinking, stopped using drugs, Continue to do addiction medicine throughout the entire time. In fact, I created an outpatient program and our specialty was on cocaine treating cocaine. And I used to give really good lectures on cocaine. On cocaine? Yeah. Wow. Yeah. So, you know, nothing I'm proud of, but it makes a good story. Uh, so how I got into the field was, I think, divinely inspired because I needed to get sober. I needed to get well. I was 41 years ago. I've been sober that long, and along the way, I've just gotten an opportunity to treat people with substance use disorders. And about 20 years ago, we're going to talk about the opioid epidemic. It was very prominent in the States, and we treated so many people with opiate dependence who would say, what are you going to do about my pain? I'm taking opioids for pain and I'd say, I don't know. I mean, I'm a family doctor, but you should go back to your pain, doctor. Well, the pain doctor is where they got the prescription, so I got real interested. And what can I do for people who have co-occurring dependence on opioids or other substances, but also who have chronic pain? And over the last 20 years, my interest in that is developed. And I've learned so much about what what it means to have chronic pain and how it affects people's lives and what we can do about that other than prescribed medication. So that's the short answer. Yeah. Question. Incredible story. So, um, I mean, being a physician yourself, uh, probably you should have known better. Or how did you get into the addiction in the first place and understanding and knowing what the effects are and treating others for it. Of course, it's a very good question, but addiction doesn't live in the frontal lobe where we know it lives, in the midbrain where I'm driven and I, you know, I my my best insight now, in hindsight, is that I was an anxious man and was very, uh, I had my own issues, let's say anger and fear. And I manage them all by leaving my work and coming home and smoking marijuana. And, you know, on some level, I would know this is a bad idea. I would give a lecture on I talked to patients about blackouts. Yes, and I would this little voice in my head would say, well, you do that and you don't remember where you drove yesterday. You were in a bar. And I would say, shut up, you know. So denial keeps you from seeing the truth until you can't deny anymore. So, uh, But it was slow going. You know, you put a frog in boiling water, it jumps out, you put a frog in cold water and you heat the water. Well, I heated the water for all that time until I was boiling to death. And thank you know, God and whatever brought me to my senses, it was really. I just couldn't, couldn't keep doing what I was doing. So and I'm grateful that I found out before I crashed the car or, God forbid, hurt somebody or hurt myself. Uh, but it was around the corner. You know, something bad was going to happen. This shows that people can be so high functioning in their jobs, even as a physician or a CEO of an organization, and you can still quietly suffer in the background. Yeah. I mean, I think that is the definition of how people's experience addiction and the jobs the last, as you know, the Blast to go. You know, because I had to earn a living and I had to do what I was doing. Uh, and I was able I mean, I'm sure my function was impaired on some level, but I compensated. You know, I was a high functioning guy, so I managed as best I could. Uh, until I just. It was on the verge of of some sort of a disaster, I think. Yes. How did you get out of it? I didn't go to treatment. Yeah. Even though I take people to treatment, I treat people as you do. But I did not go to a treatment center. I was I went to AA, uh, Alcoholics Anonymous, and I had been interested in Alcoholics Anonymous for years as a treatment person. I heard somebody lecture and say, oh, you need to know AA even if you're not alcoholics. So I started going to meetings here and there as a, as a guest listening And one day I went and listened with a different ear. And there's a line in the Alcoholics Anonymous literature that says half measures availed us nothing. And it was like, oh, God, you know, because I thought half measures would avail me half, and I wasn't that bad, you know, because I hadn't gone to jail. And, you know, the, the it was hard to give up my, in my ego and my. Yeah, I mean, I was sort of pompous and very self-centered and a little narcissistic edge, you know, and I had to give all that up to be able to get, be a part of the process. It happened slow, uh, over several years, but I, I. Managed. I'm better than managed. I, you know, I began to see answers to problems and, and, uh, because what happened for me and what happens for many people with addiction is that we stop using the substance, and life does not get better. My life did not get better. My life got worse because of the anesthetic that I was using to treat my whatevers was gone. So I was left kind of raw, uh, and, and I had to learn how to deal with that. And it turns out AA has solutions for those kinds of problems, as does the recovery process. Yes. So in the evenings you went to the AA meetings, and during the day you were treating the addiction with fathers. Telling them what to do. That's a that's a. It's a yes. It's not. I've heard it a few times from other colleagues. Yes. But it's not a common. It's a common thing. And this is 41 years ago. Correct. How has the industry changed within these decades? Um, yeah. From aversion therapy to addiction. Well, so aversion therapy was not normative. It was sort of the place I ended up, but it was not what we did routinely for addiction. I mean, they had Maybe 15 centers around the country, and they ended up having some corporate issues and they went out of business. They're gone. They are gone. Schick. Shales. Schick is the model that they use and they're still around. I believe in these two places and they treat smoking and they treat alcohol. I think they're still operating. But the the principles of recovery have changed a lot. In the early days when I was running treatment centers, there was no question that if you had a substance issue, the problem was loss of control. Once you put some in your system, you overused and without insight and without the ability to manage the dose. And the solution was abstinence. Yes. That is not the standard of care, at least in the United States. And I don't think in England either. I mean, I think now we're much more focused on what's called harm reduction, which is use less, use less often if you use don't do dangerous things. Mhm. And it makes good sense. If you're dead you can't get recovery. That's a very simple formula. But how we get from here to there and what's in between using problem using addiction and death is a whole spectrum of, of areas. And you know, I still believe that ideally optimally addiction treatment involves abstinence. And within the abstinence process, learning how to live life in a healthier way, finding joy. And, you know, the concepts of recovery and recovery capital that, you know, living a better life is valuable. And, you know, you re-enter society and you find meaning. I think that's ideal. Yes. There's a lot of standards of care that don't include any of that. Uh, you know, there. And and for good reason. You know, people can't afford the opportunity to really, you know, sort of take the time, retune and then invest the time and energy. And how do I live a quality, high quality life? Yeah. Um, but interesting. You're saying it takes time. It needs time to do also the little steps and eventually get there. So. But in today's society we expect like this quick fixes. Can I go for a week and detox and then be. Yes. And what drug can you give me to maintain the state. Exactly. Yeah, exactly. We'll get into that. So yes, just the quick fixes. Can I get the drug and I'm out. Pain and so on. Yes. You mentioned pain yourself. So what's your own experience with pain? Well, I, uh, you know, I'm old, so my body's deteriorating as we speak. But about, uh, 20 years ago, probably around the time I got interested in pain, I had my own pain syndrome that developed, and it was insignificant. Uh, I lifted an overnight bag, £20, and then all of a sudden, I felt something. And I developed some very severe pain. As I'm talking about it, I feel it in my right, my left low back lumbar area. And I got interested in what can I do about it. And I went to a pain doctor who did an MRI and showed a bulging disc and injected, uh, steroids. And they did, uh, called an ablation radiofrequency. So they burned the nerves that went to the area. As I'm talking, my back hurts even more. Wow. And none of it really helped very much. And, uh, along the way, I found a physical therapist that I started to work with, and a chiropractor and an acupuncturist, and I invited them all to come to my treatment center that I was working in at the time to say, you know, you want to come and work with us for these people who had pain, who were also opioid dependent. So my recovery from my back pain paralleled the the institution of the program that I created at Las Vegas Recovery Center. And. Okay. Uh, and my back, you know, as I said, it bothers me when it bothers me, but there's there's most I can do. Most everything. Uh, I can hike, I can walk, I can climb, you know, mountains. I can stand on my head. But it makes me too dizzy, so I don't do that anymore. But, uh, yeah, I functionally I am fine, but it's aggravates and frustrates. And, you know, if you saw me this morning, I get out of bed and I was. Like, oh. And then I do my stretches and I get. I'm ready to go. You loosen up a bit. Yes. So you manage to live with it? I did never took opioids, by the way. Never. I was long into my recovery by that point, and it just it was. And nor have I had surgery on my back. And I think that's good. Yeah. As we talk about surgery often makes matters worse. Hmm. In what way? Well. You know, take if I have a bulging disk and a doctor assesses me, typically they're going to try and take the disc out. Or standard of practice in the States is to do a fusion of the spine so that it doesn't bend and press on nerves and, you know, hollow out the spinal canal if it's under pressure. So now I have titanium rods in my spine. Mm. A doctor put me to sleep and assaulted me with a knife. And I end up less than 20% of the time with less pain in the long run. With the fusion, if back pain is the the precipitating cause and a cost of. In the States, maybe $100,000. So that's the state of the art of back surgery. And I think that's a a negative process for so many people. And they end up that, I mean, most of the people that I see with back injuries have had two, three, four, five backs, you know, back surgery and then surgery to fix the failed back surgery. And, you know, after the fifth time they go to the doctor and the doctor says, I fixed your back. You should be out of pain. Yeah. Go see psychiatrist. You know, like what? I'm crazy because you fail. You know, your surgery didn't work. Yeah. So I, you know, I have a whole opinion about medical gaslighting in the fact that the the medical profession doesn't do justice to people's chronic pain. Now, probably that's what they learned and that's what they know the best. They're not bad people. They're not out for harm, obviously, but they're not being proactive and really mindful and thoughtful of what they're doing. And the field is it's push pull. Right now there's a there's a still the standard of practices. You go through that progression of epidural and radiofrequency and then some surgery. Yes. As if it's going to fix this problem. And as we get into talking about chronic pain, one of my taglines is the tissues, not the issue. It's not the disc in the back that's really going to fix the problem. The the problem lives in the brain and how the brain processes the pain signal. This brings us to the to the big topic, chronic pain, which can can be manifesting in different ways, probably. But what is chronic pain in your understanding. So chronic pain by definition is pain that lasts more than 3 to 6 months. And it's a physical phenomenon and an emotional phenomenon. So it's really a process the body's function and structure. Mhm. And the the real key to understanding chronic pain is that. And this is based on my clinical experience but also on the data. 80% of the experience of chronic pain is in the brain. So anxiety fear anger thoughts about pain called catastrophizing. Oh my. You know when I mentioned my back my back hurts more. Yes. That's that's a psychological issue. It's a it's a brain issue now. But the the very important point for people who are listening is that doesn't mean the pain isn't real. And people often get confused about the fact that if it's in my brain, then that means it's not. It's not the same as as a disc in my back. Well, it's exactly the same. The structure, however, is the way the neurotransmitters are working in the brain and how the cells, the parts of the brain where pain. And it turns out the pain circuits are inextricably linked with emotional circuits. So physical pain and emotional pain are the same. You can't you can't separate them out. And in our culture, we want to say it's either physical or mental. And if it's mental, then you know, you're crazy. You know, I had a patient who I explained this to her and she got irate. She said, are you telling me my pain is in my head? And I said, well, you have chronic headaches. So like, where else is your pain? But the implication was that it was in somehow less significant, less real. And that's a that's a true disservice. And it's a, it's a chronic misunderstanding that really the medical profession and the, our culture, suffers from? Yes, and it is a place people get stuck in not being able to access care. I hear my children saying, yeah, everything is mental. Everything is mental. Now if all. These kids. Are 12, 14, 16. And they're saying everything is meant. Yes, they are kind of I don't know where they got this. So if someone has an issue, they say, oh, it's mental, it's mental. So it's only in your in your, in your brain. So if we think about. Yes. Chronic pain does. Is this the effect or the origin of the pain itself or does it more intensify the pain. Yes. It's both you know. So in my case, you know, I have a disc in my back. I can show it to you on the MRI scan. And when I experience my pain, it is down in the, you know, the base of my just above my butt on the left hand side. When I talk about it, I feel it more. So what does that mean? Is there something changing in the disc? I mean, I'm sitting in the same position, so what's making it feel more intense? The attention, the attention. And there's actually an area of the brain where we can distract. Yeah, Perry. It's called Perry Aqueduct. Earl Grey. There's one area that if you are distracted, you don't feel the pain in the same way. Interesting. You know that. You know, if I, I mean, as we're talking when we get engaged, I don't think about it. When I point about it, then I think about it. So that's one aspect. But there's also an awareness that, you know, comes from my prefrontal cortex. So that's the, the, the cognitive part of the brain. And then there's these emotional centers, the I'll use some big words. But the amygdala where fear is lodged and where trauma survivors really are experienced life and the insula where significance of sensation is catalogued. And then there's a whole other system related to the vagus nerve, which we're going to talk about that has to do with safety. When I am feeling threatened, like, oh, yeah, well, you know, it's people listening and what am I saying? The right thing. You know, it causes a state of threat. And if I'm in a state of threat, all, all sorts of things go wrong. And in the process of trying to defend myself from threat, call the sympathetic activation, you know, fight or flight pain sensitivity goes up. So I feel more pain when I am on alert. Yeah, that's all in the brain. You know, it's not it's not it's real. It's real as real as a disc, but it's a whole other process. And if I don't pay attention to this, and I only pay attention to that, I'm never going to get well, that's what I tell patients until and unless you deal with the thoughts and feelings that you have related to your pain, you're never going to get better. Yeah, probably. We should not talk about pain for me. Yes. Stop talking about pain. But let's continue for now. I hope you can bear this. And I have. No, no, I have a character I like to talk about, you know. Oh, let me tell. I have a shoulder problem too. But yeah. So 80% you said. Of the phenomenon. Of the phenomenon. Yeah. So there's the sensory aspect is 20%. The overall pain experience is 80% in the, the part of the brain where we process information. And that's where emotions are and that's where thoughts are created. And, uh, it's how we think about the pain. You know, I tease patients sometimes with a little irreverence, but my back is killing me. Well, if it was killing you, you'd be dead because you've had it for 20 years. And, you know. But the thought that my back is killing me, you know, which is what we say. Yeah, is imagine what that does to a the the threat phenomenon. If you tell me now. Yeah. Your, your pain is mental. It it gives away authority from my it has something with can I do something about it. And probably if it's just mental, it's okay. What can I do? Well, it turns out there's way more that you can do if you buy into the fact that it is psychological, that it is related to processing of information in your brain that's modifiable. We can modify that with mindfulness practice. We can modify that with breathwork. We can modify that with thought management so that the tendency to catastrophes is shifted from a cognitive standpoint. CBT works for that. There are a lot of things. And then movement motion is lotion. So, you know, stretching and and activating the nervous system in a safe and healthy way impacts the overall experience of pain. I mean, the program where I work at the point in Malibu. That's what we do. We we we have a variety of interventions geared towards that part of the pain experience. And it's extremely effective. People get their lives back. People return to function if they manage. And what what gets in the way of them managing well is the belief that, no, I have to get another MRI and I have to get another injection and I have to get another, you know, surgery. We have people who come who are going for their sixth surgery and they come to us instead. And most of those people never have surgery because they don't need it. So just to to follow up self-efficacy, I can you know, owning the ability to do something is one of the key prognostic indicators of good outcome for people with chronic pain. Yes. But in your case, you have pain now for so many years you manage to live with it. But you can give hope to people that they can get out of it. They can feel less or no pain. Yes. Both. Both. Less or no. I mean, I don't guarantee less pain, but, um, the the, the standard of care is less 50% or less. And almost everybody who has chronic pain, who comes in with a six, seven, eight and a ten level pain will go, will go home happily with a 3 or 4 level pain. Yes, I can assure you now. Is that the goal? No, the goal is zero. Um, but That's an unrealistic goal. You know, life is full of pain. And if emotions and thoughts drive the experience of pain in this world. You know, there's a there's this, a threatening world. So it's it's hard to find safety and find safety in a sustained fashion. We try and teach people those methodologies. But, you know, realistically, the the, the search for pain free is what got us into the opioid epidemic. And I know we're going to talk about that in a few minutes. But, you know, wanting to have no pain is unrealistic. Yeah. Wanting to have less suffering, which is the response to pain is is highly realistic and achievable. And the acceptance of what what can be done, what cannot be done. Absolutely. Which is certainly mental. Yeah. Yeah. You you mentioned now safety, um, the vagus nerve. Uh, your nervous system. How is this connected to to the to the pain? So. Uh, pain is I talked about the area in the middle part of the brain. That's where it's processed. There's an area called the thalamus and the amygdala. Insula. And there's also the areas of the nucleus accumbens, ventral tegmental area. Those are areas where the drugs work. That's where survival salience is. So it's reward dopamine. And all of those neurotransmitters is very complicated. We're not going to get there in this conversation. But all those things are interacting in a very complex, very sophisticated manner, 50 to 100 billion brain cells in each of our brains, hundreds of neurotransmitters. So all the while, these electrical impulses and chemicals are squirting around our brains, creating different phenomena. And the vagus nerve is the sort of the the conductor of the way the system transmits information. Yes. So the the Polly vagal theory, which is what we subscribe to. I it's Steven Porges is the creator of that. And essentially what he's told us is that the vagus nerve is gathering information from what we call neuro ception. So the the body is tracking all sorts of things unconsciously. It's automatically temperature, uh, fluid balance of the blood. Blood sugar, you know, blood pressure, all that stuff, plus light and, you know, sound and external influence and and then all the while, monitoring subconsciously. Oh, well, do I sound smart or do I sound dumb or. You know what? Did I make that point? That's all happening in it. It is collected from our body through the vagus nerve, and the vagus nerve travels up the spinal column, and it ends up in a variety of different areas of the brain. And then it transmits information back down to do different things in response to different stimuli. The second part of the vagus nerve function is related to. He calls it the hierarchy of the nervous system. So in response to so the and the purpose of the vagus nerve is to keep us safe under any terms safe and survive. So what do we have to do to feel safe? Well, if somebody attacks, we have three choices. We can curl up in a ball and play dead. That's the dorsal part of the vagus nerve. That's what it does. It shuts things down in in order for the danger to pass. Not a very sophisticated response to danger, but it keeps us alive in the worst of cases. And it turns out that that's activated in people who dissociate. So, you know, people who are really, really traumatized and damaged in the process so that they don't feel safe. They tend to be in that dorsal state. They crawl up in bed. They're, you know, depressed, they're low energy. They're withdrawn. The second aspect of that hierarchy is the sympathetic, which I refer to a little bit, and that's fight or flight. So that's the cardiovascular activation. Pupils are dilated. I'm on alert and I'm ready to defend myself. Also not so successful because in a defended state we're burning energy. And if there's a lion coming, which is what the vagus nerve system is about. Good. Be on alert. If I'm, you know, on a podcast and I'm afraid I'm stupid. Yeah. It's not so good to have my heart beating, you know, because my cognition is is a little insane. Yeah. I mean, if I got to be on alert, then the best part of me is, is offline. Yes. And then the third part of the vagus nerve is the cool. I call it the cool part, but it's the ventral part, and that's the part that goes from the neck up. And it's the way we create safety. And he calls that co regulation. So when I see the smile in your eyes I feel like I'm doing okay. And and you know you convey to me that I'm safe I convey back to you with the my tone of voice and with my posture. If I'm, you know, like that, you will respond accordingly and not feel safe so we can create safety for each other. And that's one of the clinical modalities that we really stress in our treatment program, because people come in traditionally with substance use, with trauma and with pain. And they they will report never feeling safe in their life. And most of these people have had what's called sentinel trauma as a child, something terrible, whether it's a rape or an accident or an injury. And then we see medical trauma, people who've gone through surgery after surgery and then go to the surgeon and the surgeon says, you know, I've done everything I can. You know, bye bye. And that's that's extremely traumatic and unsafe. And so helping people find safety is really the job, the first job of approaching anybody with any of those three conditions. And if you have all three conditions, you know, trauma, survival, substance issues we have to deal with. Yes. And chronic pain. The way in which we approach that is to to help people find a safe sensation and then to do the work and the work is is substantive. It's, you know, takes time and it takes a lot of energy and diligence. And and, you know, you mentioned hope. I mean, believing that it works is a big part of the process. You know, placebos work because the person believes they're going to work. Yes. And 25% of people believe they're going to work because I tell them that's going to work. So let's capitalize on that. Yeah. You know. So your authority as a physician making clear it will work has a big effect. Has an impact. Yeah. I, I can be a cheerleader. And because I believe in it. Uh, you know, yes, I think that there is an impact. And I'll tell you, there's a nocebo effect. Nocebo is the opposite of placebo. Nocebo is you're never going to get well. Imagine 80% impact of a negative message. So if a doctor says there's nothing I can do, you should just stay on your drugs. Yeah. The impact on the patient is is tragic or families lose hope or okay. You know, support system withdraws. Yes. The impact on the nervous system is substantial. But there is a difficult it's a it's a double edged sword here because on the one hand side you want to be honest with your patient, but on the other side you want to be motivational still. So when and to be honest. Is so I, I do my best not to be dishonest. Yeah. In fact, I'm not dishonest. I would never lie to a patient knowingly, but I can. And what I say to people is I have no guarantee, you know? I mean, but if somebody says to me, can I get. Well, I mean, I have a woman in treatment now, 77 years old. She's had five years of chronic pain, horrendous trauma history, high dependence on drugs. And I believe she can get better. And the work's going to be really hard. You know, this is not a walk in the park. This is not an easy matter. It's not going to happen overnight. And I believe you can get better. And those words impact the nervous system. And I can say those reliably, and I can think of people who've gotten better who are as bad or worse. So, you know, I can I can authentically report to somebody that there's a possibility that they're going to get well, and it's going to be directly related to how they how hard they work and, and what they do in the process. Our regular physicians are trained psychologically enough to be so motivational and give the mental supports to their patients. You're asking if most physicians are. No. No, no. Unfortunately, most physicians are ill equipped to handle this problem. Uh, and I say that with with great sadness because, you know, I get phone calls and contacts emails because I've written some, some books and such. And there's so many people who need help, who can't get help. Now there are. There's a couple of apps that are now available online. Curable and mend are two. Um, we actually use the curriculum from Minda in our treatment program. And Mendel was created by a psychologist named Les Aria, who's on our team at the point. So. And who's one of my mentors. I mean, he's taught me just a ton about poly bagel theory and about safety and about. He's a big proponent of bottom up treatments. So we could spend all day talking about what happened to you and what you believe and what you think. But if you breathe with me and you experience the shift that happens when you have a long exhale, and your parasympathetic nervous system, which is the dorsal vagus, is activated in a positive way, your physiology will change and it will inform your psychology. Oh, well, you know, I feel better. Yeah. So the clinical work that we do is a lot about how the body is is functioning. Yeah. So one one side is what you're what you're saying is a neurobiological. Yes. Um, so we have to do more the physical work to create this sense of safety. Yes. And on the other side is a more a psychological, mental, uh, work we need to do as well to create that. And it's not two sides. It's, you know, the mind and the body are connected. Yeah. And, of course, you know, but we treat it as if it's not. Yeah. You know, Descartes says, I think, therefore I am. Well, also I feel where I am. Exactly. It's not it's not a dichotomy but mind body you know. Mhm. We call it integrative care which I know you know about in your center. And we do in ours is really the only standard I think of, of how to do proper treatment? Yes. But is it is it the standard? Is it? You know, do most physicians know this? I think not. It's it's fascinating because when we say integrative care can create this sense of safety. This makes safety something I can control. Whereas maybe traditionally we would, we would see like safety is from the outside is what the environment giving us or what we expect the environment other people um, provide us. Yes. I don't know what environment you will you live in Marbella. Maybe it's safe there. You know, in the world it's not so safe. You read the news? Uh, there was a speaker yesterday who talked about, you know, it's like taking poison. The the anxiety that's provoked by the state of the world and and and what's likely to happen. And shootings and stabbings, you know, how can you feel safe in that world? Difficult? Yes. How? And? And it turns out you can feel safe by being present in this moment. You and I. You know, we can find safety in this chaotic world. I. There's a Buddhist story where the man goes out and his. He walks on the earth and all the rocks cut his feet. And he decides, I'm going to cover the earth with leather. And the teacher comes and says, my, my son. Don't. Don't waste all that leather. Put the leather on your feet, you know. Take care of yourself. Learn how to find safety in the world and you'll survive. So. And that is I think and and we as clinicians. As a doctor, I can provide avenues where people can access that care. Well that's that's that's nice. Yeah. And I think also it's about what we expose ourselves to because if we think about this comparison with the with the pain. If you think about pain and talk about pain, you are more likely to feel the pain. So if we expose ourselves to, let's say, war crimes happening in the world and, and and, and and feel it with all our sensations, we probably might feel more pain, anxiety or what what is related to 100%. And what's interesting is the poly vagal theory and the training that I received as a poly certified, uh, person physician is, uh, my state because I'm the co regulator. Yes. When I enter the room, if I'm anxious, I can't help you get safe. So I have to I have to tend to my own garden and intend very carefully. So, you know, for in in our center the work that we do as as a treatment program is really based on finding, you know, our own neuro ception. And, and how do I maintain my, you know, constancy as, as a, as a resource. And frankly, I can't do a 24 over seven. So thankfully I have a team to work with. You know, I'm only one of the members of the team, and I have my role and my function, but I can't I don't think any doctor can do this alone. I don't think any therapist can do this alone. Optimally, you're going to get support from from other people as resources. Yeah. How do you get into this centered? I mean, I do the same things that I tell patients to do. I do breathwork, I do meditation, I actually there's a there's a stimulator of the vagus nerve, and there's actually two ways to do it. There's several ways you can actually have an implanted, which I don't. But, uh, there's a device that's implanted that stimulates the ventral part of the vagus, but we have a it's called Safe and Sound Protocol, created by a company called unite, and it's delivered through earphones. And it's basically music infused with the tones of safety. Mother's lullaby. Yes, that's one vehicle. And I listen to that often. Not every day, but often. And then there's a thing called falsetto, which is a device that I'm showing because it goes around your neck. Yes. You're familiar? Yes. And it has an electrical stimulation. Yes. It's connected to an app and it stimulates the vagus nerve, and I use mine, uh, 2 or 3 times a day. And it's it's I don't know if I say it's life changing, but it's really nice. You feel the difference? Oh, yeah. Absolutely. In the pain. And it helps with sleep. Different programs because it's it's a bit I mean, it's been hyped a lot, you know? How can you symbolize your. Your vagus nerve. And it's a wellness hype. And you have this armband and the brain and, uh, do they work? I think, you know, we monitor HRV, which is heart rate variability. That's a measure of the health of the nervous system, how high you can go and how low you can go. This span is a sign of how healthy and how, uh, flexible your nervous system is. So if you can get your heart rate up high and you can then slow it down, the fact that you can do both is the sign of resilience. And it's, you know, sign of nervous system health. So we are and we're going to do some studies. And actually there's a different monitors Fitbit and such that can actually measure heart rate variability um stimulating the vagus nerve. And we do it for all of our patients. And we used to do it only for the pain patients, but we are now doing it for every single patient and we are looking at outcomes. So we're looking at pretreatment anxiety and pretreatment pain and pretreatment depression. And we're looking ongoing at how that changes over time. Being aware that it's not just these vagus nerve stimulators. There's all the you know, treatment is all encompassing. And somebody smarter than me is going to figure out how to tease out the variables. But the the short answer, that was a long answer. But the short answer is these bio hacks to stimulate the vagus nerve are effective. Yeah. And the data is there. I'm a bit careful about that. But I'm with. You not to say, yeah, just use this and then it will go away. Yeah I think you need to do the, the the basic work first. And this can be an add on Support your situation. Yes, I, I totally agree. I mean, I wouldn't say necessarily do the work first, but I would say do it along great. And don't think it's only going to be this device that's going to make you better because it doesn't. And we have we call it the five points. It's breathwork mindfulness and which is meditative uh, motion uh, thought management. And the fifth point is play. People are so often stuck in their misery. And we get people out into the ocean. We're on the ocean. So we we do surf. Polly. Vagal surf therapy. Nice. Yeah. One of our therapists created it, and it's. It's all about safety, you know? How do you find safety in the ocean? Some people are, you know, they're hopping up on the board and other people are barely paddling on the little boogie board. But people going in the water is very powerful. Vehicle for me. Probably depends on the temperature of the water. Yeah, it's. They use wetsuits because it's cold. The Pacific in Malibu is Chile. Then I might. I might try it as well. Yeah. Yeah, yeah. And we actually have people visit. We take them out surfing. Okay. But but in all seriousness to one of the things that gets really overwhelming with addiction, but also with chronic pain is the the misery is so all encompassing. It's so terrible. And we try and lighten it up, you know, in an irreverent fashion to, to say, you know, well, if you're, you know, is your pain really killing you? You know, because you're still here, you're alive. And then people. Yes. A little a little snicker and a little chuckle. Uh, so we encourage people to reengage with life and, and, and with the play aspect of life, and it it stimulates safety, you know? Yes. In short. That's the key. Finding safety and finding connection to your body. And and don't give it too much attention. All of. The above? Yes. All at the same time. Yes. Uh, and and certain different things work differently for different people. So it is not one size fits all. It's really individualized care. There are some people, people who have had trauma have very hard time with, uh, with safety. It is very interesting. So sometimes Porges says this for people with chronic trauma. Safe isn't safe. So as the defenses go down, they get activated. You know, somebody who has severe trauma closes their eyes and they get triggered. So, you know, we meet those people in a different way than we do. Somebody who's able to to settle down. So individualized approaches are key here. And not just to treat everyone the same. Absolutely not. But the principles that underlie the treatment that to me, make most sense are related to the fact that you got to pay attention to your nervous system, to your sense of safety, and to what you're doing with your thoughts and your feelings. Is is there something which makes pain chronic pain more intense besides, let's say, focus on it? What? What our life circumstances, environment experiences, we do well. So the one risk factor is trauma. So in the states there was a study the Adverse Childhood Experiences study. It was done at Kaiser 20,000 people. And they basically looked at children who had lost a parent, had addiction in the family, had sexual abuse, had physical abuse, and there were ten parameters. We know that people who have high aces scores the higher the ace of score, the more chronic illness and chronic pain they develop later in life. Um, we know that. So? So trauma is a huge precipitate. We know that traumatized brains metabolize different enzymes differently. So there's an enzyme called Comt, which metabolizes dopamine and an adrenaline. There's a variant of Comt that makes pain, makes the pain experience worse. And that's mediated by trauma. So traumatized people, traumatized brains are more sensitized to pain. Okay. So and and as I said, sympathetically activated people are more sensitive. So if you are under threat, whether it's real or imagined, you know, not imagined, but real or perceived. Yes. Because a lot of people who've had trauma are anxious, as if they're in danger when they're really not in physical danger. Those but they're suffering with their danger. And so those people experience more pain. And again, it really leads to that implication that it's the psychological stressors, the physiological brain stressors that are really manifesting as more chronic pain. Yeah, I think about inflammation and the body also. Yeah. How is this connected with with pain. And yeah, it's great. Is inflammation causing the pain or the other way more chronic. So it's another. Yes because it's both ways. But really the story of inflammation is is I feel like a little kid, you know, I mean I'm, I'm, I've been at this for over 40 years right in this field. But I in the past 3 to 5 years I've studied poly bagel theory. And I just went to a lecture and it was on see if I can get this right. The genetics of inflammation. And it starts with threats. So here's the story. In the genetic makeup, we have all these genes and only some of them are turned on. The rest of them are quiet. They get turned on if needed. What makes them needed? That's the epigenetic factor. So if the world is stressful and anxiety provoking, different genes will be turned on. Well, if there's threat and I don't feel safe, there are genes that are turned on to create protection. What? How do we protect ourselves? Inflammation. Okay. When when we have a virus or we have a bacteria, the response to the bacteria is white. Blood cells go to the particular area and they cause swelling. And they they eat up all the bad germs. But in the process we cough and there's more mucus and there's all this reaction that's inflammation. And inflammation causes pain. Well, and in that sense, the pain is helpful because it protects the the bacteria is eaten up and then the inflammation goes away. Well, yeah. In a chronic state of threat this is always activated. So we have this inflammatory process going on and on and on and on. And it whacks up the whole system. So it's the basis of autoimmune disease. It's the basis of diabetes. It's the basis of cardio. They showed that plaques in the cardiovascular, you know in the, in the um, blood vessels that go to the heart are formed by these particular cells that are activated by threat physiology. So more heart disease, more Alzheimer's, more chronic pain. So yeah, there's a direct effect of not feeling safe, being under threat. And the body responding to protect itself and in the protection causing inflammation and inflammation messes everything up. Yes. So we try to do good things but end up well. The body. You know, the body is doing what makes sense to the body, but it is not functioning for better life. Why is it not functioning the right way? It's it's it's a it's a malfunction, you know, because if again, the system is designed to protect from a lion attacking me even more, if I get bitten by a lion, bacteria are going to be injected into my blood, and I need to defend against that. So that's what the system is activated for. There are no lions here. Um, there's only, you know, going back to my, you know, my performance anxiety or am I going to make the plane or had I just read a thing? They're cutting back 20% of air flights. Well, is it going to affect my flight? My life isn't in jeopardy. But if I get engaged in that anxiety, it's the same, you know, the same system is activated, And now it's it's it's not functioning healthfully. It's it's functioning. It's dysfunction and it's causing illness. Yeah. Yeah. Does that make sense? Yes. Absolutely. I mean, stressful life can also create or intensify inflammation. So if I have a stressful life, it will also have effect on my chronic pain, uh, going forward. But on the opposite, if I think about loneliness. Oh, um. Yeah, I'm glad you mentioned that, because that part of his study was really on the highest stressor in this world is being alone in isolation, and that causes defense and that causes inflammation. So, yeah, the way in which we live our lives impacts our vulnerability to develop chronic pain and chronic illness and, you know, chronic pain. I think you had a statistic of 40 million people. So it's prevalent. There's a lot of us with chronic pain. Yeah, that's not the only manifestation. I mean, there are other manifestations of depression and anxiety and other kinds of medical illnesses that are really explainable by these these abnormalities. It's, uh. Yeah, it's. It's so fascinating just to think about also the loneliness. We think we want to find safety by withdrawing, not to isolating ourselves, but this is making it actually worse by creating more stress and stressors within our biology, which is attacking ourselves. And on the other hand. And, you know, we're built the vagus nerve circuit for Co regulation. If I don't have you to, to feed off I'm talking to myself. And it's in our minds. It's just yeah it goes everywhere. That's exactly right. And the mind, you know, for better or for worse, is often not the source of safety. Yes. You know, the mind conjures up all sorts of stories. You know, we call it the narrative. And the narrative is. And it's interesting with people with pain. The narrative is, uh oh. This is, you know, I feel this. Oh, my God, am I going to be able to finish the interview and, you know, oh, what about tonight? And I have to make a plane and that's all made up. I'm just here right now. Right here. This is great. You know. That makes that makes the people we surround ourselves with so important because they give us, like, this, this level of, um, judgment. Where are we? Where are we in the world? Are we safe? Are we not safe? Absolutely. Yeah. And really, we can convey safety to each other if we're taking care of ourselves. Yeah. That's great. So we talked about positive things we can do, which I love to be more positive. yes, but there is also a lot when it comes to chronic pain, the use of medication, particularly opioids and the effect. Um, and the world also certainly the original cultural differences. But if you look at the US and the whole opioid epidemic, what's your understanding of it? How did it come? What's the history and where are we today? It's a very depressing topic. We should have done this. I'm sorry. I want we don't want to finish on this. So here's how I understand it. Basically, we'll call Purdue Pharma. You know, they're the the villain in this. They're the one drug company. There's actually five drug companies. And they had a product opioids been around, you know, since the 1900s. And they it was very well accepted that if people were dying that we should give them all the drugs they need shouldn't die in pain. It makes really good sense to me. And it came from the hospice movement in the 50s. So they began to sell these medicines and they began to create new medicines to, you know, what are they doing? They're making profit. And at some point, I believe they sat around a table and they said, we have 40 million Americans who are dying of cancer at any one time. We have 400 million Americans who have chronic pain. Mhm. You know, your eyes got big. My eyes. That's a market huge. And they then very systematically set out to sell their drugs to people with chronic pain. And they had a very it was a very sophisticated campaign. They had very bright, very, uh, believable physicians who Portnoy was one of them. And he basically wrote an article that said, we are withholding drugs from people, they are suffering needlessly and we believe we are sure. In fact, we have data that says you can't get addicted to pain pills if you have pain. Huh? Well, I mean, come on. It doesn't make any sense. But they had a study, and the study was of, I think it was 12 million people who received maybe 12,000 who received opioids. And this is a hospital study. Yes. And one out of. Four out of this 12,000 developed addiction. That was the headline. So four out of 12,000. Then you can't get addicted. Yeah. The actual study was they went into a hospital chart and they looked at anybody who got an opioid, and they looked for the word addiction in the hospital chart. And there were only four that said addiction. That was their proof. It had nothing to do with chronic pain. It had nothing to do really with addiction because they don't diagnose addiction and post-op patients. Mhm. So the long and the short of it was they published that big splashing headlines in the New York Times and people you know what happened. I'm a patient with chronic pain. I go to the doctor and the doctor wants to help. And the doctor wants to get me out of his office or her office as quickly as they can. Mhm. Not because they're bad people because they, you know, they have 50 people in the waiting room. So you come in and you say I doctor my back hurts. Oh well okay I've read some studies. Yeah. There's no problem. Let me give you some hydrocodone, you know moderate strength opiate. So the prescriptions for hydrocodone start getting written. I, the patient, walk away saying, oh, God. You know, this really helps, I feel better. If that were the end of the story, we'd all be very happy if I only took 30 in a month. Not so bad, but 30 in a month doesn't work after a while because I developed tolerance. So do I go back the next month? And I say, doctor, the pills are great, but they don't last quite as long. What can you do for me? I'll give you twice as many as 60 the next month. It's not working. I'll give you oxycodone, which is twice as strong as hydrocodone. And then we're we're on the on the road of tolerance and then physical dependence and withdrawals and continued use to avoid withdrawals. And we're in this this downward spiral of I need these drugs to survive. Yes. And I went in for chronic pain. Turns out I have more pain on the drugs than off the drugs. They didn't tell us that. Mhm. That didn't become really prominent until. I mean, I figured it out about 15 years ago when I was detoxing people. I detoxed them and they'd have less pain. And there's two reasons for that. One is if I'm dependent on opioids in between doses, my pain spikes. So it's I'm committed to staying on them. But in actual fact, if I take them out of the system and I detox at the other side, I don't have that up down. And I might have pain, but I don't have the same amount of pain. And then there's also a phenomenon called opiate induced hyperalgesia. Opioids cause you already inflammation. They cause inflammation in the brain. And we proven that now so that people on opioids have more pain than they do when they come off the opioids. But they didn't tell any of that to to the doctors who are prescribing until any of that to the patients. And the epidemic moved along. So it was the pharmaceutical company. The patient wants relief. The doctor wants to to to please. And then the government allowed it. You know, ah, the US government was complicit in this process. And they ended up allowing drugs to be developed and sold without any real analysis and restrictions. And how they did that was they put people from the companies on the committees that approved the drugs. I mean, it was it was really nefarious. And, you know, fast forward 15, 20 years into the epidemic, 100,000 Americans are dying of opioids, got harder to get the drugs than heroin, had a resurgence. And then it got harder to get heroin and then fentanyl. Synthetic fentanyl came in. And that's what's happening right now as people are overdose and dying from fentanyl and which is illicitly produced. So we're not out of it. But we are you know, if you look at the statistics, the death rate has gone down by ten, 15% a year for the last two years at least. So that's the the the awful story was the, the really well-meaning doctors, patients wanting out of pain. And then this vehicle that ended up being the wrong methodology motivated by profit money, and they've been sued and they've settled for huge amounts of money. But we call it chump change. I mean, they make so much money on these drugs that $60 million of payoff isn't going to hurt Purdue Pharma one little bit. Yeah, I heard some statistics. It's still like in 24, the industry was about 80 billion USD in one year. So 60 million. What's that? Nothing, chump. Drop in the in the bucket. So, yeah, it leaves us, uh, in a pretty bad situation. Yes. Uh, you know, the curve has reversed a little bit. The the standard of practice in the States is not, you know, just write the script. In fact, it's hard to get a script. And, you know, we have some consequences that are not so good for there are people on opioids who've been on opioids for 20, 30 years. And all of a sudden the doctor says, I'm not going to prescribe them anymore. Yeah, well, that's not appropriate. We have to have a plan for these people. We don't have enough beds to detox them. We don't have care. You know, even if we detox them, not everybody is able to get off the opioids unless they get care for their chronic pain. So it's it's a big problem. I mean, I it's a great source of distress for me when I look at the country and the world and where we're going. And, you know, part of the problem is, at least in America, we don't want to feel pain. We don't want to feel anxiety. We don't want to feel depression. So give me a script. Give me another script. Quick script, test side effects. Give me the something for the side effects. That's the way of it. Yeah. And I think what we need to understand is it's it's not just to get off the addiction itself then to that substance. We need then also to, to work on what is really underlying the chronic pain or whatever emotional. Yes. Physiological situation we are. We have had in the first place. Yes. So this is how our conversation has started. And I mean, just to to think about it in a positive way. We there is an awareness now. Um, people are taking measures. There are ways of working on alternatives today. And and that gives a little bit of hope. Or how do you see this going forward? I guardedly optimistic. You know, I think that there's more awareness. I think there's more, you know, and we're at a conference about addiction. There's 150 people here. And they're going to take this message back to thousands more to to treatment centers and to treatment, uh, patients. Um, the task is large. I'm a part of a sort of a think tank group. Um, physician psychologists, uh, scientists who studied just what we've been talking about poly vagal theory. They talk about mitochondrial function, inflammation, and how illness is really promoted by the way in which we live, isolation, threat and how we can bring this message. And I mean, half the time we're arguing about who to bring the message to. Do we bring it to schools? Do we bring it to physicians? Do we bring it to the public? It's a real challenge, you know, how do you access, you know, how do you and and the real answer is TikTok. You know, I mean, we have to get some clever ways of conveying this information. And I think the, you know, I think I don't know if the tide has turned enough to really change the world. But, you know, there there are measures that are being instituted that may influence. And, you know, it's different now with opioids than it was ten years ago. Yeah. So it has changed in a in a positive way. Some days I get a little discouraged because we need excavation. We don't just need my miner changing. Yeah. Yeah, it's it is certainly a big problem we are in right now. And it will take time to to find ways. Time, energy, willingness, money, resources. Yeah. You know it's it's it's a big deal. Yeah. When if you could now speak to anyone in the world who suffers from chronic pain, um, or family members, how, how can they support each other and what can they do? Um. I guess the, the message I would convey is to be curious about what you've heard, if you've been listening. Yeah. Does this apply to you? And if it does, how can it it apply? If you're a family member, how can you support if you're somebody with chronic pain, where can you access more information. Where can you explore some of these activities? You know you don't need thousands of dollars to do this necessarily. As I mentioned, there are apps. There's a book called The Way Out. Written by Alan Gordon and a bunch of colleagues. And they they do a process called pain reprocessing therapy, which is one of the things we do at the point. And this study basically showed 55% of the people that got this treatment, which is psychological, had little or no pain a year after the treatment was administered. And the functional MRI scans before the treatment and after the treatment were different. So it has shown and they're in the process of doing a very large scale study, thousands of patients. We'll see how good it works. It looks like it works really good. And it's it's really the treatment is all about this, the misinterpretation of the brain that thinks I'm in danger when I'm not. So the analogy they use that I love is they said, it's like I threw you a soft ball and you think you're holding a hand grenade. Yeah. So your brain responds as if it's in danger, and you need to reorient your brain to say, no, no. Look, it's just a softball. And how you, as a person who's listening to this cast could utilize this. Be open to the possibility that there's more to your chronic pain than you've thought. Yes. And that there are there are ways out there are ways to manage this pain that are very effective. And the whole idea of this management is to have a better life. I mean, I want to encourage people to have a better life despite or in the face of their experience of chronic pain. And it can be done. How do you feel now after our conversation with your pain? I don't have any pain. I don't have. I swear to God. Good. If you mention it long enough, I feel it. I do. Okay. Yeah. Okay. But no, I haven't had any pain. But this is great. I mean, it's fun, and. And when I'm engaged, as I said, I'm I'm I'm I'm, you know, I was invested in the conversation, but I also felt safe. You know, I mean, I was having a connection. So. Yeah. The pain going away. Good job. When I know you mentioned how you stay in Co regulate with your patient, but out of that how how do you stay in balance. What do you do for the rest of your life to be and come back to balance? You know, a basic stuff. I look at nutrition, sugars, very inflammatory. So I really avoid sugar for the most part. Um, I do my best to exercise. I stretch religiously every single day, both in bed and I actually I'm seeing a chiropractor and he has me doing certain stretches before I get out of bed because I mentioned, you know, when I get out of bed, it's like, oh, and if I do the right stretches in bed, it's rather than, oh, it's oh, which is 20% better and 20%, you know, that's pretty good. And once I get up, I get moving and I go to the gym as, as regularly as I can. I walk a lot. So motion, you know, I do my own meditation and breathwork. I use that vagus stimulator I mentioned to you, I have a good life. You know, I have a life that's rich and engaged with other people. Uh, people want me to retire. They say you're an old guy. You should retire. I don't, I'm very I mean, I love what I do, I love my work, I love the team that I work with. So it keeps me in. Yes, yes. So until I can't pronounce catechol o methyltransferase, you know, when that happens, I'll retire, because then I'll be too late. But until then, I'm still here. And that's probably your blueprint to grow healthy. Yes. Uh, yes. And, you know, frankly, in recovery, we say you give it away to to keep it. You know, so me helping other people is a big part of my joy and of my purpose. And that that enriches me. And when I'm working with somebody else, I don't. I have no awareness of my pain. None gone. Totally. Because I'm engaged. Yeah. Uh, so. And I also have nice alone time. I mean, I enjoy my my alone time. Thank you for sharing your thoughts, wisdom, experience you have gained over the decades with us. I, I appreciated our conversation a lot. And, um, and thank you for all the work you do. Thank you. As well. Thank you and thanks for your opportunity. This is great. Thank you.