The Get Healthy Tampa Bay Podcast

E130 - Dr. Michael Massey on Managing Pain Without Surgery: Rehab, Injections & Real Relief

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Michael Massey, a physical medicine and rehabilitation physician and founder of Gulf Coast Pain Care. In this episode, we explore the complex world of pain—from acute flare-ups to chronic conditions—and how to manage it effectively without rushing into surgery or relying on heavy medications. Dr. Massey shares his personal story of back pain that shaped his medical path and discusses practical tools for pain relief, including physical therapy, chiropractic care, injections, supplements, and mindset. We also touch on emerging treatments like regenerative medicine and the powerful role of psychological and art therapy in healing. Whether you're dealing with back pain, migraines, or nerve pain, this episode is packed with empowering strategies.

Dr. Massey is Triple Board Certified in Physical Medicine and Rehabilitation (PM&R), Pain Medicine and Brain Injury Medicine. He trained as a pain medicine fellow at University of Washington, the founding institution of pain medicine as a medical specialty. He also trained in a PM&R residency at Schwab Rehabilitation Hospital, an academic affiliate of University of Chicago. He developed an integrated pain care service within the CentraCare Health network with multiple service lines including interventional pain medicine, medication therapy management, spine/musculoskeletal medicine, opioid transition clinic and interdisciplinary pain care. He is currently the Founder and CEO of Gulf Coast PainCare providing comprehensive pain services along the west coast of Florida. He is the primary author of Complex Regional Pain Syndrome (CRPS) chapter in Bonica’s Management of Pain, 5th edition and co-author of CRPS practical diagnostic and treatment guidelines 5th edition. 

He is the founding member of the International Research Consortium for Complex Regional Pain Syndrome. He is the co-author of multiple North American Spine Society spine coverage recommendations. He is the co-author of Adult Acute and Subacute Low Back Pain for Institute of Clinical Systems Improvement, 16th edition. Dr. Massey is a reviewer for The Spine Journal and Pain Medicine. He has served on multiple boards. Dr. Massey is a medical chart reviewer for appeals in state-run managed care and workers compensation programs. He has received training and is a Certified Physician Life Care Planner.  He is a conference speaker for a variety of topics related to PM&R, Pain Medicine and Life Care Planning.

00:00 – Welcome and guest intro
00:49 – Dr. Massey’s background and medical journey
03:35 – Why he chose to specialize in pain medicine
07:09 – How he overcame back pain without surgery
09:42 – What everyone should know about pain
11:48 – Healthy ways to approach acute pain
15:41 – Magnesium, supplements, and anti-inflammatory diets
20:52 – Collaborating with chiropractors and PTs
23:21 – Where interventional pain procedures fit in
31:08 – Advice for people with chronic pain

Connect with Dr. Massey
LinkedIn: https://www.linkedin.com/in/masseypain/
Facebook Group: https://www.facebook.com/groups/1444310059726136/
Website: https://gcpaincare.com/


Connect with Dr. Reller
Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
My linktree: linktr.ee/kerryrellermd
LinkedIn: https://www.linkedin.com/in/kerryrellermd/
Facebook: https://www.facebook.com/ClearwaterFamilyMedicine
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Tiktok: https://www.tiktok.com/@kerryrellermd
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
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Kerry:

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have a very special guest, Dr. Michael Massey. Welcome to the podcast. I just discovered that we're new neighbors in the Palm Harbor area, so this is will be very exciting to hear all about who you are and what you do. So why don't you tell us a little bit about that.

Michael:

Sure. So I grew up in Sacramento, California, so I'm a transplant to Florida. I went to med school in Kansas City. I did my training in physical medicine and rehabilitation in Chicago. After that, I did a fellowship in pain medicine in Seattle, uh, university of Washington, and I was hired by a hospital system out in Minnesota to roll out a pain service line. They were kind of like a BayCare or an Advent Health, and did that for about five years. Scouted out the space, rolled out the whole service line, and after about five years, we'd had enough of Minnesota and decided to move to Florida. My wife's family's in Florida and came to Florida and I worked with an orthopedic group for about two years as the medical director of interventional pain medicine. And then an opportunity came up where we kind of decided to part ways amicably. We're still great friends, still refer to each other and I started a practice called Gulf Coast Pain Care. We specialize in comprehensive pain medicine in Palm Harbor area. And I also am the, founder and CEO of Med, LCP, and that's a medical-legal firm where we do life care plans, independent medical evaluations, file reviews, that kind of thing.

Kerry:

That's pretty cool. Um, I did dabble in that website. I was very interested in that too, but I think we'll focus on the pain part today. So you've literally lived, like all over the country and I can definitely see why you move from Minnesota to Florida. I don't think I could handle it.

Michael:

It gets pretty cold in in Minnesota for over half the year.

Kerry:

Yeah, I did spend, a summer there once, and that was tolerable and I almost took a job before I went to med school at Medtronic in like, um, I guess medical device sales and things. And I chickened out because I couldn't, I didn't wanna move to Minnesota. I didn't think I

Michael:

Yeah. That's funny. My, my bro, I had a similar experience where I was, should I go to med school? Should I not go to med school? And I talked to my brother about it'cause he's in sales and tech sales and he said, Mike, you, I don't think you'd be good at sales. And I was like, well, what? Well. Why, you know, I, I think I'd be good in sales. And he said, you're just not very good at kissing butt. And you know, you would just want to tell'em what you really think and it probably wouldn't be good for selling. And so I just don't think you would do a good job. And I was like, oh, okay. Well thanks for the feedback, bro. And that was, I think, good advice. And so, and medicine's been good and good to me.

Kerry:

That's definitely good advice. I'm glad he told you, told you like it is, so that's perfect. So Gulf Coast Pain Care, is that what you said?

Michael:

That's correct.

Kerry:

Yeah. Awesome. Okay, so what made you from in medicine in general what made you wanna like focus in on pain?

Michael:

Sure. So when I was 16 in California, I did everything. I played a lot of sports, I played football, I played volleyball. Volleyball is big in California. I lifted weights and when I was about 16, I had an experience where I had, I. Awful low back pain and I didn't know what it was and I felt pain going down my leg, and it was really weird. It was the first time I've ever experienced anything like that. And I went to a orthopedic physician and he ended up getting an MRI of my back and it showed that I had a herniated disc, and he came up to me and my dad and said, Mike, you have a herniated disc and that's why you're having all of this pain in your back and pain going down your leg. Unfortunately we need to do surgery on your back. And I was looking at him and I said, that's just not happening, man. What? What else? What else can we do other than that? And he said, well, that's what I recommend. I was like, well, I'm not doing that. So what else do you have? And he said, well, I guess physical therapy. And then he walked out. And so I did that. I went to physical therapy and got an idea of what that's like and I was put on some medications and the pain was still there. It was still bugging me. And I was very lucky because at the time, pain medicine was kind of a relatively new field at the time. And I actually had an uncle that was at Stanford and he was in the pain medicine program at Stanford. And I talked to him and I said, Hey man, this guy's saying I should get surgery. What do you think? And he said, I think it's a very bad idea. Did he talk to you about the long-term implications of a 16-year-old having having surgery on his back and I said, no. He just said I should do it. And he said, well, what'd you say? I said, I'm not doing it. I wanna do physical therapy, something else. He says, well, that's the right thing to do because you're 16. There are reasons to have surgery, but do you have weakness in your leg? I said, no, I can walk just fine. Or Do you have progressive weakness? Anything like that? No. And he said, okay. Then don't have surgery, it'll go away eventually. It's just gonna take a long time. And so that kind of set the, the ball in motion of me getting into pain medicine. And I had other experiences where I had massive flare up flareups of back pain and when I was 20, when I was 25, and they were bad, you know? And so I got a pretty good idea of what patients go through when they have severe pain conditions. And I also got a taste of how our healthcare system is set up and how they treat patients that have the same type of conditions I have. And it's very hard to navigate. And so when I went through that whole experience, I said, you know, I would really like to be able to just help people that I, that had the same type of conditions that I went through, so that way not everybody's gonna go through with maybe a procedure or treatment that might end up in a spot where they are just struggling with it the rest of their life.

Kerry:

I, I mean, that story is so profound. I didn't expect you to say that. So that's, amazing what you've, you know, obviously going through things and having your personal experience puts a whole new light on everything. Right. I think that's very awesome. And then, like you said, pain is like kind of a newer field. It's interesting that you were, were exposed to it by your uncle. That's kind of very lucky that you had that like opportunity. So you can get that reassurance that yeah, you don't have to do surgery, especially in your cases and you're, you know, were a super active teenager and individual that needed to not just go to surgery. So how did you overcome that? Did you, did you have any like procedure at all or did you just do everything possible other than that.

Michael:

So when I was 16, I did a lot of physical therapy and in physical therapy, we did traction, we did ultrasound, we did structured exercise therapies, manual therapies, and it really took a long time for it to get better. The thing that I think. People need to understand is that when you have this type of injury, it's not like normal muscle strains where it takes about four to six weeks and then you feel better. Disc herniations could take a very long time to feel better. And so it took me over a year really to start feeling kind of better and then understanding what exercises I need to do to feel normal. And so that was the first time around. The second time around, I was playing basketball when I was 20. And I felt some pressure in my back and then it just started to keep building and, and keep building. And then it brought me to my knees and I was on the ground and it was bad. And I knew I probably had another flare up or an aggravation of a disc herniation. And I got chiropractic care. I went and got physical therapy. I got something called an epidural steroid injection, and that was helpful. It was still kind of there, but that was helpful. But one of the mainstay treatments that helped me was just good rehab, just doing the right types of exercises to bring my pain along and slowly get better. I think having realistic expectations of the process helped me because when I first had it and when I was going through the process, I just wanted someone to tell me, okay, is this ever gonna get better? Because this is really hurting and it's taken a long time to get better. And what helped me is having like my uncle or other providers that would. Coach me up and explain to me this is normal. I mean, it's normal that it takes a long time for this to get better, for the rehab, to take better, and that's very helpful and honest with, with people. You don't, and you don't wanna just jump to a procedure or jump to a medicine if you really want to try to go about the healthy way of kind of rehabbing this yourself. And so that's been, that's been really good for me is rehab.

Kerry:

Yeah, and obviously I think that's really important. Like you mentioned, setting expectations, right? For any condition, right? To know that it's not just gonna be, you know, oh you did this and you're gonna be better in like a month or a week, or whatever. So that's really. Yeah, that's helpful. So what, um, what would you say everybody should know about pain? I think that's kind of what we were gonna talk about a little bit broadly, or maybe specific, I don't know. But let's just start there. What should everybody know about it?

Michael:

I think people should understand that pain is a very personalized experience that everybody has their own unique experience when it comes to pain. For example, and you can probably appreciate this, if I see a patient in clinic and they broke their arm and someone comes in and another patient comes in with that same injury. They will most often have two completely different pain experiences. One patient might come in with a broken arm and I'll ask, Hey, how's your arm feel? They say, yeah, it hurts, but I mean, whatever. And i'll say, okay, uh, I guess go to the orthopedist and here's some Tylenol. See you later. And then another patient will come up with the same exact fracture. And they are wailing, they're, they're crying. They're begging me for me to do something to help them. And the main takeaway that I get from seeing, and I see this all the time, where people will come in with the same type of injury or disease, medical disease and they'll have different pain experiences and you gotta treat the patient where they're at and, and kind of go from there. And so you can't just assume one injury will have one certain pain response. You have to realize that people are individuals, they have their own experiences and their own, genetics that kind of contribute to whatever experience they have with pain.

Kerry:

Mm-hmm. Yeah, I would kind of define as a wimp. I think so I, I have feeling, you know falling or crying or anything where I definitely, you know, another person maybe on my soccer team or something would have the same thing and they would be perfectly fine. So I don't know, but that's interesting. Yeah, and I think, uh, even with medicine, with like say I do a lot of weight management, everything is such a individualized approach and so important to take, you know, meeting a patient where they are and you know, seeing what works for them.'cause something, everything is gonna be different. So I didn't realize that was so much in the, the pain I guess arena as well. Yeah. So, um, everyone, like you said experiences pain at some point. So how can you approach pain in a healthy way?

Michael:

So I think the first thing to remember, whenever someone has, for example, an acute episode of low back pain, that's, you know, most of what I see is neck pain and low back pain. The first thing I try to tell patients is don't freak out and understand that a lot of people experience, most people experience severe low back pain, severe neck pain at some point in their lives, and really just to understand what the red flags are and what they're not. So if somebody has severe low back pain, that's not necessarily a red flag. That's just your body telling you something's wrong with your back. A red flag would be if somebody has weakness in their arm or weakness in their leg, that's never normal. And anytime that happens, you should go to the emergency room or your primary care physician or somebody to get an evaluation immediately to make sure there's no emergency going on with your spine. The, the healthy ways that I try to coach patients on how to address their pain are to, one, understand it, get a really good diagnosis. Is this a critical issue that needs surgery? And sometimes it does need surgery. Sometimes pain issues in the neck or in the spine in the back do need surgery. And once that's kind of ruled out, usually we try to, motivate patients to start addressing it with either physical therapy or chiropractic care to get a little bit of help or coaching on maybe some exercises they can do. So when I have patients go to the physical therapist, for example, I like the physical therapist to show them what exercises to do and then have the patient demonstrate how to do those exercises to the physical therapist. And then the physical therapist will coach'em up on doing it correctly and then they go home and they do it independently. The big tagline that I try to give most of my patients is motion is lotion. We try to say, try to walk, try to move around most of the time, bedrest is bad. Most of the time moving around is good as best you can, and you don't have to force it. Like if you're moving around and it really hurts, then you know, don't do that. Try to do what your body will give you. There's actually different techniques in physical therapy that could be employed called McKenzie exercises and McKenzie Exercise techniques are when you basically do exercises that don't hurt. You should not fight the pain when you're having an acute episode of pain. You should do things that don't necessarily exacerbate the pain. That's not good. By the way, here's another thing. If you ever go to a physical therapist or somebody and they say, you need to fight through this pain, this is what you need to do. It's not necessarily good advice. And I would check with your, with your doctor, your provider, to make sure that you're getting good advice from your rehab specialist. Medicines are okay every once in a while. You know, I like personally, I like Tylenol. I think Tylenol is great. I don't think it's necessarily good to take too many pills. But if you are gonna take a pill, make sure you check with your doctor so that way you take it correctly.'cause sometimes there are, times when you should not take certain medicines, depending on your particular condition. And, uh, really just kind of go from there. There's also some cool diets that you can, that you can take when you're in pain. There's some anti-inflammatory diets and that can be helpful. Um, there's certain supplements you can take, for example, magnesium is really good for, for pain. And also just talking to the right people. You know, you want to make sure that whoever you get information from, it's not from someone who's obviously trying to sell you something. You wanna get, you wanna get some information from a provider you trust and then do it and see and see how it goes. And then follow up with them and seeing, okay, are things going normally or is something wrong? Do we need to change up our strategy? So to me that's kind of a comprehensive approach to how, on how to treat pain in a healthy way.

Kerry:

I like that you bring up, you know, dietary and supplement things too, because there's definitely ways that patients will actually have true inflammatory markers circulating their body based upon all the foods that they're consuming, and they could feel a lot better and different if they weren't doing that. So I think that's interesting. How does magnesium play a role in the pain cascade.

Michael:

Magnesium is excellent for patients that have muscle pain. So when patients have acute pain issues, they have, you typically have a lot of muscle spasms. It's very good for headaches. If somebody has upper back pain, neck pain, and they get tension headaches, that's one of the most common supplements that are, that's used by pain physicians and headache physicians to help prevent headaches, kind of calm the nerves down the, the muscles down. It also has a calming effect on your brain. It calms you down. So medicine's very good for that. Another thing, it could be a good thing or a bad thing, it helps to make your bowels a little bit more loose. And so if you are someone that suffers from constipation, it's usually a good one to start to help loosen the bowels a little bit. If you're you know, if you're going to the ba, if you're running to the toilet all the time, yeah, you might wanna back off a few doses of magnesium because you don't want to, you know, take magnesium, you know, no matter what. So. That's just an example. There's a, there's a bunch of other cool supplements you can do for a variety of pain conditions, and there's a lot of diets out there. You know, there's anti-inflammatory diets to kind of try to, to address the, the pain issue in a healthy way.

Kerry:

Yeah, I, I actually take magnesium myself, and I'm sure our mutual colleague will, will comment on this, but I have migraines, so I, I was, you know, I just heard that it's good for that. So I, I definitely know, that it can be helpful for migraines, so I take it and I take it before bedtime, you know, so it helps with sleep and things like that too.

Michael:

So I, when I, I mentioned earlier, I trained at University of Washington and there was, there was this gal there, she was the medical director of the headache clinic, and it took, it took about a year to see her, and I had the privilege of training with her and I, I basically do what she taught me and one of the big things that she taught me was she, gave me a list of all these supplements and she showed me all these supplements to give to people. And usually it just works. And every once in a while though, I'll have a patient I'm really struggling with and I'll reach out to her and I'll say, Hey, uh, I got this patient and still has headaches. Got any ideas? And the first thing she'll say is, Mike, do you have them on all the supplements? And I'll say, no. And she'll say, okay, well get them on all the supplements and then call me back, you know, if there's still issues. I was like, okay. Usually I, I mean usually that's it. Usually it's just kind of getting, getting'em to come along and get on the supplements is usually the way to go. And I know for people that have never really been on supplements or think that's a little extra, it is a lot. So when you get into headaches, for example, there's a lot of stuff that goes into treating headaches. And it's really funny though because doing just a few changes in your medications can go a long way in helping with headaches in particular.

Kerry:

Yeah, you mentioned earlier motion is lotion. I don't know if you wanna expand on that a little bit just'cause I think it's in a very important concept when dealing with most like acute or chronic pain.

Michael:

So almost every injury makes you feel like you don't wanna move. So like, if you have like a back pain, you don't, you don't wanna move, it hurts hurting, you know, moving hurts, and it's okay to rest and, and heal up a little bit. But you really do wanna move around. Our bodies are meant to move around. And when you don't move, bad things happen. For example, let's say you decide to stay in bed for a week. If you have a acute episode of low back pain, what's gonna happen is you're gonna lose muscle. If you're just gonna feel groggy, your sleep's kind of probably gonna be off, you're gonna probably gain weight and it's, it's just not good. All these other little health problems start to develop, whereas if you, you know, keep it in your head, I'm gonna try to move as much as I can, but give myself a break here and there. That usually yields better outcomes. And sometimes you have to do things like get in the pool to kind of, you know, move around. Sometimes just, just little general range of motion, just doing whatever you gotta do to, to move around. That usually yields better outcomes. And when we exercise, our bite does a lot of cool things to reward us, to let us know that's good for you. That's how we get our dopamine, that's how we get endorphins, that those are good things and that's how we want to get dopamine and endorphins. We don't wanna do it in a cheating way where we take, you know, just drugs or do just do things that are unhealthy to, to get those pops of, uh, dopamine and endorphins.

Kerry:

I like that too. Like you are getting this reward from doing physical activity as well. You had talk about these McKenzie exercises and chiropractic care. How do you like incorporate that?'cause I don't, we don't typically all the time work with chiropractors.'cause I mean, it's just not, not as traditional, but I mean, I think it's important to know how to do comprehensive care. So how do you work with them on these things?

Michael:

So chiropractors are experts of the spine, right? They, they, they're experts in the neck and and back, and they have a whole lot of modalities that they utilize to treat back pain and neck pain. When I get a patient that's really locked up, for example, let's say their neck and their muscles are just, I mean, they're just tight and they can't even move their, their head around and it's, and it's early. There's a lot of cool things you can do to kind of help loosen up the muscles. We, we have a, a colleague you mentioned, uh, Ray, who I send patients to every once in a while for dry kneeling. That's one modality you can use where you can literally just stick a needle in muscles to kind of help loosen it up. And that, that's helpful for a lot of patients. Sometimes patients really need to get a good massage, and that's helpful. Sometimes they need cupping. Sometimes acupuncture, sometimes just time is, and sometimes there's all these different types of topicals that you can. You can put in chiropractors have a lot of tools in their belt, and I utilize chiropractors to kind of help with patients primarily that have, you know, those types of injuries. And frankly, there's some patients that do really well with just getting an adjustment in their neck and back every once in a while. That's helpful too. You know, and so I, I utilize kind of a, you know, I kind of see what's going on with the patient and see what makes the most sense right here. And I have some. Colleagues that I refer to that I just, I just know what I usually know, what I'm gonna get out of sending them, my patients to them. And so I'll send it to them knowing that we have a good relationship. We, we speak to each other, and then we, and then kind of just go from there. not good is if you send a patient to a chiropractor and then they just sit there and do things there forever because one, one of the challenges of pain medicine is that a lot of times. care providers, physical therapists, or chiropractors, they'll hold on to patients for way too long and they'll go there and they'll do treatments passively for, for a very long time, meaning they're doing something to the patient as opposed to the patient doing exercises and they're really not getting better, and that's not good. You wanna make sure that. It's a progressive rehab plan to where they start doing exercises independently and their function continues to improve. If they plateau that, that's, that's not good. You wanna make sure that they continue to go and then eventually they say goodbye to everybody and they, they function independently.

Kerry:

So where do you fit in, in the, uh, treatment of, back pain, neck pain, like you said are your specialties? Where do you fit in?

Michael:

Sure. So, when someone has an acute pain injury, and let's say they went and saw Dr Reller and Dr Reller did send him to physical therapy with Ray and they did some physical therapy, and after about four weeks, it's just not getting better. And they have pain down their leg or just, they're just not better. Typically, I'll see patients about four to six weeks after they've had an acute pain injury, they may or may not have imaging in their back, but when I see them, the whole purpose of the evaluation is to determine, one, is this a surgical issue? And if it's a surgical issue, if I deem it a surgical issue, then I'll make sure that they get, they have the correct imaging for their condition and they'll send'em to a surgeon to get evaluated for a possible surgery. Now if I think somebody needs surgery, they probably need surgery. There's a lot of camps on how people think about surgery. Surgeons typically think that patients need surgery, you know, a lot sooner than maybe someone like me or or other providers. But if I think somebody needs surgery, then they most likely need surgery. Um, and I'll send'em to surgery. I also will evaluate somebody and determine is this somebody that might benefit from an interventional pain procedure? There's all different types of pain procedures that can help people in whatever type of pain injury they have or pain condition they have. So the most common thing that pain physicians do for acute low back pain or acute neck pain, and they're, and maybe it's going down their arm or leg, is we can do something called an epidural steroid injection. And that's something that we do to kind of help treat the pain. The purpose of that is not to kind of cure their issue. It's mainly just to facilitate good rehab. A lot of times pain issues interfere with their ability to do good rehab, but if you treat the pain issue, then usually they can participate better in physical therapy or home exercises and kind of go from there. Sometimes patients benefit from medicines. I'm not really a medicine guy, but when I do prescribe medicines, I prescribe the right dose. I wanna make sure that we don't do half measures, we prescribe the right dose to treat the, the issue. So, you know, most patients when by the time they've seen me have tried Tylenol or ibuprofen, actually, it's usually ibuprofen or Aleve. And I try to explain that taking ibuprofen, like candy is bad. It could actually be really bad for you. You know, when the opioid discussion started coming up, uh, what happened was a lot of providers just started prescribing everybody nSAIDs, meaning Ibuprofen and Aleve. And what they found is all these people started getting all these gastric ulcers and they get into kidney failure. And they said, oh wait, maybe that's a bad idea. And so they kind of scaled back on that and we kind of explored like different medicines. But you know, there's still a lot of docs that do that. They still will just continue to tell them, go ahead and take as much ibuprofen as you want, or as much Aleve as you want. And so I'll explain to patients and educate them, that's bad, that's not good. And they'll say things like, well, I gotta treat my inflammation. I was like, sure but that's not the only way to treat your inflammation. There's other things to to do, and that's just bad. And you explain how this could harm them. So medicine, and we talk about other medicines too. Sometimes they need heavy hitters, sometimes they need to get a course of opioids and that's not a bad thing. If it helps get them to get better. A lot of times I'm talking to them, so I'm, my primary specialty is physical medicine and rehabilitation. And so I know a lot about rehab and I'll talk to them about certain exercises they might wanna try out or different supplements, things that, that they might wanna try out. Sometimes they just need a little TLC. Sometimes it's just about, uh, you know, educating the patient that this is normal, you're actually doing a good job. They might not feel like they're doing a good job, but just letting'em know you're doing a good job. Stay the course and then kind of go from there. I see a lot of patients that come to me for a consult thinking they're gonna need a surgery or thinking they're, you're gonna need to, you know, some sort of big procedure. And I'll explain to them, you're actually getting a lot better. If you were my brother or my mom, I would just tell you keep up with the rehab you're doing really great and you know, circle back. If you need to circle back, we'll talk some more and let me know how it goes. See you later, you know, and kind of go from there. Um, I don't think it's good to always just jab people with needles and to just give people surgery if they really don't need it. And so you gotta have a very good comprehensive discussion with patients and, uh, kind of go from there. One of the benefits of being an independent community physician. I don't have big brother talking, talking to me about how we need to get our revenue up. So you might wanna offer this spinal cord stimulator or something like that. We can actually have a discussion about what's going on and then, go about the treatment in a very healthy way. I also see a lot of, uh, second opinions. Sometimes they will be re recommended to have surgery and patients will drop in just for a second opinion. And sometimes I agree that they do need surgery and sometimes they don't. And so it's a really good spot to be in as an independent community physician because you can do what you feel is right for your patient.

Kerry:

Yeah, I love that. And I also, I think it's nice that you educate them like when you need to do the epidural injection or something like that, that you're doing it really so that they can continue the physical. Exercises in the rehab. I mean, rather than just, Hey, this is going to cure you. So is there any like discussion that makes that a little more difficult or how do you approach that? Like so they really know that that's what they need to continue to do?

Michael:

I can think of one patient in particular when I was in Minnesota who I, I said to her, I really think you need to have some therapy. I, and she, she was set on having surgery and I said, I, I said, I really feel like you should do some physical therapy and try it. And she was in tears. She was bawling. She said, I, no, I, I need surgery. You know, I feel like I need surgery and my primary care physician thinks I need surgery. And I was like, listen, I respect your primary care physician. I understand why you might feel that way.'cause someone's telling you you need surgery and somebody, you know, this and that. But I'm just telling you, I really feel like you're gonna get better if you just wait a little bit longer, do some physical therapy and go from there. And, um. In the meantime, here's some medicines maybe to help you out, to help you with therapy. And, you know, let's, let's circle back in a few weeks. And she did it. And she came back and she wasn't in tears, but she said, she, she thanked me. She said, thank you so much for not letting me go and do that surgery. And, and, and listen, I'm not like an antis surgery guy, but. There's a lot of surgeries that are being done on patients that probably don't need to be done, and so it's really important that you make sure that patients get a good outcome. You know, it's our responsibility as physicians to, you know, advocate for our patients, make sure that they have the right information, and obviously they can make their own. Informed decision as opposed to just kinda going along with it and kind of passing'em along. There are certain insurance companies that require, they see someone like me to kind of tease out, does this person need to have surgery? I want you to see a nonsurgical expert before you can have the surgery. And the whole purpose of that is to really have a good conversation with the patient to make sure that they are informed of the risks and benefits of going through with the surgery and does the timing make sense? So, you know, it's, I, I, I really enjoy having those conversations because it's a, it's an opportunity to really help somebody understand what the decisions they are about to make the type of implications that they have and how it can just be a part of the whole process in helping them.

Kerry:

Are there, um, any advice that you would have for someone who's been in pain for like months and hasn't found any relief what they would do?

Michael:

Sure. I'd say woke cb I'd say there's lots of different things you can do. And just to kind of talk about real quick, the main treatments that are available for anybody that has any type of pain condition, there's five main treatments. And so the first one is surgery. The first one, you know when someone's in pain and sometimes chronic pain is cured by surgery. For example, if somebody has a hip issue and it's been bothering forever. If you get a hip replacement, usually the pain's cured. And so that's an example of how surgery can sometimes cure chronic pain. So those are the surgical issue. Someone's in pain forever. Is there an interventional pain procedure that can help someone's chronic pain? And there's a variety of interventional pain procedures that can help someone's chronic pain. And someone like me would discuss those with them. There's a whole bunch of'em. There's different types of medicines and everybody should be. Of the medicines that are out there and the implications of being on medicine. So for example, a lot of patients do want strong medicines because their pain hurts so much, and. That's very understandable. But if you start certain medicines, like for example, if you start an opioid, if you start hydrocodone or something like that, you have to ask yourself, how long do you want to be on this medicine? And will my provider be able to continue to prescribe it? Because the way healthcare is right now, there's a lot of medicines that are regulated and doctors can't just prescribe the way they used to. And so it's a little bit different now. Talking about different therapies and, and really just, that's, that's, so surgery, interventional pain procedures, medicines, all different types of therapies. That includes psychological treatments. There's a lot of good psychological treatments that are very helpful for a variety of pain conditions. And. It kind of blows people away how much it helps when they actually do it. So there's a lot of stuff out there for that. Um, there's all, like we mentioned the supplements and we mentioned how, you know, there's all these other different types of procedures. The last thing I'd say is do nothing. The last thing is more about an acceptance, like just, um, accepting the pain. Sorry, it's my dog. Um, this is Fendi.

Kerry:

Hi.

Michael:

Just, just accepting the pain and you know, understanding this is gonna be a part of my life and I gotta learn how to live with it and just doing healthy things to live, to live with the pain. But yeah, there's a whole, there's a whole lot of stuff that you can do for pain issues. What's tricky though, is that. Medicine's not very good at curing chronic pain. It's usually something you have to manage. You probably heard the term, the, the term pain management, and the reason why it's managed is because often we can't cure chronic pain. You have to, you have to manage it with those types of things that we just discussed.

Kerry:

Yeah, those are really good points. I also like how you brought up the, like the psychological training or therapy as well.'cause there's a lot of anxiety and depression that crossed over with chronic pain as well, right?

Michael:

Yeah, so there's a, you know, probably the most common drug that's prescribed for these types of issues as duloxetine or Cymbalta. I don't know if you remember the commercials, because depression hurts. And FD, so Cymbalta is FDA approved for depression. It's FDA a approved for anxiety. It's FDA a approved for chronic musculoskeletal pain. It's FDA a approved for nerve pain. It's like FDA-approved for everything. And so we, we use it a lot in pain medicine and it's not necessarily because I'm the best you know, person to prescribe a psychotropic, it's because it helps people with their pain issues and it also helps with depression. It also helps with anxiety. And we, you know, we might do a trial duloxetine for a while and kind of see how that goes. Another cool thing for, you know, you mentioned the psychological, we mentioned the psychological treatments is art therapy. So in about around 2010, I think the department defense, they spent a lot of money on our, uh, soldiers that came back from Iraq. And one of the big things they did was art therapy. And just to kind of give you an example of how some of the art therapy sessions went. They would have a mask activity. They would take a mask and they would. They would paint the mask and the instructions were, I want you to paint on the front of the mask how you think the world sees you. And so the participants would paint the mask and it was usually, you know, very like sunshiny happy, you know, happy masks. And then they said, okay, great. Now go ahead and turn it around. And I want you to paint on the mask how you see yourself and. It was usually different. It was usually a little bit more morbid, a little bit more sad, a little bit more kind of intense. And what happened was, what usually happens when the, within those types of exercises is people have a cathartic experience where they're able to maybe just express how they're feeling and that makes them feel good. Like that gives them a sense of relief when they're able to do that. A lot of times there's a lot of, unresolved experiences that people have that they can't even talk about it. And so you need a medium to be able to kind of get that out and when there's some sort of unresolved. Thing that's kind of in you, and it kind of presents a certain way. I see patients that do have stuff like this where they have these pain conditions that's obviously related to maybe a horrible trauma that happened to them in the past. And that's, you know, it's really difficult for someone to. Talk about that, especially, you know, I mean, you have to be, have a very good, um, relationship with them. And also you wanna talk about it to somebody who really deals with complex trauma and, but there's certain little things that you can, that they can do that kind of help process that, that just makes'em feel better. And our therapy, I found that our therapy is one of'em.

Kerry:

Hmm. That's so interesting. I, um, I haven't heard that at all for pain, so that's really neat. I have, I think a future episode on someone who is very focused in on trauma therapy and things like that. So maybe that will come up. That's very interesting. What, um, what, I guess what is, is there anything else you'd like to share before we close? Yeah. Anything you can think of.

Michael:

I mean, I think, I guess the big thing that I wanna share is that whenever you have a, a, a major pain issue that you really need to get good advice and make your your options are, and don't just jump to, you know, surgery. Don't just jump to medicines, don't just jump to all this most of the time. Just doing the right therapy or even just time usually that just kind of takes care of issues. But if you really wanna get good advice, you need to talk to, to a provider that you trust and make sure that you get good advice. There's a lot of cool stuff out there that's, um, available for certain conditions that are really good, you know, and sometimes it's very pro. We mentioned the epidural steroid injections That can be helpful. Kind of a popular thing right now is regenerative medicine. That's kind of an emerging field, and there's a lot of patients that could benefit from certain types of procedures with that. Like ERP is something that can be helpful. There's something called prolotherapy. There's, there's all these other regenerative techniques like laser and shockwave. There's all these different things that you can do. But again, it always comes back to speaking with somebody about your condition, getting a good diagnosis, and really just working on slowly improving your function and having realistic expectations about how long it will take for this thing to get better.

Kerry:

Yeah, I mean, one of the things I love about doing this podcast is that I find out all these other resources that can be used to treat different things, and it's just really been enlightening. Like, um, obviously, you know, the dry needling that we've mentioned, you know, radiation therapy for osteoarthritis and other conditions that things like we don't typically think of, and it's just been. Really eye-opening. So I'm hoping that everybody, you know, takes, you know, a really good listen of what you've been talking about today and kind of apply it to, you know, their own life.'cause like you said, everybody's gonna be in pain in some point or another. So if patients wanna work with you or find you, where can they, where can they do that?

Michael:

Sure. So you can Google us Gulf Coast Pain Care. That's our practice and we're located on, Tampa Road in 19. And, there's a bunch of little medical facilities in there. There's an MRI placed in there. You could give us a call. And happy to, happy to work with you. We take a lot of insurances and we see people for all things pain, any type of pain condition. Um, if you have a neuro, so we've, we've mentioned mostly neck and back. If some, if you're struggling with a neuropathic pain issue, like a nerve injury, happy to, happy to talk to you about that. Um, I got a lot of experience with, uh, neuropathic. And, and treating those conditions. You know, I mean, we have a very great staff. You know, our staff is very nice. Our goal here is to make sure that you're treated with respect and that you walk out feeling like you have a good understanding of what's going on with you, and the best way to get better. As far as, uh, providers go, um, I, I, I do my best to collaborate, um, as best I can with providers if, uh, you know, for surgeons, for example, if people need help, perioperatively happy to help with, uh, their patients before and after surgery as needed. Uh, primary care physicians like yourself, if you have any questions about something, happy to curbside, happy to see them in, in clinic, you know, whatever you want. Happy to help.

Kerry:

Awesome. Well, thank you so much for your time today and enlightening us on everything pain, and this has been a great, great discussion. So thank you. And everybody, please, you know, look for Dr. Massey, um, wherever you can find him if you need him and, or come to me and I'll refer you. But, please tune in next week for next week's episode. Take care.

Michael:

Okay. Thank you.

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Dr. Kerry Reller

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