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Speaker 1: Welcome to Live Well with UCI Health. I'm Ryan Mano from Coast one to three point five and iHeartRadio. Very pleased to be joined today by doctor Shalini Shaw. I want to get your title vice Chair of the Department of Anesthesiology and Director of Pain Services at UCI Health Center for Pain and Wellness, Doctor Shah, thank you for being here.
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Speaker 2: My pleasure.
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Speaker 1: So let's talk about pain and not the kind that comes with waking up every day, like the you know, physical pain. And I think it's probably safe to say that most people as we age, deal with pain pretty regularly, if not constantly.
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Speaker 2: Yeah, you know, the way we think about pain and right now in the country is episodic. It happens for a small time. I hurt my knee, I sprained my ankle. But there's a whole segment of people who are living with pain chronically. It's a part of their everyday life. It's going to be a part of who we are as we age, and that's a fact. And so how do we get ahead of it is really what we're focusing on here USA.
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Speaker 1: First, let's talk about the difference. There was a question, there was some terms on here that I wanted to bring up to you the difference between life's health span? What is that?
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Speaker 2: Yeah, so we hear a lot of these buzzwords. We hear the world we're lifespan, that's just how long we're going to live.
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Speaker 1: Ok.
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Speaker 2: And then we talk more about health span. Is those lives that matter or those years that matter, the quality years? And I'll tell you you know, just yesterday and clinic, I saw probably seven out of my entire panel for the day where patients who are ninety plus and those patients are going to easily touch one hundred without any difficulty. So people are living longer, right, and they're healthy to be honest, they're living longer, healthier lives. And so how do you get to be that one of those special types of people, you know where you're able to manage you have a little bit of pain and you keep that pain episodic and not chronic.
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Speaker 1: So how do you.
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Speaker 2: Here we go?
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Speaker 1: Yeah, So, typically, so as I'm understanding it, your health span will almost always be shorter than your life span. Yeah right for most people?
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Speaker 2: Really well said yes, is that right?
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Speaker 1: Yes? Okay, So how then do we and maybe you don't have exactly the answer, because if you did, you know then everyone would be wanting to know. But what can we do preventatively to give ourselves a good shot at a nice health span if.
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Speaker 2: We look at it, I like to say it in three sixty of you and I don't want to get too nerdy on those topic.
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Speaker 1: Let's go.
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Speaker 2: There's some metabolic factors, just you know, insulin resistance, visceral fat, things like that. Muscle and we'll talk about muscle in a second. Yeah. The second is some biological markers that most people don't know that they're going to the gym every day and they don't know that these are the markers that predict a long life. And that's grip strength. So if you do grip strength at the gym and you measure that, you can even buy a tool off of Amazon to measure that and to see if you can improve that. And hanging, if you can hang even for five seconds, that will that's a great marker to tell you how long you will live and how the quality of life would be.
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Speaker 1: Hanging, hanging and gripping. That is so interesting.
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Speaker 2: Yeah, and that's apart from all the metabolic factors. You know, what we put in our system and how our metabolic rate runs but.
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Speaker 1: Yeah, wow, let's talk about some of that metabolic stuff like what what do you what do you mean when you say that? Can you go a little further on?
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Speaker 2: Yeah, So, if you're in pain, you're probably not moving because it hurts to move, So you're putting on weight, and that's visceral fat, So that deep layer of fat, and that is a huge marker for why we age so fast because that fat leads to inflammation, and so inflammation visceral fat. These are all the metabolic things that limit how fast we can process either foods or metabolism things like that.
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Speaker 1: And then so for you and what you specialize in, then these things are related to pain.
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Speaker 2: Yeah, that's our goal. It's yes, you have pain, we will all have pain, But how do you work past that to keep that those metabolic markers strong?
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Speaker 1: You know, you mentioned chronic pain. What separates a pain? There's like a nagging pain versus like a When does a pain become chronic?
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Speaker 2: By definition is anything longer than six weeks to three months? Right?
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Speaker 1: Okay?
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Speaker 2: Most commonly, the number one reason why people go and seek a doctor for pain is typically low back pain. And that's about seventy to eighty percent of what we do and treat is low back pain. And to be honest, that's the space if people want promise in the world, that's the one space that's really improving. A lot of new technology is coming out, a lot of non invasive We used to think we need spine surgery. There's a lot of things that you may not need now, So that space is really improving, and so you're going to see a lot more treatments available to take care of that. The part that is harder to treat is frailty. So as we age, we get frail, and that means we losing muscle mass. And as we lose muscle mass, we're not moving as much. Where we can't support our skeleton. It's painful, and then you see the hip fractures. And then once you get in the hip fracture, then you go to the hospital, and then you need a convalescent home and all that entire cascade that we see with our parents and our grandparents, you know, and that's what we're trying to break. And so a lot of what we're trying to teach our patients is about building
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that muscle mass. So after the age of thirty, lose about three to five percent of our muscle mass every decade. Just that's normal, and we will all do that. But after sixty we start to lose about fifteen to twenty percent of our muscle every year. And I've seen those patients who've lived that to that ninety year mark or eighty five ninety ninety five year mark, they still have preserved muscle. They're still going to the gym every day as much as they can to keep gaining that muscle so they don't become frail.
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Speaker 1: Yeah, And would you say that if you had to, just you know, your own, not your own research, but your own the things you've observed, your own observations. Is that is that a commonality in those people that have not only the long life span, but the long health span. Take that muscle mass is going to the gym.
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Speaker 2: It is, Yeah, almost one of the things that I can correlate so truly is that muscle mass. I wish we did a better job in nutrition or teaching medical students about nutrition, teaching our physicians about nutrition, to educate our patients and about these things because they're simple, they're not complicated, simple things that we could.
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Speaker 1: Do, and if you do them, my dad always preaches us. I mean he's seventy eight and he still goes. He swims every morning, he's at the gym every morning, and he's always telling me get ahead of it now, or make it part of your life now, because then when you get older and you just try to play catch up with your health, and it's like, but you could have been doing that a long time ago.
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Speaker 2: Yeah, you could have done the preventative stuff.
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Speaker 1: Yes, yes, right, and so starting it now even you know, no matter how old you are, start it's never too late to start.
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Speaker 2: Yeah, And it's never too early to incorporate a lot more protein into your diet. You know, for a healthy forty to fifty year old female, taching about one hundred grams of protein a day is very easy. It's a very good thing to do, yeah, to build that muscle mess.
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Speaker 1: And it's interesting too, because I think when you're not thinking about it, you're just going through your day. You're not thinking about how those things correlate and then lead to pain and they're coming to see you going, whoa, you know, my lower back's messed up, by the way, Why is it? Like, why can't like if I think about sleeping on the like we had sleepovers as kids and we would all just like sleep on a floor, yeah, and like nothing happened. Right. We have a sleep number bed at home and my side has a leak in it, and like it'll sag a little, and I swear those mornings when I'm I'm like, what did I get in a fight? My whole body is like you know, and I'm forty five. Yeah, but we hit a point where even the smallest little difference in our day to day can cause pain, and it can ruin your day.
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Speaker 2: It can you tweak that muscle wrong, usually it's muscle, thank God. But yeah, you're absolutely right, you feel it. You're feeling it, yes, right, you're feeling it where the discs are not as supportive as they are or they once wear so you need more support from a firm mattress. Yeah, we feel it.
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Speaker 1: Yeah, and it really does. It inhibits your enjoyment of life, you know, when something's nagging at you or more worse than nagging. What are some of the ways pain is treated today?
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Speaker 2: So you're probably going to hear the word often multimodal, and what that means is many ways at the same time. So it's not just prescription painkillers or medications. It's not just physical therapy, but it's everything together. So that's what we call multimodal. We try to treat it aggressively through many means as fast as we can because we need you to get back moving and building that muscle mass.
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Speaker 1: Yep.
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Speaker 2: Right. So it's medications injections sometimes and people think, well do I get these forever? And the answer is no, you should not be getting them forever. Usually it's a series of a couple injections and then you should be better provided you're doing all the right things physical therapy, rehabilitating, so some of that. Sometimes you need surgery, and we've got great surgeons here at U see I that we partner with and they're minimally invasive. I'm talking about an inch of an incision and you take care of the problem. But the point is we take care of that problem, don't let it linger.
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Speaker 1: You mentioned prescription painkillers. Where are you as a doctor? You know, and this is your life where you out on opioids.
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Speaker 2: That's a good thing. HiT's one tool in the toolbox. I always say they have a role. That patients are in pain, especially after surgery, they're gonna need them, and we need to have them so patients can move and function, But the longevity of using them forever and ever and ever as medications probably not the best idea. Yeah, and we've got better things that are much more safer and less harmful.
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Speaker 1: How do you tackle? You know, you mentioned you've got the toolbox? I love that that term, that phrase, how do you tackle if someone's dealing with pain with other like comorbidities.
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Speaker 2: It's a great phrase that you use. Comorbidities, you know, when you're dealing with pain and then you've got all sorts of other problems. You've got heart disease, You've got you know, maybe COPD from smoking cigarettes, or you know. What we're seeing more than diabetes or heart disease or lung disease now is anxiety and depression. Really seeing a lot more mental health, and that's one of the biggest barriers to overcome when we're trying to treat pain.
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Speaker 1: Talk about that. Why how what do you mean?
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Speaker 2: You know, I don't know if it's generational or not, but we're seeing younger folks and I mean twenties, thirties, forties who are coming into us as patients
with pain who also have a considerable amount of anxiety that they're dealing with, whether it's workplace stress coping skills, and I don't know if it's a generation where they were, the cell phone generation where they cope they went to the cell phone, or you know, sometimes we just scroll and that's the way we deal with our stress.
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Speaker 1: So but how does that then that's fascinated by this, how does that then get in the way of what it is you're trying to treat.
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Speaker 2: Oh, great question. So what most people don't know is that pain, anxiety, and depression travel together, really and they synaps at the same places in the brain together. So if you have pain, likely you will develop chronic pain. I mean in some element of anxiety and depression and vice versa. So if you have anxiety and depression, you will also at some point develop pain. And so there's what we call comorbid. They exist together. So if I'm trying to treat pain and someone who's anxious or who's severely depressed, it's very difficult. I gotta I have to treat that anxiety depression component first, because they travel together. Yeah, most people don't really realize.
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Speaker 1: I know, I never would have thought that that would have been on your plate to also handle that other part of it.
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Speaker 2: Yeah, so we try to have a psychologist with us, a pain psychologist, and they're a wonderful resource for us.
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Speaker 1: Now do all places do that or is that just like something that you guys offer here at ECI Health.
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Speaker 2: We're one of the only places here in Orange County that really has an inbuilt pediatric and adult psychology program in addition to pain physicians.
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Speaker 1: Yeah, this could be a completely dumb question. Some most are that I ask on this series. Do you think that there's something to this idea of like, once once you convince yourself you're in pain or you are, Like does thinking about pain and focusing on pain make pain more painful?
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Speaker 2: Oh?
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Speaker 1: Do you know what I'm saying? Can you almost work yourself into more pain by focusing on the initial pain? Yeah?
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Speaker 2: And we have a word for it.
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Speaker 1: What is it.
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Speaker 2: It's called perseverating perverting.
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Speaker 1: You learned it here. See I knew there was something to that. Okay, let's talk about persevere.
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Speaker 2: So perseverating on the pain absolutely can make it worse. You know, you're constantly focused on it, you're micromanaging it. It's always in the forefront of your headspace, and yeah, there's a term for it. It can actually make your pain worse. And we see this a lot in migraine patients. You know, sometimes migraine patients they keep migraine diaries. I had a migraine at six am. It went down, it's eight forty five, and it came back up at one, you know, one ten. And they're constantly keeping diaries. And we try to tell our patients don't do that, because you're constantly focusing and thinking of pain.
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Speaker 1: Yes, that's right.
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Speaker 2: Yeah.
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Speaker 1: Do you find or have you encountered that some people this might sound come out the wrong way, but like they don't want the pain to go away because the pain the attention of the pain or is that a thing to people and say they don't want to be in pain, but they kind of it's like that's my thing. I'm always in.
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Speaker 2: Pain, see that time to time, not as often as you would think. Okay, I know what you're talking about. Yeah, some people live in pain, they yes their life, right. Oh, that's the hardest type to treat, you.
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Speaker 1: Know, the ones that are always in pain. Yeah, because probably one pain leads to another pain too, you know, it's funny. There's an actor, Walton Goggins.
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Speaker 2: The White Lotus Boom, look at you doctor.
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Speaker 1: So he has like he was on set and he really He put out this video on Instagram the other day where he was saying he he did something. He like tore something in his quad or something. He's going to physical therapy throughout his back led to an ankle sprain like it was boom boom boom, and he said, as I've gotten older, I have learned that if you want to live right, you get to keep your glutes tight. And so he's like, when I walk, I squeeze my ass and it's helped me prevent so many other things. So he was just like, when you walk, squeeze your but cheets, just hold clench your button. Build up that that muscle mass, right, and it's preventing him from having further injuries because of these other things.
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Speaker 2: I wish I could comment on that one, but.
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Speaker 1: Anyway, that was what he said. I don't know, but it goes back to your muscle mass. Yeah. Part ye work on your.
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Speaker 2: Muscles constantly, keeping some strong under tension. Yeah. Yes. The other part that we don't talk about, and it's you know I don't want to make it sound that it's not scientific, but it is scientific. Is your headspace, it's meditation and things like that. And what I mean by that is if you look at those patients who've also lived till their mid eighties, in their nineties about to touch one hundred, Yeah, one of the strongest thread points that we see. And this is not just my patience I'm saying from data sets is that they have some element of meditation or some element of non reactivity. They're not reactive in life. They're not letting things get to them on a daily basis, on an hourly basis. They've got that mental I don't know the strength to maintain a non reactive environment, and that's also really important for a health span.
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Speaker 1: Sure, it can be hard to do, especially with everything coming at us at all times, you know, and you can try and you can make it a point to not engage your reactive mind, but sometimes it'll hit, Yeah, what do we see on the horizon for pain management? With
what you're doing? What are some things you're looking at that you're like, I like this, this is good.
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Speaker 2: Oh, it's like I said, it's a great space to be in because of all the spaces of all the diseases that we're treating the United States. Right now, pain is the number three disease apart from heart disease and diabetes, and that space. From a technological standpoint, it's booming. It's booming. We've had new devices, new therapies coming out that are non steroidals. You don't need to have steroid injections all the time. They're non permanent, so you don't need a surgery, it doesn't have to be invasive, and they can retrain the brain of how to think about pain or how to train those pain signals from stop firing. Yeah, it's amazing. It's an amazing space to be and I think in the next one to five years we're really going to make a big headweight and the way we treat pain in this country.
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Speaker 1: Yeah really, So wait, talk more about that retrains whatnot or does?
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Speaker 2: Yeah, it retrains the brain so that you know, the longer you have pain, you mentioned it. You know, there are some people who live in pain constantly and those cells then change over time to allow more pain. They need to feel pain in order to survive the brain cells. So the new therapies that are coming around. Are working on that what we call plasticity, so it doesn't become permanent. You can actually change the way the brain thinks about pain and the brain adapts to pain signals that are coming from the spinal cord.
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Speaker 1: That's crazy in the coolest way. Oh my gosh, how exciting for you too to be in that in that space. One of my favorite things as we've done this series is to talk with doctors about how technology advancements, be it you know, AI or I've talked to some doctors who do surgeries with like the the Apple goggles on now you know, like the headsets. What how is this stuff you know coming into play with what you specialize.
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Speaker 2: In a lot of ways, a lot of out of the box ways that you wouldn't imagine. For example, we use virtual reality goggles to help treat pain, or when you come in for a pain procedure, so we can distract patients from the painfulness of the procedure itself.
00:17:09
Speaker 1: That's cool. To give me an example of like what like a my swimming with dolphins while you're treating my pain.
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Speaker 2: Whatever you like. Actually, you can put on iHeartRadio if you want it to.
00:17:17
Speaker 1: This is phenomenal. That's so cool. I love that. Like you were saying, kids.
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Speaker 2: Love that too, I'm sure, Oh, they love it as we use in the hospital too. You come in for an infusion, it could be painful where the goggles and you know, you don't experience pain. You're totally distracted by it. Patients have a great experience with it. That's some of the things we do, some of the new technologies that are coming out where you don't need surgery. We can burn the nerve
that causes the pain, destroy it, minimally invasive, no needles, no, no sutures, nothing, and so that's that's giving a lot of promise to people.
00:17:48
Speaker 1: That's cool. What excites you most about what's happening at UCI Health and your team and what you're seeing like specific to UCI Health and the way you guys handle this, I.
00:17:57
Speaker 2: Think we're very unique. You're not going to find many pain centers a locally but definitely not in the country that do what we do. And I'll tell you why. You know, part of pain is treating the pain, but sometimes you do need surgery. Right, We're very unique in that our pain physicians are also in the operating room with the surgeons, and we know who's good who's not. What they excel at, you know, and we can talk to you about very specific things and send you to the right person. Oftentimes you get a referral, you're like, you go see the person. Ah, this is not the right guy for me, or this is not the right you know. How does the referral system work in the United States? It's broken, But that's what we do really well. Here. We have a really consolidated system where we know everybody, they know us. We work down the hall. We have somebody who says, look, we say you really need to go talk to a surgeon. We walk down the hall with you, introduce you to the surgeon, and they see you right away, and we help you handpick the right referral.
00:18:50
Speaker 1: So it's like team team health care.
00:18:52
Speaker 2: It is team health care, but it's very personalized in the right way.
00:18:55
Speaker 1: You know.
00:18:57
Speaker 2: How do you find a doctor, you know, your kid needs a doctor. How do you find a doctor's go online or something? Yeah, you find you know, random health grades. Sure, yelp, yelp for I did a reservation, but not for a doctor, right totally.
00:19:10
Speaker 1: Yeah, Yeah, so that's awesome. I love hearing that and knowing that that's a great thing. Anything else that we should touch on, you know that maybe we haven't talked about that. You think it's important for people to know that maybe watching this or hearing this that are living in pain.
00:19:24
Speaker 2: I think there's hope. There's definitely hope on the horizon for whoever's listening out there, who has pain, whether it's knee pain, as we age arthritis, my god, we're all going to get arthritis, right, Do we all need hip replacement surgery?
00:19:36
Speaker 1: No?
00:19:36
Speaker 2: What else is out there? So we've got a lot of new therapies that we're bringing out, rolling out at UCI almost every few months, really, and so I think there's a lot of promise to people who are living in pain. And then it's also good pain care. You know, sometimes you may not gel with the right doctor, or you may get sent to a quack, or you know, I don't hate to use those kind of words, but it's true. You don't know who is who. And but we select our physicians very very carefully. We bring in doctors from all over the world. Harvard stand for Cleveland Clinic, and they're all here at UC Irvine, and so we really try to create a team of pain physicians where you don't need to go to the Cleveland clinic, you don't need to go to Harvard because they're here.
00:20:20
Speaker 1: That's amazing. That really is all right. Just a side personal question. If you get a headache, doctor, what do you think? What do you do? What do you do?
00:20:27
Speaker 2: Specifically caffeine?
00:20:29
Speaker 1: Really?
00:20:29
Speaker 2: Okay, Caffeine's the best thing you can do.
00:20:31
Speaker 1: Yeah, what about like if you like, if your knee hurts, your knee is sore, you know, then what are you reaching for? Not caffeine?
00:20:38
Speaker 2: Not caffeine? Usually it's an anti inflammatory. Oftentimes eight to ten out of ten times it's going to be an inflammation process. Okay, So your ibuprofen, your anti inflammatories and approxy and those times.
00:20:48
Speaker 1: Okay, good. Those are just personal, selfish questions. My playlist says it's the nineties, My lower back says it's not. Doctor. Thank you so very much. We appreciate you.
00:20:58
Speaker 2: Oh my pleasure.
00:20:59
Speaker 1: Awesome, thank you