The Truth About Adrenal Fatigue

Dr. Joel Rosen: All right. Hello everyone and welcome back to another edition of your adrenal fix where we teach exhausted and burnt-out adults the truth about their health so they can get their health back quickly. And I’m really excited to be joined by our guest, Dr. Andrea Ferland. She is a senior scientist at the K I T Research Institute and a staff physician at the Toronto Rehab Institute. She specializes in focusing on treatments for chronic pain, including medications, complementary and alternative therapies, and rehabilitation.

And I really want to discuss her new book called The Eight Steps to Conquering chronic pain, a doctor’s Guide to lifelong relief. So, Andrea, Dr. Andrea, thank you so much for being here today.

Dr. Andrea Furlan:

Thank you for inviting me today.

Dr. Joel Rosen: Yes, yeah. And so I always start the podcast knowing about who we’re speaking about and why they got into their profession and maybe any health challenges or part reasons why you got into this area. So maybe you can elucidate why you are what you are. Give us some ideas.

Dr. Andrea Furlan: Yeah, for sure. Yeah, so I graduated 30 years ago from medical school in Brazil, Sao Paulo, I then emigrated to Canada 25 years ago. And I’m a physician here and I work in the pain clinic. And all that I do is help people with chronic pain. But what got me into this, I can remember and it’s very vivid in my mind, because, first of all, I chose medicine because I suffered from menstrual cramps, all of my teenagers and young adults, and they were very debilitating, very severe, didn’t get better a lot with the conventional medications got better only after I got pregnant. It got cured after I got pregnant. But before that, they were very debilitating.

And every month I knew I was going to miss important things or had to go to exams and tests suffering pain. So I chose medicine to help people because I thought you know that there must be something to treat this healthiness. And then when I was in medical school, I never heard about physiatry. That’s the specialty that I chose physical medicine rehabilitation. That’s the specialty of the person with disabilities.

And the reason that I chose physiatry was because I was between, you know, neurology and endocrinology. I was thinking about even what patient medicine, but I chose physiatry because I remember it was because of acupuncture. I had a patient that I was an intern, and we admitted the patient for investigation of her pain, she had been all over her body.

And We admitted her so we did all kinds of investigations Inside Out upside down. As you probably know, we wanted to find something that was abnormal metabolically or endocrine or any problem. And we couldn’t then she had been all over her body. So when the physiatrist came to the consult, he came with a bunch of needles, and he stuck needles on her. Half an hour later, she was walking happily.

And we discharged her the next day. So I said, Oh my god, what is this voodoo medicine? What did you do? And he explained to me in scientific terms, he said, No, you never heard about the pain system. You never heard about the opioid endogenous opioid, beta-endorphin. I said, No, I never heard about this in medical school. So he taught me that our brain is able to produce our own medicines.

And with acupuncture, what they did is just release those medicines from the internal pharmacy in the brain. And I said I need to know more about this. And that’s how I got fascinated by pain. And then studying the pain system and studying how can we help people with pain all my life? I’m a scientist. So I do a lot of scientific studies as well. And yeah, so that’s what got me into pain medicine.

Dr. Joel Rosen: That’s excellent. So that was during, your clinical rotations. Yeah. So you decided after that I wanted to get into physiatry.

Dr. Andrea Furlan: Ziaja tree and in physiatry, I, you know, physiatry we learn about rehabilitation of people with stroke and spinal cord injury, amputations, and nerve impairment, but I focus on rehabilitation of the person with chronic pain, because I see I can see how this is so debilitating, and it’s an invisible disability that people have nothing to show that is wrong. But you still can rehabilitate them and help them to conquer their pain. And that’s what I’ve been doing for the last 30 years since I graduated from medical school.

Dr. Joel Rosen: Right um, I asked you before we got on how long did it take you to write the book and you told me about 30 years so it’s always alive. For long learning, did you end up doing your fellowship in pain or chronic pain?

Dr. Andrea Furlan: Is that Yeah. So when I came to Canada, I did a PhD here at the University of Toronto, and then a fellowship in pain medicine. So I am over-studied. Topic.

Dr. Joel Rosen: Yeah, well, which is a good segue into this book that you’ve written eight steps to conquering your chronic pain, a doctor’s guide to lifelong relief. So it’s a pretty bold statement to say lifelong relief, right? So but with how much you’ve studied, the way you’ve categorized the pain, and, and all the steps that you need to do, I guess I would ask you the first question, what are the three types of pain you identify three types of pain and maybe let’s springboard from that.

Dr. Andrea Furlan: Yeah. And that’s important. That’s the basis of the knowledge. So it’s important that people understand because they do receive different treatments, depending on what kind of pain the person has. So let me explain this in terms of an analogy of an alarm system of a house, okay? So the pain system is like the alarm system that you install in your house, it’s the alarm to detect danger. If you install an alarm system, you put sensors on the walls for smoke, fire, burglar breakings, water leak in the basement, etc. If you want them to make noise, and alert, send an impulse to the box on the wall, and that box on the wall will activate the office, the central office of the alarm company. And the alarm company will decide do I send the ambulance, the fire truck, or the police to this house. So we have exactly the same thing in our body, we have the pain system. So we have sensors for pain all over our body, mostly in the skin.

Because that’s our how we communicate with the exterior, we have little fewer in the organs, internal organs, like muscles, heart, guts, and organs, we have fewer, but we do. So they’re there to detect danger. And then they send the signals, the equivalent of the box on the wall, that thing that we have on the wall is the spinal cord. So they all bring this sensation to the spinal cord, and the spinal cord will communicate with another neuron.

But in the spinal cord, a lot of things happen there. That’s where central sensitization can happen. So in the spinal cord, you can have a block of that sensation. That’s the gate control theory that says you can block that sensation from going up to the brain. Or you can amplify central sensitization will amplify that sensation. But anyway, so when it gets to the brain, the brain is like the office of the alarm company, the brain will decide what do I do with this information? I’m receiving alarm signals from that body part.

And what do I do? Do I tell the person to stop what they’re doing and then the brain will basically activate our endogenous internal own thing? Suppression pathways, like releasing opioids, the endorphins from our inner pharmacy that we have in the brain, for example, that’s what happened to the patient that I mentioned to you. When he put acupuncture needles on her activated this inner pharmacy human brain, she releases a lot of opioids, and she was fine. We know that better endorphin takes seven days to be broken and, and finish the action. So she should be okay for about seven days better than any pill, right? No pill of opioids last seven days.

But anyway, so not susceptive being neuropathic pain, neuroplastic thing, nasty plastic pain, those are the three types of pain. Sorry that I don’t have better terms. I didn’t invent this. I’m just the messenger here. Don’t shoot me a nociceptive thing is when there is a fire in the house, so you do need the fire truck to come and put up the fire and once the fire stops, the alarm goes silent. Okay, so if you have a fracture, toothache and inflamed ear, you have inflammation you have appendicitis Those are good reasons for you to stop what you’re doing go seek medical care because something is broken.

You broke a bone and that’s natural to hurt. neuropathic pain, which is the second type of thing is when the nerve system that carries this information has some disease. So for example, in compression of a nerve like carpal tunnel syndrome, or multiple sclerosis the person loses all the myelin around their nerve. or they have a spinal cord injury or they have a stroke. So those things affect the nerves and the pathways that carry the pain impulse. And the pain is kind of different and is not the same thing as the first one. They’re not susceptive things more inflammatory is localized. When the problem is. neuropathic pain is more burning, tingling electrical shocks, and it’s localized in the area that is innervated by that nerve. that’s those are the two types of mostly acute pain.

So those two types, they have been most acutely, because after three months, six months, those injuries, they tend to heal, if there was a fracture, the fracture is healed, if there was a nerve compression, the nerve, you know, use some anti-inflammatory, and then the nerve is not compressed. So the third type of pain is equivalent is Nasi plastics, that’s an agnostic plastic because it involves plasticity. That is when those injuries have been healed, or the problem had been taken care of. So they don’t have the initial injury anymore, but the system is still making noise. So now the alarm system of the house is malfunctioning. And that’s a terrible type of pain.

Because first it’s constant. It’s very loud, usually the volume is very loud so it’s usually worse than not susceptive neuropathic, and they have nothing to show that it’s broken or injured. And they go from doctor to doctor specialist, they do more MRIs, they get injections, they get opioids, they get surgeries, and they don’t get better. So you need someone to examine them and say this is not a plastic thing, because we can examine now a person and detect that it’s the pain system that is provoking. So they’re not imagining the pain, the pain is quite real. And it’s not in their head. It’s not emotional, it’s not psychological, the pain is quite real. It’s just that the origin of the pain is now the malfunctioning of the pain system. It’s not the fire so the house is not on fire, although that’s how they feel. Because it’s so constant.

Dr. Joel Rosen: Yeah, it’s a great answer. I love the analogy. I’m big into analogies. And I would imagine that the terminology is relatively new, is it not? That the because with specialties, if they are not finding the cause of the problem, and it’s a note said no see plastic type of generator? I guess the first step in helping this is in the first step of retraining your pain system. Is that correct?

Dr. Andrea Furlan: Yeah, yeah. And let me tell you something,, in my experience, most people may have a combination of one and three, two, and three, one and two, or all three, right? So that’s why they need to be to have a good investigation. And they need to see a doctor to make this diagnosis. So don’t try to diagnose yourself isn’t all chronic pains are just nasty plastic, there might be something that is wrong, that could be treated, but the Nasik class component may be making noise in the background.

And then it’s so hard for you to find the nociceptive neuropathic if the house like if the alarm of the house is making a lot of noise and very loud, it’s hard for you to know if it is really a fire somewhere here there. But in a good physical examination, and when we talk to the patients that those kinds of pain become clear.

And again, the treatment is different. Because you just said that for Nasik’s plastic pain. You don’t do the same things that you do for acute pain, there is no susceptor because they will not work. An example is opioids, opioids. You know we are in the middle of here in Canada and the United States we are in the middle of a crisis because, with so many people who suffer from chronic pain, it’s one in five adults that have chronic pain, some type of chronic pain. physicians want to help them and healthcare professionals don’t want to see them suffering. So it is easy to prescribe an opioid because if you think okay, this person has pain if I give them an opioid, I would remove their pain so why not give it?

The problem is if the person has predominantly Nasik plastic pain, you can make that pain transform into a Fibromyalgia spread. Fibromyalgia is a pain that is spread to the body and that’s the poster child of nasty plastic pain because we know that the pharmacy the inner pharmacy in the brain of people with Fibromyalgia is not working properly. So they cannot activate those opioids endogenous adequately, they have a lot of central sensitization. And we know that if you give opioids it’s almost like putting gasoline on the fire because you’re going to spread and make this pain become more chronic and more Nasik plastic. So you really need to be careful to whom you prescribe and do interventions like this.

Dr. Joel Rosen: Right. And I’m glad you’ve done the work because it really is untangling the ball of yarn and pulling out and under uncovering, which is the generator. And I guess that’s where the difference between chronic and acute pain comes in how the central processing or the plasticity of the brain and the limbic Center and the emotions we play on it, and how that creates that perfect, vicious cycle. So maybe tell us about that and unpack that for us.

Dr. Andrea Furlan: Absolutely. And you just got it, the visual cycle is what mainly causes the disability related to chronic pain. Because the personnel, they are afraid of the pain. So pain now becomes the stressor in their life. They may tell you and I’m not afraid of my pain. I know this is okay, I’ll have pain for the rest of my life. But the brain is still being alerted that something’s wrong. And the brain needs to interpret what is going on. When the brain cannot, then when the mind can’t interpret. Listen, I’m feeling this pain. And you’re telling me that everything is alright, where is this coming from? It generates a cascade of events.

And as you probably know this better than I don’t, it generates all activates the HPA axis. And the adrenaline goes crazy cortisol hormones and stress levels go wild. And then the person just reinforced because they learn it’s a lot of our behaviors, almost all of our behaviors are learned behaviors. You learn by practicing. So they learned that, okay, I have pain. So if I don’t move, I don’t trigger pain. And maybe pain is a bad thing, I should not be feeling pain. So if I don’t move, I feel less pain. Therefore I need to move less and do less. So they stopped going places they stopped doing things that are normal parts of life.

And that just creates a more sedentary life, more bad nutrition, weight gain, hypertension, depression, and sleep problems, because now they have more time to do what sleep Sometimes they have time for some of my patients, they take long naps in the afternoon, I take three hours nap in the afternoon, and they go crazy, I say, don’t do that, because that’s the best recipe for you to have a very bad quality of sleep at night when you do need good quality sleep.

So the vicious cycle, the fear behaviors, avoidance, don’t move, sleeping more taking pills, they like to pop pills because we are in a society where we want quick fixes. They don’t want to do a lot of things for themselves. They don’t want to take charge of their life. So my book is about lifestyle modifications, you know, that’s where I want them to go be free to take charge of their life because that, in my opinion, that’s the only way that they can be rehabilitated if they start doing things for themselves.

Dr. Joel Rosen: Yeah, it’s interesting, I think you were blessed with your clinical experience to see that, versus someone like myself, where I would do a lot of mechanical support for injuries. And some people would get better and some people wouldn’t. And I realized, well, there’s got to be something else going on. And not only just the emotional component, I was fortunate in my second degree to have a psychology degree. So I understood there is a connection, but also just in the metabolic, what’s going on with this person and what else is going on in their body. And you were fortunate to get that going into it. Did that guide you in terms of making more of a clinical decision before you put in the interventions? And I guess that’s the question I’m asking.

Dr. Andrea Furlan: If I understand well, your question. So, yes, so we can separate the mind from the body. That’s one thing if we try to separate them, and if we try to just read the mind or just treat the body, especially for cramping. You can’t because we have symptom physical symptoms that are an expression of an emotion. An example of this is tears. I always tell my patients tears you know right in front of your eyes. We can’t hide, we usually can hide tears because that’s the first place that people look at us. You can have tears of joy, tears of sadness, tears of emotion. So our body expresses.

So when we talk about our metabolism when we talk about it, the other thing that I love, a passion of mine is nutrition. I think nutrition is essential for fighting chronic pain, especially chronic pain. We know so much now about nutrition that we didn’t know before. And nutrition is so integrated with our metabolism with our gut bacteria, we’re now studying a lot of, you know, the importance of our, you know, all these billions of bacteria that we have in our gut, they do amazing things, they control our mood, because our production of serotonin if you have the right composition of this bacteria, you may have good, you know, pain-free life. But if you have the wrong composition, you may have fibromyalgia, we know this. It’s amazing.

And then people can do transplant, fecal transplant from one person that has healthy bacteria to another person. So that’s another story. But so they’re all indicated. They’re all connected to hormones and diet. We can the problem is, Joel, our medical system is very good at helping people with acute problems. That’s what it would say, here in Canada, we are very efficient in fixing someone who is wrong. Like, if there’s an injury, let’s do surgery, if there’s a fracture, let’s cast and bye-bye. But when a person has a recurrent, chronic disease, the system is not prepared for this person, and the system gets overwhelmed.

And we have primary care providers, family doctors, nurse practitioners who have five minutes with each Vale, how can I expect them to do you know, a full assessment of all of this in five minutes? So I feel for those patients who need a full assessment and deserve a full assessment. But sometimes it’s really hard to get.

Dr. Joel Rosen: Yeah, you know, it’s interesting that you’re talking about it in this aspect because I don’t think the mind-body connection in traditional medicine is typically appreciated, as well as nutrition. And I do see that the tides are changing and the medicine 3.0 is hopefully coming in. And what I’m surprised about Andrea is the fact that it sort of takes the P m&r physiatry specialty to really lead the charge. Maybe you can segue into what are the eight steps because I don’t think the eight steps would just be applicable to chronic pain per se, it’d be applicable to chronic illness or chronic anything that’s chronic in nature, because those eight fundamentals are really applied across all spectrums for more chronic like presentation. So maybe it was, yeah.

Dr. Andrea Furlan: And the way that I chose the steps and align them down, you know, they are like steps, climbing a mountain and conquering a mountain. And the ones that are put at the base of the mountain are the ones that I think if people do first, it puts them in a much better position to do the other ones that I asked them to do later in the mountain. So I started with the first step is retraining the pain system.

And how do you you know, retrain your brain it’s not rocket science, you know, this is quite simple. It is first learning that you have a pin system, learning that there is a possibility you’re paying, you’re paying is not so plastic and you need the same way that you form those synapses in the plasticity, you can undo them. So you can kind of undo those synapses and disconnect that alarm system of the house that is going rogue just because it is you know making noise. And once you stop that you can now listen, okay? The nociceptive pain is there. Okay? The neuropathic pain is there and go treat that thing. So that takes the noise out of the house. So that’s the first step.

And how do you do that there are many different I don’t have time here to explain to your audience, all the possibilities, but one example is yoga. Because yoga involves the mind and body. Usually, it’s mind and body exercises, breathing exercises, activation of the percent sympathetic nervous system, going for a walk, meditation, and mindfulness, those kinds of things are excellent to retrain the brain system. The second step is your emotions. So I talk about controlling your emotions, but that’s more like knowing your emotions and knowing that emotions have an influence on your body on your pain because you If you deny those emotions and Oh, my pain is not affected my emotions, we have a problem because they do.

And you’re not acknowledging that makes, it hard for me to help you, too. Because if we can help, you know that stress reaction, the problem that you had with your husband, you know, the situation with your family, the financial situation, the angriness, the frustrations that you have, they affect you, they’re affecting your pain. If you don’t take that out of the equation, I can get in to help you with the other kinds of things. So then we talk about sleep in sleep is extremely important. We talk about nutrition, we talk about exercises, we talk about medications, one of the steps higher on the mountain is how do you use medications?

How do you talk to your physician about your pain and your pain medications? Do you know what medications you are taking, Do you know what they are for? The other step also is people around you, you need to learn how to communicate with them. Because we now have a lot of evidence that the context where the person is affects their suffering from pain. So you give an example.

So you probably heard that when people come to a pain clinic, we ask them to give a number to pain zero is no pain. 10 is the worst pain of all that you can ever imagine. When people give us a score like 789 10 It doesn’t have a this is for chronic pain, maybe not for acute pain. For chronic pain, it doesn’t have a correlation with how many injuries are legion in the body. What they are telling us is how much they’re suffering from that thing. If they say my dog, my things are nine out of 10. It’s because they’re suffering a lot.

And they’re feeling that weight. And it’s like, I can’t live in this house anymore. It’s driving me crazy because it’s so loud and it’s all the time and nobody can hear they think I’m crazy. The context, the social context that the person leaves can make the ping better or worse, that’s suffering. So for example, in the laboratory, they change it who is around the person with chronic pain. So if they bring a person with a smile, hamper at an ice cream person, that suffering decreases, so the person in the laboratory will say, Oh, my pain is not so bad. So three, four, or five. But if they show a video or pictures of angry people, people who are nasty, and Aino saying horrible things and treating kids badly, they will say Oh, my pain is 789. So changing the color.

They did this in the laboratory, they showed red collars to people with pain. Reg reminds us of fire, ambulance of danger blockage. So they rated their high napping higher. They show blue collars that remind us of sky and ocean peace and they report less so the context around us can increase this suffering or decrease the suffering. So we need to be mindful of that. Because if someone comes to me and says I’m having a nine out of 10 Ping, am I tempted to give them an injection a surgery? an opioid pill?

Yes, because I and they’re crying in front of me. And they said they really suffering. But if I know that the context where their life is they feel they’re alone. They’re lonely. The kids, don’t talk to the kids for 20 years. They don’t have any friends, they lost their job. You see the difference. So their nine out of 10 is a consequence of what’s going on around them. And the last step in the book, The eighth step is once they get to the top of the mountain, their goals leave their life this is something that people can’t believe that they can do conquering the mountain doesn’t mean that mountain is gone that it’s going to disappear.

The mountain is still there, so your pain may still be there. But you conquered means you’re paying in the back side of your life is not controlling you anymore. You can live your life you can meet your goals, and you can enjoy your life. Your life doesn’t need to stop because you have chronic pain. It is possible to do this to people sometimes they don’t believe and that’s why I have a lot of testimonials and stories in my book I’ve seen this in my 30 years of exposure means I’ve seen many people who tell me, Dr. Furlanetto, I don’t need you anymore.

I came here to discharge you. Because I still have chronic pain, but it’s really not bothering me anymore. I’m not suffering from it anymore. I have my tools, I know how to handle a flare-up. And they are prepared to tackle the next mounting, which could be cancer, it could be another chronic disease or depression. It could be another episode, another different kind of pain. So but they now are more resilient. That’s what I hope people can achieve.

Dr. Joel Rosen: It’s wonderful. I am really moved by the body of research and the information that you’re bringing I reading Peter at Tear’s book right now and talking about the 3.0 in medicine and how we get people to live with their illness, but not die from it, and increase their health span. And I think that’s exactly what you’re doing. I found that to be true as well with our patient faces. I’ll ask him. Okay, not that I have a magic wand. But if I did, and we were able to achieve what we wanted to achieve, what would that look like?

And all of them are? A lot of them are? Well, I don’t give myself permission. I’m not there yet. I don’t even think about it. I don’t even know. And I think that’s part of the reason we don’t wait until we’re ready. Before we do it. We have to have that mindset before we go into it, but I like that it’s in the mountain and of the hierarchy as well. I guess the question would be to you, Andrea, is how does this fit into the model?

That’s not quite there yet? How, especially with other specialties? I mean, I could see chronic pain and people that are presenting, but how does it change how services are provided? I mean, it’s great that you have this book in this resource, and people could do it on their own. But if doctors or the healthcare system, depending on what country you’re in, and third-party reimbursement aren’t necessarily for or against whatever, I guess what’s the utopia of this? How do you see this fitting in?

Dr. Andrea Furlan: I thought about this and I have an answer. Because I had the same thought he said, I think Joe, the people that are best equipped to help this patient with chronic pain to apply these eight steps are not healthcare professionals are other people’s peers who have conquered their own mountings. So let me back up a little bit. You need a good physician or healthcare professional to make the diagnosis and tell you this is the type of pain you have.

You have nociceptive neuropathic Nasi plastic one of the three or two or three, make the diagnosis be there if they need an injection, if they need surgery, if they need a prescription, you are available to them. But I don’t think the professionals especially doctors, nurse practitioners, physician assistants, we are so busy. We need to train peers, people who had conquered that chronic pain mounting, should take these people by the hand and coach them up the mounting. That’s my philosophy.

That’s where I would like to go. And there are many peer-to-peer groups here in Canada, I hope in the United States, you also have those. But in United here in Canada, we do have associations and I don’t mention them in my book and the resources. I have links to those many of those groups in the United Kingdom in Canada. And they have people who can affiliate with them and start going to those meetings. They usually are in groups but some of those people, also do one on one sessions.

But I think this is the model that would be best in my opinion, because I would like to be coached by someone who had the experience. I like to see them as a role model for me if I have a disease, I say Okay, tell me where to go. How do I go? How did you do on this day? How what did you think when this was so hard for you to do? And actually, that’s what a lot of groups in Canada, they’re using my book to discuss in those groups. So I hope we’ll have many more people to be coaching their peers.

Dr. Joel Rosen: Yeah, no, it’s great. I think Do you think it’s possible that with the intake and part of the diagnosis criteria that you have sort of alerts to know that there are some yellow I wouldn’t call them red flags, but yellow flags with all of these?

Dr. Andrea Furlan: I hope so. Yeah. I hope so. And so they need a checkup with their healthcare professionals regularly. You know, because maybe during this process that you were trying to conquer your mountain maybe there is a thyroid that now is out of work and you need to treat the thyroid or you need or you develop rheumatoid arthritis and you do need treatment for that. So, they are not immune to a nociception of neuropathic pain. But if everything is okay, you know, checkups with your health care professionals to make sure that you are is to you know, okay to continue doing those steps because those steps are a lifestyle.

And you don’t need a healthcare professional to teach you to eat well, to sleep well, to exercise, to socialize, to get out of your comfort zone to talk about your emotions to do journaling, meditation, mindfulness, you can do this with people who are not in the healthcare field.

Dr. Joel Rosen: Yeah, I mean, I think that’s spoken from someone who knows how the system is run and not necessarily going to knock over the, you know, the Goliath of the medicine world. But I would say that it would be nice if it was aligned to support them in those areas. But you know, what the bottom line is, it comes down to the patient, right? I mean, the patient, I think you and I would agree that the majority of them don’t want to feel this way if not all of them. And they really are looking for solutions. And they’re not crazy. And they haven’t been given the proper insight into everything that they’ve been doing.

And this is a fantastic research resource to be able to look into and say, Hey, there’s more lifestyle, emotional responsibility. And I haven’t written down here actually fear of pain equals disability confidence and activity equals recovery. I think that kind of sums it up right there. So awesome information. I was really impressed with the book, Andrea, I always like to ask my guests, we’re sort of winding down here. What do you wish you would have known because the title of our podcast is your adrenal fixed and teaching adults that are Exhausted and burnt out?

That if they would have had some kind of pain generator, acute, they would have been headed towards that crunch? chronicity? What would you have told your younger self that you wish you would have known then that you know now that might have accelerated your learning curve or given you wisdom prior to having to go through the growing pains? But what would have been some words of advice you would have told yourself?

Dr. Andrea Furlan: Yes, so so much advice that I could give myself my younger self, I would say, when we see people with chronic pain, I think in my early years, I may have thought that I could fix everybody. And here I am, I just graduated, I know all of the science, I then did a PhD and I got a degree. So let me fix you. I think I tried with many of my patients initially, let me do this acupuncture, let me do this injection, let me do this. But I am knowing now I am much less, I’d say confident in myself that I can fix someone. I probably because I see people that they fix themselves. And, once they make the change in their mind. And I don’t know, really, if it was something that I said or something that they read anywhere. They change their life, they approach life and pain differently. They change in front of my eyes.

And it could be like they need a change to eating healthier because they realize that eating junk, processed food was not getting anywhere. And another person could be, you know, my sleep is a mess. And I will take care of this when they come back to me. They are different people, they are more awake, they are more talkative, they’re happier. So each person is different. But I think I lost my pride, that I can fix them. I can help I can teach them everything I know. But a lot of chronic people, they have the answers inside of themselves. So I just need to let them know that there are these possibilities, and they need to do the majority of the work not me.

Dr. Joel Rosen: Well, that’s a great answer. I mean, you know, the root of the word doctor is to teach right? And I think when the student is ready, the teacher will appear. And I think you know, I always ask that question with a little bit of hesitancy because had you not gone through that learning curve and that smack in the head of you’re not going to fix them all. You wouldn’t have written this book to be able to give them the power to see this teacher help the student learn. So I think this is your way of helping to mold, the beautiful artist inside the body that’s ready to come out when they’re looking for it, so kudos to you. The book is called eight steps to conquering your chronic pain. It’s a doctor’s guide to lifelong relief. And you can find it wherever books are sold. And you also whereas other places, I mean, you got a beautiful silver YouTube thing behind you. So where can they find you and get more information if they already don’t know who you are?

Dr. Andrea Furlan: Yeah, so I do have a YouTube channel. It’s my name, Dr. Dot Andrea Forland. And I have a website that is Dr. D o c t o r, Andrea forland.com. And there they have links where they can order the book, but it has you said everywhere where books are sold, they can find a book. And my channel is just my name on YouTube.

Dr. Joel Rosen: Awesome. Well, thank you so much. I appreciate your time. And I thank you for your contributions, and I look forward to hearing about future successes. So thank you so much. Thank you for inviting me and talk to your audience today. Thank you.

To check out Dr. Andrea’s book, click here

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