WEBVTT 00:00:00.000 --> 00:00:12.900 Welcome to today's episode of Medically Speaking. I'm super excited about today's episode. Today we 00:00:12.900 --> 00:00:19.220 have two of our pain management physicians with us from South Regional, Dr. Sunil Agarwal and 00:00:19.220 --> 00:00:25.100 Dr. Lissa Heuwenlohe. So welcome guys and super glad to have you guys join me today on today's 00:00:25.100 --> 00:00:32.180 podcast. Thank you. Great. So let's just start with introductions a little bit. And so maybe 00:00:32.180 --> 00:00:35.560 Alyssa, why don't you go first? Just tell me a little bit about about yourself, like where you're 00:00:35.560 --> 00:00:40.440 from, where you went to medical school and did your training and those type things. So I went 00:00:40.440 --> 00:00:45.440 to medical school in New York. I'm from New York in the city. I did a lot of my training in New 00:00:45.440 --> 00:00:51.620 York. So I started off at Mount Sinai and then I ended up in California for my fellowship at Loma 00:00:51.620 --> 00:00:57.420 Melinda, and now I'm here. Nice. Glad to have you. Sunil, tell us a little bit about yourself. 00:00:57.420 --> 00:01:02.620 Yes, I was born and raised in Michigan. My parents immigrated from India about 40 to 50 years ago, 00:01:02.620 --> 00:01:08.700 went to the University of Michigan for undergrad, went to Wayne State for a graduate medical 00:01:08.700 --> 00:01:13.900 program, then did medical school at Cincinnati, and then I went back up to the University of 00:01:13.900 --> 00:01:19.340 Michigan in Ann Arbor to do an internship in general surgery, and then I did a research 00:01:19.340 --> 00:01:24.640 fellowship there in opioid prescribing. So there's an organization called the Michigan Open, 00:01:24.640 --> 00:01:31.220 and there I got interested in pain medicine and then came down to Atlanta, did my residency in 00:01:31.220 --> 00:01:37.100 anesthesiology at Emory, and did my fellowship at Emory as well in pain medicine. Wow. Yeah, 00:01:37.100 --> 00:01:41.880 definitely some awesome training, and we're super glad you guys are in Greenwood bringing your 00:01:41.880 --> 00:01:48.100 skills to the community here. That's just awesome. So let's just start with kind of a broad overview 00:01:48.100 --> 00:01:52.820 a little bit. I think there's some misperceptions sometimes when we talk about like pain management 00:01:52.820 --> 00:01:57.980 and those type things. And maybe just like from y'all's perspective, like tell me about your field. 00:01:57.980 --> 00:02:04.220 Like what do you do? Sure. So chronic pain is usually three months, at least three months of 00:02:04.220 --> 00:02:09.600 pain. So for people who have pain chronically or recurrent pain, those are the patients we 00:02:09.600 --> 00:02:16.280 primarily try to help treat. And we try to use many different ways to help treat them. So 00:02:16.280 --> 00:02:20.380 So the way I think about it is we use medications to help treat them. 00:02:20.380 --> 00:02:24.940 We use complementary therapies, physical therapy, acupuncture. 00:02:24.940 --> 00:02:28.340 Supplements can also be helpful. 00:02:28.340 --> 00:02:36.120 And then interventions, so things like injections and other implants or nerve-burning procedures, 00:02:36.120 --> 00:02:40.120 things that are a little bit more involved can be also helpful for those patients. 00:02:40.600 --> 00:02:44.300 Yeah, we really try to see patients as a whole person 00:02:44.300 --> 00:02:49.300 and treat all the different aspects of them as far as their pain. 00:02:49.300 --> 00:02:55.440 So sometimes we think of pain management as I have a problem in one part of my body 00:02:55.440 --> 00:02:58.800 and that's what I treat, but we really try to look at the whole person. 00:02:58.800 --> 00:02:59.600 Gotcha. 00:02:59.600 --> 00:03:03.260 So would you guys say you really take that holistic approach, right? 00:03:03.260 --> 00:03:06.280 Like kind of looking at not just the pain but the whole person 00:03:06.280 --> 00:03:12.400 as well as their other medical issues besides just the pain that they may be dealing with. 00:03:12.400 --> 00:03:14.520 How common is chronic pain? 00:03:14.520 --> 00:03:17.380 Yeah, chronic pain is very, very common. 00:03:17.380 --> 00:03:21.580 You know, over time, people just develop problems, 00:03:21.580 --> 00:03:27.320 and those could be either related to arthritis or musculoskeletal pain or nerve pain. 00:03:27.320 --> 00:03:34.900 So these things happen over time with injuries from either a long time ago or even more recently. 00:03:35.120 --> 00:03:37.000 And so it's a very common condition. 00:03:37.000 --> 00:03:40.300 It's one of the most common medical problems that we encounter today. 00:03:40.300 --> 00:03:45.840 Are there any common things that you see a lot in our area of South Carolina 00:03:45.840 --> 00:03:48.360 in regards to chronic pain, any particular? 00:03:48.360 --> 00:03:50.860 I think the most common thing is back pain. 00:03:50.860 --> 00:03:52.120 That's probably everywhere. 00:03:52.120 --> 00:03:59.940 Back pain, neck pain, knees, major joints, hips, shoulders. 00:03:59.940 --> 00:04:00.920 Gotcha. 00:04:00.920 --> 00:04:03.820 So tell me a little bit about it. 00:04:03.820 --> 00:04:07.720 Do you guys work with other specialties to kind of coordinate pain management? 00:04:07.720 --> 00:04:11.580 Like, say, you mentioned, like, back pain or neck pain, shoulder pain. 00:04:11.580 --> 00:04:17.220 Do you coordinate with the spine team, like the surgeons in those departments or orthopedics, for example? 00:04:17.220 --> 00:04:19.140 Tell us a little bit about how that might work. 00:04:19.140 --> 00:04:19.640 Yeah, absolutely. 00:04:19.640 --> 00:04:23.540 So we have a multidisciplinary approach to addressing pain. 00:04:23.540 --> 00:04:29.020 So we work really closely with the spine center, with the neurosurgeons over there, with the PM&R doctors over there as well. 00:04:29.020 --> 00:04:31.240 We work with the orthopedics team as well. 00:04:31.480 --> 00:04:37.060 So a lot of times, you know, a patient who can't have a procedure, we have things to 00:04:37.060 --> 00:04:40.260 offer them, or a patient who has had a procedure, we have things to offer them as well. 00:04:40.260 --> 00:04:49.160 We also work with our podiatry colleagues, who they help address some of our patients 00:04:49.160 --> 00:04:52.480 who have foot pain that we can't help, and then vice versa as well. 00:04:52.480 --> 00:04:58.840 We work with physical therapy, and so they play a very crucial role in how we help treat 00:04:58.840 --> 00:05:00.020 patients with chronic pain. 00:05:00.020 --> 00:05:01.420 Mm-hmm, mm-hmm. 00:05:01.480 --> 00:05:07.880 yeah so there's i know there's different types of pain right there's like uh i say nerve pain 00:05:07.880 --> 00:05:12.860 for example like people have neuropathy from diabetes or other chronic impingements in their 00:05:12.860 --> 00:05:19.160 back or whatever and then there's more like like shoulder like bone pain and um and cancer pain and 00:05:19.160 --> 00:05:24.000 and and different types maybe tell us a little bit about maybe the different types of pain that 00:05:24.000 --> 00:05:30.060 you treat and how your approach may be different depending on what the patient has so if they're 00:05:30.060 --> 00:05:36.740 having more like that arthritis bone pain that will be a certain type of treatment maybe depending 00:05:36.740 --> 00:05:41.340 on what joint it is their age and all the different things that are going on with them we might refer 00:05:41.340 --> 00:05:47.640 them to physical therapy and try to start with a stepwise kind of almost like a laddered approach 00:05:47.640 --> 00:05:56.020 so least invasive to most invasive would mean physical therapy maybe some topicals over the 00:05:56.020 --> 00:06:03.600 counter medications and then if they need it we could do injections and if they're really not 00:06:03.600 --> 00:06:08.920 really getting a lot of relief sometimes we refer to those other practitioners like surgeons 00:06:08.920 --> 00:06:16.000 if we're talking about neuropathic pain it just really depends on where again where the pain is 00:06:16.000 --> 00:06:22.000 but a lot of the same kind of modalities so we'll start with you can even do physical therapy for 00:06:22.000 --> 00:06:29.000 nerve pains topicals and then we do do some injections depending if you're talking more 00:06:29.000 --> 00:06:35.360 about nerve pain like a radiculopathy that would be more like a spine injection and then we can 00:06:35.360 --> 00:06:40.640 even do things where we do implants like a spinal cord stimulator people have peripheral neuropathy 00:06:40.640 --> 00:06:45.600 in their feet if they have just one nerve bothering them sometimes we can put in a 00:06:45.600 --> 00:06:52.720 peripheral nerve stimulator so we have a lot of different options yeah so those are I think she 00:06:52.720 --> 00:06:58.980 covered the majority of the options that we have available you know for people who also have 00:06:58.980 --> 00:07:02.800 narrowing around the spinal cord there's a procedure that we do that relieves some of the 00:07:02.800 --> 00:07:10.120 narrowing there's a ligament that lives in the spinal canal outside of the epidural space where 00:07:10.120 --> 00:07:16.000 we can actually peel away at that ligament. And that's a non-invasive procedure that patients can 00:07:16.000 --> 00:07:20.080 go home the same day and get relief with that narrowing around the spinal cord. It's called 00:07:20.080 --> 00:07:28.180 the MILD procedure. Okay. Okay. Talk to us a little bit about the role of opiates in pain 00:07:28.180 --> 00:07:33.820 management. I know as an ER physician, I see someone comes in with acute fracture. It's not 00:07:33.820 --> 00:07:37.760 uncommon for me to write them a few days of something a little bit stronger, Lortab or 00:07:37.760 --> 00:07:42.400 something like that to really take that edge off acutely. But what's the role or is there a role 00:07:42.400 --> 00:07:49.500 in opiate pain management just in general? And in which cases might you use that more than others? 00:07:49.500 --> 00:07:57.280 Sure. So I always explain it as every intervention has a side effect. There's a risk and a benefit 00:07:57.280 --> 00:08:03.440 to everything. So with opioid medications in the short term, they can be very helpful for an acute 00:08:03.440 --> 00:08:07.800 problem. If someone breaks a bone, has a surgery, opioids can be very helpful in getting them 00:08:07.800 --> 00:08:13.900 through that acute process. But in terms of long-term use of opioid medications, that's where 00:08:13.900 --> 00:08:18.480 the risks start to outweigh the benefits, where people start to have side effects from these 00:08:18.480 --> 00:08:23.680 medications, where they lose their effectiveness. And it's not just things like addiction or 00:08:23.680 --> 00:08:29.580 overdose that are important things to consider, which they are, but they can affect the body 00:08:29.580 --> 00:08:34.140 as a whole, so they affect the hormones, they affect the bone health, they can actually make 00:08:34.140 --> 00:08:39.440 your pain worse because your body starts to get used to these medications and can cause a concept 00:08:39.440 --> 00:08:44.860 called hyperalgesia, where your pain is actually amplified while on these medications. And so 00:08:44.860 --> 00:08:50.720 it's important to approach pain with multiple different angles, multiple different viewpoints 00:08:50.720 --> 00:08:56.800 and perspectives to try to make sure that we're targeting the pain in as many ways as possible, 00:08:56.800 --> 00:09:04.020 not just one therapy. Gotcha. So is there a role for opiates in chronic pain management? 00:09:04.020 --> 00:09:09.240 Other things may not be working, or what's your thoughts on that? So my thought is, you know, 00:09:09.240 --> 00:09:14.840 if we try to exhaust more conservative options, if those are not effective, then opioids are a last 00:09:14.840 --> 00:09:22.200 line. They are something that can be helpful, but until we try the other options, they're not 00:09:22.200 --> 00:09:27.500 usually a first line of therapy. Sure. I know you've already touched on some of the other 00:09:27.500 --> 00:09:32.400 options, but maybe dive in with me a little bit more. So you mentioned acupuncture is something 00:09:32.400 --> 00:09:38.180 that you might try. Maybe let's talk a little bit more about some of those, I guess what maybe some 00:09:38.180 --> 00:09:42.580 people would think of the alternative treatments. I'll dive into that a little bit. And how does 00:09:42.580 --> 00:09:48.380 that play into your practice? Yeah. So we, you know, it really depends on what patients have 00:09:48.380 --> 00:09:55.020 access to but there is a lot of evidence for acupuncture for um even things like mind body 00:09:55.020 --> 00:10:00.100 practices or therapy so that's going to be like mindfulness meditation yoga 00:10:00.100 --> 00:10:07.360 tai chi is really big a lot of evidence for that so um really talking chronic pain we're talking 00:10:07.360 --> 00:10:14.020 about chronic pain yeah yeah so um those are some there's a lot of different categories and i think 00:10:14.020 --> 00:10:19.740 we touched on supplements a little bit too a lot of different like herbs topicals different things 00:10:19.740 --> 00:10:27.400 that people can try that are known to be safe um massage can be really great pool therapy getting 00:10:27.400 --> 00:10:34.260 in the pool a lot of people with arthritis people have a lot of weight on their joints on land if 00:10:34.260 --> 00:10:38.960 they get in the pool they can move better and really get that workout that they need to kind 00:10:38.960 --> 00:10:45.280 sustain their body and get that strength around those joints um what else what else am i missing 00:10:45.280 --> 00:10:52.240 chiropractor chiropractor is great um you know maybe it's not the cracking is not for everyone 00:10:52.240 --> 00:10:58.960 but um chiropractor does there's a lot of overlap between a lot of different um uh like between 00:10:58.960 --> 00:11:04.560 physical therapy and chiropractors so they will give out exercises and they will do some of the 00:11:04.560 --> 00:11:11.120 the manipulation myofascial release then physical therapy will kind of do some of that too dry 00:11:11.120 --> 00:11:18.200 needling things like that and i always recommend that patients do stretching at home try to have 00:11:18.200 --> 00:11:23.400 good form when they're lifting things especially because low back pain is one of our more common 00:11:23.400 --> 00:11:29.200 commonly seen conditions and then we also have wearable devices that people can use at home 00:11:29.200 --> 00:11:33.980 things like a tens unit which is a transcutaneous electrical nerve stimulator basically a sticker 00:11:33.980 --> 00:11:38.500 that you put on your muscle and you can stimulate that muscle to help with myofascial or muscle pain. 00:11:38.500 --> 00:11:44.360 Gotcha. So how does someone get an appointment with you guys? Can they just call or do they 00:11:44.360 --> 00:11:48.800 typically need to go through some type of a primary care doctor or other physician first? 00:11:48.800 --> 00:11:55.440 How does that work? I think it depends on their insurance, right? If they have to go through their 00:11:55.440 --> 00:12:00.960 primary care, but I think they can call. I think for the most part, they see a primary care doctor 00:12:00.960 --> 00:12:07.040 first. The primary care doctor will then refer to us if that is, if they're having, if they meet 00:12:07.040 --> 00:12:11.760 the criteria for chronic pain. So if they've had pain for three months that has not responded to 00:12:11.760 --> 00:12:16.860 more conservative therapies. We also see a lot of patients who've seen the surgeons first and 00:12:16.860 --> 00:12:24.200 who've had a procedure in the past who have pain after the procedure and get some referrals from 00:12:24.200 --> 00:12:29.480 our surgical colleagues as well. Do you guys work much with our cancer center? 00:12:29.480 --> 00:12:37.120 We've started to work more with the cancer team. There are certain procedures that we do to try to 00:12:37.120 --> 00:12:43.740 address cancer pain and medications that are commonly used to help with cancer pain and also 00:12:43.740 --> 00:12:50.940 treating pain that results from therapy from cancer treatment. So a lot of times people who 00:12:50.940 --> 00:12:56.300 have chemotherapy, they can develop neuropathic pain or nerve pain. So there's certain medications 00:12:56.300 --> 00:13:02.760 that we are comfortable prescribing that can be used to treat that. I have started treating 00:13:02.760 --> 00:13:09.660 patients with stage four metastatic cancer who are receiving palliative care with 00:13:09.660 --> 00:13:15.620 neurolytic procedures. So we actually burn nerves that are responsible for the sensation that they 00:13:15.620 --> 00:13:25.320 have from tumor bulk that could be pushing on those nerves. Gotcha. Gotcha. Oh, let's touch on 00:13:25.320 --> 00:13:30.080 pain goal setting for just a little bit. This is something I remember from back in the medical 00:13:30.080 --> 00:13:34.260 school days. It's like sometimes, you know, it's easy, I guess you've been dealing with something 00:13:34.260 --> 00:13:37.780 and maybe to have sometimes an unrealistic expectation on like what you're going to be 00:13:37.780 --> 00:13:44.560 able to do. Tell me about the role of pain goal setting or goal setting in the work that you guys 00:13:44.560 --> 00:13:49.600 do. Yeah, I think expectations are really important. Just making sure that, you know, 00:13:49.600 --> 00:13:53.680 we're on the same page with the patients and understanding where they're at right now and 00:13:53.680 --> 00:14:00.000 what their idea is of where they can get their pain to. I think people hear pain management and 00:14:00.000 --> 00:14:05.020 think, I'm going to go from a 10 to a zero and it's going to happen right now. But you're right, 00:14:05.020 --> 00:14:09.560 if you've been dealing, the longer you've had something, the harder it can be or more challenging 00:14:09.560 --> 00:14:17.020 it can be to get it to kind of go down, it's not always the case that we can get pain to go away 00:14:17.020 --> 00:14:22.440 completely. So kind of setting that expectation. And there's a lot of different reasons why that 00:14:22.440 --> 00:14:32.820 could be. I think just really making sure anytime we initiate a medication or procedure or send a 00:14:32.820 --> 00:14:38.620 patient to therapy, really just making sure that they understand what the expectation is as far as 00:14:38.620 --> 00:14:42.440 what they're supposed to be getting out of it and what work the patient should put into it as well. 00:14:42.440 --> 00:14:49.000 And another thing is not just thinking about it in terms of a pain score or pain number, 00:14:49.000 --> 00:14:53.340 but it's also functionality. So are you able to do the things that you love doing that you used 00:14:53.340 --> 00:14:59.960 to be able to do prior to your chronic pain and providing quality of life? 00:14:59.960 --> 00:15:05.940 Yeah, I think it's so important to, like you guys said, to kind of have that expectation of 00:15:05.940 --> 00:15:08.780 like, what do you think you're really going to get out of this? I mean, if you come in and you 00:15:08.780 --> 00:15:12.920 think you're going to be completely pain-free, it's probably not realistic, but we can take you 00:15:12.920 --> 00:15:18.360 down from an eight to a four or something like that and, uh, and make it to where you can manage 00:15:18.360 --> 00:15:22.600 it and do the things you love to do and have some quality of life. That's really what you guys, 00:15:22.600 --> 00:15:26.960 I think, bring it along in a big way of what you do is you help people get some quality of life 00:15:26.960 --> 00:15:32.840 back. And that's a big deal. Sometimes it's even just sleep. People just want to sleep. 00:15:33.000 --> 00:15:33.400 Exactly. 00:15:33.400 --> 00:15:38.140 One of the reasons I got into pain medicine was, you know, a lot of medicine is focused on longevity. 00:15:38.140 --> 00:15:43.960 So how old we are living too, but not necessarily focusing on quality of life. 00:15:43.960 --> 00:15:49.320 So that is something that I take pride in trying to provide my patients is a better quality of life. 00:15:49.320 --> 00:15:49.920 100%. 00:15:49.920 --> 00:15:51.040 And I think you guys do that. 00:15:51.040 --> 00:15:52.380 I definitely think you guys do that. 00:15:52.380 --> 00:15:54.220 Okay. 00:15:54.220 --> 00:16:00.080 Well, I guess one other thing I wanted to touch on is just community partnerships and relationships. 00:16:00.460 --> 00:16:05.240 to me that's super important that at the hospital we're looked at no not just like we do this 00:16:05.240 --> 00:16:09.100 health care thing that's all we do but we're really more broadly involved in the community and 00:16:09.100 --> 00:16:15.120 want to really be looked at as a as a community partner tell us a little bit about some of the 00:16:15.120 --> 00:16:20.160 things that you guys are involved in in the community or whatnot um we're starting to partner 00:16:20.160 --> 00:16:26.380 with the y um we like i was saying before we want patients as many patients as possible to get into 00:16:26.380 --> 00:16:32.800 the pool and try pool therapy or aqua therapy. So we'll be starting that up soon where patients 00:16:32.800 --> 00:16:39.440 can go there for their therapy. I think it's going to be like a group class, but special for 00:16:39.440 --> 00:16:46.800 our pain management patients. Okay. Yeah. And we partner with the different physical therapy 00:16:46.800 --> 00:16:54.180 options available in the area, not just in Greenville, but also Abbeville and neighboring 00:16:54.180 --> 00:17:03.700 counties. We are also trying to connect with acupuncture resources with massage therapy and 00:17:03.700 --> 00:17:07.920 chiropractor resources as well so our patients can have access to them. And then we're also 00:17:07.920 --> 00:17:12.520 partnering with our psychiatry colleagues who can help with cognitive behavioral therapy and 00:17:12.520 --> 00:17:16.760 they're doing group sessions for patients who can benefit from that. Tell me about cognitive 00:17:16.760 --> 00:17:21.580 behavioral therapy. What is that and how does that work? So there's definitely a strong relationship 00:17:21.580 --> 00:17:29.080 between emotional state anxiety state and pain and so a lot of times when someone is in a more 00:17:29.080 --> 00:17:37.140 stressful state they have greater pain and so by helping address their emotional state and their 00:17:37.140 --> 00:17:42.420 anxiety state you can actually help improve their pain cognitive behavioral therapy specifically 00:17:42.420 --> 00:17:49.380 helps trying to help with patients in their coping mechanisms and trying to understand their pain 00:17:49.380 --> 00:17:53.400 understand how they can address their pain in their daily living and helping 00:17:53.400 --> 00:17:57.120 patients formulate their own expectations and goals too and it kind 00:17:57.120 --> 00:18:03.620 of makes these things tangible for the patient cool so just kind of changing 00:18:03.620 --> 00:18:07.540 subjects just a little bit you guys are both relatively new on our medical staff 00:18:07.540 --> 00:18:11.900 having just started with self regional in the fall just curious like what was 00:18:11.900 --> 00:18:15.300 it about self regional and Greenwood that attracted you guys to come here 00:18:15.300 --> 00:18:20.320 Because you guys, with your training, New York, gosh, Emory, you know, you guys could probably have gone anywhere. 00:18:20.320 --> 00:18:23.840 What was it that said, you know what, I think I'd like to try this out at Self Regional? 00:18:23.840 --> 00:18:27.280 Putting us on the spot. 00:18:27.280 --> 00:18:31.040 I really liked the atmosphere. 00:18:31.040 --> 00:18:37.260 I liked, I mean, from the time I met just the staff and, you know, my first interactions with Self, 00:18:37.260 --> 00:18:40.220 it was clear that there was something different about being here. 00:18:40.960 --> 00:18:46.080 I like the small community feel, but there was a lot, you have a lot of resources at 00:18:46.080 --> 00:18:50.240 this one hospital and the patient population. 00:18:50.240 --> 00:18:53.140 And then also it's the South, you know, everyone is so sweet. 00:18:53.140 --> 00:18:58.720 And I come from New York City where everyone's yelling, which is great, but it's nice to 00:18:58.720 --> 00:19:02.180 practice medicine in the South, I'll say that. 00:19:02.180 --> 00:19:03.260 Cool, cool. 00:19:03.260 --> 00:19:08.820 Yeah, and for me, you know, from the top down, leadership here, it's a physician-led hospital. 00:19:09.340 --> 00:19:16.200 And I think that is a great opportunity for providing health care, physician-led health care. 00:19:16.200 --> 00:19:20.340 And so that was something that was really interesting to me because it's not a common practice. 00:19:20.340 --> 00:19:24.300 There's a great opportunity for pain medicine from leadership. 00:19:24.300 --> 00:19:29.240 It sounded like there was a great opportunity to develop the pain medicine center 00:19:29.240 --> 00:19:34.600 and partner with our neurosurgery colleagues to form a spine center, which I think we're in the process of doing. 00:19:34.600 --> 00:19:35.300 We are, yep. 00:19:36.360 --> 00:19:40.300 And also the patients here, there's definitely a need for addressing chronic pain. 00:19:40.300 --> 00:19:44.860 This is a place where people are very friendly, people work very hard, 00:19:44.860 --> 00:19:51.500 and in South Carolina, historically, they haven't had appropriate chronic pain management. 00:19:51.500 --> 00:19:56.580 And so I've seen studies where opioids have been largely overprescribed in the southeast, 00:19:56.580 --> 00:20:00.940 and so I feel like it's a great opportunity to help address that 00:20:00.940 --> 00:20:03.240 and help provide people with proper pain management. 00:20:03.240 --> 00:20:05.520 Great. Good answers. 00:20:06.360 --> 00:20:07.060 That's awesome. 00:20:07.060 --> 00:20:14.120 Well, gosh, is there anything else you guys want to share or tell the community about what you guys do or really anything else you want to touch on? 00:20:14.120 --> 00:20:19.480 Maybe just a little, like, blurb about pelvic pain. 00:20:19.480 --> 00:20:20.320 Sure, yeah, please. 00:20:20.320 --> 00:20:22.520 You know, it can affect men and women. 00:20:22.520 --> 00:20:33.180 A lot of times, you know, people can think they're having back pain, so it presents as back pain, but it can actually be pelvic pain. 00:20:33.940 --> 00:20:39.140 And we can treat it the same way we treat everything else with the stepwise approach. 00:20:39.140 --> 00:20:45.920 But some nuances would be that we would send people to something called pelvic floor PT or physical therapy. 00:20:45.920 --> 00:20:49.840 And so we've been trying to really find some resources around. 00:20:49.840 --> 00:20:59.080 You know, we have some people that may do a little bit here, but finding some dedicated pelvic floor PT people in the community. 00:20:59.080 --> 00:21:00.820 Yeah. 00:21:00.820 --> 00:21:01.360 Okay. 00:21:01.360 --> 00:21:02.120 Cool. 00:21:02.300 --> 00:21:07.180 And, you know, it's our priority to provide care with consideration of being safe. 00:21:07.180 --> 00:21:11.600 So being safe first and foremost, and then secondarily trying to help address pain. 00:21:11.600 --> 00:21:16.440 Safety is really important, and so it's important to keep our patients safe, 00:21:16.440 --> 00:21:20.420 make sure that they're getting appropriate management with the medications that they're on 00:21:20.420 --> 00:21:22.320 and consideration of their other medical conditions. 00:21:22.320 --> 00:21:27.520 And so those are all things that we consider when we're coming up with a creative plan 00:21:27.520 --> 00:21:29.580 to try to address pretty complex problems. 00:21:29.580 --> 00:21:31.220 Awesome. 00:21:31.220 --> 00:21:31.960 Great. 00:21:32.300 --> 00:21:35.500 Well, gosh, guys, thank you all so much for joining us on today's podcast. 00:21:35.500 --> 00:21:41.200 And we hope you guys picked up a few little nuggets today about our pain management center. 00:21:41.200 --> 00:21:45.340 And thank you for trusting Self Regional Healthcare for your healthcare. 00:21:45.340 --> 00:21:46.120 Thank you. 00:21:46.120 --> 00:21:46.760 Y'all have a great day.