Episode 34: A Unique Physiotherapy Approach with Dr. Jam

Dr. Jam is a Renaissance man who is a physiotherapist, an educator, and a musician. Join Dr. Karmy for an in-depth interview with Dr. Jam about the approach he developed over 35 years of practice to managing adults and children with chronic pain. 

Of course, he had to make a musical about it, too, because why wouldn't he?

Dr. Jam's non-profit website: www.ThePainTruth.org

Schedule a consult with Dr. Jam at: 

Bahram Jam

Athlete's Care

Yonge & Empress

416-479-8685

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What makes a good physiotherapist is what most of us do is, in fact, is to promote self-efficacy, independence. Because we know based on studies, the highest predictor of chronic pain is people who have low self-efficacy, meaning people who believe that, "I need to find somebody or something to fix me." A good physiotherapist will always empower the patient that they can fix themselves. We're just a coach to teach them what's the best way to do it. Hello, this is Dr. Karmy for Chronic Pain Chronicles, and today with us we have Dr. Jam. Hello, Dr. Jam. Hello. Dr. Jam is a physiotherapist, and, he's had not a typical career as a physiotherapist. First of all, he's a doctor. Most physiotherapists get a master's degree, and then they're done. And in your case, you decided to get a doctorate. How did you end up doing that, and why? Yeah. I just wanted to clarify, it's not a PhD, because a PhD is researching one specific area. Mine is a clinical doctorate. Okay. Because it's a clinical doctorate I did it, United States, Andrews University, and it's to enhance your clinical skills, and my thesis was on the classification of low back pain.'Cause at that time, about 20 years ago, I was so passionate about, about figuring out how to classify low back pain. Yeah, and we're still somewhat, challenged by that, the whole pain and classification of pain, and they keep reclassifying things over time., S- so you started out with a doctorate and, obviously 20 years is a very long time to practice physiotherapy, so, , you can get , a lot of clinical intuition on how to treat patients,, which I think in chronic pain matters often more than necessarily a specific technique used., In addition to practicing, you've also had a fairly extensive educational career. You,, specifically trained, h- hundreds or maybe even thousands of physiotherapists., So tell me a little bit about that. Sure. I've been practicing for 34 years- … as a physiotherapist. Wow. And I've taught over 1,500 post-graduate courses on pain and chronic pain to physiotherapists and other healthcare professionals, and I'm frequently invited at conferences to speak about pain. So i'm passionate about it, speaking about pain, teaching about pain, and treating patients with, with chronic pain. It's, it's my gig. That's all I do. So clearly you saw a gap in terms of, , needs for physiotherapists, and, , your training courses are trying to fill the gap. So what do you think makes for a good physiotherapist? What makes a good physiotherapist is what most of us do is, in fact, is to promote self-efficacy, independence. Because we know based on studies, the highest predictor of chronic pain is people who have low self-efficacy, meaning people who believe that, "I need to find somebody or something to fix me." A good physiotherapist will always empower the patient that they can fix themselves. We're just a coach to teach them what's the best way to do it. And, physiotherapy is a very broad tool used for many different conditions,, and it's not just used for pain. But I guess when it comes to pain I think of two main categories. One is sports injuries, which are typically, fortunately, self-limited. And then there's physiotherapy for chronic pain. How do,, the two groups differ? Yes. See, when pain is from an actual injury, like sports injury or a car accident, the treatment is relatively easy, meaning, first of all, time heals most things, from fractures to torn muscles. Mm-hmm. That's a wonderful thing. And physiotherapy helps, you know, maintain the mobility of the patient as they, as they recover, strengthen them as they recover, so they get back to their sports, or being able to lift their child, or be able to,, walk to the grocery store again, to get them back to function. So that's when it's pain from an injury. But too often, people don't have an injury and they experience pain. Nothing's happened to them, or something happened 20 years ago, and they still blame that what happened 20 years ago. So that's when treatment becomes much more challenging, to say the least, because obviously time does not heal that kind of pain. In fact, time often makes things worse, 'cause they don't get better, and traditional physiotherapy treatments to strengthen or stretch or put machines on don't really work. Even medications prescribed by family doctors, anti-inflammatories that normally work for acute injuries, they don't work for chronic pain. So that's where people feel stuck. So we're going back a little bit to self-efficacy, and, , I guess maybe how you define that. Are, are you talking about exercise programs? Are you talking about mind over matter approaches? What are some of the, effective approaches for management of chronic pain? Yeah. Number one is you have to have a reason why you want to get better. Because if a patient's reason to get better is, "J- I just want to get rid of my pain," unfortunately, that does not work, 'cause then you're fighting an uphill battle. You're just telling your brain,"How do I get rid of pain?" And you're in a fight or flight mode. Hm. And I have a quote that I tell my patients. I say, "In life, either you're pursuing or you're escaping. There's no in between." So whenever you say, "I want to get rid of this pain," you're in escaping mode, which is in a stress mode, fight or flight mode, which is not conducive to getting better. But pursuing mode is where you pursue a goal that you desire. I ask my patients, "What do you want to be able to do again?" And three things. I mean, they could say, "I wanna be able to go back to my yoga class. I want to play tennis again. I want to play with my children again. I want to be able to go to the park with my grandchild," or, "I wanna be able to walk for one hour." Mm-hmm. Whatever it is, and then my goal is to set small goals to help them achieve it. That's it. I don't even like the word exercise. Well, first I guess I could go in two directions. One is I, I assume once you reach for small goals, you set some new ones? Yes. Whatever , they decide. I empower the patient for them to decide what their goal is, and what is the minimum amount that they think they could do this week. Yeah. It's always about them making the decisions, because when they make the decision, they're far more likely to stick to it and believe that they can achieve it. Okay. I do my best to not interfere. And it sounds like they are week by week goals,. Yes, week by week goals. If you wait too long month, and then they forget it. Okay. And so then the other question is how do they get to those goals? So if let's say they want to stand for 15 minutes so they can wash the dishes. That's their goal.. Right now, they can only stand for five minutes, and then they have to sit down. So what do they do? I mean, that's a loaded question, but, the reason- They can't stand more than five minutes to wash dishes is simple. Their brain feels that is a dangerous activity. That's it. And when the brain senses it's a dangerous activity, it has no choice but to protect the person. And one of the ways it does is by getting them to stop doing the activity, and the way it does that is by creating pain. Okay. So what we wanna teach the brain is that standing and washing dishes is not dangerous. Mm-hmm. S- some people push through, and the more you push through, the more you're giving the message to the brain it's dangerous. So the simple answer is, even though the answer is far more complex, is I would have them stand instead of five minutes, for three minutes, short of their pain, and then have the brain say,"Oh, standing wasn't dangerous then," and give the message of safety, and do it again, and do it again, and do it again, and do it again, until the brain keeps getting message, "I'm safe when I stand. I'm safe when I stand." Mm-hmm. Too often, people give up. They don't wash dishes at all then. They say, "Well, I can't do it." Or they push themselves way beyond the pain, and so either of those scenarios will just reinforce that washing dishes is dangerous. So, what you are advising isn't really so much, you know, do exercises. The focus is on goals rather than, , you know, aerobic exercising or strengthening exercises or stretching exercises. The focus is on goals and gradually working towards those goals. Am I understanding it right? You got it exactly right, because if people want to feel, I'll use their quote, "normal" again, their normal self, then I suggest focus on doing the activities that make them feel normal. If they're doing all these exercises that they wouldn't normally do if they had no pain, in fact, I suggest that they stop doing them. Because the more exercises you do that you're doing to fix yourself, the more you're telling your brain that, "I must be broken." But the more activities you do that would be the normal you, like what you used to do, then the more you're telling yourself, "Well, then I'm not broken.", There have been various ways that are mind over matter that are typically done by psychologists, and if it's not your area, that's fine, trying to sort of get to something similar, so things like cognitive behavioral therapy. The current popular one, I think, is pain reprocessing therapy. There's another one that was developed from Stanford. Then there's mindfulness meditation. Now, they don't exactly do the same thing, but there's a lot of them., Any thoughts on some of those approaches? Absolutely. I've done my best to study all of them, and done courses and everything that I could. Every one of those approaches, cognitive behavior therapy, pain reprocessing therapy, they have their benefits, and some people respond to this, some people respond to that, and the goal is all the same: make the individual feel safe in their own body. That's it. Because most people feel broken in their own body because of the information they've received over the years from different healthcare providers, from imaging, from, uh, social media, from YouTube, from ChatGPT. All those messages that they get, "I'm broken, I'm broken. I'm out of alignment. I need to be fixed. Maybe I need surgery. Maybe I have arthritis." And those messages keep going in their heads, and all those programs do the same. They try to erase those messages, have the person unlearn everything that they've learnt about pain, because you have to unlearn stuff before you can move forward. So, you have also developed a program for chronic pain at Children's Hospital? Yes. It's associated with SickKids Hospital and, but it's a private clinic in, in Vaughan. It's called Boomerang Health, and the concept is the same for children. We go by the whole philosophy of neuroplasticity, except children are easier to treat than adults, meaning I'm wearing my red rubber nose the whole time I'm there, and my job is to make the children not feel they're broken, and to make them laugh. So children have better outcomes than adults? Yes, but it, a lot depends on their parents. Because- I sometimes can't change the parents, and when I can't do that, my outcomes are poor. If the parents- remain anxious, the anxiety is passed on to the child, and the pain persists So, uh, other than that, , the approach to children is the same as approach to adults? I focus on what they want to do, whether it's to dribble a basketball or rock climb or do gymnastics or go to the park and play baseball. I focus on what they want to do, not to lie on a bed and strengthen their hips, for example. So, if from what you're telling me, if that's the case, do the sessions somehow involve parents as well? Well, the parents are always present most of the time at the sessions, yes.'Cause I want the parents to see how I am making the child feel confident in their own body, and then I have to pull the parent aside, "See? Try not to limit them." Like, the worst words that parents can tell a child is, "Be careful." I call it the B word. Don't say it, be careful.'Cause every time they say be careful, you're giving the message that they're in danger, and every time you give a message you're in danger, your, the pain persists. When it comes to chronic pain, one, you know, fairly obvious type of chronic pain is widespread pain, and then there's, localized pain. So if a child started out with a sports injury, and honestly, in my experience, most patients with chronic pain, there is a trigger of some description, and most common trigger is trauma. I- initial treatment is, , I am assuming standard physiotherapy treatment, which would probably focus on strengthening and stuff like that. So at what point, if you have a child,, do you start thinking in the direction of maybe they need the, you know, a different approach rather than just sort of strengthening the muscles?- Is it perhaps after first three months? When? Yeah, that's a great question, and I'm lucky because all my patients have already had physiotherapy treatments before. They've seen chiropractors, they've seen massage therapists, they've seen osteopaths. So whether child or adult, they've already seen other healthcare professionals for a few months. For example, if they've had already six weeks of strengthening exercises and it hasn't helped them, I can't possibly think that my exercises will be better, or my manual therapy techniques will be better than a chiropractor's. Or my soft tissue technique will be better than a massage therapist's. So I have to believe that this person will not benefit from that approach at all, and that they need a completely different approach. That's why months or years has gone by and they're still struggling with pain. They need a completely different approach than just- Okay … strengthening or stretching. So if they failed traditional treatment for, say, six months- Oh … then you start to think about maybe they need something different. I would say six weeks, maximum 12 weeks. Even fractured pelvises get better within that time. True. So when it comes to, various pain reduction strategies, be it acupuncture, massage, or machines that they will use, laser, shockwave, ultrasound, IFC, decompression tables, uh, you are not a big fan? I don't have them in my practice. So not in the last 30 years. And I'm not against them, I just, I don't have them in my practice., Most of my patients have had those things already, so why would I do it again? And knowing what I know about research studies that so clearly show that- Self-efficacy is the highest predictor of recovery, and lack of self-efficacy is the highest predictor of chronic pain. I can't get myself to use passive techniques on my patients. Mm-hmm. Because even if it helps them temporarily, you know, even if you put a machine on or a hot pack on or, or you s- do spinal manipulation, you know, crack their neck and it feels good temporarily, I'm not for that. Why? Because I have a sign in the clinic that I'm gonna put that says, "I'm not here to make you feel better. I'm here to make you get better." There's a big difference. Feeling better, just take an opioid medication if you wanted to. Drink alcohol to feel better. But neither will solve the problem. So basically, it's about being in control of your condition instead of, , something being done to you. It's about what you're doing yourself. Exactly. Because our mindset when it comes to recovery is everything. If we adopt a mindset that, , I am in control, then your recovery is so much better than if you have the mindset that I'm not in control, pain happens to me, and I need somebody to fix me. Then you become a victim of the external world. And I don't want , any of my patients to sense they're a victim, that somebody else needs to fix them. So at least in my experience, there is no silver bullet in chronic pain management, and everybody sort of has their own perspective on things. First of all, how do you define success? Do you define success that they are totally cured with zero pain? Do you define success that they're able to do more compared to before they started? Do you define success that they are more at peace with their pain and they're not as anxious? So maybe let's start there., What do you see in terms of outcomes? My success, definition of success is improvement in function, and there's two functional scores I use. One of them is called patient-specific functional scale, where I ask them, "Can you name three activities that you want to do? And then give me a rate how well you think you're doing them now." For example, they say, "I wanna be able to play golf." Zero is you can't play golf at all. 100% is you're 100% satisfied with your current ability. They may say, "I'm 0%." And then I pick three things, and then after six weeks, if they're still at 0%, then I haven't been successful. If they say, "You know what? I'm able to do nine holes now, so I'm at 50%." And I say, "Yes, that's success." The other questionnaire is Pain Disability Index, PDI. It's just five questions based on occupation, h- home activities, general, social activities. Anyways, five questions, and it's zero to 10 again. It's out of 50. And then minimal improvement I want is a score of five, and I have never had somebody who did my Pain Truth program that did not improve by at least 10, 20 in the score of Pain Disability Index and the functional outcome measure.'Cause my goal is to, even if their pain is exactly the same, which usually isn't, but even if it is the same, their function has improved. So , , am I hearing that 100% of your patients respond to the treatment- Yeah … but to, to various degrees. 100% of the patients who agree to follow the program, who don't drop out, who don't quit, who don't think I'm a quack. Okay. Of, of them, 100%. But I would say I would at least have half dropout rate. They don't do it. They think this is crazy,'cause they want to be treated. They want something done to them. And I say, "If you want something done to you, I'm sorry, I'm not your person. See somebody else." I'm assuming people , don't drop out on the first visit. They drop out over the course of treatment? First or second visit. Okay. So how long do you have to do this,, before you see enough of a benefit not to drop out? It sounds like people are just not very patient. Correct. I would say within four sessions is when people see the benefit, and six weeks is when they say, "Now I get it." Once a week for . Four weeks they see the benefit, after four sessions. So, , the next question is this, , some benefit for supervision, , because, you know, people don't know how to do things, and I think, , supervision gives people some structure because otherwise life gets in the way and, you know, they just don't think about things. And, , there is some benefit of being able to do things on their own at home because, , it's more convenient. Often it's cheaper, right?, So first of all, do you give them homework or do you do everything in the clinic? No, I don't. I make them give themselves homework, what they want to do this week. Going back to goals. Yeah, that's it. I tell them, "What do you wanna do this week that would make you feel like you achieved something?" And then, how long do you work with them, and at what point, do you tell them to just go off on their own and continue on their own? And is there a point where they need to come back? How does that part of it work? Yeah. It's very variable, but typically if somebody who's had fibromyalgia for three years, I would see them once a week for six weeks. After that, I see them once every two weeks for another six weeks, so that's another three sessions. After that, I said, "It's up to you whether you want to come back to see me or not." So what- Because I think now you know how to do things yourself. So what happens in real life? Like, what percentage of people carry on after that, and what percentage of people just go off on their own? If they do go off on their own, do you have a sense, do they tend to come back after a year or six months, or do they tend to not come back? Yeah. The honest answer is I don't know because, my brain only remembers my success stories, and in real life, I need a research assistant to keep track of all my patients, and I'm not in a research atmosphere. I'm in a clinic where I see patients, so there's no follow-up three months, a year, three years to see what happened. That would be my dream if somebody did that with my patients. Yeah. That's where research comes in. But I will say I don't know, and because I'd like to say all my patients got better, but that's absolutely not true, right? I would think even if a quarter of them maintained the improvement, that's far more than I would say most chronic pain clinics do. No, that's very fair. I mean, first of all, you, I think anytime you look at any intervention, you look at the risks against benefits, right? I think the risk of a knee replacement surgery is very different than risk of physiotherapy, right? So, what I'm trying to say is you're doing something that's incredibly safe, and you're doing it on often a very difficult patient group. If you help half the people or even a quarter of the people with zero risk, I think it's awesome. Are you the only physiotherapist using this approach, or is this part of a school of physiotherapy that maybe not as widely used in Ontario but it does exist, throughout the world? As I said, I've been teaching thousands of physiotherapists, and I teach a chronic pain program. It's called The Pain Truth Certification. So I have a website. It's called thepaintruth.org. I'm giving it a plug, but it's a non-profit. It's nothing to purchase. There's no membership. There's nothing to buy. No sponsorship. It's a completely non-profit website with only educational items and videos on there that I use for patient education. So, everybody has access to that information, from patients to healthcare providers. So you're saying basically you've developed it? Correct. Okay. Thepaintruth.org, I've developed it. It's by intention.org because it's a non-profit. There's nothing. There's nothing to sell. There's no money involved. And even with my patients who I know they have limited funds or they don't have insurance, and they've used all their insurance with their healthcare providers, when I say no risk, I say, "I will see you for six weeks once a week for free, pro bono." Because it's a private clinic. Just because I know if I don't see you, I don't know who else will be able to help you. And even with that, I have more than 50% dropout rate. But the, the specific physiotherapy approach that you're using, did you develop that approach, or is it kind of similar to some of the other physiotherapy approaches that are out there? No., It's similar by overlapping by all the other approaches out there. So I will not take credit that I've invented anything. In fact, I would say the things I teach were taught 3,000 years ago in Buddhism philosophy, is what I teach. You know, I teach my patients to not resist pain, because suffering comes when we resist pain. Pain acceptance model, which sounds horrific at first to patients, but once they understand it… So no, I've never developed these concepts. They've been around for a few thousand years. So presumably since you are teaching it, there's a list of practitioners who practice this approach? Yes, there are. I have a list of it on the website, thepaintruth.org, of practitioners across Canada , who do this., But, because there's so many courses out there, many physiotherapists even don't believe in this approach. Because what they do is they may say,"I use this approach," but at the same time they will offer patients modalities or manual therapy or spinal manipulation, which contradicts the entire approach, or they do acupuncture. And I'm not against any of those techniques, but they give contradictory messages to the patient, because patients want a treatment, and physiotherapists feel obligated from a business point of view, from a patient satisfaction point of view, to give patients what they want. So most don't practice the way I do because they don't want their business to go away, and they want to please the patient. So What happens if people get a partial response, not a complete response, and then they try to go back and do something different like a decompression or McKenzie technique or an injection? Would that undo all the good that was done? I don't think it'll undo because the lessons will stay there. If they feel like they gotta go through the process to try something, I suggest they do it. Because they're always gonna think, "What if? What if I try this and this works?" And they can't go ahead with this program as long as they have the what if mindset. But I'm not optimistic that any of those things actually work patients in the long term. Once they are centrally sensitized, once the pain is primary chronic pain, we call it, or pain system hypersensitivity, or we call it neuroplastic pain, however you wish to describe it, nociplastic pain, treatments do not work. The only thing that is effective for people with primary chronic pain is self-efficacy, is teaching them what they can do to fix themselves. So you have an interest in music- therapy? Yes. I won't call it music therapy, but- Okay… for the last five years I've worked on writing a musical, and here it is. I'm wearing the shirt, see? Pain- … the musical. And, uh, it's played four years in a row in the last four years, and sold out shows. The last show was in February 2026. It was at Factory Theatre, which is downtown Toronto, and I, advertised it a lot, marketed to people living with pain. In fact, people with ODSP, the Ontario Disability, I offered them to attend the theater for complimentary. I paid for their tickets. So I had over 100 people with ODSP attended. Mm. You know, everything from people who are in wheelchairs to people living with chronic pain. So- again, it's not very intuitive, right? Like chronic pain, certainly there's books written about it and stuff like that, but,, I don't think I've ever encountered anybody who had a musical about it. This is just so totally out, , out of the left field kind of a thing. How did you come up with the idea? Well, I'm a musician. I was in a band for 10 years, 40 years ago. Okay. And, , I've written a lot of songs, and I love musicals, so my dream was one day to write a musical, and when COVID hit, suddenly I wasn't working, I wasn't teaching. I said, "You know what? I think I'll work on my musical now." Mm. It was a dream, so I started, and the musical is, is an inspirational music, and it's always performed by people who lived with chronic pain, and the songs and the theater and the show, it's, seven characters. You know, a doctor, three, four patients, and the character Pain. Where I personified pain.. So some of it you did because, But, , you're trying to what? Explain pain to patients with pain? Are you trying to explain pain to their family members or just public at large? Yeah. Public at large, doctors. I've had the doctors from the Canadian Pain Society attended, and they gave rave reviews of it. I want every physician. I had 12 people from pain clinics- attended, and they've endorsed it. I've had orthopedic surgeons attended. But of course, mostly the public because the aim of The Pain: The Musical was to destigmatize chronic pain and give people who are living with pain hope. Mm. And give them a voice because they too often feel alone. Mm. And at the end of the show, people feel like they were heard, that their voice was presented on stage., So , you don't actually use music or role-playing in terms of some kind of a therapeutic approach, for patients? No, but I have them. Now, that's outside the musical, which only runs for a few days because that's all I can afford- Mm-hmm'cause I have to pay all the actors and performers and the theaters. But- I'm a strong fan of music therapy. I mean, not many people have access to music therapists, but a significant portion of my patients I want them to listen to music 20 minutes a day. Ideally twice a day for three weeks, that's it. And the study shows as effective as opioid medications 'cause it releases the endorphins in the body. And do you know what type of music's the best? It's the music that you enjoy. It costs nothing, and yet it can be, have profound effect, but people don't believe in it. So there is a little bit of research for music and chronic pain. There's a bit of research for music and dementia, music in Parkinson's disease, actually depression. Actually, a long list of medical conditions for which there is a bit of research that music has an effect. So do you, , listen when your pain spikes up, or do you listen at the same time every day? I wouldn't be surprised if he has resources on music, maybe apps or,, any thoughts on how to do it best? Yes I've researched it a lot because I even present on music therapy and chronic pain at conferences. There are systematic reviews. I mean, certainly the research isn't as strong as pharmaceutical- items because there's no money in music. Who's gonna fund it, right? Yeah. There's no money. There's no funding in it because it's free, and anybody can access it anywhere. So that's one of the problem with research studies. But there's still quite a bit, and there's no research that's shown any side effects from it. Let's just say that. Mm-hmm. Zero side effects, and costs nothing. I recommend my patients, for example, a significant portion of them, if they say they used to dance, I put on music and dance with them. Mm-hmm. It could be Ukrainian folk dancing to, you know, Bollywood dancing, to Persian dancing, whatever type of dancing that they like. I put on the music and dance with the patient. Because dancing is one of those activities that gets the person to move without the mindset that they're doing it to fix themselves. Remember, I'm against doing things to fix yourself, but if you move with joy, with pleasure, and with music is on, you release the body's endorphins, and it can have a tremendous effect. But don't do it for long if you've never done it, and if you haven't done it in 10 years. I just put it on for, say, some people three minutes, some people one minute of dancing with music. So people might not even notice that they're moving. Correct so basically it sounds like, start slow and gradually build it up to 20 minutes you have very severe pain and very little endurance., And, , it's not just music. It's better if it's also dancing, if you're moving your body. And, is there s- specific time of day that one would do it, or is it when they flared, or usually when their pain is a bit less severe? When is a good time to do it? Yeah. I recommend doing it any time., It doesn't matter, but don't do it with the intention of fixing pain. Okay. All right. Because if you do it with the intention of fixing your pain, then it fails. The analogy I give is the same as meditation. If somebody meditates, they say, "Okay, I'm gonna sit here and meditate for 10 minutes so I can be stress-free after 10 minutes, so I can be relaxed," and then the meditation will not work. Like meditation only works, I use air quote, "if you let go of all attachments to outcome." So the only way meditation is effective is if you sit there and stop thinking or think whatever thoughts you have for no reason. And when you do it for no reason, that's when you, after you say, "Wow, that was effective." So for dancing and music, it's the same thing. You listen to music for no reason other than to listen to music and enjoy it, and that's when it has the best effects. Any time of day… same with dancing. Best if you dance because it's one of your goals and you want to dance? Correct. Not because you're trying to fix yourself or to escape pain, 'cause then suddenly you made dancing or listening to music a form of punishment. Mm-hmm. I'm doing this to fix my pain. If that happens, then, well, that's pointless. And that goes for any exercise, any movement. Like, if people say, "I do yoga. I've been doing yoga for a year and it hasn't helped me," I say, "Would you do yoga if you had no pain?" They'd say, "No, I wouldn't do it." I said, "Then stop it." So I think there was a mention of role-playing as a approach to pain management. Did I misunderstand? No, I have… I've written about 15 scripts for my patients. It's all in a binder, that I have it at the clinic, and I do role-playing where I play the role of pain, and my patients, they read the lines as the role of the patient. And it's like I have my patients have a conversation with pain. Like, what would they say? Like, "Get out of my life. I wish you weren't here." And I say, "But I'm only here to protect you." And role play, and then they have this appreciation for me, that I'm their protector as pain. I'm their defender. I'm not their enemy. And if I can change their mindset that I'm not their enemy, the relationship changes, and the dynamic changes, and suddenly they feel like they don't have to fight pain as much. So sometimes it's easier to, instead of explaining to them all this stuff, it's sometimes easier to role play in order to get them to understand things better. Correct. I select my patients who I do this with, obviously. Yeah. Because some people may think I'm crazy. I don't care if they think I'm crazy. I only do things with the right patients. Well, like you said, If they think you are crazy, they're not likely to buy into the role playing, and it's not gonna be of benefit, and you're better off to just explain it, I assume. Correct. You, it's selective which patients I do this with. Patients who are outgoing, patients who are open-minded about this stuff. And when they do the role playing, they really get it. They're so grateful. Are there any professions, like, say, actors, that respond better to this stuff? I simply ask them, "How is your acting? Do you wanna do some role playing?" If they say no, "Okay, fine. That's it." If they say,"Yeah, I, I, I like acting"… They don't have to be actors, no, but I see how open and receptive they are to the idea. So do you have any other, , suggestions, for patients, , with chronic pain that you found useful over the years? Yes, what has been recommended by millions of people. Mindfulness, meditations. Now, mindfulness meditation, there is a very tricky thing again. I have dozens of meditations on my website, thepaintruth.org. And, , people can access the audio files for free to listen. I have various ones. For example, one of them is called the imperfect meditation, where I teach people to meditate for 10 minutes with allowing to be imperfect. Breathe however you want. Lie however you want.'Cause most people are obsessed with perfectionism- Mm-hmm … and self-criticism. So I do pain education through meditation. You can call it self-hypnosis almost. And so I find they can be, , effective. Yes, people get very, especially if you've never meditated before, I certainly have never meditated before, they get hung up, are we doing it right? Right? There's even a device that's, was sold at Best Buy that sort of reads your EEG brainwaves and tells you when your meditation is deep enough. I don't know how reliable the device is, but it certainly is there to target that anxiety about am I doing it right. I think it would cause more anxiety. And so that's a good place to end., Thank you very much, Dr. Jam, for taking the time to describe your approach.,. Thank you. Thank you very much for having me. It was a pleasure. Thank you for listening to this episode of Chronic Pain Chronicles with Dr. Karmy, our goal is to bring you clear, evidence-based insights so you can make informed decisions about your care. I'm Raveena Aujla, until next time. When it comes to your health, always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only and should not be considered medical advice or a substitute for professional medical care