Ep. 27: Bahram Jam, PhD – Paradox Effect: Why Fighting Pain Doesn’t Work

00:00 – excerpt from the episode
01:06 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:48
Dr. Maya Novak:
We’re always fighting so many things, aren’t we? We fight climate change, we fight diseases, and naturally we fight pain as well. But this is one of the reasons why so many people struggle for so long with it. Because fighting doesn’t work and pain is not something you need to conquer.
Today’s episode is an interview from 2019. And I can tell you that his passion is contagious. When you’re in the company of a person who loves their work it’s hard not to feel it. This is something I vividly remember from the conversation with Dr. Bahram Jam. We talked a lot about pain – the good, the bad, the ugly – also, how well known RICE protocol can actually harm your progress, and why, even though so common, fighting something is not the way to do it. Please enjoy this helpful discussion.

02:46
Dr. Maya Novak:
In this interview, I’m joined by Dr. Bahram Jam, who is a registered physiotherapist and pain educator with a doctorate in physical therapy. He is the founder and director of Advanced Physical Therapy Education Institute. He has been a chief instructor for over 1000 post-graduate orthopedic clinical courses across Canada, and internationally. He has presented at several national and international conferences and he continues to practice at Athlete’s Care at York University. Bahram, thank you so much for joining me.

03:19
Dr. Bahram Jam:
Well, thank you for inviting me to be here, my pleasure.

03:22
Dr. Maya Novak:
Bahram, before we go into all the pain the physical aspects of recovery, can you share a bit about yourself. What is your story? And I’m really interested why did you decide to become a physical therapist?

03:39
Dr. Bahram Jam:
Well, that’s not an exciting story. It’s just, you know, you finish school and you say what am I going to do? I’d love to say oh because I like to help people, but I just fell into it. I volunteered at a hospital for a few years as a student and saw how physical therapists do and work and thought yeah, that’s neat, they give people exercises, and I liked exercising. So that’s how I got into it and I went to school at the University of Toronto where I live.

04:05
Dr. Maya Novak:
Well, it might not be a super exciting story, like you said at the beginning, but it is your story about how you started helping people. So one thing that I want to ask you, is there anything else, like a fun fact about you that we should know?

04:30
Dr. Bahram Jam:
A fun fact about me is that I wear different socks all the time and I wear different shoes many times - shoes that are not the same. And the reason for that is my patients ask me, Bahram, you’re wearing different shoes? I say well, that’s my stand against people who believe that we should be perfectly symmetrical. Because my patients, so many of them are told your left shoulder is lower than the right shoulder, or your head is a little bit tilted to the left, or your C1 vertebrae is a little rotated, or that you have scoliosis, you’re not perfectly straight. Or that one pelvis is a little bit higher than the other one, or one foot is flatter than the other one. All these asymmetries people are told and they’re made to believe that that’s the cause of their pain. It just bothers me so much, and the amazing thing when I build a therapeutic relationship with them, then they trust me that no, the flat foot or the scoliosis, or the neck being titled, or the shoulder lower, is irrelevant to your symptoms, they get better. We stop correcting and they stop their obsession with being symmetrical and they get better, their pain goes away because they’re no longer afraid that their body is not a normal body. So I say who said we’ve got to be symmetrical. So I wear different socks and different shoes. Here I can show it to you - this is one sock, this is my other sock! [laughs]

05:47
Dr. Maya Novak:
I love this! [laughs]

05:50
Dr. Bahram Jam:
I say I like to be asymmetrical. [laughs]

05:52
Dr. Maya Novak:
Oh, I love this and it’s definitely something different than what we are used to hearing. Because it’s all about symmetry and if one hip is lower than the other, then you might have, probably have - this is what we hear - problems with your body. So your approach and the way you view the body is completely different.

06:13
Dr. Bahram Jam:
Well, it’s not different. I’m a fan of research and evidence. I’m a fan of science. And if one single study came out that said being asymmetrical was the cause of pain, I’d say I’m wrong. But every single study done shows that it’s irrelevant. People can have, for example, perfectly straight spines and have chronic lower back pain. And people with scoliosis can be able to lift 200 pounds over their shoulders and have zero pain. We know that in studies. Like being flat foot and one and not the other, or whatever shoulder being lower, it’s completely irrelevant to pain. It just is. That’s science. That’s evidence. That’s research based on thousands of people researched. So I’m not making this up, yeah.

06:54
Dr. Maya Novak:
So would you say that this asymmetry is something that a person is born with and it is different from the asymmetry that comes from a recovery process after a person has been injured?

07:09
Dr. Bahram Jam:
Correct. So there is a difference, you’re correct in that. The ones we are born with, it’s amazing. We adapt from childhood. If you walk the same way, you adapt. I’m not talking about large asymmetries, like if one leg is 10 centimeters shorter, or like you have polio or something like that. Then it does matter. Then we correct the leg length with special shoes. I’m not talking about those small – like wearing different socks is not similar to 10 centimeters leg length difference. Asymmetry, for example, if one ankle is stiffer than the other after a trauma our goal is to make it symmetrical, like if it’s a major difference. And again, the question is what is major and what is small? Our goal after a trauma is to be symmetrical or at least get you back to what you were pre that injury – as close as possible. But even if you don’t get back, it doesn’t mean you should have pain, that’s all.

08:03
Dr. Maya Novak:
Yeah, beautiful. So a few minutes ago, you mentioned that when people become aware that asymmetry might not be the cause of their problems, they are getting better. My question here is how important is it for a person to believe and trust the PT so that they will really see improvements? Is this important, or is it not?

08:30
Dr. Bahram Jam:
It’s 95% of the treatment. It doesn’t matter what PT – any healthcare professional, if you don’t have the confidence then you simply don’t respond to the treatment. It’s just the way it works. It’s called the therapeutic relationship. You have to have it whether you see a psychiatrist, whether you see a doctor, whether you see a nurse or a physical therapist. The analogy I like to give is yes, as physical therapists, we prescribe exercise. We do manual therapy. We touch people. But if I touched the back of your hand right now you’d say oh, okay he’s a physical therapist he’s touching my hand, he’s trying to whatever, I don’t know what he’s doing. But I was a stranger on the bus and touched your hand it would have a completely different interpretation to your nervous system. Your heart rate would go up, respiratory would go up, pupils would dilate. You’d be fearful. Your muscles would tense. The touch is the same, but the relationship with the person – a stranger on the bus compared to me, if I touch your hand, would be different. Or, compared to somebody you absolutely adore and love and you touch their hand like this and it would have a completely different interpretation. So it’s all about the relationship how we respond physiologically, and experiencing pain or not experiencing pain is purely 100% a physiological response.

09:52
Dr. Maya Novak:
So would you say if a person has a less than good experience with physical therapy that it’s definitely time for them to change the therapist?

10:02
Dr. Bahram Jam:
If they have lost trust in the therapist, absolutely, there’s no point. That goes to a doctor too. I mean a surgeon could do the best surgery in the world, but if you deep down don’t like the surgeon or don’t trust them, the outcome is probably going to not be good, and you’ll never be happy with the outcomes. But in fact there’s studies that people who love the surgeon, and they feel the surgeon has treated them like a human being even when the surgeon does something completely wrong, forgets a scalpel in the stomach, they’re not upset at the surgeon and actually they recover and they don’t have a lawsuit against them.

10:35
Dr. Maya Novak:
And this is probably a part of the placebo and the nocebo effect, right?

10:39
Dr. Bahram Jam:
Correct.

10:39
Dr. Maya Novak:
Yes. So when is it time to change a physical therapist? And what I mean here is I sometimes hear stories that people, they do progress, and then they stop progressing and they change the relationship with their PT. So my question is, is it important - do you advise to change the physical therapist or is it better to ask you when is that time to evaluate the progress and then maybe do this decision to change physical therapists?

11:18
Dr. Bahram Jam:
It depends on the condition, but we need to see a change in outcome measures in six weeks – well, in some climate conditions maybe three months. The outcome measures I mean, I ask my patients can you name three activities that you want to get back into doing. They say I want to do a full yoga class; I want to be able to play tennis. I want to be able to clean my house, wash my dog, whatever it is, clean my car. And I ask them what’s the percentage of your ability to do a yoga class right now? They would say, I’m at 20%, I can hardly do it. Or I would say what’s your ability to go for a walk for one hour – I can only do 10 minutes on my whatever – 15%. Then I say would you like to be 100%, like be able to go for one hour? They say absolutely. So whatever the activity is I pick three of them and then after three months we focus on these activities, whatever three it was. If there’s no change after three months – or six weeks on acute, but three months for chronic conditions – there’s still at 15% in their yoga, they’re still whatever, 20%, in their walking and they still haven’t been able to clean their house at all – something’s got to change. You can’t keep doing the same treatment. I always quote Albert Einstein who said the definition of insanity is doing the same thing and expecting different results. So you just need a different opinion, a different approach perhaps. Because as long as there’s a change in function, and they say no, I’m doing 50% of my yoga class now, brilliant – keep doing what you’re doing. But if three months later you’re still doing 50%, then change. And if you see two or three other physiotherapists and they don’t make a change, or see another doctor and they do injections, whatever, and there’s no change, perhaps you have reached what we call maximum medical recovery. Maybe 50% of yoga is all you’ll be able to do and you’ve got to be okay with that also. So certainly I can’t tell people you’ll be 100% all the time for the – then you’ll 100%. No, we’ll do our best to get people close to 100%. But if you reach a plateau, get another opinion. Again, if you reach a plateau with that one, get another opinion. I don’t think most physiotherapists get upset if people get other opinions. In fact, I’m over the moon when my patients say I went and saw another physiotherapist and he told me this. I say great. I’m not insecure to be upset by it. And what did he say? He said I should try x, y, and z. Try it – see how it works.

13:39
Dr. Maya Novak:
Yeah, so true. What you said, get a second or sometimes even third or fourth opinion is so important. I don’t know what your experience is, but I hear very often that doctors don’t advise people to have physiotherapy after an injury after an accident. Is this your experience as well?

14:07
Dr. Bahram Jam:
No. It does exist. It depends on the physician. I’m going to say those who don’t recommend physiotherapy, it’s irresponsible. It’s really selling the patient short. Let me give you an example of why it’s not a wise idea. First of all, again, I’m a fan of evidence and science and there’s what is called the Cochrane database, which has a big systematic review board. People sit around and discuss what’s the best treatment for certain conditions. For example, the Cochrane Review Board says treatment of neck pain with physical therapy involving manual therapy and exercise is much more effective than just physician care, which is just by medication. I’m just giving you an example of neck pain, or for back pain. Forget the studies. If an athlete, a football player that’s paid millions of dollars or a baseball player that’s worth millions and they injure their knee, they injure their shoulder or a golfer that’s paid millions of dollars and they’ll hurt their back. How long does it take before they see a physical therapist? How long?

15:07
Dr. Maya Novak:
Probably right away.

15:09
Dr. Bahram Jam:
Right away, right. And they get - how much rehab do they get? Once a week? Once every three months? Every day they would get the rehab in person. Why? Because they know that if they don’t get rehab there’s no way they’re going to go back to playing football or they’re going to go back to playing their soccer, or they’re going to go back to playing baseball and being able to pitch a shoulder or golf and twist their back the way they do. If rehab is important for these high-level athletes, why shouldn’t be important for the average person. Are you kidding me? Why is the average person who is simply not paid millions of dollars less important in their recovery? Why do we say no, no, rehab is – physically therapy is really important for the well-paid athletes who are on television, but not for the construction worker or for the secretary who just wants to turn their neck? So I think it’s just wrong when they’re not sent for rehab and they say well, you’re going to recover on your own. I can’t see that. If some baseball player who injures their shoulder and they’re nah, you’re just going to get better on your own, let’s wait and see – are you kidding me? Each week that goes by, they lose millions of the dollars and they’ll probably never get their shoulder back without aggressive rehab.

16:17
Dr. Maya Novak:
So what would you advise a person who heard something like that from their physician? Like no, you don’t need physical therapy, you can walk it off, or you can just wait. What would you advise that person?

16:31
Dr. Bahram Jam:
I would advise them if you were paid – again, a million dollars to do a sport – would the doctor give the same advice? The answer is no, they wouldn’t. They wouldn’t. They would get every treatment possible to get them better and they would involve every active treatment and exercises. So what’s the difference between you and a high-level athlete? Are they more important than you? No. They’re not more important. They just have physicians that have bias that they need it and the average person doesn’t.

17:04
Dr. Maya Novak:
Yes, and it’s true. Our bodies are more or less the same, so it doesn’t matter who the person is. We all can experience pain. We all can experience troubles in the future if we do not correct things. And in regards to pain, you probably know that chronic pain and disability is growing and is affecting millions and millions of people around the world. Why do you think that this is happening?

17:33
Dr. Bahram Jam:
I don’t have one answer for it, but as you said, it’s growing and it’s insane because it’s exponentially growing. Based on the World Health Organization, like musculoskeletal pain is a number of causes of disability and days lost from work, back and neck pain being on top. But then you can put every other musculoskeletal injury. Then it’s like diabetes, kidney disease, and cardiovascular disease. So chronic pain, musculoskeletal, is the number one cause of disability in the world and it’s growing. Now here’s the paradox. Our use of x-rays, MRIs, CT scans, has grown exponentially over the last number of decades. Our use of anti-inflammatories, prescription medications, opioids, has grown exponentially. Our use of physical therapy, massage therapy, chiropractor, acupuncture, has grown exponentially with every decade. And our use of surgery, injections, and cortisone injections – boom – that’s skyrocketed. Surgery for lower back pain has somehow reached a plateau and is going down, people do less of it, but you get the idea. If all these interventions, diagnostic techniques, x-rays, radiological things, medication, pharma-logical interventions, rehab interventions, physical therapy, chiropractic, massage, acupuncture – it’s all grown. Why is the disability rate continuing to grow? Not only is not reaching a plateau you should expect it decrease with the modern world of medicine. It’s actually increasing with every year. Why? I’m going to say one answer. We are at fault. “We” being healthcare providers and I’m going to quote one of the most respectable orthopedic surgeons, his name was Gordon Waddell, he passed away, and he said the number one cause of chronic pain is – and I agree with this – is the over-medicalization of pain, such as lower back pain. And the word over-medicalization means you keep seeing doctors, therapists, chiropractors, and one tells you oh, your pelvis is out of alignment. The other one tells you it’s a disc fault. The other one says oh, your x-ray shows you have arthritis or stenosis. Then the other one tells you that you have muscle knots in your neck. And everyone tells you a different medical diagnosis, and then you go on Doctor Google and type in and then you get oh, it could be x, y, and z, it could be a fracture, it could be this. Then your brain goes wired and it keeps thinking that yep, there’s things wrong with you and the brain produces pain when it believes you’re in danger. The more doctors tell you all the things that are wrong with you, the more the brain becomes sensitive to pain. Now pain is there. It should be mild, but it’s magnified because it believes you’re in danger and the pain lasts longer – which is what we call chronic pain or persistent pain.

20:11
Dr. Maya Novak:
So, I have a question here, because before we talked about getting a second opinion, third opinion, maybe even a fourth opinion if necessary. Now here we are saying that if you’re going around a lot of doctors, or therapies, you might be doing just the opposite of what your body really needs. So where is the balance here?

20:35
Dr. Bahram Jam:
Well, you’ve got to see a healthcare provider that you leave feeling good about yourself, not bad about yourself. So I suggest whether it’s the chiropractor that you see, a physical therapist that you see, an osteopath, massage therapist – I try to do my best to tell my patients all the things that is good with them, but we’re trained to say all the things that is wrong with you. Again, your left shoulder is lower, your ankle is stiff, it doesn’t turn in much, you’ve got this muscle weakness, your core is weak, all that stuff we tell people. Perhaps we should, in fact, say you know what, you’ve got an excellent hip movement ability so maybe we can do x, y and z exercises for you to do. So if you end up feeling that you’ve lots of things wrong with you at the end of a therapy session or a consult, whether it’s a doctor any healthcare professional, I suggest you change it. You’ve got to see someone who’s more optimistic and sees the good that you still have. But we’re trained to see all the bad things that we have in us, and unfortunately, being told the bad things, we think we’re doing good and it then motivates the person to get better – it actually exacerbates pain.

21:38
Dr. Maya Novak:
True. Can you just explain slightly for those who are not familiar with it – who don’t know the placebo and the nocebo effect? Can you explain this slightly, and why it is important that a person feels good in the relationship with a health provider?

21:57
Dr. Bahram Jam:
Sure, of course. We have in our body, it’s called endogenous opioids. The word endogenous means the body produces it - opioids, like morphine, that the body produces. And the word endorphin comes from endogenous morphine, so endorphin. Then we have exogenous morphine. Exogenous morphine, it comes from outside the body. That’s like OxyContin’s and opioid medications that narcotics people take with cancer pain post-surgery – which is, again, effective and essential in those scenarios. The body produces the strongest painkillers, that’s why morphine – exogenous morphine works because the body has the receptors to catch them. But the receptors aren’t there just because – or for the drug industry – the receptors are there because our body produces those so same painkillers. So in order to maximize the release of those painkillers, we actually must feel good and confident about recovery. The system that shuts the pain off, it’s called the descending pain inhibitory system – DPIS. Descending means that it goes down from the brain and the spinal cord down. Pain means pain. Inhibitory meaning inhibits pain and system. It’s a complex physiological mechanism, which I don’t want to get into the details of here but there’s surely thousands of articles and textbooks on this topic, is that placebo maximizes the descending pain inhibitory system. So it makes the person say, you know what, I am going to get better. It’s not dangerous; therefore, the body releases the morphine in order to inhibit your pain. People used to think placebo, oh, it’s just a temporary benefit. It’s actually not. In most cases, it gives permanent relief of pain because as long as you believe that you’re going to get better, the body starts the healing process. So I tell my patients – I’m upfront with them – we used to think placebos were bad and we should hide it from patients. Like drug companies, they hate the placebo effect because most drugs get not approved because they have the same benefit as a placebo. But as a therapist, I’m blunt. I say to my patients I want to maximize my placebo effect. What does that mean? I want to make you feel good about your recovery and truly believe that you’re going to get recovered. We no longer need to hide the placebo effect. In fact, where they’ve done a few studies it’s called open placebos, or honest placebos. When they give people with back pain medication, and it’s a sugar pill, and they say oh, this is a placebo medication. It has no active ingredient in it, but we want you to take it twice a day for six weeks - chronic back pain. They know it’s placebo. They take it for six weeks and they get good outcomes. They get better compared to the group that wasn’t given the placebo medication. Now, this is a remarkable thing. It was even honest. They told the patients before the study. They asked them do you think this is going to help you, and like 30% said yeah, this is crazy enough to work, and 70% said no, I don’t think this will help me because they were told it was a sugar pill placebo. It didn’t matter whether they believed or not, as long as they took the placebo, they still got better. So the brain is so – it feels like if you’re doing something to your body with the intention of getting better, the body releases the descending pain inhibitory system. Now, you asked me about nocebo, which is the complete opposite. When the brain anticipates danger, or anticipates they’re not going to get better, or anticipates that this must be a serious condition, it stops activating the descending pain inhibitory system because it wants you to feel pain. Why? Because the more pain you feel, the more likely you’re going to do something about it to protect yourself from further injury. So it’s good to stop the DPIS. When you put your hand on a hot stove, you don’t want DPIS. You want to be able to withdraw. When you bang your thumb with a hammer, you don’t want the pain gone. But, if you’re crossing a road and you sprain your ankle but there’s a truck coming towards you the brain says don’t worry about the ankle pain, it makes you have DPIS so you can run across the road so you don’t have the truck hit you. Or if you’re being attacked by a tiger and they bite you, you don’t want to feel the pain of the bite, you want to have all your power to fight the tiger to survive, so the brain releases. There’s hundreds of studies on this on soldiers in war where they’ve been shot or lose a leg and they don’t feel any pain because the brain says you know what, there’s no point in experiencing pain right now. Your goal is to survive and be safe. So the descending pain inhibitor system can be activated, which is what we call placebo. Or it can stop, which is what we nocebo. And it all has to do with our relationship and belief about our pain and recovery.

26:40
Dr. Maya Novak:
And this is – you reminded me of my situation when I had a rough time right after the accident and I didn’t know that I fractured my talus bone. I was sure that it was just a sprain and getting out of those tiny climbing shoes if I had known that there was a fracture, probably it would have hurt more, I probably I would have been afraid to take off the shoe. But because I was sure that it was just a sprain, it was pretty easy to take off with just a bit of deep breathing.

27:12
Dr. Bahram Jam:
Yeah, and that’s not always good either!

27:15
Dr. Maya Novak:
Yeah, I know!

27:20
Dr. Bahram Jam:
But it was your way of coping and surviving because you had to finish the climb. What was your option? Fall down?

27:26
Dr. Maya Novak:
Yes.

27:26
Dr. Bahram Jam:
No. You had to climb. So it was actually a good coping mechanism at that moment.

27:31
Dr. Maya Novak:
Yes. So pain – when we’re talking about pain, a lot of people perceive it as an enemy and they want to avoid it as much as possible. So many times, of course, they are taking painkiller after painkiller after painkiller. Can this have any negative effects if we are really numbing our body? Or is it good to take as many painkillers as we need so that we don’t feel anything, or just a tiny bit of pain?

28:05
Dr. Bahram Jam:
Yeah. That’s a very complex question to answer yes or no to it. It’s very individualized. Let me cover myself by saying that. Every patient is unique, so I can’t possibly say on here no one should take painkillers or tell everyone that everyone should take painkillers until they are in no pain. There is no one answer. But let me say this – you used the word painkillers. In modern medicine, we say we want the magic bullet. We want to take painkillers. The word is we want to eliminate that, we fight pain, we want to battle. To be in a battle is exhausting work. It’s like your fighting and that promotes the fight or flight response, which actually tells your body you’re in danger and stops the descending pain inhibitory system. The descending pain inhibitory system activates when we feel we’re in safety when we’re good. To be in a constant battle against pain metaphorically, you know, pain killers, magic bullet, I’m going to fight my pain, it actually has a paradox effect. It increases your pain because you’re fighting it when in fact if you – I don’t want to use the word surrender to it or give up, that’s not the term – the word is called accept your pain and be okay with it. That’s when you actually recover the most. It’s a paradox. The more we fight something - something being our physiological response, the more it’s magnified by the brain so you pay attention to it. But the more we accept it, we say you know what, I know I’m experiencing pain and I’m okay with it. It’s okay. Then the body refuses, the body has no reason to make you keep experiencing it because you’re aware and you’re okay with it. You’re not fighting it. And because the pain medication is – if you need to sleep, fine, take it. In acute situations – acute meaning the pain is less than three months - fine, take it. But if the pain has been there than three months and the medications haven’t worked whether it’s anti-inflammatory, pills, or painkillers, there’s really no point. And in fact, the opioid industry, all the research says you shouldn’t take those strong painkillers, opioids, past three months – more than three months. One, because of the high addiction rate and two, because of the high overdose rates – death overdose, and the third thing is it doesn’t work. And in fact, now we have so many new studies supporting the concept of what’s called opioid-induced hyperalgesia – OIH. Opioid means opioid. Induced means it causes it. Hyperalgesia – hyper means excessive, the word algesia means pain. It means the opioids that you’re taking to actually try to numb your pain are actually causing your pain and increases the pain, which is a paradox also because then pretty much anyone who takes opioids needs more opioids gradually and more opioids to get the same benefit. But in fact when people who are able to and it’s very difficult and it’s not – it’s not a common thing to happen for people to get rid of their opioids completely – their pain gets eliminated or acts dramatically reduced once they get off the opioids. But it’s very difficult once you become addicted to it, your body. None of it is conscious, it’s physiological.

31:22
Dr. Maya Novak:
We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word. Now let’s continue…

31:44
Dr. Maya Novak:
Yes. This is such a great point, and I would love to talk a bit more about opioids. I do have some experience. Withdrawal symptoms were horrible when I got off morphine. So I really do not want this for people – I wouldn’t want anyone to suffer from these withdrawal symptoms because they were just horrible. So what is your advice? Because talking – what you just explained – and I know that there are people who are in chronic pain and probably they are taking opioids, so hearing you saying this, it can be like what? What is your advice? How can a person start decreasing or get off of the opioids completely and really help their bodies to heal better?

32:39
Dr. Bahram Jam:
Okay. I’m not a physician, so I don’t tell patients about their medications. I’m legally not allowed, and I’m knowledgeably not capable of doing that – to tell people oh, you should wean off your opioids with x, y, and z. I tell patients you should discuss with your doctor about weaning off if you wish to do so, and that’s completely between you and the physician. I never want to make a patient feel guilty if there on opioids that they’re evil or that they’ve done something bad. No. They’re in pain and their doctor has done their best to reduce their pain for them. But if it’s been – they’ve been on it for a year, for example, even though the opioid recommendation is no longer than 90 days, if they’ve been on it for a year or two years, and they’re still in severe pain, obviously it’s not helping and there’s a good chance it’s actually making the pain worse so discuss weaning off. What I can do as a physical therapist is to try to maximize their DPIS. Remember we talked about endogenous opioids versus exogenous opioids, well the research studies show that if we take a lot of exogenous opioids, meaning opioids made outside of us, the body stops producing endogenous opioids, so it can no longer produce it. Even if you stop the opioids, the pain can increase in some people because their body can no longer produce it. You’ve lost the capability of doing it, so that’s another harm it has. Now, what is the best way to produce endogenous opioids? It is by exercise, doing meaningful joyful activities in life. That could be having coffee with a friend. That could be playing the piano if you want to do it. That could be artwork. That could be dancing. Things that you used to do, which are pretty much inevitable those people who take opioids, they stop doing those activities. Because when you get exogenous opioids, the body no longer experiences the same pleasure when they did the same activities that they did before. They no longer play with their children. They no longer want to go socialize with their family. And touch, sexual function, it’s all gone; they no longer have the desire. The more you lose endogenous opioids, the more you depend you become on the exogenous opioids, so it’s a vicious cycle. But it can’t be Sunday, okay; I’m going to take away all your exogenous opioids, now go ahead, have fun, do endogenous. It doesn’t work that way. We’re talking about months to years of reversing that effect. It depends how long you’ve been on it. If you were only on it for two weeks, like on morphine after surgery, it’s really no big deal. You can recover from that. I mean it’s still a big deal, I don’t want to minimize, but nothing compared to being on it for a year if you can imagine, or three years, whatever. So the one advice is, as much as you can, to maximize your endogenous opioid, which means doing activities in your life, as small as it can be, that you find pleasurable. That’s it, as simple as that. And of course, of all the activities, there’s only one activity that’s consistent with all human beings that release endorphins – laughter. Ha ha ha ha! But social laughter! When you laugh – alone laughter does it, but not compared to when you’re in twos or with a group of 30 people. So social laughter is the most consistent way of releasing it, and people who are opioids and in pain are in no mood to laugh. They probably haven’t laughed in months or years. We’re lucky if they’ve even smiled, so the body hasn’t produced opioids at all.

36:08
Dr. Maya Novak:
Yes. Oh, I so agree with you – with laughter and positive energy around you – that can really help. So talking about pain and talking about, of course, your opioids - but how does a person know - or are there any distinguishing signs between good pain and bad pain? Because good pain, it’s easier to accept it or to surrender to it – what we talked about before. But bad pain is something that you probably want to avoid. So how can we distinguish between these two?

36:45
Dr. Bahram Jam:
Okay. I talk about this a lot with my patients because pain – there’s no such thing as good pain, they would say. Well, I agree. Ideally, we shouldn’t have any pain in an ideal world, but if you’ve had trauma or various reasons you have pain, surgery, whatever it is, then it’s inevitable. The word I use, the phrase I like to use is it’s called pain is inevitable, suffering is optional. So inevitably we will experience pain at some point in our lives, whatever it is, but we can’t control that most times, cut what we can control is how much we suffer from that pain experience. Going back to good versus bad pain. When I’m giving exercises, physical activities to do, I say good pain is when I do an activity and they have – increase their pain beyond their baseline level of pain – but after they stop the activity the pain, after a few minutes, or a couple of hours, it goes back to their baseline - what they were before. Bad pain is if they do an activity and the pain increases, but for several hours or to the next day, they’re worse. Then they shouldn’t have done, probably, that activity. But they shouldn’t avoid that activity. They should do it again, but at 50% level of what they did before – cut back on intensity, cut back on duration, but don’t fear the activity just because it flared you up. Do it again. And if that flares you up again, cut back another 50%. But if it doesn’t flare you up, that’s good. Next time, do a tiny bit more. That’s the game you’ve got to play. It’s the constant battle between how much you do is good pain and how much you do is bad pain. Good pain will help your recovery. Bad pain will keep your body sensitized and increase your fear. Basically, it’s a time issue. The more you experience good pain, in time your body will become less sensitive.

38:36
Dr. Maya Novak:
This is great advice because I know – I do have some experience with chronic pain –when you are in chronic pain, you actually don’t want to do anything because you are afraid there is going to be more pain. So what you just advised here, don’t be afraid of activity, just observe your body and then do some moderation of something if it was worse the day after. So that’s great, great advice.

39:06
Dr. Bahram Jam:
But attempt to do it again. Don’t fear it. Fear is the ultimate cause of pain too. Go back to the activity that actually hurt or that you fear doing but, of course, not as intense.

39:18
Dr. Maya Novak:
Do you have any advice on how to get over fear? Because especially after any serious injury you probably have experienced that people are afraid. For example, with knee or ankle injuries, to start with the weight on the leg - they’re afraid to do that. What do you advise your patients, or how do you help them to get over this?

39:46
Dr. Bahram Jam:
Well, one of the most researched areas to reduce fear is through pain education. Pain education means understanding what pain actually is. Without pain education, people automatically associate every time I experience pain it means I’ve injured or damaged my body. This pain education has started with two physiotherapists in Australia named David Butler and Lorimer Mosely who are world-renowned pain educators and they’ve actually revolutionized the understanding of pain. Since then, in the last 15 years, there’s been numerous other books and other researchers who have further developed their theories. The book that they originally wrote was called Explain Pain, which is a remarkable book that for the first time to the average patient it taught what pain means. That pain does not always mean that a tissue or a structure is damaged because that’s what most physical therapists would believe. If your ankle hurts, oh you must have damaged something. Most doctors believe that. If you hurt your back, you must have damaged something. But no, pain means your body felt that it was in danger – and it could be real danger or just perceived danger. So that’s the important word – just perceived danger produces pain. So I’ve written a book myself, and that’s sold thousands of copies also in pain centers, hospitals, and clinics through pain education. My book is called The Pain Truth, and I’ve made three online videos, it’s on YouTube free to access for everyone. The book is free to access also. Just Google The Pain, Truth, and Nothing But. So I’m not in it to make money from it. The videos are there. It reassures people that when they experience pain it doesn’t always mean damage and just that understanding helps to release the DPIS – descending pain inventory system and reduces fear.

41:43
Dr. Maya Novak:
Yes, very, very important because like you said, if you perceive that something is going to be worse, or it’s going to really hurt, then your body tenses up and everything is more hurtful then.

42:00
Dr. Bahram Jam:
Absolutely. I give a simple example – and I don’t want to make fun of it – but if somebody has a headache and they go on Google, type in causes of headache, and the first thing that pops up, it could be a brain tumor. Is their headache likely to increase or decrease? Is their headache likely to go away or last longer if they believe that they could have a brain tumor? The answer is, obviously, the pain is going to increase and it’s going to last longer. In Google, you were told that you could have a brain tumor. And that’s just the way the body works if it perceives danger, it makes you experience it more. Or if your doctor tells you a catastrophic diagnosis, the body will experience more. That’s what I said, it’s the over-medicalization that’s the number one cause of chronicity, whether it’s by a doctor, therapist or by Google. Google is actually the worst thing.

42:49
Dr. Maya Novak:
Yes. Searching for something “what is wrong with me” and then finding like a gazillion options then - yes.

42:57
Dr. Bahram Jam:
Then you’ve just destroyed your descending pain inhibitory system because the body will want you to experience pain because it believes it’s in danger.

43:06
Dr. Maya Novak:
Yeah, it’s so true.

43:07
Dr. Bahram Jam:
Or pain.

43:08
Dr. Maya Novak:
So talking about pain, can we talk a bit about nerve pain and when should a person be worried about nerve pain? Because many doctors, they say to just wait because over the next few days, or weeks, or sometimes months, it’s going to get better. But is there a limit – at what point should a person be concerned about nerve pain?

43:34
Dr. Bahram Jam:
Okay. The first thing you said is when should the person be worried? I’m going to say never, because worry doesn’t help, right! [chuckles] At what point should you see further investigations? Now, nerve pain includes what is nerve irritations, that’s when the pain goes down the arm or if it’s in the back and the pain goes down the leg like we call sciatica. Sciatica is extremely common and the studies show the vast majority of people 100% recover from sciatica. But what is the best treatment? The single best treatment for sciatica or nerve pain seems to be movement. Stay active as much as possible. Don’t worry, because worry actually makes you stop releasing the descending pain inventory system. Try to do activities – your physical activity. If you can’t sit too long, then stand. If you can sit, stand, walk. And if you can’t walk 10 minutes, walk five minutes but do it frequently, as much as possible. The doctor may prescribe anti-inflammatories, which can sometimes help. Again, more than a few weeks, it’s pointless because it just bothers the stomach. If it were to work, it would work. We get concerned about nerve pain if you actually have weakness in the arm, or weakness in the leg, or the foot drops. Then it could mean that there’s actually pressure on a nerve – which is rare. I may see one or two patients a year with that. Then the treatment is you do a diagnostic – the diagnostic criteria is you get a nerve conduction test done, which is fairly simple. Meaning they put pins in and they see if the nerve conducts down. It’s not a pleasant test, but then if they see oh, the nerve is blocked, then you can get an MRI. An MRI will show aha, x, y, and z is compressing the nerve. And if it is, in rare cases, surgery – and that can be very beneficial surgery if the surgeon feels there’s actual compression of the nerve. But I have to say, most people if they have a pinched nerve and compressed it actually gets better in time also without surgery. It all depends on how bad the pain is. If the pain is severe and debilitative, no, get the surgery. I mean if you’re going to get better in a year, do you really want to suffer for a year with this pinched nerve? I’m not anti-surgery. I’m okay with surgery only if there’s actual nerve conduction loss, meaning the nerve is no longer and there’s evidence that it is compressed. Outside of nerve compression, they used to do surgery on people who just had a disc fault that was inflamed and the outcomes were not good.

46:00
Dr. Maya Novak:
Yeah, the reason why I’m asking you about nerve pain is I usually hear it from injured women and men after surgery, and there are a lot of questions about that in my Facebook support group. People are usually experiencing it after the surgery. There is a type of nerve pain and, of course, they get worried and we talked about that – what worry does. Is it better just to wait and observe?

46:32
Dr. Bahram Jam:
Yes, as long as the nerve condition is negative. As long as MRIs show there’s nothing physically compressing the nerve that they need to remove. Again, rare cases like a tumor, which I’ve only seen once in my 27-year career that could be, so I don’t want to scare people, okay. It’s a possibility, but very rare. As long as those are ruled out, then it’s really the nervous system calming exercises and doing everything to maximize your endogenous opioids, which means being active, doing meaningful things – art, dance, close relationships, going out, socializing, and laughter. Doing meaningful work, clean your house if you really love cleaning your house. Cook, enjoy music therapy, aromatherapy - smell your food, smell a bar of soap - these are the little pleasures. It seems crazy that doctors generally don’t recommend because it’s like to hocus-pocus. They’ve got to prescribe their strong drug for your nerve pain. When, in fact, nerve pain can be calmed by these activities. The problem is when you’re experiencing pain we really don’t feel like doing that stuff. Who wants to listen to music for 20 minutes if you’re in pain? Who wants to go out and have drinks with a friend when you’re in pain? You don’t, but that’s exactly what you should be doing. It’s difficult, I’m not blaming patients, but that would be the treatment - as long as serious medical pathologies have been ruled out.

48:04
Dr. Maya Novak:
Great. I love this advice. Another thing that I want to talk about is the RICE method, and especially icing. Icing after injury, in the first few days, is really advised by the doctors and physiotherapists, but with regards to icing, how long should a person ice the injured area? That’s one. But the other thing is are there any negative side effects that can – I don’t know – can something negative happen if a person ices for too long? Can you talk a bit about icing?

48:48
Dr. Bahram Jam:
Absolutely. I’ve written a whole paper on it. An article and it’s on my website. Let’s like about RICE – rest, ice, compression, elevation. I’ll go in order. Rest – bad idea. It’s the worst thing you can do when you injure a body part. You shouldn’t rest it. The more you move, the better it is. And of course, there’s extreme examples - if you’ve got a bone sticking out, or if there’s a fracture. So no, you can’t move it. But regular sprains, as severe as they may be, you need to move that part of the body as much as possible without – remember good pain versus bad pain. If it’s your finger and you do this, then you should do this as much as possible to help get the blood flow, a moment. Every study shows that – in animal studies – when they get them to rest, they actually have worse tissue recovery. So they do these experiments with poor little rabbits and rats, and what they do is they cut their tendons, for example. A third of the rabbits, they put their leg in a cast and bandage it up for six weeks. Then a third of the rabbits, they make them run on the treadmill. They force them, even with the cut, to run on the treatment. And a third of the rabbits, they’re just made to walk around as they tolerate their pain. Then what they do is – again, I apologize for quoting these studies – they take the rabbit’s tendons, they sacrifice them, and they pull their tendons apart and they put their tendons under the microscope to see which of the tissues have healed the best. Which group do you think had the best healing?

50:16
Dr. Maya Novak:
Well, probably those that were in just resting, resting and …

50:21
Dr. Bahram Jam:
Yeah, the ones that were resting didn’t do well. They tore up – tore faster. Poor healing, poor collagen formation. The ones that were put on the treadmill, forced to go – also poor. The ones that were made to just walk around, as tolerated by their pain, as the best outcome. So the two extremes are not good. You can’t ignore your pain and do stuff. And you can’t rest it either. Within pain, tolerance is the best advice.

50:46
Dr. Maya Novak:
Yes, I would say in regards to resting – so yes, you mentioned sprains – but what about when we’re talking about fractures? So when do we absolutely need time to rest? And I love that you mentioned animals because I’m a Doctor of Veterinary Medicine by degree, and a lot of the times I think about how an animal would act in that kind of situation? And after surgeries, when I was observing animals, they were resting but as soon as they were able to start moving, they started moving.

51:52
Dr. Bahram Jam:
Based on pain.

51:23
Dr. Maya Novak:
Based on pain. So, is there a difference between the seriousness of injury and resting?

51:31
Dr. Bahram Jam:
Of course there is. If you have a grade three, like an ankle sprain, and it’s really massively swollen, your pain won’t make you move it and then you’ll have to bandage it up and tensile it up, but you can’t make a general statement “rest”. So what if after a week your ankle is better? Like how long should you rest it for? Six weeks? Two weeks? There’s no – how long do you tell a dog to rest for after it injures its foot? It rests, it limps, it won’t put its foot down at all, or if it does it, it goes ooh, and it won’t do it for a while. And then gradually, it just limps until it says, oh, I wake up and then I can put weight on it. It doesn’t listen to a doctor’s recommendation or read a paper that says RICE. It just rests it as long as it needs to, and usually as little as it needs to because the sooner it can run and bark and chase after a squirrel, the better. That’s what a dog thinks. So yes, there is that thing. But after a fracture, that’s – I’m going to say it’s controversial. I know we automatically put fractures in casts, but my anecdotal experience is even if you don’t cast people – I’m not talking about bones that are separated, they need surgery and pins in place to be put back in. That’s a whole different beast. But regular un-displaced fracture, if you load the joint without moving the joint, that’s the recovery. But we’re automatically putting people in casts and saying don’t put any weight on it. I’ve had a few people with various calcaneal fractures, fibular fractures, tibia fractures, that – but again, it’s family members which I can’t do to patients – but they didn’t cast it and it got better faster. Their doctor can’t believe how fast they recovered. Better than if they were cast. So movement actually stimulates healing. But you can’t do that in modern medicine because you’ve got to cast it. What they can’t predict is what if you hit your – land in something – and then it gets un-displaced? Then the doctor’s going to get sued for not casting you, so.

53:17
Dr. Maya Novak:
Yes. So what about icing?

53:20
Dr. Bahram Jam:
Okay, next. Rest – I said resting – bad idea. Icing – terrible idea. Let me tell you why. We have had about 40-50 years of research on icing. Again, I’m a fan of science. I’m a fan of evidence. We don’t have a single study, not one study to support icing that it’s actually effective for reducing inflammation for that it’s effective for tissue recovery or healing recovery, yet it’s in mainstream medicine. Everybody’s told to ice. It does nothing. In fact, when they do animal studies on icing, when they take – again, I apologize, little rabbits and rats, they cut them and then they put ice on it for 20 minutes and then they take off. They put ice on and the other group doesn’t get ice. The one that gets icing consistently does worse. When they put their tendons under a microscope, they have worse collagen formation. Their tendons pull apart more faster. If it was my ankle, there’s no way I’d put ice on it knowing what I know. Now, you may say well, icing may decrease inflammation. How? By reducing circulation. Why do we want to reduce circulation to the part of the body that’s injured? Evolutionary wise we’ve evolved for millions of years to have the optimum amount of circulation to the body after it’s injured. Why are we icing again? The other thing is, icing will reduce lymphatic drainage because it causes what we call vassal constriction. It constricts the vessels of the lymph nodes to absorb all the waste products that are formed when we injure yourself. But when you’re constricting it, how is that improving waste elimination? There’s research to disprove icing. Now, if somebody wants to disagree with me I’m happy that you disagree with me. Just bring me a single paper that says otherwise. The only thing we have evidence for that icing does, it numbs the skin temporarily so may help pain. So the studies to support icing are, for example, after a total knee replacement – which is a very difficult surgery, it’s a painful surgery. If those use what are called cryotherapy – they wrap that around the knee and it numbs the knee – they do use a little bit less painkillers. It doesn’t make any difference to the swelling. So anyways, that’s my rant on icing. If anybody wants to read the hundreds of studies that I quoted on this, it’s on my website. They can Google my article, it’s called Questioning the Use of Ice, and Google my name, Bahram Jam, and you’ll find it.

55:44
Dr. Maya Novak:
I love that because it’s true. You can read everywhere ice it, ice it, ice it. My personal experience is I never actually like the feeling afterwards, after icing. So my natural inclination was, I don’t want to ice it, I just want to leave it like it is. But I see so many people doing it – what you’re saying can actually happen – there can be some negative consequence in the future if we ice or if we ice too much.

56:17
Dr. Bahram Jam:
I think so. Certainly animal studies show it, but they can’t do human studies because the ethics committees will not allow you to cut up a human after they’ve been iced! So all we can do is see the rate of recovery in those who’ve received ice versus those who didn’t, and there’s no difference. But I’m going to put money on that the tissue is not as healed well. It makes no difference. It’s a myth. People believe it because it’s been around for so many decades. It’s just, of course, it’s true, but it’s not.

56:48
Dr. Maya Novak:
It’s so important. So in regards to recovery and healing, what is your number one advice that you would give someone who is injured and who is in the recovery process?

57:03
Dr. Bahram Jam:
Get a good person to help guide you with your rehabilitation, a positive person. Not someone who finds all the things wrong with you, but finds the things that are good with you that you can actually those while you’re recovering. Be optimistic because you need that descending pain inhibitory system. Don’t Google – Google is your worst enemy when you just Google medical conditions and what you do. Try not to do exercises you find on YouTube or generic stuff. It should be specific to you. To me, it’s like if something’s wrong with your liver and Google what’s the best medication for your liver and you just take it randomly and go to a pharmacy and buy medications, you wouldn’t do that. For exercise, there’s thousands of prescribed exercise out there. But if you see a good rehabilitation specialist, like a physical therapist, that can prescribe you the right exercise that is right for you. Stay active as much as you can, even on the parts of the body that are not – you leave the part of the body that’s injured temporarily alone or do minimal stuff – but what about all of the other parts that are good? The other advice is to keep busy with life. Try to stay active in other areas of life rather than eliminating all the things you once enjoyed – from the arts, to pleasure, to social networking, to being with your family.

58:26
Dr. Maya Novak:
Great advice. So I know that there are also people listening to this interview right now who are in a really low place and they are losing hope about their recovery. What would you say to someone who is losing hope about their healing?

58:45
Dr. Bahram Jam:
Now, the thing is persistent pain can, in many cases, lead to depression and the problem with depression is it is a chemical imbalance and my first thing is, make sure you don’t have clinical depression. If you do, seek medical care. I’m not anti-pharmacological management of depression because the chemical imbalance needs to be addressed. You can’t tell somebody with depression well, just be hopeful and be happy. It doesn’t work that way, right. So I’m not going to demean and minimize their hopelessness. But if it’s not depression that they have, they’re just sad let’s just say, or low mood, then the single best way we know of to increase mood and hopefulness is by physical activity, which releases the same endorphins that it would if you took antidepressant medications. When they do the studies on people with mild to moderate depression, not severe, mild to moderate those who were given antidepressant medications versus those who did regular daily physical activity have the same outcomes. But the problem is it’s really hard to get people with actual depression to get motivated to do physical activity and to get past their barrier or pain to do a physical activity. That’s the challenge. So again, I’m not anti-medicine. In an ideal world, you would do both – the medication, pharmacological approach to address the hopelessness, the low mood and depression, and physical activity, whatever it is. If you can’t walk because your legs are sore or you have a bad knee or a bad ankle, then do sitting yoga, right? If you can’t move your shoulders, then just move your legs in an activity. Just go for walks outside. As a physical therapist, I’m biased. Physical activity would be the single best thing, but “graded” meaning you do a tiny bit every day. Go for – you can’t walk 20 minutes? Don’t do 20 minutes. What about three minutes? Can you do three minutes of walking? Then do three minutes of walking twice a day. The next thing you feel like it, do four minutes of walking. It’s called graded exposure. It’s the single best way to increase your optimism about your recovery. You say I only did three minutes last time, and I did four minutes today. Always start off with extremely easy so you get successful. You don’t want to do 20 minutes, flare up and feel worse and then you say oh, I’m hopeless; I’m never going to get better. That’s usually what people do. They do too much too soon.

01:01:13
Dr. Maya Novak:
This is such great advice because a lot of the times people have that big goal in front of them and it can be very overwhelming. They are thinking of going from zero to doing half marathons like in one week. So what you just said, start with a really small thing, and then slowly increase. This is brilliant, brilliant advice. There is another really burning question that a lot of people ask and that is, is there any calculation of how long it’s going to take a person to be back to normal – whatever that means. What I’m asking here is, if a person was non-weight bearing for three months, for example, and of course, they lost muscle tone. Is there any calculation how long it’s going to take them? Is this like, , if you were in bed, for three months, it’s going to take you three times longer? Is there anything like that, or is it really individual and we cannot say how long it’s going to take us?

01:02:22
Dr. Bahram Jam:
Yeah. I know people want the answer to that. I don’t have the answer, I don’t. And the second part of – back the answer – it’s very individualized, it depends on the condition. I wish I did. In fact, I’m going to say sometimes setting timelines, especially with persistent conditions and chronic conditions, is a negative thing. A negative thing because people set their goals – goals are great and wonderful – but they’ve got to be functional but not about pain. Like when is my pain going to go away? I literally tell them, I don’t know. That’s not our goal. My goal is not to eliminate your pain. Because they’ve been chasing the pain and getting rid of it and it hasn’t worked and so I’m not going to chase your pain for you. Because if you say in six weeks your pain should be better, by three months your pain should better, and if it’s not better – another failure. Then what your body does, it stops producing the DPIS in order to say you must be in danger because you’re not better. It has a paradox effect. So I understand goal setting is good, but goal setting to eliminate your pain, bad idea. It sets you up for failure. So I don’t have a timeline, I wish I did. I wish I could tell people six weeks. Acute injuries, yes - an ankle sprain I can say oh, this ankle sprain usually gets better in two weeks, this ankle sprain gets better in six weeks, normally. If you’ve had a fracture, normally three months. Like these are acute things. But once it becomes persistent and you need longer than three months, it’s unpredictable. The more timeline that’s in their head, it makes it worse because they judge themselves. You know what, I was supposed to be better than that, but I’m not better. I’m here, so you judge yourself when I’m supposed to be – and that judgment makes you feel bad. And the worse you feel; you stop releasing your descending pain inhibitory system and the nocebo kicks in and increased pain.

01:04:10
Dr. Maya Novak:
So it’s a cycle one more time, right? A negative cycle. I do have one more question, a bit more fun.

01:04:19
Dr. Bahram Jam:
Sure, sure.

01:04:19
Dr. Maya Novak:
And that is if you were stuck on a desert island with an injury and you could bring only one thing that would help you to recover perfectly or completely, what would you bring?

01:04:32
Dr. Bahram Jam:
Oh, so you’re thinking like I would say in medication, or lotion, or a thing?

01:04:38
Dr. Maya Novak:
Whatever it is.

01:04:41
Dr. Bahram Jam:
I would bring my wife with me to the island.

01:04:45
Dr. Maya Novak:
Why?

01:04:45
Dr. Bahram Jam:
Because I think whether you recover or not is irrelevant. As long as you have a social connection or a relationship or a love for anything. If you have a dog bring your dog that you love to the island because your injury should not define you. You’re more than the injury. You’re the people that are around you. You’re the person that makes the other person – because I like to make my wife feel good, she makes me feel good – I mean I could say I would bring my kids along too, but you said one! And I know my kids can do well on their own, I don’t think they’d want to be on a deserted island with me! So my wife may tolerate me until she runs away from me! But I would bring somebody who I could have a connection with and the healing would be secondary. It would be irrelevant. The relationships we have with people, the love that we feel and day-to-day is what’s relevant.

01:05:37
Dr. Maya Novak:
Yeah, beautiful. But I would go even further here and say because you would feel good with your wife; it would positively affect your healing. So actually, your wife and that love that you have, it would increase or make the healing process better.

01:05:56
Dr. Bahram Jam:
It could work the other way around if you don’t like your wife! If your wife drives you crazy it could have a negative effect too!

01:06:02
Dr. Maya Novak:
That’s true. So Bahram, I really enjoyed this and I could be talking with you for hours, but please can you share with us where people can find more about you, or if they want to reach out, how to do that.

01:06:17
Dr. Bahram Jam:
More about me – if you just go on YouTube and type in my name – Dr. Bahram Jam: – you’ll see all my little tidbits – but they’re mean for physical therapists and healthcare providers, they’re not meant for the average patient care. That’s not what my education is about. But my Pain Truth videos that I said are online, just in type in The Pain Truth and Nothing But, and various videos will come up. And if they have persistence, I’ve written a book also. It’s available on Amazon. It’s called The Pain Truth and Nothing But. It’s a workbook for chronic pain, but the free version is there also which is on – if you just Google it, you’ll find it on my website. If they want to email me, my emails are there – just Google and go to my website and you’ll find me. My email is drjamphysio@gmail.com.

01:07:12
Dr. Maya Novak:
Perfect. Bahram, thank you so much for being here and thank you for sharing your knowledge, your expertise. I know that this is going to help so many people around the world.

01:07:23
Dr. Bahram Jam:
Thank you, Maya.

01:07:25
Dr. Maya Novak:
This wraps up today’s episode with Dr. Bahram Jam. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in, and share it with your loved ones. As you know: sharing is caring. To access show notes, links, and transcript of today’s episode go to mayanovak.com/podcast. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.