Previously Recorded on Thursday, September 25, 2025
This talk introduced the WellSpan Restorative Pain Program, a pioneering initiative that integrated clinical care, body work, and behavioral therapy to address the complex nature of chronic pain. The program emphasized the brain's role in perpetuating pain signals and utilized Pain Reprocessing Therapy (PRT) to help patients 'unlearn' chronic pain. The speakers shared compelling data from the program's first cohort, demonstrating significant improvements in patients' quality of life and functional abilities.
The talk also included personalized care plans that incorporated a variety of modalities such as physical therapy, acupuncture, massage therapy, and yoga, all tailored to meet the individual needs of each patient. The talk highlighted the importance of a collaborative, real-time approach to treatment planning, where the care team continuously adjusted the plan based on the patient's current state, ensuring the most effective and holistic care possible. Additionally, the speakers addressed the program's eligibility criteria and the steps being taken to expand insurance coverage, making this innovative treatment accessible to more individuals suffering from chronic pain.
Good day. Welcome to the Wellspan inaugural uh webcast in a series that'll bring you many exciting new, uh, sessions in, in the coming future. I'm Doctor Chris Eterling. I'm a family medicine physician with WellSpan. I serve as medical director for vulnerable populations for our population health department, also practiced in the city of York, and have had a longtime interest in pain as the uh opiate stewardship co-chair with our addiction leader within WellSpan. I'd like to introduce Doctor Sergei Borodinsky. Uh, he's a board certified, uh, physiatrist and the physician lead of WellSpan's restorative pain program, which is a pioneering initiative that you'll hear about today, built on a transdisciplinary approach to chronic pain care. His work really integrates rehabilitation, medicine, neuroscience, and behavioral help to advance innovative, patient-centered models that aim to improve chronic pain with long-lasting impact on function and quality of life. Before we get started, I wanted to draw your attention to the section on the bottom left of your screen where you can submit questions. We urge you to do so, so we can have time to discuss those at the end of Doctor Borodinsky's presentation. Feel free to ask any questions you have at any time. And with that, I'll turn it over to Doctor Borodinsky. Thank you, Doctor. Hello. Um, Uh, today we're going to, uh, talk about transforming chronic pain management. And my name is, um, Doctor Sergei Baadansky. Um, I have come to this position, uh, to we specifically to start this program. As a physiatrist, um, I have been seeing chronic pain patients all my career and have been wishing. For a program that would integrate multiple disciplines cohesively, um, for some of the most complex patients. And uh today we're going to share our experience here at Wellspan where we were able to successfully do that um and uh have a program that is uh flourishing both clinically and is able to be financially feasible. So today, I'm going to describe to you, we're gonna have this conversation about what is transdisciplinary. Um, care, how is it value based, um, and, um, how is it going to address the chronic pain management, um, needs? You will also learn uh some strategies of how one can integrate multiple disciplines together in a holistic fashion. In a manner that is really patient centered, uh, and, uh, is able to be integrated within a large healthcare system. Um, we're also going to see some of the outcomes from our program, uh, to see the clinical outcomes and, uh, how this program is able to reduce the healthcare utilization. Chronic pain experience. This slide um has been put together by CMS and CDC to try to help um explain what the chronic pain management world looks like from the patient's point of view. At the bottom, you can see that uh people with chronic pain are usually Carrying the burden, often unseen burden of chronic pain. Um, some of them are, uh, also carrying the diagnosis of substance use disorder. And they feel lost without support, as well as their family members. Now the only way to get to help is to climb the proverbial mountain of the insurance and provider options. As you're trying to, as the patient is trying to sift through the multitude of options. Um, that are available to him. Um, there is a lot of stigma that comes from the outside, uh, providers, but also comes from, uh, from within for the patient who is suffering with chronic pain. Uh, by the time they do get the providers, these patients are very complex. They have, um, they have tried multiple treatments over and over, um, and so a lot of times the providers are, um, approach these patients with, with some level of, of fear and apprehension. And oftentimes they're just not able to help. And then the patient has to cross this chasm, uh, which is a fine balancing act, uh, to finally be able to reach the place where they have control over their pain and are cared for. While doing so, they need to balance lots of things, they need to balance their family, friends, caregivers, they have financial burdens, um, they need to, uh, manage their quality of life. We need to manage their mental health and just everyday work and stress. So, to be able to help them along the way, to stay along the path. Um, the CDC and CMS has shown, um, that what we need is better provider collaboration, uh, to have the right medications that are being used. Have the decisions that are patient centered. Um, have the appropriate interventions, um, include the appropriate therapies that include behavioral therapy, movement therapies, and other complementary care. So again, our program has tried to uh to address all of the above. Chronic pain experience um isn't just detrimental to the person is also uh the most expensive problem that the healthcare system is facing. 160 million Americans um have chronic pain. And that is more than the diabetes, uh, heart disease, and cancer combined. The total cost, annual cost uh for the uh chronic pain uh management, indirect and indirect costs, which includes lost productivity and disability programs. It is estimated between $560 and $635 billion. Now, this information is about a decade old, and over the past six decades. The healthcare cost has doubled every 10 years. So right now, this uh the figure that you see may be doubled. Most of the chronic pain is low back pain, headaches, neck pain, and facial pain. But let's go back to the to the figure of $635 billion. It's, it seems staggering, but To make it A more accessible. That number is approximately $20,000 per second. Think about that. By the time you're done listening to this webcast, the country. Has Essentially, uh, incurred $68 million. Uh, it was spent on chronic pain management. Well this is the problem that that has to be solved. But how are those dollars distributed? The HRQ report from 2019 was able to show that. Top 5%. Of most complex patients consume 50% of the total healthcare dollars. And top 1% of patients consumes about 21% of the of the healthcare dollars. Now if you happen to be so so the the distribution is skewed, and the healthiest 50% of population only consume 3% of total healthcare dollars. who want to make the biggest impact. For the systems, for the healthcare systems. This is the, the chronic pain management is the way to uh uh to approach. Some issues that we can encounter along the way. So, um, some of them, uh, include, uh, the patients are just not able to reach the pain management specialist, um, that includes the complementary medicines, um, and, uh, the pain management, uh, falls, uh, to the hands of already overburdened primary care providers. That have um tried their best, but they have limited in specific training. Furthermore, the population And it is aging, and the shortage of uh as well as growing, the shortage of physicians uh continues. So we're facing a huge patient to physician mismatch in the next decade. Uh, by the way, that shortage goes beyond the, uh, physicians and also includes nurses. So we really have to overcome this bottleneck. By creating uh more effective programs that are able to be both effective and scalable. Now, how to improve the um treatment of chronic pain um has been well studied. Um, we know that what we really need is to move from the current uh way of uh inefficient. Deeper service models, uh, uh, care models over to have the improved patient outcome and satisfaction. And the way to do it is to uh use the holistic care. The programs that integrate uh the pain management. Approaches. Um, So But we also have to do it, uh without bankrupting the, the healthcare system. There are um Multiple challenges along the way. Improving the efficiency of resource allocation does increase the overall efficiency, but uh doesn't always um result in uh in financial uh cost savings. Workforce shortage, even though in the short term may provide some financial reduction, reduces the efficiency of the system significantly. Uh, high-cost interventions, although are the primary drivers, uh, for the financial success of systems, are still, um, highly inefficient. So what we really Um, are is a program. Um, of integrated, uh, with integrated approach that is both. As the elements of high systemic efficiency and uh as a high financial impact on the, the reduction of total cost of care. There um there has been multiple studies that shows the effectiveness of comprehensive programs. Those studies, uh, on average, show that there is approximately 20% reduction in, uh, In pain, there is improvement in activity levels, uh, reduced opioid use. Overall, the again, the studies have repeatedly shown that the comprehensive programs um overall carry lower costs. And, uh, especially, uh, relative to surgeries or long-term opioid use and uh the one real world uh uh study for 3 week outpatient. Chronic pain management showed the reduction in um 64% of reduction in medical costs, um, one year post-treatment. So what we need is the to both reduce pain um for patients in improved activity level, um, reduce the opioid use and improve the effectiveness. There are many barriers along the way to implement these programs um within healthcare systems, because the, the answer has been um has been available to us uh for decades, but um the implementation has suffered and uh the barriers include High upfront costs, these uh the programs are expensive, uh, to start. Um, there is significant logistic complexity, so the systems need to overcome, um, and, and create the logistics that would be able to, to, uh, effectively uh treat uh the. Uh, basically the patient complexity and number. Therefore, we don't have uh we have very few personnel that's already been trained um in these uh uh types of uh treatment models. Furthermore, These programs often live in silos. Even if they do exist, many providers are not aware of their existence, and if they are aware of their existence, the understanding of what these programs do is uh lacking. Furthermore, um, Uh, there are times that these programs are trying to omit more complex patients or patients, uh, with significant, uh, mental health comorbidities. The referral processes are usually cumbersome. And of course, there's a uh a common problem of insurance coverage. In the current world of uh D for service, um, it is very difficult to fulfill all of the criteria for billing when you have an interdisciplinary program and and each individual discipline has to, um, has to document, um, uh, the same information, um, reducing the efficiency and, and moreover, um. Reducing the effectiveness of the treatment for the patient by uh by having these um unpleasant experiences of repeating the same information um over and over again, uh from uh from one provider to the next. Now, our system was uh with the the restorative pain program, uh, was able to overcome. Um, all of these limitations, um, and, uh, We did this through the implementation of what we call the transdisciplinary approach. So what is transdisciplinary? Model. So, um, In this slide you can see uh the the first figure um shows the regular disciplinary model, each individual, um, provider or specialist provides their own care. Um, these are the proverbial silos that we have all, um, um. Know about. Multi multidisciplinary approach um improves the communication between the providers, however, they continue to work in parallel. With each other. Um When we move on to interdisciplinary integration, um, now the team is working together, uh, be a very good example of the discipline integrations, uh, would be, um, an inpatient, uh, trauma, for example, uh, where there's, uh, uh, self-defined rules and. But all of the Specialists are working together. At the same time, meeting the patient's needs in real time. Transdisciplinary approach is um trying to recreate, but also improve of that integration in the outpatient setting. So, what we're looking for are providers that are working closely together, we have the the providers that create a unified plan that is patient centered, but other stakeholders. For the uh for the patient care are involved as well. Um, namely the patient themselves. And the insurance company. So, The transdisciplinary model. To be able to to unify their care. Needs the this comprehensive stakeholder collaboration. How do we do that? Um, we do that by by working under the same roof. It's a unified treatment space, uh, where all of the disciplines that are working together are able to communicate effectively. Um, there is, uh, there is the, that the effectiveness of communication. It's facilitated by central or regular team meetings, uh, that occur uh. Several times a day, every time, essentially, that we see a patient, there is a team communication that I'll describe later. To be, uh, once we create the unified plan, we can allow for flexibility. In sharing of our roles. Once we allow for that flexibility, the specialty boundaries can become blurred, so that we can, while still using our expertise, are kind of uh are able to use our uh treatment models, use the words and education to help patients um understand and move forward uh through the program. So the key components of transdisciplinary model again are uh stakeholder collaboration involving um involving the patient, involving the team, but also involving um the insurance uh uh payer, um, and we do this through frequent communication, sharing of the outcomes, and, um. Understanding of the of the decision making uh process. We have the role flexibility where the members share some of their roles. We share the knowledge in the team setting uh to meet the patient's needs. Uh, there is a shared goal alignment, and those goals are patient centered goals, um, so we can align the goals that are important to the patient, the goals that are important for the providers and payers at the same time. Um, all the providers are coordinate uh coordinating their care in a single setting, and, um, uh, the patient becomes essentially an active treatment, uh, uh, member of the team guiding the treatment progress. So when we're looking at the transdisciplinary approach as it was uh applied in our clinic. We have a team that's working with patients. Um, the team consists of an acupuncture specialist, physical therapist, behavioral health specialist. Uh, nutrition specialists, registered dietitian, massage therapist, and a physician. These are individual visits, um, uh, so when the patient comes in, they can see, uh, any one of those, uh, individuals based on the based on the uh clinical schedule that we've set up for that day. But they're also um seen within the groups um during that same time interval. So the groups may include meditation, uh, group yoga, a neuroscience education, um, and essentially this is to help uh build the community, um, and help patients intermingle and be able to kind of to learn from each other and um. Essentially encourage each other to. Stay on track. At the center Is the patient and patients goals that we work closely with patients to help them uh identify and then continue working towards. When we were building this program, we realized that we needed to have an underlying um unified force um for our treatments. And uh we realized that when you're dealing with chronic pain management, uh, when you're dealing with patients who failed multiple uh therapies, it is really all aspects of their life, uh, that, that are. Affected by the chronic pain, but also the aspects of their life are feeding back into the pain. So what we really need to do is to change their lifestyle, change what they do on a regular basis, hence the goals. Um, to do that, they need to change their relationship. With pain. And we use the pain reprocessing therapy, uh, which is a technique that was, uh, published and is now well known in psychology, uh, field. To help them, uh, mediate the pain. So, uh, in our clinic. The, we, we have provided education to all of the staff, um, about the processing therapy. Um, our behavioral health specialist is trained in it. Uh, I'm specifically trained in that approach and so we are using that as the underlying momentum where everybody is ultimately providing um that same uh message to patients in all of the aspects of our treatment both group. An individual. Um, the overall structure of the program, um, uh, is such that we have a group visit where we have 8 to 10 patients, um, which is the goal to come in per unit. Uh, they come in for 2.5 hours. Uh, we run 3 units per day. When the patients come in, um, the team of providers meets every time, uh, for 20 minutes, uh, where we go through a essentially a team, uh, a team meeting where we align our plans, review patients chart, um, make sure that we get feedback from all of the all of the providers so that we can have a unified single plan, uh, based on what the patient's needs are. Today, um, and the multidisciplinary, and the child disciplinary team includes the nurse coordinator, uh, the physiatrist in our case, behavioral health provider, physical therapist, and complementary services, so I, uh, described earlier. Moreover, When we're dealing with change. A behavioral change, a lifestyle change. Uh, ultimately we want the patient to gain control of their pain and not simply um assign the their improvement uh to the treatments uh within our program. So we have defined the program's length to be 12 months. Um, at which point the patient is graduating. So we start with seeing them more frequently and then reduce frequency, um, throughout the program. Phase one is trust building phase. Patient gets to know us, they get to try some things that they've never tried before, or even if they have tried things like physical therapy, they they get to see that we have a slightly different approach to it. That phase lasts for 1 month, and we see them 4 times during that month. Then the phase two begins, which is when we start to really dig in and introduce these new ideas to patients, help them integrate them into their life. Uh, there's a lot of education that's ongoing neuroscience education, that's when we start to bring in the ideas of danger processing therapy, and sometimes we can use the ACT approach, uh, um, action and commitment, uh, therapy as well. Um, so this phase lasts for 2 months, and uh we have 3 visits per month. After that, the phase 3 is really, uh, by this time, patients should uh will have a lot of education, and they've already started implementing some of the changes. This is the self-reliance phase. Where a patient is truly embedding the skills into their everyday life, they come back to us with questions and we help them modify um uh what they're doing. Again, really focusing on the on the patient's uh defined goals. This phase is 3 months long and uh we do 2 visits per month. And then last and final phase is phase 4, which is a sustained phase where the patient is now seeing us only once per month, uh, for the, for the 6 months uh duration. Now they have to rely on the skills that they learn. But they do get to come back to us. And Essentially run by uh our team, uh, the way that they are implementing those changes, and then at the graduation day, uh, the patient's care is transition to primary care physician or whatever specialist they they've had before. We transition the care coordination, um, and we reviewed the goals that patient was able to achieve, um, uh, during our time together. Um, we are rigorously measuring the, uh, progress using the 10 patient recorded outcomes. These outcomes include the biological uh uh biopsychosocial aspects. Um, so we have pain, uh, pain scale, we have, uh, functional, um, PEG and ostric questionnaires, um, that pain disability index, uh, we measured in catastrophizing, uh, PHQ-9 for depression, get 7 for anxiety. Um, we're also looking at the alcohol and drug use, but we also have this measurement of PGIC, which is essentially the perception of change, um. The that questionnaire is asking uh how optimistic you are about the future. Do you think you'll get worse, stay the same, or get better. And uh we have done an internal study uh from the patients that have been uh in our care from January 2023 until January 2024. So we had 79 patients who have completed all of the outcomes. Um, so we were able to see that over the six month period, um, patients were able to reduce the, uh, pain, uh, by, uh, 13, almost 14%, uh, pain disability uh reduced by 13%, catastrophizing, uh, was reduced by almost a third, and that that patient global improvement uh of change, um. Has improved, meaning that the patients are looking forward to think that yes, I can, I can control my pain better. In the future. For the same cohort of patients, we have looked at their utilization. For 6 months prior to joining uh um the restorative pain program. And then we'll look at the utilization of resources for 6 months after completion of the 6 months of treatment. So when we look at the pre and post 6 months of active treatment, I see that there is an active reduction um in uh imaging caused by 46%. Uh there is a 45% reduction in major procedures, and there's also a fewer minor procedures that were performed as well. Now, if we're looking at patients that were able to graduate, we see that the um clinical outcomes continue to improve. So when we're looking at the graduate at the graduate at the graduation time, um uh we had the patient's uh pain uh is reduced by 18%, disability. Uh, index has reduced by 26%. Pain catastrophizing was almost reduced by half, which is very much correlated with chronic pain, and patient global impression of change is improved by 45%. Um, so, uh, I just want you to, I want to highlight the fact. That this is the last visit that they will, that they have with us. Patients know that they will not be able to see us in the future, and yet. When with particularly patient global impressive change. They say that as I look into the future, I believe. I will get better. So that's uh we're very, um, we think that this is a very important outcome for us. Some implementation challenges and strategies that we had to overcome uh during implementation of this program. But first of all, we had to develop a new clinic workflow. Um, the teams have, um, have never worked together in, uh, uh, in, in this setting before. You have multiple, uh, different providers. Each one is used to seeing patient individually, each one is used to seeing patients and, uh, for half an hour or at least or or an hour on a regular basis. Well, now, uh, we had to, um, we had to figure out how to fit. Multiple group treatments and individual treatments into this two hour window frame, um, how to organize together and come up with a unified plan that occurs during our scrum, which is our team meeting before every visit. And to develop a scheme. To adjust The schedule. Based on the real-time needs of the patient. With our model. We can have one plan when the before we start the um uh the, the treatment unit. And if a patient comes in with acute uh for example, their their their. Significant other has passed away. We can, we're able to modify the schedule to meet their demands on that day by seeing a behavioral health provider and shifting the schedule around. Um, we really had to overcome the, uh, cultural shift that comes along with it, um, because now the time is shared, and, uh, the, we really need to focus on what the patient's goals are rather than what the each individual, uh, um. Treatment providers' goals, um, maybe share the responsibility of some of those tasks, um, and that took a lot of um understanding and, uh, and, and creating a new culture to be able to do that. Essentially, to understand that um even though you may not be able to get to everything in one day, there's always the next visit where you can pick up and continue working with patients. We were working very closely with the referring providers we present uh to increase the awareness of this program. To explain what this program does and how is it different from other multidisciplinary programs that were available before or are available right now. So we visited over 30 primary care and specialty offices and we've done that twice, um, in a 3 year period where we provided updates but also uh make sure that the that the primary care uh providers and specialty providers are aware of us. We reached out to the community uh by uh participating um in the community events. Uh, our team members are truly dedicated and they attend at least one community event per month where we stand and are able to uh discuss our program um with people who are uh who are living in our community so that they may understand that that the services like this are available to them. And then finally we had to develop an effective onboarding uh process, um, uh and some roles uh had to be created, um, uh, and with, uh, from scratch, essentially. As we look into the future, what we're, what we are, um, striving for is uh financial uh sustainability. I can tell you that uh that the program has reached the break even point. Um, uh, we are. Uh, we're working closely with payers, uh, to collect the, uh, claims information so that we can, uh, do additional research and, uh, are able to show their total uh the reduction in the total cost of care. We want to expand regionally right now we are centered in the inner city, uh, uh, serving that population, but ultimately we want to have a chain or uh and be able to cover a larger geographic area. And we continue to advocate for for the policy and um so that more insurance uh coverages are provided. Um, we have started. With only 2 pairs. And by now, we are able to Um, see patients from almost every Medicaid, um, payer in the area. We have, uh, one Medicare contract and we have, uh, uh, one, commercial, uh, actually, right now, we would have, uh, two commercial, uh, payers. Now, well, with pairs, we, it's important to note that we we we went beyond the fee for service. And we are, we, uh, develop individual contracts, um, we developed individual contracts with each one of those payers that provides bundled payments, um, that allows us to um to work and just focus on clinically, um, uh, improving the patient with, with, uh, less of the uh the needs for the um, that comes with the the FIFA service model. So, if you are looking to integrate uh a model like this, I would encourage you to go to your system, um, first of all, look at the chronic pain program, recognize its impact, um, ask better questions, see how, how it can be improved through a new model, then you can overcome the barriers, uh, and, uh, make sure that all stakeholders are aligned and involved. Use the transdisciplinary approach and champion the change. Um, and at this point, I'm ready to, uh, answer any questions you may have. Doctor Binsky, one of the questions we got was, um, who might be the best candidates for the program, uh, criteria to judge that on and who might, despite their suffering from chronic pain, might not be a good referral to this program. So we're looking for patients that have um Tried multiple, uh, tried and failed multiple treatment options. They would have tried a physical therapy, um, uh, oftentimes have had surgeries in the past, tried injections. If none of these, um, um, essentially physiological, uh, interventions, uh. have been working. Now we're work, now we're looking at the chronic pain aspect of it. So, um, however, we also need to make sure that the patient is stable medically and psychologically for us to be able to, to move forward. So, um, really, if they're medically and psychologically stable, even though they may have um concomitant depression, as long as they have a um You know, they're not actually psychotic or if they, if they have a behavioral health specialist that um that can help us along the along the way, um, we take these complex patients um and are able to uh enroll in the program. And I, I would add, yep, and I would add that Doctor Borinsky mentioned that the, uh, the center is located in New York, but, uh, we welcome referrals from anywhere. We have had trouble people travel an hour and a half to the program because obviously, as you've heard, this is an extraordinary program with few rivals and uh people are desperate and deserve relief for their suffering. So, Obviously, traveling a long distance is not ideal when you have chronic pain, but uh some patients have um uh decided to do that and have been really uh benefited by it. So we accept referrals from anywhere. Uh, Doctor Binsky, you talked about one of the major um constructs that the, the program uses is the idea of neuroplastic pain and pain reprocessing therapy. How, how do you, uh, given that many of us are just learning about this ourselves, how, how do you go about trying to present this to patients or, uh, or particularly patients that might be skeptical about, um, this approach? Uh, here's where the Part of medicine comes in. Um, and, uh, where our program truly shines. To be able for the patient to accept the fact that their pain may not be coming from the area where it hurts. We first need to develop trust with the patient. So slow. Progressive trust building. Can be done. In within the the frame of our program. So, as as the patients are improving with each visit, we can slowly integrate education to help them understand what their imaging truly means and what what their diagnosis uh are uh are how are they contributing or not contributing their pain and what's the likelihood of the diagnosis contributing to the pain. So yes, the patients need to be ready for change, but we can also facilitate it through uh uh through the team working um as a whole. So we provide in groups and individually we provide neuroscience education. As a physician, I help clarify whatever questions that that are coming um from this educational sessions. Furthermore, we have implemented um. Use of books. Um, there's, uh, frequently I recommend, uh, once the patient is introduced to some of the, uh, some of the ideas of pain or prostate therapy, I recommend, uh, for them to read a book called The Way Out, um, which describes this process. What I learned is that when patients are reading uh that book, when they start to see The examples of other people who are going through the same um experience. They start to reflect on themselves and are then becoming uh more interested in actually learning what is the way that I can now control the pain better. And so, um, yes, it it truly is that that's that's where the transdisciplinary care uh truly shines, um, uh. By helping basically patients on their journey, self-discovery, learning how they can control their pain themselves, giving them the autonomy um to have control over their body and what it senses. Doctor Binsky, a question about the um the, the team dynamics of the program. Obviously, most of us have for the most part practiced in solo practice, even if we practice with partners in the same building. Um, and so the idea of having others around us to care for a patient uh together is really exciting. But obviously, the folks that you mentioned, acupuncture, massage, uh, nutrition, physical therapy, behavioral health coming from dramatically different backgrounds. And so obviously, sitting them down, uh, to talk about a patient would be a, a prerequisite, but doesn't necessarily build a team and a common approach to the patient. Um, how have you found over time with the program that you've been able to help lead and coalesce that team so that they're all really coming together, so the patient isn't hearing dis uh disparate uh perspectives on what's causing their pain, but they're hearing unified messages from practitioners who are coming from quite different uh backgrounds. So first of all, when you have a team that meets 3 times a day and discusses every patient, Um, first of all, it develops the trust. When you hear that every what part of the patient's condition is being addressed by every specialty. You will feel more comfortable that that these other parts of treatments are being taken care of. Every one of those specialties and then uh and I'm sure everyone on this call understands, when you, when when somebody comes to physical therapist, they will hear questions about medications, they will hear questions about about meditation and yoga and acupuncture, and the and and each specialist is just trying their best to answer these questions, but now, when you know that there is a trusted individual, you know how they think, you know how they already contribute to the plan, you can just defer. To that patient. Once you have experienced being in a team like that, it starts to build trust and it starts to build the the understanding that, OK, I can delegate certain tasks, and I can take on certain tasks um that I am best uh suited for. So then as the team grows, then we can um uh the the the the second aspect of it was the pain reprocessing therapy. Because pain and processing therapy is uh is also a philosophy of um in essence what it says is that uh pain is essentially a message. And that it's this message has been interpreted as painful message, but there is no active tissue that is being damaged. So what we can do is retrain our brain to interpret the message in a different manner. What we've tried to do is to, um, well, through education of all the team in painter processing therapy, we can use that painter processing therapy without naming it. For example, if a patient is um having a massage, we can tell them I want, I, I would like for you, if you feel the pain in the low back, that's OK. Allow for that experience to be in there, um, while you're receiving massage. Um, physical therapy, for example, allows patients to what we call walk and talk, and the patients are going along, walking with physical therapist, and at the end of a 15 minute walk, um, we can point out that notice that your pain didn't get worse. Again, so, so this, this, this combined effect of having, uh, really this, this environment. That heals the patient, not just each individual person, the, the, the synergy of uh of of our team is, is um um um needed to be developed and, and we learned through some ups and downs of how to do it. Doctor Binsky, another question. Um, so, uh, obviously, the program began with a framework in mind, uh, an approach and a philosophy, uh, but certainly over the development 2+ years, uh, as the, the continued work on improving the program and learning from experience has occurred, uh, what are, what do you think some of the major takeaways are that have, uh, changed how the program approaches patients that are different than when the program opened 2 years ago? Um, Well, frankly, we also thought that you could, you could have multiple, you all you just all you needed was just to have all of these specialties together in one place, somehow by magic. The patients are going to get better. Um, everything that I've described earlier is what we, uh, we've, um, understood along the way, um, as we were treating a patient in this, uh, in this new environment. Um, so some of the things that I've learned, number one, you have to do things slowly. So, uh, not telling patient everything on the first visit, uh, which I have done earlier on, um, but that can, that can, uh, throw the patient for the loop and they, they feel that this is too much, so slow progression. I often describe this to patients as, as this, imagine that you are a small and a plant in a small pot and you come to a specialist and you ask, I need help growing. The specialist has this huge bucket of all of the treatments and knowledge, and they dump it all, but most of the information tends to overflow and never touches you. Whatever is left is you, you feel drowned in that information, um, and then they tell you that they will see you in 6 months or a year or never. We in here in this program are are every time you come to us, we give you just just enough information that you can absorb. But over over the course of a year, you're much more likely to grow. So, small incremental changes. The next thing we learned is the use of goals. ultimately the patient wants to have better quality of life, do things that they are not able to do. And it's actually difficult, uh, after years of pain to realize what it is that you really want or are missing. And then the second part of the uh of of setting goals. So there are two main caveats that I learned with goals. Number one, setting negative goals, negative goals can be I want less of what I don't want. A great example is I want less pain. Clearly, we want less pain for the patients, but um at the same time, it's hard to feel the progress if you go from 6 out of 10 to 4 out of 10 pain. You don't want 4 out of 10 either. So setting positive goals, for example, I want to go from 10 yards to 500 yards. That's the kind of goal that allows you to feel that you're improving every step of the way. Um, and the second caveat being, uh, adding qualifiers to the goals, uh, meaning, for example, I want to walk, walk 1000 yards without pain. So now, even if you walk 1000 yards, He said without pain and you had some pain, all of a sudden you erased all of your progress. So helping patients define the goal is just as important as having the goal in the first place. The small incremental changes, just making sure that they have a win. Every time they try. The winning becomes contagious and the patient starts to feel more empowered. Doctor Binsky, uh, maybe one last question. Obviously, you, you talked about the extraordinary improvements that, uh, patients have with the restorative pain program, but obviously, all patients don't have improvement and all don't, you also talked about as they are in the program longer, uh, they have more benefit. Can you describe a little bit the common reasons why patients might not complete the program or those patients that might not benefit as much as you and the team would, would prefer that they would. What are the common characteristics there that might lead to that? So one of the most common characteristics um is the uh difficulty with social determinants of health, lack of employment, really poor uh social uh support network, um a lack of housing. It is very difficult to tell a person that nothing is wrong with you, if you're under tremendous stress all the time. So, so the, so it's very difficult to, to make meaningful improvement, even though a lot of patients still find benefit in the in the treatments that we provide as a tool that they can at least use to to to you will escape or or or give your give themselves a break even for a few minutes. Second, uh, biggest issue is the, uh, really Not being ready for change. If a person is very much attached to their diagnosis, they want to look for external uh reason for for their pain. It is difficult to uh to over time. It's just probably not the time to to be to be in this in this program because ultimately we want uh we want to prove to the individual that you all you have that power. To be able to control the pain. It doesn't come from the outside. You don't need to find a yet another diagnosis for you, here are the tools that you can use ultimately yourself. And if you're not ready for that, um, you know, that's, that's when the patients tend to, um, step away from the problem. Thank you. Well, with that, I think we're gonna wrap up our webinar. I just want to thank you for joining us today. We hope that you've found a new insight into the transdisciplinary approach uh through this webinar about integrating clinical care, body work, behavioral therapy, and how that can really transform chronic pain management in a way that makes a difference for patients, those providing the care and is sustainable. But together, we believe at WellSpan that we can be, uh, provide innovative, compassionate care. Uh, and make it more accessible for patients who need it the most. We would encourage you, uh, to take advantage of the uh resources on the left side of the screen. The these are links to, um, uh, more information about the restorative pain program. We also encourage you to click the link on the video you see to view a video, uh, that highlights um the restorative pain program through the eyes of our patients. Um, again, much thanks for joining us today and uh um we look forward to having you join us for future webinars. Thank you. Thank you, doctor. Thank you, thank you everyone for coming.
