Dr. Deb speaks with Rafi Salazar about chronic pain and how the body responds to pain. Using a multi-disciplinary approach to managing pain can get you free from medication. 

Do not miss these highlights:

04:15 How Rafi works with a team at the Department of Veterans Affairs in developing an integrated or multidisciplinary approach to pain management.

08:25 The BioPsychosocial Approach to pain management.

14:20 Pain is a sensory and emotional experience that is a creation of your brain based on the real or perceived tissue threat.

16:04  Sometimes our brain and our sensory system get those calls wrong,  getting a series of misinterpretations over time.

17:58 If the pain is real, all we need to do is retrain that sensory system that this isn’t dangerous, so you can start moving pain-free.

19:39 The greater issue is, patients are losing hope because they’re not being given hope by the medical system.

22:44 For the longest time, healthcare and third-party payers have kind of viewed healthcare service delivery as almost industrialized.

24:56 If you’re still experiencing pain, find somebody who is talking about Neuroscience and Pain Perception.

27:37 Other kinds of practitioners that can help you with pain management.

30:28 One of the great benefits of Telehealth is that it removes this potential danger of becoming clinician dependent.

Resources Mentioned

Whether you are recovering from an illness or just looking to maintain your current overall health, schedule a consult with us at Serenity Health Care  by calling  (262)522-8640 or visit https://www.serenityhealthcarecenter.com 

About our Guest:

Rafael E. Salazar II, MHS, OTR/L (Rafi) is the Principal Owner of Rehab U Practice Solutions, a leader in patient retention strategy. He has experience in a variety of rehab settings, working with patients recovering from a variety of injuries and surgeries. He worked as the lead clinician in an outpatient specialty clinic at his local VA Medical center, where he worked on projects to improve patient & employee engagement and experience throughout the organization. In that role, Rafi led a team to roll out a patient engagement initiative rooted in relationship-based care. 

After leaving the VA, Rafi began working as a healthcare consultant, on a multi-million-dollar project for Georgia’s Department of Behavioral Health & Developmental Disabilities. This project involved work related to the transition of individuals out of state institutions to community residences and establishing statewide mobile integrated clinical services for individuals on the state Medicaid waiver program. As part of that project, Rafi developed and launched a large internal marketing & communications campaign aimed at increasing awareness for internal stakeholders about integrated clinical services within the state. 

He also developed protocols and systems to coordinate and manage interdisciplinary collaborative care within the State’s Medicaid Waiver system as well as clinical and operational guidelines for case management & telehealth and virtual service delivery.

Rafi also has experience as an assistant professor at Augusta University’s Occupational Therapy Program,, as a Licensed Board Member on the GA State OT Board, has served on several committees for the national OT Board (NBCOT), and as a consultant working for the State of Georgia’s DBHDD. He is also on the Board of Directors for NBCOT. He owns and operates Proactive Rehabilitation & Wellness, a multi-specialty outpatient clinic that treats patients experiencing musculoskeletal and orthopedic conditions as well as chronic pain.

At Rehab U Practice Solutions, Rafi helps clinics, health systems, and healthcare companies improve patient engagement & experience leading to increased revenue & lifetime patient value. He envisions a world where skilled, competent, and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction, and lasting relationships. 

https://www.linkedin.com/in/rafaelsalazarii

https://pro-activehealth.com

https://rehabupracticesolutions.com

Transcript for Episode #170:

Debra Muth 0:02
Welcome to Let’s Talk Wellness Now. I’m your host, Dr. Deb. This is where we talk about everything wellness, and learn to defy aging and live our lives on our own terms.

Debra Muth 0:16
Welcome back to Let’s Talk Wellness Now, I’m your host, Dr. Deb and today I’m talking with Rafi Salazar, and we’re going to talk about chronic pain and the importance in relationships between health care providers and patients. So Rafi is the principal owner of rehab you practice solutions a leader in patient retention strategy. He has experience in a variety of rehab settings working with patients recovering from various injuries and surgeries. He works as a lead clinician in the outpatient clinic at his local VA medical center, where he works on projects to improve patient and employee engagement and experience throughout the organization. Rafi led a team to roll out patient engagement initiative rooted in relationship based care. After leaving the VA right, Rafi began working as a healthcare consultant on a multimillion dollar project for Georgia’s Department of Behavioral Health and Developmental Disabilities. This project involves work related to the transition of individuals out of state institutes to community residents and establishing statewide mobile integrated clinical services for individuals on the state Medicaid waiver program. Rehab you practice solutions, helps clinics health systems and health care companies improve patient engagement and experience leading to increased revenue and lifetime patient value. He envisions a world where skilled, competent and caring clinicians serve and care for engaged patients to promote better clinical outcomes, unmatched patient satisfaction and lasting relationships. You know, I’m just going to say here, this is such a wonderful mission statement, because in today’s day, where it seems like everyone cares only about money and not about people. This is such an amazing vision. And I don’t think this country has always been in this mindset. I really do think health care people in general, were always out to help one another. And somewhere along the trajectory, things changed. And I’m not exactly sure where that was that it changed. But we became very money hungry and driven by money and things. And it’s very difficult to move away from that mindset, because we’ve been raised with that for so many years. So hearing Rafi talk about how he wants to engage patients and promote good clinical outcomes. So patients don’t keep spending their money and not getting any benefit of what they’re doing. And he wants to see patient satisfaction, this could completely redefine healthcare as we know it. And I really think this is where healthcare needs to go. And where we need to take a stand on healthcare is looking at actual patient outcomes and cost benefit ratios where everybody wins in the benefit of health care. So with that, I’m going to bring on my guest, Rafi and we are going to chat about how he’s looking at doing this.

Debra Muth 3:48
So, welcome back to Let’s Talk Wellness Now. I’m your host, Dr. Deb and I’m with Rafi cells are today. And we are going to talk about chronic pain and things that you can do to help with chronic pain as well as how to establish and execute your relationship between healthcare providers and patients. So Rafi, welcome to the show.

Rafi Salazar 4:09
Hey, thanks for having me.

Debra Muth 4:10
Thanks for joining us. Tell us a little bit about yourself.

Rafi Salazar 4:14
Sure. So I’m an occupational therapist by trade and I guess my work in chronic pain and life started back in when I graduated, I went and worked with the Department of Veterans Affairs and saw a lot of veterans that were experiencing chronic pain and the time I was there was that whole 2012 through 20, like 1516 timeframe where the VA for a long time had been promoting. Basically because they had too much too many patients and not enough clinicians. They weren’t they were doing a lot of opioid treatment for pain and then all 2012 and on, it’s kind of when the FDA said no, this opioid epidemic is what it’s being called now is out of control with us. are cutting people back. And they began. Some of the stories are, were pretty horrendous. There were people have been receiving fentanyl, fentanyl patches and things like that for 15-20 years, and they went into their PCPs office. And they were basically told we have to cut you off. So these patients have, at that point builds up a dependency on these medications to manage their pain and their chronic pain. And then we’re being basically cold turkey. So-

Debra Muth 5:26
yeah, no weaning process or anything with that. How terrible,

Rafi Salazar 5:31
it was it was pretty rough. Sometimes there was some stuff down, but a lot of it was the the physicians themselves are scared about prescribing opioids, because they began being monitored and watched and all of that. So in an effort to keep veterans from being just dropped, right, the VA really invested a lot of time and energy and research into non pharmaceutical methods for managing chronic pain. And I was able to work with the team to develop we call it an integrated or multidisciplinary approach to pain management. And that’s kind of where where my work with pain got started. And through that, through that work at the VA, was able to help a lot of veterans that were experiencing pain for decades, get back to living their their life as best they could. We always told people you know, chronic pain is chronic, because it’s there for a while. But it doesn’t have to limit you or keep you from doing the things you want to do. The goal is to be able to really facilitate the patient or the client to do the things they need to do while managing whatever aches and pains results from their from their work right or from their from their activity or participation in daily life. So we did a lot of work in with mindfulness and dealing with neuro plastic pain or pain that originates from the nervous system as opposed to like a tissue damage or something like that. And it was really, really meaningful work. And then I ended up leaving to go do some consulting with the Department of Behavioral Health here in Georgia and did some work on it was statewide integrated mobile clinical supports and then wanted to get back into treating patients again, did a small stance teaching at the university, and then wanted to get back to doing hands on patient treatment again and got into what we do now, which is proactive rehabilitation and wellness to way multidisciplinary outpatient rehab clinics, a physical therapists and occupational therapists really focusing on folks that have persistent or chronic musculoskeletal pains. We treat a lot of folks that have been in pain for years.

Debra Muth 7:43
That’s awesome. I love that you guys took what could be a really horrific situation. And unfortunately, is because the the world right now that we’re living in, we have a lot of people addicted to these medications, and just being cut off, but you created a program for them that could turn things around and make it easier for them. So they didn’t end up on the street looking for Oxycontin or heroin or some of the other medications that they can get on the street that act like their prescription drugs, but are going to keep them in a worse situation. So thank you for doing that. That was amazing.

Rafi Salazar 8:19
Yeah, it was it was a lot of meaningful work for sure. It’s one of those things that gets you excited when you wake up in the morning.

Debra Muth 8:25
Absolutely. Can you tell us a little bit about what that program entailed? Like what did you guys put together for people?

Rafi Salazar 8:31
Sure, so the program entailed it was multidisciplinary, meaning that it wasn’t just like you didn’t just go to the PTA office. At office, it was usually managed at at a team level really. So we had a physician involved with PTO team we had neuro psychology involved. And some psychiatry and we ended up looking at some of those. We really focus on the non physical factors for pain. So we took what’s called a bio psychosocial approach, which is the traditional medical model is been biomedical, which basically says if you have pain, because there’s a physical problem with your biological problem, maybe it’s a tissue that’s too tight, or maybe you’ve got a muscle, it’s out of balance, or maybe it’s a postural thing, or maybe there’s actual damage to your tissue that needs to be healed. And when that is taken care of that physical problem is taking care of your pain goes away. And what we know from the research is that that is especially in the realm of chronic and persistent pain, that that’s not always the case. So there are other factors. That’s where the bio psychosocial approach comes in. So there’s a biological and sometimes that that really does need to be addressed. But for most folks that have been experiencing pain for a very, very long time, just fixing the muscles in the chair Using the joints doesn’t necessarily take away the pain. So we really focus on those ancillary factors. So mental health is a big one, stress anxiety, especially at the VA, you know, you’re dealing with with folks that might have had a comorbidity of like PTSD or Post Traumatic Stress Disorder, which was impacting their pain. In fact, it’s pretty interesting research about that there, there are folks that that may have chronic musculoskeletal pain, let’s say shoulder back pain or something like that. And they will have a PTSD flashback or a reliving of that traumatic experience. And when rated on subjective pain measures, the next day, their pain will be through the roof. And if you look at it, like there’s nothing biologically changed with this patient, they didn’t pull a muscle, they didn’t fall and hurt themselves, but their lived experience of pain is much more profound now. And they really have an almost an increased perception of their pain level. And that is entirely due to their, those psychosocial factors that are affecting them their live pain experience. So when we got together and began putting these, this program in place, we it was all about building in what we called safe movement or safe participation in life not safe from like, keeping you safe from gunshots or anything like that. But if you think about what pain is, pain is, according to the International Association for the Study of pain is, pain is an unpleasant sensory and emotional experience that’s associated with either real or perceived tissue threat or tissue damage. What so if you break that down, it really just means that the pain is a creation of your brain and your central nervous system when your brain thinks that you’re in danger. So what we focused on was kind of educating patients and saying, Listen, you’re experiencing this pain, because over the last 20 to 1015 20 years, your your brain has really felt threatened. And when your brain feels threatened, and it feels like you’re going to damage yourself more, it’s going to create the sensation of pain to keep you from hurting yourself. That’s its whole job. So what we want to do is begin building in a structure that allows you to move and to do the things you want to do, again, while retraining your central nervous system, your brain, all your nerves, all of that kind of thing, that this movement is safe, and it is okay. And then once you can build that in, you can begin expanding, it’s okay, maybe it hurt to lift your arm up to your shoulder, but now we’ve retrained it, and you can lift your arm up to your shoulder that painful now it’s time to make that a functional activity. Maybe you want to throw the baseball in the backyard with your grandkid or something like that without paying well, let’s build that into a structure that you can do that in a way that retrains your nervous systems, that it is a safe and normal movement and that there is no threat or actual damage happening to your tissue. So a lot of it was was very much stemmed in that idea of neuroscience that what we’re trying to do is retrain the nervous system that this movement is okay, and it is safe, and it is not associated with any kind of threat.

Debra Muth 13:16
I love that because I think you’re you’re so on to things like when, when you’re afraid something’s gonna hurt overtime, you just don’t do it anymore, right? Like, I can’t get on the floor and play with my kids, because it’s going to be too uncomfortable to get up or I’m not going to be able to get up and people are going to see that I’m struggling to get up. And that’s going to be embarrassing to me. How does, like this is such an interesting topic for me, because some people have very little actual physical diagnostic pain that we can measure. But yet, mentally, they feel like they are in so much pain that they can barely move. How does that affect us whether it was a post traumatic stress, or maybe it was just the pain themselves, and they have a very low pain tolerance. Can you talk about that a little bit?

Rafi Salazar 14:06
Sure. Yeah. So we see this all the time in the clinic folks, they come in and they say, my back is killing me. And I’ve seen three doctors that had an x ray had an MRI and everything looks normal. So I shouldn’t be feeling pain, right? And we always try to tell them like if you think about going back to that definition of pain, that pain is a sensory and emotional experience that that is a creation of your brain based off of the real or perceived tissue threat. So if you think about your whole brains job from like a biological standpoint, from an evolutionary standpoint, it’s to keep you the organism alive and in the gene pool. It’s got a vested interest in making sure that you don’t damage yourself. So in the way normally works like typical pain response, like if you touch a hot stove or something like that, and that burner really does damage your skin and it burns those tissue Using a cause of injury, that heat from that stove stimulates those nerves that send that signal up to your brain, your brain says, Oh my gosh, this is this is causing pain, this is causing damage, we need to get your hand out of this situation. So your hand feels pain and you jerk your handle it. So you get that feeling of pain. And that’s a normal protective mechanism. There was a real threat, he was causing tissue damage, your brain took that that sensory input from the from the show and said, Wow, this is causing damage, we need to we need to get this guy to get his hand off the burner, you felt the pain, you jerked your hand away. That’s the way it’s supposed to work. And then what happens is after that time, you don’t have any more pain in your hand, right? Like once you remove your hand from the show, it doesn’t hurt. However, sometimes, and especially it’s instances of chronic or persistent pain, your your brain kind of gets that wrong, right. So your brain is always getting this input. It’s always kind of making these judgment calls. Sometimes it’s okay. And sometimes it’s right on like this is causing pain, and this is causing damage, we’re going to create pain, so you don’t you know, further injure yourself. Sometimes it gets a wrong there, right. And a great example of this happens to be I’m trying to think this is a pretty common story in the ER an example a case study that happened I think in Australia, in the pain science realm. So someone was working in construction, they they fell off a step, and they landed on a nail and the nail is sticking right on the top of their boots. And this person was in agonizing pain, couldn’t step on their foot converting weight, he was a very, very big deal, they got this guy loaded him up, took them to the arm, they decided that because of the nail sticking through his boot, they couldn’t just rip his shoe off. So they’re gonna have to cut this boot off and remove the nail and do the sutures that say they want to do this plan. Yeah. And the patient the whole time is writhing in pain. So the doctor gets there, they take their forceps or their scissors and they cut the booth. And what they see is that this nail was actually right in between the guys toes.

Debra Muth 17:04
Oh my gosh, yeah.

Rafi Salazar 17:06
Because the man looked down and saw his nail in his boots. The only logical explanation was that it went through something and it’s gonna cause a lot. So this, this person’s brain had really created this great sensation of pain to protect this individual. It just got it wrong. And the same thing happens with anybody, you know, whether you tweak your back, lifting a box or bedding down to playing with the grandkids, over time, your brain and your sensory system just gets those those calls wrong. And what happens is over a series of getting those misinterpreting the sensory input over time, that is a learned pain behavior so that the person knows Oh, man, every time I get down on the floor, it hurts my back to get back up. And it’s not that it’s you know, I always tell people, it’s not in your head, but it is a creation of your brain. So the pain you are feeling is absolutely real, the pain that these patients feel, regardless of whether the X ray shows something or the MRI doesn’t. The pain, the lived experience of pain is absolutely real, all we need to do is just retrain that sensory system that this isn’t dangerous, right? And when that happens, then you can begin moving in pain free, but it’s a little the brain is incredibly complex. And it’s interesting to say the least, especially when it comes to pain.

Debra Muth 18:26
Absolutely. I mean, and certain neurotransmitters trigger certain things. And so if you’re deficient in those neurotransmitters, your pain levels going to be higher. And everything’s going to be crazy. You know, how I just have to say this, had we had this approach prior to doling out opioids over the years, we would not have created a pandemic of opioid use and abuse and convention the number of people that wouldn’t have had to suffer all these decades being on pain meds because somebody actually told them how their body was perceiving pain and taught them how to change that perception of pain?

Rafi Salazar 19:08
Oh, yeah. It is unfortunate, you know, you got I don’t fault any of the of the doctors that they were just doing with what they knew to do at the time. But the reality is, especially now is that our that our just knowledge of pain and how it works and the complexity of it has grown. There are definitely a lot of practitioners now. They’re taking this approach with patients and trying to sit them down and saying, Listen, you know, there’s a better way to deal with your pain and thinking that something’s wrong. And I think that the greater issue for me isn’t even that these patients are just getting his medications is that they’re, they’re losing hope they’re not being given hope by the by the medical system, they’re being told you’re you’re always going to feel this pain or we’re just going to give it give you this this pill or you’re gonna have to deal with it XYZ way, whatever that may be. And the reality is that for many, many patients out there that have been experiencing pain for years, decades, even recovery is possible and self management is possible. And that’s the goal for everybody. And I tell patients that your brain is changing from the day you’re born until the day you die. So it doesn’t mean that your pain will be gone forever. But we can definitely make some inroads life a little bit more pleasant in the time that you’re here, right?

Debra Muth 20:30
Absolutely. You know, and I don’t blame doctors, either. Because those are the tools we had, I blame the medical system, because insurance never wanted to pay for this type of process or therapy. You know, they don’t want to pay for a lot of things that truly help. And so they’ll pay for a medication but might not pay for therapy. And if patients are already in pain, and they’re already not working there, funds are already limited. And if insurance doesn’t cover something, many of them don’t have the funds to access it. Or these programs don’t exist in a lot of places for them to access it. And nobody teaches the doctors in the clinic that these kinds of things actually exist, because there’s not that big pharma behind it. So nobody goes to their clinics and talks to them about it unless they learn it at a conference or something. We’re in the dark as much as the patient is in the dark.

Rafi Salazar 21:22
Yeah, a lot of times it’s the case. And then you have to look at the kind of the incentive structure behind it. You could hit it a little a little bit ago, I’m not one of those like big conspiracy theories that talk about, you know, big pharmas getting in cahoots to try to keep people hooked, I think it’s just it’s it’s incentives, right? It’s human behavior. And the pharmaceutical, pharmaceutical companies do make money and they’re and they’re in the business of making money. They’re incentivized to to get people prescribed their medication. So yeah, they’re they have a vested interest in making sure that every doctor in the country gets their pamphlet or gets their CEU course, I guess, their pain lives, whatever it happens to be. And it is unfortunate. It’s the is the situation we find ourselves in.

Debra Muth 22:09
Absolutely, I blame the insurance companies actually, because they don’t want to pay for anything. But yet, if they paid for this, they could save a ton of money on the back end of decades of medications and disability, and people’s lives being distressed and multiple medications. And then obesity, because they can’t move. I mean, we could go on and on and on of all the things that happen when someone’s in pain, and they compensate. And that’s more expensive to the insurance company than the insurance company picking up the tab for a program like what you’ve created. That’s where the problem

Debra Muth 22:43
So when we’re talking about providers, and somebody’s looking for a health care practitioner to work with them on their pain, what kind of advice can you give to them?

Rafi Salazar 24:55
Sure. So especially if you’ve been experiencing pain for a significant amount of time time or if you tried traditional aid using traditional kind of sandwich, if you tried treatment before, and now you’re kind of at your wit’s end you, you’re still experiencing pain, the biggest thing to look for when you’re looking for a clinician to help you treat your pain is to find somebody who is talking about this whole idea of, of Neuroscience and Pain perception, because that’s really where a lot of these inroads are, that’s where a lot of the research is now pointing for relief in chronic pain. So whether that’s somebody like, oh, he just wrote a book, it’s called the way out, I think his name is a long sieve. But he developed something called pain reprocessing therapy or Adrian Lowe and his work on therapeutic neuroscience, education, all of these, these treatment programs kind of centered around the same thing, which is retraining the nervous system for safe movement. So when you’re looking for, for a clinician, you don’t want to shy away from somebody who’s, who tells you, we’re going to fix your posture and your muscles and make you pain free. Because we already know that that’s not necessarily the answer, especially if you’re experiencing pain for many, many years, you want to find somebody who’s, who’s saying things like, we’re going to build, you know, put this structure around you to create a safe environment. And then we’re going to kind of pull the scaffolding back as you went to the you can begin living your life pain, three words like self management, bio, psychosocial, all those little key words, they should start, you know, reading little little bells in your in your head and saying, okay, like this, this clinician gets in and gets what I’m going through, and probably has a process in place for helping people like me, and then that that is probably the last point is you want to find somebody who has experience treating patients who have been experiencing pain for a long time. Many clinicians and many, you know, I’m from the outpatient occupational, physical therapy world, they do a lot of work with, you have a knee surgery, or you tweaked your back, let’s get you in, and let’s fix it. And that’s, that’s really where like a biomedical framework can work. You know, let’s get this muscle healed and you’ll be back to normal. But for somebody who has been experiencing pain for many, many years, we know that that’s not necessarily the case. And you want to find somebody who has that experience treating people with persistent musculoskeletal pain.

Debra Muth 27:37
Typically, in a program like that, are you also looking for a practitioner that partners with other experts, like the psychologist and the psychiatrist and other people like that?

Rafi Salazar 27:48
Yeah, it can work that way, for sure. And I know that the clinical we that we have here at Proactiv, we do have some connections with some of the pain management physicians in the area that we trust that we’ve done some work with. Sometimes it can even be like a chiropractor or something like that. Because sometimes there’s, it’s people are complex, right? Right. It is a biopsychosocial approach. And sometimes there is a muscle that needs to be stretched or tweaked. Or sometimes there is an adaptation that you need to make in the way you’re moving in your posture in order to kind of get things going, right. So yeah, you want somebody that’s got, whether it be a deep bench of people that we can refer to, so that you can get what you need from all the various disciplines because again, we try not to work in silos or we shouldn’t work in silos. You don’t want to go to a physical therapist who’s telling you it’s your posture and then you go to your primary care physician, your pain management doctor says what do you need as a pain medication, you want all of those clinicians in a working on on your case, on your specific issue to be on the same page. So we do spend a lot of time calling doctors talking to their nurses talking to patients that doesn’t three ways between doctors and even another physical therapist and the patient, just to make sure that everybody’s kind of singing from the same song sheet when it comes to treating this patient and getting their, you know, their function back. Because that’s what it’s all about. It’s not even about, you know, turf wars and all this kind of stuff, like it’s really about it should be doing what is best for the patient. And sometimes that means that we make a referral out for somebody and they don’t ever come back and see us again because they don’t need us. And that’s what I want for them. I don’t want patients to be seeing me in a year. I want them to be living their life and playing with their grandkids. Right. Absolutely.

Debra Muth 29:43
So is this program offered at the VA?

Rafi Salazar 29:48
It should still be Yeah, I’m assuming so that they still have an interdisciplinary or multidisciplinary pain management programs there especially because, you know, the the opioid epidemic hasn’t gone away. They’re still trying to limit that. Limit that that prescription. I know some VA that I’ve talked to in the past have instituted things like even music therapy and things like that for addressing again, those those non physical factors.

Debra Muth 30:16
So is this a program that can be done via telemedicine? If somebody’s a long ways away from you? Can they still do this program? Or is it a program that’s just in house?

Rafi Salazar 30:26
No, absolutely. So I personally love the move to telehealth. Because it kind of takes away I come from, I guess, when the physical medicine world, it takes away the biggest crutch that clinicians like myself have had for years, which is you’re in pain, and we can use these our hands to make you feel better, right. But relying on that sort of treatment, the manual therapy, the stretches, the manipulations, all of that kind of stuff, the mobilizations, all of the research shows that while those treatment techniques and treatment methods are good in the short term, they can be potentially damaging in the long term, because what you do is you you instill in the patient, this idea that I have pain, I need to go get an adjustment, or I have pain, I need a therapist, to massage this or stretch this. And, again, that’s that’s not necessarily the case, especially with with persistent pain. So the one of the great benefits of telehealth to me is that it removes that that crutch, which means that clinicians have to rely on those higher level really higher value services, which are facilitating self management, which is just a fancy term for helping patients with the life thing without pain, right? Absolutely. And that’s kind of so telehealth in particular, can be very effective in that because it removes this potential danger of becoming what we call clinician dependent or something like that. Were you building the sense of dependency? So tell us you can definitely work with something like this.

Debra Muth 32:09
That’s awesome. So can you tell us a little bit more about the rehab you practice solution that you have?

Rafi Salazar 32:16
Sure, yeah. So rehab solutions is my consulting firm, where I work with healthcare organizations, usually private practices, and the like to develop programs with them for their patients, whether it be we do some of the marketing stuff, and then the other piece is like the clinical operations piece. And then I’ve got proactive rehabilitation of wellness, which is the outpatient clinic that I own and operate here in Destin, Georgia. So a couple of different things.

Debra Muth 32:47
Awesome. And if our listeners are hearing this podcast right now, and they’re thinking either they themselves are in chronic pain, and they need some help, or they have a friend or a loved one that could benefit from your services, how do they get in touch with you? How do they start this process?

Rafi Salazar 33:02
Sure, the easiest way to find us is on our website, which is pro-active health.com. So pro PR0 hyphen active health.com. We’ve got all kinds of articles and videos there too, about product pain and chronic pain management. And if nothing else, if you happen to be across the country from it, nothing else, maybe it’s a good, good resource body to have a discussion with the clinician in your local area.

Debra Muth 33:28
And if they find a practitioner that’s interested in working or learning more about this, they can also contact you from the rehab you practice solutions, and you’ll work with them to create a program like what you’ve created?

Rafi Salazar 33:41
Sure, absolutely, you can find that at rehab, you practice solutions calm, that’s rehab the letter you practice solutions.com. In fact, we’ve actually got a book coming out at the tail end of this year called better outcomes, a guide for humanizing healthcare, where we spent a good bit of that book, or I spent a good bit of that book, describing some of these pain management approaches the biopsychosocial approach and facilitating human relationships and health care and all of that.

Debra Muth 34:09
That’s fantastic. And, you know, I think this is great for our listeners, because many of them can be afraid to have these conversations with their practitioners. But I will tell you as a practitioner, I love when people bring something to me that’s new and exciting that I don’t know about and I want to learn more about it. And many practitioners will be open to learning about this and taking on new skill sets if you just open the door and invite them to learn more. So don’t be afraid to share this information with your practitioner, even if they don’t know anything about it. Because you may be the key that opens the door for them to learn something new and offer it to people in there in your area.

Rafi Salazar 34:49
Absolutely, yeah. And you need to think of healthcare as it’s a it’s a two way street, right? Like healthcare is not this hierarchical approach. You should not look at your clinician It is like the god king sitting up on the throne telling you what you’re going to do. It really is a situation. It’s a human relationship, which involves co creation. So you and your clinician should be developing your treatment plan together as opposed to him or her telling you what you’re going to do all the research, so that’s gonna be the way that works out the best anyways, so look for that co creative spirit with the clinician,

Debra Muth 35:25
Absolutely. Rafi, this has just been a wonderful conversation. Thank you for joining us today and sharing this. I’m sure this is going to help a ton of people because we have a lot of chronic pain in this country, and we need to learn a better way to deal with it and people want their lives back. So this is a perfect way for them to do that. So thank you so much.

Rafi Salazar 35:44
Yeah, thanks for having me on.

Debra Muth 35:48
Hey, it has been really great sharing this time with you guys on the let’s talk wellness now podcast. If this episode has helped you or you feel as though this episode would help someone else we’d love for you to leave us a review, share this podcast. And if you don’t want to miss the most exciting episodes we have coming. We’d love for you to subscribe to our podcast on iTunes or Google Play. Until next time, live every day to the fullest.