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Continuing our conversations around diagnosing and treating persistent orofacial pain, the following article explains the new classifications for dental pain and the people behind the changes.
Professor Chris Peck is a senior transformative leader who, as a leader of a major University initiative and Dean of Faculty, has developed and delivered innovative and sustainable University- and community-wide research and education strategies. These roles have been in complex multi-stakeholder environments where he has developed industry, government, and community collaborations to produce effective and efficient outcomes with significant impact domestically and internationally.
Australian and New Zealand Academy of Orofacial Pain
– Present 13 years 4 months
Leading the National Academy that provides a unified vision for the development of clinical care, research and teaching of orofacial pain in Australia and New Zealand
It’s incredibly important to have clarity around these classifications and definitions of pain because if you can’t make the diagnosis, how are you going to treat patients appropriately? That’s been a problem in the past.
Dr Chris Peck, MJ Cousins Pain Management and Research Centre
Hope As A Therapeutic Intervention For Chronic Pain With Dillon Caswell, PT, DPT, SCS
Welcome back to the Healing Pain Podcast with Dillon Caswell, PT, DPT, SCS
The more we study pain and pain management, the more we realize how much power the person experiencing the pain has over their own experience and healing. This is why our job as practitioners is not to be the solution for our patients, but to help them find the solution for themselves. This powerful perspective is brought to us by Dillon Caswell, PT, DPT, SCS, a groundbreaking expert on using hope as a therapeutic intervention for chronic pain. In this episode, we learn how hope can easily be one of the most effective salves to pain that we have access to. This is not the passive yearning that we often associate with the word “hope”. This is something much more powerful, and it may be the thing that makes a difference in your practice or in your life. Tune in to learn more!
Watch the episode here
Listen to the podcast here
TRANSCRIPT – Hope As A Therapeutic Intervention For Chronic Pain With Dillon Caswell, PT, DPT, SCS
In this episode, we’re discussing hope, widely considered as an important therapeutic factor in health, and the usefulness of hope as a therapeutic intervention, not only for chronic pain but also for many other chronic health conditions. We’re joined by Dr. Dillon Caswell. Dillon is a sought-after doctoral-trained physical therapist with over a decade of experience in practice as well as higher education as an adjunct professor at SUNY Upstate Medical University.
In this episode, we dive headfirst into the depressing challenges society faces when it comes to pain and the process of healing. We’ll also explore the heart-wrenching question of why people give up on meaningful activities and how we can infuse hope into a healthcare system that sometimes feels like it’s drowning in despair. Dillon’s work also begins to unravel the incredible power of the human brain and how a shift in our mindset can be the key to unlocking relief for those suffering from chronic pain.
Thank you for joining us as we embark on this transformative journey of discovering the role that hope plays in chronic pain recovery. Don’t forget to hit that subscribe button and make sure to share this episode with your friends and family. Without further ado, let’s begin and let’s meet Dr. Dillon Caswell.
Joe, thanks for having me on. I’m excited to dive into this conversation.
Me too. We dance around this topic a lot, but we don’t ever talk directly to it or raise awareness around it the way you’re doing with some of the work you’re leading. I think we’re going to talk about some of the work you do as a licensed physical therapist and a practitioner and then raise awareness around this topic. Why is the topic of hope something that we should be talking about in chronic pain and chronic illness in healthcare in general?
It’s a great way to start it off and dive into it. There are a lot of misconceptions about the term hope. A lot of people will think that hope means that it’s something passive. You’re sitting there and hoping that something gets better. You’re hoping that you get out of chronic pain and get back to these activities. When we look at hope, there’s a famous researcher out of Kansas University named C.R. Schneider. He was a hope researcher and found that for hope to exist, it’s an interplay of the following three statements of self-agency, goal-directed behavior, and a framework.
When we look at that, we start to understand why hope is so important to be integrated into our healing process. Much of what we’re getting from our current healthcare system speaking to the United States is, “Nope, you go in, you’re in pain, and you’re uncertain.” You don’t know what’s going on. You want to know, “Am I going to be okay? Am I going to be able to work? Am I going to be able to provide for my family? Am I going to be able to play this sport? Am I going to be able to go for the morning run?”
All these things that make you the person that you are, you’re starting to wonder, “Am I going to be able to do these things because I’m uncertain? My movement system seems pretty chaotic right now. I’m having this pain response and may not know what’s creating it. I then go into an office. Instead of getting a solution, I’m being told or given more evidence that I’m frail and fragile.” It could be through imaging or by not being heard. There’s research showing that a person is interrupted every eleven seconds in an office when they’re trying to tell their story.
I go back and think of growing up, having an Italian family, and how frustrating it is to attempt to tell a story and then continuously get interrupted. You get to the point where you’re like, “I’m not going to tell the story anymore. I’m checked out of this because I want to move on to the next thing.” Many people are having this experience when they’re looking for some certainty, answers, or a solution. They’re getting further rejected. They then start to give up things that are meaningful because they’re afraid to live the life that they’re meant to live.
I commonly say that we have so many people in this world, but not a lot of people are alive. A lot of people are getting up and putting their effort into getting through that day. Granted, we all have those days you’re struggling to get through. Overall, we need more people who are alive, enthusiastic, and happy to be doing the things that they were meant to do. To me, that’s where hope comes in. We need self-agency. We need to recognize that we can take ownership of our actions. There’s this common thought that we have this lizard brain that controls us. This lizard brain makes us do certain things.
We talk a lot about active ways to cope with pain and other conditions. There are passive ways to cope. It sounds like what you’re saying is that hope is an active means of coping with whatever condition, situation, and poor health that someone is facing. Initially, when people think of hope, it’s almost like you hear the expression, “Tonight, I’m going to hope and pray on this.” Some people view that as taking a more passive or backseat approach to what they’re dealing with.” However, you’re trying to say, “Hope is a positive psychological way to cope with whatever it is that you’re facing.”
It’s using these self-generated actions, goal-directed behavior, and a framework to achieve it. One of my favorite sayings is that hope is learned and earned, meaning we learn to become hopeful when we face adversity and suffering. If you’re living, you’re going to face adversity and suffering as part of the human experience. One of the things that we can guarantee in this life is that there are suffering and obstacles that you’re going to face.
As you go through those and adapt and become more resilient, you start to learn that you can remain hopeful in these situations. It didn’t happen by you passively letting these things happen to you. They happen because you decided to lean into it and that there was going to be a different outcome that was going to happen from that obstacle. People think of hope as being this passive, “I’m going to hope that it gets better.” Hope is learned and then it’s earned. How is it earned? It’s earned from putting the work in and by taking actionable steps to get closer to that outcome.
Of course, this is all wrapped up in the thought of, “How do we help people heal?” I say, “How do we help people?” What you’re saying is that, in some way, our job as a practitioner, or maybe your job as a friend or a colleague, is to empower someone to heal. What are some of the challenges you see with regard to the way we approach, on this show, chronic pain, but in general, the healing of chronic illness and disease in our Western society and medicine?
It’s partly why I wrote the book Hope Not Nope to hopefully become part of the solution. I spent so much time becoming angry and complaining about the healthcare system. I said earlier that we all will face suffering, but my belief is that our suffering has been conditioned to be longer than it was meant to be because of the narrative surrounding these chronic illnesses and the lack of control.
When we look at the number of chronic diseases, it’s pretty scary. The rates of type 2 diabetes are increasing. Seeing this number increase, but people are not getting the message, “There are a lot of lifestyle habits that you can use that this thing can be preventable.” Type 1 diabetes is a completely different story, but in type 2, we have a good chance to get rid of that when we look at the current treatments that are offered for chronic pain.
Joe, I know you’ve done a lot of work in this area, but at least in the United States, people are often offered opioids as a first-line defense to taking care of their chronic pain. We know that that’s not the solution. In Upstate New York, we’ve gotten a ton of pollen. There hasn’t been a lot of rainfall, so there’s been all this pollen all over the place. I have a studio, and in front of the studio, there was this layer of pollen coating the driveway.
I spent about three weeks sweeping out the garage because of all the pollen that was in there. I kept sweeping it out to the driveway. The next day, I’d go in, pop the door open, and the pollen would come back in. I kept doing this over and over again until I had the realization that I needed to take the next step. The next step is to sweep the pollen out of the studio. Now, I need to get it out of the driveway, or else it’s going to keep blowing back in again.
When we look at chronic disease, that’s what the model is right now. It’s taking the pollen and sweeping it back into the driveway, but it’s not taking care of what’s causing that underlying condition. We offer these short-term fixes. What ends up happening is that the person then gets in the cycle that it keeps coming back because what has likely created it hasn’t been dealt with front on. It’s just been distracted.
To me, the challenge is how we get our system to start taking that second step. How do we get people to start going, “I’m going to go ahead and decline that opioid because I want a different approach that’s going to take the pollen and get it out of the driveway?” Once that’s out of the driveway, and back to that analogy, now I’m not spending my morning sweeping for an hour. I’m not spending my evening sweeping for an hour. I’ve gifted myself two hours in the day to partake in meaningful activity because sweeping is not meaningful to me. It’s a task that I do to keep my clients happy, but it’s not something I enjoy doing.
Now, I don’t have to sweep as much. That means I have two more hours to read, research, or hop into conversations. By doing that and taking that extra step, I’ve now gifted my time to be able to do things that are more fulfilling. By doing that, as that time adds up over time, my body is going to start to heal itself because of the fulfillment that it’s feeling. Instead of doing these tasks, it’s going to be, “I’m excited to do these things.”
It’s essentially because you see people with pain as well. When we talk to people with pain in their history somewhere, at one point, they had a ritual active life, and then this pain or this condition developed, or whatever happened to someone. There is this tipping point where you can see the meaningful activities at that point started to become less important, or for some reason, got pushed to the wayside or got put on the back burner.
It’s interesting to see or start to think about, “Why do people give up their meaningful activities?” If they are meaningful and bring you a sense of joy and fulfillment and you see a lot of value in what’s being done, what does lead to that straw breaking the camel’s back of, “Now, I’m not going to focus on my meaningful activities? I’m going to focus on my pain.”
The short answer to that is fear. It’s fear of, if they were to continue that activity, what potentially could happen. It starts with the conversation of what pain is because pain is this experience that most of us are going to have. I used to say all of us will have it, but there is a condition and congenital insensitivity in which a person doesn’t have that output of pain. What’s interesting is that when people have that, their lifespan is shorter. Pain gives us a constraint. It lets us know our thresholds. That can be an emotional or a physical threshold. Taking a step back, we need to change our perspective on pain.
Pain is not a bad thing. Pain is a constraint. Pain is asking us to change something about our life or being. It may be our sleep habits, relationships, work, or an activity that we’re doing. Pain is a request to change something about your being. With that being said, I was researching and reading this story about Albert Einstein, which I included in the book because it got me thinking. I start by saying it was from Albert Einstein because if you hear this story, you’d be like, “That sounds witty. That was Albert Einstein. That makes sense.”
The story goes that Albert Einstein was a freshman in his college class, and his professor stated the question, “If God exists and God created everything, then did God create evil?” The class was pretty silent. Einstein raises his hand, and he goes, “I have a question for you. Does cold exist?” The professor goes, “Of course, cold exists.” Einstein goes, “No. We have heat and mega heat. We have all these different levels of heat. We have absolute zero. We can continue to measure heat as it gets hotter, but we have no measurement for cold. Cold doesn’t exist. Cold is just the absence of heat.” The professor goes, “Okay.”
Einstein keeps going, “Does darkness exist?” The professor goes, “Of course, darkness exists.” Einstein says, “No. We can measure the speed of light. We have all these different variables for light, but we are continuously looking for dark matter and can’t find it. Darkness is the absence of light.” He keeps on going on. In the story, what stuck out to me and what I started reflecting on in our work is, “Does pain exist, or is it an absence of something?” We’ve seen the definition of pain evolve. We’ve seen international societies developing more pain definitions. Basically, what it comes down to is that it’s an individualized experience that’s specific to that person and the parameters around it.
We could have the same shoulder injury, but our response to that can be completely different depending on your previous beliefs, mindset, environment, and solutions that you’ve been offered. We can have the same injury but have a completely different pain response to it. It got me thinking, “Does pain really exist?” It’s a deep-thought question. I know it’s one that when people are tuning in, they’re probably like, “What do you mean? Yeah, pain exists.” The question that I pose is, “Does it exist, or is it an absence of meaningful activity?”
The reason that I pose that is because people I’ve worked with who are in chronic pain have that tipping point in which they’ve given up their meaningful activity. I gave an example in the book about this. I’ve worked with this one lady and she was in chronic pain for years. We tried a bunch of different things, and it seemed like nothing was working. I got to the end of it where I was like, “I don’t think I have much more that I can offer.” I’m not giving up on this, but I don’t want to be wasting her time. I want to make sure that she’s seeing the right provider and getting the right things.
She mentioned to me that her lifelong childhood dream was horseback riding. She was going on a trip to Puerto Rico, and she was wondering, “Do you think it would be a bad idea to ride the horse?” We got into the conversation and worked through it together. I was like, “It’s been your lifelong dream to ride this horse. You have the opportunity to do it. What’s keeping you?” She’s like, “The back pain that I feel.” “If you ride the horse or you don’t ride the horse, you’re still going to have back pain. Why not try it? Go for it. If it’s bothering you, then at least you tried it. You’re then not living with this what-if. You don’t have that regret anymore.”
She came back, and she had the biggest smile on her face. The entire time that she rode the horse, she had no back pain. It was the first time that she had no back pain for a part of the day in a long time. She came back and had one more appointment with me. She kept the appointment because she wanted to tell me about the experience. That’s what the appointment was for. I’m like, “You can just call.” She’s like, “No, I want to come in.” I’m like, “Okay.” I’m glad she did because I got to see that smile and the glow that she had back. It was amazing. She had no back pain while riding the horse.
When you learn about spine mechanics and all the things that you think you would need for horseback riding, you would think that this is going to “destroy her spine.” It didn’t. It led to her having a better well-being. I got into this of like, “People do well in chronic pain when we start to replace the pain they’re experiencing with meaningful activity.”
There are lots of different methods out there. When you look at a lot of methods that center around chronic pain, things like behavioral activation, activities of daily living, values-based activities, and meaningful activities, they all point in that area. You’re telling that story, which I think is a great story to tell because all of us, as physical therapists, probably have a similar story, where a patient was in pain and unsure whether they should do something. We basically encouraged or gave them permission to do that one thing. It worked out well for them. They felt good, and they didn’t have any pain from it, or at least maybe the pain didn’t get any worse.
As you’re telling the story, I’m tracking that story with you. There are three distinct parts I see there. The first is the relational piece that’s happening between you and the patient or the person you’re caring for. I see hope instilled there because you’re probably the first person who instilled hope in her that she could do something that she probably never thought she’d be able to do. I think she probably thought about it, contemplated it for a while, and hope started to build up inside of herself.
She then gets on the horse. Maybe a little nervous. She’s like, “I’m not sure I should be doing this. I’m thinking about my spine. The therapist said it was okay,” and then you do this activity. You’re in the Caribbean, it’s sunny, you’re riding a horse, it’s fun, and I’m sure there are friends and family around, etc., more hope builds. It makes me wonder as we start to look for things that alleviate pain. What you’re saying in some way is that hope is one of the great anesthetizes that we have access to.
I think it is and it’s part of the mission. From my experiences in researching this, hope can be the greatest healing agent that we have available to us. The difficulty with that is to get to the hope, you have to unpack a lot of the no that people have been given. A lot of the misinformation or lies or environment, as you were alluding to, of she was in the Caribbean, didn’t have environmental stresses, was with family, and didn’t have all these pressures on her. That environment then allowed her to have more hope and ability to have that thought process of, “I can do this. Not just I can do this, but I’m going to do this”.
Hope is super powerful. I remember doing an episode on a podcast with Chris Norton. His story, as I share it, people will probably start to remember it. He was a college football player. He wanted to make a tackle on a kickoff. He had a C-spine injury and was airlifted to the hospital. He was given a 3% chance to ever move again. Not a 3% chance to walk again, but a 3% chance to ever move again. In the process, what he said is, “That’s not 0%. I’m going to take advantage of that 3%.” With hope, he started pursuing that. In the process, he was in the hospital and started firing the providers telling him that he was making things up because he started to get some shoulder movement.
He started shrugging his shoulder, and they’re like, “No, that’s not happening.” He started to say, “I’m feeling something in my foot.” They came in and said, “That’s phantom limb pain. You’re paralyzed from the neck down. You’re not feeling these things.” He started to get movement in his toe back. Again, they came in and said, “You’re not moving it. It’s a thing that’s made up in your head.” He progressed to his college graduation and walked across the stage to receive his diploma. He gets engaged and walks down the aisle to marry his wife.
Was it the way that we would think of walking? No, he had assisted devices. He had people surrounding him, but this was a guy who was given a 3% chance to ever move again. He’s now standing and moving his limbs under his own power with support around him to do this. One of the things that he shared with me, and his documentary and book, was he had support from the community. His family started a Facebook group and people were pouring in messages of inspiration of what he was doing was impacting their lives and the difference he was making. He had his football team that was helping him to still pursue his college education. He had all the support in the world, but he was still being dealt this plate of nope.
There was one nurse who came to him at nighttime. He was at a low. He was crying and thinking, “I should start listening to this. This is what I’m stuck with. I’m not going to move again.” That nurse was the first one to get down on his level, look him in the eyes, and say, “Chris, this is possible. You can do this.” That little extra time, that look in the eye, getting to someone’s level, and giving them that message of encouragement fueled him to now get to that next level of that outcome.
As providers, that’s on us. When we’re building these relationships with people, we want to give them hope. The tricky part is that we don’t want to be unrealistic with the hope that we’re providing. We do still want to go through a thorough assessment. We want to understand their past, goals, and medical history. In doing that, we can start to provide appropriate hope. Back to the beginning, what do we need for hope? We need a framework. Getting those details allows us to develop that framework.
I’m wondering if, in some way, you think that the most giant nope people might experience is the healthcare provider who doesn’t know how to instill hope in someone’s recovery process. That most certainly exists in our Western medicine world.
It absolutely does. I’m going to take it a step further and say that it’s anyone who is a respected figure who is instilling nope into someone or rejecting someone. It can go down to the level. A lot of my work is with lifelong athletes. A lot of times, it’s from a coach they had when they were seven years old.
It could be a teacher.
A teacher like, “You stink. Go sit on the bench. Don’t get slivers in your butt.”
It could be the person who is authorizing the insurance coverage because that’s a person of respect who says, “Our data shows that people like you don’t walk again.” It could be a respected friend or even a spouse. There’s some research around a spouse or others’ influence on someone’s recovery.
I’ve worked with people a lot. They’re starting to have some knee discomfort and they don’t want to have surgery. They know a total knee replacement is available, but they don’t want that. They want an alternative way to go about it. Sometimes, the hardest part is getting their significant other on board with it. The typical conversation that I’ve run into, and maybe Joe, you’ve had a similar thing, is that the significant other goes, “They’re good when they see you, but you don’t have to hear them complaining about their pain later on. I’m dealing with the complaints, so I want this pain to be gone as soon as possible.” The way to do that is the surgery.
As a provider or bring it out to the bigger picture, as a respected figure, you have to get the team on board. You have to put in that extra time and take that next step to make sure everybody is rowing the boat in the same way. If one is rowing this way and another one is rowing that way, you’re doing a circle the whole time. I used to get myself in those circle situations all the time, and I’d be headbutting the desk of, “Why is this plan not working? What am I missing?” It was like, “I didn’t coach the whole team.”
The person that we’re working with has a support system with them that we should learn about as providers. Maybe you’re not sitting down and getting dinner with their second cousin. That’s fine. You don’t need to do that much work. At least saying, “The closest people to you, what do they think about the situation? What’s the information that you’re getting from them?”
Give us 1 or 2 practical, simple ways that someone can start to move toward this direction. There are people tuning in that are like, “I get this 100%. I’m on board with this, but I want to know how do I start to shift myself or my mindset.” A lot of this revolves around someone’s mindset. How do I start to shift my mindset toward a mindset of hope and healing?
That’s key because there’s a readiness that has to be available for this to be successful. I love the quote from Hippocrates, “When a person is saying that they’re ready to heal, ask them, are they ready to give up the things that made them ill?” I think that’s so powerful. That question of, there’s been a lot of things that have happened in your life that have led to this one point. It wasn’t just this one experience.
“When a person is saying that they’re ready to heal ask them, ‘Are they ready to give up the things that made them ill?’” – HippocratesCLICK TO TWEETI will say this, and I don’t have research to back this. This is from my clinical observation, but I’ve never worked with an athlete who got injured when they were at their best. When they were feeling their best, their families were all doing great. They had social support, sleep, and nutrition. They have never had that experience. Every athlete that I’ve worked with has gotten injured on the field. If you look a week or two weeks prior, there was a significant event that happened. The loss of a loved one, not having enough community, or not getting enough sleep. There’s something that preceded that injury happening.
With the shift in mindset to get someone on this path of healing, we have to look at the whole story. The first step is to be willing to share that story with people who are on your team to get you to that next step. After sharing, you have to have an openness to learn and make sure that you’re learning from credible information to allow that to start to shift your mindset and perspective. The worst thing that happens is when people, for example, come on a podcast and say something, and then the person goes, “I’m going to go do that because Dillon said to go do that.” No. Go put some research in and see if that is the right thing for you.
Our job is we’re here to guide people toward a solution. We’re not here to be that solution for them. When people say, “Go see Dillon, Dillon fixed me.” I go, “No, I did not fix you. I guided you to the ability to fix yourself by putting the right resources in front of you. It was you that did that.” If you’re that person who has struggled with no and has faced this rejection, you don’t want that anymore. You want to get back to hope. It starts with finding that person that you can work with, sharing their story, being open-minded, and putting the work in that you’re not receiving the information, but you’re an active part of it. As the perspective starts to shift and your body wants to start moving, that’s when we have to start to let it move.
I feel like constantly, we’re giving people permission to move. We’re creating safety. It’s interesting because when we look at research in the business world, what makes a business organization successful? Amy Edmondson has done a ton of research on this. What makes a business successful? The number one factor that has emerged is psychological safety. When people feel safe, they’re then more willing to take a potential risk because they know that they’re going to be supported.
I jokingly say, but seriously say that when a toddler is learning how to walk, they tend to fall about seventeen times per hour. Each time they fall, the parent doesn’t go, “You call that walking? That was terrible. Learn how to walk, kid.” They pick the kid up, nurture them, and say, “It’s okay. You hit the floor, but you’re going to get it. Go ahead and try it.” Even from that young age, that psychological safety that is presented allows us to then take the risk and move towards healing and experiencing hope.
Dillon, I want to make sure that we point everyone to your latest book. It’s called Hope Not Nope. Everyone can find that online. Amazon or your other favorite online book retailer. It’s a great book that Dillon wrote on this concept that we spoke about in this episode. Dillon, thanks for joining me here. Let people know how they can learn more about you and follow your work.
Thanks for having me on, Joe. It’s always great to connect with you and have these conversations. My website is www.HopeNotNope.org. Instagram is @HopeNotNope. Feel free to DM us and chat with us there. As Joe said, the book is online. It’s on Amazon and Barnes & Noble. There’s an Audiobook, physical copy, and Kindle available. Whatever one you like to read, it’s available for you there.
Everyone, hop on over to HopeNotNope.org to check out the book. If you are on Instagram, you can reach out to me or Dillon. You can find us on Instagram. We do lots of activities there. I want to thank everyone for joining us to talk about the importance of hope, healing, and overcoming chronic pain. Make sure to share this episode with your friends and family on Facebook, LinkedIn, Twitter, and Instagram, wherever anyone is talking about chronic pain and the hope to overcome it. See you next episode.
Dr. Dillon Caswell is a sought-out enthusiastic clinical Doctor of Physical Therapy with expertise and a Board Speciality Certification in Sports. He has spent more than 10 years in higher-level education both as a student and adjunct professor at SUNY Upstate Medical University.
He desires to empower and educate the next generation by cutting through the biased lies surrounding the human experience by constantly seeking and delivering the truth in science and healing. This mission has fueled him to author Hope Not Nope: Reclaiming Identity as a Lifelong Athlete in a Sick Healthcare System and to host one of the top alternative health podcasts in the world: The Prehab Podcast.
Dr. Caswell embodies servant-based leadership, bringing people that have been shamed with “nope” to the truth of hope, in a practice he founded and owns: Action Potential Performance Physical Therapy (AP3T), PLLC in Syracuse, NY.
The title of the podcast “dignity in chronic pain care” is a challenging one, and covers life living and death, especially for our community living with chronic pain and who are often left feeling there is no hope for a better life.
Dr. Chochinov has worked primarily in palliative care research, but sees a parallel in his work for people living with chronic pain. He explains what Patient Centred care really is and believes all medical professionals should strive for The Platinum Rule which he explains during the podcast.
How decisions are made and patients cared for are often guided by the Golden Rule, which would have us treat patients as we would want to be treated in similar circumstances. But when patients’ lived experiences and outlooks deviate substantively from our own, we stop being a reliable barometer of their needs, values, and goals. Inaccurate perceptions of their suffering and our personal biases may lead to distorted compassion, marked by an attitude of pity and therapeutic nihilism. In those instances, The Platinum Rule, which would have us consider doing unto patients as they would want done unto themselves, may be a more appropriate standard for achieving optimal person-centered care. This means knowing who patients are as persons, hence guiding treatment decisions and shaping a tone of care based on compassion and respect.
Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and Senior Scientist, CancerCare Manitoba Research Institute.
He is well known for many accomplishments including leading the research team that pioneered the Dignity Model and Dignity Therapy. He won the Prose award for his 2011 book – Dignity Therapy: Final Words for Final Days and he’s just published his new book: Dignity in Care – The Human Side of Medicine. He’s also the co-founder of the Canadian Virtual Hospice, the world’s largest repository of web-based information and support for dying patients, their families and healthcare providers.
The Platinum Rule
Seeing Ellen and the Platinum Rule
Strategies and approaches to dignity conserving care in practice
We are delighted to announce that Ass Prof Tasha Stanton has accepted our invitation to present webinar for our community. She has an extremely busy schedule but we have preliminary booked February 7th 2024.
The below podcast will help you understand her work.
Wednesday Aug 30, 2023
Episode 36 – Tasha Stanton (Relaunch) – Illusions and context in pain
Associate Professor Tasha Stanton delves into the realm of pain perception, context, and illusion. Prepare to embark on a journey of intellectual exploration as Assoc. Prof. Stanton shares her profound expertise in pain science and therapy. With a keen focus on research and therapeutic insights, she guides us through the labyrinthine of pain perception, revealing how our minds and bodies interact to create pain.
The “Le Pub Pain Podcast” offers a unique opportunity to engage with Assoc—Prof—Stanton’s groundbreaking research, exploring the multidimensional landscape of pain from both academic and real-world perspectives. Whether you’re a seasoned researcher, a healthcare practitioner, or simply curious about the mysteries of the human experience, this episode promises to leave you with newfound insights and a deeper appreciation for the complexity of pain.
There has been some interaction on our Facebook page referencing Stem Cell Therapy for trigeminal neuralgia. Over the years there has been some controversial claims on the subject, with medical professionals choosing which side they stood on the issue, however this is a quickly developing area of medical science.
In this article we provide educational content to help you understand the science and potential applications.
Current research is very much focused on the auto immune system and activating the bodies own healing capacities to cure invasive conditions like cancer.
So what are stem cells?
Stem cells are immature cells that have the ability to renew and differentiate to form different types of cells; in other words, they are cells that have the ability to develop into various kinds of other types of cells. For example, blood cells, nerve cells, immune cells etc. Human stem cells can be found in adult bone marrow or human embryos.
Australia is currently watching with amazement, one of our own prominent melanoma specialist treating himself with ground breaking novel treatments to try and beat a life ending brain tumour.
Stem cell therapy is not a new concept and has been researched for more than 15 years and below are highlighted two studies covering the subject.
Mesenchymal stem cells (MSCs) have been shown in animal models to attenuate chronic neuropathic pain. This preliminary study investigated if: i) injections of autologous MSCs can reduce human neuropathic pain and ii) evaluate the safety of the procedure.
Trigeminal NP encompasses variable states of diagnosis, this includes trauma resulting in maxillofacial NP, odontalgia which is atypical, and burning mouth syndrome. Trigeminal NP is considered to be a localized pain. Thereby, its patient population forms an ideal group to investigate the innovative novel therapy.
The below article link has been published via Stem Cell Care India
DISCLAIMER INFO: In 2010, for example, Regenexx sued the FDA, claiming the agency lacked the authority to regulate its procedures, which involved culturing stem cells before reinjecting them into patients. Regenexx lost its case and was countersued by the FDA, which charged that Regenexx was marketing an unapproved drug.20 June 2019
At Regenexx, we’re constantly expanding the number and type of patients we can help with precision orthobiologic procedures. While that occurs at all of our sites, our primary new treatment research site is our Colorado HQ. There we’ve been developing a new procedure to help patients with Trigeminal Neuralgia. This is very different than the Trigeminal Neuralgia stem cell treatment scams popping up at local integrative medicine practices. Let’s dig in.
What Is Trigeminal Neuralgia? How Is It Usually Treated?
Imagine that you wake up one day with severe facial pain. The pain is just like a severe toothache but in your eye, cheek, or jaw and nothing makes it go away. In fact, after a few months like this, with most doctors not knowing how to help, you’re considering the possibility that suicide could be the answer. That’s Trigeminal Neuralgia in a nutshell.
There are specialized nerves that exit the skull at various places called “Cranial nerves”. They come directly off of the brain or brainstem, unlike all other nerves that come off the spinal cord. They’re numbered 1-12 and the fifth nerve is called “Trigeminal”. It’s responsible for taking sensations from the face to the brain.
The Trigeminal nerve has three branches, the Mandibular (jaw), Ophthalmic (eye), and Maxillary (cheek):
These branches from top to bottom are also known as V1, V2, and V3.
When one or more of these nerves chronically misfires, this can cause chronic severe pain in the face, teeth, or nose. This pain is usually more intense than when other nerves in the body misfire because there’s less pain control circuitry for Cranial nerves.
The treatments are very invasive and involve either focused radiation to destroy the nerve (gamma knife or radiosurgery) or microsurgery to move an artery that may be aggravating the nerve (microvascular decompression). Both have high complication rates and aren’t always successful.
The New Orthobiologic Trigeminal Neuralgia Treatment
We’ve known for some time that platelet growth factors can help nerve function. In fact, we’ve published a paper suggesting that Platelet Lysate (the growth factors stripped from platelets in plasma) may help chronically irritated low back nerves. Others have published research showing that PRP can help the Median nerve in Carpal Tunnel Syndrome patients (4-9).
Hence, it wasn’t too far a stretch to think that if we developed a precise way to inject the Trigeminal nerve with Platelet Lysate (or PRP) that these patients may be helped as well without these invasive and destructive procedures. While I’ve treated some of these patients as well who also have Craniocervical Instability, Jason Markle, M.D. at our Colorado HQ really took the lead on this advancement. I’m proud to say that Jason has now begun to dial in this new promising therapy.
The new treatment, known as the Perc-TGN procedure is percutaneous hydrodissection of the Trigeminal nerve using Platelet Lysate. This involves first isolating platelets from the patient’s blood and creating a growth factor rich plasma in our lab. Then the doctor precisely places this mix using x-ray and ultrasound guidance around the problematic branches of the nerve. This both breaks up local scar tissue and provides growth factors for the nerve to help it heal.
Does Perc-TGN Work?
Let one of the first patients to receive this new procedure tell you about their journey:
“After a year of misdiagnosis, I was correctly diagnosed with Trigeminal Neuralgia (TN) in 2015. TN is often called the “Suicide Disease”, because of the level of pain and no cure. The TN nerve on the left side of my face was damaged, because a blood vessel was in constant contact and had worn away the Myelin Sheath, which protects the nerve. With every pulse I experienced excruciating pain. After seeing multiple neurologists and neurosurgeons in December 2018, I had Radiosurgery on the damaged nerve. This doesn’t heal the nerve, but blocks the pain signal from the nerve to the brain. The hope was that I would be pain-free for up to three years. After 13 months in February 2020, the pain returned like a freight train.
The next step would have been Microvascular Decompression Surgery. The possible complications from this surgery include a stroke or loss of hearing or sight on the side where the damaged TN nerve is located. While they have success, it’s not known how long one might be pain free. Not excited about this option, God another door opened for me.
Today there are lots of stem cell clinics. Although Centeno-Schultz in Broomfield, Colorado pioneered stem cell and PRP. Dr. Jason Markle, one of the doctors at the clinic, decided to do a small trial with me. I have had three Plasma Rich Platelets (PRP) injections over and around the damaged Trigeminal nerve. Because I was patient number one with PRP for TN at the clinic, each procedure was slightly modified. Initially, I had about three months free from pain after each procedure. It was explained, the PRP, if correctly placed, pushes the nerve and blood vessel apart and then initiates healing. It was expected after a period of time, the nerve and blood vessel would come in contact once again causing pain. When this occurred, I would have another PRP treatment.
I’m ecstatic to say, PRP is the answer to my prayers. It’s been 10½ months since my last PRP. NO PAIN for 10½ months and counting! When there’s no pain, you can easily forget that TN was ever an issue! NO PAIN whatsoever. I’m praying the nerve and blood vessel will stay in place where they belong… apart from each other. If the pain reoccurs, you can be sure I’ll schedule another treatment with Dr. Markle.”
Beware of Trigeminal Neuralgia Stem Cell Treatment Scams
This treatment approach will only work if the doctor has the skill set to use ultrasound and x-ray imaging to target these very difficult to reach areas where the Trigeminal nerve is being irritated. That takes years of specialized training that just isn’t available at your local chiropractic or integrative medicine clinic where there’s usually a nurse or poorly trained physician performing the procedures. Precision placement using advanced imaging guidance is everything in this procedure.
While you, like this patient above, may have heard about a local office offering to treat Trigeminal Neuralgia with stem cells, that’s almost always a scam. First, the birth tissues they’re using have no living and functional stem cells. Our research lab proved that in our recent publication in the American Journal of Sports Medicine (10). Second, this treatment won’t work if an alternative medicine clinic gives you an IV treatment (in the vein in your arm).
The upshot? It’s great to see that the physicians at Regenexx HQ in Colorado continue to push the envelope of what’s possible with precision ortho-biologic procedures. The new Perc-TGN procedure is a big deal as these patients in severe pain have few good options.
(1) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injection of platelet lysate for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. doi:10.1186/s40634-017-0113-5
(2) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi:10.1097/PRS.0000000000006266
(3) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi:10.1080/14712598.2017.1259409
(4) Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019 Aug 16. doi: 10.1007/s10067-019-04719-7.
(5) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.
(6) Shen YP, Li TY, Chou YC, Ho TY, Ke MJ, Chen LC, Wu YT1. Comparison of perineural platelet-rich plasma and dextrose injections for moderate carpal tunnel syndrome: A prospective randomized, single-blind, head-to-head comparative trial. J Tissue Eng Regen Med. 2019 Jul 31. doi: 10.1002/term.2950.
(7) Güven SC, Özçakar L, Kaymak B, Kara M, Akıncı A. Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med. 2019 May;13(5):709-714. doi: 10.1002/term.2815.
(8) Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg. 2017 Oct;51(5):301-305. doi: 10.1080/2000656X.2016.1260025.
(9) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.
(10) Berger DR, Centeno CJ, Kisiday JD, McIlwraith CW, Steinmetz NJ. Colony Forming Potential and Protein Composition of Commercial Umbilical Cord Allograft Products in Comparison With Autologous Orthobiologics. Am J Sports Med. 2021 Aug 16:3635465211031275. doi: 10.1177/03635465211031275. Epub ahead of print. PMID: 34398643.
Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile
If you have questions or comments about this blog post, please email us at firstname.lastname@example.org
NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.
Hello everyone I hope you enjoy this edition of my ‘President’s Reflections’.
National Support Line
During the past month, I have accumulated 347minutes of support time on the National Support Help Line for people living with TN.
Support Group Leader Meeting
I held our first support group leader meeting for the year, via Zoom 08/09/2023, I did the facilitating myself. Our support group leaders are from all walks of life and from across Australia, however the one thing we all have in common is TN. Our leaders presented many ways to hold a meeting, which worked for everyone. We discussed our part to play within the association’s framework and the best ways to help each other and our members. It was a successful meeting because we all collaborated with each other and got to know each other in a relaxed atmosphere. I’m very proud of all the support group leaders who give so much to help other people living with TN.
Support from Website
It has been my privilege to provide support for 11 new members that have asked to be contacted, via our website. I have provided them with links to our website, for articles that can support them. I’ve given them Doctors names and phone numbers. I’ve shown them how to find things on our webpage.
Once again, I’ve listened to their brave journeys with TN and provided a safe environment for them to talk and ask questions. It breaks my heart listening to their stories.
The Workshop for our committee and support group leaders is organised. Many thanks to Lyn Donnelly for her help and the countless hours of absolute skill. I believe the agenda for the Melbourne trip is finished.
A special thanks to Peter Gough for organizing our arrival, departure and transportation while we are in Melbourne.
Our first webinar for this year was held in August. The webinar was a terrific success with Assoc. Prof. Liam Caffrey chairing and Dr. Karen McCloy presenting and answering questions from the audience as well as questions from our members. Dr. McCloy is a wonderful presenter. She can fit a lot of education in, in a small amount of time. We are planning to hold a lot more webinars in the near future. Watch this space.
Instagram-Trigeminal Neuralgia Association Australia is on Instagram.
Our new Instagram account continues to gain momentum. Lyn is doing a great job taking care of our Instagram account. Lyn has many projects in the process at the moment. I will keep everyone posted.
Our Association has a lot of good things happening soon-I’m excited.
On A Personal Note:
It’s a beautiful time of the year…
Flowers are blooming.
Baby birds being born.
The smell of new blooms.
The sound of birds singing.
No cold weather to worry our trigeminal nerve.
The smell of a spring day.
The first cup of coffee on a beautiful spring day.
We have a community of people living with trigeminal neuralgia who we have connections to through face to face and online support groups and our media platform of website, Facebook, Instagram and ENEWS digital newsletter.
The following article was published via Beyond Blue and explains why connection can improve mental health.
Feeling connected to others plays a key role in our mental health and wellbeing. Discover why connection is so powerful – and how you can have more of it in your life.
How much social connection we seek out varies from one person to another, but one thing’s for sure – as humans, we share a fundamental need to interact with and feel connected to others.
“We are social creatures by nature,” says Relationships Australia National Executive Officer, Nick Tebbey. “That feeling of belonging and being connected is really important for our wellbeing.”
Research backs that up, with a 2017 study finding that social connectedness and mental health are not only inextricably linked, it tends to be connectedness that promotes good mental health rather than the other way around.
“On the other hand,” says Tebbey, “we know that feeling isolated and lonely has a significant impact on our mental and physical health.”
The many faces of connection
What it takes to feel connected can be different for everyone.
“Connection doesn’t look the same for all of us and that’s actually a real positive,” says Tebbey. “It means we’re able to connect – and feel connected – in so many different ways, regardless of our circumstances.”
So, while some kinds of connectedness revolve around physically spending time with like-minded people or doing something unifying – such as being part of a sports team or a book club – others are far less organised.
“Sometimes all it takes is making the effort to say hello to a neighbour,” says Tebbey. “Even small acts like that foster a genuine sense of connection.”
A study of Relationships Australia’s 2019 Neighbour Day – an annual campaign that encourages people to connect with others in their community – proved exactly that. Those who made the effort to do something neighbourly experienced an increased sense of belonging.
“It doesn’t have to be your next-door neighbour or neighbourhood community either,” explains Tebbey. “Communities exist in many different forms, including those you belong to online.”
And don’t forget how nice it can be to receive something in the post. Letter writing may be a lost art but there’s something really lovely about knowing someone has taken the time to put pen to paper just for you. Our premier partner Australia Post have launched a special release stamp set to encourage people to stay connected. Learn more here.
Sometimes you don’t even need anything tangible or actual interaction with others to feel connected.
“A really good example of that was the ‘teddy bear hunt’ that popped up all over the world as a response to COVID-19,” recalls Tebbey. “Simply participating made you feel like you were a part of something and, through that, more connected.”
One explanation for that is the fact that connectedness is actually a subjective thing, which means it relies far less on hard facts, like how large your social circle is, and far more on what you believe, sense or feel.
“This subjectiveness explains why it’s possible to feel connected to a group of strangers, but also why you can sometimes feel lonely or unconnected among a group of people you know,” adds Tebbey.
Starting a conversation
If you are experiencing loneliness or struggling to feel a real sense of connection, Tebbey suggests speaking up or reaching out.
“Surveys we’ve conducted at Relationships Australia indicate that most of us are quite capable of recognising when we’re feeling isolated or lonely. However, we’re less well equipped to understand why we’re feeling like that, and, importantly, what we can do about it.
“Talking to people you’re close to about how you’re feeling and asking them for help – if you feel comfortable – can be a good starting point. It may even help you identify larger issues that you need to seek support around in order to feel more connected.
“And if you don’t have someone close to talk to or find that it doesn’t help, reach out to a support service like Beyond Blue.”
The Beyond Blue online forums are a great way to connect with people online in a safe and anonymous environment. Discussion topics cover anxiety, depression, suicide, and a range of other life issues. Anyone in Australia can participate in discussions, connect with others, and share their experiences with our community.
If you need assistance visit Beyond Blue’s support services. Our mental health professionals are available 24/7 on: 1300 22 4636. Click here for a web chat (3pm-12am AEST). Alternatively, contact us via email (responses within 24 hours).
For immediate support call Lifeline on 13 11 14 and in an emergency, always call triple zero (000)
With our October Dance Festival awareness event just around the corner, this podcast exploring how artists living with chronic pain, organise their performances around their limitations is very relevant.
Is self-compassion a trait or a state of being? This edition is inspired by findings that suggest stronger self-compassion is associated with reduced impact of chronic pain.
Self-compassion, in this sense, is the ability to respond to pain and difficulties with kindness and openness rather than criticism. In this episode we ask our artistic contributors, and ourselves, how to step towards achieving self-compassion and the importance of movement in looking after our bodies.
This edition of Airing Pain was made possible by the invaluable contributions of our participating artists who showcased their works at the Edinburgh Fringe Festival, and those in the academic field. We learn the motives behind using dance as a way of supporting those in pain, but also expressing and communicating pain to audiences.
Contributors: Dr Sarah Hopfinger, Artist and Researcher (Edinburgh Fringe: “Pain and I”)
Victoria Abbott-Fleming MBE, Founder of the Burning Nights CRPS
Dr Emma Meehan, Associate Professor, Centre for Dance Research, Coventry University Tali Foxworthy Bowers, Choreographer and Movement Director (Edinburgh Fringe: “Monoslogue”)
Jenna Gillett, PhD Student, Department of Psychology University of Warwick
1:35 – Miriam Introduces Sarah Hopfinger’s “Pain and I” performance during Edinburgh’s Festival Fringe, and asks what techniques from the world of dance offer those living with pain?
3:41 – Pacing as a technique. Also see 13:25 for Sarah Hopfinger on pacing.
6:34 – Emma Meehan, at the British Pain Society, on how dancers living with pain approach pain.
8:34 – Introducing Tali Foxworthy-Bowers
15:54 – A huge thank you, and invitation, for filling in our survey
16:20 – Emma Meehan and research into what somatic practices in movement can offer those living with pain.
18:20 – The importance of sharing and telling stories about pain experiences as an act of self-compassion for performers, and mutual connection. See also 25:53 for a continuation of this sentiment from Tali Foxworthy Bowers.
21:25 – Pain catastrophising, how we frame pain, and techniques for being kinder to ourselves with self-love and compassion.
27:54 – Suggestions of how to support those close to you who are living with pain.
31:34 – Emma Meehan discussing agency with pain, as showcased at the British Pain Society ASM 2023.
35:10 – The role of charities in patient support, and what else can charities be doing?
37:27 – Chronic pain is chronic strength: acceptance of pain as part of the bodies we love and care for.
Australia is a vast and beautiful country, but for those who need Regional care coping with chronic pain, accessing appropriate medical care poses huge challenges. The following article covers the subject in depth.
Rural patients deserve better health care. We just need to be brave and implement change.
By Jack Archer – Posted
If you live in rural and remote Australia, your access to health care remains well below the standard that citizens of one of the richest nations on Earth should expect.
Rural and remote areas experience serious health workforce shortages, despite having a greater need for medical services.
There are also new initiatives identifying ways to resolve chronic workforce shortages across the sector.
The small town of Glen Innes in rural New South Wales, which suffers from serious health workforce shortages, recently secured two new local general practitioners, a pharmacist, an exercise physiologist, a diabetes educator, a nurse practitioner and a speech pathologist in just six months.
They did this by embracing the emerging Attract Connect Stay initiative that helps communities lead the way in finding, welcoming and retaining new health workers.
Despite the workforce shortages, there is already the same or a stronger presence of nurses per person in rural and remote areas.
The opportunities to enable these nurses to do more and to make their practice more rewarding and impactful are significant.
The recurring underspend should be invested in an ongoing innovation fund, with the states, private sector and philanthropists challenged to match the commitment.
Over a 10-year period, this equity-based approach to funding could generate billions of dollars to invest in trialling new ways of delivering health services at scale and then rapidly rolling out the innovations that work.
It would be a game changer for rural and remote health.
We were recently contacted by a healthcare professional to gain information about helping a client who lives with trigeminal neuralgia and also wears glasses.
Trigeminal neuralgia and wearing glasses do not necessarily go together, but options are limited to putting up with the trigger pain, or to wear contact lenses. Many people find contact lenses are not an option for them, so what can help.
In Australia most of the population do wear sunglasses due to our climate, so even if you do not need glasses for reading, our community will have to deal with TN pain triggered from pressure around the nose and ears caused by glasses.
We have found one Company in Australia which offers options to improve the comfort of wearing glasses.
If you have any hints or tips how you deal with this issue, please share by adding comments to this article.
Let’s get real: If your glasses are sitting too low on your nose, it can feel uncomfortable AF. But there is a solution to ensuring your plastic frames are more snug, and it requires a hair dryer. According to LIVESTRONG, you can actually warm up the temples of your frames for 20 seconds with a hair dryer, and then bend them to adjust accordingly.
2. Adjust the Nose Pads on Your Metal Frames If They Feel Too Tight
There’s nothing cute about nose pinching (and I’m not talking about the kind your grandma does when she tells you you’re her favorite grandchild in the world). If your metal frames are pinching your nose, you can pull the nose pads away from each other a bit (delicately, of course), according to Frames Direct.
3. Look for Slippage
If you’re constantly pushing your frames up on your face, it might look like you’re giving everyone around you the finger. (Yes, it’s happened to me and I don’t want to talk about it.)
For this, you’ll have to invest in a tiny screwdriver to tighten the screws on each side of your frames. This CVS Health Eyeglass Repair Kit is a great purchase, as it comes with four screw sizes to fit a good majority of frames.
Lastly, if you’re new to the glasses lifestyle, you might find that the skin behind your ears is a bit sore or tender. Money Versed recommends breaking out a bottle of baby powder and applying it behind your ears daily until your skin adjusts to your new frames. You’ll smell fresh AF and feel comfortable. That’s a win-win, if you ask me.
by GEORGINA BERBARI and ALEXA MELLARDO – UPDATED: ORIGINALLY PUBLISHED:
This post was originally published on Aug. 27, 2017. It was updated on Aug. 22, 2019. Additional reporting by Alexa Mellardo.