Can you imagine a world where chronic pain doesn't dictate your daily life and work routine? That's the reality we strive to understand in our fascinating conversation with the founder of Amelio Health, Kathy Hubble.
Chronic pain is a silent epidemic, quietly causing worldwide disability and impacting individuals, their families, and workplaces. Not only does it disrupt lives, but it also presents a significant financial burden on employers and healthcare systems globally. Together we peel back the layers of this complex topic, delving into the far-reaching effects of chronic pain and its subjective nature and its links to loneliness and grief.
Join us for a broad discussion of chronic pain management, acknowledging the inherent problems with opioid reliance and exploring the potential dangers of cannabis and alcohol use for pain relief. We also uncover strategies for holistic pain management, centered on mindfulness and personal values.
The second half of our journey with Kathy pivots towards the power of self-management and well-being, underlining the importance of listening to our inner voices and understanding our needs. We also discuss the role of technological aids, like wearables, in tracking our progress and the surprising links between pain, loneliness, and grief.
This episode is a vital exploration, essential for anyone battling chronic pain or supporting a loved one through this journey. Tune in and empower yourself with a refreshed understanding and a new approach to chronic pain.
Find out more about Kathy and her work with pain at https://www.ameliohealth.com/
Find our more about Wellbeing at Work's Global Summits, our Global Hub Community of C-Suite executives and our Bespoke division at wellbeingatwork.world
Hello and welcome to the latest episode of Conversations on Well-Being at Work. This is a podcast by Well-Being at Work World featuring discussions with innovative HR and wellness experts and practitioners who are going to be speaking or exhibiting and participating in our summits. Those summits take place in eight regions around the world. You can find out more about those at our website, wellbeingatworkworld. There's also a hub there with lots of really useful information for anyone who's active in the well-being field. We have some webinars on there as well, and we also do a bunch of bespoke stuff live in person with organisations around the world. I'd encourage you to check some of those things out and hopefully join us at one of our summits at some point in time. So our guest today is Cathy Hubbell. She's a CEO of Amelio Health. She's going to be exhibiting. She's one of the exhibitors at the Sydney events that's happening near the end of November. Great to have you with us here today, cathy. Our subject is going to be pain, which is something that most of us seek to avoid, I think, in life, if we can. So perhaps we'll just start by asking how you're doing, and we always like to start our episodes by finding out how our guests are doing, so if you could fill us in, that would be great.Speaker 2:
Thank you so much, john, for having me on your podcast and with well-being at work. Actually, I'm a little bit exhausted, but I think I'm running on adrenaline at the moment because I've just returned from Ensure Tech Connect in Las Vegas, which was a lot of people, a lot of fun and a lot of talking. I'm ready to get started.Speaker 1:
And it's also a long way to go. You're in Sydney. When did you get back from that? You went back in Sydney long, or?Speaker 2:
Monday last week literally a week.Speaker 1:
Yeah, takes a while to get over those kind of long long-haul trips. I find Perhaps we could start. I said we're going to be talking about pain. Perhaps you can talk brief us a little bit about Emilio Health and the work that you do there and then we'll move into talking about the issue of pain and well-being.Speaker 2:
Yeah, so Emilio Health is a digital platform for people who have chronic pain. We currently are available for people trying to navigate the perils of an insurance claim and that might be workers' compensation insurance or income protection insurance and it's where pain is preventing them from either getting back into work or life. And it's a staged education platform designed to empower people with knowledge so they can make informed choices about their care. As people are learning new strategies in the platform, our 24-7 health coaches, which are live in a live chat space, are monitoring their wearable and behavioral scores and using this to engage them in their own data so that when they learn the strategies and they put these strategies in place, they can then see how it's impacting on their own. It might be their sleep patterns, it might be their medication use, it might be their activity levels. So what we're trying to do is to get them to self-manage, but see how the strategies are actually improving their day-to-day routines. Right.Speaker 1:
So I don't. I'm infinitely active in the area of running events on well-being and a lot of them have been mental health-related, but certainly well-being in the workplace issues, and I've not seen pain coming up as often as I thought I would in those discussions at conferences. How prevalent is the issue of chronic pain and what's its impact? I think a little bit about more, about how people feel around pain, people's response to pain, but what's the impact at a sort of organisational level?Speaker 2:
Yeah, it's really a huge impact it has. It's the leading cause of disability globally. One in five people suffer from chronic pain. It's a huge number of people. It's basically every second person that really is around you, and it doesn't just affect the individual who is suffering with pain. It actually infects all of their immediate contacts, so it might be the work environment, the workplace relationships, or it might be their home environment, and when their home environment starts to collapse around them, it has this ongoing effect in the workplace as well. The other thing that we need to keep in mind is the cost associated with this and for insurers. In the US, just in 2021, it cost insurers $658 billion, and that's just in one year. So this is an enormous impact on everything that we do, because insurance underpins all of our costs in society, but also to the cost to our economies. It costs more than diabetes, heart disease and cancer combined, and this is something that is. It's really a hidden epidemic and we're not really dealing with it, and I think the reason we keep it so quiet is because it is such a subjective problem and people think I don't want to burden other people with my problems. I don't want people to know that I'm suffering. There's a whole lot of psychosocial aspects around it.Speaker 1:
Because it is quite. It's not. If I go to a lab and get my blood pressure tested or my or any other of those sort of general markers around around wellbeing, cholesterol levels or sugar with rounded diabetes, we've got a number that we can, we can point to and say one one number's healthy, one's not, or whatever that thing is there is. It is a subjective thing in many ways, right.Speaker 2:
Exactly, and people might also go to a doctor and say I've got this horrible pain, I can't get rid of it, it's interfering with my sleep, and the doctor might just assume that this person is drug-seeking for some reason and it might be that they're not listening to them. They're not hearing, subjectively, what's going on with this person and they're making assumptions and this leads to feelings of injustice and that they're not being heard, they're not being listened to and this can actually amplify pain.Speaker 1:
I wonder actually and this question is probably going to be maybe a bit from left field whether there are sort of age assumptions around pain. I sometimes jest and I shouldn't, and you'll probably. You may want to end the conversation now. I was going to say I know I'm getting old because the pain doesn't go away, it just moves around. As I get older, I'm noticing lots of aches and pains around various things which no longer seem to be causing me that that sort of issue Is. This is not a phenomenon, just of age, is it?Speaker 2:
No, definitely not, and I think we've made some very big assumptions around ageing and its association with pain, and what we do know is that they're not associated. There are people out there who are in their 80s and 90s who are very active and don't have chronic pain. However, we do know that as people age, they're more likely to develop chronic pain, and this is really due to lifestyle. It's not actually due to ageing as such, and so we've got to look at what are the actual reasons behind this person developing a chronic pain problem as they get older, and there are so many other factors their diet, their lifestyle, have they been using medications for a long period of time and become tolerant to them? There's a whole lot of other reasons behind the development of chronic pain.Speaker 1:
So what are some of the most common pain related issues that surface in the workplace and how are they impacting employees' work and also their life outside work?Speaker 2:
I think it's really important to understand the fundamentals underpinning pain, and it's a warning system that in our nervous system and it's designed to protect us from injuries. So we can have pain without necessarily having any tissue injury. And this is what is really confusing for people, because as they start to develop a pain problem, such as low back pain in those who are sitting a lot in their workplace, they start to think I must be doing something wrong. It must be the posture, it must be the chair, it must be the desk, it must be the fact that I'm not sitting up straight, or when it's really about a whole range of things that are actually going on in that workplace environment. It could be that they've got a really non-communicative boss or putting pressure on them to meet deadlines and those sorts of things, or they might have stressors at home where they're not meeting the needs of their family. There's so many other things that are actually impacting on this nervous system, becoming sensitised, and so I think we need to then look at when people move beyond the point of tissue healing after maybe an injury or a workplace injury, then develop and still have pain. We've got to look at other factors, such as psychosocial factors that are influencing this person's nervous system.Speaker 1:
Yeah, because I know one of the one of the areas I know I've seen a little bit about lately to the work place has been around sort of arthritis and pain and also that Overlapping with then with mental health issues like depression, anxiety that is driven by being in that state of pain, and that's probably quite a kind of imagine that's probably quite a common one. Again, I'm making assumptions here which may or may not be older people but also tend to be quite associated a lot with the workplace.Speaker 2:
Would that be a typical kind of issue in at work or yeah, and I think we've really got to look at the facts, and that is that there are a lot of people that don't, that have arthritis on scans that actually report no pain and quite severe impacted type joint problems. But the bottom line is they keep moving and they they're active and they they don't take a lot of medications. The other side of the coin is when a person has pain day and night for long periods of time, it starts to interfere with sleep, and sleep is a major factor in our stabilization of our mood. So we can become really cranky and irritable and depressed if we're not getting proper sleep, and that means the quality of the sleep as well as the length of sleep. So this is something that we monitor very closely with our wearables, and this is why we're getting such market improvements in people's management strategies Is because we're targeting the areas that are specific to that person, where they need to start changing their whole aspect of life. But this can take its toll on relationships, on an emotions. Pain is very isolating and we now know that isolation and loneliness are the biggest contributors to mental ill health, and all of this can lead to grieving a life that was lost because they can no longer be the person they used to be. This is about getting that person back and getting them back engaged in life and social activities, and we're measuring that as well. This program that we're running, while it is a digital platform, we have a huge amount of behavioral scores that are coming into our AI background.Speaker 1:
It seems to me, and I have some friends who have medical conditions which have quite large pain components. I had a friend who just recently had a hip replaced and he's got another one and he's got his knees done as well the medical system I don't want to say trash medical systems, but a medical system here in Canada, for instance, the average GP you may go and see doesn't necessarily they're not experts in pain and one of the sorts of things people confront when they present themselves as in pain to the medical system that are offered as solutions that maybe work short term or when is the gap from that experience to actually a process that will help them.Speaker 2:
Yeah, I think the biggest problem is that they're uninformed, and this is what we want to. We want to change this. We want to inform people of the consequences, the benefits, the good, the bad and the ugly of every treatment available to them, so they can then make these informed choices. We now have an orthopedic surgeon in Australia who is doing research into sham surgeries, so he's actually testing these surgeries, such as hip, knee, shoulder surgeries, against placebo, and what he's found is around 66% of surgeries are actually unnecessary, because we heal anyway and what we use medications for. And this is where we get caught up in the language around pain and treatments. Medications are not a treatment and we cannot cure chronic pain with any of the medications that we have at our disposal. If anything, they are a passport to movement and a passport to getting you back into a routine that you had before you had pain. So I think we've got to stop looking at opioids they're the big problem, of course, at the moment as a solution for chronic pain. They are not a solution. They are a double-edged sword. They have obviously addiction properties and we use them a lot to manage acute pain, but beyond that point of tissue healing, we have a problem because opioids actually cause hyperalgesia, which is the sensitivity of the nervous system, and the FDA in America has just come out in April and actually stated they're going to be putting this into their pamphlets, within the packets of the medications, to say these medications cause hyperalgesia.Speaker 1:
So can you just expand on hyperalgesia? What's that? Yeah?Speaker 2:
analgesia is pain relief and algeasia is increased pain. So what they do is they create an increased sensitivity in the nervous system. So you go back to your doctor saying my pain is getting worse, I'm going to have to increase the dose. So that in itself is a big problem, so one it's causing people to go back to their GPS saying I have more pain and need to go on a higher dose, which is then more addictive and then creates more hyperalgesia. So this cycle keeps building on itself. And this is what we're doing. We're actually creating a chronic pain scenario.Speaker 1:
And there's the obviously the addiction issues as well with opioids and particularly fentanyl.Speaker 2:
Yeah, fentanyl is probably just one of them. We've had the problems with, obviously, oxycontin, oxycodone, all of those opioid based medications, but one of the worst medications around for addiction properties is actually panadine for, and we have that around us every day, and so we've got to start looking at alternatives to using these medications. Particularly in the acute spain space, where people are coming out from surgeries that were probably unnecessary and placed on these medications postoperatively. We need to have now really strict guidelines of how long they can use them and what sort of alternatives can we use in that acute space to reduce the amount of opioid required postoperatively.Speaker 1:
And what about drugs that are even more easily accessible, in a sense, where people self-medicate with either cannabis or alcohol, are those related to people who are suffering pain at all.Speaker 2:
Yeah, so there has been a little bit of research with the cannabis, and particularly in people who have cancer, pain can be quite effective for their appetite and also reducing your apathetic pain. But again you're using a band-aid solution that has other problems associated with it, such as addiction and those other related things. What was the other one you were talking about, alcohol.Speaker 1:
And one of the things we've ever looked at with alcohol? Is that it results? In people who are in pain.Speaker 2:
Again, it's a double-edged sword. Remember, we were talking about sleep and alcohol is. Not only is it a depressant. You've already got a person who is depressed and anxiety associated with their pain problem. You then adding a depressant so it actually makes them more depressed, but then you're also interfering with their sleep cycle. So one of the things that people don't realise about alcohol is yeah, it might be good to get you to sleep in the first place, but you'll wake up at about 2am and you can't get back to sleep, and so it's interfering with the circadian rhythms and this is really bad. When you've got a problem with depression and anxiety, you're then interfering with the circadian rhythms and the sleep patterns and you're getting a very vicious cycle happening with food.Speaker 1:
Yes, it seems to me, just in the sort of scene you've painted for us here, that when dealing with pain, it connected to a number of other things. In those cases there we talked about, where there's something you might do that might temporarily fix the pain, but it's going to. It's going to you're going to have, you're going to get a benefit there, but you're going to pay a price around your sleep.Speaker 2:
Yeah, it's going to buy you later.Speaker 1:
Yeah, it also mentioned about grief and loneliness, etc. So what are the sort of strategies around pain that work best and how? What are the sort of? One of the things that comes to my mind is, you know, for instance, meditation, which can certainly help with sleep and, I suspect, can help with pain. So what are some of these things that you find people doing that work really well in both the point of your pain, but also have those in a more holistic way as well?Speaker 2:
Yeah, so we actually use a lot of mindfulness strategies within the program, so we're actually getting people to be in the moment and present, and when they can do that, they can actually get from moment to moment, and that might be a breathing technique. It might be something that they can do to distract their brain for a little while. One of our patients actually used to use adult coloring as and it's on our website, karen in our video to distract her brain but also to get her brain to just focus on the one thing that she was wanting to focus on, and that's a way to try and stop the brain from being overreactive to the information coming in through the nervous system from the tissues. And so we use a lot of mindfulness techniques, but it's about finding what is really important to that person that they can no longer do because of pain, and a good analogy for that is I had one person who just wanted to be a good mum and that still gives me goosebumps. It's what does that mean for you? And that's where we start to work with them on the goals that they want to achieve. We don't use the four letter work word. We use what is it really important that they value, and so we talk a lot about value based healthcare. But what we're looking at is a person's values. We're looking at what do they value, that we can start working with them and we break it down into sizable chunks where they can start to achieve what they want to achieve and this. Then they can use those strategies, because they've seen them work on their own data and they can see how their behavioral scores are changing and then, as they're progressing, they can start to use those strategies into other things that they want to achieve, and it might be going back to work, it might be getting better sleep, it might be that they can now stand for a period of 20 minutes while they make their kids sandwiches. It might be that they can now drive a car for more than 10 minutes. So it's about doing things progressively, but using strategies to then embark on other things that they really are, that are really important to them.Speaker 1:
You mentioned there about behavioral data and earlier on you mentioned, I think, about some sort of monitoring of some kind. So you've got there's a so technology element behind this. Presumably there's some AI in there somewhere. How does that sort of cumulatively affect the help people?Speaker 2:
Yeah, so we've developed a eight week program and in those eight weeks. There are learning modules, and each learning module has been embedded with the core competencies from the International Association for the Study of Pain, and that follows a building of knowledge and then embedding the knowledge and then facilitating that knowledge into practice. In doing that, we then embedded markers in there on Bloom's Taxonomy of Learning Theory, and this enables us to see what they're learning and how they're embedding that knowledge into changing behaviour Along the way. They do a number of questionnaires which have been validated in behavioural science in pain medicine, such as pain catastrophising questionnaire, chronic pain acceptance questionnaire and the pain self-efficacy questionnaires. So they're just a couple of what we do. But we also measure injustice, and one of the things that we have found within the work environment that we've been doing is that one of the major blockers for people to progress forward is feelings of injustice, and this epistemic injustice can actually come from many areas in their life. It might come from their employer, it might come from the insurer, it might even come from the health professionals that they've been working with and, in particular, the language that they're using. So what we want to do is to give people the knowledge to be able to deal with these injustices and feelings of injustice, so they can reach acceptance of where they're at and start to move forward and plan their recovery. So they know what they're doing is actually going to work, because they've tested the strategies on their own data.Speaker 1:
Because it can presumably quite often, when you're suffering from chronic pain, a sort of feeling of hopelessness. But if you can see some sort of progress, you can get past that.Speaker 2:
Yeah, and while the progress might be very small to start with, they can't see it if they're living in it and it's just this overwhelming suffering. And so when you can say to them hey, I just saw on your data last night that you got an extra hour's sleep or you got an extra 20 minutes of REM sleep, how are you feeling today? And so they can then go back and go, oh really, and go back into their own data, because they can see it on their smartphone or, and then they can start to see the progress that they're making and what the meaning of that progress is to them. So it might mean that, oh, that means I'm feeling better in myself, I don't feel as depressed, so maybe I don't need as much of that antidepressant medication that they've actually given me. I might just not use as much today. And then they can start to see that the strategy they're putting in place is actually working for them and they're actually able to start reducing their medications. One of the interesting things about using wearable devices is that we can monitor their oxygen saturations, and this is particularly interesting when you have people on opioids, and one of the side effects of opioids is that it depresses the respiratory system and this is why people overdose and die, because they stop breathing. We can actually pick up, and have picked up, people with seriously compromised oxygen saturations. We had one lady who was 85% oxygen saturation, which is very low, and she was on very high doses of Xicodone and she was also on another drug called Gabapentin and when we had these two drugs combined she actually had symptoms that were very similar to complex regional pain syndrome. When we found that she on her wearable, she was waking up more than 30 times per night, we were, and this oxygen saturation that was quite low, we were very concerned and we got her in to see her GP very quickly and he diagnosed an underlying sleep apnea which had not been diagnosed, and this was contraindicated when you are taking opioids. She completely stopped her medication and we don't actually recommend that people just stop those sorts of medications. It's really advisable to do it slowly, but that was her choice and she did go through with sorrows and she was like, so be it, this stuff is not going to kill me, I'm going to get through it. She did and by the time she got two weeks down the track she had no pain at all. So we could see that this was actually a medication induced chronic pain syndrome.Speaker 1:
So we have time now, but I have a couple of questions I want to ask you before we close. One is actually prompted by your comments about justice, that sort of feeling that people often have when they are suffering from chronic pain, that is somehow not fair and that sort of adds to their anxiety and negative feelings around pain. But there is another component about justice and pain that I just maybe throw the question out to you because I know I've seen a fair bit here and historically in the medical system in the US almost willful inability to see that black people actually experience pain the same as everybody else. And just a recent example a woman I know here in Canada who is a nurse, who is black and she posted something about her brother, I think it was, who was suffering with something and he was in hospital and they were just refusing to give him pain medication. Didn't believe he was in pain. There is quite a significant diversity element to this issue of pain, isn't there?Speaker 2:
There is, and it's extremely frustrating for people when they are suffering that they have this horrible reality that people aren't listening to them, and this actually winds up the nervous system. So if you think about cortisol as a when you're stressed and you're anxious and you're angry and you're cranky and you're depressed, this is the sort of chemical that is released from our brains that actually winds up our nervous system. So this injustice is actually going to make pain worse. The fact that these people aren't being listened to will amplify the up-regulation of the nervous system, and so we've got to keep that in mind, and I think, before we start judging people, let's listen to people and hear them and genuinely say OK, how can we make your life better? What can we do to support you? And there is a place for medications, particularly in the acute phase, but I think it's about education and empowering individuals with their knowledge. How they can actually help themselves is really important, and that's what we're about.Speaker 1:
OK, thank you. And just to conclude, as I ask all my guests on the show, for you personally, what's the one thing that is most important and effective for you in the not around pain, necessarily, but around well-being? What's the one thing that you most value?Speaker 2:
I think the fact that we care when listening to people and we're empowering people to self-manage and don't go down the pathway of multiple failed surgeries, interventions, and listen to your heart, listen to your inner voice and if your inner voice is saying, don't know about this, I don't know if this is the right thing for me, then question it. Yeah, ok.Speaker 1:
All right. Thank you. I thoroughly enjoyed this conversation. I think some of the things certainly the relationship between pain and loneliness and grief, and the use of those wearables the wearables to monitor, and how that can feed people give them a sense of achievement and progress. And I always say that need that you close in there about, for people to actually be aware of what their needs are and that speak with their voice and make sure that they're being heard. I think those are really important things. Thank you so much. Wish you all the best. I know I think you're in Sydney tomorrow for the events. I hope that goes. I'm sure that will go really well and you've given us a great insight into an important and unfortunately much, often much neglected issue when it comes to being so. Thank you very much.Speaker 2:
Thank you. Thanks for having me All right.