Maggie McKay (Host): This is the third in a series of podcasts on integrative medicine with Dr. Yoon Hang Kim, Chief Wellness Officer. Today, we'll learn about integrative pain management, what the trends are, and review the evidence. Welcome to a podcast presented by Memorial Hospital. I'm Maggie McKay. Thank you so much for being with us again, Dr. Kim. It's good to see you.

Yoon Hang Kim, MD: It's great to see you again, Maggie.

Host: Just to start with, could you please define integrative medicine?

Yoon Hang Kim, MD: So, integrative medicine means utilizing all the tools that are not taught in a conventional medical system. So, things like acupuncture, mind body medicine, using food as medicine, using functional medicine testing to get to the root causes of conditions whenever that's possible, and basically using supplements, using things that are not normally taught in medical school, and I think that's a good way to look at integrative medicine.

Host: My understanding is that you have a personal experience with pain. Could you share that with us?

Yoon Hang Kim, MD: Absolutely, so when I was going through the medical training, I developed severe pain, and at that point my son was just born. I had three jobs and commuting an hour and a half each way, and I developed severe pain. At that time, I was more conventionally minded, so I went to regular doctor, orthopedic surgeon, who said, let's go ahead and do injections.

After that, let's do surgery. And then unfortunately, like everything they did, there was side effect or it didn't help. And the surgery, it got, it made it worse. So they came back and said, let's do a second surgery. And that's when I said, no, because I know the literature that the first surgery is your best bet, and if the first surgery doesn't work, unless it's an emergency, the chances of the second surgery helping is not higher than the first surgery.

So I walked away, and then I really explored all the alternatives that was available at the time near me, and none of them helped. And I was very fortunate because one of my teachers was a physician who became physician accupuncturist to two of our presidents. So, when I learned from him, and he helped me to restore my back back to health.

And that's when I think, for me, the light bulb went off in my head that in conventional medicine, we are very good at what we are good at. So for example, my surgeon did a fantastic job. People who did the injection did a fantastic job. But that doesn't mean it's going to take care of the problem.

The problem for me was the chronic pain. So, studying with that master acupuncturist for two years really opened my eyes and since then I've really opened the multiple places. Integrative pain management has been probably the first practice I've developed probably right after integrative oncology because my mom was affected by cancer.

So that interest started from there. And then pain management started because my own experience, the conventional medicine, while the techniques were correctly executed, it didn't bring me pain relief.

Host: And what approaches does integrative medicine bring to pain? How do you treat pain with integrative medicine?

Yoon Hang Kim, MD: That's a really excellent question. The first thing is you got to make sure that you're not sitting on a time bomb. So for example, there are conditions where we say that that red flag condition. So one of them is if you lose control of the bladder. That's a big problem. So that means that the imminent nerve injury and sometimes that nerve injury does not reverse back.

Same thing if people lose their gait, people are not able to move their, one of their legs, then you have to ensure that standard of care is observed. And sometimes that means getting them an MRI and getting them to see, be seen by a neurosurgeon. It's just that sometimes you do all that, and then your surgeon says, I've already operated on that person.

There's nothing more I can do for that person. So then I will do what I do knowing that there is a big problem, but there's nothing else conventional medicine wise that can be done. So first, make sure that the patient has good evaluation, and then second, try to address the pain the way it can be addressed.

Host: So, the difference between treating someone for pain with conventional medicine as opposed to integrative medicine is, I guess, first they have surgery and then if they still have pain, they come to you?

Yoon Hang Kim, MD: So that's one scenario. Another scenario is that the primary care doctors have patients with pain, and the patients themselves are saying, I don't want to take all those medications because some of them are bad for my liver. Some of them are bad for my kidney. So then the patient says that I want to try acupuncture. I want to see what happens when I do acupuncture. So those people come to me. Recently, a pain clinic sent me a patient saying that please treat this patient five times and returned the patient back to us. So I did, and the patient came with a lot of pain and left with mild pain. And so, for us, it's a success story.

Host: And speaking of that, can you think of another patient who may be benefited from integrative medicine?

Yoon Hang Kim, MD: So there are two patients that come to my mind. And one patient actually is very interesting because she was a nurse and she was rear ended stopping in red light. She went through surgery and her pain got worse and they said let's do physical therapy, let's do other procedures and her pain got worse and worse and worse until she couldn't sleep.

And her husband came to me and first time I was a bit intimidated because he looked so severe. And luckily she had great response to acupuncture and anti inflammatory diet and supplements. And her pain was about 25 percent of where it was, and she had pain that she was passing out from, so really 10 out of 10 pain.

And the patient's husband, after a year, told me that Dr. Kim, if what you did didn't work, I would have had to do bad things to make sure she doesn't suffer anymore. So, when I came and saw you, you felt me outright. Because in my head, I was really saying I don't really have much options left. So that was one.

And so that was a case where surgeons did everything they did, but there was no more that can be done. And then a second patient is very interesting that the surgeon felt that he had a hernia. So they said, let's fix it. And they went in and tried to find it, and they couldn't find a hernia.

It turns out that there is a condition where it looks like a hernia, but it's not a hernia. It's split of the muscle, abdominal muscle, and they didn't do a CT. And because these days, not everything will get approved by the insurance company. In old days, we would get a CT to make sure that it wasn't that condition.

But the thing is that Surgeon was desperately looking for the non-existing hernia in the stomach. About three hours into operation, the patient died, had a code and the code means that you really died clinically. And then he was lucky because right next door was a cardiologist. So he was available to come and help and restart it, help to restart the heart.

He came back to life. Since then, he had severe abdominal pain every day, every hour, he would have severe abdominal pain. And he would get MRIs every month and go to different specialists looking for a solution. And in our field, the latest in integrative medicine for pain management is known as Pain Reprocessing Therapy.

So there we go and really review the records and make sure there's nothing else that can be done. So once we reach that place, which we have, I just told the patient you're having abdominal pain exactly where they would have looked for the hernia that didn't exist. He would have been poking around desperately looking because surgeons don't like to fail. And he was convinced that was a hernia and when your heart stopped, you died. And then, luckily, the heart doctor was able to restart your heart, so you came back to us. But the areas that you are touching, you're telling me where it hurts, is exactly where they would have probed. Your body knows you died.

Your brain knows that, no one really talked to you about this. How do you feel? So we, had about three more visits an hour each. And at the third of it, he said, Doc, I all get it. I get it. I was like, I said, what's wrong with you? Nothing's wrong with me. I died.

And I didn't know I should process those emotions. I didn't know I had emotions. So I told him, write a letter to the surgeon. You don't have to send it. Just write it. And if you don't want to send it, burn it. If you want to send it, send it to him. Otherwise, just burn it. So he said, I burnt it.

And then one more thing you have to do. You have to talk to my wife. I said, I can't talk to her without you, but you can bring her next time. So we spent an hour talking and said explain to her what happened. And both of them were fine. And I asked them, what's wrong with you?

And he goes, nothing, nothing's wrong with me. I died. And I was angry at the surgeon for doing that procedure that could have been avoided. But you know, but I came back, I'm thankful that I'm alive. So I don't want anything else with that, except I wrote him a letter and I burned it.

Host: Good advice. Dr. Kim, this is a little off topic, but did he say what it was like when he died? Like,

Yoon Hang Kim, MD: You know, I always ask that question. I don't think anyone has told me extraordinary stories of those. So I have, I've not had my patients tell me any stories, but when they have had near death experiences, I always ask them.

Host: Yeah, I would just, it's interesting. You mentioned acupuncture a few times and anti inflammatory diets. How much are those used and what other tools are used as well?

Yoon Hang Kim, MD: So I would say acupuncture is a big part of what I do because I use acupuncture to reprogram, reset. And I explain to patients it's very similar to hackers hacking into a computer. I'm just using acupuncture, my knowledge of acupuncture, my knowledge of the neuroanatomy to hack into their nervous system.

So there are many styles of acupuncture. So the traditional acupuncture is energy acupuncture. And then if you really go into that, there are five phases or five element acupuncture, which is all energy. And then there is more percutaneous electrical nerve stimulation, which is more dry needling plus electricity.

And in between is the idea of utilizing anatomy, especially neural anatomy, to reset the brain. So when people come in, one of the first things I want to do is, number one, make sure there's not a time bomb we're sitting in, like the red flag symptoms. If there's none, then it's not coming from an anatomy.

Then the pain resides in the nervous system. Then I can do either hand acupuncture, ear acupuncture, scalp acupuncture to try to reset the pain and sometimes it's miraculous. I have patients with especially shoulder pain with maybe two needles, it's gone and the people have had it for years. So, and I explain to them that I'd reset your brain and now your brain is convinced that you don't have it.

And then I teach them exercises so that the nervous system can communicate and reassure that's not an ongoing problem. And then the other part is that sometimes the nervous system wants to release it, but the local area, and I see this a lot with sciatica, where sciatica says, no, I'm very far away from brain and I'm the king here or the queen here, and I'm going to do things I want.

And then I use different tools. Some of them are neurostimulator devices, very, very high tech, and then the others are acupuncture, and then we use infrared light, heat, to help electricity to reset the nerves, and the muscles, so that it will do what we want it to do, not do what it wants to do.

Host: And what about back pain? How do you treat that with integrative medicine?

Yoon Hang Kim, MD: So back pain is very interesting. I tell patients that if they're overweight, I offer, if they want to, that we can do an anti inflammatory diet that puts them at a fat burning metabolism that just has a side effect of lowering inflammation. And that means that they would feel less of the inflammation. Or there are supplements like turmeric or boswellia or a combination of those that can make really make a big difference.

And the Chinese herb known as corydalis can also make a huge difference. So, It's like art or mosaic puzzle trying to figure out what tools are safe and what tools would be helpful to help patients.

Host: I recently read an article about people using some very strong herb and they didn't really know what they were doing for pain. It wasn't for recreational and they died. So it's really important to have your doctor tell you what to use as far as like Chinese herbs or things like that, right?

 T o tell you what to use as far as like Chinese herbs

Yoon Hang Kim, MD: yeah, so I think the supplement industry is still the wild, wild west of west, and you cannot expect, really FDA has no control over it the standards they have is generally regarded as safe, or it's not the same level, or it is a more of a agricultural standard where some of what they say exists, exists, then it's good enough. And to make that more interesting is that some of the people who have partial knowledge will go to different places and the, when it's prepared the right way, it's okay. But if it's not prepared the right way, then bad things can happen. And so I think part of the role that in integrative medicine is that we're guiding patients to do the right thing and making sure that the products they're using are assured or likely to be the best quality possible.

So one of the patients that I saw yesterday was very interesting that she had severe pain. She utilizes medical marijuana to help her. But what really made the most difference was herb known as holy basil. And she got ahold of the seed and she grows it herself, and then she eats several leaves and then it controls pain. In the wintertime, she brings in everything she harvested and she gets the seeds. And then she waits for springtime to plant them. But in the wintertime, she'll make tea out of it. So, corydalis is a root from a plant. And we found a tea version of it that's coming from Korea. So I told her that it would be probably better this year, but purchasing it and listening to their instructions and then make that into tea and drink it to find out if it will give her some relief.

Because when I gave her the pill version of it, she broke out. So that was not something we could do. So she said that it was really a pity because she said it worked much better than opioids. And she really wanted to do it, but she said it gave me palpitation and rash. So I told her to stop.

And then instead I'll recommend getting you edible version of corydalis and make tea out of it. If it works, then you can get a seed for this summer. And then you can, once you drink, you will find out what portions of corydalis is that you're drinking. And I said already, from the photo, it looks like root, and from our research it looks like root.

So, I said, let's experiment and see if that would give you the same relief.

Host: Dr. Kim, can people with chronic pain change that pain with lifestyle changes alone?

Yoon Hang Kim, MD: I think it really depends. So if people have a organic reason, let's say, degenerative disc disease, or they have spinal stenosis. Integrative medicine isn't going to change the anatomy. What integrative medicine can help you to do is support the patient, lessen the symptoms of pain, lessen the spasm they feel, and there are breathing techniques and meditation techniques that can really help them to distract or dissociate from pain.

So you have pain, but you're observing the pain and say, Oh, you're hurting me. It hurts. But I need you to be quiet because next hour, I'm going to take a nap. So I want you to take a nap with me. So, I talk to patients about talking to their pain, communicating with the pain and also taming their pain. What I say is the pain in your body, we cannot get rid of. It's yours. That's your home. You are his, the home, but the pain cannot be allowed to run out of control and in control of you and steal your life.

Host: That's awesome. Well, this has been so hopeful and helpful information as well to know that there are options for people and a lot of them. I wish you lived closer. Is there anything else you'd like to add in closing?

Yoon Hang Kim, MD: Well I'm just very grateful to our CEO, Ada Baer, who has dreamed of this or in a strategic session 2015. And she has been not giving up on it. And after eight years she found me in 2023. And about a year I've been, and we're making a huge difference to our community. And for that, I'm very grateful.

Host: It's just fascinating work you do. So, I just love hearing about it and I can't wait to hear about more. This has been the third episode in this series, and I look forward to talking to you again in episode four.

Yoon Hang Kim, MD: Likewise. Thank you so much, Maggie.

Host: Again, that's Dr. Yoon Hang Kim, and if you'd like to learn more, please visit mhtlc.org. That's mhtlc.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is a podcast from Memorial Hospital.