Interview with Dr. Jessica Grove

Dr. Camille Ronesi: Welcome to Beyond the Practice Spotlight Series. I’m Dr. Camille Ronesi and I’m sitting down with providers in the health and wellness space who are masters of their craft, but more importantly, they’re passionate about building strong communities that celebrate active, joyfilled, hopefully pain-free lifestyles. Join us.

Dr. Camille Ronesi: Welcome back to Beyond the Practice. I am Dr. Camille Ronesi and I am very excited to bring to you today a super cool practitioner in town who specializes in health and medical psychology. She is a licensed clinical psychologist working specifically with people with chronic pain, chronic illness, and other medical conditions. Her work focuses on the powerful connection between the brain, the emotions, and the body to help people manage the emotional load of their diagnosis, decreasing symptoms when possible, and setting up habits and routines that facilitate health and healing. Dr. Jessica Grove, I am so excited to bring you here today. A lot of people feel like psychology, physical therapy, they’re the same thing. They’re not the same thing. And I’m just yeah, I’m very excited because there’s so much we do in the physical therapy world that dances around psychology. So to actually have an expert in the field to not only give your insights, but to to share with my patients all the wonderful things that you can do for them, I think is really exciting. So where I want to start is the same place I always love to start is trying to get to understand how you got here. So Jessica, would you like to share kind of your story?

Dr. Jessica Grove: How did I get to where I’m at today? That’s a long story. I’ll try to par it down. Um, but you know, I I started graduate school a number of years ago and it’s funny is because while I was doing graduate school, I was making a ton of like lifestyle changes and I was realizing like just increasing exercise and, you know, paying attention more to those things than I had in the past. And I realized how much better like emotionally that I had felt during that time period and just how much of an impact my physical health was having on my emotional well-being and depression, anxiety, all of that. And so I kind of was just that was like the first peak of like, huh, what is going on between this connection here? Um and of course I explored more throughout graduate school but then I did a post-dctoral fellowship in at VCU health that really did a training that trained me for a year on the interconnection there between the mind and the body and how to work with the psych psychosocial aspects of someone’s diagnosis or their health. So I’ve worked with transplant centers, I’ve worked with neurology clinics, oncology clinics, um and I’ve worked you know for a number of years in the Veterans Affairs Medical Center. So lots of work with trauma and things like that and how that can impact physical functioning, emotional functioning, all of that. Um so then I finally I guess got brave enough is the right word to transition fully into private practice because as one of my colleagues had said, health psychologists are so important and they’re all hold up in the hospital systems, but there’s very few of us who are actually practicing as a health psychologist in the community. Um so that’s kind of where I was like, “All right, I’m I’m ready to do this.” So, that’s how I got where I’m at right now.

Dr. Camille Ronesi: That’s Yeah, I’m really excited to kind of learn more about that. I think I’m going to ask like the dumbest question in the world. And that’s really for everyone’s sake because I think whenever people talk about like, oh, you need to go get mental help, we really stumble around, should we be saying the counselor, the psychiatrist, the psychologist? So, help us help us parse those out a little bit.

Dr. Jessica Grove: Sure. Um, they’re all different definitions really. There are just different degrees I like literal degrees that you can get. Um, your psychiatrist is your medical doctor who’s medically trained and then has special training in the medical aspects of mental health, right? So, they’re going to be your prescribers, the things that will put you on medications and kind of treat a lot of very severe um like you know, schizophrenia, those kinds of things. Um, and they work with non- severe things too. I don’t mean to say that they don’t but mostly your prescribers and then psychologists or doctoral level practitioners as well. Um they are you they are licensed by the state so they don’t prescribe medications but they are psychotherapists. They’ll also do a lot of psychological evaluations. Um I did a lot of evaluations for transplant candidates and things like that. ADHD evaluations all of that. I don’t specifically do a lot of assessments, but a lot of psychologists will kind of go in that route. And then your counselors are kind of like um the M’s levels clinicians who treat, you know, just kind of the general counseling, mental health concerns, things like that. So there’s not like a perfect um you could say therapist, like mental health therapists, and that will encompass a lot of us. Um you could use that phrase.

Dr. Camille Ronesi: Do you ever feel strongly that people should be funneled into a specific to a specific type of provider based on their presentations?

Dr. Jessica Grove: Um well definitely psychiatry if you’ve got things that need medication management like I can’t do that. So yes like especially if I’m working with someone and they’re I’m like hey you really would benefit from an anti-depressant or things like that. Sometimes your PCP will be comfortable doing all that, but if it gets kind of like that’s not working, you probably should see a psychiatrist. Um, ADHD evaluation or I’m sorry, ADHD um, medications, things like that, definitely go to your psychiatrist. As far as like M’s levels or psychologist, um, I don’t mean to sound elitist, so that is not my intention here. And it kind of just has to do with the level of education that that person has and kind of their degree of not just using the scientific research but typically putting into so the research that they themselves are doing as well. So most doctoral level people are comp you know completing research in some degree. Um I don’t do a ton of it but that’s neither here nor there. I would say the best thing to think about is your fit with that person and if they have the background and experience to treat what you’re looking to treat. So someone might be a trauma specialist. Uh they might be a better fit than like you know a specific psychologist who has different expertise in ADHD or something like that. So just depends on the fit there.

Dr. Camille Ronesi: So you took your psychology degree and you ended up landing in the pain world.

Dr. Jessica Grove: I did. Yeah.

Dr. Camille Ronesi: So that’s kind of that’s your big thing now is the chronic pain and that uh which pain science has gone through some explosion over the last decade. I mean it’s really the the the arc is swinging quite a lot. Like I was in PT school in 2017 and it was neuroscience of pain. You know that was all over the place. And now at least in our world the the buzz is to be like well that stuff doesn’t work. I don’t know if you know that but that’s the buzz that’s happening now is now like well we spend too much time talking about pain. So, I’m curious about like what is it that got you into that pain thing and how are like what are you finding to be the really useful information that’s happening right now?

Dr. Jessica Grove: So, intriguing question. Um, what got me into chronic pain? I I think the sheer um number of clients that I had with chronic pain was what got me into this, right? like at some point you start seeing so many of a certain type of issue that you’re like I’ve got to get a lot more training, a lot more research in this to actually help the person that’s in front of me. And so I would say that that’s kind of what happened. Um, and when I was working in a neurology clinic, you know, I saw a lot of like refractory migraines and chronic headaches that were not being touched by medication or these other things. And I was like and they were being sent to me, right? Because the neurologist like, “Well, I can’t help them anymore. What What can you do for them?” and I’m like not sure. So I I think I kind of landed on getting a lot more training in how to help people with that specific like chronic pain and then it branched into just all kinds of chronic pain and chronic illness is also another specialty of mine too. Um so I I can’t say I know exactly what all the trends are doing in chronic pain uh research and all of that. I can only say what the what I’ve done in my own research and the science behind that and how the brain is kind of, you know, the command center and how it’s going to interpret some of the stuff that’s going on in the body as either dangerous or not dangerous and then kind of really create pain or not create pain um to protect us. So, I would just say that um what I my did you ask my approach? I apologize.

Dr. Camille Ronesi: This is uns if I didn’t I would have next. So I’m curious about Yeah, I am curious about how you engage with it because it’s I think the the hardest part of of pain education and I think you would absolutely speak to this is having both being on both sides of the fold of saying the pain is in your head, but that doesn’t mean it’s not real. It doesn’t mean there’s not a tissue related problem. But also we got to start with what’s in your head.

Dr. Jessica Grove: Yes. Exactly. Right.

Dr. Camille Ronesi: So if you want like yeah speak to how you address that.

Dr, Jessica Grove: Absolutely. Okay. And I actually I don’t mean this in a bad way but like I think psychologists are uniquely positioned to be able to have this conversation um if they have if they are partnering right with the right people. I should add that.

Dr. Camille Ronesi: Why do you feel why do you feel that way? What is it about the psychology um philosophy?

Dr. Jessica Grove: I think we’re uniquely positioned because we can talk about both worlds a little bit. Now, I do anytime someone comes to me, they need to have and I and we want to work specifically on chronic pain. I want to know what their imaging is saying. I want to know what tests they’ve had done, right? Like I want to know that their medical workup has been accurate and complete and all of those things. And a lot of times at the end of the day, um it’s just not improving, right? Or they’re not responding to treatments the way that they should be or should be responding, right? All these things. Um, and so I would just say that at that point, like as someone who is trained to work with emotions and, you know, thought patterns and things like that, psychologists can do a really good job of explaining, hey, what’s going on kind of with the neuroscience that you’re talking about with the pain and why that doesn’t mean that it’s you’re making this up, you’re exaggerating or you’re imagining all this pain, but it’s actually having a physiological response in your body. And there are ways to kind of tamp down that threat system that we’re talking about. Um, so I I think there has to be someone who is un knowledgeable and understanding of that but can present that information in a way that’s e like accessible and doesn’t make someone feel minimized, right, because of their experience with that. So I would just say that mental health professionals are just they generally can relay information in a little bit of a more palatable way sometimes than some of the medical professionals that I’ve worked with. And that is not me being again. I hope that doesn’t come across the wrong way.

Dr. Camille Ronesi: No, I think we all we all have our skill sets, right? And that’s and each skill set calls a certain type of person to be to work in that skill set. Um I always really like psychology. I wanted to minor in psychology, but I stopped at the research. Like it was like once they’re like you have to do research. I was like I’m out.

Dr. Jessica Grove: Yeah, that’s totally fair. And I was gonna say like I have like pts and psychologists I feel like are very much like almost like I don’t know I feel like you just need both to have some really good um progress with some of this stuff. So it’s been super helpful working with ETSs in the past.

Dr. Camille Ronesi: We’ve had frequent um half jokes in our clinic of I really wish I had a psychologist in the room when I was doing like hip work with somebody because I feel you know we start working on hips and they just start spilling like they just start word vomiting whatever stories they have in their head and like we need a psychologist here so you can talk about your feelings while I get your hips more mobile. Um, do you see do you can you do you see a change in people after like in a session of like how they walk in the room and how they walk out of a room based on going through breakthroughs with them?

Dr. Jessica Grove: Um, sometimes for sure. Um, so I would say that this as you I’m sure are familiar this work is is somewhat unpredictable, right? Like at times when we dive into some of the stuff that might be underlying a lot of pain, right? the things that are keeping kind of that threat system activated, which can be emotional stressors and things like that. Sometimes if we’re pulling all of that out, it can feel worse at first, right? So, sometimes it gets a little bit worse before it gets better. Usually, I do help people get to the better stage and if they don’t um quit on me in the middle of the hard, right? So I would say that yes and I have worked with people um and again I never promise outcomes whatsoever but I’ve worked with people with years of chronic pain and then they have come out painfree right so like there’s a lot of things that we can do to kind of start reworking some of the threat system in the brain that we I probably should do a little bit more in depth conversation about that before I dive into all that but yeah we can rework some of that wiring that learned patterns of fear and behavioral avoidance and things like that that can give us new experiences and make us feel safer and decrease some of that pain that we experience in the body.

Dr. Camille Ronesi: So why does pain why is pain such a symptom of some of these like deeper wiring issues? Why is pain the thing?

Dr. Jessica Grove: Yeah. So, it really does go back to the nervous system. And I I feel anytime I talk about this, I do feel a little like the nervous system has become this pop psychology term, and it’s almost like this like someone’s trying to sell you snake oil at this point, but that’s not what I mean by this, right? But the nervous system really is kind of our our bodies, you know, I’m not explaining this to you necessarily, but it’s our body’s threat system. And our brain is constantly learning and adapting and responding to what um what the per you know the peripheral nervous system is doing. Right? So to break it down, make it as simple as possible, right? When I touch a hot stove and I experience pain and I move my hand, my brain then learns that that stove is hot and not to do it again, right? It’s protecting me. And that pain served a very real purpose of learning that this is dangerous to my body and I need to stop doing that. But we have learned through the research now that our brain can keep those neural pathways active long after that burn on my hand has healed. Right? So even if everything kind of all the tissue damage has happened, the learned neural pathways in my brain can still say this is dangerous to my body. I need you to stop doing whatever it is. And so it gets a little bit sensitive, right? So now when I think about a stove, I start experiencing pain in my hand because my threat system gets activated again. Right? So this is kind of the and I’m oversimplifying this so I hope that’s not um not a problem very complex situation but that’s why there’s a lot of uh things that go into pain right our understanding of what is causing our pain can amp up levels of pain um our history with that particular you know movement can amp up the pain right if I um had a motorcycle accident and I injured something in my body and that trauma of that accident just kind of reinforce every time I think about it or all that, it’s going to activate those pain systems again. Um, so I’m giving kind of a wide overarching kind of a view of how I tend to work with these things or understand these things. I haven’t talked about how I work with them, but how I understand these things because emotions are part of that system too, right? Our emotions have a physiological response. They are going to alter our heart rate. They’re going to alter our um sweat glands. all of those things. Almost all of our emotions have some sort of physiological response to our body. And if we’re under intense fear, intense stress, and if we’re thinking about these injuries or things like that, it’s going to start sending messages of danger to our brain. Our brain has learned that this is dangerous, and I amp up that pain.

Dr. Camille Ronesi: Okay, that makes sense. Yeah. So, do you tell me about what that first day is like? like what what what is it like to really one I feel like are there people truly coming to you saying what do you mean it’s in my head and then how do you like that first session’s got to be the hardest in some ways um yes it can be I think because pain education is getting a lot more accessible I’m getting a lot more people coming to me saying that they know that there’s a connection here and they don’t know how to you know work on that right that’s the how is a little bit more complicated sometimes than what’s happening. But yes, I’ve often been referred people and people are like, “Oh, my doctor says this is all in my head or, you know, there’s no reason I should be in pain.” Um, so it can be complicated because I I would just say like, you know, all pain is in your head. You know, like I said, when you touch a hot stove, your brain is interpreting that and generating pain. So whether or not I touch that hot stove or I’ve got pain after, you know, 30 years ago, I twisted my ankle and now I’ve just kind of got consistent pain in that area. It’s all generated by our brain. So in that way, it’s all in our head. It doesn’t make it any more or less real. It just means that the cause of our pain is not probably tissue damage at this point. Right? I feel like people at this point are going to start making assumptions that you’re going to tell them to take deep breaths, right? Which you probably do. I mean, I would hope that you do, but also that’s that’s not the solution. Correct. Yeah. So, what like what are some of the tools in your toolkit?

Dr. Jessica Grove: Yeah. Besides deep reading, those are tools and I I would say keep doing all of those things. they are going to help kind of part a part of our brain um decrease that acute stress response that immediate like fear that you get when you’re you know about to give a big speech in front of people or you know you’re going to have to learn a new skill. So all of those things can decrease that acute kind of stress response but it doesn’t repattern the fact that our brain is interpreting that situation as dangerous right or as problematic. So pain when we’re talking about chronic pain I should say ongoing pain without kind of a clear identifiable structural cause is really because our central nervous system our brain is learned the patterns that say that’s dangerous that’s threatening. So in order to help people or help the brain start to feel a little bit safer in those situations, we have to do a lot more than just breathing, right? A lot more than just relaxing our muscles, which are all part of it. But we have to give the brain opportunities to learn new experiences with that. Um, so this is where, you know, probably you’re familiar, right, in PT, right? We do like things like great at exposure, right? We’re starting really small with just learning that, okay, this movement is actually safe and completely safe. And sometimes that pain is going to come, that doesn’t mean that this movement is any less safe. And so we give people skills while they’re going through that process of little by little exposures to these movements, to these things that all right, I’m feeling a little bit more calm. I don’t feel like this is dangerous to me anymore. And eventually our brain repatterns that takes time and repetition to decrease that sensation. So the whole point of what I do is not necessarily pain reduction. It’s creating safety in the mind and the body and often times that does result in pain reduction specifically for chronic pain.

Dr. Camille Ronesi: Right? So, I’m gonna I’m gonna play devil’s advocate, not because I believe in it, but because it poses the question, which is, you know, certainly in my like we we treat pain, right? I’m a physical therapist. I treat pain. Um, and there’s always the coaching element to it. Yeah. But there is a movement piece and I am a movement specialist. I know the anatomy. I know how something moves. I know how they should exercise. Um, so I’m curious is or I guess the push back is well like do you have them move? Do you know what they need to do when they move? Like how like do they actually move in your clinic and you find you reduce threat when they do it? How do you

Dr. Jessica Grove: occasionally? Yeah, that can certainly be part of it. Um, I’m not like specifically coaching people on the exact moves that they should be doing, but most of the time when I see chronic pain, the patterns are a little bit predictable almost, right? A lot of times it’s delayed pain, right? After I go for a walk, I come home and now I sit down and everything flares up, right? Because I maybe overdid it while I was walking or I can only sit in one specific chair. I can only do I can only bend down this way. And really, a lot of this from an anatomical viewpoint doesn’t make a ton of sense why that specific movement or this specific walk or something like that would cause this level of pain. So, I feel very confident after reviewing making sure they’ve had all of their medical workup, right? I never do this solo, but after seeing a lot of those things, it’s like, hey, walking is probably not the thing causing this pain. Now, doing too much when you’re not ready for it can cause those pain flare- ups, right? So, we want to start very small, which is what I talked about. Um, but yeah, like little things like let’s stand up in session. Let’s move, let’s do some things and give our body new experiences because also I’m that person’s probably afraid to do those movements, right? So, if I’m with them and we can do that together, that makes it a little bit safer, a little bit more accessible.

Dr. Camille Ronesi: Sure. Okay. So, how do you get them started? What what’s that first experience like for them? like the first session or

Dr. Jessica Grove: Yeah. Yeah. So, I think that that is very hard to say specifically because I kind of work with the person that’s, you know, directly in front of me. But a lot of times it’s kind of a two-pronged approach. Um, one is kind of working with the danger mechanism of the brain or the pain itself. So I give people little tools and skills to kind of help work on little exposures, little mindfulness-based strategies to kind of help reduce that harm alarm in their brain. So that could be something that I use frequently is called sematic tracking. It’s just giving our brain permission to engage with these pain sensations through a lens of safety. So I will mindfully attune to those pain sensations and also at the same time remind myself that it’s safe to experience them. they’re not harmful or dangerous to me. And then I will kind of um you know that’s not usually the first session because I want to know that someone can kind of experience that without like retraumatizing themselves from a pain point of view. So there’s all kinds of caveats that I do with people. But that’s kind of one way that I would say let’s give ourselves just a little bit of exposure to this pain through a lens of safety and see what does. Very often people will decrease their pain experience just from those types of um invivo kind of you know imaginal exposures. Um and then the second prong of kind of what I do is hey there is a lot of things that can keep us on high alert or keep our brain on high alert which is maybe it is this history of you know traumatic events that have happened and I’ve learned that anger is a dangerous thing or I’ve learned that you know sadness is dangerous to me right and so sometimes I have to make peace with a lot of these emotional experiences so that they don’t keep setting off that danger alarm too so it’s almost a two-pronged approach you need to work with the pain itself And then I need to work with some of the other things that might be keeping that system very active or on high alert.

Dr. Camille Ronesi: So I really love that you how you say that like anger is a dangerous thing. Sadness is a dangerous thing. So this is what patients are presenting to you is that they might not recognize it but that they’re always experiencing some kind of anger or an intense emotion which their brain is perceiving as a threat.

Dr. Jessica Grove: Yeah. or that it’s so stamped down, you know, that we that it’s not allowed to be expressed, right? If it’s not allowed to be expressed, then my brain says that that’s a problem and anytime I get even a hint of that emotion, it’s a threat to me.

Dr. Camille Ronesi: Does that make more sense? So, it’s almost like they’re re-ransating their anger as pain. So rather than being able to express the anger or the sadness or the intensity of whatever that emotion is, the too muchness, yeah, their body will just will redirect it into the pain pathways.

Dr. Jessica Grove: Yeah. Very.

Dr. Camille Ronesi: Have we seen have we seen chemical markers? It’s not that I don’t believe you, but like have we seen representations within the actual physicality of that happening like the lyic system?

Dr. Jessica Grove: Yes. Yes, we have seen that. I’m happy to talk about like um some of the reason

Dr. Camille Ronesi: I’m fascinated. Yeah. Yeah. Like there’s like is it functional MRI stuff?

Jessica Grove: Yeah. Um so we we have some of that data um and specifically it’s more and more coming out right about the different parts of the brain and I’m I’m not as well versed on all the parts of the brain that kind of light up during these systems or these scans. But we do see a lot of times that just the when you experience acute pain versus when you’re experiencing chronic pain, there are different parts of the brain that are lighting up here. And the ones in chronic pain are a lot of times these um the memory pathways, right? So like I’m I’m linking this to past memory or to past learning, whereas acute pain is kind of the almost the um I’m forgetting this the specific term, but right when you’re learning something new, it’s a new kind of skill, right? So I’m learning in the acute pain I injured my you know foot I broke my foot I am learning something but when it’s chronic pain or it’s been going on it’s not linked to memory it’s learned of past skills that we’ve had in those different areas of the brain and then in terms of like emotions right like we kind of already have this understanding that emotions create physiological changes right like when I’m angry my heart rate goes up or you know even at the long of at the end of a long stressful day I might have headache, right? So, we know that these changes are happening. A lot of times there’s just this disconnect where we think there’s no way my brain could be doing this with how much pain that I’m in. But really, we do see that quite a bit. Like a strong especially strong repressed emotions can really be tied to um long-term chronic pain there.

Dr. Camille Ronesi: Yeah. I I’m curious. Um you know, I think that people are so ready to accept neck stress, right? like, oh, like I people throw that out there without even thinking twice about it. They might as well be asking for a cup of coffee where they say, “Oh, of course my neck is tight. Like, I’m just so stressed all the time.” Like, it’s just instant that people will say that. But if you start expressing, “Hey, you have a lot of problems with like you have a lot of intensity around interpersonal relationships and your hips really hurt.” Do you see particular linkages of like particular body regions and types of mentation or psychology around it.

Dr. Jessica Grove: Um, I would there’s no clear-cut answer to this. I would just say in general, no. There’s not specific areas in the body that are linked to specific stresses, but it is not uncommon for an area that experienced trauma to harbor and learn those pain pathways and keep those very active. Right? This is why I talked about a motorcycle. I worked with someone who had a motorcycle accident and they were just in chronic knee pain. Even though that it was that’s because their knee really did have to go through some pretty big surgeries after the motorcycle accident even though everything was structurally and tissue had healed that pain was really ongoing for a long time. So yes, very common if that particular spot in the body um you know had a traumatic incident our brain doesn’t forget those pathways and it can also be linked to other things that are not physically traumatic. Right? if you have a history of abuse, right, or these even other areas. That’s why, you know, it’s not uncommon, right, for sexual abuse to have be associated with pelvic pain and things like that because those things definitely do come out. But I wouldn’t say that there’s a specific oneonone link, right? Chronic pain itself is linked to trauma and these other things, but we don’t see like particular areas.

Dr. Camille Ronesi: Okay. Yeah, I think that’s um we get a good I get because of the nature of our clinic, we get a lot of the weird we get a lot of the I’ve had these really long pain situations or this movement’s a real problem or it’s a lot less of the I just sprained my ankle. It’s a lot more of I’ve had 15 ankle sprains and I’m hyper mobile and like and so we are we work very closely with chronic pain in here and we have this very interesting case of somebody having had gone through a very serious trauma and it um it essentially manifested into chronic regional pain syndrome. Yep. And I’m sure you probably So we could definitely talk about that a bit because I think it’s it’s kind of this bizarre mystery. We still we have a bunch of like I don’t know. Um, so what do you see with chronic regional pain syndrome?

Dr. Jessica Grove: Um, CRPS is a is a really tough one. I’ve worked I’ve worked with one person with CRPS a while ago now. So, um, but I’m familiar with I’m part of a number of different psychologists groups that like treat chronic pain and whatnot. And so, this has always been a tough one, right? But I would just say that it’s no different. It’s just that your your body is creating this physiological response. So when we say that it’s brain generated, it doesn’t mean that it’s not having that physiological response. It doesn’t mean that the swelling isn’t real, right? Or you’re not having these other kind of responses tissue like you know things that are going on in the tissues. It just means that it’s kind of starting because of that threat response from the brain because our brain is responsible for every every physiological process that we have. Um, and so I would I would say I have worked with people who are big practitioners of um, and I I myself am too. I don’t know if you’re familiar with pain reprocessing therapy at all. Um, but it’s a specific type of psychological treatment that, you know, I’ve talked about some of the things that I do that is kind of a piece of that. But they have really good outcomes for CRPS and helping people decrease that threat response and really get some mobility and um, normalization back into their their realm.

Dr. Camille Ronesi: Help Yeah, help me with pain reprocessing theory. I have not heard of that term.

Dr. Jessica Grove: Yeah, pain reprocessing therapy is a little bit more of a more modern kind of therapy. So I would say that I use it a lot and I’ve seen a lot of benefit and um people getting a lot better through we call it PRT. So I’m gonna use the acronym there. Um but really it is all about what we’re just talking about is decreasing the threat system a specific kind of set of skills for providers themselves to um help train the patients to to work through. Um and the research and science behind this approach is really starting to blow up and get a lot of traction. I think we still need more because it’s still relatively new, but it’s definitely been life-changing for a lot of people that I’ve worked with.

Dr. Camille Ronesi: So, what would be and is it a is that the types of questions you’re guiding them through?

Dr. Jessica Grove: Yes. Um, yes, for lack of being able to break it down into every, you know, every intervention that we use, but it really is a lot of those things I talked about with kind of the graded exposure in a safe way, creating a safe environment to do that. Um, mindfulness-based approaches where we call it outcome independent, right? We’re not trying to get the pain to go away. we’re trying to increase safety in the body because a lot of times the more that we try to get pain to go away counterintuitively the more it flares back up, right? So if we are intense about not being in pain, then a lot of times our pains just keeps going, right? It’s like that pressure, that stress response. Um, so PRT is just kind of a set of interventions and actually they’re training lots of people. I’ve worked with PTs who are, you know, in this and u even medical doctors and and all of that. So learning just kind of some of the skill sets to help people feel a lot safer in their body and that in and of itself can help decrease the experience of pain. But the goal of pain reduction is less so and the goal of increasing that safety is the paramount thing.

Dr. Camille Ronesi: And I feel like we we keep saying these words a lot like threat, danger, safety. Uh and that of course that for the it is much more trendy now. So I think a lot more people are very familiar with it when you start saying things like sympathetic nervous system, parasympathetic nervous system. Um, and this is where my understanding of like cognitive behavioral therapy and ENDR, all of these things like they tap in to somehow messing with the autonomic nervous system to reprocess the information. Yep. Is that simil is that similar kind of in that pain reprocessing therapy? You’re tapping those systems.

Dr. Jessica Grove: Yeah. I would just say that with this, it’s just um a a lot more tailored to helping the pain actually go away, where some of the other approaches aren’t specifically focused on pain reduction. They’re just kind of teaching you to live better and cope better with the pain. Like CBT is a very common one where you learn to function and live your life again, even with this pain present. pain reprocessing therapy really does see a lot of big reductions in pain um and even some long-term good sustainability of that too, right?

Dr. Camille Ronesi: Interesting. That’s it’s it’s I know it’s very hard to like say things in a concrete way, right? Like because it’s it’s how do you measure a qual a quality thing, not a quantity thing. Um so with that being said, I guess I should ask the question, pain scale, we agree it sucks. Of course it sucks. Do we have a better way to measure this though? So how do you me like how do you measure what do you do to measure that quantifiable? Have we had reduction in pain?

Dr. Jessica Grove: I mean I use what the patient themselves are just telling me, right? Um so a lot of the skills that I’m working with people on I’ll tell them I you have to use the pain skill to some degree, right? If Yeah. Yeah, if the pain is too high, like it’s above a six to seven or or higher in your day, I don’t want you doing a lot of this exposure work, right? Because we’re all we’re doing is like flooding the system and almost retraumatizing and like kind of reinforcing a lot of these learned pathways. So, we have to kind of practice them when the the danger or the pain is a little bit lower. Um, I would just say that I check in every session I have with someone like what was this past week look like for you and what specific instances did you have pain and you know if it’s constant 247 like we got to look at the nuances of that too. Are there times where it’s just a little bit less a little bit higher? So I’m really using a lot of qualitative measures when I say that. Um, we can also use different scales as well if we want to, but most of the time I’m just kind of basing off of what the person’s telling me. That’s I feel like that’s the most accurate, too, right? Am I helping you, right? Like, was it better?

Dr. Camille Ronesi: Yeah. Are you seeing benefit from this?

Jessica Grove: Right. Like you were able to do the stairs today and not yesterday.

Dr. Camille Ronesi: Yeah. Exactly. Um, and that certainly plays into that fatigue piece. Uh, I’d be willing to argue that sometimes people don’t know they’re in pain. Do you like have you actually had to like expose people to saying you’re actually in pain versus fatigue or you know what I mean like there’s like pain and fatigue and the cluster of symptoms the cluster of symptoms?

Dr. Jessica Grove: Um, I don’t know that like for me the terminology matters so much. If I can kind of conceptualize any what that person is presenting with like with are you thinking like chronic fatigue syndrome and things like that or just in general?

Dr. Camille Ronesi: I think sometimes people don’t know how crappy they feel.

Dr. Jessica Grove: Oh yeah. But I would also say that that I think pain is a uniquely conscious experience, right? pain doesn’t exist unless we’re actually experiencing that pain. A lot of times people are like, “Oh, I forgot that I was in pain.” And then I remembered and I’m like, “Well, if you forgot or you weren’t, that means you weren’t kind of experiencing it at that point.” Right? If you can forget, that’s great. Um, I kind of want you to forget more and more. Like that would be the goal to just forget about the pain, right? I’m being a little facicious there, but

Dr. Camille Ronesi: No, no, I get it. No, I totally get it.

Dr. Jessica Grove: But um with these other things too, yeah, they kind of can all be sometimes threat signals from the brain, nausea, fatigue, all of that can also be part of that system for sure.

Dr. Camille Ronesi: Okay. Yeah. So where do you where do you leverage painaltering substances to facilitate their recovery?

Dr. Jessica Grove: That is such a good question. That’s a tough one, too. This is what you get for working in a complicated field that’s not provable, you know, like we can’t measure it. We can’t quantify it.

Dr. Camille Ronesi: Yeah. This is what you get. You get complicated questions with impossible answers. Good luck.

Dr. Jessica Grove: For sure. And and this is where I always just go back to it just depends on the person in front of me. But there are specific things I think we can say from a scientific viewpoint that are not good for pain, right? like chronic opioid use is not going to be good for long-term pain because it aids in what we call sensitization and things like that. Um so but it’s never my decision, right? Like someone is kind of doing their thing and this is what’s working with them and their medical provider and all of that. Um I’ll help where I can with also knowing that there’s going to be limitations potentially with certain things involved. Um, so I think we’re getting into a bit of a a tough place where, you know, I see a lot of people on gabapentin frequently. I’m like, hey, stay on everything that feels like it’s helping you until you’re feeling confident enough to start decreasing that and I’ll be with you if we notice any kind of changes in your pain or things like that. Um, so I’m never telling people to get off of medication before they feel completely ready to do that. Um, but that’s kind of an individual thing. We also can get into a little bit of like, you know, substance use concerns and I I always just feel like I have to provide a lot of education on how alcohol affects the system, how marijuana can sometimes affect the system and things like that where it’s just a a conversation, right? And we talk through what that person wants, right? Their long-term goals for for themselves and their pain and things like that.

Dr. Camille Ronesi: So, how do you find that alcohol affects pain processing?

Dr. Jessica Grove: Yes. So alcohol can sensitize the system as well, right? So chronic alcohol use is kind of uh a temporary number, but then typically the next day or even following it’s like pain levels are typically heightened, right? From what we can know from the research at this point. Uh I also see it just as kind of an avoidance behavior, which makes complete sense, right? Sometimes we just have to be out of pain for a little while because pain is so intense or so difficult. Um but then while we are using that to kind of avoid or or numb that pain for a little bit of time, um we are kind of just creating a bit of a cycle there where maybe the next day the pain flares up worse or my brain learned that that works. So that’s my first go-to resource. Anytime that that pain flares up, it’s like, “Oh, I need that alcohol. I can’t live without that alcohol.” That’s when we get into those use disorders and things like that, which may need to be treated at the same time as chronic pain.

Dr. Camille Ronesi: Right. You’re almost going to have to put them in pain to so because I can’t avoid it sometimes.

Dr. Jessica Grove: Yes. Not in like a

Dr. Camille Ronesi: Well, I don’t want I don’t want that to be the message. I’m not trying to put

Dr. Jessica Grove: No, of course not. No, I’m not. But I’m saying like if you’re going to do graded exposure, they have to chance being exposed.

Dr. Camille Ronesi: Yes. Uhhuh. and you you can’t exp it’s it’s very sim it is very similar to our world it’s when people come in for the evaluation there are lots of times where I say hey try not to take your pain medicine as long as it’s appropriate don’t take it because I need to know what causes pain and if you are on ibuprofen I can’t provoke your symptoms therefore I can’t get an answer now that said during eval that’s a tough day because I’m going to be intentionally provoking your symptoms. So there is sometimes the advice depending on the presentation of the person is you may want to take it right before the eval so it is on board and it kicks in as we wrap up the eval. And you can you can you can argue with me right now and tell me whether or not that’s bad advice and if I have better advice out there.

Dr. Jessica Grove: No, I don’t think I always do it. I just sometimes be like, “Oh, I came in. They’re like, “Oh, I took an ibuprofen. Is that okay?” And I’m like, “Well, I need Yeah, of course it’s fine, but now I’m not going to know what hurts you.” Yes, I would. That’s okay. So, that is the bottom line, right? If you’re constantly numbing with these not I don’t mean that in a punitive way, but it is numbing, right? I’m numbing the pain down to help me get through that experience. I think for our work together at some point we’re going to have to think about if you want to be off those medications like if you’re okay being on them for the rest of your life that’s not a decision that I’m going to make but if you want to come off of them we’re going to have to start titrating that down right we’re going to have to start decreasing that so in that way yes absolutely we need to give ourselves the opportunity to learn and work with what is actually the raw material right like what am I dealing with with just what’s in front of me

Dr. Camille Ronesi: and I like how you phrase that I like that that opportunity, right, of we need the opportunity.

Dr. Jessica Grove: Yeah. To see what we’re working with.

Dr. Camille Ronesi: And I think that’s I I I really appreciate how that it’s, you know, it is the power of positive thinking, but it is so much which is annoying, but it is it is what we do, right? That is therapy of like there is another door. Would you like to walk through this door? Like aren’t you tired of walking through that door? Would you like to walk through this door? Like that’s all therapy is. I think your therapy, my therapy, all therapy is like there are other ways to do this. Would you like to try?

Dr. Jessica Grove: Absolutely. Yeah. No, I think you’re you’re right about that.

Dr. Camille Ronesi: Which means you’re really having to manage fear. That’s all this like that’s what I do.

Dr. Jessica Grove: Okay. I I call myself a pain psychologist. I would really feel like I should call myself a fear psychologist because that’s what you know graded exposure, right? If you’re thinking about that, I I do have to take those steps of and that’s fear, right? I’m reprogramming fear in my body and how that shows up. And in fact, if I have some good data that says this is not structurally damaging to me and that I’m safe to do this, all that’s doing is turning the fear down on being able to do those things. And that is what helps our brains start to relearn. I’m not afraid of this. It’s not dangerous to me. I’m not harming myself. Then yeah, I can do this and I can do it little little ways so that I get more and more experiences of this is not dangerous to me. I’m not afraid of it.

Dr. Camille Ronesi: Yeah, I think Yeah. So if you were um managing fear for people with the hopes of that if they experience less fear they experience less threat. If they experience less threat they experience less pain. That would be the ultimate victory.

Dr. Jessica Grove: Yep. That’s it.

Dr. Camille Ronesi: It like it. So we just put people in front of a scary movie but we play a different soundtrack like they don’t feel anymore. Got it.

Dr. Jessica Grove: Yeah. Done.

Dr. Camille Ronesi: So, as we start to wrap things up, I I I like to ask the question of all right, people are listening to this now and somebody’s actively in chronic pain or they have an they know that they are avoiding stuff because of the pain that may be produced. What’s something you would want them to know? What’s an action they could take right now besides signing up for your group for your group program or coming in to see you? Uh what’s something what’s a takeaway that would help them today?

Dr. Jessica Grove: Such a good question. I This maybe sounds overly simplistic, but I find that my people with chronic pain are just extremely hard on themselves. Um, and maybe mad at their body and like all of these things like they’re really kind of the the tendency I see is a lot of self-critical talk and self-critical nature, right? And maybe perfectionism, right? I’m not performing to the level that I once was. So, when I think about chronic pain, those kind of images or thoughts come to me and I’m just always asking my clients, can you offer yourself a little bit of grace today? Can you offer yourself a little bit of compassion? I know that maybe things are not looking the way that they want to. Maybe things are extremely difficult and this is hard. This is hard. So, can we just allow ourselves to feel that this is hard and that I I I need to be compassionate, right, about my whole experience right now instead of beating myself up, instead of being critical. And the more that we can, you know, approach ourselves with more compassion, less self-critical talk, less all of that, in fact, the more likely we are to try new things, right? the more likely they are to experiment and see and maybe have a little bit more hope as well because a you know a dog that we beat 247 is not going to try and learn new tricks right but when we encourage ourselves and we have that compassion we have grace then we feel a little bit more hopeful we feel a little bit more confident and I would just say give yourself a little bit of grace for going through an extremely extremely difficult experience

Dr. Camille Ronesi: well I can’t think of a better way to wrap that up That was that was beautifully said. I couldn’t agree more that I think I think within working with people who are in pain, grace is kind of it, right? I we have I have the patient who wears a shirt that says practice radical self-mpathy. And it’s just this beautiful reminder of saying just give yourself room to exist and don’t worry like don’t worry about it, you know, do less. do less in order to achieve more. That’s it. And and it’s funny. Yeah, we’ll wrap it up and everything, but it’s funny how often people are like, “What should I be doing?” And I’m like, “Let’s slow down. Let’s do less.” And once we feel confident, once we feel good, we’ll move forward to the next step of things. Yeah. I think that’s Jessica. I think that’s a really a really wonderful place to wrap things up. So, you are tell me a little bit about your clinic. make sure our listeners know about your clinic and about how they can find you.

Dr. Jessica Grove: Yeah. So, I run um Virginia Health and Medical Psychology. You can find me at va health and medical psychology.com. I know it’s a mouthful. I didn’t entirely think through the the name when I here it is. Um and yeah, I’m in person and tellalth. Uh so, kind of either one that works for you. You can just pop around my website, see if what’s what you’re reading there feels like it would be helpful to you. I’m happy to just chat in 10 to 15 minutes and see if that could be helpful. But other than that, you know, keep doing with the the PT and things like that. And you are starting a group program.

Dr. Camille Ronesi: Yes. Sorry. Thank you for that. No, it’s okay. I’m here for you. April 3rd. Um, it’s gonna be virtual and it’s going to be eight weeks and it’s going to be based on what I just talked about with pain reprocessing therapy principles and the helping your body feel a little bit safer, decreasing that threat response. Um, and so I would love to chat with anyone who’s got questions about that group. You can also read more about it on my website. Um, but yeah, April 3rd, eight weeks about 90 minutes uh each session. who you know there’s lots of different types of pain right there’s you know terminal illness pain there’s fibromyalgia we don’t know why you have this pain pain there is I had a motorcycle accident so who belongs in this group

Dr. Jessica Grove: great question so I would say any um pain that has been persistent or ongoing for minimum six months and if if it’s not quite explainable by some of the things that you’ve been diagnosed with or things like that, then you could probably benefit. There’s very little harm in this group. Um, but if you’ve got a recent injury or you haven’t been medically evaluated or these other things, this isn’t the group for you. But if you have fibromyalgia, low back pain for 20 years or these other things that kind of don’t makes, you know, people haven’t been able to give you good answers on that, then this is probably the group for you.

Dr. Camille Ronesi: That’s great. I will definitely make sure that the links are as part of it so people have the opportunity to check it out. I think that we could definitely find ways to make sure that you continue to be a resource for everyone out there. I think we’re going to start seeing as we start seeing more and more and more open conversations around dysotonomias around chronic fatigues around hypermobility syndromes around the the all the itises and as we see you know our population’s aging like the millennial population is now starting to hit the age where things start to hurt all the time.

Dr. Jessica Grove: Yep. Millennials are way better about talking about their feelings.

Dr. Camille Ronesi: True. True. actually maybe starts to really see an explosion in research of of hey, there’s a got to be a better way than slap an opioid on this. Yeah. So, with that, do you have any parting thoughts that you would like to share and then we will sign this off for the day?

Dr. Jessica Grove: I think I covered it all, but I would just say thank you so much for chatting with me today and like I said, happy to just have brief conversations with people if they want to know more.

Dr. Camille Ronesi: Yeah, that’s wonderful. Dr. Jessica Grove, thank you so much. We look forward to uh partnering again with you soon in the future.

Dr. Jessica Grove: All right. Thank you.

Dr. Camille Ronesi: All right. Have a great one.