Episode 57 - Beyond the Physical: Why Treating Chronic Pain Requires Healing the Whole Person with Dr. Michelle Weiner
Dr. Michelle Weiner shares her evolution from interventional pain medicine to integrative ketamine-assisted therapy, emphasizing the biopsychosocial-spiritual model and treating central sensitization over traditional fibromyalgia approaches.
In this conversation, Dr. Michelle Weiner shares her evolution from chief resident in interventional pain medicine to pioneering integrative practitioner who treats chronic pain through a biopsychosocial-spiritual lens. Double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation, Dr. Weiner reveals why traditional procedure-focused approaches often fail chronic pain patients and how she discovered more effective ways to create lasting healing.
Dr. Weiner's journey started with her background in nutritional science and athletics, leading her through physical medicine and rehabilitation before specializing in interventional pain. But day after day of performing procedures without truly connecting with patients left her frustrated and seeking deeper solutions. Her introduction to medical cannabis as chair of Florida's advisory committee opened her mind to personalized medicine and treating the whole person rather than just diagnosis codes.
You'll hear about her unique approach to fibromyalgia, which she reframes as "central sensitization" to empower rather than limit patients. Dr. Weiner explains how trauma and adverse childhood experiences prime the nervous system for hyperreactivity, leading to chronic pain that becomes centrally mediated rather than structurally based. Her practice now integrates cannabis protocols, ketamine therapy, and comprehensive team-based care to address the root causes of both physical and emotional pain.
Dr. Weiner also shares her personal ketamine experience during training, including a profound vision that later manifested in real life, demonstrating the spiritual dimension she now incorporates into treatment. You'll also hear practical insights about building an integrative practice, the importance of set and setting, and why true healing requires addressing the person with the diagnosis, not just the diagnosis itself.
What You'll Learn in This Episode:
· Career transition insights - How Dr. Weiner evolved from high-volume interventional procedures to relationship-based integrative medicine and why she felt traditional approaches were "stringing patients along"
Central sensitization framework - Why she avoids the term "fibromyalgia" and instead explains central sensitization to empower patients and create hope rather than diagnostic limitations
Biopsychosocial-spiritual model - How incorporating the spiritual dimension creates awe-like effects and connections that traditional medicine misses, supported by neuroscience research
Medical cannabis integration - Her role on Florida's Medical Cannabis Advisory Committee and how cannabis opened conversations about personalized medicine and treating individual endocannabinoid systems
Trauma's role in chronic pain - How adverse childhood experiences and physical trauma prime the nervous system for hyperreactivity and chronic pain development
Practice building strategies - Practical advice about insurance credentialing, marketing to other providers, creating therapeutic environments, and building multidisciplinary teams
Set and setting importance - Why the physical environment, staff training, and patient preparation are crucial for maximizing ketamine therapy outcomes
Patient education approaches - How she explains that healing happens during the neuroplastic window after ketamine, not during the infusion itself, and why "more is not better"
Team-based care model - Working with coaches, therapists, and specialists trained in pain reprocessing therapy and somatic approaches to support comprehensive healing
Key Takeaways:
Traditional chronic pain treatment often perpetuates suffering - Repeatedly treating MRI findings with procedures and medications without addressing the whole person can actually worsen chronification and create hopelessness in patients
Language and framing matter profoundly - Using "central sensitization" instead of "fibromyalgia" empowers patients to understand their condition as changeable rather than a fixed diagnosis, opening possibilities for healing
The biopsychosocial-spiritual model is scientifically supported - Incorporating spiritual dimensions isn't "woo-woo" but backed by neuroscience research on awe, connection, and the brain's response to transcendent experiences
Chronic pain can stem from nervous system hyperreactivity - Trauma and adverse experiences create hypervigilant states where the nervous system perceives threats everywhere, requiring safety and nervous system regulation approaches
Ketamine works as a catalyst, not a cure - The real therapeutic value occurs during the neuroplastic window after treatment when patients can make psychological and behavioral changes with proper integration support
Authentic relationships drive healing - Moving from procedure-focused to relationship-based medicine allows providers to understand the psychosocial aspects of pain and create genuine connections with patients
Lower ketamine doses can be more effective - For patients seeking healing rather than just pain relief, lower doses that allow insight and body awareness often produce better long-term outcomes than higher sedating doses
Integration is essential for lasting change - Without proper preparation and post-treatment integration work, ketamine becomes just another medication rather than a transformative healing tool
Multidisciplinary teams enhance outcomes - Working with coaches, therapists, and specialists allows providers to address different aspects of healing while leveraging complementary skills and perspectives
Listen to the episode on Apple Podcasts, Spotify, Overcast, or on your favorite podcast platform. Watch the discussion on YouTube here.
Episode 57 show notes:
00:00:00 - Teaser: Heart-Forward Medicine and True Passion
00:00:19 - Introduction and Dr. Weiner's Background Overview
00:02:00 - Educational Journey: From Nutrition Science to Pain Medicine
00:05:13 - Colleague Reactions to Non-Traditional Approach
00:08:37 - The Pivotal Moment: From Procedures to Purpose
00:11:04 - Cannabis Integration and Personalized Medicine Discovery
00:13:43 - Biopsychosocial Model and Pain Neuroscience Education
00:17:09 - Trauma Patterns and Chronic Pain Development
00:19:54 - Reframing Fibromyalgia as Central Sensitization
00:23:54 - Adding the Spiritual Dimension: Biopsychosocial-Spiritual Model
00:29:07 - Personal Ketamine Experience and Training Story
00:34:22 - Practice Building: From Employee to Business Owner
00:38:18 - Set and Setting: Creating Therapeutic Environments
00:41:48 - Patient Misconceptions and Education Strategies
00:47:08 - Rapid Fire Questions:
00:53:55 - Advice to 18-Year-Old Self
00:55:34 - Final Thoughts: Pain Complexity and Nervous System Healing
00:56:32 - Contact Information and Practice Locations
00:57:29 - Ending and Show Resources
Thanks for Listening
Professional Education Disclaimer: This content is intended exclusively for licensed healthcare professionals and should not be used by patients for self-treatment or self-education. The information presented reflects individual provider experiences and should not replace clinical judgment, professional training, or comprehensive research. Healthcare providers must conduct their own due diligence, consult current literature, and evaluate treatment approaches within their specific practice context and regulatory environment. This educational content does not constitute medical advice for specific patients or clinical situations - treatment decisions should always be based on individual patient assessment and adherence to professional medical standards.
Frequently Asked Questions
What made Dr. Weiner transition away from traditional interventional pain medicine?
Dr. Weiner described feeling frustrated with the repetitive nature of procedures without really connecting with patients. She explained: "Day after day of going into a procedure room and seeing someone lie down face down and just getting ready to do an epidural injection without really communicating with the patient and seeing their face, I felt like I lost a lot of my ability to properly treat that person." She felt like traditional approaches were "stringing these patients along" rather than addressing the root causes of chronic pain.
Why does Dr. Weiner avoid using the term "fibromyalgia"?
According to Dr. Weiner, she calls it "central sensitization" instead because "I feel like even giving someone the diagnosis of fibromyalgia keeps them stuck." She explained that when patients get that diagnosis, "they're gonna go online and look up what that is, then they're gonna try to figure out what's the best medication or treatment for them." Since there aren't good FDA-approved options for fibromyalgia, this creates hopelessness. Using "central sensitization" instead allows her to explain the neuroplastic changes and empower patients.
What is Dr. Weiner's "biopsychosocial-spiritual" model?
Dr. Weiner adds the spiritual component to the traditional biopsychosocial model, explaining that "the spiritual component can create this awe-like effect and something like awe where it's something that you've never experienced before, it's new to the brain." She believes this helps people realize "other things are possible" and connects them to something bigger than themselves. She referenced "The Awakened Brain" by Lisa Miller as providing the science behind spirituality.
How does Dr. Weiner approach ketamine dosing differently?
Dr. Weiner emphasizes that "more is not better" and that "a lot of the insight can actually be from lower doses, where they're able to quiet their mind, get into their body a little bit more." She explained that when patients are too sedated or in an altered state for too long, "there's a lack of insight when you are too sedated or when you're in a state for too long that you can't remember."
What role does trauma play in chronic pain according to Dr. Weiner?
Dr. Weiner explained that taking a good history to understand "when the injury or trauma started that primed the nervous system for this hyperreactivity" is crucial. She noted that "there's usually something that can tie into it when that started," whether it's physical trauma like a car accident or "adverse childhood events [that] led them to this hypersensitivity within their nervous system, and now they're in this hypervigilant state looking at the world like it's a dangerous place to be."
How important is the integration component of ketamine therapy?
Dr. Weiner stressed that "the few days or weeks after [ketamine] are very significant to how your nervous system can shift over time." She explained that without integration, "it's sort of like giving someone the diagnosis of fibromyalgia and saying, 'You are now in this box'... as opposed to, 'Go home and start to open to new ways of thinking about yourself or changing some of your beliefs.'" She emphasized that if patients don't do the integration work, they might conclude "the ketamine didn't work" when the real issue is lack of follow-through.
What practical advice does Dr. Weiner give for starting an integrative pain practice?
Dr. Weiner highlighted several key elements: getting on as many insurance panels as possible, focusing on the physical space and creating quiet, safe environments with recliners and music, marketing to other providers like therapists and psychiatrists rather than competing with them, and hiring people who understand the importance of setting. She emphasized that "the teamwork is really very important to a successful practice" and working with coaches and therapists who complement your skills.
Connect with Dr. Weiner
Website: www.drmichelleweiner.com
LinkedIn: https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9
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