The Importance of Building an Integrative Practice to Redefine Pain Management

Kaylea Boutwell:  Hi guys. Welcome to my interview with JR Burgess. We are here today in the Katalyst clinic in St. Louis and we’re really excited for you to be here because today we have a real special conversation in mind. I have spent the last three or four years scouring the globe to understand, and then potentially as long, as my skepticism was overcome, to integrate into my pain management practice, regenerative medicine and progressive techniques where I do nutrient therapy and more of a functional medicine, fix it instead of patch it sort of approach to medicine. Over those years it kept leading me back to JR Burgess. Book writing, stage presentations, in all of the thought leader communities, presenting both on stage and coaching people, doing masterminds. I could not help but keep bumping into you as you are also on a similar quest, to the point of teaching this by the time I got to you. So I was able to watch that from afar and ultimately forge a relationship. So first of all, let me thank you for being here.


JR Burgess:  Oh, thank you. It’s absolutely a pleasure to get to work with visionary doctors that see that there is potential for more.  Not that what you’re already doing isn’t needed and absolutely essential for so many different people, but for those that want more there’s hope and possibility.  We’re still getting into what the future is going to hold for medicine and it’s exciting.


Kaylea Boutwell:  I certainly think so too. At least I am convinced now. I’ve got a very, very sciencey brain, so biology, chemistry, show me the evidence. I love to read academic papers as you know. I’m a lifelong learner, listening to podcasts and lectures and trying to always really understand everything on that scientific level.  I just had not seen in my mind the evidence that supported this. No one thing works for everybody and there are a lot of people that have lost hope and they may have some irreversible problems, but the evidence is there now and nearly miraculous outcomes, especially from combining techniques and approaches and really seeing the person as a whole and treating them in that model.

I know I’m talking to the choir. I mean nobody has seen this more than you and that’s how we kept coming back together. So what I was really, really hoping is that you can share with me, because I feel my mission, my place in the world is to bring this to as many people who I can, benefit them as much as possible and for as long as possible. But that starts with making them really comfortable with what it is we’re talking about, understanding how it can help them, why they need it, why it’s worth their investment, because it isn’t cheap.  For them to see it as a lifelong process so that they get better and better over time instead of worse and worse, which I know was a frustration for you, and was what I was seeing as well. I knew I just needed to nose the plane up. So could you share with me in your experience over more than a decade of working in one of the best regenerative medicine practices on the planet, while you were teaching people on other continents how to replicate what you did. How did you do it?


JR Burgess:  It was a learning experience and it all came from a need.  I was going through grad school, working as a personal trainer and I had played D1 rugby and college baseball and had numerous injuries.   Sports were my passion, they were my outlet. They were pretty much my identity at the time. So I had an injury and had already tried cortisone. I had undergone five knee surgeries.  I had tried everything to continue to manage my pain, but I would play on the weekends and limp all week long. When a client of mine, who was diabetic and wanting to avoid surgery, said he went and had this platelet rich plasma (PRP) injection. So I went and the doctor said, “JR you already exercise and eat healthy. That’s going to play a big factor in your outcome. But let me look at your labs to see if your vitamin D, your testosterone, your hormones are in balance so you can get the best outcome.” So he tweaked a few things internally.


Kaylea Boutwell:  Based on data.


JR Burgess:  Yes, based on lab results, where there was a deficiency based on his evaluation.  They were normal because I was healthy at the time, but they weren’t what he considered optimal, which is a different range.


Kaylea Boutwell:  There is definitely a different range. If you don’t mind my interrupting you.  One of the challenges I have most with my patients is getting labs back and the lab will say that they’re in range, like in normal range, but understanding that those ranges were calculated based just on people in that area, from that age, but in no way really represents where a human is really healthy or what those values could look like if they were really optimized or more importantly how they would feel. If all of those vital nutrients and minerals were all really where they were capable of being, regardless of their age or other factors. So I’m sorry to interrupt you but man, that just really resonated with me.


JR Burgess:  Yeah, it matters. So it’s just like a vehicle. You can probably put regular fuel in it, but if you put high octane fuel in there, it could potentially perform better.  There are two different sides. Traditional medicine, which again is still needed, is all about how we fit into a very standard parameter. This is for the whole general population. How do we safely and effectively, consistently know where those labs lie? There’s a whole other side for functional medicine that looks at how we perform at a higher level, safely, effectively and consistently.

There are those ranges where we can safely bring people to another level of health and we know this because we have spent the last five, six, seven years measuring this.  That’s what optimal precision and functional medicine can be. So instead of normal testosterone, where is the optimal level? Instead of regular vitamin D, is there an optimal level where there is less inflammation in the body, better recovery?  All the things that trained professionals like yourself can truly use to take people to the next level. So when we take that body of work, what are we personally doing? In our protocol you teach your patients first thing what can be done with their own nutrition, their own breathing, their own stress management.  That helps optimize what you can do from a procedure standpoint. So that’s what they did with me and then I had PRP and three months later I’m back to playing at full strength. Of course, then I had more injuries because I like to push the limits on everything that I do.


Kaylea Boutwell:  Because you went back out there.


JR Burgess:  Absolutely. I didn’t just go out there, I went out there full force, because I only know one speed, at least at certain points in my life. 


Kaylea Boutwell:  Einstein said that right? The definition of insanity is doing the same thing and expecting a different result… but we all do it.


JR Burgess:  Age is, fortunately, piece by piece, making me a little bit wiser each step along the journey.  It reminds me that I can’t still do some of the things I did when I was 20, the way I did when I was 20.  But you live and learn. 


Kaylea Boutwell:  It’s worth it to some of us. I mean, if you want to keep playing this sport, even if you get banged up a little bit and you have the ability to go back to it or at least keep doing it at some level as long as possible because it’s your joy, then that’s valuable too.


JR Burgess:  But you learn. So maybe instead of running over people, you run beside people. So, that’s something age can do.


Kaylea Boutwell:  I know you too well. I’m pretty sure that you kept running over them. But then pick him up and help him to the clinic.


JR Burgess:  Absolutely. So I had numerous, continued injuries.  Then we got into STEM cells, which I had right after my sixth knee surgery.  After the surgery I was told I needed a partial knee replacement. I was 32 years old.  So I had STEM cells and six months later I was back to running. Prior to that I was walking, I couldn’t exercise without pain anymore. But after the STEM cells, I was back to running.  Twelve months later I was back on the softball field and I could remember when I first had that injury and thought “Oh my goodness, if I can just do this again….it would change my life if I could play sports”.  And a year later I was back to playing softball and it was second nature. Since then, I’ve had STEM cells eight times, and just recently, now the ninth time with even greater cutting edge evidence showing that we can use things like exosomes, which have numerous growth factors and signaling cells that can really help the body perform in addition to what my own stem cells can do.

I needed this additional help from the exosomes because I have experienced some different health conditions such as Lyme disease that have affected my immune system (even though I’ve used amazing clinics like ours to get back to full health). For some people that type of diagnosis is a spiral down, a lifelong journey of medications, chronic pain, degeneration throughout the body but for us, we’ve been able to see these radical changes.


Kaylea Boutwell:  So I’ve got two questions for you then.  To backup a little bit, because one of the keys that I’ve always felt really enabled me to empower a patient to see this for what it is, to choose to invest in themselves has been education and that’s what got my heart too. So if you don’t mind, just in simple terms.  For example, PRP or STEM cells. I think STEM cells start to tweak some people because for some it starts to sound a little like maybe we’re playing around with stuff we shouldn’t. And then exosomes I think it’s so new which is why we’re so excited about it with great science. But do you mind just kind of breaking down what each of those things are?


JR Burgess:  So platelet rich plasma (PRP) is where you take your own blood, separate out some of the cells that cause inflammation and  basically re-injure the area by injecting the affected area and bring the blood with the most growth factors back to the area. Let’s say I had chronic tendinitis or Achilles tendonitis, which I did have, and blood that area stops getting the same healthy cells and blood flow and scar tissue can build up. So it’s going to re-injure the area slightly and introduce those growth factors to that area where regeneration may begin to occur.


Kaylea Boutwell:  And it’s signaling to the body basically that hey, we need to get on this. There’s an injury here. So it recruits other cells in the body that are your own to come and it gets more construction members on the crew.


JR Burgess:  Absolutely. Recruiting them to work together. So, that’s using your own blood. Nothing controversial there. Then when we talk STEM cells there are numerous different mechanisms or opportunities that have been out there in the industry to use STEM cells.  They may be your own, from bone marrow or your fat. Each one of them comes with different controversies and different evidence at different times. But there are trials, there are people doing them. Whether it’s using placental cells, which are not our own, we’ve seen outcomes in all of them. Each type of STEM cell has its place. So if somebody has autoimmune disease or is unhealthy internally or 80 years old prior to some different regulations, those may be a better treatment for somebody that’s not of full health.


Kaylea Boutwell:  So what I feel I’m hearing you say and what I know from education, but I would not have known otherwise, is when you’re doing the STEM cells, there are two options, fat and bone marrow.


JR Burgess:  From your own body.


Kaylea Boutwell:  That is still you healing you.


JR Burgess:  Your body using it’s own ability to heal. 


Kaylea Boutwell:   But under certain circumstances where maybe you’ve had a history of metabolic syndrome, autoimmune disorders,  maybe decades of poor nutrition, you’re a smoker or older. Maybe your cells really aren’t in the best state of health. So if you’re really wanting something to help you under those circumstances, then someone may, in certain clinics be offered the opportunity to source healthier versions of those cells from someplace else. Like if you went to the American Red Cross and you needed a blood product, you would get a blood product from a healthy donor and they would cross match that with you and make sure that it’s safe to put into your body for the purposes of whatever it was that you needed in blood. So is that all accurate?


JR Burgess:  Absolutely. So least controversial still to this day is using your own STEM cells, bone marrow primarily. These can help treat conditions like arthritis, which I’ve had, tendon issues, rotator cuff tears, labrum tears, back degeneration.  Many different injuries where I’ve seen stem cells or PRP be effective. And for those of you out there considering, I know that you wanted to see the evidence for a long time, which makes complete sense. So we wouldn’t want to ever do anything that doesn’t have its place and hasn’t been tested and trialed and then used effectively. So I always tell people, look at the latest evidence. Ten years ago we heard, “well there isn’t any evidence”. There have been so many studies over time. There is now MRI data.  All of these different products certainly have their place. So look at the new evidence that’s out there today.


Kaylea Boutwell:  Wouldn’t you say that based on the fact that you and I are both constantly… our poor families… going to conferences that are absolutely world class. So they work in orthobiologics, orthopedic surgery, neurosurgery, pain management and many have embraced these products at this point, having sufficient science to do so. If you don’t think there’s enough evidence you just aren’t up to date.


JR Burgess:  You got to look, exactly. The evidence is there, you just have to look, or you will not be up to date. So, that’s the first thing is, do your homework, source good places that are out there. The second thing is…


Kaylea Boutwell:  And if you don’t have the homework I have the homework. I’ve got it.


JR Burgess:  Second thing is, go see it.  Meaning I’ve spoken at nearly almost all the major medical conferences and there are skeptics in the audience, which I get, probably like you were from day one. That’s what you’re supposed to be. But go visit a clinic instead. In a lot of traditional clinics that are just pure pain management, we are managing the pain, but rarely are people going from pain to back to playing rugby or back to doing the things that they once weren’t able to do.


Kaylea Boutwell:   Well, that’s like the conversation you and I had so many times where the frustration of it even being called pain management. I mean pain is probably job security for me because we’re humans. If, it’s not this, it’s that. We are aging ultimately, but being so important to us to be able to say that we have a practice that’s focused on pain resolution.


JR Burgess:  Absolutely.


Kaylea Boutwell:  Significant and sustained resolution. I would like to manage this problem and then when inevitably you’ve got another one in the future, we can come back and manage and then resolve that one. And I just feel these are some of the best keys that we’ve been given in as long as I’ve been a student of pain medicine, decades now, to help actually rebuild and repair without surgery. And I guess that feeds into the next sort of thing. One of the objections I hear is, we’ve covered the evidence but that they’re afraid things aren’t really fixed.

The other thing that my practice sees day in and day out, my bread and butter you would say, are predominately spine surgeries. Because I do specialize in spine and these are patients that have had corrective, anatomical surgeries for their spine and they’re worse. And it took them 6, 8, 12 months, even to heal sufficiently from the surgical intervention to realize that their problem is not fixed and they may have new problems as well. Now I work with incredibly talented spine surgeons, orthopedic surgeons who do a wonderful job. And I do not think that it’s fair to feel that those surgeries never work. But it is a reality with those surgeries that there’s just no guarantees. Not with anything, including what we’re talking about. But the opportunity may be to address it non-operatively, more conservatively.


JR Burgess:  Safer, more effective conservative routes. Because once you have that surgery, anatomically you can’t change a fused back. Those are locked right there together. So, that changes the biomechanics of the entire body.


Kaylea Boutwell:  Meaning that the body moves differently than it was intended.


JR Burgess:  Absolutely. It’s different. So, if we look at why do these things have to be exclusive? That’s what has failed healthcare to this point is that there are so many people that are so smart, but have dogmatically thought this is the one solution.  This mindset of “I’ve got the most education so this has got to be right”. Well the answer is when we go to all these clinics, those that are getting the best outcome are looking at everything that has to do with it. Why, for example, if we’re looking into the future, if I’m an athlete and I tear my ACL, why wouldn’t we do something that optimizes it at the best time?

No different than every surgeon right now who is telling their patient to exercise, do physical therapy, eat better if you’re going to have a better outcome. But hey, why can’t we also add this growth factor to it that could speed up the outcome? So in the future, those things aren’t going to be exclusive. The future of healthcare is we are looking at the whole body, which is physical, internal and mental. How does one think, how does one believe we’re going to recover.  It’s known as the placebo effect, and it matters. Having hope, having belief in different things. And we could go on all day about cancer studies when somebody has a positive attitude towards their recovery and their ability to overcome. It changes the game.


Kaylea Boutwell:  Mindset, so important.


JR Burgess:  Absolutely. Mindset matters.


Kaylea Boutwell:  It’s essential to our practice as you know.


JR Burgess:  Part of your first step is to rethink. What do you have to offer your health condition? The choices, how you sleep, how you manage stress all plays into that outcome. So spiritually, emotionally, mentally, physically, internally, all matters.  When healthcare starts saying, either it is the whole picture or is it okay to say you could benefit from this, this, and this, and work together as a care team versus medicine in its present form which is siloed. My entry was medical fitness and medical fitness has been in hospitals forever, but they’re siloed. They don’t communicate with each other. It’s, well, they don’t have this or they don’t have that. They’re not talking together in this continuum of care looking at the whole picture.


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