Why We Founded Override: Pain is Personal to Us

by 
David Shulkin, M.D., Override Cofounder

Pain is personal to my family.  We created Override after what has now been an 8.5-year long search for chronic pain relief for my daughter and cofounder, Jennie. Few have the access to medical resources and knowledge that our family did. Others are left googling misinformation, waiting on endless wait lists to be seen by specialists, and having little control or understanding over their care regiment. We created Override to provide the type of treatment system and support that Jennie needed but didn’t exist elsewhere and to give every person with chronic pain better, more accessible, and more comprehensive care.

At Override, we match each patient with a virtual, interdisciplinary care team that actually talks to each other about patient barriers to progress and how to help patients improve. This collaboration is quite the deviation from the status quo of silo care. We provide all this care to you from the comfort of your own home and use technology to enhance the care delivery.

For a little about my background, I’ve been a physician for more than three decades, and I’ve led some of the largest health systems in the world, including the entire US Department of Veterans Affairs. As a result, I am well-connected in healthcare and have been able to reach out to a wide variety of leaders in pain management about my daughter’s condition. These conversations have led us to treatments and clinicians all over the country.  In the process, we became experts in chronic pain – understanding the shortcomings and pitfalls of most existing chronic pain treatments (i.e., one-size-fits-all and body-part solutions that fail to address the whole person and the biopsychosocial model of care) and how care can be improved. Override exists to help others find faster and more effective solutions to their chronic pain issues.  

You may be wondering: What’s different about Override? And why doesn’t anything else like it already exist? Can't a person in pain just consult their doctor and get relief?  Sometimes, yes. Often times, no. 

Why does our current pain management system so frequently fail chronic pain patients? 

  1. The difference between acute and chronic pain.

Pain management physicians are generally focused on and skilled at achieving relief for acute pain – not chronic pain, which is defined simply as pain lasting for three months or longer.  Many of these pain management experts are trained as interventionists, which means that they perform procedures like injecting medications into specific locations (often nerve roots) that relieve acute pain. The US reimbursement system rewards such procedures and interventions, which incentivizes physicians to continue performing them despite a lack of success. Similarly, it discourages them from pursuing non-interventional, more appropriate treatments for stubborn chronic pain. The result is that people in chronic pain continue receiving inappropriate treatment.

Or, just as bad, pain management clinicians often become discouraged and disinterested when the patient fails to achieve relief after several failed attempts – sending these frustrating and frustrated patients off to other referrals or providing no referrals at all.  The agonizing, expensive, and time-consuming cycle of being sent from doctor to doctor begins.  Override exists to help fill these gaps and point you in the right direction.

  1. Rarity of chronic-pain trained providers.

There certainly exist true chronic pain experts, although they are few and far between.  Very few training programs exist to teach physicians how to take care of patients with chronic pain – especially complex and stubborn chronic pain. Most medical schools have a grand total of 11 hours of pain education included in the entire four years of study. Many doctors are simply too inexperienced in chronic pain to make a difference for this patient population. Additionally, managing patients with intractable, unrelenting chronic pain is emotionally challenging compared to more responsive conditions – making the pain management field less attractive to talented clinicians.

At Override, we are identifying and training providers specifically in pain neuroscience principles and biopsychosocial approach. Everyone that patients interact with will have that specialized experience and training.

We are perhaps most proud of our specialized pain coaches. The vast majority of our coaches have lived experience with chronic pain, have overcome their pain or improved their pain experience greatly, and have since become pain coaches to help others do the same. All of them have been given special advance training in chronic pain management and neuroplasticity. While many digital health companies are adding coaches to their programs, most of them have little to no experience with pain specifically.

  1. Rarity of interdisciplinary chronic pain care.

Interdisciplinary care – care provided by teams of providers and different disciplines – for people with chronic pain has long been considered the gold standard. Yet interdisciplinary care exists in only a few pockets throughout the United States: mostly within functional restoration programs or other rehab programs that require significant out-of-pocket expense, relocating to another state, and surviving through 6–18-month waitlists. Outside of those programs, getting your physical therapist to have even a one-time 15-minute collaboration with your doctor can be harder than communicating with someone from beyond the grave; they certainly won’t collaborate on a continual basis.

From my daughter’s personal experience, we know that a support system of providers who stick with the patient makes a difference – both for clinical success and easing the emotional stress and isolation of chronic pain. At Override, we provide each patient with a team of providers who actually talk to each other to identify various barriers to progress, work together to find improved solutions, and stick with patient throughout their journey through our program.

  1. Single modality pain treatments.  

If you find a company selling an electrical stimulation device for pain relief, take a guess what they’re going to recommend for your pain problem? Electrical stimulation.  If you consult a practitioner using lasers, hyperbaric oxygen, or ketamine infusions, also take a guess that that’s what they’ll prescribe . . .  This is a great example of, “If all you have is a hammer, everything looks like a nail.”  

At Override, we don’t want you to waste time, money, and energy on treatments that won’t make a difference for your pain. We are not selling a specific product or device and have no vested interest in you pursuing any specific treatment pathway. We help you understand the various options available and help you make the most informed decisions. It’s also why at Override we focus on a team-based approach to care, where practitioners from different disciplines and perspectives collaborate to create and execute a patient’s plan of care. 

  1. Lack of continuous support & care by leveraging technology.

Living with chronic pain is a Herculean task – both emotionally and physically. It’s a constant battle – all day, every day for many. Semiannual check ins with a physician or quarterly injections are totally insufficient. And they certainly don’t adequately address the emotional and mental aspects of living with chronic pain. Leveraging technology allows Override to make real, human providers more accessible to patients between visits and to deliver education and resources to patients so that they can continually work towards becoming self-managers of their own conditions rather than passively waiting for their providers to dictate the next steps. As we mature, Override is looking to predictive analytics and artificial intelligence to more easily identify which patients will respond well to what treatment paths.

  1. The real reason why chronic pain often persists: pain & the brain.  

Many pain clinicians only pursue body-part solutions to reduce chronic pain. Unfortunately for people who develop chronic pain, research shows us that the brain has internalized new pain neural pathways and essentially keeps it going in a cycle on autopilot – even after the underlying injury or other cause has healed.  Unless we can break these pathways by calming the central nervous system and teaching the brain to “unlearn” pain, chronic pain can continue and worsen over time. The need to override these pain neural pathways is the origin of our company’s name.  

At Override, the main modality that we use is to target the brain and central nervous system.

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I’ll finish with some good news. 

First, better care for chronic pain is possible – even if you haven’t experienced it before. 

Second, there’s more research and innovation developing in the pain management industry today than in any other time in history.  For instance, virtual reality is beginning to show promise in helping the brain to unlearn pain – without medications or surgery.  At Override, we are constantly surveying the literature, speaking with the experts, and looking at new explorations in this field. 

You may have been told that there is no cure for your chronic pain . . . that you just have to live with it . . . that you are out of options. We could not disagree more. 

Our belief is that everyone needs a provider team, peer support, and health navigators to guide them on the all-encompassing journey to relief chronic pain. Let us be there for you.

Posted on 
October 5, 2022

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