Podcast: Dr. Weiner & Dustin Mangas — A Multidimensional Care Model
A conversation on healing, psychedelics, and leaving traditional medicine—with insights for both patients and physicians.
I recently sat down for a conversation that felt more like a homecoming than a podcast. Dustin Mangas and I go back—way back—to my fellowship at the University of Miami. We worked together early in my career, and it was a pleasure to reconnect as colleagues and friends to reflect on how our paths have evolved.
This episode touches on some of the most meaningful shifts I’ve made in how I practice medicine, including why I stepped away from the traditional system and what I’ve learned from working at the intersection of trauma, chronic pain, and non-ordinary states of consciousness.
Dustin mentions something that I also like to talk about a lot - it’s never just one thing that you can fix or change, or just one thing that needs fixing or changing. For example, it’s never just your gut biome that you can fix; it’s also probably sleep and general lifestyle, just like it’s never just your gut biome that’s the root of your depression. Our bodies are holistic, multi-dimensional systems, which is why we (Dustin and I) both believe in the multidimensional view of practicign medicine.
Below’s a summary of the general ideas of the podcast; you can watch the video here.
A Multi-Dimensional Approach to Healing
Years ago, I began to feel the limits of the conventional model. While interventional pain treatments and medications can help in acute cases, many of my patients were returning again and again with the same issues. Fibromyalgia, autoimmune disorders, and trauma-related pain didn’t respond the way the textbooks promised they would.
What I noticed was this: the pain wasn’t just in the body. It was tangled up in people’s stories—how they understood their pain, what they believed about healing, and what kind of life they thought was still possible for them.
That realization shifted everything.
My work focuses on listening first. I look at the full picture—how someone sleeps, moves, eats, thinks, connects, and makes meaning out of their life. Chronic pain often shows up where there's been disconnection: from the body, from joy, from community, or from a sense of purpose.
Psychedelics, including ketamine, offer a way to break through that disconnection. Not because they "fix" anything on their own, but because they create a pause in the usual patterns—a space where patients can access parts of themselves that have been quiet or afraid. With the right preparation and follow-up, those insights can become lasting changes.
Understanding Chronic Pain as a Biopsychosocial Condition
Most of my work centers on the idea that pain is biopsychosocial. This means chronic pain affects and is affected by biological, psychological, and social factors. When I started my career, I noticed many patients with fibromyalgia and other chronic pain conditions were not getting better with standard treatments like injections or medications – these treatments often address acute pain but fall short for chronic conditions.
What I began to see was how much the mind impacts the experience of pain. Patients bring their past experiences, trauma, and stress into their current pain. These factors can fuel their suffering and make healing difficult. For example, someone might have an autoimmune condition or a virus that sensitizes their nervous system, or they might be dealing with depression or anxiety. Fear and negative beliefs can also play a huge role in keeping pain alive.
So, I started to see each patient as a unique individual with a story. I realized I couldn’t just look at an MRI or prescribe a medication without understanding what the person believes about their pain and what makes their life meaningful. Chronic pain often causes people to lose their sense of purpose, and that loss can worsen their symptoms. This is why now, I have an entire team at NeuroPain Health that sees multiple aspects (many dimensions) of each client.
From Traditional Pain Management to Integrative Approaches
My background is in physical medicine and rehabilitation, focusing on musculoskeletal issues and neurological injuries. I also trained in interventional pain management, which usually involves injections and medications. But I noticed that while these approaches helped with acute pain, they didn’t solve chronic pain problems, and patients would often return back.
That’s when I began to explore integrative medicine. I started using medical cannabis as a tool to help patients manage pain and reduce opioid use. Cannabis offered a way to personalize treatment because each person reacts differently. Some patients found relief, better sleep, and mood improvement, while others had different responses–this taught me the importance of tailoring treatment to the individual.
Later, I introduced ketamine-assisted psychotherapy to my practice. Ketamine is a dissociative anesthetic that helps patients access different parts of their brain, quieting their usual pain story and opening space for healing.
In our clinic, ketamine sessions are carefully prepared for and guided. They’re not escapes—they’re mirrors. People often come away with new clarity, not just about their pain, but about who they are and what they want their life to feel like.
It’s important to support that process with real-world tools. Our team includes therapists, coaches, and psychiatric providers who help translate those experiences into everyday choices. Healing isn’t linear, but it becomes much more possible when people feel seen, supported, and capable of moving forward.
The Role of Movement and Lifestyle in Healing
I often say, movement is medicine. Our bodies are made to move, and when people stop moving because of pain, their condition often worsens. Movement doesn’t mean intense workouts; it can be simple stretches, light walking, or yoga. Getting out of the head and into the body is a crucial step for many patients.
Sleep, nutrition, and social connection also play big roles in managing pain. Poor sleep can worsen pain and mood, while unhealthy eating can create inflammation. Social isolation can increase feelings of despair. All these factors interact, which is why treatment must address more than just physical symptoms.
When patients start moving again and reconnecting with their bodies, they often begin to feel more hopeful. This hope fuels motivation and helps break the cycle of pain and negative thinking.
Personalized Assessments and Team-Based Care
Chronic pain treatment is rarely quick or simple. I conduct thorough biopsychosocial assessments, exploring physical health, patients’ beliefs, values, and emotional health. Understanding why someone thinks they have pain helps to uncover hidden barriers to healing.
I work with a team that includes psych nurse practitioners, coaches, and therapists. This team approach allows multiple perspectives and support for the patient. Sometimes, patients get stuck because of fears or limiting beliefs like “I’m not worthy” or “I can’t get better.” These need to be addressed alongside physical treatments.
Addressing the Mind-Body Connection and Spirituality
Chronic pain is often tied to how safe people feel in their bodies. Trauma and stress can make the nervous system hypervigilant, interpreting normal sensations as threats. Helping patients feel safe in their bodies again is a core part of healing.
Many patients also reconnect with a spiritual aspect of themselves during treatment. This might mean different things to different people. For some, it’s about finding purpose or inner peace. For others, it’s about understanding their pain in a broader context. These experiences often happen naturally during psychedelic therapy or cannabis use.
I encourage patients to see themselves as their own healers. Medicine can be a tool, but the real work comes from within. Helping people trust themselves and reconnect with their purpose is a powerful part of treatment.
The Importance of Reframing and Neuroplasticity
How we think about pain shapes our experience of it. Constantly focusing on pain reinforces a negative identity. I often talk about reframing—changing the story from “I am in pain” to “I am someone who is healing.” This shift can start small, like appreciating simple joys or practicing gratitude.
This process ties into neuroplasticity, the brain’s ability to change and adapt. Chronic stress and pain create rigid neural pathways that keep people stuck. But with effort and support, patients can rewire these pathways. Movement, social interaction, mindfulness, and psychedelic therapy all help create new, healthier patterns.
Challenges in Modern Medicine and the Need for Change
The current healthcare system often focuses on quick fixes like medications or injections. These can help in the short term, but many patients with chronic pain need a different approach. I’ve seen how limited time and resources prevent doctors from truly understanding their patients’ needs.
Physicians in cash-pay models can reclaim their role as leaders in patient care, having more freedom to work alongside patients as partners, guiding them through their healing journey rather than just prescribing treatments. Dustin and I talked through how I arrived at this model of care, and why it’s worth considering alternatives to the standard medical framework—especially for physicians who feel burnt out or boxed in by insurance constraints.
We also touched on concierge-style models, what they make possible, and why it’s not just “luxury medicine;” it’s also for doctors who want to offer deeply personal, sustained care.
Final Thoughts: Healing is a Journey
Healing from chronic pain or trauma is never a quick fix. It requires patience, self-awareness, and a willingness to change habits and beliefs. Medicine can assist, but the patient’s active participation is essential.
Each person’s path is unique. Some find relief through movement and nutrition, others through cannabis or ketamine therapy. The most important thing is to find a supportive team and approach that respects your story and goals.
Ultimately, healing is reconnecting with yourself, finding purpose, and learning to live fully despite pain or challenges. I’m grateful to walk alongside my patients on this journey and to share these insights with you.