Understanding CRPS, Central Sensitization & Neuromodulation | Q&A with Dan and Justine

In this episode of 'It's Not In Your Head,' Dan and Justine answer your questions around various aspects of complex chronic pain management, focusing on Complex Regional Pain Syndrome (CRPS) and central sensitization. They delve into the Budapest criteria for diagnosing CRPS, the overlap with central sensitization, and treatments like spinal cord stimulators (SCS) and their pros and cons. Dan shares insights into managing pocket pain, complications associated with SCS, and innovative treatments like Prolotherapy. They also touch on the role of the sympathetic nervous system in CRPS and potential treatment avenues. It's a comprehensive episode packed with practical advice and cutting-edge information for both patients and providers dealing with complex pain pathologies.

Timestamps

00:00 Introduction to the Podcast

00:18 Technical Difficulties and Banter

00:44 Diving into Q&A

01:09 Understanding CRPS and Central Sensitization

09:11 Neuromodulation for CRPS

10:50 Personal Experiences with Neuromodulation

16:30 Risks and Considerations of Neuromodulation

32:47 Device Malfunction and Lead Migration

34:28 Complications with DRG Leads

39:27 Pocket Pain and Treatment Options

43:20 Exploring Prolotherapy for Pain Management

54:08 Sympathetic Nervous System and CRPS

59:12 Concluding Thoughts and Future Topics

Resources:

www.iniyh.com/episodes/ep-29-ask-us-anything-aua-2

www.drdanbates.com.au

www.resilientwarriorcoachingllc.com

Understanding Central Sensitization and Chronic Pain Drivers | It's Not In Your Head Podcast
 
In this episode of 'It's Not In Your Head' podcast, Dr. Dan Bates and Justine dive deep into the intricacies of neuroinflammation in chronic pain, focusing on understanding the drivers behind it. They discuss the philosophical challenges in current pain management approaches and how this limits effective communication and treatment. By breaking down central sensitization into seven key areas, they explore how lifestyle changes and metabolic factors like prediabetes can drive this output. This discussion aims to shift the perspective from merely treating the consequences of pain to identifying and addressing more specific underlying causes, offering patients more individualization and agency in managing their pain.
 
Timestamps
00:00 Introduction to the Podcast
00:35 Central Sensitization and Neuroinflammation
02:56 Linking Lifestyle Changes to Chronic Pain
04:13 Metabolic Drivers of Pain
05:47 Understanding Central Sensitization Symptoms
07:52 Neuroinflammation and Its Impact
11:46 Persistent Injury and Pain Amplification
15:06 Exploring Common Conditions Associated with Central Sensitization
18:32 The Role of Prediabetes in Chronic Pain
21:14 Understanding Insulin and Weight Gain
21:26 The Role of Insulin in Neuropathic Pain
22:25 Investigating Insulin Levels
24:41 Metabolic Drivers and Pain Amplifiers
27:38 Linking Hyperinsulinemia to Chronic Pain
29:38 Lifestyle Changes and Chronic Pain Management
32:00 Neuroinflammation and Treatment Options
36:18 Conclusion and Future Topics

Resources

iniyh.com/episodes/ep-28-if-its-not-in-your-head-where-is-it-coming-from

Strategic Empathy: Handling Chronic Pain and Invisible Illnesses

 In the inaugural Q&A episode of 'It's Not In Your Head,' Dan and Juz discuss strategies for managing chronic pain, addressing both patient and provider perspectives. They tackle how to respond to common misconceptions about chronic pain, offer quick ways to explain one's condition without going into detail, and share methods for recognizing personal capacity and setting boundaries. Additionally, they delve into how doctors can better support chronic pain patients through strategic empathy and acknowledging the limits of medical knowledge. Tune in for practical advice and empathetic approaches to living with and understanding chronic pain.

00:00 Introduction to the Podcast

00:29 Addressing Common Misconceptions About Chronic Pain

03:58 Quick Ways to Communicate Your Condition

07:31 Creating Boundaries and Recognizing Capacity

11:06 Returning to Activities You Love

16:40 How Doctors Can Better Support Chronic Pain Patients

24:48 Conclusion and How to Submit Questions

Resources:

www.iniyh.com/episodes/ask-us-anything-aua-1 

www.resilientwarriorcoachingllc.com/basecamp

In this episode of 'It's Not In Your Head' podcast, Dan and Juz explore the myriad of challenges and strategies around traveling with chronic pain. They discuss pre-travel preparation, in-flight strategies, travel management, and post-travel recovery. Justine shares personal anecdotes about her recent trip to Costa Rica, highlighting practical tips and emotional aspects of managing pain while traveling. They also delve into medication management, communicating needs, and creating a tailored 'holiday program' with your Doctor to ensure a smoother travel experience. The episode aims to empower those with chronic pain to reclaim activities they love, like traveling, by sharing actionable insights and boosting confidence in managing their condition during extraordinary times.

Tmestamps:

00:00 Introduction and Welcome

00:30 A Lighthearted Start

01:53 Travel and Pain: An Overview

02:29 Building Travel Confidence

04:02 Pre-Travel Strategies

08:12 Medication Management

13:15 The Holiday Program

18:06 Flare Management During Travel

23:41 Travel Tips for Managing Disabilities

24:00 Using Wheelchair Services and Handling Reactions

25:06 Personal Travel Experiences and Benefits

27:06 Managing Symptoms During Flights

39:29 Post-Travel Recovery Strategies

41:40 Final Thoughts on Traveling with Pain

Resources:

www.iniyh.com/episodes/ep-26-travel-with-chronic-pain

INCB - Country Regulations for Travellers

incb.org/incb/en/travellers/country-regulations.html

Managing Complex Chronic Pain: Patient and Provider Strategies

In this episode of 'It's Not In Your Head' podcast, Dan and Juz delve into effective strategies for managing complex chronic pain for both patients and providers. The conversation is sparked by Dan's experience at a recent patient-focused conference, where problematic suggestions about managing doctor-patient conflicts arose. This episode aims to provide more constructive tips for patients to own their care, improve communication and information sharing with their doctors, and better navigate the healthcare system with complex diagnosis. They also explore the importance of a structured approach in consultations, the relevance of pre-screening forms, and the role of empathy and humility from the provider side. The goal is to bridge the gap between patients and providers, enhancing mutual understanding leading to more effective outcomes. Tune in for a thoughtful discussion that promises to ease the anxiety around talking with your Doctor, and managing complex patients if you're a provider.

00:00 Introduction to the Podcast

00:28 Dan's Conference Experience and Mental Health

00:50 Challenges in Doctor-Patient Relationships

04:02 Strategies for Complex Patients

04:57 Steps to Own Your Care

05:46 Prioritizing and Matching Problems to Doctors

14:10 Effective Communication with Doctors

14:58 Understanding Doctor's Perspective

16:12 Facilitating Doctor's Hypothesis Generation

28:14 Empathy and Communication Techniques

31:34 Pre-Screening and Diagnostic Tools

32:00 Understanding Central Sensitization Inventory

33:28 The Importance of DAS 21

34:15 Addressing Childhood Trauma in Medical History

35:52 The Role of Trust in Doctor-Patient Relationships

37:36 Barriers to Treatment Adherence

41:48 Recognizing Literacy and Communication Challenges

46:02 Managing Patient Fears and Concerns

51:12 The Value of Admitting Uncertainty

56:33 Bridging the Gap Between Doctors and Patients

Website: https://www.iniyh.com/

In this episode of 'It's Not In Your Head' podcast, hosts Dr. Dan Bates and Justine Feitelson discuss nociceptive pain, also known as body part pain. The episode delves into their Nociceptive Pain Algorithm, breaking down the different types of somatic pain, including mechanical, inflammatory, myofascial, bony, and vascular pain. It includes discussions on different pain management strategies from first-line to specialist referrals, the interplay of different pain types and overlapping issues when it comes to instability, and emphasizes the importance of proper diagnosis and treatment so you can make effective decisions as a clinician even while you are still working through a patients full presentation.

Resources:

www.iniyh.com

Timestamps:

00:00 Official Intro

00:18 Intro to Nociceptive Pain, ie, Body Part Pain

05:16 Body Part Pain Algorithm

11:34 Mechanical Pain

15:20 Inflammatory Pain

17:15 Myofascial Pain

18:43 Bony Pain

19:51 Vascular Pain

22:39 What do I need to do Next?

24:11 First Line Management

28:59 Ligament Insufficiency

33:55 What's Your Next Line?

37:53 Reviewing & Assessing Responses

41:15 Disclaimer

In this Pt. 2 of sleep episode, Dan and Juz cover the conservative measures around improving your sleep, particularly if you struggle with insomnia, or painsomnia, as many pain patients refer to the challenge of falling asleep. They cover external and environmental factors including circadian rhythm, as well as internal or behavioral variables that affect our sleep quality and drive. They dive into special topics and strategies around constructing an effective wind down routine including releases and diaphragmatic breathing, and how to nap in a way that is more helpful than harmful so you can feel tired when you want to, and have energy when you need it. Listen if you're a patient struggling with sleep, or a clinician looking for more effective resources and communication to help your patients improve this piece of pain.

Resources:

www.iniyh.com/newsletter

Timestamps:

00:00 Official Intro

00:18 Intro to Sleep Part 2

02:14 Justine's Sleep Breakdown

03:23 Internal Breakdown: Stress

05:37 Caffeine

07:24 Nicotine

08:00 Alcohol

10:17 CBD/THC

12:59 Exercise

15:00 Screen Time

17:29 Relaxation Techniques

18:51 Napping

23:56 Napping Strategies

29:23 External Environment

35:40 Circadian Rhythm Abnormalities

44:31 Wind Down Strategies

48:22 Breathing 

54:15 Release Techniques

58:12 Wrap-up

59:19 Disclaimer

Dan and Juz dive into the significant relationship between pain and sleep, and how it drives sensitization. They cover sleep basics, how lack of it long-term negatively impacts patients cognitively, and share a helpful analogy you can use as a patient to better explain what chronic pain feels like - especially with regards to increasing buckets of central sensitization. Dan then delves into the medical side of sleep, covering disorders including snoring, as well as various medications used to treat sleep. On the next episode, Juz will cover the conservative management strategies on the patient end, so you can further improve fatigue and cognitive dysfunction.

Resources:

www.iniyh.com/newsletter

Timestamps:

00:00 Official Intro

00:18 Intro

03:28 Recap of The CS Algorithm

07:32 How do you sleep to explain your pain?

11:36 Sleep Basics

12:16 Sleep Cycles

16:47 Bi-directional effect, sleep architecture and alterations

20:22 Mechanistic Perspective

22:34 Sleep Needs

27:43 Sleep Disorders 

35:12 Meds

42:24 Snoring

48:55 Wrap-up

49:47 Disclaimer

In this podcast episode, Dan and Juz explore the concept of pacing and give it a bit of a re-brand, going through their structure and personal examples to learn how to break down managing your timing, tasks and tolerance more effectively so you can reclaim activities and passions pain may have limited. Effective pacing includes careful planning, task batching, and managing context variables to adjust to fluctuating physical and emotional demands. Key strategies involve scheduling pressure-release activities, monitoring stress, and using graded exposure techniques to build resilience through movement. The episode emphasizes the importance of built in flexibility, encouraging listeners to shift tasks as needed and recognize that flare-ups are a natural part of the process, learning to adapt routines and lean on support networks to manage setbacks and regain your baseline quicker.

Resources:

www.iniyh.com

www.resilientwarriorcoachingllc.com/cpp

Timestamps:

00:00 Official Intro

00:18 Intro to Pacing

04:21 Three Components of Planning

09:22 Task Batching vs. Task Switching

14:06 Juz's Schedule Example

18:10 Tolerance

23:03 Techniques to Execute Pacing

31:25 Juz's Chorus Example

33:25 Graded Exposure 

38:09 Activity Pacing

39:04 Awareness & Monitoring

45:21 Zone 2 Cardio

48:10 Flare Management

52:48 Create Rest Around Big Toll Items

54:51 Wrap-up

57:57 Disclaimer

In this podcast episode, Dan and Juz explore a step-by-step approach to managing lower back pain. They begin with busting some significant yet persistent myths when it comes to patient recovery, and continue the conversation by identifying key patient concerns, focusing on red flags and understanding their ability to cope. For pain that is manageable and under three months in duration, they dive into the conservative treatment pathway. As pain becomes more long-lasting, they delve into appropriate medications, diagnostic considerations, potential investigations and referrals. The episode concludes with insights on differentiating between leg and back pain, offering targeted treatments based on the pain's location, whether it be hips, nerves, facets, discs, or sacroiliac joints. Listen to be able to better understand and advocate for your presentation as a patient, and more efficiently identify and treat as a physician.

Resources:

www.iniyh.com

www.resilientwarriorcoachingllc.com/neurotechniques

Timestamps:

00:00 Official Intro

00:18 Intro

02:14 What the algorithm is based on

03:17 Where are you within the algorithm?

04:07 START

04:41 Conservative Management

05:44 Coping

06:21 5 Point Structure - How are you?

07:23 Red Flags

10:59 Pain less/greater than 3 months

12:30 Where does it come from?

18:17 Consequences of Persistence of Pain

20:25 Next Myth - You can't diagnose lower back pain

22:17 Diagnostic Block

24:26 Conservative Elements: How do you move through it?

25:18 Self-Management

28:02 What's Pacing?

30:31 Goal Setting

32:59 Analgesic Options

34:31 Alter neuropathic component of pain

36:41 Review

37:02 What's going on for the patient?

37:43 Do they have any red flags?

39:50 Diagnosing

43:15 referral to the surgeon

43:54 Back Pain is Worse than Leg Pain

46:15 Back pain rules of thumb

48:03 Different structures refer pain to

48:58 point to their pain

51:54 facet joint pain

55:57 Disc Pain

01:01:49 Sacriliac Joints

01:07:20 hips

01:08:37 Wrapup

01:11:43 Disclaimer