In this episode, Dan and Juz focus on the importance of communicating and assessing pain through the use of pain diagrams, which help both clinicians and patients gain insights into the sources and amplification of their presentation. The hosts go through many different types of back, leg, and neck pain, discussing how this information contributes to goal setting and tracking progress in pain management. Unfortunately, the data on diagrams makes it seems as though they are useless - but that is if they are drawn in such a fashion. Pain diagrams when done with a clear, consistent key can provide a visual representation of the pathologies driving pain, allowing patients to turn the invisible, visible. Clinicians can then better identify underlying nociceptive and neuropathic components, and amplifying factors, so they can more effectively diagnose and treat. Listen to learn how to draw you pain better as a patient and provider.

Resources:

www.iniyh.com/newsletter

Timestamps:

00:00 Official Intro

00:17 Intro to How to Draw Pain Diagrams

03:03 Where is it? What does it feel like? What's made it worse?

04:26 Turn the Invisible, Visible

06:11 Useless Pain Drawings

07:17 Pain Key

08:51 Plain Neuropathy

09:32 Patient that's Sensitized

12:36 Five Major Causes of Lower Back Pain

17:11 Overlap - Medical Blocks & Other pain

20:15 How do we draw backs? 

20:26 Facet joint pain

21:40 SI Joint Inflammatory

23:10 SIJ Osteoarthritis

24:05 SI Joint Dysfunction

27:48 S1 Nerve Compression

28:09 L5 Nerve Root

28:49 L4 Nerve Root

29:04 L3 Nerve Root

32:04 C4 Nerve Root

32:26 C5 Nerve Root

32:45 C6 Nerve Root

33:14 C7 Nerve Root

33:46 C8 Nerve Root

34:57 C1 - 2 Facet

35:13 C2 - 3 Facet

35:49 C3 - 4 Facet

36:02 C4 - 5 Facet

36:12 C5 -6 Facet

36:44 C6 - 7 Facet

37:17 C2 - 3 & C5 - 6 Whiplash

37:38 Pathologies of Neuropathic Pain

37:59 Focal Nerve Entrapment

38:28 Peripheral Nerve - Superficial Peroneal

39:22 Diabetic Peripheral Neuropathy

40:28 Myofascial Triggers

41:57 Multiple Diagnoses

44:39 Multiple Sites

46:24 When Patients come back with Pain

48:24 Cervical Instability

49:42 Recap

53:55 Disclaimer

Agency is crucial as a chronic pain patient - especially when you feel most helpless and scared with pain at its worst. Flares are always difficult to navigate, but they don't have to make you feel so helpless and reactive. What are the phases of a flare, and how can you manage each one? This episode is a critical resource to learn how to identify and sooner recognize your own flare patterns so you end up in 'the hole' less, and can navigate your way out more effectively when it does happen.

As a provider, how can you better explain flares and give patients a prevention strategy so they are empowered to impact all the aspects they can control, and more effectively treat the pieces you can help with when they are most vulnerable? Listen to this episode for more tools and a structure you can implement right away.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:00 Official Intro

00:17 Intro - Flare Management

02:38 Reasons for this episode

03:55 Justine's Most Recent Flare

05:34  Breaking Down the 5 phases

05:43 1st Phase - Trigger or Stressor

09:27 2nd Phase - Loss of Routine

12:05 3rd Phase - Worsening Pain

15:03 4th Phase - The Hole

17:55 5th Phase - Digging Yourself Out

19:35 Phase 1 Strategies

23:34 Phase 2 Strategies

25:30 Phase 3 Strategies

30:43 Why not Opioids?

32:10 Communicating with your provider

34:44 Phase 4 Strategies

38:27 Phase 5 Strategies - The Reach Out

43:08 Pain Flares have a Cycle

46:58 WrapUp

48:54 Disclaimer

In this episode, Dan and Justine break down how they each set goals and manage expectations with their patients. We dive into why your 'why' matters, how to connect your purpose to your plan, create discipline, tap into motivation, identify your purpose and cultivate confidence, so patients can better tie their actions to their goals and create long-term progress. This episode aims to help patients improve communication and have more effective appointments with their clinicians, and clinicians link their interventions to the goals of the patient in a more compelling way to improve buy-in.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:17 Intro

02:39 Having a Great Why

04:24 Your why matters because this takes time

06:18 Connect your Purpose and your Plan together

08:35 Developing Discipline with a Morning Routine

11:13 Connecting Habits to Discipline to Motivation

12:42 Timeframe - how long will this take?

14:26 How do you identify purpose?

20:47 Finding confidence experiences

27:23 Pain is about loss

30:25 How to talk to your Doctor about this

32:33 Patients need to bring in what they need from Doctors

36:37 Expectation Management

38:38 Disclaimer

In this episode, Dr. Dan and Justine introduce their 'Central Sensitization Algorithm' designed to help healthcare providers diagnose and treat central sensitization and related neuroinflammatory disorders more effectively. The algorithm categorizes symptoms into distinct buckets of nervous system dysfunction, allowing providers to more quickly and efficiently identify and prioritize their treatment plan. By addressing potential pre-existing diagnoses and symptoms, the sensitization algorithm aims to better streamline assessments and improve outcomes for complex patients by creating a clearer picture of an otherwise confusing presentation. The episode highlights the importance of this tool in reducing diagnostic frustration and inadvertent harm, while also empowering patients to better understand and communicate their symptoms.

References:

www.iniyh.com

Timestamps:

00:00 Official Intro

00:17 Intro - How you start to think about it

01:31 Initial Presentation

03:25 Neuropathic / Nociceptive

04:01 Central Sensitization (Other side)

04:45 What is Sensitization?

05:56 How Dan Got Into Hypermobility

08:44 3 Components of Hypermobile EDS

09:18 Two Sides of Central Sensitization

11:03 Justine's Path to Central Sensitization

16:04 Dan's Frown of Frustration

18:57 Looking at the Literature

20:32 7 Main Categories of CS

22:14 Pre-existing Diagnoses 

22:37 Disproportionate, prolonged pain

24:24 Symptoms

25:30 Sensory Hypersensitivity

30:22 Sleep Disturbance

34:38 Fatigue

36:47 Cognitive Impairment

40:02 Mood Disturbance

42:46 Motor Dysfunction

45:33 Dysautonomia - Cardiovascular

47:42 Dysautonomia - Gastrointestinal System

48:34 Dysautonomia - Urinary System

49:47 Dysautonomia - Secretor Motor System

50:49 Dysautonomia - Reproductive System

52:22 Assessment

54:31 What do we do as Doctors? What is driving this patient's CS?

57:57 Final Points

01:00:13 Disclaimer

In this episode of "It's Not In Your Head," Dan and Justine dive into the nuanced aspects of how to more effectively communicate about pain with patients, focusing on the significance of specific language and its impact on patient outcomes. They caution against phrases that suggest pain is purely psychological and inadvertently blame and shame the patient, emphasizing pain is a complex interplay of physiological and psychological factors. They stress the importance of clinicians avoiding language that can be perceived as dismissive or condescending, instead advocating for a collaborative, empathetic approach.

The episode highlights the need for patients and clinicians to work together in identifying and addressing the various drivers and amplifiers of pain, including physical injuries, sensitization, and mood disorders. Importantly, they provide crisis resources for those experiencing mental health challenges associated with chronic pain, encouraging listeners to seek help when needed. Through their discussion, Dan and Justine underscore the necessity of understanding and treating chronic pain with empathy, compassion, and a focus on empowering patients in their pain management journey.

Resources:

www.iniyh.com/newsletter

Timestamps:

00:00 Official Intro

00:17 Intro

04:27 Patient Example - Suicidal thoughts

07:33 What do we do?

08:50 Mosley & Butler's Pain Neuroscience

10:11 Asher Perspective

10:57 Pain Neuroscience Messages - Good Side

13:47 The Downside

17:11 Blue Sky Effect

18:40 Pain Scales and Shifting Pain

24:26 Words That Are Misinterpreted

28:23 How to Get Around it?

31:08 4 Part Series, Step 1 - Find & Fix

32:29 Step 2 - Filtering

33:47 Step 3 - Turn Down the Amplifiers

36:14 Step 4 - Rewire

38:25 Summarize It

40:32 From The Patient Side

44:01 Disclaimer

Trigger warning: This episode deals with the topic of suicide.

Dan and I have an interesting and important discussion that bridges the gap between patients’ clear and obvious frustrations with how different versions of “it’s in your head” affect them and providers’ lack of awareness around the issue. How can this be the case? And how does being told pain is in your head possibly increase suicidal thoughts by 500-1200%? We explain how it occurs and compare it to what we’d accept from other therapies.

Chronic pain patients have a 25% likelihood of suicidal thoughts in the last 2 weeks. If how we explain pain increases that risk in as few as 5% of patients, we might need to think of another explanation.

If you are a patient who has had suicidal ideation recently, please reach out to one of the below suicide support lines in the show notes. We need you.

Resources:

www.iniyh.com/newsletter

Suicide support lines:

Australia - Lifeline 13 11 14 or call 000

USA & Canada - Suicide Crisis and Lifeline 988, or The Crisis text line 741 741

United Kingdom -Suicide Prevention Helpline 0800 689 5652 or Emergency services on 999 or the NHS on 111

Finland - MIELI Crisis Helpline 09 2525 0116

Timestamps:

0:00 Official Intro

00:17 Intro

02:30 Dan's side

05:04 Iatrogenic Psychological Harm

08:28 Young vs Older Patients

09:57 Chronic Fatigue Syndrom

13:16 Obvious to patients, not to providers

16:26 Illness Behavior

21:38 The harm - suicide risk

22:08 Patrick Ryan

27:37 Matthew Burke

31:19 Somatic symptoms and hopelessness

34:03 Bring it together

40:33 Pain Neuroscience

45:09 Wrap Up

47:28 Disclaimer

From the uterus, to witchcraft, hypnotism and more, we go through the history of what unexplainable symptoms have been blamed on and how they've been explained through history all the way up to more modern day classifications like Briquette's syndrome, somatoform, conversion, or functional disorders. We tease apart risk factors and other patterns that have been identified to lead to symptoms commonly labelled as ‘hysteria’, and the resulting biases that have carried through into modern medicine towards patients with these types of presentations. This episode is a somewhat lighter, funny change of pace from the pain education heavy start and continues to dive into why hard to treat patients with difficult to explain symptoms have struggled to be taken seriously - since the beginning of time.

Resources:

www.iniyh.com/newsletter

Timestamps:

0:00 Official Intro

00:17 Intro

01:56 Diagnostic Limitations

05:30 Doctor Side

08:57 Patient Side

11:07 Juxtaposed position

15:08 Understanding things given the time

17:31 I don't know comes with caveats

20:27 Diagnosing History

29:55 Scientific Regions

33:36 The Enlightenment

42:12 Unconcious component of the mind

51:39 Same time as Charco - Briquette

01:04:04 Symptoms Briquette starts to recognize

01:09:20 Thurbrandt - end of 1800s

01:10:56 Sigmund Freud

01:14:41 Second WW

01:17:08 Looking closer at the DSM 1

01:25:02 Unintended Consequences

01:31:25 Conversion Disorders

01:35:29 DSM 5

01:42:04 International Classification of Diseases

01:43:30 How to think about this

01:50:35 Disclaimer

In this episode, we expand upon 'Number Needed to Treat', tying that concept into overall therapeutic limitations and some other examples beyond medications, including one you are definitely going to want to hear about - the effect of pain neuroscience education in and of itself.

So how much does understanding pain actually decrease pain? It depends, but not as much as you'd think...We'll introduce a study that teases this apart and share a few different ways to interpret this so you can see how no one therapy is the be all end all of pain.

Hopefully, this information helps you better understand what aspects of pain you're treating in different situations so you can set better expectations, and make better decisions about the overall treatment plan.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:00 Official Intro

00:17 Therapeutic Limitations

01:27 Pain Neuroscience

03:00 SOPA Score

04:15 Original Paper Graph

06:56 Use these tools to improve components of pain

08:05 Pain isn't just in your head

10:02 Setting expectations for programs

12:19 Evidence-Based Medicine

15:23 Justine's Decision Making Process

17:21 A Future without the Ouch & Wrap Up

20:00 Disclaimer

The hard truth is it's normal for treatments, especially medications, not to work. But how many patients do you actually have to treat to improve things for just one even? This is where the concept 'number needed to treat' is critical to better understand so that expectations don't lead to resentments. Managing expectations as a patient is hard, it's even harder when they're unrealistic. Unfortunately, there is little conversation around what is likely to work in various settings, and what their likelihood is to compared to other options. We'll go through how you should trial medications, ways to improve communications with your provider, touch on the ecological fallacy, explain how experienced clinicians can overcome some of this, and define what evidence-based medicine actually is and should look like.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:00 Official Intro

00:17 Intro - It's normal for treatments not to work

03:07 Number Needed to treat within Neuropathic Pain

05:06 Trial it for 6 weeks

06:07 Context is important in Number needed to treat

10:23 It's an Average - the ecological fallacy

15:00 Why do we do it this way?

16:04 The experienced Clinician can predict

18:15 Develop good communication with your Physician

19:18 Evidence-Based Medicine

20:34 Final Point

21:54 Disclaimer

In this episode, we will bring the different types of pain together in an alternative way to "Pain is a Sound System',  introducing 'The Pain Pie' to tease apart the different aspects of pain that contribute to the output of symptoms patients experience.

As a provider, you can use this thinking tool to better see the different presentations as you go through the diagnostic process. As a patient, you can use it to start to better understand what you are experiencing and what interventions are most appropriate given the specific pieces of your pie.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:00 Official Intro

00:17 Intro to The Pain Pie

04:21 An Algorithm for Osteoarthritis

07:37 The Pain Pie

08:46 Neuropathic Pain

09:36 Nociplastic Pain

10:04 Associated features

11:53 How to use The Pain Pie & Wrap-Up

14:54 Disclaimer