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

Nociplastic pain, or sensitization, is the most challenging to treat due to lack of consistent identification and impactful treatments, which create a void in being able to effectively investigate and treat the symptom clusters this type of pain creates.

The vague, but persistent symptoms are often labelled as other diseases, making the picture even more confusing and overwhelming, leading patients down rabbit holes of diagnosis that seem unconnected but are being driven by nervous system dysfunction. What we need, is language to talk about symptoms that providers are able to pull out of the patients' summary and identify as central sensitization, so they can be systematically investigated and treated just like other pain types.

We share our developing model for categorizing central sensitization into various buckets including but not limited to:

• Sensory Hypersensitivity
• Sleep Disturbance
• Fatigue
• Cognitive Dysfunction
• Mood Disturbance
• Dysautonomias
• Motor dysfunction (since added)

Listen to learn how central sensitization really presents, and for examples of how to approach management strategies and prioritize interventions.

Resources:

www.iniyh.com

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

https://www.resilientwarriorcoachingllc.com/

https://www.drdanbates.com.au/

Timestamps:

00:00 Official Intro

00:17 Intro to Central Sensitization

03:19 Review of 3 Types of Pain

05:55 How Central Sensitization Presents

08:43 Diseases caused by CS

10:11 Categorize CS

10:32 1 Sensory Hypersensitivity

11:23 2 Sleep Disturbance

12:39 3 Cognitive Dysfunction

13:19 4 Mood Dysfunction

13:58 5 Dysautonomias

15:24 You end up with a cocktail of diagnosies

16:37 This gives you language to talk about symptoms

17:15 Example of First Line Management - Sleep Disturbamce

21:19 Second Line Perspective - Sleep Disturbance

22:58 First Line - Orthostatic Intolerance

24:21 Second Line - Orthostatic Intolerance

25:50 You have to ASK the Patient

29:48 CS is such a BIG deal

30:19 Final Thoughts - Look for the Comorbid Diseases

36:21 Disclaimer

Diagnosing and treating neuropathic pain, or nerve pain, can be very challenging or more straightforward depending on the presentation. Now that we've covered nociceptive pain, we’ll dive into the differences with neuropathic presentations.

We break down how to best treat various pathologies, from first line medications and navigating side effect vs benefits, through more invasive interventional options like neuromodulation, intrathecal therapies, and low dose opioids.

Making decisions around treatments can be challenging and based on many factors that are individual to the patient. We discuss the different limitations and considerations with nerve pain, so you have more options to consider as a patient or provider.

Resources:

www.iniyh.com

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

https://www.resilientwarriorcoachingllc.com/

https://www.drdanbates.com.au/

Timestamps:

00:00 Official Intro

00:17 Intro - Diagnosing & Treating Neuropathic Pain

03:32 What causes neuropathic pain?

04:28 Other causes

05:47 We miss diagnose it because we don't ask

07:05 Difference of Nociceptive pain vs Neuropathic pain presentations

10:51 The Emotional Component

15:24 Treating different types of Neuropathic Pain

18:45 First Line Medications

26:02 Side effects vs benefits

27:06 Topical Medications

29:39 Interventional Options

32:08 Neuromodulation

35:28 Trial Period

37:43 Intrathecal Therapies & Low dose Opioids

41:26 Rate at which we move through therapies

44:56 Making decisions based on ALL the other factors

46:05 Unique challenges from a patient perspective

52:10 Technological Limitations

55:55 Wrap Up & Takeaway

59:20 Disclaimer

Nociceptive pain, or body part pain, is the most common type of pain, and often underlies more complex presentations as well. We break down the differences between somatic and visceral pain within this main category, and tease apart its features including:

• Myofacial Pain
• Mechanical Pain
• Vascular Pain

We also discuss the challenges both patients and providers face in communicating and diagnosing this type of pain, so you can do a better job recognizing presentations and tease it apart more effectively.

Resources:

www.iniyh.com

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

https://www.resilientwarriorcoachingllc.com/

https://www.drdanbates.com.au/

Timestamps:

00:00 Official Intro

00:17 Intro - 3 Types of Pain

05:46 Difference between Somatic and Visceral

08:26 How do we treat this?

11:50 Pain Features

13:52 Juz's wiggles

15:05 Myofacial Pain

18:13 Mechanical Pain

19:58 Vascular Pain

22:12 Pain as a Sound System

24:24 Challenges both Patient and Providers face

27:48 Where is the Pain?

31:47 Other Challenge: A Dr's Knowledge base

35:31 Wrap Up

37:29 Disclaimer

Complex pain is, well, complicated. Explaining it effectively can be even more so. In this episode, we go through Dan's metaphor to think about and better explain pain amplification, ‘Pain is a Sound System.’

We’ll talk about how the amplification process occurs, (Justine will interrupt us with some “wiggle time”), and we’ll introduce the different types of pain that play a role including nociceptive (body part), neuropathic (nerve) and nociplastic (sensitization) pain.

With central sensitization in particular, we’ll define the different symptom buckets and pull it all together, so you can actually make sense of weird symptoms and better understand complex pain. Pain is not in your head. It is a puzzle. Let’s begin to put it together.

Resources:

www.iniyh.com

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

https://www.resilientwarriorcoachingllc.com/

https://www.drdanbates.com.au/

Timestamps:

00:00 Official Intro

00:17 Intro - thinking about and explaining pain

03:10 Pain as a Sound System

05:00 Pain is a Social Disease

06:05 Amplification

08:55 Breaking down the Components - 1st Nociceptive Pain

10:22 Features of Nociceptive Pain

11:21 2nd Neuropathic Pain - Nerve Pain

14:02 3rd Nociplastic Pain

17:02 Features of Nociplastic Pain

17:44 Sensory Hypersensitivity

20:49 Sleep Disturbance

22:10 Cognitive Dysfunction & Mood Disturbance

24:28 Dysautonomia

25:48 More Wiggles

29:59 Central Sensitization

32:34 How can we treat people? 

35:10 Pain is a Puzzle & Wrap Up

36:41 Disclaimer

Welcome to the podcast! We are so excited you are joining us. In our initial episode, we cover why we called the podcast "It's Not in Your Head", and what we want to accomplish through it.

We share about our backgrounds, experience and motivations, including Justine's journey to developing Resilient Warrior Coaching, how Dan ended up looking after pain patients, and how we came together to tackle chronic pain and complex topics within it like central sensitization, so we can communicate and treat more effectively.

Through the process of developing this podcast, we've gained unique insight into the others perspective as a Doctor and patient. We hope through listening, we can help you to better understand where patients and clinicians are coming from, and how we can come together to better solve challenges in pain care.

Resources:

www.iniyh.com

www.instagram.com/iniyhpodcast/

https://www.resilientwarriorcoachingllc.com/

https://www.drdanbates.com.au/

Timestamps:

00:00 Official Intro

00:17 Why did we call it "It's Not in Your Head"

03:00 Our plan for the podcast

04:14 Justine's background

07:31 Tackling Chronic pain and Central sensitization

08:59 More on Justine's Background

12:52 How Justine used movement to impact her situation and then coach others

15:58 About Dr. Dan

20:53 Moving Forward, what we bring to the podcast

22:32 Disclaimer