It's Not in Your Head

This episode expands the NNT framework beyond medications to examine therapeutic limitations across all types of interventions — including a surprising look at the measurable effect of pain neuroscience education itself. A key study is examined to show how no single therapy is the definitive solution for chronic pain. The discussion helps both patients and providers set more realistic expectations, make better-informed treatment decisions, and understand which aspects of pain each intervention is actually targeting.

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

It is entirely normal for chronic pain treatments not to work for every patient — but that reality is rarely communicated clearly. This episode unpacks the concept of "number needed to treat" (NNT), explains the ecological fallacy, and walks through how to properly trial medications. Patients learn how to communicate their preferences and set realistic expectations, while clinicians gain tools to navigate therapeutic limitations with evidence-based language and greater transparency.

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

This episode introduces "The Pain Pie" — a practical thinking tool for understanding the different components that contribute to a patient's overall pain experience. Building on the "Pain is a Sound System" framework, the model helps providers visualize the diagnostic picture and identify which aspects of pain to address first. For patients, it offers a clearer way to understand their own symptoms and recognize which interventions are most relevant to their specific presentation.

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 — also called central sensitization — is the most challenging pain type to identify and treat. Its symptoms are often vague, persistent, and mislabeled as unrelated conditions, sending patients down frustrating diagnostic rabbit holes. This episode introduces a model for categorizing sensitization into identifiable clinical buckets, including:

• Sensory hypersensitivity
• Sleep disturbance
• Fatigue
• Cognitive dysfunction
• Mood disturbance
• Dysautonomia
• Motor dysfunction

Listeners will learn how central sensitization really presents and how to approach prioritized, systematic management strategies.

Resources:

www.iniyh.com

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

https://www.resilientwarriorcoachingllc.com/cpp

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

Neuropathic pain — or nerve pain — ranges from straightforward to highly complex depending on the patient and presentation. This episode walks through the treatment landscape from first-line medications to more advanced options, including:

• Topical agents for focal pain
• Less invasive procedural interventions
• Neuromodulation (spinal cord stimulators)
• Intrathecal therapies
• Low-dose opioids

The goal is to help patients understand their options and advocate for themselves, while equipping providers with a structured approach to individualized treatment decisions.

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 — also called body part pain — is the most common type of pain and frequently underlies more complex chronic presentations. This episode breaks down the distinction between somatic and visceral pain, and explores its subtypes, including:

• Myofascial pain
• Mechanical pain
• Vascular pain

Both patients and providers will gain a clearer framework for recognizing and communicating this type of pain, making diagnosis and treatment more targeted and effective.

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

This episode breaks down a foundational metaphor for understanding chronic pain: "Pain is a Sound System." Dr. Dan Bates uses this framework to explain how pain signals get amplified in the nervous system and why the output doesn't always reflect the original injury. The episode introduces the three core types of pain — nociceptive (body part), neuropathic (nerve), and nociplastic (sensitization) — and sets the stage for the deeper dives that follow. Pain is not imaginary; it is a puzzle, and this episode begins 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

Dr. Dan Bates and Justine Feitelson introduce It's Not in Your Head — a podcast dedicated to cutting through the confusion of chronic pain. This first episode covers why the show is named what it is, the backgrounds and motivations of both hosts, and what listeners can expect going forward. Justine shares her journey as a patient and developing Resilient Warrior Coaching, while Dan explains how he came to specialize in chronic pain and complex pathologies. "Together, they offer a rare dual perspective — clinician and patient — that bridges chronic pain care and lived experience, helping both audiences better understand each other and tackle chronic pain more effectively.

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