Episode Summary:
In this episode of the Modern Pain Podcast, host Mark Kargela is joined by Brett Neilson, a physical therapist and professor at Hawaii Pacific University. Recorded live at the Pain Science in Motion conference in Las Vegas, the episode delves into the crucial intersection between sleep and chronic pain management. Brett shares insights from his scoping review on the integration of sleep measures in chronic low back pain research, highlighting a significant gap in current practices. The conversation covers the impact of sleep on pain, the role of wearables, and practical advice for clinicians on how to incorporate sleep assessments and interventions into their practice. Brett emphasizes the importance of understanding individual sleep needs and using tools like the CBTI Coach app to help patients improve their sleep quality.

CBT-i Coach App
Scoping Review

TIMESTAMPS:
00:00:00 Episode begins
00:01:43 Interview Start
00:02:53 Brett's Work on Sleep
00:05:04 What did they find in their systematic reveiw?
00:08:25 Clinical pearls gained in pre-conference course
00:10:43 What apps or tools are out there for clinicians?
00:13:46 Can tracking sleep excessively become anxiety generating?
00:14:57 How do we determine the right amount of sleep for the individual?
00:19:47 Mindulness or meditation for sleep
00:23:12 How do we get this in curriculum?
00:26:20 How do we get this as every day practice?
00:31:59 Sleep as a part of the big picture in pain

Key Takeaways:
Sleep and Chronic Pain Connection: There is a strong link between poor sleep and chronic pain. Addressing sleep issues can potentially alleviate pain symptoms.

Research Findings: A scoping review revealed that less than 10% of chronic low back pain trials include sleep measures, highlighting an area for improvement in research practices.

Role of Wearables: While wearables can provide useful sleep data, they should be used cautiously to avoid causing anxiety. It's best to view sleep data in the context of long-term trends rather than daily fluctuations.

Screening and Interventions: Simple questions about sleep quality can help identify patients who may benefit from further sleep assessment. Tools like the CBTI Coach app, developed by the VA, can assist clinicians in guiding patients through cognitive behavioral therapy for insomnia.

Individualized Approach: Quality of sleep is more important than quantity. Clinicians should tailor their recommendations based on the individual needs and experiences of their patients.

Practical Tips for Clinicians: Incorporate basic sleep questions into patient assessments, use validated sleep measures, and educate patients on sleep hygiene practices. Encourage patients to find relaxation strategies that work for them, whether it's mindfulness, reading, or other calming activities.

Educational Integration: Teaching about sleep and its impact on health should be integrated into PT education to better prepare future clinicians.

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Diego Hidalgo a Spanish physiotherapist and osteopath discusses their recent paper - ‘It’s all connected, so it all matters’ - the fallacy of osteopathic anatomical possibilism.

In the podcast they discuss:
• Anatomical Possibleism in Osteopathy and PT
• Anatomy, Pathologization, and Pain Discussion
• Pain Treatment and Cultural Differences
• Concerns Over Over-Diagnosing and Anatomical Possibleism
• Addressing Chronic Pain Challenges
•  Holistic Approach to Pain Management
•  Evidence-Based Approach and Transition to Modern Practice Challenges

‘It’s all connected, so it all matters’ - the fallacy of osteopathic anatomical possibilism
Jarvik study

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this conversation, Mark Kargela interviews Michael Shacklock about his journey and influences in the field of neurodynamics. They discuss the transition from the traditional view of neural tension testing to neurodynamics, the influence of pain science on clinical practice, and the importance of integrating the biological examination with psychosocial factors. Michael also shares his focus on lumbar radiculopathy in his PhD research, specifically looking at unloading the nerve root for pain relief. In this conversation, Michael Shacklock discusses the use of neurodynamic techniques in the treatment of radiculopathy. He explains that movement-related pain should respond quickly to movement, and shares his favorite patient profile for this type of treatment. Shacklock emphasizes the importance of ruling out contralateral tests if they provoke pain, as this indicates reduced cord movement. He also discusses the role of radiology in diagnosing radiculopathy and the challenges of interpreting radiology reports. Shacklock addresses the misconceptions around neurodynamic tests and highlights the need for a comprehensive approach that integrates neurodynamics with musculoskeletal function. He concludes by discussing the application of neurodynamic techniques in acute radiculopathy and the importance of adapting treatment to the individual patient's needs.

If you are looking to go deeper on topics, get training, and become a better pain care clinician, then check out our community at https://modernpaincare.com


**TIMESTAMPS**
00:00:00 Start
00:02:04 Interview Begin
00:07:15 The movement to neurodynamics versus neural tension
00:10:37 How has pain science influenced MIchael's approach
00:14:40 There is a time to specifically treat the tissues
00:18:51 Michael's PhD focus
00:23:32 Crossed straight leg raising as treatment
00:26:50 Differneces between mechanical compresison and inflammtory nerve root issues
00:32:05 Difficulties with radiolgy
00:34:16 Where physios are missing the mark in application
00:38:51 Use of neurodynamics in irritable patients
00:42:04 Michael's view on other movement approaches
00:45:09 Michael's courses and where to find him next

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

To go deeper and get support in your practice make sure you check out our community

In this conversation, Mark Kargela interviews Jason Silvernail about the definition and description of Orthopedic Manual Physical Therapy (OMPT). They discuss the misconceptions and misunderstandings surrounding manual therapy and how OMPT differs from other forms of manual therapy. They also highlight the distinguishing characteristics of OMPT, including advanced subspecialty training, focus on clinical judgment, expertise in examination and treatment, and a patient-centered long-term mindset. The conversation emphasizes the importance of evidence-based practice and the need for a nuanced understanding of OMPT. In this conversation, Jason Silvernail and Mark Kargela discuss the value and benefits of OMPT (Orthopaedic Manual Physical Therapy) fellowship training. They highlight the importance of clinical judgment and critical thinking in the practice of manual therapy. They address the misconception of elitism associated with advanced training and emphasize the need for accurate information and informed decision-making. The conversation provides insights into the distinguishing characteristics of OMPT and its role in providing high-quality, evidence-based care for patients.

Helpful Links:
Link to paper 
Clinical reasoning paper in OMPT
Jason's website
Jason's X profile 

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this conversation, Mark Kargela interviews Ian Harris, an orthopedic surgeon and researcher, about the challenges and problems in healthcare. Ian discusses his journey from being a practicing surgeon to becoming interested in the scientific method and evidence-based medicine. He talks about the resistance he has faced in challenging the status quo and the difficulties in changing the way surgeons think. They also discuss the placebo response in surgery, the blurring of normal and disease states in healthcare, and the overuse of procedures like spinal fusion and regenerative medicine. Ian shares his projects on placebo studies for rotator cuff repair and spine fusion, which aim to provide high-quality evidence to change practice.

Takeaways

• The scientific method and evidence-based medicine are crucial in improving healthcare practices.
• Surgeons often face resistance when challenging the status quo and trying to change the way they think.
• The placebo response in surgery is complex, and contextual factors play a significant role.
• The blurring of normal and disease states in healthcare leads to unnecessary interventions and medicalization of normal conditions.
• Procedures like spinal fusion and regenerative medicine are often overused despite limited evidence of their effectiveness.
• Placebo studies for rotator cuff repair and spine fusion aim to provide high-quality evidence to guide practice.

Books (Affiliate Links)
Surgery: The Ultimate Placebo
Hippocrasy: How Doctors are Betraying Their Oath

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this episode, physiotherapist Adam Dobson discusses lumbar radiculopathy and its management. He highlights the challenges in assessing and diagnosing lumbar radiculopathy, emphasizing the importance of precise terminology and understanding mixed presentations.  Adam also explains the role of the neurological examination and the stepped-care approach in managing lumbar radiculopathy. He emphasizes the need for an economical approach to treatment, focusing on patient preferences and activities that are meaningful to them. Adam also discusses the role of physiotherapy in supporting patients' recovery and the importance of balancing tissue-based and biopsychosocial approaches.

Schmid AB, Tampin B, Baron R, et al. Recommendations for terminology and the identification of neuropathic pain in people with spine-related leg pain. Outcomes from the NeuPSIG working group. *Pain*. 2023;164(8):1693-1704. doi:[10.1097/j.pain.0000000000002919](https://doi.org/10.1097/j.pain.0000000000002919)

Konstantinou K, Lewis M, Dunn KM, et al. Stratified care versus usual care for management of patients presenting with sciatica in primary care (SCOPiC): a randomised controlled trial. *Lancet Rheumatol*. 2020;2(7):e401-e411. doi:[10.1016/S2665-9913(20)30099-0](https://doi.org/10.1016/S2665-9913(20)30099-0)

Stynes S, Konstantinou K, Ogollah R, Hay EM, Dunn KM. Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain. *PLoS One*. 2018;13(4):e0191852. doi:[10.1371/journal.pone.0191852](https://doi.org/10.1371/journal.pone.0191852)

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Simon Kelly discusses his journey as a healthcare professional and his exploration of the role of physiotherapy in pain management. He questions the necessity of physiotherapy for every individual and the challenges of building a virtual practice. Simon also delves into the limitations of the biomedical model of medicine and the need for a more holistic approach.

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____________________________________
Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Summary
In this conversation, Mark Kargela interviews Seth Peterson about various topics in physical therapy practice and education. They discuss the challenges of PT education, the role of manual therapy, the influence of social media on PT practice, the importance of mentorship, the value of communication in PT practice, the state of continuing education in PT, and the role of PTs as primary care musculoskeletal practitioners.

Takeaways
- PT education should focus on developing safe clinicians and providing mentorship to help clinicians become skilled practitioners.
-  There is value in manual therapy, but it should be used in conjunction with other interventions and tailored to the individual patient.
-  Social media can create idea cults and confusion for young clinicians, but mentorship and critical thinking can help navigate these challenges.
-  Communication skills are essential for PTs and should be emphasized in education and practice.
-  Continuing education in PT should be evidence-based and focus on developing clinical reasoning and case management skills.
-  PTs have the potential to serve as primary care musculoskeletal practitioners, but there are barriers that need to be addressed, such as expanding PTs' scope of practice.

Check out Seth on X

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Dr. Howard Schubiner discusses the link between childhood trauma and pain, as well as the brain's role in creating pain. He highlights the challenges in training healthcare professionals to understand and address mind-body pain. Dr. Schubiner introduces the symptom perception model and explains the process of pain reprocessing therapy. He emphasizes the importance of ruling out structural problems and using the FIT criteria to determine if the pain is functional, inconsistent, and triggered. This conversation explores the revolutionary data on non-structural pain and the importance of transitioning to understanding the emotional piece of chronic pain. It delves into the role of emotional awareness and expression in pain management and the challenges clinicians face in incorporating a mind-body approach. The conversation also highlights the healthcare system challenges and available resources for clinicians and patients. Finally, it discusses the future of mind-body approaches and training opportunities.

***Helpful Links***
Dr. Sarno's Books
Dr. Schubiner's Website
JAMA Psychiatry Study on Pain Reprocessing Therapy

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

In this conversation, Derek discusses his journey in pain rehabilitation and the challenges faced in providing comprehensive care. He emphasizes the need for prevention and early intervention in pain management, as well as the importance of addressing the biopsychosocial factors that contribute to pain. Derek also shares strategies for introducing new narratives to patients and overcoming barriers to implementing a multidisciplinary approach. The conversation concludes with a discussion on the frontier of pain care and the potential impact of understanding the neuroimmune system on patient care. In this conversation, Derek Griffin discusses the complexity of pain and the challenges of understanding its underlying mechanisms. He emphasizes the importance of bringing complex topics to the patient's context and using relatable examples, such as allergies and the flu, to explain the body's protective responses. Derek also highlights the limitations of pain neuroscience education and the need for a more comprehensive approach to treatment. He discusses the skill set required for psychologically informed care, including active listening, dealing with uncertainty, and acknowledging the patient's expertise. Derek concludes by emphasizing the importance of continuous learning and collaboration in improving patient care.

Derek's X Profile - https://twitter.com/DerekGriffin86

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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness