The Modern Pain Podcast Modern Pain Care

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