The Modern Pain Podcast Modern Pain Care

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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