Shows
It's Not in Your Head33 Left, Right and Centrist Pain: Right Treatment, Wrong PatientUnderstanding Pain through Political Lenses: Left, Right, and Center Approaches In this insightful episode of 'It's Not In Your Head' podcast, Dan and Justine discuss the concept of managing chronic pain through political analogies—left wing, right wing, and centrist approaches. They delve into their experiences and observations, identifying different pain patterns and the treatment methodologies that work best for them. The conversation touches on the influence of media on public perception of pain treatments, specifically spinal cord stimulation, and the challenges of conveying accurate medical information in the modern day environment of misinformation we all...2025-07-3128 minIt's Not in Your Head32 Having Difficult ConversationsNavigating Difficult Conversations in Chronic Pain Care In this episode of 'It's Not In Your Head,' Dan and Justine discuss the intricacies of managing chronic pain, highlighting the importance of having difficult conversations between patients, caregivers, and medical providers. The episode delves into strategies for effective medical decision-making, including how to prepare for worst-case scenarios, manage communication challenges, and maintain control and clarity in complex medical situations. Listen for practical tips and innovative approaches to getting what you need done, so you can foster better relationships with providers and improve care outcomes. 2025-07-1744 minIt's Not in Your Head31 Dealing with Being OverwhelmedPrioritize and Execute: Managing Overwhelm in Chronic Pain In this episode of 'It's Not In Your Head' podcast, Dan and Justine discuss strategies to manage feelings of overwhelm often experienced by chronic pain patients. Using their structured pyramid of owning your care, they explain how to prioritize, execute and delegate tasks so you can take control of both medical decisions and daily aspects of managing pain to more effectively deal with complexity and decrease helplessness. Key topics include working through self assessment and monitoring, basic lifestyle habits, mind/body pieces, mainstream diagnostics and treatment, alternative o...2025-06-1251 minIt's Not in Your Head30 Making Sense of hypermobile Ehlers-Danlos Syndrome (hEDS)In this episode of 'It's Not In Your Head', Dan and Justine delve into the complex relationship between hypermobile Ehlers-Danlos Syndrome (hEDS) and central sensitization, focusing on hEDS as an example of a metabolic driver. Dan shares personal insights from his practice and elaborates on the common patterns and markers identified in patients with hEDS, how it should be diagnosed and treated, and associated challenges. Justine adds her perspective, particularly on the connection between CRPS and hypermobility, and lifestyle interventions. They explore the underlying mechanisms, preventive strategies and management techniques, emphasizing the importance of protein intake, avoiding certain drugs...2025-05-2956 minIt's Not in Your Head29 Ask US Anything (AUA-2)Understanding CRPS, Central Sensitization & Neuromodulation | Q&A with Dan and Justine In this episode of 'It's Not In Your Head,' Dan and Justine answer your questions around various aspects of complex chronic pain management, focusing on Complex Regional Pain Syndrome (CRPS) and central sensitization. They delve into the Budapest criteria for diagnosing CRPS, the overlap with central sensitization, and treatments like spinal cord stimulators (SCS) and their pros and cons. Dan shares insights into managing pocket pain, complications associated with SCS, and innovative treatments like Prolotherapy. They also touch on the role of the s...2025-05-151h 00It's Not in Your Head28 If It's Not in Your Head, Where is it Coming From?Understanding Central Sensitization and Chronic Pain Drivers | It's Not In Your Head Podcast In this episode of 'It's Not In Your Head' podcast, Dr. Dan Bates and Justine dive deep into the intricacies of neuroinflammation in chronic pain, focusing on understanding the drivers behind it. They discuss the philosophical challenges in current pain management approaches and how this limits effective communication and treatment. By breaking down central sensitization into seven key areas, they explore how lifestyle changes and metabolic factors like prediabetes can drive this output. This discussion aims to shift the perspective from merely treating the c...2025-05-0138 minIt's Not in Your Head27 Ask Us Anything (AUA-1)Strategic Empathy: Handling Chronic Pain and Invisible Illnesses In the inaugural Q&A episode of 'It's Not In Your Head,' Dan and Juz discuss strategies for managing chronic pain, addressing both patient and provider perspectives. They tackle how to respond to common misconceptions about chronic pain, offer quick ways to explain one's condition without going into detail, and share methods for recognizing personal capacity and setting boundaries. Additionally, they delve into how doctors can better support chronic pain patients through strategic empathy and acknowledging the limits of medical knowledge. Tune in for practical advice and empathetic a...2025-04-1727 minIt's Not in Your Head26 Travel with Chronic PainIn this episode of 'It's Not In Your Head' podcast, Dan and Juz explore the myriad of challenges and strategies around traveling with chronic pain. They discuss pre-travel preparation, in-flight strategies, travel management, and post-travel recovery. Justine shares personal anecdotes about her recent trip to Costa Rica, highlighting practical tips and emotional aspects of managing pain while traveling. They also delve into medication management, communicating needs, and creating a tailored 'holiday program' with your Doctor to ensure a smoother travel experience. The episode aims to empower those with chronic pain to reclaim activities they love, like traveling, by sharing...2025-04-0345 minIt's Not in Your Head25 Communicating Better: Owning Your Care & Understanding Your Doctors POVManaging Complex Chronic Pain: Patient and Provider StrategiesIn this episode of 'It's Not In Your Head' podcast, Dan and Juz delve into effective strategies for managing complex chronic pain for both patients and providers. The conversation is sparked by Dan's experience at a recent patient-focused conference, where problematic suggestions about managing doctor-patient conflicts arose. This episode aims to provide more constructive tips for patients to own their care, improve communication and information sharing with their doctors, and better navigate the healthcare system with complex diagnosis. They also explore the importance of a structured approach in consultations...2025-03-2057 minIt's Not in Your Head24 Body Part Pain AlgorithmIn this episode of 'It's Not In Your Head' podcast, hosts Dr. Dan Bates and Justine Feitelson discuss nociceptive pain, also known as body part pain. The episode delves into their Nociceptive Pain Algorithm, breaking down the different types of somatic pain, including mechanical, inflammatory, myofascial, bony, and vascular pain. It includes discussions on different pain management strategies from first-line to specialist referrals, the interplay of different pain types and overlapping issues when it comes to instability, and emphasizes the importance of proper diagnosis and treatment so you can make effective decisions as a clinician even while you are...2024-12-1241 minIt's Not in Your Head23 Sleep and Pain: Anchoring, the Rice Cooker and the NappucinoIn this Pt. 2 of sleep episode, Dan and Juz cover the conservative measures around improving your sleep, particularly if you struggle with insomnia, or painsomnia, as many pain patients refer to the challenge of falling asleep. They cover external and environmental factors including circadian rhythm, as well as internal or behavioral variables that affect our sleep quality and drive. They dive into special topics and strategies around constructing an effective wind down routine including releases and diaphragmatic breathing, and how to nap in a way that is more helpful than harmful so you can feel tired when you want...2024-11-2859 minIt's Not in Your Head22 Sleep and Pain: What's Driving What?Dan and Juz dive into the significant relationship between pain and sleep, and how it drives sensitization. They cover sleep basics, how lack of it long-term negatively impacts patients cognitively, and share a helpful analogy you can use as a patient to better explain what chronic pain feels like - especially with regards to increasing buckets of central sensitization. Dan then delves into the medical side of sleep, covering disorders including snoring, as well as various medications used to treat sleep. On the next episode, Juz will cover the conservative management strategies on the patient end, so you can...2024-11-1450 minIt's Not in Your Head21 Pacing: Flare Prevention & Energy ManagementIn this podcast episode, Dan and Juz explore the concept of pacing and give it a bit of a re-brand, going through their structure and personal examples to learn how to break down managing your timing, tasks and tolerance more effectively so you can reclaim activities and passions pain may have limited. Effective pacing includes careful planning, task batching, and managing context variables to adjust to fluctuating physical and emotional demands. Key strategies involve scheduling pressure-release activities, monitoring stress, and using graded exposure techniques to build resilience through movement. The episode emphasizes the importance of built in flexibility, encouraging...2024-10-3158 minIt's Not in Your Head20 Lower Back PainIn this podcast episode, Dan and Juz explore a step-by-step approach to managing lower back pain. They begin with busting some significant yet persistent myths when it comes to patient recovery, and continue the conversation by identifying key patient concerns, focusing on red flags and understanding their ability to cope. For pain that is manageable and under three months in duration, they dive into the conservative treatment pathway. As pain becomes more long-lasting, they delve into appropriate medications, diagnostic considerations, potential investigations and referrals. The episode concludes with insights on differentiating between leg and back pain, offering targeted treatments...2024-10-171h 12It's Not in Your Head19 Basics of Conservative Pain ManagementDan and Justine dive into the basics of conservative pain management, covering the starting points of her MARSMethod and where you need to begin as a patient no matter what types of chronic pain you have. They go through the importance of and give specific recommendations around improving protein amount, fiber intake, hydration totals, sleep quality, and movement. Listen for actionable advice you can immediately implement to begin improving the pieces of pain you impact as a patient. As a clinician, this episode gives you simple, time-effective education and strategies to communicate that support the lifestyle pieces patients need...2024-09-261h 09It's Not in Your Head18 How to Assess Your PainIn this episode, Justine and Dan go over a number of different assessments tools you can use to define what types of pain you have, what amplifiers may be playing a role, and how symptoms are affecting you functionally. Besides these validated measures, we'll also introduce our sensitization questionnaire so you can look at the information you pull out through the lens we've been looking at central sensitization through, and finish with a discussion on the impact patient mindset has on the ability to improve. To fill out these questionnaires for yourself, and get additional context and information about...2024-09-1240 minIt's Not in Your Head17 Nerve Pain ManagementDan and Juz cover the neuropathic pain algorithm, taking you through first through fourth-line treatment options from most to least conservative. They cover trialing and combining various medications including opioids, topicals for focal areas of pain, and various interventional options all the way up to neuromodulation (peripheral or spinal cord stimulators), and pain pumps. This episode helps a PCP or other physician have a guide to more efficiently work through treatments for neuropathic pain, and patients better understand their options so they can more effectively advocate for themselves. Visit the episode page at the website below for a link...2024-08-291h 20It's Not in Your Head16 How to Draw Your PainIn this episode, Dan and Juz focus on the importance of communicating and assessing pain through the use of pain diagrams, which help both clinicians and patients gain insights into the sources and amplification of their presentation. The hosts go through many different types of back, leg, and neck pain, discussing how this information contributes to goal setting and tracking progress in pain management. Unfortunately, the data on diagrams makes it seems as though they are useless - but that is if they are drawn in such a fashion. Pain diagrams when done with a clear, consistent key can...2024-08-1554 minIt's Not in Your Head15 Anatomy of a FlareAgency is crucial as a chronic pain patient - especially when you feel most helpless and scared with pain at its worst. Flares are always difficult to navigate, but they don't have to make you feel so helpless and reactive. What are the phases of a flare, and how can you manage each one? This episode is a critical resource to learn how to identify and sooner recognize your own flare patterns so you end up in 'the hole' less, and can navigate your way out more effectively when it does happen.As a provider, how can...2024-08-0149 minIt's Not in Your Head14 Goal SettingIn this episode, Dan and Justine break down how they each set goals and manage expectations with their patients. We dive into why your 'why' matters, how to connect your purpose to your plan, create discipline, tap into motivation, identify your purpose and cultivate confidence, so patients can better tie their actions to their goals and create long-term progress. This episode aims to help patients improve communication and have more effective appointments with their clinicians, and clinicians link their interventions to the goals of the patient in a more compelling way to improve buy-in.Resources:2024-07-1839 minIt's Not in Your Head13 Widespread Pain and Making Sense of Things That Don’t Make SenseIn this episode, Dr. Dan and Justine introduce their 'Central Sensitization Algorithm' designed to help healthcare providers diagnose and treat central sensitization and related neuroinflammatory disorders more effectively. The algorithm categorizes symptoms into distinct buckets of nervous system dysfunction, allowing providers to more quickly and efficiently identify and prioritize their treatment plan. By addressing potential pre-existing diagnoses and symptoms, the sensitization algorithm aims to better streamline assessments and improve outcomes for complex patients by creating a clearer picture of an otherwise confusing presentation. The episode highlights the importance of this tool in reducing diagnostic frustration and inadvertent harm, while...2024-07-041h 00It's Not in Your Head12 What Else Do You Say?In this episode of "It's Not In Your Head," Dan and Justine dive into the nuanced aspects of how to more effectively communicate about pain with patients, focusing on the significance of specific language and its impact on patient outcomes. They caution against phrases that suggest pain is purely psychological and inadvertently blame and shame the patient, emphasizing pain is a complex interplay of physiological and psychological factors. They stress the importance of clinicians avoiding language that can be perceived as dismissive or condescending, instead advocating for a collaborative, empathetic approach.The episode highlights the need for...2024-06-2044 minIt's Not in Your Head11 What's the Harm?Trigger warning: This episode deals with the topic of suicide.Dan and I have an interesting and important discussion that bridges the gap between patients’ clear and obvious frustrations with how different versions of “it’s in your head” affect them and providers’ lack of awareness around the issue. How can this be the case? And how does being told pain is in your head possibly increase suicidal thoughts by 500-1200%? We explain how it occurs and compare it to what we’d accept from other therapies.Chronic pain patients have a 25% likelihood of suicidal thoughts in...2024-06-0647 minIt's Not in Your Head10 History of HysteriaFrom the uterus, to witchcraft, hypnotism and more, we go through the history of what unexplainable symptoms have been blamed on and how they've been explained through history all the way up to more modern day classifications like Briquette's syndrome, somatoform, conversion, or functional disorders. We tease apart risk factors and other patterns that have been identified to lead to symptoms commonly labelled as ‘hysteria’, and the resulting biases that have carried through into modern medicine towards patients with these types of presentations. This episode is a somewhat lighter, funny change of pace from the pain education heavy start and...2024-05-301h 51It's Not in Your Head9 Therapeutic LimitationsIn 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.2024-05-2420 minIt's Not in Your Head8 Why Not Everything Works for EverybodyThe 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...2024-05-2422 minIt's Not in Your Head7 The Pain PieIn 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.2024-05-1715 minIt's Not in Your Head6 SensitizationLearn how central sensitization really presents. And yes, it’s a big deal that is currently essentially glossed over due to the lack of identification and treatmentsThe symptom clusters this type of pain creates long term are diseases caused by the central nervous system. The issue is that we currently lack an effective way to investigate and treat the various ways nervous system dysfunction impacts patients beyond the accepted definition of nociplastic pain.We share our model for categorizing central sensitization currently into various buckets including but not limited to:Sensory HypersensitivitySleep and Fa...2024-05-1136 minIt's Not in Your Head5 Nerve PainDiagnosing and treating nerve pain, or neuropathic pain, is very challenging. Now that you understand nociceptive pain, we’ll help you see the clear difference between that and neuropathic presentations.Justine and Dan break down how to best treat different types of pathologies, from first line medications and navigating side effect vs benefits, through fourth line more invasive interventional options like neuromodulation, intrathecal therapies and low dose opioid options.Making decisions around treatments is challenging and unique, and based on a lot of factors that are individual to the patient. We’ll discuss these different limi...2024-05-1159 minIt's Not in Your Head4 Body Part PainNociceptive pain, or body part pain, is the most common type of pain. Dr. Dan will break down the differences between somatic and visceral pain within this main category, and get into its different features includingMyofacial PainMechanical PainVascular PainJustine and Dan will also talk about the different challenges both patients and providers face in communicating and diagnosing this type of pain, so you can do a better job recognizing and addressing the different aspects.Resources:www.iniyh.comhttps://www.instagram.com/iniyhpodcast/https://www...2024-05-1137 minIt's Not in Your Head1 Welcome to It's Not in Your HeadWelcome to the podcast! We are so excited to reveal this project to you. In our initial episode, Dan and I will cover why we called the project "It's Not in Your Head", and what we want to accomplish through it.We get into Justine and Dan’s backgrounds, experience and motivations, how Justine came to develop Resilient Warrior Coaching and her MARSMethod, and how we came together to tackle chronic pain and complex, poorly understood topics within it like central sensitization so we can treat them more effectively.Through the process of developing this po...2024-05-1123 minIt's Not in Your Head2 The Empower You Chronic Pain FoundationIt’s Not in Your Head’s first guest episode with Dr. Krishnan Chakravarthy, MD, PhD and Founder of the Empower You Chronic Pain Foundation. Get to know Krish, where his desire to increase access to people in low income communities came from, and other challenges we face like stigmas and time limitations in the current system that negatively affects outcomes. What can we do about it? ‘EY’ as we also call it, is like a sister company of It’s Not in Your Head. Krish was also Justine’s original treating doctor for Complex Regional Pain Syndrome and...2024-05-1126 minIt's Not in Your Head3 Pain is a Sound SystemComplex pain is, well, complicated. Explaining it effectively can be even more so. In this episode, Dr. Dan shares his metaphor to think about and better explain pain called, ‘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 - nociceptive, neuropathic and nociplastic pain.With central sensitization in particular, we’ll define the different buckets in a way you haven't heard before, and pull it all together so you can actually make sense of various sym...2024-05-1137 min