Ep 12. 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 patients and clinicians to work together in identifying and addressing the various drivers and amplifiers of pain, including physical injuries, sensitization, and mood disorders. Importantly, they provide crisis resources for those experiencing mental health challenges associated with chronic pain, encouraging listeners to seek help when needed. Through their discussion, Dan and Justine underscore the necessity of understanding and treating chronic pain with empathy, compassion, and a focus on empowering patients in their pain management journey.

Resources:

  • Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Jan 14;1(1):CD011279.

  • White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011 Mar 5;377(9768):823–36.

  • Wilshire CE, Kindlon T, Courtney R, Matthees A, Tuller D, Geraghty K, et al. Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC Psychol. 2018 Mar 22;6(1):6

  • Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, et al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management. Mayo Clin Proc. 2021 Nov;96(11):2861–78.

  • Parry GD, Crawford MJ, Duggan C. Iatrogenic harm from psychological therapies--time to move on. Br J Psychiatry. 2016 Mar;208(3):210–2

  • Racine M. Chronic pain and suicide risk: A comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018 Dec 20;87(Pt B):269–80.

  • Stone L. Blame, shame and hopelessness: medically unexplained symptoms and the “heartsink” experience. Aust Fam Physician. 2014 Apr;43(4):191–5.

  • Burke MJ. “It’s All in Your Head”—Medicine’s Silent Epidemic. JAMA Neurol. 2019;76(12):1417–1418. doi:10.1001/jamaneurol.2019.3043

  • Ejdemyr I, Hedström F, Gruber M, Nordin S. Somatic symptoms of helplessness and hopelessness. Scand J Psychol. 2021 Jun;62(3):393–400.

  • Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022 Jan 1;79(1):13–23.

  • Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333846.

  • Ryan PC, Lowry NJ, Boudreaux E, Snyder DJ, Claassen CA, Harrington CJ, Jobes DA, Bridge JA, Pao M, Horowitz LM. Chronic Pain, Hopelessness, and Suicide Risk Among Adult Medical Inpatients. J Acad Consult Liaison Psychiatry. 2024 Mar-Apr;65(2):126-135. doi: 10.1016/j.jaclp.2023.11.686. Epub 2023 Nov 27. PMID: 38030078.

  • Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, et al. Pain Neuroscience Education for Adults With Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain. 2019 Oct;20(10):1140.e1–1140.e22.

  • Topol EJ, Bousser MG, Fox KAA, Creager MA, Despres JP, Easton JD, et al. Rimonabant for prevention of cardiovascular events (CRESCENDO): a randomised, multicentre, placebo-controlled trial. Lancet. 2010 Aug 14;376(9740):517–23.

  • Salazar-Méndez J, Cuyul-Vásquez I, Ponce-Fuentes F, Guzmán-Muñoz E, Núñez-Cortés R, Huysmans E, et al. Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. Patient Educ Couns. 2024 Jun;123:108201.

  • Czernichow S, Batty GD. Withdrawal of sibutramine for weight loss: where does this leave clinicians? Obes Facts. 2010 Jun;3(3):155–6.

  • Calverley PMA, Rabe KF, Goehring UM, Kristiansen S, Fabbri LM, Martinez FJ, et al. Roflumilast in symptomatic chronic obstructive pulmonary disease: two randomized clinical trials. Lancet. 2009 Aug 29;374(9691):685–94.

  • National Institute of Mental Health (NIMH) [Internet]. [cited 2024 May 24]. Ask Suicide-Screening Questions (ASQ) Toolkit. Available from: https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materialsg

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Ep 13. Central Sensitization Algorithm

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Ep 11. What’s the Harm?