Ep. 19 Basics of Conservative Pain Management
Dan 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 to be working on in parallel to get the most out of their treatment.
Episode Summary
In this episode, Dr. Dan Bates and Justine Feitelson (Dan and Juz) explore the fundamentals of conservative pain management, focusing on non-invasive approaches that apply to all patients, especially those dealing with chronic pain and central sensitization.
Introduction
The hosts emphasize addressing the "low-hanging fruit" in pain management, stressing that these strategies are essential for all patients. They highlight the importance of patient agency in treatment, noting that outsourcing responsibility is not an option.
The MARS Framework
Juz introduces her MARS framework: Movement, Awareness, Recovery, and Stress interventions. This comprehensive approach addresses various contributors, sensitizers, and amplifiers of pain.
Movement
Includes mobility exercises, reflexive stability training, and aerobic and strength activities
Emphasizes proper progression through a desensitization/nervous system lens
Encourages patients to understand and care for their own bodies
Awareness
Focus on pacing, mindfulness, and recognizing pain patterns
Teaches daytime energy management and organization
Recovery
Addresses sleep hygiene, including circadian rhythm and sleep/wake cycle
Emphasizes the importance of proper nutrition around meal quality and timing
Stress Management
Targets mood, stress, and allostatic load
Addresses depression, anxiety, and isolation
Incorporates techniques like diaphragmatic breathing and trauma processing[1]
Metabolic Considerations
Dan notes that metabolic changes often occur with sensitization and provides starting points for addressing these issues:
Protein Intake
They recommend 1.2g-2g of protein per kilogram of body weight
Discuss the importance of protein, especially for conditions like hEDS
Suggest using supplements initially to increase protein easily and gradually integrating dietary changes
Fiber Intake
Recommend 25-38g of fiber daily
Discuss gut-friendly options and the relevance of FODMAPs
Suggest 25g of prebiotics for females and 38g for males
Sleep Hygiene
Juz emphasizes the importance of establishing a consistent sleep routine with strategies around anchoring. Check out episode 23 on conservative sleep management strategies for more.
Discusses the role of circadian rhythm and proper wind-down techniques
Exercise
Dan recommends ways to slowly ramp up daily walking including his “letterbox program”
Juz shares her experience of gradually increasing movement with CRPS and graded exposure techniques around strength and aerobic exercise
Hydration
Stress the importance of proper hydration, meeting at least 1/2 your body weight in ounces if an adult, or even more if you have POTS.
Suggest adding electrolytes as an alternative to 10g daily salt requirements for hydration
Note can use glycerol as an alternative to salt for hydration
Conclusion
The hosts emphasize that these conservative approaches form the foundation of pain management and should be addressed before investigating more complex metabolic issues. They also mention upcoming content on nociceptive pain algorithms and central sensitization assessment, as well as future discussions on specific conditions like pelvic instability and hEDS.