Ep 7. The Pain Pie

In this episode, we will bring the different types of pain together in an alternative way introducing the 'The Pain Pie,' and using this learning tool as an alternative to 'Pain is a Sound System' to tease apart the different potential pieces of pain including nociceptive, neuropathic, and nociplastic pain, as well as other contributors to the output of symptoms patients experience.

As a provider, you can use this thinking tool to better see the different pieces of pain 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.

Introduction

In this episode of "It's Not in Your Head" podcast, Dr. Dan Bates and Justine Feitelson introduce the concept of the "Pain Pie," a thinking tool developed by Dr. Bates to better understand and manage complex chronic pain.

Origins and Evolution of the Pain Pie

Dr. Bates developed the Pain Pie concept in the early 2010s, initially focusing on osteoarthritis patients. Over time, he expanded and refined the tool to address more complex pain conditions, including back pain and hypermobile Ehlers-Danlos syndrome.

Components of the Pain Pie

The Pain Pie consists of three main components:

1. Body Part Pain (Nociceptive Pain)

2. Nerve Pain (Neuropathic Pain)

3. Amplified Pain (Nociplastic Pain)

Body Part Pain

• Characteristics: Aching, sharp, dull, or pressure sensations

• Usually focal, intermittent, and proportional

• Specific triggers and relieving factors

• Can involve inflammation, muscle, bone, or blood vessel issues

Nerve Pain

• Also known as neuropathic pain

• Symptoms: Burning, pins and needles, numbness, itching, painful cold, constriction

• Follows specific nerve distributions

• Tends to wax and wane, can be random

Amplified Pain (Central Sensitization)

• Also called nociplastic pain

• Can mimic body part or nerve pain

• Spreads beyond the initial site, becomes constant and disproportionate

• Associated features:

  • Sensory hypersensitivity

  • Sleep disturbance

  • Fatigue

  • Brain fog

  • Mood disturbance

  • Autonomic dysfunction (dysautonomia)

Applying the Pain Pie

The Pain Pie serves as a diagnostic and treatment planning tool, allowing clinicians to:

1. Identify different pain components in a patient's presentation

2. Break down complex pain conditions into manageable features

3. Develop targeted treatment strategies for each component

Benefits of the Pain Pie Approach

1. Provides a comprehensive framework for understanding complex pain

2. Helps patients better understand their pain experience

3. Allows for more targeted and effective treatment strategies

4. Empowers both clinicians and patients in pain management

Conclusion

The Pain Pie offers a valuable approach to understanding and managing chronic pain, especially in complex cases. By breaking down pain into its various components, clinicians and patients can work together to address each aspect of the pain experience, potentially leading to more effective pain management strategies.