It's Not in Your Head

This episode applies the Nociceptive Pain Algorithm to real clinical scenarios, breaking down management strategies for each subtype of somatic pain — mechanical, inflammatory, myofascial, bony, and vascular — from first-line approaches through specialist referral. The hosts address the overlapping nature of these pain types and the clinical challenge of instability, while emphasizing that effecti...

This episode focuses on the practical side of improving sleep and what strategies are most important to start with — especially for patients dealing with insomnia or "painsomnia", and higher levels of sensitization. Topics include: Circadian rhythm and sleep anchoring Environmental and behavioral factors affecting sleep quality Wind-down routines including diaphragmatic breathing How to...

Sleep and pain have a deeply interconnected relationship — and chronic sleep disruption accelerates sensitization. This episode covers sleep fundamentals, how prolonged sleep deprivation affects cognitive function, and offers an analogy patients can use to explain what chronic pain fatigue actually feels like. Dr. Bates covers the clinical side, including sleep disorders, the role of snoring, and...

This episode reframes "pacing" as a practical, personalized system rather than a vague concept. The hosts walk through how to manage timing, tasks, and tolerance to gain capacity and reclaim activities that chronic pain has limited. Key strategies include: Task batching and scheduling Managing contextual variables (stress, sleep, physical load) Graded exposure to build resilience Built-i...

This episode takes a systematic approach to lower back pain, beginning with busting persistent myths that delay recovery. The hosts walk through how to identify red flags, assess patient coping capacity, and navigate the conservative treatment pathway for acute presentations. As pain becomes chronic, the discussion moves into appropriate medications, diagnostic investigations, referrals, and how t...

No matter what type of chronic pain a patient has, certain lifestyle foundations are non-negotiable starting points - particularly with sensitization or complex presentations. This episode walks through the core elements of Justine's MARS Method, with specific, actionable recommendations around: Protein intake and fiber consumption Hydration Sleep quality Movement Patients leave with steps th...

This episode reviews validated assessment tools that help identify pain types, amplifying factors, and functional impact — and introduces the hosts' own sensitization questionnaire for viewing results through the central sensitization lens. The discussion closes with an examination of how patient mindset affects the ability to improve over time. All questionnaires discussed in this episode ar...

This episode walks through the neuropathic pain treatment algorithm from first to fourth line, giving both patients and providers a structured, evidence-based roadmap. Topics covered include: First-line oral medications and how to trial them Topical agents for localized nerve pain Interventional options including nerve blocks and neuromodulation Spinal cord stimulators and intrathecal pain pumps A...

Pain diagrams are a widely underused clinical tool — not because they don't work, but because they're often done incorrectly. This episode explains how structured pain body diagrams, drawn with a clear and consistent key, can make invisible symptoms visible and help clinicians identify nociceptive, neuropathic, and nociplastic components at a glance. The hosts walk through examples cover...

Pain flares are an inevitable part of chronic pain — but they don't have to feel unmanageable. This episode breaks down the phases of a flare and offers concrete strategies for each stage, from early recognition to recovery. Patients learn how to identify their personal flare patterns earlier, spend less time in crisis, and navigate their way out more effectively. For providers, the episode o...

Effective goal setting in chronic pain care requires more than tracking metrics — it requires connecting purpose to action. This episode breaks down how both a pain specialist and a pain coach approach goal setting with their respective patients, covering how to identify a patient's "why," build discipline, cultivate motivation, and develop confidence. Patients leave with tools to m...

This episode introduces the Central Sensitization Algorithm — a clinical tool designed to help providers more quickly and accurately diagnose and treat central sensitization and related neuroinflammatory disorders. By organizing symptoms into distinct categories of nervous system dysfunction, the algorithm creates a clearer picture from what is often a confusing clinical presentation. For patients...

This episode moves from the problem to the solution — offering specific, evidence-informed language that providers can use to communicate about pain without dismissing or inadvertently shaming patients. The discussion emphasizes that pain is a complex interplay of physiological and psychological factors, not purely one or the other. Both patients and providers are given tools to work collaborative...

Trigger warning: This episode discusses suicide. Chronic pain patients carry a 25% likelihood of having suicidal thoughts in the preceding two weeks — and research suggests that being told pain is "in your head" may increase that risk by 500–1,200%. This episode bridges the gap between what patients experience when dismissed and what providers often fail to recognize about the impact of...

From the uterus to witchcraft to hypnotism, this episode traces the long and often troubling history of how unexplainable symptoms have been labeled and dismissed. The discussion moves through historical classifications — including Briquet's syndrome, somatoform, conversion, and functional disorders — to show how deep-rooted biases have carried into modern medicine. This episode offers a ligh...

This episode expands the NNT framework beyond medications to examine therapeutic limitations across all types of interventions — including a surprising look at the measurable effect of pain neuroscience education itself. A key study is examined to show how no single therapy is the definitive solution for chronic pain. The discussion helps both patients and providers set more realistic expectations...

It is entirely normal for chronic pain treatments not to work for every patient — but that reality is rarely communicated clearly. This episode unpacks the concept of "number needed to treat" (NNT), explains the ecological fallacy, and walks through how to properly trial medications. Patients learn how to communicate their preferences and set realistic expectations, while clinicians gain...

This episode introduces "The Pain Pie" — a practical thinking tool for understanding the different components that contribute to a patient's overall pain experience. Building on the "Pain is a Sound System" framework, the model helps providers visualize the diagnostic picture and identify which aspects of pain to address first. For patients, it offers a clearer way to unde...

Nociplastic pain — also called central sensitization — is the most challenging pain type to identify and treat. Its symptoms are often vague, persistent, and mislabeled as unrelated conditions, sending patients down frustrating diagnostic rabbit holes. This episode introduces a model for categorizing sensitization into identifiable clinical buckets, including: Sensory hypersensitivity Sleep distur...

Nociceptive pain — also called body part pain — is the most common type of pain and frequently underlies more complex chronic presentations. This episode breaks down the distinction between somatic and visceral pain, and explores its subtypes, including: Myofascial pain Mechanical pain Vascular pain Both patients and providers will gain a clearer framework for recognizing and communicating this ty...

Neuropathic pain — or nerve pain — ranges from straightforward to highly complex depending on the patient and presentation. This episode walks through the treatment landscape from first-line medications to more advanced options, including: Topical agents for focal pain Less invasive procedural interventions Neuromodulation (spinal cord stimulators) Intrathecal therapies Low-dose opioids The goal i...

Dr. Dan Bates and Justine Feitelson introduce It's Not in Your Head — a podcast dedicated to cutting through the confusion of chronic pain. This first episode covers why the show is named what it is, the backgrounds and motivations of both hosts, and what listeners can expect going forward. Justine shares her journey as a patient and developing Resilient Warrior Coaching, while Dan explains h...

This episode breaks down a foundational metaphor for understanding chronic pain: "Pain is a Sound System." Dr. Dan Bates uses this framework to explain how pain signals get amplified in the nervous system and why the output doesn't always reflect the original injury. The episode introduces the three core types of pain — nociceptive (body part), neuropathic (nerve), and nociplastic (...