It's Not in Your Head

Neuromodulation represents the most advanced tier of the neuropathic pain treatment algorithm, and this episode is a comprehensive guide to navigating it. Dr. Dan Bates and Justine Feitelson cover the full journey from conservative management to permanent implant, explaining the mechanisms behind: Traditional spinal cord stimulation (SCS) Dorsal root ganglion (DRG) stimulation Peripheral nerve sti...

Sympathetic nerve blocks target the autonomic nervous system to manage pain conditions that don't respond adequately to conventional approaches. This episode covers three key injection types — stellate ganglion blocks, lumbar sympathetic ganglion blocks, and posterior tibial nerve stimulation — and explains when and how each is used. Conditions discussed include CRPS, PTSD, and chronic pelvic...

Basivertebral nerve ablation (BVNA) is an emerging procedural option for a specific and often undertreated cause of chronic back pain: discogenic, or vertebral endplate pain. This episode covers the science behind the procedure, how to identify appropriate candidates, what outcomes patients can realistically expect, and the risks involved. Dr. Bates shares clinical pearls from his own experience m...

The holiday season amplifies many of the most challenging aspects of living with chronic pain — disrupted routines, increased stress, difficult family dynamics, and the emotional weight of grief and loneliness. This episode offers a practical, compassionate guide for navigating the season, covering strategies to: Maintain routine and movement Manage stress and prevent flare escalation Prepare for...

Epidural injections are one of the most commonly performed pain procedures — yet many patients don't fully understand how they work or what to expect. This episode demystifies the topic, covering what epidurals treat, the types of injectables used, procedural technique variations (interlaminar, transforaminal, and caudal), potential complications, and recovery expectations. Both patients prep...

Building on the series on lower back pain causes, this episode focuses on sacroiliac joint diagnostic blocks — how they are performed, how to interpret results, and what treatment options follow a positive block. The hosts cover the debate around single versus double blocks, the role of radiofrequency neurotomy and prolotherapy as next steps, and the economic and logistical considerations patients...

Prolotherapy is a frequently misunderstood but clinically valuable treatment for sacroiliac joint dysfunction — particularly in patients with ligament laxity or hypermobility. This episode breaks down the mechanism of action, compares glucose and platelet-rich plasma (PRP) as injectants, and covers patient selection criteria, the diagnostic process, potential risks, and realistic outcomes. Whether...

This episode takes a detailed look at radiofrequency ablation (RFA) as a treatment for sacroiliac joint dysfunction — covering the nature of SIJ pain, the diagnostic pathway, and the specifics of how RFA is performed. Dr. Bates walks through the different approaches and techniques, shares clinical insights from his practice, and highlights recent research developments. Patients considering this pr...

This episode marks the transition from conservative management to interventional pain procedures, beginning with medial branch blocks — a key diagnostic tool for identifying facet joint pain as a driver of lower back pain. Dr. Dan Bates walks through the procedural technique, how it is used to pinpoint specific pain generators, and how results inform the next steps in treatment, including radiofre...

Radiofrequency neurotomy is a minimally invasive but highly effective option for patients with confirmed facet joint pain. This episode covers the diagnostic criteria for selecting appropriate candidates, the procedural technique itself, risk considerations, and what to expect in terms of outcomes and follow-up care. Alternative approaches for specific patient populations are also discussed. Patie...

Mood dysregulation and chronic stress are not just consequences of chronic pain — they are active amplifiers of it. This episode covers the physiological and psychological mechanisms that connect emotional wellbeing to pain output, and introduces practical strategies patients can implement immediately, including: Diaphragmatic breathing techniques Mindfulness integration into daily routines Moveme...

Dysautonomia — dysfunction of the autonomic nervous system — affects many chronic pain patients and is frequently overlooked as a contributing factor. This episode identifies the most common symptoms, including orthostatic intolerance, gastrointestinal issues, and urinary dysfunction, and walks through a practical management toolkit covering: Dietary adjustments and hydration strategies Targeted e...

When the nervous system becomes sensitized, everyday sensory stimuli like light, sound, touch, temperature etc. can become overwhelming. This episode explores the science of sensory sensitization, its connection to nociplastic pain, and a range of conservative strategies for managing it, including: Desensitization techniques Graded exposure Practical tools and gadgets for daily life Real-life exam...

Fatigue is one of the most debilitating and overlooked components of complex pain - whether excessive fatigue as a symptom, or Chronic Fatigue Syndrome (ME/CFS) as as accompanying diagnosis. This episode explores the illness behavior network and breaks down conservative management strategies for fatigue-related challenges including sleep disruption, cognitive difficulties, mood dysregulation, and...

This 'Ask Us Anything' episode addresses listener questions on central sensitization — its causes, how it presents, and how to treat it. Dr. Dan Bates and Justine Feitelson walk through how to identify both the symptoms and the underlying drivers of sensitization, how to address neuroinflammation, and how to build the right care team for a complex pain presentation. The episode also cove...

Sacroiliac joint dysfunction is a common but frequently underdiagnosed source of pelvic and lower back pain. This episode covers the full spectrum of SIJ management — from who is most commonly affected and how to recognize the presentation, through conservative treatment strategies involving movement and exercise, to advanced procedural options. Clinicians and patients will learn about the importa...

Not all chronic pain patients respond to the same treatments — and understanding why requires a more nuanced clinical lens. This episode uses a "political spectrum" analogy (left wing, right wing, and centrist approaches) to map different treatment philosophies and match them to pain patterns and patient profiles. The discussion also addresses how media coverage — particularly around spi...

Difficult conversations are unavoidable in chronic pain care — whether with a physician, an employer, or a family member. This episode equips patients with practical tools for navigating high-stakes discussions with clarity and confidence, while helping providers develop communication strategies that reduce conflict and improve outcomes. The hosts walk through real scenarios and share structures f...

When chronic pain becomes emotionally and logistically overwhelming, clear thinking and effective self-advocacy are hardest to access — and most needed. This episode addresses how patients can prepare for worst-case scenarios, manage communication breakdowns, and maintain clarity in complex medical situations. Practical strategies are offered for both patients and caregivers, with an emphasis on b...

This episode uses hypermobile Ehlers-Danlos Syndrome (hEDS) as a clinical example of how a metabolic driver can fuel central sensitization. Dr. Bates shares patterns he sees in practice, covering how hEDS should be diagnosed, what markers to look for, and how it connects to CRPS and other sensitization presentations. The discussion includes the role of genetic predisposition, why certain medicatio...

This 'Ask Us Anything' episode tackles complex listener questions around Complex Regional Pain Syndrome (CRPS), central sensitization, and neuromodulation. Topics include the Budapest criteria for CRPS diagnosis, the overlap with sensitization, the pros and cons of spinal cord stimulators (SCS), managing post-implant complications such as pocket pain, and the role of prolotherapy as an a...

This episode takes a deeper look at neuroinflammation as a driver of chronic pain — and why the current philosophical approach to pain management limits both communication and treatment. Dr. Dan Bates breaks down central sensitization into seven key areas and examines how lifestyle and metabolic factors, such as prediabetes, can drive sensitization. The shift in perspective — from managing consequ...

In the first 'Ask Us Anything' episode, Dr. Dan Bates and Justine Feitelson answer listener questions about the social and emotional realities of living with chronic pain. Topics include how to respond to common misconceptions, how to explain an invisible illness quickly without exhausting yourself, and how to set meaningful boundaries around personal capacity. On the provider side, the...

Traveling with chronic pain requires planning — but it doesn't have to mean giving up adventures. This episode covers the full travel arc, from pre-trip preparation and in-flight strategies to post-travel recovery, with practical insight drawn from Justine's personal experience traveling with chronic pain. Key topics include medication management, communicating needs to travel staff and...

Sparked by a patient-focused conference that surfaced counterproductive advice about doctor-patient conflict, this episode pivots toward constructive strategies for both sides of the clinical relationship. Patients learn how to own their care, organize their information, and navigate the healthcare system more effectively with a complex diagnosis. Providers gain perspective on the role of empathy,...