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Its Not In Your Head | Chronic Pain Podcast

@iniyhpodcast

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Pain education and resources for patients and clinicians. 🎙️ We've come together to find better ways to treat complex pain. Listen to episodes 👇

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"If you're confused, the patient is sensitized."

My @iniyhpodcast partner Dr. Dan Bates says this, and for clinicians it's less a tidy aphorism than a practical cue or trigger.

You know the moment. A complex pain patient is in front of you and you cannot make it add up. The pain has gone from proportional to disproportional, focal to widespread, intermittent to constant. Fatigue, brain fog, nausea, disrupted sleep, dysautonomia, etc. all layered on. And you feel that flick of confusion and frustration.

▶️ Here's the shift: that confusion is not a dead end. It's a clue. Used well, it's the prompt to stop and ask "is this central sensitization?", instead of letting the harder slide take over. The one where confusion becomes feeling stuck, stuck becomes the shame of not having an answer, and that shame quietly lands as blame on the patient. "A lot of things affect pain." What they hear is: "it's you, not what we treat."

Most clinicians aren't dismissive. They're working inside real diagnostic limits and a system not built for dynamic, multi-system presentations like sensitization, or nervous system dysfunction. The cue gives that confusion utility, and somewhere constructive to go.

➡️ The way Dan and I break apart complex pain and central sensitization gives it structure: drivers, amplification, and the downstream symptom "buckets," so you can separate the core diagnoses from the amplifiers and link symptoms to treatment.

💻️ I'm teaching a live masterclass on this: The Sensitization Script. It's built for patients first, but if you work with complex pain, you'll leave with a framework for turning that stuck feeling into recognition.

⏰️ Friday, July 17, 2026 · 4pm PST / 7pm EST · Just $27.

🔗 Register at my link in bio or go directly to resilientwarriorcoachingllc.com/tss by @iniyhpodcast

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4 months ago

Sensory sensitization is a piece of complex pain that is common with CRPS, hypermobility, fibromyalgia, and sensitization or nervous system dysfunction. 🔥

A common example is with allodynia with touch, but it is so much more. 👇️

▶️ Sensory sensitization is the intense, intrusive amplification of things like:
◾️ Touch
◾️ Light:
◾️ Sound
◾️ Temperature
◾️ Smell
◾️ Taste/Food

⬅️ Swipe through the carousel to see how they present, and where to start addressing each as a patient.

🎙️To dive deeper, listen to episode 37 of @iniyhpodcast.

📚 For support in managing complex pain with a community that actually gets it, check out the Complex Pain Program (CPP) from @resilientwarriorcoaching.

🔗 The program interest list is currently open at Juz's link in bio!

👉️ When you add yourself, you'll get the Desensitization Guide immediately sent directly to you so you can a head start on decreasing sensitization. 📑 by @iniyhpodcast

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4 months ago

The treatment options for CRPS, central sensitization, and related diagnosis can be daunting and difficult to manage – especially when it’s all newer.

The world of complex pain is not one you understand until you’re in it. Like playing a new sport, it takes time for things to slow down and be able to really understand the landscape.

➡️ The goal is not to throw the kitchen sink at patients and overwhelm them, but to have a clinician who can offer or help you access all the different options from a therapeutic perspective, while working through them systematically and as effectively as possible given your specific presentation.

It is also crucial that they take your wishes into account with regards to what you’re comfortable with. THAT is evidence-based medicine: the best available science, with the experience of the clinician, AND the desires of the patient.

🧠 In my case, coming of a brain injury where I was heavily medicated for 9 years, I did not want to be on a ton of medications that would again threaten the physical and cognitive independence I had worked so hard to achieve. Thus, I leaned heavier on procedures earlier.

💊 It is well known how high the side effect profiles are for medications related to these conditions like Gabapentin (Neurontin), Lyrica (Pregabalin) or Cymbalta (Duloxetene). What is less known is the NNT, or number needed to treat, i.e. how many people trial a medication for it to give just one person at least 30% pain relief.

🎙️ Check out episode 8 of @iniyhpodcast for more on managing expectations with these drugs.

With medications, starts low. If you don’t have significant side effects, you can go up, but don’t keep going up hoping for more relief despite them. This is where folks get into trouble with the things that amplify pain and make it harder to manage.

▶️ The reality is there are no magic bullets. Different medications have different mechanisms of action and are affecting different pathways, so it is logical to end up on a few that create a stack if you can tolerate them.

👉️ For personalized support managing complex pain, DM or book a discovery call at my link in bio. by @iniyhpodcast

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5 months ago

💉 I just had an L4/5 epidural to address the disc related part of my back pain.

⬅️ Swipe through this post to learn about epidurals and how they are applied in the pain space.

The procedure went super smooth and I could watch it as they did it on x-ray which was cool. (I try to make procedures kind of fun and less stressful by tapping into the music playing in the procedure room and chatting with my doc about pain stuff). I felt much better immediately after when still numb, but it took two days for the flare from the injection itself to settle and be able to more fully evaluate. 🔥

Note: This is normal and more likely in complex patients with more nervous system wind up. A moderate vs intensely disproportionate response is usually predicted by central sensitization levels going into the procedure. 👇️

📋️ If you're a complex patient, you can check out @iniyhpodcast ep 18 on pain assessments and download/fill out the Central Sensitization Inventory (CSI) for yourself at https://www.iniyh.com/episodes/ep-18-how-to-assess-your-pain

Overall post epidural - big difference! I am able to do more with less pain and definitely dropped my baseline pain score. The goal in my case is to decrease the intrusive aching and sharp pain in my spine, so the ligaments are in a better position and the multifidus muscle can stabilize the spine better.

🏋️‍♂️ Then, the pelvis and hips are in a better position to respond and function more optimally with consistent training. That is what improves the motor patterning and mobility needed to dig out of the weakness/inhibition cycle that leads to the piece of pain output from muscle dysfunction and spasming.

👉 Ideally, I can then better overcome the ligament laxity and weakness that contributes to SIJ dysfunction, and avoid prolotherapy. That, I'll be able to properly assess after giving myself a window to rebuild.

▶️ Treating multifaceted pain takes being able to strategically assess different variables, manage expectations, stay in the moment, and also have a broader 'if-this, then-that' plan based upon the results.

✍️ What's been your experience with epidurals? Drop it in the comments! by @iniyhpodcast

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5 months ago

Chronic and intrusive fatigue often comes along with complex pain.

Sometimes this becomes it's own diagnosis like with Chronic Fatigue Syndrome (ME/CFS), causing severe exhaustion that isn't improved by rest and comes with significant episodes of post-exertional malaise (PEM) even with mild activities, reaking delayed havoc on your system.

🧠 Many patients with hypermobility, POTS, CRPS etc. develop extreme fatigue as nervous system dysfunction or sensitization increases, and it is often part of the accumulation of diagnosis that makes patients feel terminally unique and like there is another thing wrong with them forever.

▶️ The reality is the non-negotiable conservative management strategies are the same whether you meet the diagnostic criteria for ME/CFS, or your fatigue is just extremely intrusive and amplifying underlying pain conditions.

When you are chronically ill, you have little to no margin for error. Even when you're on top of everything it is difficult, and if you are not, it becomes impossible. There is so much more delicacy and nuance to this process than old school graded exposure and pushing through pain without honoring your nervous systems signals.

🧶 Undoing this wind-up, like a tangled ball of yarn, is not a simple, overnight process. It can be significantly improved though with the right combination of management strategies and time.

⬅️ Swipe through the carousel for the basics to begin improving both ends of the positive feedback loop when it comes to extreme fatigue: recovery at night, and how you increase capacity and resilience during the day so you are not bubbling over your pain threshold constantly.

This is what results in symptom buckets like fatigue flaring depending on your dominant presentation of central sensitization. 🔥

📌 Save this post! For more resources: 👇️

🎙️ Go to www.iniyh.com for episodes and content on each topic in the carousel.

🔗 Check out Juz's CPP program (formerly Base Camp) at www.resilientwarriorcoachingllc.com/cpp for help actually integrating and progressing these strategies succesfully and sustainably as a patient. The interest list is now open! by @iniyhpodcast

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5 months ago

To tingle or not to tingle? That is the question...⁣
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If you live with a neuromodulation device, you have probably had this discussion with your provider.⁣
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➡️ Although spinal cord stimulation has actually been around a long time since the 1960's despite seeming like such a modern technology, it wasn't until 2010 that you could actually choose to feel that tingling (parastesia) in the area, or not.⁣
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You can tell my personal preference from the video - I'm a 'set it and forget it' gal. But many patients like that feeling that distracts from pain a bit like a TENS unit and constantly reminds you you are getting relief - and research actually supports this, so it comes down to personal preference.
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🎙️ To learn more about the different options between devices and what you can have a say in as a patient, listen to the new @iniyhpodcast episode 49 on neuromodulation.⁣
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🔗 Available wherever you get your podcasts, our YouTube channel, and on our website with additional education. ⁣

✍️ Which do you prefer? Tingling or no tingling? Drop it in the comments!
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#neuromodulation #parastesia #spinalcordstimulation #neuropathicpain #chronicpain by @iniyhpodcast

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8 months ago

With PNS, the leads are placed in the periphery under the skin over peripheral nerves (peripheral nerve stimulation) rather than at or within the spinal cord.⁣
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🔌🔋 For permanent systems, some models (like Nalu) use a wearable external transmitter, while others implant a generator under the skin like with spinal cord or DRG stimulation.⁣
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With PNS devices, you also go through a trial process to test its effectiveness prior to permanent implantation.⁣
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➡️ When do you look at peripheral nerve simulation vs spinal cord stimulation? ⁣Peripheral nerve stimulation can be a better option if: 👇⁣
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◾ Pain is more widespread and can't be isolated.⁣
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◾ You've done a trial implant of an SCS and not been able to capture enough pain to make it worth it.⁣
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◾ You have an area of primarily peripheral pain in an area like with shingles.⁣
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🎙️ To understand which devices are best for which complex pain situations and the differences between them, listen to the new @iniyhpodcast episode 49 on neuromodulation.⁣
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🔗 Available wherever you get your podcasts, our YouTube channel, and on our website with additional education. ⁣
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#pns #peripheralnervestimulation #peripheralsensitization #neuromodulation #painprocedures by @iniyhpodcast

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8 months ago

In episode 49 of @iniyhpodcast, Dan and I discuss neuromodulation - the “last house on the block” option for complex pain and neuropathic conditions like CRPS and post-surgical back pain.⁣

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🔌🔋 Swipe through this post to learn about the different types of neuromodulation.

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▶️ Neuromodulation sits last in our neuropathic pain algorithm after conservative measures (exercise, rehab, psychological support) and first- and second-line neuropathic medications (e.g., amitriptyline, gabapentin, duloxetine, pregabalin) and third line injections/radiofrequency procedures.⁣

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The reality is even after trying all appropriate neuropathic medications, about 50% of people still get little or no meaningful pain relief, which is one reason neuromodulation becomes relevant.⁣

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Neuromodulation aims to reduce pain and improve function but does not teach the nervous system a lasting pain-free state; if you turn the device off, pain typically returns.⁣

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➡️ It is important to note that neuromodulation is not a cure, but one tool within a broader, multidisciplinary pain management plan that can make a significant enough difference for patients to begin integrating and getting more benefit from the conservative management strategies mentioned above.⁣ This opens the door to continually decrease pain amplification over time.⁣
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👉 If you have struggled with persistent pain and are considering neuromodulation, listen to the latest episode to better understand what to ask your Doctor, what to expect, and how to navigate the trial to implant process.⁣

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🎙️ Episode is available on all podcast players, YouTube, and on our website with additional education.⁣
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#neuromodulation #scs #drg #pns #neoropathicpain by @iniyhpodcast

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8 months ago

How can you look at the different types of neuromodulation devices? ⁣
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🔌🔋By where the leads are placed, or the frequency they're running at. ⁣
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👉 As a patient, it's important to know the different locations the stimulation is delivered and why, as Dan explains here. The frequencies they're run at is more the clinician realm.⁣
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Different brands have different ways of creating relief for various conditions though like CRPS vs back pain, and there is enough of a market for patients to have preferences in aspects like feeling the stimulation, or having to charge a battery for example.⁣
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🎙️ For more on the different types of neuromodulation devices and where they sit in treating various types of persistent pain, listen to ep. 49 from @iniyhpodcast.⁣
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#neuromodulation #scs #drg #pns #neuropathicpain by @iniyhpodcast

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8 months ago

🔌🔋 How can we make more sense of the fascinating but complicated world of neuromodulation, and understand which technology is appropriate for which conditions? 👇

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Most companies have randomized controlled trials focused on post-surgical neuropathic back pain, making this a primary indication for standard SCS.⁣

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Abbott’s DRG stimulation has particularly targeted complex regional pain syndrome (CRPS), allowing highly focal targeting of specific nerve roots, which is useful when pain is localized (as in Juz’s own prior treatment).⁣

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Peripheral nerve stimulation is useful for very widespread or poorly localizable pain, and for
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conditions like persistent post-herpetic pain after shingles for example, where leads are placed on either side of the painful dermatomes instead of using a spinal cord lead.⁣

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➡️ From the patient’s side, you typically discuss broad approaches (SCS vs DRG vs peripheral stimulation) rather than specific waveforms or frequencies, which are more in the clinician’s domain.⁣

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▶️ However, understanding the differences and some of the personal preference pieces you may have a say in when it comes to feeling the buzzing (paresthesia) constantly vs not, or having to charge a battery vs not - are important to have knowledge around so you can ask the right questions and get the best device for you.

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🎙️To learn all about the different types of neuromodulation and how they are applied to various complex pain pathologies, listen to @iniyhpodcast episode 49⁣.
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🔗 Available on all podcast players, YouTube, and on our website at www.iniyh.com with much more additional education.⁣
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✍️ Have you lived with a neuromodulation device? Drop your experience in the comments! ⁣
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#scs #drg #pns #neuromodulation #spinalcordstimulation by @iniyhpodcast

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8 months ago

In this final procedural episode of season 2, Dan and Juz dive into the fascinating world of neuromodulation - the last step in their treatment algorithm for neuropathic pain.
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▶️ They discuss this technologies application for managing complex pain, the journey from conservative management to a permanent implant, and the different frequencies or mechanism of action of various types of neuromodulation including: 👇⁣
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◾ Traditional spinal cord stimulation⁣
◾ Dorsal root ganglion (DRG) stimulation, and⁣
◾ Peripheral nerve stimulation.⁣
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This episode is a comprehensive guide for anyone considering or curious about neuromodulation therapy.⁣ 🔌🔋⁣

👉 Listen to learn about various risks, manage expectations, and the multidisciplinary approach necessary for successfully integration of these devices into an overall treatment plan⁣
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🎙️ Episode 49 of @iniyhpodcast is available on all podcast platforms, on YouTube, and on our website with additional education at www.iniyh.com.⁣
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#neuromodulation #scs #drg #peripheralnervestimulation #neuropathicpain by @iniyhpodcast

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9 months ago

Navigating "Scan Anxiety": Refocusing When You Can’t Control the Outcome⁣. 👇⁣
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I’m currently in a waiting period that many of my patients know too well — waiting on MRI results.⁣
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It’s something I haven’t been able to do for years because of my spinal cord stimulator, and while I’m glad to finally have access to this imaging, the waiting brings its own challenges. ⁣
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👉 "Scanxiety" is that uneasy limbo between taking action and facing uncertainty. Your mind runs through a worst case scenario of “what ifs,” almost preparing you for potential emotions to come.⁣
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For me, much of the buildup centered around trying to tease out the different parts of my back pain that can come from hips, discs, nerves, facets, or SIJ.⁣
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My SIJ dysfunction from hypermobility I know about, I've addressed the nerve and sensitization component, and it's not driven from my hips, though they do need to get stronger...so what is left? Discs and facets, or multifidus wasting/fatty infiltration potentially as a result of things.
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⚠️ Scans have to match your presentation to be relevant. Spinal degeneration does not mean you are doomed - and we can build a more resilient back with better motor patterning to support and improve living with these issues. But it's still easy to feel sad and tired of dealing with things.⁣
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➡️ What’s helped me most is refocusing on what I can control. I can’t change what’s already on the scan, but I can focus on how I show up for myself - how I care for my body and use my time. From there, I prioritize and execute, refocusing on just the next indicated step, rather than the entire process.
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▶️ I choose one main goal to focus on that most moves the needle, and one that helps that goal. For me, movement supported by nutrition. These intentional actions help me stay grounded and stop overthinking into too much problem solving.⁣
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Waiting doesn’t have to mean feeling helpless and knowledge is always power - we just have to be able to navigate these moments.

🎙️ Listen to @iniyhpodcast ep 31 'Dealing with Being Overwhelmed' and ep 20 'Managing Low Back Pain for more on these topics. by @iniyhpodcast

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9 months ago