Pain Science and Sensibility
Join co-hosts Sandy Hilton and Cory Blickenstaff, physical therapists who are "in the trenches" practicing in unique settings on opposite sides of United States, as they discuss current research and topics of pain science. Listen in on occasional interviews of the prominent figures of pain science. Focus will be on making the information meaningful to practice in the clinic.
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053 Is Therapeutic Alliance a Bust?
10/27/2021
053 Is Therapeutic Alliance a Bust?
Sandy and Cory discuss a recent paper that did not find an effect of providing education with therapeutic alliance in a chronic low back pain population. Does that settle the question of whether establishing a therapeutic alliance is worthwhile, or is there more to it? Of course there's more to it. Listen in on the conversation and see if you agree with our take. Miyamoto GC, Fagundes FRC, de Melo do Espírito Santo C, et al. JOSPT. 2021 Aug;51(8):392-400. doi: 10.2519/jospt.2021.9636. Epub 2021 May 7. Music by Kevin MacLeod – : Intro – Brandenburg No4 and Meatball Parade Close – Meatball Parade
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052 Beyond the BPS Model?
02/27/2021
052 Beyond the BPS Model?
In this episode, Sandy and Cory take a look at this popular publication from 2019 proposing an "Enactive Approach" to pain. There's a lot to cover in this paper as it takes us through a history of pain science up to the Biopsychosocial model at which point it proceeds to point out some flaws in the model. GASP! Take a listen as the discussion unfolds. Peter Stilwell & Katherine Harman. Phenomenology and the Cognitive Sciences. 18, pages637–665(2019). doi: 10.1007/s11097-019-09624-7. Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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2020 PT Podcast Network Holiday Extravaganza
12/14/2020
2020 PT Podcast Network Holiday Extravaganza
The gang is all here (except Greg) for another festive dump of holiday cheer! Happy Holidays everyone!!!
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050 Pain Flare-Up
11/16/2020
050 Pain Flare-Up
Pain flare-ups are one of the most frustrating things for patients and clinicians alike. Are they normal? Who gets them? Why is it important to know their prevalence? What are Sandy and Cory's thoughts on dealing with them? All this and more in episode 50! Søren T Skou, Dorte T Grønne, Ewa M Roos. J Orthop Sports Phys Ther. 2020 Jun;50(6):309-318. doi: 10.2519/jospt.2019.9125. Epub 2019 Sep 6. Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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049 Contemplating Possibilities and the Impermanence of Pain
08/25/2020
049 Contemplating Possibilities and the Impermanence of Pain
We are joined in this episode by for a casual chat about pain. Lorimer gave us his thoughts on recent and future clinical research and the translation of the evidence into the clinic. Is there an expiration date for recovery from persistent pain? How can we enhance learning the things that matter? Was it a mistake to think that we could/should explain pain? Does Sandy work pelvic health examples into this conversation? Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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048 The SI Joint Narrative
06/27/2020
048 The SI Joint Narrative
Do you use SI joint tests? What type of information do the tests give you? Should you be using them? These are just a few of the questions that arise in the discussion of this recent perspective paper. Join us for episode 48! Palsson TS, Gibson W, Darlow B, et al. Phys Ther. 2019;99(11):1511-1519. doi:10.1093/ptj/pzz108 Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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047 Is It Safe For Women To Lift Heavy Things?
05/08/2020
047 Is It Safe For Women To Lift Heavy Things?
Is it safe to exercise and lift heavy things for people with pelvic organ prolapse symptoms? Or put more bluntly, will lifting heavy weights make your lady bits fall out? Is lifting weight asking for trouble? That is the question that our guest this month is seeking to answer and Sandy and Cory sit down to ask some questions about her recently published cross sectional study that is a start to this research. There are some important implications of this and potentially some misconceptions that are driving current approaches. Please listen as we are joined by physiotherapist and PhD candidate, Lori Forner for this episode of Pain Science and Sensibility. Forner LB, Beckman EM, Smith MD. Int Urogynecol J. 2019 Dec 7. doi: 10.1007/s00192-019-04163-w. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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046 Is There an Advantage to Pain Free Rehab?
03/13/2020
046 Is There an Advantage to Pain Free Rehab?
These questions arise very frequently in rehabilitation. Should it hurt? Is it OK if it hurts? Will I set myself back if it hurts? Will I get better if it doesn't hurt? In this episode we examine a pair of articles that examine these questions. One article is an RCT that covers pain free vs. painful exercise in an acutely injured population, while the other is a systematic review and meta analysis of the approach in chronic pain populations. Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. J Orthop Sports Phys Ther. 2020 Feb;50(2):91-103. doi: 10.2519/jospt.2020.8895. Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Br J Sports Med. 2017 Dec;51(23):1679-1687. doi: 10.1136/bjsports-2016-097383. Epub 2017 Jun 8. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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045 A Review of Surgery for Rotator Cuff Tears
01/27/2020
045 A Review of Surgery for Rotator Cuff Tears
A recent Cochrane review looked at studies of people with rotator cuff tears comparing those who had surgery with those who did not. What do you think they found? Did surgery provide benefit? Is it OK to go without surgery in these cases? Sandy and Cory discuss these findings and provide their clinical commentary in this episode of Pain Science and Sensibility. Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Cochrane Database Syst Rev. 2019 Dec 9;12:CD013502. doi: 10.1002/14651858.CD013502. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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044 Cognitive Functional Therapy Vs. Group Therapy Plus Education
11/20/2019
044 Cognitive Functional Therapy Vs. Group Therapy Plus Education
This episode covers a recent paper that compares a popular and trending approach, Cognitive Functional Therapy, against a group treatment and exercise intervention. The primary outcomes were pain and disability. The results may surprise you. Join Sandy and Cory as they discuss the findings, what to make of them, and the clinical impact. O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K. Br J Sports Med. 2019 Oct 19. pii: bjsports-2019-100780. doi: 10.1136/bjsports-2019-100780. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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043 An Interview with Dr Henrik Vaegter
10/09/2019
043 An Interview with Dr Henrik Vaegter
In the last episode (42) a systematic review was discussed regarding the value of pre-operative measures in predicting pain post-operatively. In this episode, , an author of that review joins us to discuss that research as well as several other fascinating topics regarding exercise and pain. In this interview we discuss topics of Exercise Induced Hypoalgesia, Conditioned Pain Modulation, and Temporal Summation of Pain, all of which are among the focus of Dr. Vaegter's research. What do the findings in these phenomenon tell us about how we should or should not address exercise in our patients with pain? Tune it to episode 43 for a very informative discussion! Sangesland A, Støren C, Vaegter HB. Scand J Pain. 2017 Apr;15:44-52. doi: 10.1016/j.sjpain.2016.12.002. Epub 2016 Dec 19. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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042 Does Preop Pain Predict Postop Pain?
08/30/2019
042 Does Preop Pain Predict Postop Pain?
In this episode Sandy and Cory discuss a systematic review which investigated what pre operative pain tells us about a person’s propensity for post operative pain. Is it predictive? If so, would changing it matter? The discussion gets into these topics and more. Sangesland A, Støren C, Vaegter HB. Scand J Pain. 2017 Apr;15:44-52. doi: 10.1016/j.sjpain.2016.12.002. Epub 2016 Dec 19. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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041 Bedtimes and Pain: Can You Sleep It Off?
06/12/2019
041 Bedtimes and Pain: Can You Sleep It Off?
This study looked at pain score associations between people with "typical" and "atypical" bedtimes. Sandy and Cory discuss the topic of sleep and pain broadly as well. So, perk up and see if you can make through this episode without dozing off. McHugh RK, Edwards R, Ross E, Jamison R. PAIN Reports. May/June 2019 - Volume 4 - Issue 3 - p e747. doi: 10.1097/PR9.0000000000000747. We also discussed this paper: Afolalu EF, Ramlee F, Tang NKY. Sleep Med Rev. 2018 Jun;39:82-97. doi: 10.1016/j.smrv.2017.08.001. Epub 2017 Aug 18. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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040 Does Activity Counteract Sitting?
05/13/2019
040 Does Activity Counteract Sitting?
In this month's episode we are examining more of a general health question. But it is one that is very relevant to people in pain. Much has been made of "Sitting is the new smoking" with some indications that the negative effects of sitting may not be able to be undone with exercise and activity. This study looked at that concept in particular. Join us for Episode 40. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. J Am Coll Cardiol. 2019 Apr 30;73(16):2062-2072. doi: 10.1016/j.jacc.2019.02.031. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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039 Pain Education in Low Back Pain
04/01/2019
039 Pain Education in Low Back Pain
This paper, with results that many find very surprising, has started a bit of a buzz in the PT world. What do we make of the results? Can we trust the results? What does this mean in clinical practice? We were able to discuss these topics and more with the researchers themselves as and were kind enough to share their time and help us navigate these new findings. Don't miss this episode! Traeger AC, Lee H, Hübscher M, Skinner IW, Moseley GL, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Lo S, McAuley JH. JAMA Neurol. 2018 Nov 5. doi: 10.1001/jamaneurol.2018.3376. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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038 Living Well with Chronic Pain
02/09/2019
038 Living Well with Chronic Pain
Research on chronic pain tends to aim at identifying factors that are in deficit, or are the so called "risk factors" for those who develops chronic pain. In this episode, we discuss a paper that takes a different angle in looking at what factors do those people who are successfully living well with chronic pain share. The primary author is friend of the show, Bronnie Thompson, who has made guest appearances in previous episodes. Lennox Thompson B, Gage J, Kirk R. Disabil Rehabil. 2019 Jan 11:1-12. doi: 10.1080/09638288.2018.1517195. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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2018 PT Podcast Network Holiday Extravaganza
12/11/2018
2018 PT Podcast Network Holiday Extravaganza
That's right everyone! It's that time of year again! All the PT Podcast Network voices (except for Adam) have gathered together to bring you some podcast holiday cheer! This very special episode is brought to you by My PT Insurance. Head on over to their website at to be entered into a drawing for a $250 Amazon gift card (contest ends February 28, 2019). While you are there listeners can get a $20 discount off their already low price for a professional liability policy - starting as low as $149! Music by Kevin MacLeod -
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037 Brain Representations of Expectancy Violation
11/14/2018
037 Brain Representations of Expectancy Violation
This episode covers a recent meta analysis looking at differences in brain patterns when an expectancy violation, thought to be important in effectiveness of exposure based therapies (see episodes 12, 15, and 31), occurs passively versus actively. Active expectancy violation is thought to be more likely to bring about a change in behavior. This research looked to see if there was a difference that could be identified in activated brain areas between the 2 conditions. D’Astolfo L and Rief W. Front Psychol. 2017; 8: 1253. Published online 2017 Jul 28. doi: [10.3389/fpsyg.2017.01253] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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036 Mechanism Based Pain Care
09/28/2018
036 Mechanism Based Pain Care
In this episode, Sandy and Cory discuss a recent paper proposing a "Mechanism Based approach to physical therapy management of pain." This paper proposes 5 mechanisms to consider when managing people in pain and how some common PT interventions may impact these mechanisms. The discussion goes into some of the details of these proposals as well as some of the criticisms that have been generated with regards to the paper. Chimenti RL, Frey-Law LA, Sluka KA. Phys Ther. 2018 May 1;98(5):302-314. doi: 10.1093/ptj/pzy030. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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035 The Smallest Worthwhile Effect of Physiotherapy
08/17/2018
035 The Smallest Worthwhile Effect of Physiotherapy
How much of an improvement would you need to see in order to feel that physiotherapy was going to be worthwhile for your low back, neck, or shoulder pain? This is the question that this study examines and that is discussed in this episode. Also Sandy considers opening a steak restaurant. Christiansen DH, de Vos Andersen NB, Poulsen PH, Ostelo RW. J Clin Epidemiol. 2018 May 28. pii: S0895-4356(17)31379-3. doi: 10.1016/j.jclinepi.2018.05.019. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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034 How Well Do We Remember Past Pains?
07/05/2018
034 How Well Do We Remember Past Pains?
In this episode the topic of pain memory recall is explored. How well do we remember our past pains? Are there differences in recall between populations? What might account for the differences when they occur? All of these topics covered in episode in which Sandy and Cory discuss a recent research article on the topic. Berger SE, Vachon-Presseau É, Abdullah TB, Baria AT, Schnitzer TJ, Apkarian AV. Neuroimage. 2018 Feb 1;166:86-98. doi: 10.1016/j.neuroimage.2017.10.030. Epub 2017 Nov 6. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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033 Reconsidering the IASP Definition of Pain
05/22/2018
033 Reconsidering the IASP Definition of Pain
In episode 33, Sandy and Cory are joined once again by Pain Specialist Physician, Milton Cohen. Dr. Cohen and his group have submitted a new clinical definition of pain. In the discussion, we unpack the new definition term by term and discuss issues that Dr. Cohen and his group have spelled out regarding the current and famous IASP definition. Does the current definition have important shortcomings? Do you feel that patients would agree that the current definition fits with the experience of being in pain? Does this new definition make the clinical encounter and potential directions of treatment more clear? Listen in and judge for yourself. Be sure to catch a call to action as well as a bonus discussion of the new 'nociplastic' category of pain at the end of the show. Cohen M, Quintner J, van Rysewyk S. Pain Rep. 2018 Mar 5;3(2):e634. doi: 10.1097/PR9.0000000000000634. eCollection 2018 Mar. A rebuttal article also referenced in the show: Treede RD. Pain Rep. 2018 Mar 5;3(2):e643. doi: 10.1097/PR9.0000000000000643. eCollection 2018 Mar. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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032 Are There Ethical Concerns With Mindfulness Approaches?
03/22/2018
032 Are There Ethical Concerns With Mindfulness Approaches?
A recent paper looks at the philosophical underpinnings of the practice of mindfulness and raises some concerns regarding the ethics of its use. In this episode, these concerns are discussed as well as the larger implications of informed consent and respect for patient values. Ratnayake S, Merry D. J Med Ethics. 2018 Mar 9. pii: medethics-2017-104201. doi: 10.1136/medethics-2017-104201. [Epub ahead of print] Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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031 Expectancy Violation Update
02/10/2018
031 Expectancy Violation Update
We return to exposure based therapy and an update of the topic covered in the popular episodes 12 and 15, expectancy violation. This time we discuss a clinical commentary paper reviewing the state of the evidence related to the claims of Craske et al. How have the claims held up? What is the state of the science on the topic? This and more in episode 31. Weisman JS, Rodebaugh TL. Clin Psychol Rev. 2018 Feb;59:41-51. doi: 10.1016/j.cpr.2017.10.010. Epub 2017 Oct 26. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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Episode 30: I am a Placebo: An Interview With Dr. Nortin Hadler, MD
12/28/2017
Episode 30: I am a Placebo: An Interview With Dr. Nortin Hadler, MD
Our guest in this episode is , a rheumatologist and professor of medicine at the University of North Carolina in Chapel Hill, who has spent decades right in the middle of several health care debates. Dr. Hadler, or as Sandy likes to call him "Quote Machine," spent an hour with us reflecting on a range of topics. What is medicalization and why is so important? What predicts poor health outcomes related to regional pain disorders most robustly? What is the difference between a treatment act and a treatment encounter? Why do people shop in the placebo aisle of the grocery store? How is a well intentioned provider to proceed with care? All of this and much more in this episode. Links to his books via Amazon: Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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029 Discussion of the book Meanings of Pain
11/25/2017
029 Discussion of the book Meanings of Pain
This episode has Sandy and Cory discussing a recently released book, tilted . Can we measure pain? What is the impact when we try? How do the roles we assume impact the care we provide and how it is received? Listen in as our hosts consider these and other topics that have been raised by this very interesting and comprehensive book. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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028 Does Manual Therapy Suck?
10/28/2017
028 Does Manual Therapy Suck?
In this episode of Pain Science and Sensibility, it’s another British Invasion! So, I guess that would make us the Ed Sullivan show? Special guest Adam Meakins, host of the NAF physio podcast, joins us for a discussion regarding his proclamation that “Manual Therapy Sucks.” His provocative stance has stirred a lot of attention and discussion. So, stepping away from our normal format of discussing a specific paper, in this episode we’re discussing the merit, or lack thereof, for manual therapy. Also, is there a 6 degrees of Greg Lehman effect? Meakins A. The Sports Physio. 2017 Sep 29. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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027 Transverse Abdominals in Low Back Pain
09/19/2017
027 Transverse Abdominals in Low Back Pain
Sandy and Cory discuss a popular topic in the treatment of low back pain; the role of the transverse abdominus. This paper examines the role in pregnancy related low back pain but the episode goes on to discuss the topic more broadly. Now suck in that naval and listen along! Mens JMA, Pool-Goudzwaard A. BMC Musculoskelet Disord. 2017 Aug 25;18(1):372. doi: 10.1186/s12891-017-1732-9.
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026 Can We Predict Who's at Risk for Persistent Pain
08/18/2017
026 Can We Predict Who's at Risk for Persistent Pain
What is stratified care? Can we get the right patients to the right care at the right time? In this episode we look at a study examining some of the background required to answer these questions. Can we predict who is at risk for developing persistent pain? If we can then we might be better able to direct them to the right care. The findings may surprise you. Karran EL, Traeger AC, McAuley JH, Hillier SL, Yau YH, Moseley GL. J Pain. 2017 Jun;18(6):673-686. doi: 10.1016/j.jpain.2016.12.020. Epub 2017 Jan 30. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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025 Comparing and Using Low Back Pain Clinical Guidelines
06/29/2017
025 Comparing and Using Low Back Pain Clinical Guidelines
Episode 25 has our hosts, and special guest Kelly Newman SPT discussing a recent review article comparing 3 of the major clinical guidelines for the treatment of low back pain. What is a clinical guideline? How are their recommendations established and why are there differences between them? What is "the burden of proof" and why is it relevant to this discussion? O'Connell NE, Cook CE, Wand BM, Ward SP. Best Practice & Research Clinical Rheumatology. 2017. Due to copyright laws, unless the article is we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, . Music by Kevin MacLeod - : Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade
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