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Pain Science and Sensibility

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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.

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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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.




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. The smallest worthwhile effect of primary care physiotherapy did not differ across musculoskeletal pain sites. Christiansen DH, de Vos Andersen NB, Poulsen PH, Ostelo RW. J Clin Epidemiol. 2018 May 28....


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. Hippocampal morphology mediates biased memories of chronic pain. Berger SE, Vachon-Presseau É, Abdullah TB, Baria AT, Schnitzer TJ, Apkarian AV. Neuroimage. 2018 Feb...


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...


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. Forgetting ourselves: epistemic costs and ethical concerns in mindfulness exercises. Ratnayake S, Merry D. J Med Ethics. 2018 Mar 9. pii: medethics-2017-104201. doi: 10.1136/medethics-2017-104201. [Epub ahead of...


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. Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Weisman JS, Rodebaugh...


Episode 30: I am a Placebo: An Interview With Dr. Nortin Hadler, MD

Our guest in this episode is Dr. Nortin Hadler, 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...


029 Discussion of the book Meanings of Pain

This episode has Sandy and Cory discussing a recently released book, tilted Meanings of Pain. 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 open source we cannot legally post the PDF on the website for the world to download at will. That...


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...


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! The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study. Mens JMA, Pool-Goudzwaard A. BMC Musculoskelet...


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. The Value of Prognostic Screening for Patients With Low Back Pain in Secondary Care. Karran EL, Traeger AC, McAuley JH, Hillier...


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? Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major...


024 Trigger Points, the "Third Space", and the Merit of Pain Theories with Dr. Milton Cohen

Special Guest Milton Cohen MD, Rheumatologist/Specialist Pain Physician, joins the show to discuss a variety of topics in this far ranging interview. Dr. Cohen and his research group has written extensively on topics ranging from critical appraisals of the biomedical and biopsychosocial framework to the nature of the therapeutic interaction. In the show we discuss these topics as well as the concept of the "Aporia" of pain. Additionally, his group's 2015 paper on the face validity of the...


023 Modeling Pain and Other Bayesian Topics

Episode 23 has Sandy and Cory discussing a review article about modeling pain using a Bayesian statistical model. Fear not! You'll not need an abacus to follow along as the discussion moves from considering the model to potential use and problems with the "Bayesian Brain" concepts that are currently en vogue. What is the big deal with Bayes theorem? Why has it become so popular and why is it being applied to pain? Pain: A Statistical Account. Tabor A, Thacker MA, Moseley GL, Körding...


022 Do Systematic Biases Impact Care?

Episode 22 has Sandy and Cory discussing a systematic review on whether biases are present in healthcare decisions and if so, do they have a negative impact. Are biases something that we need to worry about? Is Cory a robot? Also, Sandy coerces her DPT student Christa Wolf to join the show for an important perspective from the student side. Take a listen as the crew discusses these matters and their implications in matters such as the concept of N of 1. Cognitive biases associated with...


21 Aerobic Exercise for Pain

In this episode, Sandy and Cory are joined by special guest Roderick Henderson who is a physical therapist and strength coach. The group reviews a recent article on the impact of aerobic exercise on pain sensitivity and also goes on to talk about several topics concerning strength and conditioning aspects of care for people in pain. How much should we push our patients in pain? What constitutes "strength training?" Is Rod being attacked by a pack of wild dogs? Effects of aerobic exercise...


020 Neuropathic Pain at the Pelvis

In episode 20 Sandy and Cory discuss an exploratory research paper on Sandy's area of expertise, pelvic pain. The presence or absence of neuropathic pain in this population is not well known and Sandy provides some insight into how this gap along with some common misconceptions play out in unfortunate ways for patients with these presentations. Cory's mettle is tested once again in another low front pain episode but he contributes a self report question that is sure to make you wink. There...


Holiday Extravaganza 2016

The PT Podcast Network crew are here to spread some holiday cheer with the annual PT Podcast Network Extravaganza! They talk Jedis, rectums, Festivus, and horrible jet lag - all the holiday standards. Some say it's unlistenable...but you get to judge for yourself! Music for The PT Podcast Holiday Extravaganza: Kevin MacLeod -


018 What IS a Picture Worth

Cory and Sandy continue their search for clinical excellence (and interesting new screening tools), including an in-depth look at the benefit of using pain drawings as part of clinical assessment. Can these drawings be used to indicate signs of central sensitization? If not, are they useful anyway? How excited is Cory about the Cubs in the World Series? Expanded Distribution of Pain as a Sign of Central Sensitization in Individuals With Symptomatic Knee Osteoarthritis. Di Lernia D, Serino...


017 Are There Ghosts in Your Machine

In episode 17, Sandy and Cory attempt to tackle a difficult theoretical paper (difficult for non-neuroscientists, at least) discussing some potential implications of interoception in chronic pain. The discussion wades into "embodied cognition" and "predictive processing" among many other models that this paper attempts to cover. Also, we uncover the real reason why Sandy is going to Japan. Ghosts in the Machine. Interoceptive Modeling for Chronic Pain Treatment. Di Lernia D, Serino S,...



In this episode Sandy and Cory discuss a recent RCT in which a CBT approach was applied to the workplace. Cory works in the occupational setting and so is able to offer some insight into how this type of care might be provided. The discussion goes in some interesting directions as both of our co-hosts feel that there is application for these findings no matter the setting. Also, we find out that both Sandy and Cory are planning evil deeds for their cats. Early Workplace Communication and...