Dan and Juz cover the neuropathic pain algorithm, taking you through first through fourth-line treatment options from most to least conservative. They cover trialing and combining various medications including opioids, topicals for focal areas of pain, and various interventional options all the way up to neuromodulation (peripheral or spinal cord stimulators), and pain pumps. This episode helps a PCP or other physician have a guide to more efficiently work through treatments for neuropathic pain, and patients better understand their options so they can more effectively advocate for themselves. Visit the episode page at the website below for a link to download the paper with the algorithm.

Resources:

www.iniyh.com

Timestamps:

00:00 Official Intro

00:17 Intro

03:51 Why Did Dan Develop this Algorithm?

06:45 Starting Point - Is It Neuropathic Pain?

09:53 How to Draw Your Pain Diagram (KEY)

12:23 Consequences for Neuropathic Pain

19:04 Medication Perspective

25:09 How to Prescribe Medications

26:26 Second Line Combination Therapy

31:08 Topical Focal Treatments

36:05 Specialist Referral

40:15 Pulsed Radiofrequency

43:43 Adhesiolysis

46:49 Thermal Radiofrequency

47:59 STIM Interventions - Neuromodulation

56:09 Making Difficult Choices

01:01:50 Complications

01:04:30 SCS Pocket Pain

01:08:18 Opioids

01:15:20 Targeted Drug Therapy

01:16:56 Wrap Up

01:19:44 Disclaimer

In this episode, Dan and Juz focus on the importance of communicating and assessing pain through the use of pain diagrams, which help both clinicians and patients gain insights into the sources and amplification of their presentation. The hosts go through many different types of back, leg, and neck pain, discussing how this information contributes to goal setting and tracking progress in pain management. Unfortunately, the data on diagrams makes it seems as though they are useless - but that is if they are drawn in such a fashion. Pain diagrams when done with a clear, consistent key can provide a visual representation of the pathologies driving pain, allowing patients to turn the invisible, visible. Clinicians can then better identify underlying nociceptive and neuropathic components, and amplifying factors, so they can more effectively diagnose and treat. Listen to learn how to draw you pain better as a patient and provider.

Resources:

www.iniyh.com/newsletter

Timestamps:

00:00 Official Intro

00:17 Intro to How to Draw Pain Diagrams

03:03 Where is it? What does it feel like? What's made it worse?

04:26 Turn the Invisible, Visible

06:11 Useless Pain Drawings

07:17 Pain Key

08:51 Plain Neuropathy

09:32 Patient that's Sensitized

12:36 Five Major Causes of Lower Back Pain

17:11 Overlap - Medical Blocks & Other pain

20:15 How do we draw backs?

20:26 Facet joint pain

21:40 SI Joint Inflammatory

23:10 SIJ Osteoarthritis

24:05 SI Joint Dysfunction

27:48 S1 Nerve Compression

28:09 L5 Nerve Root

28:49 L4 Nerve Root

29:04 L3 Nerve Root

32:04 C4 Nerve Root

32:26 C5 Nerve Root

32:45 C6 Nerve Root

33:14 C7 Nerve Root

33:46 C8 Nerve Root

34:57 C1 - 2 Facet

35:13 C2 - 3 Facet

35:49 C3 - 4 Facet

36:02 C4 - 5 Facet

36:12 C5 -6 Facet

36:44 C6 - 7 Facet

37:17 C2 - 3 & C5 - 6 Whiplash

37:38 Pathologies of Neuropathic Pain

37:59 Focal Nerve Entrapment

38:28 Peripheral Nerve - Superficial Peroneal

39:22 Diabetic Peripheral Neuropathy

40:28 Myofascial Triggers

41:57 Multiple Diagnoses

44:39 Multiple Sites

46:24 When Patients come back with Pain

48:24 Cervical Instability

49:42 Recap

53:55 Disclaimer

Agency is crucial as a chronic pain patient - especially when you feel most helpless and scared with pain at its worst. Flares are always difficult to navigate, but they don't have to make you feel so helpless and reactive. What are the phases of a flare, and how can you manage each one? This episode is a critical resource to learn how to identify and sooner recognize your own flare patterns so you end up in 'the hole' less, and can navigate your way out more effectively when it does happen.

As a provider, how can you better explain flares and give patients a prevention strategy so they are empowered to impact all the aspects they can control, and more effectively treat the pieces you can help with when they are most vulnerable? Listen to this episode for more tools and a structure you can implement right away.

Resources:

www.iniyh.com

https://www.instagram.com/iniyhpodcast/

Timestamps:

00:00 Official Intro

00:17 Intro - Flare Management

02:38 Reasons for this episode

03:55 Justine's Most Recent Flare

05:34 Breaking Down the 5 phases

05:43 1st Phase - Trigger or Stressor

09:27 2nd Phase - Loss of Routine

12:05 3rd Phase - Worsening Pain

15:03 4th Phase - The Hole

17:55 5th Phase - Digging Yourself Out

19:35 Phase 1 Strategies

23:34 Phase 2 Strategies

25:30 Phase 3 Strategies

30:43 Why not Opioids?

32:10 Communicating with your provider

34:44 Phase 4 Strategies

38:27 Phase 5 Strategies - The Reach Out

43:08 Pain Flares have a Cycle

46:58 WrapUp

48:54 Disclaimer