The Modern Pain Podcast

Is "whole person reasoning" just biopsychosocial with new branding, or does it change how you actually run a session? Mark Kargela and Ben Whybrow break down why treating pain by tissue alone misses most of what's driving a patient's experience, and why that applies from day one of an acute injury, not just after the 91-day mark that turns pain "chronic."Mark tells the story of a student on his last clinical rotation who was so locked into test clusters and technique that he nearly missed a patient in visible distress, until one question about coping unlocked what she actually needed. Ben shares how a NICE-guideline question about cultural influence on pain has changed his intake conversations, plus the patient whose neck pain flared after an election result.They also dig into why "subjective" is the wrong word for a patient's story (it's not less-than the objective findings, it often predicts outcome better), how systemic biology shows up even when imaging and labs look "controlled," and why social and cultural context can make or break a treatment plan that's otherwise textbook-perfect.If you want a structured way to hold all of this in a session without turning it into another checklist, Mark and Ben mention the free Whole Person Reasoning guide, link below.LINKSFree Whole Person Reasoning guideJoin Modern Pain ProMore from Modern Pain Care#PhysicalTherapy #PainScience #BiopsychosocialModel*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if following the clinical guideline is sometimes the wrong call? Not occasionally. In the kinds of MSK situations that come up regularly. That's the argument physiotherapy researcher Matt Low makes in Part 2 of this conversation, and it's worth sitting with.About Matt: Matt Low is a physiotherapy clinician and researcher based in the UK whose work sits at the intersection of philosophy, epistemics, and clinical practice. He asks uncomfortable questions about what physical therapy actually is and where it's going.In this episode:Why rigid guideline adherence can be an ethical problem, not a clinical safety net (SIJ fusion as a concrete case)How value-based care's four pillars create friction rather than harmony in practiceWhat AI is already doing to MSK services right now (Cambridge UK is procuring AI for MSK management today)Why ambient documentation tools change more than just note-takingThe contextual architect: what the PT role looks like when AI handles algorithmic pathwaysWhat decentering the human in PT curriculum would actually mean in practiceResources mentioned:Chad Cook's paper on value-based care in MSK practiceDave Nicholls' work on the future of physiotherapyDeleuze and Guattari (rhizome concept applied to clinical thinking)Part 1 of this conversationWant to keep developing this kind of reasoning? Modern Pain Pro is the community where clinicians work through exactly this.--> Trial for 15 daysIf this episode was useful, leaving a review helps more clinicians find it.*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Evidence-based practice has a blind spot: not in the research itself, but in how we rank one form of knowledge above all others. In this episode, I sit down with physiotherapist and PhD candidate Matt Low to unpack what he calls epistemic fluency, the ability to move between different forms of clinical knowledge depending on what the situation actually requires. We cover why population-based research gives you a map but not your patient's territory, how Aristotle's three forms of knowledge apply directly to clinical reasoning, and why the biopsychosocial model functions better as an analytical tool than a practice guide. We also dig into the Back Cafe — a 3-arm RCT on lumbar spinal fusion rehab that compared a progressive training program, a video program, and a social cafe setting run by a senior physiotherapist. At the 2-year follow-up, the back-cafe group outperformed the training group on pain and beat both other groups on daily task performance. The study raises hard questions about what the active ingredient in rehabilitation actually is. This is Part 1 of 2. LINKS Join Modern Pain ProMatt Low's blogBack Cafe study (PubMed)CauseHealth (Matt's network)*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Most chronic pain patients aren't failing to improve because they aren't trying. They're failing because no one in their care has helped them see what they're actually up against.In this solo episode, Mark breaks down why even well-intentioned biopsychosocial care often falls apart in practice -- and why the fix isn't just adding more disciplines to the team.Key takeaways:-  What the Misdirected Problem Solving Model reveals about chronic pain care-  Why patients still separate the "body problem" from the "mind thing" even when seeing both PT and a psychologist-  How incoherent clinical narratives keep patients locked in biomedical thinking-  What true interdisciplinary care actually looks like vs. parallel care happening in silos-  How PTs can bring the psychosocial in -- and why psychology needs to bring the body back into the conversation-  What a unified clinical story sounds like in practiceA free webinar is coming up focused on building this framework in your own practice. Registration HEREIf this episode hit home, subscribe and check out Modern Pain Pro -- where clinicians go deep on exactly this kind of work together. - https://modernpaincare.com*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the best thing you could bring to a complex pain case… is curiosity instead of certainty?In this episode, Mark Kargela sits down with physical therapist and pelvic health specialist Faith Stokes to explore what trauma-informed, psychologically informed care actually looks like in practice. When patients present with persistent pain, grief, trauma, or complex comorbidities, rigid clinical labels and quick solutions often fail. Faith shares how clinicians can step back, regulate themselves, and create space for the patient’s story to guide care.This conversation dives into practical ways to show up more human, grounded, and effective when treating messy cases that don’t fit the textbook.In this episode, you’ll learn:Why you don’t need to be “the expert” in the roomHow clinician nervous system regulation changes patient outcomesWhat trauma-informed care actually looks like during treatmentHow curiosity improves clinical reasoning in complex pain casesWhy acknowledging a patient’s story can transform rehabilitationHow to integrate psychological awareness without abandoning physical treatmentIf you treat persistent pain, pelvic health conditions, or complex chronic cases, this conversation will change how you approach patient care.Subscribe for more conversations on modern pain care, clinical reasoning, and treating complexity.Explore the resources and programs mentioned in the links below.Link:SondermindComplex PTSD Book Holistically Treating Complex PTSD Book IG Post on Veterans  Stress and Suicide*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if biomechanics isn’t the reason your patients improve?And what if your best “tool” isn’t a tool at all?In this episode, I sit down with exercise physiologist Samuel Bulten to unpack the identity shift many clinicians face when persistent pain doesn’t respond to traditional care.We discuss:Why biomechanics has a weaker link to pain than we were taughtThe ego trap of being the “fixer” in the roomHow ACT and psychologically informed care change clinical conversationsThe tension between objective measures and meaningful life changeWhy therapeutic alliance may matter more than your techniqueHow rural practice highlights the limits of biomedical narrativesIf you’ve ever felt unsettled leaving school confident—only to feel lost with persistent pain cases—this conversation will help you recalibrate.If you’re ready to build confidence with complex pain, subscribe for weekly episodes.*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What if the guideline isn’t wrong—but incomplete?And what if your patient isn’t “non-compliant”—just complex?In this episode, I’m joined by Joost Van Wijchen to explore the tension between clinical guidelines and the messy reality of practice. We unpack the concept of mindlines—the experience-shaped frameworks that actually guide what we do—and why uncertainty isn’t a flaw in care, but part of it.You’ll learn:Why guidelines are population-informed—but patients are personalHow “mindlines” shape clinical reasoning more than we realizeWhy outcome measures like the Oswestry don’t tell the whole storyHow the capability approach shifts focus from impairments to meaningful freedomPractical ways to navigate uncertainty without losing clinical integrityHow to co-construct care instead of imposing solutionsIf you’ve ever felt the tension between measurable outcomes and meaningful outcomes, this conversation will resonate.If this episode challenges or sharpens your thinking, subscribe and share it with a colleague.*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

Mindfulness for pain isn’t candles and breathing apps.It’s measurable, mechanism-based analgesia.In this episode, we break down what the neuroscience actually shows about mindfulness and pain modulation—and why it works through pathways completely independent of opioids.You’ll learn:How mindfulness decouples sensation from suffering (insula vs. prefrontal activity)Why “trying to relax” can backfire—and what to cue insteadHow thalamic gating may reduce nociceptive input before conscious processingThe role of predictive processing and reduced anticipatory threat (amygdala + salience network)How shifting from narrative mode to experiential mode changes painWhy mindfulness still works even when endogenous opioids are blockedHow improved interoception supports emotional regulation in chronic painThis is not about turning your clinic into an eight-week meditation program. It’s about understanding the mechanisms so you can apply brief, practical strategies in real sessions.If you work with complex or persistent pain, this reframes mindfulness as a clinical skill—not a wellness add-on.Subscribe so you don’t miss Part Two, where we cover the dose-response data and the minimum effective dose.*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

What do you do when a patient says, “I don’t care about goals—I just want less pain”?This moment shows up every day in pain care—and how you respond can either reinforce stuckness or help someone get their life back.In this episode, Mark Kargela breaks down why pain reduction isn’t wrong—but often incomplete—and how clinicians can navigate this conversation without invalidating the patient or taking away hope.You’ll learn: • Why pain reduction alone can narrow a patient’s life • Red flags that someone is stuck in the pain reduction loop • How pain scores function as communication—not thermometers • How to use “creative hopelessness” without confrontation • Ways to pair short-term relief with long-term valued living • How to reframe goals when patients fear movement and activityThis episode is for clinicians who want practical, psychologically informed tools to manage complex pain conversations—without abandoning pain relief or overstepping their role.If you work with persistent pain, this discussion will sharpen how you listen, how you frame goals, and how you help patients move forward—even when pain doesn’t fully disappear.👉 Subscribe for weekly evidence-informed conversations on modern pain care. -  @ModernPainPodcast  👉 Explore the links below for related resources and deeper learning:Kenneth Craig Paper on Social Communication Model of Pain A biopsychosocial formulation of pain communication Creative Hopelessness Guide *********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

🎙️ What happens when a clinician becomes the patient—and almost doesn’t survive? 💥 HLH. ICU. Life support. Then… powerlifting again.In this powerful episode, strength coach and physio Jared Maynard shares his shocking journey through a life-threatening diagnosis of HLH, his fight to stay alive, and what he learned about healthcare, humanity, and healing.You’ll learn:What HLH is—and how it nearly ended Jared’s lifeThe deep clinical lessons from losing strength, speech, and independenceHow small human moments in care created lasting impactWhat it’s like to rebuild your life, body, and mindset after ICUHow Jared’s story reshaped his clinical work and coachingWhy “being human” matters more than “having the answer”Whether you’re burned out, feeling disconnected from your work, or want to show up better for patients—this story will move you.👇 Subscribe for more clinician-to-clinician conversations. 🧠 Join the Modern Pain Pro community. 🎓 Explore Pain Practice OS and start applying modern principles.*********************************************************************📸 - Follow us on Instagram  -  https://www.instagram.com/modernpaincare/🐦 - Follow us on Twitter -  https://www.twitter.com/modernpaincare/🎙️ - Listen to our Podcast - https://www.modernpaincare.com____________________________________Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness