From the uterus, to witchcraft, hypnotism and more, we go through the history of what unexplainable symptoms have been blamed on and how they've been explained through history all the way up to more modern day classifications like Briquette's syndrome, somatoform, conversion, or functional disorders. We tease apart risk factors and other patterns that have been identified to lead to symptoms commonly labelled as ‘hysteria’, and the resulting biases that have carried through into modern medicine towards patients with these types of presentations. This episode is a somewhat lighter, funny change of pace from the pain education heavy start and continues to dive into why hard to treat patients with difficult to explain symptoms have struggled to be taken seriously - since the beginning of time.

Resources:

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Timestamps:

0:00 Official Intro

00:17 Intro

01:56 Diagnostic Limitations

05:30 Doctor Side

08:57 Patient Side

11:07 Juxtaposed position

15:08 Understanding things given the time

17:31 I don't know comes with caveats

20:27 Diagnosing History

29:55 Scientific Regions

33:36 The Enlightenment

42:12 Unconcious component of the mind

51:39 Same time as Charco - Briquette

01:04:04 Symptoms Briquette starts to recognize

01:09:20 Thurbrandt - end of 1800s

01:10:56 Sigmund Freud

01:14:41 Second WW

01:17:08 Looking closer at the DSM 1

01:25:02 Unintended Consequences

01:31:25 Conversion Disorders

01:35:29 DSM 5

01:42:04 International Classification of Diseases

01:43:30 How to think about this

01:50:35 Disclaimer

In this episode, we expand upon 'Number Needed to Treat', tying that concept into overall therapeutic limitations and some other examples beyond medications, including one you are definitely going to want to hear about - the effect of pain neuroscience education in and of itself.

So how much does understanding pain actually decrease pain? It depends, but not as much as you'd think...We'll introduce a study that teases this apart and share a few different ways to interpret this so you can see how no one therapy is the be all end all of pain.

Hopefully, this information helps you better understand what aspects of pain you're treating in different situations so you can set better expectations, and make better decisions about the overall treatment plan.

Resources:

www.iniyh.com

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

Timestamps:

00:00 Official Intro

00:17 Therapeutic Limitations

01:27 Pain Neuroscience

03:00 SOPA Score

04:15 Original Paper Graph

06:56 Use these tools to improve components of pain

08:05 Pain isn't just in your head

10:02 Setting expectations for programs

12:19 Evidence-Based Medicine

15:23 Justine's Decision Making Process

17:21 A Future without the Ouch & Wrap Up

20:00 Disclaimer

The hard truth is it's normal for treatments, especially medications, not to work. But how many patients do you actually have to treat to improve things for just one even? This is where the concept 'number needed to treat' is critical to better understand so that expectations don't lead to resentments.

Managing expectations as a patient is hard, it's even harder when they're unrealistic. Unfortunately, there is little conversation around what is likely to work in various settings, and what their likelihood is to compared to other options. We'll go through how you should trial medications, ways to improve communications with your provider, touch on the ecological fallacy, explain how experienced clinicians can overcome some of this, and define what evidence-based medicine actually is and should look like.

Resources:

www.iniyh.com

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

Timestamps:

00:00 Official Intro

00:17 Intro - It's normal for treatments not to work

03:07 Number Needed to treat within Neuropathic Pain

05:06 Trial it for 6 weeks

06:07 Context is important in Number needed to treat

10:23 It's an Average - the ecological fallacy

15:00 Why do we do it this way?

16:04 The experienced Clinician can predict

18:15 Develop good communication with your Physician

19:18 Evidence-Based Medicine

20:34 Final Point

21:54 Disclaimer