Ep 97 Chaser – Pain Perception over a Boddington’s Ale with Steve George


Episode 97 Chaser
In this episode, Jimmy enjoys a Boddingtons Pub Ale and a chat with 2016 Golden Pen Award and Maley Lecture Award recipient Steven George. Steve shares how it feels to be the recipient of such accolades and address his colleagues, and details behind the pain research that earned him these awards. He provides his insights into understanding pain, from viewing it as a behavior, to the ways therapists should interact with patients reporting pain, and discusses the direction in which the #ChoosePT campaign should move. Steve also gives suggestions of pain researchers to watch, as well as some non-PT-related reading recommendations.

Bio: Steven Z. George, PT, PhD
Steven Z. George, PT, PhD trained at West Virginia University (BS in Physical Therapy), the University of Pittsburgh (MS in Orthopedic Physical Therapy and PhD in Rehabilitation Science) and the University of Florida (Post-Doctoral Fellowship in Pain Research and Rehabilitation Outcomes).  Steve worked clinically in the beginning of his career, but has focused on research over the past 15 years. Steve is an active member of the American Physical Therapy Association, American Pain Society, and International Association for the Study of Pain; often attending annual conferences and serving on committees.
Steve’s primary interest is research involving biopsychosocial models for the prevention and treatment of chronic musculoskeletal pain disorders.   His research projects have been supported by the National Institutes of Health, Department of Defense, Brooks Rehabilitation, Orthopaedic Section of the American Physical Therapy Association, University of Florida, and Foundation for Physical Therapy. Dr. George has authored over 170 peer-reviewed publications in physical therapy, rehabilitation, orthopedic, and pain research journals. He currently serves as a Contributing Editor for Physical Therapy and an International Editorial Review Board Member for Journal of Orthopaedic & Sports Physical Therapy.  Steve has been recognized from professional associations inside and outside of physical therapy with research awards.  In 2016 he was recognized by the American Physical Therapy Association with the Jules M. Rothstein Golden Pen Award for Scientific Writing and the John H.P. Maley Lecture Award.  The Golden Pen award recognizes demonstrated superior writing skills and a continuing record of scholarly contributions and collaborations to the benefit of Physical Therapy (PTJ) and the Maley Lecture is in recognition of distinguished contributions to the profession in clinical practice. This past summer, Steve has joined the Department of Orthopaedics at Duke University as Professor and Vice Chair of Clinical Research for the Duke Clinical Research Institute.

Episode 97 Shoutouts
Maine-Endwell Little League World Series team2016 Champions
Carole Lewis, PT, GCS, MSG, MPA, PhD, recent guest of the show and 2016 McMillan Lecture Award recipient
Sharon Dunn, PT, PhD, OCS, APTA President (@DunnSdunn2)
Kory Zimney, PT, DPT, CSMT, CAFS (@ZimneyKJ), former guest of the show
Jason Beneciuk, PT, DPT, PhD, MPH, FAAOMPT from University of Florida
Carol Greco, PhD from University of Pittsburgh
Mike Schneider, PhD, DC from University of Pittsburgh
Chris Main, Clinical & Health Psychologist, Keele University

Episode 97 Highlights:
(2:34) Lightening strikes twice: the 2016 Golden Pen and Maley Lecture Awards
(4:24) What’s it like to be up there in the middle of your colleagues, your field? What’s it like up there when you’re in the middle of it and you’re delivering your message? How does that feel?
“When you’re in the middle of it you’re kind of beyond the thinking about what it all means.”
“It’s like them asking me to throw a strike but getting to start 5 feet from the pins.”
(7:01) Variability in pain: talk a little bit about what that means to you (2016 Maley Lecture)
(10:52) Are we thinking that patient is lying or too sensitive because their pain rating is not what we expect?
(12:48) Talking biopsychosocial: the tattoo artist example
“They did the same damn post doc that I did but for a completely different reason!”
“I really thought man, this guy had a lot more fun.”
(15:00) In terms of current concepts of pain, if you were going to describe to it a first year PT student, what is pain?
(17:45) We can’t get rid of pain, does that mean it’s more important to our survival?
“I think there is some evidence that chronic musculoskeletal pain is an industrialized epidemic of industrialized societies.”
(20:58) What does PT need to do if a chronic pain patient just keeps coming back to PT?
“We’re the optimistic people in healthcare like, ‘you can do this, you’re going to make your goals.’ And I think sometimes we do that to our own detriment.”
(25:49) “Hurt doesn’t always mean harm.” – Kory Zimney: The knife cut analogy and approaching patient education about what they’re experiencing and the “why”
“Distilling these experiences down to narratives that patients can understand is challenging.”
“When the patients start dissociating pain and injury it really is powerful for them.”
(31:19) What should PTs know about pain that we don’t, that we don’t get out of school?
“You can flush away most of the neuroscience related to pain.”
“What we’re seeing is a behavior.”
“Most people, when they have a chance to let a healthcare provider know, they’re going to behave very differently than when the healthcare provider’s not there.”
“If it freaks me out, what kind of message does that send to them?”
(35:46) Summarizing the #ChoosePT campaign in one quote from the 2016 Maley Lecture
“Misjudgment or failure to understand the nature and depth of pain can be associated with serious consequences – more pain and suffering – for individuals and our society.” – Institute of Medicine, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and ResearchPreface
“It’s easy to look at opioids because they kill people or they cause addiction. We need to be very careful as a profession that we don’t say ‘we’re better than addiction and killing people.’ We need to make sure we’re finding our weaknesses where we’re causing more suffering, our side effects just aren’t as obvious.”
“Think of all the bullshit that healthcare providers perpetuate about pain.” … “Think about how much misinformation is provided by people that are supposed to be caring. That is the part that makes me angry.”
(41:28) Researchers to watch for more about pain:
-Lorimer Moseley, Body in Mind
-Pain in Motion, website, Facebook@PaininMotion
-Dr. Michael Sullivan, bio
-Keele University, Staffordshire, UK, osteoarthritis guideSTarT Back tool
-Jonathan Hill (@DrJonathanHill), bio
-Nadine Foster, bio
-Chris Main, bio
-The George Institute for Global Health, Sydney, Australia, Chris Maher
-Julie M. Fritz, PhD, PT, bio
-Tony Delitto, PhD, PT, FAPTA, bio
(43:43) Non-PT-related books:
-Malcolm Gladwell, Tipping, Blink, (website)
-The Wheel of Time series (website)
-Nate Silver, The Signal and the Noise (website)
“One of the things that drives me absolutely crazy: we have more sophisticated models for predicting who’s going to be in the major league baseball playoffs than we do for healthcare outcomes.”

“Pain is a behavior.”
“Don’t overvalue the specific things you do with the patient at the cost of the overall interaction.”
“The people who are really skilled are the people who can read the nuances of the psychosocial interactions. But also we have some things that we can provide patients that do physiologically alter and offer better outcomes, and I think the combination of those two is really powerful.”

This episode was sponsored by Aureus Medical

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