Ep. 33 Left, Right and Centrist Pain: Right Treatment, Wrong Patient
Episode Summary: Understanding Pain through Political Lenses: Left, Right, and Center Approaches
In this insightful episode of 'It's Not In Your Head' podcast, Dan and Justine discuss the concept of managing chronic pain through political analogies—left wing, right wing, and centrist approaches. They delve into their experiences and observations, identifying different pain patterns and the treatment methodologies that work best for them. The conversation touches on the influence of media on public perception of pain treatments, specifically spinal cord stimulation, and the challenges of conveying accurate medical information in the modern day environment of misinformation we all live in. They provide a comprehensive breakdown of how each 'political orientation' correlates with pain treatment philosophies, helping both patients and providers better match the best approaches for various pain presentations.
Episode Overview
1. Introduction and Context
Dan recounts reading an article critical of medical interventions (spinal cord stimulation in particular), which leads to reflecting on how narratives in pain medicine can become ideological and divisive, similar to politics. This springboards a discussion into how polarized views about pain management mirror political ideologies and what patient populations they work best for.
2. The Political Spectrum Analogy in Pain Medicine
a. Defining the Perspectives
Dan draws direct parallels between political positions (left, right, and centrist) and pain management philosophies:
Right-wing ("Individual Responsibility")
Pain is mostly the patient’s responsibility to overcome and emphasizes personal ownership.
If someone is struggling with pain, this view often sees it as their personal shortcoming; and the expectation is that individuals should fix themselves.
Look at pain as pain means damage - but if you can’t then find the cause, it’s also viewed as in one’s head
Rely much more heavily on imaging, diagnostic blocks, interventions, spinal cord stimulation, and other surgeries with medications are dominantly opiods
Approach works best for: Patients who respond well to personal empowerment, value autonomy, have more focal pain with less amplification that interventions can effectively address
Left-wing (“Societal/Systemic Factors”)
Pain is a result of external, societal structures (e.g., social status, trauma, environment).
Places greater emphasis on societal causes and minimizing blame on the individual.
Explain chronic pain as a “false alarm” and useless without a cause you can diagnose — a misinterpretation perpetuated by psychological factors, social factors, often unresponsive to strict medicalization and over investigation.
Downplays imaging and purely biomedical explanations. Treatment instead focuses on gradual loading, changing the way you think about pain, coping strategies, CBT, pain neuroscience and emphasizing psychological interventions or other pain management strategies rather than interventions and spinal cord stimulators.
Works best for: Patients feeling stigmatized by individual blame, have widespread pain with increasing sensitization that is amplified by social or psychological factors.
Centrist (Balanced/Integrative)
Recognizes both personal responsibility and external factors, balancing patient ownership with acknowledgement of societal, psychological and medical contributors.
Encourages using what's helpful from both sides: supports and empowers patients, but doesn’t ignore societal constraints or medical realities.
Look at pain as a warning system or signal that’s asking you to go and have a look. Seen as likely having an underlying cause, with a pain signal that then may get sensitized by your nervous system
Treatments involve both pain neuroscience, CBT and other coping strategies, as well as medications that are broader than just opioids like anti-neuropathics, and anti-inflammatories. Interventions are used as indicated
Works best for: Patients who have a mix of physical identified or unidentified drivers that may or may not be treatable, as well as amplification of pain who need both validation of their struggle and actionable pathways to improvement, blending addressing drivers and mechanisms of sensitization.
b. Who Benefits from Each Perspective?
The hosts clarify that any given perspective may be helpful or unhelpful depending on the patient’s pain presentation, context, and needs.
The analogy helps reveal why some treatments or advice work for certain people but not others—not because one perspective is right or wrong, but because it fits better with that individual’s pain types and amplifiers.
3. Moving Beyond “Right or Wrong”
Dan and Justine stress the importance of using the political spectrum not as a battleground, but as a tool for matching the right approach to the right patient.
Rather than judging perspectives as correct or incorrect, the real challenge is tailoring pain management wherever the clinician falls on the spectrum to the way the patient presents
They emphasize the danger of rigid ideology in medicine, urging providers and patients alike to avoid “one-size-fits-all” thinking; and instead applying the right approach to the right patient. Successful pain care often requires blending elements from the different perspectives to suit the patients causes and contributing factors.