#PTonICE Podcast Episode 1978 - Reframing Rehab for Persistent Pain: Part 1
Jan 14, 2026
Dr. Justin Dunaway, a physical therapist specializing in persistent pain management, shares insights from his clinic experiences, particularly in Haiti, highlighting the disconnect between pain and physical damage. He discusses the significance of understanding individual pain experiences, using brain response studies to reshape perceptions of pain. Justin emphasizes the importance of subjective assessments, educational strategies, and graded movement to effectively treat persistent pain, aiming to rebuild patients' confidence and validate their experiences.
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Pain Becomes A Learned Amplifier
- Expectation and prior painful experiences amplify nervous system sensitivity in a self-reinforcing loop.
- Repeated pain teaches the brain to expect and then generate larger pain responses over time.
Do Gross Movement Screens First
- In the objective exam use gross movement screens to detect maladaptive guarding, co-contraction, breath holding and willingness to move.
- Focus on observable movement behaviors rather than precise ROM degrees initially.
Measure Nervous System Function Objectively
- Measure nervous-system signs like pressure pain threshold, two-point discrimination, and left-right discrimination as objective targets.
- Reassess these targets to demonstrate nervous system change during treatment.