#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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Damage Doesn’t Equal Pain
- Justin Dunaway describes seeing severely damaged bodies in Haiti functioning pain-free, which shattered his assumptions about pain equaling damage.
- He contrasts that with locals who had minor injuries that became lifelong pain due to lack of explanation and care.
Same Stimulus, Different Brains
- The same noxious stimulus produces vastly different pain experiences and brain activation across people.
- Justin emphasizes the clinician's job is to understand why a stimulus hurts one person more than another.
Begin With Behavior And Beliefs
- Start the subjective exam by assessing symptom behavior and watch for inconsistency, diffuse pain, and fear-related descriptors.
- Then pivot to detailed cognitive and behavioral questions about beliefs, daily routines, and stressors.