In today's episode, I speak with Dr. Mark Kargela, a seasoned clinician and educator, about chronic pain—its complexity, its impact, and how practitioners can better support patients struggling with it. The discussion focuses on shifting clinical approaches from tissue-centric models to ones that integrate contemporary neuroscience and lived experience.
Key topics include:
Understanding Chronic Pain: The conversation defines chronic pain not simply by duration (e.g., beyond three months), but as a biopsychosocial phenomenon that fundamentally changes the nervous system. Dr. Kargela emphasizes that chronic pain is often not a direct marker of tissue damage, but a protective output of the nervous system influenced by biology, psychology, and social factors.
Pain Neuroscience Education (PNE): Both clinicians stress the importance of PNE in helping patients reframe their pain experience. Teaching people how pain works can reduce fear and catastrophizing, improve self-efficacy, and set the foundation for graded movement and recovery.
Central Sensitization and Nervous System Dysregulation: The discussion highlights how sensitized neural pathways can perpetuate pain even in the absence of tissue pathology. Techniques that modulate the nervous system—such as breathing, sleep optimization, gentle movement, and mindfulness—are presented as key therapeutic tools.
Limitations of Traditional Biomedical Models: Dr. Kargela critiques overly mechanical approaches that chase tissue “damage” or perfect biomechanics, advocating instead for approaches that validate patient experiences and support behavior change.
Clinician Takeaways: The episode encourages health and fitness professionals to:
Ask better questions that uncover contributors to a person’s pain narrative.
Shift from “fixing” people to coaching them toward resilience.
Recognize that empathy, listening, and patient-led goals are central to helping people move forward.
To learn more about Mark's work, visit his social media accounts and website below.
Instagram: Modern Pain Care
YouTube: Modern Pain Care