Podcast: Integrative Approaches to Chronic Pain With Julia Rodes, MD

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, chats with Julia Rodes, MD, a fourth-year psychiatry resident at the Medical University of South Carolina, about an integrative approach to chronic pain. Rodes researches brain stimulation interventions and gender differences in pain, and speaks from both a clinical and personal vantage point as a paraplegic following a spinal cord injury.

Rodes explains that she became drawn to pain research after recognizing how much of psychiatry's caseload involves comanaging chronic pain, and how closely the neural pathways of pain overlap with those of depression and anxiety. She critiques the Western medical tendency to treat pain as something to eliminate before life can resume, arguing this mindset fuels an unending search for a pain-free state and contributed to the opioid epidemic. Drawing on the biopsychosocial model, she describes pain as a combination of physical sensation, affective response (such as catastrophizing), and learned behavior shaped by caregivers and social context—which helps explain why the same objective condition can produce wildly different subjective pain scores.

A central moment in the conversation is Rodes reading a poem, "It Hurts to Be Awake" by Nina Roska, describing the relentless, inescapable nature of chronic pain. Both hosts reflect on its emotional weight, and Rodes connects it to her own experience: after her spinal cord injury changed and she regained sensation as pain, she developed a three-part approach combining a spinal stimulator, acceptance and commitment therapy—which she argues is emerging as a gold standard over cognitive behavioral therapy for pain—and reclaiming a sense of personal strength through activities like kayaking despite pain.

Rodes also discusses using her visible disability as a clinical asset, noting that patients often feel an immediate sense of being understood or "on the same level" with her. She emphasizes that roughly 20% of Americans live with chronic pain, and up to 75% of those also have comorbid anxiety or depression. Her advocacy message to clinicians: help patients feel heard, and reframe treatment goals around functionality and quality of life rather than chasing a specific pain score.

Looking ahead, she highlights transcranial magnetic stimulation as a promising nonpharmacological treatment being studied for fibromyalgia at MUSC. The episode closes with Rodes sharing that she'll soon join the VA system to care for veterans as she completes residency.