Unpacking: Your Chronic Pain Questions

Megan: 00:00:00

Even with things like arthritis, it's not simply about the joint breaking down. I've seen people with horrendous joints. In fact, one of my favorite stories was when I saw one of my first in home patients who was 90 years old.

He was the sweetest man. He was like 6 foot 3 or something. He was just lovely.

And I moved his knee and as I was moving, I heard click, click, click, click, click, click, click, click, click, click. I mean, the arthritis was tremendous. It was a swollen joint. It was just unbelievable to look at.

And so I get through the entire eval and he was so sweet. He said, thank you so much. That was lovely. Next time, are you going to work on the knee that hurts?

Intro: 00:00:47

Welcome to Unpacking Pain, a podcast dedicated to understanding the complexities of chronic pain, what causes it, how it affects our lives, and what we can do about it.

Join doctor of Physical therapy and pain science researcher, Dr. Megan Steele, and me, Holly Osborne, a chronic pain sufferer, as together we explore the biological, psychological and social aspects of chronic pain and create community and understanding in the process.

Holly: 00:01:23

Hi, everybody. We're back. Thanks for joining us at Unpacking Pain in this, our tenth and final episode of season one.

Megan: 00:01:31

We made it.

Holly: 00:01:33

We did. Ding, ding, ding.

If you've been listening all the way along, we're so grateful to you and just have been energized by and touched by the amount of support and really just feedback we've been getting.

And in fact, that is really the theme of today's episode is we've received some pretty interesting emails and some questions from some of our listeners who, by the way, are in more than 30 countries. We learned from our producers that we've got people listening from all over the world. So you are in good company.

You are in mixed company, which is the kind that we love. So we have been lucky enough to be prompted by some of our listeners. And so I've got Dr. Megan on the hot seat today. Sort of a.

A bit of a lightning round.

We're going to do with five questions that we picked that we thought were really quite interesting and would allow us to not only delve into a little bit of new territory today, but also revisit some of the themes and some of the education we've gotten over the season.

Megan: 00:02:40

I'm excited. And by we picked, you mean you picked. So I'm not quite sure what the questions will be, but I'm looking forward to them.

Holly: 00:02:48

Royal we.

Megan: 00:02:50

Yeah, the royal we. Yes, yes, yes, the royal we.

Holly: 00:02:53

And once we get through those questions, we'll go ahead and we'll wrap up for this episode and let you know what to expect for season two, because, yes, it is.

Megan: 00:03:03

Get excited.

Holly: 00:03:05

All right, Dr. Megan, I want to start with the first question that really intrigued me, and it was something that we did not necessarily touch on over the season. And maybe part of this is because neither one of us are, are pharmaceutical dispensing practitioners, right?

You are a doctor of physical therapy and on your way to getting a PhD, but you're, you're not dispensing meds. And so, you know, they always want to of tread lightly around that. But this is not a question about are meds good or bad or which one should I be on?

But rather this listener asked us that they have been able to manage their pain very successfully through medication. Now, this listener did not go on to expand further from that. We don't know what meds they're taking.

They said, if I am handling my pain, my pain is under control due to or thanks to my meds. Am I good essentially?

Is that a solution that I can just ride off into the sunset, or do I need to take deeper steps, bigger steps to actually fix what's at the root of all this?

Megan: 00:04:16

That's a great question. And I think that the answer is going to differ for everyone. So I think it's gonna differ on what your quality of life is like on this medication.

And if that's an acceptable quality of life for you. We all know every medication has side effects. If the side effects are tolerable for you, then potentially you're fine to stay on them.

If this is a medication that you're meant to be on long term, you know, we in the US at least kept people on opioids for much longer than they were ever intended to be. And so the good news there is that they're not allowing that anymore. And even short term people are having a hard time getting opioid medications.

But is this a medication that's going to affect you long term?

Those would all be questions that I would want to answer if I were someone that was saying, you know, should I really be pursuing this further or am I okay to just kind of hang out on the medications? The other concern that I think about is is this medication going to become less and less effective over time.

That would be something that is not an uncommon thing to happen with medication that, you know, it worked for a certain number of years and now it doesn't anymore. That becomes potentially a bigger problem down the road.

If you're Just sort of kicking the can down and thinking, well, I'll deal with this when this med stops working potentially. I always, you know, I'm not anti medication.

As a physical therapist, I think it's nice sometimes when people have medication because it can allow their nervous system to do more sometimes. Especially things that are like an injectable, like something like cortisone.

If you're just not able to progress someone and they're constantly irritating that joint, it's inflamed, they get a cortisone injection and then come into physical therapy. They can make much more progress sometimes if they weren't able to outside of that cortisone injection.

So sometimes things like that are really helpful to just get somebody over the hump or move the needle in a way that's going to allow them to address more of the root cause. If it were me and I were taking medication, I'm not somebody that likes to take medication. I am quite forgetful.

I don't know where my Monday, Tuesday, Wednesday pill planner is.

I've had about four of them that are, you know, have vanished into the ether and, you know, it's just not something I go on vacation, I forget my medication. You know, there's oftentimes issues with pharmacies or supply chains. I just, I, I wouldn't want to be dependent on something else.

So if it were me, I would say I'm going to use this medication as a bridge to allow me to find out what is ultimately going on here and allow me to live in a way that, you know, my quality of life is maybe a bit improved, but I can still address what might be the underlying issue.

Holly: 00:07:51

That's such a great answer. I wish that I could have heard that, those words when I was living on advil for about six or seven years.

I was living on about one thousand two hundred milligrams of ibuprofen a day.

Megan: 00:08:06

Wow.

Holly: 00:08:07

Yeah, you can probably imagine what shape my stomach was in at that point.

But I think that it is understandable that sometimes we don't have the time, the capacity, the headspace, whatever it is, to go deeper on that journey. It can be a really good sort of way station, if you will, along that journey.

But I think everything that you just mentioned, Dr. Megan, is so helpful in terms of thinking about side effects, thinking about, you know, what it might be masking, thinking about potentially the drop in efficacy over time. Really good food for thought.

Megan: 00:08:46

Yeah. And like you say, sometimes you'll have the bandwidth to address it and work on it and other Times you won't.

I worked in a hospital for a long time and they had a saying, not on this admission. You know, somebody has a clear addiction to opioids and requires a very high level of opioids in order to manage their symptoms.

But they're really there for something more acute. They say, this is not an admission problem this time. Not on this admission. That's something that they will deal with once this current issue is over.

Holly: 00:09:22

I like that actually. It's, it's. We can extrapolate that to all parts of our life. Like not this month.

Megan: 00:09:29

Yep.

Holly: 00:09:30

Not this rodeo, but you know, maybe next quarter I'll have a little bit more bandwidth and you know, so we are fortunate that we have tools like meds.

Megan: 00:09:39

Yes, absolutely. Absolutely.

Holly: 00:09:43

Hope that answered your question. Hit us back if you have any follow up questions.

Megan: 00:09:47

Yes, please do.

Holly: 00:09:48

I've got the second question lined up for you here, Megan, this listener wanted to know what was one thing you wish that all of your physical therapy patients already knew when they walked into your clinic for treatment the first time?

Megan: 00:10:05

That's a good question. I think the thing that I find myself saying over and over again is pain does not equal damage.

I think it's really hard for us in Western society to come to the realization or I guess wrap our heads around the idea that pain doesn't mean there's damage happening. And when I make the assumption that pain equals damage, I might change a lot of things about my life.

I might move less, I might have an increased fear response, I might catastrophize about what's going to happen next. And then I move even less and then I feel even worse. And it's just this kind of like spiral that can sometimes happen.

And there's a great researcher named Joshua Pate out of Australia who's doing work with pediatrics, he's doing work with children to kind of do pain inoculations, which is not an injection. But what they're doing is they're teaching children about pain from a very early age.

And it's so cute to hear these kids kind of repeat back what they've learned and they talk about, you know, I know that I have pain sometimes and pain is a normal experience. And typically pain goes away on its own. You know, it's just lovely.

And I think if we had all had that education early on, perhaps our pain rates would be lower in our general population. That's really what they're hoping to do with their research.

It's a really longitudinal study that they hope to Follow these children into adulthood and see if their incidence of chronic pain is lower.

Holly: 00:11:51

Wow, I love that. What a cool idea. And, and really to follow their journey all the way through. I'm, I'm dying to speed ahead and get the answer.

Megan: 00:12:01

I know. Grow up already, kids.

Holly: 00:12:03

Yeah, exactly. Can't we just use AI to just like model out, like pretend that you're 25 years old now?

Megan: 00:12:11

Some of the AI answers I, I'm getting, I'm. I would be concerned.

Holly: 00:12:16

Yeah, exactly. I'm sure AI would be delighted to answer it for you. Yes.

Megan: 00:12:20

Oh, for sure.

Holly: 00:12:21

Or I should say to hallucinate it for you.

Megan: 00:12:23

Exactly.

Holly: 00:12:25

I think that's a, that's a really cool.

And actually, so, you know, if I could be so bold as to say, hey, listeners, to everyone who's tuning in, if that's the one thing Dr. Megan wishes that every patient knew when they walked in to their office, let's just all decide now that we know that, let's just agree that as a community, together through Dr. Megan and unpacking Pain, that we've all learned, we without question now that pain does not always equal tissue damage and that there could be a lot more. That's why we named the darn thing Unpacking Pain because there is a lot to unpack. It's, it's not a simple two dimensional thing by any means.

Megan: 00:13:00

So, yeah, and that is great, except the fact that, you know, knowing on a cognitive level and knowing on a subconscious level are two different things. You know, I, I think to really truly know it, you have to know it on a subconscious level so that your body doesn't have that reaction every time.

So that takes a little bit longer. That probably takes a little bit more nuance. It might not just be the expertise of Megan and Holly that's going to convince you of that.

And that's okay. I think, you know, our subconscious mind responds to safety and repetition. So the more times you have injuries.

This is why athletes and dancers are kind of a special, interesting population. They have a different relationship to pain. They say, oh yeah, I have pain all the time.

It's fear leaving my body or it's something I have learned to put in the back of my mind. And the show must go on, those types of things.

And so just kind of having those experiences where you've had pain and then recovered really train your nervous system to say, oh, this is a normal human experience and it resolves and life goes on. And yeah, so some of that, you know, takes some time.

Holly: 00:14:24

I appreciate that.

Megan: 00:14:26

Yeah.

Holly: 00:14:26

I think that's a really good reminder is that these, this is not. Not only is not a quick thing, but it's also not necessarily going to be linear.

You might open yourself up to a little piece of it and then, you know, really feel like you kind of get distracted or, you know, life goes back to just really focusing on what's happening physiologically. And then you might, a couple months or a couple years even later, crack open a book. You know, that, that gets you thinking about another piece of it.

And you guys might recall from one of our earlier episodes, I mentioned the book you Can Heal youl Life by Louise Hay, and a friend had given it to me 15 years ago, but I wasn't ready to hear what Louise Hay had to say at the time.

And it took a decade and half until quite recently in twenty twenty-five, when I actually felt really ready to take that on and start delving into the psychological, sort of emotional components of my pain.

Megan: 00:15:21

Yes. And I think that's good.

The good news, bad news for us as practitioners is we think, you know, when we have a good outcome for a patient, we're like, oh my gosh, I'm amazing, aren't I?

And I just this person with 20 years of pain and I was the one who solved it, and it's like, eh, either that or that person would just was ready, you know, and they.

Holly: 00:15:44

Weren't ready before you were there, right place, right time, and you, you got them over. Over that hump, so.

Megan: 00:15:50

Exactly. So you can't pat yourself on the back too hard. But you also can't fault yourself too much when people don't.

Aren't ready and, and then maybe don't have those positive outcomes.

Holly: 00:16:03

Yeah, I think that's a great reminder. Yeah. Be patient with it. That actually is a perfect segue into the third question that I grabbed. This was from a listener who.

Yeah, this was from a listener who said they themselves have fully adopted an inner dialogue and a practice. It sounds like they're journaling. They had mentioned around the psychological and emotional aspects of. Of their pain.

They even mentioned the sociological aspect. So they're paying attention to the biopsychosocial model. Hooray.

But this listener had mentioned that they are finding that the people around them, so their spouse, their friends, and even they mentioned their orthopedist, are not on that level yet.

Megan: 00:16:49

They.

Holly: 00:16:50

So their entourage is not really meeting them at that place. And that they mentioned.

For example, anytime that I bring up pain or want to talk about how it's affecting me, my husband Goes right back to the physiological or the biological part of it.

So this listener is asking if we had any advice in how to broach that differently, Broach these conversations with different people in our lives and let them know that, actually, I don't just want to talk about my knee from a biological standpoint. I'd love you to ask me how I'm handling the stress of being in pain or how I'm handling the loss of my daily run, for example.

Megan: 00:17:28

Yeah, right. The other aspects, and that is a part of the pain journey that many people have to navigate, is how do I navigate this change in relationships?

How do I know what to ask for? How do I express myself in a way that people can understand? And there's no one blueprint for doing that.

I know there are online and in person support groups for people in pain, and I think there are as well for family members. And I know that I can attest to this, that if I say something to my husband, he'll say, oh, yeah, yeah, yeah.

And then someone at the grocery store will say the exact same thing, and he'll say, you know what I just learned today? And I will say through my teeth. That's so interesting. I am so happy that you learned that. Fantastic.

Holly: 00:18:34

Aren't you just a fountain of it. Just a sponge out there in the world, honey?

Megan: 00:18:38

Yes, and I think that's true for so many of us. I mean, I see so many spouses that say things like, would you tell her or would you tell him? And I'm like, yes, because they can't hear it from you.

And so they need to hear it from me and act surprised when they come to you with this information.

It's just one of those human nature things that it's really hard to hear from your spouse, parent, significant other, partner, whatever the case may be. But it's so much easier. It just hits our ear differently.

Even though it could be the exact same words and the exact same tone of voice, even less eloquent than we might find ourselves, perhaps. So I think those are great options are hear the same thing from someone else and.

Or written materials like you say someone shared a book with you that was really impactful, and then also, again, recognizing they might not be ready.

This is kind of a big lift for people who are saying, well, I don't understand this, and I almost have to kind of, you know, minor in this in order to understand it. And it's going to take me some time. And just like the healing journey is not linear.

I think the learning journey for partners of people in pain is not linear because sometimes it'll seem like everything's great. Hunky dory. We sort of have this big celebration, oh, this is all over. We're not going to ever deal with this again.

And then there's a flare or there's a relapse, and then they're like, wait a minute. What? I thought we weren't going to be talking about this anymore. So, yeah, it's so complex.

I think a big part of pain coursework for patients should be how do I communicate about my pain? Because we're not born with this knowledge.

We're not born with the knowledge of how do I ask for help or how do I ask for space, or how do I tell people what I'm going through to the extent that they can understand it.

You know, if we're talking about, like, the difference between a partner versus a child, I think all of that is really valuable and it can help give a voice to people who feel like they don't quite know how to navigate those situations with their family members.

Holly: 00:21:15

That's awesome advice. Yeah. I mean, I think all of that rings true in understanding that different people have different capacity for these conversations.

And, you know, I've got people in my life who are always ready, like with a big giant catcher's mitt to just receive all that I might bring to the table.

And God bless them, but also God bless them if they're not, you know, like, I. I know there are certain people who are not going to be able to go there with me. And so you pick and choose to some extent.

You know, I think that that's one thing we have to recognize is that our pain is something that we're living with, but they're not living with it.

And if you were to, for example, experience another adverse experience, something adverse like the loss of a job, those might be the very same people in your life who would be immediately ready to brainstorm with you and, you know, hey, let's get you back out there on the job market.

But they might not be the best equipped to handle the loss emotionally that you feel, how it's maybe hit your pride, how it's hit, how it's hurt your heart to. To find yourself in having lost that job. So.

Megan: 00:22:26

Yeah, and I also think a good point that you just brought up is sometimes you're not ready to hear solutions either. You're ready to vent, you're ready to commiserate, you're ready to receive empathy. And sometimes when somebody jumps into solution Mode.

It can feel very dismissive, frustrating, all the things.

Holly: 00:22:50

So true. Yeah, I think that's a really good thing to practice is to let someone know where you want the, the angle that you want the conversation to take on.

I have a girlfriend I have lunch with regularly who is wonderfully supportive about all aspects of life, but I sort of need to let her know what category of communication I'm in today. So she asks about my shoulder. I might mention some progress that I'm making physiologically. Hey, I was just able to do something in my qigong class.

I reached my lower back and I couldn't do that. That's one possibility.

But if I am feeling, if I'm having big feelings about my pain, I need to start with that with her and say, well, could I share with you a little bit about just where kind of my, my head has been? So I think you invite people into those conversations and then you watch and you observe.

Just like with any friendship or relationship or connection, you kind of, we're great at, hopefully great at reading each other's body language, tone of voice, et cetera.

I would say that it's not going to serve you as the pain sufferer to force those conversations on the people who can't go there with you because you're not going to get the response you want.

Megan: 00:24:12

Absolutely, yeah.

And if you're feeling like you have to convince someone or you have to get them to understand, you know, that's going to tend to be more draining than not.

And so, you know, like you say pick and choose, those people pick and choose the days that you have the bandwidth for that and you know, decide accordingly.

Holly: 00:24:40

Yeah, yeah, that's good advice. And you also said something too about support groups.

And I just want to give a kind of a plus one, a yes to that in that that's a wonderful place to also ask these kinds of questions.

So not only are you going to meet like minded people, but you would have a clinician, someone who's helping to mediate or mentor the group, who might be able to help you prepare a little bit of dialogue, a little, a little preamble that you might want to and, or your compatriots in that support group may say, ah, I had to do this with my teenage daughter who just, you know, would never stop for longer than 30 seconds to listen to mom or, or, you know, I had an orthopedist who was just incredibly, you know, ones and zeros, you know, very just black and white on things.

And I needed to open up that so I think you'd find a lot of really great, not just empathy, but really good direction from people who've been down this road.

Megan: 00:25:40

Absolutely. That's a great point.

Holly: 00:25:43

Okay, cool. I'm going to flip the script a little bit with this next question that really intrigued me. It's around age.

Now, earlier in the season, we talked a bit about how age, particularly around hormone fluctuations in women, could impact the pain experience. This listener identifies as they are in their late 60s, and they said that they have had an increasing experience with pain.

More things are, are starting to, you know, kind of as they described it. I feel like I'm turning into Humpty Dumpty as I age. And they're wondering if there comes a point in the aging process when pain becomes inevitable.

Is pain part of getting older? Or are they saying, should I not take this lying down even though I'm almost 70? Should I be, you know, expecting to recover?

Should I be going for broke in physical therapy? And they used a phrase that I really appreciate, which is. Or is it simply time for radical acceptance?

Megan: 00:26:50

Ooh, okay. Yeah, great question. I love that.

And I am oftentimes asked by patients, oh, this is probably just age or told, you know, it's probably because I'm getting older. And one of my favorite things to say to people is, you know, isn't your right knee the same age as your left knee? Right, yeah, yeah.

And, you know, so some things, yes, certainly we can blame on aging. We're all decaying, for lack of a better term, we're all breaking down. But the good news is we have a lot of control over how quickly we break down.

And so if I stay strong, I stay mobile, I am going to break down a lot slower than someone who is weaker, heavier, meaning overweight, and less mobile. And so, you know, the research shows us that most of our joints have an eight decade expiration date on them. That's on average.

So you get to 80, you probably need a knee replacement, you might need a hip replacement or two.

The great news is those surgeries have come a long way and they are much less invasive, much more successful, and require a lot less physical therapy. That being said, you know, again, it goes back to, what do you hope to get out of your life? Are you someone that wants to.

For example, we went to the San Diego Zoo last year for my daughter's birthday. My mother in law is a very young 60 year old. She walked the entire zoo with us. She had no complaints.

My father in law, who is younger than she is, but very heavy not an exerciser, had to sit down and didn't get to see half of the zoo with us. So, you know, age there really doesn't tell you the whole picture. And age never tells you the whole picture.

And I think also, you know, if the trend line just showed kind of a trend of as I age I have more pain, then you could say, yeah, these things are to be expected. But the highest prevalence of pain. Can you guess when that is or the age group that has the most pain?

Holly: 00:29:37

Well, I'm going to throw out perimenopausal women.

Megan: 00:29:41

Yeah. I mean, for women, of course, we're, we're more likely to experience chronic pain than men. And high levels of pain tend to happen around midlife.

Uh huh. And then the trend line starts to go back down. And so we know that it's not simply about just aging. Okay.

And even with things like arthritis, it's not simply about the joint breaking down. I've seen people with horrendous joints. In fact, one of my favorite stories was when I saw one of my first in home patients who was 90 years old.

He was the sweetest man. He was like 6 foot 3 or something. He was just lovely.

And I moved his knee and as I was moving, I heard click, click, click, click, click, click, click, click, click, click, click, click, click, click, click, click. I mean, the arthritis was tremendous. It was a swollen joint. It was just unbelievable to look at.

And so I get through the entire eval and he was so sweet. He said, thank you so much, that was lovely. Next time are you going to work on the knee that hurts?

Holly: 00:30:47

Stop it. What?

Megan: 00:30:50

I did not.

Holly: 00:30:51

That wasn't the bad knee.

Megan: 00:30:53

That wasn't the bad knee. I spent an entire hour, you know, I looked at the other side for a comparison and that knee was moving beautifully.

Holly: 00:31:05

Oh my God, I love how sweet he was that he was just like letting you hang out on the good knee. He's just like, probably just so delighted to meet you, Dr. Megan. He's like, she can touch me anywhere.

Megan: 00:31:17

He's the sweetest man. Yes. And he loved, he was very in touch with his Irish heritage.

And so he loved that I was a redhead and he invited me to an Irish pub for St Patrick's Day. They always went and got a beer and unfortunately I never got to make it.

But yeah, just that that's always a reminder that I have in my mind that it's not always about age, it's not always about degeneration. I mean, that's pretty much all that we're talking about in this podcast. Right.

Is if it were just about age, then it would just be a straight line from birth to death. Right. You know, you wouldn't see kids in pain. And there are kids who've had 11 surgeries by the time they're nine years old.

So age isn't the whole picture. And if it were me, yes, I would fight like hell.

Radical acceptance is fantastic and important and sometimes necessary, but I think if I haven't tried the options that are available to me, which when you're thinking about the biopsychosocial model, the options abound. Really, you have so many more treatment options than if you're just thinking about biology.

If I have exhausted all those, then I might focus on some radical acceptance.

Holly: 00:32:48

Yeah, that makes a lot of sense.

And, and maybe I would even suggest if you do reach that end of your rope and you're considering radical acceptance, do me just one quick favor or do yourself one favor, which is to read "You can heal your life" by Louise Hay and just see if you're, if you're ready to just throw in the towel anyway and say, because, by the way, I've been there. I, I had years of. We maxed out on the surgeries that could do anything. And what I needed was a shoulder replacement, but I was still too young.

They did not want to do a total shoulder replacement in someone who was under the age of 40. And I, the reason is because at the time, the prostheses only were supposed to last 10, 12 years. If you have it at age 40, you're broken up.

By age 50, you're getting it re replaced. And the rate of success for a re replacement is not awesome. And by the way, you're 50 at that point, God willing, you've still got another, you know.

Megan: 00:33:50

Right.

Holly: 00:33:51

Yeah. So. But I think that one thing that I just totally lost my train of thought there. As is as tends to happen.

But the idea being that if you do find yourself at time, at times just being in kind of no man's land or no, no woman's land, you know, for a little while where it's like, I, I think I have kind of reached the most I can do here for my back or for my pain, that doesn't mean that it's time to stop being kind to yourself about it. It doesn't mean that it's time to stop talking to the people around you about it.

You may come to a point where you say, I, you know, radical acceptance is the stage I'm at right now, but that doesn't mean that you tuck it under the rug and don't think about it anymore. You, you might want to journal about it. You might want to read a book like Louise Hay's book.

You might want to still be part support group that you check in with every six weeks. Because in my experience, if you ignore it, it will come back to haunt you. The pain will have.

Will find a way to say, you know, you thought status quo was going to be cool, but I don't.

Megan: 00:35:01

Yeah. Yeah. And I think actually it would be a really great idea to have a book list or a reading list.

You know, maybe Louise Hay doesn't appeal to you, so maybe somebody like Bessel van der Kolk appeals to you or Alan Gordon or John Sarno or some of these other people who are thinking about things in a non, necessarily, non just biological way. That can be your seed. I tell my students, you know, we're planting seeds. We're not growing crops here. We're not harvesting, we're planting seeds.

You know, maybe there's a seed that gets planted in you, and you, 15 years later, you take a look at that book and you say, huh, maybe there's more to this than I had originally thought. And I'm ready to start unpacking some of that or digging deeper.

Holly: 00:35:52

That's awesome that you just rattled off some of the. First of all, I should probably read all of that.

And second, we should make sure that we put that on our website so that listeners, if you are curious about some of the authors that Megan mentioned, we'll as soon as we can get those links up on the page. So you can check that out.

Megan: 00:36:15

I wrote it down. So I'm gonna lose this post it note and then forget about it. But no, I'm getting.

Holly: 00:36:20

I'll remind you, I promise. Or our producer, Karen remind us.

Megan: 00:36:24

Yes. Thank you.

Holly: 00:36:26

Okay. Another nice segue into my fifth and final question. This by no means is an exhaustive list of all the questions we've received.

So please do keep sending in your questions. We do want to address them. And like I said, we'll be back for season two, so we'll make sure that, you know, your, your questions feature in that.

But this was from a listener who had said that they themselves are ready to start taking on the two other legs of the stool. Right.

That they're, they're kind of thinking about maybe there's a little bit of work that I want to do here on how this is affecting me psychologically, on maybe the definition that I have of Pain. They mentioned something about a family history. They're wondering what is the, the phrase they used was low hanging fruit.

What is the low hanging fruit that I can pursue in terms of starting to unpack the non biological sides of my pain. So like for example, do you think they should get an emotional support animal? I mean, is it time to go get a shih tzu people? Probably.

The answer is always yes.

Megan: 00:37:33

There's never a bad time to get a shih tzu in my opinion.

Holly: 00:37:37

I mean there's so many interesting modalities and we barely, we, we haven't even scratched the surface on all of them that we want to talk about, which is next season. What, where do you think they should start? What are a couple like what's the low hanging fruit?

Megan: 00:37:50

I think a great low hanging fruit would be to bring some awareness to when you are experiencing your flares. So common for people to say to me there's no pattern to these symptoms. There's no rhyme or reason to used to be less frequent.

It's gotten more and more frequent. I can't quite figure out what are the things that are contributing to this.

And that's true for most of us because again, a lot of that lives in our subconscious.

And so I really encourage people and this would be a really cool thing to take to a practitioner to document, write down when I had a flare, what was I thinking about, what was I doing physically, who was around me, what had just happened, you know, any and all of those things. So we can start to get some contextual cues that might give us more information about some of the associations that your nervous system has made.

For example, you know, the sound of someone's voice or I can tell when someone's voice changes and starts to get a little more aggressive, that I feel my body tense up and I feel a little nerve zinger from that or when I know that I have to be around XYZ person. We just got the invite to so and so's wedding and you know, I realized I know who's going to be there, so on and so forth.

So you know, and these aren't always like these perfect little. I saw this and then I felt it, you know, and that's partly why it's a great idea to start somewhere.

Start anywhere and keep a notebook with you or keep a notepad with you and just kind of take note of, you know, I was feeling it in the grocery store or I was feeling it as I was getting ready for my morning. And then you can start to potentially See patterns or when you bring it to someone, they might be able to start to discern some patterns.

An interesting story happened recently with someone I saw who actually himself is a talk therapist, who we are great at pattern recognition with others. And talk therapists, of course, are great at pattern recognition with their clients. We don't always use those same skills on ourselves.

And he had been skiing and had a flare of his low back pain, and it's just not resolving.

He's a very avid exerciser, you know, can typically, like, stretch his way out of things and foam roll and get back to baseline, but this time it just was not happening. And he talked about the fact that he had, you know, a long history of low back pain throughout his life. He was very tall.

He had some knee issues as a kid. And I said, oh, okay, well, you know, you mentioned that you've had a long history. I wonder when do you remember this back pain starting?

And he said, oh, it started in adolescence, actually. I had an injury when I was skiing.

And the next thing I remember, I woke up and ski patrol was loading me onto gurney and they were taking me down the mountain. And I said, oh, that's interesting that, you know, this most recent flare happened with skiing and that's how things all began.

And he said, gosh, I didn't even think of that.

You know, okay, yeah, but I'm sure, you know, had he written that down, potentially that might have been like a light bulb moment or other things are like, anytime I notice that I'm feeling like a loss of control in my life, or when I feel angry or if I feel afraid, I notice my pain flares. All of those are, like, tremendously helpful bits of information that you can use to help yourself and also your practitioner can use to help you.

Holly: 00:42:11

That's awesome advice.

And I agree that it can seem that things are unrelated until you jot down just a quick note, even if it's two words, where you put Lake Tahoe and you know what that means, and you come back and you've got your next flare up, and you look back at that note and you're like, son of a gun. That's so interesting. We're headed to the altitude again.

Like, you know, maybe it's not necessarily the altitude is hitting me physically, but maybe I have a core memory around, you know, feeling vulnerable. Or maybe I originally got hurt when I needed oxygen. I don't know what it is. We don't know what it's going to be. But that's the point.

Megan: 00:42:55

Writing it down Absolutely. And your nervous system might say, oh, you know, I have a sense of less oxygen and that. I know what that means.

I need to go into protect mode and sound the alarm.

Holly: 00:43:07

Totally. Yes. Bingo. Ding, ding, ding. Yeah. So it's. Let's just assume or agree that our brain is not likely to keep.

I mean, if, if a, if a therapist, if a professional psychologist who knows to do pattern recognition with their own patients, if they're, you know, if they themselves are not always the best, we, we can't identify our own patterns. If that's the case, then just, just trust yourself to jot down the notes and a pattern may in fact emerge. I think that's great advice, Megan.

Megan: 00:43:37

I like that a lot.

Holly: 00:43:39

Yeah. And it might even help you make some changes in how you approach things. I realized that I was always having flare ups on business trips.

It doesn't take a genius to unpack some of the things that may be going on during a business trip. High stakes, high stress, jet lag, being on, you know, always on later nights than normal.

o', clock, you're in bed at: 12:30

Good.

Megan: 00:44:22

Yeah.

I think it's a great place to start and I would love to hear, you know, from this listener how it worked for them if they gave it a try and, or, you know, if they want to go for a higher piece of fruit next.

Holly: 00:44:34

Exactly.

Megan: 00:44:34

Maybe next season.

Holly: 00:44:36

Yeah. So Reno, Nevada, that answer was for you. And we'd love to know how you're progressing.

Megan: 00:44:42

Yes.

Holly: 00:44:43

Or what your patterns were. Let us know what the patterns were that you found.

Megan: 00:44:46

Oh, there you go.

Holly: 00:44:48

So cool. Well, you know what? I think this has been a really interesting process of just.

I've enjoyed this lightning round, Dr. Megan, because you've been doing all the work for the last 43 minutes and all I had to do is just fire some questions. So thank you for taking all that on.

Megan: 00:45:05

Oh, definitely. Yeah. I do have one question for you before we go, if you're up for it. Okay. Flipping the mic. I like this. Yes.

So I would love to know what, if anything, surprised you this season or maybe what surprised you the most this season that, that you hadn't known before.

Holly: 00:45:24

Oh, my goodness. Wow. I, I have learned so much this season and you know, I know it sounds like a cop out because it's one of the big things that's like a.

A big, giant takeaway. And it's not really a such a nuance thing is the biopsychosocial model.

The reason that that has stuck with me, and it's almost like I want to get that tattoo, is that I felt the most validated when you described that to me. It felt like, yes, it's not just me trying to convince someone else that there's more to this than just an X ray or what my biology is.

Is saying or not saying. The fact that there's phraseology around it. Right.

That there's kind of mnemonic around by Siso or by biopsychosocial, to me was about, yes, I'm fascinated to understand and dig into all three legs of the stool now and how they interact and work with each other.

But on a bigger, more macro level, again, I just felt like the fact that within the medical and the practitioner community, that this is an actually an acknowledged thing now and there's a phrase around it, to me was a really big revelation.

So that actually kind of surprised me, back from when you and I first started talking is I was like, I feel like there's just more to it than psychology. And, you know, I just. I don't know what you would call that. And you're like, it's called the biopsychosocial model.

Megan: 00:46:54

It's my new favorite. It's my new tattoo. No, I'm kidding.

Holly: 00:46:58

Exactly. You're like, look at my neck.

Megan: 00:47:00

Yeah. Yeah. I think that's awesome. It can be so validating for people to hear you're not crazy. It's not all in your head.

All of these things are connected, as you suspected. And. Oh, that's a nice rhyme. And. And it's a solvable problem. Those are, like, some of my favorite things to say to people.

And then one of my favorite things to hear from someone is I feel seen when you say things like that to me, I feel like you get it, or I feel like you understand because it is so hard with things that are not visible. Right. That are not swollen or red or gushing blood for, like, you say spouses or just general public to.

To understand if they haven't been through it themselves. And even sometimes for practitioners as well.

Holly: 00:47:58

Yeah, no, I agree. I think it's giving us, you know, a whole new kind of lease on. On life. You know, in this.

In this conversation, I think attached to that is the other thing that Surprised me and delighted me. Was around what, what you were teaching Dr. Megan with regard to the threat detection system. So I could never really name that.

I just felt like maybe I had a heightened system, but I sort of blamed that on my being a hyper or sort of, you know, high octane person anyway.

And I didn't realize that actually this is something that is likely going on physiologically in everybody's body that alive if we didn't have it, you know, or we might, but we wouldn't function if we didn't have a threat detection system. Right.

And yeah, yeah, that when there's a flare up that's maybe inexplicable due to physiological factors that we need to start considering the fact that our system is receiving a threat, it's detecting a threat, maybe for other reasons. And those reasons don't invalidate your physical pain. Your physical pain is. Your physical pain. Dang. It is real.

It is as real as this pink llama, this purple llama that I.

Megan: 00:49:20

Real. Yes, exactly. Gorgeous llama.

Holly: 00:49:23

Yeah, look at that llama. But yeah, that, that, you know, that gives us a whole new set of, of clues or footsteps to kind of follow.

It's like, wow, what's threat detection to something? It's, it's going off, the alarm's going off. Why dig into that?

Megan: 00:49:45

Yeah.

And I think too, like you say, you know, that the listener who had the question about should I, should I practice radical acceptance or should I dig deeper?

You know, I think a lot of times when people have tried all of the physical modalities, I've done acu, I've done pt, I've done Cairo, I've done massage, I've done exercise. They say, well, this is the end, and I say nay, because. And that's another kind of hope, life affirming piece of the puzzle, I hope for people.

Let me say that again, that's another kind of potential avenue that can create a line of hope to say, actually there are tremendous amounts of treatment options that might be helpful for this. And yes, you've explored, expanded or explored so much of the physical options, but that's, that is only one leg of the stool.

And so you have these other legs that you can really start to open up and explore and see how that affects your physical experience.

Holly: 00:50:52

That is so hopeful. And boy, there's a lot out there. I mean, color therapy is even part. I mean, it's, it's, you name it, it's out there. Equine therapy, music therapy?

Yeah, absolutely, yes. In fact, that is, I feel Like, I. If today we had a bingo card, a big one on my bingo card, big word would be segue.

And I gotta hit it again because I feel like you just beautifully created a segue into what I wanted to prompt, which is what we're looking forward to in next season. So Dr. Megan and I are going on hiatus, and we've both got some projects in the mix. She's heavily focused on some research.

And so we just, you know, we. We gotta get, you know, our house in order.

We're gonna make sure that we have a great lineup of new content for you, and that's gonna take us a little bit of time. So we'll be back with you in a couple of months.

And I'd love Dr. Megan if you'd be open to just kind of throwing a couple of those season concepts out there. Some things we've talked about wanting to cover when we see a season year for season two.

Megan: 00:52:01

Yes, absolutely. So we have an episode that we're going to dedicate to nature and pain. I think we'll also talk a little bit about.

We're going to have some guests come on and some special guests, some pain researchers, some people who have experienced pain, some people who are working in the pain world currently. And I can't think of anything else. Can you think of.

Holly: 00:52:38

Yeah, yes, to all of that and looking at some of these modalities for you, you know, you might say, okay, you didn't. You weren't serious about color therapy. We might say, oh, yes, we were.

And actually, so we want to do a bit of a round robin with you all on some of the tools and modalities that are out there that you may hear about. But wonder, what in the world is emdr? What is tapping? Hey, how about acupuncture? Never tried that. What can I expect to get out of that?

In fact, I think one of our guests is going to be speaking specifically to that.

But as Megan said, whether it's taking advantage of what nature has to offer or, you know, some of these other tools and practices that are out there, we just want to take you on a journey next season around all the things that you could be exploring. And also, we want to continue to hear from you if you have a show idea for season two.

Please reach out to us and let us know what you'd like us to cover, because we're still in the process of mapping out that whole plan. We've got about half of it baked, which means the other half is open season. So hit us with some ideas. As we continue to build on our own.

Megan: 00:53:55

Yes, absolutely. And questions. We love questions. Maybe we'll have a full episode of Questions like this year or like this season as well.

Holly: 00:54:04

Yeah.

And we might even invite you, some of our listeners, who, if you are interested, drop us a video of your question because then we can kind of get a sense for the fact that you might enjoy being part of a. Of an actual conversation, part of a dialogue.

And we'd love to have you on so we could even feature a bunch of your questions that the world is our oyster friends.

Megan: 00:54:28

Yes, we are looking forward to seeing all of you back in season two.

Holly: 00:54:33

Yes, we are. So special thanks to Dr. Megan and to our producer Karen and her team for a really awesome inaugural season.

When we started out, guys, we didn't know if just three people were going to listen to the podcast. And guess what?

That was actually okay with us because the whole point was if even one person or two people got anything out of this, then it was worth it.

We've done our jobs and in fact, yeah, like I said, we're, you know, we're in like more than 20 countries now and, and growing quickly, which just means that more people are being seen, feeling heard, that community is forming. And we're really excited about what that bodes for the future. So thank you to all of you.

Megan: 00:55:20

Yes, thank you so much. And we hope you'll stick around for the next season.

Holly: 00:55:26

Thanks, everybody. Take good care of yourselves and each other.

Outro: 00:55:33

Thank you so much for listening to this episode. We appreciate your tuning in and being part of the Unpacking Pain experience.

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You can get in touch at unpackingpain@gmail.com and we'd love to hear your thoughts or questions, your stories, even topics that you'd like us to cover in a future episode. Together, we're all fostering community as we shed light on the realities of living with chronic pain and discover new ways forward.