Unpacking: Pain

Holly: 00:00:00

Doctor Megan, if you don't mind, I actually have a really dumb question.

I want to start this whole thing off with the most basic question you've probably ever heard, and that is, why do we even have to have pain in the first place? Why do we have to hurt?

Intro: 00:00:17

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. Welcome to the inaugural episode of the Unpacking Pain podcast. We're really glad that you're here. Hi, Megan.

Megan: 00:00:59

Hi.Happy to be here.

Holly: 00:01:00

Yeah, it's so exciting. This is really day one for us, and it's day one of a new community that we're building.

And we're really thrilled that we have you here.

You, our listeners, those of us who are interested in chronic pain, either because you're living with it or because you are practicing some, you know, realm of, of supporting people who are in chronic pain. And either way, we welcome you and we're really, really glad you're here.

Megan: 00:01:30

Absolutely welcome.

Holly: 00:01:32

You know, I think what we want to do today is actually just in this first episode, define a few things and just level set, kind of get our sea legs, get our bearings, and then tell you a bit about what you can expect in the season of episodes to come. So, Dr. Megan, if you don't mind, I actually have a really dumb question.

I want to start this whole thing off with the most basic question you've probably ever heard, and that is, why do we even have to have pain in the first place? Why do we have to hurt? Please help us understand.

Megan: 00:02:04

Absolutely. And I'll start by saying that's not a stupid question.

And it's a question that I think a lot of people want to ask but maybe hesitate to because they think, well, I can't really ask that, can I? If we think back to the purpose of pain, we know that pain is necessary for our survival.

And we know this because pain is one of our body's warning signs. So it's a way that our body says to us, hey, I'd like a little attention over here.

Either you have a laceration and you're bleeding, or there's an infection and it's red and that's causing pain. Either way, you need to have some kind of attention to that area so that you can take care of it, so that you can survive.

And the problem in our Western society is that because we've lived in the biomedical model for so long, we tend to associate pain with damage. So most of us, when we have a pain, we think something is wrong.

The more recent research that's come out tells us that really pain is not a damage detector. It's a warning sign. It's our body's way of alerting us to something that needs attention. Not always damage.

Holly: 00:03:26

Okay, so this is really meant to protect us. It's meant. I mean, I guess I'm thinking back to know I was certainly not a. A student of science, was not. Not gifted in that half of the brain.

But I do remember from a really basic biology class that I took at UCLA that it was about, you know, baby touching, you know, a hot stove.

And that were it not for that pain, that baby or that part, any one of us would leave our hand on that hot stove dove long enough to do some very serious damage if we didn't feel a searing pain and pull away immediately. Absolutely. And then we were studying the poor leper societies, the leper colonies, and these. These people who could feel no pain and.

Well, what's wrong with that?

Well, the fact is that, you know, if you're out doing something and you dislocate your shoulder from pulling too hard on something and you don't feel that, you might just kind of. You know, that's probably a bad example because I think pretty quickly you'd see your arm was hanging at an odd angle. But you get my point.

Like, we need that signal to kind of fire at us.

Megan: 00:04:37

Yeah, absolutely. And there are.

There have been cases throughout history, it's quite rare that someone is not born with an area of their brain that processes pain or it's not connected to an area that gets to a conscious level of awareness. And these people tend not to live very long. They'll either get a cut, bleed, or get an infection.

Or because they haven't had that warning of previous pain experiences throughout their life.

You know, maybe their friend dares them to jump off a building and they do it because they've never had the warning signal of a bruise or a broken bone to let them know that this is not a safe situation.

Holly: 00:05:20

Does our perception of pain is. I have more basic definition questions to ask you. But I gotta ask this one thing really quickly while I'm thinking of it.

Do we start learning and sensing and anticipating pain more as we get older?

Because quick, silly example is that when I started to learn how to snow ski, I think I was like four and a half or five years old and basically just looked like this starfish, you know, kind of puffy in my, you know, ski gear, going down the mountain with no poles, and I could take a header and roll and basically end up with a yard sale of, like, items everywhere on the hill.

Megan: 00:05:55

Yeah.

Holly: 00:05:56

And just jump right back up.

And as I got older, I became more and more fearful as a skier and reached the point of being in my 30s, where I was like, I don't even know if I'm going to do this anymore.

So is that natural and normal that we actually start perceiving and then learning and then almost anticipating, like, it wasn't that I touched the hot stove and I'll never do it again. It's that now I learned I'm never going to touch the hot stove.

Megan: 00:06:21

Stove.

Holly: 00:06:22

I ain't gonna go there.

Megan: 00:06:23

Yes, to an extent. So the first piece of that is absolutely pain is a learned response.

And that's hard for some people to take in, because, you know, if you're telling me I've learned pain, are you telling me that I'm exaggerating the response or that I'm choosing to have a certain type of response? And really, that's not true. When I say that pain is a learned response, I mean assert. Associatively learned.

And a lot of us remember Pavlov and the dog and the bell. That's what I mean by associative learning. So for those that aren't familiar, Pavlov tested dogs.

He put a saliva detector in their mouths and fed them. And every time he fed them, he found that they started to salivate. And so then he paired the food with a bell.

And so then at some point, every time they heard the bell, they would start to salivate because they associated the bell with food. Food. And so, yes, we learn about pain throughout the course of our lives, and it's an associative learning.

So no one said to you, hey, don't fall down this hill again, because you might tear your acl. You probably witnessed some people tearing their acl. You might have even had some hard falls yourself.

And so then over time, you learn to be a little bit more careful and a little bit more protective, because probably every time you get up from those falls, it's a little bit tougher, Right? Every time you get up, you go, oh, I just, you know, sidestepped that landmine. I didn't turn my ACL that time.

But you know, thank goodness, that kind of thing. And so the other piece of that is we are born with fears. We're born with two fears. Research thinks. So can you think of what those two fears are?

Holly: 00:08:14

Okay, hunger.

Megan: 00:08:18

That would be a good one. That would keep us alive. Right. But, yeah, we are born with the fear of loud noises. Okay. And the fear of falling.

Those are the two that they've been able to identify in a baby.

Holly: 00:08:31

A baby is scared of falling.

Megan: 00:08:33

Yeah. So there's actually a test where you sort of, like, dip them back quickly and they lay. And one way, kind of a cruel.

Holly: 00:08:41

It's like, watch this baby freak out.

Megan: 00:08:44

That's not nice. But it is a necessary test.

Holly: 00:08:47

Yeah.

Megan: 00:08:48

And then the fear of loud noises. So everything else we learn.

And so a lot of people say to me, like, well, I don't remember learning, like, be afraid of snakes or be afraid of spiders, those types of things. And there may be a genetic component to that. So, you know, people who live in certain areas need to be more aware of things like Australia.

There are, you know, everything in Australia is, like, kind of trying to kill you. So. Oh, my God.

Holly: 00:09:20

Scary.

Megan: 00:09:21

Yeah. There are a lot of different types of snakes and a lot of different types of spiders that are deadly.

But a lot of that is learned through our lived experience.

Holly: 00:09:32

Okay, all right, so that's. That's very interesting at the. Learning over time, the lived experience.

I want to go back to one of my other basic questions, and now that I know my first question wasn't dumb, I'm feeling more confident about this one.

Megan: 00:09:44

Go for it.

Holly: 00:09:45

Okay, so there's all different kinds of pain, right? There's sharp pain, and then there's, like, a dull pain, and then there's the kind of pain, you know, from a paper cut versus a muscle tear.

What about chronic pain?

Because that's what we're really here to talk about over the course of this Unpacking Pain podcast is that we're focused on persistent pain, chronic pain. I'm the one who's been living with it. Dr. Megan, you're the expert on it. We're bringing those two things together.

But I don't really know why in the world pain becomes chronic pain or what the difference is. So can we also really cover that?

Megan: 00:10:25

Absolutely.

And the first thing I'll tell you there is that we've been studying pain as long as we've had cognition and could study pain, and we don't really know everything about it yet either. But I'll tell you what we do know. We do know that acute pain is time limited. And so acute pain has to do with tissue damage.

And tissue damage will most often heal in six to eight weeks, weeks, with the exception of bone, which tends to heal in eight to 10 weeks. And so outside of that, we know that the, the pain issue is much less likely to do with tissue damage.

And so for lack of a better way to define it, research has used time to differentiate persistent pain from acute pain. So we say six to eight weeks, 10 weeks on the outset for healing of acute pain.

But if we're going to say, okay, this is now chronic or persistent, we're going to say there's a three month time point on it. And that's in part just to give a clear definitive definition.

Because what happened in some of the early research is that people were defining persistent pain one way and finding a tremendous prevalence, whereas other people who were defining pain differently were saying, oh, we're not even really seeing it at all in our population. But really they were similar, but it was the way that they were defining it.

And so in order to really study something, it does have to have at least a semblance of a definition. And so that's why three months was used. And it's not the best. But for lack of a better option, that's how we define persistent pain.

And persistent pain does not have to do with tissue damage. The problem, in my opinion, happens when we try to use acute pain treatments for persistent pain. Because persistent pain is not about tissue damage.

And if we're searching, searching, searching for this pain producing source, we're very unlikely to find it.

Or if we're looking for a quick fix, which, you know, if you're on Instagram for more than 30 seconds, you will find at least three sales pitches for a quick fix of your carlion.

Holly: 00:12:57

Stir this into your drink once a day. Take these hundred dollar a week caplets.

Megan: 00:13:03

Absolutely. Yeah. Or anything in between.

And really what we know is that that doesn't make sense because it's not about the tissue damage, it's about threat detection. And we're going to get into more of that as we unpack over the next few episodes.

Holly: 00:13:21

Okay. Threat detect. Okay. That's huge. So to kind of put it in like everyday terms, it's the idea that I, let's see, twisted my ankle.

This actually happened in January. I fell off a ladder. Good.

Megan: 00:13:35

But you know what I mean.

Holly: 00:13:36

Sorry, I was just. You're like, oh goody examples, I love it. So I was up on a ladder and I came off the ladder. Like, there's just nothing pretty about it.

I fell off of the top rung of the ladder, twisted and sprained my right ankle. Okay, so let's say that I come and see you, Dr. Megan, at the. Let's say I tried to kind of fix it at home.

You know, I babied it, I iced it, I did some protocols with a band theraband, I don't know, whatever. Now I come into your practice, your physical therapy practice, and I'm at the eight month mark and I say, hi, nice to meet you, Dr. Megan.

I fell off a ladder way back in January. It's now August. I'm making this up.

Do you immediately then have a different set of questions already kind of running through your mind and like, your mind's going to a different place versus if I came into your practice two weeks after spraining my ankle and saying, like, I'm in a heck of a lot of pain, I fell off a ladder two weeks ago versus I fell off a ladder eight months ago, and this is not getting better. So does that kind of send people down two different paths or maybe one path that maybe just has different sort of doors that you open along the way?

Megan: 00:14:52

Yeah, I would say it's more the latter because, you know, as I said, time alone doesn't tell us the whole story. So I would want to know things like, have you been walking on it? Are you able to walk on it? What else is happening physically for you?

You know, are you. Is it still swollen? Did it bruise? Is it unstable?

You know, there are a lot of questions that I have for you, and as a practitioner, I know that you can have chronic pain on day one of an injury, and you can have an acute on chronic exacerbation on day 99 of an injury. Okay.

Holly: 00:15:35

Okay. So that really. That timeline, like you said, was really just about. That's the first strike, right? That's just our first piece of information.

But from there, you gotta really start unpacking. Okay, so it's not just as simple as it's been eight months. So there we go. Okay, that's super helpful. Y. Okay, so is the pain. When.

When it's determined the pain. The. This chronic and persistent pain isn't really about tissue damage, but it's about, you know, maybe threat detection or something.

Something you queued up there, which is super fascinating. Are we still talking about something that's solely physiological or. You had mentioned three parts to something, and I.

That's where I'm really getting curious. Can you. What? Yeah. What all is sort of made up of. What is chronic pain made up of?

Megan: 00:16:18

Sure, yeah. And. And we can talk about this in a couple different ways, but the way that I like to talk about it is the biopsychosocial model.

Holly: 00:16:28

So social.

Megan: 00:16:30

Yeah. Which encompasses the biology.

So the actual tissue damage of you spraining your ankle, so maybe you tore some ligaments on the outside, you had some swelling, you had some bruising, those types of things. And that is true biology. Tissue damage. Then we have things like sleep, which is also part of your biology, your nervous system characteristics.

So how you have dealt with pain in the past deals with your pain threshold, your pain tolerance, those types of things, your genetic makeup. That's all kind of that biology piece. And then we talk about the psychology of it.

So when you sprained your ankle, did you have a lot of catastrophizing? Were you saying, oh, oh, my gosh, this is going to be that all over again. I'm never going to get out of bed again.

My mother told me it's the ankles in our family, and once they go, it's all downhill from there.

You know, obviously that didn't happen to you, but, you know, I hear these types of stories all day long about, like, oh, we have bad backs in our family.

You know, those kind of beliefs, those cognitive beliefs, the fear that you have, the level of acceptance of, you know, this did happen to me, maybe you have some anger about it or stress about, am I going to be able to do my job? You have a history of anxiety or depression. That all plays into the amplification or the dampening down of your pain.

Holly: 00:18:05

Okay.

Megan: 00:18:06

And so sometimes when we tell people that there's a psychological component to pain that's hard to sometimes take in because it has sometimes been used to describe exaggerated pain or.

Holly: 00:18:25

Like, something that's psychosomatic. I'm just really kind of making this up, for lack of a better phrase.

Megan: 00:18:33

Exactly.

But an important thing to remember is that the way that our brain processes pain, all of our pain goes through a part of our brain called our limbic system that processes memory and emotion. So every pain that we've had, we draw back on previous pains that we've had and we say, oh, is this like that? Is this similar to that?

And that's why I say, you know, if you're somebody who has a history of catastrophizing, you've had adverse childhood experiences, you have. And so then we can also talk about the social factors.

So that's the expectations of your society that you live in your past pain experiences, your employment or lack thereof, your living status, the safety of your, your living situation, your health insurance or lack thereof, cultural barriers, language barriers, all of those things play into how much pain am I experiencing now and how likely is this to improve.

Holly: 00:19:39

So we each come into a pain event or pain. You know, I guess I'm using that as like the starter point, whatever it was that started the pain.

And it might be pelvic pain that started with fibroid, you know, uterine fibroid, might be fibromyalgia or chronic migraines. So we're, we're not just talking about, you know, busted ankles or, you know, bad backs here.

It's really anything that turns into a chronic situation.

But when that first appears to us, what you're saying, If I'm right, Dr. Megan, correct me, is that we are really bringing our whole self, our whole self is involved in how we perceive and even react to and handle that pain.

So first my perception of it, and then secondly, kind of the story that I tell myself about that, and then I was fascinating what you were talking about socially.

So then maybe my culture or my living situation or my employment status, any of those things and so much more could actually also then have a role in whether I perceive this to be a bad thing, a big thing, something I want to cry about, something I want to pretend didn't happen and get over.

Megan: 00:20:55

Absolutely, yeah.

And people who have more, you can think of it as a threat bucket or more stressors, tend to have a lower bandwidth for the highs and lows of ankle sprains, bruises, bumps, things like that.

And they're more likely to have what we call a maladaptive pain response or an alert system or a warning system that fires really quickly and really easily as compared to someone who has a more healthy nervous system. We could call it, or more quote, unquote normal. Although I don't love that because there really isn't a normal nerve for sure.

But they might say, you know, oh yeah, I sprained my ankle again. I used to play basketball. It happens all the time. It's two week recovery. I sit and I elevate it and then I get moving again.

And then I do those exercises that I learned in physical therapy those 12 other times I did it, and then I move on. Yeah, yeah.

Holly: 00:21:58

So, yeah, so we're kind of, it's. That's why it's so individualized.

We're sort of primed through all of those factors and influences to have our own flavor and our own journey with pain. And it's. It's interesting, too, how that journey changes over time, because as people will learn as.

injury I experienced back in: 1998

It changed my life. And the thing is that over those years, when I had another injury, like a, you know, skiing.

You know, a tumble on the ski slope, that other injury would stick around for a long time because I was suffering very serious pain that had become chronic by definition at that point. And it wasn't until I started addressing the other leg of the stool that Dr. Megan just introduced. So she was saying, you know, biopsychosocial.

So there was the biology of what was happening to me, and I started to address the social piece of it, like the support system, kind of how I communicated with my family, how I communicated with my boss or my co workers. And then the third piece of it that I finally started dealing with was the psychological piece, which that was the one I was most resistant to.

I was like, no, no. Like Dr. Megan said, that's not a factor here. This is all biological. Can't you see it in the X ray?

But interestingly, when I really started to get my hands around that and started to work on that piece, things started to open up for me in terms of my chronic pain. And so when I did take that fall off the ladder in January, I no longer had that same immediate fear of, oh, God, here we go again.

I've done it again. Humpty Dumpty, he's just got another patch that needs to be stuck back on. So I'm.

I'm really excited about what you're explaining to us from a science perspective, because I think that it's not just knowledge, it's also hope. It's. It's critical for us to be hearing those of us who are suffering and those of us who are treating people.

We need to know that it's not just as simple as looking at an X ray and setting up a protocol and banging our way through it. Absolutely. There's a complex person involved. Right.

Who's got fears and stories and narratives and a grandmother who had this and told them this and, you know, so.

Megan: 00:24:21

Absolutely.

And I think that it can be really challenging as someone who's suffered from pain for a long time to, like you say, not be able to see it on the X ray or they don't see anything on the MRI that can feel very horrible to people who've been suffering for so long. And I always say, great, you know, anytime I'm treating someone and they happen to have an MRI on the.

On the books, and they end up getting it or whatever it is, and they say, same again, came back clean again. I say, fantastic, this is great news. We've ruled out anything insidious, and now we can really get to work. That's a real green light for us.

And so I think as people are listening to this, I do want to give the disclaimer that we're talking about chronic musculoskeletal pain here.

And if you do have a suspicion that there is something else going on, that it's really important that you go to a doctor and have it checked out before you decide, okay, this is a biopsychosocial problem that I'm going to work on with some of the things that we're going to talk about in terms of treatment. Things like breath work, visualization, emdr, tapping, some of these other things that we're going to go through where the research is leading us.

It's really important to know that.

And the second point I want to say there is, that is one of my greatest joys when people either call me or send me an email or come in to see me, and they say, I had another flare of my symptoms and I did what we talked about or I did what I learned here, and I was able to get myself out of this flare in a short period of time. You know, it's. It's not to say. And I didn't have the catastrophizing. I didn't go into the kind of. Like you said, oh, here we go again. Right.

That is like, the best news to me. Like, two things I love to hear when people say, I feel seen, that's like, oh, yes, cup runneth over.

And then the second thing is, I. I did what we practiced, I did what I learned in physical therapy, and I didn't have the big thing that I normally have. And, you know, sometimes they get to the appointment and they're like, but, you know, I just wanted to come and see you.

You know, and you're like, you didn't have to come in.

Holly: 00:26:55

Yeah. I think that's gotta be the most rewarding part of what you do. But I also have to say that your journey is not the average.

I've been through eight surgeries now and about 10 rounds of physical therapy, and I've had some wonderful people along the way, but never had a physical therapist who really is centered on what you're focused on. Dr. Megan. And so I think this is also to say that not all practitioners are created equal. That's okay, you know, that's absolutely fine.

But what Dr. Megan and I are going to be doing this season in, in this podcast in the future is to help you know, that there is an entire reality that you can walk into and start exploring that goes beyond just the black and white imagery in, you know, an MRI or in an X ray or what a doctor tells you. And we, the doctors are critical. We're not at all talking about, you know, separation from that.

This is all about coming together in taking, you know, what you're, what you've learned from your doctor, what the X ray has told you, in addition to then working with someone like Dr. Megan who can help you explore all three legs of that stool and not just feel like, you know, hey, I've been suffering and had never gotten answers before, so let's just go back to the same set of exercises I've been doing all along. So, yeah, we want to be encouraging to you and encouragement to you to know that there is a lot to explore if you're stuck in chronic pain.

Megan: 00:28:35

Absolutely. Yeah.

And part of the problem, at least in physical therapy in this moment, is the fact that we don't have a clinical specialty, specialty for pain in this moment. They've been working on it. They've been working on it for about 11 years, I want to say maybe seven years. I can't remember.

Anyways, it takes a very long time to get a clinical specialty.

Right now we have clinical specialties in physical therapy for things like pediatrics, orthopedics, pelvic health, neuro, cardio, palm, those types of things. But we don't yet have one for pain. And it is in the works. My PhD advisor is one of the people that's on the committee that's working on it.

And it really is necessary. And that will be one way that you can also help find providers near you that have a little bit more knowledge in this area.

If you are somebody that suffers from persistent pain, because it is, it's a different animal than acute pain. And sometimes you need a specialized provider in terms of your physical therapist.

Holly: 00:29:37

Yeah, yeah, you really do. Especially if you have been on a journey like I have where. And a lot of Dr. Megan's patients are, you know, where you've tried six, seven things.

You've tried five, six things.

And you know, like Dr. Megan said, too, a lot of people are hesitant to explore, you know, maybe a social, psychological aspect to what they're going through.

But those of us who have explored that element got there because we hit a wall because we were tired of really going through the same protocols or the same treatment options and finding that we weren't getting too far.

Megan: 00:30:12

Absolutely.

And that's what I preach in my practice and what I teach my students is, you know, a lot of, especially a new grad is maybe a little bit more intimidated by somebody who comes in and says, I've seen six different practitioners and they haven't been able to help me. What are you going to do for.

Holly: 00:30:30

How can.

Megan: 00:30:30

What are you going to do differently? And I say, great, tell me what you did with them, because I'm not going to do that.

We're going to explore different avenues, and that's really helpful for me because we know what didn't work at least. And. And it's not to say that I'm never going to do that.

What I find is that people that get referred to me, we're doing the right things, just not always in the right order. And so if I'm trying to strengthen or move my way out of a very threatened, nervous, I might be doing more harm than good. And.

And it's very likely that I can strengthen and start moving once I've put the fire out. Right.

And so it's not that they were doing it wrong, it's just that maybe they did a little too much too soon or they, you know, there were pieces of the puzzle that were just missing. And so that I find that to be actually really helpful.

Holly: 00:31:28

Yeah, I think we are in the business of trying to be helpful here, and we have very similar goals and inspiration. In that piece that you said, Dr. Megan, if someone says, I feel seen, that is really the biggest thing that we care about here.

And so sort of setting the tone for what you can expect if you tune in and join us along this journey is that first and foremost, we're here to validate where you're at. Right. Like we, we. We get it. Both. That's that Yin Yang of. Dr. Megan studies it, she treats it. I've lived with it.

I've tried all kinds of treatments, and I've had some really amazing breakthroughs in my life, but also some very, very dark moments and some twists and turns along the way.

And together we want you to feel seen, we want you to feel that there is a community out there of people who are like, minded and who are looking to get better along this journey. And some of the things that we're going to be excited to jump into over the course of this season are the psychological aspects of pain.

Things like how chronic pain really can change the brain and change the nervous system and what that can do to give rise to things like increased anxiety or, or even depression and really why that happens and what to do about it. And we also want to dive into things like surgical preparation, visualization.

What are the things that allow you to take on some protocols or some treatments in your life and show up for them ready mentally, and not just mentally, but also in terms of your life and kind of how you've set up your life. We want to talk about the social aspect of things, which also includes gender.

And we're going to at one point talk about the difference in that pain in pain experience between people who are born biologically female and male and what that can end up doing to impact the pain journey.

We want to get into, as Megan said, all kinds of other treatments and modalities like interoception, meditation, mindfulness, breath work, even qigong and tapping. So we have a lot that we are eager to share with you.

Again, all through the lens of we've been there either as a sufferer or a practitioner or sometimes both. Because I know, Dr. Megan, you've not come through life unscathed.

Megan: 00:34:11

None of us have, as far as I know, thus far. Yep. We'll talk more about my pain journey as well. Yeah, I'm really excited for this season and we're really excited to hear from you as listeners.

And if you have thoughts about things you'd like to learn more about or that you'd like to hear more about, we would love to hear from you. And we'll take. We're taking requests.

Holly: 00:34:37

Listen, we just are so grateful that you've tuned in because again, we're here to be of service. We're here to help. We just want to build community so we can't do that without you.

Outro: 00:34:49

Thank you so much for listening to this episode.

We appreciate your tuning in and being part of the Unpacking pain experience. If this episode helped you, please share it with others. Leave us a review or let us know directly.

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. To get together, we're fostering community as we shed light on the realities of living with chronic pain and discover new ways forward.