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The cost & courage of caring - stories that spark resilience.
Speaker 2 (00:00.354)
Welcome to the Caregivers Podcast. I'm your host, Dr. Mark Ropeleski. You can call me Dr. Mark. Today's guest is Dr. Laura Katz, a clinical and health psychologist who sits at the crossroads of chronic GI pain, pelvic pain, endometriosis, and the nervous system. She works with people whose pain has been dismissed, misunderstood, or even minimized. She works with caregivers who are exhausted, not knowing where to turn.
And she works with clinicians who feel trapped inside a system that wasn't really designed for the level of suffering they're seeing in their patients. Chronic pain is no longer a niche issue. It's affecting young people, parents, partners, students, and caregivers everywhere. And Laura's on the front lines of helping people rewire the way the brain processes pain, especially when standard care runs out of answers. Welcome to today's episode.
Speaker 2 (00:51.224)
Welcome back to the Caregivers podcast. I'm your host, Dr. Mark Ropeleski. You can call me Dr. Mark. We're here today for yet another episode. We're grateful to be here and we're grateful that you're here. And most thankfully, we're grateful for our guest, Dr. Laura Katz, who's joining us today, a clinical and health psychologist with broad expertise and you won't want to miss this episode. So let's jump in. Laura, welcome. So happy you're here.
Thanks for having me.
Right. Well, know, you're with people who suffer in pain every day and it's hard pain and it's frightening pain. What was the moment you sort of realized that there's something deeply wrong about how we deal and respond to chronic pain?
think that's such an interesting question because there's so many different moments along the way and I continue to have those moments almost every single day that I'm in practice.
And I think it's just the fact that there's
Speaker 1 (01:51.822)
so many disjointed systems and parts and pieces. And that's really part of the big struggle of what both healthcare practitioners and patients themselves are really having a hard time with is in fact putting all those pieces together. And so I can remember moments everywhere from training to when I started working on this to private practice and trying to put all the teams together and pieces.
working in hospital systems.
Speaker 1 (02:19.072)
And there's so many different moments, and that continues every day.
interesting that you allude back to training. remember when you were doing your PhD and we were all working together in the clinic and seeing patients and there was just a whole broad dynamic interplay and even the teams in the clinics weren't used to the presence of yourself and your colleagues as we were all embarking on these, you know, detailed research projects that really played a role in framing, you know, new approaches and I'm sure many of which you actually apply in your own practice today, but that's what it took.
And to your point, think training from the beginning needs to raise awareness of chronic pain in medicine and in patient care across the board, whether it's psychology or medicine or nursing, so that there's a more holistic approach. So what do you think we kind of misunderstand the most about sort of how pain and then obviously mood and fear shape chronic pain behaviors among patients when they're suffering?
I think that initial question is that patients will come in to see me or someone else and have like 13 different care providers. And so they have someone seeing for maybe their gynecology condition and somebody that they're specifically seeing for widespread pain and somebody for migraines and somebody for GI. And then they also have all these other alternative and health care practitioners. And the reality is, is when you start
it goes back to that.
Speaker 3 (03:23.49)
lot of times.
Speaker 3 (03:31.873)
that they're seeing or
Speaker 1 (03:49.058)
to see it as one underlying condition, one person, one body, one nervous system, all of the pieces and all of the symptoms really start to come together and make sense. And that's when you start to notice big improvements and changes for a lot of these folks who tend to be labeled as treatment resistant.
Obviously integration of the whole patient in front of you, which is such a huge element, keeping it patient centered. But obviously we see a lot of, as you say, this sort of disjointed approach, which results in some element of mishandling of the whole person in front of you. And that obviously carries a huge burden on the patient. What's your feeling for when you have patients coming to meet you for the first time? What's their experience been like?
The experience is incredibly challenging. And so I work with a lot of individuals who have conditions like endometriosis or a lot of gastrointestinal symptoms. Individuals have not necessarily received appropriate diagnosis, assessment, treatment for anywhere for up to a decade. So by the time that they're finally starting to get somewhere, they've experienced so much medical trauma from being dismissed by a provider.
of these individuals have
Speaker 3 (05:06.126)
various providers.
being sent home and saying it's just menstruation or maybe you need to change your diet, have you tried losing weight? And so, you know, what it leads to is somebody who doesn't really trust their body, somebody who doesn't trust the system and is feeling really helpless and hopeless about their whole situation and doesn't know what to do next.
And obviously that carries some burden forward onto individuals involved in relationships with those individuals, with those patients, whether they be their caregivers or whether they be their partners. And I would even imagine even some professionals might approach you and say, how do I deal with these chronic problems? I never learned how I want to do better. I mean, it seems like there's a burden that's kind of spread around numerous areas. So above and beyond the patient burden,
which especially with that lead-in period until someone approaches their symptoms and their condition with a more integrative approach, which is your area of specialty, what do the caregivers and even some clinicians experience? What would have been your encounters with them? And can you shed some light on that?
Yeah, I think it's in-
Speaker 1 (06:18.414)
incredibly challenging for the caregivers and the clinicians as well because, you know, as we know, chronic pain gets so few hours in medical training. And then because of our siloed approach in healthcare system, we tend to, you know, just refer, refer, refer. And there is no holistic, you know, care plan or treatment pathway for a lot of these patients. And so, you know, I find with a lot of the clinicians and physicians that I work with, they really do
few.
Speaker 3 (06:47.79)
Do you want to help?
They just may not know how or where or what, particularly when you have 70 people on your clinic list that day and you're trying to put out a million fires. It's really challenging to fit it all in and how you integrate all of that within your practice. It's really hard.
can be really
Well, the mere fact that, you know, a lot of these require frequent follow-up and sort of building confidence and stages both in the patient practitioner relationship, but also in the patient's relationship with themselves and frequent check-ins. And as you say, the system is not designed for that, nor are time allotments historically available for that sort of holistic approach, which takes time. It's not a prescribed 10-minute visit in a busy, packed list.
unless you've known the patient perhaps for years and years and you've already gotten some headway in the process, or then you can have little touch points. what about, you experienced that caregivers sometimes during the encounter appear very distressed as well?
Speaker 3 (08:01.492)
Yes, think sometimes caregivers may.
be distressed. I don't know if they always appear distressed. And that's part of, you know, the persona of, you know, being the team leader, the medical director, and not knowing what to do or where to go. Not having a team to rely on, particularly if you're a sole practitioner in the community or something like that. It comes across as being dismissive.
and maybe it's broad.
Speaker 1 (08:34.23)
a lot of the patients that I've worked with maybe have been discharged from physicians prematurely or just said, can't help you, I don't know what to do, so what do I do next kind of thing? And so it creates a little bit of a jump between different providers, different systems. And if you were the next physician or clinician getting this referral, you're walking into a patient interaction.
where the patient, sorry, upset, invalidated, dismissed, has a decade of medical trauma. And then before you even open up your mouth or look at their chart, this is what you're walking into. And so I have incredible amounts of empathy for clinicians who are working within these kinds of populations because the system doesn't support and training doesn't necessarily support what to do next.
absolutely. And I'm sure it has an impact on non-professional caregivers, the patient's partners and their loved ones as well. Do you have your patients attend sessions with you alone or do they often come with their partner?
So in my particular practice, do.
see patients alone, but in other places that I've worked, we've often had sessions or different, you know, appointments that partners can come in.
Speaker 3 (10:00.142)
because a lot of times it's really hard to understand.
what it's like to experience a chronic pain condition that you can't see, that you can't visualize, that you can't experience because you don't live in that person's body at what that might be like. And so a lot of times there's some really good videos like Laura Murmosley, know, team the beast that we can give to patients to view with their partners and have them come along to follow up conversations.
because it's a really unique experience. It's not just acute pain, everyone has had an injury, but then as that persists and becomes widespread, very few people will actually know the true impact and how that actually affects your quality of life until you're in that body and in those roles that have been impacted and influenced.
So in your role as a health psychologist, we actually seeing a surge in chronic pain in the population or are we kind of scraping that surface where we're getting better at recognizing its existence and finally acknowledging it in a different way or is there more of it around? Is it more prevalent?
It's such an interesting and complex question. It's probably similar to the whole notion of our rates of autism higher because we're better at assessing and diagnose or we're more sensitive. So nuanced. I think that we do have better systems for detecting
Speaker 3 (11:23.84)
And it's.
Speaker 1 (11:33.482)
seeing, investigating, understanding chronic pain, it is becoming more accepted. And I think it's less taboo. So patients are feeling more comfortable coming in and talking with their doc and going to clinics and appointments. think seeing higher incidence rates also is there's so many different reasons for a variety of systemic issues, but there's so much distress in our society today.
Thanks
Speaker 3 (11:49.922)
think why we might be.
Speaker 1 (12:02.85)
the rates of things like anxiety and depression are just skyrocketing across all echelons of society and our population. And because of that, when your nervous system becomes so sensitized to emotional distress, it's not surprising that acute pain becomes chronic in a lot of different areas.
Well, we certainly see that in GI and we talk often about the brain-gut axis, but I, you know, in reading your work and being more aware of all of the different elements that can be affected, really the brain-body axis. And I'd hope to, I hope we can explore that a little bit further. In a previous interview, you spoke about, and you know, I think back to when my kids were little and how intrigued they were with dinosaurs, but you spoke about the velociraptor brain, which was sort of this.
sort of hypervigilant signaling system, but yet, you know, it may be primordial, but it may not be the solution for how we need to think about pain in 2025. So could you expand on that? And I think, you know, I always like to review it, but I'm sure our listeners also would really like to have a good understanding of where we're seeing this difference between, you the acute injury and then when chronic pain sets in. as you know,
doesn't have to always be triggered by an acute injury, just like chronic pelvic pain is not an acute injury necessarily triggering it nor migraines or other forms of pain. But can we explore a little bit for the audience, like the framework that you operate in when you think about pain and its chronicity and how our body reacts to it?
I always like to take a comprehensive approach. so like we were talking about before, often come with multiple different symptoms, issues, diagnoses, and problems. And I like to operate under the principle of parsimony. So if we can think of what is the underlying thing that might be responsible for these three or four different chronic conditions and plethora of symptoms that are happening.
Speaker 3 (13:45.454)
Like take that
Speaker 3 (13:51.278)
patient.
Speaker 3 (14:06.679)
for
Speaker 3 (14:13.015)
often
And, you know, makes a lot more sense both for, you know, the treatment coaching team, as well as the patient themselves. It's much easier to treat one or two things than to feel so utterly overwhelmed and helpless about the 30 things that they feel like they have to control and be on top of. you know, with that, I like to take that nervous system approach. And, you know, I talk about the same things when I go through psychoeducation, both with patients, as I do
So.
Speaker 3 (14:42.542)
presentations.
Academically and so on because it's the same information and I think it's really important that we don't necessarily talk down to our patients they are as and Competent in their ability to understand the neurobiology of the brain the spinal cord and all of these pain messengers and signals and Why they're exacerbating and what's happening because once they get that?
capable
Speaker 1 (15:10.008)
they're much more likely to be able to adopt coping that's effective and adaptive in their everyday lives.
Absolutely, and it's an interesting conversation. I've even alluded to some experimental models in GI that sort of explain why when you're stressed, can feel that much more for the same stimulus or if you're depressed or if you're anxious or what have you. So what are the two sort of frameworks? I think of a velociraptor as being this sort of hypervigilant sort of...
communication pathway and is there another pathway that we need to tap into like a more mellow relative of the Velociraptor just sort of grazing on herbs in the background or?
Yeah
Absolutely, and I think it goes back to, love the analogy, and I always use this with my patient, the flipping the lid. And so when we think about our window of tolerance and what we're able to actually handle day to day, a pretty regular window of tolerance, can think, we can plan, we can organize, we can control our impulses, and that's the state that
Speaker 3 (16:12.174)
we're in.
Speaker 3 (16:15.8)
We can use our prefrontal cortex.
Speaker 1 (16:24.482)
we really want to be in because we can tolerate experiencing stress and pain and cope with it relatively in a manageable sense. And this is when we're logical and rational and can think things through. Once that gets overloaded, that system and our prefrontal cortex goes offline and we start firing and acting from our amygdala, that's when we enter the velociraptor phase.
I only see that because I have two and five-year-old boys. And so our house sometimes goes from very calm and neat and organized straight into dinosaur mode, when everyone's just acting and reacting and it's chaos. And it's really hard because in your body, it starts to go to that fight or flight mode. And you're not able to think, you're not able to plan, and you're not able to cope. And so...
everything
Speaker 1 (17:17.782)
It's really important for all of us as both clinicians and patients alike are coping to the actual state that our brain and our nervous system is in. So if we're completely in panic mode, if something's going on in the office, or if our patient is coming into an appointment and they're feeling really traumatized and triggered,
to match.
Speaker 3 (17:41.358)
trying to get them to be logical and
and think things through and talk about things like a plan, it's probably not going to happen. And so it's important to take those moments to match the fact that we need to ground, we need to down-regulate and bring our nervous system back to where we can use our prefrontal cortex again. And then we're able to do all those things that we want to do.
And that's pretty tough if you have chronic distress from, you know, whether it's psychological mood disorders or even chronic moral distress, I think has been shown to actually inhibit the prefrontal cortex's ability to upregulate the amygdala. So for our listeners, I think of the amygdala as being that core sort of...
cave person brain that's located deep in the brain and then the prefrontal cortex sort of up around here sends those signals down that just sort of tell it, let's think this through a little bit. Let's look at the big picture. Let's modify our reaction to what's going on and see if we can just take it more calmly. So with that in mind though, when we think about chronic
There must be some myths out there. mean, I know you're on social media and there's a lot out there that's unfiltered, but are there actually myths regarding chronic pain that are doing more harm than good out there? And if you had a choice of some of the key ones out there that you could delete off of social media to just sort of get people away from that sort of thinking and back honed into some of the foundational framework that you use in your practice, like what would those targets be?
Speaker 1 (19:27.768)
think social media is such an incredible but also a very scary and harmful place. And we've all experienced that on some level. And because of that, you find a lot of people who are very highly educated, overqualified, are at the top of developing these gold standard treatment pathways.
And they are not the ones that the general mass public are listening or responding to. And that's the part that's a little bit scary, where you have these influencers on social media who, of course, everyone, I'll give them the benefit of the doubt. They want to connect. They want to support. They don't have ulterior motives. But the rhetoric that they're going into can be quite harmful.
Sometimes.
Speaker 1 (20:26.05)
big notion is the fact that there's no one thing that's going to take it all away. There's no one thing that's going to work for every single person. So as soon as somebody online is telling you, you absolutely have to follow this one diet or try this one supplement or do this one exercise, that's when your spidey senses should kick in and you should acknowledge that you really got to do your research in terms of what's the evidence here.
because a lot of things are just floated online without necessarily having much rigorous evidence or research to back it up and behind it.
I think it's become obvious even managing irritable bowel syndrome, for example, and chronic pain in that scenario is that when patients do improve, it's usually the sum game of three or four interventions that may help 15%, but you add them all up and then you're in that 60 to 75 % benefit range. But if you look at each one in isolation, it's not a massive game changer. But if you're patient enough and you integrate your approach with coaching,
to be able to amass those small winds, suddenly the landscape changes. And I think we're seeing more and more of that. to your point, finding the one, whether it's in love or in treatment, is probably not really how it works. how do you go from there then? Do we need more education, more dedicated online presence to really get the message out? I know you're doing a great job.
Is there sort of among associations and colleges, international organizations, is there more of a global attempt to sort of get some of the more mainstream thinking about chronic pain disseminated?
Speaker 1 (22:22.734)
I think that is absolutely what needs to be done. And 10, 20 years ago, we used to hold academics and publishing and papers to such a high regard. And somewhere over the last little while, with social media and its influences, the public isn't looking to that anymore. I would love to see more.
high quality, skilled clinicians, you know, take just moments and feel more comfortable, you know, talking about what they do and the research and what they're doing online. having a lot of these academic organizations and committees and, you know, all of these conferences that we go to, doing more presence and having more of a presence on social media just for everyday regular people and patients alike. I think that would be
such a huge component of having the dissemination of knowledge that's readily available in pieces that patients can absorb.
think with that dissemination, would sort of break that pattern where, you know, there's more of a comfort level among patients and among listeners that, okay, this is starting to make sense. I think I can handle this. Maybe I can find someone to coach me, although, you know, resources as well as the tests you can sometimes be spread out thin. But my biggest worry is that the chronic pain sort of takes over a patient's identity. And because of that vulnerability,
and can result in sort of years of sort of feeling invisible and feeling disconnected with yourself. What are some of the impressions you get during your patient encounters when you see that happening? Like what are you witnessing in the patient who feels like they're floating like an invisible island in that sort of self-vulnerability that they have and how it shapes their identity?
Speaker 1 (24:25.934)
It's question and I think that, you know, it can often be bimodal in the sense that it takes two approaches where a patient might feel totally alone, invalidated, helpless, hopeless. And, you know, their whole network has gone down, you know, the personal, their treatment network, and they don't know where to go and what to do. And there's also this other
Really good.
Speaker 3 (24:45.71)
kind of let them.
Speaker 1 (24:55.342)
kind of patient that might come forward, that it is a part of every Facebook group and 14 different networks and on every Instagram page. And that's also pretty dangerous because all they're being fed is this identity and nobody's online if they're living their life and doing well. People are online because they're struggling to cope, they're not getting resources and they need that connection. And so the approach would be similar but a little bit different for
you know the
those two populations in the sense that you really have to do an evaluation and assessment with the individual in terms of what matters, what's important to them, what do they value, and what are those characteristics right now, and what ideally would they like them to be. When you start to do that value analysis, you start to notice that ideally,
in their life.
Speaker 1 (25:50.06)
What matters to them is their children, their family, maybe their faith, their occupation, some leisure activities, and what are they doing right now? All of those things are ranked almost nothing. And so you really, once you start to notice that discrepancy, you can start to get patients to do some work and take steps towards how do we adapt your day-to-day life and functioning so you're acting in ways that are more consistent with
the values that make you and your life and your existence meaningful in your everyday life.
I guess it becomes empowering if you can get them engaged to sort of set the first little wins and series of milestones towards each of those categories and sort of build that team approach and that listening approach from the outset, probably something many haven't really experienced before. And it must be refreshing. I think you've certainly done that with your Endometriosis 360 group approach, where you've really integrated a holistic
to managing some of these individuals who've been suffering for years with this condition and feeling potentially unheard or feeling incurable or feeling unself-manageable anymore. Can you tell me a little bit about that program that you've built? And obviously it's very successful and it's growing and I'm really happy to hear that. And...
What's been the key to the success? maybe that's a blueprint for numerous other areas to really flourish in the space.
Speaker 1 (27:29.006)
to share and thank you for those words. A little bit of a backstory on the program. A lot of that work is based on some of the academic work and research I've done in Dr. Dean Tripp's lab there at Queens. And I was actually hired by the McMaster University Hospital at the DeGroote Pain Clinic to start to actually build the work that we did. And so I
So a little
Speaker 3 (27:48.622)
that pelvic pain program from
Speaker 1 (27:56.782)
along with a great team, developed and ran that program for about eight years.
and then I started to think about what might this program look like?
if we were to offer it in the community. And so that was the opportunity where I had the privilege of connecting and working with Dr. Bathier Leonardo and him and myself and some others such as a registered dietician, Emily Arthur and our incredible physiotherapist, Joe Mueller. We all co-founded Endometriosis 360. And I think what makes it so unique and so successful is it's we're a team.
Think makes sense.
Speaker 1 (28:34.496)
It's an interdisciplinary team and every single patient interaction is done in collaboration with each other. And so what's really nice about it is most of the time when patients come through,
And they've
had all of these hundreds of appointments with different disciplines and different, and they bounce from appointment to appointment to appointment. We're the first time they've ever seen three of us in that appointment altogether. And we're able to see them as a whole person, talk about these issues from the three different dynamics. We like to call it, I'm the top down approach. So the psychology, all the cognitive and emotional.
And first.
Speaker 3 (29:10.264)
Thanks.
Speaker 1 (29:15.906)
Jill is the bottom up, she does all the somatic, the functioning, the body, and Emily is the inside out. So what is the fuel and all the stuff you're putting in your body and your relationship with food? And when you're able to tackle such important concepts and see a person literally from top down, bottom up, inside out, they finally feel seen. And that's when you're able to help them get unstaffed.
from certain things that they've been struggling with potentially for decades and get them to start working toward goals and starting to see really big improvements in outcomes.
many sessions does it take for your patient to start feeling that, I've arrived somewhere new, this is a fresh experience, or I actually am starting to feel a little bit empowered?
Session one.
Alright, I like the sound of that.
Speaker 3 (30:08.5)
That's just it. from all of the, so the first time we meet.
patient we meet them for in interdisciplinary assessment. know, what's going on. Is group a good fit for them is, you know, both from our perspective and their perspective is now a good time and work out all of this sort of detail.
And that's to assess who they are and really to talk about their
perspective.
Speaker 3 (30:28.27)
and every single session we have ends being good.
of the patient, it with them quite emotional and tearful about the fact that the ever that they've heard and seen and empowered and validated. And it's so motivating for them because they want to do the treatment. They want to make changes because they really feel that all of the pieces are going to start to come together and going to be able to get somewhere. So session one.
This is the first time maybe.
Speaker 2 (30:58.228)
sounds like it's the first time they're meeting up with thoughtful, elegant design in the more holistic care delivery that's required to manage chronic pain. I can only surmise that the spillover in terms of the impact on those patients, partners in life, perhaps parents, individuals who care for them or even their friends, there's a big relief that sort of extends from the core and that
everybody around them can suddenly start feeling like they can re-contribute. As we've spoken with Dean Tripp previously, some of the catastrophizing and helplessness that arises in chronic pain can paradoxically alienate those same important people in your life, whereby not only do you feel invisible, but at times you start feeling more alone because those relationships have disintegrated around you. But this sounds like a big turning point to me.
Hmm. And if it's. So. And sometimes, you know, within our team, like I'll see people before, during and after for individual sessions, you know, aside from our group.
It's a big turning point. It's a potential.
Speaker 3 (32:06.926)
And we get things like patients on.
almost have a little bit of distress because their identity is no longer their chronic pain. And so they almost don't know how to function in their lives or their roles or their relationships. And so it requires some reimagining and re-envisioning about what do I do next? If all my time and effort and energy isn't spent on that identity and appointment, what would I like to do? And so...
Senna.
Speaker 3 (32:32.846)
Thanks
Speaker 1 (32:36.312)
helping people in terms of their relationships, their intimacy, their children, their careers. And then their treatment teams. So physicians that, after being discharged from our program, they also notice a difference that they're better able to adhere to treatments. They're much more on board with some of the options, especially when you're starting to talk about things like central sensitization and interdisciplinary care.
Also, there
Speaker 1 (33:05.708)
So I think all around it helps outcomes for patients.
I'd love to have you back one day to sort of give the synoptic for a physician audience, whether it's in primary care or even focal areas of specialized care, just sort of like the top 10, if you will, steps or approaches to facilitating engagement while not every patient has access to your program, let alone programs across the nation or in North America, because they're not yet.
fully developed, but certainly you've got a great blueprint there. We could certainly benefit as a community of medical practitioners being updated on this sort of approach to sort of make some early gains along the way. So obviously you're a busy clinical psychologist and know, fellow human, but your journey's taught you a lot up until now. And I'm sure often you find yourself sort of balancing, you know, between
life outside of the clinic and carrying someone else's suffering because it's such a powerful engagement and encounter. How do you find that balance and how do you carry the weight without collapsing?
tough and I think we're all and we all.
Speaker 1 (34:26.062)
human and have our ups and downs. And so I am a clinical psychologist. I'm married. I have a husband who's also a physician. Quite busy. We have two five-year-old boys. So there's a lot of just of day-to-day life and keeping it all together. And I think the same message that we have for our patients in terms of having that robust
for sure.
Speaker 1 (34:54.542)
care team, it applies to us too. Like we also need our village. We also need our community. And we have to know our boundaries and limits and self-care. I could look so differently for every single person. And so that might just mean taking three seconds to ground between patient appointment, be picking up kids 10 minutes late so you could just take a breath and transition. So you go from one role to the other and you're
or maybe
Speaker 1 (35:23.19)
not snappy and you're able to really be present with your family and taking the time that you need to, know, maybe it's just an hour and rather than an hour of just mindless scrolling, taking that hour for something more active in terms of relaxation and purpose that makes you feel like you and that's important to yourself.
probably translates into a lot more happiness. And that art of finding time is certainly probably one of the biggest challenges from the perspective of caregivers or those who look after others no matter in what capacity, professional or non.
You mentioned this sort of eureka moment when patients encounter your group, or I would say any group of individuals who've come together because of a shared goal of trying to help others. What do you think eases the suffering the most? Is it just knowing that there's a fresh vision? Does it translate into rather immediate effects on just
alleviating chronic pain? there like a sudden, just from the encounter, like a 40 % decrease or is it a sense of sort of empowerment? Maybe finally I can do this. Like I've read about these books, but I've never had coaches, but now I've got this team coaching me. Like what is it that pushes just that extra distance that allows people to sort of feel at ease and feeling some of that suffering that's been there for so long start to move back?
That's a great question and we should do that research study.
Speaker 2 (37:01.218)
Alright.
more work. I think, you know, from my perspective, it might be hope.
Mm-hmm.
it's maybe something is in the future that will actually start to make a difference. Hope that there's a care team that is listening, that understands, knows what to do next. So that hope can carry you really far. The exact metric and percentage about how much that alleviates and at what point.
and that
Speaker 1 (37:35.874)
I'm not sure, I don't have the data and the evidence and there's a cool research study, maybe we'll include it in our questionnaire package. But the reality is that hope that translates to self-efficacy. So efficacy that you can make a difference in your life, efficacy that you could start to do things that might actually change your situation. And that is so incredibly powerful.
When you have
Speaker 2 (38:00.364)
I can see the spillover being meant in that once you get that trigger of hope, you suddenly feel a bit of empowerment when it comes to your other relationships and your other roles, be it parenting, be it partnering with your loved one, or even your other responsibilities in everyday life.
For those of us who've only ever experienced acute pain and maybe we're caring for someone in chronic pain or we're just wanting a better understanding of what that feels like inside the body. I mean, maybe this is an overly simplistic way I've tried to imagine it, but like, know, stubbing your toe and instead of that pain receding, you know, in a minute or two, but it just stays and it's consistent. Is that close to what it's like? Can you give us an idea of what it's like for someone?
in chronic pain, what's going on inside their body? I think it's so variable. And so what might feel like chronic pain in one person's body is going to feel totally different in somebody else. And that's part of the challenge in extrapolating and understanding and being able to have empathy for what that's like. And so it might be just that sensation. One of the common themes is it starts to spread.
It's so.
Speaker 3 (39:15.768)
one.
Speaker 1 (39:19.362)
And so maybe it just starts in your toe is like a stabbing, aching or whatever. And it starts to spread up the foot into the calf and radiates into your hip. And the hip then starts to burn. And because you have to change and adapt all of your activities that starts to create a lot of dysfunction and disability and impairments in your everyday life. Because it's not going away and maybe you've been to 14 other practitioners,
And then
Speaker 3 (39:33.163)
And then
Speaker 3 (39:44.174)
and then be.
Speaker 1 (39:49.006)
and it's already been six months, you to get really down on yourself. So you start to think, is this forever? this gonna get better? And is this always gonna be my life? What does this mean for me? And then maybe you start to have a lot of anxiety in terms of, if I sit this way, is this gonna make it worse? What does this mean? Can I go with my kids to a playground? And if I can't, what are they gonna think of me? And then you start to
You start.
Speaker 3 (39:58.089)
time.
Speaker 3 (40:16.792)
Just.
see the whole trickle effect of the fear, the low mood, the avoidance and everything that comes from something. Maybe it just starts in terms of pain in your toe, but then it starts to spread to throughout your body, different characteristics, taking over your mental health, all of your life roles and functioning. And how do you get out of this and where do you intervene? I just have one more follow up to that.
.
Speaker 1 (40:43.18)
This may be a moment that you don't get to because people don't come to you into the later stages of their chronic pain career, as Dr. Tripp calls it, but there must be a moment where people look at their lives and all of these feelings and this is just taking over everything. And they must have this moment where like, holy f**k, this is my life. Like this is my whole life is going to be about this now. When does that sort of occur? And then how do you, as a clinician, sort of
get them out of that thinking and that space? That's a great question. And I think it can hit people at different points for different reasons. And we have to understand that the chronic pain patient doesn't come in just from the point of their injury. They exist and have existed for all of their previous life experiences. And so that will impact
.
Speaker 1 (41:40.258)
you know, what happens in terms of their presentation and how they're coping with things, earlier relationships, what's going on in their life, their psychosocial stressors, early childhood, stuff and trauma. And so when that person comes to see you, you have to acknowledge that whole history, their development and everything else that's going on. And when you start to see them as that whole person, that's when you can really start to make a change in their life and help them take a step forward.
I
Speaker 3 (42:00.718)
and
Speaker 1 (42:09.006)
And chronic pain is and should never be treated individually. Like this is a comp condition that requires an interdisciplinary team approach. That's exactly why, because not one single person, just like, you know, has been mentioned before, can take all of it away. You know, maybe it's 7 % from here and 10 % from there and 20 % from here. And when you add up all those pieces, know, 60 % improvement.
and
Speaker 3 (42:36.514)
there's a secret and that's it.
That's why I'm a huge proponent that in order to treat these complex chronic abdominal and pelvic pain conditions, we really do need community and a team approach.
That's a huge acknowledgement.
At the same time, what's the hardest scenario that you've come across when you're actually trying to help people with chronic pain, where you put all this out on the table, but it's not working? What do patients need to bring to the table also or be prepared to hear if they're going to benefit the most from these interventions? Because there's a two-way engagement that there has to be buy-in. So can you share with us a little bit some of the challenges?
that you come across where you get a sense that, this may not work.
Speaker 1 (43:33.038)
Hmm.
There's so many different.
different factors that go into somebody's readiness and ability to start to engage in treatment. And so, you know, when we talk about readiness for change, we have pre-contemplation, contemplation, action, and maintenance. A lot of the times, the patients that we see that are not engaging, that are treatment-resistant, all of those sorts of factors, there's contemplation phase. And what that means is that they are dead set.
stuck in the pre-
Speaker 1 (44:04.556)
this is a medical condition, there is a diagnosis that has not been found yet, there's going to be one treatment, one medication, one surgery that's gonna take it all away and fix the problem. And so our job is to help them understand that neurobiology of their nervous system and pain and how it works and why it works, because then they might start to inch towards more.
the contemplation action stages of readiness for change, and they might be more able to adapt these kinds of understandings of what their experiences are. And so that's one explanation. think issues that are really challenging. If somebody is financially unstable, if they're in and out of jobs, if they're having trouble securing housing, if they're in relationships that are unsafe,
You know, there's so many systems.
Speaker 1 (45:01.368)
physically, sexually, mentally, emotionally, you know, how are we going to get them to start to adopt this interdisciplinary approach when the reality is that their nervous system is unsafe because their environment is actually unsafe.
And so some of the first
proponents and things that you can do as part of trauma treatment is actually help that person become more stable and safe in their environment and their relationships and their life. And once they're feeling more safe, they're much more likely to be ready to make changes and adopt this interdisciplinary approach.
That's a huge message, I think, to practitioners everywhere and to patients and their advocates in that while access to these more comprehensive programs may not be accessible, taking some of the first high stakes steps towards remedying what's keeping the patient in sort of overdrive in terms of stress and anxiety
because of those same examples like you mentioned would be huge. And that's something any caregiver can advocate for or refer to, whether it's help with substance use disorders or more dedicated focal groups for abuse recovery or other types of activities. So I think that's within reach of all of us, even though, you know,
Speaker 2 (46:34.39)
model systems like yours are not on every street corner. There are things we can do to get the ball rolling to be able to prepare someone for perhaps eventually a more, not only more meaningful, a conversation that has a better likelihood of transitioning from an invisible chronic pain sufferer to someone who feels like they're back in charge of their life and with a new identity that it can actually shape the direction.
Can you share with us a before and after story of a scenario that really stands out to you where someone's relationship with their pain shifted so much that they just had this huge turnaround? Is there anything that sticks out for you?
Speaker 3 (47:25.518)
There's so.
many snippets of different interactions and things that I can share. Maybe I can walk you through what it was like for one patient that came through our Endo360 program. Longstanding issues with multiple chronic pain issues. So endometriosis, fibromyalgia.
you know, get a lot of rumination and the weird and wonderful where there may not be a definitive diagnosis or treatment that can help. And if you look at that person's history, long standing history of things like depression, anxiety, and then as you start to assess and go into their history, you know,
personal symptoms.
Speaker 1 (48:21.9)
of course, a history of something like a sexual assault that may have happened earlier on in their life. Into all these medical appointments, you know, where maybe they felt invalidated or dismissed, medical exams that kind of dissociated and go numb, they're not really paying attention. So it's really hard for them to speak up in all of these appointments.
and they start getting.
Speaker 3 (48:43.662)
And then, you know, get-
They finally in with either a gastroenterologist or a gynecologist that hears them, that sees them, that starts to put all the pieces together and diagnosis them with endometriosis. And they're able to get some treatment, potentially surgery. And then they get forwarded to our endo 360 program. And so within our consultation and assessment,
It's often the first time that they've been surrounded by a team altogether where they feel truly heard and seen and they don't feel helpless about their situation anymore. Start to give some recommendations about different things that might be helpful for them. Ultimately coming to our group program might be a good step. And so throughout the weeks, we talk about everything from, you know, that neurobiology and the science of pain and endo to how to cope and deal with flare ups to pain, sex.
intimacy and how to deal with the nervous system and trauma. so week by week, to see all these changes in terms of putting the pieces together and starting to connect with other women within our group for the first time in a very proactive and helpful way. And by the end of the program, they're not so reliant on a lot of their...
week you start.
Speaker 1 (50:05.76)
medical treatments and they're not hung up on, you know, going to all these appointments and, you know, seeking other third, fourth, fifth opinions. You ask for all these things. You evaluate, who am I? Because for the parents and most of their lives, they've been this chronic pain patient that's totally been present in every interaction in terms of their school, their dating, their future, their career.
possibly going to the end. And they start to have to re-
10 years.
Speaker 1 (50:33.634)
And then they have to truly evaluate what's next for them. And so I think being able to have a patient come all that way and then start to work with them individually and help them develop this sense of identity and talk about existentially what it means to be them as a person and what they value and what's important and help them get into finding careers and relationships that are supportive and safe and help them thrive.
help develop.
Speaker 1 (51:02.678)
It's incredibly a unique experience and I wouldn't change anything about it.
It's as though you're going from an imprisoned state to a state of freedom and it's like you can't quite fathom how you're going to function in that new state of freedom. of course, you it still takes baby steps as you engage with your new environment and your new identity. That's an incredible story.
And to follow up, you just said something that was so important that I wanted to point out, the fact that sometimes feeling safe and
on that. sir. I really want to.
Speaker 1 (51:40.628)
of pain can be as distressing and comfortable as the contrast. And so just because the patient doesn't have symptoms and you know you feel like great
My job is done. Like I helped them. They're no longer experiencing, you know, symptoms or issues anymore.
and exp-
or he still might have distress. so, you know, having that team around them and referral sources to help the patient with next steps can be as important as well.
down.
Speaker 2 (52:13.166)
There's a very famous movie, which I'm sure you know, The Shawshank Redemption, where one's identity upon release became suddenly...
traumatic experience because you had no idea how to function outside once you were used to functioning within the cone of that sphere of identity for so many decades beforehand. the analogy fits quite well in being imprisoned by that identity of chronic pain and how it completely takes over your ways of living day to day. And then suddenly you need to sort of rebuild with exuberance. But at the same time,
distressing and overwhelming in a way as well. If we were to shift to back to caregivers and loved ones who play important roles in patients suffering with chronic pain, can you leave us with a couple of sort of real practical tips how those individuals can just show up and be there for
they care for with chronic pain and suffering.
think it's the same as with any kind of relationship. Just because you don't understand or you may not even be able to empathize or get what that experience is like, just want you to be present with them. We have this natural instinct to fix, to cure, to solve.
Speaker 3 (53:31.246)
because you
Speaker 3 (53:41.134)
A lot of time people...
Speaker 3 (53:50.35)
and a lot of the
with these kinds of conditions and these complex symptoms and presentations, it may not be possible. And so if you have a chronic pain patient that you're caring for both, you know, as a clinician or personally in your life, sometimes the best thing you can do is be present with that person and listen and help them feel heard and validated because that can be so much power.
Just press.
Speaker 1 (54:22.156)
in terms of their next steps and what they do.
As you said, not take on the burden to fix because there's no immediate fix and as someone standing by another, we can't assume that we somehow have that power to take one step and fix it. The same rules apply as we shape our vision as individuals engaged with people we love or care about or professionally taken care of. So if someone listening today in the audience, and we've got a broad listenership, we're very grateful for that.
They remember only one thing about chronic pain. What would you want that to be?
That's a big one. I think.
We try.
Speaker 3 (55:10.19)
It's one thing to remember a
It's a building block to carry their own learning forward. Because I think some listeners today are going to say, hmm, I need to read more. I need to research. I need to think about this a little bit more. What's one catalyst takeaway from today that's really hopefully could turn some people in the right direction?
Speaker 1 (55:34.83)
not feel overwhelmed, shut down, walk away, refer on. I think we have a lot of ability, like we just talked about, to be present with both people personally our lives and professionally as caregivers. And there's so much that you can offer from trying to understand how 30 different symptoms or conditions may be tied to one thing. And so if we help
to not.
Speaker 3 (55:48.6)
in life.
Speaker 1 (56:04.718)
patients understand that central sensitization or nervous system approach and help guide them to potentially care teams or reference resources and referrals. That can be so incredibly helpful and not to feel like you yourself as the individual has to fix the problem.
Are there any good online resources to identify groups who provide services across the province of Ontario where we are, or even across Canada or the US? there repositories or sites where they've got regional resources? Because obviously they're spread by word of mouth, but people need to least know where they can turn. And we all know that funding can be a challenge as well, because a lot of this is
not funded through Medicaid or Medicare or other things, yet it's amazing how valuable a tool this could be in changing people's overall perception of their own health. Yet it's potentially inaccessible, hence the need for as many people to know about it as possible in the different domains of caregiving. are there good resources for the population to turn to to find out what's available for different conditions?
Absolutely. Most academic tertiary hospitals will have a pain clinic. Those pain clinics are super rich and resourceful in terms of the types of information that they can recommend. And so a referral to the pain clinic can always be helpful. And it may not be for interventions or to see an anesthesiologist or a pain medicine doc. It might just be for some of their programming.
for pain management and then education. There's some really neat resources online. I know the TAPME group has something called PainU, which has a bunch of different models that really gets into that pain neuroscience education. It's for the lay person. They've done it really nicely and well, so patients can check out PainU on TAPME.
Speaker 3 (58:19.456)
And then there's online paint management group.
I think they're done by the province. I forget their exact name, but they're eight week pain management groups. you know, all that relatable or adaptable, but the information is solid and you can definitely extrapolate and apply to whatever condition that you're going through. sometimes that's just enough to give you a head start to start to get into or realize where.
Sometimes they're not all.
Speaker 1 (58:48.61)
your next steps might be and what holes you might be getting stuck in.
So we'll try and include some of those resources with the episode links, et cetera, including your own links to your Instagram and to Endo360. We've certainly been on an interesting journey today because we've spoken about the patients and we've spoken about the individuals caring about them and the impact, but also what they can do to help patients and the people they love on their journeys and dealing with chronic pain and hopefully
reawakening towards a new path towards living more wholesomely themselves while acknowledging that some of them in a chronic pain may still be present, but that doesn't need to take over their identity. Some patients have been living with chronic pain for so long that they're not sure if they can just keep going the way they are. What would be your parting message to that?
group who are listening to you, are just at that point where they don't know where to turn or they don't know if they can keep going.
think that's the point that you might want to check out some resources for mental health support. We have the Ontario structured psychotherapy program that offers some free sessions. Your local hospital or helplines might be able to offer you some counseling. And the reality is that there is so much research and support and evidence that when you start
Speaker 1 (01:00:24.856)
to treat the underlying mental health conditions. So things like anxiety, depression, and trauma, it takes a huge weight off of the pain. And they work so bidirectionally in the sense that the more pain you have, the more mental health issues that come up, and the more mental health issues that you might have cause more pain just because of that nervous system approach. And so it's not about taking the pain away.
It's about learning to develop a different relationship with it so it doesn't impact you or distress you in the same way that it is today. And there's lots of resources that can help an individual.
lock that feed forward loop that just keeps feeding it. I was amazed at that notion of how, you you stub your toe and have acute pain and sometime down the line, you may actually have hip pain that's burning as a result of the original toe stub. a type of patient that's more prone to evolving that way from the beginning? is there, are there any biomarkers or psychological markers or tests that predict whether, or is it purely random?
No, there's a huge
huge fields of psychoneuromnology and there's a lot of really cool studies that are going on looking at all of these markers and predictors of how acute turns to chronic pain and so on. What I see clinically definitely is if your nervous system is already on a state of high alerts, hypervigilance, you're much more likely to have a wide
Speaker 1 (01:02:02.062)
spread pain response. That's evolutionary and adaptive, you know, because if you're in this state where you're chronically running from that velociraptor or that bear, it's that if your hip pain, or sorry, if your, if your toe gets stubbed, your whole body has to be hypervigilant to make sure that you can keep running because you're constantly in danger. And so
You know, it makes a lot of sense.
Speaker 1 (01:02:25.422)
there definitely is a lot of different predisposing factors that might contribute to somebody's nervous system being on that high alert, whether that's psychosocial stressors, whether that's relationship, whether that's abuse or trauma, or mental health, or lots of different factors. But essentially, it usually stems from the fact that there's something that's contributing that could even be viral or other conditions that are contributing as well.
But when that nervous system is already in a state of hypervigilance, there's much more likely to be a response that acute turns to chronic pain.
to thank you for joining us today. You've brought so much insight to the discussion. But as I step back and listen and then I think about all the resources that are out there today that we all as individuals could potentially tap into, ones that are validated and I'm starting to see recurring themes and
I really wonder whether or not, you know, it should be incorporated into either high school or college curriculum, but I know it's, been done at the Harvard Business School. It's one of the most popular courses. It's called the Happiness Course. even, I remember correctly, I remember hearing even the Department of Psychology at Queens, I think has a Happiness 101 type of introduction type course that's being offered, but maybe we all need to learn how to check in at certain key milestones in our development.
whether it's in high school or the end of college or university where we just sort of take an inventory, say maybe I gotta let a couple of things go to get me ready for what's in store. And that could have such broad sweeping effects on people's futures and would be valuable learning as valuable as probably a lot of other stuff we learn.
Speaker 2 (01:04:21.816)
in those academic pursuits which may not be as valuable in life, it's certainly starting to resonate.
If not, would be much better off. Like, aren't we in kindergarten and elementary?
Or I think, you know, I talk
Speaker 3 (01:04:36.962)
basic component.
Speaker 3 (01:04:44.142)
We just unders-
feelings.
Speaker 3 (01:04:53.87)
aren't they teaching this?
School.
in high school, in college, we would be.
courses just like you're talking about.
adapted for that age and continuum. Yeah, I agree. Totally. I think it could empower our world so much more. And it would certainly be a nice oppositional force to the dopamine-driven, depersonalizing effects of all the rapid wants and perceived needs out there, which don't automatically result in sense of fulfillment or happiness.
Speaker 2 (01:05:32.546)
hope that you might forward us a couple of good book recommendations that we'll include with the notes of this episode and want to wish you well. Thank you for being here and we look forward to hearing an update on your successes in the future and you'll always be welcome in our podcast family.
Thank you so much and it's been great for to have me and look forward to being back.
Thanks, Laura. That wraps up this week's episode. We're so glad you joined us. For those of you who are new, we hope that you learned something from us and look forward to visiting with you again. Until next week, I'm Dr. Mark. See you next time.
Before we wrap up, I wanted to remind you of something important. The conversations you hear on this podcast are here to inform, to support, to spark reflection. They're not a substitute for professional medical advice, care, therapy, or crisis services. Listening to this podcast does not create a doctor-patient or caregiver-client relationship between us. If you're facing a medical concern, health challenge, a mental health challenge, or a caregiving situation that needs guidance, I encourage you to reach out to a qualified professional who knows your story. If you're ever in crisis,
Please don't wait. Call your local emergency number or recognize Crisis Hotline right away. You deserve real-time help and support. The views you hear on this show, whether from me or my guests, are our own. They don't necessarily reflect any organizations we work with or are part of or have worked with or been part of in the past. This podcast is an independent production. It's not tied to any hospital, university, or healthcare system. Thank you for being here, for listening, and most of all, for taking the time to care for yourself while you continue to care for others. I look forward to hearing from you.