Understanding the Brain's Role in Chronic Pain with Kaitlin Touza, PhD

Dr. Laura Bluestein: [00:00:00] Welcome back, Every Bendy Body, to the Bendy Bodies podcast with your host and founder, Dr. Linda Blustein, the hypermobility MD. I am really excited about this conversation today. Because back, oh, it was probably around 2009, 2010, when I was having so much pain and I was referred to a psychologist for cognitive behavioral therapy for my pain.

And I was so upset with the doctor who referred me and, uh, you know, she thinks it's all in my head and this is not going to be helpful. And it turned out that actually learning about Pain psychology was so beneficial for me once I understood more about pain processing and remember, I was an anesthesiologist at this time, so I'd already gone through my whole residency and I was working for a number of years, but I hadn't really learned a whole lot about [00:01:00] Some of the other factors that are involved in pain processing, and there was so much more new literature.

So once I understood about that, it really helped me to get a better handle on my pain and to live with a much higher quality of life and more functional capacity. So I'm really excited to have this conversation today with Dr. Caitlin Tuzza. Dr. Tuzza is a pain psychologist. Fellowship trained at Stanford and acting assistant professor at the University of Washington's Center for Pain Relief.

She provides evidence based individual and group interventions, including, I'm going to list a number of acronyms, CBT, ACT, EAET, and PRT. She also provides consultation to a broad population throughout the Pacific Northwestern region and Alaska through UW Telepain's program. As always, this information is for educational purposes only and is not a substitute for personalized medical advice.

Be sure to stick around until the very end so you don't miss any of our special hypermobility hacks. Let's get [00:02:00] started. Dr. Tuzza, I'm so excited that you're here to talk about this really important topic.

Dr. Kaitlin Touza: I am so thrilled to be here. This is such an important topic and I've been listening to your podcast and I'm excited to be part of it.

Dr. Laura Bluestein: Oh, thank you. And. This is such an important conversation. We know that there are other factors that contribute to pain besides tissue injury, but a lot of people might not be aware of that or be aware of how important that is. So could you start out by telling us what some of those factors are? Thank you.

And

Dr. Kaitlin Touza: I think it's helpful to understand the different factors that contribute to pain by starting with thinking about what pain is. So we talk about pain signals coming from the body, but really what's coming from the body is signals that indicate tissue damage has occurred or tissue damage will occur if we stay, you know, in contact with whatever the stimulus is.

And so this tissue damage indicating signal comes into our central nervous system and our central nervous system processes it. And if multiple other [00:03:00] factors also contribute to this, you know, being read as important to pay attention to, then we experience it as pain. And so pain is a response. to tissue damage having occurred or the potential for tissue damage if we don't change our behavior.

And so when we're trying to understand what factors other than tissue damage could contribute to pain, that's that's what we're thinking about. What is your nervous system going to warn you against if you are, you know, you're experiencing too much of it or exposed to too much of it because it's likely to cause tissue damage issue in the future.

And so those are things like, you know, behavioral factors, like repetitive movement, body position, exposure to environments that cause an inflammatory or stress response. These are things that our nervous system is going to learn from and try to warn us against. It's cognitive factors.

So, all of those are going to shift what our nervous system is doing and put us into more of a heightened danger monitoring [00:04:00] mode. Recognizing that pain is a danger signal. And so if you have One thing going on in your nervous system that says danger is present, all of our other danger monitoring systems like pain or, you know, even the way that our eyes work, our vision system is going to shift into that danger monitoring mode, which is going to bring more pain awareness, you know, more pain into our awareness or more of that tissue damage indicator into our awareness.

Um, and then there's, you know, social and environmental factors, things like, you know, if you have Good social support, if you see your support, you know, if you feel it, um, if you're having positive social interactions, or if you're feeling isolated, if you feel secure about your future and your current environment, things like that.

And then we can expand beyond that to some more, um, You know, individual, perhaps, risk factors, or things that have been associated with chronic pain, things like sleep disturbance, which is going to shift all kinds of things going on in our brain and body that might contribute to an increase in pain [00:05:00] awareness.

I mentioned repetitive movements, so work related factors, like being in a, in a position that is somewhat inflexible, that we're having to do the same activity. Frequently a work environment that is not supportive. So we don't feel secure in that job. Things like that are going to contribute to it. You think about the, you know, the security of job, our job and ultimately our feeling of security in our life and how connected that would be.

It can be things like poor acute pain control after injury, after surgery and the distress we experience along with that acute pain. Poor acute pain control, fear of pain itself, anxiety about surgery, about injury, those things can contribute to or be associated with the development of chronic pain.

There's also genetic factors that we think may predispose certain people for, you know, likelihood of developing chronic pain, overall disease burden, so medical comorbidities are going to be part of it. You think about that body is dealing with a lot of potentially dangerous stuff going on in it, which is going to heighten this danger monitoring system.[00:06:00]

And then, you know, things like health behaviors, you know, what we're eating, how that impacts our immune system, how our immune system is impacted by the other things I just mentioned, all of these things. So it is a, you know, at the core, it's about danger monitoring, but our danger system is robust and it responds to a lot of things.

So it can be impacted by all kinds of things in our, in our life and in our environment.

Dr. Laura Bluestein: That's so fascinating. So we can see how so easily a person can end up in this vicious cycle of chronic pain because, you know, you have pain, so then you're not sleeping well, you feel anxious, you feel depressed, tend to socially isolate, and then that makes the pain worse, which then can contribute to those things.

So you can really see how once chronic pain develops, a lot of those things can really make it worse. persist and really contribute. Yeah, that's interesting. Absolutely. Yeah. So some people might hear some of those things and think, uh, does that mean that the patient is at fault? Uh, do you get that question a lot?

Dr. Kaitlin Touza: Yeah, I get it a [00:07:00] lot from, you know, from patients that I talk to, you know, as well as physicians who really don't want the patients that they work with to feel that way. How do I talk about this and not make it feel like some, like it's stigmatizing or it's blaming, right? And so We want to think about it like this is not a choice.

This is not a moral failing. This isn't something that somebody, this isn't something that somebody chooses and then continues to choose and ultimately is the, you know, agent of this occurring. Chronic pain develops from, for multiple different reasons and it is largely an instinctual process.

Remembering that we are designed, our central nervous system is designed to keep us alive which means that it is a danger and error detector. That is, that is what it cares about more than anything else. And so if you have experiences with pain impacting your life, your well being, your emotional well being, your, the security of your future, your relationships.

If it's taking away your ability to do things [00:08:00] that you find fun, remembering leisure and fun is a huge part of being a well human. That is going to lead to to shifts in the way that our brain is working, the way that our, you know, we're experiencing different sensory things, and that's also going to contribute to a whole shift in immune system function, organ function, general nervous system function.

This is not necessarily stuff that people have control over. We can impact it by the way that we think and the things that we do, but it's, it's, you want to think of it as, you know, an instinctual and largely subconscious learning process. And so when we're trying to think about, you know, an individual's role in that.

You're not responsible for that any more than you are for not liking tomatoes, for example, or you had a, I think it was episode 101. I really enjoyed your guest on that show. They used an example of, you know, imagining sucking on a lemon and your mouth producing saliva. is a perfect example of what we're talking about.

Yeah, can you affect that by thinking about a lemon? Yes. [00:09:00] But is it your fault that your salivary glands respond to that thought? No, you don't have control over your autonomic nervous system. That's why it's called autonomic. You can impact it. by the things that you think about and the way that you encounter stress and the way that you kind of engage with activity and the, you know, the different things that you kind of consciously have control over.

You can influence those subconscious processes, those autonomic processes, but it is not a moral failing and it's not something people have that level of control over. Yeah,

Dr. Laura Bluestein: that, uh, that's, that's really helpful. I know for me, when I was really in, in a lot of pain, I. I did feel like it was my fault, and if I just did something differently, then I could change it.

And ultimately, learning about pain processing, like this conversation, really did help me. So this is why I feel like this is just so important. And we know that there are circuits and parts of the brain that are involved in pain processing that, um, I think it might be helpful for people to understand a little bit more about [00:10:00] that so that they know that this is really coming from a very scientific foundation.

This is not just You know, this is not just your theory. So, yes.

Dr. Kaitlin Touza: Yeah. And, you know, this sort of pain neuroscience is some of my favorite stuff because I really do think it helps to demystify why, you know, if you don't have control over the pain itself, your, the control that you have over your emotions and your thought processes and your reactions, or maybe your reactions to things that you can process through, um, that is where you have control.

And through that control, you can affect these other systems, right? And when I say you have control over that, I do want to say those are skills that we have to learn. So if you're listening and saying, I don't feel like I have control over that, that may absolutely be true. These are skills just like anything else.

You kind of practice a skill and you start to realize, okay, this is how I impact these different systems in, you know, my body or my mind. Shifting the way I think about something, or how I engage with something. So, yeah, so thinking about the circuits of the brain, the [00:11:00] areas of the brain that we are aware of being part of our pain processing system is helpful for that.

I like to think about pain processing like a whole brain. experience. You know, we don't, pain isn't necessarily localized to one part of our brain. It is a, you know, an interplay of multiple systems that, you know, the behavior of one system influences the others and the behavior of those other systems comes back and influences the rest.

So, none of these things are separate. They are all working in tandem and ultimately influencing each other. But, Prefrontal cortex is a big part of it, and this is where you have things like personality, really, um, the way, you know, inhibition of behavior, so you don't fight people all the time. It's also how you direct your attention on purpose, so the ability to shift attention from your internal sensory experience to things that are happening around you, that's hugely impacted by chronic pain.

Um, And it's your logic process. So your ability to plan things out and say, this is what makes sense. And so [00:12:00] that your thinking brain is a big part of your processing of what is going on. What do I need to do about it? You also have your limbic system, which includes things like your amygdala and your memory centers, your emotion, emotional responses to things.

So you have your prefrontal cortex, your logical thinking brain, and you have your amygdala and your limbic system, which is more of our instinctual reaction, reaction to threat, as well as pulling on memories to help, you know, in response to threat, what happened before, what do we do now based on that, things like that.

And you could, you know, simplify it by saying your thinking brain, your prefrontal cortex and your amygdala and limbic system kind of work against each other, because when you're threat response, your amygdala is very active. Your frontal lobe is not as active. And so you have a harder time thinking it through and kind of saying, okay, I'm, I'm okay right now.

I'm, you know, this, this hurts, but ultimately, you know, I'm, I just, there's something I might be able to do about it, so let me think through what could be helpful, what helped last time, stuff like that. Harder to think that way when you're in a high level of [00:13:00] pain, so people who have experienced that or have had a harder time of controlling their irritability when they're in a lot of pain, you're noticing that shift in your brain function in real time when you're having that change in the way that you're feeling or thinking.

You also have parts of your brain that are responsible for motivation and reward. That shouldn't be a surprise, knowing how much, you know, pain and, you know, uh, our experience of just discomfort impacts our ability to engage in things and enjoy them. And also how pain really wants us to kind of stay away from stuff that hurts.

And so it really shifts our motivation for different things. But that's also the parts of our brain that are, you know, responsible for like, Eating motivation, you know, what do we want to eat, stuff like that. So when you're in pain, it influences, you know, that it influence our, our sexual function. That's the same part of the brain as well.

So it's, you know, when people are noticing, you know, have this pain and now I'm all this other stuff is changing too that, you know, I used to feel this way and now I don't. There's changes that are associated with pain that might be responsible for some of that. [00:14:00] You have this part of your brain called the anterior cingulate cortex, which I find to be one of the most important pieces.

This is your error detection, kind of helps you to recognize when things aren't making sense or something's gone wrong. It's also attention and motivation as part of it. But the interesting thing with pain is that it's, what we think anyways, is that this is part of the brain that's responsible for pairing distress and pain.

So why are you upset about pain? Why are you afraid of pain? Why are you angry about pain? That's that part of your brain. And we know that when people have been in pain for long periods of time, that part of your brain becomes less diversified, meaning there's fewer neurons there. And you want to think about that, meaning that there's fewer ways for you to react to pain.

So there's one path up the mountain, which is, you know, when you're in pain, you're upset. And so as people are going through something like pain psychology, or they're having more successful experiences in pain management and other settings, they might start to notice that they're not feeling as upset.

And that would be something that would be, [00:15:00] you know, reflective of that part of your brain, growing more neurons, becoming more diversified. There's more paths up the mountain. There's more ways to react to something. And so we can see the change in the brain of people who have chronic pain in some of these different parts and notice that that corresponds with a change in their experience of pain.

You also have, you know, the somatosensory cortex, which is kind of what hurts and where, and also, you know, why you move your hand away from the hot place. Burner before you really think about it, so that part of your brain can, you know, really control you and also you can control it. The insular cortex is interesting.

The anterior insular is the only part of our brain that is consistently associated with pain, consistently associated with the experience of pain. It's also, the insula is the part of your brain that pairs experience, sensory experience with awareness and with emotion. So, it's really responsible for cog, for.

Um, our concept of self, our consciousness, so the part of our brain that is, you know, kind of active with pain awareness is [00:16:00] also the part of our brain that allows us to be aware of ourselves. So, it's a pretty, you know, it's a pretty profound thing to think about. You have parts of your brain that are, you know, part of the endogenous opioid system.

Your endogenous opioid system is, uh, A system that helps to reduce pain awareness, so things like the periaqueductal gray, which is, you know, has a big influence on our sympathetic nervous system and as well as this modulation of pain awareness. It's a big part of it, it creates, you know, it provides a lot of the dopamine, you know, it projects into our frontal lobe and has a lot to do with dopamine production and use and things like that.

Um, And so your periaqueductal gray, you know, when you think about it, that's when we're talking about like your that salivation with the lemon or your, you know, subconscious brain. That's a lot of what that is doing for us, right? And your endogenous opioid system, it's quieting down some of that pain awareness, but this is also what, You know, is responsible for parent child bonding.

It is what helps us to enjoy social experiences and interaction. It's what [00:17:00] motivates us to do it in a lot of cases. You know, so positive social interaction is one of the strongest indicators of safety for a human. And so it has a, it's a huge rewarding behavior to do something that's fun and social. And it also has a lot to do with reward and aversion behavior.

So, do we like something or not? You know, it has a lot to do with that system, and so when you think about our endogenous opioid system also being part of our pain managing system, it really, again, highlights how important pain is to our, not just our survival, but our well being. You know, it's part of these same systems, um, and then, you know, a couple other ones are, well, one more is the thalamus.

which is a little bit less interesting, perhaps. It's kind of the Grand Central Station for our brain that sends signals to and from the body. It does other things, too. It is involved in some sensory processing, but, you know, for simplicity's sake, it's, I call it the Grand Central Station. So all of this stuff, you know, all of these different, you know, pieces are, you know, working together.

And what the patient is actually experiencing is changes in mood associated with pain, you know, [00:18:00] motivation to do things related to pain or not. Um, changes in self concept and self judgment, and then all of that impact on our body systems like immune system function, hormone function, organ function, all of that is, you know, that's all controlled by the brain and these systems in the brain.

So pain is going to influence all of that stuff and be influenced by it, which is helpful for us in pain psychology and pain management, because we can also harness that. It's the power of this neuroscience to reduce our awareness of pain. So it's not always, we can use it to kind of push back against that tendency of our brain to hook onto the danger signal and stay with it.

Dr. Laura Bluestein: Yeah. And while you were saying that about the endogenous opioid system and awareness of pain, I think it's also important to point out, right, that we don't need to be aware of every little sensation. I, I sometimes joke that I can feel like every cell moving through my body, not as much in a pain way that it, that it used to be.

It used to be, I used to have hyperalgesia. So, you know, being [00:19:00] hypersensitive to stimuli that normally are not really painful. Um, I know that would be allodynia, sorry. Hyperalgesia being that things that are normally a little bit painful or more painful or allodynia where things are painful that normally not painful at all.

I used to have both of those. And, um, so I think it's. It's important to note that, um, even if you work on a lot of this pain psychology, it's not that you're not going to be able to feel things when you should feel them, right? You're still going to feel them just fine.

Dr. Kaitlin Touza: Absolutely. People will often wonder about that.

They will say, you know, am I going to stop feeling the pain that I need to feel? Am I going to be able to stay safe? Yes. Your brain is not going to stop you from doing that. In fact, it's going to be, we have to do a lot of work to keep pushing the other direction because we are geared toward feeling that.

Dr. Laura Bluestein: Yeah. And I also wanted to ask you, you brought up about the autonomic nervous system and the people that listen to this podcast are most likely they have Ehlers Danlos syndrome or they have hypermobility spectrum disorder. A lot of them have dysautonomia. We know there's a lot of overlap with [00:20:00] that and it might specifically be POTS or postural orthostatic tachycardia syndrome, the metamastoid activation syndrome.

But when the autonomic nervous system is dysfunctional, then does that contribute to the sensation of pain?

Dr. Kaitlin Touza: Yes. Yeah. So you think about your autonomic nervous system is Automatic as it sounds, autonomic, automatic. And it is reading our, you know, brain, body and connection is, you know, largely this autonomic nervous system stuff.

And so if you are having a lot of autonomic dysregulation, your brain doesn't necessarily know why that's happening, right? You're the, the sort of processing part of your brain. And so if your heart rate is fluctuating a lot, if you're having, you know, changes in the way that your fatigue or energy resources are being used, if you're You're just feeling generally ill because of this stuff that's going on in your body.

Your brain is recognizing that and it's, it's part of what your brain might say, okay, something is wrong. You know, there, we are not okay. There's things going on that must mean that we're not okay. So let's [00:21:00] keep that danger monitoring system on and let's maybe amplify it so that we're aware of things.

And so something like a body sensation that might be associated with something like this this auto nomia might come along with fear, whereas maybe if you, if that wasn't what was going on, it might be annoying. It might be kind of like, okay, this isn't helpful for me right now. But when your nervous system is in this danger monitoring mode, that's going to come on with potentially something is wrong, and that fear will come.

And even if you, you know, cognitively intellectually understand that that's not what's happening, you We're talking, we're not talking about your conscious brain necessarily, that's part of it. So if you are worried about it, and you're thinking worried thoughts, that'll contribute to it. But even if you're not, you remember that this is kind of the behind the scenes stuff that's saying, if our heart rate is increasing, then there's danger, there's something wrong, right?

And so that's going to kind of push that danger monitoring up. And so, the other thing to think, which, you know, further complicates this, is that your brain is controlling. that, you know, these autonomic nervous system [00:22:00] factors. And so even it's, it's, you know, baffling and, and infinitely frustrating that it's both your brain responsible in large extent to, you know, what's going on with these fluctuations in body systems, as well as, you know, that your brain responding to what's happening in the body and then potentially further, further contributing to some of these, you know, dysautonomia symptoms and things like that.

And so, um, I think that's part of the matting aspect of this is that it is natural and instinctual to respond to a shift in body function and to take it seriously and your nervous system does that. While at the same time, the response of taking it seriously might contribute to awareness of those symptoms, distress associated with those symptoms, and ultimately, as we're talking about overall distress or pain.

Danger related reactions, they'll contribute to your awareness of pain because it's part of our sensitization process. If you, if something in your nervous system has said, we're in danger for some reason, you're going to notice all of it with more intensity. And so what that reads for the person [00:23:00] experiencing it, it hurts more and it's harder to ignore.

It's harder to distract from it.

Dr. Laura Bluestein: Yeah. Yeah, wow. And, and that kind of leads me into the next question about attention, interpretation, and behavior. And what should we know about that?

Dr. Kaitlin Touza: So this is the learning process that I'm talking about. And again, this is why I want to, you know, keep repeating. This is not somebody's fault.

This is not all in their head. This is not a choice people are making. Attention, interpretation, and behavior is how we learn and how we reinforce learning. And this is for anything, not just pain and danger related things, but in this case, we'll talk about those to make it make sense. But, um, so you notice something, attention, right?

You notice something that can be on purpose or involuntary. It's going to Something comes into your awareness, then we have an interpretation process, and that interpretation process can be very automatic, very fast, and outside of our awareness. A threat appraisal process, where your, some sensory information comes into your nervous system, into your processing [00:24:00] centers, and your nervous system really quickly is saying, what is it?

Is it dangerous? Do I have experience with it? Have I been able to stay safe from it in the past? You know, is my, does my experience indicate I'll be safe? Um, and what do I do about it? You know, and so that can happen, snap, real quick. And that's part of how we respond to something. And it's part of why we might have an instinctual stress response to one thing and not another.

And that might be just because of some experience we've had in the past that says we don't have to worry about that, but we do have to worry about this other thing. That. interpretation process is often accompanied by a conscious interpretation of thinking about it. What just happened? Why does my foot hurt?

Is it, you know, last time this happened, I had to stop doing all this other stuff. Is that going to happen again? Am I going to have to take more time off work? You know, so you have a thought process that's also associated with this more instinctual kind of reaction process. That's why you take your hand off the hot burner before you think about it.

But it's also why you [00:25:00] might think, oh, should I take reach my hand into that fire to pick up my, you know, my marshmallow stick if you've been burned before. So you have the conscious piece as well as the instinctual that will get you to move before you're thinking about it. So attention, interpretation.

Part of your interpretation is also your emotional response. Thinking about emotions as messengers. Emotions are always valid. They're always important to try to understand because they're telling, they're orienting you to an aspect of an experience. Your emotions are saying, Pay attention to this part and learn from it.

So it's really, you know, trying to get you to notice a certain aspect of something and think about it more later on. And so your emotions are part of this, how we feel about what we're thinking about or what we're noticing. And then your behavioral response to that, which can be, again, it can be internal behavior.

So it can be more rumination and worry about something. It can be an autonomic nervous system response, which is going to reinforce either that something is dangerous or not dangerous. It can [00:26:00] be a, you know, what we do with ourselves, you know, if we, you know, change our behavior around a certain activity, if we start avoiding something, if we approach it in a different way, if we approach it with more fear in the future, you know, you think of like the care we might take in doing something and whether or not we're doing it with confidence or with concern, that type of stuff.

All of that's going to come back around and influence that attention process. So how much is our nervous system dedicating to monitoring the stimulus, which again could be an internal thing or an external thing. Over time, as that keeps going, you know, that, you know, that sort of attention interpretation and behavior is, you know, if we've had, dangerous experiences with something.

If we've had experiences where something has really impacted our wellbeing, our ability to do the things we want to do or need to do, if it has affected our ability to think or to engage in the stuff that we find meaningful, all kinds of stuff, you know, that's going to contribute to I need to pay attention to this thing.

Right? And so there is a, there's thought processes that are associated with that. [00:27:00] But there's also physical processes where if you do something and it hurts, your nervous system is learning from that always. Pain is a very fast teacher. Stress and pain are really, you think about it, if you went to the same grocery store, thousand times in your life and one time you had really, you had a fender bender and somebody was really rude to you about it.

You're probably going to think about that every time you go park in that grocery store. You're going to be a little bit more careful, even though nothing actually dangerous happened. You were safe. They were safe. Everyone's okay. But you're still gonna worry about that, right? Now, if something bad happened again, if you had another, you know, aggressive interaction or another accident, you might start going to a different grocery store, even though nothing really bad ever happened there.

It was just upsetting, right? So you think about now, let's say it's pain and something hurts. And you're worried about injury, or maybe you have been injured before, and maybe that's impacted your ability to work and your security and things like that. Big [00:28:00] deal, right? So if you do something and it hurts, your nervous system is learning.

And what it's learning is, you need to avoid whatever context that pain occurred in. And this is part of how pain starts, you know, kind of getting us away from things and getting us away from environments and activities and things like that. This is not a moral failing. This is an instinctual learning process involved in exposure to stress.

Dr. Laura Bluestein: Wow. That's really fascinating. Um, and I love the, the grocery store example because I feel like that, that really, uh, makes it so much more tangible. We're going to take a quick break and when we come back, we're going to talk about how we can use this information to actually live better with pain and, uh, lower our pain levels and improve our quality of life.

So we'll be right back.

This episode of the Bendy Bodies podcast is brought to you by EDS Guardians, paying it forward in the Ehlers Danlos syndromes community, patient to patient for the common good. I am proud to serve on the inaugural board of directors for [00:29:00] EDS Guardians, a small charity with a big mission and a big heart.

Now seeking donors, volunteers, and partners. Patient advocacy and support programs available now. Travel grants launching in 2025. Learn more, shop for a cause at their swag store, and join the revolution at edsguardians. org. Okay, so we're back. Um, Dr. Tuzav, this is such important information and I'm sure people are listening to this and thinking, well, how do I take this information and actually use it to make my pain levels better?

And what are some of the different approaches that can be used? Um, and you know, how can someone find out? think about what approach might be most helpful for them. So can you tell us a little bit about that?

Dr. Kaitlin Touza: Yeah. So there's a couple different modalities specific to pain psychology. And, um, so I'll talk about those.

I would also say that, you know, there's a lot of things that we can do outside of pain psychology that are helpful. So within pain psychology, there's a couple, there's, more than what I'm going to describe, [00:30:00] but I'm going to talk about some of the most prominent, you know, therapies, the things that have been studied the most, and we have the most evidence on.

One is cognitive behavioral therapy. So cognitive behavioral therapy is what it sounds like. You're looking at your cognitions, which is your internal behaviors, things like thinking and emotional responses and our awareness of those, how we respond to those internal behaviors, as well as behavioral. So again, cognitive behavioral, what are you doing?

What are you engaging in? Are the things that you're doing ultimately things that are leading to well being? You know, how do you make changes that are, that help people to feel better in their life? Things like that. So you're going to address that interpretation process. You're going to address the behavioral response to that attention, interpretation, and behavior process.

Um, and you're going to do things like building self efficacy, building self confidence and our ability to manage whatever it is. And that matters because, you know, when you think about what is self efficacy, it's saying, okay, I'm going to be okay. And that's a safety signal, right? And that says, I, whatever's [00:31:00] going on, I can deal with it.

So you do things like that, like you recognize, you know, how can I internally increase my feeling of safety? Reduce my fear associated with these symptoms and ultimately get to a place where our nervous system is reacting less strongly to these things. That interior cingulate cortex is growing and we're not necessarily always responding with distress.

We have other ways to respond to what we're experiencing. And you know, if you could think about, you know, if you didn't feel, you know, if you had all the same symptoms you have today, yesterday, the last week, and you didn't have the emotional kind of impact of those symptoms. How would your life be different?

What would you be doing differently? That's what we're thinking about with cognitive behavioral therapy. So it's not necessarily about, you know, you shouldn't feel the way you feel. That's not what it is. It's about figuring out ways to kind of reduce that danger, you know, kind of that push of that danger nervous system taking over, right?

You also have acceptance and commitment therapy, which is one of my favorite therapy modalities. This is where, [00:32:00] you know, acceptance and commitment therapy, or ACT, is really focused on. Increasing engagement with things that are meaningful to us, um, building psychological flexibility, because that is so important, you know, as we are going through things and having frustrating experiences, potentially, or having to change the way that we interact with something, being flexible in our thinking is, can be hugely helpful.

We have pain reprocessing therapy. and Emotional Awareness and Expression Therapy. Both of these are newer therapies that have come out more recently. Pain Reprocessing Therapy is focusing on changing pain processing, like it sounds. So, starting to get your nervous system to recognize that this pain is not about survival, it's not important to pay attention to, we can shift it out of our awareness, and ultimately you do that by challenging a lot of these sort of danger related cognitive and behavioral processes, as well as using mindfulness strategies.

to help desensitize, to help to get your nervous system to desensitize to those pain related signals or those tissue damage related [00:33:00] signals that are, you know, in this case, not necessarily associated with tissue damage. And then emotional awareness and expression therapy, which has those other elements, but incorporates more of this emotional piece.

And I think that's important because we're talking about trying to self soothe or reduce our distress associated with something that is instinctually distressing. Right? It's meant to make you feel upset. And so, when we're talking also about things like, you know, the, you know, presence of anxiety or depression, trauma exposure, continuous stress, work environments where we might not feel secure, isolation socially, all kinds of things, right, that would contribute to somebody feeling, you know, perhaps that things are not going well in their life and that they need help, um, or that they are just, you know, needing things to change, you know, whatever it would be.

you're not always able to just say, okay, well, let's, let's challenge our thinking around that and expect it to change. Sometimes you need to address more of the emotional piece, address unmet emotional needs, learn how to express [00:34:00] emotions in a way that allows us a, you know, some amount of catharsis so that we're not holding those difficult and, and, you know, kind of irritating and even, you know, traumatic experiences inside us all the time.

And by expressing it. We resolve it, remembering that emotions are messengers, and when you process through something and you can resolve something like guilt by saying, you know what, I learned that lesson. I don't do that anymore. I don't have to keep reminding myself of this thing I don't want to do anymore because I don't do it anymore.

You can start to kind of release. some of the intensity of those emotions and how they impact our well being, our thinking, because if your brain is still kind of saying, be on guard, don't do that thing you feel guilty about again, it can be hard to be like, okay, well, I'm okay. I'm doing well. I don't have to worry about that.

And so sometimes you need some tools that will dig into some of the more emotional experiences from, you know, earlier in life, from current life circumstances, to get to a place where your nervous system can recognize you are safe. And this danger monitoring can calm down a little bit. [00:35:00] And so again, if people are hearing, you're saying that it's my fault that I'm in pain because I've had trauma or because I've been through distressing experiences, absolutely not.

I'm saying that your nervous system is doing what it's supposed to do when you've been through trauma or distressing experiences. It's saying, pay attention. That stuff can happen again. And what we're trying to do with this, these different therapy modalities is say, yes, it can happen again, but you don't have to worry about it.

You have a 100 percent success rate of getting through your bad days. You are able to do hard things. You've done a lot of hard things. And so it's not about saying everything's okay and you should feel fine, but it's about saying you can deal with it when it's not fine. And even when it's not fine, you can still be okay because you have.

Um, and so kind of getting people to recognize that sort of you. You know, you go through stress and then you flip the coin and you recognize, I went through that. I got through that. I did, you know, and I'm going to be able to do the next thing. So that's a lot of what these therapies are about. It's about building that confidence in self, um, building self efficacy around pain management, [00:36:00] increasing the engagement and the things that matter to us.

Cause again, having fun, especially social fun is one of the biggest indicators that we are healthy and well. So, you know, Figuring out ways to do that and then also within these modalities, it has strategies that will actually help you to desensitize to pain. So it's not just, Oh, you feel bad, go to the party anyways.

No, it's okay. We have strategies that are going to help keep your nervous system in a calmer state. during that party or that road trip or that travel or at work or when you're trying to go to sleep or when you're trying to read a book or whatever it is that you want to be able to do more of. We have strategies that are going to help you to, you know, help to signal to your nervous system that the danger monitoring system doesn't have to be on right now.

And,

Dr. Laura Bluestein: and I know a lot of people have tried some of these things and maybe they, you know, because of course every psychologist is going to approach things a little bit differently. And I think that part of it may too have to do with where maybe you were at in your life and how you were [00:37:00] educated about pain processing.

And of course, a lot of psychologists, most of them are not going to know a fraction of what you know about pain processing. So, if someone has tried. CBT, or they've tried EAET or, you know, ACT or one of these other, you know, we have a ton of acronyms, of course, DBT, you know, we love our acronyms, right? Um, so if someone has tried that before, is it worth trying again?

Should they try something different? Should they try to find a different acronym? therapist, or are there some of these things that are available online? What would you suggest?

Dr. Kaitlin Touza: I would say probably the most important piece is understanding pain neuroscience, whether you are the person with the pain or you were the provider, that's, you know, providing the intervention.

If you want to be effective in pain management, you need to understand pain neuroscience because we don't have a perfect treatment for it. So we can't say if you do this, you know, for eight sessions and you follow and you do all the homework, you're going to feel better. It's too multifactorial and it's too [00:38:00] individual for that.

And so if you can understand pain neuroscience, understand our, you know, the way that our brain responds to pain, the way that our body responds to our brain's response to pain, you know, the way those things interact, and then kind of map that onto, here's what I'm experiencing. You know, I've noticed that my pain is louder when this happens or when I'm doing this.

It's quieter in these other, you know, contexts. Then you can start to think about, well, why, what's happening for me? And think about, well, what would help that? You know, what would make me to feel more of that way than that I feel when I'm doing that stuff, when pain is quieter? What about that makes me feel good and stuff like that?

And you can kind of come up with some things that would be useful to you. And then as far as, you know, whether or not you should continue or go back to a therapy, whether it's CBT or something else, I would say, Whether or not you go back, this type of stuff is a, it's maintenance. It's not something that you do and then you're done with.

It's like physical therapy. If you [00:39:00] only do physical therapy while you're being treated, so you've got to do it during the course of treatment and then you stop. You're not going to continue to feel well. Usually physical therapy is a prescription that you use, that you're going to continue to engage in throughout life so that you keep those structures in your body healthy and moving.

I would say that, you know, any psychology is more like that, where you don't just do it and you're done and you're good. You have to keep using these tools, keep practicing these skills. And so, If you've gone through something like CBT and you didn't find it to be a good modality for you, then you should try something else.

You know, for example, um, I think, don't think I mentioned it earlier, but mindfulness is another modality we use in pain management, which helps us to tune into our body, tune into our mind. Decouple pain from distress, being able to separate that and do the mental exercise of how would I feel differently right now if I didn't feel upset about this, if I was just feeling the physical sensations.

Being able to do that mental exercise, right, so if you find that one modality isn't the one that's [00:40:00] working for you, there's all of these other ones that you can ultimately try out and see if something works better for you, and if you are understanding of that pain neuroscience at the core, you can say, okay, well I'm having trouble with this aspect of my life.

So, What I need to do is, you know, work on what my brain or body is doing in response to this certain thing, and then I can, you know, figure out a way to self soothe, or to distract, or to change the way that I engage in this, or to address unhelpful thinking that's pushing toward that feeling of danger.

Whatever it is. Um, so explore what's out there, find what works for you, understand pain neuroscience, and that's where you'll find the path to, to change. I think that, you know, one of the most important pieces here when we're thinking like this didn't work for me is to think, well, what did I want to get out of it?

you know, what was my goal? And, you know, how do I meet that goal? How do I get to that? Because I think sometimes when we're having a mismatch and something not being helpful, there might be an issue of, you know, I'm trying to do this thing, but what I'm really trying to see change is this thing [00:41:00] over here, and I'm not seeing how that connects.

And so kind of getting, you know, sort of an understanding of why you're doing something, the rationale behind it, and then ultimately making it your own, knowing that you are the best judge of your own experience. And so if something isn't working for you, and It's not because, you know, that thing, you know, you need to learn how to do that thing, or it's just, you know, that's the only thing that can help you.

It's saying, okay, this isn't working for me. What it's supposed to be doing is helping me to think less about pain, but this strategy isn't working. So what is something that helps me to do that? And how could I maybe do more of that to beef up my brain's ability to shift attention away from something?

So, To boil that down, keep trying. There's other things out there. Understand the theory behind why somebody would tell you to do something and ultimately you'll get probably a more satisfying outcome because you'll understand the rationale for why you'd be trying to do something. And that you got to keep up with it because, you know, doing something once a week isn't enough to change your brain.

Dr. Laura Bluestein: And are there times that these kind of [00:42:00] therapies are not appropriate? or even would be a bad idea?

Dr. Kaitlin Touza: I would say this would be not appropriate for somebody who's experiencing a lot of acute pain because a lot of sort of pain psychology stuff, well I shouldn't say that, I should say chronic pain interventions would not be appropriate for acute pain.

Pain psychology is wonderful in acute pain settings and it's helpful for coping with and dealing with that. But these, you know, desensitization strategies, for example, where you're trying to be able to, you know, tolerate more walking or more reading or, you know, reduce your sort of migraines associated with bright light or something like that aren't always the thing that you would want somebody who's dealing with a broken leg to do because that pain associated with that broken leg is, that's important to listen to.

That's not the same thing as chronic pain signals, right? So, we want to go ahead and do what your body's telling you to do when you're dealing with acute pain. I think it's also challenging if we are in a situation where somebody has needs beyond what pain psychology can provide. You know, so if somebody is, you know, in a [00:43:00] place where, you know, their work environment is not safe or is not something that can keep them healthy and well, then that's a social need that pain psychology isn't necessarily going to meet.

And we don't want to, you know, miss that. Practical tools that could help somebody in a situation like that by having them, you know, kind of be doing something like emotion processing exercises, right? When there might be something environmentally going on that needs to be addressed for them. Um, if somebody is in a situation where they are truly not safe.

You know, if they're not safe at home, or they're not safe in, you know, in body movement and activity and things like that, if there is some danger that needs to be addressed, pain psychology is not the thing that is likely to be helpful. And that's often, that can happen, right? We can be in environments and, you know, social situations where, um, We don't necessarily want to get stuck on emotion processing when you have something that is, you know, actively fueling that distress, you know, outside of your pain, stuff like that.

So that's not to say pain psychology wouldn't help people who are going through stuff like that. It's just that we don't want it to get in the way. We don't want to [00:44:00] kind of get in a situation of like, let's meditate through this when it's like, no. We need to make sure that this is a safe situation

Dr. Laura Bluestein: first, right?

Dr. Kaitlin Touza: Yeah.

Dr. Laura Bluestein: Yeah. Yeah. No, that's really, really helpful. And I love how you brought up about confidence. I feel like that is so important. And I know for me personally, not to keep bringing it back to myself, but, but I really struggled with confidence. I mean, it was really, really tough. And, um, and also, yeah, I stopped doing everything that I love to do.

And getting those things back in my life really helped a lot. Um, and I think also you've, you mentioned, uh, at other times I've heard you talk about self compassion and being flexible when it comes to, uh, goal setting. And I think that's especially important for people with conditions like Ehlers Danlos syndromes, hypermobility spectrum disorders, dysautonomia, mast cell activation syndrome.

Those are kind of the primary audience, uh, members or listeners for the podcast. Um, how can we foster that self compassion and flexibility when it comes to goal setting?

Dr. Kaitlin Touza: It's so important. You know, self compassion is the [00:45:00] difference between being the carrot or the stick and how you motivate yourself, right?

So self compassion, it's, it's connected to self efficacy. You know, do you think that you can do something? Do you feel confident in your abilities? Do you feel like even if you don't do something so well, it's okay? Right, you know, is it okay to struggle? Is it okay to not finish things? Do you have to, you know, live up to some rule that isn't necessarily serving you, isn't, isn't workable in your life, isn't benefiting you?

Um, being able to take a step back and say, you know what, this is, you know, who I am, this is what I'm able to do, and that that's okay. In fact, I'm even appreciative of who I am and I like who I am. That's, that is a way better motivator for sort of being productive and meeting our, our goals and things like that than saying, I'm bad and I need to try harder.

Because that doesn't motivate us. That puts us at a deficit. And so thinking about how you motivate yourself, how you talk to yourself matters. If you could take your internal [00:46:00] dialogue and put it in someone else and that person talk to you the same way you talk to yourself all day, you think like, would you want to hang out with that person?

And if the answer is no, that's a problem because that you can't get away from yourself, right? And so, you know, you think about, you know, if a child makes a mistake, How do you talk to a child? You don't say, you're bad and you're going to be bad forever. You can't do anything right. You say, okay, well, that was, what can we learn from this?

What happened? Why did that happen? What do we want to do next time? What were we trying to do? How could we do that? You know, so it's, you, you know, it's sort of a compassionate problem solving process versus, you know, I'm bad and I'm always going to be bad. And so, yeah. It's a difference in motivation and it is absolutely related to survival as well.

Everything is. So do you think you're going to be okay? Do you have confidence that you're going to be okay today, tomorrow, next year, 10 years from now? That's a huge deal related to, um, danger. right? And so self efficacy and self confidence have a lot to do with how you would answer those [00:47:00] questions. Do you feel okay or not?

And because self efficacy is part of our soothing system, right? So we're talking about danger related activity, and we've been talking about sort of that stress response, but we also have a rest response. You know, we're kind of designed to see the tiger run away and feel better. And, That feel better part is hard to achieve with chronic pain, because the tiger isn't necessarily going away, or at least your nervous system thinks it's not going away.

So we're trying to teach that nervous system that it's not a tiger, it's a kitty cat. You don't have to keep monitoring it, right? But that, you know, soothing system of the flipping the coin and feeling better after stress, Self compassion and self efficacy are part of that. Higher self efficacy, higher pain related self efficacy is associated with reduced psychological distress, improved function, and even less pain severity.

So it is absolutely related to this. And, you know, developing self compassion is hard for a lot of people because we have sort of a tendency to be self critical and to monitor [00:48:00] ourselves in sort of a negative way, which can be mocked. can be motivating if the response to that is, yeah, I can do something about that, right?

If it's, if the response is, I can't cope with this, I can't deal with this, then that kind of, that feeling of, I'm going to be okay, breaks down, right? Um, and so being flexible also in our goal pursuit is part of this, you know, part of that rigidity in goal pursuit, or the perfectionism, and I have to do it this way, and it has to be right, is That's a very stressful process.

You know, it's kind of like, if I don't do it right, if I don't do it perfectly, then I'm bad, even though I did it. And so, if we're flexible in that, if we kind of say, okay, this is my long term goal, and every step in between here and reaching that long term goal is troubleshooting. Each time I try something and it works, I'm going to say, why did it work?

How do I, you know, kind of, what do I need to remember about that so it goes better in the future? And if it doesn't work, we want to stay away from the F word. We don't want to say failure because that's not helpful. In fact, we respond to that word quite strongly [00:49:00] when you kind of do biofeedback stuff.

You can just say the word failure without any other context and people will start to stress out. So, we don't want to say that, we want to say how do I make this goal more achievable for me at this time? That was not a good goal for me at this time, how do I create a good goal for myself right now? And so, it's not about I need to try harder, it's about why is it not working?

We need to make it easier because that's the answer to being actually productive in our goal pursuit is make it easier. Don't just keep trying because you feel like you need to try harder. So again, how do you get to the place of saying, it's okay to modify this? I don't have to keep doing it the old way.

I don't have to do, you know, I don't have to keep saying, well, I used to be able to do it that way, right? Self compassion, right, of saying, okay, that didn't work, but it's not because I'm bad. It's because that didn't work for some reason. So let me figure out how to make it work for me. And that it's okay to do it in a different way.

I'm allowed to do it in the way that feels good to me. I'm allowed to do it in the way that causes the least amount of stress for me. You know, so just kind of recognizing that you are the steward of your [00:50:00] life and you get to be kind to yourself in both thought and action. It just might take some practice because it's not instinctual.

All of this stuff is hard to do for us humans.

Dr. Laura Bluestein: Yeah, it is. It sure is. And then we kind of, sometimes I think, I've noticed this with myself and I've noticed this with my patients as well. We get anxious and then we get anxious about being anxious, we blame ourselves for being anxious.

Dr. Kaitlin Touza: A

Dr. Laura Bluestein: big

Dr. Kaitlin Touza: part of what I try to do with people is remove layers of the suffering onion, right?

So our core suffering is usually bad enough, which may be pain. Or trauma, or depression, or we didn't sleep very well last night and we have a lot of stuff to do today. You know, it can be a small everyday suffering or it can be a big life suffering, right? So we have our center of our onion, and then we feel guilty about having pain, and then we feel anxious about you know, you know, how our pain is impacting other people.

And then maybe we feel, you know, starting to feel sad about that. And then we're feeling, you know, guilty about feeling sad because we're worried it's impacting other people. Right? And so it [00:51:00] can build and build and build. And so that anxiety about the anxiety is a great example. And mindfulness is a really powerful tool of being able to say, okay, I'm noticing that I'm anxious about my anxiety.

So let me see, like, how does that core anxiety feel? And, you know, how can I tell, you know, what, what. What do I feel and think about that? And, you know, is this something that I really need to give myself so hard of a time about, or can I think about it more like a learning process? So, you know, mindfulness skills allow us to kind of pull into

Dr. Laura Bluestein: that, like you described.

Dr. Kaitlin Touza: Yeah.

Dr. Laura Bluestein: Awesome. And, and I have an acronym that I use for when I'm developing comprehensive treatment plans that I've, that I've written about. And if people have already heard me, I'm not going to go into this, but, um, it's MENS PMMS. So it stands for Movement, Education, Nutrition, Sleep, Sleep. psychosocial modalities, medications, and supplements.

So, of course, there's the P in there for psychosocial. So, um, it's so great to have this conversation and just dig into this in such detail. And, uh, I feel like there's going to be people that [00:52:00] are going to want to listen to this multiple times because this was so rich with, with information. And before we wrap up and get to the hypermobility hack, was there something that you, Uh, that I didn't ask that you think I should have asked?

Well, I'll just say,

Dr. Kaitlin Touza: you know, there's, this is such a huge topic, it's impossible to cover it all. You know, we could have, you know, 20 hours of podcasting and we would still probably not get to all of it. So it's, it's a big topic. We just kind of tip of the iceberg here. Um, yeah. You know, I think, you know, one thing to think about is just to harness the power of your mind.

And I know we've, we've have talked about that, but I'll give an example of how this might work. If you were kind of practicing something like cognitive behavioral therapy or acceptance and commitment therapy, or any of those other ones that I mentioned, mindfulness, E A A T P R T. that here's an example of how this might work in real time.

If somebody's doing something and they have a pain increase, if they haven't learned about pain neuroscience, if they haven't learned about the power of the mind, they're, they're just going to have an instinctual response to that, which is not a [00:53:00] moral failing. I always say that this is not your fault.

This is not something that you're doing, but you're going to have a thought like something like something is wrong. Something is broken. I'm going to get worse. I'm not going to be able to do the things I need to do. What about my financial health? What about my family? All of it. And you're going to have a sympathetic nervous system response.

You're going to have a stress response to that, which your brain is going to read and say, yes, we're in danger. So you have the thoughts, you have the pain, and you have your body response all saying we're in danger. And that is going to lead to a behavioral response. That's likely more avoidance of something or, or fear of it.

Even if we don't avoid it, We're going to potentially, you know, disengage from the things that we might've wanted to or needed to do in that moment. And we're going to feel bad and guilty and worried. Now, if somebody has gone through some of this, you know, uh, education and they have, you know, practiced some of these skills and they have the mindfulness skills to be aware of what's going on inside them, they might have that same thing happen.

They do something, they have a pain increase, a pain flare, but they might say, okay, this is annoying, but it is not [00:54:00] dangerous. I know that this is a safe thing to do, and I know that this pain is not necessarily associated with tissue damage. It's part of my danger warning system that isn't useful in this moment.

And I have things that I can do that will be helpful here. And that person is going to have an initial stress response in their body, because again, that's very instinctual, very automatic with pain. But they're gonna be aware of it and they're gonna be aware of their thinking and they're, the way that they think about it is gonna already calm down that body response.

You don't even have to do anything else other than think about it differently. But they're also gonna know about things like releasing tension and breathing and how that also influences what our brain is doing. And, you know, kind of is incongruent with danger. You're not nice and relaxed when you're fighting a tiger, so it can help to your brain to recognize you're okay.

And they're going to have a different behavioral response. They may, you know, continue to engage in the thing that they want to do, but maybe, you know, take some care for themselves. to, you know, relax a little bit along with it. They might, you know, use other management strategies that they found as effective [00:55:00] and feel confident that they're going to be effective.

And again, confidence comes after experience as well. So maybe they've tried some things and they've seen they're helpful and so they know that they can use them again. But even if they do rest, even if they do disengage from that activity, they're going to rest feeling confident that it's that they're okay, that it's just a silly nervous system.

This is really annoying. I'd like you to stop doing this versus there's something wrong and I'm afraid of it, right? Um, and so, you know, kind of thinking about all of the different factors that would contribute to you as an individual being able to say, okay, that's okay, I don't like that it happened, we're not going to gaslight ourselves, you know, I don't like that it happened, it hurts.

But I'm okay, you know, I'm going to be okay. And, you know, I have ways that I can deal with this and I have a 100 percent success rate of getting through these moments, right? So that is, you know, ultimately what we are trying to get to. And so all of the different things that an individual might need or benefit from to be able to do that, that's, you know, that's what That's the big picture.

Dr. Laura Bluestein: Okay. I love, I love that big picture. [00:56:00] And then we're going to jump into our hypermobility hack. This is how I like to end every episode with, uh, of course you've given us already lots of tips and things, but do you have a hypermobility hack you can share with us?

Dr. Kaitlin Touza: This is a hypermobility hack. It's also just, I think, a general well being hack for anyone in life.

Find something that is meaningful to you to do when you need to rest. One of the things that I hear so much from people with, you know, hypermobility is that, and this could be true for anyone, but I hear it a lot from the hypermobile folks, There is such a vibrant zest for life and activity and interest and engagement of things and having to limit activity or take time away from activity is emotionally painful and distressing.

And we want to find something that is meaningful and important and worthwhile. while to do when we can't do our highly active things. Because we don't want our downtime to just be blank spaces in our life while we're [00:57:00] waiting to feel better. You know, when we are, when that happens during that period of time, we are anxious that that's never going to happen, that we're always going to feel that way and where it's fearful and difficult.

And then when we do feel better, we're waiting for it to happen again. When is it going to happen again? And how long is it going to take? And is that going to be the one that I never get back? And so if we can kind of shift that a little bit more and think about it, like, okay, I have this downtime period, which is annoying, but not dangerous.

And it's something that, you know, I am anticipating I might have at periods of time in my life, and I don't like it. And I don't want it to happen again. We can't necessarily prevent it from happening, but we can think about, I don't want to experience it the same way again. And often when we're anxious about something, that's really what we mean.

I don't want it to feel the same way again when it happens. I don't want the same outcome to occur when it happens, right? And so that's something we can think about changing. We often can't prevent something from happening, but we can change our experience of it, or we can think about. how we could change our experience of it and do [00:58:00] something different with ourselves.

So find something that is meaningful and interesting and worthwhile for that downtime, so it is not just being stuck in the waiting room of life and feeling anxious and upset about it. Yeah.

Dr. Laura Bluestein: Yeah. I love that. That's really fantastic. And before we go, first of all, I just want to thank you so much, Dr.

Tuzza, for coming on and sharing all this fabulous, really, really important information with us. And I just want to know, are you working on any special projects, any, any, um, any research or anything that you're doing? And also, is there a place that people could find more about what you're doing and or more information about this topic in general?

Dr. Kaitlin Touza: Yeah, so I am, you know, my passion is really in clinical work and program development. So that's what I'm spending my time on. And the program development is probably the thing that's more interesting to other people. So I am, you know, trying to get education about this out there to health care providers and people in the community, [00:59:00] you know, families and the people who are dealing with chronic pain.

So. things like webinars, learning communities, those types of things are coming up. I am part of a teleconferencing program called TelePain that the University of Washington hosts, which is all about educating, especially the primary care and family medicine providers, about the management of chronic pain.

And people hear from a, you know, a panel of experts giving opinions on different aspects of pain management, including a couple from me about pain psychology. And so that's something that people can, you know, um, join and listen to and sometimes get some consultation on. So those are things that I'm very excited about.

Um, and, you know, I think as on the research side of things, that's not something that is as active in my, um, in my personal sort of wheelhouse of what I'm doing. But, you know, with colleagues, we are always looking for a way that we can ultimately provide these informations to people. We can give people the, ways that we can give the information to people [01:00:00] that will, um, reach the most people and also get that information out to rural areas of the state and the research that we would be doing on it to see if it's working.

You know, does this stuff actually help people to learn? Is it helping, you know, with patients to get the information that they need? That kind of stuff. So, uh, If you're wanting to know more about what I'm doing, you can look me up. I'm a very easy person to Google. My name is pretty unique. But also, you know, looking into what the University of Washington is doing and what webinars that, you know, the affiliated University of Washington, um, you know, organizations are engaged in.

So, um, that would be the way.

Dr. Laura Bluestein: Okay, great. And of course, you and I met through UW Telepaine and I, and I heard you give a lecture and I was like, Oh my gosh, this information has to be shared. with my listeners because it's so, so important. And I know how much it helped me to learn about these kinds of things when I was really, really struggling, um, a number of years ago in my own life.

And the UW Telepain program, is that something that's [01:01:00] open to patients and clinicians or because I know some people are going to say, Oh, that sounds really great. But, uh, if you can explain about that, maybe.

Dr. Kaitlin Touza: Yeah, that is geared toward physicians and providers. I should have mentioned that. Yeah, so it is, it's something that, you know, I don't know that a patient would find particularly useful because it's going to, you know, get into some of the minutia of, you know, things that are not relevant to treatment.

It's more to help the provider side of things, but it, the, you know, the reason why I mentioned that is because the more we educate providers, the more that trickles down to patients and getting good pain care, right? Yeah. Um, You know, if patients are looking for resources, there's more and more stuff out there, you know, out on the Internet there, you know, there's different organizations that are creating resources for patients.

And so, if you start Googling, you know, self help for chronic pain, you're gonna get some different resources that are that are useful out there. There's many self help manuals that I love that I think are great. Um, and so. The information is out there and [01:02:00] however you want to learn, you can find it. You can find videos on YouTube if you prefer that.

Like I mentioned, manuals, books, if you prefer to read. Um, and then, you know, just kind of keeping your eye out there for things like this podcast. There's a huge amount of education on this podcast and, you know, other podcasts about chronic pain and health. And so there's lots of ways to learn. You just kind of got to search

Dr. Laura Bluestein: for it a little bit.

And the audience is, it's fascinating because there are physicians who listen to this podcast, physical therapists, you know, uh, nurse practitioners, physician's assistants, you know, uh, psychologists, oh, and, and patients and caregivers. And so the, the community is really, uh, diverse. So, so that's, uh, so that's really great to have all that information.

Um, Dr. Tuzza, thank you again so very much. This was such a great conversation. And I know that, uh, people will benefit from hearing. Everything you had to share. So, so, so very much.

Dr. Kaitlin Touza: Thank you for having me. It's been truly my pleasure. It is my passion to get this info [01:03:00] out there and to help people, you know, connect with this stuff.

So truly my pleasure.

Dr. Laura Bluestein: Well, that was such a great conversation with Dr. Tuzza. I hope you enjoyed it as much as I did. I really feel like this information is so, so important and it is Important to use in the context of everything else that you're doing for your pain. So again, that acronym that I use, P is one of those letters, and it should be part of, I think, everyone's comprehensive treatment plan when it comes to addressing chronic pain.

And I just want to thank you for listening to this week's episode of the Bendy Bodies with the Hypermobility MD podcast. You can help us spread the word about hypermobility and related disorders by leaving us a review and following the podcast. This helps to really raise awareness about these complex conditions.

And you can follow me, Dr. Linda Blustein, on many different social media platforms. I'm really active on Instagram. I'm also on Facebook, LinkedIn, X, [01:04:00] and I think that's most of them. Um, you can also find human content by producing team at human content pods on TikTok and Instagram. And you can also find full video episodes up every week on YouTube and Facebook.

at Bendy Bodies Podcast. To learn about the Bendy Bodies Program Disclaimer and Ethics Policy, Submission Verification and Licensing Terms and HIPAA Release Terms, or to leave us a question, please visit bendybodiespodcast. com. Bendy Bodies Podcast is a human content production. Thank you for being a part of our community and we'll see you next time on the Bendy Bodies Podcast.

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