Why can pain suddenly feel harder to manage in your 40s or 50s - even when scans show nothing new?

Pelvic health physical therapist Dr. Anne Collins Duch joins Holly Osborne and Dr. Megan Steele to explain how hormonal fluctuations during perimenopause and menopause may affect the nervous system, joints, sleep, pelvic health, and pain sensitivity.

The conversation explores menopausal hormone therapy, vaginal estrogen, bone health, chronic UTIs, and why treatment decisions should be based on each person’s risks, symptoms, and goals. You’ll also learn why strength training does not have to mean lifting the heaviest weight possible, and how bodyweight exercises, resistance bands, heel drops, and modified movements can still support muscle and bone health.

Anne and Megan also share practical ways to work with pain rather than pushing through it, including improving sleep, supporting bowel health, adjusting exercise during a flare, and tracking small signs of progress. If menopause has changed how your body feels or responds to movement, this conversation offers a more flexible path forward without asking you to give up the activities you love.

Guest: Anne Collins Duch, PT, DPT

Dr. Anne Collins Duch is a board certified pelvic health physical therapist and an E-RYT 500 hour yoga teacher with 27 years of experience in treating a wide variety of pelvic health conditions. Her Wilmington, Delaware private practice is housed within a vibrant yoga studio where she is able to educate her patients and yoga students on the benefits of establishing a sound movement practice that integrates effective nervous system regulation strategies for a more complete whole body experience.

Dr. Duch has a special interest in the Polyvagal Theory, which led to the development of her virtual course offering, What Happens in Vagus Doesn’t Have to Stay in Vagus: Nervous System Regulation Course. She served as a panelist at the Endometriosis Summit, the Elhers Danlos Global Learning Conference, and the Pelvic Global Menopause Conference and presents to various professional organizations and fellow clinicians about pelvic health topics, as well as the use of vagal toning strategies as part of their health and wellness management.

Physical Therapy for Women

Anne Duch, Instagram

Links to interesting things from this episode:

• “What Happens in Vagus Doesn't Have to Stay in Vagus.”
• “Estrogen Matters” by Avrum Bluming and Carol Tavris
• Dr. Jen Gunter

Why does pain fade for some people but persist for others long after an injury?

Dr. Derrick Sueki joins Holly and Megan to explain how memory, associative learning, and emotional cues can influence chronic pain. Using examples from Pavlov’s conditioning research and his clinical work, he explores how fear, anger, sadness, loneliness, and shame may amplify pain responses.

The conversation also covers the difference between acute and chronic pain, why communication between patients and providers often breaks down, and how understanding a person’s “pain language” can support treatment. For clinicians and people living with chronic pain, this interview offers a practical reminder: empathy, safety, and hope can be important parts of the healing process.

Guest: Derrick Sueki, PT, DPT, PhD, GCPT, OCS, FAAOMPT

Dr. Derrick Sueki graduated from the University of Southern California receiving his Doctorate in Physical Therapy. He completed the Post Graduate Certificate Program in Physical Therapy at the University of South Australia with a special emphasis in Manipulative Therapy and Pain Mechanisms. In 2016, he successfully defended his PhD dissertation studying the role of memory, trauma, and injury on pain and muscle responses.

Since 1999, he has been a primary instructor in the Department of Physical Therapy at Mount Saint Mary’s University and in 2015, he accepted a professorship in the Department of Physical Therapy at Azusa Pacific University.

Dr. Sueki is a chief editor of two orthopedic textbooks, Orthopedic Rehabilitation Clinical Advisor and the Orthopedic Physical Assessment Atlas and Video. In addition, he has authored and contributed to numerous chapters in orthopedic and rehabilitation texts, and peer reviewed journals.

Dr. Sueki is currently serving as Chair for the Orthopedic Specialty Council and serves on California State Physical Therapy Association's Research Council. Since 2001, he has been a primary therapist for the Association of Volleyball Professionals and current serves as their Southern California Medical Coordinator. In the past, he has also served as a consultant for the Chapman University's Women Basketball and Volleyball programs. He is a certified Orthopedic Clinical Specialist and a Fellow of the American Academy of Orthopedic Manual Physical Therapists.

Dr. Sueki is a noted leader, author, researcher, and expert in the field of chronic pain and the pain sciences having presented at both the national and local levels. He is currently on the work group to develop practice guidelines for physical therapy management of chronic pain.

Knight Physical Therapy

Links to interesting things from this episode:

• “The Five Love Languages: How to Express Heartfelt Commitment to Your Mate” by Gary Chapman

Chronic pain can change how you see your body, connect with a partner, and experience sex, but it doesn’t mean intimacy is over.

Licensed sex therapist and clinical sexologist Dr. Deborah Caust joins Holly and Megan to explain how pain, stress, body image, medication, and caregiver dynamics can affect sexual desire and response. They discuss how the nervous system influences arousal, why touch may help reduce pain, and how couples can move beyond an all-or-nothing view of sex.

You’ll learn practical ways to reconnect with your body, communicate with a partner, explore touch without pressure, and redefine intimacy around what feels possible now. Whether you’re partnered or single, this conversation offers a realistic starting point for rebuilding pleasure, trust, and connection while living with chronic pain.

Guest: Dr. Deborah Caust, Ph.D.

Dr. Caust holds a Doctorate in Sexology from the Institute for Advanced Study of Human Sexuality and a Master's in Counseling from San Francisco State University, specializing in marriage, family, and child counseling. She is a licensed psychotherapist and works with clients through her private practice. She is board-certified by the American College of Sexologists, a Diplomate of the American Board of Sexology, and a Fellow of the American Academy of Clinical Sexologists. Dr. Caust has also taught human sexuality courses at several California universities, and served as President of the Northern California Chapter of the Society for the Scientific Study of Sexuality. She is a member of the California Association for Marriage, Family Therapists and the author of the Q/A column “SexSense.”

Deborah Caust, website

What if stress isn’t something to eliminate, but a signal your body can learn to navigate?

Stress scientist and leadership advisor Dr. Alexandra Crosswell joins Holly Osborne and Dr. Megan Steele to explore the connection between chronic stress and chronic pain. They discuss why a healthy nervous system is flexible rather than calm all the time, how reframing manageable challenges can change our response, and why positive thinking has limits during illness, loss, and uncertainty.

Learn how sleep, movement, nutrition, progressive muscle relaxation, and recovery time can support the body during prolonged stress. You’ll also hear practical ways to work with uncertainty, focus on what you need today, and build resilience without dismissing difficult emotions. A helpful conversation for anyone living with pain, stress, or uncertainty who wants realistic ways to care for their well-being.

Guest: Dr. Alexandra Crosswell, Stress Scientist

Dr. Alexandra Crosswell is a psychologist and stress scientist, as well as a sought-after keynote speaker and corporate advisor. She has spent her career studying how stress shapes human behavior. Her training began at Duke University, and she went on to earn her Ph.D. from UCLA. After spending 15 years in a rigorous academic career studying stress and resilience funded by the National Institutes of Health, Dr. Crosswell began working with corporations and organizations to change the narrative around stress. Translating cutting-edge research into actionable insights, she enables leaders to operate more consistently and effectively while facing the demanding economic, societal, and technological pressures of today.

Alexandra Crosswell, website

Alexandra Crosswell, Substack

Links to interesting things from this episode:

• Wendy Berry Mendes’ Emotion Health Psychophysiology Lab
• “Rethinking Butterflies: The Affective, Physiological, and Performance Effects of Reappraising Arousal During Social Evaluation”
• “Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America” by Barbara Ehrenreich
• “Explain Pain” by Dr. David Butler and G. Lorimer Moseley
• Elissa Epel, Ph.D., an international expert on stress
• Dr. Martin Picard
• “The body does not keep the score: trauma, predictive coding, and the restoration of metastability”

Why do sexual minority youth and young adults report significantly higher rates of chronic pain - even when there may be nothing “biologically different” about sexual orientation itself?

Pain researcher and nurse Dr. Ian A. Lane (“The Gay Pain Guy”) helps make sense of what the data is starting to show: elevated rates of headaches, musculoskeletal pain, and pelvic pain across LGBTQ+ communities, alongside real barriers to care like stigma, misgendering, and not feeling safe in medical settings. This conversation connects the dots between pain science and lived experience - how minority stress, identity concealment, and lack of social support can shape the nervous system, influence threat detection, and change the course of pain over time.

You’ll also hear practical takeaways for patients and clinicians, including what helps people feel safer in healthcare environments (from inclusive intake forms to simple visual signals), why “0–10 pain scores” can miss the point for chronic conditions, and how supportive human connection can reduce suffering.

If you’ve ever wondered why some communities carry a heavier pain burden, what respectful care can look like, or how to move from “just surviving” toward a bigger life with pain, this conversation offers a grounded place to start.

Guest: Dr. Ian A. Lane, Clinical pain scientist and board-certified pain management nurse consultant

Ian A. Lane, PhD, RN, PMGT-BC, is a nursing epidemiologist, measurement scientist, and board-certified pain management nurse consultant. His work focuses on chronic pain, behavioral health, and LGBTQ health disparities.

Dr. Lane is especially interested in how persistent pain intersects with identity and healthcare experiences among LGBTQ people. He maintains an independent clinical practice focused on supporting individuals living with chronic pain and behavioral health challenges.

Ian A. Lane (The Gay Pain Guy), Instagram

“Clinical Appraisal” podcast hosted by Ian A. Lane

“Pain, Power & Pride” by Ian A. Lane

Links to interesting things from this episode:

• “Chronic pain in transgender and gender diverse youth: A mixed-methods investigation.”
• Thundermist Health Center
• Fenway Health Clinic

What if pain relief isn’t only about fixing tissue, but also about restoring flow, energy, attention, and trust in your body?

Acupuncture, Qigong, and physical therapy experts explore how Chinese medicine approaches chronic pain. Learn how qi is described in Chinese medicine, why “stuck” energy is often framed as a source of pain, and how practices like acupuncture and qigong aim to support healing by improving circulation, regulation, and resilience.

The conversation also covers practical takeaways: how qigong can be adapted for different abilities, why consistency matters more than a quick fix, and how community and the patient–practitioner relationship can influence outcomes.

Whether you’re new to Chinese medicine or looking for complementary tools alongside Western care, this interview offers a clear, grounded look at how people use these methods to manage chronic pain over the long term.

Guest: Kirstin Lindquist, Business Owner, Acupuncturist & Intuitive Trainer

Kirsten is a licensed acupuncturist (California Acupuncture License #4661) and practitioner of Traditional Chinese Medicine with more than 30 years of experience helping people remove old patterns and reconnect with their true nature. Through acupuncture, qigong, and the teaching of intuition and personal energy management, she guides patients toward lasting health and personal transformation. Kirstin practices relational medicine, bringing deep presence and compassion to every patient interaction. She holds a Master's degree in Traditional Chinese Medicine from the Academy of Chinese Culture & Health Sciences and a bachelor's degree in Political Science from Stanford University. Today, she specializes in helping patients address metabolic health challenges - including high blood pressure, blood sugar, triglycerides, and other cardiometabolic risk factors - using evidence-informed, natural approaches.

Energy Matters, Website

Energy Matters, YouTube

Guest: Gail Whang, Teacher of Dayan "Wild Goose"​ Qigong

Gail is a certified Dayan Qigong instructor and former educator who spent 30 years teaching in the Oakland Unified School District. After retiring, she discovered qigong—a practice that transformed her from a lifelong multitasker into a more mindful, balanced, and present person. Inspired by its profound impact on her health and well-being, Gail completed a year-long teacher training program at the Wen Wu School to become a certified instructor. Today, she is passionate about helping others experience the physical, emotional, and energetic benefits of qigong, empowering them to cultivate resilience, self-healing, and a more positive approach to everyday life.

Gail Whang, YouTube

9-week Beginner Qigong Online Class

Links to interesting things from this episode:

• “The Intriguing Health Benefits of Qigong” The Wall Street Journal
• “Qigong and Tai-Chi for Mood Regulation”
• “The Treatment of Depressed Chinese Americans Using Qigong in a Health Care Setting: A Pilot Study”

Every pain you’ve ever felt is sent by, communicated through, or interpreted by your nervous system - so when pain becomes chronic, the nervous system often becomes the main story, not just the injured tissue.

Dr. Megan Steele breaks down how the nervous system is organized (central vs. peripheral), why “fight or flight” isn’t the enemy, and what it really means to build a *flexible* system that can shift between activation and recovery. The conversation also unpacks central sensitization - when the alarm stays loud even after healing - and how stress, sleep, digestion, and past experiences can influence the body’s threat detection.

You’ll also get clear guidance on a common internet claim: that trauma is “stored” in muscles and can be released through dramatic bodywork. Learn what’s supported, what’s risky, and what questions to ask any practitioner so you stay safe and supported.

Links to interesting things from this episode:

• “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk
• WHOOP band
• Ōura Ring

What if 7 minutes of birdsong could measurably reduce muscle tension and help you think more clearly when pain or stress is running the show?

Chronic pain can shrink your world fast: sleep gets disrupted, stress stays high, and it becomes harder to access the “thinking brain” needed for work, relationships, and decision-making. Holly and Dr. Megan explore a practical, research-backed reset that doesn’t require special equipment, long workouts, or perfect weather: intentional exposure to nature.

You’ll learn what “forest bathing” actually is, why natural patterns like fractals may calm the brain, and how simple options like morning light, a slow walk, indoor plants (yes, even realistic fake ones), or a short nature-sound break can support stress regulation and recovery. The discussion also clears up a common question: is it true that weather changes can make pain worse? (Spoiler: you’re not imagining it.)

Links to interesting things from this episode:

• “The role of sunlight in sleep regulation: analysis of morning, evening and late exposure” BMC Public Health
• “Nature and the Mind: The Science of How Nature Improves Cognitive, Physical, and Social Well-Being” by Marc Berman
• “The Efficacy of a Brief Nature Sound Intervention on Muscle Tension, Pulse Rate, and Self-Reported Stress” by Erin Largo-Wight, PhD, Brian K. O’Hara, MD, and W.William Chen, PhD
• “View Through a Window May Influence Recovery from Surgery” by Roger S Ulrich
• Doctor Susan Abookire and the Nature & Systems Institute