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Osteopathic physician Amelia L. Bueche discusses her article, “From skin to soul: What pain reveals about our health.” In this episode, Amelia delves into the skin’s role as the body’s largest organ and its rich network of nociceptors, which alert us to pain as a signal of both external threats and internal imbalances. Drawing from her experiences as both a patient and physician, she illustrates how surface-level pain can reflect deeper physical and emotional issues, from stress-induced eczema to pancreatic cancer manifesting as rib discomfort. Amelia highlights the importance of listening to these bodily messages and adopting a holistic approach to uncover root causes, offering listeners practical insights into enhancing their health through curiosity and awareness.
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Amelia L. Bueche. She’s an osteopathic physician. Today’s KevinMD article is “From skin to soul, what pain reveals about our health.” Amelia, welcome back to the show.
Amelia L. Bueche: Thanks so much for having me. Great to see you again.
Kevin Pho: All right, so tell us what your latest article is about.
Amelia L. Bueche: This one struck me from both a personal and a professional standpoint. I’ve been really exploring pain on lots of different levels. We talked most recently about this pain epidemic and pain medication use. And this one really was about how pain presents itself and the ways we can listen to the creative ways the body tries to get our attention.
Near the end of the article, I shared two experiences—one very personal to me as a second-year med student. I had this crazy case of eczema where everybody came into the room to see what was happening, and it was nonresponsive to all the usual treatments. Then once the first round of boards was over, it largely dissipated. Oh, I was probably experiencing a whole lot more emotional strain and pain than I realized, and my skin was the way that it was alerting me. That really tuned me in to different experiences with my children, with my patients, and just offering that up to the audience here of how we might listen, both as clinicians and within ourselves, to what the message is that that superficial layer might be offering about a much deeper issue.
Kevin Pho: You always say that the skin is the largest organ. Why is it such an effective messenger for whichever health issue, both internal and external?
Amelia L. Bueche: Well, we can see it, right? I think that’s the key part because a lot of times we need to be alerted in a very key and core way. So it might be through a rash; it might be through pain. Because it’s the largest organ, it’s also the largest site of nociceptors—it really is where pain is at its highest concentration.
When I was on an inpatient service for osteopathic manipulation, we would treat patients postoperatively, and there’d be an incision. A lot of times, the biggest area of aggravation in their nervous system was from the incision, right? Because the skin had literally been aggravated by the scalpel. So going to the correlating area in the spine to calm down the sympathetic nervous system was one of the most important pieces. We would talk to them: you know, this is really where the pain is generated. Yes, the more major part happened on a deeper level, but the skin really holds such a high concentration of that pain information. It’s what can clue us in to how we’re doing. I think the messenger really is the visibility, and it has the greatest chance of getting our attention through those pain receptors.
Kevin Pho: Now, through your practice, have you encountered other cases where a skin condition could be a manifestation of something psychological, similar to the story that you shared?
Amelia L. Bueche: Absolutely. One that I shared in there was more of a physiological concern. A patient came in with rib pain, which is pretty typical for a neuromusculoskeletal medicine specialist, and it would be highly expected that I would put my hands on and treat the rib and it would be better.
But as the story came out, as I was listening to what was accompanying this rib pain, it was almost a classic board case of pancreatic cancer, unfortunately. At least it was able to be treated for this patient, but her rib did hurt—that was true, right? And so that’s the other important thing: the pain is real, but the message is coming from somewhere else. Our pancreas can’t tell us much from the inside, so it’s finding its way through different pathways to the surface level to express that.
Absolutely, different rashes and skin manifestations come through from stress, anxiety, and depression, really drawing attention in that way. One of the classic ways that we see that is through hives. Let’s say you’re about to give a presentation and your body just reacts with this big red rash. You get sweaty, you get inflamed, and it’s alerting you to a sense of lack of safety on the inside. In that setting, you could reassure yourself—nothing untoward is going to happen, maybe some embarrassment, maybe some heckling at the worst—but that’s also our body’s natural physiological response to something that feels threatening.
It alerts us on a superficial level, again, because we can see it, or those around us can see it and say, “Hey, you look different. Is something else going on?” We can begin to explore. That’s my hope in sharing this article—that as physicians, we can take some of those manifestations and ask a little bit more about that. I’m a member of Physician Mom’s Group—one of the largest medical groups for physicians on Facebook—and derm is always the highest query, right? Some of it is very classic: it just is this. But if we can sometimes turn that novel a little bit and say, “Well, what else might be here?” The derm-psych connection is really powerful in alerting ourselves to that. Also, there’s a degree of wellness—the state of our skin can also tell us just globally how our body is doing. That can be both physical health, but also mental health as well.
Kevin Pho: So I’m a primary care physician, and for those other primary care physicians who may be listening to you, someone comes in with a rash or a skin condition, some type of superficial pain—what are some other questions that we could ask them to potentially uncover something underlying?
Amelia L. Bueche: Absolutely. I think it’s important to start with some of the basics. For me, for example, with the eczema, it also was wheat-driven. I learned later in my life that I had a gluten sensitivity that I didn’t realize. So some of those more basic things—what has changed in your life, that could be food, chemicals, lotions, whatnot.
But then also what else has changed, right? Did you move? Has there been a change in your relationships? How’s your sleep? If we’re seeing that rashes or joint pains are presenting, that’s a really superficial-level thing as well for muscle tightness, and even asking a little bit more about what’s happening in their life.
We know we have a lot to unpack and manage in short intervals of time, but if we can get to the core of what’s happening, we might save ourselves multiple visits or spinning the wheels or having to apply medications that really aren’t effective because that’s not the core of what’s happening. Finding out what’s changed in your life and thinking about when this rash happened, or when this pain and this tightness in the muscles began—is there any corollary of events that happened as well?
Stress is key and core, and we know stress is at an all-time high right now. We’re seeing a lot of tumult in the country—2025 has all kinds of interesting energy—and so holding a little bit of space to say, “What else might be contributing?” And it might not just be one thing, but it might be what is exacerbating this, and can we mitigate some of that so you’re not totally inundated? Because when you have a rash or pain at a muscle level, it is highly distracting. People become less productive, they’re irritable with their families—it can be really detrimental to their health on a broad scale. Often that space to inquire is really powerful.
Kevin Pho: You alluded to that story you talked about in the article about a patient’s skin condition that ultimately led, unfortunately, to pancreatic cancer. Tell us the steps in between that led to that connection.
Amelia L. Bueche: Yeah, absolutely. I went from working in a very large health care system in Michigan and moved to Oregon. It was a solo private practice, and it was kind of a flip for me. In the large health care system, I was always the last physician anyone saw—they had all the studies, the surgeries—and so I was really the initial workup for anything, which was OK in my consultancy where I moved in Southern Oregon.
I was often the first physician, because people were somewhat skeptical of the traditional medical system, and I was on that fringe—”OK, you’re a doctor, but you seem to have an alternative approach.” So I was getting all these cases, and this was one that just struck me. This person presented with rib pain and had been seeing a number of different alternative providers and having different treatments applied, expecting to come to me and have a hands-on treatment for this rib pain to alleviate it.
But her story was almost textbook for what pancreatic cancer would present as. For her, the rib pain was real, and it’s important to validate that—yes, this is true, and I can palpate here, and I can see it feels different, right? I could treat it, but I’m not going to solve the issue, and it’s going to keep coming back. Also, thank goodness you’re being alerted to this pain because it’s telling you now that something else is happening deeper in your body.
Again, oftentimes we don’t know because the pancreas doesn’t have a whole lot to say—doesn’t have a whole lot of pain that’s going to come until it has really amassed itself. This is actually a great messaging system. From there, we were able to initiate appropriate workup and evaluation and treatment, and actually, the patient did well—survived—which is sometimes not the case with pancreatic cancer. That alert at the superficial level, maybe sooner than having waited for the organ to really demonstrate dysfunction, was quite helpful for her.
Kevin Pho: Now, you’re an osteopathic physician. Are there specific things about osteopathic education that make you more attuned to dermatological and musculoskeletal manifestations of underlying disease?
Amelia L. Bueche: Absolutely. One of the first things we learn in medical school is palpation skills. We’re looking for tissue texture changes—when we get to the skin level, we just drag our hands down and say, “Is it warm? Is it boggy? Is there a ropey texture here?” We’re asking, “What is this telling us about something deeper in the body?”
It could be telling us about the vertebral structure, but usually it’s from the nervous system alerting us, right, to the different organs and the different ways the patient is balancing out their nervous system. So, yes, from the very beginning, we’re asking, “What at the surface level is telling us about what’s deeper within the patient?” Then on a broader scale, “What, too, are we learning about the body-mind-spirit connection—how is this all being impacted?”
For me, the osteopathic approach is for everyone—for physicians of all sorts and degrees but for everybody to learn how to listen to what our body is telling us and what’s being connected mentally, spiritually, and emotionally as well.
Kevin Pho: As you know, there is an epidemic of chronic pain—that is one of the more common reasons why people come to see me in primary care. Comment about the missed opportunities that we have in terms of just looking at the pain itself and maybe looking beyond that to see what underlying conditions that pain may be masking.
Amelia L. Bueche: Absolutely. It’s interesting—I’m in this new space and phase of creating “the pain detective,” because that’s what it feels like a lot of times, just getting deeper into the layers, even recognizing what pain is. Some of the things we’ve described, you might not identify as pain. I had nummular eczema; it was a rash, it was irritating and painful, but that’s also a manifestation of strain in the system.
Acknowledging what pain even is for us, then what it’s telling us and how we process it. For me, I didn’t realize—I never identified as a person who was stressed out taking tests, but clearly on some subconscious level it was a big deal. Maybe I felt ill-prepared. I’d never taken a board exam before.
Being able to tune in to, “Something’s going on—my body is alerting me to this. What else might be bothering me?” If I panned out a bit more, we looked at food and exposures, but we didn’t necessarily say, “What else is going on in your life?” At that point, boards were so prevalent, you almost don’t notice it’s happening, but it was a new experience.
Being able to tune in to the fact that external circumstances do influence my health, and I couldn’t undo the fact that I had to take boards, but perhaps I could say, “Hey, I am stressed out about this,” and it’s OK—that’s normal. Holding space for that. It’s not always about jumping to feeling better, but sometimes understanding why can be alleviating. It wouldn’t necessarily have undone the dysfunction in that moment—the end of boards was where the rash began to resolve. But knowing, “Oh, this makes sense because I’m in a stressful experience and this is how my body is manifesting it,” can be huge. It was distressing going to appointment after appointment, trying all these different treatments, having no answer. Sometimes having the answer, even if it doesn’t resolve the condition right away, can provide a lot of internal relief.
I think that’s one of the key pieces we have the opportunity to offer our patients.
Kevin Pho: We’re talking to Amelia L. Bueche. She’s an osteopathic physician, and her KevinMD article is “From skin to soul, what pain reveals about our health.” Amelia, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Amelia L. Bueche: I think just gratitude for the power of the skin and what it has to offer us, and doing some gentle, general inspections. If you encounter something in your body that’s unusual or abnormal—yes, ask questions about what has changed in my life. But take that word “exposure” to a broader scale: what are the different stress exposures? What environmentally is happening? What emotionally is happening?
Offer that up in the clinical space—be a little more curious as physicians to say, “If I’m seeing this and it’s puzzling to me, or maybe it seems like a classic rash, I’m going to ask some deeper questions to give my patient the best chance to have a comprehensive recovery from their challenges.”
Kevin Pho: Amelia, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Amelia L. Bueche: Thanks so much.
