0:01

Ted Audio Collective Hey,

0:17

Ted Listers, it's Dr. Shoshana. When

0:20

I imagine pain, it's usually that

0:22

ouch moment from smashing my toe

0:24

on a coffee table or

0:27

the pounding in my temples after a long day

0:29

at work. But what if

0:31

we've gotten it all wrong? In

0:34

her TED 2023 talk, pain

0:37

specialist Dr. Amy Baxter throws us

0:39

a curveball. What

0:41

if pain isn't just an annoying

0:43

buzzer to shut off, but

0:46

more like Survival 101? And

0:49

what if our pain is actually informed

0:51

by so much more than a single

0:53

inciting incident? Take

0:55

a listen to hear how we may have

0:57

a bigger say over our aches and twinges

0:59

than we ever realized. This

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savings will vary. So

3:06

if you whack your thumb with a hammer, you

3:09

think pain is in your thumb. Physicians

3:12

have a more sophisticated understanding. We

3:14

know that it's an alarm that

3:16

goes on nerves to your spine

3:19

where it is translated to your brain

3:21

and pain actually happens. Somewhere.

3:26

It's a little vague. We actually only get

3:28

two days of pain education throughout all of

3:31

medical school. So, in fact,

3:33

the only pain lecture I remember

3:35

from the 90s was in

3:37

a dark room after being awake for 30

3:40

hours and hungry. Finding

3:42

out our noon lecture was sponsored

3:46

by OxyContin. We got

3:48

pens. We got great lasagna. And

3:50

they had very cool slides that

3:53

showed pain stop by

3:55

opioids. And we learned that

3:57

home opioids aren't addictive. And

3:59

if you. you stay ahead of pain,

4:02

you can keep your patients pain free.

4:06

And beyond the obviously egregious

4:08

marketing, I think it was framing

4:10

pain free as the goal that

4:12

has destroyed countless lives. My

4:16

friend, son Christopher, started

4:18

having severe abdominal pain during this

4:20

no pain era. Eventually,

4:23

he was diagnosed with a colon disease and

4:25

had surgery his senior year. He

4:28

sent Christopher home with 90 OxyContin

4:32

and then 90 more. And

4:34

then as the pain started getting faster

4:36

and faster, uncontrolled

4:38

pain is terrifying. So

4:41

when his ran out and his friend's

4:43

medicine cabinets ran out, Christopher

4:45

tried heroin. And

4:47

Christopher Wolfe lost his battle with substance use

4:49

at age 32. So

4:53

did we misunderstand pain? What

4:57

if pain isn't an alarm

5:00

to silence, but a learning

5:02

system for survival? Pain

5:05

is every organism's primary learning

5:07

system for survival. I

5:10

mean, it's like, ouch, don't touch that. Or

5:12

to paraphrase the princess bride,

5:15

life is pain, highness. Pain

5:19

free was marketing. And it made physicians think

5:21

that one pill could solve pain. It

5:23

still makes people feel like you can't be

5:25

happy if you have some pain. And

5:29

we now know that if

5:32

you want to move past pain, it takes work. Setting

5:35

the bar of pain free was too

5:37

high. Plenty of people could have been

5:39

more comfortable, but

5:41

they gave up because pain free was out of reach. We

5:44

have really good new information

5:46

that I'm going to share. And so

5:49

from now on, I want you to

5:51

think about pain as a Venn diagram

5:53

with physiology, fear, and control. I'm

5:56

going to tell you how each of these can give you

5:58

power over pain. Right

6:00

now, I'm translating these in my research

6:02

into a low- higher

6:22

balance. I was ignoring that to think

6:24

about pain. And when I

6:26

got home and reached for the door in my house, my

6:29

hand was numb. Vibrations.

6:34

So I burst in, my boy

6:36

scout husband grabbed some frozen peas,

6:38

and we had ourselves a genuine

6:40

eureka moment where cold

6:42

and vibrations lacked pain. Over

6:45

the next decade, I found the

6:48

right frequency to block pain. I got a

6:50

grant, and I created Buzzy, which

6:52

is vibration plus ice

6:56

in a B shape. And you put it

6:58

on your arm when you're getting an injection, and

7:00

to date, 45 million needle procedures

7:03

had decreased pain, and over 80

7:05

randomized controlled trials, independently

7:07

all around the world, have been published. But...

7:16

At about 30 randomized controlled trials

7:18

in, one of my colleagues came

7:20

to me and confided that he

7:22

was in opioid recovery. And

7:24

he asked whether or not Buzzy could let him get through

7:27

a total knee replacement drug-free.

7:32

I'd never thought about it. It's the

7:34

same pain nerve for knees as for

7:36

needles. So I said, maybe. And

7:40

he did it. Vibration

7:42

plus cold replaced OxyContin.

7:50

So at that point, I went all in

7:52

to figure out why. And

7:54

here is what we know. So

7:56

the reason that vibration decreases pain is because of the

7:59

pain of the brain. because the physiology of

8:01

the nerves of light

8:04

touch, pressure, stretching, and motion

8:06

all race pain to the

8:08

spine. People have

8:10

tried electricity to trigger the light touch

8:12

nerves, but we now know that motion

8:14

is what's most effective at shutting

8:16

the gate on sharp pain. This

8:19

is called gate control, and the

8:22

exact right frequency of vibration triggers the

8:24

nerves that decrease pain. The

8:27

physiology of ice is different. So

8:30

the cold goes up to the

8:32

brain where the conductor goes obnoxious

8:35

but not dangerous. I will

8:37

decrease sensations coming from everywhere,

8:39

and it decreases pain everywhere. If

8:44

a child was so freaked out

8:46

from previous experiences that even the

8:48

swab hurt, physiology

8:51

wasn't as helpful. So we

8:53

added distraction like a monkey poster, and

8:55

what we discovered was combining

8:58

counting plus making

9:01

a decision, cut pain in half.

9:04

Here is your pain hack for the day, though. If

9:06

you do not have monkeys on

9:09

hand, then find any sentence and

9:11

count how many of the letters have

9:13

holes in them. I

9:16

guarantee you and your family will use

9:18

this. The

9:21

biggest hack, though, is understanding

9:23

why distraction works. And

9:25

now through functional MRI,

9:27

we can actually see pain

9:30

happen, and it's not

9:32

one place. Pain

9:34

is a symphony of connections

9:36

from the sensation area to

9:38

the conductor to the decision

9:41

switchboard and then to fear,

9:43

memory, meaning, control. So

9:46

if the decision switchboard is

9:48

occupied sorting monkeys, it can't

9:50

notify fear and meaning and

9:53

you feel less pain. What

9:56

you feel is mostly

9:58

what you expect to feel. All

10:00

right, stay with me. If

10:03

you're a kid, the same punch hurts more

10:05

from a bully than from your buddy. And

10:09

if you're an adult and you feel something the

10:11

second you think it's cancer, it hurts

10:14

more and more until you

10:16

find out it's not. And

10:19

those same kids who had horrible

10:21

shot experiences can tolerate all kinds

10:24

of needle pain because

10:29

it is a different context. These

10:32

patterns called connectons are

10:35

very personal because experiences lay

10:37

down more of

10:39

the same sensation. And we

10:41

now know that people who have certain

10:43

areas in the brain connected feel more

10:45

pain than people with

10:47

different areas connected. And

10:50

more importantly, untreated pain or intense

10:52

pain can lay down heavier

10:55

connections so that even when your

10:57

body is healed, you will still

10:59

feel more pain. It's

11:02

this very plasticity and personalization

11:04

which makes the physiology, fear,

11:06

control matrix so useful. Because

11:11

choosing physiologic options that you

11:13

can layer that work for

11:15

you decrease pain, like

11:18

heat, cold, vibration,

11:20

deep relaxation, acupuncture,

11:23

capsaicin, exercise, meditation,

11:26

there's more. Christopher probably had

11:28

ten of these around his house and

11:30

just didn't know it. Having

11:33

control over your options decreases

11:35

pain. Deep breathing

11:38

increases control. Choosing

11:40

what to focus on increases control.

11:45

Fear and control are the volume

11:47

knobs for pain. Fear

11:50

controls so many of our sensations. This shouldn't

11:52

be unusual, but we don't practice it for

11:54

pain. So if you're home

11:56

alone and you hear a plump. Your

12:00

hearing becomes hypersensitive. But

12:04

when you remember your kids home from college, your

12:07

fear dials down and your brain overrides

12:09

it and says, don't worry about it. St.

12:13

Augustine called pain the greatest of evil.

12:17

But if it is a survival system, it

12:19

cannot be all evil. So

12:22

instead, think of pain as your nagging,

12:25

safety-obsessed, exaggerating

12:27

friend who's sometimes wrong.

12:31

And it's okay to ignore or override your

12:33

friend if you know that you're safe. This

12:37

takes practice. In

12:39

a flight that was turbulent, I had

12:42

an entire cup of scalding hot coffee

12:44

dumped straight on my ankle. Electric

12:47

jolt through my scald. I ripped off my sock.

12:50

It was already red. It

12:52

was going to blister. There was no way I

12:54

could get my foot into that little sink to

12:56

get cold water on it. And

12:59

then I remembered, physiology

13:01

hacked. I

13:03

had an open cold beer. Medical

13:07

grade cold beer went on my ankle,

13:09

stat. I

13:12

had a vibrator in my carry-on because

13:14

I would on my ankle.

13:17

And then... The

13:21

pain kind. And

13:23

then my fear hack, I'm like, there's

13:26

a barf bag that has holy letters, but I'm

13:28

going to put it in the pocket pouch and

13:30

save it because then I have increased control. And

13:33

pain MacGyver, I was no

13:35

longer that concerned. Although

13:44

then I realized I'm that guy with my

13:46

bare foot sticking out in the aisle on

13:49

a plane with a beer on it.

13:55

Power over pain isn't always pretty, but

13:58

it is possible. And it

14:00

is absolutely critical. Because

14:02

there's one more misconception we have not

14:04

talked about. I

14:07

honestly thought that opioids turned off some

14:10

pain switch. They

14:12

turn on our reward system. So

14:15

some people feel amazing, but

14:18

most people just still feel pain

14:20

but don't care. Now,

14:23

this is a godsend for people with chronic

14:25

pain diseases. We shouldn't take them away. And

14:28

in the trauma bay, the more morphine

14:30

the first 24 hours after a burn

14:32

or a wound, the less

14:35

post-traumatic stress, the less chronic

14:37

pain later. But

14:39

studies show that recovery after

14:41

surgery is just as well

14:43

accomplished with coaching and physiologic

14:45

options. And if

14:48

you're one of the people who feel amazing

14:50

with opioids, it's too

14:52

risky. A study in 2019 found

14:54

that 1 in 15 young adults who

14:58

got opioids for their wisdom tooth removal

15:01

had substance use disorder within a year.

15:05

Any person works better. So

15:09

what do we do? Well, in

15:11

my dream world, we have health care systems

15:14

pay for options and coaching

15:16

for Christophers everywhere. And

15:18

we quit giving double digit prescriptions

15:21

for opioids for home recovery. In

15:24

the real world, 80,000 people died in the US last

15:27

year from opioid overdoses. And

15:29

80% of substance use disorders starts with

15:31

a pill prescribed for pain, usually

15:34

taken from your friend's medicine cabinet.

15:39

People can't afford options. Doctors

15:41

20 years later still don't know them. But

15:46

you do. You

15:48

all now know to throw away the opioids

15:50

in your medicine cabinet. You

15:53

now know that there are options you

15:55

can use to decrease pain. And you

15:57

know that pain free should be be

16:00

ditched for more comfortable. And

16:04

whether you dump skeleton coffee

16:06

or pain wakes you and

16:09

exhausts you every day, options

16:11

that are in your control can allow

16:15

you to reframe pain. Thank

16:18

you. Amy,

16:31

thank you. Really, thank you. It's amazing.

16:35

So how do you think that

16:37

pain scales have set us back from this

16:39

work that you're doing and how is the

16:41

NIH treating pain and addiction differently now? So

16:45

one of the 120 versions of

16:47

this talk, I talked about how

16:50

the thing is in the 90s, if we wanted to

16:52

disease-ify pain, it meant that we had to be able

16:54

to measure it. And so that

16:57

was where the faces scales come from. And

16:59

they're actually very useful in the emergency department

17:02

to tell whether or not a medicine is working. In

17:04

fact, we were one of the first ones

17:06

that showed the sickle cell that the patient's

17:09

report based on the scales was what was

17:11

most indicative of whether they needed to be

17:13

admitted rather than any biologic marker. But

17:16

what we're doing now is we're

17:18

using something called the promise

17:20

scales. So it's how intense pain

17:22

is on five-point scales, how

17:25

much it interferes. So there's pain interference,

17:27

pain intensity. And the way

17:29

we're looking at pain is much more on

17:33

the impact for the person rather

17:35

than trying to pretend there's

17:37

any kind of objective pain measurement.

17:41

And you mentioned that you're working on some new

17:43

applications for Buzzy, specifically for back pain.

17:45

What are some of the possibilities that

17:47

we have here for what this could

17:50

do for us in the future? Yeah,

17:52

on my tombstone is going to be a vibrating

17:54

V. It's actually called dual-sizing. It's a thermo-therm, not

17:56

Buzzy. But what

17:58

we've learned is that there are harmonics.

18:00

of interaction between the specific frequencies that

18:02

cancel out the pain. So there's one

18:04

particular nerve, the patineum, that has a

18:07

very specific frequency range, and

18:09

by causing them to interact, we're starting

18:11

to explore more about the pain that's

18:13

coming from the fascia between the skin

18:15

and between the muscles, but that area

18:18

is where we're unexplored.

18:20

And so by interacting with

18:22

different frequencies and then layering

18:24

heat or cold pressure options,

18:28

giving people the choice of so many different ways

18:30

to do it, it's really engaging

18:32

all the different areas of the brain from

18:34

which pain comes. Wow. Okay.

18:38

Well, thank you so much, Amy. Welcome. Thank you

18:40

all. This

18:43

show is brought to you by Schwab. With

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Schwab investing themes, it's easy to invest

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in ideas you believe in, like

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active lifestyle, healthy eating, wearable

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tech, and more. Ideas

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is or customize the stocks in a theme

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more at schwab.com/thematic investing.

19:06

That's it for today's episode. Thank

19:10

you so much for listening. This

19:20

episode was produced by the American Academy

19:22

of Education. And

19:25

it was produced by Dan O'Donnell and Pat

19:27

Jaffa by Vanessa Garcia Woodward. Special

19:29

thanks to Maria Lajes, Grace

19:32

Rubenstein, Farrah D'Grinch,

19:34

Jimmy Gutierrez, Donald Phelan, Michelle Quint

19:36

at Collin Health. I'm Dr. Shoshana Sperzator. Let's

19:39

talk to you again next week.