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The Psychology of Pain · Why We Do What We Do

• 0:03
  Speaker 1: You're listening to why we do what we do? Welcome
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  Speaker 1: to why we do what we do. I am your
• 0:21
  Speaker 1: herding host, Abraham. That was kind of a zombie growl.
• 0:23
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• 0:25
  Speaker 2: I mean I feel like zombies could be in pain.
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  Speaker 1: about how to celebrate that, if you will. So, yeah,
• 3:14
  Speaker 1: today's topic we are getting into is one that you
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  Speaker 1: might maybe not necessarily think of as being directly related
• 3:21
  Speaker 1: to psychology, or maybe you do.
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  Speaker 2: I don't know.
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  Speaker 1: I don't know how you feel about these things. But
• 3:26
  Speaker 1: we're talking about pain and it is I hope we
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  Speaker 1: get this. We do this one justice. It is kind
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  Speaker 1: of a difficult topic and there's a lot. There's a
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  Speaker 1: lot that could be said about it. Pain is a
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  Speaker 1: nearly universal experience for humans and we all universally pretty
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  Speaker 1: much hate it. Yeah, although there are people who find
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  Speaker 1: joy and pain, and we're not going to really get
• 3:48
  Speaker 1: into that. Also, I think we can understand and appreciate
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  Speaker 1: the usefulness that the role pain can play during our lifetimes.
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  Speaker 2: Yeah, absolutely, So it is an interesting I'm on physically
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  Speaker 2: maybe neurologically so to speak, and psychologically that we still
• 4:05
  Speaker 2: don't really understand. And that's kind of an interesting thing
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  Speaker 2: about like bodies. I don't know if you all pay
• 4:10
  Speaker 2: attention to like studies that come out, but like we
• 4:12
  Speaker 2: discovered new things about human bodies all the time, true,
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  Speaker 2: and it's because we really don't understand very much about
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  Speaker 2: like how an electrified meat mech is walking around and
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  Speaker 2: thinking and crying. You know, it's a strange thing.
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  Speaker 1: It is, And so we will do our best to
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  Speaker 1: explain the ins and outs of pain and one single discussion.
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  Speaker 1: Although there are entire organizations and lines of research that
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  Speaker 1: all they do is study pain, entire podcasts where the
• 4:40
  Speaker 1: whole podcast's existence is just to talk about issues as
• 4:44
  Speaker 1: they relate to pain. There are journals scientific journals that
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  Speaker 1: all they do is publish research on pain, So check
• 4:51
  Speaker 1: those out for more information if you are interested in
• 4:54
  Speaker 1: learning more about this topic. After we've gotten you very
• 4:56
  Speaker 1: curious from this discussion. Maybe or just because you heard
• 4:59
  Speaker 1: us talk about it and told you to go check
• 5:01
  Speaker 1: it out. I don't know, but yeah, that's what we're
• 5:03
  Speaker 1: going to try and take on in one single discussion today.
• 5:06
  Speaker 1: I think, well, we won't need to make this a
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  Speaker 1: two parter. It's not super long. Yeah, although that is
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  Speaker 1: always the case to just cursed that and then I
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  Speaker 1: dis cursed it. Yeah. So yeah, pain is an interesting topic.
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  Speaker 1: Let's go ahead and get into it to try and
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  Speaker 1: break that curse, shall we?
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  Speaker 2: Yeah, here we go. All right. So pain is an
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  Speaker 2: evolutionary adaptation. There are a few different ways that we
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  Speaker 2: experience pain, but broadly, it is a biological process in
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  Speaker 2: which a stimulus evokes behavior to reduce that stimulus.
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  Speaker 1: And that's an important part of this definition here. It's
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  Speaker 1: the biological process in which a stimulus evokes behavior to
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  Speaker 1: reduce that stimulus. The International Association for the Study of
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  Speaker 1: Pain told you there was one of those at least,
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  Speaker 1: defines pain as a quote unpleasant sensory and emotional experience
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  Speaker 1: associated with actual or potential tissue damage, or described in
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  Speaker 1: term of such damage end quote. And I mean you
• 6:04
  Speaker 1: hear that, and I feel like you sort of followed
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  Speaker 1: it and maybe your eyes glossed over at some point.
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  Speaker 1: There were some people who've at least added to or
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  Speaker 1: expanded upon this idea. So one physician thoughtfully, in my opinion,
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  Speaker 1: very thoughtfully argue that quote pain is whatever the patient
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  Speaker 1: says it is end quote, which I actually thought was
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  Speaker 1: a very kind of useful like clinical framework at least
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  Speaker 1: for orienting to the idea of pain. Yeah, as long
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  Speaker 1: as we have a colloquial understanding of what pain is,
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  Speaker 1: we just take our patient at their word, because that
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  Speaker 1: makes the most sense for being able to provide effective care.
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  Speaker 1: And then doctor Craig Freud and Rich Freud and Reich,
• 6:41
  Speaker 1: maybe I'm gonna say Freud and Rich he helpfully suggested
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  Speaker 1: a definition of pain that it is quote a warning
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  Speaker 1: sensation to your brain that some type of stimulus is
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  Speaker 1: causing or may cause damage, and you should probably do
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  Speaker 1: something about it.
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  Speaker 2: End quote.
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  Speaker 1: That what I think is maybe the most useful of that.
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  Speaker 2: Really like that one.
• 7:00
  Speaker 1: Actually, yeah, it's very good.
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  Speaker 2: Yes, yeah, you should probably do something about it. Now,
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  Speaker 2: there are arguments of confusion around the difference between perception
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  Speaker 2: and sensation. If there is a difference between these and
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  Speaker 2: whatever it is. Pain can be either or or both
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  Speaker 2: of those things. And we'll get into some of the
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  Speaker 2: psychological philosophy about this later, but it is worth noting
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  Speaker 2: that the sensation of pain is called na susception.
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  Speaker 1: Yeah, you may hear us say that sometimes because we're
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  Speaker 1: referring to it. The Latin root of this means hurt
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  Speaker 1: while I looked at it up that far, But that
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  Speaker 1: is no suception or a suception, whichever one it's supposed
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  Speaker 1: to be, is that sensation of pain. Now, for now,
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  Speaker 1: we'll focus on the physiological aspect of pain, the physical
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  Speaker 1: like tissue part. We're going to get more into the
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  Speaker 1: psychological stuff later, and only in so far as there
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  Speaker 1: is a distinction that we can attempt to make between
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  Speaker 1: physiological and psychological. But experts seem to broadly accept three
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  Speaker 1: large categories of pain when we're talking about the physiological
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  Speaker 1: piece of it, and that is that there is acute pain,
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  Speaker 1: there is chronic pain, and there is malignant pain.
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  Speaker 2: Ooh, evil pain, ooh.
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  Speaker 1: Yeah, exactly.
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  Speaker 2: Acute pain is a description applied to pain that is
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  Speaker 2: relatively short lived. We saw in some of the research
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  Speaker 2: less than three months or up to six months. So
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  Speaker 2: there's a little bit of a range there, but it
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  Speaker 2: typically has a rapid onset, is intensive, and has an
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  Speaker 2: identifiable cause, such as physical trauma from injury, surgery, or infection. Behaviorally,
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  Speaker 2: it is a reflexive response that recoils from stimulation that
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  Speaker 2: can or does cause acute trauma. So when your skin
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  Speaker 2: is scraped or cut, you sprain or break a joint,
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  Speaker 2: or take blunt force trauma such as from a punch
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  Speaker 2: or following down, these are examples of pain we might
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  Speaker 2: generally call acute. Like these moments are going to give us,
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  Speaker 2: like a rapid onset of some painful stimulus.
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  Speaker 1: Yes, now three months seems like a long time. In
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  Speaker 1: six months is even more if my math is right.
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  Speaker 1: But to like be experiencing a cute you experiencing acute pain.
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  Speaker 1: But then we get into what is called chronic pain,
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  Speaker 1: and this lasts typically three or again more than three
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  Speaker 1: or we also saw the six months, and this is
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  Speaker 1: typically typically not always more than sometimes, but typically pain
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  Speaker 1: that persists after trauma has healed or entirely in the
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  Speaker 1: absence of some acute injury. This may have a slower onset,
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  Speaker 1: It may have be sort of intermittent or sporadic bouts
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  Speaker 1: of pain. It may be characterized as just ongoing just
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  Speaker 1: all the time, all the pain, all the time, And behaviorally,
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  Speaker 1: this is going to look more like a learned strategy
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  Speaker 1: to move or position oneself or engage in other patterns
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  Speaker 1: of behavior in such a way that noxious stimulation as
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  Speaker 1: avoided or reduced, or to take measures to prevent those
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  Speaker 1: experiences of pain perceived sense or otherwise. And this is
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  Speaker 1: going to include things like spinal injuries, illnesses, amputations, and burns.
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  Speaker 1: And that's not an exhaustive list. Those are just some
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  Speaker 1: examples of the kinds of things that you can think
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  Speaker 1: of that result in long lasting experiences of pain.
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  Speaker 2: Right, and then finally we brought up malignant pain. And
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  Speaker 2: that's similar to chronic pain because it is like a
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  Speaker 2: long lasting thing, but it is specifically pain related to
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  Speaker 2: or created by malignant tumors that put pressure on nearby
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  Speaker 2: nerves and blood vessels and they kind of like create
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  Speaker 2: kind of a cascading effect of additional painful stimuli.
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  Speaker 1: Yeah, this is sometimes even described as cancer pain. And
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  Speaker 1: so this is intended to capture the experience of people
• 10:44
  Speaker 1: who are suffering from cancer, very serious disease obviously, and
• 10:49
  Speaker 1: that kind of pain that they get. Is this like
• 10:52
  Speaker 1: sort of its own sort of ballpark? Is how I
• 10:55
  Speaker 1: saw this described and segmented out? That makes sense?
• 10:59
  Speaker 2: Yeah, yeah, that makes total sense. I was just curious though, like,
• 11:01
  Speaker 2: as you're going through the list, you said there were
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  Speaker 2: three different types of pain. For some reason, when I
• 11:04
  Speaker 2: was doing some of the research, I saw a fourth one,
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  Speaker 2: which was about ADS.
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  Speaker 1: All right, pain by virtue of suffering through ADS is
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  Speaker 1: where we find ourselves. And on the other side of
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  Speaker 1: that we shall get into the neurology of pain. All right,
• 11:28
  Speaker 1: some caveats here. This part is pretty complex. It is
• 11:32
  Speaker 1: above our level of expertise, at least mine. I'm not sure.
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  Speaker 1: How do you have a lot of like training and
• 11:36
  Speaker 1: experience with researchfulness, No, no, no, no, no.
• 11:40
  Speaker 2: I struggle with words with more than four syllables. And
• 11:43
  Speaker 2: this is this is the entire field. All of neurology
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  Speaker 2: is just super complex chemical reactions and nerves. I just
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  Speaker 2: don't understand it. I do my best.
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  Speaker 1: Yeah, yeah, exactly. We're gonna say it as we found it.
• 11:55
  Speaker 1: We're going to describe it as simply as we can,
• 11:59
  Speaker 1: do our best to unpack it and hope that that
• 12:02
  Speaker 1: lands like hope that that feels comprehensible in the things
• 12:06
  Speaker 1: that we say, and also know that, like this is
• 12:10
  Speaker 1: just not our area of expertise, so like we're kind
• 12:12
  Speaker 1: of just saying things how other people have said them,
• 12:14
  Speaker 1: and hopefully they have said them correctly, because we wouldn't
• 12:17
  Speaker 1: know otherwise. Really, I think, yeah, exactly, all right. So
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  Speaker 1: there's essentially a four part process to pain. One is
• 12:27
  Speaker 1: a person contacts anxious stimulus. Two nerve ends respond to
• 12:31
  Speaker 1: the stimulus. Three the nerves transmit this stimulation through the
• 12:35
  Speaker 1: central nervous system to the brain, and four the brain
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  Speaker 1: processes and responds to the incoming signal. Basically, it's like
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  Speaker 1: pain is the touch point that leads to your brain
• 12:45
  Speaker 1: and then travels you know, it travels along your.
• 12:47
  Speaker 2: Nerve system, your nervous system.
• 12:49
  Speaker 1: Yes, now, it was once believed, not that long ago, really,
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  Speaker 1: that there were not distinct nerves that respond to pain
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  Speaker 1: specifically versus like any other kind of sensation hot, cold, pressure, touch,
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  Speaker 1: and that the only thing that distinguished pain from other
• 13:06
  Speaker 1: sensations was the intensity of the sensation. That was kind
• 13:10
  Speaker 1: of the working idea for a while, however, for the
• 13:13
  Speaker 1: research really does suggest that instead of that, there really
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  Speaker 1: are actually some different systems in the nerves going on,
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  Speaker 1: where like a painful sensation does not need to be
• 13:24
  Speaker 1: that intense to be felt as pain, And so the
• 13:27
  Speaker 1: idea that pain is just intense sensation seems like it's
• 13:30
  Speaker 1: probably not right that the damage that comes from pain
• 13:34
  Speaker 1: specifically does in fact stimulate specific nerves that then respond
• 13:41
  Speaker 1: to that pain somewhat differently.
• 13:42
  Speaker 2: Yeah, so here we go, Super Technical Time. That's our
• 13:45
  Speaker 2: favorite news segment, So hopefully we have a jingle for that,
• 13:48
  Speaker 2: d D Super Technical Time. Not susceptor neurons sense pain
• 13:56
  Speaker 2: through what are called quote free nerve endings, which it
• 14:00
  Speaker 2: seems to mean there are nerves not specialized for a
• 14:02
  Speaker 2: specific sensitivity, kind of like how stem cells are. I
• 14:05
  Speaker 2: guess where. It's just kind of like unprogrammed nerves.
• 14:08
  Speaker 1: I think more or less. Yeah, yeah, yeah, it's like
• 14:11
  Speaker 1: they don't have any generalist things. Yes, they're generalists, although
• 14:14
  Speaker 1: it seems like it's like anything that's bad yeah they
• 14:18
  Speaker 1: respond to.
• 14:19
  Speaker 2: Yeah, yeah, absolutely. Now, the non sceptor neurons use peripheral
• 14:23
  Speaker 2: sensory nerves. The cell bodies of no sceptor nerves can
• 14:26
  Speaker 2: be found in the dorsal root ganglia of peripheral nerves
• 14:31
  Speaker 2: inside the spine. Super elementary descriptions there.
• 14:35
  Speaker 1: Yeah, those are words, yeah, that have to do with
• 14:39
  Speaker 1: spine and brain things. Yeah, the no susceptive nerves seem
• 14:43
  Speaker 1: to have less myelination than other nerves. There was a
• 14:46
  Speaker 1: whole section of this and I kind of just decided
• 14:49
  Speaker 1: at some point it really wasn't worth digging into it. Now.
• 14:53
  Speaker 1: Something about this did surprise me because my lenation if
• 14:56
  Speaker 1: for those of you who are unfamiliar with essentially how
• 14:58
  Speaker 1: neurons work is most neurons have this sort of fatty
• 15:03
  Speaker 1: tissue surrounding them, and this sort of insulation tissue allows
• 15:08
  Speaker 1: signals to be sent faster. So it's almost a linear
• 15:12
  Speaker 1: correlation between how much myelination there is and how fast
• 15:16
  Speaker 1: a signal can travel down a nerve. And these pain
• 15:19
  Speaker 1: nerves seem to actually have less myelination, which surprisingly means
• 15:24
  Speaker 1: that they cut they conduct signals less quickly than most
• 15:28
  Speaker 1: other sensations, except apparently for heat.
• 15:32
  Speaker 2: I found weird.
• 15:33
  Speaker 1: So heat will travel basically right away, but the other
• 15:36
  Speaker 1: sensations that are pain will actually travel a little slowly.
• 15:40
  Speaker 1: And I was thinking about this, and you may have
• 15:41
  Speaker 1: actually noticed times where you injured yourself, and specifically, I'm
• 15:45
  Speaker 1: thinking of instances where I, like accidentally cut myself and
• 15:49
  Speaker 1: you actually don't immediately feel the pain. Sure, there's like
• 15:52
  Speaker 1: a cut and you see it and then you like
• 15:54
  Speaker 1: a moment later it hits, and so I was like, subjectively,
• 15:57
  Speaker 1: that is actually my experience is that the pain sensation
• 16:00
  Speaker 1: of a lot of those is not instantaneous. It's not
• 16:03
  Speaker 1: far behind, but it is not instantaneous.
• 16:06
  Speaker 2: I wonder if and maybe we'll get into this, but
• 16:09
  Speaker 2: I wonder if it's because like humans are generally pretty
• 16:12
  Speaker 2: durable and like, despite being squishy meat sacks, like we're sensitive,
• 16:17
  Speaker 2: but we're also kind of durable in that, like if
• 16:19
  Speaker 2: I get an injury on my arm or my leg,
• 16:21
  Speaker 2: like it's not generally life threatening, so like it's not
• 16:24
  Speaker 2: gonna call for like such an immediate response.
• 16:26
  Speaker 1: I don't know that could be any Speculating about evolution
• 16:29
  Speaker 1: is fun though.
• 16:30
  Speaker 2: Yeah, yeah, I do. I do like to talk about that. So,
• 16:32
  Speaker 2: I mean, if evolution were real, you know, so when
• 16:35
  Speaker 2: some sort of injury happens, potassium will be released from
• 16:38
  Speaker 2: the damage cells. There's likely some to be some inflammation
• 16:41
  Speaker 2: and chemical compounds prostaglandins, histamines, and Brandon Kinnon's. That sounds
• 16:48
  Speaker 2: like a that sounds like somebody that I grew up
• 16:50
  Speaker 2: down the road from here in South Datona. It's like, oh,
• 16:53
  Speaker 2: good old Brandon Kinning over there.
• 16:55
  Speaker 1: I think it's Brady Kinnon's.
• 16:56
  Speaker 2: Brady. Okay, you're right, there's no head in there at all,
• 16:58
  Speaker 2: So I just read because there's other ends in there,
• 17:01
  Speaker 2: Brady Kinnon. Well, also Brady kittens could be Brandy Kinnon's brother.
• 17:04
  Speaker 1: True, no, very creatives.
• 17:08
  Speaker 2: Now, for some reason, these processes seem to underlie the
• 17:11
  Speaker 2: experience of pain physiologically speaking.
• 17:14
  Speaker 1: Yes, so is something about the inflammation, something about the potassium,
• 17:18
  Speaker 1: something about those chemical compounds, maybe all of those things
• 17:21
  Speaker 1: together they do happen, and that seems to be sort
• 17:24
  Speaker 1: of where worse sensing pain, And that'll be relevant when
• 17:27
  Speaker 1: we get to pain management as we talk about that. Sure,
• 17:31
  Speaker 1: so these neurons the connect to so we're talking about
• 17:34
  Speaker 1: these pain neurons here. They connect with neurons in an
• 17:37
  Speaker 1: area called the dorsal horn, which is a section of
• 17:40
  Speaker 1: the spine with gray matter, and the connecting secondary neurons
• 17:46
  Speaker 1: from there travel through the medulla to the thalamus of
• 17:49
  Speaker 1: the brain. Or there's a new connection obviously. Yeah, and
• 17:52
  Speaker 1: they keep using the word synapse to describe connection, but
• 17:55
  Speaker 1: I think that we could just say connection.
• 17:58
  Speaker 2: That's fine.
• 17:58
  Speaker 1: Yeah, So anyway, that's metally how these neurons, the sort
• 18:01
  Speaker 1: of structure of these work as they connect that way.
• 18:04
  Speaker 1: And apparently what's kind of interesting here is the face.
• 18:07
  Speaker 1: Our face. It seems to have its own sort of
• 18:09
  Speaker 1: mini nervous system that connects to the spinal cord. It's
• 18:13
  Speaker 1: called the trigeminal nerve, and from there it proceeds to
• 18:17
  Speaker 1: the brain. But it doesn't have the same overall system
• 18:20
  Speaker 1: of pain that the rest of our body has.
• 18:22
  Speaker 2: Oh interesting, yeah, right, so when when somebody's like making
• 18:26
  Speaker 2: a mean face, you could be like, hey, fix your
• 18:28
  Speaker 2: face nerves because it is different.
• 18:30
  Speaker 1: Yeah, fix your trigeminal nerves.
• 18:32
  Speaker 2: Fixture trigeneral nerves. You just look mean right now. So
• 18:36
  Speaker 2: all of this has been described in such a way
• 18:38
  Speaker 2: that it seems that most pain researchers feel that they
• 18:40
  Speaker 2: have a handle on the general process of pain perception
• 18:43
  Speaker 2: up to this point. Once it gets to the brain,
• 18:46
  Speaker 2: we're actually not sure what happens, and that's because the
• 18:48
  Speaker 2: brain is strange. It's a weird thing.
• 18:51
  Speaker 1: It is and we've talked about this before, but it's
• 18:54
  Speaker 1: a sort of like for bodies to operate efficiently, it's
• 18:58
  Speaker 1: useful for all of the body parts to connect to
• 19:01
  Speaker 1: one central hub that's kind of the control center, so
• 19:04
  Speaker 1: that it can coordinate all the systems together, which makes
• 19:07
  Speaker 1: a lot of sense. It's sort of like communication is
• 19:09
  Speaker 1: key is the underlying theme of what seems to be
• 19:12
  Speaker 1: how our brain works. And so anyway, like yeah, it
• 19:16
  Speaker 1: all sort of coalesces in the brain, and then from
• 19:18
  Speaker 1: there it becomes a little bit weird and hard to follow.
• 19:22
  Speaker 1: And for a variety of reasons, it seems that and
• 19:24
  Speaker 1: this should probably come as a surprise to no one,
• 19:27
  Speaker 1: but our brain seems to exercise some amount of control
• 19:30
  Speaker 1: over once the pain signal gets in. What happens to that,
• 19:34
  Speaker 1: How is the processed? What do we do? And for
• 19:38
  Speaker 1: one thing, evidence of this can be found in the
• 19:42
  Speaker 1: fact that simple distractions can pull your attention away from
• 19:46
  Speaker 1: your pain, so much so that it has been demonstrated
• 19:50
  Speaker 1: to successfully, albeit temporarily, reduce our reporting of pain just
• 19:56
  Speaker 1: a distraction. And I don't know if you've had this
• 19:58
  Speaker 1: experience yourself, Shane, I'd be curious to see if you have.
• 20:01
  Speaker 1: But if you've ever been to a dentist and if
• 20:03
  Speaker 1: they had to like give you a shot in the gums,
• 20:05
  Speaker 1: at least my dentists, they sort of did like a
• 20:08
  Speaker 1: wiggle on the cheek or the lip. And this is
• 20:11
  Speaker 1: using distraction in part to reduce your experience and your
• 20:15
  Speaker 1: attention to the pain produced when sticking a needle into
• 20:19
  Speaker 1: your gums, which is a painful thing. And it works
• 20:22
  Speaker 1: at least a bit, and I do appreciate it, like
• 20:24
  Speaker 1: it is like an effective strategy for having a reduced
• 20:29
  Speaker 1: experience of pain. Is just creating some other distraction.
• 20:32
  Speaker 2: Yeah, absolutely, Yeah, I've had a dentisty too, and I go, oh,
• 20:36
  Speaker 2: that's nice, thank you for thank you for pulling my
• 20:38
  Speaker 2: attention away from that needle that you're putting in my mouth.
• 20:41
  Speaker 1: That's what they're doing. And you know, if we've seen
• 20:43
  Speaker 1: on TV shows, they like give people something to bite
• 20:46
  Speaker 1: down onto, and there are a variety of reasons for that,
• 20:49
  Speaker 1: but they'll also start like trying to pull their to
• 20:51
  Speaker 1: like think about this. Think about this, and although it
• 20:54
  Speaker 1: often is not enough to overcome the acute trauma of
• 20:57
  Speaker 1: the pain, it is can be enough to at least
• 20:59
  Speaker 1: distract them for a moment.
• 21:01
  Speaker 2: Yeah. Absolutely, Also, we can respond to the fear of
• 21:05
  Speaker 2: pain and the absence of the actual physical sensation, So
• 21:08
  Speaker 2: beyond situations which people are acting for the sake of
• 21:10
  Speaker 2: a movie or play, we can even expect to feel
• 21:13
  Speaker 2: pain and report that we do, in fact subsequently feel pain.
• 21:16
  Speaker 2: We can behave with respect to hypothetical pain as intensely
• 21:20
  Speaker 2: or more so than the actual experience itself. Like we
• 21:23
  Speaker 2: have kind of this unique thing about the way that
• 21:25
  Speaker 2: we can kind of like mimic or like we said,
• 21:28
  Speaker 2: kind of like we can respond in like the in
• 21:31
  Speaker 2: response to the warning or the signal that like, hey,
• 21:34
  Speaker 2: things are about to get bad.
• 21:36
  Speaker 1: Yeah, exactly. And this is you know, speaking very colloquially.
• 21:41
  Speaker 1: The experience that we might have of someone being in
• 21:43
  Speaker 1: their own head about a situation and being frightened of
• 21:47
  Speaker 1: like the implication of the potential for pain is sort
• 21:50
  Speaker 1: of what we're talking about here, right. It's like you
• 21:53
  Speaker 1: can be so afraid of the pain that you might
• 21:57
  Speaker 1: feel that you actually then you know, I think I've
• 22:01
  Speaker 1: seen them do this in movies and shows and cartoons
• 22:03
  Speaker 1: and stuff, where they'll have someone close their eyes and
• 22:06
  Speaker 1: then they'll they'll like flinch into pain response, and they're like,
• 22:09
  Speaker 1: I haven't even done anything yet, right, It's like they're
• 22:12
  Speaker 1: sort of so freaked out about the potential for pain
• 22:15
  Speaker 1: that they actually experience some version of pain, at least
• 22:18
  Speaker 1: sort of subjectively in that moment. And subjectively experience of
• 22:22
  Speaker 1: pain is what we generally think of when I think
• 22:25
  Speaker 1: of ads. All right, we are back from that AD break.
• 22:36
  Speaker 1: Let's keep talking about physiology here with the brain involved.
• 22:41
  Speaker 2: I love it. So. Another example that we're talking about
• 22:44
  Speaker 2: here is is that pain from acute injuries tends to
• 22:47
  Speaker 2: have an intense experiential onset but eventually fades to an
• 22:51
  Speaker 2: ongoing dull ache. So either the nerves are habituating to
• 22:54
  Speaker 2: the stimulation, the brain is titrating down the intensity of
• 22:56
  Speaker 2: the pain, or endorphins are dulling the sensation of pain,
• 23:00
  Speaker 2: or some combination of any of those things. Similarly, emotions
• 23:03
  Speaker 2: and thoughts seem to impact the extent to which pain
• 23:05
  Speaker 2: is experienced, suggesting a psycho neeurological interaction between our language
• 23:09
  Speaker 2: and the experience of physical sensations, in this case pain.
• 23:13
  Speaker 2: I actually think like this is a really good example
• 23:15
  Speaker 2: to me. I think of like getting tattooed. I just
• 23:16
  Speaker 2: got tattooed recently.
• 23:18
  Speaker 1: Nice.
• 23:18
  Speaker 2: And I always think of this as like the first
• 23:20
  Speaker 2: line or two not my favorite, because it's like I'm
• 23:23
  Speaker 2: not ready for it, Like I'm just kind of like suh, right,
• 23:26
  Speaker 2: you know they draw that line and you're like, oh, yeah,
• 23:27
  Speaker 2: I hate this. I forgot that I shouldn't be doing
• 23:29
  Speaker 2: this summer and then and that happens, and then after
• 23:32
  Speaker 2: a little bit, I start to habituate to it. I
• 23:34
  Speaker 2: feel like I get comfortable with it and I don't
• 23:36
  Speaker 2: really notice it for a period of time until it
• 23:38
  Speaker 2: gets too far, and then I'm like, all right, I'm done.
• 23:40
  Speaker 2: That's enough. You've you've done enough damage, you know. So
• 23:43
  Speaker 2: I could see that. And if you've ever had a
• 23:45
  Speaker 2: tattoo that's long lasting. For some folks that are on here,
• 23:48
  Speaker 2: you've probably had that experience.
• 23:50
  Speaker 1: Yeah, Once it hits like the new bundle of nerves
• 23:52
  Speaker 1: or something that it's like, oh, there it is, Oh
• 23:54
  Speaker 1: it's back.
• 23:55
  Speaker 2: Yeah. He's like, why did you do that to my kneecap,
• 23:57
  Speaker 2: you know.
• 23:58
  Speaker 1: And they're like, because you paid me too, Yeah, you
• 24:01
  Speaker 1: asked for this. Did you forget that part already?
• 24:04
  Speaker 2: I did, and usually I did.
• 24:06
  Speaker 1: Now I had one professor who argued that behaviorally, pain
• 24:10
  Speaker 1: is pain behavior, and that is that we can describe
• 24:15
  Speaker 1: pain in a relation to the behaviors with respect to
• 24:19
  Speaker 1: the stimuli and the nature of the behaviors that correspond
• 24:24
  Speaker 1: and correlate with the pain. Okay, that was sort of
• 24:27
  Speaker 1: the argument here, is he sort of like, any thing
• 24:31
  Speaker 1: that we see that is related to pain with respect
• 24:34
  Speaker 1: to what an organism is doing is pain behavior, and
• 24:37
  Speaker 1: that's what pain is, or at least a useful clinical
• 24:40
  Speaker 1: way to think about it, suggesting essentially that even if
• 24:44
  Speaker 1: we take someone who said, like they're not showing any
• 24:47
  Speaker 1: physical signs of pain, like wincing or anything like that,
• 24:50
  Speaker 1: but they're like, I need pain medication, like that is
• 24:54
  Speaker 1: a that is pain behavior. In a way, if we
• 24:57
  Speaker 1: see them, like again, they're not grimacing or showing any
• 24:59
  Speaker 1: signs of it, but they just choose to like move
• 25:01
  Speaker 1: very slowly or not move at all, that might be
• 25:04
  Speaker 1: an example of pain behavior. Is like holding still holding
• 25:07
  Speaker 1: a specific position. Sure, so anyway, that was sort of
• 25:10
  Speaker 1: the argument here is that like pain is pain behavior,
• 25:13
  Speaker 1: which is a clinically relevant way to think about it,
• 25:15
  Speaker 1: and not super different from that quote from the doctor
• 25:18
  Speaker 1: who said pain is whatever the patient says it is right, right,
• 25:21
  Speaker 1: And so this sort of similar idea here, And still
• 25:24
  Speaker 1: others have argued that to suggest that we can use
• 25:27
  Speaker 1: body language to interpret internal states scientifically ignores the fact
• 25:33
  Speaker 1: that a physical movement or expression cannot be accurately categorized
• 25:37
  Speaker 1: per individual experience, and that there are a lot of
• 25:40
  Speaker 1: factors that participate in the experience of pain, and the
• 25:44
  Speaker 1: overt actions can be observed to correspond to the stimulus
• 25:48
  Speaker 1: in that context. And I know that sounds very esoteric
• 25:51
  Speaker 1: and like very jargony, but essentially very jargony, But you know,
• 25:56
  Speaker 1: just I think using words in such a way that
• 25:59
  Speaker 1: the meaning does not flow easily from them. Sure, the
• 26:02
  Speaker 1: point I'm making here is that, like to say that
• 26:04
  Speaker 1: there is an expression that someone can make and that
• 26:07
  Speaker 1: that correlates reliably to an internal state, it ignores the
• 26:12
  Speaker 1: fact that there are a lot of features of our
• 26:15
  Speaker 1: environment in our learning history that shape our expressions and
• 26:18
  Speaker 1: our body language. Yeah, there are cultural ones, there are
• 26:21
  Speaker 1: personal ones, there are contextual moment to moment features of
• 26:26
  Speaker 1: a situation variables that are all relevant here. And so
• 26:29
  Speaker 1: the argument here was sort of like saying that pain
• 26:33
  Speaker 1: is pain behavior assumes that we accept ex observable behaviors
• 26:39
  Speaker 1: as a proxy for an internal state when it is
• 26:42
  Speaker 1: a complex tapestry of things that are happening in any
• 26:45
  Speaker 1: given moment emotionally, cognitively, or pain or otherwise, that we
• 26:51
  Speaker 1: shouldn't necessarily treat it as though we have learned something
• 26:55
  Speaker 1: unique about the internal state of an organism by observing
• 26:58
  Speaker 1: their external behavior. And I also can appreciate philosophically the
• 27:01
  Speaker 1: point that's being made there, if that makes sense.
• 27:04
  Speaker 2: Yeah, yeah, I think that makes sense. Now. The example holds, however,
• 27:08
  Speaker 2: that we use pain behaviors to study, measure, and respond
• 27:10
  Speaker 2: to pain in others. So we engage in pain behaviors
• 27:13
  Speaker 2: when when we experience pain, and these can include vocalizations
• 27:17
  Speaker 2: or even shifts in behavior patterns in which certain behaviors
• 27:20
  Speaker 2: a reduce or increase in frequency, like taking pain medication,
• 27:23
  Speaker 2: reducing overall movement, maybe gripping or grasping a body part
• 27:27
  Speaker 2: that's in pain, Like I know that, like every now
• 27:30
  Speaker 2: and again, I'll get like a sharp pain somewhere on
• 27:32
  Speaker 2: my torso and I'll go ah, like and I'll do
• 27:34
  Speaker 2: that real quick because it'll like catch you know, It's
• 27:36
  Speaker 2: like it'll catch me and like take my breath away
• 27:38
  Speaker 2: for a second. Yeah, but that's like that collateral response.
• 27:40
  Speaker 2: You're not actually seeing me in pain. You're seeing a
• 27:42
  Speaker 2: response related to pain and that pain behavior. And that's
• 27:45
  Speaker 2: a pretty decent indicator that like, hey, maybe there's something
• 27:47
  Speaker 2: going on.
• 27:48
  Speaker 1: Well, and there's certainly something to do with respect to
• 27:51
  Speaker 1: that pain behavior, like clearly like either like do an
• 27:55
  Speaker 1: X ray or take some medication, or do some kind
• 27:58
  Speaker 1: of stretch or something like that. Like it suggests a
• 28:01
  Speaker 1: clinically relevant decision point, if that makes sense.
• 28:04
  Speaker 2: Yeah.
• 28:06
  Speaker 1: Now, most of us come readily equipped to physically experience
• 28:09
  Speaker 1: certain classes of stimulation that is, in this particular case,
• 28:12
  Speaker 1: noxious ones, and respond by attempting to reduce and remove
• 28:17
  Speaker 1: that stimulation. And what I mean by that is like,
• 28:20
  Speaker 1: this does seem to be a pretty human experience that
• 28:23
  Speaker 1: we we seem like we pretty for the most of us,
• 28:27
  Speaker 1: we can readily respond to that. Now that being said,
• 28:30
  Speaker 1: I think it is reasonable to consider that the first
• 28:34
  Speaker 1: times that we ever experience pain, we don't know. Like
• 28:40
  Speaker 1: I guess what I'm trying to say here is that
• 28:41
  Speaker 1: like any successful actions that we do that reduce that
• 28:45
  Speaker 1: pain start a process of learning by which we avoid
• 28:49
  Speaker 1: pain through our behaviors. Sure, so we think that we
• 28:53
  Speaker 1: were born basically preloaded to avoid pain, but I think
• 28:58
  Speaker 1: it's worth considering that. Like, I mean, we certainly have
• 29:00
  Speaker 1: the capacity to experience certain types of stimulation as noxious,
• 29:06
  Speaker 1: but the behaviors that we engage in to remove that
• 29:09
  Speaker 1: seems like it's probably initially we're just flopping around. We're
• 29:12
  Speaker 1: just doing anything right right as infants. It's just like
• 29:15
  Speaker 1: whatever thing that I can do that all of a sudden,
• 29:18
  Speaker 1: at various moments, I'm not feeling pain, do that thing,
• 29:21
  Speaker 1: and like then that's just the process that we for
• 29:23
  Speaker 1: the rest of our lives are learning. There is this
• 29:26
  Speaker 1: onset stimulus. Do a thing right, and whatever that thing is,
• 29:30
  Speaker 1: we'll get more and more efficient at understanding and being
• 29:32
  Speaker 1: able to respond to whatever that is. So I guess
• 29:36
  Speaker 1: what I'm trying to say is, like behaviors around this
• 29:40
  Speaker 1: I think are as much learned as anything else, but
• 29:43
  Speaker 1: obviously have roots and the biology that was evolved to
• 29:49
  Speaker 1: give us the capacity to feel that pain such in
• 29:51
  Speaker 1: such a way that it then motivates those behaviors.
• 29:54
  Speaker 2: Yeah, that makes sense, I think. With that being said, like,
• 29:57
  Speaker 2: I think, you know, just like any good scientists, you know,
• 30:00
  Speaker 2: you have to know that there are theories of things,
• 30:02
  Speaker 2: and there is, of course a theory of pain, right,
• 30:05
  Speaker 2: and so let's actually talk about the gate control theory
• 30:07
  Speaker 2: of pain, because I think this is kind of an
• 30:09
  Speaker 2: interesting fold to this entire discussion. So Ronald Melzach and
• 30:13
  Speaker 2: Patrick Wall proposed a hypothesis in nineteen sixty five to
• 30:16
  Speaker 2: describe how thoughts and emotions influence the experience of pain,
• 30:20
  Speaker 2: called the gate control theory of pain. Real quick, before
• 30:23
  Speaker 2: we get too far into this, did they talk about
• 30:25
  Speaker 2: profanity being part of this?
• 30:27
  Speaker 1: No, at least I didn't see that. I didn't. I
• 30:29
  Speaker 1: didn't dig it up. It's possible that was in there somewhere.
• 30:32
  Speaker 2: Yeah, there were some studies that showed that, like people
• 30:34
  Speaker 2: who use profanity when they're in pain, like the use
• 30:36
  Speaker 2: of profanity may be correlated with a reduction in pain
• 30:38
  Speaker 2: as well.
• 30:39
  Speaker 1: Oh, I love that. I hope that that is accurate. Yes,
• 30:43
  Speaker 1: let's just assume that that's true.
• 30:44
  Speaker 2: Yeah, yeah, I love that. You're welcome, world.
• 30:47
  Speaker 1: Yeah, this is a really interesting idea. And I remember
• 30:50
  Speaker 1: the first time I heard it, I was not sure
• 30:52
  Speaker 1: what to make of it. It kind of feels it
• 30:55
  Speaker 1: kind of feels like one of those like fit the
• 30:58
  Speaker 1: try and cram this into a world working hypothesis, but
• 31:01
  Speaker 1: they kind of make some really compelling arguments and their
• 31:04
  Speaker 1: examples kind of keep work. Like their hypothesis pretty accurately
• 31:09
  Speaker 1: predicts responses to pain, yeah, pretty much all the time.
• 31:13
  Speaker 1: So essentially, whether or not the exact mechanism that they
• 31:16
  Speaker 1: propose is what's going on, they do seem to be
• 31:18
  Speaker 1: onto something here. So they propose that there's this idea
• 31:22
  Speaker 1: of small nerve fibers and large nerve fibers synapse. Those
• 31:26
  Speaker 1: are basically the two classifications small nerves and large nerves,
• 31:29
  Speaker 1: and that they synaps on what are called projection cells
• 31:33
  Speaker 1: which travel up the spinothylamic tract to the brain and
• 31:36
  Speaker 1: inhibitory neurons in the dorsal horn. And so they inhibitory
• 31:41
  Speaker 1: neurons are either going to allow pain through or they're
• 31:44
  Speaker 1: going to block it from coming through.
• 31:46
  Speaker 2: Right, And so then there are essentially three states that
• 31:48
  Speaker 2: can exist. One, there is not stimulation to either the
• 31:51
  Speaker 2: small or large nerve fibers. The gate is closed and
• 31:54
  Speaker 2: no pain is felt. Two, there is stimulation to the
• 31:57
  Speaker 2: large nerve fibers, which is normal sensation basic sure touch
• 32:00
  Speaker 2: the gate is closed and no pain is felt. Or
• 32:03
  Speaker 2: three there is stimulation to the small nerve fibers, which
• 32:06
  Speaker 2: is acute intensive pain sensations. The gate is open and
• 32:09
  Speaker 2: pain is felt. So either it is no stimulation. Gates
• 32:13
  Speaker 2: are closed, large fiber stimulation gates are closed, small fibers
• 32:17
  Speaker 2: sensations gates are open, and that's when we feel.
• 32:19
  Speaker 1: Pain exactly right, So it can they can either be
• 32:22
  Speaker 1: open or closed, and it is whether or not you
• 32:25
  Speaker 1: have more stimulation to the large nerve fibers or the
• 32:29
  Speaker 1: small nerve fibers, and so said. More simply, what they're
• 32:33
  Speaker 1: sort of saying here is that if there is more
• 32:35
  Speaker 1: stimulation to the small nerve fibers, we feel the pain. However,
• 32:40
  Speaker 1: if there is more stimulation to the large nerve fibers
• 32:44
  Speaker 1: than there is to the small nerve fibers, even if
• 32:47
  Speaker 1: there is stimulation to those pain receptors, then the large
• 32:50
  Speaker 1: nerve fiber is what the stimulation there, It blocks the
• 32:53
  Speaker 1: experience of pain altogether because it closes the gate. That's
• 32:56
  Speaker 1: sort of how this works. Sure, this would predict and
• 33:00
  Speaker 1: it does seem to accurately describe experiences when you let's
• 33:04
  Speaker 1: say for example, bang your finger and then you rub
• 33:07
  Speaker 1: it or shake it to stimulate the somatosensory nerves which
• 33:10
  Speaker 1: close the gate and thus temporarily reduces the experience of pain.
• 33:16
  Speaker 1: And like, as soon as you don't have enough of
• 33:18
  Speaker 1: that large fiber stimulation, that pain starts to come back.
• 33:21
  Speaker 1: But it's like, if you can create enough stimulation of
• 33:25
  Speaker 1: the large nerve fibers here the like other sensations that
• 33:28
  Speaker 1: are not painful, then that can essentially override the opportunity
• 33:32
  Speaker 1: to experience pain. And I've certainly personally had that experience
• 33:36
  Speaker 1: where it's like, if you get enough stimulation that is
• 33:39
  Speaker 1: not the pain stimulation, it seems like the pain stimulation
• 33:42
  Speaker 1: goes away, at least for a moment.
• 33:44
  Speaker 2: Right.
• 33:44
  Speaker 1: This is actually also what's at play when the dentist
• 33:47
  Speaker 1: shakes your lip or cheek to try and reduce the
• 33:49
  Speaker 1: pain from the needle shot. Is like it could function
• 33:51
  Speaker 1: as a distraction, and it could also function as stimulation
• 33:55
  Speaker 1: of the large nerve fibers, where it therefore then blocks
• 33:59
  Speaker 1: some of the pain from getting through if it's sufficiently stimulated. Yeah,
• 34:02
  Speaker 1: that's sort of the idea. At least that's in play. Thus,
• 34:06
  Speaker 1: this can be one of the ways that massage because
• 34:10
  Speaker 1: we did an episode a massage not that long ago,
• 34:13
  Speaker 1: and the research on it is just it's just been
• 34:16
  Speaker 1: done so poorly that it's like hard to say like
• 34:18
  Speaker 1: the extent to which it is effective. But like, massage
• 34:22
  Speaker 1: has been shown to help reduce experiences of pain, and
• 34:25
  Speaker 1: it seems that one of the ways it helps alleviate
• 34:28
  Speaker 1: pain again at least temporarily, is by producing more stimulation
• 34:33
  Speaker 1: than the pain would be otherwise causing Sure, there's enough
• 34:37
  Speaker 1: of that sort of stimulation that comes from the pressure
• 34:40
  Speaker 1: that comes from massage and just the overall sensation that
• 34:43
  Speaker 1: comes from massage that it can help block that pain
• 34:46
  Speaker 1: at least at various moments there. I also saw some
• 34:49
  Speaker 1: things that showed that, like it's the reason that hot
• 34:53
  Speaker 1: pads can also work, and that like alternating hot and cold,
• 34:56
  Speaker 1: is that it essentially can bring blood flow to the area,
• 35:00
  Speaker 1: which can help reduce the experience of pain as well.
• 35:04
  Speaker 1: But I think that it also is in response to
• 35:06
  Speaker 1: that stimulation. And for fun here this is also likely
• 35:11
  Speaker 1: how if it works, how acupuncture and homeopathic remedies quote
• 35:17
  Speaker 1: unquote work is by providing more stimulation than the pain.
• 35:23
  Speaker 1: That's what the acupuncture at least because it's like a
• 35:27
  Speaker 1: very light, painful stimulation that is sort of mostly pricking
• 35:33
  Speaker 1: your skin a thousand different places to override the stimulation
• 35:37
  Speaker 1: from whatever the other pain might be. So there's nothing
• 35:41
  Speaker 1: magical about it, and a matter of fact, the extent
• 35:43
  Speaker 1: to which it works is extremely questionable. The research on
• 35:47
  Speaker 1: this is so bad, so like there's really no scientific
• 35:51
  Speaker 1: backing for this as anything other than the extent to
• 35:54
  Speaker 1: which it gets. Sort of the effect of this for
• 35:58
  Speaker 1: some people not consistent anyway. And then homeopathic remedies, which
• 36:02
  Speaker 1: is we did an episode on that as well, just
• 36:04
  Speaker 1: essentially pretend magic water. Placebos can work, like they legitimately
• 36:09
  Speaker 1: can work. I can tell you, like I can hand
• 36:12
  Speaker 1: you a altoid and say this is a pain medication,
• 36:15
  Speaker 1: and whatever pain you're feeling will actually often start to
• 36:18
  Speaker 1: go away. Even and we did an episode on placebos,
• 36:22
  Speaker 1: but like, even if I tell you this is a
• 36:23
  Speaker 1: placebo pain medication, it can have that effect amazingly. Yeah,
• 36:28
  Speaker 1: So it's kind of impressive how that works. So if
• 36:30
  Speaker 1: there is an extense to which things like acupuncture, Cairo practice,
• 36:34
  Speaker 1: and homeopathic remedies work, it is through these placebos and
• 36:38
  Speaker 1: in some cases get control theory of pain, that they
• 36:41
  Speaker 1: probably are getting their effect.
• 36:43
  Speaker 2: Yeah, but I mean even with all that stuff like acpuncture,
• 36:46
  Speaker 2: homeopathic remedies, like even placebos, like, I don't think that
• 36:49
  Speaker 2: there's really anything that's been proven to reduce the pain
• 36:51
  Speaker 2: of ADS at this point in time. Unless we have
• 36:53
  Speaker 2: something later we can talk about that. But I haven't
• 36:55
  Speaker 2: seen anything in the science that says that ADS are
• 36:58
  Speaker 2: pain free.
• 36:58
  Speaker 1: Just the skip forward button. Okay, we are back. So
• 37:10
  Speaker 1: we just finished covering the gate control theory of pain.
• 37:13
  Speaker 1: Let's talk about how to manage pain.
• 37:17
  Speaker 2: Yes, so obviously the gate control theory of pain is
• 37:20
  Speaker 2: one way to temporarily relieve the experience of pain. But
• 37:23
  Speaker 2: medically we can use things like non opioid drugs like
• 37:26
  Speaker 2: asperintilet all ibuprofen and a leave and they interfere with
• 37:30
  Speaker 2: the enzymes produced during tissue damage and reduce inflammation and
• 37:34
  Speaker 2: pain itself.
• 37:35
  Speaker 1: This is another space where there's like a lot of
• 37:38
  Speaker 1: technical jargon and how like certain chemicals bind to certain receptors.
• 37:42
  Speaker 1: And at some point I was just like, I feel like,
• 37:46
  Speaker 1: if you're listening to this particular podcast with a lens,
• 37:50
  Speaker 1: where like that's the kind of detail you're looking for.
• 37:53
  Speaker 1: I don't think that you made it to us for
• 37:56
  Speaker 1: that reason.
• 37:56
  Speaker 2: No, we are too low brow for that, my friends.
• 38:01
  Speaker 1: I'm not sure. I think we're low bro, but I
• 38:04
  Speaker 1: do think like we just don't get that technically into
• 38:06
  Speaker 1: the biological neurological aspects of these things.
• 38:10
  Speaker 2: Yeah.
• 38:10
  Speaker 1: So anyway, so that was the non opioid drugs that
• 38:14
  Speaker 1: can be used for this. There's also, of course, then
• 38:17
  Speaker 1: the opioid analgesics. These are used for more intense pain,
• 38:21
  Speaker 1: and these work by binding to the opioid receptors in
• 38:24
  Speaker 1: our body. This is going to be drugs such as morphine, codeine, oxycodone,
• 38:28
  Speaker 1: and fentanyl that all do work this way. But of
• 38:32
  Speaker 1: course these come with the issue that because these are
• 38:34
  Speaker 1: more powerful medications, they are easier to overdose and easy
• 38:38
  Speaker 1: to get addicted to. Sure, and so these ones tend
• 38:42
  Speaker 1: to be more tightly controlled to avoid overdoing it with
• 38:46
  Speaker 1: people or having them become dependent on those drugs. But yes, essentially,
• 38:50
  Speaker 1: again very complicated, but essentially the way that it works
• 38:53
  Speaker 1: is that these binds two receptors that make it so
• 38:57
  Speaker 1: that we cannot get the pain stimulation. Yeah, Like it
• 39:00
  Speaker 1: basically turns it, right, off at almost is kind of
• 39:03
  Speaker 1: like the gate control theory of pain, but via drugs.
• 39:06
  Speaker 2: Yeah, yeah, absolutely. Now, surgery can be an extreme measure,
• 39:09
  Speaker 2: either when the pain is extreme enough or other pain
• 39:12
  Speaker 2: management strategies that failed. So this intervention attempts to alter
• 39:15
  Speaker 2: the physical structures that underlie the experience of pain. For example,
• 39:19
  Speaker 2: rhizotomy will remove your charisma, which can be painful for
• 39:22
  Speaker 2: some other folks. Maybe not so free, not so much
• 39:24
  Speaker 2: for you. Now. It's actually a surgery that destroys portions
• 39:27
  Speaker 2: of the peripheral nerves, cutting off the nerves that carry
• 39:30
  Speaker 2: pain signals to the brain. A cordotomy destroys ascending tracks
• 39:34
  Speaker 2: in the spinal cord. These surgeries can be irreversible and
• 39:38
  Speaker 2: cause significant damage, so they are typically saved as a
• 39:41
  Speaker 2: last ditch effort. I had a friend of mine who
• 39:42
  Speaker 2: had a back surgery that had something like that where
• 39:46
  Speaker 2: I don't know if they had which surgery they had,
• 39:48
  Speaker 2: but they did essentially have a surgery that removed nerve
• 39:51
  Speaker 2: endings that were possibly related to significant lower back pain.
• 39:55
  Speaker 1: Interesting, there was another type of like it's called an analgesic.
• 40:02
  Speaker 1: It's called an adjuvant analgesic or coanalgesic. I didn't really
• 40:06
  Speaker 1: get into it because I had trouble sort of falling
• 40:10
  Speaker 1: what was even being talked about here. But it's like
• 40:12
  Speaker 1: some other condition other than the ones described sure, and
• 40:16
  Speaker 1: it happens to have like a pain reducing quality to it,
• 40:20
  Speaker 1: I think. So it's like medication that's not necessarily designed
• 40:23
  Speaker 1: to titrate pain, but it has that sort of an effect.
• 40:26
  Speaker 1: And like they actually give an example of an anti
• 40:29
  Speaker 1: epileptic drug that reduces membrane exciteability and therefore just reduces
• 40:34
  Speaker 1: the ability for like pain signals to be conducted across Sure.
• 40:37
  Speaker 1: But I just wanted to mention that is, yeah, a
• 40:39
  Speaker 1: piece in here as we're talking through it.
• 40:41
  Speaker 2: Love that.
• 40:41
  Speaker 1: Yeah, all right. So there are of course behavioral approaches
• 40:46
  Speaker 1: for pain, and you can kind of lump these into
• 40:48
  Speaker 1: two broad categories. You have approaches that are going to
• 40:51
  Speaker 1: include strategies that emphasize essentially behaviors around mitigating pain, and
• 40:57
  Speaker 1: so that would be like medication adherence Exer says, self
• 41:01
  Speaker 1: care routines, putting on a hot patch, taking a bath,
• 41:05
  Speaker 1: stretching like, these are all kinds of things that our
• 41:08
  Speaker 1: behavioral approaches where we might teach and help someone build
• 41:12
  Speaker 1: habits around those things to help them manage their pain.
• 41:16
  Speaker 1: So that's one way that this is. It's sort of
• 41:18
  Speaker 1: the behaviors around pain management, where we would help build
• 41:23
  Speaker 1: those as a habit essentially.
• 41:24
  Speaker 2: Yeah.
• 41:24
  Speaker 1: The other way that we might have behavioral approaches include
• 41:28
  Speaker 1: sort of exercises around use of language to produce the
• 41:31
  Speaker 1: experience of pain. And this will include things like mindfulness exercises,
• 41:35
  Speaker 1: relaxation techniques, and some of the work that comes from
• 41:38
  Speaker 1: like the acceptance and commitment training or acceptance and commitment
• 41:41
  Speaker 1: therapy and things like values based exercises and acceptance practices
• 41:45
  Speaker 1: and that sort of thing. So those are also come
• 41:48
  Speaker 1: from the behavioral world of things, but they get as
• 41:51
  Speaker 1: sort of the psychological approach to managing pain.
• 41:55
  Speaker 2: Yeah, I love that. And then even placebos and magical
• 41:57
  Speaker 2: thinkings such as chiropractic interventions, prayer or lucky coins can
• 42:01
  Speaker 2: wield enough influence to at least facilitate reporting less pain.
• 42:05
  Speaker 2: I know it sounds like we're being sarcastic there, but
• 42:08
  Speaker 2: like that's if you really think about it, Like some
• 42:10
  Speaker 2: of that is just kind of like some languaging or
• 42:12
  Speaker 2: placebo effects that can really be helpful for some folks.
• 42:15
  Speaker 1: Yeah, and that's sort of the point is they say,
• 42:17
  Speaker 1: like I do lump those all together because they are
• 42:20
  Speaker 1: all magical thinking things. But the point being is like
• 42:23
  Speaker 1: they can be effective, like you can, they can at
• 42:26
  Speaker 1: least have some impact.
• 42:28
  Speaker 2: Yeah, most definitely.
• 42:29
  Speaker 1: All right, we're not quite the point for an ad
• 42:32
  Speaker 1: break again, so let's instead get into our next topic here,
• 42:35
  Speaker 1: which is called congenital analgija, which is not fun to say,
• 42:41
  Speaker 1: gija gija. All right, So we need to set some
• 42:47
  Speaker 1: context here because I think it makes the point punch
• 42:52
  Speaker 1: more intensely and therefore be more painful.
• 42:55
  Speaker 2: Yeah.
• 42:56
  Speaker 1: The part of the purpose of this discussion, I think
• 42:58
  Speaker 1: is to highlight the unique feet feature of pain as
• 43:00
  Speaker 1: an evolutionary adaptation to have the capacity to respond to
• 43:05
  Speaker 1: exposure to noxious stimuli and evoke behaviors that reduce exposure
• 43:11
  Speaker 1: to that stimuli such that we are then more likely
• 43:13
  Speaker 1: to survive. Like that is part of the purpose here, Okay,
• 43:17
  Speaker 1: And so to that point, it seems aggressively, laughably arrogant
• 43:23
  Speaker 1: to think that only humans would have evolved this capacity, Right,
• 43:28
  Speaker 1: it is very likely that all behaving organisms, from the
• 43:32
  Speaker 1: lowliest insect to the most complex organism on Earth would
• 43:36
  Speaker 1: have benefited from evolving a response to painful stimulation is
• 43:41
  Speaker 1: it is simply the ability to remove noxious stimulation which
• 43:47
  Speaker 1: is likely to cause or is already causing, tissue damage,
• 43:51
  Speaker 1: and that, if not avoided, could result in serious damage
• 43:55
  Speaker 1: or death, such that that organism is no longer able
• 43:58
  Speaker 1: to reproduce. And so it makes a lot of sense
• 44:01
  Speaker 1: that selective pressures would mean that if you can do
• 44:03
  Speaker 1: something about this obnoxious stimulation, do something about it, right,
• 44:08
  Speaker 1: and that that would be something that we all that
• 44:10
  Speaker 1: all organisms evolve like. It is very silly for me
• 44:13
  Speaker 1: to think that like at some point along the trajectory
• 44:16
  Speaker 1: of all animal species, we eventually got to humans, and
• 44:19
  Speaker 1: up until that point there was no such thing as
• 44:21
  Speaker 1: pain until there were humans, and no other animals ever
• 44:25
  Speaker 1: evolved pain. That is so stupidly arrogant and dumb and
• 44:28
  Speaker 1: short sighted. So it makes sense to assume that at
• 44:32
  Speaker 1: least all behaving organisms have the capacity to feel and
• 44:36
  Speaker 1: response to.
• 44:37
  Speaker 2: Pain, right, And so the requisite physical structures for sensation
• 44:41
  Speaker 2: or feeling pain and responding to pain seem to be
• 44:43
  Speaker 2: a brain and essential nervous system. However, even then, even
• 44:47
  Speaker 2: with that, because nature breaks all sorts of laws, there
• 44:50
  Speaker 2: are plants that do move and react to quote unquote
• 44:53
  Speaker 2: stress such as like heat or other damage. As they
• 44:56
  Speaker 2: cannot physically remove themselves from a noxious stimulus, it seems
• 44:59
  Speaker 2: unlikely that it would also have evolved the ability to
• 45:03
  Speaker 2: sense pain in the same sense that we do, or
• 45:06
  Speaker 2: at least to sense it in a more acute way.
• 45:08
  Speaker 2: Right that is, they can't do anything about it, and
• 45:10
  Speaker 2: then it is not likely a trait that would have
• 45:12
  Speaker 2: been selected that that would have been selected for because
• 45:15
  Speaker 2: it increased survival. There are responses, there's all sorts of
• 45:18
  Speaker 2: things there, but maybe the way that plants experience pain
• 45:20
  Speaker 2: is a little bit different.
• 45:21
  Speaker 1: Well, and I mean just thinking about the fact that, like,
• 45:24
  Speaker 1: what good would it do evolutionarily for a plan to
• 45:27
  Speaker 1: experience pain. It can't do anything about it, right, Like,
• 45:29
  Speaker 1: it does not increase that plan's ability to survive by
• 45:33
  Speaker 1: having the ability to sense pain, right, So, like, if
• 45:36
  Speaker 1: it can't do anything about it, like, it's very unlikely
• 45:39
  Speaker 1: it would have ever evolved in the first place. So anyway,
• 45:42
  Speaker 1: that's just I think a thing to consider here is that,
• 45:44
  Speaker 1: like they do seem to do some things that are
• 45:47
  Speaker 1: like behaviors, and they do respond to environmental conditions, but
• 45:52
  Speaker 1: they like, they just cannot do anything about pain. Now,
• 45:56
  Speaker 1: like we said, they might do things in response to
• 45:58
  Speaker 1: stress situations, and that might kind of look like behaviors
• 46:02
  Speaker 1: related to pain. But again, like unless they can turn
• 46:05
  Speaker 1: it off, there's no point in having the experience to
• 46:08
  Speaker 1: have it at all, right, And there is basically the
• 46:11
  Speaker 1: same like there's no point to us having ads. I
• 46:14
  Speaker 1: mean there is a point, but like not a great point.
• 46:16
  Speaker 2: We didn't evolve to need it, but here we are.
• 46:19
  Speaker 1: No, Yeah, they just happen. All right, we're back. We're
• 46:29
  Speaker 1: actually like I think we're making pretty good time through this. Yeah,
• 46:31
  Speaker 1: look at us go yeah.
• 46:32
  Speaker 2: All right. So pain is likely a universal experience, right,
• 46:36
  Speaker 2: It's defined by its discomfort. So wouldn't it be great
• 46:38
  Speaker 2: if we could get rid of it altogether? I think
• 46:40
  Speaker 2: that sounds lovely. And you know, we're not even talking
• 46:43
  Speaker 2: about emotional pain. We're just on a physical pain ent
• 46:44
  Speaker 2: of Now. Some people are actually born this way. They
• 46:47
  Speaker 2: can't experience pain. In a rare genetic condition called congenital analgesia,
• 46:51
  Speaker 2: children do not move away from pain or engage in
• 46:54
  Speaker 2: any other behaviors that indicate that they sense painful input
• 46:58
  Speaker 2: as pain and Wall describe a case in which a
• 47:02
  Speaker 2: girl crawls across a hot radiator and sustains third degree
• 47:04
  Speaker 2: burns to her legs without trying to remove the stimulation.
• 47:07
  Speaker 2: Because this child the stimulation, I should say, because she
• 47:10
  Speaker 2: does not feel pain in the stimulus, the stimulation is
• 47:13
  Speaker 2: not painful for her. I actually worked with a client
• 47:16
  Speaker 2: that had this, and it was fascinating. This client that
• 47:20
  Speaker 2: I worked with did not experience heat or cold, any
• 47:24
  Speaker 2: of those sensations that would have prompted her to remove
• 47:27
  Speaker 2: additional layers of clothing and stuff like that had engaged
• 47:31
  Speaker 2: in behaviors that she would bind her wrists and her
• 47:33
  Speaker 2: fingers and her ankles and her toes and did not
• 47:37
  Speaker 2: sense that she was losing sensations or feelings in her
• 47:40
  Speaker 2: hands and toes and like almost lost fingers as a
• 47:42
  Speaker 2: result of it. So it's one of those really interesting
• 47:45
  Speaker 2: things where it's like, when you see it in real life,
• 47:47
  Speaker 2: you're like, wow, how does this happen? It's really kind
• 47:49
  Speaker 2: of like a little bit it's a little bit scary.
• 47:53
  Speaker 1: Yeah, No, it certainly would be like this is a
• 47:55
  Speaker 1: life threatening condition. Yeah, because pain stops us from doing
• 47:59
  Speaker 1: things or allowing things to happen that can cause significant damage,
• 48:03
  Speaker 1: and without that sensory input, these congenital analgesic children may
• 48:08
  Speaker 1: often die at a young age, and that's a terrible thing.
• 48:11
  Speaker 1: It's a horrible thing to think about. But like we
• 48:14
  Speaker 1: need that guidance that tells us when we're doing something
• 48:17
  Speaker 1: that is going to result in damage that would cause
• 48:20
  Speaker 1: us like would incapacitate us and moderate amounts, and when
• 48:24
  Speaker 1: applied in appropriate contexts, pain keeps us alive, Like it
• 48:29
  Speaker 1: is one of the most important things that keeps us alive.
• 48:32
  Speaker 1: And we really take for granted the fact that like
• 48:35
  Speaker 1: we have this as a sense as we go through
• 48:38
  Speaker 1: our day that we can respond to and do something
• 48:41
  Speaker 1: about things that are painful when they happen, because if
• 48:43
  Speaker 1: we didn't have that, we would be doing constant damage
• 48:46
  Speaker 1: to ourselves, as demonstrated by these kids who are born
• 48:49
  Speaker 1: without it. And so it is very instructive to have pain.
• 48:52
  Speaker 1: And I think while it sounds lovely to be able
• 48:55
  Speaker 1: to turn that off and make it go away, it
• 48:57
  Speaker 1: actually would be devastating to us overall. Well being all right,
• 49:03
  Speaker 1: let's talk some other sort of interesting tidbits here, as
• 49:05
  Speaker 1: we've covered so much of our content I.
• 49:08
  Speaker 2: Love tid points. So researchers consistently find that women tend
• 49:12
  Speaker 2: to report a greater sensitivity to pain than men. However,
• 49:16
  Speaker 2: there are complex social factors to consider specifically around this. So,
• 49:19
  Speaker 2: for instance, in some cultures, definitely American culture, the social
• 49:23
  Speaker 2: context for men is such that they are monished for
• 49:25
  Speaker 2: expressing pain and that it is masculine to tolerate pain. Women,
• 49:29
  Speaker 2: on the other hand, are delivered no such exceptions and
• 49:32
  Speaker 2: requirements for that and are free to emote, you know,
• 49:35
  Speaker 2: as they feel appropriate. However, I do think also we
• 49:39
  Speaker 2: do live in a society where women will emote and
• 49:42
  Speaker 2: they will describe this, and it gets disregarded or kind
• 49:46
  Speaker 2: of like ignored as like, oh, you suck it up,
• 49:49
  Speaker 2: you'll be fine, Da da dada da, And it's like
• 49:50
  Speaker 2: kind of just really bad. We don't really take pain
• 49:52
  Speaker 2: very seriously here in the United States.
• 49:55
  Speaker 1: I mean, if you're wealthy enough, sure I do. But yeah,
• 49:58
  Speaker 1: and actually this one kind of surprised me, and because
• 50:00
  Speaker 1: my own personal experience had me thinking that it was
• 50:03
  Speaker 1: the opposite, that women like tended to have greater thresholds
• 50:06
  Speaker 1: for pain. Is an example of this, Like, I've known
• 50:08
  Speaker 1: people who got tattoos in similar places to me, and
• 50:11
  Speaker 1: I remember sort of asking like, how was that, and like, oh,
• 50:13
  Speaker 1: it wasn't so bad, And I was like, man, that
• 50:14
  Speaker 1: was crippling to me what I was loving. Yeah, yeah, yeah,
• 50:17
  Speaker 1: it was so painful. I could barely stand it. And
• 50:19
  Speaker 1: they're like, oh, it wasn't that bad. And I've also
• 50:21
  Speaker 1: just seen people like I have seen women who like
• 50:25
  Speaker 1: and again maybe this is a huge social context thing
• 50:28
  Speaker 1: that's relevant for them, but like they experience some amount
• 50:31
  Speaker 1: of pain and just kind of walk it off, and
• 50:33
  Speaker 1: I'm like, man, I feel like I would be just
• 50:35
  Speaker 1: incapacitated if I just went through what you just went through.
• 50:39
  Speaker 1: So I do think there is a cultural thing around
• 50:43
  Speaker 1: this or social things around this that's going to be
• 50:45
  Speaker 1: very individual differences around this. But the research that has
• 50:49
  Speaker 1: been done, quality of which we are not clear. I'm
• 50:54
  Speaker 1: guessing a lot of it is not super great, and
• 50:56
  Speaker 1: probably a lot of it is with college students. Sure
• 50:59
  Speaker 1: suggest that there's a pattern that emerges pretty consistently and
• 51:03
  Speaker 1: over and over again that women report being more sensitive
• 51:06
  Speaker 1: to the experience of pain. But I would take that
• 51:08
  Speaker 1: with a huge grain of salt. I think, first of all,
• 51:10
  Speaker 1: trying to dichotomize us as men and women by itself
• 51:13
  Speaker 1: as kind of a foolish task, and then to try
• 51:15
  Speaker 1: and search for any meaningful differences across those in those
• 51:18
  Speaker 1: patterns is also a meaningless task. Yeah, and so I
• 51:21
  Speaker 1: think that we don't necessarily learn anything from that, but
• 51:24
  Speaker 1: that is a thing that is reported.
• 51:26
  Speaker 2: Yeah, absolutely, So this is also true for elderly people.
• 51:29
  Speaker 2: The current understanding is that we physically wear down and
• 51:32
  Speaker 2: our bodies become less capable of preventing pain, and like
• 51:36
  Speaker 2: really kind of like, you know, we start to kind
• 51:38
  Speaker 2: of lose our capacities in a lot of different ways,
• 51:40
  Speaker 2: so we feel pain all the time and are less
• 51:43
  Speaker 2: tolerant to it. And again, personal experience may be different
• 51:46
  Speaker 2: for different folks. I know that as I approach forty,
• 51:49
  Speaker 2: I feel like I experience less pain on a day
• 51:54
  Speaker 2: to day basis. But also I am not doing the
• 51:57
  Speaker 2: same physical activities that I was when I was twenty.
• 52:01
  Speaker 2: You know, I'm not playing baseball anymore, I'm not touring anymore.
• 52:04
  Speaker 2: I'm not lifting you know, music gear every day, sleeping
• 52:07
  Speaker 2: in a van, I'm sleeping in a normal bed and
• 52:09
  Speaker 2: not hurting myself every night. So like I'm you know,
• 52:12
  Speaker 2: It's one of those things where it's kind of like
• 52:14
  Speaker 2: my social context is a little bit different too, very
• 52:16
  Speaker 2: much so.
• 52:16
  Speaker 1: And I was actually going to say, like a very
• 52:18
  Speaker 1: similar thing for me personally, is that, like it's just different,
• 52:22
  Speaker 1: Like there are things now that hurt that didn't used
• 52:25
  Speaker 1: to hurt. But there's also like things that used to
• 52:28
  Speaker 1: hurt that like because I'm more used to them now,
• 52:31
  Speaker 1: I feel like I'm more tolerant of them. And I
• 52:34
  Speaker 1: have seen, you know, older people who it seems like
• 52:38
  Speaker 1: their threshold for pain is way above mine. Sure, and
• 52:41
  Speaker 1: again might just be an individual thing. And again, the
• 52:43
  Speaker 1: dichotomy of like old versus young probably not a thing
• 52:47
  Speaker 1: that exists, right, But I watched there recently. It was
• 52:51
  Speaker 1: Bill Murrie, and I forget who is with him. I
• 52:55
  Speaker 1: want to say Pete Davidson because they were in like
• 52:56
  Speaker 1: a movie coming out together or something. Yes, And they
• 52:59
  Speaker 1: were on Hot one yes and yeah yeah, and Bill
• 53:02
  Speaker 1: Murray was like totally fine the whole time, and like
• 53:04
  Speaker 1: that could have been Bill Murray being Bill Murray, but
• 53:06
  Speaker 1: like it seemed like he was legitimately fine the whole time.
• 53:09
  Speaker 1: And I feel like I've heard that that, like the
• 53:11
  Speaker 1: older people tend to be more and more resilient to
• 53:14
  Speaker 1: spicy food. But also just like I've seen like being
• 53:17
  Speaker 1: poked with needles to have blood drawn, they're just kind
• 53:19
  Speaker 1: of like whatever. Yeah, it's like their experience is with
• 53:21
  Speaker 1: the pain they've experienced, they are more tolerant too, But
• 53:24
  Speaker 1: there are just other pains that are like things that
• 53:26
  Speaker 1: didn't used to her that just now kind of always ache.
• 53:28
  Speaker 2: And hurt all the time, right right, right, absolutely.
• 53:31
  Speaker 1: So I think it's just different, is the way to
• 53:32
  Speaker 1: think about.
• 53:33
  Speaker 2: It, and it's good. I think it's a good way
• 53:34
  Speaker 2: to look at it. Now.
• 53:35
  Speaker 1: We have mentioned this before and we're gonna mention it
• 53:38
  Speaker 1: again because it's fun. But there is a huge amount
• 53:40
  Speaker 1: of like metaphor around pain and our verbal behavior around this.
• 53:46
  Speaker 1: And so like when we talk about a pain inside,
• 53:49
  Speaker 1: will usually use metaphors by alluding to external things. So
• 53:54
  Speaker 1: we call something a sharp pain, and that is like
• 53:57
  Speaker 1: something that is sharp, which also by itself as it's
• 54:00
  Speaker 1: own subjective experience. But like we metaphorically call something internal
• 54:05
  Speaker 1: sharp even though there's not actually a sharp pain. Like
• 54:09
  Speaker 1: we looked inside, we wouldn't see a sharp thing happen.
• 54:12
  Speaker 1: But the best we can relate it to is verbally
• 54:15
  Speaker 1: through the metaphor of we do know what sharp things
• 54:17
  Speaker 1: feel like when we touch them with our skin, or
• 54:19
  Speaker 1: a dull pain, or like a butterflies or and we've
• 54:22
  Speaker 1: talked about all these examples, but you think about all
• 54:25
  Speaker 1: the language that we use to describe our internal subjective
• 54:29
  Speaker 1: experience of pain, and all or almost all of it
• 54:33
  Speaker 1: is going to be metaphorical language that refers to external
• 54:36
  Speaker 1: experiences that we can have. Sure, it's a useful way
• 54:39
  Speaker 1: of thinking about it because we can sort of follow
• 54:42
  Speaker 1: the logic of that metaphor, but it is kind of interesting.
• 54:45
  Speaker 1: It's just the thing to think about.
• 54:46
  Speaker 2: I think of like when people even report pain, right,
• 54:50
  Speaker 2: they report it based on you know, like they compare
• 54:53
  Speaker 2: it to something, or they describe it in terms that
• 54:56
  Speaker 2: it's very subjective to like they use like skills to
• 54:59
  Speaker 2: describe it. Like there's lots of ways that people verbalize
• 55:01
  Speaker 2: pain and stuff like that, which is really interesting.
• 55:04
  Speaker 1: Yeah. Absolutely. And then the last thing I'll say here
• 55:07
  Speaker 1: is like emotional pain can feel like physical pain. You know,
• 55:11
  Speaker 1: we've talked about people have talked about at least the
• 55:15
  Speaker 1: idea of like having your heart broken and you feel
• 55:17
  Speaker 1: actual physical pain tightening in your chest, maybe nausea or
• 55:23
  Speaker 1: upset stomach or something like that. Like these are physical
• 55:26
  Speaker 1: sensations we then experience that are unpleasant and uncomfortable, And
• 55:31
  Speaker 1: it's entirely in the context of an emotional thing that happens, right,
• 55:35
  Speaker 1: loss or trauma or something where we experience something psychologically
• 55:41
  Speaker 1: that then affects how we feel physically, which is really
• 55:44
  Speaker 1: interesting and I think it again speaks to the power
• 55:48
  Speaker 1: of language that this ability that we have to behave
• 55:51
  Speaker 1: arbitrarily to the world around us through our language, allows
• 55:55
  Speaker 1: us to experience pain in places we otherwise wouldn't. Like
• 55:59
  Speaker 1: I don't think any anybody has a pet that is
• 56:02
  Speaker 1: like thinking about the job that they need to get
• 56:06
  Speaker 1: to support the family, and they're like stressed out about
• 56:08
  Speaker 1: the support that they're the work they're going to have
• 56:11
  Speaker 1: to do right, or like is worried about some pain
• 56:13
  Speaker 1: they might experience that hasn't happened yet. Now, they obviously
• 56:16
  Speaker 1: can be very afraid and like understand a context like
• 56:19
  Speaker 1: where we're getting in the car. Now, that's never good
• 56:21
  Speaker 1: because we always end up at the vet whenever that happens, right,
• 56:24
  Speaker 1: or you know, we're getting in the part in that
• 56:26
  Speaker 1: car that's great because we end up at the lake
• 56:27
  Speaker 1: and I get to play. But depending on the kind
• 56:29
  Speaker 1: of pet that we're talking about here. But like, there
• 56:31
  Speaker 1: are contexts in which the situation has enough pairing and
• 56:35
  Speaker 1: overlap with the experiences of like discomfort, that they then
• 56:39
  Speaker 1: sort of behave with respect to it being pain. But again,
• 56:42
  Speaker 1: with humans, we have this acute, impressive ability to simply
• 56:46
  Speaker 1: have emotions feel like physical pain to us, and that
• 56:50
  Speaker 1: seems to be essentially accommodated by or afforded by our language.
• 56:55
  Speaker 2: Yeah, I love that.
• 56:56
  Speaker 1: All right, Well, I think that's what you have to
• 56:58
  Speaker 1: say about. I think we did the thing, the pain thing.
• 57:02
  Speaker 2: I am impressed that we got through this whole thing
• 57:05
  Speaker 2: without being saying something like oh man, what a pain
• 57:07
  Speaker 2: in the ass or something like that. We did we
• 57:10
  Speaker 2: got so far without doing that. I think that we've
• 57:13
  Speaker 2: I think that we've evolved, we've matured as a podcast.
• 57:16
  Speaker 1: Yes, it wasn't too painful, so there it is.
• 57:19
  Speaker 2: Well, there it is.
• 57:21
  Speaker 1: We slip back into childish humor at the very end,
• 57:24
  Speaker 1: I guess, of course, speaking of which here are some
• 57:26
  Speaker 1: childish ads.
• 57:27
  Speaker 2: Oh boo.
• 57:36
  Speaker 1: All right, I probably should have said, like, we are
• 57:38
  Speaker 1: coming back with reasonable meaningful content, so hopefully we didn't
• 57:41
  Speaker 1: just lose everyone. But at the end of our discussions,
• 57:44
  Speaker 1: if you haven't been with us before, you might not
• 57:46
  Speaker 1: know this that we recommend some things. They're usually unrelated
• 57:49
  Speaker 1: to the topic that we're discussing. But then the way
• 57:51
  Speaker 1: you just want to say, hey, we recommend you check
• 57:53
  Speaker 1: this out or just know about it or something. There's
• 57:55
  Speaker 1: variety of ways that this can look and it's really fun.
• 57:58
  Speaker 1: But before we do that, I do need to get
• 58:00
  Speaker 1: through the credits, which are important, and then we get
• 58:02
  Speaker 1: to the fun stuff, which is the recommendations. So as
• 58:05
  Speaker 1: I mentioned before, you can support us lots of ways,
• 58:08
  Speaker 1: like and subscribe. If you enjoy what you hear, then
• 58:10
  Speaker 1: leave us a nice five star rating, and if you're
• 58:13
  Speaker 1: feeling particularly ambitious, you can accompany that rating with the
• 58:15
  Speaker 1: review and that really helps us out. You can definitely
• 58:17
  Speaker 1: go tell a friends. One of the best ways to
• 58:19
  Speaker 1: spread podcast is just by sharing information with other people.
• 58:23
  Speaker 1: And of course you can join us on Patreon if
• 58:25
  Speaker 1: you're tired of hearing those ads and you want to
• 58:27
  Speaker 1: get rid of them. I understand. I wish I could
• 58:30
  Speaker 1: do that for you too, and I probably could, but
• 58:32
  Speaker 1: you know, we are trying to keep this podcast going,
• 58:34
  Speaker 1: so we're going to keep them there for now. But
• 58:36
  Speaker 1: if you join, you get ad free content, bonus content,
• 58:39
  Speaker 1: behind the scenes things, early episodes and free episodes, all
• 58:43
  Speaker 1: that kind of stuff. You can do that by heading
• 58:45
  Speaker 1: over to our Patreon account. There's a cool group of
• 58:47
  Speaker 1: people over there, and one more particularly delectable bonus of
• 58:51
  Speaker 1: joining that Patreon group is that I will read your
• 58:54
  Speaker 1: name at the end of each and every full length episode.
• 58:57
  Speaker 1: So a big thank you to the following people who
• 59:00
  Speaker 1: support us on Patreon. Mike m Meghan, Mike T, Justin,
• 59:04
  Speaker 1: Kim Brad, Stephanie, Brian, Ashley, Kiara and Charlie. Thank you
• 59:10
  Speaker 1: all for can your continued support and just being generally awesome.
• 59:13
  Speaker 2: This is the part of the show where I do
• 59:15
  Speaker 2: the arsenio hall for all those folks, So thank you
• 59:19
  Speaker 2: for being here.
• 59:19
  Speaker 1: Very nice. Yes, thank you so much or do really
• 59:22
  Speaker 1: appreciate it. And as I said, you can join that
• 59:24
  Speaker 1: group of people by heading over there. We also have
• 59:26
  Speaker 1: a discord server. We chat with each other on that
• 59:29
  Speaker 1: if you would not like to do that, but you'd
• 59:31
  Speaker 1: like to reach out and tell us your thoughts and
• 59:33
  Speaker 1: experiences with Paine maybe have us share that as a
• 59:36
  Speaker 1: listener mail or just share it privately. Either way, we
• 59:38
  Speaker 1: love hearing from people. You can reach us directly by
• 59:41
  Speaker 1: emailing us at info at wwdwwdpodcast dot com, and you
• 59:45
  Speaker 1: can also find us on the social media platforms, particularly
• 59:48
  Speaker 1: active on Blue Sky. I think that is the things
• 59:51
  Speaker 1: I have to say about that. Thank you so much
• 59:52
  Speaker 1: to my team of people, without whom I could not
• 59:54
  Speaker 1: make this podcast writing and fact checking from Shane and myself.
• 59:58
  Speaker 1: Thank you for recording with me today, Shane, Hey, thank
• 1:00:00
  Speaker 1: you for having me. Our social media coordinator is Emma Wilson.
• 1:00:03
  Speaker 1: And the person who does audio stuff and makes it
• 1:00:06
  Speaker 1: good is Justin. He does all the music, all the sounds,
• 1:00:09
  Speaker 1: all the editing. So what comprehensive podcast you get with
• 1:00:12
  Speaker 1: like good listenable quality is because of him. So thank
• 1:00:16
  Speaker 1: you Justin.
• 1:00:16
  Speaker 2: Yes, Justin rules.
• 1:00:18
  Speaker 1: Somehow he takes these discussions that we have and turns
• 1:00:21
  Speaker 1: them into listenable content. It's kind of miraculous.
• 1:00:24
  Speaker 2: Really, yeah, you don't even know. It's magic. Really, it's
• 1:00:27
  Speaker 2: truly magic.
• 1:00:28
  Speaker 1: Yeah. And you can hear the uncut versions of these
• 1:00:30
  Speaker 1: if you join us on Patreon, and you will see
• 1:00:32
  Speaker 1: truly the job that Justin has to has to take on.
• 1:00:36
  Speaker 2: Yes, he doesn't get paid enough.
• 1:00:40
  Speaker 1: Exactly, all right, I think that's what I have to
• 1:00:42
  Speaker 1: say before we get to our recommendations. Is there anything
• 1:00:44
  Speaker 1: that I missed or that you would like to add
• 1:00:46
  Speaker 1: before we make our transition.
• 1:00:47
  Speaker 2: No, I think that's it.
• 1:00:49
  Speaker 1: That's cue the music. Who recommendation. Okay, I'm recommending a movie.
• 1:01:03
  Speaker 1: This is called Mister Monk's Last Case a Monk movie.
• 1:01:09
  Speaker 1: This is a movie that follows the TV show called
• 1:01:12
  Speaker 1: Monk Mnk about a character who is essentially a freelance
• 1:01:18
  Speaker 1: detective living in San Francisco who's just like hyper observant
• 1:01:22
  Speaker 1: but also extremely quirky, and he also does a lot
• 1:01:26
  Speaker 1: of sort of deductive logic reasoning sort of things. And
• 1:01:29
  Speaker 1: it's a comedy TV show about solving crimes, like that's
• 1:01:32
  Speaker 1: basically what it is. Typically, crime solving stuff not my
• 1:01:35
  Speaker 1: cup of tea, But I do love comedies and I
• 1:01:37
  Speaker 1: think even the comedic value can transcend the low quality
• 1:01:42
  Speaker 1: that is crime storytelling in my opinion, although I know
• 1:01:46
  Speaker 1: a lot of people strongly disagree with that. That's okay,
• 1:01:49
  Speaker 1: I'm just espousing my opinion anyway. This was released on
• 1:01:52
  Speaker 1: Peacock I assume that you can get it elsewhere, but
• 1:01:55
  Speaker 1: this is the only place that I have seen it
• 1:01:57
  Speaker 1: because Monk was owned by Peacock as a TV show.
• 1:02:01
  Speaker 1: That's where the movie is available. And it was very good, Like,
• 1:02:04
  Speaker 1: it was very funny, it felt very true to the
• 1:02:06
  Speaker 1: original show. It was a very enjoyable story like it
• 1:02:10
  Speaker 1: just I think it worked really well and I think
• 1:02:11
  Speaker 1: they did a very good job with it. And so yeah,
• 1:02:14
  Speaker 1: mister Monk's Last Case a Monk movie. You can check
• 1:02:17
  Speaker 1: that out at least on Peacock, if not other places
• 1:02:19
  Speaker 1: if you're interested in like comedic crime storytelling.
• 1:02:23
  Speaker 2: Sure. And I always like the actor too. I can't
• 1:02:25
  Speaker 2: remember his name is right now, but like Tony Tony Shalub,
• 1:02:28
  Speaker 2: that's what it is.
• 1:02:28
  Speaker 1: He's great and every good. Yeah, he is really fantastically
• 1:02:32
  Speaker 1: like he is a really good actor legitimately.
• 1:02:34
  Speaker 2: Yeah, he's so fun great. I love that. I am
• 1:02:37
  Speaker 2: going to recommend a book. I just finished this book
• 1:02:39
  Speaker 2: and it was pretty powerful for me and it made
• 1:02:41
  Speaker 2: me realize that I could probably be doing a little
• 1:02:43
  Speaker 2: bit more and also still protect my piece when it
• 1:02:46
  Speaker 2: comes to social justice stuff. And that is a book
• 1:02:48
  Speaker 2: called Let This Radicalize You. Organizing in the Revolution of
• 1:02:52
  Speaker 2: Reciprocal Care by Kelly Hayes and Mariami Kaba. And so
• 1:02:57
  Speaker 2: this book is not necessarily how too, but it's like
• 1:03:01
  Speaker 2: insightful stories and strategies for engaging in really good action
• 1:03:08
  Speaker 2: towards values and systems or values and like maybe causes
• 1:03:12
  Speaker 2: that you believe in. But it also does in a
• 1:03:13
  Speaker 2: way it's like very compassionate, it's very community focused and
• 1:03:16
  Speaker 2: community oriented, and it gives a lot of case examples
• 1:03:18
  Speaker 2: of how you can make impactful changes in your community
• 1:03:22
  Speaker 2: and be demonstrators and be protesters while still maintaining your sanity,
• 1:03:28
  Speaker 2: while still fostering hope in your communities, especially in a
• 1:03:32
  Speaker 2: world that's like completely on fire right now. And so
• 1:03:35
  Speaker 2: I do think it's a valuable read right now given
• 1:03:39
  Speaker 2: the current state of the world, especially for folks that
• 1:03:41
  Speaker 2: don't know what to do or where to start. This
• 1:03:43
  Speaker 2: is a really good place to kind of go, Hey,
• 1:03:46
  Speaker 2: like I can do good work and do this in
• 1:03:49
  Speaker 2: the way that I need to do this so that
• 1:03:50
  Speaker 2: I can be successful without being burnout. And it's really,
• 1:03:55
  Speaker 2: I think a really great read if you're interested at
• 1:03:57
  Speaker 2: all in social justice and protest behavior and things of
• 1:04:01
  Speaker 2: that nature.
• 1:04:02
  Speaker 1: Wow, that was. You basically sold me on it before
• 1:04:05
  Speaker 1: you even got to the title, so I'm definitely gonna
• 1:04:07
  Speaker 1: have to check that out.
• 1:04:08
  Speaker 2: Yeah, yeah, it's awesome. I love it. Well.
• 1:04:09
  Speaker 1: I think we said the things about reaching out to us.
• 1:04:12
  Speaker 1: We look forward to hearing from you. Thank you all
• 1:04:14
  Speaker 1: very much for listening. That was mister Monk's Last Case
• 1:04:16
  Speaker 1: a Monk movie on Peacock if you want to check
• 1:04:18
  Speaker 1: that out. And then Let's radicalize sorry, let this radicalize you.
• 1:04:22
  Speaker 1: Organizing and the Revolution of Reciprocal Care by Kelly Hayes
• 1:04:25
  Speaker 1: and Mary am Kaba the book. Those are the things
• 1:04:28
  Speaker 1: that you can check out if you'd like to take
• 1:04:30
  Speaker 1: those recommendations. And then I think that what we have
• 1:04:33
  Speaker 1: to say, is there anything that I'm missing or are
• 1:04:35
  Speaker 1: we ready to wrap this one up?
• 1:04:36
  Speaker 2: I think that covers this one perfect.
• 1:04:38
  Speaker 1: This is Abraham and this is Shane. We're out.
• 1:04:40
  Speaker 2: So yeah, you've been listening to Why We Do what
• 1:04:43
  Speaker 2: we do. You can learn more about this and other
• 1:04:46
  Speaker 2: episodes by going to WWD WWD podcast dot com. Thanks
• 1:04:51
  Speaker 2: for listening, and we hope you have an awesome day.