Latest / Stuff You Should Know / How Pain Works

Transcript

How Pain Works · Stuff You Should Know

• 0:01
  Speaker 1: Welcome to Stuff You Should Know, a production of five
• 0:03
  Speaker 1: Heart Radios How Stuff Works. Hey, and welcome to the podcast.
• 0:12
  Speaker 1: I'm Josh Clark. There's Charles W. Chuck Bryan over there,
• 0:16
  Speaker 1: and Jerry's out there running around somewhere. We just gave
• 0:19
  Speaker 1: her a hot foot. It's hilarious. Uh, and this is
• 0:22
  Speaker 1: stuff you should not tried. Are continuing exploration of pain? Mhm.
• 0:29
  Speaker 1: What else have we talked about with paint? We did
• 0:31
  Speaker 1: one on the pain scales, okay a couple of years ago,
• 0:34
  Speaker 1: and uh, then we did one on something about perceiving pain. Well,
• 0:39
  Speaker 1: this one, this one, this is just totally stuff you
• 0:43
  Speaker 1: should know them because we did a bunch of like
• 0:45
  Speaker 1: more niche stuff and now we're going back and doing
• 0:47
  Speaker 1: like the umbrella topic and we're talking about pain, which, Um,
• 0:53
  Speaker 1: is there a super ancient old evolutionary Um, right, I
• 1:00
  Speaker 1: guess that's shared basically throughout all living things. I would
• 1:05
  Speaker 1: say it's a pretty fair guess. I think so, Yeah,
• 1:08
  Speaker 1: because um, there's something that pain pain specifically, which is this.
• 1:13
  Speaker 1: We'll get into defining it and how hard that is
• 1:15
  Speaker 1: in a second, but um, it seems to be a
• 1:18
  Speaker 1: a fairly universal, almost universal process where our body says, hey,
• 1:24
  Speaker 1: there's something really bad going on, say on your hand,
• 1:28
  Speaker 1: So move your hand away from wherever it is in
• 1:30
  Speaker 1: space right now, and hopefully that will help keep it
• 1:33
  Speaker 1: from getting further damage. Like pain is a signal saying, um,
• 1:39
  Speaker 1: do something, dummy, move and it's it. I mean, that's
• 1:41
  Speaker 1: that's you know, you see it in and basically any
• 1:44
  Speaker 1: animal we've ever encountered, including the beaver and the porcupine.
• 1:49
  Speaker 1: That's right. And by the way, we did other people
• 1:51
  Speaker 1: who can't feel pain ten years ago. Yeah, it actually
• 1:56
  Speaker 1: seems longer ago than that. That's funny because I thought
• 1:59
  Speaker 1: pain Scales was forever ago and it was so Yeah,
• 2:03
  Speaker 1: I have no sense of time anymore. So, so we
• 2:06
  Speaker 1: are talking about pain, Chuck, you feel pain right or
• 2:08
  Speaker 1: do you have a high pain threshold? Are you sensitive? Uh? Well,
• 2:11
  Speaker 1: you know it's funny because I went back and listen
• 2:13
  Speaker 1: to the Pain Scales and I kind of chatted about
• 2:15
  Speaker 1: that for a bit. But I have a pretty high
• 2:18
  Speaker 1: pain threshold. Yeah, okay, I would say mine's average. Let's
• 2:24
  Speaker 1: just go with that. I wonder what I said in
• 2:26
  Speaker 1: the Pain Scales app because there's no way I didn't
• 2:29
  Speaker 1: respond to your your thing you know it will be
• 2:33
  Speaker 1: a mystery. So um. Apparently pain is the most common
• 2:38
  Speaker 1: reason that people, um go seek medical attention. But when
• 2:43
  Speaker 1: they go seek medical attention, as we talked about in
• 2:45
  Speaker 1: the pain Scales episode, the whole reason there is such
• 2:47
  Speaker 1: a thing as a pain scale is because it's a
• 2:49
  Speaker 1: fully subjective experience and it's really difficult to describe. And
• 2:55
  Speaker 1: it's taken medicine, like many, many years to get to
• 2:58
  Speaker 1: a point where they tell the people their training, doctors
• 3:02
  Speaker 1: and nurse practitioners and medical staff, like, if somebody tells
• 3:06
  Speaker 1: you they're in pain, they're experiencing pain, you have to
• 3:09
  Speaker 1: take them at their word. Um. And that's actually kind
• 3:13
  Speaker 1: of a new development because there are plenty of times
• 3:15
  Speaker 1: when it appears that there's absolutely nothing wrong and that
• 3:19
  Speaker 1: the person shouldn't be in pain. And for years doctors
• 3:22
  Speaker 1: just kind of treated people like like that like kooks
• 3:26
  Speaker 1: and didn't believe them, which was very sad. And now
• 3:28
  Speaker 1: we're finally figuring out there's situations where you can be
• 3:31
  Speaker 1: experiencing pain even though there's no reason for you to
• 3:34
  Speaker 1: be experiencing pain, which really underscores just how subjective it is.
• 3:38
  Speaker 1: That's right. Uh. In three, there was an actual definition
• 3:43
  Speaker 1: for pain that was introduced that has a couple of
• 3:45
  Speaker 1: really important caveats that will kind of play out through
• 3:48
  Speaker 1: this episode. Pain is an unpleasant, sensory and emotional experience.
• 3:54
  Speaker 1: There's the first caveat associated with actual or potential tissue
• 3:58
  Speaker 1: damage or described in terms of such damage, which is
• 4:03
  Speaker 1: a big caveat there, because you can walk into a
• 4:06
  Speaker 1: doctor's office and say, I've got some big time tissue damage. Doc,
• 4:11
  Speaker 1: I'm experiencing big time pain, and they can look you
• 4:13
  Speaker 1: over and be like, this guy didn't have any tissue
• 4:16
  Speaker 1: damage at all. So that's in the actual definition of
• 4:20
  Speaker 1: pain of pain. So I think that the reason they
• 4:22
  Speaker 1: caveatted that was for the very simple reason that pain
• 4:28
  Speaker 1: can be emotional. And I don't mean like real emotional pain.
• 4:32
  Speaker 1: I mean a physical pain that is may be made
• 4:35
  Speaker 1: worse by emotion or brought on by emotion, or that
• 4:39
  Speaker 1: you're you know, you really don't have a pain, like
• 4:42
  Speaker 1: you've got a chronic pain, let's say, but nothing's going
• 4:45
  Speaker 1: on under the hood to cause it. Yeah, And like
• 4:48
  Speaker 1: we've learned so much about pain since nineteen seventy three
• 4:51
  Speaker 1: that I saw that just this past July, um the
• 4:54
  Speaker 1: International Association for the Study of Pain updated and revised
• 4:58
  Speaker 1: their their definition. It's still basically the same, but they've
• 5:01
  Speaker 1: included a lot of stuff that we talk we're going
• 5:03
  Speaker 1: to talk about in this episode. Does it say pain
• 5:06
  Speaker 1: whatever you say, dude, right yea, they said pain is uh, yeah,
• 5:14
  Speaker 1: it is so far at least. Um. There's a bunch
• 5:18
  Speaker 1: of different types of pain, though actually not that many,
• 5:21
  Speaker 1: but there's a few. Acute pain, which is very short lasting.
• 5:26
  Speaker 1: If you if you put your finger on the burner
• 5:29
  Speaker 1: of the stove or something like that, or um, slam
• 5:32
  Speaker 1: it in a window, that's going to be an acute
• 5:34
  Speaker 1: pain where you know it's really helpful, so you know
• 5:38
  Speaker 1: your body is gonna say, wait a minute, that's super hot.
• 5:40
  Speaker 1: Or by the way, dummy, you just put your finger
• 5:42
  Speaker 1: in a window and you immediately have a reaction to
• 5:46
  Speaker 1: stop that immediate acute thing from happening, even though the
• 5:50
  Speaker 1: pain is gonna still be there. It's not like you
• 5:52
  Speaker 1: slam your finger in the window, yank your thing away
• 5:55
  Speaker 1: and shake it a little bit and it's gone. Right. Well,
• 5:57
  Speaker 1: it can be depending on the level of pain, but
• 5:59
  Speaker 1: it makes sense that it would still linger even in
• 6:02
  Speaker 1: acute paint, which from what I can tell, is like
• 6:04
  Speaker 1: the ideal version of pain. It's, like you said, it
• 6:06
  Speaker 1: makes you stop doing whatever you're doing, but the fact
• 6:09
  Speaker 1: that it still hangs around for another minute, it's almost
• 6:11
  Speaker 1: like it's teaching you a lesson, like not only stop
• 6:14
  Speaker 1: doing that, don't do that again. Yeah, and there's some
• 6:17
  Speaker 1: overlap in these, by the way, So when we talk
• 6:20
  Speaker 1: about the next one, no susceptive pain, this comes about
• 6:24
  Speaker 1: from tissue damage, like real tissue damaged by like physical
• 6:28
  Speaker 1: or a chemical agent. We're talking a chemical burn, or
• 6:31
  Speaker 1: a trauma or a surgery. This can also include slamming
• 6:34
  Speaker 1: that finger in the window. It can also include you
• 6:38
  Speaker 1: worked out really hard the day before and you're really
• 6:40
  Speaker 1: sore the next day. Yeah, as long as there's some
• 6:42
  Speaker 1: sort of like mechanical reason or some sort of damage
• 6:47
  Speaker 1: to tissue, or even temporary damage like a sore sore muscle.
• 6:51
  Speaker 1: Um And it also includes malignant pain, which is cancer pain,
• 6:54
  Speaker 1: which is where tumor starts growing in your tissue, impresses
• 6:58
  Speaker 1: on nerves and blood vessels and create pain like that.
• 7:01
  Speaker 1: And no, no susceptive pain is what most people think
• 7:04
  Speaker 1: of when they think about pain. Um And it can
• 7:07
  Speaker 1: be both acute and chronic. But I guess the best
• 7:10
  Speaker 1: way to kind of differentiate no susceptive pain from the
• 7:13
  Speaker 1: rest of it, there's actually something going on that is
• 7:16
  Speaker 1: causing the pain signal to be created. Um And it,
• 7:21
  Speaker 1: like I said, it can be short lasting or long lasting. Um.
• 7:24
  Speaker 1: And it's different from a different type of pain, appropriately
• 7:28
  Speaker 1: enough called neuropathic pain. Whereas no susceptive arise from arises
• 7:33
  Speaker 1: from tissue damage, neuropathic arises from damage to the actual
• 7:38
  Speaker 1: nerves themselves. Yeah. Like, uh, I don't know if you
• 7:41
  Speaker 1: remember this story from almost a year ago. It was
• 7:44
  Speaker 1: last October when I hit my shin on my bed
• 7:48
  Speaker 1: so hard that water started leaking out of my eyes.
• 7:54
  Speaker 1: I wasn't crying, it was just literally water coming out
• 7:57
  Speaker 1: of my eyes. And I've never felt pain like that before.
• 8:00
  Speaker 1: And it was clearly some kind of literal nerve damage
• 8:03
  Speaker 1: because for three or four months, I had like a
• 8:07
  Speaker 1: three uh three inch by three inch square on my
• 8:10
  Speaker 1: shin that was completely numb. And uh, it's it's the
• 8:14
  Speaker 1: worst pain, like physical pain I've ever felt in my life.
• 8:17
  Speaker 1: They I mean, that would definitely qualifies neuropathic pain. You
• 8:20
  Speaker 1: clearly messed up the nerves in that little area. UM,
• 8:23
  Speaker 1: and you're lucky that it only lasted three months, because
• 8:26
  Speaker 1: apparently neuropathic pain, which can include everything from hitting your
• 8:29
  Speaker 1: shin to banging your funny bone, your elbow UM two
• 8:33
  Speaker 1: things like sciatica or even multiple sclerosis. Anytime the neurons
• 8:38
  Speaker 1: in your nerve fibers are are damaged. UM, that's neuropathic pain,
• 8:43
  Speaker 1: and it can last. It can very easily translate from
• 8:45
  Speaker 1: acute pain over to chronic pain, which is pain that
• 8:48
  Speaker 1: last six months or longer um, which can itself be
• 8:52
  Speaker 1: no susceptive or neuropathic. Uh. It can also, unfortunately be psychogenic.
• 8:57
  Speaker 1: Chronic pain can be, which is where you have lasting, uh,
• 9:02
  Speaker 1: sustained pain over six months or longer um for no
• 9:06
  Speaker 1: good reason whatsoever. Yeah, and this is you know, it
• 9:10
  Speaker 1: gets really sort of murky and confusing. Here. We are
• 9:14
  Speaker 1: not saying that chronic pain is all in your head,
• 9:17
  Speaker 1: but we're saying that in some cases that there there
• 9:20
  Speaker 1: is no reason behind you continuing to feel chronic pain.
• 9:25
  Speaker 1: But so many people suffer from chronic pain. I think
• 9:28
  Speaker 1: roughly it kind of varies, you know, depending on the year.
• 9:31
  Speaker 1: But somewhere in the neighborhood of twenty adult Americans suffer
• 9:36
  Speaker 1: chronic pain every single year. Um, And it's when you
• 9:41
  Speaker 1: hear people talk about that, like, uh, I just feel
• 9:44
  Speaker 1: bad for him. I can't imagine what it's like to
• 9:46
  Speaker 1: walk around in constant pain, and it's probably even more
• 9:49
  Speaker 1: frustrating when a doctor can't trace it to a thing like, hey,
• 9:54
  Speaker 1: we fixed that. It shouldn't be hurting anymore, right, especially
• 9:57
  Speaker 1: if they're being patronizing and treating you like your cook, Well,
• 10:00
  Speaker 1: that's a bad doctor. You should not go. Sure, But again,
• 10:04
  Speaker 1: I mean, like I feel like people with fibromyalgia or
• 10:07
  Speaker 1: chronic fatigue. I don't know if you experience pain with
• 10:09
  Speaker 1: chronic fatigue, but have long been treated like their nuts,
• 10:12
  Speaker 1: like it's all in their heads, just because you know,
• 10:15
  Speaker 1: science has not been able to identify exactly what the
• 10:17
  Speaker 1: deal is. Yeah, I would say, if your doctor is
• 10:21
  Speaker 1: like that, go to a doctor with a little better
• 10:23
  Speaker 1: bedside manner. At least they might be saying the same thing.
• 10:26
  Speaker 1: But they would should treat you with respect. And if
• 10:30
  Speaker 1: if they're wearing oversized clown shoes, so much the better.
• 10:33
  Speaker 1: That's usually it did give way for a great doctor,
• 10:36
  Speaker 1: that's right. Um, I don't think we said that, uh,
• 10:40
  Speaker 1: we we talked about no susceptive pain, but no susception
• 10:43
  Speaker 1: is taken from the Latin word for hurt, and um
• 10:48
  Speaker 1: pain is its own thing like pain perception. We're talking
• 10:51
  Speaker 1: about what's going on with the central nervous system, uh
• 10:55
  Speaker 1: the peripheral central nervous system as well, and how it
• 10:59
  Speaker 1: processes this information is really uh interesting and still cloudy
• 11:06
  Speaker 1: because the brain is involved. And we've done dozens and
• 11:09
  Speaker 1: dozens of podcasts that involved the brain, and at some
• 11:12
  Speaker 1: point during all of them we usually say something like,
• 11:15
  Speaker 1: this is kind of their best guess right now, because
• 11:17
  Speaker 1: the brain is still such a mystery. Yeah, we have
• 11:20
  Speaker 1: made like advances by leaps and bounds since the sixties
• 11:23
  Speaker 1: when we kind of started to change our understanding of
• 11:25
  Speaker 1: pain and definitely refining it. But one of the things
• 11:28
  Speaker 1: we figured out is that no susception itself is separate
• 11:33
  Speaker 1: from the experience of pain. It's like the body giving
• 11:36
  Speaker 1: the brain information about something that's going on with your
• 11:40
  Speaker 1: body right now, but it's not pain itself. Pain is
• 11:44
  Speaker 1: the brain responding to that information, and so no susception,
• 11:50
  Speaker 1: as we'll see, is kind of this process where your
• 11:53
  Speaker 1: body um detects some sort of noxious stimuli UH, and
• 11:58
  Speaker 1: the no susceptors your specific kind of UM little sense
• 12:00
  Speaker 1: receptors that are tuned to pain. As we'll talk about UM.
• 12:04
  Speaker 1: They send a signal to your brain saying, hey, there's
• 12:06
  Speaker 1: something going on here, and then in your brain, your
• 12:09
  Speaker 1: your brain starts sort through the whole thing and decides
• 12:11
  Speaker 1: how to respond. So no susception and pain they're very
• 12:15
  Speaker 1: much intertwined, but they're definitely different things, and we've actually
• 12:18
  Speaker 1: seen that one can exist without the other. Yeah, I
• 12:21
  Speaker 1: mean they've done studies that UM and I. I mean
• 12:24
  Speaker 1: we had to have talked about this and other people
• 12:26
  Speaker 1: that can't feel pain UM congenital analgesia. I don't remember
• 12:32
  Speaker 1: ever saying those words before. I think we had to
• 12:35
  Speaker 1: have There's no way, although knowing us, it's possible we
• 12:40
  Speaker 1: walked around that one. Well maybe so. But there are studies,
• 12:44
  Speaker 1: including ones on that people who can't feel pain, that
• 12:47
  Speaker 1: have shown that no susception can occur without the experience
• 12:51
  Speaker 1: of pain, and UM pain can be experienced with the
• 12:54
  Speaker 1: absence of no susception. So it's sort of a two
• 12:56
  Speaker 1: way street. Yeah, that's like that psychogenic pain where you
• 12:59
  Speaker 1: there's no reason for you to be feeling that pain
• 13:02
  Speaker 1: right then, right, yeah, And because it's the brain, it's
• 13:05
  Speaker 1: um and you put in here it's like it sounds funny,
• 13:09
  Speaker 1: but your brain is what's feeling the pain. Like when
• 13:12
  Speaker 1: you smash that hand in a window. Um, you might
• 13:16
  Speaker 1: think that your hand feeling the pain, but technically it's
• 13:19
  Speaker 1: your brain, if that makes sense. Yeah, or even that
• 13:22
  Speaker 1: like you're you're that hand that window smashing your hand
• 13:26
  Speaker 1: set off a specific unique kind of um uh signal
• 13:32
  Speaker 1: that that transmits a pain signal directly your brain. Your
• 13:35
  Speaker 1: brain experiences the pain. That's just not quite right. That's
• 13:38
  Speaker 1: actually Renee des cartes interpretation of it, and can so well.
• 13:44
  Speaker 1: Considering he was working in the first half of the
• 13:46
  Speaker 1: sixteen hundreds, he wasn't that far off the mark, especially
• 13:49
  Speaker 1: considering that before him the Greeks had thought up basically
• 13:53
  Speaker 1: up to day car, everyone had thought, starting with the Greeks,
• 13:55
  Speaker 1: that pain was like a spirit intrusion, it was like
• 13:59
  Speaker 1: something external at all. And in fact, our word pain
• 14:02
  Speaker 1: comes from uh pena like subpoena, which means penalty. So
• 14:07
  Speaker 1: this like pain was considered a punishment from the gods
• 14:11
  Speaker 1: um And Dave Carr was like, no, I think this
• 14:13
  Speaker 1: is an internal process, and he had like the broad
• 14:16
  Speaker 1: strokes of it. It's just that he didn't have the
• 14:19
  Speaker 1: details that we have now today. Yeah, he kind of
• 14:22
  Speaker 1: got well he got one half of it pretty right. Um,
• 14:26
  Speaker 1: but I mentioned it was a two way street. It's
• 14:28
  Speaker 1: a two way street in a lot of ways. Because
• 14:30
  Speaker 1: what we've learned since decart is that we do have
• 14:33
  Speaker 1: pain signals that go up from nerves in the body
• 14:36
  Speaker 1: to the brain to say hey, I'm hurt. Those are
• 14:38
  Speaker 1: called ascending signals. But then we also have another signal
• 14:43
  Speaker 1: going I'm just gonna call it downstream for lack of
• 14:45
  Speaker 1: a better term, descending signals that come from the brain
• 14:49
  Speaker 1: that can kind of mute the pain or turn off
• 14:53
  Speaker 1: the pain signals. And that's you know, as we'll see
• 14:56
  Speaker 1: later when it comes to medication and stuff. It's sort
• 14:58
  Speaker 1: of managing that way, like whatever traffic light is on
• 15:02
  Speaker 1: that two way street. Yeah, well that was like a
• 15:05
  Speaker 1: huge thing, Chuck, like to figure out that. Wait a minute, Like,
• 15:07
  Speaker 1: first of all, the experience of pain is totally in
• 15:10
  Speaker 1: the in the brain. Right, your hand itself isn't actually hurting.
• 15:14
  Speaker 1: Your brain is hurt is what hurts. It just feels
• 15:17
  Speaker 1: like it's coming from your hand. And then secondly, the
• 15:19
  Speaker 1: idea that your brain can influence this the experience of pain,
• 15:24
  Speaker 1: that was just revolutionary. And so as a result, we've
• 15:28
  Speaker 1: come to kind of see pain as the brain. There's
• 15:32
  Speaker 1: a neuroscentist name vs. Rama Shan Droton who's just brilliant
• 15:36
  Speaker 1: and he um, he said that pain. This is paraphrasing him.
• 15:40
  Speaker 1: He said that pain is the brain's opinion of the
• 15:43
  Speaker 1: current state of your health. You got no pain, It's
• 15:46
  Speaker 1: all good. You've got pain. Your brain is interpreting there's
• 15:49
  Speaker 1: something wrong with like your hand or your leg, or
• 15:51
  Speaker 1: your guts or something like that. And it's just an opinion.
• 15:55
  Speaker 1: And the opinion can be gotten wrong too. Well, you
• 15:58
  Speaker 1: know what they say about opinions. Yeah, everybody's got an
• 16:02
  Speaker 1: elbow of them. All right, I think we should take
• 16:04
  Speaker 1: a break and we're gonna come back and dive into
• 16:08
  Speaker 1: some hard science right after this. Alrighty, so your brain
• 16:38
  Speaker 1: has an opinion about the current state of your health. Um,
• 16:41
  Speaker 1: we're still at the stage where we're sort of testing
• 16:43
  Speaker 1: out how pain is generated and how we experience it.
• 16:48
  Speaker 1: But what we kind of think right now is what
• 16:51
  Speaker 1: we mentioned a little bit earlier is that some of
• 16:54
  Speaker 1: the sense receptors located on the nerve endings are really
• 16:58
  Speaker 1: finely tuned two different kinds of UM, different kinds of pain,
• 17:04
  Speaker 1: but really tuned to different kinds of thing that might
• 17:06
  Speaker 1: cause pain, like a hot stove or a needle going
• 17:09
  Speaker 1: to your arm. Yeah. And you can pretty much divide
• 17:12
  Speaker 1: them into three categories. Mechanical which is pulling, stretching, tearing, cutting, chemical,
• 17:18
  Speaker 1: which say like exposure to acid or something, and then
• 17:21
  Speaker 1: thermal like like heat or cold. Um. And the idea
• 17:25
  Speaker 1: that these no susceptors are capable of being triggered by
• 17:30
  Speaker 1: exposure to those kind of stimuli from the external world,
• 17:34
  Speaker 1: that that is what kicks off the no susception process. Yeah.
• 17:39
  Speaker 1: And they, uh, they're all very different and they have
• 17:42
  Speaker 1: different ways of communicating with the brain. Um. There are
• 17:45
  Speaker 1: some that do things really really fast. Uh. These U
• 17:48
  Speaker 1: there are some called a fibers. They have a little
• 17:51
  Speaker 1: it's kind of like a little express train instead of
• 17:54
  Speaker 1: having to make stops along the way, has a fatty
• 17:58
  Speaker 1: mile in sheath that's going to insulate the electro conduction
• 18:04
  Speaker 1: basically on the wire and it really just zaps it.
• 18:06
  Speaker 1: They're really really fast not a lot of information losses
• 18:09
  Speaker 1: going on. And that's like that first really intense pain
• 18:14
  Speaker 1: you feel when you burn your hand or when you
• 18:16
  Speaker 1: slam it into the window. Is that's kind of what's
• 18:19
  Speaker 1: going on with the A fibers, right, And then you've
• 18:22
  Speaker 1: got sea fibers, which aren't insulated and they are slower conducting,
• 18:28
  Speaker 1: but they also have a bunch of they recruit a
• 18:30
  Speaker 1: bunch of them to conduct signals from different parts of
• 18:33
  Speaker 1: different areas um to the brain to say, hey, this
• 18:37
  Speaker 1: is this is actually pretty pretty problematic. We got a
• 18:40
  Speaker 1: real thing going on here. And they account for the
• 18:43
  Speaker 1: follow up like usually burning, throbbing kind of sensation that
• 18:48
  Speaker 1: can be followed by that first like bolt of pain
• 18:51
  Speaker 1: that the A fibers deliver, and then that's from the
• 18:55
  Speaker 1: actual like like uh no susceptors. There's other stuff that
• 19:00
  Speaker 1: spens to like if you cut open your hand, those
• 19:02
  Speaker 1: damage cells you know, spill their guts and so like
• 19:06
  Speaker 1: potassium and glutamate and substance peace starch start like change
• 19:10
  Speaker 1: start firing off, like other neurons in the area um
• 19:14
  Speaker 1: you might have an inflammatory response, so things like histamine
• 19:17
  Speaker 1: show up and they start setting off other nerve fibers too,
• 19:20
  Speaker 1: So it's more than just the you know, the cut hand. No,
• 19:26
  Speaker 1: susceptor is telling the brain that something's happening. Like a
• 19:29
  Speaker 1: whole bunch of different responses from the area are going
• 19:32
  Speaker 1: to arrive at the brain and produce this really complex,
• 19:35
  Speaker 1: rich message saying here's generally what's going on, and here's
• 19:39
  Speaker 1: how bad it is. You ever had a bad burn? Yes, man,
• 19:43
  Speaker 1: that's the worst. They are pretty bad. I don't even
• 19:46
  Speaker 1: remember what happened, but um, I definitely have burned myself
• 19:50
  Speaker 1: pretty bad. You may has this same spot on her
• 19:54
  Speaker 1: hand that she gets in like the confection of it.
• 19:57
  Speaker 1: Like basically every time it heals, she just re upset again.
• 20:01
  Speaker 1: She's always got this little little thing on like I
• 20:03
  Speaker 1: think it's her pinky knuckle on her right hand, and
• 20:05
  Speaker 1: she always like hits the same spot on the yep.
• 20:08
  Speaker 1: Oh man, every time you get that lady a glove
• 20:11
  Speaker 1: a hot myth. Yeah, I think by now it's just
• 20:13
  Speaker 1: so callous that she is dead. She fights sailors with
• 20:17
  Speaker 1: it these days. Yeah, those burns really linger. And that's
• 20:21
  Speaker 1: like every time I hear someone or see somebody that
• 20:24
  Speaker 1: has has you know, had been in a fire and
• 20:27
  Speaker 1: had really really bad burns over a lot of their body.
• 20:29
  Speaker 1: I just I can't imagine the lingering pain that they
• 20:33
  Speaker 1: go through. I know we've talked about this on some
• 20:35
  Speaker 1: episode before, but uh, just those burns that it seems
• 20:38
  Speaker 1: like they hurt forever. Yeah, I mean, you've got exposed
• 20:43
  Speaker 1: nerves fibers to just the air, which you know, as
• 20:46
  Speaker 1: we'll also see, when you undergo a particularly brilliant experience
• 20:52
  Speaker 1: of acute pain, it can be so thorough and it's
• 20:56
  Speaker 1: energizing of your nerves that they actually become sense of tized,
• 21:01
  Speaker 1: so like they become more sensitive than they would have
• 21:03
  Speaker 1: before that, which is actually also a problem with with
• 21:07
  Speaker 1: chronic pain too. But if you if you experience burns
• 21:10
  Speaker 1: like that deep over all of your body, not only
• 21:13
  Speaker 1: are you going through the normal pain, you're probably more
• 21:16
  Speaker 1: sensitive now to normal stuff like air blowing on your
• 21:19
  Speaker 1: exposed nerves than you wouldn't otherwise, and that just makes
• 21:23
  Speaker 1: it that much worse. Yeah. And then some things that
• 21:25
  Speaker 1: you might think really hurt don't hurt. Um, like cuts,
• 21:29
  Speaker 1: I've had cuts before that don't hurt. They might freak
• 21:32
  Speaker 1: you out, uh to look at it and to see,
• 21:35
  Speaker 1: you know, like your skin exposed and some people are
• 21:37
  Speaker 1: really freaked out by the blood. Um, I've had other
• 21:40
  Speaker 1: people I know I've never broken bones that have had
• 21:42
  Speaker 1: some pretty gnarly injuries like that. That said, it didn't
• 21:45
  Speaker 1: really hurt that much. Yeah, they're walking around like a skeleton.
• 21:49
  Speaker 1: You hang on the door with their arms just flopping
• 21:51
  Speaker 1: back and forth. It's really interesting how it all works.
• 21:53
  Speaker 1: But it really underscores, you know, how the brain can
• 21:56
  Speaker 1: get its opinion um of what's wrong with the body
• 21:59
  Speaker 1: based on the pain information wrong sometimes a lot of times,
• 22:02
  Speaker 1: like think about a hangnail. Hangnail is no threat whatsoever
• 22:06
  Speaker 1: to your survival, but those things hurt. Or a paper cut.
• 22:10
  Speaker 1: No one's going to die from a paper cut, but
• 22:11
  Speaker 1: it really really hurts too. Um. It can be overblown,
• 22:15
  Speaker 1: it can be underblown, but it really goes to show
• 22:17
  Speaker 1: like it's the brain taking all this different information together
• 22:21
  Speaker 1: and saying, here's how bad I think this is. Yeah,
• 22:24
  Speaker 1: it's pretty cool and painful. Uh. So let's say you
• 22:28
  Speaker 1: get hurt. Let's say you you slam your your hand
• 22:30
  Speaker 1: in the window like I was talking about, which I
• 22:33
  Speaker 1: think has happened. I don't know why I keep going
• 22:35
  Speaker 1: to that got your worst fear. I don't know, it's
• 22:39
  Speaker 1: I don't I don't think it's better not your worst fear.
• 22:41
  Speaker 1: That is not that bad. That'd be hard. It's a
• 22:43
  Speaker 1: lot easier to shut your hand in a car door
• 22:45
  Speaker 1: than a window. But O, man, that hurts either way. Yeah, man,
• 22:48
  Speaker 1: I had a knock wood. That hasn't happened to me
• 22:49
  Speaker 1: in a long time. Yeah. Every time my daughter shuts
• 22:52
  Speaker 1: the door, which I tried to let her do whatever
• 22:53
  Speaker 1: she can on her own, I'm always just like, don't
• 22:57
  Speaker 1: do it. Do you put ovenmits her hands first? No? No,
• 23:01
  Speaker 1: nanny stayed at our house. Uh. So you you get
• 23:04
  Speaker 1: hurt on your hand, Let's say, Um, the signal that
• 23:08
  Speaker 1: is gonna travel it travels through the into the gray
• 23:11
  Speaker 1: matter of your spinal cord, and there are gonna be
• 23:13
  Speaker 1: a lot of different connections made with the spinal neurons there,
• 23:17
  Speaker 1: and it's going to cover a broad area of the body,
• 23:19
  Speaker 1: which is why sometimes if you get hurt, um, especially
• 23:23
  Speaker 1: if it's like an internal injury, you don't know exactly
• 23:26
  Speaker 1: where the pain's coming from. You might tell your doctor
• 23:29
  Speaker 1: you just might rub around your whole torso when in
• 23:31
  Speaker 1: fact what's actually hurt is a fairly small area. Yeah,
• 23:34
  Speaker 1: or it could be like a completely different part of
• 23:36
  Speaker 1: your your body or kind of near. It's called referred pain,
• 23:40
  Speaker 1: like if you're having a heart attack, usually feel pain
• 23:42
  Speaker 1: in your arm. Yeah. If you have brain freeze, that's
• 23:46
  Speaker 1: your blood vessels on the roof of your mouth expanding
• 23:49
  Speaker 1: because they're cold. But you feel it unlike your forehead
• 23:52
  Speaker 1: really terribly, which doesn't make any sense. So yeah, I
• 23:55
  Speaker 1: think that's from those the nerve or the sea fiber
• 23:58
  Speaker 1: information where it makes it tough to also figure out
• 24:01
  Speaker 1: where it's coming from. Have you ever been to a cardiologist? No,
• 24:06
  Speaker 1: I'm going I'm going to one this week. Man. I
• 24:10
  Speaker 1: had I've known two people in the past like a
• 24:12
  Speaker 1: month that have dropped dead that are like my age.
• 24:15
  Speaker 1: What uh. One friend of mine from college had been
• 24:19
  Speaker 1: experiencing chess pains and he went to drove drove himself
• 24:23
  Speaker 1: to the hospital like collapse and died on the way
• 24:26
  Speaker 1: into the hospital. Just terrible. And I haven't been out
• 24:29
  Speaker 1: of touch since college, but it really hit me hard
• 24:32
  Speaker 1: to where I was like, you know what, I I
• 24:34
  Speaker 1: want to go, like just see what's going on in
• 24:35
  Speaker 1: there and get some preventative or not. Preventative, but just
• 24:40
  Speaker 1: some proactive tests done. Uh, you know where they see
• 24:45
  Speaker 1: how your arteries are doing. Because I've got cholesterol issues
• 24:47
  Speaker 1: because of my my family history and stuff, and I
• 24:51
  Speaker 1: wanted to be one of those things where they're like, oh, well,
• 24:54
  Speaker 1: it turns out that you know you were clogged this
• 24:56
  Speaker 1: whole time. So I don't I don't care what they say.
• 25:00
  Speaker 1: I'm going to demand those tests. Yeah. I think you
• 25:03
  Speaker 1: probably will have to pay for them out of pocket,
• 25:06
  Speaker 1: but that's not the end of the world. If, like
• 25:08
  Speaker 1: you have, you have concerns about it, no want of
• 25:10
  Speaker 1: genuine concerns, cardiologists might actually go ahead and prescribe it anyway. Well,
• 25:15
  Speaker 1: I don't have concerns in that I have chest pains
• 25:16
  Speaker 1: or anything, but but if you have a family history,
• 25:19
  Speaker 1: they may. Yeah, I just I want to know what's
• 25:21
  Speaker 1: going on. I'll I think that's great. And actually it's
• 25:23
  Speaker 1: funny like you me had suggested we do something like
• 25:25
  Speaker 1: that too, So maybe we'll see you at the cardiologists office. Well,
• 25:29
  Speaker 1: I think for women you can go get heart screenings
• 25:31
  Speaker 1: for women, um, very easily. Uh. And I don't know
• 25:35
  Speaker 1: if it's because I thought it was for both and
• 25:37
  Speaker 1: I talked to the lady on the phone. She said, O,
• 25:38
  Speaker 1: and then that's only for women. And I guess that's
• 25:41
  Speaker 1: because women are less likely to talk to doctors about
• 25:46
  Speaker 1: their heart because I think it's maybe generally thought of
• 25:49
  Speaker 1: as something that men experience more. Yeah, I guess now
• 25:52
  Speaker 1: that you say that, it does seem like more of
• 25:54
  Speaker 1: a man. So I think they're trying to be proactive
• 25:56
  Speaker 1: and saying like, hey, women, you need to think about
• 25:59
  Speaker 1: this stuff too, so we'll offer it's like a hundred
• 26:01
  Speaker 1: dollar heart screening or something like that. Gosh, is there
• 26:04
  Speaker 1: anything socialized medicine can't do? So, uh, we were talking
• 26:09
  Speaker 1: about those first um, those first set of spinal neurons.
• 26:13
  Speaker 1: Then you have secondary neurons that are going to send
• 26:16
  Speaker 1: their signals up through the white matter of the spinal cord.
• 26:19
  Speaker 1: And this is an expressway where all the traffic from
• 26:23
  Speaker 1: all of these lower segments just just speed up the
• 26:27
  Speaker 1: spinal cord. Yeah yeah, which is you know, normal for
• 26:30
  Speaker 1: any kind of sensory information. But um, the pain, the
• 26:34
  Speaker 1: pain information follows the same super highway and it goes
• 26:37
  Speaker 1: through your brain stem, your medula, and then it synapses
• 26:40
  Speaker 1: again onto a third set of neurons. Um in your thalamus,
• 26:44
  Speaker 1: which is your brain's relay center, and then from there
• 26:47
  Speaker 1: things start to get kind of market. It goes out
• 26:49
  Speaker 1: to different parts of the brain, and we'll talk about
• 26:51
  Speaker 1: pain in the brain in a second, but one thing
• 26:54
  Speaker 1: that it does it was helpful for me to imagine
• 26:56
  Speaker 1: pain a pain signal as like a pinball when when
• 27:00
  Speaker 1: you hit it with the flippers, say that's like you're
• 27:03
  Speaker 1: you cutting your hand. That pinball goes up and it's
• 27:06
  Speaker 1: going up to the top of the pinball machine. But
• 27:08
  Speaker 1: on the way, it goes through all these other things,
• 27:10
  Speaker 1: like these gates that it flips around three and sixty
• 27:13
  Speaker 1: degrees a bunch of time. Imagine that it's, you know,
• 27:15
  Speaker 1: doing that in your in your brain stem, or in
• 27:17
  Speaker 1: the gray matter of your spinal cord. It's going through
• 27:20
  Speaker 1: all these different things, and as it does on its
• 27:21
  Speaker 1: way to that final destination of the brain's somato sensory cortex,
• 27:26
  Speaker 1: it can have effects on the way to Like if
• 27:30
  Speaker 1: it's bad enough, it may enter what's called a spinal
• 27:33
  Speaker 1: reflex loop, where that pain signal doesn't even make it
• 27:36
  Speaker 1: to the brain before part of it gets redirected back
• 27:39
  Speaker 1: down to say, your hand to make your hand jerk
• 27:42
  Speaker 1: away from that hot stove before it even hit your brain.
• 27:45
  Speaker 1: Literally before your brain even knows that there's pain going on.
• 27:48
  Speaker 1: You're you have a signal going down to your arm
• 27:51
  Speaker 1: to say, move that move that hand, dummy. Yeah, because
• 27:54
  Speaker 1: if you think about burning your hand, the burn, I
• 27:57
  Speaker 1: mean it's very fast and very fast succession. The actual
• 28:01
  Speaker 1: burn pain burn happens after you've jerked your hand away. Uh.
• 28:06
  Speaker 1: And like I said, it's pretty lickety split, but you
• 28:09
  Speaker 1: jerk that hand away. It's not like you keep it
• 28:11
  Speaker 1: there and you're like, oh my goodness, I feel pain
• 28:13
  Speaker 1: on my hand. Oh my lord, it's got fire on it.
• 28:15
  Speaker 1: I should probably move it eventually. Another thing that can
• 28:18
  Speaker 1: happen is pain signals can set off your fight or
• 28:21
  Speaker 1: flight pathways as it's going through the medulla. It's been
• 28:25
  Speaker 1: a long time since we talked about or fight. Yeah,
• 28:27
  Speaker 1: it's it's been so long. They added a third one freeze. Ye.
• 28:32
  Speaker 1: It's like an old friend coming back to visit, but
• 28:35
  Speaker 1: bringing a new obnoxious friend with it. Yeah. So um,
• 28:39
  Speaker 1: it could set that off through the medulla. And you
• 28:42
  Speaker 1: know what happens there is you're gonna your heart rate
• 28:43
  Speaker 1: is gonna go up. Your blood pressure is gonna shoot up.
• 28:46
  Speaker 1: You're gonna start sweating if you're me rapid breathing, and
• 28:50
  Speaker 1: it really can. Um, it really depends on the intensity
• 28:54
  Speaker 1: of the pain, but it can definitely set off that
• 28:57
  Speaker 1: fight or flight or I guess freeze. And again, all
• 29:00
  Speaker 1: this is before it even gets to the brain. And
• 29:02
  Speaker 1: then finally when I, like I said, when it does
• 29:04
  Speaker 1: get to the brain, we're not quite sure what happens there.
• 29:07
  Speaker 1: We know from observations that the brain is definitely involved.
• 29:10
  Speaker 1: And um, one of the ways that we know this
• 29:12
  Speaker 1: is because, um, you will move your hands. Sometimes it's
• 29:16
  Speaker 1: not an immediate reaction, but sometimes it's a little later.
• 29:19
  Speaker 1: So clearly some of those signals get sent to the
• 29:21
  Speaker 1: motor cortex to say, Okay, get the hand out of there. Um.
• 29:25
  Speaker 1: But we also can tell from things like the fact
• 29:28
  Speaker 1: that if you consciously distract yourself from thinking about the
• 29:31
  Speaker 1: pain with something else, like do you remember how um,
• 29:35
  Speaker 1: Edward Norton in Fight Club when he had that lie
• 29:38
  Speaker 1: on his on the on his hand, he kept trying
• 29:41
  Speaker 1: to think of like a snow covered like forest or something.
• 29:44
  Speaker 1: He went to his his happy animal I think was
• 29:47
  Speaker 1: a penguin. That's right, that's right. He started to try
• 29:49
  Speaker 1: to concentrate on that and that it didn't work then,
• 29:52
  Speaker 1: but it could have worked depending on what other kind
• 29:55
  Speaker 1: of tissue damage was going on. And it really kind
• 29:58
  Speaker 1: of underscores the fact that if you think about something else,
• 30:01
  Speaker 1: your pain may decrease. Well, if the brain has nothing
• 30:04
  Speaker 1: to do with pain or controlling pain, then that wouldn't
• 30:06
  Speaker 1: happen at all. And so observations like that and some
• 30:10
  Speaker 1: other ones show us that, Okay, the brain is definitely
• 30:12
  Speaker 1: involved in this in some way, shape or form, and
• 30:16
  Speaker 1: pain is not just the reception of um a pain
• 30:20
  Speaker 1: signal coming from the lower parts of the body up
• 30:23
  Speaker 1: to the brain. But there's also a reciprocal thing, like
• 30:25
  Speaker 1: you were saying, where the brain descends um or, there's
• 30:29
  Speaker 1: descending pathways that the brain uses to say, Okay, alright,
• 30:32
  Speaker 1: let's just all chill out down there, Okay, let me
• 30:34
  Speaker 1: figure this out. Everybody, just shut up, shut up. I
• 30:36
  Speaker 1: can't think when you're all screaming at me. Yeah. And
• 30:40
  Speaker 1: as those signals are on the way down, there might
• 30:43
  Speaker 1: be those uh, ascending nerve signals going up right, and
• 30:47
  Speaker 1: those descending signals could overpower and say hold on, you
• 30:50
  Speaker 1: stop right there, buddy, I'm trying to calm this person down.
• 30:54
  Speaker 1: You just you just stay put, right, And so there's um,
• 30:58
  Speaker 1: there's other things that that we figured out that can
• 31:00
  Speaker 1: actually influence your experience of pain. Like to say that
• 31:06
  Speaker 1: it's subjective is just no joke. There's probably no experience
• 31:10
  Speaker 1: more subjective than the experience of pain. And there's all
• 31:14
  Speaker 1: these different factors that are involved that will have an
• 31:17
  Speaker 1: impact on how much or how little pain you experience.
• 31:21
  Speaker 1: You know. I think improv comedy is the first that's right,
• 31:26
  Speaker 1: man to see good improv is just it's just so rare,
• 31:30
  Speaker 1: but it's so good when it is good. Yeah, I mean,
• 31:33
  Speaker 1: I've seen a handful in my life that just blew
• 31:36
  Speaker 1: me away, and I've seen a bunch more that. Uh,
• 31:39
  Speaker 1: it's tough to get through. It's like horror movies, Like
• 31:42
  Speaker 1: a truly great horror movie is really tough to beat.
• 31:45
  Speaker 1: But there's a lot of really bad horror movies out there. Yeah,
• 31:50
  Speaker 1: a lot of good ones these days, Thoughnas what you
• 31:53
  Speaker 1: got well, I mean in the past five or six years,
• 31:56
  Speaker 1: I think, uh, it follows and the and Hereditary, and
• 32:04
  Speaker 1: I think there's been a bunch of new horror masters
• 32:08
  Speaker 1: So now, this was not a horror movie, but I
• 32:10
  Speaker 1: want to shout out Um and Nola Holmes on Netflix.
• 32:15
  Speaker 1: Have you seen it? It's a coming of age movie
• 32:19
  Speaker 1: about Sherlock Holmes's younger sister. Interesting and it's super cute,
• 32:25
  Speaker 1: but it's also really smart, like very smart, and it
• 32:29
  Speaker 1: takes the takes it for granted that the viewers smart
• 32:32
  Speaker 1: and paying attention. It's a really great, great movie, great movie.
• 32:35
  Speaker 1: You have to check that out. It's um Millie Bobby
• 32:38
  Speaker 1: Brown as Nola Homes just about She's about as charming
• 32:42
  Speaker 1: as they come. She's wonderful. So yeah, not a horror movie,
• 32:46
  Speaker 1: but definitely worth watching regardless. Is that based on any
• 32:49
  Speaker 1: uh literature or anything or did they just say, like, hey,
• 32:53
  Speaker 1: what if he had a little sister. I hadn't thought
• 32:55
  Speaker 1: about it, but I think it's the ladder of the two,
• 32:58
  Speaker 1: which makes it all the more amazing because they did
• 33:02
  Speaker 1: such a great job of capturing that whole um, that
• 33:06
  Speaker 1: whole world. Very cool. Yeah, where should we take a break? Yeah?
• 33:11
  Speaker 1: Why not? Let's let's take a break and we'll come
• 33:13
  Speaker 1: back and talk about a few of the factors that
• 33:14
  Speaker 1: influence your experience of pain. So, um, we're saying before
• 33:44
  Speaker 1: we started talking about in Nola Holmes and horror movies,
• 33:47
  Speaker 1: that there's like a lot of different things that will
• 33:49
  Speaker 1: influence an individual's experience of pain. Um. And it has
• 33:53
  Speaker 1: to do with not just you biologically, but weirdly also
• 33:58
  Speaker 1: you sociologic le too. Yeah, and this first one um
• 34:02
  Speaker 1: age is to me a little counterintuitive. Um. In some ways,
• 34:08
  Speaker 1: your you know, as you age, your brain circuitry is
• 34:11
  Speaker 1: gonna it's just gonna degenerate a little bit. That's just
• 34:15
  Speaker 1: that's sad fact of the matter. And if you are
• 34:20
  Speaker 1: one of our seniors, and if you're a senior that's listening. Hello,
• 34:24
  Speaker 1: got an email from a lovely eight year old lady
• 34:26
  Speaker 1: the other day that just warmed my heart. Oh yes,
• 34:28
  Speaker 1: she was great. She was great. So, um, if you
• 34:31
  Speaker 1: are one of our senior listeners and you, um, you
• 34:34
  Speaker 1: might have a lower pain threshold and more problems dealing
• 34:37
  Speaker 1: with pain. Um. This seemed a little counterintuitive because I
• 34:41
  Speaker 1: could also see a case where, uh, the neurons don't
• 34:45
  Speaker 1: fire in the correct way, such that you could be
• 34:48
  Speaker 1: feeling something painful and not really realize it. So the
• 34:51
  Speaker 1: way I took it was a little different that it
• 34:53
  Speaker 1: was almost like you know how when you form a
• 34:55
  Speaker 1: habit or a memory or something, it's because the neural
• 34:58
  Speaker 1: connection has gone over again and again. So like that
• 35:01
  Speaker 1: pathways is kind of blazed a little more clearly. My
• 35:04
  Speaker 1: interpretation was that the same can be true with pain,
• 35:08
  Speaker 1: to where once you fire a few times are over
• 35:10
  Speaker 1: and over again, it becomes easier to conduct that pain
• 35:13
  Speaker 1: signal more efficiently, and so that would account for sensitization.
• 35:18
  Speaker 1: That's how I took it. You know, hey, I'm no
• 35:21
  Speaker 1: vs rama sham drawn. Uh. There's also gender, and because
• 35:26
  Speaker 1: we're talking about medical research, they are basically still saying
• 35:31
  Speaker 1: men and women, and they're not doing research along the
• 35:33
  Speaker 1: gender spectrum. So having said that, research shows that women
• 35:37
  Speaker 1: have a higher sensitivity to pain than men. Uh, could
• 35:41
  Speaker 1: be maybe physic psychosocial stuff at work, because you know,
• 35:45
  Speaker 1: men are supposed to not show their pain or not
• 35:48
  Speaker 1: report pain or just suck it up. Dude. Uh, there
• 35:51
  Speaker 1: could be that at work. It also could be sex
• 35:53
  Speaker 1: linked genetic traits or hormonal changes that might change that
• 35:58
  Speaker 1: pain perception, right, or even the culture you're raised in,
• 36:01
  Speaker 1: like um women in Uganda, I read are expected to
• 36:05
  Speaker 1: be stoic in the face of pain. Um, whereas men
• 36:08
  Speaker 1: in Ukraine are expected to not h experience pain at
• 36:12
  Speaker 1: all or show any kind of pain whatsoever. Um. So
• 36:15
  Speaker 1: like the idea that culture can affect your interpretation or
• 36:18
  Speaker 1: how you experience pain is kind of weird if you
• 36:20
  Speaker 1: think about it. It's also weird because I know many
• 36:22
  Speaker 1: many women who would say, are you kidding me? My
• 36:25
  Speaker 1: husband is the biggest whiny baby every time he gets sick. Uh,
• 36:29
  Speaker 1: And I generally suck it up as the wife, So
• 36:31
  Speaker 1: you gandon and so you gandon. There's also memory, like
• 36:35
  Speaker 1: if you've experienced pain before, your memory of going through
• 36:38
  Speaker 1: that pain can impact how you experience it a follow
• 36:41
  Speaker 1: up time too. Yeah, and for both ways. Like I
• 36:45
  Speaker 1: used to be really, really really scared of needles, and
• 36:48
  Speaker 1: I think that was because I went a long time
• 36:50
  Speaker 1: without getting shots. Um. I think when you know, when
• 36:55
  Speaker 1: I was younger and in college, like I wasn't giving
• 36:57
  Speaker 1: blood like I should, and I wasn't getting flu shot
• 37:00
  Speaker 1: it's like I should. But now that I'm a real
• 37:02
  Speaker 1: sentient adult and responsible adult, I have needles in me
• 37:05
  Speaker 1: all the time, and it's I'm not They don't really
• 37:08
  Speaker 1: hurt that bad anymore. So when I go back I
• 37:11
  Speaker 1: get that initial fear of the needle because I've always
• 37:13
  Speaker 1: had it, But then my brain tells me, hey, Chuck,
• 37:15
  Speaker 1: it's not that bad, remember do you just just suck
• 37:18
  Speaker 1: it up and get the shot. My my sister in
• 37:21
  Speaker 1: law is like a genuine shout no and run out
• 37:26
  Speaker 1: of the room, like, yeah, needle Phobe, that's a great
• 37:31
  Speaker 1: band name. Oh my god, that's the best band name
• 37:35
  Speaker 1: in years, Chuck. What kind of band is that? Uh?
• 37:39
  Speaker 1: Needle Phobe is clearly some sort of metal, maybe new
• 37:44
  Speaker 1: metal if it were going to be ruined. But there's
• 37:47
  Speaker 1: definitely something, and there may be along the lines of
• 37:49
  Speaker 1: like Queens Rich or something. Yeah, I could see that,
• 37:51
  Speaker 1: or maybe even like horror metal. Oh yeah, like that
• 37:57
  Speaker 1: Norwegian stuff. Sure, Okay, so it's about to get weirder, Chuck.
• 38:02
  Speaker 1: So you're talking about needles. If you look at a
• 38:06
  Speaker 1: needle injected into your arm, it hurts more than if
• 38:09
  Speaker 1: you're not looking. Even if you're thinking about the needle
• 38:11
  Speaker 1: injecting into your arm being injected in your arm, just
• 38:15
  Speaker 1: not looking at it makes it hurt less, studies have shown,
• 38:18
  Speaker 1: which is weird, but in a sense it also makes
• 38:21
  Speaker 1: sense because you're being provided with additional information about that
• 38:26
  Speaker 1: through your eyes, so your brain has more information than
• 38:29
  Speaker 1: it otherwise would have, which can actually make it hurt more. Yeah,
• 38:33
  Speaker 1: and I know I've mentioned this, I still gotta look. Um.
• 38:36
  Speaker 1: I used to request a mirror to look at dental
• 38:38
  Speaker 1: work as it was going on. I don't do that anymore.
• 38:42
  Speaker 1: I try and just check out, but I always have
• 38:44
  Speaker 1: to look at the needle. There's no way. Yeah. Same here,
• 38:46
  Speaker 1: I'm like, do it slower. You're not a needle fobe,
• 38:50
  Speaker 1: You're a needle uh whatever. The opposite is file a
• 38:53
  Speaker 1: needle file. Um. So. And then there's emotions too, and
• 38:57
  Speaker 1: not just you know, like you were saying earlier, there's something.
• 39:00
  Speaker 1: There's a different thing psychic pain. Where you are your
• 39:03
  Speaker 1: emotions are so overwrought that you actually feel physically uncomfortable
• 39:09
  Speaker 1: or hurt from it. That's different. Your emotions can actually
• 39:13
  Speaker 1: affect physical pain as well. Yeah, and back when we
• 39:18
  Speaker 1: were trying to understand and we're still trying to understand this,
• 39:20
  Speaker 1: but um, why emotions and stuff might influence pain. In
• 39:25
  Speaker 1: the sixties, of course, when all this kind of cool
• 39:27
  Speaker 1: research was going on, there were a couple of dudes
• 39:30
  Speaker 1: named Ronald mel Zack and Patrick Wall, who threw up
• 39:35
  Speaker 1: a proposal about a gating mechanism existing among the connections
• 39:39
  Speaker 1: in the body sensory pathways that can help determine how
• 39:43
  Speaker 1: you're gonna feel pain and how that works with the brain. Yeah,
• 39:48
  Speaker 1: because so there's the ascending painful pathways and then the
• 39:51
  Speaker 1: descending let's all just mellow out pathways. And I don't
• 39:55
  Speaker 1: know if we knew that before um Melzack and Wall,
• 39:58
  Speaker 1: or if we know it as a result to them,
• 40:00
  Speaker 1: But the current general understanding of pain is this gate
• 40:04
  Speaker 1: control theory, where this there's stimulation of these pathways going
• 40:10
  Speaker 1: up to the brain and they have to be of
• 40:13
  Speaker 1: like a certain amount to overcome an inhibitory neuron. And
• 40:19
  Speaker 1: so if you I just like press you know, my arm,
• 40:21
  Speaker 1: I'm sending somato sensory information through those same pain pathways,
• 40:27
  Speaker 1: but that the inhibitory neuron that keeps those the pain
• 40:31
  Speaker 1: projector neurons from firing, are not overcome. But if I,
• 40:36
  Speaker 1: if I, you know, took a butcher knife and cut
• 40:40
  Speaker 1: that same part of my arm, they would be overcome.
• 40:43
  Speaker 1: The inhibitory neuron would basically be turned off by the
• 40:45
  Speaker 1: signal the intensity of the signal, and that projector neuron
• 40:48
  Speaker 1: would fire, and now our brains would have that pain signal, saying,
• 40:54
  Speaker 1: in that case, the gate is fully open for business.
• 40:58
  Speaker 1: And when otherwise, when there's no pain, no no sensory information,
• 41:02
  Speaker 1: the gates closed, or if it's just normal somatosensory information,
• 41:06
  Speaker 1: the gates still closed. It's just when it's that that
• 41:09
  Speaker 1: intensity of the pain information that the gate flies open. Yeah,
• 41:12
  Speaker 1: and this is interesting because it doesn't explain everything, but
• 41:16
  Speaker 1: it does explain like when you um, like if you
• 41:20
  Speaker 1: smash your thumb with a hammer, and your reaction is
• 41:23
  Speaker 1: to go and shake your hand really hard or too
• 41:26
  Speaker 1: or to suck on it. Maybe if you smash your
• 41:28
  Speaker 1: finger with a hammer. It seems like a weird thing
• 41:30
  Speaker 1: to do. I know it is, but it works. It does.
• 41:32
  Speaker 1: That stimulates your normal somatosensory input to those projector neurons,
• 41:37
  Speaker 1: and that's going to help override the projection neurons that
• 41:41
  Speaker 1: uh and you know, basically kind of close that gate down. Okay,
• 41:45
  Speaker 1: So now that you understand the gate theory of pain,
• 41:47
  Speaker 1: and this is the general understanding among Western science medicine
• 41:51
  Speaker 1: of pain. This is pretty much the common knowledge. Now
• 41:55
  Speaker 1: you can understand how it can go wrong, and so
• 41:58
  Speaker 1: they think that this also explain how the how you
• 42:01
  Speaker 1: can experience psychogenic pain where people have fibro mayalgia or
• 42:06
  Speaker 1: chronic pelvic pain, or tenitis or t mj or um
• 42:10
  Speaker 1: chronic back pain when there's no reason whatsoever for them
• 42:14
  Speaker 1: to experience this. The Um the really great author in
• 42:18
  Speaker 1: Surgeon a Tool go on Day, I believe he rights
• 42:21
  Speaker 1: for The New Yorker. He's also he writes some books
• 42:23
  Speaker 1: as well. He's one of one of the best writers
• 42:26
  Speaker 1: out there right now, and he's also a very accomplished surgeon.
• 42:29
  Speaker 1: And he he likens that situation to a faulty car sensor,
• 42:34
  Speaker 1: where if you have a sensor on your dashboard coming
• 42:36
  Speaker 1: on saying like, hey you got an engine problem, and
• 42:39
  Speaker 1: you go to the mechanic and the mechanics like you
• 42:40
  Speaker 1: don't have an engine problem. Eventually they're going to figure
• 42:43
  Speaker 1: out that the problems with the sensor itself, and they
• 42:46
  Speaker 1: think that this is because of this gate being opened.
• 42:49
  Speaker 1: The sensor um is open, even though there's nothing tripping it. Um,
• 42:54
  Speaker 1: that that is the problem, that that is what it
• 42:57
  Speaker 1: counts for psychogenic pain. Very interesting and it's gonna make sense, Yeah, definitely.
• 43:02
  Speaker 1: So when it comes to managing pain. Uh, there are
• 43:06
  Speaker 1: a bunch of different routes you can go, UM, depending
• 43:09
  Speaker 1: on what your doctor might recommend, depending on what you
• 43:12
  Speaker 1: as a human, UM, what what road you want to
• 43:15
  Speaker 1: go down? Uh, and these very uh and we'll you know,
• 43:18
  Speaker 1: we'll get into these, but these very from like over
• 43:21
  Speaker 1: the counter medications to prescription medications to surgery, to go
• 43:27
  Speaker 1: into a massage therapist or a uh an acupuncture specialist, acupuncturist.
• 43:33
  Speaker 1: But as far as the medications go, you've got a
• 43:35
  Speaker 1: couple of different kinds. UM. You've got your non opioid
• 43:39
  Speaker 1: analgesic like this is a tail in all or in
• 43:42
  Speaker 1: a lever or an advil or something like that, and
• 43:46
  Speaker 1: it's going to act at the side of the pain. UM.
• 43:48
  Speaker 1: When you have that damaged tissue, it releases enzymes that
• 43:51
  Speaker 1: stimulate the pain receptors locally. And what these do is
• 43:55
  Speaker 1: they interfere with those enzymes are going to reduce inflammation
• 43:59
  Speaker 1: and hopefully reduce pain. Yeah, which is really interesting because
• 44:02
  Speaker 1: that is your mind saying this pain is not nothing
• 44:06
  Speaker 1: that my brain needs to worry about. I'm going to
• 44:08
  Speaker 1: actually go to the site and cancel out those those
• 44:12
  Speaker 1: pain signals where they're beginning, because I'm judging that they're
• 44:16
  Speaker 1: not that important. Pretty cool, Yeah, it is cool, but
• 44:19
  Speaker 1: these can have effects on the liver and kidneys if
• 44:22
  Speaker 1: you use them a lot. So you know, you don't
• 44:24
  Speaker 1: want to, uh, you don't want to pop an advil
• 44:27
  Speaker 1: every day if you have like back pain, that kind
• 44:29
  Speaker 1: of thing. Um. And then there's opioids which, um they
• 44:34
  Speaker 1: actually go to the gate um and they can close
• 44:38
  Speaker 1: the gate on the one hand, and then they can
• 44:40
  Speaker 1: also go to your brain and um excite in the
• 44:44
  Speaker 1: descending pathways which will bind with like opioid receptors. And
• 44:49
  Speaker 1: of course those are hugely addictive and have a huge
• 44:54
  Speaker 1: um possibility of of overdose as well, but they do
• 44:59
  Speaker 1: help treat pain a lot. Yeah, we should do one
• 45:02
  Speaker 1: of opioids and the opioid epidemic. It's I agree. It's
• 45:06
  Speaker 1: been one of the darker spots of the new era. Yes,
• 45:10
  Speaker 1: the new era, I don't even know the last ten
• 45:15
  Speaker 1: or fifteen years. That's what I call that. A new era.
• 45:17
  Speaker 1: The modern era is what I meant. Uh, what else
• 45:21
  Speaker 1: do we have there? Um, you can actually use medicines
• 45:25
  Speaker 1: that aren't meant for treating pain to treat pain, like
• 45:28
  Speaker 1: anti epileptic drugs, brand stuff, antidepressants, anesthetics. They all do
• 45:33
  Speaker 1: things like they block can like nerve conduction in some
• 45:36
  Speaker 1: specific area, and so they weren't Yeah, they weren't meant
• 45:39
  Speaker 1: to be treated for or used for pain, but they
• 45:42
  Speaker 1: actually can come in handy for things like chronic pain
• 45:44
  Speaker 1: or neuropathic pain. Yeah. You can also have surgery is
• 45:48
  Speaker 1: a kind of a last resort um if you have
• 45:52
  Speaker 1: severe I've not had a couple of friends, actually you
• 45:53
  Speaker 1: have had back surgery where let's say you have a
• 45:55
  Speaker 1: herniated disk and that thing is compressing on a nerve.
• 46:00
  Speaker 1: As a last resort, they can go in there and
• 46:03
  Speaker 1: maybe remove a little bit of that disk that's hitting
• 46:05
  Speaker 1: that nerve and relieve that pressure. Yeah, and from what
• 46:08
  Speaker 1: I've seen, yes, that is meant to be a last resort.
• 46:10
  Speaker 1: There's also like cord ectomies where they go in and
• 46:13
  Speaker 1: say we're just gonna snip that gate so that it
• 46:15
  Speaker 1: just doesn't function at all anymore and make you a
• 46:18
  Speaker 1: super soldier. And then there's also alternative therapies and mental
• 46:22
  Speaker 1: control techniques and these work of varying degrees um. One
• 46:26
  Speaker 1: of my favorite alternative therapies. Is the TENS unit transcutaneous
• 46:30
  Speaker 1: electrical nerve stimulation and it sends electrical impulses from the
• 46:35
  Speaker 1: site of pain to base. It's basically like a defibrillator
• 46:40
  Speaker 1: for your pain gate. It's saying your pain gate is
• 46:43
  Speaker 1: is it's open, and it shouldn't be open. So we're
• 46:45
  Speaker 1: gonna We're gonna send some nerve stimulation and the hopes
• 46:48
  Speaker 1: that we can restart that inhibitory neuron and get it
• 46:51
  Speaker 1: closing that pain gate, or and or we can make
• 46:55
  Speaker 1: it all the way up to the brain and get
• 46:57
  Speaker 1: the brains descending pathways kick started as well. Is that
• 47:01
  Speaker 1: like when uh, like I had a back thing about
• 47:04
  Speaker 1: five years ago where they gave me this electro stimulator
• 47:07
  Speaker 1: thing that I put these little pads on the and
• 47:09
  Speaker 1: there's like a little handheld thing about the size of
• 47:11
  Speaker 1: a game boy that was connected to uh, not mine,
• 47:14
  Speaker 1: but I'm sure they're all different kinds. But you could
• 47:16
  Speaker 1: basically level the amount of sort of low level shock
• 47:20
  Speaker 1: and uh when you turn that thing all the way up, man,
• 47:22
  Speaker 1: it was it was pretty intense. Yeah, that's a TENS unit,
• 47:25
  Speaker 1: And as a matter of fact, that's based on some
• 47:27
  Speaker 1: really ancient thinking Apparently the pre Dynastic Egyptians from like
• 47:31
  Speaker 1: five thousand years ago used electric catfish from the Nile
• 47:35
  Speaker 1: for the same effect and impact. It's pretty amazing. Yeah. Uh.
• 47:40
  Speaker 1: And then you know we mentioned going to the chiropractor,
• 47:42
  Speaker 1: massage therapist. Um. Obviously they're hot compresses and cold compresses.
• 47:47
  Speaker 1: There's acupuncture, Um, there is you know, relaxation and hypnosis.
• 47:53
  Speaker 1: And we've already talked about distraction. If you want to
• 47:56
  Speaker 1: know what you think about hypnosis, we did a pretty
• 47:58
  Speaker 1: good episode on it a while back. Um. So, yeah,
• 48:02
  Speaker 1: they are all sorts of mental ways because they've shown
• 48:05
  Speaker 1: that that oh I'm blanking out what do you call
• 48:09
  Speaker 1: the drugs that aren't real drugs? What are the sugar bills? Placebos? Yeah,
• 48:15
  Speaker 1: that that placebos have been shown to work sometimes with
• 48:18
  Speaker 1: with limiting pain. Yeah yeah, And I mean you can
• 48:21
  Speaker 1: trick the brain for sure into not feeling pain. Like
• 48:23
  Speaker 1: Phantom limb treatment usually or sometimes involves a mirror where
• 48:27
  Speaker 1: you put a mirror over the amputated limb that's experienced pain,
• 48:31
  Speaker 1: and you move the other limb while you're looking in
• 48:33
  Speaker 1: the mirror, so it looks like you're amputated limb is
• 48:35
  Speaker 1: back and you're tricking your brain into being like, Okay,
• 48:38
  Speaker 1: it's there, it's fine, I don't have to experience pain anymore.
• 48:40
  Speaker 1: And it actually works. Yeah, but there's there's a you know,
• 48:44
  Speaker 1: there's a threshold there, like you can mind over matter
• 48:47
  Speaker 1: it to a certain degree. But um, as you say
• 48:51
  Speaker 1: in the article, like your mind and your brain are
• 48:53
  Speaker 1: two different things, so like you can't shut down that
• 48:57
  Speaker 1: gateway just by thinking it away. No, And there's a
• 49:00
  Speaker 1: real like push to to believe that over the last
• 49:03
  Speaker 1: few decades. But it's just it's becoming clear you can
• 49:06
  Speaker 1: impact it to some degree, but just not to to
• 49:08
  Speaker 1: a full degree. Yeah, And I think the mind over
• 49:11
  Speaker 1: matter is a person like the pain doesn't go away.
• 49:15
  Speaker 1: You're just able to mentally overcome it such that you're
• 49:18
  Speaker 1: not gonna either show it or let it get to
• 49:21
  Speaker 1: you or let it affect you. Right, you have actually
• 49:23
  Speaker 1: a lower stress response, and at the same time it
• 49:26
  Speaker 1: also cuts down on suffering, which is different from the
• 49:29
  Speaker 1: experience of pain. It's like associated with pain, and that's
• 49:32
  Speaker 1: like like that whole y Me thing and that seems
• 49:35
  Speaker 1: to be fixated on anticipating more pain in the immediate future.
• 49:40
  Speaker 1: And people who are mindful and meditate can actually cut
• 49:43
  Speaker 1: down and alleviate that suffering. So they experience pain, but
• 49:46
  Speaker 1: it goes away a lot faster in their response to
• 49:48
  Speaker 1: it is it nearly is pronounced, so it does have
• 49:51
  Speaker 1: an effect. You know, Chuck, this is a good one
• 49:54
  Speaker 1: man pain pain in the house. And if you want
• 49:58
  Speaker 1: to know more about pain, well, I'm not even going
• 50:00
  Speaker 1: to suggest what you can do. How about you just
• 50:02
  Speaker 1: go read up on it a little more. Uh. And
• 50:04
  Speaker 1: since I said that it's time for a listener meal,
• 50:11
  Speaker 1: I'm just gonna call this the Las Vegas Beavers. I
• 50:15
  Speaker 1: just got done listening to the Beaver podcast, which, by
• 50:17
  Speaker 1: the way, we got a lot of response on that one.
• 50:20
  Speaker 1: People love their beavers, especially baby beavers. Oh yeah, they're
• 50:23
  Speaker 1: the best. I just wanted to give you a fun
• 50:25
  Speaker 1: little tidbit of information. Chuck said that you can't find
• 50:28
  Speaker 1: or that you can find beavers almost everywhere except the desert,
• 50:31
  Speaker 1: which is somewhat true. Uh, they can't live out in
• 50:33
  Speaker 1: the open amongst the cacti. But the sizeable population of
• 50:38
  Speaker 1: beavers in Las Vegas is testament to their ability to
• 50:41
  Speaker 1: survive the heat. They're about eighty to one beavers living
• 50:46
  Speaker 1: in the Clark County, Wetlands, just just about twenty to
• 50:48
  Speaker 1: thirty minutes from the strip. It was a shock when
• 50:51
  Speaker 1: I first heard of this, but have since taken several
• 50:53
  Speaker 1: trips to see them. Thanks for all the work, enjoy
• 50:57
  Speaker 1: the show. That's from Josh. Very short and sweet us
• 51:00
  Speaker 1: from Josh uh Eretics. That's a great great first name,
• 51:05
  Speaker 1: great last name, Josh, and I love how that email
• 51:07
  Speaker 1: just kind of petered out at the end there, so
• 51:10
  Speaker 1: we're gonna we're His new name is Josh Peter Eretics. Okay, great.
• 51:15
  Speaker 1: Thanks for the email, JP, And if you want to
• 51:17
  Speaker 1: be like JP and send us an email, you can
• 51:20
  Speaker 1: do so. Wrap it up, spank it on the bottom,
• 51:22
  Speaker 1: and send it off to Stuff podcast at iHeart radio
• 51:25
  Speaker 1: dot com. Stuff you Should Know is a production of
• 51:30
  Speaker 1: iHeart Radios How Stuff Works. For more podcasts for my
• 51:33
  Speaker 1: heart Radio, visit the iHeart Radio app. Apple podcasts are
• 51:36
  Speaker 1: wherever you listen to your favorite shows.