Latest / Hardiness with Dr Paul Taylor / Joshua Pate Pain

Transcript

Joshua Pate Pain · Hardiness with Dr Paul Taylor

• 0:09
  Speaker 1: Doctor Joshua Piet, Welcome to the podcast.
• 0:12
  Speaker 2: Thanks for having me. Paul.
• 0:14
  Speaker 1: Yes, now, as we just discussed, if you grew up
• 0:17
  Speaker 1: in Belfast, you would just be called pat yet.
• 0:21
  Speaker 2: Yeah, no, that's fine. It's reminiscent of my high school years.
• 0:26
  Speaker 1: So pat and that would just be it, you'd be Patie.
• 0:30
  Speaker 1: But clearly doctor Joshua Pitt, Now you are a physiotherapist
• 0:34
  Speaker 1: with a special interest in pain and Pean education. So
• 0:40
  Speaker 1: how did you get into what was your what's your PhD?
• 0:42
  Speaker 2: In as in how kids think about pain and kind
• 0:46
  Speaker 2: of trying to get the simplest language we can about
• 0:49
  Speaker 2: this stuff because I like, clinically we saw patients getting
• 0:52
  Speaker 2: better with learning about the neuroscience and it was kind
• 0:56
  Speaker 2: of like, oh, surely people don't have to become a
• 0:59
  Speaker 2: neuroscientist get better, and like, just engaging with these active
• 1:03
  Speaker 2: strategies for a long time, having a bit of a
• 1:06
  Speaker 2: scientific foundation seem to help people. And so then the
• 1:09
  Speaker 2: goal with my PhD was like, how can we work
• 1:11
  Speaker 2: out how to simplify that as much as we can?
• 1:14
  Speaker 2: And I worked in the children's hospital and so we
• 1:17
  Speaker 2: kind of joined all those different dots together. But yeah,
• 1:20
  Speaker 2: more or less. I guess we even took a step
• 1:23
  Speaker 2: back from going, well, what should we say to the
• 1:24
  Speaker 2: kids and started thinking about how do we assess and
• 1:27
  Speaker 2: where's the starting point and so doing things like we've
• 1:31
  Speaker 2: got kids to draw whatever they think of when they
• 1:33
  Speaker 2: hear the word pain. Actually, what would you draw if
• 1:36
  Speaker 2: you had to do that task? Can to hear?
• 1:38
  Speaker 1: Its interesting? What would I draw? I would probably draw
• 1:44
  Speaker 1: something throbbing, rare, inflammation, all that stuff as probably what
• 1:50
  Speaker 1: I would draw. Yeah, I do this.
• 1:52
  Speaker 2: With my university, like the Masters of physio students, and
• 1:55
  Speaker 2: they often draw things like abstract things like a squiggly
• 1:58
  Speaker 2: line or like a mess or fire or whereas kids
• 2:02
  Speaker 2: under the age of twelve they're not thinking abstractly at all,
• 2:05
  Speaker 2: Like the brain hasn't developed that yet, and so it's
• 2:07
  Speaker 2: all very concrete. It's just like a broken bone, a
• 2:10
  Speaker 2: sad And if they've had chronic pain, they often draw
• 2:12
  Speaker 2: like emotional things like sad faces, right, broken hearts, that
• 2:16
  Speaker 2: kind of stuff, whereas if they haven't had chronic pain,
• 2:19
  Speaker 2: normally it's just an injury. And I guess if we're
• 2:21
  Speaker 2: growing up in a culture where pain is just associated
• 2:24
  Speaker 2: with injuries, it's quite hard to be empathetic if it's invisible,
• 2:28
  Speaker 2: right like, And so a lot of my research has
• 2:30
  Speaker 2: kind of been in that space, is like, can we
• 2:32
  Speaker 2: nip things in the bud and help people really early
• 2:35
  Speaker 2: on in society, like at a generational level, because potentially
• 2:40
  Speaker 2: that could stop some of at least the stigma but
• 2:42
  Speaker 2: potentially even some of the disability associated that happens with
• 2:46
  Speaker 2: pain because people go, well, it's if I'm damaged, then
• 2:49
  Speaker 2: I better rest and if I rest more then maybe
• 2:52
  Speaker 2: I'll get even better. And so then they stop engaging
• 2:55
  Speaker 2: in meaningful activities and that actually worsens pain. Bit yeah,
• 3:00
  Speaker 2: this complex web, right, yeah.
• 3:02
  Speaker 1: Yeah, absolutely, Now this complex web clearly involves the nervous
• 3:09
  Speaker 1: system and the brain. I saw a guy and a
• 3:14
  Speaker 1: really a neuroscientist on TED must be ten fifteen years ago,
• 3:19
  Speaker 1: Ramachandrin or something like that, talking about phantom limpain and
• 3:26
  Speaker 1: the use of mirror boxes. I think that's a really
• 3:28
  Speaker 1: good starting point and to dive into the whole science
• 3:33
  Speaker 1: of pain. Give it, give our listeners a view of
• 3:38
  Speaker 1: because you've done a great ted X video on phantom
• 3:41
  Speaker 1: limpiin so give us you know what is phantom limpain?
• 3:45
  Speaker 1: What do we know about it and heart of mirror
• 3:48
  Speaker 1: boxes actually help people.
• 3:51
  Speaker 2: Yeah, I think there's still a fair bit of mystery
• 3:53
  Speaker 2: around the full understanding, but I guess one way that
• 3:59
  Speaker 2: this has been explained is to think about your brain
• 4:02
  Speaker 2: having a map. It's called yourmunculus, and the map kind
• 4:06
  Speaker 2: of correlates with different parts of your body, and so yeah,
• 4:11
  Speaker 2: basically if part of the map is lighting up, then
• 4:14
  Speaker 2: you would feel pain, Like I guess if we kind
• 4:16
  Speaker 2: of have a little simple model like that, and so
• 4:18
  Speaker 2: then if someone has an amputation, they might feel pain
• 4:21
  Speaker 2: in the hand that's missing. Like I can think of
• 4:23
  Speaker 2: patients who have said, oh, it's like my hands still
• 4:25
  Speaker 2: on the Harley Davidson handlebars, but I don't have an arm,
• 4:29
  Speaker 2: and they can say, like I can tell my pinky
• 4:31
  Speaker 2: is all curled up, but there's no arm there, and
• 4:34
  Speaker 2: it's like, well, how does that, like, how can that
• 4:36
  Speaker 2: happen if there is no arm? And so yeah, remtrendry.
• 4:40
  Speaker 2: There's a bunch of different researchers from a long time ago,
• 4:42
  Speaker 2: and the idea was, well, maybe it's a top down
• 4:45
  Speaker 2: kind of brain down perspective on what's going on in
• 4:49
  Speaker 2: the body. And there's lots of research even around like
• 4:52
  Speaker 2: pery personal space, like the space around your body. Kind
• 4:55
  Speaker 2: of similar mechanisms at play here, where the brain is
• 4:58
  Speaker 2: predicting what's happening in the spinal the spinal cords predicting
• 5:01
  Speaker 2: what's happening around in the peripheral nervous system, and then
• 5:04
  Speaker 2: that's predicting what's happening in the space around you. And
• 5:07
  Speaker 2: so for fantom win pain where there's no limb there,
• 5:09
  Speaker 2: it makes better sense than that the body's trying to
• 5:12
  Speaker 2: protect that part that was really threatened. And because it
• 5:16
  Speaker 2: was such a big experience having something amputated or the
• 5:19
  Speaker 2: accident or whatever preceded it, that pain can persist and
• 5:23
  Speaker 2: it often does persist. And then that also helps explain
• 5:26
  Speaker 2: when someone puts on a prosthetic at night, or they
• 5:28
  Speaker 2: take off their prosthetic and it hurts, or they put
• 5:30
  Speaker 2: their prosthetic on in it and it gives pain relief.
• 5:33
  Speaker 1: So yeah, interesting, So they take the prosthetic off and
• 5:38
  Speaker 1: they actually feel pain and then they put it.
• 5:40
  Speaker 2: Yeah, because there's no embodiment of that. But it is tricky,
• 5:46
  Speaker 2: and there's some people who would argue, oh, no, it's
• 5:48
  Speaker 2: the nerve endings that have been cut, and that's sending
• 5:51
  Speaker 2: a peripheral message going up to the brain. And I
• 5:54
  Speaker 2: think where I sit now, like years and years on
• 5:57
  Speaker 2: from this is there. It's somewhere in the middle. And
• 5:59
  Speaker 2: I think it's both pain is a whole person experience,
• 6:02
  Speaker 2: Like it's not brain centric and it's not body part centric.
• 6:07
  Speaker 2: I think it's very hard to separate any Like, I
• 6:10
  Speaker 2: think that separation of brain and body is really kind
• 6:13
  Speaker 2: of unhelpful in some ways.
• 6:15
  Speaker 1: A bit. It's so unhelpful in so many bloody ways.
• 6:18
  Speaker 2: Yeah, And if you join them together, then the latest
• 6:22
  Speaker 2: research on the immune system and other parts of your
• 6:26
  Speaker 2: body that we kind of separate as parts or different systems,
• 6:30
  Speaker 2: you start seeing them all as overlaying on each other
• 6:33
  Speaker 2: rather than as separate things. And I think that's much
• 6:36
  Speaker 2: more helpful because then when someone comes to the clinic
• 6:38
  Speaker 2: and they've got bad sleep and they're getting sick all
• 6:41
  Speaker 2: the time, and their memory is going and all these
• 6:43
  Speaker 2: other factors, it's all one big picture, like it makes
• 6:47
  Speaker 2: perfect sense, rather than it being this confusing, anger inducing experience.
• 6:53
  Speaker 2: So I've kind of derailed a little bit from the
• 6:55
  Speaker 2: phantom blim question, But I think the key point there,
• 6:58
  Speaker 2: I guess, is thinking about a whole person's being under threat. Like,
• 7:03
  Speaker 2: so pain is about warning and threat and safety rather
• 7:06
  Speaker 2: than necessarily just about damage and blacking.
• 7:11
  Speaker 1: Yeah, yeah, yeah, and that makes sense, particularly for people
• 7:15
  Speaker 1: with chronic pin right. And I just want to come
• 7:19
  Speaker 1: back to the homunculous Penfold maps. Does that play because
• 7:25
  Speaker 1: I remember there was a neural surgeon I'm pretty sure
• 7:28
  Speaker 1: Penfold and what he would do when he was operating
• 7:31
  Speaker 1: on patients when they were conscious, he would touch different
• 7:36
  Speaker 1: parts of the brain and that with a little probe
• 7:38
  Speaker 1: and they would go, oh, I feel latten my foot. Oh,
• 7:41
  Speaker 1: I feel lattened my finger. Ooh, I feel like somewhere else.
• 7:44
  Speaker 1: And he started creating these maps, these Penfold maps. Is
• 7:48
  Speaker 1: that Does that play into the homoculous presumably it does.
• 7:52
  Speaker 2: Yeah, like all of these again, it's just so hard
• 7:55
  Speaker 2: to separate out one, Like, so you look at all
• 7:58
  Speaker 2: these studies in isolation, and then you try to add
• 8:00
  Speaker 2: them all together, and yeah, I think for sure there's
• 8:03
  Speaker 2: there's almost like the latest understanding would be there's a
• 8:06
  Speaker 2: map for the motor system and then there's a sensory
• 8:09
  Speaker 2: map and so and they're not necessarily identical or the same,
• 8:12
  Speaker 2: and they're in slightly different parts of the brain. But yeah,
• 8:15
  Speaker 2: this idea that like our world is being represented in
• 8:20
  Speaker 2: our brain somehow is a really complex thing to even
• 8:24
  Speaker 2: start grappling with. And I noticed when I said that
• 8:27
  Speaker 2: before you said, oh, that definitely applies to chronic pain
• 8:29
  Speaker 2: and that, and I think it people can latch onto
• 8:32
  Speaker 2: that idea pretty comfortably. But what I'm seeing more and
• 8:35
  Speaker 2: more is like, why wouldn't it apply to acute pain
• 8:38
  Speaker 2: and injury? And in those moments like if you, I
• 8:42
  Speaker 2: don't know, bend your finger back and it starts hurting,
• 8:45
  Speaker 2: you haven't caused any damage yet, the warning's kicking in
• 8:49
  Speaker 2: and then you let go and there's no damage and
• 8:51
  Speaker 2: the pain settles down and it's kind of in proportion relatively.
• 8:56
  Speaker 2: But it's when the pain isn't in the same proportion
• 8:59
  Speaker 2: as the damage that it gets really really hard to understand.
• 9:02
  Speaker 2: And this is what, like, I mean, twenty percent of
• 9:04
  Speaker 2: society have chronic pain in some way, and a lot
• 9:06
  Speaker 2: of that is dismissed because our society set up, oh,
• 9:10
  Speaker 2: let's go and get a scan and see the structure
• 9:12
  Speaker 2: that's wrong with you. And I guess that just that
• 9:15
  Speaker 2: whole starting point is just it doesn't make a whole
• 9:17
  Speaker 2: lot of sense based on the later science. I think
• 9:20
  Speaker 2: we need to be thinking more about the whole person
• 9:23
  Speaker 2: and threat rather than about a disk or a little
• 9:26
  Speaker 2: body part. Of course, like we need to advocate for
• 9:30
  Speaker 2: people to get a thorough assessment to know how to
• 9:32
  Speaker 2: start here. But I just I think a curious approach
• 9:35
  Speaker 2: is a helpful one at this stage in terms of
• 9:37
  Speaker 2: the research.
• 9:38
  Speaker 1: Yeah, look, there's many little rabbit holes that I'd like
• 9:42
  Speaker 1: to cook down in there, need to cook in myself.
• 9:45
  Speaker 1: But just the fact that you're talking about the whole
• 9:48
  Speaker 1: person approach. I mean, I've said many many times that
• 9:53
  Speaker 1: the way that we do Western science right that Newtonian
• 9:58
  Speaker 1: Cartesian waterview, you break things to smallest component part in
• 10:03
  Speaker 1: order to understand it. That can give us a really
• 10:06
  Speaker 1: good understanding about certain things and how things are made up.
• 10:11
  Speaker 1: But it misses the fact that we are a complex
• 10:15
  Speaker 1: ecosystem and that yes you have an immune system, and
• 10:19
  Speaker 1: yes you have a cardiovascular system and emphatic system, muscular
• 10:22
  Speaker 1: skeletal but they all interact with each other in ridiculously
• 10:27
  Speaker 1: complex ways. And this is the problem with people who
• 10:30
  Speaker 1: are real specialists in one area, Like when you're when
• 10:34
  Speaker 1: you're a hammer, everything looks like a neil. Yeah, yeah,
• 10:38
  Speaker 1: But I think that that complexity of the human condition
• 10:45
  Speaker 1: is something that we've got to explore more and more
• 10:47
  Speaker 1: and more.
• 10:48
  Speaker 2: Right, Yeah, yeah, yeah. I think it's moving from being
• 10:51
  Speaker 2: like the mechanical engineer kind of perspective or lens across
• 10:54
  Speaker 2: to like a gardener type lens where there's seasons and
• 10:58
  Speaker 2: growth is possible, and kind of just shifting that perspective
• 11:03
  Speaker 2: on the human body. It changes everything really because you
• 11:06
  Speaker 2: start just viewing all the different feelings you have, Like
• 11:10
  Speaker 2: pain is one of the best protectors that we've got
• 11:12
  Speaker 2: in terms of these invisible protective feelings we have, but
• 11:16
  Speaker 2: like fatigue and nausea and worrying, and we've got other
• 11:20
  Speaker 2: ways of keeping our body safe. And it's just an
• 11:23
  Speaker 2: interesting one to start classifying pain in that way because
• 11:26
  Speaker 2: you start zooming out from the body part and I
• 11:30
  Speaker 2: think that can be a helpful exercise in itself. But
• 11:33
  Speaker 2: it's not a one size fits all. That's the other
• 11:35
  Speaker 2: challenge here is that for some people they just go, well,
• 11:39
  Speaker 2: I've treated my body an engineer in my whole life,
• 11:42
  Speaker 2: and it kind of works, and the coping strategies are
• 11:44
  Speaker 2: within that realm, and so you don't want to like
• 11:47
  Speaker 2: throw the baby out with the bath water either way here.
• 11:50
  Speaker 2: But yeah, I totally agree that there's value in not
• 11:54
  Speaker 2: just zooming down and breaking everything into really small parts,
• 11:57
  Speaker 2: but also kind of looking at the ecosystem as a whole.
• 12:00
  Speaker 1: Yeah. Absolutely. And the interesting thing you said there about
• 12:05
  Speaker 1: the protection mechanism, I think there's a very clear link
• 12:10
  Speaker 1: there with chronic pain and some chronic mental health conditions
• 12:16
  Speaker 1: were there can be an oversensitization of of the amygdala
• 12:22
  Speaker 1: causing that that hyper sensitive, hyper vigilant threat state that
• 12:28
  Speaker 1: people then start to ruminate it a lot and can
• 12:32
  Speaker 1: cause anxiety and depression and and and often it's just
• 12:36
  Speaker 1: an overprotective mechanism. And you know, even think about things
• 12:40
  Speaker 1: like PTSD can just be that real protective mechanism that's
• 12:45
  Speaker 1: gone awry and then causes a whole heap of issues,
• 12:50
  Speaker 1: just like as you described this, this this chronic pain
• 12:54
  Speaker 1: can be a protective mechanism that is turned maladaptive rather
• 12:59
  Speaker 1: than adapt great.
• 13:00
  Speaker 2: Yeah, yeah, I agree. And I think those kind of
• 13:03
  Speaker 2: central mechanisms where like the MAP is influencing things and
• 13:08
  Speaker 2: the HPA acxis like all those stress autonomic nervous system.
• 13:11
  Speaker 2: There's a lot of overlap in the literature between all
• 13:14
  Speaker 2: these different conditions. But what often happens like and as
• 13:18
  Speaker 2: a physiotherapist early in the kind of post injury or
• 13:22
  Speaker 2: early in the disease phase, when it hasn't the volume
• 13:25
  Speaker 2: hasn't been turned up too much yet, it's not overprotective
• 13:28
  Speaker 2: yet all of most of the drivers seem to be peripheral,
• 13:32
  Speaker 2: and so people go and see a health professional and
• 13:35
  Speaker 2: it's like, Oh, I've sprained my ankle or I've hurt
• 13:37
  Speaker 2: my knee or whatever it is, and we start at
• 13:38
  Speaker 2: the knee and we look at it from that perspective,
• 13:42
  Speaker 2: and then it's like once you cross this point at
• 13:44
  Speaker 2: which oh, the body part's probably healed by now, then
• 13:47
  Speaker 2: we start looking at the top down approach and going, oh,
• 13:49
  Speaker 2: what else is going on? But I think we need
• 13:50
  Speaker 2: to do both all the time. And it's like, okay,
• 13:53
  Speaker 2: so peripheral sensitization is kicking in within forty eight hours
• 13:56
  Speaker 2: sort of thing like there's a lot of mechanisms happening
• 13:59
  Speaker 2: locally in the sore body part that could be amplified
• 14:03
  Speaker 2: and kind of driving a long term pain experience, but
• 14:07
  Speaker 2: then equally at the spinal cord, there's that chemical transaction
• 14:10
  Speaker 2: happening at the DG and then it gets into the
• 14:12
  Speaker 2: spinal cord and goes up more kind of highway lanes
• 14:15
  Speaker 2: going up the spinal cord can amplify that message. And
• 14:19
  Speaker 2: then even just some of Professor Mark Hutchinson's work on
• 14:23
  Speaker 2: the number of pathways that a no susceptive message can take,
• 14:26
  Speaker 2: it's like a out numbers even just at one level,
• 14:31
  Speaker 2: it's more than the number of stars in the universe,
• 14:33
  Speaker 2: like the number of pathways it can take.
• 14:35
  Speaker 1: And so like the.
• 14:36
  Speaker 2: Complexity of every single pain experience is just like absolutely
• 14:40
  Speaker 2: enormous because that's a danger message then being that could
• 14:43
  Speaker 2: be amplified or not. And then when it gets to
• 14:45
  Speaker 2: the brain at the mid brain, it can be amplified
• 14:47
  Speaker 2: or not. And then in the brain there's like so
• 14:50
  Speaker 2: many different parts of the brain that are active in
• 14:53
  Speaker 2: kind of determining whether or not to protect by pain.
• 14:57
  Speaker 2: And it's like hundreds it's not just like, oh, there's
• 14:59
  Speaker 2: this part of the brain that always happens, and if
• 15:01
  Speaker 2: we cut that part of the brain out, then no
• 15:03
  Speaker 2: one would feel pain. It's so complex and unique and
• 15:08
  Speaker 2: it's moment by moment. It's not like, oh, Paul today,
• 15:11
  Speaker 2: this part of your brain is the main driver. Like
• 15:14
  Speaker 2: I think, it's all these little percentages adding up and
• 15:17
  Speaker 2: compounding over time. And this is where we see, like
• 15:21
  Speaker 2: some of the latest evidence to treat chronic pain is
• 15:24
  Speaker 2: things like cognitive functional therapy where you're constantly kind of
• 15:28
  Speaker 2: challenging the nervous system in a graded exposure kind of approach,
• 15:32
  Speaker 2: but it's really really gradual and you're you're like tackling
• 15:36
  Speaker 2: fears head on. And some of these things are just super.
• 15:40
  Speaker 1: Challenging, like exposure therapy for anxiety, rightd greated exposure to
• 15:47
  Speaker 1: the thing that is causing the discomfort.
• 15:49
  Speaker 2: Yes, but like yeah, there's a few caveats because you
• 15:53
  Speaker 2: want to make sure that you're not going to be
• 15:54
  Speaker 2: causing damage, Like if someone has a tumor or something
• 15:57
  Speaker 2: going on, you don't want to be flaring those kinds
• 15:59
  Speaker 2: of things up. But that's once someone's had the assessment
• 16:03
  Speaker 2: and you know that it's safe to move, then you
• 16:06
  Speaker 2: can engage in these these kind of behavioral treatments that
• 16:09
  Speaker 2: have some pretty good evidence behind them for long term outcomes.
• 16:13
  Speaker 2: There's plenty of treatments people can get for short term
• 16:16
  Speaker 2: benefit and like, arguably you don't even know how much
• 16:20
  Speaker 2: of it is expectation and things yet because there's a
• 16:22
  Speaker 2: lot of studies. There's a colleague, Felicity Braithwait in Adelaide
• 16:27
  Speaker 2: Chi did this really cool study and they made a
• 16:30
  Speaker 2: sham dry needle and the assess the person doing the
• 16:35
  Speaker 2: dry needling couldn't tell like it clicked, and they couldn't
• 16:38
  Speaker 2: tell if the needle was penetrating the skin or not,
• 16:40
  Speaker 2: and the outcomes were the same. And so like in
• 16:42
  Speaker 2: an acute pain setting, if people want short term relief,
• 16:45
  Speaker 2: I think it's just let's just weigh up the benefits
• 16:47
  Speaker 2: versus the risks, but don't pay too much money for it.
• 16:50
  Speaker 2: But if you want long term benefits, like we want
• 16:52
  Speaker 2: to be looking at strategies that people can get back
• 16:55
  Speaker 2: to doing the stuff they love. And it's not like
• 16:57
  Speaker 2: we can guarantee that pain's going to go away. In
• 17:00
  Speaker 2: a lot of people, it does decrease, but in most
• 17:03
  Speaker 2: people we can get back to doing the stuff that
• 17:06
  Speaker 2: they love doing. And I think that's our current benchmark
• 17:09
  Speaker 2: of what we want to achieve. But yeah, it all
• 17:12
  Speaker 2: comes down like I think understanding this sensitization. The mechanisms
• 17:16
  Speaker 2: that are happening at a cellular level does inform all
• 17:19
  Speaker 2: of the approaches. Like when you were saying about like
• 17:22
  Speaker 2: if you were to do exercises of the sore body part,
• 17:24
  Speaker 2: it's like, what's happening locally with your drawing you mentioned
• 17:28
  Speaker 2: like inflammation and redness, Like what's happening at that level,
• 17:31
  Speaker 2: but also like what's happening can we change the math
• 17:33
  Speaker 2: and how does that all work? I think we need
• 17:37
  Speaker 2: to have that broader picture in mind the whole way
• 17:39
  Speaker 2: through the patient journey, rather than it being oh, yeah,
• 17:44
  Speaker 2: you've just got to learn the neuroscience or like kind
• 17:46
  Speaker 2: of oversimplifying any of these steps. I think what some
• 17:50
  Speaker 2: of the research that I read recently is about validating
• 17:53
  Speaker 2: and making sure the person who's challenged by pain is
• 17:57
  Speaker 2: truly heard, like and feels support to engage in this.
• 18:02
  Speaker 2: And I think it makes a lot of biological sense
• 18:04
  Speaker 2: because if it's it pains about threat and danger, you
• 18:10
  Speaker 2: need to be supported and feel safe in the space
• 18:13
  Speaker 2: that you're going to kind of move forward in. But
• 18:16
  Speaker 2: if you've just been told by person after person that
• 18:18
  Speaker 2: there is no way forward and you must have a surgery,
• 18:21
  Speaker 2: and you must do this, and you must, must, must.
• 18:23
  Speaker 2: It's such a passive receipt, like you're kind of the
• 18:25
  Speaker 2: passenger on a train to wherever and you don't know
• 18:29
  Speaker 2: versus like the evidence in favor of active supported self
• 18:33
  Speaker 2: management strategies. It's a much clearer kind of path forward.
• 18:37
  Speaker 1: I think I want to diet. This cheesus so much.
• 18:40
  Speaker 1: These yeah, that we can dive into a couple of
• 18:44
  Speaker 1: little diversions. So the one thing about that the support
• 18:48
  Speaker 1: of We know that in many things, not just pain,
• 18:52
  Speaker 1: but in many things that one of the biggest determinants
• 18:56
  Speaker 1: of the outcome is the strength of the therapeutic release ship. Right,
• 19:01
  Speaker 1: So whether it's in psychotherapy or whether it's even cardiology.
• 19:05
  Speaker 1: So we'll give you a great one from cardiology. So
• 19:07
  Speaker 1: cardiologists who come in somebody say, I'm in my fifties,
• 19:11
  Speaker 1: I've had a heart attack, I'm as fit ly as
• 19:15
  Speaker 1: I overrate a smoke. Cardiologists who come in and they've
• 19:19
  Speaker 1: actually done randomized control trials on this, come in and go, Paul,
• 19:23
  Speaker 1: you're fat, You're out of ship. That's why you've had
• 19:26
  Speaker 1: a heart attack. You need to change your diet, you
• 19:28
  Speaker 1: need to stop smoking, you need to reduce your drinking
• 19:31
  Speaker 1: and you need to get fit. Right, the impact on
• 19:34
  Speaker 1: the patient that, like, the chances of me making all
• 19:38
  Speaker 1: those lifestyle changes are so slim compared to a cardiologist
• 19:42
  Speaker 1: who uses motivational interviewing, Yeah, which is just one technique
• 19:45
  Speaker 1: right where they sit down and said to me, Okay,
• 19:49
  Speaker 1: how'd you get here? You tell me, and I kind
• 19:52
  Speaker 1: of go, well, that's kind of smoke too much. I drink,
• 19:55
  Speaker 1: you know, I don't exercise my dad shit, Okay, what
• 19:58
  Speaker 1: do you think you could do about it? Well, maybe
• 20:00
  Speaker 1: I should actually start extra That's a great idea, right,
• 20:03
  Speaker 1: Using that motivational interviewing with you say, the patient feels
• 20:07
  Speaker 1: heard but also has some autonomy and the treatment process
• 20:12
  Speaker 1: I think is really really key. So that's one thing
• 20:17
  Speaker 1: that I think you just mentioned that I want to
• 20:19
  Speaker 1: open people's eyes to. But then that expectation effect, right,
• 20:25
  Speaker 1: so we know with the placebo effect that big pills
• 20:29
  Speaker 1: are better than little pills, that capsules are better than pills,
• 20:33
  Speaker 1: that needles are better than capsules, and that sham surgery
• 20:37
  Speaker 1: is more effective than a needle, more effective than all them.
• 20:42
  Speaker 1: The biggest one for me was a Harvard osteopathic surgeon
• 20:48
  Speaker 1: who people with chronic back pain and they often get
• 20:52
  Speaker 1: spinal fusion. You'll be aware of this, right, And there's
• 20:55
  Speaker 1: about a fifty percent or so recovery real from that
• 21:00
  Speaker 1: chronic paean. But he did a bunch of chalm surgeries
• 21:06
  Speaker 1: where he pretended that he did the surgery to fuse
• 21:09
  Speaker 1: people's desks. They even created little punctures on them. They
• 21:13
  Speaker 1: give them afterwards, they give them Champian medication when they
• 21:18
  Speaker 1: come out of it. And it had a both to
• 21:20
  Speaker 1: seame success for it as the real surgery, right. So
• 21:24
  Speaker 1: that just shows that expectation effect. It's the whole Placeboar effect, right.
• 21:31
  Speaker 2: Yeah, and it's not I guess one thing that can
• 21:33
  Speaker 2: come up when you talk about this stuff. And Ian
• 21:36
  Speaker 2: Harris is a doctor in Australia and David Anderson. There's
• 21:39
  Speaker 2: a few researchers doing these kind of studies because they've
• 21:43
  Speaker 2: worked in like conditions like slap lesions of the shoulder
• 21:46
  Speaker 2: and nearthrooscopies and these sham surgeries. It's so fascinating. But
• 21:51
  Speaker 2: if you talk about this with someone who's facing the
• 21:54
  Speaker 2: challenges of chronic pain, and it's individual and it's horrible,
• 21:56
  Speaker 2: and it's terrible it can come across like saying, come on,
• 22:00
  Speaker 2: and you've just got to change your expectation and it's
• 22:02
  Speaker 2: all in your head. And I think that can be
• 22:04
  Speaker 2: so dismissive. And so I'm really conscious that I'm on
• 22:08
  Speaker 2: a podcast and we're talking about this stuff and there
• 22:10
  Speaker 2: might be people listening, Like the odds are that people
• 22:12
  Speaker 2: are listening who have pain, because the title of the
• 22:15
  Speaker 2: podcast probably has the word pain in it, and I
• 22:18
  Speaker 2: just don't want people to hear that. It's like that.
• 22:20
  Speaker 2: I don't think just changing expectations is sufficient, but in
• 22:24
  Speaker 2: saying that, strategies like motivational interviewing are really really appropriate
• 22:28
  Speaker 2: and effective, I think in getting that starting point. So
• 22:31
  Speaker 2: there's a tension there, and I think the pain is
• 22:34
  Speaker 2: real and the effect of the sham surgery is still real.
• 22:38
  Speaker 2: It's just that the mechanisms at play aren't. What like,
• 22:42
  Speaker 2: there's a bit of deception going on, right in a
• 22:44
  Speaker 2: sham surgery study.
• 22:46
  Speaker 1: Yeah, sorry, I just to clarify, I'm not for one
• 22:48
  Speaker 1: minute and suggesting that with any of these interventions are
• 22:52
  Speaker 1: perceive that it's bullshit. It's a real effect, right, Ye, great,
• 22:55
  Speaker 1: And you can't change people's expectations expectations. Well maybe you
• 23:01
  Speaker 1: could with a little bit of education, right, But their
• 23:04
  Speaker 1: expectations are their expectations. But it's just good. I think
• 23:08
  Speaker 1: it's kind of reinforcing your what you talked about earlier
• 23:11
  Speaker 1: with the whole person approach. And if someone believes that
• 23:16
  Speaker 1: an intervention is going to help and has a good
• 23:19
  Speaker 1: relationship with the whoever, the physician or the physiotherapist or whatever,
• 23:25
  Speaker 1: that optimizes the chances of success. And Jesus, there's probably
• 23:31
  Speaker 1: so many unexplored mechanisms that are going on throughout the
• 23:36
  Speaker 1: body and throughout the nervous system to drive that expectation effect.
• 23:42
  Speaker 1: I don't think it's just in your mind. I'm sure
• 23:46
  Speaker 1: when people really start to tease it apart that the
• 23:49
  Speaker 1: expectation effect is having a physiological impact somewhere.
• 23:53
  Speaker 2: Definitely, And I think, like so one of my phdtions,
• 23:56
  Speaker 2: we're looking at the therapeutic relationship in the context of
• 23:59
  Speaker 2: kids chronic pain where there's the parent involved, and that
• 24:02
  Speaker 2: dynamic between child, parent and clinician hasn't really been looked at,
• 24:08
  Speaker 2: and we're gonna set up we're setting up at the
• 24:09
  Speaker 2: moment the study. We haven't done it yet, but filming
• 24:12
  Speaker 2: these interactions and looking at the behaviors that do have
• 24:15
  Speaker 2: an impact and don't have an impact on outcomes, because
• 24:19
  Speaker 2: I think like even positioning, like if you're sitting straight
• 24:22
  Speaker 2: across from someone and there's a big desk in the way,
• 24:25
  Speaker 2: versus sitting alongside them and facing the same direction. There's
• 24:29
  Speaker 2: so much research on that kind of like the threatening
• 24:32
  Speaker 2: behaviors and the white code effect and all of those
• 24:34
  Speaker 2: kinds of things that I think, I guess all of
• 24:37
  Speaker 2: that for me plays into quantifying how much of a
• 24:42
  Speaker 2: power dynamic is there, like to actually change people's expectations,
• 24:47
  Speaker 2: because I know, like when I disliocated my shoulder and
• 24:49
  Speaker 2: I saw a surgeon to discuss whether or not to
• 24:51
  Speaker 2: get surgery. I went into that appointment, my back's drenched
• 24:55
  Speaker 2: in sweat, and You're like, what's he going to say?
• 24:59
  Speaker 2: And what is SCAN say? And this was when I
• 25:01
  Speaker 2: first became a physio. I thought I had magic hands.
• 25:04
  Speaker 2: Everything was very biomedical and structural, and so it was
• 25:07
  Speaker 2: a really big challenge for me to go like, now
• 25:10
  Speaker 2: I look at that, and I go, wow, Like whatever
• 25:13
  Speaker 2: that surgeon said would probably trump anything that I read
• 25:17
  Speaker 2: in the research, because it was like, like there's just
• 25:20
  Speaker 2: such a power imbalance of knowledge and of our society,
• 25:25
  Speaker 2: the perspective of a surgeon and all of that kind
• 25:27
  Speaker 2: of stuff, and that can happen at every level. And
• 25:30
  Speaker 2: some of my research with kids that even happens between
• 25:33
  Speaker 2: parents or grandparents, or like if one parent's saying one
• 25:36
  Speaker 2: thing and saying be careful where velcrow shoes don't bend,
• 25:40
  Speaker 2: and the other parents saying, come on, play rugby league
• 25:42
  Speaker 2: and get back to school, and like, those mixed messages
• 25:45
  Speaker 2: are so unlike, so challenging for a child's developing nervous
• 25:49
  Speaker 2: system to have to try and weigh up. And so
• 25:52
  Speaker 2: I think for me, it's like that, let's work out
• 25:56
  Speaker 2: what what can we do what like because maybe we
• 25:58
  Speaker 2: can change expectations for the whole next generation. And I
• 26:02
  Speaker 2: make a comparison with this kind of idea of preventative education.
• 26:06
  Speaker 2: If we go like in the nineteen eighties in Australia
• 26:09
  Speaker 2: we did slip, slop, slap, and now like I have
• 26:11
  Speaker 2: young kids and they wear hats and sunscreen and the
• 26:13
  Speaker 2: behaviors have changed. We have colored lids on our bins.
• 26:17
  Speaker 2: We do in Sydney anyway, and recycling is a normal
• 26:21
  Speaker 2: behavior when it wasn't a normal behavior a couple of
• 26:23
  Speaker 2: generations ago, And I like my dream with this research
• 26:27
  Speaker 2: is what are those behaviors that we could instill in
• 26:29
  Speaker 2: the next generation to try to counter some of these
• 26:33
  Speaker 2: kind of huge like I mean pain costs Australia, Like
• 26:36
  Speaker 2: I think it was one hundred and thirty nine billion
• 26:38
  Speaker 2: dollars a year or some ridiculous number, And it's like,
• 26:41
  Speaker 2: could we not only reduce the financial cost but the
• 26:44
  Speaker 2: societal burdens of chronic pain. I think if the research
• 26:49
  Speaker 2: just seems so far ahead of the societal misconceptions about like, oh,
• 26:53
  Speaker 2: more pain must mean more damage, and they're like pain
• 26:57
  Speaker 2: is a direct result of this, Whereas I think if
• 26:59
  Speaker 2: everyone aciated that there are so many things influencing and
• 27:03
  Speaker 2: changing the volume of every pain experience, they might start
• 27:06
  Speaker 2: thinking a bit more curiously about it and what we're
• 27:10
  Speaker 2: seeing in the school based studies we're doing. Even like
• 27:12
  Speaker 2: the principle of a school recently was like, oh, the
• 27:15
  Speaker 2: kids who don't have chronic pain are more empathetic now
• 27:18
  Speaker 2: that they've learnt this neuroscience. They're more caring and understanding.
• 27:21
  Speaker 2: There's less of this bullying going on of that poor
• 27:24
  Speaker 2: kid who is really struggling, and I find that really fascinating.
• 27:28
  Speaker 2: And we didn't expect that education about pain would help
• 27:33
  Speaker 2: kids who don't have pain, and that's it's yeah, And
• 27:37
  Speaker 2: I think, so we're stepping from going okay, like placebo
• 27:42
  Speaker 2: effects and these kind of everything has some sort of
• 27:45
  Speaker 2: biological underpinning potentially, and then we go we zoom out
• 27:49
  Speaker 2: and we go okay, so treatments can work for a
• 27:51
  Speaker 2: variety of reasons, and then we go, okay, well maybe
• 27:53
  Speaker 2: we could prevent things and change things. And so that's
• 27:57
  Speaker 2: kind of where I'm interested, is like, how do we
• 27:59
  Speaker 2: communicate all of this complexity to kind of everyone rather
• 28:05
  Speaker 2: than it just being oh, we're going to change one
• 28:07
  Speaker 2: university course or we're going to put one TV ad
• 28:10
  Speaker 2: out or something like that. And I think we should
• 28:13
  Speaker 2: do all of those things, but it's hard to know
• 28:15
  Speaker 2: what's going to help in this age where, yeah, like
• 28:19
  Speaker 2: how do we change society's behaviors at a big level
• 28:22
  Speaker 2: is kind of that big question I'm fascinated by.
• 28:26
  Speaker 1: Want I want to come back and talk about children,
• 28:29
  Speaker 1: because you do a lot of research on that, But
• 28:32
  Speaker 1: let's just do a little bit of education and let's
• 28:36
  Speaker 1: take the fourteen week course that you do for students
• 28:41
  Speaker 1: physiotherabal students. And let's take the PIN component and compress
• 28:46
  Speaker 1: it into about five minutes.
• 28:47
  Speaker 2: Okay, So just I.
• 28:50
  Speaker 1: Want people to get an understanding. You've mentioned a number
• 28:53
  Speaker 1: of the things that are important in the pein signal.
• 28:56
  Speaker 1: So let's just talk about the nervous system, the PAN receptors,
• 29:01
  Speaker 1: and they're all the way up and they're different areas
• 29:05
  Speaker 1: where that PAN can get amplified, ending up in the
• 29:09
  Speaker 1: Briand just so people can get an understanding of how
• 29:13
  Speaker 1: PAN actually works as much as we understand right now.
• 29:16
  Speaker 2: Yeah, yeah, yeah, And and I think like the starting
• 29:18
  Speaker 2: point would be to understand this word called nosyception. And often,
• 29:22
  Speaker 2: like if you go onto kids science books and I've
• 29:25
  Speaker 2: done this, it conflates like it says that pain is
• 29:28
  Speaker 2: because of nos reception, and like really just overlaps those
• 29:32
  Speaker 2: ideas way too much. Nos Reception is the encoding of
• 29:38
  Speaker 2: noxious stimuli is the technical words. It's it's about transmitting
• 29:42
  Speaker 2: a danger message. And I've made some kids books and
• 29:46
  Speaker 2: tried to convey that. And the way we did it
• 29:48
  Speaker 2: was it was like a virtual reality adventure inside the
• 29:51
  Speaker 2: brain and the body and there's like little envelopes going
• 29:54
  Speaker 2: everywhere in the body, so and no seception. Like, so
• 29:57
  Speaker 2: when a body part reaches the threat shold on these
• 30:00
  Speaker 2: nerve endings of either pressure, temperature, or a chemical change,
• 30:06
  Speaker 2: there's a point at which the no Si sceptor goes,
• 30:08
  Speaker 2: all right, there's enough danger here that I need to
• 30:10
  Speaker 2: let the next part of the body know. And so
• 30:14
  Speaker 2: then that message goes up the nerve and it can
• 30:17
  Speaker 2: like in that local area, more nerves can fire. And
• 30:21
  Speaker 2: so like you'll see when something swells, say, if you
• 30:24
  Speaker 2: have a body part the turning more and more like
• 30:26
  Speaker 2: the swelling might grow. That's more nerve receptors are now
• 30:29
  Speaker 2: sending up messages, right, and so it keeps growing exponentially,
• 30:33
  Speaker 2: and it's going there's enough danger here that we need
• 30:36
  Speaker 2: to do something about it. And so that gets to
• 30:39
  Speaker 2: the spinal cord. So the no seception message, the no
• 30:43
  Speaker 2: seceptive messages gets to the spinal cords. There's danger going
• 30:46
  Speaker 2: on here. So something's being touched or pushed or chemical
• 30:49
  Speaker 2: changes enough that there's a problem and we need to
• 30:51
  Speaker 2: let the brain know, Like let's let the central nervous
• 30:54
  Speaker 2: no and so then that nerve it's not like a
• 30:58
  Speaker 2: perfect wire that just goes directly to the brain. There's
• 31:01
  Speaker 2: that chemical transaction, and this is where it's just next
• 31:05
  Speaker 2: to your spinal cord, the dorsal root ganglion. At that point,
• 31:09
  Speaker 2: that's where all those different connections can happen. And then
• 31:12
  Speaker 2: there's the highways going up the spinal cord.
• 31:14
  Speaker 1: And how much a neural transmitter is involved at this junction.
• 31:17
  Speaker 2: Yeah, so at every so this is like a sign apse.
• 31:20
  Speaker 2: You might have heard of that term. Yes, so at
• 31:22
  Speaker 2: every kind of time that there's communication happening. We used
• 31:26
  Speaker 2: to think of glial cells like glial in Latin is
• 31:29
  Speaker 2: about glue. Like we used to think of them as
• 31:31
  Speaker 2: like a passive kind of structural they'll hold the neurons
• 31:35
  Speaker 2: in place and that, and that's kind of true. But
• 31:38
  Speaker 2: also glial cells have quite a big role in chronic
• 31:43
  Speaker 2: pain and pain this kind of idea of messaging of
• 31:47
  Speaker 2: danger systems, danger signals. And so when that chemical transaction
• 31:51
  Speaker 2: is happening, there's a whole lot of different external influences
• 31:55
  Speaker 2: that can happen. And so if we tried to make
• 31:58
  Speaker 2: the exact same chemical transaction happen, it would be very
• 32:03
  Speaker 2: very hard between people, that's for sure. Because the surrounding
• 32:07
  Speaker 2: nervous system is not identical. And so when people like
• 32:12
  Speaker 2: at the moment, there's researchers trying to go, oh, like
• 32:14
  Speaker 2: maybe we could shoot light in and do like optic
• 32:17
  Speaker 2: kind of treatments that are non invasive at that level,
• 32:20
  Speaker 2: and like there's just so many potential ways, Like there's
• 32:22
  Speaker 2: lots of opioids and different mechanisms that act on different
• 32:25
  Speaker 2: receptors that are nearby and in that area. So this
• 32:28
  Speaker 2: is all happening kind of at the spinal cord wherever
• 32:32
  Speaker 2: the nerve roote kind of enters the nervous system from
• 32:34
  Speaker 2: whatever the sore body part was. So if it was
• 32:36
  Speaker 2: your ankle, it's going in down the bottom of your back,
• 32:39
  Speaker 2: whereas if it was in your arm or your shoulder,
• 32:41
  Speaker 2: it would be up in your neck where this is happening.
• 32:44
  Speaker 1: So then this is the harndholding between the peripheral and
• 32:47
  Speaker 1: the central nervous system.
• 32:48
  Speaker 2: That's right, yes, And at that junction there's a lot
• 32:50
  Speaker 2: of potential where I guess the way that we explain
• 32:53
  Speaker 2: this with kids is like the volume of that message
• 32:56
  Speaker 2: could be louder or quieter. So in the envelope it
• 32:58
  Speaker 2: says danger, and it might lower case, but now the
• 33:02
  Speaker 2: message is capital D, A, N, G, er and like,
• 33:05
  Speaker 2: and it's stuck on the right and there's lots of
• 33:08
  Speaker 2: exclamation marks, and so the original message has already been modified.
• 33:13
  Speaker 2: It's like Australia Posts has changed the letter or there's
• 33:17
  Speaker 2: more letters and they're bigger envelopes at whatever it is.
• 33:21
  Speaker 2: And so by the time it gets to the brain,
• 33:23
  Speaker 2: it might not be exactly that same message. It's an
• 33:27
  Speaker 2: interpreted like it's kind of a modified message. And in
• 33:31
  Speaker 2: the nineteen sixties, even like we talk about this in
• 33:33
  Speaker 2: the in the course of the gate control theory kind
• 33:37
  Speaker 2: of got that bit of the physiology, right, I think
• 33:40
  Speaker 2: where there's there's had this idea of like different gates
• 33:43
  Speaker 2: where you could kind of allow messages up to the
• 33:46
  Speaker 2: brain or not. And I guess it's that threshold idea,
• 33:50
  Speaker 2: but I think we can we've moved past that. And
• 33:52
  Speaker 2: there's a lot of different theories on how this works.
• 33:54
  Speaker 2: But basically, the brain is then receiving these messages, and
• 33:58
  Speaker 2: it's got thoughts and memories and expects to deal with.
• 34:01
  Speaker 2: It's got the visual input if you've seen the body
• 34:03
  Speaker 2: part that saw or not. There's all these different things
• 34:06
  Speaker 2: that have happened, like have I had this before?
• 34:09
  Speaker 1: And then I just want to throw in there, Joshua
• 34:12
  Speaker 1: a quote from Ahmat Gotswami, who's an astrophysicist and philosopher.
• 34:18
  Speaker 1: We don't perceive reality directly. We perceive it through the
• 34:21
  Speaker 1: mirror of memory.
• 34:23
  Speaker 2: Yeah, okay, interesting, So if.
• 34:26
  Speaker 1: You've had the memory of pain there can actually change
• 34:31
  Speaker 1: how you're perceiving that message that's coming in, right.
• 34:34
  Speaker 2: And that If that sounds like gobbledygook or like pseudoscience
• 34:38
  Speaker 2: to anyone listening, check out Melanie Knowles work in Canada.
• 34:42
  Speaker 2: She's a professor there. They did some awesome studies on
• 34:46
  Speaker 2: vaccination pain and with kids they were able to reframe
• 34:50
  Speaker 2: the previous pain experience by saying things like, oh remember
• 34:54
  Speaker 2: last time when you got your needle, you got a
• 34:56
  Speaker 2: lolli and and they talk about all the positive parts
• 35:00
  Speaker 2: of the experience. Yes, and that reduces the next paint
• 35:04
  Speaker 2: in the future vaccinations. And to me, like that is
• 35:08
  Speaker 2: really exciting, Like the fact that reframing can have some
• 35:12
  Speaker 2: effect even is so cool and yes, so one hundred percent.
• 35:17
  Speaker 2: Like the posterior parietal cortex, like the part of your
• 35:19
  Speaker 2: brain where you're accessing and trying to work out how
• 35:22
  Speaker 2: is memory influencing it? This is all happening. All this
• 35:25
  Speaker 2: stuff I've been talking about for a few minutes is
• 35:27
  Speaker 2: in a split second, it's not right. Yeah, yeah, this
• 35:31
  Speaker 2: is like, so you put your hand on the hot
• 35:33
  Speaker 2: plate and maybe a memory from when you were three
• 35:37
  Speaker 2: is coming back of your grandma saying don't touch it
• 35:40
  Speaker 2: or something like this is this is hard to kind
• 35:44
  Speaker 2: of standardize in a study.
• 35:46
  Speaker 1: It's like my it's like my little guy Oscar stood
• 35:49
  Speaker 1: on one of those sea urchins when he was a kid, okay,
• 35:54
  Speaker 1: and then for years just wouldn't go into water, and
• 35:58
  Speaker 1: we didn't understand why. And then it was like, oh shit, right,
• 36:01
  Speaker 1: so there's he is remembering and associating that pin with
• 36:08
  Speaker 1: the seed.
• 36:09
  Speaker 2: Yes, that's right, and yeah, and I guess that's where
• 36:12
  Speaker 2: like fear and all of these other things are kind
• 36:14
  Speaker 2: of going to mediate that interpretation of all these danger
• 36:17
  Speaker 2: messages coming up because I still haven't even mentioned pain yet, Like,
• 36:21
  Speaker 2: had all this no suception happening, the ankle sprained, the
• 36:24
  Speaker 2: damages happened or not happened, But there's there's plenty of
• 36:28
  Speaker 2: messages going up, and then yeah, I guess that's like
• 36:31
  Speaker 2: there's all these other mechanisms going back down the nervous
• 36:34
  Speaker 2: system from the brain to the spinal cord to the
• 36:36
  Speaker 2: body part, and we call it things like if people
• 36:39
  Speaker 2: want to read like descending inhibition or you could, Yeah,
• 36:43
  Speaker 2: there's some stuff that lay language would be like top
• 36:45
  Speaker 2: down kind of modulation. And that's where I think for me,
• 36:50
  Speaker 2: like there's a lot of data in psychological treatment about
• 36:53
  Speaker 2: a sense of agency predicting good outcomes, like if you
• 36:56
  Speaker 2: have a sense of self efficacy and control over the condition,
• 36:59
  Speaker 2: or if the condition is controlling you, you tend to
• 37:03
  Speaker 2: go on a different trajectory. And that's why I think
• 37:06
  Speaker 2: learning some of this can help empower people to go, hey,
• 37:10
  Speaker 2: you know what, I can't control everything, but I can
• 37:13
  Speaker 2: control my breathing and so therefore I can control whatever
• 37:19
  Speaker 2: it is panic attacks or whatever, and that has an
• 37:23
  Speaker 2: indirect influence on my next pain experience, and that has
• 37:26
  Speaker 2: an indirect effect on my mood, which then reduces my
• 37:31
  Speaker 2: depression or whatever. Like you can see the web start
• 37:34
  Speaker 2: to build, and I think it's really hard to formulate
• 37:37
  Speaker 2: this without like an exact kind of case example that
• 37:40
  Speaker 2: we're all on the same page with. So people are
• 37:42
  Speaker 2: probably just projecting their own experiences right now, and that's fine,
• 37:46
  Speaker 2: but maybe you can start connecting the dots between like
• 37:50
  Speaker 2: your diet and your sleep and you're like just thinking
• 37:52
  Speaker 2: some some broader stuff is going to influence it. And
• 37:55
  Speaker 2: we know, for instance, like sleep, there was a great
• 37:58
  Speaker 2: study looking at the Bideck direction all effects, so like
• 38:01
  Speaker 2: if you have bad sleep, you're going to have worse
• 38:04
  Speaker 2: pain the next day, and if you have bad pain,
• 38:06
  Speaker 2: you're going to have worse sleep the next night. And
• 38:08
  Speaker 2: so just in the pain and sleep web, that cycle
• 38:11
  Speaker 2: is a vicious one and can get worse and worse
• 38:13
  Speaker 2: and worse pretty quickly. So even just the time that
• 38:17
  Speaker 2: you're on a waiting list for a sleep study, Like, yeah,
• 38:20
  Speaker 2: it's just a really hard thing. And that's just isolating
• 38:23
  Speaker 2: two variables, which is just an unbelievable simplification.
• 38:28
  Speaker 1: Yeah, I'm I'm going to throw another one into the
• 38:31
  Speaker 1: mix before we get to the brillin Right. Okay, you
• 38:33
  Speaker 1: mentioned that sense of agency. Yeah, that plays very strongly
• 38:38
  Speaker 1: into the psychology and internal lookers of control and external
• 38:42
  Speaker 1: looks and control and whole research on haartiness and whether
• 38:46
  Speaker 1: or not people high in hardiness or have a high
• 38:49
  Speaker 1: internal looks of control believe that they have a very
• 38:53
  Speaker 1: strong influence on their destiny and the heartiness research tools
• 38:57
  Speaker 1: that they recover better from operations from all these sorts
• 39:02
  Speaker 1: of things, whereas people with an external look as of
• 39:05
  Speaker 1: control they've got lower agency, They believe that they have
• 39:08
  Speaker 1: less influence of things, and they take a lot longer
• 39:13
  Speaker 1: to recover from operations and things like that. So I
• 39:16
  Speaker 1: think that the psychology plays in here in terms of
• 39:21
  Speaker 1: what my agency actually is. Do you know what I think?
• 39:26
  Speaker 2: Like there's some interesting research about like, oh, maybe knowledge
• 39:28
  Speaker 2: and belief change is not sufficient for behavior change, and
• 39:32
  Speaker 2: some of that kind of ideas really fascinating. And one
• 39:34
  Speaker 2: idea of been thinking about is with these physio students.
• 39:37
  Speaker 2: So I have like seventy five students. They've done an
• 39:40
  Speaker 2: undergraduate degree in like biomechanical type stuff, so they're thinking
• 39:44
  Speaker 2: about the body very structurally, and then they come to
• 39:46
  Speaker 2: this course and often in like somewhere between week four
• 39:51
  Speaker 2: and week eight, like the midway point, most of the
• 39:55
  Speaker 2: students start having this moment where they apply what they've
• 39:58
  Speaker 2: been learning to their own experience. And it's this weird
• 40:02
  Speaker 2: time where I get all these emails and after class,
• 40:05
  Speaker 2: people are going, hey, hey, I know you've been saying
• 40:07
  Speaker 2: this helps patients, but like for my pain, which and
• 40:11
  Speaker 2: then you can see that they're starting to go, oh,
• 40:13
  Speaker 2: when I'm at the gym and this happens, or when
• 40:15
  Speaker 2: I have headaches, this is what's going on. And I think,
• 40:19
  Speaker 2: thinking by a psychosocially, yes, it probably is actually increasing
• 40:24
  Speaker 2: agency because I mean, anecdotally, we've got data on people
• 40:29
  Speaker 2: shifting to having an internal locus of control and the like.
• 40:34
  Speaker 2: So at a student level, at a professional level, when
• 40:37
  Speaker 2: people learn this stuff, it seems to have personal benefits.
• 40:41
  Speaker 2: And I know that's true for me and a lot
• 40:43
  Speaker 2: of the researchers I work with who are like, oh,
• 40:45
  Speaker 2: we want everyone to have this same amount of knowledge.
• 40:48
  Speaker 2: And I guess that's where I'm really fascinated, is like,
• 40:51
  Speaker 2: what's the minimal dose of knowledge and belief change that's
• 40:55
  Speaker 2: sufficient to empower someone long long term? And you see
• 41:00
  Speaker 2: those people online, like there's this awesome lady on Instagram
• 41:04
  Speaker 2: who can do like backflips and handstands and really cool stuff,
• 41:07
  Speaker 2: and like that's the kind of old person that we
• 41:09
  Speaker 2: want everyone to be, right, Like these these kind of
• 41:12
  Speaker 2: active people who just having a blast, their whole life
• 41:14
  Speaker 2: seems great and maybe it's not. And but I think
• 41:19
  Speaker 2: having joy and relating that to movement and physical activity
• 41:23
  Speaker 2: just seems like a good a good target for us
• 41:26
  Speaker 2: to aim for rather than it being about aesthetics or
• 41:30
  Speaker 2: just to try and like cope with pain or whatever
• 41:33
  Speaker 2: that those other motivators are. But it's a really hard
• 41:37
  Speaker 2: thing to set our goals, like long long term goals.
• 41:41
  Speaker 2: But people with heartiness and internal lockers of control, they
• 41:45
  Speaker 2: seem to do that like they're not thinking in the
• 41:47
  Speaker 2: short or the medium term so much like they're not
• 41:50
  Speaker 2: thinking in hours or days, they're thinking in months and years.
• 41:54
  Speaker 1: And they also see things like in injury as a
• 42:01
  Speaker 1: challenge for them to overcome. Right, Yeah, And I think
• 42:04
  Speaker 1: that psychological mindset please into stuff. It pleads into your behavior,
• 42:09
  Speaker 1: It plays into your belief systems, it pleads into high,
• 42:13
  Speaker 1: high effective that the treatment would be. I would imagine
• 42:17
  Speaker 1: through that belief idea.
• 42:20
  Speaker 2: Yeah, you should on this podcast I reckon your listeners
• 42:23
  Speaker 2: would like. Sean Zion is a researcher at Stanford and
• 42:27
  Speaker 2: he's done this stuff. He made this thing called the
• 42:29
  Speaker 2: Illness Mindset Inventory, and I think it was so this
• 42:32
  Speaker 2: is memory. Now I might be wrong, but I think
• 42:35
  Speaker 2: it was about cancer, and one of the items in
• 42:38
  Speaker 2: the questionnaire was about I see it as an opportunity.
• 42:42
  Speaker 2: It's just like, to me, that's just way too confronting.
• 42:45
  Speaker 2: It gives to a patient, right, and so, and he
• 42:48
  Speaker 2: could speak to all of that that research about like
• 42:51
  Speaker 2: when you say you see an injury as a challenge,
• 42:54
  Speaker 2: you see pain as an opportunity. Those kind of ideas
• 42:56
  Speaker 2: are just so hard to even grasp and it all
• 43:00
  Speaker 2: seems offensive to say it in the face of.
• 43:03
  Speaker 1: Well the historic philosophers believe that that that so their
• 43:07
  Speaker 1: whole attitude was that when you uncover misfortune, that that
• 43:12
  Speaker 1: this is a a good wrestling partner, that that will
• 43:16
  Speaker 1: actually enhanceure your strength and your resilience and your toughness.
• 43:21
  Speaker 1: So they actually saw these things are are reframed them
• 43:24
  Speaker 1: as opportunities and actually, in the extreme, welcomed them into
• 43:29
  Speaker 1: their lives. Right. So that's that that takes it to
• 43:33
  Speaker 1: another level. But if we did a little sidetrack there,
• 43:37
  Speaker 1: we just about got to the brain from the peripheral
• 43:41
  Speaker 1: nervous to the central nervous system and then up into
• 43:43
  Speaker 1: the brain. So what then, what's the next junction that
• 43:47
  Speaker 1: influences pain perception.
• 43:49
  Speaker 2: Yeah, so the way that there's some great work, like
• 43:53
  Speaker 2: there's a book called Explain Pain by David Butler and
• 43:56
  Speaker 2: Laura and Moseley. I like that. It's like a patient
• 44:00
  Speaker 2: friendly kind of way of explaining things. And the language
• 44:03
  Speaker 2: in that is pain is a distributed process, So there's
• 44:06
  Speaker 2: many different parts of the brain affecting the pain experience,
• 44:10
  Speaker 2: and this is a hard Like one of the challenges
• 44:13
  Speaker 2: with looking at this is like to say, you do
• 44:16
  Speaker 2: functional MRI like fMRI studies, and that's about blood flow changes,
• 44:20
  Speaker 2: and it's like, is that a perfect measure of what's
• 44:23
  Speaker 2: actually happening at a cellular level and physiological level. So
• 44:28
  Speaker 2: I think a lot of what I'm saying, I guess
• 44:31
  Speaker 2: will be clarified as science keeps getting better and our
• 44:35
  Speaker 2: ways of assessing and measuring stuff gets better. But yet,
• 44:39
  Speaker 2: just broadly speaking, I think what happens in the central
• 44:43
  Speaker 2: nervous system is just so multifactorial. Like that'd be the
• 44:46
  Speaker 2: take home message here is there's just so many different
• 44:48
  Speaker 2: little processes that are adding up. And if you want
• 44:52
  Speaker 2: to kind of experiment with this and develop your own
• 44:54
  Speaker 2: internal lock as control, start reflecting on different times you've
• 44:58
  Speaker 2: had the same pain, so it might be a headache
• 45:00
  Speaker 2: or whatever it is, sawne or something, and try and compare,
• 45:03
  Speaker 2: like what are all the ingredients if it was a
• 45:05
  Speaker 2: recipe in that pain versus pain A versus pain B,
• 45:09
  Speaker 2: And you can do this like in class. I've sat
• 45:12
  Speaker 2: in a lecture once where the lecturer got out us
• 45:14
  Speaker 2: to put our hands in a really icy cold cup
• 45:17
  Speaker 2: of water, and half the audience was looking at it
• 45:21
  Speaker 2: and it was told to stare at it, and the
• 45:23
  Speaker 2: other half of the audience was told to distract each
• 45:25
  Speaker 2: other and not think about it. And it was like
• 45:27
  Speaker 2: this really simple thing. It was one minute long, and
• 45:30
  Speaker 2: the pain ratings were so different, and it was really
• 45:33
  Speaker 2: fascinating Like that kind of like you can, like at
• 45:36
  Speaker 2: an acute, short term level, distraction and different strategies can
• 45:40
  Speaker 2: seem to help a little bit with the coping and
• 45:43
  Speaker 2: probably reduce the pain intensity itself. And so that's where
• 45:46
  Speaker 2: it's like, is the goal then to just like distract
• 45:50
  Speaker 2: our way out of long term pain? I don't know,
• 45:53
  Speaker 2: but maybe it can help us in those flare ups,
• 45:55
  Speaker 2: those times where pain seems insurmountable. There are strategies I
• 46:00
  Speaker 2: guess so coming up with a plan for long term
• 46:03
  Speaker 2: improvement is good, but also coming up with a plan
• 46:05
  Speaker 2: for short term coping, I think is really helpful. And
• 46:09
  Speaker 2: you want to weigh up the benefits and risks of
• 46:11
  Speaker 2: all of the different strategies you're using. And if you
• 46:13
  Speaker 2: think you're not using any strategies, you are. You're probably
• 46:16
  Speaker 2: just resting and taking medications, and those are passive, like
• 46:20
  Speaker 2: they feel like not even a choice, but you are
• 46:22
  Speaker 2: actually choosing to do those things. And if you start
• 46:25
  Speaker 2: putting the internal lookers of control inside you, then you
• 46:30
  Speaker 2: start going, oh, I do have a choice here, and
• 46:31
  Speaker 2: if I choose to do that again, that might have
• 46:34
  Speaker 2: this consequence. And if I choose to do that, then
• 46:37
  Speaker 2: that might have this consequence. And that's when you see
• 46:39
  Speaker 2: people start going, oh, I go to the gym, but
• 46:42
  Speaker 2: I think it's about the social benefits that's really helping
• 46:45
  Speaker 2: me or whatever, And you go, yeah, pain is it's biological,
• 46:48
  Speaker 2: it's psychological, and it's social all the time, every single time.
• 46:53
  Speaker 2: And I think embracing that is just where we start
• 46:56
  Speaker 2: to see this shift, and that's where I'm optimistic about
• 46:58
  Speaker 2: the future of pain related healthcare.
• 47:01
  Speaker 1: Can I give you a very concrete example. So I'm
• 47:05
  Speaker 1: going to be your physiotherapy student and bring this. Let's
• 47:08
  Speaker 1: do it to my experience. Right. So by eighteen months
• 47:12
  Speaker 1: two years ago, there was a little issue with some
• 47:17
  Speaker 1: of my blood work were the white blood cell kind
• 47:21
  Speaker 1: was pretty low, and they did some investigations and stuff
• 47:25
  Speaker 1: like that, and went to see a specialist and they went, oh,
• 47:28
  Speaker 1: I think you're okay, did some further blow brock, and
• 47:31
  Speaker 1: then it was again, And then I suppose to Doug said,
• 47:34
  Speaker 1: on are my options here? And I said, well, the
• 47:36
  Speaker 1: obvious thing that they're worried about with that is obviously cancer, right,
• 47:42
  Speaker 1: and a particular type of cancer. So we said, the
• 47:45
  Speaker 1: way that you can just know for sure is going
• 47:48
  Speaker 1: get a lumber puncture, right, and get a what do
• 47:51
  Speaker 1: you call it? Would they take a little bit of
• 47:53
  Speaker 1: the bone marrow, right, So get a bone marrow puncture
• 47:57
  Speaker 1: and analyze that. So I said, right, let's do it.
• 48:00
  Speaker 1: So I went in to get it, and I got
• 48:04
  Speaker 1: it the day after my book Death by Comfort was published. Right,
• 48:10
  Speaker 1: So here's the context. So I go in and they
• 48:14
  Speaker 1: come around and they give you a little local anesthetic
• 48:17
  Speaker 1: and then the nurse says, right, the doctor's going to
• 48:20
  Speaker 1: be around in a minute to give you morphine, and
• 48:23
  Speaker 1: once the morphine kicks in, then we'll do the lumber puncture.
• 48:27
  Speaker 1: And I said, what's the morphine for and she said, well,
• 48:31
  Speaker 1: it's a very uncomfortable experience. The morphine is just to
• 48:35
  Speaker 1: increase your comfort level. And I looked at her and
• 48:38
  Speaker 1: I went, I can't have it. I've just published a
• 48:41
  Speaker 1: book called Death by Comfort, Why modern life is killing
• 48:44
  Speaker 1: us and what we need to do about it. You're
• 48:46
  Speaker 1: telling me this is to make me more comfortable. I
• 48:49
  Speaker 1: don't want the morphine. And she went, are you crazy
• 48:52
  Speaker 1: in the head? And she found this fascinating. So we
• 48:55
  Speaker 1: had a chat about it, and then she brought the
• 48:57
  Speaker 1: doctor over and I went, I don't want to just
• 49:01
  Speaker 1: crack on and he said, and he says, well, everybody
• 49:04
  Speaker 1: takes the morphing, he says, apart from people who have
• 49:08
  Speaker 1: a reaction to morphine analogy. Yeah. And I said, well
• 49:12
  Speaker 1: do they die and he said no. I said, well
• 49:15
  Speaker 1: crack on. And so they thought this was very interesting.
• 49:19
  Speaker 1: But the nurse then as it was happening, she grabbed
• 49:23
  Speaker 1: my hand and started talking to me, and he started
• 49:26
  Speaker 1: having a little bit of a laugh around stuff and
• 49:30
  Speaker 1: I think two things played in to make that manageable.
• 49:34
  Speaker 1: One was my internal locus of control and the fact
• 49:38
  Speaker 1: that I just published a book called Death by Comfort
• 49:40
  Speaker 1: and this was a boat identity, right, So I think
• 49:44
  Speaker 1: that gave me a certain level of control or intended control,
• 49:49
  Speaker 1: if you like, over the pain. And then the fact
• 49:52
  Speaker 1: that the nurse who thought this was so fascinating, he
• 49:56
  Speaker 1: was grabbing my hand and just trying to distract me
• 49:58
  Speaker 1: and ask about questions and we having a bit of
• 50:00
  Speaker 1: a laugh Wiley fucking because it's pretty horrible alonger for puncture, right,
• 50:06
  Speaker 1: But that for me just plays into that whole internal
• 50:11
  Speaker 1: looks of control and the distraction element of things.
• 50:14
  Speaker 2: Yeah, yeah, yeah, there was a really interesting study looking
• 50:18
  Speaker 2: at I think it was epidurals and the language that's
• 50:21
  Speaker 2: used when the doctor's about to come in and if
• 50:24
  Speaker 2: it gets compared to yeah, this is the worst part
• 50:27
  Speaker 2: of the procedure versus sorry, it's like a beasting, and
• 50:31
  Speaker 2: it's the worst part of the procedure versus something like oh,
• 50:37
  Speaker 2: I can't of remember, this is uncomfortable or a little
• 50:39
  Speaker 2: bit of pressure or something like that, and they just
• 50:42
  Speaker 2: changed I think it was seven different words in the
• 50:44
  Speaker 2: sentence in the two groups of women, and in this
• 50:48
  Speaker 2: study the pain difference was more than two out of
• 50:50
  Speaker 2: ten on average, just from the language change and your Yeah,
• 50:55
  Speaker 2: in your example, you identified that it was an identity
• 50:59
  Speaker 2: thing for you. It was good timing in terms of
• 51:01
  Speaker 2: the book. You had really good rapport with the nurse.
• 51:04
  Speaker 2: By the sound of it. It was fun and it was
• 51:06
  Speaker 2: a bit silly, and you're kind of like almost mocking
• 51:09
  Speaker 2: the facts of what's going on and all that. So
• 51:11
  Speaker 2: like it's just like a really, that's a hard thing
• 51:14
  Speaker 2: to replicate in anyone else, because no one else has
• 51:16
  Speaker 2: published that book the day before, right, and just seeing
• 51:20
  Speaker 2: these the fact that the nurse grasped onto distraction and
• 51:25
  Speaker 2: handholding and comfort and laughing and so like, you've got
• 51:29
  Speaker 2: this nice biapsychosocial coping strategy, and our body has internal
• 51:36
  Speaker 2: like they're called endogenous opioids, and so like your internal
• 51:40
  Speaker 2: system would have been doing its best.
• 51:43
  Speaker 1: No, and I suspect, you know, this is a complete
• 51:47
  Speaker 1: guess that it probably up regulated more than if I
• 51:50
  Speaker 1: got the morphine.
• 51:51
  Speaker 2: I would guess, oh, yes, yes, yes, So yeah, we
• 51:54
  Speaker 2: see this in people who take opioids long term, their
• 51:58
  Speaker 2: ability to generate the internal opioids. I think it seems
• 52:01
  Speaker 2: like it's reduced. And so there's this conditioned kind of
• 52:05
  Speaker 2: state that happens where it's called opioid induced hyper algaesier,
• 52:09
  Speaker 2: where you take the tablet and it makes the pain worse.
• 52:12
  Speaker 2: And that's a really hard thing when people are dependent
• 52:15
  Speaker 2: on it. They can't stop taking it, but it's making
• 52:17
  Speaker 2: it worse. And they can't stop taking it, but it's
• 52:18
  Speaker 2: made it worse. And that's some of the kind of
• 52:20
  Speaker 2: the challenges that we see with these these external things
• 52:25
  Speaker 2: like surgeries, needles, medications, and that's why internal strategies are promoted.
• 52:30
  Speaker 2: But I don't want people to go, oh, well, Paul
• 52:34
  Speaker 2: did it. I'm going to do the same thing necessarily,
• 52:36
  Speaker 2: I think informed decision.
• 52:39
  Speaker 1: I'm a bit of a nutter, right, they don't try this,
• 52:42
  Speaker 1: but it would have been a really interesting experiment, right
• 52:45
  Speaker 1: to do the lumber puncture with just me and the
• 52:49
  Speaker 1: boat and nan have another one where it's the gnose
• 52:53
  Speaker 1: right and and there, and do the comparison, and that'd
• 52:57
  Speaker 1: be an interesting controlled experiment to see what elements played
• 53:02
  Speaker 1: into it, whether I just published the book or not
• 53:04
  Speaker 1: published the book, and whether the nose was holding my
• 53:06
  Speaker 1: hand had distracted me or not distract me, but anyway,
• 53:09
  Speaker 1: one of the.
• 53:10
  Speaker 2: Things with that is it's really hard just to be
• 53:13
  Speaker 2: able to have the control group right, Like, you can't Yeah,
• 53:16
  Speaker 2: you can't do that very well. And there's a researcher
• 53:19
  Speaker 2: I work with. His name's Mick Thacker, who does all
• 53:21
  Speaker 2: this stuff on predictive processing, and they're doing work in AI,
• 53:24
  Speaker 2: and the long term goal is a digital twin so
• 53:27
  Speaker 2: you can FEEDO type get a similar like it's like
• 53:29
  Speaker 2: a virtual Paul, and they could test stuff and see
• 53:33
  Speaker 2: how your body would react, and then they could test
• 53:34
  Speaker 2: another condition. And so I think potentially technology might allow
• 53:38
  Speaker 2: us to start answering these questions of like, oh, if
• 53:42
  Speaker 2: we could have a control group, we'd be able to
• 53:44
  Speaker 2: find out if it why Yeah. And I think once
• 53:47
  Speaker 2: we get to that point, we'll have so many more
• 53:50
  Speaker 2: answers than questions. Whereas at the moment, I feel like
• 53:53
  Speaker 2: every study I do, like I think we're up to
• 53:56
  Speaker 2: like eight papers this year, and it's like every single paper,
• 53:59
  Speaker 2: I'm like, we've just ended up with more questions questions.
• 54:01
  Speaker 2: It's like we've chipped away at it and it's a
• 54:03
  Speaker 2: better question than ever before, and we've answered something, but
• 54:06
  Speaker 2: like now there's even more things to answer and that's
• 54:10
  Speaker 2: just I guess it's part of the excitement of research
• 54:12
  Speaker 2: is you're having discussions and you're thinking about things that
• 54:15
  Speaker 2: no one has thought about in the past because we've
• 54:17
  Speaker 2: never known what we've known now. And I love that. Like,
• 54:20
  Speaker 2: to me, that's just like in twenty years or thirty
• 54:22
  Speaker 2: forty years, I'm definitely going to have that feeling still
• 54:25
  Speaker 2: and it's really exciting.
• 54:26
  Speaker 1: Yeah, it's the never ending quest for knowledge, right, It's
• 54:29
  Speaker 1: the gift that keeps on giving. Let's I am a
• 54:32
  Speaker 1: little bit of ware of time, and I do want
• 54:33
  Speaker 1: to talk about the children's stuff, right, So you have
• 54:37
  Speaker 1: written some books on and little bits of videos for children.
• 54:43
  Speaker 1: What to talk to me about the challenge of translating
• 54:49
  Speaker 1: all of the complex stuff you know to kids and
• 54:53
  Speaker 1: what if you find that actually works.
• 54:56
  Speaker 2: I've got them actually they're just sitting here. So the
• 54:58
  Speaker 2: kids books, it's a series five independent books and then
• 55:02
  Speaker 2: you can get them in a set as well.
• 55:03
  Speaker 1: Zoe and Zach's panhakes.
• 55:05
  Speaker 2: I love it, yes, yeah, yeah. And the idea is
• 55:08
  Speaker 2: that rather than having a resource that covers lots of
• 55:10
  Speaker 2: different topics, like kind of like in this podcast, we've
• 55:13
  Speaker 2: covered so many different topics and there's all these differ
• 55:15
  Speaker 2: rabbit holes that people can go down. I think for kids, like,
• 55:19
  Speaker 2: how can we work out if all of these messages
• 55:22
  Speaker 2: are helpful or maybe some of these messages are helpful.
• 55:25
  Speaker 2: What I wanted to do is like, let's break them
• 55:27
  Speaker 2: into discrete resources and we can see, Oh, the kids
• 55:31
  Speaker 2: who have chronic pains seem to benefit most from the
• 55:33
  Speaker 2: third book, and then or if they want to engage
• 55:36
  Speaker 2: in exercise and greater exposure, the fourth book's a good
• 55:39
  Speaker 2: starting point, and we're finding out some stuff about the
• 55:42
  Speaker 2: nitty gritty of the education. Whereas I think because like
• 55:46
  Speaker 2: for some people, if you say, oh, pain doesn't relate
• 55:48
  Speaker 2: to damage very well, even in a lab setting, some
• 55:52
  Speaker 2: people get so upset with that message because it's just
• 55:55
  Speaker 2: like you're saying, Hey, are you saying I'm faking it?
• 55:58
  Speaker 1: Yeah?
• 55:58
  Speaker 2: Whereas for other people it's so oh, it's such an
• 56:01
  Speaker 2: important part of their journey, having that moment where they
• 56:04
  Speaker 2: learned that. Whereas I think everyone like the second book
• 56:08
  Speaker 2: in this series I can show you. I don't know
• 56:10
  Speaker 2: if people will be able to watch this but yeah.
• 56:13
  Speaker 2: This is called Zoe z Oppen's Lights It Up, and
• 56:15
  Speaker 2: it's based on a real lab study where in the
• 56:18
  Speaker 2: presence of a different colored light people felt different amounts
• 56:21
  Speaker 2: of pain. And so in the story, little Zoe visits
• 56:24
  Speaker 2: her grandma's lab and there's the red light and the
• 56:27
  Speaker 2: blue light. And I'm sure I reckon you could guess
• 56:29
  Speaker 2: this correctly. People felt more pain in the presence of
• 56:32
  Speaker 2: which color.
• 56:33
  Speaker 1: I would say, Oh, interesting, blue light, I would say
• 56:38
  Speaker 1: more blue.
• 56:41
  Speaker 2: So pain, more pain with blue or more pain with red?
• 56:43
  Speaker 1: What do you think I would Oh, No, more pain
• 56:47
  Speaker 1: with red, for sure, more pain with red because red
• 56:50
  Speaker 1: would be associated with pain and inflammation.
• 56:52
  Speaker 2: Yeah, sure, and stop signs and danger and warning and.
• 56:56
  Speaker 1: All of that interesting little aside. Right, So placeboll in
• 57:00
  Speaker 1: resting that blue pills are better for anxiety, right, unless
• 57:07
  Speaker 1: you're an Italian meal and which kiss they're not because
• 57:12
  Speaker 1: they get excited about blue because that's the color of
• 57:16
  Speaker 1: the national soccer teams soccer team.
• 57:17
  Speaker 2: Yeah right, yes, so it's really fac so I think yes. Anyway,
• 57:22
  Speaker 2: we basically this kid's book is about I'm kind of
• 57:26
  Speaker 2: helping kids grasp the study more or less and go
• 57:30
  Speaker 2: hang on like The key line in the book is
• 57:32
  Speaker 2: if a little light can change the volume of pain,
• 57:34
  Speaker 2: plenty more is possible in my brainy brain. And then
• 57:37
  Speaker 2: it goes through the BIA psychosocial model and it's all
• 57:40
  Speaker 2: written like a kind of Doctor Susian style, lots of
• 57:43
  Speaker 2: fun and cartoons, interactive way of thinking about it. And
• 57:46
  Speaker 2: for me, I don't think it's like the books. I mean,
• 57:50
  Speaker 2: I get emails from people saying the books have changed
• 57:53
  Speaker 2: my kid's life, it's fixed our whole family, and it's
• 57:55
  Speaker 2: like as if it's a cure, and I'm like, I
• 57:57
  Speaker 2: don't think that's really like a good way of thinking
• 58:01
  Speaker 2: about the books necessarily, like often they can be a support,
• 58:05
  Speaker 2: but for me, I think at a minimum they're a
• 58:07
  Speaker 2: conversation starter. And so a lot of clinics and stuff
• 58:09
  Speaker 2: have this open and they've got the kid with juvenile
• 58:13
  Speaker 2: arthritis and they're going the rheumatologists are saying, well, the
• 58:18
  Speaker 2: disease is at bay at the moment, it's okay, and
• 58:21
  Speaker 2: then the family's left going, well, why do I have
• 58:23
  Speaker 2: all this pain? And so the books are kind of
• 58:26
  Speaker 2: functioning as that conversation starter piece of going The science
• 58:30
  Speaker 2: doesn't need to be that inaccessible and complex, like, let's
• 58:33
  Speaker 2: bring it down and what do you think of Zoe's experience?
• 58:36
  Speaker 2: And I think having a character and a relatable way
• 58:38
  Speaker 2: of approaching the topic is much better than a textbook.
• 58:43
  Speaker 2: But obviously I'm biased. I've made the resource. But yeah,
• 58:47
  Speaker 2: so that's kind of the backstory of the books. And
• 58:49
  Speaker 2: it's been so cool to see, like you write a
• 58:52
  Speaker 2: research paper and a few thousand people see it in
• 58:54
  Speaker 2: a year or something, but you do something like a
• 58:56
  Speaker 2: ted ed video or you make kids books and it
• 58:59
  Speaker 2: just goes out to so many more people, and I
• 59:02
  Speaker 2: just I love that, Like I think, yeah, the reason
• 59:05
  Speaker 2: I moved from clinical work into to research and to
• 59:07
  Speaker 2: teaching is to try and help more than one person
• 59:10
  Speaker 2: at a time. It's like a good version of a
• 59:12
  Speaker 2: pyramid scheme kind of thing. Yeah, but it's like we
• 59:16
  Speaker 2: can using mass media and the Internet. It's facilitated the
• 59:20
  Speaker 2: chance to disseminate knowledge at a greater rate to more
• 59:24
  Speaker 2: and more people and to kind of even out some
• 59:26
  Speaker 2: of these health literacy inequalities around the world. And so
• 59:30
  Speaker 2: I want to contribute to those efforts, and I think
• 59:32
  Speaker 2: hopefully there's people wanting to do the same.
• 59:34
  Speaker 1: Have you turned the book. I thought about turning the
• 59:36
  Speaker 1: book into a series of little TikTok videos and yeah,
• 59:41
  Speaker 1: an animeate it, right, because that would go out and
• 59:44
  Speaker 1: read so many kids.
• 59:46
  Speaker 2: Yes, yes, so there's been talks about like a TV thing.
• 59:49
  Speaker 2: There's lots of these kind of it's all in early
• 59:52
  Speaker 2: stages and we haven't done it yet. So if someone's
• 59:53
  Speaker 2: listening and so, they should reach out later. But it's
• 59:58
  Speaker 2: a hard thing going, Yeah, just what's that next step? Like,
• 1:00:02
  Speaker 2: how do we help people more than what we're currently doing?
• 1:00:05
  Speaker 2: And I think that's my job as a researcher, is
• 1:00:07
  Speaker 2: to try and be strategic and think in the long
• 1:00:10
  Speaker 2: term about these strategies. But yeah, I just can't believe
• 1:00:13
  Speaker 2: how helpful a shiny resource is versus like a photocopied
• 1:00:19
  Speaker 2: stick figure drawing. It seems to have a real big
• 1:00:22
  Speaker 2: effect on our current kind of Western culture and approach
• 1:00:26
  Speaker 2: to how we consume information. It's really hard, I think. Yeah,
• 1:00:31
  Speaker 2: as you mentioned, like things like TikTok are just changing
• 1:00:33
  Speaker 2: the way that people kind of process their learning.
• 1:00:37
  Speaker 1: So me, you clearly have a very infectious enthusiasm for
• 1:00:42
  Speaker 1: what you do. What are you excited about on the horizon.
• 1:00:47
  Speaker 2: Yeah, I've actually just worked on another kids book series
• 1:00:50
  Speaker 2: for preschoolers. So like, I guess it's this question of
• 1:00:53
  Speaker 2: how young do we go right, Like do we go
• 1:00:54
  Speaker 2: back all the way to like the breastfeeding mom or
• 1:00:58
  Speaker 2: maybe in utero the expecting pair. Who do we want
• 1:01:00
  Speaker 2: to educate? And I think so the step from primary
• 1:01:03
  Speaker 2: school is to go to preschool. And you can't talk
• 1:01:06
  Speaker 2: about pain. I don't think it, Like, I mean you could,
• 1:01:08
  Speaker 2: and you could talk about acute pain management strategies, but
• 1:01:12
  Speaker 2: I think what's good for the nervous system in the
• 1:01:15
  Speaker 2: long term, Like they're the kinds of things I want
• 1:01:17
  Speaker 2: to be educating and providing the science about. And so
• 1:01:19
  Speaker 2: we've made this book for preschoolers, and it's about physical
• 1:01:23
  Speaker 2: activity and play based activity. And it's not like I'll
• 1:01:26
  Speaker 2: do three sets of ten of this exercise or anything
• 1:01:29
  Speaker 2: like that. It's like, let's just kind of normalize outdoor
• 1:01:33
  Speaker 2: fun adventures, play using our gross motor fine motor skills,
• 1:01:38
  Speaker 2: like kind of helping people readiness for school, and like
• 1:01:41
  Speaker 2: thinking just more whole child than three one body part.
• 1:01:45
  Speaker 1: Free range children rather than pregging buttery children.
• 1:01:50
  Speaker 2: That's what funny, Like I.
• 1:01:51
  Speaker 1: Don't need seriously that's what we need to get back to,
• 1:01:54
  Speaker 1: is rearsing free range kids, whether ranging and climbing trees
• 1:01:58
  Speaker 1: and doing shit and learning stuff, rather than battery kids
• 1:02:02
  Speaker 1: that are stuck inside on screens. Yeah.
• 1:02:04
  Speaker 2: Yeah, and it's funny. I'm not, like, I'm a physio
• 1:02:07
  Speaker 2: and obviously biased towards doing more exercise and stuff, but
• 1:02:10
  Speaker 2: I think screens and some of the technological advancements for
• 1:02:14
  Speaker 2: people to be able to learn more efficiently is just
• 1:02:16
  Speaker 2: like mind blowing. And so I'm not against screens, but
• 1:02:19
  Speaker 2: I think there's just the childhood that a lot of
• 1:02:22
  Speaker 2: adults grew up with is not the same now, and
• 1:02:27
  Speaker 2: there's this real thirst for like how do we marry
• 1:02:30
  Speaker 2: this up of like, Okay, screens are kind of unavoidable,
• 1:02:33
  Speaker 2: so we need to make it clear that there's benefits
• 1:02:36
  Speaker 2: of also doing other stuff. And so it's raising that conversation.
• 1:02:40
  Speaker 2: Is this next step, And I guess the to answer
• 1:02:43
  Speaker 2: your question about the excitement, it's about thinking like, can
• 1:02:46
  Speaker 2: we make a kind of curriculum or a big societal
• 1:02:50
  Speaker 2: change for every age group across the whole lifespan. That's
• 1:02:53
  Speaker 2: where I'm heading at the moment.
• 1:02:55
  Speaker 1: Yeah, very cool, Josh. This has been bloody interesting. Who
• 1:02:58
  Speaker 1: would know that a com about pain could be so
• 1:03:01
  Speaker 1: much fun.
• 1:03:03
  Speaker 2: I'm so glad. I really enjoyed it, and I appreciate
• 1:03:05
  Speaker 2: you clearly have so much knowledge about such a big,
• 1:03:08
  Speaker 2: broad number of topics. I kind of feel like I'm
• 1:03:11
  Speaker 2: so narrowly focused and got my blinders on looking at pain.
• 1:03:16
  Speaker 1: But yeah, well I'm a whatether they call it a
• 1:03:21
  Speaker 1: it's the master of none, a jack of ultra, jack
• 1:03:24
  Speaker 1: of all tree, it's a master of none. But yeah,
• 1:03:27
  Speaker 1: look for me, I think I sure your enthusiasm just
• 1:03:32
  Speaker 1: for or like awe about the body in general, and
• 1:03:37
  Speaker 1: just high freaking cool shit is when you look onto
• 1:03:41
  Speaker 1: the hoot, at the nervous system, the muscle system, you know,
• 1:03:45
  Speaker 1: all of our systems and just how they react to
• 1:03:48
  Speaker 1: inputs from the environment and psychology and all of that
• 1:03:52
  Speaker 1: stuff is just so boddy fascinating. It's very cool.
• 1:03:56
  Speaker 2: Totally agree.
• 1:03:57
  Speaker 1: So keep doing what you're doing, keep your factious enthusiasm,
• 1:04:02
  Speaker 1: because I think that that has a big impact. And
• 1:04:05
  Speaker 1: it would be very cool to be a student of
• 1:04:07
  Speaker 1: yours getting lectured too, rather than these boring as butt
• 1:04:10
  Speaker 1: shit lecturers that are tan.
• 1:04:16
  Speaker 2: Yeah, I hope there's little bits and pieces that are
• 1:04:18
  Speaker 2: helpful here and people get to have the joy of
• 1:04:21
  Speaker 2: being curious and going down all the rabbit holes that
• 1:04:23
  Speaker 2: we mentioned.
• 1:04:24
  Speaker 1: Yeah, absolutely, thanks Matte, and so well, oh, what's the
• 1:04:27
  Speaker 1: best people of saying people? It's joshuapiet dot com.
• 1:04:32
  Speaker 2: W is my middle initial. There's a NASCAR driver and
• 1:04:36
  Speaker 2: a Netflix director. There's people with the same name as me,
• 1:04:38
  Speaker 2: and so I've had to insert that W. So Joshua
• 1:04:41
  Speaker 2: wpat dot com. There's a contact form and if you
• 1:04:44
  Speaker 2: just or you could look up UTS and my name
• 1:04:46
  Speaker 2: and it will come up with contact details. So yeah,
• 1:04:49
  Speaker 2: reach out. I'd love to hear from people, happy to
• 1:04:52
  Speaker 2: kind of have more conversations and see where things had.
• 1:04:55
  Speaker 1: Awesome, great stuff. Matt, thanks for your time. This has
• 1:04:57
  Speaker 1: been bloody amazing.