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Precision Pain Relief Is Closer Than You Think | Prof. Mark Hutchinson
66 Plays27 days ago
In this episode, Lachlan Townend is joined by Professor Mark Hutchinson to explore the complexities of pain from the cellular level through to lived human experience.
Mark shares his personal journey with chronic back pain, including the challenges of navigating healthcare as both a patient and a pain scientist. He discusses his cutting-edge research into how blood biomarkers could transform pain diagnosis and treatment - bringing us one step closer to precision, personalised medicine for pain.
We also dive into practical strategies like sleep, nutrition, mindfulness, and cold-water therapy, connecting them to the molecular science of how pain develops and persists. With passion and authenticity, Mark sheds light on why there’s more hope now than ever before.
Whether you’re a clinician, researcher, or someone living with pain, this conversation offers science, story, and hope in equal measure.
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Transcript
Introduction to Personalized Medicine for Pain
00:00:00
Speaker
My heart was broken when I realised pain doesn't work like that and we can't treat pain with something in a tablet very well. i think we could actually be looking at the opportunity to have precision personalised medicine as the first pass for pain.
00:00:15
Speaker
There are Hundreds of thousands of brilliant minds literally working through the night coming up with new ways to one, recognize the pain state, diagnose the pain state and intervene.
Meet Professor Mark Hutchinson
00:00:31
Speaker
Hello and welcome to Pain Coach. Today we're joined by Professor Mark Hutchinson, a medical scientist who studies how our nervous and immune systems interact to create chronic pain.
00:00:44
Speaker
Mark is leading groundbreaking work on a blood test that can reveal the different colours of pain so that treatments can be precisely tailored to each person. He has a rare gift for turning deep cellular science into simple, practical solutions.
00:01:02
Speaker
His impressive work has also earned him a recent finalist spot for Australia's prestigious Eureka Prize for Leadership in Science. Beyond his scientific expertise, Mark also has a personal, lived experience with chronic pain.
00:01:19
Speaker
His reflections are deeply thought-provoking and his recovery inspires hope. Join us as we explore his vision for the future of pain care and practical wisdom for anyone struggling with pain.
00:01:35
Speaker
This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature.
Mark's Personal Journey and Academic Background
00:01:44
Speaker
You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
00:01:53
Speaker
Thanks, Mark, for for coming on the show. just like to get a little i would like personally to get to know you a little bit more, and I'm sure the listeners do So tell us a little bit about your life, both personally but also professionally.
00:02:08
Speaker
Yeah, sure. So I'm joining you today from Ghana country here in beautiful Adelaide. So eternally grateful to the Indigenous peoples here and across the country for helping us learn more about country. But I grew up in Sydney as a kid, generally interested in life and running around on the fields, moved to Adelaide as a youngster. It was supposed to be a 12-month move with dad with an oil and gas company and Lo and behold, 40-something years later, still in Adelaide, married with two amazing kids. We're an academic family. Professor Amanda Hutchinson, clinical psychologist, is my better half and keeps me on the straight and narrow.
00:02:50
Speaker
And and love love the research, love asking questions and remaining motivated by the huge challenge that we have with unmitigating anguish in pain.
00:03:08
Speaker
Yeah, I love the work you do and and thank you for that. I didn't know that your wife was, ah did you say clinical psychologist and yeah academic? Yeah, we're we're a merger family. So Uni Adelaide is merging with UniSA. So she's on the other side of the fence at UniSA and we're ripping down the fence and we're going to become, yes, the the Adelaide University family.
00:03:31
Speaker
Yeah, and she is she interested in the same areas or what is she, what are interests? So the crazy thing is, right, so when we were both looking to do more studies, so my postdoc and her PhD, there was one place in the world that we could work in and both benefits and it was university of colorado boulder down one end of the hall was marie banich who wrote the textbook on neuropsychology and that was mandy's thing is is neuropsych she's now working in psycho-oncology and and working with kids with with cancer and helping them work out how they're going to cognitively perform the rest of their lives
00:04:14
Speaker
as well as training the next generation of clinical psychologists. And then down the other end of the hall was Linda Watkins and Steve Mayer, the the gurus in depression, learned helplessness and pain and glial biology. And the only place in the world where we were both going to win. And that's where we ended up.
00:04:34
Speaker
Yeah, wow. Wow, cool. Tell me a little bit about your um academic work.
From Drug Development to Pain Complexity
00:04:41
Speaker
What are you studying at the moment? So maybe maybe if I say where I came from and then how I've sort of meandered to here, I guess ah early on I was a drug development guy, loved my pharmacology, loved small molecules having effect at receptors.
00:04:58
Speaker
You know, what we could put in a tablet was what I thought was the best thing that we could have these precision interventions. ah My heart was broken when I realized pain doesn't work like that and we can't treat pain with something in a tablet very well.
00:05:13
Speaker
So i ended I ended up doing a PhD in that and and trying to understand how we can do better with understanding the true complexity of the drugs that we think change the pain experience, but perhaps don't do all of that.
00:05:30
Speaker
and And a meandering journey along there from discovering new mechanisms of pain around the the immunology of the brain and how that contributes to both pain, reward, addiction, depression, anxiety, and everything else in between.
00:05:48
Speaker
through to now being back in Oz and really spending most of my days these days creating new measurement technologies that allow us to understand those cellular bits and pieces in our brain without actually having to go into the brain. And i know that sounds sort of esoterical and crazy, but we've discovered and what we're trying to unpack now as to how Things that are in your blood, that are circulating around in your blood, are changing because of the way you think and feel and you're experiencing pain right now.
00:06:25
Speaker
And that's changing so dynamically that a dumb, stupid scientist like I can make a measurement that can predict that. And where we're heading right now is...
00:06:37
Speaker
Imagine a day when you go into your doctor's surgery and you have your blood test perhaps done for your glucose in your blood for perhaps monitoring your diabetes.
00:06:50
Speaker
You have your blood pressureset pressure taken and then the same sample of blood that was there for your diabetes is also then objectively quantifying your pain state and that is then helping the clinician, your doctor, know how to intervene, how to treat and do great things for you whilst also talking to you and asking you how is your pain, how are you coping?
00:07:15
Speaker
Yeah, wow, that's that's an audacious
Challenges in Pain Measurement and Testing
00:07:18
Speaker
endeavour that you have there. How far off are we? Well, so we can so right now we can do this in animals with extreme sensitivity and specificity. So that means that around 90% of what we are seeing, we can actually predict in an animal.
00:07:38
Speaker
Now, that may sound, oh, well, if you can do it in an animal, what point is it for a human? Well, the beauty about a complex animal like a sheep or a cattle is those are animals that are living for a long period of time and we can measure other things about those animals that's telling us, yeah, they're actually feeling the types of pain that are relevant to us.
00:07:58
Speaker
So that technology right now, the FDA is taking forward to use for cattle pain measurement right now. Where we're at with the human side is we know we can do it experimentally in humans. we're We've done it in hundreds of people now. and We've got active clinical trials where we're actually using these blood tests right now as research tools to tell us about how the the various interventions that we're doing, the various trials of new ways of treating pain are actually working.
00:08:30
Speaker
But there is a big leap to go from Mark tinkering away in the lab with a blood sample through to ah doctor saying, I believe the blood sample more than what you're telling me.
00:08:43
Speaker
And that's that's a challenging space that we we don't want to supplant what somebody's saying. However, there are portions of our general population, children, for example, who who don't have language, or the aged who have lost language because of dementia, or you're unconscious in the ambulance, but your body's still experiencing the danger signals from that injury,
00:09:11
Speaker
Those are good times that would be nice for someone to know that something's happening with your pain state. And that's where we're seeing technologies like ours coming in to be able to actually provide a voice to the voiceless.
00:09:25
Speaker
It just reminds me of an experience that I've had. I had a ah client that was, she was nonverbal. And, you know, there was a lot of sort of body language type things that made made you think there's something going on here. And I was advocating for her at the time because she kept, you know, smacking her shoulder and and doing things like this. And, yeah, it was quite complex trying to work out well what was going on and and how could we help her. So that would be a game changer.
Understanding the Complexity of Pain
00:09:55
Speaker
Now, what does – obviously – you know, you're objectifying what is an ah subjective experience to some degree, which which is awesome.
00:10:10
Speaker
But what what does it look like in terms of like pain is not an on-off switch. It's not black and white. There's a lot of different varieties of how that presents.
00:10:22
Speaker
how How is that helping? Yes, you know, you've hit it you've hit the biggest challenge we've got on the head. So pain is not pain is not pain is not pain. and And I think we need to get better at acknowledging from the academic realm and nicely the International Association for the Study of Pain have updated their pain definition to say, you know,
00:10:48
Speaker
Just having a primary afferent, that first neuron from your big toe to your spine being activated does not mean that it's going to be the same. And if I tickle that fiber the same way in you, me, or, you know, Joe and Josephine on the street,
00:11:05
Speaker
The same signal there will not be recognized as danger, threat, in the same way for those four people to four million people.
00:11:16
Speaker
Everybody is unique. And yet, and this is the part that we don't understand yet, once we've integrated and experienced that, our physiology's response to our perception of that seems to respond in a measurable way in the blood.
00:11:38
Speaker
Now, I don't understand how this works, and it's not an exact science, but it's close enough that allows us to give some indication that we're on the right track.
00:11:52
Speaker
Now, the reason why I say some indication to know we're on the right track, if we're all watching the same movie and there's a scary point in the movie and we all were wearing heart rate monitors, we would all respond to that scary point of the, on the show, right?
00:12:12
Speaker
Now, my heart rate may go up a lot. You might go, and someone might grab the chair tighter. But our physiology has all responded. What we're doing in the blood is kind of like that.
00:12:26
Speaker
We're getting a little bit of the c clench of the hand on the armrest, a little bit of the and a little bit of the heart rate variability change, all integrated in a simple blood test.
00:12:37
Speaker
Now, that doesn't then tell me what it was on the screen that made us all go, and nor does it tell us, did I respond to the sound? Did I respond to the visual? Did I respond to the emotional memory of it?
00:12:50
Speaker
But we all experienced that. Now, that's where I think our immunology and our blood can actually tell us some more about that. And that's where we're sort of hooking our understanding onto.
00:13:02
Speaker
And that's a useful tool, but it's only a tool, right? So and clearly a if we have the opportunity to have more information, we'll use it, but but that's sort of the underpinnings of the biology that we're playing with.
00:13:16
Speaker
and And as we understand more, we'll know, was it a you know an action-packed thriller? was it a Was it a comedy on the screen? Or you know was it a slapstick comedy? We'll learn.
00:13:29
Speaker
So will this take some of the guesswork out of... potentially the different pain types that we we know exist in chronic pain, where they whether it be nociplastic, where the nervous system is wound up or whether it be and and ah damaged nerve or a damaged structure, will this be able to to piece apart that a little bit?
00:13:49
Speaker
Yeah, great question. Yeah, so so I think that's that's some of the work that we're actually doing right now and some of the trials coming up. and This whole field that we've sort of evolved into actually started with the simple question,
00:14:03
Speaker
do you have pain or not? Then it evolved to how much pain are you in? Where you're going, which is exactly the direction we're wanting to go is what type of pain are you in?
00:14:17
Speaker
And the reason we want to know that is not to then say, let's admire the problem. Oh, you've got neuropathic pain. Awesome. But rather to go, you've got neuropathic pain of this particular type, meaning that you're more likely to respond the interventions two and three exercise plus mindfulness plus something with maybe a little tickle over here of some cognitive based therapy and a little bit of pharmacology maybe but
00:14:49
Speaker
That really is a change from you've got pain broadly, try this drug for eight weeks and good luck and come back and see me and tell me if it worked or not.
00:15:00
Speaker
it It moves us from this empirical guesswork to a future where I think we could actually be looking at the opportunity to have precision personalised medicine as the first pass for pain.
00:15:16
Speaker
Wow. Yeah, that is very, very exciting. And I wish you but she all the best with that. Like I hope that, well, Godspeed, hope that comes on quickly.
00:15:28
Speaker
You know, it's crazy, right? So and if you get dark if you get diagnosed with cancer today, you don't just get put on one type of chemo, right? you get You get precision targeted therapeutics.
00:15:40
Speaker
if you get If you have a particular type of blood pressure or or lipids that you need to modify for your cholesterol, you get put on a defined pharmacology. Why is it that today in pain, we it's the most prevalent thing out there, we don't have these tools? So you know I think we do need some speed.
00:16:00
Speaker
The world can't wait. And yeah, we're we're trying our hardest to get this out there as fast as we can. Yeah, that's amazing. That's so exciting. One of my questions were going to be was going to be that you're on the cutting edge of research. What are you excited about?
00:16:14
Speaker
We've already got that at 14 minutes and I'm also excited about this. I think one one aspect of it I think that could be game changer is the to-do surgery, not-to-do-surgery question. you know that kind of That would take a bit of that guesswork out and The people that, I mean, we sort of clinically, you kind of have a feel of this person's not going to respond to this surgery, but, you know, they've signed up for it. It's going ahead and let's see what happens.
00:16:43
Speaker
But hopefully that heartache of failed surgery it doesn't need to be much, much longer.
When is Surgery Appropriate for Pain Management?
00:16:52
Speaker
Yeah, you know, it's interesting, right? So that that challenge of...
00:16:58
Speaker
Why we go to surgery, why it's an option, again, it's it's almost as complex as the experience that's being felt by the individual.
00:17:09
Speaker
And we have we have surgical tools, which at the end of the day, still today, macro level, right? We're we're operating at millimeter resolution at best.
00:17:23
Speaker
And yet, the things that are driving this pain experience are at the nanoscale, right? So these tiny, tiny length scales.
00:17:35
Speaker
So when we think about the need to interface a surgical blade or drill or something else with these nanoscale events, we need to sort of look at both those length dimensions and the time dimensions that go with it.
00:17:52
Speaker
Because for some people, surgery is is the right answer. But for other people, it's not. And I am excited about the future where some of these molecular tools that we can have that are telling us more about the pain types will help us not only improve the selection of the right patients for the right intervention, which may or not be surgery, but then crucially,
00:18:20
Speaker
ah surgery but then crucially help us intervene surgically with true molecular scale, nanoscale level interventions. And I think that's where I get pretty excited about where some of the novel, even quantum sensors start really raising above the the parapet to be potential, even within the next five years, these will be deployed. And I'll tell you right now, by the time 2032 Games rolls around up in Brisbane,
00:18:51
Speaker
there will be quantum sensors on the side of the the um the the track and on the side of the fields measuring acutely injuries that may have occurred on the field to get those players, to get those runners back on the field onto the track faster because of the app that the ability to know is this just a niggle or is this a you know career-ending issue.
00:19:21
Speaker
Yeah, wow. Wow. You sort of, you might have lost me just a little bit there with the Neno and the, but yeah, but it it's it sounds exciting.
00:19:34
Speaker
but So I guess you you know you think about you have an injury and you think it's an injury, but you you're not sure is it just a niggle or have I torn something in in a ah muscle group?
00:19:47
Speaker
You usually have to then sit on it for a few days. Does it feel bad or not? You might ice it. You might take some paracetamol or whatever and then Panadol and you might then end up maybe going and have a scan.
00:19:58
Speaker
Now, if you're going to have a scan, that's a few days later, the inflammation's happened, and all of that inflammation at that molecular level signaling that then creates the pain state.
00:20:11
Speaker
For an Olympic athlete, they need to know should I run that next heat or should I play the second half of the game that I've trained eight years of my life to do, right? So rather than having to wait that time,
00:20:26
Speaker
The technologies are going to allow us to take these measurement technologies to the track side so they don't need to go to hospital. Boom. They'll get the measurement right there and then. And, oh, no, you shouldn't. You should wait to, you know, the next Commonwealth Games to do your next run or, um no, you're right. Let's go.
00:20:44
Speaker
Yeah. Okay. I see. I see. Cool. I want to switch gears a little bit, if you don't mind. We'll get back to the research at some stage. so But ah so um I read an article of yours about your experience with chronic pain.
Mark's Journey with Chronic Pain and Recovery
00:21:01
Speaker
And I'd love you to just share a little bit about that. And because, you know, there's one level of expertise that comes from, you know, the academic work that you do There's a whole nother level of expertise that comes from lived experience.
00:21:17
Speaker
and feeling the struggle that yeah that pain can bring. do you mind sharing a little bit about it? Sure, absolutely. So yeah, just over a year ago, so February 2024, I was getting ready to go for a run, as I usually did, and I felt just a little bit stiffer in the hamstrings than I would like to So I just...
00:21:45
Speaker
jumped on the floor and started limbering up a bit and um had the shoes on ready to roll and it did not get looser. And was like, this is weird.
00:21:57
Speaker
So I held back from going for a run um because yeahm I'm not a young man. I'm mid-40s, right? But i I just didn't feel like I could go for the run I wanted to go for.
00:22:11
Speaker
And throughout the day, it just gradually got worse and worse and worse to the point that I had exquisite lumbar pain with the inability to move. like And yeah to the point where knew what i knew what a four out of 10 pain scale was.
00:22:32
Speaker
I didn't honestly know at that point in time what an eight and nine out of 10 actually was until that afternoon in February. Last year, long story short, identified ah needed to end up with some acute pain relief, had a locum come out, headed into emergency department because I couldn't get it sorted, was treated somewhat suboptimally umm in the emergency department. And when I say that,
00:23:00
Speaker
They couldn't work out if I was a drug-seeking user or not. i i I'm a pain guy. I could explain what was happening to me. And they ah thought there was a drug-seeking element to what I was doing.
00:23:17
Speaker
Wow. Long story short. no his history No history of that, Mark. No history. No, no, no, no. Wow. Long story short, had had a um steroid injection.
00:23:27
Speaker
The pain subsided. Conservatively managed it with exercise, physio, attempted strength training. Unfortunately, throughout that year, gradually developed further nerve injury, ah continued pain, and then motor function loss.
00:23:49
Speaker
So my my foot was unable to raise as well as it should, which it culminated in me needing to go and and have ah some some release surgery at the end of the day with with partial dystectomy. Yeah.
00:24:04
Speaker
And what was extraordinary was i went from seven out of 10 and a pain, um lack of motor control of my right foot principally with immediately after surgery, waking up pain-free and motor performance back.
00:24:25
Speaker
At that point, I felt that I wasn't still a pain person. i was I was someone who had experienced acute pain, even though up to there I was 9 out of 10. And unfortunately, through yeah daily activity, I re-herniated the issue and it was actually a more profound effect.
00:24:45
Speaker
issue the second time around and I needed to have quite rapid emergency um removal of a bit of disc that had actually blebbed off and had gone very lateral into the the lateral nerve root that was had actually meant that I had no motor function in my right leg.
00:25:04
Speaker
But again, surgery was for me was the thing that was successful, that bit of disc that had actually broken away. was removed, I regained function.
00:25:16
Speaker
And today, a um ah don't have any pain issues. I'm mobile. um I can't, I'm still in the recovery phase. i'm I'm not running yet. i hope to be running again soon.
00:25:30
Speaker
But, you know, I've just come back from a week in Boston, traveled, walked, um Walk the halls, doing the science thing, doing well. But I think it's taken me probably the last four months, I'm comfortable saying i i have lived experience with chronic pain.
00:25:50
Speaker
And I feel now I have a voice that I can authentically project into this space. It sounds bizarre, right? Because i hiim I qualify as chronic pain, but I don't feel like I've got enough of the stripes of pain experience on me yet to truly speak for people who are living long, long, long, much longer than me with pain. So, yeah, it's it's been a hell of a journey. Yeah.
00:26:19
Speaker
Yeah, the family put up with me and helped me through it. Yeah, that's it's an awesome story to hear those stories of recovery because you yeah obviously, as a clinician, you see you know how devastating it can be when it when it doesn't go that way.
00:26:35
Speaker
So yeah, it's it's really cool to to hear that. i I actually really want to read a part of you at one of your articles that you wrote because I think the words are really awesome. So I'm going to do that if you don't mind. Go for it.
00:26:47
Speaker
But this is this is you ah reflecting on this. you said You say, yesterday something extraordinary happened. After nearly 15 months marked by the persistent companion of back pain, I realised with a jolt that the familiar ache, the constant throb, the sharp stabs, they were gone.
00:27:07
Speaker
It wasn't a gradual fading or a momentary lull. It was a profound absence, a silence where there had been a relentless cacophony. This realisation washed over me with, unexpectedly, ah breath of fresh air after what felt like an eternity spent underwater.
00:27:25
Speaker
The initial feeling was one of disbelief, a hesitant questioning of whether this was real or just a fleeting reprieve. But as the hours passed and the pain did not return, ah sense of lightness began to settle in, a profound relief that permeated my entire being.
00:27:42
Speaker
This wasn't just the absence of a physical sensation. It was the lifting of a weight I hadn't fully comprehended until it was gone. that Those words, you you're you're a bit of a wordsmith, Mark, I must say.
00:27:55
Speaker
But, you know, reading that, it's it captures a lot. And I think listeners will be able to sort of, yeah, understand where you're coming from. And I do think that you can speak into this and you you can speak in into this space with a,
00:28:11
Speaker
not just from an academic point of view, but also with some some messages of hope. Now, obviously, surgery is not always the right option for every single person, but I'm i' stoked that you had the outcome that you did.
00:28:25
Speaker
Can you tell us a little bit about more about,
00:28:31
Speaker
yeah, you said it was the lifting of a weight I hadn't fully comprehended until it was gone. Can you tell us, like, Were there some dark moments through that journey?
00:28:43
Speaker
Oh, listen, that the the thing that I did not i did not understand... So I've been researching pain for the last 20 years, right? So I i know the molecular signaling. I know the pathways. I can draw it out. I can see that.
Cognitive and Systemic Challenges of Chronic Pain
00:28:59
Speaker
But the cognitive burden... that is created by both the presence, the memory, and the future anticipation of that signal is this extraordinary burden to one's consciousness.
00:29:21
Speaker
And so i i didn't realize how exhausting that was. And when I was living it, I was continually trying to still do the things that I wanted to do Whilst my consciousness is a is not an elastic, unlimited thing, more of my consciousness than I had realized was being filled by this burden of anticipatory and experience peace.
00:29:54
Speaker
And that meant that my operational memory, my RAM of actual life was drastically reduced, which absolutely did um hit a um the ability to enjoy things, the ability to to do things that I wanted to do.
00:30:11
Speaker
and and still, I mean, even though I'm not actually experiencing pain today, there is part of me that is waiting for that potential pain to return, which is not stopping me. So my, my protector meter is, is present. It is, it is active.
00:30:32
Speaker
And at the moment i'm I'm still regaining the, the core strength, the, the, the actual supporting musculoskeletal strength to ensure that everything stays good. But the protector meter is, is active.
00:30:45
Speaker
as it should be in all of us, right? But mine's still slightly tuned off. So I've got a way to go, but I guess the part that I do see here is that
00:30:58
Speaker
I now know as a pain researcher that it's not all about the ones and twos and threes and four out of ten in that single dimension of ouch hurt because there's this other stuff that we need to figure out.
00:31:16
Speaker
And it's fascinating now talking to my research colleagues I think we're at a point where in the next few years, with all the drugs coming through, we may have some of the ouch part of pain sorted out, but...
00:31:36
Speaker
the everything else, the every when of pain of the other parts, we've got a hell of a lot of work to do to then unpick that soon to really help people activate their full potential back in pain-reduced or pain-managed state.
00:31:55
Speaker
Yeah. Yeah. No, thanks for sharing. I want to, because your research is has been down to the sort of cellular level and what's going on there.
00:32:09
Speaker
and I don't know how to do this, whether we, because you're a rare breed, I think, in that you can connect that to what's going on on sort of a, on a macro level. And even as clinicians, how we, how we see the world and how we try to try to work with what the research is telling us.
00:32:26
Speaker
But where do you want to start talking about pain? Should we start at the, we're at a thousand feet flying over the forest or should we be, ah do you want to peel off a bit of bark and look it under it under the magnifying glass?
00:32:40
Speaker
Well, i think I think it's handy. We can do it at both because I think that the part that's fascinating about this pain experience is that if we get too into the weeds and we forget that the weeds are connected to the forest, then we'll always know we've got weeds.
00:32:56
Speaker
And I think the part that, you know, the massive challenge we've got in the pain space is that some of us,
00:33:07
Speaker
who do brilliant work in the biosphere, they just look at the molecules and cells. And if they look at molecules, they look at a handful and they look at a couple of cell types.
00:33:19
Speaker
But those molecules and cells are connected to these multicellular systems. And some of those multicellular systems then have multi-organ systems connected together.
00:33:29
Speaker
And oh, by the way, the head's connected to the body and we actually need to know how these two things come together. So, um mate, I'm happy to to wax lyrical, to explore the billions of pathways that we have to pain, whichever which way.
00:33:46
Speaker
Well, why don't we start from the cellular level and then you just work your way up and connect it to the ah thousand feet flying over the forest. So I guess some of the stuff that I'm most excited about most recently is some work that Ted Price has done from UT Dallas. And so this is where he has been looking at a cellular level at just this particular anatomical thing called the dorsal root ganglia.
00:34:17
Speaker
So just to to orient everybody and remind people, the dorsal root ganglia is this cell body that if there is a cell within your body that goes from your big toe and then goes up to the base of your brain, all of the genetic information and all of the bits and pieces that's the machinery of that cell sits within the dorsal root ganglia with a bunch of other of its friends.
00:34:40
Speaker
meaning that if you measure what's in the dorsal root ganglia, you can tell what proteins and signaling capacity are in your big toe and what's up in your brain. And so Ted's been really clever and he's looked at these dorsal root ganglia and there's a bunch of other cell types in and around this. you've got...
00:35:00
Speaker
sensory nerves, you've got these other support cells and a few of these immune cell types. And what Ted's done is he's taken just the cell bodies of the nerves and just the cell bodies of the immunology and he's asked, what genes are you regulating that has signaling capacity there?
00:35:21
Speaker
And so what he's then done is he's taken those two different populations and said, Do you immune cells have the things that you release to talk to neurons? And do you neurons have the ability to detect those things?
00:35:35
Speaker
And what this means is he's created this interactome of cellular talking just between two cell types. And what he's found is that there are set number of signaling pairs between immune cells talking to nerves and nerves talking to immune cells. And where I get excited is that the immune cells have more to say to nerves than nerves have to say to immune cells, which is super cool.
00:36:02
Speaker
But then mathematically, if you just look at that single pair, there are about 2 to the power of 80, so 2 to the power of 80 potential molecular pathways that are necessary and sufficient to create pain.
00:36:19
Speaker
Now, that might go, oh, 2 to the power of 80, that sounds like a decent number. Well, 2 to the power of 80 is more stars than there are in the entire universe.
00:36:30
Speaker
Right. So what that means is there are more molecular pathways to pain than there are stars in the universe, not the galaxy, our universe.
00:36:43
Speaker
That means just at that one little anatomical location, we have such complexity that we've never appreciated before. And it's 2025.
00:36:54
Speaker
And Ted made this discovery a couple of years ago. Now, that doesn't take into account male-female differences. It doesn't take into account the type of pain that's experienced. It doesn't take into account, did I eat good breakfast or bad breakfast this morning? Did I sleep or not?
00:37:10
Speaker
Is someone yelling at me? All of that complexity is there. So, We are at the infancy. we we are We are so simplistic in our view of what pain actually is at the moment.
00:37:27
Speaker
And that goes that story there just goes from single cells into complex systems to something that is more complex than the stars in our universe, just to explain simple pain.
00:37:42
Speaker
So i'm I'm always fascinated by how little we know but also have hope because if we had all the answers now, well, that's too bad, right? Yeah.
00:37:54
Speaker
If we had all the answers now, then we've just gone and got to deal with it, right? That's it. That's it. Yeah. Okay. So you talked about the DRG. What about the complex systems, like how they interact from more of a systems perspective? Yeah.
00:38:12
Speaker
so So where we're at right now, i guess, taking going building up from the DRG then is currently we now – have a theory of what acute pain transition to chronic
Transition from Acute to Chronic Pain
00:38:25
Speaker
pain looks like. So fundamentally, acute pain, even though we don't like it, actually serves a protective purpose for us.
00:38:34
Speaker
So if if we can understand and appreciate the acute pain and and and learn from it, albeit appropriately, we're going to do better.
00:38:46
Speaker
The transition to chronic pain is where there's no there's no adaptive process. It's completely maladaptive. we don't We don't want, we don't need chronic pain. Now, there are a series of things that are quite clearly happening in that transition from acute to chronic pain.
00:39:02
Speaker
And it's multiple cellular systems going bad. So we've got neuronal systems are saying, something's not right here, I'm going to start releasing some factors.
00:39:13
Speaker
Those factors are going to cause the immune cells that are adjacent to those disturbed, upset neuronal system to start recognizing that there's danger around.
00:39:25
Speaker
Now, what's crazy is those immune cells, they're not operating off just a baseline set point, right? they've They've been influenced by yesterday's dinner. They've been influenced by how much sleep you've had. They've been influenced by whether you've yeah got reactive oxygen species up the wazoo.
00:39:40
Speaker
So, All of that is then hitting this immunology. Now, that immunology can either go right, I'm going to settle you down and clean this up and there's been some damage, there's been some issue, going to convert that into a cleaned up scar tissue that should be there because we need to make it happen that way.
00:40:00
Speaker
or unfortunately, as we transition to chronic pain, those signals start saying, well, I'd like to stay reactive a little bit longer, please. I'm not sure why, but it feels good for me as an immune cell to remain active and surveillance.
00:40:14
Speaker
And that simple step for a few cells, and it's only a few, can then cause a memory of that long-term presence of a primed state so that when something else happens in oculus, these silly immune cells that shouldn't have remained reactive do,
00:40:36
Speaker
remain reactive and they then turn on in a greater sense in a pro-inflammatory driving manner. Now there's a series of different things that are occurring in those immune cells to do that. Sometimes it's the wrong processing of phagocytic eating up of processes around them.
00:40:53
Speaker
Sometimes it's an over-inflammatory signal but nevertheless if all of that's happening in and around centers that are sensory then those immune cells are turning on. Now We thought 10 years ago that this was all about phagocytic cells that happened if it was in the central nervous system to be microglia.
00:41:14
Speaker
And those microglia were really important for driving this neuroimmune signaling. In, say, in the last five years, we've added T-cells to that story. And so there's a nice T-cell to microglia to neuronal story that's come together.
00:41:29
Speaker
We've now also got peripheral macrophages coming in and talking in the central nervous system that we didn't appreciate was there. And so then the most recent player on the on the block is the B cell.
00:41:42
Speaker
So we've now got the entire suite of immunology coming to play to now be involved in what should have been 20 years ago pain was a game for neuroscientists and immunologists with just this peripheral inflammation job.
00:41:57
Speaker
This is now a true neuroimmune complex immunology play where the evidence now is very, very good that There is an autoimmune B-cell signature that is releasing antibodies, and those antibodies seem to be necessary and sufficient to create exaggerated pain states across a variety of different pain states in both animal models and humans.
00:42:24
Speaker
To the extent, and these studies are well validated now from the fibromyalgia domain, you only need to take serum from an individual with fibromyalgia and take the antibodies from that serum and put that into a rodent and those mice will start to behave with pain behaviors just like fibromyalgia.
00:42:45
Speaker
Now, that's like mind-blowing. from 20 years ago when pain was a disease of the central nervous system. And so we're really sort of still unpacking this complex multicellular nanoscale to macroscale, cells and molecules to systems response, all happening as we're living and breathing and walking around a complex environment.
00:43:11
Speaker
Yeah. Yeah. ah it's it's for It's definitely complex. it You must giggle at some of the stuff that goes around social media when you know the the complexities of it all.
00:43:23
Speaker
Yeah, like I love my current affairs shows, but honestly, if someone comes on and says, spend $29 a month for this one thing and it's going to fix all of your problems, I'm like, oh, come on, team.
00:43:38
Speaker
It might fix it for you. i mean, I believe your story, the one person, but don't try and generalise this to the entire Australian population.
00:43:49
Speaker
Totally. i mean There are more pathways to pain than all of the stars in the universe. So let's find that universe where that one today-tonight program is relevant and let's use it there. And then I get going back to where we started.
00:44:06
Speaker
We need to evolve our interventions from empirical guesswork to precision personalised medicine. And the only way I think we can do that is if we start developing measurement-enabled understanding of our pain conditions collectively,
00:44:22
Speaker
that then allows us to select precision personalized interventions that aren't single magic bullets you know it's not going to be one drug it's not going to be one surgical technique who knew we're going to have to eat well we're going to have to sleep well we're going to need to live life well and here are a range of prescribed defined interventions that will help for your state today yeah no that'll be amazing I think that's where I want to go is to more, okay, now we've sort of unpacked the complexities of of pain, which is something that, you know, a lot of people that have chronic pain have sort of come to terms with because they keep going to specialists and they they're scratching their heads going, I don't know what to do here.
The Role of Sleep and Simple Interventions in Pain Management
00:45:09
Speaker
So a lot of people, they sort of they sort of get it, the complexities, but they also, i think sometimes as a clinician, if I'm putting my clinician hat on, we let them sort of drown in that complexity and don't give them any like simple, actionable tasks of like, okay, this is how I think you can help yourself or be helped.
00:45:30
Speaker
what ah What do you think are the real practical things that based on your study, zooming, you know, way back out to, okay, what's what's the person listening going to do?
00:45:44
Speaker
Yeah, so I think this is where the pain education piece becomes really important. So we all know that we should sleep well. right We should get our scheduled sleep. But let's unpack that. Why is that beneficial for someone in pain?
00:46:01
Speaker
So all of those systems and signaling processes that I've spoken to are occurring within the central nervous system within a really, really tightly regulated, controlled anatomical compartments of the brain and spinal cord.
00:46:16
Speaker
Now, when we sleep and we sleep well, we have the literally the trash compactors go around our central nervous system and flush all the crap out of our central nervous system from the day before.
00:46:29
Speaker
Now, if we don't sleep well, all of that gradually builds up. And as it happens, all of the immunology that I've told you is contributing to the pain becomes most reactive at nighttime.
00:46:42
Speaker
So if you're not sleeping well and you're not giving your body enough chance to sleep well, which it's really hard to sleep well when you've got pain as well, right? But we're not necessarily doing the sleep hygiene things right.
00:46:54
Speaker
then all of those factors that we know are creating exaggerated painful experiences at the cellular level or inran increased danger signals at the level of the cellular are going to accumulate.
00:47:09
Speaker
So simply by saying get more sleep, actually I think if we explain to people and break that down to your sleep You have greater, it's called glymphatic drainage.
00:47:21
Speaker
You have greater glymphatic drainage. Your autophagy trash compactors of your central nervous system works better. Your central nervous system trash compactors are working better. You're cleaning up the the stuff about the signaling that was all driving the propane signal.
00:47:36
Speaker
All of that collectively is then going to help your pain state. Now, Then my my RAM of life with pain and without, all of that I've just spoken about is what's happening in my sensory components of my central nervous system.
00:47:52
Speaker
The same is happening in my higher brain life processing components of my central nervous system as well, meaning that all of that burden of my day of worrying if I'm going to have had pain or not is also getting cleared out and reset for the next day.
00:48:09
Speaker
So suddenly that sensory to life enjoyment component just on a sleep experience suddenly becomes molecularly driven connecting nanoscale to systems level.
00:48:23
Speaker
and And so I think just just unpacking that pain experience for sleep and and truly this is not ambiguous. This is well-validated evidence now coming through that that's quite profound.
00:48:37
Speaker
Yeah. I had to take this opportunity to introduce you to Pain Coach, a lifestyle tracker that helps you take the guesswork out of pain relief. Sleep is one of the five factors we track to see how it relates to your pain.
00:48:52
Speaker
We are rolling Pain Coach out with select clinicians across Australia. Whether you are a clinician or a patient, we'd love to work with you. Please register your interest by joining the waitlist at paincoach.online.
00:49:06
Speaker
Link in the description. Now, back to the show. Reducing the drinking levels. Same discussion about, you know living life better there. The one I still can't quite get my head around is I'm terrible at activating my transverse abdominis.
00:49:21
Speaker
And i I just, no matter what I can do there, I can't strengthen that yet. So if if we can work out for Mark's precision personalised intervention, if I can get these stupid little cores going a bit better for me, please, someone...
00:49:35
Speaker
but I'm here to tell you, Mark, it might not even matter. ah but But let's not go there. But yeah, I see what you're saying. and it's, you know, the education piece is great because ah it's it's a motivation of like, okay, well, why?
00:49:52
Speaker
Why should I sleep? And why should I eat better? and And, you all those lifestyle factors that are so important. And we've seen that they're important from like those behaviors There's more clinical studies that look at, okay, how does that affect pain?
00:50:10
Speaker
Yeah, its it's it's really cool cool to see. I heard, I think I saw something about you doing a study on Wim Hof for endometriosis.
Potential of the Wim Hof Method for Endometriosis
00:50:23
Speaker
Tell me a little bit about – has that been released yet? I couldn't find it being released. Yes, we're still doing the trial right now. Okay. So this is a trial that is sponsored by the Philanthropic Foundation, the the Wilson Foundation.
00:50:37
Speaker
Okay. with We're looking at trying to understand how cold water exposure, mindfulness and breath exercise contributes changing the complex pain state that is experienced during endometriosis.
00:50:59
Speaker
It's funny, my my own practice of breath and mindfulness comes from around the COVID time. So in 2019, when it became clear that COVID was kicking in I ah was working with US Air Force special operators and a few others and and and we were looking at you know, what was the current evidence that we could control our illness response to sickness?
00:51:28
Speaker
And there's a wealth of literature that shows that autonomic nervous system control a key element. variable that changes how we feel in sick in sickness when we get exposed to a bug.
00:51:45
Speaker
And that bug could be a virus or a bacteria or even some forms of of damage to our physiology. and And the the early data that came through, which is yeah over a decade old now, has shown that When an individual, an everyday human being is trained to have mindfulness and mindfulness practice With the breath control exercises and exposure to cold, each of those culminates in the ability to have some, and we'll call it voluntary, control of the autonomic nervous system.
00:52:25
Speaker
And at a molecular level, what that means is that if you have control of the the of the autonomic nervous system, when you get exposed to a bug, the bug...
00:52:39
Speaker
doesn't make your immune system go strongly, right, whatever that means in immune land, but massively pro-inflammatory. What it does is it creates a balanced immune response, which both identifies the presence of the bug, but also then clears it really quickly rather than just saying, oh, I'm going to go really angry.
00:52:58
Speaker
So if you think then about an endometriosis experience, at a cellular level, what's happening from what we believe is happening is that when the immune system sees the presence of damaged endometrial tissue and the lesions, there's this persistent signal of bug-like response, which happens to be endometrial tissue, driving a persistence of inflammatory response, which drives a maladaptive systems-level change of pain, um cognitive impairment,
00:53:33
Speaker
feeling crap. i mean, that's as complex as it goes. You feel terrible. The theory is then if we can train these women who ah to have the experience of mindfulness, to have the cold water exposure, which again has a controllability factor as well as an anti-inflammatory effect,
00:53:53
Speaker
And the fascinating thing is the breath hold is is creating both a controllability from a I can do this, but it's also activating all those hypoxic inducible scavenging factors as well, which is anti-inflammatory.
00:54:07
Speaker
The triple hit of that resets that immunology to say, oh, I can remember how to turn off. Thanks very much, body. And the theory is to be tested, to be determined.
00:54:20
Speaker
We've got the people actively in the trial at the moment. Does that change Two things. One, does it change the disease progression of the endometriosis itself?
00:54:32
Speaker
We don't know. Does it change the pain experience, the threat level, the protectometer level, to then change their experience of their physiology to that presence of the endo?
00:54:45
Speaker
Yeah, wow. Jury's out. Data's out. that That's why we're running the trial, seeing if we can get some fantastic people volunteering for that trial. to We're still recruiting. We're running it just in Adelaide.
00:54:55
Speaker
um Loads of opportunities there. If people want to be a part of it, how do they how do they sign up ah The trial is called EndoChill, as in E-N-D-O-Chill.
00:55:08
Speaker
and And you can search for that at the University of Adelaide website um or flick me an email and I'll put you in touch with the recruitment team. And, yeah, anybody with endometriosis in the South Australian area, let us know.
00:55:21
Speaker
Yeah. Awesome. that's that's That's really cool work. And I just – I love – that stuff because it's really practical, right? You know, it's something that, you know, if it works and if it pays off, you'll see everyone in, I don't know what they you call them down there, but we have like rigs and those kinds of things up here, which are, know, that hot and hotton cold therapy, which feels amazing.
00:55:43
Speaker
I think there's merit to it. and And, you know, i come at it from the molecular side. So what is it about the the coldness that's actually – what physiological systems are we actually activating there, right? So you go into the cold.
00:55:58
Speaker
You have a vasoconstriction response. So you have your system is recognizing, one, that it's cold. And, oh, by the way, I better pull that blood back from the perpheral but of peripheral circulation.
00:56:11
Speaker
That is an activation, just like you're doing your sets and reps for muscle development. You're activating cellular systems to then can so control physiological responses.
00:56:22
Speaker
Now, the first time you get in cold, you want to get the hell out of there, right? this this is the This is an unpleasant experience. Yeah. But that unpleasant experience is an integration up here of controllability.
00:56:34
Speaker
but um What happens if my leg's falling off? what What happens if i I can't get out of here? What if I'm going to die because I'm in this cold? Now, those are irrational thoughts, right? Because you're in there in entirely controlled environment.
00:56:46
Speaker
yeah And this is where the the convergence of the worlds that I've worked in with Steve Mayer, who was at the beginning of the field of depression with identifying learned helplessness and now learned optimism, and my world of Linda Watkins coming together on neuroimmune. So I see...
00:57:04
Speaker
cold water exposure, not only being anti-inflammatory because of these reduction in reactive oxygen species and coldness factors, but the controllability signal that is given to your higher cognitive processes that says, I just did that and I was okay.
00:57:23
Speaker
That is a profound signal to the rest of your body to go, you got this. That's okay. So that then, you know, to me, my RAM full of, oh, what happens if, but what maybes of pain,
00:57:38
Speaker
that's got its own little cycle of, well, don't worry, you were able to do cold water, completely different, not the same, but it was okay. So this this amount of RAM, maybe you can just go down to here.
00:57:50
Speaker
And that's not Mark tricking himself in it. These are actual medial prefrontal cortical exercises that's part of my brain regaining control of processes that otherwise diminish.
00:58:05
Speaker
And I think we we need to give we need to give our brains credit for the fact that they are amazingly complex, but also amazingly simple at the end of the day, because they're only cells and systems trying to work in a complex system together.
00:58:22
Speaker
a Yeah, no, it's cool stuff. It's really, really cool. Tell tell me around the mind-body interactions in pain. How does that all work? And how can our thoughts, feelings, memories influence pain?
00:58:37
Speaker
Yeah, so I guess if if we take this example of you know my RAM full of a certain amount of memory of what the pain was, i'm my threat levels of willingness to persist with a little niggle of pain is going to, I've got a danger signal coming in, i'm going to amplify that.
00:58:57
Speaker
And so that then means that when my stress levels, whatever that means, are then activated by the current flare-up of my own pain, my autonomic nervous system goes inappropriately into a stressful response.
00:59:13
Speaker
Now, if that stressful response kicks off, you know, I'm not going to eat well, I'm not going to sleep well. And so a simple molecular signal just activated 20 different endocrine systems that fill up three quarters of the medical school textbook, right, from a single molecular signal.
00:59:32
Speaker
So when we go and say mind-body connectivity, we we really do need to sort of break that classic Descartes principle of my brain's my brain, and if I take my brain out, it'll work the same way.
00:59:47
Speaker
Well, no, because it's connected to the body. And, yeah you know, you don't – If you isolate a heart from a body, it'll keep beating, right?
00:59:58
Speaker
but But that heart, when it's back in the body, if it's sitting in front of the movie, it's going to change dependent upon the romance, the action, whatever it is on the TV, on the on the screen at the movie, because the mind and the body are connected.
01:00:11
Speaker
And and we we've sort of lost that realisation in our modern Western lives that how we're thinking, it's not some wishful approach that how we think is is somehow connected to our physiology.
01:00:27
Speaker
Actually, there are intended systems that are connected from our brain via our visceral organs to our our sensory organs that are actually in dynamic equilibrium.
01:00:42
Speaker
And that's just the neuronal systems, let alone the circulating factors that are going around. And it is far more complicated than we really truly acknowledge.
01:00:56
Speaker
But the beauty about it being complicated is it's also quite simple. And it can be quite simple. So, for example, going back to the sleep thing. If there's just noise on um in a system, the simplest way to create a consistency within that noise is to implement large signals rhythmic rhythmically during that day.
01:01:21
Speaker
Now, what are the things that we can do rhythmically that have massive impacts on our own biology? when we get up in the morning and when we go to bed at night. Huge shifts, we're changing our conscious state from being awake and asleep.
01:01:37
Speaker
Okay, so consistent bedtimes, consistent night times, bedtimes, night times, light stimulus. from outside and inside. Now that's not, I'm not so much on, you know decreasing total number of photons from screens at night, blah, blah. I'm talking about actual out there full body exposure to the photons from the sun. Let's get that daylight in.
01:02:00
Speaker
So we've then got our body knows, okay, this is daytime and this nighttime. It also probably then means that when we start looking at when we eat, actually grazing throughout the day may not be, for so for certain reintroduction of rhythmicity, may not actually be much of a signal or sufficient a signal for our bodies to actually know okay, this is when I should be doing things of processing food. So yeah decent meals rhythmically through the day with periods of no nutrition. Like fast breakfast fast breakfast is actually breaking the fast, right? You should probably not have nutrition during the night phase.
01:02:44
Speaker
So those are simple things which, again, from a systems biology perspective, allows us to do the things we should always be doing anyway. But from a physiological perspective, from mind-body connection, if you've lost that control, especially in chronic pain, where the systems aren't in sync, there is this noise in the system, there is I think, some good reasons why we should be adding these things back into the day to be rhythmic because then all of that conscious energy
01:03:19
Speaker
control ability of I know when I'm eating, I know when I'm sleeping, I know when I'm getting light and when I'm not, all of those, for me, I'm seeing that allowing me to decrease the RAM that's being occupied by the every when of pain.
01:03:36
Speaker
Mm-hmm. Yeah, it's cool stuff. You know, the placebo studies in are you know show the same thing in terms of like, it's not just when you think that you're getting a certain intervention that, you know, it's just all in your mind and you're making it up and, you know, it's something just in your mind. It actually changes your physiology and they've looked at that in terms of like, you know, your endogenous opioid systems and the rising levels. So basically, you know, if you think,
01:04:07
Speaker
If you think something different, your physiology changes. And if your physiology changes, you might think something different. They're so intertwined that I think we need to, ah yeah, you maybe maybe there'll be a day where we don't actually really need to talk about mind-body. We'll just know that they're just one.
01:04:25
Speaker
but And um so this is, so in Eastern practice, this concept of mind body is this, what what is this? I mean, of course they're connected, right? that this is This is stupid that we're we're treating it independently. i think the thing about placebo, I'm glad you raised it.
Psychological Influences on Pain Perception
01:04:40
Speaker
Everybody knows about Pavlov's dog, right? The dog was pared paired, the bell ring with the presentation of food. And then when they just just rang the bell, the dog salivated.
01:04:53
Speaker
Now, wait Nobody's saying it was all in the dog's mind. No, the dog was anticipating. It was conditioned to expect this is what it gets, right? yeah Placebo is exactly that same process.
01:05:08
Speaker
We've just called it something else because it then has i a placebo effect, an absence of the the the pharmacological or the other intervention effect.
01:05:21
Speaker
The placebo was the bell. The bell led to the presentation of the salivation. And so I think, again, this is this rhythmicity. If we pair daylight with a nice experience and we just have daylight, oh, we'll experience the nice experience, not because we've made it up, but we've expected to have that response.
01:05:44
Speaker
We've had a placebo effect, a conditioned effect. Yeah. and yeah So you know when we when we do our exercises, and I trick myself all the time, right, I reward myself for doing the exercises that I know I don't like, right, because – I'm rewarding myself appropriately with something that then when I do my exercises and I don't have my reward, I'm still getting the conditioned response of, oh, this was actually okay, right?
01:06:11
Speaker
I've literally done the the little kid in the candy store trick, right? Yes, you get your yeah lolly after you've done your homework stuff. Great. Do it that way. That's how our brain works. That's, you atomic habits kind of approach.
01:06:25
Speaker
Yeah. Yeah, no, cool, cool. I could, you know, we could speak for hours and hours and hours on end. I could. I don't know. You wouldn't have the time.
01:06:35
Speaker
you know, I would probably run out of time too. But, you know, i'm I love the the conversation and and where it's going. But what I would love to to sort of finish on is just a bit of a practical message for someone listening that is, yeah, feeling a bit,
01:06:53
Speaker
helpless, down in the dumps, they don't really know what to do because they're struggling with pain.
Global Research and Emerging Treatments
01:06:58
Speaker
What what be some what would be a practical takeaway? and then how can you provide them with a bit of hope for the future?
01:07:06
Speaker
I guess let me start with the hope.
01:07:10
Speaker
There are hundreds of thousands of brilliant minds around the work, around the world, literally working through the night, coming up with new ways to, one, recognize the pain state,
01:07:28
Speaker
diagnose the pain state and intervene. And of any point in human history, literally since 5,000 years since we discovered opioids, morphine, for the management of pain, our oldest drug that we still use today, the first pharmacology,
01:07:48
Speaker
We have today, within the next five years, the greatest number of new pharmacological therapies coming onto the market ever before.
01:08:00
Speaker
Now, that's still within the next five years, but just as a it is changing, our worldview of pain, our humanity's view of pain is changing so much faster than we have ever had happen.
01:08:15
Speaker
And I hold that as hope because if we didn't have that massive intellectual activity, we wouldn't have these solutions. Yeah. the beyond just hope, and it's not luck, it's actual intentional hope.
01:08:32
Speaker
We're doing things intentionally here. i think we can approach this and and what I have done in my management of my own pain, I've tried to approach it intentionally.
01:08:45
Speaker
And that sucks because it's admiring much of the problem, but it also is hopeful because then i actually know that I'm having a better day than just,
01:08:57
Speaker
experiencing the pain and that just the glimmers of hope of, like actually, this
Mindful Approaches to Pain Management
01:09:04
Speaker
and and hence you know what you read out, I realized that the pain wasn't there.
01:09:10
Speaker
Otherwise, i could have been stuck in the anticipation of until the pain comes again. and And I think just as a simple example, mind exercise of am i feeling the same pain that I felt yesterday and what did I do that may be changing that, that is a molecular neurosurgery that's changing through education our brains processing of that current pain experience.
01:09:42
Speaker
And that's not to focus entirely your whole being on it, right, but rather to understand it to then acknowledge it. And then i have conceptualized that right now.
01:09:54
Speaker
i now know I can put that back into an ever-diminishing portion of RAM that's off to the side. And I think that's probably for me without, you know, saying, you know, go for a walk and do sleep and all that sort of stuff.
01:10:08
Speaker
These are things that between the two ears, we can start understanding and educating ourselves on today is a new day. going to try to do what I should be doing because it's good.
01:10:24
Speaker
And going to acknowledge that the protectometer is there to protect me, but I need to then help train that protectometer to not overprotect my system because my physiology is going to get there.
01:10:39
Speaker
Yeah, yeah. What would be one practical way that you would train? Would it be mindfulness? If you had to give like, i know you said, I don't want to give sleep, you know, but I think sometimes people like those really practical things.
01:10:52
Speaker
so would you say So practically, the the simplest thing that we can do that is independent of sleep, right? Because sleep finding sleep when you're trying to find it is hard, is to get light.
01:11:09
Speaker
find light at defined times of the day and find darkness at defined times of the day and you can be in pain and you can quite happily happily find darkness yeah you can be in pain and you can quite happily find the light and i would say that is the simplest thing that we could start doing better to just give that first signature of rhythm back to our physiology.
01:11:42
Speaker
Now, sneakily, to do the light, you're probably going to go outside. And if you go on outside, you might have had to walk. Oh, no, I've just done it, right?
01:11:53
Speaker
But that's that's the piece. So yeah that that's ah that's the trick. If you can enter that rhythmicity, boom, um yeah and then that's go from there. And that's because of all you explained around what sleep does for someone in pain. That makes perfect sense.
Conclusion: Appreciating Mark's Insights
01:12:10
Speaker
Something that's super practical in their control, go out and see the sunlight when you wake up and during the day and the opposite at night.
01:12:21
Speaker
Yeah, that's really cool. Awesome. Thank you so much, Mark. you awesome have ah have a really good way of explaining very complex things, but in in ways that are easy to grasp and um practical as well. So I really appreciate it. Thanks for your time.
01:12:37
Speaker
Good on you, mate. Appreciate it. All best. If you enjoyed this conversation, can you please leave a review? This would help us reach more people suffering with pain with messages of hope.