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Speaker 1: Doctor Joshua Piet, Welcome to the podcast.

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Speaker 2: Thanks for having me. Paul.

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Speaker 1: Yes, now, as we just discussed, if you grew up

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Speaker 1: in Belfast, you would just be called pat yet.

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Speaker 2: Yeah, no, that's fine. It's reminiscent of my high school years.

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Speaker 1: So pat and that would just be it, you'd be Patie.

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Speaker 1: But clearly doctor Joshua Pitt, Now you are a physiotherapist

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Speaker 1: with a special interest in pain and Pean education. So

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Speaker 1: how did you get into what was your what's your PhD?

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Speaker 2: In as in how kids think about pain and kind

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Speaker 2: of trying to get the simplest language we can about

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Speaker 2: this stuff because I like, clinically we saw patients getting

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Speaker 2: better with learning about the neuroscience and it was kind

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Speaker 2: of like, oh, surely people don't have to become a

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Speaker 2: neuroscientist get better, and like, just engaging with these active

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Speaker 2: strategies for a long time, having a bit of a

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Speaker 2: scientific foundation seem to help people. And so then the

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Speaker 2: goal with my PhD was like, how can we work

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Speaker 2: out how to simplify that as much as we can?

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Speaker 2: And I worked in the children's hospital and so we

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Speaker 2: kind of joined all those different dots together. But yeah,

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Speaker 2: more or less. I guess we even took a step

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Speaker 2: back from going, well, what should we say to the

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Speaker 2: kids and started thinking about how do we assess and

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Speaker 2: where's the starting point and so doing things like we've

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Speaker 2: got kids to draw whatever they think of when they

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Speaker 2: hear the word pain. Actually, what would you draw if

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Speaker 2: you had to do that task? Can to hear?

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Speaker 1: Its interesting? What would I draw? I would probably draw

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Speaker 1: something throbbing, rare, inflammation, all that stuff as probably what

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Speaker 1: I would draw. Yeah, I do this.

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Speaker 2: With my university, like the Masters of physio students, and

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Speaker 2: they often draw things like abstract things like a squiggly

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Speaker 2: line or like a mess or fire or whereas kids

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Speaker 2: under the age of twelve they're not thinking abstractly at all,

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Speaker 2: Like the brain hasn't developed that yet, and so it's

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Speaker 2: all very concrete. It's just like a broken bone, a

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Speaker 2: sad And if they've had chronic pain, they often draw

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Speaker 2: like emotional things like sad faces, right, broken hearts, that

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Speaker 2: kind of stuff, whereas if they haven't had chronic pain,

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Speaker 2: normally it's just an injury. And I guess if we're

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Speaker 2: growing up in a culture where pain is just associated

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Speaker 2: with injuries, it's quite hard to be empathetic if it's invisible,

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Speaker 2: right like, And so a lot of my research has

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Speaker 2: kind of been in that space, is like, can we

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Speaker 2: nip things in the bud and help people really early

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Speaker 2: on in society, like at a generational level, because potentially

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Speaker 2: that could stop some of at least the stigma but

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Speaker 2: potentially even some of the disability associated that happens with

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Speaker 2: pain because people go, well, it's if I'm damaged, then

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Speaker 2: I better rest and if I rest more then maybe

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Speaker 2: I'll get even better. And so then they stop engaging

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Speaker 2: in meaningful activities and that actually worsens pain. Bit yeah,

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Speaker 2: this complex web, right, yeah.

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Speaker 1: Yeah, absolutely, Now this complex web clearly involves the nervous

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Speaker 1: system and the brain. I saw a guy and a

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Speaker 1: really a neuroscientist on TED must be ten fifteen years ago,

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Speaker 1: Ramachandrin or something like that, talking about phantom limpain and

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Speaker 1: the use of mirror boxes. I think that's a really

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Speaker 1: good starting point and to dive into the whole science

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Speaker 1: of pain. Give it, give our listeners a view of

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Speaker 1: because you've done a great ted X video on phantom

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Speaker 1: limpiin so give us you know what is phantom limpain?

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Speaker 1: What do we know about it and heart of mirror

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Speaker 1: boxes actually help people.

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Speaker 2: Yeah, I think there's still a fair bit of mystery

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Speaker 2: around the full understanding, but I guess one way that

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Speaker 2: this has been explained is to think about your brain

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Speaker 2: having a map. It's called yourmunculus, and the map kind

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Speaker 2: of correlates with different parts of your body, and so yeah,

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Speaker 2: basically if part of the map is lighting up, then

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Speaker 2: you would feel pain, Like I guess if we kind

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Speaker 2: of have a little simple model like that, and so

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Speaker 2: then if someone has an amputation, they might feel pain

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Speaker 2: in the hand that's missing. Like I can think of

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Speaker 2: patients who have said, oh, it's like my hands still

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Speaker 2: on the Harley Davidson handlebars, but I don't have an arm,

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Speaker 2: and they can say, like I can tell my pinky

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Speaker 2: is all curled up, but there's no arm there, and

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Speaker 2: it's like, well, how does that, like, how can that

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Speaker 2: happen if there is no arm? And so yeah, remtrendry.

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Speaker 2: There's a bunch of different researchers from a long time ago,

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Speaker 2: and the idea was, well, maybe it's a top down

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Speaker 2: kind of brain down perspective on what's going on in

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Speaker 2: the body. And there's lots of research even around like

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Speaker 2: pery personal space, like the space around your body. Kind

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Speaker 2: of similar mechanisms at play here, where the brain is

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Speaker 2: predicting what's happening in the spinal the spinal cords predicting

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Speaker 2: what's happening around in the peripheral nervous system, and then

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Speaker 2: that's predicting what's happening in the space around you. And

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Speaker 2: so for fantom win pain where there's no limb there,

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Speaker 2: it makes better sense than that the body's trying to

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Speaker 2: protect that part that was really threatened. And because it

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Speaker 2: was such a big experience having something amputated or the

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Speaker 2: accident or whatever preceded it, that pain can persist and

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Speaker 2: it often does persist. And then that also helps explain

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Speaker 2: when someone puts on a prosthetic at night, or they

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Speaker 2: take off their prosthetic and it hurts, or they put

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Speaker 2: their prosthetic on in it and it gives pain relief.

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Speaker 1: So yeah, interesting, So they take the prosthetic off and

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Speaker 1: they actually feel pain and then they put it.

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Speaker 2: Yeah, because there's no embodiment of that. But it is tricky,

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Speaker 2: and there's some people who would argue, oh, no, it's

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Speaker 2: the nerve endings that have been cut, and that's sending

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Speaker 2: a peripheral message going up to the brain. And I

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Speaker 2: think where I sit now, like years and years on

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Speaker 2: from this is there. It's somewhere in the middle. And

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Speaker 2: I think it's both pain is a whole person experience,

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Speaker 2: Like it's not brain centric and it's not body part centric.

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Speaker 2: I think it's very hard to separate any Like, I

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Speaker 2: think that separation of brain and body is really kind

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Speaker 2: of unhelpful in some ways.

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Speaker 1: A bit. It's so unhelpful in so many bloody ways.

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Speaker 2: Yeah, And if you join them together, then the latest

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Speaker 2: research on the immune system and other parts of your

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Speaker 2: body that we kind of separate as parts or different systems,

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Speaker 2: you start seeing them all as overlaying on each other

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Speaker 2: rather than as separate things. And I think that's much

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Speaker 2: more helpful because then when someone comes to the clinic

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Speaker 2: and they've got bad sleep and they're getting sick all

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Speaker 2: the time, and their memory is going and all these

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Speaker 2: other factors, it's all one big picture, like it makes

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Speaker 2: perfect sense, rather than it being this confusing, anger inducing experience.

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Speaker 2: So I've kind of derailed a little bit from the

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Speaker 2: phantom blim question, But I think the key point there,

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Speaker 2: I guess, is thinking about a whole person's being under threat. Like,

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Speaker 2: so pain is about warning and threat and safety rather

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Speaker 2: than necessarily just about damage and blacking.

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Speaker 1: Yeah, yeah, yeah, and that makes sense, particularly for people

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Speaker 1: with chronic pin right. And I just want to come

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Speaker 1: back to the homunculous Penfold maps. Does that play because

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Speaker 1: I remember there was a neural surgeon I'm pretty sure

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Speaker 1: Penfold and what he would do when he was operating

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Speaker 1: on patients when they were conscious, he would touch different

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Speaker 1: parts of the brain and that with a little probe

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Speaker 1: and they would go, oh, I feel latten my foot. Oh,

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Speaker 1: I feel lattened my finger. Ooh, I feel like somewhere else.

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Speaker 1: And he started creating these maps, these Penfold maps. Is

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Speaker 1: that Does that play into the homoculous presumably it does.

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Speaker 2: Yeah, like all of these again, it's just so hard

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Speaker 2: to separate out one, Like, so you look at all

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Speaker 2: these studies in isolation, and then you try to add

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Speaker 2: them all together, and yeah, I think for sure there's

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Speaker 2: there's almost like the latest understanding would be there's a

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Speaker 2: map for the motor system and then there's a sensory

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Speaker 2: map and so and they're not necessarily identical or the same,

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Speaker 2: and they're in slightly different parts of the brain. But yeah,

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Speaker 2: this idea that like our world is being represented in

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Speaker 2: our brain somehow is a really complex thing to even

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Speaker 2: start grappling with. And I noticed when I said that

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Speaker 2: before you said, oh, that definitely applies to chronic pain

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Speaker 2: and that, and I think it people can latch onto

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Speaker 2: that idea pretty comfortably. But what I'm seeing more and

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Speaker 2: more is like, why wouldn't it apply to acute pain

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Speaker 2: and injury? And in those moments like if you, I

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Speaker 2: don't know, bend your finger back and it starts hurting,

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Speaker 2: you haven't caused any damage yet, the warning's kicking in

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Speaker 2: and then you let go and there's no damage and

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Speaker 2: the pain settles down and it's kind of in proportion relatively.

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Speaker 2: But it's when the pain isn't in the same proportion

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Speaker 2: as the damage that it gets really really hard to understand.

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Speaker 2: And this is what, like, I mean, twenty percent of

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Speaker 2: society have chronic pain in some way, and a lot

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Speaker 2: of that is dismissed because our society set up, oh,

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Speaker 2: let's go and get a scan and see the structure

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Speaker 2: that's wrong with you. And I guess that just that

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Speaker 2: whole starting point is just it doesn't make a whole

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Speaker 2: lot of sense based on the later science. I think

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Speaker 2: we need to be thinking more about the whole person

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Speaker 2: and threat rather than about a disk or a little

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Speaker 2: body part. Of course, like we need to advocate for

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Speaker 2: people to get a thorough assessment to know how to

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Speaker 2: start here. But I just I think a curious approach

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Speaker 2: is a helpful one at this stage in terms of

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Speaker 2: the research.

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Speaker 1: Yeah, look, there's many little rabbit holes that I'd like

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Speaker 1: to cook down in there, need to cook in myself.

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Speaker 1: But just the fact that you're talking about the whole

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Speaker 1: person approach. I mean, I've said many many times that

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Speaker 1: the way that we do Western science right that Newtonian

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Speaker 1: Cartesian waterview, you break things to smallest component part in

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Speaker 1: order to understand it. That can give us a really

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Speaker 1: good understanding about certain things and how things are made up.

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Speaker 1: But it misses the fact that we are a complex

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Speaker 1: ecosystem and that yes you have an immune system, and

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Speaker 1: yes you have a cardiovascular system and emphatic system, muscular

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Speaker 1: skeletal but they all interact with each other in ridiculously

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Speaker 1: complex ways. And this is the problem with people who

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Speaker 1: are real specialists in one area, Like when you're when

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Speaker 1: you're a hammer, everything looks like a neil. Yeah, yeah,

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Speaker 1: But I think that that complexity of the human condition

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Speaker 1: is something that we've got to explore more and more

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Speaker 1: and more.

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Speaker 2: Right, Yeah, yeah, yeah. I think it's moving from being

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Speaker 2: like the mechanical engineer kind of perspective or lens across

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Speaker 2: to like a gardener type lens where there's seasons and

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Speaker 2: growth is possible, and kind of just shifting that perspective

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Speaker 2: on the human body. It changes everything really because you

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Speaker 2: start just viewing all the different feelings you have, Like

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Speaker 2: pain is one of the best protectors that we've got

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Speaker 2: in terms of these invisible protective feelings we have, but

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Speaker 2: like fatigue and nausea and worrying, and we've got other

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Speaker 2: ways of keeping our body safe. And it's just an

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Speaker 2: interesting one to start classifying pain in that way because

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Speaker 2: you start zooming out from the body part and I

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Speaker 2: think that can be a helpful exercise in itself. But

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Speaker 2: it's not a one size fits all. That's the other

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Speaker 2: challenge here is that for some people they just go, well,

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Speaker 2: I've treated my body an engineer in my whole life,

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Speaker 2: and it kind of works, and the coping strategies are

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Speaker 2: within that realm, and so you don't want to like

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Speaker 2: throw the baby out with the bath water either way here.

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Speaker 2: But yeah, I totally agree that there's value in not

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Speaker 2: just zooming down and breaking everything into really small parts,

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Speaker 2: but also kind of looking at the ecosystem as a whole.

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Speaker 1: Yeah. Absolutely. And the interesting thing you said there about

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Speaker 1: the protection mechanism, I think there's a very clear link

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Speaker 1: there with chronic pain and some chronic mental health conditions

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Speaker 1: were there can be an oversensitization of of the amygdala

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Speaker 1: causing that that hyper sensitive, hyper vigilant threat state that

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Speaker 1: people then start to ruminate it a lot and can

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Speaker 1: cause anxiety and depression and and and often it's just

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Speaker 1: an overprotective mechanism. And you know, even think about things

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Speaker 1: like PTSD can just be that real protective mechanism that's

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Speaker 1: gone awry and then causes a whole heap of issues,

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Speaker 1: just like as you described this, this this chronic pain

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Speaker 1: can be a protective mechanism that is turned maladaptive rather

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Speaker 1: than adapt great.

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Speaker 2: Yeah, yeah, I agree. And I think those kind of

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Speaker 2: central mechanisms where like the MAP is influencing things and

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Speaker 2: the HPA acxis like all those stress autonomic nervous system.

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Speaker 2: There's a lot of overlap in the literature between all

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Speaker 2: these different conditions. But what often happens like and as

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Speaker 2: a physiotherapist early in the kind of post injury or

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Speaker 2: early in the disease phase, when it hasn't the volume

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Speaker 2: hasn't been turned up too much yet, it's not overprotective

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Speaker 2: yet all of most of the drivers seem to be peripheral,

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Speaker 2: and so people go and see a health professional and

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Speaker 2: it's like, Oh, I've sprained my ankle or I've hurt

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Speaker 2: my knee or whatever it is, and we start at

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Speaker 2: the knee and we look at it from that perspective,

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Speaker 2: and then it's like once you cross this point at

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Speaker 2: which oh, the body part's probably healed by now, then

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Speaker 2: we start looking at the top down approach and going, oh,

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Speaker 2: what else is going on? But I think we need

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Speaker 2: to do both all the time. And it's like, okay,

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Speaker 2: so peripheral sensitization is kicking in within forty eight hours

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Speaker 2: sort of thing like there's a lot of mechanisms happening

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Speaker 2: locally in the sore body part that could be amplified

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Speaker 2: and kind of driving a long term pain experience, but

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Speaker 2: then equally at the spinal cord, there's that chemical transaction

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Speaker 2: happening at the DG and then it gets into the

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Speaker 2: spinal cord and goes up more kind of highway lanes

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Speaker 2: going up the spinal cord can amplify that message. And

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Speaker 2: then even just some of Professor Mark Hutchinson's work on

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Speaker 2: the number of pathways that a no susceptive message can take,

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Speaker 2: it's like a out numbers even just at one level,

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Speaker 2: it's more than the number of stars in the universe,

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Speaker 2: like the number of pathways it can take.

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Speaker 1: And so like the.

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Speaker 2: Complexity of every single pain experience is just like absolutely

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Speaker 2: enormous because that's a danger message then being that could

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Speaker 2: be amplified or not. And then when it gets to

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Speaker 2: the brain at the mid brain, it can be amplified

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Speaker 2: or not. And then in the brain there's like so

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Speaker 2: many different parts of the brain that are active in

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Speaker 2: kind of determining whether or not to protect by pain.

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Speaker 2: And it's like hundreds it's not just like, oh, there's

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Speaker 2: this part of the brain that always happens, and if

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Speaker 2: we cut that part of the brain out, then no

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Speaker 2: one would feel pain. It's so complex and unique and

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Speaker 2: it's moment by moment. It's not like, oh, Paul today,

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Speaker 2: this part of your brain is the main driver. Like

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Speaker 2: I think, it's all these little percentages adding up and

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Speaker 2: compounding over time. And this is where we see, like

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Speaker 2: some of the latest evidence to treat chronic pain is

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Speaker 2: things like cognitive functional therapy where you're constantly kind of

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Speaker 2: challenging the nervous system in a graded exposure kind of approach,

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Speaker 2: but it's really really gradual and you're you're like tackling

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Speaker 2: fears head on. And some of these things are just super.

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Speaker 1: Challenging, like exposure therapy for anxiety, rightd greated exposure to

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Speaker 1: the thing that is causing the discomfort.

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Speaker 2: Yes, but like yeah, there's a few caveats because you

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Speaker 2: want to make sure that you're not going to be

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Speaker 2: causing damage, Like if someone has a tumor or something

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Speaker 2: going on, you don't want to be flaring those kinds

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Speaker 2: of things up. But that's once someone's had the assessment

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Speaker 2: and you know that it's safe to move, then you

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Speaker 2: can engage in these these kind of behavioral treatments that

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Speaker 2: have some pretty good evidence behind them for long term outcomes.

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Speaker 2: There's plenty of treatments people can get for short term

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Speaker 2: benefit and like, arguably you don't even know how much

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Speaker 2: of it is expectation and things yet because there's a

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Speaker 2: lot of studies. There's a colleague, Felicity Braithwait in Adelaide

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Speaker 2: Chi did this really cool study and they made a

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Speaker 2: sham dry needle and the assess the person doing the

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Speaker 2: dry needling couldn't tell like it clicked, and they couldn't

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Speaker 2: tell if the needle was penetrating the skin or not,

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Speaker 2: and the outcomes were the same. And so like in

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Speaker 2: an acute pain setting, if people want short term relief,

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Speaker 2: I think it's just let's just weigh up the benefits

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Speaker 2: versus the risks, but don't pay too much money for it.

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Speaker 2: But if you want long term benefits, like we want

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Speaker 2: to be looking at strategies that people can get back

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Speaker 2: to doing the stuff they love. And it's not like

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Speaker 2: we can guarantee that pain's going to go away. In

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Speaker 2: a lot of people, it does decrease, but in most

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Speaker 2: people we can get back to doing the stuff that

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Speaker 2: they love doing. And I think that's our current benchmark

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Speaker 2: of what we want to achieve. But yeah, it all

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Speaker 2: comes down like I think understanding this sensitization. The mechanisms

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Speaker 2: that are happening at a cellular level does inform all

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Speaker 2: of the approaches. Like when you were saying about like

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Speaker 2: if you were to do exercises of the sore body part,

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Speaker 2: it's like, what's happening locally with your drawing you mentioned

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Speaker 2: like inflammation and redness, Like what's happening at that level,

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Speaker 2: but also like what's happening can we change the math

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Speaker 2: and how does that all work? I think we need

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Speaker 2: to have that broader picture in mind the whole way

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Speaker 2: through the patient journey, rather than it being oh, yeah,

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Speaker 2: you've just got to learn the neuroscience or like kind

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Speaker 2: of oversimplifying any of these steps. I think what some

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Speaker 2: of the research that I read recently is about validating

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Speaker 2: and making sure the person who's challenged by pain is

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Speaker 2: truly heard, like and feels support to engage in this.

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Speaker 2: And I think it makes a lot of biological sense

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Speaker 2: because if it's it pains about threat and danger, you

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Speaker 2: need to be supported and feel safe in the space

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Speaker 2: that you're going to kind of move forward in. But

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Speaker 2: if you've just been told by person after person that

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Speaker 2: there is no way forward and you must have a surgery,

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Speaker 2: and you must do this, and you must, must, must.

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Speaker 2: It's such a passive receipt, like you're kind of the

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Speaker 2: passenger on a train to wherever and you don't know

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Speaker 2: versus like the evidence in favor of active supported self

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Speaker 2: management strategies. It's a much clearer kind of path forward.

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Speaker 1: I think I want to diet. This cheesus so much.

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Speaker 1: These yeah, that we can dive into a couple of

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Speaker 1: little diversions. So the one thing about that the support

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Speaker 1: of We know that in many things, not just pain,

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Speaker 1: but in many things that one of the biggest determinants

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Speaker 1: of the outcome is the strength of the therapeutic release ship. Right,

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Speaker 1: So whether it's in psychotherapy or whether it's even cardiology.

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Speaker 1: So we'll give you a great one from cardiology. So

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Speaker 1: cardiologists who come in somebody say, I'm in my fifties,

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Speaker 1: I've had a heart attack, I'm as fit ly as

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Speaker 1: I overrate a smoke. Cardiologists who come in and they've

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Speaker 1: actually done randomized control trials on this, come in and go, Paul,

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Speaker 1: you're fat, You're out of ship. That's why you've had

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Speaker 1: a heart attack. You need to change your diet, you

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Speaker 1: need to stop smoking, you need to reduce your drinking

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Speaker 1: and you need to get fit. Right, the impact on

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Speaker 1: the patient that, like, the chances of me making all

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Speaker 1: those lifestyle changes are so slim compared to a cardiologist

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Speaker 1: who uses motivational interviewing, Yeah, which is just one technique

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Speaker 1: right where they sit down and said to me, Okay,

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Speaker 1: how'd you get here? You tell me, and I kind

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Speaker 1: of go, well, that's kind of smoke too much. I drink,

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Speaker 1: you know, I don't exercise my dad shit, Okay, what

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Speaker 1: do you think you could do about it? Well, maybe

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Speaker 1: I should actually start extra That's a great idea, right,

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Speaker 1: Using that motivational interviewing with you say, the patient feels

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Speaker 1: heard but also has some autonomy and the treatment process

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Speaker 1: I think is really really key. So that's one thing

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Speaker 1: that I think you just mentioned that I want to

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Speaker 1: open people's eyes to. But then that expectation effect, right,

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Speaker 1: so we know with the placebo effect that big pills

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Speaker 1: are better than little pills, that capsules are better than pills,

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Speaker 1: that needles are better than capsules, and that sham surgery

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Speaker 1: is more effective than a needle, more effective than all them.

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Speaker 1: The biggest one for me was a Harvard osteopathic surgeon

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Speaker 1: who people with chronic back pain and they often get

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Speaker 1: spinal fusion. You'll be aware of this, right, And there's

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Speaker 1: about a fifty percent or so recovery real from that

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Speaker 1: chronic paean. But he did a bunch of chalm surgeries

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Speaker 1: where he pretended that he did the surgery to fuse

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Speaker 1: people's desks. They even created little punctures on them. They

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Speaker 1: give them afterwards, they give them Champian medication when they

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Speaker 1: come out of it. And it had a both to

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Speaker 1: seame success for it as the real surgery, right. So

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Speaker 1: that just shows that expectation effect. It's the whole Placeboar effect, right.

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Speaker 2: Yeah, and it's not I guess one thing that can

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Speaker 2: come up when you talk about this stuff. And Ian

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Speaker 2: Harris is a doctor in Australia and David Anderson. There's

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Speaker 2: a few researchers doing these kind of studies because they've

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Speaker 2: worked in like conditions like slap lesions of the shoulder

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Speaker 2: and nearthrooscopies and these sham surgeries. It's so fascinating. But

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Speaker 2: if you talk about this with someone who's facing the

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Speaker 2: challenges of chronic pain, and it's individual and it's horrible,

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Speaker 2: and it's terrible it can come across like saying, come on,

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Speaker 2: and you've just got to change your expectation and it's

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Speaker 2: all in your head. And I think that can be

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Speaker 2: so dismissive. And so I'm really conscious that I'm on

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Speaker 2: a podcast and we're talking about this stuff and there

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Speaker 2: might be people listening, Like the odds are that people

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Speaker 2: are listening who have pain, because the title of the

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Speaker 2: podcast probably has the word pain in it, and I

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Speaker 2: just don't want people to hear that. It's like that.

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Speaker 2: I don't think just changing expectations is sufficient, but in

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Speaker 2: saying that, strategies like motivational interviewing are really really appropriate

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Speaker 2: and effective, I think in getting that starting point. So

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Speaker 2: there's a tension there, and I think the pain is

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Speaker 2: real and the effect of the sham surgery is still real.

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Speaker 2: It's just that the mechanisms at play aren't. What like,

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Speaker 2: there's a bit of deception going on, right in a

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Speaker 2: sham surgery study.

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Speaker 1: Yeah, sorry, I just to clarify, I'm not for one

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Speaker 1: minute and suggesting that with any of these interventions are

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Speaker 1: perceive that it's bullshit. It's a real effect, right, Ye, great,

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Speaker 1: And you can't change people's expectations expectations. Well maybe you

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Speaker 1: could with a little bit of education, right, But their

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Speaker 1: expectations are their expectations. But it's just good. I think

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Speaker 1: it's kind of reinforcing your what you talked about earlier

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Speaker 1: with the whole person approach. And if someone believes that

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Speaker 1: an intervention is going to help and has a good

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Speaker 1: relationship with the whoever, the physician or the physiotherapist or whatever,

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Speaker 1: that optimizes the chances of success. And Jesus, there's probably

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Speaker 1: so many unexplored mechanisms that are going on throughout the

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Speaker 1: body and throughout the nervous system to drive that expectation effect.

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Speaker 1: I don't think it's just in your mind. I'm sure

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Speaker 1: when people really start to tease it apart that the

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Speaker 1: expectation effect is having a physiological impact somewhere.

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Speaker 2: Definitely, And I think, like so one of my phdtions,

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Speaker 2: we're looking at the therapeutic relationship in the context of

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Speaker 2: kids chronic pain where there's the parent involved, and that

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Speaker 2: dynamic between child, parent and clinician hasn't really been looked at,

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Speaker 2: and we're gonna set up we're setting up at the

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Speaker 2: moment the study. We haven't done it yet, but filming

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Speaker 2: these interactions and looking at the behaviors that do have

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Speaker 2: an impact and don't have an impact on outcomes, because

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Speaker 2: I think like even positioning, like if you're sitting straight

432
00:24:22,280 --> 00:24:24,920
Speaker 2: across from someone and there's a big desk in the way,

433
00:24:25,200 --> 00:24:29,640
Speaker 2: versus sitting alongside them and facing the same direction. There's

434
00:24:29,680 --> 00:24:32,360
Speaker 2: so much research on that kind of like the threatening

435
00:24:32,400 --> 00:24:34,720
Speaker 2: behaviors and the white code effect and all of those

436
00:24:34,800 --> 00:24:37,320
Speaker 2: kinds of things that I think, I guess all of

437
00:24:37,320 --> 00:24:42,240
Speaker 2: that for me plays into quantifying how much of a

438
00:24:42,320 --> 00:24:47,200
Speaker 2: power dynamic is there, like to actually change people's expectations,

439
00:24:47,200 --> 00:24:49,480
Speaker 2: because I know, like when I disliocated my shoulder and

440
00:24:49,520 --> 00:24:51,679
Speaker 2: I saw a surgeon to discuss whether or not to

441
00:24:51,720 --> 00:24:55,480
Speaker 2: get surgery. I went into that appointment, my back's drenched

442
00:24:55,520 --> 00:24:58,600
Speaker 2: in sweat, and You're like, what's he going to say?

443
00:24:59,320 --> 00:25:01,480
Speaker 2: And what is SCAN say? And this was when I

444
00:25:01,600 --> 00:25:04,040
Speaker 2: first became a physio. I thought I had magic hands.

445
00:25:04,040 --> 00:25:07,480
Speaker 2: Everything was very biomedical and structural, and so it was

446
00:25:07,480 --> 00:25:10,840
Speaker 2: a really big challenge for me to go like, now

447
00:25:10,880 --> 00:25:13,080
Speaker 2: I look at that, and I go, wow, Like whatever

448
00:25:13,359 --> 00:25:17,840
Speaker 2: that surgeon said would probably trump anything that I read

449
00:25:17,880 --> 00:25:20,719
Speaker 2: in the research, because it was like, like there's just

450
00:25:20,760 --> 00:25:25,320
Speaker 2: such a power imbalance of knowledge and of our society,

451
00:25:25,560 --> 00:25:27,399
Speaker 2: the perspective of a surgeon and all of that kind

452
00:25:27,440 --> 00:25:30,000
Speaker 2: of stuff, and that can happen at every level. And

453
00:25:30,520 --> 00:25:33,040
Speaker 2: some of my research with kids that even happens between

454
00:25:33,080 --> 00:25:36,600
Speaker 2: parents or grandparents, or like if one parent's saying one

455
00:25:36,640 --> 00:25:39,760
Speaker 2: thing and saying be careful where velcrow shoes don't bend,

456
00:25:40,040 --> 00:25:42,440
Speaker 2: and the other parents saying, come on, play rugby league

457
00:25:42,480 --> 00:25:45,520
Speaker 2: and get back to school, and like, those mixed messages

458
00:25:45,760 --> 00:25:49,520
Speaker 2: are so unlike, so challenging for a child's developing nervous

459
00:25:49,560 --> 00:25:52,760
Speaker 2: system to have to try and weigh up. And so

460
00:25:52,800 --> 00:25:55,920
Speaker 2: I think for me, it's like that, let's work out

461
00:25:56,000 --> 00:25:58,679
Speaker 2: what what can we do what like because maybe we

462
00:25:58,720 --> 00:26:02,439
Speaker 2: can change expectations for the whole next generation. And I

463
00:26:02,520 --> 00:26:05,880
Speaker 2: make a comparison with this kind of idea of preventative education.

464
00:26:06,760 --> 00:26:09,159
Speaker 2: If we go like in the nineteen eighties in Australia

465
00:26:09,160 --> 00:26:11,359
Speaker 2: we did slip, slop, slap, and now like I have

466
00:26:11,440 --> 00:26:13,760
Speaker 2: young kids and they wear hats and sunscreen and the

467
00:26:13,800 --> 00:26:17,719
Speaker 2: behaviors have changed. We have colored lids on our bins.

468
00:26:17,960 --> 00:26:21,439
Speaker 2: We do in Sydney anyway, and recycling is a normal

469
00:26:21,440 --> 00:26:23,720
Speaker 2: behavior when it wasn't a normal behavior a couple of

470
00:26:23,800 --> 00:26:26,920
Speaker 2: generations ago, And I like my dream with this research

471
00:26:27,000 --> 00:26:29,600
Speaker 2: is what are those behaviors that we could instill in

472
00:26:29,640 --> 00:26:33,000
Speaker 2: the next generation to try to counter some of these

473
00:26:33,440 --> 00:26:36,320
Speaker 2: kind of huge like I mean pain costs Australia, Like

474
00:26:36,359 --> 00:26:38,119
Speaker 2: I think it was one hundred and thirty nine billion

475
00:26:38,160 --> 00:26:41,439
Speaker 2: dollars a year or some ridiculous number, And it's like,

476
00:26:41,480 --> 00:26:44,000
Speaker 2: could we not only reduce the financial cost but the

477
00:26:44,040 --> 00:26:49,320
Speaker 2: societal burdens of chronic pain. I think if the research

478
00:26:49,440 --> 00:26:53,760
Speaker 2: just seems so far ahead of the societal misconceptions about like, oh,

479
00:26:53,800 --> 00:26:57,040
Speaker 2: more pain must mean more damage, and they're like pain

480
00:26:57,160 --> 00:26:59,439
Speaker 2: is a direct result of this, Whereas I think if

481
00:26:59,440 --> 00:27:03,199
Speaker 2: everyone aciated that there are so many things influencing and

482
00:27:03,320 --> 00:27:06,920
Speaker 2: changing the volume of every pain experience, they might start

483
00:27:06,960 --> 00:27:10,360
Speaker 2: thinking a bit more curiously about it and what we're

484
00:27:10,359 --> 00:27:12,800
Speaker 2: seeing in the school based studies we're doing. Even like

485
00:27:12,920 --> 00:27:14,960
Speaker 2: the principle of a school recently was like, oh, the

486
00:27:15,440 --> 00:27:18,120
Speaker 2: kids who don't have chronic pain are more empathetic now

487
00:27:18,119 --> 00:27:21,320
Speaker 2: that they've learnt this neuroscience. They're more caring and understanding.

488
00:27:21,520 --> 00:27:24,240
Speaker 2: There's less of this bullying going on of that poor

489
00:27:24,320 --> 00:27:28,760
Speaker 2: kid who is really struggling, and I find that really fascinating.

490
00:27:28,800 --> 00:27:32,920
Speaker 2: And we didn't expect that education about pain would help

491
00:27:33,119 --> 00:27:37,199
Speaker 2: kids who don't have pain, and that's it's yeah, And

492
00:27:37,240 --> 00:27:41,919
Speaker 2: I think, so we're stepping from going okay, like placebo

493
00:27:42,000 --> 00:27:45,439
Speaker 2: effects and these kind of everything has some sort of

494
00:27:45,440 --> 00:27:49,359
Speaker 2: biological underpinning potentially, and then we go we zoom out

495
00:27:49,359 --> 00:27:51,359
Speaker 2: and we go okay, so treatments can work for a

496
00:27:51,480 --> 00:27:53,800
Speaker 2: variety of reasons, and then we go, okay, well maybe

497
00:27:53,800 --> 00:27:57,320
Speaker 2: we could prevent things and change things. And so that's

498
00:27:57,400 --> 00:27:59,480
Speaker 2: kind of where I'm interested, is like, how do we

499
00:27:59,520 --> 00:28:05,240
Speaker 2: communicate all of this complexity to kind of everyone rather

500
00:28:05,280 --> 00:28:07,040
Speaker 2: than it just being oh, we're going to change one

501
00:28:07,119 --> 00:28:10,080
Speaker 2: university course or we're going to put one TV ad

502
00:28:10,119 --> 00:28:13,080
Speaker 2: out or something like that. And I think we should

503
00:28:13,119 --> 00:28:15,800
Speaker 2: do all of those things, but it's hard to know

504
00:28:15,840 --> 00:28:19,280
Speaker 2: what's going to help in this age where, yeah, like

505
00:28:19,320 --> 00:28:22,080
Speaker 2: how do we change society's behaviors at a big level

506
00:28:22,200 --> 00:28:25,200
Speaker 2: is kind of that big question I'm fascinated by.

507
00:28:26,480 --> 00:28:29,200
Speaker 1: Want I want to come back and talk about children,

508
00:28:29,240 --> 00:28:31,159
Speaker 1: because you do a lot of research on that, But

509
00:28:32,600 --> 00:28:36,800
Speaker 1: let's just do a little bit of education and let's

510
00:28:36,840 --> 00:28:41,840
Speaker 1: take the fourteen week course that you do for students

511
00:28:41,880 --> 00:28:46,240
Speaker 1: physiotherabal students. And let's take the PIN component and compress

512
00:28:46,280 --> 00:28:47,680
Speaker 1: it into about five minutes.

513
00:28:47,840 --> 00:28:50,120
Speaker 2: Okay, So just I.

514
00:28:50,080 --> 00:28:53,080
Speaker 1: Want people to get an understanding. You've mentioned a number

515
00:28:53,080 --> 00:28:55,960
Speaker 1: of the things that are important in the pein signal.

516
00:28:56,360 --> 00:29:00,800
Speaker 1: So let's just talk about the nervous system, the PAN receptors,

517
00:29:01,400 --> 00:29:05,600
Speaker 1: and they're all the way up and they're different areas

518
00:29:05,680 --> 00:29:09,520
Speaker 1: where that PAN can get amplified, ending up in the

519
00:29:09,560 --> 00:29:12,400
Speaker 1: Briand just so people can get an understanding of how

520
00:29:13,120 --> 00:29:16,080
Speaker 1: PAN actually works as much as we understand right now.

521
00:29:16,200 --> 00:29:18,160
Speaker 2: Yeah, yeah, yeah, And and I think like the starting

522
00:29:18,160 --> 00:29:21,880
Speaker 2: point would be to understand this word called nosyception. And often,

523
00:29:22,080 --> 00:29:25,280
Speaker 2: like if you go onto kids science books and I've

524
00:29:25,320 --> 00:29:28,520
Speaker 2: done this, it conflates like it says that pain is

525
00:29:28,560 --> 00:29:32,680
Speaker 2: because of nos reception, and like really just overlaps those

526
00:29:32,720 --> 00:29:38,120
Speaker 2: ideas way too much. Nos Reception is the encoding of

527
00:29:38,280 --> 00:29:42,400
Speaker 2: noxious stimuli is the technical words. It's it's about transmitting

528
00:29:42,480 --> 00:29:46,760
Speaker 2: a danger message. And I've made some kids books and

529
00:29:46,800 --> 00:29:48,440
Speaker 2: tried to convey that. And the way we did it

530
00:29:48,480 --> 00:29:51,200
Speaker 2: was it was like a virtual reality adventure inside the

531
00:29:51,240 --> 00:29:54,040
Speaker 2: brain and the body and there's like little envelopes going

532
00:29:54,080 --> 00:29:56,960
Speaker 2: everywhere in the body, so and no seception. Like, so

533
00:29:57,080 --> 00:30:00,800
Speaker 2: when a body part reaches the threat shold on these

534
00:30:00,880 --> 00:30:06,120
Speaker 2: nerve endings of either pressure, temperature, or a chemical change,

535
00:30:06,160 --> 00:30:08,120
Speaker 2: there's a point at which the no Si sceptor goes,

536
00:30:08,120 --> 00:30:10,880
Speaker 2: all right, there's enough danger here that I need to

537
00:30:10,960 --> 00:30:14,280
Speaker 2: let the next part of the body know. And so

538
00:30:14,320 --> 00:30:17,440
Speaker 2: then that message goes up the nerve and it can

539
00:30:17,920 --> 00:30:21,640
Speaker 2: like in that local area, more nerves can fire. And

540
00:30:21,680 --> 00:30:24,120
Speaker 2: so like you'll see when something swells, say, if you

541
00:30:24,120 --> 00:30:26,280
Speaker 2: have a body part the turning more and more like

542
00:30:26,320 --> 00:30:29,520
Speaker 2: the swelling might grow. That's more nerve receptors are now

543
00:30:29,600 --> 00:30:32,840
Speaker 2: sending up messages, right, and so it keeps growing exponentially,

544
00:30:33,880 --> 00:30:35,960
Speaker 2: and it's going there's enough danger here that we need

545
00:30:36,000 --> 00:30:39,440
Speaker 2: to do something about it. And so that gets to

546
00:30:39,480 --> 00:30:42,960
Speaker 2: the spinal cord. So the no seception message, the no

547
00:30:43,040 --> 00:30:46,040
Speaker 2: seceptive messages gets to the spinal cords. There's danger going

548
00:30:46,080 --> 00:30:49,320
Speaker 2: on here. So something's being touched or pushed or chemical

549
00:30:49,400 --> 00:30:51,720
Speaker 2: changes enough that there's a problem and we need to

550
00:30:51,800 --> 00:30:54,440
Speaker 2: let the brain know, Like let's let the central nervous

551
00:30:54,440 --> 00:30:58,120
Speaker 2: no and so then that nerve it's not like a

552
00:30:58,400 --> 00:31:01,120
Speaker 2: perfect wire that just goes directly to the brain. There's

553
00:31:01,160 --> 00:31:05,440
Speaker 2: that chemical transaction, and this is where it's just next

554
00:31:05,480 --> 00:31:08,800
Speaker 2: to your spinal cord, the dorsal root ganglion. At that point,

555
00:31:09,160 --> 00:31:11,959
Speaker 2: that's where all those different connections can happen. And then

556
00:31:12,000 --> 00:31:13,920
Speaker 2: there's the highways going up the spinal cord.

557
00:31:14,200 --> 00:31:17,160
Speaker 1: And how much a neural transmitter is involved at this junction.

558
00:31:17,560 --> 00:31:20,160
Speaker 2: Yeah, so at every so this is like a sign apse.

559
00:31:20,160 --> 00:31:22,080
Speaker 2: You might have heard of that term. Yes, so at

560
00:31:22,160 --> 00:31:26,400
Speaker 2: every kind of time that there's communication happening. We used

561
00:31:26,440 --> 00:31:29,600
Speaker 2: to think of glial cells like glial in Latin is

562
00:31:29,640 --> 00:31:31,920
Speaker 2: about glue. Like we used to think of them as

563
00:31:31,960 --> 00:31:35,040
Speaker 2: like a passive kind of structural they'll hold the neurons

564
00:31:35,040 --> 00:31:38,680
Speaker 2: in place and that, and that's kind of true. But

565
00:31:38,800 --> 00:31:43,040
Speaker 2: also glial cells have quite a big role in chronic

566
00:31:43,080 --> 00:31:46,920
Speaker 2: pain and pain this kind of idea of messaging of

567
00:31:47,000 --> 00:31:51,640
Speaker 2: danger systems, danger signals. And so when that chemical transaction

568
00:31:51,720 --> 00:31:55,720
Speaker 2: is happening, there's a whole lot of different external influences

569
00:31:55,720 --> 00:31:58,640
Speaker 2: that can happen. And so if we tried to make

570
00:31:58,680 --> 00:32:03,160
Speaker 2: the exact same chemical transaction happen, it would be very

571
00:32:03,280 --> 00:32:07,520
Speaker 2: very hard between people, that's for sure. Because the surrounding

572
00:32:07,840 --> 00:32:12,000
Speaker 2: nervous system is not identical. And so when people like

573
00:32:12,080 --> 00:32:14,040
Speaker 2: at the moment, there's researchers trying to go, oh, like

574
00:32:14,120 --> 00:32:17,040
Speaker 2: maybe we could shoot light in and do like optic

575
00:32:17,200 --> 00:32:20,120
Speaker 2: kind of treatments that are non invasive at that level,

576
00:32:20,520 --> 00:32:22,880
Speaker 2: and like there's just so many potential ways, Like there's

577
00:32:22,920 --> 00:32:25,560
Speaker 2: lots of opioids and different mechanisms that act on different

578
00:32:25,560 --> 00:32:28,920
Speaker 2: receptors that are nearby and in that area. So this

579
00:32:28,960 --> 00:32:32,040
Speaker 2: is all happening kind of at the spinal cord wherever

580
00:32:32,080 --> 00:32:34,640
Speaker 2: the nerve roote kind of enters the nervous system from

581
00:32:34,640 --> 00:32:36,320
Speaker 2: whatever the sore body part was. So if it was

582
00:32:36,360 --> 00:32:39,120
Speaker 2: your ankle, it's going in down the bottom of your back,

583
00:32:39,440 --> 00:32:41,320
Speaker 2: whereas if it was in your arm or your shoulder,

584
00:32:41,600 --> 00:32:43,960
Speaker 2: it would be up in your neck where this is happening.

585
00:32:44,440 --> 00:32:47,520
Speaker 1: So then this is the harndholding between the peripheral and

586
00:32:47,560 --> 00:32:48,680
Speaker 1: the central nervous system.

587
00:32:48,760 --> 00:32:50,960
Speaker 2: That's right, yes, And at that junction there's a lot

588
00:32:50,960 --> 00:32:53,640
Speaker 2: of potential where I guess the way that we explain

589
00:32:53,680 --> 00:32:56,000
Speaker 2: this with kids is like the volume of that message

590
00:32:56,040 --> 00:32:58,840
Speaker 2: could be louder or quieter. So in the envelope it

591
00:32:58,880 --> 00:33:02,360
Speaker 2: says danger, and it might lower case, but now the

592
00:33:02,400 --> 00:33:05,280
Speaker 2: message is capital D, A, N, G, er and like,

593
00:33:05,360 --> 00:33:08,520
Speaker 2: and it's stuck on the right and there's lots of

594
00:33:08,560 --> 00:33:13,080
Speaker 2: exclamation marks, and so the original message has already been modified.

595
00:33:13,120 --> 00:33:17,560
Speaker 2: It's like Australia Posts has changed the letter or there's

596
00:33:17,600 --> 00:33:21,160
Speaker 2: more letters and they're bigger envelopes at whatever it is.

597
00:33:21,240 --> 00:33:23,640
Speaker 2: And so by the time it gets to the brain,

598
00:33:23,920 --> 00:33:27,720
Speaker 2: it might not be exactly that same message. It's an

599
00:33:27,760 --> 00:33:31,200
Speaker 2: interpreted like it's kind of a modified message. And in

600
00:33:31,240 --> 00:33:33,600
Speaker 2: the nineteen sixties, even like we talk about this in

601
00:33:33,720 --> 00:33:37,880
Speaker 2: the in the course of the gate control theory kind

602
00:33:37,880 --> 00:33:40,280
Speaker 2: of got that bit of the physiology, right, I think

603
00:33:40,360 --> 00:33:43,440
Speaker 2: where there's there's had this idea of like different gates

604
00:33:43,480 --> 00:33:46,760
Speaker 2: where you could kind of allow messages up to the

605
00:33:46,800 --> 00:33:50,160
Speaker 2: brain or not. And I guess it's that threshold idea,

606
00:33:50,200 --> 00:33:52,400
Speaker 2: but I think we can we've moved past that. And

607
00:33:52,440 --> 00:33:54,440
Speaker 2: there's a lot of different theories on how this works.

608
00:33:54,480 --> 00:33:58,120
Speaker 2: But basically, the brain is then receiving these messages, and

609
00:33:58,160 --> 00:34:01,120
Speaker 2: it's got thoughts and memories and expects to deal with.

610
00:34:01,520 --> 00:34:03,920
Speaker 2: It's got the visual input if you've seen the body

611
00:34:03,920 --> 00:34:06,720
Speaker 2: part that saw or not. There's all these different things

612
00:34:06,720 --> 00:34:08,280
Speaker 2: that have happened, like have I had this before?

613
00:34:09,200 --> 00:34:12,080
Speaker 1: And then I just want to throw in there, Joshua

614
00:34:12,640 --> 00:34:17,520
Speaker 1: a quote from Ahmat Gotswami, who's an astrophysicist and philosopher.

615
00:34:18,040 --> 00:34:21,680
Speaker 1: We don't perceive reality directly. We perceive it through the

616
00:34:21,719 --> 00:34:22,680
Speaker 1: mirror of memory.

617
00:34:23,760 --> 00:34:26,400
Speaker 2: Yeah, okay, interesting, So if.

618
00:34:26,239 --> 00:34:31,240
Speaker 1: You've had the memory of pain there can actually change

619
00:34:31,280 --> 00:34:34,720
Speaker 1: how you're perceiving that message that's coming in, right.

620
00:34:34,560 --> 00:34:38,240
Speaker 2: And that If that sounds like gobbledygook or like pseudoscience

621
00:34:38,280 --> 00:34:42,720
Speaker 2: to anyone listening, check out Melanie Knowles work in Canada.

622
00:34:42,800 --> 00:34:46,360
Speaker 2: She's a professor there. They did some awesome studies on

623
00:34:46,640 --> 00:34:50,040
Speaker 2: vaccination pain and with kids they were able to reframe

624
00:34:50,719 --> 00:34:54,040
Speaker 2: the previous pain experience by saying things like, oh remember

625
00:34:54,080 --> 00:34:56,120
Speaker 2: last time when you got your needle, you got a

626
00:34:56,160 --> 00:35:00,200
Speaker 2: lolli and and they talk about all the positive parts

627
00:35:00,200 --> 00:35:03,720
Speaker 2: of the experience. Yes, and that reduces the next paint

628
00:35:04,120 --> 00:35:08,080
Speaker 2: in the future vaccinations. And to me, like that is

629
00:35:08,200 --> 00:35:11,960
Speaker 2: really exciting, Like the fact that reframing can have some

630
00:35:12,120 --> 00:35:16,960
Speaker 2: effect even is so cool and yes, so one hundred percent.

631
00:35:17,080 --> 00:35:19,600
Speaker 2: Like the posterior parietal cortex, like the part of your

632
00:35:19,600 --> 00:35:22,080
Speaker 2: brain where you're accessing and trying to work out how

633
00:35:22,160 --> 00:35:25,560
Speaker 2: is memory influencing it? This is all happening. All this

634
00:35:25,600 --> 00:35:27,640
Speaker 2: stuff I've been talking about for a few minutes is

635
00:35:27,680 --> 00:35:31,680
Speaker 2: in a split second, it's not right. Yeah, yeah, this

636
00:35:31,840 --> 00:35:33,439
Speaker 2: is like, so you put your hand on the hot

637
00:35:33,440 --> 00:35:36,880
Speaker 2: plate and maybe a memory from when you were three

638
00:35:37,280 --> 00:35:40,160
Speaker 2: is coming back of your grandma saying don't touch it

639
00:35:40,280 --> 00:35:44,919
Speaker 2: or something like this is this is hard to kind

640
00:35:44,920 --> 00:35:46,480
Speaker 2: of standardize in a study.

641
00:35:46,760 --> 00:35:49,400
Speaker 1: It's like my it's like my little guy Oscar stood

642
00:35:49,520 --> 00:35:54,240
Speaker 1: on one of those sea urchins when he was a kid, okay,

643
00:35:54,640 --> 00:35:57,440
Speaker 1: and then for years just wouldn't go into water, and

644
00:35:58,200 --> 00:36:01,080
Speaker 1: we didn't understand why. And then it was like, oh shit, right,

645
00:36:01,160 --> 00:36:07,640
Speaker 1: so there's he is remembering and associating that pin with

646
00:36:08,280 --> 00:36:08,720
Speaker 1: the seed.

647
00:36:09,320 --> 00:36:12,279
Speaker 2: Yes, that's right, and yeah, and I guess that's where

648
00:36:12,360 --> 00:36:14,480
Speaker 2: like fear and all of these other things are kind

649
00:36:14,480 --> 00:36:17,800
Speaker 2: of going to mediate that interpretation of all these danger

650
00:36:17,800 --> 00:36:20,920
Speaker 2: messages coming up because I still haven't even mentioned pain yet, Like,

651
00:36:21,280 --> 00:36:24,440
Speaker 2: had all this no suception happening, the ankle sprained, the

652
00:36:24,520 --> 00:36:28,000
Speaker 2: damages happened or not happened, But there's there's plenty of

653
00:36:28,040 --> 00:36:31,239
Speaker 2: messages going up, and then yeah, I guess that's like

654
00:36:31,520 --> 00:36:34,720
Speaker 2: there's all these other mechanisms going back down the nervous

655
00:36:34,719 --> 00:36:36,480
Speaker 2: system from the brain to the spinal cord to the

656
00:36:36,480 --> 00:36:39,479
Speaker 2: body part, and we call it things like if people

657
00:36:39,520 --> 00:36:43,040
Speaker 2: want to read like descending inhibition or you could, Yeah,

658
00:36:43,080 --> 00:36:45,319
Speaker 2: there's some stuff that lay language would be like top

659
00:36:45,360 --> 00:36:50,239
Speaker 2: down kind of modulation. And that's where I think for me,

660
00:36:50,560 --> 00:36:53,200
Speaker 2: like there's a lot of data in psychological treatment about

661
00:36:53,200 --> 00:36:56,160
Speaker 2: a sense of agency predicting good outcomes, like if you

662
00:36:56,200 --> 00:36:59,040
Speaker 2: have a sense of self efficacy and control over the condition,

663
00:36:59,880 --> 00:37:03,400
Speaker 2: or if the condition is controlling you, you tend to

664
00:37:03,400 --> 00:37:06,120
Speaker 2: go on a different trajectory. And that's why I think

665
00:37:06,360 --> 00:37:10,480
Speaker 2: learning some of this can help empower people to go, hey,

666
00:37:10,520 --> 00:37:13,520
Speaker 2: you know what, I can't control everything, but I can

667
00:37:13,680 --> 00:37:19,120
Speaker 2: control my breathing and so therefore I can control whatever

668
00:37:19,160 --> 00:37:23,440
Speaker 2: it is panic attacks or whatever, and that has an

669
00:37:23,480 --> 00:37:26,400
Speaker 2: indirect influence on my next pain experience, and that has

670
00:37:26,440 --> 00:37:31,000
Speaker 2: an indirect effect on my mood, which then reduces my

671
00:37:31,080 --> 00:37:34,280
Speaker 2: depression or whatever. Like you can see the web start

672
00:37:34,360 --> 00:37:37,520
Speaker 2: to build, and I think it's really hard to formulate

673
00:37:37,520 --> 00:37:40,400
Speaker 2: this without like an exact kind of case example that

674
00:37:40,440 --> 00:37:42,799
Speaker 2: we're all on the same page with. So people are

675
00:37:42,800 --> 00:37:46,120
Speaker 2: probably just projecting their own experiences right now, and that's fine,

676
00:37:46,760 --> 00:37:49,400
Speaker 2: but maybe you can start connecting the dots between like

677
00:37:50,120 --> 00:37:52,720
Speaker 2: your diet and your sleep and you're like just thinking

678
00:37:52,760 --> 00:37:55,160
Speaker 2: some some broader stuff is going to influence it. And

679
00:37:55,160 --> 00:37:58,239
Speaker 2: we know, for instance, like sleep, there was a great

680
00:37:58,280 --> 00:38:01,520
Speaker 2: study looking at the Bideck direction all effects, so like

681
00:38:01,719 --> 00:38:03,960
Speaker 2: if you have bad sleep, you're going to have worse

682
00:38:04,000 --> 00:38:06,360
Speaker 2: pain the next day, and if you have bad pain,

683
00:38:06,400 --> 00:38:08,640
Speaker 2: you're going to have worse sleep the next night. And

684
00:38:08,680 --> 00:38:11,800
Speaker 2: so just in the pain and sleep web, that cycle

685
00:38:11,920 --> 00:38:13,919
Speaker 2: is a vicious one and can get worse and worse

686
00:38:13,960 --> 00:38:17,560
Speaker 2: and worse pretty quickly. So even just the time that

687
00:38:17,600 --> 00:38:20,879
Speaker 2: you're on a waiting list for a sleep study, Like, yeah,

688
00:38:20,960 --> 00:38:23,880
Speaker 2: it's just a really hard thing. And that's just isolating

689
00:38:23,920 --> 00:38:27,560
Speaker 2: two variables, which is just an unbelievable simplification.

690
00:38:28,120 --> 00:38:31,200
Speaker 1: Yeah, I'm I'm going to throw another one into the

691
00:38:31,200 --> 00:38:33,759
Speaker 1: mix before we get to the brillin Right. Okay, you

692
00:38:33,880 --> 00:38:38,400
Speaker 1: mentioned that sense of agency. Yeah, that plays very strongly

693
00:38:38,440 --> 00:38:42,400
Speaker 1: into the psychology and internal lookers of control and external

694
00:38:42,400 --> 00:38:45,880
Speaker 1: looks and control and whole research on haartiness and whether

695
00:38:46,000 --> 00:38:49,360
Speaker 1: or not people high in hardiness or have a high

696
00:38:49,400 --> 00:38:53,279
Speaker 1: internal looks of control believe that they have a very

697
00:38:53,400 --> 00:38:57,640
Speaker 1: strong influence on their destiny and the heartiness research tools

698
00:38:57,680 --> 00:39:02,879
Speaker 1: that they recover better from operations from all these sorts

699
00:39:02,880 --> 00:39:05,040
Speaker 1: of things, whereas people with an external look as of

700
00:39:05,040 --> 00:39:08,360
Speaker 1: control they've got lower agency, They believe that they have

701
00:39:08,520 --> 00:39:13,160
Speaker 1: less influence of things, and they take a lot longer

702
00:39:13,239 --> 00:39:16,600
Speaker 1: to recover from operations and things like that. So I

703
00:39:16,640 --> 00:39:20,719
Speaker 1: think that the psychology plays in here in terms of

704
00:39:21,040 --> 00:39:25,800
Speaker 1: what my agency actually is. Do you know what I think?

705
00:39:26,040 --> 00:39:28,960
Speaker 2: Like there's some interesting research about like, oh, maybe knowledge

706
00:39:28,960 --> 00:39:32,040
Speaker 2: and belief change is not sufficient for behavior change, and

707
00:39:32,080 --> 00:39:34,839
Speaker 2: some of that kind of ideas really fascinating. And one

708
00:39:34,880 --> 00:39:37,560
Speaker 2: idea of been thinking about is with these physio students.

709
00:39:37,600 --> 00:39:39,960
Speaker 2: So I have like seventy five students. They've done an

710
00:39:40,040 --> 00:39:44,120
Speaker 2: undergraduate degree in like biomechanical type stuff, so they're thinking

711
00:39:44,320 --> 00:39:46,719
Speaker 2: about the body very structurally, and then they come to

712
00:39:46,760 --> 00:39:51,000
Speaker 2: this course and often in like somewhere between week four

713
00:39:51,040 --> 00:39:55,080
Speaker 2: and week eight, like the midway point, most of the

714
00:39:55,120 --> 00:39:58,560
Speaker 2: students start having this moment where they apply what they've

715
00:39:58,600 --> 00:40:02,200
Speaker 2: been learning to their own experience. And it's this weird

716
00:40:02,640 --> 00:40:05,480
Speaker 2: time where I get all these emails and after class,

717
00:40:05,480 --> 00:40:07,600
Speaker 2: people are going, hey, hey, I know you've been saying

718
00:40:07,640 --> 00:40:11,680
Speaker 2: this helps patients, but like for my pain, which and

719
00:40:11,719 --> 00:40:13,480
Speaker 2: then you can see that they're starting to go, oh,

720
00:40:13,520 --> 00:40:15,399
Speaker 2: when I'm at the gym and this happens, or when

721
00:40:15,440 --> 00:40:19,160
Speaker 2: I have headaches, this is what's going on. And I think,

722
00:40:19,360 --> 00:40:24,520
Speaker 2: thinking by a psychosocially, yes, it probably is actually increasing

723
00:40:24,600 --> 00:40:29,560
Speaker 2: agency because I mean, anecdotally, we've got data on people

724
00:40:29,719 --> 00:40:33,960
Speaker 2: shifting to having an internal locus of control and the like.

725
00:40:34,040 --> 00:40:37,719
Speaker 2: So at a student level, at a professional level, when

726
00:40:37,719 --> 00:40:41,280
Speaker 2: people learn this stuff, it seems to have personal benefits.

727
00:40:41,280 --> 00:40:42,960
Speaker 2: And I know that's true for me and a lot

728
00:40:43,000 --> 00:40:45,080
Speaker 2: of the researchers I work with who are like, oh,

729
00:40:45,120 --> 00:40:47,720
Speaker 2: we want everyone to have this same amount of knowledge.

730
00:40:48,680 --> 00:40:50,960
Speaker 2: And I guess that's where I'm really fascinated, is like,

731
00:40:51,000 --> 00:40:55,800
Speaker 2: what's the minimal dose of knowledge and belief change that's

732
00:40:55,800 --> 00:41:00,520
Speaker 2: sufficient to empower someone long long term? And you see

733
00:41:00,560 --> 00:41:04,560
Speaker 2: those people online, like there's this awesome lady on Instagram

734
00:41:04,600 --> 00:41:07,560
Speaker 2: who can do like backflips and handstands and really cool stuff,

735
00:41:07,560 --> 00:41:09,799
Speaker 2: and like that's the kind of old person that we

736
00:41:09,840 --> 00:41:12,279
Speaker 2: want everyone to be, right, Like these these kind of

737
00:41:12,320 --> 00:41:14,880
Speaker 2: active people who just having a blast, their whole life

738
00:41:14,960 --> 00:41:18,840
Speaker 2: seems great and maybe it's not. And but I think

739
00:41:19,400 --> 00:41:23,160
Speaker 2: having joy and relating that to movement and physical activity

740
00:41:23,239 --> 00:41:26,680
Speaker 2: just seems like a good a good target for us

741
00:41:26,719 --> 00:41:30,560
Speaker 2: to aim for rather than it being about aesthetics or

742
00:41:30,640 --> 00:41:33,800
Speaker 2: just to try and like cope with pain or whatever

743
00:41:33,840 --> 00:41:37,120
Speaker 2: that those other motivators are. But it's a really hard

744
00:41:37,160 --> 00:41:41,040
Speaker 2: thing to set our goals, like long long term goals.

745
00:41:41,960 --> 00:41:45,640
Speaker 2: But people with heartiness and internal lockers of control, they

746
00:41:45,680 --> 00:41:47,680
Speaker 2: seem to do that like they're not thinking in the

747
00:41:47,680 --> 00:41:50,120
Speaker 2: short or the medium term so much like they're not

748
00:41:50,160 --> 00:41:55,840
Speaker 2: thinking in hours or days, they're thinking in months and years.

749
00:41:54,880 --> 00:42:01,160
Speaker 1: And they also see things like in injury as a

750
00:42:01,239 --> 00:42:04,640
Speaker 1: challenge for them to overcome. Right, Yeah, And I think

751
00:42:04,680 --> 00:42:09,640
Speaker 1: that psychological mindset please into stuff. It pleads into your behavior,

752
00:42:09,719 --> 00:42:13,120
Speaker 1: It plays into your belief systems, it pleads into high,

753
00:42:13,800 --> 00:42:16,800
Speaker 1: high effective that the treatment would be. I would imagine

754
00:42:17,080 --> 00:42:20,600
Speaker 1: through that belief idea.

755
00:42:20,280 --> 00:42:23,280
Speaker 2: Yeah, you should on this podcast I reckon your listeners

756
00:42:23,320 --> 00:42:27,640
Speaker 2: would like. Sean Zion is a researcher at Stanford and

757
00:42:27,719 --> 00:42:29,560
Speaker 2: he's done this stuff. He made this thing called the

758
00:42:29,600 --> 00:42:32,799
Speaker 2: Illness Mindset Inventory, and I think it was so this

759
00:42:32,880 --> 00:42:35,399
Speaker 2: is memory. Now I might be wrong, but I think

760
00:42:35,400 --> 00:42:38,359
Speaker 2: it was about cancer, and one of the items in

761
00:42:38,400 --> 00:42:41,360
Speaker 2: the questionnaire was about I see it as an opportunity.

762
00:42:42,640 --> 00:42:45,440
Speaker 2: It's just like, to me, that's just way too confronting.

763
00:42:45,560 --> 00:42:48,120
Speaker 2: It gives to a patient, right, and so, and he

764
00:42:48,160 --> 00:42:50,880
Speaker 2: could speak to all of that that research about like

765
00:42:51,239 --> 00:42:53,400
Speaker 2: when you say you see an injury as a challenge,

766
00:42:54,080 --> 00:42:56,560
Speaker 2: you see pain as an opportunity. Those kind of ideas

767
00:42:56,560 --> 00:42:59,840
Speaker 2: are just so hard to even grasp and it all

768
00:43:00,120 --> 00:43:03,279
Speaker 2: seems offensive to say it in the face of.

769
00:43:03,880 --> 00:43:07,719
Speaker 1: Well the historic philosophers believe that that that so their

770
00:43:07,800 --> 00:43:12,080
Speaker 1: whole attitude was that when you uncover misfortune, that that

771
00:43:12,239 --> 00:43:16,919
Speaker 1: this is a a good wrestling partner, that that will

772
00:43:16,960 --> 00:43:21,319
Speaker 1: actually enhanceure your strength and your resilience and your toughness.

773
00:43:21,440 --> 00:43:24,600
Speaker 1: So they actually saw these things are are reframed them

774
00:43:24,600 --> 00:43:29,439
Speaker 1: as opportunities and actually, in the extreme, welcomed them into

775
00:43:29,520 --> 00:43:33,279
Speaker 1: their lives. Right. So that's that that takes it to

776
00:43:33,600 --> 00:43:37,160
Speaker 1: another level. But if we did a little sidetrack there,

777
00:43:37,239 --> 00:43:41,320
Speaker 1: we just about got to the brain from the peripheral

778
00:43:41,320 --> 00:43:43,640
Speaker 1: nervous to the central nervous system and then up into

779
00:43:43,680 --> 00:43:47,759
Speaker 1: the brain. So what then, what's the next junction that

780
00:43:47,920 --> 00:43:49,480
Speaker 1: influences pain perception.

781
00:43:49,600 --> 00:43:53,200
Speaker 2: Yeah, so the way that there's some great work, like

782
00:43:53,239 --> 00:43:55,960
Speaker 2: there's a book called Explain Pain by David Butler and

783
00:43:56,080 --> 00:43:59,880
Speaker 2: Laura and Moseley. I like that. It's like a patient

784
00:44:00,080 --> 00:44:03,080
Speaker 2: friendly kind of way of explaining things. And the language

785
00:44:03,080 --> 00:44:06,200
Speaker 2: in that is pain is a distributed process, So there's

786
00:44:06,200 --> 00:44:09,360
Speaker 2: many different parts of the brain affecting the pain experience,

787
00:44:10,239 --> 00:44:12,680
Speaker 2: and this is a hard Like one of the challenges

788
00:44:13,440 --> 00:44:15,880
Speaker 2: with looking at this is like to say, you do

789
00:44:16,080 --> 00:44:20,600
Speaker 2: functional MRI like fMRI studies, and that's about blood flow changes,

790
00:44:20,640 --> 00:44:23,640
Speaker 2: and it's like, is that a perfect measure of what's

791
00:44:23,680 --> 00:44:28,560
Speaker 2: actually happening at a cellular level and physiological level. So

792
00:44:28,640 --> 00:44:31,560
Speaker 2: I think a lot of what I'm saying, I guess

793
00:44:31,640 --> 00:44:35,200
Speaker 2: will be clarified as science keeps getting better and our

794
00:44:35,200 --> 00:44:38,960
Speaker 2: ways of assessing and measuring stuff gets better. But yet,

795
00:44:39,040 --> 00:44:43,200
Speaker 2: just broadly speaking, I think what happens in the central

796
00:44:43,200 --> 00:44:46,120
Speaker 2: nervous system is just so multifactorial. Like that'd be the

797
00:44:46,120 --> 00:44:48,840
Speaker 2: take home message here is there's just so many different

798
00:44:48,880 --> 00:44:52,279
Speaker 2: little processes that are adding up. And if you want

799
00:44:52,320 --> 00:44:54,560
Speaker 2: to kind of experiment with this and develop your own

800
00:44:54,600 --> 00:44:58,040
Speaker 2: internal lock as control, start reflecting on different times you've

801
00:44:58,040 --> 00:45:00,000
Speaker 2: had the same pain, so it might be a headache

802
00:45:00,200 --> 00:45:03,400
Speaker 2: or whatever it is, sawne or something, and try and compare,

803
00:45:03,640 --> 00:45:05,880
Speaker 2: like what are all the ingredients if it was a

804
00:45:05,920 --> 00:45:09,320
Speaker 2: recipe in that pain versus pain A versus pain B,

805
00:45:09,960 --> 00:45:12,000
Speaker 2: And you can do this like in class. I've sat

806
00:45:12,040 --> 00:45:14,759
Speaker 2: in a lecture once where the lecturer got out us

807
00:45:14,760 --> 00:45:17,439
Speaker 2: to put our hands in a really icy cold cup

808
00:45:17,440 --> 00:45:21,600
Speaker 2: of water, and half the audience was looking at it

809
00:45:21,640 --> 00:45:23,480
Speaker 2: and it was told to stare at it, and the

810
00:45:23,520 --> 00:45:25,440
Speaker 2: other half of the audience was told to distract each

811
00:45:25,440 --> 00:45:27,799
Speaker 2: other and not think about it. And it was like

812
00:45:27,840 --> 00:45:30,600
Speaker 2: this really simple thing. It was one minute long, and

813
00:45:30,640 --> 00:45:33,080
Speaker 2: the pain ratings were so different, and it was really

814
00:45:33,120 --> 00:45:36,719
Speaker 2: fascinating Like that kind of like you can, like at

815
00:45:36,760 --> 00:45:40,279
Speaker 2: an acute, short term level, distraction and different strategies can

816
00:45:40,360 --> 00:45:43,480
Speaker 2: seem to help a little bit with the coping and

817
00:45:43,600 --> 00:45:46,960
Speaker 2: probably reduce the pain intensity itself. And so that's where

818
00:45:46,960 --> 00:45:50,719
Speaker 2: it's like, is the goal then to just like distract

819
00:45:50,800 --> 00:45:53,239
Speaker 2: our way out of long term pain? I don't know,

820
00:45:53,400 --> 00:45:55,480
Speaker 2: but maybe it can help us in those flare ups,

821
00:45:55,480 --> 00:46:00,200
Speaker 2: those times where pain seems insurmountable. There are strategies I

822
00:46:00,200 --> 00:46:03,239
Speaker 2: guess so coming up with a plan for long term

823
00:46:03,239 --> 00:46:05,720
Speaker 2: improvement is good, but also coming up with a plan

824
00:46:05,840 --> 00:46:09,160
Speaker 2: for short term coping, I think is really helpful. And

825
00:46:09,200 --> 00:46:11,200
Speaker 2: you want to weigh up the benefits and risks of

826
00:46:11,239 --> 00:46:13,520
Speaker 2: all of the different strategies you're using. And if you

827
00:46:13,520 --> 00:46:16,560
Speaker 2: think you're not using any strategies, you are. You're probably

828
00:46:16,640 --> 00:46:20,359
Speaker 2: just resting and taking medications, and those are passive, like

829
00:46:20,400 --> 00:46:22,879
Speaker 2: they feel like not even a choice, but you are

830
00:46:22,960 --> 00:46:25,280
Speaker 2: actually choosing to do those things. And if you start

831
00:46:25,520 --> 00:46:29,960
Speaker 2: putting the internal lookers of control inside you, then you

832
00:46:30,000 --> 00:46:31,719
Speaker 2: start going, oh, I do have a choice here, and

833
00:46:31,760 --> 00:46:34,520
Speaker 2: if I choose to do that again, that might have

834
00:46:34,600 --> 00:46:37,279
Speaker 2: this consequence. And if I choose to do that, then

835
00:46:37,320 --> 00:46:39,960
Speaker 2: that might have this consequence. And that's when you see

836
00:46:39,960 --> 00:46:42,520
Speaker 2: people start going, oh, I go to the gym, but

837
00:46:42,600 --> 00:46:45,200
Speaker 2: I think it's about the social benefits that's really helping

838
00:46:45,239 --> 00:46:48,560
Speaker 2: me or whatever, And you go, yeah, pain is it's biological,

839
00:46:48,600 --> 00:46:52,360
Speaker 2: it's psychological, and it's social all the time, every single time.

840
00:46:53,440 --> 00:46:56,000
Speaker 2: And I think embracing that is just where we start

841
00:46:56,040 --> 00:46:58,880
Speaker 2: to see this shift, and that's where I'm optimistic about

842
00:46:58,880 --> 00:47:01,400
Speaker 2: the future of pain related healthcare.

843
00:47:01,920 --> 00:47:05,520
Speaker 1: Can I give you a very concrete example. So I'm

844
00:47:05,560 --> 00:47:08,319
Speaker 1: going to be your physiotherapy student and bring this. Let's

845
00:47:08,320 --> 00:47:12,520
Speaker 1: do it to my experience. Right. So by eighteen months

846
00:47:12,520 --> 00:47:17,080
Speaker 1: two years ago, there was a little issue with some

847
00:47:17,200 --> 00:47:21,440
Speaker 1: of my blood work were the white blood cell kind

848
00:47:21,640 --> 00:47:25,040
Speaker 1: was pretty low, and they did some investigations and stuff

849
00:47:25,080 --> 00:47:28,640
Speaker 1: like that, and went to see a specialist and they went, oh,

850
00:47:28,920 --> 00:47:31,120
Speaker 1: I think you're okay, did some further blow brock, and

851
00:47:31,160 --> 00:47:34,000
Speaker 1: then it was again, And then I suppose to Doug said,

852
00:47:34,000 --> 00:47:36,239
Speaker 1: on are my options here? And I said, well, the

853
00:47:36,320 --> 00:47:42,440
Speaker 1: obvious thing that they're worried about with that is obviously cancer, right,

854
00:47:42,520 --> 00:47:45,160
Speaker 1: and a particular type of cancer. So we said, the

855
00:47:45,200 --> 00:47:48,040
Speaker 1: way that you can just know for sure is going

856
00:47:48,080 --> 00:47:51,400
Speaker 1: get a lumber puncture, right, and get a what do

857
00:47:51,440 --> 00:47:53,160
Speaker 1: you call it? Would they take a little bit of

858
00:47:53,200 --> 00:47:57,080
Speaker 1: the bone marrow, right, So get a bone marrow puncture

859
00:47:57,280 --> 00:47:59,960
Speaker 1: and analyze that. So I said, right, let's do it.

860
00:48:00,080 --> 00:48:04,239
Speaker 1: So I went in to get it, and I got

861
00:48:04,320 --> 00:48:10,239
Speaker 1: it the day after my book Death by Comfort was published. Right,

862
00:48:10,560 --> 00:48:14,400
Speaker 1: So here's the context. So I go in and they

863
00:48:14,520 --> 00:48:17,880
Speaker 1: come around and they give you a little local anesthetic

864
00:48:17,920 --> 00:48:20,600
Speaker 1: and then the nurse says, right, the doctor's going to

865
00:48:20,600 --> 00:48:23,359
Speaker 1: be around in a minute to give you morphine, and

866
00:48:23,480 --> 00:48:27,000
Speaker 1: once the morphine kicks in, then we'll do the lumber puncture.

867
00:48:27,480 --> 00:48:30,800
Speaker 1: And I said, what's the morphine for and she said, well,

868
00:48:31,000 --> 00:48:35,520
Speaker 1: it's a very uncomfortable experience. The morphine is just to

869
00:48:35,680 --> 00:48:38,600
Speaker 1: increase your comfort level. And I looked at her and

870
00:48:38,600 --> 00:48:41,799
Speaker 1: I went, I can't have it. I've just published a

871
00:48:41,800 --> 00:48:44,719
Speaker 1: book called Death by Comfort, Why modern life is killing

872
00:48:44,800 --> 00:48:46,759
Speaker 1: us and what we need to do about it. You're

873
00:48:46,800 --> 00:48:49,319
Speaker 1: telling me this is to make me more comfortable. I

874
00:48:49,360 --> 00:48:52,120
Speaker 1: don't want the morphine. And she went, are you crazy

875
00:48:52,120 --> 00:48:55,360
Speaker 1: in the head? And she found this fascinating. So we

876
00:48:55,400 --> 00:48:57,279
Speaker 1: had a chat about it, and then she brought the

877
00:48:57,320 --> 00:49:01,400
Speaker 1: doctor over and I went, I don't want to just

878
00:49:01,640 --> 00:49:04,520
Speaker 1: crack on and he said, and he says, well, everybody

879
00:49:04,560 --> 00:49:08,200
Speaker 1: takes the morphing, he says, apart from people who have

880
00:49:08,719 --> 00:49:12,640
Speaker 1: a reaction to morphine analogy. Yeah. And I said, well

881
00:49:12,640 --> 00:49:15,520
Speaker 1: do they die and he said no. I said, well

882
00:49:15,719 --> 00:49:19,160
Speaker 1: crack on. And so they thought this was very interesting.

883
00:49:19,200 --> 00:49:23,440
Speaker 1: But the nurse then as it was happening, she grabbed

884
00:49:23,440 --> 00:49:26,800
Speaker 1: my hand and started talking to me, and he started

885
00:49:26,800 --> 00:49:29,600
Speaker 1: having a little bit of a laugh around stuff and

886
00:49:30,640 --> 00:49:34,360
Speaker 1: I think two things played in to make that manageable.

887
00:49:34,920 --> 00:49:38,560
Speaker 1: One was my internal locus of control and the fact

888
00:49:38,560 --> 00:49:40,640
Speaker 1: that I just published a book called Death by Comfort

889
00:49:40,680 --> 00:49:44,359
Speaker 1: and this was a boat identity, right, So I think

890
00:49:44,520 --> 00:49:49,520
Speaker 1: that gave me a certain level of control or intended control,

891
00:49:49,560 --> 00:49:52,319
Speaker 1: if you like, over the pain. And then the fact

892
00:49:52,360 --> 00:49:55,920
Speaker 1: that the nurse who thought this was so fascinating, he

893
00:49:56,080 --> 00:49:58,520
Speaker 1: was grabbing my hand and just trying to distract me

894
00:49:58,560 --> 00:50:00,640
Speaker 1: and ask about questions and we having a bit of

895
00:50:00,640 --> 00:50:05,359
Speaker 1: a laugh Wiley fucking because it's pretty horrible alonger for puncture, right,

896
00:50:06,520 --> 00:50:11,520
Speaker 1: But that for me just plays into that whole internal

897
00:50:11,560 --> 00:50:14,680
Speaker 1: looks of control and the distraction element of things.

898
00:50:14,760 --> 00:50:18,720
Speaker 2: Yeah, yeah, yeah, there was a really interesting study looking

899
00:50:18,719 --> 00:50:21,399
Speaker 2: at I think it was epidurals and the language that's

900
00:50:21,520 --> 00:50:24,799
Speaker 2: used when the doctor's about to come in and if

901
00:50:24,840 --> 00:50:27,399
Speaker 2: it gets compared to yeah, this is the worst part

902
00:50:27,400 --> 00:50:31,239
Speaker 2: of the procedure versus sorry, it's like a beasting, and

903
00:50:31,239 --> 00:50:37,239
Speaker 2: it's the worst part of the procedure versus something like oh,

904
00:50:37,360 --> 00:50:39,600
Speaker 2: I can't of remember, this is uncomfortable or a little

905
00:50:39,600 --> 00:50:41,799
Speaker 2: bit of pressure or something like that, and they just

906
00:50:42,200 --> 00:50:44,239
Speaker 2: changed I think it was seven different words in the

907
00:50:44,320 --> 00:50:48,200
Speaker 2: sentence in the two groups of women, and in this

908
00:50:48,280 --> 00:50:50,759
Speaker 2: study the pain difference was more than two out of

909
00:50:50,760 --> 00:50:55,919
Speaker 2: ten on average, just from the language change and your Yeah,

910
00:50:55,960 --> 00:50:59,239
Speaker 2: in your example, you identified that it was an identity

911
00:50:59,280 --> 00:51:01,520
Speaker 2: thing for you. It was good timing in terms of

912
00:51:01,560 --> 00:51:04,759
Speaker 2: the book. You had really good rapport with the nurse.

913
00:51:04,800 --> 00:51:06,480
Speaker 2: By the sound of it. It was fun and it was

914
00:51:06,520 --> 00:51:09,440
Speaker 2: a bit silly, and you're kind of like almost mocking

915
00:51:09,480 --> 00:51:11,200
Speaker 2: the facts of what's going on and all that. So

916
00:51:11,360 --> 00:51:14,080
Speaker 2: like it's just like a really, that's a hard thing

917
00:51:14,160 --> 00:51:16,040
Speaker 2: to replicate in anyone else, because no one else has

918
00:51:16,040 --> 00:51:20,000
Speaker 2: published that book the day before, right, and just seeing

919
00:51:20,080 --> 00:51:24,920
Speaker 2: these the fact that the nurse grasped onto distraction and

920
00:51:25,000 --> 00:51:29,560
Speaker 2: handholding and comfort and laughing and so like, you've got

921
00:51:29,560 --> 00:51:35,480
Speaker 2: this nice biapsychosocial coping strategy, and our body has internal

922
00:51:36,000 --> 00:51:40,560
Speaker 2: like they're called endogenous opioids, and so like your internal

923
00:51:40,600 --> 00:51:42,920
Speaker 2: system would have been doing its best.

924
00:51:43,239 --> 00:51:47,240
Speaker 1: No, and I suspect, you know, this is a complete

925
00:51:47,280 --> 00:51:50,400
Speaker 1: guess that it probably up regulated more than if I

926
00:51:50,440 --> 00:51:51,360
Speaker 1: got the morphine.

927
00:51:51,680 --> 00:51:54,480
Speaker 2: I would guess, oh, yes, yes, yes, So yeah, we

928
00:51:54,480 --> 00:51:57,960
Speaker 2: see this in people who take opioids long term, their

929
00:51:58,239 --> 00:52:01,560
Speaker 2: ability to generate the internal opioids. I think it seems

930
00:52:01,560 --> 00:52:04,920
Speaker 2: like it's reduced. And so there's this conditioned kind of

931
00:52:05,000 --> 00:52:09,080
Speaker 2: state that happens where it's called opioid induced hyper algaesier,

932
00:52:09,160 --> 00:52:11,400
Speaker 2: where you take the tablet and it makes the pain worse.

933
00:52:12,600 --> 00:52:15,160
Speaker 2: And that's a really hard thing when people are dependent

934
00:52:15,200 --> 00:52:17,279
Speaker 2: on it. They can't stop taking it, but it's making

935
00:52:17,280 --> 00:52:18,680
Speaker 2: it worse. And they can't stop taking it, but it's

936
00:52:18,719 --> 00:52:20,840
Speaker 2: made it worse. And that's some of the kind of

937
00:52:20,880 --> 00:52:25,520
Speaker 2: the challenges that we see with these these external things

938
00:52:25,600 --> 00:52:30,800
Speaker 2: like surgeries, needles, medications, and that's why internal strategies are promoted.

939
00:52:30,840 --> 00:52:33,919
Speaker 2: But I don't want people to go, oh, well, Paul

940
00:52:34,000 --> 00:52:36,560
Speaker 2: did it. I'm going to do the same thing necessarily,

941
00:52:36,600 --> 00:52:38,680
Speaker 2: I think informed decision.

942
00:52:39,040 --> 00:52:42,200
Speaker 1: I'm a bit of a nutter, right, they don't try this,

943
00:52:42,800 --> 00:52:45,279
Speaker 1: but it would have been a really interesting experiment, right

944
00:52:45,360 --> 00:52:49,239
Speaker 1: to do the lumber puncture with just me and the

945
00:52:49,239 --> 00:52:52,640
Speaker 1: boat and nan have another one where it's the gnose

946
00:52:53,239 --> 00:52:57,520
Speaker 1: right and and there, and do the comparison, and that'd

947
00:52:57,560 --> 00:53:02,040
Speaker 1: be an interesting controlled experiment to see what elements played

948
00:53:02,080 --> 00:53:04,680
Speaker 1: into it, whether I just published the book or not

949
00:53:04,680 --> 00:53:06,719
Speaker 1: published the book, and whether the nose was holding my

950
00:53:06,760 --> 00:53:09,080
Speaker 1: hand had distracted me or not distract me, but anyway,

951
00:53:09,760 --> 00:53:10,200
Speaker 1: one of the.

952
00:53:10,160 --> 00:53:13,080
Speaker 2: Things with that is it's really hard just to be

953
00:53:13,120 --> 00:53:16,439
Speaker 2: able to have the control group right, Like, you can't Yeah,

954
00:53:16,480 --> 00:53:19,440
Speaker 2: you can't do that very well. And there's a researcher

955
00:53:19,480 --> 00:53:21,359
Speaker 2: I work with. His name's Mick Thacker, who does all

956
00:53:21,360 --> 00:53:23,960
Speaker 2: this stuff on predictive processing, and they're doing work in AI,

957
00:53:24,520 --> 00:53:27,480
Speaker 2: and the long term goal is a digital twin so

958
00:53:27,520 --> 00:53:29,880
Speaker 2: you can FEEDO type get a similar like it's like

959
00:53:29,920 --> 00:53:33,000
Speaker 2: a virtual Paul, and they could test stuff and see

960
00:53:33,000 --> 00:53:34,919
Speaker 2: how your body would react, and then they could test

961
00:53:34,920 --> 00:53:38,840
Speaker 2: another condition. And so I think potentially technology might allow

962
00:53:38,960 --> 00:53:42,279
Speaker 2: us to start answering these questions of like, oh, if

963
00:53:42,280 --> 00:53:44,360
Speaker 2: we could have a control group, we'd be able to

964
00:53:44,360 --> 00:53:47,239
Speaker 2: find out if it why Yeah. And I think once

965
00:53:47,280 --> 00:53:50,520
Speaker 2: we get to that point, we'll have so many more

966
00:53:50,600 --> 00:53:53,360
Speaker 2: answers than questions. Whereas at the moment, I feel like

967
00:53:53,400 --> 00:53:56,200
Speaker 2: every study I do, like I think we're up to

968
00:53:56,280 --> 00:53:59,000
Speaker 2: like eight papers this year, and it's like every single paper,

969
00:53:59,040 --> 00:54:01,240
Speaker 2: I'm like, we've just ended up with more questions questions.

970
00:54:01,680 --> 00:54:03,239
Speaker 2: It's like we've chipped away at it and it's a

971
00:54:03,239 --> 00:54:06,680
Speaker 2: better question than ever before, and we've answered something, but

972
00:54:06,760 --> 00:54:10,000
Speaker 2: like now there's even more things to answer and that's

973
00:54:10,080 --> 00:54:12,320
Speaker 2: just I guess it's part of the excitement of research

974
00:54:12,440 --> 00:54:15,200
Speaker 2: is you're having discussions and you're thinking about things that

975
00:54:15,280 --> 00:54:17,359
Speaker 2: no one has thought about in the past because we've

976
00:54:17,360 --> 00:54:20,160
Speaker 2: never known what we've known now. And I love that. Like,

977
00:54:20,239 --> 00:54:22,440
Speaker 2: to me, that's just like in twenty years or thirty

978
00:54:22,480 --> 00:54:24,920
Speaker 2: forty years, I'm definitely going to have that feeling still

979
00:54:25,160 --> 00:54:26,240
Speaker 2: and it's really exciting.

980
00:54:26,320 --> 00:54:28,759
Speaker 1: Yeah, it's the never ending quest for knowledge, right, It's

981
00:54:29,400 --> 00:54:32,239
Speaker 1: the gift that keeps on giving. Let's I am a

982
00:54:32,280 --> 00:54:33,960
Speaker 1: little bit of ware of time, and I do want

983
00:54:33,960 --> 00:54:37,840
Speaker 1: to talk about the children's stuff, right, So you have

984
00:54:37,920 --> 00:54:43,040
Speaker 1: written some books on and little bits of videos for children.

985
00:54:43,400 --> 00:54:48,000
Speaker 1: What to talk to me about the challenge of translating

986
00:54:49,280 --> 00:54:53,080
Speaker 1: all of the complex stuff you know to kids and

987
00:54:53,480 --> 00:54:55,840
Speaker 1: what if you find that actually works.

988
00:54:56,080 --> 00:54:58,640
Speaker 2: I've got them actually they're just sitting here. So the

989
00:54:58,719 --> 00:55:02,759
Speaker 2: kids books, it's a series five independent books and then

990
00:55:02,760 --> 00:55:03,879
Speaker 2: you can get them in a set as well.

991
00:55:03,920 --> 00:55:05,560
Speaker 1: Zoe and Zach's panhakes.

992
00:55:05,560 --> 00:55:08,160
Speaker 2: I love it, yes, yeah, yeah. And the idea is

993
00:55:08,200 --> 00:55:10,759
Speaker 2: that rather than having a resource that covers lots of

994
00:55:10,760 --> 00:55:13,000
Speaker 2: different topics, like kind of like in this podcast, we've

995
00:55:13,000 --> 00:55:15,080
Speaker 2: covered so many different topics and there's all these differ

996
00:55:15,160 --> 00:55:19,000
Speaker 2: rabbit holes that people can go down. I think for kids, like,

997
00:55:19,200 --> 00:55:22,480
Speaker 2: how can we work out if all of these messages

998
00:55:22,520 --> 00:55:24,840
Speaker 2: are helpful or maybe some of these messages are helpful.

999
00:55:25,160 --> 00:55:27,040
Speaker 2: What I wanted to do is like, let's break them

1000
00:55:27,080 --> 00:55:31,080
Speaker 2: into discrete resources and we can see, Oh, the kids

1001
00:55:31,080 --> 00:55:33,880
Speaker 2: who have chronic pains seem to benefit most from the

1002
00:55:33,960 --> 00:55:36,720
Speaker 2: third book, and then or if they want to engage

1003
00:55:36,719 --> 00:55:39,319
Speaker 2: in exercise and greater exposure, the fourth book's a good

1004
00:55:39,320 --> 00:55:42,520
Speaker 2: starting point, and we're finding out some stuff about the

1005
00:55:42,600 --> 00:55:46,360
Speaker 2: nitty gritty of the education. Whereas I think because like

1006
00:55:46,440 --> 00:55:48,880
Speaker 2: for some people, if you say, oh, pain doesn't relate

1007
00:55:48,920 --> 00:55:52,759
Speaker 2: to damage very well, even in a lab setting, some

1008
00:55:52,800 --> 00:55:55,840
Speaker 2: people get so upset with that message because it's just

1009
00:55:55,880 --> 00:55:57,799
Speaker 2: like you're saying, Hey, are you saying I'm faking it?

1010
00:55:58,040 --> 00:55:58,279
Speaker 1: Yeah?

1011
00:55:58,520 --> 00:56:01,319
Speaker 2: Whereas for other people it's so oh, it's such an

1012
00:56:01,360 --> 00:56:04,560
Speaker 2: important part of their journey, having that moment where they

1013
00:56:04,680 --> 00:56:08,479
Speaker 2: learned that. Whereas I think everyone like the second book

1014
00:56:08,560 --> 00:56:10,640
Speaker 2: in this series I can show you. I don't know

1015
00:56:10,680 --> 00:56:13,360
Speaker 2: if people will be able to watch this but yeah.

1016
00:56:13,360 --> 00:56:15,080
Speaker 2: This is called Zoe z Oppen's Lights It Up, and

1017
00:56:15,320 --> 00:56:18,120
Speaker 2: it's based on a real lab study where in the

1018
00:56:18,120 --> 00:56:21,600
Speaker 2: presence of a different colored light people felt different amounts

1019
00:56:21,600 --> 00:56:24,240
Speaker 2: of pain. And so in the story, little Zoe visits

1020
00:56:24,239 --> 00:56:27,200
Speaker 2: her grandma's lab and there's the red light and the

1021
00:56:27,200 --> 00:56:29,839
Speaker 2: blue light. And I'm sure I reckon you could guess

1022
00:56:29,840 --> 00:56:32,719
Speaker 2: this correctly. People felt more pain in the presence of

1023
00:56:32,760 --> 00:56:33,320
Speaker 2: which color.

1024
00:56:33,760 --> 00:56:38,240
Speaker 1: I would say, Oh, interesting, blue light, I would say

1025
00:56:38,680 --> 00:56:39,920
Speaker 1: more blue.

1026
00:56:41,360 --> 00:56:43,680
Speaker 2: So pain, more pain with blue or more pain with red?

1027
00:56:43,719 --> 00:56:47,080
Speaker 1: What do you think I would Oh, No, more pain

1028
00:56:47,120 --> 00:56:49,640
Speaker 1: with red, for sure, more pain with red because red

1029
00:56:50,000 --> 00:56:52,160
Speaker 1: would be associated with pain and inflammation.

1030
00:56:52,840 --> 00:56:56,080
Speaker 2: Yeah, sure, and stop signs and danger and warning and.

1031
00:56:56,360 --> 00:56:59,759
Speaker 1: All of that interesting little aside. Right, So placeboll in

1032
00:57:00,080 --> 00:57:07,520
Speaker 1: resting that blue pills are better for anxiety, right, unless

1033
00:57:07,560 --> 00:57:12,520
Speaker 1: you're an Italian meal and which kiss they're not because

1034
00:57:12,600 --> 00:57:15,960
Speaker 1: they get excited about blue because that's the color of

1035
00:57:16,000 --> 00:57:17,840
Speaker 1: the national soccer teams soccer team.

1036
00:57:17,920 --> 00:57:22,880
Speaker 2: Yeah right, yes, so it's really fac so I think yes. Anyway,

1037
00:57:22,880 --> 00:57:26,680
Speaker 2: we basically this kid's book is about I'm kind of

1038
00:57:26,680 --> 00:57:30,480
Speaker 2: helping kids grasp the study more or less and go

1039
00:57:30,600 --> 00:57:32,600
Speaker 2: hang on like The key line in the book is

1040
00:57:32,600 --> 00:57:34,600
Speaker 2: if a little light can change the volume of pain,

1041
00:57:34,920 --> 00:57:37,360
Speaker 2: plenty more is possible in my brainy brain. And then

1042
00:57:37,360 --> 00:57:40,080
Speaker 2: it goes through the BIA psychosocial model and it's all

1043
00:57:40,080 --> 00:57:43,360
Speaker 2: written like a kind of Doctor Susian style, lots of

1044
00:57:43,440 --> 00:57:46,600
Speaker 2: fun and cartoons, interactive way of thinking about it. And

1045
00:57:46,640 --> 00:57:50,439
Speaker 2: for me, I don't think it's like the books. I mean,

1046
00:57:50,560 --> 00:57:53,400
Speaker 2: I get emails from people saying the books have changed

1047
00:57:53,440 --> 00:57:55,840
Speaker 2: my kid's life, it's fixed our whole family, and it's

1048
00:57:55,840 --> 00:57:57,480
Speaker 2: like as if it's a cure, and I'm like, I

1049
00:57:57,520 --> 00:58:01,600
Speaker 2: don't think that's really like a good way of thinking

1050
00:58:01,640 --> 00:58:04,360
Speaker 2: about the books necessarily, like often they can be a support,

1051
00:58:05,000 --> 00:58:07,000
Speaker 2: but for me, I think at a minimum they're a

1052
00:58:07,000 --> 00:58:09,920
Speaker 2: conversation starter. And so a lot of clinics and stuff

1053
00:58:09,960 --> 00:58:13,240
Speaker 2: have this open and they've got the kid with juvenile

1054
00:58:13,600 --> 00:58:17,960
Speaker 2: arthritis and they're going the rheumatologists are saying, well, the

1055
00:58:18,000 --> 00:58:21,080
Speaker 2: disease is at bay at the moment, it's okay, and

1056
00:58:21,120 --> 00:58:23,200
Speaker 2: then the family's left going, well, why do I have

1057
00:58:23,240 --> 00:58:26,120
Speaker 2: all this pain? And so the books are kind of

1058
00:58:26,160 --> 00:58:30,720
Speaker 2: functioning as that conversation starter piece of going The science

1059
00:58:30,760 --> 00:58:33,439
Speaker 2: doesn't need to be that inaccessible and complex, like, let's

1060
00:58:33,440 --> 00:58:36,000
Speaker 2: bring it down and what do you think of Zoe's experience?

1061
00:58:36,000 --> 00:58:38,480
Speaker 2: And I think having a character and a relatable way

1062
00:58:38,800 --> 00:58:43,000
Speaker 2: of approaching the topic is much better than a textbook.

1063
00:58:43,600 --> 00:58:47,040
Speaker 2: But obviously I'm biased. I've made the resource. But yeah,

1064
00:58:47,080 --> 00:58:49,400
Speaker 2: so that's kind of the backstory of the books. And

1065
00:58:49,520 --> 00:58:52,440
Speaker 2: it's been so cool to see, like you write a

1066
00:58:52,480 --> 00:58:54,480
Speaker 2: research paper and a few thousand people see it in

1067
00:58:54,520 --> 00:58:56,880
Speaker 2: a year or something, but you do something like a

1068
00:58:56,880 --> 00:58:59,040
Speaker 2: ted ed video or you make kids books and it

1069
00:58:59,240 --> 00:59:02,040
Speaker 2: just goes out to so many more people, and I

1070
00:59:02,160 --> 00:59:05,120
Speaker 2: just I love that, Like I think, yeah, the reason

1071
00:59:05,160 --> 00:59:07,760
Speaker 2: I moved from clinical work into to research and to

1072
00:59:07,880 --> 00:59:10,240
Speaker 2: teaching is to try and help more than one person

1073
00:59:10,240 --> 00:59:12,440
Speaker 2: at a time. It's like a good version of a

1074
00:59:12,480 --> 00:59:16,640
Speaker 2: pyramid scheme kind of thing. Yeah, but it's like we

1075
00:59:16,680 --> 00:59:20,120
Speaker 2: can using mass media and the Internet. It's facilitated the

1076
00:59:20,200 --> 00:59:24,040
Speaker 2: chance to disseminate knowledge at a greater rate to more

1077
00:59:24,120 --> 00:59:26,640
Speaker 2: and more people and to kind of even out some

1078
00:59:26,680 --> 00:59:30,160
Speaker 2: of these health literacy inequalities around the world. And so

1079
00:59:30,200 --> 00:59:32,120
Speaker 2: I want to contribute to those efforts, and I think

1080
00:59:32,520 --> 00:59:34,200
Speaker 2: hopefully there's people wanting to do the same.

1081
00:59:34,680 --> 00:59:36,720
Speaker 1: Have you turned the book. I thought about turning the

1082
00:59:36,720 --> 00:59:41,520
Speaker 1: book into a series of little TikTok videos and yeah,

1083
00:59:41,560 --> 00:59:44,480
Speaker 1: an animeate it, right, because that would go out and

1084
00:59:44,480 --> 00:59:45,800
Speaker 1: read so many kids.

1085
00:59:46,360 --> 00:59:49,280
Speaker 2: Yes, yes, so there's been talks about like a TV thing.

1086
00:59:49,880 --> 00:59:52,240
Speaker 2: There's lots of these kind of it's all in early

1087
00:59:52,280 --> 00:59:53,920
Speaker 2: stages and we haven't done it yet. So if someone's

1088
00:59:53,960 --> 00:59:58,680
Speaker 2: listening and so, they should reach out later. But it's

1089
00:59:58,720 --> 01:00:02,640
Speaker 2: a hard thing going, Yeah, just what's that next step? Like,

1090
01:00:02,680 --> 01:00:05,280
Speaker 2: how do we help people more than what we're currently doing?

1091
01:00:05,360 --> 01:00:07,840
Speaker 2: And I think that's my job as a researcher, is

1092
01:00:07,880 --> 01:00:09,959
Speaker 2: to try and be strategic and think in the long

1093
01:00:10,040 --> 01:00:13,840
Speaker 2: term about these strategies. But yeah, I just can't believe

1094
01:00:13,920 --> 01:00:18,959
Speaker 2: how helpful a shiny resource is versus like a photocopied

1095
01:00:19,040 --> 01:00:22,720
Speaker 2: stick figure drawing. It seems to have a real big

1096
01:00:22,720 --> 01:00:26,200
Speaker 2: effect on our current kind of Western culture and approach

1097
01:00:26,240 --> 01:00:31,200
Speaker 2: to how we consume information. It's really hard, I think. Yeah,

1098
01:00:31,240 --> 01:00:33,360
Speaker 2: as you mentioned, like things like TikTok are just changing

1099
01:00:33,360 --> 01:00:36,760
Speaker 2: the way that people kind of process their learning.

1100
01:00:37,560 --> 01:00:41,600
Speaker 1: So me, you clearly have a very infectious enthusiasm for

1101
01:00:42,400 --> 01:00:46,720
Speaker 1: what you do. What are you excited about on the horizon.

1102
01:00:47,080 --> 01:00:50,560
Speaker 2: Yeah, I've actually just worked on another kids book series

1103
01:00:50,600 --> 01:00:53,040
Speaker 2: for preschoolers. So like, I guess it's this question of

1104
01:00:53,080 --> 01:00:54,880
Speaker 2: how young do we go right, Like do we go

1105
01:00:54,960 --> 01:00:58,240
Speaker 2: back all the way to like the breastfeeding mom or

1106
01:00:58,240 --> 01:01:00,760
Speaker 2: maybe in utero the expecting pair. Who do we want

1107
01:01:00,800 --> 01:01:03,840
Speaker 2: to educate? And I think so the step from primary

1108
01:01:03,880 --> 01:01:06,320
Speaker 2: school is to go to preschool. And you can't talk

1109
01:01:06,320 --> 01:01:08,520
Speaker 2: about pain. I don't think it, Like, I mean you could,

1110
01:01:08,600 --> 01:01:12,520
Speaker 2: and you could talk about acute pain management strategies, but

1111
01:01:12,600 --> 01:01:15,280
Speaker 2: I think what's good for the nervous system in the

1112
01:01:15,320 --> 01:01:17,240
Speaker 2: long term, Like they're the kinds of things I want

1113
01:01:17,280 --> 01:01:19,840
Speaker 2: to be educating and providing the science about. And so

1114
01:01:19,920 --> 01:01:23,160
Speaker 2: we've made this book for preschoolers, and it's about physical

1115
01:01:23,160 --> 01:01:26,720
Speaker 2: activity and play based activity. And it's not like I'll

1116
01:01:26,720 --> 01:01:29,120
Speaker 2: do three sets of ten of this exercise or anything

1117
01:01:29,160 --> 01:01:33,240
Speaker 2: like that. It's like, let's just kind of normalize outdoor

1118
01:01:33,680 --> 01:01:37,720
Speaker 2: fun adventures, play using our gross motor fine motor skills,

1119
01:01:38,240 --> 01:01:41,480
Speaker 2: like kind of helping people readiness for school, and like

1120
01:01:41,600 --> 01:01:45,840
Speaker 2: thinking just more whole child than three one body part.

1121
01:01:45,800 --> 01:01:49,200
Speaker 1: Free range children rather than pregging buttery children.

1122
01:01:50,560 --> 01:01:51,800
Speaker 2: That's what funny, Like I.

1123
01:01:51,720 --> 01:01:53,920
Speaker 1: Don't need seriously that's what we need to get back to,

1124
01:01:54,120 --> 01:01:58,600
Speaker 1: is rearsing free range kids, whether ranging and climbing trees

1125
01:01:58,640 --> 01:02:02,280
Speaker 1: and doing shit and learning stuff, rather than battery kids

1126
01:02:02,280 --> 01:02:04,360
Speaker 1: that are stuck inside on screens. Yeah.

1127
01:02:04,440 --> 01:02:07,480
Speaker 2: Yeah, and it's funny. I'm not, like, I'm a physio

1128
01:02:07,560 --> 01:02:10,560
Speaker 2: and obviously biased towards doing more exercise and stuff, but

1129
01:02:10,800 --> 01:02:14,320
Speaker 2: I think screens and some of the technological advancements for

1130
01:02:14,360 --> 01:02:16,440
Speaker 2: people to be able to learn more efficiently is just

1131
01:02:16,520 --> 01:02:19,560
Speaker 2: like mind blowing. And so I'm not against screens, but

1132
01:02:19,600 --> 01:02:22,800
Speaker 2: I think there's just the childhood that a lot of

1133
01:02:22,840 --> 01:02:26,720
Speaker 2: adults grew up with is not the same now, and

1134
01:02:27,560 --> 01:02:30,200
Speaker 2: there's this real thirst for like how do we marry

1135
01:02:30,240 --> 01:02:33,000
Speaker 2: this up of like, Okay, screens are kind of unavoidable,

1136
01:02:33,520 --> 01:02:36,160
Speaker 2: so we need to make it clear that there's benefits

1137
01:02:36,160 --> 01:02:40,680
Speaker 2: of also doing other stuff. And so it's raising that conversation.

1138
01:02:40,800 --> 01:02:43,600
Speaker 2: Is this next step, And I guess the to answer

1139
01:02:43,600 --> 01:02:46,240
Speaker 2: your question about the excitement, it's about thinking like, can

1140
01:02:46,280 --> 01:02:50,200
Speaker 2: we make a kind of curriculum or a big societal

1141
01:02:50,320 --> 01:02:53,400
Speaker 2: change for every age group across the whole lifespan. That's

1142
01:02:53,400 --> 01:02:54,760
Speaker 2: where I'm heading at the moment.

1143
01:02:55,120 --> 01:02:58,720
Speaker 1: Yeah, very cool, Josh. This has been bloody interesting. Who

1144
01:02:58,760 --> 01:03:01,200
Speaker 1: would know that a com about pain could be so

1145
01:03:01,280 --> 01:03:01,760
Speaker 1: much fun.

1146
01:03:03,000 --> 01:03:05,560
Speaker 2: I'm so glad. I really enjoyed it, and I appreciate

1147
01:03:05,920 --> 01:03:08,840
Speaker 2: you clearly have so much knowledge about such a big,

1148
01:03:08,920 --> 01:03:11,920
Speaker 2: broad number of topics. I kind of feel like I'm

1149
01:03:11,960 --> 01:03:16,240
Speaker 2: so narrowly focused and got my blinders on looking at pain.

1150
01:03:16,320 --> 01:03:19,800
Speaker 1: But yeah, well I'm a whatether they call it a

1151
01:03:21,480 --> 01:03:24,800
Speaker 1: it's the master of none, a jack of ultra, jack

1152
01:03:24,840 --> 01:03:27,479
Speaker 1: of all tree, it's a master of none. But yeah,

1153
01:03:27,720 --> 01:03:32,000
Speaker 1: look for me, I think I sure your enthusiasm just

1154
01:03:32,200 --> 01:03:36,760
Speaker 1: for or like awe about the body in general, and

1155
01:03:37,000 --> 01:03:41,400
Speaker 1: just high freaking cool shit is when you look onto

1156
01:03:41,440 --> 01:03:45,120
Speaker 1: the hoot, at the nervous system, the muscle system, you know,

1157
01:03:45,160 --> 01:03:48,080
Speaker 1: all of our systems and just how they react to

1158
01:03:48,320 --> 01:03:52,080
Speaker 1: inputs from the environment and psychology and all of that

1159
01:03:52,120 --> 01:03:55,720
Speaker 1: stuff is just so boddy fascinating. It's very cool.

1160
01:03:56,160 --> 01:03:56,960
Speaker 2: Totally agree.

1161
01:03:57,200 --> 01:04:01,720
Speaker 1: So keep doing what you're doing, keep your factious enthusiasm,

1162
01:04:02,320 --> 01:04:04,440
Speaker 1: because I think that that has a big impact. And

1163
01:04:05,800 --> 01:04:07,880
Speaker 1: it would be very cool to be a student of

1164
01:04:07,920 --> 01:04:10,919
Speaker 1: yours getting lectured too, rather than these boring as butt

1165
01:04:10,960 --> 01:04:13,640
Speaker 1: shit lecturers that are tan.

1166
01:04:16,640 --> 01:04:18,880
Speaker 2: Yeah, I hope there's little bits and pieces that are

1167
01:04:18,880 --> 01:04:21,080
Speaker 2: helpful here and people get to have the joy of

1168
01:04:21,120 --> 01:04:23,440
Speaker 2: being curious and going down all the rabbit holes that

1169
01:04:23,480 --> 01:04:24,040
Speaker 2: we mentioned.

1170
01:04:24,360 --> 01:04:27,760
Speaker 1: Yeah, absolutely, thanks Matte, and so well, oh, what's the

1171
01:04:27,800 --> 01:04:32,160
Speaker 1: best people of saying people? It's joshuapiet dot com.

1172
01:04:32,360 --> 01:04:36,000
Speaker 2: W is my middle initial. There's a NASCAR driver and

1173
01:04:36,000 --> 01:04:38,360
Speaker 2: a Netflix director. There's people with the same name as me,

1174
01:04:38,760 --> 01:04:41,360
Speaker 2: and so I've had to insert that W. So Joshua

1175
01:04:41,520 --> 01:04:44,480
Speaker 2: wpat dot com. There's a contact form and if you

1176
01:04:44,640 --> 01:04:46,680
Speaker 2: just or you could look up UTS and my name

1177
01:04:46,760 --> 01:04:49,800
Speaker 2: and it will come up with contact details. So yeah,

1178
01:04:49,840 --> 01:04:51,880
Speaker 2: reach out. I'd love to hear from people, happy to

1179
01:04:52,120 --> 01:04:55,080
Speaker 2: kind of have more conversations and see where things had.

1180
01:04:55,240 --> 01:04:57,600
Speaker 1: Awesome, great stuff. Matt, thanks for your time. This has

1181
01:04:57,640 --> 01:05:03,720
Speaker 1: been bloody amazing.