1 00:00:00,200 --> 00:00:03,640 Speaker 1: Earlier this week we were talking about chronic pain. This 2 00:00:03,720 --> 00:00:06,320 Speaker 1: is Pain Week, National Pain Week, and a lot of 3 00:00:06,360 --> 00:00:10,240 Speaker 1: work being undertaken around the country, including here in South Australia, 4 00:00:10,400 --> 00:00:13,039 Speaker 1: tackling the issue of pain and how to deal with it, 5 00:00:13,119 --> 00:00:16,120 Speaker 1: how it works and how to get on top. Director 6 00:00:16,160 --> 00:00:20,480 Speaker 1: of the Visceral Pain Research Group at Samary, the SA 7 00:00:20,560 --> 00:00:24,160 Speaker 1: Health Medical Research Institute on North Terrace. So she's greater building. 8 00:00:24,800 --> 00:00:28,280 Speaker 1: Professor Stewart Briley is on the light. Stewart, good morning, 9 00:00:30,640 --> 00:00:33,599 Speaker 1: Thank you for your time. Tell us about pain, how 10 00:00:33,640 --> 00:00:37,600 Speaker 1: it works, different kinds. How does it work? Pain? Obviously 11 00:00:37,680 --> 00:00:38,600 Speaker 1: it's a nerve thing, I. 12 00:00:38,479 --> 00:00:42,960 Speaker 2: Imagine that's right. So you know, on a daily basis, 13 00:00:43,000 --> 00:00:45,720 Speaker 2: pain's got an important function. It helps protect us. It 14 00:00:45,800 --> 00:00:48,760 Speaker 2: helps us interact with our own environment. So if we 15 00:00:48,800 --> 00:00:52,320 Speaker 2: go and we touch a hot kettle, we experience pain. 16 00:00:52,960 --> 00:00:56,280 Speaker 2: That's to help protect us and also remember next time, hey, 17 00:00:56,480 --> 00:00:59,360 Speaker 2: don't touch the kettle. It's going to hurt. The reason 18 00:00:59,360 --> 00:01:04,080 Speaker 2: it hurts because it causes damage that case of our fingers, 19 00:01:04,160 --> 00:01:08,440 Speaker 2: but also it sends impulses up to our through nerves, 20 00:01:08,520 --> 00:01:11,039 Speaker 2: up to our brain saying we have pain. But that 21 00:01:11,120 --> 00:01:14,440 Speaker 2: sort of pain has a purpose and after that for 22 00:01:14,480 --> 00:01:16,440 Speaker 2: a couple of days, we'll know that if we just 23 00:01:16,560 --> 00:01:20,319 Speaker 2: gently touch our fingers after we've burnt them, will experience 24 00:01:20,360 --> 00:01:23,040 Speaker 2: pain when we normally don't. And that's really a protective 25 00:01:23,120 --> 00:01:27,160 Speaker 2: mechanism that lets the tissue heal back to normal. For 26 00:01:27,240 --> 00:01:29,360 Speaker 2: most of us, that's the last of the pain we 27 00:01:29,920 --> 00:01:33,760 Speaker 2: will experience. But for patients who have chronic pain, and 28 00:01:33,800 --> 00:01:36,479 Speaker 2: this is pain which lasts for three months or more 29 00:01:37,080 --> 00:01:40,440 Speaker 2: in many cases can last for years or decades, these 30 00:01:40,480 --> 00:01:44,600 Speaker 2: patients will experience ongoing chronic pain and it can be 31 00:01:44,640 --> 00:01:47,400 Speaker 2: from multiple different parts of the body. It can be migrained, 32 00:01:47,440 --> 00:01:51,200 Speaker 2: it can be back pain, osterearthritis pain. It can be 33 00:01:51,240 --> 00:01:55,480 Speaker 2: also visceral pain, which you know a condition such as 34 00:01:56,000 --> 00:02:02,640 Speaker 2: irritable bower syndrome, inflammatory bow disease, demetriosis. These are debilitating 35 00:02:02,680 --> 00:02:07,120 Speaker 2: conditions and it's the chronic pain is Australia's number one 36 00:02:07,120 --> 00:02:09,600 Speaker 2: disability at the moment. Really, yet you know there are 37 00:02:09,600 --> 00:02:11,160 Speaker 2: so few treatments for it. 38 00:02:11,480 --> 00:02:15,120 Speaker 1: Okay, why is that? Why have we not got on 39 00:02:15,600 --> 00:02:18,200 Speaker 1: top of it? Is it difficult to work out the 40 00:02:18,280 --> 00:02:20,760 Speaker 1: source and therefore the treatment. Is that part of the answer. 41 00:02:22,480 --> 00:02:24,840 Speaker 2: Well, that's right, I mean calling something pain is a 42 00:02:24,880 --> 00:02:28,560 Speaker 2: bit like calling something cancer. There's lots of different underlying 43 00:02:29,000 --> 00:02:31,480 Speaker 2: forms of cancer, and there's lots of different underlying forms 44 00:02:31,520 --> 00:02:36,360 Speaker 2: of pain, and there are different ways in which pain 45 00:02:36,480 --> 00:02:40,359 Speaker 2: is generated in these states, and also over time, the 46 00:02:41,120 --> 00:02:43,519 Speaker 2: cause of the pain can be at various sides to 47 00:02:43,560 --> 00:02:46,239 Speaker 2: the body, but might start off in the periphery. It 48 00:02:46,320 --> 00:02:49,320 Speaker 2: might start off with those burnt fingers, or it might 49 00:02:49,400 --> 00:02:51,359 Speaker 2: start off with a back issue, or or it might 50 00:02:51,480 --> 00:02:55,840 Speaker 2: start off with an issue in our gut. But over time, 51 00:02:56,080 --> 00:03:01,120 Speaker 2: these ongoing false salaams can then signal from the proofery 52 00:03:01,160 --> 00:03:04,760 Speaker 2: can then change things within the spinal cord and also 53 00:03:04,760 --> 00:03:07,959 Speaker 2: in our brain. And a lot of patients with chronic 54 00:03:08,000 --> 00:03:13,440 Speaker 2: pain also experience anxiety and depression, so can really sort 55 00:03:13,440 --> 00:03:16,239 Speaker 2: of become entrenched and affect general well being. 56 00:03:16,240 --> 00:03:19,239 Speaker 1: And these patients, you're a bit of an expert, I 57 00:03:19,320 --> 00:03:22,280 Speaker 1: understand on the gut brain axis. Tell us about that? 58 00:03:22,600 --> 00:03:23,160 Speaker 1: What is that? 59 00:03:24,840 --> 00:03:28,360 Speaker 2: Yeah, So, just like our skin and our fingers that 60 00:03:28,400 --> 00:03:33,680 Speaker 2: are innovated by nerves also gas ro intestinal tractors for 61 00:03:33,760 --> 00:03:35,920 Speaker 2: most of us on a daily basis, if we're lucky, 62 00:03:37,000 --> 00:03:40,080 Speaker 2: don't really detect anything from our gut apart from maybe 63 00:03:40,680 --> 00:03:42,800 Speaker 2: I'm hungry, I need to eat, or I've got to 64 00:03:42,880 --> 00:03:46,800 Speaker 2: go to the bathroom. For patients who suffer from chronic 65 00:03:46,840 --> 00:03:50,680 Speaker 2: visceral pains such as irritable bows and drummer inflammatory bio disease, 66 00:03:51,600 --> 00:03:54,840 Speaker 2: and they have this ongoing pain signal coming from the 67 00:03:55,320 --> 00:03:58,560 Speaker 2: gas ro intestinal tract. When you talk to these patients 68 00:03:58,560 --> 00:04:00,880 Speaker 2: and you ask them to describe that, they say, well, 69 00:04:01,520 --> 00:04:04,760 Speaker 2: you've ever had food poisoning where you're crippled over an 70 00:04:04,760 --> 00:04:07,960 Speaker 2: agony and you've got to go to the bathroom. Basically say, 71 00:04:07,960 --> 00:04:10,880 Speaker 2: it's like that, but on a daily, weekly basis for 72 00:04:10,960 --> 00:04:17,279 Speaker 2: potentially years at a time. So it's just horrendous. And really, 73 00:04:17,279 --> 00:04:19,440 Speaker 2: what we're starting to understand now is that there's this 74 00:04:19,560 --> 00:04:25,240 Speaker 2: really complicated signaling environment within our gastro intestinal tract. As 75 00:04:25,279 --> 00:04:29,040 Speaker 2: the microbiome, the living bacteria within our gut. They help 76 00:04:29,680 --> 00:04:34,599 Speaker 2: shape the way our body responds to the pathogens and 77 00:04:34,680 --> 00:04:36,840 Speaker 2: also shape our well being. And we know there's a 78 00:04:36,880 --> 00:04:39,440 Speaker 2: lot of nerve fibers in the gut, which lots of 79 00:04:39,440 --> 00:04:42,919 Speaker 2: physiological functions, but they can also be activated by pain. 80 00:04:43,960 --> 00:04:47,919 Speaker 2: And there's various other mechanisms in this such as food 81 00:04:47,960 --> 00:04:52,640 Speaker 2: allergy that can trigger activation of these nerve fibers, and 82 00:04:52,720 --> 00:04:56,960 Speaker 2: there's also changes in gastri intestinal motility which will change 83 00:04:57,040 --> 00:05:01,000 Speaker 2: activation of these fibers. So know that there's a lot 84 00:05:01,000 --> 00:05:04,839 Speaker 2: of peripheral mechanisms for a gut brain access in the 85 00:05:04,880 --> 00:05:08,320 Speaker 2: way symptoms are generated, but there's also changes within the 86 00:05:08,360 --> 00:05:12,760 Speaker 2: spinal cord and the brain, which means that pain and 87 00:05:12,839 --> 00:05:15,600 Speaker 2: sensation for these patients is far worse than what it 88 00:05:15,640 --> 00:05:19,239 Speaker 2: is for the general population. We also know that women 89 00:05:19,240 --> 00:05:21,640 Speaker 2: are far more affected by these conditions than men. 90 00:05:21,839 --> 00:05:22,520 Speaker 1: Why is that. 91 00:05:24,279 --> 00:05:27,400 Speaker 2: We think it has to do with the sex hall modes, 92 00:05:27,440 --> 00:05:30,719 Speaker 2: which are different between men and women, and we think 93 00:05:30,800 --> 00:05:33,560 Speaker 2: what it does, particularly in the case the females, is 94 00:05:33,760 --> 00:05:40,200 Speaker 2: estrogen is changing the threshold for signaling pain. Therefore, women 95 00:05:40,240 --> 00:05:43,200 Speaker 2: are sitting closer to the threshold for pain, and therefore 96 00:05:43,240 --> 00:05:46,760 Speaker 2: they don't need much of additional stimuli to take them 97 00:05:46,800 --> 00:05:47,760 Speaker 2: over that threshold. 98 00:05:48,600 --> 00:05:51,120 Speaker 1: Is this such a thing as a pain threshold that 99 00:05:51,200 --> 00:05:53,720 Speaker 1: the same level of pain. I don't know how you'd 100 00:05:53,760 --> 00:05:57,320 Speaker 1: measure that, but it's felt differently in different people. 101 00:05:58,520 --> 00:06:00,480 Speaker 2: Certably is I mean there are some people people who 102 00:06:00,880 --> 00:06:05,000 Speaker 2: are more resilient to to stimulate, there are some people 103 00:06:05,040 --> 00:06:08,680 Speaker 2: who are more sensitive. Those things can be changed on 104 00:06:08,720 --> 00:06:14,039 Speaker 2: a daily basis in individuals, if you're depressed or anxious, 105 00:06:14,200 --> 00:06:20,240 Speaker 2: your pain sensitivity can be a lot lower, meaning that 106 00:06:20,320 --> 00:06:22,080 Speaker 2: you know, it doesn't take very much to trigger pain. 107 00:06:23,120 --> 00:06:25,080 Speaker 2: And it's also your perception of pain as well. If 108 00:06:25,120 --> 00:06:27,200 Speaker 2: you think something is going to be painful, then it's 109 00:06:27,279 --> 00:06:30,200 Speaker 2: more likely to be. There's lots of influences in our 110 00:06:30,240 --> 00:06:34,200 Speaker 2: body in terms of what we're experiencing from our environment 111 00:06:34,640 --> 00:06:37,080 Speaker 2: and how we're actually perceiving it and whether we think 112 00:06:37,120 --> 00:06:42,719 Speaker 2: there's going to be pain. So it's pretty insidious conditions, 113 00:06:42,800 --> 00:06:45,960 Speaker 2: chronic pain, and there's a lot of people in Australia 114 00:06:46,040 --> 00:06:51,239 Speaker 2: suffering from it. You're looking at you know, basically anywhere 115 00:06:51,240 --> 00:06:54,159 Speaker 2: between eleven and twenty percent of the population. And we 116 00:06:54,279 --> 00:06:57,840 Speaker 2: know that opioids aren't the answer in fact make things 117 00:06:57,839 --> 00:06:58,560 Speaker 2: worse overtime. 118 00:06:58,760 --> 00:07:04,680 Speaker 1: Indeed, can it be controlled mentally? Is that pain threshold 119 00:07:04,680 --> 00:07:08,920 Speaker 1: at least? Can can you use your mind to rein 120 00:07:09,000 --> 00:07:11,040 Speaker 1: it in in some way or learn I don't know 121 00:07:11,120 --> 00:07:14,560 Speaker 1: tricks the right word to control it to make it tolerable. 122 00:07:16,160 --> 00:07:19,160 Speaker 2: Yeah, there's certainly components of that. So the pain field, 123 00:07:19,200 --> 00:07:22,200 Speaker 2: it's sort of described as this. You know, the components 124 00:07:22,200 --> 00:07:26,120 Speaker 2: of pain and the biocycle social elements of that, so 125 00:07:26,840 --> 00:07:34,119 Speaker 2: you can have various techniques breathing, meditation, et cetera. Some 126 00:07:34,120 --> 00:07:37,800 Speaker 2: some patients find that useful to be able to control 127 00:07:37,880 --> 00:07:42,400 Speaker 2: their anxiety, control their stress, control their depression, which helps 128 00:07:42,400 --> 00:07:46,440 Speaker 2: in terms of the amount of pain they're experiencing and 129 00:07:47,520 --> 00:07:49,840 Speaker 2: how it can be controlled. And the other thing for 130 00:07:49,880 --> 00:07:52,480 Speaker 2: a lot of patients is is there can be various triggers. 131 00:07:53,480 --> 00:07:55,640 Speaker 2: For some people, that might be if they've got migraine, 132 00:07:55,680 --> 00:07:58,840 Speaker 2: it might be bright lights. For back pain, it might 133 00:07:58,880 --> 00:08:00,960 Speaker 2: be if you know you're bending over a certain way. 134 00:08:01,240 --> 00:08:04,720 Speaker 2: That people with adominal pain could be that it's certain 135 00:08:04,760 --> 00:08:07,920 Speaker 2: food types they're eating. It's also learning about what your 136 00:08:08,240 --> 00:08:13,360 Speaker 2: personal particular triggers are as well. So it's very complicated. 137 00:08:13,360 --> 00:08:17,600 Speaker 2: It involves nerves, the immune system, a whole variety of 138 00:08:17,640 --> 00:08:20,640 Speaker 2: different factors throughout our body. And you know, we've really 139 00:08:20,680 --> 00:08:24,560 Speaker 2: got to tackle this in a holistic approach, and it's 140 00:08:24,560 --> 00:08:27,480 Speaker 2: really about educating people about this and doing more research 141 00:08:27,560 --> 00:08:32,120 Speaker 2: and finding novel therapies for each of these different conditions. 142 00:08:31,880 --> 00:08:34,400 Speaker 1: And probably for each individual person because we're all different 143 00:08:34,440 --> 00:08:36,600 Speaker 1: to some extent, aren't we. 144 00:08:36,600 --> 00:08:38,520 Speaker 2: Well, that's right, and you know, we need to know 145 00:08:38,600 --> 00:08:45,000 Speaker 2: what someone's medical history is. For instance, in IBS, for instance, 146 00:08:45,040 --> 00:08:51,280 Speaker 2: a lot of patients can track their pain back to 147 00:08:51,360 --> 00:08:56,800 Speaker 2: a pry about of gastrite rhiness and that can different 148 00:08:56,880 --> 00:09:00,400 Speaker 2: parts of the gastrointestinal tract. Once you have a bit 149 00:09:00,440 --> 00:09:03,800 Speaker 2: more information, you can then start to center in on 150 00:09:03,880 --> 00:09:07,560 Speaker 2: what's going on in that individual and you know, actually 151 00:09:07,720 --> 00:09:11,960 Speaker 2: have more of a personalized approach in terms of understanding 152 00:09:12,000 --> 00:09:13,680 Speaker 2: and therefore treating their pain. 153 00:09:14,600 --> 00:09:18,560 Speaker 1: You'll do some amazing things there at Samary collectively, So 154 00:09:19,040 --> 00:09:21,840 Speaker 1: in terms of pain, you say, opioids aren't the answer 155 00:09:22,480 --> 00:09:26,360 Speaker 1: anything on the horizon. That is because obviously with chronic 156 00:09:26,400 --> 00:09:29,640 Speaker 1: pain or any pain, we just want it to go away. 157 00:09:30,880 --> 00:09:33,760 Speaker 2: Well, that's right, because essentially, you know, it's an ongoing 158 00:09:34,440 --> 00:09:36,640 Speaker 2: false alarms a's pain when they shouldn't be. 159 00:09:36,760 --> 00:09:37,200 Speaker 1: Yeah. 160 00:09:37,280 --> 00:09:42,320 Speaker 2: Yeah, opioids certainly aren't the answer. They also cause tolerance 161 00:09:42,400 --> 00:09:46,920 Speaker 2: and addiction independence. They cause constipation, which is not great 162 00:09:47,480 --> 00:09:49,360 Speaker 2: for a lot of patients with visceral pain because they 163 00:09:49,360 --> 00:09:54,360 Speaker 2: already have constipation. But there are more and more studies 164 00:09:54,440 --> 00:09:58,720 Speaker 2: looking at the underlying cause and what the mechanisms are. Certainly, know, 165 00:09:58,800 --> 00:10:02,080 Speaker 2: in the gut field, few different therapies out there at 166 00:10:02,080 --> 00:10:04,880 Speaker 2: the moment that target the gas or intestinal tract itself 167 00:10:05,520 --> 00:10:09,760 Speaker 2: that they've shown to be efficacious. And there's a variety 168 00:10:09,800 --> 00:10:12,040 Speaker 2: of different studies at the moment, you know, trying to 169 00:10:12,040 --> 00:10:16,560 Speaker 2: dissect out what the best therapies are based on, you know, 170 00:10:16,600 --> 00:10:20,439 Speaker 2: whether it's coming from the proofery, whether the spinal cord change, 171 00:10:20,559 --> 00:10:22,240 Speaker 2: whether it's in the brain as well. So there's lots 172 00:10:22,240 --> 00:10:24,240 Speaker 2: of clinical trials and what's of research going on at 173 00:10:24,240 --> 00:10:27,480 Speaker 2: Sammara at the moment understand it and also more broadly 174 00:10:27,520 --> 00:10:30,080 Speaker 2: across Australia and globally. 175 00:10:30,440 --> 00:10:33,520 Speaker 1: Indeed we'll find follow those with interest. Appreciate your time 176 00:10:33,520 --> 00:10:38,200 Speaker 1: this morning, Stewart, thank you, thank you. Math Professor Stewart Bridley, 177 00:10:38,240 --> 00:10:41,280 Speaker 1: who is director of the Visceral Pain Research Group at 178 00:10:41,320 --> 00:10:45,400 Speaker 1: SAMARY the Essay Health Medical Research Institute on North Terrace. 179 00:10:45,559 --> 00:10:48,760 Speaker 1: Just amazing what happens in that building and the work 180 00:10:48,760 --> 00:10:52,600 Speaker 1: that goes on, but understanding pain, how it works and 181 00:10:52,840 --> 00:10:56,320 Speaker 1: coming up with suitable treatments moving forward. Excellent work.