Speaker 1: Shingles is a disease that has been around for thousands
Speaker 1: of years. It affects millions of people every year, but
Speaker 1: as recently as the middle of the twentieth century, scientists
Speaker 1: didn't really know how the disease worked. It was clear
Speaker 1: that shingles and chicken pox were related. People sometimes got
Speaker 1: chicken pox from people with shingles, but the clarity ended there.
Speaker 1: How were the diseases related. Were they caused by different
Speaker 1: viruses or the same virus. Could you get shingles from
Speaker 1: someone with chicken pox? Nobody knew. But by the mid
Speaker 1: nineteen sixties, scientists had figured out what was going on.
Speaker 1: And one of the people who did the most to
Speaker 1: figure it out was not some high powered researcher at
Speaker 1: a prestigious university. It was a family doctor in a
Speaker 1: small British town. His name was Edgar Hope Simpson. I'm
Speaker 1: Jacob Goldstein and this is Incubation, a show about viruses.
Speaker 1: In the second half of the show, we'll talk about
Speaker 1: the most common symptom of shingles, pain and we'll talk
Speaker 1: about the surprising methods that some doctors are using to
Speaker 1: try and alleviate that pain. In this part of the show.
Speaker 1: We're going to talk about Edgar Hope Simpson, that family
Speaker 1: doctor who helped solve the mystery of shingles. I talked
Speaker 1: about Hope Simpson with Anne Arvin. Anne's retired now, but
Speaker 1: she spent decades as a clinician and a microbiologist at Stanford.
Speaker 1: She studied the Vericella zoster virus, the virus that causes shingles.
Speaker 2: Edgar Hope Simpson, as you just said, was a GP
Speaker 2: who was very interested, as many practitioners are, in trying
Speaker 2: to solve unresolved issues in medicine. And his practice was
Speaker 2: largely older people, and he was seeing a lot of
Speaker 2: shingles relatively speaking, but he was also seeing kids with
Speaker 2: chicken pox. It was really easy to see that one
Speaker 2: kid with chicken pox would give it to fifteen other kids.
Speaker 2: They would get chicken pox. That was easy to observe,
Speaker 2: Uh huh. It was a lot more difficult to nail
Speaker 2: down the question of what about shingles and does exposure
Speaker 2: of a child to shingles really result in chicken pox
Speaker 2: or is that just coincidence proximity?
Speaker 1: Huh?
Speaker 2: And so that was his question.
Speaker 1: There's this moment, I guess in the nineteen forties when
Speaker 1: Edgar Hope Simpson reads in a British medical journal just
Speaker 1: a case report, just a letter from a doctor on
Speaker 1: this remote Shetland island called Yell. Tell me about Edgar
Speaker 1: Hope Simpson and this island of Yell and this sort
Speaker 1: of quest to understand the relationship between chicken pox and shingles.
Speaker 2: Yes, so why did he jump on the boat or
Speaker 2: train or boat and train or whatever to go practically
Speaker 2: a day and a half to get from where he
Speaker 2: was in sort of southern England up to this remote
Speaker 2: island in the Shetland Islands in the North Sea. Why
Speaker 2: did you do that?
Speaker 1: It was going to go on summer vacation. And he's like, no,
Speaker 1: I'm not going to go on summer vacation. I'm going
Speaker 1: to go investigate this.
Speaker 2: Outbreak because the letter that he read said there was
Speaker 2: a school teacher who had shingles and there was an
Speaker 2: outbreak of chicken pox in her class.
Speaker 1: In nineteen forty six, Hope Simpson reads this letter in
Speaker 1: the medical journal about the school teacher case in Yell,
Speaker 1: and then Hope Simpson reaches out to the local doctor
Speaker 1: who wrote about the case and they stay in touch
Speaker 1: they're corresponding with each other. Eventually, Hope Simpson learns that
Speaker 1: there is another outbreak on the island. There's something like
Speaker 1: one hundred chicken pox cases that seem to have come
Speaker 1: from a single case of shingles.
Speaker 2: When he heard about this crofter who had shingles and
Speaker 2: whose five children then had chicken pox, he thought, this
Speaker 2: is an irresistible opportunity. I will go up there and
Speaker 2: I will actually see this outbreak unfold in real time
Speaker 2: from this shingles case. And so undoubtedly the shingles case
Speaker 2: did lead to chicken pox in that family. The question
Speaker 2: was could he then trace a further outbreak.
Speaker 1: I mean, I guess there's something about a remote island
Speaker 1: that's actually a perfect place to test the hypothesis, right
Speaker 1: because unlike in you know, twentieth century England, people are
Speaker 1: taking trains, people are coming and going, this was like
Speaker 1: truly a remote people are like crofters which I don't
Speaker 1: even know they're farmers or they're raising sheep or something.
Speaker 1: Right Like, it's it's very out there. So he goes
Speaker 1: out there and I mean it's amazing, Like what he's
Speaker 1: doing is contact tracing basically. Right, there's here, he wrote
Speaker 1: this reminiscence that I just want to read because I
Speaker 1: love just a paragraph of it. There's this moment when
Speaker 1: like they're trying to track down one case and he says,
Speaker 1: the team, which is just like him and two other
Speaker 1: people walked from mid Yell to the south shore of
Speaker 1: the vau Vae is apparently a Shetland word for a
Speaker 1: little cove or something road themselves across. He means ourselves
Speaker 1: rode themselves across to north of Vo and walked for
Speaker 1: several miles across the heather to the home of K six.
Speaker 1: And then he was hoping this one particular connection was
Speaker 1: going to answer everything, and he writes, alas no, because
Speaker 1: this girl who was going to tie it all together
Speaker 1: for it was not in fact at this other place.
Speaker 1: So anyways, it's a great story.
Speaker 2: I love that. I love that description too, And I
Speaker 2: had to look up what is a voe? So I'm
Speaker 2: sad that we now know a voe is a bay,
Speaker 2: a small bay. I can tell you that kind of
Speaker 2: vs V Barricela's osterro virus research. That is not how
Speaker 2: we do it now, but it looked kind of interesting
Speaker 2: to be able to do that.
Speaker 1: You never you never wrote, did you? How much rowing
Speaker 1: did you do in your research?
Speaker 2: Absolutely not so. Anyway, he was trying to see whether
Speaker 2: he could get a second, a reproducible finding, so to speak,
Speaker 2: because he heard that the person in the other location
Speaker 2: had shingles, and then he thought, well, there's going to
Speaker 2: be maybe another traceable cluster of cases. So back to
Speaker 2: your question about why islands, islands are really important in
Speaker 2: epidemiology of infectious diseases, and so the reason is because
Speaker 2: the populations are tiny and in that particular geography, as
Speaker 2: you just said, you row your boat, you walk three
Speaker 2: miles or ten miles or whatever, there's a lot less
Speaker 2: contact in a very rural situation. So you can have
Speaker 2: the situation in epidemiologic terms where there's a fair number
Speaker 2: of susceptibles and you can actually then take the so
Speaker 2: called index case and you can map literally house to
Speaker 2: house the cases.
Speaker 1: Yeah, but then I think he sort of dug further
Speaker 1: and figured out more connections, right, and it did suggest,
Speaker 1: although it wasn't conclusive, well, that it's the same virus
Speaker 1: and that you can catch chicken pox from someone with ching.
Speaker 2: Right, he went a great distance, so to speak, towards
Speaker 2: actually proving that hypothesis.
Speaker 1: I picture him with like a wall, like a map,
Speaker 1: but with like pushpins that maybe like red yarn, you know,
Speaker 1: like a like in a detective show or something.
Speaker 2: Sure, well, epidemiology is basically a detective story most of
Speaker 2: the time. So yes, I think that's exactly what he did.
Speaker 2: They went around house to house, took records and ask people.
Speaker 1: Yeah, so this is like a very colorful and you know,
Speaker 1: kind of low key heroic thing he's doing to try
Speaker 1: and learn something for the benefit of humanity. But he
Speaker 1: is doing this longer term study based on his practice
Speaker 1: right where he's closely tracking all of the chicken pox
Speaker 1: cases and all of the shingles cases over many, many years,
Speaker 1: and he winds up giving a lecture, publishing a paper
Speaker 1: that is the summation of that work, and he does
Speaker 1: wind up solving this mystery. Tell me about that paper.
Speaker 2: That paper is about his long term study. And he
Speaker 2: apparently studied everyone in his practice who got shingles. So
Speaker 2: not only did he make the diagnosis, he made a
Speaker 2: chart of each person and marked on this chart here's
Speaker 2: where this person lesions were, this is where the other
Speaker 2: person's lesions were. And so he had an enormous set
Speaker 2: of data on where the shingles rash appears on people's bodies,
Speaker 2: and he also had all of the chicken pox data.
Speaker 2: And what he was able to conclude is it's a
Speaker 2: one way traffic. Shingles causes vericella. Vericella does not cause jingles, right,
Speaker 2: chicken pox. Yeah, So that was his finding, his fundamental observation.
Speaker 2: And it's a one way traffic. So that means where
Speaker 2: does the virus come from when you've got shingles?
Speaker 1: Uh huh. It doesn't come from someone with chicken pox,
Speaker 1: and it doesn't come from someone with shingles, right.
Speaker 2: That's also what he observed. And so he had all
Speaker 2: this massive data sets of people who had shingles and
Speaker 2: were in close contact with somebody or several other somebodies
Speaker 2: and they didn't get shingles, but if there were kids around,
Speaker 2: they got chicken pox, but not vice versa.
Speaker 1: So from that beautiful data set he can show clinically
Speaker 1: what's happening. And from this clinical finding, he presents in
Speaker 1: this paper a hypothesis of what's going on at the
Speaker 1: micro level, at the cellular scale.
Speaker 2: What does he hypothesize the hypothesis is what we now
Speaker 2: know to call latency. That is, when you have chicken pox.
Speaker 2: In the course of your chicken pox episode, the virus
Speaker 2: you can imagine, is in those little boxes all over.
Speaker 2: And what is also in the skin Right next to
Speaker 2: where those boxes are, which are full of virus, there
Speaker 2: are nerve endings. And so the virus has created a
Speaker 2: great scheme for persisting by taking not just the opportunity
Speaker 2: to form skin lesions, but to go backwards up the
Speaker 2: nerve axons to the nerve cell body, which is in
Speaker 2: what's called sensory ganglia, all up and down the spinal
Speaker 2: cord and cervical spine and face. But developing the hypothesis
Speaker 2: of how the virus got to the sensory ganglia, he
Speaker 2: outlined what he called suppositions. I like the phrase suppositions.
Speaker 1: There's a nice humility to it, right, I don't know,
Speaker 1: but let's suppose.
Speaker 2: Yeah. So he created a set of suppositions that have
Speaker 2: subsequently been found right. But also because they were suppositions,
Speaker 2: a number of them were not right.
Speaker 1: What did he get wrong?
Speaker 2: Well, for starters, he thought chicken pox was a pox virus,
Speaker 2: which it isn't. It's a herpes virus related to herpes
Speaker 2: simplex type one and type two.
Speaker 1: Let's talk for a minute about just herpes viruses, and
Speaker 1: in particular the persistence, right the fact that they have
Speaker 1: this from the point of view of virus clever, from
Speaker 1: the point of view of a human host, insidious quality
Speaker 1: of hanging around forever. Tell me more about that.
Speaker 2: First of all, these viruses are ancient, and they sort
Speaker 2: of evolved into different subgroups over millions of years. And
Speaker 2: if you look at every specie, they all have their
Speaker 2: herpes viruses too. It's not just us. You have a
Speaker 2: guinea pig, that guinea pig has guinea pig herpyes virus.
Speaker 2: So it is. It is a story that encompasses the
Speaker 2: entire family of viruses. And what we know is that
Speaker 2: for the most part. The other thing the virus as
Speaker 2: agent has to keep in mind is don't make the
Speaker 2: person too sick, right, accommodate if you can, just don't
Speaker 2: even cause any symptoms at all. Just arrange to be
Speaker 2: periodically showing up at a mucosal surface. In fact, a
Speaker 2: few cells, dump a few virus particles into the saliva
Speaker 2: or whatever, and so be it.
Speaker 1: Everybody's happy. Everybody's happy, right, problem.
Speaker 2: No problem, so in fact, you know, chicken pox is
Speaker 2: a bit unusual in the It does typically cause symptoms,
Speaker 2: but very very mild. When it's not mild, it is
Speaker 2: potentially lethal. And so that's why all of us in
Speaker 2: the field work so hard to develop vaccines, vaccine for
Speaker 2: chicken pox and vaccine for shingles.
Speaker 1: So when you look back at Hope Simpson's work, what
Speaker 1: do you make of it?
Speaker 2: Well, I think it's pretty straightforward for me to say
Speaker 2: why I and my colleagues so much admired the work
Speaker 2: that he did and the suppositions that he came up
Speaker 2: with because he was looking from an evolutionary perspective. He
Speaker 2: was asking why does this happen? And what he proposed,
Speaker 2: which is definitely true, is that the virus gives itself
Speaker 2: a kind of second chance to spread. So, if you
Speaker 2: look at it from an evolutionary perspective, and you're thinking
Speaker 2: from the point of view of the virus, how to
Speaker 2: sustain your life if you will, your life cycle in
Speaker 2: a community is as important as how to sustain it
Speaker 2: in one person. And so you have to imagine a
Speaker 2: rural community if chicken pox isn't reintroduced as a kid
Speaker 2: with chicken pox showing up from somewhere. That is it
Speaker 2: for the virus unless unless there's another way for it
Speaker 2: to introduce itself again, so to speak. And that is
Speaker 2: where the Shingles think. So that is why his work
Speaker 2: in Yale was really important. He was actually showing that
Speaker 2: life cycle as it rolls out in a community.
Speaker 1: Yeah, like the virus as agent. Right, it's giving the
Speaker 1: virus agency.
Speaker 2: Which we know not to do. But it's so.
Speaker 1: Tempting, I mean, whatever that's a word. I mean, I
Speaker 1: think there's a non anthropomorphic way, Like, I don't care
Speaker 1: what anybody says, it's clever that the virus is doing that.
Speaker 1: It's very clever.
Speaker 2: Certainly my point of view. Yeah, So it's an evolutionary
Speaker 2: strategy of the virus. That's one reason why this work
Speaker 2: is important. And the other reason, I think is back
Speaker 2: to the suppositions. He did not assume that the story
Speaker 2: was fully understood, and that was that he knew and
Speaker 2: identified the gaps. So there's a way in which you
Speaker 2: can say we've been filling in the gaps that he
Speaker 2: placed out there as suppositions.
Speaker 1: I think there's something also really elegant, maybe even romantic,
Speaker 1: if I'm being honest about the family doctor, the general
Speaker 1: practitioner as epidemiologist. You know, he's he's there every day
Speaker 1: treating patients. And the thing that he did, I mean
Speaker 1: besides going to yell, which is very dramatic, but the
Speaker 1: less dramatic but maybe ultimately more important thing that he
Speaker 1: did is keep this meticulous data as you say, about
Speaker 1: where the where the rashes are and what the household
Speaker 1: connections are. I mean that transforms his work from you know,
Speaker 1: helping individuals to like making this significant breakthrough in human
Speaker 1: knowledge exactly.
Speaker 2: And picking picking a question. I mean, there's always a
Speaker 2: science of great challenge is pick a question where you
Speaker 2: can really gather some data that's going to lead somewhere.
Speaker 2: That's as much of a contribution as a researcher as
Speaker 2: actually finding answers to some of those questions.
Speaker 1: Thank you for your time. It was great to talk
Speaker 1: with you. You too, And Trevin is a retired clinician
Speaker 1: and microbiologist at Stanford. In a minute, I'll talk with
Speaker 1: a physician and researcher who was a friend of the
Speaker 1: late Edgar Hope Simpson and who has spent decades studying
Speaker 1: shingles and pain.
Speaker 3: Anyone who has done any work on shingles. Probably the
Speaker 3: first name they will come across is Edgar Hope Simpson.
Speaker 1: Is it true that you knew him?
Speaker 3: Oh? Yes, I can't tell you precisely when, but I'll
Speaker 3: tell you how.
Speaker 1: Robert Johnson is a physician who spent decades treating shingle's patients.
Speaker 1: He no longer has a clinical practice, but he still
Speaker 1: does research at the University of Bristol.
Speaker 3: It was about nineteen ninety four. There were a group
Speaker 3: of us who were going to be presenting in a
Speaker 3: symposium and somebody said, is Simpson still alive? And I said,
Speaker 3: I have no idea. Let's have a look and telephone directory.
Speaker 3: So we looked up and there was Hope sinstance siahen sister.
Speaker 3: So we phoned him. I think it was about eight
Speaker 3: o'clock one evening, and there was a fairly brusque answer.
Speaker 3: I Hope Simpson here, I said, is that doctor Egger
Speaker 3: Hope Simpson? He said yes, And I said, could I
Speaker 3: ask you? Are you still interested in shingles?
Speaker 1: Oh?
Speaker 3: Yes, he said, And that was the start of it.
Speaker 3: And he was brilliant. He was the most humble man
Speaker 3: you can imagine, an enormous breadth of knowledge. Everyone had
Speaker 3: stories about him, both from the medical point of view,
Speaker 3: as a friend and in particular as a general practitioner.
Speaker 3: He was clearly extremely caring, and they told me that
Speaker 3: he'd be known to ski in the winter out to
Speaker 3: a patient for an emergency call. He was obviously a
Speaker 3: very dedicated a character.
Speaker 1: So I want to talk about shingles as a disease
Speaker 1: and about your work with shingles. What happens in the
Speaker 1: body when you get shingles.
Speaker 3: What happens is that the virus, which has been dormant
Speaker 3: in nerve tissue near to the spinal cord and near
Speaker 3: to the certain areas of the brain, has found itself
Speaker 3: able to reactivate without getting an immune response adequate to
Speaker 3: prevent its spread. And then the virus replicates it, It
Speaker 3: increases its numbers, it multiplies and spreads along the peripheral
Speaker 3: nerve that runs from the area where it was latent
Speaker 3: and eventually reaches the skin, where you get the typical
Speaker 3: rash of shingles.
Speaker 1: So I had chicken pucks decades ago, and right now
Speaker 1: inside my nerve cells inside my body, there is that
Speaker 1: virus still just hanging out weeding more or less and
Speaker 1: if there is some moment when my immune system is
Speaker 1: compromised in some set of factors, a line I will
Speaker 1: get shingles.
Speaker 3: Yes, you're absolutely right. In a lifetime, about thirty percent
Speaker 3: of us will get shingles, and if one lives into
Speaker 3: one's eighties, which these days is very common, it's about
Speaker 3: a fifty percent chance of getting shingles.
Speaker 1: Tell me more about the symptoms of having shingles. What
Speaker 1: is it like to have shingles?
Speaker 3: Very frequently one has several days of pain or tingling sensation,
Speaker 3: maybe feeling a little bit unwell, but then the rash
Speaker 3: appears and the diagnosis becomes clear. Almost always, the acute disease,
Speaker 3: the first three or four weeks is painful, and it
Speaker 3: can be extremely painful. In some people, the lucky ones,
Speaker 3: the rash the pain over a period of ten days
Speaker 3: to three weeks disappear. There's often a little bit of
Speaker 3: scarring and that's the end of it. But in others
Speaker 3: that's not the case. The pain persists. It can be intermittent,
Speaker 3: but it can go on for weeks, months, or even years,
Speaker 3: and when it reaches three months from the rash appearance,
Speaker 3: we call it post Pettit euralgia.
Speaker 1: So post herpetic neuralgia is the technical term, the term
Speaker 1: of art for basically long term pain after you have shingles.
Speaker 1: You can sort of unpack it right, post her petic
Speaker 1: after herpes and neuralgia is a pain from from the nerves,
Speaker 1: right from the nerve, absolutely, and it seems like that
Speaker 1: is I mean, shingles is the thing you don't want.
Speaker 1: Post herpetic neuralgia, long term pain from shingles is the
Speaker 1: thing you really don't want, right, So let's talk some
Speaker 1: more about that. I know you're working on that. What
Speaker 1: is the mechanism of post her petic neuralgia. Why is
Speaker 1: it that some people get it and some people don't.
Speaker 3: I'd say I don't know, but I will try and
Speaker 3: give you a full answer without waffling too much. There
Speaker 3: is definite damage to nerve tissue, nerve fibers right from
Speaker 3: the skin to the spinal cord and indeed within the
Speaker 3: spinal cord. But the problem starts with the clinical side,
Speaker 3: because there is no single pain syndrome of post de
Speaker 3: pendant euralgia. You can have numbness, or you can have
Speaker 3: a severely increased sensitivities to touch. You can have a
Speaker 3: reduction in sensitivity to heat and cold, or you can
Speaker 3: have an increase. You can have a continuous burning pain,
Speaker 3: you can have severe intermittent lancinating, page shooting, electric shock
Speaker 3: like pains, And if you take that forward to months
Speaker 3: and years, you can see what it can do to
Speaker 3: a patient.
Speaker 1: Let's talk about eatment and prevention, right, Okay, what can
Speaker 1: you do to avoid getting shingles in.
Speaker 3: The first place? Don't have chicken pox, And the only
Speaker 3: way you can be fairly confident in not having chicken
Speaker 3: pox is to be vaccinated against it, which in the
Speaker 3: States you have done pretty routinely since nineteen ninety five.
Speaker 3: But it's going to be some years before we see
Speaker 3: any marked effect on that in shingles because those people
Speaker 3: are still, relatively speaking young as far as the age
Speaker 3: for getting shingles is concerned. So vaccination against chicken pox
Speaker 3: is one, the next one is vaccination against shingles.
Speaker 1: If you are not fortunate enough to prevent shingles, what
Speaker 1: is the treatment both for the initial disease and for
Speaker 1: post herpetic neuroalgia.
Speaker 3: Right, Well, one may have a capacity to actually even
Speaker 3: when shingles has started prevent post to pedant euralgea. It's
Speaker 3: a bit uncertain. Anti virals we hoped would have a
Speaker 3: massive effect on that. And the anti viral drugs are
Speaker 3: remarkable for treating the acute symptoms and any serious disease,
Speaker 3: But how much they influence development of post to pedant
Speaker 3: euralgia's always remained a bit of a gray area. It's
Speaker 3: very hard to see why they wouldn't. But if they do,
Speaker 3: it hasn't reduced the incidence of post pedant euralgia overall
Speaker 3: very much.
Speaker 1: If they work, we can't see it.
Speaker 3: Well, that's sort of how it is. Yes, Having said that,
Speaker 3: I wouldn't want to underplay the value of the antiviral drugs.
Speaker 3: My personal view is that almost everybody who gets shingles
Speaker 3: should receive them.
Speaker 1: I know you're working now on a study looking at
Speaker 1: it at another way of treating shingle's patients with lasting pain.
Speaker 1: Tell me about that.
Speaker 3: We're now looking. In England, we have a study based
Speaker 3: on Bristol looking at amitriptlen that was originally an antidepressant drug,
Speaker 3: but in very low doses it has an effect on
Speaker 3: europathic pain. And another neurologist called David Bouscher from Liverpool
Speaker 3: in England had published a study all three decades ago,
Speaker 3: perhaps basically showing that probably low dose ami triptlen given
Speaker 3: early in the course of jingles reduced the incidents of
Speaker 3: post dependant eualgia dramatically. David Bouscher was a character and
Speaker 3: he did push the case of herpes oster extremely well
Speaker 3: as far as people getting interested in research in it.
Speaker 3: It was a very interesting paper and very indicative that
Speaker 3: further research was needed, but it didn't prove the case.
Speaker 1: This is a very odd the decades or antidepressant yes,
Speaker 1: or drug that was developed as an antidepressant, yes, why
Speaker 1: why might it help reduce postropedic neuralgia.
Speaker 3: Well, again it's not fully understood, but it does have
Speaker 3: certain effects which can affect transmission of impulses within nerves
Speaker 3: and excitability of damaged nerve tissue, possibly effects within the
Speaker 3: spinal cord at inhibition of pain from impulses which traveled
Speaker 3: down from the brain out towards the spinal cord and
Speaker 3: the peripheral nerves. There are all sorts of possible mechanisms,
Speaker 3: but I think it would be wrong with me to
Speaker 3: say we know the answer.
Speaker 1: I want to talk about pain a little bit more
Speaker 1: more broadly. And you know, when you mentioned an antidepressant
Speaker 1: as a treatment for pain, there's one universe where there
Speaker 1: is some very direct mechanism in the peripheral nervous system.
Speaker 1: I mean, there is also a universe where pain is
Speaker 1: related to our psychological state. And as a doctor who
Speaker 1: has treated pain a lot, I'm curious about your view
Speaker 1: on that. More generally, on pain, you know, as part
Speaker 1: of this broader complex of well of a person psychological state. Oh.
Speaker 3: Absolutely, pain is biopsychosocial. There's a pathology, the biobit, there's
Speaker 3: the psychology, and there's the social the environment that we
Speaker 3: live in, and all these things play a part in
Speaker 3: pain and how we respond to it. And you know,
Speaker 3: just go back to Hope Simpson for a second. When
Speaker 3: Hope Simpson talked about management of patients in general practice
Speaker 3: with shingles, he said the main thing was to care
Speaker 3: for the patient, to take an interest in the patient,
Speaker 3: to follow the patient up, to encourage them. And this
Speaker 3: is so true. My wife and I started a herpesoster
Speaker 3: clinic here in Bristol or many years ago now, and
Speaker 3: we saw mainly post a petit euralgia patients, but we
Speaker 3: were very happy to see acute patients that general practitioners
Speaker 3: referred us who had unusual features or severe pain, or
Speaker 3: were particularly distressed. And it was really the persistence and
Speaker 3: the interest shown in the patients which made a huge
Speaker 3: difference to their progress. The treatments we had available were
Speaker 3: pretty limited, and you just had to persevere. We worked
Speaker 3: through the treatments with them, We discussed the treatments with them,
Speaker 3: and I think it makes a world of difference how
Speaker 3: you treat the patient overall. And one of the things
Speaker 3: that is essential is to encourage them to get back
Speaker 3: to social interactions, to go out and meet people, not
Speaker 3: to hide away nursing the pain.
Speaker 1: Why Why is that so important?
Speaker 3: Because pain is multifactorial, and if you can address one
Speaker 3: or more of the bio psychosocial elements, you're going to
Speaker 3: get improvement. Well, the bio we weren't so good on,
Speaker 3: although we did have drugs and we did have other treatments.
Speaker 3: The psycho, I don't know much about that, but the social, yes,
Speaker 3: you could definitely influence that. Encouragement and taking a concern
Speaker 3: about the patient's problem is essential.
Speaker 1: It was really lovely to talk with you. I thank
Speaker 1: you for being so generous with your time. Thank you,
Speaker 1: Andrew Knowledge, Thank you very much. Robert Johnson is a
Speaker 1: researcher at the University of Bristol. Thanks to both my
Speaker 1: guests today, Anne Arvin and Robert Johnson. By the way,
Speaker 1: last week's show, in case you missed it was all
Speaker 1: so about a herpes virus. That show was about the
Speaker 1: epstein bar virus EBV, which also has some very insidious
Speaker 1: long term effects. Next week on the show, the HIV
Speaker 1: epidemic that changed the world and the scientists who are
Speaker 1: racing to understand it. We have something, We have something.
Speaker 1: Incubation is a co production of Pushkin Industries and Ruby
Speaker 1: Studio at iHeartMedia. It's produced by Kate Ferby and Brittany Cronin.
Speaker 1: The show is edited by Lacey Roberts. It's mastered by
Speaker 1: Sarah Bruguier, fact checking by Joseph Friedman. Our executive producers
Speaker 1: are Lacey Roberts and Matt Romono. I'm Jacob Goldstein. Thanks
Speaker 1: for listening.