Speaker 1: Brought to you by Toyota. Let's go places. Welcome to
Speaker 1: Forward Thinking. Hey, and welcome to Forward Thinking, the podcast
Speaker 1: that looks at the future and says, I guess I'm
Speaker 1: always hoping that you'll end this rain. I'm Joe McCormick
Speaker 1: and I'm Lauren Bob and our regular host Jonathan Strickland
Speaker 1: is not with us today. He's I think it a
Speaker 1: castle in Wales playing quidditch or something something to that extent. Yes,
Speaker 1: uh so, you know, go Thunderbucks. And in his absence,
Speaker 1: we are going to to talk about a kind of
Speaker 1: a kind of upsetting subject today. It's great, but it's universal.
Speaker 1: It is. We're talking about pain. Yeah, the future of
Speaker 1: pain and of pain management, of counter pain, you might say, yes,
Speaker 1: more of an emphasis I think on on you know,
Speaker 1: trying to prevent pain. We're not just talking about the
Speaker 1: future of causing causing pain, right because Okay, there's been
Speaker 1: a lot of sad news lately about the increasing rates
Speaker 1: of pain medication over use or abuse and the tragic
Speaker 1: consequences thereof. Yeah, I think a lot of this came
Speaker 1: in the wake of Prince's death recently, which I know
Speaker 1: has been linked in the media to uh to use
Speaker 1: of an opioid drug to treat chronic pain. I believe, yeah,
Speaker 1: I think. I think his official cause of death has
Speaker 1: been listed as an accidental overdose of fentanyl, which is
Speaker 1: this opioid pain relief drug. But but I mean Prince aside,
Speaker 1: and that was certainly tragic. We all miss Prince um.
Speaker 1: But the problem is is very widespread and very serious.
Speaker 1: Some some numbers for you guys. According to the CDC,
Speaker 1: in the United States alone, in over fourteen thousand people
Speaker 1: died from overdoses involving prescription opioids UM. A national survey
Speaker 1: that same year reported that almost two million Americans were
Speaker 1: abusing or physically dependent on prescription opioids, and a thousand
Speaker 1: people go to the emergency room in this country every
Speaker 1: day for misusing prescription opioid drugs. Opioid. I'm sorry, that's
Speaker 1: a funny sounding word to say it is, Isn't it
Speaker 1: like a like the name of a pet, walrus or something.
Speaker 1: It sounds like fiords. It's got that eel in it.
Speaker 1: It reminds me of the of the nerd from Dominoes.
Speaker 1: For some reason, I'm not sure why the nerd the
Speaker 1: noid anyway, at any rate. Yeah, of course, opioids are
Speaker 1: are a class of drugs. They contain drugs like morphine
Speaker 1: and all those opium derived drugs. We'll get into more
Speaker 1: of the specifical thing, Yeah, more of the specifics of
Speaker 1: that lately. But yeah, this is obviously a huge problem.
Speaker 1: But it's not just a problem that people are overdosing
Speaker 1: on these drugs. I mean, pain is a big enough
Speaker 1: problem on its own to merit some sort of intense solutions. Oh. Absolutely,
Speaker 1: And we're not trying to put out a DARE episode here,
Speaker 1: I don't. I don't know if you were in the
Speaker 1: DARE program when you were in high school. The the
Speaker 1: drugs are are rotten, all y'all. I that's not an acronym,
Speaker 1: but they're rotten, so you should get some fresh ones.
Speaker 1: They've gone off. I'm mostly impressed that I just tried
Speaker 1: to make the E and DARE stand for all y'all um.
Speaker 1: But yeah, we're not. It's right, it's not just a
Speaker 1: drugs are bad problem. And and furthermore, it's not just
Speaker 1: kids that are abusing these drugs. It's a range of
Speaker 1: ages of humans who are doing it. Um. And and
Speaker 1: the problem, of course is that medical science has not
Speaker 1: figured out how to solve pain yet. Yeah. Pain, surprisingly,
Speaker 1: despite the fact that we do know some things about it,
Speaker 1: it is in many ways an open problem in medical science.
Speaker 1: We have some ways of treating it. Obviously, the best
Speaker 1: thing to do to address pain is to go in
Speaker 1: and fix the problem that's causing pain to begin with.
Speaker 1: But then there are lots of issues that will talk about,
Speaker 1: such as chronic pain, where in many cases you've sort
Speaker 1: of lost track of what the original causes and now
Speaker 1: you're just having the subjective experiential problem of distress and
Speaker 1: and unpleasant feelings. Uh and and what can you do
Speaker 1: but treat the feelings themselves at that point? But yeah,
Speaker 1: so pain is a pain is a big problem. Pain
Speaker 1: is a big problem all over the world, in the
Speaker 1: United States alone. In a report in the Journal of Pain,
Speaker 1: good journal name tried to calculate pain, but it tried
Speaker 1: to calculate the cost of chronic pain in the United States.
Speaker 1: And chronic pain has costs, of course, not only because
Speaker 1: you have to pay for the treatment. The drugs cost money,
Speaker 1: the doctor visits cost money, but because it complicates treatments
Speaker 1: for other medical conditions. Say, for example, if if you've
Speaker 1: got chronic pain, Your your your outlook for a different
Speaker 1: kind of condition might be different because you've already got
Speaker 1: this other problem to deal with. You might not be
Speaker 1: able to take the drugs or get the surgeries or
Speaker 1: something like that. Uh two that you would need to
Speaker 1: deal with this other condition. And also because workers tend
Speaker 1: to lose productivity as they experience pain, the more you hurt,
Speaker 1: the less you have to offer. Often. I mean not
Speaker 1: to say you're any worth any less as a person,
Speaker 1: but sure, but it's just different cuts into your ability
Speaker 1: to do things. Yeah, yeah, absolutely So they in this
Speaker 1: study estimated that every year chronic pain costs the United
Speaker 1: States between five hundred and sixty and six hundred and
Speaker 1: thirty five billion dollars, which is actually more than the
Speaker 1: estimated annual costs of cancer, diabetes, or heart disease. So,
Speaker 1: I mean, it's pretty much a no brainer that we
Speaker 1: should be focusing our efforts on finding ways to solve
Speaker 1: the problem of pain. But that's a lot easier said
Speaker 1: than done. Sure, but coming down to the to the
Speaker 1: basic factor that we we don't have a complete concept
Speaker 1: of what pain is. Yeah, it's kind of hard to
Speaker 1: get underneath pain and define it. Isn't it like it's
Speaker 1: such a basic subjective feeling. Pain almost seems like the
Speaker 1: thing by which you describe other things is not a
Speaker 1: thing that you describe unto itself. Because it's one of
Speaker 1: those baseline experiences of being a human being that it's
Speaker 1: just hard to put your put your mind around it.
Speaker 1: But to give a basic definition, a task force for
Speaker 1: the International Association for the Study of Pain did try
Speaker 1: to give a pretty universal medical definition of pain, and
Speaker 1: it's the one I've seen sided most often, and it
Speaker 1: goes like this quote, pain is an unpleasant, sensory and
Speaker 1: emotional experience that is associated with actual or potential tissue
Speaker 1: damage or described in such terms. Uh So, that's basically
Speaker 1: just saying like pain hurts and is upsetting. Yeah, and
Speaker 1: that emotional part, the upsetting nous is crucial, and I
Speaker 1: want to talk about that more towards the end of
Speaker 1: the episode. But in addition to this really basic definition,
Speaker 1: usually doctors and medical professionals are going to divide pain
Speaker 1: into two, uh basic, very different types, which are acute
Speaker 1: pain and chronic pain. Right, so let's let's start with acute. Yeah,
Speaker 1: Acute pain is the kind of pain that everybody is
Speaker 1: familiar with. It's a temporary result of disease, injury, or inflammation,
Speaker 1: and it's good. It warns you that something is wrong,
Speaker 1: and for this reason it is quite useful, especially in
Speaker 1: today's medicine. So in an evolutionary sense, acute pain is
Speaker 1: useful even you know, if you can't get to a doctor.
Speaker 1: It's useful even in the wild, because you might, for example,
Speaker 1: stop putting weight on that injured leg of yours because
Speaker 1: it hurts when you do, and that gives that leg
Speaker 1: time and ability to heal. Without you continuously putting stress
Speaker 1: on it is just going to make the problem worse. Sure,
Speaker 1: Or if you touch a hot surface, yeah, you remove
Speaker 1: your body apart from it immediately because it hurts, preventing
Speaker 1: further injury, as opposed to just leaning on I don't
Speaker 1: know what's that hot surface. Our our caveman versions of
Speaker 1: ourselves are encountering really hot rocks. I mean fire is bad,
Speaker 1: so yeah, pretty but bad. To stop getting struck by lightning,
Speaker 1: that's the fourth time this week, exactly, I gotta stop
Speaker 1: climbing up this tree. Uh but yeah, So in fact,
Speaker 1: they're there're certain recognized conditions that prevent people from feeling pain,
Speaker 1: and that's not a good thing. Obviously, that sounds great
Speaker 1: because we don't like pain. But you need your pain.
Speaker 1: You need this. It's very important to very useful trait. Exactly,
Speaker 1: people who are born without the ability to feel pain
Speaker 1: have what's known as congenital analgesia, and it is very dangerous.
Speaker 1: People can suffer injuries or illnesses without being aware of them. Uh,
Speaker 1: and then those illness, illnesses, injuries, whatever, the bad state
Speaker 1: can progress without treatment and lead to disability or even death.
Speaker 1: And if you have congenital insensitivity to pain, you have
Speaker 1: to be on the lookout all the time. You have
Speaker 1: to be extremely vigilant of what's going on with your
Speaker 1: body because you're it's not going to let you know
Speaker 1: when something is wrong. You have to basically scope. You
Speaker 1: have to observe it right right, You're not a leg
Speaker 1: is bent sideways and you're not going to feel that
Speaker 1: splinter in your foot. You're you have to find it.
Speaker 1: You have to notice it in other ways. So acute
Speaker 1: pain is good and useful, but of course it's not useful. Say, well,
Speaker 1: you know, once you're already aware of the disease, if
Speaker 1: you've got a broken bone or something, you probably will
Speaker 1: need some pain killers to deal with that, and we
Speaker 1: have pretty good remedies for that, right. Yeah, Acute pain
Speaker 1: is a category of pain that we're we're usually pretty
Speaker 1: good at treating these days. You know, like if you've
Speaker 1: got sinus pain due to inflammation because of an infection,
Speaker 1: you could be able to treat the infection, uh, and
Speaker 1: you can definitely take an anti inflammatory to treat the
Speaker 1: cause of that pain. If you've got a knee injury,
Speaker 1: you can help the leg return to normal function faster,
Speaker 1: again treating the cause using you know, a brace or
Speaker 1: physical therapy or again anti inflammatories. And you might also
Speaker 1: you might also be prescribed like muscle relaxers or electrical
Speaker 1: stimulation to lessen the pain while the knee heals. All
Speaker 1: of these are are you know, wonderful modern treatments and
Speaker 1: and has offer all of that. Um uh. But but
Speaker 1: the other type of pain, chronic pain, is a little
Speaker 1: bit more troublesome. Yeah, this is where things get really hairy.
Speaker 1: So long term and for the most part, pointless pain
Speaker 1: is chronic pain. What what does long term mean? Some
Speaker 1: say longer than three months. I've seen longer than six months,
Speaker 1: So I guess we could say longer than three to
Speaker 1: six months might be an approximate general rule. But the
Speaker 1: idea is pain is chronic if it lasts longer than
Speaker 1: the healing time for the problem that's causing it. Ah yeah.
Speaker 1: And and these are again, these are the types of
Speaker 1: issues that we're not so great at treating because often
Speaker 1: we don't have fixes for them. They sometimes involve damage
Speaker 1: to the nervous system itself, or or ongoing tissue damage
Speaker 1: due to some kind of bodily system dysfunction that we
Speaker 1: can mitigate but not necessarily cure, as in a cancer, arthritis,
Speaker 1: And so in these cases we're really just treating the symptoms,
Speaker 1: not the cause. Yeah. So let's look at the cause
Speaker 1: of pain. Uh yeah, because we've are amazing modern medical
Speaker 1: concept of it has not been around forever. Yeah, that's true.
Speaker 1: Perhaps unsurprisingly, ancient people often interpreted pain through a magical
Speaker 1: or spiritual lens. Who would have guessed, uh, it was
Speaker 1: an affliction, you know, it's a punishment, something being done
Speaker 1: to you by another worldly agent. Very common to look
Speaker 1: at pain in these terms, and this type of thinking
Speaker 1: is still somewhat reflected in the origins of the English
Speaker 1: word pain actually, which comes originally through the Old French,
Speaker 1: but originally from the Latin poena, meaning punishment or penalty.
Speaker 1: And in the earliest uses of pain in English we
Speaker 1: still see this connotation, like if you go back to
Speaker 1: the thirteenth century, say, to look at how pain is
Speaker 1: used in English, you'll see uses like if you hunt
Speaker 1: in the duke's private forest, it is a crime punishable
Speaker 1: on pain of death, meaning you get the death pen
Speaker 1: punishment of death. Yeah. I had never thought about that before. Yeah,
Speaker 1: pretty creepy, hunh. So when you have a pain in
Speaker 1: your in your eyeball, why did I pick eyeball? That's
Speaker 1: a terrible thing. Do you have a stabbing pain in
Speaker 1: your eyeball? It is a punishment from someone. To be fair,
Speaker 1: if I had a stabbing pain in my eyeball, I
Speaker 1: would pretty much assume that anyway, even with science. But
Speaker 1: how fragile science is. But then, of course that you
Speaker 1: get to the ancient Greek physicians, and they sometimes wrote
Speaker 1: about pain as being a result of some form of
Speaker 1: imbalance or disorder or unnatural state. And this is a
Speaker 1: very Greek way of thinking. I think we're going to
Speaker 1: get into the humors again, aren't we, Yes, Yes, so
Speaker 1: health and pleasure were created by order and harmony, things
Speaker 1: being balanced and in their natural state. Pain and displeasure
Speaker 1: were created by chaos and unnatural corruption, or things being
Speaker 1: imbalanced or out of order. And this general philosophical orientation,
Speaker 1: I think informed their literal understanding of the medical causes
Speaker 1: of pain. So I want to read a quote from
Speaker 1: On the Nature of Man, which is an ancient Greek
Speaker 1: medical treatise in the Hippocratic Cannon, not written by Hippocrates,
Speaker 1: but part of his school of thoughts. So it goes
Speaker 1: like this. The body of man has in itself blood, flim,
Speaker 1: yellow bile, and black bile. These make up the nature
Speaker 1: of the body, and through these he feels pain or
Speaker 1: enjoys health. Now he enjoys the most perfect health when
Speaker 1: these elements are duly proportioned to one another in respect
Speaker 1: to compounding, power and bulk, and when they are perfectly mingled.
Speaker 1: Pain is felt when one of these elements is in
Speaker 1: defect or excess, or is isolated in the body without
Speaker 1: being compounded with all the others. Oh yeah, I hate
Speaker 1: it when my flim gets in my toes and causes
Speaker 1: them to ate exactly, So you've got flam in your
Speaker 1: toes and you don't have any you don't have any
Speaker 1: black bile to balance it out. What are you gonna do?
Speaker 1: My toe is gonna hurt, I guess. So that's that's
Speaker 1: why I've got gout. It's not all those I think
Speaker 1: everyone is eating pastries. I think that's a common Yeah,
Speaker 1: we get Tracy and Holly on the line. What did
Speaker 1: they like, ancient ancient cured fish pastries. I'm sure cured
Speaker 1: fish pastries. I would try cured fish pastry. I'll speculate.
Speaker 1: I'll say that's it. But eventually, of course, medical science
Speaker 1: came to understand beyond the idea of the four humors,
Speaker 1: And part of me thinks that that's only got to
Speaker 1: be a partial explanation, right, because they thought, okay, so
Speaker 1: in some sense pain is caused by an imbalance of humors.
Speaker 1: But surely they didn't think that was what caused pain
Speaker 1: when you cut yourself, right, or maybe maybe because you're
Speaker 1: like losing blood at that point, and so, well about
Speaker 1: what about a pricking feeling that doesn't quite pierce the skin?
Speaker 1: I don't know, I mean that seems a little off,
Speaker 1: like it doesn't fit their model. Not quite. Yeah, I'm
Speaker 1: not sure that they had entirely thought this through, to
Speaker 1: be fair, they were probably busy with other things. Yes, yeah,
Speaker 1: not to insult those of the Hippocratic school of thought,
Speaker 1: but yeah, no, no. If y'all are time travelers and
Speaker 1: listening to this, we respect you, right. But of course,
Speaker 1: like we were saying, eventually medical science did come to
Speaker 1: understand the crucial role of the nervous system in the
Speaker 1: perception of pain. So, in a standard pain response to
Speaker 1: like a damaging stimulus and knife goes into your skin
Speaker 1: or something, sensory neurons throughout the body or in the
Speaker 1: place where you're getting damaged, called no susceptors set off
Speaker 1: a chain reaction that travels through the nervous system via
Speaker 1: electrical impulses, through the spinal cord and eventually up to
Speaker 1: the brain. And the brain is what processes your pain
Speaker 1: and your reaction to it. Now, this is interesting. It's
Speaker 1: not just like you have one pain center in your brain.
Speaker 1: Multiple regions of the brain are involved in reacting to pain,
Speaker 1: illustrating how pain is sort of a complex phenomenon within
Speaker 1: our bodies. Is not just that one sensation, but a
Speaker 1: state of mind. So it involves direct sensory information, you know,
Speaker 1: like Okay, this pain is thermal and it's intense, and
Speaker 1: it's on my left ankle, and then it involves emotions
Speaker 1: like I don't like that, that's bad, motivation, get away quick,
Speaker 1: and cognition like a plan for escaping this torch being
Speaker 1: held to your ankle or whatever whatever it may be.
Speaker 1: To make it a little bit more complicated, because clearly
Speaker 1: we needed that here. A part of the issue and
Speaker 1: no susceptive pain, that this pain that results from injury
Speaker 1: are chemicals that you're damaged, tissue releases called prostaglandins, which
Speaker 1: a help boost the signal to your spinal cord that
Speaker 1: you know something's up, hey, warning stuff is going down.
Speaker 1: Um and and be they help regulate things like your
Speaker 1: your blood flow and you're clotting principles, So they're they're
Speaker 1: what causes inflammation around an injury. And more on that
Speaker 1: in a minute. Um and I also wanted to mention
Speaker 1: here that there's a second type of pain in contrast
Speaker 1: to no susceptive pain, called called clinical pain or neuropathic pain.
Speaker 1: And neuropathic we can probably guess from that word involves
Speaker 1: the nervous system. Yeah, yeah, this is the pain that
Speaker 1: occurs even though there was no negative stimulation to the
Speaker 1: no susceptors. So either your nerves themselves have received damage
Speaker 1: or something has gone wrong in your pain signaling system somewhere.
Speaker 1: It's like getting pain spam. Yeah exactly, It's just word
Speaker 1: salads full of pain spam, and and your brain is
Speaker 1: going like, well, crape, I still have to deal with
Speaker 1: this email, I guess. So, yeah, you don't really have
Speaker 1: a choice, do you. We can. We can route spam
Speaker 1: into a into a junk folder. If only we could
Speaker 1: do that with pain spam. Yeah, oh man, let's call
Speaker 1: let's call some science science dudes. Well, that may be
Speaker 1: part of our part of our solution profile later on.
Speaker 1: So today we do have some comprehension of how pain
Speaker 1: works in the body, but we still don't know everything, right,
Speaker 1: But the more we learn, the better we can treat pain.
Speaker 1: One of the things that we're that we're learning about
Speaker 1: is how chronic pain changes the brain. And doesn't sound good.
Speaker 1: It does. It's not good. That's terrible, um for for
Speaker 1: reasons that we really don't understand very well yet. Chronic
Speaker 1: pain creates changes in the brain's connections and chemistry. Yeah,
Speaker 1: so Most of the stories you hear about the plasticity
Speaker 1: of the adult brain are positive, but this one not
Speaker 1: so much. Not so much. Yeah, it leads to abnormal
Speaker 1: functioning that can increase the sensation of pain and the
Speaker 1: likelihood of emotional conditions like anxiety and depression, which is
Speaker 1: just a horrible, no good feedback loop. And and so
Speaker 1: this is one of the really big things that would
Speaker 1: be super rad to figure out, no doubt. So we
Speaker 1: we certainly have these pain problems. Of course, you've got
Speaker 1: the more manageable acute pain pain problems. You know, you've
Speaker 1: got hurt. It hurts, and you've got to figure out
Speaker 1: a way to deal with that. But that's temporary. We've
Speaker 1: got sort of a handle on that. Then we've got
Speaker 1: these bigger problems chronic pain. Uh, the way chronic pain
Speaker 1: changes the way our nervous system works and all that.
Speaker 1: So what are our pain treatment options today? What are
Speaker 1: the things that are most often used by doctors and
Speaker 1: by people dealing with pain to fix the problems. As
Speaker 1: we said earlier, there are some physical therapies, but but
Speaker 1: the drug therapies are what we wanted to concentrate on today.
Speaker 1: So I think the first category to consider is the
Speaker 1: nonsteroidal anti inflammatory drugs, which are like aspirin and like
Speaker 1: the proof and stuff like that. We're pretty familiar with these,
Speaker 1: Oh yeah, yeah, they're They're the most commonly used drugs
Speaker 1: for acute pain because they work by by blocking the
Speaker 1: effects of a couple of particular enzymes that are necessary
Speaker 1: for your body to make those aforementioned prostaglandins UM that
Speaker 1: that caused the inflammation and and stronger pain signals to
Speaker 1: go to the brain. So that is how they work
Speaker 1: pretty simple over the counter. Don't usually need a prescription
Speaker 1: for them, um, unless you get them in very very
Speaker 1: high doses or if they're mixed with something else. But yeah,
Speaker 1: moving over into the prescription category, you've got antidepressants and
Speaker 1: anti epileptics, which are sometimes used in in chronic and
Speaker 1: especially in neuropathic pain. Both are actually really poorly understood
Speaker 1: in their mechanisms, like no one's really entirely sure how
Speaker 1: they work, but researchers think that the chemical actions of
Speaker 1: both might help block pain pathways, might help block those
Speaker 1: signals that are shooting around telling your brain that stuff sucks.
Speaker 1: UM and anidepressants, of course, have a bonus action of
Speaker 1: maybe making a patient feel emotionally better, which helps to
Speaker 1: de stabilized that that feedback loop. Well, yeah, as we've
Speaker 1: established already, emotion clearly is part of the medically recognized
Speaker 1: profile of pain. It's not just sensory information on your ankle,
Speaker 1: it's it's your whole disposition towards it's your feelings about
Speaker 1: it as well, Shure. So antidepressants can help with that.
Speaker 1: The category of drugs that we started this episode off
Speaker 1: talking about opioids, is the category that are that's the
Speaker 1: subjective of the most concern for a number of reasons,
Speaker 1: all basically boiling down to the facts that they're really
Speaker 1: effective at blocking pain and also that they have really
Speaker 1: dangerous side effects. We'll get into the side effects in
Speaker 1: a second. But how opioids work. Okay, so your body
Speaker 1: makes opioids. They are neurotransmitters that plug into particular neuro
Speaker 1: receptors and relief pain. Yeah. Yeah, because your your body
Speaker 1: has a sort of internal dialogue, Gwen, pain is going on.
Speaker 1: There's like there there are pain amplifiers and then pain
Speaker 1: pain dampeners to sort of to regulate what's going on
Speaker 1: back and forth between your nerve cells in your brain. Right,
Speaker 1: and so so this this is one of those pain
Speaker 1: relievers in your body, and opioid drugs work by plugging
Speaker 1: into those same neural receptors and producing similar effects yea,
Speaker 1: or not yea, because they're not quite the same as
Speaker 1: the opioids that your body makes, and those chemical differences
Speaker 1: lead to the unpleasant side effects that we see, right,
Speaker 1: and so there are a lot of side effects. In fact,
Speaker 1: we should try to address as well as we can
Speaker 1: a sort of broad range of the problems with pain
Speaker 1: treatment options that exist in the drugs of today. One
Speaker 1: of the most straightforward ones, though it's probably worth mentioning,
Speaker 1: is simple inadequacy. Yeah, Like, a problem with a lot
Speaker 1: of pain treatments and medications is that they do not work,
Speaker 1: or they do not work enough. This maybe should go
Speaker 1: without saying, but it's something to consider. You know, you
Speaker 1: might be taking a tile and all for your pain
Speaker 1: and find uh i k I already took the pill,
Speaker 1: but it's still really really hurts. It does not reduced
Speaker 1: the pain to a tolerable level, right, sure, or that
Speaker 1: your body develops a tolerance to it over time, in
Speaker 1: the case of opioids in particular. Yeah, And so another
Speaker 1: one of the big things is going to be side effects,
Speaker 1: as you just mentioned. Yeah, and and even those over
Speaker 1: the counter nonstoridal anti inflammatories like aspirin should definitely be
Speaker 1: treated with care because they're they're known to cause pretty
Speaker 1: serious gastro intestinal bleeding, especially when taken regularly or along
Speaker 1: with other acidic foods like like alcohol. Yeah, oh yeah,
Speaker 1: and so a lot of them come with those warnings, right, yeah, yeah,
Speaker 1: that's basically why it says not to drink and take
Speaker 1: it at the same time, because nobody wants your stomach
Speaker 1: to bleed, right. But then, of course the side effects
Speaker 1: of opioids are one of the big problems for concerns.
Speaker 1: So according to a two thousand eight article in Pain Physician,
Speaker 1: most common side effects for opioids include quote sedation, Okay,
Speaker 1: that's pretty expected, but dizziness, nausea, vomiting, constipation, physical dependence, tolerance,
Speaker 1: and respiratory depression. The most common of these being constipation
Speaker 1: and nausea, which in some cases, I mean, those sound
Speaker 1: like things that are bad but maybe in some cases
Speaker 1: preferable to intense pain to intense crazy pain all the time,
Speaker 1: depending on depending on the patient and the pain and
Speaker 1: that whole round of information. But then, of course, in
Speaker 1: some cases even constipation and nausea alone might be severe
Speaker 1: enough that the patient is just going to have to
Speaker 1: discontinue use of the drug. And so in many cases,
Speaker 1: when you're treating pain with an opioid, you're going to
Speaker 1: have sort of an arms race going on, uh, fighting
Speaker 1: back and forth between is the opioid enough to fix
Speaker 1: the pain without the side effects getting so bad that
Speaker 1: they're worse than the pain itself. Yeah, which is which
Speaker 1: is of course the question in any drug treatment, but
Speaker 1: is is particularly common in in opioid pain relievers. And
Speaker 1: of course the physical dependence and addiction are major concerns
Speaker 1: that make the make the opioids especially controversial when it
Speaker 1: comes to treating chronic pain. Sure, And and that respiratory
Speaker 1: depression is it's not a it's not a frenzies kind
Speaker 1: of problem. Yeah, that was the last one I mentioned
Speaker 1: in the list. It's not just like an uncomfortable feeling
Speaker 1: or an annoyance. Respiratory depression is the cause of death
Speaker 1: in most fatalities due to opioid overdose. You stop breathing,
Speaker 1: That's what it does to your body. Uh. And according
Speaker 1: to the World Health Organization. In the United States of
Speaker 1: America alone, in two thousand and ten, there were an
Speaker 1: estimated sixteen thousand, six hundred and fifty one deaths due
Speaker 1: to overdose on prescription opioids. Uh. And then on top
Speaker 1: of that, there were three thousand and thirty six due
Speaker 1: to overdose on heroin, which of course is still an
Speaker 1: opioid but a street drug. Yeah. And you know, even
Speaker 1: if you even if you live through it, that that
Speaker 1: tolerance and dependence and addiction are are also quite serious matter. Yeah.
Speaker 1: Of course, tolerance is a big problem with this because
Speaker 1: over time, lots of pain medications, including opioids this is
Speaker 1: where you often encounter this, become less effective. The body
Speaker 1: builds up a tolerance to them, and this means people
Speaker 1: need to continue upping their dosage. You've got to take
Speaker 1: more to get the same effect. But then of course
Speaker 1: you're into another one of these gambling games here. Uh.
Speaker 1: It can be dangerous because the more you up the dosage,
Speaker 1: the more risk you have of side effects or major
Speaker 1: side effects up to and including death. Yeah. Tolerance is
Speaker 1: also a symptom of dependence. Lots of drugs, opioids included
Speaker 1: change the body's chemistry and functions enough that if you've
Speaker 1: been taking the drug and you suddenly stop, you'll go
Speaker 1: through withdrawal. And and that's that's another one one of
Speaker 1: those symptoms. It means that your your body is dependent
Speaker 1: physically on that chemical and addiction, in contrast, is a
Speaker 1: mental or emotional process of mental or emotional dependence. But
Speaker 1: but it can all absolutely involve physical dependence as well.
Speaker 1: And because opioids do their job relatively well, addiction is
Speaker 1: again an unfortunately common problem. Yeah, and then of course
Speaker 1: another big problem. The stuff ain't cheap. Dealing with pain
Speaker 1: is not a cheap proposal. Oh yeah, well, you know
Speaker 1: when when you're in chronic pain, the costs of these
Speaker 1: medications are perpetual. You know, we're we're treating the symptom
Speaker 1: more than the cause. And when you add those direct
Speaker 1: financial costs to the personal costs of being less able
Speaker 1: to work, it can be really financially crippling. Um. The
Speaker 1: exact costs of all of these medications very really, really
Speaker 1: really widely um thanks to our you know, kind of
Speaker 1: convoluted prescription system and and our and our very complex
Speaker 1: drug manufacturing and labeling industry as well. But uh, to
Speaker 1: give you a number, Okay. According to a survey of
Speaker 1: approximately six hundred and ninety million outpatient doctor visits made
Speaker 1: in the United States for chronic pain from the years
Speaker 1: two thousand through two thousand seven, the total cost of
Speaker 1: the pain relievers subscribed was seven teen point eight billion annually.
Speaker 1: It's it's more than two. It's it's a bunch. I
Speaker 1: wonder how much. I wonder how that compares to how
Speaker 1: much we spent on pizza. Though I did not pull
Speaker 1: that number, I'm wishing that I had uh in the meanwhile.
Speaker 1: But it's nothing to sniff at, especially for for the individual.
Speaker 1: Oh yeah, yeah. And in addition to all of that,
Speaker 1: um and part of what we've been talking about with
Speaker 1: with the effectiveness of these drugs, we've also got the
Speaker 1: placebo effect um Because okay, so you know, pain is
Speaker 1: tricky and subjective, and the medications that treat it are
Speaker 1: as well. And as we've said, a patient's attitude toward
Speaker 1: a pain medication can have as much impact on its
Speaker 1: effectiveness as the actual chemical pathways that are in use.
Speaker 1: So for for example, trials with placebo and with medium
Speaker 1: doses of morphine have shown that of patients will receive
Speaker 1: pain relief from the placebo and thirty six percent will
Speaker 1: receive pain relief from the morphine. It's crazy. It's it's
Speaker 1: actually like a problem in the dug in the drug
Speaker 1: industry to get these kinds of things through testing because
Speaker 1: the rates of placebo effectiveness are so high. Uh, it's
Speaker 1: a thing that people are trying to think about. There's
Speaker 1: there's a lot of drugs that have not come to
Speaker 1: market because of that. Well, I mean, the whole issue
Speaker 1: of dealing with pain is so strange because it's not
Speaker 1: an externally verifiable You can't measure it from the outside.
Speaker 1: You can only ask people about their perception of it.
Speaker 1: I'm trying to think what would be an external measure
Speaker 1: of pain. I guess you could like measure what people
Speaker 1: are capable of doing with certain levels of pain. But
Speaker 1: even then that's going to vary depending on their their
Speaker 1: attitude towards things and how how they feel. It's just
Speaker 1: it's a first person, subjective, internal experience and it's very real,
Speaker 1: but there's there's no way you can look on the outside. Yeah,
Speaker 1: I'm I'm wondering if there's some way that you could.
Speaker 1: I mean, this would be be obviously way too expensive.
Speaker 1: For just an average patient doctor experience, but to measure
Speaker 1: like like neuron activity or some kind of some of
Speaker 1: the chemicals going on in the brain. But even then,
Speaker 1: I can guess that it wouldn't be the same the
Speaker 1: person from person to person. So one person's high level
Speaker 1: of neuron activity might not be enough to prevent them
Speaker 1: from living their lives normally, whereas in another person it would. Yeah,
Speaker 1: and there's so much abuse in the industry that I
Speaker 1: think that a lot of doctors are very skeptical. I
Speaker 1: did you know anecdotally? Um, you know, like like I
Speaker 1: certainly know a number of people who have, for example,
Speaker 1: ongoing back pain problems or something who whenever they go
Speaker 1: into a new doctor, the doctor is always like, really,
Speaker 1: are you sure you crazy? Oxycode own grunt, and they're
Speaker 1: calling them on the streets. I think. I think it's
Speaker 1: not at all. But all of this could hopefully change
Speaker 1: in the future with some of the research that people
Speaker 1: are putting into into what pain is and how to
Speaker 1: make it better. Yeah, so it's hard to say exactly
Speaker 1: what the future of pain treatment is going to be,
Speaker 1: but we just wanted to share with you a few
Speaker 1: interesting avenues of research we've come across that that might
Speaker 1: lead to different and better ways of treating pain in
Speaker 1: the future that don't rely so much on dependence forming
Speaker 1: and endangerous opioids, or even if they do rely on them,
Speaker 1: it might help us get better use of them to
Speaker 1: treat pain better and cause fewer side effects and cost less. Sure.
Speaker 1: And the first one, of course, because we couldn't get
Speaker 1: through a Joe and Lauren episode without mentioning some kind
Speaker 1: of creepy Crawley's has to do with tarential of venom. Yes,
Speaker 1: what can we learn from tarenttial venom? What can't we learn? Really? Yes,
Speaker 1: that that is the proper way of formulating the question.
Speaker 1: So as as you may remember, Lauren and I have
Speaker 1: talked about the potential usefulness of animal venom before and
Speaker 1: figuring out ways to beat hard problems in medicine. I
Speaker 1: remember in one previous episode we did on that we
Speaker 1: talked about using a type of scorpion venom. I believe
Speaker 1: it was that binds to certain types of cells in
Speaker 1: the body and then allows them to be highlighted for
Speaker 1: surgical purposes. But anyway, so studying venom or studying specifically
Speaker 1: the toxins in venom is a very fruitful avenue of
Speaker 1: medical research because though the venoms usually do unpleasant things
Speaker 1: to us, when we're trying to find ways to create
Speaker 1: targeted biomedical or biochemical changes inside the body, sort of
Speaker 1: smart bombs for the body, venoms can be a really
Speaker 1: helpful place to start because they have already been honed
Speaker 1: by nature to have a very specific effect. They do
Speaker 1: stuff real good. Yeah uh. And by studying these specific effects,
Speaker 1: you might be able to specifically actually use the toxin
Speaker 1: in the venom to say, seek out and target a
Speaker 1: certain type of receptor in the body, or you might
Speaker 1: just be able to use it for research purposes to
Speaker 1: help you better understand what's happening at the very tiniest
Speaker 1: micro level. And so one researcher who's been studying the
Speaker 1: relationship between animal toxins and pain is the you see
Speaker 1: San Francisco physiologist David Julius. He there was a June
Speaker 1: article in Nature called selective spider toxins reveal a role
Speaker 1: for the NAV one point one channel in mechanical pain.
Speaker 1: And what this was really about was looking at tarantula
Speaker 1: venom to better understand the what's going on in these tiny, tiny,
Speaker 1: little receptors, these molecular structures down inside our bodies when
Speaker 1: we experience pain. And I did want to give a
Speaker 1: shout out that there is a great piece in Wired
Speaker 1: by Chelsea lou profiling Julius and this line of research,
Speaker 1: which which was a fun read if you want to
Speaker 1: look it up. But following that, so what's going on
Speaker 1: in this researcher in Julius's career? Well, so, different toxins
Speaker 1: and venom such as that of a spider may cause
Speaker 1: different types of pain, right, So some might bind with
Speaker 1: receptors that indicate mechanical pain, like a knife goes into
Speaker 1: your skin. And I've used that example before. I guess
Speaker 1: I just can't get it out of my brain. Uh.
Speaker 1: Some might bind with receptors that do something else, like
Speaker 1: they indicate thermal pain, such as a burning sensation, or
Speaker 1: like the cap sasan in the hot chili pepper. You
Speaker 1: know that simulates a burning sensation, et cetera. And you
Speaker 1: can think about this pretty easily. You felt this difference before.
Speaker 1: Just imagine without any stimulus, how you've probably, at some
Speaker 1: point in your stomach or somewhere in your body felt
Speaker 1: a stabbing pain and a burning pain and they're different
Speaker 1: types of sensations, and they sort of mimic this fire
Speaker 1: or knife kind of feeling. So Julius and colleagues have
Speaker 1: been studying the many different ways that these venoms on
Speaker 1: cells at the micro level to cause different types of
Speaker 1: pain experience. For example, in a May two thousand tin
Speaker 1: article and cell Julius and and his co authors described
Speaker 1: a toxin from the venom of the earth tiger to tarantula.
Speaker 1: And you should definitely google image search that. By the way,
Speaker 1: Earth tiger tarantula straight up eight legged tigers, furry, glorious orange.
Speaker 1: It's like a cheeto came to life and was at
Speaker 1: the same time a spider and a tiger. Beautiful, fuzzy
Speaker 1: and cute. It's great. But so they found out that
Speaker 1: the venom in this earth tiger tarantula quote selectively and
Speaker 1: irreversibly activates the cap sasan and heat sensitive channel TRPV one.
Speaker 1: And I've actually talked about that before. I remember when
Speaker 1: I was doing something with with Ben Bolan and Kristen
Speaker 1: Conger about about why spicy foods trigger burning in your mouth.
Speaker 1: All right, for the short lived but excellent food stuff.
Speaker 1: So yeah, you have chili pepper spider fangs. Essentially, they
Speaker 1: found what this toxin does, is it props open I
Speaker 1: think those were their words, props open this channel that's
Speaker 1: usually activated by heat and by other things that simulate heats,
Speaker 1: such as hot peppers. But back to this June research
Speaker 1: in nature, So there is a tarantula called Heterosquadra maculata,
Speaker 1: and it's also known under a few odd names like
Speaker 1: the Togo starburst or the Togo starburst baboon. Oh, I'm
Speaker 1: looking it up. It's pretty too, so many spiders for
Speaker 1: you to google. Folks at home. I hope you're having
Speaker 1: a pleasant experience now. This spider's venom uh simulates mechanical
Speaker 1: pain specifically, and that that's key because it's not like
Speaker 1: any type of pain. It's not a burning pain. It's
Speaker 1: a stabbing pain, like you would feel if something was
Speaker 1: mechanically doing damage to the tissues in your body. Lauren's
Speaker 1: making a stabbing motion with your hands. Uh. And one
Speaker 1: of the things I was wondering here though, was should
Speaker 1: you say that the spider venoms emulates mechanical pain or
Speaker 1: should you just say it causes it? Because pain is
Speaker 1: subjective internal experience. Anyway, because it's not causing the damage,
Speaker 1: it's causing the pain, which is a separate Yeah, so
Speaker 1: I guess you can say it really does cause mechanical pain. Okay,
Speaker 1: that makes sense. But anyway, so, cells in the nervous
Speaker 1: system rely on tiny structures called sodium channels as part
Speaker 1: of their system for communicating with one another. So you're
Speaker 1: your neurons, your your no susceptors want to tell your
Speaker 1: brain that, hey, you know something's hurting you. They rely
Speaker 1: on these sodium channels to to trade information back and forth.
Speaker 1: But the researchers noticed that this venoms toxins that zero
Speaker 1: in on one very specific type of sodium channel in
Speaker 1: the pain receptors. There are a bunch of different types
Speaker 1: of them. So the researchers were able to figure out
Speaker 1: that these sodium channels in particular were responsible for creating
Speaker 1: the feeling of mechanical pain, the stabby pain, not the
Speaker 1: Bernie pain. So what different inst does this actually make
Speaker 1: that we learned this. Well, for instance, what if we
Speaker 1: were able to come up with pain killers that selectively
Speaker 1: target individual sodium channels, meaning that you block pain but
Speaker 1: not all sensations. So you're anesthetic means it it doesn't
Speaker 1: hurt when they do a little local operation on you,
Speaker 1: but you don't have to go numb all day. Or
Speaker 1: what about a pain killer that doesn't even block all
Speaker 1: types of pain, Because, as we've mentioned, pain can be
Speaker 1: very useful, even life saving, when it provides a warning
Speaker 1: that there's a problem with the body. And so these
Speaker 1: avenues of research I think could potentially help get us
Speaker 1: more targeted ways of fighting pain much less of a
Speaker 1: new kit for morebit mentality. Yeah, because that's basically what
Speaker 1: what most of our pain killing drugs these days do. Yeah,
Speaker 1: the opioids definitely are a new kit for MOREBIT. Yes,
Speaker 1: feel no pain, feel no emotional pain. Uh, lie on
Speaker 1: your couch. Probably, I really don't like opioids. They're not
Speaker 1: my friend. Uh. Genetics and gene therapy is another away
Speaker 1: from the conversation about my own personal drug uses. Alas
Speaker 1: we're talking about tar angelas. Were totally talking about tar angelas.
Speaker 1: So yeah, you said gene therapy. Gene therapy. Yeah, So
Speaker 1: researchers are looking for and furthermore starting to identify genes
Speaker 1: that have a whole lot of different things to do
Speaker 1: with pain, like like genes that affect how much pain
Speaker 1: you feel after an injury or after a surgery. Genes
Speaker 1: that affect how your body responds to drugs, Genes that
Speaker 1: are responsible for particular conditions, like like migraines. Yeah, and
Speaker 1: I've seen that there have been some clinical trials now
Speaker 1: using gene therapy as a possible remedy for pain. Absolutely.
Speaker 1: Other research is bent on figuring out how to interrupt
Speaker 1: the neural pathways that create that sensation of pain. Um,
Speaker 1: perhaps by messing around with the RNA of neural cells. So, yeah,
Speaker 1: gene therapy. Other forms of therapy that are in the
Speaker 1: works are brain and or central nervous system arapies, because
Speaker 1: as we learn more about how chronic pain affects the
Speaker 1: brain and the nervous system to create those those feedback
Speaker 1: loops that we've been talking about, we might be able
Speaker 1: to gain insight into how to stop those feedback loops. Um.
Speaker 1: For for example, we're learning that immune system disorders that
Speaker 1: create inflammation in the body can cause inflammation in the
Speaker 1: brain sometimes too, which leads to neuropathic chronic pain. Okay,
Speaker 1: so that was the pain that just comes from the
Speaker 1: nervous system, right right, and and it can and it
Speaker 1: can happen because of not damage to the nervous system
Speaker 1: per se, but damage to other parts of the body
Speaker 1: that's leading your immune system to also attack and create
Speaker 1: inflammation in the in the nervous system directly. So, so
Speaker 1: targeting the like brain specific immune cells and structures that
Speaker 1: are participating in this could help fix it. Or hey,
Speaker 1: maybe we could learn how to replace dysfunctional nervous system
Speaker 1: cells that are encouraging neuropathic pain through something like stem
Speaker 1: cell research. Yeah. Scientists are furthermore investigating therapies that would
Speaker 1: that would generally be termed psychological um like a like
Speaker 1: virtual reality therapy for example, but which can well, you know,
Speaker 1: it's it's the idea that with that kind of psychological
Speaker 1: therapy you can change your brain's pathways, because that's of
Speaker 1: course what thoughts are doing. So if you are going
Speaker 1: through a targeted therapy to help change your brain's pathways,
Speaker 1: you could hypothetically change the pathways that are causing that
Speaker 1: emotional physical feedback loop that creates chronic pain. Yeah. Oh yeah, well,
Speaker 1: I mean that that is something I've definitely seen some
Speaker 1: of the people writing on this issue saying that that
Speaker 1: statement pain is in the brain. Yeah, it is. I
Speaker 1: mean it's a mental it's a mental phenomenon. While we
Speaker 1: feel it in the part of our body that's hurting,
Speaker 1: it's relying on the central nervous system in the brain
Speaker 1: to create, certainly the feeling of pain and the reaction
Speaker 1: to the pain that makes it so distressing. And and
Speaker 1: that actually it comes back to something that I kind
Speaker 1: of would like to end on um which remember that
Speaker 1: that International Association for the Study of Pain definition. So
Speaker 1: pain is an unpleasant sensory and emotional experience. And when
Speaker 1: you think about it, it's kind of strange because if
Speaker 1: you follow me for a second here, why is pain bad?
Speaker 1: Like why do we have a negative emotional association with it?
Speaker 1: Why is pain not just useful information? It could just
Speaker 1: be a sensation that is emotionally neutral. But you once
Speaker 1: you have this information, you're like, Okay, I need to
Speaker 1: get away from that. It could be informing you without
Speaker 1: without making feel so unhappy. Yeah, yeah, I thought for
Speaker 1: half a second you were going to get into some
Speaker 1: weird like Clive Barker tarritory separate pleasure and pain, indivisible,
Speaker 1: infinite exactly. But but we don't really feel the So
Speaker 1: that's a question we can ask. But in practice, I
Speaker 1: know I don't. You probably don't feel at liberty to
Speaker 1: change your opinion on the positivity or negativity of pain.
Speaker 1: You know you you can't just say, you know what,
Speaker 1: I'm gonna give intense extreme pain a chance. I'm gonna
Speaker 1: do my best to enjoy it and just not let
Speaker 1: it bother me. For some reason, it's got this access
Speaker 1: channel to our emotions that gives pain the ability to
Speaker 1: cause major problems in our lives and make us unhappy,
Speaker 1: no matter how much we would like to resolve to
Speaker 1: just ignore it or not let it bother us, you
Speaker 1: know what I mean? Uh So, what if there were
Speaker 1: some psychological let's say, you know, you've said virtual reality,
Speaker 1: but maybe whatever the true way of getting there is.
Speaker 1: What if there were some therapy psychological or maybe more
Speaker 1: at the somatic level, but neurological treatment that managed to
Speaker 1: deactivate one half of the I s P definition without
Speaker 1: deactivating the other. Because, as we've said a couple of
Speaker 1: times now, you wouldn't want to deactivate the sensory experience
Speaker 1: of pain. It's a partant. Yes, yes, In the words
Speaker 1: of William Shatner in that that scene from Star Trek five,
Speaker 1: the final frontier. I don't want my pain taken away.
Speaker 1: I need my pain. He's right, we do need it.
Speaker 1: It's very useful information. But what if we had some
Speaker 1: neurological procedure that would allow us to keep the pain
Speaker 1: and just take away the distressing reaction to the pain. So,
Speaker 1: in this scenario, pain becomes emotionally neutral information. It's like
Speaker 1: a string tied around your finger. You can feel it,
Speaker 1: you can notice it's there, but it just doesn't really
Speaker 1: bother you. I don't know, I don't know. Do you
Speaker 1: think that would work. I mean, on one hand, that
Speaker 1: seems like a preferable thing. But then on the other hand,
Speaker 1: I wonder if the emotional distress caused by pain is
Speaker 1: still just as a critic, right, So maybe maybe as
Speaker 1: a counter to my thought experiment here, what if people
Speaker 1: who are aware that they've injured themselves but it doesn't
Speaker 1: cause them distress, those people are just not very likely
Speaker 1: to seek medical attention for their injury because they don't
Speaker 1: feel the sense of urgency created by emotional unhappiness. Yeah,
Speaker 1: that's that's an interesting question, especially considering the kind of
Speaker 1: epidemic we have about people not seeking treatment about something
Speaker 1: until it's way too late, and it's like an emergency
Speaker 1: room level kind of issue, which, of course is is
Speaker 1: driven by a lot of socionomic, socio economic factors and
Speaker 1: stuff like that. But uh, but yeah, I wonder. I wonder,
Speaker 1: like trying to think about yourself. Imagine somebody mad scientist
Speaker 1: is offering you this procedure. You know that it actually works,
Speaker 1: but they say, okay, we will give you a give
Speaker 1: you some kind of neurological therapy that allows you to
Speaker 1: experience pain as an emotionally neutral sensory experience. I think
Speaker 1: I think that being being a relatively healthy young person,
Speaker 1: I'm I'm biased, but I don't think I would take it. Uh.
Speaker 1: And then again, like I'm not in chronic pain. I
Speaker 1: don't have fibromyalgia. You know, I don't suffer migraines or
Speaker 1: anything like that, so I can't I I don't know.
Speaker 1: I don't know if I would want that thing. I
Speaker 1: feel like I feel like I like my emotional distress.
Speaker 1: I need my pain. Like Captain Kirk right, how about
Speaker 1: it makes us who we are? How about you? How
Speaker 1: do you feel? I don't know. I mean, I feel
Speaker 1: both ways on this. I do I'm probably in the
Speaker 1: same boat you are actually, I mean I I could
Speaker 1: maybe cavalierly turn it down just because I am fortunate
Speaker 1: enough to personally not have severe pain to deal with.
Speaker 1: But maybe if I was somebody who had severe pain,
Speaker 1: I would take this. I don't know, Yeah, I want
Speaker 1: like I would ask the mad scientists, like, can I
Speaker 1: come back to you in like thirty years when I
Speaker 1: will probably have a lot of arthritis. I think a
Speaker 1: lot of the decision would just come down to how
Speaker 1: much do you trust yourself to do something about pain,
Speaker 1: even if it's not nagging at you, if it's just
Speaker 1: it's just there. I'm supremely lazy. So I don't know
Speaker 1: if that's a good plan for me personally, But it's
Speaker 1: an important question and it's an interesting discussion. It's an
Speaker 1: interesting thought of of what what if that is indeed
Speaker 1: the future of pain? Well, I guess that's going to
Speaker 1: be it for the day. But if you folks out
Speaker 1: there have come across any interesting researcher reading about the
Speaker 1: future of dealing with pain, you should send it our way.
Speaker 1: We'd like to see it. Yeah, absolutely, And also if
Speaker 1: you have any any other topics that you would like
Speaker 1: to hear us cover. We would love to hear from you.
Speaker 1: We might even get around to answering your email. We've
Speaker 1: been bad about that lately, but we're trying to get
Speaker 1: back on track. Uh. That email address is FW thinking
Speaker 1: at how Stuff Works dot com. Of course, you can
Speaker 1: visit our website at fw thinking dot com. You can
Speaker 1: also check us out on Twitter and Facebook, where we
Speaker 1: occasionally post things. Our Twitter handle is also fw thinking,
Speaker 1: and just just search that. Just search that term on
Speaker 1: Facebook and we'll pop right up. We hope to hear
Speaker 1: from you, and one way or another, you will hear
Speaker 1: from us again very soon. For more on this topic
Speaker 1: and the future of technology, visit forward thinking dot com.
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