How to Hack Your Brain When You're in Pain | Amy Baxter

How to Hack Your Brain When You're in Pain | Amy Baxter

So when you strike your thumb with a hammer, you think it hurts. Physicians have a more in-depth grasp. We know it's an alert that travels from your nerves to your spine, where it is translated to your brain, and pain occurs... someplace. It's a little ambiguous. Throughout medical school, we only get two days of pain instruction, so... In fact, the only pain lecture I recall from the 1990s was in a dark room like this, after being awake for 30 hours and hungry, and discovering our lunchtime talk was sponsored by OxyContin.

We got pens, we got great lasagna, and they had very cool slides that showed pain stopped by opioids. And we learned that home opioids aren't addictive, and if you stay ahead of pain --

you can keep your patients pain-free. And beyond the obviously egregious marketing, I think it was framing "pain-free" as the goal that has destroyed countless lives.

My friend's son Christopher started having severe abdominal pain during this "no-pain" era. Eventually, he was diagnosed with a colon disease and had surgery his senior year. They sent Christopher home with 90 OxyContin, and then 90 more, and then, as the pain started getting faster and faster ... Uncontrolled pain is terrifying. So when his ran out and his friends' medicine cabinets ran out,

Christopher tried heroin. And Christopher Wolf lost his battle with substance use at age 32. So did we misunderstand pain?

What if pain isn’t an alarm to silence but a learning system for survival?

Pain is the basic survival learning system of all organisms. It's almost as though they're saying, "Ouch. Don't even think of touching it." To quote "The Princess Bride," "Life is a pain, Highness." "Pain-free" was a marketing term that led doctors to believe that just one medication could alleviate pain. It still makes people believe that you can't be happy if you're in pain, yet we now know that moving past pain requires effort. Setting the standard at "pain-free" was unrealistic. Many people may have been more comfortable, but they gave up since pain-free living was out of reach for them.

We have some incredibly exciting new material to present, so I want you to think about pain as a Venn diagram, with physiology, fear, and control. I'll explain how each of these can give you control over pain. In my current research, I'm converting these into a low-back pain gadget to reduce opiate use. But 20 years ago, all I wanted was a quick fix for needle discomfort, IV access, and my children's vaccinations.

My hands were quivering on the steering wheel as I drove home one night after a graveyard shift because we needed to get the tyres balanced. I was ignoring it in order to focus on my discomfort, and when I got home and reached for the door of my house,

My hand had gone numb. Vibration. So I rushed in, my Boy Scout husband grabbed some frozen peas, and we had a genuine epiphany moment in which cold and vibration prevented pain. Over the next decade, I discovered the correct frequency to block pain, received funding, and developed Buzzy, which is vibration with ice... in the shape of a bee. When you get an injection, you put it on your arm. To date, 45 million needle treatments have reduced pain, and over 80 randomised controlled trials have been published separately all around the world.

But ...

At about 30 randomized controlled trials in, one of my colleagues came to me and confided that he was in opioid recovery. And he asked whether or not Buzzy could let him get through a total knee replacement drug-free. I'd never thought about it. It's the same pain nerve for knees as for needles, so I said maybe. And he did it. Vibration plus cold replaced OxyContin.

So I went all in to figure out why at that time. And here's what we know thus far. Because the physiology of the nerves of mild touch, pressure, stretching, and motion all race pain to the spine, vibration reduces pain. People have tried using electricity to stimulate the light-touch nerves, but we now know that motion, as indicated in green, is the most successful at blocking acute pain. This is known as gate control, because the precise proper frequency of vibration activates the nerves that reduce pain. Ice has a distinct physiology. As a result, the cold travels to the brain, where the conductor declares, "Obnoxious, but not dangerous."

I'm going to reduce sensations from everywhere." It also reduces pain throughout the body. If a youngster had been so traumatised by earlier experiences that even the swab hurt... physiology wasn't as useful. As a result, we added distractions such as a monkey poster. And what we noticed was that combining counting with decision-making

cut pain in half.

So, for example, "How many monkeys are actually touching the bed?" activates the decision switchboard. I know what you guys are doing. It's five.

Here is your pain hack for the day, though. If you do not have monkeys on hand, then find any sentence and count how many of the letters have holes in them. Counting, deciding. So, like, you've got a g-hole,

o-hole, a ... hole.

I guarantee you and your family will use this.

The most important hack, though, is understanding why distraction works. And now, thanks to functional MRI, we can witness pain in action. And it's not just one location. Pain is a symphony of connections, beginning with the sensation region and progressing to the conductor, the decision switchboard, and finally to fear, memory, meaning, and control. As a result, if the decision switchboard is busy sorting monkeys, it cannot notify fear and meaning, and you experience less pain. What you feel is primarily what you anticipate feeling. Please bear with me. A blow from a bully hurts more than a punch from a friend if you're a kid. And if you're an adult and you feel something, the second you believe it's cancer, the pain intensifies until you realise it's not.

And those same kids who had horrible shot experiences can tolerate all kinds of needle pain ... to look cool. Because it is a different context.

Because experiences lay down more of the same sensation, these patterns, known as connectomes, are quite personal. And we now know that persons who have particular brain areas linked feel more pain than people who have various areas linked. 

More significantly, untreated or strong pain can lay down heavier connections, causing you to feel more pain long after your body has healed. It is precisely because of this suppleness and personalisation that

which makes the physiology, fear, control matrix so useful. Because choosing physiologic options that you can layer, that work for you, decreases pain, like heat, cold, vibration, deep relaxation, acupuncture, capsaicin, exercise, meditation ...

There's more. Christopher probably had 10 of these around his house and just didn't know it. Having control over your options decreases pain. Deep breathing increases control. Choosing what to focus on increases control.

Fear and control are the volume knobs for pain. Fear controls so many of our sensations, this shouldn't be unusual, but we don't practice it for pain. So if you're home alone and you hear a clunk ... your hearing becomes hypersensitive.

When you remember your child's return from college, your panic fades and your brain takes over, saying, "Don't worry about it." Pain, according to Saint Augustine, is the greatest of all evils. However, if it is a survival system, it cannot be entirely wicked. Consider pain to be your nagging, safety-obsessed, exaggerated friend who is occasionally incorrect. It's also fine to ignore or override your friend if you know you're safe.

This takes practice. On a flight that was turbulent, I had an entire cup of scalding-hot coffee dumped straight on my ankle. Electric jolt through my scalp. I ripped off my sock; it was already red. It was going to blister.

There was no way I could get my foot into that little sink to get cold water on it. And then I remembered. Physiology hack. I had an unopened cold beer.

Medical-grade cold beer went on my ankle, stat. I had a vibrator in my carry-on, because I would. On my ankle. And then --

The pain kind. And then my fear hack. I'm like, "There's a barf bag that has holy letters, but I'm going to put it in the pocket pouch and save it, because then, I have increased control." And, pain , I was no longer that concerned. Although then, I realized I'm that guy,

with my bare foot sticking out in the aisle on a plane, with a beer on it. Power over pain isn’t always pretty, but it is possible and it is absolutely critical. Because there’s one more misconception we have not talked about.

I honestly thought that opioids turned off some pain switch. They turn on our reward system. So some people feel amazing, but most people just still feel pain, but don't care. Now, this is a godsend for people with chronic pain diseases.

We should not take them away. And in the trauma bay, the more morphine in the first 24 hours after a burn or a wound, the less post-traumatic stress, the less chronic pain later. But studies show that recovery after surgery is just as well accomplished with coaching and physiologic options. And if you're one of the people who feel amazing with opioids, it's too risky.

A study in 2019 found that one in 15 young adults who got opioids for their wisdom tooth removal had substance-use disorder within a year. Ibuprofen works better.

So what do we do?

Well, in my dream world, we have health-care systems -- paid-for options and coaching -- for Christophers everywhere. And we quit giving double-digit prescriptions for opioids for home recovery. In the real world, and 80 percent of substance-use disorders start with a pill prescribed for pain ... Usually taken from your friend's medicine cabinet. People can’t afford options.

Doctors, 20 years later, still don't know them. But you do. You all now know to throw away the opioids in your medicine cabinet. You now know that there are options you can use to decrease pain, and you know that "pain-free" should be ditched for "more comfortable." And whether you dump scalding coffee or pain wakes you and exhausts you every day ... Options that are in your control ... can allow you to reframe pain.

Whitney Pennington Rodgers: Amy, thank you, it's amazing. So how do you think that pain scales have set us back from this work that you're doing, and how is the NIH treating pain and addiction differently now?

Amy Baxter: So in one of the 120 versions of this talk, I talked about how the thing is, in the '90s, if we wanted to “disease-ify” pain, it meant we had to be able to measure it. So that was where the FACES scales come from, and they're actually very useful in the emergency department to tell whether or not a medicine is working. In fact, we were one of the first ones that showed, with sickle cell, that the patient's report, based on those scales,

was what was most indicative of whether they needed to be admitted, rather than any biologic marker.

But what we're doing now is we're using something called the PROMIS scales, so it’s how intense pain is on five-point scales, how much it interferes, so there's pain interference, pain intensity.

And the way we're looking at pain is much more on the impact for the person, rather than trying to pretend there's any kind of objective pain measurement.

WPR: OK.

And you mentioned that you're working on some new applications for Buzzy, specifically for back pain. What are some of the possibilities that we have here for what this could do for us in the future? AB: On my tombstone, there's going to be a vibrating bee. It's actually called DuoTherm, not Buzzy. But what we've learned is that there are harmonics of interaction between the specific frequencies that cancel out the pain.

So there’s one particular nerve called the Pacinian that has a very specific frequency range, and by causing them to interact, we're starting to explore more about the pain that's coming from the fascia between the skin and between the muscles, but that area is where we're unexplored, and so by interacting with different frequencies and then layering heat or cold, pressure options, giving people the choice of so many different ways to do it, it's really engaging all the different areas of the brain from which pain comes.

WPR: Wow, OK. Well, thank you so much, Amy.

Thank you, all.