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 WELL, GOOD AFTERNOON,

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EVERYONE.

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I'M NOT NINA SCHOR, AS YOU CAN

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TELL.

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SHE SENDS REGRETS, NOT ABLE TO

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INTRODUCE TODAY'S SPEAKERS.

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I'M DAVID SHURTLEFF.

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IT'S MY GREAT HONOR AND PLEASURE

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TO INTRODUCE ONE OF OUR OWN, DR.

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LAUREN ATLAS, A YEAR TWO WEEKS

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AGO, A GREAT ACCOMPLISHMENT,

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WE'RE SO PROUD OF HER, ALL SHE'S

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BRINGING TO OUR PROGRAM.

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BACKGROUND, DR. ATLAS IS AN

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EXPERIMENTAL PSYCHOLOGIST, AND

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AFFECTIVE NEUROSCIENTIST

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RECENTLY TENURED SENIOR

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INVESTIGATOR, AND CHIEF OF NCCIH

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EFFECTIVE NEUROSCIENCE AND PAIN

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LABORATORY.

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SHE ALSO AS JOINT POINT WITH

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NIDA, NIMH, AND UNIVERSITY OF

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MARYLAND, BACHELOR OF ARTS IN

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PSYCHOLOGY UNIVERSITY OF CHICAGO

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IN 2003, Ph.D. IN PSYCHOLOGY

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FROM COLUMBIA UNIVERSITY IN

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2011.

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COMPLETED A POSTDOC AT NYU

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DEPARTMENT OF PSYCHOLOGY.

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2024 DR. ATLAS JOINED US HERE AT

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NCCIH.

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AT THAT TIME WE WERE A BRAND-NEW

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INTRAMURAL PROGRAM, JUST FORMED

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IN 2012.

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SHE CAME TWO YEARS LATER.

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WHEN SHE ARRIVED SHE LAUNCHED A

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SECTION ON AFFECTIVE

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NEUROSCIENCE AND PAIN, THROUGH

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HER RESEARCH COMBINES EXPERTISE

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IN PAIN RESEARCH HOW 

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PSYCHOLOGICAL FACTORS SHAPE

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PAIN,  EMOTIONAL FACTOR.

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I'M A PSYCHOLOGIST TOO, IT

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BRINGS SO MUCH RICH INFORMATION

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AND INSIGHT INTO A DISORDER SUCH

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AS PAIN BECAUSE IT'S MORE THAN

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KNOWS NOCICEPTION.

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SHE AND HER TIME COMBINE

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ADVANCED fMRI ANALYSIS WITH

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EXPERIMENT DESIGN TO EVALUATE

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EXPECTATION AND SOCIAL FACTORS,

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PUBLISHING 55 FACTORS SINCE SHE

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JOINED THE NIH, AND HER TRAINEES

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HAVE DONE GREAT THINGS INCLUDING

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FACULTY POSITIONS AND PROGRAM

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OFFICERS IN FACT HERE AT THE

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NIH.

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DR. ATLAS HAS HELD NUMEROUS

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EDITORIAL AND LEADERSHIP

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POSITIONS IN THE PAIN RESEARCH

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AND  AFFECTIVE NEUROSCIENCE

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COMMUNITIES, CO-CHAIR OF UNITED

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STATES ASSOCIATION FOR STUDY OF

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PAIN, NEUROIMAGING SPECIAL

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INTEREST GROUP, AND FINALLY DR.

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ATLAS IS AN ENTHUSIASTIC AND

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ACTIVE MEMBER OF THE NIH

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INTRAMURAL RESEARCH COMMUNITY

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WITH SERVICE AND LEADERSHIP

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ROLES IN  IN ADVISORY GROUPS ACS

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THE NIH.

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JOIN ME IN WELCOMING DR. ATLAS

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TO THE PODIUM FOR THIS NIH

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DIRECTOR'S LECTURE.

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THANK YOU.

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[APPLAUSE]

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>> THANKS SO MUCH, DAVID,
FOR

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THE WARM INTRODUCTION.

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SO NICE TO ACTUALLY SEE PEOPLE

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IN PERSON.

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I WAS CONFIDENT WITH THE WEATHER

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THAT WE'D HAVE A VERY EMPTY ROOM

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BUT IT'S REALLY NICE SO MANY

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PEOPLE CAME OUT.

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TODAY I'LL BE TALKING ABOUT OUR

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WORK OVER THE PAST TEN YEARS ON

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NEURAL AND PSYCHOLOGICAL

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INFLUENCES ON PAIN AND ITS

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ASSESSMENT.

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I WANT TO REALLY ACKNOWLEDGE ALL

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OF THE TRAINEES I'VE HAD THE

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BENEFIT OF WORKING WITH. 

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I WORKED WITH STELLAR

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ENTHUSIASTIC, BRILLIANT, AND

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KIND PEOPLE.

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IT'S BEEN A PLEASURE TO BOTH

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CONTRIBUTE TO YOUR GROWTH AS

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TRAINEES, ALSO TO GROW MYSELF

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THROUGH THE YEARS AND  CHAPTERS.

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THE MISSION, TO UNDERSTAND HOW

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PSYCHOLOGICAL FACTORS SHAPE

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PAIN.

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IN AMERICA MORE THAN 30% OF

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AMERICANS ARE LIVING WITH SOME

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FORM OF CHRONIC OR SEVERE PAIN,

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OVER 7% REPORT DEBILITATING

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PAIN, MORE PEOPLE LIVE WITH

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CHRONIC PAIN THAN CANCER, HEART

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DISEASE, DIABETES COMBINED.

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WE ALSO SEE THAT PAIN IS AT THE

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INTERSECTION OF MULTIPLE

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DIFFERENT URGENT HEALTH CRISES

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IN AMERICA.

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WE KNOW THAT THE LACK OF

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NON-ADDICTIVE TREATMENTS FOR

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PAIN CONTRIBUTED TO THE OPIOID

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EPIDEMIC, WITH HUGE HEALTH

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DISPARITIES IN PAIN.

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NON-WHITE INDIVIDUALS AND WOMEN

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ARE LESS LIKELY TO BE TREATED

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DESPITE EXPERIENCING MORE PAIN

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IN THE LAB AND CLINIC.

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THESE ARE BOTH TOPICS THAT I

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THINK WE AS PSYCHOLOGISTS CAN

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MAKE CRITICAL INSIGHTS ON IN

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TERMS OF REALLY KIND OF

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UNDERSTANDING THE RELATIONSHIP

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BETWEEN PAIN, SOCIAL PROCESSING

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DECISIONS AND MORE AS DAVID

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ALLUDED TO.

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WE USE PLACEBO ANALGESIA, WHICH

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REFERS TO REDUCTIONS IN PAIN DUE

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TO INERT TREATMENTS, AS A

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GUIDING MODEL TO HELP US ISOLATE

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HOW EXPECTATIONS AND

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PSYCHOSOCIAL CONTEXT SURROUNDING

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TREATMENT DIRECTLY INFLUENCE

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CLINICAL OUTCOMES.

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WE THINK PLACEBO EFFECTS DEPEND

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ON THE COMBINED PSYCHOLOGICAL

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PROCESSES OF EXPECTATION FOR

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PAIN RELIEF OR BENEFICIAL

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OUTCOMES, SHIFTS IN EMOTION SO

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FEELING LESS ANXIETY OR BETTER

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BEING CARED FOR, AND THE ACTUAL

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INTERPERSONAL SOCIAL TREATMENT

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CONTEXT.

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AND SO WE SYSTEMATICALLY

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MANIPULATE AND MEASURE EFFECTS

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ON PAIN.

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NOW, MANY PEOPLE ARE AWARE OF

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PLACEBO EFFECTS BECAUSE WE

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GENERALLY TRY TO CONTROL FOR

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THEM IN CLINICAL TRIALS IN ORDER

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TO ISOLATE THE PURE EFFECT OF

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THE DRUGS.

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BUT BY INCLUDING -- I'LL TRY

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THIS POINTER.

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BY INCLUDING A NATURAL HISTORY

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CONTROL GROUP, CLINICAL TRIALS

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CAN ACTUALLY ISOLATE PLACEBO

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EFFECT, NOT JUST THE DRUG

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EFFECT.

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IN 2001 AND AGAIN IN 2004 THESE

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AUTHORS CONDUCTED A

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META-ANALYSIS OF CLINICAL TRIALS

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THAT COMPARED PLACEBO TREATMENT

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WITH NO TREATMENT.

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AND WHAT THEY FOUND IS THAT

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PLACEBO EFFECTS WERE STRONGEST

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IN PAIN AND SUBJECTIVE OUTCOMES.

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ON ONE HAND, THIS COULD BE A

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GREAT OPPORTUNITY FOR US TO

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ISOLATE THESE PSYCHOLOGICAL

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FACTORS, COMBINE WITH TREATMENT,

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HELP PEOPLE HAVE THE BEST

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OUTCOMES WHEN IT COMES TO PAIN,

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DEPRESSION, DIFFERENT THINGS

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THAT DEPEND ON SUBJECTIVE

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DECISIONS.

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ON THE OTHER HAND, IF THIS IS

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JUST PEOPLE SAYING THEY ARE

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FEELING BETTER WITHOUT ANY REAL

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BIOLOGICAL CHANGES, THEN THESE

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KINDS OF EFFECTS COULD JUST BE

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PEOPLE WHINING ABOUT HOW THEY

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ARE FEELING.

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THIS HAS CATAPULTED RESEARCH IN

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THE AREA OF MECHANISTIC WORK ON

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PLACEBO AND PAIN RELIEF.

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AND WITH THE KEY QUESTIONS BEING

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CAN WE IDENTIFY PAIN-SPECIFIC

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CIRCUITS, DO EXPECTATIONS

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MODULATE PAIN THROUGH

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PAIN-SPECIFIC CIRCUITS OR MORE

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GENERAL CIRCUITS INVOLVED IN

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EMOTION AND DECISION MAKING, AND

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KIND OF MORE BROADLY HOW DO

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PSYCHOSOCIAL FACTORS SHAPE PAIN.

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SO, TO DO THIS, WE ADMINISTERED

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PAIN IN THE LAB USING

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SPECIALIZED DEVICES TO HEALTHY

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VOLUNTEERS.

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WE MEASURE HOW MUCH MAIN THIS

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ELICITS. 

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USEEL TOOLS FROM NEUROSCIENCE

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MANIPULATE THE SOCIAL CONTEXT,

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AND USE BRAIN IMAGING TO STUDY

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THE PATHWAYS.

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TODAY I WILL GIVE EXAMPLES,

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FIRST ISOLATING PAIN RESPONSES

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AND HIGHLIGHTING SEX DIFFERENCES

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IN THESE RELATIONSHIPS AS WELL

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AS INTRODUCING THIS IDEA OF

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USING BRAIN IMAGING TO IDENTIFY

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PAIN BIOMARKERS.

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NEXT I'LL TALK ABOUT OUR WORK ON

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HOW EXPECTATIONS SHAPE PAIN AND

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AFFECTIVE EXPERIENCE TO ADDRESS

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THIS QUESTION WHETHER THIS IS

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THROUGH PAIN SPECIFIC OR GENERAL

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AFFECTIVE PROCESSES.

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AND FINALLY I'LL INTRODUCE THE

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MOST RECENT LINE OF WORK WE'VE

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BEEN WORKING ON IN THE LAB,

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REALLY LOOKING AT HOW SOCIAL

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INFLUENCES SPECIFICALLY

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INFLUENCE PAIN EXPECTATIONS AND

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PAIN ASSESSMENT.

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SO, PAIN IS DEFINED AS

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UNPLEASANT SENSORY AND EMOTIONAL

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EXPERIENCE ASSOCIATED WITH

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ACTUAL OR POTENTIAL TISSUE

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DAMAGE OR DESCRIBED IN TERMS OF

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SUCH DAMAGE.

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AS DAVID HIGHLIGHTED IN THE

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INTRODUCTION THIS IS DISTINCT

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FROM NOCICEPTION, THE NEURAL

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PROCESS OF ENCODING THE NOXIOUS

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STIMULUS ITSELF.

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WE CAN DIVIDE PAIN INTO

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INTENSITY, HEAT, WHERE IT IS ON

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YOUR BODY VERSUS AFFECTIVE OR

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MOTIVATIONAL COMPONENTS, THE

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THINGS THAT DRIVE YOU TO WANT TO

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ESCAPE THE PAIN AND CAN BE

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MEASURED IN TERMS OF

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UNPLEASANTNESS.

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SO WHAT IT LOOKS LIKE IN THE LAB

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IS WE HAVE PEOPLE COME IN, WE

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USE THIS DEVICE CALLED A

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THERMODE, HEAT IT AND YOU ASK

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PEOPLE TO RATE IT USING 0-10

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SCALE DEFINING TWO AS START OF

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PAIN, EIGHT AS MAXIMUM PAIN

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PEOPLE WOULD BE WILLING TO

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TOLERATE.

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IF IT WERE A HOT CUP OF COFFEE

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AT 8 YOU COULD HOLD ON BUT

260
00:10:06,781 --> 00:10:14,422
BEYOND THAT YOU PUT IT DOWN.

261
00:10:14,422 --> 00:10:23,764
WE AP AVOIDED PLACES NOCICEPTORS

262
00:10:23,764 --> 00:10:28,803
DON'T RESPOND, OVER CALIBRATION

263
00:10:28,803 --> 00:10:30,771
CAN IDENTIFY UNIQUE THRESHOLDS,

264
00:10:30,771 --> 00:10:32,306
TOLERANCE, AND CORRELATION

265
00:10:32,306 --> 00:10:34,075
BETWEEN TEMPERATURE AND PAIN.

266
00:10:34,075 --> 00:10:36,477
SO, IF PEOPLE HAVE RELIABLE

267
00:10:36,477 --> 00:10:37,511
RELATIONSHIPS BETWEEN

268
00:10:37,511 --> 00:10:38,746
TEMPERATURE AND PAIN, WE THEN

269
00:10:38,746 --> 00:10:40,948
CAN BRING THEM BACK TO OUR OTHER

270
00:10:40,948 --> 00:10:46,320
STUDIES WHERE WE ACTUALLY

271
00:10:46,320 --> 00:10:47,421
MANIPULATE PSYCHOLOGICAL FACTORS

272
00:10:47,421 --> 00:10:49,156
BECAUSE THERE'S A RELATIONSHIP

273
00:10:49,156 --> 00:10:52,560
BETWEEN THE INPUT AND THEIR

274
00:10:52,560 --> 00:10:52,927
EXPERIENCE.

275
00:10:52,927 --> 00:10:57,365
PRIOR TO THE PANDEMIC WE DID

276
00:10:57,365 --> 00:10:59,233
THIS IN 300 HEALTHY INDIVIDUALS,

277
00:10:59,233 --> 00:11:02,303
170 CAME BACK FOR MULTIPLE

278
00:11:02,303 --> 00:11:04,939
VISITS. 

279
00:11:04,939 --> 00:11:06,774
THREE POSTDOCS IN MY LAB

280
00:11:06,774 --> 00:11:07,575
REALIZED THIS WAS A GREAT

281
00:11:07,575 --> 00:11:10,111
OPPORTUNITY TO LOOK AT THE

282
00:11:10,111 --> 00:11:11,512
RELIABILITY OF THESE MEASURES.

283
00:11:11,512 --> 00:11:13,614
SO, WHAT THEY DID IS THEY LOOKED

284
00:11:13,614 --> 00:11:16,350
AT PEOPLE WHO HAD COME BACK FOR

285
00:11:16,350 --> 00:11:18,519
MULTIPLE VISITS.

286
00:11:18,519 --> 00:11:22,590
YOU CAN SEE VISIT 1 ON X-AXIS,

287
00:11:22,590 --> 00:11:25,559
VISIT 2 ON Y-AXIS, THAT'S THE

288
00:11:25,559 --> 00:11:26,160
TEMPERATURE ASSOCIATED WITH

289
00:11:26,160 --> 00:11:26,961
START OF PAIN.

290
00:11:26,961 --> 00:11:31,132
WHAT YOU SEE IS STRONG

291
00:11:31,132 --> 00:11:32,099
RELATIONSHIPS ACROSS INDIVIDUALS

292
00:11:32,099 --> 00:11:36,370
AND THEN VERY CONSISTENT

293
00:11:36,370 --> 00:11:37,838
RELATIONSHIPS BETWEEN PAIN

294
00:11:37,838 --> 00:11:38,773
THRESHOLD ACROSS VISITS.

295
00:11:38,773 --> 00:11:40,541
SIMILAR EFFECT WITH PAIN

296
00:11:40,541 --> 00:11:40,975
TOLERANCE.

297
00:11:40,975 --> 00:11:43,911
USING A MEASURE CALLED

298
00:11:43,911 --> 00:11:45,980
INTRACLASS CORRELATION WHICH

299
00:11:45,980 --> 00:11:49,717
LOOKS AT BETWEEN SUBJECT VERSUS

300
00:11:49,717 --> 00:11:52,653
WITHIN-PERSON VARIABILITY WE SEE

301
00:11:52,653 --> 00:11:54,188
MODERATE TO GOOD TOLERANCE.

302
00:11:54,188 --> 00:11:56,624
WHAT THIS MEANS IS THAT THERE'S

303
00:11:56,624 --> 00:11:57,925
SOMEWHAT STABLE INDIVIDUAL

304
00:11:57,925 --> 00:11:59,894
DIFFERENCES, WE CAN RELIABLY

305
00:11:59,894 --> 00:12:02,196
MANIPULATE THE STIMULUS, NOXIOUS

306
00:12:02,196 --> 00:12:04,065
INPUT, MEASURE SUBJECTIVE PAIN.

307
00:12:04,065 --> 00:12:06,801
WHEN WE LOOK AT THIS, IT'S LESS

308
00:12:06,801 --> 00:12:07,935
CONSISTENT, THAT'S IN PART

309
00:12:07,935 --> 00:12:10,071
BECAUSE WE HAVE SO MANY PEOPLE

310
00:12:10,071 --> 00:12:12,606
WHO ARE UP HERE IN THE EXTREMELY

311
00:12:12,606 --> 00:12:17,411
ACCURATE READINGS AS WELL AS

312
00:12:17,411 --> 00:12:19,914
FACT IF LESS THAN .4 WE DON'T

313
00:12:19,914 --> 00:12:21,582
BRING THEM BACK TO A SECOND

314
00:12:21,582 --> 00:12:21,949
VISIT.

315
00:12:21,949 --> 00:12:23,351
PEOPLE ARE GOOD AT RATING PAIN

316
00:12:23,351 --> 00:12:25,853
IN RESPONSE TO CHANGES IN

317
00:12:25,853 --> 00:12:26,487
TEMPERATURE.

318
00:12:26,487 --> 00:12:28,255
SO, THIS KIND OF GIVES US --

319
00:12:28,255 --> 00:12:29,557
HOPEFULLY GIVES YOU A FLAVOR OF

320
00:12:29,557 --> 00:12:32,760
WHAT IT LOOKS LIKE FOR US TO

321
00:12:32,760 --> 00:12:34,829
MANIPULATE PAIN IN THE LAB.

322
00:12:34,829 --> 00:12:37,998
BUT WHAT WE REALIZED IS ACTUALLY

323
00:12:37,998 --> 00:12:40,067
WITH THIS SAMPLE SIZE OF PEOPLE

324
00:12:40,067 --> 00:12:41,168
WHO CAME BACK ACROSS MULTIPLE

325
00:12:41,168 --> 00:12:42,603
VISITS WE HAD A REALLY NICE

326
00:12:42,603 --> 00:12:44,438
BREAKDOWN IN TERMS OF SEX

327
00:12:44,438 --> 00:12:46,607
DIFFERENCES BETWEEN OUR FEMALE

328
00:12:46,607 --> 00:12:47,942
AND MALE PARTICIPANTS.

329
00:12:47,942 --> 00:12:50,111
ALLOWING US TO ACTUALLY ASK

330
00:12:50,111 --> 00:12:51,879
FORMALLY WHETHER WE SEE SEX

331
00:12:51,879 --> 00:12:53,013
DIFFERENCES IN RELIABILITY.

332
00:12:53,013 --> 00:12:56,150
THIS IS REALLY IMPORTANT BECAUSE

333
00:12:56,150 --> 00:12:57,118
WOMEN HAVE TRADITIONALLY BEEN

334
00:12:57,118 --> 00:12:58,319
EXCLUDED FROM RESEARCH IN PAIN

335
00:12:58,319 --> 00:13:03,257
AND OTHER FIELDS BECAUSE OF

336
00:13:03,257 --> 00:13:03,891
ASSUMPTION HORMONAL VARIABILITY

337
00:13:03,891 --> 00:13:05,760
ACROSS THE CYCLE WILL MAKE THEM

338
00:13:05,760 --> 00:13:06,861
LESS CONSISTENT IN THEIR PAIN.

339
00:13:06,861 --> 00:13:09,697
WHAT DO WE SEE WHEN WE LOOK AT

340
00:13:09,697 --> 00:13:10,598
CORRELATION MEASURES?

341
00:13:10,598 --> 00:13:12,867
WE SEE WOMEN ARE MORE CONSISTENT

342
00:13:12,867 --> 00:13:15,403
THAN MEN ACROSS VISITS FOR ALL

343
00:13:15,403 --> 00:13:17,605
DIFFERENT PAIN MEASURES.

344
00:13:17,605 --> 00:13:19,240
TO US, THIS CONTRADICTS

345
00:13:19,240 --> 00:13:20,775
ASSUMPTION FEMALE PARTICIPANTS

346
00:13:20,775 --> 00:13:22,410
WILL BE LESS CONSISTENT BECAUSE

347
00:13:22,410 --> 00:13:25,479
OF HORMONAL FACTORS, AND

348
00:13:25,479 --> 00:13:27,314
TRADITIONAL RATIONALE FROM

349
00:13:27,314 --> 00:13:28,516
EXCLUDING WOMEN FROM RESEARCH,

350
00:13:28,516 --> 00:13:31,819
WHETHER FEMALE PARTICIPANTS IN

351
00:13:31,819 --> 00:13:37,591
HUMAN STUDIES OR IN ANIMAL WORK.

352
00:13:37,591 --> 00:13:41,662
AND BECCA HAS SEASON INCREASED

353
00:13:41,662 --> 00:13:45,299
VARIABILITY IN MALE RODENTS

354
00:13:45,299 --> 00:13:47,802
TASKS OF FORAGING BEHAVIOR.

355
00:13:47,802 --> 00:13:51,839
BUILDING ON THIS, A POSTDOC WHO

356
00:13:51,839 --> 00:13:54,875
CAME TO MY LAB IN 2021, JULIE

357
00:13:54,875 --> 00:13:56,444
PARSONS, WANTED TO LOOK AT THE

358
00:13:56,444 --> 00:13:58,946
SAME GOODNESS OF FIT MEASURE, R

359
00:13:58,946 --> 00:14:00,080
SQUARED, CORRELATION BETWEEN

360
00:14:00,080 --> 00:14:01,048
TEMPERATURE AND PAIN, WHEN

361
00:14:01,048 --> 00:14:03,250
PEOPLE DID TWO TYPES OF PAIN

362
00:14:03,250 --> 00:14:06,720
ASSESSMENTS WITHIN A VISIT.

363
00:14:06,720 --> 00:14:08,823
SO, PEOPLE EITHER EXPERIENCED

364
00:14:08,823 --> 00:14:14,295
EIGHT SECOND STIMULI USING THE

365
00:14:14,295 --> 00:14:15,396
THERMO OR THREE-SECOND STIMULI,

366
00:14:15,396 --> 00:14:18,132
A DEVICE THAT IS BETTER FOR

367
00:14:18,132 --> 00:14:19,667
DOING THINGS LIKE EEG STUDIES.

368
00:14:19,667 --> 00:14:22,069
BEFORE WE WANTED TO USE THIS WE

369
00:14:22,069 --> 00:14:29,276
WANTED TO SEE HOW SIMILAR THIS

370
00:14:29,276 --> 00:14:29,844
IS.

371
00:14:29,844 --> 00:14:31,378
SO, FOR FEMALE PARTICIPANTS R

372
00:14:31,378 --> 00:14:33,214
SQUAREDS WERE THE SAME

373
00:14:33,214 --> 00:14:36,851
REGARDLESS OF STIMULUS DURATION

374
00:14:36,851 --> 00:14:40,988
OR TEMPERATURE THAT -- STIMULUS

375
00:14:40,988 --> 00:14:41,755
DURATION OR THERMODE SIZE,

376
00:14:41,755 --> 00:14:43,057
BECAUSE THEY ARE TWO DIFFERENT

377
00:14:43,057 --> 00:14:43,924
SIZES.

378
00:14:43,924 --> 00:14:45,693
WE SAW THE MALE PARTICIPANTS

379
00:14:45,693 --> 00:14:49,063
WERE LESS ACCURATE WHEN TESTED

380
00:14:49,063 --> 00:14:51,699
WITH THIS SECOND STIMULI THAN

381
00:14:51,699 --> 00:14:53,033
EIGHT-SECOND STIMULI, AGAIN

382
00:14:53,033 --> 00:14:55,669
SHOWING THAT OUR FEMALE

383
00:14:55,669 --> 00:14:56,770
PARTICIPANTS WERE MORE

384
00:14:56,770 --> 00:14:57,972
CONSISTENT ACROSS -- FIRST

385
00:14:57,972 --> 00:15:02,142
ACROSS VISITS, AND NOW WITHIN

386
00:15:02,142 --> 00:15:03,544
VISITS ACROSS STIMULUS

387
00:15:03,544 --> 00:15:04,311
DURATIONS.

388
00:15:04,311 --> 00:15:07,848
NOW, ALTHOUGH I THINK THIS KIND

389
00:15:07,848 --> 00:15:09,450
OF SHOWS THAT THE HORMONAL

390
00:15:09,450 --> 00:15:10,885
FLUCTUATIONS AREN'T LEADING TO

391
00:15:10,885 --> 00:15:12,953
INCREASED VARIABILITY IN THE

392
00:15:12,953 --> 00:15:14,154
WOMEN, WE DO CONSISTENTLY STILL

393
00:15:14,154 --> 00:15:15,623
GET THE QUESTION, IS THERE

394
00:15:15,623 --> 00:15:17,892
ANYTHING HAVING TO DO WITH THE

395
00:15:17,892 --> 00:15:18,759
MENSTRUAL CYCLE.

396
00:15:18,759 --> 00:15:20,194
JULIE DID A PILOT STUDY WHERE

397
00:15:20,194 --> 00:15:23,030
SHE WENT BACK TO OUR FIRST STUDY

398
00:15:23,030 --> 00:15:26,100
AND FOUND WHICH WOMEN HAD

399
00:15:26,100 --> 00:15:26,734
REPORTED THEIR HORMONAL STATUS,

400
00:15:26,734 --> 00:15:30,905
WHETHER OR NOT THEY WERE IN

401
00:15:30,905 --> 00:15:32,439
CONTRACEPTIVES AS WELL AS WHICH

402
00:15:32,439 --> 00:15:33,774
MENSTRUAL PHASE WHEN THEY CAME

403
00:15:33,774 --> 00:15:35,509
IN, WHEN THE START OF THE CYCLE.

404
00:15:35,509 --> 00:15:38,445
WE DIDN'T HAVE THIS DATA ON

405
00:15:38,445 --> 00:15:40,748
EVERYBODY SO THESE ARE SMALL

406
00:15:40,748 --> 00:15:43,384
SAMPLES BUT STILL OUR BEST WAY

407
00:15:43,384 --> 00:15:45,953
TO ANSWER THE REQUEST WHETHER

408
00:15:45,953 --> 00:15:47,121
THERE'S ANYTHING RELATED TO THE

409
00:15:47,121 --> 00:15:48,355
MENSTRUAL CYCLE WITH THE MEASURE

410
00:15:48,355 --> 00:15:48,989
OF PAIN.

411
00:15:48,989 --> 00:15:51,926
THESE ARE WOMEN ON HORMONAL

412
00:15:51,926 --> 00:15:53,694
CONTRACEPTIVES, AND ON THE

413
00:15:53,694 --> 00:15:54,795
Y-AXIS I'M SHOWING THE

414
00:15:54,795 --> 00:15:57,831
DIFFERENCE BETWEEN VISITS.

415
00:15:57,831 --> 00:15:58,933
WE SEE BASICALLY IT'S ABSOLUTE

416
00:15:58,933 --> 00:16:01,569
VALUE OF THE CHANGE BETWEEN

417
00:16:01,569 --> 00:16:03,537
VISITS, SO THE THRESHOLD AND

418
00:16:03,537 --> 00:16:04,838
TOLERANCE DIFFER BY ABOUT 1

419
00:16:04,838 --> 00:16:05,272
DEGREE.

420
00:16:05,272 --> 00:16:07,675
WHAT HAPPENS WHEN WE LOOK AT

421
00:16:07,675 --> 00:16:09,543
WOMEN WHO ACTUALLY CAME IN AT

422
00:16:09,543 --> 00:16:10,978
DIFFERENT PHASES IN THEIR CYCLE?

423
00:16:10,978 --> 00:16:16,550
WHAT WE SEE IS THAT THE WOMEN

424
00:16:16,550 --> 00:16:24,258
WHOSE CYCLES  WITH CONTRACEPTIVS

425
00:16:24,258 --> 00:16:25,426
HELD STABLE.

426
00:16:25,426 --> 00:16:26,627
THERE WAS NO DIFFERENCE BETWEEN

427
00:16:26,627 --> 00:16:28,462
THEM, WE DIDN'T SEE ANY

428
00:16:28,462 --> 00:16:29,430
DIFFERENCE IN PAIN TOLERANCE,

429
00:16:29,430 --> 00:16:31,231
AND WE SAW SIMILAR FINDINGS WHEN

430
00:16:31,231 --> 00:16:33,734
WE LOOKED AT THAT R SQUARED

431
00:16:33,734 --> 00:16:34,501
MEASURE, WITH SMALLER

432
00:16:34,501 --> 00:16:35,235
DIFFERENCES BETWEEN SESSIONS IN

433
00:16:35,235 --> 00:16:38,405
THE WOMEN WHO ARE NOT ACTUALLY

434
00:16:38,405 --> 00:16:38,772
CYCLING.

435
00:16:38,772 --> 00:16:40,174
BUT, AGAIN, IF WE COMPARE THIS

436
00:16:40,174 --> 00:16:42,142
TO THE MEN, WE SEE IN ALL CASES

437
00:16:42,142 --> 00:16:45,112
MEN ARE JUST AS VARIABLE, IF NOT

438
00:16:45,112 --> 00:16:45,312
MORE.

439
00:16:45,312 --> 00:16:48,382
SO, WHAT I HAVE SHOWN IN THIS

440
00:16:48,382 --> 00:16:50,784
FIRST SECTION IS THAT WE CAN

441
00:16:50,784 --> 00:16:55,956
RELIABLY ELICIT PAIN IN RESPONSE

442
00:16:55,956 --> 00:16:57,157
TO NOXIOUS STIMULATION, USING

443
00:16:57,157 --> 00:16:57,858
THIS THERMODE.

444
00:16:57,858 --> 00:16:59,793
PAIN SENSITIVITY IS MORE

445
00:16:59,793 --> 00:17:01,762
RELIABLE IN WOMEN THAN MEN

446
00:17:01,762 --> 00:17:04,331
REGARDLESS OF HORMONAL STATUS.

447
00:17:04,331 --> 00:17:05,399
AND PROVOCATIVE, WHEN WE'RE

448
00:17:05,399 --> 00:17:06,500
TALKING ABOUT SEX AS A

449
00:17:06,500 --> 00:17:08,369
BIOLOGICAL VARIABLE, INSTEAD OF

450
00:17:08,369 --> 00:17:10,237
SAYING IS THE HORMONAL CYCLE

451
00:17:10,237 --> 00:17:11,872
AFFECTING THINGS WE SHOULD

452
00:17:11,872 --> 00:17:13,374
UNDERSTAND WHY MEN ARE SO MUCH

453
00:17:13,374 --> 00:17:16,610
MORE VARIABLE ACROSS.

454
00:17:16,610 --> 00:17:19,113
NOW THAT WE KNOW WE CAN ELICIT

455
00:17:19,113 --> 00:17:25,219
PAIN IN THE LAB USING ACUTE

456
00:17:25,219 --> 00:17:26,120
PAINFUL STIMULI WE CAN ASK

457
00:17:26,120 --> 00:17:28,756
WHETHER OR NOT WE CAN IDENTIFY

458
00:17:28,756 --> 00:17:29,957
BIOMARKERS FOR PAIN.

459
00:17:29,957 --> 00:17:32,359
NOW, SEARCH FOR BIOMARKERS WAS

460
00:17:32,359 --> 00:17:34,962
REALLY KIND OF ONE OF THE KEY

461
00:17:34,962 --> 00:17:36,864
GOALS LAID OUT WITH NIH HEAL

462
00:17:36,864 --> 00:17:38,832
INITIATIVE, AND THE REASON FOR

463
00:17:38,832 --> 00:17:41,001
THAT IS BECAUSE THIS WOULD

464
00:17:41,001 --> 00:17:43,070
REALLY PROVIDE AN OBJECTIVE

465
00:17:43,070 --> 00:17:44,405
MEASURE TO AUGMENT SUBJECTIVE

466
00:17:44,405 --> 00:17:45,172
PAIN READING.

467
00:17:45,172 --> 00:17:47,007
NOW, IT'S IMPORTANT THAT THIS

468
00:17:47,007 --> 00:17:48,776
NOT BE TO REPLACE PAIN RATINGS.

469
00:17:48,776 --> 00:17:50,511
WE WANT THE PATIENT'S PAIN TO BE

470
00:17:50,511 --> 00:17:51,612
FIRST AND FOREMOST.

471
00:17:51,612 --> 00:17:54,982
BUT IN CASES WHERE THERE ARE

472
00:17:54,982 --> 00:17:58,052
NON-VERBAL INDIVIDUALS OR THEN

473
00:17:58,052 --> 00:18:00,587
THIS COULD ALSO SUPPLEMENT

474
00:18:00,587 --> 00:18:01,488
SUBJECTIVE PAIN READINGS.

475
00:18:01,488 --> 00:18:03,424
IN ADDITION IT ALLOWS US TO ASK

476
00:18:03,424 --> 00:18:07,594
HOW PAIN IS MEDIATED IN

477
00:18:07,594 --> 00:18:09,096
DIFFERENT CONTEXT, LIKE THE

478
00:18:09,096 --> 00:18:19,540
QUESTION IS HOW IS PLACEBO

479
00:18:23,544 --> 00:18:24,978
ANALGESIA MEDIATED.

480
00:18:24,978 --> 00:18:27,581
OVER TIME YOU SEE KIND OF WHERE

481
00:18:27,581 --> 00:18:30,150
WE'VE BEEN SINCE 2010 THERE.

482
00:18:30,150 --> 00:18:32,653
SO, BECAUSE WE CAN OBJECTIVELY

483
00:18:32,653 --> 00:18:40,961
MANIPULATE PAIN, AND WE HAVE MR

484
00:18:40,961 --> 00:18:43,363
COMPATIBLE THERMODE WE CAN LOOK

485
00:18:43,363 --> 00:18:45,199
AT THE NOCICEPTIVE PROCESS AT

486
00:18:45,199 --> 00:18:47,401
PATHWAYS WHICH CAN BE IMAGED

487
00:18:47,401 --> 00:18:57,945
USING  FMRI, THIS COLLECTION OF

488
00:18:58,746 --> 00:19:01,515
READINGS, WE GENERALLY SEE

489
00:19:01,515 --> 00:19:03,150
STRONG ROBUST ACTIVATION IN

490
00:19:03,150 --> 00:19:04,384
fMRI SCANNER WHEN PEOPLE

491
00:19:04,384 --> 00:19:07,654
EXPERIENCE HIGH VERSUS LOW

492
00:19:07,654 --> 00:19:09,189
INTENSITY HEAT.

493
00:19:09,189 --> 00:19:12,693
AND WHILE THIS IS PROMISING, AND

494
00:19:12,693 --> 00:19:17,598
FOR A LONG TIME KATHERINE

495
00:19:17,598 --> 00:19:21,101
BUSHNELL SHOWED WE COULD FIND

496
00:19:21,101 --> 00:19:23,203
RESPONSES TO PAIN, AND WE

497
00:19:23,203 --> 00:19:26,473
ACTUALLY HAVE SHOWN WITHIN THESE

498
00:19:26,473 --> 00:19:28,041
REGIONS DORSAL ANTERIOR

499
00:19:28,041 --> 00:19:32,646
CINGULATE AND INSULA WE SEE

500
00:19:32,646 --> 00:19:35,916
GRADIENTS MORE SPECIFIC TO PAIN

501
00:19:35,916 --> 00:19:37,451
VERSUS NOCICEPTION AND CAN MAKE

502
00:19:37,451 --> 00:19:38,118
DISTINCTIONS ABOUT THE

503
00:19:38,118 --> 00:19:38,986
SUBJECTIVE EXPERIENCE.

504
00:19:38,986 --> 00:19:40,721
THESE REGIONS ARE THE SAME BRAIN

505
00:19:40,721 --> 00:19:42,189
REGIONS INVOLVED IN ANYTHING

506
00:19:42,189 --> 00:19:46,994
SALIENT IN THE SCANNER SO THESE

507
00:19:46,994 --> 00:19:48,395
ARE META-ANALYSES FROM A PROGRAM

508
00:19:48,395 --> 00:19:49,930
CALLED NEUROSENSE.

509
00:19:49,930 --> 00:19:52,666
YOU SEE BASICALLY ANY TASK THAT

510
00:19:52,666 --> 00:19:53,767
INVOLVES ATTENTION AND

511
00:19:53,767 --> 00:19:56,270
CONCENTRATION IS GOING TO ELICIT

512
00:19:56,270 --> 00:19:58,272
ACTIVATION IN WHAT WE CALL

513
00:19:58,272 --> 00:20:00,007
SALIENCE NETWORK, SPECIFIC TO

514
00:20:00,007 --> 00:20:01,642
DORSAL ANTERIOR CINGULATE AND

515
00:20:01,642 --> 00:20:03,377
INSULA.

516
00:20:03,377 --> 00:20:04,378
LIKEWISE ANY STUDY THAT INVOLVES

517
00:20:04,378 --> 00:20:05,946
A SENSE OF YOUR OWN BODY IS

518
00:20:05,946 --> 00:20:08,415
GOING TO INVOLVE THE SAME

519
00:20:08,415 --> 00:20:09,383
NETWORKS.

520
00:20:09,383 --> 00:20:11,051
SO WE CAN'T REALLY SEE

521
00:20:11,051 --> 00:20:12,152
ACTIVATION IN THIS SYSTEM AND

522
00:20:12,152 --> 00:20:15,422
SAY THEREFORE THE PERSON IS

523
00:20:15,422 --> 00:20:15,823
EXPERIENCING PAIN.

524
00:20:15,823 --> 00:20:19,893
SO WHAT WE DID IS USED MACHINE

525
00:20:19,893 --> 00:20:23,197
LEARNING, IN 2013 OR EARLIER,

526
00:20:23,197 --> 00:20:27,701
AND DEVELOPED A BRAIN-BASED

527
00:20:27,701 --> 00:20:28,702
CLASSIFIER, NEUROLOGIC PAIN

528
00:20:28,702 --> 00:20:30,204
SIGNATURE, A PATTERN OF WEIGHTS

529
00:20:30,204 --> 00:20:33,841
WHEN COMBINED WITH BRAIN

530
00:20:33,841 --> 00:20:34,942
ACTIVATION PATTERN, SO ANY

531
00:20:34,942 --> 00:20:38,412
CONTRAST FOR THOSE WHO DO fMRI

532
00:20:38,412 --> 00:20:40,514
CAN PREDICT WHETHER SOMETHING IS

533
00:20:40,514 --> 00:20:47,754
PAINFUL OR NOT, IN NEW

534
00:20:47,754 --> 00:20:50,023
SCANNER,S, NEW STUDIES, NEW

535
00:20:50,023 --> 00:20:51,158
SUBJECTS, IT'S BEEN ASTOUNDING

536
00:20:51,158 --> 00:20:52,159
TO SEE HOW ACCURATE THIS HAS

537
00:20:52,159 --> 00:20:53,861
BEEN OVER THE YEARS.

538
00:20:53,861 --> 00:20:54,761
IMPORTANTLY THIS PATTERN OF

539
00:20:54,761 --> 00:20:56,296
ACTIVATION IS HIGHLY SPECIFIC TO

540
00:20:56,296 --> 00:20:57,931
PAIN SO IT CAN DIFFERENTIATE

541
00:20:57,931 --> 00:21:00,667
BETWEEN PAIN AND OTHER TYPES OF

542
00:21:00,667 --> 00:21:01,735
AVERSIVE EXPERIENCES.

543
00:21:01,735 --> 00:21:03,503
JUST TO SHOW A RECENT EXAMPLE OF

544
00:21:03,503 --> 00:21:09,977
THIS, THIS IS A STUDY LED BY A

545
00:21:09,977 --> 00:21:12,379
FORMER -- CURRENT POST DOC AND

546
00:21:12,379 --> 00:21:16,550
FORMER POSTDOC, NOW FACULTY AT

547
00:21:16,550 --> 00:21:17,751
UNIVERSITY, WITH SUPPORT FROM

548
00:21:17,751 --> 00:21:19,953
INDIVIDUALS AND LABORATORY BRAIN

549
00:21:19,953 --> 00:21:23,457
AND COGNITION NIMH WERE ABLE TO

550
00:21:23,457 --> 00:21:25,726
COMPARE PAIN WITH HEDONIC

551
00:21:25,726 --> 00:21:28,629
PLEASANT OR UNPLEASANT CASE IN

552
00:21:28,629 --> 00:21:30,030
THE fMRI SCANNER, WORKED WITH

553
00:21:30,030 --> 00:21:31,365
A PHARMACY.

554
00:21:31,365 --> 00:21:33,000
A LOT OF PEOPLE HELPED OVER THE

555
00:21:33,000 --> 00:21:33,200
YEARS.

556
00:21:33,200 --> 00:21:36,503
PEOPLE DID THAT EXACT SAME PAIN

557
00:21:36,503 --> 00:21:37,471
CALIBRATION PROCEDURE OUTLINED

558
00:21:37,471 --> 00:21:39,539
EARLIER BUT NOW THEY EXPERIENCED

559
00:21:39,539 --> 00:21:42,709
NOT JUST HEAT BUT ALSO DIFFERENT

560
00:21:42,709 --> 00:21:45,913
CONCENTRATIONS OF SALT OR SUGAR

561
00:21:45,913 --> 00:21:48,882
OR NEUTRAL RINSE THAT MIMICS

562
00:21:48,882 --> 00:21:50,183
ARTIFICIAL SALIVA.

563
00:21:50,183 --> 00:21:51,618
YOU SEE SIMILAR ASSOCIATIONS

564
00:21:51,618 --> 00:21:54,588
BETWEEN CHANGES IN TEMPERATURE

565
00:21:54,588 --> 00:21:55,889
OR CONCENTRATION, ABLE TO PUT

566
00:21:55,889 --> 00:21:59,927
EVERYBODY ON THE SAME RANGE,

567
00:21:59,927 --> 00:22:02,763
PERCEIVED INTENSITY.

568
00:22:02,763 --> 00:22:04,097
INTERESTINGLY, PEOPLE WHO HAD

569
00:22:04,097 --> 00:22:06,266
HIGHER HEAT TOLERANCE ARE HIGHER

570
00:22:06,266 --> 00:22:10,570
TOLERANCE FOR SUGAR AND SALT,

571
00:22:10,570 --> 00:22:12,306
CROSS-MODAL EFFECT HERE.

572
00:22:12,306 --> 00:22:14,374
WE HAD THESE PEOPLE EXPERIENCE

573
00:22:14,374 --> 00:22:17,044
HEALTH, SALT, SUGAR IN fMRI

574
00:22:17,044 --> 00:22:18,912
SCANNER, EITHER IN RESPONSE TO

575
00:22:18,912 --> 00:22:20,981
STIMULI OR WITH CUES THAT

576
00:22:20,981 --> 00:22:22,716
PREDICTED LEVELS, I'LL COME BACK

577
00:22:22,716 --> 00:22:23,951
TO CUES LATER.

578
00:22:23,951 --> 00:22:26,553
WHEN WE COMBINE ACROSS THE TWO

579
00:22:26,553 --> 00:22:29,056
AVERSIVE OUTCOMES, AND LOOK AT

580
00:22:29,056 --> 00:22:30,490
BRAIN REGIONS THAT COMPARE HIGH

581
00:22:30,490 --> 00:22:32,693
VERSUS -- RESPOND TO HIGH VERSUS

582
00:22:32,693 --> 00:22:34,528
LOW INTENSITY HEAT OR SALT, WHAT

583
00:22:34,528 --> 00:22:40,667
WE SEE IS ACTIVATION OF THE

584
00:22:40,667 --> 00:22:41,735
SALIENCE NETWORK.

585
00:22:41,735 --> 00:22:45,272
WHEN WE LOOK AT THE NPS WE SEE

586
00:22:45,272 --> 00:22:47,774
SIGNIFICANT NPS EXPRESSION WHEN

587
00:22:47,774 --> 00:22:50,277
WE LOOK AT HEAT, HIGH VERSUS LOW

588
00:22:50,277 --> 00:22:52,512
HEAT STIMULI, AND THAT IS

589
00:22:52,512 --> 00:22:54,982
GREATER THAN SALT OR SUGAR.

590
00:22:54,982 --> 00:22:56,249
INTERESTINGLY PEOPLE ACTUALLY

591
00:22:56,249 --> 00:22:57,617
PERCEIVE THE SALT AS MORE

592
00:22:57,617 --> 00:22:59,619
INTENSE IN THE SCANNER, SO IT'S

593
00:22:59,619 --> 00:23:02,122
REALLY SHOWING THAT EVEN THOUGH

594
00:23:02,122 --> 00:23:04,191
THE PERCEPTION MIGHT BE MORE

595
00:23:04,191 --> 00:23:05,058
INTENSE, THIS SIGNATURE IS

596
00:23:05,058 --> 00:23:06,493
REALLY SPECIFIC TO HEAT.

597
00:23:06,493 --> 00:23:07,794
THERE'S OTHER SIGNATURES THAT

598
00:23:07,794 --> 00:23:09,329
HAVE SINCE BEEN DEVELOPED, SUCH

599
00:23:09,329 --> 00:23:12,499
AS THIS ONE FOR NEGATIVE AFFECT

600
00:23:12,499 --> 00:23:15,435
IN GENERAL, TRAINED TO LOOK AT

601
00:23:15,435 --> 00:23:19,406
DOMAIN GENERAL NEGATIVE AFFECT,

602
00:23:19,406 --> 00:23:20,407
UNPLEASANT HEAT, VIDEOS, SOUNDS,

603
00:23:20,407 --> 00:23:27,514
THINGS LIKE THAT,  ILLUSTRATING

604
00:23:27,514 --> 00:23:28,615
HOW NEURAL SIGNATURES CAN HELP

605
00:23:28,615 --> 00:23:39,126
US  HOW THEY ARE IN THE BRAIN.

606
00:23:40,594 --> 00:23:42,195
RESPONSES TO PAINFUL STIMULATION

607
00:23:42,195 --> 00:23:43,597
COMBINE PAIN SPECIFIC NETWORKS

608
00:23:43,597 --> 00:23:45,232
WITH THOSE INVOLVED MORE

609
00:23:45,232 --> 00:23:46,800
GENERALLY IN NEGATIVE AFFECT,

610
00:23:46,800 --> 00:23:48,869
BOTH HAPPENING IN PARALLEL, AND

611
00:23:48,869 --> 00:23:51,605
USING THESE CLASSIFIERS WE CAN

612
00:23:51,605 --> 00:23:52,939
DISTINGUISH THEIR SEPARATE

613
00:23:52,939 --> 00:23:54,141
CONTRIBUTIONS.

614
00:23:54,141 --> 00:23:56,543
SO NOW WITH THAT FOUNDATION, WE

615
00:23:56,543 --> 00:23:58,745
CAN ACTUALLY ASK HOW IS IT THEN

616
00:23:58,745 --> 00:24:00,914
THAT EXPECTATIONS AND THINGS

617
00:24:00,914 --> 00:24:07,387
LIKE PLACEBO SHAPE PAIN

618
00:24:07,387 --> 00:24:07,821
EXPERIENCE.

619
00:24:07,821 --> 00:24:17,898
SO -- I JUST WANT TO GET WATER.

620
00:24:17,898 --> 00:24:18,131
SORRY.

621
00:24:18,131 --> 00:24:20,033
WE CAN ASK WHETHER PLACEBOS

622
00:24:20,033 --> 00:24:22,602
REDUCE PAIN THROUGH CHANGES IN

623
00:24:22,602 --> 00:24:23,804
THESE PAIN-SPECIFIC MECHANISMS

624
00:24:23,804 --> 00:24:28,175
OR THROUGH SHAPING MORE

625
00:24:28,175 --> 00:24:29,810
DOMAIN-GENERAL MECHANISMS

626
00:24:29,810 --> 00:24:34,214
INVOLVED IN SHIFT IN AFFECT,

627
00:24:34,214 --> 00:24:35,715
THESE ARE THEORIZED IN THE AREA

628
00:24:35,715 --> 00:24:36,817
OF PLACEBO ANALGESIA.

629
00:24:36,817 --> 00:24:38,118
HOW DO WE DO THIS IN THE

630
00:24:38,118 --> 00:24:38,718
SCANNER?

631
00:24:38,718 --> 00:24:41,521
THIS IS A CLASSIC DESIGN, SO

632
00:24:41,521 --> 00:24:43,523
BASICALLY PEOPLE ARE TOLD THAT

633
00:24:43,523 --> 00:24:46,560
ONE -- THAT ABOUT -- INSTRUCTED

634
00:24:46,560 --> 00:24:48,495
ABOUT TWO CREAMS, BOTH ARE

635
00:24:48,495 --> 00:24:50,730
INERT, BUT ONE THEY ARE INFORMED

636
00:24:50,730 --> 00:24:54,601
IS A POTENT ANALGESIC.

637
00:24:54,601 --> 00:24:55,902
THEN DURING CONDITIONING PHASE,

638
00:24:55,902 --> 00:24:58,305
THE CONTROL CREAM IS PAIRED WITH

639
00:24:58,305 --> 00:25:01,274
HIGH INTENSITY PAIN STIMULUS BUT

640
00:25:01,274 --> 00:25:05,846
UNBEKNOWNST TO PARTICIPANTS, THE

641
00:25:05,846 --> 00:25:07,714
PLACEBO ANALGESIC CREAM PAIRED

642
00:25:07,714 --> 00:25:09,149
WITH LOW INTENSITY STIMULUS TO

643
00:25:09,149 --> 00:25:10,550
REINFORCE THE INSTRUCTIONS.

644
00:25:10,550 --> 00:25:12,385
AND THEN DURING A TEST PHASE

645
00:25:12,385 --> 00:25:14,621
PEOPLE GET THE SAME TEMPERATURE

646
00:25:14,621 --> 00:25:17,724
ON BOTH SITES WHICH ALLOWS US TO

647
00:25:17,724 --> 00:25:19,926
TEST WHETHER THIS COMBINED

648
00:25:19,926 --> 00:25:21,361
INSTRUCTION PLUS LEARNING LEADS

649
00:25:21,361 --> 00:25:24,431
TO EXPECTATIONS THAT IN TURN

650
00:25:24,431 --> 00:25:24,931
DOWNREGULATE PAIN.

651
00:25:24,931 --> 00:25:27,467
SO THIS DESIGN HAS BEEN USED BY

652
00:25:27,467 --> 00:25:29,236
MANY RESEARCHERS AROUND THE

653
00:25:29,236 --> 00:25:29,669
WORLD.

654
00:25:29,669 --> 00:25:32,839
WE POOLED OUR DATA, SO WE HAD

655
00:25:32,839 --> 00:25:33,740
OVER 600 INDIVIDUALS WHO HAD

656
00:25:33,740 --> 00:25:35,475
GONE THROUGH THIS TYPE OF

657
00:25:35,475 --> 00:25:38,645
PARADIGM, AND WHAT WE SEE IS

658
00:25:38,645 --> 00:25:40,947
RELIABLE, SO WE CONDUCTED

659
00:25:40,947 --> 00:25:42,582
META-ANALYSIS ACROSS THOSE

660
00:25:42,582 --> 00:25:45,118
INDIVIDUALS AND SEE REDUCTION IN

661
00:25:45,118 --> 00:25:47,087
PAIN WITH PLACEBO CREAM RELATIVE

662
00:25:47,087 --> 00:25:48,822
TO THE CONTROL CREAM.

663
00:25:48,822 --> 00:25:50,790
WHAT HAPPENS TO THE NPS?

664
00:25:50,790 --> 00:25:53,426
WE SEE NO PLACEBO EFFECT ON THE

665
00:25:53,426 --> 00:25:53,760
NPS.

666
00:25:53,760 --> 00:25:55,996
SO THIS SUGGESTS THAT PLACEBOS

667
00:25:55,996 --> 00:25:58,398
ARE REDUCING PAIN BUT NOT VIA

668
00:25:58,398 --> 00:26:01,568
CHANGES IN THIS NEUROLOGIC PAIN

669
00:26:01,568 --> 00:26:02,569
SIGNATURE PATTERN.

670
00:26:02,569 --> 00:26:05,272
AND THIS IS IMPORTANT TO SAY

671
00:26:05,272 --> 00:26:07,941
BECAUSE OTHER PSYCHOLOGICAL

672
00:26:07,941 --> 00:26:10,210
PROCESSES DO SEEM TO IMPACT NPS,

673
00:26:10,210 --> 00:26:16,983
SO THIS IS FROM A STUDY ON

674
00:26:16,983 --> 00:26:18,985
MINDFULNESS, NPS ON THE Y-AXIS.

675
00:26:18,985 --> 00:26:19,853
RELATIVE TO INSTRUCTION FOR

676
00:26:19,853 --> 00:26:25,025
PEOPLE TO ACCEPT THE PAINFUL

677
00:26:25,025 --> 00:26:30,363
HEAT RATHER THAN REACT, 25 OR

678
00:26:30,363 --> 00:26:32,199
26% DROP IN NPS EXPRESSION.

679
00:26:32,199 --> 00:26:33,633
WHEN WE DELIVER CUES THAT TELL

680
00:26:33,633 --> 00:26:35,268
PEOPLE ABOUT INTENSITY OF THE

681
00:26:35,268 --> 00:26:37,704
NOXIOUS STIMULATION BUT GIVE

682
00:26:37,704 --> 00:26:39,673
THEM THE SAME TEMPERATURE DURING

683
00:26:39,673 --> 00:26:42,943
TEST WE AGAIN SEE ABOUT A 20%

684
00:26:42,943 --> 00:26:45,912
REDUCTION IN NPS, AND THEN WHEN

685
00:26:45,912 --> 00:26:50,183
WE GIVE PEOPLE THE NEW OPIOID

686
00:26:50,183 --> 00:26:51,618
AGONIST THROUGH AN I.V. WHETHER

687
00:26:51,618 --> 00:26:53,687
WE TELL THEM WE'RE GIVING IT TO

688
00:26:53,687 --> 00:26:56,089
THEM OR IN THE ABSENCE OF THEIR

689
00:26:56,089 --> 00:26:57,824
KNOWLEDGE, WE SEE SIMILAR

690
00:26:57,824 --> 00:27:01,328
EFFECTS ON THE NPS SUGGESTING

691
00:27:01,328 --> 00:27:03,530
AGAIN THAT THIS INFORMATION

692
00:27:03,530 --> 00:27:04,764
ACTIVATES OTHER CIRCUITS.

693
00:27:04,764 --> 00:27:07,801
SO WHAT IS -- HOW IS PLACEBO

694
00:27:07,801 --> 00:27:09,002
AFFECTING RESPONSES?

695
00:27:09,002 --> 00:27:11,071
WE DID A META-ANALYSIS OF

696
00:27:11,071 --> 00:27:12,939
PLACEBO OF BRAIN IMAGING STUDIES

697
00:27:12,939 --> 00:27:18,612
OF PLACEBO, AND WHAT WE SEE IS

698
00:27:18,612 --> 00:27:20,814
RELIABLE REDUCTION IN THE

699
00:27:20,814 --> 00:27:22,249
REGIONS INVOLVED IN SALIENCE,

700
00:27:22,249 --> 00:27:26,186
AND INCREASES WITH EXPECTATIONS

701
00:27:26,186 --> 00:27:30,790
FOR REDUCTION IN THE FRONTAL

702
00:27:30,790 --> 00:27:32,425
CORTEX, AND STRIATUM, AND THESE

703
00:27:32,425 --> 00:27:36,930
REGIONS ARE INVOLVED IN SHIFT IN

704
00:27:36,930 --> 00:27:39,432
AFFECT, EMOTION REGULATION,

705
00:27:39,432 --> 00:27:40,867
VALUE-BASED LEARNING.

706
00:27:40,867 --> 00:27:42,035
I'M GOING TO FOCUS IN PARTICULAR

707
00:27:42,035 --> 00:27:47,207
ON THE ROLE OF THE ORBITO

708
00:27:47,207 --> 00:27:50,043
FRONTAL CORTEX, THIS REGION IS A

709
00:27:50,043 --> 00:27:52,279
HUB THAT RECEIVES INPUT FROM

710
00:27:52,279 --> 00:27:54,547
LIMBIC AREAS, SENSORY AREAS, AND

711
00:27:54,547 --> 00:27:56,082
ALSO PROJECTS TO DIFFERENT AREAS

712
00:27:56,082 --> 00:28:01,454
THAT ARE CRITICAL FOR AFFECTIVE

713
00:28:01,454 --> 00:28:02,522
PROCESSING, AND MAINTENANCE,

714
00:28:02,522 --> 00:28:03,657
HOMEOSTASIS, LEARNING, ALL SORTS

715
00:28:03,657 --> 00:28:04,557
OF FUNCTIONS.

716
00:28:04,557 --> 00:28:06,760
AND WE HERE AT NIH ARE FORTUNATE

717
00:28:06,760 --> 00:28:10,964
TO HAVE TWO OF THE WORLD LEADERS

718
00:28:10,964 --> 00:28:18,972
IN THE FIELD, MURRAY AND

719
00:28:18,972 --> 00:28:20,507
SHANBAUM, THIS IS A REVIEW OF

720
00:28:20,507 --> 00:28:22,676
WHAT WE KNOW AFTER 20 YEARS THAT

721
00:28:22,676 --> 00:28:24,110
WAS PUBLISHED IN 2007, SINCE

722
00:28:24,110 --> 00:28:25,211
THEN PEOPLE HAVE CONTINUED TO

723
00:28:25,211 --> 00:28:28,048
ARGUE ABOUT THE FUNCTION OF THE

724
00:28:28,048 --> 00:28:30,850
OFC AND WE CAN GET INTO

725
00:28:30,850 --> 00:28:32,419
SPECIFICS I THINK WE CAN SAY IN

726
00:28:32,419 --> 00:28:35,588
GENERAL THIS REGION IS

727
00:28:35,588 --> 00:28:36,890
FUNDAMENTAL FOR PREDICTION,

728
00:28:36,890 --> 00:28:37,791
EXPECTED VALUE, LEARNING.

729
00:28:37,791 --> 00:28:44,064
WE ARE TALKING ABOUT HOW THE OFC

730
00:28:44,064 --> 00:28:45,365
IS NECESSARY LEARNING,

731
00:28:45,365 --> 00:28:46,900
DEFINITELY INVOLVED FOR ASPECTS

732
00:28:46,900 --> 00:28:49,035
OF PREDICTION AND LEARNING.

733
00:28:49,035 --> 00:28:51,805
I ALSO WANT TO SAY -- OKAY, HERE

734
00:28:51,805 --> 00:28:52,806
IS BACKWARDS.

735
00:28:52,806 --> 00:28:54,741
THAT MOST OF THESE STUDIES HAVE

736
00:28:54,741 --> 00:28:57,377
STUDIED THE ROLE OF THE OFC IN

737
00:28:57,377 --> 00:28:58,578
CONTEXT OF REWARD.

738
00:28:58,578 --> 00:29:00,447
DO WE SEE SIMILAR ROLES WHEN IT

739
00:29:00,447 --> 00:29:01,981
COMES TO PAIN?

740
00:29:01,981 --> 00:29:06,586
SO, THE WAY WE STUDY THIS IS TO

741
00:29:06,586 --> 00:29:09,356
KIND OF -- SOMEWHAT ALLUDED TO

742
00:29:09,356 --> 00:29:12,392
IN CONTEXT OF PLACEBO BUT WE

743
00:29:12,392 --> 00:29:15,261
COMBINE CONDITIONING WITH VERBAL

744
00:29:15,261 --> 00:29:17,430
INSTRUCTIONS IN MANY CASES TO

745
00:29:17,430 --> 00:29:18,965
ELICIT EXPECTATIONS IN RESPONSE

746
00:29:18,965 --> 00:29:21,034
TO PAIN PREDICTIVE CUES.

747
00:29:21,034 --> 00:29:22,369
SO BASICALLY DURING CONDITIONING

748
00:29:22,369 --> 00:29:23,903
PHASE, PEOPLE WILL HEAR ONE CUE

749
00:29:23,903 --> 00:29:26,506
WHICH THEY ARE TOLD IS GOING TO

750
00:29:26,506 --> 00:29:32,412
PREDICT LOW PAIN, ANOTHER CUE

751
00:29:32,412 --> 00:29:33,747
HIGH PAIN, CONDITIONING TO

752
00:29:33,747 --> 00:29:34,848
REINFORCE EXPECTATIONS.

753
00:29:34,848 --> 00:29:43,690
DURING TEST PHASE PEOPLE EITHER

754
00:29:43,690 --> 00:29:44,891
EXPERIENCE THE PREDICTED LEVEL

755
00:29:44,891 --> 00:29:47,527
OR SINGLE LEVEL OF HEAT

756
00:29:47,527 --> 00:29:49,829
CALIBRATED TO ELICIT MODERATE

757
00:29:49,829 --> 00:29:50,130
PAIN.

758
00:29:50,130 --> 00:29:52,665
NOW, WE HAVE -- THIS IS PAIN

759
00:29:52,665 --> 00:29:55,301
READINGS IN RESPONSE TO MEDIUM

760
00:29:55,301 --> 00:29:57,904
TRIAL ON THE Y-AXIS, AND ALL THE

761
00:29:57,904 --> 00:29:59,439
DIFFERENT -- MANY DIFFERENT

762
00:29:59,439 --> 00:30:01,641
STUDIES WHERE WE REPLICATED

763
00:30:01,641 --> 00:30:02,108
EFFECTS.

764
00:30:02,108 --> 00:30:05,011
WE SEE BOTH IN HEALTHY

765
00:30:05,011 --> 00:30:07,781
VOLUNTEERS AS WELL AS YOUTH WITH

766
00:30:07,781 --> 00:30:09,416
OR WITHOUT ANXIETY DISORDERS

767
00:30:09,416 --> 00:30:10,950
RELIABLE REDUCTION OF 20% SO

768
00:30:10,950 --> 00:30:13,052
BASICALLY WHEN THE SAME EXACT

769
00:30:13,052 --> 00:30:15,021
TEMPERATURE IS PRECEDED BY LOW

770
00:30:15,021 --> 00:30:17,090
PAIN CUES RELATIVE TO HIGH PAIN

771
00:30:17,090 --> 00:30:18,391
CUES, AND THAT DIFFERENCE IS

772
00:30:18,391 --> 00:30:24,197
ESSENTIALLY QUIFF  EQUIVALENT TO

773
00:30:24,197 --> 00:30:25,064
CLINICALLY SIGNIFICANT

774
00:30:25,064 --> 00:30:26,232
DIFFERENCE, ALTHOUGH IN THE

775
00:30:26,232 --> 00:30:28,868
CONTEXT OF ACUTE PAIN STIMULI I

776
00:30:28,868 --> 00:30:32,539
AM CAREFUL NOT TO OVERREACH

777
00:30:32,539 --> 00:30:32,739
THERE.

778
00:30:32,739 --> 00:30:34,073
SO, WHAT HAPPENS IN THE CONTEXT

779
00:30:34,073 --> 00:30:38,778
OF THIS TYPE OF LEARNED

780
00:30:38,778 --> 00:30:39,179
EXPECTATION?

781
00:30:39,179 --> 00:30:39,879
THE ORBITOFRONTAL CORTEX.

782
00:30:39,879 --> 00:30:42,482
WHAT WE'VE SEEN OVER AND OVER IS

783
00:30:42,482 --> 00:30:45,652
OFC IS CRITICAL FOR THIS TYPE OF

784
00:30:45,652 --> 00:30:47,320
CUE-BASED EXPECTATION AND PAIN

785
00:30:47,320 --> 00:30:47,754
MODULATION.

786
00:30:47,754 --> 00:30:51,458
IN THE FIRST STUDY IN 2010, WE

787
00:30:51,458 --> 00:30:57,397
SAW RESPONSES IN THE VENTRAL

788
00:30:57,397 --> 00:31:00,233
STRIATUM AND VMPFC MEDIATED

789
00:31:00,233 --> 00:31:02,302
WHICH DROVE TRIAL-BY-TRIAL PAIN.

790
00:31:02,302 --> 00:31:04,070
WE'VE USED COMPUTATIONAL MODELS

791
00:31:04,070 --> 00:31:06,239
TO TEASE APART ROLE OF THIS

792
00:31:06,239 --> 00:31:07,674
REGION AND OTHERS IN THE CONTEXT

793
00:31:07,674 --> 00:31:10,310
OF DYNAMIC LEARNING BY

794
00:31:10,310 --> 00:31:11,478
INTRODUCING INSTRUCTIONS ABOUT

795
00:31:11,478 --> 00:31:14,681
CHANGING CONTINGENCIES, AND WE

796
00:31:14,681 --> 00:31:19,986
SEE THAT THE MPFC UPDATES WITH

797
00:31:19,986 --> 00:31:23,456
INSTRUCTIONS,  AMYGDALA AND OTHR

798
00:31:23,456 --> 00:31:27,894
REGIONS RESPOND TO FEEDBACK.

799
00:31:27,894 --> 00:31:29,128
MOST RECENT STUDY COME PINING

800
00:31:29,128 --> 00:31:32,665
PAIN WITH SALT AND SUGAR, AGAIN

801
00:31:32,665 --> 00:31:33,733
PRESENTED CUES THAT PREDICTED

802
00:31:33,733 --> 00:31:36,803
HIGH OR LOW HEAT WITH TEST PHASE

803
00:31:36,803 --> 00:31:39,772
MEDIUM TEMPERATURES, WE SEE THAT

804
00:31:39,772 --> 00:31:41,941
WE SEE SIMILAR REDUCTIONS IN THE

805
00:31:41,941 --> 00:31:44,244
INTENSITY RATING REGARDLESS OF

806
00:31:44,244 --> 00:31:46,546
WHETHER PEOPLE EXPERIENCE HEAT,

807
00:31:46,546 --> 00:31:48,381
SALT, SUGAR DURING fMRI

808
00:31:48,381 --> 00:31:53,753
SCANNING  ALTHOUGH SALT PERCEIVD

809
00:31:53,753 --> 00:31:55,388
MORE INTENSE IN GENERAL,

810
00:31:55,388 --> 00:31:57,156
MAGNITUDE IS SIMILAR, NO

811
00:31:57,156 --> 00:31:58,558
DIFFERENCE BETWEEN GROUPS.

812
00:31:58,558 --> 00:32:00,527
SO, WHEN WE LOOK AT WHAT HAPPENS

813
00:32:00,527 --> 00:32:04,264
IN THE BRAIN DURING THIS PATH WE

814
00:32:04,264 --> 00:32:11,471
SEE ALL THREE GROUPS SHOW LARGER

815
00:32:11,471 --> 00:32:12,805
DEACTIVATION IN THE VMPC WITH

816
00:32:12,805 --> 00:32:16,209
THE LOW CUE RELATIVE TO HIGH CUE

817
00:32:16,209 --> 00:32:17,710
DURING ANTICIPATION OF THE

818
00:32:17,710 --> 00:32:19,245
STIMULUS, AND THEN WHEN WE LOOK

819
00:32:19,245 --> 00:32:26,386
AT RESPONSE TO THE ACTUAL

820
00:32:26,386 --> 00:32:28,788
MODERATE INTENSITY STIMULUS

821
00:32:28,788 --> 00:32:30,523
VMPFC IS LARGER FOR THE LEFT,

822
00:32:30,523 --> 00:32:32,625
HERE WE SEE THERE'S MORE DID HE

823
00:32:32,625 --> 00:32:34,260
ACTIVATION FOR THE HIGH CUE IN

824
00:32:34,260 --> 00:32:36,095
THE HEAT GROUP AND MORE

825
00:32:36,095 --> 00:32:38,231
DEACTIVATION FOR THE LOW CUE IN

826
00:32:38,231 --> 00:32:40,266
THE SUGAR GROUP BECAUSE

827
00:32:40,266 --> 00:32:43,469
BASICALLY THAT'S PREDICTING LESS

828
00:32:43,469 --> 00:32:45,405
SUGAR OR MORE HEAT.

829
00:32:45,405 --> 00:32:50,243
BUT ONE OF THE BIGGEST

830
00:32:50,243 --> 00:32:52,178
LIMITATIONS OF fMRI THIS IS A

831
00:32:52,178 --> 00:32:54,647
CORRELATION MEASURE.

832
00:32:54,647 --> 00:32:58,418
WE SEE CORRELATIONS IN THE VMPFC

833
00:32:58,418 --> 00:33:01,387
BUT TO WHAT EXTENT IS IT

834
00:33:01,387 --> 00:33:02,288
CAUSEALLY LINKED TO EXPECTANCY

835
00:33:02,288 --> 00:33:03,156
EFFECTS ON PAIN.

836
00:33:03,156 --> 00:33:05,458
I WAS REALLY DELIGHTED TO HAVE

837
00:33:05,458 --> 00:33:10,897
THE OPPORTUNITY TO TEST THIS IN

838
00:33:10,897 --> 00:33:14,534
COLLABORATION WITH JULIAN, NOW A

839
00:33:14,534 --> 00:33:19,973
FELLOW AT UCSF IN NEUROLOGY.

840
00:33:19,973 --> 00:33:23,710
JULIAN IDENTIFIED FIVE PATIENTS

841
00:33:23,710 --> 00:33:34,220
WITH OR BITOMENINGIOMAS, RARE

842
00:33:35,955 --> 00:33:37,223
PATIENTS ENCOMPASSING MEDIAL

843
00:33:37,223 --> 00:33:38,958
ORBITOFRONTAL CORTEX, COMPARED

844
00:33:38,958 --> 00:33:40,393
TO HEALTHY CONTROL PARTICIPANTS,

845
00:33:40,393 --> 00:33:45,331
GO THROUGH PAIN ASSESSMENT

846
00:33:45,331 --> 00:33:46,633
PROCEDURE, CALIBRATION AT THE

847
00:33:46,633 --> 00:33:48,067
BEGINNING AND EXPECTANCY TASK.

848
00:33:48,067 --> 00:33:50,269
WE SAW THERE'S NO DIFFERENCE

849
00:33:50,269 --> 00:33:52,872
BETWEEN HEALTHY CONTROLS AND

850
00:33:52,872 --> 00:33:54,741
VMPFC PARTICIPANTS IN

851
00:33:54,741 --> 00:33:55,408
RELATIONSHIP BETWEEN TEMPERATURE

852
00:33:55,408 --> 00:33:58,011
AND PAIN, WHETHER WE MEASURED

853
00:33:58,011 --> 00:33:59,612
INTENSITY OR UNPLEASANTNESS

854
00:33:59,612 --> 00:34:01,314
DURING OUR CALIBRATION TASK.

855
00:34:01,314 --> 00:34:03,549
HERE WE SEPARATED OUT INTENSITY

856
00:34:03,549 --> 00:34:06,786
AND UNPLEASANTNESS BECAUSE OF

857
00:34:06,786 --> 00:34:07,987
THE VMPFC ROLE IN VALUE.

858
00:34:07,987 --> 00:34:11,157
WHAT HAPPENS WHEN WE LOOK AT

859
00:34:11,157 --> 00:34:12,892
EXPECTANCY, HERE ON THE Y-AXIS

860
00:34:12,892 --> 00:34:15,228
IS THE DIFFERENCE BETWEEN MEDIUM

861
00:34:15,228 --> 00:34:17,063
HEAT IS PERCEIVED BY HIGH PAIN

862
00:34:17,063 --> 00:34:18,831
CUE VERSUS LOW PAIN CUE, IN

863
00:34:18,831 --> 00:34:21,467
HEALTHY CONTROLS WE AGAIN SEE

864
00:34:21,467 --> 00:34:23,403
ABOUT A 2-POINT DIFFERENCE ON

865
00:34:23,403 --> 00:34:26,372
THE INTENSITY SCALE, A LITTLE

866
00:34:26,372 --> 00:34:27,674
BIT LESS FOR UNPLEASANTNESS.

867
00:34:27,674 --> 00:34:29,776
WHEN WE LOOK AT PATIENTS WE SEE

868
00:34:29,776 --> 00:34:32,512
THEY SHOW LARGER EFFECTS OF

869
00:34:32,512 --> 00:34:36,949
EXPECTANCY ON SUBJECTIVE PAIN.

870
00:34:36,949 --> 00:34:38,184
SO, THE LESION ACTUALLY ENHANCES

871
00:34:38,184 --> 00:34:40,920
EXTENT TO WHICH PEOPLE REPORT

872
00:34:40,920 --> 00:34:42,121
DIFFERENCES WHEN THE SAME

873
00:34:42,121 --> 00:34:43,656
TEMPERATURE IS PRECEDED BY LOW

874
00:34:43,656 --> 00:34:45,425
PAIN RELATIVE TO HIGH PAIN CUES.

875
00:34:45,425 --> 00:34:46,959
I DON'T HAVE TIME TO GET INTO

876
00:34:46,959 --> 00:34:49,796
THIS TODAY BUT WE THINK THIS IS

877
00:34:49,796 --> 00:34:52,632
OVER RELIANCE ON VERBAL

878
00:34:52,632 --> 00:34:55,601
INSTRUCTIONS AS OPPOSED TO NOT

879
00:34:55,601 --> 00:34:56,302
HAVING EXPECTATIONS.

880
00:34:56,302 --> 00:34:57,570
SO, WHAT I'VE SHOWN IN THE

881
00:34:57,570 --> 00:35:00,206
SECOND PART OF MY TALK IS THAT

882
00:35:00,206 --> 00:35:03,242
WE DO NOT SEE ANY RELIABLE

883
00:35:03,242 --> 00:35:05,745
PLACEBO EFFECT ON NPS.

884
00:35:05,745 --> 00:35:07,513
INSTEAD, EXPECTATIONS AFFECT

885
00:35:07,513 --> 00:35:16,923
NEGATIVE AFFECT SYSTEMS, WE SEE

886
00:35:16,923 --> 00:35:19,125
SIMILAR MECHANISMS BETWEEN PAIN,

887
00:35:19,125 --> 00:35:20,760
AND OUR STUDY WITH LESION

888
00:35:20,760 --> 00:35:24,030
PARTICIPANTS DID SHOW A CAUSAL

889
00:35:24,030 --> 00:35:30,937
INFLUENCE ON THESE EXPECTANCY

890
00:35:30,937 --> 00:35:31,404
EFFECTS.

891
00:35:31,404 --> 00:35:33,473
SO, WE'RE GOOD ON TIME SO WITH

892
00:35:33,473 --> 00:35:37,176
THE LAST THIRD OF MY TALK I'M

893
00:35:37,176 --> 00:35:39,112
NOW GOING TO SWITCH TO TALKING

894
00:35:39,112 --> 00:35:41,781
ABOUT SOCIAL INFLUENCES ON PAIN

895
00:35:41,781 --> 00:35:43,182
EXPECTATIONS AND ASSESSMENT.

896
00:35:43,182 --> 00:35:44,717
SO, THE VAST MAJORITY OF

897
00:35:44,717 --> 00:35:47,019
RESEARCH IN THIS AREA IS PAIN

898
00:35:47,019 --> 00:35:49,322
MODULATION HAS FOCUSED ON WHAT

899
00:35:49,322 --> 00:35:50,656
WE CALL INTRAPERSONAL

900
00:35:50,656 --> 00:35:53,359
PSYCHOLOGICAL FACTORS, THINGS

901
00:35:53,359 --> 00:35:54,460
LIKE OUR EXPECTATION, EMOTION,

902
00:35:54,460 --> 00:35:56,863
THE MEANING WE MIGHT ASCRIBE TO

903
00:35:56,863 --> 00:35:58,965
AN EXPERIENCE, MEMORIES, AND OUR

904
00:35:58,965 --> 00:36:00,700
PRIOR ASSOCIATIONS WITH THINGS

905
00:36:00,700 --> 00:36:02,869
LIKE THE CLINICAL CONTEXT.

906
00:36:02,869 --> 00:36:05,538
BUT WE KNOW THAT MOST CLINICAL

907
00:36:05,538 --> 00:36:06,506
ENCOUNTERS DON'T HAPPEN IN

908
00:36:06,506 --> 00:36:08,574
ISOLATION, EVEN WITH THE

909
00:36:08,574 --> 00:36:10,143
PANDEMIC THERE'S STILL A

910
00:36:10,143 --> 00:36:11,778
CLINICAL -- A SOCIAL CONTEXT

911
00:36:11,778 --> 00:36:14,046
SURROUNDING TREATMENT.

912
00:36:14,046 --> 00:36:17,016
AND SO WE HAVE MOVED SINCE 2018

913
00:36:17,016 --> 00:36:19,886
SPEARHEADED FIRST BY LIZ MECCA,

914
00:36:19,886 --> 00:36:25,124
NOW A PROGRAM OFFICER, IN NIA, A

915
00:36:25,124 --> 00:36:27,527
SOCIAL NEUROSCIENTIST BEFORE MY

916
00:36:27,527 --> 00:36:30,696
LAB, WE'VE MOVED FROM LOOKING AT

917
00:36:30,696 --> 00:36:32,765
INTRAPERSONAL PROCESSES TO

918
00:36:32,765 --> 00:36:33,466
INTERPERSONAL PROCESSES.

919
00:36:33,466 --> 00:36:38,070
AND SO LIZ WANTED TO ASK WHETHER

920
00:36:38,070 --> 00:36:40,072
OUR PERCEPTIONS OF PROVIDER'S

921
00:36:40,072 --> 00:36:42,341
IMPACT ARE EXPECTATIONS ABOUT

922
00:36:42,341 --> 00:36:42,675
PAIN.

923
00:36:42,675 --> 00:36:44,443
WE KNOW FROM WORK IN THE CLINIC

924
00:36:44,443 --> 00:36:45,978
AND IN LABORATORY MODELS THAT

925
00:36:45,978 --> 00:36:47,613
THE PLACEBO RESPONSE CAN BE

926
00:36:47,613 --> 00:36:49,048
INFLUENCED BY THE QUALITY OF THE

927
00:36:49,048 --> 00:36:51,117
RELATIONSHIP BETWEEN A PATIENT

928
00:36:51,117 --> 00:36:53,386
AND PROVIDER, BY THE WARMTH OR

929
00:36:53,386 --> 00:36:55,154
COMPETENCE OF THE PROVIDER, SO

930
00:36:55,154 --> 00:36:56,989
IN A SIMULATED CLINICAL

931
00:36:56,989 --> 00:36:59,425
INTERACTION IF THE PROVIDER USES

932
00:36:59,425 --> 00:37:02,829
YOUR NAME, VERSUS DOESN'T, OR

933
00:37:02,829 --> 00:37:05,231
KNOCKS OVER A JAR OF WATER,

934
00:37:05,231 --> 00:37:06,632
THOSE AFFECT THE MAGNITUDE OF

935
00:37:06,632 --> 00:37:10,036
PLACEBO RESPONSE.

936
00:37:10,036 --> 00:37:12,238
AND THEN ALSO LIZ HAS DONE

937
00:37:12,238 --> 00:37:15,374
ELEGANT WORK LOOKING AT HOW

938
00:37:15,374 --> 00:37:16,709
SIMILARITY OR CONCORDANCE WITH

939
00:37:16,709 --> 00:37:19,011
PROVIDER CAN IMPACT PLACEBO IN A

940
00:37:19,011 --> 00:37:20,513
PAIN MODEL.

941
00:37:20,513 --> 00:37:22,081
BUT LIZ WANTED TO KNOW WHETHER

942
00:37:22,081 --> 00:37:24,483
WE ALSO SEE EFFECTS OF SOCIAL

943
00:37:24,483 --> 00:37:26,219
CONTEXT EVEN BASED ON INITIAL

944
00:37:26,219 --> 00:37:26,552
IMPRESSION.

945
00:37:26,552 --> 00:37:29,188
SO BASICALLY DO OUR FIRST

946
00:37:29,188 --> 00:37:30,523
IMPRESSIONS OF PROVIDERS

947
00:37:30,523 --> 00:37:33,893
INFLUENCE OUR EXPECTATIONS EVEN

948
00:37:33,893 --> 00:37:34,894
BEFORE OUR INTERACTIONS.

949
00:37:34,894 --> 00:37:37,196
SHE WANTED TO KNOW THIS BECAUSE

950
00:37:37,196 --> 00:37:38,731
THERE'S LARGE LITERATURE IN

951
00:37:38,731 --> 00:37:39,866
SOCIAL PSYCHOLOGY INDICATING

952
00:37:39,866 --> 00:37:42,235
THAT PEOPLE PREFER MORE

953
00:37:42,235 --> 00:37:43,135
COMPETENT-LOOKING FACES ACROSS

954
00:37:43,135 --> 00:37:45,104
MANY DOMAINS, SO IF YOU ASK

955
00:37:45,104 --> 00:37:46,739
PEOPLE TO JUDGE WHICH FACE LOOKS

956
00:37:46,739 --> 00:37:49,275
MORE COMPETENT, THIS CAN PREDICT

957
00:37:49,275 --> 00:37:50,209
OUTCOMES OF ELECTIONS WHEN

958
00:37:50,209 --> 00:37:51,143
PEOPLE KNOW NOTHING ABOUT THE

959
00:37:51,143 --> 00:37:51,811
CANDIDATES.

960
00:37:51,811 --> 00:37:53,746
THERE'S A LARGE BODY OF WORK.

961
00:37:53,746 --> 00:37:56,382
AND THESE FEATURES HAVE BEEN

962
00:37:56,382 --> 00:37:58,150
IDENTIFIED THAT BASICALLY MAP

963
00:37:58,150 --> 00:37:59,318
ONTO PERCEIVED COMPETENCE.

964
00:37:59,318 --> 00:38:02,188
WE CAN LOOK AT COMPETENCE

965
00:38:02,188 --> 00:38:03,055
IRRESPECTIVE OF WARMTH AND STUFF

966
00:38:03,055 --> 00:38:05,157
LIKE THAT.

967
00:38:05,157 --> 00:38:09,595
THIS IS DRIVEN BY ALEX TODOROF'S

968
00:38:09,595 --> 00:38:12,932
LAB, THIS IS A FACE MORPHED TO

969
00:38:12,932 --> 00:38:13,900
HAVE DIFFERENT LEVELS OF

970
00:38:13,900 --> 00:38:14,200
COMPETENCE.

971
00:38:14,200 --> 00:38:15,868
YOU CAN KIND OF MAKE YOUR OWN

972
00:38:15,868 --> 00:38:17,937
JUDGMENT WHAT ARE THE FEATURES

973
00:38:17,937 --> 00:38:19,572
THAT ARE ASSOCIATED WITH

974
00:38:19,572 --> 00:38:19,872
COMPETENCE.

975
00:38:19,872 --> 00:38:22,208
AND THIS IS, YOU KNOW, VALIDATED

976
00:38:22,208 --> 00:38:25,077
ACROSS MANY LARGE SAMPLES OF

977
00:38:25,077 --> 00:38:25,344
JUDGMENT.

978
00:38:25,344 --> 00:38:28,581
SO LIZ FOCUSED ON ROLE OF

979
00:38:28,581 --> 00:38:30,316
COMPETENCE AND SIMILARITY.

980
00:38:30,316 --> 00:38:32,285
PERCEIVED SURGE IN COMPETENCE

981
00:38:32,285 --> 00:38:33,486
CAN PREDICT RATINGS OF

982
00:38:33,486 --> 00:38:35,788
TRUSTWORTHINESS OF PAIN IN THIRD

983
00:38:35,788 --> 00:38:36,188
MOLAR EXTRACTION.

984
00:38:36,188 --> 00:38:43,095
WE CONDUCT THE A SERIES OF FIVE

985
00:38:43,095 --> 00:38:44,630
STUDIES ONLINE, PRESENTED

986
00:38:44,630 --> 00:38:46,265
DIFFERENT HYPOTHETICAL PROVIDERS

987
00:38:46,265 --> 00:38:47,833
TO PARTICIPANTS AND ASKED THEM

988
00:38:47,833 --> 00:38:51,003
TO TELL US WHICH PARTICIPANTS

989
00:38:51,003 --> 00:38:53,306
THEY WOULD PREFER FOR A

990
00:38:53,306 --> 00:38:55,074
HYPOTHETICAL PAINFUL MEDICAL

991
00:38:55,074 --> 00:38:55,708
PROCEDURE.

992
00:38:55,708 --> 00:38:57,710
STUDIES ONE AND TWO PRESENTED

993
00:38:57,710 --> 00:38:59,245
ORIGINAL MORPHED FACES THAT I

994
00:38:59,245 --> 00:39:02,281
MENTIONED ON THE PREVIOUS SLIDE,

995
00:39:02,281 --> 00:39:04,050
THREE AND FOUR USED THE SAME

996
00:39:04,050 --> 00:39:12,058
COMPETENCE FEATURED ON MEN AND

997
00:39:12,058 --> 00:39:14,927
WOMEN, AND IN STUDY FIVE REAL

998
00:39:14,927 --> 00:39:17,563
PROVIDERS WHOSE FACES WEREN'T

999
00:39:17,563 --> 00:39:19,198
MORPHED, REAL INDIVIDUALS, NOT

1000
00:39:19,198 --> 00:39:20,399
PROVIDERS, PICTURES OF REAL

1001
00:39:20,399 --> 00:39:22,702
INDIVIDUALS WHOSE FACES WERE NOT

1002
00:39:22,702 --> 00:39:25,871
MORPHED AND WHO VARIED BOTH IN

1003
00:39:25,871 --> 00:39:27,940
RACE, ETHNICITY, AND SEX.

1004
00:39:27,940 --> 00:39:29,709
DURING THE TASK, AGAIN PEOPLE

1005
00:39:29,709 --> 00:39:33,346
WOULD FIRST SELECT WHICH

1006
00:39:33,346 --> 00:39:34,780
PROVIDER THEY WOULD -- PEOPLE

1007
00:39:34,780 --> 00:39:36,082
FIRST REPORTED WHICH PROVIDER

1008
00:39:36,082 --> 00:39:38,484
THEY WOULD SELECT FOR PAINFUL

1009
00:39:38,484 --> 00:39:40,453
MEDICAL PROCEDURE, AND WERE

1010
00:39:40,453 --> 00:39:42,221
ASKED TO IMAGINE THE PROVIDER

1011
00:39:42,221 --> 00:39:43,322
WERE PERFORMING A PAINFUL

1012
00:39:43,322 --> 00:39:45,057
MEDICAL PROCEDURE ON YOU.

1013
00:39:45,057 --> 00:39:46,058
SORRY, WRONG BUTTON.

1014
00:39:46,058 --> 00:39:48,694
HOW PAINFUL WOULD THE PROCEDURE

1015
00:39:48,694 --> 00:39:49,228
BE.

1016
00:39:49,228 --> 00:39:51,931
AFTER THE PROCEDURE YOU MORE ARE

1017
00:39:51,931 --> 00:39:55,601
LIKELY TO USE OVER THE COUNTER

1018
00:39:55,601 --> 00:39:56,235
PRESCRIPTION MEDICATION AND HOW

1019
00:39:56,235 --> 00:39:57,436
SIMILAR DO YOU EXPECT THE

1020
00:39:57,436 --> 00:39:58,104
PROVIDER TO BE TO YOU.

1021
00:39:58,104 --> 00:40:02,008
I'M GOING TO BE PRESENTING

1022
00:40:02,008 --> 00:40:06,212
RESULTS OF META-ANALYSES

1023
00:40:06,212 --> 00:40:08,047
COLLAPSING DATA RATHER THAN

1024
00:40:08,047 --> 00:40:08,481
INDIVIDUALLY.

1025
00:40:08,481 --> 00:40:12,685
AND SO WHAT WE FOUND IS THAT THE

1026
00:40:12,685 --> 00:40:16,088
APPARENT COMPETENCE OF PROVIDER

1027
00:40:16,088 --> 00:40:21,560
INFLUENCED CHOICE  AND

1028
00:40:21,560 --> 00:40:22,261
EXPECTATION.

1029
00:40:22,261 --> 00:40:24,296
X-AXIS IS THE LIKELIHOOD OF

1030
00:40:24,296 --> 00:40:26,699
CHOOSING THE MORE COMPETENT

1031
00:40:26,699 --> 00:40:27,600
PROVIDER.

1032
00:40:27,600 --> 00:40:29,802
AND SO YOU SEE THIS IS CHANCE.

1033
00:40:29,802 --> 00:40:32,271
YOU SEE PEOPLE ARE SELECTING THE

1034
00:40:32,271 --> 00:40:34,140
MORE COMPETENT PROVIDER

1035
00:40:34,140 --> 00:40:36,208
EXCEPTION FOR STUDY 3, WHERE

1036
00:40:36,208 --> 00:40:39,278
PEOPLE PREFERRED THE LESS

1037
00:40:39,278 --> 00:40:40,713
COMPETENT FEMALE FACE.

1038
00:40:40,713 --> 00:40:42,982
WE SAW ALSO ACROSS ALL THE

1039
00:40:42,982 --> 00:40:45,184
STUDIES THAT THE HIGHER THE

1040
00:40:45,184 --> 00:40:48,587
COMPETENCE, THE LESS PAIN PEOPLE

1041
00:40:48,587 --> 00:40:49,088
EXPECTED.

1042
00:40:49,088 --> 00:40:51,757
AND SO THIS SUGGESTS THAT SIMPLY

1043
00:40:51,757 --> 00:40:54,693
VIEWING THE FACES IS ASSOCIATED

1044
00:40:54,693 --> 00:40:57,696
WITH CONSISTENT JUDGMENTS ABOUT

1045
00:40:57,696 --> 00:41:02,501
EXPECTATIONS AND DECISIONS ABOUT

1046
00:41:02,501 --> 00:41:02,968
PAIN.

1047
00:41:02,968 --> 00:41:04,470
WE THINK THIS IS RELEVANT WHERE

1048
00:41:04,470 --> 00:41:08,841
WE SEE HEAD THOUGHTS  -- HEAD

1049
00:41:08,841 --> 00:41:10,609
SHOTS OF PHYSICIANS EVEN IN THAT

1050
00:41:10,609 --> 00:41:12,445
REDUCED ENVIRONMENT WE'RE STILL

1051
00:41:12,445 --> 00:41:13,879
USING SOCIAL CUES TO MAKE

1052
00:41:13,879 --> 00:41:15,314
EXPECTATIONS AND DECISIONS.

1053
00:41:15,314 --> 00:41:19,985
WE ALSO SAW THAT SIMILARITY IN

1054
00:41:19,985 --> 00:41:22,955
SOCIAL CATEGORY IMPACTED

1055
00:41:22,955 --> 00:41:24,824
EXPECTATION, ACROSS STUDIES WE

1056
00:41:24,824 --> 00:41:28,027
SAW HIGHER THE SIMILARITY, LESS

1057
00:41:28,027 --> 00:41:28,994
PAIN PEOPLE EXPECTED.

1058
00:41:28,994 --> 00:41:33,132
AND WHEN WE ASKED ABOUT THE

1059
00:41:33,132 --> 00:41:35,000
EXPECTATIONS ABOUT ANALGESIC USE

1060
00:41:35,000 --> 00:41:36,635
WE FOUND THAT AFFECT OF

1061
00:41:36,635 --> 00:41:40,139
SIMILARITY WAS STRONGEST IN

1062
00:41:40,139 --> 00:41:41,340
WHITE PARTICIPANTS, LIKELY TO

1063
00:41:41,340 --> 00:41:43,209
REFLECT IN GROUP EFFECT BECAUSE

1064
00:41:43,209 --> 00:41:46,278
OF THE STUDIES INCLUDED ONLY

1065
00:41:46,278 --> 00:41:49,882
WHITE PROVIDERS FROM 1-4, AND NO

1066
00:41:49,882 --> 00:41:52,184
OTHER EFFECTS OF DEMOGRAPHIC ON

1067
00:41:52,184 --> 00:41:53,052
THESE DECISIONS.

1068
00:41:53,052 --> 00:41:58,524
IN STUDY 5 WHETHER WE ACTUALLY

1069
00:41:58,524 --> 00:42:00,292
HAD MANIPULATED OR PRESENTED

1070
00:42:00,292 --> 00:42:03,162
DIFFERENT PROVIDERS IN TERMS OF

1071
00:42:03,162 --> 00:42:06,866
RACE AND ETHNICITY OR SEX WE

1072
00:42:06,866 --> 00:42:12,905
FOUND SOCIAL STEREOTYPES  SEEM O

1073
00:42:12,905 --> 00:42:15,774
HAVE IMPACTED PAIN AND

1074
00:42:15,774 --> 00:42:16,942
MEDICATION USE, HIGHEST

1075
00:42:16,942 --> 00:42:17,943
LIKELIHOOD OF OVER-THE-COUNTER

1076
00:42:17,943 --> 00:42:18,811
PRESCRIPTION FOR ASIAN

1077
00:42:18,811 --> 00:42:20,446
PROVIDERS, AND WE ALSO SAW

1078
00:42:20,446 --> 00:42:23,983
PEOPLE EXPECTED TO USE LESS

1079
00:42:23,983 --> 00:42:25,484
MEDICATION WHEN THE PROVIDER WAS

1080
00:42:25,484 --> 00:42:26,919
FEMALE RELATIVE TO WHEN IT WAS

1081
00:42:26,919 --> 00:42:27,219
MALE.

1082
00:42:27,219 --> 00:42:29,855
AND THESE I WANT TO SAY ARE ALL

1083
00:42:29,855 --> 00:42:32,391
DONE BETWEEN GROUPS SO PEOPLE

1084
00:42:32,391 --> 00:42:33,559
AREN'T MAKING JUDGMENTS BETWEEN

1085
00:42:33,559 --> 00:42:35,861
MALE OR FEMALE PROVIDERS SO

1086
00:42:35,861 --> 00:42:39,165
PEOPLE ONLY SAW PROVIDERS OF A

1087
00:42:39,165 --> 00:42:42,468
GIVEN RACE AND SEX COMBINATION.

1088
00:42:42,468 --> 00:42:47,506
SO THIS SUGGESTS TO US THAT --

1089
00:42:47,506 --> 00:42:52,411
WELL, THOSE DATA SUGGEST THAT

1090
00:42:52,411 --> 00:42:52,978
OUR STEREOTYPES INFLUENCE

1091
00:42:52,978 --> 00:42:54,914
DECISIONS ABOUT PROVIDERS.

1092
00:42:54,914 --> 00:42:56,782
WE KNOW STEREOTYPES FROM

1093
00:42:56,782 --> 00:42:58,217
PROVIDERS CAN IMPACT PAIN

1094
00:42:58,217 --> 00:42:58,651
ASSESSMENT.

1095
00:42:58,651 --> 00:43:06,225
THIS IS REALLY SHOWN IN THIS

1096
00:43:06,225 --> 00:43:07,526
GROUNDBREAKING WORK FROM HOFFMAN

1097
00:43:07,526 --> 00:43:11,130
IN 2016, NURSES AND FIRST-YEAR

1098
00:43:11,130 --> 00:43:12,665
MED STUDENTS ACTUALLY ENDORSE

1099
00:43:12,665 --> 00:43:14,133
FALSE BELIEFS ABOUT BIOLOGICAL

1100
00:43:14,133 --> 00:43:15,768
DIFFERENCES BETWEEN BLACK AND

1101
00:43:15,768 --> 00:43:17,069
WHITE PARTICIPANTS SPECIFICALLY

1102
00:43:17,069 --> 00:43:22,541
ALSO IN THE CONTEXT OF PAIN.

1103
00:43:22,541 --> 00:43:23,976
AND MORE RECENTLY, PETER,

1104
00:43:23,976 --> 00:43:25,911
UNIVERSITY OF DELAWARE, HAS DONE

1105
00:43:25,911 --> 00:43:27,213
PHENOMENAL WORK LOOKING AT KIND

1106
00:43:27,213 --> 00:43:35,654
OF HOW THESE TYPES OF RACIAL

1107
00:43:35,654 --> 00:43:38,057
BIASES AFFECT PAIN RECOGNITION.

1108
00:43:38,057 --> 00:43:39,158
HE HAD ACTORS DEPICT PAIN,

1109
00:43:39,158 --> 00:43:40,926
PRESENTED A VIDEO THAT RANGES

1110
00:43:40,926 --> 00:43:43,229
FROM NO PAIN AT ALL TO TOTALLY

1111
00:43:43,229 --> 00:43:44,296
PAINFUL EXPRESSION.

1112
00:43:44,296 --> 00:43:49,902
AND WHAT HE FOUND IS THAT HIS

1113
00:43:49,902 --> 00:43:55,040
PARTICIPANTS WHO WERE ALL WHITE

1114
00:43:55,040 --> 00:43:57,743
NEEDED MORE -- NEEDED TO SEE

1115
00:43:57,743 --> 00:43:58,978
LARGER EXPRESSIONS BEFORE

1116
00:43:58,978 --> 00:44:00,746
DETECTING PAIN ON THOSE BLACK

1117
00:44:00,746 --> 00:44:03,148
FACES, SO BASICALLY THE

1118
00:44:03,148 --> 00:44:04,350
THRESHOLD FOR IDENTIFYING

1119
00:44:04,350 --> 00:44:05,884
EMOTION OF PAINFUL WAS HIGHER

1120
00:44:05,884 --> 00:44:08,954
FOR BLACK FACES AND LARGER THIS

1121
00:44:08,954 --> 00:44:12,224
DIFFERENCE, THE LESS LIKELY THEY

1122
00:44:12,224 --> 00:44:13,993
WERE TO PRESCRIBE OPIOID

1123
00:44:13,993 --> 00:44:15,961
MEDICATION TO THE BLACK

1124
00:44:15,961 --> 00:44:16,762
PARTICIPANTS.

1125
00:44:16,762 --> 00:44:18,897
WE WANTED TO KNOW WHETHER

1126
00:44:18,897 --> 00:44:21,100
SIMILAR BIASES ARE PRESENT WHEN

1127
00:44:21,100 --> 00:44:22,735
PEOPLE EVALUATE REAL PAIN BASED

1128
00:44:22,735 --> 00:44:23,902
ON NON-VERBAL RESPONSES BECAUSE

1129
00:44:23,902 --> 00:44:25,237
THESE ARE ACTORS SO WE DON'T

1130
00:44:25,237 --> 00:44:27,206
REALLY KNOW HOW WELL THAT

1131
00:44:27,206 --> 00:44:30,242
GENERALIZES TO OUR RESPONSES TO

1132
00:44:30,242 --> 00:44:32,444
OTHER PEOPLE'S REAL NON-VERBAL

1133
00:44:32,444 --> 00:44:33,078
PAIN.

1134
00:44:33,078 --> 00:44:36,081
AND SO MY FORMER Ph.D. STUDENT

1135
00:44:36,081 --> 00:44:39,551
TROY WHO IS IN THE LAB SINCE THE

1136
00:44:39,551 --> 00:44:41,120
BEGINNING AND THEN DID HIS

1137
00:44:41,120 --> 00:44:44,256
Ph.D. WITH US AND IS NOW A

1138
00:44:44,256 --> 00:44:46,392
POSTDOC AT STANFORD, MEASURED

1139
00:44:46,392 --> 00:44:48,661
FACIAL RESPONSES AND ACUTE PAIN

1140
00:44:48,661 --> 00:44:53,032
IN OVER 100 HEALTHY INDIVIDUALS

1141
00:44:53,032 --> 00:44:53,932
WHO EXPERIENCED HEAT, SHOTS,

1142
00:44:53,932 --> 00:44:56,669
COLD PRESS OR PAIN IN THE LAB.

1143
00:44:56,669 --> 00:44:58,203
PEOPLE PROVIDED READINGS IN

1144
00:44:58,203 --> 00:45:00,606
TERMS OF HOW PAINFUL STIMULUS

1145
00:45:00,606 --> 00:45:04,209
WAS AND HOW INTENSE IT WAS AND

1146
00:45:04,209 --> 00:45:08,947
WE MEASURED USING HEAD-MOUNTED

1147
00:45:08,947 --> 00:45:10,249
GO PRO MEASURED PAIN ACROSS THE

1148
00:45:10,249 --> 00:45:10,582
TRIALS.

1149
00:45:10,582 --> 00:45:11,684
A SUBSET OF THESE INDIVIDUALS

1150
00:45:11,684 --> 00:45:13,852
AGREED TO HAVE THEIR VIDEOS

1151
00:45:13,852 --> 00:45:14,620
SHOWN TO OTHERS.

1152
00:45:14,620 --> 00:45:19,892
SO THAT WE CAN MEASURE HOW PAIN

1153
00:45:19,892 --> 00:45:22,728
ASSESSMENT SPECIFICALLY.

1154
00:45:22,728 --> 00:45:25,464
SO WE HAD  54 HEALTHY VOLUNTEERS

1155
00:45:25,464 --> 00:45:26,899
VIEW VIDEOS OF INDIVIDUALS, WE

1156
00:45:26,899 --> 00:45:31,136
CALL TARGETS, AND WE SELECTED

1157
00:45:31,136 --> 00:45:32,338
VIDEOS BALANCED FOR RACE,

1158
00:45:32,338 --> 00:45:33,238
GENDER, PAIN.

1159
00:45:33,238 --> 00:45:37,609
BASICALLY WE MADE SURE THAT

1160
00:45:37,609 --> 00:45:41,080
ACROSS RACE AND GENDER, WE

1161
00:45:41,080 --> 00:45:41,747
SELECTED VIDEOS THAT WERE

1162
00:45:41,747 --> 00:45:43,615
EQUIVALENT IN TERMS OF HOW MUCH

1163
00:45:43,615 --> 00:45:46,685
PAIN THEY DETECTED SO WE SHOWED

1164
00:45:46,685 --> 00:45:48,253
INNOCUOUS AND PAINFUL VIDEOS AND

1165
00:45:48,253 --> 00:45:50,055
HIGH AND LOW INTENSITY.

1166
00:45:50,055 --> 00:45:51,857
AND SO PEOPLE WOULD SEE THE

1167
00:45:51,857 --> 00:45:53,192
VIDEO AND RATE WHETHER OR NOT

1168
00:45:53,192 --> 00:45:55,094
THE PERSON WAS IN PAIN AND HOW

1169
00:45:55,094 --> 00:45:57,162
INTENSE IT WAS USING EXACT SAME

1170
00:45:57,162 --> 00:46:00,466
SCALES THE TARGETS USED

1171
00:46:00,466 --> 00:46:00,833
THEMSELVES.

1172
00:46:00,833 --> 00:46:03,302
SO HERE WHAT I'LL SHOW IS THE

1173
00:46:03,302 --> 00:46:04,603
BREAKDOWN AS A FUNCTION OF THE

1174
00:46:04,603 --> 00:46:08,440
APPARENT GENDER AND RACE OF THE

1175
00:46:08,440 --> 00:46:08,674
TARGET.

1176
00:46:08,674 --> 00:46:09,875
AND PEOPLE'S LIKELIHOOD OF

1177
00:46:09,875 --> 00:46:11,510
RATING THAT VIDEO AS PAINFUL.

1178
00:46:11,510 --> 00:46:14,113
AND WHAT WE SEE IS THAT EVEN

1179
00:46:14,113 --> 00:46:15,547
THOUGH THE VIDEOS DEPICTED EXACT

1180
00:46:15,547 --> 00:46:17,316
SAME AMOUNT OF PAIN ACROSS ALL

1181
00:46:17,316 --> 00:46:19,518
OF THE TARGETS, PEOPLE WERE LESS

1182
00:46:19,518 --> 00:46:21,019
LIKELY TO RATE THE VIDEO AS

1183
00:46:21,019 --> 00:46:24,990
PAINFUL WHEN IT DEPICTED BLACK

1184
00:46:24,990 --> 00:46:26,225
INDIVIDUALS RELATIVE TO WHITE

1185
00:46:26,225 --> 00:46:26,525
INDIVIDUALS.

1186
00:46:26,525 --> 00:46:27,726
IF WE BREAK THIS DOWN FURTHER

1187
00:46:27,726 --> 00:46:29,695
THE FUNCTION OF THE ACTUAL TYPE

1188
00:46:29,695 --> 00:46:31,397
OF VIDEO WE SELECTED, WHAT WE

1189
00:46:31,397 --> 00:46:33,399
FIND IS THIS IS SPECIFICALLY

1190
00:46:33,399 --> 00:46:35,801
DRIVEN BY A FAILURE TO IDENTIFY

1191
00:46:35,801 --> 00:46:39,772
PAIN IN BLACK MALES WHEN THEY

1192
00:46:39,772 --> 00:46:41,607
WERE EXPERIENCING PAIN.

1193
00:46:41,607 --> 00:46:44,710
AND WE ALSO EVALUATED A LOT OF

1194
00:46:44,710 --> 00:46:45,811
DIFFERENT SOCIAL FACTORS

1195
00:46:45,811 --> 00:46:46,645
INCLUDING IMPLICIT BIAS SCORES

1196
00:46:46,645 --> 00:46:50,716
AND THINGS LIKE THAT, AND THE

1197
00:46:50,716 --> 00:46:53,018
ONLY FACTOR THAT'S CORRELATED

1198
00:46:53,018 --> 00:46:54,987
WITH THESE DIFFERENCES WAS

1199
00:46:54,987 --> 00:46:56,622
ENDORSEMENT OF EXPLICIT RACISM

1200
00:46:56,622 --> 00:46:59,158
THROUGH THE MODERN RACISM SCALE,

1201
00:46:59,158 --> 00:47:05,964
PER 

1202
00:47:05,964 --> 00:47:07,800
WE'RE ALL SUBJECT TO THE SAME

1203
00:47:07,800 --> 00:47:09,668
KINDS OF IMPLICIT SIGNALS IN OUR

1204
00:47:09,668 --> 00:47:11,103
SOCIETY IN THE U.S.

1205
00:47:11,103 --> 00:47:14,606
AND WE DID THIS STUDY ONLY IN

1206
00:47:14,606 --> 00:47:15,908
PEOPLE WHO WERE RAISED IN THE

1207
00:47:15,908 --> 00:47:23,248
U.S. AND ARE AMERICANS SO THAT

1208
00:47:23,248 --> 00:47:24,483
EVERYBODY IN THE STUDY WAS

1209
00:47:24,483 --> 00:47:28,153
EXPOSED TO THE SAME KIND OF

1210
00:47:28,153 --> 00:47:29,054
CULTURAL MESSAGING.

1211
00:47:29,054 --> 00:47:32,324
SO FINALLY THE LAST STUDY I WANT

1212
00:47:32,324 --> 00:47:34,226
TO PRESENT BRIEFLY, REALLY THIS

1213
00:47:34,226 --> 00:47:39,097
IS BRAND NEW DATA LED WITH HELP

1214
00:47:39,097 --> 00:47:41,200
FROM THE POSTDOCS HERE ALSO, WE

1215
00:47:41,200 --> 00:47:44,269
WANTED TO KNOW CAN WE IMPROVE

1216
00:47:44,269 --> 00:47:45,137
PAIN ASSESSMENT ACCURACY,

1217
00:47:45,137 --> 00:47:46,238
THERE'S BIASES, IS THERE

1218
00:47:46,238 --> 00:47:47,773
ANYTHING WE CAN DO TO HELP

1219
00:47:47,773 --> 00:47:50,075
PEOPLE BECOME MORE ACCURATE IN

1220
00:47:50,075 --> 00:47:52,010
JUDGING OTHER PEOPLE'S PAIN?

1221
00:47:52,010 --> 00:47:54,112
SO PEOPLE SAW THE SAME VIDEOS

1222
00:47:54,112 --> 00:47:59,051
THAT I JUST MENTIONED. 

1223
00:47:59,051 --> 00:48:00,986
AND AGAIN MADE RATINGS ABOUT HOW

1224
00:48:00,986 --> 00:48:02,754
PAINFUL IT WAS, AS WELL AS

1225
00:48:02,754 --> 00:48:04,056
CONFIDENCE, AND NOW DIFFERENT

1226
00:48:04,056 --> 00:48:05,290
FROM THE PREVIOUS STUDY PEOPLE

1227
00:48:05,290 --> 00:48:07,092
GOT THE CHANCE TO SEE THAT SAME

1228
00:48:07,092 --> 00:48:08,460
PERSON OVER AND OVER.

1229
00:48:08,460 --> 00:48:10,229
SO THERE'S ONE CHANCE PEOPLE

1230
00:48:10,229 --> 00:48:12,297
JUST SIMPLY LEARN HOW TO JUDGE

1231
00:48:12,297 --> 00:48:14,032
SOMEBODY'S PAIN THROUGH

1232
00:48:14,032 --> 00:48:14,566
EXPERIENCE.

1233
00:48:14,566 --> 00:48:16,201
AND EVEN WITHOUT FEEDBACK.

1234
00:48:16,201 --> 00:48:18,837
AND A SECOND GROUP WE TOLD THEM

1235
00:48:18,837 --> 00:48:21,907
AFTER EACH TRIAL HOW MUCH PAIN

1236
00:48:21,907 --> 00:48:23,642
THE PERSON WAS ACTUALLY

1237
00:48:23,642 --> 00:48:24,076
EXPERIENCING.

1238
00:48:24,076 --> 00:48:27,246
AND SO WE COULD TEST WHETHER

1239
00:48:27,246 --> 00:48:29,214
THAT FEEDBACK IMPROVES PAIN

1240
00:48:29,214 --> 00:48:30,749
ASSESSMENT ACCURACY.

1241
00:48:30,749 --> 00:48:35,053
AND WHAT WE SEE ON THE Y-AXIS IS

1242
00:48:35,053 --> 00:48:36,455
ABSOLUTE DIFFERENCE OF THE --

1243
00:48:36,455 --> 00:48:39,858
ABSOLUTE VALUE OF DIFFERENCE

1244
00:48:39,858 --> 00:48:41,393
BETWEEN THE PERCEIVER'S PAIN

1245
00:48:41,393 --> 00:48:43,595
VERSUS TARGET'S ACTUAL PAIN, WE

1246
00:48:43,595 --> 00:48:45,564
SEE THAT DIFFERENCE DOES

1247
00:48:45,564 --> 00:48:47,099
DECREASE OVER TIME WITH AN

1248
00:48:47,099 --> 00:48:48,867
EXPERIENCE FOR EACH TARGET THAT

1249
00:48:48,867 --> 00:48:50,068
PEOPLE SAW.

1250
00:48:50,068 --> 00:48:51,403
SUGGESTING THAT SIMPLY THROUGH

1251
00:48:51,403 --> 00:48:54,573
PRACTICE, PEOPLE ARE GETTING

1252
00:48:54,573 --> 00:48:56,341
BETTER AT RATING PAIN, DIDN'T

1253
00:48:56,341 --> 00:48:58,210
DIFFER BETWEEN GROUPS.

1254
00:48:58,210 --> 00:49:00,212
WE SEE OVERALL THAT THE FEEDBACK

1255
00:49:00,212 --> 00:49:02,581
GROUP IS MORE ACCURATE THAN THE

1256
00:49:02,581 --> 00:49:04,650
NO-FEEDBACK GROUP IN TERMS OF

1257
00:49:04,650 --> 00:49:07,286
PAIN ASSESSMENT, WHETHER WE

1258
00:49:07,286 --> 00:49:09,922
LOOKED AT THIS DIFFERENCE IN

1259
00:49:09,922 --> 00:49:12,991
PAIN INTENSITY OR LIKELIHOOD OF

1260
00:49:12,991 --> 00:49:15,093
RATING PAIN AND BEING ACCURATE.

1261
00:49:15,093 --> 00:49:17,296
THIS INDICATES PAIN ASSESSMENT

1262
00:49:17,296 --> 00:49:18,797
ACCURACY IMPROVES THROUGH

1263
00:49:18,797 --> 00:49:20,999
EXPERIENCE, AND FEEDBACK

1264
00:49:20,999 --> 00:49:21,867
ENHANCES ACCURACY.

1265
00:49:21,867 --> 00:49:23,735
WE'RE NOW EXAMINING THE ROLE OF

1266
00:49:23,735 --> 00:49:24,836
GAZE POSITION SO WHERE PEOPLE

1267
00:49:24,836 --> 00:49:28,640
WERE LOOKING ON THE FACES.

1268
00:49:28,640 --> 00:49:30,075
THE ACTUAL NON-VERBAL FACIAL

1269
00:49:30,075 --> 00:49:31,043
EXPRESSIONS, HOW PEOPLE USE

1270
00:49:31,043 --> 00:49:32,811
FEEDBACK FROM THE FACE TO MAKE

1271
00:49:32,811 --> 00:49:35,447
THEIR JUDGMENT, AND THE LEARNING

1272
00:49:35,447 --> 00:49:36,982
PROCESS THROUGH COLLABORATION

1273
00:49:36,982 --> 00:49:38,617
WITH ANGELA LANGDON, WHO IS

1274
00:49:38,617 --> 00:49:45,257
HERE, AND BRUNO EVERBECK.

1275
00:49:45,257 --> 00:49:47,459
OUR FIRST IMPRESSIONS OF OUR

1276
00:49:47,459 --> 00:49:50,529
PROVIDERS DO SHAPE OUR

1277
00:49:50,529 --> 00:49:52,064
EXPECTATIONS ABOUT PAINFUL

1278
00:49:52,064 --> 00:49:53,365
PROCEDURES, THAT SOCIAL

1279
00:49:53,365 --> 00:49:54,900
STEREOTYPES IMPACT PAIN

1280
00:49:54,900 --> 00:49:56,568
EXPECTATIONS AND ASSESSMENT, AND

1281
00:49:56,568 --> 00:49:59,738
THAT WE CAN IMPROVE ACCURACY IN

1282
00:49:59,738 --> 00:50:00,839
PAIN ASSESSMENT AND IN THE

1283
00:50:00,839 --> 00:50:02,574
FUTURE WE HOPE TO TEST WHETHER

1284
00:50:02,574 --> 00:50:04,876
THIS IN TURN CAN REDUCE THOSE

1285
00:50:04,876 --> 00:50:08,180
BIASES THAT WE SEE.

1286
00:50:08,180 --> 00:50:10,816
SO, OVERALL, WHAT I'VE SHOWN

1287
00:50:10,816 --> 00:50:14,319
TODAY IS THAT PAIN PERCEPTION

1288
00:50:14,319 --> 00:50:15,621
INVOLVES PAIN-SPECIFIC PROCESSES

1289
00:50:15,621 --> 00:50:17,356
AND CIRCUITS GENERALLY INVOLVED

1290
00:50:17,356 --> 00:50:19,891
IN PAIN AFFECT AND DECISION

1291
00:50:19,891 --> 00:50:20,759
MAKING.

1292
00:50:20,759 --> 00:50:21,860
PLACEBO ANALGESIA SEEMS TO

1293
00:50:21,860 --> 00:50:24,129
REFLECT SHIFTS IN EMOTION,

1294
00:50:24,129 --> 00:50:25,464
LEARNING, EXPECTATIONS, RATHER

1295
00:50:25,464 --> 00:50:26,898
THAN CHANGES IN NOCICEPTION, BUT

1296
00:50:26,898 --> 00:50:27,966
THIS DOESN'T MEAN PLACEBO

1297
00:50:27,966 --> 00:50:29,067
EFFECTS AREN'T REAL.

1298
00:50:29,067 --> 00:50:33,472
IT REALLY CAN BE WE KNOW EMOTION

1299
00:50:33,472 --> 00:50:35,207
IS REAL, WELL-BEING IS REAL.

1300
00:50:35,207 --> 00:50:39,611
SHIFTING SOMEBODY'S ANXIETY OR

1301
00:50:39,611 --> 00:50:41,013
IMPROVING POSITIVE AFFECT CAN

1302
00:50:41,013 --> 00:50:42,681
HAVE REAL EFFECT ON HEALTH,

1303
00:50:42,681 --> 00:50:43,548
SOMETHING PROVIDERS SHOULD THINK

1304
00:50:43,548 --> 00:50:49,221
ABOUT IN TERMS OF HOW YOU TREAT

1305
00:50:49,221 --> 00:50:50,222
THE TREATMENT, TIMES, BECAUSE

1306
00:50:50,222 --> 00:50:54,226
THEY ARE AREN'T CHANGING

1307
00:50:54,226 --> 00:50:57,863
NOCICEPTION DOESN'T MEAN THIS IS

1308
00:50:57,863 --> 00:50:58,430
REPORT BIAS.

1309
00:50:58,430 --> 00:50:59,297
FINALLY HOW ASSOCIATE FACTORS

1310
00:50:59,297 --> 00:51:02,200
SHAPE PAIN, WHERE WE SEE THE

1311
00:51:02,200 --> 00:51:02,934
SOCIAL CONTEXT AND STEREOTYPES

1312
00:51:02,934 --> 00:51:05,203
IMPACT PAIN BUT WE ALSO SEE

1313
00:51:05,203 --> 00:51:06,204
IMPORTANT SEX DIFFERENCES EVEN

1314
00:51:06,204 --> 00:51:09,474
IN THE MOST BASIC RELATIONSHIPS

1315
00:51:09,474 --> 00:51:11,543
BETWEEN NOCICEPTION AND PAIN.

1316
00:51:11,543 --> 00:51:14,746
SO WHERE ARE WE GOING FROM HERE?

1317
00:51:14,746 --> 00:51:18,684
WE HAVE HAD THE OPPORTUNITY TO

1318
00:51:18,684 --> 00:51:21,953
COLLABORATE WITH PEOPLE WHO ARE

1319
00:51:21,953 --> 00:51:25,323
RECORDING DIRECTLY FROM THE

1320
00:51:25,323 --> 00:51:26,525
GRAY, HOW THE SUBCORTICAL

1321
00:51:26,525 --> 00:51:28,126
CIRCUITS CONTRIBUTE TO PAIN AND

1322
00:51:28,126 --> 00:51:29,928
EMOTION, AND WHETHER THIS IS

1323
00:51:29,928 --> 00:51:32,664
ALTERED IN PAIN GROUPS SUCH AS

1324
00:51:32,664 --> 00:51:34,966
INDIVIDUALS WITH CHRONIC PAIN OR

1325
00:51:34,966 --> 00:51:35,534
MAJOR DEPRESSION.

1326
00:51:35,534 --> 00:51:37,269
WE FOR A LONG TIME HAVE WANTED

1327
00:51:37,269 --> 00:51:43,275
TO TEST THE ROLE OF ENDOGENOUS

1328
00:51:43,275 --> 00:51:45,143
OPIOIDS AND DOPAMINE, WE'RE

1329
00:51:45,143 --> 00:51:47,245
HOPING TO DO PHARMACOLOGICAL

1330
00:51:47,245 --> 00:51:51,083
WORK, POTENTIALLY USE NEW

1331
00:51:51,083 --> 00:51:52,617
SIMULTANEOUS PET SCANNER TO LOOK

1332
00:51:52,617 --> 00:51:56,321
AT HOW OPIOIDS AND DOPAMINE

1333
00:51:56,321 --> 00:51:56,955
CONTRIBUTE TO MODULATORY

1334
00:51:56,955 --> 00:51:59,157
MECHANISMS INVOLVED IN PLACEBO.

1335
00:51:59,157 --> 00:52:00,592
AND FINALLY IN JUST A COUPLE

1336
00:52:00,592 --> 00:52:02,360
WEEKS WE'RE PLANNING TO BEGIN A

1337
00:52:02,360 --> 00:52:04,096
STUDY LOOKING AT NEURAL

1338
00:52:04,096 --> 00:52:05,297
MECHANISMS OF THIS SOCIAL

1339
00:52:05,297 --> 00:52:07,799
LEARNING, AND OVER TIME ACTUALLY

1340
00:52:07,799 --> 00:52:09,668
SEE WHETHER THIS REDUCES PAIN

1341
00:52:09,668 --> 00:52:10,569
ASSESSMENT BIASES.

1342
00:52:10,569 --> 00:52:13,171
SO WITH THAT, I WANT TO ONCE

1343
00:52:13,171 --> 00:52:14,940
AGAIN ACKNOWLEDGE ALL THE FORMER

1344
00:52:14,940 --> 00:52:16,341
STAFF AND TRAINEES WHO

1345
00:52:16,341 --> 00:52:18,310
CONTRIBUTED TO THIS WORK, AS

1346
00:52:18,310 --> 00:52:20,078
WELL AS THE CRITICAL CLINICAL

1347
00:52:20,078 --> 00:52:24,483
SUPPORT WE'VE GOTTEN FROM NURSE

1348
00:52:24,483 --> 00:52:26,451
PRACTITIONERS, AND THEN THE

1349
00:52:26,451 --> 00:52:28,086
PROGRAM SUPPORT AND WONDERFUL

1350
00:52:28,086 --> 00:52:29,721
COLLABORATIONS AND MENTORSHIP

1351
00:52:29,721 --> 00:52:32,891
I'VE HAD OVER THE YEARS WITHIN

1352
00:52:32,891 --> 00:52:35,327
NCCIH, GOING TO KATHERINE

1353
00:52:35,327 --> 00:52:41,867
BUSHNELL WHO HIRED ME, ALL THESE

1354
00:52:41,867 --> 00:52:44,202
WONDERFUL PEOPLE, WHO HAVE

1355
00:52:44,202 --> 00:52:45,804
HELPED OUR TEAM GO.

1356
00:52:45,804 --> 00:52:46,905
OUR COLLEAGUES, COLLABORATORS

1357
00:52:46,905 --> 00:52:50,108
AND MENTORS IN NIMH AND NIDA,

1358
00:52:50,108 --> 00:52:52,644
AND FINALLY MY FORMER MENTORS

1359
00:52:52,644 --> 00:52:54,279
AND COLLABORATORS OUTSIDE OF THE

1360
00:52:54,279 --> 00:52:54,613
NIH.

1361
00:52:54,613 --> 00:52:55,714
WE HAVE POSITIONS AVAILABLE AND

1362
00:52:55,714 --> 00:52:57,215
I'M HAPPY TO TAKE QUESTIONS.

1363
00:52:57,215 --> 00:52:59,384
[APPLAUSE]

1364
00:52:59,384 --> 00:53:05,423
 

1365
00:53:05,423 --> 00:53:08,794
 

1366
00:53:08,794 --> 00:53:09,628
>> OPEN FOR QUESTIONS,
PLEASE

1367
00:53:09,628 --> 00:53:11,196
COME TO THE MIC.

1368
00:53:11,196 --> 00:53:14,599
I'LL BE FIELDING ANY QUESTIONS.

1369
00:53:14,599 --> 00:53:17,669
>> HAVE YOU LOOKED AT THE
AFFECT

1370
00:53:17,669 --> 00:53:19,204
OF DISTRACTION ON PAIN

1371
00:53:19,204 --> 00:53:19,604
PERCEPTION?

1372
00:53:19,604 --> 00:53:21,072
>>  GREAT QUESTION.

1373
00:53:21,072 --> 00:53:24,676
SO WE HAVE DONE SOME STUDIES TO

1374
00:53:24,676 --> 00:53:28,180
TRY TO LOOK AT THE AFFECT OF

1375
00:53:28,180 --> 00:53:29,481
ATTENTION WHICH PROBABLY WERE

1376
00:53:29,481 --> 00:53:33,485
MEDIATED BY DISTRACTION, WHETHER

1377
00:53:33,485 --> 00:53:35,687
EXPECTATIONS CAUSE YOU TO PAY

1378
00:53:35,687 --> 00:53:38,657
ATTENTION DIFFERENTLY TO THE

1379
00:53:38,657 --> 00:53:39,224
STIMULUS.

1380
00:53:39,224 --> 00:53:41,293
SO, WE HAVEN'T DONE -- WE FOUND

1381
00:53:41,293 --> 00:53:43,695
BASICALLY THAT WHEN WE HAVE

1382
00:53:43,695 --> 00:53:45,797
PEOPLE DO TWO -- HAVE TOO MUCH

1383
00:53:45,797 --> 00:53:47,332
COGNITIVE LOAD WE SEE REDUCTION

1384
00:53:47,332 --> 00:53:48,733
IN PAIN SO THAT'S PROBABLY

1385
00:53:48,733 --> 00:53:50,869
MEDIATED BY CHANGES IN

1386
00:53:50,869 --> 00:53:53,238
DISTRACTION BUT WE HAVEN'T

1387
00:53:53,238 --> 00:53:54,639
REALLY TRIED SPECIFICALLY TO

1388
00:53:54,639 --> 00:53:55,640
MANIPULATE DISTRACTION IN THE

1389
00:53:55,640 --> 00:53:55,907
LAB.

1390
00:53:55,907 --> 00:53:57,275
SO I THINK THAT'S SOMETHING WE

1391
00:53:57,275 --> 00:54:00,245
HAVE TO ALWAYS KIND OF KEEP AN

1392
00:54:00,245 --> 00:54:03,081
EYE OUT ON, KATHERINE BUSHNELL,

1393
00:54:03,081 --> 00:54:05,750
HER LAB HAD DONE A LOT OF WORK

1394
00:54:05,750 --> 00:54:07,152
ON ATTENTION DISTRACTION AND

1395
00:54:07,152 --> 00:54:10,222
FOCUS ON PAIN AND SHOWED THAT IT

1396
00:54:10,222 --> 00:54:11,223
CAN CHANGE BRAIN RESPONSES AND

1397
00:54:11,223 --> 00:54:13,391
PAIN IN THE WAY THAT WE THINK

1398
00:54:13,391 --> 00:54:17,462
WE'RE SEEING IN OUR LAB TOO.

1399
00:54:17,462 --> 00:54:17,829
THANKS.

1400
00:54:17,829 --> 00:54:18,430
RICHARD?

1401
00:54:18,430 --> 00:54:18,763
>>  HI.

1402
00:54:18,763 --> 00:54:20,732
A QUESTION ABOUT EARLY SLIDE,

1403
00:54:20,732 --> 00:54:22,701
QUESTION ABOUT THE LAST SECTION.

1404
00:54:22,701 --> 00:54:23,134
>> OKAY.

1405
00:54:23,134 --> 00:54:25,971
>> IN THE EARLY SLIDE YOU
SHOWED

1406
00:54:25,971 --> 00:54:27,839
CORRELATIONS TEST 1, TEST 2, ON

1407
00:54:27,839 --> 00:54:28,807
PAIN RATING.

1408
00:54:28,807 --> 00:54:29,708
>> YES.

1409
00:54:29,708 --> 00:54:31,009
>> MOST PEOPLE HAD HIGH

1410
00:54:31,009 --> 00:54:32,244
CORRELATIONS.

1411
00:54:32,244 --> 00:54:33,411
>> YES.

1412
00:54:33,411 --> 00:54:35,380
>> THERE WERE ABOUT TEN I
THINK

1413
00:54:35,380 --> 00:54:36,381
WHO HAD LOW CORRELATION.

1414
00:54:36,381 --> 00:54:38,884
DID YOU LOOK AT WHO THEY WERE?

1415
00:54:38,884 --> 00:54:39,885
>>  THERE'S SOMETHING
REALLY

1416
00:54:39,885 --> 00:54:41,720
INTERESTING ABOUT THAT.

1417
00:54:41,720 --> 00:54:43,488
FIRST OF ALL, I THINK I'LL HAVE

1418
00:54:43,488 --> 00:54:46,124
A HARD TIME -- LET ME GO BACK.

1419
00:54:46,124 --> 00:54:47,092
>> IT WAS REALLY EARLY,
YEAH.

1420
00:54:47,092 --> 00:54:48,860
>> HAPPY TO TALK ABOUT IT

1421
00:54:48,860 --> 00:54:50,929
BECAUSE WE THINK THESE ARE

1422
00:54:50,929 --> 00:54:51,563
REALLY INTERESTING AND PROBABLY

1423
00:54:51,563 --> 00:54:53,231
AT THIS POINT DO HAVE THE SAMPLE

1424
00:54:53,231 --> 00:54:56,968
SIZE TO BE ABLE TO LOOK AT THEM.

1425
00:54:56,968 --> 00:55:00,572
>> WAY EARLY. 

1426
00:55:00,572 --> 00:55:01,539
>> IT'S HERE.

1427
00:55:01,539 --> 00:55:01,840
>> OKAY.

1428
00:55:01,840 --> 00:55:03,541
>> WAIT, NO THE ONE
BEFORE.

1429
00:55:03,541 --> 00:55:06,845
BASICALLY WHAT I WANT TO DRAW

1430
00:55:06,845 --> 00:55:08,346
YOUR ATTENTION TO IS THAT THIS

1431
00:55:08,346 --> 00:55:10,015
IS LIMITED TO PEOPLE WHO WERE

1432
00:55:10,015 --> 00:55:11,650
INVITED BACK FOR THE SECOND

1433
00:55:11,650 --> 00:55:12,083
VISIT.

1434
00:55:12,083 --> 00:55:16,988
THESE ARE ACTUALLY PEOPLE WHO

1435
00:55:16,988 --> 00:55:18,790
ORIGINALLY HAD R SQUARED VALUES

1436
00:55:18,790 --> 00:55:20,825
.4 BUT SECOND TIME NO LONGER

1437
00:55:20,825 --> 00:55:23,929
ELIGIBLE BASED ON THAT CRITERIA.

1438
00:55:23,929 --> 00:55:26,965
WE SEE IN GENERAL IF I WOULD

1439
00:55:26,965 --> 00:55:30,702
HAVE JUST SHOWN YOU THE 360 OR

1440
00:55:30,702 --> 00:55:35,640
400 PEOPLE, 10% OF PEOPLE ARE R

1441
00:55:35,640 --> 00:55:37,943
SQUARED LESS THAN .4, 10% HAVE

1442
00:55:37,943 --> 00:55:38,877
TOLERANCE VALUES HIGHER THAN 50

1443
00:55:38,877 --> 00:55:42,314
WHICH MEAN WE CAN'T ACTUALLY

1444
00:55:42,314 --> 00:55:43,515
SAFELY ADMINISTER.

1445
00:55:43,515 --> 00:55:46,584
WE'VE NEVER LOOKED AT WHAT

1446
00:55:46,584 --> 00:55:47,585
FACTORS PREDICT SOMEBODY'S R

1447
00:55:47,585 --> 00:55:49,187
SQUARED VALUES WHICH I THINK IS

1448
00:55:49,187 --> 00:55:51,623
A REALLY IMPORTANT QUESTION.

1449
00:55:51,623 --> 00:55:54,125
AND IT'S PROBABLY AT THIS POINT

1450
00:55:54,125 --> 00:55:55,961
ABOUT 50 OR SO PEOPLE WHO HAVE

1451
00:55:55,961 --> 00:55:56,161
THAT.

1452
00:55:56,161 --> 00:55:57,729
WE HAVE THE DATA IF YOU'D LIKE

1453
00:55:57,729 --> 00:55:58,930
TO LOOK AT IT.

1454
00:55:58,930 --> 00:55:59,597
>> I MIGHT.

1455
00:55:59,597 --> 00:56:01,433
>> IT WOULD BE REALLY
COOL, YES.

1456
00:56:01,433 --> 00:56:04,302
>> AND AT THE END WHEN YOU
WERE

1457
00:56:04,302 --> 00:56:05,837
LOOKING AT PEOPLE'S RATINGS

1458
00:56:05,837 --> 00:56:10,542
BASED ON SEX AND RACE, DID YOU

1459
00:56:10,542 --> 00:56:11,609
HAVE ENOUGH PEOPLE, PARTICIPANTS

1460
00:56:11,609 --> 00:56:14,012
OF DIFFERENT SEXES AND RACES, TO

1461
00:56:14,012 --> 00:56:14,779
LOOK AT CROSS-CORRELATION?

1462
00:56:14,779 --> 00:56:15,547
>>  YES, GREAT QUESTION.

1463
00:56:15,547 --> 00:56:18,516
WE'VE SEEN THIS IN ALL OF OUR

1464
00:56:18,516 --> 00:56:20,251
STUDIES.

1465
00:56:20,251 --> 00:56:25,090
WE -- IF WE LOOK AT -- I'LL CALL

1466
00:56:25,090 --> 00:56:27,292
IT TARGET PERCEIVER CONCORDANCE,

1467
00:56:27,292 --> 00:56:28,259
WHETHER YOU SHARE THE SAME

1468
00:56:28,259 --> 00:56:30,261
IDENTITY AS TARGET WITH RESPECT

1469
00:56:30,261 --> 00:56:34,499
TO RACE OR GENDER REALLY DOESN'T

1470
00:56:34,499 --> 00:56:35,400
AFFECT DECISIONS BUT HOW SIMILAR

1471
00:56:35,400 --> 00:56:37,702
YOU SAY YOU FEEL TO THE TARGET

1472
00:56:37,702 --> 00:56:39,337
DOES IN EVERY SINGLE STUDY WE'VE

1473
00:56:39,337 --> 00:56:39,704
DONE.

1474
00:56:39,704 --> 00:56:41,172
WE JUST SAW THIS AGAIN IN THE

1475
00:56:41,172 --> 00:56:43,475
MOST RECENT LEARNING TASK.

1476
00:56:43,475 --> 00:56:45,010
SO PROBABLY SOME PEOPLE MIGHT BE

1477
00:56:45,010 --> 00:56:46,745
USING THOSE KINDS OF FEATURES TO

1478
00:56:46,745 --> 00:56:49,180
SAY I FEEL MORE SIMILAR BUT

1479
00:56:49,180 --> 00:56:50,615
THERE'S SOMETHING THAT GOES

1480
00:56:50,615 --> 00:56:52,550
BEYOND JUST KIND OF CENSUS

1481
00:56:52,550 --> 00:56:55,286
CATEGORIES THAT IS DRIVING THAT

1482
00:56:55,286 --> 00:56:55,854
SIMILARITY.

1483
00:56:55,854 --> 00:56:57,288
AND WE'RE SETTING UP NOW TO DO

1484
00:56:57,288 --> 00:56:58,890
HOPEFULLY LIKE IN THE NEXT WEEK

1485
00:56:58,890 --> 00:57:05,063
OR SO WE'LL BE LAUNCHING THIS IN

1486
00:57:05,063 --> 00:57:06,564
A MUCH LARGER SAMPLE ONLINE TO

1487
00:57:06,564 --> 00:57:08,233
LOOK IN A MORE CONSISTENT WAY

1488
00:57:08,233 --> 00:57:11,169
BECAUSE THESE ARE SMALL SAMPLES.

1489
00:57:11,169 --> 00:57:11,569
>> INTERESTING.

1490
00:57:11,569 --> 00:57:11,803
THANKS.

1491
00:57:11,803 --> 00:57:12,704
>> THANK YOU.

1492
00:57:12,704 --> 00:57:12,937
>> HI.

1493
00:57:12,937 --> 00:57:15,340
THAT WAS A GREAT TALK.

1494
00:57:15,340 --> 00:57:16,441
TWO QUESTIONS.

1495
00:57:16,441 --> 00:57:18,410
ONE, I GUESS SIMILAR TO THE

1496
00:57:18,410 --> 00:57:20,245
QUESTION THAT ROLAND ASKED.

1497
00:57:20,245 --> 00:57:23,448
SO, HAVE YOU LOOKED TO SEE IF

1498
00:57:23,448 --> 00:57:25,316
PERCEPTION OF PAIN IS INFLUENCED

1499
00:57:25,316 --> 00:57:30,355
BY TIME OF DAY? 

1500
00:57:30,355 --> 00:57:31,623
SO DO PEOPL PERCEIVE DIFFERENTLY

1501
00:57:31,623 --> 00:57:33,958
EARLY IN THE MORNING VERSE U.S.

1502
00:57:33,958 --> 00:57:36,361
LATE AT NIGHT AND A MORE GENERAL

1503
00:57:36,361 --> 00:57:38,963
QUESTION, THESE SIGNATURES THAT

1504
00:57:38,963 --> 00:57:42,467
YOU SEE DURING ACUTE PAIN USING

1505
00:57:42,467 --> 00:57:44,903
fMRI, HOW DO THOSE COMPARE TO

1506
00:57:44,903 --> 00:57:47,338
WHAT IS SEEN FOR PEOPLE WHO HAVE

1507
00:57:47,338 --> 00:57:47,939
CHRONIC PAIN?

1508
00:57:47,939 --> 00:57:50,041
>>  THANK YOU FOR THOSE

1509
00:57:50,041 --> 00:57:50,375
QUESTIONS.

1510
00:57:50,375 --> 00:57:51,509
WELL, FIRST QUESTION, NO.

1511
00:57:51,509 --> 00:57:53,578
WE'VE NEVER LOOKED AT TIME OF

1512
00:57:53,578 --> 00:57:54,345
DAY.

1513
00:57:54,345 --> 00:57:56,014
WE'RE SORT OF CONSTRAINED BY,

1514
00:57:56,014 --> 00:58:00,385
YOU KNOW, OUR CLINICAL

1515
00:58:00,385 --> 00:58:00,718
AVAILABILITY.

1516
00:58:00,718 --> 00:58:01,119
>> SURE, SURE.

1517
00:58:01,119 --> 00:58:02,887
>> WE -- YOU KNOW, I KNOW
SYLVIA

1518
00:58:02,887 --> 00:58:04,422
IS DOING WORK NOW WITH CORTISOL

1519
00:58:04,422 --> 00:58:05,223
AND STRESS.

1520
00:58:05,223 --> 00:58:08,159
WE COULD ACTUALLY LOOK AT

1521
00:58:08,159 --> 00:58:10,228
DIURNAL CHANGES IN CORTISOL BUT

1522
00:58:10,228 --> 00:58:13,865
EVEN I'LL GO MORE BROADLY, OUR

1523
00:58:13,865 --> 00:58:14,732
ANALYSIS OF MENSTRUAL CYCLE,

1524
00:58:14,732 --> 00:58:16,935
THAT WAS ALSO LIMITED BECAUSE WE

1525
00:58:16,935 --> 00:58:18,837
DIDN'T ACTUALLY MEASURE THE

1526
00:58:18,837 --> 00:58:19,871
HORMONES SPECIFICALLY.

1527
00:58:19,871 --> 00:58:21,072
I THINK IT WOULD BE REALLY GREAT

1528
00:58:21,072 --> 00:58:23,274
AT SOME POINT FOR US TO INCLUDE

1529
00:58:23,274 --> 00:58:25,910
THOSE MEASURES AND THEN WE WOULD

1530
00:58:25,910 --> 00:58:27,512
DEFINITELY WANT TO TAKE THAT

1531
00:58:27,512 --> 00:58:28,313
INTO ACCOUNT.

1532
00:58:28,313 --> 00:58:31,783
WITH RESPECT TO DIFFERENCE

1533
00:58:31,783 --> 00:58:33,585
BETWEEN NPS IN PATIENT GROUPS,

1534
00:58:33,585 --> 00:58:38,223
IT DOESN'T PREDICT IN GROUPS.

1535
00:58:38,223 --> 00:58:40,692
IT PREDICTSES NOCICEPTIVE PAIN,

1536
00:58:40,692 --> 00:58:43,428
NOT CHRONIC PAIN.

1537
00:58:43,428 --> 00:58:46,131
A COLLEAGUE HAS DEVELOPED A

1538
00:58:46,131 --> 00:58:48,099
BRAIN-BASED CLASSIFIER THAT CAN

1539
00:58:48,099 --> 00:58:51,503
PREDICT PAIN IN INDIVIDUALS WITH

1540
00:58:51,503 --> 00:58:52,470
FIBROMYALGIA, REALLY A GENERAL

1541
00:58:52,470 --> 00:58:53,338
SENSORY RESPONSE.

1542
00:58:53,338 --> 00:58:54,873
IT'S NOT VERY SPECIFIC TO PAIN.

1543
00:58:54,873 --> 00:58:58,476
SO WE KIND OF THINK ABOUT THIS

1544
00:58:58,476 --> 00:58:59,811
AS THE NOCICEPTIVE CIRCUIT, AND

1545
00:58:59,811 --> 00:59:03,114
CAN SEE THAT IT ALSO PREDICTS

1546
00:59:03,114 --> 00:59:07,051
CIRCUITS IN PARTICIPANTS WITH

1547
00:59:07,051 --> 00:59:08,887
CHRONIC PAIN BUT IDENTIFYING THE

1548
00:59:08,887 --> 00:59:10,088
BRAIN SYSTEMS THAT ARE

1549
00:59:10,088 --> 00:59:12,624
RESPONSIBLE FOR CHRONIC PAIN

1550
00:59:12,624 --> 00:59:13,825
SPECIFICALLY IS AN ENTIRELY

1551
00:59:13,825 --> 00:59:15,827
DIFFERENT KIND OF NETWORK WE

1552
00:59:15,827 --> 00:59:16,928
ASSUME AND THAT'S SOMETHING

1553
00:59:16,928 --> 00:59:20,632
PEOPLE IN THE HEAL INITIATIVE

1554
00:59:20,632 --> 00:59:22,700
AND THE COMMON FUND HAVE BEEN

1555
00:59:22,700 --> 00:59:23,234
WORKING ON HARD.

1556
00:59:23,234 --> 00:59:25,570
HOPEFULLY IN THE NEXT COUPLE

1557
00:59:25,570 --> 00:59:27,205
YEARS WE'LL HAVE BRAIN-BASED

1558
00:59:27,205 --> 00:59:28,306
CLASSIFIERS FOR CHRONIC PAIN AS

1559
00:59:28,306 --> 00:59:28,506
WELL.

1560
00:59:28,506 --> 00:59:32,343
>> WE HAVE A QUESTION FROM

1561
00:59:32,343 --> 00:59:33,878
ONLINE FROM DR. PAO, GREAT TALK.

1562
00:59:33,878 --> 00:59:36,414
HAVE YOU CONSIDERED ANY PATIENT

1563
00:59:36,414 --> 00:59:39,050
POPULATIONS SUCH AS SOMATIC

1564
00:59:39,050 --> 00:59:40,685
SYMPTOM DISORDER PATIENTS TO

1565
00:59:40,685 --> 00:59:42,220
TEST EXPECTANCIES IN LEARNING

1566
00:59:42,220 --> 00:59:42,487
PARADIGMS?

1567
00:59:42,487 --> 00:59:45,957
>>  THANK YOU FOR THAT
QUESTION.

1568
00:59:45,957 --> 00:59:48,359
I GUESS I WILL ANSWER IN A

1569
00:59:48,359 --> 00:59:50,195
COUPLE WAYS.

1570
00:59:50,195 --> 00:59:52,297
WE ARE ALWAYS ENTHUSIASTIC TO

1571
00:59:52,297 --> 00:59:53,831
PARTNER WITH GROUPS THAT HAVE

1572
00:59:53,831 --> 00:59:56,334
ACCESS TO CLINICAL PATIENTS WHO

1573
00:59:56,334 --> 00:59:57,101
MIGHT SPECIFICALLY SHOW

1574
00:59:57,101 --> 01:00:00,138
DIFFERENCES IN THESE KINDS OF

1575
01:00:00,138 --> 01:00:03,208
PROCESSES, SO WE HAVE THE PAIN

1576
01:00:03,208 --> 01:00:04,842
RESEARCH CENTERS, GREAT TIME TO

1577
01:00:04,842 --> 01:00:06,010
ADVERTISE IT.

1578
01:00:06,010 --> 01:00:09,147
WE'D LOVE TO KIND OF STAY IN

1579
01:00:09,147 --> 01:00:10,982
TOUCH WITH WHAT ASPECTS OUR TASK

1580
01:00:10,982 --> 01:00:12,417
MIGHT MAKE SENSE TO TEST ACROSS

1581
01:00:12,417 --> 01:00:16,454
A WIDE RANGE OF PATIENTS AND SO

1582
01:00:16,454 --> 01:00:17,789
IF THE SOMATOSENSORY OR SENSORY

1583
01:00:17,789 --> 01:00:18,756
SYMPTOM DISORDER, THAT WOULD BE

1584
01:00:18,756 --> 01:00:22,794
GREAT TO TALK MORE ABOUT THAT.

1585
01:00:22,794 --> 01:00:25,964
ALSO, WE HAVE SOME POTENTIAL

1586
01:00:25,964 --> 01:00:28,132
UPCOMING COLLABORATIONS, WITH

1587
01:00:28,132 --> 01:00:29,367
SYLVIA LOPEZ GUZMAN, LOOKING AT

1588
01:00:29,367 --> 01:00:31,102
PAN IN THE CONTEXT OF NEGATIVE

1589
01:00:31,102 --> 01:00:32,537
AFFECT AND DECISIONS THAT MIGHT

1590
01:00:32,537 --> 01:00:34,939
BE RELATED TO ADDICTION.

1591
01:00:34,939 --> 01:00:37,108
AND ALSO WITH CARLOS IN THE

1592
01:00:37,108 --> 01:00:39,978
CONTEXT OF SOME POTENTIAL

1593
01:00:39,978 --> 01:00:41,613
NON-OPIOID ANALGESICS THAT WE'RE

1594
01:00:41,613 --> 01:00:42,480
REALLY EXCITED ABOUT FOR THE

1595
01:00:42,480 --> 01:00:44,349
FUTURE BUT KIND OF BEYOND THE

1596
01:00:44,349 --> 01:00:45,750
SCOPE OF THIS TALK.

1597
01:00:45,750 --> 01:00:47,318
THAT'S DEFINITELY THE NEXT PHASE

1598
01:00:47,318 --> 01:00:50,588
OF OUR WORK WE HOPE TO MOVE FROM

1599
01:00:50,588 --> 01:00:52,557
MECHANISTIC INTO WHAT'S GOING ON

1600
01:00:52,557 --> 01:00:53,758
IN PATIENTS.

1601
01:00:53,758 --> 01:00:54,525
>> GREAT.

1602
01:00:54,525 --> 01:00:54,859
>> AWESOME.

1603
01:00:54,859 --> 01:00:56,728
REALLY NICE TALK.

1604
01:00:56,728 --> 01:00:57,161
>> THANK YOU.

1605
01:00:57,161 --> 01:00:59,564
>> 55 PAPERS IS A LOT.

1606
01:00:59,564 --> 01:01:00,865
TWO QUESTIONS.

1607
01:01:00,865 --> 01:01:03,635
THE FIRST HAS TWO PRONGS.

1608
01:01:03,635 --> 01:01:05,703
IT'S MORE ABOUT META BELIEFS IN

1609
01:01:05,703 --> 01:01:07,338
PEOPLE, LIKE HAVE YOU LOOKED AT

1610
01:01:07,338 --> 01:01:09,440
WHETHER THE PLACEBO EFFECT

1611
01:01:09,440 --> 01:01:14,279
DIFFERS IN PEOPLE THAT HAVE

1612
01:01:14,279 --> 01:01:15,346
BELIEFS WELL-BEING CAN CHANGE

1613
01:01:15,346 --> 01:01:16,681
THEIR LIFE, OR FAITH AND THINGS

1614
01:01:16,681 --> 01:01:19,284
LIKE THAT AND A FOLLOW-UP TO

1615
01:01:19,284 --> 01:01:20,385
THAT, THAT COMPONENT, LIKE DO

1616
01:01:20,385 --> 01:01:22,053
YOU THINK IT WOULD BE THE SAME

1617
01:01:22,053 --> 01:01:23,788
CIRCUITS THAT WOULD GET

1618
01:01:23,788 --> 01:01:25,657
ACTIVATED IN THOSE KIND OF

1619
01:01:25,657 --> 01:01:29,694
CONDITIONS AS PLACEBO FOR PAIN?

1620
01:01:29,694 --> 01:01:31,362
>>  YES.

1621
01:01:31,362 --> 01:01:33,798
A THIRD QUESTION?

1622
01:01:33,798 --> 01:01:34,766
>>  THE SECOND QUESTION.

1623
01:01:34,766 --> 01:01:37,402
>> CAN I ANSWER THOSE?

1624
01:01:37,402 --> 01:01:42,740
I WANT TO HEAR THE NEXT QUESTION

1625
01:01:42,740 --> 01:01:42,974
TOO.

1626
01:01:42,974 --> 01:01:45,476
SO, WE ORIGINALLY IN THIS SAME

1627
01:01:45,476 --> 01:01:50,315
TASK WE USED THIS TASK AT ONE

1628
01:01:50,315 --> 01:01:52,917
POINT TO EXPLORE WHETHER WE

1629
01:01:52,917 --> 01:01:56,321
MIGHT BE ABLE TO IDENTIFY

1630
01:01:56,321 --> 01:01:58,189
IMPLICIT MARKERS THAT WERE TO

1631
01:01:58,189 --> 01:02:00,692
HELP US SEE WHEN SOMEBODY

1632
01:02:00,692 --> 01:02:02,393
EXPERIENCES A PLACEBO, DO THEY

1633
01:02:02,393 --> 01:02:04,095
EXPERIENCE LESS PAIN BUT ALSO

1634
01:02:04,095 --> 01:02:04,762
BECOME MORE UNCERTAIN ABOUT

1635
01:02:04,762 --> 01:02:05,496
THEIR PAIN?

1636
01:02:05,496 --> 01:02:06,597
SO MAYBE WHAT HAPPENS IS YOU

1637
01:02:06,597 --> 01:02:08,366
KIND OF LIKE TELL ME YOU FEEL

1638
01:02:08,366 --> 01:02:10,001
BETTER BUT YOU'RE ALSO NOT QUITE

1639
01:02:10,001 --> 01:02:12,637
CERTAIN, AND SO WHAT WE DID IS

1640
01:02:12,637 --> 01:02:14,539
USED EYE TRACKING AND HOW PEOPLE

1641
01:02:14,539 --> 01:02:16,808
LOOKED AT THE SCALE TO SEE

1642
01:02:16,808 --> 01:02:22,213
WHETHER -- AND WE INCLUDED

1643
01:02:22,213 --> 01:02:22,847
SUBJECTIVE CONFIDENCE RATINGS

1644
01:02:22,847 --> 01:02:24,282
WHEN THEY WERE LESS CONFIDENT

1645
01:02:24,282 --> 01:02:25,717
LOOKED AROUND THE SCALE MORE AND

1646
01:02:25,717 --> 01:02:26,918
IF THAT WERE THE CASE WE WOULD

1647
01:02:26,918 --> 01:02:29,754
HAVE BEEN ABLE TO USE THAT AS AN

1648
01:02:29,754 --> 01:02:31,489
IMPLICIT MEASURE TO TEST WHETHER

1649
01:02:31,489 --> 01:02:33,257
PEOPLE REPORT LESS PAIN BUT

1650
01:02:33,257 --> 01:02:36,861
ACTUALLY ARE LESS CERTAIN ABOUT

1651
01:02:36,861 --> 01:02:38,196
THEIR PAIN.

1652
01:02:38,196 --> 01:02:39,430
APPROACHES LIKE MOUSE TRACKING

1653
01:02:39,430 --> 01:02:42,233
ALSO THAT WE'VE EXPLORED USING

1654
01:02:42,233 --> 01:02:43,134
FOR THAT.

1655
01:02:43,134 --> 01:02:45,937
WE DID SEE THAT PEOPLE WITH

1656
01:02:45,937 --> 01:02:48,272
HIGHER R SQUARED SHOWED STRONGER

1657
01:02:48,272 --> 01:02:50,475
RELATIONSHIP BETWEEN FIXATION ON

1658
01:02:50,475 --> 01:02:53,344
THE SCALE AND CONFIDENCE BUT

1659
01:02:53,344 --> 01:02:54,078
DIDN'T GENERALIZE ACROSS

1660
01:02:54,078 --> 01:03:00,351
EVERYBODY,  WE HAVEN'T LOOKED AT

1661
01:03:00,351 --> 01:03:03,287
EVERYBODY BUT IT'S IMPORTANT TO

1662
01:03:03,287 --> 01:03:04,756
ME, STILL A HYPOTHESIS THAT I

1663
01:03:04,756 --> 01:03:08,760
KEEP IN THE BACK OF MY HEAD.

1664
01:03:08,760 --> 01:03:10,828
WITH RESPECT TO PEOPLE WHO MAYBE

1665
01:03:10,828 --> 01:03:13,598
HAVE MORE SPIRITUAL BELIEFS OR

1666
01:03:13,598 --> 01:03:16,768
KIND OF DESIRE FOR RELIEF, THE

1667
01:03:16,768 --> 01:03:20,271
FIELD OF RESEARCH, ONE THING I

1668
01:03:20,271 --> 01:03:21,506
MENTION IS THE MEANING RESPONSE,

1669
01:03:21,506 --> 01:03:23,775
WHEN WE TALK ABOUT WHAT IS

1670
01:03:23,775 --> 01:03:26,944
PLACEBO, THERE IS THIS IDEA THAT

1671
01:03:26,944 --> 01:03:28,913
IT MIGHT BE KIND OF MAKING MORE

1672
01:03:28,913 --> 01:03:32,083
MEANING OUT OF THE CLINICAL

1673
01:03:32,083 --> 01:03:32,550
CONTEXT.

1674
01:03:32,550 --> 01:03:35,253
AND PEOPLE -- SO IT'S LESS ABOUT

1675
01:03:35,253 --> 01:03:36,554
SOME STUDIES IN PATIENTS

1676
01:03:36,554 --> 01:03:38,322
SUGGESTING IT'S LESS ABOUT

1677
01:03:38,322 --> 01:03:39,757
EXPECTATION OF RELIEF BUT RATHER

1678
01:03:39,757 --> 01:03:42,460
DESIRE FOR RELIEF WHICH COULD

1679
01:03:42,460 --> 01:03:44,896
ACTUALLY THEN BRING ON BOARD

1680
01:03:44,896 --> 01:03:48,499
OTHER THINGS YOU'RE TALKING

1681
01:03:48,499 --> 01:03:48,900
ABOUT.

1682
01:03:48,900 --> 01:03:50,568
LASTLY, A COLLEAGUE KATIA AT

1683
01:03:50,568 --> 01:03:53,070
OXFORD DID A STUDY WHERE SHE

1684
01:03:53,070 --> 01:03:54,739
LOOKED AT RELIGIOUS INDIVIDUALS

1685
01:03:54,739 --> 01:03:56,541
INSTEAD OF PRESENTING EXPECTANCY

1686
01:03:56,541 --> 01:03:58,776
CUES DID PRESENT RELIGIOUS CUES,

1687
01:03:58,776 --> 01:04:01,612
AND SHE SHOWED SIMILAR

1688
01:04:01,612 --> 01:04:02,947
MODULATION OF PAIN IN ANTERIOR

1689
01:04:02,947 --> 01:04:05,683
INSULA SO PEOPLE HAVE USED THAT

1690
01:04:05,683 --> 01:04:10,288
KIND OF MEANING AS A TYPE OF

1691
01:04:10,288 --> 01:04:10,588
EXPECTATION.

1692
01:04:10,588 --> 01:04:12,457
WHETHER PEOPLE WHO ENDORSE THOSE

1693
01:04:12,457 --> 01:04:14,091
BELIEFS SHOW LARGER PLACEBO

1694
01:04:14,091 --> 01:04:15,726
RESPONSES IN CLINIC I'M NOT SURE

1695
01:04:15,726 --> 01:04:16,794
ABOUT.

1696
01:04:16,794 --> 01:04:23,601
SO THANKS FOR THAT FIRST

1697
01:04:23,601 --> 01:04:24,602
QUESTION.

1698
01:04:24,602 --> 01:04:24,836
SECOND?

1699
01:04:24,836 --> 01:04:27,138
>>  IF THEY WERE TO SAY
THIS

1700
01:04:27,138 --> 01:04:29,106
PERSON IS NOT VERY CONFIDENT,

1701
01:04:29,106 --> 01:04:30,541
NOT SO MUCH PLACEBO RESPONSE, IF

1702
01:04:30,541 --> 01:04:33,377
YOU CAME BACK AND TOLD THEM

1703
01:04:33,377 --> 01:04:35,680
THAT'S ACTUALLY OUR BEST PERSON

1704
01:04:35,680 --> 01:04:37,215
THAT TRAINED AT STANFORD, THEY

1705
01:04:37,215 --> 01:04:40,918
ARE THE PAIN WIZARD, DO YOU

1706
01:04:40,918 --> 01:04:41,719
THINK THEY WOULD UNMASK?

1707
01:04:41,719 --> 01:04:48,059
>>  I LOVE THAT QUESTION. 

1708
01:04:48,059 --> 01:04:49,060
I WAS TELLING SOMEONE, PEOPLE

1709
01:04:49,060 --> 01:04:52,096
WOULD CHOOSE A MALE PROVIDER BUT

1710
01:04:52,096 --> 01:04:53,731
HAVING A FEMALE PROVIDER MAKES

1711
01:04:53,731 --> 01:04:57,869
YOU MORE LIKELY TO SURVIVE

1712
01:04:57,869 --> 01:04:59,537
REGARDLESS OF YOUR GENDER SO

1713
01:04:59,537 --> 01:05:02,273
TEACHING PEOPLE WHAT IS

1714
01:05:02,273 --> 01:05:05,443
IMPORTANT FOR THE HEALTH COULD

1715
01:05:05,443 --> 01:05:06,544
HOPEFULLY OVERRIDE EXPECTATIONS.

1716
01:05:06,544 --> 01:05:08,279
SO WE HAVE ONLY LOOKED AT THAT

1717
01:05:08,279 --> 01:05:12,216
QUESTION IN THE CONTEXT OF MY

1718
01:05:12,216 --> 01:05:14,418
WORK ON AVERSIVE LEARNING WHERE

1719
01:05:14,418 --> 01:05:16,187
WE ACTUALLY KIND OF PIT

1720
01:05:16,187 --> 01:05:19,123
INSTRUCTION AGAINST  FEEDBACK

1721
01:05:19,123 --> 01:05:20,758
HISTORY AND WE THINK IT DEPENDS

1722
01:05:20,758 --> 01:05:22,894
ON CIRCUMSTANCES.

1723
01:05:22,894 --> 01:05:25,997
IF WE USED SOCIAL INSTEAD OF

1724
01:05:25,997 --> 01:05:27,565
AVERSIVE STIMULI I IMAGINE WE

1725
01:05:27,565 --> 01:05:29,200
COULD SEE PARALLEL DUAL

1726
01:05:29,200 --> 01:05:30,167
PROCESSES FOR TRACKING KNOWLEDGE

1727
01:05:30,167 --> 01:05:33,671
AND HOPEFULLY GETTING THE

1728
01:05:33,671 --> 01:05:34,972
PREDICTIONERS TO UPDATE EXPECTED

1729
01:05:34,972 --> 01:05:35,373
BELIEFS.

1730
01:05:35,373 --> 01:05:36,541
I LIKE THAT IDEA.

1731
01:05:36,541 --> 01:05:42,213
>> WE HAVE TIME FOR ONE
MORE

1732
01:05:42,213 --> 01:05:42,880
QUESTION.

1733
01:05:42,880 --> 01:05:43,648
DR. CARRASQUILLO?

1734
01:05:43,648 --> 01:05:49,687
>>  BEAUTIFUL TALK,
LAUREN. 

1735
01:05:49,687 --> 01:05:49,987
>> THANKS.

1736
01:05:49,987 --> 01:05:50,888
>> TWO QUESTIONS.

1737
01:05:50,888 --> 01:05:53,291
YOU CHOOSE, I'LL TELL YOU TWO,

1738
01:05:53,291 --> 01:05:55,259
YOU CHOOSE WHICH TO ANSWER.

1739
01:05:55,259 --> 01:05:57,461
>> OR I'LL PUT THEM
TOGETHER.

1740
01:05:57,461 --> 01:05:59,430
>> ONE OF THEM IS EASY,
I'VE

1741
01:05:59,430 --> 01:06:00,965
HEARD YOU SAY MANY TIMES ONE OF

1742
01:06:00,965 --> 01:06:03,134
THE ADVANTAGES TO BE HERE IS

1743
01:06:03,134 --> 01:06:06,103
THAT YOU GET PEOPLE THAT ARE OF

1744
01:06:06,103 --> 01:06:08,873
DIFFERENT AGES THAN WHEN YOU ARE

1745
01:06:08,873 --> 01:06:10,408
AT COLLEGE INSTITUTIONS.

1746
01:06:10,408 --> 01:06:11,842
>> YES, YES.

1747
01:06:11,842 --> 01:06:12,376
>> PARTICIPANTS.

1748
01:06:12,376 --> 01:06:15,012
SO I WAS WONDERING IF ANYTHING

1749
01:06:15,012 --> 01:06:19,483
YOU'VE SHOWN IS -- IF YOU SEE

1750
01:06:19,483 --> 01:06:21,452
ANYTHING RELATED TO AGE,

1751
01:06:21,452 --> 01:06:23,821
PARTICULARLY BOTH OF COURSE THE

1752
01:06:23,821 --> 01:06:25,923
PARTICIPANTS, BUT ALSO IN THE

1753
01:06:25,923 --> 01:06:29,427
LATER PART, WONDERING IF PEOPLE

1754
01:06:29,427 --> 01:06:31,629
PERCEIVED OLDER PEOPLE AS WISER

1755
01:06:31,629 --> 01:06:33,598
AND MORE COMPETENT THAN YOUNGER

1756
01:06:33,598 --> 01:06:35,132
PEOPLE EVEN IF THEY HAVE THE

1757
01:06:35,132 --> 01:06:39,870
SAME COMPETENCY ON PAPER, AND

1758
01:06:39,870 --> 01:06:43,507
THEN HOW PREVIOUS LIFE TRAUMA,

1759
01:06:43,507 --> 01:06:45,009
WHETHER PHYSICAL OR MENTAL, LIKE

1760
01:06:45,009 --> 01:06:47,445
FITS INTO EVERYTHING THAT YOU'VE

1761
01:06:47,445 --> 01:06:48,179
SAID, EXPECTATIONS, YOU KNOW,

1762
01:06:48,179 --> 01:06:51,349
ALL OF THAT.

1763
01:06:51,349 --> 01:06:57,288
THE SECOND ONE OF COURSE LOVE

1764
01:06:57,288 --> 01:06:59,690
YOUR SEX/GENDER BECAUSE IT'S

1765
01:06:59,690 --> 01:07:01,092
VERY UNEXPECTED AND IMPORTANT,

1766
01:07:01,092 --> 01:07:02,526
WAS WONDERING WITH THE FEMALES

1767
01:07:02,526 --> 01:07:08,332
IF YOU HAVE BROKEN THEM UP IN

1768
01:07:08,332 --> 01:07:09,634
REPRODUCTIVE LIKE, YOU KNOW,

1769
01:07:09,634 --> 01:07:11,102
STATUS OR WHETHER THEY HAVE HAD

1770
01:07:11,102 --> 01:07:12,703
CHILDREN OR NOT HAVE CHILDREN,

1771
01:07:12,703 --> 01:07:17,408
AND THEN ALSO WHETHER YOU'VE

1772
01:07:17,408 --> 01:07:19,143
TAKEN HISTORY OF HOW PAINFUL

1773
01:07:19,143 --> 01:07:20,778
THEIR MENSTRUAL CYCLES ARE AND

1774
01:07:20,778 --> 01:07:23,981
THINGS LIKE THAT.

1775
01:07:23,981 --> 01:07:24,548
>> OKAY.

1776
01:07:24,548 --> 01:07:25,316
SO I'LL ANSWER --

1777
01:07:25,316 --> 01:07:26,917
>> WE CAN TALK ABOUT IT
LATER

1778
01:07:26,917 --> 01:07:27,084
TOO.

1779
01:07:27,084 --> 01:07:29,520
>> THANK YOU FOR THE
QUESTION.

1780
01:07:29,520 --> 01:07:31,722
WE'VE TALKED ABOUT US NEEDING TO

1781
01:07:31,722 --> 01:07:33,457
ADD THIS QUESTION ABOUT WHETHER

1782
01:07:33,457 --> 01:07:34,358
PEOPLE HAVE HAD PREGNANCY, WHAT

1783
01:07:34,358 --> 01:07:35,292
WAS THEIR EXPERIENCE.

1784
01:07:35,292 --> 01:07:36,761
I CAME BACK TO THE LAB

1785
01:07:36,761 --> 01:07:38,295
IMMEDIATELY, WE NEED TO DO THIS.

1786
01:07:38,295 --> 01:07:41,365
WE NEVER ASKED ANYTHING ABOUT

1787
01:07:41,365 --> 01:07:41,966
THAT.

1788
01:07:41,966 --> 01:07:43,567
SO I GENERALLY THINK THAT AS WE

1789
01:07:43,567 --> 01:07:45,836
RAMP UP NEW STUDIES WE WANT TO

1790
01:07:45,836 --> 01:07:46,604
INCLUDE THOSE QUESTIONS.

1791
01:07:46,604 --> 01:07:49,040
I THINK IT'S A GREAT PROJECT FOR

1792
01:07:49,040 --> 01:07:50,875
A POSTDOC TO KIND OF DO

1793
01:07:50,875 --> 01:07:52,643
SECONDARY RESEARCH AND GO BACK

1794
01:07:52,643 --> 01:07:56,147
AND ACTUALLY SEE ABOUT WHETHER

1795
01:07:56,147 --> 01:07:57,048
PEOPLE'S EXPERIENCE AFFECTS

1796
01:07:57,048 --> 01:07:59,850
THEIR RESPONSES IN THE LAB.

1797
01:07:59,850 --> 01:08:01,485
SO, WE HAVEN'T BUT I HOPE THAT'S

1798
01:08:01,485 --> 01:08:03,788
SOMETHING WE DO GOING FORWARD.

1799
01:08:03,788 --> 01:08:07,658
THE OTHER QUESTION I WILL JUST

1800
01:08:07,658 --> 01:08:11,462
TALK ABOUT THE LIFESPAN AND

1801
01:08:11,462 --> 01:08:12,163
TRAUMA HISTORY.

1802
01:08:12,163 --> 01:08:15,299
WE'RE NOW INTERESTED IN LOOKING

1803
01:08:15,299 --> 01:08:15,966
AT CHILDHOOD TRAUMA, COLLECTED

1804
01:08:15,966 --> 01:08:19,570
IN THE PAST BUT NOT

1805
01:08:19,570 --> 01:08:21,005
CONSISTENTLY, WE DON'T QUITE

1806
01:08:21,005 --> 01:08:22,440
HAVE THE NUMBERS.

1807
01:08:22,440 --> 01:08:26,610
THERE'S A MEASURE THAT WE, NIDA,

1808
01:08:26,610 --> 01:08:29,780
NIAAA AND NIMH WERE GOING TO USE

1809
01:08:29,780 --> 01:08:31,849
IN HEALTHY VOLUNTEER PROTOCOLS

1810
01:08:31,849 --> 01:08:34,118
TO LOOK SYSTEMATICALLY ABOUT HOW

1811
01:08:34,118 --> 01:08:34,719
CHILDHOOD TRAUMA AFFECTS PAIN,

1812
01:08:34,719 --> 01:08:36,554
ADDICTION, MENTAL HEALTH.

1813
01:08:36,554 --> 01:08:37,988
WE DECIDED THAT IN 2017 I THINK

1814
01:08:37,988 --> 01:08:40,391
AND HAVEN'T COME BACK TOGETHER.

1815
01:08:40,391 --> 01:08:41,826
AND SO WE HAVEN'T LOOKED AT THAT

1816
01:08:41,826 --> 01:08:44,462
ALONE IN THE LAB YET BUT HOPE TO

1817
01:08:44,462 --> 01:08:46,664
IN THE NEXT PHASE OF PAIN

1818
01:08:46,664 --> 01:08:49,400
STUDIES WE'RE DOING.

1819
01:08:49,400 --> 01:08:52,670
AND WITH RESPECT TO LIFESPAN, WE

1820
01:08:52,670 --> 01:08:55,206
WERE SHOCKED THAT WE DIDN'T SEE

1821
01:08:55,206 --> 01:08:57,708
ANY DIFFERENCES BETWEEN USE IN

1822
01:08:57,708 --> 01:08:58,576
ADULTS IN COLLABORATIONS WITH

1823
01:08:58,576 --> 01:09:00,177
DANNY, WE THOUGHT THE PREFRONTAL

1824
01:09:00,177 --> 01:09:03,280
CORTEX WOULD BE NECESSARY FOR

1825
01:09:03,280 --> 01:09:04,081
THIS.

1826
01:09:04,081 --> 01:09:10,721
AND WE ONLY STUDY UP TO 50 OR 60

1827
01:09:10,721 --> 01:09:13,357
TO BETTER TO LOOK AT LIFESPAN

1828
01:09:13,357 --> 01:09:15,659
PERSPECTIVE BUT WE HAVEN'T.

1829
01:09:15,659 --> 01:09:17,428
>> A FANTASTIC TALK,
BRINGING

1830
01:09:17,428 --> 01:09:18,596
THE PSYCHOLOGICAL COMPONENT TO

1831
01:09:18,596 --> 01:09:20,464
PAIN AND JUST THE AMAZING AMOUNT

1832
01:09:20,464 --> 01:09:22,299
OF WORK IN SUCH A SHORT TIME.

1833
01:09:22,299 --> 01:09:24,435
I WANT TO CONGRATULATE YOU ON

1834
01:09:24,435 --> 01:09:28,005
YOUR TENURE AND YOUR TALK TODAY

1835
01:09:28,005 --> 01:09:31,542
AND PLEASE ALL OF US JOIN US IN

1836
01:09:31,542 --> 01:09:33,410
CONGRATULATING DR. LAUREN ATLAS.

1837
01:09:33,410 --> 01:09:48,526
[APPLAUSE] 

1838
01:09:48,526 --> 01:09:58,569