1 00:00:05,520 --> 00:00:10,320 WELCOME TO THIS MEETING OF THE 2 00:00:10,320 --> 00:00:14,840 INTERAGENCY PAIN RESEARCH 3 00:00:14,840 --> 00:00:18,320 COORDINATING COMMITTEE THE 4 00:00:18,320 --> 00:00:19,480 MEETING IS BEING RECORDED. 5 00:00:19,480 --> 00:00:21,440 THIS IS MY FIRST MEETING AS 6 00:00:21,440 --> 00:00:23,480 CHAIR OF THE MEETING SO IT'S MY 7 00:00:23,480 --> 00:00:24,120 GREAT PLEASURE TO WELCOME YOU 8 00:00:24,120 --> 00:00:26,120 ALL. 9 00:00:26,120 --> 00:00:30,400 I ESPECIALLY WANT TO WELCOME ALL 10 00:00:30,400 --> 00:00:31,680 CURRENT AND ALSO SOME POTENTIAL 11 00:00:31,680 --> 00:00:33,560 NEW MEMBERS THAT ARE JOINING US 12 00:00:33,560 --> 00:00:36,320 AND OTHERS WHO MAY BE LISTENING 13 00:00:36,320 --> 00:00:37,280 TO THIS MEETING THROUGH THE NIH 14 00:00:37,280 --> 00:00:40,520 VIDEOCAST. 15 00:00:40,520 --> 00:00:46,200 AND I WANT TO ESPECIALLY GIVE A 16 00:00:46,200 --> 00:00:48,440 BIG THANK YOU TO DR. WALTER 17 00:00:48,440 --> 00:00:50,800 KOROSHETZ FOR HIS LONG SERVICE 18 00:00:50,800 --> 00:00:55,480 AS THE PREVIOUS CHAIR OF THIS 19 00:00:55,480 --> 00:00:56,920 COMMITTEE AND HIS VERY VERY 20 00:00:56,920 --> 00:00:58,600 WELCOME CONTINUED COMMITMENT TO 21 00:00:58,600 --> 00:01:00,600 THE EFFORT AND GOAL OF THE 22 00:01:00,600 --> 00:01:03,240 IRPCC. 23 00:01:03,240 --> 00:01:05,240 JUST A LITTLE BIT OF HISTORY 24 00:01:05,240 --> 00:01:06,640 THAT THE COMMITTEE WAS 25 00:01:06,640 --> 00:01:07,960 ESTABLISHED UNDER THE AFFORDABLE 26 00:01:07,960 --> 00:01:15,920 CARE ACT IN 2010 AND HELD ITS 27 00:01:15,920 --> 00:01:19,120 FIRST MEETING IN 2011. 28 00:01:19,120 --> 00:01:20,920 WHEN DR. LANDIS RETIRED 29 00:01:20,920 --> 00:01:23,680 DR. KOROSHETZ FINISHED THE TERM 30 00:01:23,680 --> 00:01:25,880 AS ACTING CHAIR AND THEN WAS 31 00:01:25,880 --> 00:01:28,200 ELECTED CHAIR AND SO SERVED MORE 32 00:01:28,200 --> 00:01:30,440 THAN TWO FULL TERMS AS THE CHAIR 33 00:01:30,440 --> 00:01:33,360 OF THE COMMITTEE AND UNDER HIS 34 00:01:33,360 --> 00:01:35,240 GUIDE ANSWERS THE COMMITTEE 35 00:01:35,240 --> 00:01:36,240 RELEASED THE NATIONAL PAIN 36 00:01:36,240 --> 00:01:40,320 STRATEGY AND DEVELOPED AND 37 00:01:40,320 --> 00:01:43,240 IMPLEMENTED THE FEDERAL PAIN 38 00:01:43,240 --> 00:01:44,880 RESEARCH STRATEGY BOTH WERE HIGH 39 00:01:44,880 --> 00:01:47,240 PRIORITY RESPONSES TO THE 40 00:01:47,240 --> 00:01:48,720 RECOMMENDATIONS OF THE 2010 41 00:01:48,720 --> 00:01:51,160 INSTITUTE OF MEDICINE REPORT ON 42 00:01:51,160 --> 00:01:53,360 PAIN IN AMERICA. 43 00:01:53,360 --> 00:01:53,920 SO VERY LANDMARK 44 00:01:53,920 --> 00:01:57,120 ACCOMPLISHMENTS. 45 00:01:57,120 --> 00:01:58,960 SO THANK YOU SO MUCH, WALTER. 46 00:01:58,960 --> 00:02:01,320 WE'RE SO GLAD YOU'RE STILL HERE 47 00:02:01,320 --> 00:02:06,320 WITH US AND I'M HONORED TO BE 48 00:02:06,320 --> 00:02:07,840 TAKING THE BATON FROM YOU AND 49 00:02:07,840 --> 00:02:10,280 LOOKING FORWARD TO WHAT WE CAN 50 00:02:10,280 --> 00:02:11,400 ALL DO TOGETHER. 51 00:02:11,400 --> 00:02:15,120 >> WE HAVE A GREAT TEAM AT NIH 52 00:02:15,120 --> 00:02:17,800 NOW SO HELENE, IT'S FUN HAVING 53 00:02:17,800 --> 00:02:18,400 YOU CHAIRING THIS. 54 00:02:18,400 --> 00:02:19,720 THIS IS GREAT. 55 00:02:19,720 --> 00:02:25,160 >> I'M VERY EXCITED. 56 00:02:25,160 --> 00:02:26,840 SO ALSO THANK YOU TO ALL THE 57 00:02:26,840 --> 00:02:30,680 CURRENT MEMBERS, ESPECIALLY 58 00:02:30,680 --> 00:02:32,760 THOSE WHOSE TERMS WERE EXTENDED 59 00:02:32,760 --> 00:02:34,640 TO ALLOW THEM TO ATTEND ME 60 00:02:34,640 --> 00:02:36,040 MEETING WHILE WE WAIT FOR FINAL 61 00:02:36,040 --> 00:02:38,920 APPROVAL OF THE INCOMING 62 00:02:38,920 --> 00:02:39,200 NOMINEES. 63 00:02:39,200 --> 00:02:40,760 SOME OF THESE MEMBERS WILL 64 00:02:40,760 --> 00:02:42,080 RETIRE FROM THEIR THREE-YEAR 65 00:02:42,080 --> 00:02:43,080 PLUS TERM ON THE COMMITTEE AT 66 00:02:43,080 --> 00:02:48,920 THE END OF JANUARY, 2023. 67 00:02:48,920 --> 00:02:51,720 IN ADDITION, A FEW OF THE 68 00:02:51,720 --> 00:02:53,160 EXTENDED MEMBERS ARE ON THE LIST 69 00:02:53,160 --> 00:02:54,640 FOR RE-APPOINTMENT AND SHOULD 70 00:02:54,640 --> 00:02:56,480 HAVE BEEN CONTACTED REGARDING 71 00:02:56,480 --> 00:02:57,600 THEIR ACCEPTANCE FOR A LONGER 72 00:02:57,600 --> 00:03:03,720 STAY WITH THE IRPCC. 73 00:03:03,720 --> 00:03:14,280 NOW I'LL TURN TO LINDA TO CALL 74 00:03:20,160 --> 00:03:21,520 NOW YOU'LL CALL THE ORDER. 75 00:03:21,520 --> 00:03:27,560 >> WE'D LIKE TO START WITH OUR 76 00:03:27,560 --> 00:03:38,080 CURRENT MEMBERS TELL YOU ARE 77 00:03:40,360 --> 00:03:45,640 YOUR NAME AND WHY YOU'RE SERVING 78 00:03:45,640 --> 00:03:56,120 ON THE COMMITTEE AND IF WE'RE 79 00:03:59,400 --> 00:03:59,920 MISSING SOMEBODY WE'LL COME 80 00:03:59,920 --> 00:04:10,000 BACK. 81 00:04:13,000 --> 00:04:23,200 >> WE HAVE BETH. 82 00:04:24,960 --> 00:04:25,080 IRMA. 83 00:04:25,080 --> 00:04:30,320 >> I COME IN FROM A CORPORATE 84 00:04:30,320 --> 00:04:32,600 AND EDUCATIONAL BACKGROUND AND 85 00:04:32,600 --> 00:04:42,320 ROLLED OFF SERVING AS FORMER 86 00:04:42,320 --> 00:04:52,800 CHAIR OF THE INTERCYSTITIS 87 00:04:57,280 --> 00:04:57,480 INSTITUTE. 88 00:04:57,480 --> 00:05:00,320 >> I'M JOSÉ MORON. 89 00:05:00,320 --> 00:05:03,120 I DO RESEARCH ON PAIN MECHANISMS 90 00:05:03,120 --> 00:05:04,840 AND ALSO IN THE INTERACTION 91 00:05:04,840 --> 00:05:05,320 BETWEEN PAIN AND OPIOID 92 00:05:05,320 --> 00:05:09,400 ADDICTION. 93 00:05:09,400 --> 00:05:09,760 >> THANK YOU. 94 00:05:09,760 --> 00:05:14,400 CHRISTINE SANG. 95 00:05:14,400 --> 00:05:14,920 >> HI. 96 00:05:14,920 --> 00:05:19,120 I AM A PEDIATRIC AND ADULT 97 00:05:19,120 --> 00:05:20,600 ANESTHESIOLOGIST AND ACUTE AND 98 00:05:20,600 --> 00:05:22,400 CHRONIC PAIN SPECIALIST IN 99 00:05:22,400 --> 00:05:25,840 BOSTON AT THE BRIGHAM WOMEN'S 100 00:05:25,840 --> 00:05:28,280 HOSPITAL AND ASSOCIATE PROFESSOR 101 00:05:28,280 --> 00:05:32,440 OF ANESTHESIA AT HARVARD MEDICAL 102 00:05:32,440 --> 00:05:34,280 SCHOOL AND AT THE BRIGHAM OUR 103 00:05:34,280 --> 00:05:37,880 FOCUS IS ON THE DESIGN AND 104 00:05:37,880 --> 00:05:39,120 CONDUCT OF INNOVATIVE TRIAL 105 00:05:39,120 --> 00:05:42,680 STRATEGIES TO ACCELERATE THE 106 00:05:42,680 --> 00:05:45,200 CLINICAL DEVELOPMENT OF 107 00:05:45,200 --> 00:05:45,520 ANALGESICS. 108 00:05:45,520 --> 00:05:45,960 THANK YOU. 109 00:05:45,960 --> 00:05:46,560 >> THANK YOU FOR YOUR WORK ON 110 00:05:46,560 --> 00:05:52,720 THIS. 111 00:05:52,720 --> 00:05:53,120 DAVE WILLIAMS. 112 00:05:53,120 --> 00:05:56,240 >> HI, I'M A PSYCHOLOGIST BY 113 00:05:56,240 --> 00:05:58,160 TRAINING AND THE ASSOCIATE 114 00:05:58,160 --> 00:06:00,720 DIRECTOR OF THE CHRONIC PAIN AND 115 00:06:00,720 --> 00:06:02,000 FATIGUE RESEARCH CENTER AT THE 116 00:06:02,000 --> 00:06:03,280 UNIVERSITY OF MICHIGAN WITH WE 117 00:06:03,280 --> 00:06:05,720 LOOK AT PAIN MECHANISMS AS WELL 118 00:06:05,720 --> 00:06:07,680 AS INTERVENTIONS BOTH 119 00:06:07,680 --> 00:06:09,880 PHARMACOLOGIC AND 120 00:06:09,880 --> 00:06:10,480 NON-PHARMACOLOGIC FOR CHRONIC 121 00:06:10,480 --> 00:06:16,360 PAIN. 122 00:06:16,360 --> 00:06:22,240 >> I KNOW WE HAVE SOME NOT ABLE 123 00:06:22,240 --> 00:06:32,520 TO ATTEND TODAY. 124 00:06:33,080 --> 00:06:34,320 AND WE HAVE SUE PINKHAM. 125 00:06:34,320 --> 00:06:40,320 YOU ARE MUTED. 126 00:06:40,320 --> 00:06:43,520 >> I'M THE PRESIDENT OF THE 127 00:06:43,520 --> 00:06:45,080 COALITION AGAINST PEDIATRIC 128 00:06:45,080 --> 00:06:45,280 PAIN. 129 00:06:45,280 --> 00:06:46,960 WE SUPPORT CHILDREN AND FAMILIES 130 00:06:46,960 --> 00:06:47,480 WHO LIVE WIN CHRONIC PAIN 131 00:06:47,480 --> 00:06:50,960 CONDITIONS. 132 00:06:50,960 --> 00:06:52,120 AND I'M IN THE BOSTON AREA. 133 00:06:52,120 --> 00:07:02,440 >> THANK YOU, SUE. 134 00:07:02,920 --> 00:07:07,160 JULIE ELLER. 135 00:07:07,160 --> 00:07:10,360 >> I'M A PATIENT ADVOCATE BY 136 00:07:10,360 --> 00:07:11,960 BACKGROUND AND GREW UP WITH 137 00:07:11,960 --> 00:07:16,080 JUVENILE ARTHRITIS AND 138 00:07:16,080 --> 00:07:17,920 TRANSLATED THAT TO PROFESSIONAL 139 00:07:17,920 --> 00:07:19,360 WORK AND CURRENTLY I'M BASED IN 140 00:07:19,360 --> 00:07:20,200 BOSTON. 141 00:07:20,200 --> 00:07:22,240 SORRY FOR THE BACKGROUND NOISE 142 00:07:22,240 --> 00:07:25,360 I'M AT A LIBRARY AND CURRENT 143 00:07:25,360 --> 00:07:26,880 MASTER STUDENT AT HARVARD CHAN 144 00:07:26,880 --> 00:07:29,240 AND MY FOCUS IS ON PATIENT 145 00:07:29,240 --> 00:07:31,120 ACCESS AND PATIENT ADVOCACY AND 146 00:07:31,120 --> 00:07:32,960 MAKING SURE PATIENTS HAVE A 147 00:07:32,960 --> 00:07:33,840 VOICE IN CONVERSATIONS LIKE 148 00:07:33,840 --> 00:07:34,760 THESE. 149 00:07:34,760 --> 00:07:35,640 THANK YOU FOR HAVING ME. 150 00:07:35,640 --> 00:07:45,920 >> THANKS, JULIE. 151 00:07:49,640 --> 00:07:50,720 TODD VANNERAH. 152 00:07:50,720 --> 00:07:52,440 >> I'M AT THE COLLEGE OF 153 00:07:52,440 --> 00:07:53,560 MEDICINE AT THE UNIVERSITY OF 154 00:07:53,560 --> 00:07:55,560 ARIZONA IN TUCSON, ARIZONA. 155 00:07:55,560 --> 00:07:57,280 ALSO A DIRECTOR OF OUR 156 00:07:57,280 --> 00:07:58,960 COMPREHENSIVE PAIN AND ADDICTION 157 00:07:58,960 --> 00:08:02,000 CENTER AND I'VE WORKED IN THE 158 00:08:02,000 --> 00:08:02,680 AREAS OF CHRONIC PAIN SPECIFIC 159 00:08:02,680 --> 00:08:04,600 AND NEUROPATHIC PAIN AND CANCER 160 00:08:04,600 --> 00:08:08,800 PAIN FOR MANY YEARS LOOKING AT 161 00:08:08,800 --> 00:08:09,520 ALTERNATIVES TO OPIATES FOR 162 00:08:09,520 --> 00:08:11,120 THOSE. 163 00:08:11,120 --> 00:08:12,320 THANK YOU. 164 00:08:12,320 --> 00:08:21,320 >> THANK YOU. 165 00:08:21,320 --> 00:08:27,040 >> I'M FRIEDHELM COMING FROM THE 166 00:08:27,040 --> 00:08:28,160 VETERANS HEALTH ADMINISTRATION I 167 00:08:28,160 --> 00:08:30,560 LEAD A COMPREHENSIVE PAIN 168 00:08:30,560 --> 00:08:30,760 CLINIC. 169 00:08:30,760 --> 00:08:33,120 I'M THE EXECUTIVE DIRECTOR FOR 170 00:08:33,120 --> 00:08:35,880 PAIN MANAGEMENT, OPIATE SAFETY 171 00:08:35,880 --> 00:08:37,480 AND PRESCRIPTION DRUG MONITORING 172 00:08:37,480 --> 00:08:40,120 IN THE V.A. SYSTEM AND IN THIS 173 00:08:40,120 --> 00:08:41,920 WAY OUR EMPHASIS IS CERTAINLY ON 174 00:08:41,920 --> 00:08:46,680 THE FIRST SPECTRUM OF PAIN CARE 175 00:08:46,680 --> 00:08:48,640 AND HEALTH CARE IN GENERAL AND 176 00:08:48,640 --> 00:08:51,080 IN PARTICULAR INTERDISCIPLINARY 177 00:08:51,080 --> 00:08:51,920 PAIN CARE AND OPIATE SAFETY AND 178 00:08:51,920 --> 00:09:01,800 STEWARDSHIP. 179 00:09:01,800 --> 00:09:08,000 >> AND A NOT QUITE BRAND NEW 180 00:09:08,000 --> 00:09:16,440 MEMBER LET'S GO NOW TO ELIZABETH 181 00:09:16,440 --> 00:09:17,480 KATO FOR RESEARCH AND QUALITY. 182 00:09:17,480 --> 00:09:19,360 I'M THE ACTING DEPUTY DIRECTOR 183 00:09:19,360 --> 00:09:21,720 FOR THE CENTER FOR EVIDENCE AND 184 00:09:21,720 --> 00:09:26,520 PRACTICE IMPROVEMENT AND HELP TO 185 00:09:26,520 --> 00:09:30,320 COORDINATE AHRQ'S SUBSTANCE USE 186 00:09:30,320 --> 00:09:40,680 DISORDER ACTIVITIES. 187 00:09:49,160 --> 00:09:56,000 >> I'M RIGO ROCA AND THE AGENDA 188 00:09:56,000 --> 00:09:59,360 HAS ME AS THE CENTER FOR DRUGS 189 00:09:59,360 --> 00:10:00,920 WHICH IS A LITTLE BIT HIGHER UP 190 00:10:00,920 --> 00:10:01,400 IN MANAGEMENT. 191 00:10:01,400 --> 00:10:03,120 I'M JUST AT THE DIVISION LEVEL 192 00:10:03,120 --> 00:10:03,920 WITHIN OAD. 193 00:10:03,920 --> 00:10:12,960 >> THANK YOU VERY MUCH. 194 00:10:12,960 --> 00:10:15,120 WE HAVE WALTER KOROSHETZ. 195 00:10:15,120 --> 00:10:20,360 WOULD YOU LIKE TO SAY ANYTHING 196 00:10:20,360 --> 00:10:30,200 MORE IN GETTING US GOING TODAY? 197 00:10:30,200 --> 00:10:34,240 >> I'M WALTER KOROSHETZ THE 198 00:10:34,240 --> 00:10:40,680 DIRECTOR OF NINDS AND WORKING ON 199 00:10:40,680 --> 00:10:42,040 DEVELOPING BETTER PAIN 200 00:10:42,040 --> 00:10:43,520 MANAGEMENT TOOLS AND PRACTICES 201 00:10:43,520 --> 00:10:47,840 AND THAT INCLUDES THE HEAL 202 00:10:47,840 --> 00:10:53,880 INITIATIVE AND THE NIH PAIN 203 00:10:53,880 --> 00:10:54,200 CONSORTIUM. 204 00:10:54,200 --> 00:11:00,400 VERY VIBRANT GROUP AND VIG RATE 205 00:11:00,680 --> 00:11:06,680 -- INVIGORATED BY THE ARRIVAL 206 00:11:06,680 --> 00:11:12,080 OF HELENE. 207 00:11:12,080 --> 00:11:14,520 >> WE HAVE A LIMITED UNDER OF 208 00:11:14,520 --> 00:11:16,840 WILL HAVE OFFICIALS. 209 00:11:16,840 --> 00:11:27,400 SO WE HAVE SHANNON SANG AND 210 00:11:27,400 --> 00:11:27,600 ZENK. 211 00:11:27,600 --> 00:11:29,400 >> I'M THE DIRECTOR OF NATIONAL 212 00:11:29,400 --> 00:11:30,840 INSTITUTE OF NURSING RESEARCH. 213 00:11:30,840 --> 00:11:36,400 GOOD TO BE WITH YOU. 214 00:11:36,400 --> 00:11:46,880 >> RENA D'SOUZA AND WE HAVE 215 00:11:54,560 --> 00:11:55,280 MELISSA. 216 00:11:55,280 --> 00:11:59,080 >> I'M PROXYING TEMPORARILY FOR 217 00:11:59,080 --> 00:12:04,320 RENA AND I'M THE PROGRAM 218 00:12:04,320 --> 00:12:11,840 DIRECTOR FOR PAIN AT DISORDERS. 219 00:12:11,840 --> 00:12:16,480 >> AND I'M THE DIRECTOR OF 220 00:12:16,480 --> 00:12:16,680 NIAMS. 221 00:12:16,680 --> 00:12:18,040 I'VE BEEN IN THIS ROLE A LITTLE 222 00:12:18,040 --> 00:12:19,480 OVER A YEAR AND A HALF AND 223 00:12:19,480 --> 00:12:21,640 DELIGHTED TO SERVE AS AN 224 00:12:21,640 --> 00:12:24,120 EX-OFFICIO NUMBER AND PAIN IS A 225 00:12:24,120 --> 00:12:27,400 VERY IMPORTANT COMPONENT AND 226 00:12:27,400 --> 00:12:28,720 MANIFESTATION OF MOST THE 227 00:12:28,720 --> 00:12:29,960 CONDITIONS WITHIN THE PORTFOLIO 228 00:12:29,960 --> 00:12:31,080 SO HIGHLY RELEVANT FOR OUR WORK. 229 00:12:31,080 --> 00:12:41,280 THANK YOU. 230 00:12:51,280 --> 00:13:00,680 DO WE HAVE WILL? 231 00:13:00,680 --> 00:13:07,040 LET ME GIVE ONE MORE CALL FOR 232 00:13:07,040 --> 00:13:17,480 CHRISTINE GOERTZ AND BETH 233 00:13:19,760 --> 00:13:25,080 DARNELL. 234 00:13:25,080 --> 00:13:26,680 AHELENE MENTIONED WE HAVE SOME 235 00:13:26,680 --> 00:13:28,920 NEW MEMBERS THAT MAY BE JOINING 236 00:13:28,920 --> 00:13:31,600 IN THE NEAR FUTURE AS OFFICIAL 237 00:13:31,600 --> 00:13:32,080 MEMBERS. 238 00:13:32,080 --> 00:13:34,960 AND HELENE, DID YOU WANT TO 239 00:13:34,960 --> 00:13:37,000 INTRODUCE THEM OR DID YOU WANT 240 00:13:37,000 --> 00:13:38,760 ME TO KEEP GOING? 241 00:13:38,760 --> 00:13:39,200 UP TO YOU. 242 00:13:39,200 --> 00:13:41,680 >> I'D BE HAPPY TO DO THAT. 243 00:13:41,680 --> 00:13:44,240 I ALSO WANT TO MENTION THAT I'VE 244 00:13:44,240 --> 00:13:47,080 HAD THE OPPORTUNITY TO SPEAK 245 00:13:47,080 --> 00:13:50,480 WITH MANY OF YOU ONE-ON-ONE IN 246 00:13:50,480 --> 00:13:52,760 THE LAST COUPLE OF WEEKS AND 247 00:13:52,760 --> 00:13:54,640 IT'S BEEN WONDERFUL TO HEAR 248 00:13:54,640 --> 00:13:57,920 ABOUT YOUR IDEAS, YOUR 249 00:13:57,920 --> 00:13:59,440 REFLECTIONS ON YOUR PAST SERVICE 250 00:13:59,440 --> 00:14:01,360 ON THE IRPCC AND YOUR IDEAS FOR 251 00:14:01,360 --> 00:14:02,120 THE FUTURE. 252 00:14:02,120 --> 00:14:04,480 FOR THOSE OF YOU THAT I HAVE NOT 253 00:14:04,480 --> 00:14:06,160 YESTERDAY HAD A CHANCE TO 254 00:14:06,160 --> 00:14:08,760 SCHEDULE AND WE HAD SOME 255 00:14:08,760 --> 00:14:10,160 SCHEDULING CHALLENGES WITH JUST 256 00:14:10,160 --> 00:14:11,520 A FEW ACTUALLY. 257 00:14:11,520 --> 00:14:14,920 I GOT TO SPEAK WITH MOST OF YOU. 258 00:14:14,920 --> 00:14:18,520 I WANTED TO THANK EVERYBODY FOR 259 00:14:18,520 --> 00:14:20,160 MAKING THE TIME. 260 00:14:20,160 --> 00:14:21,680 IT'S AN IMPORTANT THING FOR ME 261 00:14:21,680 --> 00:14:27,920 TO GET A SENSE OF HOW YOU 262 00:14:27,920 --> 00:14:31,120 INDIVIDUALLY FEEL HOW YOU FEEL 263 00:14:31,120 --> 00:14:32,920 THIS COMMITTEE CAN BE A FORCE 264 00:14:32,920 --> 00:14:33,840 FOR MOVING THE PAIN FIELD 265 00:14:33,840 --> 00:14:34,080 FORWARD. 266 00:14:34,080 --> 00:14:40,600 SO THANK YOU. 267 00:14:40,600 --> 00:14:43,120 AS FAR AS THE NEW POTENTIAL 268 00:14:43,120 --> 00:14:46,240 MEMBERS, I CAN BRIEFLY INTRODUCE 269 00:14:46,240 --> 00:14:50,840 EACH ONE AND ASK THEM TO JUST 270 00:14:50,840 --> 00:14:54,600 SAY A FEW WORDS ABOUT THEIR 271 00:14:54,600 --> 00:14:57,400 THOUGHTS AND ABOUT WHAT THEY DO 272 00:14:57,400 --> 00:15:00,040 AND THEIR AREAS OF INTEREST. 273 00:15:00,040 --> 00:15:01,520 AND WHY THEY'RE INTERESTED IN 274 00:15:01,520 --> 00:15:02,320 THIS COMMITTEE. 275 00:15:02,320 --> 00:15:04,680 SO FIRST, IS KATE NICHOLSON. 276 00:15:04,680 --> 00:15:07,640 THE FOUNDER AND EXECUTIVE 277 00:15:07,640 --> 00:15:09,480 DIRECTOR OF THE NATIONAL PAIN 278 00:15:09,480 --> 00:15:11,760 ADVOCACY CENTER DEDICATED TO 279 00:15:11,760 --> 00:15:13,160 ADVANCING THE HEALTH AND HUMAN 280 00:15:13,160 --> 00:15:16,120 RIGHTS OF PEOPLE IN PAIN. 281 00:15:16,120 --> 00:15:19,800 THE NPAC IS A POLICY FOCUSSED 282 00:15:19,800 --> 00:15:22,080 ALLIANCE OF SCIENTISTS AND 283 00:15:22,080 --> 00:15:24,320 CLINICIANS, CIVIL RIGHTS 284 00:15:24,320 --> 00:15:25,040 ADVOCATES AND PEOPLE WITH LIVED 285 00:15:25,040 --> 00:15:26,680 EXPERIENCE WORKING TO CHANGE THE 286 00:15:26,680 --> 00:15:28,720 MIND SETS, SYSTEMS AND POLICIES 287 00:15:28,720 --> 00:15:31,080 THAT POSE BARRIERS TO THE HEALTH 288 00:15:31,080 --> 00:15:32,520 OF PEOPLE LIVING IN PAIN. 289 00:15:32,520 --> 00:15:36,440 MS. NICHOLSON IS A CIVIL RIGHTS 290 00:15:36,440 --> 00:15:38,560 ATTORNEY AND NATIONALLY 291 00:15:38,560 --> 00:15:39,120 RECOGNIZED EXPERT ON THE 292 00:15:39,120 --> 00:15:40,480 AMERICANS WITH DISABILITIES ACT. 293 00:15:40,480 --> 00:15:41,240 SHE SERVED IN THE 294 00:15:41,240 --> 00:15:43,240 U.S. DEPARTMENT OF JUSTICE FOR 295 00:15:43,240 --> 00:15:45,640 18 YEARS WHERE SHE LITIGATED AND 296 00:15:45,640 --> 00:15:48,400 MANAGED CASES, COORDINATED 297 00:15:48,400 --> 00:15:50,160 FEDERAL DISABILITY POLICY AND 298 00:15:50,160 --> 00:15:51,120 DRAFTED CURRENTS A.D.A. 299 00:15:51,120 --> 00:15:53,720 REGULATIONS. 300 00:15:53,720 --> 00:15:59,040 SO ARE YOU HERE? 301 00:15:59,040 --> 00:16:01,440 >> THANK YOU FOR THAT 302 00:16:01,440 --> 00:16:01,760 INTRODUCTION. 303 00:16:01,760 --> 00:16:04,520 I'M VERY EXCITED TO POTENTIALLY 304 00:16:04,520 --> 00:16:07,360 BE PART OF THIS GROUP. 305 00:16:07,360 --> 00:16:08,760 OBVIOUSLY OUR INTEREST AND PACK 306 00:16:08,760 --> 00:16:13,440 IS IN MOVING PAIN CARE FORWARD 307 00:16:13,440 --> 00:16:14,560 AND THIS COMMITTEE IS A VERY 308 00:16:14,560 --> 00:16:18,360 IMPORTANT ASPECT OF THAT. 309 00:16:18,360 --> 00:16:19,560 SO THANK YOU. 310 00:16:19,560 --> 00:16:20,600 THANK YOU. 311 00:16:20,600 --> 00:16:24,160 THANK YOU FOR JOINING US TODAY. 312 00:16:24,160 --> 00:16:30,920 NEXT IS DR. PAUL ARNESTINE 313 00:16:30,920 --> 00:16:33,000 WORKING TO EXPAND THE CAPACITY 314 00:16:33,000 --> 00:16:35,840 TO PROVIDE OPIOID SPEARING PAIN 315 00:16:35,840 --> 00:16:38,680 CONTROL METHODS ACROSS AGE 316 00:16:38,680 --> 00:16:39,320 GROUPS, DIAGNOSTIC CATEGORIES 317 00:16:39,320 --> 00:16:41,120 AND THE CONTINUUM OF CARE. 318 00:16:41,120 --> 00:16:42,720 HE'S BEEN AN ACTIVE PARTICIPANT 319 00:16:42,720 --> 00:16:44,720 IN NON-PROFIT ORGANIZATIONS 320 00:16:44,720 --> 00:16:46,840 SERVING AS PAST PRESIDENTS FOR 321 00:16:46,840 --> 00:16:50,160 THE NEW HAMPSHIRE CANCER PAIN 322 00:16:50,160 --> 00:16:51,640 INITIATIVE, THE NEW ENGLAND PAIN 323 00:16:51,640 --> 00:16:52,640 SOCIETY AND THE AMERICAN SOCIETY 324 00:16:52,640 --> 00:16:55,320 FOR PAIN MANAGEMENT NURSING. 325 00:16:55,320 --> 00:16:57,480 HE'S SUPPORTED PAST ACTIVITIES 326 00:16:57,480 --> 00:16:59,160 AS A MEMBER OF THE NATIONAL PAIN 327 00:16:59,160 --> 00:17:02,840 STRATEGY WORKING GROUPS. 328 00:17:02,840 --> 00:17:13,200 SO PAUL ARE YOU HERE? 329 00:17:18,760 --> 00:17:24,080 NEXT, DR. MONICA MALANPAWI FROM 330 00:17:24,080 --> 00:17:25,320 THE INSTITUTE OF WOMEN'S HEALTH 331 00:17:25,320 --> 00:17:26,760 STUDY AND EXPERT IN WOMEN'S 332 00:17:26,760 --> 00:17:29,200 HEALTH AND SEX DIFFERENCES AND 333 00:17:29,200 --> 00:17:30,920 ADVOCATE AND THOUGHT LEADER ON 334 00:17:30,920 --> 00:17:32,720 ISSUES PERTAINING TO ALL ASPECTS 335 00:17:32,720 --> 00:17:34,320 OF WOMEN'S HEALTH ACROSS THE 336 00:17:34,320 --> 00:17:35,960 LIFE SPAN. 337 00:17:35,960 --> 00:17:38,480 SHE'S CURRENTLY THE SENIOR 338 00:17:38,480 --> 00:17:41,320 SCIENTIFIC ADVISER AT THE 339 00:17:41,320 --> 00:17:43,120 NON-PROFIT HEALTHY WOMEN WHICH 340 00:17:43,120 --> 00:17:46,320 SHE REPRESENTED AS A MEMBER OF 341 00:17:46,320 --> 00:17:47,640 THE COALITION FOR HEADACHE AND 342 00:17:47,640 --> 00:17:49,920 MIGRAINE PATIENTS AND THE PAST 343 00:17:49,920 --> 00:17:51,760 VICE PRESIDENT OF SCIENTIFIC 344 00:17:51,760 --> 00:17:54,040 AFFAIRS AT THE SOCIETY FOR 345 00:17:54,040 --> 00:18:00,160 WOMEN'S HEALTH RESEARCH. 346 00:18:00,160 --> 00:18:09,760 MONICA. 347 00:18:09,760 --> 00:18:11,040 >> I'M A TRAINED BASIC RESEARCH 348 00:18:11,040 --> 00:18:12,240 AND MOVED INTO SCIENCE AND 349 00:18:12,240 --> 00:18:13,480 HEALTH POLICY AND HAVE BEEN 350 00:18:13,480 --> 00:18:14,520 FOCUSSING ON WOMEN'S HEALTH FROM 351 00:18:14,520 --> 00:18:18,640 THE SEX AND GENDER ANGLE FOR 352 00:18:18,640 --> 00:18:23,160 MANY YEARS NOW AND SO THE PAIN 353 00:18:23,160 --> 00:18:26,280 I'VE BASKETBALL OBSERVING THIS 354 00:18:26,280 --> 00:18:27,520 FOR YEARS NOW AND REALIZE THERE 355 00:18:27,520 --> 00:18:32,600 HASN'T BEEN MUCH FOCUS ON WOMEN 356 00:18:32,600 --> 00:18:35,400 SPECIFICALLY AND IN 2019 I DID A 357 00:18:35,400 --> 00:18:36,600 TWO-DAY CONFERENCE FOCUSSED ON 358 00:18:36,600 --> 00:18:39,600 THE TOPIC OF ELIMINATING CHRONIC 359 00:18:39,600 --> 00:18:45,240 PAIN AND RECEIVED ATTENTION TO 360 00:18:45,240 --> 00:18:52,120 THAT SUBSEQUENTLY. 361 00:18:52,120 --> 00:18:53,600 AND CONTINUING TO FOCUS ON WOMEN 362 00:18:53,600 --> 00:18:54,000 AND CHRONIC PAIN. 363 00:18:54,000 --> 00:19:04,160 THANK YOU. 364 00:19:07,960 --> 00:19:09,400 >> WE REACHED OUT TO IMPORTANT 365 00:19:09,400 --> 00:19:10,520 AREAS WITH PEOPLE WITH 366 00:19:10,520 --> 00:19:14,240 DISABILITIES AND WOMEN ACROSS 367 00:19:14,240 --> 00:19:17,280 THE LIFE SPAN AND WE'RE EXCITED 368 00:19:17,280 --> 00:19:21,200 TO HAVE THIS INPUT AND WE HOPE 369 00:19:21,200 --> 00:19:24,400 ALL OF YOU WILL BE ABLE TO JOIN 370 00:19:24,400 --> 00:19:25,120 US. 371 00:19:25,120 --> 00:19:27,080 NEXT, WE HAVE POTENTIAL NEW 372 00:19:27,080 --> 00:19:29,520 SCIENTIFIC MEMBERS, DR. TAMARA 373 00:19:29,520 --> 00:19:31,320 BAKER WHO I DON'T THINK IS ABLE 374 00:19:31,320 --> 00:19:33,520 TO ATTEND TODAY, RIGHT, LINDA? 375 00:19:33,520 --> 00:19:34,840 BUT I CAN TELL YOU A LITTLE BIT 376 00:19:34,840 --> 00:19:35,560 ABOUT HER. 377 00:19:35,560 --> 00:19:37,120 SHE'S A PROFESSOR OF PSYCHIATRY 378 00:19:37,120 --> 00:19:39,120 AT THE UNIVERSITY OF NORTH 379 00:19:39,120 --> 00:19:40,680 CAROLINA CHAPEL HILL. 380 00:19:40,680 --> 00:19:42,280 SHE'S KNOWN INTERNATIONALLY FOR 381 00:19:42,280 --> 00:19:43,440 WORK ON RACIAL DIFFERENCES IN 382 00:19:43,440 --> 00:19:46,200 PAIN IN OLDER ADULTS. 383 00:19:46,200 --> 00:19:48,640 SHE'S ON THE EDITORIAL BOARDS OF 384 00:19:48,640 --> 00:19:49,760 SEVERAL MAJOR SCIENTIFIC 385 00:19:49,760 --> 00:19:53,240 JOURNALS AND IS CHAIR OF 386 00:19:53,240 --> 00:19:54,320 GERONTOLOGICAL SOCIETY OF 387 00:19:54,320 --> 00:19:55,680 AMERICA BEHAVIORAL AND SOCIAL 388 00:19:55,680 --> 00:19:56,440 SCIENCE SECTION. 389 00:19:56,440 --> 00:19:59,080 DR. BAKER'S WORK FOCUSES ON 390 00:19:59,080 --> 00:20:00,400 UNDERSTANDING FACTORS THAT 391 00:20:00,400 --> 00:20:01,840 INFLUENCE HEALTH OUTCOMES AND 392 00:20:01,840 --> 00:20:03,160 WELCOME BACK OF WELL BEING AMONG 393 00:20:03,160 --> 00:20:04,840 OLDER ADULTS AND ADDRESSING 394 00:20:04,840 --> 00:20:06,960 ISSUES OF EQUALITIES AND EQUITY 395 00:20:06,960 --> 00:20:11,560 AMONG OLDER AUTO DIFFICULTS. 396 00:20:11,560 --> 00:20:15,760 NEXT IS A PEDIATRIC CLINICAL 397 00:20:15,760 --> 00:20:19,080 NURSE SPECIALIST IN 398 00:20:19,080 --> 00:20:20,720 ANESTHESIOLOGY IN NURSING 399 00:20:20,720 --> 00:20:22,600 RESEARCH AT THE CHURNS HOSPITAL 400 00:20:22,600 --> 00:20:24,120 OF CHICAGO. 401 00:20:24,120 --> 00:20:31,640 SHE'S ASSOCIATE PROFESSOR OF 402 00:20:31,640 --> 00:20:31,920 PEDIATRICS. 403 00:20:31,920 --> 00:20:36,520 HER RESEARCH AND ASSESSING AND 404 00:20:36,520 --> 00:20:37,760 TREATING CHILDREN'S PAIN 405 00:20:37,760 --> 00:20:39,080 ESPECIALLY THOSE WITH 406 00:20:39,080 --> 00:20:40,320 COMMUNICATION LIMITATIONS. 407 00:20:40,320 --> 00:20:41,760 SHE'S BEEN AN ADVOCATE FOR 408 00:20:41,760 --> 00:20:42,960 IMPROVING DISSEMINATION OF 409 00:20:42,960 --> 00:20:43,560 RESEARCH AND TRAINING 410 00:20:43,560 --> 00:20:47,120 INFORMATION TO IMPROVE THE CARE 411 00:20:47,120 --> 00:20:54,600 OF CHILDREN WITH PAIN. 412 00:20:54,600 --> 00:20:55,760 >> SORRY I'M LATE THANK YOU FOR 413 00:20:55,760 --> 00:20:57,200 THAT INTRODUCTION AND SO HAPPY 414 00:20:57,200 --> 00:21:02,280 TO BE ABLE TO JOIN YOU TODAY. 415 00:21:02,280 --> 00:21:04,560 >> THANK YOU FOR JOINING US. 416 00:21:04,560 --> 00:21:08,520 NEXT DR. SCOTT FISHMAN PE 417 00:21:08,520 --> 00:21:11,120 ENDOWED CHAIR PROFESSOR OF 418 00:21:11,120 --> 00:21:12,600 ANESTHESIOLOGY AND PSYCHIATRY AT 419 00:21:12,600 --> 00:21:14,480 U.S. DAVIS AND EXECUTIVE VICE 420 00:21:14,480 --> 00:21:16,400 CHAIR FOR THE DEPARTMENT OF 421 00:21:16,400 --> 00:21:16,720 PHYSIOLOGY. 422 00:21:16,720 --> 00:21:19,600 ALSO THE DIRECTOR OF THE CENTER 423 00:21:19,600 --> 00:21:23,760 FOR ADVANCING PAIN AT U.C. 424 00:21:23,760 --> 00:21:24,320 DAVIS. 425 00:21:24,320 --> 00:21:25,280 HAD HAS INITIATIVES FOR THE 426 00:21:25,280 --> 00:21:28,200 NATIONAL ACADEMY OF MEDICINE 427 00:21:28,200 --> 00:21:30,880 PARTICIPATED IN MAJOR 428 00:21:30,880 --> 00:21:34,480 INITIATIVES AND THE STATE BOARDS 429 00:21:34,480 --> 00:21:39,680 AND LICENSURE EXAMINATION. 430 00:21:39,680 --> 00:21:40,960 HE'S RECOGNIZED IN EFFORTS TO 431 00:21:40,960 --> 00:21:42,720 EDUCATE PRIMARY CARE PROVIDERS 432 00:21:42,720 --> 00:21:45,120 AND TRAINEES TO IMPROVE THE 433 00:21:45,120 --> 00:21:53,160 FIELD OF PAIN MANAGEMENT. 434 00:21:53,160 --> 00:21:55,960 >> I DON'T THINK HE'S ON. 435 00:21:55,960 --> 00:21:57,400 WE'LL PERHAPS CATCH UP WITH HIM 436 00:21:57,400 --> 00:21:59,000 LATER. 437 00:21:59,000 --> 00:22:00,080 I RAN THROUGH THE LIST AND 438 00:22:00,080 --> 00:22:05,480 SKIPPED A NAME A VERY IMPORTANT 439 00:22:05,480 --> 00:22:06,840 PERSON. 440 00:22:06,840 --> 00:22:10,840 M 441 00:22:10,840 --> 00:22:12,320 MAGGIE BUCKLEY IS ON. 442 00:22:12,320 --> 00:22:13,480 >> I'M IN CALIFORNIA. 443 00:22:13,480 --> 00:22:17,120 IT'S VERY EARLY HERE. 444 00:22:17,120 --> 00:22:19,360 I'M BOARD CERTIFIED PATIENT 445 00:22:19,360 --> 00:22:20,040 ADVOCATE. 446 00:22:20,040 --> 00:22:23,120 I'VE BEEN ADVOCATING FOR ACCESS 447 00:22:23,120 --> 00:22:26,960 TO COMPREHENSIVE INTEGRATIVE 448 00:22:26,960 --> 00:22:29,600 PAIN MANAGEMENT FOR CLOSE TO 35 449 00:22:29,600 --> 00:22:29,800 YEARS. 450 00:22:29,800 --> 00:22:35,400 I CURRENTLY VOLUNTEER WITH THE 451 00:22:35,400 --> 00:22:38,320 ANDLER SOCIETY AND BOARD OF THE 452 00:22:38,320 --> 00:22:39,600 DIRECTORS OF THE PAIN COMMUNITY 453 00:22:39,600 --> 00:22:41,560 AND WE'RE THE SPONSOR FOR THE 454 00:22:41,560 --> 00:22:44,480 ALLIANCE TO ADVANCE 455 00:22:44,480 --> 00:22:47,080 COMPREHENSIVE INTEGRATIVE PAIN 456 00:22:47,080 --> 00:22:49,840 MANAGEMENT AND MANY OF YOU HAVE 457 00:22:49,840 --> 00:22:55,520 PARTICIPATED IN EVENTS WITH THAT 458 00:22:55,520 --> 00:22:56,960 AND MAY HAVE BEEN ON THE 459 00:22:56,960 --> 00:22:57,360 ADVISORY COUNCIL. 460 00:22:57,360 --> 00:23:07,520 THANK YOU. 461 00:23:09,600 --> 00:23:11,640 >> I THINK WE HAVE COVERED 462 00:23:11,640 --> 00:23:12,320 EVERYONE. 463 00:23:12,320 --> 00:23:14,480 SO HELENE, IF I CAN MOVE INTO 464 00:23:14,480 --> 00:23:15,080 THE MINUTES ARE WE ALL SET? 465 00:23:15,080 --> 00:23:21,200 >> YES. 466 00:23:21,200 --> 00:23:23,400 >> THE CURRENT OFFICIAL MEMBERS 467 00:23:23,400 --> 00:23:27,200 ARE ASKED TO REVIEW AND LOOK AT 468 00:23:27,200 --> 00:23:28,680 THE MEETING MINUTES FROM OUR 469 00:23:28,680 --> 00:23:31,520 PRIOR MEETING EACH TIME WE MEET. 470 00:23:31,520 --> 00:23:33,560 AND SO THEY WERE DISTRIBUTED TO 471 00:23:33,560 --> 00:23:37,640 YOU A FEW DAYS OR SO BACK. 472 00:23:37,640 --> 00:23:39,640 AND HOPEFULLY YOU HAD A LITTLE 473 00:23:39,640 --> 00:23:41,440 BIT OF TIME TO LOOK THROUGH THEM 474 00:23:41,440 --> 00:23:42,680 AND MAKE SURE EVERYTHING LOOKED 475 00:23:42,680 --> 00:23:42,880 OKAY. 476 00:23:42,880 --> 00:23:44,960 THE MEETING WAS RECORDED SO IF 477 00:23:44,960 --> 00:23:46,720 YOU WANT TO GO BACK TO IT HAVE 478 00:23:46,720 --> 00:23:50,680 YOU NOT ONLY THE MINUTES BUT 479 00:23:50,680 --> 00:23:51,400 RECORDING OF THE MEETING. 480 00:23:51,400 --> 00:23:53,280 WHAT I'D LIKE TO DO NOW, WE NEED 481 00:23:53,280 --> 00:23:59,200 AN OFFICIAL VOTE TO APPROVE THE 482 00:23:59,200 --> 00:24:02,560 MEETING MINUTES OR TO REVIEW AND 483 00:24:02,560 --> 00:24:03,760 REVISE THEM IF ANNIVERSARY. 484 00:24:03,760 --> 00:24:04,960 IF YOU'VE ALL HAD A CHANCE TO 485 00:24:04,960 --> 00:24:06,720 LOOK AT THEM AND WILLING TO VOTE 486 00:24:06,720 --> 00:24:09,120 AT THIS POINT, THESE ARE 487 00:24:09,120 --> 00:24:13,040 OFFICIAL MEMBERS. 488 00:24:13,040 --> 00:24:15,720 IF SOMEONE WOULDN'T MIND MAKING 489 00:24:15,720 --> 00:24:20,680 A MOTION TO APPROVE OR COMMENTS 490 00:24:20,680 --> 00:24:21,680 THAT ON ANYTHING THAT NEED TO BE 491 00:24:21,680 --> 00:24:30,640 REVISED. 492 00:24:30,640 --> 00:24:32,160 >> I'M MAKE A MOTION WE APPROVE 493 00:24:32,160 --> 00:24:33,120 THE MINUTES. 494 00:24:33,120 --> 00:24:35,000 >> THANK YOU, MAGGIE. 495 00:24:35,000 --> 00:24:35,560 >> I'LL SECOND. 496 00:24:35,560 --> 00:24:40,520 >> ANY DISCUSSION OR REVIEWS 497 00:24:40,520 --> 00:24:42,120 NEEDED ? 498 00:24:42,120 --> 00:24:44,520 TODD HAS SECONDED IT. 499 00:24:44,520 --> 00:24:51,040 I THINK I CAN SEE THE QUORUM ON 500 00:24:51,040 --> 00:24:53,280 ANY SCREEN SO IF YOU CAN RAISE 501 00:24:53,280 --> 00:25:03,800 HANDS WE'LL MAKE THIS SIMPLE. 502 00:25:24,200 --> 00:25:26,040 >> WE RECEIVED A REPORT ON THE 503 00:25:26,040 --> 00:25:28,400 NEW BILLING CODES AND EMBEDDED 504 00:25:28,400 --> 00:25:34,240 IN THE 330 PAGE REPORT IS A 505 00:25:34,240 --> 00:25:34,960 SECTION ON CHRONIC PAIN 506 00:25:34,960 --> 00:25:35,840 MANAGEMENT. 507 00:25:35,840 --> 00:25:40,520 I THINK THIS IS A DOCUMENT THAT 508 00:25:40,520 --> 00:25:43,360 WILL BE VERY IMPORTANT. 509 00:25:43,360 --> 00:25:46,360 IT REVIEWS A LOT OF IMPORTANT 510 00:25:46,360 --> 00:25:49,760 MEANS OF MOVING TOWARDS MORE 511 00:25:49,760 --> 00:25:50,400 INTEGRATED COORDINATED CHRONIC 512 00:25:50,400 --> 00:25:51,800 PAIN CARE AND REIMBURSEMENT 513 00:25:51,800 --> 00:25:55,680 STRATEGIES HOW TO DO THAT ON THE 514 00:25:55,680 --> 00:25:58,080 PART OF CENTERS FOR MEDICAID AND 515 00:25:58,080 --> 00:26:01,080 MEDICARE. 516 00:26:01,080 --> 00:26:05,200 IT'S IN PART RESPONSE TO THE 517 00:26:05,200 --> 00:26:06,480 TODD GRAHAM BILL AND WE WERE 518 00:26:06,480 --> 00:26:07,720 FORTUNATE TO WORK WITH THEM. 519 00:26:07,720 --> 00:26:11,640 THERE WAS A PARTNERSHIP BETWEEN 520 00:26:11,640 --> 00:26:17,880 NIH AND CMS WHERE WE HAD A TINY 521 00:26:17,880 --> 00:26:21,560 ROLE IN THAT REPORT BUT WE 522 00:26:21,560 --> 00:26:25,560 HELPED WITH THEM A RESOURCE TOOL 523 00:26:25,560 --> 00:26:27,320 FOR PAIN CARE PROVIDERS WHERE 524 00:26:27,320 --> 00:26:30,280 THEY CAN GO TO A WEBSITE WE 525 00:26:30,280 --> 00:26:35,400 POSTED ON OUR PAIN CONSORTIUM 526 00:26:35,400 --> 00:26:38,080 PAGE TO LOOK AT GRADING TOOLS 527 00:26:38,080 --> 00:26:39,080 THAT WOULD BE MOST APPROPRIATE 528 00:26:39,080 --> 00:26:45,880 FOR THEM TO ASSESS PAIN IN THEIR 529 00:26:45,880 --> 00:26:46,160 OFFICE. 530 00:26:46,160 --> 00:26:51,000 IT'S A LIST OF LOW TIME BURDEN 531 00:26:51,000 --> 00:26:53,320 AND RELEVANT SCREENING TOOLS 532 00:26:53,320 --> 00:26:55,680 THAT COULD BE USED FAIRLY 533 00:26:55,680 --> 00:26:59,000 QUICKLY, FAIRLY EASILY AND TO 534 00:26:59,000 --> 00:27:00,880 SOME EXTENT COULD BE PAIN 535 00:27:00,880 --> 00:27:04,640 CONDITION SPECIFIC IF THOSE 536 00:27:04,640 --> 00:27:13,760 VALIDATED AND NON-COPYRIGHTED 537 00:27:13,760 --> 00:27:15,080 RULES ARE AVAILABLE AND WE 538 00:27:15,080 --> 00:27:17,600 WORKED CLOSELY TO MAKE IT 539 00:27:17,600 --> 00:27:18,760 MEANINGFUL TO THE COMMUNITY. 540 00:27:18,760 --> 00:27:21,640 THE INTENT IS TO CONTINUE TO ADD 541 00:27:21,640 --> 00:27:27,520 NEW SCREENING TOOLS AS WE GET 542 00:27:27,520 --> 00:27:31,000 FEEDBACK FROM THE USERS OR THEY 543 00:27:31,000 --> 00:27:34,280 ARE VALIDATED AND SOME FOLKS ON 544 00:27:34,280 --> 00:27:39,040 THE CALL HELPED WITH ONE AND WE 545 00:27:39,040 --> 00:27:42,960 HAD A SCREENER FOR THAT. 546 00:27:42,960 --> 00:27:44,280 I'LL PUT THE LINK IN THE CHAT 547 00:27:44,280 --> 00:27:46,240 AND WE CAN MAIL THAT OUT LATER 548 00:27:46,240 --> 00:27:46,800 AS WELL. 549 00:27:46,800 --> 00:27:49,880 SO THERE'S A LINK TO THE REPORT. 550 00:27:49,880 --> 00:27:51,920 IT'S 330 PAGES. 551 00:27:51,920 --> 00:27:54,040 THE PAIN COMPONENT STARTS ON 552 00:27:54,040 --> 00:27:54,800 PAGE 410. 553 00:27:54,800 --> 00:27:58,840 YOU DON'T HAVE TO READ THROUGH 554 00:27:58,840 --> 00:28:02,360 THE ENTIRE 3300 PAGES. 555 00:28:02,360 --> 00:28:05,200 WE'LL ALSO SEND THE LINK TO THE 556 00:28:05,200 --> 00:28:05,880 WEBSITE AND WOULD MOST 557 00:28:05,880 --> 00:28:08,280 APPRECIATE ESPECIALLY THOSE WHO 558 00:28:08,280 --> 00:28:11,480 SEE PATIENTS, ARE IN CLINICS 559 00:28:11,480 --> 00:28:16,880 WOULD HAVE A LOOK AT THEM AND 560 00:28:16,880 --> 00:28:18,920 SEE IF WE ARE PERHAPS MISSING 561 00:28:18,920 --> 00:28:19,760 CRUCIAL SCREENING TOOLS YOU 562 00:28:19,760 --> 00:28:22,280 THINK WOULD BE HELPFUL FOR PAIN 563 00:28:22,280 --> 00:28:24,520 ASSESSMENT IN CLINICAL SETTINGS. 564 00:28:24,520 --> 00:28:27,080 ALL FEEDBACK WOULD BE MOST 565 00:28:27,080 --> 00:28:27,360 APPRECIATED. 566 00:28:27,360 --> 00:28:28,720 AS I SAID, THIS IS A LIVING 567 00:28:28,720 --> 00:28:30,040 DOCUMENT AND WE WANT TO BE ABLE 568 00:28:30,040 --> 00:28:32,360 TO MAKE IT AS USEFUL AND HELPFUL 569 00:28:32,360 --> 00:28:34,800 TO PROVIDERS AS WE CAN. 570 00:28:34,800 --> 00:28:37,920 IT'S BEEN REALLY NICE WORKING 571 00:28:37,920 --> 00:28:41,640 WITH CMS AND BEING ABLE TO ADD A 572 00:28:41,640 --> 00:28:43,280 LITTLE BIT TO THAT REPORT. 573 00:28:43,280 --> 00:28:47,040 MORE TO COME ON THAT BUT KEEP AN 574 00:28:47,040 --> 00:28:49,880 EYE ON THE SAT AND I'LL SEND A 575 00:28:49,880 --> 00:28:50,720 LINK MOMENTARILY. 576 00:28:50,720 --> 00:28:53,080 GIVEN THAT, LET'S MOVE TO OUR 577 00:28:53,080 --> 00:28:59,080 FEDERAL MEMBER UPDATES AND IF WE 578 00:28:59,080 --> 00:29:09,600 CAN START WITH DR. SANDBRINK. 579 00:29:15,120 --> 00:29:17,160 >> THREW FOR GIVING US THE 580 00:29:17,160 --> 00:29:19,520 OPPORTUNITY TO TALK ABOUT OUR 581 00:29:19,520 --> 00:29:21,760 CLINICAL PRACTICE GUIDELINE THE 582 00:29:21,760 --> 00:29:24,520 NEW ONE WE JUST ISSUED IN THE 583 00:29:24,520 --> 00:29:26,000 V.A. WITH OUR DOD COLLEAGUES 584 00:29:26,000 --> 00:29:29,080 ABOUT THE USE OF OPIOIDS IN THE 585 00:29:29,080 --> 00:29:29,920 MANAGEMENT OF CHRONIC PAIN OR 586 00:29:29,920 --> 00:29:35,320 OPIATE THERAPY FOR CHRONIC PAIN 587 00:29:35,320 --> 00:29:39,280 AND SPECIFICALLY FOR THE USE OF 588 00:29:39,280 --> 00:29:45,280 BUPRENORPHINE INSTEAD OF FULL 589 00:29:45,280 --> 00:29:49,520 AGONIST OPIOID FOR CHRONIC PAIN. 590 00:29:49,520 --> 00:29:50,400 IN REGARD TO THE CLINICAL 591 00:29:50,400 --> 00:29:51,880 PRACTICE GUIDELINE IN GENERAL 592 00:29:51,880 --> 00:29:55,480 THE V.A. WITH THE DOD ISSUES A 593 00:29:55,480 --> 00:29:56,480 LARGE NUMBER OF CLINICAL 594 00:29:56,480 --> 00:29:58,920 PRACTICE GUIDELINE LISTED ON THE 595 00:29:58,920 --> 00:30:02,120 BOTTOM OF THE SCREEN ON THE 596 00:30:02,120 --> 00:30:04,320 HEALTH QUALITY SIDE. 597 00:30:04,320 --> 00:30:07,320 THEY PROVIDED THE EVIDENCE 598 00:30:07,320 --> 00:30:07,640 REVIEW. 599 00:30:07,640 --> 00:30:10,200 IT'S A STANDARD PROCESS THE GOAL 600 00:30:10,200 --> 00:30:12,520 IS OF COURSE TO BE 601 00:30:12,520 --> 00:30:13,440 PATIENT-CENTERED, TO BE IN 602 00:30:13,440 --> 00:30:17,560 SUPPORT OF WHAT CLINICIANS DO 603 00:30:17,560 --> 00:30:19,000 AND KEEPING SAFETY AND CLINICAL 604 00:30:19,000 --> 00:30:20,480 OUTCOMES IN MIND. 605 00:30:20,480 --> 00:30:23,920 ON THE NEXT SLIDE JUST A LITTLE 606 00:30:23,920 --> 00:30:25,400 BIT MORE ABOUT OUR SPECIFIC 607 00:30:25,400 --> 00:30:27,280 GUIDELINE THAT WE'RE TALKING 608 00:30:27,280 --> 00:30:29,880 ABOUT THE USE OF OPIOIDS IN THE 609 00:30:29,880 --> 00:30:31,200 MANAGEMENT OF CHRONIC PAIN. 610 00:30:31,200 --> 00:30:32,840 THE PREVIOUS VERSION WAS IN 2017 611 00:30:32,840 --> 00:30:36,960 SO THIS IS AN UPDATE THAT HAS 612 00:30:36,960 --> 00:30:42,560 EVIDENCE TO APRIL 2021. 613 00:30:42,560 --> 00:30:45,200 THE PROJECT HERE WITH THE DOD 614 00:30:45,200 --> 00:30:48,000 AND DR. MURPHY, IS MY COLLEAGUE. 615 00:30:48,000 --> 00:30:50,480 THOSE ARE SPECIFICALLY 616 00:30:50,480 --> 00:30:52,400 RECOGNIZED HERE AND I DON'T TO 617 00:30:52,400 --> 00:30:53,880 GO THROUGH THE CPG PROCESS. 618 00:30:53,880 --> 00:30:55,400 IT'S A STANDARD PROCESS IN MANY 619 00:30:55,400 --> 00:30:58,800 WAYS BUT WE DID DEVELOP KEY 620 00:30:58,800 --> 00:31:01,800 QUESTIONS WE HAD AND STAKEHOLDER 621 00:31:01,800 --> 00:31:02,760 INPUT IN PARTICULAR FROM PATIENT 622 00:31:02,760 --> 00:31:04,000 GROUPS AND THERE'S A FOCUS GROUP 623 00:31:04,000 --> 00:31:05,720 FOR PATIENTS AND THE GUIDELINE 624 00:31:05,720 --> 00:31:10,440 PROCESS IS OUTLINED HERE. 625 00:31:10,440 --> 00:31:12,840 I HAVE A FEW SLIDES THAT HAVE 626 00:31:12,840 --> 00:31:16,640 THE ACTUAL RECOMMENDATIONS IN 627 00:31:16,640 --> 00:31:17,080 HERE. 628 00:31:17,080 --> 00:31:18,960 WE HAVE A TOTAL. 629 00:31:18,960 --> 00:31:22,760 THE FIRST SIX ARE ABOUT 630 00:31:22,760 --> 00:31:26,480 INITIATION AND CONTINUATION OF 631 00:31:26,480 --> 00:31:26,720 OPIOIDS. 632 00:31:26,720 --> 00:31:29,800 AND THE FIRST ONE I THINK SETS 633 00:31:29,800 --> 00:31:33,280 THE STAGE WHICH IS WE RECOMMEND 634 00:31:33,280 --> 00:31:36,480 AGAINST THE INITIATION OF OPIOID 635 00:31:36,480 --> 00:31:39,320 THERAPY FOR THE MANAGEMENT OF 636 00:31:39,320 --> 00:31:40,320 CHRONIC NON-CANCER PAIN. 637 00:31:40,320 --> 00:31:41,960 I WANT TO MAKE SURE PEOPLE 638 00:31:41,960 --> 00:31:43,560 INTERPRET THIS DIRECTLY IN THE 639 00:31:43,560 --> 00:31:47,120 SENSE THIS IS ABOUT NOT STARTING 640 00:31:47,120 --> 00:31:49,360 NEW PATIENTS ON OPIOID THERAPY 641 00:31:49,360 --> 00:31:52,720 AND SPECIFICALLY FOR CHRONIC 642 00:31:52,720 --> 00:31:53,000 PAIN. 643 00:31:53,000 --> 00:31:54,800 WE'RE NOTE TALKING ABOUT AN 644 00:31:54,800 --> 00:31:56,880 ACUTE EXACERBATION OF PAIN OR 645 00:31:56,880 --> 00:32:00,160 PATIENTS ALREADY ON OPIOID 646 00:32:00,160 --> 00:32:00,720 MEDICATION. 647 00:32:00,720 --> 00:32:01,600 I'LL GIVE BACKGROUND ABOUT THIS 648 00:32:01,600 --> 00:32:04,480 AND WHY WE CAME TO THIS 649 00:32:04,480 --> 00:32:08,400 CONCLUSION AS WE DISCUSS THE 650 00:32:08,400 --> 00:32:14,200 BUPRENORPHINE IN PARTICULAR. 651 00:32:14,200 --> 00:32:18,040 CLEARLY IT RECOMMENDS AGAINST 652 00:32:18,040 --> 00:32:19,040 LONG-TERM OPIOID THERAPY FOR 653 00:32:19,040 --> 00:32:20,800 YOUNGER GROUPS AND FOR THOSE 654 00:32:20,800 --> 00:32:23,200 WITH SUBSTANCE USE DISORDER AND 655 00:32:23,200 --> 00:32:25,280 WE HAVE THIS ON HERE. 656 00:32:25,280 --> 00:32:34,280 THIS IS WHERE THE TWO 657 00:32:34,280 --> 00:32:35,600 BUPRENORPHINE RECOMMENDATIONS 658 00:32:35,600 --> 00:32:37,680 FOUR IS ABOUT PATIENT WHO'S 659 00:32:37,680 --> 00:32:40,560 RECEIVE MEDICATION FOR 660 00:32:40,560 --> 00:32:41,760 BUPRENORPHINE AND INSUFFICIENT 661 00:32:41,760 --> 00:32:43,640 RECOMMENDATION TO RECOMMEND 662 00:32:43,640 --> 00:32:49,440 AGAINST METHADONE BUPRENORPHINE 663 00:32:49,440 --> 00:32:53,000 OR NA TREXONE AND TRYING TO FIND 664 00:32:53,000 --> 00:32:54,640 IF ONE MEDICATION WOULD BE 665 00:32:54,640 --> 00:32:57,800 PREFERRED AS WE TREAT PATIENTS 666 00:32:57,800 --> 00:33:00,360 WHO HAVE ON THE REGIMENT FOR 667 00:33:00,360 --> 00:33:04,000 OPIOID USE DISORDER AND 668 00:33:04,000 --> 00:33:14,440 CONFIRMED AND FOR PATIENTS 669 00:33:23,160 --> 00:33:30,360 RECEIVING DAILY BUPRENORPHINE WE 670 00:33:30,360 --> 00:33:34,240 SUGGEST THIS RATIONALE AND WHAT 671 00:33:34,240 --> 00:33:35,560 WE'RE TRYING TO EMPHASIZE. 672 00:33:35,560 --> 00:33:36,520 I THINK THE OTHER 673 00:33:36,520 --> 00:33:37,040 RECOMMENDATIONS WE CAN GO 674 00:33:37,040 --> 00:33:40,800 THROUGH THIS FAST. 675 00:33:40,800 --> 00:33:47,880 ONE IS ABOUT OPIOID 676 00:33:47,880 --> 00:33:49,880 BENZODIAZEPINE RECOMMENDTION AND 677 00:33:49,880 --> 00:33:51,600 OWE NEXT IS ABOUT THE DOSE, 678 00:33:51,600 --> 00:33:52,120 DURATION AND TAPERING OF 679 00:33:52,120 --> 00:34:02,280 OPIOIDS. 680 00:34:05,360 --> 00:34:07,760 WE HAVE THE SHORTEST DURATION 681 00:34:07,760 --> 00:34:09,600 AND RE-EVALUATION WHEN 682 00:34:09,600 --> 00:34:11,800 CONSIDERING AN INCREASE IN 683 00:34:11,800 --> 00:34:13,000 DOSAGE AND VARIATION AFTER 30 684 00:34:13,000 --> 00:34:13,920 DAYS AFTER YOU START THE OPIOID 685 00:34:13,920 --> 00:34:24,080 THERAPY. 686 00:34:25,480 --> 00:34:26,760 THIS IS AGAINST THE 687 00:34:26,760 --> 00:34:27,800 RECOMMENDATION AGAINST LONG 688 00:34:27,800 --> 00:34:30,440 ACTING OPIOID FOR ACUTE PAIN 689 00:34:30,440 --> 00:34:34,280 AS-NEEDED MEDICATION AND WHEN 690 00:34:34,280 --> 00:34:35,760 YOU INITIATE LONG-TERM THERAPY 691 00:34:35,760 --> 00:34:37,480 AND WHEN IT COMES TAPERING, 692 00:34:37,480 --> 00:34:40,400 THERE'S A CONTINUATION OF WHAT 693 00:34:40,400 --> 00:34:44,320 WE HAD RECOMMENDED IN 2017. 694 00:34:44,320 --> 00:34:45,800 THAT PATIENT WHO ARE BEING 695 00:34:45,800 --> 00:34:47,160 CONSIDERED FOR OPIOID TAPERING, 696 00:34:47,160 --> 00:34:50,600 THIS IS DONE IN A 697 00:34:50,600 --> 00:34:55,080 COLLABORATIVE-PATIENT-CENTERED 698 00:34:55,080 --> 00:34:56,120 APPROACH BUT THERE'S NO 699 00:34:56,120 --> 00:34:58,200 SUFFICIENT EVIDENCE TO RECOMMEND 700 00:34:58,200 --> 00:34:59,440 FOR OR AGAINST ANY SPECIFIC 701 00:34:59,440 --> 00:35:01,000 TAPERING STRATEGIES. 702 00:35:01,000 --> 00:35:06,920 AND THE LAST SLIDE AND THIS IS 703 00:35:06,920 --> 00:35:12,080 ABOUT MORE ABOUT SCREENING, 704 00:35:12,080 --> 00:35:14,800 ASSESSMENT AND EVALUATION, YOU 705 00:35:14,800 --> 00:35:16,200 SEE THE ASSESSMENT FOR 706 00:35:16,200 --> 00:35:17,080 BEHAVIORAL HEALTH CONDITIONS. 707 00:35:17,080 --> 00:35:22,600 I'M NOT GOING TO READ THIS OUT 708 00:35:22,600 --> 00:35:27,960 BUT PAIN CATASTROPHIZING AND THE 709 00:35:27,960 --> 00:35:29,760 RISKS ARE LISTED HERE. 710 00:35:29,760 --> 00:35:32,360 AND THE LAST SLIDE WE DO 711 00:35:32,360 --> 00:35:35,360 RECOMMEND IN REGARD TO RISK 712 00:35:35,360 --> 00:35:37,200 MITIGATION STRATEGIES AND DRUG 713 00:35:37,200 --> 00:35:38,240 TESTING BECAUSE WE HAD 714 00:35:38,240 --> 00:35:39,600 SUFFICIENT EVIDENCE TO DO THAT. 715 00:35:39,600 --> 00:35:42,640 AND LOTS OF WHAT IS COMMONLY 716 00:35:42,640 --> 00:35:44,200 DONE IN CLINICAL PRACTICE 717 00:35:44,200 --> 00:35:49,000 SETTING FOR RISK MITIGATION IS 718 00:35:49,000 --> 00:35:50,080 NOT NECESSARILY EVIDENCE-BASED 719 00:35:50,080 --> 00:35:53,760 TO MAKE IT IN AS A FORMAL 720 00:35:53,760 --> 00:35:55,080 RECOMMENDATION BASED ON THE 721 00:35:55,080 --> 00:35:57,000 EVIDENCE BASE WE HAVE BUT WE 722 00:35:57,000 --> 00:35:58,360 HAVE A RECOMMENDATION FOR 723 00:35:58,360 --> 00:36:03,160 INTERDISCIPLINARY CARE 724 00:36:03,160 --> 00:36:06,400 SPECIFICALLY AND FOR BEHAVIORAL 725 00:36:06,400 --> 00:36:07,600 HEALTH PROBLEMS IDENTIFIED AS HY 726 00:36:07,600 --> 00:36:09,920 RISK FOR BEHAVIOR AND WE HAVE 727 00:36:09,920 --> 00:36:14,000 ONE RECOMMENDATION THE LAST ONE 728 00:36:14,000 --> 00:36:14,960 UNDER 20 ABOUT SUFFICIENT 729 00:36:14,960 --> 00:36:16,560 EVIDENCE TO MAKE THE 730 00:36:16,560 --> 00:36:21,200 RECOMMENDATION FOR EDUCATION. 731 00:36:21,200 --> 00:36:22,240 LET'S GO TO RECOMMENDATION 732 00:36:22,240 --> 00:36:25,440 NUMBER 5 ON THE NEXT SLIDE. 733 00:36:25,440 --> 00:36:28,600 THERE'S ONE MORE SLIDE TO SHOW 734 00:36:28,600 --> 00:36:31,520 WE HAVE THREE ALGORITHMS THAT 735 00:36:31,520 --> 00:36:34,080 YOU CAN SEE AND I'M MENTIONING 736 00:36:34,080 --> 00:36:38,680 THEM AND SPECIFICALLY TALK TO 737 00:36:38,680 --> 00:36:39,760 CERTAIN COMPONENTS OF OUR 738 00:36:39,760 --> 00:36:41,440 ASSESSMENTS AND YOU SEE 739 00:36:41,440 --> 00:36:42,800 COMPONENTS OF THE PAIN AND 740 00:36:42,800 --> 00:36:44,840 SOCIAL ASSESSMENT. 741 00:36:44,840 --> 00:36:46,880 LET'S GO TO THE RECOMMENDATION 5 742 00:36:46,880 --> 00:36:47,320 SPECIFICALLY. 743 00:36:47,320 --> 00:36:48,400 SO I ALREADY READ THIS OUT TO 744 00:36:48,400 --> 00:36:48,960 YOU. 745 00:36:48,960 --> 00:36:51,960 THIS IS THE USE OF BUPRENORPHINE 746 00:36:51,960 --> 00:36:54,320 INSTEAD OF FULL AGONIST OPIOIDS 747 00:36:54,320 --> 00:36:58,600 WHEN PATIENTS RECEIVE OR ARE ON 748 00:36:58,600 --> 00:36:58,920 DAILY OPIOIDS. 749 00:36:58,920 --> 00:37:00,720 AS YOU CAN SEE FROM THE 750 00:37:00,720 --> 00:37:01,680 JUSTIFICATION IN THE 751 00:37:01,680 --> 00:37:03,320 RECOMMENDATION ITSELF IT'S 752 00:37:03,320 --> 00:37:06,360 PRIMARILY THROUGH TO THE LOWER 753 00:37:06,360 --> 00:37:07,560 RISK OF OPIOIDS. 754 00:37:07,560 --> 00:37:11,200 I QUOTED THE CPG HERE IN THE 755 00:37:11,200 --> 00:37:12,440 GUIDELINE IN REGARD TO 756 00:37:12,440 --> 00:37:17,120 EXPLAINING THIS FURTHER. 757 00:37:17,120 --> 00:37:23,160 THERE'S REALLY LITTLE EVIDENCE 758 00:37:23,160 --> 00:37:24,680 THE EVIDENCE WE HAVE SPEAKS TO 759 00:37:24,680 --> 00:37:28,200 THE BUPRENORPHINE AND OTHER 760 00:37:28,200 --> 00:37:30,040 AGONISTS AND WITH LOW QUALITY 761 00:37:30,040 --> 00:37:31,400 EVIDENCE IT'S CONSIDERED 762 00:37:31,400 --> 00:37:32,400 SIMILARLY EFFECTIVE FOR CHRONIC 763 00:37:32,400 --> 00:37:32,840 PAIN. 764 00:37:32,840 --> 00:37:35,200 WE HAVE REALLY GOOD EVIDENCE 765 00:37:35,200 --> 00:37:37,120 ABOUT THE SUPERIOR SAFETY 766 00:37:37,120 --> 00:37:41,680 PROFILE GIVEN IT IS AN AGONIST 767 00:37:41,680 --> 00:37:43,600 ON THE LOWER RISK OF DEPRESSION 768 00:37:43,600 --> 00:37:47,040 AND THIS IS WHAT JUSTIFIES THIS 769 00:37:47,040 --> 00:37:47,400 RECOMMENDATION. 770 00:37:47,400 --> 00:37:48,520 IF YOU GO TO THE NEXT SLIDE, 771 00:37:48,520 --> 00:37:50,800 THIS IS JUST A LITTLE BIT MORE 772 00:37:50,800 --> 00:37:51,320 ABOUT THIS. 773 00:37:51,320 --> 00:37:55,160 WE HAVE SYSTEMIC REVIEWS THAT 774 00:37:55,160 --> 00:37:56,760 CLEARLY PROVIDE EVIDENCE AND 775 00:37:56,760 --> 00:38:01,240 OPIOIDS IN GENERAL HAVE SOME 776 00:38:01,240 --> 00:38:04,240 BENEFIT IN REGARD TO PAIN AND 777 00:38:04,240 --> 00:38:04,680 PHYSICAL FUNCTION. 778 00:38:04,680 --> 00:38:08,000 THOSE SYSTEMATIC REVIEWS DO NOT 779 00:38:08,000 --> 00:38:09,680 REALLY PROVIDE DATA SPECIFICALLY 780 00:38:09,680 --> 00:38:10,640 FOR BUPRENORPHINE. 781 00:38:10,640 --> 00:38:12,040 THEY'RE ALL LUMPED TOGETHER IN 782 00:38:12,040 --> 00:38:12,600 THEIR REPORTS. 783 00:38:12,600 --> 00:38:14,800 ON THE OTHER HAND, THE 784 00:38:14,800 --> 00:38:16,880 LIMITATIONS OF THE STUDIES ARE 785 00:38:16,880 --> 00:38:21,080 THAT MANY EXCLUDED PATIENTS WITH 786 00:38:21,080 --> 00:38:23,120 CURRENT OR PRIOR SUBSTANCE USE 787 00:38:23,120 --> 00:38:27,200 DISORDER OR WHEN ON PSYCHTROPHIC 788 00:38:27,200 --> 00:38:29,000 MEDICATION AND YOU CAN CAN SEE 789 00:38:29,000 --> 00:38:31,120 POTENTIAL WEN FIT FROM OPIOIDS 790 00:38:31,120 --> 00:38:33,280 IN THOSE CAREFULLY SELECTED 791 00:38:33,280 --> 00:38:34,560 PATIENTS IN THE SHORT TERM IS 792 00:38:34,560 --> 00:38:38,080 LIKELY OUTWEIGHED BY THE RISK IN 793 00:38:38,080 --> 00:38:40,120 REGARD TO LONG-TERM VIEWS WITH 794 00:38:40,120 --> 00:38:41,480 REGARD TO OVERDOSE AND OPIOID 795 00:38:41,480 --> 00:38:43,120 USE DISORDER. 796 00:38:43,120 --> 00:38:45,840 THIS IS WHAT INFORMED THE 797 00:38:45,840 --> 00:38:46,800 RECOMMENDATION AND THE 798 00:38:46,800 --> 00:38:48,400 BACKGROUND FOR THE 799 00:38:48,400 --> 00:38:49,040 RECOMMENDATION FOR NUMBER 5. 800 00:38:49,040 --> 00:38:52,320 AND IF YOU GO THEN TO THE NEXT 801 00:38:52,320 --> 00:38:54,160 SLIDE THAT EXPLAINS A LITTLE BIT 802 00:38:54,160 --> 00:38:58,120 MORE THAT THERE WERE TWO 803 00:38:58,120 --> 00:38:59,320 META-ANALYSES INCLUDED IN OUR 804 00:38:59,320 --> 00:39:04,320 EVIDENCE BASE THAT SPEAK TO THE 805 00:39:04,320 --> 00:39:05,840 PAIN REDUCTION OF BUPRENORPHINE 806 00:39:05,840 --> 00:39:07,760 TO OTHER OPIOIDS AND IN MOST 807 00:39:07,760 --> 00:39:09,400 CASES SHOWED NO DIFFERENCE. 808 00:39:09,400 --> 00:39:12,080 WE ALSO LOOKED AT ADDITIONAL 809 00:39:12,080 --> 00:39:13,280 EVIDENCE TO INFORM THIS THOUGH 810 00:39:13,280 --> 00:39:14,600 THAT'S NOT GOING TO THE QUALITY 811 00:39:14,600 --> 00:39:17,320 OR STRENGTH OF RECOMMENDATION 812 00:39:17,320 --> 00:39:19,120 BUT THERE ARE SEVERAL OTHER 813 00:39:19,120 --> 00:39:20,320 STUDIES OUT THERE ALSO AVAILABLE 814 00:39:20,320 --> 00:39:27,200 THAT DOCUMENT THE EFFECTIVENESS, 815 00:39:27,200 --> 00:39:29,360 THE ANALGESIC EFFECT OF 816 00:39:29,360 --> 00:39:30,120 BUPRENORPHINE. 817 00:39:30,120 --> 00:39:33,320 AT THE SAME TIME LOOKING AT THE 818 00:39:33,320 --> 00:39:34,480 LOWER RISK. 819 00:39:34,480 --> 00:39:36,800 OUR RECOMMENDATION WAS MADE AND 820 00:39:36,800 --> 00:39:39,560 I THINK IT FITS QUITE NICELY AND 821 00:39:39,560 --> 00:39:41,120 THAT'S THE LAST SLIDE I HAVE 822 00:39:41,120 --> 00:39:45,480 WITH WHAT HEALTH AND HUMAN -- 823 00:39:45,480 --> 00:39:50,560 WHAT WAS IN OUR BEST PRACTICES 824 00:39:50,560 --> 00:39:54,400 REPORT FROM 2019 ON PAGE 29 IT 825 00:39:54,400 --> 00:39:57,080 TALKS ABOUT IN THE GAP FOR AND 826 00:39:57,080 --> 00:40:00,200 RECOMMENDATION UNDER 4B IT TALKS 827 00:40:00,200 --> 00:40:03,560 ABOUT ENCOURAGE PRIME USE OF 828 00:40:03,560 --> 00:40:04,200 BUPRENORPHINE RATHER THAN USE 829 00:40:04,200 --> 00:40:08,560 ONLY AFTER THE FAILURE OF 830 00:40:08,560 --> 00:40:13,320 STANDARD MU AGONIST AND GIVES 831 00:40:13,320 --> 00:40:13,840 EXAMPLES. 832 00:40:13,840 --> 00:40:17,240 SO THIS IS -- WE'D BE HAPPY TO 833 00:40:17,240 --> 00:40:19,560 ANSWER IF YOU HAVE QUESTIONS AND 834 00:40:19,560 --> 00:40:28,960 FEEL FREE TO CONTACT ME. 835 00:40:28,960 --> 00:40:30,440 THIS IS WHERE HAVE OUR 836 00:40:30,440 --> 00:40:40,640 GUIDELINES. 837 00:40:43,160 --> 00:40:45,880 >> WE'D LIKE TO OPEN IT UP TO 838 00:40:45,880 --> 00:40:51,360 QUESTIONS NOW FOR DR. SANDBRINK. 839 00:40:51,360 --> 00:41:01,880 >> THIS IS INTERESTING DATA IT'S 840 00:41:06,000 --> 00:41:08,640 BEEN SHOWN CHRONIC PAIN LEADS TO 841 00:41:08,640 --> 00:41:10,640 COMORBIDITIES LIKE DYSPHORIA AND 842 00:41:10,640 --> 00:41:14,080 AT LEAST IN ANIMAL STUDIES 843 00:41:14,080 --> 00:41:19,720 RECEPTORS ANTAGONISTS MAY 844 00:41:19,720 --> 00:41:28,360 PREVENT THOSE AFFECTS. 845 00:41:28,360 --> 00:41:32,000 AND LOOKING AT COMORBIDITIES 846 00:41:32,000 --> 00:41:34,200 SUCH AS DEPRESSION AND ANXIETY. 847 00:41:34,200 --> 00:41:36,560 >> I THINK IT MAY PROBABLY BE 848 00:41:36,560 --> 00:41:39,720 TOO EARLY TO REALLY SHOW THIS IN 849 00:41:39,720 --> 00:41:40,800 OUR CLINICAL EVIDENCE. 850 00:41:40,800 --> 00:41:43,480 CERTAINLY IT WAS NOT IN THE 851 00:41:43,480 --> 00:41:46,760 EVIDENCE THAT WE COULD INCLUDE 852 00:41:46,760 --> 00:41:50,280 GIVEN THE INCLUSION OF ANY SUCH 853 00:41:50,280 --> 00:41:52,240 DATA. 854 00:41:52,240 --> 00:41:54,080 ANIMAL DATA IS NOT CONSIDERED IN 855 00:41:54,080 --> 00:41:55,080 ORDER TO MAKE THE CLINICAL 856 00:41:55,080 --> 00:42:05,640 PRACTICE GUIDELINES BUT I THINK 857 00:42:05,640 --> 00:42:16,120 IT'S SOMETHING TO CONSIDER. 858 00:42:17,080 --> 00:42:18,960 >> THEY GO INTO EFFECT WHEN THEY 859 00:42:18,960 --> 00:42:20,960 GET PUBLISHED. 860 00:42:20,960 --> 00:42:23,240 WE PUBLISHED THIS PROBABLY IN 861 00:42:23,240 --> 00:42:28,360 DECEMBER OF THIS YEAR. 862 00:42:28,360 --> 00:42:29,440 I DON'T KNOW. 863 00:42:29,440 --> 00:42:32,520 IT GOES THROUGH THE REVIEW 864 00:42:32,520 --> 00:42:35,080 PROCESSES AND ONCE IT GETS 865 00:42:35,080 --> 00:42:36,920 PUBLISHED IT BECOMES A 866 00:42:36,920 --> 00:42:37,360 REPLACEMENT. 867 00:42:37,360 --> 00:42:41,120 >> THE IMPLEMENTATION THEN IS 868 00:42:41,120 --> 00:42:42,400 SOMEWHAT GRADUAL. 869 00:42:42,400 --> 00:42:43,800 WAS IT PUBLISHED AND AVAILABLE 870 00:42:43,800 --> 00:42:46,040 FOR USE? 871 00:42:46,040 --> 00:42:50,320 >> AS WE PUBLISH THIS WE CONNECT 872 00:42:50,320 --> 00:42:55,960 WITH AN EVIDENCE TO EDUCATE OUR 873 00:42:55,960 --> 00:42:57,480 PROVIDERS. 874 00:42:57,480 --> 00:42:59,240 WE -- THIS IS NOT THE FIRST TIME 875 00:42:59,240 --> 00:42:59,880 WE TALK ABOUT BUPRENORPHINE FOR 876 00:42:59,880 --> 00:43:08,160 PAIN. 877 00:43:08,160 --> 00:43:09,840 WE INTEGRATE OPIATE USE DISORDER 878 00:43:09,840 --> 00:43:12,520 IN OUR PAIN CLINICS. 879 00:43:12,520 --> 00:43:15,680 WE HAVE MANY PROVIDERS AND 880 00:43:15,680 --> 00:43:16,400 CLINICIANS FAMILIAR WITH 881 00:43:16,400 --> 00:43:19,080 BUPRENORPHINE AND I'M 882 00:43:19,080 --> 00:43:20,280 INCORPORATING THIS ALREADY AND 883 00:43:20,280 --> 00:43:21,720 STRENGTHENS FURTHER THE EVIDENCE 884 00:43:21,720 --> 00:43:32,240 TO SUPPORT US IN THIS ROLLOUT. 885 00:43:38,000 --> 00:43:38,640 AND TRYING TO SUPPORT THIS 886 00:43:38,640 --> 00:43:40,160 CAMPAIGN IN ADDITION TO JUST 887 00:43:40,160 --> 00:43:41,920 PUBLISHING. 888 00:43:41,920 --> 00:43:43,480 >> JULIE. 889 00:43:43,480 --> 00:43:45,560 >> I APPRECIATE THE CONVERSATION 890 00:43:45,560 --> 00:43:47,120 ESPECIALLY WHEN IT COMES TO 891 00:43:47,120 --> 00:43:48,440 ACCESS AND WHAT THAT LOOKS LIKE. 892 00:43:48,440 --> 00:43:54,400 I'D BE CURIOUS TO HEAR FROM THE 893 00:43:54,400 --> 00:43:55,520 IMPLEMENTATION PERSPECTIVE MY 894 00:43:55,520 --> 00:43:57,160 UNDERSTANDING OFTEN A LIMITED 895 00:43:57,160 --> 00:44:00,280 NUMBER OF PROVIDERS ARE ABLE TO 896 00:44:00,280 --> 00:44:01,560 BE PRESCRIBING BUPRENORPHINE OR 897 00:44:01,560 --> 00:44:03,120 HAVE A LIMIT TO HOW MANY THEY 898 00:44:03,120 --> 00:44:04,720 CAN PRESCRIBE TO PER DAY. 899 00:44:04,720 --> 00:44:10,440 I'D BE CURIOUS IF THERE'S ANY 900 00:44:10,440 --> 00:44:15,920 DATA CAPTURE PLANNED FOR HOW WE 901 00:44:15,920 --> 00:44:24,400 TRY TO TO EXPAND ACCESS AND 902 00:44:24,400 --> 00:44:28,840 ENCOURAGE GREATER PRESCRIBING 903 00:44:28,840 --> 00:44:31,520 POWER THERE. 904 00:44:31,520 --> 00:44:32,920 >> THERE'S CERTAIN CHALLENGES 905 00:44:32,920 --> 00:44:38,840 WITH IMPLEMENTATION OF THE USE 906 00:44:38,840 --> 00:44:40,520 OF BUPRENORPHINE. 907 00:44:40,520 --> 00:44:44,880 AND THAT'S FOR THE USE OF 908 00:44:44,880 --> 00:44:47,360 BUPRENORPHINE FOR THE OPIATE USE 909 00:44:47,360 --> 00:44:47,880 DISORDER. 910 00:44:47,880 --> 00:44:50,520 THOSE ARE HIGHER DOSE PRODUCTS. 911 00:44:50,520 --> 00:44:57,200 WHAT WE TALK ABOUT HERE IN THIS 912 00:44:57,200 --> 00:45:01,280 CLINICAL RECOMMENDATION AND 913 00:45:01,280 --> 00:45:02,880 THOSE APPROVED FOR THE USE FOR 914 00:45:02,880 --> 00:45:07,680 INDICATE OF PAIN ARE NOT 915 00:45:07,680 --> 00:45:08,680 RESTRICTED IN THE NUMBER OF 916 00:45:08,680 --> 00:45:14,400 PATIENTS AND I THINK IN PART IT 917 00:45:14,400 --> 00:45:24,960 MAY BE BUT WE HAVE IT INDICATED 918 00:45:26,840 --> 00:45:27,280 FOR PAIN. 919 00:45:27,280 --> 00:45:29,640 AND IT'S ACCESSIBLE FOR OUR 920 00:45:29,640 --> 00:45:31,720 CLINICIANS AND WE SHOULD POINT 921 00:45:31,720 --> 00:45:35,360 OUT EVEN THE USE OF 922 00:45:35,360 --> 00:45:36,480 BUPRENORPHINE PRODUCTS THAT ARE 923 00:45:36,480 --> 00:45:38,840 AT HIGHER DOSES AND APPROVED FOR 924 00:45:38,840 --> 00:45:44,000 OPIATE USE DISORDER CAN BE USED 925 00:45:44,000 --> 00:45:54,520 FOR PAIN AS WELL 1KE -- THOSE 926 00:46:03,080 --> 00:46:04,640 DON'T HAVE RESTRICTION FOR PAIN 927 00:46:04,640 --> 00:46:08,880 AND WE HAVE IN OUR PAIN CLINICS 928 00:46:08,880 --> 00:46:16,960 MORE THAN 4,000 PROVIDERS AND WE 929 00:46:16,960 --> 00:46:20,920 KNOW THE NUMBER WE HAVE AND THE 930 00:46:20,920 --> 00:46:22,440 NUMBER OF BUPRENORPHINE PRODUCTS 931 00:46:22,440 --> 00:46:23,600 THEY USE AND MANY HAVE 932 00:46:23,600 --> 00:46:24,200 AUTHORIZATION BUT MAY NOT 933 00:46:24,200 --> 00:46:28,920 ACTUALLY USE IT. 934 00:46:28,920 --> 00:46:30,360 WE ARE TRYING TO LOWER THE 935 00:46:30,360 --> 00:46:34,880 THRESHOLD BY MAKING SURE OUR 936 00:46:34,880 --> 00:46:39,760 PROVIDERS GET THIS AND DO USE 937 00:46:39,760 --> 00:46:41,520 THIS AND HAVE A SUPPORT SYSTEM 938 00:46:41,520 --> 00:46:43,280 BEHIND THE PROVIDERS SO THEY 939 00:46:43,280 --> 00:46:44,800 FEEL MORE COMFORTABLE. 940 00:46:44,800 --> 00:46:45,920 THERE'S A HESITATION SOMETIMES 941 00:46:45,920 --> 00:46:50,280 TO GO THE NEXT STEP AND OFFER 942 00:46:50,280 --> 00:46:52,400 THIS TREATMENT AND WE WANT TO 943 00:46:52,400 --> 00:47:02,680 ENCOURAGE THOSE. 944 00:47:06,000 --> 00:47:06,560 >> THANK YOU. 945 00:47:06,560 --> 00:47:08,160 >> I THINK JOSÉ'S NEXT. 946 00:47:08,160 --> 00:47:10,200 >> DID YOU HAVE ANOTHER 947 00:47:10,200 --> 00:47:11,960 QUESTION? 948 00:47:11,960 --> 00:47:13,760 >> A QUICK QUESTION. 949 00:47:13,760 --> 00:47:18,280 SO BUPRENORPHINE IS ONE WE NEED 950 00:47:18,280 --> 00:47:20,720 TO REMEMBER IS IN SOME STUDIES 951 00:47:20,720 --> 00:47:22,160 ESPECIALLY FOR OPIATE USE 952 00:47:22,160 --> 00:47:24,960 DISORDERS THERE'S SOME KIND OF 953 00:47:24,960 --> 00:47:28,600 POTENTIAL ABUSE LIABILITY THAT 954 00:47:28,600 --> 00:47:31,680 COULD AFFECT THE USE OF THE 955 00:47:31,680 --> 00:47:34,240 MEDICATION. 956 00:47:34,240 --> 00:47:38,280 DO YOU HAVE DATA ON THE ABUSE 957 00:47:38,280 --> 00:47:39,440 VIABILITY AS WELL? 958 00:47:39,440 --> 00:47:41,080 >> WE DON'T HAVE SPECIFIC DATA 959 00:47:41,080 --> 00:47:45,480 FOR THAT AT THIS POINT. 960 00:47:45,480 --> 00:47:47,920 >> I WANTED TO ASK. 961 00:47:47,920 --> 00:47:50,720 THAT'S FANTASTIC BUT IS THERE 962 00:47:50,720 --> 00:47:51,720 INTENTIONS TO USE BUPRENORPHINE 963 00:47:51,720 --> 00:47:52,840 IN CANCER PAIN AND THIS IS MY 964 00:47:52,840 --> 00:47:56,920 AREA AND WHAT WE HAVE SEEN OVER 965 00:47:56,920 --> 00:47:59,280 AND OVER AS WELL AS IN THE 966 00:47:59,280 --> 00:48:05,240 CLINIC THE HIGHLY EFFICACIOUS MU 967 00:48:05,240 --> 00:48:10,400 AGONISTS CAUSE MORE RAPID BONE 968 00:48:10,400 --> 00:48:12,640 LOSS THAN EVERYTHING WE SEE AND 969 00:48:12,640 --> 00:48:14,440 WE SAY EVERYTHING EXCEPT FOR 970 00:48:14,440 --> 00:48:17,320 CANCER PAIN AND WONDERING IF 971 00:48:17,320 --> 00:48:18,920 THERE'S SOMETHING LIKE USING 972 00:48:18,920 --> 00:48:20,200 BUPRENORPHINE FOR SOMETHING LIKE 973 00:48:20,200 --> 00:48:22,000 CANCER PAIN AS A PARTIAL 974 00:48:22,000 --> 00:48:22,600 AGONIST. 975 00:48:22,600 --> 00:48:24,720 >> THE GUIDELINE WAS OBVIOUSLY 976 00:48:24,720 --> 00:48:26,720 NOT INTENDED TO SPEAK TO CANCER 977 00:48:26,720 --> 00:48:31,280 PAIN SPECIFICALLY BUT THE 978 00:48:31,280 --> 00:48:32,760 MEDICATION'S AVAILABLE FOR ANY 979 00:48:32,760 --> 00:48:33,360 OF THOSE INDICATIONS INCLUDING 980 00:48:33,360 --> 00:48:38,880 CANCER PAIN. 981 00:48:38,880 --> 00:48:40,800 I'M AWARE OF WHAT YOU'RE TALKING 982 00:48:40,800 --> 00:48:43,080 ABOUT IN REGARD TO BONE LOSS AND 983 00:48:43,080 --> 00:48:46,920 CERTAINLY THE HOPE IS 984 00:48:46,920 --> 00:48:48,760 BUPRENORPHINE WILL HAVE SOME 985 00:48:48,760 --> 00:48:49,640 LESSER LONG-TERM SIDE EFFECTS 986 00:48:49,640 --> 00:48:52,280 FOR PATIENTS NOT JUST IN THIS 987 00:48:52,280 --> 00:48:59,840 REGARD BUT OTHER CONSIDERATIONS. 988 00:48:59,840 --> 00:49:00,920 NEVERTHELESS I THINK THERE'S THE 989 00:49:00,920 --> 00:49:03,160 ADDITIONAL CONCERN AS YOU HAVE A 990 00:49:03,160 --> 00:49:05,120 PATIENT ESPECIALLY ON THE HIGHER 991 00:49:05,120 --> 00:49:08,760 DOSE BUPRENORPHINE PRODUCTS, IF 992 00:49:08,760 --> 00:49:10,360 YOU NEED ANY ADDITIONAL 993 00:49:10,360 --> 00:49:12,400 AS-NEEDED MEDICATION AND AGONIST 994 00:49:12,400 --> 00:49:15,160 FOR TEMPORARY USE WHETHER FOR 995 00:49:15,160 --> 00:49:17,000 SURGERY OR EXACERBATION OF PAIN 996 00:49:17,000 --> 00:49:23,640 YOU REDUCE THE EFFECTIVENESS OR 997 00:49:23,640 --> 00:49:31,040 EFFICACY OF THOSE AS NEEDED 998 00:49:31,040 --> 00:49:31,640 MEDICATIONS. 999 00:49:31,640 --> 00:49:36,200 THERE'S POSES A CHALLENGE FOR AN 1000 00:49:36,200 --> 00:49:37,160 ESCALATION NEED IN MEDICATION 1001 00:49:37,160 --> 00:49:40,000 THAT'S REQUIRED. 1002 00:49:40,000 --> 00:49:42,080 WE'RE TRYING TO PROVIDE 1003 00:49:42,080 --> 00:49:42,400 GUIDANCE. 1004 00:49:42,400 --> 00:49:47,480 WE HAVE RECOMMENDATION FOR THE 1005 00:49:47,480 --> 00:49:51,720 SETTING OR PATIENTS USING 1006 00:49:51,720 --> 00:49:52,800 BUPRENORPHINE SO CLINICIANS ARE 1007 00:49:52,800 --> 00:49:54,440 BETTER GUIDED HOW TO APPROACH 1008 00:49:54,440 --> 00:49:58,800 THOSE SITUATIONS RATHER THAN 1009 00:49:58,800 --> 00:50:00,560 WHICH HAPPENED WITH THE 1010 00:50:00,560 --> 00:50:02,760 BUPRENORPHINE PRODUCTS AND 1011 00:50:02,760 --> 00:50:04,440 SWITCHED OVER TO AGONIST AND 1012 00:50:04,440 --> 00:50:06,480 THEN LATER AFTER SURGERY OR 1013 00:50:06,480 --> 00:50:08,040 WHATEVER IT IS WE SWITCH BACK. 1014 00:50:08,040 --> 00:50:08,920 I THINK THERE'S BEST WAYS OF 1015 00:50:08,920 --> 00:50:17,080 TRYING TO DO THIS. 1016 00:50:17,080 --> 00:50:18,840 >> WALTER, DID YOU HAVE A 1017 00:50:18,840 --> 00:50:19,120 QUESTION? 1018 00:50:19,120 --> 00:50:29,560 >> YES, THANKS VERY MUCH. 1019 00:50:35,120 --> 00:50:36,200 THE THINGS INDICATE AS WEAK 1020 00:50:36,200 --> 00:50:37,640 EVIDENCE BUT STILL IN THE 1021 00:50:37,640 --> 00:50:48,160 GUIDELINE AS I CAN UNDERSTAND IT 1022 00:50:49,240 --> 00:50:52,520 THINGS LIKE ASSESSING, 1023 00:50:52,520 --> 00:50:53,600 CATASTROPHIZING AND THE QUESTION 1024 00:50:53,600 --> 00:50:59,680 IS THERE A WAY -- IS THERE DATA 1025 00:50:59,680 --> 00:51:00,960 COLLECTION GOING ON TO 1026 00:51:00,960 --> 00:51:03,480 UNDERSTAND IN THE V.A. PRACTICE 1027 00:51:03,480 --> 00:51:09,560 WHAT IS ACTUALLY HAPPENING IN 1028 00:51:09,560 --> 00:51:13,760 THESE FUZZIER ZONES TO KNOW WHAT 1029 00:51:13,760 --> 00:51:14,520 THE PRACTICE IS. 1030 00:51:14,520 --> 00:51:16,800 >> THE GUIDELINE ITSELF IS 1031 00:51:16,800 --> 00:51:18,760 INFORMED BY THE LITERATURE 1032 00:51:18,760 --> 00:51:21,080 THAT'S OUT THERE FROM NO MATTER 1033 00:51:21,080 --> 00:51:23,200 WHERE IT IS AND I THINK AN 1034 00:51:23,200 --> 00:51:25,600 INTERNAL ASSESSMENT IN ITSELF 1035 00:51:25,600 --> 00:51:29,320 UNLESS IT GETS PUBLISHED IN A 1036 00:51:29,320 --> 00:51:31,120 PEER-REVIEWED JOURNAL EVEN 1037 00:51:31,120 --> 00:51:34,760 INTERIM DATA WON'T BE UTILIZED. 1038 00:51:34,760 --> 00:51:35,640 NEVERTHELESS NOW THAT WE HAVE 1039 00:51:35,640 --> 00:51:37,520 THE GUIDELINES ISSUED, WE'RE 1040 00:51:37,520 --> 00:51:40,760 LOOKING BACK AT SUPPORTING THE 1041 00:51:40,760 --> 00:51:42,080 IMPLEMENTATION AND ASSESSING THE 1042 00:51:42,080 --> 00:51:47,600 RESULT OF THE IMPLEMENTATION 1043 00:51:47,600 --> 00:51:50,080 INCLUDING WE HAVE KNOWN 1044 00:51:50,080 --> 00:51:52,080 PSYCHOLOGICAL FACTORS INCREASE 1045 00:51:52,080 --> 00:52:00,400 THE RISK OF OPIOID MEDICATION. 1046 00:52:00,400 --> 00:52:04,720 WE HAVE A TOOL FOR OPIOID USE 1047 00:52:04,720 --> 00:52:06,400 MITIGATION WHERE WE USE THE DATA 1048 00:52:06,400 --> 00:52:13,440 SET MAKE PREDICTIVE ANALYTIC 1049 00:52:13,440 --> 00:52:14,880 ASSESSMENTS OF AN INDIVIDUAL'S 1050 00:52:14,880 --> 00:52:16,480 RISK AND IT'S VERY WELL 1051 00:52:16,480 --> 00:52:18,240 SUPPORTED IN OUR OWN VETERAN 1052 00:52:18,240 --> 00:52:20,600 DATABASE THAT PSYCHOLOGICAL 1053 00:52:20,600 --> 00:52:23,360 FACTORS AND PSYCHIATRIC 1054 00:52:23,360 --> 00:52:24,000 CO-MORBIDITIES IN PARTICULAR 1055 00:52:24,000 --> 00:52:28,320 DRIVE THE RISK OF OVERDOSES AND 1056 00:52:28,320 --> 00:52:29,480 SUICIDE DEATH AND DEATH IN 1057 00:52:29,480 --> 00:52:30,320 PARTICULAR. 1058 00:52:30,320 --> 00:52:33,560 WE KNOW THE ROLE OF THOSE 1059 00:52:33,560 --> 00:52:34,760 PSYCHOLOGICAL FACTORS AND 1060 00:52:34,760 --> 00:52:35,480 PSYCHIATRIC CONDITIONS ALREADY 1061 00:52:35,480 --> 00:52:45,880 FROM OUR OWN DATA SET. 1062 00:52:46,360 --> 00:52:50,960 WHETHER A SCREENING IN 1063 00:52:50,960 --> 00:52:52,200 CATASTROPHIZING DOWN THE ROAD 1064 00:52:52,200 --> 00:52:53,960 THAT WE MADE THE RECOMMENDATION 1065 00:52:53,960 --> 00:52:58,360 IS SOMETHING WE HAVE TO ASSESS. 1066 00:52:58,360 --> 00:52:59,960 HOWEVER, THERE WAS SUFFICIENT 1067 00:52:59,960 --> 00:53:01,160 EVIDENCE IN THE LITERATURE TO 1068 00:53:01,160 --> 00:53:04,840 SUGGEST SUCH A RISK ASSESSMENT 1069 00:53:04,840 --> 00:53:12,640 CAN BE BENEFICIAL TO MAKE 1070 00:53:12,640 --> 00:53:14,000 DECISIONS IN THE USE OF OPIOID 1071 00:53:14,000 --> 00:53:14,720 MEDICATIONS. 1072 00:53:14,720 --> 00:53:19,640 >> AND I GUESS THE OTHER 1073 00:53:19,640 --> 00:53:21,280 SOMEWHAT RELATED IS THE ISSUE OF 1074 00:53:21,280 --> 00:53:22,880 PEOPLE WHO HAVE PAIN AND 1075 00:53:22,880 --> 00:53:23,840 SUBSTANCE USE DISORDER. 1076 00:53:23,840 --> 00:53:27,800 SO THE USE OF OPIOIDS FOR THEIR 1077 00:53:27,800 --> 00:53:29,320 PAIN IS DISCOURAGED -- I DON'T 1078 00:53:29,320 --> 00:53:35,880 FLOW IF THAT'S THE WORD. 1079 00:53:35,880 --> 00:53:37,400 WHAT HAPPENS TO THAT GROUP AND 1080 00:53:37,400 --> 00:53:39,600 WHETHER IT'S DISCOURAGED BUT 1081 00:53:39,600 --> 00:53:44,320 USED ANYWAY BECAUSE THERE'S NO 1082 00:53:44,320 --> 00:53:47,240 OTHER OPTIONS OR WHETHER THEY'RE 1083 00:53:47,240 --> 00:53:50,040 NOT USED AND THERE'S ADVERSE 1084 00:53:50,040 --> 00:53:50,440 EVENTS. 1085 00:53:50,440 --> 00:53:51,520 I'M WONDERING IF YOU KNOW IF 1086 00:53:51,520 --> 00:53:53,440 THAT'S A BIG GROUP? 1087 00:53:53,440 --> 00:53:55,360 IS THAT SOMETHING THAT DATA 1088 00:53:55,360 --> 00:53:57,000 COULD COME OUT OF THAT GROUP IN 1089 00:53:57,000 --> 00:53:58,120 TERMS OF HOW THEY'RE TREATED AND 1090 00:53:58,120 --> 00:54:02,840 WHAT THE OUTCOMES ARE? 1091 00:54:02,840 --> 00:54:05,120 >> YEAH, SO IT CERTAINLY IS A 1092 00:54:05,120 --> 00:54:06,400 SIGNIFICANT -- IF YOU THINK 1093 00:54:06,400 --> 00:54:08,480 ABOUT THE MAJORITY OF PATIENTS 1094 00:54:08,480 --> 00:54:12,200 WHO ACTUALLY HAVE AN OPIATE USE 1095 00:54:12,200 --> 00:54:14,480 DISORDER HAVE PAIN COMPLAINTS AS 1096 00:54:14,480 --> 00:54:17,040 WELL AS MANY PATIENTS IN THE 1097 00:54:17,040 --> 00:54:18,920 SUBSET ON THE PAIN SIDE AND USE 1098 00:54:18,920 --> 00:54:21,280 DISORDER LOWER IN THIS REGARD. 1099 00:54:21,280 --> 00:54:23,000 NEVERTHELESS, I THINK WHAT WE 1100 00:54:23,000 --> 00:54:24,120 HAVE COME TO IS THE 1101 00:54:24,120 --> 00:54:28,080 BUPRENORPHINE PRODUCTS ARE 1102 00:54:28,080 --> 00:54:30,000 PROBABLY -- THAT'S THE RIGHT 1103 00:54:30,000 --> 00:54:34,480 INDICATION FOR THOSE PRODUCTS. 1104 00:54:34,480 --> 00:54:36,160 WE WERE SURPRISED WHERE WE COULD 1105 00:54:36,160 --> 00:54:40,400 NOT SHOW BUPRENORPHINE WAS MORE 1106 00:54:40,400 --> 00:54:42,400 EFFECTIVE AND LONG ACTING 1107 00:54:42,400 --> 00:54:44,400 NALTREXONE IN HELPING WITH PAIN 1108 00:54:44,400 --> 00:54:49,600 CONTROL IN A PATIENT WHO HAS USE 1109 00:54:49,600 --> 00:54:50,840 DISORDER THAT'S WHY THE 1110 00:54:50,840 --> 00:54:52,600 RECOMMENDATION CAME IN BASED ON 1111 00:54:52,600 --> 00:54:54,600 THE LITERATURE BUT I THINK FOR 1112 00:54:54,600 --> 00:54:56,680 THE MAJORITY OF PATIENTS WHO 1113 00:54:56,680 --> 00:54:58,280 HAVE SIGNIFICANT USE DISORDER AS 1114 00:54:58,280 --> 00:54:59,520 WE GUIDE THEM TOWARDS TREATMENT, 1115 00:54:59,520 --> 00:55:03,680 WE WANT TO USE A MEDICATION THAT 1116 00:55:03,680 --> 00:55:05,240 ALSO HELPS WITH PAIN AND 1117 00:55:05,240 --> 00:55:06,160 BUPRENORPHINE HAS CLEARLY 1118 00:55:06,160 --> 00:55:10,560 EVIDENCE OF TREATING AND 1119 00:55:10,560 --> 00:55:12,240 SUPPORTING PAIN MANAGEMENT, THAT 1120 00:55:12,240 --> 00:55:13,640 IS WHAT IS COMMONLY USED. 1121 00:55:13,640 --> 00:55:17,840 THIS IS THE REASON WHY WE ALSO 1122 00:55:17,840 --> 00:55:20,960 MAKE THE USE DISORDER TREATMENT 1123 00:55:20,960 --> 00:55:24,520 PART OF OUR PAIN TO ADDRESS BOTH 1124 00:55:24,520 --> 00:55:25,120 CONDITIONS SIMULTANEOUSLY TO 1125 00:55:25,120 --> 00:55:35,240 THEM. 1126 00:55:50,080 --> 00:55:52,920 >> CHRISTINE. 1127 00:55:52,920 --> 00:55:55,000 >> WE COLLABORATE IN OUR 1128 00:55:55,000 --> 00:56:01,040 HOSPITAL AND IN ALMOST ALL CASES 1129 00:56:01,040 --> 00:56:03,480 WE'LL CO-CONSULT WITH THEM AND 1130 00:56:03,480 --> 00:56:08,520 AN INITIATION OF BUPRENORPHINE 1131 00:56:08,520 --> 00:56:11,320 MUST ALWAYS BE SUPERVISED BY THE 1132 00:56:11,320 --> 00:56:12,920 ADDICTION SERVICE IN-HOUSE. 1133 00:56:12,920 --> 00:56:18,400 MAY I SUGGEST FUTURE STUDIES 1134 00:56:18,400 --> 00:56:19,800 CONSIDER INCORPORATING AND 1135 00:56:19,800 --> 00:56:21,720 PERHAPS THERE CAN BE A LITTLE 1136 00:56:21,720 --> 00:56:23,200 MORE OF AN EMPHASIS ON 1137 00:56:23,200 --> 00:56:24,880 INCORPORATING THE CONTEXT OF 1138 00:56:24,880 --> 00:56:26,360 USE, FOR EXAMPLE, THE EXTENT OF 1139 00:56:26,360 --> 00:56:35,760 THE SURGERY, THE EXISTENCE OF 1140 00:56:35,760 --> 00:56:41,400 PAINFUL CONDITIONS AND SO ON 1141 00:56:41,400 --> 00:56:46,120 INCLUDING THE COMBINANT 1142 00:56:46,120 --> 00:56:49,520 TREATMENTS FOR PAIN SUCH AS 1143 00:56:49,520 --> 00:56:54,800 ADJUNCTS AND REGIONAL 1144 00:56:54,800 --> 00:56:55,160 ANALGESICS. 1145 00:56:55,160 --> 00:57:03,040 IT ALL FITS INTO IT ALL FITS IN 1146 00:57:03,040 --> 00:57:05,160 THE BIGGER PICTURE IN ADDITION 1147 00:57:05,160 --> 00:57:06,840 TO PLANS FOR EACH INDIVIDUAL 1148 00:57:06,840 --> 00:57:12,520 PATIENT FOLLOWING SURGERY. 1149 00:57:12,520 --> 00:57:16,600 WILL THEY BE RELEASED TO HOME OR 1150 00:57:16,600 --> 00:57:18,320 DISCHARGED TO OTHER SERVICES 1151 00:57:18,320 --> 00:57:19,280 WHERE TREATMENT MAY NOT BE 1152 00:57:19,280 --> 00:57:27,120 AVAILABLE. 1153 00:57:27,120 --> 00:57:29,600 FOR EXTENSIVE SURGERIES WE 1154 00:57:29,600 --> 00:57:34,800 CLINICALLY DO SEE WHAT IS OF 1155 00:57:34,800 --> 00:57:40,960 COURSE SHOWN THAT IS THE AFFECT 1156 00:57:40,960 --> 00:57:44,240 OF BUPRENORPHINE AND THIS 1157 00:57:44,240 --> 00:57:45,080 BECOMES FAIRLY COMPLEX AS WE 1158 00:57:45,080 --> 00:57:52,320 DISCOVERED OVER MANY YEARS. 1159 00:57:52,320 --> 00:57:53,520 MUCH WORK NEEDS TO BE DONE I 1160 00:57:53,520 --> 00:57:57,400 THINK THOUGH THE CONTEXT OF THE 1161 00:57:57,400 --> 00:58:02,480 USE OF BUPRENORPHINE CAN BE 1162 00:58:02,480 --> 00:58:04,800 QUITE VARIABLE AND AND NEED TO 1163 00:58:04,800 --> 00:58:06,400 BE TEASED THROUGH. 1164 00:58:06,400 --> 00:58:07,040 THANK YOU. 1165 00:58:07,040 --> 00:58:09,880 >> I THINK IT SPEAKS TO THE 1166 00:58:09,880 --> 00:58:10,560 LIMITATIONS OF THE CLINICAL 1167 00:58:10,560 --> 00:58:12,040 PRACTICE GUIDELINE WHICH IS 1168 00:58:12,040 --> 00:58:13,680 LIMITED TO THE USE OF OPIOIDS 1169 00:58:13,680 --> 00:58:15,040 AND THE MANAGEMENT OF CHRONIC 1170 00:58:15,040 --> 00:58:15,240 PAIN. 1171 00:58:15,240 --> 00:58:17,560 SO THE GUIDELINE ITSELF WAS NOT 1172 00:58:17,560 --> 00:58:28,080 INTENDED TO PROVIDE AN ACUTE 1173 00:58:29,560 --> 00:58:30,240 PAIN TREATMENT. 1174 00:58:30,240 --> 00:58:33,040 EARLIER THIS YEAR WE PUBLISHED 1175 00:58:33,040 --> 00:58:34,720 THE CLINICAL PRACTICE GUIDELINE 1176 00:58:34,720 --> 00:58:36,040 FOR THE TREATMENT OF LOW BACK 1177 00:58:36,040 --> 00:58:36,280 PAIN. 1178 00:58:36,280 --> 00:58:39,120 WE HAVE A SEPARATE ONE THAT 1179 00:58:39,120 --> 00:58:43,000 TALKS ABOUT JOINT PAIN IN 1180 00:58:43,000 --> 00:58:45,240 PARTICULAR AND THAT SPEAKS MORE 1181 00:58:45,240 --> 00:58:46,680 TO THE ADJUNCT OR OTHER 1182 00:58:46,680 --> 00:58:50,240 ANALGESIC MEDICATIONS AVAILABLE. 1183 00:58:50,240 --> 00:58:51,840 THEY SPEAK TO THE 1184 00:58:51,840 --> 00:58:56,720 NON-PHARMACOLOGIC TREATMENTS AND 1185 00:58:56,720 --> 00:59:04,240 TO THE PAIN CARE. 1186 00:59:04,240 --> 00:59:05,720 THIS WAS LIMITING ITSELF. 1187 00:59:05,720 --> 00:59:06,160 >> THANK YOU FOR THE 1188 00:59:06,160 --> 00:59:08,560 CLARIFICATION. 1189 00:59:08,560 --> 00:59:11,080 I REALLY APPRECIATE THE WORK IN 1190 00:59:11,080 --> 00:59:16,440 CHRONIC PAIN AND THE GUIDELINES 1191 00:59:16,440 --> 00:59:19,200 FOR CHRONIC PAIN. 1192 00:59:19,200 --> 00:59:20,680 I WANTED TO MENTION THE ACUTE 1193 00:59:20,680 --> 00:59:23,480 PAIN AND DID NOT KNOW WHAT YOUR 1194 00:59:23,480 --> 00:59:28,040 PLANS WERE FOR ACUTE PAIN. 1195 00:59:28,040 --> 00:59:29,960 I HAD HEARD OTHER GROUPS BRING 1196 00:59:29,960 --> 00:59:35,400 THIS UP SO THANK YOU FOR WORKING 1197 00:59:35,400 --> 00:59:37,320 WITH ME ON THAT. 1198 00:59:37,320 --> 00:59:42,680 >> I DO WANT TO JUST MAYBE ADD 1199 00:59:42,680 --> 00:59:44,360 ONE COMMENT THAT IS THAT WOE 1200 00:59:44,360 --> 00:59:46,840 CERTAINLY AND OTHERS AS WELL ARE 1201 00:59:46,840 --> 00:59:52,440 TRYING TO BRING THE TREATMENT OF 1202 00:59:52,440 --> 00:59:59,200 OPIOID USE DISORDER WE SEND THEM 1203 00:59:59,200 --> 01:00:01,040 TO A SUBSTANCE USE DISORDER 1204 01:00:01,040 --> 01:00:02,760 SPECIALTY MENTAL HEALTH CLINIC. 1205 01:00:02,760 --> 01:00:04,280 THOSE ARE NEEDED AND EXTREMELY 1206 01:00:04,280 --> 01:00:06,160 VALUABLE AND OTHER LEADERS IN 1207 01:00:06,160 --> 01:00:08,040 THIS REGARD BUT WE TRY TO EXTEND 1208 01:00:08,040 --> 01:00:13,120 BEYOND THAT BY INCORPORATING 1209 01:00:13,120 --> 01:00:15,880 ACCESS TO OPIOID USE DISORDER 1210 01:00:15,880 --> 01:00:18,000 INCLUDING BUPRENORPHINE 1211 01:00:18,000 --> 01:00:20,160 PRESCRIBING TO OUR PAIN CLINICAL 1212 01:00:20,160 --> 01:00:22,200 SETTINGS TO THE EMERGENCY ROOM 1213 01:00:22,200 --> 01:00:23,520 WHERE A TREATMENT CAN BE 1214 01:00:23,520 --> 01:00:23,800 INITIATED. 1215 01:00:23,800 --> 01:00:26,040 IN ORDER TO MAKE SURE WE DON'T 1216 01:00:26,040 --> 01:00:28,760 LOSE PATIENTS DURING THIS 1217 01:00:28,760 --> 01:00:30,760 REFERRAL PROCESS. 1218 01:00:30,760 --> 01:00:33,240 IN AN IN-PATIENT SETTING IT'S 1219 01:00:33,240 --> 01:00:35,440 MORE CONTROLLED BUT IN AN 1220 01:00:35,440 --> 01:00:36,240 OUT-PATIENT SETTING WHERE WE'RE 1221 01:00:36,240 --> 01:00:38,000 MORE DEPENDENT MAKING SURE WE 1222 01:00:38,000 --> 01:00:40,480 HAVE A WARM HANDOFF TO THE 1223 01:00:40,480 --> 01:00:41,120 EVIDENCE-BASED TREATMENT WE ARE 1224 01:00:41,120 --> 01:00:41,680 TRYING TO BRING IT TO THE 1225 01:00:41,680 --> 01:00:51,800 PATIENT. 1226 01:01:01,920 --> 01:01:06,280 >> KATE HAS A QUESTION. 1227 01:01:06,280 --> 01:01:07,880 >> THE GUIDELINE SEEMS TO 1228 01:01:07,880 --> 01:01:12,480 CONTINUE TO GO BEYOND THE 1229 01:01:12,480 --> 01:01:13,920 EXISTING CDC GUIDELINE AND THE 1230 01:01:13,920 --> 01:01:14,720 RECOMMENDATION AGAINST 1231 01:01:14,720 --> 01:01:16,080 PRESCRIBING FOR ALL TYPES OF 1232 01:01:16,080 --> 01:01:17,760 PAIN AND WE KNOW CHRONIC PAIN IS 1233 01:01:17,760 --> 01:01:19,120 A PRETTY BIG RANGE -- INCLUDES A 1234 01:01:19,120 --> 01:01:29,440 RANGE OF CONDITIONS. 1235 01:01:31,040 --> 01:01:35,240 AND 1236 01:01:35,240 --> 01:01:37,240 >> IF YOU LOOK AT THE DETAILS 1237 01:01:37,240 --> 01:01:39,480 THIS IS NOT FOR A PALLIATIVE 1238 01:01:39,480 --> 01:01:39,920 CARE SETTING. 1239 01:01:39,920 --> 01:01:45,880 THOSE PATIENTS ARE INCLUDED IN 1240 01:01:45,880 --> 01:01:47,080 ITSELF. 1241 01:01:47,080 --> 01:01:48,520 THEY'RE NOT GOING TO PREVENT 1242 01:01:48,520 --> 01:01:50,040 SOMEBODY IF THERE'S SITUATIONS 1243 01:01:50,040 --> 01:01:57,080 WHERE OPIOID THERAPY IS NEEDED 1244 01:01:57,080 --> 01:01:59,560 THIS IS NOT IN ANY WAY POLICY 1245 01:01:59,560 --> 01:02:01,080 AND IT'S A DOCUMENT THAT SPEAKS 1246 01:02:01,080 --> 01:02:04,760 TO THE MAJORITY OF SITUATIONS 1247 01:02:04,760 --> 01:02:06,320 BUT THEY HAVE TO BE INDIVIDUAL 1248 01:02:06,320 --> 01:02:07,440 MODIFICATIONS THAT CAN BE DONE 1249 01:02:07,440 --> 01:02:11,120 BUT IT DOES NOT SPEAK AT ALL TO 1250 01:02:11,120 --> 01:02:13,440 HOSPICE CARE, PALLIATIVE CARE OR 1251 01:02:13,440 --> 01:02:14,240 PATIENTS WITH CANCER. 1252 01:02:14,240 --> 01:02:16,240 WE NEED TO UNDERSTAND THE 1253 01:02:16,240 --> 01:02:16,800 LIMITATIONS OF THE PATIENT 1254 01:02:16,800 --> 01:02:17,120 POPULATION. 1255 01:02:17,120 --> 01:02:17,200 1256 01:02:18,920 --> 01:02:29,120 >> THANK YOU. 1257 01:02:32,240 --> 01:02:32,800 >> THANK YOU. 1258 01:02:32,800 --> 01:02:38,440 PERHAPS NEXT YEAR WE CAN GET AN 1259 01:02:38,440 --> 01:02:42,440 UPDATE 1260 01:02:42,440 --> 01:02:45,480 >> WE WILL NOW MOVE TO RIGO FROM 1261 01:02:45,480 --> 01:02:52,160 THE FDA WHO IS GOING TO TELL US 1262 01:02:52,160 --> 01:02:54,240 A BIT ABOUT THE FDA EFFORTS TO 1263 01:02:54,240 --> 01:02:56,160 FOSTER DEVELOPMENT OF NON-OPIOID 1264 01:02:56,160 --> 01:02:57,560 MEDICATIONS FOR ACUTE PAIN 1265 01:02:57,560 --> 01:02:58,200 MANAGEMENT RIGO. 1266 01:02:58,200 --> 01:03:08,440 >> THANK YOU. 1267 01:03:16,480 --> 01:03:24,440 >> THIS SAYS DEVELOPMENT OF 1268 01:03:24,440 --> 01:03:27,200 NON-OPIOID ANALGESICS FOR ACUTE 1269 01:03:27,200 --> 01:03:29,200 PAIN AND THE DOCUMENT RECEIVED A 1270 01:03:29,200 --> 01:03:30,560 VARIETY OF COMMENTS 1271 01:03:30,560 --> 01:03:36,040 APPROXIMATELY 20, 25 OR SO AND 1272 01:03:36,040 --> 01:03:40,000 THEY RANGE FROM PHARMACEUTICALS, 1273 01:03:40,000 --> 01:03:46,120 PHARMACISTS, CLINICIANS, TRADES 1274 01:03:46,120 --> 01:03:47,120 AS WELL AS PATIENT ADVOCACY 1275 01:03:47,120 --> 01:03:57,680 GROUPS AND WHAT DOES A GUIDELINE 1276 01:04:01,160 --> 01:04:02,520 COVER AND MAKING SURE IT'S CLEAR 1277 01:04:02,520 --> 01:04:03,960 WHAT GUIDELINES COVER AND TRYING 1278 01:04:03,960 --> 01:04:05,840 TO MAKE SURE WHAT THE GUIDANCE 1279 01:04:05,840 --> 01:04:14,800 WILL COVER. 1280 01:04:14,800 --> 01:04:18,440 YOU PROVIDE INFORMATION THAT 1281 01:04:18,440 --> 01:04:21,760 WILL APPLY INTO A GREATER SOURCE 1282 01:04:21,760 --> 01:04:24,040 DEGREE OF SITUATIONS AND WE WERE 1283 01:04:24,040 --> 01:04:29,480 GETTING COMMENTS MORE DETAILS 1284 01:04:29,480 --> 01:04:39,960 SHOULD HAVE BEEN PROVIDED AND 1285 01:04:42,120 --> 01:04:46,520 HAVE GUIDANCE FOR A PARTICULAR 1286 01:04:46,520 --> 01:04:48,160 PHARMACEUTICAL COMPANY AND IT 1287 01:04:48,160 --> 01:04:49,200 ASKED FOR CLARIFICATION OF WHAT 1288 01:04:49,200 --> 01:04:50,920 WE DID THINK TO MAKE SURE IT WAS 1289 01:04:50,920 --> 01:04:52,360 CLEAR WHAT WE WERE TRYING TO GET 1290 01:04:52,360 --> 01:04:57,600 AT AND THERE WERE A COUPLE 1291 01:04:57,600 --> 01:05:01,280 COMMENTS THAT TALKED ABOUT 1292 01:05:01,280 --> 01:05:03,960 BRINGING IN THANK YOU TOPICS AND 1293 01:05:03,960 --> 01:05:04,960 BRINGS SCOPE TO THE GUIDANCE. 1294 01:05:04,960 --> 01:05:10,560 I'M NOT GOING TO GO OVER THE 1295 01:05:10,560 --> 01:05:15,320 ENTIRE GUIDANCE THIS IS A PDF 1296 01:05:15,320 --> 01:05:20,720 FILE AVAILABLE AT THE LINK I CAN 1297 01:05:20,720 --> 01:05:24,040 SHARE WITH YOU GUYS. 1298 01:05:24,040 --> 01:05:27,200 IT'S FOR ACUTE PAIN FOR 1299 01:05:27,200 --> 01:05:28,520 NON-OPIOID ANALGESICS. 1300 01:05:28,520 --> 01:05:34,480 WE MAKE A NOTE THERE'S PLANS TO 1301 01:05:34,480 --> 01:05:36,400 WRITE ONE FOR CHRONIC PAIN. 1302 01:05:36,400 --> 01:05:38,000 I WANT TO TALK ABOUT THIS AND 1303 01:05:38,000 --> 01:05:43,200 THERE'S AN INTRODUCTION AND 1304 01:05:43,200 --> 01:05:46,080 BACKGR 1305 01:05:46,080 --> 01:05:47,920 BACKGROUND WITH CONSIDERATION OF 1306 01:05:47,920 --> 01:05:50,200 THE GUIDELINE THE GUIDANCE IS 1307 01:05:50,200 --> 01:05:54,800 AIMED AT INDUSTRY. 1308 01:05:54,800 --> 01:05:56,480 OBVIOUSLY, CLINICIANS WHO ARE 1309 01:05:56,480 --> 01:05:57,440 PARTICIPATING WILL FIND THIS 1310 01:05:57,440 --> 01:06:00,840 USEFUL WITH RESPECT TO OUR 1311 01:06:00,840 --> 01:06:02,520 THINKING ABOUT CLINICAL TRIALS 1312 01:06:02,520 --> 01:06:03,920 AND CLINICAL TRIAL DESIGNS. 1313 01:06:03,920 --> 01:06:06,520 THERE ARE GENERAL CONSIDERATIONS 1314 01:06:06,520 --> 01:06:08,840 INCLUDING ALSO ABOUT WHAT 1315 01:06:08,840 --> 01:06:10,640 OUTCOME MEASURES WE ARE 1316 01:06:10,640 --> 01:06:12,240 CONSIDERING AND SAFETY 1317 01:06:12,240 --> 01:06:12,600 CONSIDERATIONS. 1318 01:06:12,600 --> 01:06:16,960 WE'RE GOING DETAIL ABOUT THAT. 1319 01:06:16,960 --> 01:06:21,600 AND ONE THING THIS FOCUSES ON IS 1320 01:06:21,600 --> 01:06:24,200 THE LATER FACES OF DEVELOPMENT. 1321 01:06:24,200 --> 01:06:28,600 AS YOU WOULD DEVELOPMENT IT 1322 01:06:28,600 --> 01:06:29,760 INVOLVES CLINICAL CHEMISTRY, 1323 01:06:29,760 --> 01:06:32,400 FORMULATION ISSUES IS NOT 1324 01:06:32,400 --> 01:06:33,280 COVERED. 1325 01:06:33,280 --> 01:06:34,560 IT'S SPEAKING TO PHASE 3 TRIALS. 1326 01:06:34,560 --> 01:06:36,480 THE ONES THAT ARE GOING TO BE 1327 01:06:36,480 --> 01:06:42,040 UTILIZED MORE TO DEMONSTRATE THE 1328 01:06:42,040 --> 01:06:52,560 FINAL WE TOUCHED ON THE ISSUE OR 1329 01:06:54,680 --> 01:06:58,480 QUESTION OF A COMPANY'S 1330 01:06:58,480 --> 01:07:00,880 INTERESTED IN TRYING TO 1331 01:07:00,880 --> 01:07:02,200 DEMONSTRATE THE PRODUCT HAS THE 1332 01:07:02,200 --> 01:07:04,160 BUILT TO REDUCE OPIOID USE. 1333 01:07:04,160 --> 01:07:07,600 YOU MAY HAVE HEARD THIS IN A 1334 01:07:07,600 --> 01:07:11,920 COMMON LANGUAGE OUT THERE. 1335 01:07:11,920 --> 01:07:15,000 SOMETHING DESCRIBED AS OPIOID 1336 01:07:15,000 --> 01:07:15,280 SPEARING. 1337 01:07:15,280 --> 01:07:18,320 BETWEEN FRIENDS WE DO USE THE 1338 01:07:18,320 --> 01:07:19,360 TERMINOLOGY. 1339 01:07:19,360 --> 01:07:22,800 OPIOID SPARING IS A LITTLE BIT 1340 01:07:22,800 --> 01:07:23,200 VAGUE. 1341 01:07:23,200 --> 01:07:27,160 FROM A FORMAL PROTOCOL 1342 01:07:27,160 --> 01:07:28,400 DEVELOPMENT DISCUSSION WE DON'T 1343 01:07:28,400 --> 01:07:30,640 USE OPIOID SPARING WE TRY TO 1344 01:07:30,640 --> 01:07:31,800 DESCRIBE WHAT IT IS THEY'RE 1345 01:07:31,800 --> 01:07:34,400 HOPING TO DO WHETHER ELIMINATION 1346 01:07:34,400 --> 01:07:35,800 REDUCING OPIOID USE, ETCETERA. 1347 01:07:35,800 --> 01:07:37,680 WE TALK ABOUT WHAT KIND OF DATA 1348 01:07:37,680 --> 01:07:43,200 ARE NEEDED TO SUPPORT THOSE 1349 01:07:43,200 --> 01:07:53,720 CLAIMS AND AND WE THINK IT'S 1350 01:07:57,040 --> 01:07:59,920 IMPORTANT TO REFLEBLTH CLINICAL 1351 01:07:59,920 --> 01:08:00,160 BENEFIT. 1352 01:08:00,160 --> 01:08:02,600 I THINK MOST OF US WOULD FEEL 1353 01:08:02,600 --> 01:08:03,680 COMFORTABLE THE OPIOID USE IS 1354 01:08:03,680 --> 01:08:10,400 COMPLETELY ELIMINATED IN THAT 1355 01:08:10,400 --> 01:08:11,640 CLINICAL SCENARIO OF BOYD USE BY 1356 01:08:11,640 --> 01:08:15,080 THE PATIENT THAT WOULD BE A 1357 01:08:15,080 --> 01:08:25,400 CLINICAL BENEFIT. 1358 01:08:25,720 --> 01:08:30,760 AND LOOKING AT WHETHER 1359 01:08:30,760 --> 01:08:36,080 ANALGESICS ARE ON BOARD AND WE 1360 01:08:36,080 --> 01:08:39,600 HAVE TALKED ABOUT REDUCING 1361 01:08:39,600 --> 01:08:41,840 ADVERSE EVENTS SOME YOU THINK 1362 01:08:41,840 --> 01:08:43,080 ABOUT ARE THE MORE COMMON 1363 01:08:43,080 --> 01:08:47,440 ADVERSE EVENTS WE SEE WITH 1364 01:08:47,440 --> 01:08:47,680 OPIOIDS. 1365 01:08:47,680 --> 01:08:53,280 THE NAUSEA, VOMITING AND ONE 1366 01:08:53,280 --> 01:08:54,080 ADVISORY COMMITTEE IT WAS 1367 01:08:54,080 --> 01:08:55,880 POINTED OUT, THOSE ARE ADVERSE 1368 01:08:55,880 --> 01:08:58,000 EVENTS BUT THERE'S A SENSE 1369 01:08:58,000 --> 01:08:59,480 UNLESS IT'S AN EXTREME SITUATION 1370 01:08:59,480 --> 01:09:05,040 MOST CAN BE CLINICALLY MANAGED. 1371 01:09:05,040 --> 01:09:07,200 THE INTEREST WAS IN ADVERSE 1372 01:09:07,200 --> 01:09:12,280 EVENTS WITH MORBIDITY AND 1373 01:09:12,280 --> 01:09:22,040 MORTALITY AND DESCRIBED AND WERE 1374 01:09:22,040 --> 01:09:22,560 PERHAPS MORE SIGNIFICANT. 1375 01:09:22,560 --> 01:09:27,240 I DO ACKNOWLEDGE AND THERE'S A 1376 01:09:27,240 --> 01:09:30,560 DESIRE TO FOCUS ON OTHERS. 1377 01:09:30,560 --> 01:09:31,600 WE TALK ABOUT WHAT DATA IS 1378 01:09:31,600 --> 01:09:35,320 NEEDED TO SUPPORT THE LANGUAGE 1379 01:09:35,320 --> 01:09:38,360 AND LABELLING WHICH IS BASICALLY 1380 01:09:38,360 --> 01:09:44,880 WHAT WE TALKED ABOUT. 1381 01:09:44,880 --> 01:09:47,640 I'LL BE HAPPY TO ANSWER ANY 1382 01:09:47,640 --> 01:09:52,840 SPECIFIC QUESTIONS PEOPLE MAY 1383 01:09:52,840 --> 01:09:58,440 HAVE AND I KNOW IT'S 11:10 AND 1384 01:09:58,440 --> 01:10:00,360 WE'RE RUNNING SHORT ON TIME. 1385 01:10:00,360 --> 01:10:03,760 THERE'S A SECTION EXPEDITED 1386 01:10:03,760 --> 01:10:08,080 PROGRAM AND THERE'S A GUIDANCE 1387 01:10:08,080 --> 01:10:10,840 FOR SERIOUS CONDITIONS WHICH 1388 01:10:10,840 --> 01:10:12,440 CONTAINS A LOT OF GOOD 1389 01:10:12,440 --> 01:10:13,120 INFORMATION WHERE BASICALLY 1390 01:10:13,120 --> 01:10:15,320 THERE ARE FOUR THINGS TO 1391 01:10:15,320 --> 01:10:15,560 CONSIDER. 1392 01:10:15,560 --> 01:10:19,720 ONE IS FAST TRACK DESIGNATION. 1393 01:10:19,720 --> 01:10:25,600 THE NEXT IS BREAKTHROUGH THERAPY 1394 01:10:25,600 --> 01:10:28,240 DESIGNATION AND PRIORITY REVIEW 1395 01:10:28,240 --> 01:10:36,880 AND ACCELERATED APPROVAL. 1396 01:10:36,880 --> 01:10:39,400 THAT CAN BE DONE AT ANY TIME IN 1397 01:10:39,400 --> 01:10:40,920 THE IMD PROCESS AND THE 1398 01:10:40,920 --> 01:10:46,440 INDICATION IS LOOKING FOR A 1399 01:10:46,440 --> 01:10:49,760 SERIOUS CONDITION THAT THE 1400 01:10:49,760 --> 01:10:54,200 AVAILABILITY IS MINIMAL OR NON 1401 01:10:54,200 --> 01:10:55,400 EXISTENT AND HAVE SAFETY FOR 1402 01:10:55,400 --> 01:10:57,680 BOTH AND THE DATA THAT NEEDS TO 1403 01:10:57,680 --> 01:11:00,280 SUPPORT THE FAST TRACK 1404 01:11:00,280 --> 01:11:04,000 DESIGNATION CAN BE VERY EARLY. 1405 01:11:04,000 --> 01:11:06,480 AND HAVE ANIMAL STUDIES AS WE 1406 01:11:06,480 --> 01:11:08,240 ALL KNOW ANIMAL STUDIES ARE 1407 01:11:08,240 --> 01:11:10,320 USEFUL BUT SOMETIMES IT'S HARD 1408 01:11:10,320 --> 01:11:13,280 TO TRANSLATE BUT AT A FAST TRACK 1409 01:11:13,280 --> 01:11:13,920 DESIGNATION STAGE WE CONSIDER 1410 01:11:13,920 --> 01:11:24,280 ALL THAT INFORMATION. 1411 01:11:29,720 --> 01:11:30,800 AND GET FAST TRACK DESIGNATION 1412 01:11:30,800 --> 01:11:33,400 AND ALLOWS US TO RECEIVE 1413 01:11:33,400 --> 01:11:39,120 COMMISSIONS FOR THE APPLICATION 1414 01:11:39,120 --> 01:11:44,440 ITSELF WHERE THEY CAN SUBMIT IN 1415 01:11:44,440 --> 01:11:44,760 SECTIONS. 1416 01:11:44,760 --> 01:11:55,320 AND THE LAST PART WOULD BE LESS 1417 01:11:56,720 --> 01:11:59,400 TO REVIEW IN BULK NOW YOU HAVE 1418 01:11:59,400 --> 01:12:00,160 CLINICAL TRIALS THAT 1419 01:12:00,160 --> 01:12:03,080 DEMONSTRATES THE ISSUES WE JUST 1420 01:12:03,080 --> 01:12:03,840 DESCRIBED. 1421 01:12:03,840 --> 01:12:05,720 PRIORITY REVIEW IS SOMETHING 1422 01:12:05,720 --> 01:12:05,920 ELSE. 1423 01:12:05,920 --> 01:12:07,160 IT RELATE TO AFTER THE 1424 01:12:07,160 --> 01:12:08,440 APPLICATION HAS BEEN SUBMITTED 1425 01:12:08,440 --> 01:12:10,120 INSTEAD OF A REGULAR TIME LINE 1426 01:12:10,120 --> 01:12:11,960 OF APPROXIMATELY 10 MONTHS, THEY 1427 01:12:11,960 --> 01:12:14,080 WOULD END UP HAVING A SHORTENED 1428 01:12:14,080 --> 01:12:14,880 REVIEW TIME LINE. 1429 01:12:14,880 --> 01:12:16,160 ONE OF THE THINGS YOU WOULD 1430 01:12:16,160 --> 01:12:19,440 THINK ABOUT IS SOMETHING HAS A 1431 01:12:19,440 --> 01:12:22,120 FAST TRACK DESIGNATION IS 1432 01:12:22,120 --> 01:12:23,120 PROBABLY A HIGH PROBABILITY 1433 01:12:23,120 --> 01:12:24,880 THEY'D GET A PRIORITY REVIEW 1434 01:12:24,880 --> 01:12:25,760 BECAUSE SOME OF THE THINGS YOU 1435 01:12:25,760 --> 01:12:27,760 WOULD HAVE LOOKED FOR IN THE 1436 01:12:27,760 --> 01:12:30,480 PREVIOUS DESIGNATIONS APPLIED 1437 01:12:30,480 --> 01:12:34,880 FOR PRIORITY. 1438 01:12:34,880 --> 01:12:45,440 IT HAS PROMISE AND WITH THE DATA 1439 01:12:47,040 --> 01:12:51,280 COMING IN MAYBE THE HOPE THE 1440 01:12:51,280 --> 01:12:51,720 THI 1441 01:12:51,720 --> 01:12:53,000 THING WE'D LOOK FOR IS NOT THERE 1442 01:12:53,000 --> 01:12:56,440 AND PRIORITY REVIEW IS A 1443 01:12:56,440 --> 01:12:59,480 POSSIBILITY, HIGH PROBABILITY 1444 01:12:59,480 --> 01:13:03,000 AND ACCELERATED APPROVAL AND THE 1445 01:13:03,000 --> 01:13:05,640 ABILL TO APPROVE A PRODUCT BASED 1446 01:13:05,640 --> 01:13:08,440 ON A BIOMARKER. 1447 01:13:08,440 --> 01:13:09,080 GENERALLY THAT'S BECAUSE WITH 1448 01:13:09,080 --> 01:13:15,280 YOU DON'T GENERALLY HAVE A GOOD 1449 01:13:15,280 --> 01:13:19,920 PARAMETER TO ASSESS. 1450 01:13:19,920 --> 01:13:21,480 AND WE ALREADY HAVE GOOD 1451 01:13:21,480 --> 01:13:22,880 CLINICALLY ACCESSIBLE PARAMETERS 1452 01:13:22,880 --> 01:13:26,520 THAT CAN BE MEASURED. 1453 01:13:26,520 --> 01:13:27,400 THOUGH WERE ALWAYS OPEN AND 1454 01:13:27,400 --> 01:13:29,360 WILLING TO LISTEN TO COMPANIES 1455 01:13:29,360 --> 01:13:31,880 COME IN WITH POTENTIAL 1456 01:13:31,880 --> 01:13:33,360 BIOMARKERS, THEY WOULD THEY 1457 01:13:33,360 --> 01:13:34,800 WOULD HAVE TO MAKE GOOD 1458 01:13:34,800 --> 01:13:36,120 ARGUMENTS WHETHER IT SHOULD BE 1459 01:13:36,120 --> 01:13:43,000 THE EFFICACY PARAMETER ASSESSED 1460 01:13:43,000 --> 01:13:45,240 COMPARED TO THE PAIN REDUCTION 1461 01:13:45,240 --> 01:13:47,240 AND ANALGESIC AFFECT AND YOU CAN 1462 01:13:47,240 --> 01:13:49,480 USE A BIOMARKER IN TANDEM BUT 1463 01:13:49,480 --> 01:13:52,080 WHETHER IT WILL BE THE EFFICACY 1464 01:13:52,080 --> 01:13:53,320 PARAMETER TO ALLOW THEM TO BE 1465 01:13:53,320 --> 01:13:54,680 APPROVED WILL BE THE QUESTION 1466 01:13:54,680 --> 01:13:56,080 AND AT THIS POINT THEY WOULD 1467 01:13:56,080 --> 01:14:02,040 HAVE TO ADDRESS ALL THOSE 1468 01:14:02,040 --> 01:14:02,280 ISSUES. 1469 01:14:02,280 --> 01:14:03,600 THAT WAS QUICK AND I WANT TO 1470 01:14:03,600 --> 01:14:05,280 MAKE SURE WE HAVE A CHANCE TO DO 1471 01:14:05,280 --> 01:14:07,440 WHAT WE NEEDED TO DO AND I'LL 1472 01:14:07,440 --> 01:14:08,920 STOP THERE AND SEE IF THERE'S 1473 01:14:08,920 --> 01:14:09,800 SPECIFIC QUESTIONS IF NOT I'LL 1474 01:14:09,800 --> 01:14:20,240 TURN IT BACK TO YOU GUYS. 1475 01:14:23,960 --> 01:14:25,920 >> I'M WONDERING IF THE DOCUMENT 1476 01:14:25,920 --> 01:14:31,400 IS AVAILABLE FOR US TO LOOK 1477 01:14:31,400 --> 01:14:33,320 LIEU? 1478 01:14:33,320 --> 01:14:36,080 >> I CAN PUT THE LINK TO THIS 1479 01:14:36,080 --> 01:14:38,360 FDA.gov REGULATORY INFORMATION. 1480 01:14:38,360 --> 01:14:41,880 I CAN PUT THIS IN THE CHAT AND 1481 01:14:41,880 --> 01:14:44,120 THAT WILL TAKE YOU TO BE ABLE TO 1482 01:14:44,120 --> 01:14:49,280 DOWNLOAD IT AS AS WELL AS WHAT 1483 01:14:49,280 --> 01:14:59,600 THE REGISTER WAS. 1484 01:15:24,720 --> 01:15:28,480 >> THERE YOU GO WE CARN GO TO 1485 01:15:28,480 --> 01:15:30,960 ELIZABETH KATO FOR THE LAST 1486 01:15:30,960 --> 01:15:31,680 UPDATE FOR THIS MORNING. 1487 01:15:31,680 --> 01:15:33,080 >> THIS IS GOING TO BE VERY 1488 01:15:33,080 --> 01:15:36,080 QUICK BUT I WANTED TO LET THE 1489 01:15:36,080 --> 01:15:37,800 COMMITTEE KNOW ABOUT A FEW OF 1490 01:15:37,800 --> 01:15:39,120 THE PROJECTS THAT AHRQ HAS BEEN 1491 01:15:39,120 --> 01:15:42,920 WORKING ON RELATED TO OUR WORK. 1492 01:15:42,920 --> 01:15:45,440 ONE IS THAT OVER THE PAST FEW 1493 01:15:45,440 --> 01:15:48,360 YEARS AHRQ HAS BEEN WORKING ON A 1494 01:15:48,360 --> 01:15:50,120 SUITE OF SYSTEMATIC REVIEWS 1495 01:15:50,120 --> 01:15:51,640 RELATED TO PAIN MANAGEMENT TO 1496 01:15:51,640 --> 01:15:55,120 HELP SUPPORT THE CDC GUIDELINES. 1497 01:15:55,120 --> 01:15:57,120 THOSE ARE NOW OFFICIALLY 1498 01:15:57,120 --> 01:15:58,400 COMPLETE AND AVAILABLE ON THE 1499 01:15:58,400 --> 01:15:59,800 ARC WEBSITE. 1500 01:15:59,800 --> 01:16:01,840 THAT'S OPIOID TREATMENTS FOR 1501 01:16:01,840 --> 01:16:03,880 CHRONIC PAIN, NON-OPIOID 1502 01:16:03,880 --> 01:16:06,480 PHARMACOLOGICAL TREATMENTS FOR 1503 01:16:06,480 --> 01:16:09,400 CHRONIC PAIN AND INVASIVE 1504 01:16:09,400 --> 01:16:11,440 NON-PHARMACOLOGIC TREATMENT AND 1505 01:16:11,440 --> 01:16:12,640 TREATMENT FOR EPISODIC MIGRAINE 1506 01:16:12,640 --> 01:16:15,800 AND IN ADDITION WE HAVE SEMI 1507 01:16:15,800 --> 01:16:19,560 RELATED SYSTEMATIC REVIEW ON 1508 01:16:19,560 --> 01:16:25,360 PLANT-BASED TREME PARTICULARLY 1509 01:16:25,360 --> 01:16:27,800 KRATOM AND CANNABINOIDS. 1510 01:16:27,800 --> 01:16:31,160 WE DO SURVEILLANCE EVERY QUARTER 1511 01:16:31,160 --> 01:16:35,080 AND THE MOST RECENT UPDATE WAS 1512 01:16:35,080 --> 01:16:41,840 SEPTEMBER. 1513 01:16:41,840 --> 01:16:45,000 WE HAVE AN UPCOMING DRAFT UP 1514 01:16:45,000 --> 01:16:46,680 FIELD BUT IS OF INTEREST WHICH 1515 01:16:46,680 --> 01:16:51,760 IS WE'RE GOING SYSTEM JATIC REVW 1516 01:16:51,760 --> 01:16:53,360 FOR HEALTH AND PRIMARY CARE 1517 01:16:53,360 --> 01:16:55,120 WHICH CAN SOMETIMES TOUCH ON 1518 01:16:55,120 --> 01:16:57,880 PAIN MANAGEMENT AND THE DRAFT 1519 01:16:57,880 --> 01:16:59,280 WILL BE AVAILABLE IN HOPEFULLY 1520 01:16:59,280 --> 01:17:03,840 BY MARCH OF 2023 AND WILL BE 1521 01:17:03,840 --> 01:17:05,800 LOOKING FOR FEEDBACK AND INPUT 1522 01:17:05,800 --> 01:17:07,880 BEFORE WE FINDS THAT. 1523 01:17:07,880 --> 01:17:10,240 ANOTHER THING I WANTED TO 1524 01:17:10,240 --> 01:17:13,400 MENTION IS THAT IN THE PAST AHRQ 1525 01:17:13,400 --> 01:17:16,480 HAS DONE STAT BRIEFS ON OPIOID 1526 01:17:16,480 --> 01:17:17,680 PRESCRIBING THROUGH THE SURVEY 1527 01:17:17,680 --> 01:17:18,920 AND WE'VE DECIDED WE'RE GOING 1528 01:17:18,920 --> 01:17:21,120 FOR THE NEXT FEW YEARS WE'RE 1529 01:17:21,120 --> 01:17:23,320 GOING BE DOING ANNUAL UPDATES 1530 01:17:23,320 --> 01:17:25,080 LOOKING AT ANY USE AND FREQUENT 1531 01:17:25,080 --> 01:17:31,800 USE OF OPIOIDS BY AGE AND SOCIO 1532 01:17:31,800 --> 01:17:33,400 ECONOMICS AND WE POSTED ONE LAST 1533 01:17:33,400 --> 01:17:34,320 SPRING AND LOOK OUT IN THE 1534 01:17:34,320 --> 01:17:39,840 SPRING AND THERE SHOULD BE AN 1535 01:17:39,840 --> 01:17:46,920 ANNUAL UPDATE UNTIL THIS IS 1536 01:17:46,920 --> 01:17:48,280 UNDER CONTROL AND NO LONGER AN 1537 01:17:48,280 --> 01:17:48,480 ISSUE. 1538 01:17:48,480 --> 01:17:49,040 WE HAVE GRANTS UNDER THE 1539 01:17:49,040 --> 01:17:52,320 COMMITTEE. 1540 01:17:52,320 --> 01:17:54,480 TWO ARE LOOK AT ADVERSE EVENTS 1541 01:17:54,480 --> 01:17:57,480 ON DRUG INTERACTIONS AND 1542 01:17:57,480 --> 01:17:58,160 OPIOID-RELATED EMERGENCY ROOM 1543 01:17:58,160 --> 01:17:58,680 VISIT. 1544 01:17:58,680 --> 01:18:00,840 PARTICULARLY LOOKING AT SSRI 1545 01:18:00,840 --> 01:18:01,920 INTERACTION AND ANOTHER LOOKING 1546 01:18:01,920 --> 01:18:04,520 AT THE PRESCRIBING OF OPIOIDS AT 1547 01:18:04,520 --> 01:18:05,960 HOSPITAL DISCHARGE AND 1548 01:18:05,960 --> 01:18:09,040 ASSOCIATED ADVERSE PATIENT 1549 01:18:09,040 --> 01:18:11,840 OUTCOMES AND TWO LOOKING AT 1550 01:18:11,840 --> 01:18:12,840 POST-SURGICAL MAIN MANAGEMENT 1551 01:18:12,840 --> 01:18:17,400 USING HIT BUT IN DIFFERENT WAYS. 1552 01:18:17,400 --> 01:18:21,040 ONE IS LOOKING AT PAIRING A TOOL 1553 01:18:21,040 --> 01:18:29,320 WITH A PATIENT-FACING SMART 1554 01:18:29,320 --> 01:18:33,160 PHONE APP AND THE OTHER IS TO 1555 01:18:33,160 --> 01:18:36,520 TAILOR THE POST DISCHARGE 1556 01:18:36,520 --> 01:18:40,200 PRESCRIPTION TO EACH INDIVIDUAL 1557 01:18:40,200 --> 01:18:47,640 PATIENT'S LIKELY NEEDS. 1558 01:18:47,640 --> 01:18:49,520 WE LOOK AT OPIOID 1559 01:18:49,520 --> 01:18:51,120 DISCONTINUATION HOPING IT WILL 1560 01:18:51,120 --> 01:18:56,160 HELP INFORM FUTURE TAPERING 1561 01:18:56,160 --> 01:18:58,280 EFFORTS AND DOING A 1562 01:18:58,280 --> 01:18:58,960 BIOBEHAVIORAL TEAM TRAINING 1563 01:18:58,960 --> 01:18:59,480 PROGRAM. 1564 01:18:59,480 --> 01:19:01,120 WE'LL SEE IF THAT CAN ALSO HELP 1565 01:19:01,120 --> 01:19:11,680 GET A HANDLE ON PAIN MANAGEMENT. 1566 01:19:14,040 --> 01:19:15,440 THAT'S ALL FROM AHRQ AT THE 1567 01:19:15,440 --> 01:19:15,680 MOMENT. 1568 01:19:15,680 --> 01:19:19,160 >> THANK YOU, ELIZABETH. 1569 01:19:19,160 --> 01:19:22,760 ARE THERE QUESTIONS FOR 1570 01:19:22,760 --> 01:19:25,120 ELISABETH? 1571 01:19:25,120 --> 01:19:26,880 >> A QUICK QUESTION AND DO I 1572 01:19:26,880 --> 01:19:29,720 APOLOGIZE FOR BACKGROUND NOISE. 1573 01:19:29,720 --> 01:19:36,640 I WOULD BE CURIOUS AND BUT 1574 01:19:36,640 --> 01:19:38,480 GENERALLY FROM A PROCESS 1575 01:19:38,480 --> 01:19:40,120 PERSPECTIVE WHEN ARE CLINICAL 1576 01:19:40,120 --> 01:19:41,160 GUIDELINES RELEASED I'M CURIOUS 1577 01:19:41,160 --> 01:19:43,120 HOW WE SOCIALIZE THEM AND IF 1578 01:19:43,120 --> 01:19:44,760 THERE'S A PROCESS FOR GETTING 1579 01:19:44,760 --> 01:19:46,240 THEM IN THE HANDS OF COMMITTEES 1580 01:19:46,240 --> 01:19:51,800 AND THINGS LIKE THAT FOR 1581 01:19:51,800 --> 01:19:52,640 STRUCTURING PAYMENT DECISIONS IN 1582 01:19:52,640 --> 01:19:54,040 REAL WORLD SETTINGS. 1583 01:19:54,040 --> 01:19:58,480 I'D BE CURIOUS TO HEAR MORE 1584 01:19:58,480 --> 01:19:59,640 ABOUT THAT. 1585 01:19:59,640 --> 01:20:03,480 >> AHRQ DOES NOT GO CLINICAL 1586 01:20:03,480 --> 01:20:06,080 GUIDELINES WE DO THE BEHIND THE 1587 01:20:06,080 --> 01:20:07,320 SCENES EVIDENCE WORK AND CDC DID 1588 01:20:07,320 --> 01:20:12,400 THESE GUIDELINES. 1589 01:20:12,400 --> 01:20:15,400 WE ALSO DID WORK UNDER THE 1590 01:20:15,400 --> 01:20:23,200 SUPPORT ACT 1003 TO DO SOME 1591 01:20:23,200 --> 01:20:27,080 EVIDENCE SMITHS TO SUPPORT THEIR 1592 01:20:27,080 --> 01:20:32,840 COVERAGE DECISIONS. 1593 01:20:32,840 --> 01:20:34,840 AND WE'RE LIKE INTEL THE CHIP 1594 01:20:34,840 --> 01:20:35,920 INSIDE. 1595 01:20:35,920 --> 01:20:46,320 >> THANK YOU SO MUCH. 1596 01:20:51,000 --> 01:20:53,600 >> I'M WONDERING DO THE AHRQ 1597 01:20:53,600 --> 01:20:54,600 REPORTS INCLUDE RECOMMENDATIONS 1598 01:20:54,600 --> 01:20:56,480 FOR FURTHER RESEARCH? 1599 01:20:56,480 --> 01:20:59,320 >> YES, EACH REPORT HAS A 1600 01:20:59,320 --> 01:21:09,680 SECTION ON RESEARCH GAPS. 1601 01:21:09,680 --> 01:21:11,400 WE CAN PUT THEM IN ONE DOCUMENT 1602 01:21:11,400 --> 01:21:13,600 THAT WOULD BE EASIER FOR 1603 01:21:13,600 --> 01:21:13,920 DISSEMINATION? 1604 01:21:13,920 --> 01:21:20,080 >> THAT WOULD BE FABULOUS, 1605 01:21:20,080 --> 01:21:30,240 ELIZABETH. 1606 01:21:32,320 --> 01:21:32,920 FOR EACH OF THE RECORDS. 1607 01:21:32,920 --> 01:21:43,160 >> THANK YOU. 1608 01:21:48,880 --> 01:21:50,520 >> DID YOU WANT TO SAY ANYTHING 1609 01:21:50,520 --> 01:21:53,600 BEFORE WE WRAP UP? 1610 01:21:53,600 --> 01:21:54,520 WE'RE A LITTLE BIT AHEAD OF 1611 01:21:54,520 --> 01:22:04,680 SCHEDULE. 1612 01:22:05,600 --> 01:22:08,720 >> HEARING ABOUT THE EFFORTS 1613 01:22:08,720 --> 01:22:13,880 GOING ON IN THE THREE 1614 01:22:13,880 --> 01:22:19,720 PRESENTATIONS THAT WE JUST HEARD 1615 01:22:19,720 --> 01:22:24,760 AND WE CAN BE AWARE OF THE 1616 01:22:24,760 --> 01:22:26,800 IMPORTANT WORK AND OUR JOB AT 1617 01:22:26,800 --> 01:22:34,400 THE IS TO SYNERGIZE ALL OF THIS 1618 01:22:34,400 --> 01:22:34,960 AND INTEGRATE. 1619 01:22:34,960 --> 01:22:37,240 I FEEL THESE ARE GREAT EXAMPLES 1620 01:22:37,240 --> 01:22:47,800 AND THINGS THAT ARE REALLY MAKE 1621 01:22:53,520 --> 01:22:55,440 A DIFFERENCE GOING FORWARD. 1622 01:22:55,440 --> 01:22:56,520 WE'LL HAVE TO SEE BUT THE 1623 01:22:56,520 --> 01:23:01,920 IMPORTANT THING IS TO FOR US TO 1624 01:23:01,920 --> 01:23:05,880 LOOK TOGETHER AND SEE HOW IT 1625 01:23:05,880 --> 01:23:06,880 IMPACTS OUR RESPECTIVE EFFORTS 1626 01:23:06,880 --> 01:23:08,200 TO HAVE A MORE COORDINATED 1627 01:23:08,200 --> 01:23:09,600 APPROACH AS A GROUP IS VERY 1628 01:23:09,600 --> 01:23:18,680 ENCOURAGING SO THANK YOU. 1629 01:23:18,680 --> 01:23:20,880 >> ANY LAST COMMENTS OR QUESTION 1630 01:23:20,880 --> 01:23:24,520 OR SHOULD WE MOVE FORWARD? 1631 01:23:24,520 --> 01:23:29,600 WE SHOULD ALSO PUBLISH THE 1632 01:23:29,600 --> 01:23:35,520 DOCUMENT WE BOTH SHARED BECAUSE 1633 01:23:35,520 --> 01:23:38,280 IF IT'S OKAY THEN I'LL MOVE ON 1634 01:23:38,280 --> 01:23:38,920 WITH A LITTLE BIT OF A 1635 01:23:38,920 --> 01:23:49,440 BACKGROUND ON THE NEXT SESSION. 1636 01:23:51,560 --> 01:23:55,880 WE HAD AN EFFORT WITH THIS 1637 01:23:55,880 --> 01:23:57,680 COMMITTEE AND I DON'T THINK 1638 01:23:57,680 --> 01:24:00,320 THERE'S ANYBODY ON THE XT THAT 1639 01:24:00,320 --> 01:24:01,440 WAS HEAR WHEN WE STARTED THE 1640 01:24:01,440 --> 01:24:03,840 PAIN STRATEGY AND THE FOLLOW-UP 1641 01:24:03,840 --> 01:24:06,000 SECTION TO IT THE FEDERAL PAIN 1642 01:24:06,000 --> 01:24:07,080 RESEARCH STRATEGY. 1643 01:24:07,080 --> 01:24:09,120 THIS WAS POSTED SEVERAL YEARS 1644 01:24:09,120 --> 01:24:09,560 AGO. 1645 01:24:09,560 --> 01:24:11,200 A LOT HAS CHANGED SINCE THAT 1646 01:24:11,200 --> 01:24:12,240 RESEARCH STRATEGY CAME OUT SO 1647 01:24:12,240 --> 01:24:14,600 WHAT I'D LIKE TO DO THIS MORNING 1648 01:24:14,600 --> 01:24:16,560 IS TO WALK YOU THROUGH THE 1649 01:24:16,560 --> 01:24:19,440 HISTORY OF HOW THIS RESEARCH 1650 01:24:19,440 --> 01:24:21,240 STRATEGY EVOLVED, WHY THE 1651 01:24:21,240 --> 01:24:23,440 COMMITTEE WAS INVOLVED IN 1652 01:24:23,440 --> 01:24:26,320 OVERSEEING IT AND WHERE WE STAND 1653 01:24:26,320 --> 01:24:27,800 TODAY WITH PROGRESS ON THE 1654 01:24:27,800 --> 01:24:31,120 RECOMMENDATIONS THAT WERE 1655 01:24:31,120 --> 01:24:32,400 EMBEDDED IN THE RESEARCH 1656 01:24:32,400 --> 01:24:32,680 STRATEGY. 1657 01:24:32,680 --> 01:24:38,440 WE ALSO INVITED REBECCA BAKER TO 1658 01:24:38,440 --> 01:24:41,080 JOIN IN AND GIVE US HIGHLIGHTS 1659 01:24:41,080 --> 01:24:43,920 ON THE HEAL PROGRAMS THAT HAVE 1660 01:24:43,920 --> 01:24:46,560 BEEN REALLY IMPORTANT AS FAR AS 1661 01:24:46,560 --> 01:24:50,480 FILLING IN THE GAPS THAT LED TO 1662 01:24:50,480 --> 01:24:52,640 RESEARCH RECOMMENDATIONS THAT 1663 01:24:52,640 --> 01:24:53,360 WERE HIGHLIGHTED IN THE RESEARCH 1664 01:24:53,360 --> 01:24:54,360 STRATEGY. 1665 01:24:54,360 --> 01:24:59,200 SO I'M GOING TO SEE IF I CAN 1666 01:24:59,200 --> 01:25:09,720 QUICKLY OPEN MY SCREEN AND CAN 1667 01:25:37,920 --> 01:25:38,720 YOU SEE THIS? 1668 01:25:38,720 --> 01:25:40,040 >> IT LOOKS GREAT. 1669 01:25:40,040 --> 01:25:42,320 >> THEN I'LL GO FORWARD WITH 1670 01:25:42,320 --> 01:25:43,000 THIS. 1671 01:25:43,000 --> 01:25:48,280 TO BRIEFLY GO BACK IN HISTORY 1672 01:25:48,280 --> 01:25:52,320 AND REMIND YOU THIS COMMITTEE 1673 01:25:52,320 --> 01:25:54,080 WAS FORMED DREW THE AFFORDABLE 1674 01:25:54,080 --> 01:25:57,440 CARE ACT WHICH WAS RELEASED IN 1675 01:25:57,440 --> 01:25:58,080 2010. 1676 01:25:58,080 --> 01:26:01,600 HISTORICALLY THE COMMITTEE GOES 1677 01:26:01,600 --> 01:26:03,400 WAY BACK IN TIME AND A COUPLE 1678 01:26:03,400 --> 01:26:04,920 THEMES THAT WERE REALLY 1679 01:26:04,920 --> 01:26:07,920 IMPORTANT IN THAT AFFORDABLE 1680 01:26:07,920 --> 01:26:11,720 CARE ACT RELATED TO PAIN CARE 1681 01:26:11,720 --> 01:26:13,920 AND RESEARCH WERE THERE WAS A 1682 01:26:13,920 --> 01:26:15,320 PAIN CARE BILL A LOT OF ADVOCACY 1683 01:26:15,320 --> 01:26:16,880 GROUPS WORKED TOGETHER AND 1684 01:26:16,880 --> 01:26:20,920 PROVIDERS FOR YEARS TO TRY TO 1685 01:26:20,920 --> 01:26:23,600 GET PASSED AND EVENTUALLY THE 1686 01:26:23,600 --> 01:26:24,880 PAIN CARE BILL WAS EMBEDDED IN 1687 01:26:24,880 --> 01:26:35,040 THE AFFORDABLE CARE ACT. 1688 01:26:35,040 --> 01:26:37,280 AND THEY CALLED FOR A CONFERENCE 1689 01:26:37,280 --> 01:26:39,240 ON PAIN TO RECOGNIZE PAIN AS A 1690 01:26:39,240 --> 01:26:42,040 SIGNIFICANT HEALTH PROBLEM FOR 1691 01:26:42,040 --> 01:26:45,120 THE PUBLIC HOW WE CARE FOR PAIN, 1692 01:26:45,120 --> 01:26:49,400 THE BARRIERS TO HIGH QUALITY 1693 01:26:49,400 --> 01:26:50,480 PAIN AND ESTABLISH ACTION PLANS 1694 01:26:50,480 --> 01:26:52,200 TO REDUCE THE BARRIERS AND 1695 01:26:52,200 --> 01:26:52,880 IMPROVE PAIN RESEARCH, EDUCATION 1696 01:26:52,880 --> 01:26:57,080 AND CARE. 1697 01:26:57,080 --> 01:26:58,400 THE OTHER BIG PIECE IN THE 1698 01:26:58,400 --> 01:27:00,760 AFFORDABLE CARE ACT RELEVANT TO 1699 01:27:00,760 --> 01:27:05,440 US WAS TO ESTABLISH INTERAGENCY 1700 01:27:05,440 --> 01:27:06,680 PEER RESEARCH COORDINATING 1701 01:27:06,680 --> 01:27:07,040 COMMITTEE. 1702 01:27:07,040 --> 01:27:09,240 HERE WE ARE NEARLY 12, 13 YEARS 1703 01:27:09,240 --> 01:27:09,840 LATER AND OBVIOUSLY A LOT HAS 1704 01:27:09,840 --> 01:27:17,680 HAPPENED. 1705 01:27:17,680 --> 01:27:19,920 SHORTLY AFTER THE PAIN CARE BILL 1706 01:27:19,920 --> 01:27:23,120 CAME OUT THE INSTITUTE OF 1707 01:27:23,120 --> 01:27:25,840 MEDICINE REPORT WAS INITIATED 1708 01:27:25,840 --> 01:27:27,920 AND SUPPORTED BY THE NIH AND SO 1709 01:27:27,920 --> 01:27:30,680 THERE WAS A ONE-YEAR TURNAROUND 1710 01:27:30,680 --> 01:27:33,360 ON THIS REPORT REALLY FAST, 1711 01:27:33,360 --> 01:27:35,800 REALLY AGGRESSIVE, SUPER 1712 01:27:35,800 --> 01:27:37,640 WONDERFUL AND ENGAGED GROUP OF 1713 01:27:37,640 --> 01:27:39,840 PEOPLE THAT HELPED PUT THAT 1714 01:27:39,840 --> 01:27:43,840 REPORT TOGETHER IN A SHORT TIME 1715 01:27:43,840 --> 01:27:44,040 FRAME. 1716 01:27:44,040 --> 01:27:49,080 THAT IS RELIEVING PAIN IN 1717 01:27:49,080 --> 01:27:51,800 AMERICA FROM 2011 AND HAD 1718 01:27:51,800 --> 01:27:56,680 HIGH-LEVEL S -- LEVEL 1719 01:27:56,680 --> 01:27:58,000 RECOMMENDATION OF 1720 01:27:58,000 --> 01:27:58,640 RECOMMENDATIONS GOING TO THE 1721 01:27:58,640 --> 01:28:00,000 AGENCY SUPPORT PAIN RESEARCH AND 1722 01:28:00,000 --> 01:28:02,160 BEYOND WAS THE SECRETARY SHOULD 1723 01:28:02,160 --> 01:28:05,480 DEVELOP A COMPREHENSIVE 1724 01:28:05,480 --> 01:28:06,400 POPULATION-LEVEL STRATEGY FOR 1725 01:28:06,400 --> 01:28:07,560 PREVENTION OF PAIN, TREATMENT OF 1726 01:28:07,560 --> 01:28:10,560 PAIN, MANAGEMENT OF PAIN, 1727 01:28:10,560 --> 01:28:15,800 EDUCATION AND PAIN CARE AND AT 1728 01:28:15,800 --> 01:28:17,640 THE PUBLIC LEVEL REIMBURSEMENT 1729 01:28:17,640 --> 01:28:19,240 FOR PAIN AND RESEARCH, GOALS, 1730 01:28:19,240 --> 01:28:19,760 ACTIONS, TIME FRAMES AND 1731 01:28:19,760 --> 01:28:24,440 RESOURCES. 1732 01:28:24,440 --> 01:28:26,520 THAT LED TO OVERSEEING THE PAIN 1733 01:28:26,520 --> 01:28:26,960 STRATEGY. 1734 01:28:26,960 --> 01:28:29,760 THAT WAS PUBLISHED IN 2016 ABOUT 1735 01:28:29,760 --> 01:28:35,120 THE SAME TIME AS THE CDC 1736 01:28:35,120 --> 01:28:36,760 GUIDELINES AND AS PART OF THE 1737 01:28:36,760 --> 01:28:40,640 WAY OF FORMATTING HOW WE DID 1738 01:28:40,640 --> 01:28:43,720 THAT WAS THAT THE FOLKS WHO 1739 01:28:43,720 --> 01:28:45,720 HELPED US ON THE NATIONAL PAIN 1740 01:28:45,720 --> 01:28:48,760 STRATEGY WHICH WERE 80 OR MORE 1741 01:28:48,760 --> 01:28:50,800 EXPERTS FROM OUTSIDE THAT WERE 1742 01:28:50,800 --> 01:28:55,000 CARE PROVIDERS, EDUCATORS, 1743 01:28:55,000 --> 01:29:00,040 PEOPLE WITH LIVED EXPERIENCE. 1744 01:29:00,040 --> 01:29:02,120 LIKE, RESEARCHERS AND THEY PUT 1745 01:29:02,120 --> 01:29:04,760 TOGETHER A DOCUMENT THAT MADE 1746 01:29:04,760 --> 01:29:06,760 HIGH-LEVEL SET OF CRITERIA HOW 1747 01:29:06,760 --> 01:29:09,360 TO MOVE FORWARD STEP WISE TO 1748 01:29:09,360 --> 01:29:12,560 IMPROVE ALL THOSE AREAS OF PAIN 1749 01:29:12,560 --> 01:29:14,800 CARE AND PAIN EDUCATION AND PAIN 1750 01:29:14,800 --> 01:29:18,520 PERCEPTION THAT WERE PART OF THE 1751 01:29:18,520 --> 01:29:20,240 SECRETARY'S MANDATE. 1752 01:29:20,240 --> 01:29:22,600 WHAT WE DID LATER BECAUSE IT WAS 1753 01:29:22,600 --> 01:29:23,720 ANOTHER BIG EFFORT AND WOULD 1754 01:29:23,720 --> 01:29:25,560 TAKE WHAT WE THOUGHT WOULD BE A 1755 01:29:25,560 --> 01:29:30,440 DIFFERENT SET OF SUBJECT MATTER 1756 01:29:30,440 --> 01:29:31,520 EXPERTS THAT WOULD BE NEEDED TO 1757 01:29:31,520 --> 01:29:37,040 HELP WITH THAT, WE PUT THE 1758 01:29:37,040 --> 01:29:38,240 RESEARCH STRATEGY AFTER TIME 1759 01:29:38,240 --> 01:29:39,800 WISE ON THE NATIONAL PAIN 1760 01:29:39,800 --> 01:29:40,560 STRATEGY ITSELF. 1761 01:29:40,560 --> 01:29:42,960 THEY'RE DEFINITELY LINKED 1762 01:29:42,960 --> 01:29:43,240 TOGETHER. 1763 01:29:43,240 --> 01:29:45,200 WE CONSIDER THE PAIN RESEARCH 1764 01:29:45,200 --> 01:29:47,560 STRATEGY A CRUCIAL COMPONENT OF 1765 01:29:47,560 --> 01:29:49,400 THE NATIONAL PAIN STRATEGY. 1766 01:29:49,400 --> 01:29:51,680 A SEPARATE DOCUMENT MORE 1767 01:29:51,680 --> 01:29:56,320 TARGETED TO THE FEDERAL AGENCIES 1768 01:29:56,320 --> 01:30:00,040 THAT SUPPORT PAIN RESEARCH AND 1769 01:30:00,040 --> 01:30:01,920 VERY IMPORTANT AS FAR AS MOVING 1770 01:30:01,920 --> 01:30:03,640 FORWARD TO STRATEGIES ON WHAT 1771 01:30:03,640 --> 01:30:04,560 PAIN RESEARCH AREAS NEEDED 1772 01:30:04,560 --> 01:30:05,160 ATTENTION AND NEEDED TO MOVE 1773 01:30:05,160 --> 01:30:12,760 FORWARD. 1774 01:30:12,760 --> 01:30:16,080 THAT SAID WE PULLED TOGETHER 1775 01:30:16,080 --> 01:30:18,000 ANOTHER SET OF EXPERTS AND FIRST 1776 01:30:18,000 --> 01:30:20,760 TALKED ABOUT HOW WE SHOULD SET 1777 01:30:20,760 --> 01:30:24,200 UP THE FEDERAL PAIN STRATEGY 1778 01:30:24,200 --> 01:30:25,240 RESEARCH STRATEGY AND CAME UP 1779 01:30:25,240 --> 01:30:28,000 WITH THIS PLAN WE WOULD LOOK AT 1780 01:30:28,000 --> 01:30:29,440 RESEARCH GAPS IN THE AREAS THAT 1781 01:30:29,440 --> 01:30:33,680 WOULD GO ALL THE WAY FROM 1782 01:30:33,680 --> 01:30:37,600 PREVENTION OF PAIN AT THE ACUTE 1783 01:30:37,600 --> 01:30:39,520 AND CHRONIC LEVELS AND PRIMARY, 1784 01:30:39,520 --> 01:30:45,440 SECONDARY AND TERTIARY 1785 01:30:45,440 --> 01:30:46,360 PREVENTION AND CHRONIC PAIN PAIN 1786 01:30:46,360 --> 01:30:47,000 MANAGE 1787 01:30:47,000 --> 01:30:48,920 THE AND HIGH IMPACT CHRONIC PAIN 1788 01:30:48,920 --> 01:30:52,440 AS THE NEXT STEP TO CHRONIC PAIN 1789 01:30:52,440 --> 01:30:54,040 THAT WAS LESS LABELLING, IF YOU 1790 01:30:54,040 --> 01:30:58,840 WILL, FOR THE PERSON WITH PAIN. 1791 01:30:58,840 --> 01:31:04,440 WITH ALSO LOOKED AT DISPARITIES 1792 01:31:04,440 --> 01:31:08,680 IN PAIN CARE AND DIFFERENCES IN 1793 01:31:08,680 --> 01:31:09,480 POPULATIONS LOOK FORWARD TO 1794 01:31:09,480 --> 01:31:11,200 HEALTH DISPARITIES. 1795 01:31:11,200 --> 01:31:13,480 WE CALL THIS THE CONTINUUM OF 1796 01:31:13,480 --> 01:31:13,680 PAIN. 1797 01:31:13,680 --> 01:31:15,520 I DON'T THINK EVERYONE SEES IT 1798 01:31:15,520 --> 01:31:18,680 AS A CONTINUUM BUT FOR PURPOSES 1799 01:31:18,680 --> 01:31:22,560 OF THE REPORT AND WE ASKED THE 1800 01:31:22,560 --> 01:31:24,560 QUESTIONS OF FIRST, HOW DO WE 1801 01:31:24,560 --> 01:31:28,880 LOOK AT THE GAPS AND DESCRIBE 1802 01:31:28,880 --> 01:31:30,400 HOW WE SHOULD PROCEED WITH 1803 01:31:30,400 --> 01:31:31,600 DEFINING THEM AND GROUPING THEM, 1804 01:31:31,600 --> 01:31:41,840 IF YOU WILL. 1805 01:31:58,600 --> 01:32:02,760 WHAT HAPPENS WHEN YOU HAVE PAIN 1806 01:32:02,760 --> 01:32:03,240 AND WHY -- 1807 01:32:03,240 --> 01:32:05,920 >> THE SLIDES ARE GONE. 1808 01:32:05,920 --> 01:32:06,720 I CAN'T SEE THEM. 1809 01:32:06,720 --> 01:32:08,560 >> YOU CAN NO LONGER STE THE 1810 01:32:08,560 --> 01:32:08,840 SCREENING? 1811 01:32:08,840 --> 01:32:19,160 >> NOT YOUR SLIDES. 1812 01:32:59,360 --> 01:33:03,320 >> WE BROUGHT YOUR SLIDES UP. 1813 01:33:03,320 --> 01:33:09,000 >> SO IN THIS WE LOOKED AT A 1814 01:33:09,000 --> 01:33:09,440 RESEARCH PERSPECTIVE. 1815 01:33:09,440 --> 01:33:11,440 THE BASIC SCIENCE COMPONENTS AND 1816 01:33:11,440 --> 01:33:14,400 THE CLINICAL SCIENCE AND THE 1817 01:33:14,400 --> 01:33:17,040 MECHANISTIC OR THE CLINICAL 1818 01:33:17,040 --> 01:33:18,400 IMPLICATIONS OF THE RESEARCH AND 1819 01:33:18,400 --> 01:33:20,080 UNDERSTANDING THE MECHANISMS AND 1820 01:33:20,080 --> 01:33:21,720 TRANSLATING THOSE MECHANISMS TO 1821 01:33:21,720 --> 01:33:23,280 HOW WE WOULD BEST TREAT PAIN 1822 01:33:23,280 --> 01:33:23,920 THROUGH INFORMING IT THROUGH THE 1823 01:33:23,920 --> 01:33:31,600 RESEARCH. 1824 01:33:31,600 --> 01:33:33,120 WE NEEDED TO LOOK AT THE 1825 01:33:33,120 --> 01:33:34,200 PORTFOLIO WE ALREADY HAD AND 1826 01:33:34,200 --> 01:33:36,560 SHARE THAT WITH THE EXPERTS 1827 01:33:36,560 --> 01:33:39,120 HELPING US TO LOOK AT THE GAPS 1828 01:33:39,120 --> 01:33:40,800 IN THE PORTFOLIO AND MAKE 1829 01:33:40,800 --> 01:33:42,160 RECOMMENDATIONS OF WHERE WE 1830 01:33:42,160 --> 01:33:45,160 NEEDED MOST TO MOVE FORWARD WITH 1831 01:33:45,160 --> 01:33:52,280 THE FEDERAL RESEARCH AGENDA. 1832 01:33:52,280 --> 01:33:54,800 WE AT ONE POINT HAD AN EXTENSIVE 1833 01:33:54,800 --> 01:34:00,400 WAY OF LOOKING AT A RESEARCH 1834 01:34:00,400 --> 01:34:05,600 PORTFOLIO AND SLICING IT UP AND 1835 01:34:05,600 --> 01:34:09,320 LOOKING AT THE TYPE OF RESEARCH 1836 01:34:09,320 --> 01:34:13,200 INTO THE BOXES ON THE LEFT SIDE. 1837 01:34:13,200 --> 01:34:14,880 EIGHT OF HAND CURATION TO FIGURE 1838 01:34:14,880 --> 01:34:20,480 OUT HOW AND WHAT WE HAD IN THE 1839 01:34:20,480 --> 01:34:21,960 RESEARCH PORTFOLIO TOE LEAD UP 1840 01:34:21,960 --> 01:34:23,880 TO IDENTIFYING GAPS AND MAKE 1841 01:34:23,880 --> 01:34:28,560 RECOMMENDATIONS MOVING THE 1842 01:34:28,560 --> 01:34:34,640 AGENDA FORWARD. 1843 01:34:34,640 --> 01:34:37,160 THIS SHOWS YOU A BIT OF THE 1844 01:34:37,160 --> 01:34:43,960 FINAL OUTPUT, IF YOU WILL, OF 1845 01:34:43,960 --> 01:34:46,200 RESEARCH RECOMMENDATIONS AND SO 1846 01:34:46,200 --> 01:34:47,360 AS WE WENT THROUGH THE WORK 1847 01:34:47,360 --> 01:34:50,440 GROUPS, THE PREVENTION OF PAIN, 1848 01:34:50,440 --> 01:34:55,840 ACUTE PAIN, CHRONIC PAIN AND 1849 01:34:55,840 --> 01:35:06,160 DESPAI 1850 01:35:06,160 --> 01:35:06,640 DESPA 1851 01:35:06,640 --> 01:35:07,520 DESPA 1852 01:35:07,520 --> 01:35:10,480 DESPAIRS -- DISPARITIES AND 1853 01:35:10,480 --> 01:35:11,920 GOING THROUGH A PROCESS TO 1854 01:35:11,920 --> 01:35:13,360 PRIORITIZE THE RECOMMENDATIONS 1855 01:35:13,360 --> 01:35:18,760 INCLUDING ONE WHERE WE ASKED ALL 1856 01:35:18,760 --> 01:35:22,520 THE GROUPS TO RANK WHAT CAME OUT 1857 01:35:22,520 --> 01:35:24,120 FROM ACROSS THE WORK GROUPS AND 1858 01:35:24,120 --> 01:35:26,160 PUT THEM INTO A SET OF TOP 1859 01:35:26,160 --> 01:35:26,960 PRIORITY RECOMMENDATIONS. 1860 01:35:26,960 --> 01:35:29,480 SO THE GOVERNMENT AGENCIES WHO 1861 01:35:29,480 --> 01:35:34,480 WERE PUTTING TOGETHER THEIR 1862 01:35:34,480 --> 01:35:37,200 STRATE 1863 01:35:37,200 --> 01:35:40,200 STRATEGIES AND MOVE FORWARD IN 1864 01:35:40,200 --> 01:35:41,600 INTO AREAS OF PAIN RESEARCH. 1865 01:35:41,600 --> 01:35:45,120 IF YOU COULD MAKE A COUPLE MORE 1866 01:35:45,120 --> 01:35:50,200 CLIPS TO ADVANCE THE SLIDE. 1867 01:35:50,200 --> 01:35:52,280 THIS WAS THE SET OF PRIORITIES 1868 01:35:52,280 --> 01:35:54,600 THAT WERE DECIDED AS THE TOP 1869 01:35:54,600 --> 01:35:56,560 MOST IMPORTANT PRIORITIES FOR 1870 01:35:56,560 --> 01:35:59,720 PAIN RESEARCH AT THE TIME. 1871 01:35:59,720 --> 01:36:04,440 AND THIS WAS COMPLETED IN 2018 1872 01:36:04,440 --> 01:36:07,000 AND YOU CAN SEE HERE THERE ARE 1873 01:36:07,000 --> 01:36:10,440 ONLY A FEW OF THESE IN ITALICS. 1874 01:36:10,440 --> 01:36:12,880 QUICKLY LOOKING THROUGH THESE. 1875 01:36:12,880 --> 01:36:15,640 THE ITALICIZED ONES ARE WHEN WE 1876 01:36:15,640 --> 01:36:17,840 DO A CROSS WITH WHAT WAS 1877 01:36:17,840 --> 01:36:19,560 RECOMMENDATIONS FOR YEARS AGO IN 1878 01:36:19,560 --> 01:36:21,760 THE RESEARCH STRATEGY AND WHAT 1879 01:36:21,760 --> 01:36:23,120 WE'VE ACCOMPLISHED SO FAR AS 1880 01:36:23,120 --> 01:36:25,400 MOVING THE RESEARCH GAPS 1881 01:36:25,400 --> 01:36:28,760 FORWARD. 1882 01:36:28,760 --> 01:36:39,280 IT'S THE I TAL -- I TALICIZED 1883 01:36:50,280 --> 01:36:53,800 ONES AND WHAT NEEDED TO BE DONE 1884 01:36:53,800 --> 01:36:55,840 AND THE PREVENTION GROUP SAID 1885 01:36:55,840 --> 01:36:56,720 THE ASSOCIATION BETWEEN 1886 01:36:56,720 --> 01:36:58,160 PREVENTION AND INTERVENTION 1887 01:36:58,160 --> 01:37:00,120 FACTORS OF HOW WE COULD HELP 1888 01:37:00,120 --> 01:37:03,160 PREVENT PAIN AT THE ACUTE STAGE, 1889 01:37:03,160 --> 01:37:05,280 THE ACUTE PAIN MANAGEMENT WANTED 1890 01:37:05,280 --> 01:37:06,360 US TO -- THOUGHT IT WAS 1891 01:37:06,360 --> 01:37:08,960 IMPORTANT TO LOOK AT THE 1892 01:37:08,960 --> 01:37:11,160 CIRCUITRY AND IT INVOLVED TO 1893 01:37:11,160 --> 01:37:14,720 BETTER TARGET THERAPIES, 1894 01:37:14,720 --> 01:37:16,520 TRANSITION AND LOOK AT THE 1895 01:37:16,520 --> 01:37:19,520 PLASTICITY MECHANISMS THAT 1896 01:37:19,520 --> 01:37:23,640 PROMOTE PERSISTENT PAIN OR 1897 01:37:23,640 --> 01:37:25,040 RESILIENCE TO PAIN, CHRONIC PAIN 1898 01:37:25,040 --> 01:37:28,440 MECHANISMS AS IS YOU STAINED OR 1899 01:37:28,440 --> 01:37:31,760 RESOLVED CHRONIC PAIN AND HOW 1900 01:37:31,760 --> 01:37:34,600 THEY MIGHT BE MODULATED AND THE 1901 01:37:34,600 --> 01:37:36,560 DISPARITIES GROUP THE MOST 1902 01:37:36,560 --> 01:37:38,760 IMPORTANT THING INVESTIGATE THE 1903 01:37:38,760 --> 01:37:40,840 BIOLOGICAL, PSYCHOSOCIAL 1904 01:37:40,840 --> 01:37:42,640 MECHANISMS THAT CONTRIBUTE TO 1905 01:37:42,640 --> 01:37:46,040 POPULATION DIFFERENCES IN 1906 01:37:46,040 --> 01:37:46,920 DIFFERENT GROUPS WITH HEALTH 1907 01:37:46,920 --> 01:37:49,160 CARE DISPARITIES. 1908 01:37:49,160 --> 01:37:54,560 THE NEXT SLIDE IS A SLIGHTLY 1909 01:37:54,560 --> 01:37:55,880 DIFFERENT WAY AND WHAT 1910 01:37:55,880 --> 01:37:56,640 RECOMMENDATIONS SHOULD MOVE 1911 01:37:56,640 --> 01:38:02,560 FORWARD FIRST IS WHAT THIS SLIDE 1912 01:38:02,560 --> 01:38:12,720 ADDRESSES. 1913 01:38:18,680 --> 01:38:22,520 AND MOVING THEM FORWARD AND THE 1914 01:38:22,520 --> 01:38:23,520 RECOMMENDATIONS HERE ARE 1915 01:38:23,520 --> 01:38:28,400 DIFFERENT AND PERHAPS MORE 1916 01:38:28,400 --> 01:38:28,840 URGENT, IF YOU WILL. 1917 01:38:28,840 --> 01:38:33,760 AS WE RUN THROUGH THE NEXT 1918 01:38:33,760 --> 01:38:35,800 SEVERAL SLIDES, WHAT WE DID WAS 1919 01:38:35,800 --> 01:38:38,480 MERGE THE RECOMMENDATIONS 1920 01:38:38,480 --> 01:38:39,640 TOGETHER IN ORDER TO LOOK AT 1921 01:38:39,640 --> 01:38:42,200 WHAT WE HAVE BEEN ABLE TO DO 1922 01:38:42,200 --> 01:38:46,800 MOVING THE RESEARCH AGENDA 1923 01:38:46,800 --> 01:38:48,640 ACROSS THE FEDERAL GOVERNMENT 1924 01:38:48,640 --> 01:38:51,080 FORWARD OVER THE NEXT FOUR YEARS 1925 01:38:51,080 --> 01:38:53,920 AND DID A CROSSWALK AND TRIED TO 1926 01:38:53,920 --> 01:38:56,920 FIT IN WITH A RECOMMENDATION HOW 1927 01:38:56,920 --> 01:38:59,880 THE WORK GROUP DESCRIBED THE 1928 01:38:59,880 --> 01:39:05,040 GAP, THE PRIMARY RECOMMENDATION 1929 01:39:05,040 --> 01:39:09,800 DESCRIPTION THEY PUT FORWARD AND 1930 01:39:09,800 --> 01:39:12,600 TO GIVE YOU EXAMPLES OF WHERE 1931 01:39:12,600 --> 01:39:14,400 OUR CURRENT RESEARCH HELPED TO 1932 01:39:14,400 --> 01:39:16,200 FILL THE GAPS AND WHERE THE 1933 01:39:16,200 --> 01:39:17,720 SUPPORT CAME IN ORDER TO DO 1934 01:39:17,720 --> 01:39:18,000 THAT. 1935 01:39:18,000 --> 01:39:19,480 SO THERE'S A LOT OF INFORMATION 1936 01:39:19,480 --> 01:39:20,520 IN THE NEXT COUPLE SLIDES. 1937 01:39:20,520 --> 01:39:24,920 I TRIED TO KEEP IT HIGH LEVEL 1938 01:39:24,920 --> 01:39:27,200 BUT WE CAN SHARE THE CROSSWALK 1939 01:39:27,200 --> 01:39:27,680 WITH YOU. 1940 01:39:27,680 --> 01:39:29,680 WE CAN ALSO SHARE THE LINK WITH 1941 01:39:29,680 --> 01:39:31,800 THE RESEARCH STRATEGY SO YOU CAN 1942 01:39:31,800 --> 01:39:33,720 KIND OF SEE HOW THIS 1943 01:39:33,720 --> 01:39:36,000 PRESENTATION IS ORGANIZED BUT 1944 01:39:36,000 --> 01:39:39,000 THE RESEARCH STRATEGY ALSO AS A 1945 01:39:39,000 --> 01:39:42,160 REMINDER, HAS A LOT OF OTHER 1946 01:39:42,160 --> 01:39:43,200 RECOMMENDATIONS THAT DON'T FALL 1947 01:39:43,200 --> 01:39:47,160 INTO THE TOP PRIORITY, THE 1948 01:39:47,160 --> 01:39:49,320 GREATEST VALUE OR HIGH IMPACT 1949 01:39:49,320 --> 01:39:50,600 RECOMMENDATIONS AND THEY'RE NOT 1950 01:39:50,600 --> 01:39:56,840 LISTS -- LISTED HERE TODAY IN 1951 01:39:56,840 --> 01:39:57,840 THE PRESENTATION. 1952 01:39:57,840 --> 01:40:01,280 I TRIED TO ORGANIZE THESE A 1953 01:40:01,280 --> 01:40:02,640 LITTLE BIT MECHANISTIC 1954 01:40:02,640 --> 01:40:05,160 PRIORITIES TOGETHER AND MORE 1955 01:40:05,160 --> 01:40:06,280 CLINICALLY RELATED PRIORITIES 1956 01:40:06,280 --> 01:40:12,080 TOGETHER TO MAKE IT EASIER TO 1957 01:40:12,080 --> 01:40:22,600 DIGEST ALL THIS INFORMATION AND 1958 01:40:23,120 --> 01:40:24,560 THESE ARE RELATED IN THE NEXT 1959 01:40:24,560 --> 01:40:26,320 SLIDES AND THE PRIORITIES ARE 1960 01:40:26,320 --> 01:40:32,280 LISTED HERE IN THE MIDDLE OF THE 1961 01:40:32,280 --> 01:40:35,440 COLUMN AND THE PROGRAMS AT NIH 1962 01:40:35,440 --> 01:40:38,680 OR AGENCIES THAT ADDRESSED THESE 1963 01:40:38,680 --> 01:40:39,880 AND GAP PRIORITY AND THE 1964 01:40:39,880 --> 01:40:41,320 RECOMMENDATION AND THE PROGRAMS 1965 01:40:41,320 --> 01:40:47,360 THAT HAVE AT LEAST IN PART IF 1966 01:40:47,360 --> 01:40:49,720 NOT ADDRESSED THE PRIORITY 1967 01:40:49,720 --> 01:40:50,440 RECOMMENDATIONS IN THE PAIN 1968 01:40:50,440 --> 01:40:54,400 RESEARCH STRATEGY AND ON THE FAR 1969 01:40:54,400 --> 01:40:58,200 RIGHT HAND COLUMN ARE THE 1970 01:40:58,200 --> 01:40:59,800 SOURCES OF SUPPORT FOR THE 1971 01:40:59,800 --> 01:41:03,840 PROGRAMS ADDRESSING THE 1972 01:41:03,840 --> 01:41:04,240 PRIORITIES. 1973 01:41:04,240 --> 01:41:06,480 THIS IS VERY NIH CENTRIC AND 1974 01:41:06,480 --> 01:41:09,320 HEAL HAS MADE AN ENORMOUS 1975 01:41:09,320 --> 01:41:14,440 CONTRIBUTION TO FILLING IN SOME 1976 01:41:14,440 --> 01:41:17,880 OF THE GAPS THROUGH THEIR VISION 1977 01:41:17,880 --> 01:41:18,720 FOR LARGER COMPREHENSIVE 1978 01:41:18,720 --> 01:41:20,200 PROGRAMS AND WITH THE SUPPORT 1979 01:41:20,200 --> 01:41:21,680 THEY RECEIVED FOR THE FEDERAL 1980 01:41:21,680 --> 01:41:23,160 GOVERNMENT AND LAUNCHED THE HEAL 1981 01:41:23,160 --> 01:41:33,440 PROGRAM IN 2018. 1982 01:41:40,480 --> 01:41:42,040 IF WE LOOKED AT THE PROPERTIES 1983 01:41:42,040 --> 01:41:45,600 OF THE UNIQUE CIRCUITS OR CELLS, 1984 01:41:45,600 --> 01:41:48,720 THE PRIORITY WAS TO LOOK AT THE 1985 01:41:48,720 --> 01:41:51,080 HETEROGENEITY OF THE CIRCUITRY 1986 01:41:51,080 --> 01:41:53,040 AND WHAT LOADS TO HETEROGENEITY 1987 01:41:53,040 --> 01:41:55,440 IN PAIN SENSATIONS. 1988 01:41:55,440 --> 01:41:56,560 RATHER THAN THROUGH READ THROUGH 1989 01:41:56,560 --> 01:41:57,760 EACH PRIORITY I THINK WHAT I'D 1990 01:41:57,760 --> 01:42:00,520 LIKE TO DO IS TELL YOU A LITTLE 1991 01:42:00,520 --> 01:42:06,040 BIT ABOUT THE PROGRAMS THAT THAT 1992 01:42:06,040 --> 01:42:07,000 ADDRESS THE PRIORITIES. 1993 01:42:07,000 --> 01:42:09,440 THE INSTITUTES AND CENTERS AND 1994 01:42:09,440 --> 01:42:11,800 THROUGH OUR SMALL BUSINESS PLAN 1995 01:42:11,800 --> 01:42:14,680 AWARDS HAVE DONE A LOT TO LOOK 1996 01:42:14,680 --> 01:42:19,960 AT THE CIRCUITRY INVOLVED IN 1997 01:42:19,960 --> 01:42:24,200 PAIN THE BRAIN INITIATIVE HAS 1998 01:42:24,200 --> 01:42:25,960 DONE A LOT TO LOOK AT CIRCUITRY 1999 01:42:25,960 --> 01:42:28,040 IN GENERAL IN THE BRAIN AND 2000 01:42:28,040 --> 01:42:29,960 SEVERAL OF THOSE PROGRAMS AND 2001 01:42:29,960 --> 01:42:34,400 PROJECTS ARE RELATED TO PAIN 2002 01:42:34,400 --> 01:42:35,120 CIRCUITRY. 2003 01:42:35,120 --> 01:42:37,000 ONE SPECIFIC PROGRAM THROUGH 2004 01:42:37,000 --> 01:42:39,280 HEAL IS CALLED REJOIN WHICH WILL 2005 01:42:39,280 --> 01:42:41,840 LOOK AT IMPLICATIONS OF 2006 01:42:41,840 --> 01:42:42,800 INNERVATIONS OF PAIN IN 2007 01:42:42,800 --> 01:42:45,040 DIFFERENT JOINT STRUCTURES. 2008 01:42:45,040 --> 01:42:49,480 AND NCATS HAS A HUMAN TISSUES 2009 01:42:49,480 --> 01:42:50,480 MODEL PROGRAM FOR SCREENING 2010 01:42:50,480 --> 01:42:52,120 DIFFERENT ASSETS THAT MIGHT COME 2011 01:42:52,120 --> 01:42:56,680 IN DEVELOPING PAIN MODELS IN 2012 01:42:56,680 --> 01:42:57,840 HUMAN TISSUE MODELS OF CIRCUITRY 2013 01:42:57,840 --> 01:42:58,960 AND PAIN. 2014 01:42:58,960 --> 01:43:01,880 THERE'S A NEW PROGRAM LAUNCHING 2015 01:43:01,880 --> 01:43:07,800 ON MYOFASCIAL PAIN MEASURES 2016 01:43:07,800 --> 01:43:16,280 LOOKING AT WAYS TO ASSESS PAIN 2017 01:43:16,280 --> 01:43:21,280 AND THE BACPAC CONSORTIUM LOOKS 2018 01:43:21,280 --> 01:43:27,160 AT DIAGNOSTICS, TECHNOLOGIES TO 2019 01:43:27,160 --> 01:43:31,040 TREAT, PHENOTYPING, AND 2020 01:43:31,040 --> 01:43:33,880 EFFECTIVE OF TREATMENT OF BACK 2021 01:43:33,880 --> 01:43:35,520 PAIN PART OF THE INITIATIVE 2022 01:43:35,520 --> 01:43:41,000 THROUGH THE BACPAC CONSORTIUM. 2023 01:43:41,000 --> 01:43:44,320 WE ALSO HAVE A BIG HAVE A 2024 01:43:44,320 --> 01:43:46,040 PROGRAM FOR SAFER ANALGESICS AND 2025 01:43:46,040 --> 01:43:51,800 THIS IS A BIG PROGRAM THE 2026 01:43:51,800 --> 01:43:53,000 THERAPEUTICS DEVELOPMENT PROGRAM 2027 01:43:53,000 --> 01:43:54,560 THROUGH HEAL AND NINDS ALSO HAS 2028 01:43:54,560 --> 01:43:56,160 SOME WORK IN THAT AREA THEY'VE 2029 01:43:56,160 --> 01:43:58,240 BEEN DOING FOR QUITE A LONG TIME 2030 01:43:58,240 --> 01:43:58,400 NOW. 2031 01:43:58,400 --> 01:44:01,560 SO HEAL HAS REALLY BUILT A LARGE 2032 01:44:01,560 --> 01:44:02,040 AND STRONG ANALGESIC 2033 01:44:02,040 --> 01:44:09,560 THERAPEUTICS PROGRAM. 2034 01:44:09,560 --> 01:44:14,400 THIS IS AN EXAMPLE OF THE OTHER 2035 01:44:14,400 --> 01:44:18,440 GAP AREAS THAT WERE MOSTLY FROM 2036 01:44:18,440 --> 01:44:19,440 THE TRANSITION GROUP AND WHAT 2037 01:44:19,440 --> 01:44:23,880 THEY WANTED TO LOOK AT WAS 2038 01:44:23,880 --> 01:44:24,640 SUSCEPTIBILITY AND RESILIENCE TO 2039 01:44:24,640 --> 01:44:25,840 CHRONIC PAIN AND THE MECHANISMS 2040 01:44:25,840 --> 01:44:29,120 THAT DRIVE IT AND SO THE COMMON 2041 01:44:29,120 --> 01:44:32,440 FUND HAS A SIGNATURES PROGRAM. 2042 01:44:32,440 --> 01:44:33,720 VERY LARGE PROGRAM LOOKING AT 2043 01:44:33,720 --> 01:44:36,000 THE COHORTS OF SURGICAL 2044 01:44:36,000 --> 01:44:36,640 PATIENTS. 2045 01:44:36,640 --> 01:44:42,000 ONE COMING IN FOR TOTAL KNEE 2046 01:44:42,000 --> 01:44:46,280 REPLACEMENT AND ONE THROUGH 2047 01:44:46,280 --> 01:44:46,680 THORACIC SURGERY. 2048 01:44:46,680 --> 01:44:48,360 THIS TRACKS FOLKS WHO COME IN 2049 01:44:48,360 --> 01:44:53,560 FROM THE DIFFERENT PROCEDURES 2050 01:44:53,560 --> 01:44:55,280 AND AT BASELINE COLLECT IMAGING 2051 01:44:55,280 --> 01:45:00,920 AND TESTING AND DIFFERENT BIO 2052 01:45:00,920 --> 01:45:02,000 PSYCHOSOCIAL SCREENING TOOLS AND 2053 01:45:02,000 --> 01:45:04,360 ALSO DOING OMIC TESTING ON BLOOD 2054 01:45:04,360 --> 01:45:05,840 SAMPLES AND FOLLOWING THESE 2055 01:45:05,840 --> 01:45:07,880 FOLKS OUT FOR UP TO SIX MONTHS 2056 01:45:07,880 --> 01:45:09,360 AFTER THE SURGICAL PROCEDURE 2057 01:45:09,360 --> 01:45:13,880 TRYING REALLY HARD AND VERY 2058 01:45:13,880 --> 01:45:16,880 LARGE COHORTS TO GET A CLEAR 2059 01:45:16,880 --> 01:45:18,720 PHENOTYPIC SIGNATURE OF THOSE 2060 01:45:18,720 --> 01:45:21,520 LIKELY TO TRANSITION TO CHRONIC 2061 01:45:21,520 --> 01:45:23,120 PAIN AND THOSE WHO HAVE 2062 01:45:23,120 --> 01:45:24,200 RESILIENCE FACTORS TO NOT 2063 01:45:24,200 --> 01:45:29,760 TRANSITION TO CHRONIC PAIN. 2064 01:45:29,760 --> 01:45:30,480 THAT'S BEEN UNDERWAY FOR THREE 2065 01:45:30,480 --> 01:45:35,080 YEARS NOW. 2066 01:45:35,080 --> 01:45:36,040 AND THEN THERE'S A PROGRAM 2067 01:45:36,040 --> 01:45:37,680 THAT'S BEEN AROUND A LONG TIME 2068 01:45:37,680 --> 01:45:42,000 THE MULTI-DISCIPLINARY APPROACH 2069 01:45:42,000 --> 01:45:43,720 TO PAIN THAT NIDDK WAS THE 2070 01:45:43,720 --> 01:45:50,760 PRIMARY LEAD ON. 2071 01:45:50,760 --> 01:45:52,520 AND THEY MOVED TO ANIMAL STUDIES 2072 01:45:52,520 --> 01:45:53,680 AND SET UP A RESEARCH NETWORK 2073 01:45:53,680 --> 01:45:56,680 AND PART OF THEIR GOAL IS 2074 01:45:56,680 --> 01:45:58,200 LOOKING AT THE TRANSITION ACUTE 2075 01:45:58,200 --> 01:46:03,600 TO CHRONIC PAIN AND THEN WE ALSO 2076 01:46:03,600 --> 01:46:07,280 HAVE A PROGRAM TO LOOK AT 2077 01:46:07,280 --> 01:46:10,760 BIOMARKERS OF DISEASE 2078 01:46:10,760 --> 01:46:11,680 PROGRESSION IN EIGHT CONDITIONS 2079 01:46:11,680 --> 01:46:22,200 AND THAT'S CURRENTLY UNDERWAY. 2080 01:46:31,800 --> 01:46:35,400 AND MORE OF THE BIOMARKER 2081 01:46:35,400 --> 01:46:38,280 CONDITION AND HERE WE HAVE A 2082 01:46:38,280 --> 01:46:38,840 BIOMARKER PROGRAM THAT'S 2083 01:46:38,840 --> 01:46:41,840 DIFFERENT FROM THE ONE I JUST 2084 01:46:41,840 --> 01:46:45,160 MENTIONED IN THAT THEY'RE LOOK 2085 01:46:45,160 --> 01:46:49,520 FOR BIOMARKERS FOR TREATMENT 2086 01:46:49,520 --> 01:46:51,520 RESPONSE MONITORING MOST FOR THE 2087 01:46:51,520 --> 01:46:53,240 MOST PART ASSOCIATED WITH THE 2088 01:46:53,240 --> 01:46:56,000 NEED FOR CLINICAL TRIALS AND 2089 01:46:56,000 --> 01:46:57,200 THAT'S A HEAL INITIATIVE PROJECT 2090 01:46:57,200 --> 01:47:03,120 AND THE MYOFASCIAL PAIN MEASURES 2091 01:47:03,120 --> 01:47:04,120 ONE FITS NICELY INTO ADDRESSING 2092 01:47:04,120 --> 01:47:13,760 THIS RESEARCH PRIORITY. 2093 01:47:13,760 --> 01:47:16,080 RESEARCH NETWORKS WAS A NEXT ONE 2094 01:47:16,080 --> 01:47:18,000 IN THE FDRS. 2095 01:47:18,000 --> 01:47:23,560 I PUT THE NETWORKS AND MODELS OF 2096 01:47:23,560 --> 01:47:25,640 CARE TOGETHER AND THERE'S BEEN 2097 01:47:25,640 --> 01:47:27,560 AN AMAZING JOB OF SETTING UP 2098 01:47:27,560 --> 01:47:30,640 RESEARCH NETWORKS THAT DID NOT 2099 01:47:30,640 --> 01:47:38,000 EXIST BEFORE. 2100 01:47:38,000 --> 01:47:44,360 AND HEAL SET UP THE BACPAC 2101 01:47:44,360 --> 01:47:45,720 CONSORTIUM THE BACK PAIN 2102 01:47:45,720 --> 01:47:47,840 CONSORTIUM AND THAT HAS THE 2103 01:47:47,840 --> 01:47:51,080 CAPACITY NOT ONLY DO TO-DO ALL 2104 01:47:51,080 --> 01:47:52,080 THE COMPONENTS ABOUT DIAGNOSTIC 2105 01:47:52,080 --> 01:47:53,760 AND PHENOTYPING AND HAS THE 2106 01:47:53,760 --> 01:47:56,920 CAPACITY TO DO TRIALS ESPECIALLY 2107 01:47:56,920 --> 01:48:04,960 PHASE 2 TRIALS AND WE HAVE AN 2108 01:48:04,960 --> 01:48:07,720 EARLY PHASE NETWORK TO LOOK AT 2109 01:48:07,720 --> 01:48:09,280 TRIALS ASSETS COMING IN FOR PAIN 2110 01:48:09,280 --> 01:48:11,480 AND THAT PROGRAM IS ABOUT TO OR 2111 01:48:11,480 --> 01:48:15,040 IN THE PROCESS OF LAUNCHING 2112 01:48:15,040 --> 01:48:18,320 THREE CLINICAL TRIALS WITH NOVEL 2113 01:48:18,320 --> 01:48:19,680 INNOVATIVE ASSET TO TEST FOR 2114 01:48:19,680 --> 01:48:21,120 SAFETY AND EFFICACY. 2115 01:48:21,120 --> 01:48:22,680 THE EFFECTIVENESS RESEARCH 2116 01:48:22,680 --> 01:48:27,880 NETWORK PAIN MANAGEMENT IS 2117 01:48:27,880 --> 01:48:33,840 CURRENTLY GOT A COMBINATION OF 2118 01:48:33,840 --> 01:48:38,920 PHARMACOLOGIC INTERVENTIONS AND 2119 01:48:38,920 --> 01:48:49,440 FOR THERE'S A NETWORK LED BY 2120 01:48:58,920 --> 01:48:59,080 NCCIH. 2121 01:48:59,080 --> 01:49:02,520 IT'S ALL COMPARATIVE 2122 01:49:02,520 --> 01:49:03,840 EFFECTIVENESS FOR 2123 01:49:03,840 --> 01:49:08,880 NON-PHARMACOLOGIC APPROACHES FOR 2124 01:49:08,880 --> 01:49:17,520 CHRONIC PAIN AND A NEW PROGRAM 2125 01:49:17,520 --> 01:49:21,480 AND TRYING TO EMBED INTEGRATIVE 2126 01:49:21,480 --> 01:49:24,400 PAIN CARE INTO SYSTEMS AND THESE 2127 01:49:24,400 --> 01:49:26,400 ARE ALL HEAL INITIATES EXCEPT 2128 01:49:26,400 --> 01:49:28,280 FOR MAP AT THE TOP. 2129 01:49:28,280 --> 01:49:36,240 AND THE NEXT SLIDE LOOKS AT SOME 2130 01:49:36,240 --> 01:49:38,720 OF THE TRIALS IN THE DIFFERENT 2131 01:49:38,720 --> 01:49:43,960 NETWORKS AND PROGRAMS THAT WERE 2132 01:49:43,960 --> 01:49:44,320 LI 2133 01:49:44,320 --> 01:49:47,120 LISTED AS PRIORITY AREAS TO LOOK 2134 01:49:47,120 --> 01:49:52,160 AT EFFECTIVE CHRONIC PAIN 2135 01:49:52,160 --> 01:49:54,200 MANAGEMENT INCLUDING 2136 01:49:54,200 --> 01:49:54,920 SELF-MANAGEMENT STRATEGIES. 2137 01:49:54,920 --> 01:49:56,720 WHEN IT WAS ESTABLISHED WE WERE 2138 01:49:56,720 --> 01:49:58,680 DOING LITTLE RESEARCH THAT 2139 01:49:58,680 --> 01:50:02,360 EMBEDDED SOFT MANAGEMENT 2140 01:50:02,360 --> 01:50:02,680 STRATEGIES. 2141 01:50:02,680 --> 01:50:04,120 WE'RE NOW DOING A LOT THROUGH 2142 01:50:04,120 --> 01:50:08,320 THE HEAL INITIATIVE. 2143 01:50:08,320 --> 01:50:10,440 SOME OF THE TRIALS COMPARATIVE 2144 01:50:10,440 --> 01:50:15,360 EFFECTIVENESS TRIALS INCLUDE 2145 01:50:15,360 --> 01:50:15,960 SELF-MANAGEMENT AND THE SAME 2146 01:50:15,960 --> 01:50:18,640 THING FOR THE PRAGMATIC TRIALS 2147 01:50:18,640 --> 01:50:21,800 AND I THINK COVID DID A LOT OF 2148 01:50:21,800 --> 01:50:23,200 MOVING FROM PROGRAMS TO 2149 01:50:23,200 --> 01:50:27,600 TELEHEALTH AND SO WE'VE LEARNED 2150 01:50:27,600 --> 01:50:31,440 A LOT FROM THAT INADVERTENTLY 2151 01:50:31,440 --> 01:50:34,200 AND WE HAVE A PROGRAM FUNDING 11 2152 01:50:34,200 --> 01:50:35,360 TRIALS IN POPULATIONS WITH 2153 01:50:35,360 --> 01:50:40,960 HEALTH DISPARITIES AND THOSE ARE 2154 01:50:40,960 --> 01:50:46,400 INCLUDING CULTURALLY APPROPRIATE 2155 01:50:46,400 --> 01:50:50,560 SELF-MANAGEMENT PROGRAMS AND 2156 01:50:50,560 --> 01:50:54,400 DETERMINING THE BEST PAIN CARE 2157 01:50:54,400 --> 01:50:59,800 FOR THOSE PARTICULAR 2158 01:50:59,800 --> 01:51:03,320 POPULATIONS. 2159 01:51:03,320 --> 01:51:03,960 HE'LL 2160 01:51:03,960 --> 01:51:05,240 HEAL IS ALSO LOOKING AT TWO 2161 01:51:05,240 --> 01:51:07,480 PROGRAMS TO TRY AND TREAT BOTH 2162 01:51:07,480 --> 01:51:12,800 PAIN AND OUD OR RISK FOR OUD IN 2163 01:51:12,800 --> 01:51:16,040 PEOPLE WHO HAVE BOTH CONDITIONS 2164 01:51:16,040 --> 01:51:17,840 AND NIDA ALSO HAS STUDIES IN 2165 01:51:17,840 --> 01:51:20,040 THAT REALM AS WELL. 2166 01:51:20,040 --> 01:51:22,480 AND THESE ARE LOOKING FOR 2167 01:51:22,480 --> 01:51:26,560 INTEGRATIVE PROGRAMS TREATING 2168 01:51:26,560 --> 01:51:29,040 THE FULL PERSON WHO HAS PAIN AND 2169 01:51:29,040 --> 01:51:35,520 OUD OR AT RISK FOR OUD WITH SOME 2170 01:51:35,520 --> 01:51:37,920 PHARMACOLOGIC AND 2171 01:51:37,920 --> 01:51:40,920 NON-PHARMACOLOGIC AND 2172 01:51:40,920 --> 01:51:43,200 SELF-MANAGEMENT AND NICHD HAS 2173 01:51:43,200 --> 01:51:46,200 RESEARCH IN MOST EFFECTIVE 2174 01:51:46,200 --> 01:51:49,280 STRATEGIES FOR THIS USING 2175 01:51:49,280 --> 01:51:59,800 NON-PHARMACOLOGIC APPROACHES. 2176 01:52:10,320 --> 01:52:12,240 THE NEXT SLIDE LOOKS AT MORE 2177 01:52:12,240 --> 01:52:14,920 THAN ONE PAIN CONDITION OR 2178 01:52:14,920 --> 01:52:17,800 WHETHER IT'S ANOTHER CHRONIC 2179 01:52:17,800 --> 01:52:20,680 PAIN CONDITION AND SO WHERE THE 2180 01:52:20,680 --> 01:52:22,400 PRIORITY SAYS BI-DIRECTIONAL, 2181 01:52:22,400 --> 01:52:26,560 THESE AREN'T SPECIFICALLY 2182 01:52:26,560 --> 01:52:27,760 LOOKING AT BI-DIRECTIONAL BUT 2183 01:52:27,760 --> 01:52:29,080 RESPONSE TO TREATMENTS OF PEOPLE 2184 01:52:29,080 --> 01:52:34,720 WHO EITHER HAVE MORE THAN ONE 2185 01:52:34,720 --> 01:52:38,600 CHRONIC PAIN CONDITION OR HAVE 2186 01:52:38,600 --> 01:52:39,360 CHRONIC PAIN CONDITIONS AND IN 2187 01:52:39,360 --> 01:52:41,160 THE EQUITIES PROGRAM THERE'S SIX 2188 01:52:41,160 --> 01:52:43,800 OR SEVEN STUDIES LOOKING AT PAIN 2189 01:52:43,800 --> 01:52:48,640 AND DEPRESSION AND HOW TO BEST 2190 01:52:48,640 --> 01:52:50,600 TREAT BOTH IN DIFFERENT 2191 01:52:50,600 --> 01:52:51,080 POPULATIONS WITH HEALTH 2192 01:52:51,080 --> 01:52:58,120 DISPARITIES. 2193 01:52:58,120 --> 01:53:01,400 THIS IS THE LAST ONE ON THE 2194 01:53:01,400 --> 01:53:02,480 PRIORITIES. 2195 01:53:02,480 --> 01:53:06,840 THIS IS LOOKING AT TO SUM IT UP, 2196 01:53:06,840 --> 01:53:11,800 THE PRIORITIES THAT WE HAVEN'T 2197 01:53:11,800 --> 01:53:15,120 REALLY GOTTEN TO YET IN A ROBUST 2198 01:53:15,120 --> 01:53:15,440 WAY. 2199 01:53:15,440 --> 01:53:20,040 SO WE HAVE COMPONENTS IN HERE 2200 01:53:20,040 --> 01:53:23,160 ABOUT MECHANISMS OF CHILDHOOD 2201 01:53:23,160 --> 01:53:24,880 CHRONIC PAIN AND WHAT MIGHT 2202 01:53:24,880 --> 01:53:27,480 DRIVE THAT PAIN, HOW IT MIGHT 2203 01:53:27,480 --> 01:53:32,120 AFFECT ADULTS WHO HAD PAIN AS A 2204 01:53:32,120 --> 01:53:32,480 CHILD. 2205 01:53:32,480 --> 01:53:35,320 MECHANISTIC TRIALS OF RESILIENCE 2206 01:53:35,320 --> 01:53:36,560 TO CHRONIC PAIN. 2207 01:53:36,560 --> 01:53:41,800 SO WE'VE DONE A LOT OF ON 2208 01:53:41,800 --> 01:53:43,840 TRANSITION TO CHRONIC PAIN BUT 2209 01:53:43,840 --> 01:53:51,640 THE TRIALS THAT ARE MECHANISTIC 2210 01:53:51,640 --> 01:53:54,720 AND MANAGING PAIN AND WE HAVEN'T 2211 01:53:54,720 --> 01:53:57,760 STEPPED FORWARD ON THAT IN A BIG 2212 01:53:57,760 --> 01:53:59,920 WAY AND THE PATIENT INTERVENTION 2213 01:53:59,920 --> 01:54:03,120 SO GOING BACK TO SOME OF THE 2214 01:54:03,120 --> 01:54:04,920 PREVENTION STRATEGIES ARE 2215 01:54:04,920 --> 01:54:07,080 PROBABLY AREAS THAT WE HAVEN'T 2216 01:54:07,080 --> 01:54:08,680 REALLY ADDRESSED ROBUSTLY IN THE 2217 01:54:08,680 --> 01:54:15,440 GAP AREAS OF THE RESEARCH. 2218 01:54:15,440 --> 01:54:22,080 AND THE NEXT SLIDE GIVES A SENSE 2219 01:54:22,080 --> 01:54:27,160 OF WHAT WE INTEND ED STRATEGY TN 2220 01:54:27,160 --> 01:54:29,840 USED FOR AND ACCOMPLISH A GOOD 2221 01:54:29,840 --> 01:54:30,760 ROBUST HIGH QUALITY AGENDA 2222 01:54:30,760 --> 01:54:32,000 ACROSS THE FEDERAL AGENCIES. 2223 01:54:32,000 --> 01:54:37,800 SO IT WAS SET UP SO THAT THESE 2224 01:54:37,800 --> 01:54:39,440 COULD BE TAKEN ON AND THE 2225 01:54:39,440 --> 01:54:41,120 RECOMMENDATIONS COULD BE TAKEN 2226 01:54:41,120 --> 01:54:44,560 ON BY INDIVIDUAL AGENCIES OR 2227 01:54:44,560 --> 01:54:47,000 DEPARTMENTS IN A WAY THAT WAS 2228 01:54:47,000 --> 01:54:52,200 MISSION RELEVANT TO THEIR 2229 01:54:52,200 --> 01:54:57,440 ORGANIZATION IN HOPES OF 2230 01:54:57,440 --> 01:54:59,400 COLLABORATION ACROSS THE AGENCY 2231 01:54:59,400 --> 01:55:00,200 AND DEPARTMENT AND MOST 2232 01:55:00,200 --> 01:55:02,480 IMPORTANT WOULD SERVE AS A 2233 01:55:02,480 --> 01:55:04,000 DOCUMENT TO HELP ANY OF THE 2234 01:55:04,000 --> 01:55:10,480 AGENCIES OR DEPARTMENTS OR EVEN 2235 01:55:10,480 --> 01:55:11,080 INDIVIDUAL INSTITUTES FOR 2236 01:55:11,080 --> 01:55:21,600 EXAMPLE TO AND PUTTING THIS INTO 2237 01:55:22,200 --> 01:55:24,240 LONGER TERM STRATEGIC PLANNING 2238 01:55:24,240 --> 01:55:27,640 FOR THEIR SUPPORT ETCETERA. 2239 01:55:27,640 --> 01:55:31,520 THE TIMING BEING RELEASED IN 2240 01:55:31,520 --> 01:55:33,160 ADVANCE OF THE ALLOCATION OF 2241 01:55:33,160 --> 01:55:40,480 FUNDS THAT CAME IN FOR THE HEAL 2242 01:55:40,480 --> 01:55:42,080 INITIATIVE WAS HELPFUL IN 2243 01:55:42,080 --> 01:55:44,240 INFORMING THE EFFORT TO BEGIN 2244 01:55:44,240 --> 01:55:49,360 THE PLANNING OF WHAT HEAL SHOULD 2245 01:55:49,360 --> 01:55:51,560 INITIALLY LOOK LIKE AND WHERE IT 2246 01:55:51,560 --> 01:55:52,840 MAY BE MOVING TOWARD IN THE 2247 01:55:52,840 --> 01:55:53,360 FUTURE. 2248 01:55:53,360 --> 01:55:59,000 TIMING WISE THE DOCUMENT WAS 2249 01:55:59,000 --> 01:55:59,200 HELPFUL. 2250 01:55:59,200 --> 01:56:02,800 I HOPE I'VE GIVEN YOU A SENSE OF 2251 01:56:02,800 --> 01:56:05,520 HOW MUCH HAS BEEN ACCOMPLISHED 2252 01:56:05,520 --> 01:56:08,400 IN TARGETING THE HIGH PRIORITY 2253 01:56:08,400 --> 01:56:10,320 GOALS IN PART TO THE ADDITIONAL 2254 01:56:10,320 --> 01:56:12,680 FUNDING THAT CAME IN FOR HEAL 2255 01:56:12,680 --> 01:56:19,440 BUT ALSO THROUGH OTHER SOURCES 2256 01:56:19,440 --> 01:56:26,640 RECOGNIZE THE FACT THAT THIS 2257 01:56:26,640 --> 01:56:28,640 PUBLIC HEALTH CRISES NEEDED 2258 01:56:28,640 --> 01:56:29,200 SUPPORT. 2259 01:56:29,200 --> 01:56:30,280 THANK YOU FOR YOUR ATTENTION. 2260 01:56:30,280 --> 01:56:32,040 THERE'S A LOT IN HERE AND WE CAN 2261 01:56:32,040 --> 01:56:33,240 SHARE THE SLIDE IF YOU WANT TO 2262 01:56:33,240 --> 01:56:35,000 LOOK AT THEM LATER AND SHARE THE 2263 01:56:35,000 --> 01:56:39,960 LINK TO THE DOCUMENT ITSELF AND 2264 01:56:39,960 --> 01:56:41,880 THE CROSSWALK IN WORD FORMAT IS 2265 01:56:41,880 --> 01:56:46,680 PROBABLY A LITTLE BIT EASIER TO 2266 01:56:46,680 --> 01:56:47,320 DIGEST WHEN HAVE YOU TIME TO 2267 01:56:47,320 --> 01:56:52,960 LOOK THROUGH IT. 2268 01:56:52,960 --> 01:56:55,760 IF I CAN CALL ON DAVE WILLIAMS 2269 01:56:55,760 --> 01:57:01,240 AND IRMA RODRIGUEZ HAVE KINDLY 2270 01:57:01,240 --> 01:57:02,760 OFFERED TO MODERATE ANY 2271 01:57:02,760 --> 01:57:03,400 QUESTIONS YOU MIGHT HAVE FOR US 2272 01:57:03,400 --> 01:57:07,720 HERE. 2273 01:57:07,720 --> 01:57:09,200 TO OPEN A DISCUSSION BUT I'D 2274 01:57:09,200 --> 01:57:11,960 LIKE TO CHECK FIRST TO SEE IF 2275 01:57:11,960 --> 01:57:17,480 REBECCA BAKER WAS ABLE TO JOIN 2276 01:57:17,480 --> 01:57:19,240 US. 2277 01:57:19,240 --> 01:57:29,760 HER SCHEDULE WAS COMPLICATED. 2278 01:57:37,600 --> 01:57:43,440 SO SHE IS PLANNING TO TALK ABOUT 2279 01:57:43,440 --> 01:57:45,560 SOME OF THE SPECIFIC HEAL 2280 01:57:45,560 --> 01:57:51,480 PROGRAMS MOST EXCITING TO THE 2281 01:57:51,480 --> 01:57:53,520 RESEARCH AND PERHAPS WE CAN GO 2282 01:57:53,520 --> 01:57:55,880 TO DAVE AND IRMA NOW TO OPEN THE 2283 01:57:55,880 --> 01:57:57,440 DISCUSSION HERE AS TO WHAT WE 2284 01:57:57,440 --> 01:58:00,040 HAVE LEFT TO DO. 2285 01:58:00,040 --> 01:58:02,880 WE HAVE A LOT LEFT TO DO AND 2286 01:58:02,880 --> 01:58:03,760 WHEN REBECCA JOINS PERHAPS WE 2287 01:58:03,760 --> 01:58:05,120 CAN INTERRUPT AND LET HER TALK A 2288 01:58:05,120 --> 01:58:14,520 LITTLE BIT ABOUT HEAL. 2289 01:58:14,520 --> 01:58:16,560 >> FIRST, THAT WAS A NICE 2290 01:58:16,560 --> 01:58:18,080 SUMMARY, LINDA AND I APPRECIATE 2291 01:58:18,080 --> 01:58:19,680 SEEING THAT. 2292 01:58:19,680 --> 01:58:21,520 I WAS PART OF THE -- A MEMBER OF 2293 01:58:21,520 --> 01:58:27,120 THE COMMITTEE THAT HELPED PUT 2294 01:58:27,120 --> 01:58:28,160 THAT TOGETHER AND I REMEMBER AT 2295 01:58:28,160 --> 01:58:33,800 THE TIME IT WAS A HUGE 2296 01:58:33,800 --> 01:58:44,360 UNDERTAKING AND A PROCESS OF 2297 01:58:45,120 --> 01:58:45,720 REFINING WHAT THE PROCESS WOULD 2298 01:58:45,720 --> 01:58:47,200 BE AND THERE WAS THE QUESTION OF 2299 01:58:47,200 --> 01:58:49,680 WHAT WILL HAPPEN TO THIS AND 2300 01:58:49,680 --> 01:58:53,360 WILL IT GO ON A WEBSITE OR WILL 2301 01:58:53,360 --> 01:58:55,720 WE SEE EXPECT COME OF THESE 2302 01:58:55,720 --> 01:58:56,080 RECOMMENDATIONS. 2303 01:58:56,080 --> 01:58:59,920 IT'S NICE NOW SEVERAL YEARS 2304 01:58:59,920 --> 01:59:00,560 LATER TO SEE GAPS BEING FILLED 2305 01:59:00,560 --> 01:59:10,640 IN. 2306 01:59:11,280 --> 01:59:12,920 I REMEMBER THERE WAS A QUESTION 2307 01:59:12,920 --> 01:59:18,440 HOW WE WOULD DISSEMINATE THE 2308 01:59:18,440 --> 01:59:24,640 FILLING OF THE GAPS AND AS WE 2309 01:59:24,640 --> 01:59:29,360 FILL IN THE GAPS VERY MUCH LIKE 2310 01:59:29,360 --> 01:59:32,600 THE SLIDES YOU JUST SHOWED AND 2311 01:59:32,600 --> 01:59:38,040 HAVE THEM AVAILABLE FOR THE 2312 01:59:38,040 --> 01:59:41,040 PUBLIC AND FOR FOLKS TO DIGEST 2313 01:59:41,040 --> 01:59:43,040 HOW THE PROCESS IS UNFOLDING AND 2314 01:59:43,040 --> 01:59:46,080 HOW THE GAPS ARE BEING FILLED. 2315 01:59:46,080 --> 01:59:47,560 I'M WONDERING IF THERE ARE PLANS 2316 01:59:47,560 --> 01:59:51,800 OR MAYBE THIS COMMITTEE WOULD 2317 01:59:51,800 --> 01:59:54,440 THINK ABOUT WAYS AS THIS PROCESS 2318 01:59:54,440 --> 02:00:02,560 UNFOLDS WE HAVE WAYS OF TRACKING 2319 02:00:02,560 --> 02:00:07,320 THAT. 2320 02:00:07,320 --> 02:00:09,200 THESE PRIORITIES ARE BEING TAKEN 2321 02:00:09,200 --> 02:00:11,280 CARE OF AND MAYBE A SYNOPSIS OF 2322 02:00:11,280 --> 02:00:13,920 WHAT THE STUDIES HAVE SHOWN HOW 2323 02:00:13,920 --> 02:00:15,600 WE'VE FILLED EACH OF THESE. 2324 02:00:15,600 --> 02:00:17,560 WE DO HAVE A NICE FRAMEWORK FOR 2325 02:00:17,560 --> 02:00:20,440 WHAT THE GAPS ARE. 2326 02:00:20,440 --> 02:00:22,000 AND IT WOULD BE COOL TO SEE THEM 2327 02:00:22,000 --> 02:00:23,240 FILL IN AND HAVE THE ANSWERS TO 2328 02:00:23,240 --> 02:00:33,640 THAT AS WE GO FORWARD. 2329 02:00:36,480 --> 02:00:38,520 IS THAT WOULD BE NEAT TO SEE 2330 02:00:38,520 --> 02:00:38,840 COMING. 2331 02:00:38,840 --> 02:00:48,120 WE HAVE A QUESTION FROM JOSÉ. 2332 02:00:48,120 --> 02:00:54,000 >> I HAVE A COUPLE OF QUESTIONS 2333 02:00:54,000 --> 02:00:58,440 ABOUT PRIORITIES THAT I DIDN'T 2334 02:00:58,440 --> 02:00:59,760 SEE MUCH REPRESENTATION OR GAP 2335 02:00:59,760 --> 02:01:05,800 AND AS WALTER MENTIONED BEFORE, 2336 02:01:05,800 --> 02:01:12,560 IT'S ALSO IMPORTANT TO TREAT 2337 02:01:12,560 --> 02:01:14,120 INDIVIDUALS WITH PAIN AND I SAW 2338 02:01:14,120 --> 02:01:17,320 ONE PRIORITY THAT'S SIMPLE. 2339 02:01:17,320 --> 02:01:22,800 THERE'S A LOT OF FOCUS ON NEURO 2340 02:01:22,800 --> 02:01:29,600 BIOLOGY AND CIRCUITRY AND I CAN 2341 02:01:29,600 --> 02:01:30,760 SEE MORE FOCUS BETWEEN PAIN 2342 02:01:30,760 --> 02:01:33,320 MANAGEMENT OR MECHANISMS AND 2343 02:01:33,320 --> 02:01:33,760 OPIOID USE DISORDER. 2344 02:01:33,760 --> 02:01:43,360 THAT'S ONE THING. 2345 02:01:43,360 --> 02:01:45,000 AND IF YOU WERE TALKING ABOUT 2346 02:01:45,000 --> 02:01:46,840 DIFFERENT TYPES OF PAIN OR 2347 02:01:46,840 --> 02:01:48,720 COMORBIDITIIES ASSOCIATED WITH 2348 02:01:48,720 --> 02:01:53,600 THE PAIN CONDITION. 2349 02:01:53,600 --> 02:02:04,120 YOU MENTIONED SOMETHING ABOUT 2350 02:02:17,240 --> 02:02:20,200 AND I DON'T KNOW IF THEY'RE 2351 02:02:20,200 --> 02:02:23,120 GOING TO TALK ABOUT THE HEAL 2352 02:02:23,120 --> 02:02:24,400 INITIATIVE BUT IT SEEMS TO BE 2353 02:02:24,400 --> 02:02:26,120 FOCUSSED ON PAIN ONE SIDE AND 2354 02:02:26,120 --> 02:02:30,600 OPIOID USE DISORDER THE OTHER 2355 02:02:30,600 --> 02:02:30,760 WAY. 2356 02:02:30,760 --> 02:02:32,360 I DON'T KNOW IF BECAUSE THEY'RE 2357 02:02:32,360 --> 02:02:33,320 MANAGED BY DIFFERENT INSTITUTES. 2358 02:02:33,320 --> 02:02:34,840 I DON'T KNOW THAT'S THE CASE BUT 2359 02:02:34,840 --> 02:02:38,040 I WOULD LIKE TO SEE MORE ON THE 2360 02:02:38,040 --> 02:02:38,680 INTERSECTION OF BOTH. 2361 02:02:38,680 --> 02:02:40,480 IT'S GOOD TO LOOK AT BOTH 2362 02:02:40,480 --> 02:02:43,560 INDIVIDUALLY BUT WE ALSO HAVE TO 2363 02:02:43,560 --> 02:02:44,600 LOOK AT THE INTERSECTION. 2364 02:02:44,600 --> 02:02:47,640 >> BOTH ARE GREAT IDEAS, JOSÉ. 2365 02:02:47,640 --> 02:02:50,760 REBECCA, I'M NOT SURE WHICH 2366 02:02:50,760 --> 02:02:52,080 PROGRAMS SHE'LL TALK ABOUT I GOT 2367 02:02:52,080 --> 02:02:54,120 A NOTE SHE SHOULD BE HERE AT 2368 02:02:54,120 --> 02:02:56,240 12:15 SO WE HAVE TIME TO TALK 2369 02:02:56,240 --> 02:02:57,320 ABOUT SHE GETS HERE. 2370 02:02:57,320 --> 02:03:00,880 HEAL DOES HAVE AND I THINK YOUR 2371 02:03:00,880 --> 02:03:02,760 POINT ABOUT INSTITUTE SPECIFIC 2372 02:03:02,760 --> 02:03:06,560 INTEREST, HE'LL -- HEAL HAS TWO 2373 02:03:06,560 --> 02:03:09,160 PROGRAMS RUNNING FOR PAIN AND 2374 02:03:09,160 --> 02:03:11,520 OUD MANAGEMENT AND IT WAS NICE 2375 02:03:11,520 --> 02:03:12,480 TO HE SEE THE V.A. GUIDANCE IN 2376 02:03:12,480 --> 02:03:15,960 THAT PARTICULAR AREA. 2377 02:03:15,960 --> 02:03:18,240 THE COMORBIDITIES PIECE THE 2378 02:03:18,240 --> 02:03:20,680 HEALTH EQUITIES PROGRAMS ARE 2379 02:03:20,680 --> 02:03:25,280 ASKING FOR DIFFERENT RESEARCH ON 2380 02:03:25,280 --> 02:03:35,760 DIFFERENT COMORBIDITIES NOT 2381 02:03:43,720 --> 02:03:44,800 THERE'S A START THERE BUT IT'S 2382 02:03:44,800 --> 02:03:48,040 NOT A TREATMENT START, IT'S MORE 2383 02:03:48,040 --> 02:03:49,520 AN OF A TRACKING START. 2384 02:03:49,520 --> 02:03:59,720 BACK TO YOU. 2385 02:04:00,160 --> 02:04:10,640 >> MAGGIE MIGHT HAVE BEEN FIRST. 2386 02:04:15,600 --> 02:04:18,280 >> I WANT TO SAY IT'S NICE TO 2387 02:04:18,280 --> 02:04:20,560 SEE HOW FAR WE'VE COME. 2388 02:04:20,560 --> 02:04:23,120 AND SEE WE HAVE ACCOMPLISHED 2389 02:04:23,120 --> 02:04:25,000 SOME OF THE THINGS WE STARTED 2390 02:04:25,000 --> 02:04:26,160 WITH AT THE OUTSET. 2391 02:04:26,160 --> 02:04:28,680 IN ADDITION TO THE 2392 02:04:28,680 --> 02:04:30,520 COMORBIDITIES, ONE OF THE THINGS 2393 02:04:30,520 --> 02:04:32,560 IDENTIFIED EARLY ON WAS THE 2394 02:04:32,560 --> 02:04:40,440 DIVERSITY AND ACCESS. 2395 02:04:40,440 --> 02:04:45,920 I'D LIKE TO SEE A LITTLE MORE 2396 02:04:45,920 --> 02:04:47,440 CONSISTENT ADDRESSING OF THOSE 2397 02:04:47,440 --> 02:04:48,840 ISSUES GOING FORWARD AND FOR THE 2398 02:04:48,840 --> 02:04:50,600 PEOPLE WITH LIVED EXPERIENCE, 2399 02:04:50,600 --> 02:04:55,040 IT'S NEVER A SINGLE CAUSE FOR 2400 02:04:55,040 --> 02:04:55,640 THE PAIN. 2401 02:04:55,640 --> 02:04:59,040 IT'S MORE THAN ONE THING. 2402 02:04:59,040 --> 02:05:01,600 MY OWN LIVED EXPERIENCE WITH THE 2403 02:05:01,600 --> 02:05:04,280 SYNDROME AND I HAVE MASS CELL 2404 02:05:04,280 --> 02:05:08,200 ACTIVATION DISORDER AND I HAVE 2405 02:05:08,200 --> 02:05:09,480 ARTHRITIS AND SEVERAL THINGS 2406 02:05:09,480 --> 02:05:10,200 GOING ON. 2407 02:05:10,200 --> 02:05:12,720 IT'S HARD TO PICK AND CHOOSE AND 2408 02:05:12,720 --> 02:05:14,920 SAY MY PAIN COMES FROM X AND 2409 02:05:14,920 --> 02:05:16,560 THIS IS THE RESEARCH PROJECT I 2410 02:05:16,560 --> 02:05:25,720 SHOULD BE A PART OF. 2411 02:05:25,720 --> 02:05:27,000 DIFFERS DID I NEEDS TO BE UNDER 2412 02:05:27,000 --> 02:05:28,440 SCORED AND HAS BEEN DISCUSSED 2413 02:05:28,440 --> 02:05:29,840 SINCE THE BEGINNING AS LIN TA 2414 02:05:29,840 --> 02:05:40,080 WILL RECALL. 2415 02:05:50,920 --> 02:05:52,560 >> AND WHAT ABOUT PEDIATRIC PAIN 2416 02:05:52,560 --> 02:05:55,080 AND GOING DOWN THAT LINE AND WE 2417 02:05:55,080 --> 02:05:58,320 MAY NEED REBECCA AS FAR AS AN 2418 02:05:58,320 --> 02:06:00,680 RFA AND HOW WE ADDRESS PEDIATRIC 2419 02:06:00,680 --> 02:06:03,120 PAIN AND SEEMS LIKE IT'S A 2420 02:06:03,120 --> 02:06:04,240 DIFFICULT AREA TO ADDRESS EVEN 2421 02:06:04,240 --> 02:06:06,520 IN CLINICAL TRIALS OR 2422 02:06:06,520 --> 02:06:08,280 PRE-CLINICAL TRIALS AND I'M 2423 02:06:08,280 --> 02:06:10,080 CURIOUS WHAT'S BEING DONE THERE. 2424 02:06:10,080 --> 02:06:11,640 SORRY, MAYBE THAT'S WHAT YOU 2425 02:06:11,640 --> 02:06:12,640 WERE ALSO GOING TO ASK. 2426 02:06:12,640 --> 02:06:14,520 >> I THINK RENE'S PROBABLY GOING 2427 02:06:14,520 --> 02:06:16,320 IT TELL US THE SAME THING. 2428 02:06:16,320 --> 02:06:20,080 I'LL PUT MY HAND DOWN AND BE 2429 02:06:20,080 --> 02:06:20,360 QUIET. 2430 02:06:20,360 --> 02:06:22,400 >> I WOULD DISAGREE IT'S 2431 02:06:22,400 --> 02:06:23,600 DIFFICULT TO DO A CLINICAL TRIAL 2432 02:06:23,600 --> 02:06:26,200 IT'S DIFFICULT TO GET FUNDING 2433 02:06:26,200 --> 02:06:27,520 BUT IT'S NOT DIFFICULT TO DO A 2434 02:06:27,520 --> 02:06:27,880 CLINICAL TRIAL. 2435 02:06:27,880 --> 02:06:35,040 >> FAIR ENOUGH. 2436 02:06:35,040 --> 02:06:37,120 >> THAT WOULD BE MY QUESTION. 2437 02:06:37,120 --> 02:06:42,800 WHERE IS THE FUNDING AND WHERE'S 2438 02:06:42,800 --> 02:06:45,880 CHILDREN AS THE PRIORITY BECAUSE 2439 02:06:45,880 --> 02:06:47,040 WHAT WE'VE SEEN OVER THE YEARS 2440 02:06:47,040 --> 02:06:49,440 IS LEGISLATION MAKING IT MORE 2441 02:06:49,440 --> 02:06:52,000 DIFFICULT TO TREAT CHILDREN WITH 2442 02:06:52,000 --> 02:06:52,760 ACUTE AND CHRONIC PAIN. 2443 02:06:52,760 --> 02:06:54,680 IT SEEMED TO BE VERY EASY FOR 2444 02:06:54,680 --> 02:07:00,800 PEOPLE TO SAY, WELL, THE 2445 02:07:00,800 --> 02:07:02,480 OVERBENEFIT WOULD BE TO NOT GIVE 2446 02:07:02,480 --> 02:07:04,640 THEM ANYTHING FOR PAIN TREATMENT 2447 02:07:04,640 --> 02:07:06,440 AND THEN THEY WON'T GET OPIOID 2448 02:07:06,440 --> 02:07:07,240 USE DISORDER. 2449 02:07:07,240 --> 02:07:09,040 THE BARRIERS TO PAIN TREATMENT 2450 02:07:09,040 --> 02:07:10,120 ARE AS GREAT AS THEY WERE IN THE 2451 02:07:10,120 --> 02:07:16,120 1980s. 2452 02:07:16,120 --> 02:07:17,720 WE'VE SEEN TREMENDOUS DIFFICULT 2453 02:07:17,720 --> 02:07:18,640 FROM CHILDREN'S PAIN AND THE 2454 02:07:18,640 --> 02:07:29,000 PANDEMIC DIDN'T HELP. 2455 02:07:29,880 --> 02:07:32,160 I THINK HEAL HAS ATTENTION DRAWN 2456 02:07:32,160 --> 02:07:32,760 TO THIS. 2457 02:07:32,760 --> 02:07:34,680 THE LIST ON THE FIRST WAS 2458 02:07:34,680 --> 02:07:36,400 LOOKING AT RISK FACTORS FOR 2459 02:07:36,400 --> 02:07:42,680 CHILDHOOD PAIN AND THAT'S AN 2460 02:07:42,680 --> 02:07:52,880 AREA AND THERE'S TRIALS FOR 2461 02:07:52,880 --> 02:07:56,320 PAIN EQUITIES AND A LIFE SPAN 2462 02:07:56,320 --> 02:08:01,840 ELDER AND INFANTS DOES INCLUDE 2463 02:08:01,840 --> 02:08:04,840 IN SPECIAL POPULATIONS SOME 2464 02:08:04,840 --> 02:08:09,720 TRIALS TARGETED TO CHILDREN. 2465 02:08:09,720 --> 02:08:17,080 ONE IS PRE-OPERATIVE PAIN. 2466 02:08:17,080 --> 02:08:27,640 THESE ARE NEW PROGRAMS AND THE 2467 02:08:31,520 --> 02:08:36,560 TARGETED TRIALS GOING ON IN 2468 02:08:36,560 --> 02:08:37,240 HEAL. 2469 02:08:37,240 --> 02:08:41,440 CONVERSATIONS ARE FOLLOWING AND 2470 02:08:41,440 --> 02:08:42,560 IT'S A TOPIC FOR FUTURE YEARS TO 2471 02:08:42,560 --> 02:08:52,800 BE CONSIDERED. 2472 02:08:54,320 --> 02:08:59,200 >> FIRST, THANK YOU SO MUCH, 2473 02:08:59,200 --> 02:09:00,440 LINDA. 2474 02:09:00,440 --> 02:09:02,200 THOUGH I'VE BEEN IMMERSED IN 2475 02:09:02,200 --> 02:09:04,040 THIS IT WAS SO NICE TO TAKE A 2476 02:09:04,040 --> 02:09:06,040 STEP BACK AND LOOK AT NOT ONLY 2477 02:09:06,040 --> 02:09:10,920 WHAT ALL OF THESE INITIATIVES 2478 02:09:10,920 --> 02:09:13,480 HAVE DONE BUT THEY PLUG INTO THE 2479 02:09:13,480 --> 02:09:14,440 GOALS OF THE PAIN RESEARCH 2480 02:09:14,440 --> 02:09:14,720 STRATEGY. 2481 02:09:14,720 --> 02:09:21,000 I THOUGHT IT WAS A NICE SUMMARY. 2482 02:09:21,000 --> 02:09:22,160 ONE THING THAT SOME OF THE 2483 02:09:22,160 --> 02:09:23,240 DISCUSSIONS I'VE HAD WITH SOME 2484 02:09:23,240 --> 02:09:25,440 OF YOU PRIOR TO THE MEETING IT 2485 02:09:25,440 --> 02:09:27,280 SEEMS LIKE IT MAY BE NICE TO 2486 02:09:27,280 --> 02:09:32,280 TAKE ADVANTAGE OF THE FACT WE'RE 2487 02:09:32,280 --> 02:09:36,720 ALL HERE TO LOOK AT WHAT OTHER 2488 02:09:36,720 --> 02:09:38,120 AGENCIES HAVE BEEN DOING AND 2489 02:09:38,120 --> 02:09:39,040 THERE'S COMPLIMENTARY WORK IN 2490 02:09:39,040 --> 02:09:44,040 THE SPACE AN IN THE DEPARTMENT 2491 02:09:44,040 --> 02:09:54,760 OF DEFENSE AND V.A. AND IN OTHER 2492 02:09:54,760 --> 02:10:00,200 PLACES, PCORI ARE IN ANSWER TO 2493 02:10:00,200 --> 02:10:00,680 PRIORITY. 2494 02:10:00,680 --> 02:10:05,320 IT MAY BE NICE TO HAVE MAYBE 2495 02:10:05,320 --> 02:10:09,920 NEXT TIME HAVE A SYNOPSIS THAT 2496 02:10:09,920 --> 02:10:13,640 MAY INCLUDE OTHER BODIES OF WORK 2497 02:10:13,640 --> 02:10:14,160 THAT ARE INFORMED BY THE 2498 02:10:14,160 --> 02:10:24,360 STRATEGY. 2499 02:10:25,400 --> 02:10:31,640 >> AND IT'S SO IMPRESSIVE TO SEE 2500 02:10:31,640 --> 02:10:36,920 WHAT A BOOST THE BOOST FUNDING 2501 02:10:36,920 --> 02:10:38,680 HAS COME TURBO CHARGED. 2502 02:10:38,680 --> 02:10:39,680 THE AREA IS ALMOST DIZZYING TO 2503 02:10:39,680 --> 02:10:49,920 LOOK AT THIS. 2504 02:10:53,920 --> 02:10:57,520 AND YOUR PRESENTATION 2505 02:10:57,520 --> 02:11:00,240 HIGHLIGHTED THAT NICELY. 2506 02:11:00,240 --> 02:11:02,080 MAYBE THE COMMITTEE COULD WEIGH 2507 02:11:02,080 --> 02:11:04,920 IN ON HOW WE COULD GO ABOUT 2508 02:11:04,920 --> 02:11:06,240 MAKING THIS MORE COMPREHENSIVE 2509 02:11:06,240 --> 02:11:09,440 ANALYSIS OF WHAT'S OUT THERE 2510 02:11:09,440 --> 02:11:11,080 INCLUDING OTHER AGENCIES, WHERE 2511 02:11:11,080 --> 02:11:13,160 TO PUT THE INFORMATION. 2512 02:11:13,160 --> 02:11:19,360 WE HAVE THE WEBSITE AND PROBABLY 2513 02:11:19,360 --> 02:11:21,400 NICER TO GET MORE BROADLY 2514 02:11:21,400 --> 02:11:23,120 DISSEMINATED THAN THAT AND IF 2515 02:11:23,120 --> 02:11:23,880 THERE'S FOLKS ON THE COMMITTEE 2516 02:11:23,880 --> 02:11:25,960 THAT MAY WANT TO FORM A SUB 2517 02:11:25,960 --> 02:11:28,880 GROUP TO SEE, WHAT, WHERE, HOW 2518 02:11:28,880 --> 02:11:39,360 AND WHEN WE SHOULD DO THAT. 2519 02:11:40,040 --> 02:11:41,240 AND THE EFFORTS TO AS SMOOTH AS 2520 02:11:41,240 --> 02:11:42,920 AND THE COMMENT ABOUT OKAY, WHAT 2521 02:11:42,920 --> 02:11:43,840 DID WE FIND? 2522 02:11:43,840 --> 02:11:45,240 FOR A LOT OF THE STUDIES THAT 2523 02:11:45,240 --> 02:11:48,600 WERE IN LINDA'S SLIDES, THESE 2524 02:11:48,600 --> 02:11:53,000 STUDIES ARE OBVIOUSLY EITHER GOT 2525 02:11:53,000 --> 02:11:54,400 FUNDED RECENTLY OR IT'S GOING TO 2526 02:11:54,400 --> 02:11:55,240 BE A WHILE BEFORE WE KNOW THE 2527 02:11:55,240 --> 02:12:02,680 RESULTS. 2528 02:12:02,680 --> 02:12:08,320 YOU HOPE IT BE NICE TO ENGAGE 2529 02:12:08,320 --> 02:12:16,960 THE REVIEWS AND EFFORTS FOR WHEN 2530 02:12:16,960 --> 02:12:19,560 THEY START POURING IN. 2531 02:12:19,560 --> 02:12:22,640 >> IT WAS DEVELOPFUL IN THE FOAs 2532 02:12:22,640 --> 02:12:24,920 THAT WENT OUT LAST YEAR AND THE 2533 02:12:24,920 --> 02:12:33,160 YEAR BEFORE. 2534 02:12:33,160 --> 02:12:34,880 >> AND THE RESEARCH GAPS 2535 02:12:34,880 --> 02:12:36,720 IMPORTANT TO ADDRESS PAIN 2536 02:12:36,720 --> 02:12:38,960 MANAGEMENT FOR OLDER ADULTS AND 2537 02:12:38,960 --> 02:12:41,240 HOW CAN THIS BE APPLIED TO OTHER 2538 02:12:41,240 --> 02:12:43,040 POPULATIONS WHETHER IT'S INFANTS 2539 02:12:43,040 --> 02:12:45,240 OR CHILDREN, DISABILITIES, 2540 02:12:45,240 --> 02:12:51,080 PEOPLE WITH COMMUNICATION ISSUES 2541 02:12:51,080 --> 02:12:55,240 AND HOW DO WE ADDRESS THAT? 2542 02:12:55,240 --> 02:12:56,920 >> I THINK THAT'S AN IMPORTANT 2543 02:12:56,920 --> 02:12:57,480 AREA AND COMMENT FROM THE 2544 02:12:57,480 --> 02:13:05,680 COMMITTEE. 2545 02:13:05,680 --> 02:13:07,800 >> ONE ISSUE WITH OLDER ADULTS 2546 02:13:07,800 --> 02:13:09,800 PARTICULARLY IF YOU'RE THINKING 2547 02:13:09,800 --> 02:13:15,040 OF DOING BOTH PHARMACOLOGIC AND 2548 02:13:15,040 --> 02:13:16,120 NON-PHARMACOLOGIC INTERVENTION 2549 02:13:16,120 --> 02:13:19,760 IS THE ENGAGEMENT PIECE WITH THE 2550 02:13:19,760 --> 02:13:24,520 NON-PHARM PARTS. 2551 02:13:24,520 --> 02:13:26,360 WE HAVE A LOT OF TRIALS LOOKING 2552 02:13:26,360 --> 02:13:28,640 AT SELF-MANAGEMENT AND 2553 02:13:28,640 --> 02:13:30,320 NON-PHARMACOLOGIC INTERVENTIONS 2554 02:13:30,320 --> 02:13:35,360 IN YOUNGER POPULATIONS BUT 2555 02:13:35,360 --> 02:13:38,400 THERE'S A WHOLE IT'S HARD TO GET 2556 02:13:38,400 --> 02:13:39,360 ENGAGEMENT WITH THAT GROUP BUT 2557 02:13:39,360 --> 02:13:42,080 WHEN YOU WORK WITH OLDER ADULTS 2558 02:13:42,080 --> 02:13:44,800 THOUGH WE MAY HAVE EF CARINGS WE 2559 02:13:44,800 --> 02:13:48,520 KNOW THEY CAN BE EF CARINGS AND 2560 02:13:48,520 --> 02:13:50,320 GETTING THE ENGAGEMENT PIECE 2561 02:13:50,320 --> 02:13:55,840 WITH OLDER FOLKS IS CHALLENGING 2562 02:13:55,840 --> 02:13:57,920 AND HAVING A SPECIALIZED LOOK AT 2563 02:13:57,920 --> 02:14:00,440 HOW WE DO THE ENGAGEMENT IS 2564 02:14:00,440 --> 02:14:05,880 HELPFUL FOR FOLKS. 2565 02:14:05,880 --> 02:14:15,400 IN ARIZONA WE HAVE A HUGE 2566 02:14:15,400 --> 02:14:22,360 PROBLEM WITH ARTH -- ARTHRITIS 2567 02:14:22,360 --> 02:14:24,360 AND GOING BACK TO OLD OR YOUNG 2568 02:14:24,360 --> 02:14:26,800 AND SLEEP AND THEY SEEM TO GET 2569 02:14:26,800 --> 02:14:28,600 OFF ON THE SLEEP CYCLE WHICH 2570 02:14:28,600 --> 02:14:30,920 BECOMES A BIGGER MESS AND BIGGER 2571 02:14:30,920 --> 02:14:36,040 MESS WHEN THERE'S OPIATES 2572 02:14:36,040 --> 02:14:38,320 INVOLVED AND IT LOOKS LIKE 2573 02:14:38,320 --> 02:14:39,920 ACROSS AGES SLEEP IS SOMETHING 2574 02:14:39,920 --> 02:14:42,000 WE DON'T KNOW A WHOLE LOT ABOUT 2575 02:14:42,000 --> 02:14:43,800 BUT INFLUENCED BY CHRONIC PAIN 2576 02:14:43,800 --> 02:14:45,040 AS WELL AS THE TREATMENTS WE'RE 2577 02:14:45,040 --> 02:14:46,640 GIVING WHETHER IT'S AN OPIATE OR 2578 02:14:46,640 --> 02:14:49,800 ANTIDEPRESSANT. 2579 02:14:49,800 --> 02:14:54,720 I DON'T HAVE AN ANSWER BUT I 2580 02:14:54,720 --> 02:14:57,000 FEEL LIKE IT'S ONE THING WE CAN 2581 02:14:57,000 --> 02:15:01,720 PAY ATTENTION TO THE SLEEP AND 2582 02:15:01,720 --> 02:15:02,640 QUALITY OF SLEEP BECAUSE IT 2583 02:15:02,640 --> 02:15:05,200 AFFECTS THE QUALITY OF LIFE AND 2584 02:15:05,200 --> 02:15:09,880 ATTITUDE AND ANXIETY OR 2585 02:15:09,880 --> 02:15:17,000 DEPRESSION THE PERSON HAS. 2586 02:15:17,000 --> 02:15:18,440 >> THERE'S A QUESTION ABOUT THE 2587 02:15:18,440 --> 02:15:24,520 COMORBIDITIES AND WHAT WAS IN 2588 02:15:24,520 --> 02:15:27,320 ITALICS WAS THAT THE 2589 02:15:27,320 --> 02:15:28,880 BI-DIRECTIONAL RELATIONSHIP OF 2590 02:15:28,880 --> 02:15:30,440 COMORBIDITIES AND WONDER IF YOU 2591 02:15:30,440 --> 02:15:33,560 EXPLORE THAT FURTHER. 2592 02:15:33,560 --> 02:15:34,760 CERTAINLY IN MANY CLINICAL 2593 02:15:34,760 --> 02:15:38,080 TRIALS, COMORBIDITIES ARE 2594 02:15:38,080 --> 02:15:38,760 SELECTED FOR EXAMPLE YOU'LL KNOW 2595 02:15:38,760 --> 02:15:44,760 IF ANXIETY'S THERE, DEPRESSION'S 2596 02:15:44,760 --> 02:15:48,200 THERE OR LOOK AT PAIN 2597 02:15:48,200 --> 02:15:48,680 CONDITIONS. 2598 02:15:48,680 --> 02:15:52,120 I ASSUME POST THE CONDITIONS ARE 2599 02:15:52,120 --> 02:15:53,640 BEING LOOKED AT USING THOSE 2600 02:15:53,640 --> 02:15:55,280 THINGS AS MODERATORS OR 2601 02:15:55,280 --> 02:16:05,680 MEDIATORS TO THE AFFECT. 2602 02:16:22,440 --> 02:16:28,120 WE COLLECT THE INFORMATION ON 2603 02:16:28,120 --> 02:16:33,440 COMORBIDI 2604 02:16:33,440 --> 02:16:35,440 COMORBIDITIES AND IT'S NOT AN 2605 02:16:35,440 --> 02:16:37,520 EASY THING TO SORT OUT BUT 2606 02:16:37,520 --> 02:16:40,640 SOMETHING WE HAVEN'T GIVEN MUCH 2607 02:16:40,640 --> 02:16:42,360 ATTENTION TO AS FAR AS WHICH IS 2608 02:16:42,360 --> 02:16:44,880 THE DRIVER AND WE'D TREAT THE 2609 02:16:44,880 --> 02:16:46,120 COMORBIDITY MORE AGGRESSIVELY 2610 02:16:46,120 --> 02:16:48,080 THAN TREATING THE PAIN. 2611 02:16:48,080 --> 02:16:53,520 THEY'RE BOTH COMORBIDITIES AND 2612 02:16:53,520 --> 02:17:04,040 TREATING ONE OVER THE OTHER AND 2613 02:17:07,440 --> 02:17:08,840 THIS PERSON HAS HEALTH ISSUES 2614 02:17:08,840 --> 02:17:09,800 AND WHERE DO YOU START? 2615 02:17:09,800 --> 02:17:11,880 YOU START WITH THIS ONE BECAUSE 2616 02:17:11,880 --> 02:17:13,280 IT BOTHERS THEM THE MOST OR 2617 02:17:13,280 --> 02:17:14,480 START WITH THIS ONE BECAUSE YOU 2618 02:17:14,480 --> 02:17:15,800 THINK IT WAS A DRIVER OF 2619 02:17:15,800 --> 02:17:16,600 SOMETHING ELSE. 2620 02:17:16,600 --> 02:17:23,000 AND THERE WAS NO REAL GOOD 2621 02:17:23,000 --> 02:17:25,720 CONSENSUS ON PUTTING THAT INTO A 2622 02:17:25,720 --> 02:17:27,120 RECIPE, IF YOU WILL, OF HOW DO 2623 02:17:27,120 --> 02:17:28,960 YOU APPROACH IT AS FAR AS PAIN 2624 02:17:28,960 --> 02:17:29,400 MANAGEMENT GOES. 2625 02:17:29,400 --> 02:17:32,520 NOT SO MUCH THE BUT THE PAIN 2626 02:17:32,520 --> 02:17:36,800 MANAGEMENT PART. 2627 02:17:36,800 --> 02:17:39,600 IT'S AN INTERESTING -- 2628 02:17:39,600 --> 02:17:41,840 >> JOSÉ, YOU HAVE A QUESTION? 2629 02:17:41,840 --> 02:17:46,960 >> I HAVE A QUESTION THAT CAN BE 2630 02:17:46,960 --> 02:17:48,800 APPLIED FOR ANY FOCUS ON WHAT 2631 02:17:48,800 --> 02:17:49,920 WE'RE TALKING ABOUT AND IT 2632 02:17:49,920 --> 02:17:53,560 SOMETIMES IS DIFFICULTY TO 2633 02:17:53,560 --> 02:17:54,920 TRANSLATE THE CLINICAL STUDIES 2634 02:17:54,920 --> 02:17:56,920 LIKE ESPECIALLY WITH PAIN. 2635 02:17:56,920 --> 02:17:58,520 I WONDER IF THERE WILL BE A 2636 02:17:58,520 --> 02:18:00,280 POSSIBILITY FOR HEAL OR ANY 2637 02:18:00,280 --> 02:18:03,120 RESEARCH THIS PROMOTES THE 2638 02:18:03,120 --> 02:18:04,120 INTERACTION BETWEEN BASIC AND 2639 02:18:04,120 --> 02:18:05,560 CLINICAL INVESTIGATORS IN A 2640 02:18:05,560 --> 02:18:08,520 SINGLE APPLICATION AND THIS IS 2641 02:18:08,520 --> 02:18:13,560 SOMETIMES DIFFICULT TO ACHIEVE 2642 02:18:13,560 --> 02:18:15,680 WITH A REGULAR PROGRAM BECAUSE 2643 02:18:15,680 --> 02:18:16,640 IT DOESN'T WORK OUT. 2644 02:18:16,640 --> 02:18:19,840 I WONDER IF WE CAN PROPOSE FOR 2645 02:18:19,840 --> 02:18:22,680 HEAL TO HAVE A SPECIFIC PRODUCT 2646 02:18:22,680 --> 02:18:26,480 BRIDGING BETWEEN CLINIC AND 2647 02:18:26,480 --> 02:18:26,680 BASIC. 2648 02:18:26,680 --> 02:18:30,160 WE CAN STUDY EVERYTHING IN BASIC 2649 02:18:30,160 --> 02:18:36,120 RESEARCH LIKE FROM SINGLE CELL 2650 02:18:36,120 --> 02:18:37,760 TO NEURAL CIRCUITRY BUT 2651 02:18:37,760 --> 02:18:39,360 SOMETIMES THEY CAN'T BE 2652 02:18:39,360 --> 02:18:40,680 TRANSLATED TO CLINICAL STUDIES 2653 02:18:40,680 --> 02:18:42,000 BECAUSE THE MODELS ARE MAYBE NOT 2654 02:18:42,000 --> 02:18:43,040 THE BEST ONES. 2655 02:18:43,040 --> 02:18:45,840 I WONDER IF WE CAN HAVE SOME 2656 02:18:45,840 --> 02:18:47,920 PRODUCT THAT ALLOWS THAT 2657 02:18:47,920 --> 02:18:48,560 INTERACTION BETWEEN BOTH FIELD 2658 02:18:48,560 --> 02:18:51,080 TOGETHER. 2659 02:18:51,080 --> 02:18:53,240 >> IT'S A GOOD POINT. 2660 02:18:53,240 --> 02:18:56,120 I THINK THERE'S PROBABLY 2661 02:18:56,120 --> 02:18:57,280 APPROPRIATE FOAs WHERE THE 2662 02:18:57,280 --> 02:19:00,240 MECHANISM COULD BE HELPFUL. 2663 02:19:00,240 --> 02:19:02,560 THE CROSS TALK WITH THE TWO ENDS 2664 02:19:02,560 --> 02:19:09,200 OF THE CONTINUUM. 2665 02:19:09,200 --> 02:19:10,960 THERE'S A GOOD POINT IN CHAT 2666 02:19:10,960 --> 02:19:12,440 WITH COMPLEX MEDICAL PATIENTS 2667 02:19:12,440 --> 02:19:16,200 YOU SEE A SPECIALIST FOR EACH 2668 02:19:16,200 --> 02:19:17,000 COMPONENT OF WHATEVER YOUR 2669 02:19:17,000 --> 02:19:20,600 HEALTH ISSUES ARE. 2670 02:19:20,600 --> 02:19:23,120 INSTEAD OF INTEGRATING THAT IN 2671 02:19:23,120 --> 02:19:25,840 ONE PLACE WHICH IS PROBABLY 2672 02:19:25,840 --> 02:19:31,000 REALLY FRUSTRATING FOR SOME. 2673 02:19:31,000 --> 02:19:39,720 >> PEGGY, YOU HAVE A QUESTION? 2674 02:19:39,720 --> 02:19:39,920 MAGGIE? 2675 02:19:39,920 --> 02:19:42,760 >> YEAH. 2676 02:19:42,760 --> 02:19:43,160 TWO THINGS. 2677 02:19:43,160 --> 02:19:44,760 AS ALWAYS THERE'S A MILLION 2678 02:19:44,760 --> 02:19:46,360 THINGS GOING ON IN MY MIND AS I 2679 02:19:46,360 --> 02:19:51,880 LISTEN TO EVERYBODY AND WITH THE 2680 02:19:51,880 --> 02:19:54,040 COMORBIDITIES ISSUE THERE IS 2681 02:19:54,040 --> 02:19:55,520 RESEARCH THAT'S COME OUT ALOOKS 2682 02:19:55,520 --> 02:19:56,840 AT THE UNDERLYING MECHANISMS OF 2683 02:19:56,840 --> 02:19:58,240 THE DIFFERENT COMORBIDITIES 2684 02:19:58,240 --> 02:20:00,080 IDEAL WITH MYSELF AND DEAL WITH 2685 02:20:00,080 --> 02:20:02,680 PATIENTS I ADVOCATE FOR. 2686 02:20:02,680 --> 02:20:05,680 FOR EXAMPLE, ANXIETY. 2687 02:20:05,680 --> 02:20:10,040 ANXIETY ON ITS OWN IS CONSIDERED 2688 02:20:10,040 --> 02:20:14,720 A MENTAL HEALTH ISSUE BUT 2689 02:20:14,720 --> 02:20:17,560 IT'S -- IT ALSO SHARES THE SAME 2690 02:20:17,560 --> 02:20:18,680 SYMPTOMS AS RELATES TO CHRONIC 2691 02:20:18,680 --> 02:20:24,000 PAIN FROM ANYWHERE. 2692 02:20:24,000 --> 02:20:32,120 CARDIAC ISSUES, MASS CELL AND 2693 02:20:32,120 --> 02:20:36,480 MASTOCYTOSIS CONDITIONS AND TODD 2694 02:20:36,480 --> 02:20:37,960 TALKED ABOUT SLEEP AND PEDIATRIC 2695 02:20:37,960 --> 02:20:40,960 MARKET OF PATIENTS AND SLEEP. 2696 02:20:40,960 --> 02:20:41,880 THE MORE WE LEARN THE SYMPTOMS 2697 02:20:41,880 --> 02:20:44,040 AND THE CROSSOVER OF THE 2698 02:20:44,040 --> 02:20:46,640 COMORBIDITIES THE MORE WE CAN 2699 02:20:46,640 --> 02:20:53,040 SUPPORT PEOPLE ADD A YOUNGER AGE 2700 02:20:53,040 --> 02:20:56,560 IN EARLY DIAGNOSTIC JOURNEY TO 2701 02:20:56,560 --> 02:21:00,680 MANAGE CHRONIC PAIN. 2702 02:21:00,680 --> 02:21:03,920 I HAVE ONE PATIENT WHO HAS 2703 02:21:03,920 --> 02:21:07,160 SIMILAR TO MY OWN, WHO HAS 2704 02:21:07,160 --> 02:21:08,520 LEARNED IN THE LAST 50 YEARS 2705 02:21:08,520 --> 02:21:11,400 EVERY TIME THE DOCTOR SAYS, OH, 2706 02:21:11,400 --> 02:21:15,400 IT'S JUST ANXIETY, SHE ASKS FOR 2707 02:21:15,400 --> 02:21:17,720 A REFERRAL FOR A PSYCHOLOGICAL 2708 02:21:17,720 --> 02:21:22,920 VACCINATION -- EVALUATION AND 2709 02:21:22,920 --> 02:21:24,200 SAID, OKAY WE DEALT WITH WHAT 2710 02:21:24,200 --> 02:21:25,960 YOU SAID IS GOING ON NOW LET'S 2711 02:21:25,960 --> 02:21:27,360 LOOK AT WHAT'S REALLY GOING ON 2712 02:21:27,360 --> 02:21:30,000 BECAUSE I HAVE THIS NOTE FROM 2713 02:21:30,000 --> 02:21:31,400 THIS MENTAL HEALTH CARE 2714 02:21:31,400 --> 02:21:33,680 PROFESSIONAL THAT SAYS, YES, MY 2715 02:21:33,680 --> 02:21:36,880 ANXIETY IS PHYSIOLOGICAL NOT 2716 02:21:36,880 --> 02:21:38,360 PSYCHOLOGICAL AND I'M DOING ALL 2717 02:21:38,360 --> 02:21:44,280 THE CBT AND SLEEP MANAGEMENT AND 2718 02:21:44,280 --> 02:21:50,720 EVERYTHING ELSE ALREADY WHICH 2719 02:21:50,720 --> 02:21:52,280 THEN BRINGS US IN THE 2720 02:21:52,280 --> 02:21:53,640 MULTI-MODAL APPROACH AND SOME 2721 02:21:53,640 --> 02:21:55,560 WAY TO CAPTURE THAT IN FUTURE 2722 02:21:55,560 --> 02:21:56,160 RESEARCH IS VERY IMPORTANT AS 2723 02:21:56,160 --> 02:22:06,240 WELL. 2724 02:22:07,520 --> 02:22:09,400 WE'RE ALSO SURVEYING 2725 02:22:09,400 --> 02:22:10,240 PARTICIPANTS AND NOT CAPTURING 2726 02:22:10,240 --> 02:22:11,840 THE DATA OF WHAT ELSE ARE THEY 2727 02:22:11,840 --> 02:22:16,000 DOING AND WHAT ARE INTEGRATIVE 2728 02:22:16,000 --> 02:22:19,480 ALTERNATIVE TREATMENTS 2729 02:22:19,480 --> 02:22:22,240 EMPLOYEEING DURING THAT TIME. 2730 02:22:22,240 --> 02:22:24,640 -- EMPLOYING DURING THAT TIME. 2731 02:22:24,640 --> 02:22:30,120 >> THIS IS CLEARLY AN TOPIC AND 2732 02:22:30,120 --> 02:22:32,160 WE'LL FOLLOW-UP ON THE COMMENTS 2733 02:22:32,160 --> 02:22:38,200 AND IT'S A CRUCIAL AREA OF 2734 02:22:38,200 --> 02:22:40,200 COMORBIDI 2735 02:22:40,200 --> 02:22:44,040 COMORBIDITIES AND SOMETHING OF 2736 02:22:44,040 --> 02:22:46,840 INTEREST WITH REBECCA BUT I'M 2737 02:22:46,840 --> 02:22:48,440 STARTING TO LOSE HOPE SHE'S 2738 02:22:48,440 --> 02:22:48,680 JOINING. 2739 02:22:48,680 --> 02:22:53,840 >> I THINK SHE JUST JOINED. 2740 02:22:53,840 --> 02:23:01,480 >> YOU'RE TALKING ABOUT ME. 2741 02:23:01,480 --> 02:23:02,560 >> WE HAD A WONDERFUL 2742 02:23:02,560 --> 02:23:03,520 CONVERSATION ABOUT THE FOLLOW-UP 2743 02:23:03,520 --> 02:23:09,320 TO THE PROGRESS UPDATE AND A 2744 02:23:09,320 --> 02:23:14,760 COUPLE HIGHLIGHTS TO GIVE YOU 2745 02:23:14,760 --> 02:23:17,320 BACKGROUND AND TALKING ABOUT 2746 02:23:17,320 --> 02:23:18,160 COMORBIDITIES AND THE 2747 02:23:18,160 --> 02:23:20,000 UNDERSTANDING OF SHARED 2748 02:23:20,000 --> 02:23:20,800 MECHANISMS AND PAIN CONDITIONS 2749 02:23:20,800 --> 02:23:28,720 AND SLEEP, ANXIETY, DEPRESSION, 2750 02:23:28,720 --> 02:23:33,520 MULTIPLE CONDITIONS AND DIABETES 2751 02:23:33,520 --> 02:23:36,160 OR ARTHRITIS. 2752 02:23:36,160 --> 02:23:40,480 AND LOU -- HOW WE HAVE 2753 02:23:40,480 --> 02:23:46,080 TREATMENT APPROACHES FOR PEOPLE 2754 02:23:46,080 --> 02:23:50,840 WITH COMORBID CONDITIONS AND NOT 2755 02:23:50,840 --> 02:23:52,120 JUST ONE UNDERLYING PROBLEM IT'S 2756 02:23:52,120 --> 02:23:54,400 USUALLY MULTIPLE PROBLEMS. 2757 02:23:54,400 --> 02:23:56,200 THE BI-DIRECTIONAL RELATIONSHIP 2758 02:23:56,200 --> 02:23:57,920 CAME UP BETWEEN COMORBIDITIES 2759 02:23:57,920 --> 02:23:59,000 AND WHAT'S DRIVING WHAT AND HOW 2760 02:23:59,000 --> 02:24:03,040 WE MIGHT LOOK AT THAT. 2761 02:24:03,040 --> 02:24:05,760 WE ALSO TALKED ABOUT ENHANCING 2762 02:24:05,760 --> 02:24:07,520 ON TREATMENT FOR PEOPLE WITH 2763 02:24:07,520 --> 02:24:08,840 PAIN AND OU D. 2764 02:24:08,840 --> 02:24:10,200 I KNOW HEAL HAS GOT A GOOD START 2765 02:24:10,200 --> 02:24:18,800 ON THAT. 2766 02:24:18,800 --> 02:24:22,520 AND YOU CAN TELL US ANYTHING WE 2767 02:24:22,520 --> 02:24:24,080 TALKED ABOUT RISK FOR PAIN IN 2768 02:24:24,080 --> 02:24:27,640 CHILDREN AND EXPANDING RESEARCH 2769 02:24:27,640 --> 02:24:29,200 ON EFFECTIVE TREATMENTS FOR 2770 02:24:29,200 --> 02:24:35,240 CHILDREN WITH ACUTE AND CHRONIC 2771 02:24:35,240 --> 02:24:39,160 PAIN. 2772 02:24:39,160 --> 02:24:42,600 AND I'LL STOP AND SEE IF THERE'S 2773 02:24:42,600 --> 02:24:43,280 SOMETHING YOU WERE ALREADY 2774 02:24:43,280 --> 02:24:51,960 PLANNING TO TALK ABOUT. 2775 02:24:51,960 --> 02:24:53,320 >> I HAD TO STEP AWAY BUT I 2776 02:24:53,320 --> 02:24:55,440 HEARD THE BEGINNING OF IT. 2777 02:24:55,440 --> 02:24:59,240 I WOULD FIRST START BY SAYING 2778 02:24:59,240 --> 02:25:01,720 THAT THE PAIN RESEARCH STRATEGY 2779 02:25:01,720 --> 02:25:03,680 SET UP HEAL AND NIH'S EFFORT TO 2780 02:25:03,680 --> 02:25:06,520 DO SOMETHING SIGNIFICANT IN THE 2781 02:25:06,520 --> 02:25:07,720 RESEARCH SPACE AROUND PAIN AS 2782 02:25:07,720 --> 02:25:09,920 PART OF OUR RESPONSE TO THE 2783 02:25:09,920 --> 02:25:19,440 OPIOID AND OVERDOSE CRISIS. 2784 02:25:19,440 --> 02:25:22,240 AND WE HAVE A TOOL TO DRAW UPON 2785 02:25:22,240 --> 02:25:25,120 IN WHAT THE COMMUNITY IDENTIFIED 2786 02:25:25,120 --> 02:25:30,120 AS CHALLENGES AND EVIDENCE GAPS. 2787 02:25:30,120 --> 02:25:33,000 MANY OF THE BIG AREAS OF 2788 02:25:33,000 --> 02:25:35,920 PRIORITY FOR HEAL INCLUDING THE 2789 02:25:35,920 --> 02:25:36,800 DEVELOPMENT OF TREATMENTS THAT 2790 02:25:36,800 --> 02:25:38,560 WOULD REDUCE THE RISK OF OPIOIDS 2791 02:25:38,560 --> 02:25:43,200 FOR PEOPLE WITH PAIN. 2792 02:25:43,200 --> 02:25:47,000 OR INFORMATION AROUND DIFFERENT 2793 02:25:47,000 --> 02:25:50,160 NON-PHARMACOLOGIC STRATEGIES FOR 2794 02:25:50,160 --> 02:25:51,320 TREATING PAIN OR CLINICAL TRIAL 2795 02:25:51,320 --> 02:25:54,720 PRINCIPLES IN TERMS OF HOW TO 2796 02:25:54,720 --> 02:25:59,760 INCORPORATE DIFFERENT INPUTS AND 2797 02:25:59,760 --> 02:26:04,080 MEASURES INTO STUDIES AMONG 2798 02:26:04,080 --> 02:26:05,800 PEOPLE FROM PAIN WE WERE ABLE TO 2799 02:26:05,800 --> 02:26:07,120 BUILD IN THE RESEARCH HEAL IS 2800 02:26:07,120 --> 02:26:08,640 SUPPORTING ALREADY AND I DON'T 2801 02:26:08,640 --> 02:26:14,040 KNOW IF YOU ALREADY KIND OF WENT 2802 02:26:14,040 --> 02:26:16,120 THROUGH ALL THOSE EXAMPLES OF 2803 02:26:16,120 --> 02:26:17,160 THE PARTICULARS. 2804 02:26:17,160 --> 02:26:22,840 I THINK WHAT WE ARE REALLY 2805 02:26:22,840 --> 02:26:30,480 WORKING TO DO NOW IS TO ON THE 2806 02:26:30,480 --> 02:26:31,800 EARLY SEMINOLE EFFORTS AND 2807 02:26:31,800 --> 02:26:34,400 ENSURE THE WORK WE'RE DOING HAS 2808 02:26:34,400 --> 02:26:37,320 MEANING FOR PEOPLE WITH PAIN AND 2809 02:26:37,320 --> 02:26:41,560 ISN'T JUST A PUBLICATION IN PEER 2810 02:26:41,560 --> 02:26:43,360 REVIEWED JOURNAL OR A FINDING 2811 02:26:43,360 --> 02:26:45,680 THAT ALIGNS WITH PREVIOUS 2812 02:26:45,680 --> 02:26:47,800 FINDINGS BUT DOESN'T MAKE A 2813 02:26:47,800 --> 02:26:52,320 SIGNIFICANT IMPACT ON CLINICAL 2814 02:26:52,320 --> 02:26:54,520 PRACTICE AND THAT COMES TO SOME 2815 02:26:54,520 --> 02:26:58,400 OF THE COMMUNITY-BASED RESEARCH 2816 02:26:58,400 --> 02:27:03,840 BRIDGES THAT WARE BUI -- WE'RE 2817 02:27:03,840 --> 02:27:09,160 BUILDING AND BUILDING 2818 02:27:09,160 --> 02:27:10,840 RELATIONSHIPS SO AS WE BUILD IN 2819 02:27:10,840 --> 02:27:13,000 THE PIPELINE WE HAVE SOMEONE TO 2820 02:27:13,000 --> 02:27:14,440 COMMERCIALIZE AND ADDRESSING 2821 02:27:14,440 --> 02:27:17,560 SOME OF THE SYSTEM LEVEL 2822 02:27:17,560 --> 02:27:21,040 CHALLENGES WITH REGARD TO BIAS 2823 02:27:21,040 --> 02:27:22,600 AND DISCRIMINATION AND 2824 02:27:22,600 --> 02:27:24,280 INEQUITIES IN HEALTH CARE 2825 02:27:24,280 --> 02:27:25,720 SYSTEMS AND ADDRESS HOW CAN WE 2826 02:27:25,720 --> 02:27:27,040 PUT INTO PLACE MODELS OF CARE 2827 02:27:27,040 --> 02:27:30,080 THAT ARE EQUITABLE OR HOW COULD 2828 02:27:30,080 --> 02:27:31,920 WE TAKE THE INTERVENTIONS THAT 2829 02:27:31,920 --> 02:27:34,440 WE HAVE NOW -- WE KNOW TO BE 2830 02:27:34,440 --> 02:27:35,840 EFFECTIVE IN THE STUDIES 2831 02:27:35,840 --> 02:27:37,240 CONDUCTED TO DATE AND MAKE THEM 2832 02:27:37,240 --> 02:27:38,960 MORE CULTURALLY SENSITIVE OR 2833 02:27:38,960 --> 02:27:40,760 APPROPRIATE OR JUST USEFUL FOR 2834 02:27:40,760 --> 02:27:42,800 THE DIFFERENT GROUPS WHO ARE 2835 02:27:42,800 --> 02:27:44,240 AFFECTED BY PAIN. 2836 02:27:44,240 --> 02:27:46,520 SO THAT'S I THINK THE CURRENT 2837 02:27:46,520 --> 02:27:50,400 STATUS AND OF COURSE I'M SURE 2838 02:27:50,400 --> 02:27:52,680 DR. KOROSHETZ AND DR. LANGEVIN 2839 02:27:52,680 --> 02:27:54,440 HAVE MORE TO ADD ABOUT WAYS WE 2840 02:27:54,440 --> 02:27:56,720 CONTINUE TO PULL FROM THE 2841 02:27:56,720 --> 02:27:59,400 RESEARCH COMMUNITY AS NEW 2842 02:27:59,400 --> 02:28:02,280 UNDERSTANDING OF PAIN COMES FROM 2843 02:28:02,280 --> 02:28:07,840 THE VARIOUS DIFFERENT BASIC AND 2844 02:28:07,840 --> 02:28:10,400 OTHER RESEARCH PROGRAMS THE 2845 02:28:10,400 --> 02:28:11,760 INSTITUTES AND CENTERS SUPPORT 2846 02:28:11,760 --> 02:28:13,640 AND LEVERAGE THEM AND CONVERT 2847 02:28:13,640 --> 02:28:24,160 THEM TO ADVANCES FOR PATIENTS. 2848 02:28:34,880 --> 02:28:35,160 >> THANK YOU. 2849 02:28:35,160 --> 02:28:37,760 SORRY WE HAD YOU ON SUCH A BUSY 2850 02:28:37,760 --> 02:28:43,760 DAY WE GOT FEEDBACK AND HELPFUL 2851 02:28:43,760 --> 02:28:45,320 IDEAS GENERATED. 2852 02:28:45,320 --> 02:28:46,400 THEY MAY BE OF INTEREST TO YOU 2853 02:28:46,400 --> 02:28:47,280 GOING FORWARD. 2854 02:28:47,280 --> 02:28:49,040 >> LINDA, DID YOU TALK AT ALL 2855 02:28:49,040 --> 02:28:54,680 ABOUT WHAT SEEMS TO BE A REAL 2856 02:28:54,680 --> 02:28:57,920 PRIORITY FROM THE BIDEN-HARRIS 2857 02:28:57,920 --> 02:29:02,800 ADMINISTRATION INCLUDING MENTAL 2858 02:29:02,800 --> 02:29:06,360 HEALTH AND THE DIFFERENT OF 2859 02:29:06,360 --> 02:29:11,720 SYSTEMS OF CARE WE HAVE 2860 02:29:11,720 --> 02:29:13,320 LEADERSHIP AND THOUGH IT'S 2861 02:29:13,320 --> 02:29:14,320 SOMETHING WE HAVE LIMITED 2862 02:29:14,320 --> 02:29:16,080 INVESTMENT IN AND TRYING TO 2863 02:29:16,080 --> 02:29:24,040 ADDRESS IT'S NOT AN EASY TOPIC 2864 02:29:24,040 --> 02:29:26,080 >> WE DIDN'T TOUCH ON THAT OTHER 2865 02:29:26,080 --> 02:29:27,760 THAN MAKING SURE IT INCLUDED 2866 02:29:27,760 --> 02:29:32,880 MENTAL HEALTH PROBLEMS BUT NOT 2867 02:29:32,880 --> 02:29:35,320 ON A LARGER SCALE THE 2868 02:29:35,320 --> 02:29:45,800 ADMINISTRATION IS LOOKING FOR. 2869 02:29:49,640 --> 02:29:57,080 OTHER QUESTIONS FOR REBECCA OR 2870 02:29:57,080 --> 02:29:59,280 RELATED TO THE FPRS. 2871 02:29:59,280 --> 02:30:01,720 >> RENE HAD A QUESTION BEFORE 2872 02:30:01,720 --> 02:30:11,720 REBECCA CAME ON AND I THINK 2873 02:30:11,720 --> 02:30:14,280 OTHER HANDS ARE UP. 2874 02:30:14,280 --> 02:30:17,960 >> MAYBE EVEN GOING BACK TO 2875 02:30:17,960 --> 02:30:20,960 DR. ROCA AND GOING BACK TO 2876 02:30:20,960 --> 02:30:22,400 COMORBID CONDITIONS AND AGE AND 2877 02:30:22,400 --> 02:30:26,320 WE OFTEN CHOOSE THE HEALTHIEST 2878 02:30:26,320 --> 02:30:27,600 PEOPLE IN THE MIDDLE ADULT AGE 2879 02:30:27,600 --> 02:30:34,080 RANGE TO TEST AND THEN PUT THE 2880 02:30:34,080 --> 02:30:36,200 DISCREPANCIES OR WARNINGS, DON'T 2881 02:30:36,200 --> 02:30:38,280 GIVE TO THE ELDERLY AND CHILDREN 2882 02:30:38,280 --> 02:30:45,480 AND INFANT TIYLENOL IS NOT 2883 02:30:45,480 --> 02:30:46,920 APPROVED BY THE FDA FOR INFANTS 2884 02:30:46,920 --> 02:30:48,680 AND IT'S BEEN AROUND A LONG 2885 02:30:48,680 --> 02:30:48,880 TIME. 2886 02:30:48,880 --> 02:30:57,800 AS WE PUT IN GUIDANCE, ARE WE 2887 02:30:57,800 --> 02:31:00,000 TRYING TO MAKE SURE AND WE'VE 2888 02:31:00,000 --> 02:31:02,360 TRIED TO GET PHARMACOLOGIC 2889 02:31:02,360 --> 02:31:04,840 TESTING IN KIDS, IS THAT PART OF 2890 02:31:04,840 --> 02:31:15,120 THE GUIDANCE? 2891 02:31:32,200 --> 02:31:34,880 >> CHILDREN OFTEN NEED SPECIAL 2892 02:31:34,880 --> 02:31:36,360 TREATMENT AND I'M NOT SURE 2893 02:31:36,360 --> 02:31:37,720 THERE'S A LOT IN THE PORTFOLIO 2894 02:31:37,720 --> 02:31:38,840 FOR WHAT IS SPECIFICALLY 2895 02:31:38,840 --> 02:31:47,800 LABELLED FOR THOSE AGE GROUPS. 2896 02:31:47,800 --> 02:31:49,920 >> ANY BRACKET THAT COMES IN 2897 02:31:49,920 --> 02:31:55,560 THEY HAVE TO ALSO BRING IN AS 2898 02:31:55,560 --> 02:31:57,720 EARLY AS PHASE 2 TO SUBMIT 2899 02:31:57,720 --> 02:31:59,760 INITIAL PEDIATRIC STUDY PLAN 2900 02:31:59,760 --> 02:32:01,640 WHICH SPECIFICALLY ADDRESSES 2901 02:32:01,640 --> 02:32:09,360 WHAT THEY'RE LOOKING FOR AND THE 2902 02:32:09,360 --> 02:32:18,960 PEDIATRIC AGE GROUPS AND COME IN 2903 02:32:18,960 --> 02:32:20,880 WITH THE NDA. 2904 02:32:20,880 --> 02:32:22,120 WE HAVE A LOT OF INTERACTS WITH 2905 02:32:22,120 --> 02:32:26,040 THE COMPANIES TRYING TO TALK 2906 02:32:26,040 --> 02:32:27,400 ABOUT EVERYTHING FROM HOW MANY 2907 02:32:27,400 --> 02:32:30,360 STUDIES AND WHAT THE PROTOCOL 2908 02:32:30,360 --> 02:32:31,240 SHOULD BE. 2909 02:32:31,240 --> 02:32:33,960 SOME CAN'T BE FINALIZED UNTIL 2910 02:32:33,960 --> 02:32:36,680 YOU HAVE THE ADULT DATA COMES IN 2911 02:32:36,680 --> 02:32:38,600 WITH DOSAGE, ETCETERA. 2912 02:32:38,600 --> 02:32:41,560 THE FINAL PEDIATRIC PROTOCOLS 2913 02:32:41,560 --> 02:32:43,800 MINOT BE DECIDED UPON UNTIL MORE 2914 02:32:43,800 --> 02:32:44,640 DATA COMES IN BUT THE BOTTOM 2915 02:32:44,640 --> 02:32:46,080 LINE IS THERE'S A NEED TO 2916 02:32:46,080 --> 02:32:50,600 ESTABLISH THE PEDIATRIC PLANS 2917 02:32:50,600 --> 02:32:55,040 EARLY ON. 2918 02:32:55,040 --> 02:33:04,800 >> THAT WAS INTERESTING 2919 02:33:04,800 --> 02:33:07,400 >> WE ENCOURAGE STUDIES TO STUDY 2920 02:33:07,400 --> 02:33:10,240 MORE THAN THE PROTOTYPICAL 2921 02:33:10,240 --> 02:33:13,520 PATIENT AND WHEN WE WANT TO 2922 02:33:13,520 --> 02:33:14,680 ESTABLISH A TREATMENT EFFECTIVE 2923 02:33:14,680 --> 02:33:20,440 PRODUCT AND WANT TO TRY TO GET 2924 02:33:20,440 --> 02:33:22,440 AS MUCH INFORMATION BY A 2925 02:33:22,440 --> 02:33:24,040 POPULATION TO ELIMINATE 2926 02:33:24,040 --> 02:33:27,080 POTENTIAL CONFOUNDERS. 2927 02:33:27,080 --> 02:33:30,320 YOU GET AS GOOD AN ASSESSMENT 2928 02:33:30,320 --> 02:33:33,120 YOU CAN AS AN ANALGESIC BUT WHEN 2929 02:33:33,120 --> 02:33:35,560 WE DO PHASE 3 WE ENCOURAGE 2930 02:33:35,560 --> 02:33:38,160 COMPANIES TO EXPAND THE PATIENT 2931 02:33:38,160 --> 02:33:40,400 POPULATION TO GET A BETTER 2932 02:33:40,400 --> 02:33:42,000 REPRESENTATION OF THE PATIENTS 2933 02:33:42,000 --> 02:33:43,400 THAT WILL BE USING THE PRODUCT. 2934 02:33:43,400 --> 02:33:45,600 WE DON'T WANT PEOPLE TO DO TWO 2935 02:33:45,600 --> 02:33:56,080 TRIALS ESSENTIALLY THE SAME. 2936 02:34:00,760 --> 02:34:03,720 IF THEY CAN GIVE TWO TRIALS WITH 2937 02:34:03,720 --> 02:34:08,120 SLIGHTLY END POINTS AND COMORBID 2938 02:34:08,120 --> 02:34:09,960 CONDITIONS IT WILL HELP FLUSH 2939 02:34:09,960 --> 02:34:11,400 OUT WHAT THE PRODUCT'S EFFICACY 2940 02:34:11,400 --> 02:34:13,720 AND SAFETY IS AND POTENTIALLY 2941 02:34:13,720 --> 02:34:14,760 HELP ACCOMPLISH OUT WHERE THE 2942 02:34:14,760 --> 02:34:19,200 PRODUCT COULD BE USED, ETCETERA 2943 02:34:19,200 --> 02:34:20,280 AND LASTLY WHETHER ADDITIONAL 2944 02:34:20,280 --> 02:34:22,120 INFORMATION NEEDS TO BE GENERATE 2945 02:34:22,120 --> 02:34:23,080 FORD SPECIFIC PATIENT 2946 02:34:23,080 --> 02:34:23,400 POPULATION. 2947 02:34:23,400 --> 02:34:25,240 WE DO WANT PEOPLE TO DO MORE 2948 02:34:25,240 --> 02:34:26,560 THAN JUST MONOLITHIC PATIENT 2949 02:34:26,560 --> 02:34:36,760 POPULATION. 2950 02:34:52,600 --> 02:34:54,720 >> HELENE. 2951 02:34:54,720 --> 02:34:57,200 >> I CAN CEDE MY SPACE TO OTHERS 2952 02:34:57,200 --> 02:34:59,200 AND GO AT THE END. 2953 02:34:59,200 --> 02:34:59,920 >> JOSÉ. 2954 02:34:59,920 --> 02:35:07,160 >> THIS IS FOR REBECCA. 2955 02:35:07,160 --> 02:35:08,720 AS A BASIC INVESTIGATOR SOMETIME 2956 02:35:08,720 --> 02:35:12,080 WE HAVE ISSUES BETWEEN 2957 02:35:12,080 --> 02:35:13,400 TRANSLATION BETWEEN BASIC 2958 02:35:13,400 --> 02:35:14,280 SCIENCE AND CLINICAL RESEARCH 2959 02:35:14,280 --> 02:35:16,640 AND SOMETIMES IT'S DIFFICULT TO 2960 02:35:16,640 --> 02:35:18,280 PUT IT TOGETHER THROUGH THE 2961 02:35:18,280 --> 02:35:19,920 REGULAR MECHANISM. 2962 02:35:19,920 --> 02:35:27,400 I'M WONDERING ARE WHAT HEAL HAS 2963 02:35:27,400 --> 02:35:32,800 IN MIND TO PUT PROMOTE THE 2964 02:35:32,800 --> 02:35:33,280 INTERACTION OF RESEARCH. 2965 02:35:33,280 --> 02:35:39,200 >> GREAT QUESTION. 2966 02:35:39,200 --> 02:35:45,720 THE ANSWER IS YES. 2967 02:35:45,720 --> 02:35:47,520 IN BUILDING BI-DIRECTIONAL 2968 02:35:47,520 --> 02:35:48,680 COMMUNICATION BETWEEN BASIC 2969 02:35:48,680 --> 02:35:50,960 SCIENCES AND MORE EXPERIENCED 2970 02:35:50,960 --> 02:35:52,760 CLINICIANS WHO MAY NOT KNOW ALL 2971 02:35:52,760 --> 02:35:57,520 THE ELEMENTS OF THE BASIC 2972 02:35:57,520 --> 02:36:02,600 SCIENCE RESEARCH AND WITH A 2973 02:36:02,600 --> 02:36:04,040 BASIC SCIENCE RESEARCH COMMUNITY 2974 02:36:04,040 --> 02:36:05,200 HOW CAN WE VAST TAKE ADVANTAGE 2975 02:36:05,200 --> 02:36:08,760 OF THE IDEAS FOR HEAL AND FOR 2976 02:36:08,760 --> 02:36:08,960 PAIN. 2977 02:36:08,960 --> 02:36:15,400 WE HAVE PUT OUT A FEW DIFFERENT 2978 02:36:15,400 --> 02:36:17,880 CATEGORIES OF RESEARCH 2979 02:36:17,880 --> 02:36:20,280 OPPORTUNITIES WITH THIS AS A 2980 02:36:20,280 --> 02:36:21,120 GOAL. 2981 02:36:21,120 --> 02:36:22,720 SOME ARE VERY COMPLICIT AND 2982 02:36:22,720 --> 02:36:26,360 THEIR DESIGN IS TO INTEGRATE 2983 02:36:26,360 --> 02:36:29,440 BASIC AND CLINICAL SCIENTISTS 2984 02:36:29,440 --> 02:36:32,080 AND SOME ARE A LITTLE BIT MORE 2985 02:36:32,080 --> 02:36:35,000 OPEN-ENDED IN TERMS OF HIGH 2986 02:36:35,000 --> 02:36:37,240 RICK, HIGH REWARD OR EARLY STAGE 2987 02:36:37,240 --> 02:36:38,560 INVESTIGATORS AND TRAINING AND 2988 02:36:38,560 --> 02:36:39,400 MENTORING OPPORTUNITIES SO 2989 02:36:39,400 --> 02:36:44,320 PEOPLE WHO ARE EARLIER IN THEIR 2990 02:36:44,320 --> 02:36:46,480 CAREER WHO ARE INTERESTED IN 2991 02:36:46,480 --> 02:36:48,240 TAKING PART IN HEAL AND WORKING 2992 02:36:48,240 --> 02:36:52,200 AS PART OF OUR COMMUNITY AND 2993 02:36:52,200 --> 02:36:54,480 THINKING HOW THEY MAY FIND 2994 02:36:54,480 --> 02:36:56,800 APPLICATIONS OR POTENTIAL AF 2995 02:36:56,800 --> 02:36:58,800 NEWS FOR THEIR RESEARCH TOWARDS 2996 02:36:58,800 --> 02:37:02,200 THE MORE TRANSLATIONAL SPACE 2997 02:37:02,200 --> 02:37:04,320 GIVING THEM DEDICATED FUNDING TO 2998 02:37:04,320 --> 02:37:08,160 THINK ABOUT THAT TOO. 2999 02:37:08,160 --> 02:37:10,360 I'M HAPPY TO PROVIDE SPECIFICS 3000 02:37:10,360 --> 02:37:15,200 IN TERMS OF THE LINK AND FOAs. 3001 02:37:15,200 --> 02:37:16,240 >> THAT WOULD BE GREAT. 3002 02:37:16,240 --> 02:37:16,760 THANK YOU SO MUCH. 3003 02:37:16,760 --> 02:37:18,880 >> CHRISTINE IS NEXT ON THE 3004 02:37:18,880 --> 02:37:21,760 LIST. 3005 02:37:21,760 --> 02:37:22,520 >> THANK YOU. 3006 02:37:22,520 --> 02:37:27,960 THIS IS COROLLARY TO WHAT RIGO 3007 02:37:27,960 --> 02:37:28,160 SAID. 3008 02:37:28,160 --> 02:37:33,920 TO EMPHASIZE WHAT MAGGIE HAS 3009 02:37:33,920 --> 02:37:42,200 SAID AND EDS AND ARTHRITIS AND 3010 02:37:42,200 --> 02:37:45,000 MAST CELL DYSFUNCTION. 3011 02:37:45,000 --> 02:37:48,600 CENTRALLY IN NEURAL PATHIC PAIN 3012 02:37:48,600 --> 02:37:52,800 WITH THE AUTONOMIC DYSFUNCTION, 3013 02:37:52,800 --> 02:37:53,080 SPACTICITY. 3014 02:37:53,080 --> 02:37:55,000 THESE ARE EXAMPLES OF WHAT 3015 02:37:55,000 --> 02:37:56,800 PERSONALIZATION IS SO IMPORTANT 3016 02:37:56,800 --> 02:38:02,280 TO INCORPORATE EVEN WITHIN 3017 02:38:02,280 --> 02:38:07,440 TRIALS BUT WE HAVE THIS 3018 02:38:07,440 --> 02:38:10,560 COMPETITION BETWEEN ENRICHMENT 3019 02:38:10,560 --> 02:38:14,320 AND GENERALIZABILITY RIGO 3020 02:38:14,320 --> 02:38:14,880 ALLUDED TO AND PHASE OF 3021 02:38:14,880 --> 02:38:25,280 DEVELOPMENT AND SO ON. 3022 02:38:26,520 --> 02:38:28,920 AND INCLUDE BIO STATISTICIANS AT 3023 02:38:28,920 --> 02:38:29,880 EVERY LEVEL. 3024 02:38:29,880 --> 02:38:36,520 AND I'M THINKING OUTLOUD FOR 3025 02:38:36,520 --> 02:38:38,960 EXAMPLE THE ONCOLOGY SPACE WITH 3026 02:38:38,960 --> 02:38:43,520 BIOMARKERS AND WE CANNOT FOR 3027 02:38:43,520 --> 02:38:48,800 EXAMPLE, PURSUE UMBRELLA TRIALS 3028 02:38:48,800 --> 02:38:54,880 THAT THEY USE WITH 3029 02:38:54,880 --> 02:38:59,080 PERSONALIZATION OF TRIALS BUT IN 3030 02:38:59,080 --> 02:39:05,920 THE SAME THOUGHT PROCESS WE DO 3031 02:39:05,920 --> 02:39:08,160 NEED TO THINK ABOUT HOW WE MIGHT 3032 02:39:08,160 --> 02:39:12,960 BE ABLE TO APPROACH THIS 3033 02:39:12,960 --> 02:39:13,320 PERSONALIZATION. 3034 02:39:13,320 --> 02:39:16,640 ON ONE HAND EARLY IN DEVELOPMENT 3035 02:39:16,640 --> 02:39:23,640 AND ONE PATIENT CENTRIC STUDIES 3036 02:39:23,640 --> 02:39:24,920 SHOULD SUPPLEMENT THE TRIALS. 3037 02:39:24,920 --> 02:39:34,800 MANY OF US USE OTHER TYPES OF WE 3038 02:39:34,800 --> 02:39:39,640 TRY TO INCORPORATE SOME 3039 02:39:39,640 --> 02:39:41,480 INNOVATIONS AND WHAT LEADS TO 3040 02:39:41,480 --> 02:39:44,280 PERSONALIZATION AND ONCE AGAIN 3041 02:39:44,280 --> 02:39:51,120 IT'S ENRICHMENT VERSUS 3042 02:39:51,120 --> 02:39:51,520 GENERALIZABILITY. 3043 02:39:51,520 --> 02:39:58,760 I THINK INCORPORATING 3044 02:39:58,760 --> 02:39:59,560 STATISTICIAN INPUT WOULD BE VERY 3045 02:39:59,560 --> 02:40:08,080 HELPFUL. 3046 02:40:08,080 --> 02:40:10,880 THANK YOU. 3047 02:40:10,880 --> 02:40:21,360 >> KATE, YOU HAVE A QUESTION? 3048 02:40:24,040 --> 02:40:28,080 ONE TOPIC WAS DISPARITIES IN THE 3049 02:40:28,080 --> 02:40:29,640 PAIN RESEARCH AND ADDICTION AND 3050 02:40:29,640 --> 02:40:31,520 I WAS CURIOUS ABOUT HEAL'S 3051 02:40:31,520 --> 02:40:36,280 EFFORTS TO REALLY FOCUS ON THAT 3052 02:40:36,280 --> 02:40:40,880 ASPECT GOING FORWARD AND ALSO 3053 02:40:40,880 --> 02:40:42,240 CURIOUS ABOUT TO THE IDEA OF 3054 02:40:42,240 --> 02:40:44,520 LOOKING AT THINGS IN TERMS OF 3055 02:40:44,520 --> 02:40:45,320 INTERSECTIONALITY BECAUSE IT'S 3056 02:40:45,320 --> 02:40:49,600 JUST AS PEOPLE HAVE OVERLAPPING 3057 02:40:49,600 --> 02:40:51,880 PAIN CONDITIONS PEOPLE COME IN 3058 02:40:51,880 --> 02:40:52,400 MULTIPLE IDENTITIES AND 3059 02:40:52,400 --> 02:40:53,440 SOMETIMES AT THE HIGH LEVEL WE 3060 02:40:53,440 --> 02:40:55,080 DON'T SEE THAT. 3061 02:40:55,080 --> 02:40:56,560 WE END UP HAVING SITUATIONS 3062 02:40:56,560 --> 02:40:57,680 WHERE WE KNOW PEOPLE MAY HAVE 3063 02:40:57,680 --> 02:41:01,400 MORE PAIN AS THEY AGE. 3064 02:41:01,400 --> 02:41:05,680 WE KNOW PAIN MAY DISPARATELY 3065 02:41:05,680 --> 02:41:08,120 AFFECT BIAS RACIALIZED 3066 02:41:08,120 --> 02:41:09,160 POPULATIONS BUT THERE'S NOT A 3067 02:41:09,160 --> 02:41:12,720 LOT OF RESEARCH OR FOCUS ON PAIN 3068 02:41:12,720 --> 02:41:14,480 AND AGING BLACK MEN, FOR 3069 02:41:14,480 --> 02:41:17,560 EXAMPLE, UNLESS WE LOOK AT 3070 02:41:17,560 --> 02:41:20,080 DISPARITIES IN A MORE HOLISTIC 3071 02:41:20,080 --> 02:41:23,160 WAY WE END UP LEAVING GROUPS UP 3072 02:41:23,160 --> 02:41:24,560 AND WONDERING WHAT HEAL'S 3073 02:41:24,560 --> 02:41:26,560 COMMITMENT IS TO LOOKING AT 3074 02:41:26,560 --> 02:41:27,400 THOSE ISSUES AND HOW YOU'RE 3075 02:41:27,400 --> 02:41:37,640 FRAMING IT. 3076 02:41:45,320 --> 02:41:47,960 WE HAVE TWO FUNDED OPPORTUNITIES 3077 02:41:47,960 --> 02:41:50,880 LOOKING AT HEALTH EQUITY AND 3078 02:41:50,880 --> 02:41:52,080 BIAS AND DISCRIMINATION IN PAIN 3079 02:41:52,080 --> 02:41:52,360 MANAGEMENT. 3080 02:41:52,360 --> 02:41:57,520 THE FIRST ENDED UP LOOKING AT 3081 02:41:57,520 --> 02:42:01,560 DIFFERENT INTERVENTIONS HOW TO 3082 02:42:01,560 --> 02:42:03,120 TARGET THEM TO DIFFERENT GROUPS 3083 02:42:03,120 --> 02:42:05,720 WHO MAY NOT ALWAYS RECEIVE HIGH 3084 02:42:05,720 --> 02:42:07,240 QUALITY CARE AND BUILDING BOTH 3085 02:42:07,240 --> 02:42:11,920 MORE CULTURALLY SENSITIVE 3086 02:42:11,920 --> 02:42:13,640 INFORMATION AND ALSO BUILDING 3087 02:42:13,640 --> 02:42:14,640 RELATIONSHIPS TO UNDERSTAND WHAT 3088 02:42:14,640 --> 02:42:17,840 THE STUMBLING BLOCKS. 3089 02:42:17,840 --> 02:42:19,560 THE SECOND FUNDING OPPORTUNITY 3090 02:42:19,560 --> 02:42:22,240 ANNOUNCEMENT WAS MORE FOCUSSED 3091 02:42:22,240 --> 02:42:23,240 ON COMORBIDITIES AND PLACES 3092 02:42:23,240 --> 02:42:25,520 WHERE A PERSON WITH PAIN HAS 3093 02:42:25,520 --> 02:42:26,920 ANOTHER HEALTH CONDITION THAT 3094 02:42:26,920 --> 02:42:30,600 AFFECTS THEIR CARE AND TREATMENT 3095 02:42:30,600 --> 02:42:35,080 AND WHERE BY BEING PART OF A 3096 02:42:35,080 --> 02:42:36,000 RECOGNIZED DISPARITIES GROUP OR 3097 02:42:36,000 --> 02:42:38,040 HAVING CHALLENGES AND ACCESS TO 3098 02:42:38,040 --> 02:42:38,640 HIGH QUALITY CARE COMPLICATED 3099 02:42:38,640 --> 02:42:42,840 THAT. 3100 02:42:42,840 --> 02:42:44,520 AND CHALLENGE IN PAIN 3101 02:42:44,520 --> 02:42:45,040 MANAGEMENT. 3102 02:42:45,040 --> 02:42:48,440 MOST OF THOSE I THINK ENDED UP 3103 02:42:48,440 --> 02:42:51,720 FOCUSSING MORE ON NEW DISORDERS 3104 02:42:51,720 --> 02:42:54,080 AND ANXIETY RATHER THAN SOME OF 3105 02:42:54,080 --> 02:42:56,640 THE OTHER HEALTH CONDITIONS I 3106 02:42:56,640 --> 02:42:57,680 SAW IN THE CHAT LIKE OTHER 3107 02:42:57,680 --> 02:43:04,920 PHYSICAL HEALTH CONDITIONS. 3108 02:43:04,920 --> 02:43:06,240 IN TERMS OF WHAT HAPPENS NEXT 3109 02:43:06,240 --> 02:43:11,120 AND HOW POINTS OF INTERSECTION 3110 02:43:11,120 --> 02:43:15,920 GET TO BE CAPTURED IN THOSE 3111 02:43:15,920 --> 02:43:16,640 NEWLY-LAUNCHED PROGRAMS I HOPE 3112 02:43:16,640 --> 02:43:18,800 THAT COMES THROUGH IN A VERY 3113 02:43:18,800 --> 02:43:21,640 SINCERE AND VERY ENGAGED 3114 02:43:21,640 --> 02:43:22,840 CONNECTION WITH THE PEOPLE'S 3115 02:43:22,840 --> 02:43:23,840 LIVED EXPERIENCE WHO ARE 3116 02:43:23,840 --> 02:43:25,000 CONTRIBUTING TO THE DEVELOPMENT 3117 02:43:25,000 --> 02:43:28,680 OF THE STUDIES THAT AS WE BEGIN 3118 02:43:28,680 --> 02:43:30,400 TO -- BECAUSE THOSE ARE BOTH NEW 3119 02:43:30,400 --> 02:43:31,320 PROGRAMS THAT WE FUNDED IN THE 3120 02:43:31,320 --> 02:43:34,680 LAST YEAR. 3121 02:43:34,680 --> 02:43:35,920 AND AS THEY GO INTO STUDIES 3122 02:43:35,920 --> 02:43:40,320 THEY'RE ABLE TO INCORPORATE 3123 02:43:40,320 --> 02:43:43,520 THESE DIFFERENT PERSPECTIVES AND 3124 02:43:43,520 --> 02:43:44,960 DIFFERENCES EVEN WITHIN A 3125 02:43:44,960 --> 02:43:47,200 CATEGORY IN TERMS OF HOW A 3126 02:43:47,200 --> 02:43:48,920 PERSON MIGHT RESPOND TO A 3127 02:43:48,920 --> 02:43:50,640 CLINICAL ENCOUNTER OR WHAT THEY 3128 02:43:50,640 --> 02:43:53,200 HOPE FOR THROUGH THE RESEARCH. 3129 02:43:53,200 --> 02:43:54,200 ALSO, RECOGNIZE THIS IS REALLY A 3130 02:43:54,200 --> 02:44:04,480 STARTING POINT. 3131 02:44:04,960 --> 02:44:07,320 WE HAVE THIS RESEARCH UNDERWAY 3132 02:44:07,320 --> 02:44:08,920 AND WORK WITH THE COMMUNITY TO 3133 02:44:08,920 --> 02:44:10,240 MAKE SURE THE SCIENCE COMING OUT 3134 02:44:10,240 --> 02:44:12,080 OF THESE STUDIES IS AS 3135 02:44:12,080 --> 02:44:12,640 MEANINGFUL TO THE DIFFERENT 3136 02:44:12,640 --> 02:44:18,800 POPULATIONS AS POSSIBLE. 3137 02:44:18,800 --> 02:44:22,440 >> ARE YOU REFERRING THE RDEK? 3138 02:44:22,440 --> 02:44:24,440 >> NO, EACH PROGRAM WILL 3139 02:44:24,440 --> 02:44:26,240 ESTABLISH COMMUNITY ADVISORY 3140 02:44:26,240 --> 02:44:26,440 BOARDS. 3141 02:44:26,440 --> 02:44:27,640 THEY'RE GOING TO PUT TOGETHER 3142 02:44:27,640 --> 02:44:29,280 RESOURCES FOR INVESTIGATORS TO 3143 02:44:29,280 --> 02:44:30,720 BRING IN DIFFERENT LIVED 3144 02:44:30,720 --> 02:44:31,040 EXPERIENCES. 3145 02:44:31,040 --> 02:44:32,920 THEY'RE GOING TO PUT OUT 3146 02:44:32,920 --> 02:44:34,360 MATERIALS AND BEST PRACTICES. 3147 02:44:34,360 --> 02:44:38,320 I THINK IN THAT CONTEXT THAT'S 3148 02:44:38,320 --> 02:44:40,320 THE DIALOGUE RIGHT NOW. 3149 02:44:40,320 --> 02:44:43,040 THE RDEK IS A COMPONENT PART OF 3150 02:44:43,040 --> 02:44:45,320 THE HEAL DATA ECO SYSTEM WHICH 3151 02:44:45,320 --> 02:44:47,320 ITSELF IS DEVISED TO TAKE OUR 3152 02:44:47,320 --> 02:44:49,360 RESEARCH FINDING AND MAKE IT 3153 02:44:49,360 --> 02:44:50,720 MEANINGFUL TO THE POPULATIONS 3154 02:44:50,720 --> 02:44:52,800 THAT WE'RE SUPPOSED TO BE 3155 02:44:52,800 --> 02:44:54,800 SERVING IN PARTNERSHIP WITH 3156 02:44:54,800 --> 02:44:57,400 COMMUNITIES, CAREGIVERS, 3157 02:44:57,400 --> 02:45:03,000 PATIENTS, PARTICIPANTS AND OUR 3158 02:45:03,000 --> 02:45:05,480 BROADER COMMUNITY AND IN THAT 3159 02:45:05,480 --> 02:45:07,280 REGARD I SEE THAT AS MORE OF A 3160 02:45:07,280 --> 02:45:08,080 DISSEMINATION EFFORT. 3161 02:45:08,080 --> 02:45:10,080 I THINK THE PROGRAMS THAT WE 3162 02:45:10,080 --> 02:45:12,120 JUST LAUNCHED WE WANT OUR 3163 02:45:12,120 --> 02:45:13,120 RESEARCHERS TO LEARN FROM PEOPLE 3164 02:45:13,120 --> 02:45:15,120 WITH PAIN IN THE CONTEXT OF 3165 02:45:15,120 --> 02:45:16,040 THOSE SPECIFIC STUDIES. 3166 02:45:16,040 --> 02:45:18,520 WHAT QUESTIONS TO ASK, HOW TO 3167 02:45:18,520 --> 02:45:21,560 DESIGN A PROTOCOL, HOW TO TITLE 3168 02:45:21,560 --> 02:45:22,360 YOUR PROGRAM. 3169 02:45:22,360 --> 02:45:23,760 EVERY SINGLE ASPECT OF THE 3170 02:45:23,760 --> 02:45:25,040 RESEARCH SHOULD INCORPORATE 3171 02:45:25,040 --> 02:45:25,760 THOSE PERSPECTIVES AT THE 3172 02:45:25,760 --> 02:45:35,920 BEGINNING. 3173 02:45:37,120 --> 02:45:40,000 >> YOU HAD A QUESTION AFTER 3174 02:45:40,000 --> 02:45:40,440 EVERYBODY ELSE? 3175 02:45:40,440 --> 02:45:43,760 >> I THINK IT'S A GOOD TIME FOR 3176 02:45:43,760 --> 02:45:44,400 MY COMMENT. 3177 02:45:44,400 --> 02:45:45,440 I HAVE TWO COMMENTS. 3178 02:45:45,440 --> 02:45:47,520 ONE IS IN RESPONSE TO WHAT 3179 02:45:47,520 --> 02:45:48,800 REBECCA WAS SAYING ABOUT OKAY, 3180 02:45:48,800 --> 02:45:51,760 WHAT DO WE DO NEXT? 3181 02:45:51,760 --> 02:45:53,000 WE WANT TO MAKE SURE ALL THIS 3182 02:45:53,000 --> 02:45:59,000 RESEARCH IMPACTS THE CARE OF 3183 02:45:59,000 --> 02:46:09,160 PATIENTS. 3184 02:46:10,800 --> 02:46:13,000 AND LEARNING HOW TO EMBED 3185 02:46:13,000 --> 02:46:13,880 CLINICAL TRIALS IN THE HEALTH 3186 02:46:13,880 --> 02:46:15,480 CARE SYSTEMS. 3187 02:46:15,480 --> 02:46:20,800 THIS IS SOMETHING THAT THERE'S A 3188 02:46:20,800 --> 02:46:31,240 LOT OF OTHER EFFORTS AND 3189 02:46:32,000 --> 02:46:33,440 LEARNING HOW TO DO STUDIES 3190 02:46:33,440 --> 02:46:34,120 EMBEDDED IN THE HEALTH CARE 3191 02:46:34,120 --> 02:46:35,800 SYSTEM AND AT THE DEPARTMENT OF 3192 02:46:35,800 --> 02:46:36,600 DEFENSE AT V.A. AND DOD I 3193 02:46:36,600 --> 02:46:42,920 MENTIONED EARLIER. 3194 02:46:42,920 --> 02:46:47,120 AND PART OF THE TRIALS ARE 3195 02:46:47,120 --> 02:46:49,040 EFFECTIVENESS AND THERE CAN ALSO 3196 02:46:49,040 --> 02:46:50,800 BE AN IMPLEMENTATION COMPONENT 3197 02:46:50,800 --> 02:46:52,760 AND THE FRUSTRATION IS WE'VE 3198 02:46:52,760 --> 02:46:56,960 KNOWN FOR SO MANY YEARS THAT YOU 3199 02:46:56,960 --> 02:46:59,400 REALLY SHOULD BE NOT USING SAY 3200 02:46:59,400 --> 02:47:00,880 FOR EXAMPLE OPIOIDS AS 3201 02:47:00,880 --> 02:47:01,960 FIRST-LINE TREATMENT AND IT 3202 02:47:01,960 --> 02:47:03,200 CONTINUES TO HAPPEN FOR CHRONIC 3203 02:47:03,200 --> 02:47:05,360 PAIN ESPECIALLY. 3204 02:47:05,360 --> 02:47:07,200 WELL, WHY IS IT THIS IS SO HARD 3205 02:47:07,200 --> 02:47:09,520 TO IMPLEMENT AND SO BY DOING 3206 02:47:09,520 --> 02:47:10,360 IMPLEMENTATION RESEARCH, YOU'RE 3207 02:47:10,360 --> 02:47:12,040 LOOKING AT WHAT ARE THE BARRIERS 3208 02:47:12,040 --> 02:47:13,560 TO IMPLEMENTATION AND THERE'S 3209 02:47:13,560 --> 02:47:15,560 ALSO A SIDE EFFECT OF DOING THAT 3210 02:47:15,560 --> 02:47:18,200 WHICH IS THAT BY EMBEDDING THE 3211 02:47:18,200 --> 02:47:18,880 CLINICAL TRIALS IN THE HEALTH 3212 02:47:18,880 --> 02:47:23,960 CARE SYSTEM, THE HEALTH CARE 3213 02:47:23,960 --> 02:47:26,120 SYSTEM CAN ALL OF A SUDDEN START 3214 02:47:26,120 --> 02:47:29,560 LEARNING AND TESTING A HIGH BOTH 3215 02:47:29,560 --> 02:47:30,960 IS THE WITHIN THE HEALTH CARE 3216 02:47:30,960 --> 02:47:35,360 SYSTEM ITSELF AND CAN PROMOTE 3217 02:47:35,360 --> 02:47:37,200 CHANGE RIGHT THEN AND THERE. 3218 02:47:37,200 --> 02:47:38,680 THE OTHER AREA THERE'S BEEN A 3219 02:47:38,680 --> 02:47:40,560 LOT OF DISCUSSIONS AROUND THE 3220 02:47:40,560 --> 02:47:42,240 COMORBIDITIES AND CO-OCCURRING 3221 02:47:42,240 --> 02:47:43,400 CONDITIONS, IT'S ALL HAPPENING 3222 02:47:43,400 --> 02:47:50,280 INSIDE THE SAME PERSON, RIGHT. 3223 02:47:50,280 --> 02:47:51,920 AND THIS GAP IDENTIFIED THAT 3224 02:47:51,920 --> 02:47:53,280 LINDA POINTED OUT ABOUT 3225 02:47:53,280 --> 02:47:55,480 PLASTICITY MECHANISMS THAT 3226 02:47:55,480 --> 02:47:59,960 PROMOTE PERSISTENT PAIN AS WELL 3227 02:47:59,960 --> 02:48:00,520 AS POSSIBLE INDIGENOUS 3228 02:48:00,520 --> 02:48:05,960 RESOLUTION MECHANISMS THAT HELP 3229 02:48:05,960 --> 02:48:09,800 A PERSON RECOVER WELL, A LOT OF 3230 02:48:09,800 --> 02:48:11,520 THE TIME WHEN WE THINK OF PAIN 3231 02:48:11,520 --> 02:48:13,800 MECHANISMS WE THINK OF THEM IN 3232 02:48:13,800 --> 02:48:15,480 THE ANNIVERSARY SYSTEM BUT THE 3233 02:48:15,480 --> 02:48:17,200 PLASTICITY SYSTEMS MAY HAPPEN 3234 02:48:17,200 --> 02:48:18,560 OUTSIDE THE NERVOUS SYSTEM 3235 02:48:18,560 --> 02:48:19,720 PARTIALLY OR ENTIRELY. 3236 02:48:19,720 --> 02:48:23,840 THINK WHAT THE CO-OCCURRING 3237 02:48:23,840 --> 02:48:26,040 CONUNDRUM IS TELLING US TO DO IS 3238 02:48:26,040 --> 02:48:27,520 TO START LOOKING AT THE 3239 02:48:27,520 --> 02:48:29,280 MECHANISM QUESTION IN A BROADER 3240 02:48:29,280 --> 02:48:30,640 WAY AND IT WILL BE INTERESTING 3241 02:48:30,640 --> 02:48:35,680 THE DISCUSSION WE'RE GOING HAVE 3242 02:48:35,680 --> 02:48:38,480 THIS AFTERNOON ABOUT ACUTE PAIN 3243 02:48:38,480 --> 02:48:40,440 AND IMMUNE MECHANISMS THAT'S 3244 02:48:40,440 --> 02:48:43,000 GOING TO BE VERY INTERESTING. 3245 02:48:43,000 --> 02:48:45,040 CLEARLY, WE GET THE IMMUNE 3246 02:48:45,040 --> 02:48:46,520 SYSTEM AND WE HAVE TO LOOK AT 3247 02:48:46,520 --> 02:48:48,520 IT, NO QUESTION, BUT THERE'S 3248 02:48:48,520 --> 02:48:49,640 OTHER SYSTEMS WE START TO HAVE 3249 02:48:49,640 --> 02:48:50,760 TO INCORPORATE IN OUR WAY TO 3250 02:48:50,760 --> 02:48:53,400 THINK ABOUT PAIN. 3251 02:48:53,400 --> 02:48:56,680 THIS IS ONE WAY WE CAN KILL TWO 3252 02:48:56,680 --> 02:48:58,960 BIRDS WITH ONE STONE, BE MORE 3253 02:48:58,960 --> 02:49:00,000 INTEGRATIVE IN OUR UNDERSTANDING 3254 02:49:00,000 --> 02:49:03,440 OF MECHANISMS AND STARTING TO 3255 02:49:03,440 --> 02:49:04,520 UNDERSTAND WHAT WE'VE BEEN 3256 02:49:04,520 --> 02:49:05,960 TALKING A LOT ABOUT AND THINKING 3257 02:49:05,960 --> 02:49:07,800 ABOUT THE WHOLE PERSON. 3258 02:49:07,800 --> 02:49:10,200 I THINK IT'S VERY PROMISING AREA 3259 02:49:10,200 --> 02:49:10,840 THAT'S GOING TO SOLVE A LOT OF 3260 02:49:10,840 --> 02:49:18,960 PROBLEMS. 3261 02:49:18,960 --> 02:49:19,960 >> ARE THERE ANY OTHER QUESTIONS 3262 02:49:19,960 --> 02:49:23,680 FROM ANYONE? 3263 02:49:23,680 --> 02:49:26,040 >> I HAVE ONE I MIGHT THROW OUT. 3264 02:49:26,040 --> 02:49:29,240 THIS IS RELATED TO MORE RESEARCH 3265 02:49:29,240 --> 02:49:32,360 INFRASTRUCTURE THAT'S BEEN 3266 02:49:32,360 --> 02:49:35,040 ASSOCIATED WITH HEAL. 3267 02:49:35,040 --> 02:49:37,320 THERE'S ONE OF THE 3268 02:49:37,320 --> 02:49:39,280 RECOMMENDATIONS FROM THE FEDERAL 3269 02:49:39,280 --> 02:49:40,720 PAIN RESEARCH STRATEGY WAS TO 3270 02:49:40,720 --> 02:49:43,080 FORM NETWORKS AND WE'VE DONE 3271 02:49:43,080 --> 02:49:46,160 VERY WELL IN THAT AREA. 3272 02:49:46,160 --> 02:49:48,480 SO WELL I THINK WE'RE STARTING 3273 02:49:48,480 --> 02:49:50,920 TO HAVE A LITTLE BIT OF 3274 02:49:50,920 --> 02:49:52,560 CONFUSION SO FROM THE 3275 02:49:52,560 --> 02:49:54,120 PERSPECTIVE OF SOME RESEARCHERS. 3276 02:49:54,120 --> 02:49:56,640 WE HAVE A LOT OF DIFFERENT 3277 02:49:56,640 --> 02:49:57,640 NETWORKS THAT CAN DO CLINICAL 3278 02:49:57,640 --> 02:50:03,080 TRIALS. 3279 02:50:03,080 --> 02:50:04,520 AND FOR EXAMPLE IT MIGHT BE 3280 02:50:04,520 --> 02:50:06,600 WELL, IF I HAVE AN IDEA FOR A 3281 02:50:06,600 --> 02:50:08,080 CLINICAL TRIAL, WHICH NETWORK DO 3282 02:50:08,080 --> 02:50:10,440 I PUT IT ON? 3283 02:50:10,440 --> 02:50:18,240 THE EIN NETWORK, DO I USE PRISM, 3284 02:50:18,240 --> 02:50:21,200 AND THERE'S THE TIN NETWORK AND 3285 02:50:21,200 --> 02:50:28,920 DO WE DEAL WITH THE TICKS 3286 02:50:28,920 --> 02:50:30,520 ASSOCIATED AND PCORI HAS A 3287 02:50:30,520 --> 02:50:31,760 CONNECTION AND ONE QUESTION I 3288 02:50:31,760 --> 02:50:34,120 OFTEN GET FROM RESEARCHERS, 3289 02:50:34,120 --> 02:50:36,120 THERE'S ALL THESE DIFFERENT 3290 02:50:36,120 --> 02:50:37,320 NETWORKS, WHICH DO I USE. 3291 02:50:37,320 --> 02:50:39,040 I WONDER IF YOU CAN GIVE 3292 02:50:39,040 --> 02:50:39,840 INSIGHTS ON THAT. 3293 02:50:39,840 --> 02:50:48,560 IT'S A GOOD PROBLEM TO HAVE BUT 3294 02:50:48,560 --> 02:50:50,200 WE WANT TO GIVE GUIDANCE TO 3295 02:50:50,200 --> 02:50:51,800 THOSE CONDUCTING CLINICAL 3296 02:50:51,800 --> 02:50:52,040 TRIALS. 3297 02:50:52,040 --> 02:50:59,000 >> IS THAT ONE DIRECTED AT ME? 3298 02:50:59,000 --> 02:51:01,920 >> WHAT A GREAT QUESTION THIS 3299 02:51:01,920 --> 02:51:03,240 IS, AND REBECCA YOU SHOULD 3300 02:51:03,240 --> 02:51:03,920 ANSWER THIS. 3301 02:51:03,920 --> 02:51:05,600 I HAVE MY OWN THOUGHTS BUT GO 3302 02:51:05,600 --> 02:51:05,800 AHEAD. 3303 02:51:05,800 --> 02:51:08,240 >> FIRST OF ALL I WOULD SAY THAT 3304 02:51:08,240 --> 02:51:13,960 THE CHALLENGES WE HAVE IN TERMS 3305 02:51:13,960 --> 02:51:15,080 OF EVIDENCE GAPS FOR PAIN 3306 02:51:15,080 --> 02:51:16,120 MANAGEMENT ARE WIDE. 3307 02:51:16,120 --> 02:51:17,920 WE HAVE A LOT OF DIFFERENT AREAS 3308 02:51:17,920 --> 02:51:19,720 FOR IMPROVEMENT. 3309 02:51:19,720 --> 02:51:21,000 HELENE JUST MENTIONED ONE 3310 02:51:21,000 --> 02:51:23,160 SPECIFIC TYPE OF PRAGMATIC 3311 02:51:23,160 --> 02:51:24,240 IMPLEMENTATION STUDY WE ARE 3312 02:51:24,240 --> 02:51:27,440 FUNDING AND THEN ON THE FLIP 3313 02:51:27,440 --> 02:51:28,600 SIDE WE HAVE NOVEL THERAPEUTICS 3314 02:51:28,600 --> 02:51:34,640 FOR PAIN WE'RE TESTING THROUGH A 3315 02:51:34,640 --> 02:51:41,640 PHASE 2 CLINICAL NETWORK AND 3316 02:51:41,640 --> 02:51:43,320 HAVE THE NCATS INFRASTRUCTURE 3317 02:51:43,320 --> 02:51:44,760 YOU ALLUDED TO. 3318 02:51:44,760 --> 02:51:46,680 IN PART THE DIVERSITY OF 3319 02:51:46,680 --> 02:51:49,680 NETWORKS REFLECT THE DIVERSITY 3320 02:51:49,680 --> 02:51:51,160 OF IMPORTANT QUESTIONS THAT 3321 02:51:51,160 --> 02:51:58,960 WE'RE SEEKING TO INVESTIGATE AND 3322 02:51:58,960 --> 02:52:00,240 IN TERMS OF INVESTIGATORS AND 3323 02:52:00,240 --> 02:52:01,480 WHERE THEIR RESEARCH IDEA BEST 3324 02:52:01,480 --> 02:52:04,640 FITS IN HEAL, I TAKE THAT TO THE 3325 02:52:04,640 --> 02:52:07,480 HEART BECAUSE WE TRY TO 3326 02:52:07,480 --> 02:52:12,040 COMMUNICATE OUR RESEARCH GOALS 3327 02:52:12,040 --> 02:52:12,800 AND OPPORTUNITIES TO THE 3328 02:52:12,800 --> 02:52:14,240 COMMUNITY AND BE IN A POSITION 3329 02:52:14,240 --> 02:52:16,320 TO ANSWER THEIR QUESTIONS. 3330 02:52:16,320 --> 02:52:18,600 I DON'T LIKE TO HEAR THAT'S A 3331 02:52:18,600 --> 02:52:24,760 LITTLE BIT OVERWHELMING. 3332 02:52:24,760 --> 02:52:32,400 WE TEND TO RELEASE OUR FOAs AN 3333 02:52:32,400 --> 02:52:36,840 BURSTS ON THE FISCAL YEAR AND 3334 02:52:36,840 --> 02:52:38,480 WHEN WE NEXT DO THIS IT WOULD BE 3335 02:52:38,480 --> 02:52:41,040 GOOD TO OF BASED ON YOUR ADVICE 3336 02:52:41,040 --> 02:52:44,640 TO CLARIFY WHAT FITS WHERE AND 3337 02:52:44,640 --> 02:52:47,280 WHO THEY SHOULD REACH OUT TO FOR 3338 02:52:47,280 --> 02:52:47,960 ADDITIONAL INFORMATION. 3339 02:52:47,960 --> 02:52:49,200 SO THEY FIND THE BEST FIT. 3340 02:52:49,200 --> 02:52:52,560 THE OTHER THING I WILL SAY IS 3341 02:52:52,560 --> 02:52:55,720 THAT UNLIKE SOME OTHER PROGRAMS 3342 02:52:55,720 --> 02:52:57,880 AND THE WAYS OTHER FUNDING 3343 02:52:57,880 --> 02:53:02,960 OPPORTUNITIES NIH WORK WE TRY TO 3344 02:53:02,960 --> 02:53:06,120 BE TRANSPARENT EARLY ON AND ALL 3345 02:53:06,120 --> 02:53:08,080 THE CONCEPTS THEY'RE FUNDING 3346 02:53:08,080 --> 02:53:08,880 OPPORTUNITY ANNOUNCEMENTS GET 3347 02:53:08,880 --> 02:53:10,400 POSTED ON THE HEAL WEB PAGE AND 3348 02:53:10,400 --> 02:53:12,400 WE HAVE A SPECIAL SECTION FOR 3349 02:53:12,400 --> 02:53:14,080 THAT AND THEN ALSO WE TRY TO PUT 3350 02:53:14,080 --> 02:53:17,840 OUT NURSES OF INTENT TO PUBLISH 3351 02:53:17,840 --> 02:53:18,960 AND COMMUNICATE AROUND WHAT WE 3352 02:53:18,960 --> 02:53:22,560 INTEND TO DO LOOKING FORWARD AND 3353 02:53:22,560 --> 02:53:23,800 SO A LOT OF INFORMATION IS ON 3354 02:53:23,800 --> 02:53:27,080 OUR WEBSITE THAT MAY NOT BE A 3355 02:53:27,080 --> 02:53:30,920 PUBLISHED FOA BUT CAN BE HELPFUL 3356 02:53:30,920 --> 02:53:33,720 IN ALLOWING RESEARCHERS TO THINK 3357 02:53:33,720 --> 02:53:35,360 ABOUT WHAT TYPE OF RESEARCH THEY 3358 02:53:35,360 --> 02:53:38,760 MIGHT LIKE TO PUT FORWARD AND 3359 02:53:38,760 --> 02:53:39,360 WHAT OPPORTUNITY THEY WANT TO 3360 02:53:39,360 --> 02:53:43,000 APPLY TO. 3361 02:53:43,000 --> 02:53:45,160 DOES THAT GET TO YOUR QUESTION? 3362 02:53:45,160 --> 02:53:48,520 >> YES. 3363 02:53:48,520 --> 02:53:53,840 I THINK IT'S NOT A CRITICISM AS 3364 02:53:53,840 --> 02:53:55,080 WELL AS PEOPLE HEAR ABOUT THESE 3365 02:53:55,080 --> 02:53:57,480 THINGS AND THE DIFFERENT 3366 02:53:57,480 --> 02:54:02,400 NETWORKS AND MATCHING FOLKS UP 3367 02:54:02,400 --> 02:54:12,920 WITH THE PROGRAM. 3368 02:54:12,920 --> 02:54:14,800 >> AND COMMUNICATING THE 3369 02:54:14,800 --> 02:54:17,640 RICHNESS OF THE FUNDING 3370 02:54:17,640 --> 02:54:18,480 OPPORTUNITIES TO INVESTIGATORS 3371 02:54:18,480 --> 02:54:21,040 AND A LOT OF TIMES THIS IS ALL 3372 02:54:21,040 --> 02:54:24,000 HAPPENING AS REBECCA SAID, KIND 3373 02:54:24,000 --> 02:54:24,640 OF FAST. 3374 02:54:24,640 --> 02:54:29,480 WE HAVE TO SOMETIMES ISSUE THESE 3375 02:54:29,480 --> 02:54:30,800 FUNDING OPPORTUNITIES NEARBY 3376 02:54:30,800 --> 02:54:32,520 CONSTRAINTS IN TERMS OF TIME 3377 02:54:32,520 --> 02:54:33,920 LINES AND IT'S VERY CHALLENGING 3378 02:54:33,920 --> 02:54:37,440 AND THIS IS ONE OF THE THINGS WE 3379 02:54:37,440 --> 02:54:40,120 STRUGGLE AT NCCIH AND I'M SURE 3380 02:54:40,120 --> 02:54:42,920 OTHER INSTITUTES DO AS WELL TO 3381 02:54:42,920 --> 02:54:46,360 HOW DO WE BEST UNDERSTAND 3382 02:54:46,360 --> 02:54:49,680 WHETHER THE MESSAGE WE'RE 3383 02:54:49,680 --> 02:54:52,440 COMMUNICATING OUT ARE BEING 3384 02:54:52,440 --> 02:54:54,480 RECEIVED, UNDERSTOOD AND ACTED 3385 02:54:54,480 --> 02:54:54,680 UPON. 3386 02:54:54,680 --> 02:54:57,120 SO IT'S VERY HELPFUL TO HEAR THE 3387 02:54:57,120 --> 02:54:59,800 KIND OF COMMENT YOU'RE MAKING, 3388 02:54:59,800 --> 02:55:03,320 DAVID, ABOUT WE'RE CONFUSED. 3389 02:55:03,320 --> 02:55:05,440 WELL, PEOPLE ARE CONFUSED ABOUT 3390 02:55:05,440 --> 02:55:07,760 A LOT OF THINGS SO IT'S GREAT TO 3391 02:55:07,760 --> 02:55:09,280 HEAR THAT BECAUSE IT HELPS US IN 3392 02:55:09,280 --> 02:55:09,920 OUR COMMUNICATION STRATEGIES IN 3393 02:55:09,920 --> 02:55:14,600 GENERAL. 3394 02:55:14,600 --> 02:55:17,120 IT'S VERY CHALLENGING BECAUSE 3395 02:55:17,120 --> 02:55:19,040 WHEN YOU'RE INSIDE NIH IT'S 3396 02:55:19,040 --> 02:55:20,400 CHALLENGING EVEN FOR PEOPLE AT 3397 02:55:20,400 --> 02:55:26,600 NIH. 3398 02:55:26,600 --> 02:55:27,600 THERE'S VOLUME AND COMPLEXITY 3399 02:55:27,600 --> 02:55:31,920 BUT PEOPLE OUTSIDE OF NIH IT'S 3400 02:55:31,920 --> 02:55:33,400 EVEN HARDER. 3401 02:55:33,400 --> 02:55:35,640 THIS IS WHERE WE NEED TO HEAR 3402 02:55:35,640 --> 02:55:36,200 THAT KIND OF FEEDBACK. 3403 02:55:36,200 --> 02:55:41,480 >> THANK YOU. 3404 02:55:41,480 --> 02:55:46,160 >> MAY I ASK, IS IT HELPFUL WHEN 3405 02:55:46,160 --> 02:55:49,760 YOU BLAST E-MAILS TO INCLUDE 3406 02:55:49,760 --> 02:55:50,520 ORGANIZATIONS WITHIN THE PAIN 3407 02:55:50,520 --> 02:55:53,960 SPACE AND ORGANIZATIONS IN 3408 02:55:53,960 --> 02:56:00,600 ADDITION TO INDIVIDUALS? 3409 02:56:00,600 --> 02:56:02,440 >> IN RESPONSE TO WHAT? 3410 02:56:02,440 --> 02:56:09,120 >> SORRY, WHEN YOU SEND OUT YOUR 3411 02:56:09,120 --> 02:56:12,280 NOTIC 3412 02:56:12,280 --> 02:56:13,240 NOTICES, DO YOU THINK IT MIGHT 3413 02:56:13,240 --> 02:56:18,880 BE HELPFUL AS PART OF 3414 02:56:18,880 --> 02:56:22,160 COMMUNICATION TO SEND TO 3415 02:56:22,160 --> 02:56:27,000 ORGANIZATIONS WITHIN THE PAIN 3416 02:56:27,000 --> 02:56:31,760 SPACE THAT CAN HELP TEASE OUT 3417 02:56:31,760 --> 02:56:38,040 WHERE ANNOUNCEMENTS SHOULD GO? 3418 02:56:38,040 --> 02:56:40,040 I'M PUTTING IT OUT THERE 3419 02:56:40,040 --> 02:56:42,120 >> EVERY INSTITUTE AND CENTER AT 3420 02:56:42,120 --> 02:56:43,120 NIH HAS THEIR OWN COMMUNICATION 3421 02:56:43,120 --> 02:56:48,480 STRATEGIES. 3422 02:56:48,480 --> 02:56:55,320 HOW DO YOU REACH PEOPLE AND DO 3423 02:56:55,320 --> 02:57:01,000 VIDEO WEBCASTS AND WE DO 3424 02:57:01,000 --> 02:57:05,000 WORKSH 3425 02:57:05,000 --> 02:57:12,440 WORKSHOPS I THINK THE POINT AND 3426 02:57:12,440 --> 02:57:22,480 ALL OF THAT IS WE ALL HAVE 3427 02:57:22,480 --> 02:57:24,120 THINGS WE SEND OUT AND MAKING 3428 02:57:24,120 --> 02:57:27,520 SURE THE RIGHT ORGANIZATIONS ARE 3429 02:57:27,520 --> 02:57:29,320 AWARE OF THIS. 3430 02:57:29,320 --> 02:57:37,400 THIS IS AN IMPORTANT POINT. 3431 02:57:37,400 --> 02:57:39,600 >> WE TRY TO ENCOURAGE WHERE WE 3432 02:57:39,600 --> 02:57:42,000 KNOW WE CAN REACH OUT TO AND 3433 02:57:42,000 --> 02:57:43,760 LIST SERVE AND TYPICALLY WE'LL 3434 02:57:43,760 --> 02:57:46,120 PUT OUT FUNDING OPPORTUNITY 3435 02:57:46,120 --> 02:57:48,040 ANNOUNCEMENTS TO THAT LIST SERVE 3436 02:57:48,040 --> 02:57:50,520 AND HEAL HAS A LIST SERVE. 3437 02:57:50,520 --> 02:57:54,880 HOW TO GET THEM TO JOIN THE LIST 3438 02:57:54,880 --> 02:57:56,200 SERVES IS A LITTLE HARD FROM OUR 3439 02:57:56,200 --> 02:57:58,320 END BUT WE DO ENCOURAGE THE 3440 02:57:58,320 --> 02:58:00,240 ORGANIZATIONS IF THEY WANT TO 3441 02:58:00,240 --> 02:58:01,520 PUT THE INFORMATION ON THE 3442 02:58:01,520 --> 02:58:02,680 WEBSITES THEY CAN, FOR EXAMPLE, 3443 02:58:02,680 --> 02:58:06,640 IF AS THE RELEVANT TO THEM. 3444 02:58:06,640 --> 02:58:08,960 IT'S HARD FOR US TO CAPTURE THEM 3445 02:58:08,960 --> 02:58:09,600 IN ORDER FOR US TO SEND THEM THE 3446 02:58:09,600 --> 02:58:12,480 INFORMATION. 3447 02:58:12,480 --> 02:58:14,200 IF YOU HAVE THOUGHTS ON THAT HOW 3448 02:58:14,200 --> 02:58:19,120 WE COULD REACH OUT A LITTLE BIT 3449 02:58:19,120 --> 02:58:21,480 BETTER WE CAN TRY TO GET OUR 3450 02:58:21,480 --> 02:58:26,240 LIST SERVE ON THAT. 3451 02:58:26,240 --> 02:58:30,920 >> I'M SURE SEVERAL ON THIS 3452 02:58:30,920 --> 02:58:32,720 COMMITTEE CAN GATHER TOGETHER. 3453 02:58:32,720 --> 02:58:34,320 >> WHAT WE'LL DO AFTER THE 3454 02:58:34,320 --> 02:58:36,160 MEETING, THIS IS A TINY FIRST 3455 02:58:36,160 --> 02:58:38,760 STEP BUT IT'S A FIRST STEP, 3456 02:58:38,760 --> 02:58:42,160 WE'LL SEND THIS COMMITTEE THE 3457 02:58:42,160 --> 02:58:46,080 INFORMATION TO GET ON THE PAIN 3458 02:58:46,080 --> 02:58:47,600 CONSORTIUM LIST SERVE. 3459 02:58:47,600 --> 02:58:48,800 THAT'S JUST ONE EXTRA ROUTE BUT 3460 02:58:48,800 --> 02:58:51,240 WE CAN DO THAT IF YOU WANT TO 3461 02:58:51,240 --> 02:59:01,720 DISTRIBUTE TO ANYBODY YOU CAN. 3462 02:59:07,000 --> 02:59:08,720 >> THAT'S PERFECT AND OVER THE 3463 02:59:08,720 --> 02:59:10,160 LAST YEAR OR SO WE ALSO HAVE A 3464 02:59:10,160 --> 02:59:13,600 LIST THAT COULD BE HELPFUL. 3465 02:59:13,600 --> 02:59:15,120 I WILL DIG THAT UP. 3466 02:59:15,120 --> 02:59:18,200 >> THANK YOU. 3467 02:59:18,200 --> 02:59:20,240 >> THE HEAL INITIATIVE PUTS OUT 3468 02:59:20,240 --> 02:59:22,560 FREQUENT COMMUNICATIONS IN WHICH 3469 02:59:22,560 --> 02:59:24,920 WE SPOTLIGHT OPEN FUNDING 3470 02:59:24,920 --> 02:59:26,960 OPPORTUNITY ANNOUNCEMENTS OR 3471 02:59:26,960 --> 02:59:28,040 NEWLY RELEASED FUNDING 3472 02:59:28,040 --> 02:59:31,200 OPPORTUNITY ANNOUNCEMENTS FROM 3473 02:59:31,200 --> 02:59:32,360 ACROSS THE INITIATIVE. 3474 02:59:32,360 --> 02:59:34,680 BY SIGNING UP FOR UPDATES ON THE 3475 02:59:34,680 --> 02:59:37,920 WEBSITE YOU GET ADDED TO THAT 3476 02:59:37,920 --> 02:59:40,040 DISTRIBUTION LIST AND I'LL SHARE 3477 02:59:40,040 --> 02:59:41,240 THE INFORMATION WITH THE GROUP 3478 02:59:41,240 --> 02:59:43,560 HERE SO YOU CAN ACCESS THAT. 3479 02:59:43,560 --> 02:59:47,640 FOR FOLKS JUST LISTENING IN AND 3480 02:59:47,640 --> 02:59:49,760 MAYBE NOT EVEN SURE WHERE TO 3481 02:59:49,760 --> 02:59:52,080 START, I WOULD SAY THAT WE IN 3482 02:59:52,080 --> 02:59:57,080 THE GOVERNMENT WE WORK FOR YOU 3483 02:59:57,080 --> 03:00:01,000 AND HAVE STAFF WHOSE JOB IT IS 3484 03:00:01,000 --> 03:00:05,560 TO RESPOND AND LINDA AND I TALK 3485 03:00:05,560 --> 03:00:07,880 TOGETHER AND HELENE AND WE MEET 3486 03:00:07,880 --> 03:00:10,400 FREQUENTLY AND KEPT APPRISED OF 3487 03:00:10,400 --> 03:00:13,480 ONE ANOTHER'S RESEARCH 3488 03:00:13,480 --> 03:00:14,800 ACTIVITIES SO WHEN QUESTIONS 3489 03:00:14,800 --> 03:00:17,720 COME IN WE CAN PROVIDE THE BEST 3490 03:00:17,720 --> 03:00:20,480 ADVICE TO THE RESEARCHER. 3491 03:00:20,480 --> 03:00:23,000 NEVER HESITATE AND FEEL 3492 03:00:23,000 --> 03:00:24,600 COMFORTABLE ASKING FOR HELP 3493 03:00:24,600 --> 03:00:29,600 BECAUSE THAT'S WHY WE'RE HERE. 3494 03:00:29,600 --> 03:00:33,920 >> I WANTED TO FOLLOW UP ON WHAT 3495 03:00:33,920 --> 03:00:35,320 YOU ASKED AND MY UNDERSTANDING 3496 03:00:35,320 --> 03:00:37,560 WAS THERE WERE PEOPLE IN THE 3497 03:00:37,560 --> 03:00:39,840 COMMUNITY WHO WANT TO DO 3498 03:00:39,840 --> 03:00:45,360 CLINICAL RESEARCH IS THAT RIGHT 3499 03:00:45,360 --> 03:00:47,560 OR CLINICAL TRIALS AND NOT SURE 3500 03:00:47,560 --> 03:00:48,520 WHERE TO GO. 3501 03:00:48,520 --> 03:00:54,160 ONE THING REBECCA SAID IS A THAT 3502 03:00:54,160 --> 03:00:57,240 WE USUALLY PUT OUT FOAs FOR 3503 03:00:57,240 --> 03:01:01,600 THINGS AND NOT EVERY YEAR. 3504 03:01:01,600 --> 03:01:03,840 BUT DO YOU HAVE A SENSE THERE'S 3505 03:01:03,840 --> 03:01:07,440 A LOT OF INTEREST TO DO MORE 3506 03:01:07,440 --> 03:01:08,320 CLINICAL TRIALS IN PAIN THAT 3507 03:01:08,320 --> 03:01:12,920 WOULD BE RELEVANT TO HEAL? 3508 03:01:12,920 --> 03:01:14,960 >> YEAH, I DO. 3509 03:01:14,960 --> 03:01:17,320 ONE OF THE ROLES I PLAY WITH 3510 03:01:17,320 --> 03:01:19,600 CTSA AND WE GET A NUMBER OF 3511 03:01:19,600 --> 03:01:20,800 INVESTIGATORS COMING TO US WITH 3512 03:01:20,800 --> 03:01:21,040 IDEAS. 3513 03:01:21,040 --> 03:01:22,760 MANY OF THOSE IDEAS ARE ABOUT 3514 03:01:22,760 --> 03:01:25,960 SOMETHING RELATED TO PAIN OR A 3515 03:01:25,960 --> 03:01:28,680 COMORBIDITY OF PAIN. 3516 03:01:28,680 --> 03:01:30,400 AND AS THEY'RE THINKING ABOUT 3517 03:01:30,400 --> 03:01:32,760 THE DESIGN OF THEIR TRIAL, ONE 3518 03:01:32,760 --> 03:01:35,080 OF THE QUESTIONS THAT FREQUENTLY 3519 03:01:35,080 --> 03:01:36,480 COMES UP AS WELL IF WE'RE GOING 3520 03:01:36,480 --> 03:01:41,720 IT TAKE THIS INTO LIKE 3521 03:01:41,720 --> 03:01:44,560 MULTI-SITE SITUATION DO WE WORK 3522 03:01:44,560 --> 03:01:51,520 WITH PCOR NET, WHAT ABOUT THE 3523 03:01:51,520 --> 03:01:53,880 NEW NETWORKS OR PRISM NETWORK 3524 03:01:53,880 --> 03:01:56,120 AND THERE'S OPTIONS BEFORE THEM. 3525 03:01:56,120 --> 03:01:58,080 EVEN BEFORE THEY MAY BE 3526 03:01:58,080 --> 03:02:01,280 RESPONDING TO A SPECIFIC 3527 03:02:01,280 --> 03:02:01,800 ANNOUNCEMENT BUT THEY'RE 3528 03:02:01,800 --> 03:02:03,520 CONSIDERING WHICH NETWORK THEY 3529 03:02:03,520 --> 03:02:06,560 MIGHT WANT TO WORK WITH AND THE 3530 03:02:06,560 --> 03:02:08,200 QUESTION IS WHICH ONE BEST 3531 03:02:08,200 --> 03:02:12,760 MATCHES WITH MY IDEA AND, I 3532 03:02:12,760 --> 03:02:14,320 MEAN, I DON'T HAVE A CHOICE IF I 3533 03:02:14,320 --> 03:02:16,520 HAVE TO GO AFTER A SPECIFIC 3534 03:02:16,520 --> 03:02:16,880 ANNOUNCEMENT. 3535 03:02:16,880 --> 03:02:18,080 I HAVE TO USE THAT ONE. 3536 03:02:18,080 --> 03:02:19,600 BUT MANY TIMES THERE'S AN OPTION 3537 03:02:19,600 --> 03:02:24,920 TO MAYBE GO WITH THE TIN NETWORK 3538 03:02:24,920 --> 03:02:28,000 OR PCORI NET OR THE OTHERS. 3539 03:02:28,000 --> 03:02:30,560 I THINK AN ISSUE WE FREQUENTLY 3540 03:02:30,560 --> 03:02:34,560 HAVE TO DEAL WITH IS EXPLAINING 3541 03:02:34,560 --> 03:02:36,160 WHAT ARE THE DIFFERENT NETWORKS 3542 03:02:36,160 --> 03:02:36,960 OUT THERE AND HOW TO BEST MATCH 3543 03:02:36,960 --> 03:02:46,480 PEOPLE. 3544 03:02:46,480 --> 03:02:51,400 >> I LIKE CHRISTINE'S COMMENT IN 3545 03:02:51,400 --> 03:02:55,840 THE CHAT THAT WE COULD TAKE THIS 3546 03:02:55,840 --> 03:03:04,760 ON AS AN IRPCC TASK TO REALLY 3547 03:03:04,760 --> 03:03:09,720 EXAMINE HOW BEST TO COALESCE THE 3548 03:03:09,720 --> 03:03:11,600 INFORMATION LIKE WE STARTED 3549 03:03:11,600 --> 03:03:15,040 DOING AND LIKE LINDA DID EARLIER 3550 03:03:15,040 --> 03:03:18,080 AND ADD THE OTHER OPPORTUNITIES 3551 03:03:18,080 --> 03:03:19,920 THAT ARE OUT THERE BEYOND NIH 3552 03:03:19,920 --> 03:03:25,880 AND REALLY PACKAGE IT SO THE 3553 03:03:25,880 --> 03:03:26,520 COMMUNITY CAN UNDERSTAND BETTER 3554 03:03:26,520 --> 03:03:30,640 WHAT'S AVAILABLE. 3555 03:03:30,640 --> 03:03:31,640 >> GOOD POINT. 3556 03:03:31,640 --> 03:03:35,560 I THINK I'VE SAID THIS BEFORE 3557 03:03:35,560 --> 03:03:37,240 THAT HEAL HAS THE OPIOID SIDE 3558 03:03:37,240 --> 03:03:39,880 AND THE PAIN SIDE AND THE MIDDLE 3559 03:03:39,880 --> 03:03:41,440 SIDE WHICH JOSÉ MENTIONED HOW 3560 03:03:41,440 --> 03:03:42,960 IMPORTANT IT IS AND WE DO WANT 3561 03:03:42,960 --> 03:03:50,840 TO ATTACK ALL THOSE. 3562 03:03:50,840 --> 03:03:54,000 BUT THE OPIOID SIDE HAS NIDA 3563 03:03:54,000 --> 03:03:56,000 WHICH HAS BEEN AN INSTITUTE FOR 3564 03:03:56,000 --> 03:03:57,880 A LONG TIME AND TO PATCH IN THE 3565 03:03:57,880 --> 03:04:02,880 WORKFORCE AND EVERYTHING IS 3566 03:04:02,880 --> 03:04:03,120 EASY. 3567 03:04:03,120 --> 03:04:05,960 FOR US WE'RE BUILDING FROM 3568 03:04:05,960 --> 03:04:10,640 SCRATCH ELEMENT AND FROM THEM 3569 03:04:10,640 --> 03:04:12,840 WE'RE IN THE BUILDING STAGES AND 3570 03:04:12,840 --> 03:04:15,280 NEED THE WORKFORCE AND PEOPLE 3571 03:04:15,280 --> 03:04:17,680 WHO BECOME EXPERIENCED IN DOING 3572 03:04:17,680 --> 03:04:20,800 THIS TYPE OF RESEARCH AND 3573 03:04:20,800 --> 03:04:21,760 RECRUITING OTHER PEOPLE TO BRING 3574 03:04:21,760 --> 03:04:24,800 THEM IN. 3575 03:04:24,800 --> 03:04:30,920 AND SO ONE THING I WANTED TO 3576 03:04:30,920 --> 03:04:35,080 MENTION WE ARE PUTTING EMPHASIS 3577 03:04:35,080 --> 03:04:43,720 ON TRAINING AS JOSÉ MENTIONED 3578 03:04:43,720 --> 03:04:45,640 AND THE BASIC RESEARCH CAN 3579 03:04:45,640 --> 03:04:47,720 IDENTIFY THE CLINICAL RESEARCH 3580 03:04:47,720 --> 03:04:49,240 IN THE PAIN SPACE. 3581 03:04:49,240 --> 03:04:50,240 PEOPLE, PLEASE LOOK FOR THAT. 3582 03:04:50,240 --> 03:04:58,240 MY PROBLEM IS I CAN NEVER 3583 03:04:58,240 --> 03:04:59,760 REMEMBER WHAT'S PUBLIC AND NOT 3584 03:04:59,760 --> 03:05:02,160 PUBLIC AND CAN'T TALK ABOUT BUT 3585 03:05:02,160 --> 03:05:02,720 THERE'S A LOT OF TRAINING 3586 03:05:02,720 --> 03:05:07,520 OPPORTUNITIES EITHER THERE OR 3587 03:05:07,520 --> 03:05:17,560 COMING CONNECTING THE BASIC AND 3588 03:05:17,560 --> 03:05:21,240 CLINICAL PEOPLE. 3589 03:05:21,240 --> 03:05:23,600 DID I SAY ANYTHING WRONG I 3590 03:05:23,600 --> 03:05:24,920 SHOULDN'T SAY? 3591 03:05:24,920 --> 03:05:26,240 >> NEVER, WALTER. 3592 03:05:26,240 --> 03:05:30,520 I WOULD ADD A LOT OF TIMES IT'S 3593 03:05:30,520 --> 03:05:32,160 NOT JUST GETTING THE BASIC 3594 03:05:32,160 --> 03:05:35,000 SCIENTISTS TO THINK HOW TO TEST 3595 03:05:35,000 --> 03:05:37,440 CLINICALLY BUT OUR CLINICAL 3596 03:05:37,440 --> 03:05:39,360 RESEARCH IS THIS INCREDIBLY 3597 03:05:39,360 --> 03:05:45,400 VALUABLE DATA SOURCE FOR NEW 3598 03:05:45,400 --> 03:05:48,920 BASIC QUESTION AND SO WE'RE ALSO 3599 03:05:48,920 --> 03:05:50,720 INFORMING NEW LINES OF INQUIRY 3600 03:05:50,720 --> 03:05:52,640 AND NOT PROVIDING JUST A SIMPLE 3601 03:05:52,640 --> 03:05:52,880 ANSWER. 3602 03:05:52,880 --> 03:05:58,480 IN TERMS OF HOW TO KNOW WHAT'S 3603 03:05:58,480 --> 03:06:00,800 PUBLIC OR NOT THAT'S WHERE 3604 03:06:00,800 --> 03:06:03,800 RESOURCES CAN BE HELPFUL BECAUSE 3605 03:06:03,800 --> 03:06:10,320 ONCE THE FOAs ARE OUT THEY'RE 3606 03:06:10,320 --> 03:06:12,840 THERE AND SEARCHABLE AND 3607 03:06:12,840 --> 03:06:14,800 TYPICALLY HAVE A POINT OF 3608 03:06:14,800 --> 03:06:16,800 CONTACT AND YOU CAN REACH OUT TO 3609 03:06:16,800 --> 03:06:18,640 A PERSON AT NIH WITH QUESTIONS. 3610 03:06:18,640 --> 03:06:20,280 >> WALTER, THE TRAINING PROGRAM 3611 03:06:20,280 --> 03:06:24,520 YOU MAYBE WANTED TO TALK ABOUT I 3612 03:06:24,520 --> 03:06:25,120 THINK WE HAVE IT HERE ON THE 3613 03:06:25,120 --> 03:06:29,880 SCREEN. 3614 03:06:29,880 --> 03:06:33,200 THERE'S A NATIONAL PROGRAM WHICH 3615 03:06:33,200 --> 03:06:37,320 IS PARTNERED UP WITH A 3616 03:06:37,320 --> 03:06:39,840 COORDINATING CENTER TO SET UP A 3617 03:06:39,840 --> 03:06:47,600 PLATFORM FOR NETWORKING AND 3618 03:06:47,600 --> 03:06:50,160 INACTIVE NETWORKING ACTIVITIES 3619 03:06:50,160 --> 03:06:52,720 AND BRINGING TOGETHER BASIC AND 3620 03:06:52,720 --> 03:06:53,280 CLINICAL RESEARCHERS AT 3621 03:06:53,280 --> 03:06:53,920 DIFFERENT OPPORTUNITIES WHERE 3622 03:06:53,920 --> 03:06:56,280 THEY CAN SET UP COLLABORATIONS, 3623 03:06:56,280 --> 03:06:57,040 THEY CAN BEGIN TO NETWORK, 3624 03:06:57,040 --> 03:07:00,720 ETCETERA. 3625 03:07:00,720 --> 03:07:02,520 I THINK THAT'S AN EXCITING 3626 03:07:02,520 --> 03:07:06,120 PROGRAM THAT'S GETTING LAUNCHED. 3627 03:07:06,120 --> 03:07:07,880 >> THANK YOU. 3628 03:07:07,880 --> 03:07:10,960 IT'S ALREADY LOOKING EXCITING. 3629 03:07:10,960 --> 03:07:15,120 >> WE'RE EXCITED ABOUT GETTING 3630 03:07:15,120 --> 03:07:15,800 IT GOING. 3631 03:07:15,800 --> 03:07:22,480 >> CAN ANYONE SAY ABOUT THE 3632 03:07:22,480 --> 03:07:24,280 WORKFORCE TO DO PAIN RESEARCH IN 3633 03:07:24,280 --> 03:07:24,960 CHILDREN WHAT THAT LOOKS LIKE 3634 03:07:24,960 --> 03:07:33,920 NOW? 3635 03:07:33,920 --> 03:07:34,920 >> I THINK IT PROBABLY NEEDS TO 3636 03:07:34,920 --> 03:07:45,120 BE ADVANCED. 3637 03:07:47,600 --> 03:07:48,840 >> WE CAN COME BACK TO THAT IN 3638 03:07:48,840 --> 03:07:49,200 THE AFTERNOON. 3639 03:07:49,200 --> 03:07:51,480 >> THANK YOU. 3640 03:07:51,480 --> 03:07:52,960 >> THIS HAS BEEN GREAT, 3641 03:07:52,960 --> 03:07:53,240 EVERYBODY. 3642 03:07:53,240 --> 03:07:59,880 I HAVE NOTES AND NOTES AND NOTES 3643 03:07:59,880 --> 03:08:03,200 TO BRING BACK AND SHARE AND A 3644 03:08:03,200 --> 03:08:04,480 LOT OF GOOD THOUGHTS I THINK 3645 03:08:04,480 --> 03:08:05,720 WILL MOVE THINGS FORWARD. 3646 03:08:05,720 --> 03:08:07,640 WE HAVE ALMOST A FULL HOUR FOR 3647 03:08:07,640 --> 03:08:08,960 LUNCH BECAUSE WE'RE FIVE MINUTES 3648 03:08:08,960 --> 03:08:12,640 OR SO EARLY FOR THE BREAK. 3649 03:08:12,640 --> 03:08:16,960 SO IF EVERYBODY WILL BE BACK AT 3650 03:08:16,960 --> 03:08:18,720 2:00, WE THINK WE'LL HAVE 3651 03:08:18,720 --> 03:08:20,840 INTERESTING PRESENTATIONS THIS 3652 03:08:20,840 --> 03:08:22,120 AFTERNOON ON NSAIDS. 3653 03:08:22,120 --> 03:08:28,320 AND THESE ARE TOPIC AREAS. 3654 03:08:28,320 --> 03:08:29,880 HELENE WILL TELL YOU MORE THIS 3655 03:08:29,880 --> 03:08:30,200 AFTERNOON. 3656 03:08:30,200 --> 03:08:30,840 SEE YOU AT 2:00. 3657 03:08:30,840 --> 03:08:33,880 >> ARE WE READY TO START, 3658 03:08:33,880 --> 03:08:34,080 I GUESS? 3659 03:08:34,080 --> 03:08:34,320 WONDERFUL. 3660 03:08:34,320 --> 03:08:35,640 LOOKING FORWARD TO THE 3661 03:08:35,640 --> 03:08:38,720 PRESENTATIONS THIS AFTERNOON AND 3662 03:08:38,720 --> 03:08:41,480 DISCUSSION THAT WILL FOLLOW. 3663 03:08:41,480 --> 03:08:46,760 AND JUST AS A PREAMBLE TO THE 3664 03:08:46,760 --> 03:08:47,760 TALKS YOU'RE GOING TO HEAR, I 3665 03:08:47,760 --> 03:08:50,600 ALONG WITH I'M SURE MANY OF YOU 3666 03:08:50,600 --> 03:08:53,400 HAD THE PLEASURE OF ATTENDING 3667 03:08:53,400 --> 03:08:56,800 THE MEETING IN TORONTO IN 3668 03:08:56,800 --> 03:08:57,040 SEPTEMBER. 3669 03:08:57,040 --> 03:08:57,680 THE INTERNATIONAL ASSOCIATION 3670 03:08:57,680 --> 03:08:59,880 FOR THE STUDY OF PAIN WHERE 3671 03:08:59,880 --> 03:09:02,880 THERE WERE A NUMBER OF 3672 03:09:02,880 --> 03:09:05,080 PROVOCATIVE TALKS THAT REALLY, I 3673 03:09:05,080 --> 03:09:07,720 MEAN I CAN SPEAK FOR MYSELF THAT 3674 03:09:07,720 --> 03:09:13,200 STOPPED ME IN MY TRACKS. 3675 03:09:13,200 --> 03:09:16,320 TWO OF THESE TALKS WE INVITED 3676 03:09:16,320 --> 03:09:19,280 TWO OF THE SPEAKERS TO TALK 3677 03:09:19,280 --> 03:09:19,720 HERE. 3678 03:09:19,720 --> 03:09:25,960 THEY BOTH TALKED ABOUT THE 3679 03:09:25,960 --> 03:09:28,840 EFFECT OF NON-STEROIDAL 3680 03:09:28,840 --> 03:09:31,280 ANTI-INFLAMMATORY AGENTS WITH 3681 03:09:31,280 --> 03:09:33,040 PAIN AND THE UNINTENDED 3682 03:09:33,040 --> 03:09:37,560 CONSEQUENCES OF TREATING ACUTE 3683 03:09:37,560 --> 03:09:40,240 OR CHRONIC PAIN WITH THESE 3684 03:09:40,240 --> 03:09:41,120 DRUGS. 3685 03:09:41,120 --> 03:09:47,520 OUR FIRST SPEAKER IS DR. MARY 3686 03:09:47,520 --> 03:09:50,400 BARBE FROM THE CENTER OF 3687 03:09:50,400 --> 03:09:52,680 TRANSLATIONAL MEDICINE AND 3688 03:09:52,680 --> 03:09:53,760 CENTER FOR SUBSTANCE ABUSE 3689 03:09:53,760 --> 03:09:57,560 RESEARCH AT TEMPLE UNIVERSITY. 3690 03:09:57,560 --> 03:10:00,120 SHE RECEIVED A B.A. FROM NORTH 3691 03:10:00,120 --> 03:10:04,680 CAROLINA, Ph.D. IN ANATOMY FROM 3692 03:10:04,680 --> 03:10:07,520 WORKFORCE AND POST-DOCTORAL 3693 03:10:07,520 --> 03:10:11,520 RESEARCH FELLOWSHIP IN THE NEURO 3694 03:10:11,520 --> 03:10:12,360 BIOLOGY IN THE UNIVERSITY OF 3695 03:10:12,360 --> 03:10:15,760 PENNSYLVANIA AND FOCUSSED ON THE 3696 03:10:15,760 --> 03:10:17,920 REPUTATION AND FORCE ON 3697 03:10:17,920 --> 03:10:18,640 MUSCULOSKELETAL AND NEURAL 3698 03:10:18,640 --> 03:10:21,040 SYSTEMS AND THEIR INTERACTION IN 3699 03:10:21,040 --> 03:10:25,400 A UNIQUE RAT MODEL OF UNIQUE 3700 03:10:25,400 --> 03:10:32,840 RELATED MUSCULOSKELETAL DISORDER 3701 03:10:32,840 --> 03:10:35,800 AND LOOKING CEREBRAL PALSY AND 3702 03:10:35,800 --> 03:10:42,600 THE SURGICAL MEANS OF BLADDER 3703 03:10:42,600 --> 03:10:44,120 RE-INTEGRATION AFTER SURGERY. 3704 03:10:44,120 --> 03:10:48,080 WE HAVE INTERESTING MODELS. 3705 03:10:48,080 --> 03:10:55,160 SHE'S GOING TO TALK TO US ABOUT 3706 03:10:55,160 --> 03:10:56,200 ANTI-INFLAMMATORY MODELS. 3707 03:10:56,200 --> 03:10:58,760 THANK YOU FOR JOINING US, MARY. 3708 03:10:58,760 --> 03:11:03,080 >> YOU ARE MUTED. 3709 03:11:03,080 --> 03:11:07,400 >> I WILL SHARE MY SCREEN. 3710 03:11:07,400 --> 03:11:15,440 I'LL HIT SHARE. 3711 03:11:15,440 --> 03:11:16,600 CAN EVERYONE SEE IT? 3712 03:11:16,600 --> 03:11:20,240 SO IF YOU HAVE QUESTIONS, JUST 3713 03:11:20,240 --> 03:11:21,240 YELL OUT AND I'LL STOP. 3714 03:11:21,240 --> 03:11:26,440 IT'S HARD TO SEE A CHAT SO IT'S 3715 03:11:26,440 --> 03:11:28,440 BETTER TO YELL IT OUT, OKAY. 3716 03:11:28,440 --> 03:11:31,680 THANK YOU FOR THE INVITATION. 3717 03:11:31,680 --> 03:11:38,720 AND I DO WORK ON WORK-RELATED 3718 03:11:38,720 --> 03:11:41,240 MUSCULOSKELETAL DISORDERS OR 3719 03:11:41,240 --> 03:11:46,760 REPETITIVE STRAIN INJURIES AND 3720 03:11:46,760 --> 03:11:48,080 IT'S USUALLY MULTI-FACTORIAL AND 3721 03:11:48,080 --> 03:11:49,720 A PROBLEM OF WORK. 3722 03:11:49,720 --> 03:11:52,360 IT'S NOT EXERCISE. 3723 03:11:52,360 --> 03:11:55,240 REMEMBER IF WORK WAS EXERCISE 3724 03:11:55,240 --> 03:11:56,080 WE'D BE MORE FIT AFTER LONG DAYS 3725 03:11:56,080 --> 03:11:59,120 AT WORK. 3726 03:11:59,120 --> 03:12:04,160 IT'S A PHYSICAL TASK OF I'M 3727 03:12:04,160 --> 03:12:09,720 MAINLY GOING TO INTENSE HIGH 3728 03:12:09,720 --> 03:12:14,040 HIGH-PEPTITION AND HIGH FORCE 3729 03:12:14,040 --> 03:12:17,320 AND IT'S INVOLVED WITH SICKNESS 3730 03:12:17,320 --> 03:12:19,480 ABSENCE WHICH IS WHAT IS OF 3731 03:12:19,480 --> 03:12:22,720 INTEREST TO YOU ALL BECAUSE 3732 03:12:22,720 --> 03:12:23,680 NSAIDS ARE THE MOST PREVALENT 3733 03:12:23,680 --> 03:12:25,800 DRUG USED BY WORKERS AND EVEN 3734 03:12:25,800 --> 03:12:29,880 DISPENSED IN VENDING MACHINES. 3735 03:12:29,880 --> 03:12:33,960 BUT IS THESE LONG PERSISTENT 3736 03:12:33,960 --> 03:12:35,040 DISORDERS ASSOCIATED WITH 3737 03:12:35,040 --> 03:12:37,680 INCREASED ABSENCE, DEPRESSION 3738 03:12:37,680 --> 03:12:38,200 AND CHRONIC PAIN? 3739 03:12:38,200 --> 03:12:40,280 IT'S QUITE COSTLY TO THE 3740 03:12:40,280 --> 03:12:43,440 U.S. WITH 32% OF ALL WORK LOSS 3741 03:12:43,440 --> 03:12:47,040 TIME ACCOUNTED FOR BY THESE 3742 03:12:47,040 --> 03:12:47,400 DISORDERS. 3743 03:12:47,400 --> 03:12:48,960 THERE ARE BIO BEHAVIORAL 3744 03:12:48,960 --> 03:12:51,400 MECHANISMS WITH THE WORK-RELATED 3745 03:12:51,400 --> 03:12:52,520 DEPRESSION AND CHRONIC PAINS 3746 03:12:52,520 --> 03:12:54,480 WHICH HAVE BEEN ELUSIVE, SOME OF 3747 03:12:54,480 --> 03:12:57,280 WHICH I'LL TALK BAND YES, 3748 03:12:57,280 --> 03:12:58,760 EFFECTIVE INTERVENTIONS ARE 3749 03:12:58,760 --> 03:13:01,640 STILL UNDER INVESTIGATION. 3750 03:13:01,640 --> 03:13:11,880 THE MODEL LOOKS LIKE THIS. 3751 03:13:11,880 --> 03:13:14,800 THE ANIMAL IS TAUGHT TO LOOK 3752 03:13:14,800 --> 03:13:17,720 INTO A CONSTRAINED PORTAL SO 3753 03:13:17,720 --> 03:13:18,800 IT'S A CONSTRAINED POSITION OVER 3754 03:13:18,800 --> 03:13:21,840 FIVE TO SIX WEEKS AND PULL A 3755 03:13:21,840 --> 03:13:24,600 LEVER BAR AND IF THEY PULL IN 3756 03:13:24,600 --> 03:13:28,880 THE RIGHT TIME FRAME AND THE 3757 03:13:28,880 --> 03:13:30,200 RIGHT FORCE A LIGHT CUE WILL GO 3758 03:13:30,200 --> 03:13:32,640 OVER AND A FOOD PELLET WILL DROP 3759 03:13:32,640 --> 03:13:34,320 INTO THE TROUGH AND THEY WILL 3760 03:13:34,320 --> 03:13:36,560 GET A FOOD REWARD. 3761 03:13:36,560 --> 03:13:38,960 AND ALL THIS IS COMPUTERIZED 3762 03:13:38,960 --> 03:13:40,960 WITH A FORCED TRANSDUCER AND 3763 03:13:40,960 --> 03:13:46,320 LOTS OF COMPUTERS. 3764 03:13:46,320 --> 03:13:51,560 IT IS AN OPERANT TANK AND THEY 3765 03:13:51,560 --> 03:13:53,800 LEARN SOME THINGS AND THEY LEARN 3766 03:13:53,800 --> 03:13:56,000 HIGH REPETITION, HIGH FORCE WITH 3767 03:13:56,000 --> 03:13:59,800 BARBARA SILVERMAN SHOWING IN 3768 03:13:59,800 --> 03:14:02,320 HUMANS AND RATS THAT HIGH 3769 03:14:02,320 --> 03:14:04,400 REPETITION IS A MINUTE OR OVER 3770 03:14:04,400 --> 03:14:07,240 AND HIGH FORCE IS APPROXIMATELY 3771 03:14:07,240 --> 03:14:11,640 50% OF MORE OF THE ANIMAL OR 3772 03:14:11,640 --> 03:14:13,560 HUMAN'S MAXIMUM VOLUNTARY 3773 03:14:13,560 --> 03:14:14,720 PULLING FORCE. 3774 03:14:14,720 --> 03:14:17,360 IT'S NOT A COMPUTER JOB. 3775 03:14:17,360 --> 03:14:19,000 THIS IS CONSTRUCTION TYPE JOB 3776 03:14:19,000 --> 03:14:21,480 MORE LIKE A ROAD TIE JOB WHERE 3777 03:14:21,480 --> 03:14:23,680 THEY'RE PULLING FORWARD AND 3778 03:14:23,680 --> 03:14:24,520 PULLING BACK VERY HARD ON LEVER 3779 03:14:24,520 --> 03:14:34,600 BAR. 3780 03:14:35,280 --> 03:14:36,560 THE BIGGEST QUESTION IS WHEN DO 3781 03:14:36,560 --> 03:14:38,720 YOU INTERVENE? 3782 03:14:38,720 --> 03:14:43,360 WHAT I DEVELOPED OVER THE YEARS 3783 03:14:43,360 --> 03:14:46,720 THERE'S A REPETITIVE TASK AND 3784 03:14:46,720 --> 03:14:48,360 ACUTE INFLAMMATION. 3785 03:14:48,360 --> 03:14:50,440 IT CAN BECOME CHRONIC OR IF THE 3786 03:14:50,440 --> 03:14:51,960 ANIMAL DECIDES TO REFUSE TO 3787 03:14:51,960 --> 03:14:56,120 WORK, WHICH THEY CAN, IT CAN GO 3788 03:14:56,120 --> 03:14:58,120 BACK TO A LITTLE LOOP THROUGH 3789 03:14:58,120 --> 03:15:00,920 HERE BACK TO INJURY AND MAYBE 3790 03:15:00,920 --> 03:15:03,160 REPAIR AND RESOLUTION AND NOT GO 3791 03:15:03,160 --> 03:15:05,080 BACK TO CHRONIC AGAIN. 3792 03:15:05,080 --> 03:15:10,040 BUT IF THIS LOOP OF ACUTE AND 3793 03:15:10,040 --> 03:15:12,320 CHRONIC INFLAMMATION CONTINUES, 3794 03:15:12,320 --> 03:15:19,360 THERE'S FIBROTIC REPAIR THAT CAN 3795 03:15:19,360 --> 03:15:20,920 CREATE ANOTHER LOCAL INJURY 3796 03:15:20,920 --> 03:15:23,360 BECAUSE THE TISSUES ARE 3797 03:15:23,360 --> 03:15:23,600 TETHERED. 3798 03:15:23,600 --> 03:15:25,840 THERE'S RESOLUTION AND ON THE 3799 03:15:25,840 --> 03:15:28,960 BOTTOM ARE OUTWARD PHYSICAL 3800 03:15:28,960 --> 03:15:30,600 SIGNS OF PAIN DEVELOPMENT OR 3801 03:15:30,600 --> 03:15:32,200 PAINS THAT PERSIST. 3802 03:15:32,200 --> 03:15:34,160 AVO 3803 03:15:34,160 --> 03:15:36,240 AVOIDANCE, DECREASED PACE IN THE 3804 03:15:36,240 --> 03:15:37,960 TASK, HYPERSENSITIVITY WHICH WE 3805 03:15:37,960 --> 03:15:41,680 INTERPRET AS A PAIN BEHAVIOR, 3806 03:15:41,680 --> 03:15:43,920 DECREASED GRIP STRENGTH. 3807 03:15:43,920 --> 03:15:49,640 THIS CAN BE ALSO A MUSCLE PAIN 3808 03:15:49,640 --> 03:15:52,040 ANALGESIA OR DECREASED MUSCLE 3809 03:15:52,040 --> 03:15:54,120 MOTOR COORDINATION. 3810 03:15:54,120 --> 03:15:56,760 SO WHEN DO YOU INTERVENE? 3811 03:15:56,760 --> 03:15:58,640 DO YOU PREVENT IT? 3812 03:15:58,640 --> 03:16:00,400 THAT'S ALWAYS THE BEST BUT HOW 3813 03:16:00,400 --> 03:16:01,120 IS IT POSSIBLE? 3814 03:16:01,120 --> 03:16:06,760 DO YOU TREAT IT EARLY OR LATE 3815 03:16:06,760 --> 03:16:13,640 ONCE IT'S BECOME CHRONIC? 3816 03:16:13,640 --> 03:16:18,280 I BEGAN LOOKING AT IBUPROFEN 3817 03:16:18,280 --> 03:16:21,520 BECAUSE IT'S THE MOST PREVALENT 3818 03:16:21,520 --> 03:16:31,400 AND LOOKED AT A REMMICAID AND A 3819 03:16:31,400 --> 03:16:31,640 VARIETY. 3820 03:16:31,640 --> 03:16:34,360 THERE'S A SCARY DIAGRAM AND I 3821 03:16:34,360 --> 03:16:36,840 APOLOGIZE BUT THE TOPE ARE THE 3822 03:16:36,840 --> 03:16:41,840 NORMAL CONTROLS TREATED OR NOT 3823 03:16:41,840 --> 03:16:45,880 WITH VEHICLES OR THE DRUG AND 3824 03:16:45,880 --> 03:16:48,320 THEY ANIMALS GET A LITTLE BIT OF 3825 03:16:48,320 --> 03:16:50,480 FOOD RESTRICTION, 5%, 10% TO GET 3826 03:16:50,480 --> 03:16:51,400 INTERESTED IN THE FOOD PELLET 3827 03:16:51,400 --> 03:16:52,040 BECAUSE THEY WORK FOR A FOOD 3828 03:16:52,040 --> 03:16:59,840 REWARD. 3829 03:16:59,840 --> 03:17:02,640 AND NOTICE THERE'S TWO DOSES OF 3830 03:17:02,640 --> 03:17:02,920 IBUPROFEN. 3831 03:17:02,920 --> 03:17:04,360 I'M TESTING A DOSE HERE. 3832 03:17:04,360 --> 03:17:10,520 OR THERE'S THE SIX-WEEKS OF 3833 03:17:10,520 --> 03:17:13,000 TRAINING. 3834 03:17:13,000 --> 03:17:15,040 IT DOES TAKE THAT LONG OF WHAT 3835 03:17:15,040 --> 03:17:17,040 IS THIS, YOU WANT ME TO REACH 3836 03:17:17,040 --> 03:17:19,480 FORWARD THEN FOOD REWARD AND 3837 03:17:19,480 --> 03:17:22,400 THEN LEARN THEY LIKE THE YOGURT 3838 03:17:22,400 --> 03:17:23,240 OR THE CHOCOLATE GRAIN FLAVOR 3839 03:17:23,240 --> 03:17:25,720 HERE SO THEY WORK FOR THE FOOD 3840 03:17:25,720 --> 03:17:25,960 REWARD. 3841 03:17:25,960 --> 03:17:31,560 THEY HAVE TO LEARN IT TAKES A 3842 03:17:31,560 --> 03:17:33,520 LITTLE BIT OF TIME ESPECIALLY IF 3843 03:17:33,520 --> 03:17:34,360 THEY'RE TRAINING AT HIGH FORCE 3844 03:17:34,360 --> 03:17:44,920 AND YOU HAVE THE VEHICLE FOR THE 3845 03:17:47,920 --> 03:17:48,120 IBUPROFEN. 3846 03:17:48,120 --> 03:17:50,760 BACK TO THE IBUPROFEN AND THERE 3847 03:17:50,760 --> 03:17:52,080 ARE PAIN BEHAVIORS INDUCED IN 3848 03:17:52,080 --> 03:18:00,640 THE TRAINING PERIOD. 3849 03:18:00,640 --> 03:18:02,640 THEY'RE TRAINING AT HIGH FORCE 3850 03:18:02,640 --> 03:18:03,880 AND IT GOES TO THE NEXT WEEK 3851 03:18:03,880 --> 03:18:05,760 WHEN THEY END AT HIGH FORCE. 3852 03:18:05,760 --> 03:18:07,720 THAT'S THE PERIOD WHERE THERE'S 3853 03:18:07,720 --> 03:18:08,440 TISSUE INJURY. 3854 03:18:08,440 --> 03:18:10,960 THAT'S THE ACUTE PERIOD, THE 3855 03:18:10,960 --> 03:18:15,720 MOST ACUTE PERIOD OF A MUSCLE, 3856 03:18:15,720 --> 03:18:18,000 TENDERNESS OR NERVE INJURY AND 3857 03:18:18,000 --> 03:18:20,720 THEREFORE THE ONSET OF PAIN 3858 03:18:20,720 --> 03:18:26,920 BEHAVIORS. 3859 03:18:26,920 --> 03:18:29,880 I'M LOOKING AT ACUTE 3860 03:18:29,880 --> 03:18:32,720 HYPERSENSITIVE OF THE FOREARM, 3861 03:18:32,720 --> 03:18:35,040 FOREPAW AND I'M LOOKING AT THE 3862 03:18:35,040 --> 03:18:36,520 AFFECTS OF THE TRAINING AFFECTS 3863 03:18:36,520 --> 03:18:39,720 AND THEN IF THESE DRUGS ARE 3864 03:18:39,720 --> 03:18:41,360 WORKING PROPHYLACTICALLY. 3865 03:18:41,360 --> 03:18:44,720 SO THERE'S NO TREATMENT AND YOU 3866 03:18:44,720 --> 03:18:46,840 CAN SEE THE TRAIN IS BLACK AND 3867 03:18:46,840 --> 03:18:48,800 THE CONTROL IS WHITE. 3868 03:18:48,800 --> 03:18:54,240 WE HAVE INCREASE IN FOREPAW 3869 03:18:54,240 --> 03:18:54,560 WITHDRAWAL. 3870 03:18:54,560 --> 03:18:57,320 VEHICLES NO POSITIVE EFFECT-THE 3871 03:18:57,320 --> 03:18:59,720 IBUPROFEN AT 20 MILLIGRAMS IS 3872 03:18:59,720 --> 03:19:00,760 NOT ANTI-INFLAMMATORY ENOUGH SO 3873 03:19:00,760 --> 03:19:03,240 IF A PERSON'S NOT TAKE THE FULL 3874 03:19:03,240 --> 03:19:06,080 DOSE, THEY'RE TAKING HALF DOSE 3875 03:19:06,080 --> 03:19:07,880 OR LIKE TAKING THE MORNING OR 3876 03:19:07,880 --> 03:19:09,240 NOT IN THE AFTERNOON, THEY'RE 3877 03:19:09,240 --> 03:19:12,920 NOT REALLY ATTENDING TO THE FULL 3878 03:19:12,920 --> 03:19:15,760 ANTI-INFLAMMATORY DOSE THOUGH 3879 03:19:15,760 --> 03:19:23,760 THEY'RE TAKING THIS IBUPROFEN 20 3880 03:19:23,760 --> 03:19:34,280 MISSION MIGS THEY STILL HAVE A 3881 03:19:34,960 --> 03:19:35,160 REDUCTION. 3882 03:19:35,160 --> 03:19:36,280 AND THERE'S A SIGNIFICANT 3883 03:19:36,280 --> 03:19:36,880 REDUCTION IN THEIR PAIN 3884 03:19:36,880 --> 03:19:43,880 BEHAVIORS. 3885 03:19:43,880 --> 03:19:46,280 IN THE ANTI-TNF ALPHA THERE'S NO 3886 03:19:46,280 --> 03:19:51,480 BIG BENEFIT AND TAKING A STRONG 3887 03:19:51,480 --> 03:19:53,360 DRUG OVER AN ANTI-INFLAMMATORY 3888 03:19:53,360 --> 03:19:57,440 DRUG OF IBUPROFEN AT THIS POINT. 3889 03:19:57,440 --> 03:20:02,240 AND THEN THE ANTI-IL1 BETA WAS 3890 03:20:02,240 --> 03:20:05,360 ABYSMAL AND DIDN'T WORK. 3891 03:20:05,360 --> 03:20:06,680 GRIP STRENGTH. 3892 03:20:06,680 --> 03:20:09,400 THIS IS NOT LIKE HOW HARD THE 3893 03:20:09,400 --> 03:20:14,720 ANIMAL PULLS ON THE LEVER, THIS 3894 03:20:14,720 --> 03:20:18,120 IS IF THEY HAVE MUSCLE PLAIN AND 3895 03:20:18,120 --> 03:20:22,320 WE PULL IT GENTLY UNTIL THEY LET 3896 03:20:22,320 --> 03:20:22,680 GO. 3897 03:20:22,680 --> 03:20:24,040 YOU CAN SEE THE IBUPROFEN'S 3898 03:20:24,040 --> 03:20:25,600 WORKING OKAY. 3899 03:20:25,600 --> 03:20:27,320 THEY'RE NOT GETTING STRONGER. 3900 03:20:27,320 --> 03:20:28,760 YOU WOULD THINK THAT IF AN 3901 03:20:28,760 --> 03:20:31,520 ANIMAL IS WORKING REGULARLY THEY 3902 03:20:31,520 --> 03:20:32,480 WOULD GET STRONGER. 3903 03:20:32,480 --> 03:20:35,480 BUT THEY DON'T GET STRONGER WITH 3904 03:20:35,480 --> 03:20:38,760 A HIGH REPETITION, HIGH FORCE 3905 03:20:38,760 --> 03:20:40,840 TASK BECAUSE THE TISSUE INJURY 3906 03:20:40,840 --> 03:20:43,120 IS BEING EQUALLED BY THE 3907 03:20:43,120 --> 03:20:44,680 TRAINING AFFECT THAT MAY BE 3908 03:20:44,680 --> 03:20:46,920 POSITIVE SO THERE'S NO GAIN, 3909 03:20:46,920 --> 03:20:48,120 NEGATIVE AND POSITIVE ARE 3910 03:20:48,120 --> 03:20:50,720 CANCELLING EACH OTHER OUT. 3911 03:20:50,720 --> 03:20:53,360 IT CAN ALSO BE THE IBUPROFEN IS 3912 03:20:53,360 --> 03:20:53,960 KNOWN TO CREATE PROBLEMS WITH 3913 03:20:53,960 --> 03:20:57,400 MUSCLE REPAIR. 3914 03:20:57,400 --> 03:20:59,800 DISRUPTING SOME OF THE 3915 03:20:59,800 --> 03:21:02,160 MITOCHONDRIAL FUNCTION IF USED 3916 03:21:02,160 --> 03:21:02,400 LONG-TERM. 3917 03:21:02,400 --> 03:21:06,280 SO THERE'S NO REPAIR PROCESS. 3918 03:21:06,280 --> 03:21:08,440 THEY'RE JUST MAINTAINING AND THE 3919 03:21:08,440 --> 03:21:10,800 TFF ALPHA WORKED WELL AND GOT 3920 03:21:10,800 --> 03:21:14,360 BETTER THAN CONTROL LEVELS. 3921 03:21:14,360 --> 03:21:17,200 IF YOU LOOK AT THE NERVE YOU GO 3922 03:21:17,200 --> 03:21:18,920 EXCELLENT, THE PROPHYLACTIC 3923 03:21:18,920 --> 03:21:21,720 DRUGS ARE WORKING PRETTY WELL 3924 03:21:21,720 --> 03:21:26,760 EACH AND EVERY ONE ARE DAMPENING 3925 03:21:26,760 --> 03:21:31,040 THE SERUM OR NERVE SO SYSTEMIC 3926 03:21:31,040 --> 03:21:32,880 AS WELL AS LOCAL. 3927 03:21:32,880 --> 03:21:36,680 SO SUMMARY 1, PROPHYLACTIC 3928 03:21:36,680 --> 03:21:37,600 ANTI-INFLAMMATORIES IS USED AT 3929 03:21:37,600 --> 03:21:38,360 THE HIGHEST LEVELS CAN BE 3930 03:21:38,360 --> 03:21:43,720 EFFECTIVE. 3931 03:21:43,720 --> 03:21:46,040 YET, HOW IS PROPHYLACTIC DRUG 3932 03:21:46,040 --> 03:21:46,640 TREATMENT FEASIBLE? 3933 03:21:46,640 --> 03:21:47,240 YOU DON'T PLAN ON HAVING AN 3934 03:21:47,240 --> 03:21:52,120 INJURY. 3935 03:21:52,120 --> 03:21:53,360 HOW'S IT RESPONSIBLE TREATMENT 3936 03:21:53,360 --> 03:21:55,920 KNOWING HIGH DOSES -- BECAUSE 3937 03:21:55,920 --> 03:21:57,600 THIS IS THE HIGHEST DOSE CAN 3938 03:21:57,600 --> 03:22:01,680 CAUSE GASTRIC ISSUES AND HUMANS 3939 03:22:01,680 --> 03:22:02,760 PARTICULARLY AND HAS BEEN SHOWN 3940 03:22:02,760 --> 03:22:06,760 BY MANY PEOPLE TO IMPACT MUSCLE 3941 03:22:06,760 --> 03:22:14,680 HEAL. 3942 03:22:14,680 --> 03:22:17,440 BUT SINCE WORKERS GONE TO 3943 03:22:17,440 --> 03:22:19,760 IBUPROFEN I WENT TO A LONGER ONE 3944 03:22:19,760 --> 03:22:23,400 AND GAVE DRUGS TO CONTROLS AND 3945 03:22:23,400 --> 03:22:26,360 PLUS OR MINUS IBUPROFEN UP TO 12 3946 03:22:26,360 --> 03:22:29,400 WEEKS AND PLUS OR MINUS THE 3947 03:22:29,400 --> 03:22:31,760 IBUPROFEN YOU JUST SAW OR WORK 3948 03:22:31,760 --> 03:22:33,600 FOR SIX WEEKS WIN IBUPROFEN TWO 3949 03:22:33,600 --> 03:22:35,680 WEEKS OR FOR 12 WEEKS FOR 3950 03:22:35,680 --> 03:22:36,600 IBUPROFEN FOR EIGHT WEEKS. 3951 03:22:36,600 --> 03:22:39,400 SO IT'S A VARIETY OF DIFFERENT 3952 03:22:39,400 --> 03:22:40,040 TIMINGS I'M ABOUT TO PRESENT TO 3953 03:22:40,040 --> 03:22:42,640 YOU. 3954 03:22:42,640 --> 03:22:45,400 I ALSO HAVE ERGONOMIC TASK 3955 03:22:45,400 --> 03:22:45,680 REDUCTIONS. 3956 03:22:45,680 --> 03:22:46,760 THEY GET MOVED TO AN EASIER 3957 03:22:46,760 --> 03:22:52,760 TASK. 3958 03:22:52,760 --> 03:22:57,240 THE ANSWER IS AGAIN THE NERVE 3959 03:22:57,240 --> 03:23:00,920 INFLAMMATORY CYTOKINES ARE 3960 03:23:00,920 --> 03:23:04,240 FAIRLY EFFECTIVELY DAMPENED BY 3961 03:23:04,240 --> 03:23:11,160 THE IBUPROFEN OR ERGONOMIC TASK 3962 03:23:11,160 --> 03:23:11,760 REDUCT 3963 03:23:11,760 --> 03:23:12,000 REDUCTION. 3964 03:23:12,000 --> 03:23:12,920 THE IBUPROFEN DOESN'T WORK AS 3965 03:23:12,920 --> 03:23:13,720 WELL WITHIN THE NERVE COMPARED 3966 03:23:13,720 --> 03:23:16,720 TO THE CONTROLS BUT THERE IS 3967 03:23:16,720 --> 03:23:21,840 IMPROVEMENT IN THE PERIPHERY. 3968 03:23:21,840 --> 03:23:25,720 IF YOU LOOK AT GRIP STRENGTH, 3969 03:23:25,720 --> 03:23:29,600 THE TWO WEEKS OF IBUPROFEN 3970 03:23:29,600 --> 03:23:34,440 IMPROVES GRIP STRENGTH, 3971 03:23:34,440 --> 03:23:36,400 REFLEXIVE GRIP STRENGTH OVER 3972 03:23:36,400 --> 03:23:38,840 HIGH REPETITION ANIMALS BUT NOT 3973 03:23:38,840 --> 03:23:42,760 IMPROVING IT TO CONTROL LEVELS. 3974 03:23:42,760 --> 03:23:46,000 SO THERE'S A LIMIT TO HOW MUCH 3975 03:23:46,000 --> 03:23:48,800 IBUPROFEN IS EFFECTIVELY 3976 03:23:48,800 --> 03:23:51,040 DAMPENING THE MUSCLE PAIN OR 3977 03:23:51,040 --> 03:23:52,040 STRENGTH LOSS. 3978 03:23:52,040 --> 03:23:54,040 IF YOU LOOKS THE NERVE ITSELF, 3979 03:23:54,040 --> 03:24:01,480 YOU SEE MACROPHAGIA IN THE NERVE 3980 03:24:01,480 --> 03:24:05,880 LIKE CYTOKINES AND THE 3981 03:24:05,880 --> 03:24:09,280 INFLAMMATION INDUCED 3982 03:24:09,280 --> 03:24:11,600 FIBROGENESIS IS IMPROVING AND 3983 03:24:11,600 --> 03:24:14,640 THE NERVE CONDUCTION VELOCITY 3984 03:24:14,640 --> 03:24:17,560 ARE THE IBUPROFEN TREATED 3985 03:24:17,560 --> 03:24:19,200 ANIMALS AND THE CONDUCTION 3986 03:24:19,200 --> 03:24:21,120 VELOCITY HAS IMPROVED AND THE 3987 03:24:21,120 --> 03:24:23,720 CONDUCTION VELOCITY CORRELATES 3988 03:24:23,720 --> 03:24:25,840 WITH GRIP STRENGTH, YOU CAN SAY 3989 03:24:25,840 --> 03:24:26,120 EXCELLENT. 3990 03:24:26,120 --> 03:24:29,160 THAT MAY BE WHAT'S IMPROVING THE 3991 03:24:29,160 --> 03:24:30,840 IBUPROFEN OR MAYBE IT'S THE -- 3992 03:24:30,840 --> 03:24:33,080 THE GRIP STRENGTH HERE WITH 3993 03:24:33,080 --> 03:24:33,640 IBUPROFEN TREATMENT. 3994 03:24:33,640 --> 03:24:37,680 OR MAYBE IT'S THE IMPROVED 3995 03:24:37,680 --> 03:24:40,120 MACROPHAGES TO NORMAL LEVELS. 3996 03:24:40,120 --> 03:24:42,320 BUT THERE IS STILL A BIT OF A 3997 03:24:42,320 --> 03:24:44,520 LIMIT TO HOW THE GRIP STRENGTH 3998 03:24:44,520 --> 03:24:46,160 IS I AM PROVING. 3999 03:24:46,160 --> 03:24:50,440 AS YOU WELL KNOW, WITH REGULAR 4000 03:24:50,440 --> 03:24:52,400 EXERCISE ONE OUGHT TO HAVE 4001 03:24:52,400 --> 03:24:53,000 IMPROVED STRENGTH NOT SLIGHTLY 4002 03:24:53,000 --> 03:24:55,000 LOWER. 4003 03:24:55,000 --> 03:24:57,480 OR EVEN MAINTAIN. 4004 03:24:57,480 --> 03:25:01,440 SO SOMETHING'S HINDERING SOME OF 4005 03:25:01,440 --> 03:25:07,800 THE MUSCLE AFFECTS HERE. 4006 03:25:07,800 --> 03:25:09,800 SOO WE LOOKED AT OUR TASK. 4007 03:25:09,800 --> 03:25:11,120 THAT LEVER BAR GIVES STRENGTH 4008 03:25:11,120 --> 03:25:13,560 HOW WE CAN ASK HOW THE ANIMALS 4009 03:25:13,560 --> 03:25:14,640 ARE WORKING ON A VOLUNTARY 4010 03:25:14,640 --> 03:25:20,600 BASIS. 4011 03:25:20,600 --> 03:25:22,600 TO THE ANIMALS WILL WORK FOR 4012 03:25:22,600 --> 03:25:32,240 FOOD REWARD EVEN IN PAIN. 4013 03:25:32,240 --> 03:25:34,760 AND THE ANIMALS ARE WORKING BUT 4014 03:25:34,760 --> 03:25:37,800 THERE'S A LIMIT TO THE IBUPROFEN 4015 03:25:37,800 --> 03:25:38,960 YOU'LL SEE IN A SECOND. 4016 03:25:38,960 --> 03:25:42,120 HERE IF WE LOOK AT THE ONES IN 4017 03:25:42,120 --> 03:25:42,600 ARROWS. 4018 03:25:42,600 --> 03:25:45,520 WE HAD THE STRIPED WITH THE BLUE 4019 03:25:45,520 --> 03:25:47,280 ARROW THE HIGH REPETITION, HIGH 4020 03:25:47,280 --> 03:25:50,720 FORCE IN EACH FIGURE AND THE 4021 03:25:50,720 --> 03:25:53,960 BLACK WITH THE BLUE ARROW WITH 4022 03:25:53,960 --> 03:25:57,200 THE RED OUTLINE IS OUR HIGH 4023 03:25:57,200 --> 03:26:00,320 FORCE PLUS IBUPROFEN AND WE'RE 4024 03:26:00,320 --> 03:26:02,480 STILL PURSUING OUR REFLEXIVE 4025 03:26:02,480 --> 03:26:04,920 GRIP STRENGTH ASSAY HERE. 4026 03:26:04,920 --> 03:26:06,760 CAN SEE FROM NAIVE WHERE THE 4027 03:26:06,760 --> 03:26:08,120 ANIMALS BEGAN AT. 4028 03:26:08,120 --> 03:26:09,240 THESE ARE THE SAME ANIMALS 4029 03:26:09,240 --> 03:26:13,920 ACROSS TIME. 4030 03:26:13,920 --> 03:26:17,480 THE IBUPROFEN DID NOT IMPROVE 4031 03:26:17,480 --> 03:26:19,040 GRIP STRENGTH TO CONTROL LEVELS 4032 03:26:19,040 --> 03:26:23,040 OR ABOVE THE HIGH REPETITION, 4033 03:26:23,040 --> 03:26:24,680 HIGH FORCE LEVELS DESPITE IT BE 4034 03:26:24,680 --> 03:26:26,360 ON BOARD NOW SIX WEEKS. 4035 03:26:26,360 --> 03:26:28,360 BY EIGHT WEEKS OF TREATMENT, 4036 03:26:28,360 --> 03:26:29,480 BECAUSE THEY WERE AND DEVELOPED 4037 03:26:29,480 --> 03:26:31,360 THE PROBLEMS BEFORE YOU GIVE IT 4038 03:26:31,360 --> 03:26:32,800 TO THEM, THE DRUG IS GIVEN WEEK 4039 03:26:32,800 --> 03:26:36,120 FOUR. 4040 03:26:36,120 --> 03:26:39,400 THEY GET IT CONTINUOUSLY AND 4041 03:26:39,400 --> 03:26:41,640 DRINKING WATER EVERY DAY FOR UP 4042 03:26:41,640 --> 03:26:43,720 TO EIGHT WEEKS FOR THE END HERE. 4043 03:26:43,720 --> 03:26:47,080 YOU CAN SEE DESPITE THE 4044 03:26:47,080 --> 03:26:49,400 IBUPROFEN AT THE 4045 03:26:49,400 --> 03:26:50,680 ANTI-INFLAMMATORY LEVELS GRIP 4046 03:26:50,680 --> 03:26:54,720 STRENGTH IS STILL SIGNIFICANTLY 4047 03:26:54,720 --> 03:27:01,360 BELOW NAIVE LEVELS. 4048 03:27:01,360 --> 03:27:06,320 AND IF YOU LOOK AT THE DURATION 4049 03:27:06,320 --> 03:27:08,800 AND AS AN INDICATION OF GLOBAL 4050 03:27:08,800 --> 03:27:09,360 PARTICIPATION AND HOW MUCH 4051 03:27:09,360 --> 03:27:11,200 THEY'RE TRYING TO WORK. 4052 03:27:11,200 --> 03:27:12,720 YOU CAN SEE THEM PULLING ON THE 4053 03:27:12,720 --> 03:27:13,720 LEVER BAR HERE. 4054 03:27:13,720 --> 03:27:15,960 THEY HAVE A COUPLE DIFFERENT 4055 03:27:15,960 --> 03:27:18,160 TYPES OF LEVER BAR PULLS ALL 4056 03:27:18,160 --> 03:27:20,360 DIGITS, SOME DIGITS. 4057 03:27:20,360 --> 03:27:23,040 IF ALL FINGERS BUT ONE WORKS 4058 03:27:23,040 --> 03:27:25,120 THEY'LL JUST PULL WITH ONE 4059 03:27:25,120 --> 03:27:25,280 DIGIT. 4060 03:27:25,280 --> 03:27:28,360 SO THEY'RE THEIR BEST TO GET 4061 03:27:28,360 --> 03:27:28,920 THEIR BANANA OR CHOCOLATE 4062 03:27:28,920 --> 03:27:30,960 FLAVORED FOOD REWARD. 4063 03:27:30,960 --> 03:27:33,160 AND SO THIS IS HOW MUCH THEY'RE 4064 03:27:33,160 --> 03:27:33,360 TRYING. 4065 03:27:33,360 --> 03:27:34,920 THIS IS THE PERCENT OF TARGET 4066 03:27:34,920 --> 03:27:36,880 PULLS EVERY DAY AND THIS IS LIKE 4067 03:27:36,880 --> 03:27:42,760 THE 100% OF TARGET AND THE BLUE 4068 03:27:42,760 --> 03:27:46,120 ARROWS ARE WEEK 1, WEEK 9 AND 4069 03:27:46,120 --> 03:27:48,440 WEEK 1 OF UNTREATED TASK RATS 4070 03:27:48,440 --> 03:27:50,800 AND IN THE BLUE WITH THE RED IS 4071 03:27:50,800 --> 03:27:54,280 THE HIGH REPETITION, HIGH FORCE 4072 03:27:54,280 --> 03:27:58,240 WEEK 1, WEEK 9, WEEK 12. 4073 03:27:58,240 --> 03:28:03,120 YOU CAN SEE THEY REACHED TARGET. 4074 03:28:03,120 --> 03:28:05,160 THE IBUPROFEN AFFECTIVELY THEM 4075 03:28:05,160 --> 03:28:07,400 TO PULL AND HOLD THE LEVER BAR 4076 03:28:07,400 --> 03:28:13,920 FOR THE FULL DURATION. 4077 03:28:13,920 --> 03:28:15,400 AND PULL EVERY TIME. 4078 03:28:15,400 --> 03:28:19,560 AND THE FORCE WAS GREAT TOO. 4079 03:28:19,560 --> 03:28:23,800 THIS IS THE TASK FORCE HERE AND 4080 03:28:23,800 --> 03:28:26,720 YOU CAN REACH FORCE ON THE LEVER 4081 03:28:26,720 --> 03:28:27,720 BAR. 4082 03:28:27,720 --> 03:28:31,680 THE COMPUTER TELLS ME HOW STRONG 4083 03:28:31,680 --> 03:28:33,720 THEY'RE PULLING AND THE MAXIMUM 4084 03:28:33,720 --> 03:28:37,120 PULLING FORCE TARGET WAS UP HERE 4085 03:28:37,120 --> 03:28:42,320 AT 60% FOR THE STUDY. 4086 03:28:42,320 --> 03:28:44,880 AND YOU CAN SEE AGAIN ACROSS 4087 03:28:44,880 --> 03:28:47,440 TIME THE IBUPROFEN AT WEEK 4 4088 03:28:47,440 --> 03:28:49,840 ONBOARD EVERY DAY IN DRINKING 4089 03:28:49,840 --> 03:28:50,600 WATER THEY'RE PULLING AT FULL 4090 03:28:50,600 --> 03:28:57,840 MAXIMUM FORCE. 4091 03:28:57,840 --> 03:29:01,800 AT THE END IT GOES DOWN AND AT 4092 03:29:01,800 --> 03:29:03,200 WEEK 9 THEY'RE PULLING STRONGER 4093 03:29:03,200 --> 03:29:07,440 AND THE PULL IS ABOVE THE LOWER 4094 03:29:07,440 --> 03:29:07,640 LIMIT. 4095 03:29:07,640 --> 03:29:10,320 THEY'RE IN THE TARGET ZONE OF 4096 03:29:10,320 --> 03:29:12,320 FORCE AND THEY'RE PULLING IN THE 4097 03:29:12,320 --> 03:29:14,720 RIGHT TIME FRAME AND THEY GET A 4098 03:29:14,720 --> 03:29:19,600 REWARD. 4099 03:29:19,600 --> 03:29:21,520 BUT WHAT IS INTERESTING AT THIS 4100 03:29:21,520 --> 03:29:26,600 POINT IS THE NEXT PICTURE. 4101 03:29:26,600 --> 03:29:28,720 THEY'RE PULLING, THEY'RE 4102 03:29:28,720 --> 03:29:30,960 PARTICIPATING AND PULLING WITH 4103 03:29:30,960 --> 03:29:33,320 FORCE BUT THEIR PERCENT SUCCESS 4104 03:29:33,320 --> 03:29:36,640 IN ALL THE FOOD REWARD HERE IS 4105 03:29:36,640 --> 03:29:41,120 FAILING. 4106 03:29:41,120 --> 03:29:44,840 THE IBUPROFEN IS MASKING 4107 03:29:44,840 --> 03:29:45,120 SOMETHING. 4108 03:29:45,120 --> 03:29:47,360 THEY'RE REACH SUCCESS IS A 4109 03:29:47,360 --> 03:29:47,600 FAILURE. 4110 03:29:47,600 --> 03:29:49,560 LOWER THAN EVEN THE UNTREATED 4111 03:29:49,560 --> 03:29:49,760 ANIMALS. 4112 03:29:49,760 --> 03:29:53,480 SO IF I JUST GO BACK A SECOND 4113 03:29:53,480 --> 03:29:56,400 THIS IS THEIR REFLECTIVE GRIP 4114 03:29:56,400 --> 03:29:56,680 STRENGTH. 4115 03:29:56,680 --> 03:29:58,800 YOU CAN SEE IT'S LOWER THEN IT 4116 03:29:58,800 --> 03:30:02,400 SHOULD BE BY WEEK 12. 4117 03:30:02,400 --> 03:30:08,720 THEY'RE PULLING ON THE LEVER BAR 4118 03:30:08,720 --> 03:30:09,360 THE PERCENT TIMES OF TRYING IS 4119 03:30:09,360 --> 03:30:19,480 HIGH. 4120 03:30:25,200 --> 03:30:26,200 THEY'RE PULLING AT A RIGHT FORCE 4121 03:30:26,200 --> 03:30:27,400 AND ARE THEY PULLING AT THE 4122 03:30:27,400 --> 03:30:31,480 RIGHT TIME FRAME OR TO THE TOTAL 4123 03:30:31,480 --> 03:30:35,440 FORCE OR SOMETHING IS 4124 03:30:35,440 --> 03:30:35,720 NETWORKING. 4125 03:30:35,720 --> 03:30:39,080 THEIR PERCENT SUCCESSFUL REACHES 4126 03:30:39,080 --> 03:30:40,080 EVEN WITH IBUPROFEN IS LOWER 4127 03:30:40,080 --> 03:30:41,480 THAN THE UNTREATED ANIMALS 4128 03:30:41,480 --> 03:30:50,720 THEMSELVES. 4129 03:30:50,720 --> 03:30:53,280 WE REPEATED IT THINKING WE DID 4130 03:30:53,280 --> 03:30:55,040 SOMETHING WRONG AND IN BLUE ARE 4131 03:30:55,040 --> 03:31:00,160 THE ANIMALS WHO GOT IBUPROFEN 4132 03:31:00,160 --> 03:31:02,560 AND IN RED THE ANIMALS WITH NONE 4133 03:31:02,560 --> 03:31:04,160 AND YOU SEE THE IBUPROFEN BEGAN 4134 03:31:04,160 --> 03:31:13,520 AT 4 WEEKS THE ANIMALS REACHED 6 4135 03:31:13,520 --> 03:31:15,400 WEEKS BUT DECREASES 4136 03:31:15,400 --> 03:31:23,120 PRECIPITOUSLY THEREAFTER. 4137 03:31:23,120 --> 03:31:23,920 THE SENSITIVITY DECREASED 4138 03:31:23,920 --> 03:31:29,080 SIGNIFICANTLY. 4139 03:31:29,080 --> 03:31:32,520 THE WITHDRAWAL IS LOWER AT THIS 4140 03:31:32,520 --> 03:31:33,400 POINT. 4141 03:31:33,400 --> 03:31:37,320 THEY HAVE LOWER WITHDRAWAL 4142 03:31:37,320 --> 03:31:40,400 THRESHOLD AND WHAT THIS IS THAT 4143 03:31:40,400 --> 03:31:45,840 MAKES THEM PULL THEIR ARM AWAY. 4144 03:31:45,840 --> 03:31:47,680 THIS BEGINS AFTER TRAINING AND 4145 03:31:47,680 --> 03:31:51,200 THESE ARE ANIMALS TRAINED ONLY 4146 03:31:51,200 --> 03:31:53,600 IN THE REST WITH IBUPROFEN. 4147 03:31:53,600 --> 03:31:56,360 AND THE LOWER LEFT IS ANIMALS 4148 03:31:56,360 --> 03:31:59,680 CONTINUING TO PERFORM THE TASK 4149 03:31:59,680 --> 03:32:06,200 WITHOUT IBUPROFEN. 4150 03:32:06,200 --> 03:32:07,320 SO SECONDARY IBUPROFEN 4151 03:32:07,320 --> 03:32:08,120 INTERVENTIONS LOWERS 4152 03:32:08,120 --> 03:32:10,800 INFLAMMATION AND IMPROVES SOME 4153 03:32:10,800 --> 03:32:12,560 OF THE TASK LIKE DURATION AND 4154 03:32:12,560 --> 03:32:15,040 REACH FORCE BUT IT FAILS TO 4155 03:32:15,040 --> 03:32:16,720 IMPROVE SUCCESS. 4156 03:32:16,720 --> 03:32:21,280 IN FACT IT'S QUITE ABYSMAL AND 4157 03:32:21,280 --> 03:32:24,840 THE FOREPAW IS ABYSMAL. 4158 03:32:24,840 --> 03:32:27,080 THEY HAVE A LOT OF PAIN 4159 03:32:27,080 --> 03:32:27,320 BEHAVIORS. 4160 03:32:27,320 --> 03:32:37,840 IS THAT CENTRAL SENSITIZATION? 4161 03:32:38,160 --> 03:32:39,600 THERE'S A LOT OF INFLAMMATORY 4162 03:32:39,600 --> 03:32:42,800 SOUP SOFTEN CARRIED BACK TO THE 4163 03:32:42,800 --> 03:32:48,000 SPINAL CORD AND CARRIED TO THE 4164 03:32:48,000 --> 03:32:50,000 GANGLIA AND DORSAL HORNS AND 4165 03:32:50,000 --> 03:32:52,400 THAT'S WHERE I BEGAN MY 4166 03:32:52,400 --> 03:32:52,720 INVESTIGATION. 4167 03:32:52,720 --> 03:32:58,520 THE ANSWER'S, YES. 4168 03:32:58,520 --> 03:33:00,120 IBUPROFEN REDUCED THE DORSAL 4169 03:33:00,120 --> 03:33:01,440 HORN SENSITIVITY BUT ONLY 4170 03:33:01,440 --> 03:33:03,320 INITIALLY AT THE WEEK 6 POINT 4171 03:33:03,320 --> 03:33:03,960 WHERE THE ANIMALS WERE PULLING 4172 03:33:03,960 --> 03:33:07,520 MORE. 4173 03:33:07,520 --> 03:33:11,160 BY WEEK 12 THE IBUPROFEN IN 4174 03:33:11,160 --> 03:33:16,400 GREEN HERE IS THE SAME SORT OF 4175 03:33:16,400 --> 03:33:26,040 HIGH AMOUNT OF NOCICEPTIVE 4176 03:33:26,040 --> 03:33:29,120 PEPTIDE AND THE RECEPTOR THE 4177 03:33:29,120 --> 03:33:33,800 SECOND ORDER RECEPTOR RECEIVING 4178 03:33:33,800 --> 03:33:36,000 THE SUBSTANCE P. 4179 03:33:36,000 --> 03:33:40,280 THE IBUPROFEN WORKS A LITTLE BIT 4180 03:33:40,280 --> 03:33:44,000 AND HIGHER THAN NORMAL CONTROLS 4181 03:33:44,000 --> 03:33:47,360 OR TRAIN ONLY. 4182 03:33:47,360 --> 03:33:50,200 THE IBUPROFEN IS FAILING TO 4183 03:33:50,200 --> 03:33:53,240 ACROSS THE BLOOD SPINAL CORD 4184 03:33:53,240 --> 03:33:56,960 BARRIER AND DAMPENING THE 4185 03:33:56,960 --> 03:33:59,920 SENSITIVITY IN THE SPINAL CORD. 4186 03:33:59,920 --> 03:34:05,480 TNF ALPHA IS SLIGHTLY DECREASED 4187 03:34:05,480 --> 03:34:08,760 BUT STILL UP IN THE IBUPROFEN 4188 03:34:08,760 --> 03:34:15,680 AND THE ASTROCYTE REACTIVITY IS 4189 03:34:15,680 --> 03:34:17,320 IN THE DORSAL HORN AND YOU HAVE 4190 03:34:17,320 --> 03:34:22,400 ACTIVATION IN THE SPINAL CORD. 4191 03:34:22,400 --> 03:34:27,240 MORE SO IS THE VENTRAL HORN THE 4192 03:34:27,240 --> 03:34:29,520 TFF ALPHA EXPRESSION AND THE 4193 03:34:29,520 --> 03:34:32,480 DORSAL HORN HAS TNF ALPHA 4194 03:34:32,480 --> 03:34:34,760 EXPRESSION. 4195 03:34:34,760 --> 03:34:36,720 THAT MEANS THE CENTRAL 4196 03:34:36,720 --> 03:34:39,800 SENSITIZATION CHANGES THAT ARE 4197 03:34:39,800 --> 03:34:41,800 OCCURRING IN THE SPINAL CORD ARE 4198 03:34:41,800 --> 03:34:48,400 NOT DAMPENED BY THE IBUPROFEN 4199 03:34:48,400 --> 03:34:58,080 TREATMENT IT WAS DAMPENING A PER 4200 03:34:58,080 --> 03:35:04,840 IVE -- PERIPHERAL PAIN AND THE 4201 03:35:04,840 --> 03:35:06,480 ANIMALS THAT REST THE MOST 4202 03:35:06,480 --> 03:35:10,960 NATURALLY REFUSE TO WORK DON'T 4203 03:35:10,960 --> 03:35:14,320 DEVELOP THIS SAME LEVEL OF 4204 03:35:14,320 --> 03:35:16,320 CENTRAL SENSITIZATION IN THE 4205 03:35:16,320 --> 03:35:17,320 SPINAL CORD AS THE ANIMALS THAT 4206 03:35:17,320 --> 03:35:22,640 CONTINUED TO WORK. 4207 03:35:22,640 --> 03:35:25,480 AND AFTER THE ONSET OF PAIN 4208 03:35:25,480 --> 03:35:27,960 REDUCED SPINAL CORD 4209 03:35:27,960 --> 03:35:28,600 SENSITIZATION TEMPORARILY BUT 4210 03:35:28,600 --> 03:35:30,240 LONG-TERM DID NOT AND LIKELY AS 4211 03:35:30,240 --> 03:35:33,280 THE UNDERLYING REASON FOR THE 4212 03:35:33,280 --> 03:35:35,600 PERSISTENT REFLEXIVE GRIP 4213 03:35:35,600 --> 03:35:38,000 STRENGTH DECLINES AND MECHANICAL 4214 03:35:38,000 --> 03:35:40,520 SENSITIVITY IN THE DECLINES IN 4215 03:35:40,520 --> 03:35:42,200 TASK PERFORMANCE PARTICULARLY 4216 03:35:42,200 --> 03:35:42,960 THE PERCENT SUCCESS. 4217 03:35:42,960 --> 03:35:45,160 COULD THEY DO THE TASK AT THE 4218 03:35:45,160 --> 03:35:47,720 LEVEL THAT REALLY MEANT THEY GOT 4219 03:35:47,720 --> 03:35:54,000 THEIR FOOD REWARD? 4220 03:35:54,000 --> 03:35:56,000 LET'S GO BACK TO THE 4221 03:35:56,000 --> 03:36:01,160 INFLAMMATORY SIGHT OWE -- 4222 03:36:01,160 --> 03:36:04,960 CYTOKINES IT INCREASED BECAUSE 4223 03:36:04,960 --> 03:36:07,920 THE TISSUES WERE UNDERGOING A 4224 03:36:07,920 --> 03:36:08,520 LOT OF INJURY. 4225 03:36:08,520 --> 03:36:11,720 AND ITS MUSCLES, TENDON, NERVE 4226 03:36:11,720 --> 03:36:14,240 AND BONE ALL UNDERGOING IN THE 4227 03:36:14,240 --> 03:36:15,880 INJURIES TO INFLAMMATORY 4228 03:36:15,880 --> 03:36:18,360 CYTOKINES IN THE LOCAL TISSUE 4229 03:36:18,360 --> 03:36:19,640 SPILL OVER TO THE BLOODSTREAM 4230 03:36:19,640 --> 03:36:28,080 BECOME DETECTABLE IN THE SERUM. 4231 03:36:28,080 --> 03:36:32,560 YOU CAN SEE IT'S HIGH IN THE 4232 03:36:32,560 --> 03:36:36,360 LATTER WEEKS AND PARTIALLY 4233 03:36:36,360 --> 03:36:38,600 DAMPENED BY THE IBUPROFEN BY THE 4234 03:36:38,600 --> 03:36:46,720 CHEMO KINE. 4235 03:36:46,720 --> 03:36:47,560 THAT'S INTERESTING THERE'S 4236 03:36:47,560 --> 03:36:50,400 SICKNESS BEHAVIORS IN HUMANS, 4237 03:36:50,400 --> 03:36:53,240 WORKERS, DESPITE OTHER IBUPROFEN 4238 03:36:53,240 --> 03:36:55,520 TREATMENT OR OTHER THINGS THEY 4239 03:36:55,520 --> 03:36:56,320 MIGHT DO TO CONTINUE GETTING 4240 03:36:56,320 --> 03:36:59,120 THEIR PAYCHECK. 4241 03:36:59,120 --> 03:37:02,760 THE SYSTEMIC CYTOKINES INDUCE A 4242 03:37:02,760 --> 03:37:05,680 SICKNESS BEHAVIOR WHICH ARE 4243 03:37:05,680 --> 03:37:07,400 LINKED TO INFECTION OR STERILE 4244 03:37:07,400 --> 03:37:09,840 INJURY WHICH IS WHAT THE WORKERS 4245 03:37:09,840 --> 03:37:12,120 WOULD BE GETTING AND THE 4246 03:37:12,120 --> 03:37:18,640 SUBSEQUENT INCREASES IN THE 4247 03:37:18,640 --> 03:37:20,280 CYTOKINES AND THROUGH 4248 03:37:20,280 --> 03:37:23,080 MACROPHAGES ACTIVATING HERE AND 4249 03:37:23,080 --> 03:37:25,440 GETTING IN THE BRAIN CREATING A 4250 03:37:25,440 --> 03:37:26,720 MIRROR INFLAMMATORY SORT OF 4251 03:37:26,720 --> 03:37:31,360 REACTION IN THE BRAIN YOU CAN 4252 03:37:31,360 --> 03:37:33,600 LOOK AT THIS AND SICKNESS 4253 03:37:33,600 --> 03:37:36,720 RESPONSES LIKE ANOREXIA, FATIGUE 4254 03:37:36,720 --> 03:37:39,640 AND WITHDRAWAL. 4255 03:37:39,640 --> 03:37:41,600 THE FATIGUE THE GRIP STRENGTH 4256 03:37:41,600 --> 03:37:44,560 COULD BE FATIGUE AS A 4257 03:37:44,560 --> 03:37:49,560 CONSEQUENCE OF THE SYNDROME. 4258 03:37:49,560 --> 03:37:53,120 AND THE WITHDRAWAL AND YOU'LL 4259 03:37:53,120 --> 03:37:54,320 SEE SOCIAL BEHAVIOR THINGS BUT 4260 03:37:54,320 --> 03:37:56,720 IN HUMANS IT COULD BE THE 4261 03:37:56,720 --> 03:37:59,720 SICKNESS ABSENCE. 4262 03:37:59,720 --> 03:38:02,560 IB ANIMALS WE LOOK AT -- IN 4263 03:38:02,560 --> 03:38:04,720 ANIMALS WE LOOK AT SOCIAL 4264 03:38:04,720 --> 03:38:06,880 INTERACTION BEHAVIOR WITH 4265 03:38:06,880 --> 03:38:08,960 JUVENILE RATS AND TRACK THAT AND 4266 03:38:08,960 --> 03:38:10,760 IF IT'S POSITIVE IT'S GROOMING 4267 03:38:10,760 --> 03:38:12,280 AND LICKING AND CRAWLING BUT IF 4268 03:38:12,280 --> 03:38:16,000 IT'S A NEGATIVE REACTION THERE'S 4269 03:38:16,000 --> 03:38:17,280 AGGRESSION TOWARDS THE JUVENILE 4270 03:38:17,280 --> 03:38:19,400 AND BITING AND WRESTLING, 4271 03:38:19,400 --> 03:38:21,200 KICKING, YOU HAVE TO REMOVE THE 4272 03:38:21,200 --> 03:38:23,640 ABUT RAT AND THAT ENDS THEIR 4273 03:38:23,640 --> 03:38:26,960 POSITIVE SOCIAL INTERACTION 4274 03:38:26,960 --> 03:38:27,520 IMMEDIATELY AND IT SCORES 4275 03:38:27,520 --> 03:38:29,360 IMMIGRATION. 4276 03:38:29,360 --> 03:38:30,480 -- AGGRESSION. 4277 03:38:30,480 --> 03:38:32,800 IF WE LOOK AT THE DATA HERE, 4278 03:38:32,800 --> 03:38:34,920 THIS IS THE SECOND OF SOCIAL 4279 03:38:34,920 --> 03:38:36,000 INTERACTION YOU'RE HOPING FOR A 4280 03:38:36,000 --> 03:38:36,800 HIGHER SCORE. 4281 03:38:36,800 --> 03:38:40,880 IF YOU LOOK AGAIN AT THE 4282 03:38:40,880 --> 03:38:42,160 PROPHYLACTIC TREATMENT, 4283 03:38:42,160 --> 03:38:44,040 IBUPROFEN WASN'T HELPING THAT 4284 03:38:44,040 --> 03:38:50,480 VERY MUCH ABOVE TRAINED ALONE. 4285 03:38:50,480 --> 03:38:52,880 COMPARED TO CONTROLS AND IF YOU 4286 03:38:52,880 --> 03:38:53,880 LOOK LONG-TERM THE IBUPROFEN 4287 03:38:53,880 --> 03:38:59,960 DOES HELP OVER TIME AND GAINS 4288 03:38:59,960 --> 03:39:08,240 SOME STRENGTH AND IT'S 4289 03:39:08,240 --> 03:39:11,080 COMPLICATED BECAUSE WE'RE JUST 4290 03:39:11,080 --> 03:39:15,320 LOOKING AT SOME OF THE 4291 03:39:15,320 --> 03:39:16,360 ATTRIBUTES OF SOCIAL INTERACTION 4292 03:39:16,360 --> 03:39:17,400 BUT WE SEE SOME INCREASE AND 4293 03:39:17,400 --> 03:39:20,920 THAT MATCHES WHAT YOU SEE HERE 4294 03:39:20,920 --> 03:39:24,840 THE DURATION AND SOCIAL 4295 03:39:24,840 --> 03:39:28,040 INTERACTION IS CORRELATING WITH 4296 03:39:28,040 --> 03:39:34,960 THE PICO GRAMS PER MILL OF 4297 03:39:34,960 --> 03:39:37,480 CYTOKINE IN THE SERUM. 4298 03:39:37,480 --> 03:39:40,040 THERE'S A LINK BETWEEN 4299 03:39:40,040 --> 03:39:43,040 INFLAMMATORY CYTOKINE AND DIRECT 4300 03:39:43,040 --> 03:39:44,280 INTERACTION AND THE IBUPROFEN 4301 03:39:44,280 --> 03:39:50,720 DID IMPROVE THAT IF WE LOOKED AT 4302 03:39:50,720 --> 03:39:54,240 THIS IN TERMS OF THE IL1 BETA 4303 03:39:54,240 --> 03:39:58,080 AND YOU CAN SEE AS YOU LOOK 4304 03:39:58,080 --> 03:40:02,440 THERE IS IMPROVEMENT IN SOCIAL 4305 03:40:02,440 --> 03:40:03,240 INTERACTION. 4306 03:40:03,240 --> 03:40:05,440 AT THIS TIME POINT AND WHEN WE 4307 03:40:05,440 --> 03:40:11,080 LOOK AT THE GRAIN IN THE TREATED 4308 03:40:11,080 --> 03:40:13,680 ANIMALS THE IBUPROFEN DOES 4309 03:40:13,680 --> 03:40:18,040 REDUCE THE IL1 BETA EXPRESSION 4310 03:40:18,040 --> 03:40:21,920 IN PERI VENTRICULAR APPENDMALL 4311 03:40:21,920 --> 03:40:23,760 CELLS WHICH IS LIKELY WHY THE 4312 03:40:23,760 --> 03:40:25,160 IMPROVEMENT OF SOCIAL BEHAVIOR 4313 03:40:25,160 --> 03:40:33,640 AT THIS TIME. 4314 03:40:33,640 --> 03:40:38,720 THE SECONDARY NSAIDS PROVIDED 4315 03:40:38,720 --> 03:40:43,600 THE ONSET OF PAIN BEHAVIORS CAN 4316 03:40:43,600 --> 03:40:45,280 REDUCE CHRONIC INFLAMMATORY 4317 03:40:45,280 --> 03:40:46,840 CYTOKINE SICKNESS AND BRAIN 4318 03:40:46,840 --> 03:40:48,200 SENSITIZATION BUT DID NOT WORK 4319 03:40:48,200 --> 03:40:53,360 AT THE SPINAL CORD. 4320 03:40:53,360 --> 03:40:56,960 NOW, IN LONGER STUDIES THE 4321 03:40:56,960 --> 03:40:59,400 IBUPROFEN HAS A LIMIT OR THE 4322 03:40:59,400 --> 03:41:00,880 ANTIINFLAMMATORIES HAVE A LIMIT 4323 03:41:00,880 --> 03:41:08,560 TO WHAT THEY CAN DO AFTER THE 4324 03:41:08,560 --> 03:41:11,040 12-WEEK TIME POINT. 4325 03:41:11,040 --> 03:41:14,720 THERE'S A TIME LIMIT ON HOW LONG 4326 03:41:14,720 --> 03:41:15,240 THE IBUPROFEN CAN WORK. 4327 03:41:15,240 --> 03:41:20,720 CONCLUSIONS FOR ALL THIS IS 4328 03:41:20,720 --> 03:41:22,120 PROPHYLACTIC NSAIDS CAN 4329 03:41:22,120 --> 03:41:28,320 EFFECTIVELY AFFECT THE PAIN 4330 03:41:28,320 --> 03:41:29,720 BEHAVIORS BUT CAN YOU HAVE THEM 4331 03:41:29,720 --> 03:41:32,160 STAY ON THEM ALL THE TIME IN 4332 03:41:32,160 --> 03:41:34,600 LIGHT OF GASTRIC PROBLEMS FROM 4333 03:41:34,600 --> 03:41:36,600 IBUPROFEN OR THE MITOCHONDRIAL 4334 03:41:36,600 --> 03:41:42,840 ISSUES THAT CAN LIMIT HEALING IN 4335 03:41:42,840 --> 03:41:44,000 MUSCLES? 4336 03:41:44,000 --> 03:41:46,480 SECONDARY, IBUPROFEN LOWERS 4337 03:41:46,480 --> 03:41:54,040 THINGS PROIVE -- PERIPHERAL BUT 4338 03:41:54,040 --> 03:41:59,120 DOESN'T ADDRESS ALL THE 4339 03:41:59,120 --> 03:42:04,000 FUNCTIONAL DECLINES AND IT 4340 03:42:04,000 --> 03:42:09,800 APPEARS TO BE DUE TO THE SER 4341 03:42:09,800 --> 03:42:11,800 PERSISTENT SPINAL CORD BUT 4342 03:42:11,800 --> 03:42:13,240 THERE'S AFFECT ON THE BRAIN 4343 03:42:13,240 --> 03:42:13,600 SENSITIZATION. 4344 03:42:13,600 --> 03:42:19,840 I WANT TO THANK ALL MY FUNDING 4345 03:42:19,840 --> 03:42:21,080 SOURCES AND COLLEAGUES BUT I 4346 03:42:21,080 --> 03:42:26,520 WANTED TO END WITH THIS SLIDE 4347 03:42:26,520 --> 03:42:32,600 INSTEAD THAT PAIN IS A COMPLEX 4348 03:42:32,600 --> 03:42:34,080 REALITY TISSUE INJURY AND THEN 4349 03:42:34,080 --> 03:42:37,680 THERE CAN BE LOOPS OF ACUTE TO 4350 03:42:37,680 --> 03:42:39,360 CHRONIC SYSTEMIC LEADING TO 4351 03:42:39,360 --> 03:42:39,600 FIBROSIS. 4352 03:42:39,600 --> 03:42:42,840 EACH OF WHICH CAN LEAD TO PAIN 4353 03:42:42,840 --> 03:42:46,160 AND LOSS OF FUNCTION BY 4354 03:42:46,160 --> 03:42:46,440 THEMSELVES. 4355 03:42:46,440 --> 03:42:49,400 MUCH LESS MIXED TOGETHER. 4356 03:42:49,400 --> 03:42:52,960 WE ALSO NEED TO BE TRADING OUR 4357 03:42:52,960 --> 03:42:57,200 RATS AND OUR PATIENTS ABOUT 4358 03:42:57,200 --> 03:43:00,440 CENTRAL NERVOUS ORGANIZATION 4359 03:43:00,440 --> 03:43:02,120 ENHANCING CENTRAL SENSITIZATION 4360 03:43:02,120 --> 03:43:03,680 AND LEADING TO SICKNESS 4361 03:43:03,680 --> 03:43:07,560 BEHAVIORS AND PERSISTENT PAIN 4362 03:43:07,560 --> 03:43:10,960 AND THE WHOLE UPPER LOBE WITH 4363 03:43:10,960 --> 03:43:12,360 ANYTHING LIKE NSAIDS ARE FAILING 4364 03:43:12,360 --> 03:43:17,720 TO TREAT AT LEAST LONG-TERM. 4365 03:43:17,720 --> 03:43:27,200 AND I SUGGEST THEY SHOULD BE 4366 03:43:27,200 --> 03:43:28,720 MORE DESIGN TO MATCH THE COMPLEX 4367 03:43:28,720 --> 03:43:39,080 PROBLEM THAT WE SEE. 4368 03:43:39,320 --> 03:43:49,800 >> THANK YOU FOR SUM ARRIZE -- 4369 03:43:52,840 --> 03:43:53,760 SUMMARIZING THIS. 4370 03:43:53,760 --> 03:43:55,040 LINDA, SHOULD WE SAVE THE 4371 03:43:55,040 --> 03:43:56,360 QUESTIONS FOR AFTER WE HEARD 4372 03:43:56,360 --> 03:43:59,000 BOTH TALKS OR BECAUSE I THINK 4373 03:43:59,000 --> 03:43:59,680 BOTH TALKS WILL BE COMPLEMENTARY 4374 03:43:59,680 --> 03:44:06,120 TO EACH OTHER. 4375 03:44:06,120 --> 03:44:08,720 -- SORRY, I CAN'T HEAR YOU. 4376 03:44:08,720 --> 03:44:10,720 >> SORRY, IT'S MY LAPTOP. 4377 03:44:10,720 --> 03:44:15,960 I'M CHECKING QUICKLY TO SEE 4378 03:44:15,960 --> 03:44:21,320 WHETHER LUDA -- THERE SHE IS. 4379 03:44:21,320 --> 03:44:31,840 WE COULD MAYBE SAVE THEM BOTH. 4380 03:44:32,280 --> 03:44:39,200 WE HAVE CHRISTINE GERTZ AND 4381 03:44:39,200 --> 03:44:40,480 UNLESS PEOPLE HAVE RETURNING OF 4382 03:44:40,480 --> 03:44:42,680 BURNING QUESTIONS NOW I THINK 4383 03:44:42,680 --> 03:44:53,040 WE'RE PRETTY FLEXIBLE. 4384 03:44:53,720 --> 03:44:58,240 >> WHY DON'T WE GO ON WITH LI 4385 03:44:58,240 --> 03:45:00,640 LIEU -- LUDA'S TALK. 4386 03:45:00,640 --> 03:45:06,880 WE NEED TO INTRODUCE LUDA. 4387 03:45:06,880 --> 03:45:08,960 >> THANK YOU. 4388 03:45:08,960 --> 03:45:16,120 VERY MUCH WE'RE DELIGHTED TO 4389 03:45:16,120 --> 03:45:19,120 HAVE DR. LUDA DIATCHENKO AN 4390 03:45:19,120 --> 03:45:20,320 EXCELLENCE RESEARCH CHAIR IN 4391 03:45:20,320 --> 03:45:21,760 HUMAN PAIN GENETICS AND 4392 03:45:21,760 --> 03:45:23,360 PROFESSOR OF MEDICINE IN THE 4393 03:45:23,360 --> 03:45:24,960 DEPARTMENT OF ANESTHESIA AND 4394 03:45:24,960 --> 03:45:27,520 ORAL SCIENCES AT McGILL 4395 03:45:27,520 --> 03:45:29,160 UNIVERSITY AND THE CENTER FOR 4396 03:45:29,160 --> 03:45:31,600 RESEARCH ON PAIN. 4397 03:45:31,600 --> 03:45:38,200 SHE EARNED HER M.D. AND Ph.D. 4398 03:45:38,200 --> 03:45:41,160 FROM FROM THE UNIVERSITY OF 4399 03:45:41,160 --> 03:45:42,400 NORTH CAROLINA. 4400 03:45:42,400 --> 03:45:52,160 DR. DA CERTAI-- DIATCHENKO'S LO 4401 03:45:52,160 --> 03:45:54,200 RISK OF DEVELOPMENT OF CHRONIC 4402 03:45:54,200 --> 03:45:55,960 PAIN CONDITIONS ENABLING NEW 4403 03:45:55,960 --> 03:45:58,120 APPROACHES TO IDENTIFY NEW DRUG 4404 03:45:58,120 --> 03:45:59,320 TARGETS AND RESPONSE TO 4405 03:45:59,320 --> 03:46:00,560 ANALGESICS AND DIAGNOSTICS. 4406 03:46:00,560 --> 03:46:03,720 SHE'S A MEMBER AND ACTIVE 4407 03:46:03,720 --> 03:46:05,000 OFFICER OF SEVERAL NATIONAL AND 4408 03:46:05,000 --> 03:46:05,920 INTERNATIONAL SCIENTIFIC 4409 03:46:05,920 --> 03:46:06,600 SOCIETIES INCLUDING THE NATIONAL 4410 03:46:06,600 --> 03:46:08,640 ASSOCIATION FOR THE STUDY OF 4411 03:46:08,640 --> 03:46:10,080 PAIN, AMERICAN PAIN SOCIETY AND 4412 03:46:10,080 --> 03:46:12,200 AMERICAN SOCIETY OF HUMAN 4413 03:46:12,200 --> 03:46:13,160 GENETICS. 4414 03:46:13,160 --> 03:46:22,160 WELCOME, DR. DIATCHENKO. 4415 03:46:22,160 --> 03:46:22,840 >> THANK YOU. 4416 03:46:22,840 --> 03:46:31,360 CAN EVERYBODY HEAR ME, YES? 4417 03:46:31,360 --> 03:46:40,920 ALL RIGHT. 4418 03:46:40,920 --> 03:46:41,640 THERE'S INTERESTING ON 4419 03:46:41,640 --> 03:46:46,680 COLLUSIONS THOUGH WE START AT 4420 03:46:46,680 --> 03:46:51,120 DIFFERENT POINT WE STARTED 4421 03:46:51,120 --> 03:46:56,720 WIT 4422 03:46:56,720 --> 03:47:01,640 WITHAN -- WITH HUMAN SAMPLES 4423 03:47:01,640 --> 03:47:04,960 AND WE STARTED WITH THE BLOOD OF 4424 03:47:04,960 --> 03:47:10,520 THE HUMAN WITH LOW BACK PAIN AT 4425 03:47:10,520 --> 03:47:12,680 THE ACUTE STAGE AND THREE MONTHS 4426 03:47:12,680 --> 03:47:12,880 LATER. 4427 03:47:12,880 --> 03:47:18,200 AFTER THREE MONTHS, HALF THE 4428 03:47:18,200 --> 03:47:21,480 PEOPLE REPORT NO PAIN AND HALF 4429 03:47:21,480 --> 03:47:31,440 THE PEOPLE STILL REPORTED PAIN. 4430 03:47:31,440 --> 03:47:34,080 AND THIS WAS COLLECTED IN ITALY. 4431 03:47:34,080 --> 03:47:36,160 WE LOOKED AT THE CHANGES IN THE 4432 03:47:36,160 --> 03:47:39,960 BLOOD AND WHAT WE SAW WAS 4433 03:47:39,960 --> 03:47:46,240 ASTONISHING IN HOW DIFFERENT THE 4434 03:47:46,240 --> 03:47:51,840 WHO DEAL WITH PAIN BEHAVE OR 4435 03:47:51,840 --> 03:47:52,320 CELLS BEHAVE. 4436 03:47:52,320 --> 03:48:01,000 ON THE DATA HAS BEEN ANALYZED BY 4437 03:48:01,000 --> 03:48:11,560 A BIO STATISTICIAN IN MY GROUP 4438 03:48:13,240 --> 03:48:15,600 WE ANALYZED THE DATA IN 4439 03:48:15,600 --> 03:48:17,360 DIFFERENT WAYS AND COMPARED THE 4440 03:48:17,360 --> 03:48:22,280 RNA SAMPLE OVER THREE MONTHS. 4441 03:48:22,280 --> 03:48:30,920 IN PEOPLE WHO HAD PAIN AND EACH 4442 03:48:30,920 --> 03:48:36,080 DOT IS A GENE THE DOTS GO TO THE 4443 03:48:36,080 --> 03:48:38,520 LEFT AND DOWN REGULATED AND THE 4444 03:48:38,520 --> 03:48:41,080 MAGENTA LINE IS THE LINE FOR 4445 03:48:41,080 --> 03:48:49,040 SIGNIFICANCE. 4446 03:48:49,040 --> 03:48:50,440 AND HERE THE NUMBER OF 4447 03:48:50,440 --> 03:48:54,760 EXPRESSION AND THOUSANDS OF GENE 4448 03:48:54,760 --> 03:48:56,240 EXCHANGE EXPRESSION IN THE 4449 03:48:56,240 --> 03:48:59,120 PEOPLE WHO RESOLVE PAIN UP AND 4450 03:48:59,120 --> 03:49:01,280 DOWN REGULATED. 4451 03:49:01,280 --> 03:49:02,720 SO ALMOST HALF OF ALL THE 4452 03:49:02,720 --> 03:49:06,080 EXPRESSED BLOOD AND THIS IS 4453 03:49:06,080 --> 03:49:09,040 AFTER ALL THIS. 4454 03:49:09,040 --> 03:49:09,800 WHAT HAPPENS IN THE PEOPLE WHO 4455 03:49:09,800 --> 03:49:14,760 DIDN'T RESOLVE PAIN, NOTHING. 4456 03:49:14,760 --> 03:49:18,760 SO THE TRANSCRIPTOME WAS FROZEN 4457 03:49:18,760 --> 03:49:23,800 OVER TIME OVER THE THREE MONTHS 4458 03:49:23,800 --> 03:49:27,640 WE ASKED MAYBE THIS IS SOME 4459 03:49:27,640 --> 03:49:30,760 SIGNIFICANT CHANGE IN THE BLOOD 4460 03:49:30,760 --> 03:49:34,560 COMPOSITION IN WHICH DRIVES THE 4461 03:49:34,560 --> 03:49:36,560 TRANSCRIPTION BUT IT'S NOT ONLY 4462 03:49:36,560 --> 03:49:39,000 DRIVING THE CHANGE IN 4463 03:49:39,000 --> 03:49:39,320 TRANSCRIPTION. 4464 03:49:39,320 --> 03:49:40,800 SO THE ONLY GAINED SIGNIFICANT 4465 03:49:40,800 --> 03:49:42,480 DIFFERENCES SO IT'S OVER TIME IN 4466 03:49:42,480 --> 03:49:45,240 THE PEOPLE WHO RESOLVE PAIN SUCH 4467 03:49:45,240 --> 03:49:48,120 ADDS OVER THREE MONTHS AND THE 4468 03:49:48,120 --> 03:49:53,680 NEUTROPHILS GO DOWN AND THE T 4469 03:49:53,680 --> 03:49:56,280 CELLS GO UP AND THE RELEASE OF 4470 03:49:56,280 --> 03:49:58,240 THE MOUSE CELLS WAS GOING DOWN. 4471 03:49:58,240 --> 03:50:04,440 BUT WHEN WE CONTROL FOR THE -- 4472 03:50:04,440 --> 03:50:06,000 AGAIN, A LOT OF CHANGE HAPPENED 4473 03:50:06,000 --> 03:50:10,680 BUT ONLY WHO RESOLVED PAIN THERE 4474 03:50:10,680 --> 03:50:11,520 WAS NO DIFFERENCE IN THE BLOOD 4475 03:50:11,520 --> 03:50:14,760 OVER TIME. 4476 03:50:14,760 --> 03:50:17,320 WE CONTROLLED FOR THE NUMBER OF 4477 03:50:17,320 --> 03:50:19,360 DIFFERENT CELL TYPES BUT DIDN'T 4478 03:50:19,360 --> 03:50:22,760 CHANGE MUCH NUMBER OF THE 4479 03:50:22,760 --> 03:50:26,880 DIFFERENTLY EXPRESSED GENES. 4480 03:50:26,880 --> 03:50:30,040 PEOPLE WHO RESOLVE PAIN HAVE 4481 03:50:30,040 --> 03:50:33,200 CHANGES IN THE CELL COMPOSITION 4482 03:50:33,200 --> 03:50:33,960 AND THERE'S THE PATHWAYS IN THE 4483 03:50:33,960 --> 03:50:44,080 BLOOD. 4484 03:50:45,280 --> 03:50:48,320 IT DIDN'T LOOK WISE TO LOOK AT 4485 03:50:48,320 --> 03:50:49,280 THE DIFFERENTIALLY EXPRESSED 4486 03:50:49,280 --> 03:50:53,120 GENE SO WE LOOK AT THE PATHWAYS 4487 03:50:53,120 --> 03:51:04,080 AND WE USED THE GENGENONTOLOGY 4488 03:51:04,560 --> 03:51:06,000 APPROACH AND WE LOOKED AT THE 4489 03:51:06,000 --> 03:51:11,240 ACUTE STAGE OF PEOPLE WHO 4490 03:51:11,240 --> 03:51:14,560 RESOLVE PAIN OR NOT SO WHAT ARE 4491 03:51:14,560 --> 03:51:16,440 THE MOST SIGNIFICANT PATHWAY? 4492 03:51:16,440 --> 03:51:18,120 WE SAW THOUSAND OF EXPRESSED 4493 03:51:18,120 --> 03:51:28,000 PATHWAYS IN THE ACUTE STAGE. 4494 03:51:28,000 --> 03:51:31,320 THE MOST SPECIFIC PATHWAY IN 4495 03:51:31,320 --> 03:51:34,520 PROTEIN SYNTHESIS, SFRECHL, 4496 03:51:34,520 --> 03:51:41,840 SIGNIFICANT PATH -- FOR EXAMPLE 4497 03:51:41,840 --> 03:51:43,480 WAS SIGNIFICANT INFLAMMATORY 4498 03:51:43,480 --> 03:51:45,760 RESPONSE BUT I WOULD NEVER GUESS 4499 03:51:45,760 --> 03:51:49,040 SUCH THAT THE PEOPLE WHO RESOLVE 4500 03:51:49,040 --> 03:51:51,680 PAIN HAVE VERY HIGH INFLAMMATORY 4501 03:51:51,680 --> 03:52:01,080 RESPONSE CAPTURED IN THE BLOOD. 4502 03:52:01,080 --> 03:52:04,320 IT WAS GOING DOWN AND IT WENT 4503 03:52:04,320 --> 03:52:08,360 DOWN IN THE PEOPLE WHO HAD 4504 03:52:08,360 --> 03:52:08,920 PERSISTENT PAIN. 4505 03:52:08,920 --> 03:52:10,920 THE SECOND AND IT DEPENDS HOW 4506 03:52:10,920 --> 03:52:13,400 YOU MEASURE BUT BASICALLY IT WAS 4507 03:52:13,400 --> 03:52:18,640 CLEAR THE INFLAMMATORY RESPONSE 4508 03:52:18,640 --> 03:52:24,440 WAS DRIVEN BY LEUKOCYTE 4509 03:52:24,440 --> 03:52:29,560 ACTIVATION WAS MUCH HIGHER IN 4510 03:52:29,560 --> 03:52:31,680 PEOPLE WHO RESOLVE PAIN GOING 4511 03:52:31,680 --> 03:52:38,560 DOWN OVER TIME AND BASICALLY WOE 4512 03:52:38,560 --> 03:52:41,400 SAW THIS LEADING TO INFLAMMATORY 4513 03:52:41,400 --> 03:52:43,280 RESPONSE AND WAS HIGHER IN 4514 03:52:43,280 --> 03:52:43,880 PEOPLE WHO RESOLVE PAIN OVER 4515 03:52:43,880 --> 03:52:49,160 TIME. 4516 03:52:49,160 --> 03:52:52,880 THEN WE ASKED IF PEOPLE WHO -- 4517 03:52:52,880 --> 03:52:57,280 OKAY, MAYBE THE RESULT OF 4518 03:52:57,280 --> 03:52:57,880 STATISTICAL ANALYSIS HERE AND 4519 03:52:57,880 --> 03:53:00,880 THERE'S A SIGNIFICANT BUT WE CAN 4520 03:53:00,880 --> 03:53:04,720 ONLY CALCULATE THE PATHWAY 4521 03:53:04,720 --> 03:53:07,440 ACTIVATIONS IN THE PEOPLE WHO 4522 03:53:07,440 --> 03:53:09,520 RESOLVE PAIN OVER TIME AND ASK 4523 03:53:09,520 --> 03:53:14,760 QUESTION, IF PEOPLE WHO RESOLVE 4524 03:53:14,760 --> 03:53:16,120 PAIN DO THEY DO SOMETHING FROM 4525 03:53:16,120 --> 03:53:18,080 PEOPLE WHO DON'T RESOLVE PAIN OR 4526 03:53:18,080 --> 03:53:24,320 IS IT AN ORDER OF MAGNITUDE AND 4527 03:53:24,320 --> 03:53:25,840 COMPARING PATHWAYS IN PEOPLE WHO 4528 03:53:25,840 --> 03:53:30,760 RESOLVE AND DON'T RESOLVE PAIN 4529 03:53:30,760 --> 03:53:35,960 AND THEY CORRELATE. 4530 03:53:35,960 --> 03:53:37,920 IT'S 0.42. 4531 03:53:37,920 --> 03:53:40,960 THEY CALCULATE SIGNIFICANTLY BUT 4532 03:53:40,960 --> 03:53:42,640 NOT HERE SO THE GOLDEN LINE IS 4533 03:53:42,640 --> 03:53:48,800 WHAT WOULD HAPPEN IF THEY 4534 03:53:48,800 --> 03:53:49,520 CALCULATE PERFECTLY. 4535 03:53:49,520 --> 03:53:53,880 THE MAGENTA LINE IS HOW THEY 4536 03:53:53,880 --> 03:53:55,440 CARRY AND WE CAN LOOK AT THE 4537 03:53:55,440 --> 03:53:57,760 DIFFERENCE BETWEEN MAGENTA AND 4538 03:53:57,760 --> 03:54:01,440 GOLDEN LINE AND CALCULATE THE 4539 03:54:01,440 --> 03:54:06,600 DIFFERENCE IT'S ABOUT 34 IN THE 4540 03:54:06,600 --> 03:54:08,520 COHORT SO BASICALLY PEOPLE WHO 4541 03:54:08,520 --> 03:54:09,160 DIDN'T RESOLVE PAIN OR THE 4542 03:54:09,160 --> 03:54:11,040 IMMUNE SYSTEM OF THE PEOPLE WHO 4543 03:54:11,040 --> 03:54:12,000 DIDN'T RESOLVE PAIN WAS TRYING 4544 03:54:12,000 --> 03:54:17,960 TO DO THE SAME AS THE PEOPLE WHO 4545 03:54:17,960 --> 03:54:19,760 RESOLVED PAIN BUT LESS 4546 03:54:19,760 --> 03:54:26,360 EFFICIENT. 4547 03:54:26,360 --> 03:54:29,240 THIS REPRESENTS SIMILAR IDEA 4548 03:54:29,240 --> 03:54:31,600 THOSE WHO RESOLVE -- WHO DIDN'T 4549 03:54:31,600 --> 03:54:35,240 RESOLVE PAIN, YOU SEE THE 4550 03:54:35,240 --> 03:54:38,640 COLLAPSE THE DIFFERENTIAL 4551 03:54:38,640 --> 03:54:39,320 EXPRESSIONS COLLAPSE AROUND ZERO 4552 03:54:39,320 --> 03:54:44,000 AND THOSE WHO WILL RESOLVE PAIN 4553 03:54:44,000 --> 03:54:47,160 HAVE THE DIFFERENTIAL 4554 03:54:47,160 --> 03:54:48,800 EXPRESSION. 4555 03:54:48,800 --> 03:54:50,240 BASICALLY BASICALLY SIMILAR 4556 03:54:50,240 --> 03:54:50,840 PROCESSES BUT DIFFERENCE IN 4557 03:54:50,840 --> 03:54:58,360 MAGNITUDE. 4558 03:54:58,360 --> 03:55:01,240 IT TOOK ME A LONG TIME TO 4559 03:55:01,240 --> 03:55:06,640 BELIEVE THIS DATA MYSELF. 4560 03:55:06,640 --> 03:55:10,480 WE CHECKED THE PATIENT I.D. AND 4561 03:55:10,480 --> 03:55:13,360 ANALYSIS AND SIGN OF STATISTICAL 4562 03:55:13,360 --> 03:55:15,120 ANALYSIS AND THEN YOU SAY, WELL, 4563 03:55:15,120 --> 03:55:18,480 I THINK THE BEST WAY TO SEE IF 4564 03:55:18,480 --> 03:55:22,160 IT'S TRUE IF IT CAN REPLICATE IT 4565 03:55:22,160 --> 03:55:25,280 AND WE SAID WE HAVE COHORT. 4566 03:55:25,280 --> 03:55:26,200 WE WERE TRYING TO FIND LOW BACK 4567 03:55:26,200 --> 03:55:36,760 PAIN AND DIDN'T BUT WE HAD THIS 4568 03:55:39,600 --> 03:55:44,400 COHORT AND WE HAVE PEOPLE WITH 4569 03:55:44,400 --> 03:55:46,320 ACUTE FACIAL PAIN AND THE BLOOD 4570 03:55:46,320 --> 03:55:49,840 OF THE PEOPLE SIX MONTHS LATER. 4571 03:55:49,840 --> 03:55:53,080 WE ASKED DO WE SEE -- IT'S A 4572 03:55:53,080 --> 03:55:55,360 DIFFERENT BUT IF THEY HAVE THE 4573 03:55:55,360 --> 03:55:56,960 SYSTEMIC MAYBE WE'LL SEE THE 4574 03:55:56,960 --> 03:55:57,600 SAME PROCESSES. 4575 03:55:57,600 --> 03:55:58,960 THIS IS WHAT WE SEE. 4576 03:55:58,960 --> 03:56:02,640 FIRST, YOU CAN SEE IT'S NOT AS 4577 03:56:02,640 --> 03:56:03,880 PRONOUNCED AS LOW BACK PAIN BUT 4578 03:56:03,880 --> 03:56:05,360 PEOPLE WHO WILL NOT -- A PATIENT 4579 03:56:05,360 --> 03:56:10,240 WHO WILL NOT RESOLVE PAIN, THE 4580 03:56:10,240 --> 03:56:10,800 DIFFERENTIAL EXPRESSION 4581 03:56:10,800 --> 03:56:14,000 COLLAPSED AROUND ZERO AND PEOPLE 4582 03:56:14,000 --> 03:56:18,160 WHO WILL RESOLVE PAIN THE 4583 03:56:18,160 --> 03:56:19,680 EXPRESSION WAS MUCH BROADER IN 4584 03:56:19,680 --> 03:56:21,800 THE CHANGE OF GENE EXPRESSION 4585 03:56:21,800 --> 03:56:28,560 WAS MUCH MORE SIGNIFICANT. 4586 03:56:28,560 --> 03:56:31,520 WE ALSO ASKED IN THE SAME 4587 03:56:31,520 --> 03:56:36,560 PATHWAY LIKE DO WE ALSO SEE THE 4588 03:56:36,560 --> 03:56:40,480 INFLAMMATORY RESPONSE DRIVEN BY 4589 03:56:40,480 --> 03:56:44,240 A NEW ACTIVATION? 4590 03:56:44,240 --> 03:56:47,480 IS IT UP REGULATED AND THE 4591 03:56:47,480 --> 03:56:49,280 ANSWER WAS YES VERY 4592 03:56:49,280 --> 03:56:54,720 SIGNIFICANTLY SO AND IN THE SAME 4593 03:56:54,720 --> 03:56:57,280 DIRECTION AGAIN IT WAS UP 4594 03:56:57,280 --> 03:57:00,960 REGULATED IN THE PEOPLE WHO 4595 03:57:00,960 --> 03:57:01,560 RESOLVE PAIN. 4596 03:57:01,560 --> 03:57:05,760 SO PEOPLE WHO RESOLVE PAIN FOR 4597 03:57:05,760 --> 03:57:07,200 TMD2 HAVE HIGHER INFLAMMATORY 4598 03:57:07,200 --> 03:57:13,320 RESPONSE. 4599 03:57:13,320 --> 03:57:16,440 A QUESTION, IF WE DON'T SEE 4600 03:57:16,440 --> 03:57:17,560 CHANGES IN THE PEOPLE WHO HAVE 4601 03:57:17,560 --> 03:57:22,200 INFLAMMATORY RESPONSE AND THE 4602 03:57:22,200 --> 03:57:25,440 PEOPLE WHO DON'T RESOLVE PAIN 4603 03:57:25,440 --> 03:57:26,320 MAYBE THEY HAVE HIGH 4604 03:57:26,320 --> 03:57:30,040 INFLAMMATORY RESPONSE AND IT'S 4605 03:57:30,040 --> 03:57:30,880 NOT GOING DOWN. 4606 03:57:30,880 --> 03:57:35,600 THEY ALSO HAVE HEALTHY CONTROL 4607 03:57:35,600 --> 03:57:37,400 AND WE HAVE CHRONIC PAIN 4608 03:57:37,400 --> 03:57:37,680 PATIENTS. 4609 03:57:37,680 --> 03:57:42,200 SO WE WERE HAPPY FOR BOTH 4610 03:57:42,200 --> 03:57:44,120 BECAUSE OKAY, HEALTHY CONTROL WE 4611 03:57:44,120 --> 03:57:46,600 CAN SEE IF THE PEOPLE WITH THE 4612 03:57:46,600 --> 03:57:52,760 ACUTE PAIN DO THEY UPREGULATE 4613 03:57:52,760 --> 03:57:58,240 THEIR INFLAMMATORY RESPONSE? 4614 03:57:58,240 --> 03:58:00,400 WE CAN LOOK AT THE CHRONIC PAIN 4615 03:58:00,400 --> 03:58:02,200 PATIENT AND WE KNOW FOR DECADES 4616 03:58:02,200 --> 03:58:05,800 THEY HAVE LOW-GRADE UNDERLYING. 4617 03:58:05,800 --> 03:58:15,000 -- INFLAMMATION. 4618 03:58:15,000 --> 03:58:17,240 AND WE COMPARE ALL THE THREE 4619 03:58:17,240 --> 03:58:18,000 DIFFERENT PAIN STATES WITH THE 4620 03:58:18,000 --> 03:58:27,960 HEALTHY CONTROLS. 4621 03:58:27,960 --> 03:58:31,480 THEN WE ASKED HOW ABOUT THIS 4622 03:58:31,480 --> 03:58:34,000 INFLAMMATORY RESPONSE IT 4623 03:58:34,000 --> 03:58:36,000 RESOLVES TO ZERO. 4624 03:58:36,000 --> 03:58:38,800 IT'S SIGNIFICANT UPREGULATED. 4625 03:58:38,800 --> 03:58:43,280 WHAT'S HAPPENED WITH 4626 03:58:43,280 --> 03:58:44,320 INFLAMMATORY RESPONSE IN PEOPLE 4627 03:58:44,320 --> 03:58:46,360 W 4628 03:58:46,360 --> 03:58:47,840 WHO HAVE ZERO IT'S SIGNIFICANTLY 4629 03:58:47,840 --> 03:58:58,120 DOWN REGULATED. 4630 03:59:01,400 --> 03:59:02,760 IN THE INFLAMMATORY RESPONSE AND 4631 03:59:02,760 --> 03:59:04,560 THE ACUTE STAGE PEOPLE WHO 4632 03:59:04,560 --> 03:59:08,920 RESOLVE PAIN HAVE SIGNIFICANT UP 4633 03:59:08,920 --> 03:59:09,480 REGULATION. 4634 03:59:09,480 --> 03:59:12,320 AND THEN WHAT HAPPENED WITH 4635 03:59:12,320 --> 03:59:15,000 CHRONIC PAIN, CHRONIC PAIN THEY 4636 03:59:15,000 --> 03:59:17,160 DO HAVE ALSO INCREASE IN 4637 03:59:17,160 --> 03:59:17,960 INFLAMMATORY RESPONSE AS WE 4638 03:59:17,960 --> 03:59:24,200 WOULD EXPECT AS WE KNOW BUT THE 4639 03:59:24,200 --> 03:59:28,880 MAGNITUDE IS MUCH LOW. 4640 03:59:28,880 --> 03:59:30,760 SO WE THOUGHT THIS HOW IT LOOKS 4641 03:59:30,760 --> 03:59:37,600 LIKE. 4642 03:59:37,600 --> 03:59:39,680 IT LOOKS LIKE PEOPLE WHO RESOLVE 4643 03:59:39,680 --> 03:59:42,880 PAIN HAVE A SHARP ACTIVATION OF 4644 03:59:42,880 --> 03:59:43,520 INFLAMMATORY RESPONSE WHICH THEN 4645 03:59:43,520 --> 03:59:53,840 GOES DOWN QUICKLY. 4646 03:59:55,040 --> 03:59:56,240 OVER TIME THE INFLAMMATORY 4647 03:59:56,240 --> 04:00:02,240 RESPONSE CONTINUES TO GO UP AND 4648 04:00:02,240 --> 04:00:03,800 CREATES WHAT WE OBSERVE THE 4649 04:00:03,800 --> 04:00:10,040 STATE OF LOW-GRADE INFLAMMATION. 4650 04:00:10,040 --> 04:00:20,560 AND I HAD LUNCH WITH A COLLEAGUE 4651 04:00:26,800 --> 04:00:32,000 A 4652 04:00:32,000 --> 04:00:32,280 A 4653 04:00:32,280 --> 04:00:42,840 AND WE HAD TO MODULATE IT AND IT 4654 04:00:44,000 --> 04:00:46,880 CANNOT BE BECAUSE WE KNOW FOR 4655 04:00:46,880 --> 04:00:48,480 DECADES IF YOU GIVE 4656 04:00:48,480 --> 04:00:49,360 ANTI-INFLAMMATORY DRUG TO MICE 4657 04:00:49,360 --> 04:00:56,080 IT'S VERY ANALGESIC. 4658 04:00:56,080 --> 04:00:58,760 THEY SAID HOW LONG DO WE WATCH 4659 04:00:58,760 --> 04:01:01,840 THEM? 4660 04:01:01,840 --> 04:01:02,560 WE DON'T. 4661 04:01:02,560 --> 04:01:08,760 SO LET'S DO THE STUDY AND JEFF 4662 04:01:08,760 --> 04:01:13,240 AND HIS POSTDOC, LUCAS, WHAT 4663 04:01:13,240 --> 04:01:18,800 THEY DID WAS IN SEVERAL STUDIES 4664 04:01:18,800 --> 04:01:26,480 THEY STARTED WITH THE INDUCEMENT 4665 04:01:26,480 --> 04:01:34,800 OF THE -- WELL, COMPLETE CHRONIC 4666 04:01:34,800 --> 04:01:40,000 PAIN AND THEY INDUCE THIS 4667 04:01:40,000 --> 04:01:42,040 INFLAMMATORY MICE AND THEY TREAT 4668 04:01:42,040 --> 04:01:44,440 THE MICE BECAUSE THE DECISION 4669 04:01:44,440 --> 04:01:50,280 WAS LET'S GIVE MICE THIS BECAUSE 4670 04:01:50,280 --> 04:01:50,920 IT WILL INHIBIT INFLAMMATION BUT 4671 04:01:50,920 --> 04:01:52,320 ANY IMMUNE RESPONSE BECAUSE WE 4672 04:01:52,320 --> 04:01:54,240 SAW IN THE BLOOD OF THE PEOPLE 4673 04:01:54,240 --> 04:01:56,760 WHO RESOLVE PAIN THERE'S MANY 4674 04:01:56,760 --> 04:01:57,320 PROCESSES. 4675 04:01:57,320 --> 04:01:58,960 WE JUST PICK UP THE TOP BUT 4676 04:01:58,960 --> 04:02:09,520 THERE'S MANY PROCESSES GOING ON. 4677 04:02:10,680 --> 04:02:16,600 YOU WE LOOK AT THE SENSITIVITY 4678 04:02:16,600 --> 04:02:23,840 IN THE MICE IN A MONTH JEFF SENT 4679 04:02:23,840 --> 04:02:33,960 THE SLIDE AND SAID LOOK AT THIS. 4680 04:02:33,960 --> 04:02:35,640 IT'S SUPPORTING THE HUMAN DATA 4681 04:02:35,640 --> 04:02:41,480 IN THE WAY THAT WE HAVE A MODEL 4682 04:02:41,480 --> 04:02:45,960 A 4683 04:02:45,960 --> 04:02:47,760 AND BEFORE THE INJECTION AND 4684 04:02:47,760 --> 04:02:58,040 FIVE DAYS LATER. 4685 04:02:58,480 --> 04:03:01,120 AND WE SEE A SIGNIFICANT 4686 04:03:01,120 --> 04:03:02,840 DIFFERENCE BUT BY DAY 15 MICE 4687 04:03:02,840 --> 04:03:07,960 WITH VEHICLE, THEY RESOLVED 4688 04:03:07,960 --> 04:03:10,760 THEIR PAIN AND WERE FINE AFTER 4689 04:03:10,760 --> 04:03:16,960 BUT MICE WHO RECEIVED THIS THEY 4690 04:03:16,960 --> 04:03:20,880 DEVELOP A STATE. 4691 04:03:20,880 --> 04:03:23,480 AND THEY STILL HAD THIS BUT IT 4692 04:03:23,480 --> 04:03:30,440 WASN'T EXPLAINED IN ANY WAY BY 4693 04:03:30,440 --> 04:03:36,920 THE MEASURE AND THERE WAS SOME 4694 04:03:36,920 --> 04:03:39,120 DIFFERENCE BUT AFTER THIS WAS NO 4695 04:03:39,120 --> 04:03:44,560 DIFFERENCE BUT THERE WAS A 4696 04:03:44,560 --> 04:03:50,160 ROBUST DIFFERENCE HERE. 4697 04:03:50,160 --> 04:03:51,200 AND THEY SAID HOW LONG WILL THEY 4698 04:03:51,200 --> 04:03:52,280 CONTINUE TO HAVE PAIN AND HERE'S 4699 04:03:52,280 --> 04:03:54,040 THE ANSWER. 4700 04:03:54,040 --> 04:03:59,840 IT'S ONLY DAY 140 WHEN FINALLY 4701 04:03:59,840 --> 04:04:03,960 THE MICE WHO DIDN'T GET IT THEY 4702 04:04:03,960 --> 04:04:07,920 ALIGNED COMBINED. 4703 04:04:07,920 --> 04:04:10,160 REMEMBER THE MICE WHO DIDN'T GET 4704 04:04:10,160 --> 04:04:14,320 THIS RESOLVED THEIR PAIN AND AT 4705 04:04:14,320 --> 04:04:22,600 TWO WEEKS, DAY 15. 4706 04:04:22,600 --> 04:04:25,800 IT WAS TRUE FOR THE OTHER MODEL 4707 04:04:25,800 --> 04:04:32,480 WHICH WE TRIED IN THIS PAPER AND 4708 04:04:32,480 --> 04:04:36,080 REPORTED WHICH WAS THE CCI MODEL 4709 04:04:36,080 --> 04:04:46,560 AND NGF MODEL OF INJURED MICE. 4710 04:04:48,640 --> 04:04:51,520 IT WAS SIGNIFICANT AND THE SAME 4711 04:04:51,520 --> 04:04:53,160 FOR THE MODEL AGAIN IT WAS LOW 4712 04:04:53,160 --> 04:04:58,200 BUT SIGNIFICANT. 4713 04:04:58,200 --> 04:05:00,480 BASICALLY, MICE GETTING THIS AT 4714 04:05:00,480 --> 04:05:05,560 THE BEGINNING OF THE INJURY HAVE 4715 04:05:05,560 --> 04:05:09,280 IMMEDIATE ANALGESIA AND OF 4716 04:05:09,280 --> 04:05:12,160 COURSE IF WE THINK ABOUT OUR 4717 04:05:12,160 --> 04:05:15,280 ANIMAL, WHEN DO WE MEASURE PAIN 4718 04:05:15,280 --> 04:05:15,560 BEHAVIOR. 4719 04:05:15,560 --> 04:05:18,120 WE MEASURE IN THE PEAK OF PAIN. 4720 04:05:18,120 --> 04:05:19,600 WE LOOK FOR THE IMMEDIATE 4721 04:05:19,600 --> 04:05:28,560 ANALGESIC AFFECT OF THE DRUGS. 4722 04:05:28,560 --> 04:05:34,760 THIS HAS BEEN DONE AND THEY 4723 04:05:34,760 --> 04:05:37,480 TRIED THE CONCEPT FOR 4724 04:05:37,480 --> 04:05:42,400 POST-OPERATIVE TRAIN IN THE 4725 04:05:42,400 --> 04:05:45,000 MODEL AND THE MODEL WAS STRONGER 4726 04:05:45,000 --> 04:05:53,200 AND YOU CAN HE SEE HERE CLEARLY 4727 04:05:53,200 --> 04:05:55,480 IN THE MODEL THIS DIDN'T EVEN 4728 04:05:55,480 --> 04:06:01,840 SHOW ANALGESIC EFFICACY. 4729 04:06:01,840 --> 04:06:05,080 THE MINE DEVELOPED STRONG 4730 04:06:05,080 --> 04:06:08,040 HYPERALGESIA AND MICE TREATED 4731 04:06:08,040 --> 04:06:11,880 WITH SALINE RESTORED THEIR PAIN 4732 04:06:11,880 --> 04:06:17,400 BEHAVIOR IN LITTLE MORE THAN TWO 4733 04:06:17,400 --> 04:06:17,600 WEEKS. 4734 04:06:17,600 --> 04:06:22,440 IT WAS OVER 180 DAYS FOR MICE 4735 04:06:22,440 --> 04:06:22,960 WHO DID COME BACK TO THE 4736 04:06:22,960 --> 04:06:32,840 BASELINE. 4737 04:06:32,840 --> 04:06:36,680 AND LUCAS WHO SAID, WELL, IT'S 4738 04:06:36,680 --> 04:06:47,240 ALL ABOUT NEUTROPHILS THAN AND 4739 04:06:49,600 --> 04:06:53,200 REDUCE THE NEUTROPHIL TO THE 4740 04:06:53,200 --> 04:06:56,120 INJURY. 4741 04:06:56,120 --> 04:06:58,080 HE USED THIS SPORT INJURY MODEL 4742 04:06:58,080 --> 04:07:00,480 IN THE MICE WHEN HE APPLIED ICE 4743 04:07:00,480 --> 04:07:02,400 TO THE SITE OF INJURY AND 4744 04:07:02,400 --> 04:07:08,600 BASICALLY ICE DOING ALMOST THE 4745 04:07:08,600 --> 04:07:10,040 AND PROVIDED IMMEDIATE ANALGESIA 4746 04:07:10,040 --> 04:07:14,080 AND THE TWO LINES SWITCH AND 4747 04:07:14,080 --> 04:07:15,480 THEN THE MICE HAVE HYPERALGESIA 4748 04:07:15,480 --> 04:07:20,680 FOR A LONG TIME. 4749 04:07:20,680 --> 04:07:29,320 THE NEXT SET OF EXPERIMENTS ASK 4750 04:07:29,320 --> 04:07:31,640 IS IT INFLAMMATION WHICH WE 4751 04:07:31,640 --> 04:07:33,600 SHOULD NOT PLAY WITH OR SHOULD 4752 04:07:33,600 --> 04:07:39,200 NOT OR A CONSEQUENCE OF THE 4753 04:07:39,200 --> 04:07:44,640 ANALGESIC CELL AND LUCAS DID ALL 4754 04:07:44,640 --> 04:07:54,800 THE EXPERIMENTS AND IN THE MODEL 4755 04:07:54,800 --> 04:08:03,400 ONLY THE DICLOFENAC CREATE THE 4756 04:08:03,400 --> 04:08:05,720 STATE OF LONG-TERM 4757 04:08:05,720 --> 04:08:08,560 HYPERANALGESIC AND SIGNIFICANT 4758 04:08:08,560 --> 04:08:15,600 AND ALL DRUG WAS ANALGESIC 4759 04:08:15,600 --> 04:08:26,160 IMMEDIATELY AS THEY SHOULD BE WE 4760 04:08:40,440 --> 04:08:47,760 WE SAW THE RESPONSE DRIVEN BY 4761 04:08:47,760 --> 04:08:52,000 NEUTROPHIL ACTIVATION AND IN 4762 04:08:52,000 --> 04:08:56,240 THIS ANALYSIS WE USED AN 4763 04:08:56,240 --> 04:09:05,080 ADJUVANT MODEL AND USED THE 4764 04:09:05,080 --> 04:09:07,920 ANTIBODY SO IT IMMEDIATELY 4765 04:09:07,920 --> 04:09:14,120 REMOVED NEUTRAL NEUTROPHILS. 4766 04:09:14,120 --> 04:09:16,960 EACH NEXT DAY FOR 20 DAYS WE 4767 04:09:16,960 --> 04:09:19,280 REMOVED NEUTROPHILS. 4768 04:09:19,280 --> 04:09:28,840 AND YES, IT'S NEUTROPHILS THE 4769 04:09:28,840 --> 04:09:33,400 GRAPH SEEMS LIKE THIS AND THE 4770 04:09:33,400 --> 04:09:35,480 BARS ARE THE ANTIBIOTIC AND 4771 04:09:35,480 --> 04:09:36,920 NEUTROPHILS AND THE IMMEDIATE 4772 04:09:36,920 --> 04:09:41,160 ANALGESIA AND THE LINES CROSS 4773 04:09:41,160 --> 04:09:48,400 AND THEN THERE'S A LONG HYPER 4774 04:09:48,400 --> 04:09:57,200 ANALGESIA. 4775 04:09:57,200 --> 04:10:02,360 AND THEY'RE THE FIRST WHO COME 4776 04:10:02,360 --> 04:10:05,520 A 4777 04:10:05,520 --> 04:10:07,960 AND IF YOU ADD NEUTROPHILS IN 4778 04:10:07,960 --> 04:10:13,480 THE MODEL IT WILL ALLEVIATE THE 4779 04:10:13,480 --> 04:10:16,000 LONG-LASTING HYPERALGESIA AND WE 4780 04:10:16,000 --> 04:10:24,280 ADD THIS TO THE PROTEIN S100A8 4781 04:10:24,280 --> 04:10:30,400 AND A9 AND THEY'RE SMALL 4782 04:10:30,400 --> 04:10:34,000 PROTEINS AND IT'S A SIGNALLING 4783 04:10:34,000 --> 04:10:37,760 MOLECULE AND NEUTROPHILS FILL 4784 04:10:37,760 --> 04:10:41,160 THIS AND 40% OF ALL PROTEINS ARE 4785 04:10:41,160 --> 04:10:43,480 THESE PROTEINS. 4786 04:10:43,480 --> 04:10:45,520 AND I DIDN'T KNOW THIS SO THE 4787 04:10:45,520 --> 04:10:49,160 REASON WHY WE STARTED TO SAY, 4788 04:10:49,160 --> 04:10:56,760 MAYBE WE SHOULD LOOK AT THESE 4789 04:10:56,760 --> 04:10:58,520 TWO MOLECULES WE ASKED, WHAT ARE 4790 04:10:58,520 --> 04:11:03,920 THE MOLECULES THE MOST 4791 04:11:03,920 --> 04:11:07,720 DIFFERENCE IN HUMAN AND WAS 4792 04:11:07,720 --> 04:11:08,720 GOING DOWN THE QUICKEST THE 4793 04:11:08,720 --> 04:11:13,680 HIGHEST BETA. 4794 04:11:13,680 --> 04:11:15,880 IT WAS THIS PROTEIN AND WE 4795 04:11:15,880 --> 04:11:17,000 THOUGHT THIS MAKES SENSE BECAUSE 4796 04:11:17,000 --> 04:11:18,720 THIS IS WHAT NEUTROPHILS RELEASE 4797 04:11:18,720 --> 04:11:22,920 WHEN THEY SIGNAL. 4798 04:11:22,920 --> 04:11:25,960 SO THE ANSWER WAS, YES, IF WE 4799 04:11:25,960 --> 04:11:31,760 WILL GIVE NEUTROPHILS OR S100 4800 04:11:31,760 --> 04:11:36,560 PROTEIN TO MICE TREATED AND WE 4801 04:11:36,560 --> 04:11:40,560 HAVE THE HYPER ANALGESIA AND THE 4802 04:11:40,560 --> 04:11:50,200 BLANK LINE IS THE VEHICLE AND 4803 04:11:50,200 --> 04:12:00,640 THEY DIDN'T DEVELOP IT'S 4804 04:12:02,840 --> 04:12:07,000 NEUTROPHILS PROTECTING AGAINST 4805 04:12:07,000 --> 04:12:09,120 THE HYPERANALGESIC AND WE WERE 4806 04:12:09,120 --> 04:12:13,600 LOOKING FOR HUMAN STUDIES. 4807 04:12:13,600 --> 04:12:16,440 SO WE LOOKED AT SOME STUDY 4808 04:12:16,440 --> 04:12:22,760 BECAUSE OF SOURCE HUMAN TREATED 4809 04:12:22,760 --> 04:12:27,640 WITH ANTI-INFLAMMATORY IN THE 4810 04:12:27,640 --> 04:12:34,360 ACUTE STAGE WE CAN SEE FROM 4811 04:12:34,360 --> 04:12:38,560 EXISTING DATA THIS AFFECT OF 4812 04:12:38,560 --> 04:12:40,240 PROMOTING THIS. 4813 04:12:40,240 --> 04:12:44,200 AND WE WENT TO THE U.K. BIO 4814 04:12:44,200 --> 04:12:44,400 BANK. 4815 04:12:44,400 --> 04:12:51,760 IT'S THE BIG OPEN ACCESS COHORT 4816 04:12:51,760 --> 04:12:57,680 OF HALF A MILLION PEOPLE WHERE A 4817 04:12:57,680 --> 04:12:59,920 LOT OF PHENOTYPE INCLUDING PAIN. 4818 04:12:59,920 --> 04:13:03,920 WE USED THE TWO QUESTIONS IN THE 4819 04:13:03,920 --> 04:13:04,920 U.K. BIOBANK. 4820 04:13:04,920 --> 04:13:08,720 THE FIRST QUESTION WE ASSESS 4821 04:13:08,720 --> 04:13:11,040 ACUTE PAIN WAS IN THE LAST MONTH 4822 04:13:11,040 --> 04:13:14,200 HAVE YOU EXPERIENCED ANY OF THE 4823 04:13:14,200 --> 04:13:15,480 FOLLOWING WHICH INTERFERE WITH 4824 04:13:15,480 --> 04:13:19,160 YOUR USUAL ACTIVITY AND PEOPLE 4825 04:13:19,160 --> 04:13:23,920 HAD A CHOICE TO CHOOSE. 4826 04:13:23,920 --> 04:13:26,240 WE LOOKED AT THE PAIN IN THE 4827 04:13:26,240 --> 04:13:28,680 LAST MONTHS AND THEN THE SECOND 4828 04:13:28,680 --> 04:13:30,640 QUESTION WAS IF PEOPLE SAID YES, 4829 04:13:30,640 --> 04:13:34,160 I HAVE PAIN IN THE LAST MONTHS, 4830 04:13:34,160 --> 04:13:35,560 THE NEXT QUESTION IN THE U.K. 4831 04:13:35,560 --> 04:13:37,400 BIO BANK IS HAVE YOU HAD PAINS 4832 04:13:37,400 --> 04:13:43,800 FOR MORE THAN THREE MONTHS? 4833 04:13:43,800 --> 04:13:46,760 THE PEOPLE WHO SAID NO AND IT 4834 04:13:46,760 --> 04:13:52,640 WAS NOT FOR MONTHS. 4835 04:13:52,640 --> 04:13:53,480 OKAY. 4836 04:13:53,480 --> 04:13:58,920 AND U.K. BIOBANK HAS THIS 4837 04:13:58,920 --> 04:14:02,760 PROSPECTIVE COMPONENT AND MANY 4838 04:14:02,760 --> 04:14:05,200 PEOPLE COME BACK FOR THE VISIT 4839 04:14:05,200 --> 04:14:07,240 WITHIN TWO TO SIX YEAR. 4840 04:14:07,240 --> 04:14:11,440 BASICALLY WE LOOK AT THE PEOPLE 4841 04:14:11,440 --> 04:14:12,440 WHO HAVE REPORTED ACUTE PAIN IN 4842 04:14:12,440 --> 04:14:16,440 THE FIRST ENROLLMENT AND 4843 04:14:16,440 --> 04:14:17,480 REPORTED CHRONIC PAIN AT THE 4844 04:14:17,480 --> 04:14:19,920 SECOND ENROLLMENT. 4845 04:14:19,920 --> 04:14:26,240 WHEN WE HAVE ALSO DRUG USAGE 4846 04:14:26,240 --> 04:14:30,760 ASKED IF THE DRUG USE AFFECTS 4847 04:14:30,760 --> 04:14:33,600 THE RISK OF THE CHRONIC PAIN 4848 04:14:33,600 --> 04:14:34,280 DEVELOP 4849 04:14:34,280 --> 04:14:35,400 DEVELOPMENT IN THE SECOND VISIT. 4850 04:14:35,400 --> 04:14:45,120 AND THE QUESTION WAS YES, SO A 4851 04:14:45,120 --> 04:14:47,320 PROFESSOR AT McGILL IS A 4852 04:14:47,320 --> 04:14:49,920 SOCIOLOGIST AND DID THE STUDY 4853 04:14:49,920 --> 04:14:50,760 WITH TWO STUDENTS. 4854 04:14:50,760 --> 04:14:54,160 FIRST WE HAVE BEEN ABLE TO 4855 04:14:54,160 --> 04:14:56,160 ASSESS THREE DRUGS. 4856 04:14:56,160 --> 04:15:00,200 OUR CRITERIA WAS THAT PEOPLE 4857 04:15:00,200 --> 04:15:01,920 SHOULD REPORT CHRONIC PAIN, 4858 04:15:01,920 --> 04:15:05,040 ACUTE PAIN AND WE SHOULD HAVE AT 4859 04:15:05,040 --> 04:15:09,520 LEAST 10 SUBJECT WHO ALSO REPORT 4860 04:15:09,520 --> 04:15:10,880 PARTICULAR DRUG CATEGORY. 4861 04:15:10,880 --> 04:15:16,400 SO WE END UP HAVING THREE DRUG 4862 04:15:16,400 --> 04:15:27,080 CATEGORY AND ANTI-DEPRESSANT AND 4863 04:15:27,080 --> 04:15:31,200 N SAD INCREASED THE RISK OF 4864 04:15:31,200 --> 04:15:34,080 CHRONIC PAIN LATER ON 1.7 FOLD 4865 04:15:34,080 --> 04:15:37,280 BUT NOT ANTI-DEPRESSANT. 4866 04:15:37,280 --> 04:15:39,480 IN THE MODEL WHEN WE USE ALL THE 4867 04:15:39,480 --> 04:15:43,040 DRUG AS A COVARIANT IT WAS THE 4868 04:15:43,040 --> 04:15:50,920 SAME 1.7 FOLD AND ONLY NSAIDS TO 4869 04:15:50,920 --> 04:15:52,840 INCREASE THE RISK OF REPORTING 4870 04:15:52,840 --> 04:15:56,400 CHRONIC PAIN. 4871 04:15:56,400 --> 04:16:06,960 SO WE ALSO USE PANELFUL SITE AND 4872 04:16:13,440 --> 04:16:15,880 IT DIDN'T CHANGE OUR RESULT WAS 4873 04:16:15,880 --> 04:16:23,360 THE SAME 1.7 FOLD. 4874 04:16:23,360 --> 04:16:25,920 WE LOOKED AT THE NEUTROPHIL 4875 04:16:25,920 --> 04:16:29,040 COUNT AND IT'S CLOSE TO THE 0 4876 04:16:29,040 --> 04:16:30,080 BUT SIGNIFICANT BECAUSE 4877 04:16:30,080 --> 04:16:35,400 NEUTROPHIL WAS PROTECTIVE. 4878 04:16:35,400 --> 04:16:37,320 IT'S ON THE LEFT. 4879 04:16:37,320 --> 04:16:39,200 SO PEOPLE WITH HIGH NEUTROPHIL 4880 04:16:39,200 --> 04:16:42,120 LEVEL HAD LESS CHANCE TO REPORT 4881 04:16:42,120 --> 04:16:49,880 CHRONIC PAIN IN THE SECOND. 4882 04:16:49,880 --> 04:16:52,320 TOGETHER I HAVE THE NEXT TWO OR 4883 04:16:52,320 --> 04:16:54,120 THREE SLIDES AND I'D LIKE TO GO 4884 04:16:54,120 --> 04:16:54,920 THROUGH THE CONCLUSION OF OUR 4885 04:16:54,920 --> 04:16:59,000 RESULTS. 4886 04:16:59,000 --> 04:17:01,560 FIRST I'D LIKE TO GO THROUGH THE 4887 04:17:01,560 --> 04:17:02,760 CONCEPTUAL BREAKTHROUGHS AT 4888 04:17:02,760 --> 04:17:05,240 LEAST FOR ME. 4889 04:17:05,240 --> 04:17:07,360 IT TOOK ME TIME TO CONCEPTUALIZE 4890 04:17:07,360 --> 04:17:08,800 IT BECAUSE IT REALIZED IT WAS 4891 04:17:08,800 --> 04:17:14,240 AGAINST MY BELIEF AND I THINK 4892 04:17:14,240 --> 04:17:20,080 AGAINST BELIEF AND EXPECTATION 4893 04:17:20,080 --> 04:17:24,440 IN AND WE GENERALLY THINK ABOUT 4894 04:17:24,440 --> 04:17:30,240 THE CHRONIC PAIN AS AN ACTIVE 4895 04:17:30,240 --> 04:17:38,760 PATHOLOGICAL PROCESS AND AND CAN 4896 04:17:38,760 --> 04:17:44,400 BE CONCEPTUALIZED AS THE 4897 04:17:44,400 --> 04:17:46,000 ADOPTIVE PROCESS ARE THE PEOPLE 4898 04:17:46,000 --> 04:17:51,720 DOING WELL DOING WORK OR THE 4899 04:17:51,720 --> 04:17:52,800 IMMUNE SYSTEM DOING A LOT OF 4900 04:17:52,800 --> 04:17:59,080 WORK AND THE PEOPLE WHO DON'T 4901 04:17:59,080 --> 04:18:00,440 RESOLVE PAIN HAVE ABSENCE OF 4902 04:18:00,440 --> 04:18:00,760 THIS PROCESS. 4903 04:18:00,760 --> 04:18:06,400 THE SECOND IS WE GENERALLY TRY 4904 04:18:06,400 --> 04:18:14,120 TO FIND THE PAIN GENE BUT THERE 4905 04:18:14,120 --> 04:18:16,480 ARE PAIN PROCESS AND PROCESSES 4906 04:18:16,480 --> 04:18:18,400 GOING ON LEADING TO PAIN 4907 04:18:18,400 --> 04:18:18,760 RESOLUTION. 4908 04:18:18,760 --> 04:18:21,000 WE GENERALLY MEASURE PAIN 4909 04:18:21,000 --> 04:18:23,280 INTENSITY WHEN THE MOST 4910 04:18:23,280 --> 04:18:30,080 IMPORTANT IS PAIN DURATION. 4911 04:18:30,080 --> 04:18:32,520 WE GENERALLY THINK OF PAIN 4912 04:18:32,520 --> 04:18:35,320 RESOLUTION AS A DEVELOPING 4913 04:18:35,320 --> 04:18:41,000 PROCESS WHEN IT CAN BE 4914 04:18:41,000 --> 04:18:43,560 CONCEPTUALIZED LIKE A DEVELOPED 4915 04:18:43,560 --> 04:18:43,800 PROCESS. 4916 04:18:43,800 --> 04:18:46,240 WHAT I MEAN IS WE USUALLY THINK 4917 04:18:46,240 --> 04:18:50,640 OR AT LEAST ME, THERE'S THE WAY 4918 04:18:50,640 --> 04:18:54,160 THINGS HAPPEN AND MORE OF THE 4919 04:18:54,160 --> 04:19:00,040 BAD THINGS LEAD TO INCREASE TO 4920 04:19:00,040 --> 04:19:06,160 PAIN BUT THE INFLAMMATORY 4921 04:19:06,160 --> 04:19:15,400 RESPONSE NEUTROPHILS ARE CALLED 4922 04:19:15,400 --> 04:19:17,520 MACROPHAGES AND THEN THEY LEAVE 4923 04:19:17,520 --> 04:19:18,720 AND THEY CALL T CELLS AND THEN 4924 04:19:18,720 --> 04:19:23,400 THEY COME. 4925 04:19:23,400 --> 04:19:25,600 IT'S A SPIRAL OF BIOLOGICAL 4926 04:19:25,600 --> 04:19:26,400 PROCESSES THAT GOES RIGHT FOR 4927 04:19:26,400 --> 04:19:30,080 PAIN RESOLUTION. 4928 04:19:30,080 --> 04:19:32,720 AND THEN THE CONCLUSION WILL BE 4929 04:19:32,720 --> 04:19:35,200 THEN THERE'S ACTIVE ADOPTIVE 4930 04:19:35,200 --> 04:19:37,880 COMPONENT OF IMMUNE SYSTEM IN 4931 04:19:37,880 --> 04:19:39,000 ACUTE TO CHRONIC PAIN TRANSITION 4932 04:19:39,000 --> 04:19:45,040 IN LOW-BACK PATIENTS IN LIKELY 4933 04:19:45,040 --> 04:19:51,040 IN OTHER PAIN CONDITION AND LOOK 4934 04:19:51,040 --> 04:19:52,360 AT THE MUSCLE PAIN AFTER THIS 4935 04:19:52,360 --> 04:19:54,360 AND WE SEE THE SAME THINGS. 4936 04:19:54,360 --> 04:19:57,720 PEOPLE WHO DEVELOP PAIN ARE 4937 04:19:57,720 --> 04:19:58,480 THOSE WHO DON'T UPREGULATE 4938 04:19:58,480 --> 04:20:00,320 INFLAMMATORY RESPONSE. 4939 04:20:00,320 --> 04:20:06,120 SO THE SECOND CONCLUSION THAT 4940 04:20:06,120 --> 04:20:09,320 INHIBITS THIS ADAPTIVE ADOPTIVE 4941 04:20:09,320 --> 04:20:15,160 RESPONSE WITH INJURY MAY LEAD TO 4942 04:20:15,160 --> 04:20:25,640 PAIN AND CRONIFICATION AND 4943 04:20:27,640 --> 04:20:30,360 DEVELOPING CHRONIC PAIN AND WE 4944 04:20:30,360 --> 04:20:31,240 SHOULD TARGET RESOLUTION RATHER 4945 04:20:31,240 --> 04:20:36,200 THAN EFFICACY. 4946 04:20:36,200 --> 04:20:44,520 THE SECOND IS AND WE MAY NEED TO 4947 04:20:44,520 --> 04:20:46,000 TARGET ACTIVATION OF IMMUNE 4948 04:20:46,000 --> 04:20:48,600 RESPONSE INSTEAD OF INHIBITION. 4949 04:20:48,600 --> 04:20:54,360 I ALWAYS THINK WHAT SHOULD I 4950 04:20:54,360 --> 04:20:54,600 INHIBIT. 4951 04:20:54,600 --> 04:20:56,960 AND LET ME APPLY ALL MY GENETIC 4952 04:20:56,960 --> 04:20:58,920 SKILLS TO FIND WHAT I CAN 4953 04:20:58,920 --> 04:21:00,840 INHIBIT BUT IT LOOKS LIKE WE 4954 04:21:00,840 --> 04:21:02,560 NEED TO ACTIVATE. 4955 04:21:02,560 --> 04:21:05,720 THIS IS WHERE OUR DRUG 4956 04:21:05,720 --> 04:21:06,440 DEVELOPMENT SHOULD GO. 4957 04:21:06,440 --> 04:21:09,840 IN FACT I START TO THINK WHAT WE 4958 04:21:09,840 --> 04:21:12,760 KNOW WORKS AGAINST CHRONIC PAIN 4959 04:21:12,760 --> 04:21:18,760 IS PHYSICAL EXERCISE, PHYSICAL 4960 04:21:18,760 --> 04:21:28,200 ACUPUNCTURE, PHYSICAL THERAPY, 4961 04:21:28,200 --> 04:21:30,760 THEY'RE ALL THINGS WHICH 4962 04:21:30,760 --> 04:21:33,160 ACTIVATE IMMUNE RESPONSE IN THE 4963 04:21:33,160 --> 04:21:36,040 CONTROL ADOPTIVE MANNER. 4964 04:21:36,040 --> 04:21:40,520 AND THE LAST POINT WHICH HAS 4965 04:21:40,520 --> 04:21:43,640 BEEN CAPTURED BY MANY NEWS 4966 04:21:43,640 --> 04:21:47,040 AGENCY IS DESPITE HIGH ANALGESIC 4967 04:21:47,040 --> 04:21:50,080 EFFICACY AT THE EARLY DOWN POINT 4968 04:21:50,080 --> 04:21:51,680 THE ACUTE AND INFLAMMATORY 4969 04:21:51,680 --> 04:21:53,400 RESPONSE IN MANAGEMENT MAY BE 4970 04:21:53,400 --> 04:21:54,280 COUNTER PRODUCTIVE FOR LONG-TERM 4971 04:21:54,280 --> 04:22:01,840 OUTCOME. 4972 04:22:01,840 --> 04:22:04,600 SO WITH THIS I WOULD LIKE TO 4973 04:22:04,600 --> 04:22:10,760 THANK MY GROUP. 4974 04:22:10,760 --> 04:22:15,760 WE AND WE CAN STUDY PAIN AT MANY 4975 04:22:15,760 --> 04:22:20,480 LEVELS AND THANKS TO ALL 4976 04:22:20,480 --> 04:22:24,080 AGENCIES SUPPORTING OUR RESEARCH 4977 04:22:24,080 --> 04:22:26,400 THANK YOU FOR COMING AND I'M 4978 04:22:26,400 --> 04:22:27,200 HAPPY TO HEAR YOUR OPINION AND 4979 04:22:27,200 --> 04:22:37,440 YOUR QUESTION. 4980 04:22:37,720 --> 04:22:40,000 >> THIS IS SO INSPIRING AND I 4981 04:22:40,000 --> 04:22:41,160 LOOK FORWARD TO HEARING 4982 04:22:41,160 --> 04:22:44,800 REACTIONS, COMMENTS, QUESTIONS 4983 04:22:44,800 --> 04:22:52,120 FROM THE GROUP. 4984 04:22:52,120 --> 04:22:54,120 >> I'M CHRISTINE GOERTZ. 4985 04:22:54,120 --> 04:22:57,600 WE'RE GOING TO BE MODERATING 4986 04:22:57,600 --> 04:22:58,560 THIS SESSION. 4987 04:22:58,560 --> 04:23:00,920 I AM GOING TO BE MODERATING THE 4988 04:23:00,920 --> 04:23:02,760 CHAT AND SUE IS GOING TO LOOK 4989 04:23:02,760 --> 04:23:04,120 FOR RAISED HANDS BECAUSE I'M 4990 04:23:04,120 --> 04:23:09,360 SURE EVERYONE IS JUST AS EXCITED 4991 04:23:09,360 --> 04:23:11,360 AS I AM TO HEAR THIS 4992 04:23:11,360 --> 04:23:12,760 GROUNDBREAKING WORK AND BE ABLE 4993 04:23:12,760 --> 04:23:14,080 TO ASK QUESTIONS. 4994 04:23:14,080 --> 04:23:16,720 I KNOW I'M ALREADY THINKING OF 4995 04:23:16,720 --> 04:23:20,560 HOW TO INCORPORATE THIS WORK 4996 04:23:20,560 --> 04:23:21,680 INTO FURTHER INVESTIGATION IN 4997 04:23:21,680 --> 04:23:23,640 THESE AREAS IN THE WORK I'M 4998 04:23:23,640 --> 04:23:24,960 ALREADY DOING. 4999 04:23:24,960 --> 04:23:28,200 I'M HOPING THAT NIH IS HAVING 5000 04:23:28,200 --> 04:23:32,280 THOSE SAME THOUGHTS AS WE ME OF 5001 04:23:32,280 --> 04:23:33,080 FORWARD. 5002 04:23:33,080 --> 04:23:34,880 OPENING IT UP FOR QUESTIONS OR 5003 04:23:34,880 --> 04:23:45,280 COMMENTS AT THIS POINT. 5004 04:23:50,640 --> 04:23:52,400 >> I HAVE A QUESTION FOR MARY. 5005 04:23:52,400 --> 04:23:53,560 I LIKE YOUR TALK. 5006 04:23:53,560 --> 04:23:56,080 I HAVE A QUESTION ABOUT THE 5007 04:23:56,080 --> 04:24:00,240 MODEL YOU'RE USING. 5008 04:24:00,240 --> 04:24:03,600 IT SEEMS TO ME IT'S OPEN ENDED 5009 04:24:03,600 --> 04:24:03,880 BEHAVIORS. 5010 04:24:03,880 --> 04:24:09,920 THE ANIMAL IS STRAINED WITH A 5011 04:24:09,920 --> 04:24:13,520 CUE AND GETTING A REWARD. 5012 04:24:13,520 --> 04:24:15,920 SOMETIMES THOSE MODEL USED TOY 5013 04:24:15,920 --> 04:24:18,400 BEHAVIOR AND WE DO THAT IN THE 5014 04:24:18,400 --> 04:24:18,560 LAB. 5015 04:24:18,560 --> 04:24:20,240 WHICH PROTOCOL ARE YOU USING? 5016 04:24:20,240 --> 04:24:22,400 EVERY TIME THEY PULL THEY GET 5017 04:24:22,400 --> 04:24:29,200 THE REWARD OR YOU DO THIS MODEL 5018 04:24:29,200 --> 04:24:31,080 WHERE YOU LOOK AT THE ANIMAL AND 5019 04:24:31,080 --> 04:24:32,200 WHETHER THAT'S THE CASE IN 5020 04:24:32,200 --> 04:24:33,520 ADDITION TO LOOKING AT 5021 04:24:33,520 --> 04:24:37,120 NOCICEPTION YOU MAY LOOK AT THE 5022 04:24:37,120 --> 04:24:37,760 MOTIVATIONAL STATE OF THE ANIMAL 5023 04:24:37,760 --> 04:24:43,320 AS WELL. 5024 04:24:43,320 --> 04:24:44,880 >> LOOKING AT BOTH. 5025 04:24:44,880 --> 04:24:47,960 IT'S A MODEL DEVELOPED IN MY 5026 04:24:47,960 --> 04:24:49,840 LAB. 5027 04:24:49,840 --> 04:24:52,920 I'VE USED IT 22 YEARS, 24. 5028 04:24:52,920 --> 04:24:59,360 I'M ABLE TO VARY THE TASK TO LOW 5029 04:24:59,360 --> 04:25:00,680 REPETITION, LOW FORCE, HIGH 5030 04:25:00,680 --> 04:25:01,760 REPETITION, HIGH FORCE. 5031 04:25:01,760 --> 04:25:03,080 IT'S A UNION JOB. 5032 04:25:03,080 --> 04:25:04,760 THEY DON'T WORK ALL THE TIME. 5033 04:25:04,760 --> 04:25:07,440 THEY WORK IN HALF AN HOUR 5034 04:25:07,440 --> 04:25:09,400 INCREMENTS WITH AN HOUR AND A 5035 04:25:09,400 --> 04:25:10,960 HALF BREAK BETWEEN SESSIONS, 5036 04:25:10,960 --> 04:25:13,080 THREE DAYS A WEEK. 5037 04:25:13,080 --> 04:25:14,560 IT'S TWO HOURS A DAY ON THOSE 5038 04:25:14,560 --> 04:25:15,440 THREE DAYS A WEEK. 5039 04:25:15,440 --> 04:25:24,560 YES, THEY CAN REFUSE TO WORK. 5040 04:25:24,560 --> 04:25:27,960 EYE THEY HAVE THE RIGHT TO 5041 04:25:27,960 --> 04:25:28,200 REFUSE. 5042 04:25:28,200 --> 04:25:30,760 WHAT I CAN SEE WITH THIS IS IT 5043 04:25:30,760 --> 04:25:32,800 IS MOTIVATION AND NOCICEPTION. 5044 04:25:32,800 --> 04:25:39,200 IF THE ANIMALS ARE DOING LIKE 5045 04:25:39,200 --> 04:25:42,280 LOW REPETITION OR HIGH-FORCE 5046 04:25:42,280 --> 04:25:45,760 TASK, JUST AS LUDA WAS 5047 04:25:45,760 --> 04:25:49,360 EXPLAINING THEY HAVE A SMALL 5048 04:25:49,360 --> 04:25:51,520 PEAK OF INFLAMMATION. 5049 04:25:51,520 --> 04:25:54,840 SOME OF MY STUDIES -- IF YOU 5050 04:25:54,840 --> 04:26:04,720 CONCLUDE THE TRAINING 36 WEEKS. 5051 04:26:04,720 --> 04:26:06,800 SOMETIMES THEY REST FOR 18, 24 5052 04:26:06,800 --> 04:26:07,160 WEEKS. 5053 04:26:07,160 --> 04:26:08,440 I'M FOLLOWING THEM 5054 04:26:08,440 --> 04:26:09,040 LONGITUDINALLY. 5055 04:26:09,040 --> 04:26:12,640 THE ANIMAL ON THE LESS INTENSE 5056 04:26:12,640 --> 04:26:15,640 TASK GET BIGGER, STRONGER. 5057 04:26:15,640 --> 04:26:17,880 BONES GET STRONGER, MUSCLE GETS 5058 04:26:17,880 --> 04:26:18,200 STRONGER. 5059 04:26:18,200 --> 04:26:19,080 EVERYTHING GETS BIGGER. 5060 04:26:19,080 --> 04:26:21,920 IT'S THE ANIMALS WITH THE MOST 5061 04:26:21,920 --> 04:26:26,320 INTENSE TASK THAT WITH THIS HAVE 5062 04:26:26,320 --> 04:26:28,480 BEEN ABLE TO ACTUALLY PROVE THE 5063 04:26:28,480 --> 04:26:31,520 FATIGUE FAILURE THEORY, MEANING 5064 04:26:31,520 --> 04:26:31,960 FATIGUE TISSUES. 5065 04:26:31,960 --> 04:26:35,520 THE TISSUES ARE ACTUALLY 5066 04:26:35,520 --> 04:26:36,440 BREAKING. 5067 04:26:36,440 --> 04:26:38,560 THERE'S A CALCIUM CHANNEL LEAK 5068 04:26:38,560 --> 04:26:41,680 WITH A PLASMA MEMBRANE BREAK. 5069 04:26:41,680 --> 04:26:43,720 IN ADDITION, THAT'S PERIPHERAL 5070 04:26:43,720 --> 04:26:46,440 IN ADDITION TO THE NOCICEPTIVE 5071 04:26:46,440 --> 04:26:50,560 CHANGES AND THE REASON FOR 5072 04:26:50,560 --> 04:26:53,080 ADDING THE SOCIAL BEHAVIOR ALSO 5073 04:26:53,080 --> 04:26:53,920 HAVE TEMPERATURE-PLACED 5074 04:26:53,920 --> 04:26:56,120 PREFERENCE AS THE ANIMAL'S 5075 04:26:56,120 --> 04:26:59,320 CHOICE, LOCAL MOTION IS THE 5076 04:26:59,320 --> 04:26:59,800 ANIMAL'S CHOICE. 5077 04:26:59,800 --> 04:27:01,560 I'M ALSO LOOKING AT THEIR 5078 04:27:01,560 --> 04:27:02,160 MOTIVATION TO DO THE TASK AS 5079 04:27:02,160 --> 04:27:04,520 WELL. 5080 04:27:04,520 --> 04:27:04,960 YEAH. 5081 04:27:04,960 --> 04:27:10,080 IT IS A COMBINATION WHICH IS WHY 5082 04:27:10,080 --> 04:27:20,000 I USE 12, 15 ASSAYS PER STUDY TO 5083 04:27:20,000 --> 04:27:25,080 LINNIATE IF THAT HELPS YOU. 5084 04:27:25,080 --> 04:27:26,400 I'M GLAD YOU SEE THAT. 5085 04:27:26,400 --> 04:27:29,720 >> ANY OTHER QUESTIONS? 5086 04:27:29,720 --> 04:27:30,920 >> I'M NOT SEEING ANYTHING IN 5087 04:27:30,920 --> 04:27:32,360 THE CHAT SO I'M GOING TO TAKE 5088 04:27:32,360 --> 04:27:36,040 THE OPPORTUNITY TO ASK A 5089 04:27:36,040 --> 04:27:36,960 QUESTION, IF I MAY. 5090 04:27:36,960 --> 04:27:41,360 TO MARY AND LUDA, IF YOU'RE AN 5091 04:27:41,360 --> 04:27:42,840 NIH PROGRAM OFFICER RESPONSIBLE 5092 04:27:42,840 --> 04:27:45,000 FOR WRITING THE RFA FOR THE NEXT 5093 04:27:45,000 --> 04:27:47,200 PHASE OF THIS RESEARCH, WHAT 5094 04:27:47,200 --> 04:27:50,760 WOULD YOU RECOMMEND THAT 5095 04:27:50,760 --> 04:27:55,080 INCLUDE? 5096 04:27:55,080 --> 04:27:56,840 >> FOR ME I SEE DIFFERENCES IN 5097 04:27:56,840 --> 04:28:00,160 MY MODEL AND MORE ACUTE MODELS. 5098 04:28:00,160 --> 04:28:05,800 I THINK LUDA IS TO THE POINT THE 5099 04:28:05,800 --> 04:28:07,760 LONGITUDINAL STUDIES NEED TO 5100 04:28:07,760 --> 04:28:12,560 LOOKED AT AND HOW CAN YOU SEE 5101 04:28:12,560 --> 04:28:14,160 THIS RESULT? 5102 04:28:14,160 --> 04:28:16,440 BECAUSE I'M LOOKING LONG-TERM OR 5103 04:28:16,440 --> 04:28:18,040 A CHRONIC CHANGE OVER TIME WHERE 5104 04:28:18,040 --> 04:28:19,880 THE ANIMALS GET BETTER OR WORSE 5105 04:28:19,880 --> 04:28:22,640 WITH THIS TASK, THAT TASK. 5106 04:28:22,640 --> 04:28:27,360 I'M TRYING TO MODEL A WORKER 5107 04:28:27,360 --> 04:28:31,280 SITUATION NOT A SINGLE POINT OF 5108 04:28:31,280 --> 04:28:33,160 INJURY AND THEN YOU LOOK LIKE 5109 04:28:33,160 --> 04:28:35,520 HOW THE ANIMALS ARE REACTING IN 5110 04:28:35,520 --> 04:28:37,760 THE NEXT TWO HOURS TO THREE 5111 04:28:37,760 --> 04:28:38,520 DAYS. 5112 04:28:38,520 --> 04:28:41,520 I'M LOOKING AT 18 TO 36 WEEKS. 5113 04:28:41,520 --> 04:28:42,880 IT'S SUPPOSED TO LOOK LIKE 5114 04:28:42,880 --> 04:28:44,360 WHAT'S ACROSS THE LIFE SPAN. 5115 04:28:44,360 --> 04:28:48,360 I WOULD ENCOURAGE PEOPLE TO DO 5116 04:28:48,360 --> 04:28:50,040 THAT BECAUSE AT MY AGE NOW I SEE 5117 04:28:50,040 --> 04:28:52,080 THE INJURIES THAT HAVE 5118 04:28:52,080 --> 04:28:54,760 ACCUMULATED OVER THE LIFE SPAN 5119 04:28:54,760 --> 04:28:56,280 AND WOULD LIKE TO HAVE MORE 5120 04:28:56,280 --> 04:29:01,920 TREATMENT FOR THAT OPPOSED TO 5121 04:29:01,920 --> 04:29:04,360 SOMETHING THAT I DID AT AGE 22 5122 04:29:04,360 --> 04:29:06,520 WHICH I RECOVERED FROM OR NOT 5123 04:29:06,520 --> 04:29:07,720 DEPENDING ON WHAT IT WAS. 5124 04:29:07,720 --> 04:29:14,720 >> THANK YOU, LUDA, THOUGHTS? 5125 04:29:14,720 --> 04:29:18,360 >> IT WAS FASCINATING MARY, TO 5126 04:29:18,360 --> 04:29:23,440 SEE THE PRESENTATION AND TAKE 5127 04:29:23,440 --> 04:29:28,840 THE TIME TO MODEL MORE REALISTIC 5128 04:29:28,840 --> 04:29:29,600 ENVIRONMENT AND SEE WHAT'S 5129 04:29:29,600 --> 04:29:31,240 HAPPENED OVER TIME. 5130 04:29:31,240 --> 04:29:37,040 I THINK I HAVE A FEW -- I'LL GET 5131 04:29:37,040 --> 04:29:44,720 THREE ANSWER TO YOUR QUESTION. 5132 04:29:44,720 --> 04:29:48,160 IN THE HIGHER LEVEL THIS IS WHAT 5133 04:29:48,160 --> 04:29:50,880 I LEARNED. 5134 04:29:50,880 --> 04:29:54,760 WE NEED TO PAY MORE ATTENTION TO 5135 04:29:54,760 --> 04:29:56,880 THE PROCESS THAT HAPPENED AND 5136 04:29:56,880 --> 04:29:59,800 IT'S IMPORTANT WHEN YOU STUDY 5137 04:29:59,800 --> 04:30:01,800 HUMAN AND NOT SO WELL CONTROLLED 5138 04:30:01,800 --> 04:30:04,560 COHORT. 5139 04:30:04,560 --> 04:30:06,040 WHEN YOU CONTROL PEOPLE WHEN YOU 5140 04:30:06,040 --> 04:30:10,560 COLLECT COHORTS FROM THE HUMAN 5141 04:30:10,560 --> 04:30:11,960 SUBJECT, PEOPLE AT DIFFERENT 5142 04:30:11,960 --> 04:30:12,520 TIME OF THEIR INFLAMMATORY 5143 04:30:12,520 --> 04:30:21,640 RESPONSE. 5144 04:30:21,640 --> 04:30:22,800 IF YOU DON'T DO THE TIME LINE 5145 04:30:22,800 --> 04:30:25,120 YOU PROBABLY WILL NOT SEE MUCH 5146 04:30:25,120 --> 04:30:26,160 OR UNDERSTAND AND HIGH 5147 04:30:26,160 --> 04:30:29,200 INFLAMMATORY RESPONSE CAN MEAN 5148 04:30:29,200 --> 04:30:30,040 DIFFERENT THINGS AT DIFFERENT 5149 04:30:30,040 --> 04:30:36,440 TIME OF THE PAIN RESOLUTION. 5150 04:30:36,440 --> 04:30:38,080 THIS IS ONE. 5151 04:30:38,080 --> 04:30:41,120 THIS IS WHAT WE WOULD LIKE TO 5152 04:30:41,120 --> 04:30:44,840 KNOW AND I DON'T THINK WE 5153 04:30:44,840 --> 04:30:48,520 USUALLY FOLLOW WHAT HAPPENED 5154 04:30:48,520 --> 04:30:56,960 OVER TIME IN THE ANIMAL MODEL OF 5155 04:30:56,960 --> 04:31:01,280 HUMAN NOT JUST IN THE PEAK OF 5156 04:31:01,280 --> 04:31:02,760 PAIN BEHAVIOR BUT WHAT'S 5157 04:31:02,760 --> 04:31:10,720 HAPPENED OVER TIME. 5158 04:31:10,720 --> 04:31:14,760 WITH BIOLOGICAL EXPRESSION AND 5159 04:31:14,760 --> 04:31:17,080 RESPONSE AND SO FORTH. 5160 04:31:17,080 --> 04:31:22,720 I WOULD LIKE TO DO AND I'M 5161 04:31:22,720 --> 04:31:25,640 TRYING TO FIND A COLLEAGUE 5162 04:31:25,640 --> 04:31:29,640 WILLING TO DO CLEAR CLINICAL 5163 04:31:29,640 --> 04:31:32,280 TRIAL ON USING ANTI-INFLAMMATORY 5164 04:31:32,280 --> 04:31:33,560 DRUG IN INJURY MODEL. 5165 04:31:33,560 --> 04:31:38,160 THE EASIEST ONE IS 5166 04:31:38,160 --> 04:31:40,560 POST-OPERATIVE PAIN. 5167 04:31:40,560 --> 04:31:42,680 WE KNOW WHEN IT'S HAPPENED AND 5168 04:31:42,680 --> 04:31:49,160 IT'S MOSTLY CONTROLLED INJURY 5169 04:31:49,160 --> 04:31:51,280 AND USING INFLAMMATORY DRUGS IS 5170 04:31:51,280 --> 04:31:59,560 COMMON IF NOT MANDATORY. 5171 04:31:59,560 --> 04:32:01,920 CAN WE DO CLINICAL TRIAL TO LOOK 5172 04:32:01,920 --> 04:32:04,080 AT INCREASES RISK OF PAIN AFTER 5173 04:32:04,080 --> 04:32:10,560 SURGERY. 5174 04:32:10,560 --> 04:32:11,880 IT CAN BE OTHER MODEL BUT I'D 5175 04:32:11,880 --> 04:32:20,960 LIKE TO DO CLINICAL TRIALS. 5176 04:32:20,960 --> 04:32:21,720 >> ANOTHER INTERESTING 5177 04:32:21,720 --> 04:32:24,920 POPULATION TO LOOK AT MAY BE 5178 04:32:24,920 --> 04:32:26,040 ATHLETES. 5179 04:32:26,040 --> 04:32:30,960 A LOT OF ATHLETES, ESPECIALLY 5180 04:32:30,960 --> 04:32:33,880 COMPETITIVE ATHLETES USING 5181 04:32:33,880 --> 04:32:37,880 ANTI-INFLAMMATORY DRUGS 5182 04:32:37,880 --> 04:32:38,360 PROPHYLACTICALLY WITH 5183 04:32:38,360 --> 04:32:40,600 PERFORMANCE OR A RACE AND THAT 5184 04:32:40,600 --> 04:32:43,240 MAY BE ONE WAY TO LOOK AT THAT 5185 04:32:43,240 --> 04:32:46,600 AND OF COURSE THEY HAVE LOTS OF 5186 04:32:46,600 --> 04:32:48,320 INJURIES AND HAVE LOTS OF PAIN. 5187 04:32:48,320 --> 04:32:50,600 >> THEY DON'T QUIT. 5188 04:32:50,600 --> 04:32:51,760 >> AND THEY DON'T QUIT. 5189 04:32:51,760 --> 04:33:02,160 THEY'RE VERY MOTIVATED. 5190 04:33:06,240 --> 04:33:08,280 >> SOME ATHLETES ADAPT. 5191 04:33:08,280 --> 04:33:14,520 >> THEY TAKE THEM LIKE CANDY. 5192 04:33:14,520 --> 04:33:16,960 IT'S UNBELIEVABLE HOW PREVALENT 5193 04:33:16,960 --> 04:33:17,320 IT IS. 5194 04:33:17,320 --> 04:33:18,440 IT'S PART OF THE CULTURE OF 5195 04:33:18,440 --> 04:33:28,600 SPORTS. 5196 04:33:30,880 --> 04:33:32,680 I'M MONITORING THE CHAT AND 5197 04:33:32,680 --> 04:33:43,240 LOOKS LIKE JOSÉ HAS SOMETHING. 5198 04:33:45,080 --> 04:33:47,560 >> ONE OF THE THINGS PEOPLE DO 5199 04:33:47,560 --> 04:33:54,480 IN PROTOCOLS THEY CHANGE THE 5200 04:33:54,480 --> 04:33:57,160 NUMBER OF PROCESS THE ANIMAL HAS 5201 04:33:57,160 --> 04:34:00,080 TO DO TO GET THE REWARD AND %HIS 5202 04:34:00,080 --> 04:34:02,320 CAN BE INCREASED IN A RANDOM WAY 5203 04:34:02,320 --> 04:34:12,800 SO THE ANIMAL DOESN'T KNOW. 5204 04:34:16,720 --> 04:34:17,560 THAT WOULD BE THE WAY TO 5205 04:34:17,560 --> 04:34:19,440 SEPARATE THE ASPECT MUCH THIS 5206 04:34:19,440 --> 04:34:19,720 BEHAVIOR. 5207 04:34:19,720 --> 04:34:24,240 >> I HAVE. 5208 04:34:24,240 --> 04:34:27,000 I'VE DONE MAYBE NOT AS CLEARLY 5209 04:34:27,000 --> 04:34:32,840 AS ONE COULD BUT IT'S A CUSTOM 5210 04:34:32,840 --> 04:34:35,840 MADE PROGRAM SO LIKE AT 9:00 5211 04:34:35,840 --> 04:34:38,000 A.M. MONDAY THEY HAVE TO DO 5212 04:34:38,000 --> 04:34:42,320 COMPLETE PROTOCOL AND REACH PAST 5213 04:34:42,320 --> 04:34:45,720 CERTAIN ONE AND AT 11:30 I DO 5214 04:34:45,720 --> 04:34:48,280 PARTIAL WHICH CHANGES THE 5215 04:34:48,280 --> 04:34:50,760 THRESHOLD OF THE UPPER OR LOWER 5216 04:34:50,760 --> 04:34:53,600 THRESHOLD AND THEN SWITCH IT 5217 04:34:53,600 --> 04:34:58,760 BACK AND FORTH AND RANDOMIZE IT 5218 04:34:58,760 --> 04:35:04,640 AND ACROSS THE WEEKS. 5219 04:35:04,640 --> 04:35:06,640 I'M NOT SURE A SEE A HUGE 5220 04:35:06,640 --> 04:35:07,640 DIFFERENCE. 5221 04:35:07,640 --> 04:35:09,080 THE ANIMALS BECOME VERY 5222 04:35:09,080 --> 04:35:10,720 FRUSTRATED IF IT'S VERY 5223 04:35:10,720 --> 04:35:14,720 RESTRICTED AND THEY PREFER THE 5224 04:35:14,720 --> 04:35:17,440 MORE WIDESPREAD PARTIAL PULLS 5225 04:35:17,440 --> 04:35:18,600 WHERE THEY CAN PULL MAYBE A 5226 04:35:18,600 --> 04:35:20,320 LITTLE BIT LOWER HERE OR HIGHER 5227 04:35:20,320 --> 04:35:23,520 THERE OR FIGURE OUT THEY CAN 5228 04:35:23,520 --> 04:35:25,000 REST A SECOND AND THEN RUN UP 5229 04:35:25,000 --> 04:35:26,880 AND PULL THREE TIMES IN A ROW 5230 04:35:26,880 --> 04:35:36,240 AND GET THREE REWARDS IN A ROW. 5231 04:35:36,240 --> 04:35:46,560 THEY CHEAT A LOT. 5232 04:35:46,560 --> 04:35:51,800 THE MONKEY MODEL DEVELOPED THE 5233 04:35:51,800 --> 04:35:53,000 ANIMALS PULL WITH ONE HAND OR 5234 04:35:53,000 --> 04:35:57,160 ANOTHER AND TWIST LIKE THIS. 5235 04:35:57,160 --> 04:36:02,640 THEY BY THEMSELVES ARE ALTERING 5236 04:36:02,640 --> 04:36:07,800 THE PROTOCOL AND FIND EVERY WEAK 5237 04:36:07,800 --> 04:36:10,920 POINT, YES, THEY GET FRUSTRATED 5238 04:36:10,920 --> 04:36:17,520 IF I KEEP IT VERY RESTRICTED AND 5239 04:36:17,520 --> 04:36:19,520 MORE MOTIVATION IF I HAVE MORE 5240 04:36:19,520 --> 04:36:20,200 VARIATION IN THEIR CHOICE ACROSS 5241 04:36:20,200 --> 04:36:22,240 THE WEEK. 5242 04:36:22,240 --> 04:36:23,640 >> YOU CAN ASSESS WHAT WE CALL 5243 04:36:23,640 --> 04:36:28,560 THE BREAK POINT. 5244 04:36:28,560 --> 04:36:31,680 IT'S THE LEVEL OF FRUSTRATION 5245 04:36:31,680 --> 04:36:35,920 THAT'S A MEASUREMENT OF 5246 04:36:35,920 --> 04:36:37,200 MOTIVATIONAL STATE THAT'S THE 5247 04:36:37,200 --> 04:36:45,520 WRITE WAY TO LOOK INTO IT. 5248 04:36:45,520 --> 04:36:46,280 BY FRIDAY AFTERNOON THEY'RE 5249 04:36:46,280 --> 04:36:53,200 SITTING IN THE CORNER. 5250 04:36:53,200 --> 04:36:57,760 >> I WONDER IF YOU HAVE 5251 04:36:57,760 --> 04:36:59,600 RECORDING OF THE ANIMALS IN THE 5252 04:36:59,600 --> 04:37:02,760 BOX SOMETIMES WE CAN SEE HOW THE 5253 04:37:02,760 --> 04:37:06,200 ANIMALS APPROACH. 5254 04:37:06,200 --> 04:37:08,160 WHETHER THEY SPEND THEIR TIME IN 5255 04:37:08,160 --> 04:37:09,480 THE CORNER AND IT'S WAY FOR US 5256 04:37:09,480 --> 04:37:15,600 TO MONITOR THE ANIMALS. 5257 04:37:15,600 --> 04:37:17,640 WE LOOK AT THE BEHAVIOR AS 5258 04:37:17,640 --> 04:37:18,600 MOTIVATION AND SEE THE APPROACH 5259 04:37:18,600 --> 04:37:19,840 WHERE THEY GO DIFFERENT WAYS. 5260 04:37:19,840 --> 04:37:22,680 I WONDER IF THAT'S ALSO 5261 04:37:22,680 --> 04:37:22,960 AFFECTED. 5262 04:37:22,960 --> 04:37:26,000 >> I PUBLISHED ON THAT. 5263 04:37:26,000 --> 04:37:27,480 WHETHER ESPECIALLY WHEN I WAS 5264 04:37:27,480 --> 04:37:29,920 DOING A FOOD RETRIEVAL, ARE THEY 5265 04:37:29,920 --> 04:37:32,480 SCOOPING AND RAKING AND HOW IT 5266 04:37:32,480 --> 04:37:35,640 ALTER THE BRAIN MAP ITSELF AND 5267 04:37:35,640 --> 04:37:38,760 CURRENTLY I'M ALTER, OVERHAND, 5268 04:37:38,760 --> 04:37:44,600 UNDER HAND, EXTRA PULLS AND HAVE 5269 04:37:44,600 --> 04:37:47,360 PUBLISHED A LOT OF THEIR REACH 5270 04:37:47,360 --> 04:37:52,840 STRATEGIES AND THE ALTERATIONS 5271 04:37:52,840 --> 04:37:58,000 IN THE STRATEGY INCREASES WITH 5272 04:37:58,000 --> 04:38:01,400 CORRELATING WITH THEIR KNOWN 5273 04:38:01,400 --> 04:38:04,720 PAIN BEHAVIORS WITH NOCICEPTION. 5274 04:38:04,720 --> 04:38:11,680 HOW STRATEGIES THEY'RE DOING. 5275 04:38:11,680 --> 04:38:13,240 THEY'RE LOSING THEIR NORMAL 5276 04:38:13,240 --> 04:38:14,600 PATTERN AND SEARCHING FOR ANY 5277 04:38:14,600 --> 04:38:15,200 PATTERN THAT WORKS BUT WE'RE 5278 04:38:15,200 --> 04:38:25,480 LOOKING AT THAT. 5279 04:38:33,320 --> 04:38:34,720 >> THANK YOU. 5280 04:38:34,720 --> 04:38:36,560 >> BACK TO CHRISTINE GOERTZ YOU 5281 04:38:36,560 --> 04:38:38,600 ASKED WHAT WE THINK WE SHOULD BE 5282 04:38:38,600 --> 04:38:40,520 DOING, I THINK MANY PEOPLE ARE 5283 04:38:40,520 --> 04:38:45,880 DOING IT BUT THERE SHOULD BE AN 5284 04:38:45,880 --> 04:38:51,600 EXPANSION ASSESSING BEHAVIORS 5285 04:38:51,600 --> 04:38:55,680 BEYOND THE SIMPLE TOOL HOUSE. 5286 04:38:55,680 --> 04:38:58,440 WE SHOULD HAVE A BROADER SCALE 5287 04:38:58,440 --> 04:39:00,640 OF WHAT WE'RE CONSIDERING PAIN 5288 04:39:00,640 --> 04:39:01,240 BEHAVIORS JUST AS WE DO IN 5289 04:39:01,240 --> 04:39:11,320 HUMANS. 5290 04:39:11,320 --> 04:39:13,720 >> THANK YOU. 5291 04:39:13,720 --> 04:39:16,600 >> ANY OTHER QUESTIONS OR 5292 04:39:16,600 --> 04:39:17,760 COMMENTS? 5293 04:39:17,760 --> 04:39:18,960 ELAINE, IS YOUR HAND UP AGAIN? 5294 04:39:18,960 --> 04:39:19,480 >> YES. 5295 04:39:19,480 --> 04:39:22,600 I WANT TO ASK A QUESTION TO THE 5296 04:39:22,600 --> 04:39:23,720 GROUP. 5297 04:39:23,720 --> 04:39:24,400 -- HELENE. 5298 04:39:24,400 --> 04:39:29,760 >> I THINK AT THE END OF 5299 04:39:29,760 --> 04:39:31,960 DIATCHENKO'S TALK A FUNDAMENTAL 5300 04:39:31,960 --> 04:39:37,480 QUESTION AND I'D LOVE PEOPLE'S 5301 04:39:37,480 --> 04:39:41,560 RESPONSE, ARE WE READY TO 5302 04:39:41,560 --> 04:39:47,400 MEASURE PAIN INTENSITY AND LOOK 5303 04:39:47,400 --> 04:39:51,480 AT PAIN DURATION. 5304 04:39:51,480 --> 04:39:53,600 ARE WE READY TO THINK ABOUT THAT 5305 04:39:53,600 --> 04:39:55,000 FROM PURCHASE OF RESEARCH AND 5306 04:39:55,000 --> 04:39:55,560 FROM THE POINT OF VIEW OF 5307 04:39:55,560 --> 04:40:00,560 PATIENT CARE? 5308 04:40:00,560 --> 04:40:01,720 THAT'S PRETTY FUNDAMENTAL. 5309 04:40:01,720 --> 04:40:02,880 WHAT PEOPLE WANT AND WHAT WE 5310 04:40:02,880 --> 04:40:05,520 WANT TO GIVE OUR PATIENTS IS 5311 04:40:05,520 --> 04:40:08,360 ANALGE 5312 04:40:08,360 --> 04:40:08,640 ANALGESIA. 5313 04:40:08,640 --> 04:40:13,080 THE IDEA IS IF THE MOST 5314 04:40:13,080 --> 04:40:17,800 IMPORTANT THING IS RESOLUTION OR 5315 04:40:17,800 --> 04:40:20,120 RESTORATION IT MAY BE AT THE 5316 04:40:20,120 --> 04:40:22,400 SUCCESS OF LESS ANALGESIA. 5317 04:40:22,400 --> 04:40:24,480 IT COULD BE THERE'S OTHER 5318 04:40:24,480 --> 04:40:26,440 ANALGESICS AND I'M CURIOUS ABOUT 5319 04:40:26,440 --> 04:40:28,960 THE OTHER ANALGESICS YOU TESTED. 5320 04:40:28,960 --> 04:40:32,040 DO YOU THINK THAT'S THE ANSWER 5321 04:40:32,040 --> 04:40:35,400 TO DO ANALGESIA WITHOUT 5322 04:40:35,400 --> 04:40:36,800 SACRIFICING THE INFLAMMATORY 5323 04:40:36,800 --> 04:40:37,040 COMPONENT? 5324 04:40:37,040 --> 04:40:40,560 WHAT ARE YOUR THOUGHTS ABOUT 5325 04:40:40,560 --> 04:40:40,760 THAT? 5326 04:40:40,760 --> 04:40:46,040 >> SO I DISCUSSED IT WITH MY 5327 04:40:46,040 --> 04:40:56,560 COLLEAGUE AND WE LOOKED AT A 5328 04:40:59,960 --> 04:41:10,440 HYPER ALGESIA BEHAVIOR AND A 5329 04:41:15,080 --> 04:41:20,280 CERTAIN CHANNEL BLOCKER WORK 5330 04:41:20,280 --> 04:41:26,480 WELL. 5331 04:41:26,480 --> 04:41:31,760 THEY SAID WE ALREADY DEVELOPED 5332 04:41:31,760 --> 04:41:41,200 PROTOCOL FOR SURGERY FOR 5333 04:41:41,200 --> 04:41:47,760 INTESTINAL SURGERY. 5334 04:41:47,760 --> 04:41:51,720 WE GIVE PEOPLE CHANNEL BLOCKERS 5335 04:41:51,720 --> 04:41:58,600 FOR TWO DAYS AND ONE DAY IN 5336 04:41:58,600 --> 04:41:58,880 HOSPITAL. 5337 04:41:58,880 --> 04:42:03,960 WE SAW IT WORKS WELL. 5338 04:42:03,960 --> 04:42:09,120 WE'RE INTERESTED AND NEED TO 5339 04:42:09,120 --> 04:42:14,760 FIND AND IT IT'S INTERESTING TO 5340 04:42:14,760 --> 04:42:24,080 USE IN OTHER SURGERIES AND LOOK 5341 04:42:24,080 --> 04:42:25,520 AT PEOPLE WITH THIS IN REDUCED 5342 04:42:25,520 --> 04:42:25,800 PROTOCOL. 5343 04:42:25,800 --> 04:42:32,240 THIS IS ONE. 5344 04:42:32,240 --> 04:42:33,880 WE THINK THE CHRONIC PAIN IS 5345 04:42:33,880 --> 04:42:44,400 JUST ACUTE PAIN WHICH CONTINUES. 5346 04:42:49,360 --> 04:42:51,640 THIS IS IMMEDIATE STIMULUS. 5347 04:42:51,640 --> 04:42:52,240 BUT THE CHRONIC PAIN OF COURSE 5348 04:42:52,240 --> 04:42:57,080 NOT. 5349 04:42:57,080 --> 04:42:58,680 THE WAY WE DEVELOP OUR DRUGS FOR 5350 04:42:58,680 --> 04:43:02,600 ACUTE PAIN AND IT SHOWS WE DON'T 5351 04:43:02,600 --> 04:43:05,000 HAVE PROBLEMS WITH ACUTE PAIN. 5352 04:43:05,000 --> 04:43:06,720 WE HAVE PROBLEM WITH CHRONIC 5353 04:43:06,720 --> 04:43:16,840 PAIN. 5354 04:43:17,360 --> 04:43:18,400 >> I LIKE ADAPTABILITY AND 5355 04:43:18,400 --> 04:43:22,800 TISSUES IN GENERAL. 5356 04:43:22,800 --> 04:43:25,640 ENHANCE THE RESTORATIVE RESPONSE 5357 04:43:25,640 --> 04:43:29,960 AND MAKE THE TISSUES STRONGER 5358 04:43:29,960 --> 04:43:32,720 AFTER A SERIOUS INJURY WHICH IS 5359 04:43:32,720 --> 04:43:33,240 WHAT YOU SUGGESTED WITH 5360 04:43:33,240 --> 04:43:43,400 EXERCISE. 5361 04:43:52,360 --> 04:43:54,600 >> YOU SHOULD HAVE A SIMULATING 5362 04:43:54,600 --> 04:44:00,240 FACTOR AND PEOPLE WITH THERAPY 5363 04:44:00,240 --> 04:44:02,360 RECEIVE BECAUSE THE NEUTROPHIL 5364 04:44:02,360 --> 04:44:12,720 COUNT CHANGES QUICKLY. 5365 04:44:17,480 --> 04:44:23,560 I'D LIKE TO FIND A WAY TO 5366 04:44:23,560 --> 04:44:24,800 ENHANCE AND RESOLVE INJURY AND 5367 04:44:24,800 --> 04:44:33,200 PAIN. 5368 04:44:33,200 --> 04:44:35,600 >> IS THIS ROBIN? 5369 04:44:35,600 --> 04:44:36,960 >> IT'S RENE. 5370 04:44:36,960 --> 04:44:40,960 I HEARD SOMETHING DIFFERENT THAN 5371 04:44:40,960 --> 04:44:41,760 WHAT HELENE HEARD. 5372 04:44:41,760 --> 04:44:44,000 I HEARD AS AN ACUTE PAIN 5373 04:44:44,000 --> 04:44:44,960 MANAGEMENT CLINICIAN I SHOULD BE 5374 04:44:44,960 --> 04:44:52,400 DOING MORE TO RESOLVE THEIR PAIN 5375 04:44:52,400 --> 04:44:52,840 SOO 5376 04:44:52,840 --> 04:44:54,600 SOONER, OPPOSED TO PROVIDING 5377 04:44:54,600 --> 04:44:55,760 ANALGESIA AND BEING OKAY WITH 5378 04:44:55,760 --> 04:44:58,760 THEIR PAIN REDUCED ABOUT THE NOT 5379 04:44:58,760 --> 04:45:02,800 RELIE 5380 04:45:02,800 --> 04:45:03,200 RELIEVED. 5381 04:45:03,200 --> 04:45:07,720 AM I MISINTERPRETING YOUR ANIMAL 5382 04:45:07,720 --> 04:45:07,920 DATA. 5383 04:45:07,920 --> 04:45:13,680 >> I'M THINKING THE WAY YOU DO. 5384 04:45:13,680 --> 04:45:15,520 MY LAB STUDIES HEALTH 5385 04:45:15,520 --> 04:45:15,840 RESTORATION. 5386 04:45:15,840 --> 04:45:20,360 I WAS PLAYING DEVIL'S ADVOCATE 5387 04:45:20,360 --> 04:45:22,560 THINKING THIS IF THE PROBLEM IS 5388 04:45:22,560 --> 04:45:24,760 WE'RE USING THE WRONG DRUG MAYBE 5389 04:45:24,760 --> 04:45:26,120 WE SHOULD USE A DRUG THAT ISN'T 5390 04:45:26,120 --> 04:45:29,480 HAVE THIS PROBLEM BUT ULTIMATELY 5391 04:45:29,480 --> 04:45:33,720 WE NEED TO FIGURE OUT THIS 5392 04:45:33,720 --> 04:45:35,000 RESOLUTION PHASE SEEMS TO BE SO 5393 04:45:35,000 --> 04:45:35,240 IMPORTANT. 5394 04:45:35,240 --> 04:45:36,640 WE WANT TO PROMOTE IT. 5395 04:45:36,640 --> 04:45:42,840 AT THE SAME TIME, TOLERATING OF 5396 04:45:42,840 --> 04:45:46,400 PAIN INITIALLY MAY BE IMPORTANT 5397 04:45:46,400 --> 04:45:50,800 IF IT'S PART AND PARCEL OF THE 5398 04:45:50,800 --> 04:45:54,760 NATURAL ABILITY BUT PEOPLE DON'T 5399 04:45:54,760 --> 04:45:57,760 LIKE HAVING PAIN. 5400 04:45:57,760 --> 04:45:58,840 IT'S AN INTERESTING ISSUE. 5401 04:45:58,840 --> 04:46:00,560 WE NEED TO THINK ABOUT BOTH. 5402 04:46:00,560 --> 04:46:04,080 >> I DON'T THINK WE SHOULD I 5403 04:46:04,080 --> 04:46:05,400 DON'T THINK IT'S ONE OR THE 5404 04:46:05,400 --> 04:46:06,800 OTHER. 5405 04:46:06,800 --> 04:46:09,880 I THINK IT'S TWO DIFFERENT 5406 04:46:09,880 --> 04:46:19,560 PROBLEMS WE SHOULD INHIBIT PAIN 5407 04:46:19,560 --> 04:46:21,240 WE ALSO NEED TO DEVELOP 5408 04:46:21,240 --> 04:46:22,880 TREATMENT FOR CHRONIC PAIN WHICH 5409 04:46:22,880 --> 04:46:28,640 SEEMS TO HAVE A DIFFERENT 5410 04:46:28,640 --> 04:46:31,360 MECHANISM AND SEE HOW TO 5411 04:46:31,360 --> 04:46:40,600 INTERFERE. 5412 04:46:40,600 --> 04:46:42,320 >> FOR ME ONE OF THE IMPORTANT 5413 04:46:42,320 --> 04:46:45,040 TAKE HOME MESSAGES IS HOW DO WE 5414 04:46:45,040 --> 04:46:47,280 PREVENT AND WE KEEP TALKING 5415 04:46:47,280 --> 04:46:51,160 ABOUT THE CHRONIC PAIN FROM 5416 04:46:51,160 --> 04:46:53,640 TRANSITIONING INTO CHRONIC PAIN. 5417 04:46:53,640 --> 04:46:57,720 THINK BOTH OF YOUR WORK IS 5418 04:46:57,720 --> 04:46:59,600 ILLUSTRATES THE WAY WE'VE BEEN 5419 04:46:59,600 --> 04:47:01,280 THINKING ABOUT THAT MAY BE 5420 04:47:01,280 --> 04:47:02,760 COMPLETELY WRONG. 5421 04:47:02,760 --> 04:47:04,960 TRYING TO THINK ABOUT WHAT THIS 5422 04:47:04,960 --> 04:47:08,560 MEANS FROM A RESEARCH 5423 04:47:08,560 --> 04:47:13,400 PERSPECTIVE FROM A CLINICAL 5424 04:47:13,400 --> 04:47:14,720 PERSPECTIVE IS IMPORTANT. 5425 04:47:14,720 --> 04:47:17,320 >> THE TREADMILL DIDN'T WORK 5426 04:47:17,320 --> 04:47:19,440 WELL WITH THE RATS BECAUSE IT'S 5427 04:47:19,440 --> 04:47:29,160 A FOREARM PROBLEM THEY HAVE AND 5428 04:47:29,160 --> 04:47:31,760 TEN THEY'RE LOADING A LIMB WITH 5429 04:47:31,760 --> 04:47:35,640 INJURED TENDONS AND MUSCLES AND 5430 04:47:35,640 --> 04:47:36,760 THEY'RE BEING FORCED. 5431 04:47:36,760 --> 04:47:38,840 IF THEY'RE BEING FORCED TO RUN 5432 04:47:38,840 --> 04:47:41,120 WITH THE TREADMILL. 5433 04:47:41,120 --> 04:47:42,840 I PUBLISHED IT WITH FORCED 5434 04:47:42,840 --> 04:47:45,200 EXERCISE IN THE TITLE. 5435 04:47:45,200 --> 04:47:47,560 CURRENTLY IT WAS A VOLUNTARY 5436 04:47:47,560 --> 04:47:49,120 RUNNING WHEEL. 5437 04:47:49,120 --> 04:47:51,000 YOU ATTACH IT TO THE END OF 5438 04:47:51,000 --> 04:47:52,080 THEIR AGE. 5439 04:47:52,080 --> 04:47:54,520 THEY GET IN THERE AT NIGHT AND 5440 04:47:54,520 --> 04:47:57,280 RUN MAYBE TWO MILES AND THEY 5441 04:47:57,280 --> 04:48:00,760 HAVE BEEN ACUTELY INJURED WITH 5442 04:48:00,760 --> 04:48:05,640 SCIATIC NERVE CONSTRICTION 5443 04:48:05,640 --> 04:48:07,600 INJURY NOW WITH THE HIGH FORCE 5444 04:48:07,600 --> 04:48:10,960 TASK THEY SEEM TO LOVE IT AND IT 5445 04:48:10,960 --> 04:48:14,200 SEEMS TO BE WORKING BETTER THAN 5446 04:48:14,200 --> 04:48:14,960 THE DRUGS THAT I'VE GIVEN IN THE 5447 04:48:14,960 --> 04:48:25,040 PAST. 5448 04:48:27,800 --> 04:48:29,760 >> I LIKE HEARING WHAT EVERYBODY 5449 04:48:29,760 --> 04:48:32,040 ELSE AND HOW EVERYONE ELSE IS 5450 04:48:32,040 --> 04:48:34,200 INTERPRETING ALL OF THIS AND 5451 04:48:34,200 --> 04:48:35,360 FROM THE PATIENT PERSPECTIVE I 5452 04:48:35,360 --> 04:48:45,840 THINK THE INTERPRETATION IS 5453 04:48:46,120 --> 04:48:47,960 QUITE DIFFERENT AND HOPEFUL AND 5454 04:48:47,960 --> 04:48:51,920 GOING FROM ACUTE TO CHRONIC 5455 04:48:51,920 --> 04:48:54,320 FIRST OF ALL AND LUDA POINTED 5456 04:48:54,320 --> 04:48:58,480 OUT THAT MAYBE IT ISN'T 5457 04:48:58,480 --> 04:48:58,800 ANALGESICS. 5458 04:48:58,800 --> 04:48:59,880 FROM THE PATIENT PERSPECTIVE 5459 04:48:59,880 --> 04:49:02,440 WHEN THE PAIN IS ACUTE THE 5460 04:49:02,440 --> 04:49:03,000 ANALGESICS ARE EXTREMELY 5461 04:49:03,000 --> 04:49:09,560 IMPORTANT. 5462 04:49:09,560 --> 04:49:10,120 THE HOPE AND EXPECTATION 5463 04:49:10,120 --> 04:49:13,200 CULTURALLY IS IT WILL REVOLVE 5464 04:49:13,200 --> 04:49:15,400 THE PROBLEM AND PREVENT IT FROM 5465 04:49:15,400 --> 04:49:17,000 BECOMING CHRONIC. 5466 04:49:17,000 --> 04:49:18,760 FROM THE CHRONIC PERSPECTIVE 5467 04:49:18,760 --> 04:49:24,600 AFTER 18 MONTHS OR TWO YEARS OR 5468 04:49:24,600 --> 04:49:26,800 WHATEVER THE ANALGESICS AREN'T 5469 04:49:26,800 --> 04:49:28,480 MAKE THAT MUCH OF A DIFFERENCE 5470 04:49:28,480 --> 04:49:34,520 OR THERE'S UNINTENDED SIDE 5471 04:49:34,520 --> 04:49:36,120 EFFECTS THAT AREN'T REALLY 5472 04:49:36,120 --> 04:49:40,960 COPACETIC SO THEY START LOOKING 5473 04:49:40,960 --> 04:49:42,880 FOR OTHER OPTIONS. 5474 04:49:42,880 --> 04:49:44,080 ACUPUNCTURE WAS MENTIONED, 5475 04:49:44,080 --> 04:49:49,520 PHYSICAL ACTIVITY WAS MENTIONED 5476 04:49:49,520 --> 04:49:53,040 AND MARY WAS TALKING ABOUT HOW 5477 04:49:53,040 --> 04:49:54,640 THE RATS RESPOND DIFFERENTLY 5478 04:49:54,640 --> 04:50:00,200 FROM THE ACTIVITIES THAT ARE 5479 04:50:00,200 --> 04:50:03,080 PRESEN 5480 04:50:03,080 --> 04:50:06,240 PRESENTED WE THESE TO THINK MORE 5481 04:50:06,240 --> 04:50:08,040 INTEGRATIVELY AND THEY NEED TO 5482 04:50:08,040 --> 04:50:12,840 BE INTRODUCED IN THE ACUTE PHASE 5483 04:50:12,840 --> 04:50:13,680 RATHER THAN THE CHRONIC, WHAT 5484 04:50:13,680 --> 04:50:24,240 ELSE CAN I THROW AT THIS PHASE. 5485 04:50:27,280 --> 04:50:31,200 ONE BEGINS WITH NUTRITIONAL 5486 04:50:31,200 --> 04:50:33,200 COUNSELLING AND CBT YOU CAN'T DO 5487 04:50:33,200 --> 04:50:34,600 WITH RATS. 5488 04:50:34,600 --> 04:50:37,840 >> YOU CAN. 5489 04:50:37,840 --> 04:50:40,760 THERE'S A LOT OF CANNABINOIDS 5490 04:50:40,760 --> 04:50:42,320 FOR RATS. 5491 04:50:42,320 --> 04:50:50,440 RATS ARE SMART. 5492 04:50:50,440 --> 04:50:52,800 >> DISTRACTION IS ONE THING I 5493 04:50:52,800 --> 04:50:53,720 HEAR FROM CHRONIC PAIN PATIENTS. 5494 04:50:53,720 --> 04:50:55,120 WHEN I HAVE THEM GO THROUGH 5495 04:50:55,120 --> 04:50:56,520 THEIR DAY OR WEEK AND DESCRIBE 5496 04:50:56,520 --> 04:50:58,640 THE THINGS THAT ARE HELPING THEM 5497 04:50:58,640 --> 04:51:01,120 TO FEEL BETTER, DISTRACTION IS A 5498 04:51:01,120 --> 04:51:02,880 HUGE THEME WHETHER IT'S PLAYING 5499 04:51:02,880 --> 04:51:05,720 GAMES, CHANGING THEIR LOCATION, 5500 04:51:05,720 --> 04:51:07,160 CHANGING VISUAL STIMULATION OR 5501 04:51:07,160 --> 04:51:17,280 ORAL STIMULATION. 5502 04:51:17,280 --> 04:51:18,520 INCORPORATING MORE OF THAT AND 5503 04:51:18,520 --> 04:51:21,400 THAT'S PRETTY EXCITING, MARY YOU 5504 04:51:21,400 --> 04:51:26,960 CAN DO ALL OF THE THOSE THINGS 5505 04:51:26,960 --> 04:51:33,920 WITH RATS CULTURALLY WE HAVE 5506 04:51:33,920 --> 04:51:35,200 EXPECTATI 5507 04:51:35,200 --> 04:51:37,520 EXPECTATIONS I'M FROM A HISPANIC 5508 04:51:37,520 --> 04:51:41,760 BACKGROUND SO IN MY FAMILY THERE 5509 04:51:41,760 --> 04:51:43,440 WERE CERTAIN THINGS THAT WERE 5510 04:51:43,440 --> 04:51:45,040 DONE OR PROVIDED GROWING UP 5511 04:51:45,040 --> 04:51:49,400 BECAUSE IN THE '70s I HAD 5512 04:51:49,400 --> 04:51:50,760 PEDIATRIC PAIN AND THE BEST 5513 04:51:50,760 --> 04:51:52,120 RESEARCH WAS SAYING THAT 5514 04:51:52,120 --> 04:51:52,880 CHILDREN DIDN'T EXPERIENCE PAIN 5515 04:51:52,880 --> 04:51:54,640 THE SAME WAY ADULTS DID SO WE 5516 04:51:54,640 --> 04:52:04,920 DIDN'T TREAT IT. 5517 04:52:11,200 --> 04:52:14,800 WE HAD HERBAL REMEDIES OR 5518 04:52:14,800 --> 04:52:17,720 MASSAGE WAS VERY IMPORTANT. 5519 04:52:17,720 --> 04:52:22,840 INTERACTION AGAIN DISTRACTION, 5520 04:52:22,840 --> 04:52:28,800 TOUCH, ALL THOSE THINGS AND WE 5521 04:52:28,800 --> 04:52:30,320 LOOK AT HOW TO ADDRESS CHRONIC 5522 04:52:30,320 --> 04:52:30,760 PAIN. 5523 04:52:30,760 --> 04:52:33,520 THOSE WERE MY TWO BIG THINGS TO 5524 04:52:33,520 --> 04:52:38,760 SHARE WITH YOU WHAT I'M HEARING 5525 04:52:38,760 --> 04:52:49,280 AND AND YOU CAN INTRODUCE THOSE 5526 04:52:50,000 --> 04:52:51,240 SUPPOSEDLY HUMAN THINGS INTO THE 5527 04:52:51,240 --> 04:52:55,720 CONTROL STUDIES. 5528 04:52:55,720 --> 04:53:00,840 >> I HAVEN'T PRESENTED ALL OF MY 5529 04:53:00,840 --> 04:53:02,240 WORK BECAUSE IT'S TOO MANY YEARS 5530 04:53:02,240 --> 04:53:07,480 BUT DUE TO THE KINDNESS AND 5531 04:53:07,480 --> 04:53:13,440 SUPPORT OF NICHD I WAS SPOESHTED 5532 04:53:13,440 --> 04:53:16,320 BY MANUAL THERAPY AND THOSE 5533 04:53:16,320 --> 04:53:19,160 TREATMENTS WORKED PREVENTIVELY. 5534 04:53:19,160 --> 04:53:21,680 IF I DID IT FROM THE BEGINNING 5535 04:53:21,680 --> 04:53:23,520 OF THE INJURY TO 12 WEEKS OR 5536 04:53:23,520 --> 04:53:25,880 WHATEVER, FOUR WEEKS, SIX WEEKS, 5537 04:53:25,880 --> 04:53:30,680 12 WEEKS IT ALL WORKED. 5538 04:53:30,680 --> 04:53:32,640 MANUAL THERAPY WAS QUITE NICE 5539 04:53:32,640 --> 04:53:33,640 FOR THE RATS. 5540 04:53:33,640 --> 04:53:36,560 IT WASN'T UNTIL I WAITED TO THE 5541 04:53:36,560 --> 04:53:38,040 END AND I TRY TO REVERSE IT AT 5542 04:53:38,040 --> 04:53:42,320 THE END, IT'S TOO LATE. 5543 04:53:42,320 --> 04:53:49,000 IT NEEDED TO OCCUR EARLIER. 5544 04:53:49,000 --> 04:53:56,080 OR SOMETHING ELSE LIKE THE 5545 04:53:56,080 --> 04:53:57,840 COGNITIVE BEHAVIORAL THERAPY 5546 04:53:57,840 --> 04:53:58,840 SOMETHING MORE AT THE LATE 5547 04:53:58,840 --> 04:53:59,040 POINT. 5548 04:53:59,040 --> 04:54:00,800 >> I KNOW CHRISTINE HAS THOUGHTS 5549 04:54:00,800 --> 04:54:02,520 AN WHAT I SAID AND KATE WILL 5550 04:54:02,520 --> 04:54:03,240 HAVE LOTS OF THOUGHTS ON WHAT I 5551 04:54:03,240 --> 04:54:13,120 SAID. 5552 04:54:13,120 --> 04:54:14,720 >> WHAT ABOUT THE AGE OF THE 5553 04:54:14,720 --> 04:54:17,080 MICE AND MAGGIE YOU DID A GREAT 5554 04:54:17,080 --> 04:54:19,520 JOB EXPLAINING WE USED TO THINK 5555 04:54:19,520 --> 04:54:19,960 KIDS DIDN'T FEEL PAIN. 5556 04:54:19,960 --> 04:54:25,480 I NEVER DID. 5557 04:54:25,480 --> 04:54:26,880 CERTAINLY THE MEDICAL COMMUNITY 5558 04:54:26,880 --> 04:54:27,280 DID. 5559 04:54:27,280 --> 04:54:30,600 WE KNOW THAT'S NOT THE CASE BUT 5560 04:54:30,600 --> 04:54:33,000 DO SEE LESS ACUTE TO CHRONIC 5561 04:54:33,000 --> 04:54:36,800 PAIN OR PERSISTENT POST-SURGICAL 5562 04:54:36,800 --> 04:54:38,280 PAIN IN KIDS. 5563 04:54:38,280 --> 04:54:39,920 IS THAT AN AGE PHENOMENON OR 5564 04:54:39,920 --> 04:54:50,480 PERHAPS A TREATMENT DIFFERENCE? 5565 04:54:53,000 --> 04:54:55,680 FOR THE RATS, IT'S AGE RELATED. 5566 04:54:55,680 --> 04:54:58,600 I DO MATURE ADULT AND VERY 5567 04:54:58,600 --> 04:55:04,160 MATURE ADULTS AND A VERY MATURE 5568 04:55:04,160 --> 04:55:14,680 AGED ADULTS HAD AND THEY HAD AN 5569 04:55:19,520 --> 04:55:23,480 ENHANCED GLIAL RESPONSE AND THEY 5570 04:55:23,480 --> 04:55:26,160 DIDN'T HAVE THE MECHANISMS TO I 5571 04:55:26,160 --> 04:55:33,760 AM IMPROVE. 5572 04:55:33,760 --> 04:55:39,400 >> DEFINITELY ALL THE STUDIES 5573 04:55:39,400 --> 04:55:44,080 SHOW FAIR AND SQUARE AND A YOUNG 5574 04:55:44,080 --> 04:55:45,880 ANIMAL WILL DEVELOP LESS CHRONIC 5575 04:55:45,880 --> 04:55:46,240 PAIN. 5576 04:55:46,240 --> 04:55:56,760 WE ALSO NEED TO DO STUDIES AND 5577 04:56:06,400 --> 04:56:07,720 HUMANS HAVE HIGHER INFLAMMATORY 5578 04:56:07,720 --> 04:56:13,320 STATE AS WE AGE AND HAVE LESS 5579 04:56:13,320 --> 04:56:16,720 RESPONSE AS WE AGE. 5580 04:56:16,720 --> 04:56:17,880 WE DIDN'T DISCUSS THE DIFFERENCE 5581 04:56:17,880 --> 04:56:19,320 BETWEEN MALES AND FEMALES AND 5582 04:56:19,320 --> 04:56:22,600 SHORT OF THIS IT WAS NO 5583 04:56:22,600 --> 04:56:23,080 DIFFERENCE. 5584 04:56:23,080 --> 04:56:27,120 MALES AND FEMALES AND IN ANIMAL 5585 04:56:27,120 --> 04:56:33,360 ALSO IT WAS THE SAME HAVE THE 5586 04:56:33,360 --> 04:56:38,120 SAME PHENOMENON. 5587 04:56:38,120 --> 04:56:40,840 WE SAW A HIGHER RESPONSE AND THE 5588 04:56:40,840 --> 04:56:48,360 MORE ROBUST AND DOWN REGULATED. 5589 04:56:48,360 --> 04:56:49,680 THERE'S MORE IN YOUNG MALES. 5590 04:56:49,680 --> 04:57:00,120 THE PROCESS IS THE SAME. 5591 04:57:02,480 --> 04:57:04,120 >> I WANTED TO MENTION THE USE 5592 04:57:04,120 --> 04:57:06,160 OF MULTIPLE MODELS WHEN YOU WORK 5593 04:57:06,160 --> 04:57:10,120 WITH RATS AND MICE TO LOOK AT 5594 04:57:10,120 --> 04:57:11,680 THE AFFECT OF PAIN AND NSAIDS 5595 04:57:11,680 --> 04:57:14,760 AND PEOPLE ARE USING WHAT WE 5596 04:57:14,760 --> 04:57:16,040 CALL NATURALISTIC BEHAVIOR. 5597 04:57:16,040 --> 04:57:19,240 THE MAJORITY OF TIME WE PUT THE 5598 04:57:19,240 --> 04:57:21,240 RATS OR MICE IN BOXES OR 5599 04:57:21,240 --> 04:57:22,280 ENVIRONMENT WHICH IS NOT THE 5600 04:57:22,280 --> 04:57:22,840 DAILY ENVIRONMENT FOR THE 5601 04:57:22,840 --> 04:57:26,640 ANIMALS. 5602 04:57:26,640 --> 04:57:29,960 WE CAN MONITOR DAILY ACTIVITIES 5603 04:57:29,960 --> 04:57:36,960 WHETHER IT'S CONSUMATORY 5604 04:57:36,960 --> 04:57:40,760 BEHAVIOR AND GROOMING BEHAVIOR 5605 04:57:40,760 --> 04:57:42,960 AND SURVEY THE ANIMAL IN THIS 5606 04:57:42,960 --> 04:57:45,800 BIG BROTHER HOUSE AND INDEUCE A 5607 04:57:45,800 --> 04:57:48,800 PAIN CONDITION AND SEE HOW THE 5608 04:57:48,800 --> 04:57:54,760 ANIMAL LIKE ACTIVITY CHANGES 5609 04:57:54,760 --> 04:57:58,000 THEN YOU TREAT THAT. 5610 04:57:58,000 --> 04:58:01,360 IT DOESN'T NEED TO RELY ON 5611 04:58:01,360 --> 04:58:02,080 ANALGESIC. 5612 04:58:02,080 --> 04:58:03,320 IT CAN RELY ON SOMETHING ELSE 5613 04:58:03,320 --> 04:58:05,560 AND I CAN IMPROVE THE LIFE OF 5614 04:58:05,560 --> 04:58:06,160 PEOPLE SUFFERING FROM CHRONIC 5615 04:58:06,160 --> 04:58:16,280 PAIN. 5616 04:58:19,160 --> 04:58:21,400 LOOK INTO NATURALISTIC BEHAVIOR 5617 04:58:21,400 --> 04:58:24,240 AND HOW WE CAN REVERSE THE PAIN. 5618 04:58:24,240 --> 04:58:27,960 THAT'S ONE OF THE WAYS WE COULD 5619 04:58:27,960 --> 04:58:29,600 MAKE THE GAP BETWEEN WHAT WE DO 5620 04:58:29,600 --> 04:58:31,680 IN THE LAB WITH ANIMALS TO WHAT 5621 04:58:31,680 --> 04:58:32,280 HAPPENED WITH PATIENTS IN THE 5622 04:58:32,280 --> 04:58:42,440 STREET. 5623 04:58:45,480 --> 04:58:46,840 >> WHEN WE LOOK AT THE 5624 04:58:46,840 --> 04:58:47,840 NATURALIST BEHAVIOR. 5625 04:58:47,840 --> 04:58:53,200 THE PEOPLE WHO RESOLVE PAIN ARE 5626 04:58:53,200 --> 04:58:55,200 THE ONES WHO HAVE THE NATURAL 5627 04:58:55,200 --> 04:59:00,880 RESPONSES WELL ALIGNED. 5628 04:59:00,880 --> 04:59:11,360 AND SO IF WE CAN SEE WHAT'S 5629 04:59:12,320 --> 04:59:13,280 HAPPENED IN THE PROCESS IS WHAT 5630 04:59:13,280 --> 04:59:23,600 WE USUALLY DON'T DO. 5631 04:59:25,880 --> 04:59:30,160 IF WE GIVE THE EXAMPLES TO MICE 5632 04:59:30,160 --> 04:59:32,360 WE HAVE THE CLARIFICATION BUT IF 5633 04:59:32,360 --> 04:59:33,440 THEY HAVE ACCESS TO THE WHEEL 5634 04:59:33,440 --> 04:59:43,760 THEY DON'T HAVE IT. 5635 04:59:47,960 --> 04:59:49,360 THE MOMENT YOU PUT ACCESS TO THE 5636 04:59:49,360 --> 04:59:50,160 WHEEL THAT'S IT. 5637 04:59:50,160 --> 05:00:00,680 THEY DON'T HAVE PAIN BEHAVIOR. 5638 05:00:01,200 --> 05:00:03,120 EXERCISE LEADS TO ACTIVATION AND 5639 05:00:03,120 --> 05:00:06,760 INCREASE THE NUMBER OF 5640 05:00:06,760 --> 05:00:16,760 NEUTROPHILS. 5641 05:00:16,760 --> 05:00:27,000 THIS SAY FACT. 5642 05:00:29,360 --> 05:00:35,800 IMMUNE SYSTEM RESPONDS HUGELY 5643 05:00:35,800 --> 05:00:44,880 CONTROLLED BY WE THE NEW THINK 5644 05:00:44,880 --> 05:00:46,080 AND WHEN WE TALK ABOUT THE 5645 05:00:46,080 --> 05:00:49,480 INTERACTION WE USUALLY THINK 5646 05:00:49,480 --> 05:00:52,960 ABOUT IT'S A MICROGLIA OR 5647 05:00:52,960 --> 05:00:55,920 INFLAMMATORY CYTOKINES NEXT TO 5648 05:00:55,920 --> 05:00:56,520 THE NEURON. 5649 05:00:56,520 --> 05:01:07,080 BUT ACTUALLY THERE'S A HUGE AND 5650 05:01:14,840 --> 05:01:19,480 SO THE MOTOR CORTEX ACTIVATION 5651 05:01:19,480 --> 05:01:20,800 LEADS TO A HUGE INCREASE IN THE 5652 05:01:20,800 --> 05:01:31,160 NUMBER OF NEUTROPHILS. 5653 05:01:38,840 --> 05:01:45,440 WE LOOK AT THE NEURONAL SYSTEM 5654 05:01:45,440 --> 05:01:50,560 WE DON'T THINK OF THE BRAIN 5655 05:01:50,560 --> 05:02:01,080 AFFECT THE IMMUNE SYSTEM IT'S 5656 05:02:05,360 --> 05:02:10,040 THE ALLOSTATIC LOAD AND THEY DID 5657 05:02:10,040 --> 05:02:11,680 WORK WHERE THE BRAIN IS THE 5658 05:02:11,680 --> 05:02:16,720 MODULATOR OF IT ALL. 5659 05:02:16,720 --> 05:02:19,160 YOU HAVE THE CHRONIC STRESSORS, 5660 05:02:19,160 --> 05:02:21,760 ACUTE STRESSORS. 5661 05:02:21,760 --> 05:02:24,240 I HAD IT CIRCLED BECAUSE IT WAS 5662 05:02:24,240 --> 05:02:27,280 THE DEMAND AND HOW THE BRAIN IS 5663 05:02:27,280 --> 05:02:29,440 PERCEIVING THAT AND LIKE IT'S 5664 05:02:29,440 --> 05:02:32,280 AFFECTING THE BRAIN AND 5665 05:02:32,280 --> 05:02:34,600 CONTROLLING ALL THESE THINGS AND 5666 05:02:34,600 --> 05:02:36,280 PHYSIOLOGICAL RESPONSES WHICH 5667 05:02:36,280 --> 05:02:39,160 WILL INCLUDE THE IMMUNE RESPONSE 5668 05:02:39,160 --> 05:02:41,000 WHICH ISN'T EVEN SHOWN IN THE 5669 05:02:41,000 --> 05:02:42,160 PICTURE. 5670 05:02:42,160 --> 05:02:52,600 HAVE YOU THEALO -- THE 5671 05:02:59,920 --> 05:03:00,160 ALLOSTASIS. 5672 05:03:00,160 --> 05:03:02,760 I FEEL LIKE I WANT TO GO BACK 5673 05:03:02,760 --> 05:03:06,120 AND FIGURE OUT HOW TO PLAN 5674 05:03:06,120 --> 05:03:07,640 EXPERIMENTS AND LOOK AT THINGS 5675 05:03:07,640 --> 05:03:13,960 AND THE SUGGESTIONS MADE IN THE 5676 05:03:13,960 --> 05:03:15,080 1990 MODEL AND HOW IT FITS AND 5677 05:03:15,080 --> 05:03:24,240 WORKS. 5678 05:03:24,240 --> 05:03:26,040 I NEED TO LOOK AT THE WORK AFTER 5679 05:03:26,040 --> 05:03:27,160 THIS CONVERSATION. 5680 05:03:27,160 --> 05:03:29,720 >> WELL, THIS HAS BEEN A 5681 05:03:29,720 --> 05:03:31,680 FASCINATING CONVERSATION. 5682 05:03:31,680 --> 05:03:42,240 I WANT TO THANK EVERYONE FOR THE 5683 05:03:42,240 --> 05:03:43,240 THOUGHTS AND REFLECTIONS. 5684 05:03:43,240 --> 05:03:48,440 I DON'T KNOW IF I CAN SPEAK FOR 5685 05:03:48,440 --> 05:03:48,800 MYSELF. 5686 05:03:48,800 --> 05:03:51,160 I FIND IT THOUGHT PROVOKING ON 5687 05:03:51,160 --> 05:03:54,760 SO MANY LEVELS AND LOVELY TO 5688 05:03:54,760 --> 05:03:56,960 HEAR HOW THE FINDINGS FROM 5689 05:03:56,960 --> 05:04:00,000 MARY'S ANIMAL MODEL AND LUDA'S 5690 05:04:00,000 --> 05:04:05,800 STUDIES IN HUMANS AND ANIMAL 5691 05:04:05,800 --> 05:04:09,640 MODELS YOU USED REALLY PUSH US 5692 05:04:09,640 --> 05:04:11,480 TO RECONSIDER SOME OF OUR 5693 05:04:11,480 --> 05:04:16,760 ASSUMPTIONS AS TO WHAT KIND OF 5694 05:04:16,760 --> 05:04:18,880 QUESTIONS WE WANT TO ASK AND 5695 05:04:18,880 --> 05:04:20,600 GOING BACK TO THE COMMENT FROM 5696 05:04:20,600 --> 05:04:24,040 THIS MORNING IN HAVING TO THINK 5697 05:04:24,040 --> 05:04:26,040 ABOUT THINGS THAT COULD BE 5698 05:04:26,040 --> 05:04:28,720 IMPACTING PAIN FROM DIRECTIONS 5699 05:04:28,720 --> 05:04:29,240 THAT WE MAY NOT NECESSARY 5700 05:04:29,240 --> 05:04:30,880 EXPECT. 5701 05:04:30,880 --> 05:04:37,680 AND LUDA, YOU DESCRIBED IT 5702 05:04:37,680 --> 05:04:39,600 NICELY IN YOUR TALK. 5703 05:04:39,600 --> 05:04:41,960 YOU HAVE TO LOOK AT YOUR 5704 05:04:41,960 --> 05:04:44,080 ASSUMPTIONS AGAIN AND WHEN WE 5705 05:04:44,080 --> 05:04:44,920 TALK ABOUT NEURAL AND IMMUNE 5706 05:04:44,920 --> 05:04:46,920 DIRECTION AND TALKING ABOUT THE 5707 05:04:46,920 --> 05:04:50,080 AFFECT OF BRAIN ACTIVATION WE 5708 05:04:50,080 --> 05:04:53,920 SEE NEURAL IMMUNE INTERACTIONS 5709 05:04:53,920 --> 05:04:57,320 ARE OCCURRING WITHIN THE NERVOUS 5710 05:04:57,320 --> 05:05:00,800 SYSTEM AND SOME MAY BE OUTSIDE 5711 05:05:00,800 --> 05:05:01,400 THAT SYSTEM. 5712 05:05:01,400 --> 05:05:03,160 WE HAVE TO BEAR THAT IN MIND 5713 05:05:03,160 --> 05:05:13,320 VERY MUCH. 5714 05:05:18,200 --> 05:05:22,080 WE'RE A LITTLE BEHIND TIME 5715 05:05:22,080 --> 05:05:25,640 TOPICS FOR THE NEXT MEETING. 5716 05:05:25,640 --> 05:05:28,200 WE HAVE PUBLIC COMMENT AT -- 5717 05:05:28,200 --> 05:05:30,400 >> I HAVE A WRITTEN COMMENT THAT 5718 05:05:30,400 --> 05:05:37,080 WAS SUBMITTED AND DISTRIBUTED. 5719 05:05:37,080 --> 05:05:40,840 I CAN MENTION IT BUT THAT'S IT. 5720 05:05:40,840 --> 05:05:44,520 WE HAVE TIME TO TALK AND HAVE 5721 05:05:44,520 --> 05:05:45,240 ONE QUICK ANNOUNCEMENT I'LL DO 5722 05:05:45,240 --> 05:05:50,600 AFTER. 5723 05:05:50,600 --> 05:05:52,280 >> DO YOU WANT TO MAKE THE 5724 05:05:52,280 --> 05:05:52,720 ANNOUNCEMENT NOW? 5725 05:05:52,720 --> 05:05:56,120 >> I CAN DO IT NOW. 5726 05:05:56,120 --> 05:05:58,360 CAN I HAVE EACH YEAR WHEN WE 5727 05:05:58,360 --> 05:06:00,360 HAVE OPENINGS COMING UP IN THE 5728 05:06:00,360 --> 05:06:05,920 COMMUNITY FOR NEW MEMBERS, WE 5729 05:06:05,920 --> 05:06:09,720 PUT OUT THE NOMINEES AND THERE'S 5730 05:06:09,720 --> 05:06:11,440 AN ONLINE FORUM TO NOMINATE 5731 05:06:11,440 --> 05:06:12,600 PEOPLE TO SERVE. 5732 05:06:12,600 --> 05:06:14,800 ONCE WE COLLECT ALL THOSE 5733 05:06:14,800 --> 05:06:19,760 NOMINATIONS, WE HAVE A PROCESS 5734 05:06:19,760 --> 05:06:23,880 HERE FOR REVIEWING THE 5735 05:06:23,880 --> 05:06:27,520 APPLICABILITY FOR THE NOMINEES 5736 05:06:27,520 --> 05:06:34,560 AND HOW THEY FIT IN AS FAR AS 5737 05:06:34,560 --> 05:06:40,640 MEMBERS GO AND THE DEMOGRAPHIC 5738 05:06:40,640 --> 05:06:43,520 DISTRIBUTION AND THAT'S NOW 5739 05:06:43,520 --> 05:06:46,680 LIVE. 5740 05:06:46,680 --> 05:06:48,600 I'M PUTTING IN THE LINK THE 5741 05:06:48,600 --> 05:06:53,680 NOMINATION SITE TO SEE IF 5742 05:06:53,680 --> 05:06:55,360 ANYBODY WANTS TO DISTRIBUTE THAT 5743 05:06:55,360 --> 05:07:01,840 LINK OR SUBMIT A NAME OF 5744 05:07:01,840 --> 05:07:03,920 SOMEBODY FOR NEXT YEAR'S 2023 5745 05:07:03,920 --> 05:07:04,200 NOMINATION. 5746 05:07:04,200 --> 05:07:09,520 WE HAVE OPENINGS FOR TWO PUBLIC 5747 05:07:09,520 --> 05:07:10,080 MEMBERS AND ONE SCIENTIFIC 5748 05:07:10,080 --> 05:07:15,520 PROVIDER. 5749 05:07:15,520 --> 05:07:19,160 ONE MORE THING AND THEN I'LL BE 5750 05:07:19,160 --> 05:07:20,760 DONE BEFORE THE PUBLIC COMMENT. 5751 05:07:20,760 --> 05:07:27,920 WE HAVE A VOLUNTEER FOR ANALYSIS 5752 05:07:27,920 --> 05:07:28,720 ON THE FEDERAL PORTFOLIO GAPS 5753 05:07:28,720 --> 05:07:39,240 BUT WE'LL COME BACK TO THAT. 5754 05:07:39,240 --> 05:07:41,560 >> WE WANTED TO HEAR YOUR 5755 05:07:41,560 --> 05:07:43,840 THOUGHTS ABOUT TWO THINGS. 5756 05:07:43,840 --> 05:07:46,760 TOPICS WE MAY WANT TO DISCUSS AT 5757 05:07:46,760 --> 05:07:48,280 THE NEXT MEETING EITHER RELATED 5758 05:07:48,280 --> 05:07:48,880 TO WHAT WE DISCUSSED TODAY OR 5759 05:07:48,880 --> 05:07:54,160 NOT. 5760 05:07:54,160 --> 05:07:57,440 ALSO SOME ACTION ITEMS. 5761 05:07:57,440 --> 05:07:59,040 MAYBE WE SHOULD START WITH THE 5762 05:07:59,040 --> 05:08:03,720 ACTION ITEMS. 5763 05:08:03,720 --> 05:08:09,200 I HEARD ONE POSSIBLE ACTION ITEM 5764 05:08:09,200 --> 05:08:12,960 OF TAKING THAT BIRD'S-EYE VIEW 5765 05:08:12,960 --> 05:08:17,760 LINDA PRESENTED THAT WAS MAINLY 5766 05:08:17,760 --> 05:08:21,360 WHAT'S GOING ON AT NIH IN 5767 05:08:21,360 --> 05:08:24,360 RESPONSE TO THE PAIN RESEARCH 5768 05:08:24,360 --> 05:08:26,000 STRATEGY AND MAYBE EXPANDING 5769 05:08:26,000 --> 05:08:27,640 THAT TO LOOK AT OTHER PLACES 5770 05:08:27,640 --> 05:08:33,760 WHERE RESEARCH IS OCCURRING. 5771 05:08:33,760 --> 05:08:34,960 WONDERING IF THIS IS SOMETHING 5772 05:08:34,960 --> 05:08:36,400 THE GROUP WOULD PERHAPS LIKE TO 5773 05:08:36,400 --> 05:08:38,920 FORM A GROUP TO DO THIS BECAUSE 5774 05:08:38,920 --> 05:08:40,640 THIS INFORMATION WILL BE COMING 5775 05:08:40,640 --> 05:08:41,200 FROM A VARIETY OF DIFFERENT 5776 05:08:41,200 --> 05:08:51,080 PLACES. 5777 05:08:51,080 --> 05:08:53,280 I THINK SOMEBODY VOLUNTEERED 5778 05:08:53,280 --> 05:08:55,080 ALREADY THIS MORNING OR WAS I 5779 05:08:55,080 --> 05:08:55,360 DREAMING? 5780 05:08:55,360 --> 05:09:00,640 DAVID. 5781 05:09:09,400 --> 05:09:13,240 >> I THINK THAT WOULD BE USEFUL. 5782 05:09:13,240 --> 05:09:15,240 SINCE IT STARTED WITH THE 5783 05:09:15,240 --> 05:09:16,720 COMMITTEE AND FOLLOWING IT OUT 5784 05:09:16,720 --> 05:09:19,600 AND SEEING THE PROGRESS AND 5785 05:09:19,600 --> 05:09:21,040 CONSOLIDATE FINDINGS AND 5786 05:09:21,040 --> 05:09:24,240 IDENTIFY WHERE THE GAPS STILL 5787 05:09:24,240 --> 05:09:24,480 REMAIN. 5788 05:09:24,480 --> 05:09:26,560 I THINK THAT WOULD BE A USEFUL 5789 05:09:26,560 --> 05:09:32,280 THING FOR THE COMMITTEE TO DO. 5790 05:09:32,280 --> 05:09:33,760 >> YEAH. 5791 05:09:33,760 --> 05:09:35,240 I THINK WE'LL FIND AREAS WHERE 5792 05:09:35,240 --> 05:09:37,120 THERE'S RESEARCH GOING ON IN 5793 05:09:37,120 --> 05:09:38,760 DOMAINS THAT DON'T KNOW ABOUT 5794 05:09:38,760 --> 05:09:46,320 EACH OTHER OR COULD KNOW MORE. 5795 05:09:46,320 --> 05:09:46,720 ALL RIGHT. 5796 05:09:46,720 --> 05:09:47,720 ANYBODY ELSE INTERESTED IN 5797 05:09:47,720 --> 05:09:48,920 WORKING ON THIS? 5798 05:09:48,920 --> 05:09:50,320 >> THIS IS JULIE. 5799 05:09:50,320 --> 05:09:52,960 I'D BE HAPPY TO HELP ON THAT 5800 05:09:52,960 --> 05:09:53,520 FRONT. 5801 05:09:53,520 --> 05:09:55,720 EVEN JUST SOME OF THE QUESTIONS 5802 05:09:55,720 --> 05:09:57,320 WE'RE ASKING BEFORE AS OUR 5803 05:09:57,320 --> 05:09:58,760 SECOND ACTION ITEM TO GENERATE 5804 05:09:58,760 --> 05:10:00,600 QUESTIONS FOR FUTURE MEETINGS OR 5805 05:10:00,600 --> 05:10:02,600 EVEN TO IDENTIFY POTENTIAL 5806 05:10:02,600 --> 05:10:04,000 NOMINEES FOR THE PANEL I THINK 5807 05:10:04,000 --> 05:10:08,320 ARE QUESTIONS WE CAN POSE TO A 5808 05:10:08,320 --> 05:10:10,040 LARGER GROUP AS WE TRY TO 5809 05:10:10,040 --> 05:10:12,280 COALESCE AROUND THE ANSWERS 5810 05:10:12,280 --> 05:10:21,240 BEING ANSWERED AND SO ON. 5811 05:10:21,240 --> 05:10:31,760 >> I'M HAPPY TO HELP IF I CAN. 5812 05:10:33,280 --> 05:10:34,080 YOU'RE HARD TO HEAR. 5813 05:10:34,080 --> 05:10:35,920 >> I'M SORRY. 5814 05:10:35,920 --> 05:10:38,160 AS WE MORE CLEAR PLAN HOW TO 5815 05:10:38,160 --> 05:10:39,720 MOVE FORWARD, WE CAN REACH OUT 5816 05:10:39,720 --> 05:10:44,920 MORE BROADLY TO THE FULL GROUP 5817 05:10:44,920 --> 05:10:49,920 AND SEE IF OTHER FOLKS CAN FIT 5818 05:10:49,920 --> 05:10:51,360 IN SPECIFIC COMPONENTS OF THAT 5819 05:10:51,360 --> 05:10:59,160 ACTION ITEM TO HELP OUT. 5820 05:10:59,160 --> 05:11:05,040 >> AND SO DEPENDING ON HOW THAT 5821 05:11:05,040 --> 05:11:08,840 GOES THAT COULD BE A TOPIC OR 5822 05:11:08,840 --> 05:11:10,400 THE NEXT MEETING POSSIBLY. 5823 05:11:10,400 --> 05:11:13,000 ARE THERE ANY OTHER TOPICS 5824 05:11:13,000 --> 05:11:14,840 PEOPLE WOULD LIKE TO PROPOSE OR 5825 05:11:14,840 --> 05:11:25,160 OTHER ACTION ITEMS? 5826 05:11:33,800 --> 05:11:36,320 >> I WAS GOING TO THROW 5827 05:11:36,320 --> 05:11:39,000 SOMETHING OUT BUT NOT SURE IT 5828 05:11:39,000 --> 05:11:40,120 WILL BE INTERESTING. 5829 05:11:40,120 --> 05:11:43,840 MAYBE JOSÉ CAN CHIME IN. 5830 05:11:43,840 --> 05:11:48,840 JUST LISTENING TO THE 5831 05:11:48,840 --> 05:11:50,520 PRESENTATIONS TODAY I THINK 5832 05:11:50,520 --> 05:11:52,880 WE'RE GOING TO BE FORCED TO GO 5833 05:11:52,880 --> 05:11:58,600 FROM SYSTEMIC MANIPULATION TO A 5834 05:11:58,600 --> 05:11:59,440 BEHAVIORAL OUTCOME WHICH WE 5835 05:11:59,440 --> 05:12:01,200 THINK IS RELATED TO CHANGE IN 5836 05:12:01,200 --> 05:12:06,000 THE PAIN CIRCUITS. 5837 05:12:06,000 --> 05:12:10,800 THE QUESTION I HAD IS WHETHER OR 5838 05:12:10,800 --> 05:12:15,200 NOT SOME DISCUSSION OF HOW DO WE 5839 05:12:15,200 --> 05:12:16,760 ASSESS THE PAIN CIRCUIT ACTIVITY 5840 05:12:16,760 --> 05:12:20,920 AS A CIRCUIT ACTIVITY OPPOSED TO 5841 05:12:20,920 --> 05:12:24,680 BEHAVIORAL MANIFESTATIONS WOULD 5842 05:12:24,680 --> 05:12:25,640 BE USEFUL. 5843 05:12:25,640 --> 05:12:27,120 IS MAYBE A LITTLE PREMATURE AND 5844 05:12:27,120 --> 05:12:32,600 IN TERMS OF WHAT WE'RE DOING IN 5845 05:12:32,600 --> 05:12:34,040 THE BRAIN INITIATIVE THAT'S THE 5846 05:12:34,040 --> 05:12:39,480 TOTAL FOCUS IS TRYING TO GET AT 5847 05:12:39,480 --> 05:12:46,480 THE CIRCUITS IN BETWEEN. 5848 05:12:46,480 --> 05:12:51,440 ANYWAY, THAT'S ON MY MIND. 5849 05:12:51,440 --> 05:12:53,040 I'M NOT SURE ABOUT THE 5850 05:12:53,040 --> 05:12:53,360 NEUROSCIENCE. 5851 05:12:53,360 --> 05:12:54,840 >> I THINK THAT'S A GOOD IDEA 5852 05:12:54,840 --> 05:12:58,080 AND GOOD QUESTION. 5853 05:12:58,080 --> 05:12:59,480 I DON'T KNOW HOW READY WE ARE IN 5854 05:12:59,480 --> 05:13:01,080 THE PAIN FIELD. 5855 05:13:01,080 --> 05:13:02,680 THIS IS SOMETHING THAT I DO A 5856 05:13:02,680 --> 05:13:04,480 LOT OF ADDICTION AND THAT'S WHAT 5857 05:13:04,480 --> 05:13:06,680 ADDICTION FIELD IS DOING RIGHT 5858 05:13:06,680 --> 05:13:08,320 NOW BECAUSE WE HAVE DIFFERENT 5859 05:13:08,320 --> 05:13:10,600 GOOD WAYS TO MEASURE THOSE 5860 05:13:10,600 --> 05:13:12,680 OUTCOMES. 5861 05:13:12,680 --> 05:13:15,000 WE HAVE GOOD POINTS TO RELATE TO 5862 05:13:15,000 --> 05:13:16,560 WHAT HAPPENS IN AN ANIMAL TO 5863 05:13:16,560 --> 05:13:17,680 WHAT HAPPENS IN A HUMAN BEING 5864 05:13:17,680 --> 05:13:19,720 WITHOUT TAKING DRUGS. 5865 05:13:19,720 --> 05:13:22,120 WITH PAIN IT'S DIFFICULT BECAUSE 5866 05:13:22,120 --> 05:13:26,320 IT'S MULTI-DIMENSIONAL AND AS 5867 05:13:26,320 --> 05:13:28,320 WHETHER YOU LOOK AT MOTIVATION, 5868 05:13:28,320 --> 05:13:32,840 ANXIETY, DAILY ACTIVITIES IS 5869 05:13:32,840 --> 05:13:35,280 SOMETHING WE SHOULD -- IT 5870 05:13:35,280 --> 05:13:38,720 DOESN'T MEAN WE CAN'T HAVE A 5871 05:13:38,720 --> 05:13:39,640 DISCUSSION BY DEFAULT. 5872 05:13:39,640 --> 05:13:42,040 EVEN PEOPLE WHO ARE NOT WORKING 5873 05:13:42,040 --> 05:13:46,360 IN THE PAIN FIELD ARE LOOKING AT 5874 05:13:46,360 --> 05:13:48,160 BRAIN MODULATION RELATED TO 5875 05:13:48,160 --> 05:13:50,520 OTHER CONDITIONS THAT COULD BE 5876 05:13:50,520 --> 05:14:01,040 HAPPY TO MOVE TO THE PAIN FIELD. 5877 05:14:02,480 --> 05:14:03,760 IT MAY TAKE SEVERAL MEETINGS AND 5878 05:14:03,760 --> 05:14:05,600 SEVERAL YEARS BUT WE HAVE TO 5879 05:14:05,600 --> 05:14:06,760 START THINKING ABOUT THAT. 5880 05:14:06,760 --> 05:14:08,120 I AGREE IT'S A GREAT IDEA. 5881 05:14:08,120 --> 05:14:13,240 YEAH. 5882 05:14:13,240 --> 05:14:15,240 >> I'D LIKE TO ASK A QUESTION 5883 05:14:15,240 --> 05:14:17,800 ABOUT PAIN CIRCUIT. 5884 05:14:17,800 --> 05:14:19,920 YOU'RE TALKING ABOUT NEURONAL 5885 05:14:19,920 --> 05:14:22,760 CIRCUITS I PRESUME. 5886 05:14:22,760 --> 05:14:28,960 I THINK IT'S CLEAR THOUGH THAT 5887 05:14:28,960 --> 05:14:34,440 THE NEURONAL CIRCUITS THERE'S IN 5888 05:14:34,440 --> 05:14:36,120 AN INTERNAL PIECE AND THERE'S AN 5889 05:14:36,120 --> 05:14:41,320 EXTERNAL PIECE OF WHAT'S GOING 5890 05:14:41,320 --> 05:14:44,080 ON AROUND THE NERVOUS SYSTEMS 5891 05:14:44,080 --> 05:14:49,000 IMPACTING THE CIRCUITS. 5892 05:14:49,000 --> 05:14:50,440 THEY'RE BOTH IMPORTANT. 5893 05:14:50,440 --> 05:14:56,960 THE PAIN CIRCUITS THEMSELVES AND 5894 05:14:56,960 --> 05:15:03,720 THEN INFLUENCED MODULATION 5895 05:15:03,720 --> 05:15:04,800 IMPACT ON OTHER SYSTEMS. 5896 05:15:04,800 --> 05:15:07,800 THAT WOULD BE INTERESTING. 5897 05:15:07,800 --> 05:15:15,680 >> I AGREE WITH YOU. 5898 05:15:15,680 --> 05:15:17,720 AND INTERESTED IN LOOKING AT THE 5899 05:15:17,720 --> 05:15:19,040 BRAIN STEM AND RESPIRATORY 5900 05:15:19,040 --> 05:15:20,720 BEHAVIORS IN OPIATES AND 5901 05:15:20,720 --> 05:15:23,560 OVERDOSES AND LOOKING AT THE 5902 05:15:23,560 --> 05:15:26,400 INPUTS FROM THE PERIPHERY AND WE 5903 05:15:26,400 --> 05:15:29,480 SEE THERE'S A LOT OF OPIOID 5904 05:15:29,480 --> 05:15:32,560 RECEPTOR THERE. 5905 05:15:32,560 --> 05:15:33,480 I THINK SOMETHING WE CAN FOCUS 5906 05:15:33,480 --> 05:15:36,400 LIKE START WITH THE BRAIN BUT 5907 05:15:36,400 --> 05:15:38,520 ANYTHING LIKE RELATED TO THE 5908 05:15:38,520 --> 05:15:40,600 SPINAL CORD AND THE PERIPHERAL 5909 05:15:40,600 --> 05:15:45,080 INPUTS AS WELL WOULD BE GREAT. 5910 05:15:45,080 --> 05:15:47,520 >> ON WHEN THE PERIPHERAL INPUTS 5911 05:15:47,520 --> 05:15:50,520 REFLECT THE STATUS OF THE 5912 05:15:50,520 --> 05:15:56,960 EXTERNAL ORGANS OUTSIDE NERVOUS 5913 05:15:56,960 --> 05:15:59,040 INPUT AND VAGAL INPUT IS 5914 05:15:59,040 --> 05:16:02,160 INFLUENCED BY THE GUT WE CANT 5915 05:16:02,160 --> 05:16:04,520 STOP AT THE VAGUS NERVE ITSELF. 5916 05:16:04,520 --> 05:16:14,760 IT'S A HUGE UNDERTAKING. 5917 05:16:14,760 --> 05:16:18,120 WE STARTED LOOKING AT THE 5918 05:16:18,120 --> 05:16:20,920 PERIPHERAL INPUTS COMING FROM 5919 05:16:20,920 --> 05:16:24,720 THE ORGANS AND YOU'RE TALKING 5920 05:16:24,720 --> 05:16:29,920 ABOUT THIS AND STARTING TO 5921 05:16:29,920 --> 05:16:35,280 UNDERSTAND THE CONVERSATION 5922 05:16:35,280 --> 05:16:39,840 BETWEEN THE PERIPHERAL NERVOUS 5923 05:16:39,840 --> 05:16:43,200 SYSTEM AND FOR THE BRAIN THE 5924 05:16:43,200 --> 05:16:44,800 SAME WILL BE TRUE REGARDLESS OF 5925 05:16:44,800 --> 05:16:45,360 WHICH PERIPHERAL TISSUE IS 5926 05:16:45,360 --> 05:16:55,400 INVOLVED. 5927 05:16:55,400 --> 05:16:59,440 WHETHER IT'S MUSCLE OR BLADDER 5928 05:16:59,440 --> 05:17:01,160 OR WHATEVER TISSUE IS 5929 05:17:01,160 --> 05:17:01,480 INNERVATED. 5930 05:17:01,480 --> 05:17:06,760 THERE'S A CONVERSATION GOING ON. 5931 05:17:06,760 --> 05:17:08,480 WHATEVER NEURONAL CIRCUITS ARE 5932 05:17:08,480 --> 05:17:09,960 INVOLVED IS NOT ISOLATED FROM 5933 05:17:09,960 --> 05:17:12,080 WHAT'S GOING ON OUTSIDE. 5934 05:17:12,080 --> 05:17:18,760 THE NERVOUS SYSTEM. 5935 05:17:18,760 --> 05:17:21,680 >> IF I MAY ADD. 5936 05:17:21,680 --> 05:17:25,280 WHAT I FOUND FRUSTRATING IS WHEN 5937 05:17:25,280 --> 05:17:26,600 I REALIZED AGAIN THAT IT'S 5938 05:17:26,600 --> 05:17:30,880 ABSENCE OF THE POSITIVE CHANGE 5939 05:17:30,880 --> 05:17:31,920 WHICH LEAD TO CHRONIC PAIN. 5940 05:17:31,920 --> 05:17:33,960 IT'S UNCLEAR WHAT WE SHOULD 5941 05:17:33,960 --> 05:17:34,160 LOOK. 5942 05:17:34,160 --> 05:17:38,120 IT'S LIKE WE NEED TO LOOK FOR 5943 05:17:38,120 --> 05:17:39,560 THE BLACK CAT WHEN IN THE DARK 5944 05:17:39,560 --> 05:17:41,280 ROOM WHEN THE CAT IS NOT THERE. 5945 05:17:41,280 --> 05:17:42,400 WE'RE LOOKING FOR SOMETHING 5946 05:17:42,400 --> 05:17:48,360 WHICH IS ABSENT ON OUR PATIENT. 5947 05:17:48,360 --> 05:17:53,040 ON THE LEVEL OF NEURONAL 5948 05:17:53,040 --> 05:17:54,400 CIRCUITRY THERE MUST BE SOME 5949 05:17:54,400 --> 05:17:57,680 NEURONAL CIRCUITRY INVOLVED BUT 5950 05:17:57,680 --> 05:18:00,120 EVERYTHING WHICH HAS HAPPENED 5951 05:18:00,120 --> 05:18:01,200 BEFORE IS ABSENCE OF ADAPTIVE 5952 05:18:01,200 --> 05:18:06,480 PROCESSES. 5953 05:18:06,480 --> 05:18:08,160 >> DO YOU THINK THE THING THAT'S 5954 05:18:08,160 --> 05:18:10,640 ABSENT IS LIKELY TO BE IN THE 5955 05:18:10,640 --> 05:18:11,760 NERVOUS SYSTEM OR OUTSIDE THE 5956 05:18:11,760 --> 05:18:13,960 NERVOUS SYSTEM OR BOTH? 5957 05:18:13,960 --> 05:18:16,000 >> I THINK BOTH. 5958 05:18:16,000 --> 05:18:22,760 IN THE END NEURONS SHOULD BE 5959 05:18:22,760 --> 05:18:32,400 INVOLVED THEY SHOULD SENSE THE 5960 05:18:32,400 --> 05:18:35,280 SIGNAL AND NEURON INVOLVED BUT 5961 05:18:35,280 --> 05:18:36,880 IMMUNE SYSTEM PLAYING A VERY 5962 05:18:36,880 --> 05:18:47,160 IMPORTANT ROLE. 5963 05:18:48,960 --> 05:18:52,440 WE MUST THINK OF AN ANIMAL MODEL 5964 05:18:52,440 --> 05:18:56,000 BECAUSE IT'S MORE ACUTE THAN 5965 05:18:56,000 --> 05:18:56,320 CHRONIC. 5966 05:18:56,320 --> 05:18:59,240 THE RESPONSE IN WHICH WE MEASURE 5967 05:18:59,240 --> 05:19:01,960 THEY ALMOST ALWAYS ACUTE EVEN 5968 05:19:01,960 --> 05:19:04,320 WHEN WE LOOK FOR NEUROPATHIC 5969 05:19:04,320 --> 05:19:07,320 PAIN AND MAYBE PARTICULARLY IN 5970 05:19:07,320 --> 05:19:08,560 NEUROPATHIC PAIN IT'S ALL TRUE 5971 05:19:08,560 --> 05:19:14,800 AND IT CONTINUES. 5972 05:19:14,800 --> 05:19:18,560 AND NOW I'M LOOKING FOR AN 5973 05:19:18,560 --> 05:19:20,200 EXPRESSION AND I FOUND AN 5974 05:19:20,200 --> 05:19:23,840 THERE'S A FEW PAPERS IN THIS IF 5975 05:19:23,840 --> 05:19:30,560 I LOOK AT THE SHAM SURGERY AND 5976 05:19:30,560 --> 05:19:33,680 NEUROPATHIC MODEL I SEE MORE 5977 05:19:33,680 --> 05:19:34,840 GOING IN THE SURGERY IN TERMS OF 5978 05:19:34,840 --> 05:19:41,320 GENE EXPRESSION. 5979 05:19:41,320 --> 05:19:42,720 THERE'S MORE ACTIVITY IN THE 5980 05:19:42,720 --> 05:19:47,480 SHAM SURGERY. 5981 05:19:47,480 --> 05:19:58,000 THERE'S MAYBE MORE ACTIVITY IN 5982 05:19:59,920 --> 05:20:02,440 THE SYSTEM AND IF WE PREVENT 5983 05:20:02,440 --> 05:20:04,760 THIS AND ADAPTATION DOES NOT 5984 05:20:04,760 --> 05:20:05,040 HAPPEN. 5985 05:20:05,040 --> 05:20:08,680 >> I AGREE WITH LUDA THIS IS 5986 05:20:08,680 --> 05:20:12,520 LIKE GOING TO BE INTERACTIONS 5987 05:20:12,520 --> 05:20:19,040 BETWEEN PERIPHERAL AND CENTRAL 5988 05:20:19,040 --> 05:20:25,440 AND WE'RE LOOKING AT THE VAGAL 5989 05:20:25,440 --> 05:20:30,560 INPUT AND WE CAN SEE HOW TO 5990 05:20:30,560 --> 05:20:31,640 MANIPULATE THAT AND ONE PART 5991 05:20:31,640 --> 05:20:34,680 GOES TO THE ORGAN AND ONE TO THE 5992 05:20:34,680 --> 05:20:39,440 BRAIN THEM AND WE CAN CHANGE THE 5993 05:20:39,440 --> 05:20:41,840 ACTIVITY OF THE NEURONS AN BRAIN 5994 05:20:41,840 --> 05:20:45,040 STEM AND IT WILL AFFECT OTHER 5995 05:20:45,040 --> 05:20:48,680 CIRCUITRY IN THE BRAIN AND SO 5996 05:20:48,680 --> 05:20:50,720 WHAT WE SEE IS THE DISRUPTION IN 5997 05:20:50,720 --> 05:20:55,400 THE CONNECTIVITY BETWEEN THE 5998 05:20:55,400 --> 05:20:58,320 GANGLIA AND THE BRAIN STEM AND 5999 05:20:58,320 --> 05:20:59,160 THERE'S SOMETHING MISSING AND 6000 05:20:59,160 --> 05:21:04,880 THE PAIN IS DOING THAT AND IT'S 6001 05:21:04,880 --> 05:21:06,600 GOING TO CREATE DIFFERENT 6002 05:21:06,600 --> 05:21:08,480 AFFECTS AT DIFFERENT POINTS. 6003 05:21:08,480 --> 05:21:11,400 THIS INTERACTION BETWEEN THE 6004 05:21:11,400 --> 05:21:11,920 PERIPHERY AND CENTRAL 6005 05:21:11,920 --> 05:21:12,800 INFORMATION SYSTEM IS THE FUTURE 6006 05:21:12,800 --> 05:21:23,160 FOR US TO UNDERSTAND. 6007 05:21:30,000 --> 05:21:33,600 >> RIGHT NOW THIS IS WHAT I 6008 05:21:33,600 --> 05:21:34,080 HAVE. 6009 05:21:34,080 --> 05:21:37,360 ME, FOR EXAMPLE, I WOULD LIKE TO 6010 05:21:37,360 --> 05:21:46,840 LOOK AT THE MODEL OF DEXAME 6011 05:21:46,840 --> 05:21:48,120 DEXAMETHASONE USE BECAUSE A 6012 05:21:48,120 --> 05:21:49,920 MODEL OF CHRONIC PAIN FROM A 6013 05:21:49,920 --> 05:21:51,040 COMBINATION OF INJURY AND 6014 05:21:51,040 --> 05:22:01,520 INHIBITION OF IMMUNE RESPONSE. 6015 05:22:03,640 --> 05:22:09,840 AFTER LEAST IN HUMAN WE COLLECT 6016 05:22:09,840 --> 05:22:14,880 SAMPLES IN HUMAN AND WITHOUT 6017 05:22:14,880 --> 05:22:19,440 ANIMAL WE CANNOT VALIDATE ANY OF 6018 05:22:19,440 --> 05:22:24,040 OUR HYPOTHESIS. 6019 05:22:24,040 --> 05:22:27,560 WE NEED ANIMALS AND I VOTE TO 6020 05:22:27,560 --> 05:22:29,600 THINK CAREFULLY THE ACUTE AND 6021 05:22:29,600 --> 05:22:30,200 CHRONIC PAIN IS TWO DIFFERENT 6022 05:22:30,200 --> 05:22:37,920 THINGS. 6023 05:22:37,920 --> 05:22:39,960 >> PEOPLE NEED TO REMEMBER 6024 05:22:39,960 --> 05:22:42,840 CIRCUITS ARE NOT STATIC. 6025 05:22:42,840 --> 05:22:45,400 IN MY LARGE ANIMAL MODEL LOOKING 6026 05:22:45,400 --> 05:22:54,680 AT BLADDER REINNERVATION THE 6027 05:22:54,680 --> 05:22:58,520 VAGAL SERVES ALTER AND I WANT OF 6028 05:22:58,520 --> 05:23:03,680 WASN'T DOING ANYTHING, SO I 6029 05:23:03,680 --> 05:23:06,880 THOUGHT, AND CIRCUITRY CHANGED. 6030 05:23:06,880 --> 05:23:11,960 AND THE ANIMALS HAVE A LOT OF 6031 05:23:11,960 --> 05:23:18,400 COGNITIVE COMING FROM HERE AND I 6032 05:23:18,400 --> 05:23:28,920 CAN DE-EFFERENT DOWN HERE BUT 6033 05:23:30,840 --> 05:23:32,120 MICHTERATION IS LIFE. 6034 05:23:32,120 --> 05:23:35,760 >> IT'S REWIRING WITH PAIN AND 6035 05:23:35,760 --> 05:23:37,200 THE BRAIN REWIRES. 6036 05:23:37,200 --> 05:23:39,480 >> POSITIVE OR NEGATIVE. 6037 05:23:39,480 --> 05:23:47,120 >> ONE WAY OR ANOTHER. 6038 05:23:47,120 --> 05:23:47,680 >> IT REQUIRES INFLAMMATORY 6039 05:23:47,680 --> 05:23:51,560 CELLS. 6040 05:23:51,560 --> 05:23:54,560 >> WALTER, NICE. 6041 05:23:54,560 --> 05:23:56,200 >> I'M PERFECTLY SERIOUS. 6042 05:23:56,200 --> 05:24:06,480 IT'S COMPLICATED. 6043 05:24:13,320 --> 05:24:14,080 >> THANK YOU. 6044 05:24:14,080 --> 05:24:16,040 THAT WAS A FUN DISCUSSION. 6045 05:24:16,040 --> 05:24:17,160 >> MAY I GO. 6046 05:24:17,160 --> 05:24:19,800 I HAVE TO TAKE CARE OF OTHER 6047 05:24:19,800 --> 05:24:20,040 THINGS. 6048 05:24:20,040 --> 05:24:25,680 >> THANK YOU BOTH FOR STAYING. 6049 05:24:25,680 --> 05:24:27,080 GOOD LUCK IN ALL YOU DO. 6050 05:24:27,080 --> 05:24:37,480 THANK YOU FOR YOUR WORK. 6051 05:24:42,600 --> 05:24:44,880 >> ONE THOUGHT IS TO PUT A GROUP 6052 05:24:44,880 --> 05:24:46,920 FOR A SET OF RECOMMENDATIONS AND 6053 05:24:46,920 --> 05:24:50,000 ANOTHER IS TO THINK ABOUT A 6054 05:24:50,000 --> 05:24:52,080 WORKSHOP TO BEGIN TO THINK OF 6055 05:24:52,080 --> 05:24:54,720 WHERE WE ARE AN WHERE TO GO FOR 6056 05:24:54,720 --> 05:24:58,040 ASSESSING CIRCUIT ACTIVITY. 6057 05:24:58,040 --> 05:24:59,840 OR A SERIOUS OF WORKSHOPS OVER 6058 05:24:59,840 --> 05:25:00,040 TIME. 6059 05:25:00,040 --> 05:25:02,080 IS THAT WHAT YOU WERE THINKING 6060 05:25:02,080 --> 05:25:04,440 WALTER AS A STARTING POINT TO 6061 05:25:04,440 --> 05:25:06,760 PULL TOGETHER SOME FOLKS FROM 6062 05:25:06,760 --> 05:25:08,720 OUTSIDE THE PAIN FIELD AND SEE 6063 05:25:08,720 --> 05:25:10,120 WHAT THEY'RE DOING THAT COULD BE 6064 05:25:10,120 --> 05:25:10,600 APPLIED AND START THE 6065 05:25:10,600 --> 05:25:20,840 CONVERSATION. 6066 05:25:34,040 --> 05:25:36,560 >> CAN WE CALL ON YOU FOR 6067 05:25:36,560 --> 05:25:36,840 SUGGESTIONS. 6068 05:25:36,840 --> 05:25:37,800 >> HAPPY TO DO THIS. 6069 05:25:37,800 --> 05:25:43,560 YEP. 6070 05:25:45,440 --> 05:25:48,760 >> HELENE, IF THERE'S NOTHING 6071 05:25:48,760 --> 05:25:50,480 ELSE OR COMMENTS I CAN MENTION 6072 05:25:50,480 --> 05:25:51,080 BRIEFLY THE COMMENT PUBLIC WE 6073 05:25:51,080 --> 05:25:57,640 RECEIVED. 6074 05:25:57,640 --> 05:25:58,000 >> SURE. 6075 05:25:58,000 --> 05:26:01,960 >> VERY RELEVANT TO THIS 6076 05:26:01,960 --> 05:26:02,560 CONVERSATION. 6077 05:26:02,560 --> 05:26:04,600 >> AND BY COINCIDENCE. 6078 05:26:04,600 --> 05:26:10,240 >> THE AGENDA WAS NOT DEVELOPED 6079 05:26:10,240 --> 05:26:19,320 BEFORE THIS CAME IN. 6080 05:26:19,320 --> 05:26:24,120 >> YOU ALL HAVE THE PUBLIC 6081 05:26:24,120 --> 05:26:28,480 COMMENT WRITTEN I DISTRIBUTED 6082 05:26:28,480 --> 05:26:29,480 JUST YESTERDAY. 6083 05:26:29,480 --> 05:26:31,920 WE TYPICALLY DO NOT READ OR 6084 05:26:31,920 --> 05:26:33,200 PRESENT THEM AS ORAL COMMENTS 6085 05:26:33,200 --> 05:26:35,400 UNLESS THEY'RE REQUESTED AS ORAL 6086 05:26:35,400 --> 05:26:38,120 COMMENTS AND THEN THEY ARE 6087 05:26:38,120 --> 05:26:40,600 PRE-REVIEWED FOR PRESENTATION AT 6088 05:26:40,600 --> 05:26:44,040 THE IRPCC MEETING. 6089 05:26:44,040 --> 05:26:45,560 WE DO DISTRIBUTE THEM TO THE 6090 05:26:45,560 --> 05:26:46,760 MEMBERS AND I CAN BRIEFLY SAY 6091 05:26:46,760 --> 05:26:48,120 FOR THOSE WHO HAVEN'T LOOKED AT 6092 05:26:48,120 --> 05:26:55,360 THEM YET THE TOPIC AREA IS 6093 05:26:55,360 --> 05:27:05,280 NSAIDS AND SUBMITTED BY 6094 05:27:05,280 --> 05:27:15,240 ELIZABETH BREWER WHO HAD TALKED 6095 05:27:15,240 --> 05:27:23,360 ABOUT WHAT PARTICULAR PRODUCTS 6096 05:27:23,360 --> 05:27:25,600 HELLEON PRODUCTS THAT ARE KNOWN 6097 05:27:25,600 --> 05:27:27,920 TO US AND THE EVIDENCE BASE AND 6098 05:27:27,920 --> 05:27:30,400 THE FREQUENT USE FOR DIFFERENT 6099 05:27:30,400 --> 05:27:31,640 TYPES OF CHRONIC PAIN THAT THESE 6100 05:27:31,640 --> 05:27:34,720 PRODUCTS ARE USED FOR. 6101 05:27:34,720 --> 05:27:36,480 SO ENCOURAGE EVERYBODY TO HAVE A 6102 05:27:36,480 --> 05:27:40,440 LOOK AT THEM IF YOU WANT TO SEND 6103 05:27:40,440 --> 05:27:43,800 COMMENTS TO US, WE'RE HAPPY TO 6104 05:27:43,800 --> 05:27:46,400 RELAY THEM BACK TO THE COMPANY 6105 05:27:46,400 --> 05:27:50,360 OR WE COULD PROBABLY CONNECT 6106 05:27:50,360 --> 05:27:51,400 THEM DIRECTLY. 6107 05:27:51,400 --> 05:27:52,200 THEIR CONTACT INFORMATION IS IN 6108 05:27:52,200 --> 05:27:59,480 THE DOCUMENT. 6109 05:27:59,480 --> 05:28:01,360 WITH THAT, HELENE, BACK TO YOU 6110 05:28:01,360 --> 05:28:08,920 FOR ADJOURNMENT, I GUESS. 6111 05:28:08,920 --> 05:28:10,840 >> I'M VERY HAPPY WITH THIS 6112 05:28:10,840 --> 05:28:11,720 MEETING. 6113 05:28:11,720 --> 05:28:15,360 I THINK WE COVERED A LOT. 6114 05:28:15,360 --> 05:28:17,920 I LOOK FORWARD TO CONNECTING 6115 05:28:17,920 --> 05:28:20,200 WITH A COUPLE MEMBERS THAT I 6116 05:28:20,200 --> 05:28:24,480 HAVE NOT YET CONNECTED WITH IN 6117 05:28:24,480 --> 05:28:26,400 THE MEANTIME WE'LL GET BACK TO 6118 05:28:26,400 --> 05:28:32,440 YOU REGARDING THE ACTION ITEMS 6119 05:28:32,440 --> 05:28:43,160 THAT LINDA OUTLINED AND FEEDBACK 6120 05:28:43,160 --> 05:28:45,160 AND SO THE NEXT MEETING -- DO WE 6121 05:28:45,160 --> 05:28:45,840 HAVE A SCHEDULE? 6122 05:28:45,840 --> 05:28:47,560 >> WE DON'T HAVE A SPECIFIC 6123 05:28:47,560 --> 05:28:47,960 DATE. 6124 05:28:47,960 --> 05:28:50,560 TYPICALLY WE HAVE A SHORTER 6125 05:28:50,560 --> 05:28:55,280 MEETING IN THE LATE SPRING/EARLY 6126 05:28:55,280 --> 05:28:56,960 SUMMER JUNE TIME FRAME WHICH IS 6127 05:28:56,960 --> 05:28:58,160 ABOUT TWO AND A HALF HOURS. 6128 05:28:58,160 --> 05:29:02,240 WE CAN BE FLEXIBLE WITH THAT AND 6129 05:29:02,240 --> 05:29:03,840 THE NEXT FULL MEETING WILL BE 6130 05:29:03,840 --> 05:29:06,240 USUALLY IN THE OCTOBER/NOVEMBER 6131 05:29:06,240 --> 05:29:08,360 TIME FRAME IS WHAT WE'VE BEEN 6132 05:29:08,360 --> 05:29:08,640 DOING. 6133 05:29:08,640 --> 05:29:10,920 WE'LL TRY TO GET THE DATES 6134 05:29:10,920 --> 05:29:13,640 SCHEDULED AND INFORMATION OUT TO 6135 05:29:13,640 --> 05:29:14,920 THE COMMITTEE SO THAT YOU CAN 6136 05:29:14,920 --> 05:29:17,720 PUT TIMES ON HOLD. 6137 05:29:17,720 --> 05:29:21,360 IT'S DIFFICULT TO GET EVEN THE 6138 05:29:21,360 --> 05:29:23,160 INSTITUTE DIRECTORS TO HAVE AN 6139 05:29:23,160 --> 05:29:24,080 OPEN DATE. 6140 05:29:24,080 --> 05:29:25,440 WE'LL DO OUR BEST TO MAKE SURE 6141 05:29:25,440 --> 05:29:28,680 WE'RE AVOIDING BIG MEETINGS OR 6142 05:29:28,680 --> 05:29:30,200 SCHOOL BREAKS OR SOMETHING ALONG 6143 05:29:30,200 --> 05:29:31,600 THOSE LINES AND HOPE EVERYBODY 6144 05:29:31,600 --> 05:29:34,640 CAN HOLD THE DATES ON THOSE. 6145 05:29:34,640 --> 05:29:37,240 >> ALWAYS BLAME IT ON US. 6146 05:29:37,240 --> 05:29:40,920 >> WE ALWAYS BLAME THE I.C. 6147 05:29:40,920 --> 05:29:41,280 DIRECTORS. 6148 05:29:41,280 --> 05:29:42,840 >> THAT'S RIGHT. 6149 05:29:42,840 --> 05:29:48,480 I THINK AS A COMMITTEE, I THINK 6150 05:29:48,480 --> 05:29:51,640 WE CAN FEEL GOOD ABOUT THE 6151 05:29:51,640 --> 05:29:52,960 COMMITTEE IMPACTFUL. 6152 05:29:52,960 --> 05:29:55,920 I THINK IT'S CLEAR IF YOU JUST 6153 05:29:55,920 --> 05:30:05,480 LOOK AT WHAT HAS HAPPENED FROM 6154 05:30:05,480 --> 05:30:11,400 THE OUTPUT OF GOING THROUGH THE 6155 05:30:11,400 --> 05:30:12,920 RECOMMENDATIONS FROM THE FEDERAL 6156 05:30:12,920 --> 05:30:14,320 PAIN RESEARCH SO WHAT'S BEEN 6157 05:30:14,320 --> 05:30:16,040 ACCOMPLISHED IN A RELATIVELY 6158 05:30:16,040 --> 05:30:17,680 SHORT AMOUNT OF TIME IF YOU 6159 05:30:17,680 --> 05:30:19,320 THINK ABOUT IT, IT'S FIVE YEARS, 6160 05:30:19,320 --> 05:30:25,560 I THINK IT CAN MAKE US VERY 6161 05:30:25,560 --> 05:30:29,160 OPTIMISTIC THAT THIS IS NOT JUST 6162 05:30:29,160 --> 05:30:31,120 IDLE -- A LOT OF TIMES I THINK 6163 05:30:31,120 --> 05:30:32,800 WHEN A LOT OF ACTIVITY HAPPENS 6164 05:30:32,800 --> 05:30:35,400 THERE'S A WORRY IT'S JUST GOING 6165 05:30:35,400 --> 05:30:37,160 TO BE CHURNING AND I THINK WHAT 6166 05:30:37,160 --> 05:30:40,720 WE'RE SEEING DOES NOT FEEL LIKE 6167 05:30:40,720 --> 05:30:41,080 THAT. 6168 05:30:41,080 --> 05:30:44,520 IT FEELS VERY PURPOSEFUL AND YOU 6169 05:30:44,520 --> 05:30:47,320 HAVE TO STEP AWAY TO SEE THE 6170 05:30:47,320 --> 05:30:48,680 STRUCTURE. 6171 05:30:48,680 --> 05:30:50,720 HOPEFULLY WHAT WE'RE GOING SEE 6172 05:30:50,720 --> 05:30:53,520 NEXT TIME IS GOING TO BE EVEN 6173 05:30:53,520 --> 05:30:54,640 MORE REVEALING AND WE LOOK 6174 05:30:54,640 --> 05:30:59,840 FORWARD TO THAT. 6175 05:30:59,840 --> 05:31:00,560 WALTER, ANY THOUGHTS? 6176 05:31:00,560 --> 05:31:03,240 >> NO, YOU SAID IT ALL. 6177 05:31:03,240 --> 05:31:05,480 THANK YOU, HELENE, AND THANK YOU 6178 05:31:05,480 --> 05:31:06,040 EVERYONE FOR YOUR INPUT AND 6179 05:31:06,040 --> 05:31:09,200 ADVICE. 6180 05:31:09,200 --> 05:31:09,800 >> GREAT. 6181 05:31:09,800 --> 05:31:11,680 UNTIL NEXT TIME, THANKS SO MUCH. 6182 05:31:11,680 --> 05:31:13,640 >> THANK YOU. 6183 05:31:13,640 --> 05:31:14,920 >> HAVE A GOOD EVENING. 6184 05:31:14,920 --> 05:31:25,080 BYE-BYE.