1 00:00:05,840 --> 00:00:07,080 >> I'M DANIEL JOHNSTON, 2 00:00:07,080 --> 00:00:10,440 ACTING CHIEF OF THE 3 00:00:10,440 --> 00:00:12,160 GYNECOLOGIC HEALTH AND DISEASE 4 00:00:12,160 --> 00:00:15,600 BRANCH AT THE NICHD, ALSO CHIEF 5 00:00:15,600 --> 00:00:16,600 OF THE CONTRACEPTION RESEARCH 6 00:00:16,600 --> 00:00:16,840 BRANCH. 7 00:00:16,840 --> 00:00:19,320 I'D LIKE TO WELCOME YOU TODAY TO 8 00:00:19,320 --> 00:00:21,400 THE SYMPOSIUM HOT TOPICS AND 9 00:00:21,400 --> 00:00:23,280 EMERGING TRENDS IN GYNECOLOGIC 10 00:00:23,280 --> 00:00:24,520 PAIN RESEARCH, THE NICHD STAFF 11 00:00:24,520 --> 00:00:27,200 IS EXCITED TO HEAR PRESENTATIONS 12 00:00:27,200 --> 00:00:29,320 AND LISTEN TO DISCUSSIONS. 13 00:00:29,320 --> 00:00:31,520 BRIEFLY THE BRANCH WAS FOUNDED 14 00:00:31,520 --> 00:00:35,160 IN 2012, IT WAS LED BY DR. LISA 15 00:00:35,160 --> 00:00:37,320 HALVERSON FROM 2014 UNTIL 16 00:00:37,320 --> 00:00:38,520 OCTOBER OF LAST YEAR. 17 00:00:38,520 --> 00:00:41,000 A DEFINED FOCUS ON GYNECOLOGIC 18 00:00:41,000 --> 00:00:42,920 PAIN IS RELATIVELY NEW FOR THE 19 00:00:42,920 --> 00:00:43,560 GYNECOLOGIC HEALTH AND DISEASE 20 00:00:43,560 --> 00:00:46,520 BRANCH, AN AREA THE BRANCH FEELS 21 00:00:46,520 --> 00:00:50,240 STRONGLY ABOUT AND IS EXCITED 22 00:00:50,240 --> 00:00:50,920 ABOUT. 23 00:00:50,920 --> 00:00:53,720 SUPPORT FROM NICHD MANAGEMENT IS 24 00:00:53,720 --> 00:00:55,160 CLEAR BOTH DEMONSTRATED BY THE 25 00:00:55,160 --> 00:00:58,560 HIRING OF A PROGRAM OFFICER, 26 00:00:58,560 --> 00:01:00,440 SPECIFICALLY FOR THIS AREA, DR. 27 00:01:00,440 --> 00:01:04,280 HELENA AHN WHO YOU'LL HEAR FROM 28 00:01:04,280 --> 00:01:05,800 SHORTLY, ALSO IN ALLOWING US TO 29 00:01:05,800 --> 00:01:07,000 HAVE THE WORKSHOP. 30 00:01:07,000 --> 00:01:08,840 I WANT TO COVER WHAT ARE WE 31 00:01:08,840 --> 00:01:10,520 TRYING TO GET OUT OF THIS 32 00:01:10,520 --> 00:01:11,280 MEETING, WHAT IS THE NIH 33 00:01:11,280 --> 00:01:12,480 INTERESTED IN. 34 00:01:12,480 --> 00:01:14,240 FIRST, WE WANT TO UNDERSTAND 35 00:01:14,240 --> 00:01:16,040 GENERAL INTEREST IN THIS AREA, 36 00:01:16,040 --> 00:01:18,720 IT'S CLEAR INTEREST IS HIGH. 37 00:01:18,720 --> 00:01:20,520 THERE ARE OVER 200 PERSONS 38 00:01:20,520 --> 00:01:22,160 REGISTERED FOR THIS MEETING. 39 00:01:22,160 --> 00:01:22,920 THAT'S EXCEPTIONAL. 40 00:01:22,920 --> 00:01:25,520 WE WANT TO SHARE SOME SCIENCE 41 00:01:25,520 --> 00:01:27,640 AND GYNECOLOGIC PAIN WE FIND 42 00:01:27,640 --> 00:01:28,520 INTERESTING. 43 00:01:28,520 --> 00:01:29,920 WE WANT TO STIMULATE DISCUSSION. 44 00:01:29,920 --> 00:01:32,080 WE WANT TO HEAR THAT DISCUSSION. 45 00:01:32,080 --> 00:01:34,480 AND I THINK ALL THAT IS PROBABLY 46 00:01:34,480 --> 00:01:34,720 OBVIOUS. 47 00:01:34,720 --> 00:01:35,920 I THINK THERE'S ANOTHER 48 00:01:35,920 --> 00:01:38,320 OBJECTIVE, THAT IS THAT WE WANT 49 00:01:38,320 --> 00:01:42,960 TO KNOW AND FEEL COMFORTABLE 50 00:01:42,960 --> 00:01:43,680 COMMUNICATING WITH THE GHDB 51 00:01:43,680 --> 00:01:44,200 PROGRAM STAFF. 52 00:01:44,200 --> 00:01:45,720 PART OF THE OUR JOB IS TO 53 00:01:45,720 --> 00:01:48,800 UNDERSTAND THE SCIENCE IN THE 54 00:01:48,800 --> 00:01:51,120 AREA, UNDERSTAND WHERE THE FIELD 55 00:01:51,120 --> 00:01:52,960 IS PRIMED TO GO, AND FACILITATE 56 00:01:52,960 --> 00:01:56,120 THE OPENING UP OF NEW AREAS OF 57 00:01:56,120 --> 00:01:57,680 GYNECOLOGIC PAIN AND CERTAIN 58 00:01:57,680 --> 00:01:58,880 WITHIN GYNECOLOGIC PAIN. 59 00:01:58,880 --> 00:02:01,800 PART OF THE JOY OF OUR POSITIONS 60 00:02:01,800 --> 00:02:04,120 AT THE NICHD AND NIH IS 61 00:02:04,120 --> 00:02:06,040 UNDERSTAND A VERY BROAD RANGE OF 62 00:02:06,040 --> 00:02:06,280 SCIENCE. 63 00:02:06,280 --> 00:02:07,080 WE SEE A LOT. 64 00:02:07,080 --> 00:02:10,360 WE HEAR A LOT FROM THE 65 00:02:10,360 --> 00:02:14,160 APPLICATIONS AND MEETINGS WE 66 00:02:14,160 --> 00:02:14,400 ATTEND. 67 00:02:14,400 --> 00:02:17,200 BUT WE ALSO WANT TO HEAR FROM 68 00:02:17,200 --> 00:02:19,160 PEOPLE IN THE FIELD OUTSIDE OF 69 00:02:19,160 --> 00:02:19,600 SCIENTIFIC MEETINGS. 70 00:02:19,600 --> 00:02:21,800 WE WANT YOU TO FEEL COMFORTABLE 71 00:02:21,800 --> 00:02:23,440 COMMUNICATING WITH US NOT JUST 72 00:02:23,440 --> 00:02:23,880 TODAY, THROUGH YOUR 73 00:02:23,880 --> 00:02:27,960 APPLICATIONS, BUT AT MEETINGS, 74 00:02:27,960 --> 00:02:29,160 REACHING OUT TO COMMUNICATE. 75 00:02:29,160 --> 00:02:30,120 IT'S IMPORTANT FOR THE FIELD AND 76 00:02:30,120 --> 00:02:31,320 TO HELP US UNDERSTAND WHERE THE 77 00:02:31,320 --> 00:02:33,360 FIELD IS, WHERE THE FIELD IS 78 00:02:33,360 --> 00:02:35,880 PRIMED TO GO, AND HOW WE SHOULD 79 00:02:35,880 --> 00:02:37,520 BE THINKING ABOUT ASSISTING THE 80 00:02:37,520 --> 00:02:37,920 FIELD. 81 00:02:37,920 --> 00:02:39,400 WITH THAT, I'D LIKE TO GIVE 82 00:02:39,400 --> 00:02:41,960 CONTROL TO DR. HELENA AHN, 83 00:02:41,960 --> 00:02:43,760 GYNECOLOGIC HEALTH AND DISEASE 84 00:02:43,760 --> 00:02:45,160 PROGRAM OFFICER, WITH 85 00:02:45,160 --> 00:02:47,560 RESPONSIBILITY FOR THE 86 00:02:47,560 --> 00:02:54,520 GYNECOLOGIC PAIN PORTFOLIO. 87 00:02:54,520 --> 00:02:55,120 HELENA? 88 00:02:55,120 --> 00:02:56,840 >> THANK YOU, DR. JOHNSTON. 89 00:02:56,840 --> 00:03:07,040 I WILL SHARE MY SCREEN. 90 00:03:07,040 --> 00:03:09,960 CAN YOU SEE MY SCREEN? 91 00:03:09,960 --> 00:03:14,240 >> YES. 92 00:03:14,240 --> 00:03:18,200 93 00:03:18,200 --> 00:03:22,920 94 00:03:22,920 --> 00:03:30,200 95 00:03:30,200 --> 00:03:30,320 96 00:03:30,320 --> 00:03:34,680 >> SORRY. 97 00:03:34,680 --> 00:03:36,880 THANK YOU FOR JOINING THE 98 00:03:36,880 --> 00:03:38,320 GYNECOLOGY PAIN RESEARCH VIRTUAL 99 00:03:38,320 --> 00:03:39,640 MEETING TODAY. 100 00:03:39,640 --> 00:03:43,560 I'M HELENA AHN, PROGRAM OFFICER 101 00:03:43,560 --> 00:03:45,600 IN THE GYNECOLOGY DISEASE 102 00:03:45,600 --> 00:03:46,040 BRANCH. 103 00:03:46,040 --> 00:03:48,920 DID I TURN ON MY CAMERA? 104 00:03:48,920 --> 00:03:51,960 MAYBE NOT. 105 00:03:51,960 --> 00:03:55,040 106 00:03:55,040 --> 00:04:02,240 I'LL GO AHEAD. 107 00:04:02,240 --> 00:04:05,320 SO FIRST I WOULD LIKE TO LET YOU 108 00:04:05,320 --> 00:04:08,320 KNOW THE TECHNICAL CONSIDERATION 109 00:04:08,320 --> 00:04:09,680 FOR THIS MEETING. 110 00:04:09,680 --> 00:04:13,720 THIS MEETING IS BEING RECORDED. 111 00:04:13,720 --> 00:04:14,720 A RECORDING WITH SPEAKERS 112 00:04:14,720 --> 00:04:16,120 APPROVAL AND MEETING SUMMARY 113 00:04:16,120 --> 00:04:17,880 WILL BE POSTED ON THE WEBSITE 114 00:04:17,880 --> 00:04:20,320 AFTER THIS MEETING, ON THE GHDB 115 00:04:20,320 --> 00:04:20,560 WEBSITE. 116 00:04:20,560 --> 00:04:25,280 CLOSED CAPTIONING WILL BE 117 00:04:25,280 --> 00:04:26,280 AUTOMATICALLY GENERATED, TITLES 118 00:04:26,280 --> 00:04:28,560 VIEWED AT THE BOTTOM OF THE 119 00:04:28,560 --> 00:04:28,800 SCREEN. 120 00:04:28,800 --> 00:04:30,520 FOR ATTENDEES CAMERAS WILL BE 121 00:04:30,520 --> 00:04:35,800 TURNED OFF. 122 00:04:35,800 --> 00:04:37,200 LINES WILL REMAIN MUTED. 123 00:04:37,200 --> 00:04:39,720 THERE WILL BE FIVE MINUTES AFTER 124 00:04:39,720 --> 00:04:40,880 A 20-MINUTE TALK AND DISCUSSION 125 00:04:40,880 --> 00:04:42,320 TOWARDS THE END OF THE MEETING. 126 00:04:42,320 --> 00:04:43,880 IF YOU HAVE A COMMENT OR 127 00:04:43,880 --> 00:04:46,080 QUESTION PLEASE USE THE CHAT 128 00:04:46,080 --> 00:04:49,280 PANEL AT THE BOTTOM OF YOUR 129 00:04:49,280 --> 00:04:51,520 SCREEN OR RAISE YOUR HAND. 130 00:04:51,520 --> 00:04:53,680 I AM CURRENTLY OVERSEEING THE 131 00:04:53,680 --> 00:04:57,120 GYNECOLOGY PAIN PROGRAM IN THE 132 00:04:57,120 --> 00:05:00,760 GYNECOLOGY HEALTH AND DISEASE 133 00:05:00,760 --> 00:05:01,320 BRANCH. 134 00:05:01,320 --> 00:05:03,760 THE GYNECOLOGY PAIN PROGRAM 135 00:05:03,760 --> 00:05:05,720 SUPPORTS CLINICAL TRANSLATIONAL 136 00:05:05,720 --> 00:05:09,520 BASIC RESEARCH ON GYNECOLOGY 137 00:05:09,520 --> 00:05:12,760 PAIN CONDITIONS. 138 00:05:12,760 --> 00:05:16,600 THE GHDB RECENTLY RELEASED THE 139 00:05:16,600 --> 00:05:20,240 INTEGRITY RESEARCH IN GYNECOLOGY 140 00:05:20,240 --> 00:05:22,720 FOA, THE SCOPE INCLUDES 141 00:05:22,720 --> 00:05:25,360 GYNECOLOGY PAIN SYNDROMES, 142 00:05:25,360 --> 00:05:27,120 APPLICATION TODAY IS APRIL 18, 143 00:05:27,120 --> 00:05:30,800 2022, IF YOU HAVE ANY QUESTIONS 144 00:05:30,800 --> 00:05:39,440 REGARDING THIS FOA FEEL FREE TO 145 00:05:39,440 --> 00:05:45,240 CONTACT CANDACE TINGEN. 146 00:05:45,240 --> 00:05:49,080 THE INITIATIVE TO STEM PUBLIC 147 00:05:49,080 --> 00:05:51,160 HEALTH CRISIS, IF YOU GO TO THE 148 00:05:51,160 --> 00:05:54,920 NIH GRANTS AND FUNDING WEBSITE 149 00:05:54,920 --> 00:05:59,040 HERE, IF YOU CAN SEE THE DETAILS 150 00:05:59,040 --> 00:06:10,240 OF THESE TWO FOAs AND NOTICES. 151 00:06:10,240 --> 00:06:12,280 TODAY WE INVITED SEVEN SPEAKERS 152 00:06:12,280 --> 00:06:14,760 TO TALK ABOUT GYNECOLOGY PAIN 153 00:06:14,760 --> 00:06:16,560 RESEARCH COVERING FIVE AREAS 154 00:06:16,560 --> 00:06:17,680 RELATED TO GYNECOLOGY PAIN 155 00:06:17,680 --> 00:06:20,320 INCLUDING HOT TOPICS AND 156 00:06:20,320 --> 00:06:21,920 EMERGING TRENDS IN 157 00:06:21,920 --> 00:06:23,560 CHRONIC/GYNECOLOGIC PAIN 158 00:06:23,560 --> 00:06:30,360 RESEARCH, CHRONIC PELVIC PAIN, 159 00:06:30,360 --> 00:06:31,480 DYSMENORRHEA, VESTIBULODYNIA AND 160 00:06:31,480 --> 00:06:33,760 GYNECOLOGIC PAIN MANAGEMENT AND 161 00:06:33,760 --> 00:06:34,920 TREATMENT. 162 00:06:34,920 --> 00:06:43,960 I WILL MODERATE SESSION 1. 163 00:06:43,960 --> 00:06:46,760 FIRST, THE SPEAKER IS FROM 164 00:06:46,760 --> 00:06:53,520 UNIVERSITY OF MICHIGAN SCHOOL OF 165 00:06:53,520 --> 00:06:55,400 MEDICINE. 166 00:06:55,400 --> 00:06:57,280 NICKS DR. SUSAN SA-SANIE, 167 00:06:57,280 --> 00:06:58,800 DEPARTMENT OF OBSTETRICS AND 168 00:06:58,800 --> 00:07:01,800 GYNECOLOGY, TALKING ABOUT PELVIC 169 00:07:01,800 --> 00:07:07,960 PAIN, UNIVERSITY OF MICHIGAN. 170 00:07:07,960 --> 00:07:10,280 AND THEN DR. FRANK TU IS GOING 171 00:07:10,280 --> 00:07:15,760 TO TALK ABOUT MENSTRUAL BRAIN 172 00:07:15,760 --> 00:07:18,440 AND CHRONIC PELVIC PAIN 173 00:07:18,440 --> 00:07:26,920 UNIVERSITY OF CHICAGO. 174 00:07:26,920 --> 00:07:30,960 LASTLY DR. NACKLEY, DEPARTMENT 175 00:07:30,960 --> 00:07:37,480 OF PHYSIOLOGY, DUKE UNIVERSITY. 176 00:07:37,480 --> 00:07:40,600 SESSION 2, A MEDICAL OFFICER IN 177 00:07:40,600 --> 00:07:50,720 THE JCB WILL MODERATE THE 178 00:07:50,720 --> 00:07:51,480 SESSION 2. 179 00:07:51,480 --> 00:08:00,320 THERE WILL BE A DISCUSSION 180 00:08:00,320 --> 00:08:00,560 SESSION. 181 00:08:00,560 --> 00:08:02,240 DR. TINGEN AND I WILL MODERATE. 182 00:08:02,240 --> 00:08:06,880 I WOULD LIKE TO THANK THE 183 00:08:06,880 --> 00:08:12,320 MEETING ORGANIZERS IN THE GCB 184 00:08:12,320 --> 00:08:12,560 PROGRAM. 185 00:08:12,560 --> 00:08:14,920 IF YOU HAVE QUESTIONS REGARDING 186 00:08:14,920 --> 00:08:18,320 THE GYNECOLOGY HEALTH AND 187 00:08:18,320 --> 00:08:20,200 DISEASE BRANCH FEEL FREE TO 188 00:08:20,200 --> 00:08:29,200 CONTACT US AT ANY TIME. 189 00:08:29,200 --> 00:08:31,240 I WILL STOP SHARING. 190 00:08:31,240 --> 00:08:40,760 SO OUR FIRST SPEAKER IS DR. 191 00:08:40,760 --> 00:08:41,960 DANIEL CHLOE. 192 00:08:41,960 --> 00:08:45,720 COULD YOU SHARE YOUR SLIDES? 193 00:08:45,720 --> 00:08:51,720 >> ARE YOU SEEING THEM OKAY? 194 00:08:51,720 --> 00:08:52,120 >> YES. 195 00:08:52,120 --> 00:08:53,760 >> ARE YOU READY FOR ME TO 196 00:08:53,760 --> 00:08:54,320 START? 197 00:08:54,320 --> 00:08:54,600 >> SURE. 198 00:08:54,600 --> 00:08:56,400 YES, GO AHEAD. 199 00:08:56,400 --> 00:08:57,000 >> GREAT. 200 00:08:57,000 --> 00:08:58,920 THANKS FOR INVITING ME. 201 00:08:58,920 --> 00:09:00,440 I'LL GIVE A WHIRL WIND TALK 202 00:09:00,440 --> 00:09:01,880 ABOUT A NEW TERM FOR A REALLY 203 00:09:01,880 --> 00:09:05,920 OLD TYPE OF PAIN, THAT IS 204 00:09:05,920 --> 00:09:12,000 NOCIPLASTIC PAIN. 205 00:09:12,000 --> 00:09:20,400 I'M CLINICALLY TRAINED AS A 206 00:09:20,400 --> 00:09:21,320 RHEUMATOLOGIST,AT GEORGETOWN. 207 00:09:21,320 --> 00:09:22,720 WE THOUGHT EVERYONE WITH THE 208 00:09:22,720 --> 00:09:27,920 KNEE ON THE RIGHT WOULD HAVE 209 00:09:27,920 --> 00:09:31,760 PAIN BUT THIS IS NOW ABOUT A 210 00:09:31,760 --> 00:09:34,840 30-YEAR HISTORY OF RESEARCH IN 211 00:09:34,840 --> 00:09:35,920 OSTEOARTHRITIS, POPULATION BASED 212 00:09:35,920 --> 00:09:38,200 STUDIES IT APPEARED IN THE 213 00:09:38,200 --> 00:09:39,720 '90s A RELATIONSHIP BETWEEN 214 00:09:39,720 --> 00:09:41,360 WHAT PEOPLE'S X-RAY LOOKED LIKE 215 00:09:41,360 --> 00:09:42,040 AND WHETHER THEY WERE 216 00:09:42,040 --> 00:09:43,040 EXPERIENCING PAIN, AND HOW 217 00:09:43,040 --> 00:09:46,320 SEVERE THE PAIN WAS GOING TO BE. 218 00:09:46,320 --> 00:09:47,920 AND WHAT WAS MOST SURPRISING ARE 219 00:09:47,920 --> 00:09:49,920 ALL THE INDIVIDUALS THAT HAD 220 00:09:49,920 --> 00:09:50,920 REALLY BAD-LOOKING X-RAYS LIKE 221 00:09:50,920 --> 00:09:54,600 THE ONE I SHOWED ON THE RIGHT 222 00:09:54,600 --> 00:09:56,680 AND 30 TO 40% OF PEOPLE IN THE 223 00:09:56,680 --> 00:09:57,760 U.S. POPULATION ACTUALLY, THAT 224 00:09:57,760 --> 00:09:59,560 HAVE THAT X-RAY, DON'T HAVE ANY 225 00:09:59,560 --> 00:10:02,120 PAIN, NEARLY ALL OF THEM ARE 226 00:10:02,120 --> 00:10:05,680 MEN, AND I'LL EXPLAIN WHY THAT 227 00:10:05,680 --> 00:10:07,080 IS, BUT IN OSTEOARTHRITIS THERE 228 00:10:07,080 --> 00:10:09,800 WAS A FAIRLY RAPID MOVEMENT AWAY 229 00:10:09,800 --> 00:10:13,400 FROM THINKING THAT WHAT YOU SAW 230 00:10:13,400 --> 00:10:14,600 IN THE PERIPHERALLY ENTIRELY 231 00:10:14,600 --> 00:10:15,640 EXPLAINED THE DISEASE, WHEN 232 00:10:15,640 --> 00:10:17,040 PEOPLE SAW THEY INDIVIDUALS THAT 233 00:10:17,040 --> 00:10:18,560 HAD PAIN THAT COULDN'T BE REALLY 234 00:10:18,560 --> 00:10:20,440 EXPLAINED ON THE BASIS OF 235 00:10:20,440 --> 00:10:22,680 PERIPHERAL FINDINGS THE FIRST 236 00:10:22,680 --> 00:10:23,920 TENDENCY IS TO BLAME 237 00:10:23,920 --> 00:10:26,760 PSYCHOLOGICAL FACTORS BUT IN 238 00:10:26,760 --> 00:10:29,520 POINT OF FACT THEY DON'T EXPLAIN 239 00:10:29,520 --> 00:10:30,520 THE VARIANCE BETWEEN WHAT YOU 240 00:10:30,520 --> 00:10:35,880 SEE ON AN X-RAY OR MRI. OF THE 241 00:10:35,880 --> 00:10:37,080 KNEE AND WHAT SOMEONE IS 242 00:10:37,080 --> 00:10:38,040 EXPERIENCING WITH REGARD TO 243 00:10:38,040 --> 00:10:38,280 PAIN. 244 00:10:38,280 --> 00:10:39,800 THE OTHER PART I LIKE SHOWING, 245 00:10:39,800 --> 00:10:42,400 THERAPIES WE USED TO THINK 246 00:10:42,400 --> 00:10:43,720 WORKED WELL IN KNEE 247 00:10:43,720 --> 00:10:50,720 OSTEOARTHRITIS, FOR EXAMPLE, 248 00:10:50,720 --> 00:10:51,800 NON-STEROIDAL ANTI-INFLAMMATORY 249 00:10:51,800 --> 00:10:57,840 DRUGS, I'VE ALWAYS BEEN 250 00:10:57,840 --> 00:10:59,480 ANTI-OPIOID, EVEN SURGERY FAILS 251 00:10:59,480 --> 00:11:00,680 TO RELIEVE PAIN IN 30% OF 252 00:11:00,680 --> 00:11:02,120 INDIVIDUALS WITH KNEE OR HIP 253 00:11:02,120 --> 00:11:02,520 REPLACED. 254 00:11:02,520 --> 00:11:04,520 I'LL SHOW YOU DATA WHERE WE'VE 255 00:11:04,520 --> 00:11:06,200 USED, IF YOU WILL, SURGICAL 256 00:11:06,200 --> 00:11:08,760 RELIEF OF PAIN AS A MODEL TO TRY 257 00:11:08,760 --> 00:11:10,640 TO HELP EXPLAIN OR UNDERSTAND 258 00:11:10,640 --> 00:11:11,280 NOCIPLASTIC PAIN. 259 00:11:11,280 --> 00:11:14,240 THE OTHER CONDITION I'M GOING TO 260 00:11:14,240 --> 00:11:15,720 ALLUDE TO TODAY IS FIBROMYALGIA, 261 00:11:15,720 --> 00:11:18,720 OUR GROUP IS INVOLVED IN 262 00:11:18,720 --> 00:11:20,440 RESEARCH IN FIBROMYALGIA, BUT 263 00:11:20,440 --> 00:11:21,520 THE ORIGINAL CRITERIA FOR 264 00:11:21,520 --> 00:11:22,680 FIBROMYALGIA REQUIRED THAT THE 265 00:11:22,680 --> 00:11:23,520 INDIVIDUALS HAD A CERTAIN NUMBER 266 00:11:23,520 --> 00:11:27,440 OF TENDER POINTS AS WELL AS 267 00:11:27,440 --> 00:11:28,600 HAVING WIDESPREAD PAIN, 268 00:11:28,600 --> 00:11:30,040 ORIGINALLY SKEWED THE DIAGNOSIS 269 00:11:30,040 --> 00:11:32,000 TO BEING ALMOST ENTIRELY WOMEN, 270 00:11:32,000 --> 00:11:34,120 BUT MORE RECENTLY AS THE NEW 271 00:11:34,120 --> 00:11:36,160 FIBROMYALGIA CRITERIA THAT I'LL 272 00:11:36,160 --> 00:11:38,680 TALK ABOUT WERE DEVELOPED, NOW 273 00:11:38,680 --> 00:11:40,960 FIBROMYALGIA IS ONLY ABOUT 1 1/2 274 00:11:40,960 --> 00:11:42,720 TO 2 TIMES MORE COMMON IN WOMEN 275 00:11:42,720 --> 00:11:43,360 THAN MEN. 276 00:11:43,360 --> 00:11:44,520 WHAT I'M GOING TO TALK ABOUT 277 00:11:44,520 --> 00:11:46,920 REALLY IS OVER THE LAST THREE 278 00:11:46,920 --> 00:11:47,880 DECADES OR SO FIBROMYALGIA HAS 279 00:11:47,880 --> 00:11:48,960 GONE FROM BEING THIS CONDITION 280 00:11:48,960 --> 00:11:51,160 THAT NO ONE WAS SURE IT WAS REAL 281 00:11:51,160 --> 00:11:53,880 ENTITY TO BEING THE POSTER CHILD 282 00:11:53,880 --> 00:11:55,480 FOR THIS THIRD NEW MECHANISM OF 283 00:11:55,480 --> 00:11:57,360 PAIN THAT IS MORE THAN JUST PAIN 284 00:11:57,360 --> 00:12:00,400 BUT AGAIN THOSE OF US THAT ARE 285 00:12:00,400 --> 00:12:02,520 PAIN RESEARCHERS HAVE COINED 286 00:12:02,520 --> 00:12:03,160 THIS TERM NOCIPLASTIC PAIN. 287 00:12:03,160 --> 00:12:06,240 I'M GOING TO TRY TO CONVINCE YOU 288 00:12:06,240 --> 00:12:07,320 WE UNDERSTAND THE 289 00:12:07,320 --> 00:12:09,320 PATHOPHYSIOLOGY OF THIS PROCESS 290 00:12:09,320 --> 00:12:10,280 FAIRLY WELL. 291 00:12:10,280 --> 00:12:11,360 ONE OF THE ANALOGIES I'VE BEEN 292 00:12:11,360 --> 00:12:15,120 USING FOR A LONG TIME, FIRST TO 293 00:12:15,120 --> 00:12:16,800 HELP UNDERSTAND, HAVE PATIENTS 294 00:12:16,800 --> 00:12:20,160 UNDERSTAND PAIN, AND THEN MORE 295 00:12:20,160 --> 00:12:21,280 RECENTLY DOCTORS AND SCIENTISTS, 296 00:12:21,280 --> 00:12:22,720 THE AMOUNT OF PAIN SOMEONE IS 297 00:12:22,720 --> 00:12:23,920 EXPERIENCING IS AKIN TO THE 298 00:12:23,920 --> 00:12:26,720 LOUDNESS OF AN ELECTRIC GUITAR. 299 00:12:26,720 --> 00:12:27,960 EVERYONE KNOWS THERE'S TWO WAYS 300 00:12:27,960 --> 00:12:29,680 TO MAKE IT LOUDER, STRUM THE 301 00:12:29,680 --> 00:12:32,760 STRINGS HARDER OR TURN UP THE 302 00:12:32,760 --> 00:12:33,040 AMPLIFIER. 303 00:12:33,040 --> 00:12:35,200 WELL, THERE ARE SENSORY NERVES 304 00:12:35,200 --> 00:12:37,920 REALLY QUITE ANALOGOUS TO THE 305 00:12:37,920 --> 00:12:39,640 DIFFERENT STRINGS ON A GUITAR 306 00:12:39,640 --> 00:12:40,440 THAT BRING DIFFERENT INFORMATION 307 00:12:40,440 --> 00:12:41,320 ABOUT WHAT'S GOING ON IN 308 00:12:41,320 --> 00:12:44,120 DIFFERENT AREAS OF THE BODY UP 309 00:12:44,120 --> 00:12:46,600 TO THE BRAIN BUT ALL THIS 310 00:12:46,600 --> 00:12:47,320 INFORMATION HAS TO GO THROUGH 311 00:12:47,320 --> 00:12:48,600 THE SPINAL CORD AND BRAIN AND 312 00:12:48,600 --> 00:12:50,240 REALLY THE SPINAL CORD AND BRAIN 313 00:12:50,240 --> 00:12:52,680 ARE THE EQUIVALENT OF THE 314 00:12:52,680 --> 00:12:56,840 AMPLIFIER ON AN ELECTRIC GUITAR 315 00:12:56,840 --> 00:12:58,920 BECAUSE YOU CAN INCREASE THE 316 00:12:58,920 --> 00:13:00,120 LIKELIHOOD SOMEONE WILL 317 00:13:00,120 --> 00:13:02,160 EXPERIENCE PAIN SIMPLY BY, IF 318 00:13:02,160 --> 00:13:04,680 YOU WILL, CHANGING THE SPINAL 319 00:13:04,680 --> 00:13:06,880 AND CORTICAL ACTIVITY THAT'S 320 00:13:06,880 --> 00:13:07,680 PROCESSING PAIN. 321 00:13:07,680 --> 00:13:10,840 SO WE KNOW ONE OF THE REASONS 322 00:13:10,840 --> 00:13:12,480 PEOPLE CAN HAVE PAIN EVEN THOUGH 323 00:13:12,480 --> 00:13:15,080 THEY HAVE A NORMAL KNEE X-RAY 324 00:13:15,080 --> 00:13:24,760 THERE'S AN INCREASE IN 325 00:13:24,760 --> 00:13:25,720 DESCENDING FACILATORY, ALLOWING 326 00:13:25,720 --> 00:13:29,560 MORE SIGNALS TO BE FELT AT PAIN 327 00:13:29,560 --> 00:13:31,440 BUT THIS ALSO HELPS US 328 00:13:31,440 --> 00:13:33,400 UNDERSTAND OR EXPLAIN WHY SOME 329 00:13:33,400 --> 00:13:34,400 INDIVIDUALS HAVE BAD LOOKING 330 00:13:34,400 --> 00:13:36,040 KNEE X-RAYS OR BAD LOOKING 331 00:13:36,040 --> 00:13:37,560 SURGICAL FIELDS AND NOT HAVE ANY 332 00:13:37,560 --> 00:13:39,720 PAIN, THEY JUST HAPPEN TO BE 333 00:13:39,720 --> 00:13:41,920 FORTUNATE ENOUGH THEY HAVE LOWER 334 00:13:41,920 --> 00:13:46,880 AMPLIFIER SETTING AND NOT PAIN 335 00:13:46,880 --> 00:13:47,120 SENSITIVE. 336 00:13:47,120 --> 00:13:49,360 WOMEN HAVE 1 1/2 TO 2 TIMES ANY 337 00:13:49,360 --> 00:13:51,120 TYPE OF CHRONIC PAIN THAN MEN, 338 00:13:51,120 --> 00:13:54,400 O.A. IS A GREAT MODEL, THERE'S 339 00:13:54,400 --> 00:13:55,120 ALMOST NO DIFFERENCE BETWEEN 340 00:13:55,120 --> 00:13:58,000 WHAT WOMEN AND MEN LOOK LIKE AND 341 00:13:58,000 --> 00:14:07,280 KNEE ON KNEE X-RAY BUT ARE 1 342 00:14:07,280 --> 00:14:09,680 1/2 TO 2 TIMES MORE LIKE LIE TO 343 00:14:09,680 --> 00:14:19,520 FEEL, THEY HAVE A HIGHER 344 00:14:19,520 --> 00:14:21,480 AMPLIFIER, NOISES, ODORS, IN 345 00:14:21,480 --> 00:14:22,480 FACT THIS HYPERSENSITIVITY NOT 346 00:14:22,480 --> 00:14:26,360 JUST TO PAIN BUT TO OTHER TYPES 347 00:14:26,360 --> 00:14:27,920 OF SENSORY EXPERIENCES IS PART 348 00:14:27,920 --> 00:14:30,720 OF THE DEFINITION FOR DISTURBED 349 00:14:30,720 --> 00:14:32,840 MECHANISM OF PAIN, NOCIPLASTIC 350 00:14:32,840 --> 00:14:33,040 PAIN. 351 00:14:33,040 --> 00:14:35,560 WE LOOK FOR HOW WIDESPREAD THE 352 00:14:35,560 --> 00:14:37,440 PAIN IS. 353 00:14:37,440 --> 00:14:38,960 THE MORE WIDESPREAD, MORE LIKELY 354 00:14:38,960 --> 00:14:40,920 COMING FROM AMPLIFIER RATHER 355 00:14:40,920 --> 00:14:42,720 THAN GUITAR, LOOK FOR FATIGUE, 356 00:14:42,720 --> 00:14:44,120 SLEEP PROBLEMS AND MEMORY 357 00:14:44,120 --> 00:14:46,080 PROBLEMS, AND AGAIN LOOK FOR 358 00:14:46,080 --> 00:14:47,600 OTHER TYPES OF SENSORY 359 00:14:47,600 --> 00:14:48,320 SENSITIVITIES. 360 00:14:48,320 --> 00:14:50,240 THIS REALLY SEEMS TO BE THE PAIN 361 00:14:50,240 --> 00:14:52,520 MECHANISM THAT IS FRONT AND 362 00:14:52,520 --> 00:14:53,760 CENTER IN CONDITIONS LIKE 363 00:14:53,760 --> 00:14:56,240 FIBROMYALGIA, FUNCTIONAL G.I. 364 00:14:56,240 --> 00:14:57,600 DISORDERS, A NUMBER OF DIFFERENT 365 00:14:57,600 --> 00:14:58,800 CONDITIONS THAT THE NIH ACTUALLY 366 00:14:58,800 --> 00:15:01,800 COINED THE TERM A COUPLE YEARS 367 00:15:01,800 --> 00:15:03,720 AGO CHRONIC OVERLAPPING PAIN 368 00:15:03,720 --> 00:15:05,560 CONDITIONS TO INDICATE THESE 369 00:15:05,560 --> 00:15:07,960 CONDITIONS SUCH AS FIBROMYALGIA, 370 00:15:07,960 --> 00:15:09,640 IRRITABLE BOWEL, TENSION 371 00:15:09,640 --> 00:15:11,360 HEADACHE, ALL REALLY WERE MORE 372 00:15:11,360 --> 00:15:13,000 LIKELY IF SOMEONE HAD ONE OF 373 00:15:13,000 --> 00:15:13,640 THESE CONDITIONS THEY WERE MUCH 374 00:15:13,640 --> 00:15:14,880 MORE LIKELY TO HAVE MANY OF 375 00:15:14,880 --> 00:15:16,040 THESE CONDITIONS. 376 00:15:16,040 --> 00:15:17,720 THEY RUN STRONGLY IN FAMILY. 377 00:15:17,720 --> 00:15:19,320 AND IN FACT A LOT OF THESE 378 00:15:19,320 --> 00:15:20,720 THINGS ARE MERELY LABELS FOR 379 00:15:20,720 --> 00:15:22,560 PAIN THAT IS IN A CERTAIN AREA 380 00:15:22,560 --> 00:15:25,120 OF THE BODY THAT CLINICIANS 381 00:15:25,120 --> 00:15:28,360 CAN'T FIND AN ALTERNATE 382 00:15:28,360 --> 00:15:28,720 EXPLANATION FOR. 383 00:15:28,720 --> 00:15:30,760 AND SO MEASURING THE NUMBER OF 384 00:15:30,760 --> 00:15:31,400 CHRONIC OVERLAPPING PAIN 385 00:15:31,400 --> 00:15:32,400 CONDITIONS SOMEONE HAS BEEN 386 00:15:32,400 --> 00:15:33,920 DIAGNOSED WITH OVER THE COURSE 387 00:15:33,920 --> 00:15:35,760 OF THE LIFETIME IS A GOOD 388 00:15:35,760 --> 00:15:37,600 PHENOTYPIC MARKER OF THE DEGREE 389 00:15:37,600 --> 00:15:39,320 OF WHICH THEY HAVE THIS 390 00:15:39,320 --> 00:15:41,840 NOCIPLASTIC PAIN PROCESS BUT WE 391 00:15:41,840 --> 00:15:46,720 KNOW THE SAME NOCIPLASTIC PAIN 392 00:15:46,720 --> 00:15:47,920 MECHANISMS OFTEN ARE 393 00:15:47,920 --> 00:15:49,120 SUPERIMPOSED UPON NOCICEPTIVE 394 00:15:49,120 --> 00:15:50,680 PAIN OR NEUROPATHIC PAIN. 395 00:15:50,680 --> 00:15:53,960 30% OF PAIN WITH AUTOIMMUNE 396 00:15:53,960 --> 00:15:56,280 DISORDERS LIKE ARTHRITIS OR 397 00:15:56,280 --> 00:15:59,040 LUPUS HAVE THE SAME 398 00:15:59,040 --> 00:15:59,640 FIBROMYALGIA-LIKE NOCIPLASTIC 399 00:15:59,640 --> 00:16:00,720 PLAIN SUPERIMPOSED. 400 00:16:00,720 --> 00:16:03,800 NEW CRITERIA FOR FIBROMYALGIA, 401 00:16:03,800 --> 00:16:06,280 DON'T DO A TENDER POINT, HOW 402 00:16:06,280 --> 00:16:08,800 WIDESPREAD ON THE LEFT SIDE AND 403 00:16:08,800 --> 00:16:10,440 WHETHER SOMEONE HAS COMORBID 404 00:16:10,440 --> 00:16:12,520 FATIGUE, MEMORY, SLEEP PROBLEMS. 405 00:16:12,520 --> 00:16:13,920 THIS CAN BE QUANTITATIVELY 406 00:16:13,920 --> 00:16:17,720 SCORED FROM ZERO TO 31, AND FRED 407 00:16:17,720 --> 00:16:18,720 WOLF WAS A RHEUMATOLOGIST THAT 408 00:16:18,720 --> 00:16:20,120 SHOWED WE SHOULDN'T REALLY THINK 409 00:16:20,120 --> 00:16:21,760 OF FIBROMYALGIA AS YES OR NO. 410 00:16:21,760 --> 00:16:23,480 WE SHOULD THINK OF DIFFERENT 411 00:16:23,480 --> 00:16:26,280 PEOPLE HAVE VARIABLE DEGREES. 412 00:16:26,280 --> 00:16:29,240 NOW AS WE MORE -- FIBROMYALGIA 413 00:16:29,240 --> 00:16:31,720 BEING THE POSTER CHILD FOR 414 00:16:31,720 --> 00:16:32,600 NOCIPLASTIC PAIN IT'S TRUE 415 00:16:32,600 --> 00:16:34,560 NOCIPLASTIC PAIN IS NOT PRESENT 416 00:16:34,560 --> 00:16:36,120 OR ABSENT, IT REALLY IS THAT WE 417 00:16:36,120 --> 00:16:38,280 SHOULD THINK OF IT AS A VOLUME 418 00:16:38,280 --> 00:16:41,440 CONTROL OR AMPLIFIER THAT IS 419 00:16:41,440 --> 00:16:42,440 OFTEN SUPERIMPOSED UPON OTHER 420 00:16:42,440 --> 00:16:45,160 ONGOING PAIN MECHANISMS OR CAN 421 00:16:45,160 --> 00:16:47,360 OCCUR IN ISOLATION BUT REALLY, 422 00:16:47,360 --> 00:16:50,320 AGAIN, IS AN AMPLIFIER OR CNS 423 00:16:50,320 --> 00:16:50,880 DRIVEN PROBLEM. 424 00:16:50,880 --> 00:16:52,360 YOU MIGHT IMAGINE IF SOMEONE HAS 425 00:16:52,360 --> 00:16:54,000 PAIN IN A SINGLE LOCATION OF THE 426 00:16:54,000 --> 00:16:55,120 BODY, THEY ARE QUITE DIFFERENT 427 00:16:55,120 --> 00:16:56,880 THAN SOMEONE HAS PAIN ALL OVER. 428 00:16:56,880 --> 00:16:59,520 THIS IS SOMEONE WITH MAD DOG 429 00:16:59,520 --> 00:16:59,840 FIBROMYALGIA. 430 00:16:59,840 --> 00:17:01,560 BUT WHAT WE KNOW NOW IS 431 00:17:01,560 --> 00:17:03,040 EVERYTHING IN BETWEEN IS 432 00:17:03,040 --> 00:17:04,520 IMPORTANT AND THAT THE PEOPLE 433 00:17:04,520 --> 00:17:05,600 THAT CARRY LABELS LIKE 434 00:17:05,600 --> 00:17:06,920 FIBROMYALGIA ARE THE TIP OF THE 435 00:17:06,920 --> 00:17:07,160 ICEBERG. 436 00:17:07,160 --> 00:17:08,680 MOST OF THE PEOPLE WITH THIS 437 00:17:08,680 --> 00:17:12,720 SAME KIND OF PAIN CARRY LABELS 438 00:17:12,720 --> 00:17:15,200 LIKE LOW BACK PAIN, 439 00:17:15,200 --> 00:17:16,120 OSTEOARTHRITIS, ENDOMETRIOSIS, 440 00:17:16,120 --> 00:17:18,640 SO WE KNOW THIS KIND OF PAIN IS 441 00:17:18,640 --> 00:17:21,920 COMMON AND OFT EVERYBODY GOES 442 00:17:21,920 --> 00:17:22,520 UNRECOGNIZED, UNTREATED, THE 443 00:17:22,520 --> 00:17:25,080 PROBLEM IS THIS KIND OF PAIN 444 00:17:25,080 --> 00:17:25,800 RESPONDS TO MARKEDLY DIFFERENT 445 00:17:25,800 --> 00:17:26,120 TREATMENTS. 446 00:17:26,120 --> 00:17:27,960 THIS IS A RECENT ARTICLE ON THE 447 00:17:27,960 --> 00:17:31,120 OLD TERM FOR THIS CENTRAL 448 00:17:31,120 --> 00:17:32,240 SENSITIZATION, POINTING OUT THAT 449 00:17:32,240 --> 00:17:33,760 ACROSS ALL CHRONIC PAIN 450 00:17:33,760 --> 00:17:35,720 CONDITIONS, IF SOMEONE HAS 451 00:17:35,720 --> 00:17:36,360 CENTRAL SENSITIZATION, IT 452 00:17:36,360 --> 00:17:37,560 MARKEDLY AFFECTS WHAT'S GOING TO 453 00:17:37,560 --> 00:17:40,600 WORK AND NOT WORK WITH RESPECT 454 00:17:40,600 --> 00:17:40,920 TO TREATMENT. 455 00:17:40,920 --> 00:17:43,920 THESE ARE STUDIES WE DID IN OUR 456 00:17:43,920 --> 00:17:49,080 GROUP, LED BY CHAD BROMET, KNEE 457 00:17:49,080 --> 00:17:50,520 AND HIP REPLACEMENT SURGERY AS A 458 00:17:50,520 --> 00:17:51,320 SURGICAL PROCEDURE WHERE WE 459 00:17:51,320 --> 00:17:53,000 COULD MEASURE WHAT WAS GOING ON 460 00:17:53,000 --> 00:17:55,160 IN THE PERIPHERY, COULD THEN PUT 461 00:17:55,160 --> 00:17:59,920 IN A SHINY TITANIUM KNEE, AND 462 00:17:59,920 --> 00:18:01,120 SEE THE DEGREE TO SOMEONE OF 463 00:18:01,120 --> 00:18:04,280 WHICH SOMEONE DID OR DID NOT 464 00:18:04,280 --> 00:18:04,640 IMPROVE. 465 00:18:04,640 --> 00:18:05,320 MAIN HYPOTHESES FIBROMYALGIA 466 00:18:05,320 --> 00:18:07,200 MEASURE WOULD BE STRONGLY 467 00:18:07,200 --> 00:18:09,840 PREDICTIVE OF SOMEONE FAILING TO 468 00:18:09,840 --> 00:18:10,920 RESPOND TO SURGERY. 469 00:18:10,920 --> 00:18:12,720 AND WE DIDN'T JUST GIVE PEOPLE 470 00:18:12,720 --> 00:18:14,640 THE FIBROMYALGIA MEASURE. 471 00:18:14,640 --> 00:18:16,240 WE MEASURED ANXIETY, DEPRESSION, 472 00:18:16,240 --> 00:18:16,880 CATASTROPHIZING. 473 00:18:16,880 --> 00:18:18,120 THE ONLY THING UNIQUE IN THESE 474 00:18:18,120 --> 00:18:21,840 STUDIES AS WELL AS THE ONES 475 00:18:21,840 --> 00:18:24,320 SUSIE ASANI LED WHICH SHE WILL 476 00:18:24,320 --> 00:18:26,640 TALK ABOUT AND I'LL ALLUDE TO, 477 00:18:26,640 --> 00:18:28,400 WE GAVE THIS MEASURE ON THE DAY 478 00:18:28,400 --> 00:18:29,560 OF SURGERY AND LOOKED AT THE 479 00:18:29,560 --> 00:18:32,440 DEGREE TO WHICH IT INFLUENCED 480 00:18:32,440 --> 00:18:34,720 LONG-TERM OUTCOMES AND FOUND FOR 481 00:18:34,720 --> 00:18:36,480 EACH ONE POINT INCREASE IN 482 00:18:36,480 --> 00:18:37,320 FIBROMYALGIA MEASURE PEOPLE 483 00:18:37,320 --> 00:18:38,960 GETTING HEE OR ANYPLACE 484 00:18:38,960 --> 00:18:39,640 REPLACEMENT SURGERY NEEDED MORE 485 00:18:39,640 --> 00:18:41,600 OPIOIDS TO CONTROL THEIR PAIN, 486 00:18:41,600 --> 00:18:44,320 MUCH LESS LIKELY TO GET 487 00:18:44,320 --> 00:18:45,920 IMPROVEMENT. 488 00:18:45,920 --> 00:18:46,760 THESE PHENOMENON WERE LINEAR, 489 00:18:46,760 --> 00:18:48,720 NOTHING MAGICAL ABOUT THE CUT 490 00:18:48,720 --> 00:18:52,680 POINT OF 13 THAT SAYS SOMEONE 491 00:18:52,680 --> 00:18:54,720 HAS FIBROMYALGIA. 492 00:18:54,720 --> 00:18:57,880 ONE POINT INCREASE LED TO LESS 493 00:18:57,880 --> 00:18:59,200 LIKELY WOULD GETTER IF WE DID 494 00:18:59,200 --> 00:19:00,200 SURGERY TO REPLACE KNEE OTHER 495 00:19:00,200 --> 00:19:00,960 LIP. 496 00:19:00,960 --> 00:19:04,040 THIS IS A DATA SLIDE FROM THOSE 497 00:19:04,040 --> 00:19:04,960 KNEE AND HIP ARTHROPLASTIES, ON 498 00:19:04,960 --> 00:19:06,960 THE Y-AXIS ARE THE NUMBER OF 499 00:19:06,960 --> 00:19:08,320 PEOPLE THAT HAVE THE 500 00:19:08,320 --> 00:19:10,120 FIBROMYALGIA SCORE, HERE IS THE 501 00:19:10,120 --> 00:19:10,560 FIBROMYALGIA SCORE. 502 00:19:10,560 --> 00:19:13,520 13 CUT POINT IS ON THE RIGHT 503 00:19:13,520 --> 00:19:16,240 SIDE, PEOPLE ARE SAID TO HAVE 504 00:19:16,240 --> 00:19:17,760 DIAGNOSIS OF FIBROMYALGIA BUT I 505 00:19:17,760 --> 00:19:19,840 WANT TO POINT OUT THIS PATIENT 506 00:19:19,840 --> 00:19:21,280 HERE HAS A HIGHER FIBROMYALGIA 507 00:19:21,280 --> 00:19:22,920 SCORE THAN THIS PERSON HERE, 508 00:19:22,920 --> 00:19:24,440 DOESN'T CROSS THE RED LINE, 509 00:19:24,440 --> 00:19:25,640 DOESN'T HAVE FIBROMYALGIA BUT 510 00:19:25,640 --> 00:19:28,120 LOOK HOW IMPORTANT THAT IS. 511 00:19:28,120 --> 00:19:29,600 THIS PERSON, JUST BECAUSE THE 512 00:19:29,600 --> 00:19:32,320 PAIN IS MORE WIDESPREAD, HE ALSO 513 00:19:32,320 --> 00:19:37,760 HAS SOME FATIGUE, MEMORY 514 00:19:37,760 --> 00:19:38,680 PROBLEMS, SLEEP DISTURBANCE, 515 00:19:38,680 --> 00:19:43,920 FIVE TIMES LESS LIKELY TO HAVE A 516 00:19:43,920 --> 00:19:46,200 50% IMPROVEMENT IN PAIN WITH 517 00:19:46,200 --> 00:19:48,480 KNEE REPLACED, SUSIE REPLICATEED 518 00:19:48,480 --> 00:19:50,800 ALMOST IDENTICAL WOMEN WITH 519 00:19:50,800 --> 00:20:01,360 CHRONIC PELVIC PAIN GETTING 520 00:20:01,360 --> 00:20:02,280 HISSERRECTOMY. 521 00:20:02,280 --> 00:20:04,880 THESE ARE NOT SUBTLE FINDINGS. 522 00:20:04,880 --> 00:20:06,000 IN REGULAR CLINICAL PRACTICE 523 00:20:06,000 --> 00:20:07,200 PEOPLE HAVE MARKEDLY DIFFERENT 524 00:20:07,200 --> 00:20:09,120 SCORES ON THIS MEASURE, IT 525 00:20:09,120 --> 00:20:09,920 MARKEDLY INFLUENCES WHAT'S GOING 526 00:20:09,920 --> 00:20:11,480 TO WORK AND WHAT'S NOT GOING TO 527 00:20:11,480 --> 00:20:13,520 WORK BECAUSE WHAT WE'VE COME TO 528 00:20:13,520 --> 00:20:14,800 REALIZE IS THAT ALL PAIN STATES 529 00:20:14,800 --> 00:20:16,120 ARE MIXED PAIN STATES. 530 00:20:16,120 --> 00:20:19,320 WE USED TO THINK ALL PEOPLE WITH 531 00:20:19,320 --> 00:20:20,720 OSTEOARTHRITIS OR AUTOIMMUNE 532 00:20:20,720 --> 00:20:22,400 DISORDERS HAD NOCICEPTIVE PAIN. 533 00:20:22,400 --> 00:20:23,560 PEOPLE WITH DIABETIC PAINFUL 534 00:20:23,560 --> 00:20:24,600 NEUROPATHY HAD NEUROPATHIC PAIN. 535 00:20:24,600 --> 00:20:27,760 AND ALL PEOPLE ARE CONDITIONS 536 00:20:27,760 --> 00:20:30,280 LIKE FIBROMYALGIA ONLY HAD 537 00:20:30,280 --> 00:20:31,520 NOCIPLASTIC PAIN. 538 00:20:31,520 --> 00:20:37,160 WE KNOW THESE OCCUR, THIS PAIN 539 00:20:37,160 --> 00:20:38,080 MECHANISM OCCURS WITH THIS PAIN 540 00:20:38,080 --> 00:20:40,000 MECHANISM AND PEOPLE DON'T 541 00:20:40,000 --> 00:20:40,560 IDENTIFY THIS. 542 00:20:40,560 --> 00:20:42,520 IF YOU SEE THE PAIN IS MORE 543 00:20:42,520 --> 00:20:43,840 WIDESPREAD OR GIVE THE FORECAST 544 00:20:43,840 --> 00:20:44,840 MEASURE AND THEY SCORE HIGHER, 545 00:20:44,840 --> 00:20:46,360 IT DOESN'T TELL YOU WHAT ISN'T 546 00:20:46,360 --> 00:20:47,640 GOING TO WORK BUT WHAT IS GOING 547 00:20:47,640 --> 00:20:48,880 TO WORK. 548 00:20:48,880 --> 00:20:52,120 THIS IS THE DRUG DULOXETINE, 549 00:20:52,120 --> 00:20:53,920 APPROVED FOR USE IN 550 00:20:53,920 --> 00:20:54,880 OSTEOARTHRITIS AND CHRONIC LOW 551 00:20:54,880 --> 00:20:55,520 BACK PAIN. 552 00:20:55,520 --> 00:20:59,520 WASN'T UNTIL WELL AFTER THE DRUG 553 00:20:59,520 --> 00:21:01,760 WAS NO LONGER A BRAND NAME DRUG 554 00:21:01,760 --> 00:21:03,320 THAT WE REALIZE THE GIVING 555 00:21:03,320 --> 00:21:04,840 SOMEONE A BODY MAP WITH LOW BACK 556 00:21:04,840 --> 00:21:06,560 PAIN WILL PREDICT WHO IS GOING 557 00:21:06,560 --> 00:21:08,000 TO RESPOND TO THIS DRUG. 558 00:21:08,000 --> 00:21:09,920 THE MORE SITES OF PAIN ON A BODY 559 00:21:09,920 --> 00:21:12,040 MAP WITH LOW BACK PAIN, THE MORE 560 00:21:12,040 --> 00:21:15,720 LIKELY DULOXETINE IS GOING TO 561 00:21:15,720 --> 00:21:16,040 WORK. 562 00:21:16,040 --> 00:21:17,560 SIMILARLY, SAME THING SHOWN IN 563 00:21:17,560 --> 00:21:19,320 OSTEOARTHRITIS, THE MORE SITES 564 00:21:19,320 --> 00:21:20,720 OF PAIN, THE MORE LIKELY 565 00:21:20,720 --> 00:21:23,480 DULOXETINE WAS GOING TO WORK TO 566 00:21:23,480 --> 00:21:24,120 TREAT OSTEOARTHRITIS. 567 00:21:24,120 --> 00:21:27,320 WE KNOW ABOUT THE 568 00:21:27,320 --> 00:21:30,320 PATHOPHYSIOLOGY, WE CAN DO 569 00:21:30,320 --> 00:21:31,480 FUNCTIONAL BRAIN IMAGING THAT 570 00:21:31,480 --> 00:21:32,880 SHOWS THEY ARE MORE SENSITIVE TO 571 00:21:32,880 --> 00:21:35,960 NOT JUST PAIN BUT ANY TYPE OF 572 00:21:35,960 --> 00:21:37,480 SENSORY STIMULI, THE DEGREE TO 573 00:21:37,480 --> 00:21:38,880 WHICH BRAIN REGIONS ARE TOO 574 00:21:38,880 --> 00:21:39,600 CONNECTED OR NOT CONNECTED 575 00:21:39,600 --> 00:21:40,760 ENOUGH TO EACH OTHER. 576 00:21:40,760 --> 00:21:44,120 AND THIS IS A FAIRLY 577 00:21:44,120 --> 00:21:45,320 REPRODUCIBLE NEURAL SIGNATURE OF 578 00:21:45,320 --> 00:21:48,400 NOCIPLASTIC PLAIN. 579 00:21:48,400 --> 00:21:50,280 YOU CAN START TO SEE THESE SAME 580 00:21:50,280 --> 00:21:53,120 FINDINGS THAT WE AND OTHERS HAVE 581 00:21:53,120 --> 00:21:54,640 BEEN PUBLISHING IN NOCIPLASTIC 582 00:21:54,640 --> 00:21:56,520 PAIN FOR 15 YEARS NOW, YOU CAN 583 00:21:56,520 --> 00:21:59,440 SEE THIS IN KIDS THAT ARE PAIN 584 00:21:59,440 --> 00:22:01,400 FREE, TWO YEARS LATER DEVELOP 585 00:22:01,400 --> 00:22:03,320 NEW MULTI-SITE PAIN IN THE ABCD 586 00:22:03,320 --> 00:22:05,600 STUDY THAT WE CAN SEE ON BRAIN 587 00:22:05,600 --> 00:22:07,880 IMAGING WHILE THE KIDS ARE STILL 588 00:22:07,880 --> 00:22:08,520 SYMPTOM FREE AND ASYMPTOMATIC 589 00:22:08,520 --> 00:22:10,400 THAT THEY ARE ON THEIR WAY TO 590 00:22:10,400 --> 00:22:11,720 DEVELOP THIS KIND OF PAIN WHICH 591 00:22:11,720 --> 00:22:14,160 IS REALLY EXCITING WITH RESPECT 592 00:22:14,160 --> 00:22:16,040 TO OUR ABILITY TO PREVENT PEOPLE 593 00:22:16,040 --> 00:22:17,560 FROM DEVELOPING THIS, ESPECIALLY 594 00:22:17,560 --> 00:22:19,640 IF WE TARGET SOME OF THE STUDIES 595 00:22:19,640 --> 00:22:20,840 IN ADOLESCENTS THAT ARE 596 00:22:20,840 --> 00:22:21,600 DEVELOPING NEW PAIN. 597 00:22:21,600 --> 00:22:24,560 EVEN THE SIZE AND SHAPE OF THE 598 00:22:24,560 --> 00:22:26,960 BRAIN CHANGES IN NOCIPLASTIC 599 00:22:26,960 --> 00:22:30,720 PAIN PROBABLY BECAUSE OF 600 00:22:30,720 --> 00:22:31,120 NEUROPLASTICITY. 601 00:22:31,120 --> 00:22:34,720 I'LL MOVE TO PELVIC PAIN, I'VE 602 00:22:34,720 --> 00:22:36,360 STUDIED IT, WE'RE INVOLVED IN 603 00:22:36,360 --> 00:22:39,880 THE NIH MAP NETWORK THAT STUDIED 604 00:22:39,880 --> 00:22:43,040 PEOPLE WITH INTERSTITIAL 605 00:22:43,040 --> 00:22:45,120 CYSTITIS AND CHRONIC PELVIC 606 00:22:45,120 --> 00:22:46,320 PAIN, THE MAJOR FINDING BY A 607 00:22:46,320 --> 00:22:50,240 LONG SHOT IS THE DEGREE OF 608 00:22:50,240 --> 00:22:52,680 CENTRAL SENSITIZATION MARKEDLY 609 00:22:52,680 --> 00:22:56,320 IMPACTS NOT JUST WHAT 610 00:22:56,320 --> 00:22:57,840 QUANTITATIVE SENSORY TESTING OR 611 00:22:57,840 --> 00:22:58,880 BRAIN IMAGING LOOK LIKE IN 612 00:22:58,880 --> 00:23:02,120 STUDIES DONE IN THE MAP NETWORK. 613 00:23:02,120 --> 00:23:03,720 BASICALLY PEOPLE WITH CHRONIC 614 00:23:03,720 --> 00:23:05,160 PELVIC PAIN, I'M SORRY, GO BACK, 615 00:23:05,160 --> 00:23:07,760 THAT HAD PAIN CONFINED TO THE 616 00:23:07,760 --> 00:23:09,520 PELVIS, THAT'S ONE PHENOTYPE. 617 00:23:09,520 --> 00:23:10,880 CHRONIC PELVIC PAIN WITH PAIN 618 00:23:10,880 --> 00:23:13,080 STILL IN THE PELVIC REGION. 619 00:23:13,080 --> 00:23:14,960 MORE WIDESPREAD PAIN IN THE MAP 620 00:23:14,960 --> 00:23:18,360 NETWORK, ABOUT 15% OF THE 621 00:23:18,360 --> 00:23:25,760 INTERSTITIAL CYSTITIS PATIENTS 622 00:23:25,760 --> 00:23:27,680 HAD THIS PHENOTYPE, 20% THIS, 40 623 00:23:27,680 --> 00:23:29,960 TO 50% THIS. 624 00:23:29,960 --> 00:23:32,320 THOSE WITH WIDESPREAD PAIN 625 00:23:32,320 --> 00:23:33,040 LOOKED IDENTICAL TO FIBROMYALGIA 626 00:23:33,040 --> 00:23:37,280 PATIENTS, PEOPLE ARE LOCALIZE 627 00:23:37,280 --> 00:23:39,280 THE PAIN NOCIPLASTIC PAIN HAD 628 00:23:39,280 --> 00:23:40,600 NORMAL fMRIs, THEY DIDN'T 629 00:23:40,600 --> 00:23:46,720 HAVE INCREASE IN AMPLIFIER. 630 00:23:46,720 --> 00:23:50,320 WE STARTED TO COLLECT DATA WHAT 631 00:23:50,320 --> 00:23:55,560 TREATMENTS PEOPLE WERE RECEIVING 632 00:23:55,560 --> 00:23:56,440 FOR INTERSTITIAL CYSTITIS, 633 00:23:56,440 --> 00:23:57,880 URINARY CHRONIC PAIN SYNDROMES 634 00:23:57,880 --> 00:24:00,160 AND SOME EXCITING DATA SUGGESTS 635 00:24:00,160 --> 00:24:04,320 THAT PERIPHERALLY DIRECTED 636 00:24:04,320 --> 00:24:05,200 TREATMENTS LIKE PHYSICAL THERAPY 637 00:24:05,200 --> 00:24:07,720 WORK REALLY, REALLY WELL IN 638 00:24:07,720 --> 00:24:09,280 PEOPLE WITH THAT PAIN PHENOTYPE 639 00:24:09,280 --> 00:24:11,880 LOCALIZED WHERE THEY ARE PAIN IS 640 00:24:11,880 --> 00:24:13,400 LOCALIZED TO THE PELVIS BUT 641 00:24:13,400 --> 00:24:14,080 PHYSICAL THERAPY BARELY WORKS AT 642 00:24:14,080 --> 00:24:16,840 ALL IN THE PEOPLE WITH 643 00:24:16,840 --> 00:24:18,920 WIDESPREAD PAIN. 644 00:24:18,920 --> 00:24:21,560 CONVERSELY, DRUGS WORKING 645 00:24:21,560 --> 00:24:26,480 CENTRALLY, SEROTONIN, NOR 646 00:24:26,480 --> 00:24:27,240 NOREPINEPHRINE REUPTAKE 647 00:24:27,240 --> 00:24:30,320 INHIBITORS WORK WITH PEOPLE WITH 648 00:24:30,320 --> 00:24:31,920 MORE WIDESPREAD PAIN, RARELY 649 00:24:31,920 --> 00:24:34,800 WORK WITH THE INTERMEDIATE 650 00:24:34,800 --> 00:24:35,440 PHENOTYPE. 651 00:24:35,440 --> 00:24:38,520 WE THINK PHENOTYPING STUDIES 652 00:24:38,520 --> 00:24:40,800 LOOKING AT HOW WIDESPREAD, OR 653 00:24:40,800 --> 00:24:41,840 ADDING FUNCTIONAL BRAIN IMAGING, 654 00:24:41,840 --> 00:24:44,640 ANOTHER STUDY PUBLISHED A COUPLE 655 00:24:44,640 --> 00:24:46,040 DAYS AGO, JUST PEOPLE GETTING 656 00:24:46,040 --> 00:24:47,040 PHYSICAL THERAPY, WHERE THEY 657 00:24:47,040 --> 00:24:57,000 WERE ON THE FIBROMYALGIA 658 00:24:57,000 --> 00:24:57,680 CONTINUUM MARKEDLY AFFECTED 659 00:24:57,680 --> 00:24:59,320 WHETHER P.T. OR NOT. 660 00:24:59,320 --> 00:25:01,800 THIS IS BACPAC, COMPONENT OF 661 00:25:01,800 --> 00:25:04,120 "HEAL" TRYING TO APPLY PRECISION 662 00:25:04,120 --> 00:25:05,200 MEDICINE APPROACH TO PAIN. 663 00:25:05,200 --> 00:25:06,520 THIS IS A STUDY THAT'S GOING TO 664 00:25:06,520 --> 00:25:09,120 START IN THE NEXT COUPLE OF 665 00:25:09,120 --> 00:25:11,960 MONTHS, FROM "HEAL," AND IN THIS 666 00:25:11,960 --> 00:25:13,640 STUDY WE'RE USING SEQUENTIAL 667 00:25:13,640 --> 00:25:15,120 RANDOMIZATION AND SMART AND 668 00:25:15,120 --> 00:25:16,720 ADAPTIVE DESIGNS IN A DIFFERENT 669 00:25:16,720 --> 00:25:18,600 WAY, USING THEM WHERE WE 670 00:25:18,600 --> 00:25:20,560 ACTUALLY PHENOTYPE PEOPLE AT 671 00:25:20,560 --> 00:25:22,320 BASELINE AND GIVE THEM SEVERAL 672 00:25:22,320 --> 00:25:23,520 TREATMENTS WE KNOW WORK IN A 673 00:25:23,520 --> 00:25:24,760 GROUP OF PEOPLE WITH CHRONIC LOW 674 00:25:24,760 --> 00:25:27,320 BACK PAIN BUT DON'T KNOW WHAT 675 00:25:27,320 --> 00:25:28,320 SUBSET OF PEOPLE WITH CHRONIC 676 00:25:28,320 --> 00:25:29,880 LOW BACK PAIN THEY WORK IN. 677 00:25:29,880 --> 00:25:32,600 WHAT WE'RE MOST INTERESTED IN IN 678 00:25:32,600 --> 00:25:35,120 THESE STUDIES IS MATCHING THE 679 00:25:35,120 --> 00:25:36,560 PHENOTYPE AT BASELINE WITH 680 00:25:36,560 --> 00:25:38,720 WHAT'S GOING TO WORK. 681 00:25:38,720 --> 00:25:41,560 AFTER WE DO INTENSIVE 682 00:25:41,560 --> 00:25:42,800 PHENOTYPING RANDOMIZE PEOPLE, 683 00:25:42,800 --> 00:25:45,520 THERE'S FOUR TREATMENTS THEY CAN 684 00:25:45,520 --> 00:25:47,800 RECEIVE, ENHANCED SELF-CARE, 685 00:25:47,800 --> 00:25:48,920 ACCEPTANCE COMMITMENT THERAPY, 686 00:25:48,920 --> 00:25:52,720 BASICALLY PHYSICAL THERAPY, AND 687 00:25:52,720 --> 00:25:56,800 DULOXETINE, STRONG A PRIORI 688 00:25:56,800 --> 00:25:58,920 HYPOTHESES AND THINK WE CAN TAKE 689 00:25:58,920 --> 00:26:00,280 A DRUG LIKE DULOXETINE OR 690 00:26:00,280 --> 00:26:01,520 PHYSICAL THERAPY FROM RIGHT NOW 691 00:26:01,520 --> 00:26:04,320 WHEN YOU USE IT IN AN UNSELECTED 692 00:26:04,320 --> 00:26:05,320 POPULATION, THESE WORK IN ABOUT 693 00:26:05,320 --> 00:26:07,320 A THIRD OF INDIVIDUALS, BUT WHEN 694 00:26:07,320 --> 00:26:08,520 WE GET SMARTER ABOUT WHICH 695 00:26:08,520 --> 00:26:09,720 TREATMENTS WE USE, WHICH PEOPLE, 696 00:26:09,720 --> 00:26:11,200 WE THINK WE CAN RAISE THE 697 00:26:11,200 --> 00:26:13,600 RESPONSE RATES OF SOME OF OUR 698 00:26:13,600 --> 00:26:15,680 CURRENT TREATMENTS FROM 30% TO 699 00:26:15,680 --> 00:26:18,840 ON A 50 OR 60% BY USING SIMPLE 700 00:26:18,840 --> 00:26:20,280 PHENOTYPING THAT WOULD BE 701 00:26:20,280 --> 00:26:21,920 BROADLY AVAILABLE IN CLINICAL 702 00:26:21,920 --> 00:26:23,120 PRACTICE, STARTING WITH SIMPLE 703 00:26:23,120 --> 00:26:24,440 THINGS LIKE A BODY MAP. 704 00:26:24,440 --> 00:26:26,320 I'LL STOP THERE AND TAKE ANY 705 00:26:26,320 --> 00:26:30,520 QUESTIONS THAT PEOPLE HAVE. 706 00:26:30,520 --> 00:26:33,080 THANK YOU. 707 00:26:33,080 --> 00:26:37,200 708 00:26:37,200 --> 00:26:38,960 >> THANK YOU, DR. CLAUW, FOR 709 00:26:38,960 --> 00:26:40,600 YOUR GREAT PRESENTATION. 710 00:26:40,600 --> 00:26:42,680 CAN YOU SEE THE CHAT BOX? 711 00:26:42,680 --> 00:26:43,880 >> I CAN. 712 00:26:43,880 --> 00:26:47,000 DO YOU WANT ME TO -- 713 00:26:47,000 --> 00:26:51,320 >> SO, IF YOU HAVE ANY 714 00:26:51,320 --> 00:26:53,080 QUESTIONS, OR COMMENTS, PLEASE 715 00:26:53,080 --> 00:26:55,480 PUT YOUR QUESTIONS IN THE CHAT 716 00:26:55,480 --> 00:26:55,920 PANEL. 717 00:26:55,920 --> 00:26:58,920 CHAT BOX. 718 00:26:58,920 --> 00:27:04,280 SO OUR FIRST QUESTION IS FROM 719 00:27:04,280 --> 00:27:06,520 MARK GOODMAN. 720 00:27:06,520 --> 00:27:07,480 IS THERE INCREASED INCIDENCE OF 721 00:27:07,480 --> 00:27:15,920 FIBROMYALGIA DUE IN PART TO 722 00:27:15,920 --> 00:27:17,720 INCREASED SUSTAINED STATIN USE? 723 00:27:17,720 --> 00:27:21,160 >> A SMALL SUBSET OF PEOPLE ON 724 00:27:21,160 --> 00:27:22,120 STATINS DEVELOP MYALGIAS, BUT 725 00:27:22,120 --> 00:27:23,520 THEY DON'T DEVELOP THE OTHER 726 00:27:23,520 --> 00:27:25,080 PART OF THE SORT OF FIBROMYALGIA 727 00:27:25,080 --> 00:27:26,240 PICTURE WITH THE SLEEP AND 728 00:27:26,240 --> 00:27:27,920 MEMORY AND ALL THOSE OTHER KINDS 729 00:27:27,920 --> 00:27:28,760 OF PROBLEMS. 730 00:27:28,760 --> 00:27:32,920 AND THAT REALLY WOULDN'T BE 731 00:27:32,920 --> 00:27:33,480 CALLED FIBROMYALGIA. 732 00:27:33,480 --> 00:27:35,880 THAT WOULD BE A SIDE EFFECT OF 733 00:27:35,880 --> 00:27:36,120 STATINS. 734 00:27:36,120 --> 00:27:38,320 YOU TAKE PEOPLE OFF AND EXPECT 735 00:27:38,320 --> 00:27:39,040 THAT WOULD RESOLVE. 736 00:27:39,040 --> 00:27:40,600 IT DOESN'T SEEM LIKE WHAT WE'RE 737 00:27:40,600 --> 00:27:41,920 SEEING WITH RESPECT TO 738 00:27:41,920 --> 00:27:42,560 FIBROMYALGIA -- THERE'S REPORTS 739 00:27:42,560 --> 00:27:44,120 OF WHAT WE KNOW TO BE 740 00:27:44,120 --> 00:27:45,040 FIBROMYALGIA IN THE SCIENTIFIC 741 00:27:45,040 --> 00:27:54,920 LILT A -- LITERATURE GOING BACK 742 00:27:54,920 --> 00:27:56,320 HUNDREDS MUCH YEARS, 743 00:27:56,320 --> 00:27:56,920 RECONCEPTUALIZING WHAT WAS 744 00:27:56,920 --> 00:27:58,960 CAUSED AT THE END OF THE LAST 745 00:27:58,960 --> 00:28:01,720 CURRENTLY, NOT THE CURRENT 746 00:28:01,720 --> 00:28:04,800 CENTURY, BUT THINKING EVOLVED 747 00:28:04,800 --> 00:28:07,400 EVOLVED ABOUT THE SYNDROMES. 748 00:28:07,400 --> 00:28:13,560 THIS IS A FAIRLY UBIQUITOUS 749 00:28:13,560 --> 00:28:16,280 PHENOMENA, IT'S MORE COMMON IN 750 00:28:16,280 --> 00:28:20,160 ENDOMETRIOSIS PATIENTS, BUT IF 751 00:28:20,160 --> 00:28:21,120 YOU LOOK AT SUBTHRESHOLD 752 00:28:21,120 --> 00:28:23,520 FIBROMYALGIA, A GROUP OF WOMEN 753 00:28:23,520 --> 00:28:24,320 DIAGNOSED WITH ENDOMETRIOSIS 754 00:28:24,320 --> 00:28:26,600 THAT MEASURE, THEY WILL BE 755 00:28:26,600 --> 00:28:29,040 HEAVILY SKEWED TOWARDS HAVING 756 00:28:29,040 --> 00:28:36,840 HIGHER DEGREES. 757 00:28:36,840 --> 00:28:38,320 IF THE PAIN IS COMING MORE SO 758 00:28:38,320 --> 00:28:40,080 FROM THE BRAIN AND CENTRAL 759 00:28:40,080 --> 00:28:41,160 NERVOUS SYSTEM THEN SURGERY 760 00:28:41,160 --> 00:28:42,560 ISN'T NEARLY AS LIKELY TO WORK 761 00:28:42,560 --> 00:28:44,520 IN THOSE PATIENTS. 762 00:28:44,520 --> 00:28:45,400 WE THINK THAT FIBROMYALGIA 763 00:28:45,400 --> 00:28:47,880 MEASURE AT PRESENT IS THE BEST 764 00:28:47,880 --> 00:28:50,360 SURROGATE MEASURE OF THE DEGREE 765 00:28:50,360 --> 00:28:51,560 OF NOCIPLASTIC PAIN YOU CAN USE 766 00:28:51,560 --> 00:28:53,200 IN A STUDY. 767 00:28:53,200 --> 00:28:55,160 A BODY MAP ALONE DOES A GOOD 768 00:28:55,160 --> 00:28:55,400 JOB. 769 00:28:55,400 --> 00:28:57,800 JUST WE THINK THE OTHER 770 00:28:57,800 --> 00:28:59,200 COMPONENTS OF THE FIBROMYALGIA 771 00:28:59,200 --> 00:29:02,040 MEASURE GETTING AT THE COMORBID 772 00:29:02,040 --> 00:29:04,120 FATIGUE, SLEEP, MEMORY PROBLEMS, 773 00:29:04,120 --> 00:29:05,720 AND SENSORY SENSITIVITY, ALSO 774 00:29:05,720 --> 00:29:08,040 HELPS IDENTIFY THAT PHENOTYPE AS 775 00:29:08,040 --> 00:29:10,960 WELL. 776 00:29:10,960 --> 00:29:12,760 777 00:29:12,760 --> 00:29:15,200 >> SO WE HAVE ANOTHER QUESTION 778 00:29:15,200 --> 00:29:17,920 FROM KATHLEEN. 779 00:29:17,920 --> 00:29:23,120 WHAT JOURNAL WAS THAT PUBLISHED? 780 00:29:23,120 --> 00:29:26,320 WHO WOULD BENEFIT FROM HAVING 781 00:29:26,320 --> 00:29:26,880 PHYSICAL THERAPY? 782 00:29:26,880 --> 00:29:28,120 >> OH, I WISH I KNEW. 783 00:29:28,120 --> 00:29:30,560 IT WAS PUBLISHED IN A PHYSICAL 784 00:29:30,560 --> 00:29:31,720 MEDICINE AND REHAB JOURNAL. 785 00:29:31,720 --> 00:29:32,600 OOPS, I'M SORRY. 786 00:29:32,600 --> 00:29:33,960 BUT I'LL TRY TO FIND THAT OUT 787 00:29:33,960 --> 00:29:46,640 AND PUT IT IN THE CHAT. 788 00:29:46,640 --> 00:29:48,520 >> AND THERE'S ANOTHER QUESTION. 789 00:29:48,520 --> 00:29:50,320 >> LET ME RESPOND, I WANT TO 790 00:29:50,320 --> 00:29:53,080 MAKE SURE I WASN'T UNCLEAR. 791 00:29:53,080 --> 00:29:54,160 PSYCHOLOGICAL FACTORS ARE 792 00:29:54,160 --> 00:29:55,240 INCREDIBLY IMPORTANT TO ASSESS 793 00:29:55,240 --> 00:29:56,800 AND TREAT PEOPLE WITH CHRONIC 794 00:29:56,800 --> 00:29:57,000 PAIN. 795 00:29:57,000 --> 00:30:01,280 IT'S JUST THAT I THINK THEY HAVE 796 00:30:01,280 --> 00:30:02,360 BEEN OVEREMPHASIZED WITH RESPECT 797 00:30:02,360 --> 00:30:03,720 TO TRANSITION FROM ACUTE TO 798 00:30:03,720 --> 00:30:05,000 CHRONIC PAIN. 799 00:30:05,000 --> 00:30:09,160 THINGS LIKE CATASTROPHE IZING 800 00:30:09,160 --> 00:30:12,440 ARE MORE A STATE THAN TRAIT,ING 801 00:30:12,440 --> 00:30:13,520 WHAT CATASTROPHIZING OFTEN IS, 802 00:30:13,520 --> 00:30:15,840 THESE ARE PEOPLE THAT HAVE HAD 803 00:30:15,840 --> 00:30:18,480 PAIN FOR A WHILE, AND WHEN THEY 804 00:30:18,480 --> 00:30:19,840 SEEK HEALTH CARE THEY HAVEN'T 805 00:30:19,840 --> 00:30:20,520 BEEN RELIEVED OF PAIN. 806 00:30:20,520 --> 00:30:24,680 THAT'S WHY THEY THINK THAT WAY. 807 00:30:24,680 --> 00:30:26,880 I THINK THAT THERE'S A LOT OF 808 00:30:26,880 --> 00:30:28,760 CHALLENGE OF SORT OF -- WHAT'S 809 00:30:28,760 --> 00:30:30,400 THE DIRECTIONALITY OF THE 810 00:30:30,400 --> 00:30:31,600 RELATIONSHIP BETWEEN MOOD 811 00:30:31,600 --> 00:30:32,880 DISORDERS AND PAIN. 812 00:30:32,880 --> 00:30:34,880 MOST PEOPLE USED TO THINK THAT 813 00:30:34,880 --> 00:30:35,920 THE PSYCHOLOGICAL PROBLEMS 814 00:30:35,920 --> 00:30:37,320 ALMOST ALWAYS CAME FIRST. 815 00:30:37,320 --> 00:30:39,160 I THINK THE DATA ARE NOW 816 00:30:39,160 --> 00:30:41,800 SUGGESTING THAT IT'S VERY 817 00:30:41,800 --> 00:30:44,280 BIDIRECTIONAL AND WITH RESPECT 818 00:30:44,280 --> 00:30:50,920 TO NUANCE PSYCHOLOGICAL FACTORS 819 00:30:50,920 --> 00:30:52,920 MAY BE LESS IMPORTANT WITH THE 820 00:30:52,920 --> 00:30:54,800 TRANSITION TO CHRONIC PAIN. 821 00:30:54,800 --> 00:30:58,760 >> THANK YOU. 822 00:30:58,760 --> 00:31:01,720 NEXT QUESTION, IS FIBROMYALGIA 823 00:31:01,720 --> 00:31:03,920 MORE COMMON IN ENDOMETRIOSIS 824 00:31:03,920 --> 00:31:04,200 PATIENTS? 825 00:31:04,200 --> 00:31:05,600 >> YEAH, I ANSWERED THAT. 826 00:31:05,600 --> 00:31:06,960 YEP. 827 00:31:06,960 --> 00:31:10,480 IT IS. 828 00:31:10,480 --> 00:31:11,480 IT'S A BIDIRECTIONAL, BECAUSE 829 00:31:11,480 --> 00:31:12,400 ENDOMETRIOSIS IS ONE OF THE 830 00:31:12,400 --> 00:31:14,120 TERMS OF THE NIH PROGRAM STAFF 831 00:31:14,120 --> 00:31:15,880 THAT COINED THE TERM, CHRONIC 832 00:31:15,880 --> 00:31:16,600 OVERLAPPING PAIN CONDITIONS, 833 00:31:16,600 --> 00:31:18,600 THIS CAME FROM THE NIH PAIN 834 00:31:18,600 --> 00:31:20,840 CONSORTIUM, THAT TERM. 835 00:31:20,840 --> 00:31:22,400 AND THEY PUT ENDOMETRIOSIS IN 836 00:31:22,400 --> 00:31:24,720 THAT BECAUSE OF THE DATA THAT 837 00:31:24,720 --> 00:31:26,920 DID SHOW THIS BIDIRECTIONAL 838 00:31:26,920 --> 00:31:30,000 RELATIONSHIP BETWEEN 839 00:31:30,000 --> 00:31:32,680 ENDOMETRIOSIS AND SOME CHRONIC 840 00:31:32,680 --> 00:31:36,760 OTHER OVERLAPPING PAIN 841 00:31:36,760 --> 00:31:37,080 CONDITIONS. 842 00:31:37,080 --> 00:31:38,240 >> ANOTHER QUESTION. 843 00:31:38,240 --> 00:31:44,360 DO WE KNOW WHAT MAKES SOME 844 00:31:44,360 --> 00:31:45,920 PATIENTS MORE SENSITIZED 845 00:31:45,920 --> 00:31:46,200 CENTRALLY? 846 00:31:46,200 --> 00:31:48,320 >> SOME IS GENETIC AND FAMILIAL, 847 00:31:48,320 --> 00:31:49,120 STUDIES SUGGESTED THAT ABOUT 848 00:31:49,120 --> 00:31:51,320 HALF OF THE RISK OF DEVELOPING 849 00:31:51,320 --> 00:31:53,200 THIS IS GENETIC AND FAMILIAL. 850 00:31:53,200 --> 00:31:54,600 WE KNOW EARLY LIFE TRAUMA AND 851 00:31:54,600 --> 00:31:58,040 STRESS CAN CONTRIBUTE TO THIS. 852 00:31:58,040 --> 00:32:00,120 SO CANNOT SLEEPING WELL AND NOT 853 00:32:00,120 --> 00:32:01,080 EXERCISING ENOUGH, THINGS LIKE 854 00:32:01,080 --> 00:32:01,720 THAT. 855 00:32:01,720 --> 00:32:04,480 THIS IS WHY WE USE SLEEP AND 856 00:32:04,480 --> 00:32:06,440 ACTIVITY AND EXERCISE SO 857 00:32:06,440 --> 00:32:08,120 AGGRESSIVELY IN TREATING 858 00:32:08,120 --> 00:32:09,160 NOCIPLASTIC PAIN. 859 00:32:09,160 --> 00:32:10,920 SOME RECENT STUDIES WE'VE DONE 860 00:32:10,920 --> 00:32:13,280 ALSO LOOKING AT THE ABCD DATASET 861 00:32:13,280 --> 00:32:16,840 THAT I SHOWED YOU CHELSEA'S 862 00:32:16,840 --> 00:32:18,040 ARTICLE SUGGESTS BEFORE KIDS 863 00:32:18,040 --> 00:32:20,560 DEVELOP NUANCE AT A MULTI-SITE 864 00:32:20,560 --> 00:32:23,000 PAIN SLEEP DISORDER IS ALMOST 865 00:32:23,000 --> 00:32:25,120 ALWAYS PRE-DATING THAT, AS DO 866 00:32:25,120 --> 00:32:26,160 SOME FATIGUE AND SOME MEMORY 867 00:32:26,160 --> 00:32:26,560 PROBLEMS. 868 00:32:26,560 --> 00:32:29,480 AND SO I THINK WE'RE ALSO 869 00:32:29,480 --> 00:32:35,160 GETTING -- GOING BACK TO EARLY 870 00:32:35,160 --> 00:32:36,240 STUDIES, APPRECIATING HOW 871 00:32:36,240 --> 00:32:38,200 IMPORTANT SLEEP IS ESPECIALLY, 872 00:32:38,200 --> 00:32:39,400 AGAIN, IN THAT TRANSITION FROM 873 00:32:39,400 --> 00:32:44,280 ACUTE TO CHRONIC PAIN AND IN 874 00:32:44,280 --> 00:32:45,880 REALLY TRYING TO GET CHRONIC 875 00:32:45,880 --> 00:32:46,720 PAIN PATIENTS SLEEPING WELL 876 00:32:46,720 --> 00:32:49,200 BECAUSE IT SEEMS TO BE 877 00:32:49,200 --> 00:32:50,320 INCREDIBLY IMPORTANT, AS DOES A 878 00:32:50,320 --> 00:32:53,040 CERTAIN AMOUNT OF ACTIVITY OR 879 00:32:53,040 --> 00:32:58,400 EXERCISE. 880 00:32:58,400 --> 00:33:00,320 >> NEXT QUESTION, IF 15% OF I.C. 881 00:33:00,320 --> 00:33:02,680 IS LOCALIZED DO WE KNOW HOW MUCH 882 00:33:02,680 --> 00:33:06,720 OF MYOFASCIAL PELVIC PAIN IS 883 00:33:06,720 --> 00:33:07,920 LOCALIZED VERSUS CENTRALLY 884 00:33:07,920 --> 00:33:08,240 SENSITIZED? 885 00:33:08,240 --> 00:33:12,720 >> NO, THAT'S A GREAT QUESTION, 886 00:33:12,720 --> 00:33:13,720 BECAUSE AGAIN THE MAPP STUDY 887 00:33:13,720 --> 00:33:14,840 STRONGLY SUGGESTED PEOPLE THAT 888 00:33:14,840 --> 00:33:18,440 RESPOND TO P.T. WERE PEOPLE WITH 889 00:33:18,440 --> 00:33:19,760 THE MORE LOCALIZED PAIN, BUT I 890 00:33:19,760 --> 00:33:21,920 KNOW A LOT OF CLINICIANS SEE A 891 00:33:21,920 --> 00:33:23,720 LOT OF THAT SORT OF THOSE 892 00:33:23,720 --> 00:33:26,000 MYOFASCIAL TENDER POINTS AND 893 00:33:26,000 --> 00:33:27,680 TRIGGER POINTS IN THE PELVIC 894 00:33:27,680 --> 00:33:28,720 REGION, AND THINK THAT'S A GOOD 895 00:33:28,720 --> 00:33:31,120 MARKER OF SORT OF CENTRAL 896 00:33:31,120 --> 00:33:34,960 SENSITIZATION OR NOCIPLASTIC 897 00:33:34,960 --> 00:33:35,200 PAIN. 898 00:33:35,200 --> 00:33:36,360 THOSE AREN'T MUTUALLY EXCLUSIVE 899 00:33:36,360 --> 00:33:39,440 BUT WE HAVE TO BETTER STUDY SORT 900 00:33:39,440 --> 00:33:40,000 OF THE INTERSECTION OF 901 00:33:40,000 --> 00:33:43,080 MYOFASCIAL PAIN AND THEN ALL THE 902 00:33:43,080 --> 00:33:44,880 WAY TO CENTRAL SENSITIZATION 903 00:33:44,880 --> 00:33:46,000 NOCIPLASTIC PAIN AND WHAT DO THE 904 00:33:46,000 --> 00:33:49,400 PEOPLE AT DIFFERENT POINTS IN 905 00:33:49,400 --> 00:33:50,520 THAT CONTINUUM RESPOND TO 906 00:33:50,520 --> 00:33:52,800 ESPECIALLY WITH RESPECT TO 907 00:33:52,800 --> 00:33:53,280 P.T.-BASED MODALITIES. 908 00:33:53,280 --> 00:33:56,520 I'M A HUGE FAN OF THE P.T.-BASED 909 00:33:56,520 --> 00:33:58,920 MODALITIES BUT THEY CLEARLY ARE 910 00:33:58,920 --> 00:33:59,800 OF DIFFERENTIAL BENEFIT IN 911 00:33:59,800 --> 00:34:06,720 PEOPLE THAT ARE AT DIFFERENT 912 00:34:06,720 --> 00:34:08,480 POINTS IN THIS CONTINUUM. 913 00:34:08,480 --> 00:34:10,720 >> CAN YOU MAKE AVAILABLE THE 914 00:34:10,720 --> 00:34:14,680 BODY MAP OR FM SCORE FOR THE 915 00:34:14,680 --> 00:34:15,120 AUDIENCE? 916 00:34:15,120 --> 00:34:16,240 >> YEAH, I'M HAPPY TO SEND 917 00:34:16,240 --> 00:34:17,360 ANYTHING YOU WANT. 918 00:34:17,360 --> 00:34:30,960 JUST SEND ME AN E-MAIL, 919 00:34:30,960 --> 00:34:33,480 DCLAUW@MICHIGAN.EDU, HAPPY TO 920 00:34:33,480 --> 00:34:34,120 DISTRIBUTE THAT. 921 00:34:34,120 --> 00:34:41,120 >> ONE MINUTE LEFT. 922 00:34:41,120 --> 00:34:43,320 NEXT QUESTION, ANY 923 00:34:43,320 --> 00:34:47,240 RECOMMENDATION TO USE THE 924 00:34:47,240 --> 00:34:48,000 C.S.I., CENTRAL SENSITIZATION 925 00:34:48,000 --> 00:34:48,920 INVENTORY TO DETERMINE WHICH 926 00:34:48,920 --> 00:34:53,600 PATIENTS WOULD BENEFIT FROM THE 927 00:34:53,600 --> 00:34:59,280 PELVIC PHYSICAL THERAPY OR 928 00:34:59,280 --> 00:35:03,320 ENDOMETRIOSIS SURGERY? 929 00:35:03,320 --> 00:35:04,520 >> C.S.I. IS PURPORTED TO 930 00:35:04,520 --> 00:35:05,720 MEASURE, WE DON'T THINK IT WORKS 931 00:35:05,720 --> 00:35:16,600 AS WELL AS THE FIBROMYALGIA 932 00:35:16,600 --> 00:35:17,280 MEASURE. 933 00:35:17,280 --> 00:35:18,760 WE HAVE ONGOING STUDIES 934 00:35:18,760 --> 00:35:19,960 INCLUDING CENTRAL SENSITIZATION 935 00:35:19,960 --> 00:35:22,440 INDEX AS WELL AS FIBROMYALGIA 936 00:35:22,440 --> 00:35:26,760 MEASURE, NOT PUBLISHED YET, BUT, 937 00:35:26,760 --> 00:35:28,080 AGAIN, WE'RE QUITE COMFORTABLE 938 00:35:28,080 --> 00:35:31,240 THAT REALLY THESE STUDIES WHERE 939 00:35:31,240 --> 00:35:33,080 WE REPLICATED ALMOST EXACTLY 940 00:35:33,080 --> 00:35:36,360 THAT FIBROMYALGIA MEASURE 941 00:35:36,360 --> 00:35:40,320 PREDICTED SO STRONGLY OPIOID 942 00:35:40,320 --> 00:35:41,120 NONRESPONSIVENESS AND SURGERY 943 00:35:41,120 --> 00:35:42,600 NONRESPONSIVENESS, THE C.S.I. 944 00:35:42,600 --> 00:35:44,560 NEVER HAD STUDIES THAT SHOWED 945 00:35:44,560 --> 00:35:46,960 CLINICAL OUTCOMES WERE THAT 946 00:35:46,960 --> 00:35:52,080 HEAVILY PREDICTED BY THAT PRO. 947 00:35:52,080 --> 00:35:53,320 WE THINK THE FIBROMYALGIA 948 00:35:53,320 --> 00:35:54,320 MEASURE IS BETTER AND ARE 949 00:35:54,320 --> 00:35:56,320 COLLECTING MORE DATA TO SHOW 950 00:35:56,320 --> 00:35:56,520 THAT. 951 00:35:56,520 --> 00:35:58,120 WE THINK THERE'S NEWER BETTER 952 00:35:58,120 --> 00:35:58,920 MEASURED CONSTRUCTED, WE'RE 953 00:35:58,920 --> 00:36:02,600 GOING TO TRY TO DEVELOP A MORE 954 00:36:02,600 --> 00:36:03,240 DATA-DRIVEN MEASURE THAT STARTS 955 00:36:03,240 --> 00:36:06,120 WITH SOME OF THE ELEMENTS OF THE 956 00:36:06,120 --> 00:36:08,400 FIBROMYALGIA MEASURE BUT THEN 957 00:36:08,400 --> 00:36:10,600 WEIGHTS THEM DIFFERENTLY, ADDS 958 00:36:10,600 --> 00:36:12,000 SENSORY SENSITIVITY, BECAUSE WE 959 00:36:12,000 --> 00:36:14,400 THINK, YOU KNOW, A NEW GOOD 960 00:36:14,400 --> 00:36:16,320 MEASURE OF NOCIPLASTIC PAIN WILL 961 00:36:16,320 --> 00:36:18,520 NOT -- WE WON'T STILL BE USING 962 00:36:18,520 --> 00:36:19,640 THAT FIBROMYALGIA MAYBE 3 TO 5 963 00:36:19,640 --> 00:36:21,560 YEARS FROM NOW, WE'LL HAVE A 964 00:36:21,560 --> 00:36:28,560 BETTER MEASURE THAT CAPTURES 965 00:36:28,560 --> 00:36:28,920 THOSE DOMAINS. 966 00:36:28,920 --> 00:36:29,320 >> THANK YOU. 967 00:36:29,320 --> 00:36:31,680 WE WOULD LIKE TO MOVE ON DUE TO 968 00:36:31,680 --> 00:36:37,920 TIME REMAINING. 969 00:36:37,920 --> 00:36:42,760 OUR NEXT SPEAKER, DR. SUSAN 970 00:36:42,760 --> 00:36:43,240 ASANI. 971 00:36:43,240 --> 00:36:54,600 WOULD YOU SHARE YOUR SLIDES. 972 00:36:54,600 --> 00:36:56,280 >> CAN YOU SEE MY SLIDES? 973 00:36:56,280 --> 00:36:56,760 >> YES. 974 00:36:56,760 --> 00:36:58,160 >> GREAT. 975 00:36:58,160 --> 00:36:59,600 I WOULD LIKE TO THANK YOU AS 976 00:36:59,600 --> 00:37:01,360 WELL AS THE NICHD FOR ORGANIZING 977 00:37:01,360 --> 00:37:03,520 THIS REALLY IMPORTANT SEMINAR AS 978 00:37:03,520 --> 00:37:06,680 WELL AS OPPORTUNITY TO SHARE 979 00:37:06,680 --> 00:37:08,160 WORK IN UNDERSTANDING THE 980 00:37:08,160 --> 00:37:09,160 NEUROBIOLOGICAL MECHANISMS OF 981 00:37:09,160 --> 00:37:10,120 PELVIC PAIN. 982 00:37:10,120 --> 00:37:13,120 I COULD JUST STOP HERE AND JUST 983 00:37:13,120 --> 00:37:16,120 SAY THAT EVERYTHING THAT DR. 984 00:37:16,120 --> 00:37:18,520 CLAUW SAID WE REPLICATED A LOT, 985 00:37:18,520 --> 00:37:20,120 SPECIFICALLY IN PELVIC PAIN AND 986 00:37:20,120 --> 00:37:21,240 ENDOMETRIOSIS, BUT WE'LL GO 987 00:37:21,240 --> 00:37:25,200 THROUGH THE CONTENT. 988 00:37:25,200 --> 00:37:26,280 THESE ARE MY DISCLOSURES. 989 00:37:26,280 --> 00:37:28,560 OAMPED 990 00:37:28,560 --> 00:37:34,800 ENDOMETRIOSIS IS ONE OF THE MOST 991 00:37:34,800 --> 00:37:35,520 ENIGMATIC FIELDS. 992 00:37:35,520 --> 00:37:36,880 WE STILL KNOW VERY LITTLE ABOUT 993 00:37:36,880 --> 00:37:38,720 THE RELATIONSHIP BETWEEN THE 994 00:37:38,720 --> 00:37:40,680 ACTUAL ENDOMETRIOSIS LESIONS AND 995 00:37:40,680 --> 00:37:41,360 PELVIC PAIN SYMPTOMS. 996 00:37:41,360 --> 00:37:44,440 SO IF I ASKED WHICH OF THESE 997 00:37:44,440 --> 00:37:46,720 PATIENTS HAS PELVIC PAIN AND HOW 998 00:37:46,720 --> 00:37:49,240 SEVERE WOULD IT BE, LOGIC WOULD 999 00:37:49,240 --> 00:37:51,720 DICTATE INTENSITY AND FREQUENCY 1000 00:37:51,720 --> 00:37:52,440 SHOULD INCREASE WITH WORSENING 1001 00:37:52,440 --> 00:37:54,680 PATHOLOGY AS YOU GO FROM TOP 1002 00:37:54,680 --> 00:37:58,000 SLIDE TO BOTTOM SLIDE. 1003 00:37:58,000 --> 00:38:01,920 AS WAS MENTIONED, SIMILAR TOO 1004 00:38:01,920 --> 00:38:03,240 EVERY OTHER CONDITION, THE 1005 00:38:03,240 --> 00:38:04,800 DEGREE OF PELVIC PATHOLOGY DOES 1006 00:38:04,800 --> 00:38:05,760 NOT DEGREE WITH SEVERITY OF 1007 00:38:05,760 --> 00:38:06,680 PATIENT SYMPTOMS. 1008 00:38:06,680 --> 00:38:09,360 IT'S QUITE COMMON FOR THE 1009 00:38:09,360 --> 00:38:10,120 PATIENT WITH NORMAL ANATOMY TO 1010 00:38:10,120 --> 00:38:12,240 EXPERIENCE SEVERE PAIN AND ONE 1011 00:38:12,240 --> 00:38:13,240 WITH STAGE 4 ENDOMETRIOSIS TO 1012 00:38:13,240 --> 00:38:15,800 ALSO HAVE LITTLE OR NO PAIN AT 1013 00:38:15,800 --> 00:38:16,160 ALL. 1014 00:38:16,160 --> 00:38:18,640 THIS QUESTION OF WHICH PATIENTS 1015 00:38:18,640 --> 00:38:20,080 WITH ENDOMETRIOSIS EXPERIENCE 1016 00:38:20,080 --> 00:38:23,360 PAIN AND WHY, ABOUT 25% OF WOMEN 1017 00:38:23,360 --> 00:38:25,560 WITH ENDOMETRIOSIS EXPERIENCE 1018 00:38:25,560 --> 00:38:31,120 PERSISTENT PAIN DESPITE ALL 1019 00:38:31,120 --> 00:38:32,120 AGGRESSIVE TREATMENT AS 1020 00:38:32,120 --> 00:38:32,760 INTERESTED AND FRUSTRATED ME 1021 00:38:32,760 --> 00:38:36,480 SINCE I WAS A RESIDENT IN 1022 00:38:36,480 --> 00:38:36,760 OB/GYN. 1023 00:38:36,760 --> 00:38:38,120 BEFORE I TALK ABOUT THIS, I 1024 00:38:38,120 --> 00:38:40,200 WANTED TO SAY THAT I PURSUED A 1025 00:38:40,200 --> 00:38:41,560 CAREER AS A CLINICIAN SCIENTIST 1026 00:38:41,560 --> 00:38:42,920 AND HAVE BEEN VERY FORTUNATE TO 1027 00:38:42,920 --> 00:38:44,320 DO SO AT THE UNIVERSITY OF 1028 00:38:44,320 --> 00:38:45,760 MICHIGAN BECAUSE I'VE HAD THE 1029 00:38:45,760 --> 00:38:48,800 PRIVILEGE TO BE MENTORED BY DR. 1030 00:38:48,800 --> 00:38:49,000 CLAUW. 1031 00:38:49,000 --> 00:38:50,080 BUT THIS IS ALSO INCLUDING THE 1032 00:38:50,080 --> 00:38:51,720 OPPORTUNITY TO WORK WITH HIS 1033 00:38:51,720 --> 00:38:53,680 TEAM AT THE CHRONIC PAIN AND 1034 00:38:53,680 --> 00:38:55,640 FATIGUE RESEARCH CENTER, BEFORE 1035 00:38:55,640 --> 00:38:58,000 I DIVE INTO GIVING YOU AN 1036 00:38:58,000 --> 00:38:58,920 OVERVIEW OF OUR COLLABORATIVE 1037 00:38:58,920 --> 00:39:00,560 EFFORTS I WANT TO RECOGNIZE AND 1038 00:39:00,560 --> 00:39:01,680 THANK THESE EXCEPTIONAL 1039 00:39:01,680 --> 00:39:05,720 SCIENTISTS WHO MADE THIS WORK 1040 00:39:05,720 --> 00:39:06,920 POSSIBLE. 1041 00:39:06,920 --> 00:39:16,640 DR. CLAUW, - HARRIS, SCHREPF, 1042 00:39:16,640 --> 00:39:22,560 HARTE, HASET AND BRUMMET, ROBERT 1043 00:39:22,560 --> 00:39:24,920 TAYLOR AND STACY MISSMER. 1044 00:39:24,920 --> 00:39:28,240 MY OBJECTIVES TODAY ARE FIRST TO 1045 00:39:28,240 --> 00:39:31,080 PRESENT EVIDENCE THAT 1046 00:39:31,080 --> 00:39:33,280 NOCIPLASTIC PAIN IN PRESENT TO 1047 00:39:33,280 --> 00:39:39,600 REVIEW CLINICAL IMMRI 1048 00:39:39,600 --> 00:39:41,800 IMPLICATION, AND FINALLY TO 1049 00:39:41,800 --> 00:39:43,960 PROPOSE STRATEGIES TO INTEGRATE 1050 00:39:43,960 --> 00:39:45,720 MEASURES OF NOCIPLASTIC PAIN IN 1051 00:39:45,720 --> 00:39:47,360 CLINICAL RESEARCH STUDIES WITH 1052 00:39:47,360 --> 00:39:50,200 OVERALL HEALTH GOAL OF ENHANCING 1053 00:39:50,200 --> 00:39:51,960 PATIENT CARE. 1054 00:39:51,960 --> 00:39:54,920 AS YOU KNOW, ENDOMETRIOSIS IS 1055 00:39:54,920 --> 00:40:01,040 DEFINED AS PRESENCE OF 1056 00:40:01,040 --> 00:40:03,960 ENDOMETRIAL TISSUE OUTSIDE THE 1057 00:40:03,960 --> 00:40:07,480 UTERUS, MOST WIDELY HELD VIEW OF 1058 00:40:07,480 --> 00:40:09,720 ENDOMETRIOSIS IS A NOCIPLASTIC 1059 00:40:09,720 --> 00:40:12,600 PAIN CONDITION THAT OCCURS TO 1060 00:40:12,600 --> 00:40:15,680 DIRECT ACTIVATION BY THE 1061 00:40:15,680 --> 00:40:17,560 LESIONS, AND SIGNALS INTERPRETS 1062 00:40:17,560 --> 00:40:19,160 THE SIGNAL OF PAIN. 1063 00:40:19,160 --> 00:40:20,760 CERTAINLY THERE'S A SUBSTANTIAL 1064 00:40:20,760 --> 00:40:22,000 AMOUNT OF EVIDENCE THAT 1065 00:40:22,000 --> 00:40:28,320 ENDOMETRIOSIS CAN CAUSE PAIN DUE 1066 00:40:28,320 --> 00:40:30,320 TO THE NOCIPLASTIC MECHANISM, 1067 00:40:30,320 --> 00:40:32,160 ENERVATED BY SENSORY FIBERS AND 1068 00:40:32,160 --> 00:40:33,280 ENDOMETRIOSIS LESIONS RELEASE 1069 00:40:33,280 --> 00:40:40,520 CYTOKINES AS WELL AS OTHER PRO 1070 00:40:40,520 --> 00:40:43,920 NOCICEPTIVE MOLECULES THAT CAN 1071 00:40:43,920 --> 00:40:44,880 ACTIVATE RECEPTORS. 1072 00:40:44,880 --> 00:40:47,320 AS WAS DESCRIBED, THERE'S NO 1073 00:40:47,320 --> 00:40:50,360 CHRONIC PAIN CONDITION ENTIRELY 1074 00:40:50,360 --> 00:40:51,440 EXPLAINED BY PERIPHERAL 1075 00:40:51,440 --> 00:40:52,200 PATHOLOGY, BECAUSE CENTRAL 1076 00:40:52,200 --> 00:41:00,920 NERVOUS SYSTEM HAS ABILITY TO 1077 00:41:00,920 --> 00:41:02,320 AMPLIFY AND DAMPEN SIGNALS. 1078 00:41:02,320 --> 00:41:03,680 MODERN UNDERSTANDING PAIN IS 1079 00:41:03,680 --> 00:41:05,120 OUTPUT OF THE BRAIN, BALANCE 1080 00:41:05,120 --> 00:41:06,760 BETWEEN THE PERIPHERAL INPUT AND 1081 00:41:06,760 --> 00:41:14,640 CENTRAL NERVOUS SYSTEM OR VOLUME 1082 00:41:14,640 --> 00:41:14,880 CONTROL. 1083 00:41:14,880 --> 00:41:16,760 NOCIPLASTIC PAIN CAN LEAD TO 1084 00:41:16,760 --> 00:41:18,200 PAIN INDEPENDENT OF THE SIGNAL. 1085 00:41:18,200 --> 00:41:22,920 WHAT DO WE KNOW ABOUT 1086 00:41:22,920 --> 00:41:28,120 ENDOMETRIOSIS, CHRONIC PAIN AND 1087 00:41:28,120 --> 00:41:28,920 THE BRAIN? 1088 00:41:28,920 --> 00:41:44,360 USING A DESIGN TO UNDERSTAND THE 1089 00:41:44,360 --> 00:41:44,720 RELATIONSHIP. 1090 00:41:44,720 --> 00:41:50,000 WE RECRUITED PATIENTS WITH AND 1091 00:41:50,000 --> 00:41:52,480 WITHOUT ENDOMETRIOSIS AND LITTLE 1092 00:41:52,480 --> 00:41:55,320 TO NO PAIN, NO SIGNIFICANT 1093 00:41:55,320 --> 00:41:57,200 DYSMENORRHEA, COMPARED TO EACH 1094 00:41:57,200 --> 00:41:59,960 OTHER AND HEALTHY CONTROLS. 1095 00:41:59,960 --> 00:42:02,320 THREE KEY STUDIES ARE SHOWN, 1096 00:42:02,320 --> 00:42:04,640 USING THIS DESIGN WOMEN WITH 1097 00:42:04,640 --> 00:42:06,720 CHRONIC PELVIC PAIN INCLUDING 1098 00:42:06,720 --> 00:42:18,000 THOSE WITH AND WITHOUT 1099 00:42:18,000 --> 00:42:18,960 ENDOMETRIOSIS DEMONSTRATE 1100 00:42:18,960 --> 00:42:21,360 INCREASED SENSITIVITY. 1101 00:42:21,360 --> 00:42:22,960 CHANGES IN BRAIN STRUCTURE, 1102 00:42:22,960 --> 00:42:26,040 WOMEN WITH CHRONIC PELVIC PAIN 1103 00:42:26,040 --> 00:42:27,680 DEMONSTRATE DECREASED GRAY 1104 00:42:27,680 --> 00:42:32,800 MATTER VOLUME, IN THE THALAMUS, 1105 00:42:32,800 --> 00:42:34,480 CINGULATE GYRUS, AND CHANGES IN 1106 00:42:34,480 --> 00:42:37,120 BRAIN FUNCTION WITH INCREASED 1107 00:42:37,120 --> 00:42:37,760 LEVELS OF EXCITATORY 1108 00:42:37,760 --> 00:42:40,120 NEUROTRANSMITTERS IN THE INSULA 1109 00:42:40,120 --> 00:42:41,040 AND INCREASED CONNECTIVITY 1110 00:42:41,040 --> 00:42:44,200 BETWEEN PAIN REGULATORY REGIONS 1111 00:42:44,200 --> 00:42:46,720 SUCH AS ANTERIOR INSULA AND 1112 00:42:46,720 --> 00:42:48,280 PREFRONTAL CORTEX, FOUND IN 1113 00:42:48,280 --> 00:42:49,880 WOMEN WITH PAIN COMPARED TO PAIN 1114 00:42:49,880 --> 00:42:50,880 WITH CONTROLS AND WAS 1115 00:42:50,880 --> 00:42:53,120 INDEPENDENT OF THE PRESENCE OR 1116 00:42:53,120 --> 00:42:53,800 SEVERITY OF ENDOMETRIOSIS. 1117 00:42:53,800 --> 00:42:56,760 I WANT TO POINT OUT BECAUSE 1118 00:42:56,760 --> 00:42:58,320 WE'RE SPECIFICALLY WANTING TO 1119 00:42:58,320 --> 00:43:00,200 DEMONSTRATE THESE WERE SPECIFIC 1120 00:43:00,200 --> 00:43:01,320 TO PATIENTS WITH ENDOMETRIOSIS 1121 00:43:01,320 --> 00:43:03,640 AND NOT JUST THOSE WITH 1122 00:43:03,640 --> 00:43:05,880 OVERLAPPING PAIN CONDITIONS, 1123 00:43:05,880 --> 00:43:07,720 THESE BRAIN NEUROIMAGING STUDIES 1124 00:43:07,720 --> 00:43:10,480 WE ONLY RECRUITED PATIENTS THAT 1125 00:43:10,480 --> 00:43:11,960 HAD ENDOMETRIOSIS AND SCREENED 1126 00:43:11,960 --> 00:43:13,880 OUT PATIENTS THAT HAD 1127 00:43:13,880 --> 00:43:14,480 ENDOMETRIOSIS WITH OVERLAPPING 1128 00:43:14,480 --> 00:43:16,200 PAIN CONDITIONS. 1129 00:43:16,200 --> 00:43:19,360 SO THESE ARE TRULY PATIENTS 1130 00:43:19,360 --> 00:43:21,520 WITHOUT ANY OTHER IDENTIFIABLE 1131 00:43:21,520 --> 00:43:22,880 SOURCE OF PAIN. 1132 00:43:22,880 --> 00:43:24,520 THESE FINDINGS SUGGESTED THESE 1133 00:43:24,520 --> 00:43:26,400 MEASURES OF NOCIPLASTIC PAIN ARE 1134 00:43:26,400 --> 00:43:28,160 RELATED TO EXPERIENCE OF HAVING 1135 00:43:28,160 --> 00:43:29,680 CHRONIC PAIN, IN THESE PATIENTS, 1136 00:43:29,680 --> 00:43:31,760 NOT JUST LIMITED TO THOSE WITH 1137 00:43:31,760 --> 00:43:32,880 ENDOMETRIOSIS OR OTHERWISE WE 1138 00:43:32,880 --> 00:43:34,160 SHOULD HAVE SEEN THESE CHANGES 1139 00:43:34,160 --> 00:43:37,880 IN WOMEN THAT HAVE PAIN-FREE 1140 00:43:37,880 --> 00:43:38,320 ENDOMETRIOSIS. 1141 00:43:38,320 --> 00:43:40,760 SO WHAT ABOUT THE PATIENTS WITH 1142 00:43:40,760 --> 00:43:41,280 PAIN-FREE ENDOMETRIOSIS? 1143 00:43:41,280 --> 00:43:43,320 CAN THE BRAIN EXPLAIN WHY SOME 1144 00:43:43,320 --> 00:43:44,200 OF THESE WOMEN EXPERIENCE LITTLE 1145 00:43:44,200 --> 00:43:46,800 TO NO PAIN AT ALL? 1146 00:43:46,800 --> 00:43:48,920 SO AS I MENTIONED BEFORE, THREE 1147 00:43:48,920 --> 00:43:51,720 STUDIES I REVIEWED, THESE WOMEN 1148 00:43:51,720 --> 00:43:52,640 WITH PAIN-FREE ENDOMETRIOSIS 1149 00:43:52,640 --> 00:43:54,480 LOOK VERY SIMILAR TO HEALTHY 1150 00:43:54,480 --> 00:43:56,120 CONTROLS. 1151 00:43:56,120 --> 00:43:57,960 THEY DID NOT DEMONSTRATE 1152 00:43:57,960 --> 00:44:02,920 HYPERALGESIA AND DID NOT HAVE 1153 00:44:02,920 --> 00:44:04,720 CHANGES IN BRAIN FUNCTION EXCEPT 1154 00:44:04,720 --> 00:44:06,080 FOR ONE THING. 1155 00:44:06,080 --> 00:44:08,480 THESE PAIN FREE WITH 1156 00:44:08,480 --> 00:44:10,440 ENDOMETRIOSIS OVER 50% HAD STAGE 1157 00:44:10,440 --> 00:44:11,320 4 DISEASE. 1158 00:44:11,320 --> 00:44:13,320 THESE WOMEN DID HOWEVER SHOW ONE 1159 00:44:13,320 --> 00:44:15,760 CRITICAL DIFFERENCE COMPARED TO 1160 00:44:15,760 --> 00:44:19,360 PAIN-FREE CONTROLS, INCREASED 1161 00:44:19,360 --> 00:44:20,440 GRAY MATTER VOLUME IN 1162 00:44:20,440 --> 00:44:23,400 PERIAQUEDUCTAL GRAY, AN AREA OF 1163 00:44:23,400 --> 00:44:25,200 THE BRAINSTEM CRITICAL FOR 1164 00:44:25,200 --> 00:44:28,000 DESCENDING PAIN MODULATION, BY 1165 00:44:28,000 --> 00:44:36,040 WAY THE BRAIN WITH ATTENUATE OR 1166 00:44:36,040 --> 00:44:38,520 DOWNREGULATE NOCIPLASTIC SIGNALS 1167 00:44:38,520 --> 00:44:42,400 SUGGESTING ONE REASON WOMEN 1168 00:44:42,400 --> 00:44:45,880 PAIN-FREE ENDOMETRIOSIS, LITTLE 1169 00:44:45,880 --> 00:44:49,600 TO NO PAIN, A CHANGE THAT 1170 00:44:49,600 --> 00:44:50,840 DAMPENS THE NOCICEPTIVE INPUT. 1171 00:44:50,840 --> 00:44:53,720 SHIFTING GEARS TO RECENT WORK TO 1172 00:44:53,720 --> 00:44:57,840 FURTHER EXPLORE THE 1173 00:44:57,840 --> 00:44:59,040 NEUROBIOLOGICAL MECHANISMS, WE 1174 00:44:59,040 --> 00:45:01,320 KNOW IT'S WELL ESTABLISHED 1175 00:45:01,320 --> 00:45:03,560 ENDOMETRIOSIS IS AN ESTROGEN 1176 00:45:03,560 --> 00:45:08,560 DRIVEN DISEASE. 1177 00:45:08,560 --> 00:45:10,520 I PROVIDED DATA THAT NOCIPLASTIC 1178 00:45:10,520 --> 00:45:12,320 PAIN IS ALSO AN IMPORTANT 1179 00:45:12,320 --> 00:45:12,680 MECHANISM. 1180 00:45:12,680 --> 00:45:13,840 THIS RAISES AN IMPORTANT 1181 00:45:13,840 --> 00:45:16,920 QUESTION, WHETHER THERE'S A LINK 1182 00:45:16,920 --> 00:45:17,720 BETWEEN SYSTEMIC INFLAMMATION 1183 00:45:17,720 --> 00:45:19,480 AND NOCIPLASTIC PAIN. 1184 00:45:19,480 --> 00:45:21,880 IN OTHER WORDS, SYSTEMIC 1185 00:45:21,880 --> 00:45:23,560 INFLAMMATION AND MECHANISM BY 1186 00:45:23,560 --> 00:45:24,520 WHICH ENDOMETRIOSIS TO LEAD TO 1187 00:45:24,520 --> 00:45:25,360 NOCIPLASTIC PAIN. 1188 00:45:25,360 --> 00:45:30,400 THIS IS A COURTESY OF A 1189 00:45:30,400 --> 00:45:31,320 COLLEAGUE AND COLLABORATOR AND 1190 00:45:31,320 --> 00:45:36,800 ILLUSTRATES ONE OF THE PATHWAYS 1191 00:45:36,800 --> 00:45:38,360 BY WHICH SYSTEMIC INFLAMMATION 1192 00:45:38,360 --> 00:45:43,960 LEADS TO NOCIPLASTIC PAIN 1193 00:45:43,960 --> 00:45:44,520 INVOLVING MICROGLIA, STAINED 1194 00:45:44,520 --> 00:45:46,040 GREEN, CELLS IN THE CENTRAL 1195 00:45:46,040 --> 00:45:48,760 NERVOUS SYSTEM KNOWN TO MODULATE 1196 00:45:48,760 --> 00:45:49,960 COMMUNICATION BETWEEN NERVE 1197 00:45:49,960 --> 00:45:53,880 FIBERS STAINED RED. 1198 00:45:53,880 --> 00:45:57,720 MICROGLIA AND AND ASTROCYTES 1199 00:45:57,720 --> 00:45:59,560 ACTIVATE TOLL-LIKE RECEPTORS, ON 1200 00:45:59,560 --> 00:46:01,440 THE CELLS IN THE DORSAL HORN OF 1201 00:46:01,440 --> 00:46:05,760 THE SPINAL CORD SHOWN TO RELEASE 1202 00:46:05,760 --> 00:46:06,320 PRO-INFLAMMATORY CYTOKINES. 1203 00:46:06,320 --> 00:46:09,320 THIS IS THOUGHT TO BE ONE OF THE 1204 00:46:09,320 --> 00:46:12,480 CONTRIBUTING MECHANISMS FOR 1205 00:46:12,480 --> 00:46:13,280 NOCIPLASTIC PAIN CHARACTERIZED 1206 00:46:13,280 --> 00:46:22,240 BY WIDESPREAD AND AND FATIGUE, 1207 00:46:22,240 --> 00:46:23,280 NON-RESTORATIVE SLEEP, MEMORY 1208 00:46:23,280 --> 00:46:24,320 DIFFICULTIES. 1209 00:46:24,320 --> 00:46:26,800 MEMBERS OF THE MAPP NETWORK 1210 00:46:26,800 --> 00:46:27,560 INVESTIGATED THIS RELATIONSHIP 1211 00:46:27,560 --> 00:46:34,360 SPECIFICALLY IN FEMALE PATIENTS 1212 00:46:34,360 --> 00:46:35,520 WITH PAINFUL BLADDER SYNDROME. 1213 00:46:35,520 --> 00:46:36,960 THIS EXAMINES THE RELATIONSHIP 1214 00:46:36,960 --> 00:46:42,960 BETWEEN CYTOKINE RESPONSE TO LPS 1215 00:46:42,960 --> 00:46:44,800 STIMULATION WITH DEGREE OF 1216 00:46:44,800 --> 00:46:50,600 WIDESPREAD PAIN. 1217 00:46:50,600 --> 00:46:52,400 FOR EVERY ONE STANDARD DEVIATION 1218 00:46:52,400 --> 00:46:57,480 INCREASE THERE WAS 60% INCREASE 1219 00:46:57,480 --> 00:46:58,320 OF LIKELIHOOD REPORTING 1220 00:46:58,320 --> 00:46:59,120 WIDESPREAD PAIN. 1221 00:46:59,120 --> 00:47:01,520 AS SHOWN IN THIS BODY MAP WHERE 1222 00:47:01,520 --> 00:47:04,360 THE DARK COLOR REPRESENTS A HIGH 1223 00:47:04,360 --> 00:47:05,360 PROPORTION OF PATIENTS WITH PAIN 1224 00:47:05,360 --> 00:47:07,680 IN THE AREA, YOU CAN SEE 1225 00:47:07,680 --> 00:47:09,960 PATIENTS WITH THE LOW STIMULATED 1226 00:47:09,960 --> 00:47:11,360 INFLAMMATORY RESPONSE ARE 1227 00:47:11,360 --> 00:47:12,240 GENERAL REPLACEMENT THOSE WITH 1228 00:47:12,240 --> 00:47:14,920 FOCAL PAIN IN THE PELVIS. 1229 00:47:14,920 --> 00:47:17,560 HOWEVER THIS IS IN CONTRAST TO 1230 00:47:17,560 --> 00:47:22,360 PATIENTS WITH A VERY STIMULATED 1231 00:47:22,360 --> 00:47:23,480 INFLAMMATORY RESPONSE 1232 00:47:23,480 --> 00:47:26,120 CHARACTERIZED BY HAVING 1233 00:47:26,120 --> 00:47:28,800 WIDESPREAD PAIN, CARDINAL 1234 00:47:28,800 --> 00:47:33,720 FEATURE OF NOCIPLASTIC PAIN. 1235 00:47:33,720 --> 00:47:34,640 DR. SHREPF LED THE FOLLOWING 1236 00:47:34,640 --> 00:47:36,280 ANALYSIS AIMED TO DETERMINE 1237 00:47:36,280 --> 00:47:37,120 WHETHER THERE'S A SIMILAR 1238 00:47:37,120 --> 00:47:41,920 RELATIONSHIP IN WOMEN WITH 1239 00:47:41,920 --> 00:47:43,600 CHRONIC PELVIC PAIN. 1240 00:47:43,600 --> 00:47:48,400 MIHYST IS A STUDY LED BY ME AND 1241 00:47:48,400 --> 00:47:54,960 DR. CLAUW TO INVESTIGATE 1242 00:47:54,960 --> 00:47:56,920 CORRELATES OF POST HYSTERECTOMY 1243 00:47:56,920 --> 00:47:57,800 PAIN, RECEIVING SELF-REPORT 1244 00:47:57,800 --> 00:48:02,040 MEASURES OF PAIN AND SYMPTOMS, 1245 00:48:02,040 --> 00:48:07,560 PATIENTS UNDERGO STANDARDIZED 1246 00:48:07,560 --> 00:48:10,360 PELVIC EXAM, BLOOD SAMPLES 1247 00:48:10,360 --> 00:48:12,840 ASSESS SYSTEMIC INFLAMMATION, AS 1248 00:48:12,840 --> 00:48:16,360 WELL AS SUBSET OF FUNCTIONAL MRI 1249 00:48:16,360 --> 00:48:16,880 AND QUANTITATIVE SENSORY 1250 00:48:16,880 --> 00:48:17,520 TESTING. 1251 00:48:17,520 --> 00:48:23,000 AT THE TIME OF HYSTERECTOMY WE 1252 00:48:23,000 --> 00:48:25,680 RETRIEVED FLUID AND PERFORMED 1253 00:48:25,680 --> 00:48:27,320 ENDOMETRIAL BIOPSIES, SENT TO 1254 00:48:27,320 --> 00:48:31,040 DR. TAYLOR FOR MEASURES OF 1255 00:48:31,040 --> 00:48:31,440 NEUROANGIOGENESIS. 1256 00:48:31,440 --> 00:48:33,000 PARTICIPANTS COMPLETE SURVEYS TO 1257 00:48:33,000 --> 00:48:34,280 ASSESS PELVIC PAIN ASSOCIATED 1258 00:48:34,280 --> 00:48:38,400 SYMPTOMS FOR ONE YEAR AFTER 1259 00:48:38,400 --> 00:48:38,720 HYSTERECTOMY. 1260 00:48:38,720 --> 00:48:42,840 THIS STUDY IS ONGOING, USING 1261 00:48:42,840 --> 00:48:45,960 PRELIMINARY DATA WE'VE 17, WE 1262 00:48:45,960 --> 00:48:50,160 ASKED 17 WOMEN, 11 HAD SURGICAL 1263 00:48:50,160 --> 00:48:52,920 CONFIRMED, BLOOD WAS DRAWN AND 1264 00:48:52,920 --> 00:48:54,720 STIMULATED WITH LPS SIMILAR TO 1265 00:48:54,720 --> 00:49:00,120 THE MAPP STUDY FOR 24 HOURS 1266 00:49:00,120 --> 00:49:00,400 PRIOR. 1267 00:49:00,400 --> 00:49:02,320 WE EXAMINED THE CORRELATION 1268 00:49:02,320 --> 00:49:04,840 BETWEEN LPS STIMULATED CYTOKINES 1269 00:49:04,840 --> 00:49:06,920 AND CHEMOKINES AND SELF-REPORT 1270 00:49:06,920 --> 00:49:08,280 INDICES OF PELVIC PAIN. 1271 00:49:08,280 --> 00:49:09,720 RESULTS ARE SHOWN HERE. 1272 00:49:09,720 --> 00:49:11,160 YOU CAN SEE IN CORRELATION 1273 00:49:11,160 --> 00:49:13,040 PLOTS, WE LOOKED AT SEVERAL 1274 00:49:13,040 --> 00:49:18,760 DIFFERENT CYTOKINES, BUT THE ONE 1275 00:49:18,760 --> 00:49:21,520 THAT STOOD OUT WAS ASSOCIATED 1276 00:49:21,520 --> 00:49:24,240 WITH ALL SUBTYPES OF PELVIC PAIN 1277 00:49:24,240 --> 00:49:26,120 INCLUDING INTENSITY OF PAIN, 1278 00:49:26,120 --> 00:49:29,560 BLADDER PAIN, BOWEL PAIN. 1279 00:49:29,560 --> 00:49:33,120 SO TO VALIDATE FINDINGS IN A 1280 00:49:33,120 --> 00:49:34,520 SECOND COHORT CONDUCTED THE SAME 1281 00:49:34,520 --> 00:49:41,960 ANALYSIS IN 15 PRE-MENOPAUSAL 1282 00:49:41,960 --> 00:49:43,600 WOMEN, CONFIRMED ALMOST EXACTLY 1283 00:49:43,600 --> 00:49:44,760 THE SAME RELATIONSHIP IN 1284 00:49:44,760 --> 00:49:51,280 PATIENTS IN THIS NETWORK WITH 1285 00:49:51,280 --> 00:49:52,880 BLADDER PAIN. 1286 00:49:52,880 --> 00:49:54,640 WE EXAMINED THE RELATIONSHIP 1287 00:49:54,640 --> 00:49:56,400 BETWEEN PROVOKED SYSTEMIC 1288 00:49:56,400 --> 00:49:57,200 INFLAMMATION AND FUNCTIONAL 1289 00:49:57,200 --> 00:50:02,760 BRAIN IMAGING. 1290 00:50:02,760 --> 00:50:07,920 THEY SPECIFICALLY CONDUCTED A 1291 00:50:07,920 --> 00:50:10,960 SEED REGION TO WHOLE BRAIN 1292 00:50:10,960 --> 00:50:13,040 ANALYSIS, MODULATED BY SYSTEMIC 1293 00:50:13,040 --> 00:50:13,360 INFLAMMATION. 1294 00:50:13,360 --> 00:50:15,240 THEY USED A SEED REPRESENTING 1295 00:50:15,240 --> 00:50:16,520 THE PELVIC TRUNK AND GENITAL 1296 00:50:16,520 --> 00:50:20,360 PORTION SHOWN HERE OF THE 1297 00:50:20,360 --> 00:50:21,800 PRIMARY SOMATOSENSORY CORTEX, 1298 00:50:21,800 --> 00:50:24,200 THE AREA WAS PREVIOUSLY SHOWN TO 1299 00:50:24,200 --> 00:50:26,960 BE STRUCTURAL DEFICIENT IN WOMEN 1300 00:50:26,960 --> 00:50:29,520 WITH UROLOGIC PELVIC PAIN. 1301 00:50:29,520 --> 00:50:32,720 WHAT WE FOUND WAS, AGAIN, THE 1302 00:50:32,720 --> 00:50:41,320 SAME CYTOKINE I SHOWED 1303 00:50:41,320 --> 00:50:42,920 MIP1-ALPHA, THE PELVIC S1 AREA 1304 00:50:42,920 --> 00:50:46,720 BECAME MORE CONNECTED TO THE 1305 00:50:46,720 --> 00:50:51,440 MEDIAL PREFRONTAL CORTEX AS THE 1306 00:50:51,440 --> 00:50:54,560 MIP1-ALPHA LEVELS INCREASED 1307 00:50:54,560 --> 00:50:57,000 SHOWING THE RELATIONSHIP IN THE 1308 00:50:57,000 --> 00:50:58,120 CENTRAL NERVOUS SYSTEM WITH 1309 00:50:58,120 --> 00:50:59,000 INVOLVEMENT OF PRECISELY THE 1310 00:50:59,000 --> 00:51:00,880 EXPECT THE BRAIN REGION THAT S1 1311 00:51:00,880 --> 00:51:03,280 REGION THAT YOU WOULD EXPECT IN 1312 00:51:03,280 --> 00:51:05,760 PELVIC PAIN PATIENTS. 1313 00:51:05,760 --> 00:51:07,640 WE FEEL THIS IS UNLIKELY A 1314 00:51:07,640 --> 00:51:10,160 SPURIOUS FINDING BECAUSE THE 1315 00:51:10,160 --> 00:51:12,760 SAME REGION, MEDIAL PREFRONTAL 1316 00:51:12,760 --> 00:51:14,960 CORTEX WAS IMPLICATED IN SIMILAR 1317 00:51:14,960 --> 00:51:15,680 ANALYSIS OF SYSTEMIC 1318 00:51:15,680 --> 00:51:18,720 INFLAMMATION AND BRAIN 1319 00:51:18,720 --> 00:51:21,760 CONNECTIVITY IN PATIENTS WITH 1320 00:51:21,760 --> 00:51:24,680 RHEUMATOID ARTHRITIS PUBLISHED 1321 00:51:24,680 --> 00:51:27,200 IN NATURE COMMUNICATION IN 2018. 1322 00:51:27,200 --> 00:51:28,080 WHY DOES THIS MATTER? 1323 00:51:28,080 --> 00:51:30,680 I SPEND QUITE A BIT OF TIME 1324 00:51:30,680 --> 00:51:32,520 SEEING PATIENTS, WE NEED TO 1325 00:51:32,520 --> 00:51:36,400 REMEMBER THE GOAL OF RESEARCH, 1326 00:51:36,400 --> 00:51:37,320 STUDYING MECHANISMS OF DISEASE, 1327 00:51:37,320 --> 00:51:38,480 TO IMPROVE HEALTH AND QUALITY OF 1328 00:51:38,480 --> 00:51:40,520 LIFE OF PEOPLE WHO SUFFER FROM 1329 00:51:40,520 --> 00:51:41,640 THAT DISEASE. 1330 00:51:41,640 --> 00:51:43,000 THIS KNOWLEDGE SHOULD DRIVE 1331 00:51:43,000 --> 00:51:43,600 CLINICAL DECISION MAKING 1332 00:51:43,600 --> 00:51:44,520 INCLUDING WHICH TREATMENTS ARE 1333 00:51:44,520 --> 00:51:46,320 MOST LIKELY TO BE SUCCESSFUL, 1334 00:51:46,320 --> 00:51:48,640 AND WHICH TREATMENTS MIGHT EVEN 1335 00:51:48,640 --> 00:51:50,400 BE HARMFUL. 1336 00:51:50,400 --> 00:51:52,440 AND CLINICIANS MUST CARE 1337 00:51:52,440 --> 00:51:53,440 PARTICULARLY THOSE OF US WHO ARE 1338 00:51:53,440 --> 00:51:54,640 SURGEONS BECAUSE OTHERWISE WE 1339 00:51:54,640 --> 00:51:58,720 MIGHT DO MORE HARM THAN GOOD. 1340 00:51:58,720 --> 00:51:59,680 TO EXAMINE CLINICAL RELEVANCE, 1341 00:51:59,680 --> 00:52:04,560 WE PERFORMED A COUPLE STUDIES, 1342 00:52:04,560 --> 00:52:05,000 SOME WERE MENTIONED. 1343 00:52:05,000 --> 00:52:07,320 THIS WAS ONE OF THE FIRST 1344 00:52:07,320 --> 00:52:14,440 STUDIES, PROSPECTIVE, 1345 00:52:14,440 --> 00:52:17,240 ADMINISTERED FIBROMYALGIA SURVEY 1346 00:52:17,240 --> 00:52:18,560 SCORE PRIOR TO HYSTERECTOMY, 1347 00:52:18,560 --> 00:52:20,320 LOOKED AT OPIOID USE AND DAILY 1348 00:52:20,320 --> 00:52:23,480 PAIN SCORES FOR TWO WEEKS AFTER 1349 00:52:23,480 --> 00:52:24,640 SURGERY. 1350 00:52:24,640 --> 00:52:25,560 PATIENTS STRATIFIED BY 1351 00:52:25,560 --> 00:52:27,520 PREOPERATIVE TERTILE OF THE 1352 00:52:27,520 --> 00:52:29,920 FIBROMYALGIA SCORE, YOU SEE IN 1353 00:52:29,920 --> 00:52:32,440 PATIENTS WITH THE HIGHEST 1354 00:52:32,440 --> 00:52:37,680 TERTILE OF FIBROMYALGIA SCORE 1355 00:52:37,680 --> 00:52:38,880 HAD GREATER OPIOID CONSUMPTION 1356 00:52:38,880 --> 00:52:40,120 FOR LONGER PERIODS AND HIGHER 1357 00:52:40,120 --> 00:52:44,040 POST POP PAIN SCORES WITH 1358 00:52:44,040 --> 00:52:45,240 SIGNIFICANT RECOVERY. 1359 00:52:45,240 --> 00:52:47,920 THIS PAPER DR. CLAW MENTIONED, 1360 00:52:47,920 --> 00:52:50,120 WE USED IN A DIFFERENT COHORT OF 1361 00:52:50,120 --> 00:52:55,200 PATIENTS UNDERGOING 1362 00:52:55,200 --> 00:52:57,240 HYSTERECTOMY, LOOKING AT 1363 00:52:57,240 --> 00:52:58,440 INCIDENCE OF PERSISTENT PAIN SIX 1364 00:52:58,440 --> 00:53:00,960 MONTHS AFTER SURGERY. 1365 00:53:00,960 --> 00:53:03,120 IN OUR PARTICULAR COHORT THE 1366 00:53:03,120 --> 00:53:04,320 INCIDENCE OF SUCCESS AFTER 1367 00:53:04,320 --> 00:53:08,080 SURGERY WAS QUITE HIGH, ONLY 1368 00:53:08,080 --> 00:53:09,480 11%, REPORTED LESS THAN 50% 1369 00:53:09,480 --> 00:53:11,440 IMPROVEMENT IN PAIN, AT SIX 1370 00:53:11,440 --> 00:53:15,920 MONTHS THAT RELATIONSHIP BETWEEN 1371 00:53:15,920 --> 00:53:16,520 SURGICAL -- PRE-SURGICAL 1372 00:53:16,520 --> 00:53:27,120 FIBROMYALGIA SCORE WAS STRONGLY 1373 00:53:27,120 --> 00:53:29,920 PREDICTIVE OF PAIN. 1374 00:53:29,920 --> 00:53:32,080 YOU MIGHT WONDER WHAT ABOUT 1375 00:53:32,080 --> 00:53:34,720 CLINICAL FACTORS THAT WE WOULD 1376 00:53:34,720 --> 00:53:35,760 TYPICALLY THINK TO PREDICT 1377 00:53:35,760 --> 00:53:39,080 PERSISTENT PAIN WERE NOT SHOWN 1378 00:53:39,080 --> 00:53:40,480 TO PREDICT PERSISTENT PAIN, 1379 00:53:40,480 --> 00:53:45,080 ADENOMYOSIS, PRESENCE OF LARGE 1380 00:53:45,080 --> 00:53:46,960 UTERINE FIBROIDS, SURGICAL 1381 00:53:46,960 --> 00:53:48,760 FIBROID, DID NOT -- 1382 00:53:48,760 --> 00:53:50,280 FIBROIDS, ADENOMYOSIS DID NOT 1383 00:53:50,280 --> 00:53:53,120 PREDICT RISK OF PERSISTENT PAIN. 1384 00:53:53,120 --> 00:53:55,320 ALL RIGHT. 1385 00:53:55,320 --> 00:53:56,440 HOW SHOULD WE INTEGRATE MEASURES 1386 00:53:56,440 --> 00:53:58,280 OF NOCIPLASTIC PAIN TO RESEARCH 1387 00:53:58,280 --> 00:54:00,480 STUDIES TO ENHANCE PATIENT CARE? 1388 00:54:00,480 --> 00:54:01,840 FIRST AND FOREMOST RESEARCH MUST 1389 00:54:01,840 --> 00:54:02,840 ACKNOWLEDGE THAT CHRONIC PELVIC 1390 00:54:02,840 --> 00:54:05,120 PAIN IS A SYMPTOM AND THERE ARE 1391 00:54:05,120 --> 00:54:06,080 MANY OVERLAPPING PATHWAYS THAT 1392 00:54:06,080 --> 00:54:08,400 CAN LEAD TO CHRONIC PELVIC PAIN. 1393 00:54:08,400 --> 00:54:10,240 THIS MEANS THE MECHANISM OF PAIN 1394 00:54:10,240 --> 00:54:14,280 CAN VARY FROM PERSON TO PERSON, 1395 00:54:14,280 --> 00:54:15,600 INFLAMMATION AND NEURO 1396 00:54:15,600 --> 00:54:16,200 ANGIOGENESISES ASSOCIATED WITH 1397 00:54:16,200 --> 00:54:19,720 ENDOMETRIOSIS FOR EXAMPLE CAN BE 1398 00:54:19,720 --> 00:54:33,160 A SOURCE OF DIRECT NOCICEPTIVE. 1399 00:54:33,160 --> 00:54:35,840 PAIN CAN BE DUE TO COMBINATION 1400 00:54:35,840 --> 00:54:43,320 OF OTHER CONDITIONS IN THE 1401 00:54:43,320 --> 00:54:50,840 GASTROINTESTINAL, UROLOGIC AND 1402 00:54:50,840 --> 00:54:53,600 MUSCULOSKELETAL PAIN GENERATORS. 1403 00:54:53,600 --> 00:54:54,720 THESE MIGHT CO-OCCUR, 1404 00:54:54,720 --> 00:54:56,000 INDEPENDENT OF ENDOMETRIOSIS 1405 00:54:56,000 --> 00:54:56,240 LESIONS. 1406 00:54:56,240 --> 00:54:58,200 THIS MEANS JUST BECAUSE THE 1407 00:54:58,200 --> 00:55:01,240 PELVIC PATHOLOGY IS PRESENT SUCH 1408 00:55:01,240 --> 00:55:03,760 AS ENDOMETRIOSIS OR ADENOMYOSIS 1409 00:55:03,760 --> 00:55:04,480 OR FIBROIDS IT'S NOT NECESSARILY 1410 00:55:04,480 --> 00:55:07,600 THE CAUSE OF PAIN IN THAT 1411 00:55:07,600 --> 00:55:07,840 PATIENT. 1412 00:55:07,840 --> 00:55:09,800 FINALLY IT'S NOTABLE THAT ALL OF 1413 00:55:09,800 --> 00:55:11,840 THESE FACTORS ARE INFLUENCED BY 1414 00:55:11,840 --> 00:55:14,040 GENETIC VARIABILITY, EARLY LIFE 1415 00:55:14,040 --> 00:55:16,760 TRAUMA, ENVIRONMENTAL STRESSORS, 1416 00:55:16,760 --> 00:55:18,080 PSYCHOLOGICAL FACTORS. 1417 00:55:18,080 --> 00:55:19,240 THE IMPLICATIONS ARE MULTIPLE 1418 00:55:19,240 --> 00:55:21,360 BUT THE MOST IMPORTANT IS ALSO 1419 00:55:21,360 --> 00:55:24,640 SOMETHING THAT DR. CLAW SPOKE 1420 00:55:24,640 --> 00:55:28,800 ABOUT, THAT MOST CHRONIC PAIN 1421 00:55:28,800 --> 00:55:30,520 CONDITIONS REPRESENT A HIGHLY 1422 00:55:30,520 --> 00:55:31,400 HETEROGENEOUS POPULATION THAT 1423 00:55:31,400 --> 00:55:34,000 LIE ALONG A CONTINUUM BETWEEN 1424 00:55:34,000 --> 00:55:36,640 THOSE PURELY PERIPHERAL VERSUS 1425 00:55:36,640 --> 00:55:37,160 THOSE PURELY NOCIPLASTIC. 1426 00:55:37,160 --> 00:55:40,800 ON THE LEFT SIDE THERE'S A GROUP 1427 00:55:40,800 --> 00:55:48,440 OF WOMEN PELVIC PAIN IS PURELY 1428 00:55:48,440 --> 00:55:49,760 NOCICEPTIVE, ON THE OTHER SIDE 1429 00:55:49,760 --> 00:55:52,520 LESIONS ARE NO LONGER RELEVANT 1430 00:55:52,520 --> 00:55:55,040 AND PAIN IS ENTIRELY 1431 00:55:55,040 --> 00:55:55,360 NOCIPLASTIC. 1432 00:55:55,360 --> 00:55:56,320 THERE'S PROBABLY A LARGE GROUP 1433 00:55:56,320 --> 00:55:58,960 OF WOMEN IN THE MIDDLE WHOSE 1434 00:55:58,960 --> 00:56:07,360 PAIN IS A MIX OF NOSICECPITE AND 1435 00:56:07,360 --> 00:56:10,480 NOCIPLASTIC PAIN. 1436 00:56:10,480 --> 00:56:11,840 AND REMOVAL OF ENDOMETRIOSIS 1437 00:56:11,840 --> 00:56:20,160 MIGHT REDUCE IT. 1438 00:56:20,160 --> 00:56:22,240 IMPLICATIONS CANNOT BE 1439 00:56:22,240 --> 00:56:22,720 UNDERSTATED. 1440 00:56:22,720 --> 00:56:23,520 IT'S LIKELY THE PATIENTS ON THE 1441 00:56:23,520 --> 00:56:25,040 FAR LEFT WILL HAVE A VERY 1442 00:56:25,040 --> 00:56:26,920 DIFFERENT OUTCOME THAN THOSE ON 1443 00:56:26,920 --> 00:56:27,680 THE FAR RIGHT. 1444 00:56:27,680 --> 00:56:29,840 IF THE RESEARCH STUDY DOES NOT 1445 00:56:29,840 --> 00:56:31,320 RECOGNIZE OR MEASURE THIS, 1446 00:56:31,320 --> 00:56:34,240 PATIENTS ARE ANALYZED AS SINGLE 1447 00:56:34,240 --> 00:56:37,840 GROUP, WE CAN'T UNDERSTAND OR 1448 00:56:37,840 --> 00:56:41,680 PREDICT WHICH PATIENTS ARE MOST 1449 00:56:41,680 --> 00:56:43,440 LIKELY TO BENEFIT. 1450 00:56:43,440 --> 00:56:44,280 IF YOU RECOGNIZE THIS AND 1451 00:56:44,280 --> 00:56:46,680 EXCLUDE PATIENTS ON THE FAR 1452 00:56:46,680 --> 00:56:48,640 RIGHT, THOSE WITH WIDESPREAD 1453 00:56:48,640 --> 00:56:50,760 PAIN, GENERALIZABILITY AND REAL 1454 00:56:50,760 --> 00:56:55,440 WORLD EFFICACY ARE SEVERELY 1455 00:56:55,440 --> 00:56:55,680 LIMITED. 1456 00:56:55,680 --> 00:56:58,640 THE NUMBER OF PATIENTS IN THIS 1457 00:56:58,640 --> 00:57:06,840 CATEGORY SHOULD NOT BE 1458 00:57:06,840 --> 00:57:07,640 UNDERESTIMATED. 1459 00:57:07,640 --> 00:57:09,240 41% OF THESE PATIENTS ARE 1460 00:57:09,240 --> 00:57:10,320 WIDESPREAD PAIN, HIGHER IN 1461 00:57:10,320 --> 00:57:12,960 PATIENTS WE SEE AS REFERRAL 1462 00:57:12,960 --> 00:57:16,040 CLINIC, HOWEVER IF OUR GOAL IS 1463 00:57:16,040 --> 00:57:19,240 TO IMPROVE PAIN FOR ALL 1464 00:57:19,240 --> 00:57:20,000 PATIENTS, INCLUDING REFRACTORY 1465 00:57:20,000 --> 00:57:22,080 TO FIRST LINE PATIENTS WE NEED 1466 00:57:22,080 --> 00:57:23,080 TO INCLUDE THESE PATIENTS AS 1467 00:57:23,080 --> 00:57:23,480 WELL. 1468 00:57:23,480 --> 00:57:27,880 I WANT TO THANK THE NIH FOR 1469 00:57:27,880 --> 00:57:35,720 CONDUCTING THIS AND GIVE A FEW 1470 00:57:35,720 --> 00:57:36,560 SUGGESTIONS, ACKNOWLEDGING THIS 1471 00:57:36,560 --> 00:57:39,400 IS MY BIAS BUT THIS IS MY BIAS 1472 00:57:39,400 --> 00:57:42,840 AS A CLINICIAN, VERY ACTIVE 1473 00:57:42,840 --> 00:57:43,840 CLINICAL PRACTICE AND SURGICAL 1474 00:57:43,840 --> 00:57:45,640 PRACTICE WITH PATIENTS WITH 1475 00:57:45,640 --> 00:57:46,600 PELVIC PAIN AND ENDOMETRIOSIS 1476 00:57:46,600 --> 00:57:48,560 AND HAVE THE OPPORTUNITY TO SEE 1477 00:57:48,560 --> 00:57:50,000 FIRST HAND THE COMPLEXITY OF 1478 00:57:50,000 --> 00:57:51,080 THIS PATIENT POPULATION AND 1479 00:57:51,080 --> 00:57:53,640 AMOUNT THEY SUFFER FROM ONE 1480 00:57:53,640 --> 00:57:54,360 TREATMENT TO ANOTHER. 1481 00:57:54,360 --> 00:57:57,320 FIRST I THINK WE NEED TO REALLY 1482 00:57:57,320 --> 00:58:00,040 EXPAND OUR FOCUS FROM 1483 00:58:00,040 --> 00:58:00,920 ENDOMETRIOSIS LESION TO 1484 00:58:00,920 --> 00:58:02,400 RECOGNIZING ENDOMETRIOSIS AND 1485 00:58:02,400 --> 00:58:03,640 PELVIC PAIN AS SYSTEMIC DISEASE, 1486 00:58:03,640 --> 00:58:05,840 NOT THAT THE ENDOMETRIOSIS 1487 00:58:05,840 --> 00:58:06,960 LESION IS NOT IMPORTANT BUT IF 1488 00:58:06,960 --> 00:58:08,960 WE DON'T TAKE IT INTO THE 1489 00:58:08,960 --> 00:58:10,040 CONTEXT OF THE WHOLE PERSON, 1490 00:58:10,040 --> 00:58:12,200 WHOLE BODY, I DON'T THINK WE'LL 1491 00:58:12,200 --> 00:58:13,600 MAKE FORWARD PROGRESS. 1492 00:58:13,600 --> 00:58:14,800 SECOND WE NEED TO ACKNOWLEDGE 1493 00:58:14,800 --> 00:58:17,480 THE EXPERIENCE OF PAIN CAN BE 1494 00:58:17,480 --> 00:58:18,640 CAUSED BY MULTIPLE BIOLOGICAL 1495 00:58:18,640 --> 00:58:19,800 MECHANISMS, WHICH ARE MODIFIED 1496 00:58:19,800 --> 00:58:22,840 BY BOTH SOCIAL, AS WELL IT'S A 1497 00:58:22,840 --> 00:58:23,840 ENVIRONMENTAL AS ENVIRONMENTAL 1498 00:58:23,840 --> 00:58:24,240 FACTORS. 1499 00:58:24,240 --> 00:58:27,840 LOOKING AT THE LESION, 1500 00:58:27,840 --> 00:58:29,680 BIOLOGICAL PATHWAYS, YOU REALLY 1501 00:58:29,680 --> 00:58:31,680 CAN ONLY DO THE ENTIRE RESEARCH 1502 00:58:31,680 --> 00:58:33,320 IN HUMANS THAT ARE IN THE 1503 00:58:33,320 --> 00:58:35,000 CONTEXT OF THEIR ENVIRONMENT. 1504 00:58:35,000 --> 00:58:37,960 AND FINALLY WE REALLY WILL ONLY 1505 00:58:37,960 --> 00:58:40,440 SUCCEED IF WE CHARACTERIZE 1506 00:58:40,440 --> 00:58:41,760 INTERACTION OF BIOLOGICAL 1507 00:58:41,760 --> 00:58:43,840 MECHANISMS BY WHICH PELVIC PAIN 1508 00:58:43,840 --> 00:58:44,240 BECOMES PERSISTENT. 1509 00:58:44,240 --> 00:58:48,760 IN ORDER TO DO THIS WE NEED TO 1510 00:58:48,760 --> 00:58:51,040 CONDUCT LARGE MULTI-CENTER 1511 00:58:51,040 --> 00:58:52,160 PROSPECTIVE STUDIES THAT REALLY 1512 00:58:52,160 --> 00:58:54,000 CAREFULLY PHENOTYPE ALL THE 1513 00:58:54,000 --> 00:58:55,840 PUTATIVE FACTORS THAT INFLUENCE 1514 00:58:55,840 --> 00:58:56,640 PAIN. 1515 00:58:56,640 --> 00:58:58,400 AS DR. CLAW MENTIONED, THIS 1516 00:58:58,400 --> 00:59:01,400 COULD BE MODELED AVALANCHED 1517 00:59:01,400 --> 00:59:02,200 NIDDK MAPP RESEARCH NETWORK, 1518 00:59:02,200 --> 00:59:03,000 PRODUCING AN IMPRESSIVE AMOUNT 1519 00:59:03,000 --> 00:59:05,800 OF DATA AS WELL AS PROFOUNDLY 1520 00:59:05,800 --> 00:59:11,480 CHANGING THE WAY WE THINK ABOUT 1521 00:59:11,480 --> 00:59:13,160 UROLOGYOGIC APPROACH AND SUPPORT 1522 00:59:13,160 --> 00:59:14,840 TEAMS WITH EXPERTISE IN 1523 00:59:14,840 --> 00:59:17,440 GYNECOLOGIC PAIN AS WELL AS PAIN 1524 00:59:17,440 --> 00:59:19,520 SCIENCE, IN ADDITION TO 1525 00:59:19,520 --> 00:59:20,120 REPRODUCTIVE BIOLOGISTS THAT 1526 00:59:20,120 --> 00:59:21,640 WORK HEAVILY IN THIS FIELD AND 1527 00:59:21,640 --> 00:59:22,840 NIECE ARE ALL DISTINCT GROUPS 1528 00:59:22,840 --> 00:59:25,240 THAT NEED TO BE BROUGHT 1529 00:59:25,240 --> 00:59:25,880 TOGETHER. 1530 00:59:25,880 --> 00:59:27,640 AND FINALLY STUDY SECTIONS WHO 1531 00:59:27,640 --> 00:59:32,440 REVIEW GRANTS NEED TO HAVE THE 1532 00:59:32,440 --> 00:59:38,840 INTERDISCIPLINARY EXPERTISE 1533 00:59:38,840 --> 00:59:57,200 RESEARCHERS ARE STUDYING AT. 1534 00:59:57,200 --> 00:59:59,040 THANK YOU. 1535 00:59:59,040 --> 00:59:59,960 >> I'M SORRY FOR THE 1536 00:59:59,960 --> 01:00:00,840 INTERRUPTION. 1537 01:00:00,840 --> 01:00:01,240 >> THAT'S OKAY. 1538 01:00:01,240 --> 01:00:01,840 WE'RE ALL HERE. 1539 01:00:01,840 --> 01:00:04,440 >> WE WOULD LIKE TO MOVE ON. 1540 01:00:04,440 --> 01:00:06,160 WE'LL ADVANCE THE QUESTIONS IN 1541 01:00:06,160 --> 01:00:07,400 THE CHAT DURING THE DISCUSSION 1542 01:00:07,400 --> 01:00:08,200 SESSION, IS IT OKAY? 1543 01:00:08,200 --> 01:00:09,320 >> YEAH, OF COURSE. 1544 01:00:09,320 --> 01:00:11,320 THANK YOU. 1545 01:00:11,320 --> 01:00:14,480 >> THANK YOU FOR YOUR 1546 01:00:14,480 --> 01:00:15,160 UNDERSTANDING. 1547 01:00:15,160 --> 01:00:19,480 OUR NEXT SPEAKER IS DR. FRANK 1548 01:00:19,480 --> 01:00:21,560 TU, TALKING ABOUT MENSTRUAL PAIN 1549 01:00:21,560 --> 01:00:23,600 AND CHRONIC PELVIC PAIN RISK. 1550 01:00:23,600 --> 01:00:36,520 DR. TU, CAN YOU SHARE YOUR 1551 01:00:36,520 --> 01:00:36,760 SLIDES? 1552 01:00:36,760 --> 01:00:38,600 >> CAN YOU HEAR ME OKAY? 1553 01:00:38,600 --> 01:00:39,760 >> YES. 1554 01:00:39,760 --> 01:00:42,200 >> AND SLIDES LOOK OKAY? 1555 01:00:42,200 --> 01:00:42,440 >> YES. 1556 01:00:42,440 --> 01:00:42,800 GREAT. 1557 01:00:42,800 --> 01:00:47,800 >> ALL RIGHT. 1558 01:00:47,800 --> 01:00:48,760 FANTASTIC. 1559 01:00:48,760 --> 01:00:51,400 I WANT TO ECHO COMMENTS, MY 1560 01:00:51,400 --> 01:00:53,040 APPRECIATION TO NICHD FOR 1561 01:00:53,040 --> 01:00:57,720 SETTING UP THIS WEBINAR TODAY. 1562 01:00:57,720 --> 01:01:00,240 MY TALK DYSMENORRHEA AND CHRONIC 1563 01:01:00,240 --> 01:01:06,280 PAIN IS ALREADY PRESAGED BY MY 1564 01:01:06,280 --> 01:01:09,320 TWO CLOSE COLLEAGUES, 1565 01:01:09,320 --> 01:01:10,440 COLLABORATORS, MENTORS SPEAKING 1566 01:01:10,440 --> 01:01:13,320 ABOUT SPECTRUM OF DISEASE, WE'VE 1567 01:01:13,320 --> 01:01:14,120 BEEN FOCUSED ON CHRONIC PELVIC 1568 01:01:14,120 --> 01:01:17,800 PAIN WITH THE HELP OF NICHD AND 1569 01:01:17,800 --> 01:01:21,000 NIDDK WE'VE SHIFTED ATTENTION TO 1570 01:01:21,000 --> 01:01:23,040 DYSMENORRHEA, RECOGNIZING 1571 01:01:23,040 --> 01:01:25,240 LOOKING EARLIER ON INTO THE 1572 01:01:25,240 --> 01:01:27,320 TRAJECTORY OF THE EMERGENCE OF 1573 01:01:27,320 --> 01:01:35,880 CHRONIC PAIN MIGHT LEARN 1574 01:01:35,880 --> 01:01:39,360 DIMENSIONS OF WHAT MATTERS, 1575 01:01:39,360 --> 01:01:40,120 DYSMENORRHEA. 1576 01:01:40,120 --> 01:01:45,360 I WANT TO LOOK AT TRANSITION IN 1577 01:01:45,360 --> 01:01:47,440 RELATION TO CONCEPTUAL MODELS. 1578 01:01:47,440 --> 01:01:49,080 I SUSPECT MANY PEOPLE ARE 1579 01:01:49,080 --> 01:01:52,040 ALREADY FAMILIAR WITH THE 1580 01:01:52,040 --> 01:01:52,920 PATHOPHYSIOLOGY OF DYSMENORRHEA, 1581 01:01:52,920 --> 01:01:57,880 RELATED UTERINE DISORDERS, 1582 01:01:57,880 --> 01:01:59,680 STILL WORTH LOOKING AT. 1583 01:01:59,680 --> 01:02:02,720 LASTLY TO TALK ABOUT PUTATIVE 1584 01:02:02,720 --> 01:02:03,840 INTERMEDIATE PHENOTYPE THAT 1585 01:02:03,840 --> 01:02:05,920 WE'VE BEEN LOOKING AT OVER THE 1586 01:02:05,920 --> 01:02:08,320 PAST SEVEN YEARS THAT WE HOPE IS 1587 01:02:08,320 --> 01:02:09,760 AN OPPORTUNITY TO TALK FURTHER 1588 01:02:09,760 --> 01:02:11,280 ABOUT BETTER WAYS TO IDENTIFY 1589 01:02:11,280 --> 01:02:13,160 EARLIER FORMS OF CHRONIC PELVIC 1590 01:02:13,160 --> 01:02:16,240 PAIN THAT MIGHT BE AMENABLE TO 1591 01:02:16,240 --> 01:02:19,240 TREATMENT AND PREVENTION. 1592 01:02:19,240 --> 01:02:21,000 SO, DYSMENORRHEA IS WELL KNOWN. 1593 01:02:21,000 --> 01:02:23,880 IT'S A COMMON PERHAPS PREVALENT, 1594 01:02:23,880 --> 01:02:28,440 UP TO 85% OF WOMEN OF 1595 01:02:28,440 --> 01:02:30,280 REPRODUCTIVE AGE, NOT ALL 1596 01:02:30,280 --> 01:02:33,360 SEVERE, 15% BUT A SUBSTANTIAL 1597 01:02:33,360 --> 01:02:34,640 AMOUNT HAVE MODERATE TO SEVERE 1598 01:02:34,640 --> 01:02:36,000 ONLY LIMITED TO A FEW DAYS, 1599 01:02:36,000 --> 01:02:37,280 THERE ARE WORSE VERSIONS. 1600 01:02:37,280 --> 01:02:43,840 WE TALK ABOUT A PRIMARY VERSUS 1601 01:02:43,840 --> 01:02:44,920 SECONDARY CLASSIFICATION. 1602 01:02:44,920 --> 01:02:45,920 SECONDARY CAN FALL INTO THE WE 1603 01:02:45,920 --> 01:02:48,640 CAN SEE IT OR FEEL IT, PRIMARY 1604 01:02:48,640 --> 01:02:50,440 IS RELATED TO ONES WITH NO 1605 01:02:50,440 --> 01:02:51,520 OBVIOUS CAUSE AND TYPICALLY 1606 01:02:51,520 --> 01:02:52,200 IDENTIFIED AS START OF 1607 01:02:52,200 --> 01:02:57,840 IMMEDIATELY AT THE TIME OF 1608 01:02:57,840 --> 01:03:02,360 MENARCHE, CLOSE THEREOF. 1609 01:03:02,360 --> 01:03:05,160 PATHOPHYSIOLOGY, IN THE '50s 1610 01:03:05,160 --> 01:03:05,840 IN "NATURE," IDENTIFIED PRESENCE 1611 01:03:05,840 --> 01:03:20,880 OF PROSTAGLANDINS, WORK '40s 1612 01:03:20,880 --> 01:03:21,640 IDENTIFIED HYPERCONTRACTILITY, 1613 01:03:21,640 --> 01:03:26,920 MANY PATIENTS HAVE SOME FORM OF 1614 01:03:26,920 --> 01:03:28,160 SENSORY DYSREGULATION AKIN TO 1615 01:03:28,160 --> 01:03:29,640 WHAT WAS REFERRED TO. 1616 01:03:29,640 --> 01:03:33,360 TREATMENTS ATTEMPT TO FOCUS ON 1617 01:03:33,360 --> 01:03:35,880 SUPPRESSING INFLAMMATION RELATED 1618 01:03:35,880 --> 01:03:40,240 TO RELEASE OF UTERINE LINING ON 1619 01:03:40,240 --> 01:03:42,120 A CYCLICAL BASIS, REMARKABLE 1620 01:03:42,120 --> 01:03:44,160 WORK SINCE THE LATE '70s TO 1621 01:03:44,160 --> 01:03:46,400 REDUCE PROBABLY 80% OF THE 1622 01:03:46,400 --> 01:03:48,240 BURDEN OF DISEASE WITH NSAIDs. 1623 01:03:48,240 --> 01:03:52,360 AND WITH REGARD TO SECONDARY 1624 01:03:52,360 --> 01:03:54,240 CAUSES, SURGEONS ARE CALLED UPON 1625 01:03:54,240 --> 01:03:58,720 TO EXCISE THESE UTERINE PAIN 1626 01:03:58,720 --> 01:03:59,480 GENERATORS, WHETHER 1627 01:03:59,480 --> 01:04:01,640 ENDOMETRIOSIS, MEIOSIS, WITH 1628 01:04:01,640 --> 01:04:04,120 SOME DEGREE OF SUCCESS. 1629 01:04:04,120 --> 01:04:07,960 SO WHAT COMPELLED US TO LOOK AT 1630 01:04:07,960 --> 01:04:09,600 PAINFUL PERIODS WAS THE FACT 1631 01:04:09,600 --> 01:04:12,000 MANY PATIENTS TOLD US THEY HAD 1632 01:04:12,000 --> 01:04:13,080 PAINFUL PERIODS FOREVER AND 1633 01:04:13,080 --> 01:04:17,520 CHRONIC PAIN THEY HAD BEEN 1634 01:04:17,520 --> 01:04:23,200 SEEING US FOR MORE RECENTLY BUT 1635 01:04:23,200 --> 01:04:25,280 EPIDEMIOLOGY IS SUMMARIZED 1636 01:04:25,280 --> 01:04:27,680 SHOWING A HEAVY OVERLAP, IF YOU 1637 01:04:27,680 --> 01:04:28,880 HAVE CHRONIC PELVIC PAIN 80% OF 1638 01:04:28,880 --> 01:04:31,200 THE TIME YOU REPORT COMPONENT OF 1639 01:04:31,200 --> 01:04:32,040 PAINFUL PERIODS. 1640 01:04:32,040 --> 01:04:36,120 AND STARTING WITH THAT WOULD BE 1641 01:04:36,120 --> 01:04:37,640 INSUFFICIENT, ALL PEOPLE MIGHT 1642 01:04:37,640 --> 01:04:39,400 NEED TO BE STUDIED TO IDENTIFY 1643 01:04:39,400 --> 01:04:41,800 THOSE WITH CHRONIC PELVIC PAIN, 1644 01:04:41,800 --> 01:04:47,600 30% WITH DYSMENORRHEA APPEAR TO 1645 01:04:47,600 --> 01:04:49,920 HAVE THIS RELATIONSHIP. 1646 01:04:49,920 --> 01:04:59,840 THE SEARCH WAS ON FOR BETTER 1647 01:04:59,840 --> 01:05:00,720 SPECIFICITY. 1648 01:05:00,720 --> 01:05:01,280 ZONDERVANT'S WORK PROMOTES 1649 01:05:01,280 --> 01:05:03,920 INQUIRY, DOING DEEPER WHERE TO 1650 01:05:03,920 --> 01:05:05,960 FOCUS ON MECHANISMS. 1651 01:05:05,960 --> 01:05:08,560 DR. AS-SANI POPPED ON THE 1652 01:05:08,560 --> 01:05:09,280 CONCEPTUAL MODEL. 1653 01:05:09,280 --> 01:05:10,360 I THINK IT'S CRITICAL TO 1654 01:05:10,360 --> 01:05:13,520 RECOGNIZE WE TEND TO FOCUS AS 1655 01:05:13,520 --> 01:05:15,040 CLINICIANS ON SYMPTOMATOLOGY AND 1656 01:05:15,040 --> 01:05:17,960 HEALTH CARE UTILIZATION, THE 1657 01:05:17,960 --> 01:05:22,520 SHIFT AWAY FROM THESE IN 1658 01:05:22,520 --> 01:05:23,240 PERIPHERAL FIELDS, GYNECOLOGY 1659 01:05:23,240 --> 01:05:23,760 AND NEUROLOGY, HIGHLIGHTED 1660 01:05:23,760 --> 01:05:27,080 IMPORTANCE OF THE CENTRAL 1661 01:05:27,080 --> 01:05:27,440 NERVOUS SYSTEM. 1662 01:05:27,440 --> 01:05:30,320 WE TENT TO FOCUS ON UTERINE AND 1663 01:05:30,320 --> 01:05:32,640 PELVIC ORGAN PHYSIOLOGY, 1664 01:05:32,640 --> 01:05:33,600 STRUCTURAL OR ANATOMIC ISSUES 1665 01:05:33,600 --> 01:05:35,880 BUT THEY ALL INTERFACE TO A 1666 01:05:35,880 --> 01:05:39,480 LARGE DEGREE AS DAN AND SUSIE 1667 01:05:39,480 --> 01:05:40,480 ALLUDED TO, TREMENDOUS 1668 01:05:40,480 --> 01:05:42,440 OPPORTUNITIES TO NOT JUST LOOK 1669 01:05:42,440 --> 01:05:44,640 INSIDE BOXES BUT DO STUDIES THAT 1670 01:05:44,640 --> 01:05:47,040 LOOK AT INTERACTIONS BETWEEN HOW 1671 01:05:47,040 --> 01:05:48,600 ONE CRITICAL COMPONENT INTERACTS 1672 01:05:48,600 --> 01:05:49,560 WITH OTHER CRITICAL COMPONENTS. 1673 01:05:49,560 --> 01:06:02,800 WE TEND TO FOCUS ONLY ON THE BOX 1674 01:06:02,800 --> 01:06:04,240 ENDOMETRIUM, WE CAN LEARN A LOT 1675 01:06:04,240 --> 01:06:07,640 FROM THE MODEL. 1676 01:06:07,640 --> 01:06:08,840 THIS FOLLOWS DISEASE FRAMEWORK. 1677 01:06:08,840 --> 01:06:10,880 I WILL TALK ABOUT SOME WORK THAT 1678 01:06:10,880 --> 01:06:12,640 NICHD IS FUNDING US TO DO THAT 1679 01:06:12,640 --> 01:06:15,160 DOES TURN OUR ATTENTION TO 1680 01:06:15,160 --> 01:06:16,440 EARLIER FACTORS THAT SUSI 1681 01:06:16,440 --> 01:06:16,720 ALLUDED TO. 1682 01:06:16,720 --> 01:06:19,040 WE WANT TO LOOK AT EARLY 1683 01:06:19,040 --> 01:06:19,600 INFLUENCES, ENVIRONMENTAL 1684 01:06:19,600 --> 01:06:20,960 FACTORS, AS THEY HAVE CERTAINLY 1685 01:06:20,960 --> 01:06:22,880 DONE IN A NUMBER OF PEDIATRIC 1686 01:06:22,880 --> 01:06:23,240 DISORDERS. 1687 01:06:23,240 --> 01:06:24,840 AND I THINK THAT'S A REALLY 1688 01:06:24,840 --> 01:06:28,880 IMPORTANT OPPORTUNITY FOR US TO 1689 01:06:28,880 --> 01:06:29,440 BUILD ON. 1690 01:06:29,440 --> 01:06:31,840 SO WHAT I THINK WE SHOULD TALK 1691 01:06:31,840 --> 01:06:32,720 ABOUT RELATING TO CONCEPTUAL 1692 01:06:32,720 --> 01:06:34,240 MODEL IS BROADER AREAS AND GET 1693 01:06:34,240 --> 01:06:36,840 INTO DETAILS OF WORK WE'VE DONE. 1694 01:06:36,840 --> 01:06:38,440 WE DON'T KNOW THAT MUCH ABOUT 1695 01:06:38,440 --> 01:06:42,240 GENETICS, GIVEN THAT THESE ARE 1696 01:06:42,240 --> 01:06:50,040 COMPLEX POLY GENOMIC DISORDERS, 1697 01:06:50,040 --> 01:06:54,880 THE FINDING OF ZMIZ1 IS ONLY ONE 1698 01:06:54,880 --> 01:06:55,800 ASPECT. 1699 01:06:55,800 --> 01:06:58,080 NOT A MAJOR STORY THERE. 1700 01:06:58,080 --> 01:07:00,160 WHEN YOU THINK ABOUT MENSTRUAL 1701 01:07:00,160 --> 01:07:04,440 PAIN, YOU ASSUME IT COMES FROM 1702 01:07:04,440 --> 01:07:09,080 THE UTERUS, THE BLADDER AND 1703 01:07:09,080 --> 01:07:11,840 UTERUS AND BLADDER AND COLON OR 1704 01:07:11,840 --> 01:07:15,280 UTERUS AND COLON OR UTERUS AND 1705 01:07:15,280 --> 01:07:16,880 SKELETAL MUSCLE TISSUES COULD BE 1706 01:07:16,880 --> 01:07:18,400 THE FUNDAMENTAL SOURCE OF 1707 01:07:18,400 --> 01:07:19,600 PATIENT SUFFERING. 1708 01:07:19,600 --> 01:07:22,840 IN SMALL WORK BY A FORMER GRAD 1709 01:07:22,840 --> 01:07:26,040 OPPORTUNITY OF OF ANDREA 1710 01:07:26,040 --> 01:07:27,680 NACKLEY, OUR POSTDOC, WE WERE 1711 01:07:27,680 --> 01:07:30,240 ABLE TO LOOK AT SOME, FOR 1712 01:07:30,240 --> 01:07:30,920 EXAMPLE, EVIDENCE MUCH ABDOMINAL 1713 01:07:30,920 --> 01:07:32,920 WALL ACTIVITY THAT MAY BE LINKED 1714 01:07:32,920 --> 01:07:34,440 TO SYMPTOMS IN PATIENTS WITH 1715 01:07:34,440 --> 01:07:35,840 PAINFUL PERIODS SUGGESTING AS IS 1716 01:07:35,840 --> 01:07:37,520 KNOWN IN ANIMAL WORK THAT THE 1717 01:07:37,520 --> 01:07:38,640 PRIMARY SOURCE OF NOCICEPTION 1718 01:07:38,640 --> 01:07:40,600 MIGHT NOT BE IN THE UTERUS BUT 1719 01:07:40,600 --> 01:07:42,640 COULD BE IN THE ABDOMINAL WALL 1720 01:07:42,640 --> 01:07:52,040 OR PELVIC FLOOR IN SOME 1721 01:07:52,040 --> 01:07:53,120 PATIENTS. 1722 01:07:53,120 --> 01:07:54,360 SOME OF OUR WORK WILL SHOW YOU 1723 01:07:54,360 --> 01:07:57,560 HOW WE'VE LOOKED AT WAYS TO 1724 01:07:57,560 --> 01:07:59,360 QUANTIFY A PERSON'S RELATIVE 1725 01:07:59,360 --> 01:07:59,640 SENSITIVITY. 1726 01:07:59,640 --> 01:08:01,480 SUSIE HAS DONE ELEGANT WORK AS 1727 01:08:01,480 --> 01:08:05,000 AS THE LARGER MICHIGAN GROUP, 1728 01:08:05,000 --> 01:08:07,640 I'M LOOKING AT CONNECTIVITY 1729 01:08:07,640 --> 01:08:09,240 BETWEEN DIFFERENT CORTICAL 1730 01:08:09,240 --> 01:08:09,800 SITES, STRUCTURAL AND 1731 01:08:09,800 --> 01:08:11,320 METABOLISM, IF YOU LOOK AT SOME 1732 01:08:11,320 --> 01:08:14,680 WORK THAT'S BEEN DONE BY KATIE 1733 01:08:14,680 --> 01:08:15,880 VINCENT, PRELIMINARY WORK OUT OF 1734 01:08:15,880 --> 01:08:21,880 LAURA PAYNE'S GROUP AND WORK OUT 1735 01:08:21,880 --> 01:08:23,880 OF TAIWAN, THERE IS EVIDENCE 1736 01:08:23,880 --> 01:08:26,080 THAT EVEN IN PRIMARY 1737 01:08:26,080 --> 01:08:27,320 DYSMENORRHEA THERE ARE 1738 01:08:27,320 --> 01:08:33,920 ALTERATIONS IN THE FUNDAMENTAL 1739 01:08:33,920 --> 01:08:35,040 NEURAL FRAMEWORK, CRITICAL TO 1740 01:08:35,040 --> 01:08:35,840 UNDERSTAND TO REDUCE 1741 01:08:35,840 --> 01:08:36,120 SENSITIVITY. 1742 01:08:36,120 --> 01:08:37,440 THERE'S A NUMBER OF SPEAKERS ON 1743 01:08:37,440 --> 01:08:42,440 THIS CALL WHO SPENT TIME LOOKING 1744 01:08:42,440 --> 01:08:43,280 AT THE ENDOMETRIAL ENVIRONMENT, 1745 01:08:43,280 --> 01:08:47,960 WE STILL HAVE YET TO MARRY WORK 1746 01:08:47,960 --> 01:08:49,280 IN ADENOMYOSIS OR ENDOMETRIOSIS 1747 01:08:49,280 --> 01:08:52,520 TO LOOK AT DYSMENORRHEA 1748 01:08:52,520 --> 01:08:54,600 SPECIFICALLY, LOOKING AT 1749 01:08:54,600 --> 01:08:55,840 INFLAMMATORY REGULATION, 1750 01:08:55,840 --> 01:08:57,360 CERTAINLY LOOKING AT VARIATION 1751 01:08:57,360 --> 01:08:58,920 HORMONES WITHIN AND ACROSS 1752 01:08:58,920 --> 01:09:01,840 INDIVIDUALS COULD BE A CRITICAL 1753 01:09:01,840 --> 01:09:10,880 AREA TO BETTER UNDERSTAND WHY 1754 01:09:10,880 --> 01:09:11,440 DYSMENORRHEA POSES PAIN. 1755 01:09:11,440 --> 01:09:17,240 I THOUGHT IT WOULD BE IMPORTANT 1756 01:09:17,240 --> 01:09:19,600 TO TALK BRIEFLY ABOUT CONCEPTS 1757 01:09:19,600 --> 01:09:22,800 DAN CLAW SHARED EARLY IN MY 1758 01:09:22,800 --> 01:09:24,040 CAREER. 1759 01:09:24,040 --> 01:09:26,960 THIS WORK FROM MY CLOSE 1760 01:09:26,960 --> 01:09:30,040 COLLEAGUE, WORK EARLY ON, HE 1761 01:09:30,040 --> 01:09:32,080 LOOKED AT OVERALL PRESSURE PAIN 1762 01:09:32,080 --> 01:09:35,440 SENSITIVITY OF THE PELVIC FLOOR 1763 01:09:35,440 --> 01:09:37,000 IN INDIVIDUALS WITH AND WITHOUT 1764 01:09:37,000 --> 01:09:38,680 CHRONIC PAIN, AND SOME WEIGHTED 1765 01:09:38,680 --> 01:09:40,600 WITH MORE PAINFUL PERIOD. 1766 01:09:40,600 --> 01:09:42,840 I POINTED OUT LOOKING AT 1767 01:09:42,840 --> 01:09:46,200 INDIVIDUAL ASSESSMENT OF SENSORY 1768 01:09:46,200 --> 01:09:46,800 SENSITIVITY ISN'T SUFFICIENT. 1769 01:09:46,800 --> 01:09:48,000 IF YOU LOOKED AT A SECOND 1770 01:09:48,000 --> 01:09:51,560 COMPONENT, WHETHER OR NOT THAT 1771 01:09:51,560 --> 01:09:53,440 PERSON AFTER HAVING CONTROLLED 1772 01:09:53,440 --> 01:09:57,320 PROVOCATION OF PELVIC FLOOR WITH 1773 01:09:57,320 --> 01:10:04,600 NOVEL PAIN PROVOCATION, IF YOU 1774 01:10:04,600 --> 01:10:07,040 HAD MORE PAIN SENSATION AFTER 1775 01:10:07,040 --> 01:10:08,840 APPLICATION OF THIS TESTING, IT 1776 01:10:08,840 --> 01:10:12,680 WOULD AFFECT LIKELIHOOD YOU 1777 01:10:12,680 --> 01:10:14,640 ACTUALLY HAD CHRONIC PELVIC PAIN 1778 01:10:14,640 --> 01:10:16,800 AT THE TIME OF CLASSIFICATION 1779 01:10:16,800 --> 01:10:18,560 BASED ON THRESHOLD, THRESHOLD 1780 01:10:18,560 --> 01:10:19,640 WAS RELEVANT, AS RELEVANT AS 1781 01:10:19,640 --> 01:10:21,240 WHAT HAPPENED WITH ANOTHER 1782 01:10:21,240 --> 01:10:21,520 COMPONENT. 1783 01:10:21,520 --> 01:10:22,640 IT'S IMPORTANT TO NOTE 1784 01:10:22,640 --> 01:10:26,400 FORTUNATELY MOST PEOPLE DIDN'T 1785 01:10:26,400 --> 01:10:27,480 HAVE THIS COMPONENT, NOT 1786 01:10:27,480 --> 01:10:28,600 SURPRISING, MOST PEOPLE DON'T 1787 01:10:28,600 --> 01:10:29,440 HAVE CHRONIC PAIN IN THE 1788 01:10:29,440 --> 01:10:31,760 POPULATION. 1789 01:10:31,760 --> 01:10:35,440 IT WAS A LESSON YOU COULDN'T 1790 01:10:35,440 --> 01:10:37,560 LOOK AT SENSORY SENSITIVITY IN 1791 01:10:37,560 --> 01:10:37,840 ISOLATION. 1792 01:10:37,840 --> 01:10:41,880 A SECOND OUTPUT, WE IDENTIFIED 1793 01:10:41,880 --> 01:10:44,440 THAT WE HAD PATIENTS TESTED FOR 1794 01:10:44,440 --> 01:10:46,080 BLADDER SENSITIVITY, IN THAT 1795 01:10:46,080 --> 01:10:49,360 STUDY, IT WAS AN ATTEMPT TO LOOK 1796 01:10:49,360 --> 01:10:50,920 AT SOME OTHER NOVEL WAYS TO 1797 01:10:50,920 --> 01:10:52,240 IDENTIFY BLADDER PAIN SYNDROME. 1798 01:10:52,240 --> 01:10:54,840 WE FOUND THAT IF YOU HAD HIGH 1799 01:10:54,840 --> 01:10:57,120 LEVELS OF PERIOD PAIN, UPPER 1800 01:10:57,120 --> 01:11:01,400 QUARTILE IN THIS B GRAPH HERE, 1801 01:11:01,400 --> 01:11:02,760 YOUR MAXIMUM BLADDER PAIN, WHEN 1802 01:11:02,760 --> 01:11:04,000 YOU HAD YOUR BLADDER FULL AFTER 1803 01:11:04,000 --> 01:11:05,440 DRINKING A LARGE AMOUNT OF 1804 01:11:05,440 --> 01:11:07,840 WATER, WAS AT A HIGH LEVEL, IN 1805 01:11:07,840 --> 01:11:09,160 THIS CASE 6 OUT OF 10 ON 1806 01:11:09,160 --> 01:11:10,040 AVERAGE, NOT NUMBERS WE WOULD 1807 01:11:10,040 --> 01:11:11,320 HAVE EXPECTED OUT OF THE GENERAL 1808 01:11:11,320 --> 01:11:11,800 POPULATION. 1809 01:11:11,800 --> 01:11:14,080 THIS WAS A VALIDATION STUDY, 1810 01:11:14,080 --> 01:11:17,120 TREATING THESE WOMEN OFF COLLEGE 1811 01:11:17,120 --> 01:11:18,760 CAMPUSES, REPORTED CHRONIC PAIN 1812 01:11:18,760 --> 01:11:20,920 FREE YET THIS NUMBER IS AS HIGH 1813 01:11:20,920 --> 01:11:24,640 AS YOU SEE IN PATIENTS WITH 1814 01:11:24,640 --> 01:11:25,080 CHRONIC BLADDER PAIN. 1815 01:11:25,080 --> 01:11:26,400 SUGGESTION PERHAPS WE NEED TO 1816 01:11:26,400 --> 01:11:31,400 TURN AWAY FROM PELVIC FLOOR, 1817 01:11:31,400 --> 01:11:33,280 LOOKING AT THE VISCERA, AND WERE 1818 01:11:33,280 --> 01:11:36,440 FORTUNATE TO GET NIDDK TO FUND A 1819 01:11:36,440 --> 01:11:37,640 STUDY LOOKING AT THIS GROUP OF 1820 01:11:37,640 --> 01:11:38,760 WOMEN WITH BOTH PAINFUL PERIOD 1821 01:11:38,760 --> 01:11:40,840 AS WELL AS HAD THIS SILENT 1822 01:11:40,840 --> 01:11:42,440 BLADDER SENSITIVITY. 1823 01:11:42,440 --> 01:11:45,040 SO THEY DON'T HAVE A COMPLAINT 1824 01:11:45,040 --> 01:11:45,640 OF BLADDER DISTRESS OR 1825 01:11:45,640 --> 01:11:47,680 DISCOMFORT THEY ARE AWARE OF. 1826 01:11:47,680 --> 01:11:51,240 I WANT TO GO OVER SOME RESULTS 1827 01:11:51,240 --> 01:11:57,000 QUICKLY OF THOSE STUDIES HERE. 1828 01:11:57,000 --> 01:11:59,400 CRAMP, WHAT THIS R01 WAS FUNDED 1829 01:11:59,400 --> 01:12:01,040 TO DO, LOOK AT SEVERAL THINGS, 1830 01:12:01,040 --> 01:12:03,040 ONE TO CONFIRM THERE WAS A GROUP 1831 01:12:03,040 --> 01:12:04,840 OF WOMEN SINCE WE HAD ONLY FOUND 1832 01:12:04,840 --> 01:12:08,160 THIS IN 15 OR SO WOMEN INITIALLY 1833 01:12:08,160 --> 01:12:10,880 THAT HAD THIS DYSMENORRHEA PLUS 1834 01:12:10,880 --> 01:12:11,640 BLADDER SENSITIVITY PHENOTYPE, 1835 01:12:11,640 --> 01:12:14,040 SO WE DID A LARGER SAMPLE SIZE. 1836 01:12:14,040 --> 01:12:16,960 THEN TO SAY, WELL, IF THEY HAVE 1837 01:12:16,960 --> 01:12:17,840 THIS LEVEL VISCERAL SENSITIVITY 1838 01:12:17,840 --> 01:12:21,160 ON A SIMPLE BLADDER TEST 1839 01:12:21,160 --> 01:12:23,280 INVOLVING JUST DRINKING 20 1840 01:12:23,280 --> 01:12:26,000 OUNCES, WAITING TO FILL, RATING 1841 01:12:26,000 --> 01:12:30,640 PAIN, DO THEY HAVE OTHER 1842 01:12:30,640 --> 01:12:31,280 NEUROPHYSIOLOGICAL FEATURES WITH 1843 01:12:31,280 --> 01:12:34,160 MEASURES OF ANXIETY AND 1844 01:12:34,160 --> 01:12:35,000 DEPRESSION, EVEN IF THEY ARE 1845 01:12:35,000 --> 01:12:36,280 YOUNG AND FEEL LIKE THEY ARE 1846 01:12:36,280 --> 01:12:38,160 HEALTHY PEOPLE. 1847 01:12:38,160 --> 01:12:39,160 FINALLY WE ATTEMPTED 1848 01:12:39,160 --> 01:12:42,320 INTERVENTIONAL ARM TO SAY AS A 1849 01:12:42,320 --> 01:12:42,960 PERSON'S DYSMENORRHEA CONTINUES 1850 01:12:42,960 --> 01:12:44,560 UNCHECKED, HOW MUCH OF THE 1851 01:12:44,560 --> 01:12:45,600 ACTUAL PAIN EXPERIENCE VERSUS 1852 01:12:45,600 --> 01:12:49,520 THE FACT THEY MAY HAVE ALTERED 1853 01:12:49,520 --> 01:12:51,640 SEX HORMONE LEVELS IMPACTS ON 1854 01:12:51,640 --> 01:12:56,720 FACTORS RELATED TO CHRONIC PAIN, 1855 01:12:56,720 --> 01:13:02,240 IMPAIRED MODULATION, OR 1856 01:13:02,240 --> 01:13:03,320 UNDERLYING SENSITIVITY. 1857 01:13:03,320 --> 01:13:09,560 WE WERE ABLE TO VALIDATE THIS 1858 01:13:09,560 --> 01:13:11,840 BLADDER TEST DOES WORK, WOMEN 1859 01:13:11,840 --> 01:13:13,360 HAVE THIS PHENOTYPE AND HAVE 1860 01:13:13,360 --> 01:13:14,960 BROAD PAIN SENSITIVITY AND 1861 01:13:14,960 --> 01:13:16,240 PSYCHOSOCIAL DYSREGULATION. 1862 01:13:16,240 --> 01:13:17,920 THIS WAS MORE DRAMATIC THAN JUST 1863 01:13:17,920 --> 01:13:21,280 WOMEN WITH MODERATE TO SEVERE 1864 01:13:21,280 --> 01:13:22,360 DYSMENORRHEA ALONE. 1865 01:13:22,360 --> 01:13:23,680 PECULIAR, WHEN YOU ASKED SIMPLE 1866 01:13:23,680 --> 01:13:24,600 QUESTIONS LIKE HOW MUCH PELVIC 1867 01:13:24,600 --> 01:13:27,320 PAIN IN THE LAST WEEK, WE 1868 01:13:27,320 --> 01:13:27,840 LEARNED SOME PRACTICAL 1869 01:13:27,840 --> 01:13:29,400 IMPLICATION ALSO IF YOU ASK 1870 01:13:29,400 --> 01:13:30,680 PEOPLE THIS QUESTION YOU LEARN 1871 01:13:30,680 --> 01:13:31,440 WERE SOME DRUG TRIALS ARE HARD 1872 01:13:31,440 --> 01:13:33,040 TO DO. 1873 01:13:33,040 --> 01:13:34,640 THAT IS THAT WOMEN WITH 1874 01:13:34,640 --> 01:13:37,040 DYSMENORRHEA ALONE WHEN RATING A 1875 01:13:37,040 --> 01:13:40,120 MON MENSTRUAL PAIN WEEK THE WEEK 1876 01:13:40,120 --> 01:13:41,200 BEFORE REPORT AVERAGE PAIN 25 1877 01:13:41,200 --> 01:13:43,600 OUT OF 100. 1878 01:13:43,600 --> 01:13:45,360 WOMEN WITH DYSMENORRHEA PLUS 1879 01:13:45,360 --> 01:13:46,640 BLADDER PAIN 35 OVER 100, 1880 01:13:46,640 --> 01:13:48,360 DESPITE THE FACT THEY DO NOT 1881 01:13:48,360 --> 01:13:50,400 CONSIDER THEMSELVES TO HAVE 1882 01:13:50,400 --> 01:13:51,680 CHRONIC PAIN, IMPLICATIONS 1883 01:13:51,680 --> 01:13:53,480 CREATING FLOOR EFFECTS FOR 1884 01:13:53,480 --> 01:13:58,360 FUTURE DRUG TRIALS IN PELVIC 1885 01:13:58,360 --> 01:13:58,800 PAIN. 1886 01:13:58,800 --> 01:14:04,800 SOME SPECIFIC DATA OFF CRAMPP, 1887 01:14:04,800 --> 01:14:05,960 SEVERAL PAPERS GOT PUBLISHED, 1888 01:14:05,960 --> 01:14:08,040 WAS TO SHOW IN THE GROUP OF 1889 01:14:08,040 --> 01:14:14,280 WOMEN WE CONSIDER AT RISK THIS 1890 01:14:14,280 --> 01:14:17,240 IS THE SISOMETRY, PROVOKED 1891 01:14:17,240 --> 01:14:18,520 BLADDER FEELING THIS HEALTHY 1892 01:14:18,520 --> 01:14:19,960 GROUP OF WOMEN WITH PAINFUL 1893 01:14:19,960 --> 01:14:22,040 PERIODS HAVE INDEED ALMOST AS 1894 01:14:22,040 --> 01:14:28,440 MUCH BLADDER PAIN AT MAXIMAL 1895 01:14:28,440 --> 01:14:29,520 CAPACITY. 1896 01:14:29,520 --> 01:14:32,720 YOU CAN SEE THIS EFFECT IS LESS 1897 01:14:32,720 --> 01:14:34,840 DRAMATIC AT FIRST SENSATION BUT 1898 01:14:34,840 --> 01:14:36,840 IMPORTANT TO CORROBORATE INITIAL 1899 01:14:36,840 --> 01:14:37,040 WORK. 1900 01:14:37,040 --> 01:14:38,960 PELVIC FLOOR WORK WE CONDUCTED 1901 01:14:38,960 --> 01:14:42,800 EARLIER SHOWS THAT THERE WAS NOT 1902 01:14:42,800 --> 01:14:43,680 ONLY REDUCED PELVIC FLOOR 1903 01:14:43,680 --> 01:14:45,200 SENSITIVITY, THIS IS MEASURED IN 1904 01:14:45,200 --> 01:14:51,840 THE AMOUNT OF NEWTONS TO PROVOKE 1905 01:14:51,840 --> 01:14:54,360 PAIN AT DIFFERENT SITES IN THE 1906 01:14:54,360 --> 01:14:56,560 VESTIBULE, WE FOUND IN BOTH 1907 01:14:56,560 --> 01:14:57,680 BLADDER PAIN AND DYSMENORRHEA 1908 01:14:57,680 --> 01:14:59,280 PLUS BLADDER PAIN GROUPS 1909 01:14:59,280 --> 01:15:00,960 COMPARED TO HEALTHY CONTROLS BUT 1910 01:15:00,960 --> 01:15:02,800 FOR PELVIC FLOOR SITES PRESENT 1911 01:15:02,800 --> 01:15:04,120 IN JUST DYSMENORRHEA PATIENT 1912 01:15:04,120 --> 01:15:07,880 ALONE SUGGESTING SOME DEGREE OF 1913 01:15:07,880 --> 01:15:08,840 VISCERAL SOMATIC CONVERGENCE IN 1914 01:15:08,840 --> 01:15:10,440 THE BROADER POPULATION OF WOMEN 1915 01:15:10,440 --> 01:15:11,440 WITH JUST DYSMENORRHEA. 1916 01:15:11,440 --> 01:15:14,440 THIS WORK IN TOTAL LED US TO 1917 01:15:14,440 --> 01:15:16,960 THINK ABOUT WHAT COULD WE DO 1918 01:15:16,960 --> 01:15:17,160 NEXT. 1919 01:15:17,160 --> 01:15:18,960 THESE ARE IMPORTANT IMPLICATIONS 1920 01:15:18,960 --> 01:15:20,520 IN FINDING POTENTIAL 1921 01:15:20,520 --> 01:15:21,440 INTERMEDIATE PHENOTYPE. 1922 01:15:21,440 --> 01:15:31,280 IF YOU LOOK AT THE WORK FROM 1923 01:15:31,280 --> 01:15:33,840 CAREENA ZONDERVAN, DOES THIS 1924 01:15:33,840 --> 01:15:37,160 HELP US GET CLOSER? 1925 01:15:37,160 --> 01:15:38,680 BIRTH CONTROL PILLS TO THESE 1926 01:15:38,680 --> 01:15:39,840 WOMEN TO ELIMINATE EXPOSURE TO 1927 01:15:39,840 --> 01:15:42,320 PAINFUL PERIOD FOR A PERIOD OF 1928 01:15:42,320 --> 01:15:43,640 TIME, SEE IF SOME MEASURES 1929 01:15:43,640 --> 01:15:48,240 REDUCED, WE FOUND OVER 40% OF 1930 01:15:48,240 --> 01:15:50,040 WOMEN OFFERED BIRTH CONTROL 1931 01:15:50,040 --> 01:15:51,520 PILLS DECLINED OFFER SAYING THEY 1932 01:15:51,520 --> 01:15:53,960 WERE SUSPICIOUS THAT THE PILL 1933 01:15:53,960 --> 01:15:56,160 WOULD GIVE SIDE EFFECTS OR HAD 1934 01:15:56,160 --> 01:15:57,800 MAIN SIDE EFFECTS, NOT WELL 1935 01:15:57,800 --> 01:15:58,320 DESCRIBED IN PREVIOUS 1936 01:15:58,320 --> 01:16:00,520 POPULATIONS THERE'S A GROUP OF 1937 01:16:00,520 --> 01:16:02,160 WOMEN THAT DON'T TOLERATE BIRTH 1938 01:16:02,160 --> 01:16:03,680 CONTROL WELL, SOLD OVER THE 1939 01:16:03,680 --> 01:16:05,720 COUNTER IN MANY COUNTRIES, MILD 1940 01:16:05,720 --> 01:16:09,720 DRUG EVEN THOUGH IT HAS VENOUS 1941 01:16:09,720 --> 01:16:10,480 THROMBOLISM RISKS. 1942 01:16:10,480 --> 01:16:13,520 THERE'S OTHER THINGS TO DO. 1943 01:16:13,520 --> 01:16:19,200 IF YOU LOOK AT DATA PRODUCED BY 1944 01:16:19,200 --> 01:16:21,720 DR. TU'S PROGRAM AT TAIWAN, 1945 01:16:21,720 --> 01:16:23,240 NATIONAL HEALTH DATABASE OUT OF 1946 01:16:23,240 --> 01:16:25,600 TAIWAN AND SUGGESTED INDEED RISK 1947 01:16:25,600 --> 01:16:26,480 OF FIBROMYALGIA DEVELOPING IN 1948 01:16:26,480 --> 01:16:27,920 PATIENTS WITH PAINFUL PERIODS 1949 01:16:27,920 --> 01:16:30,320 DOES SEEM TO BE ATTENUATED BY 1950 01:16:30,320 --> 01:16:33,840 PRIOR EXPOSURE TO BIRTH CONTROL 1951 01:16:33,840 --> 01:16:34,800 PILLS. 1952 01:16:34,800 --> 01:16:37,920 SIMPLER STUDY DESIGNS MAY BE 1953 01:16:37,920 --> 01:16:39,520 NECESSARY IF THIS GROUP IS 1954 01:16:39,520 --> 01:16:41,400 HIGHLY SENSITIVE CENTRALLY. 1955 01:16:41,400 --> 01:16:42,560 ANOTHER THING IS POSSIBILITY WE 1956 01:16:42,560 --> 01:16:46,040 COULD PERHAPS LOOK AT OTHER 1957 01:16:46,040 --> 01:16:46,480 DIMENSIONS. 1958 01:16:46,480 --> 01:16:49,200 THIS IS A SMALL STUDY, WHAT'S 1959 01:16:49,200 --> 01:16:52,080 INTERESTING, IT SHOWS WHEN A 1960 01:16:52,080 --> 01:16:53,840 PERSON'S BLADDER IS FILLING, 1961 01:16:53,840 --> 01:16:56,120 TYPICALLY AN INDIVIDUAL DOWN 1962 01:16:56,120 --> 01:16:57,040 HERE, NORMAL HEALTHY INDIVIDUAL, 1963 01:16:57,040 --> 01:16:58,800 PAIN FREE, DOESN'T HAVE PAINFUL 1964 01:16:58,800 --> 01:17:01,040 PERIODS, ONCE THEY HAVE GOTTEN 1965 01:17:01,040 --> 01:17:02,920 BLADDER TO FILL UP THE HEART 1966 01:17:02,920 --> 01:17:04,560 RATE DROPS, ALMOST LIKE THAT'S 1967 01:17:04,560 --> 01:17:06,520 OBVIOUS, YOU KNOW, RELIEF THAT 1968 01:17:06,520 --> 01:17:07,720 WE ALL GET. 1969 01:17:07,720 --> 01:17:09,240 YET WHEN LOOKING AT THE SAME 1970 01:17:09,240 --> 01:17:12,080 HEART RATE MEASUREMENT IN THESE 1971 01:17:12,080 --> 01:17:13,520 INDIVIDUALS WHO HAVE PERIOD 1972 01:17:13,520 --> 01:17:16,120 PAIN-FREE OR BLADDER PAIN 1973 01:17:16,120 --> 01:17:19,360 SYNDROME FAIL TO GET THIS 1974 01:17:19,360 --> 01:17:22,960 RECOVER. 1975 01:17:22,960 --> 01:17:26,920 MORE DYNAMIC TESTS MIGHT BE 1976 01:17:26,920 --> 01:17:33,440 NEEDED SUCH AS WEARABLES, GIVING 1977 01:17:33,440 --> 01:17:34,160 US FUTURE DIRECTION. 1978 01:17:34,160 --> 01:17:37,440 THIS IS A VIRTUAL CONFERENCE. 1979 01:17:37,440 --> 01:17:41,280 I WANT TO SHOUT OUT AS WAS DONE 1980 01:17:41,280 --> 01:17:41,960 FOR MENTORS AND COLLABORATORS, 1981 01:17:41,960 --> 01:17:49,160 THIS IS A SHOT AT TOKYO BAY, 1982 01:17:49,160 --> 01:17:51,440 DAN CLAW SAT DOWN WITH ME WITH 1983 01:17:51,440 --> 01:17:52,600 THIS AMAZING VIEW TO TALK ABOUT 1984 01:17:52,600 --> 01:17:55,040 WHERE WE OUGHT TO TAKE THIS 1985 01:17:55,040 --> 01:17:55,640 WORK. 1986 01:17:55,640 --> 01:17:58,080 THERE'S THIS CONCERN MAYBE 1987 01:17:58,080 --> 01:17:59,400 CONTAMINATION OF SOME RELEVANT 1988 01:17:59,400 --> 01:18:01,160 CONSTRUCTS IN CHRONIC PAIN 1989 01:18:01,160 --> 01:18:02,800 PATIENTS HAPPENS BECAUSE WE 1990 01:18:02,800 --> 01:18:04,240 STUDY LATER IN DISEASE PROCESS, 1991 01:18:04,240 --> 01:18:05,440 ENCOURAGING US TO CONSIDER 1992 01:18:05,440 --> 01:18:07,320 COMING TO NICHD TO LOOK AT 1993 01:18:07,320 --> 01:18:08,720 YOUNGER PATIENTS BEFORE CHRONIC 1994 01:18:08,720 --> 01:18:10,600 PAIN EMERGES AND SO WE ACTUALLY 1995 01:18:10,600 --> 01:18:11,920 IN THE COURSE OF THE DISCUSSION 1996 01:18:11,920 --> 01:18:18,880 WITH DAN ON THE SECOND FLOOR OF 1997 01:18:18,880 --> 01:18:19,680 THE HOTEL INTERCONTINENTAL 1998 01:18:19,680 --> 01:18:21,440 DECIDED TO STUDY THEM ACROSS THE 1999 01:18:21,440 --> 01:18:22,440 MENSTRUAL PAIN TRANSITION. 2000 01:18:22,440 --> 01:18:23,600 I WANT TO DO SOME BRIEF 2001 01:18:23,600 --> 01:18:28,200 INTRODUCTION OF WHAT WE FOUND 2002 01:18:28,200 --> 01:18:31,240 THERE. 2003 01:18:31,240 --> 01:18:38,160 EMPATHY IS RECRUITING 400 AT THE 2004 01:18:38,160 --> 01:18:40,560 AGE OF MENARCHE, SLOWED BY 2005 01:18:40,560 --> 01:18:46,600 COVID, BLADDER PAIN SENSITIVITY, 2006 01:18:46,600 --> 01:18:47,680 NEUROPHYSIOLOGICAL MEASURES, EDG 2007 01:18:47,680 --> 01:18:49,640 WORK WITH A POSTDOC GIVING US A 2008 01:18:49,640 --> 01:18:51,560 CHANCE TO LOOK AT CENTRAL 2009 01:18:51,560 --> 01:18:52,600 CORRELATES, EVEN MORE SO. 2010 01:18:52,600 --> 01:18:54,720 THIS SLIDE SHOWS THE FEASIBILITY 2011 01:18:54,720 --> 01:18:57,280 DATA TO SHOW YOU CAN GET A YOUNG 2012 01:18:57,280 --> 01:18:59,840 GIRL WHO NEVER THOUGHT ABOUT 2013 01:18:59,840 --> 01:19:02,080 SCIENCE OR HER BLADDER TO 2014 01:19:02,080 --> 01:19:07,200 DEMONSTRATE SHE CAN FIGURE OUT 2015 01:19:07,200 --> 01:19:10,200 MAXIMUM TOLERANCE, URGENCY AND 2016 01:19:10,200 --> 01:19:13,000 PAIN, DATA IS VALID, A SMALLER 2017 01:19:13,000 --> 01:19:13,480 BLADDER THAN ADULT WHICH 2018 01:19:13,480 --> 01:19:15,320 SUGGESTS THIS IS IN FACT SOME 2019 01:19:15,320 --> 01:19:17,560 VALID DATA AS WE HOPED FOR. 2020 01:19:17,560 --> 01:19:20,960 LIKEWISE WE DO BASIC TESTS LIKE 2021 01:19:20,960 --> 01:19:22,160 PRESSURE PAIN THRESHOLD TESTING, 2022 01:19:22,160 --> 01:19:24,440 SKIPPED PELVIC FLOOR TESTING 2023 01:19:24,440 --> 01:19:26,080 SINCE THAT'S QUITE CHALLENGING 2024 01:19:26,080 --> 01:19:28,280 IN ADULTS, KNEE AND SHOULDER 2025 01:19:28,280 --> 01:19:29,840 PRESSURE PAIN THRESHOLDS GET 2026 01:19:29,840 --> 01:19:36,680 SIMILAR RESULTS IN ADULTS, AND 2027 01:19:36,680 --> 01:19:43,040 CAN FIND EVIDENCE FOR DESCENDING 2028 01:19:43,040 --> 01:19:43,840 MODULATION. 2029 01:19:43,840 --> 01:19:45,640 THIS WAS PUBLISHED THIS YEAR IN 2030 01:19:45,640 --> 01:19:49,160 "PAIN," A NICE TESTIMONY TO OUR 2031 01:19:49,160 --> 01:19:49,640 COLLEAGUE GLEN WALKER, 2032 01:19:49,640 --> 01:19:54,960 TREMENDOUSED A LESS -- 2033 01:19:54,960 --> 01:19:57,320 ADOLESCENT PAIN PSYCHOLOGIST. 2034 01:19:57,320 --> 01:19:58,560 I'M GRATEFUL TO NICHD FOR 2035 01:19:58,560 --> 01:20:00,280 FUNDING THIS. 2036 01:20:00,280 --> 01:20:02,280 LAST COMMENTS AND WE'LL TAKE 2037 01:20:02,280 --> 01:20:06,640 TIME FOR QUESTIONS. 2038 01:20:06,640 --> 01:20:07,440 NIH IPRCC INDICATED WE SHOULD 2039 01:20:07,440 --> 01:20:11,360 FOLK UNDER THE CIRCUMSTANCES ON 2040 01:20:11,360 --> 01:20:12,240 FINDING -- FOCUSED ON FINDING 2041 01:20:12,240 --> 01:20:13,600 BETTER MARKERS AND HOPE THIS IS 2042 01:20:13,600 --> 01:20:16,240 A PATHWAY TO LOOK FOR CHRONIC 2043 01:20:16,240 --> 01:20:17,600 PAIN VULNERABILITY. 2044 01:20:17,600 --> 01:20:18,840 WE RELY ON YOU TO CONTINUE TO 2045 01:20:18,840 --> 01:20:20,480 THINK ABOUT WAYS TO TEST 2046 01:20:20,480 --> 01:20:22,040 TREATMENTS AND SEE IF THEY 2047 01:20:22,040 --> 01:20:24,200 IMPACT ON THESE MARKERS OR HELP 2048 01:20:24,200 --> 01:20:25,400 US REFINE THEM. 2049 01:20:25,400 --> 01:20:26,720 I WANT TO SUGGEST THERE ARE A 2050 01:20:26,720 --> 01:20:29,080 COUPLE KEY AREAS WE NEED TO LOOK 2051 01:20:29,080 --> 01:20:30,440 AT BETTER ACROSS TIME, 2052 01:20:30,440 --> 01:20:31,720 DESCENDING MODULATION BEING ONE. 2053 01:20:31,720 --> 01:20:33,400 WE DIDN'T TALK ABOUT INFLUENCE 2054 01:20:33,400 --> 01:20:35,120 OF SOCIAL MODEL, AN IMPORTANT 2055 01:20:35,120 --> 01:20:36,960 AREA LOOKING AT YOUNGER GIRLS 2056 01:20:36,960 --> 01:20:39,160 AND THEIR PARENTS. 2057 01:20:39,160 --> 01:20:40,760 A NUMBER OF MOLECULAR SCIENTISTS 2058 01:20:40,760 --> 01:20:42,880 ON THE CALL TO HELP US WITH 2059 01:20:42,880 --> 01:20:47,880 DYNAMIC MODEL, IN RELATION TO 2060 01:20:47,880 --> 01:20:49,760 MORE GROSS METHODS. 2061 01:20:49,760 --> 01:20:54,040 MY LAST SLIDE, TO EXPRESS 2062 01:20:54,040 --> 01:20:56,160 GRATITUDE FOR COLLEAGUES FROM 2063 01:20:56,160 --> 01:21:01,440 NIDDK AND NICHD FUNDING, MY 2064 01:21:01,440 --> 01:21:12,120 ORIGINAL K23 WAS HERE, THE GYLL 2065 01:21:12,120 --> 01:21:21,680 LAB, POSTDOCS, DAN CLAUW AND LYN 2066 01:21:21,680 --> 01:21:25,440 WALKER OUT OF VANDERBILT, AND 2067 01:21:25,440 --> 01:21:27,960 TWO VERY DIFFERENT SCIENTISTS, 2068 01:21:27,960 --> 01:21:30,680 TOM CHELIMSKY WHO LOOKS AT 2069 01:21:30,680 --> 01:21:35,360 AUTONOMIC FUNCTION AND GERRI 2070 01:21:35,360 --> 01:21:36,880 GEBHART IN RETIREMENT AGREED TO 2071 01:21:36,880 --> 01:21:42,680 DRINK COFFEE WITH US AND 2072 01:21:42,680 --> 01:21:43,240 CRITIQUE. 2073 01:21:43,240 --> 01:21:44,040 FORMER ISB PRESIDENT, PIONEER IN 2074 01:21:44,040 --> 01:21:44,880 THE PAIN WORLD. 2075 01:21:44,880 --> 01:21:54,560 I'LL TAKE QUESTIONS IF WE HAVE 2076 01:21:54,560 --> 01:21:55,080 TIME. 2077 01:21:55,080 --> 01:21:58,400 >> THANK YOU. 2078 01:21:58,400 --> 01:21:59,240 IF YOU HAVE QUESTIONS PUT YOUR 2079 01:21:59,240 --> 01:22:01,040 QUESTION IN THE CHAT. 2080 01:22:01,040 --> 01:22:10,840 WE HAVE ONE MINUTE. 2081 01:22:10,840 --> 01:22:12,840 IF YOU DON'T HAVE SPECIFIC 2082 01:22:12,840 --> 01:22:14,200 QUESTIONS FOR DR. TU WE CAN MOVE 2083 01:22:14,200 --> 01:22:19,880 ON. 2084 01:22:19,880 --> 01:22:23,840 2085 01:22:23,840 --> 01:22:35,960 2086 01:22:35,960 --> 01:22:37,680 IF YOU NEED TIME TO THINK OF 2087 01:22:37,680 --> 01:22:50,920 QUESTIONS WE'LL ADDRESS THAT IN 2088 01:22:50,920 --> 01:22:55,440 THE DISCUSSION SESSION. 2089 01:22:55,440 --> 01:22:59,480 IT'S 2:25, I'D LIKE TO MOVE ON. 2090 01:22:59,480 --> 01:23:03,000 DR. NACKLEY, WOULD YOU TURN ON 2091 01:23:03,000 --> 01:23:12,080 YOUR CAMERA AND SHARE YOUR 2092 01:23:12,080 --> 01:23:13,240 SLIDES. 2093 01:23:13,240 --> 01:23:16,600 DR. NACKLEY IS GOING TO TALK 2094 01:23:16,600 --> 01:23:19,280 ABOUT VESTIBULODYNIA. 2095 01:23:19,280 --> 01:23:21,520 >> YOU CAN SEE MY SLIDES 2096 01:23:21,520 --> 01:23:22,920 CLEARLY? 2097 01:23:22,920 --> 01:23:23,240 >> YES. 2098 01:23:23,240 --> 01:23:23,520 >> GREAT. 2099 01:23:23,520 --> 01:23:25,960 SO, I'D LIKE TO BEGIN BY 2100 01:23:25,960 --> 01:23:27,600 THANKING DR. AHN AND ORGANIZERS 2101 01:23:27,600 --> 01:23:29,240 FOR PUTTING THIS WORKSHOP 2102 01:23:29,240 --> 01:23:39,360 TOGETHER TO DISCUSS CURRENT AND 2103 01:23:39,360 --> 01:23:40,080 FUTURE NEEDS. 2104 01:23:40,080 --> 01:23:41,160 IT'S BEEN AN UNDERREPRESENTED 2105 01:23:41,160 --> 01:23:41,520 AREA. 2106 01:23:41,520 --> 01:23:50,440 I'D LIKE TO GIVE THANKS FOR 2107 01:23:50,440 --> 01:23:51,000 INTRODUCING TERMINOLOGY AND 2108 01:23:51,000 --> 01:23:55,680 CONCEPTS WHICH I THINK ARE 2109 01:23:55,680 --> 01:23:57,560 COMMON THROUGHOUT OUR SESSION. 2110 01:23:57,560 --> 01:23:59,360 FOR THE NEXT 20 MINUTES I'D LIKE 2111 01:23:59,360 --> 01:24:06,680 TO TALK ABOUT MY GROUP'S WORK IN 2112 01:24:06,680 --> 01:24:07,840 THE AREA AND EMPHASIZE 2113 01:24:07,840 --> 01:24:10,240 IMPORTANCE OF WHAT'S BEEN 2114 01:24:10,240 --> 01:24:12,600 DISCUSSED ABOUT CONSIDERING PAIN 2115 01:24:12,600 --> 01:24:14,920 BEYOND THE LOCAL ORGAN OF 2116 01:24:14,920 --> 01:24:17,160 PRIMARY CHIEF COMPLAINT. 2117 01:24:17,160 --> 01:24:29,200 PAIN BEYOND THE VESTIBULE AND 2118 01:24:29,200 --> 01:24:30,400 EVEN THE PELVIS. 2119 01:24:30,400 --> 01:24:46,840 MY SLIDES ARE NOT ADVANCING. 2120 01:24:46,840 --> 01:24:49,480 I'LL PROVIDE AND OVERVIEW, SHARE 2121 01:24:49,480 --> 01:24:51,880 FINDINGS WHERE WE IDENTIFIED 2122 01:24:51,880 --> 01:24:58,360 CLINICAL FEATURES AND BIOMARKERS 2123 01:24:58,360 --> 01:25:00,040 THAT DISTINGUISH SUBTYPES. 2124 01:25:00,040 --> 01:25:01,520 I'LL INTRODUCE THE CLINICAL 2125 01:25:01,520 --> 01:25:04,960 TRIAL TO SEEKS TO DETERMINE 2126 01:25:04,960 --> 01:25:07,800 TREATMENT FOR DIFFERENT BBD 2127 01:25:07,800 --> 01:25:14,720 SUBTYPES WHILE MEASURING 2128 01:25:14,720 --> 01:25:19,720 BIOMARKERS TO UNDERSTAND 2129 01:25:19,720 --> 01:25:20,080 PATHOPHYSIOLOGY. 2130 01:25:20,080 --> 01:25:22,840 IT IS CHARACTERIZED BY PROVOKED 2131 01:25:22,840 --> 01:25:26,640 PAIN AT THE AREA OF THE VAGINA, 2132 01:25:26,640 --> 01:25:28,840 THREE MONTHS OR LONGER, THE MOST 2133 01:25:28,840 --> 01:25:32,240 COMMON FORM OF SEXUAL PAIN, 16% 2134 01:25:32,240 --> 01:25:39,360 OF REPRODUCTIVE AGE WOMEN IN 2135 01:25:39,360 --> 01:25:43,440 THE UNITED STATES, IT REMAINS 2136 01:25:43,440 --> 01:25:45,280 INEFFECTIVELY TREATED BECAUSE WE 2137 01:25:45,280 --> 01:25:50,880 DON'T UNDERSTAND CAUSE, CLINICAL 2138 01:25:50,880 --> 01:25:52,600 PRESENTATION IS HETEROGENEOUS IN 2139 01:25:52,600 --> 01:25:53,320 NATURE. 2140 01:25:53,320 --> 01:25:56,440 SOME WOMEN PRESENT WITH 2141 01:25:56,440 --> 01:25:59,160 LOCALIZED PAIN THAT'S RESTRICTED 2142 01:25:59,160 --> 01:26:01,880 TO THE VAGINAL VESTIBULE, OTHERS 2143 01:26:01,880 --> 01:26:03,440 HAVE VESTIBULAR PAIN AND 2144 01:26:03,440 --> 01:26:05,360 GENERALIZED PAIN AT OTHER 2145 01:26:05,360 --> 01:26:11,040 GENERAL PELVIC SITES. 2146 01:26:11,040 --> 01:26:19,520 STILL OTHERS HAVE VBD. 2147 01:26:19,520 --> 01:26:21,800 VBD CO-OCCURS OR OVERLAPS WITH 2148 01:26:21,800 --> 01:26:23,040 CHRONIC PAIN CONDITIONS THAT 2149 01:26:23,040 --> 01:26:25,640 AFFECT OTHER PELVIC OR ABDOMINAL 2150 01:26:25,640 --> 01:26:25,840 SITES. 2151 01:26:25,840 --> 01:26:34,840 FOR EXAMPLE, UPWARDS OF 35% OF 2152 01:26:34,840 --> 01:26:43,160 WOMEN WITH VBD HAVE ( 2153 01:26:43,160 --> 01:26:43,840 INDISCERNIBLE). 2154 01:26:43,840 --> 01:26:51,440 75% HAVE TMD WHICH AFFECTS 2155 01:26:51,440 --> 01:26:54,840 OROFACIAL MUSCLES, 25% HAVE 2156 01:26:54,840 --> 01:26:58,200 FIBROMYALGIA, AND IS PREVALENT 2157 01:26:58,200 --> 01:27:03,000 WIDESPREAD MUSCULOSKELETAL PAIN 2158 01:27:03,000 --> 01:27:03,360 CONDITION. 2159 01:27:03,360 --> 01:27:04,720 NEUROPATHIC PAIN RESULT FROM 2160 01:27:04,720 --> 01:27:07,680 INJURY TO NERVES OR SPINAL CORD 2161 01:27:07,680 --> 01:27:08,760 OR INFLAMMATORY PAIN FROM 2162 01:27:08,760 --> 01:27:10,280 ACTIVATION OF IMMUNE CELLS IN 2163 01:27:10,280 --> 01:27:13,440 RESPONSE TO ANTIGEN EXPOSURE OR 2164 01:27:13,440 --> 01:27:18,040 TISSUE INJURY, VBD AND THESE 2165 01:27:18,040 --> 01:27:20,400 OTHER CHRONIC OVERLAPPING PAIN 2166 01:27:20,400 --> 01:27:25,840 CONDITIONS ARE CHRONIC PRIMARY 2167 01:27:25,840 --> 01:27:27,200 PAIN UNEXPLAINED BY PHYSICAL 2168 01:27:27,200 --> 01:27:29,120 FINDINGS, NOCIPLASTIC PAIN 2169 01:27:29,120 --> 01:27:30,480 CONDITIONS. 2170 01:27:30,480 --> 01:27:33,480 THE OVERLAP IS HIGHLIGHTED IN A 2171 01:27:33,480 --> 01:27:39,880 REPORT RELIEVING PAIN IN 2172 01:27:39,880 --> 01:27:40,440 AMERICA, SUGGESTING COMMON 2173 01:27:40,440 --> 01:27:40,720 ETIOLOGY. 2174 01:27:40,720 --> 01:27:43,920 I'D LIKE TO SHARE PRIOR WORK 2175 01:27:43,920 --> 01:27:49,800 FOCUSED ON IDENTIFYING SOME 2176 01:27:49,800 --> 01:27:50,400 DISTINGUISHING CLINICAL 2177 01:27:50,400 --> 01:27:52,480 BIOMARKERS, FEATURES UNIQUE TO 2178 01:27:52,480 --> 01:27:55,040 WOMEN WITH LOCALIZED VBD VERSUS 2179 01:27:55,040 --> 01:27:58,840 THOSE THAT HAVE OVERLAPPING PAIN 2180 01:27:58,840 --> 01:27:59,440 CONDITIONS. 2181 01:27:59,440 --> 01:28:02,920 WOMEN WITH VBD HEALTHY CONTROLS 2182 01:28:02,920 --> 01:28:04,760 RECRUITED BY LOCAL 2183 01:28:04,760 --> 01:28:07,360 ADVERTISEMENTS IN PAIN CLINICS, 2184 01:28:07,360 --> 01:28:13,320 FOLLOWING SCREEN STATUS VERIFIED 2185 01:28:13,320 --> 01:28:15,480 BY SELF-REPORTED PAIN. 2186 01:28:15,480 --> 01:28:18,440 COPC CASE STATUS USING STANDARD 2187 01:28:18,440 --> 01:28:24,360 CONDITION SPECIFIC DIAGNOSTIC 2188 01:28:24,360 --> 01:28:26,040 CRITERIA, IN THIS STUDY, AND 2189 01:28:26,040 --> 01:28:29,480 EXPERIMENTAL PAIN TESTING WAS 2190 01:28:29,480 --> 01:28:33,560 PERFORMED AT LOCAL AND REMOTE 2191 01:28:33,560 --> 01:28:35,520 SITES, QUESTIONNAIRES 2192 01:28:35,520 --> 01:28:36,840 ADMINISTRATE TO EVALUATE, 2193 01:28:36,840 --> 01:28:39,320 FINALLY SAMPLES WERE COLLECTED, 2194 01:28:39,320 --> 01:28:42,640 IN THIS CASE BLOOD SAMPLES, TO 2195 01:28:42,640 --> 01:28:47,040 EVALUATE CIRCULATING LEVELS OF 2196 01:28:47,040 --> 01:28:48,600 CYTOKINES AND microRNAs. 2197 01:28:48,600 --> 01:28:53,040 SO WHAT WE FOUND IS THAT PAIN 2198 01:28:53,040 --> 01:28:59,480 INTENSITY AND THRESHOLD MEASURED 2199 01:28:59,480 --> 01:29:06,280 AT SITES 5 AND 7 ON ONE, 6 ON 2200 01:29:06,280 --> 01:29:08,600 THE OTHER, THESE SITES, WHEN 2201 01:29:08,600 --> 01:29:09,680 PRESSURE WAS APPLIED 2202 01:29:09,680 --> 01:29:11,120 PARTICIPANTS HAD INCREASED PAIN 2203 01:29:11,120 --> 01:29:13,520 INTENSITY, REDUCE THE PRESSURE 2204 01:29:13,520 --> 01:29:16,560 PAIN THRESHOLD IN BOTH THE VBD 2205 01:29:16,560 --> 01:29:18,600 LOCALIZED GROUP AND VBD WITH 2206 01:29:18,600 --> 01:29:19,680 COPC GROUP. 2207 01:29:19,680 --> 01:29:21,360 AS YOU CAN SEE THOSE WITH 2208 01:29:21,360 --> 01:29:23,480 OVERLAPPING PAIN CONDITIONS ARE 2209 01:29:23,480 --> 01:29:24,440 SIGNIFICANTLY GREATER PAIN. 2210 01:29:24,440 --> 01:29:26,480 WHEN WE MEASURED PAIN AT REMOTE 2211 01:29:26,480 --> 01:29:29,240 BODY SITES SUCH AS TRAPEZIUS 2212 01:29:29,240 --> 01:29:34,040 MUSCLE WOMEN WITH VBD PLUS COPC 2213 01:29:34,040 --> 01:29:35,160 HAD REDUCEED THRESHOLD, VBD 2214 01:29:35,160 --> 01:29:36,240 ALONE DID NOT. 2215 01:29:36,240 --> 01:29:42,040 WOMEN WITH OVERLAPPING PAINS 2216 01:29:42,040 --> 01:29:46,840 EXHIBITED GREATEST DEGREE TO 2217 01:29:46,840 --> 01:29:48,480 THERMAL PAIN, INDICATIVE OF 2218 01:29:48,480 --> 01:29:49,200 CENTRAL SENSITIZATION. 2219 01:29:49,200 --> 01:29:52,000 SO WHEN WE LOOKED AT THE RESULTS 2220 01:29:52,000 --> 01:29:53,440 FROM THE QUESTIONNAIRE DATA, WE 2221 01:29:53,440 --> 01:29:56,160 ALSO FOUND THAT WOMEN WITH VBD 2222 01:29:56,160 --> 01:30:01,840 AND OVERLAPPING PAIN REPORT 2223 01:30:01,840 --> 01:30:04,240 GREATER ACHING, MORE LIKELY TO 2224 01:30:04,240 --> 01:30:06,760 HAVE HISTORY OF SPONTANEOUS 2225 01:30:06,760 --> 01:30:11,320 GENITAL PAIN, HALLMARK OF 2226 01:30:11,320 --> 01:30:12,040 CENTRAL SENSITIZATION. 2227 01:30:12,040 --> 01:30:13,800 WOMEN REPORT FOR GENERAL HEALTH 2228 01:30:13,800 --> 01:30:15,840 AND PHYSICAL HEALTH RATINGS MORE 2229 01:30:15,840 --> 01:30:16,680 SOMATIC AWARENESS, GREATER 2230 01:30:16,680 --> 01:30:20,760 IMPACT OF PAIN ON DAILY 2231 01:30:20,760 --> 01:30:21,240 ACTIVITY. 2232 01:30:21,240 --> 01:30:24,920 IN CONTRAST TO OTHER STUDIES 2233 01:30:24,920 --> 01:30:25,880 OBSERVING POSITIVE CORRELATION 2234 01:30:25,880 --> 01:30:27,960 BETWEEN PAIN SEVERITY AND VBD 2235 01:30:27,960 --> 01:30:30,600 ONSET, WOMEN IN THE GROUP WERE 2236 01:30:30,600 --> 01:30:33,320 LESS LIKELY TO HAVE EARLY ONSET 2237 01:30:33,320 --> 01:30:35,200 WITH FIRST INTERCOURSE OR TAMPON 2238 01:30:35,200 --> 01:30:37,120 INSERTION, THAT COULDN'T EXPLAIN 2239 01:30:37,120 --> 01:30:39,680 THE DIFFERENCE IN THE PAIN IN 2240 01:30:39,680 --> 01:30:40,440 THE TWO GROUPS. 2241 01:30:40,440 --> 01:30:52,960 IN SOME IT'S CLEAR FROM THESE 2242 01:30:52,960 --> 01:30:56,200 FINDINGS, POOR OVERALL HEALTH. 2243 01:30:56,200 --> 01:30:58,400 NEXT WE MEASURED LEVELS OF 2244 01:30:58,400 --> 01:31:01,000 CYTOKINE PROTEINS AND SMALL 2245 01:31:01,000 --> 01:31:02,360 REGULATORY RNAs IN BLOOD 2246 01:31:02,360 --> 01:31:03,360 SAMPLES COLLECTED FROM THE 2247 01:31:03,360 --> 01:31:14,320 COHORT IN HOPES OF IDENTIFYING 2248 01:31:14,320 --> 01:31:14,600 BIOMARKERS. 2249 01:31:14,600 --> 01:31:16,720 CYTOKINES ARE SIGNALING PROTEINS 2250 01:31:16,720 --> 01:31:20,840 CREATED BY IMMUNE CELLS, AND 2251 01:31:20,840 --> 01:31:23,880 NOCICEPTORS, SKIN CELLS. 2252 01:31:23,880 --> 01:31:27,400 THEY CAN PROMOTE WOUND HEALING 2253 01:31:27,400 --> 01:31:29,600 AND REPAIR. 2254 01:31:29,600 --> 01:31:31,440 SUSTAINED INCREASES PROMOTE 2255 01:31:31,440 --> 01:31:34,320 CENTRALIZATION AND CENTRAL 2256 01:31:34,320 --> 01:31:37,920 SENSITIZATION, EITHER THROUGH 2257 01:31:37,920 --> 01:31:39,880 ACTIVATION OF TRANSDUCER 2258 01:31:39,880 --> 01:31:42,040 CHANNELS AND INDUCING EXPRESSION 2259 01:31:42,040 --> 01:31:44,600 OF OTHER PRO-INFLAMMATORY AND 2260 01:31:44,600 --> 01:31:46,480 PRO NOCICEPTIVE MOLECULES. 2261 01:31:46,480 --> 01:31:48,320 HERE WE IDENTIFIED SIGNIFICANT 2262 01:31:48,320 --> 01:31:55,840 CASE CONTROL DIFFERENCES IN TWO 2263 01:31:55,840 --> 01:31:56,840 CYTOKINES. 2264 01:31:56,840 --> 01:31:59,040 IL-8 IS A PRO-INFLAMMATORY 2265 01:31:59,040 --> 01:32:07,840 CYTOKINE, CAN SENSITIZE 2266 01:32:07,840 --> 01:32:09,240 NOCICEPTORS, IL-1 BINDS TO 2267 01:32:09,240 --> 01:32:11,160 REGULATE ACTIVITY AND CAN 2268 01:32:11,160 --> 01:32:13,640 REGULATE OR SUPPRESS EXPRESSION 2269 01:32:13,640 --> 01:32:14,160 OF IL-8. 2270 01:32:14,160 --> 01:32:17,040 SO YOU CAN SEE WOMEN WITH 2271 01:32:17,040 --> 01:32:23,840 LOCALIZED VBD HAVE INCREASED 2272 01:32:23,840 --> 01:32:26,680 IL-8 ALONGSIDE INCREASED IL1RA. 2273 01:32:26,680 --> 01:32:34,200 WOMEN WITH VBD PLUS COPC HAVE 2274 01:32:34,200 --> 01:32:37,160 INCREASE IN IL-8, WE OBSERVED 2275 01:32:37,160 --> 01:32:40,360 SAME SIGNATURE IN A CASE CONTROL 2276 01:32:40,360 --> 01:32:42,560 STUDY, INDIVIDUALS WITH 2277 01:32:42,560 --> 01:32:47,040 LOCALIZED TMD ARE INCREASE IN 2278 01:32:47,040 --> 01:32:49,880 IL1RA, THOSE WITH TMD WIDESPREAD 2279 01:32:49,880 --> 01:32:52,200 PAIN HAVE INCREASED LEVELS OF 2280 01:32:52,200 --> 01:32:58,720 IL-8 WITH NO COMPETENCE TORE 2281 01:32:58,720 --> 01:32:59,720 INCREASE IN IL1RA. 2282 01:32:59,720 --> 01:33:02,240 THE SAME MARKERS MAY BE ABLE TO 2283 01:33:02,240 --> 01:33:05,400 DISTINGUISH OVER THE PRESENCE OF 2284 01:33:05,400 --> 01:33:07,680 OVERLAPPING PAIN, IN THIS CASE 2285 01:33:07,680 --> 01:33:13,240 WE FOUND IL-8 AND IL1RA TO BE 2286 01:33:13,240 --> 01:33:15,800 THE SUBTYPES SELECTIVE 2287 01:33:15,800 --> 01:33:19,880 BIOMARKERS. 2288 01:33:19,880 --> 01:33:21,320 WE VALUED EXPRESSION OF 750 2289 01:33:21,320 --> 01:33:22,320 microRNAs, SMALL MOLECULES 2290 01:33:22,320 --> 01:33:24,280 THAT PLAY A VITAL ROLE IN 2291 01:33:24,280 --> 01:33:26,880 REGULATING EXPRESSION OF GENES 2292 01:33:26,880 --> 01:33:27,920 IMPORTANT FOR ALL NORMAL 2293 01:33:27,920 --> 01:33:30,080 PHYSIOLOGIC PROCESSES INCLUDING 2294 01:33:30,080 --> 01:33:30,560 PAIN AND INFLAMMATION. 2295 01:33:30,560 --> 01:33:38,080 THEY ARE LOOKING AT 2296 01:33:38,080 --> 01:33:40,360 INTRACELLULAR NUCLEATED CELLS. 2297 01:33:40,360 --> 01:33:42,560 THEY REGULATE THE EXPRESSION OF 2298 01:33:42,560 --> 01:33:46,280 GENES BY BINDING TO THE THREE 2299 01:33:46,280 --> 01:33:48,360 PRIME UTR OR UNTRANSLATED REGION 2300 01:33:48,360 --> 01:33:49,800 OF TRANSCRIPTS TO PREVENT 2301 01:33:49,800 --> 01:33:53,200 TRANSLATION OR TARGET THEM FOR 2302 01:33:53,200 --> 01:33:53,600 DEGRADATION. 2303 01:33:53,600 --> 01:34:00,240 WE IDENTIFIED 17 microRNAs, 2304 01:34:00,240 --> 01:34:01,400 SO DOWNREGULATED microRNAs 2305 01:34:01,400 --> 01:34:06,200 ARE SHOWN IN RED, UPREGULATED 2306 01:34:06,200 --> 01:34:09,240 SHOWN IN BLUE. 2307 01:34:09,240 --> 01:34:10,840 SYSTEMIC DYSREGULATED, FOUR IN 2308 01:34:10,840 --> 01:34:15,280 BOTH GROUPS, SIX SPECIFIC TO 2309 01:34:15,280 --> 01:34:21,920 VBD, SEVEN SPECIFIC TO VBD PLUS 2310 01:34:21,920 --> 01:34:22,880 COPC. 2311 01:34:22,880 --> 01:34:25,560 IN ORDER TO PUT THIS 2312 01:34:25,560 --> 01:34:29,160 DYSREGULATION IN CONTEXT, WE 2313 01:34:29,160 --> 01:34:41,280 USED PATHWAY ANALYSIS SOFTWARE, 2314 01:34:41,280 --> 01:34:42,200 MIRAPLAST, PREDICTED TO BE 2315 01:34:42,200 --> 01:34:43,840 DYSREGULATED BASED ON RNA 2316 01:34:43,840 --> 01:34:46,760 RESULTS. 2317 01:34:46,760 --> 01:34:49,480 THE FOUR microRNAs ARE IN 2318 01:34:49,480 --> 01:34:51,480 THE TGF-BETA PATHWAY, AN 2319 01:34:51,480 --> 01:34:55,200 IMPORTANT REGULATOR OF 2320 01:34:55,200 --> 01:34:57,480 INFLAMMATION THAT CAN INHIBIT 2321 01:34:57,480 --> 01:34:59,840 MACROPHAGE ACTIVATION AND B 2322 01:34:59,840 --> 01:35:03,960 CELLS AND CAN DOWNREGULATE 2323 01:35:03,960 --> 01:35:07,320 INFLAMMATORY CYTOKINE DIRECTION. 2324 01:35:07,320 --> 01:35:11,840 UPREGULATION WOULD CAUSE REDUCED 2325 01:35:11,840 --> 01:35:15,760 LEVELS OF TGF-BETA, THIS MAY BE 2326 01:35:15,760 --> 01:35:24,440 AN IMPORTANT HUB FOR LOCAL AND 2327 01:35:24,440 --> 01:35:26,560 WIDESPREAD PAIN. 2328 01:35:26,560 --> 01:35:28,280 ESTROGEN IS IMPORTANT FOR 2329 01:35:28,280 --> 01:35:30,520 SUPPORT, PREDICTED TO BE BLUNTED 2330 01:35:30,520 --> 01:35:38,240 IN WOMEN WITH VBD. 2331 01:35:38,240 --> 01:35:41,840 THE MIR-449 HAS PREVIOUSLY BEEN 2332 01:35:41,840 --> 01:35:44,400 SHOWN IN ANOTHER STUDY TO BE 2333 01:35:44,400 --> 01:35:47,840 IMPLICATED IN ENDOMETRIOSIS AND 2334 01:35:47,840 --> 01:35:50,840 IN BLADDER PAIN, THIS REGULATES 2335 01:35:50,840 --> 01:35:53,840 NEUROKIND 1 RECEPTOR, IMPORTANT, 2336 01:35:53,840 --> 01:35:57,960 SO MIR-449B MAY PLAY A ROLE IN 2337 01:35:57,960 --> 01:35:59,800 PATHOPHYSIOLOGY OF PELVIC PAIN. 2338 01:35:59,800 --> 01:36:04,040 AND THERE WERE SEVEN MIRs 2339 01:36:04,040 --> 01:36:09,840 DYSREGULATED IN WOMEN WITH VBD 2340 01:36:09,840 --> 01:36:14,960 AND COPCs, THAT INCLUDES 2341 01:36:14,960 --> 01:36:16,840 microRNAS THAT REGULATE 2342 01:36:16,840 --> 01:36:22,640 INTEGRIN B1, ALSO KINASES SUCH 2343 01:36:22,640 --> 01:36:24,600 AS P30 MAP KINASE, IMPORTANT FOR 2344 01:36:24,600 --> 01:36:28,040 INTEGRIN B1 AND OTHER MEMBERS OF 2345 01:36:28,040 --> 01:36:28,880 THE EXTRACELLULAR MATRIX PATHWAY 2346 01:36:28,880 --> 01:36:30,080 WHERE STRUCTURE AND FUNCTION OF 2347 01:36:30,080 --> 01:36:33,400 NERVES, IMMUNE CELLS AND NERVES, 2348 01:36:33,400 --> 01:36:36,440 P38 MAP KINASE SIGNALING IS 2349 01:36:36,440 --> 01:36:48,240 IMPORTANT FOR CENTRAL 2350 01:36:48,240 --> 01:36:51,280 SENSITIZATION, PROMOTING PAIN 2351 01:36:51,280 --> 01:36:54,360 THROUGH UPREGULATION, AND 2352 01:36:54,360 --> 01:36:55,080 microRNA ASSOCIATED WITH IL-8 2353 01:36:55,080 --> 01:36:58,280 LEVELS IN THE COHORT. 2354 01:36:58,280 --> 01:37:00,280 TOGETHER DATA IMPLICATE MORE 2355 01:37:00,280 --> 01:37:02,680 SEVERE DYSREGULATION IN PATHWAYS 2356 01:37:02,680 --> 01:37:07,840 REGULATING IMMUNE AND SENSORY 2357 01:37:07,840 --> 01:37:15,040 PROCESSING, POSSIBLY LINKED TO 2358 01:37:15,040 --> 01:37:17,840 CENTRAL SENSITIZATION. 2359 01:37:17,840 --> 01:37:19,000 TO DETERMINE POTENTIAL 2360 01:37:19,000 --> 01:37:21,160 EFFECTIVENESS OF PERIPHERAL 2361 01:37:21,160 --> 01:37:24,760 VERSUS CENTRALLY TARGETED 2362 01:37:24,760 --> 01:37:27,040 TREATMENTS, WE COLLABORATED WITH 2363 01:37:27,040 --> 01:37:30,960 DR. RAPPKIN AT UCLA TO CONDUCT A 2364 01:37:30,960 --> 01:37:31,720 PILOT STUDY MEASURING 2365 01:37:31,720 --> 01:37:36,800 SELF-REPORTED PAIN IN A Q-TIP 2366 01:37:36,800 --> 01:37:38,360 TEST FOR 50 WOMEN AND FOLLOWING 2367 01:37:38,360 --> 01:37:41,680 TREATMENT IN THE CLINIC. 2368 01:37:41,680 --> 01:37:43,400 WE FOCUSED ON COMMONLY 2369 01:37:43,400 --> 01:37:45,440 PRESCRIBED TREATMENT AND TO SEE 2370 01:37:45,440 --> 01:37:48,040 WHICH ONES MAY WORK BETTER IN 2371 01:37:48,040 --> 01:37:51,000 WHICH OF THE GROUPS, WITH 2372 01:37:51,000 --> 01:37:53,440 LOCALIZED VBD OR THOSE WITH 2373 01:37:53,440 --> 01:37:54,960 OVERLAPPING PAIN. 2374 01:37:54,960 --> 01:37:57,920 TO THE TREATMENTS WE FOCUSED ON 2375 01:37:57,920 --> 01:38:03,360 WERE TOPICAL TREATMENTS SUCH AS 2376 01:38:03,360 --> 01:38:05,040 LIDOCAINE WHICH PREVENTS 2377 01:38:05,040 --> 01:38:05,840 TRANSDUCTION AND TRANSMISSION OF 2378 01:38:05,840 --> 01:38:11,120 PAIN,ES ESTRADIOL CAN REDUCE 2379 01:38:11,120 --> 01:38:19,880 INFLAMMATION, CENTRALLY TARGETED 2380 01:38:19,880 --> 01:38:21,360 TREATMENTS THAT PROMOTE 2381 01:38:21,360 --> 01:38:23,600 DESCENDING INHIBITION, ALL THE 2382 01:38:23,600 --> 01:38:28,680 WOMEN WERE FIRST GIVEN TOPICAL 2383 01:38:28,680 --> 01:38:32,720 LIDOCAINE TREATMENT AND THOSE 2384 01:38:32,720 --> 01:38:34,640 WHO DIDN'T RESPOND MOVED TO THE 2385 01:38:34,640 --> 01:38:37,160 CENTRALLY TARGETED TREATMENT. 2386 01:38:37,160 --> 01:38:40,600 WHAT WE FOUND WAS THAT TOPICAL 2387 01:38:40,600 --> 01:38:41,880 TREATMENTS ALLEVIATED PAIN IN 2388 01:38:41,880 --> 01:38:46,520 65% OF WOMEN WITH LOCALIZED VBD, 2389 01:38:46,520 --> 01:38:50,720 ONLY AS SMALL AS 36% OF WOMEN 2390 01:38:50,720 --> 01:38:51,840 WITH OVERLAPPING PAIN. 2391 01:38:51,840 --> 01:38:55,040 OF THOSE THAT FAILED TO RESPOND, 2392 01:38:55,040 --> 01:38:58,120 TO THE PERIPHERALLY TARGETED 2393 01:38:58,120 --> 01:39:16,760 TREATMENT, CENTRALLY ACTING 2394 01:39:16,760 --> 01:39:17,840 TRICYCLIC SSRIS, SUGGESTING 2395 01:39:17,840 --> 01:39:18,960 RESPONSE CENTRAL TARGETED 2396 01:39:18,960 --> 01:39:19,240 TREATMENT. 2397 01:39:19,240 --> 01:39:21,120 I DIDN'T PRESS THAT BUTTON SO 2398 01:39:21,120 --> 01:39:25,240 YOU CAN SEE THE GRAPH. 2399 01:39:25,240 --> 01:39:28,720 SO IN SUM FROM THIS PART OF THE 2400 01:39:28,720 --> 01:39:31,240 TALK WE HAVE DETERMINED THAT 2401 01:39:31,240 --> 01:39:32,160 WOMEN WITH OVERLAPPING PAINS 2402 01:39:32,160 --> 01:39:37,520 COMPARED TO THOSE WITH VBD HAVE 2403 01:39:37,520 --> 01:39:38,600 WIDESPREAD CENTRAL 2404 01:39:38,600 --> 01:39:39,880 SENSITIZATION, SUCH THAT THEY 2405 01:39:39,880 --> 01:39:45,360 HAVE GREATER PAIN AT THE SITE OF 2406 01:39:45,360 --> 01:39:46,960 CHIEF COMPLAINT, WIND UP AT 2407 01:39:46,960 --> 01:39:50,000 SITES REMOTE FROM THE SITE OF 2408 01:39:50,000 --> 01:39:52,080 CHIEF COMPLAINT, AND POOR AFFECT 2409 01:39:52,080 --> 01:39:56,040 AND PERCEIVED HEALTH. 2410 01:39:56,040 --> 01:40:01,040 TWO SUBTYPES, WOMEN WITH VBD 2411 01:40:01,040 --> 01:40:06,680 ALONE HAVE INCREASED LEVELS OF 2412 01:40:06,680 --> 01:40:17,440 IL-8 AND IR 1RA. 2413 01:40:17,440 --> 01:40:20,600 THOSE WITH COPCs HAVE 2414 01:40:20,600 --> 01:40:23,880 DYSREGULATION LINKED TO IMMUNE 2415 01:40:23,880 --> 01:40:24,160 FUNCTION. 2416 01:40:24,160 --> 01:40:25,520 OUR EARLY PILOT DATA SUGGESTS 2417 01:40:25,520 --> 01:40:27,400 THESE WOMEN MAY BENEFIT FROM 2418 01:40:27,400 --> 01:40:30,080 DIFFERENT TYPES OF TREATMENT. 2419 01:40:30,080 --> 01:40:32,840 REALLY WE NEED LARGER CONTROLLED 2420 01:40:32,840 --> 01:40:34,720 TRIALS TO DETERMINE OPTIMAL 2421 01:40:34,720 --> 01:40:36,400 TREATMENT STRATEGIES FOR THESE 2422 01:40:36,400 --> 01:40:39,880 AND POSSIBLY OTHER SUBTYPES. 2423 01:40:39,880 --> 01:40:43,240 SO THIS LEADS ME TO THE FINAL 2424 01:40:43,240 --> 01:40:46,080 SEGMENT OF MY TALK, WHERE I'D 2425 01:40:46,080 --> 01:40:56,240 LIKE TO SHARE OUR ONGOING 2426 01:40:56,240 --> 01:40:58,880 EFFORTS THROUGH THIS 2427 01:40:58,880 --> 01:40:59,240 COLLABORATION. 2428 01:40:59,240 --> 01:41:04,120 WE'RE CONDUCTING A CLINICAL 2429 01:41:04,120 --> 01:41:05,000 TRIAL FOR VESTIBULODYNIA, 2430 01:41:05,000 --> 01:41:06,760 UNDERSTANDING PATHOPHYSIOLOGY 2431 01:41:06,760 --> 01:41:10,240 AND DETERMINING APPROPRIATE 2432 01:41:10,240 --> 01:41:11,320 TREATMENT, THE UPDATE STUDY, 2433 01:41:11,320 --> 01:41:13,600 CONNECTIONING THIS IN AN EFFORT 2434 01:41:13,600 --> 01:41:15,400 TO GUIDE OPTIMAL TREATMENT 2435 01:41:15,400 --> 01:41:16,840 STRATEGIES IN AND EVIDENCE-BASED 2436 01:41:16,840 --> 01:41:17,040 WAY. 2437 01:41:17,040 --> 01:41:21,120 AND SO THE PURPOSE IS TO FIRST 2438 01:41:21,120 --> 01:41:24,080 COMPARE THE EFFICACY OF 2439 01:41:24,080 --> 01:41:25,400 PERIPHERAL LIDOCAINE AND 2440 01:41:25,400 --> 01:41:26,600 ESTRADIOL TREATMENT, CENTRALLY 2441 01:41:26,600 --> 01:41:29,760 TARGETED TREATMENTS OR COMBINED 2442 01:41:29,760 --> 01:41:31,600 TREATMENTS, ALLEVIATING PAIN AND 2443 01:41:31,600 --> 01:41:36,840 IMPROVING PATIENT OUTCOMES AND 2444 01:41:36,840 --> 01:41:39,240 NORMALIZING CYTOKINES AND RNAs 2445 01:41:39,240 --> 01:41:45,600 HOPING TO DETERMINE BIOMARKERS 2446 01:41:45,600 --> 01:41:48,320 IN THE SUBTYPES. 2447 01:41:48,320 --> 01:41:52,240 WE'RE ENROLLING FEMALES AGE 18 2448 01:41:52,240 --> 01:41:54,040 TO 50, WITH VAGINAL PAIN FOR 2449 01:41:54,040 --> 01:41:57,320 THREE MONTHS. 2450 01:41:57,320 --> 01:41:58,200 WE PLAN TO ENROLL 400 WOMEN, 200 2451 01:41:58,200 --> 01:42:01,320 AT EACH OF THE TWO SITES FOR 2452 01:42:01,320 --> 01:42:02,120 24-WEEK STUDY. 2453 01:42:02,120 --> 01:42:06,960 PARTICIPANTS WILL BE ASSIGNED TO 2454 01:42:06,960 --> 01:42:09,400 RECEIVE EITHER COMBINED 2455 01:42:09,400 --> 01:42:12,440 COMPOUNDED LIDOCAINE ESTRADIOL 2456 01:42:12,440 --> 01:42:15,320 CREAM WITH PLACEBO PILL, PLACEBO 2457 01:42:15,320 --> 01:42:22,080 CREAM WITH ACTIVE PILL, 2458 01:42:22,080 --> 01:42:25,120 ACTIVE-ACTIVE OR PLACEBO-PLACEBO 2459 01:42:25,120 --> 01:42:25,400 TREATMENT. 2460 01:42:25,400 --> 01:42:27,080 PARTICIPATION INCLUDES FOUR 2461 01:42:27,080 --> 01:42:30,120 STUDY VISITS TO EVALUATE VBD AND 2462 01:42:30,120 --> 01:42:32,440 OVERLAPPING PAIN TO MEASURE PAIN 2463 01:42:32,440 --> 01:42:34,720 AND SELF-REPORTED HEALTH, AND 2464 01:42:34,720 --> 01:42:37,720 ALSO TO PLOT BIOLOGIC SAMPLES, 2465 01:42:37,720 --> 01:42:40,840 INCLUDING LOCAL AS WELL AS 2466 01:42:40,840 --> 01:42:42,600 CIRCULATING BLOOD. 2467 01:42:42,600 --> 01:42:43,560 >> ONE MINUTE LEFT. 2468 01:42:43,560 --> 01:42:43,800 SORRY. 2469 01:42:43,800 --> 01:42:44,120 >> OKAY. 2470 01:42:44,120 --> 01:42:48,520 I'M ALMOST TO THE END. 2471 01:42:48,520 --> 01:42:52,880 SO THIS WILL INCLUDE DATA AND 2472 01:42:52,880 --> 01:42:58,560 SAMPLES INCLUDED, COLLECTED AT 8 2473 01:42:58,560 --> 01:43:00,600 WEEKS, 16 WEEKS, AND WEEKS AFTER 2474 01:43:00,600 --> 01:43:02,280 TREATMENT IS DISCONTINUED. 2475 01:43:02,280 --> 01:43:05,760 WE'LL BE MEASURING A NUMBER OF 2476 01:43:05,760 --> 01:43:09,600 PRIMARY AND SECONDARY VARIABLES, 2477 01:43:09,600 --> 01:43:15,360 WHICH ARE SHOWN HERE, INCLUDING 2478 01:43:15,360 --> 01:43:18,720 PAIN, EXPERIMENTAL PAIN, 2479 01:43:18,720 --> 01:43:20,680 SELF-REPORTED PAIN, 2480 01:43:20,680 --> 01:43:22,240 PSYCHOLOGICAL MOOD, OTHER 2481 01:43:22,240 --> 01:43:26,240 SELF-REPORTED HEALTH VARIABLES, 2482 01:43:26,240 --> 01:43:27,400 AND IMPORTANTLY BIOMARKERS, 2483 01:43:27,400 --> 01:43:29,880 COLLECTED AGAIN AT FOUR TIME 2484 01:43:29,880 --> 01:43:32,240 POINT, I THINK THIS IS PRETTY 2485 01:43:32,240 --> 01:43:32,520 POWERFUL. 2486 01:43:32,520 --> 01:43:36,360 AND SO IN THE INTEREST OF TIME 2487 01:43:36,360 --> 01:43:38,280 I'LL JUST HIGHLIGHT THAT 2488 01:43:38,280 --> 01:43:39,280 ENROLLMENT IS ONGOING AND IF 2489 01:43:39,280 --> 01:43:41,480 YOU'D LIKE TO LEARN MORE OR 2490 01:43:41,480 --> 01:43:42,920 REFER A PARTICIPANT OUR WAY, YOU 2491 01:43:42,920 --> 01:43:48,400 CAN CHECK OUT THE WEBSITE, OR 2492 01:43:48,400 --> 01:43:53,720 CHECK US OUT ON FACEBOOK OR 2493 01:43:53,720 --> 01:43:54,000 INSTAGRAM. 2494 01:43:54,000 --> 01:43:56,040 IN CONCLUSION, I'D LIKE TO 2495 01:43:56,040 --> 01:44:00,840 HIGHLIGHT THAT WOMEN WITH 2496 01:44:00,840 --> 01:44:07,200 LOCALIZED VBD EXHIBIT MODERATE 2497 01:44:07,200 --> 01:44:08,880 PERIPHERAL SENSITIZATION, AND 2498 01:44:08,880 --> 01:44:10,120 MAY BENEFIT FROM PERIPHERALLY 2499 01:44:10,120 --> 01:44:13,600 TARGETED THERAPIES. 2500 01:44:13,600 --> 01:44:16,680 NOT ONLY PHARMACOLOGIC BUT ALSO 2501 01:44:16,680 --> 01:44:19,840 SUCH AS PHYSICAL THERAPY. 2502 01:44:19,840 --> 01:44:22,120 THESE WOMEN, THEIR PAIN MAY STAY 2503 01:44:22,120 --> 01:44:24,720 THE SAME OR WORSEN, SUSTAINED 2504 01:44:24,720 --> 01:44:25,520 PERIPHERAL INFLAMMATION IN THE 2505 01:44:25,520 --> 01:44:28,600 CASE OF THOSE WHERE THE PAIN 2506 01:44:28,600 --> 01:44:30,320 WORSENED COULD RESULT IN 2507 01:44:30,320 --> 01:44:35,240 AMPLIFIED CENTRAL RESPONSES TO 2508 01:44:35,240 --> 01:44:36,640 PERIPHERAL STIMULI. 2509 01:44:36,640 --> 01:44:38,440 SO WOMEN WITH VBD ARE AT RISK 2510 01:44:38,440 --> 01:44:39,520 FOR OTHER CHRONIC PAIN 2511 01:44:39,520 --> 01:44:40,640 CONDITIONS AND HEALTH DISORDERS 2512 01:44:40,640 --> 01:44:44,640 THAT AFFECT OTHER BODY SITES 2513 01:44:44,640 --> 01:44:48,600 AND SYSTEMS. 2514 01:44:48,600 --> 01:44:51,360 IT'S IMPERATIVE WE EXPLORE 2515 01:44:51,360 --> 01:44:53,400 BEYOND THE PELVIS AND LOOK AT 2516 01:44:53,400 --> 01:44:54,000 OTHER HEALTH CONDITIONS ASIDE 2517 01:44:54,000 --> 01:44:55,040 FROM JUST PAIN. 2518 01:44:55,040 --> 01:45:04,440 WE FOUND WOMEN WITH OVERLAPPING 2519 01:45:04,440 --> 01:45:05,640 PAIN EXHIBIT PERIPHERAL 2520 01:45:05,640 --> 01:45:08,600 SENSITIZATION, SHIFT TO IL-8 2521 01:45:08,600 --> 01:45:10,800 MARKERS, CHANGES IN 2522 01:45:10,800 --> 01:45:13,880 microRNAs LINKED TO PAIN AND 2523 01:45:13,880 --> 01:45:14,360 INFLAMMATION. 2524 01:45:14,360 --> 01:45:16,560 THEY MAY BENEFIT FROM CENTRALLY 2525 01:45:16,560 --> 01:45:18,600 TARGETED OR COMBINED THERAPIES. 2526 01:45:18,600 --> 01:45:20,240 AND ULTIMATELY WHICH OF THESE 2527 01:45:20,240 --> 01:45:22,440 TWO OR MORE PATHS ON WHICH A 2528 01:45:22,440 --> 01:45:25,040 WOMAN FIND HERSELF IS DUE TO 2529 01:45:25,040 --> 01:45:28,880 INTERACTIONS BETWEEN GENETIC AND 2530 01:45:28,880 --> 01:45:30,320 ENVIRONMENTAL FACTORS, WE'RE 2531 01:45:30,320 --> 01:45:33,040 JUST BEGINNING TO SCRATCH THE 2532 01:45:33,040 --> 01:45:34,600 SURFACE, SO HOPEFULLY THROUGH 2533 01:45:34,600 --> 01:45:36,880 OUR WORK AND PARTNERSHIPS WITH 2534 01:45:36,880 --> 01:45:40,680 OTHER COLLEAGUES, WE'LL BE ABLE 2535 01:45:40,680 --> 01:45:42,680 TO IDENTIFY MECHANISMS AND 2536 01:45:42,680 --> 01:45:44,000 TREATMENTS FOR THESE WOMEN. 2537 01:45:44,000 --> 01:45:50,120 WITH THAT I WOULD LIKE TO THANK 2538 01:45:50,120 --> 01:45:53,280 MY COLLEAGUES IN MY LAB AND 2539 01:45:53,280 --> 01:45:58,000 THOSE AT UNC AND UCLA AND 2540 01:45:58,000 --> 01:45:59,000 ESPECIALLY LATE BILL MAIXNER, 2541 01:45:59,000 --> 01:46:02,160 AND I THANK NICHD AND OTHER 2542 01:46:02,160 --> 01:46:03,200 INSTITUTES FOR FUNDING AND I'D 2543 01:46:03,200 --> 01:46:04,640 LIKE TO THANK THE AUDIENCE AND 2544 01:46:04,640 --> 01:46:08,280 TAKE ANY QUESTIONS IF WE HAVE 2545 01:46:08,280 --> 01:46:12,600 TIME. 2546 01:46:12,600 --> 01:46:14,240 2547 01:46:14,240 --> 01:46:15,360 >> THANK YOU, DR. NACKLEY. 2548 01:46:15,360 --> 01:46:21,400 CAN YOU SEE THE CHAT? 2549 01:46:21,400 --> 01:46:23,440 FIRST QUESTION IS FROM JUDY. 2550 01:46:23,440 --> 01:46:27,040 IN THIS MODEL WHAT GROUP DO 2551 01:46:27,040 --> 01:46:29,320 WOMEN WITH GENERALIZE DISCERN 2552 01:46:29,320 --> 01:46:40,440 FALL INTO, VBD WITH COP GROUP? 2553 01:46:40,440 --> 01:46:44,200 >> IN THE INTRODUCTION I POINTED 2554 01:46:44,200 --> 01:46:45,600 OUT HETEROGENEITY IN THE 2555 01:46:45,600 --> 01:46:46,200 POPULATION. 2556 01:46:46,200 --> 01:46:49,880 FOR THE PURPOSE OF THIS STUDY, 2557 01:46:49,880 --> 01:46:52,400 SMALLER STUDY, THAT I PRESENTED 2558 01:46:52,400 --> 01:46:56,640 DATA ON, WE PRIMARILY FOCUSED ON 2559 01:46:56,640 --> 01:47:05,960 THOSE WITH VESTIBULODYNIA ALONE, 2560 01:47:05,960 --> 01:47:10,880 INCLUDING GENERALIZEED PAIN. 2561 01:47:10,880 --> 01:47:13,960 WE FOCUSED ON TMD, FIBROMYALGIA 2562 01:47:13,960 --> 01:47:14,400 AND HEADACHE. 2563 01:47:14,400 --> 01:47:16,120 ONGOING CLINICAL TRIALS WE'LL BE 2564 01:47:16,120 --> 01:47:19,880 ABLE TO LOOK IN A MORE DETAILED 2565 01:47:19,880 --> 01:47:26,440 WAY AT GENERALIZED PAIN AS WELL. 2566 01:47:26,440 --> 01:47:28,000 WE'RE CAPTURING PAIN IN A MORE 2567 01:47:28,000 --> 01:47:45,200 DETAILED WAY. . 2568 01:47:45,200 --> 01:47:49,600 >> CAN YOU SEE THE QUESTION ON 2569 01:47:49,600 --> 01:47:50,040 THE CHAT? 2570 01:47:50,040 --> 01:47:54,600 >> I'VE GOT MY SLIDE OPEN. 2571 01:47:54,600 --> 01:47:54,880 LET'S SEE. 2572 01:47:54,880 --> 01:47:55,760 >> WHERE DOES (INDISCERNIBLE) 2573 01:47:55,760 --> 01:48:07,640 FALL INTO THIS OR IS THAT THIS 2574 01:48:07,640 --> 01:48:09,120 NOT PART OF VDB. 2575 01:48:09,120 --> 01:48:13,760 >> YOU HAVE A PATHOLOGY, THERE 2576 01:48:13,760 --> 01:48:15,360 MIGHT BE SOME LINKS. 2577 01:48:15,360 --> 01:48:17,840 THAT WOULD BE AN EXCLUSIONARY 2578 01:48:17,840 --> 01:48:19,640 CRITERIA FOR PARTICIPATION. 2579 01:48:19,640 --> 01:48:24,440 WE'RE LOOKING MORE AT THIS 2580 01:48:24,440 --> 01:48:30,600 PRIMARY NOCIPLASTIC PAIN, NOT 2581 01:48:30,600 --> 01:48:33,080 PAIN ATTRIBUTABLE TO 2582 01:48:33,080 --> 01:48:33,480 ABNORMALITY. 2583 01:48:33,480 --> 01:48:36,680 >> NEXT QUESTION FROM STEVE 2584 01:48:36,680 --> 01:48:37,640 WALKER. 2585 01:48:37,640 --> 01:48:42,240 WHAT TISSUE WAS THE microRNA 2586 01:48:42,240 --> 01:48:42,840 PERFORMED IN? 2587 01:48:42,840 --> 01:48:43,880 >> THE PROFILING IN THE DATA 2588 01:48:43,880 --> 01:48:47,160 THAT I SHOWED WAS FROM BLOOD, 2589 01:48:47,160 --> 01:48:49,240 THIS IS CIRCULATING 2590 01:48:49,240 --> 01:48:51,320 microRNAs, WE CAN ONLY 2591 01:48:51,320 --> 01:48:55,360 EXTRAPOLATE WHAT WE KNOW ABOUT 2592 01:48:55,360 --> 01:48:56,600 CENTRAL TARGET. 2593 01:48:56,600 --> 01:49:04,280 IN OUR ONGOING STUDY WE'RE 2594 01:49:04,280 --> 01:49:05,600 COLLECTING VAGINAL SWAB SAMPLES 2595 01:49:05,600 --> 01:49:08,440 AND CAPTURING OR COLLECTING 2596 01:49:08,440 --> 01:49:11,320 VAGINAL LAVAGE FLUID TO MEASURE 2597 01:49:11,320 --> 01:49:12,840 LOCAL CYTOKINES. 2598 01:49:12,840 --> 01:49:15,240 AND WE'RE LOOKING AT 2599 01:49:15,240 --> 01:49:16,000 microRNAs AND CYTOKINES 2600 01:49:16,000 --> 01:49:21,760 CIRCULATING IN BLOOD AS WELL. 2601 01:49:21,760 --> 01:49:22,960 >> THANK YOU. 2602 01:49:22,960 --> 01:49:25,920 WE HAVE MORE QUESTIONS IN THE 2603 01:49:25,920 --> 01:49:29,600 CHAT BUT WE WOULD LIKE -- DUE TO 2604 01:49:29,600 --> 01:49:33,800 THE TIME LIMIT WE WOULD LIKE TO 2605 01:49:33,800 --> 01:49:35,520 HAVE THE BREAK NOW. 2606 01:49:35,520 --> 01:49:43,080 SO WE WILL HAVE A BREAK. 2607 01:49:43,080 --> 01:49:46,200 ENJOY YOUR BREAK. 2608 01:49:46,200 --> 01:49:49,280 PLEASE COME BACK AT THREE FIVE. 2609 01:49:49,280 --> 01:49:53,200 LET'S START WITH INTRODUCING DR. 2610 01:49:53,200 --> 01:49:56,280 JERRY LOUDER, ASSOCIATE 2611 01:49:56,280 --> 01:49:58,360 PROFESSOR OF OB/GYN AT 2612 01:49:58,360 --> 01:50:03,760 WASHINGTON UNIVERSITY IN 2613 01:50:03,760 --> 01:50:04,280 ST. LOUIS. 2614 01:50:04,280 --> 01:50:13,320 HE HAS COMPLETE THE FELLOWSHIP 2615 01:50:13,320 --> 01:50:17,000 AT UPMC AND MASTER'S DEGREE, 2616 01:50:17,000 --> 01:50:18,160 CLINICAL RESEARCH, THE 2617 01:50:18,160 --> 01:50:19,640 INSPIRATION FOR AREAS OF 2618 01:50:19,640 --> 01:50:20,920 CLINICAL RESEARCH INTERESTS 2619 01:50:20,920 --> 01:50:22,480 INCLUDING CLINICAL EFFECTIVENESS 2620 01:50:22,480 --> 01:50:25,200 RESEARCH FOCUSING ON THE 2621 01:50:25,200 --> 01:50:29,080 UTILIZATION OF APICAL SUPPORT 2622 01:50:29,080 --> 01:50:41,040 PROCEDURES IN PELVIC ORGAN 2623 01:50:41,040 --> 01:50:42,280 PROLAPSE SURGERY. 2624 01:50:42,280 --> 01:50:44,840 NEXT DR. DIAZ, WHO IS A 2625 01:50:44,840 --> 01:50:46,080 PRINCIPAL RESEARCH SCIENTIST AND 2626 01:50:46,080 --> 01:50:49,560 CO-FOUNDER AT HILL MED, INC., 2627 01:50:49,560 --> 01:50:54,480 UNDERGRADUATE AND Ph.D. 2628 01:50:54,480 --> 01:50:55,880 DEGREES IN BIOMEDICAL 2629 01:50:55,880 --> 01:50:58,280 ENGINEERING, RESEARCH HAS 2630 01:50:58,280 --> 01:50:59,600 UTILIZED NOVEL HIGH DENSITY 2631 01:50:59,600 --> 01:51:00,680 ELECTROPHYSIOLOGIC TOOLS TO 2632 01:51:00,680 --> 01:51:02,120 ASSESS NEURAL PROPERTIES AND 2633 01:51:02,120 --> 01:51:05,720 INNERVATION OF MUSCLES INVOLVED 2634 01:51:05,720 --> 01:51:07,640 IN URINARY, YOU NEED A Ph.D. 2635 01:51:07,640 --> 01:51:10,440 TO SAY ALL THAT. 2636 01:51:10,440 --> 01:51:11,880 CURRENT RESEARCH COMBINES 2637 01:51:11,880 --> 01:51:15,560 MULTI-DISCIPLINARY EXPERIENCE IN 2638 01:51:15,560 --> 01:51:18,840 PELVIC FLOOR ANATOMY AND HIGH 2639 01:51:18,840 --> 01:51:20,840 DENSITY SURFACE EMG TO DEVELOP 2640 01:51:20,840 --> 01:51:34,920 HIGH DENSITY SURFACE EMG AND 2641 01:51:34,920 --> 01:51:41,200 INNERVATION SYSTEM. 2642 01:51:41,200 --> 01:51:45,560 DR. SUSAN EVANS, IN 2643 01:51:45,560 --> 01:51:52,400 COLLABORATION WITH DR. MARK 2644 01:51:52,400 --> 01:51:53,320 HUTCHINSON FOUNDED ALIRA 2645 01:51:53,320 --> 01:51:55,360 BIOTECH, THEY ARE 2646 01:51:55,360 --> 01:51:55,960 COMMERCIALIZING INTRAUTERINE 2647 01:51:55,960 --> 01:51:58,640 NEUROIMMUNE MODULATION TO TREAT 2648 01:51:58,640 --> 01:52:06,880 WIDE RANGE OF CENTRALLY MEDIATED 2649 01:52:06,880 --> 01:52:17,480 NEUROIMMUNE SYSTEMS IN WOMEN. 2650 01:52:17,480 --> 01:52:22,040 WE WELCOME AND THANK ALL THREE. 2651 01:52:22,040 --> 01:52:26,520 DR. LOWDEW, IT'S YOUR SHOW. 2652 01:52:26,520 --> 01:52:26,880 >> EXCELLENT. 2653 01:52:26,880 --> 01:52:27,280 GOOD AFTERNOON. 2654 01:52:27,280 --> 01:52:31,520 I'D LIKE TO THANK THE NIH FOR 2655 01:52:31,520 --> 01:52:34,600 INVITING ME TO PARTICIPATE IN 2656 01:52:34,600 --> 01:52:35,760 THIS WEBINAR. 2657 01:52:35,760 --> 01:52:44,720 I'M HONORED TO BE PART OF THIS 2658 01:52:44,720 --> 01:52:45,240 ESTEEMED PANEL. 2659 01:52:45,240 --> 01:52:50,880 SO, THESE ARE MY DISCLOSURES. 2660 01:52:50,880 --> 01:52:55,920 AND TODAY I'D LIKE TO FOCUS ON 2661 01:52:55,920 --> 01:52:56,680 TERMINOLOGY, THEORIES OF 2662 01:52:56,680 --> 01:52:59,160 EPIGENESIS, RELATION WITH PELVIC 2663 01:52:59,160 --> 01:53:00,360 FLOOR DISORDER SYMPTOMS, 2664 01:53:00,360 --> 01:53:03,880 EXAMINATION OF THE PELVIC FLOOR, 2665 01:53:03,880 --> 01:53:06,560 RESULTS OF TREATMENTS FOR 2666 01:53:06,560 --> 01:53:08,440 MYOFASCIAL PAIN AND IMPACT ON 2667 01:53:08,440 --> 01:53:09,160 DISORDER SYMPTOMS. 2668 01:53:09,160 --> 01:53:11,480 MANY TERMS HAVE BEEN USED TO 2669 01:53:11,480 --> 01:53:15,000 DESCRIBE DYSFUNCTION OF THE 2670 01:53:15,000 --> 01:53:20,280 PELVIC FLOOR, MOST CONVEYING 2671 01:53:20,280 --> 01:53:21,880 MUSCLE SPASTICITY AND PAIN. 2672 01:53:21,880 --> 01:53:36,000 A WIDE VARIETY OF TERMS MAY BE 2673 01:53:36,000 --> 01:53:40,480 CONFUSING IN 2005 STANDARDIZED 2674 01:53:40,480 --> 01:53:41,680 TERMINOLOGY WAS PUBLISHED, 2675 01:53:41,680 --> 01:53:43,320 INCLUDING CONTRACTION AND 2676 01:53:43,320 --> 01:53:45,080 RELAXATION WHICH INCLUDE 2677 01:53:45,080 --> 01:53:46,920 VOLUNTARY AND INVOLUNTARY 2678 01:53:46,920 --> 01:53:48,320 COMPONENT. 2679 01:53:48,320 --> 01:53:49,520 FOR EXAMPLE, VOLUNTARY PELVIC 2680 01:53:49,520 --> 01:53:51,720 FLOOR MUSCLE CONTRACTION ON 2681 01:53:51,720 --> 01:53:53,600 DEMAND, CLASSIFIED AS STRONG, 2682 01:53:53,600 --> 01:53:55,880 NORMAL, WEAK, ABSENT. 2683 01:53:55,880 --> 01:54:00,120 INVOLUNTARY PELVIC FLOOR MUSCLE 2684 01:54:00,120 --> 01:54:02,840 RELAXATION WHEN STRANGE WITH 2685 01:54:02,840 --> 01:54:04,080 DEFECATION, CLASSIFIED AS A 2686 01:54:04,080 --> 01:54:07,040 ABSENT OR PRESENT. 2687 01:54:07,040 --> 01:54:10,800 DYSFUNCTION NON-CONTRACTING, 2688 01:54:10,800 --> 01:54:12,480 NON-RELAXING, NON-CONTRACTING 2689 01:54:12,480 --> 01:54:13,880 NON-RELAXING. 2690 01:54:13,880 --> 01:54:15,760 THEY DEFINED CONDITIONS WHICH 2691 01:54:15,760 --> 01:54:18,480 REQUIRES CHARACTERISTICS 2692 01:54:18,480 --> 01:54:21,320 SYMPTOMS AND SIGNS, NORMAL WHERE 2693 01:54:21,320 --> 01:54:22,960 VOLUNTARY AND INVOLUNTARY 2694 01:54:22,960 --> 01:54:27,880 CONTRACTION AND RELAXATION ARE 2695 01:54:27,880 --> 01:54:29,000 PRESENT. 2696 01:54:29,000 --> 01:54:32,800 OVERACTIVE DO NOT RELAX OR 2697 01:54:32,800 --> 01:54:47,480 CONTRACT WHEN RELAXATION IS 2698 01:54:47,480 --> 01:54:48,680 NEEDED. 2699 01:54:48,680 --> 01:54:50,680 NON-FUNCTIONING HAVE NO PALPABLE 2700 01:54:50,680 --> 01:55:04,480 MUSCLE ACTION, WOULD BE 2701 01:55:04,480 --> 01:55:05,560 NON-CONTRACTING, NON-RELAXING. 2702 01:55:05,560 --> 01:55:07,280 IN 2017, JOINT REPORT, AUTHORS 2703 01:55:07,280 --> 01:55:09,280 IDENTIFIED NEED FOR EXTENSIVE 2704 01:55:09,280 --> 01:55:12,080 DESCRIPTION OF PELVIC FLOOR 2705 01:55:12,080 --> 01:55:15,160 MUSCLE DYSFUNCTION, SYMPTOMS 2706 01:55:15,160 --> 01:55:17,040 SECTIONS DEFINED MYALGIA AS 2707 01:55:17,040 --> 01:55:19,080 MUSCLE PAIN, MAY BE PRESENT WITH 2708 01:55:19,080 --> 01:55:22,280 OR WITHOUT A CHANGE IN PELVIC 2709 01:55:22,280 --> 01:55:24,680 FLOOR MUSCLE TONE. 2710 01:55:24,680 --> 01:55:25,880 MYOFASCIAL PAIN CAUSED BY 2711 01:55:25,880 --> 01:55:27,720 PRESENCE OF TRIGGER POINTS. 2712 01:55:27,720 --> 01:55:37,280 RELEVANT DIAGNOSIS WAS CHRONIC 2713 01:55:37,280 --> 01:55:52,000 PELVIC FLOOR MYOFASCIAL PAIN 2714 01:55:52,000 --> 01:55:55,160 SYNDROME. 2715 01:55:55,160 --> 01:55:57,280 THERE'S BEEN AN UPDATED 2716 01:55:57,280 --> 01:55:59,040 DOCUMENT. 2717 01:55:59,040 --> 01:56:01,160 THE PATHOGENESIS OF PELVIC FLOOR 2718 01:56:01,160 --> 01:56:05,680 MYOFASCIAL PAIN IS INCLEAR, 2719 01:56:05,680 --> 01:56:10,120 PRIOR PRESENTER SET THE STAGE, 2720 01:56:10,120 --> 01:56:11,240 INCLUDING MICROTRAUMA, 2721 01:56:11,240 --> 01:56:12,080 IMBALANCE, CENTRALIZATION OF 2722 01:56:12,080 --> 01:56:14,600 PAIN, LIKELY WORK IN 2723 01:56:14,600 --> 01:56:15,480 COMBINATION. 2724 01:56:15,480 --> 01:56:17,680 ACUTE TRAUMA OR REPETITIVE 2725 01:56:17,680 --> 01:56:20,680 MICROTRAUMAS CAN LEAD TO CHRONIC 2726 01:56:20,680 --> 01:56:26,080 MUSCLE CONTRACTION, FORMATION OF 2727 01:56:26,080 --> 01:56:27,680 TRIGGER POINTS, METABOLIC 2728 01:56:27,680 --> 01:56:29,640 IMBALANCE BUILDING ELEVATED 2729 01:56:29,640 --> 01:56:30,840 LEVELS OF PAIN-PRODUCING 2730 01:56:30,840 --> 01:56:31,960 COMPOUNDS DEMONSTRATED IN THE 2731 01:56:31,960 --> 01:56:33,480 VICINITY OF TRIGGER POINTS. 2732 01:56:33,480 --> 01:56:35,320 CENTRALIZATION OF PAIN OCCURS 2733 01:56:35,320 --> 01:56:39,360 WHEN THE SENSORY PAIN 2734 01:56:39,360 --> 01:56:41,240 INFLAMMATION IS ABNORMALLY 2735 01:56:41,240 --> 01:56:41,800 PROCESSED, CENTRAL 2736 01:56:41,800 --> 01:56:43,680 SENSITIZATION, APPEARS TO RESULT 2737 01:56:43,680 --> 01:56:47,840 IN PAIN PERPETUATED BY THE CNS. 2738 01:56:47,840 --> 01:56:49,680 WOMEN GENERALLY PRESENT WITH 2739 01:56:49,680 --> 01:56:54,720 PAIN IN THE PELVIS, VAGINA, 2740 01:56:54,720 --> 01:56:57,080 VULVA, RECTUM OR BLADDER. 2741 01:56:57,080 --> 01:57:03,600 ASSOCIATED SYMPTOMS INCLUDE 2742 01:57:03,600 --> 01:57:08,640 ACHING, HEAVINESS, BURNING, OR 2743 01:57:08,640 --> 01:57:09,960 SYMPTOMS OF OVERACTIVE BLADDER, 2744 01:57:09,960 --> 01:57:10,280 CONSTIPATION. 2745 01:57:10,280 --> 01:57:12,120 I'D LIKE TO DISCUSS PELVIC FLOOR 2746 01:57:12,120 --> 01:57:13,680 DISORDER SYMPTOMS IN WOMEN WITH 2747 01:57:13,680 --> 01:57:32,360 PELVIC FLOOR MYOFASCIAL PAIN ON 2748 01:57:32,360 --> 01:57:34,560 PALPATION IT'S A CHRONIC PAIN 2749 01:57:34,560 --> 01:57:36,720 DISORDER, ARISING IN MUSCLE AND 2750 01:57:36,720 --> 01:57:38,840 FASCIA, PATIENTS HAVE CONTRACTED 2751 01:57:38,840 --> 01:57:41,320 BANDS OF SKELETAL MUSCLE, WITHIN 2752 01:57:41,320 --> 01:57:44,960 THESE BANDS DISCRETE PAINFUL 2753 01:57:44,960 --> 01:57:49,000 NODULES, TRIGGER POINTS, TENDER 2754 01:57:49,000 --> 01:57:49,400 POINTS. 2755 01:57:49,400 --> 01:57:50,320 PALPATION PRODUCES LOCAL AND 2756 01:57:50,320 --> 01:57:53,920 REFERRED PAIN, ACTIVE OR LATENT. 2757 01:57:53,920 --> 01:57:55,400 LATENT TRIGGER POINTS ARE TENDER 2758 01:57:55,400 --> 01:57:57,320 WHEN PALPATED. 2759 01:57:57,320 --> 01:58:00,560 THEY CAN REMAIN LATENT FOR YEARS 2760 01:58:00,560 --> 01:58:00,960 UNTIL REACTIVATED. 2761 01:58:00,960 --> 01:58:05,320 WHEN FIRM PRESSURE IS APPLIED 2762 01:58:05,320 --> 01:58:06,560 PATIENTS MAY HAVE AUTONOMIC 2763 01:58:06,560 --> 01:58:08,320 SYMPTOMS, PAIN IS DESCRIBED IN 2764 01:58:08,320 --> 01:58:11,120 THE NECK, UPPER BACK, FACE AND 2765 01:58:11,120 --> 01:58:13,960 JAW, IN THE PELVIS MYOFASCIAL 2766 01:58:13,960 --> 01:58:15,760 PAIN OFTEN ARISESES IN MUSCLES 2767 01:58:15,760 --> 01:58:20,240 AND CONNECTIVE TISSUE OF HIP, 2768 01:58:20,240 --> 01:58:27,720 AND HAS BEEN DESCRIBED IN THE 2769 01:58:27,720 --> 01:58:51,280 COXIGEUOS AND PYRAFORMIS. 2770 01:58:51,280 --> 01:59:01,200 I'D LIKE TO TOUCH ON THE 2771 01:59:01,200 --> 01:59:01,520 HYPERTONICITY. 2772 01:59:01,520 --> 01:59:02,920 CLINICALLY WE ADD ANATOMIC 2773 01:59:02,920 --> 01:59:08,880 PROXIMITY, SO WHILE CENTRAL 2774 01:59:08,880 --> 01:59:09,600 SENSITIZATION UNDERLIES PAIN 2775 01:59:09,600 --> 01:59:12,520 DISORDERS, LARGE DRIVER OF THE 2776 01:59:12,520 --> 01:59:19,920 FINDING OF PELVIC FLOOR 2777 01:59:19,920 --> 01:59:22,280 MYOFASCIAL PAIN, CONVERGENCE MAY 2778 01:59:22,280 --> 01:59:23,920 EXPLAIN RELATIONSHIP BETWEEN 2779 01:59:23,920 --> 01:59:25,080 PELVIC FLOOR MYOFASCIAL PAIN AND 2780 01:59:25,080 --> 01:59:35,200 SYMPTOMS IN WOMEN WITHOUT 2781 01:59:35,200 --> 01:59:37,080 CHRONIC PELVIC PAIN. 2782 01:59:37,080 --> 01:59:45,680 AFFERENT FIBERS FROM THE PELVIC 2783 01:59:45,680 --> 01:59:48,520 FLOOR MUSCLES, THE SAME DORSAL 2784 01:59:48,520 --> 01:59:50,840 HORN BEFORE ASCENDING FOR 2785 01:59:50,840 --> 01:59:52,560 CORTICAL INTERPRETATION, BECAUSE 2786 01:59:52,560 --> 01:59:55,880 OF PROXIMITY OF FIBERS 2787 01:59:55,880 --> 01:59:56,920 CROSS-TALK CAN LEAD TO 2788 01:59:56,920 --> 02:00:01,320 PERCEPTION OF PAIN FROM ONE OR 2789 02:00:01,320 --> 02:00:02,120 BOTH STRUCTURES. 2790 02:00:02,120 --> 02:00:04,320 ANATOMIC PROXIMITY MAY EXPLAIN 2791 02:00:04,320 --> 02:00:05,440 CONCURRENT SYMPTOMS, WITH 2792 02:00:05,440 --> 02:00:07,680 BLADDER FILLING, BLADDER COMES 2793 02:00:07,680 --> 02:00:10,960 TO REST ON THE MUSCLES, ONE 2794 02:00:10,960 --> 02:00:12,800 COULD IMAGINE THE TRIGGER POINTS 2795 02:00:12,800 --> 02:00:17,800 OR TINDER POINTS WHICH WE CAN 2796 02:00:17,800 --> 02:00:18,880 PALPATE AND ACTIVATE 2797 02:00:18,880 --> 02:00:20,080 TRANSVAGINAL PALPATION COULD BE 2798 02:00:20,080 --> 02:00:22,040 ACTIVATED WHEN THE BLADDER COMES 2799 02:00:22,040 --> 02:00:22,920 IN CONTACT LEADING TO 2800 02:00:22,920 --> 02:00:25,600 STIMULATION OF THE TRIGGER 2801 02:00:25,600 --> 02:00:27,440 POINTS WHICH MAY MANIFEST AS 2802 02:00:27,440 --> 02:00:29,320 PAIN WITH BLADDER FILLING, OR 2803 02:00:29,320 --> 02:00:43,960 SENSATION OF URGENCY OR 2804 02:00:43,960 --> 02:00:44,280 FREQUENCY. 2805 02:00:44,280 --> 02:00:46,560 MUSCLE ACTIVATION WITH FULL 2806 02:00:46,560 --> 02:00:47,800 BLADDER COULD ACTIVATE TRIGGER 2807 02:00:47,800 --> 02:00:51,280 POINTS IF PRESENT. 2808 02:00:51,280 --> 02:00:54,120 PREVALENCE ESTIMATES FOR PAIN 2809 02:00:54,120 --> 02:00:57,280 VARY WIDELY IN LITERATURE 2810 02:00:57,280 --> 02:01:01,520 DEPENDING ON POPULATION STUDIED, 2811 02:01:01,520 --> 02:01:04,080 FROM 17% OF PAIN-FREE PATIENTS, 2812 02:01:04,080 --> 02:01:08,880 TO AS HIGH AS 87% IN POPULATION 2813 02:01:08,880 --> 02:01:16,240 OF PATIENTS WITH INTERSTITIAL 2814 02:01:16,240 --> 02:01:17,720 CYSTITIS, MANY CONTRIBUTORS TO 2815 02:01:17,720 --> 02:01:18,600 DATA. 2816 02:01:18,600 --> 02:01:20,680 DYSFUNCTION IS BEING RECOGNIZED 2817 02:01:20,680 --> 02:01:22,320 IN SIGNIFICANT PROPORTION OF 2818 02:01:22,320 --> 02:01:24,040 PATIENTS PRESENTING FOR 2819 02:01:24,040 --> 02:01:25,920 EVALUATION OF OTHER NON-PAIN 2820 02:01:25,920 --> 02:01:27,800 PELVIC FLOOR DISORDERS, APPEARS 2821 02:01:27,800 --> 02:01:37,000 TO INFLUENCE SEVERITY OF THEIR 2822 02:01:37,000 --> 02:01:44,120 SYMPTOMS. 2823 02:01:44,120 --> 02:01:46,280 THESE PATIENTS REPORTED GREATER 2824 02:01:46,280 --> 02:01:50,240 SYMPTOMS RELATED TO PROLAPSE, 2825 02:01:50,240 --> 02:01:51,840 URINARY SYMPTOMS COMPARED TO 2826 02:01:51,840 --> 02:01:55,680 PATIENTS WHO DID NOT HAVE 2827 02:01:55,680 --> 02:01:56,560 LEVATOR MYALGIA. 2828 02:01:56,560 --> 02:02:00,040 PATIENTS REFERRED TO ANOTHER 2829 02:02:00,040 --> 02:02:01,440 UNIVERSITY-BASED PROGRAM, PAIN 2830 02:02:01,440 --> 02:02:03,520 WAS FOUND IN 32%, THESE PATIENTS 2831 02:02:03,520 --> 02:02:06,680 HAD A GREATER DEGREE OF SYMPTOM 2832 02:02:06,680 --> 02:02:13,880 DESPITE LOWER IMMUNE STAGE OF 2833 02:02:13,880 --> 02:02:15,240 PROLAPSE WITHOUT PAIN, DRIVING 2834 02:02:15,240 --> 02:02:19,600 THE SYMPTOMS IN THIS GROUP. 2835 02:02:19,600 --> 02:02:22,240 THE STUDY, WE HAD SIMILAR 2836 02:02:22,240 --> 02:02:23,080 FINDINGS, PELVIC FLOOR 2837 02:02:23,080 --> 02:02:30,440 MYOFASCIAL PAIN WAS HIGHLY 2838 02:02:30,440 --> 02:02:32,400 PREVALENT, AND PAIN SCORE 2839 02:02:32,400 --> 02:02:34,280 DISTRIBUTIONS WERE EXAMINED IN 2840 02:02:34,280 --> 02:02:36,400 THE FULL SAMPLE, STRATIFIED BY 2841 02:02:36,400 --> 02:02:41,000 PAIN AS PRESENTING COMPLAIN 2842 02:02:41,000 --> 02:02:43,360 USING BOX PLOTS, LEFT SIDE 2843 02:02:43,360 --> 02:02:47,080 REPRESENTS WITHOUT PAIN AS CHIEF 2844 02:02:47,080 --> 02:02:47,680 COMPLAINT. 2845 02:02:47,680 --> 02:02:51,440 WOMEN WITHOUT COMPLAINT HAD MEAN 2846 02:02:51,440 --> 02:02:52,480 PELVIC PAIN SCORES ONE POINT 2847 02:02:52,480 --> 02:03:00,040 LOWER THAN WITH CHIEF COMPLAINT 2848 02:03:00,040 --> 02:03:00,800 OF PAIN. 2849 02:03:00,800 --> 02:03:02,240 PAIN WITH PALPATION IS COMMON 2850 02:03:02,240 --> 02:03:03,520 AND SHOULD BE SCREENED FOR AS 2851 02:03:03,520 --> 02:03:18,720 MAYBE PLAYING A ROLE IN OTHER 2852 02:03:18,720 --> 02:03:20,880 PELVIC FLOOR SYMPTOMS. 2853 02:03:20,880 --> 02:03:25,520 HERE WE LOOKED AT CORRELATION. 2854 02:03:25,520 --> 02:03:28,080 OF NOTE ONLY 27% OF THIS SAMPLE 2855 02:03:28,080 --> 02:03:32,840 HAD STAGE 2 OR GREATER PROLAPSE 2856 02:03:32,840 --> 02:03:36,000 OF THE ORGAN PROLAPSE 2857 02:03:36,000 --> 02:03:37,200 QUANTIFICATION EXAM, MAJORITY 2858 02:03:37,200 --> 02:03:43,160 HAD STAGE ZERO OR 1 SUPPORT AND 2859 02:03:43,160 --> 02:03:43,720 SHOULD BE ASYMPTOMATIC, 2860 02:03:43,720 --> 02:03:47,360 CORRELATED WITH PRESSURE AND 2861 02:03:47,360 --> 02:04:06,280 LOWER ABDOMEN, PELVIC HEAVINESS, 2862 02:04:06,280 --> 02:04:08,680 HAVING TO PUSH. 2863 02:04:08,680 --> 02:04:10,520 THE CONVERSE, WE CREATED 2864 02:04:10,520 --> 02:04:12,720 OBJECTIVE SYMPTOM SUMMARY SCORE 2865 02:04:12,720 --> 02:04:13,520 INCLUDING QUESTIONS RELATED TO 2866 02:04:13,520 --> 02:04:19,280 BULGE SEEN OR FELT, NEED TO PUSH 2867 02:04:19,280 --> 02:04:21,840 TO COMPLETE URINATION, 2868 02:04:21,840 --> 02:04:25,080 CORRELATED WITH LEADING EDGE BUT 2869 02:04:25,080 --> 02:04:28,680 NOT PELVIC FLOOR MYOFASCIAL PAIN 2870 02:04:28,680 --> 02:04:29,480 SEVERITY. 2871 02:04:29,480 --> 02:04:32,520 SEVERITY EACH SIDE EXAMINED 2872 02:04:32,520 --> 02:04:33,640 OVERALL WAS SIGNIFICANTLY 2873 02:04:33,640 --> 02:04:35,600 CORRELATED WITH TOTAL SCORE AS 2874 02:04:35,600 --> 02:04:36,840 WELL AS SUBJECTIVE SUMMARY 2875 02:04:36,840 --> 02:04:39,480 SCORE, WE FOUND SIMILAR FINDINGS 2876 02:04:39,480 --> 02:04:41,720 WITH LOWER URINARY TRACT 2877 02:04:41,720 --> 02:04:45,080 SYMPTOMS, ASSESSED BY URINARY 2878 02:04:45,080 --> 02:04:45,880 DISTRESS INVENTORY SIX SCALE. 2879 02:04:45,880 --> 02:04:48,760 WE FOUND NOT ONLY DO WE SEE 2880 02:04:48,760 --> 02:04:50,480 ASSOCIATION BETWEEN PRESENCE OF 2881 02:04:50,480 --> 02:04:52,680 PELVIC FLOOR MYOFASCIAL PAIN AND 2882 02:04:52,680 --> 02:04:54,520 SYMPTOMS, WE ALSO FOUND 2883 02:04:54,520 --> 02:04:55,760 SIGNIFICANT CORRELATION BETWEEN 2884 02:04:55,760 --> 02:04:58,560 SEVERITY OF PELVIC FLOOR 2885 02:04:58,560 --> 02:04:59,800 MYOFASCIAL PAIN, ON EXAMINATION, 2886 02:04:59,800 --> 02:05:01,880 AND DEGREE OF PELVIC FLOOR 2887 02:05:01,880 --> 02:05:05,280 SYMPTOM SUCH AS THOSE WITH MORE 2888 02:05:05,280 --> 02:05:06,680 SEVERE PELVIC PAIN REPORTED 2889 02:05:06,680 --> 02:05:14,480 GREATER SYMPTOM BOTHER FROM 2890 02:05:14,480 --> 02:05:20,840 THESE PELVIC FLOOR SYMPTOMS. 2891 02:05:20,840 --> 02:05:25,280 WE DEVELOPED A PROTOCOL TO 2892 02:05:25,280 --> 02:05:25,880 ASSESS THIS. 2893 02:05:25,880 --> 02:05:26,920 IMPORTANT COMPONENTS INCLUDING 2894 02:05:26,920 --> 02:05:28,600 ORIENTING PATIENT TO PRESSURE 2895 02:05:28,600 --> 02:05:30,240 THAT WE APPLIED INTERNALLY AT 2896 02:05:30,240 --> 02:05:33,920 FIRST OR BY FIRST DEMONSTRATING 2897 02:05:33,920 --> 02:05:35,360 EXTERNALLY ON MID-THIGH, 2898 02:05:35,360 --> 02:05:40,280 PROVIDES REFERENCE FOR PRESSURE 2899 02:05:40,280 --> 02:05:42,360 PALPATION AND DEMONSTRATES 2900 02:05:42,360 --> 02:05:45,080 PRESSURE NOT PAIN, USED 2901 02:05:45,080 --> 02:05:47,920 NUMERICAL RATING SCORE TO SCORE 2902 02:05:47,920 --> 02:05:49,600 DEGREE OF COMFORT, AND FOR 2903 02:05:49,600 --> 02:05:52,520 MUSCLE, CENTER OF THE MUSCLE 2904 02:05:52,520 --> 02:05:54,960 BELLY AS PALPATED AND THEN IN 2905 02:05:54,960 --> 02:05:56,200 SWIFT MOTION ALONG THE LENGTH OF 2906 02:05:56,200 --> 02:05:59,920 THE MUSCLE IN DIRECTION OF THE 2907 02:05:59,920 --> 02:06:02,880 ORIENTATION OF THE MUSCLE, EXAM 2908 02:06:02,880 --> 02:06:25,480 STARTS WITH THE RIGHT, LEFT. 2909 02:06:25,480 --> 02:06:26,320 LET'S TRANSITION TO TREATMENT 2910 02:06:26,320 --> 02:06:29,280 STRATEGIES AND MANY OF THESE 2911 02:06:29,280 --> 02:06:31,600 PELVIC FLOOR SYMPTOMS RESOLVE OR 2912 02:06:31,600 --> 02:06:35,400 IMPROVE WHEN PAIN IS ADDRESSED. 2913 02:06:35,400 --> 02:06:37,400 MANY THERAPIES WORK WELL WHEN 2914 02:06:37,400 --> 02:06:39,680 COMBINED, AND PAIN IS OFTEN A 2915 02:06:39,680 --> 02:06:41,520 CHRONIC CONDITION THAT CAN 2916 02:06:41,520 --> 02:06:46,960 MANAGE, BUT MAY FLARE, THEORIZED 2917 02:06:46,960 --> 02:06:48,880 FLARES INVOLVE REACTIVATION EVER 2918 02:06:48,880 --> 02:06:50,840 LATE TRIGGER POINTS. 2919 02:06:50,840 --> 02:06:53,680 I WANT TO FOCUS ON NOVEL 2920 02:06:53,680 --> 02:06:59,240 FINDINGS WITH PELVIC FLOOR P.T. 2921 02:06:59,240 --> 02:07:00,000 TYPE, VAGINAL CRYOTHERAPY 2922 02:07:00,000 --> 02:07:02,680 ALLUDED TO EARLY IN 2923 02:07:02,680 --> 02:07:05,000 PRESENTATIONS, DIFFERING METHODS 2924 02:07:05,000 --> 02:07:05,760 OUT THERE. 2925 02:07:05,760 --> 02:07:10,960 PELVIC FLOOR P.T. IS THE 2926 02:07:10,960 --> 02:07:12,040 CORNERSTONE, MAINSTAY OF 2927 02:07:12,040 --> 02:07:12,760 TREATMENT. 2928 02:07:12,760 --> 02:07:14,640 AGAIN APPROACH IS HIGHLY 2929 02:07:14,640 --> 02:07:17,360 VARIABLE, DEPENDING ON THERAPIST 2930 02:07:17,360 --> 02:07:18,160 TRAINING AND BACKGROUND. 2931 02:07:18,160 --> 02:07:21,680 AND SOME P.T.s, MYOFASCIAL 2932 02:07:21,680 --> 02:07:23,120 RELEASE BASED TECHNIQUE, OTHERS 2933 02:07:23,120 --> 02:07:25,480 USE MOVEMENT BASED, IDENTIFY AND 2934 02:07:25,480 --> 02:07:27,600 TREATMENT MOVEMENT IMPAIRMENT 2935 02:07:27,600 --> 02:07:28,600 DISORDERS. 2936 02:07:28,600 --> 02:07:32,480 STRETCHING OF AFFECTED MUSCLES, 2937 02:07:32,480 --> 02:07:34,480 STRENGTHENING USED BY BOTH, 2938 02:07:34,480 --> 02:07:36,480 SUCCESS VARIES BY THERAPIST 2939 02:07:36,480 --> 02:07:36,720 TRAINING. 2940 02:07:36,720 --> 02:07:42,400 CLINICAL I TELL PATIENTS IF THEY 2941 02:07:42,400 --> 02:07:44,880 ARE DOING KEGEL TO STOP UNTIL 2942 02:07:44,880 --> 02:08:05,120 THEY SEE THEIR P.T. 2943 02:08:05,120 --> 02:08:07,760 TRADITIONAL P.T. CAN IMPROVE 2944 02:08:07,760 --> 02:08:08,080 LEAKAGE. 2945 02:08:08,080 --> 02:08:12,360 THE LESS INFORMATION IS KNOWN, 2946 02:08:12,360 --> 02:08:15,840 SPECIFICALLY TYPES OF P.T. 2947 02:08:15,840 --> 02:08:18,200 A STUDY IN WOMEN WITH OVERACTIVE 2948 02:08:18,200 --> 02:08:21,080 BLADDER AND PAINFUL SYMPTOMS 2949 02:08:21,080 --> 02:08:23,400 WITH OR WITHOUT INCONTINENCE, 2950 02:08:23,400 --> 02:08:26,880 10-WEEK COURSE OF MYOFASCIAL 2951 02:08:26,880 --> 02:08:29,320 RELEASE BASED P.T., STRESS 2952 02:08:29,320 --> 02:08:35,360 INCONTINENCE AND HAD BEEN ON 2953 02:08:35,360 --> 02:08:41,800 ANTICHOLINERGIC MEDICATIONS WERE 2954 02:08:41,800 --> 02:08:42,520 EXCLUDED. 2955 02:08:42,520 --> 02:08:47,160 THERE WAS A SIGNIFICANT DECREASE 2956 02:08:47,160 --> 02:08:52,600 IN TOTAL PFDI 20 SCORES ASSESSED 2957 02:08:52,600 --> 02:08:57,120 AND URINARY SYMPTOMS IN BOTH OAB 2958 02:08:57,120 --> 02:09:01,760 GROUP AND PAINFUL BLADDER GROUP. 2959 02:09:01,760 --> 02:09:04,120 BOTHER IMPROVES WITH MYOFASCIAL 2960 02:09:04,120 --> 02:09:06,760 RELEASE BASED P.T., FOCUSING ON 2961 02:09:06,760 --> 02:09:08,320 MYOFASCIAL PAIN AND DYSFUNCTION, 2962 02:09:08,320 --> 02:09:13,040 NOT SIMPLY STRENGTHENING OF THE 2963 02:09:13,040 --> 02:09:13,320 MUSCLES. 2964 02:09:13,320 --> 02:09:17,280 THE PELVIC FLOOR P.T.s USE OF 2965 02:09:17,280 --> 02:09:24,920 AT OUR INSTITUTION UTILIZE 2966 02:09:24,920 --> 02:09:26,080 MOVEMENT BASED. 2967 02:09:26,080 --> 02:09:31,560 SCORES OF 4 OR GREATER OUT OF 2968 02:09:31,560 --> 02:09:33,360 10, TWO OR MORE SITES, REFERRAL 2969 02:09:33,360 --> 02:09:35,480 WAS SPECIFICALLY WRITTEN TO 2970 02:09:35,480 --> 02:09:37,520 ADDRESS PELVIC FLOOR MUSCLE 2971 02:09:37,520 --> 02:09:40,280 DYSFUNCTION, NOT URINARY 2972 02:09:40,280 --> 02:09:40,600 INCONTINENCE. 2973 02:09:40,600 --> 02:09:45,320 OUTCOME WAS CHANGED IN THE 2974 02:09:45,320 --> 02:09:45,720 INVENTORY. 2975 02:09:45,720 --> 02:09:48,560 BASELINE NO DIFFERENCE IN TOTAL 2976 02:09:48,560 --> 02:09:50,440 OR SUBSCALE SCORES BETWEEN WOMEN 2977 02:09:50,440 --> 02:09:52,560 WHO DID OR DID NOT ATTEND P.T. 2978 02:09:52,560 --> 02:09:54,440 WOMEN WHO DID ATTEND MOVEMENT 2979 02:09:54,440 --> 02:09:59,320 BASED P.T. THERE WAS SIGNIFICANT 2980 02:09:59,320 --> 02:10:03,320 IMPROVEMENT COMPARED TO WOMEN 2981 02:10:03,320 --> 02:10:05,320 WHO DID NOT ATTEND. 2982 02:10:05,320 --> 02:10:07,600 THERE WAS SIGNIFICANT DECREASE 2983 02:10:07,600 --> 02:10:10,640 IN MEAN CHANGE OF TOTAL AND 2984 02:10:10,640 --> 02:10:12,680 SUBSCALES OF THE UVI. 2985 02:10:12,680 --> 02:10:14,040 REPORTING MYOFASCIAL PAIN WITH 2986 02:10:14,040 --> 02:10:15,800 PALPATION SCORES, WOMEN WHO 2987 02:10:15,800 --> 02:10:17,840 ATTENDED PELVIC FLOOR P.T., 2988 02:10:17,840 --> 02:10:20,240 DECREASE IN PAIN SCORES IN ALL 2989 02:10:20,240 --> 02:10:25,600 MUSCLE GROUPS SHOWING 2990 02:10:25,600 --> 02:10:27,120 SIGNIFICANT CHANGE. 2991 02:10:27,120 --> 02:10:30,840 URINARY SYMPTOMS AND BOTHER 2992 02:10:30,840 --> 02:10:32,440 SYMPTOMS WITH MOVEMENT-BASED 2993 02:10:32,440 --> 02:10:32,880 P.T. IMPROVED. 2994 02:10:32,880 --> 02:10:37,200 AGAIN, THIS WAS P.T. FOCUSED ON 2995 02:10:37,200 --> 02:10:40,880 MUSCLE DYSFUNCTION, NOT JUST 2996 02:10:40,880 --> 02:10:41,200 STRENGTHENING. 2997 02:10:41,200 --> 02:10:45,360 P.T.S AT OUR INSTITUTION HAVE 2998 02:10:45,360 --> 02:10:46,520 BEEN USING CONCOMITANT VAGINAL 2999 02:10:46,520 --> 02:10:47,360 CRYOTHERAPY. 3000 02:10:47,360 --> 02:10:48,960 PATIENTS HAD TO WAIT SIX WEEKS 3001 02:10:48,960 --> 02:10:51,320 TO SEE P.T. 3002 02:10:51,320 --> 02:10:53,840 WE BEGAN INITIATING VAGINAL 3003 02:10:53,840 --> 02:10:55,080 CRYOTHERAPY CLINICALLY, PRIOR TO 3004 02:10:55,080 --> 02:10:58,480 PATIENTS GETTING IN TO SEE THE 3005 02:10:58,480 --> 02:10:59,480 PHYSICAL THERAPIST, REPORTING 3006 02:10:59,480 --> 02:11:02,480 IMPROVEMENTS IN PELVIC FLOOR 3007 02:11:02,480 --> 02:11:05,240 SYMPTOMS WITH ICING ALONE. 3008 02:11:05,240 --> 02:11:11,120 WE DECIDED TO FORMALLY STUDY 3009 02:11:11,120 --> 02:11:13,080 THIS, ENROLLED 163 PATIENTS. 3010 02:11:13,080 --> 02:11:14,480 PARTICIPANTS IN CRYOTHERAPY ARM 3011 02:11:14,480 --> 02:11:15,440 WOULD ICE VAGINALLY FOR TEN 3012 02:11:15,440 --> 02:11:18,680 MINUTES DAILY FOR TWO WEEKS. 3013 02:11:18,680 --> 02:11:20,360 PLACEBO ARM PARTICIPANTS WOULD 3014 02:11:20,360 --> 02:11:28,200 PLACE ROOM TEMPERATURE TUBE 3015 02:11:28,200 --> 02:11:29,280 DAILY, BOTH COMPLETED A DIARY 3016 02:11:29,280 --> 02:11:32,480 AND RETURNED FOR EXAMINATION 3017 02:11:32,480 --> 02:11:39,480 PRIOR TO STARTING P.T. 3018 02:11:39,480 --> 02:11:41,320 MEDIAN TIME TO FOLLOW-UP THREE 3019 02:11:41,320 --> 02:11:42,760 WEEKS. 3020 02:11:42,760 --> 02:11:43,640 AFTER TWO WEEKS, TYPICALLY 3021 02:11:43,640 --> 02:11:44,480 CLINICALLY WOULDN'T SEE PATIENTS 3022 02:11:44,480 --> 02:11:46,480 BACK FOR A MINIMUM OF SIX TO 3023 02:11:46,480 --> 02:11:48,680 EIGHT WEEKS, WOMEN IN THE 3024 02:11:48,680 --> 02:11:49,760 CRYOTHERAPY ARM SHOWED 3025 02:11:49,760 --> 02:11:52,600 STATISTICALLY SIGNIFICANT 3026 02:11:52,600 --> 02:11:53,320 DECREASE IN PELVIC FLOOR 3027 02:11:53,320 --> 02:12:02,280 MYOFASCIAL PAIN IN THE RIGHT AND 3028 02:12:02,280 --> 02:12:02,720 LEFT. 3029 02:12:02,720 --> 02:12:05,800 AT TWO WEEKS WOMEN PERFORMING 3030 02:12:05,800 --> 02:12:10,080 ICING SHOWED BORDERLINE 3031 02:12:10,080 --> 02:12:11,200 STATISTICAL SIGNIFICANT 3032 02:12:11,200 --> 02:12:12,680 IMPROVEMENT, P-VALUE OF .05. 3033 02:12:12,680 --> 02:12:14,440 WOMEN PERFORMING ICING HAD 3034 02:12:14,440 --> 02:12:18,600 GREATER IMPROVEMENT IN ALL 3035 02:12:18,600 --> 02:12:24,600 SYMPTOM SCALES, TOTAL OF 20, 3036 02:12:24,600 --> 02:12:26,800 SUBSCALE SCORES PROLAPSE SHOWING 3037 02:12:26,800 --> 02:12:29,000 STATISTICAL SIS CANS. 3038 02:12:29,000 --> 02:12:32,400 THERE'S NO BIOLOGIC PLAUSIBILITY 3039 02:12:32,400 --> 02:12:37,680 FOR WHY VAGINAL CRYOTHERAPY 3040 02:12:37,680 --> 02:12:40,280 SHOULD IMPROVE PROLAPSE 3041 02:12:40,280 --> 02:12:40,560 SYMPTOMS. 3042 02:12:40,560 --> 02:12:41,280 SYMPTOM IMPROVEMENT IS LIKELY 3043 02:12:41,280 --> 02:12:45,440 DUE TO EFFECT ON PELVIC FLOOR 3044 02:12:45,440 --> 02:12:46,000 MUSCLES. 3045 02:12:46,000 --> 02:12:53,520 SO THIS NEEDS FURTHER STUDY, 3046 02:12:53,520 --> 02:12:54,720 OVERALL PELVIC FLOOR MYOFASCIAL 3047 02:12:54,720 --> 02:12:59,320 PAIN SCORES APPEAR TO IMPROVE 3048 02:12:59,320 --> 02:13:02,480 WITH VAGINAL CRYOTHERAPY. 3049 02:13:02,480 --> 02:13:03,600 >> A MINUTE LEFT. 3050 02:13:03,600 --> 02:13:09,000 >> IN SUMMARY, PAIN WITH 3051 02:13:09,000 --> 02:13:12,240 PALPATION IS ASSOCIATED WITH 3052 02:13:12,240 --> 02:13:16,160 SYMPTOMS, SEVERAL PATHWAYS 3053 02:13:16,160 --> 02:13:16,400 EXIST. 3054 02:13:16,400 --> 02:13:17,520 IT'S COMMON AND APPEARS TO 3055 02:13:17,520 --> 02:13:19,280 RESPOND TO P.T. OF THE 3056 02:13:19,280 --> 02:13:21,920 MYOFASCIAL RELEASE BASED AND 3057 02:13:21,920 --> 02:13:22,680 MOVEMENT BASED APPROACHES, 3058 02:13:22,680 --> 02:13:26,400 APPEARS TO RESPOND TO VAGINAL 3059 02:13:26,400 --> 02:13:28,280 CRYOTHERAPY, AGAIN BOTH NEED 3060 02:13:28,280 --> 02:13:30,360 MORE STUDY, I THINK THE CONVERSE 3061 02:13:30,360 --> 02:13:32,960 OF THAT IS IMPORTANT TO STRESS 3062 02:13:32,960 --> 02:13:36,160 URINARY AND PROLAPSE SYMPTOMS IN 3063 02:13:36,160 --> 02:13:38,880 WOMEN WITH PAIN WITH PALPATION 3064 02:13:38,880 --> 02:13:43,280 IMPROVES WITH P.T. AND 3065 02:13:43,280 --> 02:13:43,600 CRYOTHERAPY. 3066 02:13:43,600 --> 02:13:44,480 WE NEED TO IMPROVE 3067 02:13:44,480 --> 02:13:48,400 IDENTIFICATION OF WOMEN WITH 3068 02:13:48,400 --> 02:13:49,280 PELVIC FLOOR MYOFASCIAL 3069 02:13:49,280 --> 02:13:52,600 PALPATION AND SYMPTOMS BY 3070 02:13:52,600 --> 02:13:53,520 EDUCATING PROVIDERS ABOUT 3071 02:13:53,520 --> 02:13:56,120 SCREENING, INCREASING AWARENESS 3072 02:13:56,120 --> 02:13:58,120 OF EDUCATION, AMONG PROVIDERS 3073 02:13:58,120 --> 02:14:00,520 AND PATIENTS, OPTIMIZING 3074 02:14:00,520 --> 02:14:01,720 TREATMENT ALGORITHMS AND 3075 02:14:01,720 --> 02:14:03,360 IMAGING, LOOKING FOR BEST 3076 02:14:03,360 --> 02:14:05,680 METHODS TO IDENTIFY TRIGGER 3077 02:14:05,680 --> 02:14:10,680 POINTS POSSIBLY FOR INJECTIONS, 3078 02:14:10,680 --> 02:14:11,240 FOR RESEARCH DEVELOPING 3079 02:14:11,240 --> 02:14:12,800 NON-INVASIVE SCREENING TOOLS TO 3080 02:14:12,800 --> 02:14:15,160 IDENTIFY WOMEN AT RISK, MAPP, 3081 02:14:15,160 --> 02:14:16,840 DR. ACKERMAN ARE WORKING ON 3082 02:14:16,840 --> 02:14:20,720 THOSE USING QUESTIONNAIRE AND 3083 02:14:20,720 --> 02:14:21,200 DATABASES. 3084 02:14:21,200 --> 02:14:22,680 OPTIMIZING TREATMENT ALGORITHMS, 3085 02:14:22,680 --> 02:14:25,160 USING ROBUST CLINICAL TRIALS AND 3086 02:14:25,160 --> 02:14:33,480 IMAGING ESPECIALLY WITH SOME 3087 02:14:33,480 --> 02:14:38,000 NEWER TECHNOLOGY OF MR 3088 02:14:38,000 --> 02:14:38,680 ELASTOGRAPHY WITHOUT REQUIRING 3089 02:14:38,680 --> 02:14:39,520 BIOPSIES. 3090 02:14:39,520 --> 02:14:40,440 I THANK MY LOCAL COLLABORATORS 3091 02:14:40,440 --> 02:14:46,240 AND LOOK FORWARD TO YOUR 3092 02:14:46,240 --> 02:14:46,480 QUESTIONS. 3093 02:14:46,480 --> 02:14:46,800 THANK YOU. 3094 02:14:46,800 --> 02:14:47,280 >> THANK YOU. 3095 02:14:47,280 --> 02:14:49,880 WE'LL MOVE TO THE NEXT 3096 02:14:49,880 --> 02:14:51,680 PRESENTATION AND WE CAN ADDRESS 3097 02:14:51,680 --> 02:14:54,320 THE QUESTIONS AT THE END, 3098 02:14:54,320 --> 02:14:54,600 HOPEFULLY. 3099 02:14:54,600 --> 02:14:56,240 >> SORRY FOR RUNNING OVER. 3100 02:14:56,240 --> 02:14:57,920 >> YOU'RE DOING OKAY. 3101 02:14:57,920 --> 02:15:00,200 WE COULD TAKE A COUPLE OF 3102 02:15:00,200 --> 02:15:00,920 QUESTIONS. 3103 02:15:00,920 --> 02:15:06,120 BUT WE'LL MOVE ON TO DR. DIAZ, 3104 02:15:06,120 --> 02:15:10,880 AND WE WILL DO ALL THE QUESTIONS 3105 02:15:10,880 --> 02:15:12,000 AT THE END. 3106 02:15:12,000 --> 02:15:23,280 DR. DIAZ, PLEASE FELL -- FEEL 3107 02:15:23,280 --> 02:15:24,040 FREE TO START. 3108 02:15:24,040 --> 02:15:29,280 >> THANK YOU FOR INVITING ME TO 3109 02:15:29,280 --> 02:15:30,680 SHARE ON ASSESSING TREATMENT. 3110 02:15:30,680 --> 02:15:32,440 WE'RE USING A FEW TECHNOLOGIES. 3111 02:15:32,440 --> 02:15:36,120 WE FOCUS ON OUR HIGH DENSITY 3112 02:15:36,120 --> 02:15:43,200 SURFACE EMG TECHNOLOGY IN THIS 3113 02:15:43,200 --> 02:15:44,000 PRESENTATION. 3114 02:15:44,000 --> 02:15:49,280 I'M A CO-FOUNDER AND SHAREHOLDER 3115 02:15:49,280 --> 02:15:51,280 OF HILLMED, A UNIVERSITY OF 3116 02:15:51,280 --> 02:15:52,400 HOUSTON SPIN-OUT, EARLY STAGE 3117 02:15:52,400 --> 02:15:54,240 START-UP COMPANY. 3118 02:15:54,240 --> 02:15:56,160 WE'RE WORKING ON PROVIDING 3119 02:15:56,160 --> 02:15:57,280 NEURAL ENGINEERING SOLUTIONS TO 3120 02:15:57,280 --> 02:16:02,720 IMPROVE CHRONIC PELVIC PAIN 3121 02:16:02,720 --> 02:16:03,160 MANAGEMENT, NEURAL 3122 02:16:03,160 --> 02:16:08,440 REHABILITATION AND PRECISION 3123 02:16:08,440 --> 02:16:10,160 BOTOX INJECTIONS, COMBINING 3124 02:16:10,160 --> 02:16:11,280 ENGINEERS WITH SOME 3125 02:16:11,280 --> 02:16:12,120 ENTREPRENEURIAL EXPERIENCE TO 3126 02:16:12,120 --> 02:16:20,440 BRING THIS DREAM TO FRUITION. 3127 02:16:20,440 --> 02:16:21,200 MY OBJECTIVES TO EXPLORE 3128 02:16:21,200 --> 02:16:24,080 POTENTIAL GAPS IN THE DIAGNOSIS 3129 02:16:24,080 --> 02:16:26,880 AND CARE OF PELVIC FLOOR MUSCLE 3130 02:16:26,880 --> 02:16:27,760 OVERACTIVITY, OVERVIEW OF 3131 02:16:27,760 --> 02:16:30,080 CURRENT TOOLS AND HOW WE'RE 3132 02:16:30,080 --> 02:16:32,320 AIMING TO IMPROVE THESE TOOLS BY 3133 02:16:32,320 --> 02:16:35,360 ACTUALLY GIVING YOU A 2D MAP OF 3134 02:16:35,360 --> 02:16:37,040 OVERACTIVITY, AND LOOK AT SOME 3135 02:16:37,040 --> 02:16:39,760 FUTURE APPLICATIONS OF THIS TOOL 3136 02:16:39,760 --> 02:16:41,080 TO GUIDE BOTOX INJECTIONS AND 3137 02:16:41,080 --> 02:16:48,040 IMPROVE THE CONSERVATIVE CARE OF 3138 02:16:48,040 --> 02:16:50,160 PELVIC FLOOR MUSCLE 3139 02:16:50,160 --> 02:16:50,520 OVERACTIVATING. 3140 02:16:50,520 --> 02:16:53,280 A VERY, VERY BRIEF OVERVIEW OF 3141 02:16:53,280 --> 02:16:55,000 SOME GAPS THAT WE'VE IDENTIFIED, 3142 02:16:55,000 --> 02:16:58,280 THERE'S A LACK OF OBJECTIVE 3143 02:16:58,280 --> 02:16:59,520 MUSCLE TONE DIAGNOSIS TOOL, 3144 02:16:59,520 --> 02:17:04,480 RIGHT NOW YOU USE DIGITAL 3145 02:17:04,480 --> 02:17:05,880 PALPATION AND ONE OPINION MAY 3146 02:17:05,880 --> 02:17:09,400 NOT BE THE SAME AS ANOTHER 3147 02:17:09,400 --> 02:17:10,160 DOCTOR'S UPON. 3148 02:17:10,160 --> 02:17:13,280 WE'D LIKE TO PROVIDE YOU WITH A 3149 02:17:13,280 --> 02:17:17,080 QUANTIFIABLE MEASURE OF THE 3150 02:17:17,080 --> 02:17:18,480 OVERACTIVITY OF THE MUSCLE. 3151 02:17:18,480 --> 02:17:21,720 THERE'S A LACK OF ADAPTIVE 3152 02:17:21,720 --> 02:17:25,320 AT-HOME TREATMENT AND LACK OF 3153 02:17:25,320 --> 02:17:26,960 PERSONALIZED INJECTION TOOL. 3154 02:17:26,960 --> 02:17:37,880 INTRAMUSCULAR EMG HAS BEEN USED, 3155 02:17:37,880 --> 02:17:40,200 PALPATION OF TRIGGER POINTS, NO 3156 02:17:40,200 --> 02:17:41,720 CONSENSUS OF A GOOD TOOL FOR 3157 02:17:41,720 --> 02:17:45,240 INJECTION OF BOTOX. 3158 02:17:45,240 --> 02:17:47,320 THERE'S A PIECE FROM DR. 3159 02:17:47,320 --> 02:17:49,280 LOWDER'S PRESENTATION AND I 3160 02:17:49,280 --> 02:17:53,280 COMBINED PAPERS TO MAKE THIS 3161 02:17:53,280 --> 02:17:53,520 FLOWCHART. 3162 02:17:53,520 --> 02:17:54,960 THERE'S A VISCERAL PAIN 3163 02:17:54,960 --> 02:17:56,560 GENERATOR IN THE PELVIS, IN THE 3164 02:17:56,560 --> 02:18:03,320 CASE OF OUR STUDIES WE'VE LOOKED 3165 02:18:03,320 --> 02:18:04,680 AT ICBPS, THE BLADDER, LEADING 3166 02:18:04,680 --> 02:18:07,280 TO MUSCLE PAIN. 3167 02:18:07,280 --> 02:18:08,480 ONCE THE MUSCLE BECOMES PAINFUL 3168 02:18:08,480 --> 02:18:22,120 THERE'S PATHWAYS THAT CAN LEAD 3169 02:18:22,120 --> 02:18:23,160 TO HYPERTONICITY. 3170 02:18:23,160 --> 02:18:28,080 ONCE THE PELVIC FLOOR MUSCLE IS 3171 02:18:28,080 --> 02:18:30,120 HYPER CLONIC, LOOPS OCCUR. 3172 02:18:30,120 --> 02:18:31,880 TRIGGER POINTS FORM LEADING TO 3173 02:18:31,880 --> 02:18:33,400 PAIN AND FEEDS BACK INTO ITSELF. 3174 02:18:33,400 --> 02:18:41,480 MORE PAIN IN THE MUSCLE LEADS TO 3175 02:18:41,480 --> 02:18:43,680 MORE HYPERTONICITY, INCREASE THE 3176 02:18:43,680 --> 02:18:45,680 SEXUAL DYSFUNCTION, FEEDING INTO 3177 02:18:45,680 --> 02:18:46,840 THE VISCERAL PAIN WITH LOOPS 3178 02:18:46,840 --> 02:18:55,280 EVERYWHERE, YOU NEED TO BREAK 3179 02:18:55,280 --> 02:18:56,120 LOOPS. 3180 02:18:56,120 --> 02:19:06,040 IC - BPS IS THE CENTRAL 3181 02:19:06,040 --> 02:19:06,920 GENERATOR, AND AFFECTS 7 TO 9 3182 02:19:06,920 --> 02:19:09,200 MILLION WOMEN IN THE U.S. 3183 02:19:09,200 --> 02:19:12,720 ON MRI THIS LOOKS LIKE A 3184 02:19:12,720 --> 02:19:17,440 SHORTENED PELVIC PAIN MUSCLE, A 3185 02:19:17,440 --> 02:19:20,160 STUDY COMPARED 15 WOMEN WITH 15 3186 02:19:20,160 --> 02:19:21,400 CONTROLS, WITH SIGNIFICANTLY 3187 02:19:21,400 --> 02:19:22,680 SHORTER PELVIC FLOOR MUSCLES 3188 02:19:22,680 --> 02:19:29,080 COMPARED TO THOSE WITH NO 3189 02:19:29,080 --> 02:19:32,480 IC/BPS, UP TO 85% OF PATIENTS 3190 02:19:32,480 --> 02:19:39,560 WITH IC OR CHRONIC PAIN SYNDROME 3191 02:19:39,560 --> 02:19:42,080 EXHIBIT HYPERTONIC OR OVERACTIVE 3192 02:19:42,080 --> 02:19:43,280 PELVIC FLOOR MUSCLES. 3193 02:19:43,280 --> 02:19:47,080 THERE'S TOOLS OUT TO ASSESS THE 3194 02:19:47,080 --> 02:19:48,040 PELVIC FLOOR MUSCLE ACTIVITY, IN 3195 02:19:48,040 --> 02:19:54,960 ALL SHAPES AND SIZES. 3196 02:19:54,960 --> 02:19:59,480 YOU GET ONE MEASURE OF PELVIC 3197 02:19:59,480 --> 02:20:02,160 FLOOR MUSCLE ACTIVITY, YOU CAN 3198 02:20:02,160 --> 02:20:03,480 USE THIS FOR BIOFEEDBACK BUT 3199 02:20:03,480 --> 02:20:04,680 THERE'S NO LOCALIZATION THAT CAN 3200 02:20:04,680 --> 02:20:10,480 BE DONE WITH THESE TOOLS. 3201 02:20:10,480 --> 02:20:12,480 WE'RE DEVELOPING A TECHNIQUE, 3202 02:20:12,480 --> 02:20:17,280 ESSENTIALLY A HIGH DENSITY ARRAY 3203 02:20:17,280 --> 02:20:19,560 OF SURFACE EMG ELECTRODES, 3204 02:20:19,560 --> 02:20:21,240 ALLOWING US TO MAP ACTIVITY 3205 02:20:21,240 --> 02:20:23,840 INSIDE THE VAGINAL LUMEN USING 3206 02:20:23,840 --> 02:20:25,280 SINGLE SIGNAL ACQUISITION. 3207 02:20:25,280 --> 02:20:27,680 SO IT'S NOT LIKE NEEDLE EMG 3208 02:20:27,680 --> 02:20:29,280 WHERE YOU POKE AROUND AND GET 3209 02:20:29,280 --> 02:20:32,240 MULTIPLE MEASURES TO MAP THE 3210 02:20:32,240 --> 02:20:34,400 ACTIVITY OR SURFACE PROBE, YOU 3211 02:20:34,400 --> 02:20:52,080 GET ONE MEASURE OF THE PELVIC FLOOR. 3212 02:20:52,080 --> 02:20:54,040 . 3213 02:20:54,040 --> 02:20:56,320 THIS IS THE MOTOR UNIT TRAVELING 3214 02:20:56,320 --> 02:20:58,880 DOWN THE MUSCLE FIBER, YOU CAN 3215 02:20:58,880 --> 02:21:00,080 TRACK IN TIME AS IT'S TRAVELING 3216 02:21:00,080 --> 02:21:03,680 DOWN THE MUSCLE FIBER, PROVIDED 3217 02:21:03,680 --> 02:21:05,240 YOU HAVE A DIFFERENTIAL SIGNAL 3218 02:21:05,240 --> 02:21:07,200 SET UP. 3219 02:21:07,200 --> 02:21:10,160 THIS FIGURE B OVER HERE, MOTOR 3220 02:21:10,160 --> 02:21:11,360 UNIT TRAVELS DOWN THE MUSCLE 3221 02:21:11,360 --> 02:21:11,880 FIBER. 3222 02:21:11,880 --> 02:21:15,640 YOU CAN TRACK THIS BACKWARDS, 3223 02:21:15,640 --> 02:21:18,120 THIS IS WHERE THE MOTOR UNIT 3224 02:21:18,120 --> 02:21:20,920 EXPONENTIAL ORIGINATED FROM. 3225 02:21:20,920 --> 02:21:23,960 THAT'S CONSIDERED THE 3226 02:21:23,960 --> 02:21:26,280 INNERVATION ZONE AND THAT'S 3227 02:21:26,280 --> 02:21:33,080 WHERE NEUROMUSCULAR JUNCTIONS 3228 02:21:33,080 --> 02:21:34,560 ARE MOST DENSELY DISTRIBUTED. 3229 02:21:34,560 --> 02:21:45,280 THIS ALLOWS UNDER -- ALLOWS US 3230 02:21:45,280 --> 02:21:51,360 TO TAKE THIS, PUT IT THROUGH A 3231 02:21:51,360 --> 02:21:54,280 DECOMPOSITION ALGORITHM FOR THE 3232 02:21:54,280 --> 02:21:55,160 INDIVIDUAL MOTOR UNITS CAPTURED 3233 02:21:55,160 --> 02:21:58,480 AND LOOKS LIKE THIS FIGURE OVER 3234 02:21:58,480 --> 02:22:01,120 HERE ON THE RIGHT, YOUR TYPICAL 3235 02:22:01,120 --> 02:22:03,960 PLOT OF A NEURAL SIGNAL, ONCE 3236 02:22:03,960 --> 02:22:04,920 YOU HAVE THESE INDIVIDUAL MOTOR 3237 02:22:04,920 --> 02:22:08,080 UNIT FIRINGS, YOU CAN USE THEM 3238 02:22:08,080 --> 02:22:19,680 TO TIME LOCK THAT ORIGINAL MESSY 3239 02:22:19,680 --> 02:22:21,360 SURFACE INTERFERENTIAL PATTERN. 3240 02:22:21,360 --> 02:22:23,120 THAT IS SHOWN ON THE RIGHT. 3241 02:22:23,120 --> 02:22:27,600 YOU HAVE THAT -- YOU START WITH 3242 02:22:27,600 --> 02:22:30,880 THE FILTERED MESSY SURFACE 3243 02:22:30,880 --> 02:22:33,080 PATTERN, PUT IT THROUGH THE 3244 02:22:33,080 --> 02:22:37,400 ALGORITHM, WE USE THE CLUSTERING 3245 02:22:37,400 --> 02:22:37,920 CONVOLUTION COMPENSATION 3246 02:22:37,920 --> 02:22:39,640 ALGORITHM, TIME LOCK THE SIGNALS 3247 02:22:39,640 --> 02:22:41,080 IN EACH CHANNEL WITH RESPECT TO 3248 02:22:41,080 --> 02:22:44,880 EACH OF THOSE SPIKE TIMINGS 3249 02:22:44,880 --> 02:22:45,960 OBTAINED FROM THE DECOMPOSITION 3250 02:22:45,960 --> 02:22:48,280 TO GET THE OUTPUT OF THE MOTOR 3251 02:22:48,280 --> 02:22:49,880 UNIT TERRITORY FOR THAT 3252 02:22:49,880 --> 02:22:50,760 IDENTIFIED MOTOR UNIT. 3253 02:22:50,760 --> 02:22:56,440 FROM THERE YOU CAN DO THE 3254 02:22:56,440 --> 02:22:57,040 INNERVATION ZONE LOCALIZATION, 3255 02:22:57,040 --> 02:23:02,920 CLEAR TO SEE THAT IN THE BICEP, 3256 02:23:02,920 --> 02:23:08,440 ALSO DONE IN THE PELVIC FLOOR 3257 02:23:08,440 --> 02:23:11,080 MUSCLES ON THE OVERLAP HERE. 3258 02:23:11,080 --> 02:23:13,800 ONE APPLICATION OF THIS ZONE 3259 02:23:13,800 --> 02:23:14,880 IDENTIFICATION TECHNIQUE IS TO 3260 02:23:14,880 --> 02:23:19,480 POTENTIALLY USE IT TO GUIDE THE 3261 02:23:19,480 --> 02:23:22,080 INJECTION OF BOTOX TOWARDS THE 3262 02:23:22,080 --> 02:23:25,320 INNERVATION ZONE WHERE THEY ARE 3263 02:23:25,320 --> 02:23:27,040 DENSELY DISTRIBUTED. 3264 02:23:27,040 --> 02:23:32,160 THESE BOTULISM TOXIN INJECTIONS 3265 02:23:32,160 --> 02:23:35,000 FOR PELVIC FLOOR PAIN HAVE GROWN 3266 02:23:35,000 --> 02:23:37,000 INTEREST, TRIALS HAVE SHOWN 3267 02:23:37,000 --> 02:23:38,280 INCONSISTENT OUTCOME, SOME SHOW 3268 02:23:38,280 --> 02:23:41,280 GREAT RESULT, SOME NO BETTER 3269 02:23:41,280 --> 02:23:42,680 THAN PLACEBO. 3270 02:23:42,680 --> 02:23:44,960 ONE EXPLANATION COULD BE THEY 3271 02:23:44,960 --> 02:23:46,840 ARE NON-TARGETED INJECTIONS. 3272 02:23:46,840 --> 02:23:48,040 TEMPLATES WITH USED, EVERY 3273 02:23:48,040 --> 02:23:50,200 PATIENT IS GETTING A 5:00 AND 3274 02:23:50,200 --> 02:23:53,720 7:00 INFECTION WHICH MAY NOT BE 3275 02:23:53,720 --> 02:23:55,960 ACTUALLY HITTING THAT 3276 02:23:55,960 --> 02:23:57,880 NEUROMUSCULAR JUNCTION OF THE 3277 02:23:57,880 --> 02:23:58,720 INNERVATION ZONE REGION 3278 02:23:58,720 --> 02:23:59,280 SUFFICIENTLY. 3279 02:23:59,280 --> 02:24:03,000 OR THEY ARE BEING INJECTED INTO 3280 02:24:03,000 --> 02:24:04,280 THE MYOFASCIAL TRIGGER POINTS 3281 02:24:04,280 --> 02:24:05,840 SHOWN DRY NEEDLING CAN HELP. 3282 02:24:05,840 --> 02:24:08,560 YOU DON'T NEED TO INJECT THE 3283 02:24:08,560 --> 02:24:09,120 BOTOX. 3284 02:24:09,120 --> 02:24:12,560 POTENTIALLY THERE'S A BETTER 3285 02:24:12,560 --> 02:24:16,680 TARGET FOR THESE INJECTIONS. 3286 02:24:16,680 --> 02:24:26,960 SO FIRST WE DEVELOPED THE PELVIC 3287 02:24:26,960 --> 02:24:28,040 FLOOR HYPERTONICITY TECHNIQUE 3288 02:24:28,040 --> 02:24:31,320 COMPARED 15 HEALTHY VOLUNTEERS 3289 02:24:31,320 --> 02:24:33,720 AND 15 WITH PELVIC PAIN. 3290 02:24:33,720 --> 02:24:44,840 THE PATIENTS FILLED OUT A SLEW 3291 02:24:44,840 --> 02:24:50,600 OF SURVEYS, UNDERWENT PHYSICAL 3292 02:24:50,600 --> 02:24:52,720 ASSESSMENT, COULD THEY RELAX, 3293 02:24:52,720 --> 02:24:53,440 LOWER IT, CONTRACT IT? 3294 02:24:53,440 --> 02:24:55,920 ALL OF THAT. 3295 02:24:55,920 --> 02:25:00,280 THEY MOVED INTO ENG ASSESSMENT 3296 02:25:00,280 --> 02:25:05,720 WITH ONE MINUTE BASELINE 3297 02:25:05,720 --> 02:25:07,280 FOLLOWED BY VOLUNTARY 3298 02:25:07,280 --> 02:25:08,280 CONTRACTION, REST AND 3299 02:25:08,280 --> 02:25:18,880 CONTRACTION, SO FORTH. 3300 02:25:18,880 --> 02:25:23,440 MORE DETAILS, PALPATED FOR 3301 02:25:23,440 --> 02:25:24,680 PRESENCE OF MYOFASCIAL TRIGGER 3302 02:25:24,680 --> 02:25:26,440 POINTS AND PAIN. 3303 02:25:26,440 --> 02:25:27,480 ELEMENTS OF CONTROL WERE 3304 02:25:27,480 --> 02:25:28,000 EXAMINED. 3305 02:25:28,000 --> 02:25:30,480 HOW IS THE PELVIC FLOOR ALIGNED 3306 02:25:30,480 --> 02:25:32,240 AT REST, SHORTENED, LENGTHENED, 3307 02:25:32,240 --> 02:25:32,760 NORMAL? 3308 02:25:32,760 --> 02:25:35,640 COULD THE SUBJECT RELAX THE 3309 02:25:35,640 --> 02:25:37,360 PELVIC FLOOR AFTER CONTRACTION 3310 02:25:37,360 --> 02:25:39,440 AND LOWER THE PELVIC FLOOR, ONCE 3311 02:25:39,440 --> 02:25:41,280 AT REST WERE THEY ABLE TO LOWER 3312 02:25:41,280 --> 02:25:47,520 THE PELVIC FLOOR AS IF TO USE 3313 02:25:47,520 --> 02:25:48,960 THE RESTROOM. 3314 02:25:48,960 --> 02:25:52,760 80% OF SUBJECTS EXHIBITED 3315 02:25:52,760 --> 02:25:54,960 SHORTENED PELVIC FLOOR MUSCLE 3316 02:25:54,960 --> 02:25:56,680 UPON EXAM, 80% OF THE I.C.s 3317 02:25:56,680 --> 02:25:58,840 WERE ABLE TO RELAX AFTER 3318 02:25:58,840 --> 02:26:02,040 CONTRACTION, ALL OF THE HEALTHYS 3319 02:26:02,040 --> 02:26:02,280 COULD. 3320 02:26:02,280 --> 02:26:06,080 40% OF PATIENTS COULD LOWER THE 3321 02:26:06,080 --> 02:26:08,480 PELVIC FLOOR MUSCLES WHEN 3322 02:26:08,480 --> 02:26:11,600 REQUESTED COMPARED TO 73%. 3323 02:26:11,600 --> 02:26:15,720 WE SAW SIGNIFICANTLY INCREASED 3324 02:26:15,720 --> 02:26:21,080 RESTING RMS, THIS IS THE 3325 02:26:21,080 --> 02:26:24,640 AMPLITUDE OF THE EMG SIGNAL AT 3326 02:26:24,640 --> 02:26:25,800 REST COMPARED TO CONTROLS. 3327 02:26:25,800 --> 02:26:28,240 WE WANTED TO LOOK AT HOW THIS 3328 02:26:28,240 --> 02:26:29,440 RELATED TO KIND OF THE 3329 02:26:29,440 --> 02:26:31,480 ACTIVATION CAPACITY OF THE 3330 02:26:31,480 --> 02:26:33,880 MUSCLES, SO WE NORMALIZED THE 3331 02:26:33,880 --> 02:26:35,840 RESTING ACTIVITY WITH RESPECT TO 3332 02:26:35,840 --> 02:26:38,040 THE MAXIMUM AMPLITUDE REACHED 3333 02:26:38,040 --> 02:26:39,680 DURING MAXIMUM VOLUNTARY 3334 02:26:39,680 --> 02:26:42,640 CONTRACTION TO GIVE US THIS RMS 3335 02:26:42,640 --> 02:26:45,240 RATIO MAPPING WHICH THESE 3336 02:26:45,240 --> 02:26:46,840 COLORFUL MAPPINGS ARE SHOWN 3337 02:26:46,840 --> 02:26:47,040 HERE. 3338 02:26:47,040 --> 02:26:50,400 AND WE SAW A MUCH MORE 3339 02:26:50,400 --> 02:26:51,760 SIGNIFICANTLY INCREASED 3340 02:26:51,760 --> 02:26:52,320 INTENSITY OF THESE RATIO 3341 02:26:52,320 --> 02:26:56,560 MAPPINGS IN THE I.C. PATIENTS 3342 02:26:56,560 --> 02:27:00,320 COMPARED TO CONTROL PATIENTS. 3343 02:27:00,320 --> 02:27:03,280 THIS CORRELATED WITH SCORES AS 3344 02:27:03,280 --> 02:27:04,960 WELL AS BASELINE PAIN. 3345 02:27:04,960 --> 02:27:06,600 FURTHERMORE IT WAS SIGNIFICANTLY 3346 02:27:06,600 --> 02:27:08,280 INCREASED IN THE PATIENTS WITH 3347 02:27:08,280 --> 02:27:10,800 SHORTENED PELVIC FLOOR MUSCLE 3348 02:27:10,800 --> 02:27:12,120 UPON EXAM, WHEN COMPARED TO 3349 02:27:12,120 --> 02:27:13,640 PATIENTS WITH NORMAL LENGTH 3350 02:27:13,640 --> 02:27:17,120 PELVIC FLOOR MUSCLE ON EXAM. 3351 02:27:17,120 --> 02:27:19,720 AND WE ALSO TOOK THIS ONE STEP 3352 02:27:19,720 --> 02:27:22,400 FURTHER AND DECOMPOSED ALL OF 3353 02:27:22,400 --> 02:27:26,320 THOSE HIGH DENSITY SURFACE ENG 3354 02:27:26,320 --> 02:27:29,200 SIGNALS INTO POTENTIALS AND 3355 02:27:29,200 --> 02:27:31,040 DEVELOPED INNERVATION ZONE MAPS 3356 02:27:31,040 --> 02:27:34,320 FOR SUBJECTS AND OVERLAID THESE 3357 02:27:34,320 --> 02:27:36,920 ON THE RESTING RMS HEAT MAPS 3358 02:27:36,920 --> 02:27:37,960 SHOWN HERE. 3359 02:27:37,960 --> 02:27:42,240 WE CAN SEE NOT EVERY INNERVATION 3360 02:27:42,240 --> 02:27:43,520 ZONE WAS IDENTIFIED AS 3361 02:27:43,520 --> 02:27:45,800 CORRESPOND BE TO HYPERTONIC 3362 02:27:45,800 --> 02:27:47,080 ZONE. 3363 02:27:47,080 --> 02:27:47,880 WE CAN IDENTIFY HYPERTONIC 3364 02:27:47,880 --> 02:27:51,400 INNERVATION ZONES AND THOSE ARE 3365 02:27:51,400 --> 02:27:53,280 SHOWN HERE, LET ME PULL UP THE 3366 02:27:53,280 --> 02:27:56,880 LASER POINTER IF I CAN. 3367 02:27:56,880 --> 02:28:00,040 I WON'T MESS WITH THAT. 3368 02:28:00,040 --> 02:28:03,040 THE CIRCLE WITH THE BLACK ARMS 3369 02:28:03,040 --> 02:28:05,120 EXTENDING, THAT RECOMMENDS ONE 3370 02:28:05,120 --> 02:28:06,440 INNERVATION ZONE IDENTIFIED 3371 02:28:06,440 --> 02:28:07,400 THROUGH DECOMPOSITION. 3372 02:28:07,400 --> 02:28:10,080 WE CAN TAKE AN AVERAGE OF THESE 3373 02:28:10,080 --> 02:28:13,880 TO GIVE A PHYSICIAN A TARGET FOR 3374 02:28:13,880 --> 02:28:15,080 THE BOTOX INJECTION, THAT'S THE 3375 02:28:15,080 --> 02:28:17,080 SAME THING SHOWN IN FIGURE C AND 3376 02:28:17,080 --> 02:28:21,320 D, THIS IS A POLAR 3377 02:28:21,320 --> 02:28:23,000 REPRESENTATION, SO WHICH CHANNEL 3378 02:28:23,000 --> 02:28:25,280 DOES THE INNERVATION ZONE AND 3379 02:28:25,280 --> 02:28:31,120 HOW DEEP INTO FROM THE VAGINAL 3380 02:28:31,120 --> 02:28:32,800 INTROITUS DOES IT FALL. 3381 02:28:32,800 --> 02:28:34,480 MY COLLEAGUES AT THE UNIVERSITY 3382 02:28:34,480 --> 02:28:36,680 OF HOUSTON AND UT HEALTH 3383 02:28:36,680 --> 02:28:38,880 CONDUCTED A CLINICAL TRIAL 3384 02:28:38,880 --> 02:28:43,080 LOOKING AT ABILITY OF THIS 3385 02:28:43,080 --> 02:28:45,320 INNERVATION ZONE TARGETED BOTOX 3386 02:28:45,320 --> 02:28:46,720 INJECTION TECHNIQUE IN STROKES 3387 02:28:46,720 --> 02:28:48,920 PLASTICITY PATIENTS, LOOKED AT 3388 02:28:48,920 --> 02:28:53,440 SIX CONTROLS, SIX -- NO, SIX 3389 02:28:53,440 --> 02:28:58,320 PATIENTS, I'M SORRY, TWELVE 3390 02:28:58,320 --> 02:29:00,280 PATIENTS, GROUPED SIX INTO THE 3391 02:29:00,280 --> 02:29:02,880 CONTROL GROUP, SIX INTO 3392 02:29:02,880 --> 02:29:04,280 EXPERIMENTAL GROUP. 3393 02:29:04,280 --> 02:29:07,600 CONTROLS RECEIVED YOUR OF 3394 02:29:07,600 --> 02:29:10,000 ROUTINE INJECTION, EXPERIMENTAL 3395 02:29:10,000 --> 02:29:15,600 GROUP RECEIVED IZ-GUIDED 3396 02:29:15,600 --> 02:29:16,840 INJECTION, BOTH SAW DECREASE IN 3397 02:29:16,840 --> 02:29:23,480 AMPLY FEUD -- AMPLITUDE. 3398 02:29:23,480 --> 02:29:27,160 THE GUIDED GROUP SAW 3399 02:29:27,160 --> 02:29:28,440 SIGNIFICANTLY REDUCED COMPOUND 3400 02:29:28,440 --> 02:29:30,040 MUSCLE POTENTIAL COMPARED TO 3401 02:29:30,040 --> 02:29:32,640 CONTROL GROUP. 3402 02:29:32,640 --> 02:29:34,160 SIGNIFYING GREATER REDUCTION IN 3403 02:29:34,160 --> 02:29:41,280 MOTOR UNIT ACTIVITY IN GUIDED 3404 02:29:41,280 --> 02:29:41,920 GROUP. 3405 02:29:41,920 --> 02:29:44,320 FUTURE WORK APPLYING TO PELVIC 3406 02:29:44,320 --> 02:29:45,640 FLOOR MUSCLE. 3407 02:29:45,640 --> 02:29:48,920 WE'RE WE DEVELOPING THE PROBE 3408 02:29:48,920 --> 02:29:52,200 INTO A COMMERCIALLY VIABLE 3409 02:29:52,200 --> 02:29:53,280 DESIGN WITH LESS ELECTRODES, 3410 02:29:53,280 --> 02:29:56,120 GROUPING IN A MORE DENSE 3411 02:29:56,120 --> 02:29:58,840 ARRANGEMENT TO HIT THE PELVIC 3412 02:29:58,840 --> 02:30:02,000 FLOOR MUSCLES, WITH NO 3413 02:30:02,000 --> 02:30:03,520 ELECTRODES READING FROM THE 3414 02:30:03,520 --> 02:30:05,080 PELVIC FLOOR MUSCLING, MOVING IN 3415 02:30:05,080 --> 02:30:06,280 THE DEVELOPMENT PROCESS. 3416 02:30:06,280 --> 02:30:09,200 ONCE WE GO THROUGH VERIFICATION 3417 02:30:09,200 --> 02:30:11,680 TESTING WE'LL GO INTO IN VIVO 3418 02:30:11,680 --> 02:30:13,280 STUDY LOOKING AT 15 CONTROLS, 46 3419 02:30:13,280 --> 02:30:16,320 WOMEN WITH IC OR WITH CHRONIC 3420 02:30:16,320 --> 02:30:17,640 PELVIC PAIN. 3421 02:30:17,640 --> 02:30:20,080 IT WILL BE A SIMILAR SETUP TO 3422 02:30:20,080 --> 02:30:23,040 THE STUDY I JUST PRESENTED. 3423 02:30:23,040 --> 02:30:24,640 MORE SUBJECTS USING THE NEW 3424 02:30:24,640 --> 02:30:24,880 DEVICE. 3425 02:30:24,880 --> 02:30:27,200 AFTER THAT THE WOMEN WITH 3426 02:30:27,200 --> 02:30:30,560 CHRONIC PELVIC PAIN WILL MOVE 3427 02:30:30,560 --> 02:30:33,200 INTO CLINICAL FEASIBILITY STUDY 3428 02:30:33,200 --> 02:30:38,680 LOOKING AT GUIDED INJECTIONS 3429 02:30:38,680 --> 02:30:40,480 VERSUS TEMPLATE INJECTS, ONCE 3430 02:30:40,480 --> 02:30:42,600 THE DRUG WASHES OUT WE'LL HAVE A 3431 02:30:42,600 --> 02:30:48,320 CROSSOVER AND THEY WILL RECEIVE 3432 02:30:48,320 --> 02:30:49,720 THE ALTERNATE INJECTION TYPE. 3433 02:30:49,720 --> 02:30:51,880 ANOTHER THING WE'RE WORKING ON 3434 02:30:51,880 --> 02:30:55,120 IS PERSONALIZATION OF THE PELVIC 3435 02:30:55,120 --> 02:30:56,280 FLOOR MUSCLE PHYSICAL THERAPY. 3436 02:30:56,280 --> 02:31:01,560 AND WE'RE WORKING TO DEVELOP AN 3437 02:31:01,560 --> 02:31:04,760 AT-HOME TECHNIQUE TO HELP TREAT 3438 02:31:04,760 --> 02:31:06,960 CHRONIC PELVIC PAIN USING 3439 02:31:06,960 --> 02:31:07,680 INTRAVAGINAL PROBE, THERE'S 3440 02:31:07,680 --> 02:31:10,480 NOTHING NEW ABOUT THAT BUT WE'LL 3441 02:31:10,480 --> 02:31:12,000 BE INCLUDING THE ABILITY TO 3442 02:31:12,000 --> 02:31:14,400 MEASURE SIGNAL FROM THE TRUNK, 3443 02:31:14,400 --> 02:31:19,000 THE LEG, HIP AND ABDOMINAL 3444 02:31:19,000 --> 02:31:20,960 MUSCLES, HELPING US TACKLE THAT 3445 02:31:20,960 --> 02:31:22,680 POSTURAL COMPONENT, THE MOVEMENT 3446 02:31:22,680 --> 02:31:23,920 COMPONENTS LACKING IN THESE EMG 3447 02:31:23,920 --> 02:31:27,800 TECHNIQUES IN THE PAST. 3448 02:31:27,800 --> 02:31:29,280 THE PAST, BIOFEEDBACK TECHNIQUES 3449 02:31:29,280 --> 02:31:31,800 HAVE BEEN A VAGINAL PROBE, 3450 02:31:31,800 --> 02:31:34,280 HOWEVER WE'RE GOING TO INCLUDE A 3451 02:31:34,280 --> 02:31:44,240 MUSCLE NETWORK TECHNIQUE IN 3452 02:31:44,240 --> 02:31:47,680 CONCURRENCE TO GUIDE CONTRACTURE 3453 02:31:47,680 --> 02:31:49,160 OF PELVIC FLOOR. 3454 02:31:49,160 --> 02:31:51,880 THIS IS MY -- I'D LIKE TO THANK 3455 02:31:51,880 --> 02:31:52,480 OUR CLINICAL COLLABORATORS, 3456 02:31:52,480 --> 02:31:55,200 WE'RE A TEAM OF ENGINEERS, WE 3457 02:31:55,200 --> 02:31:57,280 NEED COLLABORATORS TO HELP WITH 3458 02:31:57,280 --> 02:32:08,760 THESE PRODUCTS. 3459 02:32:08,760 --> 02:32:11,640 DR. LAI AND SPITZNAGLE AND OTHERS. 3460 02:32:11,640 --> 02:32:15,000 THAT'S IT. 3461 02:32:15,000 --> 02:32:15,720 >> THANK YOU. 3462 02:32:15,720 --> 02:32:19,960 I'D LIKE TO OPEN IT UP TO THE 3463 02:32:19,960 --> 02:32:21,440 AUDIENCE IN GENERAL FOR THE 3464 02:32:21,440 --> 02:32:21,720 QUESTIONS. 3465 02:32:21,720 --> 02:32:23,040 I'M GOING TO GO THROUGH SOME OF 3466 02:32:23,040 --> 02:32:27,480 MY OWN AS WELL AS SOME IN THE 3467 02:32:27,480 --> 02:32:27,680 CHAT. 3468 02:32:27,680 --> 02:32:30,000 >> RECORDING IN PROGRESS. 3469 02:32:30,000 --> 02:32:34,640 >> SO WE'LL START WITH DR. 3470 02:32:34,640 --> 02:32:36,240 LOWDER. 3471 02:32:36,240 --> 02:32:40,840 IF YOU WOULDN'T MIND COMMENTS 3472 02:32:40,840 --> 02:32:46,480 AGAIN, CRYOTHERAPY PROTOCOL. 3473 02:32:46,480 --> 02:32:46,760 >> SURE. 3474 02:32:46,760 --> 02:32:49,640 SO, ONE THING I MENTIONED IN THE 3475 02:32:49,640 --> 02:32:52,360 CHAT WE DO HAVE PATIENTS ICE 3476 02:32:52,360 --> 02:32:53,280 LONGER THAN IN THE PROTOCOL, 3477 02:32:53,280 --> 02:32:57,760 THAT WAS JUST TO KEEP IT IN LINE 3478 02:32:57,760 --> 02:32:59,280 WITH THE IMMEDIATE ICING STUDY 3479 02:32:59,280 --> 02:33:01,240 THAT WE DID IN CLINIC. 3480 02:33:01,240 --> 02:33:04,560 AND GO OVER THOSE RESULTS. 3481 02:33:04,560 --> 02:33:12,000 PROTOCOL BASICALLY WE BUY THE 15 3482 02:33:12,000 --> 02:33:14,480 ML TUBES, CENTRIFUGE, HAVE 3483 02:33:14,480 --> 02:33:17,520 PATIENTS FILL THEM WITH 3 MLs 3484 02:33:17,520 --> 02:33:20,720 OF ALCOHOL, 12 MLs OF TAP 3485 02:33:20,720 --> 02:33:23,640 WATER, SCREW CAP ON, PLACE IN 3486 02:33:23,640 --> 02:33:24,840 FREEZER. 3487 02:33:24,840 --> 02:33:27,920 THEY DON'T FREEZE SOLID, SO WE 3488 02:33:27,920 --> 02:33:31,600 THEN HAVE PATIENTS ICE, ONE TUBE 3489 02:33:31,600 --> 02:33:34,320 AT A TEAM, LEAVE ONE IN THE 3490 02:33:34,320 --> 02:33:35,440 FREEZER, BECAUSE THEY COULD 3491 02:33:35,440 --> 02:33:36,840 POTENTIALLY GET TO ROOM TESTIFY 3492 02:33:36,840 --> 02:33:38,760 BEFORE THEY GET DONE ICING WITH 3493 02:33:38,760 --> 02:33:39,680 THE FIRST TUBE. 3494 02:33:39,680 --> 02:33:42,640 MOST SAY IT WILL STAY COLD FOR 7 3495 02:33:42,640 --> 02:33:44,880 MINUTES, SO A 15-MINUTE PROCESS. 3496 02:33:44,880 --> 02:33:48,840 THEY WASH THEM WITH SOAP AND 3497 02:33:48,840 --> 02:33:51,240 WATER, DRY THEM, PUT THEM IN A 3498 02:33:51,240 --> 02:33:52,880 DIFFERENT BAG SO THERE'S NO 3499 02:33:52,880 --> 02:33:54,640 CONTAMINATION, PUT THEM BACK IN 3500 02:33:54,640 --> 02:33:56,480 THE FREEZER. 3501 02:33:56,480 --> 02:33:58,160 WE TYPICALLY HAVE THEM ICE, YOU 3502 02:33:58,160 --> 02:34:01,040 KNOW, AS LONG AS THEY ARE 3503 02:34:01,040 --> 02:34:04,520 CONTINUING TO HAVE SYMPTOMS. 3504 02:34:04,520 --> 02:34:08,840 AND THEY CAN KEEP THOSE TO ICE 3505 02:34:08,840 --> 02:34:09,120 FOR FLARES. 3506 02:34:09,120 --> 02:34:11,240 I DIDN'T GET A CHANCE TO TALK 3507 02:34:11,240 --> 02:34:15,000 ABOUT, WHEN WE DESIGNED THE 3508 02:34:15,000 --> 02:34:19,440 STUDY WITH OUR FELLOWS, AND WITH 3509 02:34:19,440 --> 02:34:22,080 COLLABORATION WITH PHYSICAL 3510 02:34:22,080 --> 02:34:23,640 THERAPIST, WHO DR. DIAS 3511 02:34:23,640 --> 02:34:26,000 COLLABORATES WITH AS WELL, WE 3512 02:34:26,000 --> 02:34:28,320 WANTED A PLACEBO, THE BEST WE 3513 02:34:28,320 --> 02:34:30,840 COULD REALLY DO WAS WE THOUGHT 3514 02:34:30,840 --> 02:34:32,240 WOULD BE A ROOM TEMPERATURE 3515 02:34:32,240 --> 02:34:32,440 TUBE. 3516 02:34:32,440 --> 02:34:35,080 BUT IF YOU HAD A CHANCE TO LOOK 3517 02:34:35,080 --> 02:34:38,640 AT SOME OF THE SYMPTOMS WE SAW 3518 02:34:38,640 --> 02:34:40,280 SOME IMPROVEMENT WITH JUST THE 3519 02:34:40,280 --> 02:34:42,040 ROOM TEMPERATURE TUBE SO THE 3520 02:34:42,040 --> 02:34:43,880 ROOM TEMPERATURE TUBE MAY NOT 3521 02:34:43,880 --> 02:34:47,200 HAVE BEEN A TRUE PLACEBO. 3522 02:34:47,200 --> 02:34:52,120 AND TALKING WITH P.T.s, 3523 02:34:52,120 --> 02:34:53,280 DEPENDING HOW YOU MANIPULATE A 3524 02:34:53,280 --> 02:34:54,520 MUSCLE YOU CAN CAUSE IT TO 3525 02:34:54,520 --> 02:34:55,680 CONTRACT OR RELAX. 3526 02:34:55,680 --> 02:34:58,480 ONE THING TO LOOK AT IN THE 3527 02:34:58,480 --> 02:35:02,680 FUTURE IS THE ROLE OF THE ROOM 3528 02:35:02,680 --> 02:35:04,040 TEMPERATURE TUBE BECAUSE FOR 3529 02:35:04,040 --> 02:35:07,520 FOLKS THAT EXPERIENCE PAIN WITH 3530 02:35:07,520 --> 02:35:11,400 ICING, THAT MAY WORK AS WELL. 3531 02:35:11,400 --> 02:35:13,800 FUTURE WORK TO BE DONE THERE. 3532 02:35:13,800 --> 02:35:16,120 DOES THAT ANSWER YOUR QUESTION? 3533 02:35:16,120 --> 02:35:17,360 >> FOR THAT ONE. 3534 02:35:17,360 --> 02:35:18,320 SO ONE OTHER FOLLOW-UP QUESTION 3535 02:35:18,320 --> 02:35:20,720 TO WHAT YOU JUST MENTIONED, DO 3536 02:35:20,720 --> 02:35:22,360 YOU THINK THAT THERE'S A PLACEBO 3537 02:35:22,360 --> 02:35:24,040 EFFECT OR DO YOU THINK THAT 3538 02:35:24,040 --> 02:35:25,840 MAYBE IT'S JUST THE GENERAL 3539 02:35:25,840 --> 02:35:27,960 PRESSURE THAT THE ROOM 3540 02:35:27,960 --> 02:35:29,800 TEMPERATURE TUBE MIGHT HAVE -- 3541 02:35:29,800 --> 02:35:31,320 IS THERE SOME SORT OF 3542 02:35:31,320 --> 02:35:32,080 STIMULATION OF THE MUSCLE? 3543 02:35:32,080 --> 02:35:34,960 >> I THINK THAT NEEDS FUTURE 3544 02:35:34,960 --> 02:35:37,240 WORK, ALSO TO DETERMINE WHAT 3545 02:35:37,240 --> 02:35:39,640 KIND OF MINIMALLY IMPORTANT 3546 02:35:39,640 --> 02:35:41,240 DIFFERENCE IN PAIN SCORES. 3547 02:35:41,240 --> 02:35:43,440 TYPICALLY WE DON'T SEE PATIENTS 3548 02:35:43,440 --> 02:35:45,760 BACK FOR 6 TO 8 WEEKS, IF THEY 3549 02:35:45,760 --> 02:35:51,760 ARE JUST DOING ICING ALONE. 3550 02:35:51,760 --> 02:35:53,840 AND I THINK WE'VE ANECDOTALLY 3551 02:35:53,840 --> 02:35:55,440 SEEN AND HEARD, NOT SURE I HEARD 3552 02:35:55,440 --> 02:35:57,440 A RESPONSE, SO I THINK THIS ALSO 3553 02:35:57,440 --> 02:36:00,680 NEEDS TO BE TESTED FOR A LONGER 3554 02:36:00,680 --> 02:36:00,920 PERIOD. 3555 02:36:00,920 --> 02:36:04,640 BUT SINCE WE WERE SENDING 3556 02:36:04,640 --> 02:36:07,200 PATIENTS TO P.T. DID NOT WANT TO 3557 02:36:07,200 --> 02:36:08,400 SLOW THEIR GETTING INTO PHYSICAL 3558 02:36:08,400 --> 02:36:09,680 THERAPY. 3559 02:36:09,680 --> 02:36:13,840 AND SO WE CHOSE TWO WEEKS AS A 3560 02:36:13,840 --> 02:36:14,920 FIRST TIME POINT. 3561 02:36:14,920 --> 02:36:20,280 SO I MEAN THAT NEEDS TO BE 3562 02:36:20,280 --> 02:36:22,360 ASSESSED BUT AGAIN THIS IS 3563 02:36:22,360 --> 02:36:24,440 ANECDOTAL, BUT CLINICALLY SEEING 3564 02:36:24,440 --> 02:36:25,520 PATIENTS WHO REPORT ALMOST 3565 02:36:25,520 --> 02:36:26,640 COMPLETE RESOLUTION OF THEIR 3566 02:36:26,640 --> 02:36:29,040 SYMPTOMS, I THINK IT IS MORE 3567 02:36:29,040 --> 02:36:30,240 THAN -- ICING IS MORE THAN 3568 02:36:30,240 --> 02:36:34,320 PLACEBO, WE HAVE TO FIND OUT 3569 02:36:34,320 --> 02:36:37,120 ABOUT THE ROOM TEMPERATURE. 3570 02:36:37,120 --> 02:36:40,360 >> SO, ALONG THE LINES, WE HAD A 3571 02:36:40,360 --> 02:36:42,160 QUESTION THAT COULD STATISTICAL 3572 02:36:42,160 --> 02:36:44,680 DIFFERENCE IN THE PELVIC FLOOR 3573 02:36:44,680 --> 02:36:45,640 ASSESSMENT NOTED ON THE RIGHT 3574 02:36:45,640 --> 02:36:47,440 SIDE BE BASED ON THE FACT THE 3575 02:36:47,440 --> 02:36:50,360 EXAM STARTED ON THE RIGHT SIDE 3576 02:36:50,360 --> 02:36:54,440 OF THE MUSCLES? 3577 02:36:54,440 --> 02:36:56,240 >> YEAH, I MEAN, WE'VE 3578 02:36:56,240 --> 02:36:59,000 STANDARDIZED WITHIN THE PROTOCOL 3579 02:36:59,000 --> 02:37:00,440 OUR PALPATION, LIKE THE DEPTH 3580 02:37:00,440 --> 02:37:05,560 AND PRESSURE THAT WE USED. 3581 02:37:05,560 --> 02:37:08,720 BUT WHEN WE LOOKED, WE FOUND 3582 02:37:08,720 --> 02:37:09,920 ASSOCIATION WITH PEOPLE THAT ARE 3583 02:37:09,920 --> 02:37:11,960 RIGHT-HANDED, OFT FINANCE YOU 3584 02:37:11,960 --> 02:37:16,320 WATCH PEOPLE STAND, P.T.s OR 3585 02:37:16,320 --> 02:37:17,640 PHYSIATRIST TO SPEAK TO THIS 3586 02:37:17,640 --> 02:37:19,760 BETTER THAN I CAN, PEOPLE OFTEN 3587 02:37:19,760 --> 02:37:22,600 STAND ON ONE HIP MORE THAN THE 3588 02:37:22,600 --> 02:37:22,840 OTHER. 3589 02:37:22,840 --> 02:37:26,760 AND SO WE THINK IT MAY HAVE BEEN 3590 02:37:26,760 --> 02:37:28,920 ASSOCIATED WITH THAT. 3591 02:37:28,920 --> 02:37:32,400 THAT ALSO NEEDS FURTHER 3592 02:37:32,400 --> 02:37:32,680 EVALUATION. 3593 02:37:32,680 --> 02:37:36,000 >> I HAD A QUESTION, MYSELF, 3594 02:37:36,000 --> 02:37:39,200 JUST ABOUT THE PATIENTS THAT YOU 3595 02:37:39,200 --> 02:37:43,760 DID NOTE HAD MORE BOTHER FROM 3596 02:37:43,760 --> 02:37:45,840 THEIR PROLAPSE, THEIR URINARY 3597 02:37:45,840 --> 02:37:47,760 INCONTINENCE SYMPTOMS IF THEY 3598 02:37:47,760 --> 02:37:51,000 HAD THE MYOFASCIAL COMPONENT. 3599 02:37:51,000 --> 02:37:52,640 IN YOUR PRACTICE, MAYBE AN AREA 3600 02:37:52,640 --> 02:37:54,800 TO ASK, SHOULD WE BE ADDRESSING 3601 02:37:54,800 --> 02:37:56,760 THAT FOR EVERYBODY AND MAYBE 3602 02:37:56,760 --> 02:37:59,840 TRYING TO ADDRESS THAT PRIOR TO 3603 02:37:59,840 --> 02:38:02,920 ANY OTHER INTERVENTIONS FOR 3604 02:38:02,920 --> 02:38:04,080 OTHER PELVIC FLOOR DISORDERS? 3605 02:38:04,080 --> 02:38:07,440 >> WE DO AS PART OF STANDARD 3606 02:38:07,440 --> 02:38:08,400 INTAKE EXAM PRETTY MUCH ON 3607 02:38:08,400 --> 02:38:10,200 EVERYBODY THAT COMES THROUGH, WE 3608 02:38:10,200 --> 02:38:13,680 DO THAT EXAM AND WE REPORTED, WE 3609 02:38:13,680 --> 02:38:16,040 HAVE SUCH A LARGE NUMBER WHEN WE 3610 02:38:16,040 --> 02:38:19,920 DID OUR RETROSPECTIVE STUDY, WE 3611 02:38:19,920 --> 02:38:20,720 COULD LOOK AT. 3612 02:38:20,720 --> 02:38:23,840 WHAT I -- EVEN MORE WITH 3613 02:38:23,840 --> 02:38:26,200 PROLAPSE, I THINK WHEN PATIENTS 3614 02:38:26,200 --> 02:38:33,200 HAVE PRESSURE HEAVINESS, YOU SEE 3615 02:38:33,200 --> 02:38:38,720 POP Q IT'S NOT EVEN THROUGH THE 3616 02:38:38,720 --> 02:38:40,480 INTROITUS, I ENCOURAGE PATIENTS 3617 02:38:40,480 --> 02:38:48,040 TO TRY P.T. FIRST, TO ADDRESS 3618 02:38:48,040 --> 02:38:50,440 THAT MYOFASCIAL PAN IF THEY HAVE 3619 02:38:50,440 --> 02:38:50,840 IT CONCOMITANTLY. 3620 02:38:50,840 --> 02:38:51,960 A LOT OF TIMES PRESSURE GOES 3621 02:38:51,960 --> 02:38:54,200 AWAY, THEY DON'T NEED OR DESIRE 3622 02:38:54,200 --> 02:38:57,640 SURGERY BUT A LOT OF TIMES THEY 3623 02:38:57,640 --> 02:39:00,600 HAVE BEEN TOLD ON INITIAL 3624 02:39:00,600 --> 02:39:01,600 COMPASSION, OH, PRESSURE 3625 02:39:01,600 --> 02:39:03,120 HEAVINESS, A LITTLE BIT OF 3626 02:39:03,120 --> 02:39:05,440 CHANGE THAT IS VERY COMMON IN 3627 02:39:05,440 --> 02:39:07,840 WOMEN THAT HAD PREGNANCIES AND 3628 02:39:07,840 --> 02:39:09,240 DELIVERIES, THAT THEY HAVE 3629 02:39:09,240 --> 02:39:11,080 PROLAPSE, THEY CAN COME IN 3630 02:39:11,080 --> 02:39:13,200 SAYING, OH, I NEED SURGERY. 3631 02:39:13,200 --> 02:39:15,840 I'M A BIG FAN OF IT. 3632 02:39:15,840 --> 02:39:17,880 WHAT WE ALSO TYPICALLY DO IS, 3633 02:39:17,880 --> 02:39:20,480 THERE'S USUALLY A WAIT FOR 3634 02:39:20,480 --> 02:39:21,760 SURGERY, THAT ENCOURAGE THEM TO 3635 02:39:21,760 --> 02:39:26,480 DO THE P.T., DO THE ICING, AND 3636 02:39:26,480 --> 02:39:30,240 WE REASSESS AT FOLLOW-UP PRE-OP 3637 02:39:30,240 --> 02:39:30,440 VISIT. 3638 02:39:30,440 --> 02:39:32,240 IF SYMPTOMS RESOLVED, THEY MAY 3639 02:39:32,240 --> 02:39:34,920 NOT NEED SURGERY. 3640 02:39:34,920 --> 02:39:35,920 I DO ENCOURAGE INCORPORATING 3641 02:39:35,920 --> 02:39:38,360 THAT EXAM AS PART OF A STANDARD 3642 02:39:38,360 --> 02:39:41,360 INTAKE EXAM IN WOMEN WITH PELVIC 3643 02:39:41,360 --> 02:39:42,000 FLOOR DISORDER SYMPTOMS. 3644 02:39:42,000 --> 02:39:42,840 >> THANK YOU SO MUCH. 3645 02:39:42,840 --> 02:39:46,440 I'M GOING TO SOME QUESTIONS FOR 3646 02:39:46,440 --> 02:39:46,720 DR. DIAS. 3647 02:39:46,720 --> 02:39:47,080 >> THANK YOU. 3648 02:39:47,080 --> 02:39:48,920 >> IF YOU HAVE OTHER QUESTIONS 3649 02:39:48,920 --> 02:39:50,640 FOR DR. LOWDER PUT THEM IN THE 3650 02:39:50,640 --> 02:39:52,520 CHAT SO WE CAN BOTHER HIM AGAIN 3651 02:39:52,520 --> 02:40:02,320 LATER, NOT GIVE HIM FREE TIME. 3652 02:40:02,320 --> 02:40:08,840 THERE WAS A QUESTION THE STROKE 3653 02:40:08,840 --> 02:40:10,080 SPASTICITY HYPERTONICITY IS 3654 02:40:10,080 --> 02:40:10,360 DIFFERENT. 3655 02:40:10,360 --> 02:40:11,320 DO YOU ANTICIPATE BETTER UTILITY 3656 02:40:11,320 --> 02:40:16,440 OF THE DEVICE IN ONE GROUP OVER 3657 02:40:16,440 --> 02:40:18,160 ANOTHER AND COULD YOU PLEASE 3658 02:40:18,160 --> 02:40:21,800 EXPLAIN WHY? 3659 02:40:21,800 --> 02:40:22,200 >> SURE. 3660 02:40:22,200 --> 02:40:23,120 THE SIMPLE EXPLANATION, IF WE 3661 02:40:23,120 --> 02:40:26,720 CAN SHUT DOWN THE MUSCLE, TARGET 3662 02:40:26,720 --> 02:40:29,800 INNERVATION, WE'LL SEE SIMILAR 3663 02:40:29,800 --> 02:40:33,800 OUTCOMES IN BOTH. 3664 02:40:33,800 --> 02:40:35,760 THE MUSCLE IS SHORT SO YOU HAVE 3665 02:40:35,760 --> 02:40:38,920 TO FIND ANOTHER WAY TO TREAT IT. 3666 02:40:38,920 --> 02:40:41,240 I WOULD EXPECT SIMILAR OUTCOMES 3667 02:40:41,240 --> 02:40:43,200 FROM BOTH PATIENT GROUPS. 3668 02:40:43,200 --> 02:40:47,000 AS LONG AS WE CAN HIT THE 3669 02:40:47,000 --> 02:40:47,560 NEUROMUSCULAR JUNCTION WITH 3670 02:40:47,560 --> 02:40:50,480 BOTOX AND SHUT THE MUSCLE DOWN. 3671 02:40:50,480 --> 02:40:51,240 >> FANTASTIC. 3672 02:40:51,240 --> 02:40:54,520 AND I BELIEVE THIS WAS PROBABLY 3673 02:40:54,520 --> 02:40:55,440 THE NEXT QUESTION, DIRECTED 3674 02:40:55,440 --> 02:40:59,640 TOWARDS DR. EVANS SO WE CAN GO 3675 02:40:59,640 --> 02:40:59,840 THERE. 3676 02:40:59,840 --> 02:41:02,840 DOES ANYBODY ELSE HAVE ANY 3677 02:41:02,840 --> 02:41:06,600 QUESTIONS FOR DR. DIAS? 3678 02:41:06,600 --> 02:41:07,600 WE MAY COME BACK TO YOU. 3679 02:41:07,600 --> 02:41:10,080 I WANT TO MAKE SURE WE HAVE TIME 3680 02:41:10,080 --> 02:41:12,320 FOR EVERYBODY. 3681 02:41:12,320 --> 02:41:16,040 SOME MAY BE COMPLICATED AND TAKE 3682 02:41:16,040 --> 02:41:16,320 SOME TIME. 3683 02:41:16,320 --> 02:41:17,840 SO, DR. EVANS, IF WE COULD JUMP 3684 02:41:17,840 --> 02:41:21,360 TO YOU, THERE WAS A COMMENT 3685 02:41:21,360 --> 02:41:24,640 AGAIN TLR INNATE IMMUNE FAMILY 3686 02:41:24,640 --> 02:41:30,840 ARE QUITE INTERRELATED, REDONE 3687 02:41:30,840 --> 02:41:31,800 REDONANT IN FUNCTION. 3688 02:41:31,800 --> 02:41:35,960 ARE YOU LOOKING AT EFFECTING ONS 3689 02:41:35,960 --> 02:41:37,040 OTHER TOLL-LIKE RECEPTORS 3690 02:41:37,040 --> 02:41:38,960 BESIDES TLR 4. 3691 02:41:38,960 --> 02:41:42,960 >> TO VARYING DEGREES, YES. 3692 02:41:42,960 --> 02:41:45,720 WE'RE AWARE THERE TEN IN HUMANS, 3693 02:41:45,720 --> 02:41:47,200 THEY HAVE DIFFERENT ACTIVITIES. 3694 02:41:47,200 --> 02:41:49,200 AND SO WE'RE LOOKING AT A RANGE 3695 02:41:49,200 --> 02:41:50,480 OF TOLL-LIKE RECEPTORS BUT I 3696 02:41:50,480 --> 02:41:52,440 DON'T HAVE THINGS I CAN SHARE 3697 02:41:52,440 --> 02:41:59,560 WITH THAT AT THE MOMENT. 3698 02:41:59,560 --> 02:42:03,240 >> WAS THERE A COMMENT FROM 3699 02:42:03,240 --> 02:42:03,480 SOMEBODY? 3700 02:42:03,480 --> 02:42:05,920 I'LL GIVE THEM ANOTHER MINUTE. 3701 02:42:05,920 --> 02:42:08,440 IF NOT, SORT OF ON THE SAME 3702 02:42:08,440 --> 02:42:10,720 LINES OF THAT TLR 4 HAS MANY 3703 02:42:10,720 --> 02:42:12,480 FUNCTIONS, ACTUALLY CONNECTED TO 3704 02:42:12,480 --> 02:42:19,360 UTERINE DISORDERS SUCH AS 3705 02:42:19,360 --> 02:42:21,880 PRE-TERM LABOR, ANY SPECULATION 3706 02:42:21,880 --> 02:42:26,160 OF LOCAL DELIVERY FOR INHIBITORS 3707 02:42:26,160 --> 02:42:31,640 ON MYOMETRIAL OR PREEXISTING 3708 02:42:31,640 --> 02:42:32,840 DISORDERS ASIDE FROM EXPECTED 3709 02:42:32,840 --> 02:42:33,680 EFFECT ON PAIN? 3710 02:42:33,680 --> 02:42:37,480 >> THEY HAVE LOTS OF POTENTIAL, 3711 02:42:37,480 --> 02:42:38,560 AS YET UNDERDEVELOPED. 3712 02:42:38,560 --> 02:42:40,320 CERTAINLY THERE'S BEEN PAPERS 3713 02:42:40,320 --> 02:42:43,800 COMING OUT SUGGESTING THAT 3714 02:42:43,800 --> 02:42:47,000 EXCESS TLR 4 ACTIVATION 3715 02:42:47,000 --> 02:42:47,760 DISINCREASE PRE-TERM LABOR, 3716 02:42:47,760 --> 02:42:50,720 QUITE A BUSINESS FROM SARAH 3717 02:42:50,720 --> 02:42:52,200 ROBINSON, ROBINSON RESEARCH 3718 02:42:52,200 --> 02:42:53,880 INSTITUTE HERE. 3719 02:42:53,880 --> 02:42:55,440 I THINK - -- I DON'T THINK I CAN 3720 02:42:55,440 --> 02:42:59,240 SAY AT THE MOMENT BUT I THINK 3721 02:42:59,240 --> 02:43:02,960 THAT DR. HENDI IS THINKING WELL 3722 02:43:02,960 --> 02:43:04,440 IN THIS AREA. 3723 02:43:04,440 --> 02:43:10,480 >> AS HE USUALLY DOES. 3724 02:43:10,480 --> 02:43:12,120 I WOULD LIKE TO INVITE THE 3725 02:43:12,120 --> 02:43:13,880 PANELISTS IF THERE ARE NO MORE 3726 02:43:13,880 --> 02:43:14,840 QUESTIONS FROM THE AUDIENCE IN 3727 02:43:14,840 --> 02:43:17,360 THE CHAT. 3728 02:43:17,360 --> 02:43:21,640 3729 02:43:21,640 --> 02:43:23,640 I THINK THE TOPICS WERE A LITTLE 3730 02:43:23,640 --> 02:43:25,360 BIT OVER OUR HEADS. 3731 02:43:25,360 --> 02:43:25,920 MINE INCLUDED. 3732 02:43:25,920 --> 02:43:27,800 WE DO THANK YOU. 3733 02:43:27,800 --> 02:43:28,640 THESE ARE EXCELLENT 3734 02:43:28,640 --> 02:43:29,240 PRESENTATIONS. 3735 02:43:29,240 --> 02:43:31,040 AND ONE OF THE THINGS THAT WE 3736 02:43:31,040 --> 02:43:33,120 ARE HOPING TO ACCOMPLISH WITH 3737 02:43:33,120 --> 02:43:36,000 THIS IS GETTING THE DISCUSSION 3738 02:43:36,000 --> 02:43:37,520 GOING, AND TALKING AMONGST THE 3739 02:43:37,520 --> 02:43:40,160 DIFFERENT EXPERTISE TO SEE WHERE 3740 02:43:40,160 --> 02:43:40,480 THINGS CAN GO. 3741 02:43:40,480 --> 02:43:42,920 AND SO ONE OF THE QUESTIONS I 3742 02:43:42,920 --> 02:43:46,240 WOULD HAVE TO ALL OF OUR 3743 02:43:46,240 --> 02:43:47,960 PRESENTERS WOULD BE DO YOU HAVE 3744 02:43:47,960 --> 02:43:50,440 ANY THOUGHTS ON WHAT THE ISSUES 3745 02:43:50,440 --> 02:43:51,000 WITH HEALTH DISPARITY AND 3746 02:43:51,000 --> 02:43:56,280 DIVERSITY IN THE FIELD OF 3747 02:43:56,280 --> 02:43:59,080 GYNECOLOGIC PAIN RESEARCH ARE? 3748 02:43:59,080 --> 02:44:00,840 WITH RELATIONSHIP TO WHAT YOU'RE 3749 02:44:00,840 --> 02:44:01,480 DOING SPECIFICALLY. 3750 02:44:01,480 --> 02:44:03,640 >> CAN I TALK ON THAT ONE? 3751 02:44:03,640 --> 02:44:03,880 >> YES. 3752 02:44:03,880 --> 02:44:05,760 SINCE WE HAVE YOU UP. 3753 02:44:05,760 --> 02:44:08,560 >> MY OTHER HAT OF COURSE IS 3754 02:44:08,560 --> 02:44:11,000 RUNNING A PELVIC PAIN CENTER OF 3755 02:44:11,000 --> 02:44:11,640 AUSTRALIA, WE'VE ASKED 3756 02:44:11,640 --> 02:44:14,400 THROUGHOUT ALL THE STATES OF 3757 02:44:14,400 --> 02:44:16,440 AUSTRALIA NOW ON PAIN, 3758 02:44:16,440 --> 02:44:17,120 ENDOMETRIOSIS, PELVIC PAIN 3759 02:44:17,120 --> 02:44:19,520 PERIODS, AND I THINK WE HAVE TO 3760 02:44:19,520 --> 02:44:22,080 GET BACK TO THE EARLY STAGES OF 3761 02:44:22,080 --> 02:44:22,960 HOW ALL THIS STARTED. 3762 02:44:22,960 --> 02:44:26,080 AND WE HAVE TO GET AWAY FROM THE 3763 02:44:26,080 --> 02:44:28,160 SORT OF LINEAR CONCEPT WITH 3764 02:44:28,160 --> 02:44:31,240 THINGS THAT YOU HAVE A HEALTHY 3765 02:44:31,240 --> 02:44:34,040 CHILD, GETS A PERIOD, RETROGRADE 3766 02:44:34,040 --> 02:44:35,040 MENSTRUATION, DEVELOPS 3767 02:44:35,040 --> 02:44:36,000 ENDOMETRIOSIS LESION, GETS PAIN, 3768 02:44:36,000 --> 02:44:41,600 AS IF THEY ARE ALL CAUSAL AND 3769 02:44:41,600 --> 02:44:41,840 ALIGNED. 3770 02:44:41,840 --> 02:44:46,760 GIRLS SAY MY FIRST PERIOD WAS 3771 02:44:46,760 --> 02:44:48,800 DREADFUL, OR SOON THEREAFTER. 3772 02:44:48,800 --> 02:44:50,520 CENTRAL MECHANISMS, THEY START 3773 02:44:50,520 --> 02:44:51,280 YOUNG. 3774 02:44:51,280 --> 02:44:53,840 AND WE NEED TO START YOUNG AND 3775 02:44:53,840 --> 02:44:55,240 LOOK AT THE BIG PICTURE, NOT 3776 02:44:55,240 --> 02:44:59,280 JUST WHAT WE CAN SEE DOWN THE 3777 02:44:59,280 --> 02:45:00,600 LAPAROSCOPE IF WE'RE GOING TO 3778 02:45:00,600 --> 02:45:02,800 MAKE MAJOR CHANGE IN THIS AREA. 3779 02:45:02,800 --> 02:45:03,640 >> THAT'S AN EXCELLENT POINT. 3780 02:45:03,640 --> 02:45:07,040 THAT WAS BROUGHT UP IN OUR 3781 02:45:07,040 --> 02:45:09,960 PREVIOUS SESSION 2, TRYING TO 3782 02:45:09,960 --> 02:45:12,040 EXAMINE THIS PRIOR TO THE PAIN 3783 02:45:12,040 --> 02:45:13,240 EVEN STARTING, MAYBE LOOKING 3784 02:45:13,240 --> 02:45:13,640 YOUNGER. 3785 02:45:13,640 --> 02:45:15,240 DR. EVANS, COULD YOU GIVE US -- 3786 02:45:15,240 --> 02:45:17,640 I WANTED TO ASK SINCE WE HAVE A 3787 02:45:17,640 --> 02:45:18,880 FEW MINUTES, CURIOUS ABOUT THIS 3788 02:45:18,880 --> 02:45:21,120 PROGRAM THAT YOU DO HAVE IN 3789 02:45:21,120 --> 02:45:22,640 AUSTRALIA, IF YOU COULD GIVE US 3790 02:45:22,640 --> 02:45:23,760 A BACKGROUND. 3791 02:45:23,760 --> 02:45:25,400 >> IT'S JUST FANTASTIC. 3792 02:45:25,400 --> 02:45:26,840 SO, I CO-WROTE THE PROGRAM 3793 02:45:26,840 --> 02:45:27,240 MYSELF. 3794 02:45:27,240 --> 02:45:29,560 I TRAIN ALL THE EDUCATORS. 3795 02:45:29,560 --> 02:45:31,960 SO WE HAVE GOVERNMENT FUNDING 3796 02:45:31,960 --> 02:45:33,400 TO -- WE'VE BEEN THREE YEARS IN 3797 02:45:33,400 --> 02:45:34,840 MY STATE HERE, TWO YEARS IN 3798 02:45:34,840 --> 02:45:37,480 ANOTHER ONE, WE GOT FUNDING TO 3799 02:45:37,480 --> 02:45:40,440 EXTEND TO EVERY STATE IN 3800 02:45:40,440 --> 02:45:42,440 AUSTRALIA. 3801 02:45:42,440 --> 02:45:44,200 SO WE HAVE TRAINED EDUCATORS WHO 3802 02:45:44,200 --> 02:45:45,840 TALK TO GIRLS ABOUT HOW THEY CAN 3803 02:45:45,840 --> 02:45:48,560 RECOGNIZE IF THEIR PAIN IS 3804 02:45:48,560 --> 02:45:49,640 NORMAL OR ABNORMAL. 3805 02:45:49,640 --> 02:45:51,160 WE DON'T WANT TO FEARMONGER 3806 02:45:51,160 --> 02:45:52,440 EVERYBODY, JUST WANT TO HELP 3807 02:45:52,440 --> 02:45:54,240 THEM WORK AT WHAT'S NORMAL, 3808 02:45:54,240 --> 02:45:55,520 WHAT'S NOT NORMAL, SIMPLE THINGS 3809 02:45:55,520 --> 02:45:57,160 THEY CAN DO THEMSELVES, HOW THE 3810 02:45:57,160 --> 02:45:59,800 OTHER SYMPTOMS FIT IN, THE BIG 3811 02:45:59,800 --> 02:46:00,440 PICTURE, AND WHEN THEY -- 3812 02:46:00,440 --> 02:46:02,200 WHETHER THEY ARE SOMEONE WHO 3813 02:46:02,200 --> 02:46:03,840 SHOULD GO LOOKING FOR HELP 3814 02:46:03,840 --> 02:46:04,040 EARLY. 3815 02:46:04,040 --> 02:46:06,800 AND HOW TO DO THAT. 3816 02:46:06,800 --> 02:46:07,800 WE HAVE OUR PRE-PRESENTATIONS, 3817 02:46:07,800 --> 02:46:12,040 FOR THE ONES WHO HAVEN'T GOT 3818 02:46:12,040 --> 02:46:13,480 MUCH HEALTH LITERACY AND POST 3819 02:46:13,480 --> 02:46:14,720 PRESENTATIONS, IF YOU HAVE PAIN 3820 02:46:14,720 --> 02:46:16,320 WHAT TO DO NEXT. 3821 02:46:16,320 --> 02:46:18,640 WE ALSO ACTUALLY ARE BRINGING IN 3822 02:46:18,640 --> 02:46:20,440 OUR PROGRAM FOR -- MODIFIED 3823 02:46:20,440 --> 02:46:24,200 PROGRAM FOR BOYS TO HELP THEM BE 3824 02:46:24,200 --> 02:46:24,800 MORE COMFORTABLE UNDERSTANDING 3825 02:46:24,800 --> 02:46:26,280 AND TALKING ABOUT THESE ISSUES, 3826 02:46:26,280 --> 02:46:27,640 AND ALSO TEACHING THEM HOW TO 3827 02:46:27,640 --> 02:46:29,320 SUPPORT THE WOMEN IN THEIR LIFE 3828 02:46:29,320 --> 02:46:30,080 WITH PAIN. 3829 02:46:30,080 --> 02:46:31,840 SO IT'S GOING REALLY WELL. 3830 02:46:31,840 --> 02:46:35,880 IT'S CALLED THE PEP TALK 3831 02:46:35,880 --> 02:46:36,120 PROGRAM. 3832 02:46:36,120 --> 02:46:38,400 AND IT'S SO POPULAR. 3833 02:46:38,400 --> 02:46:42,560 100% OF SCHOOLS WANT US BACK. 3834 02:46:42,560 --> 02:46:43,720 >> FANTASTIC. 3835 02:46:43,720 --> 02:46:44,440 CONGRATULATIONS ON BEING ABLE TO 3836 02:46:44,440 --> 02:46:46,440 DEVELOP SUCH A GREAT PROGRAM. 3837 02:46:46,440 --> 02:46:47,640 >> THANK YOU. 3838 02:46:47,640 --> 02:46:49,720 >> AND INCORPORATING MEN. 3839 02:46:49,720 --> 02:46:51,200 >> YES, WE LOVE EVERYBODY. 3840 02:46:51,200 --> 02:46:54,880 >> IT'S ALWAYS A BRILLIANT 3841 02:46:54,880 --> 02:46:58,200 THING. 3842 02:46:58,200 --> 02:46:59,480 DR. DIAS, IN CLINICAL PRACTICE A 3843 02:46:59,480 --> 02:47:01,920 LOT OF PATIENTS GET BORED OF 3844 02:47:01,920 --> 02:47:03,760 TRAINING, MORE IMPORTANTLY 3845 02:47:03,760 --> 02:47:04,440 FORGET TRAINING, EVEN MAYBE 3846 02:47:04,440 --> 02:47:06,040 PROVIDERS WHO TALK ABOUT THAT 3847 02:47:06,040 --> 02:47:07,360 SORT OF TRAINING ALL DAY LONG 3848 02:47:07,360 --> 02:47:09,880 DON'T EVEN REMEMBER TO DO THEIR 3849 02:47:09,880 --> 02:47:10,240 OWN TRAINING. 3850 02:47:10,240 --> 02:47:14,240 DO YOU HAVE ANY WORDS OF WISDOM? 3851 02:47:14,240 --> 02:47:14,720 >> SURE. 3852 02:47:14,720 --> 02:47:15,920 SO I CAN SPEAK. 3853 02:47:15,920 --> 02:47:20,840 THERE'S BEEN SOME PUSH TO TRY TO 3854 02:47:20,840 --> 02:47:22,480 GAMIFY PELVIC FLOOR MUSCLE 3855 02:47:22,480 --> 02:47:23,240 THERAPY. 3856 02:47:23,240 --> 02:47:24,360 YOU'VE SEEN THE BIOFEEDBACK 3857 02:47:24,360 --> 02:47:26,520 DEVICES IN THE CLINIC NOW, 3858 02:47:26,520 --> 02:47:26,960 RIGHT? 3859 02:47:26,960 --> 02:47:28,600 IT'S A SCREEN THAT MAYBE SHOWS A 3860 02:47:28,600 --> 02:47:29,680 SIGNAL OR MAYBE A LIGHT THAT 3861 02:47:29,680 --> 02:47:32,840 YOUR MUSCLE IS ON, MAY NOT SHOW 3862 02:47:32,840 --> 02:47:34,160 A SIGNAL AND VAGINAL PROBE. 3863 02:47:34,160 --> 02:47:36,840 THERE'S BEEN SOME WORK TO TRY TO 3864 02:47:36,840 --> 02:47:41,040 GAMIFY THIS INTO A CELL PHONE 3865 02:47:41,040 --> 02:47:43,080 APP, DETAILED SIGNAL, GIVE 3866 02:47:43,080 --> 02:47:44,640 ACHIEVEMENTS AS YOU PROGRESS 3867 02:47:44,640 --> 02:47:46,040 THROUGH YOUR TREATMENT. 3868 02:47:46,040 --> 02:47:49,320 AND THEN TRY TO LOOP THE CLOUD 3869 02:47:49,320 --> 02:47:52,000 INTO IT AND LOOP THE CLINICIAN 3870 02:47:52,000 --> 02:47:53,440 IN WHO HELP TRACK THE TREATMENT. 3871 02:47:53,440 --> 02:47:55,360 THERE'S A LOT OF WAYS. 3872 02:47:55,360 --> 02:47:59,440 IT'S A HUGE ISSUE THOUGH, THESE 3873 02:47:59,440 --> 02:48:00,120 AT-HOME TREATMENTS, PATIENTS 3874 02:48:00,120 --> 02:48:01,400 FORGET TO DO THEIR TREATMENT OR 3875 02:48:01,400 --> 02:48:02,360 GET BORED. 3876 02:48:02,360 --> 02:48:04,320 JUST AS YOU SAID. 3877 02:48:04,320 --> 02:48:06,840 SO IF THERE'S SOME WAY BRINGING 3878 02:48:06,840 --> 02:48:09,600 ON THE CELL PHONE, GAMIFY IT, 3879 02:48:09,600 --> 02:48:13,320 GIVE BENCHMARKS AS THE PATIENT 3880 02:48:13,320 --> 02:48:14,840 MOVES ALONG. 3881 02:48:14,840 --> 02:48:15,280 >> REWARDS. 3882 02:48:15,280 --> 02:48:15,560 >> YEAH. 3883 02:48:15,560 --> 02:48:17,560 AND IT LOOPS BACK IN HOW DO WE 3884 02:48:17,560 --> 02:48:19,760 MAKE SURE WE'RE HITTING ALL OUR 3885 02:48:19,760 --> 02:48:20,160 POPULATIONS. 3886 02:48:20,160 --> 02:48:22,840 IF YOU PUT THE CELL PHONE APP, 3887 02:48:22,840 --> 02:48:23,720 MAYBE YOUR OLDER PATIENTS MAY 3888 02:48:23,720 --> 02:48:25,800 NOT BE AS GOOD WITH THE CELL 3889 02:48:25,800 --> 02:48:28,880 PHONE OR DOWNLOADING AN APP, 3890 02:48:28,880 --> 02:48:29,640 CONNECTING TO BLUETOOTH, RIGHT? 3891 02:48:29,640 --> 02:48:33,080 YOU HAVE TO MAKE SURE THE OLDER 3892 02:48:33,080 --> 02:48:40,720 ONES ARE TRAINED AS WELL. 3893 02:48:40,720 --> 02:48:45,360 >> WHAT IS THE SAFE TLR 4 3894 02:48:45,360 --> 02:48:46,800 INHIBITOR IN THE MARKET? 3895 02:48:46,800 --> 02:48:50,800 TO YOU, DR. EVANS. 3896 02:48:50,800 --> 02:48:52,520 >> THERE'S A LOT CURRENTLY 3897 02:48:52,520 --> 02:48:52,840 AVAILABLE. 3898 02:48:52,840 --> 02:49:02,600 THE POSTER ONE IS CALLED TAC2 3899 02:49:02,600 --> 02:49:06,440 42, A FEWER SELECTIVE TLR4, 3900 02:49:06,440 --> 02:49:07,480 INHIBITOR, TRIALS IN SEPSIS, AND 3901 02:49:07,480 --> 02:49:11,640 SO THE THING IS WITH ALL OF 3902 02:49:11,640 --> 02:49:16,400 THEM -- OH, THERE'S NUTRITIONAL 3903 02:49:16,400 --> 02:49:19,240 SUBSTANCES WITH SOME INHIBITOR 3904 02:49:19,240 --> 02:49:22,640 ACTION, FOR EXAMPLE CURCUMIN, 3905 02:49:22,640 --> 02:49:27,400 PALMITOL ETHANOLAMID, SOME ARE 3906 02:49:27,400 --> 02:49:28,120 ORAL MEDICATIONS THAT REDUCE 3907 02:49:28,120 --> 02:49:28,560 INFLAMMATION. 3908 02:49:28,560 --> 02:49:29,760 QUITE A FEW. 3909 02:49:29,760 --> 02:49:30,920 OURS IS VERY DIFFERENT BECAUSE 3910 02:49:30,920 --> 02:49:34,000 WE'RE DOING IT JUST IN THE 3911 02:49:34,000 --> 02:49:36,240 UTERUS, AND WE'RE NOT -- WITH 3912 02:49:36,240 --> 02:49:37,240 MINIMAL SYSTEMIC ANYTHING. 3913 02:49:37,240 --> 02:49:41,040 SO OURS IS WORKING ON THAT 3914 02:49:41,040 --> 02:49:41,640 UTERUS CNS CIRCUIT, WHEREAS IF 3915 02:49:41,640 --> 02:49:43,520 YOU THINK OF A LOT OF THINGS 3916 02:49:43,520 --> 02:49:44,760 THAT PEOPLE HEAR ABOUT THAT ARE 3917 02:49:44,760 --> 02:49:46,520 GOOD FOR THEM THEY SAY, OH, THIS 3918 02:49:46,520 --> 02:49:49,400 IS GOOD FOR ME, YOU'LL FIND IT'S 3919 02:49:49,400 --> 02:49:50,440 GOT AN ANTI-INFLAMMATORY EFFECT. 3920 02:49:50,440 --> 02:49:53,320 AND QUITE A BIT OF THAT IS 3921 02:49:53,320 --> 02:49:55,280 THROUGH TOLL-LIKE RECEPTORS. 3922 02:49:55,280 --> 02:49:56,520 >> COULD YOU ELABORATE WHAT THE 3923 02:49:56,520 --> 02:49:58,520 SIDE EFFECTS WOULD BE WHEN GIVEN 3924 02:49:58,520 --> 02:50:03,800 MORE SYSTEMIC ALLY? 3925 02:50:03,800 --> 02:50:04,840 >> IT DEPENDS ON THE DRUG, AND 3926 02:50:04,840 --> 02:50:05,520 THE COMPOUND. 3927 02:50:05,520 --> 02:50:10,480 I DON'T HAVE ALL OF THOSE HERE. 3928 02:50:10,480 --> 02:50:12,440 BUT I THINK QUITE -- THERE'S 3929 02:50:12,440 --> 02:50:13,360 SOME -- QUITE A FEW THINGS. 3930 02:50:13,360 --> 02:50:15,960 I DON'T THINK I CAN TODAY, TO 3931 02:50:15,960 --> 02:50:20,560 OUTLINE ALL THE SIDE EFFECTS AND 3932 02:50:20,560 --> 02:50:20,880 THINGS. 3933 02:50:20,880 --> 02:50:24,240 SOME DRUGS ORALLY DO HAVE THOSE 3934 02:50:24,240 --> 02:50:24,720 EFFECTS. 3935 02:50:24,720 --> 02:50:27,840 BUT NOT ALWAYS WELL TOLERATED BY 3936 02:50:27,840 --> 02:50:29,080 HUMANS WHEN USED ORALLY. 3937 02:50:29,080 --> 02:50:30,720 >> WE HAD ANOTHER QUESTION IN 3938 02:50:30,720 --> 02:50:31,680 THE LAST MINUTE. 3939 02:50:31,680 --> 02:50:33,440 I'LL DIRECT THIS TO ANY OF THE 3940 02:50:33,440 --> 02:50:36,360 PANELISTS, BUT MANY WOMEN WILL 3941 02:50:36,360 --> 02:50:37,240 RECEIVE ORAL CONTRACEPTIVES AS 3942 02:50:37,240 --> 02:50:39,760 FIRST LINE THERAPY FOR CHRONIC 3943 02:50:39,760 --> 02:50:42,000 PELVIC PAIN BEFORE SEEN MY 3944 02:50:42,000 --> 02:50:44,080 RESEARCH ORIENTED SPECIALIST 3945 02:50:44,080 --> 02:50:44,520 CLINICIANS. 3946 02:50:44,520 --> 02:50:47,080 HOW DOES PRIOR EXPOSURE TO ORAL 3947 02:50:47,080 --> 02:50:50,240 CONTRACEPTIVES IMPACT YOUR 3948 02:50:50,240 --> 02:50:50,640 ASSESSMENT OF PAIN? 3949 02:50:50,640 --> 02:50:52,480 >> YES, YOU'RE ASKING ME? 3950 02:50:52,480 --> 02:50:53,040 OR ANYBODY? 3951 02:50:53,040 --> 02:50:54,280 >> IT WAS A GENERAL QUESTION SO 3952 02:50:54,280 --> 02:50:58,400 I'LL PUT IT OUT TO ANYBODY WHO 3953 02:50:58,400 --> 02:50:59,560 IS WILLING TO ANSWER. 3954 02:50:59,560 --> 02:51:01,720 GO FOR IT, DR. EVANS. 3955 02:51:01,720 --> 02:51:03,440 >> I CAN THINK OF ONE MAJOR 3956 02:51:03,440 --> 02:51:05,080 THING THAT'S OFTEN OVERLOOKED. 3957 02:51:05,080 --> 02:51:09,640 I PRESENTED THIS AT THE WORLD 3958 02:51:09,640 --> 02:51:10,240 ENDOCONGRESS IN 2021, I THINK 3959 02:51:10,240 --> 02:51:13,240 ONE OF THE THINGS THE PILL DOES, 3960 02:51:13,240 --> 02:51:16,440 IT'S GOT UNDOUBTED BENEFITS BY 3961 02:51:16,440 --> 02:51:18,640 REDUCING MENSTRUATION, BLOOD 3962 02:51:18,640 --> 02:51:22,640 LOSS, BUT ALSO DRAMATICALLY 3963 02:51:22,640 --> 02:51:23,960 REDUCES ANDROGENS, INCREASES SEX 3964 02:51:23,960 --> 02:51:25,360 HORMONE BINDING GLOBULIN. 3965 02:51:25,360 --> 02:51:30,840 YOU PUT SOMEONE ON THE PILL 3966 02:51:30,840 --> 02:51:35,000 YOU'RE DRAMATICALLY REDUCING HER 3967 02:51:35,000 --> 02:51:36,040 ANDROGEN EFFECT, THE LOWER THAT, 3968 02:51:36,040 --> 02:51:38,440 THE MORE DAYS OF PELVIC PAIN. 3969 02:51:38,440 --> 02:51:38,880 TWO-EDGED THING. 3970 02:51:38,880 --> 02:51:40,240 THERE'S BENEFITS TO THE PILL AND 3971 02:51:40,240 --> 02:51:42,600 THERE'S DOWN SIDES TO THE PILL. 3972 02:51:42,600 --> 02:51:44,440 AND THIS IS ANOTHER REASON WHY 3973 02:51:44,440 --> 02:51:46,880 IF WE CAN DO OUR BEST AS 3974 02:51:46,880 --> 02:51:49,320 CLINICIANS TO SOMETIMES MOVE 3975 02:51:49,320 --> 02:51:51,320 MORE TO THE INTRAUTERINE DEVICE 3976 02:51:51,320 --> 02:51:52,760 AND ALLOW NATURAL CYCLES WE'RE 3977 02:51:52,760 --> 02:51:55,880 AT LEAST REDUCING ONE FACTOR 3978 02:51:55,880 --> 02:51:57,120 THAT DIMINISHES ANDROGENS, SO 3979 02:51:57,120 --> 02:51:59,240 ANDROGENS AND PELVIC PAIN IS MY 3980 02:51:59,240 --> 02:51:59,840 OTHER INTEREST IN RESEARCH. 3981 02:51:59,840 --> 02:52:00,920 >> THANK YOU VERY MUCH. 3982 02:52:00,920 --> 02:52:03,240 THANK YOU SO MUCH TO THE THREE 3983 02:52:03,240 --> 02:52:03,720 SPEAKERS. 3984 02:52:03,720 --> 02:52:04,320 GO AHEAD. 3985 02:52:04,320 --> 02:52:06,520 >> I WOULD JUMP IN AND SAY 3986 02:52:06,520 --> 02:52:08,680 THOUGH, I THINK IT'S PRETTY 3987 02:52:08,680 --> 02:52:09,240 COMPLEX ISSUE. 3988 02:52:09,240 --> 02:52:11,760 WE KNOW THAT MANY OF THESE 3989 02:52:11,760 --> 02:52:14,600 GYNECOLOGIC PAIN CONDITIONS LIKE 3990 02:52:14,600 --> 02:52:16,680 ENDOMETRIOSIS AND ADENOMYOSIS 3991 02:52:16,680 --> 02:52:19,200 ARE ESTROGEN DRIVEN AND ESTROGEN 3992 02:52:19,200 --> 02:52:23,680 DRIVES INFLAMMATION AS WELL AS 3993 02:52:23,680 --> 02:52:32,280 SOME OTHER PATHWAYS, AND 3994 02:52:32,280 --> 02:52:34,480 ESTRADIOL SUPPRESSION IS 3995 02:52:34,480 --> 02:52:36,280 CURRENTLY THE ONLY ONE APPROVED, 3996 02:52:36,280 --> 02:52:40,880 TO REDUCE ESTRADIOL BEFORE THEY 3997 02:52:40,880 --> 02:52:48,880 GET A DIAGNOSIS OF ENDOMETRIOSIS 3998 02:52:48,880 --> 02:52:51,960 AND WE DON'T KNOW ENOUGH YET 3999 02:52:51,960 --> 02:52:53,920 ABOUT ITS EFFECTS ON 4000 02:52:53,920 --> 02:52:56,320 TESTOSTERONE TO REALLY HELP US 4001 02:52:56,320 --> 02:52:58,920 GUIDE WHICH LIKE AMONGST THE 4002 02:52:58,920 --> 02:53:01,880 MANY DIFFERENT TYPES OF HORMONE 4003 02:53:01,880 --> 02:53:02,640 SUPPRESSION, WHAT THOSE EFFECTS 4004 02:53:02,640 --> 02:53:03,840 WOULD BE. 4005 02:53:03,840 --> 02:53:04,840 AND SO IT VARIES. 4006 02:53:04,840 --> 02:53:06,920 IT PROBABLY IS JUST UNCLEAR AND 4007 02:53:06,920 --> 02:53:10,520 I THINK THIS IS WHY THIS TYPE OF 4008 02:53:10,520 --> 02:53:11,960 DETAILED PHENOTYPING IS GOING TO 4009 02:53:11,960 --> 02:53:12,920 BE CRITICAL. 4010 02:53:12,920 --> 02:53:15,320 I WAS ACTUALLY JUST LOOKING UP A 4011 02:53:15,320 --> 02:53:18,560 REFERENCE FOR THIS, IN A BIG 4012 02:53:18,560 --> 02:53:20,840 HEALTH CLAIMS DATA ANALYSIS. 4013 02:53:20,840 --> 02:53:24,400 ANYWHERE BETWEEN 42 AND 60% OF 4014 02:53:24,400 --> 02:53:31,840 WOMEN ARE USING SOME METHOD OF 4015 02:53:31,840 --> 02:53:35,240 ESTROGEN PROGESTIN, IT GOES UP 4016 02:53:35,240 --> 02:53:36,320 AFTERWARDS, IT IS EFFECTIVE, I 4017 02:53:36,320 --> 02:53:38,680 DON'T WANT PEOPLE TO WALK AWAY 4018 02:53:38,680 --> 02:53:41,040 THINKING THAT WE SHOULD BE 4019 02:53:41,040 --> 02:53:42,240 TAKING AWAY HORMONE SUPPRESSION 4020 02:53:42,240 --> 02:53:46,160 AND FOR SPECIFIC TYPES OF 4021 02:53:46,160 --> 02:53:48,360 PATIENTS SOMETHING LIKE 4022 02:53:48,360 --> 02:53:49,320 PROGESTIN OR IUD-BASED TREATMENT 4023 02:53:49,320 --> 02:53:55,480 WILL ACTUALLY NOT BE E 4024 02:53:55,480 --> 02:53:55,880 EFFECTIVE. 4025 02:53:55,880 --> 02:53:58,480 WHERE OVULATION IS A BIG PART OF 4026 02:53:58,480 --> 02:54:01,480 THE PATHOPHYSIOLOGY, WE KNOW WE 4027 02:54:01,480 --> 02:54:03,120 DON'T GET ADEQUATE OVULATION 4028 02:54:03,120 --> 02:54:05,080 SUPPRESSION, WITH IUDs, SO WE 4029 02:54:05,080 --> 02:54:09,800 NEED TO THINK ABOUT IT IN A 4030 02:54:09,800 --> 02:54:10,360 MORE -- A NUANCED FASHION. 4031 02:54:10,360 --> 02:54:13,400 >> THANK YOU SO MUCH. 4032 02:54:13,400 --> 02:54:17,320 I'M GOING TO TURN THE PROJECTION 4033 02:54:17,320 --> 02:54:24,080 BACK TO DR. TING AND DR. AHN FOR 4034 02:54:24,080 --> 02:54:27,080 OUR FINAL DISCUSSION. 4035 02:54:27,080 --> 02:54:32,760 >> THANK YOU VERY MUCH FOR 4036 02:54:32,760 --> 02:54:36,320 MODERATING THIS SESSION 2. 4037 02:54:36,320 --> 02:54:40,160 I WILL MODERATE THE DISCUSSION 4038 02:54:40,160 --> 02:54:40,400 SESSION. 4039 02:54:40,400 --> 02:54:42,920 DR. TING, COULD YOU BRIEFLY 4040 02:54:42,920 --> 02:54:43,840 INTRODUCE YOURSELF? 4041 02:54:43,840 --> 02:54:44,760 >> OF COURSE, YES. 4042 02:54:44,760 --> 02:54:47,160 I KNOW A LOT OF PEOPLE ON THE 4043 02:54:47,160 --> 02:54:48,400 CALL FROM OVERSEEING THE 4044 02:54:48,400 --> 02:54:51,640 PORTFOLIO IN THE PAST. 4045 02:54:51,640 --> 02:54:55,440 I'M A PROGRAM OFFICER IN THE 4046 02:54:55,440 --> 02:54:57,600 GYNECOLOGIC DISEASE BRANCH, FOR 4047 02:54:57,600 --> 02:55:02,520 ABOUT SEVEN YEARS NOW. 4048 02:55:02,520 --> 02:55:04,520 HAVE OVERSEEN THIS, WE'RE SO 4049 02:55:04,520 --> 02:55:07,440 HAPPY TO HAVE A NEUROSCIENTIST 4050 02:55:07,440 --> 02:55:15,960 SPECIALIST AMONG US NOW THAT CAN 4051 02:55:15,960 --> 02:55:20,160 SPEAK TO THESE ISSUES. 4052 02:55:20,160 --> 02:55:22,240 >> TODAY DR. LISA HALVORSON 4053 02:55:22,240 --> 02:55:28,840 JOINS US, FORMER BRANCH CHIEF, 4054 02:55:28,840 --> 02:55:30,840 NOW SENIOR MEDICAL DIRECTOR. 4055 02:55:30,840 --> 02:55:31,080 WELCOME. 4056 02:55:31,080 --> 02:55:31,440 >> THANK YOU. 4057 02:55:31,440 --> 02:55:35,440 I'M HONORED TO BE ASKED TO SAY 4058 02:55:35,440 --> 02:55:36,960 HELLO TO THIS GROUP. 4059 02:55:36,960 --> 02:55:39,200 MANY FACES THAT ARE FAMILIAR TO 4060 02:55:39,200 --> 02:55:44,400 ME, IT'S TERRIFIC TO BE ABLE TO 4061 02:55:44,400 --> 02:55:47,880 SEE THIS MEETING COME TO 4062 02:55:47,880 --> 02:55:51,680 FRUITION. 4063 02:55:51,680 --> 02:55:56,640 I HAD THE HONOR OF BEING CHIEF 4064 02:55:56,640 --> 02:55:58,240 BRANCH FOR MANY YEARS, I WILL 4065 02:55:58,240 --> 02:56:01,240 USE THIS AS A PLUG TO TELL ANY 4066 02:56:01,240 --> 02:56:02,840 OF YOU OUT THERE IF YOU HAVE ANY 4067 02:56:02,840 --> 02:56:04,800 THOUGHTS OF WAYS IN WHICH PHARMA 4068 02:56:04,800 --> 02:56:08,880 COULD BE OF USE TO YOU, EITHER 4069 02:56:08,880 --> 02:56:10,080 IN THE THERAPEUTIC OR DIAGNOSTIC 4070 02:56:10,080 --> 02:56:12,640 SPACES, ALWAYS FEEL FREE TO 4071 02:56:12,640 --> 02:56:21,320 REACH OUT TO ME. 4072 02:56:21,320 --> 02:56:21,960 LISA.HALVORON@BAYER.COM OR TRACK 4073 02:56:21,960 --> 02:56:23,240 ME DOWN THROUGH THE BRANCH 4074 02:56:23,240 --> 02:56:23,640 MEMBERS. 4075 02:56:23,640 --> 02:56:26,360 I WANT TO SAY WE'VE TALKED ABOUT 4076 02:56:26,360 --> 02:56:27,480 WANTING TO HAVE A MEETING LIKE 4077 02:56:27,480 --> 02:56:35,320 THIS FOR A NUMBER OF YEARS, 4078 02:56:35,320 --> 02:56:37,280 BETWEEN COVID AND NOT HAVING THE 4079 02:56:37,280 --> 02:56:38,040 CORRECT PROGRAM OFFICER IT 4080 02:56:38,040 --> 02:56:39,400 WASN'T THE TIME TO DO IT. 4081 02:56:39,400 --> 02:56:42,520 I'M THRILLED TO SEE THIS COME TO 4082 02:56:42,520 --> 02:56:45,960 FRUITION, TERRIFIC, TERRIFIC 4083 02:56:45,960 --> 02:56:46,920 TALKS TODAY. 4084 02:56:46,920 --> 02:56:47,600 ONE OF THE ADVANTAGES OF 4085 02:56:47,600 --> 02:56:55,040 DELAYING IS THE FIELD HAS MADE A 4086 02:56:55,040 --> 02:56:55,840 REMARKABLE AMOUNT OF PROGRESS 4087 02:56:55,840 --> 02:56:58,200 WE'RE ABLE TO SEE PRESENTED TO 4088 02:56:58,200 --> 02:56:58,720 US. 4089 02:56:58,720 --> 02:57:09,320 CONGRATS TO THE INVESTIGATORS 4090 02:57:09,320 --> 02:57:11,280 AND PRESENTERS AND GHDB FOR 4091 02:57:11,280 --> 02:57:12,480 PULLING THIS TOGETHER, I TAKE 4092 02:57:12,480 --> 02:57:14,320 PRIDE EVEN THOUGH I HAD NOTHING 4093 02:57:14,320 --> 02:57:16,280 TO DO WITH IT COMING TOGETHER. 4094 02:57:16,280 --> 02:57:16,640 THANKS AGAIN. 4095 02:57:16,640 --> 02:57:25,640 >> VERY HAPPY TO SEE YOU AGAIN, 4096 02:57:25,640 --> 02:57:26,240 DR. HALVORSON. 4097 02:57:26,240 --> 02:57:28,840 CAN YOU PUT YOUR CONTACT 4098 02:57:28,840 --> 02:57:30,800 INFORMATION IN THE CHAT? 4099 02:57:30,800 --> 02:57:33,160 SO THERE ARE MANY QUESTIONS WE 4100 02:57:33,160 --> 02:57:36,040 HAVE NOT ADDRESSED DURING THE 4101 02:57:36,040 --> 02:57:36,760 MEETING. 4102 02:57:36,760 --> 02:57:38,880 IF YOU HAVE ANY QUESTIONS, YOU 4103 02:57:38,880 --> 02:57:42,240 WOULD LIKE TO ASK NOW, PLEASE 4104 02:57:42,240 --> 02:57:46,640 RAISE YOUR HAND SO YOU CAN 4105 02:57:46,640 --> 02:57:46,960 SPEAK. 4106 02:57:46,960 --> 02:57:48,240 OR COPY AND PASTE YOUR QUESTION 4107 02:57:48,240 --> 02:57:51,480 ON THE CHAT SO THAT WE CAN SEE 4108 02:57:51,480 --> 02:57:54,840 THEM EASILY. 4109 02:57:54,840 --> 02:57:59,080 >> I CAN MAKE A MODERATOR'S 4110 02:57:59,080 --> 02:58:00,640 PERSPECTIVE TO ASK A QUESTION? 4111 02:58:00,640 --> 02:58:00,880 >> SURE. 4112 02:58:00,880 --> 02:58:02,480 >> I WILL. 4113 02:58:02,480 --> 02:58:07,000 THIS QUESTION IS FOR DAN, SUSIE, 4114 02:58:07,000 --> 02:58:08,400 MAYBE FRANK, ANDREA TALKED ABOUT 4115 02:58:08,400 --> 02:58:09,920 THIS TOO. 4116 02:58:09,920 --> 02:58:13,520 THIS IDEA THAT THESE PHENOTYPES, 4117 02:58:13,520 --> 02:58:16,440 DIFFERENT PHENOTYPES BETWEEN 4118 02:58:16,440 --> 02:58:19,560 PERIPHERAL PAIN AND NOCIPLASTIC 4119 02:58:19,560 --> 02:58:23,560 PAIN, MAYBE INTERMEDIATE 4120 02:58:23,560 --> 02:58:25,640 PHENOTYPE FOR ENDO, AND THE FACT 4121 02:58:25,640 --> 02:58:31,920 WE NEED TO DISAGGREGATE BEFORE 4122 02:58:31,920 --> 02:58:32,640 THE STUDIES. 4123 02:58:32,640 --> 02:58:35,720 HOW DO WE PROPOSE THAT WE DO 4124 02:58:35,720 --> 02:58:37,200 THIS IN STANDARDIZED WAY? 4125 02:58:37,200 --> 02:58:40,160 DO WE NEED TO BE BEFORE WE EVEN 4126 02:58:40,160 --> 02:58:45,880 START HAVE fMRI OR ARE THERE 4127 02:58:45,880 --> 02:58:48,040 CERTAIN INCLUSION/EXCLUSION 4128 02:58:48,040 --> 02:58:50,840 CRITERIA APPLIED, A PAIN 4129 02:58:50,840 --> 02:58:51,640 QUESTIONNAIRE, SOME VERSION TO 4130 02:58:51,640 --> 02:58:52,280 HELP US SCREEN? 4131 02:58:52,280 --> 02:58:57,840 I DON'T SEE THAT DONE IN OUR 4132 02:58:57,840 --> 02:58:58,440 PROPOSALS. 4133 02:58:58,440 --> 02:59:03,000 REVIEWERS ARE CRITICAL ABOUT 4134 02:59:03,000 --> 02:59:04,040 INVESTIGATING HETEROGENEITY OF 4135 02:59:04,040 --> 02:59:05,840 ENDOMETRIOSIS IN THE SENSE OF 4136 02:59:05,840 --> 02:59:08,360 LESION TYPE, NOT NECESSARILY 4137 02:59:08,360 --> 02:59:11,360 PAIN PHENOTYPES WHICH SEEMS TO 4138 02:59:11,360 --> 02:59:13,360 BE PROBLEMATICALLY STILL 4139 02:59:13,360 --> 02:59:13,680 AGGREGATED. 4140 02:59:13,680 --> 02:59:17,720 ANY FEEDBACK HERE ABOUT AN 4141 02:59:17,720 --> 02:59:19,240 OBJECTIVE STANDARDIZED WAY TO 4142 02:59:19,240 --> 02:59:19,920 ADDRESS THAT? 4143 02:59:19,920 --> 02:59:21,840 >> I'LL TAKE A CRACK. 4144 02:59:21,840 --> 02:59:24,480 I THINK STARTING IN THE MAP 4145 02:59:24,480 --> 02:59:26,720 NETWORK WE SPEND A LOT OF TIME 4146 02:59:26,720 --> 02:59:34,960 IN THE DIFFERENT DOMAINS HOW TO 4147 02:59:34,960 --> 02:59:36,000 STANDARDIZE PHENOTYPING, THERE 4148 02:59:36,000 --> 02:59:39,160 WAS NO INCENTIVE FOR GROUPS TO 4149 02:59:39,160 --> 02:59:40,600 STANDARDIZE ACROSS SITES LIKE 4150 02:59:40,600 --> 02:59:41,680 QUANTITATIVE SENSORY TESTING OR 4151 02:59:41,680 --> 02:59:43,320 THINGS LIKE THAT. 4152 02:59:43,320 --> 02:59:44,520 THE NETWORK STARTING WITH THE 4153 02:59:44,520 --> 02:59:46,160 MAPP, NOW ALL THE NETWORKS THAT 4154 02:59:46,160 --> 02:59:49,640 US AND OTHERS ARE INVOLVED IN 4155 02:59:49,640 --> 02:59:52,040 HAVE REALLY LED TO A LOT OF 4156 02:59:52,040 --> 02:59:54,640 MATURITY IN A STANDARDIZED SET 4157 02:59:54,640 --> 02:59:56,600 OF PHENOTYPING TOOLS THAT LOOK 4158 02:59:56,600 --> 02:59:58,160 VERY SIMILAR, FOR EXAMPLE, WE'RE 4159 02:59:58,160 --> 03:00:00,240 A SITE IN THE ACUTE TO CHRONIC 4160 03:00:00,240 --> 03:00:02,800 PAIN NETWORK, AS WELL AS BACPAC 4161 03:00:02,800 --> 03:00:06,840 NETWORK, AND PROs WE'RE 4162 03:00:06,840 --> 03:00:09,240 GIVING, FUNCTIONAL IMAGING 4163 03:00:09,240 --> 03:00:10,560 PARADIGMS, QSD BATTERIES, REALLY 4164 03:00:10,560 --> 03:00:12,000 QUITE SIMILAR ACROSS THOSE 4165 03:00:12,000 --> 03:00:14,720 NETWORKS BECAUSE THERE'S BEEN A 4166 03:00:14,720 --> 03:00:15,920 BIG ATTEMPT TO HARMONIZE AS WELL 4167 03:00:15,920 --> 03:00:19,320 SO WE CAN LOOK AT OUR DATA AND 4168 03:00:19,320 --> 03:00:20,520 SAY, WELL, HOW DOES THIS 4169 03:00:20,520 --> 03:00:21,280 CONNECTIVITY DATA LOOK COMPARED 4170 03:00:21,280 --> 03:00:25,080 TO THE U.K. BIOBANK THAT HAS 4171 03:00:25,080 --> 03:00:26,400 IMAGES ON A COUPLE HUNDRED 4172 03:00:26,400 --> 03:00:27,360 THOUSAND PEOPLE. 4173 03:00:27,360 --> 03:00:30,800 SO JUST AS A PART OF -- AND 4174 03:00:30,800 --> 03:00:32,640 THERE'S ALSO THE EXERCISE IN THE 4175 03:00:32,640 --> 03:00:37,400 NIH THAT'S TRIED TO STANDARDIZE 4176 03:00:37,400 --> 03:00:38,480 PHENOTYPING NOW GOING INTO THE 4177 03:00:38,480 --> 03:00:39,520 PAIN SPACE. 4178 03:00:39,520 --> 03:00:42,080 IF PEOPLE JUST LOOK AT SOME OF 4179 03:00:42,080 --> 03:00:43,520 THE NETWORKS, "HEAL" NETWORKS, 4180 03:00:43,520 --> 03:00:45,120 WHAT IS BEING DONE THERE, THAT 4181 03:00:45,120 --> 03:00:46,920 REALLY PRETTY MUCH IS THE GOLD 4182 03:00:46,920 --> 03:00:50,520 STANDARD, YOU CAN DO A LOT WITH 4183 03:00:50,520 --> 03:00:52,520 PROs ALONE, YOU KNOW, AND A 4184 03:00:52,520 --> 03:00:53,000 BODY MAP. 4185 03:00:53,000 --> 03:00:55,000 PLEASE, EVERY STUDY THAT HAS A 4186 03:00:55,000 --> 03:00:55,960 CHRONIC PAIN PATIENT IN IT 4187 03:00:55,960 --> 03:00:57,280 THAT'S EVER FUNDED BY THE NIH, 4188 03:00:57,280 --> 03:00:58,920 IT SHOULD BE NEW RULE, IF I 4189 03:00:58,920 --> 03:00:59,800 COULD MAKE IT. 4190 03:00:59,800 --> 03:01:05,040 YOU HAVE TO PUT A BODY MAP IN. 4191 03:01:05,040 --> 03:01:05,640 THIS IS RIDICULOUS. 4192 03:01:05,640 --> 03:01:07,800 YOU LEARN SO MUCH FROM A BODY 4193 03:01:07,800 --> 03:01:10,200 MAP AS FAR AS WHAT SORT OF 4194 03:01:10,200 --> 03:01:14,200 SUBSET -- THERE'S A LOT MORE BUT 4195 03:01:14,200 --> 03:01:16,280 I'M SAYING START THERE AND MOVE 4196 03:01:16,280 --> 03:01:17,720 OUTWARD FROM SIMPLE THINGS THAT 4197 03:01:17,720 --> 03:01:20,800 MAKE A BIG DIFFERENCE IN 4198 03:01:20,800 --> 03:01:21,640 PHENOTYPING. 4199 03:01:21,640 --> 03:01:22,840 >> OKAY. 4200 03:01:22,840 --> 03:01:26,920 THAT'S PERFECT. 4201 03:01:26,920 --> 03:01:27,400 IMPLEMENTAL SUGGESTION. 4202 03:01:27,400 --> 03:01:30,200 >> I WANT TO JUMP IN. 4203 03:01:30,200 --> 03:01:38,320 I'D LIKE TO ECHO WHAT DAN WAS 4204 03:01:38,320 --> 03:01:40,400 SAYING IN TERMS IRRESPECTIVE OF 4205 03:01:40,400 --> 03:01:44,040 THE PAIN CONDITION, I WAS 4206 03:01:44,040 --> 03:01:46,640 WORKING IN TMD, WE SEE THESE 4207 03:01:46,640 --> 03:01:47,360 INDIVIDUALS WITH OVERLAPPING 4208 03:01:47,360 --> 03:01:49,880 PAINS ARE MORE LIKE ONE ANOTHER, 4209 03:01:49,880 --> 03:01:52,440 WHETHER INDEX CONDITION IS 4210 03:01:52,440 --> 03:01:54,600 ENDOMETRIOSIS OR TMD OR 4211 03:01:54,600 --> 03:01:54,880 VULVODYNIA. 4212 03:01:54,880 --> 03:01:59,840 AND ONE OF THE DIFFICULTIES IS 4213 03:01:59,840 --> 03:02:01,720 THEN THAT PHENOTYPING HAS BEEN 4214 03:02:01,720 --> 03:02:06,360 ORGAN CENTRIC AND WE HAVEN'T 4215 03:02:06,360 --> 03:02:08,640 REALLY DEVELOPED QST PROTOCOLS 4216 03:02:08,640 --> 03:02:11,840 THAT ARE SIMILAR IN DIFFERENT 4217 03:02:11,840 --> 03:02:12,640 RESEARCH ARENAS. 4218 03:02:12,640 --> 03:02:16,520 I THINK DEVELOPMENT OF THESE 4219 03:02:16,520 --> 03:02:18,480 PROTOCOLS TO CAPTURE MAYBE 4220 03:02:18,480 --> 03:02:21,640 GLOBAL PAIN AND STARTING WITH 4221 03:02:21,640 --> 03:02:25,240 THIS BODY MAP ARE REALLY 4222 03:02:25,240 --> 03:02:25,840 IMPERATIVE. 4223 03:02:25,840 --> 03:02:26,880 FOR CLINICAL TRIALS IT'S 4224 03:02:26,880 --> 03:02:28,320 ONGOING. 4225 03:02:28,320 --> 03:02:30,960 WE BEGIN WITH BODY MAP, TO 4226 03:02:30,960 --> 03:02:33,360 EVALUATE ALL OF THE PAINFUL 4227 03:02:33,360 --> 03:02:36,440 AREAS, AS WELL. 4228 03:02:36,440 --> 03:02:38,040 AND WE'VE DEVELOPED TOOLS, 4229 03:02:38,040 --> 03:02:42,000 STUDIES ARE ELECTRONIC AND ALL 4230 03:02:42,000 --> 03:02:43,720 OF OUR SURVEYS INCLUDING THE 4231 03:02:43,720 --> 03:02:45,360 BODY MAP ARE ELECTRONIC AND 4232 03:02:45,360 --> 03:02:46,880 DEVELOPED THROUGH REDCap. 4233 03:02:46,880 --> 03:02:50,040 THOSE SHOULD BE AVAILABLE TO 4234 03:02:50,040 --> 03:02:51,680 ANYONE ELSE THROUGH REDCap AS 4235 03:02:51,680 --> 03:02:52,040 WELL. 4236 03:02:52,040 --> 03:02:54,200 I THINK IT'S IMPORTANT THAT WE 4237 03:02:54,200 --> 03:02:57,240 SHARE RESOURCES. 4238 03:02:57,240 --> 03:02:59,440 THAT HAVE BEEN DEVELOPED. 4239 03:02:59,440 --> 03:03:03,440 AND WHAT ARE TO STREAMLINE 4240 03:03:03,440 --> 03:03:08,400 CURRENT AND FUTURE STUDIES. 4241 03:03:08,400 --> 03:03:09,280 >> ONE OTHER PLUG, LINDA PORTER 4242 03:03:09,280 --> 03:03:14,640 AS PART OF THE PAIN CONSORTIUM 4243 03:03:14,640 --> 03:03:17,160 HAD BILL AND DAVE DEVELOP COPC 4244 03:03:17,160 --> 03:03:21,960 SCREENER, THE LATE BILL MAIXNER 4245 03:03:21,960 --> 03:03:22,480 UNFORTUNATELY, SHOULD BE 4246 03:03:22,480 --> 03:03:24,880 AVAILABLE IN THE NEXT THREE TO 4247 03:03:24,880 --> 03:03:26,120 SIX DAYS, DAVE IS COMPLETING 4248 03:03:26,120 --> 03:03:27,400 THAT PROJECT. 4249 03:03:27,400 --> 03:03:30,600 LINDA PUT OUT A NOSI, HIGHLY 4250 03:03:30,600 --> 03:03:32,120 RECOMMENDING AND SUGGESTING THAT 4251 03:03:32,120 --> 03:03:34,520 PEOPLE INCORPORATE THAT INTO 4252 03:03:34,520 --> 03:03:35,680 STUDIES, ANOTHER PHENOTYPING 4253 03:03:35,680 --> 03:03:36,440 TOOL THAT'S USED. 4254 03:03:36,440 --> 03:03:39,400 AGAIN, BECAUSE ALL THE DIFFERENT 4255 03:03:39,400 --> 03:03:42,160 CATEGORICAL INSTITUTES FUND WORK 4256 03:03:42,160 --> 03:03:44,320 ON LIKE ONE LITTLE ORGAN. 4257 03:03:44,320 --> 03:03:44,760 >> RIGHT. 4258 03:03:44,760 --> 03:03:49,080 >> IF WE ALL SAID, OKAY, NIAMS, 4259 03:03:49,080 --> 03:03:50,400 IF YOU FIND FIBROMYALGIA 4260 03:03:50,400 --> 03:03:53,120 RESEARCH MAKE SURE EVERY 4261 03:03:53,120 --> 03:03:54,040 PARTICIPANT FILLED OUT COPC 4262 03:03:54,040 --> 03:03:56,040 SCREENER TO SEE WHAT SUBSET 4263 03:03:56,040 --> 03:03:57,400 MEETS CRITERIA FOR IRRITABLE 4264 03:03:57,400 --> 03:03:58,800 BOWEL, WHATEVER, WE'D LEARN MORE 4265 03:03:58,800 --> 03:03:59,880 ABOUT THAT. 4266 03:03:59,880 --> 03:04:01,520 SO THAT'S ANOTHER TOOL THAT I 4267 03:04:01,520 --> 03:04:03,840 THINK WILL BE COMING OUT SOON 4268 03:04:03,840 --> 03:04:05,800 THAT MOST I THINK CONTEMPORARY 4269 03:04:05,800 --> 03:04:08,000 PAIN RESEARCHERS WILL USE, IT 4270 03:04:08,000 --> 03:04:09,680 DOES START WITH BODY MAP AND 4271 03:04:09,680 --> 03:04:10,840 GIVERS PEOPLE ITEMS, FOR 4272 03:04:10,840 --> 03:04:12,120 EXAMPLE, FOR IRRITABLE BOWEL IF 4273 03:04:12,120 --> 03:04:14,840 THEY HAVE PAIN IN THE ABDOMEN, 4274 03:04:14,840 --> 03:04:19,240 DOES IT IN A FAIRLY RAPID WAY 4275 03:04:19,240 --> 03:04:20,560 WITH LOW PARTICIPANT BURDEN 4276 03:04:20,560 --> 03:04:23,400 USING SMART LOGIC IN THE 4277 03:04:23,400 --> 03:04:24,040 BACKGROUND. 4278 03:04:24,040 --> 03:04:25,040 >> OKAY, FANTASTIC. 4279 03:04:25,040 --> 03:04:27,120 SUSIE, DID YOU HAVE ANYTHING 4280 03:04:27,120 --> 03:04:28,640 EXTRA TO ADD? 4281 03:04:28,640 --> 03:04:29,960 >> NO, GREAT SUMMARY. 4282 03:04:29,960 --> 03:04:33,040 WE'RE JUST A BIT BEHIND IN THE 4283 03:04:33,040 --> 03:04:34,000 GYNECOLOGIC AND ENDOMETRIOSIS 4284 03:04:34,000 --> 03:04:36,800 WORLD, IT'S JUST TAKEN LONGER TO 4285 03:04:36,800 --> 03:04:39,400 MOVE AWAY FROM FOCUSING ON THE 4286 03:04:39,400 --> 03:04:41,040 LESION TO THE ENTIRE PATIENT 4287 03:04:41,040 --> 03:04:42,680 OVERALL. 4288 03:04:42,680 --> 03:04:43,280 >> RIGHT. 4289 03:04:43,280 --> 03:04:45,240 >> JUST KEEP PUSHING THIS 4290 03:04:45,240 --> 03:04:47,000 KNOWLEDGE AND AGENDA WILL BE 4291 03:04:47,000 --> 03:04:47,840 VERY HELPFUL. 4292 03:04:47,840 --> 03:04:48,200 >> FANTASTIC. 4293 03:04:48,200 --> 03:04:48,480 THANK YOU. 4294 03:04:48,480 --> 03:04:50,040 THAT WAS A REALLY GREAT 4295 03:04:50,040 --> 03:04:50,880 DISCUSSION OF THAT. 4296 03:04:50,880 --> 03:04:53,520 HELENA IS THE PERSON TO 4297 03:04:53,520 --> 03:04:54,920 INSTITUTE THAT RULE FOR NICHD 4298 03:04:54,920 --> 03:04:55,280 FUNDING. 4299 03:04:55,280 --> 03:05:00,280 THAT'S A GOOD PERSON TO HAVE THE 4300 03:05:00,280 --> 03:05:00,880 ERO. 4301 03:05:00,880 --> 03:05:02,480 THERE ARE A FEW QUESTIONS. 4302 03:05:02,480 --> 03:05:07,080 >> KATIE, WOULD YOU LIKE TO 4303 03:05:07,080 --> 03:05:07,640 SPEAK? 4304 03:05:07,640 --> 03:05:09,480 WOULD YOU LIKE TO -- WOULD YOU 4305 03:05:09,480 --> 03:05:20,000 LIKE TO ASK YOUR QUESTION? 4306 03:05:20,000 --> 03:05:22,560 >> YOU MAY WANT TO JUST READ IT. 4307 03:05:22,560 --> 03:05:25,400 >> I HAVE A BOLD QUESTION ABOUT 4308 03:05:25,400 --> 03:05:26,240 MENSTRUAL PAIN. 4309 03:05:26,240 --> 03:05:31,800 TO WHAT EXTENT DO WE EXPECT 4310 03:05:31,800 --> 03:05:33,520 ADDRESSING MECHANICAL MECHANISMS 4311 03:05:33,520 --> 03:05:36,440 IN THE UTERUS TO REDUCE PAIN? 4312 03:05:36,440 --> 03:05:44,240 DOES THIS REDUCE THE PAIN RELIEF 4313 03:05:44,240 --> 03:05:44,960 (INDISCERNIBLE) FROM TREATMENTS? 4314 03:05:44,960 --> 03:05:46,240 >> THIS IS FOR ANYONE WHO WANTS 4315 03:05:46,240 --> 03:05:49,040 TO ANSWER IT. 4316 03:05:49,040 --> 03:05:54,080 4317 03:05:54,080 --> 03:06:00,080 TALKING ABOUT CONTRACTALITY. 4318 03:06:00,080 --> 03:06:02,280 >> IT WOULD BE LIKELY THAT THEY 4319 03:06:02,280 --> 03:06:03,840 HAVEN'T DONE LARGE SCALE 4320 03:06:03,840 --> 03:06:05,320 STUDIES, CLINICAL EXPERIENCE IS 4321 03:06:05,320 --> 03:06:06,360 PATIENTS WHO HAVE MULTIPLE 4322 03:06:06,360 --> 03:06:09,240 COPCs ARE NOT GOING TO RESPOND 4323 03:06:09,240 --> 03:06:11,040 AS WELL TO NSAIDs AS DAN 4324 03:06:11,040 --> 03:06:13,760 ALLUDED TO IN ARTHRITIS, FOR 4325 03:06:13,760 --> 03:06:14,640 EXAMPLE. 4326 03:06:14,640 --> 03:06:15,760 IT WORKS IN 85% OF PATIENTS 4327 03:06:15,760 --> 03:06:16,560 PRETTY WELL. 4328 03:06:16,560 --> 03:06:19,160 THAT WAS ONE OF THE DRAMATIC 4329 03:06:19,160 --> 03:06:25,800 BREAKTHROUGHS IN THE '80s. 4330 03:06:25,800 --> 03:06:27,000 THE PRIOR MECHANISMS, 4331 03:06:27,000 --> 03:06:27,960 CONTRACTILITY AND INFLAMMATION. 4332 03:06:27,960 --> 03:06:30,840 IT GOES BACK TO SAYING THAT ANY 4333 03:06:30,840 --> 03:06:33,240 CHANGE EARLY SCREENING FOR 4334 03:06:33,240 --> 03:06:37,840 INDIVIDUALS WITH MULTIPLE 4335 03:06:37,840 --> 03:06:39,240 DIAGNOSES WIDESPREAD POSITIVE 4336 03:06:39,240 --> 03:06:40,640 SYMPTOMS SOMETHING MAY NOT WORK 4337 03:06:40,640 --> 03:06:43,000 THAT WELL, WHETHER FOR JOINT 4338 03:06:43,000 --> 03:06:47,120 PAIN OR PERIOD PAIN. 4339 03:06:47,120 --> 03:06:52,240 POSTOPERATIVE, WE TRY TO FOCUS 4340 03:06:52,240 --> 03:06:52,880 ON THAT AREA. 4341 03:06:52,880 --> 03:06:56,040 >> THERE'S ANOTHER QUESTION IN 4342 03:06:56,040 --> 03:07:00,400 THE CHAT, DO THE PANELISTS THINK 4343 03:07:00,400 --> 03:07:02,040 THERE'S AN MSKCPP PHENOTYPE 4344 03:07:02,040 --> 03:07:03,600 DEFINED NOT JUST BODY MAP PAIN 4345 03:07:03,600 --> 03:07:05,360 LOCATION BUT MOVEMENT INDUCED 4346 03:07:05,360 --> 03:07:09,240 PAIN, IS IT JUST THAT C OR IS 4347 03:07:09,240 --> 03:07:13,160 THAT JUST THE CPP REGIONAL 4348 03:07:13,160 --> 03:07:17,680 INTERMEDIATE PHENOTYPE? 4349 03:07:17,680 --> 03:07:19,680 >> I THINK THAT'S A GREAT 4350 03:07:19,680 --> 03:07:20,280 QUESTION. 4351 03:07:20,280 --> 03:07:23,080 I DON'T KNOW THAT WE KNOW. 4352 03:07:23,080 --> 03:07:24,840 I MEAN, IF YOU ASK ME 4353 03:07:24,840 --> 03:07:26,600 CLINICALLY, I WOULD TEND TO 4354 03:07:26,600 --> 03:07:31,840 THINK ABOUT MOVEMENT INDUCED 4355 03:07:31,840 --> 03:07:34,040 PAIN AS BEING MORE PERIPHERAL 4356 03:07:34,040 --> 03:07:36,520 VERSUS THOSE THAT HAVE 4357 03:07:36,520 --> 03:07:38,040 SPONTANEOUS PAIN, BEING MOVING 4358 03:07:38,040 --> 03:07:40,360 MORE ON THE NOCIPLASTIC AND 4359 03:07:40,360 --> 03:07:42,080 SOMETHING THAT DR. NACKLEY 4360 03:07:42,080 --> 03:07:43,040 PRESENTED MADE ME THINK ABOUT 4361 03:07:43,040 --> 03:07:45,040 THAT A LITTLE BIT MORE IN TERMS 4362 03:07:45,040 --> 03:07:51,400 OF THE PHENOTYPES OF PATIENTS 4363 03:07:51,400 --> 03:08:00,040 WITH PROMOTE VESTIBULEDYNIA, I'D 4364 03:08:00,040 --> 03:08:03,360 BE INTERESTED IN WHAT OTHER 4365 03:08:03,360 --> 03:08:06,400 PEOPLE THINK AS WELL. 4366 03:08:06,400 --> 03:08:09,360 >> I FEEL LIKE THE MOVEMENT PAIN 4367 03:08:09,360 --> 03:08:11,560 PATIENTS TEND TO RESPOND TO P.T. 4368 03:08:11,560 --> 03:08:15,240 A BIT BETTER THAN THOSE THAT 4369 03:08:15,240 --> 03:08:16,120 HAVE WIDESPREAD SPONTANEOUS PAIN 4370 03:08:16,120 --> 03:08:19,960 WITHOUT MOVEMENT. 4371 03:08:19,960 --> 03:08:22,440 >> THAT'S BEEN LOOKED AT IN 4372 03:08:22,440 --> 03:08:24,120 OSTEOARTHRITIS, THOUGHT THE 4373 03:08:24,120 --> 03:08:26,280 MOVEMENT INDUCED PAIN IS REALLY 4374 03:08:26,280 --> 03:08:29,040 A QUITE DIFFERENT MECHANISM THAN 4375 03:08:29,040 --> 03:08:31,640 THE SPONTANEOUS PAIN, AND AGAIN 4376 03:08:31,640 --> 03:08:34,640 IT IS MORE NOCICEPTIVE TYPICALLY 4377 03:08:34,640 --> 03:08:38,160 THAN MOVEMENT INDUCED PAIN. 4378 03:08:38,160 --> 03:08:40,240 >> I GUESS I WAS ASKING, IF WE 4379 03:08:40,240 --> 03:08:42,640 COULD PHENOTYPE THIS GROUP A 4380 03:08:42,640 --> 03:08:45,800 LITTLE BIT MORE, YOU KNOW, 4381 03:08:45,800 --> 03:08:46,840 MOVEMENT-BASED POPULATION, WE 4382 03:08:46,840 --> 03:08:50,280 MIGHT BE ABLE TO REALLY LOOK AT 4383 03:08:50,280 --> 03:08:51,200 THE PHYSICAL THERAPY RESULTS 4384 03:08:51,200 --> 03:08:52,040 MORE CLEARLY. 4385 03:08:52,040 --> 03:08:54,480 THAT'S WHY I ASKED. 4386 03:08:54,480 --> 03:08:55,440 SO THANK YOU. 4387 03:08:55,440 --> 03:08:57,240 >> THERE ARE SHADES OF GRAY, 4388 03:08:57,240 --> 03:08:58,640 IT'S NOT NECESSARILY THAT 4389 03:08:58,640 --> 03:09:03,240 THERE'S ONE TREATMENT FOR ONE 4390 03:09:03,240 --> 03:09:07,520 SUBTYPE BUT PROBABLY DIFFERENT 4391 03:09:07,520 --> 03:09:08,880 COMBINATIONS OF TREATMENT MAY BE 4392 03:09:08,880 --> 03:09:10,360 IMPORTANT, WE NEED TO GET PAST 4393 03:09:10,360 --> 03:09:11,520 THE TRIAL AND ERROR APPROACH 4394 03:09:11,520 --> 03:09:14,080 WHERE WE START WITH THE LEAST 4395 03:09:14,080 --> 03:09:15,640 INVASIVE AND JUST SLOWLY 4396 03:09:15,640 --> 03:09:18,120 PROGRESS TO MORE INVASIVE 4397 03:09:18,120 --> 03:09:21,480 TREATMENTS, AND REALLY NEED TO 4398 03:09:21,480 --> 03:09:23,640 INDIVIDUALIZE TREATMENT 4399 03:09:23,640 --> 03:09:25,840 APPROACHES, MAY NOT BE ONE SIZE 4400 03:09:25,840 --> 03:09:26,120 FITS ALL. 4401 03:09:26,120 --> 03:09:28,280 >> TO FOLLOW UP REALLY WELL ON 4402 03:09:28,280 --> 03:09:30,920 THAT POINT ABOUT WHEN TO WE USE 4403 03:09:30,920 --> 03:09:31,800 CERTAIN TREATMENTS, ONE QUESTION 4404 03:09:31,800 --> 03:09:35,600 FROM THE CHAT AND I WANT HELENA 4405 03:09:35,600 --> 03:09:38,640 TO ASK A QUESTION, ABOUT HEALTH 4406 03:09:38,640 --> 03:09:39,800 DISPARITIES THAT WE HAVEN'T 4407 03:09:39,800 --> 03:09:40,240 COVERED YET. 4408 03:09:40,240 --> 03:09:43,160 THIS IS FOR YOU, DR. TU, BUT 4409 03:09:43,160 --> 03:09:44,320 OTHERS CAN CHIP IN. 4410 03:09:44,320 --> 03:09:49,840 WHEN SHOULD WE THINK ABOUT USING 4411 03:09:49,840 --> 03:09:50,880 YOUR SOPHISTICATED CONTRACTILITY 4412 03:09:50,880 --> 03:09:52,960 METHODS, ONLY AFTER THEY FAIL 4413 03:09:52,960 --> 03:09:54,840 OTPs? 4414 03:09:54,840 --> 03:09:57,280 >> I APPRECIATE THE QUESTION. 4415 03:09:57,280 --> 03:10:00,720 DR. HELMAN HAS A ROBUST LINE OF 4416 03:10:00,720 --> 03:10:04,520 WORK TRYING TO DO ASSESSMENT OF 4417 03:10:04,520 --> 03:10:05,400 UTERINE ACTIVITY AND UTERINE 4418 03:10:05,400 --> 03:10:05,960 PHYSIOLOGY. 4419 03:10:05,960 --> 03:10:10,680 THIS IS WHAT HE'S REFERRING TO. 4420 03:10:10,680 --> 03:10:12,880 THAT GRANT, BASED ON A COUPLE 4421 03:10:12,880 --> 03:10:16,480 SMALLER PRELIMINARY STUDIES, IS 4422 03:10:16,480 --> 03:10:17,040 STILL EARLY, RECRUITING WAS 4423 03:10:17,040 --> 03:10:17,840 HAMSTRUNG BY COVID. 4424 03:10:17,840 --> 03:10:19,640 IT WILL BE A FEW YEARS BEFORE WE 4425 03:10:19,640 --> 03:10:21,280 CAN USE IT TO SUBTYPE 4426 03:10:21,280 --> 03:10:21,600 INDIVIDUALS. 4427 03:10:21,600 --> 03:10:23,240 IT'S A GREAT QUESTION 4428 03:10:23,240 --> 03:10:26,680 CLINICALLY. 4429 03:10:26,680 --> 03:10:31,520 WE HAD ONE RECENTLY, MASSIVE 4430 03:10:31,520 --> 03:10:34,600 WORKUP, CITY OF CHICAGO, PAIN 4431 03:10:34,600 --> 03:10:40,800 PROVOKED WITH ATHLETIC ACTIVITY 4432 03:10:40,800 --> 03:10:42,400 AND ORGASM, NEGATIVE WORKUP, THE 4433 03:10:42,400 --> 03:10:43,600 ONLY THING WE COULD THINK ABOUT 4434 03:10:43,600 --> 03:10:45,840 IS LOOK AT SOME SORT OF EQUATION 4435 03:10:45,840 --> 03:10:47,440 TO MODEL WHAT THEY ARE UTERINE 4436 03:10:47,440 --> 03:10:49,040 ACTIVITY IS THERE WOULD BE A 4437 03:10:49,040 --> 03:10:52,560 SIGNAL THAT MIGHT ALLOW US TO 4438 03:10:52,560 --> 03:10:54,720 ARGUE SHE HAS A DIFFERENCE, ALL 4439 03:10:54,720 --> 03:10:55,640 THE OTHER STRUCTURAL EVALUATION, 4440 03:10:55,640 --> 03:10:57,360 THE FACT THAT SHE'S PAIN FREE AT 4441 03:10:57,360 --> 03:11:03,080 REST DOESN'T SEEM TO HELP US 4442 03:11:03,080 --> 03:11:03,400 MUCH. 4443 03:11:03,400 --> 03:11:05,640 I THINK IN THE MEANTIME WE OF 4444 03:11:05,640 --> 03:11:08,880 COURSE DO WHAT HE SAID, TRY TO 4445 03:11:08,880 --> 03:11:11,520 SUPPRESS TO AVOID HORMONAL 4446 03:11:11,520 --> 03:11:12,800 CYCLING. 4447 03:11:12,800 --> 03:11:14,880 I WENT BACK TO EARLY LITERATURE 4448 03:11:14,880 --> 03:11:16,920 IN ADVANCE OF THE TALK, WE 4449 03:11:16,920 --> 03:11:19,480 UNDERUTILIZE DRUGS IN THE '80s 4450 03:11:19,480 --> 03:11:22,440 AND '90s FOR PERIOD PAIN, 4451 03:11:22,440 --> 03:11:23,400 MUSCLE RELAXANTS, INTERESTING 4452 03:11:23,400 --> 03:11:26,480 ENOUGH DAN HAS SAID SOME 4453 03:11:26,480 --> 03:11:29,040 NEUROMODULATORS WORK BADLY FOR 4454 03:11:29,040 --> 03:11:31,400 NOCICEPTIVE PAIN, SOME ARE NOT 4455 03:11:31,400 --> 03:11:32,840 NOCICEPTIVE, JUST LIKE LIKE THEY 4456 03:11:32,840 --> 03:11:36,720 ARE, WHEN YOU'RE FACED WITH AN 4457 03:11:36,720 --> 03:11:39,120 ACTUAL PATIENT WITH DEPUTY 4458 03:11:39,120 --> 03:11:39,800 OPERATION, OFF LABEL 4459 03:11:39,800 --> 03:11:40,840 NEUROMODULATORS FAMILIAR WITH 4460 03:11:40,840 --> 03:11:43,400 USING IN CHRONIC PAIN, OR AS DR. 4461 03:11:43,400 --> 03:11:46,880 EVANS POINTED OUT SOMETHING LIKE 4462 03:11:46,880 --> 03:11:50,480 PEA, A SMALL BIT OF DATA ON IT, 4463 03:11:50,480 --> 03:11:51,800 FOR ENDOMETRIOSIS, THE IMPORTANT 4464 03:11:51,800 --> 03:11:54,000 IS TO BE HONEST, I'LL WILLING TO 4465 03:11:54,000 --> 03:11:56,200 TRY THINGS TO MODULATE INSTEAD 4466 03:11:56,200 --> 03:11:57,480 OF SAYING, WELL, YOU JUST HAVE 4467 03:11:57,480 --> 03:12:01,120 TO LIVE WITH IT OR TAKE MORE 4468 03:12:01,120 --> 03:12:01,800 NSAIDs. 4469 03:12:01,800 --> 03:12:04,840 WE HAVE TO BE ON THE LOOKOUT FOR 4470 03:12:04,840 --> 03:12:05,320 BETTER OPTIONS. 4471 03:12:05,320 --> 03:12:06,840 >> HELENA, DO YOU WANT TO ASK 4472 03:12:06,840 --> 03:12:09,640 YOUR QUESTION? 4473 03:12:09,640 --> 03:12:10,000 >> YES. 4474 03:12:10,000 --> 03:12:11,840 THANK YOU. 4475 03:12:11,840 --> 03:12:15,560 WE'RE WONDERING, WHAT ARE THE 4476 03:12:15,560 --> 03:12:18,720 ISSUES WITH HEALTH DISPARITIES 4477 03:12:18,720 --> 03:12:20,000 IN THE GYNECOLOGIC PAIN 4478 03:12:20,000 --> 03:12:22,400 RESEARCH, HOW CAN WE ADVANCE 4479 03:12:22,400 --> 03:12:24,080 HEALTH EQUITY AND DIVERSITY? 4480 03:12:24,080 --> 03:12:30,840 THIS IS THE QUESTION FOR ALL THE 4481 03:12:30,840 --> 03:12:31,280 SPEAKERS. 4482 03:12:31,280 --> 03:12:35,400 >> I'LL TAKE A CRACK AT THIS. 4483 03:12:35,400 --> 03:12:39,480 YOU'RE PROBABLY AWARE OUR GROUP 4484 03:12:39,480 --> 03:12:42,800 HAS GOTTEN A LOT OF NIH FUNDINGS 4485 03:12:42,800 --> 03:12:44,480 UNTIL RECENTLY, DIDN'T TAKE 4486 03:12:44,480 --> 03:12:46,600 SERIOUSLY HAVING TO PUT MORE 4487 03:12:46,600 --> 03:12:48,200 TIME AND EFFORT, SPECIFICALLY, 4488 03:12:48,200 --> 03:12:49,720 INTO RECRUITING AND COMMUNITIES 4489 03:12:49,720 --> 03:12:50,840 OF COLOR. 4490 03:12:50,840 --> 03:12:53,240 AND BECAUSE THE NIH MADE 4491 03:12:53,240 --> 03:12:54,280 SUPPLEMENTS RECENTLY AVAILABLE 4492 03:12:54,280 --> 03:12:57,720 FOR SOME OF OUR GRANTS LIKE OUR 4493 03:12:57,720 --> 03:12:59,240 "HEAL" GRANTS, WE HAVE SORT OF 4494 03:12:59,240 --> 03:13:00,560 PERMANENTLY CHANGED THE WAY WE 4495 03:13:00,560 --> 03:13:04,400 DO BUSINESS WHETHER WE WILL HAVE 4496 03:13:04,400 --> 03:13:06,840 RESEARCH COORDINATORS IN 4497 03:13:06,840 --> 03:13:07,880 COMMUNITIES OF COLOR THAT ARE 4498 03:13:07,880 --> 03:13:11,400 AROUND US AND THAT WE WILL 4499 03:13:11,400 --> 03:13:13,240 FOREVER MORE BE RECRUITING 4500 03:13:13,240 --> 03:13:14,360 ADEQUATE NUMBERS OF PARTICIPANTS 4501 03:13:14,360 --> 03:13:15,520 FROM THOSE COMMUNITIES INTO OUR 4502 03:13:15,520 --> 03:13:19,680 STUDIES BUT I THINK MOST OF US 4503 03:13:19,680 --> 03:13:21,760 HAVE HISTORICALLY NOT TAKEN THIS 4504 03:13:21,760 --> 03:13:25,160 AS SERIOUSLY AS WE SHOULD HAVE. 4505 03:13:25,160 --> 03:13:28,400 TO BE FAIR, IT TAKES A LOT OF 4506 03:13:28,400 --> 03:13:30,840 MONEY AND EFFORT, PEOPLE THAT 4507 03:13:30,840 --> 03:13:32,160 ARE ACTUALLY TRAINED IN 4508 03:13:32,160 --> 03:13:33,720 COMMUNITY BASED PARTICIPATORY 4509 03:13:33,720 --> 03:13:34,840 RESEARCH TO DO THIS RIGHT AND 4510 03:13:34,840 --> 03:13:35,080 WELL. 4511 03:13:35,080 --> 03:13:37,800 WE HIRED A FACULTY MEMBER 4512 03:13:37,800 --> 03:13:41,960 FABULOUS WITH TRAINING IN THAT, 4513 03:13:41,960 --> 03:13:51,480 BUT PEOPLE THAT -- 4514 03:13:51,480 --> 03:13:53,400 WELL-INTENTIONED RESEARCHERS CAN 4515 03:13:53,400 --> 03:13:54,640 CAUSE A MESS, RIGHT INTENTIONED, 4516 03:13:54,640 --> 03:13:56,600 DOING THE WRONG THINGS. 4517 03:13:56,600 --> 03:13:59,120 I'M HAPPY THE NIH HAS MADE SOME 4518 03:13:59,120 --> 03:14:00,000 SUPPLEMENTS AVAILABLE AND THAT 4519 03:14:00,000 --> 03:14:03,280 THEY SEEM TO BE TAKING THIS 4520 03:14:03,280 --> 03:14:05,240 SERIOUS, IT WILL ALLOW ALL OF US 4521 03:14:05,240 --> 03:14:07,840 INTO OUR FUTURE STUDIES TO HAVE 4522 03:14:07,840 --> 03:14:08,400 ADEQUATE PARTICIPATION FROM 4523 03:14:08,400 --> 03:14:11,680 PEOPLE IN COMMUNITIES OF COLOR. 4524 03:14:11,680 --> 03:14:13,640 THERE'S STARK DISPARITIES. 4525 03:14:13,640 --> 03:14:15,400 THERE'S GOT TO BE IN PELVIC 4526 03:14:15,400 --> 03:14:17,240 PAIN, THERE IS IN ALL PAIN 4527 03:14:17,240 --> 03:14:19,800 CONDITIONS, THERE ARE IN ALL 4528 03:14:19,800 --> 03:14:20,440 MEDICAL CONDITIONS. 4529 03:14:20,440 --> 03:14:23,080 I WANT TO SAY AGAIN I'M GLAD THE 4530 03:14:23,080 --> 03:14:24,840 NIH IS TAKING IT SERIOUSLY AND 4531 03:14:24,840 --> 03:14:29,840 SO ARE GROUPS OF INVESTIGATORS. 4532 03:14:29,840 --> 03:14:32,120 >> I WOULD ECHO DAN'S COMMENTS 4533 03:14:32,120 --> 03:14:33,600 ABOUT -- THERE'S THE UNIVERSITY 4534 03:14:33,600 --> 03:14:34,640 OF MICHIGAN TEAM THAT ARE 4535 03:14:34,640 --> 03:14:37,440 WRITTEN A NICE ARTICLE HOW TO 4536 03:14:37,440 --> 03:14:39,320 INTERFACE WITH COMMUNITIES THAT 4537 03:14:39,320 --> 03:14:40,280 WERE UNDERREPRESENTED. 4538 03:14:40,280 --> 03:14:45,760 THE PAPER IS QUITE A FEW YEARS 4539 03:14:45,760 --> 03:14:47,120 OLD BUT A RESEARCHER IN 4540 03:14:47,120 --> 03:14:48,800 PSYCHOLOGY FOUND IT, THEY HAVE A 4541 03:14:48,800 --> 03:14:49,080 NICE TABLE. 4542 03:14:49,080 --> 03:14:52,880 I CAN SHARE THE LINK, THIS IS 4543 03:14:52,880 --> 03:14:55,400 HOW YOU DO ENGAGED RESEARCH. 4544 03:14:55,400 --> 03:14:56,400 IT'S QUITE CHALLENGING. 4545 03:14:56,400 --> 03:14:58,440 YOU DON'T JUST DABBLE IN IT. 4546 03:14:58,440 --> 03:15:00,200 IT COMES TO THINGS LIKE YOU GO 4547 03:15:00,200 --> 03:15:02,160 TO THE COMMUNITIES AND YOU 4548 03:15:02,160 --> 03:15:04,360 BECOME PART OF THE PROCESS. 4549 03:15:04,360 --> 03:15:07,840 YOU VOLUNTEER AT THE FESTIVALS. 4550 03:15:07,840 --> 03:15:10,600 YOU ATTEND THE RELIGIOUS 4551 03:15:10,600 --> 03:15:10,840 SERVICES. 4552 03:15:10,840 --> 03:15:12,360 YOU IT AND FIND OPPORTUNITIES 4553 03:15:12,360 --> 03:15:13,320 FOR JOB TRAINING THAT ARE NOT 4554 03:15:13,320 --> 03:15:14,840 JUST SO YOU CAN MAKE YOUR TEAM 4555 03:15:14,840 --> 03:15:17,160 MORE ABLE TO DO IT BUT BECAUSE 4556 03:15:17,160 --> 03:15:18,520 YOU BELIEVE IN IT, IT SOUNDS 4557 03:15:18,520 --> 03:15:20,720 LIKE FROM WHAT I READ FROM THESE 4558 03:15:20,720 --> 03:15:21,760 SEASONED RESEARCHERS AT 4559 03:15:21,760 --> 03:15:24,280 MICHIGAN, IT'S A MULTI-YEAR 4560 03:15:24,280 --> 03:15:24,840 PROCESS, POSSIBLY 4561 03:15:24,840 --> 03:15:26,880 MULTI-GENERATIONAL PROCESS. 4562 03:15:26,880 --> 03:15:29,720 OUR OWN EXPERIENCES VERY NAIVELY 4563 03:15:29,720 --> 03:15:31,480 WE GOT MINORITY SUPPLEMENT 4564 03:15:31,480 --> 03:15:34,600 FUNDING IN THE PAST, VERY 4565 03:15:34,600 --> 03:15:36,480 HELPFUL, BUT TAUGHT US THAT IT 4566 03:15:36,480 --> 03:15:37,880 DOESN'T STOP WITH ONE HIRE. 4567 03:15:37,880 --> 03:15:40,080 YOU HAVE TO LOOK AT MIDDLE 4568 03:15:40,080 --> 03:15:41,840 SCHOOL CHILDREN WHO WANT GET 4569 03:15:41,840 --> 03:15:44,160 INTERESTED IN SCIENCE, EMBED 4570 03:15:44,160 --> 03:15:45,600 PROCESSES IN TEN YEARS AHEAD OF 4571 03:15:45,600 --> 03:15:46,680 TIME OR LONGER. 4572 03:15:46,680 --> 03:15:48,520 IT'S HARD TO GET THE LONG-TERM 4573 03:15:48,520 --> 03:15:51,360 VISION IF YOU DON'T HAVE 4574 03:15:51,360 --> 03:15:53,120 SUSTAINED INPUT OR FINANCES FROM 4575 03:15:53,120 --> 03:15:55,720 PARTICIPANTS AND FUND 4576 03:15:55,720 --> 03:15:56,040 ORGANIZERS. 4577 03:15:56,040 --> 03:15:58,600 YOU WON'T SEE ANSWERS UNTIL YOU 4578 03:15:58,600 --> 03:16:00,800 SEE IT ACROSS THE SPECTRUM IN 4579 03:16:00,800 --> 03:16:04,680 SCIENTIFIC INQUIRY AND TRAINING. 4580 03:16:04,680 --> 03:16:06,320 >> ALSO, DR. HINDY BROUGHT UP A 4581 03:16:06,320 --> 03:16:09,800 GREAT POINT FROM PATIENT 4582 03:16:09,800 --> 03:16:10,480 PERSPECTIVE THERE'S ALMOST 4583 03:16:10,480 --> 03:16:12,880 CERTAINLY BIAS IN DIAGNOSIS OF 4584 03:16:12,880 --> 03:16:14,320 CHRONIC PAIN CONDITIONS 4585 03:16:14,320 --> 03:16:15,840 ACCORDING TO RACE. 4586 03:16:15,840 --> 03:16:19,080 CERTAINLY AS WELL DOCUMENTED IN 4587 03:16:19,080 --> 03:16:19,960 ENDOMETRIOSIS, THE VERY FIRST 4588 03:16:19,960 --> 03:16:23,200 TIME THAT IT WAS DESCRIBED IN 4589 03:16:23,200 --> 03:16:25,320 THE LITERATURE WAS BY A 4590 03:16:25,320 --> 03:16:26,400 GYNECOLOGIST WHO SPECIFICALLY 4591 03:16:26,400 --> 03:16:28,400 SAID IN HIS ORIGINAL ARTICLE 4592 03:16:28,400 --> 03:16:31,600 THAT ENDOMETRIOSIS WAS A DISEASE 4593 03:16:31,600 --> 03:16:34,080 IN WOMEN OF -- OF WHITE WOMEN IN 4594 03:16:34,080 --> 03:16:36,520 HIGHER BRACKETS AND THAT IDEA 4595 03:16:36,520 --> 03:16:41,400 HAS BEEN PROPAGATED IN DIAGNOSIS 4596 03:16:41,400 --> 03:16:43,760 ANT ATTRIBUTION SINCE THEN. 4597 03:16:43,760 --> 03:16:45,160 THERE ISN'T MUCH EPIDEMIOLOGIC 4598 03:16:45,160 --> 03:16:45,360 DATA. 4599 03:16:45,360 --> 03:16:55,560 THERE'S A NICE PAPER OUT OF YOU 4600 03:16:55,560 --> 03:16:58,600 CANADA WITH DR. BOOUGIE, BLACK 4601 03:16:58,600 --> 03:16:59,800 WOMEN AND HISPANIC WOMEN WERE 4602 03:16:59,800 --> 03:17:02,200 HALF AS LIKELY TO BE DIAGNOSED 4603 03:17:02,200 --> 03:17:03,960 WITH ENDOMETRIOSIS COMPARED TO 4604 03:17:03,960 --> 03:17:08,760 CAUCASIAN WOMEN AND ASIAN WOMEN, 4605 03:17:08,760 --> 03:17:12,720 ALMOST 50% MORE LIKELY TO BE 4606 03:17:12,720 --> 03:17:13,120 DIAGNOSED. 4607 03:17:13,120 --> 03:17:14,400 PARTICULARLY WITH ENDOMETRIOSIS, 4608 03:17:14,400 --> 03:17:16,560 UNTIL MORE RECENTLY REQUIRES A 4609 03:17:16,560 --> 03:17:18,200 SURGICAL DIAGNOSIS, WE CANNOT 4610 03:17:18,200 --> 03:17:20,400 SEPARATE THAT FROM ISSUES OF 4611 03:17:20,400 --> 03:17:22,240 ACCESS TO CARE, ACCESS TO 4612 03:17:22,240 --> 03:17:24,320 SURGEONS, AND WE HAVE TREMENDOUS 4613 03:17:24,320 --> 03:17:24,800 HEALTH CARE DISPARITIES 4614 03:17:24,800 --> 03:17:27,800 PARTICULARLY IN THE U.S. WHETHER 4615 03:17:27,800 --> 03:17:29,880 WE DON'T HAVE GOVERNMENT FUNDED 4616 03:17:29,880 --> 03:17:31,760 INSURANCE AND SO PATIENTS JUST 4617 03:17:31,760 --> 03:17:32,960 DON'T HAVE ACCESS TO THE RIGHT 4618 03:17:32,960 --> 03:17:33,520 CARE. 4619 03:17:33,520 --> 03:17:34,640 IF THEY DON'T HAVE ACCESS 4620 03:17:34,640 --> 03:17:36,120 DOCTORS ARE NOT THINKING ABOUT 4621 03:17:36,120 --> 03:17:39,360 IT, THEY CONSIDER IT TO BE A 4622 03:17:39,360 --> 03:17:43,000 CONDITION OF WHITE WOMEN. 4623 03:17:43,000 --> 03:17:46,400 AS WELL AS THERE ALSO MIGHT BE 4624 03:17:46,400 --> 03:17:50,160 DIFFERENCE IN NORMALIZATION AND 4625 03:17:50,160 --> 03:17:52,400 STIGMATIZATION OF PAIN THAT VARY 4626 03:17:52,400 --> 03:17:53,760 ACROSS RACES, I THINK, WE HAVE A 4627 03:17:53,760 --> 03:17:57,360 LOT OF WORK TO BE DONE HERE. 4628 03:17:57,360 --> 03:17:58,680 >> YEAH, THANK YOU, SUSIE. 4629 03:17:58,680 --> 03:18:01,800 IT'S A STRONG POINT. 4630 03:18:01,800 --> 03:18:02,960 FROM THE FIBROID THERE IS 4631 03:18:02,960 --> 03:18:04,440 RESEARCH BEING DONE, WHEN PAIN 4632 03:18:04,440 --> 03:18:06,400 IS THE PRIMARY COMPLAINT THAT 4633 03:18:06,400 --> 03:18:08,040 THERE ARE DIFFERENCES IN 4634 03:18:08,040 --> 03:18:09,320 REFERRALS AND/OR TREATMENT 4635 03:18:09,320 --> 03:18:10,680 RECOMMENDED BASED ON RACE. 4636 03:18:10,680 --> 03:18:12,680 I THINK THAT IS CERTAINLY 4637 03:18:12,680 --> 03:18:14,400 SOMETHING TO THINK ABOUT. 4638 03:18:14,400 --> 03:18:15,520 HELENA, YOU HAVE A FEW MINUTES 4639 03:18:15,520 --> 03:18:15,760 LOAFORT. 4640 03:18:15,760 --> 03:18:17,880 I DON'T KNOW IF YOU WANT TO GET 4641 03:18:17,880 --> 03:18:19,800 INTO ANOTHER QUESTION OR OPEN IT 4642 03:18:19,800 --> 03:18:21,600 UP TO THE ROOM. 4643 03:18:21,600 --> 03:18:27,200 YOUR COVID QUESTION MIGHT BE 4644 03:18:27,200 --> 03:18:27,400 LENGTHY. 4645 03:18:27,400 --> 03:18:29,040 >> SO OUR NEXT QUESTION IS WHAT 4646 03:18:29,040 --> 03:18:34,840 IS THE EFFECT OF THE COVID 4647 03:18:34,840 --> 03:18:36,640 PANDEMIC ON GYNECOLOGY RESEARCH 4648 03:18:36,640 --> 03:18:37,640 AND TREATMENT? 4649 03:18:37,640 --> 03:18:42,440 >> WE KNOW IT HAS AFFECTED 4650 03:18:42,440 --> 03:18:44,320 RECRUITMENT IN STUDIES. 4651 03:18:44,320 --> 03:18:45,960 ARE WE SEEING DIFFERENCES IN 4652 03:18:45,960 --> 03:18:49,920 PAIN REPORTING, IN SOME OF THESE 4653 03:18:49,920 --> 03:18:50,200 QUESTIONS? 4654 03:18:50,200 --> 03:18:52,320 ANDREA, YOU UNMUTED. 4655 03:18:52,320 --> 03:18:54,920 >> I THINK WE ALL KNOW 4656 03:18:54,920 --> 03:18:56,240 DEVASTATING CONSEQUENCES OF 4657 03:18:56,240 --> 03:18:56,960 COVID-19, ON RECRUITMENT. 4658 03:18:56,960 --> 03:18:59,400 SO I THOUGHT I WOULD JUST PUT A 4659 03:18:59,400 --> 03:19:02,600 POSITIVE SPIN ON IT AND SAY 4660 03:19:02,600 --> 03:19:10,120 THAT, YOU KNOW, IN LIEU OF 4661 03:19:10,120 --> 03:19:13,080 COVID-19, WE DID DEVELOP SOME -- 4662 03:19:13,080 --> 03:19:17,440 WE MOVED TOWARDS TELEVISITS FOR 4663 03:19:17,440 --> 03:19:18,640 FOLLOW-UP VISITS FOR 4664 03:19:18,640 --> 03:19:20,240 PARTICIPANTS ALREADY ENROLLED 4665 03:19:20,240 --> 03:19:20,640 AND ON MEDICATION. 4666 03:19:20,640 --> 03:19:23,600 THEY WERE PERMITTED TO COME BACK 4667 03:19:23,600 --> 03:19:25,440 FOR THE FOLLOW-UP VISITS, BUT I 4668 03:19:25,440 --> 03:19:28,200 DON'T THINK ANYONE CAME BACK 4669 03:19:28,200 --> 03:19:30,400 DURING THAT LOCKDOWN TIME. 4670 03:19:30,400 --> 03:19:33,000 YOU KNOW, FOR AN IN-PERSON 4671 03:19:33,000 --> 03:19:33,200 VISIT. 4672 03:19:33,200 --> 03:19:38,400 WE WERE ABLE TO KIND OF PIVOT 4673 03:19:38,400 --> 03:19:40,800 AND ADAPT OUR SURVEY FOR 4674 03:19:40,800 --> 03:19:45,080 ELECTRONIC, WE WERE ABLE TO GIVE 4675 03:19:45,080 --> 03:19:50,200 THOSE KIND OF LIKE A TELEVISIT 4676 03:19:50,200 --> 03:19:51,080 AND COMPUTER-BASED VISIT. 4677 03:19:51,080 --> 03:19:52,840 AND THEN WE WORKED WITH 4678 03:19:52,840 --> 03:19:55,680 PHARMACIES AND RESEARCH TEAM TO 4679 03:19:55,680 --> 03:19:58,960 MAIL OUT LIKE THE PREGNANCY 4680 03:19:58,960 --> 03:20:00,080 TEST, TAMPON TEST, THINGS LIKE 4681 03:20:00,080 --> 03:20:01,320 THAT. 4682 03:20:01,320 --> 03:20:04,960 WE DID EVERYTHING EXCEPT FOR 4683 03:20:04,960 --> 03:20:06,400 COLLECT BIOLOGIC SAMPLES. 4684 03:20:06,400 --> 03:20:11,520 AND SO ONCE THE STUDY 4685 03:20:11,520 --> 03:20:12,280 PARTICIPANTS RETURNED, IN-PERSON 4686 03:20:12,280 --> 03:20:13,720 VISITS, IF SOMEONE MOVED AWAY OR 4687 03:20:13,720 --> 03:20:16,080 SOMETHING LIKE THAT CAME UP, WE 4688 03:20:16,080 --> 03:20:19,320 WERE PREPARED TO HANDLE THAT 4689 03:20:19,320 --> 03:20:21,720 SITUATION WITH THIS COMBINATION 4690 03:20:21,720 --> 03:20:24,640 TELECOMPUTER VISIT. 4691 03:20:24,640 --> 03:20:25,400 IF ANYTHING, IT DID PROMOTE US 4692 03:20:25,400 --> 03:20:28,040 TO BE A LITTLE BIT MORE FLEXIBLE 4693 03:20:28,040 --> 03:20:33,240 AND HAVE MORE OPTIONS WITH STUDY 4694 03:20:33,240 --> 03:20:33,600 PARTICIPANTS. 4695 03:20:33,600 --> 03:20:35,720 BUT, YEAH, THAT WAS ONE SILVER 4696 03:20:35,720 --> 03:20:41,440 LINING THAT WE FOUND. 4697 03:20:41,440 --> 03:20:44,400 4698 03:20:44,400 --> 03:20:45,720 >> IT'S MADE CLINICAL RESEARCH 4699 03:20:45,720 --> 03:20:47,800 MORE EFFECTIVE IN A DISRUPTIVE 4700 03:20:47,800 --> 03:20:49,640 WAY, THAT WOULDN'T HAVE 4701 03:20:49,640 --> 03:20:50,520 OTHERWISE HAPPENED, PARTICIPANT 4702 03:20:50,520 --> 03:20:51,800 BURDEN IS WAY DOWN, 4703 03:20:51,800 --> 03:20:53,160 INTERVENTIONS WE DIDN'T THINK 4704 03:20:53,160 --> 03:20:57,280 COULD BE DELIVERED REMOTELY ARE 4705 03:20:57,280 --> 03:20:57,760 BEING DELIVERED. 4706 03:20:57,760 --> 03:20:59,360 LOOK WHAT HAPPENED TO CLINICAL 4707 03:20:59,360 --> 03:21:03,360 CARE, HOW MANY VISITS FLIPPED 4708 03:21:03,360 --> 03:21:03,560 OVER. 4709 03:21:03,560 --> 03:21:04,760 THERE'S A LOT OF REALLY GOOD 4710 03:21:04,760 --> 03:21:08,160 THINGS THAT HAPPENED TO CLINICAL 4711 03:21:08,160 --> 03:21:09,480 RESEARCH ENTERPRISE WITH RESPECT 4712 03:21:09,480 --> 03:21:12,600 TO TOTALLY RETHINKING HOW WE DO 4713 03:21:12,600 --> 03:21:13,280 THINGS. 4714 03:21:13,280 --> 03:21:16,520 I HAD GIVE A TALK FOR ISP, 4715 03:21:16,520 --> 03:21:18,400 PEOPLE THAT GET HURT THE MOST 4716 03:21:18,400 --> 03:21:21,680 ARE TRAINEES, PEOPLE THAT WERE 4717 03:21:21,680 --> 03:21:22,680 IN MORE VULNERABLE POSITIONS, 4718 03:21:22,680 --> 03:21:23,960 LIKE HEALTH DISPARITIES WITH 4719 03:21:23,960 --> 03:21:24,320 COVID. 4720 03:21:24,320 --> 03:21:26,960 WHAT WE'RE TALKING ABOUT IS THE 4721 03:21:26,960 --> 03:21:30,120 PEOPLE IN THE RESEARCH 4722 03:21:30,120 --> 03:21:31,800 ENTERPRISE, A LOT OF TRAINEES 4723 03:21:31,800 --> 03:21:32,840 SUFFERED BECAUSE OF COVID. 4724 03:21:32,840 --> 03:21:34,600 NOT HAVING THE KIND OF TRAINING 4725 03:21:34,600 --> 03:21:36,000 EXPERIENCES THEY WOULD OTHERWISE 4726 03:21:36,000 --> 03:21:38,400 GET. 4727 03:21:38,400 --> 03:21:38,680 >> RIGHT. 4728 03:21:38,680 --> 03:21:39,440 GOOD POINTS. 4729 03:21:39,440 --> 03:21:44,280 THANK YOU ALSO FOR OPTIMISM FROM 4730 03:21:44,280 --> 03:21:44,600 TWO OF YOU. 4731 03:21:44,600 --> 03:21:47,120 I THINK THAT'S THE TIME FOR YOUR 4732 03:21:47,120 --> 03:21:48,320 DISCUSSION SESSION. 4733 03:21:48,320 --> 03:21:50,240 I'LL TURN IT BACK OVER TO YOU 4734 03:21:50,240 --> 03:21:54,560 FOR CLOSING REMARKS. 4735 03:21:54,560 --> 03:21:55,920 4736 03:21:55,920 --> 03:21:58,200 >> THANK YOU. 4737 03:21:58,200 --> 03:22:03,440 THANK YOU VERY MUCH FOR YOUR 4738 03:22:03,440 --> 03:22:04,600 GREAT TALKS, EXCELLENT TALKS AND 4739 03:22:04,600 --> 03:22:05,000 GREAT DISCUSSION. 4740 03:22:05,000 --> 03:22:07,880 THANK YOU VERY MUCH FOR STAYING 4741 03:22:07,880 --> 03:22:10,080 WITH US AND PARTICIPATING IN THE 4742 03:22:10,080 --> 03:22:11,280 MEETING UNTIL NOW. 4743 03:22:11,280 --> 03:22:13,480 IT WAS MY GREAT HONOR AND 4744 03:22:13,480 --> 03:22:16,520 PLEASURE TO DISCUSS WITH YOU 4745 03:22:16,520 --> 03:22:19,040 ABOUT GYNECOLOGY PAIN RESEARCH. 4746 03:22:19,040 --> 03:22:22,480 THE RECORDING WITH SPEAKERS' 4747 03:22:22,480 --> 03:22:23,720 APPROVAL AND SUMMARY STATEMENT 4748 03:22:23,720 --> 03:22:25,920 WILL BE POSTED ON THE WEBSITE 4749 03:22:25,920 --> 03:22:28,960 AFTER THIS MEETING. 4750 03:22:28,960 --> 03:22:33,120 THEY MAY BE AVAILABLE PROBABLY 4751 03:22:33,120 --> 03:22:34,800 IN APRIL, SO IT WILL TAKE SOME 4752 03:22:34,800 --> 03:22:35,200 TIME. 4753 03:22:35,200 --> 03:22:44,160 IF YOU HAVE FURTHER QUESTIONS, 4754 03:22:44,160 --> 03:22:46,880 REGARDING THE GHDB OR QUESTIONS 4755 03:22:46,880 --> 03:22:48,040 FOR SPEAKERS, PLEASE DON'T 4756 03:22:48,040 --> 03:22:50,040 HESITATE TO CONTACT US. 4757 03:22:50,040 --> 03:22:52,800 WE WILL TRY TO ADDRESS ALL THE 4758 03:22:52,800 --> 03:22:53,520 QUESTIONS WE HAVE NOT BEEN ABLE 4759 03:22:53,520 --> 03:22:54,720 TO ANSWER. 4760 03:22:54,720 --> 00:00:00,000 THANK YOU.