1 00:00:04,738 --> 00:00:08,508 BUT FIRST I'D JUST LIKE TO 2 00:00:08,575 --> 00:00:17,817 ACKNOWLEDGE TH TO THANK THOSE FR 3 00:00:17,884 --> 00:00:20,019 HELPING TO ORGANIZE THIS, THEY 4 00:00:20,086 --> 00:00:21,221 DID AN AMAZING JOB, SO THANK 5 00:00:21,287 --> 00:00:21,454 YOU. 6 00:00:21,521 --> 00:00:26,359 THIS IS THE 19TH ANNUAL PAIN 7 00:00:26,426 --> 00:00:26,659 CONSORTIUM. 8 00:00:26,726 --> 00:00:28,294 IT'S HARD TO BELIEVE IT'S BEEN 9 00:00:28,361 --> 00:00:30,163 THAT LONG BUT IT HAS, AND IT'S 10 00:00:30,230 --> 00:00:31,498 THE FIRST ONE ON WOMEN'S HEALTH 11 00:00:31,564 --> 00:00:32,799 AND THAT'S -- FOCUSING ON 12 00:00:32,866 --> 00:00:33,333 WOMEN'S HEALTH. 13 00:00:33,400 --> 00:00:34,567 THAT'S WHY I'M ONE OF THE 14 00:00:34,634 --> 00:00:36,136 CO-CHAIRS OF THIS FROM THE 15 00:00:36,202 --> 00:00:40,440 OFFICE OF RESEARCH OND WOMEN' OS 16 00:00:40,507 --> 00:00:41,441 HEALTH, FOCUSING ON THIS 17 00:00:41,508 --> 00:00:43,109 IMPORTANT ISSUE THAT AFFECTS 18 00:00:43,176 --> 00:00:46,946 WOMEN PREDOMINANTLY OR MORE SO 19 00:00:47,013 --> 00:00:47,480 THAN MEN. 20 00:00:47,547 --> 00:00:50,850 WITH THAT, I'D LIKE TO INTRODUCE 21 00:00:50,917 --> 00:00:55,655 OUR FIRST SPEAKER, WHO IS 22 00:00:55,722 --> 00:01:00,160 DR. COURTNEY AKLIN, ACTING 23 00:01:00,226 --> 00:01:01,795 DIRECTOR OF NINR BUT PREVIOUSLY 24 00:01:01,861 --> 00:01:03,530 WITH THE OD DOING A TREMENDOUS 25 00:01:03,596 --> 00:01:05,131 JOB, BEFORE THAT, THE DEPUTY 26 00:01:05,198 --> 00:01:07,600 DIRECTOR OF NIMHD AND I DON'T 27 00:01:07,667 --> 00:01:09,469 HAVE HER BIO SO I CAN'T GO BACK 28 00:01:09,536 --> 00:01:10,570 ANY FURTHER BUT WE'RE THRILLED 29 00:01:10,637 --> 00:01:12,839 TO HAVE YOU HERE, AND ALSO 30 00:01:12,906 --> 00:01:14,140 CONNECTED TO THE PAIN 31 00:01:14,207 --> 00:01:14,874 CONSORTIUM, BECAUSE HER HUSBAND, 32 00:01:14,941 --> 00:01:16,676 A FRIEND OF MINE, IS NOW THE 33 00:01:16,743 --> 00:01:18,178 NIDA PAIN CONSORTIUM REP. 34 00:01:18,244 --> 00:01:19,612 SO THERE'S THAT CONNECTION TOO. 35 00:01:19,679 --> 00:01:21,581 SO COURTNEY, HOPE YOUR SLIDES 36 00:01:21,648 --> 00:01:23,550 WORK BUT IT'S ALL YOURS. 37 00:01:23,616 --> 00:01:24,951 >> GOOD MORNING, EVERYONE. 38 00:01:25,018 --> 00:01:26,386 THANK YOU SO MUCH FOR YOUR 39 00:01:26,453 --> 00:01:28,588 PATIENCE AS WE ARE DEALING WITH 40 00:01:28,655 --> 00:01:29,355 TECHNICAL DIFFICULTIES. 41 00:01:29,422 --> 00:01:30,423 I BELIEVE THOSE ON ZOOM MAY NOT 42 00:01:30,490 --> 00:01:31,858 BE ABLE TO SEE MY SLIDES BUT I'M 43 00:01:31,925 --> 00:01:33,059 GOING TO RUN THROUGH THIS VERY 44 00:01:33,126 --> 00:01:34,160 QUICKLY BECAUSE THERE'S SO MANY 45 00:01:34,227 --> 00:01:35,795 OTHER PEOPLE COMING AFTER ME. 46 00:01:35,862 --> 00:01:36,996 WE HAVE SOME REALLY GREAT TALKS 47 00:01:37,063 --> 00:01:38,198 TO TALK ABOUT THE RESEARCH THAT 48 00:01:38,264 --> 00:01:39,499 WE'RE REALLY INTERESTED IN. 49 00:01:39,566 --> 00:01:41,601 I WANT TO WELCOME YOU ALL ON 50 00:01:41,668 --> 00:01:42,469 BEHALF OF THE EXECUTIVE 51 00:01:42,535 --> 00:01:44,604 COMMITTEE OF THE NATIONAL 52 00:01:44,671 --> 00:01:47,173 INSTITUTES OF HEALTH PAIN 53 00:01:47,240 --> 00:01:47,474 CONSORTIUM. 54 00:01:47,540 --> 00:01:48,708 THE SYMPOSIUM IS TRULY AN HONOR 55 00:01:48,775 --> 00:01:51,478 TO BE HERE WITH YOU TODAY, SUCH 56 00:01:51,544 --> 00:01:53,079 A DISTINGUISHED AUDIENCE OF 57 00:01:53,146 --> 00:01:54,948 RESEARCHER, THOUGHT LEADERS, 58 00:01:55,014 --> 00:01:56,349 STAKEHOLDERS WHO ARE DEDICATED 59 00:01:56,416 --> 00:01:59,452 TO UNDERSTANDING THE UNDERLYINGS 60 00:01:59,519 --> 00:02:00,420 OF PAIN AND TREAT M OF PAIN. 61 00:02:00,487 --> 00:02:02,188 OVER THE NEXT TWO DAYS WE HAVE 62 00:02:02,255 --> 00:02:03,356 EXCITING SESSIONS FOR ALL OF YOU 63 00:02:03,423 --> 00:02:04,891 IN CONVERSATION CENTERED AROUND 64 00:02:04,958 --> 00:02:06,426 UNDERSTANDING THIS YEAR'S THEME 65 00:02:06,493 --> 00:02:08,294 OF SEX AND GENDER DIFFERENCES IN 66 00:02:08,361 --> 00:02:10,363 NEUROBIOLOGY OF PAIN, ITS 67 00:02:10,430 --> 00:02:11,898 EXPERIENCES AND MANAGEMENT. 68 00:02:11,965 --> 00:02:14,200 SO I'M GOING TO TALK JUST A 69 00:02:14,267 --> 00:02:15,502 LITTLE BIT BECAUSE AGAIN WE HAVE 70 00:02:15,568 --> 00:02:17,570 SPEAKERS FOLLOWING OF ME OF WHAT 71 00:02:17,637 --> 00:02:22,942 IT IS WE'RE TRYING TO FOCUS ON. 72 00:02:23,009 --> 00:02:24,177 THE MISSION AS WE GATHER HERE 73 00:02:24,244 --> 00:02:25,778 TODAY BOTH IN PERSON AND 74 00:02:25,845 --> 00:02:27,313 VIRTUALLY, WE ARE UNITED BY A 75 00:02:27,380 --> 00:02:28,515 COMMON GOAL WHICH IS TO PUSH THE 76 00:02:28,581 --> 00:02:31,784 BOUNDARIES OF PAIN RESEARCH AND 77 00:02:31,851 --> 00:02:33,152 TO IMPROVE THE LIVES OF MILLIONS 78 00:02:33,219 --> 00:02:34,420 WHO SUFFER FROM PAIN. 79 00:02:34,487 --> 00:02:36,055 PAIN AS WE KNOW IS NOT JUST A 80 00:02:36,122 --> 00:02:38,091 MEDICAL CONDITION BUT A PROFOUND 81 00:02:38,157 --> 00:02:41,394 HUMAN EXPERIENCE THAT AFFECTS 82 00:02:41,461 --> 00:02:42,762 CONDITIONS PHYSICALLY, MENTALLY 83 00:02:42,829 --> 00:02:43,730 AND SOCIAL WELL-BEING OF ALL OF 84 00:02:43,796 --> 00:02:44,497 US. 85 00:02:44,564 --> 00:02:45,365 OUR COLLECTIVE EFFORTS IN THIS 86 00:02:45,431 --> 00:02:46,933 FIELD ARE MORE CRITICAL NOW THAN 87 00:02:47,000 --> 00:02:50,069 EVER BEFORE. 88 00:02:50,136 --> 00:02:53,573 25 INSTITUTES ACROSS NIH AND 89 00:02:53,640 --> 00:02:54,674 BOUND TOGETHER FOR THIS 90 00:02:54,741 --> 00:02:55,542 CONSORTIUM TO ADDRESS SOME OF 91 00:02:55,608 --> 00:02:57,176 THE MOST CHALLENGING AND COMPLEX 92 00:02:57,243 --> 00:02:58,945 ISSUES AND QUESTIONS RELATING TO 93 00:02:59,012 --> 00:03:00,146 DETERMINING THE UNDERLYING 94 00:03:00,213 --> 00:03:02,649 CAUSES OF PAIN AND FOR 95 00:03:02,715 --> 00:03:03,550 DEVELOPING TARGETED 96 00:03:03,616 --> 00:03:04,817 INTERVENTIONS TO ALLEVIATE PAIN 97 00:03:04,884 --> 00:03:08,254 SYMPTOMS. 98 00:03:08,321 --> 00:03:09,556 WE MUST CONTINUE THE EFFORTS 99 00:03:09,622 --> 00:03:11,524 THAT HAVE BEEN OUTLINED OVER THE 100 00:03:11,591 --> 00:03:12,926 PAST 19 CONSORTIUMS, SUPPORTING 101 00:03:12,992 --> 00:03:14,594 AND DEVELOPING RESEARCH 102 00:03:14,661 --> 00:03:16,095 RESOURCES AND TOOLS AND HOSTING 103 00:03:16,162 --> 00:03:17,864 EVENTS LIKE THIS ONE WHERE WE 104 00:03:17,931 --> 00:03:19,732 HAVE THE OPPORTUNITY TO PROMOTE 105 00:03:19,799 --> 00:03:20,967 COLLABORATION AND HIGHLIGHT 106 00:03:21,034 --> 00:03:27,040 ADVANCES IN PAIN RESEARCH. 107 00:03:27,106 --> 00:03:28,675 AS THE DEPUTY DIRECTOR OF THE 108 00:03:28,741 --> 00:03:30,009 NATIONAL INSTITUTE OF NURSING 109 00:03:30,076 --> 00:03:31,077 RESEARCH, I'M PARTICULARLY 110 00:03:31,144 --> 00:03:32,178 EXCITED ABOUT WHAT IT IS THAT WE 111 00:03:32,245 --> 00:03:33,546 WILL BE TALKING ABOUT OVER THE 112 00:03:33,613 --> 00:03:34,814 NEXT TWO DAYS. 113 00:03:34,881 --> 00:03:36,482 IN THE CONTEXT OF PEOPLE'S LIVES 114 00:03:36,549 --> 00:03:40,486 AND LIVED EXPERIENCES AS WHERE 115 00:03:40,553 --> 00:03:42,055 NURSING SITS TRADITIONALLY, 116 00:03:42,121 --> 00:03:43,122 CLINICALLY AND RESEARCH ORIENTED 117 00:03:43,189 --> 00:03:44,324 BUT AS MANY IN THE AUDIENCE 118 00:03:44,390 --> 00:03:45,725 PROBABLY ALREADY KNOW THE 119 00:03:45,792 --> 00:03:47,060 NURSES' APPROACH TO PREVENTION, 120 00:03:47,126 --> 00:03:48,695 TREATMENT AND CARE IS HOLISTIC 121 00:03:48,761 --> 00:03:50,330 AND IN CONTEXT. 122 00:03:50,396 --> 00:03:52,298 NURSES FOCUS ON PEOPLE, THEIR 123 00:03:52,365 --> 00:03:53,766 LIVES, AND THEIR LIVING 124 00:03:53,833 --> 00:03:54,901 CONDITIONS. 125 00:03:54,968 --> 00:03:56,269 AND BECAUSE NURSES WORK SO 126 00:03:56,336 --> 00:03:57,804 CLOSELY IN A WIDE RANGE OF 127 00:03:57,870 --> 00:03:59,839 SETTINGS, THE ARE GENERALLY THE 128 00:03:59,906 --> 00:04:00,506 MOST TRUSTED INDIVIDUALS IN THE 129 00:04:00,573 --> 00:04:00,873 ROOM. 130 00:04:00,940 --> 00:04:02,842 AND BECAUSE OF THAT, THAT ALLOWS 131 00:04:02,909 --> 00:04:04,978 THEM ACCESS TO TRULY ASK THE 132 00:04:05,044 --> 00:04:06,879 QUESTIONS AND CHALLENGING 133 00:04:06,946 --> 00:04:08,514 ASPECTS TO FORGE FORWARD AND TO 134 00:04:08,581 --> 00:04:12,118 ADDRESS INEQUITIES. 135 00:04:12,185 --> 00:04:13,586 IN FACT, WE BELIEVE THIS SO 136 00:04:13,653 --> 00:04:15,288 STRONGLY THAT THE INSTITUTE HAS 137 00:04:15,355 --> 00:04:16,255 PIVOTED AND MADE THIS PART OF 138 00:04:16,322 --> 00:04:20,727 OUR MISSION, AS YOU SEE HERE. 139 00:04:20,793 --> 00:04:22,629 THE FOCUS OF THIS YEAR'S 140 00:04:22,695 --> 00:04:23,997 SYMPOSIUM SPECIFICALLY ON SEX 141 00:04:24,063 --> 00:04:25,264 AND GENDER DIFFERENCES AND THE 142 00:04:25,331 --> 00:04:26,532 EXPERIENCE AND MANAGEMENT OF 143 00:04:26,599 --> 00:04:31,804 PAIN PAIN SHOULD AUTOMATICALLY 144 00:04:31,871 --> 00:04:33,640 CHALLENGE US TO CONSIDER PAIN 145 00:04:33,706 --> 00:04:35,375 FROM A HEALTH EQUITY PERSPECTIVE 146 00:04:35,441 --> 00:04:37,276 AND ASK OURSELVES THOSE TOUGH 147 00:04:37,343 --> 00:04:38,244 QUESTIONS ON WHY THESE 148 00:04:38,311 --> 00:04:38,911 DIFFERENCES EXIST. 149 00:04:38,978 --> 00:04:40,546 QUESTIONS SUCH AS WHY ARE WOMEN 150 00:04:40,613 --> 00:04:41,981 VETERANS MORE LIKELY TO BE 151 00:04:42,048 --> 00:04:43,149 PRESCRIBED PSYCHIATRIC MEDICINE 152 00:04:43,216 --> 00:04:45,585 FOR PAIN THAN THEIR MALE 153 00:04:45,652 --> 00:04:46,219 COUNTERPARTS? 154 00:04:46,285 --> 00:04:48,388 WHY ARE BLACK, HISPANIC AND 155 00:04:48,454 --> 00:04:52,592 ASIAN WOMEN OFTEN GIVEN NARCOTIC 156 00:04:52,659 --> 00:04:56,529 MEDICATION FOR CESAREAN BIRTH? 157 00:04:56,596 --> 00:04:59,298 WHY DO SEXUAL MINORITY MINORITN 158 00:04:59,365 --> 00:05:02,001 HAVE A LIFETIME RISK OF 159 00:05:02,068 --> 00:05:03,069 EXPERIENCING CHRONIC PELVIC 160 00:05:03,136 --> 00:05:03,736 PAIN? 161 00:05:03,803 --> 00:05:05,405 THEY DO NOT ORIGINATE IN ANY 162 00:05:05,471 --> 00:05:06,706 EXAM ROOM OR HEALTHCARE SETTING 163 00:05:06,773 --> 00:05:08,975 BUT ACTUALLY ARE RATHER THE 164 00:05:09,042 --> 00:05:10,309 EARLIER ECONOMIC STANDARDS AND 165 00:05:10,376 --> 00:05:11,878 PLACES IN SOCIETY THAT AFFECT 166 00:05:11,944 --> 00:05:16,849 THEM. 167 00:05:16,916 --> 00:05:19,385 JUST TO PIVOT FOR A SECOND WE 168 00:05:19,452 --> 00:05:23,990 MUCH LOOK AT THE BIGGER PICTURE. 169 00:05:24,057 --> 00:05:25,692 IT IS ALSO CLEAR THESE UPSTREAM 170 00:05:25,758 --> 00:05:27,260 FACTORS HAVE AN IMPACT ON HOW 171 00:05:27,326 --> 00:05:29,662 WELL INTERVENTIONS WORK AT THE 172 00:05:29,729 --> 00:05:30,296 INDIVIDUAL LEVEL. 173 00:05:30,363 --> 00:05:33,366 PAIN IS MULTIFACETED. 174 00:05:33,433 --> 00:05:36,202 IT'S INFLUENCED BY THE 175 00:05:36,269 --> 00:05:37,070 PSYCHOLOGICAL, SOCIAL AND 176 00:05:37,136 --> 00:05:38,004 ENVIRONMENTAL FACTORS. 177 00:05:38,071 --> 00:05:43,309 SOCIAL DETERMINANTS SUCH AS 178 00:05:43,376 --> 00:05:44,644 SOCIO AND ECONOMIC STATUS AFFECT 179 00:05:44,711 --> 00:05:46,045 A PERSON'S EXPERIENCE OF PAIN 180 00:05:46,112 --> 00:05:47,380 AND THEIR ABILITY TO SEEK 181 00:05:47,447 --> 00:05:48,681 TREATMENT. 182 00:05:48,748 --> 00:05:49,215 FOR PAIN MANAGEMENT 183 00:05:49,282 --> 00:05:50,016 SPECIFICALLY, IT IS NOT 184 00:05:50,083 --> 00:05:51,084 EFFECTIVE IF WE DO NOT THINK 185 00:05:51,150 --> 00:05:52,719 ABOUT THESE PARTICULAR ASPECTS. 186 00:05:52,785 --> 00:05:53,853 SIMPLY INTERVENING AT THE LEVEL 187 00:05:53,920 --> 00:05:55,621 OF SOCIAL DETERMINANT REPRESENTS 188 00:05:55,688 --> 00:05:57,123 AN UPSTREAM APPROACH TO PAIN 189 00:05:57,190 --> 00:05:58,191 MANAGEMENT, AND BY ADDRESSING 190 00:05:58,257 --> 00:05:59,826 THESE BROADER CONCEPTS SUCH AS 191 00:05:59,892 --> 00:06:01,594 HOUSING AND STABLE EMPLOYMENT, 192 00:06:01,661 --> 00:06:04,464 WE CAN PREVENT CHRONIC PAIN. 193 00:06:04,530 --> 00:06:06,599 WE CAN ALSO MITIGATE THEM 194 00:06:06,666 --> 00:06:08,401 EARLIER ON AND REDUCE THE BURDEN 195 00:06:08,468 --> 00:06:09,368 OF HEALTHCARE AND DISPARITIES 196 00:06:09,435 --> 00:06:11,804 THAT WE SEE. 197 00:06:11,871 --> 00:06:13,539 BUT WE MUST MAKE IT A PRIORITY 198 00:06:13,606 --> 00:06:15,608 AS SCIENTISTS TO INCLUDE THESE 199 00:06:15,675 --> 00:06:17,009 SOCIAL DETERMINANTS OF HEALTH 200 00:06:17,076 --> 00:06:18,678 INTO OUR RESEARCH IN A RIGOROUS 201 00:06:18,745 --> 00:06:19,746 AND MEANINGFUL WAY IF WE'RE 202 00:06:19,812 --> 00:06:21,581 GOING TO ACHIEVE THE EQUITABLE 203 00:06:21,647 --> 00:06:24,016 LANDSCAPE THAT WE'RE SET OUT TO 204 00:06:24,083 --> 00:06:26,319 DO. 205 00:06:26,385 --> 00:06:27,954 IN ESSENCE OF TIME I'M JUST 206 00:06:28,020 --> 00:06:29,355 GOING TO HIGHLIGHT ONE STUDY 207 00:06:29,422 --> 00:06:31,124 THAT NINR HAS RECENTLY SUPPORTED 208 00:06:31,190 --> 00:06:32,225 TO ILLUSTRATE THE POINTS I'VE 209 00:06:32,291 --> 00:06:32,792 JUST SPOKE ABOUT. 210 00:06:32,859 --> 00:06:34,727 IN THIS STUDY, RESEARCHERS ARE 211 00:06:34,794 --> 00:06:36,729 USING TELEHEALTH TO IMPLEMENT 212 00:06:36,796 --> 00:06:39,031 EFFECTIVE, EVIDENCE-BASED AND 213 00:06:39,098 --> 00:06:39,999 NON-OPIOID INTERVENTIONS FOR 214 00:06:40,066 --> 00:06:41,167 CHRONIC PAIN MANAGEMENT. 215 00:06:41,234 --> 00:06:42,602 CHALLENGES THAT ARE FACED BY 216 00:06:42,668 --> 00:06:43,903 VETERANS RESIDING IN RURAL AND 217 00:06:43,970 --> 00:06:45,138 REMOTE AREAS. 218 00:06:45,204 --> 00:06:47,306 THE STUDY PURPOSELY DESIGNED TO 219 00:06:47,373 --> 00:06:48,074 ADDRESS SEVERAL SOCIAL 220 00:06:48,141 --> 00:06:49,175 DETERMINANTS OF HEALTH INCLUDING 221 00:06:49,242 --> 00:06:51,611 ACCESS TO CARE BY UTILIZING 222 00:06:51,677 --> 00:06:53,646 TELEHEALTH TO BRIDGE THIS GAP. 223 00:06:53,713 --> 00:06:55,081 MAKING NON-OPIOID PAIN 224 00:06:55,148 --> 00:06:56,115 MANAGEMENT STRATEGIES MORE 225 00:06:56,182 --> 00:06:59,886 ACCESSIBLE TO RURAL COMMUNITIES. 226 00:06:59,952 --> 00:07:00,987 HEALTHCARE INFRASTRUCTURE. 227 00:07:01,053 --> 00:07:02,188 BY IMPLEMENTING WHAT HAS ALREADY 228 00:07:02,255 --> 00:07:04,357 BEEN IN PLACE AND USING THE VA'S 229 00:07:04,423 --> 00:07:05,792 INFRASTRUCTURE THAT ALREADY HAS 230 00:07:05,858 --> 00:07:07,260 INCLUDED WELL HEALTH COACHES, 231 00:07:07,326 --> 00:07:08,995 YOU HAVE THE ABILITY TO SCALE 232 00:07:09,061 --> 00:07:11,931 AND TO REACH AND HAVE A FURTHER 233 00:07:11,998 --> 00:07:17,069 OPPORTUNITY TO HELP VETERANS ANN 234 00:07:17,136 --> 00:07:17,837 THEIR PARTICULAR PLACES WHERE 235 00:07:17,904 --> 00:07:19,038 THEY LIVE AND WORK. 236 00:07:19,105 --> 00:07:20,439 ALSO COMMUNITY ENGAGEMENT, 237 00:07:20,506 --> 00:07:21,474 INVOLVING VETERANS EARLY IN THE 238 00:07:21,541 --> 00:07:23,976 PROCESS SO IN ORDER TO LOOK AT 239 00:07:24,043 --> 00:07:24,477 ACCEPTABILITY AS WELL AS 240 00:07:24,544 --> 00:07:25,678 SCALABILITY. 241 00:07:25,745 --> 00:07:27,046 IN ESSENCE OF TIME I'M GOING TO 242 00:07:27,113 --> 00:07:27,647 SKIP THROUGH THIS. 243 00:07:27,713 --> 00:07:28,848 AND JUST SAY BEFORE I TURN 244 00:07:28,915 --> 00:07:30,817 THINGS OVER TO MY COLLEAGUE FROM 245 00:07:30,883 --> 00:07:33,085 THE OFFICE OF RESEARCH ON 246 00:07:33,152 --> 00:07:34,253 WOMEN'S HEALTH, I WANT TO CLOSE 247 00:07:34,320 --> 00:07:36,189 BY HIGH HEIGHTING THAT THIS 248 00:07:36,255 --> 00:07:37,857 CONSORTIUM HAS SUCCESSFULLY 249 00:07:37,924 --> 00:07:39,792 EXPANDED THE PORTFOLIO OF PAIN 250 00:07:39,859 --> 00:07:40,893 RESEARCH WITHIN NIH BY 251 00:07:40,960 --> 00:07:41,894 ADDRESSING A DIVERSE RANGE OF 252 00:07:41,961 --> 00:07:44,330 PAIN CONDITIONS AND EXPLORING 253 00:07:44,397 --> 00:07:46,065 THE THERAPEUTIC AVENUES. 254 00:07:46,132 --> 00:07:47,266 PROMOTING INTERDISCIPLINARY 255 00:07:47,333 --> 00:07:48,701 COLLABORATIVE WORK, A LITTLE BIT 256 00:07:48,768 --> 00:07:49,969 OF A HEAD NOD BECAUSE I THINK 257 00:07:50,036 --> 00:07:51,404 THAT IS EXTREMELY IMPORTANT, 258 00:07:51,470 --> 00:07:53,272 ESPECIALLY AS WE CONTINUE TO 259 00:07:53,339 --> 00:07:55,007 DELVE INTO THESE COMPLEX ISSUES, 260 00:07:55,074 --> 00:07:56,576 BUT NINR IS PLEASED TO BE A PART 261 00:07:56,642 --> 00:07:58,277 OF THIS CONSORTIUM EVENT AND I'M 262 00:07:58,344 --> 00:07:59,612 SO EXCITED TO LEARN OVER THE 263 00:07:59,679 --> 00:08:01,347 NEXT TWO DAYS OF SOME OF THE NEW 264 00:08:01,414 --> 00:08:02,348 ASPECTS THAT ARE COMING FORWARD 265 00:08:02,415 --> 00:08:02,982 FROM ALL OF YOU. 266 00:08:03,049 --> 00:08:03,983 AND WITH THAT, I'M GOING TO 267 00:08:04,050 --> 00:08:06,853 CLOSE AND TURN IT OVER TO 268 00:08:06,919 --> 00:08:13,259 DR. VIVIAN OTA WONG, DEPUTY 269 00:08:13,326 --> 00:08:14,260 DIRECTOR OF THE NIH OFFICE OF 270 00:08:14,327 --> 00:08:24,871 RESEARCH ON WOMEN'S HEALTH. 271 00:08:24,937 --> 00:08:25,571 >> GOOD MORNING. 272 00:08:25,638 --> 00:08:27,073 IT'S GOING TO LOOK LIKE WE HAVE 273 00:08:27,139 --> 00:08:28,541 SIMILAR SLIDES BUT HERE WE GO. 274 00:08:28,608 --> 00:08:30,009 SO ANYWAY, I'M THE DEPUTY 275 00:08:30,076 --> 00:08:30,910 DIRECTOR OF THE OFFICE OF 276 00:08:30,977 --> 00:08:32,078 RESEARCH ON WOMEN'S HEALTH AT 277 00:08:32,144 --> 00:08:33,980 NIH AND I JUST WOULD ALSO LIKE 278 00:08:34,046 --> 00:08:36,148 TO WELCOME YOU AND PROVIDE YOU A 279 00:08:36,215 --> 00:08:38,551 FEW OPENING REMARKS TO LEVELSET 280 00:08:38,618 --> 00:08:39,318 SOME OF THE THINGS WE'RE GOING 281 00:08:39,385 --> 00:08:42,755 TO BE TALKING ABOUT TODAY. 282 00:08:42,822 --> 00:08:45,391 I WANT ALL OF YOU TO IMAGINE A 283 00:08:45,458 --> 00:08:47,526 WORLD IN WHICH EVERY WOMAN 284 00:08:47,593 --> 00:08:49,061 RECEIVES EVIDENCE-BASED DISEASE 285 00:08:49,128 --> 00:08:50,696 PREVENTION AND TREATMENT 286 00:08:50,763 --> 00:08:53,866 TAILORED TO HER OWN NEEDS, 287 00:08:53,933 --> 00:08:55,501 CIRCUMSTANCES, AND GOALS, AND 288 00:08:55,568 --> 00:08:59,105 FOR YOUR PARTICULAR AREA, WHAT 289 00:08:59,171 --> 00:09:00,806 IS PAIN AND HOW ARE WE TRULY 290 00:09:00,873 --> 00:09:03,743 GOING TO DO THAT? 291 00:09:03,809 --> 00:09:04,810 A DIFFERENT VERSION OF WHAT YOU 292 00:09:04,877 --> 00:09:06,545 JUST SAW, I THINK WE NEED TO PAY 293 00:09:06,612 --> 00:09:08,581 ATTENTION TO THE FULL DIASPORA 294 00:09:08,648 --> 00:09:09,382 OF THE LIVED EXPERIENCE. 295 00:09:09,448 --> 00:09:10,683 WE HAVE THE BIOLOGICAL PIECE 296 00:09:10,750 --> 00:09:12,585 THAT SOME OF YOU ARE DOING MORE 297 00:09:12,652 --> 00:09:13,886 BENCH SCIENCE, WE HAVE TO 298 00:09:13,953 --> 00:09:15,988 UNDERSTAND THE WORLD WHERE WE 299 00:09:16,055 --> 00:09:17,957 LIVE, AND HOW THE POLICIES THAT 300 00:09:18,024 --> 00:09:20,893 WE ARE ACTUALLY OPERATING UNDER 301 00:09:20,960 --> 00:09:23,629 INFLUENCE HUMAN HEALTH. 302 00:09:23,696 --> 00:09:25,264 BECAUSE WHAT WE KNOW IS THAT MEN 303 00:09:25,331 --> 00:09:27,767 AND WOMEN FOLLOW MANY DIFFERENT 304 00:09:27,833 --> 00:09:31,504 PATHS TO DISEASE AND HEALTH, AND 305 00:09:31,570 --> 00:09:32,371 PART OF OUR GOAL IN THIS ROOM 306 00:09:32,438 --> 00:09:34,006 AND IN SCIENCE IS TO FIGURE OUT 307 00:09:34,073 --> 00:09:35,341 WHAT THOSE PATHS ARE AND WHAT WE 308 00:09:35,408 --> 00:09:37,510 CAN DO TO ACTUALLY IMPROVE TO 309 00:09:37,576 --> 00:09:40,813 IMPROVE HEALTH. 310 00:09:40,880 --> 00:09:42,114 THIS IS A BIT OF A BUSY SLIDE 311 00:09:42,181 --> 00:09:43,749 BUT IT'S REALLY TO DEMONSTRATE 312 00:09:43,816 --> 00:09:44,417 TWO POINTS. 313 00:09:44,483 --> 00:09:46,719 ONE, THAT WOMEN DIFFERENTLY 314 00:09:46,786 --> 00:09:47,720 EXPERIENCE HEALTH AND DISEASE 315 00:09:47,787 --> 00:09:49,121 AND AS YOU SEE ON THE RIGHT, 316 00:09:49,188 --> 00:09:50,756 IT'S JUST A LIST OF DIFFERENT 317 00:09:50,823 --> 00:09:52,525 DISEASES, AND WE DO KNOW THAT 318 00:09:52,591 --> 00:09:54,827 WOMEN EXPERIENCE PAIN MORE AND 319 00:09:54,894 --> 00:09:57,296 MORE FREQUENTLY IN INTENSITY 320 00:09:57,363 --> 00:09:58,965 THAN MEN, BUT WHAT THIS ALSO 321 00:09:59,031 --> 00:10:01,734 SHOWS IS THAT THE FREQUENCY OF 322 00:10:01,801 --> 00:10:05,838 THE TYPES OF SYMPTOMS DIFFER BY 323 00:10:05,905 --> 00:10:07,606 MEN AND WOMEN NOT ONLY IN TERMS 324 00:10:07,673 --> 00:10:12,144 OF AMOUNT BUT ALSO BY MAGNITUDE. 325 00:10:12,211 --> 00:10:13,846 SO THIS IS HOW WE SORT OF THINK 326 00:10:13,913 --> 00:10:15,614 ABOUT HEALTH OF WOMEN ACROSS THE 327 00:10:15,681 --> 00:10:16,682 LIFE COURSE AT THE OFFICE OF 328 00:10:16,749 --> 00:10:20,186 RESEARCH ON WOMEN'S HEALTH. 329 00:10:20,252 --> 00:10:22,054 WE LOOK AT THE BOTTOM OF THE 330 00:10:22,121 --> 00:10:23,756 BIOLOGICAL PERSPECTIVES, THEIR 331 00:10:23,823 --> 00:10:24,457 INTERNAL FACTORS. 332 00:10:24,523 --> 00:10:27,860 IT CAN GO AS MICROSCOPING INTO 333 00:10:27,927 --> 00:10:30,029 THE GENOMICS OR GENOMIC 334 00:10:30,096 --> 00:10:30,363 FUNCTIONING. 335 00:10:30,429 --> 00:10:32,198 WE HAVE TO PUT THIS ON THE 336 00:10:32,264 --> 00:10:34,300 LIFESPAN SCALE TO UNDERSTAND THE 337 00:10:34,367 --> 00:10:37,036 LIVED EXPERIENCE OF GIRLS AND 338 00:10:37,103 --> 00:10:38,337 WOMEN FOR PREPREGNANCY ALL THE 339 00:10:38,404 --> 00:10:39,338 WAY TO ADULTHOOD. 340 00:10:39,405 --> 00:10:40,973 THEN WE HAVE TO PUT THE WOMEN IN 341 00:10:41,040 --> 00:10:43,309 CONTEXT, WHAT ARE THE LIVES THAT 342 00:10:43,376 --> 00:10:45,111 THEY LEAD AND WHERE DO THEY LIVE 343 00:10:45,177 --> 00:10:46,212 THAT MAKE A DIFFERENCE IN TERMS 344 00:10:46,278 --> 00:10:48,714 OF THEIR HEALTH OUTCOMES. 345 00:10:48,781 --> 00:10:52,685 IF YOU LOOK ON THE FAR LEFT, 346 00:10:52,752 --> 00:10:53,352 THERE'S INTERACTION EVENT THAT 347 00:10:53,419 --> 00:10:58,157 INTERACTION EFFECTS WEHAVE TO P. 348 00:10:58,224 --> 00:11:04,697 WE HAVE TO PAY ATTENTION TO 349 00:11:04,764 --> 00:11:06,265 INTERACTION OF SEX, THE MODIFY 350 00:11:06,332 --> 00:11:11,037 IRESMODIFIERS ARE BECAUSE OF THE 351 00:11:11,103 --> 00:11:12,371 SOCIAL DETERMINANTS OF HEALTH 352 00:11:12,438 --> 00:11:13,806 THAT WE ARE TALKING ABOUT. 353 00:11:13,873 --> 00:11:14,907 THEY ARE NOT MOVING. 354 00:11:14,974 --> 00:11:16,509 I AM CLICKING AND IT NOT MOVING. 355 00:11:16,575 --> 00:11:18,277 YOU'VE MISSED ALL MY COOL 356 00:11:18,344 --> 00:11:19,178 SLIDES. 357 00:11:19,245 --> 00:11:22,348 OKAY, HERE WE GO. 358 00:11:22,415 --> 00:11:23,616 I'LL GIVE YOU A FLASH. 359 00:11:23,682 --> 00:11:28,788 IT'S STILL NOT WORKING. 360 00:11:28,854 --> 00:11:31,791 WELL, I AM SO SORRY. 361 00:11:31,857 --> 00:11:42,001 HOLD ON. 362 00:11:42,268 --> 00:11:43,669 OKAY, HERE'S MY FIRST SLIDE. 363 00:11:43,736 --> 00:11:45,337 I'M TRYING TO KEEP YOUR 364 00:11:45,404 --> 00:11:50,810 ATTENTION. 365 00:11:50,876 --> 00:11:51,977 IMAGINE THAT WORLD! 366 00:11:52,044 --> 00:11:53,612 OH, NOW IT'S GOING REALLY FAST. 367 00:11:53,679 --> 00:12:02,588 IT'S SKIPPING OVER EVERYTHING. 368 00:12:02,655 --> 00:12:03,689 THERE'S THE BUSY SLIDE I WAS 369 00:12:03,756 --> 00:12:05,458 TELLING YOU ABOUT. 370 00:12:05,524 --> 00:12:06,058 MAGNITUDE AND FREQUENCY. 371 00:12:06,125 --> 00:12:09,395 THIS IS THE DATA THAT SHOWS THAT 372 00:12:09,462 --> 00:12:10,930 WE NEED TO DO SOMETHING, AND WE 373 00:12:10,996 --> 00:12:12,431 NEED TO DO IT NOW, AND WE NEED 374 00:12:12,498 --> 00:12:14,733 TO REALLY FIGURE OUT WHAT IS 375 00:12:14,800 --> 00:12:17,136 GOING ON AROUND WOMEN'S HEALTH 376 00:12:17,203 --> 00:12:20,072 AND WOMEN'S HEALTH RESEARCH. 377 00:12:20,139 --> 00:12:20,539 OKAY. 378 00:12:20,606 --> 00:12:24,043 I'M CATCHING UP. 379 00:12:24,110 --> 00:12:25,678 SO THIS IS WHAT I WAS TALKING 380 00:12:25,744 --> 00:12:26,979 ABOUT ON THE FAR LEFT, TALKING 381 00:12:27,046 --> 00:12:28,447 ABOUT EPIGENOMIC MODIFIERS. 382 00:12:28,514 --> 00:12:30,082 WHY I BRING THIS UP, WE'VE 383 00:12:30,149 --> 00:12:31,584 TALKED A LOT ABOUT GENE 384 00:12:31,650 --> 00:12:32,451 ENVIRONMENT INTERACTION BUT WHAT 385 00:12:32,518 --> 00:12:34,520 WE'RE LEARNING ABOUT THE GENOME, 386 00:12:34,587 --> 00:12:37,256 IT'S THE SOCIAL DETERMINANTS OF 387 00:12:37,323 --> 00:12:39,792 HEALTH THAT DETERMINE WHEN THE 388 00:12:39,859 --> 00:12:41,627 GENES GET TURNED ON AND OFF AND 389 00:12:41,694 --> 00:12:42,962 IT'S ALSO THOSE SOCIAL 390 00:12:43,028 --> 00:12:43,896 DETERMINANTS OF HEALTH THAT ARE 391 00:12:43,963 --> 00:12:45,464 LIKE THE VOLUME OF HOW MUCH 392 00:12:45,531 --> 00:12:46,999 INFLUENCE THEY HAVE ON THE 393 00:12:47,066 --> 00:12:47,867 OUTCOME. 394 00:12:47,933 --> 00:12:53,572 THAT'S WHY THEY'RE SO IMPORTANT. 395 00:12:53,639 --> 00:12:54,874 SO I JUST WANTED TO GIVE YOU A 396 00:12:54,940 --> 00:12:56,509 PLUG FOR THE OFFICE OF RESEARCH 397 00:12:56,575 --> 00:12:57,510 ON WOMEN'S HEALTH, AND OUR 398 00:12:57,576 --> 00:12:59,678 MISSION IS REALLY TO FOCUS ON 399 00:12:59,745 --> 00:13:00,980 WOMEN'S HEALTH RESEARCH BY 400 00:13:01,046 --> 00:13:02,214 INCLUDING WOMEN AND MINORITY 401 00:13:02,281 --> 00:13:04,817 GROUPS IN CLINICAL RESEARCH, AS 402 00:13:04,884 --> 00:13:06,685 WELL AS PROMOTING THE CAREER 403 00:13:06,752 --> 00:13:08,120 DEVELOPMENT FOR WOMEN IN 404 00:13:08,187 --> 00:13:09,421 BIOMEDICAL CAREERS THROUGHOUT 405 00:13:09,488 --> 00:13:10,723 THEIR CAREERS, NOT ONLY AT THE 406 00:13:10,789 --> 00:13:12,591 BEGINNING. 407 00:13:12,658 --> 00:13:13,893 I JUST WANTED TO REMIND ALL OF 408 00:13:13,959 --> 00:13:16,295 US THAT OUR WORK IS REALLY IN 409 00:13:16,362 --> 00:13:18,230 LINE WITH THE NIH VISION AND 410 00:13:18,297 --> 00:13:19,598 MISSION STATEMENT AND THAT 411 00:13:19,665 --> 00:13:21,800 ACTUALLY HIGHLIGHTS THAT SEX AND 412 00:13:21,867 --> 00:13:24,069 GENDER SHOULD BE INTEGRATED INTO 413 00:13:24,136 --> 00:13:27,139 BIOMEDICAL RESEARCH. 414 00:13:27,206 --> 00:13:28,374 EVERYONE AND EVERY WOMAN SHOULD 415 00:13:28,440 --> 00:13:30,843 RECEIVE EVIDENCE-BASED CARE, AND 416 00:13:30,910 --> 00:13:32,178 THAT WOMEN IN SCIENCE CAREERS 417 00:13:32,244 --> 00:13:33,712 REACH THEIR FULL POTENTIAL, NOT 418 00:13:33,779 --> 00:13:36,282 JUST WHAT THE SYSTEM SAYS THEY 419 00:13:36,348 --> 00:13:38,317 SHOULD BE. 420 00:13:38,384 --> 00:13:38,651 OKAY. 421 00:13:38,717 --> 00:13:40,586 SO WHAT WE'RE TALKING ABOUT IS 422 00:13:40,653 --> 00:13:41,987 INCORPORATING SEX AND GENDER 423 00:13:42,054 --> 00:13:44,757 ACROSS THE RESEARCH CONTINUUM TO 424 00:13:44,823 --> 00:13:46,825 ADVANCE SCIENTIFIC RIGOR, 425 00:13:46,892 --> 00:13:48,394 DISCOVERY, AND EQUITY. 426 00:13:48,460 --> 00:13:53,732 AND IT WAS NICE TO HEAR 427 00:13:53,799 --> 00:13:54,800 DR. AKLIN TALKING ABOUT EQUITY 428 00:13:54,867 --> 00:13:55,968 BECAUSE IT'S ALSO A SHARED 429 00:13:56,035 --> 00:13:56,735 FOUNDATION WE HAVE AT THE OFFICE 430 00:13:56,802 --> 00:13:59,071 OF RESEARCH ON WOMEN'S HEALTH. 431 00:13:59,138 --> 00:14:01,240 BUT LET ME TALK A LITTLE BIT 432 00:14:01,307 --> 00:14:03,275 ABOUT THE SEX AS A BIOLOGICAL 433 00:14:03,342 --> 00:14:03,676 VARIABLE POLICY. 434 00:14:03,742 --> 00:14:04,777 THIS HAS BEEN A POLICY THAT'S 435 00:14:04,843 --> 00:14:07,613 BEEN IN PLACE SINCE 2016, AND 436 00:14:07,680 --> 00:14:09,248 HOW DID WE GET THERE TO BEGIN 437 00:14:09,315 --> 00:14:09,682 WITH? 438 00:14:09,748 --> 00:14:11,417 WHY WAS IT NECESSARY? 439 00:14:11,483 --> 00:14:13,419 AND WHAT WE FOUND OUT, THAT A 440 00:14:13,485 --> 00:14:14,753 LOT OF THE RESEARCH, WHETHER 441 00:14:14,820 --> 00:14:17,790 THEY WERE MALE ANIMALS, CELLS OR 442 00:14:17,856 --> 00:14:19,425 PEOPLE, WEREN'T PAYING ATTENTION 443 00:14:19,491 --> 00:14:20,059 TO SEX EFFECTS. 444 00:14:20,125 --> 00:14:21,427 THEY LACKED TRANSPARENCY IN 445 00:14:21,493 --> 00:14:23,028 TERMS OF THE ANALYSIS AND DATA 446 00:14:23,095 --> 00:14:25,197 THEY WERE PRESENTING, AND THEY 447 00:14:25,264 --> 00:14:26,198 WERE INCONSISTENT IN THE 448 00:14:26,265 --> 00:14:29,268 REPORTING IN THEIR MA MANUSCRIP. 449 00:14:29,335 --> 00:14:30,803 SO WHAT IS THE RESULT OF THAT 450 00:14:30,869 --> 00:14:31,470 FOR WOMEN'S HEALTH? 451 00:14:31,537 --> 00:14:32,538 IT MEANS THERE'S INCOMPLETE 452 00:14:32,605 --> 00:14:33,772 KNOWLEDGE ABOUT US AND WHO WE 453 00:14:33,839 --> 00:14:35,074 ARE AND OUR HEALTH STATUS. 454 00:14:35,140 --> 00:14:40,212 IT MEANS THAT WE ARE AT RISK 455 00:14:40,279 --> 00:14:48,621 FORKER FORERRONEOUS CONCLUSIONS. 456 00:14:48,687 --> 00:14:50,823 IT MEANS THE RESEARCH IS EAR 457 00:14:50,889 --> 00:14:51,690 REPRODUCIBLE AND DOESN'T HAVE 458 00:14:51,757 --> 00:14:53,325 THE RIGOR, AND IMPORTANTLY, IT 459 00:14:53,392 --> 00:14:54,426 REALLY PUTS AT RISK PUBLIC 460 00:14:54,493 --> 00:14:57,263 TRUST. 461 00:14:57,329 --> 00:14:59,131 SO SABV IS -- I LIVE IN A WORLD 462 00:14:59,198 --> 00:15:02,301 OF ACRONYM, SO WE'RE GOING TO 463 00:15:02,368 --> 00:15:05,137 ACCULTURATE THAT TO YOU AS WELL. 464 00:15:05,204 --> 00:15:06,572 SABV IS SEX AS A BIOLOGICAL 465 00:15:06,639 --> 00:15:06,839 VARIABLE. 466 00:15:06,905 --> 00:15:08,807 WHAT WE'RE TALKING ABOUT HERE IS 467 00:15:08,874 --> 00:15:11,577 OUR WAY OF UNDERSTANDING TO 468 00:15:11,644 --> 00:15:12,444 REALLY CLOSE THOSE GAPS. 469 00:15:12,511 --> 00:15:17,016 WE WANT TO IMPROVE THE DESIGN OF 470 00:15:17,082 --> 00:15:17,683 ETHICAL RESEARCH AND TRAITS. 471 00:15:17,750 --> 00:15:19,618 IT'S IMPORTANT THAT WE INFORM -- 472 00:15:19,685 --> 00:15:22,688 HAVE SEX-INFORMED AND 473 00:15:22,755 --> 00:15:23,222 GENDER-AWARE DIAGNOSES AND 474 00:15:23,289 --> 00:15:26,191 TREATMENT AND IT TRULY ENABLES 475 00:15:26,258 --> 00:15:28,060 INDIVIDUALIZED APPROACHES FOR 476 00:15:28,127 --> 00:15:30,229 WOMEN AND MEN IN THEIR 477 00:15:30,296 --> 00:15:32,197 HEALTHCARE. 478 00:15:32,264 --> 00:15:33,766 BECAUSE WHAT WE'RE DOING, IT 479 00:15:33,832 --> 00:15:36,535 FOSTERS A TRUE SYSTEM-BASED 480 00:15:36,602 --> 00:15:37,403 UNDERSTANDING THAT DR. AKLIN 481 00:15:37,469 --> 00:15:39,204 ALSO TALKED ABOUT FOR SEX AND 482 00:15:39,271 --> 00:15:41,106 GENDER INFLUENCES IN HEALTH. 483 00:15:41,173 --> 00:15:42,574 SO LET ME GIVE YOU AN EXAMPLE. 484 00:15:42,641 --> 00:15:43,742 THE DIFFERENCE IF WE HAVING A 485 00:15:43,809 --> 00:15:47,112 GATED RESULTS OR NOT. 486 00:15:47,179 --> 00:15:48,847 IT'S REALLY NOT DOING IT AGAIN. 487 00:15:48,914 --> 00:15:52,785 OKAY. 488 00:15:52,851 --> 00:15:59,124 IT'S NOT LIKING ME TODAY. 489 00:15:59,191 --> 00:16:01,427 I REALLY WANT TO SHOW YOU THE 490 00:16:01,493 --> 00:16:02,194 NEXT SLIDE. 491 00:16:02,261 --> 00:16:03,295 OKAY. 492 00:16:03,362 --> 00:16:05,364 SO THIS IS REALLY SHOWING ON THE 493 00:16:05,431 --> 00:16:08,200 LEFT, IF WE WERE JUST REPORTING 494 00:16:08,267 --> 00:16:09,201 AGGREGATED RESULTS BASED ON 495 00:16:09,268 --> 00:16:13,572 CONTROL OR TREATMENT, HOW THE 496 00:16:13,639 --> 00:16:13,939 TREATMENT WORKS. 497 00:16:14,006 --> 00:16:15,441 IF YOU LOOK ON THE RIGHT, YOU'LL 498 00:16:15,507 --> 00:16:16,742 FIND THERE'S A SEX DIFFERENCE, 499 00:16:16,809 --> 00:16:19,378 THAT FOR MALES WHEN IT WORKS, IT 500 00:16:19,445 --> 00:16:21,213 REDUCES OBSTRUCTION OF BLOOD 501 00:16:21,280 --> 00:16:22,348 SUPPLY. 502 00:16:22,414 --> 00:16:26,585 BUT FOR FEMALES, IT ACTUALLY 503 00:16:26,652 --> 00:16:27,920 ACCENTUATES IT AND DECREASES IT. 504 00:16:27,986 --> 00:16:33,892 SO THIS IS WHY SEX MATTERS. 505 00:16:33,959 --> 00:16:39,965 AND WHY DOES IT MATTER FOR YOU? 506 00:16:40,032 --> 00:16:43,001 BECAUSE FOR PAIN, THERE ARE 507 00:16:43,068 --> 00:16:44,336 BIOLOGICAL AND SOCIAL FACTORS 508 00:16:44,403 --> 00:16:46,071 FOR SEX AND GENDER DIFFERENCES, 509 00:16:46,138 --> 00:16:48,374 BECAUSE WHAT WE KNOW IS THAT 510 00:16:48,440 --> 00:16:51,076 FEMALES EXPERIENCE MORE CHRONIC 511 00:16:51,143 --> 00:16:52,678 PAIN, THEY RESPOND DIFFERENTLY 512 00:16:52,745 --> 00:16:54,480 TO PAIN AS YOU HEARD EARLIER. 513 00:16:54,546 --> 00:16:57,649 NOT ONLY IN TERMS OF REACTIONS 514 00:16:57,716 --> 00:17:01,820 TO MEDICATION, BUT ALSO THEIR 515 00:17:01,887 --> 00:17:02,788 SELF-ASSESSMENT OF THE MAGNITUDE 516 00:17:02,855 --> 00:17:03,655 OF PAIN. 517 00:17:03,722 --> 00:17:06,492 PART OF IT'S BIOLOGY. 518 00:17:06,558 --> 00:17:08,394 IN GENERAL, FEMALES HAVE SMALLER 519 00:17:08,460 --> 00:17:11,230 BODY MASS WITH HIGHER 520 00:17:11,296 --> 00:17:12,765 FAT-TO-WATER RATIOS THAT MAKE A 521 00:17:12,831 --> 00:17:13,832 DIFFERENCE. 522 00:17:13,899 --> 00:17:15,467 AND WHAT YOU HEARD EARLIER IS 523 00:17:15,534 --> 00:17:16,769 THAT THEY'RE MORE LIKELY TO BE 524 00:17:16,835 --> 00:17:19,438 PRESCRIBED OPIOIDS AT HIGHER 525 00:17:19,505 --> 00:17:22,141 DOSES THAN OTHER -- AND LONGER 526 00:17:22,207 --> 00:17:32,317 COMPARED TO MEN. 527 00:17:32,384 --> 00:17:33,852 SO I CAN TELL YOU WHAT I AM 528 00:17:33,919 --> 00:17:35,053 SEEING ON MY SCREEN IS NOT WHAT 529 00:17:35,120 --> 00:17:44,329 YOU'RE SEEING ON THE SCREEN. 530 00:17:44,396 --> 00:17:45,130 NEXT SLIDE. 531 00:17:45,197 --> 00:17:47,833 HOOKAY, HERE WE GO. 532 00:17:47,900 --> 00:17:50,035 SO THIS IS REALLY EMPHASIZING 533 00:17:50,102 --> 00:17:51,336 THAT WE REALLY NEED TO PAY 534 00:17:51,403 --> 00:17:53,205 ATTENTION TO THE BIOLOGICAL AND 535 00:17:53,272 --> 00:17:56,041 SOCIAL FACTORS IN YOUR WORK IN 536 00:17:56,108 --> 00:17:57,910 PAIN, AND BECAUSE THERE ARE 537 00:17:57,976 --> 00:17:59,445 FACTORS FOR SEX AND GENDER 538 00:17:59,511 --> 00:18:00,546 DIFFERENCES. 539 00:18:00,612 --> 00:18:02,114 I'M JUST GOING TO SKIP THIS, BUT 540 00:18:02,181 --> 00:18:03,315 IT'S REALLY MAKING THE POINT 541 00:18:03,382 --> 00:18:04,817 THAT WE NEED TO PAY ATTENTION TO 542 00:18:04,883 --> 00:18:06,985 THESE DIFFERENCES BECAUSE THERE 543 00:18:07,052 --> 00:18:10,155 ARE PSYCHOLOGICAL AND EMOTIONAL 544 00:18:10,222 --> 00:18:12,391 CONSEQUENCES PAID BY IGNORES 545 00:18:12,458 --> 00:18:13,992 THESE ISSUES. 546 00:18:14,059 --> 00:18:23,101 NOW IT'S MOVING ON ITS OWN. 547 00:18:23,168 --> 00:18:25,637 I'M ACTUALLY -- IT'S NOT WORKING 548 00:18:25,704 --> 00:18:28,006 WELL SO I'M JUST GOING TO JUST 549 00:18:28,073 --> 00:18:30,943 CONTINUE WITHOUT THE SLIDES. 550 00:18:31,009 --> 00:18:33,245 WHAT I DO WANT TO SORT OF END 551 00:18:33,312 --> 00:18:34,780 WITH IS THERE IS SOME EXCITING 552 00:18:34,847 --> 00:18:36,181 WORK ON FOOT. 553 00:18:36,248 --> 00:18:38,050 AND WHAT THAT EXCITING WORK IS, 554 00:18:38,116 --> 00:18:39,685 THAT THERE IS A WHITE HOUSE 555 00:18:39,751 --> 00:18:41,320 INITIATIVE ON WOMEN'S HEALTH 556 00:18:41,386 --> 00:18:42,154 RESEARCH. 557 00:18:42,221 --> 00:18:43,956 AND THE EXECUTIVE ORDER WAS 558 00:18:44,022 --> 00:18:45,591 SIGNED IN THE MIDDLE OF MARCH. 559 00:18:45,657 --> 00:18:48,260 AND WHAT IT'S DOING IS REALLY 560 00:18:48,327 --> 00:18:50,195 MOBILIZING THE FEDERAL 561 00:18:50,262 --> 00:18:52,698 GOVERNMENT INTO FOUR MAIN 562 00:18:52,764 --> 00:18:54,800 POINTS, INTEGRATING WOMEN'S 563 00:18:54,867 --> 00:18:55,868 HEALTH AND HEALTH RESEARCH 564 00:18:55,934 --> 00:18:58,504 ACROSS THE ENTIRE FEDERAL 565 00:18:58,570 --> 00:19:00,205 GOVERNMENT, NOT ONLY THE 566 00:19:00,272 --> 00:19:01,707 NATIONAL INSTITUTES OF HEALTH. 567 00:19:01,773 --> 00:19:04,142 IT IS REALLY PRIORITIZING 568 00:19:04,209 --> 00:19:05,711 INVESTMENTS IN WOMEN'S HEALTH 569 00:19:05,777 --> 00:19:07,913 RESEARCH, WHICH ACTUALLY IS ALL 570 00:19:07,980 --> 00:19:10,215 OF YOU. 571 00:19:10,282 --> 00:19:11,984 AND IN A REALLY EXCITING WAY, 572 00:19:12,050 --> 00:19:14,953 IT'S GALVANIZING NEW RESEARCH IN 573 00:19:15,020 --> 00:19:16,154 WOMEN'S MID LIFE HEALTH. 574 00:19:16,221 --> 00:19:18,190 SO PEOPLE ASK ME WHY MID LIFE 575 00:19:18,257 --> 00:19:19,525 OUT OF ALL OF THE PARTS OF THE 576 00:19:19,591 --> 00:19:19,958 LIFESPAN? 577 00:19:20,025 --> 00:19:21,426 BECAUSE WHAT WE KNOW ABOUT 578 00:19:21,493 --> 00:19:23,428 WOMEN'S MID LIFE, IT'S AN 579 00:19:23,495 --> 00:19:24,763 INFLECTION POINT WHERE WOMEN -- 580 00:19:24,830 --> 00:19:26,064 THAT'S WHERE A LOT OF THE 581 00:19:26,131 --> 00:19:27,366 CHRONIC DISEASES START TO POP UP 582 00:19:27,432 --> 00:19:29,368 IN OUR LIVES. 583 00:19:29,434 --> 00:19:31,336 NOT ONLY DO THEY POP UP, IT'S 584 00:19:31,403 --> 00:19:33,739 USUALLY MORE THAN ONE. 585 00:19:33,805 --> 00:19:39,444 SO OUR HEL CARE A OUR HEALTHCARH 586 00:19:39,511 --> 00:19:40,946 STATUS BECOMES A LOT MORE 587 00:19:41,013 --> 00:19:41,847 COMPLICATED AND WE NEED TO 588 00:19:41,914 --> 00:19:42,481 UNDERSTAND THAT BETTER. 589 00:19:42,548 --> 00:19:44,116 ONE OF THE WAYS WE NEED TO DO 590 00:19:44,182 --> 00:19:45,417 THAT, WE NEED TO FIGURE OUT 591 00:19:45,484 --> 00:19:46,351 WHAT'S GOING ORANGES WE NEED TO 592 00:19:46,418 --> 00:19:51,523 ON, WE NEED TOFIGURE OUT THE GAE 593 00:19:51,590 --> 00:19:54,526 PREPARED FOR THE NEXT STAGE, 594 00:19:54,593 --> 00:19:56,595 THAT NEXT GENERATION RESEARCH OF 595 00:19:56,662 --> 00:19:57,563 WOMEN'S HEALTH RESEARCH BUT WE 596 00:19:57,629 --> 00:19:58,997 ALSO HAVE A RESPONSIBILITY FOR 597 00:19:59,064 --> 00:20:00,432 THE NEXT GENERATION OF 598 00:20:00,499 --> 00:20:01,934 PRACTITIONERS AS WELL. 599 00:20:02,000 --> 00:20:03,602 SO THERE'S AN INVESTMENT OF 600 00:20:03,669 --> 00:20:06,138 CAREER DEVELOPMENT. 601 00:20:06,204 --> 00:20:07,673 I'M SORRY YOU CAN'T SEE MY 602 00:20:07,739 --> 00:20:08,974 SLIDES, THEY LOOKED REALLY QUITE 603 00:20:09,041 --> 00:20:11,043 PRETTY FROM MY END HERE, BUT I 604 00:20:11,109 --> 00:20:12,344 THINK THEY'LL BE ACCESSIBLE FOR 605 00:20:12,411 --> 00:20:13,879 YOU, BUT I JUST WANTED TO AT 606 00:20:13,946 --> 00:20:15,881 LEAST GIVE SOME TIME SPACE SO 607 00:20:15,948 --> 00:20:17,482 YOU CAN ACTUALLY HEAR THIS 608 00:20:17,549 --> 00:20:18,550 KEYNOTE SPEAKER BECAUSE I THINK 609 00:20:18,617 --> 00:20:21,453 SHE PROBABLY HAS REALLY MUCH 610 00:20:21,520 --> 00:20:22,554 MORE INTERESTING THINGS TO SAY 611 00:20:22,621 --> 00:20:23,055 THAN I DO. 612 00:20:23,121 --> 00:20:24,323 SO THANK YOU SO MUCH FOR YOUR 613 00:20:24,389 --> 00:20:24,523 TIME. 614 00:20:24,590 --> 00:20:34,766 [APPLAUSE] 615 00:20:43,075 --> 00:20:44,142 >> THANK YOU, VIVIAN. 616 00:20:44,209 --> 00:20:47,412 YOU DID A GREAT JOB DESPITE THE 617 00:20:47,479 --> 00:20:49,514 TECHNICAL DIFFICULTIES. 618 00:20:49,581 --> 00:20:50,816 AND NOW WE'RE GOING TO TURN TO 619 00:20:50,882 --> 00:20:52,584 OUR KEYNOTE SPEAKER, IT'S MY 620 00:20:52,651 --> 00:20:56,521 PLEASURE TO INTRODUCE MARJORIE 621 00:20:56,588 --> 00:20:59,691 JENKINS, WHO IS THE M.D., THE 622 00:20:59,758 --> 00:21:03,362 DEAN OF THE UNIVERSITY OF THE 623 00:21:03,428 --> 00:21:04,496 SOUTH DAKOTA MEDICAL SCHOOL. 624 00:21:04,563 --> 00:21:08,133 SHE'S GOING TO TALK ON PAIN, 625 00:21:08,200 --> 00:21:09,201 SCIENCE, SEX AND STEREOTYPES. 626 00:21:09,267 --> 00:21:10,502 I'M REALLY LOOKING FORWARD TO 627 00:21:10,569 --> 00:21:11,503 HEARING THIS. 628 00:21:11,570 --> 00:21:16,308 ALL YOURS. 629 00:21:16,375 --> 00:21:17,843 >> WELL, GOOD MORNING. 630 00:21:17,909 --> 00:21:20,812 I'M A LITTLE NERVOUS BECAUSE I 631 00:21:20,879 --> 00:21:25,484 HAVE BAD TECH KARMA ANYWAY. 632 00:21:25,550 --> 00:21:27,152 SO IT MAY JUST BE ME CHATTING 633 00:21:27,219 --> 00:21:27,819 WITH YOU HERE. 634 00:21:27,886 --> 00:21:30,088 WE'RE JUST GOING TO SEE. 635 00:21:30,155 --> 00:21:31,757 OH, YES, YOU DON'T SEE. 636 00:21:31,823 --> 00:21:34,259 I DON'T SEE WHAT YOU SEE. 637 00:21:34,326 --> 00:21:44,870 LET ME SEE WHAT WE CAN DO HERE. 638 00:21:52,244 --> 00:21:53,545 MAYBE A LITTLE TUTORIAL MIGHT 639 00:21:53,612 --> 00:21:55,047 HELP ME. 640 00:21:55,113 --> 00:21:57,349 HERE WE GO. 641 00:21:57,416 --> 00:21:57,783 OKAY. 642 00:21:57,849 --> 00:21:59,751 HERE WE DID. 643 00:21:59,818 --> 00:22:00,619 GO. 644 00:22:00,686 --> 00:22:00,786 YES. 645 00:22:00,852 --> 00:22:01,953 ALL RIGHT. 646 00:22:02,020 --> 00:22:04,790 IT COULD WORK. 647 00:22:04,856 --> 00:22:05,557 OKAY. 648 00:22:05,624 --> 00:22:06,992 SO THANK YOU FOR THE 649 00:22:07,059 --> 00:22:07,959 INTRODUCTION. 650 00:22:08,026 --> 00:22:10,562 AND YOU HAVE MY BIO OR YOU CAN 651 00:22:10,629 --> 00:22:11,663 GOOGLE ME, DON'T BELIEVE 652 00:22:11,730 --> 00:22:13,198 EVERYTHING YOU READ ON GOOGLE, 653 00:22:13,265 --> 00:22:13,732 PLEASE. 654 00:22:13,799 --> 00:22:14,399 I'M AN M.D. 655 00:22:14,466 --> 00:22:16,368 I HAVE A MASTER'S IN EDUCATION 656 00:22:16,435 --> 00:22:19,204 FOR HEALTH PROFESSIONS, AND I'VE 657 00:22:19,271 --> 00:22:21,273 WORKED IN THE SEX AND GENDER 658 00:22:21,339 --> 00:22:24,609 FIELD FOR OVER 20 YEARS. 659 00:22:24,676 --> 00:22:26,545 I HAVE KNOWN JANINE CLAYTON AND 660 00:22:26,611 --> 00:22:27,946 THE OFFICE OF RESEARCH ON 661 00:22:28,013 --> 00:22:29,948 WOMEN'S HEALTH AND ALL OF THEIR 662 00:22:30,015 --> 00:22:32,551 AMAZING WORK, IN ADDITION TO THE 663 00:22:32,617 --> 00:22:34,753 SABV POLICY, WHICH WAS -- FOR 664 00:22:34,820 --> 00:22:36,388 THOSE OF US IN THE SEX AND 665 00:22:36,455 --> 00:22:39,157 GENDER WORLD, LIKE FOR ME, IT 666 00:22:39,224 --> 00:22:41,460 WAS LIKE MY BIRTHDAY. 667 00:22:41,526 --> 00:22:43,595 WHEN I SAW THAT POLICY WAS BEING 668 00:22:43,662 --> 00:22:45,897 LAUNCHED. 669 00:22:45,964 --> 00:22:50,068 I'M AN INTERNAL MEDICINE 670 00:22:50,135 --> 00:22:51,937 PHYSICIAN, SO WHEN I WOULD 671 00:22:52,003 --> 00:22:54,339 INTRODUCE MYSELF AS A WOMEN'S 672 00:22:54,406 --> 00:22:57,843 HEALTH PHYSICIAN IN 2001 TO 2, 673 00:22:57,909 --> 00:23:00,879 PEOPLE WOULD ASK ME TO DELIVER 674 00:23:00,946 --> 00:23:02,647 THEIR BABY, OR TAKE OUT THEIR 675 00:23:02,714 --> 00:23:05,050 UTERUS. 676 00:23:05,117 --> 00:23:07,786 SO INTERNS DON'T DO THAT. 677 00:23:07,853 --> 00:23:09,988 DO WE HAVE CLINICIANS IN HERE, 678 00:23:10,055 --> 00:23:12,124 ANY CLINICIANS? 679 00:23:12,190 --> 00:23:14,493 YOU DON'T WANT AN INTERNIST 680 00:23:14,559 --> 00:23:15,827 DOING THAT, UNLESS IT'S ON THE 681 00:23:15,894 --> 00:23:18,396 SIDE OF THE ROAD AND THAT BABY 682 00:23:18,463 --> 00:23:19,798 IS COMING. 683 00:23:19,865 --> 00:23:21,333 SO I'M SORT OF A TEE-OFF FOR YOU 684 00:23:21,399 --> 00:23:23,168 FOR THE CONFERENCE, AND I JUST 685 00:23:23,235 --> 00:23:25,403 WANT TO THANK THE OFFICE OF 686 00:23:25,470 --> 00:23:28,140 WOMEN'S HEALTH, THE PLANNING 687 00:23:28,206 --> 00:23:33,712 COMMITTEE, IT'S SUCH AN HONOR TO 688 00:23:33,779 --> 00:23:34,446 BE BACK HERE. 689 00:23:34,513 --> 00:23:40,118 MY HUSBAND AND I MOVED BACK TO 690 00:23:40,185 --> 00:23:42,120 SILVER SPRING, IT'S REALLY 691 00:23:42,187 --> 00:23:43,655 AWESOME TO BE BACK IN YOUR 692 00:23:43,722 --> 00:23:44,189 SPACE. 693 00:23:44,256 --> 00:23:48,593 SO I HAVE JUST PUT A WORD CLOUD 694 00:23:48,660 --> 00:23:49,995 TOGETHER OF ALL OF THE AMAZING 695 00:23:50,061 --> 00:23:52,564 THINGS WE'RE GOING TO TALK ABOUT 696 00:23:52,631 --> 00:23:52,764 TODAY. 697 00:23:52,831 --> 00:23:54,399 I THINK THE PLANNERS HAVE PUT 698 00:23:54,466 --> 00:23:59,638 TOGETHER A REALLY UNIQUE AND 699 00:23:59,704 --> 00:24:00,972 DIVERSE AGENDA FOR YOU. 700 00:24:01,039 --> 00:24:04,242 YOU'RE GOING TO HEAR FROM 701 00:24:04,309 --> 00:24:06,945 SPEAKERS WHO ARE TOP IN THEIR 702 00:24:07,012 --> 00:24:08,747 FIELD. 703 00:24:08,814 --> 00:24:10,182 AND I THINK IT'S GOING TO BE 704 00:24:10,248 --> 00:24:12,784 REALLY EXCITING AND INTERESTING, 705 00:24:12,851 --> 00:24:13,785 AND I'M LOOKING FORWARD TO 706 00:24:13,852 --> 00:24:16,154 HEARING ABOUT IT. 707 00:24:16,221 --> 00:24:18,123 SO ONE THING WHEN I DO THE -- 708 00:24:18,190 --> 00:24:21,860 WHEN I LISTEN TO SPEAKERS AT 709 00:24:21,927 --> 00:24:23,595 CONFERENCES, YOU READ THEIR 710 00:24:23,662 --> 00:24:25,263 BIOBUT YOU REALLY DON'T KNOW 711 00:24:25,330 --> 00:24:25,931 WHERE THEY'RE FROM. 712 00:24:25,997 --> 00:24:26,998 SO I THOUGHT I WOULD TELL YOU 713 00:24:27,065 --> 00:24:28,200 JUST A LITTLE BIT ABOUT WHERE 714 00:24:28,266 --> 00:24:32,337 I'M FROM, BECAUSE I'M GOING TO 715 00:24:32,404 --> 00:24:33,772 CLOSE THIS LOOP AT THE END OF MY 716 00:24:33,839 --> 00:24:34,206 TALK. 717 00:24:34,272 --> 00:24:38,043 I GREW UP HERE. 718 00:24:38,109 --> 00:24:41,379 THIS IS ME AT MY 5-YEAR 719 00:24:41,446 --> 00:24:43,515 GRADUATION CAP AND GOWN. 720 00:24:43,582 --> 00:24:44,482 VERY PRECOCIOUS CHILD. 721 00:24:44,549 --> 00:24:48,386 I'M THE YOUNGEST OF 8 CHILDREN 722 00:24:48,453 --> 00:24:49,988 IN APPALACHIA. 723 00:24:50,055 --> 00:24:51,423 MY MOM MARRIED AT 15. 724 00:24:51,489 --> 00:24:54,693 SHE HAD 8 CHILDREN BY 28, SHE 725 00:24:54,759 --> 00:24:57,629 WAS WIDOWED AT 34 WITH NO HIGH 726 00:24:57,696 --> 00:25:03,768 SCHOOL DIPLOMA. 727 00:25:03,835 --> 00:25:05,937 THIS IS MY JOURNEY. 728 00:25:06,004 --> 00:25:08,139 I WAS TOLD I COULDN'T BE AN 729 00:25:08,206 --> 00:25:10,542 M.D., SO I BECAME A CHEMICAL 730 00:25:10,609 --> 00:25:11,009 ENGINEER. 731 00:25:11,076 --> 00:25:13,044 I'M A CONTROL SYSTEMS ENGINEER 732 00:25:13,111 --> 00:25:16,648 RECOVERING AND WORKED AT KODAK. 733 00:25:16,715 --> 00:25:18,950 I THEN COULD NOT NOT GO TO 734 00:25:19,017 --> 00:25:20,919 MEDICAL SCHOOL, SO I WENT TO 735 00:25:20,986 --> 00:25:21,586 EAST TENNESSEE STATE. 736 00:25:21,653 --> 00:25:24,556 I TRAINED AT UNIVERSITY OF 737 00:25:24,623 --> 00:25:25,824 CINCINNATI IN INTERNAL MEDICINE, 738 00:25:25,891 --> 00:25:27,092 I WENT INTO PRIVATE PRACTICE BUT 739 00:25:27,158 --> 00:25:29,461 I LONGED TO BE IN ACADEMIC 740 00:25:29,527 --> 00:25:29,794 MEDICINE. 741 00:25:29,861 --> 00:25:31,196 BUT MY HUSBAND TOLD ME I NEEDED 742 00:25:31,263 --> 00:25:32,964 TO PAY OFF MY SCHOOL LOANS SO I 743 00:25:33,031 --> 00:25:36,034 HAD TO GET A JOB QUICKLY. 744 00:25:36,101 --> 00:25:39,070 BUT EVENTUALLY MADE TO TEXAS TO 745 00:25:39,137 --> 00:25:42,173 ACADEMIC MEDICINE IN 2001. 746 00:25:42,240 --> 00:25:45,010 AND IN MY PRACTICE, I REALIZED 747 00:25:45,076 --> 00:25:50,115 THAT IN MY 75% WOMEN, 25% MEN 748 00:25:50,181 --> 00:25:51,049 PATIENTS, WOMEN COMMUNICATED 749 00:25:51,116 --> 00:25:51,950 WITH ME DIFFERENTLY. 750 00:25:52,017 --> 00:25:54,185 WOMEN WERE ALSO PARSED OUT TO 751 00:25:54,252 --> 00:25:56,054 DIFFERENT PHYSICIANS. 752 00:25:56,121 --> 00:25:58,156 THEY HAD THEIR PRIMARY CARE, WHO 753 00:25:58,223 --> 00:25:59,858 MIGHT BE FAMILY MEDICINE OR 754 00:25:59,925 --> 00:26:01,192 INTERNAL MEDICINE, AND THEN THEY 755 00:26:01,259 --> 00:26:04,696 WERE SENT TO OB-GYN FOR THEIR 756 00:26:04,763 --> 00:26:06,765 MENOPAUSE MANAGEMENT, HORMONAL 757 00:26:06,831 --> 00:26:09,634 THERAPIES, ET CETERA. 758 00:26:09,701 --> 00:26:12,003 THAT BOTHERED ME, AND THAT AS A 759 00:26:12,070 --> 00:26:14,139 WOMAN, I WANTED TO HAVE WHOLE 760 00:26:14,205 --> 00:26:16,608 CARE IN ONE PLACE WITH ONE 761 00:26:16,675 --> 00:26:17,943 PHYSICIAN BUILDING TRUST IN THAT 762 00:26:18,009 --> 00:26:21,646 SPACE. 763 00:26:21,713 --> 00:26:24,316 SO I QUICKLY LEARNED, STARTED 764 00:26:24,382 --> 00:26:27,319 TALKING ABOUT SEX AND GENDER, 765 00:26:27,385 --> 00:26:30,956 AND LEARNED THAT MARYANN LEGADO 766 00:26:31,022 --> 00:26:34,526 HAD WRITTEN A NINE-HUNDRED PAGE 767 00:26:34,592 --> 00:26:36,294 TOME CALLED GENDER-SPECIFIC 768 00:26:36,361 --> 00:26:36,561 MEDICINE. 769 00:26:36,628 --> 00:26:38,697 IT CAME OUT IN 2003, 2004. 770 00:26:38,763 --> 00:26:42,000 SOMEONE SEPTEMBER SENT ME A CO. 771 00:26:42,067 --> 00:26:43,335 IT WAS THIS BIG. 772 00:26:43,401 --> 00:26:45,603 I SAT IT BY MY BED AND I READ IT 773 00:26:45,670 --> 00:26:47,405 FOR A YEAR AND I WAS LIKE, THIS 774 00:26:47,472 --> 00:26:48,239 IS IT FOR ME. 775 00:26:48,306 --> 00:26:50,408 LIKE, THIS IS THE BEST KEPT 776 00:26:50,475 --> 00:26:54,713 SECRET OF MEDICINE. 777 00:26:54,779 --> 00:26:56,381 IF PEOPLE KNOW THIS, HOW CAN 778 00:26:56,448 --> 00:26:59,951 THEY NOT ACCEPT IT AND ACTUALLY, 779 00:27:00,018 --> 00:27:02,153 THIS IS NOT GOING TO TAKE THAT 780 00:27:02,220 --> 00:27:05,090 LONG TO GET INTO RESEARCH AND 781 00:27:05,156 --> 00:27:06,057 MEDICINE BECAUSE ONCE THEY HEAR 782 00:27:06,124 --> 00:27:11,329 ABOUT IT, IT'S A GIVEN. 783 00:27:11,396 --> 00:27:14,065 THEN IN 2007, I WAS GIVEN THE 784 00:27:14,132 --> 00:27:15,567 OPPORTUNITY TO FOUND IS THE 785 00:27:15,633 --> 00:27:17,102 LAURA BUSH INSTITUTE FOR WOMEN'S 786 00:27:17,168 --> 00:27:19,504 HEALTH AND BECAUSE OF MY 787 00:27:19,571 --> 00:27:21,439 INTERESTS, IT IS FOUNDED ON SEX 788 00:27:21,506 --> 00:27:22,941 AND GENDER DIFFERENCES. 789 00:27:23,008 --> 00:27:24,642 THIS IS WHEN MRS. BUSH WAS IN 790 00:27:24,709 --> 00:27:26,845 THE WHITE HOUSE, AND I WAS THE 791 00:27:26,911 --> 00:27:28,146 FOUNDING EXECUTIVE DIRECTOR OF 792 00:27:28,213 --> 00:27:31,449 THAT AND MY CAREER TOOK QUITE A 793 00:27:31,516 --> 00:27:32,550 DIFFERENT TURN THEN INTO 794 00:27:32,617 --> 00:27:34,619 BUILDING THAT INSTITUTE. 795 00:27:34,686 --> 00:27:38,757 AND AFTER 15 YEARS AT TEXAS 796 00:27:38,823 --> 00:27:41,426 TECH, I HAD AN ENCOUNTER WITH 797 00:27:41,493 --> 00:27:43,495 THE FDA ON A VISIT AND WAS 798 00:27:43,561 --> 00:27:45,397 INVITED TO COME TO WORK IN THE 799 00:27:45,463 --> 00:27:48,233 OFFICE OF WOMEN'S HEALTH IN THE 800 00:27:48,299 --> 00:27:48,967 OFFICE OF THE COMMISSIONER 801 00:27:49,034 --> 00:27:50,368 BECAUSE ALTHOUGH THEY HAD 802 00:27:50,435 --> 00:27:51,803 WOMEN'S HEALTH EXPERTISE, THEY 803 00:27:51,870 --> 00:27:55,940 DID NOT HAVE SEX AND GENDER 804 00:27:56,007 --> 00:27:59,010 EXPERTISE YET IN THAT SPACE. 805 00:27:59,077 --> 00:28:00,979 SO I WAS INVITED FOR A YEAR AND 806 00:28:01,046 --> 00:28:02,313 THEN EVERY SIX MONTHS OR SO, I 807 00:28:02,380 --> 00:28:04,082 WAS INVITED TO STAY ANOTHER 808 00:28:04,149 --> 00:28:04,916 YEAR. 809 00:28:04,983 --> 00:28:06,151 MY INSTITUTION WAS ASKED COULD 810 00:28:06,217 --> 00:28:08,319 THEY BORROW ME, SO I STAYED FOUR 811 00:28:08,386 --> 00:28:10,488 YEARS, AND IT WAS REMARKABLE. 812 00:28:10,555 --> 00:28:13,691 IT WAS A REALLY AMAZING THING TO 813 00:28:13,758 --> 00:28:17,429 LEARN ABOUT REGULATORY SCIENCE 814 00:28:17,495 --> 00:28:21,900 DRUG AND DEVICE APPROVALS. 815 00:28:21,966 --> 00:28:23,868 SO AFTER THE FDA GOING BACK TO 816 00:28:23,935 --> 00:28:25,737 ACADEMIC MEDICINE, I THEN HAD 817 00:28:25,804 --> 00:28:27,572 NOT ON MY BUCKET LIST TO BECOME 818 00:28:27,639 --> 00:28:29,874 THE DEAN OF A MEDICAL SCHOOL AND 819 00:28:29,941 --> 00:28:32,510 THE CHIEF ACADEMIC OFFICER FOR A 820 00:28:32,577 --> 00:28:33,511 $6 MILLION HEALTHCARE SYSTEM, 821 00:28:33,578 --> 00:28:34,913 BUT THAT'S WHERE MY JOURNEY TOOK 822 00:28:34,979 --> 00:28:36,581 ME, THAT'S WHERE MY FAITH TAKES 823 00:28:36,648 --> 00:28:39,184 ME, SO I PLANTED THERE FOR FIVE 824 00:28:39,250 --> 00:28:42,353 YEARS. 825 00:28:42,420 --> 00:28:47,158 I COULD NOT NOT BE ASSOCIATED 826 00:28:47,225 --> 00:28:48,359 WITH SEX AND GENDER MEDICINE. 827 00:28:48,426 --> 00:28:51,096 IT IS IN MY -- IT IS LITERALLY 828 00:28:51,162 --> 00:28:52,397 IN MY DNA. 829 00:28:52,464 --> 00:28:56,134 I AM A PASSIONATE PHYSICIAN AND 830 00:28:56,201 --> 00:28:57,001 SCIENTIST AND EDUCATOR ABOUT 831 00:28:57,068 --> 00:28:57,769 THIS ISSUE. 832 00:28:57,836 --> 00:28:59,404 AND I WILL SHARE WITH YOU THAT 833 00:28:59,471 --> 00:29:00,939 I'VE BEEN TALKING ABOUT THESE 834 00:29:01,005 --> 00:29:04,342 TWO TERMS FOR OVER 20 YEARS. 835 00:29:04,409 --> 00:29:08,913 SEX AS A BIOLOGICAL VARIABLE, 836 00:29:08,980 --> 00:29:12,350 MAJORITY NON-BINARY BUT NOT 837 00:29:12,417 --> 00:29:13,051 TOTALLY. 838 00:29:13,118 --> 00:29:14,719 AND GENDER AS A SOCIAL 839 00:29:14,786 --> 00:29:15,086 CONSTRUCT. 840 00:29:15,153 --> 00:29:18,256 AND WHEN I TALK TO MY SCIENTIST 841 00:29:18,323 --> 00:29:19,324 COLLEAGUES AND RESEARCH 842 00:29:19,390 --> 00:29:20,792 COLLEAGUES AND EVEN CLINICIAN 843 00:29:20,859 --> 00:29:22,727 COLLEAGUES, WHEN I GOT TO THE 844 00:29:22,794 --> 00:29:24,662 SEX DIFFERENCES PIECE OF THEIR 845 00:29:24,729 --> 00:29:25,663 DISEASE PROCESS, WHETHER THEY 846 00:29:25,730 --> 00:29:28,066 WERE A PULMONOLOGIST, A 847 00:29:28,133 --> 00:29:30,201 CARDIOLOGIST, A RHEUMATOLOGIST, 848 00:29:30,268 --> 00:29:34,205 IT WAS ACTUALLY -- THEY GOT IT. 849 00:29:34,272 --> 00:29:36,708 I COULD SHOW THEM DATA AND 850 00:29:36,774 --> 00:29:38,243 RESEARCH, BUT WHEN I STARTED 851 00:29:38,309 --> 00:29:42,614 TALKING ABOUT THE GENDER SOCIAL 852 00:29:42,680 --> 00:29:44,382 CONSTRUCT, THEY GLAZED OVER. 853 00:29:44,449 --> 00:29:48,086 YOU CANNOT -- THESE ARE 854 00:29:48,153 --> 00:29:49,053 INEXORABLY LINKED. 855 00:29:49,120 --> 00:29:52,390 SO GENDER IS A SPECTRUM AND A 856 00:29:52,457 --> 00:29:53,691 SOCIAL CONSTRUCT AND MUCH MORE 857 00:29:53,758 --> 00:29:56,427 COMPLEX. 858 00:29:56,494 --> 00:29:58,663 AND IN FACT, THEY ARE FREQUENTLY 859 00:29:58,730 --> 00:29:59,898 INTERCHANGED, LESS SO NOW IN 860 00:29:59,964 --> 00:30:10,441 2024, BUT STILL SO, AND I -- 861 00:30:13,912 --> 00:30:15,213 YES, IT IS AHEAD OF ME BUT 862 00:30:15,280 --> 00:30:18,816 THAT'S OKAY. 863 00:30:18,883 --> 00:30:20,118 I'M JUST GOING TO LEARN HOW TO 864 00:30:20,185 --> 00:30:30,461 DO THIS BETTER. 865 00:30:40,705 --> 00:30:43,208 SO WE STILL USE THESE 866 00:30:43,274 --> 00:30:43,975 INTERCHANGEABLY WHICH MAKES IT 867 00:30:44,042 --> 00:30:45,410 VERY DIFFICULT TO SEARCH IN THE 868 00:30:45,476 --> 00:30:55,687 LITERATURE. 869 00:30:57,255 --> 00:31:02,160 LIVING MY LIFE ALL OVER AGAIN. 870 00:31:02,227 --> 00:31:03,294 NEXT SLIDE. 871 00:31:03,361 --> 00:31:04,796 SO IN THAT SLIDE WITH THE BARS, 872 00:31:04,862 --> 00:31:08,066 WHAT YOU SAW WAS IN A BASIC 873 00:31:08,132 --> 00:31:09,701 SCIENCE JOURNAL OF PHYSIOLOGY, 874 00:31:09,767 --> 00:31:11,569 WHICH REALLY DOESN'T DO A LOT OF 875 00:31:11,636 --> 00:31:13,871 HUMAN TRIALS THAT SOMEWHERE IN 876 00:31:13,938 --> 00:31:15,940 THE 80s AND 90s, WE DECIDED 877 00:31:16,007 --> 00:31:19,143 THAT THAT SEX AND GENDER WERE 878 00:31:19,210 --> 00:31:20,545 EQUAL. 879 00:31:20,612 --> 00:31:23,848 AND WHEN WE DID THAT, WHY DO YOU 880 00:31:23,915 --> 00:31:25,783 THINK THAT HAPPENED IN THE LATE 881 00:31:25,850 --> 00:31:27,552 80s AND EARLY 90s? 882 00:31:27,619 --> 00:31:30,855 CAN ANYONE TELL ME A SOCIAL 883 00:31:30,922 --> 00:31:32,257 NATIONAL GLOBAL EMERGING ISSUE 884 00:31:32,323 --> 00:31:34,792 THAT CAME UP THAT MIGHT MAKE US, 885 00:31:34,859 --> 00:31:36,961 IN SCIENCE, NOT WANT TO USE THE 886 00:31:37,028 --> 00:31:47,238 TERM "SEX"? 887 00:31:47,605 --> 00:31:48,172 >> [INAUDIBLE] 888 00:31:48,239 --> 00:31:50,208 >> GOOD THOUGHT. 889 00:31:50,275 --> 00:31:51,409 AIDS. 890 00:31:51,476 --> 00:31:52,176 EXACTLY. 891 00:31:52,243 --> 00:31:55,680 SO SCIENTISTS VEERED AWAY FROM 892 00:31:55,747 --> 00:31:57,282 THAT, THAT WORD, AND THEY BEGAN 893 00:31:57,348 --> 00:31:59,917 USING GENDER IN RELATION TO 894 00:31:59,984 --> 00:32:03,855 MOLECULAR LEVEL STUDIES, ANIMAL 895 00:32:03,921 --> 00:32:04,756 STUDIES. 896 00:32:04,822 --> 00:32:11,763 WHICH IS ABSOLUTELY NOT 897 00:32:11,829 --> 00:32:12,930 GENDERED. 898 00:32:12,997 --> 00:32:17,769 THOSE ARE SEX VARIABLES. 899 00:32:17,835 --> 00:32:18,636 PLEASE GO BACK. 900 00:32:18,703 --> 00:32:21,506 YOU'RE ONE AHEAD OF ME. 901 00:32:21,572 --> 00:32:23,975 SO, I'VE LEARNED AFTER 20-PLUS 902 00:32:24,042 --> 00:32:27,045 YEARS THAT SEX AND GENDER TERMS 903 00:32:27,111 --> 00:32:30,448 ARE CONCEPTUALLY IMPRECISE. 904 00:32:30,515 --> 00:32:31,749 AS A SCIENTIST, THAT HURTS MY 905 00:32:31,816 --> 00:32:33,951 HEART. 906 00:32:34,018 --> 00:32:36,487 WE LIKE PRECISION SOMETIMES TO 907 00:32:36,554 --> 00:32:37,689 THE .0001. 908 00:32:37,755 --> 00:32:40,792 WE DON'T LIKE OUR DATA TO BE 909 00:32:40,858 --> 00:32:42,927 SCATTERED, WE LIKE TO BE 910 00:32:42,994 --> 00:32:44,462 CONSISTENT, WE WANT OUR RESEARCH 911 00:32:44,529 --> 00:32:47,732 TO BE REPRODUCIBLE. 912 00:32:47,799 --> 00:32:49,400 SO SEX AS A BIOLOGICAL VARIABLE, 913 00:32:49,467 --> 00:32:50,301 THAT IS PRETTY STRAIGHTFORWARD 914 00:32:50,368 --> 00:32:51,803 AS I SAID, BUT GENDER DOES NOT 915 00:32:51,869 --> 00:32:55,573 HAVE A OW UNIVERSAL DEFINITION,D 916 00:32:55,640 --> 00:32:56,841 LET ME TELL YOU WHY THIS 917 00:32:56,908 --> 00:32:57,975 DEFINITION HERE IS NOT A 918 00:32:58,042 --> 00:33:00,011 DEFINITION, BECAUSE IT JUST SAYS 919 00:33:00,078 --> 00:33:06,017 "GENDER REFERS TO" -- X, Y, Z. 920 00:33:06,084 --> 00:33:07,552 THAT IS A DESCRIPTOR, NOT A 921 00:33:07,618 --> 00:33:07,852 DEFINITION. 922 00:33:07,919 --> 00:33:09,253 THAT MAKES IT EVEN HARDER FOR US 923 00:33:09,320 --> 00:33:11,089 TO APPLY THIS TO OUR CLINICAL 924 00:33:11,155 --> 00:33:15,660 CARE. 925 00:33:15,727 --> 00:33:17,962 SO IN 2013, 2014, I WAS 926 00:33:18,029 --> 00:33:20,631 SEARCHING THE LITERATURE TRYING 927 00:33:20,698 --> 00:33:22,033 TO IMPLEMENT SEX AND GENDER INTO 928 00:33:22,100 --> 00:33:25,136 A CURRICULUM, AND WHAT I FOUND 929 00:33:25,203 --> 00:33:30,575 WAS THERE WAS NO SEARCH TOOL IN 930 00:33:30,641 --> 00:33:32,243 PUBMED, SO WE CREATED AND 931 00:33:32,310 --> 00:33:33,311 VALIDATED ONE, AND YOU CAN HAVE 932 00:33:33,378 --> 00:33:33,778 ACCESS TO THIS. 933 00:33:33,845 --> 00:33:35,513 WHEN I FIRST RAN THE FIRST 934 00:33:35,580 --> 00:33:38,015 VALIDATION, THERE WERE ABOUT 935 00:33:38,082 --> 00:33:40,385 43,000 ARTICLES THAT MENTION SEX 936 00:33:40,451 --> 00:33:42,720 AND GENDER IN DIFFERENT SPACES. 937 00:33:42,787 --> 00:33:44,689 I JUST RAN THIS LAST WEEK AND 938 00:33:44,756 --> 00:33:46,457 THERE ARE 120,000 NOW. 939 00:33:46,524 --> 00:33:49,394 SO FROM 2015 TO CURRENTLY. 940 00:33:49,460 --> 00:33:52,997 BUT WHAT ARE WE NOT FINDING? 941 00:33:53,064 --> 00:33:57,268 WE'RE FINDING THAT PEOPLE ARE 942 00:33:57,335 --> 00:34:00,605 ACTUALLY ALTHOUGH PEOPLE ARE 943 00:34:00,671 --> 00:34:02,106 WRITING ABOUT SEX AND GENDER IN 944 00:34:02,173 --> 00:34:06,511 THE MAINSTREAM PUBLICATIONS, 945 00:34:06,577 --> 00:34:08,112 LIKE THE NEW ENGLAND JOURNAL, 946 00:34:08,179 --> 00:34:09,480 WE'RE NOT SEEING THAT. 947 00:34:09,547 --> 00:34:13,084 WE'RE NOT SEEING RESULTS 948 00:34:13,151 --> 00:34:14,285 REPORTED BY SEX OR GENDER. 949 00:34:14,352 --> 00:34:17,688 WE'RE SEEING DESCRIPTORS OF THE 950 00:34:17,755 --> 00:34:19,223 PARTICIPANTS, AND THEN IT JUST 951 00:34:19,290 --> 00:34:20,091 ENDS FROM THERE. 952 00:34:20,158 --> 00:34:22,493 SO YOU CAN SEE WHO ARE FOLLOWING 953 00:34:22,560 --> 00:34:25,163 THE SAG EVIDENT R GUIDELINES, 954 00:34:25,229 --> 00:34:28,199 JAMA, BMJ, AND THEN ALL OF THESE 955 00:34:28,266 --> 00:34:29,934 HIGH IMPACT JOURNALS THAT ARE 956 00:34:30,001 --> 00:34:32,036 REALLY NOT PAYING ATTENTION IN 957 00:34:32,103 --> 00:34:32,904 THEIR EDITORIAL GUIDELINES TO 958 00:34:32,970 --> 00:34:35,173 WHERE WE NEED TO GO. 959 00:34:35,239 --> 00:34:36,307 SO YOUR RESEARCH GETTING 960 00:34:36,374 --> 00:34:38,576 PUBLISHED IN A JOURNAL THAT 961 00:34:38,643 --> 00:34:40,545 DOESN'T REQUIRE THEIR EDITORIAL 962 00:34:40,611 --> 00:34:44,348 REVIEW BOARD TO ACTUALLY LOOK AT 963 00:34:44,415 --> 00:34:45,917 SEX AND GENDER, AND IF YOU HAVE 964 00:34:45,983 --> 00:34:47,785 NOT DISAGGREGATED YOUR DATA AND 965 00:34:47,852 --> 00:34:49,854 ANALYZED IT, IT WASN'T POWERED, 966 00:34:49,921 --> 00:34:52,290 YOU AT LEAST MENTION WHY. 967 00:34:52,356 --> 00:34:56,461 SO THIS JUST TOTAL VACUUM CAUSES 968 00:34:56,527 --> 00:34:58,863 A VACUUM IN THE LITERATURE, 969 00:34:58,930 --> 00:35:01,065 WHICH IS WHERE WE AS CLINICIANS 970 00:35:01,132 --> 00:35:02,667 GET OUR EVIDENCE TO CRAFT THIS 971 00:35:02,733 --> 00:35:06,737 EVIDENCE-BASED MEDICINE. 972 00:35:06,804 --> 00:35:09,273 SO THEN I STARTED LOOKING AT THE 973 00:35:09,340 --> 00:35:10,541 STUDY OF PAIN. 974 00:35:10,608 --> 00:35:14,045 I AM ONE OF THOSE PHYSICIANS, AS 975 00:35:14,111 --> 00:35:16,581 I MOVED IN TO CONSULTATIVE 976 00:35:16,647 --> 00:35:18,249 MEDICINE, I AM ONE OF THOSE 977 00:35:18,316 --> 00:35:21,085 PHYSICIANS THAT WELCOMED TAKING 978 00:35:21,152 --> 00:35:23,721 PATIENTS WITH CHRONIC PELVIC 979 00:35:23,788 --> 00:35:25,590 PAIN, FIBROMYALGIA, ALL THE 980 00:35:25,656 --> 00:35:26,424 SYNDROMES, BECAUSE WHEN 981 00:35:26,491 --> 00:35:28,426 SOMETHING HAS A SYNDROME, YOU 982 00:35:28,493 --> 00:35:30,428 CAN ALMOST BET THAT 8 OUT OF THE 983 00:35:30,495 --> 00:35:32,597 10 PATIENTS ARE WOMEN. 984 00:35:32,663 --> 00:35:35,700 AND I LOOKED UP THE DEFINITION 985 00:35:35,766 --> 00:35:38,736 OF PAIN AND I THINK I LEFT MY 986 00:35:38,803 --> 00:35:46,177 WATER. 987 00:35:46,244 --> 00:35:48,045 IN 1964, YOU CAN READ THAT 988 00:35:48,112 --> 00:35:48,412 DEFINITION. 989 00:35:48,479 --> 00:35:51,883 THEN I LOOKED AT THE IASP 990 00:35:51,949 --> 00:35:53,384 DEFINITION FROM 1979. 991 00:35:53,451 --> 00:35:57,822 AND THEN I READ THE ENTIRE 992 00:35:57,889 --> 00:36:01,425 DOCUMENT AROUND THE REVISION OF 993 00:36:01,492 --> 00:36:03,594 THE 2020 DEFINITION. 994 00:36:03,661 --> 00:36:06,430 AND THE 2020 DEFINITION ACTUALLY 995 00:36:06,497 --> 00:36:08,299 DID ADD EIGHT BULLETS AFTER IT. 996 00:36:08,366 --> 00:36:12,036 AND SO I JUST WANT TO SHARE WITH 997 00:36:12,103 --> 00:36:21,345 YOU, AND I DON'T MEAN THIS TO BE 998 00:36:21,412 --> 00:36:22,980 PERSECUTORIAL AT ALL, IF YOU 999 00:36:23,047 --> 00:36:24,015 NEED EIGHT BULLETS AFTER IT, 1000 00:36:24,081 --> 00:36:25,283 IT'S NOT REALLY A GREAT 1001 00:36:25,349 --> 00:36:26,183 DEFINITION FOR US TO READ AND 1002 00:36:26,250 --> 00:36:29,687 APPLY. 1003 00:36:29,754 --> 00:36:32,957 ALSO THIS REMINDED ME OF THE 1004 00:36:33,024 --> 00:36:34,392 CARTOONS OF "FIND THE DIFFERENCE 1005 00:36:34,458 --> 00:36:35,293 BETWEEN THE TWO." 1006 00:36:35,359 --> 00:36:36,727 BECAUSE I HAD TO REALLY FIND THE 1007 00:36:36,794 --> 00:36:38,362 DIFFERENCE IN THE WORDS. 1008 00:36:38,429 --> 00:36:39,964 AND CAN YOU FIND THE DIFFERENCE 1009 00:36:40,031 --> 00:36:41,399 IN THE WORDS? 1010 00:36:41,465 --> 00:36:44,035 THERE'S LIKE THREE. 1011 00:36:44,101 --> 00:36:45,570 ALL RIGHT. 1012 00:36:45,636 --> 00:36:47,872 SO PAIN IS CHALLENGING TO STUDY. 1013 00:36:47,939 --> 00:36:49,273 I THINK WE CAN ALL APPRECIATE 1014 00:36:49,340 --> 00:36:51,042 THAT. 1015 00:36:51,108 --> 00:36:53,344 AND IT IS A HERCULEAN EFFORT TO 1016 00:36:53,411 --> 00:36:55,112 DEFINE IT. 1017 00:36:55,179 --> 00:36:56,881 AND MANY, MANY BRILLIANT PEOPLE 1018 00:36:56,948 --> 00:36:58,816 CAME UP WITH THIS DOCUMENT THAT 1019 00:36:58,883 --> 00:37:00,017 I READ AND PUT A LOT OF WORK 1020 00:37:00,084 --> 00:37:03,221 INTO IT, BUT IT JUST -- IT'S 1021 00:37:03,287 --> 00:37:09,994 JUST -- IT'S A LITTLE AMBIGUOUS. 1022 00:37:10,061 --> 00:37:10,795 LET'S GO TO THE NEXT. 1023 00:37:10,861 --> 00:37:12,563 SO I WANT TO POINT OUT TO YOU AS 1024 00:37:12,630 --> 00:37:14,432 WE TALK ABOUT HEALTH EQUITY, 1025 00:37:14,498 --> 00:37:15,433 FIRST AND FOREMOST, I DON'T 1026 00:37:15,499 --> 00:37:18,035 THINK WE WILL EVER GET TO 1027 00:37:18,102 --> 00:37:21,339 PRECISION CARE IF WE FORGET TWO 1028 00:37:21,405 --> 00:37:22,974 BASIC HUMAN VARIABLES WE HAVE 1029 00:37:23,040 --> 00:37:23,507 WITHOUT FAIL. 1030 00:37:23,574 --> 00:37:25,009 I TELL MY STUDENTS, MY TRAINEES 1031 00:37:25,076 --> 00:37:28,679 AND MY COLLEAGUES, YOU CANNOT DO 1032 00:37:28,746 --> 00:37:29,981 PERSONALIZED MEDICINE IF YOU 1033 00:37:30,047 --> 00:37:31,182 FORGET GENDER AND SEX. 1034 00:37:31,248 --> 00:37:32,383 BECAUSE ALL OF YOUR PATIENTS ARE 1035 00:37:32,450 --> 00:37:33,484 GOING TO HAVE THOSE TWO 1036 00:37:33,551 --> 00:37:35,019 VARIABLES. 1037 00:37:35,086 --> 00:37:37,622 THEY ARE FOUNDATIONAL HUMAN 1038 00:37:37,688 --> 00:37:39,557 VARIABLES THAT FOR THOUSANDS OF 1039 00:37:39,624 --> 00:37:40,725 YEARS SCIENCE JUST SKIPPED RIGHT 1040 00:37:40,791 --> 00:37:43,294 OVER. 1041 00:37:43,361 --> 00:37:44,762 SO HERE ARE THE WORDS THAT I 1042 00:37:44,829 --> 00:37:46,430 PULLED OUT OF SOME PAIN 1043 00:37:46,497 --> 00:37:48,833 LITERATURE. 1044 00:37:48,899 --> 00:37:50,067 MOSTLY RELATED TO WOMEN 1045 00:37:50,134 --> 00:37:51,902 SUBJECTS. 1046 00:37:51,969 --> 00:37:54,171 AND LOOK AT THE WORDS THAT 1047 00:37:54,238 --> 00:37:55,973 REALLY HIT HOME FOR ME. 1048 00:37:56,040 --> 00:37:58,342 SENSITIVITY. 1049 00:37:58,409 --> 00:38:00,211 PAIN AWARENESS. 1050 00:38:00,277 --> 00:38:02,647 PERCEPTION. 1051 00:38:02,713 --> 00:38:04,181 CONCEPTUALIZING PAIN. 1052 00:38:04,248 --> 00:38:07,451 EXPERIENCING PAIN. 1053 00:38:07,518 --> 00:38:10,187 CHARACTERIZING PAIN, REPORTING 1054 00:38:10,254 --> 00:38:10,388 PAIN. 1055 00:38:10,454 --> 00:38:12,289 WOMEN DO REPORT ADVERSE EVENTS, 1056 00:38:12,356 --> 00:38:13,724 ET CETERA, AND THEIR PAIN. 1057 00:38:13,791 --> 00:38:15,126 WE ENGAGE WITH THE HEALTHCARE 1058 00:38:15,192 --> 00:38:16,093 SYSTEM MORE OFTEN. 1059 00:38:16,160 --> 00:38:22,400 LET'S GO TO THE NEXT SLIDE. 1060 00:38:22,466 --> 00:38:24,869 SO HERE, YOU MAY BE ABLE TO READ 1061 00:38:24,935 --> 00:38:26,537 THIS, BUT DO YOU SEE THE WORD 1062 00:38:26,604 --> 00:38:29,273 VULNERABLE AND PSYCHOSOCIAL 1063 00:38:29,340 --> 00:38:31,375 STRESS IN HERE? 1064 00:38:31,442 --> 00:38:33,310 AND IT'S RELATED TO WOMEN WHEN 1065 00:38:33,377 --> 00:38:34,545 IT'S DESCRIBING WOMEN IN THIS 1066 00:38:34,612 --> 00:38:37,915 ABSTRACT. 1067 00:38:37,982 --> 00:38:38,883 WE'RE USING THESE TERMS. 1068 00:38:38,949 --> 00:38:41,385 IT REMINDS ME OF WHEN WOMEN WERE 1069 00:38:41,452 --> 00:38:43,621 PROTECTED SUBJECTS IN RESEARCH. 1070 00:38:43,688 --> 00:38:47,324 WHICH ENDED UP FOR DECADES 1071 00:38:47,391 --> 00:38:48,993 PROTECTING WOMEN FROM RESEARCH 1072 00:38:49,060 --> 00:38:52,697 INSTEAD OF WITH RESEARCH. 1073 00:38:52,763 --> 00:38:56,067 NEXT. 1074 00:38:56,133 --> 00:38:57,635 SO I -- YOU KNOW, I EAT THIS 1075 00:38:57,702 --> 00:38:59,170 STUFF FOR BREAKFAST. 1076 00:38:59,236 --> 00:39:03,140 SO I JUST DID A GOOGLE SEARCH OF 1077 00:39:03,207 --> 00:39:04,642 CHEST PAIN, LIKE PICTURES OF 1078 00:39:04,709 --> 00:39:09,013 PATIENTS WITH CHEST PAIN. 1079 00:39:09,080 --> 00:39:10,981 SO HOW MANY MEN DO YOU SEE IN 1080 00:39:11,048 --> 00:39:11,182 HERE? 1081 00:39:11,248 --> 00:39:12,516 THIS IS JUST A SCREENSHOT FROM 1082 00:39:12,583 --> 00:39:16,687 MY LAPTOP. 1083 00:39:16,754 --> 00:39:18,322 LIKE 12 OR SO. 1084 00:39:18,389 --> 00:39:22,059 THEN I GOGGLED "PATIENTS WITH 1085 00:39:22,126 --> 00:39:23,294 HEAD PAIN." 1086 00:39:23,360 --> 00:39:27,765 NEXT. 1087 00:39:27,832 --> 00:39:30,367 IT IS INSIDIOUS. 1088 00:39:30,434 --> 00:39:32,503 WE SAY IMPLICIT BECAUSE IT'S 1089 00:39:32,570 --> 00:39:36,640 KIND. 1090 00:39:36,707 --> 00:39:39,310 BUT AT 2024, WE PROBABLY NEED TO 1091 00:39:39,376 --> 00:39:41,445 USE EXACTLY WHAT IT IS. 1092 00:39:41,512 --> 00:39:45,382 WE ARE BIASING THE ENTIRE 1093 00:39:45,449 --> 00:39:46,383 POPULATION AROUND WHAT WOMEN 1094 00:39:46,450 --> 00:39:49,120 HAVE AND WHAT MEN HAVE, AND HOW 1095 00:39:49,186 --> 00:39:51,355 THEY EXPERIENCE PAIN. 1096 00:39:51,422 --> 00:39:55,159 NOT ONLY THAT, THERE ARE RARELY 1097 00:39:55,226 --> 00:39:57,027 ANY HEALTHCARE PROVIDERS IN 1098 00:39:57,094 --> 00:39:59,764 THESE PICTURES AS OPPOSED TO THE 1099 00:39:59,830 --> 00:40:02,633 PREVIOUS ONES, RALLYING AROUND 1100 00:40:02,700 --> 00:40:07,538 MEN IN THE E.R. 1101 00:40:07,605 --> 00:40:09,840 SO NOW LET'S TALK ABOUT 1102 00:40:09,907 --> 00:40:10,708 STEREOTYPE. 1103 00:40:10,775 --> 00:40:13,677 YOU KNOW, STEREOTYPE IS A BRIEF 1104 00:40:13,744 --> 00:40:15,112 DESCRIPTOR, STRAIGHTFORWARD, 1105 00:40:15,179 --> 00:40:24,088 USUALLY NOT APPLICABLE -- DOES 1106 00:40:24,155 --> 00:40:25,523 ANYONE HAVE A POSITIVE FEELING 1107 00:40:25,589 --> 00:40:28,592 ABOUT THE WORD STEREOTYPE? 1108 00:40:28,659 --> 00:40:30,394 NO. 1109 00:40:30,461 --> 00:40:33,297 BECAUSE IT HIDES -- EVERYTHING 1110 00:40:33,364 --> 00:40:34,298 ELSE HIDES BEHIND IT. 1111 00:40:34,365 --> 00:40:36,100 OH, THAT'S JUST STEREOTYPICAL. 1112 00:40:36,167 --> 00:40:37,368 BUT ALL OF THESE OTHER WORDS 1113 00:40:37,434 --> 00:40:44,141 COME INTO PLAY. 1114 00:40:44,208 --> 00:40:46,143 I'M GOING TO MOVE INTO 1115 00:40:46,210 --> 00:40:47,945 BIOLOGICAL PLAUSIBILITY. 1116 00:40:48,012 --> 00:40:49,446 THE EQUITY, THE HEALTH EQUITY, 1117 00:40:49,513 --> 00:40:53,384 THE SEX AND GENDER NEED, THE 1118 00:40:53,450 --> 00:40:54,952 IMPLICIT, IF YOU WANT TO CALL 1119 00:40:55,019 --> 00:40:57,254 THAT, BIAS THAT WE SEE IN OUR 1120 00:40:57,321 --> 00:40:58,989 EVERYDAY WORLD, AND I SEE IN 1121 00:40:59,056 --> 00:41:00,991 LEARNING MATERIALS WHEN WE TEACH 1122 00:41:01,058 --> 00:41:02,726 FUTURE DOCTORS. 1123 00:41:02,793 --> 00:41:04,528 BUT BIOLOGICAL PLAUSIBILITY IS 1124 00:41:04,595 --> 00:41:07,731 ACTUALLY A CONCEPT THAT I HOPE, 1125 00:41:07,798 --> 00:41:09,200 IF YOU HAVEN'T THOUGHT ABOUT IT, 1126 00:41:09,266 --> 00:41:11,168 THAT YOU WILL THINK ABOUT IT AS 1127 00:41:11,235 --> 00:41:12,469 I GO THROUGH THIS EXAMPLE, AND 1128 00:41:12,536 --> 00:41:14,338 I'M GOING TO GO THROUGH AN 1129 00:41:14,405 --> 00:41:16,207 EXAMPLE THAT I UTILIZED WHEN I 1130 00:41:16,273 --> 00:41:18,275 WAS SPEAKING TO SOME REVIEW 1131 00:41:18,342 --> 00:41:19,910 GROUPS AT THE FDA, AND IT IS NOT 1132 00:41:19,977 --> 00:41:23,714 ABOUT PAIN. 1133 00:41:23,781 --> 00:41:24,114 NEXT. 1134 00:41:24,181 --> 00:41:26,217 I TALKED ABOUT THE RESEARCH 1135 00:41:26,283 --> 00:41:30,020 ENVIRONMENTS WHERE WE LIVE. 1136 00:41:30,087 --> 00:41:32,456 DISCOVERY RESEARCH AT NIH. 1137 00:41:32,523 --> 00:41:38,963 AND MANY OTHER RESEARCH, 50, 1138 00:41:39,029 --> 00:41:40,564 $48 BILLION WORLD RENOWNED 1139 00:41:40,631 --> 00:41:41,098 ENTITY. 1140 00:41:41,165 --> 00:41:43,100 AND THEN WE LOOK INTO INDUSTRY 1141 00:41:43,167 --> 00:41:44,501 AND PRODUCT DEVELOPMENT, AND 1142 00:41:44,568 --> 00:41:46,971 THEN WE GO INTO THE FDA FOR 1143 00:41:47,037 --> 00:41:49,773 PRODUCT APPROVAL AND THEN 1144 00:41:49,840 --> 00:41:50,074 POSTMARKET. 1145 00:41:50,140 --> 00:41:52,843 AND THE FDA DOES LOOK AT BASIC 1146 00:41:52,910 --> 00:41:54,678 SCIENCE STUDIES AND IN FACT, 1147 00:41:54,745 --> 00:41:56,347 SOMETIMES THAT'S ALL THEY HAVE 1148 00:41:56,413 --> 00:41:58,415 TO LOOK AT, ARE ANIMAL STUDIES 1149 00:41:58,482 --> 00:41:59,984 TO INCLUDE IN A LABEL, 1150 00:42:00,050 --> 00:42:00,718 ESPECIALLY AROUND PREGNANT 1151 00:42:00,784 --> 00:42:01,619 WOMEN. 1152 00:42:01,685 --> 00:42:05,122 AND THEN ACADEMICS AND HEALTH 1153 00:42:05,189 --> 00:42:07,124 SYSTEMS COME INTO PLAY AS WELL. 1154 00:42:07,191 --> 00:42:08,626 WE KNOW THAT THE RESEARCH 1155 00:42:08,692 --> 00:42:11,595 PIPELINE IS LINED WITH MALES. 1156 00:42:11,662 --> 00:42:13,097 ALTHOUGH WOMEN ARE BECOMING MORE 1157 00:42:13,163 --> 00:42:15,266 AND MORE THE MAJORITY IN 1158 00:42:15,332 --> 00:42:16,100 CLINICAL TRIALS. 1159 00:42:16,166 --> 00:42:17,868 BUT IF YOU DON'T DISAGGREGATE 1160 00:42:17,935 --> 00:42:20,571 THE DATA, AND YOU JUST CLUMP IT 1161 00:42:20,638 --> 00:42:26,510 ALL TOGETHER, WHAT DOES THAT DO? 1162 00:42:26,577 --> 00:42:27,278 IT DILUTES DIFFERENCES. 1163 00:42:27,344 --> 00:42:29,013 AND YET WOMEN ARE MORE LIKELY TO 1164 00:42:29,079 --> 00:42:30,281 ENGAGE IN THE HEALTHCARE SYSTEM 1165 00:42:30,347 --> 00:42:31,949 AND THE WORLD HEALTH 1166 00:42:32,016 --> 00:42:33,284 ORGANIZATION SAYS THAT WE ARE 1167 00:42:33,350 --> 00:42:34,718 80% OF GLOBAL HEALTHCARE 1168 00:42:34,785 --> 00:42:41,091 CONSUMERS. 1169 00:42:41,158 --> 00:42:42,760 SO THIS IS SEX BIAS IN 1170 00:42:42,826 --> 00:42:43,861 INFECTIOUS DISEASES, 1171 00:42:43,928 --> 00:42:44,695 INFLAMMATORY DISEASES AND 1172 00:42:44,762 --> 00:42:45,262 CANCERS. 1173 00:42:45,329 --> 00:42:46,597 VERY QUICKLY, THE NEXT EXAMPLE 1174 00:42:46,664 --> 00:42:48,432 GOING THROUGH THE CHECKPOINT 1175 00:42:48,499 --> 00:42:52,803 INHIBITORS. 1176 00:42:52,870 --> 00:42:56,874 THIS WAS THE RATIONALE FOR THIS 1177 00:42:56,941 --> 00:42:58,509 STUDY, BECAUSE SEX HORMONES 1178 00:42:58,575 --> 00:42:59,710 REGULATE THE EXPRESSION AND 1179 00:42:59,777 --> 00:43:03,113 FUNCTION OF PD-1 AND PD-. 1180 00:43:03,180 --> 00:43:04,982 L1, MEDIATING AUTO IMMUNITY. 1181 00:43:05,049 --> 00:43:07,184 WHO IS MORE LIKELY TO HAVE 1182 00:43:07,251 --> 00:43:07,618 AUTOIMMUNE DISEASES? 1183 00:43:07,685 --> 00:43:09,620 TO THE TUNE OF 7, RIGHT? 1184 00:43:09,687 --> 00:43:14,525 7 OUT OF 10 AUTOIMMUNE DISEASES. 1185 00:43:14,591 --> 00:43:14,858 NEXT. 1186 00:43:14,925 --> 00:43:18,495 HERE WE LOOKED AT INCREASED 1187 00:43:18,562 --> 00:43:20,431 ADVERSE EVENTS AND MORTALITY IN 1188 00:43:20,497 --> 00:43:22,967 RANDOMIZED CONTROLLED TRIALS IN 1189 00:43:23,033 --> 00:43:24,301 CHECKPOINT INHIBITOR, AND IN 1190 00:43:24,368 --> 00:43:25,369 FACT SOME OF THEM EVEN CROSS 1191 00:43:25,436 --> 00:43:28,038 OVER TO NOT BEING -- THE 1192 00:43:28,105 --> 00:43:28,906 INTERVENTION NOT BEING BETTER 1193 00:43:28,973 --> 00:43:30,341 FOR WOMEN. 1194 00:43:30,407 --> 00:43:34,044 NEXT. 1195 00:43:34,111 --> 00:43:35,846 AND THEN HERE'S SOME OTHER 1196 00:43:35,913 --> 00:43:37,348 BIOLOGICAL PLAUSIBILITY ABOUT 1197 00:43:37,414 --> 00:43:38,449 WHY WE WOULD BE THINKING ABOUT 1198 00:43:38,515 --> 00:43:39,249 THIS. 1199 00:43:39,316 --> 00:43:41,618 FEMALE TUMORS ARE MORE RESISTANT 1200 00:43:41,685 --> 00:43:43,387 TO IMMUNOTHERAPIES. 1201 00:43:43,454 --> 00:43:43,988 INCREASED SUSCEPTIBILITY OF 1202 00:43:44,054 --> 00:43:45,589 WOMEN TO AUTOIMMUNE DISORDERS 1203 00:43:45,656 --> 00:43:48,759 COULD LEAD TO MORE CHECKPOINT 1204 00:43:48,826 --> 00:43:49,426 INHIBITOR-ADVERSE EVENTS. 1205 00:43:49,493 --> 00:43:51,161 THAT DOES HAPPEN. 1206 00:43:51,228 --> 00:43:51,729 GENDER DIFFERENCES. 1207 00:43:51,795 --> 00:43:55,165 NOW THIS IS HOW WE DRESS. 1208 00:43:55,232 --> 00:43:58,769 THIS IS EXPOSURE TO SUN, 1209 00:43:58,836 --> 00:44:00,070 BEHAVIORS LIKE SMOKING. 1210 00:44:00,137 --> 00:44:01,939 SMOKING BEHAVIOR, MEN MORE THAN 1211 00:44:02,006 --> 00:44:03,407 WOMEN, ULTRAVIOLET EXPOSURE, MEN 1212 00:44:03,474 --> 00:44:03,941 LESS THAN WOMEN. 1213 00:44:04,008 --> 00:44:07,411 SO THINK ABOUT HOW WE GO FROM 1214 00:44:07,478 --> 00:44:13,317 THE BENCH TO POST MARKET 1215 00:44:13,384 --> 00:44:15,219 CLINICAL CARE THERAPY FOR CANCER 1216 00:44:15,285 --> 00:44:18,522 IN A DRUG THAT INTUITIVELY WE 1217 00:44:18,589 --> 00:44:20,924 ARE EXPECTING TO HAVE INCREASED 1218 00:44:20,991 --> 00:44:25,729 INCIDENCE OF AUTOIMMUNE DISEASES 1219 00:44:25,796 --> 00:44:28,165 AND CANCER PATIENTS AND MAY BE 1220 00:44:28,232 --> 00:44:32,002 LESS RESPONSE OF THEIR TUMORS. 1221 00:44:32,069 --> 00:44:33,003 SO THERE'S A GREAT SUMMARY IN 1222 00:44:33,070 --> 00:44:33,404 THIS. 1223 00:44:33,470 --> 00:44:34,405 I'VE JUST HIGHLIGHTED SOME OF 1224 00:44:34,471 --> 00:44:36,340 THE WORDS. 1225 00:44:36,407 --> 00:44:37,374 PATIENTS' SEX SHOULD BE TAKEN 1226 00:44:37,441 --> 00:44:38,575 INTO ACCOUNT. 1227 00:44:38,642 --> 00:44:40,144 RESEARCHERS WHO ARE DESIGNING 1228 00:44:40,210 --> 00:44:41,779 NEW IMMUNOTHERAPY STUDIES -- YOU 1229 00:44:41,845 --> 00:44:43,514 CAN PUT PAIN THERE AS WELL, 1230 00:44:43,580 --> 00:44:45,049 SHOULD ENSURE A LARGER INCLUSION 1231 00:44:45,115 --> 00:44:47,684 OF WOMEN IN TRIALS TO AVOID 1232 00:44:47,751 --> 00:44:49,620 ERRONEOUSLY EXTENDING TO WOMEN'S 1233 00:44:49,686 --> 00:44:51,555 RESULTS THAT ARE OBTAINED MAINLY 1234 00:44:51,622 --> 00:44:52,322 IN MALES. 1235 00:44:52,389 --> 00:44:54,425 AND BECAUSE I AM OBSESSIVE ABOUT 1236 00:44:54,491 --> 00:44:57,394 THE WORDS WE USE AS I TOLD YOU 1237 00:44:57,461 --> 00:45:02,066 BEFORE, THAT SENTENCE, WOMEN 1238 00:45:02,132 --> 00:45:03,600 JUXTAPOSED WITH MALE ARE 1239 00:45:03,667 --> 00:45:05,502 DISCORDANT TERMS. 1240 00:45:05,569 --> 00:45:10,107 THAT IS A GENDER TERM TO A 1241 00:45:10,174 --> 00:45:13,143 BIOLOGICAL TERM, MALE/FEMALE OR 1242 00:45:13,210 --> 00:45:13,777 MEN/WOMEN. 1243 00:45:13,844 --> 00:45:15,412 THAT'S AN ASIDE. 1244 00:45:15,479 --> 00:45:17,047 NEXT. 1245 00:45:17,114 --> 00:45:18,549 SO THIS IS A PAIN CHALLENGE. 1246 00:45:18,615 --> 00:45:20,517 IT COULD BE A PAINFUL CHALLENGE. 1247 00:45:20,584 --> 00:45:20,984 I DON'T KNOW. 1248 00:45:21,051 --> 00:45:22,519 I'M GOING TO BE HERE MOST OF THE 1249 00:45:22,586 --> 00:45:23,954 DAY. 1250 00:45:24,021 --> 00:45:25,556 AND I WOULD LIKE YOU TO THINK 1251 00:45:25,622 --> 00:45:29,126 ABOUT A CASE FOR BU BIOLOGICAL 1252 00:45:29,193 --> 00:45:30,761 PLAUSIBILITY IN YOUR EXPERT 1253 00:45:30,828 --> 00:45:31,161 AREA. 1254 00:45:31,228 --> 00:45:32,729 AND IF YOU WOULD, PLEASE EMAIL 1255 00:45:32,796 --> 00:45:33,197 TO ME. 1256 00:45:33,263 --> 00:45:38,302 BECAUSE I WOULD LOVE TO SEE IT. 1257 00:45:38,368 --> 00:45:41,271 AND ONE OF THE PEOPLE WHO SENT 1258 00:45:41,338 --> 00:45:44,908 ME THIS CASE, I WILL TELL YOU 1259 00:45:44,975 --> 00:45:46,543 WHAT YOU WILL RECEIVE AT THE END 1260 00:45:46,610 --> 00:45:48,979 OF MY TALK. 1261 00:45:49,046 --> 00:45:50,481 SO NCAA, I'M A GAMER. 1262 00:45:50,547 --> 00:45:51,215 GAMIFICATION. 1263 00:45:51,281 --> 00:45:52,483 I LIKE IT. 1264 00:45:52,549 --> 00:45:55,152 I HOPE YOU WILL SHARE YOUR 1265 00:45:55,219 --> 00:45:56,186 EXPERTISE WITH ME BECAUSE I CAN 1266 00:45:56,253 --> 00:45:59,523 USE IT IN THE FUTURE AS WELL. 1267 00:45:59,590 --> 00:46:00,157 AND YOU'RE THE EXPERTS. 1268 00:46:00,224 --> 00:46:07,297 I COULD TALK ABOUT MURRAY MU RES 1269 00:46:07,364 --> 00:46:08,499 AND TELESCOPING, I COULD HAVE 1270 00:46:08,565 --> 00:46:09,700 TALKED ABOUT THAT KAI BUT I 1271 00:46:09,766 --> 00:46:11,702 REALLY WANTED YOU TO SEE THE 1272 00:46:11,768 --> 00:46:14,771 CONCEPT AND THEN TELL ME WHY 1273 00:46:14,838 --> 00:46:16,974 YOUR RESEARCH AT THE BENCH IS 1274 00:46:17,040 --> 00:46:18,709 BIOLOGICALLY PLAUSIBLE FOR WHAT 1275 00:46:18,775 --> 00:46:25,415 WE'RE SEEING ON THE OTHER END. 1276 00:46:25,482 --> 00:46:27,151 SO NOW FOR THE WRAPPING UP, GAPS 1277 00:46:27,217 --> 00:46:29,186 IN THE DIAGNOSIS AND TREATMENT 1278 00:46:29,253 --> 00:46:30,387 OF PAIN SYNDROMES IN CLINICAL 1279 00:46:30,454 --> 00:46:32,189 CARE. 1280 00:46:32,256 --> 00:46:35,959 HERE ARE PAIN SYNDROMES. 1281 00:46:36,026 --> 00:46:37,427 FEMALE PREVALENCE ON THE LEFT, 1282 00:46:37,494 --> 00:46:40,597 MALE PREVALENCE IN THE MIDDLE, 1283 00:46:40,664 --> 00:46:48,605 NO SEX PREVALENCE ON THE END. 1284 00:46:48,672 --> 00:46:51,108 SO I'VE ENLARGED THE MEN AND 1285 00:46:51,175 --> 00:46:54,645 WOMEN. 1286 00:46:54,711 --> 00:46:59,016 AND IN THIS, THERE'S AT LEAST 1287 00:46:59,082 --> 00:47:02,719 FIVE TO SIX SYNDROMES I TOLD YOU 1288 00:47:02,786 --> 00:47:04,188 ABOUT, WHICH MEANS WE DON'T HAVE 1289 00:47:04,254 --> 00:47:07,691 A BIOMARKER, AN ANATOMICAL 1290 00:47:07,758 --> 00:47:11,295 DIAGNOSIS AS A CULMINATION OF 1291 00:47:11,361 --> 00:47:13,897 SYMPTOMS, PHYSICAL EXAM AND 1292 00:47:13,964 --> 00:47:14,431 SYMPTOMATOLOGY. 1293 00:47:14,498 --> 00:47:16,400 SO I THOUGHT I'D GO THROUGH WITH 1294 00:47:16,466 --> 00:47:21,838 YOU A CONDITION A, CONDITION A 1295 00:47:21,905 --> 00:47:24,875 HAS PAIN. 1296 00:47:24,942 --> 00:47:29,413 WHICH IS OFTEN EXPERIENCED, 1297 00:47:29,479 --> 00:47:30,747 PATIENTS WITH CONDITION A, 1298 00:47:30,814 --> 00:47:32,516 INCREASED SENSITIVITY. 1299 00:47:32,583 --> 00:47:34,251 MUSCLE STIFFNESS, SLEEP 1300 00:47:34,318 --> 00:47:38,121 DISTURBANCES AND HEADACHES. 1301 00:47:38,188 --> 00:47:39,323 YOU KNOW YOU'RE GOING TO HAVE TO 1302 00:47:39,389 --> 00:47:40,390 GUESS CONDITION A, RIGHT? 1303 00:47:40,457 --> 00:47:51,068 I'M JUST GIVING YOU A HEADS UP. 1304 00:47:55,339 --> 00:47:57,374 SO 50% OF PRIMARY CARE 1305 00:47:57,441 --> 00:48:01,311 PHYSICIANS DO NOT APPLY THE 1306 00:48:01,378 --> 00:48:02,679 ACCEPTED DIAGNOSTIC CRITERIA 1307 00:48:02,746 --> 00:48:03,747 WITHIN PATIENT CARE FOR 1308 00:48:03,814 --> 00:48:04,514 CONDITION A. 1309 00:48:04,581 --> 00:48:05,849 STUDENTS ARE TAUGHT ABOUT THIS 1310 00:48:05,916 --> 00:48:07,918 CONDITION LESS THAN 40% -- LESS 1311 00:48:07,985 --> 00:48:13,423 THAN 40% OF NATIONAL CURRICULA. 1312 00:48:13,490 --> 00:48:15,592 THESE ARE THE DRUGS THAT CAN BE 1313 00:48:15,659 --> 00:48:20,530 USED IN CONDITION A, BUT ONLY 1314 00:48:20,597 --> 00:48:24,968 ONE OF THE GROUPS HAS 1315 00:48:25,035 --> 00:48:26,270 FDA-APPROVED MEDICATIONS, 1316 00:48:26,336 --> 00:48:34,111 APPROVED FOR CONDITION A. 1317 00:48:34,177 --> 00:48:35,545 PATIENTS WITH THIS CONDITION MAY 1318 00:48:35,612 --> 00:48:37,681 ENDURE MEDICAL AND PERSONAL 1319 00:48:37,748 --> 00:48:38,248 GASLIGHTING. 1320 00:48:38,315 --> 00:48:39,750 EVERYBODY KNOW WHAT GASLIGHTING 1321 00:48:39,816 --> 00:48:41,718 IS? 1322 00:48:41,785 --> 00:48:43,053 IT'S AMAZING THAT A DATING TERM 1323 00:48:43,120 --> 00:48:45,289 HAD TO BRING IT INTO MEDICINE. 1324 00:48:45,355 --> 00:48:49,626 THAT'S ALL I'M SAYING. 1325 00:48:49,693 --> 00:48:52,296 SO GAS LIGHTING IS WHEN SOMEONE 1326 00:48:52,362 --> 00:48:55,132 TRIES TO GET YOU TO KNOW THAT 1327 00:48:55,198 --> 00:48:56,433 WHAT YOU KNOW IS TRUE IS NOT 1328 00:48:56,500 --> 00:48:57,868 TRUE AND THEY REALLY TRY TO DO 1329 00:48:57,934 --> 00:48:58,568 MIND GAMES WITH YOU. 1330 00:48:58,635 --> 00:49:00,203 THIS IS ALL IN YOUR HEAD. 1331 00:49:00,270 --> 00:49:01,405 YOU'RE NOT -- NOTHING IS WRONG 1332 00:49:01,471 --> 00:49:01,838 WITH YOU. 1333 00:49:01,905 --> 00:49:04,207 WE DID ALL YOUR LABS AND X-RAYS. 1334 00:49:04,274 --> 00:49:05,809 YOU'RE NOT HAVING ANY PAIN. 1335 00:49:05,876 --> 00:49:07,978 OH, OKAY, THANK YOU. 1336 00:49:08,045 --> 00:49:11,982 VERY MUCH. 1337 00:49:12,049 --> 00:49:14,184 THIS IS WHAT PATIENTS HEAR. 1338 00:49:14,251 --> 00:49:15,485 YOU'RE FINE, YOU'RE FINE. 1339 00:49:15,552 --> 00:49:18,021 THIS IS WHAT THEY SAY TO 1340 00:49:18,088 --> 00:49:20,390 THEMSELVES. 1341 00:49:20,457 --> 00:49:22,092 I BASICALLY CANNOT OWN MY OWN 1342 00:49:22,159 --> 00:49:22,959 EXPERIENCE AND WE'RE GOING TO 1343 00:49:23,026 --> 00:49:24,294 TALK ABOUT LIFE EXPERIENCE 1344 00:49:24,361 --> 00:49:26,463 TODAY. 1345 00:49:26,530 --> 00:49:27,931 AND I STARTED TO FEEL LIKE THE 1346 00:49:27,998 --> 00:49:33,103 COMPLAINER THAT I WAS. 1347 00:49:33,170 --> 00:49:34,271 AND ALSO OUR FAMILY AND OUR 1348 00:49:34,338 --> 00:49:35,806 FRIENDS, BECAUSE WE DON'T HAVE 1349 00:49:35,872 --> 00:49:38,975 OBVIOUS SIGNS OF DISEASE, DON'T 1350 00:49:39,042 --> 00:49:42,946 UNDERSTAND AND SUPPORT US 1351 00:49:43,013 --> 00:49:43,180 EITHER. 1352 00:49:43,246 --> 00:49:44,981 I CAN'T GO OUT WITH YOU TODAY 1353 00:49:45,048 --> 00:49:46,516 BECAUSE I AM SO TIRED, I HAVE TO 1354 00:49:46,583 --> 00:49:50,220 LAY ON THE COUCH ALL DAY. 1355 00:49:50,287 --> 00:49:53,223 I CANNOT WALK BECAUSE MY HIPS 1356 00:49:53,290 --> 00:49:55,959 ARE HURTING. 1357 00:49:56,026 --> 00:49:58,161 OH, COME ON, TAKE SOME TYLENOL, 1358 00:49:58,228 --> 00:50:07,904 ADVIL. 1359 00:50:07,971 --> 00:50:09,873 THEN THIS IS A STUDY THAT 1360 00:50:09,940 --> 00:50:11,608 BASICALLY CHILDHOOD EXPERIENCES 1361 00:50:11,675 --> 00:50:12,476 AND LIFE EXPERIENCES WHICH 1362 00:50:12,542 --> 00:50:13,610 YOU'RE GOING TO HEAR ABOUT AS 1363 00:50:13,677 --> 00:50:17,447 WELL IMPACT PAIN CONDITIONS. 1364 00:50:17,514 --> 00:50:19,916 AND THE POTENTIAL YOU MAY HAVE A 1365 00:50:19,983 --> 00:50:24,821 PAIN CONDITION LATER IN LIFE. 1366 00:50:24,888 --> 00:50:26,022 WHO'S HEARD OF THE ADVERSE 1367 00:50:26,089 --> 00:50:27,657 CHILDHOOD EXPERIENCES, ACE? 1368 00:50:27,724 --> 00:50:30,227 ACE, ACE, ACE. 1369 00:50:30,293 --> 00:50:30,494 EVERYBODY. 1370 00:50:30,560 --> 00:50:31,328 WHO'S CALCULATED THEIR ACE 1371 00:50:31,395 --> 00:50:34,064 SCORE? 1372 00:50:34,131 --> 00:50:35,732 I'M AN OBSESSIVE COMPULSIVE. 1373 00:50:35,799 --> 00:50:37,167 I TAKE THESE TESTS. 1374 00:50:37,234 --> 00:50:43,140 SO MY ACE SCORE OUT OF 10 IS 8. 1375 00:50:43,206 --> 00:50:44,374 SO SEVERAL RESEARCH STUDIES 1376 00:50:44,441 --> 00:50:45,942 SUGGEST THERE MAY BE A 1377 00:50:46,009 --> 00:50:47,210 CORRELATION OF CONDITION A WITH 1378 00:50:47,277 --> 00:50:48,945 EARLY CHILDHOOD TRAUMA. 1379 00:50:49,012 --> 00:50:50,113 ALL RIGHT? 1380 00:50:50,180 --> 00:50:53,183 SO NEXT. 1381 00:50:53,250 --> 00:50:58,688 AND THEN JUST BECAUSE I AM -- 1382 00:50:58,755 --> 00:51:00,190 THIS IS REALLY A LITTLE BIT OF A 1383 00:51:00,257 --> 00:51:03,493 SOAP BOX ISSUE FOR ME AS WOMEN 1384 00:51:03,560 --> 00:51:05,162 IN PREGNANCY AND LACTATION AND 1385 00:51:05,228 --> 00:51:06,496 HOW WE ARE NOT TAKING CARE OF 1386 00:51:06,563 --> 00:51:07,697 THEM WITH RESEARCH. 1387 00:51:07,764 --> 00:51:09,533 SO LET'S SAY SOMEONE WITH 1388 00:51:09,599 --> 00:51:10,901 CONDITION A IS PREGNANT. 1389 00:51:10,967 --> 00:51:17,808 LET'S GO TO THE NEXT SLIDE. 1390 00:51:17,874 --> 00:51:18,675 GO TO THE ONE BEFORE. 1391 00:51:18,742 --> 00:51:19,643 SO I REPRESENTED THE 1392 00:51:19,709 --> 00:51:20,811 COMMISSIONER ON A CONGRESSIONAL 1393 00:51:20,877 --> 00:51:22,779 TASK FORCE FOR A YEE, THE PRGLAC 1394 00:51:22,846 --> 00:51:24,614 TASK FORCE. 1395 00:51:24,681 --> 00:51:25,382 FOR A YEAR. 1396 00:51:25,449 --> 00:51:32,422 I INITIATED AN AUDIT OF 517 1397 00:51:32,489 --> 00:51:36,526 DRUGS THAT HAD THEIR LABELS 1398 00:51:36,593 --> 00:51:38,562 CHANGED FROM THE ABCD TO THE NEW 1399 00:51:38,628 --> 00:51:39,362 LABELING. 1400 00:51:39,429 --> 00:51:40,797 WHAT I WANTED TO FIND OUT WAS 1401 00:51:40,864 --> 00:51:43,800 HOW MUCH HUMAN DATA THERE WAS IN 1402 00:51:43,867 --> 00:51:48,104 THE SECTION 8 1, 2 AND 3 FOR 1403 00:51:48,171 --> 00:51:50,106 PREGNANCY AND LACTATION. 1404 00:51:50,173 --> 00:51:51,975 72% OF THOSE DRUGS HAD NO HUMAN 1405 00:51:52,042 --> 00:51:52,409 DATA. 1406 00:51:52,476 --> 00:51:53,743 SO AS A CLINICIAN, IF I'M TAKING 1407 00:51:53,810 --> 00:51:55,412 CARE OF A PREGNANT WOMAN OR A 1408 00:51:55,479 --> 00:51:57,047 WOMAN WHO'S BREASTFEEDING AND I 1409 00:51:57,113 --> 00:51:59,583 GO TO THAT SECTION OF THE LABEL, 1410 00:51:59,649 --> 00:52:03,987 WHICH BY THE WAY IS IN 3-POINT 1411 00:52:04,054 --> 00:52:05,956 FONT AND I'M LIKE, OKAY, AND I 1412 00:52:06,022 --> 00:52:08,291 READ THIS MUCH, IT STILL DOESN'T 1413 00:52:08,358 --> 00:52:10,227 GIVE ME WHAT I NEED TO KNOW TO 1414 00:52:10,293 --> 00:52:16,733 HELP COUNSEL THIS PERSON. 1415 00:52:16,800 --> 00:52:17,868 SO I'M GOING TO GO WITH THE END 1416 00:52:17,934 --> 00:52:19,603 OF THIS SECTION ON CLINICAL 1417 00:52:19,669 --> 00:52:21,872 CARE, THE POINT OF CARE, TO WHAT 1418 00:52:21,938 --> 00:52:24,708 I CALL MJ STACKING MODEL OF 1419 00:52:24,774 --> 00:52:27,177 DISPROPORTIONATE IMPACT. 1420 00:52:27,244 --> 00:52:28,879 NO, I HAVE NOT PUBLISHED THIS 1421 00:52:28,945 --> 00:52:31,515 AND SO DON'T REPEAT IT, AS A 1422 00:52:31,581 --> 00:52:34,784 PEER REVIEWED PUBLICATION MODEL. 1423 00:52:34,851 --> 00:52:37,354 BUT THINK ABOUT HOW WE STACK 1424 00:52:37,420 --> 00:52:39,322 BECAUSE WE TALK ABOUT 1425 00:52:39,389 --> 00:52:41,725 INTERSECTIONALITY, RIGHT? 1426 00:52:41,791 --> 00:52:45,228 RACE, GENDER, SOCIOECONOMIC 1427 00:52:45,295 --> 00:52:50,534 STATUS, DISABILITY. 1428 00:52:50,600 --> 00:52:51,501 SEXUAL IDENTITY. 1429 00:52:51,568 --> 00:52:52,802 GENDER IDENTITY. 1430 00:52:52,869 --> 00:52:54,604 ALL OF THAT INTERSECTS. 1431 00:52:54,671 --> 00:52:56,373 BUT THAT, TO ME, IS SIMPLIFIED 1432 00:52:56,439 --> 00:52:58,542 BECAUSE THAT MEANS IT INTERSECTS 1433 00:52:58,608 --> 00:53:00,844 AT A POINT. 1434 00:53:00,911 --> 00:53:02,612 THIS IS WHAT HAPPENS IN THE 1435 00:53:02,679 --> 00:53:06,383 CLINICAL SPACE. 1436 00:53:06,449 --> 00:53:09,019 SO THE PATIENT HAS INCREASED 1437 00:53:09,085 --> 00:53:10,687 ADVERSE CHILDHOOD EXPERIENCES IF 1438 00:53:10,754 --> 00:53:11,321 THEY'RE A WOMAN. 1439 00:53:11,388 --> 00:53:12,055 RESEARCH SHOWS THAT. 1440 00:53:12,122 --> 00:53:14,591 WE HAVE MORE. 1441 00:53:14,658 --> 00:53:16,092 INTERACTION WITH THE HEALTHCARE 1442 00:53:16,159 --> 00:53:16,326 SYSTEM. 1443 00:53:16,393 --> 00:53:18,194 WE INTERACT MORE BECAUSE OF OUR 1444 00:53:18,261 --> 00:53:20,096 REPRODUCTIVE NEEDS. 1445 00:53:20,163 --> 00:53:22,032 AND WE'RE MORE LIKELY TO ENGAGE 1446 00:53:22,098 --> 00:53:24,434 ANYWAY WITH THE SYSTEM. 1447 00:53:24,501 --> 00:53:26,369 WE HAVE INCREASED PREVALENCE OF 1448 00:53:26,436 --> 00:53:28,338 PAIN SYNDROMES. 1449 00:53:28,405 --> 00:53:31,608 WE HAVE DELAYS IN DIAGNOSING AND 1450 00:53:31,675 --> 00:53:32,776 GASLIGHTING THAT HAPPENS AROUND 1451 00:53:32,842 --> 00:53:34,711 PAIN. 1452 00:53:34,778 --> 00:53:37,013 AND WE HAVE LIMITED TREATMENT SO 1453 00:53:37,080 --> 00:53:42,152 WE START SELF-MEDICATING, 1454 00:53:42,218 --> 00:53:44,187 ALCOHOL, DRUGS. 1455 00:53:44,254 --> 00:53:48,058 PAIN LEADS TO DEPRESSION, THE 1456 00:53:48,124 --> 00:53:49,426 MAJORITY OF PEOPLE WITH CHRONIC 1457 00:53:49,492 --> 00:53:51,127 DAILY PAIN HAVE DEPRESSION, AND 1458 00:53:51,194 --> 00:53:53,797 THAT BUILDS UP TO THAT PERSON 1459 00:53:53,863 --> 00:53:56,366 NOT BEING ABLE TO WORK, TO 1460 00:53:56,433 --> 00:53:57,367 SUPPORT THEIR FAMILY, TO ENGAGE 1461 00:53:57,434 --> 00:53:58,535 WITH THEIR CHILDREN, TO ENGAGE 1462 00:53:58,602 --> 00:54:00,270 WITH THEIR LIFE. 1463 00:54:00,337 --> 00:54:04,774 YOU CAN STACK AN ENTIRELY 1464 00:54:04,841 --> 00:54:06,176 'NOTHER PICTURE OF THAT STACK 1465 00:54:06,242 --> 00:54:08,378 WITH THE SOCIAL DETERMINANTS OF 1466 00:54:08,445 --> 00:54:09,613 HEALTH THAT THAT PERSON COULD 1467 00:54:09,679 --> 00:54:11,281 ALSO HAVE. 1468 00:54:11,348 --> 00:54:14,884 WOMEN OF COLOR. 1469 00:54:14,951 --> 00:54:17,520 LGBTQ POPULATIONS. 1470 00:54:17,587 --> 00:54:19,356 TRANSGENDER PEOPLE. 1471 00:54:19,422 --> 00:54:21,424 AND YOU ARE GOING TO GET THIS 1472 00:54:21,491 --> 00:54:24,160 BROAD STACK THAT IS HEAVILY 1473 00:54:24,227 --> 00:54:25,695 WEIGHTED DOWN UNTIL IT WILL 1474 00:54:25,762 --> 00:54:29,599 LITERALLY CRUSHES THAT PATIENT. 1475 00:54:29,666 --> 00:54:31,001 AND THEY ARE NOT GOING TO GET 1476 00:54:31,067 --> 00:54:33,737 WHAT THEY NEED FROM THE HEALTH 1477 00:54:33,803 --> 00:54:36,373 SYSTEM OR THEIR PROVIDER. 1478 00:54:36,439 --> 00:54:39,075 AND THEIR LIFE IS INEXORABLY 1479 00:54:39,142 --> 00:54:40,877 IMPACTED. 1480 00:54:40,944 --> 00:54:43,747 NEXT. 1481 00:54:43,813 --> 00:54:45,148 SO THE PRACTICE OF MEDICINE IS 1482 00:54:45,215 --> 00:54:46,483 BASED ON SCIENTIFIC EVIDENCE AND 1483 00:54:46,549 --> 00:54:48,151 ALL OF YOUR WORK MATTERS. 1484 00:54:48,218 --> 00:54:51,221 YOU ARE ALL IMPORTANT TO WHAT 1485 00:54:51,287 --> 00:54:53,323 THAT CONTINUUM IS. 1486 00:54:53,390 --> 00:54:59,496 TO TREATING THAT PATIENT. 1487 00:54:59,562 --> 00:55:02,332 HOWEVER, RESEARCH DOES NOT SAVE 1488 00:55:02,399 --> 00:55:02,766 LIVES. 1489 00:55:02,832 --> 00:55:05,068 PLEASE DON'T THROW ANYTHING AT 1490 00:55:05,135 --> 00:55:05,235 ME. 1491 00:55:05,301 --> 00:55:10,674 NEXT. 1492 00:55:10,740 --> 00:55:13,309 IT CAN AND DOES SAVE LIVES WHEN 1493 00:55:13,376 --> 00:55:15,078 IT'S APPLIED TO PATIENT CARE. 1494 00:55:15,145 --> 00:55:17,480 THE VITAL STEP IN THIS PROCESS 1495 00:55:17,547 --> 00:55:21,317 IS EDUCATING THE PROVIDER. 1496 00:55:21,384 --> 00:55:22,352 WE TALK ABOUT THE VALLEY OF 1497 00:55:22,419 --> 00:55:23,653 DEATH IN RESEARCH. 1498 00:55:23,720 --> 00:55:28,324 THIS IS THE VALLEY OF DEATH IN 1499 00:55:28,391 --> 00:55:29,626 GIVING EVIDENCE-BASED MEDICINE 1500 00:55:29,693 --> 00:55:33,530 TO THE PATIENT. 1501 00:55:33,596 --> 00:55:34,764 MEDICAL STUDENTS WANT TO KNOW 1502 00:55:34,831 --> 00:55:36,966 ABOUT SEX AND GENDER 1503 00:55:37,033 --> 00:55:38,001 DIFFERENCES, AND YET THE 1504 00:55:38,068 --> 00:55:39,202 MAJORITY OF MEDICAL SCHOOLS ARE 1505 00:55:39,269 --> 00:55:44,874 NOT TEACHING THIS. 1506 00:55:44,941 --> 00:55:46,342 SPECIFICALLY IN PAIN, WE DON'T 1507 00:55:46,409 --> 00:55:48,278 HAVE FORMAL CURRICULA. 1508 00:55:48,344 --> 00:55:51,114 I STARTED AND BUILT A NATIONAL 1509 00:55:51,181 --> 00:55:52,115 INITIATIVE WITH COLLEAGUES 1510 00:55:52,182 --> 00:55:53,983 AROUND SEX AND GENDER IN 1511 00:55:54,050 --> 00:55:56,453 MEDICINE, NURSING AND PHARMACY 1512 00:55:56,519 --> 00:55:58,521 IN ALLIED HEALTH SCHOOLS, AND 1513 00:55:58,588 --> 00:56:00,557 BUILT AND STARTED A REPOSITORY 1514 00:56:00,623 --> 00:56:02,492 AT THE LAURA BUSH INSTITUTE THAT 1515 00:56:02,559 --> 00:56:07,063 IS STILL GROWING TODAY, TO HELP 1516 00:56:07,130 --> 00:56:08,031 EDUCATORS INTRODUCE SEX AND 1517 00:56:08,098 --> 00:56:08,264 GENDER. 1518 00:56:08,331 --> 00:56:08,898 WE NEED THAT FOR PAIN. 1519 00:56:08,965 --> 00:56:10,567 WE NEED TO EDUCATE OUR STUDENTS 1520 00:56:10,633 --> 00:56:12,702 ABOUT PAIN. 1521 00:56:12,769 --> 00:56:16,072 WHAT DO PHYSICIANS AND NURSE 1522 00:56:16,139 --> 00:56:18,975 PRACTITIONERS AND OTHER -- PAs 1523 00:56:19,042 --> 00:56:20,276 THAT ARE FRONT LINE POINT OF 1524 00:56:20,343 --> 00:56:21,711 CARE WANT TO DO FOR THEIR 1525 00:56:21,778 --> 00:56:25,381 PATIENTS MORE THAN ANYTHING? 1526 00:56:25,448 --> 00:56:29,786 THEY WANT TO HELP THEM. 1527 00:56:29,853 --> 00:56:31,755 WHEN PATIENTS COME IN WITH 1528 00:56:31,821 --> 00:56:33,490 CHRONIC PAIN OF YEARS, OR 1529 00:56:33,556 --> 00:56:35,158 MONTHS, HAVE TRIED FIVE 1530 00:56:35,225 --> 00:56:36,259 DIFFERENT TREATMENTS, THEY'RE 1531 00:56:36,326 --> 00:56:38,695 FRUSTRATED, THEY MAY HAVE BEEN 1532 00:56:38,762 --> 00:56:40,630 GASLIGHTED, PHYSICIANS FEEL 1533 00:56:40,697 --> 00:56:41,998 FRUSTRATED, AND THEY FEEL AT A 1534 00:56:42,065 --> 00:56:42,332 LOSS. 1535 00:56:42,398 --> 00:56:52,308 WE HAVE TO GIVE THEM THE TOOLS. 1536 00:56:52,375 --> 00:56:54,144 SO IF YOU EVER ARE IN THE 1537 00:56:54,210 --> 00:56:56,513 POSITION TO INSTITUTE CURRICULAR 1538 00:56:56,579 --> 00:57:01,651 CHANGE, WHETHER IT'S MASTERS, 1539 00:57:01,718 --> 00:57:04,487 HEALTH PROFESSIONS, UNDERGRAD, 1540 00:57:04,554 --> 00:57:06,055 YOU HAVE TO HAVE A TEAM, AND 1541 00:57:06,122 --> 00:57:07,624 THESE ARE THE TEAM MEMBERS 1542 00:57:07,690 --> 00:57:09,826 BECAUSE I'VE DONE THIS SEVERAL 1543 00:57:09,893 --> 00:57:11,027 TIMES BEFORE, THIS IS WHAT YOU 1544 00:57:11,094 --> 00:57:15,165 NEED TO CREATE THE CHANGE. 1545 00:57:15,231 --> 00:57:16,966 NEXT. 1546 00:57:17,033 --> 00:57:19,402 AND THEN A SHAMELESS PLUG FOR 1547 00:57:19,469 --> 00:57:21,304 ME -- NO, NOT REALLY. 1548 00:57:21,371 --> 00:57:25,775 I WAS SO EXCITED IN 2019 WHEN, 1549 00:57:25,842 --> 00:57:29,612 AFTER 20 YEARS, I WAS ABLE TO 1550 00:57:29,679 --> 00:57:32,816 WORK WITH A GROUP OF REALLY 1551 00:57:32,882 --> 00:57:34,150 TALENTED SEX AND GENDER 1552 00:57:34,217 --> 00:57:36,452 RESEARCHERS AND CLINICIANS TO 1553 00:57:36,519 --> 00:57:38,321 CREATE A PRACTICAL CLINICAL 1554 00:57:38,388 --> 00:57:39,556 TEXTBOOK AROUND SEX AND GENDER 1555 00:57:39,622 --> 00:57:41,424 IN CLINICAL CARE, AND IT TOOK 20 1556 00:57:41,491 --> 00:57:42,759 YEARS FOR ME TO GET THERE. 1557 00:57:42,826 --> 00:57:45,829 I ALSO LED ONE IN 2006 THAT 1558 00:57:45,895 --> 00:57:47,931 NEVER HIT THE MARKET. 1559 00:57:47,997 --> 00:57:50,133 BECAUSE IT WASN'T READY YET. 1560 00:57:50,200 --> 00:57:51,768 THE SECOND EDITION WILL COME OUT 1561 00:57:51,835 --> 00:57:54,370 NEXT YEAR. 1562 00:57:54,437 --> 00:57:57,106 I ALSO WROTE A LABOR OF LOVE 1563 00:57:57,173 --> 00:57:59,943 WITH SOME COLLEAGUES ON WHY 1564 00:58:00,009 --> 00:58:00,743 WOMEN AREN'T WINNING AT HEALTH 1565 00:58:00,810 --> 00:58:02,645 BUT CAN, WHICH INCLUDES SOME OF 1566 00:58:02,712 --> 00:58:05,048 THE THINGS WE TALKED ABOUT 1567 00:58:05,114 --> 00:58:06,583 TODAY. 1568 00:58:06,649 --> 00:58:09,485 IF YOU SEND ME YOUR BIOLOGICAL 1569 00:58:09,552 --> 00:58:18,661 PLAUSIBILITY CASE, MJENKINS@ -- 1570 00:58:18,728 --> 00:58:20,096 I'M SORRY, IT'S NOT SOUTH 1571 00:58:20,163 --> 00:58:20,997 DAKOTA. 1572 00:58:21,064 --> 00:58:22,665 I DON'T WHAT TO TAKE THAT SCHOOL 1573 00:58:22,732 --> 00:58:25,001 AS MY SCHOOL. 1574 00:58:25,068 --> 00:58:31,507 I WILL LET YOU KNOW IF YOU 1575 00:58:31,574 --> 00:58:33,009 WIN -- YOU CAN SELECT EITHER 1576 00:58:33,076 --> 00:58:34,344 BOOK YOU WANT AND I'LL SEND TO 1577 00:58:34,410 --> 00:58:37,146 YOU. 1578 00:58:37,213 --> 00:58:37,714 NEXT. 1579 00:58:37,780 --> 00:58:39,282 SO I WANT TO SAY THANK YOU. 1580 00:58:39,349 --> 00:58:40,750 I KNOW WE'RE RUNNING BEHIND. 1581 00:58:40,817 --> 00:58:42,685 I'M GOING TO STAY AROUND FOR 1582 00:58:42,752 --> 00:58:43,353 QUESTIONS TODAY. 1583 00:58:43,419 --> 00:58:45,221 I'LL BE AVAILABLE AROUND LUNCH. 1584 00:58:45,288 --> 00:58:47,590 I'M HAPPY TO TAKE YOUR EMAIL AND 1585 00:58:47,657 --> 00:58:50,193 EMAIL WITH YOU, TALK TO YOU. 1586 00:58:50,260 --> 00:58:53,730 I JUST WANT TO LET YOU KNOW THAT 1587 00:58:53,796 --> 00:58:56,266 IN YOUR CAREER, SOMETIMES IT'S 1588 00:58:56,332 --> 00:58:57,267 FRUSTRATING, BUT SOMETIMES 1589 00:58:57,333 --> 00:58:59,102 THERE'S GREAT JOY. 1590 00:58:59,168 --> 00:59:02,372 AND SO THIS IS MY GRANDSON. 1591 00:59:02,438 --> 00:59:04,741 SUPER COOPER. 1592 00:59:04,807 --> 00:59:07,610 OVER HERE, THIS SEEMS TO ME LIKE 1593 00:59:07,677 --> 00:59:17,086 ME WHEN I G I GOT THE 800-PAGE , 1594 00:59:17,153 --> 00:59:18,054 READ IT AND THOUGHT THIS IS A 1595 00:59:18,121 --> 00:59:19,489 REAL THING, EVEN THOUGH I WAS 1596 00:59:19,555 --> 00:59:20,890 THREAT EBBED TO HAVE MY MEDICAL 1597 00:59:20,957 --> 00:59:22,292 LICENSE PULLED IN TEXAS BECAUSE 1598 00:59:22,358 --> 00:59:25,828 I WAS PRACTICING THIS SEX AND AD 1599 00:59:25,895 --> 00:59:26,729 GENDER MEDICINE. 1600 00:59:26,796 --> 00:59:28,998 AND THEN WHEN THE SABV POLICY 1601 00:59:29,065 --> 00:59:30,133 CAME OUT, I HAVE TO SEND THIS TO 1602 00:59:30,199 --> 00:59:31,834 JANINE, THIS IS WHAT I LOOKED 1603 00:59:31,901 --> 00:59:32,268 LIKE. 1604 00:59:32,335 --> 00:59:32,902 WE GOT IT! 1605 00:59:32,969 --> 00:59:38,975 HERE WE ARE! 1606 00:59:39,042 --> 00:59:40,176 AND THEN THIS IS WHERE I AM 1607 00:59:40,243 --> 00:59:41,911 TODAY WHEN I SEE THE AMAZING 1608 00:59:41,978 --> 00:59:42,512 PROGRESS THAT WE MADE. 1609 00:59:42,578 --> 00:59:44,380 YOU'RE GOING TO HEAR THERE'S 1610 00:59:44,447 --> 00:59:47,216 AMBIGUITY, YOU'RE GOING TO HEAR 1611 00:59:47,283 --> 00:59:48,718 THERE'S GAPS, BUT THAT'S WHAT 1612 00:59:48,785 --> 00:59:49,919 WE'RE HERE FOR, TO FILL THE 1613 00:59:49,986 --> 00:59:50,887 GAPS. 1614 00:59:50,954 --> 00:59:54,090 THAT'S WHAT YOU DO. 1615 00:59:54,157 --> 00:59:55,425 AND I KNOW YOU ARE ALL GOING TO 1616 00:59:55,491 --> 00:59:55,792 CONTRIBUTE WELL. 1617 00:59:55,858 --> 00:59:57,226 SO THANK YOU SO MUCH FOR YOUR 1618 00:59:57,293 --> 00:59:59,729 TIME AND THE HONOR OF BEING YOUR 1619 00:59:59,796 --> 01:00:09,939 KEYNOTE. 1620 01:00:57,854 --> 01:01:00,556 >> GOOD MORNING, EVERYONE. 1621 01:01:00,623 --> 01:01:02,291 SO THEY'LL TRY TO FIX IT FOR THE 1622 01:01:02,358 --> 01:01:04,560 ZOOM SPEAKER BECAUSE OUR FIRST 1623 01:01:04,627 --> 01:01:08,965 SPEAKER OF THIS PANEL SESSION IS 1624 01:01:09,032 --> 01:01:10,133 GIVING TALK THROUGH ZOOM. 1625 01:01:10,199 --> 01:01:15,471 SO WELCOME AGAIN, AND THIS 1626 01:01:15,538 --> 01:01:16,272 CONVERSATION IS SPECIFICALLY ON 1627 01:01:16,339 --> 01:01:18,608 PAIN BY SEX, GENDER AND SEXUAL 1628 01:01:18,674 --> 01:01:19,475 IDENTITY, WHAT ARE THE 1629 01:01:19,542 --> 01:01:22,345 DIFFERENCES AND WHAT ARE THE 1630 01:01:22,412 --> 01:01:22,879 EXPERIENCES THERE. 1631 01:01:22,945 --> 01:01:25,982 SO AS YOU ALREADY HEARD AND WE 1632 01:01:26,049 --> 01:01:29,052 ALL KNOW FROM THE PUBLISHED 1633 01:01:29,118 --> 01:01:30,620 LITERATURE AND FROM CLINICAL 1634 01:01:30,686 --> 01:01:31,854 PRACTICE, THAT THERE ARE MANY 1635 01:01:31,921 --> 01:01:33,956 ASPECTS IN CHRONIC AND ACUTE 1636 01:01:34,023 --> 01:01:35,458 PAIN THAT ARE REALLY INFLUENCED 1637 01:01:35,525 --> 01:01:39,462 BY SEX, GENDER AND SEXUAL 1638 01:01:39,529 --> 01:01:41,898 IDENTITIES, AND IT'S NOT ONLY IN 1639 01:01:41,964 --> 01:01:44,600 HUMANS BUT ALSO IN OTHER SPECIES 1640 01:01:44,667 --> 01:01:47,937 TOO, AND YO YOU'LL HEAR SOME 1641 01:01:48,004 --> 01:01:49,472 STORIES AND SOME SCIENCE FROM 1642 01:01:49,539 --> 01:01:50,273 THERE. 1643 01:01:50,339 --> 01:01:52,942 WE KNOW IN HUMANS, AS YOU HEARD 1644 01:01:53,009 --> 01:01:55,044 ALREADY, THAT MORE WOMEN 1645 01:01:55,111 --> 01:01:56,345 EXPERIENCE PAIN AND REPORT MORE 1646 01:01:56,412 --> 01:02:00,249 OF CHRONIC PAIN AND HIGH IMPACT 1647 01:02:00,316 --> 01:02:01,651 CHRONIC PAIN THAN IN MEN. 1648 01:02:01,717 --> 01:02:03,619 AND ALSO THERE ARE SEVERAL 1649 01:02:03,686 --> 01:02:08,658 STUDIES WHICH HAVE SAID A LOT OF 1650 01:02:08,724 --> 01:02:10,460 LIGHT ON THE MECHANISMS OF 1651 01:02:10,526 --> 01:02:12,295 UNDERSTANDING -- NOT ONLY 1652 01:02:12,361 --> 01:02:13,196 BIOLOGICAL UNDERSTANDING BUT 1653 01:02:13,262 --> 01:02:14,397 ALSO PSYCHOSOCIAL ASPECTS OF 1654 01:02:14,464 --> 01:02:16,766 THESE UNDERLYING SEX AND GENDER 1655 01:02:16,833 --> 01:02:18,768 DIFFERENCES IN PAIN. 1656 01:02:18,835 --> 01:02:21,704 SORE WITH THAT, WE'LL HAVE FOUR 1657 01:02:21,771 --> 01:02:24,140 SPEAKERS IN THIS PANEL SESSION, 1658 01:02:24,207 --> 01:02:25,441 AND OUR FIRST SPEAKER IS 1659 01:02:25,508 --> 01:02:28,111 ACTUALLY JOINING OVER ZOOM SO 1660 01:02:28,177 --> 01:02:35,084 LET'S HOPE -- I SEE THEM THERE, 1661 01:02:35,151 --> 01:02:36,252 AND PLEASE KEEP ALL YOUR 1662 01:02:36,319 --> 01:02:37,320 QUESTIONS DURING THE END OF THE 1663 01:02:37,386 --> 01:02:38,221 PANEL DISCUSSION SO THAT WE'LL 1664 01:02:38,287 --> 01:02:39,622 HAVE ALL THE SPEAKERS SPEAK 1665 01:02:39,689 --> 01:02:40,857 ABOUT THEIR TALKS AND THEN WE 1666 01:02:40,923 --> 01:02:43,359 CAN GO TO THE PANEL DISCUSSION. 1667 01:02:43,426 --> 01:02:45,661 SO WITH THAT, LET ME INTRODUCE 1668 01:02:45,728 --> 01:02:47,763 OUR FIRST SPEAKER. 1669 01:02:47,830 --> 01:02:51,367 HE'S DR. JEFF MOGIL. 1670 01:02:51,434 --> 01:02:54,003 HE'S CURRENTLY HOLDING A 1671 01:02:54,070 --> 01:02:55,004 PROFESSORSHIP IN PAIN STUDIES 1672 01:02:55,071 --> 01:03:00,776 AND ALSO HE'S A DISTINGUISHED 1673 01:03:00,843 --> 01:03:02,445 MCGILL PROFESSOR IN CANADA. 1674 01:03:02,512 --> 01:03:05,148 DR. MOGIL HAS MADE SO MANY 1675 01:03:05,214 --> 01:03:07,016 SEMINAL CONTRIBUTIONS TO OUR 1676 01:03:07,083 --> 01:03:10,653 UNDERSTANDING IN PAIN, SEX 1677 01:03:10,720 --> 01:03:12,155 DIFFERENCES IN PAIN, AS WELL AS 1678 01:03:12,221 --> 01:03:14,824 PAIN TESTING METHODS IN 1679 01:03:14,891 --> 01:03:17,527 LABORATORY ANIMALS AND MULTIPLE 1680 01:03:17,593 --> 01:03:18,361 SPECIES THERE. 1681 01:03:18,427 --> 01:03:20,429 HE HAS EXTENSIVELY PUBLISHED IN 1682 01:03:20,496 --> 01:03:23,299 THE PAIN FIELD, INCLUDING IN 1683 01:03:23,366 --> 01:03:24,934 THESE SPECIFIC AREAS, SEX AND 1684 01:03:25,001 --> 01:03:27,303 GENDER DIFFERENCES AND PAIN. 1685 01:03:27,370 --> 01:03:31,307 AND HE IS THE RECIPIENT OF 1686 01:03:31,374 --> 01:03:32,241 LIFETIME ACHIEVEMENT AWARDS FROM 1687 01:03:32,308 --> 01:03:33,676 MULTIPLE SOCIETIES LIKE AMERICAN 1688 01:03:33,743 --> 01:03:38,381 PAIN SOCIETY AND CANADIAN PAIN 1689 01:03:38,447 --> 01:03:39,415 SOCIETY, CANADIAN PSYCHOLOGICAL 1690 01:03:39,482 --> 01:03:39,916 ASSOCIATION. 1691 01:03:39,982 --> 01:03:43,419 HE'S ALSO CURRENTLY A FELLOW OF 1692 01:03:43,486 --> 01:03:45,388 THE CANADIAN ACADEMY OF HEALTH 1693 01:03:45,454 --> 01:03:46,656 RESEARCH AND ROYAL SOCIETY OF 1694 01:03:46,722 --> 01:03:47,823 CANADA. 1695 01:03:47,890 --> 01:03:51,027 HE HAS SERVED IN MULTIPLE ROLES, 1696 01:03:51,093 --> 01:03:52,161 INCLUDING EDITORIAL ROLES IN THE 1697 01:03:52,228 --> 01:03:54,197 JOURNAL OF PAIN, AS A 1698 01:03:54,263 --> 01:03:55,932 COUNCILMEMBER TO INTERNATIONAL 1699 01:03:55,998 --> 01:03:59,135 ASSOCIATION FOR STUDY OF PAIN AS 1700 01:03:59,202 --> 01:04:00,870 A MEMBER THROUGH PROGRAM 1701 01:04:00,937 --> 01:04:03,406 COMMITTEES AND CHAIRING 1702 01:04:03,472 --> 01:04:04,607 COMMITTEES IN -- OF PAIN. 1703 01:04:04,674 --> 01:04:11,380 HE'S ALSO THE FOU FOUNDER/DIRECR 1704 01:04:11,447 --> 01:04:13,616 OF THE NORTH AMERICAN PAIN 1705 01:04:13,683 --> 01:04:15,151 SCHOOL, ONE OF OUR SPEAKERS ONE 1706 01:04:15,218 --> 01:04:16,152 OF THE PAIN SCHOOL GRADUATES 1707 01:04:16,219 --> 01:04:16,786 FROM THERE. 1708 01:04:16,852 --> 01:04:20,189 SO WITH THAT, I'LL ASK DR. MOGIL 1709 01:04:20,256 --> 01:04:24,026 TO TAKE OVER AND HIS TALK WILL 1710 01:04:24,093 --> 01:04:26,295 GO OVER ALMOST ALL ASPECTS OF 1711 01:04:26,362 --> 01:04:30,266 PAIN, SEX, GENDER, SO REALLY 1712 01:04:30,333 --> 01:04:31,500 INTERESTED TO LEARN ABOUT THAT. 1713 01:04:31,567 --> 01:04:35,171 SO JEFF, PLEASE TAKE OVER. 1714 01:04:35,238 --> 01:04:37,974 >> THANKS A LOT, DP. 1715 01:04:38,040 --> 01:04:39,075 ARE THINGS WORKING? 1716 01:04:39,141 --> 01:04:49,418 CAN PEOPLE SEE? 1717 01:04:50,486 --> 01:04:51,921 >> WE CAN SEE THE SLIDES HERE 1718 01:04:51,988 --> 01:04:58,961 BUT NOT THERE. 1719 01:04:59,028 --> 01:05:01,097 >> I THOUGHT NOT BEING IN 1720 01:05:01,163 --> 01:05:02,465 BETHESDA MIGHT ACTUALLY BE AN 1721 01:05:02,531 --> 01:05:13,042 ADVANTAGE TODAY BUT MAYBE NOT. 1722 01:05:16,912 --> 01:05:19,282 >> JEFF, IF YOU CAN HEAR US, WE 1723 01:05:19,348 --> 01:05:20,616 HAVE A LITTLE BIT OF TECHNICAL 1724 01:05:20,683 --> 01:05:21,784 TROUBLE GOING ON SO THEY'RE 1725 01:05:21,851 --> 01:05:22,551 TRYING TO FIX THE SLIDES. 1726 01:05:22,618 --> 01:05:23,719 >> I'LL WAIT FOR IT. 1727 01:05:23,786 --> 01:05:24,887 CAN YOU HEAR ME? 1728 01:05:24,954 --> 01:05:26,455 >> YES, WE CAN HEAR YOU. 1729 01:05:26,522 --> 01:05:30,626 >> OKAY. 1730 01:05:30,693 --> 01:05:32,228 >> YOU CAN START WITH THE STORY 1731 01:05:32,295 --> 01:05:33,362 BY THE TIME THEY ARE FIGURING 1732 01:05:33,429 --> 01:05:33,529 OUT. 1733 01:05:33,596 --> 01:05:36,632 >> NO, I'M GOING TO NEED SLIDES. 1734 01:05:36,699 --> 01:05:37,400 SORRY, WE'RE GOING TO HAVE TO 1735 01:05:37,466 --> 01:05:47,576 WAIT. 1736 01:06:59,682 --> 01:07:01,317 >> JEFF, WE CAN SEE THE SLIDES. 1737 01:07:01,384 --> 01:07:02,017 YOU'RE GOOD TO GO. 1738 01:07:02,084 --> 01:07:03,419 >> OKAY, GREAT. 1739 01:07:03,486 --> 01:07:06,355 THANKS, DP, AND IT'S NICE TO BE 1740 01:07:06,422 --> 01:07:07,456 HERE, SORRY I COULDN'T BE THERE 1741 01:07:07,523 --> 01:07:08,924 IN PERSON. 1742 01:07:08,991 --> 01:07:10,826 SO I'M GOING TO GO QUICKLY 1743 01:07:10,893 --> 01:07:11,727 THROUGH THIS FIRST PART BECAUSE 1744 01:07:11,794 --> 01:07:13,129 IT'S COME UP, BUT I THINK IT'S 1745 01:07:13,195 --> 01:07:14,330 IMPORTANT THAT WE ALL TAKE A 1746 01:07:14,397 --> 01:07:15,564 LOOK AT THE NUMBERS. 1747 01:07:15,631 --> 01:07:16,565 WHENEVER THIS TOPIC COMES UP, 1748 01:07:16,632 --> 01:07:18,300 THIS IS THE FIRST QUESTION 1749 01:07:18,367 --> 01:07:19,802 PEOPLE ASK, WHO'S MORE SENSITIVE 1750 01:07:19,869 --> 01:07:20,503 TO PAIN. 1751 01:07:20,569 --> 01:07:21,570 IT'S A VERY INTERESTING 1752 01:07:21,637 --> 01:07:22,571 SCIENTIFIC QUESTION IN THAT 1753 01:07:22,638 --> 01:07:23,973 EVERYONE HAS AN OPINION, YOU GO 1754 01:07:24,039 --> 01:07:25,307 AND ASK PEOPLE ON THE STREET 1755 01:07:25,374 --> 01:07:26,542 THIS QUESTION, THEY'LL GIVE YOU 1756 01:07:26,609 --> 01:07:27,843 AN ANSWER. 1757 01:07:27,910 --> 01:07:30,246 USUALLY THEIR ANSWER USES THE 1758 01:07:30,312 --> 01:07:32,748 LOGIC OF THIS OLD JOKE. 1759 01:07:32,815 --> 01:07:34,683 BUT THE FIRST PERSON TO ACTUALLY 1760 01:07:34,750 --> 01:07:36,819 THINK ABOUT THIS IN A SYSTEMATIC 1761 01:07:36,886 --> 01:07:39,088 WAY WAS KAREN BERKELEY, WHO 1762 01:07:39,155 --> 01:07:41,657 WROTE THIS LOVELY REVIEW PAPER 1763 01:07:41,724 --> 01:07:43,092 IN 1997 FEATURING THIS TABLE, 1764 01:07:43,159 --> 01:07:44,794 WHERE SHE TOOK ALL OF THE 1765 01:07:44,860 --> 01:07:46,762 CHRONIC PAIN SYNDROMES KNOWN AT 1766 01:07:46,829 --> 01:07:49,532 THE TIME AND SHE DIVIDED THEM 1767 01:07:49,598 --> 01:07:50,800 INTO THREE CATEGORIES, THOSE 1768 01:07:50,866 --> 01:07:52,935 KNOWN TO HAVE FEMALE PREVALENCE, 1769 01:07:53,002 --> 01:07:54,036 THOSE THAT WERE KNOWN TO HAVE 1770 01:07:54,103 --> 01:07:55,137 MALE PREFER LANCE, THOSE THAT 1771 01:07:55,204 --> 01:07:56,572 DIDN'T APPEAR TO HAVE A SEX 1772 01:07:56,639 --> 01:07:56,872 PREVALENCE. 1773 01:07:56,939 --> 01:07:57,873 YOU CAN SEE OF COURSE THAT THE 1774 01:07:57,940 --> 01:07:58,974 FEMALE LIST IS LONGER THAN THE 1775 01:07:59,041 --> 01:07:59,508 MALE LIST. 1776 01:07:59,575 --> 01:08:01,410 IT IS ALSO THE CASE THAT THE 1777 01:08:01,477 --> 01:08:02,745 DISORDERS ON THE FEMALE LIST ARE 1778 01:08:02,812 --> 01:08:05,147 MORE PREVALENT OVERALL, AND SO 1779 01:08:05,214 --> 01:08:06,882 YOU COULD GUESS, THEN, THAT THE 1780 01:08:06,949 --> 01:08:08,417 MAJORITY OF CHRONIC PAIN 1781 01:08:08,484 --> 01:08:09,552 PATIENTS ARE GOING TO BE WOMEN 1782 01:08:09,618 --> 01:08:12,922 AND INDEED, IF YOU ASK PEOPLE 1783 01:08:12,988 --> 01:08:14,290 RUNNING TERTIARY PAIN PRACTICES 1784 01:08:14,356 --> 01:08:15,357 HOW MANY OF YOUR PATIENTS ARE 1785 01:08:15,424 --> 01:08:17,626 WOMEN, YOU GET ESTIMATES THAT 1786 01:08:17,693 --> 01:08:18,928 ABOUT 70% OF THEM ARE. 1787 01:08:18,994 --> 01:08:21,163 NOW THAT MIGHT BE BECAUSE WOMEN 1788 01:08:21,230 --> 01:08:22,598 ARE MORE SENSITIVE TO PAIN, BUT 1789 01:08:22,665 --> 01:08:24,033 THERE ARE A LOT OF OTHER REASONS 1790 01:08:24,099 --> 01:08:27,369 THAT COULD BE, INCLUDING THE 1791 01:08:27,436 --> 01:08:28,137 WELL-KNOWN GENDER DIFFERENCE 1792 01:08:28,204 --> 01:08:29,705 THAT WOMEN ARE MORE LIKELY TO GO 1793 01:08:29,772 --> 01:08:32,141 TO THE DOCTOR OR, MORE 1794 01:08:32,208 --> 01:08:33,509 ACCURATELY, THAT MEN ARE LESS 1795 01:08:33,576 --> 01:08:34,977 LIKELY TO GO TO THE DOCTOR. 1796 01:08:35,044 --> 01:08:36,612 IF YOU DON'T GO TO THE DOCTOR, 1797 01:08:36,679 --> 01:08:37,813 YOU CAN'T BECOME A PATIENT. 1798 01:08:37,880 --> 01:08:39,281 SO MAYBE THE BETTER WAY TO ASK 1799 01:08:39,348 --> 01:08:42,017 THE QUESTION IS TO DO A LARGE 1800 01:08:42,084 --> 01:08:43,252 EPIDEMIOLOGICAL SURVEY AND ASK 1801 01:08:43,319 --> 01:08:44,753 PEOPLE IF THEY ENDORSE HAVING 1802 01:08:44,820 --> 01:08:47,957 THE SYMPTOMS OF CHRONIC PAIN. 1803 01:08:48,023 --> 01:08:50,426 THIS HAS BEEN DONE A NUMBER OF 1804 01:08:50,493 --> 01:08:51,994 TIMES, OF COURSE ALL THE STUDIES 1805 01:08:52,061 --> 01:08:53,963 HAD COMPLETELY DIFFERENT 1806 01:08:54,029 --> 01:08:55,598 DEFINITIONS OF WHAT PAIN WAS BUT 1807 01:08:55,664 --> 01:08:57,366 TO FACILITATE COMPARING APPLES 1808 01:08:57,433 --> 01:08:59,902 TO ORANGE, I'VE SIMPLY 1809 01:08:59,969 --> 01:09:04,340 SUBTRACTED THE MALE PREVALENCE 1810 01:09:04,406 --> 01:09:05,341 FROM THE FEMALE PREVALENCE IN 1811 01:09:05,407 --> 01:09:05,875 THAT STUDY. 1812 01:09:05,941 --> 01:09:07,443 YOU CAN SEE ACROSS THE BOARD 1813 01:09:07,510 --> 01:09:08,444 WITH ONE EXCEPTION, WOMEN ARE 1814 01:09:08,511 --> 01:09:09,411 MORE LIKELY TO ENDORSE HAVING 1815 01:09:09,478 --> 01:09:10,379 THE SYMPTOMS OF CHRONIC PAIN. 1816 01:09:10,446 --> 01:09:11,780 NOW AGAIN, THAT MIGHT BE BECAUSE 1817 01:09:11,847 --> 01:09:13,782 THEY'RE MORE SENSITIVE TO 1818 01:09:13,849 --> 01:09:14,917 CHRONIC PAIN OR MORE SENSITIVE 1819 01:09:14,984 --> 01:09:16,418 TO PAIN IN GENERAL, BUT AGAIN 1820 01:09:16,485 --> 01:09:17,486 THERE'S ANOTHER POSSIBILITY, 1821 01:09:17,553 --> 01:09:19,555 WHICH IS THAT WOMEN MIGHT JUST 1822 01:09:19,622 --> 01:09:21,790 BE MORE SUSCEPTIBLE TO 1823 01:09:21,857 --> 01:09:23,759 DEVELOPING DISORDERS THAT HAVE 1824 01:09:23,826 --> 01:09:24,827 PAIN AS A SYMPTOM. 1825 01:09:24,894 --> 01:09:26,061 SO REALLY THE ONLY WAY TO 1826 01:09:26,128 --> 01:09:26,929 ACTUALLY ANSWER THE QUESTION IS 1827 01:09:26,996 --> 01:09:28,697 TO TAKE MEN AND WOMEN INTO THE 1828 01:09:28,764 --> 01:09:30,332 LABORATORY AND GIVE THEM 1829 01:09:30,399 --> 01:09:31,867 CONTROLLED STIMULI AND SEE WHO'S 1830 01:09:31,934 --> 01:09:32,835 MORE SENSITIVE TO PAIN. 1831 01:09:32,902 --> 01:09:34,236 AND THIS HAS BEEN DONE HUNDREDS 1832 01:09:34,303 --> 01:09:35,471 AND HUNDREDS OF TIMES. 1833 01:09:35,538 --> 01:09:36,572 I'M GOING TO SHOW YOU THE RESULT 1834 01:09:36,639 --> 01:09:37,907 IN A SECOND, ALTHOUGH YOU'VE 1835 01:09:37,973 --> 01:09:39,675 SEEN IT ALREADY THIS MORNING, 1836 01:09:39,742 --> 01:09:43,412 AND THE RESULT HERE IS SO 1837 01:09:43,479 --> 01:09:44,380 OVERWHELMINGLY LOPSIDED THAT 1838 01:09:44,446 --> 01:09:45,614 IT'S AMAZING TO ME THAT THERE'S 1839 01:09:45,681 --> 01:09:46,715 STILL A QUESTION FLOATING IN THE 1840 01:09:46,782 --> 01:09:47,750 WORLD. 1841 01:09:47,816 --> 01:09:51,687 THE REASON WHY THIS QUESTION IN 1842 01:09:51,754 --> 01:09:52,888 SOME PEOPLE'S MINDS IS 1843 01:09:52,955 --> 01:09:54,223 UNANSWERED IS THAT IN SOME OF 1844 01:09:54,290 --> 01:09:58,594 THESE STUDIES, THERE'S A 1845 01:09:58,661 --> 01:09:59,128 STATISTICALLY SIGNIFICANT 1846 01:09:59,194 --> 01:09:59,895 DIFFERENCE BETWEEN WOMEN AND 1847 01:09:59,962 --> 01:10:01,463 MEN, AND IN OTHER STUDIES, THERE 1848 01:10:01,530 --> 01:10:01,664 ISN'T. 1849 01:10:01,730 --> 01:10:03,632 BUT THAT, OF COURSE, IS SIMPLY 1850 01:10:03,699 --> 01:10:05,067 BECAUSE SOME STUDIES ARE 1851 01:10:05,134 --> 01:10:05,601 UNDERPOWERED. 1852 01:10:05,668 --> 01:10:07,336 IF YOU FORGET ABOUT THE ISSUE OF 1853 01:10:07,403 --> 01:10:08,437 STATISTICAL SIGNIFICANCE AND YOU 1854 01:10:08,504 --> 01:10:09,738 SIMPLY ASKED WHO WAS MORE 1855 01:10:09,805 --> 01:10:10,973 SENSITIVE TO PAIN IN THAT STUDY, 1856 01:10:11,040 --> 01:10:12,508 YOU CAN SEE THAT IT DOESN'T 1857 01:10:12,575 --> 01:10:14,043 MATTER HOW YOU MEASURE PAIN AND 1858 01:10:14,109 --> 01:10:15,678 IT DOESN'T MATTER WHAT KIND OF 1859 01:10:15,744 --> 01:10:18,547 PAIN YOU MEASURE, WOMEN ARE, IN 1860 01:10:18,614 --> 01:10:19,748 FACT, MORE SENSITIVE TO PAIN 1861 01:10:19,815 --> 01:10:20,316 THAN MEN. 1862 01:10:20,382 --> 01:10:21,617 NOW WE COULD QUIBBLE ABOUT HOW 1863 01:10:21,684 --> 01:10:23,252 MUCH AND HOW MUCH IT MATTERS, 1864 01:10:23,319 --> 01:10:24,787 BUT THIS QUESTION IN MY MIND IS 1865 01:10:24,853 --> 01:10:26,121 CLEARLY ANSWERED. 1866 01:10:26,188 --> 01:10:28,090 IT'S NOT, HOWEVER, THE IMPORTANT 1867 01:10:28,157 --> 01:10:28,357 QUESTION. 1868 01:10:28,424 --> 01:10:31,260 THE BIGGER PICTURE, THE BIGGER 1869 01:10:31,327 --> 01:10:33,529 PROBLEM, IS THIS DISCONNECT 1870 01:10:33,596 --> 01:10:35,164 BETWEEN THE CLINICAL PROBLEM ON 1871 01:10:35,230 --> 01:10:37,199 THE LEFT AND HOW WE MODEL THAT 1872 01:10:37,266 --> 01:10:39,702 PROBLEM ON THE RIGHT. 1873 01:10:39,768 --> 01:10:41,036 AND THE PROBLEM, OF COURSE, 1874 01:10:41,103 --> 01:10:42,271 ISN'T THAT IT'S A RAT. 1875 01:10:42,338 --> 01:10:45,007 IT'S THAT IT'S A YOUNG MALE RAT 1876 01:10:45,074 --> 01:10:45,975 OVERWHELMINGLY STANDING IN FOR 1877 01:10:46,041 --> 01:10:46,742 THAT WOMAN. 1878 01:10:46,809 --> 01:10:49,144 AND THAT MAY OR MAY NOT BE AN 1879 01:10:49,211 --> 01:10:51,313 APPROPRIATE WAY TO MODEL WOMEN 1880 01:10:51,380 --> 01:10:53,115 IN PAIN, AND I'M GOING TO TRY TO 1881 01:10:53,182 --> 01:10:57,119 CONVINCE YOU THAT IT NOT, BUT OF 1882 01:10:57,186 --> 01:10:58,020 COURSE PEOPLE HAVE FIGURED THIS 1883 01:10:58,087 --> 01:10:59,154 OUT BY NOW, RIGHT? 1884 01:10:59,221 --> 01:11:02,791 SO FUNDING AGENCIES AROUND THE 1885 01:11:02,858 --> 01:11:04,693 WORLD, AND AT NIH, THE POLICY 1886 01:11:04,760 --> 01:11:06,128 WAS ANNOUNCED IN 2014, IT WENT 1887 01:11:06,195 --> 01:11:07,997 INTO EFFECT IN 2016. 1888 01:11:08,063 --> 01:11:09,565 I WILL REMIND YOU THAT CANADA 1889 01:11:09,632 --> 01:11:13,936 BEAT YOU ON THIS BY 10 YEARS. 1890 01:11:14,003 --> 01:11:16,005 BUT THE QUESTION IS WHETHER THIS 1891 01:11:16,071 --> 01:11:18,340 POLICY, WHICH IS ONE OF A SERIES 1892 01:11:18,407 --> 01:11:21,677 OF POLICIES KNOWN AS SEX AS A 1893 01:11:21,744 --> 01:11:23,112 BIOLOGICAL VARIABLE POLICIES OR 1894 01:11:23,178 --> 01:11:24,113 SABV, ARE ACTUALLY WORKING. 1895 01:11:24,179 --> 01:11:25,447 SO I WENT INTO THE LITERATURE 1896 01:11:25,514 --> 01:11:27,983 AND I LOOKED AT PAPERS PUBLISHED 1897 01:11:28,050 --> 01:11:29,051 IN THE FLAGSHIP JOURNAL IN THE 1898 01:11:29,118 --> 01:11:33,088 FIELD CALLED PAIN FROM 2015 TO 1899 01:11:33,155 --> 01:11:33,288 2019. 1900 01:11:33,355 --> 01:11:34,590 OVER ON THE LEFT, YOU CAN SEE 1901 01:11:34,657 --> 01:11:35,624 FIRST OF ALL THAT THERE WAS A 1902 01:11:35,691 --> 01:11:37,026 BIG SPIKE IN THE NUMBER OF 1903 01:11:37,092 --> 01:11:38,494 STUDIES THAT WERE SPECIFICALLY 1904 01:11:38,560 --> 01:11:40,562 ABOUT SEX DIFFERENCES. 1905 01:11:40,629 --> 01:11:40,863 BY 2019. 1906 01:11:40,929 --> 01:11:42,398 BUT MORE IMPORTANTLY, ON THE 1907 01:11:42,464 --> 01:11:45,701 RIGHT, YOU CAN SEE THAT STARTING 1908 01:11:45,768 --> 01:11:48,037 IN 2015, WHICH WAS NO DIFFERENT 1909 01:11:48,103 --> 01:11:50,072 FROM TWO DECADES BEFORE THAT, 1910 01:11:50,139 --> 01:11:52,041 THE NUMBER OF STUDIES USING MALE 1911 01:11:52,107 --> 01:11:54,476 MICE OR MALE RATS ONLY HAS 1912 01:11:54,543 --> 01:11:57,513 DECREASED FROM ABOUT 80% IN 2015 1913 01:11:57,579 --> 01:11:59,715 TO ONLY 50% IN 2019. 1914 01:11:59,782 --> 01:12:02,084 NOW THERE'S STILL A WAYS TO GO 1915 01:12:02,151 --> 01:12:03,686 THERE, BUT THIS IS A DEFINITE 1916 01:12:03,752 --> 01:12:04,987 IMPROVEMENT AND IT SUGGESTS THAT 1917 01:12:05,054 --> 01:12:06,321 THE POLICIES ARE EFFECTIVE. 1918 01:12:06,388 --> 01:12:09,692 NOW THAT'S THE GOOD NEWS. 1919 01:12:09,758 --> 01:12:11,226 THE BAD NEWS IS WHEN I SHOW YOU 1920 01:12:11,293 --> 01:12:13,962 THE DATA FROM STUDIES WITH HUMAN 1921 01:12:14,029 --> 01:12:15,197 SUBJECTS IN THE SAME JOURNAL 1922 01:12:15,264 --> 01:12:18,033 OVER THE SAME TIME PERIOD, AND 1923 01:12:18,100 --> 01:12:19,435 ALTHOUGH VIRTUALLY ALL STUDIES 1924 01:12:19,501 --> 01:12:22,971 IN HUMANS USE BOTH MALES AND 1925 01:12:23,038 --> 01:12:24,940 FEMALES, THERE IS NO DIFFERENCE 1926 01:12:25,007 --> 01:12:26,575 OVER TIME IN THE PROPORTION OF 1927 01:12:26,642 --> 01:12:29,044 STUDIES THAT ARE COLORED IN 1928 01:12:29,111 --> 01:12:30,245 GREEN THERE, WHICH MEANS THAT 1929 01:12:30,312 --> 01:12:32,648 THEY ACTUALLY MENTION TO THE 1930 01:12:32,715 --> 01:12:35,217 READER AT ANY POINT LATER IN THE 1931 01:12:35,284 --> 01:12:36,218 STUDY WHETHER THERE WAS OR 1932 01:12:36,285 --> 01:12:37,152 WASN'T A DIFFERENCE BETWEEN THE 1933 01:12:37,219 --> 01:12:38,253 MALES AND FEMALES. 1934 01:12:38,320 --> 01:12:40,956 THAT IS TO SAY IN HUMAN STUDIES, 1935 01:12:41,023 --> 01:12:43,892 MALES AND FEMALES ARE BOTH USED, 1936 01:12:43,959 --> 01:12:46,762 BUT THE DATA 50% OF THE TIME IS 1937 01:12:46,829 --> 01:12:49,031 NOT DISAGGREGATED SO WE HAVE NO 1938 01:12:49,098 --> 01:12:49,832 IDEA WHETHER THERE WAS OR WASN'T 1939 01:12:49,898 --> 01:12:51,166 A SEX DIFFERENCE. 1940 01:12:51,233 --> 01:12:54,203 BECAUSE OF THESE POLICIES, 1941 01:12:54,269 --> 01:12:55,738 PANDORA'S BOX HAS BEEN OPENED. 1942 01:12:55,804 --> 01:12:57,506 AND FOR REASONS THAT ARE UNCLEAR 1943 01:12:57,573 --> 01:13:01,343 TO ME AT THIS POINT, THE BIOLOGY 1944 01:13:01,410 --> 01:13:04,980 OF PAIN IS ROBUSTLY SEXUALLY 1945 01:13:05,047 --> 01:13:07,015 DIMORPHIC. 1946 01:13:07,082 --> 01:13:09,184 THIS IS A REVIEW PAPER THAT WILL 1947 01:13:09,251 --> 01:13:12,354 BE COMING OUT IN A FEW MONTHS. 1948 01:13:12,421 --> 01:13:13,522 AND I WENT VERY CAREFULLY 1949 01:13:13,589 --> 01:13:16,125 THROUGH THE LITERATURE AND FOUND 1950 01:13:16,191 --> 01:13:18,127 EVERY GENE OR PROTEIN THAT 1951 01:13:18,193 --> 01:13:20,329 ANYONE HAS CLAIMED AND PROVIDED 1952 01:13:20,395 --> 01:13:21,730 CAUSAL EVIDENCE IS INVOLVED IN 1953 01:13:21,797 --> 01:13:24,066 PAIN BIOLOGY IN EITHER MALES BUT 1954 01:13:24,133 --> 01:13:26,368 NOT FEMALES ON THE LEFT OR 1955 01:13:26,435 --> 01:13:27,803 FEMALES BUT NOT MALES ON THE 1956 01:13:27,870 --> 01:13:29,004 RIGHT, BUT YOU CAN SEE THERE'S A 1957 01:13:29,071 --> 01:13:29,872 BUNCH. 1958 01:13:29,938 --> 01:13:30,739 THERE'S 50 PROTEINS IN MALES 1959 01:13:30,806 --> 01:13:32,841 THAT ARE SEX-SPECIFIC, AND ABOUT 1960 01:13:32,908 --> 01:13:35,043 35 IN FEMALES THAT A 1961 01:13:35,110 --> 01:13:40,883 SEX-SPECIFIC, AND THIS NUMBER IS 1962 01:13:40,949 --> 01:13:41,784 GROWING EVERY COUPLE OF WEEKS. 1963 01:13:41,850 --> 01:13:45,587 IT REALLY IS AMAZING HOW FAST 1964 01:13:45,654 --> 01:13:46,488 THIS FIELD IS MOVING. 1965 01:13:46,555 --> 01:13:47,689 I WANT TO TELL YOU A COUPLE 1966 01:13:47,756 --> 01:13:48,891 STORIES THAT HAVE COME OUT OF MY 1967 01:13:48,957 --> 01:13:50,659 LAB AND THIS ONE WILL EXPLAIN 1968 01:13:50,726 --> 01:13:52,261 THE ODD TITLE OF MY TALK. 1969 01:13:52,327 --> 01:13:55,631 SO THIS IS JOHN LIEBESKIND, HE 1970 01:13:55,697 --> 01:13:57,900 WAS MY GRADUATE ADVISOR, AND HE 1971 01:13:57,966 --> 01:14:00,068 WROTE THIS ARTICLE OR EDITORIAL 1972 01:14:00,135 --> 01:14:03,105 REALLY IN THE JOURNAL PAIN IN 1973 01:14:03,172 --> 01:14:05,107 1991 CALLED PAIN CAN KILL IN 1974 01:14:05,174 --> 01:14:09,144 WHICH HE ARGUES PEOPLE DON'T 1975 01:14:09,211 --> 01:14:10,712 TAKE PAIN SERIOUSLY BECAUSE IT 1976 01:14:10,779 --> 01:14:12,481 CAN DILL KIL YOU, BULL THAT IT 1977 01:14:12,548 --> 01:14:14,883 DOES IT INDIRECTLY. 1978 01:14:14,950 --> 01:14:17,085 THIS PAPER HAS ABOUT 20 CYTES, 1979 01:14:17,152 --> 01:14:19,154 IT'S BEEN COMPLETELY IGNORED 1980 01:14:19,221 --> 01:14:21,356 BECAUSE JOHN WAS WAY AHEAD OF 1981 01:14:21,423 --> 01:14:23,992 ITS TIME BUT IT'S CAUGHT UP TO 1982 01:14:24,059 --> 01:14:26,395 JOHN, AND THE LATEST META 1983 01:14:26,461 --> 01:14:28,730 ESTIMATE OF THE MORTALITY RISK 1984 01:14:28,797 --> 01:14:31,099 OF LIVING WITH CHRONIC 1985 01:14:31,166 --> 01:14:32,568 WIDESPREAD PAIN AS YOU CAN SEE 1986 01:14:32,634 --> 01:14:34,203 HERE IS 1.57. 1987 01:14:34,269 --> 01:14:38,040 NOW, LIKE YOU, I HAD NO IDEA 1988 01:14:38,106 --> 01:14:39,808 WHAT THAT MEANS, SO I EMAILED 1989 01:14:39,875 --> 01:14:41,343 GARY MCFARLAND AND I SAID CAN 1990 01:14:41,410 --> 01:14:42,444 YOU REPHRASE THAT IN TERMS THAT 1991 01:14:42,511 --> 01:14:43,779 NORMAL PEOPLE CAN UNDERSTAND? 1992 01:14:43,846 --> 01:14:46,648 AND HE CAME BACK A DAY LATER AND 1993 01:14:46,715 --> 01:14:49,918 SAID, THE MORTALITY RISK RATIO 1994 01:14:49,985 --> 01:14:51,854 OF 1.57 IS EQUIVALENT TO SAYING 1995 01:14:51,920 --> 01:14:53,255 THAT CHRONIC PAIN PATIENTS HAVE 1996 01:14:53,322 --> 01:14:55,190 AN EFFECTIVE AGE OF SIX YEARS 1997 01:14:55,257 --> 01:14:56,758 HIGHER THAN THEIR CHRONOLOGICAL 1998 01:14:56,825 --> 01:14:58,393 AGE AND THAT MUCH CLOSER TO 1999 01:14:58,460 --> 01:14:58,727 DEATH. 2000 01:14:58,794 --> 01:15:00,696 NOW TO ME, THAT'S SOMETHING THAT 2001 01:15:00,762 --> 01:15:02,798 IS REALLY WORTH EXPLAINING. 2002 01:15:02,865 --> 01:15:05,434 AND TO MAKE A LONG STORY SHORT, 2003 01:15:05,500 --> 01:15:09,137 WE'VE TRIED VERY HARD TO START 2004 01:15:09,204 --> 01:15:10,439 TRYING TO EXPLAIN THAT. I WANT 2005 01:15:10,505 --> 01:15:11,874 TO TELL YOU ONE VERY INTERESTING 2006 01:15:11,940 --> 01:15:12,641 STUDY THAT WAS PUBLISHED A 2007 01:15:12,708 --> 01:15:16,044 COUPLE YEARS AGO WHERE WI WE DID 2008 01:15:16,111 --> 01:15:17,379 SOMETHING AMAZINGLY WHICH HAD 2009 01:15:17,446 --> 01:15:19,882 NEVER BEEN DONE BEFORE, WHICH IS 2010 01:15:19,948 --> 01:15:26,021 LOOK TETRAJEK TRI OF CHRONIC 2011 01:15:26,088 --> 01:15:29,191 LOOK AT THE TRAJECTORY -- SHE 2012 01:15:29,258 --> 01:15:32,928 WAS A STUDENT OF LAURA STONE'S, 2013 01:15:32,995 --> 01:15:34,897 RESEARCH ASSOCIATE, CAME INTO MY 2014 01:15:34,963 --> 01:15:36,965 LAB EVERY DAY FOR 3 1/2 MONTHS, 2015 01:15:37,032 --> 01:15:38,567 TESTED SOME MICE AND THEN I 2016 01:15:38,634 --> 01:15:39,902 DIDN'T SEE HER AGAIN FOR 3 1/2 2017 01:15:39,968 --> 01:15:40,636 MONTH. 2018 01:15:40,702 --> 01:15:42,404 WE USED SOMETHING CALLED THE 2019 01:15:42,471 --> 01:15:45,407 SPARED NERVE INJURY WHICH 2020 01:15:45,474 --> 01:15:46,475 PRODUCES MECHANICAL ALLODYNIA. 2021 01:15:46,541 --> 01:15:47,876 THAT APPARENTLY LASTS FOREVER, 2022 01:15:47,943 --> 01:15:49,611 AND INDEED, IN MALE MICE, IT 2023 01:15:49,678 --> 01:15:50,779 REALLY DOES LAST FOREVER. 2024 01:15:50,846 --> 01:15:52,948 SO YOU CAN SEE IN THE DARK BLUE 2025 01:15:53,015 --> 01:15:55,350 THERE THAT THERE'S A LITTLE DROP 2026 01:15:55,417 --> 01:15:57,819 FROM THE 3 TO 6-MONTH TIME POINT 2027 01:15:57,886 --> 01:15:59,721 BUT AFTER THAT, WITHIN THE 2028 01:15:59,788 --> 01:16:01,356 LIMITS OF THE ERROR BARS, IT'S 2029 01:16:01,423 --> 01:16:03,258 MORE OR LESS SOLID UNTIL THE DAY 2030 01:16:03,325 --> 01:16:04,059 THE MOUSE DIES. 2031 01:16:04,126 --> 01:16:06,094 IN FEMALES, ON THE OTHER HAND, 2032 01:16:06,161 --> 01:16:06,762 SOMETHING MUCH DIFFERENT 2033 01:16:06,828 --> 01:16:10,565 HAPPENS. 2034 01:16:10,632 --> 01:16:12,034 WHICH IS THAT THEY HAVE 2035 01:16:12,100 --> 01:16:13,902 MECHANICAL ALLODYNIA BUT BY 2036 01:16:13,969 --> 01:16:16,939 6 AND 9 MONTHS IT COMPLETELY 2037 01:16:17,005 --> 01:16:17,506 RESOLVED. 2038 01:16:17,572 --> 01:16:19,041 WE'VE ACTUALLY SEEN THAT THREE 2039 01:16:19,107 --> 01:16:20,475 OR FOUR TIMES BEFORE BUT WHAT WE 2040 01:16:20,542 --> 01:16:22,010 DIDN'T SEE BECAUSE WE NEVER 2041 01:16:22,077 --> 01:16:23,111 LOOKED LONG ENOUGH IS THAT IT 2042 01:16:23,178 --> 01:16:25,314 ACTUALLY COMES BACK, AND THAT BY 2043 01:16:25,380 --> 01:16:28,850 12, 15, 18 MONTHS, WE'RE RIGHT 2044 01:16:28,917 --> 01:16:30,052 BACK WHERE THE MALES WERE. 2045 01:16:30,118 --> 01:16:33,188 THIS IS SOMETHING THAT DOES 2046 01:16:33,255 --> 01:16:34,523 REALLY NEED TO BE EXPLAINED. 2047 01:16:34,589 --> 01:16:36,658 I HAVE SOME HYPOTHESES HERE THAT 2048 01:16:36,725 --> 01:16:38,460 SOMEONE MAY WANT TO ASK ME 2049 01:16:38,527 --> 01:16:38,927 LATER. 2050 01:16:38,994 --> 01:16:41,964 BUT THE REAL REASON WASN'T TO 2051 01:16:42,030 --> 01:16:43,332 LOOK TETRAJEK TRI OF PAIN 2052 01:16:43,398 --> 01:16:44,733 BEHAVIOR, BUT RATHER TO SEE IF 2053 01:16:44,800 --> 01:16:47,035 PAIN HAD ANY EFFECT, ANY IMPACT 2054 01:16:47,102 --> 01:16:49,071 ON HOW LONG THE MICE LIVED. 2055 01:16:49,137 --> 01:16:50,405 AND AS YOU CAN IMAGINE, THIS 2056 01:16:50,472 --> 01:16:52,140 STUDY COST ME A LOT OF MONEY IN 2057 01:16:52,207 --> 01:16:53,809 PER DIEMS AND A LOT OF TIME, 2058 01:16:53,875 --> 01:16:56,678 THREE YEARS-PLUS, AND THUS I WAS 2059 01:16:56,745 --> 01:16:58,947 UNHAPPY WHEN I MADE THIS GRAPH 2060 01:16:59,014 --> 01:17:02,985 ONE DAY, WHICH SHOWS THAT THE 2061 01:17:03,051 --> 01:17:06,455 SPARED NERVE INJURY OR SNI HAS 2062 01:17:06,521 --> 01:17:08,757 ABSOLUTELY NO EFFECT ON LIFESPAN 2063 01:17:08,824 --> 01:17:11,760 IN EITHER MALE OR FEMALE MICE. 2064 01:17:11,827 --> 01:17:12,828 BUT AFTER SPENDING THIS MUCH 2065 01:17:12,894 --> 01:17:14,463 TIME AND MONEY I WASN'T WILLING 2066 01:17:14,529 --> 01:17:16,131 TO LET THINGS LIE SO I STARTED 2067 01:17:16,198 --> 01:17:17,232 PLAYING AROUND WITH THE DATA A 2068 01:17:17,299 --> 01:17:17,866 LITTLE BIT. 2069 01:17:17,933 --> 01:17:20,102 I ENDED UP DOING THE FOLLOWING 2070 01:17:20,168 --> 01:17:20,302 THING. 2071 01:17:20,369 --> 01:17:22,104 SINCE WE HAD DATA OF HOW MUCH 2072 01:17:22,170 --> 01:17:23,839 PAIN OR AT LEAST HOW MUCH 2073 01:17:23,905 --> 01:17:26,274 MECHANICAL ALLODYNIA MICE HAD 2074 01:17:26,341 --> 01:17:27,609 EVERY THREE MONTHS, I DECIDED 2075 01:17:27,676 --> 01:17:29,778 THAT I WOULD SIMPLY AVERAGE THEM 2076 01:17:29,845 --> 01:17:31,780 OVER THE LIFESPAN OF THAT MOUSE 2077 01:17:31,847 --> 01:17:33,448 TO GET AN AVERAGE LEVEL OF HOW 2078 01:17:33,515 --> 01:17:36,518 MUCH PAIN THAT MOUSE WAS IN 2079 01:17:36,585 --> 01:17:37,919 OVERALL, OVER ITS LIFESPAN. 2080 01:17:37,986 --> 01:17:39,488 AND I CORRELATED THAT AVERAGE 2081 01:17:39,554 --> 01:17:41,123 WITH HOW MUCH EACH MOUSE LIVED 2082 01:17:41,189 --> 01:17:42,991 AND WHEN YOU DO THAT, YOU SEE 2083 01:17:43,058 --> 01:17:45,293 THE FOLLOWING RATHER AMAZING 2084 01:17:45,360 --> 01:17:47,295 FINDING, WHICH IS THAT IN MALE 2085 01:17:47,362 --> 01:17:50,899 MICE ONLY, THERE IS A 2086 01:17:50,966 --> 01:17:51,533 SIGNIFICANT CORRELATION BETWEEN 2087 01:17:51,600 --> 01:17:53,068 HOW MUCH PAIN THEY WERE IN ON 2088 01:17:53,135 --> 01:17:54,870 AVERAGE AND HOW LONG THEY LIVED, 2089 01:17:54,936 --> 01:17:58,140 SUCH THAT THOSE WHO WERE IN MORE 2090 01:17:58,206 --> 01:17:59,608 PAIN DIED YOUNGER, THOSE WHO 2091 01:17:59,674 --> 01:18:01,676 WERE IN LESS PAIN LIVED LONGER, 2092 01:18:01,743 --> 01:18:04,312 FOR FEMALES, IT HAD ABSOLUTELY 2093 01:18:04,379 --> 01:18:06,181 NO IMPACT AT ALL. 2094 01:18:06,248 --> 01:18:08,050 AND THEN WE ASKED OURSELF, OKAY, 2095 01:18:08,116 --> 01:18:09,818 IF THAT'S TRUE FOR MICE, IS IT 2096 01:18:09,885 --> 01:18:11,553 ALSO TRUE IN PEOPLE AND IT TURNS 2097 01:18:11,620 --> 01:18:13,989 OUT THAT THERE'S A WAY TO ANSWER 2098 01:18:14,056 --> 01:18:16,858 THAT QUESTION WITH THE U.K. 2099 01:18:16,925 --> 01:18:19,161 BIOBANK, WHICH IS DATA FROM A 2100 01:18:19,227 --> 01:18:21,396 HALF A MILLION BRITS, AND WHEN 2101 01:18:21,463 --> 01:18:24,232 WE ANALYZE THIS DATA, WE SEE THE 2102 01:18:24,299 --> 01:18:25,333 FOLLOWING PATTERN. 2103 01:18:25,400 --> 01:18:27,769 IN THE U.K. BIOBANK, THEY DON'T 2104 01:18:27,836 --> 01:18:28,670 ACTUALLY HAVE PAIN LEVELS. 2105 01:18:28,737 --> 01:18:30,872 WHAT THEY HAVE INSTEAD IS HOW 2106 01:18:30,939 --> 01:18:35,010 MANY BODY PARTS YOU ENDORSE THAT 2107 01:18:35,077 --> 01:18:36,912 ARE IN PAIN, BUT THIS TURNS OUT 2108 01:18:36,978 --> 01:18:37,979 TO CORRELATE VERY HIGHLY WITH 2109 01:18:38,046 --> 01:18:39,181 PAIN LEVELS SO IT CAN BE 2110 01:18:39,247 --> 01:18:40,415 CONSIDERED A PROXY. 2111 01:18:40,482 --> 01:18:41,783 AND YOU CAN SEE THAT IN MEN BUT 2112 01:18:41,850 --> 01:18:44,853 NOT WOMEN, THE MORE BODY SITES 2113 01:18:44,920 --> 01:18:47,189 THEY HAVE THAT ARE IN PAIN, THE 2114 01:18:47,255 --> 01:18:49,458 QUICKER THEY DIE. 2115 01:18:49,524 --> 01:18:51,359 AND THAT IS AN EFFECT THAT JUST 2116 01:18:51,426 --> 01:18:52,627 ISN'T SEEN IN WOMEN. 2117 01:18:52,694 --> 01:18:54,229 NOW, THIS IS SORT OF A STRIKING 2118 01:18:54,296 --> 01:18:56,465 FINDING BUT IN SOME SENSE, IT'S 2119 01:18:56,531 --> 01:18:58,166 ABSOLUTELY EXPLAINABLE, BECAUSE 2120 01:18:58,233 --> 01:19:00,502 WE KNOW AND WE'VE KNOWN FOR A 2121 01:19:00,569 --> 01:19:04,372 LONG TIME THAT THERE IS A SEX 2122 01:19:04,439 --> 01:19:06,508 DIFFERENCE IN HEALTH AND DISEASE 2123 01:19:06,575 --> 01:19:08,944 SUCH THAT WOMEN ARE MORE 2124 01:19:09,010 --> 01:19:11,379 AFFECTED BY MORBIDITY, RIGHT, 2125 01:19:11,446 --> 01:19:14,182 THEY'RE MORE LIKELY TO HAVE THE 2126 01:19:14,249 --> 01:19:15,083 CHRONIC DISORDER, WHEREAS MEN 2127 01:19:15,150 --> 01:19:17,519 ARE MORE SUSCEPTIBLE TO 2128 01:19:17,586 --> 01:19:17,786 MORTALITY. 2129 01:19:17,853 --> 01:19:18,753 THEY'RE MORE LIKELY TO DIE FROM 2130 01:19:18,820 --> 01:19:19,054 IT. 2131 01:19:19,121 --> 01:19:20,822 SO IT SEEMS FOR CHRONIC PAIN, 2132 01:19:20,889 --> 01:19:23,091 THIS IS ALSO TRUE. 2133 01:19:23,158 --> 01:19:24,059 NOW, THE FINAL THING I WANT TO 2134 01:19:24,126 --> 01:19:28,130 SPEND A FEW MINUTE TELLING YOUSU 2135 01:19:28,196 --> 01:19:29,164 ABOUT IS SOMETHING THAT I'M KIND 2136 01:19:29,231 --> 01:19:29,764 OF EXCITED ABOUT. 2137 01:19:29,831 --> 01:19:32,300 I SHOULD POINT OUT, THESE ARE 2138 01:19:32,367 --> 01:19:33,568 ABSOLUTELY PRELIMINARY, 2139 01:19:33,635 --> 01:19:34,970 UNPUBLISHED DATA FROM OUR LAB. 2140 01:19:35,036 --> 01:19:36,505 BUT I THINK THEY MIGHT BE 2141 01:19:36,571 --> 01:19:37,973 MEANINGFUL, SO I WANT TO SPEND A 2142 01:19:38,039 --> 01:19:39,040 FEW MINUTES. 2143 01:19:39,107 --> 01:19:42,677 THEY INVOLVE THE FORMALIN TEST 2144 01:19:42,744 --> 01:19:45,413 WHICH I'LL REMIND EVERYONE THAT 2145 01:19:45,480 --> 01:19:48,383 INVOLVES THE INJECTION OF AN 2146 01:19:48,450 --> 01:19:50,685 INFLAMMATORY SUBSTANCE INTO THE 2147 01:19:50,752 --> 01:19:57,392 HIND PAW AND THEY SHOW LICKING 2148 01:19:57,459 --> 01:19:58,326 BEHAVIOR. 2149 01:19:58,393 --> 01:20:00,028 THIS EXPERIMENT INVOLVED TWO 2150 01:20:00,095 --> 01:20:02,030 DIFFERENT SOCIAL CONDITIONS. 2151 01:20:02,097 --> 01:20:04,566 SO ON THE LEFT THERE'S THE 2152 01:20:04,633 --> 01:20:06,201 NON-SOCIAL CONDITION, A MOUSE IS 2153 01:20:06,268 --> 01:20:07,769 IN A HOME CAGE AND THERE IS ONE 2154 01:20:07,836 --> 01:20:09,905 OBJECT IN THAT CAGE, WHICH IS 2155 01:20:09,971 --> 01:20:12,974 THIS RED TUBE, WHICH IS A 2156 01:20:13,041 --> 01:20:14,576 TRANSPARENT TO US BUT TO MICE, 2157 01:20:14,643 --> 01:20:16,645 THAT IS AN OPAQUE TUBE, A GOOD 2158 01:20:16,711 --> 01:20:18,413 PLACE TO HIDE IN. 2159 01:20:18,480 --> 01:20:20,649 AND IN THE SOCIAL CONDITION, 2160 01:20:20,715 --> 01:20:22,050 THERE ARE NOW THREE MICE AND 2161 01:20:22,117 --> 01:20:23,051 THREE TUBES SO THERE'S NO 2162 01:20:23,118 --> 01:20:24,386 COMPETITION TO GET IN THE TUBE, 2163 01:20:24,452 --> 01:20:26,588 BUT ONLY ONE MOUSE IS INJECTED 2164 01:20:26,655 --> 01:20:27,122 WITH FORMALIN. 2165 01:20:27,189 --> 01:20:29,824 IN THE NON-SOCIAL CONDITION, 2166 01:20:29,891 --> 01:20:30,725 HERE'S WHAT WE SEE. 2167 01:20:30,792 --> 01:20:32,594 IT TURNS OUT THAT MALES ARE 2168 01:20:32,661 --> 01:20:33,862 SIGNIFICANTLY MORE LIKELY TO 2169 01:20:33,929 --> 01:20:36,498 SPEND TIME IN THE TUBE WHEN 2170 01:20:36,565 --> 01:20:38,333 GIVEN FORMALIN, WHICH IS 2171 01:20:38,400 --> 01:20:38,800 INTERESTING. 2172 01:20:38,867 --> 01:20:40,635 THERE IS NO DIFFERENCE IN THE 2173 01:20:40,702 --> 01:20:42,304 OVERALL AMOUNT OF PAIN BEHAVIOR, 2174 01:20:42,370 --> 01:20:44,873 WHICH IS LICKING OF THE AFFECTED 2175 01:20:44,940 --> 01:20:46,074 HINDPAW BETWEEN MALES AND 2176 01:20:46,141 --> 01:20:47,209 FEMALES AND MOST IMPORTANTLY FOR 2177 01:20:47,275 --> 01:20:49,177 THIS STUDY, THERE IS NO 2178 01:20:49,244 --> 01:20:51,446 DIFFERENCE IN WHERE THE LICKING 2179 01:20:51,513 --> 01:20:53,181 BEHAVIOR OCCURS, WHETHER IN THE 2180 01:20:53,248 --> 01:20:56,084 TUBE OR OUTSIDE OF THE TUBE. 2181 01:20:56,151 --> 01:20:58,386 HOWEVER, IN THE SOCIAL 2182 01:20:58,453 --> 01:20:59,487 CONDITION, AGAIN, MALE MICE ARE 2183 01:20:59,554 --> 01:21:01,223 A LITTLE BIT MORE LIKELY TO GO 2184 01:21:01,289 --> 01:21:02,057 IN THE TUBE. 2185 01:21:02,123 --> 01:21:03,725 AGAIN, THERE'S NO DIFFERENCE IN 2186 01:21:03,792 --> 01:21:06,728 OVERALL PAIN BEHAVIOR, BUT NOW A 2187 01:21:06,795 --> 01:21:07,629 VERY INTERESTING THING HAPPENS, 2188 01:21:07,696 --> 01:21:10,665 WHICH YOU CAN SEE MOST EASILY IN 2189 01:21:10,732 --> 01:21:11,967 GRAPH E. 2190 01:21:12,033 --> 01:21:13,068 MALE MICE ARE DOING A LOT OF 2191 01:21:13,134 --> 01:21:14,869 THEIR LICKING BEHAVIOR INSIDE 2192 01:21:14,936 --> 01:21:16,905 THE TUBE, WHEREAS FEMALE MICE 2193 01:21:16,972 --> 01:21:18,673 ARE DOING ESSENTIALLY ALL OF 2194 01:21:18,740 --> 01:21:20,008 THEIR LICKING BEHAVIOR OUTSIDE 2195 01:21:20,075 --> 01:21:22,711 THE TUBE. 2196 01:21:22,777 --> 01:21:24,045 SO WHAT'S GOING ON HERE? 2197 01:21:24,112 --> 01:21:25,847 AND IT SEEMS TO ME THAT THERE'S 2198 01:21:25,914 --> 01:21:28,116 TWO OPTIONS. 2199 01:21:28,183 --> 01:21:30,418 IT EITHER THAT MALES WANT TO DO 2200 01:21:30,485 --> 01:21:33,688 THEIR PAIN BEHAVIOR PRIVATELY, 2201 01:21:33,755 --> 01:21:38,727 PROB BLIL BECAPROBABLY BECAUSE , 2202 01:21:38,793 --> 01:21:40,528 OR FEMALES ACTUALLY WANT TO DO 2203 01:21:40,595 --> 01:21:42,097 THEIR PAIN BEHAVIOR PUBLICLY. 2204 01:21:42,163 --> 01:21:43,498 IN FACT, IF YOU COMPARE THE 2205 01:21:43,565 --> 01:21:45,267 NON-SOCIAL TO THE SOCIAL 2206 01:21:45,333 --> 01:21:46,234 CONDITION, IT ACTUALLY LOOKS 2207 01:21:46,301 --> 01:21:48,570 LIKE IT'S THE SECOND EXPLANATION 2208 01:21:48,637 --> 01:21:50,438 THAT IS THE RIGHT ONE, AND 2209 01:21:50,505 --> 01:21:51,539 THAT'S PRETTY INTERESTING, 2210 01:21:51,606 --> 01:21:54,276 BECAUSE IN 2010, AND BY THE WAY, 2211 01:21:54,342 --> 01:21:57,145 THERE'S A PAPER COMING OUT IN 2212 01:21:57,212 --> 01:21:59,014 NEURON, IT'S ALREADY PROBABLY 2213 01:21:59,080 --> 01:22:00,882 AVAILABLE, THAT REPLICATE THESE 2214 01:22:00,949 --> 01:22:02,217 FINDINGS EXACTLY. 2215 01:22:02,284 --> 01:22:04,719 THE PAPER WE PUBLISHED IN 2010, 2216 01:22:04,786 --> 01:22:07,289 WHERE WE'RE LOOKING AT WHERE A 2217 01:22:07,355 --> 01:22:11,026 MOUSE THAT'S FREE TO ROAM GOES 2218 01:22:11,092 --> 01:22:12,527 IF PUT IN PROXIMITY TO A MOUSE 2219 01:22:12,594 --> 01:22:14,829 IN PAIN VERSUS A MOUSE THAT'S 2220 01:22:14,896 --> 01:22:16,898 NOT IN PAIN, AND WHAT WE FOUND 2221 01:22:16,965 --> 01:22:19,267 IS THAT IF ALL THREE MICE ARE 2222 01:22:19,334 --> 01:22:21,469 GIRLS, IF THEY KNOW EACH OTHER, 2223 01:22:21,536 --> 01:22:25,240 SO IF THEY'RE CAGE-MATES, AND IF 2224 01:22:25,307 --> 01:22:26,141 PHYSICAL CONTACT BETWEEN THE 2225 01:22:26,207 --> 01:22:29,978 MICE THROUGH THE JAIL BARS 2226 01:22:30,045 --> 01:22:31,813 HOLDING THE MICE IN AT THE END 2227 01:22:31,880 --> 01:22:33,181 IS ALLOWED, THEN THE MOUSE IN 2228 01:22:33,248 --> 01:22:34,482 THE MIDDLE WILL SPEND MORE TIME 2229 01:22:34,549 --> 01:22:36,951 IN PROXIMITY TO THE MOUSE IN 2230 01:22:37,018 --> 01:22:39,688 PAIN AND THE MORE TIME SHE 2231 01:22:39,754 --> 01:22:41,423 SPENDS IN PROXIMITY TO THE MOUSE 2232 01:22:41,489 --> 01:22:43,725 IN PAIN, THE LESS PAIN THE HOUSE 2233 01:22:43,792 --> 01:22:44,826 IN PAIN IS IN. 2234 01:22:44,893 --> 01:22:46,961 SO IT LOOKS LIKE THIS SOCIAL 2235 01:22:47,028 --> 01:22:50,165 APPROACH OR SOCIAL CONTACT IS 2236 01:22:50,231 --> 01:22:51,766 ANALGESIA, AND THAT MAY BE WHY 2237 01:22:51,833 --> 01:22:53,635 FEMALE MICE ARE ADVERTISING 2238 01:22:53,702 --> 01:22:56,304 THEIR PAIN BEHAVIOR, TO TRY TO 2239 01:22:56,371 --> 01:22:58,006 SOLICIT THIS SORT OF SOCIAL 2240 01:22:58,073 --> 01:23:01,409 APPROACH. 2241 01:23:01,476 --> 01:23:02,877 NOW WHY I'M EXCITED ABOUT THESE 2242 01:23:02,944 --> 01:23:03,978 DATA IS THAT I THINK THIS MIGHT 2243 01:23:04,045 --> 01:23:05,513 NOT BE A SEX DIFFERENCE. 2244 01:23:05,580 --> 01:23:07,549 I THINK IT MIGHT BE A GENDER 2245 01:23:07,615 --> 01:23:08,950 DIFFERENCE. 2246 01:23:09,017 --> 01:23:11,486 BECAUSE EVERY DEFINITION THAT I 2247 01:23:11,553 --> 01:23:14,222 CAN PULL OF THE WORD "GENDER" 2248 01:23:14,289 --> 01:23:17,359 OFF OF THE INTERNET HAS ONE 2249 01:23:17,425 --> 01:23:18,426 THING IN COMMON, WHICH IS THAT 2250 01:23:18,493 --> 01:23:20,395 IT IS SOMETHING EXPRESSED IN A 2251 01:23:20,462 --> 01:23:21,696 SOCIAL CONTEXT. 2252 01:23:21,763 --> 01:23:23,298 AND HERE IS A BEHAVIORAL 2253 01:23:23,365 --> 01:23:24,399 DIFFERENCE BETWEEN MALE AND 2254 01:23:24,466 --> 01:23:26,368 FEMALE MICE THAT CAN ONLY BE 2255 01:23:26,434 --> 01:23:29,237 SEEN IN A SOCIAL CONTEXT. 2256 01:23:29,304 --> 01:23:31,106 NOW, IS THIS GENDER THE SAME WAY 2257 01:23:31,172 --> 01:23:33,007 WE SEE IT IN HUMANS? 2258 01:23:33,074 --> 01:23:35,043 ALMOST CERTAINLY NOT. 2259 01:23:35,110 --> 01:23:37,212 BUT DOES IT DESERVE THE WORD? 2260 01:23:37,278 --> 01:23:38,279 I DON'T KNOW. 2261 01:23:38,346 --> 01:23:38,813 MAYBE. 2262 01:23:38,880 --> 01:23:40,048 I'D BE INTERESTED IN YOUR 2263 01:23:40,115 --> 01:23:40,815 THOUGHTS ON THAT MATTER. 2264 01:23:40,882 --> 01:23:41,783 SO I WANT TO THANK THE FOLKS 2265 01:23:41,850 --> 01:23:43,184 THAT HAVE DONE THE WORK, AND I 2266 01:23:43,251 --> 01:23:44,419 WANT TO THANK YOU ALL FOR YOUR 2267 01:23:44,486 --> 01:23:44,853 ATTENTION. 2268 01:23:44,919 --> 01:23:53,595 THANK YOU VERY MUCH. 2269 01:23:53,661 --> 01:23:55,196 >> THANK YOU, JEFF, FOR A 2270 01:23:55,263 --> 01:23:57,165 STIMULATING TALK. 2271 01:23:57,232 --> 01:23:59,234 HOPEFULLY YOU'LL BE JOINING US 2272 01:23:59,300 --> 01:24:00,902 FOR THE PANEL DISCUSSION AT THE 2273 01:24:00,969 --> 01:24:01,770 END. 2274 01:24:01,836 --> 01:24:03,271 >> I'LL BE HERE. 2275 01:24:03,338 --> 01:24:06,174 >> AND SORRY FOR THE TECHNICAL 2276 01:24:06,241 --> 01:24:06,574 GLITCH. 2277 01:24:06,641 --> 01:24:09,511 SO OUR NEXT SPEAKER IS 2278 01:24:09,577 --> 01:24:11,146 DR. ROBERT SORGE. 2279 01:24:11,212 --> 01:24:12,380 SO HE'S AN ASSOCIATE PROFESSOR 2280 01:24:12,447 --> 01:24:14,249 IN THE DEPARTMENT OF PSYCHOLOGY 2281 01:24:14,315 --> 01:24:16,317 AT THE UNIVERSITY OF ALABAMA AT 2282 01:24:16,384 --> 01:24:17,051 BIRMINGHAM. 2283 01:24:17,118 --> 01:24:21,256 HE'S ALSO THE DIRECTOR OF A LAB 2284 01:24:21,322 --> 01:24:22,657 AND ALSO LEADING THE CORE 2285 01:24:22,724 --> 01:24:26,161 DIRECTORSHIP OF UNDERGRADUATE 2286 01:24:26,227 --> 01:24:27,896 NEUROSCIENCE PROGRAM THERE, AND 2287 01:24:27,962 --> 01:24:30,565 HE HAS BEEN STUDYING SEX 2288 01:24:30,632 --> 01:24:31,399 DIFFERENCES IN PAIN STARTING 2289 01:24:31,466 --> 01:24:33,034 FROM HIS GRADUATE TIME. 2290 01:24:33,101 --> 01:24:37,405 OF COURSE WITH JEFF. 2291 01:24:37,472 --> 01:24:38,940 AND IN HIS INDEPENDENT CAREER, 2292 01:24:39,007 --> 01:24:42,277 HE HAS REALLY CONTINUED FORWARD 2293 01:24:42,343 --> 01:24:44,312 WITH THIS AND NOW CONSIDERS 2294 01:24:44,379 --> 01:24:46,815 HIMSELF AS THE TRANSLATIONAL A 2295 01:24:46,881 --> 01:24:48,450 AND MORE TOWARDS CLINICAL 2296 01:24:48,516 --> 01:24:49,350 SCIENTIST, BECAUSE HIS LAB IS 2297 01:24:49,417 --> 01:24:51,252 CURRENTLY NOT ONLY LOOKING INTO 2298 01:24:51,319 --> 01:24:53,721 THE BASIC SCIENCE BUT ALSO 2299 01:24:53,788 --> 01:24:55,156 TRANSLATIONAL AS WELL AS 2300 01:24:55,223 --> 01:24:56,591 CLINICAL RESEARCH STUDIES WITH 2301 01:24:56,658 --> 01:24:57,992 CLINICAL TRIAL INTERVENTIONS. 2302 01:24:58,059 --> 01:25:00,962 SO HE'LL TALK MORE ON PAIN FROM 2303 01:25:01,029 --> 01:25:03,031 MICE TO MEN TO WOMEN, SO 2304 01:25:03,097 --> 01:25:13,541 HOPEFULLY THE SLIDE WORKS. 2305 01:25:15,143 --> 01:25:15,643 >> ALL RIGHT. 2306 01:25:15,710 --> 01:25:16,711 THANK YOU AGAIN TO THE 2307 01:25:16,778 --> 01:25:17,846 ORGANIZERS FOR INVITING ME. 2308 01:25:17,912 --> 01:25:19,881 I'M HAPPY TO BE HERE. 2309 01:25:19,948 --> 01:25:22,417 FOR DR. JENKINS, I GREW UP ON A 2310 01:25:22,484 --> 01:25:24,519 FARM, SO I LIVE IN ONTARIO IN A 2311 01:25:24,586 --> 01:25:26,488 HAMLET OF 350 PEOPLE ON A GRAVEL 2312 01:25:26,554 --> 01:25:27,922 ROAD, SO THERE YOU GO, THAT'S 2313 01:25:27,989 --> 01:25:30,124 WHERE I'M COMING FROM. 2314 01:25:30,191 --> 01:25:33,728 YES, VERY LEAP TO HAPPY TO BE H. 2315 01:25:33,795 --> 01:25:36,998 I'M GOING TO TALK ABOUT OUR 2316 01:25:37,065 --> 01:25:38,132 JOURNEY FROM MICE TO MEN TO 2317 01:25:38,199 --> 01:25:39,200 WOMEN AND HOPEFULLY THIS ALL 2318 01:25:39,267 --> 01:25:39,567 WORKS. 2319 01:25:39,634 --> 01:25:42,504 THIS IS A BRIEF OUTLINE. 2320 01:25:42,570 --> 01:25:45,173 DP ASKED ME TO ADD A LITTLE BIT 2321 01:25:45,240 --> 01:25:46,474 OF MECHANISM SO I'M GOING TO 2322 01:25:46,541 --> 01:25:48,142 TOUCH A LITTLE ON THE MECHANISM 2323 01:25:48,209 --> 01:25:49,477 STUFF AND GO INTO SOME OF OUR 2324 01:25:49,544 --> 01:25:49,978 CLINICAL WORK. 2325 01:25:50,044 --> 01:25:51,846 SO IN 2015, WE PUBLISHED THIS 2326 01:25:51,913 --> 01:25:53,581 PAPER WHICH WAS THE FIRST TO 2327 01:25:53,648 --> 01:25:55,116 IDENTIFY THE SEX DIFFERENCE IN 2328 01:25:55,183 --> 01:25:56,184 IMMUNE CELL MODULATION OF PAIN 2329 01:25:56,251 --> 01:25:58,620 IN MICE. 2330 01:25:58,686 --> 01:25:59,687 SPECIFICALLY WITHIN THE SPINAL 2331 01:25:59,754 --> 01:26:00,021 CORD. 2332 01:26:00,088 --> 01:26:03,625 SO THE SHORT VERSION OF THIS IS 2333 01:26:03,691 --> 01:26:07,896 THAT IF WE GAVE MICROGLIAL 2334 01:26:07,962 --> 01:26:09,264 INHIBITORS INTRATHECALLY IN MALE 2335 01:26:09,330 --> 01:26:11,733 AND FEMALE MICE, WHAT WE SAW IS 2336 01:26:11,799 --> 01:26:16,571 THESE DRUGS REVERSED ALLODYNIA 2337 01:26:16,638 --> 01:26:18,773 IN FEMALE MICE, WE FOUND THIS 2338 01:26:18,840 --> 01:26:20,708 EFFECT WAS TESTOSTERONE 2339 01:26:20,775 --> 01:26:20,975 DEPENDENT. 2340 01:26:21,042 --> 01:26:22,944 WE TOOK TESTOSTERONE AWAY, THE 2341 01:26:23,011 --> 01:26:24,379 DRUGS DIDN'T WORK, IF WE GAVE IT 2342 01:26:24,445 --> 01:26:25,580 BACK, THE DRUGS WOULD WORK, AND 2343 01:26:25,647 --> 01:26:29,284 IF WE GAVE TESTOSTERONE TO THE 2344 01:26:29,350 --> 01:26:30,718 FEMALES, THEN THE DRUG WOULD 2345 01:26:30,785 --> 01:26:32,921 WORK SO IT DID SEEM TO DEPEND ON 2346 01:26:32,987 --> 01:26:33,655 TESTOSTERONE. 2347 01:26:33,721 --> 01:26:36,190 SO THE HE REQUEST IS IF THE 2348 01:26:36,257 --> 01:26:37,959 FEMALES ARE NOT USING MICROGLIA 2349 01:26:38,026 --> 01:26:40,962 WHAT ARE THEY USING, THEY SEEMED 2350 01:26:41,029 --> 01:26:42,063 TO BE USING T CELLS IN THE 2351 01:26:42,130 --> 01:26:42,430 SPINAL CORD. 2352 01:26:42,497 --> 01:26:44,098 SO AGAIN, IF YOU TAKE THOSE T 2353 01:26:44,165 --> 01:26:46,501 CELLS AWAY, THE MICROGLIAL 2354 01:26:46,568 --> 01:26:48,036 INHIBITORS WORK JUST FINE, GIVE 2355 01:26:48,102 --> 01:26:51,339 THE T CELLS BACK, THEN THOSE 2356 01:26:51,406 --> 01:26:52,974 INHIBITORS NO LONGER WORK. 2357 01:26:53,041 --> 01:26:54,943 AND SO THE LAST LITTLE BIT OF 2358 01:26:55,009 --> 01:26:56,177 DATA FROM THIS EXPERIMENT THAT I 2359 01:26:56,244 --> 01:26:59,781 WANT TO SHOW IS LOOKING AT 2360 01:26:59,847 --> 01:27:01,015 T-CELL INFILTRATION INTO THE 2361 01:27:01,082 --> 01:27:02,483 SPINAL CORD AFTER A NERVE INJURY 2362 01:27:02,550 --> 01:27:04,185 IN THESE MALE AND FEMALE MICE. 2363 01:27:04,252 --> 01:27:05,687 SO WHAT YOU'LL NOTICE HERE IS 2364 01:27:05,753 --> 01:27:08,222 THAT BOTH MALE AND FEMALE MICE 2365 01:27:08,289 --> 01:27:09,757 HAVE T CELLS INFILTRATING INTO 2366 01:27:09,824 --> 01:27:12,927 THE SPINAL CORD, SO BOTH SEXES 2367 01:27:12,994 --> 01:27:15,763 HAVE BOTH SYSTEMS, BUT FEMALES 2368 01:27:15,830 --> 01:27:18,733 JUST HAVE MORE T CELLS 2369 01:27:18,800 --> 01:27:19,667 INFILTRATING INTO THE SPINAL 2370 01:27:19,734 --> 01:27:20,802 CORD THAN THE MALES. 2371 01:27:20,868 --> 01:27:23,538 SO AGAIN, THE IMPORTANT THING IS 2372 01:27:23,605 --> 01:27:25,239 THAT BOTH SEXES HAVE BOTH 2373 01:27:25,306 --> 01:27:26,741 PATHWAYS BUT THEY PREFERENTIALLY 2374 01:27:26,808 --> 01:27:28,810 USE ONE OR THE OTHER BASED ON 2375 01:27:28,876 --> 01:27:29,577 HORMONE LEVELS AND THE 2376 01:27:29,644 --> 01:27:30,578 AVAILABILITY OF THOSE SYSTEMS. 2377 01:27:30,645 --> 01:27:32,447 SO I WANT TO HIGHLIGHT THIS 2378 01:27:32,513 --> 01:27:35,617 BECAUSE THIS IS GOING TO SHOW UP 2379 01:27:35,683 --> 01:27:37,385 AGAIN, TAKEN FROM MONTE PYTHON, 2380 01:27:37,452 --> 01:27:39,253 IN OUR CLINICAL WORK. 2381 01:27:39,320 --> 01:27:42,390 AND SO SINCE THAT TIME, THERE 2382 01:27:42,457 --> 01:27:43,858 HAVE BEEN A NUMBER OF STUDYS 2383 01:27:43,925 --> 01:27:45,259 THAT HAVE REPLICATED THESE SORTS 2384 01:27:45,326 --> 01:27:46,694 OF EFFECTS IN ANIMALS. 2385 01:27:46,761 --> 01:27:48,529 THIS IS NOT AN EXHAUSTIVE LIST, 2386 01:27:48,596 --> 01:27:50,431 OF COURSE, BUT THERE'S BEEN A 2387 01:27:50,498 --> 01:27:51,833 DECENT NUMBER OF STUDIES AND FOR 2388 01:27:51,899 --> 01:27:53,368 THOSE OF US THAT DIDN'T REALLY 2389 01:27:53,434 --> 01:27:54,535 BELIEVE WHAT WE WERE SEEING AT 2390 01:27:54,602 --> 01:27:56,571 THE BEGINNING, THIS WAS VERY 2391 01:27:56,638 --> 01:27:57,171 VINDICATED. 2392 01:27:57,238 --> 01:28:00,074 SO THIS HAS BEEN SHOWN NOW 2393 01:28:00,141 --> 01:28:01,509 TWICE, SO I'M NOT GOING TO 2394 01:28:01,576 --> 01:28:02,477 BELABOR THIS POINT, BUT I DO 2395 01:28:02,543 --> 01:28:05,213 WANT TO HIGHLIGHT THAT WHEN THIS 2396 01:28:05,279 --> 01:28:06,981 WAS PUBLISHED, THE IDEA WAS THAT 2397 01:28:07,048 --> 01:28:09,384 MALES AND FEMALES ARE 2398 01:28:09,450 --> 01:28:10,418 DIFFERENTIAL LISTENSTIVE TO 2399 01:28:10,485 --> 01:28:12,387 ACUTE PAIN BUT WHEN WE TALK 2400 01:28:12,453 --> 01:28:13,254 ABOUT THIS, WE TALK ABOUT THIS 2401 01:28:13,321 --> 01:28:15,356 IN TERMS OF MEN AND WOMEN, AND 2402 01:28:15,423 --> 01:28:17,425 AS DR. JENKINS SAID, THOSE ARE 2403 01:28:17,492 --> 01:28:18,760 VERY DIFFERENT TERMS. 2404 01:28:18,826 --> 01:28:21,396 AND SO NOT TO STEP ON JEFF'S 2405 01:28:21,462 --> 01:28:23,364 TOES AT ALL, BUT IN MY LAB, 2406 01:28:23,431 --> 01:28:28,770 THESE ARE HOW WE DEFINE THESE 2407 01:28:28,836 --> 01:28:29,637 TERMS. 2408 01:28:29,704 --> 01:28:34,375 SEX IS A BIOLOGICAL ATTRIBUTE, 2409 01:28:34,442 --> 01:28:35,810 SEX ASSIGNED AT BIRTH. 2410 01:28:35,877 --> 01:28:38,012 GENDER IS A SOCIAL ROLE MORE IN 2411 01:28:38,079 --> 01:28:39,647 TUNE WITH SELF-IDENTITY, SO WE 2412 01:28:39,714 --> 01:28:41,849 RESERVE THAT FOR PEOPLE. 2413 01:28:41,916 --> 01:28:43,184 BUT THAT'S NOT ALWAYS THE CASE 2414 01:28:43,251 --> 01:28:45,720 FOR EVERYONE, I GUESS. 2415 01:28:45,787 --> 01:28:47,221 SO THEN SOME OTHER TERMS THAT I 2416 01:28:47,288 --> 01:28:49,023 WANT TO GO THROUGH. 2417 01:28:49,090 --> 01:28:50,558 I'M GOING TO BE USING THESE 2418 01:28:50,625 --> 01:28:55,263 SHORT FORMS A LOT, SO CIS MEN 2419 01:28:55,329 --> 01:29:00,835 AND WOMEN, NON-BINARY ADULTS, 2420 01:29:00,902 --> 01:29:01,936 HORMONE REPLACEMENT THERAPY. 2421 01:29:02,003 --> 01:29:03,838 SO A FEW YEARS AGO AS PART OF 2422 01:29:03,905 --> 01:29:05,707 ANOTHER ONGOING STUDY, WE 2423 01:29:05,773 --> 01:29:09,410 HAPPENED TO RECRUIT A NUMBER OF 2424 01:29:09,477 --> 01:29:14,182 TRANS WOMEN ADGED W AND WE THOUT 2425 01:29:14,248 --> 01:29:15,049 IT WOULD BE REALLY INTERESTING 2426 01:29:15,116 --> 01:29:16,484 TO SEE WHAT WAS GOING ON WITH 2427 01:29:16,551 --> 01:29:18,152 PAIN SENSITIVITY IN THESE WOMEN. 2428 01:29:18,219 --> 01:29:20,054 THESE WERE ALL BLACK 2429 01:29:20,121 --> 01:29:21,322 INDIVIDUALS, ALL HIV-POSITIVE, 2430 01:29:21,389 --> 01:29:23,157 ALL HAD CHRONIC PAIN, ALL WERE 2431 01:29:23,224 --> 01:29:25,493 AT OR BELOW THE POVERTY LINE. 2432 01:29:25,560 --> 01:29:26,894 WE HAD SEVEN TRANS WOMEN, NOW 2433 01:29:26,961 --> 01:29:28,429 FOR THOSE THAT AREN'T FAMILIAR 2434 01:29:28,496 --> 01:29:29,897 WITH THE TERMS, THESE ARE MALE 2435 01:29:29,964 --> 01:29:31,299 ASSIGNED AT BIRTH AND IDENTIFY 2436 01:29:31,365 --> 01:29:33,067 AS WOMEN. 2437 01:29:33,134 --> 01:29:34,402 AND THEY RAN THROUGH A BUNCH OF 2438 01:29:34,469 --> 01:29:36,838 OUR STUDIES AND WHAT I WANT TO 2439 01:29:36,904 --> 01:29:39,440 HIGHLIGHT IS THE TEMPORAL 2440 01:29:39,507 --> 01:29:40,308 SUMMATION OF HEAT PAIN. 2441 01:29:40,374 --> 01:29:43,077 SO WHEN WE LOOK AT CIS MEN AND 2442 01:29:43,144 --> 01:29:44,612 WOMEN, WE SEE THE SAME THING 2443 01:29:44,679 --> 01:29:46,380 THAT'S BEEN SEEN AS JEFF SAID 2444 01:29:46,447 --> 01:29:47,582 HUNDREDS AND HUNDREDS OF TIMES 2445 01:29:47,648 --> 01:29:49,350 IN STUDIES ALL OVER THE WORLD 2446 01:29:49,417 --> 01:29:51,419 WHERE WOMEN ARE REPORTING HIGHER 2447 01:29:51,486 --> 01:29:56,858 LEVELS OF PAIN THAN THE MEN ARE. 2448 01:29:56,924 --> 01:29:57,525 NOT TERRIBLY SURPRISING. 2449 01:29:57,592 --> 01:29:58,526 BUT WHAT WAS VERY INTERESTING IS 2450 01:29:58,593 --> 01:30:00,695 WHEN WE MAP THE TRANS WOMEN, 2451 01:30:00,762 --> 01:30:02,864 THEY ARE REPORTING VERY SIMILAR 2452 01:30:02,930 --> 01:30:05,299 PAIN SENSITIVITY TO CIS WOMEN. 2453 01:30:05,366 --> 01:30:09,837 SO FOR ALL INTENTS AT PURNSES, , 2454 01:30:09,904 --> 01:30:11,773 THEY ARE BEHAVING EXACTLY LIKE 2455 01:30:11,839 --> 01:30:12,774 ALL THE OTHER WOMEN IN THE 2456 01:30:12,840 --> 01:30:13,141 STUDY. 2457 01:30:13,207 --> 01:30:14,776 SO THAT BRINGS US TO OUR CURRENT 2458 01:30:14,842 --> 01:30:16,444 STUDY, ONE I'M REALLY, REALLY 2459 01:30:16,511 --> 01:30:17,311 EXCITED TO TALK TO YOU ABOUT. 2460 01:30:17,378 --> 01:30:18,646 SO THIS IS OUR SHIEP STUDY. 2461 01:30:18,713 --> 01:30:23,484 SHINE STUDY.THESE ARE SOME VERYY 2462 01:30:23,551 --> 01:30:24,285 RESULTS. 2463 01:30:24,352 --> 01:30:27,522 I WANT TO THANK NINR FOR FUNDING 2464 01:30:27,588 --> 01:30:36,397 THIS WORK. 2465 01:30:36,464 --> 01:30:37,832 THIS STUDY HAD THREE BASIC AIMS, 2466 01:30:37,899 --> 01:30:43,137 TO LOOK AT THE RELATIONSHIP 2467 01:30:43,204 --> 01:30:47,441 BETWEEN GENDER IDENTITY AND PAIN 2468 01:30:47,508 --> 01:30:48,676 SENSITIVITY, AIM TWO, 2469 01:30:48,743 --> 01:30:50,211 PSYCHOLOGICAL FACTORS AND PAIN 2470 01:30:50,278 --> 01:30:51,078 SENSITIVITY, AND AIM THREE, 2471 01:30:51,145 --> 01:30:52,747 BECAUSE OF MY BACKGROUND LOOKING 2472 01:30:52,814 --> 01:30:54,515 AT IMMUNE CELLS AND PATHWAY, 2473 01:30:54,582 --> 01:30:55,817 WE'RE GOING TO LOOK AT IMMUNE 2474 01:30:55,883 --> 01:30:58,953 CELL DIFFERENCES IN OUR 2475 01:30:59,020 --> 01:30:59,821 DIFFERENT GROUPS OF INDIVIDUALS. 2476 01:30:59,887 --> 01:31:00,855 OUR GROUPS OF INDIVIDUALS ARE 2477 01:31:00,922 --> 01:31:01,389 SHOWN HERE. 2478 01:31:01,455 --> 01:31:03,691 SO WHAT WE'VE DONE HERE IS SORT 2479 01:31:03,758 --> 01:31:05,326 OF ROUGHLY AGGREGATED THEM INTO 2480 01:31:05,393 --> 01:31:09,430 DIFFERENT GROUPS. 2481 01:31:09,497 --> 01:31:11,199 THE IDEA HERE IS TO ALLOW US, 2482 01:31:11,265 --> 01:31:12,733 BASED ON THE OUTCOME, TO SEE 2483 01:31:12,800 --> 01:31:14,569 WHAT VARIABLE MIGHT ALLOW FOR 2484 01:31:14,635 --> 01:31:18,339 THAT SEPARATION OF GROUPS. 2485 01:31:18,406 --> 01:31:19,540 SO FOR INSTANCE, IF GENDER 2486 01:31:19,607 --> 01:31:20,741 IDENTITY WAS THE KEY VARIABLE 2487 01:31:20,808 --> 01:31:22,643 THAT SEPARATED GROUPS, THEN WE 2488 01:31:22,710 --> 01:31:29,617 MIGHT EXPECT THEN THAT CIS MEN 2489 01:31:29,684 --> 01:31:31,485 MEN -- AND CIS MEN AND TRANS 2490 01:31:31,552 --> 01:31:34,055 WOMEN BOTH ON OR OFF HRT WOULD 2491 01:31:34,121 --> 01:31:34,488 ALSO GROUP TOGETHER. 2492 01:31:34,555 --> 01:31:36,023 SO DEPENDING ON THE OUTCOME AND 2493 01:31:36,090 --> 01:31:37,925 THE GROUPINGS, WE MIGHT BE ABLE 2494 01:31:37,992 --> 01:31:38,793 TO FIGURE OUT WHICH VARIABLE OF 2495 01:31:38,860 --> 01:31:40,228 INTEREST WAS THE KEY DETERMINING 2496 01:31:40,294 --> 01:31:43,164 FACTOR. 2497 01:31:43,231 --> 01:31:44,832 SO AS OF I GUESS TWO WEEKS AGO, 2498 01:31:44,899 --> 01:31:46,467 WHEN I PULLED THIS DATA, THIS IS 2499 01:31:46,534 --> 01:31:48,035 OUR GROUP SIZES SO THEY'RE 2500 01:31:48,102 --> 01:31:48,870 ROUGHLY THE SAME SIZE. 2501 01:31:48,936 --> 01:31:50,571 THE AGES ARE SIMILAR, THOUGH 2502 01:31:50,638 --> 01:31:54,275 WE'VE HAD MORE YOUNGER TRANS MEN 2503 01:31:54,342 --> 01:31:56,143 THAN SOME OF THE OTHER GROUPS. 2504 01:31:56,210 --> 01:31:58,346 THE RANGES ARE SIMILAR AND OUR 2505 01:31:58,412 --> 01:32:00,848 RACIAL DEMOGRAPHIC BREAK DOWN IS 2506 01:32:00,915 --> 01:32:01,415 VERY SIMILAR ACROSS THESE 2507 01:32:01,482 --> 01:32:01,749 GROUPS. 2508 01:32:01,816 --> 01:32:03,751 SO I WANT TO START BY SHOWING 2509 01:32:03,818 --> 01:32:06,354 YOU SOME OF OUR DATA. 2510 01:32:06,420 --> 01:32:07,989 THESE ARE THREE DIFFERENT TESTS. 2511 01:32:08,055 --> 01:32:09,223 IN THE FAR LEFT, THIS IS THE 2512 01:32:09,290 --> 01:32:10,992 COLD PRESSOR TEST. 2513 01:32:11,058 --> 01:32:12,026 WE ASK PEOPLE TO STICK THEIR 2514 01:32:12,093 --> 01:32:13,494 HAND IN COLD WATER AND THEN 2515 01:32:13,561 --> 01:32:15,329 REPORT ON A ZERO TO 100 SCALE 2516 01:32:15,396 --> 01:32:16,597 WHAT THE INTENSITY OF THAT PAIN 2517 01:32:16,664 --> 01:32:17,932 IS, SO THAT'S WHAT'S SHOWN ON 2518 01:32:17,999 --> 01:32:18,566 THE AXIS THERE. 2519 01:32:18,633 --> 01:32:20,801 IN THE MIDDLE, THIS IS HEAT PAIN 2520 01:32:20,868 --> 01:32:24,105 THRESHOLD, SO THIS IS THERMOD ON 2521 01:32:24,171 --> 01:32:25,873 THE FOREARM AND AS THE HEAT 2522 01:32:25,940 --> 01:32:27,074 RAMPS UP, THEY'RE ASKED TO CLICK 2523 01:32:27,141 --> 01:32:28,809 A BUTTON WHEN IT BECOMES PAINFUL 2524 01:32:28,876 --> 01:32:29,911 AND WE RECORD THAT TEMPERATURE. 2525 01:32:29,977 --> 01:32:32,113 AND THEN ON THE FAR RIGHT, WE 2526 01:32:32,179 --> 01:32:34,148 HAVE THE TRAPEZIUS PRESSURE PAIN 2527 01:32:34,215 --> 01:32:34,448 THRESHOLD. 2528 01:32:34,515 --> 01:32:36,617 SO WE DO PRESSURE PAIN ON THE 2529 01:32:36,684 --> 01:32:39,520 TRAPEZIUS MUSCLE AND ON THE 2530 01:32:39,587 --> 01:32:40,922 FOREARM, THAT'S THE AMOUNT OF 2531 01:32:40,988 --> 01:32:41,923 PRESSURE UNTIL THEY REPORT THAT 2532 01:32:41,989 --> 01:32:42,790 AS BEING PAINFUL. 2533 01:32:42,857 --> 01:32:43,925 AND THESE ARE THE FOUR GROUPS 2534 01:32:43,991 --> 01:32:45,059 THAT WE HAVE SO FAR. 2535 01:32:45,126 --> 01:32:46,394 AND SO WHAT YOU'LL NOTICE HERE, 2536 01:32:46,460 --> 01:32:48,296 NOW THESE ARE VERY SORT OF BACK 2537 01:32:48,362 --> 01:32:50,398 OF THE ENVELOPE STATISTICAL 2538 01:32:50,464 --> 01:32:51,499 COMPARISONS, IS THAT WHAT YOU'LL 2539 01:32:51,565 --> 01:32:55,202 SEAL IS THAT MEN AND WOMEN, 2540 01:32:55,269 --> 01:32:56,671 WHETHER THEY BE CIS OR TRANS, 2541 01:32:56,737 --> 01:32:57,538 ARE DIFFERENT. 2542 01:32:57,605 --> 01:33:00,274 WHERE MEN REPORT LESS 2543 01:33:00,341 --> 01:33:01,609 SENSITIVITY ACROSS ALL OF THESE 2544 01:33:01,676 --> 01:33:04,812 MEASURES THAN THE WOMEN. 2545 01:33:04,879 --> 01:33:05,913 AND AGAIN, IT DOESN'T MATTER 2546 01:33:05,980 --> 01:33:07,348 WHETHER THEY ARE CIS WOMEN OR 2547 01:33:07,415 --> 01:33:11,252 TRANS WOMEN, THEY TEND TO GROUP 2548 01:33:11,319 --> 01:33:11,719 TOGETHER. 2549 01:33:11,786 --> 01:33:13,020 NOW A SUBSET OF THESE 2550 01:33:13,087 --> 01:33:15,323 INDIVIDUALS, WE RAN THROUGH FLOW 2551 01:33:15,389 --> 01:33:17,058 CYTOMETRY, RAN THEIR BLOOD 2552 01:33:17,124 --> 01:33:18,626 THROUGH FLOW CYTOMETRY TO LOOK 2553 01:33:18,693 --> 01:33:19,827 AT IMMUNE CELL POPULATIONS. 2554 01:33:19,894 --> 01:33:22,363 SO THIS IS FOR CD4 POSITIVE 2555 01:33:22,430 --> 01:33:24,999 CELLS AND ACTIVATED CD4 POSITIVE 2556 01:33:25,066 --> 01:33:26,434 CELLS, AND AGAIN, JUST LIKE YOU 2557 01:33:26,500 --> 01:33:29,837 WOULD EXPECT, WOMEN HAVE MORE 2558 01:33:29,904 --> 01:33:33,040 CD4 POSITIVE CELLS AND MORE 2559 01:33:33,107 --> 01:33:35,643 ACTIVATED -- THAN MEN DO 2560 01:33:35,710 --> 01:33:38,279 REGARDLESS OF WHETHER THEY ARE 2561 01:33:38,346 --> 01:33:40,114 CIS OR TRANS. 2562 01:33:40,181 --> 01:33:41,515 OBVIOUSLY HORMONES SHOULD HAVE A 2563 01:33:41,582 --> 01:33:43,351 MAJOR IMPACT ON IMMUNE CELL 2564 01:33:43,417 --> 01:33:43,651 POPULATIONS. 2565 01:33:43,718 --> 01:33:45,119 AS IT TURNED OUT WHEN WE RAN 2566 01:33:45,186 --> 01:33:48,389 THIS STUDY, WE HAD ONE TRANS MAN 2567 01:33:48,456 --> 01:33:49,490 AND ONE TRANS WOMAN THAT 2568 01:33:49,557 --> 01:33:51,258 REPORTED NOT BEING ON HRT. 2569 01:33:51,325 --> 01:33:52,693 WE HAVEN'T RUN THE HORMONE ASSAY 2570 01:33:52,760 --> 01:33:54,328 YET SO WE CAN'T CONFIRM ALL 2571 01:33:54,395 --> 01:33:56,564 THAT, BUT IF WE JUST GO BY 2572 01:33:56,630 --> 01:33:58,899 SELF-REPORT, WHAT WE SEE HERE IS 2573 01:33:58,966 --> 01:34:00,401 THAT THAT REALLY DOESN'T MAKE 2574 01:34:00,468 --> 01:34:01,702 MUCH OF A DIFFERENCE. 2575 01:34:01,769 --> 01:34:04,472 SO THE INDIVIDUALS NOT ON THE 2576 01:34:04,538 --> 01:34:07,208 HRT ARE ON THE DOTTED BARS BUT 2577 01:34:07,274 --> 01:34:09,176 THEY TEND TO BE VERY SIMILAR TO 2578 01:34:09,243 --> 01:34:10,277 THE OTHER INDIVIDUALS WITHIN 2579 01:34:10,344 --> 01:34:12,313 THAT GROUP. 2580 01:34:12,380 --> 01:34:15,016 NOW, AM I SUGGESTING THAT GENDER 2581 01:34:15,082 --> 01:34:16,150 IDENTITY AFFECTS CELL 2582 01:34:16,217 --> 01:34:16,584 POPULATIONS? 2583 01:34:16,650 --> 01:34:18,019 NO. 2584 01:34:18,085 --> 01:34:18,552 BUT MAYBE. 2585 01:34:18,619 --> 01:34:20,054 MAYBE I WILL BE A LITTLE BIT 2586 01:34:20,121 --> 01:34:21,622 LATER ON, ONCE WE HAVE MORE 2587 01:34:21,689 --> 01:34:22,189 DATA. 2588 01:34:22,256 --> 01:34:26,660 BUT IT DOES BEAR THINKING ABOUT. 2589 01:34:26,727 --> 01:34:28,629 NOW THE NEXT THING I WANTED TO 2590 01:34:28,696 --> 01:34:31,265 DO TO SORT OF BRING US BACK TO 2591 01:34:31,332 --> 01:34:33,467 THAT FIRST MOUSE STUDY IS A LOOK 2592 01:34:33,534 --> 01:34:34,935 ALL OF THESE INDIVIDUALS BASED 2593 01:34:35,002 --> 01:34:39,974 ON THEIR OWN SELF REPORTS, WHAT 2594 01:34:40,041 --> 01:34:41,809 THEIR PREDOMINANT HORMONE SHOULD 2595 01:34:41,876 --> 01:34:42,410 BE. 2596 01:34:42,476 --> 01:34:44,378 NOW AGAIN THIS IS ALL BASED ON 2597 01:34:44,445 --> 01:34:45,880 SELF-REPORT, SO FOR CYST MEN 2598 01:34:45,946 --> 01:34:48,215 THAT WOULD BE TESTOSTERONE, 2599 01:34:48,282 --> 01:34:49,483 TRANS WOMEN, THAT WOULD BE 2600 01:34:49,550 --> 01:34:50,017 ESTROGEN. 2601 01:34:50,084 --> 01:34:51,318 IF WE BROKE IT DOWN THAT WAY, 2602 01:34:51,385 --> 01:34:52,820 WHAT WE SEE FOR ALL THESE 2603 01:34:52,887 --> 01:34:55,589 DIFFERENT CELL POPULATIONS IS 2604 01:34:55,656 --> 01:34:57,358 THAT INDIVIDUALS WITH HIGHER -- 2605 01:34:57,425 --> 01:34:58,325 PRESUMABLY HIGHER LEVELS OF 2606 01:34:58,392 --> 01:34:59,794 ESTROGEN HAVE HIGHER LEVELS OF 2607 01:34:59,860 --> 01:35:01,562 ALL OF THESE DIFFERENT T-CELL 2608 01:35:01,629 --> 01:35:03,197 MARKERS. 2609 01:35:03,264 --> 01:35:06,700 SO CD3 POSITIVE, 4 POSITIVE, 2610 01:35:06,767 --> 01:35:08,903 8 POSITIVE, ACTIVATED CD8 AND 2611 01:35:08,969 --> 01:35:10,137 CD4 AND REGULATORY T CELLS. 2612 01:35:10,204 --> 01:35:13,507 SO AGAIN, RIGHT BACK TO THAT 2613 01:35:13,574 --> 01:35:15,142 ANIMAL STUDY SHOWING THAT 2614 01:35:15,209 --> 01:35:16,477 FEMALES JUST HAVE MORE OF THESE 2615 01:35:16,544 --> 01:35:16,844 CELLS. 2616 01:35:16,911 --> 01:35:18,779 AND THAT IS SOMETHING THAT'S 2617 01:35:18,846 --> 01:35:21,248 BEEN SEEN FOR MANY, MANY YEARS, 2618 01:35:21,315 --> 01:35:22,416 AND IS SEEN HERE. 2619 01:35:22,483 --> 01:35:24,885 SO FROM OUR DATA SO FAR, IT 2620 01:35:24,952 --> 01:35:26,787 WOULD SUGGEST THAT GENDER 2621 01:35:26,854 --> 01:35:28,756 DIFFERENCES ARE THE KEY PLAYER 2622 01:35:28,823 --> 01:35:31,258 WHEN IT COMES TO ACUTE PAIN 2623 01:35:31,325 --> 01:35:32,960 SENSITIVITY THAT SEEMS TO BE 2624 01:35:33,027 --> 01:35:34,728 INDEPENDENT OF SEX ASSIGNED AT 2625 01:35:34,795 --> 01:35:38,399 BIRTH OR GENDER MINORITY STATUS. 2626 01:35:38,466 --> 01:35:39,700 WHETHER CIS OR TRANS. 2627 01:35:39,767 --> 01:35:40,801 HOWEVER, AND THIS IS WHERE IT 2628 01:35:40,868 --> 01:35:42,136 GETS A LITTLE BIT MORE 2629 01:35:42,203 --> 01:35:43,337 COMPLICATED, WHEN WE START 2630 01:35:43,404 --> 01:35:46,006 LOOKING AT THE PSYCHOSOCIAL 2631 01:35:46,073 --> 01:35:49,243 ASPECTS, WE SEE THAT THERE ARE 2632 01:35:49,310 --> 01:35:51,812 VERY BIG DIFFERENCES THAT SEEM 2633 01:35:51,879 --> 01:35:54,648 TO SEGREGATE BASED ON GENERAL 2634 01:35:54,715 --> 01:36:00,688 GENDERMINORITY ASPECTS. 2635 01:36:00,754 --> 01:36:02,790 SO ON YOU CAN SEE TRANS 2636 01:36:02,857 --> 01:36:03,991 INDIVIDUALS REPORT HIGHER LEVELS 2637 01:36:04,058 --> 01:36:06,026 THAN OUR CIS INDIVIDUALS. 2638 01:36:06,093 --> 01:36:08,162 SO IT ISN'T AS SIMPLE AS JUST 2639 01:36:08,229 --> 01:36:11,665 JEB DGENDER DIFFERENCES. 2640 01:36:11,732 --> 01:36:12,633 GENDER AND GENDER MINORITY 2641 01:36:12,700 --> 01:36:14,001 STATUS ALSO PLAYS A VERY BIG 2642 01:36:14,068 --> 01:36:14,969 ROLE IN THESE DIFFERENT 2643 01:36:15,035 --> 01:36:16,504 POPULATIONS. 2644 01:36:16,570 --> 01:36:18,072 WHEN WE LOOK AT FINANCIAL 2645 01:36:18,139 --> 01:36:19,140 SECURITY, AND AGAIN, THIS IS 2646 01:36:19,206 --> 01:36:20,908 JUST SELF-REPORTED FINANCIAL 2647 01:36:20,975 --> 01:36:24,178 SECURITY OR INSECURITY, WE SEE 2648 01:36:24,245 --> 01:36:25,279 OUR TRANS INDIVIDUALS ARE MORE 2649 01:36:25,346 --> 01:36:27,314 LIKELY TO REPORT BEING SOMEWHAT 2650 01:36:27,381 --> 01:36:29,650 INSECURE OR TOTALLY FINANCIALLY 2651 01:36:29,717 --> 01:36:31,051 INSECURE. 2652 01:36:31,118 --> 01:36:34,989 WHICH, AGAIN, SPEAKS TO ALL OF 2653 01:36:35,055 --> 01:36:35,756 THESE VARIABLES. 2654 01:36:35,823 --> 01:36:36,891 NOW THE LAST THING I WANT TO 2655 01:36:36,957 --> 01:36:38,425 MENTION IS, AGAIN, A VERY 2656 01:36:38,492 --> 01:36:41,228 INTERINTERESTING THING FOR US. 2657 01:36:41,295 --> 01:36:43,164 WE HAD A SIMILAR STUDY RUNNING 2658 01:36:43,230 --> 01:36:46,467 THAT ENROLLED THREE NON-BINARY 2659 01:36:46,534 --> 01:36:48,802 ADULTS SO I WANT TO SHOW YOU HOW 2660 01:36:48,869 --> 01:36:50,804 THOSE DATA STACK UP AGAINST OUR 2661 01:36:50,871 --> 01:36:55,042 DATA SO FAR. 2662 01:36:55,109 --> 01:36:57,011 IN THE COLD PRESSOR TEST AND 2663 01:36:57,077 --> 01:36:59,480 HEAT THRESHOLD, THE NON-BINARY 2664 01:36:59,547 --> 01:37:00,548 ARE SHOWN IN BLUE THERE. 2665 01:37:00,614 --> 01:37:01,882 WHAT YOU'LL NOTICE IS THEY MAP 2666 01:37:01,949 --> 01:37:03,717 VERY CLOSELY TO THE WOMEN. 2667 01:37:03,784 --> 01:37:08,789 NOW, AS IT TUSHES TURNS OUT, AE 2668 01:37:08,856 --> 01:37:11,559 WERE ASSIGNED FEMALE AT BIRTH. 2669 01:37:11,625 --> 01:37:13,794 SO FAR WE DON'T KNOW WHETHER 2670 01:37:13,861 --> 01:37:15,329 NON-BINARY INDIVIDUALS ARE MORE 2671 01:37:15,396 --> 01:37:18,032 SENSITIVE AND THAT HAPPENS TO BE 2672 01:37:18,098 --> 01:37:21,368 MORE SIMILAR TO THE WOMEN, OR, 2673 01:37:21,435 --> 01:37:22,670 WHETHER IN THE ABSENCE OF 2674 01:37:22,736 --> 01:37:24,371 IDENTIFYING AS A BINARY GENDER, 2675 01:37:24,438 --> 01:37:25,973 SEX THEN BECOMES THE DETERMINING 2676 01:37:26,040 --> 01:37:26,774 FACTOR WHEN IT COMES TO PAIN 2677 01:37:26,840 --> 01:37:29,176 SENSITIVITY. 2678 01:37:29,243 --> 01:37:32,046 HOPEFULLY I CAN ANSWER THAT 2679 01:37:32,112 --> 01:37:33,781 QUESTION, BECAUSE WE'VE APPLIED 2680 01:37:33,847 --> 01:37:35,216 FOR AN ADMINISTRATIVE SUPPLEMENT 2681 01:37:35,282 --> 01:37:36,483 TO DO THIS, TO ADD 40 2682 01:37:36,550 --> 01:37:39,153 INDIVIDUALS TO THE STUDY TO SEE 2683 01:37:39,220 --> 01:37:40,888 WHERE THAT FALLS. 2684 01:37:40,955 --> 01:37:42,289 SO WE'RE REALLY EXCITED ABOUT 2685 01:37:42,356 --> 01:37:45,259 THAT POTENTIAL. 2686 01:37:45,326 --> 01:37:46,694 SO HOPEFULLY IN ANOTHER FEW 2687 01:37:46,760 --> 01:37:47,861 YEARS, I'LL BE ABLE TO TELL YOU 2688 01:37:47,928 --> 01:37:50,364 THE ANSWER TO THAT QUESTION. 2689 01:37:50,431 --> 01:37:52,099 SO FOR RIGHT NOW, FINAL 2690 01:37:52,166 --> 01:37:54,034 THOUGHTS, SEX AND HORMONES PLAY 2691 01:37:54,101 --> 01:37:57,037 A KEY ROLE IN THOSE NEUROIMMUNE 2692 01:37:57,104 --> 01:37:57,404 PAIN MECHANISMS. 2693 01:37:57,471 --> 01:37:58,906 WE'VE SHOWN THAT IN ANIMALS, WE 2694 01:37:58,973 --> 01:38:01,675 SEE THAT IN PEOPLE AS WELL. 2695 01:38:01,742 --> 01:38:04,245 BUT GENDER IDENTITY PROBABLY 2696 01:38:04,311 --> 01:38:07,481 PLAYS A MUCH BIGGER ROLE IN PAIN 2697 01:38:07,548 --> 01:38:09,083 EXPERIENCE, BUT ALL OF THESE 2698 01:38:09,149 --> 01:38:10,851 OTHER ASPECTS OF THIS 2699 01:38:10,918 --> 01:38:12,152 BIOPSYCHOSOCIAL MODEL DEFINITELY 2700 01:38:12,219 --> 01:38:16,423 INTERACT IN ORDER TO REALLY 2701 01:38:16,490 --> 01:38:17,191 CREATE THAT WHOLE PAIN 2702 01:38:17,258 --> 01:38:18,225 EXPERIENCE AND SHOULD BE TAKEN 2703 01:38:18,292 --> 01:38:20,861 INTO ACCOUNT. 2704 01:38:20,928 --> 01:38:22,363 SO I TRIED TO SPEED THROUGH THIS 2705 01:38:22,429 --> 01:38:24,031 TO GET US CLOSER TO ON TIME. 2706 01:38:24,098 --> 01:38:24,832 SO I WANT TO THANK THE PEOPLE 2707 01:38:24,898 --> 01:38:26,267 THAT HELPED ALONG THE WAY, IN 2708 01:38:26,333 --> 01:38:30,037 JEFF'S LAB, MY COLLABORATOR, 2709 01:38:30,104 --> 01:38:33,407 BUREL GOODIN, MY LAB AT UAB, OUR 2710 01:38:33,474 --> 01:38:35,209 FUNDING SOURCES, OF COURSE, AND 2711 01:38:35,276 --> 01:38:35,809 THE TWO COMMUNITY GROUPS THAT 2712 01:38:35,876 --> 01:38:38,846 HAVE HELPED US WITH THIS SHINE 2713 01:38:38,912 --> 01:38:40,681 STUDY, BIRMINGHAM AIDS OUTREACH 2714 01:38:40,748 --> 01:38:41,715 AND TAKE BIRMINGHAM. 2715 01:38:41,782 --> 01:38:42,683 SO WITH THAT, THANK YOU VERY 2716 01:38:42,750 --> 01:38:52,860 MUCH. 2717 01:38:54,995 --> 01:38:57,031 >> THANK YOU, ROB. 2718 01:38:57,097 --> 01:38:59,600 THAT WAS VERY STIMULATING AND A 2719 01:38:59,667 --> 01:39:00,501 LOT OF INTERESTING FINDINGS. 2720 01:39:00,567 --> 01:39:02,202 I'M SURE THERE WILL BE MANY 2721 01:39:02,269 --> 01:39:06,774 QUESTIONS AND THEORIES ON THAT, 2722 01:39:06,840 --> 01:39:08,075 AND REALLY LOOKING FORWARD FOR 2723 01:39:08,142 --> 01:39:09,176 MORE LIKE ACTIVE DISCUSSION ON 2724 01:39:09,243 --> 01:39:10,277 THAT. 2725 01:39:10,344 --> 01:39:12,246 IT'S REALLY EXCITING. 2726 01:39:12,313 --> 01:39:16,317 SO OUR NEXT SPEAKER IS DR. HANNA 2727 01:39:16,383 --> 01:39:16,784 GROL-PROKOPCZYK. 2728 01:39:16,850 --> 01:39:19,720 I AM SORRY IF I'M -- I APOLOGIZE 2729 01:39:19,787 --> 01:39:21,088 IF I'M PRONOUNCING YOUR NAME 2730 01:39:21,155 --> 01:39:23,157 WRONG. 2731 01:39:23,223 --> 01:39:26,460 SHE'S AN ASSOCIATE PROFESSOR OF 2732 01:39:26,527 --> 01:39:30,931 SOCIOLOGY AT UNIVERSITY AT 2733 01:39:30,998 --> 01:39:33,033 BUFFALO, MEDICAL SOCIOLOGIST AND 2734 01:39:33,100 --> 01:39:33,701 DEMOGRAPHER. 2735 01:39:33,767 --> 01:39:35,135 REALLY INTERESTING BACKGROUND 2736 01:39:35,202 --> 01:39:37,571 AND BRINGS SOME VERY IMPORTANT 2737 01:39:37,638 --> 01:39:42,743 PROSPECT TO THIS ASPECT OF PAIN. 2738 01:39:42,810 --> 01:39:45,779 SHE HAS BEEN STUDYING PAIN, 2739 01:39:45,846 --> 01:39:48,115 CHRONIC PAIN AND MULTIPLE ANGLES 2740 01:39:48,182 --> 01:39:49,383 LIKE ITS MEASUREMENTS, THE 2741 01:39:49,450 --> 01:39:50,751 SOCIAL DISTRIBUTION, 2742 01:39:50,818 --> 01:39:51,985 CONSEQUENCES, INCLUDING OPIOID 2743 01:39:52,052 --> 01:39:56,323 USE AND MORTALITY, AND SHE ALSO 2744 01:39:56,390 --> 01:39:57,925 CONDUCTED A SEARCH ON HOW 2745 01:39:57,991 --> 01:40:03,063 SURVEYS CAN REALLY BEST -- 2746 01:40:03,130 --> 01:40:03,797 INTERPERSONALLY AS WELL AS 2747 01:40:03,864 --> 01:40:04,698 INTERNATIONALLY, HOW IT CAN 2748 01:40:04,765 --> 01:40:08,001 REALLY BE MADE COMPARABLE WITH 2749 01:40:08,068 --> 01:40:09,870 THOSE FINDINGS, MEASURES AND 2750 01:40:09,937 --> 01:40:10,838 SUBJECT TO HEALTH CONDITIONS NOT 2751 01:40:10,904 --> 01:40:13,273 ONLY IN THE U.S. BUT ALSO 2752 01:40:13,340 --> 01:40:15,008 INTERNATIONALLY AND SHE ALSO 2753 01:40:15,075 --> 01:40:18,912 SERVES ON THE U.S. -- POLICY 2754 01:40:18,979 --> 01:40:21,115 SIDE, SO SHE'LL TALK ON 2755 01:40:21,181 --> 01:40:22,549 CORRELATES OF CHRONIC PAIN BY 2756 01:40:22,616 --> 01:40:23,250 SEXUAL IDENTITY. 2757 01:40:23,317 --> 01:40:33,727 SO PLEASE TAKE IT AWAY. 2758 01:40:36,096 --> 01:40:37,398 >> SO I JUST WANT TO CHECK IF I 2759 01:40:37,464 --> 01:40:38,365 WILL BE DRIVING. 2760 01:40:38,432 --> 01:40:38,966 I THINK I CAN. 2761 01:40:39,032 --> 01:40:43,103 ALL RIGHT. 2762 01:40:43,170 --> 01:40:44,204 THANK YOU SO MUCH FOR INVITING 2763 01:40:44,271 --> 01:40:44,538 ME. 2764 01:40:44,605 --> 01:40:45,773 IT'S AN HONOR TO BE HERE. 2765 01:40:45,839 --> 01:40:46,807 SO MUCH OF WHAT I'M GOING TO 2766 01:40:46,874 --> 01:40:48,275 TALK ABOUT TODAY IS KEY FINDINGS 2767 01:40:48,342 --> 01:40:50,344 FROM A PAPER THAT MY RESEARCH 2768 01:40:50,411 --> 01:40:53,514 GROUP PUBLISHED LAST YEAR ON 2769 01:40:53,580 --> 01:40:55,282 CHRONIC PAIN PREVALENCE IN 2770 01:40:55,349 --> 01:40:57,484 SEXUAL AND MINORITY GROUPS. 2771 01:40:57,551 --> 01:41:02,189 BUT I WILL ALSO HEED THE CALL TO 2772 01:41:02,256 --> 01:41:04,858 LOOK AT EVERYTHING, YOU KNOW, 2773 01:41:04,925 --> 01:41:08,128 INTERSECTED WITH SEX/GENDER, SO 2774 01:41:08,195 --> 01:41:09,897 I'LL ALSO SHARE FINDINGS 2775 01:41:09,963 --> 01:41:11,031 FOCUSING SPECIFICALLY ON THIS. 2776 01:41:11,098 --> 01:41:13,000 SO THIS RESEARCH IS SUPPORTED BY 2777 01:41:13,066 --> 01:41:15,002 AN R01 FROM THE NATIONAL 2778 01:41:15,068 --> 01:41:17,438 INSTITUTE ON AGING THAT I'M VERY 2779 01:41:17,504 --> 01:41:18,872 GRATEFUL FOR, AND THE PAPER I 2780 01:41:18,939 --> 01:41:23,110 MENTIONED WAS LEAD AUTHORED BY 2781 01:41:23,177 --> 01:41:25,045 MYCO-INVESTIGATOR AND FREQUENT 2782 01:41:25,112 --> 01:41:27,448 COLLABORATOR, ANNA ZAJACOVA, 2783 01:41:27,514 --> 01:41:33,954 ALONG WITH HUI LIU, RIN AND 2784 01:41:34,021 --> 01:41:34,421 RICHARD. 2785 01:41:34,488 --> 01:41:35,856 SO SINCE THE HIV/AIDS EPIDEMIC 2786 01:41:35,923 --> 01:41:38,358 OF THE 1980s, THERE'S BEEN 2787 01:41:38,425 --> 01:41:39,927 GROWING INTEREST IN HEALTH AMONG 2788 01:41:39,993 --> 01:41:41,995 SEXUAL MINORITIES. 2789 01:41:42,062 --> 01:41:45,165 AND IF YOU HAD TO SORT OF 2790 01:41:45,232 --> 01:41:46,667 SUMMARIZE A WHOLE BODY OF 2791 01:41:46,733 --> 01:41:47,868 RESEARCH IN ONE SENTENCE, YOU 2792 01:41:47,935 --> 01:41:49,736 MIGHT SAY SOMETHING LIKE STUDIES 2793 01:41:49,803 --> 01:41:51,505 OFTEN BUT NOT ALWAYS FIND THAT 2794 01:41:51,572 --> 01:41:53,707 SEXUAL MINORITIES HAVE HIGHER 2795 01:41:53,774 --> 01:41:55,242 MORTALITY AND WORSE MENTAL AND 2796 01:41:55,309 --> 01:41:56,243 PHYSICAL HEALTH THAN STRAIGHT 2797 01:41:56,310 --> 01:41:59,313 INDIVIDUALS. 2798 01:41:59,379 --> 01:42:00,514 HOWEVER, THERE ARE EXCEPTIONS 2799 01:42:00,581 --> 01:42:01,582 AND ALSO THESE FINDINGS CONTINUE 2800 01:42:01,648 --> 01:42:02,649 OVER TIME. 2801 01:42:02,716 --> 01:42:07,321 SO FOR EXAMPLE, THE ACCESS 2802 01:42:07,387 --> 01:42:09,323 MORTALITY OF GAY MEN RELATIVE TO 2803 01:42:09,389 --> 01:42:11,792 STRAIGHTMEN THAT EMERGED DURING 2804 01:42:11,859 --> 01:42:13,393 THE HIV EPIDEMIC, RECENT STUDIES 2805 01:42:13,460 --> 01:42:15,362 THAT LOOK AT YOUNGER COHORTS 2806 01:42:15,429 --> 01:42:17,364 DON'T SEW THAT. 2807 01:42:17,431 --> 01:42:19,066 SEE THAT, THEY SEE NO 2808 01:42:19,132 --> 01:42:20,834 MORTALITY DISADVANTAGE FOR GAY 2809 01:42:20,901 --> 01:42:21,001 MEN. 2810 01:42:21,068 --> 01:42:21,835 YOU MIGHT ALSO THINK, WELL, 2811 01:42:21,902 --> 01:42:24,137 THERE HAVE BEEN A LOT OF 2812 01:42:24,204 --> 01:42:25,672 IMPORTANT LEGISLATIVE VICTORIES 2813 01:42:25,739 --> 01:42:27,241 FOR SEXUAL MINORITIES, THERE'S 2814 01:42:27,307 --> 01:42:31,879 GREATER SOCIAL ACCEPTANCE, BUT 2815 01:42:31,945 --> 01:42:32,946 WE CAN'T ASSUME THAT CHANGES 2816 01:42:33,013 --> 01:42:34,281 OVER TIME WILL ALWAYS BE CHANGES 2817 01:42:34,348 --> 01:42:36,750 FOR THE BETTER. 2818 01:42:36,817 --> 01:42:40,354 IN FACT, A RECENT STUDY BY LIU 2819 01:42:40,420 --> 01:42:42,789 AND RECZEK FOUND THAT MENTAL 2820 01:42:42,856 --> 01:42:44,258 HEALTH DISPARITIES BY SEXUAL 2821 01:42:44,324 --> 01:42:48,695 IDENTITY ARE ACTUALLY LARGER FOR 2822 01:42:48,762 --> 01:42:51,131 YOUNGER COHORT, MILLENNIALS, 2823 01:42:51,198 --> 01:42:54,801 THAN THEY ARE FOR GEN X'ERS OR 2824 01:42:54,868 --> 01:42:57,204 BABY BOOMERS, SO GREATER HEALTH 2825 01:42:57,271 --> 01:42:57,437 PENALTY. 2826 01:42:57,504 --> 01:43:00,774 SO WE HAVE TO SORT OF KEEP 2827 01:43:00,841 --> 01:43:01,308 MONITORING. 2828 01:43:01,375 --> 01:43:03,510 REGARDING CHRONIC PAIN IN 2829 01:43:03,577 --> 01:43:06,713 PARTICULAR, SO CHRONIC PAIN IS 2830 01:43:06,780 --> 01:43:07,948 VERY COMMON AND VERY COSTLY. 2831 01:43:08,015 --> 01:43:09,449 THIS AUDIENCE PROBABLY IS 2832 01:43:09,516 --> 01:43:10,350 ALREADY AWARE. 2833 01:43:10,417 --> 01:43:13,520 BUT I'M JUST GOING TO ADD TO 2834 01:43:13,587 --> 01:43:20,494 THAT, THAT CHRONIC PAIN IS 2835 01:43:20,561 --> 01:43:21,795 FAIRLY UNIQUE AMONG COMMON 2836 01:43:21,862 --> 01:43:24,498 CHRONIC HEALTH CONDITIONS TO THE 2837 01:43:24,565 --> 01:43:26,567 EXTENT THAT IT CORRELATES 2838 01:43:26,633 --> 01:43:28,702 STRONGLY WITH PHYSICAL HEALTH 2839 01:43:28,769 --> 01:43:30,704 CONDITIONS AND MENTAL HEALTH, 2840 01:43:30,771 --> 01:43:31,905 DEPRESSION AND ANXIETY IN 2841 01:43:31,972 --> 01:43:32,539 PARTICULAR. 2842 01:43:32,606 --> 01:43:34,942 SO BECAUSE OF THAT ABILITY TO 2843 01:43:35,008 --> 01:43:36,343 PICK UP ON PHYSICAL AND MENTAL 2844 01:43:36,410 --> 01:43:37,778 HEALTH, THAT'S ONE REASON THAT 2845 01:43:37,844 --> 01:43:41,348 WE'VE ARGUED THAT PAIN IS A 2846 01:43:41,415 --> 01:43:42,249 PARTICULARLY SENSITIVE BAROMETER 2847 01:43:42,316 --> 01:43:45,485 OF POPULATION HEALTH. 2848 01:43:45,552 --> 01:43:47,788 NONETHELESS, WE FOUND ONLY ONE, 2849 01:43:47,854 --> 01:43:48,889 SPECIFICALLY ON HEADACHE, THAT 2850 01:43:48,956 --> 01:43:51,158 USED NATIONAL DATA TO 2851 01:43:51,224 --> 01:43:52,459 CHARACTERIZE PAIN BY SEXUAL 2852 01:43:52,526 --> 01:43:53,427 IDENTITY. 2853 01:43:53,493 --> 01:43:54,962 WHEN WE STARTED WORKING ON THIS 2854 01:43:55,028 --> 01:44:00,867 PAPER AROUND 2021. 2855 01:44:00,934 --> 01:44:02,603 ALSO SOME GROUPS ARE 2856 01:44:02,669 --> 01:44:09,142 UNDERSTUDIES, SO HISTORIC AND WA 2857 01:44:09,209 --> 01:44:10,811 GROWING NUMBER OF INDIVIDUALS 2858 01:44:10,877 --> 01:44:12,346 THAT ARE CLASSIFIED AS 2859 01:44:12,412 --> 01:44:14,214 "SOMETHING ELSE," SO NOT 2860 01:44:14,281 --> 01:44:19,419 STRAIGHT, GAY, LESS TB LESBIAN R 2861 01:44:19,486 --> 01:44:24,024 BISEXUAL AND THAT GROUP REMAINS 2862 01:44:24,091 --> 01:44:27,494 UNDERSTUDIED, AND THOSE WITH 2863 01:44:27,561 --> 01:44:28,261 DISPARITIES NEED TO BE STUDIED 2864 01:44:28,328 --> 01:44:28,795 MORE. 2865 01:44:28,862 --> 01:44:31,098 SO OUR GOAL IN THIS STUDY WAS 2866 01:44:31,164 --> 01:44:32,165 FIRST TO CHARACTERIZE PAIN 2867 01:44:32,232 --> 01:44:34,201 PREVALENCE BY SEXUAL IDENTITY 2868 01:44:34,267 --> 01:44:35,469 USING NATIONALLY REPRESENTATIVE 2869 01:44:35,535 --> 01:44:37,337 DATA AND INCLUDING LESS COMMONLY 2870 01:44:37,404 --> 01:44:38,905 STUDIED GROUPS, AND SECOND, TO 2871 01:44:38,972 --> 01:44:41,908 THE EXTENT THAT WE COULD, USING 2872 01:44:41,975 --> 01:44:43,010 CROSS-SECTIONAL DATA, TO SEE IF 2873 01:44:43,076 --> 01:44:45,345 WE COULD IDENTIFY SOME POTENTIAL 2874 01:44:45,412 --> 01:44:47,214 MECHANISMS FOR THE OBSERVED 2875 01:44:47,280 --> 01:44:52,352 DISPARITY. 2876 01:44:52,419 --> 01:44:54,321 SO WE USED SIX CONSECUTIVE YEARS 2877 01:44:54,388 --> 01:44:56,023 OF DATA FROM THE NATIONAL HEALTH 2878 01:44:56,089 --> 01:44:57,658 INTERVIEW SURVEY. 2879 01:44:57,724 --> 01:44:58,892 POOLED THEM TOGETHER TO MAXIMIZE 2880 01:44:58,959 --> 01:44:59,993 OUR SAMPLE SIZE. 2881 01:45:00,060 --> 01:45:01,995 WE STARTED WITH 2013, SINCE THAT 2882 01:45:02,062 --> 01:45:06,133 WAS THE FIRST YEAR IN WHICH -- 2883 01:45:06,199 --> 01:45:08,502 ASKED ABOUT SEXUAL IDENTITY, AND 2884 01:45:08,568 --> 01:45:10,303 WENT THROUGH 2018, THE LAST YEAR 2885 01:45:10,370 --> 01:45:15,676 BEFORE A MAJOR SURVEY REDESIGN 2886 01:45:15,742 --> 01:45:18,078 PRECLUDED FROM LATER YEARS. 2887 01:45:18,145 --> 01:45:20,247 USUALLY WHEN WE USE NH IS, WE 2888 01:45:20,313 --> 01:45:22,015 USE THE FULL ADULT AGE RANGE, 2889 01:45:22,082 --> 01:45:24,584 BUT BECAUSE WE WANTED TO INCLUDE 2890 01:45:24,651 --> 01:45:26,787 THE BISEXUAL AND SOMETHING ELSE 2891 01:45:26,853 --> 01:45:29,089 GROUPS, AND VERY FEW INDIVIDUALS 2892 01:45:29,156 --> 01:45:32,125 ABOVE AGE 64 IDENTIFIED IN THAT 2893 01:45:32,192 --> 01:45:36,897 WAY, FOR SAMPLE SIZE REASONS, WE 2894 01:45:36,963 --> 01:45:39,866 DECIDED TO CAP OUR AGE RANGE AT 2895 01:45:39,933 --> 01:45:40,467 AGE 64. 2896 01:45:40,534 --> 01:45:43,136 BUT WE DID LOOK AT FINDINGS 2897 01:45:43,203 --> 01:45:44,404 THROUGH AGE 84 FOR STRAIGHT, GAY 2898 01:45:44,471 --> 01:45:46,606 AND LESBIAN INDIVIDUALS AND THE 2899 01:45:46,673 --> 01:45:48,175 BASIC PATTERNS I'M GOING TO SHOW 2900 01:45:48,241 --> 01:45:50,310 YOU ARE OBSERVED IN THOSE OLDER 2901 01:45:50,377 --> 01:45:51,945 AGE GROUPS AS WELL. 2902 01:45:52,012 --> 01:45:53,814 SO WE ACTUALLY LOOKED AT A WHOLE 2903 01:45:53,880 --> 01:45:54,881 BUNCH OF PAIN MEASURES. 2904 01:45:54,948 --> 01:45:56,850 THERE ARE A LOT OF WAYS YOU CAN 2905 01:45:56,917 --> 01:45:59,419 CONSTRUCT PAIN MEASURES FROM 2906 01:45:59,486 --> 01:46:01,154 NHIS DATA, BUT IN THE PAPER, WE 2907 01:46:01,221 --> 01:46:03,623 HIGHLIGHTED TWO OF THEM, AND SO 2908 01:46:03,690 --> 01:46:05,158 I'M GOING TO FOCUS ON THOSE HERE 2909 01:46:05,225 --> 01:46:08,562 AS WELL. 2910 01:46:08,628 --> 01:46:10,130 CHRONIC PAIN WAS OPERATIONALIZED 2911 01:46:10,197 --> 01:46:12,866 HERE AS HAVING PAIN MOST DAYS OR 2912 01:46:12,933 --> 01:46:14,568 EVERY DAY IN THE PAST THREE TO 2913 01:46:14,634 --> 01:46:15,402 SIX MONTHS. 2914 01:46:15,469 --> 01:46:16,937 SAMPLE SIZE FOR THOSE ANALYSES 2915 01:46:17,003 --> 01:46:19,272 WAS OVER 95,000. 2916 01:46:19,339 --> 01:46:22,876 AND OUR SAMPLE ADJUSTED 2917 01:46:22,943 --> 01:46:24,511 PREVALENCE WAS 17.4%. 2918 01:46:24,578 --> 01:46:26,113 THAT IS A LITTLE LOWER THAN THE 2919 01:46:26,179 --> 01:46:29,082 COMMONLY CITED FIGURE OF 20% 2920 01:46:29,149 --> 01:46:30,717 CHRONIC PAIN PREVALENCE IN THE 2921 01:46:30,784 --> 01:46:32,285 COUNTRY, BUT REMEMBER WE 2922 01:46:32,352 --> 01:46:33,954 EXCLUDED PEOPLE OVER AGE 64, AND 2923 01:46:34,020 --> 01:46:36,456 THEY WOULD HAVE RAISED THAT 2924 01:46:36,523 --> 01:46:37,891 NUMBER. 2925 01:46:37,958 --> 01:46:39,559 THE SECOND MEASURE IS PAIN IN 2926 01:46:39,626 --> 01:46:42,596 THREE OR MORE SITES OUT OF THE 2927 01:46:42,662 --> 01:46:45,065 FIVE SITES THAT NHIS ASKS ABOUT. 2928 01:46:45,132 --> 01:46:47,033 SO IT ASKS ABOUT LOW BACK PAIN, 2929 01:46:47,100 --> 01:46:50,370 NECK PAIN, SEVERE HEADACHE OR 2930 01:46:50,437 --> 01:46:51,905 MIGRAINE, FACIAL/JAW PAIN AND 2931 01:46:51,972 --> 01:46:52,773 JOINT PAIN. 2932 01:46:52,839 --> 01:46:55,142 AND FOR THOSE ANALYSES, OUR 2933 01:46:55,208 --> 01:46:57,010 SAMPLE SIZE WAS ABOVE 130,000 2934 01:46:57,077 --> 01:47:01,314 AND THE PREVALENCE WAS 11.7%. 2935 01:47:01,381 --> 01:47:04,184 THE SEXUAL IDENTITY QUESTION IN 2936 01:47:04,251 --> 01:47:05,919 NHIS READS, WHICH BEST 2937 01:47:05,986 --> 01:47:08,021 REPRESENTS HOW YOU THINK OF 2938 01:47:08,088 --> 01:47:09,022 YOURSELF? 2939 01:47:09,089 --> 01:47:10,357 LESBIAN OR GAY, STRAIGHT, THAT 2940 01:47:10,423 --> 01:47:12,159 IS NOT GAY, BISEXUAL, OR 2941 01:47:12,225 --> 01:47:15,095 SOMETHING ELSE? 2942 01:47:15,162 --> 01:47:17,297 AND WE ALSO HAD A COUPLE DOZEN 2943 01:47:17,364 --> 01:47:24,738 VO CACOVARIATES, DEMOGRAPHIC, 2944 01:47:24,805 --> 01:47:26,439 SOCIOECONOMIC, HEALTH 2945 01:47:26,506 --> 01:47:28,208 BEHAVIORS/HEALTHCARE, AND 2946 01:47:28,275 --> 01:47:29,609 PSYCHOLOGICAL DISTRESS THAT WE 2947 01:47:29,676 --> 01:47:31,444 OBSERVED AS POTENTIAL MEDIATORS 2948 01:47:31,511 --> 01:47:33,713 OF DISPARITIES. 2949 01:47:33,780 --> 01:47:38,318 I WANT THED TO HIGHLIGHT THESE,E 2950 01:47:38,385 --> 01:47:40,287 PSYCHOLOGICAL DISTRESS MEASURE 2951 01:47:40,353 --> 01:47:43,590 THAT WAS THE KESSLER 6 ITEM 2952 01:47:43,657 --> 01:47:44,958 SCALE THAT ASKS PEOPLE HOW 2953 01:47:45,025 --> 01:47:47,394 FREQUENTLY IN THE PAST MONTH 2954 01:47:47,460 --> 01:47:49,629 THEY FELT SAD, RESTLESS, 2955 01:47:49,696 --> 01:47:52,265 HOPELESS, WORTHLESS, NERVOUS, OR 2956 01:47:52,332 --> 01:47:54,467 LIKE EVERYTHING WAS AN EFFORT. 2957 01:47:54,534 --> 01:47:55,402 SO ESSENTIALLY THIS IS TRYING TO 2958 01:47:55,468 --> 01:47:56,903 GET AT SYMPTOMS OF DEPRESSION 2959 01:47:56,970 --> 01:47:59,439 AND ANXIETY. 2960 01:47:59,506 --> 01:48:02,475 YOU MIGHT BE WONDERING WHO 2961 01:48:02,542 --> 01:48:05,412 IDENTIFIES AS SOMETHING ELSE IN 2962 01:48:05,478 --> 01:48:06,613 TERMS OF SEXUAL IDENTITY. 2963 01:48:06,680 --> 01:48:10,984 SO I'M REALLY GRATEFUL TO 2964 01:48:11,051 --> 01:48:12,252 RICHARD WHO POINTED OUT TO US 2965 01:48:12,319 --> 01:48:14,921 THAT WHEN NIHS IS DEVELOPING OR 2966 01:48:14,988 --> 01:48:16,556 FIELDING NEW QUESTION, THEY DO 2967 01:48:16,623 --> 01:48:18,024 IN DEPTH COGNITIVE INTERVIEWS 2968 01:48:18,091 --> 01:48:19,926 AND THERE'S A GREAT REPORT THAT 2969 01:48:19,993 --> 01:48:22,829 SUMMARIZES WHAT THEY LEARNED 2970 01:48:22,896 --> 01:48:24,831 FROM THE 386 PEOPLE WHO THEY 2971 01:48:24,898 --> 01:48:25,532 INTERVIEWED ASKING THEM WHAT 2972 01:48:25,599 --> 01:48:27,033 THEY MEANT OR HOW THEY 2973 01:48:27,100 --> 01:48:28,268 INTERPRETED THE SEXUAL IDENTITY 2974 01:48:28,335 --> 01:48:30,871 QUESTION. 2975 01:48:30,937 --> 01:48:33,139 FROM THAT, WE LEARNED THAT MANY 2976 01:48:33,206 --> 01:48:33,740 TRANSGENDER INDIVIDUALS CHOSE 2977 01:48:33,807 --> 01:48:35,775 THE "SOMETHING ELSE" CATEGORY, 2978 01:48:35,842 --> 01:48:38,612 SO ALREADY A FIRST HINT THAT YOU 2979 01:48:38,678 --> 01:48:41,848 CAN'T REALLY ANALYZE SEXUAL 2980 01:48:41,915 --> 01:48:46,419 IDENTITY IN ISOLATION OF GENDER. 2981 01:48:46,486 --> 01:48:49,089 PEOPLE IDENTIFIED AS QUEER, 2982 01:48:49,155 --> 01:48:50,757 PEOPLE WHO REJECTED OTHER LABELS 2983 01:48:50,824 --> 01:48:53,393 OR AT LEAST THE LABELS THAT NHIS 2984 01:48:53,460 --> 01:48:54,594 OFFERED, AND PEOPLE WHO 2985 01:48:54,661 --> 01:48:57,364 IDENTIFIED AS ASEXUAL. 2986 01:48:57,430 --> 01:48:59,032 SO THIS REASSURES US THAT THE 2987 01:48:59,099 --> 01:49:00,333 "SOMETHING ELSE" GROUP, THIS 2988 01:49:00,400 --> 01:49:02,302 WASN'T JUST SYNONYMOUS WITH, YOU 2989 01:49:02,369 --> 01:49:04,104 KNOW, DON'T KNOW/REFUSE, WITH 2990 01:49:04,170 --> 01:49:08,541 YOU PEOPLBUTPEOPLE WERE SELECTIS 2991 01:49:08,608 --> 01:49:10,410 CATEGORY DELIBERATELY AND IT'S A 2992 01:49:10,477 --> 01:49:12,712 MEANINGFUL CATEGORY. 2993 01:49:12,779 --> 01:49:14,648 SO OUR MAIN RESULT, I GUESS, CAN 2994 01:49:14,714 --> 01:49:17,651 BE SUMMARIZED WITH THIS FIGURE. 2995 01:49:17,717 --> 01:49:20,453 YOU CAN SEE HERE WE HAVE AGE 2996 01:49:20,520 --> 01:49:22,589 ALONG THE X AXIS AND THE GENERAL 2997 01:49:22,656 --> 01:49:23,556 CHRONIC PAIN PREVALENCE ALONG 2998 01:49:23,623 --> 01:49:24,791 THE Y, AND YOU CAN SEE THAT 2999 01:49:24,858 --> 01:49:27,994 THERE ARE SORT OF TWO PAIRS OF 3000 01:49:28,061 --> 01:49:29,262 LINES. 3001 01:49:29,329 --> 01:49:30,797 SO THE RED AND ORANGE LINE AT 3002 01:49:30,864 --> 01:49:32,532 THE TOP SHOWED PREVALENCE FOR 3003 01:49:32,599 --> 01:49:34,367 THE "SOMETHING ELSE" AND 3004 01:49:34,434 --> 01:49:35,235 BISEXUAL GROUPS. 3005 01:49:35,302 --> 01:49:37,404 AND THEN THE GREY AND BLACK 3006 01:49:37,470 --> 01:49:43,944 LINES BELOW ARE A SURE 3007 01:49:44,010 --> 01:49:44,511 GAY/LESBIAN AND STRAIGHT. 3008 01:49:44,577 --> 01:49:48,548 IN OUR MODEL, THE DIFFERENCE 3009 01:49:48,615 --> 01:49:50,050 BETWEEN -- YOU CAN SEE 3010 01:49:50,116 --> 01:49:51,918 SUBSTANTIVELY IT'S A RELATIVELY 3011 01:49:51,985 --> 01:49:53,353 SMALL DIFFERENCE IN PAIN 3012 01:49:53,420 --> 01:49:53,787 PREVALENCE. 3013 01:49:53,853 --> 01:49:55,722 BUT AS YOU MOVE FROM THOSE LOWER 3014 01:49:55,789 --> 01:49:57,257 TWO LINES TO THE UPPER TWO 3015 01:49:57,324 --> 01:49:59,960 LINES, THAT'S A VERY SIZABLE 3016 01:50:00,026 --> 01:50:03,129 DIFFERENCE. 3017 01:50:03,196 --> 01:50:04,030 THE DIFFERENCE IS ALREADY 3018 01:50:04,097 --> 01:50:05,498 APPARENT AT AGE 18, PERSISTS AND 3019 01:50:05,565 --> 01:50:06,933 EVEN WIDENS OVER THE COURSE OF 3020 01:50:07,000 --> 01:50:09,970 THE LIFE COURSE, AND EVEN 3021 01:50:10,036 --> 01:50:15,342 LOOKING AT AGE 18, YOU'RE SEEING 3022 01:50:15,408 --> 01:50:16,409 ABOUT TWICE THE PREVALENCE AMONG 3023 01:50:16,476 --> 01:50:18,044 THE SOMETHING ELSE AND BISEXUAL 3024 01:50:18,111 --> 01:50:21,014 GROUPS THAT YOU SEE AMONG THE 3025 01:50:21,081 --> 01:50:23,249 STRAIGHT AND GAY/LESBIAN GROUP. 3026 01:50:23,316 --> 01:50:24,351 SO IT'S A VERY SIZABLE 3027 01:50:24,417 --> 01:50:25,518 DIFFERENCE AND JUST IN ABSOLUTE 3028 01:50:25,585 --> 01:50:27,220 TERMS FOR PEOPLE WHO IDENTIFY AS 3029 01:50:27,287 --> 01:50:30,690 BISEXUAL OR SOMETHING ELSE, BY 3030 01:50:30,757 --> 01:50:32,158 AGE 60 OR SO, PAIN PREVALENCE IS 3031 01:50:32,225 --> 01:50:34,527 IN THE RANGE OF -- CHRONIC PAIN 3032 01:50:34,594 --> 01:50:36,229 PREVALENCE IS IN THE RANGE OF 3033 01:50:36,296 --> 01:50:37,764 50%, WHICH IS REALLY 3034 01:50:37,831 --> 01:50:40,934 STAGGERINGLY HIGH. 3035 01:50:41,001 --> 01:50:43,103 FOR THE PAIN IN THREE OR MORE 3036 01:50:43,169 --> 01:50:44,771 SITES, THE PATTERN WAS A LITTLE 3037 01:50:44,838 --> 01:50:45,071 DIFFERENT. 3038 01:50:45,138 --> 01:50:49,009 WE HAVE THIS SORT OF DOWNTURN IN 3039 01:50:49,075 --> 01:50:51,478 PREVALENCE BY AGE FOR BISEXUAL 3040 01:50:51,544 --> 01:50:52,912 INDIVIDUALS, SO A BIT OF A 3041 01:50:52,979 --> 01:50:54,881 CONVERGENCE WITH STRAIGHT AND 3042 01:50:54,948 --> 01:50:58,118 GAY/LEZLESS BLESBIAN BUT THE GEL 3043 01:50:58,184 --> 01:51:01,087 PATTERN OF HIGHER PAIN AS THOSE 3044 01:51:01,154 --> 01:51:04,124 TWO IDENTIFY AS SOMETHING ELSE 3045 01:51:04,190 --> 01:51:05,625 OR BISEXUAL THAT WE'RE STILL 3046 01:51:05,692 --> 01:51:06,092 SEEING. 3047 01:51:06,159 --> 01:51:08,695 SO WE DID A FORMAL DECOMPOSITION 3048 01:51:08,762 --> 01:51:11,531 ANALYSIS TO SEE WHICH OF THESE 3049 01:51:11,598 --> 01:51:14,034 KINDS OF CHARACTERISTICS MAY BE 3050 01:51:14,100 --> 01:51:15,568 DRIVING DIFFERENCES IN 3051 01:51:15,635 --> 01:51:16,970 PREVALENCE BETWEEN STRAIGHT AND 3052 01:51:17,037 --> 01:51:20,073 SEXUAL MINORITY ADULTS. 3053 01:51:20,140 --> 01:51:22,709 SO I'M GOING TO SHOW SORT OF THE 3054 01:51:22,776 --> 01:51:23,309 PERCENTAGE EXPLAINED. 3055 01:51:23,376 --> 01:51:24,411 SOME OF THESE ARE NEGATIVE 3056 01:51:24,477 --> 01:51:25,912 BECAUSE THE FACTORS WERE 3057 01:51:25,979 --> 01:51:27,781 SUPPRESSORS RATHER THAN 3058 01:51:27,847 --> 01:51:28,548 MEDIATORS, BUT IN THE INTEREST 3059 01:51:28,615 --> 01:51:30,316 OF TIME, LET ME JUMP RIGHT TO 3060 01:51:30,383 --> 01:51:33,219 THE MAIN FINDING HERE. 3061 01:51:33,286 --> 01:51:35,321 IF YOU POSIT THAT PSYCHOLOGICAL 3062 01:51:35,388 --> 01:51:36,823 DISTRESS IS A POTENTIAL 3063 01:51:36,890 --> 01:51:39,359 MEDIATOR, IT SEEMS TO EXPLAIN 3064 01:51:39,426 --> 01:51:42,629 ABOUT 63% OF THE MINORITY PAIN 3065 01:51:42,695 --> 01:51:45,031 DISADVANTAGE. 3066 01:51:45,098 --> 01:51:48,201 AND WE'VE DONE DECOMPOSITION 3067 01:51:48,268 --> 01:51:49,669 ANALYSES TO SEE WHAT FACTORS MAY 3068 01:51:49,736 --> 01:51:51,371 BE DRIVING RACIAL/ETHNIC 3069 01:51:51,438 --> 01:51:53,406 DIFFERENCES IN PAIN, AND REALLY 3070 01:51:53,473 --> 01:51:55,642 USUALLY NOTHING EXPLAINS 63%. 3071 01:51:55,708 --> 01:51:59,546 I MEAN, THAT'S A REALLY HIGH 3072 01:51:59,612 --> 01:52:02,315 PERCENTAGE THERE. 3073 01:52:02,382 --> 01:52:03,850 SO I ACTUALLY AM GOING TO GO 3074 01:52:03,917 --> 01:52:05,452 BACK TO DESCRIPTIVE STATISTICS 3075 01:52:05,518 --> 01:52:06,453 BRIEFLY SINCE NOW IT'S CLEAR 3076 01:52:06,519 --> 01:52:07,854 THAT THAT PSYCHOLOGICAL DISTRESS 3077 01:52:07,921 --> 01:52:12,459 IS SO IMPORTANT. 3078 01:52:12,525 --> 01:52:19,866 IF WE CLASSIFY THAT INTO LOW, 3079 01:52:19,933 --> 01:52:21,201 MODERATE, SEVERE TO 3080 01:52:21,267 --> 01:52:23,169 PSYCHOLOGICAL DISTRESS, AMONG 3081 01:52:23,236 --> 01:52:23,970 STRAIGHT INDIVIDUALS, 3.5% FALL 3082 01:52:24,037 --> 01:52:25,905 INTO THE SEVERE DISTRESS 3083 01:52:25,972 --> 01:52:26,973 CATEGORY. 3084 01:52:27,040 --> 01:52:29,976 BUT WITH EACH SUCCESSIVE GROUP 3085 01:52:30,043 --> 01:52:31,311 MOVING LEFT TO RIGHT, THAT 3086 01:52:31,377 --> 01:52:32,479 NUMBER GETS HIGHER AND THE 3087 01:52:32,545 --> 01:52:34,080 SOMETHING ELSE GROUP ACTUALLY 3088 01:52:34,147 --> 01:52:35,648 HAS A FOUR TIMES HIGHER 3089 01:52:35,715 --> 01:52:37,417 PREVALENCE OF SEVERE 3090 01:52:37,484 --> 01:52:41,788 PSYCHOLOGICAL DISTRESS. 3091 01:52:41,855 --> 01:52:45,458 SO IF ANYONE WANTS TO TALK TO ME 3092 01:52:45,525 --> 01:52:46,893 ABOUT THE DISTRESS SIDE OF 3093 01:52:46,960 --> 01:52:48,328 THINGS, THIS IS SOMETHING I VERY 3094 01:52:48,394 --> 01:52:50,830 MUCH WANT TO LEARN MORE ABOUT. 3095 01:52:50,897 --> 01:52:52,132 SO DO THESE PATTERNS DIFFER 3096 01:52:52,198 --> 01:52:53,533 BETWEEN MEN AND WOMEN? 3097 01:52:53,600 --> 01:52:57,137 I WANT TO EXPLAIN THAT NHIS 3098 01:52:57,203 --> 01:53:00,773 STRICTLY ENFORCES CLASSIFYING 3099 01:53:00,840 --> 01:53:02,609 ALL ITS PARTICIPANTS AS WHAT IT 3100 01:53:02,675 --> 01:53:04,477 CALLS MALE OR FEMALE. 3101 01:53:04,544 --> 01:53:07,147 SO I'M NOT ABLE TO DISTINGUISH 3102 01:53:07,213 --> 01:53:09,816 SEX FROM GENDER, SO I'LL TALK 3103 01:53:09,883 --> 01:53:11,217 ABOUT THESE GROUPS AS MEN AND 3104 01:53:11,284 --> 01:53:13,620 WOMEN FOR NOW, BUT IDEALLY WE 3105 01:53:13,686 --> 01:53:15,155 WOULD GET SOME MORE INFORMATION 3106 01:53:15,221 --> 01:53:17,423 IN THE FUTURE ON WHAT THOSE 3107 01:53:17,490 --> 01:53:21,227 CATEGORIES MEAN TO PEOPLE. 3108 01:53:21,294 --> 01:53:23,997 SO FOR MEN, BEING A SEXUAL 3109 01:53:24,063 --> 01:53:26,833 MINORITY DOES NOT ALWAYS PREDICT 3110 01:53:26,900 --> 01:53:28,835 HIGHER RISK OF PAIN. 3111 01:53:28,902 --> 01:53:31,070 SO FOR THE GENERAL CHRONIC PAIN 3112 01:53:31,137 --> 01:53:32,372 MEASURE, THE PREVALENCE IS 3113 01:53:32,438 --> 01:53:35,175 ACTUALLY VERY SIMILAR ACROSS THE 3114 01:53:35,241 --> 01:53:36,576 SEXUAL IDENTITY GROUPS, ALTHOUGH 3115 01:53:36,643 --> 01:53:39,012 FOR PAIN IN THREE OR MORE SITES, 3116 01:53:39,078 --> 01:53:41,548 WE DO SEE SIGNIFICANTLY HIGHER 3117 01:53:41,614 --> 01:53:42,549 PREVALENCE AMONG BUY SECTION 3118 01:53:42,615 --> 01:53:44,584 EULS. 3119 01:53:44,651 --> 01:53:45,018 BISEXUALS. 3120 01:53:45,084 --> 01:53:46,753 FOR WOMEN IN CONTRAST, IT'S VERY 3121 01:53:46,819 --> 01:53:47,687 CONSISTENT FOR THESE TWO 3122 01:53:47,754 --> 01:53:48,988 OUTCOMES AND ALSO FOR VARIOUS 3123 01:53:49,055 --> 01:53:50,223 OTHER OUTCOMES WE TESTED, THAT 3124 01:53:50,290 --> 01:53:52,425 BEING A SEXUAL MINORITY PREDICTS 3125 01:53:52,492 --> 01:53:53,660 HIGHER LEVELS OF PAIN. 3126 01:53:53,726 --> 01:53:58,498 SO THERE IS AN IMPORTANT 3127 01:53:58,565 --> 01:54:00,333 SEX/GENDER DIFFERENCE HERE. 3128 01:54:00,400 --> 01:54:03,937 SO TO BRIEFLY SUMMARIZE, SEXUAL 3129 01:54:04,003 --> 01:54:05,238 MINORITIES, ESPECIALLY WOMEN, 3130 01:54:05,305 --> 01:54:08,074 HAVE HIGHER PAIN PREVALENCE THAN 3131 01:54:08,141 --> 01:54:09,509 THEIR STRAIGHT COUNTERPARTS. 3132 01:54:09,576 --> 01:54:10,977 PAIN PREVALENCE IS ESPECIALLY 3133 01:54:11,044 --> 01:54:12,412 HIGH FOR INDIVIDUALS IDENTIFYING 3134 01:54:12,478 --> 01:54:13,613 AS BISEXUAL OR SOMETHING ELSE 3135 01:54:13,680 --> 01:54:16,549 FROM YOUNG ADULTHOOD ONWARDS. 3136 01:54:16,616 --> 01:54:18,651 THE STRONGEST CORRELATIVE OF 3137 01:54:18,718 --> 01:54:20,053 THESE DISPARITIES IS 3138 01:54:20,119 --> 01:54:23,856 PSYCHOLOGICAL DISTRESS. 3139 01:54:23,923 --> 01:54:26,459 SO I SEE AT LEAST THREE HIGH 3140 01:54:26,526 --> 01:54:28,962 PRIORITY DIRECTIONS FOR FUTURE 3141 01:54:29,028 --> 01:54:29,629 RESEARCH. 3142 01:54:29,696 --> 01:54:31,331 SO A REALLY BIG QUESTION IS, 3143 01:54:31,397 --> 01:54:33,633 WHAT EXACTLY IS THE CAUSAL 3144 01:54:33,700 --> 01:54:35,635 RELATIONSHIP BETWEEN THE 3145 01:54:35,702 --> 01:54:37,437 PSYCHOLOGICAL DISTRESS, THE 3146 01:54:37,503 --> 01:54:41,608 PAIN, AND SEXUAL IDENTITY? 3147 01:54:41,674 --> 01:54:43,376 SO THERE DEFINITELY IS A LOT OF 3148 01:54:43,443 --> 01:54:45,245 EVIDENCE FROM LITERATURE ON 3149 01:54:45,311 --> 01:54:47,413 SEXUAL MINORITY HEALTH IN 3150 01:54:47,480 --> 01:54:53,720 GENERAL THAT -- DISCRIMINATION 3151 01:54:53,786 --> 01:54:55,488 INCREASE STRESS WHICH, YOU KNOW, 3152 01:54:55,555 --> 01:54:57,323 WE CAN POSIT COULD INCREASE RISK 3153 01:54:57,390 --> 01:54:57,657 OF PAIN. 3154 01:54:57,724 --> 01:55:00,793 BUT WE ALSO HAVE DECADES OF 3155 01:55:00,860 --> 01:55:02,662 RESEARCH IN THE PAIN WORLD 3156 01:55:02,729 --> 01:55:04,964 SHOWING THAT THERE'S ACTUALLY A 3157 01:55:05,031 --> 01:55:07,333 COMPLEX RECIPROCAL RELATIONSHIP 3158 01:55:07,400 --> 01:55:09,669 BETWEEN PAIN AND DEPRESSION, AND 3159 01:55:09,736 --> 01:55:10,903 THAT THE TWO SOMETIMES SEEM TO 3160 01:55:10,970 --> 01:55:15,141 SORT OF EMERGE IN TANDEM, SO TO 3161 01:55:15,208 --> 01:55:17,610 KIND OF UNDERSTAND WHAT CAUSES 3162 01:55:17,677 --> 01:55:19,679 WHAT AND HOW MUCH, WE NEED TO DO 3163 01:55:19,746 --> 01:55:21,914 SOME MORE WORK WITH LONGITUDAL 3164 01:55:21,981 --> 01:55:23,716 DATA. 3165 01:55:23,783 --> 01:55:25,018 AS I MENTIONED, I DIDN'T HAVE 3166 01:55:25,084 --> 01:55:26,552 THE DATA TO LOOK AT HOW THESE 3167 01:55:26,619 --> 01:55:29,255 PATTERNS DIFFER ACROSS THIS 3168 01:55:29,322 --> 01:55:31,457 TRANS AND NON-BINARY GENDERS BUT 3169 01:55:31,524 --> 01:55:32,425 THINK THAT WOULD BE A VERY 3170 01:55:32,492 --> 01:55:33,526 IMPORTANT DIRECTION. 3171 01:55:33,593 --> 01:55:37,630 AND ANOTHER THING THAT'S REALLY 3172 01:55:37,697 --> 01:55:38,264 IMPORTANT GIVEN SORT OF WHAT'S 3173 01:55:38,331 --> 01:55:40,066 GOING ON IN THE WORLD THESE 3174 01:55:40,133 --> 01:55:42,735 DAYS, YOU KNOW, OUR DATA -- OR 3175 01:55:42,802 --> 01:55:44,470 THE DATA WE USE ENDED IN 2018, 3176 01:55:44,537 --> 01:55:47,273 WHICH IS ONLY SIX YEARS AGO. 3177 01:55:47,340 --> 01:55:49,542 IN OUR DATA, FEWER THAN ONE HALF 3178 01:55:49,609 --> 01:55:51,644 OF 1% OF RESPONDENTS IDENTIFIED 3179 01:55:51,711 --> 01:55:54,013 AS SOMETHING ELSE. 3180 01:55:54,080 --> 01:55:56,816 BUT IF YOU WERE TO LOOK AT DATA 3181 01:55:56,883 --> 01:55:59,452 TODAY, I WOULD EXPECT THAT 3182 01:55:59,519 --> 01:56:01,354 PERCENTAGE TO BE HIGHER, 3183 01:56:01,421 --> 01:56:02,622 ESPECIALLY IF YOU'RE LOOKING AT 3184 01:56:02,689 --> 01:56:03,589 YOUNG ADULTS. 3185 01:56:03,656 --> 01:56:04,991 AND THERE ARE STUDIES SHOWING 3186 01:56:05,058 --> 01:56:07,860 MUCH HIGHER PREVALENCE OF PEOPLE 3187 01:56:07,927 --> 01:56:10,697 CHOOSING NON-BINARY -- OR 3188 01:56:10,763 --> 01:56:12,498 IDENTIFYING WITH NON-BINARY 3189 01:56:12,565 --> 01:56:14,367 GENDER OR SORT OF LESS 3190 01:56:14,434 --> 01:56:16,035 TRADITIONAL SEXUAL IDENTITY 3191 01:56:16,102 --> 01:56:17,737 CATEGORIES, AND SO I THINK IT'S 3192 01:56:17,804 --> 01:56:21,474 SORT OF AN OPEN QUESTION, WILL 3193 01:56:21,541 --> 01:56:25,712 PEOPLE WHO TAKE ON THESE LESS 3194 01:56:25,778 --> 01:56:28,014 COMMON IDENTIFICATIONS SHOW THE 3195 01:56:28,081 --> 01:56:29,315 POOR PSYCHOLOGICAL DISTRESS AND 3196 01:56:29,382 --> 01:56:31,184 PAIN OUTCOMES THAT WE SAW HERE, 3197 01:56:31,250 --> 01:56:34,020 OR WILL THERE ACTUALLY BE A SORT 3198 01:56:34,087 --> 01:56:35,955 OF DESTIGMATIZATION, GREATER 3199 01:56:36,022 --> 01:56:37,824 LEVEL OF SUPPORT, SORT OF SAFETY 3200 01:56:37,890 --> 01:56:40,793 IN NUMBERS, COULD WE ACTUALLY 3201 01:56:40,860 --> 01:56:43,930 SEE THINGS MOVE IN THE OPPOSITE 3202 01:56:43,996 --> 01:56:45,598 DIRECTION THAT THESE GROUPS 3203 01:56:45,665 --> 01:56:47,266 BECOME LESS STIGMATIZED AND 3204 01:56:47,333 --> 01:56:48,768 THERE'S LESS DISTRESS AND PAIN, 3205 01:56:48,835 --> 01:56:50,136 SO THAT'S AN IMPORTANT OPEN 3206 01:56:50,203 --> 01:56:50,403 QUESTION. 3207 01:56:50,470 --> 01:56:52,472 ALL RIGHT. 3208 01:56:52,538 --> 01:56:52,905 SO THAT'S IT. 3209 01:56:52,972 --> 01:56:53,473 THANK YOU. 3210 01:56:53,539 --> 01:57:03,716 [APPLAUSE] 3211 01:57:04,884 --> 01:57:05,918 >> THANK YOU, HANNA. 3212 01:57:05,985 --> 01:57:07,653 THIS WAS NOT ONLY INTERESTING, 3213 01:57:07,720 --> 01:57:09,622 EYE OPENING AT LEAST TO ME, A 3214 01:57:09,689 --> 01:57:12,492 LOT OF NEW DATA AND NEW 3215 01:57:12,558 --> 01:57:12,792 INFORMATION. 3216 01:57:12,859 --> 01:57:15,762 THANK YOU AGAIN. 3217 01:57:15,828 --> 01:57:17,263 SO OUR LAST SPEAKER, NOT LEAST 3218 01:57:17,330 --> 01:57:20,233 BUT VERY INTERESTING TALK COMING 3219 01:57:20,299 --> 01:57:21,100 UP. 3220 01:57:21,167 --> 01:57:31,010 SO IT'S BY DR. GU GUNISHA KAUR, 3221 01:57:31,077 --> 01:57:32,245 FOUNDING DIRECTOR OF HUMAN 3222 01:57:32,311 --> 01:57:37,683 RIGHTS IMPACTS LAB THERE IN THE 3223 01:57:37,750 --> 01:57:39,152 COLLEGE, AND SHE HAS A REALLY 3224 01:57:39,218 --> 01:57:41,154 EXTENSIVE BACKGROUND IN 3225 01:57:41,220 --> 01:57:43,356 NEUROSCIENCE, AS A HEALTH -- AN 3226 01:57:43,423 --> 01:57:45,091 LICK LITH CAL FRAMEWORK 3227 01:57:45,158 --> 01:57:47,026 RESEARCH, AND HER GOAL IS TO 3228 01:57:47,093 --> 01:57:50,096 REALLY ADVANCE STUDIES ON -- 3229 01:57:50,163 --> 01:57:51,864 HEALTH THROUGH SCIENTIFIC -- AND 3230 01:57:51,931 --> 01:57:54,233 SHE HAS MADE REALLY SEMINAL 3231 01:57:54,300 --> 01:57:55,234 CONTRIBUTIONS TO THE 3232 01:57:55,301 --> 01:57:58,638 UNDERSTANDING OF PAIN AND 3233 01:57:58,704 --> 01:58:00,606 DISTRESS MAINLY IN THE FORCIBLY 3234 01:58:00,673 --> 01:58:01,874 DISTRESSED POPULATION AND HER 3235 01:58:01,941 --> 01:58:04,277 WORK HAS BEEN REALLY PUBLISHED 3236 01:58:04,343 --> 01:58:05,878 IN MULTIPLE LEADING SCIENTIFIC 3237 01:58:05,945 --> 01:58:09,549 AND MEDICAL JOURNALS, AS WELL AS 3238 01:58:09,615 --> 01:58:11,484 IN MAINSTREAM NEWS MEDIA 3239 01:58:11,551 --> 01:58:11,984 OUTLETS. 3240 01:58:12,051 --> 01:58:14,587 SHE HAS GIVEN REALLY OVER A 3241 01:58:14,654 --> 01:58:16,589 HUNDRED NATIONAL/INTERNATIONAL 3242 01:58:16,656 --> 01:58:17,957 KEYNOTE PRESENTATIONS TO GLOBAL 3243 01:58:18,024 --> 01:58:22,061 LEADERS, TO UNITED NATIONS, AND 3244 01:58:22,128 --> 01:58:23,129 UNITED STATES GOVERNMENT ON THIS 3245 01:58:23,196 --> 01:58:25,064 ASPECT AND THIS TOPIC 3246 01:58:25,131 --> 01:58:25,965 SPECIFICALLY. 3247 01:58:26,032 --> 01:58:30,570 SHE'S A FACULTY FELLOW AT THE 3248 01:58:30,636 --> 01:58:35,475 CENTER FOR INNATIO INTERNATIONAL 3249 01:58:35,541 --> 01:58:36,742 STUDIES, AND KELLER TEAM MEMBER 3250 01:58:36,809 --> 01:58:38,811 AT THE COUNCIL OF FOREIGN 3251 01:58:38,878 --> 01:58:40,580 RELATIONS. 3252 01:58:40,646 --> 01:58:44,517 SO IN 2022, SHE WAS SELECTED BY 3253 01:58:44,584 --> 01:58:46,085 THE -- AS AN EMERGING LEADER IN 3254 01:58:46,152 --> 01:58:48,454 HEALTH AND MEDICINE, AND THE 3255 01:58:48,521 --> 01:58:53,359 VERY NEXT YEAR, 2023, SHE WON 3256 01:58:53,426 --> 01:58:54,927 THE NATIONAL ACADEMY OF MEDICINE 3257 01:58:54,994 --> 01:58:55,328 PRIZE. 3258 01:58:55,394 --> 01:58:57,597 SO SHE WILL TALK TODAY, SHEDDING 3259 01:58:57,663 --> 01:58:58,998 MORE LIGHT INTO UNDERSTANDING 3260 01:58:59,065 --> 01:59:01,200 AND ASSESSING PAIN IN FORCIBLY 3261 01:59:01,267 --> 01:59:03,135 DISPLACED POPULATIONS. 3262 01:59:03,202 --> 01:59:12,712 SO GUNISHA, PLEASE TAKE OVER. 3263 01:59:12,778 --> 01:59:14,247 >> THANK YOU SO MUCH FOR HAVING 3264 01:59:14,313 --> 01:59:14,680 ME. 3265 01:59:14,747 --> 01:59:16,315 I'M HONORED TO BE HERE TO SHARE 3266 01:59:16,382 --> 01:59:18,284 MY EXPERIENCES AS AN 3267 01:59:18,351 --> 01:59:20,353 ANESTHESIOLOGIST AND MEDICAL 3268 01:59:20,419 --> 01:59:21,120 ANTHROPOLOGIST AND REFUGEE 3269 01:59:21,187 --> 01:59:22,021 HEALTH RESEARCHER. 3270 01:59:22,088 --> 01:59:23,723 I'M REALLY GOING TO SHARE THE 3271 01:59:23,789 --> 01:59:25,892 EXPERIENCES PART OF PAIN IN A 3272 01:59:25,958 --> 01:59:28,628 UNIQUE MINORITY POPULATION. 3273 01:59:28,694 --> 01:59:30,496 MEDICAL ANTHROPOLOGISTS ARE BY 3274 01:59:30,563 --> 01:59:31,998 TRAINING STORYTELLERS, AND I'LL 3275 01:59:32,064 --> 01:59:36,269 START BY SHARING THE STORY OF A 3276 01:59:36,335 --> 01:59:38,538 6-YEAR-OLD CHILD IN OUR CLINIC 3277 01:59:38,604 --> 01:59:41,841 WHO I'LL CALL NOR. 3278 01:59:41,908 --> 01:59:42,708 NOR'S FAMILY LIVED IN 3279 01:59:42,775 --> 01:59:43,976 AFGHANISTAN, WHERE FOR YEARS HER 3280 01:59:44,043 --> 01:59:47,280 FATHER WORKED IN A HIGH-RANKING 3281 01:59:47,346 --> 01:59:48,080 POSITION FOR THE U.S. 3282 01:59:48,147 --> 01:59:48,414 GOVERNMENT. 3283 01:59:48,481 --> 01:59:52,084 WHEN THE 2021 WITHDRAWAL BECAME 3284 01:59:52,151 --> 01:59:54,487 INEVIDENT ABLE, NOR'S FAMILY WAS 3285 01:59:54,554 --> 01:59:55,555 ESCORTED TO THE AIRPORT, WHERE 3286 01:59:55,621 --> 01:59:57,657 IN THE CHAOS, THEY WERE 3287 01:59:57,723 --> 02:00:01,227 SEPARATED. 3288 02:00:01,294 --> 02:00:02,762 6-YEAR-OLD NOR MADE IT ON TO THE 3289 02:00:02,828 --> 02:00:05,164 FLIGHT WITH NO PARENT AND NO 3290 02:00:05,231 --> 02:00:05,965 SIBLINGS. 3291 02:00:06,032 --> 02:00:08,301 SHE SPENT WEEKS UNIDENTIFIED IN 3292 02:00:08,367 --> 02:00:10,403 A REFUGEE CAMP IN THE MIDDLE 3293 02:00:10,469 --> 02:00:12,471 EAST UNTIL, FINALLY, SHE WAS 3294 02:00:12,538 --> 02:00:14,206 CONNECTED TO AN UNCLE THAT SHE 3295 02:00:14,273 --> 02:00:15,541 HAD NEVER MET BEFORE, AND SENT 3296 02:00:15,608 --> 02:00:16,909 TO LIVE WITH HIM IN NEW YORK 3297 02:00:16,976 --> 02:00:20,446 CITY. 3298 02:00:20,513 --> 02:00:22,548 WITHIN MINUTES OF MEETING NOR AS 3299 02:00:22,615 --> 02:00:23,849 PART OF OUR CLINIC VISIT, IT WAS 3300 02:00:23,916 --> 02:00:25,484 CLEAR TO ME THAT SHE NEEDED 3301 02:00:25,551 --> 02:00:26,152 URGENT MEDICAL CARE. 3302 02:00:26,218 --> 02:00:27,987 SHE WAS CRYING NONSTOP ASKING 3303 02:00:28,054 --> 02:00:29,288 FOR HER PARENTS, BANGING HER 3304 02:00:29,355 --> 02:00:32,124 HEAD AGAINST THE WALL, AND 3305 02:00:32,191 --> 02:00:33,893 EXPRESSING PAIN AND DISTRESS, 3306 02:00:33,960 --> 02:00:35,494 AND SHE WAS RUNNING OUT INTO THE 3307 02:00:35,561 --> 02:00:36,729 STREETS OF QUEENS AT NIGHT, 3308 02:00:36,796 --> 02:00:38,364 THINKING THAT SHE WAS IN KABUL 3309 02:00:38,431 --> 02:00:40,866 AND TRYING TO GET HOME. 3310 02:00:40,933 --> 02:00:41,968 BUT THERE WAS ONE THING THAT WE 3311 02:00:42,034 --> 02:00:43,035 NEEDED TO WORK ON MORE 3312 02:00:43,102 --> 02:00:44,370 IMMEDIATELY THAN ANYTHING ELSE, 3313 02:00:44,437 --> 02:00:45,638 AND THAT WAS GETTING HER 3314 02:00:45,705 --> 02:00:49,041 REUNITED WITH HER PARENTS IN THE 3315 02:00:49,108 --> 02:00:50,476 NOW 72 HOURS BEFORE U.S. 3316 02:00:50,543 --> 02:00:54,146 WITHDRAWAL. 3317 02:00:54,213 --> 02:00:56,449 BUT NOR WAS NEVER REUNITED WITH 3318 02:00:56,515 --> 02:00:58,851 HER PARENTS, NOT THEN AND NOT 3319 02:00:58,918 --> 02:00:59,251 NOW. 3320 02:00:59,318 --> 02:01:01,454 THEIR SPECIAL IMMIGRANT VISA 3321 02:01:01,520 --> 02:01:02,855 APPLICATION LANGUISHED IN THE 3322 02:01:02,922 --> 02:01:04,590 U.S. IMMIGRATION SYSTEM. 3323 02:01:04,657 --> 02:01:06,559 6-YEAR-OLD NOR LANGUISHED IN THE 3324 02:01:06,626 --> 02:01:09,862 U.S. IMMIGRATION SYSTEM. 3325 02:01:09,929 --> 02:01:11,297 AND AS THE SUMMER TURNED TO FALL 3326 02:01:11,364 --> 02:01:13,366 AND AS THE FALL TURNED TO 3327 02:01:13,432 --> 02:01:15,468 WINTER, AS AMERICA'S WRAPPED 3328 02:01:15,534 --> 02:01:18,037 ATTENTION TO THE WITHDRAWAL IN 3329 02:01:18,104 --> 02:01:19,472 AFGHANISTAN DRIFTED AWAY, NOR'S 3330 02:01:19,538 --> 02:01:21,374 STORY WAS FORGOTTEN. 3331 02:01:21,440 --> 02:01:24,343 NOR AND THE TENS OF THOUSANDS OF 3332 02:01:24,410 --> 02:01:29,348 CHILDREN LIKE HER WHO LA 3333 02:01:29,415 --> 02:01:31,117 LANGUISHED, TOO YOUNG AND TOO 3334 02:01:31,183 --> 02:01:32,818 INNOCENT TO HAVE THEIR LIVES 3335 02:01:32,885 --> 02:01:34,687 IMPACTED BY SUCH PROFOUND 3336 02:01:34,754 --> 02:01:35,955 ADVERSITY WERE SIMPLY ERASED 3337 02:01:36,022 --> 02:01:39,291 FROM OUR COLLECTIVE MEMORIES. 3338 02:01:39,358 --> 02:01:41,127 AT THE WEILL CORNELL CENTER FOR 3339 02:01:41,193 --> 02:01:42,895 HUMAN RIGHTS, WE SEE HUNDREDS OF 3340 02:01:42,962 --> 02:01:46,265 STORIES LIKE NOR'S EACH YEAR. 3341 02:01:46,332 --> 02:01:48,067 OUR CLINIC PROVIDES FORENSIC 3342 02:01:48,134 --> 02:01:49,435 MEDICAL EVALUATIONS AS PEOPLE 3343 02:01:49,502 --> 02:01:52,038 SEEK ASYLUM IN THE U.S., 3344 02:01:52,104 --> 02:01:53,239 TRANSLATING PHYSICAL AND 3345 02:01:53,305 --> 02:01:55,341 PSYCHOLOGICAL SCARS INTO WORDS 3346 02:01:55,408 --> 02:01:56,776 THAT AN IMMIGRATION JUDGE CAN 3347 02:01:56,842 --> 02:01:57,176 UNDERSTAND. 3348 02:01:57,243 --> 02:01:59,011 FOR EXAMPLE, THAT MEMORY GAPS 3349 02:01:59,078 --> 02:02:02,081 MAY BE A SYMPTOM OF PTSD OR 3350 02:02:02,148 --> 02:02:03,315 DEPRESSION, NOT NECESSARILY A 3351 02:02:03,382 --> 02:02:05,484 SIGN OF LYING. 3352 02:02:05,551 --> 02:02:07,119 WHEREAS THE NATIONAL RATE OF 3353 02:02:07,186 --> 02:02:09,422 ASYLUM LINGERS AROUND 30% WITH 3354 02:02:09,488 --> 02:02:12,224 THE FORENSIC MEDICAL EVALUATION 3355 02:02:12,291 --> 02:02:12,792 IN HAND. 3356 02:02:12,858 --> 02:02:14,326 AT OUR CLINIC, THAT RATE JUMPS 3357 02:02:14,393 --> 02:02:17,396 TO OVER 95%. 3358 02:02:17,463 --> 02:02:19,031 OUR PATIENTS COME FROM ALL OVER 3359 02:02:19,098 --> 02:02:22,201 THE WORLD. 3360 02:02:22,268 --> 02:02:24,637 AND AS WAR AND VIOLENCE AND 3361 02:02:24,704 --> 02:02:26,906 CLIMATE CHANGE INCREASINGLY 3362 02:02:26,972 --> 02:02:28,307 DISPLACE MEN, WOMEN AND 3363 02:02:28,374 --> 02:02:29,875 CHILDREN, CURRENTLY AT A RATE OF 3364 02:02:29,942 --> 02:02:33,045 NEAR LEGAL 50,000 PEOPLE EACH 3365 02:02:33,112 --> 02:02:35,514 DAY, UNDERSTANDING THE NEEDS OF 3366 02:02:35,581 --> 02:02:36,849 THIS UNIQUE, IMPORTANT AND 3367 02:02:36,916 --> 02:02:39,251 RAPIDLY GROWING PATIENT 3368 02:02:39,318 --> 02:02:44,190 POPULATION IS INCREDIBLY 3369 02:02:44,256 --> 02:02:45,458 IMPORTANT AT THIS TIME. 3370 02:02:45,524 --> 02:02:47,326 ONLY 2% OF THE WORLD'S MIGRANTS 3371 02:02:47,393 --> 02:02:49,061 CROSS AN INTERNATIONAL BOUNDARY 3372 02:02:49,128 --> 02:02:53,899 AS ASYLUM SEEKERS, SO THESE 3373 02:02:53,966 --> 02:02:56,268 PATIENTS, THAT TINY DARK SLIVER 3374 02:02:56,335 --> 02:02:57,169 YOU SEE THERE. 3375 02:02:57,236 --> 02:02:59,004 THESE PATIENTS TEND TO BE 3376 02:02:59,071 --> 02:03:00,339 EDUCATED, HEALTHY, HAVE VAST 3377 02:03:00,406 --> 02:03:01,841 SOCIAL NETWORKS AND RESOURCES, 3378 02:03:01,907 --> 02:03:02,742 AND THESE ARE THE PATIENTS THAT 3379 02:03:02,808 --> 02:03:05,244 WE SEE IN OUR CLINIC. 3380 02:03:05,311 --> 02:03:07,747 WHERE A VAST MAJORITY OF PEOPLE 3381 02:03:07,813 --> 02:03:09,415 WERE PROFESSIONALS IN THEIR HOME 3382 02:03:09,482 --> 02:03:11,784 COUNTRIES, EITHER TEACHERS OR 3383 02:03:11,851 --> 02:03:13,753 ENGINEERS, HEALTHCARE PROVIDERS. 3384 02:03:13,819 --> 02:03:15,821 THERE'S A NEAR EQUAL SPLIT 3385 02:03:15,888 --> 02:03:18,991 BETWEEN MEN AND WOMEN, AND ABOUT 3386 02:03:19,058 --> 02:03:20,626 40% ARE CHILDREN UNDER THE AGE 3387 02:03:20,693 --> 02:03:23,262 OF 18, AND THESE GLOBAL 3388 02:03:23,329 --> 02:03:25,331 MIGRATION FLOWS REALLY MIMIC 3389 02:03:25,397 --> 02:03:26,966 WAR, VIOLENCE AND PERSECUTION 3390 02:03:27,032 --> 02:03:28,300 THAT IS HAPPENING ACROSS THE 3391 02:03:28,367 --> 02:03:28,734 WORLD. 3392 02:03:28,801 --> 02:03:30,703 SO WHEN PEOPLE COME TO US, 3393 02:03:30,770 --> 02:03:32,338 THEY'RE TYPICALLY COMING BECAUSE 3394 02:03:32,404 --> 02:03:33,639 OF AN ACUTE SITUATION, AND YOU 3395 02:03:33,706 --> 02:03:35,141 CAN SEE THAT IN THESE SPIKES IN 3396 02:03:35,207 --> 02:03:37,710 THE FIGURES. 3397 02:03:37,777 --> 02:03:38,911 THIS IS A POPULATION, AGAIN, 3398 02:03:38,978 --> 02:03:40,346 THAT TENDS TO BE OTHERWISE YOUNG 3399 02:03:40,412 --> 02:03:41,514 AND HEALTHY. 3400 02:03:41,580 --> 02:03:43,582 THE AVERAGE AGE IN OUR CLINIC IS 3401 02:03:43,649 --> 02:03:45,151 JUST 38 YEARS. 3402 02:03:45,217 --> 02:03:48,621 BUT AS THEY MIGRATE, THEY FACE 3403 02:03:48,687 --> 02:03:49,722 EXTREME PRESSURES AND STRESS 3404 02:03:49,789 --> 02:03:51,557 FROM OBTAINING LEGAL STATUS IN 3405 02:03:51,624 --> 02:03:54,994 THEIR HOST COUNTRIES, EXTREME 3406 02:03:55,060 --> 02:03:56,862 POVERTY, HOMELESSNESS, LACK OF 3407 02:03:56,929 --> 02:03:59,165 ACCESS TO BASIC MEDICAL CARE FOR 3408 02:03:59,231 --> 02:04:01,801 THEMSELVES AND THEIR CHILDREN. 3409 02:04:01,867 --> 02:04:04,737 THE PATIENTS THAT WE SEE HAVE 3410 02:04:04,804 --> 02:04:06,372 INKRED BLIP COMPLEX LIFE AND 3411 02:04:06,438 --> 02:04:07,506 MEDICAL HISTORIES. 3412 02:04:07,573 --> 02:04:10,976 THAT ARE INEXTRICABLY 3413 02:04:11,043 --> 02:04:11,343 INTERTWINED. 3414 02:04:11,410 --> 02:04:12,845 THAT IS PARTICULARLY SO FOR 3415 02:04:12,912 --> 02:04:14,914 WOMEN WHO MAY FACE SEXUAL 3416 02:04:14,980 --> 02:04:16,682 VIOLENCE IN THEIR HOME 3417 02:04:16,749 --> 02:04:19,285 COUNTRIES, TRAFFICKING DURING 3418 02:04:19,351 --> 02:04:20,719 MIGRATION JOURNEYS, AND SEXUAL 3419 02:04:20,786 --> 02:04:22,254 ABUSE ON ARRIVAL TO A HOST 3420 02:04:22,321 --> 02:04:22,788 COUNTRY. 3421 02:04:22,855 --> 02:04:24,423 I'M AN ANESTHESIOLOGIST BY 3422 02:04:24,490 --> 02:04:24,990 TRAINING. 3423 02:04:25,057 --> 02:04:27,293 MY CLINICAL PRACTICE IS ROOTED 3424 02:04:27,359 --> 02:04:29,461 IN COMPLEX AIRWAY DISEASE AND 3425 02:04:29,528 --> 02:04:31,597 ABDOMINAL DISEASE, AND I CAN SAY 3426 02:04:31,664 --> 02:04:33,866 OVER THE PAST 15 YEARS, THESE 3427 02:04:33,933 --> 02:04:36,035 ARE BY FAR THE MOST COMPLEX 3428 02:04:36,101 --> 02:04:39,205 PATIENTS THAT WE SEE IN A 3429 02:04:39,271 --> 02:04:47,546 REFUGEE CRA CAMP IN GREECE, CHIN 3430 02:04:47,613 --> 02:04:49,481 AS YOUNG AS 4 WERE BEING 3431 02:04:49,548 --> 02:04:50,583 TRASKTED AND SOLD INTO MARRIAGE 3432 02:04:50,649 --> 02:04:51,684 BECAUSE THEIR FAMILIES JUST 3433 02:04:51,750 --> 02:04:53,853 COULD NOT SUPPORT THEM. 3434 02:04:53,919 --> 02:04:55,487 SO GLOBALLY, THERE'S A MAJOR GAP 3435 02:04:55,554 --> 02:04:57,489 IN OUR UNDERSTANDING OF THE 3436 02:04:57,556 --> 02:04:58,591 HEALTH AND HEALTHCARE NEEDS OF 3437 02:04:58,657 --> 02:05:01,126 THIS PATIENT POPULATION. 3438 02:05:01,193 --> 02:05:02,962 AT THE HUMAN RIGHTS IMPACT LAB, 3439 02:05:03,028 --> 02:05:03,963 WE AIM TO CHANGE THAT. 3440 02:05:04,029 --> 02:05:06,999 WE AIM TO ESTABLISH A STANDARD 3441 02:05:07,066 --> 02:05:08,901 OF CARE FOR THESE PATIENTS 3442 02:05:08,968 --> 02:05:09,501 THROUGH A RIGOROUS SCIENTIFIC 3443 02:05:09,568 --> 02:05:11,203 APPROACH TO REFUGEE HEALTH 3444 02:05:11,270 --> 02:05:13,405 RESEARCH. 3445 02:05:13,472 --> 02:05:14,907 FOUNDED IN 2010, WE ARE THE 3446 02:05:14,974 --> 02:05:16,876 OLDEST AND LARGEST MEDICAL-LEGAL 3447 02:05:16,942 --> 02:05:18,444 ASYLUM CLINIC IN THE COUNTRY, 3448 02:05:18,510 --> 02:05:20,579 AND ONE OF THE ONLY SUCH CLINICS 3449 02:05:20,646 --> 02:05:22,014 WITH INVESTIGATORS THAT ARE 3450 02:05:22,081 --> 02:05:23,983 SUPPORTED BY NIH FUNDING, AND I 3451 02:05:24,049 --> 02:05:25,651 THINK THAT JUST GIVES US A 3452 02:05:25,718 --> 02:05:27,253 REALLY WONDERFUL OPPORTUNITY TO 3453 02:05:27,319 --> 02:05:28,721 FORGE THIS NEW LINE OF 3454 02:05:28,787 --> 02:05:31,857 SCIENTIFIC INQUIRY. 3455 02:05:31,924 --> 02:05:33,092 THERE ARE SEVERAL CATEGORIES OF 3456 02:05:33,158 --> 02:05:34,927 RESEARCH THAT WE CONDUCT THAT 3457 02:05:34,994 --> 02:05:35,794 I'M VERY BRIEFLY GOING TO GO 3458 02:05:35,861 --> 02:05:36,996 OVER AS BACKGROUND. 3459 02:05:37,062 --> 02:05:39,131 THE FIRST IS CLINICAL RESEARCH, 3460 02:05:39,198 --> 02:05:41,500 LIKE INVESTIGATING HOW TO 3461 02:05:41,567 --> 02:05:43,135 ACCURATELY DIAGNOSE AND TREAT 3462 02:05:43,202 --> 02:05:44,403 SOMATIC PAIN AFTER TORTURE, 3463 02:05:44,470 --> 02:05:47,406 WHICH IS THE FOCUS OF MY NINDS 3464 02:05:47,473 --> 02:05:49,808 K23, AND THIS IS IN A PATIENT 3465 02:05:49,875 --> 02:05:51,677 POPULATION WHERE NEARLY ALL OF 3466 02:05:51,744 --> 02:05:53,412 PAIN IS THOUGHT TO BE 3467 02:05:53,479 --> 02:05:56,048 PSYCHIATRIC OR PSYCHOSOMATIC IN 3468 02:05:56,115 --> 02:05:56,282 NATURE. 3469 02:05:56,348 --> 02:06:00,119 PEOPLE OBVIOUSLY HAVE A LOT OF 3470 02:06:00,185 --> 02:06:01,420 PSYCHOLOGICAL TRAUMA, AND WHEN 3471 02:06:01,487 --> 02:06:02,488 YOU LACK AT THE STUDIES THAT 3472 02:06:02,554 --> 02:06:05,658 HAVE BEEN DONE ON PAIN, IT'S 3473 02:06:05,724 --> 02:06:08,494 ALMOST ALWAYS THOUGHT TO BE 3474 02:06:08,560 --> 02:06:10,763 PURELY SINGULARLY PSYCHIATRIC OR 3475 02:06:10,829 --> 02:06:11,196 PSYCHOSOMATIC. 3476 02:06:11,263 --> 02:06:13,632 BUT WE HAVE FOUND THAT IN ALMOST 3477 02:06:13,699 --> 02:06:16,936 90% OF CASES, THE PAIN IS 3478 02:06:17,002 --> 02:06:18,604 DIRECTLY ASSOCIATED WITH THE 3479 02:06:18,671 --> 02:06:19,772 MECHANISM OF TRAUMA, MEANING 3480 02:06:19,838 --> 02:06:21,974 THAT IT'S NOT SIMPLY PSYCHIATRIC 3481 02:06:22,041 --> 02:06:23,108 OR PSYCHOSOMATIC. 3482 02:06:23,175 --> 02:06:24,109 THE SECOND TYPE OF RESEARCH THAT 3483 02:06:24,176 --> 02:06:25,911 WE DO IS LARGE DATABASE 3484 02:06:25,978 --> 02:06:28,247 RESEARCH, WHERE WE ANALYZE 3485 02:06:28,314 --> 02:06:30,349 TRENDS LIKE THE STUDY LOOKING AT 3486 02:06:30,416 --> 02:06:33,519 PAIN AND CVD AND STRESS-RELATED 3487 02:06:33,585 --> 02:06:36,188 SPECIFICALLY TO THE THREAT OF 3488 02:06:36,255 --> 02:06:36,655 DEPORTATION. 3489 02:06:36,722 --> 02:06:38,424 THE THIRD TYPE OF RESEARCH IS 3490 02:06:38,490 --> 02:06:39,391 DIGITAL TECHNOLOGY RESEARCH, 3491 02:06:39,458 --> 02:06:41,260 WHERE WE USE CUTTING EDGE 3492 02:06:41,327 --> 02:06:42,461 DIGITAL TOOLS TO ADVANCE THE 3493 02:06:42,528 --> 02:06:44,196 HEALTH OF THIS REALLY VULNERABLE 3494 02:06:44,263 --> 02:06:45,097 POPULATION. 3495 02:06:45,164 --> 02:06:46,498 WHILE PEOPLE HAVE ALMOST NOTHING 3496 02:06:46,565 --> 02:06:48,901 WHEN THEY CROSS AN INTERNATIONAL 3497 02:06:48,968 --> 02:06:51,236 BOUNDARY, ALMOST EVERYBODY HAS A 3498 02:06:51,303 --> 02:06:52,404 SMARTPHONE, OUR STUDIES HAVE 3499 02:06:52,471 --> 02:06:54,173 SHOWN THAT OVER 90% OF U.S. 3500 02:06:54,239 --> 02:06:57,009 ASYLUM SEEKERS CARRY 3501 02:06:57,076 --> 02:07:00,946 SMARTPHONES, IF% HAVE IPHONES 3502 02:07:01,013 --> 02:07:03,349 AND 100% OF OUR PATIENTS HAVE 3503 02:07:03,415 --> 02:07:07,286 THE DIGITAL LITERACY NEEDED FOR 3504 02:07:07,353 --> 02:07:08,921 CUTTING EDGE DIGITAL EDGE 3505 02:07:08,988 --> 02:07:09,254 INTERVENTIONS. 3506 02:07:09,321 --> 02:07:11,657 THIS IS A GROUP SO FEARFUL OF 3507 02:07:11,724 --> 02:07:12,925 POLICIES LIKE FAMILY SEPARATION 3508 02:07:12,992 --> 02:07:15,194 OR DEPORTATION OR IMMIGRATION 3509 02:07:15,260 --> 02:07:17,696 DETENTION THAT THEY AVOID 3510 02:07:17,763 --> 02:07:18,664 ACCESSING HEALTHCARE AT ALMOST 3511 02:07:18,731 --> 02:07:19,865 ALL COSTS. 3512 02:07:19,932 --> 02:07:22,301 SO FOR EXAMPLE, WE'VE HAD HIGH 3513 02:07:22,368 --> 02:07:24,169 RISK PREGNANT PATIENTS REFUSE 3514 02:07:24,236 --> 02:07:25,804 SICKLE CELL TESTING BECAUSE THEY 3515 02:07:25,871 --> 02:07:28,073 WERE AFRAID OF BEING SEPARATED 3516 02:07:28,140 --> 02:07:28,941 FROM THEIR CHILDREN. 3517 02:07:29,008 --> 02:07:31,176 BUT WE HAVE SHOWN THAT WE CAN 3518 02:07:31,243 --> 02:07:34,446 USE TECHNOLOGY WEARABLE DEVICES, 3519 02:07:34,513 --> 02:07:39,585 SMARTPHONES, TO DETECT AND TREAT 3520 02:07:39,651 --> 02:07:42,454 CERTAIN DISEASES REMOTELY AND 3521 02:07:42,521 --> 02:07:43,422 EARLY IN THIS PATIENT 3522 02:07:43,489 --> 02:07:44,523 POPULATION, WHICH OBVIOUSLY NOT 3523 02:07:44,590 --> 02:07:46,191 ONLY ADVANCES THEIR HEALTH BUT 3524 02:07:46,258 --> 02:07:46,759 ALSO PUBLIC HEALTH. 3525 02:07:46,825 --> 02:07:49,428 ONE OF OUR STUDY, FOR EXAMPLE, 3526 02:07:49,495 --> 02:07:52,264 EVALUATES THE EARLY DIAGNOSIS OF 3527 02:07:52,331 --> 02:07:53,165 HYPERTENSIVE DISORDERS AND PAIN 3528 02:07:53,232 --> 02:07:55,134 IN PREGNANT REFUGEE WOMEN, AND 3529 02:07:55,200 --> 02:07:56,869 OUR ABILITY TO CONNECT THESE 3530 02:07:56,935 --> 02:07:58,303 HIGH RISK PATIENTS TO HEALTHCARE 3531 02:07:58,370 --> 02:08:03,142 PROVIDERS EITHER VIRTUALLY OR IN 3532 02:08:03,208 --> 02:08:05,277 PERSON AND LIKE MY CHILDREN, I 3533 02:08:05,344 --> 02:08:08,247 TRY NOT TO PICK FAVORITE STUDIES 3534 02:08:08,313 --> 02:08:10,449 BUT THIS IS A REALLY IMPORTANT 3535 02:08:10,516 --> 02:08:11,784 STUDY THAT'S NEAR AND DEAR TO MY 3536 02:08:11,850 --> 02:08:12,951 HEART BECAUSE I THINK THIS IDEA 3537 02:08:13,018 --> 02:08:14,520 THAT WE CAN POTENTIALLY ADVANCE 3538 02:08:14,586 --> 02:08:15,921 THE HEALTH OF HUNDREDS OF 3539 02:08:15,988 --> 02:08:17,256 THOUSANDS OF PREGNANT REFUGEE 3540 02:08:17,322 --> 02:08:18,690 WOMEN AND THEIR NEWBORN BABIES 3541 02:08:18,757 --> 02:08:22,161 IS JUST SO EXCITING. 3542 02:08:22,227 --> 02:08:24,696 SO THIS IS AN EXAMPLE OF ONE OF 3543 02:08:24,763 --> 02:08:25,597 OUR HEALTHCARE RESOURCES THAT 3544 02:08:25,664 --> 02:08:29,034 WE'VE DESIGNED, A SYSTEM THAT 3545 02:08:29,101 --> 02:08:30,702 ALLOWS US TO USE A.I. AND 3546 02:08:30,769 --> 02:08:32,571 MACHINE LEARNING FOR EARLY PAIN 3547 02:08:32,638 --> 02:08:33,806 DETECTION IN THIS PATIENT 3548 02:08:33,872 --> 02:08:34,907 POPULATION, AGAIN, A POPULATION 3549 02:08:34,973 --> 02:08:36,642 THAT DOES NOT ENGAGE WITH 3550 02:08:36,708 --> 02:08:39,378 HEALTHCARE PROVIDERS IN PERSON 3551 02:08:39,445 --> 02:08:41,814 IN GENERAL. 3552 02:08:41,880 --> 02:08:44,850 WE CAN USE THE SYSTEM TO 3553 02:08:44,917 --> 02:08:48,387 DIAGNOSE DISEASE EARLY OR TRIAGE 3554 02:08:48,454 --> 02:08:49,555 FOR FURTHER ASSESSMENT AND 3555 02:08:49,621 --> 02:08:51,790 PROVIDE TARGETED CARE. 3556 02:08:51,857 --> 02:08:53,759 I THINK IT'S JUST THIS 3557 02:08:53,826 --> 02:08:56,261 OPPORTUNITY IS REALLY 3558 02:08:56,328 --> 02:08:57,463 TRANSFORMATIVE FOR THIS PATIENT 3559 02:08:57,529 --> 02:08:58,864 POPULATION, AND THERE'S A LOT OF 3560 02:08:58,931 --> 02:09:00,833 PROMISE IN IT. 3561 02:09:00,899 --> 02:09:02,835 OUR PRIMARY GOAL IS REALLY TO 3562 02:09:02,901 --> 02:09:06,305 ADVANCE THE HEALTH OF THIS 3563 02:09:06,371 --> 02:09:07,940 OTHERWISE YOUNG AND OTHERWISE 3564 02:09:08,006 --> 02:09:09,608 HEALTHY PATIENT POPULATION BY 3565 02:09:09,675 --> 02:09:12,978 PROVIDING THEM HIGH QUALITY 3566 02:09:13,045 --> 02:09:14,413 EVIDENCE-BASED CARE THAT 3567 02:09:14,480 --> 02:09:16,915 CONSIDERS NOT JUST THEIR MEDICAL 3568 02:09:16,982 --> 02:09:18,684 HISTORIES, BUT ALSO THEIR LIFE 3569 02:09:18,750 --> 02:09:19,885 HISTORIES, SO SPECIFICALLY, WHEN 3570 02:09:19,952 --> 02:09:24,823 WE LOOK AT CHRONIC SOMATIC PAIN 3571 02:09:24,890 --> 02:09:28,327 IN REFUGEE WOMEN, WE FIND THAT 3572 02:09:28,393 --> 02:09:31,396 ALL OF WHAT I'VE JUST TALKED 3573 02:09:31,463 --> 02:09:34,233 ABOUT, THEIR HISTORIES FLEEING 3574 02:09:34,299 --> 02:09:35,234 PERSECUTION, SEXUAL ASSAULT, 3575 02:09:35,300 --> 02:09:37,102 WAR, VIOLENCE, CARING FOR THEIR 3576 02:09:37,169 --> 02:09:39,104 CHILDREN, THOSE SORTS OF THINGS, 3577 02:09:39,171 --> 02:09:41,039 THAT DEEPLY INFLUENCES THEIR 3578 02:09:41,106 --> 02:09:42,141 EXPERIENCES OF PAIN. 3579 02:09:42,207 --> 02:09:43,775 WHAT MANY PEOPLE WOULD CALL THE 3580 02:09:43,842 --> 02:09:45,544 SOCIAL DETERMINANTS OF HEALTH. 3581 02:09:45,611 --> 02:09:48,380 IN OUR PATIENT POPULATION, LIKE 3582 02:09:48,447 --> 02:09:49,915 HANNA WAS JUST TALKING ABOUT, 3583 02:09:49,982 --> 02:09:52,317 THE PSYCHOLOGICAL AND PHYSICAL 3584 02:09:52,384 --> 02:09:53,886 SYMPTOMS REALLY INFORM ONE 3585 02:09:53,952 --> 02:09:54,953 ANOTHER. 3586 02:09:55,020 --> 02:09:57,156 AND THERE'S THIS COMPLEX 3587 02:09:57,222 --> 02:09:59,791 INTERPLAY BETWEEN ONE'S LIFE 3588 02:09:59,858 --> 02:10:02,094 EXPERIENCES AND THEIR HEALTH. 3589 02:10:02,161 --> 02:10:04,963 FOR EXAMPLE, IN A SYSTEMATIC 3590 02:10:05,030 --> 02:10:06,765 REVIEW AND META-ANALYSIS OF 3591 02:10:06,832 --> 02:10:08,433 GLOBAL METHODS OF HARM WHERE WE 3592 02:10:08,500 --> 02:10:10,736 REVIEWED ALMOST 250, 260 STUDIES 3593 02:10:10,802 --> 02:10:13,572 AND INCLUDED OVER 100,000 3594 02:10:13,639 --> 02:10:15,440 PATIENTS, WE FOUND THAT TORTURE 3595 02:10:15,507 --> 02:10:17,843 AS CLASSIFIED BY THE UNITED 3596 02:10:17,910 --> 02:10:19,178 NATIONS CONVENTION AGAINST 3597 02:10:19,244 --> 02:10:20,812 TORTURE WAS SYSTEMATICALLY 3598 02:10:20,879 --> 02:10:23,982 PRACTICED IN OVER 100 OF THE 3599 02:10:24,049 --> 02:10:27,152 WORLD'S COUNTRIES, AND 3600 02:10:27,219 --> 02:10:29,021 IMPORTANTLY, THE EXPERIENCE OF 3601 02:10:29,087 --> 02:10:30,122 WOMEN AND MEN DIFFERED. 3602 02:10:30,189 --> 02:10:31,323 WOMEN WERE SIGNIFICANTLY MORE 3603 02:10:31,390 --> 02:10:33,425 LIKELY THAN MEN TO EXPERIENCE 3604 02:10:33,492 --> 02:10:35,294 TORTURE SUCH AS RAPE OR BURNING 3605 02:10:35,360 --> 02:10:37,296 OR PENETRATING TRAUMA, WHEREAS 3606 02:10:37,362 --> 02:10:40,432 MEN WERE MORE LIKELY THAN WOMEN 3607 02:10:40,499 --> 02:10:42,167 TO EXPERIENCE SUSPENSION FROM 3608 02:10:42,234 --> 02:10:43,835 UPPER EXTREMITIES OR BEATING OF 3609 02:10:43,902 --> 02:10:45,504 THE SOLES OF THE FEET OR BINDING 3610 02:10:45,571 --> 02:10:47,005 OR RESTRICTED MOVEMENTS. 3611 02:10:47,072 --> 02:10:49,007 AND AS YOU CAN IMAGINE, THAT 3612 02:10:49,074 --> 02:10:51,276 RESULTS IN DIFFERENT PAIN 3613 02:10:51,343 --> 02:10:52,611 SYNDROMES AND EXPERIENCES OF 3614 02:10:52,678 --> 02:10:53,378 PAIN. 3615 02:10:53,445 --> 02:10:54,680 AND NOT LISTED HERE IN THIS 3616 02:10:54,746 --> 02:10:56,548 FIGURE ARE TORTURE METHODS 3617 02:10:56,615 --> 02:10:57,549 APPLIED TO JUST ONE GENDER. 3618 02:10:57,616 --> 02:10:59,184 FOR EXAMPLE, FEMALE GENITAL 3619 02:10:59,251 --> 02:11:02,788 MUTILATION OR CUTTING IN WOMEN 3620 02:11:02,854 --> 02:11:04,122 VERSUS ROLLER CRUSHING OF 3621 02:11:04,189 --> 02:11:06,625 MUSCLES, WHICH IS EXPERIENCED IN 3622 02:11:06,692 --> 02:11:07,292 SOUTHEAST ASIA SPECIFICALLY, 3623 02:11:07,359 --> 02:11:09,428 ONLY FOR MEN. 3624 02:11:09,494 --> 02:11:12,130 SO THESE EXPERIENCES OF TRAUMA 3625 02:11:12,197 --> 02:11:15,968 HAD VERY REAL IMPLICATIONS FOR 3626 02:11:16,034 --> 02:11:18,136 THE TYPE AND SEVERITY AND 3627 02:11:18,203 --> 02:11:21,673 QUALITIES OF POST-TRAUMATIC PAIN 3628 02:11:21,740 --> 02:11:22,841 EXPERIENCED BY OUR PATIENTS. 3629 02:11:22,908 --> 02:11:24,243 AND I'LL GIVE YOU AN EXAMPLE 3630 02:11:24,309 --> 02:11:26,345 SPECIFICALLY OF FEMALE GENITAL 3631 02:11:26,411 --> 02:11:29,381 MUTILATION OR CUTTING. 3632 02:11:29,448 --> 02:11:30,716 WHILE THE WORLD HEALTH 3633 02:11:30,782 --> 02:11:32,718 ORGANIZATION CALLS FOR A 3634 02:11:32,784 --> 02:11:36,755 UNIVERSAL BAN ON FGM/C, OVER 3635 02:11:36,822 --> 02:11:37,756 200 MILLION WOMEN AND GIRLS 3636 02:11:37,823 --> 02:11:40,058 AROUND THE WORLD ARE AFFECTED BY 3637 02:11:40,125 --> 02:11:45,097 THIS OON THIS ONGOING PRACTICE. 3638 02:11:45,163 --> 02:11:47,065 IN 2020, OVER HALF OF THE TOP 10 3639 02:11:47,132 --> 02:11:49,468 COUNTRIES OF ORIGIN FOR ASYLUM 3640 02:11:49,534 --> 02:11:50,802 SEEKERS ADMITTED TO THE UNITED 3641 02:11:50,869 --> 02:11:53,472 STATES PRACTICED FGM/C WITH SOME 3642 02:11:53,538 --> 02:11:54,773 NATIONS HAVE A PREVALENCE OF 3643 02:11:54,840 --> 02:11:55,173 NEARLY 90%. 3644 02:11:55,240 --> 02:11:56,608 SO WE ARE SEEING THESE PATIENTS 3645 02:11:56,675 --> 02:11:58,043 IN OUR CLINICAL PRACTICES. 3646 02:11:58,110 --> 02:11:59,578 WE CONDUCTED A STUDY LACKING AT 3647 02:11:59,645 --> 02:12:01,546 THE IMPACT OF FEMALE GENITAL 3648 02:12:01,613 --> 02:12:03,849 MUTILATION OR CUTTING ON PAINFUL 3649 02:12:03,915 --> 02:12:05,284 GYNECOLOGIC OR OBSTETRIC 3650 02:12:05,350 --> 02:12:06,351 OUTCOMES, AND SO THIS IS A 3651 02:12:06,418 --> 02:12:08,120 FIGURE OF THE FOUR DIFFERENT 3652 02:12:08,186 --> 02:12:10,022 TYPES OF FGM/C AND WHAT YOU CAN 3653 02:12:10,088 --> 02:12:12,190 SEE THAT EACH OF THESE TYPES 3654 02:12:12,257 --> 02:12:14,226 WOULD RESULT IN SIGNIFICANT 3655 02:12:14,293 --> 02:12:16,695 COMPLICATIONS FOR CHILDBIRTH AND 3656 02:12:16,762 --> 02:12:19,131 IN EVERYDAY LIFE IN TERMS OF 3657 02:12:19,197 --> 02:12:19,331 PAIN. 3658 02:12:19,398 --> 02:12:21,066 THROUGH OUR PAPER, WE FOUND 3659 02:12:21,133 --> 02:12:23,602 EVIDENCE THAT INDIVIDUALS WITH 3660 02:12:23,669 --> 02:12:26,138 FG M/C ARE VERY CLEARLY AT 3661 02:12:26,204 --> 02:12:32,444 HIGHER RISK FOR DIS -- PROLONGED 3662 02:12:32,511 --> 02:12:43,155 LABOR AND' PIECE AND EE PEAZ EP. 3663 02:12:43,221 --> 02:12:45,891 WOMEN UNDERGOING FGM/C 3664 02:12:45,957 --> 02:12:46,758 EXPERIENCED DISRESPECT FROM 3665 02:12:46,825 --> 02:12:47,859 WESTERN MEDICAL PROFESSIONALS 3666 02:12:47,926 --> 02:12:50,295 WHO WERE UNFAMILIAR WITH THE 3667 02:12:50,362 --> 02:12:50,962 PRACTICE, POTENTIALLY 3668 02:12:51,029 --> 02:12:52,264 THREATENING DOCTOR-PATIENT 3669 02:12:52,331 --> 02:12:53,665 RELATIONSHIPS AND OUTCOMES. 3670 02:12:53,732 --> 02:12:56,668 A SURVEY OF OVER 400 SOMALI 3671 02:12:56,735 --> 02:12:59,438 REFUGEE WOMEN WHO GAVE BIRTH IN 3672 02:12:59,504 --> 02:13:01,707 CANADA AFTER FGM/C FOR EXAMPLE 3673 02:13:01,773 --> 02:13:03,442 FOUND THAT THE VAST MAJORITY 3674 02:13:03,508 --> 02:13:04,843 REPORTED OFFENSIVE COMMENTS FROM 3675 02:13:04,910 --> 02:13:06,178 THEIR CAREGIVERS BECAUSE OF 3676 02:13:06,244 --> 02:13:07,612 THEIR CUTTING. 3677 02:13:07,679 --> 02:13:10,082 PATIENTS REPORTED BEING REGARDED 3678 02:13:10,148 --> 02:13:11,883 WITH DISGUST AND WITH SHOCK. 3679 02:13:11,950 --> 02:13:13,985 THE MAJORITY ALSO FELT THAT 3680 02:13:14,052 --> 02:13:15,354 DOCTORS DID NOT UNDERSTAND THEIR 3681 02:13:15,420 --> 02:13:16,988 PAIN AND THAT THEIR PHYSICIANS 3682 02:13:17,055 --> 02:13:19,858 DID NOT UNDERSTAND THAT WOMEN 3683 02:13:19,925 --> 02:13:21,626 WITH FGM/C EXPERIENCED 3684 02:13:21,693 --> 02:13:23,261 PARTICULARLY SEVERE POSTPARTUM 3685 02:13:23,328 --> 02:13:24,463 PAIN. 3686 02:13:24,529 --> 02:13:25,897 THE LITERATURE ALSO DOCUMENTS 3687 02:13:25,964 --> 02:13:29,067 WOMEN WHO HAVE BEEN AFFECTED BY 3688 02:13:29,134 --> 02:13:31,970 FGM/C BEING LEFT IN STIR UPS FOR 3689 02:13:32,037 --> 02:13:33,271 EXTENDED PERIODS OF TIME AS 3690 02:13:33,338 --> 02:13:34,473 MEDICAL STUDENTS AND RESIDENTS 3691 02:13:34,539 --> 02:13:36,541 INSPECTED THEIR ANATOMY, AND 3692 02:13:36,608 --> 02:13:38,777 THESE PATIENTS REPORTED FEELING 3693 02:13:38,844 --> 02:13:39,945 DEHUMANIZED WHEN INTERACTING 3694 02:13:40,011 --> 02:13:42,414 WITH HEALTHCARE PROVIDERS IN 3695 02:13:42,481 --> 02:13:44,683 HIGH INCOME NATIONS. 3696 02:13:44,750 --> 02:13:46,418 2 OUT OF 5 WOMEN STATED THEY 3697 02:13:46,485 --> 02:13:48,086 WOULD NOT RETURN TO THE SAME 3698 02:13:48,153 --> 02:13:49,788 HOSPITAL FOR FUTURE DELIVERIES 3699 02:13:49,855 --> 02:13:51,590 AND MORE THAN 10% OF WOMEN 3700 02:13:51,656 --> 02:13:53,658 STATED THAT THEY WOULD PREFER 3701 02:13:53,725 --> 02:13:56,728 NOT TO ATTEND ANY HOSPITAL FOR 3702 02:13:56,795 --> 02:14:01,800 FEFUTURE BIRTHS WHICH IS A 3703 02:14:01,867 --> 02:14:05,370 PARTICULARLY POOR OUT COME GIVEN 3704 02:14:05,437 --> 02:14:07,205 POTENTIAL COMPLICATIONS OF 3705 02:14:07,272 --> 02:14:08,473 FGM/C. 3706 02:14:08,540 --> 02:14:11,243 SO WHY IS THIS ALL IMPORTANT? 3707 02:14:11,309 --> 02:14:13,011 AS A MEDICAL ANTHROPOLOGIST, I'M 3708 02:14:13,078 --> 02:14:15,680 HERE TO STRESS HOW IMPORTANT IT 3709 02:14:15,747 --> 02:14:18,650 IS TO UNDERSTAND THE 3710 02:14:18,717 --> 02:14:19,418 BIOPSYCHOSOCIAL CONTEXT FROM 3711 02:14:19,484 --> 02:14:22,254 WHICH A PERSON IS COMING TO 3712 02:14:22,320 --> 02:14:24,556 EXPLAIN THOSE PAIN EXPERIENCES. 3713 02:14:24,623 --> 02:14:26,992 FIRSTLY, WHEN WE KNOW A PERSON'S 3714 02:14:27,058 --> 02:14:28,293 LIFE HISTORY, FOR EXAMPLE, THAT 3715 02:14:28,360 --> 02:14:32,130 THEY ARE FROM A COUNTRY IN 3716 02:14:32,197 --> 02:14:34,232 AFRICA WHERE 90% OF WOMEN 3717 02:14:34,299 --> 02:14:36,401 EXPERIENCE FGM/C RESULTING IN 3718 02:14:36,468 --> 02:14:38,203 CHRONIC PELVIC PAIN OR MENSTRUAL 3719 02:14:38,270 --> 02:14:39,504 PAIN, OR THE MIDDLE EAST, WHERE 3720 02:14:39,571 --> 02:14:40,906 SUSPENSION FROM UPPER 3721 02:14:40,972 --> 02:14:44,109 EXTREMITIES RESULTS IN BRACHIAL 3722 02:14:44,176 --> 02:14:46,077 PLEXUS INJURIES OR FROM 3723 02:14:46,144 --> 02:14:47,946 SOUTHEAST ASIA, WHERE LEG 3724 02:14:48,013 --> 02:14:50,115 HYPEREXTENSION IS VERY COMMON, 3725 02:14:50,182 --> 02:14:52,551 RESULTING IN LUMBOSACRAL PLEXUS 3726 02:14:52,617 --> 02:14:53,718 INJURIES, THEN I CAN ASK THE 3727 02:14:53,785 --> 02:14:54,920 RIGHT QUESTIONS AS A CLINICIAN 3728 02:14:54,986 --> 02:14:56,521 AND PROVIDE THE RIGHT DIAGNOSES 3729 02:14:56,588 --> 02:14:56,855 AND TREATMENT. 3730 02:14:56,922 --> 02:14:58,323 SO THAT'S ONE REASON WHY IT'S 3731 02:14:58,390 --> 02:14:59,257 IMPORTANT. 3732 02:14:59,324 --> 02:15:01,893 THE SECOND IS THAT THESE ARE 3733 02:15:01,960 --> 02:15:03,795 MODIFIABLE RISK FACTORS. 3734 02:15:03,862 --> 02:15:06,097 IN MANY CASES, OUR RESEARCH HAS 3735 02:15:06,164 --> 02:15:07,833 DISCOVERED THAT, FOR EXAMPLE, 3736 02:15:07,899 --> 02:15:10,469 STRESS RELATED TO THE THREAT OF 3737 02:15:10,535 --> 02:15:12,337 DEPORTATION REALLY HAS A 3738 02:15:12,404 --> 02:15:16,074 PROFOUND IMPACT ON PAIN 3739 02:15:16,141 --> 02:15:16,741 EXPERIENCES, AND THAT IS 3740 02:15:16,808 --> 02:15:18,043 SOMETHING THAT IS MODIFIABLE. 3741 02:15:18,109 --> 02:15:19,911 HERE WE SHOW HOW WOMEN ARE CARED 3742 02:15:19,978 --> 02:15:22,647 FOR ITSELF. 3743 02:15:22,714 --> 02:15:24,182 THEIR EXPERIENCES WITHIN THE 3744 02:15:24,249 --> 02:15:25,150 HEALTHCARE SYSTEM, THAT THAT CAN 3745 02:15:25,217 --> 02:15:28,019 BE A MODIFIABLE RISK FACTOR FOR 3746 02:15:28,086 --> 02:15:31,223 HOW WOMEN EXPERIENCE PAIN OR 3747 02:15:31,289 --> 02:15:32,324 WHAT THEIR EXPERIENCES ARE IN 3748 02:15:32,390 --> 02:15:34,392 SEEKING CARE FOR PAIN. 3749 02:15:34,459 --> 02:15:35,861 NOT UNDERSTANDING, FOR EXAMPLE, 3750 02:15:35,927 --> 02:15:38,797 THAT A WOMAN WITH FGM/C WILL 3751 02:15:38,864 --> 02:15:40,131 HAVE WORSE POSTPARTUM PAIN WILL 3752 02:15:40,198 --> 02:15:42,734 LEAD TO UNDER- OR MISSED 3753 02:15:42,801 --> 02:15:45,937 DIAGNOSES, LACK OF TREATMENT AND 3754 02:15:46,004 --> 02:15:46,671 RESULTING DISENGAGEMENT OF 3755 02:15:46,738 --> 02:15:47,572 PATIENTS WITH THE HEALTHCARE 3756 02:15:47,639 --> 02:15:47,806 SYSTEM. 3757 02:15:47,873 --> 02:15:51,409 AND I THINK THAT'S REALLY WHERE 3758 02:15:51,476 --> 02:15:52,744 WE HAVE AN OPPORTUNITY TO MAKE A 3759 02:15:52,811 --> 02:15:53,712 DIFFERENCE, TO MAKE CONNECTIONS 3760 02:15:53,778 --> 02:15:56,147 AND TO HAVE A REAL IMPACT. 3761 02:15:56,214 --> 02:15:57,682 AND THAT BRINGS ME TO THE FOURTH 3762 02:15:57,749 --> 02:15:59,651 STREAM OF RESEARCH AT THE HUMAN 3763 02:15:59,718 --> 02:16:01,820 RIGHTS IMPACT LAB, WHERE WE'RE 3764 02:16:01,887 --> 02:16:04,789 CONDUCTING CROSS-DISCIPLINARY 3765 02:16:04,856 --> 02:16:05,891 INVESTIGATIONS LIKE OUR WORK 3766 02:16:05,957 --> 02:16:16,434 WITH ATTORNEYS OR ECONOMISTINGS, 3767 02:16:16,501 --> 02:16:18,403 ORINTHOLOGY, FOR EXAMPLE, OP WHY 3768 02:16:18,470 --> 02:16:19,404 REFUGEES, SPECIFICALLY REFUGEE 3769 02:16:19,471 --> 02:16:21,139 WOMEN, DO NOT ACCESS PUBLIC 3770 02:16:21,206 --> 02:16:22,674 BENEFITS LIKE PREVENTIVE CARE 3771 02:16:22,741 --> 02:16:24,576 FOR THEIR CHRONIC SOMATIC 3772 02:16:24,643 --> 02:16:26,444 TORTURE PAIN OR PRENATAL CARE OR 3773 02:16:26,511 --> 02:16:27,412 CHILDHOOD VACCINATIONS. 3774 02:16:27,479 --> 02:16:30,782 AND AS WE'RE DOING THIS 3775 02:16:30,849 --> 02:16:31,483 SCIENTIFIC RESEARCH, WE'RE 3776 02:16:31,550 --> 02:16:37,188 REALLY WORKING TO BRING OUR 3777 02:16:37,255 --> 02:16:38,290 FINDINGS TO THE PUBLIC, WHERE 3778 02:16:38,356 --> 02:16:40,625 WE'RE REACHING BEYOND 3779 02:16:40,692 --> 02:16:43,828 TRADITIONAL SCIENTIFIC AUDIENCE 3780 02:16:43,895 --> 02:16:48,033 TO CHANGE THE LANGUAGE AROUND 3781 02:16:48,099 --> 02:16:49,267 REFUGEES AND DEPICTIONS OF WHAT 3782 02:16:49,334 --> 02:16:51,236 PEOPLE EXPERIENCE TO BRING OUR 3783 02:16:51,303 --> 02:16:52,871 PATIENTS' STORIES TO THE MEDIA, 3784 02:16:52,938 --> 02:16:55,173 TO THE PUBLIC, THROUGH RADIO 3785 02:16:55,240 --> 02:16:57,142 INTERVIEWS AND ARTICLES. 3786 02:16:57,208 --> 02:17:00,946 THE IDEA THAT WE CAN ACTUALLY 3787 02:17:01,012 --> 02:17:02,981 REALLY CHANGE THE LIVES OF 3788 02:17:03,048 --> 02:17:05,283 PATIENTS WHEN WE BRING THAT 3789 02:17:05,350 --> 02:17:09,120 SCIENCE TO THE PUBLIC. 3790 02:17:09,187 --> 02:17:11,289 IF I KNOW THAT 10S OF THOUSANDS 3791 02:17:11,356 --> 02:17:15,160 OF WOMEN ARE COMING TO THE U.S. 3792 02:17:15,226 --> 02:17:16,227 WITH FGM/C AND WILL DELIVER 3793 02:17:16,294 --> 02:17:18,229 BABIES AND WILL INTERACT WITH 3794 02:17:18,296 --> 02:17:20,198 OBs AND ANESTHESIOLOGISTS AND 3795 02:17:20,265 --> 02:17:22,500 GYNECOLOGISTS AFTERWARDS, WE 3796 02:17:22,567 --> 02:17:24,035 FEEL THAT IT'S OUR DUTY TO BRING 3797 02:17:24,102 --> 02:17:26,671 THAT TO THE PUBLIC TO AUDIENCES 3798 02:17:26,738 --> 02:17:29,741 BEYOND THE MEDICAL JOURNALS 3799 02:17:29,808 --> 02:17:31,076 WHERE WE TYPICALLY PUBLISH. 3800 02:17:31,142 --> 02:17:32,410 SO WHY DOES THIS RESEARCH 3801 02:17:32,477 --> 02:17:33,411 MATTER? 3802 02:17:33,478 --> 02:17:35,580 WHY IS ANY OF IT AS IMPORTANT AS 3803 02:17:35,647 --> 02:17:36,715 MECHANISMS OF ANESTHESIA 3804 02:17:36,781 --> 02:17:38,683 RESEARCH, WHICH IS WHAT A LOT OF 3805 02:17:38,750 --> 02:17:40,752 MY COLLEAGUES DO OR ION CHANNEL 3806 02:17:40,819 --> 02:17:42,020 RESEARCH OR ADDICTION RESEARCH, 3807 02:17:42,087 --> 02:17:43,488 AND THERE'S THREE REASONS THAT I 3808 02:17:43,555 --> 02:17:45,624 WILL SHARE WITH YOU. 3809 02:17:45,690 --> 02:17:48,994 THE FIRST IS REALLY THE VOICE OF 3810 02:17:49,060 --> 02:17:50,295 THE MY GRANT IN ME. 3811 02:17:50,362 --> 02:17:52,497 MY FAMILY CAME TO THE U.S. TO 3812 02:17:52,564 --> 02:17:54,599 ESCAPE POLITICAL VIOLENCE IN THE 3813 02:17:54,666 --> 02:17:58,203 1980s, AND SO I KNOW FIRSTHAND 3814 02:17:58,269 --> 02:18:00,071 HOW THE EXPERIENCE OF BEING A 3815 02:18:00,138 --> 02:18:01,706 NEW IMMIGRANT AND A MY GRANT CAN 3816 02:18:01,773 --> 02:18:04,009 LEAVE A DEEP MARK ON AN 3817 02:18:04,075 --> 02:18:06,311 INDIVIDUAL'S FUTURE, AND THAT 3818 02:18:06,378 --> 02:18:09,214 PROVIDING REALLY EVIDENCE-BASED 3819 02:18:09,280 --> 02:18:11,616 CARE TO THIS PATIENT POPULATION, 3820 02:18:11,683 --> 02:18:14,019 HOW THAT CAN COMPLETELY ALTER 3821 02:18:14,085 --> 02:18:16,321 LIFE TRAJECTORIES. 3822 02:18:16,388 --> 02:18:17,789 THE SECOND IS THE VOICE OF THE 3823 02:18:17,856 --> 02:18:20,091 CLINICIAN IN ME THAT SAYS THAT 3824 02:18:20,158 --> 02:18:24,529 AS WAR AND VIOLENCE AND CLIMATE 3825 02:18:24,596 --> 02:18:26,331 CHANGE INCREASINGLY DISPLACES 3826 02:18:26,398 --> 02:18:27,332 PEOPLE ACROSS THE WORLD, THAT WE 3827 02:18:27,399 --> 02:18:28,633 WILL SEE PEOPLE WHO HAVE BEEN 3828 02:18:28,700 --> 02:18:30,168 DISPLACED FROM THEIR HOMES AS 3829 02:18:30,235 --> 02:18:31,169 PATIENTS IN OUR CLINICAL 3830 02:18:31,236 --> 02:18:33,905 PRACTICES MORE FREQUENTLY. 3831 02:18:33,972 --> 02:18:34,673 PATIENTS LIKE NOR. 3832 02:18:34,739 --> 02:18:37,409 AND AS CLINICIANS, WE NEED TO 3833 02:18:37,475 --> 02:18:38,243 KNOW HOW TO CARE FOR THEM. 3834 02:18:38,309 --> 02:18:41,079 WE NEED TO UNDERSTAND THE 3835 02:18:41,146 --> 02:18:41,713 BIOPSYCHOSOCIAL FACTORS THAT 3836 02:18:41,780 --> 02:18:45,884 BROUGHT THEM HERE, AND HOW THAT 3837 02:18:45,950 --> 02:18:49,054 CHANGES THEIR EXPERIENCES 3838 02:18:49,120 --> 02:18:50,288 PHYSICALLY, PSYCHOLOGICALLY AND 3839 02:18:50,355 --> 02:18:52,891 IN THE HEALTHCARE SYSTEM. 3840 02:18:52,957 --> 02:18:54,192 AND THE FINAL IS THE VOICE OF 3841 02:18:54,259 --> 02:18:55,660 THE MEDICAL ANTHROPOLOGIST IN ME 3842 02:18:55,727 --> 02:18:58,730 THAT SAYS THAT THESE MIGRANTS 3843 02:18:58,797 --> 02:18:59,698 ARE PEOPLE JUST LIKE YOU AND 3844 02:18:59,764 --> 02:19:01,700 JUST LIKE ME WHO HAVE FOUND 3845 02:19:01,766 --> 02:19:03,668 THEMSELVES IN THIS EXTREMELY 3846 02:19:03,735 --> 02:19:04,669 VULNERABLE POSITION, AND THE 3847 02:19:04,736 --> 02:19:06,871 ONLY THING THAT REALLY SEPARATES 3848 02:19:06,938 --> 02:19:09,274 US IS AN EARTHQUAKE OR A FLOOD 3849 02:19:09,340 --> 02:19:10,975 OR A MOMENT OF SOCIAL OR 3850 02:19:11,042 --> 02:19:13,011 POLITICAL ERUPTION AT HOME, AND 3851 02:19:13,078 --> 02:19:15,013 I THINK IT'S THAT SHARED 3852 02:19:15,080 --> 02:19:16,448 HUMANITY THAT MAKES IT OUR 3853 02:19:16,514 --> 02:19:19,284 RESPONSIBILITY TO DO THIS WORK. 3854 02:19:19,350 --> 02:19:20,852 I BELIEVE VERY CLEARLY THAT 3855 02:19:20,919 --> 02:19:22,854 FORCED MIGRATION IS THE MOST 3856 02:19:22,921 --> 02:19:24,355 URGENT ISSUE OF OUR LIFETIMES, 3857 02:19:24,422 --> 02:19:26,357 AND HOW WE RESPOND TO IT WILL 3858 02:19:26,424 --> 02:19:28,126 DEFINE OUR GENERATION, AND I 3859 02:19:28,193 --> 02:19:29,728 THANK YOU FOR BEING HERE TODAY 3860 02:19:29,794 --> 02:19:32,464 WITH ME TO SHARE THIS BRIEF 3861 02:19:32,530 --> 02:19:34,599 JOURNEY ON OUR WORK TO IMPROVE 3862 02:19:34,666 --> 02:19:36,801 THE HEALTH AND WELL-BEING OF THE 3863 02:19:36,868 --> 02:19:40,839 PEOPLE, SPESM SPECIFICALLY THEN 3864 02:19:40,905 --> 02:19:42,307 AND GIRLS AFFECTED BY MIGRATION, 3865 02:19:42,373 --> 02:19:43,041 AND I'LL END THERE. 3866 02:19:43,108 --> 02:19:51,082 THANK YOU. 3867 02:19:51,149 --> 02:19:53,017 >> THANK YOU, GUNISHA. 3868 02:19:53,084 --> 02:19:54,819 THAT WAS A BIG EYE OPENER FOR 3869 02:19:54,886 --> 02:19:55,487 MANY, I'M SURE, HERE. 3870 02:19:55,553 --> 02:19:57,856 SO I WOULD LIKE TO THANK ALL THE 3871 02:19:57,922 --> 02:19:59,958 SPEAKERS AT THIS POINT, AND ALSO 3872 02:20:00,024 --> 02:20:01,926 INVITE THEM TO THE PODIUM SO WE 3873 02:20:01,993 --> 02:20:03,361 CAN START THE PANEL DISCUSSION 3874 02:20:03,428 --> 02:20:06,698 AND LET'S HOPE JEFF IS ONLINE. 3875 02:20:06,765 --> 02:20:07,398 JEFF, CAN YOU HEAR US? 3876 02:20:07,465 --> 02:20:10,201 >> YEP. 3877 02:20:10,268 --> 02:20:12,771 >> CAN YOU SAY, JEFF? 3878 02:20:12,837 --> 02:20:14,005 >> HELLO, HELLO. 3879 02:20:14,072 --> 02:20:15,039 >> NO, I CANNOT HEAR YOU. 3880 02:20:15,106 --> 02:20:25,416 >> I CAN HEAR YOU. 3881 02:20:27,051 --> 02:20:30,255 >> WHILE WE FIGURE OUT THE 3882 02:20:30,321 --> 02:20:32,490 TECHNICAL ISSUES, AUDIENCE, 3883 02:20:32,557 --> 02:20:35,660 PLEASE COME UP WITH ANY 3884 02:20:35,727 --> 02:20:36,628 QUESTIONS, THOUGHTS YOU HAVE. 3885 02:20:36,694 --> 02:20:40,665 I DEFINITELY HAVE MANY. 3886 02:20:40,732 --> 02:20:42,333 SO MAYBE I'LL START WITH SOME. 3887 02:20:42,400 --> 02:20:44,869 SO JUST FRESH WITH GUNISHA, YOUR 3888 02:20:44,936 --> 02:20:47,272 TALK, IT WAS REALLY EYE OPENING. 3889 02:20:47,338 --> 02:20:50,041 I'M QUITE SURE IT IS VERY 3890 02:20:50,108 --> 02:20:52,577 CHALLENGING, NUMBER ONE, TO NOT 3891 02:20:52,644 --> 02:20:54,546 ONLY RECRUIT THESE SUBJECTS AND 3892 02:20:54,612 --> 02:20:56,548 ALSO HOW YOU DO RESEARCH AND 3893 02:20:56,614 --> 02:20:59,717 COLLECT DATA FROM THAT. 3894 02:20:59,784 --> 02:21:06,024 IT'S ALWAYS A BIG CHALLENGE, HOW 3895 02:21:06,090 --> 02:21:07,325 YOU DESIGN A STUDY, SO MAYBE YOU 3896 02:21:07,392 --> 02:21:09,260 CAN SHED A LITTLE LIGHT ON THAT 3897 02:21:09,327 --> 02:21:10,461 AND HOPEFULLY WE'LL HAVE MORE 3898 02:21:10,528 --> 02:21:11,129 QUESTIONS. 3899 02:21:11,196 --> 02:21:12,230 >> SURE. 3900 02:21:12,297 --> 02:21:14,532 THANKS FOR THAT QUESTION. 3901 02:21:14,599 --> 02:21:16,000 SO I AGREE WITH YOU, I THINK IT 3902 02:21:16,067 --> 02:21:18,703 IS REALLY HARD TO WORK WITH 3903 02:21:18,770 --> 02:21:20,505 MINORITY POPULATIONS AND I THINK 3904 02:21:20,572 --> 02:21:22,040 SOMETIMES LIKE OUR KEYNOTE 3905 02:21:22,106 --> 02:21:25,410 SPEAKER WAS SAYING WITH PREGNANT 3906 02:21:25,476 --> 02:21:28,479 WOMEN, MINORITY GROUPS, PEOPLE 3907 02:21:28,546 --> 02:21:30,348 ARE SO FEARFUL OF DOING 3908 02:21:30,415 --> 02:21:32,784 RESEARCH, OF HARMING PEOPLE, 3909 02:21:32,851 --> 02:21:36,054 THAT THE DEFAULT IS TO JUST NOT 3910 02:21:36,120 --> 02:21:37,488 DO THE WORK, NOT DO THE 3911 02:21:37,555 --> 02:21:38,723 RESEARCH, AND I'LL SAY THAT WHEN 3912 02:21:38,790 --> 02:21:41,192 WE STARTED THIS WORK IN 20 3913 02:21:41,259 --> 02:21:43,428 THRIRN, I THINK IT TOOK US LIKE 3914 02:21:43,494 --> 02:21:46,598 A YEAR OR YEAR AND A HALF TO GET 3915 02:21:46,664 --> 02:21:50,468 OUR FIRST MINIMAL RISK IRB STUDY 3916 02:21:50,535 --> 02:21:52,770 APPROVED, BECAUSE PEOPLE WERE 3917 02:21:52,837 --> 02:21:56,474 JUST SO FEARFUL OF HARMING THIS 3918 02:21:56,541 --> 02:21:57,475 PATIENT POPULATION AND THE WORK 3919 02:21:57,542 --> 02:21:59,177 WE'RE DOING RIGHT NOW IN 3920 02:21:59,244 --> 02:22:00,445 PREGNANT REFUGEE WOMEN SIMILARLY 3921 02:22:00,511 --> 02:22:02,580 SAT WITH THE IRB FOR A YEAR AND 3922 02:22:02,647 --> 02:22:06,384 A HALF BEFORE WE GOT APPROVAL. 3923 02:22:06,451 --> 02:22:08,186 I THINK FOR US IT'S REALLY BEEN 3924 02:22:08,253 --> 02:22:13,658 ABOUT PERSISTENCE, ABOUT FINDING 3925 02:22:13,725 --> 02:22:14,826 THE RIGHT PEOPLE THAT WILL 3926 02:22:14,893 --> 02:22:15,860 SUPPORT THE WORK. 3927 02:22:15,927 --> 02:22:18,796 THE NIH HAS BEEN UNBELIEVABLY 3928 02:22:18,863 --> 02:22:24,035 WONDERFUL, AND I THINK IS REA 3929 02:22:24,102 --> 02:22:25,970 REALLY -- I SEE THE NIH AS, 3930 02:22:26,037 --> 02:22:29,173 LIKE, ON THE CUTTING EDGE OF THE 3931 02:22:29,240 --> 02:22:30,909 WORK THAT WE SHOULD BE DOING AND 3932 02:22:30,975 --> 02:22:32,010 SUPPORTING, AND THE FACT THAT 3933 02:22:32,076 --> 02:22:33,845 THE NIH IS SUPPORTING THIS WORK, 3934 02:22:33,912 --> 02:22:35,280 I THINK MAKES PEOPLE REALIZE 3935 02:22:35,346 --> 02:22:37,482 THAT IT'S NOT JUST THESE 3936 02:22:37,548 --> 02:22:38,383 INDIVIDUAL STORIES, THAT THERE'S 3937 02:22:38,449 --> 02:22:39,717 SOME TATA, THERE'S SOMETHING TO 3938 02:22:39,784 --> 02:22:41,819 BE FOUND THERE, AND WORK TO BE 3939 02:22:41,886 --> 02:22:43,087 DONE, AND WHEN YOU CAN COLLECT 3940 02:22:43,154 --> 02:22:44,923 IT AND PULL IT TOGETHER, THERE'S 3941 02:22:44,989 --> 02:22:46,958 A REALLY PROFOUND IMPACT OF 3942 02:22:47,025 --> 02:22:48,960 SEEING THE DATA IN THE WAY THAT 3943 02:22:49,027 --> 02:22:54,032 WE DO NOW. 3944 02:22:54,098 --> 02:22:54,465 >> THANK YOU. 3945 02:22:54,532 --> 02:22:55,833 WE HAVE A QUESTION FROM MICHAEL. 3946 02:22:55,900 --> 02:22:58,169 >> AGAIN, EVERYBODY ON THE 3947 02:22:58,236 --> 02:23:00,004 PANEL, THANK YOU SO MUCH FOR SO 3948 02:23:00,071 --> 02:23:05,576 MANY STIMULATING TALKS. 3949 02:23:05,643 --> 02:23:06,878 I POSE THE QUESTION TO YOU BUT 3950 02:23:06,945 --> 02:23:08,980 I'M SURE THIS QUESTION CAN BE 3951 02:23:09,047 --> 02:23:11,182 ANSWERED BY THE OTHER PANELISTS, 3952 02:23:11,249 --> 02:23:13,885 AND I ENCOURAGE YOU TO ANSWER IT 3953 02:23:13,952 --> 02:23:14,218 ALSO. 3954 02:23:14,285 --> 02:23:16,054 BUT USING A VULNERABLE 3955 02:23:16,120 --> 02:23:17,588 POPULATION, OR USING A 3956 02:23:17,655 --> 02:23:19,557 POPULATION SUCH AS REFUGEES OR 3957 02:23:19,624 --> 02:23:22,827 THOSE WHO EXPERIENCE TORTURE AS 3958 02:23:22,894 --> 02:23:24,629 A MODEL TO UNDERSTAND THE 3959 02:23:24,696 --> 02:23:27,165 PSYCHOSOCIAL ASPECTS OF PAIN, 3960 02:23:27,231 --> 02:23:28,466 COULD YOU GIVE US SOME MORE 3961 02:23:28,533 --> 02:23:31,903 DETAILS ON THAT, ON HOW YOU'RE 3962 02:23:31,970 --> 02:23:33,271 INCORPORATING IN YOUR RESEARCH 3963 02:23:33,338 --> 02:23:36,207 AND HOW WE CAN INSPIRE OTHER 3964 02:23:36,274 --> 02:23:38,609 RESEARCHERS TO INCORPORATE IT 3965 02:23:38,676 --> 02:23:40,278 INTO EITHER THEIR ANIMAL MODEL 3966 02:23:40,345 --> 02:23:41,579 STUDIES OR THEIR HUMAN STUDIES 3967 02:23:41,646 --> 02:23:43,147 TO REALLY LOOK AT THAT 3968 02:23:43,214 --> 02:23:46,884 PSYCHOSOCIAL ASPECT FROM 3969 02:23:46,951 --> 02:23:48,486 MODELING -- USING SPECIAL 3970 02:23:48,553 --> 02:23:51,823 POPULATIONS AS A MODEL? 3971 02:23:51,889 --> 02:23:54,125 >> THANK YOU FOR THAT QUESTION. 3972 02:23:54,192 --> 02:23:55,994 THIS IS MY ABSOLUTELY LOVELY 3973 02:23:56,060 --> 02:23:59,564 P.O. WHO HAS SINGLE HANDEDLY 3974 02:23:59,630 --> 02:24:01,399 CHANGED MY LIFE, WHO I OWE ALL 3975 02:24:01,466 --> 02:24:06,637 OF MY CAREER TO RIGHT THERE. 3976 02:24:06,704 --> 02:24:09,941 YOU KNOW, IT'S INTERESTING, WE 3977 02:24:10,008 --> 02:24:12,076 ARE STILL -- THE WORK IS SO WHAT 3978 02:24:12,143 --> 02:24:14,345 I LIKE TO CALL FRINGY, IT'S LIKE 3979 02:24:14,412 --> 02:24:16,748 CUTTING EDGE BUT IT'S SCARY TO 3980 02:24:16,814 --> 02:24:18,783 USE THIS POPULATION AS SORT OF 3981 02:24:18,850 --> 02:24:23,287 YOUR SAMPLE POPULATION FOR OTHER 3982 02:24:23,354 --> 02:24:26,157 SUBGROUPS BUT EVERY TALK THAT I 3983 02:24:26,224 --> 02:24:28,026 HEARD TODAY, I WAS LIKE, THAT IS 3984 02:24:28,092 --> 02:24:29,360 EXACTLY WHAT WE'RE SEEING IN OUR 3985 02:24:29,427 --> 02:24:31,195 PATIENT POPULATION, AND HOW CAN 3986 02:24:31,262 --> 02:24:32,764 WE USE WHAT WE'RE DOING, YOU 3987 02:24:32,830 --> 02:24:34,198 KNOW, WHAT OUR PATIENTS ARE 3988 02:24:34,265 --> 02:24:35,199 EXPERIENCING, THIS 3989 02:24:35,266 --> 02:24:36,267 SUBPOPULATION, THIS SUPER 3990 02:24:36,334 --> 02:24:37,635 INTERESTING POPULATION WHERE 3991 02:24:37,702 --> 02:24:40,805 THEY HAVE EXPERIENCED EXTREME 3992 02:24:40,872 --> 02:24:42,673 PSYCHOLOGICAL TRAUMA, EXTREME 3993 02:24:42,740 --> 02:24:43,207 PHYSICAL TRAUMA. 3994 02:24:43,274 --> 02:24:45,243 HOW CAN YOU USE THAT TO ADVANCE 3995 02:24:45,309 --> 02:24:49,614 THE HEALTH OF WAR VETERANS OR OF 3996 02:24:49,680 --> 02:24:51,315 SEXUAL ASSAULT SURVIVORS IN THE 3997 02:24:51,382 --> 02:24:51,816 U.S.? 3998 02:24:51,883 --> 02:24:53,051 I MEAN, THERE'S SO MANY 3999 02:24:53,117 --> 02:24:55,219 POPULATIONS WHERE YOU COULD TAKE 4000 02:24:55,286 --> 02:24:57,555 THIS WORK IN REFUGEES, THIS 4001 02:24:57,622 --> 02:24:59,424 LITTLE MICROCHASM, THIS VERY 4002 02:24:59,490 --> 02:25:00,291 SPECIFIC UNIQUE POPULATION AND 4003 02:25:00,358 --> 02:25:03,594 THEN TAKE IT BEYOND THAT. 4004 02:25:03,661 --> 02:25:06,030 I THINK WE'RE GETTING THERE, 4005 02:25:06,097 --> 02:25:10,101 WE'RE NOT FULLY THERE YET, 4006 02:25:10,168 --> 02:25:11,669 BECAUSE WHEN YOU LOOK AT THIS 4007 02:25:11,736 --> 02:25:15,139 FIELD, THERE'S JUST A TOTAL GAP, 4008 02:25:15,206 --> 02:25:17,041 THERE'S LIKE NO STUDIES AND SO 4009 02:25:17,108 --> 02:25:18,309 MANY OF THESE DIFFERENT 4010 02:25:18,376 --> 02:25:19,477 IMPORTANT AREAS. 4011 02:25:19,544 --> 02:25:21,312 SO I THINK FIRST WE'RE SORT OF 4012 02:25:21,379 --> 02:25:25,483 SETTING THAT UP AND CREATING 4013 02:25:25,550 --> 02:25:27,351 THAT EVIDENCE BASE, AND THEN WE 4014 02:25:27,418 --> 02:25:28,786 WILL LAYER ON TOP OF IT. 4015 02:25:28,853 --> 02:25:35,593 THAT'S MY 40-YEAR WORK PLAN. 4016 02:25:35,660 --> 02:25:39,630 >> I CAN ADD JUST A LITTLE BIT 4017 02:25:39,697 --> 02:25:40,231 TO THAT. 4018 02:25:40,298 --> 02:25:42,600 SO WITH OUR GENDER MINORITY 4019 02:25:42,667 --> 02:25:44,602 POPULATIONS, ONE OF THE ISSUES 4020 02:25:44,669 --> 02:25:47,572 IS GETTING RECRUITMENT, BUT WE 4021 02:25:47,638 --> 02:25:49,874 FOUND REACHING OUT TO COMMUNITY 4022 02:25:49,941 --> 02:25:52,210 GROUPS AND SORT OF GETTING THAT 4023 02:25:52,276 --> 02:25:53,077 RELATIONSHIP AND MAKING SURE 4024 02:25:53,144 --> 02:25:54,278 THAT THEY UNDERSTAND THAT 4025 02:25:54,345 --> 02:25:56,447 THEY'RE NOT BEING USED AS GUINEA 4026 02:25:56,514 --> 02:25:58,916 PIGS AND THAT THE IDEA IS TO 4027 02:25:58,983 --> 02:26:00,551 ACTUALLY ADVANCE OUR 4028 02:26:00,618 --> 02:26:01,552 UNDERSTANDING AND HEALTH AND 4029 02:26:01,619 --> 02:26:03,754 EVERYTHING FOR EVERYONE, AND SO 4030 02:26:03,821 --> 02:26:06,290 IT ISN'T AS SORT OF A 4031 02:26:06,357 --> 02:26:07,258 TRANSACTIONAL THING OR IT IS -- 4032 02:26:07,325 --> 02:26:09,594 IT'S FOR THE GREATER GOOD AND SO 4033 02:26:09,660 --> 02:26:11,462 WE'VE HAD GOOD LUCK WITH 4034 02:26:11,529 --> 02:26:11,996 RECRUITMENT BECAUSE WE'VE 4035 02:26:12,063 --> 02:26:13,231 BROUGHT THEM IN TO DO 4036 02:26:13,297 --> 02:26:14,765 SENSITIVITY TRAINING WITH OUR 4037 02:26:14,832 --> 02:26:15,867 LAB AND THEY'VE VETTED ALL OF 4038 02:26:15,933 --> 02:26:17,368 THE QUESTIONNAIRES TO MAKE SURE 4039 02:26:17,435 --> 02:26:20,071 THAT ALL THE LANGUAGE IS 4040 02:26:20,138 --> 02:26:22,707 APPROPRIATE, SO I THINK JUST -- 4041 02:26:22,773 --> 02:26:28,913 AGAIN, I THINK RESPECTING YOUR 4042 02:26:28,980 --> 02:26:30,014 POPULATION IS A BIG KEY, AND I 4043 02:26:30,081 --> 02:26:32,416 THINK ALL OF US RESPECT OUR 4044 02:26:32,483 --> 02:26:33,417 POPULATIONS. 4045 02:26:33,484 --> 02:26:34,886 >> AND HANNA, LIKE IF YOU WANT 4046 02:26:34,952 --> 02:26:38,089 TO ADD ANYTHING, BECAUSE YOU ARE 4047 02:26:38,156 --> 02:26:40,024 ALSO SERVING A POPULATION WHICH 4048 02:26:40,091 --> 02:26:43,628 HAVE A LOT OF SIMILARITIES. 4049 02:26:43,694 --> 02:26:44,061 WITH 4050 02:26:44,128 --> 02:26:45,163 DISPLACED POPULATIONS IN TERMS 4051 02:26:45,229 --> 02:26:48,566 OF THEIR PSYCHOSOCIAL CHALLENGES 4052 02:26:48,633 --> 02:26:50,468 AND ALSO DAILY LIFE CHALLENGES 4053 02:26:50,535 --> 02:26:54,005 COMING TO THE CLINIC. 4054 02:26:54,071 --> 02:26:58,109 >> SINCE I'M DOING SECONDARY 4055 02:26:58,176 --> 02:26:59,577 DATA ANALYSIS AND NOT DEALING 4056 02:26:59,644 --> 02:27:03,080 WITH PEOPLE FACE-TO-FACE, I 4057 02:27:03,147 --> 02:27:05,950 THINK THESE WERE BETTER FOLKS TO 4058 02:27:06,017 --> 02:27:08,119 ANSWER, BUT YOU KNOW, WE SEE 4059 02:27:08,186 --> 02:27:10,054 THESE PATTERNS BUT FROM OUR BIG 4060 02:27:10,121 --> 02:27:11,656 NATIONAL DATASETS, WE CAN'T GET 4061 02:27:11,722 --> 02:27:13,524 AT LOW LEVEL MECHANISMS AND 4062 02:27:13,591 --> 02:27:15,426 PROCESSES AND THAT'S WHY I LOVE 4063 02:27:15,493 --> 02:27:16,561 LEARNING ABOUT THIS WORK BECAUSE 4064 02:27:16,627 --> 02:27:20,698 IT CAN REALLY SORT OF INFORM US 4065 02:27:20,765 --> 02:27:23,834 IN INTERPRETING WHAT MIGHT BE 4066 02:27:23,901 --> 02:27:24,735 DRIVING THOSE BROAD NATIONAL 4067 02:27:24,802 --> 02:27:26,804 PATTERNS. 4068 02:27:26,871 --> 02:27:28,439 >> QUESTION FROM WALTER. 4069 02:27:28,506 --> 02:27:29,840 >> HI. 4070 02:27:29,907 --> 02:27:31,242 REALLY GREAT STUFF. 4071 02:27:31,309 --> 02:27:32,977 HANNA, I JUST HAD A QUESTION FOR 4072 02:27:33,044 --> 02:27:33,544 YOU. 4073 02:27:33,611 --> 02:27:36,614 YOU SHOWED THE DATA IN TERMS OF 4074 02:27:36,681 --> 02:27:38,683 THE PAIN INCIDENCE AND IT'S 4075 02:27:38,749 --> 02:27:41,886 CERTAINLY VERY AGE-DEPENDENT. 4076 02:27:41,953 --> 02:27:43,955 WONDERING WITH THE PSYCHOLOGICAL 4077 02:27:44,021 --> 02:27:45,389 STRESS, DO YOU HAVE THAT SAME 4078 02:27:45,456 --> 02:27:47,458 KIND OF DATA TO KNOW IF THE 4079 02:27:47,525 --> 02:27:49,327 PSYCHOLOGICAL STRESS IS COMING 4080 02:27:49,393 --> 02:27:52,296 EARLIER AND THE PAIN IS 4081 02:27:52,363 --> 02:27:53,464 FOLLOWING, OR IS THE 4082 02:27:53,531 --> 02:27:55,099 PSYCHOLOGICAL STRESS COMING 4083 02:27:55,166 --> 02:27:58,236 AFTER THE BUMP AND THE PAIN? 4084 02:27:58,302 --> 02:27:59,904 >> SO THAT'S A GREAT QUESTION 4085 02:27:59,971 --> 02:28:07,478 THAT I WISH WE COULD ANSWER. 4086 02:28:07,545 --> 02:28:09,247 SO BECAUSE WE JUST HAD 4087 02:28:09,313 --> 02:28:11,682 CROSS-SECTIONAL DATA, WE 4088 02:28:11,749 --> 02:28:14,552 COULDN'T WITH NHIS DO ANYTHING, 4089 02:28:14,619 --> 02:28:15,486 BUT THERE WAS AN INTERESTING 4090 02:28:15,553 --> 02:28:22,260 STUDY PUBLISHED RECENTLY USING 4091 02:28:22,326 --> 02:28:23,561 DATA THAT SORT OF TRIED TO 4092 02:28:23,628 --> 02:28:26,530 QUANTIFY HOW MUCH IS IT 4093 02:28:26,597 --> 02:28:31,469 DEPRESSION INCREASE B INCREASIN, 4094 02:28:31,535 --> 02:28:33,170 HOW MUCH INCREASING RISK OF 4095 02:28:33,237 --> 02:28:33,671 DEPRESSION. 4096 02:28:33,738 --> 02:28:34,572 THERE WAS EVIDENCE IN BOTH. 4097 02:28:34,639 --> 02:28:36,107 IN THIS STUDY, THEY ACTUALLY 4098 02:28:36,173 --> 02:28:38,409 FOUND THAT CHRONIC PAIN WAS A 4099 02:28:38,476 --> 02:28:45,182 STRONGER PREDICT TER OF PREDICTN 4100 02:28:45,249 --> 02:28:46,851 CAME VICE VERSA, SO THE PAIN 4101 02:28:46,917 --> 02:28:49,553 MATTERED MORE FOR THE 4102 02:28:49,620 --> 02:28:49,854 DEPRESSION. 4103 02:28:49,920 --> 02:28:51,122 EVEN THAT, LIKE YOU ALWAYS HAVE 4104 02:28:51,188 --> 02:28:54,325 TO THINK ABOUT HOW IS THE PAIN 4105 02:28:54,392 --> 02:29:01,032 MEASURED, AND THAT SURVEY 4106 02:29:01,098 --> 02:29:01,666 SURVEYS EVERYONE EVERY TWO YEARS 4107 02:29:01,732 --> 02:29:03,334 SO IT NOT A FINE GRAIM TEMPORAL 4108 02:29:03,401 --> 02:29:04,201 MEASUREMENT THERE, SO I DON'T 4109 02:29:04,268 --> 02:29:05,703 KNOW THAT WE HAVE A DEFINITIVE 4110 02:29:05,770 --> 02:29:06,203 ANSWER. 4111 02:29:06,270 --> 02:29:07,905 AND ALSO THE ANSWER COULD DIFFER 4112 02:29:07,972 --> 02:29:08,773 ACROSS DIFFERENT GROUPS TOO. 4113 02:29:08,839 --> 02:29:09,974 SO IT'S A GREAT QUESTION THAT I 4114 02:29:10,041 --> 02:29:11,442 DON'T HAVE THE BEST ANSWER TO, 4115 02:29:11,509 --> 02:29:12,877 I'M AFRAID. 4116 02:29:12,943 --> 02:29:17,581 >> WHAT DO YOU THINK ALL NEW 4117 02:29:17,648 --> 02:29:19,083 DATA TYPES, QUESTIONS YOU MIGHT 4118 02:29:19,150 --> 02:29:22,253 ASK OR YOU WOULD LIKE TO HAVE IN 4119 02:29:22,320 --> 02:29:22,887 THAT DATABASE? 4120 02:29:22,953 --> 02:29:30,294 SO THAT HE CAN GET THOSE DATA? 4121 02:29:30,361 --> 02:29:34,899 >> SO SOME MORE FINE GRAIN DATA 4122 02:29:34,965 --> 02:29:38,836 WOULD BE GREAT, AND I ALSO WOULD 4123 02:29:38,903 --> 02:29:40,971 LOVE TO SEE, AND I'M NOT QUITE 4124 02:29:41,038 --> 02:29:45,776 SURE HOW THIS COULD BE DONE, BUT 4125 02:29:45,843 --> 02:29:47,745 I WOULD LOVE TO SORT OF COMBINE 4126 02:29:47,812 --> 02:29:48,746 SOME LONGITUDINAL TATA 4127 02:29:48,813 --> 02:29:50,281 COLLECTION WITH QST, SO WE CAN 4128 02:29:50,348 --> 02:29:52,717 KIND OF SEE ON A LIKE LOWER 4129 02:29:52,783 --> 02:29:55,753 LEVEL WHAT'S GOING ON WITH 4130 02:29:55,820 --> 02:29:58,356 CHANGES OVER TIME. 4131 02:29:58,422 --> 02:30:06,530 PEOPLE'S PAIN PERCEPTIONS. 4132 02:30:06,597 --> 02:30:09,300 >> WONDERFUL TALKS. 4133 02:30:09,367 --> 02:30:15,673 MY QUESTION IS PRIMARILY FOR DR. 4134 02:30:15,740 --> 02:30:16,774 SO I WAS THINKING DURING YOUR 4135 02:30:16,841 --> 02:30:18,309 TALK JUST ABOUT WHAT COULD 4136 02:30:18,376 --> 02:30:23,047 EXPLAIN YOUR RESULTS AND I WAS 4137 02:30:23,114 --> 02:30:24,315 THINKING ABOUT THE ROLE OF A MAN 4138 02:30:24,382 --> 02:30:25,916 IN SOCIETY, AND IT MADE ME 4139 02:30:25,983 --> 02:30:28,786 THINK, DID YOU GATHER ANY DATA 4140 02:30:28,853 --> 02:30:34,392 ON HESITANCY TO REPORT PAIN WHEN 4141 02:30:34,458 --> 02:30:36,260 YOU IDENTIFY AS A MAN OR IF 4142 02:30:36,327 --> 02:30:37,261 THERE'S ANY QUESTIONNAIRES THAT 4143 02:30:37,328 --> 02:30:41,065 HAVE TO DO WITH HOW PEOPLE WERE 4144 02:30:41,132 --> 02:30:43,434 THINKING ABOUT PAIN AND IN 4145 02:30:43,501 --> 02:30:48,038 RESPECT TO THEIR IDENTITY? 4146 02:30:48,105 --> 02:30:49,240 >> GREAT QUESTION, THANK YOU. 4147 02:30:49,306 --> 02:30:51,041 SO WE'RE USING THE GENDER ROLE 4148 02:30:51,108 --> 02:30:52,576 EXPECTATION OF PAIN AS WELL, SO 4149 02:30:52,643 --> 02:30:56,280 THAT LOOKS AT DO YOU THINK THAT 4150 02:30:56,347 --> 02:30:58,115 MEN OR WOMEN ARE MORE LIKELY TO 4151 02:30:58,182 --> 02:30:59,417 REPORT PAIN, WHAT IS YOUR 4152 02:30:59,483 --> 02:31:01,719 WILLINGNESS TO REPORT PAIN, YOU 4153 02:31:01,786 --> 02:31:03,587 KNOW, RELATIVE TO THE AVERAGE 4154 02:31:03,654 --> 02:31:07,258 MAN OR WOMAN. 4155 02:31:07,324 --> 02:31:09,226 SO WE DO HAVE THAT DATA SO WE'LL 4156 02:31:09,293 --> 02:31:10,461 BE ABLE TO LOOK AT THAT A LITTLE 4157 02:31:10,528 --> 02:31:10,861 BIT. 4158 02:31:10,928 --> 02:31:13,431 I WILL SAY THAT BASED ON HANNA'S 4159 02:31:13,497 --> 02:31:16,100 PAPER, ONE OF THE THINGS THAT 4160 02:31:16,167 --> 02:31:18,035 WE'VE ADDED IS ADDING QUESTIONS 4161 02:31:18,102 --> 02:31:22,706 ABOUT SEXUAL ORIENTATION. 4162 02:31:22,773 --> 02:31:25,443 THE ASSUMPTION, FALSE 4163 02:31:25,509 --> 02:31:26,877 ASSUMPTION, IS THAT EVERY CIS 4164 02:31:26,944 --> 02:31:28,612 INDIVIDUAL IS STRAIGHT, AND THAT 4165 02:31:28,679 --> 02:31:30,581 IS ABSOLUTELY NOT TRUE. 4166 02:31:30,648 --> 02:31:32,883 IN FACT, ABOUT A QUARTER TO A 4167 02:31:32,950 --> 02:31:37,254 THIRD OF EACH OF OUR GROUPS, YOU 4168 02:31:37,321 --> 02:31:39,924 KNOW, HAS A DIFFERENT SEXUAL 4169 02:31:39,990 --> 02:31:40,658 ORIENTATION THAN SOME OF THE 4170 02:31:40,724 --> 02:31:41,759 REST. 4171 02:31:41,826 --> 02:31:43,761 SO JUST GETTING THAT AMOUNT OF 4172 02:31:43,828 --> 02:31:46,597 DETAIL IS GOING TO BE VERY, VERY 4173 02:31:46,664 --> 02:31:47,865 IMPORTANT. 4174 02:31:47,932 --> 02:31:48,933 WHEN IT COMES TO 4175 02:31:48,999 --> 02:31:53,971 REALLY LOOKING AT THIS DATA. 4176 02:31:54,038 --> 02:32:02,546 >> I HAVE -- LOOKING NOOB CD4 T 4177 02:32:02,613 --> 02:32:04,648 CELLS IN MEN AND WOMEN, SO I'M 4178 02:32:04,715 --> 02:32:06,050 JUST WONDERING, HAVE YOU 4179 02:32:06,116 --> 02:32:08,419 CORRELATED OR LOOKED AT THE 4180 02:32:08,486 --> 02:32:15,292 LITERATURE, HOW DO ACTIVATED CDN 4181 02:32:15,359 --> 02:32:16,961 AND WOMEN ALSO CORRELATE WITH 4182 02:32:17,027 --> 02:32:18,662 PEOPLE WHO HAVE AUTOIMMUNE 4183 02:32:18,729 --> 02:32:21,832 DISORDERS OR WHO HAVE 4184 02:32:21,899 --> 02:32:23,133 IMMUNE-RELATED DISORDERS, AND 4185 02:32:23,200 --> 02:32:24,535 WHAT'S THE INTERSECTION OF THAT 4186 02:32:24,602 --> 02:32:26,403 WITH PAIN ASSOCIATED WITH THOSE 4187 02:32:26,470 --> 02:32:28,839 IMMUNE SYSTEM DISORDERS? 4188 02:32:28,906 --> 02:32:32,009 >> THAT'S A GOOD QUESTION. 4189 02:32:32,076 --> 02:32:33,944 SO CERTAINLY PEOPLE WITH 4190 02:32:34,011 --> 02:32:35,012 AUTOIMMUNE DISORDERS WILL HAVE 4191 02:32:35,079 --> 02:32:36,247 VERY DIFFERENT CELL POPULATIONS. 4192 02:32:36,313 --> 02:32:37,214 THESE INDIVIDUALS ARE OTHERWISE 4193 02:32:37,281 --> 02:32:40,484 ALL HEALTHY, SO THOSE ACTIVATED 4194 02:32:40,551 --> 02:32:43,287 LEVELS ARE LOW RELATIVE TO A 4195 02:32:43,354 --> 02:32:44,922 CLINICAL POPULATION. 4196 02:32:44,989 --> 02:32:46,524 BUT YES, THERE CERTAINLY IS 4197 02:32:46,590 --> 02:32:49,593 GOING TO BE MASSIVE DIFFERENCES. 4198 02:32:49,660 --> 02:32:53,063 AND GENERALLY THE FACT THAT 4199 02:32:53,130 --> 02:32:54,899 WOMEN HAVE HIGHER ACTIVATED 4200 02:32:54,965 --> 02:32:56,734 LEVELS, THAT MAY BE ONE OF THE 4201 02:32:56,800 --> 02:33:01,038 UNDERLYING REASONS THAT 4202 02:33:01,105 --> 02:33:02,072 THEY'RE -- AUTOIMMUNE DISORDERS. 4203 02:33:02,139 --> 02:33:04,808 >> THAT COULD BE ALSO EXTENDED 4204 02:33:04,875 --> 02:33:08,145 TO CERTAIN SPECIFIC PAIN 4205 02:33:08,212 --> 02:33:10,514 CONDITIONS WHERE PERIPHERAL -- 4206 02:33:10,581 --> 02:33:13,284 OR THE -- ADAPTIVE IMMUNE SYSTEM 4207 02:33:13,350 --> 02:33:18,022 INVOLVEMENT IS SO DEEP, MANY 4208 02:33:18,088 --> 02:33:18,756 NEUROPATHIES AND PAIN. 4209 02:33:18,822 --> 02:33:20,257 >> YEAH, SO ONE OF THE OTHER 4210 02:33:20,324 --> 02:33:21,559 TESTS THAT WE'LL BE DOING WITH 4211 02:33:21,625 --> 02:33:23,527 FLOW CYTOMETRY IS TAKING THOSE 4212 02:33:23,594 --> 02:33:26,497 CELLS AND STIMULATING THEM TO 4213 02:33:26,564 --> 02:33:30,200 SEE WHAT SORT OF A STIMULATED 4214 02:33:30,267 --> 02:33:31,468 CYTOKINE RESPONSE WE GET FROM 4215 02:33:31,535 --> 02:33:34,538 THOSE CELLS, SO NOT ONLY THERE 4216 02:33:34,605 --> 02:33:36,173 WILL BE -- BUT HOW ROW ACTIVE 4217 02:33:36,240 --> 02:33:39,076 ARE THOSE CELLS TO STIMULATION. 4218 02:33:39,143 --> 02:33:40,077 >> I'M SPECIFICALLY INTERESTED 4219 02:33:40,144 --> 02:33:43,881 IN ONE OF THOSE CIP -- THOSE 4220 02:33:43,948 --> 02:33:47,251 ALREADY NON-PHENOMENON, FOR 4221 02:33:47,318 --> 02:33:51,055 CERTAIN TIEF OF CA TYPE OF CANCD 4222 02:33:51,121 --> 02:33:52,990 CERTAIN TYPE OF CHEMOTHERAPY, 4223 02:33:53,057 --> 02:33:54,858 CHEMOTHERAPY AGENTS, THEY 4224 02:33:54,925 --> 02:33:58,529 DEVELOP MORE CIPN AND MORE 4225 02:33:58,596 --> 02:34:00,264 PAINFUL -- LIKE NEUROPATHY 4226 02:34:00,331 --> 02:34:04,335 VERSUS NON-PAINFUL, SO THAT'S 4227 02:34:04,401 --> 02:34:07,738 WHY I'M INTERESTED. 4228 02:34:07,805 --> 02:34:11,141 PLEASE. 4229 02:34:11,208 --> 02:34:12,509 >> GREAT TALKS. 4230 02:34:12,576 --> 02:34:14,044 ONE QUESTION I HAVE FOR ALL OF 4231 02:34:14,111 --> 02:34:19,283 YOU, ANY OF YOU REALLY, OBVIOUS 4232 02:34:19,350 --> 02:34:21,352 DIFFERENCE BETWEEN MEN AND WOMEN 4233 02:34:21,418 --> 02:34:26,190 OR MALES AND FEMALES IS THE -- I 4234 02:34:26,256 --> 02:34:27,224 GUESS IT WOULD BE MALES AND 4235 02:34:27,291 --> 02:34:29,426 FEMALES IN THIS CASE, IS 4236 02:34:29,493 --> 02:34:31,996 MENSTRUAL CRAMPS, RIGHT? 4237 02:34:32,062 --> 02:34:34,398 THE HISTORY OF HAVING RECURRING 4238 02:34:34,465 --> 02:34:37,835 PAIN STARTING IN EARLY 4239 02:34:37,901 --> 02:34:40,571 ADOLESCENCE, WHAT EFFECT DOES 4240 02:34:40,638 --> 02:34:43,140 THAT HAVE ON THE STILL 4241 02:34:43,207 --> 02:34:46,176 DEVELOPING NERVOUS SYSTEM IN 4242 02:34:46,243 --> 02:34:49,913 GIRLS? 4243 02:34:49,980 --> 02:34:51,649 AND HAS THAT BEEN LOOKED AT? 4244 02:34:51,715 --> 02:34:54,551 COULD THAT BE PART OF THE REASON 4245 02:34:54,618 --> 02:34:58,288 WHY IN THE LONG RUN, YOU KNOW, 4246 02:34:58,355 --> 02:35:01,091 WOMEN HAVE -- COULD HAVE MORE 4247 02:35:01,158 --> 02:35:01,992 PAIN SENSITIVITY, HAVING BEEN 4248 02:35:02,059 --> 02:35:04,028 EXPOSED TO THIS RECURRING PAIN 4249 02:35:04,094 --> 02:35:07,331 AS THEY WERE DEVELOPING? 4250 02:35:07,398 --> 02:35:11,535 BUT ALSO PERHAPS GREATER PAIN 4251 02:35:11,602 --> 02:35:13,203 ENDURANCE AND BEING LESS KILLED 4252 02:35:13,270 --> 02:35:15,072 IN THE END BY PAIN. 4253 02:35:15,139 --> 02:35:19,810 SO I'M JUST CURIOUS, AS JEFF WAS 4254 02:35:19,877 --> 02:35:21,111 MENTIONING, JUST CURIOUS YOUR 4255 02:35:21,178 --> 02:35:26,283 THOUGHTS ON THIS. 4256 02:35:26,350 --> 02:35:27,851 >> JEFF, YOU WANT TO GO FIRST? 4257 02:35:27,918 --> 02:35:28,886 >> CAN YOU HEAR ME? 4258 02:35:28,952 --> 02:35:30,020 >> YES. 4259 02:35:30,087 --> 02:35:30,788 >> OKAY. 4260 02:35:30,854 --> 02:35:34,525 I'LL GO FIRST. 4261 02:35:34,591 --> 02:35:38,595 UM, SO THERE IS PROBABLY A 4262 02:35:38,662 --> 02:35:41,365 LITERATURE ON OUTCOMES OF WOMEN 4263 02:35:41,432 --> 02:35:43,200 WITH MENSTRUAL CRAMPS VERSUS 4264 02:35:43,267 --> 02:35:45,102 THOSE WITHOUT. 4265 02:35:45,169 --> 02:35:46,870 I'M NOT FAMILIAR WITH IT OFF THE 4266 02:35:46,937 --> 02:35:49,807 TOP OF MY HEAD, BUT AS A MORE 4267 02:35:49,873 --> 02:35:51,508 GENERAL SENSE, ONE OF THE BEST 4268 02:35:51,575 --> 02:35:56,847 PREDICTORS OF FUEL TOUR P T FUTS 4269 02:35:56,914 --> 02:35:58,382 PAST PAIN, SO LOGICALLY YOU'D 4270 02:35:58,449 --> 02:36:00,417 EXPECT THAT RELATIONSHIP, IF IT 4271 02:36:00,484 --> 02:36:02,786 WERE THERE, TO BE A POSITIVE 4272 02:36:02,853 --> 02:36:03,187 ONE. 4273 02:36:03,253 --> 02:36:06,757 THE ISSUE, THOUGH, ABOUT -- I 4274 02:36:06,824 --> 02:36:09,693 FORGET EXACTLY HOW YOU PHRASED 4275 02:36:09,760 --> 02:36:11,228 IT, BUT REMEMBER IT'S A 4276 02:36:11,295 --> 02:36:12,262 DOUBLE-EDGED SWORD, RIGHT? 4277 02:36:12,329 --> 02:36:15,332 SO YEAH, MEN DIE, WHICH IS BAD, 4278 02:36:15,399 --> 02:36:18,068 BUT WOMEN SUFFER, WHICH IS BAD. 4279 02:36:18,135 --> 02:36:20,537 SO YOU HAVE TO ASK YOURSELF 4280 02:36:20,604 --> 02:36:21,538 WHO'S GOT IT WORSE. 4281 02:36:21,605 --> 02:36:30,180 IT'S NOT AT ALL CLEAR TO ME. 4282 02:36:30,247 --> 02:36:33,183 >> I WAS JUST GOING TO SAY, I 4283 02:36:33,250 --> 02:36:37,121 THINK THE ISSUE RVETION OF IS -T 4284 02:36:37,187 --> 02:36:38,689 HISTORY I THINK HAS A HUGE ROLE 4285 02:36:38,756 --> 02:36:41,258 TO PLAY, BUT EVEN CULTURALLY, 4286 02:36:41,325 --> 02:36:43,861 THE BEING COMFORTABLE EXPRESSING 4287 02:36:43,927 --> 02:36:47,131 THAT PAIN ALSO REALLY DOES 4288 02:36:47,197 --> 02:36:49,533 CONTRIBUTE, AND SO AS WE LEARN 4289 02:36:49,600 --> 02:36:51,502 MORE AND MORE, YOU KNOW, GETTING 4290 02:36:51,568 --> 02:36:53,637 A BETTER IDEA OF PAST HISTORY IS 4291 02:36:53,704 --> 02:36:54,838 ALWAYS GOING TO HELP TRY TO 4292 02:36:54,905 --> 02:37:00,010 EXPLAIN SOME OF THESE PHENOMENA. 4293 02:37:00,077 --> 02:37:01,545 >> WE HAVE ONE QUESTION. 4294 02:37:01,612 --> 02:37:04,248 >> I'M GOING TO ASK ABOUT SORT 4295 02:37:04,314 --> 02:37:05,449 OF THE CONVERSE IN TERMS OF WHAT 4296 02:37:05,516 --> 02:37:07,417 MAKES THE PAIN BETTER. 4297 02:37:07,484 --> 02:37:12,623 AND SO WHAT WE KNOW FROM PEOPLE 4298 02:37:12,689 --> 02:37:14,158 WHO LIVE WITH PAIN WHO ATTEND 4299 02:37:14,224 --> 02:37:16,326 SUPPORT GROUPS AND HAVE A GOOD 4300 02:37:16,393 --> 02:37:18,562 RELATIONSHIP WITH A PROVIDER WHO 4301 02:37:18,629 --> 02:37:20,898 BELIEVES THEM AND WILL PARTNER 4302 02:37:20,964 --> 02:37:22,766 WITH THEM HELPS THEM A LOT. 4303 02:37:22,833 --> 02:37:25,169 AND I'M JUST WONDERING IN THE 4304 02:37:25,235 --> 02:37:33,243 VERY EXTREME CASE THAT DR. KAUR 4305 02:37:33,310 --> 02:37:35,112 YOU'VE TALKED ABOUT, IF YOU'VE 4306 02:37:35,179 --> 02:37:36,280 SEEN THINGS IN A SUBSEQUENT 4307 02:37:36,346 --> 02:37:37,648 LIFE, LIKE THIS LITTLE GIRL YOU 4308 02:37:37,714 --> 02:37:39,650 GAVE AN EXAMPLE OF, IF SHE GETS 4309 02:37:39,716 --> 02:37:42,152 INTO A GOOD FAMILY SITUATION OR 4310 02:37:42,219 --> 02:37:44,454 IF SHE DEVELOPS FRIENDSHIPS WITH 4311 02:37:44,521 --> 02:37:47,157 OTHER KIDS WITH PAIN, HAS ANYONE 4312 02:37:47,224 --> 02:37:50,427 FOLLOWED THEM TO SEE WOULD THEY 4313 02:37:50,494 --> 02:37:53,063 REDUCE THEIR PAIN FROM CERTAIN 4314 02:37:53,130 --> 02:37:53,697 SOCIAL INTERACTIONS? 4315 02:37:53,764 --> 02:37:55,432 >> IT'S SUCH A GREAT QUESTION. 4316 02:37:55,499 --> 02:37:58,502 AND THE ANSWER IS YES, AND LET 4317 02:37:58,569 --> 02:38:00,370 ME TELL YOU A LITTLE BIT OF OUR 4318 02:38:00,437 --> 02:38:01,538 RESEARCH EXPERIENCE. 4319 02:38:01,605 --> 02:38:03,740 SO THE LAB THAT WE RUN IS 4320 02:38:03,807 --> 02:38:05,209 FOUNDED ON THE IDEA THAT TRAUMA 4321 02:38:05,275 --> 02:38:07,277 IS NOT FIXED, THAT ALL OF THIS 4322 02:38:07,344 --> 02:38:14,418 IS MODIFIABLE, THAT THE PAIN, 4323 02:38:14,484 --> 02:38:15,919 PAIN OUTCOMES ARE MODIFIABLE. 4324 02:38:15,986 --> 02:38:16,987 I'LL GIVE YOU A SPECIFIC EXAMPLE 4325 02:38:17,054 --> 02:38:19,289 OF A STUDY WE JUST FINISHED, 4326 02:38:19,356 --> 02:38:21,291 PART OF MY K23, WHERE WE LOOKED 4327 02:38:21,358 --> 02:38:23,193 AT THE THREAT OF DEPORTATION, 4328 02:38:23,260 --> 02:38:25,095 JUST THE IDEA THAT SOMEBODY 4329 02:38:25,162 --> 02:38:26,396 COULD BE DEPORTED, THAT IDEA, 4330 02:38:26,463 --> 02:38:27,130 THAT'S IT. 4331 02:38:27,197 --> 02:38:28,632 JUST THE THOUGHT THAT THEY COULD 4332 02:38:28,699 --> 02:38:33,604 BE -- BEING IN AN UNSTABLE 4333 02:38:33,670 --> 02:38:36,707 WAITING FOR ASYLUM, WHICH IN THE 4334 02:38:36,773 --> 02:38:38,008 U.S. TAKES ABOUT FIVE TO SEVEN 4335 02:38:38,075 --> 02:38:38,208 YEARS. 4336 02:38:38,275 --> 02:38:42,713 AND PEOPLE'S PAIN SEVERITY AND 4337 02:38:42,779 --> 02:38:45,115 HOW MANY PAIN SYMPTOMS THEY HAD 4338 02:38:45,182 --> 02:38:47,985 WERE WORSE, AND WHEN THAT SOCIAL 4339 02:38:48,051 --> 02:38:50,153 FACTOR CHANGED, AS SOON AS THEY 4340 02:38:50,220 --> 02:38:52,422 GOT STATUS, IT FLIPPED AND THEIR 4341 02:38:52,489 --> 02:38:53,624 PAIN ALMOST DISAPPEARED. 4342 02:38:53,690 --> 02:38:57,527 NOW THESE ARE PEOPLE WITH LIKE 4343 02:38:57,594 --> 02:38:59,396 REAL NEUROPATHIC -- I MEAN, IT'S 4344 02:38:59,463 --> 02:39:03,100 REAL PHYSICAL PAIN. 4345 02:39:03,166 --> 02:39:05,035 BUT PART OF WHAT'S HAPPENING IS 4346 02:39:05,102 --> 02:39:05,636 THE BIOSOCIAL CONTEXT AROUND 4347 02:39:05,702 --> 02:39:06,236 THEM. 4348 02:39:06,303 --> 02:39:07,571 WHEN THEY'RE AFRAID OF BEING 4349 02:39:07,638 --> 02:39:08,772 DEPORTED THEY DON'T LEAVE THE 4350 02:39:08,839 --> 02:39:10,340 HOUSE, THEY DON'T MOVE, THEIR 4351 02:39:10,407 --> 02:39:15,379 PAIN GETS WORSE, THEY'RE MORE 4352 02:39:15,445 --> 02:39:16,580 DEPRESSED, THERE'S THIS 4353 02:39:16,647 --> 02:39:19,449 INTERACTION, AND WHEN THEY 4354 02:39:19,516 --> 02:39:20,550 SUDDENLY HAVE THE ABILITY TO 4355 02:39:20,617 --> 02:39:22,686 LEAVE THEIR HOME OR ENGAGE WITH 4356 02:39:22,753 --> 02:39:25,656 HEALTHCARE PROVIDERS WHO, ARE 4357 02:39:25,722 --> 02:39:26,623 TRAUMA-INFORMED, LIKE IT HAS TO 4358 02:39:26,690 --> 02:39:28,258 BE THE RIGHT KIND OF HEALTHCARE 4359 02:39:28,325 --> 02:39:30,527 PROVIDER, THEN THEIR HEALTH 4360 02:39:30,594 --> 02:39:32,062 TRAJECTORIES COMPLETELY CHANGE, 4361 02:39:32,129 --> 02:39:33,330 AND I THINK THAT'S THE PROMISE 4362 02:39:33,397 --> 02:39:34,431 OF THIS RESEARCH, IS THAT YOU 4363 02:39:34,498 --> 02:39:36,066 CAN ACTUALLY CHANGE HEALTH 4364 02:39:36,133 --> 02:39:36,500 OUTCOMES. 4365 02:39:36,566 --> 02:39:38,769 AND THAT'S WHAT'S SO EXCITING 4366 02:39:38,835 --> 02:39:39,102 ABOUT IT. 4367 02:39:39,169 --> 02:39:42,572 TO THE QUESTION EARLIER ALSO 4368 02:39:42,639 --> 02:39:44,908 ABOUT THE PSYCHOLOGICAL AND THE 4369 02:39:44,975 --> 02:39:46,610 PHYSICAL AND THE INTERPLAY, I 4370 02:39:46,677 --> 02:39:47,611 MEAN, I THINK THERE'S REALLY 4371 02:39:47,678 --> 02:39:49,579 GOOD STUDIES IN VETERANS THAT 4372 02:39:49,646 --> 02:39:54,685 SHOW US THAT WHILE THERE IS THIS 4373 02:39:54,751 --> 02:39:57,187 SORT OF DUAL OFTEN LIKE -- IN 4374 02:39:57,254 --> 02:39:59,056 OUR PATIENT POPULATION, 85% OF 4375 02:39:59,122 --> 02:40:00,590 PEOPLE HAVE PAIN AND 85% OF 4376 02:40:00,657 --> 02:40:02,326 PEOPLE HAVE SOME KIND OF 4377 02:40:02,392 --> 02:40:03,961 PSYCHIATRIC OR PSYCHOLOGICAL 4378 02:40:04,027 --> 02:40:06,697 SEQUELLA OF THEIR TRAUMA, BUT IN 4379 02:40:06,763 --> 02:40:07,898 VETERANS, THERE'S REALLY GOOD 4380 02:40:07,965 --> 02:40:11,134 STUDIES THAT SHOW THAT PAIN, IF 4381 02:40:11,201 --> 02:40:11,668 TREATED APPROPRIATELY -- 4382 02:40:11,735 --> 02:40:13,804 DIAGNOSED AND TREATED 4383 02:40:13,870 --> 02:40:16,173 APPROPRIATELY, DESPITE THE 4384 02:40:16,239 --> 02:40:17,274 PSYCHOLOGICAL TRAUMA, CAN BE 4385 02:40:17,341 --> 02:40:19,142 CHANGED, IT CAN BE ALTERED, IT 4386 02:40:19,209 --> 02:40:20,544 CAN IMPROVE IF IT'S TREATED. 4387 02:40:20,610 --> 02:40:23,213 AND I THINK THAT'S WHERE THERE'S 4388 02:40:23,280 --> 02:40:24,815 SO MUCH MORE WORK TO BE DONE TO 4389 02:40:24,881 --> 02:40:26,149 UNDERSTAND THE PAIN AND 4390 02:40:26,216 --> 02:40:28,385 UNDERSTAND THE PSYCHOLOGICAL 4391 02:40:28,452 --> 02:40:30,387 TRAUMA AND INTERPLAY, BUT 4392 02:40:30,454 --> 02:40:31,555 THERE'S ALSO LIKE THIS SEPARATE 4393 02:40:31,621 --> 02:40:32,322 THING WHICH IS THAT YOU CAN 4394 02:40:32,389 --> 02:40:33,857 TREAT IT WITH SOCIAL 4395 02:40:33,924 --> 02:40:35,225 INTERACTIONS, WITH CHANGING OF 4396 02:40:35,292 --> 02:40:37,661 STATUS, WITH ENGAGEMENT WITH 4397 02:40:37,728 --> 02:40:39,229 HEALTHCARE SYSTEMS. 4398 02:40:39,296 --> 02:40:42,232 NOR, FOR EXAMPLE, HER ENGAGEMENT 4399 02:40:42,299 --> 02:40:43,967 WITH HEALTHCARE PROVIDERS, 4400 02:40:44,034 --> 02:40:46,570 PEDIATRICIANS, PSYCHOLOGISTS, 4401 02:40:46,636 --> 02:40:50,807 HAS ALTERED SOME OF THAT PAIN 4402 02:40:50,874 --> 02:40:53,143 EXPERIENCE AND SUF IRING. 4403 02:40:53,210 --> 02:41:00,684 SUFFERING. 4404 02:41:00,751 --> 02:41:02,886 >> SO THE HEAL INITIATIVE LATE 4405 02:41:02,953 --> 02:41:04,788 TO THE GAME IS JUST STARTING TO 4406 02:41:04,855 --> 02:41:06,990 FOCUS ON KIDS' PAIN, SO 4407 02:41:07,057 --> 02:41:08,392 WONDERING IF ANYBODY AS THOUGHTS 4408 02:41:08,458 --> 02:41:14,398 ABOUT MALE/FEMALE DIFFERENCES IN 4409 02:41:14,464 --> 02:41:14,731 KIDS. 4410 02:41:14,798 --> 02:41:16,900 HAVE YOU EVER DONE THOSE 4411 02:41:16,967 --> 02:41:22,005 EXPERIMENTS IN PRE-PUBERTAL 4412 02:41:22,072 --> 02:41:22,773 ANIMALS THAT WOULD BE IMPORTANT 4413 02:41:22,839 --> 02:41:23,974 IN TERMS OF GOING AFTER THE 4414 02:41:24,041 --> 02:41:29,813 KIDS? 4415 02:41:29,880 --> 02:41:32,282 >> CHRISTINE CHAMBERS HAS DONE A 4416 02:41:32,349 --> 02:41:35,352 META-ANALYSIS OF THE LITERATURE 4417 02:41:35,419 --> 02:41:37,087 ON ACUTE PAIN SENSITIVITY 4418 02:41:37,154 --> 02:41:38,822 SHOWING THAT THE SEX DIFFERENCES 4419 02:41:38,889 --> 02:41:40,457 DON'T EMERGE UNTIL PUBERTY, SO 4420 02:41:40,524 --> 02:41:44,594 THAT'S NOT ALL THAT SURPRISING. 4421 02:41:44,661 --> 02:41:47,764 BUT IN TERMS OF THESE SEXUALLY 4422 02:41:47,831 --> 02:41:51,568 DIMORPHIC PAIN MECHANISMS THAT 4423 02:41:51,635 --> 02:41:52,869 ARE UNDERLYING WHATEVER THE 4424 02:41:52,936 --> 02:41:56,573 OVERALL OUTPUT IS, THAT'S A 4425 02:41:56,640 --> 02:41:57,941 LITTLE BIT MORE COMPLICATED. 4426 02:41:58,008 --> 02:42:00,710 A LOT OF THEM ARE 4427 02:42:00,777 --> 02:42:01,711 TESTOSTERONE-BASED, AND THAT'S 4428 02:42:01,778 --> 02:42:03,547 SOMETHING THAT COMES ON SLOW. 4429 02:42:03,613 --> 02:42:05,949 JUST SOME OF THEM ARE 4430 02:42:06,016 --> 02:42:06,616 ORGANIZATIONAL EFFECTS, SO SOME 4431 02:42:06,683 --> 02:42:08,785 OF THOSE ARE THERE FROM BIRTH. 4432 02:42:08,852 --> 02:42:10,787 THERE'S ONLY BEEN A SLIGHT BIT 4433 02:42:10,854 --> 02:42:15,992 OF WORK DONE ON THE SEX 4434 02:42:16,059 --> 02:42:18,562 DIFFERENCES IN PAIN IN NEONATAL 4435 02:42:18,628 --> 02:42:19,930 MICE AND RATS, SO I DON'T THINK 4436 02:42:19,996 --> 02:42:24,334 THERE'S ENOUGH OF A LITERATURE 4437 02:42:24,401 --> 02:42:25,235 THERE TO COME TO ANY CONCLUSION 4438 02:42:25,302 --> 02:42:26,870 BUT PEOPLE ARE WORKING ON IT 4439 02:42:26,937 --> 02:42:30,774 SLOWLY BUT SURELY. 4440 02:42:30,841 --> 02:42:32,309 >> ROB, YOU WANT TO ADD 4441 02:42:32,375 --> 02:42:32,576 ANYTHING? 4442 02:42:32,642 --> 02:42:34,010 >> NO, I DON'T THINK I CAN ADD 4443 02:42:34,077 --> 02:42:39,516 TOO MUCH TO THAT. 4444 02:42:39,583 --> 02:42:40,383 >> LAURA. 4445 02:42:40,450 --> 02:42:42,619 >> PICKING UP WHERE WALTER -- 4446 02:42:42,686 --> 02:42:44,921 HANNA, I'M WONDERING ABOUT NHIS 4447 02:42:44,988 --> 02:42:46,756 OR ANY OTHER LONGITUDINAL 4448 02:42:46,823 --> 02:42:47,290 DATASET THAT INCORPORATE 4449 02:42:47,357 --> 02:42:48,291 CHILDREN UNDER THE AGE OF 18. 4450 02:42:48,358 --> 02:42:51,061 IT LOOKED LIKE WITH YOUR DATA AT 4451 02:42:51,128 --> 02:42:52,529 18, WE WERE ALREADY STARTING TO 4452 02:42:52,596 --> 02:42:54,064 SEE THE DIFFERENCES, AND SO THE 4453 02:42:54,131 --> 02:42:56,366 QUESTION I HAVE IS, DO WE HAVE 4454 02:42:56,433 --> 02:42:58,869 DATA OR DOES NIH HAVE -- GOING 4455 02:42:58,935 --> 02:43:00,704 DOWN TO 12 OR OTHER YEARS TO BE 4456 02:43:00,770 --> 02:43:02,439 ABLE TO LOOK AT SOME OF THOSE 4457 02:43:02,506 --> 02:43:04,407 DIFFERENCES IN CHILDHOOD, WHICH 4458 02:43:04,474 --> 02:43:05,475 MIGHT PREDICT SOME OF THOSE 4459 02:43:05,542 --> 02:43:07,811 CHANGES INTO ADULTHOOD. 4460 02:43:07,878 --> 02:43:09,846 >> YEAH, ACTUALLY THE PREVIOUS 4461 02:43:09,913 --> 02:43:11,581 QUESTION JUST MADE ME THINK 4462 02:43:11,648 --> 02:43:14,451 ABOUT THAT AS WELL, SO WE HAVE 4463 02:43:14,518 --> 02:43:18,054 USUALLY USED THE ADULT DATA FROM 4464 02:43:18,121 --> 02:43:19,456 NHIS BECAUSE FOR EXAMPLE, WE DO 4465 02:43:19,523 --> 02:43:25,328 RESEARCH ON HOW HIGHEST LEVEL OF 4466 02:43:25,395 --> 02:43:25,929 EDUCATIONAL ATTAINMENT SHAPES 4467 02:43:25,996 --> 02:43:27,063 PAIN, SO YOU NEED TO WAIT UNTIL 4468 02:43:27,130 --> 02:43:28,798 PEOPLE ARE OLD ENOUGH TO HAVE 4469 02:43:28,865 --> 02:43:30,901 COMPLETED COLLEGE OR NOT. 4470 02:43:30,967 --> 02:43:33,170 BUT THERE IS DATA -- I'M LOOKING 4471 02:43:33,236 --> 02:43:34,971 AT RICHARD BECAUSE HE KNOWS NHIS 4472 02:43:35,038 --> 02:43:37,240 BETTER THAN ANYONE I KNOW. 4473 02:43:37,307 --> 02:43:38,875 THE PAIN QUESTIONS AREN'T IN THE 4474 02:43:38,942 --> 02:43:39,643 CHILD QUESTIONNAIRE. 4475 02:43:39,709 --> 02:43:40,043 OKAY. 4476 02:43:40,110 --> 02:43:41,811 SO THAT'S THE LIMITATION. 4477 02:43:41,878 --> 02:43:43,413 SO WE DON'T HAVE THE RIGHT DATA 4478 02:43:43,480 --> 02:43:45,749 ABOUT THE CHILDREN FROM THAT. 4479 02:43:45,815 --> 02:43:46,783 THAT'S HELPFUL. 4480 02:43:46,850 --> 02:43:50,854 THANK YOU. 4481 02:43:50,921 --> 02:44:01,298 >> ONE MORE QUESTION. 4482 02:44:04,968 --> 02:44:06,503 >> -- WOULD DIFFER, BUT IS 4483 02:44:06,570 --> 02:44:09,406 THERE RESEARCH ON HOW MALES AND 4484 02:44:09,472 --> 02:44:12,175 FEMALES ARE NOT SEXUALLY 4485 02:44:12,242 --> 02:44:12,943 DYSMORPHIC? 4486 02:44:13,009 --> 02:44:13,910 THINKING AFTER TREATMENT 4487 02:44:13,977 --> 02:44:17,347 STRATEGY, WE ARE THINKING 4488 02:44:17,414 --> 02:44:20,217 PRECISE TREATMENTS, AND WE 4489 02:44:20,283 --> 02:44:21,885 TALKED ABOUT THE EDUCATION GAP 4490 02:44:21,952 --> 02:44:22,986 IN MEDICAL STUDENTS AND HOW WE 4491 02:44:23,053 --> 02:44:25,889 HAVE TO ACTUALLY, YOU KNOW, HEAR 4492 02:44:25,956 --> 02:44:27,324 THE STORY OF THE PERSON, THAT'S 4493 02:44:27,390 --> 02:44:29,926 ALL IMPORTANT, BUT AS FAR AS 4494 02:44:29,993 --> 02:44:31,461 THINKING ON A TREATMENT 4495 02:44:31,528 --> 02:44:33,430 CONSOLIDATION, DO WE HAVE 4496 02:44:33,496 --> 02:44:37,667 RESEARCH ON HOW MALES AND 4497 02:44:37,734 --> 02:44:39,603 FEMALES EITHER IN RODENTS OR 4498 02:44:39,669 --> 02:44:41,271 HUMANS RESPOND SIMILARLY AS FAR 4499 02:44:41,338 --> 02:44:43,640 AS MECHANISMS OR TO TREATMENT 4500 02:44:43,707 --> 02:44:47,077 OPTIONS? 4501 02:44:47,143 --> 02:44:50,747 >> I CAN ADDRESS THAT. 4502 02:44:50,814 --> 02:44:53,984 YEAH, SO THERE'S NO GOOD 4503 02:44:54,050 --> 02:44:55,018 EVIDENCE SUGGESTING THAT ANY 4504 02:44:55,085 --> 02:44:56,886 EXISTING TREATMENT OF PAIN IS 4505 02:44:56,953 --> 02:44:58,622 SEXUALLY DIMORPHIC IN ANY WAY 4506 02:44:58,688 --> 02:45:01,591 WORTH TALKING ABOUT. 4507 02:45:01,658 --> 02:45:02,759 WOMEN ARE A LITTLE BIT MORE 4508 02:45:02,826 --> 02:45:05,528 SENSITIVE TO OPIOIDS ACTUALLY. 4509 02:45:05,595 --> 02:45:06,763 THERE'S ONE PAPER THAT'S NEVER 4510 02:45:06,830 --> 02:45:09,532 BEEN REPLICATED SUGGESTING THEY 4511 02:45:09,599 --> 02:45:11,601 MAY BE LESS SENSITIVE TO 4512 02:45:11,668 --> 02:45:13,403 NSAIDs, BUT LIKE IN GENERAL, 4513 02:45:13,470 --> 02:45:14,404 EVERYTHING USED NOW, THERE'S NOT 4514 02:45:14,471 --> 02:45:16,306 A LOT OF SEXUAL DIMORPHISM. 4515 02:45:16,373 --> 02:45:19,276 THE ISSUE IS EVERYTHING THAT IS 4516 02:45:19,342 --> 02:45:21,344 CURRENTLY BEING RESEARCHED AND 4517 02:45:21,411 --> 02:45:23,179 CLINICAL TRIALS THAT HAVE ALMOST 4518 02:45:23,246 --> 02:45:25,448 CERTAINLY FAILED BECAUSE THERE 4519 02:45:25,515 --> 02:45:26,750 WERE SEX DIFFERENCES THERE THAT 4520 02:45:26,816 --> 02:45:29,853 NO ONE KNEW ABOUT. 4521 02:45:29,919 --> 02:45:31,588 SO I THINK THIS IS A BIGGER 4522 02:45:31,655 --> 02:45:34,090 STORY IN TERMS OF DRUG 4523 02:45:34,157 --> 02:45:36,293 DEVELOPMENT THAN IT IS TO 4524 02:45:36,359 --> 02:45:38,028 EXPLAIN ANY TREATMENT EFFICACY 4525 02:45:38,094 --> 02:45:38,561 TODAY. 4526 02:45:38,628 --> 02:45:41,831 THERE'S JUST -- SEX DIFFERENCES 4527 02:45:41,898 --> 02:45:43,700 ARE ONE OF A LARGE NUMBER OF 4528 02:45:43,767 --> 02:45:45,535 SOURCES OF VARIABILITY LEADING 4529 02:45:45,602 --> 02:45:47,437 TO DIFFERENTIAL TREATMENT 4530 02:45:47,504 --> 02:45:51,341 EFFICACY. 4531 02:45:51,408 --> 02:45:53,510 >> WE HAVE LAST TWO QUESTIONS IN 4532 02:45:53,576 --> 02:45:54,377 THE INTEREST OF TIME. 4533 02:45:54,444 --> 02:45:54,978 GO AHEAD. 4534 02:45:55,045 --> 02:45:58,014 >> OKAY. 4535 02:45:58,081 --> 02:45:59,883 SO THE LAST COUPLE OF QUESTIONS 4536 02:45:59,949 --> 02:46:02,919 WERE PERTAINING TO CHILDREN IN 4537 02:46:02,986 --> 02:46:03,653 PAIN. 4538 02:46:03,720 --> 02:46:05,422 I GUESS MY QUESTION IS, WE KNOW 4539 02:46:05,488 --> 02:46:08,792 THAT THERE ARE CERTAIN 4540 02:46:08,858 --> 02:46:09,426 SOCIOECONOMIC FACTORS THAT CAN 4541 02:46:09,492 --> 02:46:11,261 KIND OF PUSH KIDS TO HAVE TO 4542 02:46:11,328 --> 02:46:14,431 TAKE ON MORE ADULT LIKE 4543 02:46:14,497 --> 02:46:15,432 RESPONSIBILITIES OR BE TREATED 4544 02:46:15,498 --> 02:46:18,134 AS ADULTS, AND I WAS WONDERING 4545 02:46:18,201 --> 02:46:20,236 FOR THOSE OF YOU WHO WORK 4546 02:46:20,303 --> 02:46:22,405 DIRECTLY WITH PATIENTS, ARE 4547 02:46:22,472 --> 02:46:24,074 THOSE FACTORS SOMETHING THAT YOU 4548 02:46:24,140 --> 02:46:27,877 LOOK INTO AND I GUESS FOR 4549 02:46:27,944 --> 02:46:29,412 DR. MOGIL AS A PRE-CLINICAL 4550 02:46:29,479 --> 02:46:31,081 RESEARCHER MYSELF, I'M WONDERING 4551 02:46:31,147 --> 02:46:34,084 DO YOU HAVE ANY IDEAS ON HOW WE 4552 02:46:34,150 --> 02:46:36,286 COULD LIKE MODEL THAT TYPE OF 4553 02:46:36,353 --> 02:46:41,458 STRESS IN ANIMALS? 4554 02:46:41,524 --> 02:46:43,193 >> I MEAN -- 4555 02:46:43,259 --> 02:46:44,761 >> GO AHEAD. 4556 02:46:44,828 --> 02:46:45,895 >> I'LL JUST QUICKLY SAY, WE 4557 02:46:45,962 --> 02:46:46,896 MODEL STRESS IN ANIMALS ALL THE 4558 02:46:46,963 --> 02:46:47,230 TIME. 4559 02:46:47,297 --> 02:46:49,599 WE DO IT PRETTY GROSSLY, YOU 4560 02:46:49,666 --> 02:46:51,201 KNOW, WE PUT THEM IN RESTRAINING 4561 02:46:51,267 --> 02:46:54,637 TUBES OR WE PUT THEM IN COLD 4562 02:46:54,704 --> 02:46:56,072 WATER OR SOMETHING AND, YOU 4563 02:46:56,139 --> 02:46:58,641 KNOW, YOU CAN EITHER BE A LUMPER 4564 02:46:58,708 --> 02:47:00,009 AND SAY STRESS IS STRESS, IT'S 4565 02:47:00,076 --> 02:47:01,511 PROBABLY SIMILAR, OR YOU CAN BE 4566 02:47:01,578 --> 02:47:02,812 A SPLITTER AND SAY THAT THAT 4567 02:47:02,879 --> 02:47:03,913 KIND OF STRESS IS NOTHING LIKE 4568 02:47:03,980 --> 02:47:04,881 THE STRESS YOU'RE TALKING ABOUT. 4569 02:47:04,948 --> 02:47:09,652 I DON'T KNOW THE ANSWER. 4570 02:47:09,719 --> 02:47:11,187 >> ANY OF YOU WANT TO ADD 4571 02:47:11,254 --> 02:47:12,789 ANYTHING? 4572 02:47:12,856 --> 02:47:17,460 ANY THOUGHTS? 4573 02:47:17,527 --> 02:47:18,895 >> I THINK IT'S A GOOD QUESTION. 4574 02:47:18,962 --> 02:47:20,864 I THINK MODELING THAT IN ANIMALS 4575 02:47:20,930 --> 02:47:22,298 IS GOING TO BE DIFFICULT. 4576 02:47:22,365 --> 02:47:24,033 I MEAN, YOU KNOW, IT COULD BE 4577 02:47:24,100 --> 02:47:25,835 LIKE THE MATERNAL SEPARATION 4578 02:47:25,902 --> 02:47:27,370 MODEL IN ANIMALS, YOU KNOW, THAT 4579 02:47:27,437 --> 02:47:29,339 MAY BE AN ASPECT. 4580 02:47:29,406 --> 02:47:30,573 BUT I DON'T THINK IT GETS TO 4581 02:47:30,640 --> 02:47:32,742 WHAT YOU'RE TALKING ABOUT. 4582 02:47:32,809 --> 02:47:35,712 I THINK WHEN WE START LOOKING AT 4583 02:47:35,779 --> 02:47:37,414 ADULTS, ONE OF THE THINGS THAT 4584 02:47:37,480 --> 02:47:39,682 WE TALK ABOUT IN THE PLENARY, 4585 02:47:39,749 --> 02:47:41,684 AND IN MY TALK, THE ADVERSE 4586 02:47:41,751 --> 02:47:43,186 CHILDHOOD EXPERIENCES, THAT MAY 4587 02:47:43,253 --> 02:47:44,988 BE A WAY TO START GETTING AT 4588 02:47:45,054 --> 02:47:45,288 THAT. 4589 02:47:45,355 --> 02:47:47,690 I MEAN, BUT WE'RE LOOKING AT 4590 02:47:47,757 --> 02:47:49,325 ADULTS, AND SORT OF WHAT THOSE 4591 02:47:49,392 --> 02:47:51,060 SORT OF CHILDHOOD EXPERIENCES, 4592 02:47:51,127 --> 02:47:53,129 HOW THEY MAY CONTRIBUTE TO THE 4593 02:47:53,196 --> 02:47:54,364 CURRENT STATE OF THEIR PAIN OR 4594 02:47:54,431 --> 02:47:58,968 THEIR PAIN SENSITIVITY. 4595 02:47:59,035 --> 02:48:00,703 >> FOR WHAT IT'S WORTH, A NUMBER 4596 02:48:00,770 --> 02:48:03,540 OF BIG NATIONAL SURVEYS HAVE 4597 02:48:03,606 --> 02:48:06,376 THESE INVENTORIES OF SORT OF 4598 02:48:06,443 --> 02:48:07,777 STRESSFUL LIFE EVENTS. 4599 02:48:07,844 --> 02:48:09,212 EVERYTHING FROM HAVE YOU EVER 4600 02:48:09,279 --> 02:48:11,181 HAD A PARENT DIE, HAVE YOU EVER 4601 02:48:11,247 --> 02:48:12,282 FILED FOR BANKRUPTCY, HAVE YOU 4602 02:48:12,348 --> 02:48:14,150 EVER SEEN SOMEONE BE KILLED, ALL 4603 02:48:14,217 --> 02:48:18,955 KINDS OF THINGS, AND THIS ISN'T 4604 02:48:19,022 --> 02:48:20,723 GOING TO BE OF USE IN A 4605 02:48:20,790 --> 02:48:22,358 PRE-CLINICAL SETTING, BUT THERE 4606 02:48:22,425 --> 02:48:23,960 IS POTENTIAL TO KIND OF LOOK AT 4607 02:48:24,027 --> 02:48:25,728 THOSE ASSOCIATIONS WITH SOME 4608 02:48:25,795 --> 02:48:26,463 NATIONAL DATASETS. 4609 02:48:26,529 --> 02:48:27,664 NOT EXACTLY WHAT YOU WERE 4610 02:48:27,730 --> 02:48:28,965 TALKING ABOUT, BUT MAYBE SOME 4611 02:48:29,032 --> 02:48:32,402 KIND OF RELATED TYPES OF STRESS. 4612 02:48:32,469 --> 02:48:35,004 >> THE OTHER ASPECT IS THAT IN 4613 02:48:35,071 --> 02:48:36,306 SOME SITUATIONS LIKE THAT, WHAT 4614 02:48:36,372 --> 02:48:38,808 YOU END UP SEEING AS WELL IS 4615 02:48:38,875 --> 02:48:40,243 RESILIENCE MEASURES. 4616 02:48:40,310 --> 02:48:45,248 AND SO I THINK ADDING THAT NOT 4617 02:48:45,315 --> 02:48:46,783 ONLY LOOKING AT EVERYTHING AS A 4618 02:48:46,850 --> 02:48:48,117 NEGATIVE STRESSOR, BUT SOME OF 4619 02:48:48,184 --> 02:48:51,054 THOSE DO LEAD TO GREATER LEVELS 4620 02:48:51,120 --> 02:48:52,555 OF RESILIENCE, SO MEASURING SORT 4621 02:48:52,622 --> 02:48:55,492 OF BOTH ASPECTS, I THINK IS 4622 02:48:55,558 --> 02:48:56,459 PORCHLT 4623 02:48:56,526 --> 02:48:58,695 >> THANK YOU. 4624 02:48:58,761 --> 02:49:01,664 >> THE LAST QUESTION. 4625 02:49:01,731 --> 02:49:02,632 >> THANK YOU. 4626 02:49:02,699 --> 02:49:04,467 SO I KNOW IT WAS BROUGHT UP THAT 4627 02:49:04,534 --> 02:49:05,435 WE'RE TRYING TO GET THIS 4628 02:49:05,502 --> 02:49:06,769 RESEARCH OUT TO THE COMMUNITY, 4629 02:49:06,836 --> 02:49:11,674 WHICH IS GREAT, AND IN -- THINK 4630 02:49:11,741 --> 02:49:13,443 THAT'S AMAZING, I WORK ON HEAL 4631 02:49:13,510 --> 02:49:14,677 CONNECTIONS AS A FACILITATOR OF 4632 02:49:14,744 --> 02:49:16,412 THE LIVED EXPERIENCE PANEL, AND 4633 02:49:16,479 --> 02:49:21,117 OUR GOAL WAS AS TO ALLOW 4634 02:49:21,184 --> 02:49:21,718 INDIVIDUALS FROM THE COMMUNITY 4635 02:49:21,784 --> 02:49:23,653 TO TELL US HOW THEY WANT TO 4636 02:49:23,720 --> 02:49:26,723 RECEIVE RESEARCH. 4637 02:49:26,789 --> 02:49:27,690 ANOTHER SIDE OF THAT IS THE 4638 02:49:27,757 --> 02:49:29,192 AMAZING WORK BEING DONE BY THE 4639 02:49:29,259 --> 02:49:31,461 ADDICTION POLICY FORUM. 4640 02:49:31,528 --> 02:49:36,065 JESSICA HA HALSEY IS SPEARHEADIG 4641 02:49:36,132 --> 02:49:37,634 THAT AND HAS TONS OF ASSOCIATION 4642 02:49:37,700 --> 02:49:38,902 PARTNERS INCLUDING INDIVIDUALS 4643 02:49:38,968 --> 02:49:39,969 WHO ARE PAYOR PROVIDERS O.A.R. 4644 02:49:40,036 --> 02:49:41,871 FITS. OR 4645 02:49:41,938 --> 02:49:42,472 PHYSICIANS. 4646 02:49:42,539 --> 02:49:44,474 WHAT WE'VE LEARNED IS SOMETIMES 4647 02:49:44,541 --> 02:49:46,676 PHYSICIANS OR OTHER RESEARCHERS 4648 02:49:46,743 --> 02:49:49,479 DON'TNESS SAIR LEGAL HAVE TIME 4649 02:49:49,546 --> 02:49:52,215 TO READ OUT AN ENTIRE SCIENTIFIC 4650 02:49:52,282 --> 02:49:56,185 ARTICLE WHEN THEY HAVE 15-MINUTE 4651 02:49:56,252 --> 02:49:57,253 PATIENT APPOINTMENTS BACK TO 4652 02:49:57,320 --> 02:49:57,687 BACK. 4653 02:49:57,754 --> 02:49:59,455 AND SO I'M JUST CURIOUS ON WHAT 4654 02:49:59,522 --> 02:50:03,226 WE'RE DOING TO TRY TO GET THIS 4655 02:50:03,293 --> 02:50:06,095 RESEARCH ACROSS DIFFERENT FIELDS 4656 02:50:06,162 --> 02:50:09,165 AND TO LIKE PCPs OR PROVIDERS, 4657 02:50:09,232 --> 02:50:14,671 OTHER PROVIDERS. 4658 02:50:14,737 --> 02:50:16,639 > 4659 02:50:16,706 --> 02:50:18,141 >> I OBVIOUSLY AGREE WITH YOU, I 4660 02:50:18,207 --> 02:50:18,908 THINK IT'S SO IMPORTANT. 4661 02:50:18,975 --> 02:50:20,643 SOME OF WHAT WE'VE DONE, SO FOR 4662 02:50:20,710 --> 02:50:23,046 EXAMPLE, ONE OF OUR STUDIES 4663 02:50:23,112 --> 02:50:26,649 SHOWED THAT REFUGEES AND ASYLUM 4664 02:50:26,716 --> 02:50:27,250 SEEKERS SPECIFICALLY DISENGAGE 4665 02:50:27,317 --> 02:50:29,052 FROM PUBLIC BENEFITS BECAUSE 4666 02:50:29,118 --> 02:50:31,120 THEY'RE SO FEARFUL OF 4667 02:50:31,187 --> 02:50:34,390 IMMIGRATION POLICY, AND WITH 4668 02:50:34,457 --> 02:50:35,024 DIFFERENT ADMINISTRATIONS, 4669 02:50:35,091 --> 02:50:37,594 THERE'S BEEN LIKE 400 CHANGES TO 4670 02:50:37,660 --> 02:50:39,329 IMMIGRATION LAW AND POLICY, AND 4671 02:50:39,395 --> 02:50:43,266 SO WE FOUND THAT PEOPLE WERE NOT 4672 02:50:43,333 --> 02:50:49,038 SEEKING PRENATAL VISITS, THEY 4673 02:50:49,105 --> 02:50:50,473 WEREN'T -- CHILDHOOD 4674 02:50:50,540 --> 02:50:51,407 VACCINATIONS, THOSE KINDS OF 4675 02:50:51,474 --> 02:50:51,641 THINGS. 4676 02:50:51,708 --> 02:50:52,775 SO ONE OF THE THINGS WE DID WAS 4677 02:50:52,842 --> 02:50:57,146 WE PARTNERED WITH A DIGITAL TECH 4678 02:50:57,213 --> 02:50:59,115 COMMUNICATIONS GROUP, A GROUP OF 4679 02:50:59,182 --> 02:51:00,883 ATTORNEYS, AND WE CREATED THAT 4680 02:51:00,950 --> 02:51:02,418 RESOURCE SO WE CREATED THIS 4681 02:51:02,485 --> 02:51:04,020 WEBSITE CALLED RIGHTS FOR HEALTH 4682 02:51:04,087 --> 02:51:06,689 WHERE SOMEONE CAN GO IN AND 4683 02:51:06,756 --> 02:51:08,324 ENTER WHO THEY ARE AND THEIR 4684 02:51:08,391 --> 02:51:09,325 MEDICAL CONDITION SO THEY'LL SAY 4685 02:51:09,392 --> 02:51:10,827 I'M A PREGNANT WOMAN. 4686 02:51:10,893 --> 02:51:12,161 WHAT DO I NEED? 4687 02:51:12,228 --> 02:51:14,430 SO IT SHOWS UP YOU NEED EIGHT 4688 02:51:14,497 --> 02:51:15,431 PRENATAL VISITS, THESE ARE THE 4689 02:51:15,498 --> 02:51:16,866 THINGS THAT YOU NEED TO DO, AND 4690 02:51:16,933 --> 02:51:18,801 THEN IT PAIRS IT WITH WHAT THEY 4691 02:51:18,868 --> 02:51:23,740 ARE LEGALLY ALLOWED TO ACCESS. 4692 02:51:23,806 --> 02:51:25,575 SO IT WILL SAY YOU NEED -- THIS 4693 02:51:25,642 --> 02:51:27,110 WILL NOT AFFECT YOUR IMMIGRATION 4694 02:51:27,176 --> 02:51:29,078 CASE, AND THIS IS WHAT IT MEANS, 4695 02:51:29,145 --> 02:51:30,279 AND SO THOSE KINDS OF SERVICES, 4696 02:51:30,346 --> 02:51:31,447 AND THEN IT ACTUALLY LINKS 4697 02:51:31,514 --> 02:51:33,016 PEOPLE TO PROVIDERS, HEALTHCARE 4698 02:51:33,082 --> 02:51:36,386 PROVIDERS AND LEGAL PROVIDERS. 4699 02:51:36,452 --> 02:51:37,587 I THINK THAT'S AN EXAMPLE OF HOW 4700 02:51:37,654 --> 02:51:39,355 WE CAN CONVERT IT FOR THE 4701 02:51:39,422 --> 02:51:39,889 PATIENT POPULATION. 4702 02:51:39,956 --> 02:51:42,525 I THINK THAT'S REALLY IMPORTANT. 4703 02:51:42,592 --> 02:51:43,893 AND THAT EVERYBODY'S RESEARCH, 4704 02:51:43,960 --> 02:51:48,431 I'M SURE IS JUST SO -- LIKE PAIN 4705 02:51:48,498 --> 02:51:49,599 RESEARCH IS SO IMPORTANT AND 4706 02:51:49,666 --> 02:51:50,800 SHOULD JUST BE OUT THERE IN 4707 02:51:50,867 --> 02:51:51,801 WHATEVER WAY WE CAN FOR 4708 02:51:51,868 --> 02:51:52,335 PATIENTS. 4709 02:51:52,402 --> 02:51:54,871 AND THEN THERE'S THE SECOND 4710 02:51:54,937 --> 02:51:56,606 ASPECT OF GETTING TO PROVIDERS, 4711 02:51:56,673 --> 02:51:58,441 AND ONE OF THE THINGS THAT WE'VE 4712 02:51:58,508 --> 02:52:00,543 HEARD AGAIN AND AGAIN FROM OUR 4713 02:52:00,610 --> 02:52:03,379 PATIENT POPULATION IS THAT THEIR 4714 02:52:03,446 --> 02:52:04,981 ATTORNEYS TELL THEM INFORMATION 4715 02:52:05,048 --> 02:52:07,183 THAT'S INCORRECT, DOCTORS TELL 4716 02:52:07,250 --> 02:52:08,384 THEM INFORMATION THAT'S 4717 02:52:08,451 --> 02:52:09,952 INCORRECT, WE'VE HAD PATIENTS 4718 02:52:10,019 --> 02:52:14,323 SAY MY DOCTOR TOLL ME NO TOLD MT 4719 02:52:14,390 --> 02:52:16,092 ANY MORE PRENATAL VISITS BECAUSE 4720 02:52:16,159 --> 02:52:17,994 I WOULD BE DEPORTED, WHICH IS SO 4721 02:52:18,061 --> 02:52:18,761 FRUSTRATING. 4722 02:52:18,828 --> 02:52:19,962 SO I THINK IT IS LIKE YOU'RE 4723 02:52:20,029 --> 02:52:21,264 SAYING ABOUT DISSEMINATION. 4724 02:52:21,330 --> 02:52:22,799 THE WAY WE'VE FOUND THAT TO BE 4725 02:52:22,865 --> 02:52:24,767 EFFECTIVE IS THROUGH MEDIA 4726 02:52:24,834 --> 02:52:25,868 ARTICLES, BECAUSE PEOPLE CAN 4727 02:52:25,935 --> 02:52:28,938 READ LIKE A THREE-MINUTE, YOU 4728 02:52:29,005 --> 02:52:31,307 KNOW, NBC ARTICLE WHEN IT MIGHT 4729 02:52:31,374 --> 02:52:32,408 TAKE A LITTLE BIT MORE EFFORT TO 4730 02:52:32,475 --> 02:52:34,110 READ A PAPER AND WE CAN 4731 02:52:34,177 --> 02:52:35,678 HYPERLINK THE PAPER AND THAT'S 4732 02:52:35,745 --> 02:52:37,847 USEFUL. 4733 02:52:37,914 --> 02:52:42,018 I THINK MY EXPERIENCE IS THAT 4734 02:52:42,085 --> 02:52:45,855 PEOPLE IN MEDIA ARE SO EAGER AND 4735 02:52:45,922 --> 02:52:47,557 INTERESTED TO SPREAD AWARENESS 4736 02:52:47,623 --> 02:52:49,025 ABOUT SCIENTIFIC FINDINGS AND 4737 02:52:49,092 --> 02:52:50,793 REALLY IMPORTANT ARTICLES AND 4738 02:52:50,860 --> 02:52:52,762 THAT WE JUST AS SCIENTISTS NEED 4739 02:52:52,829 --> 02:52:54,997 TO DO A BETTER JOB OF LIKE 4740 02:52:55,064 --> 02:52:56,666 PITCHING, YOU KNOW, TO THOSE 4741 02:52:56,733 --> 02:52:59,268 GROUPS TO GET THAT INFORMATION 4742 02:52:59,335 --> 02:53:00,770 OUT TO PROVIDERS WHO ARE GOING 4743 02:53:00,837 --> 02:53:02,105 TO CARE FOR HUNDREDS OR 4744 02:53:02,171 --> 02:53:04,273 THOUSANDS OF PATIENTS DURING 4745 02:53:04,340 --> 02:53:07,543 THEIR LIFETIMES. 4746 02:53:07,610 --> 02:53:09,312 AND I THINK THERE'S REALLY EASY 4747 02:53:09,378 --> 02:53:10,413 WAYS TO DO THAT. 4748 02:53:10,480 --> 02:53:13,483 WE HAVE REALLY GOOD SUPPORT 4749 02:53:13,549 --> 02:53:14,617 SYSTEMS FOR GRANTS MANAGEMENT 4750 02:53:14,684 --> 02:53:16,853 BUT NOT REALLY FOR PR AND MEDIA 4751 02:53:16,919 --> 02:53:18,287 ENGAGEMENT AND GETTING THE WORK 4752 02:53:18,354 --> 02:53:19,856 OUT ONCE THERE'S A FINDING. 4753 02:53:19,922 --> 02:53:20,523 HOW MANY PEOPLE READ A 4754 02:53:20,590 --> 02:53:21,491 PARTICULAR PAPER VERSUS HOW MANY 4755 02:53:21,557 --> 02:53:23,793 PEOPLE WOULD READ A NEWS ARTICLE 4756 02:53:23,860 --> 02:53:26,195 OR LISTEN TO A PODCAST? 4757 02:53:26,262 --> 02:53:28,498 SO BOTH ARE -- IT'S NOT LIKE ONE 4758 02:53:28,564 --> 02:53:29,465 IS -- JUST THAT IS IMPORTANT, 4759 02:53:29,532 --> 02:53:31,400 BUT I THINK WE SHOULD AND COULD 4760 02:53:31,467 --> 02:53:33,736 DO A BETTER JOB WITH THAT. 4761 02:53:33,803 --> 02:53:37,673 >> TOTALLY AGREE. 4762 02:53:37,740 --> 02:53:42,044 HOW DO YOU REALLY SIMPLIFY AND 4763 02:53:42,111 --> 02:53:47,950 ALSO LIKE TAYLOR MAKE RESEARCH 4764 02:53:48,017 --> 02:53:51,554 FINDINGS TO THE PUBLIC, THEIR 4765 02:53:51,621 --> 02:53:57,126 SIMPLIFIED UNDERSTANDING AN. 4766 02:53:57,193 --> 02:53:58,227 AGAIN, I WOULD LIKE TO THANK ALL 4767 02:53:58,294 --> 02:54:00,229 THE SPEAKERS AND ALSO ALL THE 4768 02:54:00,296 --> 02:54:01,764 AUDIENCE HERE FOR ACTIVE 4769 02:54:01,831 --> 02:54:02,064 DISCUSSION. 4770 02:54:02,131 --> 02:54:12,041 THANK YOU AGAIN. 4771 02:54:12,108 --> 02:54:14,110 >> HI, EVERYONE. 4772 02:54:14,177 --> 02:54:15,211 THANK YOU ALL FOR COMING AND 4773 02:54:15,278 --> 02:54:16,412 THANKS TO EVERYONE WHO'S 4774 02:54:16,479 --> 02:54:16,879 WATCHING ONLINE. 4775 02:54:16,946 --> 02:54:20,650 I JUST WANT TO GIVE YOU SOME 4776 02:54:20,716 --> 02:54:21,083 HOUSEKEEPING STUFF. 4777 02:54:21,150 --> 02:54:23,319 OVER THE NEXT COUPLE OF HOURS. 4778 02:54:23,386 --> 02:54:25,488 SO WE HAVE A POSTER SESSION 4779 02:54:25,555 --> 02:54:27,023 GOING ON IN THE ATRIUM. 4780 02:54:27,089 --> 02:54:31,360 IT'S SCHEDULED FROM -- WELL, 4781 02:54:31,427 --> 02:54:32,795 NOW, UNTIL 12:30, BUT FEEL FREE 4782 02:54:32,862 --> 02:54:34,230 TO TAKE AS MUCH TIME AS YOU WANT 4783 02:54:34,297 --> 02:54:34,897 LOOKING AT THE POSTERS. 4784 02:54:34,964 --> 02:54:37,400 WE WILL BE BACK HERE AT 1:30. 4785 02:54:37,466 --> 02:54:42,038 SO FROM 12:30 UNTIL 1:30, WE 4786 02:54:42,104 --> 02:54:44,106 HAVE A ROOM THAT WILL BE 4787 02:54:44,173 --> 02:54:44,874 LABELED, THERE ARE SIGNS 4788 02:54:44,941 --> 02:54:46,909 POINTING YOU TO IT, I THINK IT'S 4789 02:54:46,976 --> 02:54:50,546 ROOM AB, IF YOU'D LIKE TO SET 4790 02:54:50,613 --> 02:54:51,848 UP -- IF YOU'D LIKE TO NETWORK 4791 02:54:51,914 --> 02:54:52,481 WITH EACH OTHER. 4792 02:54:52,548 --> 02:54:54,116 I DON'T ACTUALLY KNOW WHAT THE 4793 02:54:54,183 --> 02:54:54,617 WEATHER IS LIKE OUTSIDE. 4794 02:54:54,684 --> 02:54:56,018 IF THE WEATHER IS BEAUTIFUL, GO 4795 02:54:56,085 --> 02:54:57,320 OUTSIDE, TALK TO PEOPLE OUTSIDE, 4796 02:54:57,386 --> 02:54:58,621 BUT IF YOU NEED A PLACE TO 4797 02:54:58,688 --> 02:55:00,489 GATHER, IF YOU NEED A QUIET 4798 02:55:00,556 --> 02:55:02,358 PLACE, WE HAVE A ROOM. 4799 02:55:02,425 --> 02:55:04,193 THERE IS A CAFETERIA UPSTAIRS 4800 02:55:04,260 --> 02:55:08,130 WHERE YOU CAN GET LUNCH I. 4801 02:55:08,197 --> 02:55:09,465 IF YOU NEED ANY OTHER 4802 02:55:09,532 --> 02:55:10,733 INFORMATION, JUST FIND ME OR ONE 4803 02:55:10,800 --> 02:55:11,901 OF OUR OTHER NIH COLLEAGUES AND 4804 02:55:11,968 --> 02:55:13,135 WE'LL BE HAPPY TO POINT YOU IN 4805 02:55:13,202 --> 02:55:13,870 THE RIGHT DIRECTION. 4806 02:55:13,936 --> 02:55:15,104 AGAIN, THANK YOU SO MUCH AND WE 4807 02:55:15,171 --> 02:55:25,548 WILL SEE YOU AT 1:30. 4808 02:57:26,068 --> 02:57:26,669 SO IT'S INTERESTING THAT EVEN 4809 02:57:26,736 --> 02:57:29,472 THOUGH WE SEE ABDOMINAL PAIN AS 4810 02:57:29,538 --> 02:57:32,274 ONE OF THE HIGHEST REPORTED 4811 02:57:32,341 --> 02:57:34,443 SYMPTOMS AMONG THIS PATIENT 4812 02:57:34,510 --> 02:57:36,879 POPULATION, IT IS NOT THE CORE 4813 02:57:36,946 --> 02:57:38,714 SYMPTOM THAT SEEMS TO BE DRIVING 4814 02:57:38,781 --> 02:57:44,120 THOSE RELATIONSHIPS WITH OTHER 4815 02:57:44,186 --> 02:57:44,387 SYMPTOMS. 4816 02:57:44,453 --> 02:57:46,589 WE ARE EXCITED TO DIVE INTO THIS 4817 02:57:46,655 --> 02:57:49,025 MORE AND TO REALLY UNDERSTAND 4818 02:57:49,091 --> 02:57:56,899 WHAT IS GOING ON. 4819 02:57:56,966 --> 02:58:00,269 >> HELLO, MY NAME IS BRIAN, I'M 4820 02:58:00,336 --> 02:58:02,138 GOING TO BE TALKING TO YOU ABOUT 4821 02:58:02,204 --> 02:58:11,981 MY DISSERTATION PROJECT. 4822 02:58:12,048 --> 02:58:15,151 WHAT IS CIPN? 4823 02:58:15,217 --> 02:58:17,653 CIPN IS A PREDOMINANTLY SENSORY 4824 02:58:17,720 --> 02:58:28,764 DOSE-LIMIT BELIMITING SIDE EFFEO 4825 02:58:28,831 --> 02:58:30,032 HAVE TO REDUCE OR CEASE 4826 02:58:30,099 --> 02:58:30,800 TREATMENT. 4827 02:58:30,866 --> 02:58:31,434 UNFORTUNATELY THERE ARE 4828 02:58:31,500 --> 02:58:33,102 CURRENTLY NO FDA-APPROVED DRUGS 4829 02:58:33,169 --> 02:58:35,071 SPECIFICALLY FOR THE PREVENTION 4830 02:58:35,137 --> 02:58:38,741 OR TREATMENT OF CIPN, AND SO IN 4831 02:58:38,808 --> 02:58:41,177 ORDER TO IDENTIFY NOVEL 4832 02:58:41,243 --> 02:58:42,244 THERAPEUTIC TARGETS, WE WANTED 4833 02:58:42,311 --> 02:58:43,813 TO LOOK AT WHAT ARE SOME 4834 02:58:43,879 --> 02:58:45,214 BIOLOGICAL PROCESSES THAT MAY BE 4835 02:58:45,281 --> 02:58:46,415 CONTRIBUTING TO THE DEVELOPMENT 4836 02:58:46,482 --> 02:58:50,086 OF CIPN, SUCH AS 4837 02:58:50,152 --> 02:58:50,619 NEUROINFLAMMATION. 4838 02:58:50,686 --> 02:58:51,554 NEUROINFLAMMATION IS MEDIATED BY 4839 02:58:51,620 --> 02:58:54,657 THE ACTIVATION OF INFLAMMATORY 4840 02:58:54,723 --> 02:58:56,358 IMMUNE CELLS SUCH AS MACROPHAGES 4841 02:58:56,425 --> 02:59:00,096 WHICH WILL THEN INFILTRATE 4842 02:59:00,162 --> 02:59:02,631 PERIPHERAL NEUROLOGICAL TISSUES. 4843 02:59:02,698 --> 02:59:03,933 ONE PROTEIN THAT REALLY STOOD 4844 02:59:03,999 --> 02:59:07,002 OUT TO US THAT MAY POTENTIALLY 4845 02:59:07,069 --> 02:59:09,738 HAVE A ROLE IN THIS PROCESS WAS 4846 02:59:09,805 --> 02:59:11,674 ASTROCYTE ELEVATED GENE 1 OR 4847 02:59:11,740 --> 02:59:14,110 AEG1. 4848 02:59:14,176 --> 02:59:16,278 AEG1 IS A SCAFFOLDING PROTEIN 4849 02:59:16,345 --> 02:59:19,248 THAT PRIMARILY FUNCTIONS BY 4850 02:59:19,315 --> 02:59:19,882 PROTEIN-PROTEIN INTERACTIONS AND 4851 02:59:19,949 --> 02:59:23,319 HAS BEEN SHOWN TO MODULATE NF KB 4852 02:59:23,385 --> 02:59:24,720 INDEPENDENT INFLAMMATION AS WELL 4853 02:59:24,787 --> 02:59:26,055 AS MACROPHAGE ACTIVITY. 4854 02:59:26,122 --> 02:59:30,726 IN FACT, LOSS RENDERS THEM 4855 02:59:30,793 --> 02:59:33,329 FUNCTIONALLY ANERGIC, SO WE 4856 02:59:33,395 --> 02:59:34,230 HYPOTHESIZED THAT THIS 4857 02:59:34,296 --> 02:59:35,531 EXPRESSION IN MYELOID CELLS 4858 02:59:35,598 --> 02:59:36,999 CONTRIBUTES TO THE DEVELOPMENT 4859 02:59:37,066 --> 02:59:38,701 AND MAINTENANCE OF CIPN. 4860 02:59:38,767 --> 02:59:41,470 WE UTILIZED A MODEL OF CIPN THAT 4861 02:59:41,537 --> 02:59:52,047 IS INDUCED BY PACK PACLITAXEL Y 4862 02:59:52,114 --> 02:59:55,985 USING GENETICALLY MODIFIED MICE 4863 02:59:56,051 --> 02:59:59,388 THAT DO NOT EXPRESS AEG1. 4864 02:59:59,455 --> 03:00:01,624 SO WE CAN SEE THE DELETION OF 4865 03:00:01,690 --> 03:00:06,162 AEG1 IN M MYELOID CELLS -- YOU N 4866 03:00:06,228 --> 03:00:08,998 SEE OUR WILD TYPE MICE STILL 4867 03:00:09,064 --> 03:00:10,432 DEVELOPED HYPERMECHANICAL 4868 03:00:10,499 --> 03:00:13,702 SENSITIVITY BUT AEG1 KNOCKOUT 4869 03:00:13,769 --> 03:00:14,737 MICE DO NOT. 4870 03:00:14,803 --> 03:00:19,074 WE SEE SIMILAR -- AND REDUCTIONS 4871 03:00:19,141 --> 03:00:26,415 IN PERIPHERAL NERVE FIBER -- THE 4872 03:00:26,482 --> 03:00:29,018 LOSS OF INTRAEPIDERMAL NERVE 4873 03:00:29,084 --> 03:00:31,520 FIBER DENSITY AS WELL AS A 4874 03:00:31,587 --> 03:00:33,622 REDUCTION IN THE EXPRESSION OF 4875 03:00:33,689 --> 03:00:35,024 SEVERAL PRO-INFLAMMATORY 4876 03:00:35,090 --> 03:00:36,859 CYTOKINES IN THE LUMBER DRGs 4877 03:00:36,926 --> 03:00:42,264 AND A COMPLETE INHIBITION OF 4878 03:00:42,331 --> 03:00:43,732 MYELOID CELL INFILTRATION INTO 4879 03:00:43,799 --> 03:00:46,735 THE DRGs WHICH ARE MARKED 4880 03:00:46,802 --> 03:00:48,804 USING F480, A MARKER FOR 4881 03:00:48,871 --> 03:00:49,471 MACROPHAGES. 4882 03:00:49,538 --> 03:00:51,840 WE'VE ALSO GOT SOME INTERESTING 4883 03:00:51,907 --> 03:00:53,976 DATA WHERE WE HAVE DEVELOPED 4884 03:00:54,043 --> 03:00:57,780 NANOPARTICLES THAT DELIVER 4885 03:00:57,846 --> 03:01:00,416 AEG16789 S RNA AND THAT HAS 4886 03:01:00,482 --> 03:01:03,252 SHOWN A LOT OF PROMISE IN 4887 03:01:03,319 --> 03:01:05,321 POTENTIALLY PREVENTING AND EVEN 4888 03:01:05,387 --> 03:01:07,957 REVERSING PACLITAXEL-INDUCED 4889 03:01:08,023 --> 03:01:09,191 MECHANICAL AND COLD 4890 03:01:09,258 --> 03:01:09,725 HYPERSENSITIVITY. 4891 03:01:09,792 --> 03:01:11,393 SO IF YOU HAVE ANY QUESTIONS OR 4892 03:01:11,460 --> 03:01:13,429 YOU'RE INTERESTED IN DATA, 4893 03:01:13,495 --> 03:01:14,964 PLEASE STOP BY AND FEEL FREE TO 4894 03:01:15,030 --> 03:01:15,598 ASK ANY QUESTIONS. 4895 03:01:15,664 --> 03:01:16,265 THANK YOU. 4896 03:01:16,332 --> 03:01:19,235 BYE. 4897 03:01:19,301 --> 03:01:23,038 >> I AM FROM THE CHILDREN'S 4898 03:01:23,105 --> 03:01:24,039 HOSPITAL OF PHILADELPHIA, AND I 4899 03:01:24,106 --> 03:01:25,908 WILL BE DISCUSSING CLUSTER 4900 03:01:25,975 --> 03:01:27,743 ANALYSIS OF MIGRAINE-ASSOCIATED 4901 03:01:27,810 --> 03:01:29,178 SYMPTOMS IN YOUTH. 4902 03:01:29,245 --> 03:01:30,479 EVERYONE IS FAMILIAR WITH WHAT A 4903 03:01:30,546 --> 03:01:31,714 HEADACHE IS. 4904 03:01:31,780 --> 03:01:33,115 BUT MIGRAINE IS A PARTICULAR 4905 03:01:33,182 --> 03:01:34,650 TYPE OF HEADACHE THAT IS NOT 4906 03:01:34,717 --> 03:01:37,152 ONLY DEFINED BY SEVERE 4907 03:01:37,219 --> 03:01:38,687 POTENTIALLY DISABLING HEAD PAIN, 4908 03:01:38,754 --> 03:01:40,122 BUT ALSO NEUROLOGICAL SYMPTOMS 4909 03:01:40,189 --> 03:01:43,392 THAT COME ALONG WITH THE PAIN. 4910 03:01:43,459 --> 03:01:47,229 SOME OF THESE INCLUDING LIGHT 4911 03:01:47,296 --> 03:01:48,530 SENSITIVITY, PAIN AND NAUSEA ARE 4912 03:01:48,597 --> 03:01:51,300 USED TO DEFINE MAY GRAIN HOWEVER 4913 03:01:51,367 --> 03:01:53,702 BRAIN FOG, LIGHT-HEADEDNESS AND 4914 03:01:53,769 --> 03:01:55,571 ROOM SPINNINGAGE OTHERS ARE ALSO 4915 03:01:55,638 --> 03:01:56,839 COMMONLY EXPERIENCED IN PEOPLE 4916 03:01:56,905 --> 03:01:57,973 WITH MIGRAINE. 4917 03:01:58,040 --> 03:02:00,109 THERE'S ALSO A HINT THAT 4918 03:02:00,175 --> 03:02:02,344 SYMPTOMS COMING ALONG WITH 4919 03:02:02,411 --> 03:02:03,512 MIGRAINE CHANGE AS CHILDREN GET 4920 03:02:03,579 --> 03:02:04,079 OLDER. 4921 03:02:04,146 --> 03:02:05,581 HOWEVER, WHAT IS NOT KNOWN IS 4922 03:02:05,648 --> 03:02:07,383 HOW A BROADER RANGE OF SYMPTOMS 4923 03:02:07,449 --> 03:02:08,317 ASSOCIATED WITH HEADACHE RELATE 4924 03:02:08,384 --> 03:02:09,652 TO EACH OTHER AND WHAT THEY TELL 4925 03:02:09,718 --> 03:02:11,053 US ABOUT THE BURDEN OF MIGRAINE 4926 03:02:11,120 --> 03:02:12,488 IN DAILY LIFE AND HOW THESE 4927 03:02:12,554 --> 03:02:14,056 SYMPTOMS CHANGE ACROSS CHILD 4928 03:02:14,123 --> 03:02:15,224 DEVELOPMENT. 4929 03:02:15,291 --> 03:02:16,892 WE SURVEYED OVER 10,000 YOUTH 4930 03:02:16,959 --> 03:02:19,328 BETWEEN THE AGES OF 6 AND 18 4931 03:02:19,395 --> 03:02:21,130 YEARS OLD WHO ARE BEING SEEN FOR 4932 03:02:21,196 --> 03:02:24,400 HEADACHE AND WE ASKED ABOUT 11 4933 03:02:24,466 --> 03:02:25,000 MIGRAINE-ASSOCIATED SYMPTOMS 4934 03:02:25,067 --> 03:02:26,201 WHICH ARE SHOWN IN THE GREEN 4935 03:02:26,268 --> 03:02:27,569 GRAPH. 4936 03:02:27,636 --> 03:02:29,838 WE USED MULTIPLE CORRESPONDENCE 4937 03:02:29,905 --> 03:02:31,206 ANALYSIS TO LOOK AT HOW THESE 4938 03:02:31,273 --> 03:02:32,541 RELATE TO EACH OTHER. 4939 03:02:32,608 --> 03:02:34,310 THE MAIN FINDINGS ACROSS THE 4940 03:02:34,376 --> 03:02:35,911 THREE DIMENSIONS ARE SUMMARIZED 4941 03:02:35,978 --> 03:02:37,746 IN THE SCHEMATIC. 4942 03:02:37,813 --> 03:02:41,350 SHOWN HERE. 4943 03:02:41,417 --> 03:02:42,885 THE FIRST DIMENSION SHOWED THAT 4944 03:02:42,951 --> 03:02:44,420 YOUTH WHO REPORTED ANY SYMPTOMS 4945 03:02:44,486 --> 03:02:46,088 WERE LIKELY TO REPORT MULTIPLE. 4946 03:02:46,155 --> 03:02:46,855 THIS CONSISTENT WITH THE VERY 4947 03:02:46,922 --> 03:02:52,094 DIFFICULT NIGDEFINITION OF MIGR, 4948 03:02:52,161 --> 03:02:53,295 SEPARATING THOSE WHO HAVE 4949 03:02:53,362 --> 03:02:54,730 NEUROLOGIC SYMPTOMS WITH THEIR 4950 03:02:54,797 --> 03:02:55,798 HEADACHE FROM THOSE WHO ARE 4951 03:02:55,864 --> 03:02:56,131 DON'T. 4952 03:02:56,198 --> 03:02:57,466 FOR YOUTH WHO REPORTED 4953 03:02:57,533 --> 03:02:59,001 RELATIVELY FEW SYMPTOMS, THEY 4954 03:02:59,068 --> 03:03:01,170 TENDED TO BE FEATURES THAT 4955 03:03:01,236 --> 03:03:02,671 DEFINE MIGRAINE WHEREAS SYMPTOMS 4956 03:03:02,738 --> 03:03:05,107 LIKE LIGHT-HEADEDNESS, 4957 03:03:05,174 --> 03:03:06,075 DIFFICULTY THINKING AND VISION 4958 03:03:06,141 --> 03:03:07,943 CHANGES WERE LIKELY TO BE 4959 03:03:08,010 --> 03:03:09,912 RECORDED WHEN ONLY MANY OTHER 4960 03:03:09,978 --> 03:03:11,914 SYMPTOMS WERE PRESENT. 4961 03:03:11,980 --> 03:03:13,949 THE SECOND SEPARATED THE 4962 03:03:14,016 --> 03:03:15,517 CLASSICAL FROM NON-CLASSICAL 4963 03:03:15,584 --> 03:03:18,287 FEATURES OF MIGRAINE AND THE 4964 03:03:18,354 --> 03:03:21,724 THIRD SEPARATED THOSE WERE -- 4965 03:03:21,790 --> 03:03:22,825 FROM VESTIBULAR SYMPTOMS AND 4966 03:03:22,891 --> 03:03:23,992 VOMITING. 4967 03:03:24,059 --> 03:03:25,594 WE FOUND THESE REVEALED 4968 03:03:25,661 --> 03:03:27,863 INFORMATION ABOUT HOW MIGRAINE 4969 03:03:27,930 --> 03:03:29,498 ASSOCIATED SYMPTOMS CHANGE 4970 03:03:29,565 --> 03:03:31,900 ACROSS HEADACHE BURDEN AND CHILD 4971 03:03:31,967 --> 03:03:32,568 DEVELOPMENT. 4972 03:03:32,634 --> 03:03:36,839 YOUTH WHO REPORTED -- 4973 03:03:36,905 --> 03:03:37,573 HEADACHE-RELATED DISABILITY AND 4974 03:03:37,639 --> 03:03:39,575 WERE MORE LIKELY TO BE OLDER. 4975 03:03:39,641 --> 03:03:40,876 THERE WAS ALSO A SPLIT AROUND 4976 03:03:40,943 --> 03:03:43,278 THE AGE OF PUBERTY WHERE FEMALES 4977 03:03:43,345 --> 03:03:44,413 STARTED REPORTING MORE SYMPTOMS 4978 03:03:44,480 --> 03:03:47,015 THAN MALES. 4979 03:03:47,082 --> 03:03:49,385 YOUNGER CHILDREN TENDED TO ONLY 4980 03:03:49,451 --> 03:03:50,052 REPORT SYMPTOMS THAT WERE PART 4981 03:03:50,119 --> 03:03:51,887 OF THE CLASSICAL MIGRAINE 4982 03:03:51,954 --> 03:03:53,055 DIAGNOSIS WHILE TEENS REPORTED A 4983 03:03:53,122 --> 03:03:58,160 ADDITIONAL NON-CLASSICAL 4984 03:03:58,227 --> 03:03:58,827 SYMPTOMS. 4985 03:03:58,894 --> 03:04:00,229 LOOKING AT A BROADER RANGE OF 4986 03:04:00,295 --> 03:04:03,866 SYMPTOMS ASSOCIATED WITH 4987 03:04:03,932 --> 03:04:05,033 MIGRAINE AND CLUSTERS AND 4988 03:04:05,100 --> 03:04:07,136 PROVIDES ADDITIONAL IMPORTANT 4989 03:04:07,202 --> 03:04:08,203 INFORMATION ABOUT HEADACHE 4990 03:04:08,270 --> 03:04:09,972 BURDEN AND DEVELOPMENTAL CHANGES 4991 03:04:10,038 --> 03:04:11,173 IN MIGRAINE. 4992 03:04:11,240 --> 03:04:13,142 FURTHER STUDY IS NEEDED TO 4993 03:04:13,208 --> 03:04:14,576 DETERMINE IF THESE CLUSTERS CAN 4994 03:04:14,643 --> 03:04:17,413 BE USED TO TO PROVIDE MORE 4995 03:04:17,479 --> 03:04:19,047 PERSONALIZED SYMPTOM-BASED 4996 03:04:19,114 --> 03:04:19,515 MIGRAINE CARE. 4997 03:04:19,581 --> 03:04:21,583 >> HI, MY NAME IS DESIREE, I'LL 4998 03:04:21,650 --> 03:04:22,651 BE TALKING TO YOU TODAY ABOUT 4999 03:04:22,718 --> 03:04:25,287 THE FEASIBILITY TESTING OF AN 5000 03:04:25,354 --> 03:04:26,355 MHEALTH APPLICATION THAT 5001 03:04:26,422 --> 03:04:28,390 INTEGRATE COGNITIVE BEHAVIORAL 5002 03:04:28,457 --> 03:04:30,192 THERAPY FOR PAIN WITH 5003 03:04:30,259 --> 03:04:31,960 PHARMACOLOGIC EDUCATION TO 5004 03:04:32,027 --> 03:04:34,797 SUPPORT ADVANCED CANCER 5005 03:04:34,863 --> 03:04:36,098 PATIENTS' MANAGING PAIN. 5006 03:04:36,165 --> 03:04:37,065 WE DEVELOPED THE APP THAT WAS 5007 03:04:37,132 --> 03:04:38,200 DESIGNED SPECIFICALLY FOR 5008 03:04:38,267 --> 03:04:39,735 ADVANCED CANCER PATIENTS USING 5009 03:04:39,802 --> 03:04:41,437 OPIOIDS TO MANAGE CHRONIC PAIN. 5010 03:04:41,503 --> 03:04:43,772 IT UTILIZES DAILY SURVEYS OF 5011 03:04:43,839 --> 03:04:45,674 PAIN, MOOD, CATASTROPHIZING, 5012 03:04:45,741 --> 03:04:47,276 SLEEP AND OPIOID USE. 5013 03:04:47,342 --> 03:04:49,778 IT ALSO DELIVERS TAILORED 5014 03:04:49,845 --> 03:04:51,413 MESSAGES IN RESPONSE TO THEIR 5015 03:04:51,480 --> 03:04:52,714 SYMPTOMS USING JUST IN TIME 5016 03:04:52,781 --> 03:04:54,283 ADAPTIVE ALGORITHMS. 5017 03:04:54,349 --> 03:04:56,318 THE APP DELIVERS DAILY 5018 03:04:56,385 --> 03:04:59,087 PSYCHOEDUCATION ON PAIN, OPIOIDS 5019 03:04:59,154 --> 03:05:01,256 AND PAIN CVT PRINCIPLES USING 5020 03:05:01,323 --> 03:05:04,626 ANIMATED VIDEOS AND BEHAVIORAL 5021 03:05:04,693 --> 03:05:06,328 ALONG WITH RELAXATION EXERCISES 5022 03:05:06,395 --> 03:05:07,930 AND WRITTEN ARTICLES. 5023 03:05:07,996 --> 03:05:10,232 WE CONDUCTED A SINGLE ARM PILOT 5024 03:05:10,299 --> 03:05:12,301 STUDY TO EVALUATE THE 5025 03:05:12,367 --> 03:05:13,402 FEASIBILITY AT THE STEVENSON 5026 03:05:13,469 --> 03:05:16,572 CANCER CENTER IN OKLAHOMA CITY, 5027 03:05:16,638 --> 03:05:17,139 OKLAHOMA. 5028 03:05:17,206 --> 03:05:20,776 ADD DULTS WITH SAID VANED SOLID 5029 03:05:20,843 --> 03:05:25,881 TUMOR MALIGNANCIES OR HEMO -- 5030 03:05:25,948 --> 03:05:27,816 4 OR GREATER OUT OF 10 ON THE 5031 03:05:27,883 --> 03:05:29,585 BPI AND ACTIVE OPIOID USE WERE 5032 03:05:29,651 --> 03:05:30,686 INCLUDED. 5033 03:05:30,752 --> 03:05:32,054 SO 26 PARTICIPANTS ENROLLED IN 5034 03:05:32,120 --> 03:05:35,190 THE STUDY AND TESTED OUT FOR 28 5035 03:05:35,257 --> 03:05:35,991 DAYS. 5036 03:05:36,058 --> 03:05:38,393 62% OF THEM WERE FEMALE, AND 54 5037 03:05:38,460 --> 03:05:40,429 YEARS OLD ON AVERAGE RANGING 5038 03:05:40,496 --> 03:05:44,066 FROM 21 TO 74 YEARS OLD. 5039 03:05:44,132 --> 03:05:48,136 AND WHILE 71% WERE WHITE, 19% 5040 03:05:48,203 --> 03:05:49,371 WERE NATIVE AMERICAN AND 7% WERE 5041 03:05:49,438 --> 03:05:50,806 BLACK. 5042 03:05:50,873 --> 03:05:52,908 76% OF PARTICIPANTS USE THE APP 5043 03:05:52,975 --> 03:05:54,843 ON MORE THAN HALF OF STUDY DAYS 5044 03:05:54,910 --> 03:05:56,712 INDICATING GOOD FEASIBILITY. 5045 03:05:56,778 --> 03:05:58,580 PARTICIPANTS COMPLETED A MEDIAN 5046 03:05:58,647 --> 03:06:00,749 OF 71% OF THE DAILY SURVEYS AND 5047 03:06:00,816 --> 03:06:02,851 ABOUT 50% OF THE DAILY 5048 03:06:02,918 --> 03:06:04,152 EDUCATIONAL CONTENT. 5049 03:06:04,219 --> 03:06:05,687 THEY ENGAGE WITH SURVEYS FOR AN 5050 03:06:05,754 --> 03:06:06,989 AVERAGE OF JUST UNDER FIVE 5051 03:06:07,055 --> 03:06:09,191 MINUTES PER DAY, AND SPENT AN 5052 03:06:09,258 --> 03:06:10,826 AVERAGE OF 3 1/2 HOURS USING THE 5053 03:06:10,893 --> 03:06:13,896 APP IN TOTAL ACROSS THE 28 DAYS. 5054 03:06:13,962 --> 03:06:17,065 SOME PATIENTS USE IT FOR ABOUT 5055 03:06:17,132 --> 03:06:18,600 26 ^ MINUTES IN TOTAL AND OTHERS 5056 03:06:18,667 --> 03:06:21,870 FOR UP TO 1 13 HOURS IN TOTAL. 5057 03:06:21,937 --> 03:06:23,071 OVERALL ACCEPTABILITY OF THE APP 5058 03:06:23,138 --> 03:06:25,707 WAS HIGH, WITH PARTICIPANTS 5059 03:06:25,774 --> 03:06:28,343 RATING 81% OF ALL ACCEPTABILITY 5060 03:06:28,410 --> 03:06:30,646 ITEMS AS 4 OR GREATER ON A 5061 03:06:30,712 --> 03:06:31,947 5-POINT SCALE. 5062 03:06:32,014 --> 03:06:34,883 17 PISHTS COMPLETED OPTIONAL 5063 03:06:34,950 --> 03:06:36,418 POST STUDY INTERVIEWS AND 5064 03:06:36,485 --> 03:06:37,419 THEMATIC ANALYSIS SUGGESTED THAT 5065 03:06:37,486 --> 03:06:38,720 MOST PATIENTS FELT THE APP 5066 03:06:38,787 --> 03:06:40,923 IMPROVED THEIR ABILITY TO 5067 03:06:40,989 --> 03:06:42,224 SELF-MANAGE THEIR CANCER 5068 03:06:42,291 --> 03:06:44,192 CONTINUE RELATED PAIN, BY 5069 03:06:44,259 --> 03:06:44,960 SPECIFICALLY FACILITATING 5070 03:06:45,027 --> 03:06:46,595 INSIGHT INTO THEIR PAIN TRIGGER, 5071 03:06:46,662 --> 03:06:47,963 BUT ALSO BECAUSE IT HELPED TO 5072 03:06:48,030 --> 03:06:49,131 INCREASE INSIGHT ON THE 5073 03:06:49,197 --> 03:06:49,765 RELATIONSHIP BETWEEN STRESS AND 5074 03:06:49,831 --> 03:06:51,066 PAIN. 5075 03:06:51,133 --> 03:06:52,200 A PORTION ALSO STATED THAT THE 5076 03:06:52,267 --> 03:06:55,337 APP HELPED TO REDUCE PERCEIVED 5077 03:06:55,404 --> 03:06:57,205 STIGMA ABOUT USING OPIOIDS AND, 5078 03:06:57,272 --> 03:06:57,873 THEREFORE, PROMOTING 5079 03:06:57,940 --> 03:06:58,840 CONVERSATIONS WITH THEIR CARE 5080 03:06:58,907 --> 03:06:59,641 TEAMS. 5081 03:06:59,708 --> 03:07:00,609 MOST PARTICIPANTS WOULD 5082 03:07:00,676 --> 03:07:01,910 RECOMMEND THE APP TO ANOTHER 5083 03:07:01,977 --> 03:07:02,911 PATIENT. 5084 03:07:02,978 --> 03:07:05,180 SO IN CONCLUSION, INTEGRATING 5085 03:07:05,247 --> 03:07:07,249 PAIN CVT WITH OPIOID SUPPORT WAS 5086 03:07:07,316 --> 03:07:08,483 BOTH FEASIBLE AND ACCEPTABLE TO 5087 03:07:08,550 --> 03:07:10,319 PATIENTS WITH ADVANCED CANCER. 5088 03:07:10,385 --> 03:07:12,854 SO WE WILL NEXT BE TESTING THE 5089 03:07:12,921 --> 03:07:14,590 APP IN A RANDOMIZED PILOT TRIAL 5090 03:07:14,656 --> 03:07:16,325 TO FURTHER EVALUATE FEASIBILITY 5091 03:07:16,391 --> 03:07:17,659 AND PRELIMINARY EFFICACY FOR 5092 03:07:17,726 --> 03:07:22,264 PATIENTS WITH ADVANCED CANCER 5093 03:07:22,331 --> 03:07:24,032 END PAIN USING OPIOIDS. 5094 03:07:24,099 --> 03:07:29,271 >> MY NAME IS MEREDITH BARRY. 5095 03:07:29,338 --> 03:07:30,439 THANK YOU FOR INVITING ME TO 5096 03:07:30,505 --> 03:07:31,239 PRESENT MY POSTER. 5097 03:07:31,306 --> 03:07:32,207 TODAY I'M GOING TO TALK ABOUT 5098 03:07:32,274 --> 03:07:34,610 THE POTENTIAL OF OXYTOCIN TO 5099 03:07:34,676 --> 03:07:36,912 REDUCE EXPERIMENTAL PAIN AND 5100 03:07:36,979 --> 03:07:37,646 OPIOID-LIKE ABILITY. 5101 03:07:37,713 --> 03:07:39,414 OF COURSE OPIOID MISUSE IS A 5102 03:07:39,481 --> 03:07:41,183 MAJOR SOURCE OF MORBIDITY AND 5103 03:07:41,249 --> 03:07:42,150 MORTALITY. 5104 03:07:42,217 --> 03:07:43,452 AND PAIN OF COURSE IS THE 5105 03:07:43,518 --> 03:07:45,120 LEADING CAUSE OF DISABILITY IN 5106 03:07:45,187 --> 03:07:48,724 THE U.S. 5107 03:07:48,790 --> 03:07:50,459 OXYCODONE SPECIFICALLY IS 5108 03:07:50,525 --> 03:07:51,259 SPECIFICALLY DESCRIBED FOR PAIN 5109 03:07:51,326 --> 03:07:54,529 BUT CAN ALSO BE INVOLVED IN 5110 03:07:54,596 --> 03:07:55,964 OVERDOSE DEATHS AND IS WIDELY 5111 03:07:56,031 --> 03:07:58,567 MISUSED. 5112 03:07:58,634 --> 03:08:00,102 THE POINT OF THIS STUDY IS TO 5113 03:08:00,168 --> 03:08:01,870 EXAMINE A NOVEL ADJUNCT 5114 03:08:01,937 --> 03:08:02,938 TREATMENT OPTION FOR PAIN 5115 03:08:03,005 --> 03:08:05,273 MANAGEMENT THAT COULD 5116 03:08:05,340 --> 03:08:06,742 SIMULTANEOUSLY REDUCE THE MISUSE 5117 03:08:06,808 --> 03:08:10,278 OF POTENTIAL OPIOIDS, WHICH IS 5118 03:08:10,345 --> 03:08:12,014 OXYTOCIN, SOME PROMISING ANIMAL 5119 03:08:12,080 --> 03:08:13,682 STUDIES AND HUMAN STUDIES HAVE 5120 03:08:13,749 --> 03:08:15,817 LED TO THIS QUESTION SO THE AIMS 5121 03:08:15,884 --> 03:08:17,252 OF THE PRESENT STUDY WERE TO 5122 03:08:17,319 --> 03:08:18,887 DETERMINE THE EFFECTS OF 5123 03:08:18,954 --> 03:08:25,594 INTRAINNASA 5124 03:08:25,661 --> 03:08:29,331 OXYTOCIN ---LIKE ABILITY. 5125 03:08:29,398 --> 03:08:32,901 SO WE USE THE DOUBLE BLIND 5126 03:08:32,968 --> 03:08:35,537 PLACEBO CONTROL STUDY AND THERE 5127 03:08:35,604 --> 03:08:38,907 WERE SIX SESSIONS, WITH VARIOUS 5128 03:08:38,974 --> 03:08:43,612 COMBINATIONS OF PLACEBO, 5129 03:08:43,679 --> 03:08:46,148 OXYCODONE, AND PLACEBO OXYTOCIN 5130 03:08:46,214 --> 03:08:47,783 ON 48 NATIONAL UNITS OF 5131 03:08:47,849 --> 03:08:48,550 OXYTOCIN. 5132 03:08:48,617 --> 03:08:51,620 OUR TARGET IS 30 PARTICIPANTS, 5133 03:08:51,687 --> 03:08:53,288 DATA COLLECTION IS ONGOING, AND 5134 03:08:53,355 --> 03:08:56,591 WE ONLY HAVE FOUR RIGHT NOW AND 5135 03:08:56,658 --> 03:08:58,393 FIVE AND SIX ARE CURRENTLY 5136 03:08:58,460 --> 03:08:59,294 RUNNING IN THE STUDY. 5137 03:08:59,361 --> 03:09:02,798 SO WE HOPE TO FLECT CLOACT A GRT 5138 03:09:02,864 --> 03:09:03,432 DEAL MORE. 5139 03:09:03,498 --> 03:09:04,566 OUR PRIMARY OUT COME MEASURES 5140 03:09:04,633 --> 03:09:06,468 I'M GOING TO FOCUS ON TODAY IS 5141 03:09:06,535 --> 03:09:08,236 THERMAL PAIN AND SUBJECT RATED 5142 03:09:08,303 --> 03:09:10,405 MISUSE VIABILITY ON A VISUAL 5143 03:09:10,472 --> 03:09:10,872 ANALOG SCALE. 5144 03:09:10,939 --> 03:09:16,545 SO JUST VERY QUICKLY GIVEN TIME 5145 03:09:16,611 --> 03:09:17,379 CONSTRAINTS THE PRELIMINARY 5146 03:09:17,446 --> 03:09:18,413 RESULTS SHOWED THERE DOESN'T 5147 03:09:18,480 --> 03:09:22,484 APPEAR TO BE MUCH OF AN EFFECT 5148 03:09:22,551 --> 03:09:25,087 IN PAIN RATINGS FOR HEAT PAIN AS 5149 03:09:25,153 --> 03:09:26,521 THE PAIN -- OR THE HEAT 5150 03:09:26,588 --> 03:09:29,024 GRADUALLY INCREASES ACROSS DOSE 5151 03:09:29,091 --> 03:09:29,891 CONDITIONS TIME ONE IS BEFORE 5152 03:09:29,958 --> 03:09:32,127 THEY RECEIVED DRUG AND TIME TWO 5153 03:09:32,194 --> 03:09:33,161 IS AFTER THEY RECEIVED DRUG AND 5154 03:09:33,228 --> 03:09:34,696 THIS IS THE DOSE CONTINUE, THESE 5155 03:09:34,763 --> 03:09:35,263 ARE PAIRED. 5156 03:09:35,330 --> 03:09:38,900 SO THERE DOESN'T APPEAR TO BE 5157 03:09:38,967 --> 03:09:40,268 MUCH DIFFERENCE THERE WHEN 5158 03:09:40,335 --> 03:09:41,603 TESTED ON THE HAND, HOWEVER WHEN 5159 03:09:41,670 --> 03:09:46,174 WE TEST ON THE TRAPEZIUS USING 5160 03:09:46,241 --> 03:09:47,943 COLD PAIN RATING, SO THE COLD 5161 03:09:48,009 --> 03:09:51,313 TEMPERATURE INCREASES, THERE 5162 03:09:51,379 --> 03:09:52,647 DOES APPEAR TO BE A LITTLE BIT 5163 03:09:52,714 --> 03:09:53,749 MORE VARIABILITY AND IN SOME 5164 03:09:53,815 --> 03:09:57,652 CASES IN TIME ONE, WHERE BEFORE 5165 03:09:57,719 --> 03:10:00,722 THE DRUG IS RECEIVED, AND AFTER 5166 03:10:00,789 --> 03:10:05,961 TIME TWO, AFTER DRUG, PLACEBO IS 5167 03:10:06,027 --> 03:10:06,962 RECEIVED, THERE DOES APPEAR TO 5168 03:10:07,028 --> 03:10:08,063 BE REDUCTION IN PAIN ACROSS SOME 5169 03:10:08,130 --> 03:10:08,964 OF THESE CONDITIONS. 5170 03:10:09,030 --> 03:10:11,032 SO IT DEPENDS ON THE BODY SITE 5171 03:10:11,099 --> 03:10:12,567 AND TYPE OF PAIN ASSAY AND WE'VE 5172 03:10:12,634 --> 03:10:16,104 ONLY INITIALLY LOOKED AT THERMAL 5173 03:10:16,171 --> 03:10:18,039 PAIN ASSAYS AND WE STILL HAVE 5174 03:10:18,106 --> 03:10:19,474 MECHANICAL TO UNPACK. 5175 03:10:19,541 --> 03:10:23,478 AND THEN HERE ARE THE 5176 03:10:23,545 --> 03:10:25,547 PRELIMINARY RESULTS OF THE 5177 03:10:25,614 --> 03:10:27,682 OPIOID-LIKE ABILITY AND THE 5178 03:10:27,749 --> 03:10:31,453 DRUG-LIKABILITY IN GENERAL, AND 5179 03:10:31,520 --> 03:10:33,121 SO I AM STILL BLINDED TO THESE 5180 03:10:33,188 --> 03:10:33,889 CONDITIONS BUT SOME APPEAR A 5181 03:10:33,955 --> 03:10:35,957 LITTLE BIT HIGHER THAN OTHERS, 5182 03:10:36,024 --> 03:10:37,592 AND THEN THERE APPEARS TO BE 5183 03:10:37,659 --> 03:10:39,895 SOME EXPECTANCY EFFECTS WITH -- 5184 03:10:39,961 --> 03:10:42,397 BECAUSE ONE OF THESE IS 5185 03:10:42,464 --> 03:10:45,667 PLACEBO-PLOPLACEBOPLACEBO CONDI. 5186 03:10:45,734 --> 03:10:46,568 SO DATA CHECK SHOULD BE IS 5187 03:10:46,635 --> 03:10:49,938 GOING, MORE DATA ARE NEEDED TO 5188 03:10:50,005 --> 03:10:52,574 EVALUATE THE PAIN AND MISUSE 5189 03:10:52,641 --> 03:10:53,575 LIABILITY AND FOR SOME 5190 03:10:53,642 --> 03:10:54,876 PARTICIPANTS BUT NOT ALL, THE 5191 03:10:54,943 --> 03:10:57,179 SESSIONS IN WHICH EXPERIMENTAL 5192 03:10:57,245 --> 03:11:00,215 PAIN SENSITIVITY IS LOWER, THE 5193 03:11:00,282 --> 03:11:03,418 MISUSE -- IS LOWER BUT WE NEED 5194 03:11:03,485 --> 03:11:04,719 TO LOOK AT THE DATA ON AN 5195 03:11:04,786 --> 03:11:06,188 INDIVIDUAL LEVEL AND CONSIDER 5196 03:11:06,254 --> 03:11:08,123 THE EFFECTS MIGHT NOT BE THE 5197 03:11:08,190 --> 03:11:11,159 SAME ACROSS INDIVIDUAL SUBJECTS. 5198 03:11:11,226 --> 03:11:13,261 THIS STUDY HAS POTENTIAL IN 5199 03:11:13,328 --> 03:11:14,229 EXAMINING OXYTOCIN AS A 5200 03:11:14,296 --> 03:11:18,099 PROMISING AGENT FOR 5201 03:11:18,166 --> 03:11:20,468 SIMULTANEOUSLY PAIN, SO 5202 03:11:20,535 --> 03:11:22,003 ULTIMATELY CONFIRMATION OF OUR 5203 03:11:22,070 --> 03:11:23,438 HYPOTHESES COULD RESULT IN A 5204 03:11:23,505 --> 03:11:26,141 LARGER CLINICAL TRIAL TO COMPARE 5205 03:11:26,208 --> 03:11:28,577 THE EFFECTS OF OXYTOCIN VERSUS 5206 03:11:28,643 --> 03:11:30,645 PLACEBO, WITH AN OPIOID 5207 03:11:30,712 --> 03:11:33,481 PRESCRIPTION FOLLOWING SURGERY 5208 03:11:33,548 --> 03:11:35,350 AND LOOK AT POTENTIAL OPIOID 5209 03:11:35,417 --> 03:11:35,884 SPARING EFFECTS. 5210 03:11:35,951 --> 03:11:38,553 THANK YOU VERY MUCH FOR YOUR 5211 03:11:38,620 --> 03:11:41,022 TIME. 5212 03:11:41,089 --> 03:11:42,791 AND I APPRECIATE BEING ABLE TO 5213 03:11:42,858 --> 03:11:43,358 PRESENT. 5214 03:11:43,425 --> 03:11:44,125 >> HELLO. 5215 03:11:44,192 --> 03:11:46,294 MY NAME IS DR. STAR BOOKER FROM 5216 03:11:46,361 --> 03:11:48,063 THE UNIVERSITY OF FLORIDA. 5217 03:11:48,129 --> 03:11:49,931 THE PATTERNS BETWEEN PAIN AND 5218 03:11:49,998 --> 03:11:51,433 MOVEMENT ARE SO SEEMINGLY 5219 03:11:51,499 --> 03:11:53,935 INTUITIVE THAT WE REALLY HADN'T 5220 03:11:54,002 --> 03:11:55,403 STUDIED HOW REALTIME MOVEMENT 5221 03:11:55,470 --> 03:11:56,905 AFFECTS HIGH IMPACT CHRONIC PAIN 5222 03:11:56,972 --> 03:11:58,206 CONDITIONS SUCH AS 5223 03:11:58,273 --> 03:11:59,608 OSTEOARTHRITIS. 5224 03:11:59,674 --> 03:12:02,043 USING DATA FROM MY K23 STUDY, WE 5225 03:12:02,110 --> 03:12:04,546 ARE EXAMINING INTRARACIAL 5226 03:12:04,613 --> 03:12:06,414 VARIABILITY AND MOVEMENT EVOKED 5227 03:12:06,481 --> 03:12:08,283 PAIN BY SYSTEMATICALLY 5228 03:12:08,350 --> 03:12:09,484 ASSESSING, QUANTIFYING AND 5229 03:12:09,551 --> 03:12:11,653 CHARACTERIZING PATTERNS IN 5230 03:12:11,720 --> 03:12:14,489 AFRICAN AMERICAN ADULTS. 5231 03:12:14,556 --> 03:12:16,591 WE MEASURED ZERO TO 10 USING A 5232 03:12:16,658 --> 03:12:18,894 PAIN RATING SCALE AND PAIN 5233 03:12:18,960 --> 03:12:21,096 SURFACE AREA WHICH IS THE AMOUNT 5234 03:12:21,162 --> 03:12:22,597 OF THE KNEE IN PAIN AFTER 5235 03:12:22,664 --> 03:12:26,301 MOVEMENT ZERO TO 100% BEFORE 5236 03:12:26,368 --> 03:12:28,403 DURING AND AFTER LOW INTENSITY 5237 03:12:28,470 --> 03:12:30,205 ACTIVITY SUCH AS THE SHORT 5238 03:12:30,272 --> 03:12:32,674 PHYSICAL PERFORMANCE BATTERY, 5239 03:12:32,741 --> 03:12:36,044 AND ONE LEG STAND AND THE WALK. 5240 03:12:36,111 --> 03:12:37,846 MODERATE INTENSIVITY ACTIVITY 5241 03:12:37,913 --> 03:12:40,415 SUCH AS THE THREE MINUTE WALK, 5242 03:12:40,482 --> 03:12:44,452 AND HIGH INTENSITY ACTIVITY, 5243 03:12:44,519 --> 03:12:48,089 FLEXION AND EXTENSION AT 90 AND 5244 03:12:48,156 --> 03:12:48,857 180 DEGREES. 5245 03:12:48,924 --> 03:12:51,159 OUR SAMPLE WAS PRIMARILY WOMEN 5246 03:12:51,226 --> 03:12:54,529 WITH A MEAN AGE OF 65 YEARS. 5247 03:12:54,596 --> 03:12:58,800 SO FIRST WE IMAIR -- BY HAVING 5248 03:12:58,867 --> 03:12:59,801 PARTICIPANTS VIEW PICTURES OF 5249 03:12:59,868 --> 03:13:01,436 PHYSICAL ACTIVITY AND RATE THE 5250 03:13:01,503 --> 03:13:02,637 AMOUNT OF PAIN, THE AMOUNT OF 5251 03:13:02,704 --> 03:13:05,941 KNEE PAIN THEY WOULD FEEL AND WE 5252 03:13:06,007 --> 03:13:07,809 ALSO MEASURED REALTIME MOVEMENT 5253 03:13:07,876 --> 03:13:10,412 EVOKED PAIN USING A BATTERY OF 5254 03:13:10,478 --> 03:13:11,713 STANDARDIZED PERFORMANCE BASED 5255 03:13:11,780 --> 03:13:12,247 PHYSICAL ACTIVITY. 5256 03:13:12,314 --> 03:13:15,116 AS YOU CAN SEE AT THE TABLE, 5257 03:13:15,183 --> 03:13:18,853 THERE IS -- FOR MOST ACTIVITIES 5258 03:13:18,920 --> 03:13:21,489 EXCEPT FOR STANDING FROM A 5259 03:13:21,556 --> 03:13:22,757 SEATED, LAYING POSITION, 5260 03:13:22,824 --> 03:13:25,160 ASCENDING STAIRS, AND KNEE 5261 03:13:25,226 --> 03:13:26,962 FLEXION AND EXTENSION ON THE LEG 5262 03:13:27,028 --> 03:13:28,663 PRESS. 5263 03:13:28,730 --> 03:13:30,632 SO HERE WE ATTEMPT TO QUANTIFY 5264 03:13:30,699 --> 03:13:31,967 MOVEMENT OF EVOKED PAIN IN FIVE 5265 03:13:32,033 --> 03:13:33,234 DIFFERENT WAYS AND THERE WAS 5266 03:13:33,301 --> 03:13:35,003 CURRENTLY NO STANDARD METHOD. 5267 03:13:35,070 --> 03:13:37,839 ZOO FISO FIRST WE CALCULATED A E 5268 03:13:37,906 --> 03:13:39,407 WHICH SHOWED MILD PAIN FOR LOW 5269 03:13:39,474 --> 03:13:40,942 AND MILD INTENSITY ACTIVITIES, 5270 03:13:41,009 --> 03:13:43,878 THEN WE AVERAGED EACH FUNCTIONAL 5271 03:13:43,945 --> 03:13:46,815 ACTIVITY AND LOW INTENSITY 5272 03:13:46,881 --> 03:13:53,288 ACTIVITIES HAD A MEAN RANGE, 5273 03:13:53,355 --> 03:13:55,323 REPEATED CHAIR STANDS RESULTED 5274 03:13:55,390 --> 03:13:57,525 IN HIGHER PAIN INTENSITY AND 5275 03:13:57,592 --> 03:14:06,067 MORE OF THE AREA HURTING. 5276 03:14:06,134 --> 03:14:08,036 THE AVERAGE -- 42% OF THE KNEE 5277 03:14:08,103 --> 03:14:09,671 HURTING, AND THE RANGE FOR HIGH 5278 03:14:09,738 --> 03:14:13,308 INTENSITY ACTIVITY WAS 4.4 TO 5279 03:14:13,375 --> 03:14:15,043 5.1. 5280 03:14:15,110 --> 03:14:16,678 IN PARTICULAR THE BIODEX 5281 03:14:16,745 --> 03:14:18,546 RESULTED IN MILD TO MODERATE 5282 03:14:18,613 --> 03:14:19,848 PAIN INTENSITY SCORES DURING AND 5283 03:14:19,914 --> 03:14:24,953 AFTER MOVEMENT WITH LOW AND 5284 03:14:25,020 --> 03:14:25,854 MODERATE ACTIVITIES. 5285 03:14:25,920 --> 03:14:28,690 THIRDLY WE AVERAGED ALL POST 5286 03:14:28,757 --> 03:14:31,926 ACTIVITY RATINGS AND LOW 5287 03:14:31,993 --> 03:14:34,295 INTENSITY ACTIVITIES 3.7 AND 5288 03:14:34,362 --> 03:14:36,364 HIGH INTENSITY ACTIVITY HAD A 5289 03:14:36,431 --> 03:14:37,866 MEAN OF 4.2. 5290 03:14:37,932 --> 03:14:42,370 THE ANALYSIS FOR CALCULATING A 5291 03:14:42,437 --> 03:14:44,239 CHANGE SCORE AND MAXIMUM RATING 5292 03:14:44,305 --> 03:14:45,673 ARE STILL IN PROGRESS AS WE'RE 5293 03:14:45,740 --> 03:14:46,741 STILL TRYING TO FIGURE OUT THE 5294 03:14:46,808 --> 03:14:48,309 BEST FORMULA FOR THESE, HOWEVER 5295 03:14:48,376 --> 03:14:49,844 SOME ARE INDICATING POSSIBLE 5296 03:14:49,911 --> 03:14:54,549 MOVEMENT EVOKED ANALGESIA VERSUS 5297 03:14:54,616 --> 03:14:55,717 MOVEMENT EVOKED PAIN FOR SOME 5298 03:14:55,784 --> 03:14:56,484 ACTIVITIES. 5299 03:14:56,551 --> 03:14:57,919 SO OUR NEXT STEPS IN 5300 03:14:57,986 --> 03:14:59,020 CHARACTERIZING MOVEMENT EVOKED 5301 03:14:59,087 --> 03:15:01,089 PAIN IS TO PERFORM A CLUSTER 5302 03:15:01,156 --> 03:15:04,726 ANALYSIS AND TO IDENTIFY 5303 03:15:04,793 --> 03:15:08,196 SPAISPATIENTS BASED ON 5304 03:15:08,263 --> 03:15:08,563 SOCIODEMOGRAPHIC 5305 03:15:08,630 --> 03:15:08,930 CHARACTERISTICS. 5306 03:15:08,997 --> 03:15:10,265 SO STAY TUNED, THERE'S MORE TO 5307 03:15:10,331 --> 03:15:14,569 COME, AND SEE YOU IN D.C. . 5308 03:15:14,636 --> 03:15:16,671 >> THANK YOU SO VERY MUCH FOR 5309 03:15:16,738 --> 03:15:18,039 JOINING US HERE TODAY FOR THIS 5310 03:15:18,106 --> 03:15:18,807 PRESENTATION. 5311 03:15:18,873 --> 03:15:25,146 MY NAME IS -- TO SHARE OUR 5312 03:15:25,213 --> 03:15:27,449 LATEST RESEARCH FINDINGS WITH 5313 03:15:27,515 --> 03:15:28,216 YOU. 5314 03:15:28,283 --> 03:15:29,684 TODAY I'M PLEASED TO PRESENT OUR 5315 03:15:29,751 --> 03:15:31,286 POSTER TITLED IDENTIFYING 5316 03:15:31,352 --> 03:15:33,455 FACTORS THAT INFLUENCE THE 5317 03:15:33,521 --> 03:15:35,356 TRANSITION FROM ACUTE TO CHRONIC 5318 03:15:35,423 --> 03:15:37,926 LOW BACK PAIN IN BLACK/AFRICAN 5319 03:15:37,992 --> 03:15:46,734 AMERICANS. 5320 03:15:46,801 --> 03:15:51,406 THIS IS A SIGNIFICANT PROBLEM IN 5321 03:15:51,473 --> 03:15:53,908 THE UNITED STATES, MAY NOT HAVE 5322 03:15:53,975 --> 03:15:55,777 THE HIGHER OVERALL PREVALENCE OF 5323 03:15:55,844 --> 03:16:00,081 CHRONIC LOWER BACK PAIN, THEY DO 5324 03:16:00,148 --> 03:16:01,783 BEAR A DISPROPORTIONATE BURDEN. 5325 03:16:01,850 --> 03:16:06,387 OUR STUDY REALLY AIMED TO -- BY 5326 03:16:06,454 --> 03:16:08,756 IDENTIFYING THE PSYCHOSOCIAL AND 5327 03:16:08,823 --> 03:16:09,991 NEUROPHYSIOLOGICAL RISK FACTORS 5328 03:16:10,058 --> 03:16:12,427 FOR CHRONIC LOWER BACK PAIN THAT 5329 03:16:12,494 --> 03:16:13,161 SPECIFICALLY AMONG BLACK AFRICAN 5330 03:16:13,228 --> 03:16:21,136 AMERICANS. 5331 03:16:21,202 --> 03:16:22,403 WE TRANSITION FROM ACUTE TO 5332 03:16:22,470 --> 03:16:23,872 CHRONIC LOW BACK PAIN, WE 5333 03:16:23,938 --> 03:16:26,274 EXAMINE THE DIFFERENCES IN 5334 03:16:26,341 --> 03:16:29,444 FACTORS SUCH AS PAIN SEVERITY, 5335 03:16:29,511 --> 03:16:34,115 STRESS, COPING MECHANISMS, PAIN 5336 03:16:34,182 --> 03:16:35,517 SENSITIVITY AT TWO TIME POINTS, 5337 03:16:35,583 --> 03:16:38,987 ACUTE ONSET AND AT SIX MONTHS 5338 03:16:39,053 --> 03:16:39,454 FOLLOW-UP. 5339 03:16:39,521 --> 03:16:41,256 RESULT REALLY INDICATED BLACK 5340 03:16:41,322 --> 03:16:43,224 AFRICAN AMERICANS REPORTED 5341 03:16:43,291 --> 03:16:45,727 HIGHER PAIN INTENSITY, DIFFERENT 5342 03:16:45,793 --> 03:16:47,162 COPING STRATEGIES, INCREASED 5343 03:16:47,228 --> 03:16:50,698 PAIN SENSITIVITY, COMPARED TO 5344 03:16:50,765 --> 03:17:01,109 NON-HISPANIC WHITES. 5345 03:17:09,017 --> 03:17:11,219 ALL FOUND TO INFLUENCE THE 5346 03:17:11,286 --> 03:17:21,729 TRANSITION IN BOTH GROUPS. 5347 03:17:22,096 --> 03:17:23,264 ASSOCIATED WITH INFLAMMATION, 5348 03:17:23,331 --> 03:17:33,841 IMMUNITY AND STRESS RESPONSE. 5349 03:17:40,782 --> 03:17:42,617 VERSUS THE UNIQUE RISK THAT RISK 5350 03:17:42,684 --> 03:17:44,586 FACTORS THAT REALLY -- TO THE 5351 03:17:44,652 --> 03:17:45,820 CHRONIC LOWER BACK PAIN IN BLACK 5352 03:17:45,887 --> 03:17:48,990 AFRICAN AMERICANS. 5353 03:17:49,057 --> 03:17:51,392 IMPLI KAYTIVELY OUR STUDY 5354 03:17:51,459 --> 03:17:53,027 UNDERSCORES THE NECESSITY FOR 5355 03:17:53,094 --> 03:17:56,764 TAYLORED APPROACHES TO PAIN 5356 03:17:56,831 --> 03:17:58,166 MANAGEMENT AND INTERVENTIONS 5357 03:17:58,233 --> 03:18:01,002 THAT HAVE BOTH PSYCHOSOCIAL AND 5358 03:18:01,069 --> 03:18:02,337 NEUROBIOLOGICAL ASPECT TO 5359 03:18:02,403 --> 03:18:04,205 MITIGATE THE RISK OF CHRONIC 5360 03:18:04,272 --> 03:18:06,074 PAIN AND -- IN BLACK AFRICAN 5361 03:18:06,140 --> 03:18:07,141 AMERICAN -- THANK YOU SO VERY 5362 03:18:07,208 --> 03:18:09,210 MUCH. 5363 03:18:09,277 --> 03:18:19,520 FOR LISTENING. 5364 03:18:39,540 --> 03:18:40,942 OF SENSORY ION CHANNELS. 5365 03:18:41,009 --> 03:18:44,679 SENSORY ION CHANNELS RESIDE IN 5366 03:18:44,746 --> 03:18:45,747 NEURONS, NOCICEPTOR, THAT 5367 03:18:45,813 --> 03:18:47,715 INTERFACE WITH OUR EXTERNAL 5368 03:18:47,782 --> 03:18:49,017 ENVIRONMENT AND RECOGNIZE BOTH 5369 03:18:49,083 --> 03:18:50,551 NON-PAIN CAUSING AND PAINFUL 5370 03:18:50,618 --> 03:18:52,754 SIGNALS. 5371 03:18:52,820 --> 03:18:55,390 SUCH AS ITCH, TEMPERATURE, 5372 03:18:55,456 --> 03:18:56,257 CHEMICAL IRRITANTS AND 5373 03:18:56,324 --> 03:18:57,258 MECHANICAL FORCE. 5374 03:18:57,325 --> 03:18:59,794 UPON RECOGNIZING THESE STIMULI, 5375 03:18:59,861 --> 03:19:01,829 THE ION CHANNELS OPEN AND 5376 03:19:01,896 --> 03:19:03,164 ELECTRICAL SIGNALS ARE 5377 03:19:03,231 --> 03:19:04,432 TRANSMITTED TO OUR SPINAL CORD 5378 03:19:04,499 --> 03:19:05,967 AND ULTIMATELY OUR BRAIN. 5379 03:19:06,034 --> 03:19:10,672 IN SOME CASES, THIS CAUSES PAIN. 5380 03:19:10,738 --> 03:19:12,774 TODAY I WOULD LIKE TO SPEAK TO 5381 03:19:12,840 --> 03:19:15,710 YOU ABOUT THE PRIMARY DETECTOR 5382 03:19:15,777 --> 03:19:16,911 OF ENVIRONMENTAL COLD. 5383 03:19:16,978 --> 03:19:19,447 IT IS ALSO TARGETED BY MENTHOL, 5384 03:19:19,514 --> 03:19:23,718 A NATURAL PRODUCT FROM MINT. 5385 03:19:23,785 --> 03:19:27,255 IT'S A NON-SELECTIVE CHANNEL AND 5386 03:19:27,322 --> 03:19:29,390 IT IS AN IMPORTANT TARGET FOR 5387 03:19:29,457 --> 03:19:31,492 TREATING BOTH PATHOLOGICAL COLD 5388 03:19:31,559 --> 03:19:32,060 HYPERSENSITIVITY AND CHRONIC 5389 03:19:32,126 --> 03:19:37,332 PAIN. 5390 03:19:37,398 --> 03:19:40,668 SINGLE PARTICLE CRYO-EM HAS 5391 03:19:40,735 --> 03:19:41,969 REVOLUTIONIZED MEMBER AND 5392 03:19:42,036 --> 03:19:43,271 PROTEIN STRUCTURAL BIOLOGY. 5393 03:19:43,338 --> 03:19:44,272 THE MAJOR ADVANTAGE OF THIS 5394 03:19:44,339 --> 03:19:46,341 TECHNIQUE IS THAT THE PROTEIN OF 5395 03:19:46,407 --> 03:19:47,675 INTEREST DOESN'T NEED TO RESIDE 5396 03:19:47,742 --> 03:19:49,811 IN A SINGLE STATE TO BE CAPTURED 5397 03:19:49,877 --> 03:19:53,481 AT HIGH RESOLUTION. 5398 03:19:53,548 --> 03:19:55,083 ACTUALLY MULTIPLE DISTINCT 5399 03:19:55,149 --> 03:19:56,918 CONFIRMATIONAL STATES CAN BE 5400 03:19:56,984 --> 03:19:57,418 CAPTURED SIMULTANEOUSLY. 5401 03:19:57,485 --> 03:19:59,454 THIS APPROACH SUCCESSFULLY 5402 03:19:59,520 --> 03:20:01,556 CAPTURED TWO DISTINCT 5403 03:20:01,622 --> 03:20:03,691 CONFIRMATIONAL STATES, CLOSED 5404 03:20:03,758 --> 03:20:04,726 AND DESENSITIZED. 5405 03:20:04,792 --> 03:20:07,362 BOTH ARE NON-CONDUCTING. 5406 03:20:07,428 --> 03:20:08,563 THE CLOSED STATE WAS OBSERVED 5407 03:20:08,629 --> 03:20:11,833 BOTH IN THE ABSENCE OF LIGANDS 5408 03:20:11,899 --> 03:20:13,801 AS WELL AS THE PRESENCE OF 5409 03:20:13,868 --> 03:20:15,536 ANTAGONISTS. 5410 03:20:15,603 --> 03:20:16,304 THE DESENSITIZED STATE WAS 5411 03:20:16,371 --> 03:20:18,406 OBSERVED IN THE PRESENCE OF 5412 03:20:18,473 --> 03:20:21,776 COLD, AN AGONIST, AND CALCIUM. 5413 03:20:21,843 --> 03:20:23,077 CONSISTENT WITH THE FACT THAT 5414 03:20:23,144 --> 03:20:26,948 CALCIUM PLAYS A ROLE IN 5415 03:20:27,014 --> 03:20:30,351 DESENSITIZATION. 5416 03:20:30,418 --> 03:20:32,420 I SAW STRUCTURE WITH TWO 5417 03:20:32,487 --> 03:20:33,621 DIFFERENT ANTAGONISTS AND 5418 03:20:33,688 --> 03:20:35,089 OBSERVED THAO THESE DRUGS BIND 5419 03:20:35,156 --> 03:20:40,361 TO A SIMILAR REGION WITHIN THE 5420 03:20:40,428 --> 03:20:41,696 TRANS -- INTERESTINGLY, IT IS 5421 03:20:41,763 --> 03:20:44,198 NOW KNOWN THAT ANTAGONISTS, 5422 03:20:44,265 --> 03:20:45,967 AGONISTS AND MODULATORY LIPIDS 5423 03:20:46,033 --> 03:20:47,502 BIND TO THE SITE. 5424 03:20:47,568 --> 03:20:49,370 I ALSO DISCOVERED THAT CALCIUM 5425 03:20:49,437 --> 03:20:51,739 BINDS DIRECTLY TO THE CHANNEL. 5426 03:20:51,806 --> 03:20:53,508 THE CALCIUM BINDING SITE IS ALSO 5427 03:20:53,574 --> 03:20:55,343 LOCATED IN A SIMILAR REGION OF 5428 03:20:55,410 --> 03:20:57,111 THE TRANSMEMBRANE DOMAIN. 5429 03:20:57,178 --> 03:20:59,213 HOWEVER, IT'S NOT AS DEEPLY 5430 03:20:59,280 --> 03:21:02,250 NESTLED WITHIN. 5431 03:21:02,316 --> 03:21:06,387 WHAT I MUTATED THE CALCIUM 5432 03:21:06,454 --> 03:21:08,489 COORDINATING -- THIS HAS LED US 5433 03:21:08,556 --> 03:21:13,494 TO PROPOSE THE FOLLOWING MODEL. 5434 03:21:13,561 --> 03:21:16,931 WHEN IT'S OPENED, CALCIUM FLOWS 5435 03:21:16,998 --> 03:21:17,565 IN. 5436 03:21:17,632 --> 03:21:19,100 IT THEN BINDS TO AN INTERNAL 5437 03:21:19,167 --> 03:21:20,301 SITE ON THE CHANNEL. 5438 03:21:20,368 --> 03:21:23,371 AND THIS CAUSES THE CHANNEL TO 5439 03:21:23,438 --> 03:21:25,440 ENTER A DESENSITIZED STATE AND 5440 03:21:25,506 --> 03:21:26,908 ONCE AGAIN CLOSE. 5441 03:21:26,974 --> 03:21:28,543 >> I'M ASSISTANT PROFESSOR AT 5442 03:21:28,609 --> 03:21:29,043 TEMPLE UNIVERSITY. 5443 03:21:29,110 --> 03:21:30,912 I'LL BE PRESENTING RESEARCH 5444 03:21:30,978 --> 03:21:32,346 EXPLORING CHANGES IN PAIN 5445 03:21:32,413 --> 03:21:34,549 INTERFERENCE FOLLOWING A TAI CHI 5446 03:21:34,615 --> 03:21:36,150 INTERVENTION FOR ADULTS WITH HIV 5447 03:21:36,217 --> 03:21:37,251 AND CHRONIC PAIN. 5448 03:21:37,318 --> 03:21:39,420 I HAVE NO DISCLOSURES OR 5449 03:21:39,487 --> 03:21:40,755 CONFLICTS OF INTEREST TO REPORT. 5450 03:21:40,822 --> 03:21:43,057 THIS WORK WAS FUNDED BY NIH, 5451 03:21:43,124 --> 03:21:44,892 SPECIFICALLY THE NATIONAL CENTER 5452 03:21:44,959 --> 03:21:46,227 FOR COMPLEMENTARY AND 5453 03:21:46,294 --> 03:21:46,761 INTEGRATIVE HEALTH. 5454 03:21:46,828 --> 03:21:49,831 SO ADULTS WITH HIV EXPERIENCE 5455 03:21:49,897 --> 03:21:50,832 CHRONIC PAIN AT HIGHER RATES 5456 03:21:50,898 --> 03:21:51,899 COMPARED TO THE GENERAL 5457 03:21:51,966 --> 03:21:52,233 POPULATION. 5458 03:21:52,300 --> 03:21:53,668 RECENT WORK BY OUR GROUP AND 5459 03:21:53,734 --> 03:21:55,169 OTHERS HAS DEMONSTRATED THAT 5460 03:21:55,236 --> 03:21:58,372 WHILE HIV IS WELL MANAGED, 5461 03:21:58,439 --> 03:21:59,674 CURRENT EFFORTS TOWARDS MANAGING 5462 03:21:59,740 --> 03:22:00,875 CHRONIC PAIN ARE INEFFECTIVE FOR 5463 03:22:00,942 --> 03:22:01,309 MANY. 5464 03:22:01,375 --> 03:22:03,110 WE CONDUCTED A SMALL RANDOMIZED 5465 03:22:03,177 --> 03:22:05,012 TRIAL TO EXAMINE THE FEES ANLT 5466 03:22:05,079 --> 03:22:06,881 AND ACCEPTABILITY OF TAI CHI 5467 03:22:06,948 --> 03:22:08,583 COMPARED TO A HEALTH EDUCATION 5468 03:22:08,649 --> 03:22:10,818 CONTROL GROUP. 5469 03:22:10,885 --> 03:22:12,053 AS YOU CAN SEE IN THE FLOW 5470 03:22:12,119 --> 03:22:14,422 CHART, WE RECRUITED AND 5471 03:22:14,489 --> 03:22:16,390 RANDOMIZED 36 PARTICIPANTS, 5472 03:22:16,457 --> 03:22:18,392 RETENTION AT EACH FOLLOW-UP WAS 5473 03:22:18,459 --> 03:22:20,027 NEARLY 90% AND ALL PARTICIPANTS 5474 03:22:20,094 --> 03:22:21,662 COMPLETED AT LEAST ONE FOLLOW-UP 5475 03:22:21,729 --> 03:22:24,198 ASSESSMENT. 5476 03:22:24,265 --> 03:22:26,167 OVERALL THE SAMPLE WAS PRIMARILY 5477 03:22:26,234 --> 03:22:28,236 FEMALE AND BLACK WITH 14% 5478 03:22:28,302 --> 03:22:31,506 REPORTING HISPANIC ETHNICITY, 5479 03:22:31,572 --> 03:22:33,241 THE MEAN AGE WAS 61 YEARS. 5480 03:22:33,307 --> 03:22:34,342 WHILE OUR RETENTION WAS 5481 03:22:34,408 --> 03:22:35,543 ADEQUATE, THERE WAS A SUBSET OF 5482 03:22:35,610 --> 03:22:37,311 PARTICIPANT WHO FAILED TO ATTEND 5483 03:22:37,378 --> 03:22:40,248 ANY INTERVENTION OR CONTROL 5484 03:22:40,314 --> 03:22:40,681 SESSIONS. 5485 03:22:40,748 --> 03:22:42,416 WE DECIDED TO SEPARATE OUT THESE 5486 03:22:42,483 --> 03:22:43,551 PARTICIPANTS TO HAVE A CLEAR 5487 03:22:43,618 --> 03:22:45,553 ESSENCE OF ANY CHANGES DETECTED 5488 03:22:45,620 --> 03:22:47,054 THAT MIGHT BE ASSOCIATED WITH 5489 03:22:47,121 --> 03:22:49,690 TAI CHI OR HEALTH EDUCATION 5490 03:22:49,757 --> 03:22:50,558 SESSIONS. 5491 03:22:50,625 --> 03:22:52,059 WE THOUGHT THIS SUBSET COULD 5492 03:22:52,126 --> 03:22:54,028 SERVE AS A THIRD GROUP, THOSE 5493 03:22:54,095 --> 03:22:57,632 RECEIVING ASSESSMENT ONLY. 5494 03:22:57,698 --> 03:23:00,935 WE HYPOTHESIZE PARTICIPANTS IN 5495 03:23:01,002 --> 03:23:02,470 THE TAI CHI GROUP -- RELATIVE TO 5496 03:23:02,537 --> 03:23:03,771 HEALTH EDUCATION AND THE 5497 03:23:03,838 --> 03:23:05,172 ASSESSMENT ONLY PARTICIPANTS. 5498 03:23:05,239 --> 03:23:07,842 WE USED REPEATED MEASURES TO 5499 03:23:07,909 --> 03:23:09,310 EXPLORE THESE DIFFERENCES ACROSS 5500 03:23:09,377 --> 03:23:14,015 TIME POINTS. 5501 03:23:14,081 --> 03:23:15,283 AS YOU CAN SEE IN THE FIGURE 5502 03:23:15,349 --> 03:23:17,552 HERE, THOSE WHO FAILED TO ATTEND 5503 03:23:17,618 --> 03:23:19,420 ANY SESSIONS REPORTED THE LOWEST 5504 03:23:19,487 --> 03:23:20,521 PAIN INTERFERENCE AT BASELINE, 5505 03:23:20,588 --> 03:23:21,589 WHICH WAS SIGNIFICANTLY 5506 03:23:21,656 --> 03:23:23,324 DIFFERENT THAN THOSE IN HEALTH 5507 03:23:23,391 --> 03:23:24,458 EDUCATION AND MARGINALLY 5508 03:23:24,525 --> 03:23:25,693 DIFFERENT THAN THOSE RECEIVING 5509 03:23:25,760 --> 03:23:28,930 TAI CHI. 5510 03:23:28,996 --> 03:23:30,998 AT POST INTERVENTION WE OBSERVED 5511 03:23:31,065 --> 03:23:32,300 SIGNIFICANT DECREASE IN PAIN 5512 03:23:32,366 --> 03:23:33,434 INTERFERENCE AMONG PARTICIPANTS 5513 03:23:33,501 --> 03:23:35,369 WHO RECEIVED TAI CHI AND THIS 5514 03:23:35,436 --> 03:23:36,470 DIFFERENCE WAS SIGNIFICANTLY 5515 03:23:36,537 --> 03:23:37,338 DIFFERENT THAN THOSE WHO 5516 03:23:37,405 --> 03:23:40,408 RECEIVED HEALTH EDUCATION OR 5517 03:23:40,474 --> 03:23:41,108 ATTENDED NO SESSIONS. 5518 03:23:41,175 --> 03:23:42,710 AS IS THE CASE WITH MANY 5519 03:23:42,777 --> 03:23:44,011 BEHAVIORAL TRIALS, THIS 5520 03:23:44,078 --> 03:23:47,448 DIFFERENCE MODERATED AT LATER 5521 03:23:47,515 --> 03:23:48,015 FOLLOW-UP. 5522 03:23:48,082 --> 03:23:49,250 SO THESE FINDINGS SUGGEST THAT 5523 03:23:49,317 --> 03:23:50,818 TAI CHI MAY BE EFFECTIVE AT 5524 03:23:50,885 --> 03:23:52,320 REDUCING PAIN INTERFERENCE FOR 5525 03:23:52,386 --> 03:23:56,057 ADULTS WITH HIV. 5526 03:23:56,123 --> 03:23:58,092 FOR THOSE THAT DID NOT ATTEND, 5527 03:23:58,159 --> 03:23:59,460 ONE HYPOTHESIS IS THAT LOWER 5528 03:23:59,527 --> 03:24:01,429 PAIN INTERFERENCE AT BASELINE 5529 03:24:01,495 --> 03:24:04,799 REDUCED THEIR -- WE ACKNOWLEDGE 5530 03:24:04,865 --> 03:24:06,067 THAT THIS STUDY IS LIMITED BY 5531 03:24:06,133 --> 03:24:07,635 THE SMALL SAMPLE SIZE AS IT WAS 5532 03:24:07,702 --> 03:24:10,037 A PILOT TRIAL AND NOT POWERED TO 5533 03:24:10,104 --> 03:24:10,805 DETECT SIGNIFICANCE. 5534 03:24:10,871 --> 03:24:13,007 I WANT TO AGAIN THANK NCCIH FOR 5535 03:24:13,074 --> 03:24:14,442 THEIR FUNDING AND SUPPORT AND 5536 03:24:14,508 --> 03:24:15,509 THANK YOU FOR YOUR INTEREST IN 5537 03:24:15,576 --> 03:24:19,280 THIS RESEARCH. 5538 03:24:19,347 --> 03:24:20,581 >> HI, EVERYONE. 5539 03:24:20,648 --> 03:24:22,216 TODAY I'LL BE DISCUSSING SOME 5540 03:24:22,283 --> 03:24:24,819 RECENT WORK ON THE EFFICACY OF 5541 03:24:24,885 --> 03:24:26,988 ALCOHOL IN REGULATING HIV 5542 03:24:27,054 --> 03:24:29,090 ASSOCIATED NEUROPATHIC PAIN. 5543 03:24:29,156 --> 03:24:30,491 APPROXIMATELY 70% OF PEOPLE WITH 5544 03:24:30,558 --> 03:24:32,927 HIV ARE AFFECTED BY NEUROPATHY, 5545 03:24:32,994 --> 03:24:34,895 AND ALCOHOL USE DISORDER OR AUD 5546 03:24:34,962 --> 03:24:38,065 IS ALSO FREQUENTLY CALLED -- IN 5547 03:24:38,132 --> 03:24:41,535 PEOPLE WITH HIV AND CAN ACTUALLY 5548 03:24:41,602 --> 03:24:42,837 EXACERBATE NEUROPATHY SYMPTOMS. 5549 03:24:42,903 --> 03:24:43,771 THE RATIONAL FOR ALCOHOL 5550 03:24:43,838 --> 03:24:45,272 CONSUMPTION IN THIS PATIENT 5551 03:24:45,339 --> 03:24:46,574 POPULATION MAY EXTEND FROM A 5552 03:24:46,641 --> 03:24:48,442 DESIRE FOR SELF-MEDICATION OF 5553 03:24:48,509 --> 03:24:50,111 PAIN DUE TO THE ANALGESIC 5554 03:24:50,177 --> 03:24:52,046 PROPERTIES OF ALCOHOL. 5555 03:24:52,113 --> 03:24:55,549 FURTHERMORE, CHRONIC PAIN AND 5556 03:24:55,616 --> 03:25:00,454 AUD ARE ASSOCIATED -- ANXIETY 5557 03:25:00,521 --> 03:25:01,722 AND DEPRESSION. 5558 03:25:01,789 --> 03:25:03,557 WE ARE UTILIZING BOTH THE 5559 03:25:03,624 --> 03:25:04,525 PRE-CLINICAL ANIMAL MODEL 5560 03:25:04,592 --> 03:25:05,860 ALONGSIDE A CLINICAL COHORT OF 5561 03:25:05,926 --> 03:25:07,695 PEOPLE WITH HIV. 5562 03:25:07,762 --> 03:25:09,997 OUR PRE-CLINICAL WORK USING THE 5563 03:25:10,064 --> 03:25:11,632 RODENT MODEL OF HIV NEUROPATHY 5564 03:25:11,699 --> 03:25:13,167 WHICH INVOLVES WRAPPING A 5565 03:25:13,234 --> 03:25:14,235 SURGICAL MESH SOAKED IN SOLUTION 5566 03:25:14,301 --> 03:25:16,337 OF GP120, WHICH IS ONE OF THE 5567 03:25:16,404 --> 03:25:18,406 ENVELOPE PROTEINS OF THE HIV 5568 03:25:18,472 --> 03:25:21,375 VIRUS AROUND THE LEFT SCIATIC 5569 03:25:21,442 --> 03:25:23,844 NERVE WHICH INDUCES A NEUROPATHY 5570 03:25:23,911 --> 03:25:24,779 PHENOTYPE SIMILAR TO THAT SEEN 5571 03:25:24,845 --> 03:25:26,614 IN PEOPLE WITH HIV. 5572 03:25:26,681 --> 03:25:28,683 OUR CLINICAL WORK SOURCES 5573 03:25:28,749 --> 03:25:31,285 FINDINGS FROM THE ALCOHOL USE IN 5574 03:25:31,352 --> 03:25:33,187 HIV STUDY AND IN THIS 5575 03:25:33,254 --> 03:25:33,954 CROSS-SECTIONAL ANALYSIS OF THAT 5576 03:25:34,021 --> 03:25:37,258 DATA, OUR EXPOSURE WAS RECENT 5577 03:25:37,324 --> 03:25:39,226 ALCOHOL USE AND WE EXTENDED 5578 03:25:39,293 --> 03:25:40,728 THREE OUTCOMES, PAIN, ANXIETY 5579 03:25:40,795 --> 03:25:43,798 AND DEPRESSION. 5580 03:25:43,864 --> 03:25:45,966 IN A PRE-CLINICAL MODEL, WE 5581 03:25:46,033 --> 03:25:47,735 FOUND THAT PERINEURAL MODEL 5582 03:25:47,802 --> 03:25:50,671 RESULTS IN MECHANICAL 5583 03:25:50,738 --> 03:25:51,872 HYPERALGESIA, WHICH IS EVIDENT 5584 03:25:51,939 --> 03:25:54,608 BY THIS REDUCTION IN THRESHOLD 5585 03:25:54,675 --> 03:25:57,111 IN OUR GP120 GROUP. 5586 03:25:57,178 --> 03:25:58,546 OUR ALCOHOL DOSE-RESPONSE DATA 5587 03:25:58,612 --> 03:26:03,684 REVEALED THAT ALCOHOL -- 5588 03:26:03,751 --> 03:26:05,453 RETURNING THOSE THRESHOLDS CLOSE 5589 03:26:05,519 --> 03:26:07,521 TO BASELINE, AND IN THE MALES, 5590 03:26:07,588 --> 03:26:10,691 WE SEE THIS ALMOST COMPLETE 5591 03:26:10,758 --> 03:26:12,793 ATTENUATION OF THE HYPERALGESIA 5592 03:26:12,860 --> 03:26:15,062 EVEN AFTER A MODERATE DOSE OF 5593 03:26:15,129 --> 03:26:16,397 ALCOHOL WHILE IN FEMALES IT 5594 03:26:16,464 --> 03:26:19,100 REALLY REQUIRES THAT HIGHER 5595 03:26:19,166 --> 03:26:21,769 DOSE, THE 1-GRAM PER KILOGRAM 5596 03:26:21,836 --> 03:26:22,737 DOSE, TO FULLY ATTENUATE THAT 5597 03:26:22,803 --> 03:26:23,738 PAIN. 5598 03:26:23,804 --> 03:26:26,273 IN THE NOAH COHORT, WE FOUND 5599 03:26:26,340 --> 03:26:29,410 RECENT ALCOHOL USE AS ASSESSED 5600 03:26:29,477 --> 03:26:30,811 BY ETHANOL IS ASSOCIATED WITH 5601 03:26:30,878 --> 03:26:34,315 REDUCED PAIN INTENSITY AND PAIN 5602 03:26:34,381 --> 03:26:35,950 INTERFERENCE SYMPTOMS OR HIGHER 5603 03:26:36,016 --> 03:26:39,453 SF36 SCORES. 5604 03:26:39,520 --> 03:26:41,422 ADDITIONALLY THERE WAS A 5605 03:26:41,489 --> 03:26:42,623 SIGNIFICANT -- WHERE FEMALES 5606 03:26:42,690 --> 03:26:43,724 REPORTED SIGNIFICANTLY MORE PAIN 5607 03:26:43,791 --> 03:26:45,359 COMPARED TO MALES. 5608 03:26:45,426 --> 03:26:47,128 AGAIN, SIGNIFICANTLY LOWER SF36 5609 03:26:47,194 --> 03:26:49,730 SCORES. 5610 03:26:49,797 --> 03:26:52,700 WE THEN LOOKED AT THE 5611 03:26:52,767 --> 03:26:54,568 RELATIONSHIP AND WE FOUND 5612 03:26:54,635 --> 03:26:56,003 SIGNIFICANT NEGATIVE 5613 03:26:56,070 --> 03:26:56,437 CORRELATIONS. 5614 03:26:56,504 --> 03:26:58,506 AGAIN NOTING BACK TO THE 5615 03:26:58,572 --> 03:27:00,908 INVERTED NATURE OF THE SF36 5616 03:27:00,975 --> 03:27:02,243 SCALE, NEGATIVE CORRELATIONS 5617 03:27:02,309 --> 03:27:03,010 REPRESENT POSITIVE ASSOCIATIONS 5618 03:27:03,077 --> 03:27:04,311 SO PEOPLE WITH MORE PAIN ARE 5619 03:27:04,378 --> 03:27:05,279 EXPERIENCING MORE ANXIETY AND 5620 03:27:05,346 --> 03:27:07,381 DEPRESSION. 5621 03:27:07,448 --> 03:27:08,883 SO TO SUMMARIZE, OUR 5622 03:27:08,949 --> 03:27:09,984 PRE-CLINICAL AND CLINICAL DATA 5623 03:27:10,050 --> 03:27:12,520 SUGGESTS THAT ACUTE ALCOHOL 5624 03:27:12,586 --> 03:27:14,255 ALLEVIATES HIV NEUROPATHY 5625 03:27:14,321 --> 03:27:17,291 SYMPTOMS AND PAIN IN THE KNOW A 5626 03:27:17,358 --> 03:27:18,959 COHORT IS -- 5627 03:27:19,026 --> 03:27:21,162 >> I'M A PHARMACOLOGY PH.D. 5628 03:27:21,228 --> 03:27:23,464 CANDIDATE IN THE LAB OF ANDY 5629 03:27:23,531 --> 03:27:24,298 KNACKLY AT DUKE UNIVERSITY. 5630 03:27:24,365 --> 03:27:25,399 THANK YOU FOR YOUR INTEREST IN 5631 03:27:25,466 --> 03:27:28,135 MY PROJECT, MICRORNA 374 FAMILY 5632 03:27:28,202 --> 03:27:30,971 AS A KEY REGULATOR OF CHRONIC 5633 03:27:31,038 --> 03:27:32,673 MIPRIMARY PAIN ONSET. 5634 03:27:32,740 --> 03:27:33,941 YOU HAVE TO COME TO MY POSTER IF 5635 03:27:34,008 --> 03:27:35,509 YOU WANT MORE DETAILS BUT FOR 5636 03:27:35,576 --> 03:27:37,011 NOW I'LL GIVE YOU A HIGH LEVEL 5637 03:27:37,077 --> 03:27:38,112 OVERVIEW OF WHAT I'VE BEEN 5638 03:27:38,179 --> 03:27:38,946 RESEARCHING. 5639 03:27:39,013 --> 03:27:40,748 IN THE LAB, WE STUDY CHRONIC 5640 03:27:40,815 --> 03:27:41,916 PRIMARY PAIN CONDITIONS. 5641 03:27:41,982 --> 03:27:45,753 WHICH INCLUDE CONDITIONS LIKE 5642 03:27:45,820 --> 03:27:48,589 FIBROMYALGIA SYNDROME, 5643 03:27:48,656 --> 03:27:50,057 TEMPOROMANDIBULAR SYNDROME AND 5644 03:27:50,124 --> 03:27:51,659 WIDESPREAD BODY PAIN. 5645 03:27:51,725 --> 03:27:56,263 WE LOOK AT MICRORNAs, GUIDED 5646 03:27:56,330 --> 03:27:58,666 TO SPECIFIC MRNA TRANSCRIPTS AND 5647 03:27:58,732 --> 03:27:59,967 IB HIBT THEIR TRANSLATION, SO 5648 03:28:00,034 --> 03:28:02,069 YOU HAVE THIS INVERSE 5649 03:28:02,136 --> 03:28:05,005 RELATIONSHIP WITH PRO -- GENES. 5650 03:28:05,072 --> 03:28:06,106 THROUGH DEEP SEQUENCING 5651 03:28:06,173 --> 03:28:07,408 APPROACHES AND THREE DIFFERENT 5652 03:28:07,474 --> 03:28:09,276 HUMAN CLINICAL COHORTS, WE 5653 03:28:09,343 --> 03:28:11,245 IDENTIFIED THE DOWN REGULATION 5654 03:28:11,312 --> 03:28:13,981 OF ONE MICRORNA FAMILY, MICRORNA 5655 03:28:14,048 --> 03:28:17,551 374, ACROSS TEMPOROMANDIBULAR 5656 03:28:17,618 --> 03:28:18,886 DISORDER, FIBROMYALGIA SYNDROME 5657 03:28:18,953 --> 03:28:19,787 AND INDIVIDUALS EXPERIENCING 5658 03:28:19,854 --> 03:28:20,855 PAIN FOLLOWING A MOTOR VEHICLE 5659 03:28:20,921 --> 03:28:22,523 COLLISION. 5660 03:28:22,590 --> 03:28:24,391 FURTHER, WE WERE ABLE TO 5661 03:28:24,458 --> 03:28:26,260 REPLICATE THIS DOWN REGULATION 5662 03:28:26,327 --> 03:28:28,529 IN A MOUSE MODEL OF CHRONIC 5663 03:28:28,596 --> 03:28:30,798 PRIMARY PAIN CONDITIONS AND 5664 03:28:30,865 --> 03:28:31,832 FOUND IT WAS SPECIFICALLY DRIVEN 5665 03:28:31,899 --> 03:28:34,535 BY FEMALE MICE MORE THAN MAIL 5666 03:28:34,602 --> 03:28:35,002 MICE. 5667 03:28:35,069 --> 03:28:37,171 THIS IS INTERESTING BECAUSE 5668 03:28:37,238 --> 03:28:38,472 WOMEN ARE ACTUALLY MORE LIKELY 5669 03:28:38,539 --> 03:28:40,341 TO BE DIAGNOSED AND SUFFER FROM 5670 03:28:40,407 --> 03:28:42,076 THESE TYPES OF PAIN CONDITIONS. 5671 03:28:42,142 --> 03:28:43,944 AND WE THINK THAT THIS SIGNAL OF 5672 03:28:44,011 --> 03:28:45,679 DOWN REGULATION IS COMING FROM 5673 03:28:45,746 --> 03:28:48,482 WHITE ADIPOSE TISSUE, SO OUR LAB 5674 03:28:48,549 --> 03:28:49,516 HAS BEEN BUILDING A LOT OF 5675 03:28:49,583 --> 03:28:51,852 RESEARCH AND EVIDENCE FOR THE 5676 03:28:51,919 --> 03:28:52,920 CROSSTALK BETWEEN FAT CELLS AND 5677 03:28:52,987 --> 03:28:54,421 THE NERVOUS SYSTEM AND THE 5678 03:28:54,488 --> 03:28:56,857 EXCHANGE OF INFLAMMATORY 5679 03:28:56,924 --> 03:28:57,958 CYTOKINES, NEUROTRANSMITTERS AND 5680 03:28:58,025 --> 03:29:00,794 NOW MICRORNAs IN THIS PROCESS. 5681 03:29:00,861 --> 03:29:03,631 SO WE'RE DEVELOPING THIS WORKING 5682 03:29:03,697 --> 03:29:05,065 HYPOTHESIS THAT DOWN REGULATION 5683 03:29:05,132 --> 03:29:06,834 STARTS FROM WHITE ADIPOSE TISSUE 5684 03:29:06,901 --> 03:29:09,003 WHERE THIS LEADS TO IMPACTS IN 5685 03:29:09,069 --> 03:29:13,807 THE NERVOUS SYSTEM SUCH AS 5686 03:29:13,874 --> 03:29:14,708 UNINHIBITED PAIN -- IN PLACES 5687 03:29:14,775 --> 03:29:17,211 LIKE THE SPINAL CORD WHERE WE 5688 03:29:17,278 --> 03:29:18,178 SEE AT DIFFERENT POINTS IN OUR 5689 03:29:18,245 --> 03:29:20,614 MODEL DOWN REG LITION OF THIS 5690 03:29:20,681 --> 03:29:22,049 MICRORNA SPECIFICALLY IN FEMALE 5691 03:29:22,116 --> 03:29:26,387 MICE. 5692 03:29:26,453 --> 03:29:29,456 BECAUSE ONE MICRORNA TARGET 5693 03:29:29,523 --> 03:29:30,524 CAN -- BINDING PARTNERS, WE'VE 5694 03:29:30,591 --> 03:29:32,726 BEEN DOING SOME GENE NETWORK 5695 03:29:32,793 --> 03:29:34,061 ANALYSIS AND SPECIFIC TARGETED 5696 03:29:34,128 --> 03:29:36,764 APPROACHES WITH QPCR TO TRY TO 5697 03:29:36,830 --> 03:29:38,332 IDENTIFY GENE SETS THAT COULD BE 5698 03:29:38,399 --> 03:29:41,268 DRIVING THIS PHENOTYPE. 5699 03:29:41,335 --> 03:29:43,003 SO ON THE RIGHT HERE WE ARE ABLE 5700 03:29:43,070 --> 03:29:44,972 TO IDENTIFY TISSUE AND 5701 03:29:45,039 --> 03:29:45,873 SEX-SPECIFIC PATTERNS IN 5702 03:29:45,940 --> 03:29:47,141 RESPONSE TO THE DOWN REGULATION 5703 03:29:47,207 --> 03:29:48,475 OF THE SAME MICRORNA. 5704 03:29:48,542 --> 03:29:52,012 FOR EXAMPLE, THIS CLUSTER HERE 5705 03:29:52,079 --> 03:29:55,916 OF HIP 1 ALPHA BETA RECEPTOR 5706 03:29:55,983 --> 03:29:58,319 2 ARE GENES INVOLVED IN 5707 03:29:58,385 --> 03:30:00,087 NEUROPATHIC PAIN UPREGULATED 5708 03:30:00,154 --> 03:30:02,489 HERE IN FEMALE MICE IN OUR 5709 03:30:02,556 --> 03:30:03,457 MODEL, SPECIFICALLY WHIED 5710 03:30:03,524 --> 03:30:05,326 ADIPOSE TISSUE, WHERE THESE SAME 5711 03:30:05,392 --> 03:30:07,695 TARGETS ACTUALLY ARE DOWN 5712 03:30:07,761 --> 03:30:09,463 REGULATED IN MALE MICE IN THE 5713 03:30:09,530 --> 03:30:10,464 SPINAL CORD. 5714 03:30:10,531 --> 03:30:13,100 THIS GIVES US NEW EVIDENCE FOR 5715 03:30:13,167 --> 03:30:14,802 POTENTIAL HYPOTHESES TO TEST IN 5716 03:30:14,868 --> 03:30:18,505 FUTURE EXPERIMENTS. 5717 03:30:18,572 --> 03:30:26,347 FLEUPAIN POSES A COMPLEX PROBLES 5718 03:30:26,413 --> 03:30:27,748 UNDERMANAGED PAIN BUT ALSO 5719 03:30:27,815 --> 03:30:30,951 INCREASED MEDICATION USE SUCH AS 5720 03:30:31,018 --> 03:30:33,454 ANALGESICS ARE BOTH ASSOCIATED 5721 03:30:33,520 --> 03:30:34,855 WITH WORSE PHYSICAL AND 5722 03:30:34,922 --> 03:30:36,423 PSYCHOLOGICAL HEALTH OUTCOMES. 5723 03:30:36,490 --> 03:30:37,591 SPARKING AN INTEREST IN THE 5724 03:30:37,658 --> 03:30:39,893 DEVELOPMENT OF NON-PHARMACOLOGIC 5725 03:30:39,960 --> 03:30:41,962 APPROACHES THAT COULD BE 5726 03:30:42,029 --> 03:30:45,299 IMPLEMENTED INTO CLINICAL CARE. 5727 03:30:45,366 --> 03:30:47,634 LISTENING TO MUSIC HAS PROMISING 5728 03:30:47,701 --> 03:30:49,436 ANALGESIC EFFECTS, HOWEVER THE 5729 03:30:49,503 --> 03:30:50,738 BIOLOGICAL MECHANISMS DRIVING 5730 03:30:50,804 --> 03:30:52,039 THESE EFFECTS ARE SO POORLY 5731 03:30:52,106 --> 03:30:52,973 UNDERSTOOD, WHICH IS REFLECTED 5732 03:30:53,040 --> 03:30:55,442 IN THE INCONSISTENT INTERVENTION 5733 03:30:55,509 --> 03:30:56,844 DELIVERY FOR MUSIC LISTENING IN 5734 03:30:56,910 --> 03:30:59,580 THE LITERATURE, AND THIS THEN 5735 03:30:59,646 --> 03:31:01,248 IMPEDES OUR ABILITY TO 5736 03:31:01,315 --> 03:31:02,750 STANDARDIZE AND IMPLEMENT INTO 5737 03:31:02,816 --> 03:31:05,285 OUR CLINICAL CARE. 5738 03:31:05,352 --> 03:31:06,820 SO THE OBJECTIVES OF THIS STUDY 5739 03:31:06,887 --> 03:31:08,222 WILL DETERMINE THE FEASIBILITY 5740 03:31:08,288 --> 03:31:10,958 OF SELECTING SALIVA AND 5741 03:31:11,025 --> 03:31:12,059 BIOMARKERS TO CHARACTERIZE THE 5742 03:31:12,126 --> 03:31:13,694 CHANGE IN THESE BIOMARKERS IN 5743 03:31:13,761 --> 03:31:18,298 RESPONSE TO MUSIC LISTENING. 5744 03:31:18,365 --> 03:31:19,500 CHILDREN RECEIVING MECHANICAL 5745 03:31:19,566 --> 03:31:24,972 VERNT LAITIVENTILATION IN THE PE 5746 03:31:25,039 --> 03:31:26,473 MUSIC THE CHILD'S PREFERRED 5747 03:31:26,540 --> 03:31:27,307 SONGS FOR 20 MINUTES THREE TIMES 5748 03:31:27,374 --> 03:31:30,244 A WEEK FOR UP TO TWO WEEKS. 5749 03:31:30,310 --> 03:31:32,413 WE COLLECTED SALIVA BASED 5750 03:31:32,479 --> 03:31:35,149 CORTISOL USING COTTON SWABS AND 5751 03:31:35,215 --> 03:31:37,985 THE CHILD'S BEDSIDE MONITOR 5752 03:31:38,052 --> 03:31:40,087 RECORDING OF THEIR 5753 03:31:40,154 --> 03:31:42,156 ECHOCARDIOGRAM LEADS WAS 5754 03:31:42,222 --> 03:31:43,590 EXTRACTIONED THE 20 MINUTES PRE 5755 03:31:43,657 --> 03:31:45,225 TO THE 20 MINUTES POST MUSIC AND 5756 03:31:45,292 --> 03:31:48,295 USED TO CALCULATE IN FIVE MINUTE 5757 03:31:48,362 --> 03:31:49,596 SAMPLES RESPIRATION RATE, HEART 5758 03:31:49,663 --> 03:31:51,432 RATE AND HEART RATE VARIABILITY 5759 03:31:51,498 --> 03:31:52,232 METRICS. 5760 03:31:52,299 --> 03:31:53,667 THESE BIOMARKERS WERE EXPLORED 5761 03:31:53,734 --> 03:31:56,737 AND SALIVA WAS COMPARED AND WE 5762 03:31:56,804 --> 03:31:58,405 ASSESSED THE CHANGES IN OUR 5763 03:31:58,472 --> 03:32:00,307 PHYSIOLOGIC BIOMARKERS USING 5764 03:32:00,374 --> 03:32:01,642 LINEAR GENERALIZED ESTIMATING 5765 03:32:01,708 --> 03:32:03,944 EQUATION MODELS CONTROLLING FOR 5766 03:32:04,011 --> 03:32:07,414 THE CHILD'S AGE, SEX AND -- SI 5767 03:32:07,481 --> 03:32:14,988 VERITY AT PICU ADMISSION. 5768 03:32:15,055 --> 03:32:15,989 ACROSS THESE SECTIONS WE WERE 5769 03:32:16,056 --> 03:32:19,026 ABLE TO COLLECT USABLE SALIVA 5770 03:32:19,093 --> 03:32:22,663 FOR 39% TO 61% OF THOSE 5771 03:32:22,729 --> 03:32:25,265 BIOMARKERS, AND FOR 74% OF OUR 5772 03:32:25,332 --> 03:32:29,870 PHYSIOLOGIC BASED BIOMARKERS. 5773 03:32:29,937 --> 03:32:31,505 CHANGES CAN BE SEEN TO THE RIGHT 5774 03:32:31,572 --> 03:32:32,573 AND THE TABLE DEMONSTRATES THAT 5775 03:32:32,639 --> 03:32:35,676 WE SAW A SMALL CHANGE IN OUR 5776 03:32:35,742 --> 03:32:39,379 CORTISOL AND INTERLEUKIN 6 AND 5777 03:32:39,446 --> 03:32:42,216 THE MOST PROMISING OR VISIBLE 5778 03:32:42,282 --> 03:32:44,218 CHANGES IN PHYSIOLOGIC 5779 03:32:44,284 --> 03:32:44,718 BIOMARKERS. 5780 03:32:44,785 --> 03:32:46,620 SO TO SUM, BIOMARKER COLLECTION 5781 03:32:46,687 --> 03:32:49,223 IS FEASIBLE, AND OUR PRELIMINARY 5782 03:32:49,289 --> 03:32:51,091 FINDINGS SUGGEST THAT MUSIC MAY 5783 03:32:51,158 --> 03:32:53,494 INFLUENCE PAIN BY MODULATING THE 5784 03:32:53,560 --> 03:32:55,229 AUTO MONIC NERVOUS SYSTEM 5785 03:32:55,295 --> 03:32:57,965 POSSIBLY DRIVEN BY THE REDUCTION 5786 03:32:58,031 --> 03:32:58,899 RESPIRATION RATES WE SEE IN THE 5787 03:32:58,966 --> 03:33:00,067 FIGURE TO THE RIGHT. 5788 03:33:00,134 --> 03:33:01,802 FUTURE WORK WILL EXPLORE 5789 03:33:01,869 --> 03:33:04,204 INTERACTIONS BETWEEN THESE 5790 03:33:04,271 --> 03:33:07,708 BIOMARKERS IN ASSOCIATION WITH 5791 03:33:07,774 --> 03:33:08,909 VALIDATED PAIN MEASURES AND WE 5792 03:33:08,976 --> 03:33:10,110 LOOK FORWARD TO DEVELOPING 5793 03:33:10,177 --> 03:33:12,746 ADDITIONAL WAYS WE CAN IMPROVE 5794 03:33:12,813 --> 03:33:14,381 OUR AINLT TO PROVIDE COMFORT 5795 03:33:14,448 --> 03:33:14,848 DURING CRITICAL CARE. 5796 03:33:14,915 --> 03:33:16,917 >> MANY OF US HAVE EITHER 5797 03:33:16,984 --> 03:33:18,585 WATCHED A VIDEO OR EXPERIENCED 5798 03:33:18,652 --> 03:33:22,022 THE EFFECTS FOLLOWING A 5799 03:33:22,089 --> 03:33:22,723 PROCEDURE. 5800 03:33:22,789 --> 03:33:28,395 MECHANISMS OF NITROUS OXIDE -- 5801 03:33:28,462 --> 03:33:29,263 UNDERSTUDIED. 5802 03:33:29,329 --> 03:33:33,300 NITRIC OXIDE IS COMMONLY USED -- 5803 03:33:33,367 --> 03:33:41,175 UNLIKE GENERAL ANESTHETICS, 5804 03:33:41,241 --> 03:33:44,478 NITROUS OXIDE TO PROVIDE POTENT 5805 03:33:44,545 --> 03:33:45,679 AN'GESIC EFFECTS IN A STATE OF 5806 03:33:45,746 --> 03:33:46,780 SEDATION WHILE ALSO ALLOWING 5807 03:33:46,847 --> 03:33:51,251 PATIENTS TO REMAIN CONSCIOUSLY 5808 03:33:51,318 --> 03:33:54,621 RESPONSIVE. 5809 03:33:54,688 --> 03:33:56,823 PAIN RELIES ON INDIVIDUAL 5810 03:33:56,890 --> 03:34:03,597 SELF-REPORT. 5811 03:34:03,664 --> 03:34:04,698 MEASURING -- IN THE BRAIN 5812 03:34:04,765 --> 03:34:08,435 THROUGH FUNCTIONAL ACTIVITY 5813 03:34:08,502 --> 03:34:10,871 OR -- BETWEEN -- SHARED 5814 03:34:10,938 --> 03:34:13,574 FUNCTIONAL RELEVANCE. 5815 03:34:13,640 --> 03:34:15,809 RECENTLY WE'VE SHOWN -- OF 5816 03:34:15,876 --> 03:34:19,046 NITROUS OXIDE INDUCED CHANGES IN 5817 03:34:19,112 --> 03:34:20,714 BRAIN FUNCTIONAL REACTIVITY. 5818 03:34:20,781 --> 03:34:23,350 BECAUSE BRAIN NETWORKS THAT 5819 03:34:23,417 --> 03:34:25,185 INVOLVE THE SOMATOSENSORY CORTEX 5820 03:34:25,252 --> 03:34:26,720 ARE ASSOCIATED WITH CHANGES IN 5821 03:34:26,787 --> 03:34:28,355 PAIN PERCEPTION, HERE OUR 5822 03:34:28,422 --> 03:34:29,790 INVESTIGATION FOCUSED ON 5823 03:34:29,856 --> 03:34:31,959 EXAMINING THE EFFECTS OF PAIN 5824 03:34:32,025 --> 03:34:40,734 AND NITROUS OXIDE WITH THE -- 70 5825 03:34:40,801 --> 03:34:42,269 DATA FROM 16 HEALTHY INDIVIDUALS 5826 03:34:42,336 --> 03:34:49,109 WHO CONSENT TODAY OUR STUDY -- 5827 03:34:49,176 --> 03:34:53,880 NITROUS OXIDE AT REST -- 5828 03:34:53,947 --> 03:34:58,252 INDIVIDUALS -- EVOKE MODERATE 5829 03:34:58,318 --> 03:34:59,353 PAIN -- AFTER THE STIMULUS, 5830 03:34:59,419 --> 03:35:02,022 VOLUNTEERS REPORTED RECEIVING 5831 03:35:02,089 --> 03:35:04,391 INTENSITY -- OF THE STIMULUS ON 5832 03:35:04,458 --> 03:35:06,593 A ZERO TO 10 SCALE WHERE ZERO 5833 03:35:06,660 --> 03:35:09,129 EQUALS NO PAIN TO 10 EQUALS 5834 03:35:09,196 --> 03:35:16,536 WORST PAIN IMAGINABLE. 5835 03:35:16,603 --> 03:35:19,606 WE FOUND -- DURING EXPOSURE TO 5836 03:35:19,673 --> 03:35:26,613 NITROUS OXIDE COMPARED TO BEFORE 5837 03:35:26,680 --> 03:35:31,451 NITROUS. 5838 03:35:31,518 --> 03:35:36,156 SIGNIFICANTLY HIGHER -- DURING 5839 03:35:36,223 --> 03:35:37,591 EXPOSURE TO NITROUS OXIDE AND 5840 03:35:37,658 --> 03:35:40,527 THE -- STIMULUS, S1 CONNECTIVITY 5841 03:35:40,594 --> 03:35:47,034 TO THE -- AND CINGULATE CORT 5842 03:35:47,100 --> 03:35:49,636 CORTEX -- LOWER PRIOR TO NITROUS 5843 03:35:49,703 --> 03:35:53,240 OXIDE. 5844 03:35:53,307 --> 03:35:55,342 -- PAIN INTENSITY AND 5845 03:35:55,409 --> 03:35:56,510 UNPLEASANTNESS. 5846 03:35:56,576 --> 03:35:59,146 MOREOVER, FUNCTIONAL 5847 03:35:59,212 --> 03:36:03,684 CONNECTIVITY INCREASED WITH 5848 03:36:03,750 --> 03:36:04,751 THE -- SIGNIFICANTLY DECREASED 5849 03:36:04,818 --> 03:36:07,587 DURING NITROUS OXIDE 5850 03:36:07,654 --> 03:36:08,655 ADMINISTRATION. 5851 03:36:08,722 --> 03:36:09,690 THESE FINDINGS SUGGEST ONE OF 5852 03:36:09,756 --> 03:36:13,493 THE MECHANISMS OF NITROUS OXIDE 5853 03:36:13,560 --> 03:36:15,696 INCLUDE DISRUPTION OF -- 5854 03:36:15,762 --> 03:36:17,130 ACTIVITY BETWEEN -- AND OTHER 5855 03:36:17,197 --> 03:36:18,131 NETWORK. 5856 03:36:18,198 --> 03:36:21,501 MOREOVER, THROUGH EXAMINING 5857 03:36:21,568 --> 03:36:22,803 BRAIN NETWORKS, WE HOPE TO 5858 03:36:22,869 --> 03:36:24,004 ENHANCE OUR UNDERSTANDING OF 5859 03:36:24,071 --> 03:36:29,076 PAIN MECHANISMS AND ANALGESIC IN 5860 03:36:29,142 --> 03:36:30,243 THE TREATMENT OF BOTH ACUTE AND 5861 03:36:30,310 --> 03:36:30,877 CHRONIC PAIN. 5862 03:36:30,944 --> 03:36:32,579 >> ABOUT 10% OF THE WORLD'S 5863 03:36:32,646 --> 03:36:33,547 POPULATION IS AFFECTED BY 5864 03:36:33,613 --> 03:36:35,115 CHRONIC PAIN. 5865 03:36:35,182 --> 03:36:36,717 WHILE MOST BASIC RESEARCH 5866 03:36:36,783 --> 03:36:41,655 FOCUSES ON SOMATIC PAIN, IT 5867 03:36:41,722 --> 03:36:43,090 REMAINS UNDERSTUDIED. 5868 03:36:43,156 --> 03:36:44,091 OUR LAB IS INTERESTED IN LOOKING 5869 03:36:44,157 --> 03:36:46,560 AT THE CENTRAL AMYGDALA AND THE 5870 03:36:46,626 --> 03:36:49,329 ROLE IT PLAYS IN BLADDER PAIN 5871 03:36:49,396 --> 03:36:50,397 PROCESSING. 5872 03:36:50,464 --> 03:36:52,299 THE CENTRAL AMYGDALA HAS BEEN 5873 03:36:52,366 --> 03:36:54,568 SHOWN TO PAY A KEY ROLE IN PAIN 5874 03:36:54,634 --> 03:36:55,902 PROCESSING AND WHAT'S REALLY 5875 03:36:55,969 --> 03:36:58,638 INTERESTING ABOUT THE CENTRAL 5876 03:36:58,705 --> 03:37:00,407 AMYGDALA IS THAT HUMAN AND 5877 03:37:00,474 --> 03:37:01,641 ANIMAL RESEARCH HAS SHOWN 5878 03:37:01,708 --> 03:37:03,243 EVIDENCE OF LATERALIZATION. 5879 03:37:03,310 --> 03:37:05,078 SO THE AMYGDALA THAT IS ON THE 5880 03:37:05,145 --> 03:37:06,179 RIGHT HEMISPHERE OF THE BRAIN IS 5881 03:37:06,246 --> 03:37:08,048 THOUGHT TO INCREASE BOTH SOMATIC 5882 03:37:08,115 --> 03:37:09,916 AND VISCERAL PAIN, WHERE THE 5883 03:37:09,983 --> 03:37:12,119 LEFT AMYGDALA HAS BEEN SHOWN TO 5884 03:37:12,185 --> 03:37:13,086 DECREASE BLADDER PAIN. 5885 03:37:13,153 --> 03:37:14,721 SO NATURALLY WE'RE INTERESTED IN 5886 03:37:14,788 --> 03:37:16,390 WHAT CELL TYPES WITHIN THE 5887 03:37:16,456 --> 03:37:18,358 CENTRAL AMYGDALA ARE INVOLVED IN 5888 03:37:18,425 --> 03:37:19,793 THE FUNCTIONAL LATERALIZATION 5889 03:37:19,860 --> 03:37:20,293 THAT WE SEE. 5890 03:37:20,360 --> 03:37:22,295 SO OUR LAB IS FOCUSING ON ONE OF 5891 03:37:22,362 --> 03:37:26,366 THOSE CELL TYPES, BEING 5892 03:37:26,433 --> 03:37:27,367 CALCITONIN GENE-RELATED POSITIVE 5893 03:37:27,434 --> 03:37:28,869 NEWER ONS IN THE CENTRAL 5894 03:37:28,935 --> 03:37:30,303 AMYGDALA. 5895 03:37:30,370 --> 03:37:33,573 SO WE ARE USING A MOUSE MODEL IN 5896 03:37:33,640 --> 03:37:38,245 WHICH WE ARE INJECTING MICE WITH 5897 03:37:38,311 --> 03:37:48,488 CYCLOFOS SPHAMIDE, OR ABDOMINAL 5898 03:37:48,555 --> 03:37:53,960 VON FRY0 TO 21 DAYS POST INJURY. 5899 03:37:54,027 --> 03:37:56,596 SO WHAT DID I FIND? 5900 03:37:56,663 --> 03:38:01,334 WELL, I FOUND THAT 5901 03:38:01,401 --> 03:38:02,502 CYCLOPHOSPHAMIDE INDUCES 5902 03:38:02,569 --> 03:38:03,870 HYPERSENSITIVITY THAT PERSISTS 5903 03:38:03,937 --> 03:38:05,372 ABOUT 14 DAYS POST INJURY, AND 5904 03:38:05,439 --> 03:38:07,240 THIS SEEN AT TWO DIFFERENT 5905 03:38:07,307 --> 03:38:08,341 PRESSURES. 5906 03:38:08,408 --> 03:38:12,379 I ALSO SEE OPPOSING EFFECTS OF 5907 03:38:12,446 --> 03:38:16,316 CGRP RECEPTOR ANTAGONIST CGRP 5908 03:38:16,383 --> 03:38:16,483 837. 5909 03:38:16,550 --> 03:38:20,921 SO WHEN THE AN TAG ANYTHING CGRP 5910 03:38:20,987 --> 03:38:23,356 738 IS INJECTED INTO THE RIGHT 5911 03:38:23,423 --> 03:38:26,960 CENTRAL AMYGDALA, YOU SEE AN 5912 03:38:27,027 --> 03:38:28,962 ATTENUATED EFFECT OF MECHANICAL 5913 03:38:29,029 --> 03:38:29,696 ABDOMINAL HYPERSENSITIVITY 5914 03:38:29,763 --> 03:38:31,765 COMPARED TO ANIMALS THAT 5915 03:38:31,832 --> 03:38:33,767 RECEIVED A CSF. 5916 03:38:33,834 --> 03:38:35,635 HOWEVER, THE SAME ANTAGONIST, 5917 03:38:35,702 --> 03:38:37,704 WHEN IT'S INJECTED INTO THE LEFT 5918 03:38:37,771 --> 03:38:40,006 CENTRAL AMYGDALA, THOSE ANIMALS 5919 03:38:40,073 --> 03:38:42,843 ARE STILL EXPERIENCING SEVERE 5920 03:38:42,909 --> 03:38:44,277 ABDOMINAL MECHANICAL 5921 03:38:44,344 --> 03:38:45,145 HYPERSENSITIVITY. 5922 03:38:45,212 --> 03:38:48,548 SIMILAR TO THE CONTROL GROUP. 5923 03:38:48,615 --> 03:38:50,750 SUGGESTING THAT CGRP RECEPTORS 5924 03:38:50,817 --> 03:38:52,652 ARE, IN FACT, INVOLVED IN 5925 03:38:52,719 --> 03:38:54,254 FUNCTIONAL LATERALIZATION OF THE 5926 03:38:54,321 --> 03:38:55,455 AMYGDALA IN THE CONTEXT OF 5927 03:38:55,522 --> 03:38:55,989 BLADDER PAIN. 5928 03:38:56,056 --> 03:38:58,992 SO WHY IS THIS IMPORTANT? 5929 03:38:59,059 --> 03:39:00,527 WELL, THIS RESEARCH SUPPORTS THE 5930 03:39:00,594 --> 03:39:04,331 NOTION THAT ANTICGRP MEDICATIONS 5931 03:39:04,397 --> 03:39:05,265 ALREADY FDA-APPROVED FOR 5932 03:39:05,332 --> 03:39:06,566 MIGRAINE COULD, IN FACT, BE 5933 03:39:06,633 --> 03:39:07,734 USEFUL FOR BLADDER PAIN. 5934 03:39:07,801 --> 03:39:09,603 IT ALSO HIGHLIGHTS THE NECESSITY 5935 03:39:09,669 --> 03:39:13,240 FOR MORE LATERALIZED RESEARCH IN 5936 03:39:13,306 --> 03:39:15,842 THAT ONE SINGLE DRUG COULD HAVE 5937 03:39:15,909 --> 03:39:18,345 TWO DIFFERENT OPPOSING EFFECTS. 5938 03:39:18,411 --> 03:39:19,813 SO IF YOU'RE INTERESTED ABOUT MY 5939 03:39:19,880 --> 03:39:20,680 RESEARCH OR INTERESTED MORE 5940 03:39:20,747 --> 03:39:22,582 ABOUT WHAT WE DO IN THE LAB, 5941 03:39:22,649 --> 03:39:25,719 FEEL FREE TO CONTACT ME OR LOOK 5942 03:39:25,785 --> 03:39:28,522 AT OUR LAB WEBSITE. 5943 03:39:28,588 --> 03:39:33,827 >> HELLO, MY NAME IS EVELYN LEE. 5944 03:39:33,894 --> 03:39:35,128 POSTBACCALAUREATE RESEARCH 5945 03:39:35,195 --> 03:39:36,062 FELLOW AT THE NIH. 5946 03:39:36,129 --> 03:39:37,797 TODAY I WILL BE PRESENTING MY 5947 03:39:37,864 --> 03:39:46,039 WORK ON MOLECULAR TR TRANSCRIPTE 5948 03:39:46,106 --> 03:39:49,109 OUR RESEARCH AIMS TO UNDERSTAND 5949 03:39:49,175 --> 03:39:50,243 MOLECULAR PROCESSES BY WHICH 5950 03:39:50,310 --> 03:39:54,714 PAIN BEGINS THROUGH LONGITUDAL 5951 03:39:54,781 --> 03:39:56,883 SAMPLING OF TISSUE AS OUTLINED 5952 03:39:56,950 --> 03:40:01,288 IN PANEL A FROM PATIENTS UND 5953 03:40:01,354 --> 03:40:03,723 UNDERGOING -- MODELS THAT ARE 5954 03:40:03,790 --> 03:40:05,792 UPREGULATED AND SECRETED AT THE 5955 03:40:05,859 --> 03:40:07,093 PATHOLOGICAL WOUND EDGE THAT 5956 03:40:07,160 --> 03:40:09,062 POTENTIALLY INTERACT WITH VIE 5957 03:40:09,129 --> 03:40:12,999 BERS OF PAIN SENSING NERVE 5958 03:40:13,066 --> 03:40:14,134 TERMINALS. 5959 03:40:14,200 --> 03:40:15,869 INDUCED BY SURGICAL INCISION 5960 03:40:15,936 --> 03:40:17,571 REMARKED AS HITS IN RNA SEQ AND 5961 03:40:17,637 --> 03:40:18,838 WE FURTHER SELECTED FOR GENES 5962 03:40:18,905 --> 03:40:20,373 THAT ALSO ENCODED SECRETED 5963 03:40:20,440 --> 03:40:22,475 PROTEINS MARKING POTENTIAL 5964 03:40:22,542 --> 03:40:25,879 MOLECULAR ANALGESIC TARGETS. 5965 03:40:25,946 --> 03:40:28,615 WE SPECIFICALLY PRIORITIZE 5966 03:40:28,682 --> 03:40:29,950 TRANSCRIPTS BASED ON MAGNITUDE 5967 03:40:30,016 --> 03:40:32,352 OF TRANSCRIPTIONAL CHANGES OF 5968 03:40:32,419 --> 03:40:35,088 WHICH WE -- THAT ARE ALSO 5969 03:40:35,155 --> 03:40:37,524 STRONGLY INDUCED IN THE HEAT MAP 5970 03:40:37,591 --> 03:40:38,258 IN PANEL B. 5971 03:40:38,325 --> 03:40:40,827 AS YOU CAN SEE, CYTOKINES AND 5972 03:40:40,894 --> 03:40:43,463 ANTIMICROBIAL MOLECULES 5973 03:40:43,530 --> 03:40:45,632 PREDOMINATE TRANSCRIPTS GIVING 5974 03:40:45,699 --> 03:40:47,500 AN IDEA UNDERLYING THE ACUTE 5975 03:40:47,567 --> 03:40:49,903 PAIN STATE. 5976 03:40:49,970 --> 03:40:52,973 TO BUILD UP OUR DATA WE FOCUSED 5977 03:40:53,039 --> 03:40:55,075 ON SOME OF OUR MOST STRONGLY 5978 03:40:55,141 --> 03:40:56,943 INDUCED GENES IN ORDER TO 5979 03:40:57,010 --> 03:40:58,244 ANATOMICALLY LOCATE WHERE THESE 5980 03:40:58,311 --> 03:41:00,413 TRANSDUCTION EVENTS WERE 5981 03:41:00,480 --> 03:41:04,951 OCCURRING. 5982 03:41:05,018 --> 03:41:09,756 COMPRISED OF PROTEIN S100A8 AND 5983 03:41:09,823 --> 03:41:11,391 9 AMONG OUR TOP INDUCED 5984 03:41:11,458 --> 03:41:11,725 TRANSCRIPTS. 5985 03:41:11,791 --> 03:41:14,361 AS SHOWN IN FIGURE ONE, WE 5986 03:41:14,427 --> 03:41:17,530 OBSERVED MARKING NEUTROPHILS IN 5987 03:41:17,597 --> 03:41:18,999 A GRADIENT-LIKE FASHION 5988 03:41:19,065 --> 03:41:20,400 THROUGHOUT THE TISSUE BUT 5989 03:41:20,467 --> 03:41:21,701 PARTICULARLY AMPLIFIED NEAR THE 5990 03:41:21,768 --> 03:41:22,802 WOUND EDGE. 5991 03:41:22,869 --> 03:41:24,804 THERE WE WANTED TO FURTHER 5992 03:41:24,871 --> 03:41:26,039 LOCALIZE TRANSDUCTION EVENTS TO 5993 03:41:26,106 --> 03:41:29,409 A GREATER DEGREE OF SPECIFICITY. 5994 03:41:29,476 --> 03:41:34,014 WITH MULTI- -- WE FOUND CYTOKINE 5995 03:41:34,080 --> 03:41:35,749 INDUCTION IN ACTIVATED 5996 03:41:35,815 --> 03:41:37,283 LEUKOCYTES OF BLOOD VESSELS 5997 03:41:37,350 --> 03:41:38,184 SHOWN IN FIGURE TWO. 5998 03:41:38,251 --> 03:41:39,819 THIS IS JUST ONE PART OF WHAT WE 5999 03:41:39,886 --> 03:41:42,155 ARE SEEING IN THE EARLY PAIN 6000 03:41:42,222 --> 03:41:43,456 RESPONSE WITH IMMUNE PATHWAYS 6001 03:41:43,523 --> 03:41:48,395 SUCH AS NEUTROPHIL ATTRACTION 6002 03:41:48,461 --> 03:41:49,596 AND ENDOTHELIAL MIGRATION TO 6003 03:41:49,663 --> 03:41:50,797 SITES OF TISSUE DAMAGE. 6004 03:41:50,864 --> 03:41:53,733 WE ALSO FOUND THAT INDUCTION 6005 03:41:53,800 --> 03:41:56,736 CYTOKINES -- WHICH WE BELIEVE TO 6006 03:41:56,803 --> 03:41:58,238 BE SOME CELL POPULATIONS THAT 6007 03:41:58,304 --> 03:42:01,908 ARE ALSO IMPLICATED IN THE NENGS 6008 03:42:01,975 --> 03:42:04,110 US OF PAIN SIGNALING AND FURTHER 6009 03:42:04,177 --> 03:42:06,613 WORK CAN BE VIEWED AT MY POSTER. 6010 03:42:06,680 --> 03:42:08,782 OVERALL, OUR DATASET REVEALINGS 6011 03:42:08,848 --> 03:42:10,450 THE INDUCTION OF POTENTIAL PAIN 6012 03:42:10,517 --> 03:42:11,851 CONTRIBUTING MOLECULES IN 6013 03:42:11,918 --> 03:42:13,420 MEDIATORS IN VASCULAR AND 6014 03:42:13,486 --> 03:42:14,254 FOLLICULAR STRUCTURES OF THE 6015 03:42:14,320 --> 03:42:18,458 SKIN FOLLOWING TISSUE DAMAGE. 6016 03:42:18,525 --> 03:42:20,527 WE PLAN TO FURTHER CLARIFY THE 6017 03:42:20,593 --> 03:42:21,861 DOWNSTREAM MECHANISMS AND 6018 03:42:21,928 --> 03:42:24,731 INTERACTION OF THESE DRIVERS TO 6019 03:42:24,798 --> 03:42:26,466 ASSESS THEIR ABILITIES IN ORDER 6020 03:42:26,533 --> 03:42:27,767 TO UNDERSTAND HOW THEY 6021 03:42:27,834 --> 03:42:30,537 CONTRIBUTE TO NOCICEPTOR 6022 03:42:30,603 --> 03:42:33,707 SENSITIZATION AND PAIN. 6023 03:42:33,773 --> 03:42:35,542 >> HI, I'M AN ASSISTANT 6024 03:42:35,608 --> 03:42:37,210 PROFESSOR IN THE DEPARTMENT OF 6025 03:42:37,277 --> 03:42:38,511 EPIDEMIOLOGY AT THE UNIVERSITY 6026 03:42:38,578 --> 03:42:39,746 OF TEXAS MEDICAL BRANCH. 6027 03:42:39,813 --> 03:42:43,149 TODAY I WILL BE TALKING ABOUT GR 6028 03:42:43,216 --> 03:42:44,017 DIFFERENCES IN THE DIAGNOSIS OF 6029 03:42:44,084 --> 03:42:46,086 PAIN AMONG OLDER PLED CARE 6030 03:42:46,152 --> 03:42:47,721 BENEFICIARIES. 6031 03:42:47,787 --> 03:42:49,189 PAIN IS OFTEN UNDERDIAGNOSED 6032 03:42:49,255 --> 03:42:50,690 AMONG WOMEN ESPECIALLY BLACK 6033 03:42:50,757 --> 03:42:52,459 WOMEN WITH THE EXTENT OF 6034 03:42:52,525 --> 03:42:55,962 UNDERDIAGNOSIS IS UNKNOWN. 6035 03:42:56,029 --> 03:42:57,597 COGNITIVE STATUS CAN ALSO 6036 03:42:57,664 --> 03:42:58,598 COMPLICATE PAIN REPORTING AND 6037 03:42:58,665 --> 03:42:59,899 DIAGNOSIS WITH THOSE WHO ARE 6038 03:42:59,966 --> 03:43:01,134 COGNITIVELY IMPAIRED BEING LESS 6039 03:43:01,201 --> 03:43:04,170 ABLE TO REPORT THEIR PAIN. 6040 03:43:04,237 --> 03:43:05,538 OUR OBJECTIVE WAS TO ASSESS THE 6041 03:43:05,605 --> 03:43:07,373 ODDS OF HAVING A PAIN DIAGNOSIS 6042 03:43:07,440 --> 03:43:08,775 DOCUMENTED IN THE MEDICAL RECORD 6043 03:43:08,842 --> 03:43:10,343 BY GENDER WHILE CONSIDERING RACE 6044 03:43:10,410 --> 03:43:12,946 AND ETHNICITY IN COGNITIVE 6045 03:43:13,012 --> 03:43:13,346 SETTINGS. 6046 03:43:13,413 --> 03:43:15,381 WE USED DATA FROM THE 2018 6047 03:43:15,448 --> 03:43:16,583 HEALTH IN RETIREMENT STUDY WHICH 6048 03:43:16,649 --> 03:43:18,351 IS A NATIONALLY REPRESENTATIVE 6049 03:43:18,418 --> 03:43:22,055 STUDY OF ADULTS OVER 50 IN THE 6050 03:43:22,122 --> 03:43:22,956 U.S. 6051 03:43:23,022 --> 03:43:23,923 THIS WAS LINKED TO MEDICARE 6052 03:43:23,990 --> 03:43:24,491 CLAIMS. 6053 03:43:24,557 --> 03:43:25,959 WE COMBINE SELF-REPORTED PAIN 6054 03:43:26,025 --> 03:43:27,994 WITH DIAGNOSIS OF CHRONIC PAIN 6055 03:43:28,061 --> 03:43:29,395 INDICATIONS INTO A THREE-LEVEL 6056 03:43:29,462 --> 03:43:31,364 OUT COME. 6057 03:43:31,431 --> 03:43:32,732 THOSE WITH NO PAIN, 6058 03:43:32,799 --> 03:43:34,033 SELF-REPORTED PAIN ONLY AND 6059 03:43:34,100 --> 03:43:36,803 DIAGNOSED PAIN WHICH INCLUDED 6060 03:43:36,870 --> 03:43:38,138 THOSE WHO HAD BOTH DIAGNOSED 6061 03:43:38,204 --> 03:43:42,509 PAIN ONLY AND THOSE WHO 6062 03:43:42,575 --> 03:43:44,043 SELF-REPORTED PAIN AND DIAGNOSED 6063 03:43:44,110 --> 03:43:44,377 PAIN. 6064 03:43:44,444 --> 03:43:46,446 WE LOOKED AT RACE AND ETHNICITY 6065 03:43:46,513 --> 03:43:48,548 AND COGNITIVE STATUS AS 6066 03:43:48,615 --> 03:43:53,920 POTENTIAL EFFECT MODIFIERS. 6067 03:43:53,987 --> 03:43:54,821 FIGURE ONE SHOWS THOSE REPORTING 6068 03:43:54,888 --> 03:43:57,023 PAIN BY GENDER WITH WOMEN IN RED 6069 03:43:57,090 --> 03:43:57,857 AND MEN IN TEAL. 6070 03:43:57,924 --> 03:43:59,626 WOMEN MORE OFTEN HAD DIAGNOSED 6071 03:43:59,692 --> 03:44:01,928 PAIN WHILE MEN MORE OFTEN HAD NO 6072 03:44:01,995 --> 03:44:05,765 PAIN OR UNDIAGNOSED PAIN. 6073 03:44:05,832 --> 03:44:07,834 WE USE REGRESSION MODELS TO 6074 03:44:07,901 --> 03:44:09,102 ASSESS THE ODDS OF PAIN 6075 03:44:09,169 --> 03:44:13,006 DIAGNOSIS BY GENDER CONTROLLING 6076 03:44:13,072 --> 03:44:15,408 FOR SOCIODEMOGRAPHIC AND HEALTH 6077 03:44:15,475 --> 03:44:15,842 CHARACTERISTICS. 6078 03:44:15,909 --> 03:44:17,644 WOMEN HAD HIGHER ODDS OF 6079 03:44:17,710 --> 03:44:20,380 DIAGNOSED PAIN COMPARED TO MEN. 6080 03:44:20,446 --> 03:44:21,681 THERE IS A SIGNIFICANT 6081 03:44:21,748 --> 03:44:22,448 INTERACTION BETWEEN PAIN AND 6082 03:44:22,515 --> 03:44:27,554 RACE AND ETHNICITY WHICH PEEL WL 6083 03:44:27,620 --> 03:44:29,088 FOCUS ON BUT NOT BETWEEN PAIN 6084 03:44:29,155 --> 03:44:30,156 AND COGNITIVE STATUS. 6085 03:44:30,223 --> 03:44:31,391 FIGURE TWO SHOWS REGRESSION 6086 03:44:31,457 --> 03:44:33,426 RESULTS WITH ASSOCIATION OF PAIN 6087 03:44:33,493 --> 03:44:37,831 WITH RACE ANDE AND ETHNICITY 6088 03:44:37,897 --> 03:44:41,234 STRATIFIED BY GENDER. 6089 03:44:41,301 --> 03:44:44,170 THE SOLID BLACK DOTS ARE FOR 6090 03:44:44,237 --> 03:44:45,605 UNDIAGNOSED PAIN WHERE THE WHITE 6091 03:44:45,672 --> 03:44:50,844 DOTS REPRESENT THOSE -- COMPARED 6092 03:44:50,910 --> 03:44:53,046 TO THEIR NON-HISPANIC WHITE 6093 03:44:53,112 --> 03:44:54,380 COUNTERPARTS, NON-HISPANIC BLACK 6094 03:44:54,447 --> 03:44:55,448 WOMEN HAD LOWER ODDS OF 6095 03:44:55,515 --> 03:44:56,616 DIAGNOSED PAIN WHICH IS 6096 03:44:56,683 --> 03:44:57,217 CONSISTENT IN THE LITERATURE 6097 03:44:57,283 --> 03:44:59,752 THAT SHOWS BLACK WOMEN HAVE 6098 03:44:59,819 --> 03:45:04,524 THEIR PAIN UNDER 6099 03:45:10,296 --> 03:45:11,798 ODDS BOTH DIAGNOSED AND 6100 03:45:11,865 --> 03:45:12,198 UNDIAGNOSED PAIN. 6101 03:45:12,265 --> 03:45:13,800 THIS MIGHT BE DUE TO THE FACT 6102 03:45:13,867 --> 03:45:15,802 WE HAVE SMALL NUMBERS OF BLACK 6103 03:45:15,869 --> 03:45:18,938 AND HISPANIC MEN BUT OUR FUTURE 6104 03:45:19,005 --> 03:45:21,975 WORK WILL PULL DATA FROM 6105 03:45:22,041 --> 03:45:23,476 2006-2018 SO WE CAN LOOK AT 6106 03:45:23,543 --> 03:45:25,411 THIS ON A LARGER SCALE. 6107 03:45:25,478 --> 03:45:26,579 THANK YOU SO MUCH FOR YOUR TIME 6108 03:45:26,646 --> 03:45:31,384 AND ATTENTION. 6109 03:45:31,451 --> 03:45:33,086 >> CHRONIC SKELETAL MUSCLE PAIN 6110 03:45:33,152 --> 03:45:39,459 IS THE MOST COMMON TYPE. 6111 03:45:39,525 --> 03:45:40,159 THE CRITICAL DEVELOPMENTAL 6112 03:45:40,226 --> 03:45:42,428 PERIOD INCLUDES MANY CHANGES. 6113 03:45:42,495 --> 03:45:43,997 NOT TO MENTION SEVERAL 6114 03:45:44,063 --> 03:45:46,532 CHALLENGES SUCH AS ESTABLISHING 6115 03:45:46,599 --> 03:45:48,568 AUTONOMY AND INDEPENDENCE IN 6116 03:45:48,635 --> 03:45:50,870 VARIOUS AREAS INCLUDING HIGHER 6117 03:45:50,937 --> 03:45:52,071 EDUCATION, RELATIONSHIPS AND 6118 03:45:52,138 --> 03:45:53,806 EVEN TRANSITIONING FROM 6119 03:45:53,873 --> 03:45:54,407 PEDIATRIC TO ADULT HEALTHCARE 6120 03:45:54,474 --> 03:45:56,309 SETTINGS. 6121 03:45:56,376 --> 03:45:57,543 THESE CHALLENGES ARE ALREADY 6122 03:45:57,610 --> 03:45:59,779 DEMANDING FOR YOUTH IN GENERAL. 6123 03:45:59,846 --> 03:46:01,180 NOW IMAGINE HOW DIFFICULT THIS 6124 03:46:01,247 --> 03:46:03,216 BECOMES WHILE ALSO COPING WITH 6125 03:46:03,283 --> 03:46:04,784 THE PSYCHO SOCIAL AND 6126 03:46:04,851 --> 03:46:06,719 FUNCTIONAL LIMITATIONS THAT 6127 03:46:06,786 --> 03:46:07,520 TYPICALLY ACCOMPANY CHRONIC 6128 03:46:07,587 --> 03:46:09,022 PAIN. 6129 03:46:09,088 --> 03:46:10,089 UNTIL RECENTLY RESEARCH FOCUSED 6130 03:46:10,156 --> 03:46:12,959 ON UNDERSTANDING THE RISK AND 6131 03:46:13,026 --> 03:46:13,426 VULNERABILITY FACTORS 6132 03:46:13,493 --> 03:46:15,528 UNDERLYING PAIN. 6133 03:46:15,595 --> 03:46:17,330 HOWEVER, IT'S ESSENTIAL TO 6134 03:46:17,397 --> 03:46:19,232 UNCOVER THE POSITIVE PROTECTIVE 6135 03:46:19,299 --> 03:46:21,301 FACTORS THAT MAY PROMOTE 6136 03:46:21,367 --> 03:46:22,302 RESILIENCE WITH THE ABILITY TO 6137 03:46:22,368 --> 03:46:26,739 BOUNCE BACK IN THE FACE OF PAIN. 6138 03:46:26,806 --> 03:46:28,608 WE KNOW RESILIENCE PLAYS AN 6139 03:46:28,675 --> 03:46:33,313 IMPORTANT ROLE WITH PAIN. 6140 03:46:33,379 --> 03:46:34,614 HOWEVER PSYCHOLOGICAL, SOCIAL, 6141 03:46:34,681 --> 03:46:36,816 BIOLOGICAL AND HEALTH AND 6142 03:46:36,883 --> 03:46:38,651 LIFESTYLE DOMAINS HAVE YET TO 6143 03:46:38,718 --> 03:46:41,287 BE EXPLORED IN MANY WAYS. 6144 03:46:41,354 --> 03:46:44,524 OUR ON GOING INVESTIGATION AIMS 6145 03:46:44,590 --> 03:46:46,426 TO CHARACTERIZE RESILIENCE 6146 03:46:46,492 --> 03:46:48,494 PROFILES ACROSS DOMAINS AND 6147 03:46:48,561 --> 03:46:54,867 A.Y.A.'S WITH AND WITHOUT 6148 03:46:54,934 --> 03:46:58,738 CHRONIC MUSCULAR SKELETAL PAIN. 6149 03:46:58,805 --> 03:47:01,374 PAIN MODULATION AND ESTABLISH 6150 03:47:01,441 --> 03:47:02,175 PREDICTIVE UTILITY OVERTIME. 6151 03:47:02,241 --> 03:47:05,812 AGES 16-21 YEARS ALONG WITH 6152 03:47:05,878 --> 03:47:08,181 THEIR PARENT OR CAREGIVER 6153 03:47:08,247 --> 03:47:09,349 COMPLETE QUESTIONNAIRES 6154 03:47:09,415 --> 03:47:09,882 INCLUDING LIFE AND SOCIAL 6155 03:47:09,949 --> 03:47:13,686 FACTORS. 6156 03:47:13,753 --> 03:47:15,922 THEY ATTEND TWO LABORATORY 6157 03:47:15,989 --> 03:47:18,257 VISITS TO MEASURE PAIN 6158 03:47:18,324 --> 03:47:20,093 SENSITIVITY AND CONDITIONED 6159 03:47:20,159 --> 03:47:21,794 PAIN MODULATION USING PRESSURE 6160 03:47:21,861 --> 03:47:27,333 AND COLD WATER STIMULI AND 6161 03:47:27,400 --> 03:47:31,070 PERFORMING FUNCTIONAL TASK. 6162 03:47:31,137 --> 03:47:32,372 ASSESSMENT OF DAILY ACTIVITY OF 6163 03:47:32,438 --> 03:47:35,341 PAIN IN REAL-TIME. 6164 03:47:35,408 --> 03:47:36,175 ALL PARTICIPANTS ATTEND A 6165 03:47:36,242 --> 03:47:39,946 6-MONTH FOLLOW-UP VISIT. 6166 03:47:40,013 --> 03:47:42,582 THUS FAR WE SUCCESSFULLY 6167 03:47:42,648 --> 03:47:46,052 ENROLLED TEN PARTICIPANTS AND 6168 03:47:46,119 --> 03:47:46,953 TEN HEALTHY CONTROLS. 6169 03:47:47,020 --> 03:47:49,422 PRELIMINARY ANALYSES FOR YOUTH 6170 03:47:49,489 --> 03:47:52,992 WITH PAIN REVEAL HIGHER LEVELS 6171 03:47:53,059 --> 03:47:56,329 HOPE AND SELF-EFFICACY ARE 6172 03:47:56,396 --> 03:47:56,863 ASSOCIATED WITH LESS PAIN 6173 03:47:56,929 --> 03:47:59,265 FUNCTIONALITY. 6174 03:47:59,332 --> 03:48:01,367 GREATER THAN 7 DAY IS 6175 03:48:01,434 --> 03:48:01,934 ASSOCIATED WITH LESS SOCIAL 6176 03:48:02,001 --> 03:48:03,870 SUPPORT. 6177 03:48:03,936 --> 03:48:04,637 THESE SIGNIFICANT RELATIONSHIPS 6178 03:48:04,704 --> 03:48:07,940 ARE PROMISING AS WE CONTINUE TO 6179 03:48:08,007 --> 03:48:10,777 EXAMINE PROTECTIVE FACTORS 6180 03:48:10,843 --> 03:48:12,879 RELATED TO PAIN AND 6181 03:48:12,945 --> 03:48:13,212 DISABILITIES. 6182 03:48:13,279 --> 03:48:14,614 INFORMATION GAINED FROM THIS 6183 03:48:14,680 --> 03:48:18,217 WORK WILL BE INVALUABLE FOR 6184 03:48:18,284 --> 03:48:19,952 DEVELOPING PATIENT CENTERED 6185 03:48:20,019 --> 03:48:25,091 STRENGTH-BASED PREVENTION OR 6186 03:48:25,158 --> 03:48:25,625 INTERVENTION EFFORTS FOR 6187 03:48:25,691 --> 03:48:27,627 MUSCULAR SKELETAL PAIN. 6188 03:48:27,693 --> 03:48:30,863 >> I'M WITH THE SCHOOL OF 6189 03:48:30,930 --> 03:48:35,535 NURSING, OUR PROJECT FOCUSED ON 6190 03:48:35,601 --> 03:48:37,203 EXPLORING RELATIONSHIP BETWEEN 6191 03:48:37,270 --> 03:48:38,171 PAIN AND DEPRESSION. 6192 03:48:38,237 --> 03:48:39,505 PAIN IS A STRESSOR, ACCORDING 6193 03:48:39,572 --> 03:48:42,308 TO THE MODEL THAT COULD BE 6194 03:48:42,375 --> 03:48:45,044 EXPERIENCED FOCALLY OR AS A 6195 03:48:45,111 --> 03:48:46,045 PRIMARY CONCERN, CONTEXTUALLY 6196 03:48:46,112 --> 03:48:50,049 AS A STRESSOR THAT IS SECONDARY 6197 03:48:50,116 --> 03:48:52,985 OR TERTIARY OR A RESIDUAL TYPE 6198 03:48:53,052 --> 03:48:53,286 OF STRESSOR. 6199 03:48:53,352 --> 03:48:55,321 ONE IS NOT EVEN IDENTIFIED YET. 6200 03:48:55,388 --> 03:48:59,058 WE ALSO KNOW THERE'S A PAIN 6201 03:48:59,125 --> 03:49:00,193 DEPRESSION CYCLE UNMET PAIN 6202 03:49:00,259 --> 03:49:02,695 NEEDS WORSEN THE EXPERIENCE OF 6203 03:49:02,762 --> 03:49:05,098 DEPRESSION AND DEPRESSION 6204 03:49:05,164 --> 03:49:05,698 SYMPTOMS CAN EXACERBATE PAIN 6205 03:49:05,765 --> 03:49:07,733 INTERFERENCE. 6206 03:49:07,800 --> 03:49:09,869 INTERESTINGLY DESPITE THE HIGH 6207 03:49:09,936 --> 03:49:12,805 INCIDENCE OF PAIN AMONG BLACK 6208 03:49:12,872 --> 03:49:14,607 OLDER ADULTS, THE INCIDENCE OF 6209 03:49:14,674 --> 03:49:15,842 DEPRESSION IS REALLY NOT AS 6210 03:49:15,908 --> 03:49:19,512 HIGH AS WE WOULD EXPECT. 6211 03:49:19,579 --> 03:49:21,647 WHILE WE KNOW CULTURE 6212 03:49:21,714 --> 03:49:22,715 INFLUENCES HEALTH BEHAVIORS 6213 03:49:22,782 --> 03:49:24,350 INCLUDING EXPRESSION OF PAIN, 6214 03:49:24,417 --> 03:49:25,651 DEPRESSION AND OTHER HEALTH 6215 03:49:25,718 --> 03:49:27,186 SYMPTOMS THERE'S BEEN LITTLE 6216 03:49:27,253 --> 03:49:28,688 WORK TO INVESTIGATE THE FACTOR 6217 03:49:28,754 --> 03:49:29,222 THAT'S CONTRIBUTE TO THE 6218 03:49:29,288 --> 03:49:30,490 EXPERIENCES. 6219 03:49:30,556 --> 03:49:32,925 WE AIM TO EXPLORE THE 6220 03:49:32,992 --> 03:49:35,461 RELATIONSHIP BETWEEN PAIN 6221 03:49:35,528 --> 03:49:37,597 INTENSITY AND DEPRESSION 6222 03:49:37,663 --> 03:49:39,398 SYMPTOMS BY STUDYING 6223 03:49:39,465 --> 03:49:41,601 COMMUNITIES OF A BLACK ADULTS. 6224 03:49:41,667 --> 03:49:43,469 TWO RESULTS WERE A PAIN 6225 03:49:43,536 --> 03:49:44,570 INTERVENTION GROUP 6226 03:49:44,637 --> 03:49:47,473 PARTICIPATING IN A LARGE PAIN 6227 03:49:47,540 --> 03:49:51,177 CLINICAL TRIAL IN WHICH WE 6228 03:49:51,244 --> 03:49:53,579 GATHER PRELIMINARY OR BASELINE 6229 03:49:53,646 --> 03:49:54,547 ASSESSMENT, INCLUDING BOTH 6230 03:49:54,614 --> 03:49:55,381 DEPRESSION AND PAIN MEASURES 6231 03:49:55,448 --> 03:49:56,983 FROM THIS GROUP. 6232 03:49:57,049 --> 03:49:59,685 AS WELL AS A VERY DIFFERENT 6233 03:49:59,752 --> 03:50:00,987 GROUP OF FAMILY CAREGIVERS, 6234 03:50:01,053 --> 03:50:04,023 BOTH GROUPS WERE OF COURSE 6235 03:50:04,090 --> 03:50:06,058 OLDER ADULTS AND BLACK OLDER 6236 03:50:06,125 --> 03:50:06,292 ADULTS. 6237 03:50:06,359 --> 03:50:08,394 AND IN THE SECOND GROUP, THE 6238 03:50:08,461 --> 03:50:10,530 GROUP OF FAMILY CAREGIVERS 6239 03:50:10,596 --> 03:50:11,631 THESE INDIVIDUALS WERE 6240 03:50:11,697 --> 03:50:12,832 PARTICIPATING IN FOCUS GROUPS 6241 03:50:12,899 --> 03:50:15,568 AND THEY ALSO HAD PAIN AND 6242 03:50:15,635 --> 03:50:17,170 DEPRESSIVE MEASURES THAT WERE 6243 03:50:17,236 --> 03:50:18,237 COMPLETED PRIOR TO THEIR FOCUS 6244 03:50:18,304 --> 03:50:19,338 GROUP EXPERIENCE. 6245 03:50:19,405 --> 03:50:21,908 WHAT WE FOUND IS THAT 100% OF 6246 03:50:21,974 --> 03:50:24,043 COURSE OF THE PAIN STUDY 6247 03:50:24,110 --> 03:50:29,615 PARTICIPANTS AND AROUNDLE 88% 6248 03:50:29,682 --> 03:50:30,183 OF THE CAREGIVERS REPORTED 6249 03:50:30,249 --> 03:50:32,218 DAILY PAIN. 6250 03:50:32,285 --> 03:50:33,853 USING PROMISE MEASURES FOR BOTH 6251 03:50:33,920 --> 03:50:36,222 GROUPS AND BOTH ACTUALLY FELL 6252 03:50:36,289 --> 03:50:37,690 INTO NORMAL POPULATION RANGES, 6253 03:50:37,757 --> 03:50:40,126 WHICH AMOUNTS TO AROUND 11% OF 6254 03:50:40,193 --> 03:50:42,061 THE GROUP EXPERIENCE AND 6255 03:50:42,128 --> 03:50:43,729 DEPRESSION. 6256 03:50:43,796 --> 03:50:45,398 WITHIN A FOCUS GROUP 6257 03:50:45,464 --> 03:50:47,667 PARTICIPANTS IN PARTICULAR, WE 6258 03:50:47,733 --> 03:50:50,102 FOUND THAT THEY HAD MULTIPLE 6259 03:50:50,169 --> 03:50:51,037 DESCRIPTIONS OF DEPRESSION WHEN 6260 03:50:51,103 --> 03:50:52,838 TALKING ABOUT THE EXPERIENCE OF 6261 03:50:52,905 --> 03:50:54,840 CARE GIVING, MORE SO THAN WHAT 6262 03:50:54,907 --> 03:50:55,708 WAS REPORTED ON THE ASSESSMENT 6263 03:50:55,775 --> 03:50:57,410 MEASURES. 6264 03:50:57,476 --> 03:50:59,812 THEY ALSO DID NOT REALLY BRING 6265 03:50:59,879 --> 03:51:01,247 UP THEIR PAIN EXPERIENCES AT 6266 03:51:01,314 --> 03:51:02,315 ALL. 6267 03:51:02,381 --> 03:51:04,917 AND WOULD NOT HAVE BEEN 6268 03:51:04,984 --> 03:51:06,919 CAPTURED, HAD NOT THE SPECIFIC 6269 03:51:06,986 --> 03:51:10,122 PAIN QUESTIONS BEEN ASKED OF 6270 03:51:10,189 --> 03:51:10,723 THE GROUP. 6271 03:51:10,790 --> 03:51:13,226 WE IDENTIFIED THAT THE STRONG 6272 03:51:13,292 --> 03:51:14,860 BLACK WOMAN SCHEMA WHICH 6273 03:51:14,927 --> 03:51:16,696 CHARACTERIZES AN OBLIGATION TO 6274 03:51:16,762 --> 03:51:18,397 PRESENT A STRONG SUPPRESS 6275 03:51:18,464 --> 03:51:19,732 EMOTIONS, BE INDEPENDENT, BE 6276 03:51:19,799 --> 03:51:22,368 DETERMINED TO SUCCEED AND HELP 6277 03:51:22,435 --> 03:51:26,806 OTHERS CAN ACTUALLY LEAD TO 6278 03:51:26,872 --> 03:51:28,274 LIMITATIONS SEEKING BEHAVIOR AS 6279 03:51:28,341 --> 03:51:31,043 WELL AS EXPRESSION OF EMOTIONS 6280 03:51:31,110 --> 03:51:32,245 WHICH POSSIBLY MIGHT EXPLAIN 6281 03:51:32,311 --> 03:51:34,046 WHY WE ARE SEEING THESE 6282 03:51:34,113 --> 03:51:35,181 VARIANCES AND HOW PEOPLE 6283 03:51:35,248 --> 03:51:36,115 EXPERIENCE DEPRESSION AND HOW 6284 03:51:36,182 --> 03:51:38,050 THEY ARE WILLING TO TALK AND 6285 03:51:38,117 --> 03:51:38,551 REPORT THEIR DEPRESSIVE 6286 03:51:38,618 --> 03:51:38,818 SYMPTOMS. 6287 03:51:38,884 --> 03:51:40,353 THANK YOU. 6288 03:51:40,419 --> 03:51:42,555 >> HELLO, WE KNOW THAT 6289 03:51:42,622 --> 03:51:47,093 APPROXIMATELY 30% OF THOSE WHO 6290 03:51:47,159 --> 03:51:48,928 HAVE END METRIOSIS WILL 6291 03:51:48,995 --> 03:51:50,730 CONTINUE TO RECEIVE PAIN EVEN 6292 03:51:50,796 --> 03:51:52,231 AFTER LESIONS HAVE BEEN REMOVED 6293 03:51:52,298 --> 03:51:56,969 DURING SURGERY. 6294 03:51:57,036 --> 03:51:58,437 THEREFORE WE LOOKED AT A NUMBER 6295 03:51:58,504 --> 03:52:03,209 OF FACTORS AND HOW THEY ARE 6296 03:52:03,276 --> 03:52:06,946 RELATED TO PELVIC PAIN OR PAIN 6297 03:52:07,013 --> 03:52:09,815 ASSOCIATED WITH MENSTRUATION. 6298 03:52:09,882 --> 03:52:16,455 WE USE THE A.T.A. STUDY, 6299 03:52:16,522 --> 03:52:26,832 INCLUDE 426 WITH DIAGNOSED 6300 03:52:26,899 --> 03:52:30,036 ENDOMETRIOSIS. 6301 03:52:30,102 --> 03:52:32,538 THE MENTAL COMPONENT SCORE 12. 6302 03:52:32,605 --> 03:52:37,243 PAIN SEVERITY IN THE PAST THREE 6303 03:52:37,310 --> 03:52:37,710 MONTHS REPORTED 0-10. 6304 03:52:37,777 --> 03:52:39,512 WE USE MODELING OF THE THREE 6305 03:52:39,578 --> 03:52:46,652 OUTCOMES AND PUT THOSE INTO A 6306 03:52:46,719 --> 03:52:48,621 LOGISTIC REGRESSION MODEL. 6307 03:52:48,688 --> 03:52:52,458 TABLE 1 YOU CAN SEE 6308 03:52:52,525 --> 03:52:54,794 PARTICIPANTS ARE YOUNG ON 6309 03:52:54,860 --> 03:52:58,097 AVERAGE, WHITE AND CURRENT 6310 03:52:58,164 --> 03:52:59,665 HORMONE USERS AND EARLY STAGE 6311 03:52:59,732 --> 03:53:02,101 ENDOMETRIOSIS. 6312 03:53:02,168 --> 03:53:06,505 YOU COULD SEE SCORES WHICH 6313 03:53:06,572 --> 03:53:11,243 RANGE. 6314 03:53:11,310 --> 03:53:12,111 59% OF PARTICIPANTS FELL IN 6315 03:53:12,178 --> 03:53:14,880 THIS BLUE. 6316 03:53:14,947 --> 03:53:18,484 12% IN THE RED. 6317 03:53:18,551 --> 03:53:20,119 THOSE IN THAT GROUP WERE MORE 6318 03:53:20,186 --> 03:53:23,289 LIKELY TO HAVE OTHER PAIN 6319 03:53:23,356 --> 03:53:25,291 CONDITIONS IN ADDITION TO 6320 03:53:25,358 --> 03:53:25,891 ENDOMETRIOSIS COMPARED TO THE 6321 03:53:25,958 --> 03:53:28,728 AVERAGE GROUP. 6322 03:53:28,794 --> 03:53:30,463 MORE LIKELY TO REPORT BEING 6323 03:53:30,529 --> 03:53:30,996 LESS THAN THE POPULATION 6324 03:53:31,063 --> 03:53:34,333 AVERAGE GROUP. 6325 03:53:34,400 --> 03:53:37,036 SCORE RESULTS WERE SIMILAR TO 6326 03:53:37,103 --> 03:53:40,172 THOSE IN P.C.S. 12 RESULTS. 6327 03:53:40,239 --> 03:53:43,209 FIGURE 2 PILL VICK PAIN SCORES. 6328 03:53:43,275 --> 03:53:45,811 THIS RANGES FROM 0 AS NO PAIN, 6329 03:53:45,878 --> 03:53:48,748 10 WORST PAIN IMAGINABLE. 6330 03:53:48,814 --> 03:53:49,882 ABOUT 40% OF PARTICIPANTS FELL 6331 03:53:49,949 --> 03:53:53,686 IN THIS GROUP. 6332 03:53:53,753 --> 03:53:57,923 23% IN INCREASING PAIN GROUP. 6333 03:53:57,990 --> 03:54:00,793 13% IN THE RED. 6334 03:54:00,860 --> 03:54:03,429 WE SAW THOSE IN INCREASING PAIN 6335 03:54:03,496 --> 03:54:06,332 AND NON MILD WERE MORE LIKELY 6336 03:54:06,399 --> 03:54:08,768 TO REPORT OTHER PAIN CONDITIONS. 6337 03:54:08,834 --> 03:54:11,604 MILD PAIN GROUP MORE LIKELY TO 6338 03:54:11,670 --> 03:54:13,305 REPORT HIGHER SCORES, BETTER 6339 03:54:13,372 --> 03:54:15,441 MENTAL HEALTH QUALITY OF LIFE, 6340 03:54:15,508 --> 03:54:17,476 COMPARED TO THE PERSISTENT PAIN 6341 03:54:17,543 --> 03:54:17,676 GROUP. 6342 03:54:17,743 --> 03:54:19,545 WE SAW ALMOST HALF OUR 6343 03:54:19,612 --> 03:54:21,113 PARTICIPANTS HAVE PERSISTENT 6344 03:54:21,180 --> 03:54:24,683 PAIN AND PELVIC PAIN THROUGHOUT 6345 03:54:24,750 --> 03:54:27,253 THREE YEARS OF FOLLOW-UP. 6346 03:54:27,319 --> 03:54:29,488 THERE'S SUGGESTION OF SOME 6347 03:54:29,555 --> 03:54:31,590 FACTORS THAT MAY BE PREDICTORS 6348 03:54:31,657 --> 03:54:33,726 OF TRAJECTORIES AND HOW 6349 03:54:33,793 --> 03:54:34,293 TREATMENTS MAY IMPACT THESE 6350 03:54:34,360 --> 03:54:34,593 TRAJECTORIS. 6351 03:54:34,660 --> 03:54:38,697 THANK YOU. 6352 03:54:38,764 --> 03:54:41,667 >> MY NAME IS EMMA STETTLER, 6353 03:54:41,734 --> 03:54:42,601 VISITING FELLOW IN THE 6354 03:54:42,668 --> 03:54:46,071 DEPARTMENT OF MEDICINE. 6355 03:54:46,138 --> 03:54:47,940 POTENTIAL ENERGY TARGETS 6356 03:54:48,007 --> 03:54:55,114 SENSORY NEURONS. 6357 03:54:55,181 --> 03:55:03,989 WE KNOW FROM ANIMAL MODELS ONE 6358 03:55:04,056 --> 03:55:05,124 ESSENTIAL ELEMENT, MEDIATES BY 6359 03:55:05,191 --> 03:55:07,026 INHIBITION OF CHANNELS. 6360 03:55:07,092 --> 03:55:11,297 THIS IS THE UNDERLYING 6361 03:55:11,363 --> 03:55:11,831 MECHANISM OF ADMINISTERED 6362 03:55:11,897 --> 03:55:14,533 OPIOIDS. 6363 03:55:14,600 --> 03:55:17,970 PAIN FROM TISSUE DAMAGE IS 6364 03:55:18,037 --> 03:55:18,671 COMPLETELY REDUCED, REDUCTION 6365 03:55:18,737 --> 03:55:20,272 OF NEUROPATHIC PAIN IS MODERATE 6366 03:55:20,339 --> 03:55:25,544 TO POOR. 6367 03:55:25,611 --> 03:55:27,880 WE HYPOTHESIZED EXPRESSION OF 6368 03:55:27,947 --> 03:55:28,881 GENE, TISSUE DAMAGE AND OTHER 6369 03:55:28,948 --> 03:55:31,684 -- POPULATIONS. 6370 03:55:31,750 --> 03:55:35,354 TO INVESTIGATE THIS HYPOTHESIS 6371 03:55:35,421 --> 03:55:35,855 WE CONDUCTED SERIES OF 6372 03:55:35,921 --> 03:55:38,724 EXPERIMENTS. 6373 03:55:38,791 --> 03:55:42,027 THESE STUDIES HAD A MATRIX WITH 6374 03:55:42,094 --> 03:55:44,029 TRIP U1. 6375 03:55:44,096 --> 03:55:46,632 TOGETHER THE OPIUM ONE AND 6376 03:55:46,699 --> 03:55:50,002 COMBINATIONS OF ANALGESIC 6377 03:55:50,069 --> 03:55:54,106 MOLECULAR MODELS. 6378 03:55:54,173 --> 03:55:56,175 WE DIDN'T DETERMINE SEX 6379 03:55:56,242 --> 03:55:58,110 DIFFERENCE EXPRESSION OF 6380 03:55:58,177 --> 03:55:59,578 MOLECULAR MARKERS. 6381 03:55:59,645 --> 03:56:01,247 OUR RESULTS CONFIRMED INITIAL 6382 03:56:01,313 --> 03:56:03,215 HYPOTHESIS. 6383 03:56:03,282 --> 03:56:09,688 DETECTED A LARGE POPULATION OF 6384 03:56:09,755 --> 03:56:15,561 C NODE RECEPTORS -- 6385 03:56:15,628 --> 03:56:16,762 THIS COMBINATION OF GENES, 6386 03:56:16,829 --> 03:56:20,699 TISSUE DAMAGE PAIN -- 6387 03:56:20,766 --> 03:56:22,968 HIGHEST EXPRESSION DETECTED AND 6388 03:56:23,035 --> 03:56:27,640 DISTINCT -- OPIUM 1 POSITIVE 6389 03:56:27,706 --> 03:56:35,180 AND -- NEGATIVE. 6390 03:56:35,247 --> 03:56:36,815 UNRESPONSIVE TO STIMULATION 6391 03:56:36,882 --> 03:56:45,424 UNDER PHYSIOLOGIC CONDITIONS. 6392 03:56:45,491 --> 03:56:51,430 WE DETECTED ANOTHER POPULATION. 6393 03:56:51,497 --> 03:56:52,765 IT WAS NEGATIVE FOR EXPRESSION 6394 03:56:52,831 --> 03:56:54,767 OF OPIUM 1. 6395 03:56:54,833 --> 03:56:56,802 THESE WERE CHARACTERIZED BY 6396 03:56:56,869 --> 03:57:00,105 EXPRESSION OF THE H RECEPTOR 6397 03:57:00,172 --> 03:57:01,840 GMRD AND POPULATION HAS BEEN 6398 03:57:01,907 --> 03:57:12,418 SHOWED IN ANIMAL MODELS IN A 6399 03:57:16,522 --> 03:57:20,025 SUPERFICIAL EPIDERMIS. 6400 03:57:20,092 --> 03:57:20,659 A SIGNIFICANT CONTRIBUTOR TO 6401 03:57:20,726 --> 03:57:26,665 NEUROPATHIC PAIN. 6402 03:57:26,732 --> 03:57:28,367 IT CANNOT BE ATTENUATED. 6403 03:57:28,434 --> 03:57:38,978 OUR INVESTIGATION IS THE FIRST 6404 03:57:46,885 --> 03:57:49,254 TO PROVIDE EMPIRICAL EVIDENCE 6405 03:57:49,321 --> 03:57:50,122 NOCICEPTIVE. 6406 03:57:50,189 --> 03:57:52,324 >> [ INDISCERNIBLE ] 6407 03:57:52,391 --> 03:57:57,563 I'M VERY EXCITED TO SHOW YOU 6408 03:57:57,630 --> 03:58:03,836 OUR LATEST [ INDISCERNIBLE ] 6409 03:58:03,902 --> 03:58:05,571 LAB FOCUSED ON -- INVOLVING 6410 03:58:05,638 --> 03:58:15,748 PAIN. 6411 03:58:20,686 --> 03:58:24,156 IT PLAYS AN IMPORTANT ROLE. 6412 03:58:24,223 --> 03:58:30,029 [ INDISCERNIBLE ] IN THE CENTER 6413 03:58:30,095 --> 03:58:30,663 AMYGDALA. 6414 03:58:30,729 --> 03:58:36,168 WE ARE AIMING TO UNDERSTAND 6415 03:58:36,235 --> 03:58:37,169 FUNCTIONAL -- CDRPR EXPRESS 6416 03:58:37,236 --> 03:58:47,646 IN THE CONTEXT OF PAIN. 6417 03:58:51,150 --> 03:58:56,588 I USE MODEL WE DEMONSTRATED -- 6418 03:58:56,655 --> 03:58:58,023 HYPERSENSITIVITY AS COMPARED 6419 03:58:58,090 --> 03:59:05,164 TO -- GENES. 6420 03:59:05,230 --> 03:59:13,706 HISTOLOGY -- WHAT WE FOUND 6421 03:59:13,772 --> 03:59:16,742 THE IMPLANATION WE FOUND IT WAS 6422 03:59:16,809 --> 03:59:19,144 CO-LOCALIZED. 6423 03:59:19,211 --> 03:59:23,515 SO THESE REGIONS DEMONSTRATED 6424 03:59:23,582 --> 03:59:27,186 THE CDR [ INDISCERNIBLE ] AFTER 6425 03:59:27,252 --> 03:59:32,524 THIS EXPERIMENT, WHAT WE FOUND 6426 03:59:32,591 --> 03:59:37,596 IN THIS EXPERIMENT INDUCED 6427 03:59:37,663 --> 03:59:40,099 SPIKE IN THE POSTERIOR AS 6428 03:59:40,165 --> 03:59:43,168 OPPOSED TO [ INDISCERNIBLE ]. 6429 03:59:43,235 --> 03:59:45,170 WE WERE INTERESTED IN THE 6430 03:59:45,237 --> 03:59:49,708 BEHAVIOR. 6431 03:59:49,775 --> 03:59:54,379 EXPERIMENT INJECTED -- IN THE 6432 03:59:54,446 --> 03:59:56,181 CEA-CGRPR MICE. 6433 03:59:56,248 --> 04:00:02,721 IN SUMMARY WHAT WE FOUND IN 6434 04:00:02,788 --> 04:00:03,255 THIS EXPERIENCE, NEURON 6435 04:00:03,322 --> 04:00:04,823 HYPERSENSITIVITY AS YOU CAN SEE 6436 04:00:04,890 --> 04:00:07,693 HERE IN THE CUFF MOUSE. 6437 04:00:07,760 --> 04:00:11,263 NEURONS IN THE CENTER AMYGDALA 6438 04:00:11,330 --> 04:00:14,099 PAIN RELATED HYPE SENSITIVITY. 6439 04:00:14,166 --> 04:00:16,368 AS YOU CAN SEE. 6440 04:00:16,435 --> 04:00:17,970 WE WERE ALSO INVESTIGATED TO 6441 04:00:18,036 --> 04:00:19,438 UNDERSTAND THE ROLE IN MOUSE 6442 04:00:19,505 --> 04:00:21,306 MODEL. 6443 04:00:21,373 --> 04:00:24,977 WE HAVE YOUTH -- SO WHAT WE 6444 04:00:25,043 --> 04:00:29,915 FOUND IN THIS EXPERIMENT WE 6445 04:00:29,982 --> 04:00:32,117 FOUND THE MODEL DOESN'T HAVE 6446 04:00:32,184 --> 04:00:34,219 DIFFERENCE IN THE SERUM 6447 04:00:34,286 --> 04:00:40,225 INJECTED MOUSE. 6448 04:00:40,292 --> 04:00:41,527 WE FOUND INHIBITION OF 6449 04:00:41,593 --> 04:00:48,767 CEA-CGRPR NEURONS. 6450 04:00:48,834 --> 04:00:51,236 SO DEMONSTRATED THAT CDR 6451 04:00:51,303 --> 04:00:53,705 NEURONS PLAYS A CRUCIAL ROLE IN 6452 04:00:53,772 --> 04:00:54,106 PAIN SENSITIVITY. 6453 04:00:54,173 --> 04:00:55,073 SO THANK YOU ALL FOR YOUR KIND 6454 04:00:55,140 --> 04:00:56,508 ATTENTION. 6455 04:00:56,575 --> 04:00:59,211 >> GOOD MORNING, MY NAME IS 6456 04:00:59,278 --> 04:01:01,146 LAURA, I'M ASSISTANT PROFESSOR 6457 04:01:01,213 --> 04:01:04,850 AT UNIVERSITY OF PUERTO RICO, 6458 04:01:04,917 --> 04:01:07,319 I'M WORKING WITH -- ALSO [ 6459 04:01:07,386 --> 04:01:09,221 INDISCERNIBLE ] WITH A MEMBER 6460 04:01:09,288 --> 04:01:13,258 OF NATIONAL CENTER FOR [ 6461 04:01:13,325 --> 04:01:13,792 INDISCERNIBLE ] AT N.I.H. 6462 04:01:13,859 --> 04:01:16,995 OUR PROJECT IS TITLED EFFECTS 6463 04:01:17,062 --> 04:01:19,598 OF CLOSED HEAD INJURY ON PAIN 6464 04:01:19,665 --> 04:01:22,100 LIKE BEHAVIORS IN RATS. 6465 04:01:22,167 --> 04:01:23,869 LEADS TO CHRONIC PAIN FROM THE 6466 04:01:23,936 --> 04:01:26,939 SITE OF INJURY IN ABOUT 60% OF 6467 04:01:27,005 --> 04:01:31,610 ADULT PATIENTS. 6468 04:01:31,677 --> 04:01:34,346 MEASURE OF THE FUNCTION, 6469 04:01:34,413 --> 04:01:34,913 SPECIFICALLY IN THE VENTRI 6470 04:01:34,980 --> 04:01:38,584 LATERAL. 6471 04:01:38,650 --> 04:01:41,019 A DECREASED -- WAS ALSO 6472 04:01:41,086 --> 04:01:42,221 CORRELATED WITH HIGHER PAIN 6473 04:01:42,287 --> 04:01:43,856 SCORES IN THESE PATIENTS. 6474 04:01:43,922 --> 04:01:46,758 THEREFORE OUR GOAL IS TO TEST 6475 04:01:46,825 --> 04:01:49,094 THE HYPOTHESIS THAT MALADAPTIVE 6476 04:01:49,161 --> 04:01:51,630 CHANGES IN CONNECTIVITY BETWEEN 6477 04:01:51,697 --> 04:01:52,865 RAIN REGIONS CONTRIBUTE TO 6478 04:01:52,931 --> 04:01:54,900 CHRONIC PAIN AFTER MILD TO 6479 04:01:54,967 --> 04:01:56,468 MODERATE PAIN INJURY. 6480 04:01:56,535 --> 04:02:01,673 TO PERFORM OUR GOAL WE FIRST 6481 04:02:01,740 --> 04:02:03,242 PERFORMED INJURY USING WEIGHT 6482 04:02:03,308 --> 04:02:04,509 DROP MODEL REPRESENTED IN THIS 6483 04:02:04,576 --> 04:02:07,579 DIAGRAM. 6484 04:02:07,646 --> 04:02:09,281 WE MEASURED MECHANICAL AND 6485 04:02:09,348 --> 04:02:10,048 THERMAL SENSITIVITIES AT TIME 6486 04:02:10,115 --> 04:02:12,451 POINTS AFTER INJURY. 6487 04:02:12,517 --> 04:02:18,290 WE THEN TEST THE DIFFERENT 6488 04:02:18,357 --> 04:02:19,725 BRAIN MARKERS IN BRAIN 6489 04:02:19,791 --> 04:02:23,595 HISTOLOGY TO UNDERSTAND THE 6490 04:02:23,662 --> 04:02:25,697 ROLE OF INFLAMMATION. 6491 04:02:25,764 --> 04:02:28,200 IN OUR WEIGHT DROP MODEL WE HAD 6492 04:02:28,267 --> 04:02:31,870 A WEIGHT OF 500 GRAMS AND A 6493 04:02:31,937 --> 04:02:34,539 GUIDE ONE -- 6494 04:02:34,606 --> 04:02:36,475 RIGHT AFTER RELEASING THE 6495 04:02:36,541 --> 04:02:39,711 WEIGHT WE MEASURED THE TIME TO 6496 04:02:39,778 --> 04:02:41,480 WAKE, THE TIME TO WRITE AND 6497 04:02:41,546 --> 04:02:44,149 TIME TO AMBULATE. 6498 04:02:44,216 --> 04:02:45,083 NO SIGNIFICANT CHANGES WERE 6499 04:02:45,150 --> 04:02:46,285 OBSERVED BETWEEN GROUPS. 6500 04:02:46,351 --> 04:02:49,888 THIS IS IMPORTANT BECAUSE THIS 6501 04:02:49,955 --> 04:02:51,323 REPRESENTS NO LOSS OF 6502 04:02:51,390 --> 04:02:55,027 CONSCIOUSNESS WHICH IS A 6503 04:02:55,093 --> 04:02:57,362 HALLMARK OF HEAD INJURY. 6504 04:02:57,429 --> 04:02:59,364 WE MEASURE BEHAVIORS. 6505 04:02:59,431 --> 04:03:01,366 WE USE ELEMENTS TO TEST FOR 6506 04:03:01,433 --> 04:03:02,301 MECHANICAL SENSITIVITY. 6507 04:03:02,367 --> 04:03:06,571 AS YOU CAN SEE HERE LOWER 6508 04:03:06,638 --> 04:03:07,506 THRESHOLD WAS OBSERVED IN THE 6509 04:03:07,572 --> 04:03:10,108 INJURY GROUP. 6510 04:03:10,175 --> 04:03:10,776 AND HYPERSENSITIVITY WAS 6511 04:03:10,842 --> 04:03:13,312 PROLONGED UP UNTIL THE LAST DAY 6512 04:03:13,378 --> 04:03:14,913 WE MEASURED THE SENSITIVITY 6513 04:03:14,980 --> 04:03:18,450 WHICH WAS AT DAY 35. 6514 04:03:18,517 --> 04:03:23,188 HOWEVER, FOR THE OTHER TEST 6515 04:03:23,255 --> 04:03:24,489 WHICH MEASURE THERMAL STIMULI 6516 04:03:24,556 --> 04:03:26,124 SENSITIVITY WE DIDN'T SEE ANY 6517 04:03:26,191 --> 04:03:26,758 SIGNIFICANT CHANGES BETWEEN THE 6518 04:03:26,825 --> 04:03:28,427 TWO GROUPS. 6519 04:03:28,493 --> 04:03:29,895 IN THE ONGOING EXPERIMENTS WE 6520 04:03:29,962 --> 04:03:33,398 ARE MEASURING THE EXPRESSION OF 6521 04:03:33,465 --> 04:03:40,038 IVA1, A MARKER OF NODAL 6522 04:03:40,105 --> 04:03:40,605 INFLAMMATION, SPECIFICALLY 6523 04:03:40,672 --> 04:03:43,909 MICRO GLIA. 6524 04:03:43,976 --> 04:03:45,410 CINGULAR CORTEX. 6525 04:03:45,477 --> 04:03:47,746 BUT WE WILL INCLUDE THIS OTHER 6526 04:03:47,813 --> 04:03:49,448 BRAIN REGION FOR PAIN PROCESS. 6527 04:03:49,514 --> 04:03:54,186 IN OUR FUTURE DIRECTIONS WE 6528 04:03:54,252 --> 04:03:55,887 WILL USE ANTEROGRADE AND 6529 04:03:55,954 --> 04:04:01,193 RETROGRADE IN THE LATERAL -- 6530 04:04:01,259 --> 04:04:04,162 COMBINED WITH MONITORING TO 6531 04:04:04,229 --> 04:04:07,666 IDENTIFY THE SPECIFIC NODAL 6532 04:04:07,733 --> 04:04:09,034 CIRCUIT INVOLVED IN INJURY 6533 04:04:09,101 --> 04:04:09,968 INDUCED HYPERSENSITIVITY. 6534 04:04:10,035 --> 04:04:12,337 THANK YOU FOR YOUR ATTENTION. 6535 04:04:12,404 --> 04:04:14,539 >> HELLO, I'M A Ph.D. CANDIDATE 6536 04:04:14,606 --> 04:04:16,575 AND NEURO SCIENCE AT THE 6537 04:04:16,641 --> 04:04:18,777 UNIVERSITY OF MARYLAND, I WILL 6538 04:04:18,844 --> 04:04:21,446 GIVE AN OVERVIEW OF TREATMENT 6539 04:04:21,513 --> 04:04:23,482 EXPECTANCIES AND ROLE OF 6540 04:04:23,548 --> 04:04:24,950 TESTOSTERONE IN BOTH PHENOMENON. 6541 04:04:25,017 --> 04:04:27,786 WHAT WE KNOW FROM RESEARCH OF 6542 04:04:27,853 --> 04:04:30,589 SEX DIFFERENCE OF PAIN, WOMEN 6543 04:04:30,655 --> 04:04:31,289 EXPERIENCE GREATER PAIN THAN 6544 04:04:31,356 --> 04:04:34,159 MEN. 6545 04:04:34,226 --> 04:04:35,727 THE MECHANISMS UNDERLYING 6546 04:04:35,794 --> 04:04:36,294 DISPARITIES REMAIN LARGELY 6547 04:04:36,361 --> 04:04:41,400 UNKNOWN. 6548 04:04:41,466 --> 04:04:42,934 PROTECTIVE EFFECTS OF 6549 04:04:43,001 --> 04:04:44,970 TESTOSTERONE HAVE BEEN 6550 04:04:45,037 --> 04:04:46,405 DEMONSTRATED BUT EFFECTS ON 6551 04:04:46,471 --> 04:04:52,944 TREATMENT UNDETERMINED. 6552 04:04:53,011 --> 04:04:55,647 DIAGNOSED WITH TMD. 6553 04:04:55,714 --> 04:04:58,350 HYPOTHESIZE THE TREATMENT 6554 04:04:58,417 --> 04:04:59,985 EXPECTANCY AND WOULD BE GREATER 6555 04:05:00,052 --> 04:05:03,655 IN WOMEN COMPARED TO MEN BASED 6556 04:05:03,722 --> 04:05:08,894 ON PREVIOUS STUDY ON SEX 6557 04:05:08,960 --> 04:05:11,897 DIFFERENCES, WOMEN WITH TMD 6558 04:05:11,963 --> 04:05:12,464 EXPERIENCE GREATER PLACEBO 6559 04:05:12,531 --> 04:05:16,134 EFFECTS COMPARED TO MEN. 6560 04:05:16,201 --> 04:05:18,470 WE THOUGHT HIGHER TESTOSTERONE 6561 04:05:18,537 --> 04:05:19,704 WOULD BE ASSOCIATED WITH HIGHER 6562 04:05:19,771 --> 04:05:22,941 PAIN TOLERANCE. 6563 04:05:23,008 --> 04:05:25,143 WE COLLECTED SPECIMEN OF BLOOD 6564 04:05:25,210 --> 04:05:27,546 AND SALIVA FOR HORMONE ANALYSIS 6565 04:05:27,612 --> 04:05:28,080 AS WELL AS PSYCHOLOGICAL 6566 04:05:28,146 --> 04:05:31,716 ASSESSMENT. 6567 04:05:31,783 --> 04:05:33,285 WE CONDUCTED PAIN SENSITIVITY 6568 04:05:33,351 --> 04:05:35,620 ASSESSMENTS DETERMINE HIGH AND 6569 04:05:35,687 --> 04:05:37,322 LOW THERMAL PAIN LEVELS 6570 04:05:37,389 --> 04:05:41,726 TAILORED TO EACH PARTICIPANT. 6571 04:05:41,793 --> 04:05:43,762 PARTICIPANTS WERE TOLD 6572 04:05:43,829 --> 04:05:45,564 ELECTRODE DELIVERED ON THE 6573 04:05:45,630 --> 04:05:47,032 MIDDLE FINGER WOULD BE 6574 04:05:47,099 --> 04:05:49,301 EFFECTIVE FOR PAIN REDUCTION. 6575 04:05:49,367 --> 04:05:56,374 THEY WERE TOLD SEEING A GREEN 6576 04:05:56,441 --> 04:05:57,576 SCREEN WOULD PROVIDE PAIN 6577 04:05:57,642 --> 04:06:02,214 RELIEF AND RED WAS OFF. 6578 04:06:02,280 --> 04:06:03,148 THE RED SCREEN WAS CORRELATED 6579 04:06:03,215 --> 04:06:05,250 WITH HIGH PAIN. 6580 04:06:05,317 --> 04:06:06,751 DURING THE TESTING PHASE BOTH 6581 04:06:06,818 --> 04:06:08,353 WERE PAIRED WITH A MODERATE 6582 04:06:08,420 --> 04:06:09,988 PAIN TO TEST FOR PLACEBO 6583 04:06:10,055 --> 04:06:12,023 EFFECTS. 6584 04:06:12,090 --> 04:06:12,858 PRESENTATIONS WERE IN A COUNTER 6585 04:06:12,924 --> 04:06:13,825 BALANCE MEASURE. 6586 04:06:13,892 --> 04:06:16,061 WHAT DID WE FIND? 6587 04:06:16,128 --> 04:06:20,565 WE FOUND THAT WOMEN WITH CMB 6588 04:06:20,632 --> 04:06:21,666 DEMONSTRATED GREATER REINFORCED 6589 04:06:21,733 --> 04:06:23,268 EXPECTATIONS AND POST TEST 6590 04:06:23,335 --> 04:06:24,202 EXPECTATIONS COMPARED TO MEN 6591 04:06:24,269 --> 04:06:25,871 WITH TMD. 6592 04:06:25,937 --> 04:06:29,374 WE OBSERVED THAT WOMEN IN BOTH 6593 04:06:29,441 --> 04:06:32,611 TMD AND HEALTHY GROUPS SHOWED 6594 04:06:32,677 --> 04:06:33,278 LARGER PLACEBO EFFECTS COMPARED 6595 04:06:33,345 --> 04:06:38,783 TO MEN. 6596 04:06:38,850 --> 04:06:40,652 TESTOSTERONE WAS CORRELATED 6597 04:06:40,719 --> 04:06:41,153 WITH GREATER HEAT PAIN 6598 04:06:41,219 --> 04:06:44,723 TOLERANCE. 6599 04:06:44,789 --> 04:06:45,857 OVERALL UNDERSTANDING OF SEXUAL 6600 04:06:45,924 --> 04:06:48,560 -- PAIN IS CRITICAL FOR 6601 04:06:48,627 --> 04:06:49,294 DEMONSTRATING RELEVANCE 6602 04:06:49,361 --> 04:06:51,596 INCLUDING SEX AS A FACTOR THAT 6603 04:06:51,663 --> 04:06:52,430 COULD INFLUENCE INTERPRETATION 6604 04:06:52,497 --> 04:06:56,034 OF TRIALS IN CLINICAL OUTCOMES. 6605 04:06:56,101 --> 04:07:00,872 WE WOULD LIKE TO THANK THE 6606 04:07:00,939 --> 04:07:02,073 NICDR AND NIH FOR FACILITATING 6607 04:07:02,140 --> 04:07:02,374 THIS WORK. 6608 04:07:02,440 --> 04:07:04,209 THANK YOU. 6609 04:07:04,276 --> 04:07:10,081 >> HELLO, MY NAME IS WEI JAN. 6610 04:07:10,148 --> 04:07:13,485 OUT OF UNIVERSITY OF PITTSBURGH. 6611 04:07:13,552 --> 04:07:14,286 LIFE TRIGGERED LOCAL AN THEES 6612 04:07:14,352 --> 04:07:23,929 SHA. 6613 04:07:23,995 --> 04:07:27,265 LOCAL ANESTHETICS ARE A GREAT 6614 04:07:27,332 --> 04:07:27,799 ALTERNATIVE FOR TREATING 6615 04:07:27,866 --> 04:07:29,968 LOCALIZED PAIN. 6616 04:07:30,035 --> 04:07:34,372 HOWEVER SHORT DURATION OF 6617 04:07:34,439 --> 04:07:34,973 ACTION NECESSITATES REPEATED 6618 04:07:35,040 --> 04:07:36,608 INJECTION. 6619 04:07:36,675 --> 04:07:46,751 EVEN WHEN THE DURATION COULD BE 6620 04:07:46,818 --> 04:07:48,286 EXTENDED WITH THESE SYSTEMS, 6621 04:07:48,353 --> 04:07:51,790 THERE IS A CRITICAL NEED TO 6622 04:07:51,856 --> 04:07:53,625 DEVELOP LOCAL AND STATIC 6623 04:07:53,692 --> 04:07:56,127 RELEASE SYSTEM WHICH AFTER 6624 04:07:56,194 --> 04:07:57,395 FIRST ADMINISTRATION, MULTIPLE 6625 04:07:57,462 --> 04:07:59,831 EVENTS OF LOCAL ANESTHESIA CAN 6626 04:07:59,898 --> 04:08:01,866 BE TREATED AGAIN. 6627 04:08:01,933 --> 04:08:05,403 ONLY WHEN AND WHERE IT IS 6628 04:08:05,470 --> 04:08:05,637 NEEDED. 6629 04:08:05,704 --> 04:08:08,106 TO ACHIEVE THIS GOAL WE HAVE 6630 04:08:08,173 --> 04:08:13,211 THIS RESPONSIVE CONJUGATE. 6631 04:08:13,278 --> 04:08:17,415 IN THE DESIGN WE SELECT 6632 04:08:17,482 --> 04:08:26,391 TETRACAINE BECAUSE OF 6633 04:08:26,458 --> 04:08:33,832 RELATIVELY HIGH POTENCY. 6634 04:08:33,898 --> 04:08:36,635 WE SELECTED COUMARIN AS LINKAGE 6635 04:08:36,701 --> 04:08:37,802 BECAUSE OF GOOD PHOTO CLEAVAGE 6636 04:08:37,869 --> 04:08:39,671 EFFICIENCY. 6637 04:08:39,738 --> 04:08:41,306 THE MATERIAL SHOWED STRONG 6638 04:08:41,373 --> 04:08:46,011 ADOPTION IN THE BLUE RANGE AND 6639 04:08:46,077 --> 04:08:46,578 SHOWED MODULATION NEAR BODY 6640 04:08:46,645 --> 04:08:48,680 TEMPERATURE. 6641 04:08:48,747 --> 04:08:53,051 THE ABILITY OF THE MATERIAL TO 6642 04:08:53,118 --> 04:08:54,519 RELEASE TETRACAINE WAS ALSO 6643 04:08:54,586 --> 04:08:57,255 STARTED IN VITRO. 6644 04:08:57,322 --> 04:09:03,328 NEXT WE TEST THE MATERIALS IN 6645 04:09:03,395 --> 04:09:05,563 VIVO EFFICACY USE A RAT MODEL. 6646 04:09:05,630 --> 04:09:08,400 WE CAN SEE THE DRUG WAS 6647 04:09:08,466 --> 04:09:10,101 INACTIVATED WHEN CONJUGATED TO 6648 04:09:10,168 --> 04:09:14,239 THE POLYMER AND THERE'S NO 6649 04:09:14,306 --> 04:09:17,075 ANESTHETIC EFFECT UNLESS THE 6650 04:09:17,142 --> 04:09:21,246 INJECTION SITE WAS IRRADIATED 6651 04:09:21,313 --> 04:09:24,683 WITH L.E.D. 6652 04:09:24,749 --> 04:09:28,687 IT COULD BE MODERATED BY 6653 04:09:28,753 --> 04:09:30,322 ADJUSTING IRRADIATION AND COULD 6654 04:09:30,388 --> 04:09:31,089 BE TRIGGERED AND REPEATED AGAIN 6655 04:09:31,156 --> 04:09:32,857 AND AGAIN. 6656 04:09:32,924 --> 04:09:33,825 WE ALSO CHECKED BIO 6657 04:09:33,892 --> 04:09:36,261 COMPATIBILITY OF THE MATERIAL. 6658 04:09:36,328 --> 04:09:39,130 THE TISSUE REACTION WAS SIMILAR 6659 04:09:39,197 --> 04:09:44,469 TO THAT BY THE TETRACAINE, 6660 04:09:44,536 --> 04:09:45,203 INDICATING THE MATERIAL WAS 6661 04:09:45,270 --> 04:09:46,771 SAFE TO BE USED. 6662 04:09:46,838 --> 04:09:50,408 LAST BUT NOT LEAST WE 6663 04:09:50,475 --> 04:09:51,710 DEMONSTRATED THAT SUCH DRUG 6664 04:09:51,776 --> 04:09:54,145 SYSTEM DESIGN COULD ALSO BE 6665 04:09:54,212 --> 04:09:54,746 GENERALLY APPLICABLE TO OTHER 6666 04:09:54,813 --> 04:09:55,480 DRUGS. 6667 04:09:55,547 --> 04:10:02,053 THANK YOU. 6668 04:10:02,120 --> 04:10:09,728 >> HI, EVERYONE, I'M A POST DOC. 6669 04:10:09,794 --> 04:10:12,330 I'M HAPPY TO PRESENT MY POSTER, 6670 04:10:12,397 --> 04:10:13,932 THE TITLE IS ENHANCING PAIN 6671 04:10:13,998 --> 04:10:16,868 ASSESSMENT ACCURACY. 6672 04:10:16,935 --> 04:10:18,803 THE IMPACT OF REAL-TIME 6673 04:10:18,870 --> 04:10:21,506 FEEDBACK AND TARGET RELIABILITY 6674 04:10:21,573 --> 04:10:22,140 ON INTERPRETING EXPRESSIONS OF 6675 04:10:22,207 --> 04:10:26,177 THEM. 6676 04:10:26,244 --> 04:10:27,879 FACIAL RESPONSE TO PAIN ARE 6677 04:10:27,946 --> 04:10:30,048 NEED FOR SOCIAL SUPPORT AND 6678 04:10:30,115 --> 04:10:31,216 CLINICAL ATTENTION. 6679 04:10:31,282 --> 04:10:36,654 TRAINING WITH FEEDBACK CAN 6680 04:10:36,721 --> 04:10:37,589 ENHANCE INDIVIDUALS' 6681 04:10:37,655 --> 04:10:38,323 PERFORMANCE TO RECOGNIZE 6682 04:10:38,390 --> 04:10:46,664 EMOTIONAL CUES IN OTHERS. 6683 04:10:46,731 --> 04:10:49,200 THE ROLE OF QUANTIFIED FEEDBACK 6684 04:10:49,267 --> 04:10:52,637 UNDERLYING EMOTION RECOGNITION 6685 04:10:52,704 --> 04:10:53,972 PARTICULARLY PAIN RECOGNITION 6686 04:10:54,038 --> 04:10:58,176 AND THE INFLUENCE OF TARGETS 6687 04:10:58,243 --> 04:11:01,045 REMAINS LARGELY UNEXPLORED. 6688 04:11:01,112 --> 04:11:02,614 OUR HYPOTHESES, FEEDBACK 6689 04:11:02,680 --> 04:11:03,314 IMPROVED PARTICIPANTS 6690 04:11:03,381 --> 04:11:06,217 RECOGNITION ACCURACY OF PAIN 6691 04:11:06,284 --> 04:11:07,452 BOTH FOR DISTINGUISHING BETWEEN 6692 04:11:07,519 --> 04:11:09,788 EXPRESSIONS OF PAIN AND NO PAIN 6693 04:11:09,854 --> 04:11:11,556 AND ASSESSING THE INTENSITY OF 6694 04:11:11,623 --> 04:11:15,960 PAIN EXPERIENCED BY OTHERS. 6695 04:11:16,027 --> 04:11:18,096 PERSONS IN BOTH GROUPS 6696 04:11:18,163 --> 04:11:21,933 CALCULATED PAIN VERSUS NO PAIN 6697 04:11:22,000 --> 04:11:23,201 JUDGMENT TASK AND PAIN 6698 04:11:23,268 --> 04:11:26,171 INTENSITY JUDGMENT TASK. 6699 04:11:26,237 --> 04:11:27,872 FOR BOTH GROUPS SHOWING TARGET 6700 04:11:27,939 --> 04:11:32,010 VISUAL RESPONSES WHEN THIS 6701 04:11:32,076 --> 04:11:33,311 PERSON WAS RECEIVING 6702 04:11:33,378 --> 04:11:37,081 STIMULATION ON LEFT ARM. 6703 04:11:37,148 --> 04:11:38,583 AFTER RATED EITHER PAIN OR NO 6704 04:11:38,650 --> 04:11:41,519 PAIN FOR THE TARGET OR HOW MUCH 6705 04:11:41,586 --> 04:11:42,454 PAIN THEY THOUGHT THE TARGET 6706 04:11:42,520 --> 04:11:43,588 WAS GIVEN. 6707 04:11:43,655 --> 04:11:49,093 AFTER THE RATING, PERSON IN THE 6708 04:11:49,160 --> 04:11:50,795 FEEDBACK GROUP SHOW THE REAL 6709 04:11:50,862 --> 04:11:54,265 TARGET OF THE PAIN FEEDBACK. 6710 04:11:54,332 --> 04:11:56,568 MULTI-MODAL ANALYSIS SHOW FOR 6711 04:11:56,634 --> 04:11:59,170 BOTH TASK FEEDBACK GROUP MORE 6712 04:11:59,237 --> 04:11:59,737 ACCURACY COMPARED WITH NO 6713 04:11:59,804 --> 04:12:03,341 FEEDBACK GROUP. 6714 04:12:03,408 --> 04:12:04,742 PERSON THAT DEMONSTRATED 6715 04:12:04,809 --> 04:12:05,777 DISTINGUISHED LEARNING 6716 04:12:05,844 --> 04:12:07,779 PERFORMANCE ON DIFFERENT TASKS 6717 04:12:07,846 --> 04:12:08,947 ACROSS BOTH FEEDBACK AND NO 6718 04:12:09,013 --> 04:12:11,850 FEEDBACK GROUP. 6719 04:12:11,916 --> 04:12:13,952 PARTICULARLY WHEN JUDGING PAIN 6720 04:12:14,018 --> 04:12:15,653 INTENSITY, FEEDBACK GROUP 6721 04:12:15,720 --> 04:12:18,590 SHOWED DIFFERENT LEARNING 6722 04:12:18,656 --> 04:12:19,691 PERFORMANCE ON DIFFERENT 6723 04:12:19,757 --> 04:12:22,227 TARGETS COMPARED TO NO FEEDBACK 6724 04:12:22,293 --> 04:12:22,494 GROUP. 6725 04:12:22,560 --> 04:12:24,462 IN CONCLUSION FEEDBACK IMPROVE 6726 04:12:24,529 --> 04:12:25,563 LEARNING PERFORMANCE IN BOTH 6727 04:12:25,630 --> 04:12:27,365 JUDGING PAIN AND NO PAIN AND 6728 04:12:27,432 --> 04:12:29,701 JUDGING PAIN INTENSITY. 6729 04:12:29,767 --> 04:12:34,038 THE SECOND LEARNING EFFECT WAS 6730 04:12:34,105 --> 04:12:34,672 MODULATED BY TARGET RELIABILITY. 6731 04:12:34,739 --> 04:12:36,407 THIS RESEARCH CONTRIBUTE TO OUR 6732 04:12:36,474 --> 04:12:37,575 UNDERSTANDING HOW THE 6733 04:12:37,642 --> 04:12:40,178 MECHANISMS CAN IMPROVE THE 6734 04:12:40,245 --> 04:12:42,514 ACCURACY OF PAIN WITH OTHERS 6735 04:12:42,580 --> 04:12:44,649 WITH POTENTIAL IMPLICATIONS FOR 6736 04:12:44,716 --> 04:12:46,818 MEDICAL PROFESSIONALS IN 6737 04:12:46,885 --> 04:12:47,585 OPTIMIZING PAIN ASSESSMENT AND 6738 04:12:47,652 --> 04:12:47,986 MANAGE STRATEGIES. 6739 04:12:48,052 --> 04:12:50,455 THANK YOU. 6740 04:12:50,522 --> 04:12:52,557 GOOD AFTERNOON. 6741 04:12:52,624 --> 04:12:54,492 WELCOME TO THE AFTERNOON 6742 04:12:54,559 --> 04:12:56,995 SESSION OF THE PAIN CONSORTIUM 6743 04:12:57,061 --> 04:12:57,228 MEETING. 6744 04:12:57,295 --> 04:12:58,596 I'M DAVE THOMAS WITH THE 6745 04:12:58,663 --> 04:13:00,265 RESEARCH IN WOMEN'S HEALTH. 6746 04:13:00,331 --> 04:13:03,167 IT'S A SUPER BIG HONOR FOR ME 6747 04:13:03,234 --> 04:13:05,937 TO PRESENT, OR INTRODUCE THE 6748 04:13:06,004 --> 04:13:09,841 MITCHELL MAX SESSION TODAY. 6749 04:13:09,908 --> 04:13:10,942 I KNEW MITCHELL VERY WELL FOR 6750 04:13:11,009 --> 04:13:13,278 MANY YEARS. 6751 04:13:13,344 --> 04:13:15,346 HE IS A BRILLIANT PAIN 6752 04:13:15,413 --> 04:13:18,416 RESEARCHER AND A BRILLIANT 6753 04:13:18,483 --> 04:13:19,951 CLINICIAN WHO WORKED AT NIDR, 6754 04:13:20,018 --> 04:13:21,653 FOR THOSE OF YOU WHO WEREN'T 6755 04:13:21,719 --> 04:13:22,787 AROUND THERE THAT WAS THE 6756 04:13:22,854 --> 04:13:24,789 DENTAL INSTITUTE. 6757 04:13:24,856 --> 04:13:27,225 HE WAS A FRIEND, A COLLEAGUE, A 6758 04:13:27,292 --> 04:13:28,993 MENTOR TO SO MANY AND ALL THOSE 6759 04:13:29,060 --> 04:13:34,165 THINGS TO ME. 6760 04:13:34,232 --> 04:13:36,701 IT WAS SUCH AN HONOR TO HAVE A 6761 04:13:36,768 --> 04:13:38,836 PILLAR IN THE PAIN FIELD TEACH 6762 04:13:38,903 --> 04:13:42,874 ME AND WHEN I WAS JUST A NEWBIE 6763 04:13:42,941 --> 04:13:45,910 IN THE PAIN FIELD. 6764 04:13:45,977 --> 04:13:48,746 AND THE NIDR PAIN LAB WAS WORLD 6765 04:13:48,813 --> 04:13:50,248 RENOWNED. 6766 04:13:50,315 --> 04:13:51,416 IT REALLY WAS, FOLKS FROM 6767 04:13:51,482 --> 04:13:52,417 AROUND THE WORLD CAME TO BE IN 6768 04:13:52,483 --> 04:13:55,787 THAT LAB. 6769 04:13:55,853 --> 04:13:58,323 THEY ROTATE IN 2-3 YEARS TO 6770 04:13:58,389 --> 04:13:59,724 LEARN AND MITCHELL WAS EYE 6771 04:13:59,791 --> 04:14:00,959 ESSENTIAL TO THAT LEARNING THAT 6772 04:14:01,025 --> 04:14:02,560 HAPPENED WHEN PEOPLE CAME IN. 6773 04:14:02,627 --> 04:14:05,496 I'M SO GLAD THE PAIN CONSORTIUM 6774 04:14:05,563 --> 04:14:07,832 HONORS HIS LEGACY WITH A 6775 04:14:07,899 --> 04:14:09,367 SESSION AND THAT IT ALSO 6776 04:14:09,434 --> 04:14:12,170 HIGHLIGHTS SO MANY PEOPLE THAT 6777 04:14:12,236 --> 04:14:13,705 ARE EARLY IN THEIR CAREERS SO 6778 04:14:13,771 --> 04:14:17,542 IT'S ALL GOOD THINGS. 6779 04:14:17,609 --> 04:14:18,409 CAN I HAVE THE NEXT SLIDE, 6780 04:14:18,476 --> 04:14:25,650 PLEASE? 6781 04:14:25,717 --> 04:14:29,554 BUT THIS YEAR I WILL SAY A 6782 04:14:29,621 --> 04:14:30,955 LITTLE BIT ABOUT MITCHELL AND 6783 04:14:31,022 --> 04:14:32,790 THE CONTEXT OF WHERE HE WORKED 6784 04:14:32,857 --> 04:14:37,962 AND WHO THEY WERE. 6785 04:14:38,029 --> 04:14:42,300 HERE SAY 1994 VERSION OF 6786 04:14:42,367 --> 04:14:43,868 NEUROLOGY AND ANESTHESIA LAB 6787 04:14:43,935 --> 04:14:44,135 INSTITUTE. 6788 04:14:44,202 --> 04:14:45,703 THE LAB STARTED IN THE EARLY 6789 04:14:45,770 --> 04:14:47,271 70s AND CONTINUED FOR MANY 6790 04:14:47,338 --> 04:14:49,440 YEARS AFTER THIS PHOTO WAS 6791 04:14:49,507 --> 04:14:50,041 TAKEN. 6792 04:14:50,108 --> 04:14:53,011 I KNEW MANY OF THE PEOPLE IN 6793 04:14:53,077 --> 04:14:53,311 THIS PHOTO. 6794 04:14:53,378 --> 04:14:55,013 I'M NOT PICTURED BUT IT ALMOST 6795 04:14:55,079 --> 04:14:56,614 FEELS LIKE YESTERDAY WE WERE 6796 04:14:56,681 --> 04:15:00,018 ALL THIS TEAM WORKING ON THIS 6797 04:15:00,084 --> 04:15:00,752 MISSION TOGETHER. 6798 04:15:00,818 --> 04:15:02,186 SOME OF THE PEOPLE IN THE 6799 04:15:02,253 --> 04:15:06,958 PICTURE ARE STILL AT THE NIH. 6800 04:15:07,025 --> 04:15:08,526 THAT INCLUDES MIKE IDEROLA, 6801 04:15:08,593 --> 04:15:12,997 DONNA MESSERSMITH. 6802 04:15:13,064 --> 04:15:18,136 RIGHT NEXT TO MITCHELL. 6803 04:15:18,202 --> 04:15:20,138 AND SUE MANIS WHO WILL CHAIR 6804 04:15:20,204 --> 04:15:21,673 ONE OF OUR SESSIONS LATER ON. 6805 04:15:21,739 --> 04:15:24,909 AND OTHERS IN THE LAB NOT IN 6806 04:15:24,976 --> 04:15:27,912 THE PHOTO INCLUDE WENDY SMITH, 6807 04:15:27,979 --> 04:15:33,785 RICHARD NAHAN JUCH OVER THERE 6808 04:15:33,851 --> 04:15:35,019 ANSWERING QUESTIONS AND INNA 6809 04:15:35,086 --> 04:15:36,320 BELFER. 6810 04:15:36,387 --> 04:15:37,455 IT'S ALMOST LIKE COMING HOME 6811 04:15:37,522 --> 04:15:39,991 WHEN WE COME TO THESE MEETINGS. 6812 04:15:40,058 --> 04:15:41,359 THE LAB WAS TRANSLATIONAL 6813 04:15:41,426 --> 04:15:42,460 BEFORE THE CONCEPT OF 6814 04:15:42,527 --> 04:15:44,128 TRANSLATION WAS CREATED. 6815 04:15:44,195 --> 04:15:47,031 FROM CELLS TO RATS TO NON HUMAN 6816 04:15:47,098 --> 04:15:48,166 PRIMATES TO PEOPLE. 6817 04:15:48,232 --> 04:15:49,534 AND THE BASIC RESEARCHERS WOULD 6818 04:15:49,600 --> 04:15:51,402 GO INTO THE CLINIC AND HELP 6819 04:15:51,469 --> 04:15:53,204 WITH THE CLINICAL STUFF AND 6820 04:15:53,271 --> 04:15:54,505 LEARN FROM THE CLINICAL STUFF 6821 04:15:54,572 --> 04:15:55,540 AND CLINICAL PEOPLE IN THE 6822 04:15:55,606 --> 04:15:57,742 GROUP WOULD COME BACK TO THE 6823 04:15:57,809 --> 04:15:58,876 BASIC RESEARCHERS AND WE WOULD 6824 04:15:58,943 --> 04:16:01,446 ALL INTERMIX. 6825 04:16:01,512 --> 04:16:05,249 SOMETIMES ALL BE INVOLVED WITH 6826 04:16:05,316 --> 04:16:07,819 THE EXPERIENCE. 6827 04:16:07,885 --> 04:16:12,290 FOR EXAMPLE A DOC LIKE ME GOT 6828 04:16:12,356 --> 04:16:13,791 INJECTED WITH CAPSAICIN TO SEE 6829 04:16:13,858 --> 04:16:16,661 IF IT HURTS AND IT DOES, SO 6830 04:16:16,728 --> 04:16:16,994 DON'T DO THAT. 6831 04:16:17,061 --> 04:16:19,263 AND JUST, I WOULD LIKE TO PAY 6832 04:16:19,330 --> 04:16:20,665 TRIBUTE TO A COUPLE SIGNIFICANT 6833 04:16:20,732 --> 04:16:23,034 PEOPLE FROM THIS GROUP THAT ARE 6834 04:16:23,101 --> 04:16:24,402 NO LONGER WITH US. 6835 04:16:24,469 --> 04:16:28,039 FIRST MRS. RONALD DUBNER. 6836 04:16:28,106 --> 04:16:32,977 -- MR. RONALD DUBNER. 6837 04:16:33,044 --> 04:16:33,544 VISIONARY AND TRANSLATIONAL 6838 04:16:33,611 --> 04:16:34,812 RESEARCHER. 6839 04:16:34,879 --> 04:16:36,614 WORLD EXPERT ON PAIN AND EVEN 6840 04:16:36,681 --> 04:16:39,250 AFTER HE LEFT NIH IN THE LATE 6841 04:16:39,317 --> 04:16:41,152 90s, HE CONTINUED TO COME AND 6842 04:16:41,219 --> 04:16:45,189 BE PART OF THE VARIOUS PAIN 6843 04:16:45,256 --> 04:16:46,023 ACTIVITIES LIKE PAIN CONSORTIUM 6844 04:16:46,090 --> 04:16:47,725 ACTIVITIES AND THINGS LIKE THAT. 6845 04:16:47,792 --> 04:16:52,363 SO HE WAS STILL PART OF THE NIH 6846 04:16:52,430 --> 04:16:54,332 UNTIL HE WAS GONE. 6847 04:16:54,398 --> 04:16:55,533 I REALLY WANTED TO DRAW 6848 04:16:55,600 --> 04:17:05,143 ATTENTION TO THE WOMAN AT THE 6849 04:17:05,209 --> 04:17:07,745 TOP RIGHT, EMMA RUTA, DEPUTY TO 6850 04:17:07,812 --> 04:17:10,782 RON DEBNER IN THAT GROUP. 6851 04:17:10,848 --> 04:17:18,189 SHE DISCOVERED OPIOID RECEPTORS 6852 04:17:18,256 --> 04:17:23,795 ON PRIMARY AMARINTHS. 6853 04:17:23,861 --> 04:17:28,266 I MENTION HER, SHE WAS 6854 04:17:28,332 --> 04:17:31,269 PROMOTING THE NEED TO STUDY MEN 6855 04:17:31,335 --> 04:17:35,907 AND WOMEN'S PAIN WAY BACK THEN. 6856 04:17:35,973 --> 04:17:38,709 SHE PUT OUT A ARTICLE OR 6857 04:17:38,776 --> 04:17:40,678 EDITORIAL IN PAIN IN 1993 6858 04:17:40,745 --> 04:17:44,182 TALKING ABOUT HOW WE HAVE TO 6859 04:17:44,248 --> 04:17:45,817 INCLUDE MALES AND FEMALES. 6860 04:17:45,883 --> 04:17:47,952 SHE WAS MAKING THE SAME CASE WE 6861 04:17:48,019 --> 04:17:50,955 ARE MAKING TODAY WAY BACK THEN. 6862 04:17:51,022 --> 04:17:52,990 DO NOTE SHE CALLED IT GENDER 6863 04:17:53,057 --> 04:17:55,693 BACK THEN BECAUSE I GUESS NOW I 6864 04:17:55,760 --> 04:17:57,028 LEARNED IT'S BECAUSE OF AIDS 6865 04:17:57,094 --> 04:17:58,863 BUT THAT WAS AN ISSUE OF 6866 04:17:58,930 --> 04:18:00,965 CALLING IT SEX OR GENDER. 6867 04:18:01,032 --> 04:18:04,068 IN FACT IN HER ARTICLE SHE 6868 04:18:04,135 --> 04:18:07,038 MENTIONS THAT DILEMMA. 6869 04:18:07,104 --> 04:18:08,773 SO SHE WAS A PIONEER. 6870 04:18:08,840 --> 04:18:12,810 THE COVER PAIN FOR A WHOLE YEAR 6871 04:18:12,877 --> 04:18:15,513 RAN THIS COVER JUST TO RAISE 6872 04:18:15,580 --> 04:18:23,221 AWARENESS OF THE ISSUE. 6873 04:18:23,287 --> 04:18:25,489 SO I THINK GETTING BACK TO 6874 04:18:25,556 --> 04:18:26,858 MITCHELL, MITCHELL WAS PART OF 6875 04:18:26,924 --> 04:18:29,260 THE LAB BUT THE LAB WAS PART OF 6876 04:18:29,327 --> 04:18:29,594 MITCHELL. 6877 04:18:29,660 --> 04:18:30,928 ALL OF US, WE STILL SAY WE ARE 6878 04:18:30,995 --> 04:18:32,597 FROM THAT LAB. 6879 04:18:32,663 --> 04:18:34,398 SO IN SOME WAYS I FEEL LIKE 6880 04:18:34,465 --> 04:18:37,768 THIS AWARD IS A LITTLE BIT AN 6881 04:18:37,835 --> 04:18:39,704 AWARD FOR THAT LAB TOO. 6882 04:18:39,770 --> 04:18:41,939 I JUST WANT TO PUT MITCHELL IN 6883 04:18:42,006 --> 04:18:44,675 CONTEXT AND SHARE SOME OF THE 6884 04:18:44,742 --> 04:18:45,676 GREATNESS THAT HAPPENED YEARS 6885 04:18:45,743 --> 04:18:49,914 AGO AT THE NIH. 6886 04:18:49,981 --> 04:18:55,753 TODAY WE ARE GOING TO GIVE, WE 6887 04:18:55,820 --> 04:18:58,856 ARE HAVING THREE PRESENTATIONS 6888 04:18:58,923 --> 04:19:01,425 IN THE MITCHELL MAX SESSION. 6889 04:19:01,492 --> 04:19:06,163 AND THE PROCESS THAT WE HAVE 6890 04:19:06,230 --> 04:19:09,934 USED IS TO PEOPLE YOUNG NEW 6891 04:19:10,001 --> 04:19:12,436 INVESTIGATORS WHO SUBMITTED 6892 04:19:12,503 --> 04:19:13,537 POSTERS, THE NIH PAIN 6893 04:19:13,604 --> 04:19:15,473 CONSORTIUM WOULD REVIEW THEM, 6894 04:19:15,539 --> 04:19:17,608 THEY ARE ALL GREAT BUT WE 6895 04:19:17,675 --> 04:19:19,076 NARROWED THEM TO THREE AND 6896 04:19:19,143 --> 04:19:21,746 ASKED THOSE PEOPLE TO PRESENT. 6897 04:19:21,812 --> 04:19:23,748 AND THEN AFTER THE 6898 04:19:23,814 --> 04:19:26,384 PRESENTATION, PAIN CONSORTIUM 6899 04:19:26,450 --> 04:19:29,754 MEMBERS ARE GOING TO RANK THE 6900 04:19:29,820 --> 04:19:30,855 PRESENTATIONS AND THEN WE WILL 6901 04:19:30,922 --> 04:19:33,491 COME UP WITH A WINNER THAT WILL 6902 04:19:33,557 --> 04:19:35,192 BE ANNOUNCED LATER TODAY. 6903 04:19:35,259 --> 04:19:38,963 AND THAT PERSON WILL BECOME 6904 04:19:39,030 --> 04:19:44,802 PART OF PAIN CONSORTIUM HISTORY. 6905 04:19:44,869 --> 04:19:47,939 OUR THREE PRESENTERS ARE FIRST 6906 04:19:48,005 --> 04:19:48,873 DR. KENDRA CAMP, ASSOCIATE 6907 04:19:48,940 --> 04:19:55,413 PROFESSOR IN THE DEPARTMENT OF 6908 04:19:55,479 --> 04:19:57,448 NEUROBIOLOGICAL BIO BEHAVIORAL 6909 04:19:57,515 --> 04:19:59,116 NURSING AND HEALTH INFORMATICS 6910 04:19:59,183 --> 04:20:01,686 AT THE UNIVERSITY OF WASHINGTON. 6911 04:20:01,752 --> 04:20:06,357 AND THE DIRECTOR OF THE 6912 04:20:06,424 --> 04:20:08,392 GASTROINTESTINAL HEALTH AND 6913 04:20:08,459 --> 04:20:08,726 WELLNESS LAB. 6914 04:20:08,793 --> 04:20:09,994 HER RESEARCH FOCUSES ON 6915 04:20:10,061 --> 04:20:11,629 UNDERSTANDING AND IMPROVING, 6916 04:20:11,696 --> 04:20:19,036 INCLUDING ABDOMINAL PAIN, 6917 04:20:19,103 --> 04:20:21,973 FATIGUE AND SLEEP DISTURBANCES 6918 04:20:22,039 --> 04:20:22,573 ASSOCIATED WITH INFLAMMATORY 6919 04:20:22,640 --> 04:20:23,674 BOWEL DISEASE. 6920 04:20:23,741 --> 04:20:24,775 THE SECOND, I WILL ANNOUNCE 6921 04:20:24,842 --> 04:20:26,277 THEM FOR THE KICKOFF HERE SO I 6922 04:20:26,344 --> 04:20:29,380 DON'T GET IN THE WAY LATER ON. 6923 04:20:29,447 --> 04:20:32,350 THE SECOND SPEAKER WILL BE DR. 6924 04:20:32,416 --> 04:20:34,885 BRYAN McIVER, WHO IS A RECENT 6925 04:20:34,952 --> 04:20:39,523 Ph.D. LEVEL GRADUATE AT THE LAB 6926 04:20:39,590 --> 04:20:42,426 OF DR. IMAN DUMAGE IN THE 6927 04:20:42,493 --> 04:20:47,398 DEPARTMENT OF PHARMACOLOGY AND 6928 04:20:47,465 --> 04:20:49,533 TOXICOLOGY AT VIRGINIA 6929 04:20:49,600 --> 04:20:50,034 COMMONWEALTH UNIVERSITY. 6930 04:20:50,101 --> 04:20:51,569 RESEARCH PRIMARILY FOCUSED ON 6931 04:20:51,635 --> 04:20:56,607 INVESTIGATING THE ROLE OF ASTRO 6932 04:20:56,674 --> 04:21:03,681 CYTES IN GENE 1 IN MAMMALS, 6933 04:21:03,748 --> 04:21:06,017 CHRONIC PAIN AND OPIOID INDUCED 6934 04:21:06,083 --> 04:21:09,754 NOSE SEPTEMBEROR. 6935 04:21:09,820 --> 04:21:14,458 HE HAS ACTED WITH CANCER 6936 04:21:14,525 --> 04:21:15,192 SURVIVAL PROGRAM AT MASSEY 6937 04:21:15,259 --> 04:21:18,796 CANCER CENTER. 6938 04:21:18,863 --> 04:21:20,631 LAST DR. CAROLYN PATTERSON 6939 04:21:20,698 --> 04:21:21,832 HEADACHE SPECIALIST AND 6940 04:21:21,899 --> 04:21:23,334 SCIENTIST AT CHILDRENS HOSPITAL 6941 04:21:23,401 --> 04:21:26,003 OF PHILADELPHIA AND ITS 6942 04:21:26,070 --> 04:21:27,004 ASSOCIATE PROFESSOR OF 6943 04:21:27,071 --> 04:21:31,542 NEUROLOGY AND PEDIATRICS AT THE 6944 04:21:31,609 --> 04:21:32,443 UNIVERSITY OF PENNSYLVANIA, 6945 04:21:32,510 --> 04:21:34,445 PEARLMAN SCHOOL OF MEDICINE. 6946 04:21:34,512 --> 04:21:36,781 HER RESEARCH FOCUSES ON 6947 04:21:36,847 --> 04:21:37,982 IMPROVING MIGRAINE DIAGNOSIS 6948 04:21:38,049 --> 04:21:45,890 AND IDENTIFYING EARLY 6949 04:21:45,956 --> 04:21:47,425 BIOMARKERS FOR PROLONGED 6950 04:21:47,491 --> 04:21:48,726 RECOVERY FROM CONCUSSION AND 6951 04:21:48,793 --> 04:21:52,129 HEAD INJURY IN YOUTH. 6952 04:21:52,196 --> 04:21:54,265 FIRST, DR. KENDRA. 6953 04:21:54,331 --> 04:21:55,699 I FORGOT TO SAY NEXT SLIDE, 6954 04:21:55,766 --> 04:22:05,876 SORRY. 6955 04:22:06,811 --> 04:22:08,612 >> THANK YOU. 6956 04:22:08,679 --> 04:22:11,515 THANK YOU SO MUCH, EVERYONE. 6957 04:22:11,582 --> 04:22:12,883 IT'S TRULY AN HONOR TO BE WITH 6958 04:22:12,950 --> 04:22:23,227 YOU HERE TODAY. 6959 04:22:25,096 --> 04:22:26,997 JUST WAIT A MOMENT FOR THE 6960 04:22:27,064 --> 04:22:28,999 SLIDES TO GET PULLED UP AND 6961 04:22:29,066 --> 04:22:30,434 THANK YOU TO THE I.T. TEAM FOR 6962 04:22:30,501 --> 04:22:33,070 ALL THE WORK YOU ARE DOING 6963 04:22:33,137 --> 04:22:34,038 BEHIND AND IN FRONT OF THE 6964 04:22:34,105 --> 04:22:35,172 SCENES. 6965 04:22:35,239 --> 04:22:45,583 YEP, THAT'S THE ONE. 6966 04:22:50,454 --> 04:22:53,057 ALL RIGHT, SO TODAY I WILL BE 6967 04:22:53,124 --> 04:22:55,693 TALKING ON GENDER AND SEX 6968 04:22:55,759 --> 04:22:57,728 DIFFERENCES AND ABDOMINAL PAIN 6969 04:22:57,795 --> 04:22:59,930 AND CORE SYMPTOMS IN FOLKS WITH 6970 04:22:59,997 --> 04:23:01,432 INFLAMMATORY BOWEL DISEASE AND 6971 04:23:01,499 --> 04:23:02,533 WE TOOK A NETWORK ANALYSIS 6972 04:23:02,600 --> 04:23:08,906 APPROACH. 6973 04:23:08,973 --> 04:23:11,842 SO I WANT TO THANK NIH AND 6974 04:23:11,909 --> 04:23:12,843 SPECIFICALLY THE NATIONAL 6975 04:23:12,910 --> 04:23:14,378 INSTITUTES OF NURSING RESEARCH 6976 04:23:14,445 --> 04:23:17,181 FOR SUPPORTING MYSELF THROUGH A 6977 04:23:17,248 --> 04:23:18,549 K-23, AS WELL AS SUPPORTING 6978 04:23:18,616 --> 04:23:22,253 OTHER MEMBERS OF MY TEAM 6979 04:23:22,319 --> 04:23:23,154 THROUGH OUR INSTITUTIONAL T-32 6980 04:23:23,220 --> 04:23:27,591 FUNDING AS WELL AS A PRE-DOC 6981 04:23:27,658 --> 04:23:31,228 AWARD AND 31 TO LINDA YU. 6982 04:23:31,295 --> 04:23:33,430 SOME WAS FUNDED THROUGH SIGMA 6983 04:23:33,497 --> 04:23:35,900 THETA TAO. 6984 04:23:35,966 --> 04:23:39,703 AND COLLEAGUES FUNDED BY 6985 04:23:39,770 --> 04:23:41,105 NATIONAL HEALTH INSTITUTES IN 6986 04:23:41,172 --> 04:23:43,474 TAIWAN. 6987 04:23:43,541 --> 04:23:44,575 BACKGROUND, INFLAMMATORY BOWEL 6988 04:23:44,642 --> 04:23:47,077 DISEASE IS KNOWN AS IBD. 6989 04:23:47,144 --> 04:23:47,611 IT'S A CHRONIC AUTOIMMUNE 6990 04:23:47,678 --> 04:23:49,413 CONDITION. 6991 04:23:49,480 --> 04:23:56,187 AND IT'S COMPRISED OF BOTH 6992 04:23:56,253 --> 04:23:57,721 ULCERATIVE COLITIS AND CRONE'S 6993 04:23:57,788 --> 04:23:59,190 DISEASE. 6994 04:23:59,256 --> 04:24:00,124 COMMONLY DIAGNOSED IN YOUNG 6995 04:24:00,191 --> 04:24:03,627 ADULTHOOD AROUND THE AGE OF 30. 6996 04:24:03,694 --> 04:24:04,461 THERE'S ANOTHER PEAK INCIDENCE 6997 04:24:04,528 --> 04:24:05,863 LATER IN LIFE AROUND THE AGE OF 6998 04:24:05,930 --> 04:24:08,098 60. 6999 04:24:08,165 --> 04:24:09,466 PRIMARY SYMPTOM PATIENTS 7000 04:24:09,533 --> 04:24:12,369 EXPERIENCE IS ABDOMINAL PAIN. 7001 04:24:12,436 --> 04:24:13,470 IN THE COURSE OF IBD CAN FLICT 7002 04:24:13,537 --> 04:24:16,674 WAIT. 7003 04:24:16,740 --> 04:24:18,709 -- FLUCTUATE. 7004 04:24:18,776 --> 04:24:19,810 PERIODS OF ACTIVE DISEASE AND 7005 04:24:19,877 --> 04:24:21,712 PERIODS OF REMISSION. 7006 04:24:21,779 --> 04:24:24,882 EVEN WHEN PATIENTS ARE IN 7007 04:24:24,949 --> 04:24:26,150 REMISSION ENDOSCOPICKLY THEY 7008 04:24:26,217 --> 04:24:28,118 CAN CONTINUE TO EXPERIENCE 7009 04:24:28,185 --> 04:24:30,621 SYMPTOMS SUCH AS ABDOMINAL PAIN. 7010 04:24:30,688 --> 04:24:33,357 WE SEE SYMPTOMS MAY VARY BASED 7011 04:24:33,424 --> 04:24:35,059 ON SEX AND/OR GENDER. 7012 04:24:35,125 --> 04:24:36,093 WE SEE FEMALES HAVE INCREASED 7013 04:24:36,160 --> 04:24:37,428 DISEASE BURDEN. 7014 04:24:37,494 --> 04:24:42,800 THEY HAVE A LONGER TIME TO 7015 04:24:42,866 --> 04:24:43,367 DIAGNOSIS, GREATER DISEASE 7016 04:24:43,434 --> 04:24:45,369 ACTIVITY, POORER QUALITY OF 7017 04:24:45,436 --> 04:24:45,869 LIFE. 7018 04:24:45,936 --> 04:24:47,972 AS ALREADY HAS BEEN HIGHLIGHTED 7019 04:24:48,038 --> 04:24:50,341 TODAY, THE PREVIOUS LITERATURE 7020 04:24:50,407 --> 04:24:53,244 CAN BE A BIT HARD TO EVALUATE 7021 04:24:53,310 --> 04:24:54,678 BASED ON DIFFERENT DEFINITIONS 7022 04:24:54,745 --> 04:24:56,614 OF SEX AND GENDER OR LACK OF 7023 04:24:56,680 --> 04:25:00,751 DEFINITIONS IN GENERAL. 7024 04:25:00,818 --> 04:25:02,052 AND FURTHERMORE, THERE'S AN 7025 04:25:02,119 --> 04:25:02,753 INADEQUATE REPRESENTATION IN 7026 04:25:02,820 --> 04:25:05,556 THE RESEARCH FOR THOSE WHO ARE 7027 04:25:05,623 --> 04:25:08,592 OUTSIDE THE GENDER BINARY. 7028 04:25:08,659 --> 04:25:11,228 SO THE AIMS OF THIS SPECIFIC 7029 04:25:11,295 --> 04:25:14,265 PROJECT WERE TO EXAMINE IF 7030 04:25:14,331 --> 04:25:15,866 ABDOMINAL PAIN DIFFERED BY 7031 04:25:15,933 --> 04:25:18,302 GENDER AND/OR SEX AND TO 7032 04:25:18,369 --> 04:25:19,303 EXPLORE THE RELATIONSHIPS 7033 04:25:19,370 --> 04:25:21,372 BETWEEN SYMPTOMS USING A 7034 04:25:21,438 --> 04:25:25,709 NETWORK ANALYSIS. 7035 04:25:25,776 --> 04:25:27,745 WE RECRUITED PARTICIPANTS 7036 04:25:27,811 --> 04:25:30,147 ONLINE THROUGH RESEARCH MATCH. 7037 04:25:30,214 --> 04:25:31,849 RESEARCH MATCH IS AN ONLINE 7038 04:25:31,915 --> 04:25:34,752 DATABASE OF INDIVIDUALS WHO ARE 7039 04:25:34,818 --> 04:25:36,086 INTERESTED IN PARTICIPATING IN 7040 04:25:36,153 --> 04:25:37,588 RESEARCH AND IT IS FUNDED BY 7041 04:25:37,655 --> 04:25:40,457 THE NIH. 7042 04:25:40,524 --> 04:25:42,660 WE RECRUITED ADULTS AGE 18 AND 7043 04:25:42,726 --> 04:25:44,728 OLDER WHO HAD IBD. 7044 04:25:44,795 --> 04:25:48,165 THEY COMPLETED A VARIETY OF 7045 04:25:48,232 --> 04:25:48,966 QUESTIONNAIRES INCLUDING 7046 04:25:49,033 --> 04:25:51,235 PROMISE SYMPTOM QUESTIONNAIRES 7047 04:25:51,302 --> 04:25:55,406 OF ABDOMINAL PAIN, FATIGUE, 7048 04:25:55,472 --> 04:25:56,073 SLEEP DISTURBANCE, 7049 04:25:56,140 --> 04:25:56,607 SLEEP-RELATED IMPAIRMENT, 7050 04:25:56,674 --> 04:25:57,574 ANXIETY AND DEPRESSION. 7051 04:25:57,641 --> 04:26:00,978 THEY ALSO COMPLETED A VARIETY 7052 04:26:01,045 --> 04:26:01,545 OF DEMOGRAPHIC AND CLINICAL 7053 04:26:01,612 --> 04:26:11,889 QUESTIONNAIRES. 7054 04:26:17,394 --> 04:26:20,397 WE DIVIDED INTO THREE 7055 04:26:20,464 --> 04:26:20,731 DEMOGRAPHICS. 7056 04:26:20,798 --> 04:26:22,366 THEY RESPONDED TO A QUESTION 7057 04:26:22,433 --> 04:26:24,435 REGARDING THEIR SEX ASSIGNED AT 7058 04:26:24,501 --> 04:26:25,402 BIRTH, AS FEMALE, MALE OR 7059 04:26:25,469 --> 04:26:28,305 PREFER NOT TO ANSWER. 7060 04:26:28,372 --> 04:26:30,808 THEY ALSO RESPONDED TO 7061 04:26:30,874 --> 04:26:35,746 SELF-IDENTIFIED GENDER 7062 04:26:35,813 --> 04:26:40,851 VARIABLES, MAN, WOMAN, 7063 04:26:40,918 --> 04:26:41,652 NON-BINARY, TRANSGENDER, GENDER 7064 04:26:41,719 --> 04:26:43,821 QUEER, NONE OF THESE DESCRIBE 7065 04:26:43,887 --> 04:26:46,357 ME OR PREFER NOT TO ANSWER. 7066 04:26:46,423 --> 04:26:47,558 INDIVIDUALS WERE IDENTIFIED IF 7067 04:26:47,624 --> 04:26:50,694 THEIR SEX ASSIGNED AT BIRTH WAS 7068 04:26:50,761 --> 04:26:51,161 DIFFERENT FROM THEIR 7069 04:26:51,228 --> 04:26:53,497 SELF-IDENTIFIED GENDER. 7070 04:26:53,564 --> 04:26:57,167 WE THEN USE NETWORK ANALYSIS TO 7071 04:26:57,234 --> 04:26:59,703 IDENTIFY THOSE CORE SYMPTOMS 7072 04:26:59,770 --> 04:27:00,204 WHICH DRIVE THE SYMPTOM 7073 04:27:00,270 --> 04:27:03,040 STRUCTURE. 7074 04:27:03,107 --> 04:27:06,243 SO OUR PARTICIPANTS. 7075 04:27:06,310 --> 04:27:08,379 WE HAD 248 PARTICIPANTS WITH A 7076 04:27:08,445 --> 04:27:12,850 MEAN AGE AROUND 38 YEARS OLD. 7077 04:27:12,916 --> 04:27:19,223 45% OF THE SAMPLE HAD CRONE'S 7078 04:27:19,289 --> 04:27:22,092 DISEASE AND 48% HAD ACTIVE 7079 04:27:22,159 --> 04:27:22,626 DISEASE BASED ON SYMPTOM 7080 04:27:22,693 --> 04:27:25,963 QUESTIONNAIRES. 7081 04:27:26,029 --> 04:27:30,300 WE HAD 167 CISGENDER MEN, 84 7082 04:27:30,367 --> 04:27:33,437 SIS GENDER MEN AND SEVEN GENDER 7083 04:27:33,504 --> 04:27:36,073 DIVERSE INDIVIDUALS. 7084 04:27:36,140 --> 04:27:37,474 WE THEN COMPARED SYMPTOMS 7085 04:27:37,541 --> 04:27:40,611 ACROSS THE THREE GROUPS AND 7086 04:27:40,677 --> 04:27:43,147 OBSERVED THAT ABDOMINAL PAIN 7087 04:27:43,213 --> 04:27:44,248 WAS THE HIGHEST SYMPTOM 7088 04:27:44,314 --> 04:27:44,982 SEVERITY OUT OF ALL THE 7089 04:27:45,048 --> 04:27:46,283 SYMPTOMS. 7090 04:27:46,350 --> 04:27:49,987 AND WHEN LOOKING AT THE TOTAL 7091 04:27:50,053 --> 04:27:52,222 SAMPLE, THE MEAN WAS 59.2. 7092 04:27:52,289 --> 04:27:54,124 WHICH INDICATES MODERATE TO 7093 04:27:54,191 --> 04:27:56,126 HIGH SYMPTOM SEE VIROITY. 7094 04:27:56,193 --> 04:27:57,227 -- SEVERITY. 7095 04:27:57,294 --> 04:28:00,297 I THINK IT'S ESPECIALLY 7096 04:28:00,364 --> 04:28:03,133 IMPORTANT THIS IS A YOUNGER AGE 7097 04:28:03,200 --> 04:28:05,035 POPULATION WHO IS STILL 7098 04:28:05,102 --> 04:28:05,569 EXPERIENCING THESE HIGH 7099 04:28:05,636 --> 04:28:06,770 SYMPTOMS. 7100 04:28:06,837 --> 04:28:09,406 WHEN WE LOOKED ACROSS OUR THREE 7101 04:28:09,473 --> 04:28:10,941 GROUPS WE SAW ABDOMINAL PAIN 7102 04:28:11,008 --> 04:28:13,577 DID DIFFER BASED ON SEX AND 7103 04:28:13,644 --> 04:28:15,446 GENDER. 7104 04:28:15,512 --> 04:28:21,819 WE SEE THAT CISGENDER MEN HAD 7105 04:28:21,885 --> 04:28:26,590 ABDOMINAL PAIN SCORE OF 61.8. 7106 04:28:26,657 --> 04:28:28,192 TRANSGENDER OR GENDER DIVERSE, 7107 04:28:28,258 --> 04:28:30,494 61.3 AND CISGENDER WOMEN HAD A 7108 04:28:30,561 --> 04:28:32,463 SCORE OF 57.8. 7109 04:28:32,529 --> 04:28:35,065 WE ALSO SAW DIFFERENCES IN 7110 04:28:35,132 --> 04:28:36,967 LEVELS OF DEPRESSION AND WE 7111 04:28:37,034 --> 04:28:39,903 ALREADY HEARD THIS THEME TODAY 7112 04:28:39,970 --> 04:28:42,739 COMING OUT IN TERMS OF PSYCHO 7113 04:28:42,806 --> 04:28:43,307 SOCIAL DISTRESS AND MENTAL 7114 04:28:43,373 --> 04:28:45,375 HEALTH. 7115 04:28:45,442 --> 04:28:46,176 WE THEN CONDUCTED A NETWORK 7116 04:28:46,243 --> 04:28:52,616 ANALYSIS. 7117 04:28:52,683 --> 04:28:54,985 THE FIRST NETWORK ANALYSIS 7118 04:28:55,052 --> 04:28:56,987 INCLUDES ALL PARTICIPANTS, ALL 7119 04:28:57,054 --> 04:28:57,354 248 INDIVIDUALS. 7120 04:28:57,421 --> 04:29:00,724 AND THEN WE LOOKED AT CISGENDER 7121 04:29:00,791 --> 04:29:01,792 WOMEN SEPARATELY AND CISGENDER 7122 04:29:01,859 --> 04:29:02,526 MEN. 7123 04:29:02,593 --> 04:29:04,261 DUE TO SAMPLE SIZE WE ARE NOT 7124 04:29:04,328 --> 04:29:07,397 ABLE TO DO A NETWORK ANALYSIS 7125 04:29:07,464 --> 04:29:11,502 FOR THE GROUP OF TRANSGENDER 7126 04:29:11,568 --> 04:29:14,171 AND GENDER DIVERSE INDIVIDUALS. 7127 04:29:14,238 --> 04:29:15,472 IN THIS FIGURE EACH CIRCLE 7128 04:29:15,539 --> 04:29:17,407 REPRESENTS A SYMPTOM. 7129 04:29:17,474 --> 04:29:20,143 AND THE STRENGTH BETWEEN THOSE 7130 04:29:20,210 --> 04:29:21,912 SYMPTOMS ARE REPRESENTED BY 7131 04:29:21,979 --> 04:29:24,348 THAT THICKNESS OF THE EDGES. 7132 04:29:24,414 --> 04:29:25,749 A THICKER EDGE INDICATES A 7133 04:29:25,816 --> 04:29:29,219 STRONGER RELATIONSHIP. 7134 04:29:29,286 --> 04:29:31,822 SO WE SAW THAT ANXIETY AND 7135 04:29:31,889 --> 04:29:32,356 DEPRESSION HAVE A STRONG 7136 04:29:32,422 --> 04:29:33,257 RELATIONSHIP. 7137 04:29:33,323 --> 04:29:36,560 AND WE SEE THIS HOLD UP ACROSS 7138 04:29:36,627 --> 04:29:39,796 ALL PARTICIPANTS AS WELL AS 7139 04:29:39,863 --> 04:29:40,964 AMONG CISGENDER WOMEN AND 7140 04:29:41,031 --> 04:29:43,333 CISGENDER MEN. 7141 04:29:43,400 --> 04:29:47,671 AND FOR INSTANCE, HERE IS THE 7142 04:29:47,738 --> 04:29:48,772 RELATIONSHIP BETWEEN FATIGUE 7143 04:29:48,839 --> 04:29:54,478 AND SLEEP-RELATED IMPAIRMENT. 7144 04:29:54,545 --> 04:29:55,279 SLEEP-RELATED IMPAIRMENT IS 7145 04:29:55,345 --> 04:29:57,714 LIKE DAYTIME SLEEPINESS. 7146 04:29:57,781 --> 04:29:58,949 WE SEE ALONG CISGENDER WOMEN 7147 04:29:59,016 --> 04:30:01,718 THE LINE IS A LOT THICKER, SO 7148 04:30:01,785 --> 04:30:02,553 THEY ARE MORE STRONGLY 7149 04:30:02,619 --> 04:30:04,121 CONNECTED THAN IT IS FOR 7150 04:30:04,187 --> 04:30:07,124 CISGENDERED MEN. 7151 04:30:07,190 --> 04:30:11,361 WE THEN LOOKED AT THE STRENGTH 7152 04:30:11,428 --> 04:30:13,797 CENTRALITY. 7153 04:30:13,864 --> 04:30:15,432 THIS SHOWS STANDARDIZED Z 7154 04:30:15,499 --> 04:30:19,036 SCORES FOR SYMPTOMS. 7155 04:30:19,102 --> 04:30:20,437 AND HIGHER VALUES INDICATE A 7156 04:30:20,504 --> 04:30:21,738 GREATER STRENGTH. 7157 04:30:21,805 --> 04:30:23,307 MEANING THAT IS THE CORE 7158 04:30:23,373 --> 04:30:24,575 SYMPTOM. 7159 04:30:24,641 --> 04:30:28,111 SO WHEN YOU LOOK AT THE TOTAL 7160 04:30:28,178 --> 04:30:30,347 SAMPLE, WE SEE THAT BOTH 7161 04:30:30,414 --> 04:30:31,515 FATIGUE AND ANXIETY ARE CORE 7162 04:30:31,582 --> 04:30:34,484 SYMPTOMS. 7163 04:30:34,551 --> 04:30:36,520 THE CORE SYMPTOMS ARE THOSE 7164 04:30:36,587 --> 04:30:41,058 THAT ARE MOST HIGHLY CONNECTED. 7165 04:30:41,124 --> 04:30:43,193 AND THE THEORY BEHIND IT IS 7166 04:30:43,260 --> 04:30:44,928 PERHAPS INTERVENING ON THE CORE 7167 04:30:44,995 --> 04:30:46,396 SYMPTOMS YOU CAN THEN IMPACT 7168 04:30:46,463 --> 04:30:47,731 THE REST OF THE SYMPTOMS IN THE 7169 04:30:47,798 --> 04:30:48,932 NETWORK. 7170 04:30:48,999 --> 04:30:50,534 NOW WHEN WE SPLIT IT INTO THE 7171 04:30:50,601 --> 04:30:53,370 GROUPS AND WE LOOK AT IT, BASED 7172 04:30:53,437 --> 04:30:56,106 ON SEX AND GENDER, WE SEE THAT 7173 04:30:56,173 --> 04:30:59,376 FOR CISGENDER WOMEN, THE CORE 7174 04:30:59,443 --> 04:31:01,778 SYMPTOM IS FATIGUE, WHEREAS FOR 7175 04:31:01,845 --> 04:31:02,646 CISGENDER MEN, THE CORE SYMPTOM 7176 04:31:02,713 --> 04:31:10,654 IS ANXIETY. 7177 04:31:10,721 --> 04:31:13,890 SO IN CONCLUSION WE SEE 7178 04:31:13,957 --> 04:31:16,293 ABDOMINAL PAIN DIFFERS IN SEX 7179 04:31:16,360 --> 04:31:17,628 AND GENDER, AND ALTHOUGH 7180 04:31:17,694 --> 04:31:19,129 ABDOMINAL PAIN WAS THE HIGH 7181 04:31:19,196 --> 04:31:21,932 OEFT REPORTED SYMPTOM, WHEN WE 7182 04:31:21,999 --> 04:31:23,533 LOOK AT SYMPTOMS IN NETWORK 7183 04:31:23,600 --> 04:31:27,738 ANALYSIS APPROACH WE SEE 7184 04:31:27,804 --> 04:31:29,873 FATIGUE AND ANXIETY APPEAR AS 7185 04:31:29,940 --> 04:31:32,376 CORE SYMPTOMS AND DEMONSTRATE 7186 04:31:32,442 --> 04:31:33,644 POTENTIAL SEX AND GENDER 7187 04:31:33,710 --> 04:31:34,277 DIFFERENCE. 7188 04:31:34,344 --> 04:31:35,912 WE BELIEVE REPLICATION OF THE 7189 04:31:35,979 --> 04:31:38,682 STUDY IS NEEDED WITH AN EVEN 7190 04:31:38,749 --> 04:31:40,450 FURTHER CONSIDERATION FOR 7191 04:31:40,517 --> 04:31:41,551 TRANSGENDER AND GENDER DIVERSE 7192 04:31:41,618 --> 04:31:42,285 PATIENTS. 7193 04:31:42,352 --> 04:31:44,087 AND OF COURSE, LIKE ALL GOOD 7194 04:31:44,154 --> 04:31:46,523 RESEARCH, THIS HAS LEFT US WITH 7195 04:31:46,590 --> 04:31:48,225 MORE QUESTIONS THAN WE BEGAN 7196 04:31:48,291 --> 04:31:52,396 WITH. 7197 04:31:52,462 --> 04:31:53,196 SO THANK YOU SO MUCH FOR YOUR 7198 04:31:53,263 --> 04:31:53,997 TIME. 7199 04:31:54,064 --> 04:31:55,999 I WOULD LIKE TO THANK EVERYONE 7200 04:31:56,066 --> 04:31:58,301 IN THE RESEARCH LAB WHO HAS 7201 04:31:58,368 --> 04:31:59,836 CONTRIBUTED TO THIS WORK, AS 7202 04:31:59,903 --> 04:32:02,139 YOU ALL ARE AWARE IT TRULY DOES 7203 04:32:02,205 --> 04:32:03,707 TAKE A TEAM TO DO SCIENCE. 7204 04:32:03,774 --> 04:32:14,184 SO THANK YOU VERY MUCH. 7205 04:32:29,199 --> 04:32:31,368 >> THANK YOU. 7206 04:32:31,435 --> 04:32:32,803 I HAVE A FEW QUESTIONS. 7207 04:32:32,869 --> 04:32:34,304 WITH THE DIAGRAM I HAVE SEEN 7208 04:32:34,371 --> 04:32:36,940 THOSE SORT OF BEFORE AND WE 7209 04:32:37,007 --> 04:32:39,209 HAVE TO GET USED TO LOOK AT 7210 04:32:39,276 --> 04:32:41,178 DATA IN NEW WAYS. 7211 04:32:41,244 --> 04:32:43,747 GET THE THICKNESS IN LINE BUT 7212 04:32:43,814 --> 04:32:46,616 WHAT ABOUT THE DISTANCE BETWEEN 7213 04:32:46,683 --> 04:32:47,250 THE NODES, IS THAT MEANINGFUL? 7214 04:32:47,317 --> 04:32:49,152 >> YES. 7215 04:32:49,219 --> 04:32:51,621 IT ALL IS FACTORED INTO HOW 7216 04:32:51,688 --> 04:32:54,925 THOSE DIAGRAMS ARE CREATED. 7217 04:32:54,991 --> 04:32:55,892 THE DISTANCE IS PART OF THAT 7218 04:32:55,959 --> 04:32:57,427 EQUATION. 7219 04:32:57,494 --> 04:33:00,063 BUT AS CAN IMAGINE IT'S 7220 04:33:00,130 --> 04:33:03,233 ACTUALLY A 3D REPRESENTATION 7221 04:33:03,300 --> 04:33:05,035 PUT ON A 2D SCREEN SO SOMETIMES 7222 04:33:05,102 --> 04:33:07,137 IT'S HARD TO KNOW WHAT THAT 7223 04:33:07,204 --> 04:33:09,473 DISTANCE LOOKS LIKE IN A 3D 7224 04:33:09,539 --> 04:33:11,108 SPACE. 7225 04:33:11,174 --> 04:33:13,210 >> [OFF MIC] 7226 04:33:13,276 --> 04:33:14,745 >> IT'S FACTORED INTO THAT 7227 04:33:14,811 --> 04:33:16,046 STRENGTH CALCULATION. 7228 04:33:16,113 --> 04:33:18,648 YES? 7229 04:33:18,715 --> 04:33:19,950 >> THIS WAS A VERY INTERESTING 7230 04:33:20,016 --> 04:33:26,923 PRESENTATION. 7231 04:33:26,990 --> 04:33:27,457 IN CHILDREN WITH CROHN'S 7232 04:33:27,524 --> 04:33:29,159 DISEASE. 7233 04:33:29,226 --> 04:33:30,694 GROWTH PROBLEMS ARE THREE TIMES 7234 04:33:30,761 --> 04:33:33,463 MORE COMMON IN MALES WITH 7235 04:33:33,530 --> 04:33:36,133 CROHNS DISEASE. 7236 04:33:36,199 --> 04:33:38,435 IT APPEARS THAT INFLAMMATION 7237 04:33:38,502 --> 04:33:39,870 AFFECTS DIFFERENT PATHWAYS IN 7238 04:33:39,936 --> 04:33:43,507 MALES VERSUS FEMALES. 7239 04:33:43,573 --> 04:33:53,717 THE GROWTH HORMONE IGF AXIS IS 7240 04:33:53,784 --> 04:33:55,051 INVOLVED IN MALES AND 7241 04:33:55,118 --> 04:33:58,121 HYPERPITUITARY IN FEMALES. 7242 04:33:58,188 --> 04:34:01,324 IT WOULD BE INTERESTED TO LOOK 7243 04:34:01,391 --> 04:34:03,360 AT, THEY WOULD BE INTERESTING 7244 04:34:03,426 --> 04:34:03,627 FINDINGS. 7245 04:34:03,693 --> 04:34:05,395 >> YES, THANK YOU FOR THAT 7246 04:34:05,462 --> 04:34:05,762 COMMENT. 7247 04:34:05,829 --> 04:34:07,531 THAT'S DEFINITELY AN AREA WE 7248 04:34:07,597 --> 04:34:10,267 ARE HOPING TO EXPLORE MORE AT 7249 04:34:10,333 --> 04:34:10,967 THOSE INFLAMMATORY MARKERS MORE 7250 04:34:11,034 --> 04:34:13,837 IN DEPTH. 7251 04:34:13,904 --> 04:34:18,642 MOST OUR WORK SO FAR IS FECAL, 7252 04:34:18,708 --> 04:34:20,477 AND ENDOSCOPIC BUT LIKE YOU 7253 04:34:20,544 --> 04:34:22,379 SAID THERE'S A WHOLE HOST OF 7254 04:34:22,445 --> 04:34:24,815 FACTORS WE SHOULD CONSIDER MORE. 7255 04:34:24,881 --> 04:34:26,616 THANK YOU. 7256 04:34:26,683 --> 04:34:27,217 >> ALL RIGHT. 7257 04:34:27,284 --> 04:34:37,460 THANK YOU. 7258 04:34:42,465 --> 04:34:44,835 >> THANKS, KENDRA. 7259 04:34:44,901 --> 04:34:47,237 OUR NEXT SPEAKER IS DR. BRIAN 7260 04:34:47,304 --> 04:34:57,447 McIVER. 7261 04:35:04,354 --> 04:35:06,256 >> IT'S ALWAYS REFRESHING TO 7262 04:35:06,323 --> 04:35:07,624 HEAR THAT DOCTOR PART, AS A 7263 04:35:07,691 --> 04:35:08,925 RECENT GRADUATE. 7264 04:35:08,992 --> 04:35:12,596 TODAY I WILL TALK TO YOU ALL 7265 04:35:12,662 --> 04:35:13,597 ABOUT MY DISSERTATION PROJECT 7266 04:35:13,663 --> 04:35:18,335 WHERE I INVESTIGATED THE ROLE 7267 04:35:18,401 --> 04:35:24,808 OF ASTRO CYTE ELEVATED AEG1, 7268 04:35:24,875 --> 04:35:27,210 MULTI-FUNCTIONAL PROTEIN IN 7269 04:35:27,277 --> 04:35:29,346 CHEMOTHERAPY INDUCED -- 7270 04:35:29,412 --> 04:35:39,623 NEUROPATHY. 7271 04:35:46,463 --> 04:35:50,934 BRIEFLY I WANT TO GIVE 7272 04:35:51,001 --> 04:35:53,970 BACKGROUND ON CHEMOTHERAPY 7273 04:35:54,037 --> 04:35:54,571 INDUCED PERIPHERAL NEUROPATHY 7274 04:35:54,638 --> 04:35:57,474 OR CIPN. 7275 04:35:57,540 --> 04:35:59,743 THE A PREDOMINANTLY SENSORY 7276 04:35:59,809 --> 04:36:01,211 DOSE LIMITED SIDE EFFECT OF 7277 04:36:01,278 --> 04:36:05,882 CHEMOTHERAPY TREATMENTS. 7278 04:36:05,949 --> 04:36:08,251 MANY INCLUDE ALLODYNIA, COLD 7279 04:36:08,318 --> 04:36:08,652 BURNING SENSATION. 7280 04:36:08,718 --> 04:36:13,189 THERE ARE DIFFERENT CLASSES OF 7281 04:36:13,256 --> 04:36:19,162 CHEMO THERAPEUTICS THAT HAVE 7282 04:36:19,229 --> 04:36:26,436 VARYING PREVALENCES OF CIPN. 7283 04:36:26,503 --> 04:36:32,108 ONE IS TAXANES AND PLATINUM 7284 04:36:32,175 --> 04:36:35,545 BASED DRUGS LIKE PACILITAXEL 7285 04:36:35,612 --> 04:36:38,081 AND OXALIPLATIN. 7286 04:36:38,148 --> 04:36:40,617 MANY HAVE DID I MIN SHISHED 7287 04:36:40,684 --> 04:36:43,153 EFFICACY WITH LONG TERM USE AND 7288 04:36:43,219 --> 04:36:43,954 CAN PRODUCE SEVERE NEGATIVE 7289 04:36:44,020 --> 04:36:45,789 SIDE EFFECTS. 7290 04:36:45,855 --> 04:36:49,326 IT'S IMPORTANT WE PRODUCE MORE 7291 04:36:49,392 --> 04:36:52,329 EFFICACIOUS TREATMENTS SO WE 7292 04:36:52,395 --> 04:36:54,230 CAN DEVELOP PROPHYLACTICS AND 7293 04:36:54,297 --> 04:36:54,798 TREATMENTS SPECIFICALLY FOR 7294 04:36:54,864 --> 04:36:59,202 CIPN. 7295 04:36:59,269 --> 04:37:01,738 IN ORDER TO DO THAT WE WANT TO 7296 04:37:01,805 --> 04:37:04,441 LOOK AT MECHANISMS THAT UNDER 7297 04:37:04,507 --> 04:37:08,712 LIE THE DEVELOPMENT OF CIPN. 7298 04:37:08,778 --> 04:37:10,246 SO ONE IS NEUROINFLAMMATION. 7299 04:37:10,313 --> 04:37:13,383 AS MANY OF YOU KNOW, STUDY 7300 04:37:13,450 --> 04:37:15,919 PAIN, NEUROINFLAMMATION IS A 7301 04:37:15,986 --> 04:37:17,887 COMMON BIOLOGICAL PROCESS 7302 04:37:17,954 --> 04:37:21,358 UNDERLYING MANY CHRONIC PAIN 7303 04:37:21,424 --> 04:37:21,691 CONDITIONS. 7304 04:37:21,758 --> 04:37:26,963 I WANT TO BRIEFLY GO THROUGH 7305 04:37:27,030 --> 04:37:34,871 HOW PACLITAXEL INFLUENCES NEURO 7306 04:37:34,938 --> 04:37:39,242 INFLAMMATION. 7307 04:37:39,309 --> 04:37:41,378 IN THE DRG'S WILL INDUCE NERVE 7308 04:37:41,444 --> 04:37:44,814 DAMAGE BY DYING BACK ON THE 7309 04:37:44,881 --> 04:37:45,815 AXONS THAT INNERVATE PERIPHERAL 7310 04:37:45,882 --> 04:37:46,616 TISSUES SUCH AS THE HANDS AND 7311 04:37:46,683 --> 04:37:51,254 FEET. 7312 04:37:51,321 --> 04:37:52,889 WITHIN THOSE TISSUES PACILTAXEL 7313 04:37:52,956 --> 04:37:55,925 AS WELL AS DAMAGE ASSOCIATED 7314 04:37:55,992 --> 04:37:57,727 MOLECULAR PATTERNS THAT COME 7315 04:37:57,794 --> 04:38:02,866 OFF THE DAMAGED NEURONS 7316 04:38:02,932 --> 04:38:13,410 STIMULATE THE ACTIVATION OF 7317 04:38:15,345 --> 04:38:19,449 PERIPHERAL MILE SITES THAT WILL 7318 04:38:19,516 --> 04:38:21,384 EXACERBATE NERVE DAMAGE AND 7319 04:38:21,451 --> 04:38:21,785 NEUROINFLAMMATION. 7320 04:38:21,851 --> 04:38:24,821 LOTS OF PAPERS HAVE GONE ONTO 7321 04:38:24,888 --> 04:38:30,660 SHOW PROMINENT THERAPEUTIC 7322 04:38:30,727 --> 04:38:34,431 STRATEGY IS TO BLOCK PAC 7323 04:38:34,497 --> 04:38:37,867 MEDIATED TO PREVENT CIPN. 7324 04:38:37,934 --> 04:38:39,769 WE IDENTIFIED AEG1, AS YOU SAW 7325 04:38:39,836 --> 04:38:43,073 ON THE DIAGRAM ONE KEY 7326 04:38:43,139 --> 04:38:45,375 PROMINENT PROTEIN ACTIVATED IS 7327 04:38:45,442 --> 04:38:53,817 NF KAPPA B. 7328 04:38:53,883 --> 04:39:03,359 ASTROCYTE. 7329 04:39:03,426 --> 04:39:06,463 YOU CAN SEE FROM THIS DIAGRAM 7330 04:39:06,529 --> 04:39:08,331 FROM HUMAN TISSUE ATLAS 7331 04:39:08,398 --> 04:39:09,966 PRIMARILY EXPRESSED AT HIGH 7332 04:39:10,033 --> 04:39:12,602 LEVELS CELLS RESULTING FROM THE 7333 04:39:12,669 --> 04:39:13,503 BONE MARROW AND LYMPHOID 7334 04:39:13,570 --> 04:39:14,871 ISSUES, THAT WOULD INCLUDE YOUR 7335 04:39:14,938 --> 04:39:18,842 IMMUNE CELLS. 7336 04:39:18,908 --> 04:39:21,077 IT'S ALSO A MULTI-FUNCTIONAL 7337 04:39:21,144 --> 04:39:23,313 SCAFFOLDING PROTEIN, IT HAS 7338 04:39:23,379 --> 04:39:24,380 PROTEIN TO PROTEIN INTERACTIONS 7339 04:39:24,447 --> 04:39:26,850 WHICH ALLOWS IT TO BE INVOLVED 7340 04:39:26,916 --> 04:39:30,587 IN MANY SIGNAL PATHWAYS SUCH AS 7341 04:39:30,653 --> 04:39:34,858 THE NFP KAPPA B PATHWAY. 7342 04:39:34,924 --> 04:39:37,260 IT'S ABLE TO MODULATE 7343 04:39:37,327 --> 04:39:39,662 INFLAMMATION THROUGH DIRECT 7344 04:39:39,729 --> 04:39:43,199 INTERACTION WITH MULTIPLE 7345 04:39:43,266 --> 04:39:45,368 PROTEINS INVOLVED IN 7346 04:39:45,435 --> 04:39:46,469 INNERVATION. 7347 04:39:46,536 --> 04:39:48,371 STUDIES HAVE SHOWN THAT AEG1 IS 7348 04:39:48,438 --> 04:39:52,408 INVOLVED IN A REGULATION OF 7349 04:39:52,475 --> 04:39:54,644 MACROPHAGE ACTIVITY WHEN AEG IS 7350 04:39:54,711 --> 04:39:57,280 LOST, FAK FAITH AND OTHER NERVE 7351 04:39:57,347 --> 04:39:58,348 CELLS ARE UNABLE TO 7352 04:39:58,414 --> 04:40:01,117 DIFFERENTIATE OR ACTIVATE WHEN 7353 04:40:01,184 --> 04:40:03,086 THEY ARE STIMULATED WITH 7354 04:40:03,153 --> 04:40:04,888 CHEMAKINS AND CYTOKINES. 7355 04:40:04,954 --> 04:40:07,757 BASED ON THIS INFORMATION WE 7356 04:40:07,824 --> 04:40:09,359 THOUGHT AEG1 AS MODULATOR OF 7357 04:40:09,425 --> 04:40:12,962 INTHE KING AND QUEEN HAVE A OR 7358 04:40:13,029 --> 04:40:14,430 -- INFLAMMATION MAY LEAD TO 7359 04:40:14,497 --> 04:40:15,832 DEVELOPMENT OF CIPN. 7360 04:40:15,899 --> 04:40:21,437 THIS IS A BRIEF LIST OF 7361 04:40:21,504 --> 04:40:26,042 MATERIALS, INCLUDING ANIMALS. 7362 04:40:26,109 --> 04:40:31,114 THE DRUGS I WILL BE USING. 7363 04:40:31,181 --> 04:40:32,482 I WILL GO THROUGH THESE METHODS 7364 04:40:32,549 --> 04:40:33,216 AS WELL. 7365 04:40:33,283 --> 04:40:35,485 I WANT TO EMPHASIZE, I KNOW WE 7366 04:40:35,552 --> 04:40:39,088 ARE HERE TO TALK ABOUT THE 7367 04:40:39,155 --> 04:40:42,559 INPLICATIONS OF BIOLOGICAL SEX. 7368 04:40:42,625 --> 04:40:44,794 MY STUDIES INCLUDED MALE AND 7369 04:40:44,861 --> 04:40:46,596 FEMALE AND WHEN BIOLOGICAL SEX 7370 04:40:46,663 --> 04:40:48,932 PRODUCED A SIGNIFICANT EFFECT 7371 04:40:48,998 --> 04:40:50,166 THE ANIMALS WERE SEPARATED BY 7372 04:40:50,233 --> 04:40:53,069 SEX, IF NOT THEY WERE CONDENSED 7373 04:40:53,136 --> 04:40:53,570 INTO SINGLE EXPERIMENT 7374 04:40:53,636 --> 04:40:56,206 ALLOGROUPS. 7375 04:40:56,272 --> 04:40:59,309 SO JUST A QUICK BACKGROUND ON 7376 04:40:59,375 --> 04:41:02,912 MY MODEL CIPN. 7377 04:41:02,979 --> 04:41:09,385 BY FOUR INJECTIONS OF 7378 04:41:09,452 --> 04:41:15,391 PACILTAXEL. 7379 04:41:15,458 --> 04:41:17,260 THERE ARE RELEVANT STUDY 7380 04:41:17,327 --> 04:41:17,927 OUTCOMES TO STUDY NEUROPATHY IN 7381 04:41:17,994 --> 04:41:22,198 MICE. 7382 04:41:22,265 --> 04:41:25,335 BEHAVIORAL STUDIES WHICH ARE 7383 04:41:25,401 --> 04:41:27,604 VON FREY TO ASSESS MECHANICAL 7384 04:41:27,670 --> 04:41:30,406 SENSITIVITY. 7385 04:41:30,473 --> 04:41:33,042 LOOK AT VOLUNTARY MOVEMENTS AND 7386 04:41:33,109 --> 04:41:35,945 PHYSIOLOGICAL OUTCOMES WHICH 7387 04:41:36,012 --> 04:41:37,247 LOOK AT ELECTROCONDUCTIVITIES 7388 04:41:37,313 --> 04:41:40,717 OF PERIPHERAL NERVE FIEBS AND 7389 04:41:40,783 --> 04:41:42,852 LOOK AT MORPHOLOGICAL CHANGES 7390 04:41:42,919 --> 04:41:44,988 ASSOCIATED WITH PACILTAXEL 7391 04:41:45,054 --> 04:41:45,355 ADMINISTRATION. 7392 04:41:45,421 --> 04:41:48,791 HERE WE SEE IT REDUCES THE 7393 04:41:48,858 --> 04:41:52,328 AMOUNT OF INNERVATING NERVE 7394 04:41:52,395 --> 04:41:52,695 FIBERS IN MICE. 7395 04:41:52,762 --> 04:41:54,597 I WILL BRIEFLY GO THROUGH 7396 04:41:54,664 --> 04:41:55,398 GLOBAL KNOCKOUT MICE DATA FOR 7397 04:41:55,465 --> 04:41:58,668 THE SAKE OF TIME. 7398 04:41:58,735 --> 04:42:01,104 THE EFFECTS OF GLOBAL AEG 7399 04:42:01,170 --> 04:42:06,876 PREVENTED PRETTY MUCH ALL OUR 7400 04:42:06,943 --> 04:42:09,379 BEHAVIORAL ELECTROPHYSIOLOGICAL 7401 04:42:09,445 --> 04:42:09,946 AND MORPHOLOGICAL OUTCOMES. 7402 04:42:10,013 --> 04:42:11,614 FAILED TO PRODUCE COLD 7403 04:42:11,681 --> 04:42:16,886 SENSITIVITY. 7404 04:42:16,953 --> 04:42:17,520 ELECTROPERIPHERAL NEVER OR IENF 7405 04:42:17,587 --> 04:42:18,921 DENSITY. 7406 04:42:18,988 --> 04:42:23,259 WE SEE UP REGULATION OF 7407 04:42:23,326 --> 04:42:24,394 PROINFLAMMATORY CYTOKINES OR 7408 04:42:24,460 --> 04:42:25,662 PROINFLAMMATORY GENES IN WILD 7409 04:42:25,728 --> 04:42:28,898 TYPE WITH THE BLACK BARS 7410 04:42:28,965 --> 04:42:29,999 COMPLETELY BLOCKED IN OUR AEG1 7411 04:42:30,066 --> 04:42:32,235 KNOCKOUT MICE. 7412 04:42:32,302 --> 04:42:42,378 WE ALSO SEE THAT GLOBAL 7413 04:42:42,445 --> 04:42:43,713 DILUTION OF AEG-1 REDUCES 7414 04:42:43,780 --> 04:42:47,383 OXALIPLATIN, MEDIATED BY OTHER 7415 04:42:47,450 --> 04:42:50,920 CLASSES OF CHEMOTHERAPIES AND 7416 04:42:50,987 --> 04:42:52,955 EFFECTS OF PACILTAXEL IN AEG-1 7417 04:42:53,022 --> 04:42:56,626 WE SAW IT INDUCES UP REGULATION 7418 04:42:56,693 --> 04:42:58,728 OF AEG-1 IN THE DRG'S OF MICE 7419 04:42:58,795 --> 04:43:01,164 BUT NOT IN THE SPINAL CORD. 7420 04:43:01,230 --> 04:43:10,073 AND IN PER TONE YAL MACROPHAGES 7421 04:43:10,139 --> 04:43:11,774 FROM PACILTAXEL TREATMENT 7422 04:43:11,841 --> 04:43:15,211 THERE'S UP REGULATION OF AEG-1 7423 04:43:15,278 --> 04:43:17,647 IN PACILTAXEL TREATED ANIMALS 7424 04:43:17,714 --> 04:43:18,748 AND FEMALE MICE COMPARED TO 7425 04:43:18,815 --> 04:43:20,450 MALE MICE. 7426 04:43:20,516 --> 04:43:22,819 UNFORTUNATELY THIS IS THE ONLY 7427 04:43:22,885 --> 04:43:26,022 DATASET I SAW A SEX DIFFERENCE. 7428 04:43:26,089 --> 04:43:28,524 SO ALL TOGETHER THIS DATA LED 7429 04:43:28,591 --> 04:43:31,794 US TO BELIEVE THAT THERE MAY BE 7430 04:43:31,861 --> 04:43:34,897 IMPLICATION FOR AEG-1 7431 04:43:34,964 --> 04:43:36,332 EXPRESSION IN MYELOID CELL 7432 04:43:36,399 --> 04:43:37,500 THAT'S MAY BE CONTRIBUTING TO 7433 04:43:37,567 --> 04:43:40,169 CIPN. 7434 04:43:40,236 --> 04:43:42,305 WE NEXT USE CONDITIONAL 7435 04:43:42,372 --> 04:43:44,607 KNOCKOUT MICE WHICH LACK AEG-1 7436 04:43:44,674 --> 04:43:45,408 EXPRESSION IN ONLY MYELOID 7437 04:43:45,475 --> 04:43:49,178 TISSUE AND AGAIN WE SEE A 7438 04:43:49,245 --> 04:43:57,553 COMPLETE BLOCK OF IN OF 7439 04:43:57,620 --> 04:43:59,555 PACILTAXEL, MECHANICAL 7440 04:43:59,622 --> 04:44:01,224 SENSITIVITY, COLD AND 7441 04:44:01,290 --> 04:44:04,794 DEPRESSION -- WE SEE 7442 04:44:04,861 --> 04:44:10,466 PREVENTION, REDUCTION IN 7443 04:44:10,533 --> 04:44:12,635 PERIPHERAL NERVE FIBER 7444 04:44:12,702 --> 04:44:15,438 AMPLITUDE AND LOSS OF IENF 7445 04:44:15,505 --> 04:44:18,107 DENSITY. 7446 04:44:18,174 --> 04:44:20,042 WE LOOKED AT OUR DRG 7447 04:44:20,109 --> 04:44:22,712 EXPRESSION, WE SEE A SIMILAR 7448 04:44:22,779 --> 04:44:23,980 PATTERN WHERE PROINFLAMMATORY 7449 04:44:24,046 --> 04:44:28,017 GENES ARE UP REGULATED IN WILD 7450 04:44:28,084 --> 04:44:32,121 TYPE BUT COMPLETELY BLOCKED IN 7451 04:44:32,188 --> 04:44:36,626 OUR AEG-1 KNOCKOUT MICE. 7452 04:44:36,692 --> 04:44:41,431 HISS STO CHEMISTRY STUDIES 7453 04:44:41,497 --> 04:44:42,231 LOOKING AT MACROPHAGES, USING 7454 04:44:42,298 --> 04:44:46,702 F480 AS A MARKER. 7455 04:44:46,769 --> 04:44:48,237 IN WILD TYPE PAXEL TREATED 7456 04:44:48,304 --> 04:44:52,008 THERE'S AN INCREASE IN OUR 7457 04:44:52,074 --> 04:44:52,542 CONDITIONAL KNOCKOUT MICE. 7458 04:44:52,608 --> 04:44:56,112 SIMILARLY THERE'S A BLOCK CADE 7459 04:44:56,179 --> 04:45:06,656 OF NF KAPPA B AND THEY ARE 7460 04:45:09,992 --> 04:45:18,334 TREATED WITH PACLITAXIN. 7461 04:45:18,401 --> 04:45:20,403 -- 7462 04:45:20,470 --> 04:45:22,605 HERE WE PERFORMED A TIME COURSE 7463 04:45:22,672 --> 04:45:26,742 TO LOOK AT WHEN IS THE OPTIMAL 7464 04:45:26,809 --> 04:45:27,577 KNOCK DOWN WITH OUR NANO 7465 04:45:27,643 --> 04:45:29,445 PARTICLES. 7466 04:45:29,512 --> 04:45:32,982 WE SEE IT'S ON DAY 3. 7467 04:45:33,049 --> 04:45:35,117 AND SO WE THEN INJECTED MICE 7468 04:45:35,184 --> 04:45:38,955 AGAIN AND WE STIMULATED PER 7469 04:45:39,021 --> 04:45:41,424 TONE YAL MACROPHAGES USING GLIO 7470 04:45:41,491 --> 04:45:45,394 GLYCOLATE, HERE WE SEE OUR NANO 7471 04:45:45,461 --> 04:45:47,330 PARTICLES CARRYING AEG1 NOT 7472 04:45:47,396 --> 04:45:48,798 ONLY DOWN REGULATED IN OUR 7473 04:45:48,865 --> 04:45:51,868 MACROPHAGES BUT ALSO 7474 04:45:51,934 --> 04:45:53,169 SUBSEQUENTLY GENES ASSOCIATED 7475 04:45:53,236 --> 04:45:54,604 WITH NF KAPPA B ACTIVATION. 7476 04:45:54,670 --> 04:45:57,240 THERE WAS NO CHANGE IN OUR 7477 04:45:57,306 --> 04:45:59,909 DEPLETED CELLS WHICH ARE NON 7478 04:45:59,976 --> 04:46:02,178 MACROPHAGE TYPE CELLS. 7479 04:46:02,245 --> 04:46:04,714 SO THEN WE WANTED TO SEE CAN WE 7480 04:46:04,780 --> 04:46:15,291 UTILIZE THIS AS A STRATEGY TO 7481 04:46:16,526 --> 04:46:18,628 REVERSE PACILTAXEL. 7482 04:46:18,694 --> 04:46:22,798 FOUR DAYS AFTER FIRST INJECTION 7483 04:46:22,865 --> 04:46:24,133 THEY DEVELOPED MECHANICAL 7484 04:46:24,200 --> 04:46:25,635 HYPERSENSITIVITY AND NEXT WE 7485 04:46:25,701 --> 04:46:27,770 SAVE SRNRA. 7486 04:46:27,837 --> 04:46:30,239 WE SEE A TIME DEPENDENT 7487 04:46:30,306 --> 04:46:33,476 REVERSAL OF NOT ONLY MECHANICAL 7488 04:46:33,543 --> 04:46:35,411 SENSITIVITY BUT ALSO COLD 7489 04:46:35,478 --> 04:46:36,012 HYPERSENSITIVITY. 7490 04:46:36,078 --> 04:46:39,649 NOW THAT WE CONFIRMED A SINGLE 7491 04:46:39,715 --> 04:46:41,984 INJECTION IS EFFECTIVE TO 7492 04:46:42,051 --> 04:46:45,254 REVERSE MECHANICAL AND COLD 7493 04:46:45,321 --> 04:46:45,955 HYPER SENSITIVE CAN WE PREVENT 7494 04:46:46,022 --> 04:46:47,456 IT? 7495 04:46:47,523 --> 04:46:50,693 ANSWER TURNS OUT YES. 7496 04:46:50,760 --> 04:46:52,895 WE PRE-TREATED MICE WITH SRNA 7497 04:46:52,962 --> 04:46:57,667 NANO PARTICLES AND GAVE THEM 7498 04:46:57,733 --> 04:47:02,805 TWO INJECTIONS OF PACILTAXEL. 7499 04:47:02,872 --> 04:47:05,041 THAT WAS SUFFICIENT TO 7500 04:47:05,107 --> 04:47:07,677 COMPLETELY PREVINT MECHANICAL 7501 04:47:07,743 --> 04:47:12,081 AND COLD HYPERSENSITIVITY 7502 04:47:12,148 --> 04:47:13,115 INDUCED BY PACILTAXEL IN OUR 7503 04:47:13,182 --> 04:47:14,750 MOUSE MODEL. 7504 04:47:14,817 --> 04:47:15,618 THIS IS A BRIEF SUMMARY OF THE 7505 04:47:15,685 --> 04:47:16,852 DATA. 7506 04:47:16,919 --> 04:47:20,089 OVERALL I THINK THE MAJOR TAKE 7507 04:47:20,156 --> 04:47:24,627 AWAY IS TARGETED INHIBITION OF 7508 04:47:24,694 --> 04:47:25,761 AEG-1 REPRESENTS POTENTIALLY 7509 04:47:25,828 --> 04:47:27,363 NOVEL THERAPEUTIC TREATMENT FOR 7510 04:47:27,430 --> 04:47:29,665 NOT ONLY THE PREVENTION BUT 7511 04:47:29,732 --> 04:47:32,234 REVERSAL OF CIPN. 7512 04:47:32,301 --> 04:47:34,136 AND SOME FUTURE DIRECTIONS 7513 04:47:34,203 --> 04:47:37,139 INCLUDE LOOKING AT CHANGES IN 7514 04:47:37,206 --> 04:47:40,543 AEG-1 EXPRESSION IN DIFFERENT 7515 04:47:40,610 --> 04:47:42,345 POPULATIONS OF MYELOID CELLS. 7516 04:47:42,411 --> 04:47:45,348 IT'S A TERM USED FOR HOMOGENOUS 7517 04:47:45,414 --> 04:47:45,715 GROUP OF CELLS. 7518 04:47:45,781 --> 04:47:48,250 SO YOU WANT TO LOOK AT NOT JUST 7519 04:47:48,317 --> 04:47:50,686 TARGETING IN MACROPHAGES BUT 7520 04:47:50,753 --> 04:47:52,722 ALSO IN DENDRITIC CELLS OR 7521 04:47:52,788 --> 04:47:53,723 OTHER TYPES OF MYELOID CELLS 7522 04:47:53,789 --> 04:47:56,158 AND WE WANT TO DO MORE STUDIES 7523 04:47:56,225 --> 04:47:59,495 LOOKING AT IMPACT OF BIOLOGICAL 7524 04:47:59,562 --> 04:48:02,598 SEX ON AEG1 EXPRESSION AND 7525 04:48:02,665 --> 04:48:05,534 NEURO INFLAMMATION IN MYELOID 7526 04:48:05,601 --> 04:48:07,903 CELLS IN CIPN. 7527 04:48:07,970 --> 04:48:12,108 WE WANT TO OPTIMIZE OUR USAGE 7528 04:48:12,174 --> 04:48:13,376 OF AEG-1 TARGETED NANO 7529 04:48:13,442 --> 04:48:13,976 PARTICLES. 7530 04:48:14,043 --> 04:48:17,380 WE ONLY TIED ONE DOSE, THIS IS 7531 04:48:17,446 --> 04:48:19,782 TOWARD THE END OF MY 7532 04:48:19,849 --> 04:48:20,616 DISSERTATION STUDIES, THAT'S 7533 04:48:20,683 --> 04:48:22,018 ALL I HAD TIME FOR. 7534 04:48:22,084 --> 04:48:24,353 WE WILL CONTINUE TO LOOK AT 7535 04:48:24,420 --> 04:48:26,288 DIFFERENT DOSES AND DIFFERENT 7536 04:48:26,355 --> 04:48:30,226 TIME POINTS TO TRULY OPTIMIZE 7537 04:48:30,292 --> 04:48:31,193 OUR TARGETING OF AEG-1 AND 7538 04:48:31,260 --> 04:48:32,628 DETERMINE HOW MUCH DO WE NEED 7539 04:48:32,695 --> 04:48:36,065 TO KNOCK IT DOWN TO PREVENT 7540 04:48:36,132 --> 04:48:42,104 CIPN AND OTHER PATHOLOGIES 7541 04:48:42,171 --> 04:48:43,572 POTENTIALLY WITH OTHER CLASSES 7542 04:48:43,639 --> 04:48:45,775 OF CHEMOTHERAPIES AS WELL. 7543 04:48:45,841 --> 04:48:48,678 I WANT TO THANK MY LAB MEMBERS. 7544 04:48:48,744 --> 04:48:52,715 FORMER POSTDOCS OF MY LAB, MY 7545 04:48:52,782 --> 04:48:52,982 CO-MENTOR. 7546 04:48:53,049 --> 04:48:54,316 MANY PEOPLE FROM MY UNIVERSITY, 7547 04:48:54,383 --> 04:48:55,584 INCLUDING MY DEPARTMENT AND 7548 04:48:55,651 --> 04:48:59,822 COMMITTEE AS WELL AS NIH FOR 7549 04:48:59,889 --> 04:49:01,524 THE MULTIPLE FELLOWSHIPS I HAVE 7550 04:49:01,590 --> 04:49:05,428 RECEIVED AT MY TIME AT VCU AND 7551 04:49:05,494 --> 04:49:06,362 F-31 FUNDING. 7552 04:49:06,429 --> 04:49:16,706 AND THAT IS IT. 7553 04:49:29,318 --> 04:49:32,421 >> HOPING IT DIDN'T HAVE 7554 04:49:32,488 --> 04:49:34,423 EFFECTS OF ANTI-CANCER EFFECTS? 7555 04:49:34,490 --> 04:49:35,958 >> THAT IS DEFINITELY SOMETHING 7556 04:49:36,025 --> 04:49:41,330 WE ARE INTERESTED IN STUDYING. 7557 04:49:41,397 --> 04:49:45,701 AEG-1 IS A PROMINENT ONCOGENE 7558 04:49:45,768 --> 04:49:50,940 AND PLAYS A ROLE IN MANY 7559 04:49:51,006 --> 04:49:51,774 HALLMARKS OF CANCER, INCLUDING 7560 04:49:51,841 --> 04:49:53,609 CHEMO-RESISTANCE, MY GOAL FOR 7561 04:49:53,676 --> 04:49:55,578 THIS AS FUTURE STUDIES MY HOPE 7562 04:49:55,644 --> 04:49:57,513 IS SOMEONE WILL COME ALONG AND 7563 04:49:57,580 --> 04:50:04,987 CONTINUE TO INVESTIGATE, YOU 7564 04:50:05,054 --> 04:50:06,222 KNOW, TARGETING AEG-1 IN 7565 04:50:06,288 --> 04:50:08,524 MACROPHAGES DOES IT ALTER THE 7566 04:50:08,591 --> 04:50:09,759 AMOUNT OF CHEMOTHERAPY THAT IS 7567 04:50:09,825 --> 04:50:11,927 NEEDED IN ORDER TO, I GUESS, 7568 04:50:11,994 --> 04:50:13,696 KILL CANCER CELLS. 7569 04:50:13,763 --> 04:50:16,398 BUT CAN IT ALSO MEDIATE THAT 7570 04:50:16,465 --> 04:50:17,867 LEVEL OF PREVENTION OF CIPN WE 7571 04:50:17,933 --> 04:50:19,335 SEE WITH MY RESIECH. 7572 04:50:19,401 --> 04:50:22,171 -- RESEARCH. 7573 04:50:22,238 --> 04:50:23,405 IT WOULD BE POTENTIALLY 7574 04:50:23,472 --> 04:50:24,673 DUALISTIC TYPE OF TREATMENT. 7575 04:50:24,740 --> 04:50:26,809 THAT'S THE GOAL, WE HAVEN'T 7576 04:50:26,876 --> 04:50:28,010 GOTTEN THERE YET BUT DEFINITELY 7577 04:50:28,077 --> 04:50:30,679 SOMETHING WE ARE INTERESTED IN. 7578 04:50:30,746 --> 04:50:40,990 >> THANK YOU. 7579 04:50:42,792 --> 04:50:44,293 >> BRYAN, IT'S OKAY NOT TO FIND 7580 04:50:44,360 --> 04:50:45,628 SEX DIFFERENCES. 7581 04:50:45,694 --> 04:50:46,829 IT'S IMPORTANT TO LOOK BUT YOU 7582 04:50:46,896 --> 04:50:49,265 DON'T HAVE TO FIND THEM. 7583 04:50:49,331 --> 04:50:52,334 AND LAST SPEAKER IN THIS 7584 04:50:52,401 --> 04:50:54,837 SESSION IS DR. CAROLINE 7585 04:50:54,904 --> 04:51:05,214 PATTERSON GENTILE. 7586 04:51:05,748 --> 04:51:07,116 >> WONDERFUL. 7587 04:51:07,183 --> 04:51:07,783 THANK YOU FOR OPPORTUNITY TO 7588 04:51:07,850 --> 04:51:09,952 SHARE THIS WORK. 7589 04:51:10,019 --> 04:51:11,287 IT'S A REAL HONOR TO BE HERE 7590 04:51:11,353 --> 04:51:12,655 WITH ALL OF YOU. 7591 04:51:12,721 --> 04:51:15,624 I'M GOING TO BE DISCUSSING A 7592 04:51:15,691 --> 04:51:18,260 MULTI-CENTERED VALIDATION OF 7593 04:51:18,327 --> 04:51:20,596 CLUSTER ANALYSIS WITH MIGRAINE 7594 04:51:20,663 --> 04:51:21,430 ASSOCIATED SYMPTOMS WHICH WE 7595 04:51:21,497 --> 04:51:24,066 CALL 7596 04:51:24,133 --> 04:51:34,543 CAMS FOR SHORT IN YOUTH. 7597 04:51:36,679 --> 04:51:37,947 THESE ARE JUST MY DISCLOSURES. 7598 04:51:38,013 --> 04:51:39,648 SO WHEN WE THINK OF MIGRAINE, 7599 04:51:39,715 --> 04:51:42,184 THE FIRST THING THAT COMES TO 7600 04:51:42,251 --> 04:51:44,119 MOST PEOPLE'S MIND IS HEAD PAIN. 7601 04:51:44,186 --> 04:51:47,456 HOWEVER IT'S REALLY IMPORTANT 7602 04:51:47,523 --> 04:51:50,092 TO NOTE MIGRAINE IS IN PART 7603 04:51:50,159 --> 04:51:52,194 NEUROLOGICAL SYMPTOMS OF HEAD 7604 04:51:52,261 --> 04:51:52,394 PAIN. 7605 04:51:52,461 --> 04:51:53,195 THESE SYMPTOMS ARE VERY 7606 04:51:53,262 --> 04:51:54,496 IMPORTANT FOR THE INDIVIDUALS 7607 04:51:54,563 --> 04:51:55,030 WITH LIVED EXPERIENCE OF 7608 04:51:55,097 --> 04:51:57,867 MIGRAINE. 7609 04:51:57,933 --> 04:52:02,171 CRITERION D OF THE 7610 04:52:02,238 --> 04:52:03,539 INTERNATIONAL CLASSIFICATION OF 7611 04:52:03,606 --> 04:52:08,444 HEADACHE DISORDERS LIGHT AND 7612 04:52:08,510 --> 04:52:09,778 SOUND SENSITIVITY, THEY ARE 7613 04:52:09,845 --> 04:52:12,581 BASED ON EXPERT OPINION AND 7614 04:52:12,648 --> 04:52:13,382 MANY SYMPTOMS ARE ASSOCIATED 7615 04:52:13,449 --> 04:52:16,118 WITH MIGRAINE. 7616 04:52:16,185 --> 04:52:17,553 DIZZINESS LIKE LIGHT HEADEDNESS 7617 04:52:17,620 --> 04:52:19,121 OR VERTIGO, AS WELL AS MENTAL 7618 04:52:19,188 --> 04:52:19,955 FOGGINESS. 7619 04:52:20,022 --> 04:52:22,291 NOW WE HAVE THE ABILITY WITH 7620 04:52:22,358 --> 04:52:23,392 LARGE DATA REGISTRIES TO 7621 04:52:23,459 --> 04:52:26,128 PROVIDE A MEANS TO MAKE 7622 04:52:26,195 --> 04:52:27,529 DATA-DRIVEN DIAGNOSTIC 7623 04:52:27,596 --> 04:52:27,830 CATEGORIES. 7624 04:52:27,897 --> 04:52:31,066 WHY THIS IS SO IMPORTANT IS HOW 7625 04:52:31,133 --> 04:52:32,701 WE DEFINE THESE CONDITIONS 7626 04:52:32,768 --> 04:52:34,503 DETERMINES WHO IS INCLUDED IN 7627 04:52:34,570 --> 04:52:36,939 CLINICAL TRIALS AND WHO HAS THE 7628 04:52:37,006 --> 04:52:38,674 AVAILABLE TREATMENTS. 7629 04:52:38,741 --> 04:52:42,278 TO LOOK WE ASSESS THE 7630 04:52:42,344 --> 04:52:43,812 UNDERLYING RELATIONSHIPS OF 7631 04:52:43,879 --> 04:52:45,547 SYMPTOMS YOUTH BETWEEN 6-17 7632 04:52:45,614 --> 04:52:48,083 YEARS OLD WITH CROSS SECTIONAL 7633 04:52:48,150 --> 04:52:50,819 MULTI-CENTERED STUDY BASED ON 7634 04:52:50,886 --> 04:52:53,389 HEADACHE INTAKE QUESTIONNAIRES. 7635 04:52:53,455 --> 04:52:55,824 I'VE HAD THE GREAT FORTUNE OF 7636 04:52:55,891 --> 04:52:56,659 WORKING WITH TWO GIANTS IN MY 7637 04:52:56,725 --> 04:53:00,996 FIELD. 7638 04:53:01,063 --> 04:53:01,997 ONE DR. CHRISTINE SZPERKA 7639 04:53:02,064 --> 04:53:03,532 SITTING OVER THERE, YOU WILL 7640 04:53:03,599 --> 04:53:05,501 HEAR FROM HER, MY BOSS AT THE 7641 04:53:05,567 --> 04:53:06,001 CHILDREN'S HOSPITAL OF 7642 04:53:06,068 --> 04:53:08,270 PHILADELPHIA. 7643 04:53:08,337 --> 04:53:12,708 SHE HAS WORKED WITH DR. 7644 04:53:12,775 --> 04:53:14,510 HERSHEY, BOTH IN COLLABORATION 7645 04:53:14,576 --> 04:53:17,246 WITH DR. HERSHEY HAVE BUILT 7646 04:53:17,313 --> 04:53:19,748 THESE LARGE HEADACHE REGISTRIES 7647 04:53:19,815 --> 04:53:20,883 BASED ON HEADACHE 7648 04:53:20,950 --> 04:53:21,483 QUESTIONNAIRES FILLED OUT AT 7649 04:53:21,550 --> 04:53:23,419 CLINICAL VISITS. 7650 04:53:23,485 --> 04:53:25,654 WHAT'S GREAT ABOUT THESE 7651 04:53:25,721 --> 04:53:27,156 REGISTRIES THEY HAVE VERY 7652 04:53:27,222 --> 04:53:28,691 SIMILAR WAYS THE QUESTIONS WERE 7653 04:53:28,757 --> 04:53:29,391 ASKED BUT THERE WERE KEY 7654 04:53:29,458 --> 04:53:33,128 DIFFERENCES. 7655 04:53:33,195 --> 04:53:35,831 AT CINCINNATI CHILDREN'S, THESE 7656 04:53:35,898 --> 04:53:38,267 ARE CLINICIAN-GUIDED, THERE'S A 7657 04:53:38,334 --> 04:53:39,868 HEADACHE PROVIDER SITTING WITH 7658 04:53:39,935 --> 04:53:42,805 THEM HELPING FILL IT OUT, BASED 7659 04:53:42,871 --> 04:53:46,342 ON PATIENT RESPONSE EVEN BEFORE 7660 04:53:46,408 --> 04:53:49,378 THEY SEE A CLINICAL PROVIDER. 7661 04:53:49,445 --> 04:53:51,981 AT CHOP ANYONE COMING INTO 7662 04:53:52,047 --> 04:53:53,682 GENERAL NEUROLOGY OR HEADACHE 7663 04:53:53,749 --> 04:53:55,184 PROGRAM AND RANGE OF DATA 7664 04:53:55,250 --> 04:53:56,952 COLLECTION WAS DIFFERENT FOR 7665 04:53:57,019 --> 04:53:57,152 THESE. 7666 04:53:57,219 --> 04:53:59,588 SO INCLUDED IN THIS STUDY WAS 7667 04:53:59,655 --> 04:54:01,156 REALLY ALL YOUTH WITH HEADACHE, 7668 04:54:01,223 --> 04:54:03,525 NOT JUST MIGRAINE. 7669 04:54:03,592 --> 04:54:05,060 THIS INCLUDED OVER 10,000 7670 04:54:05,127 --> 04:54:07,363 RESPONDENTS ACROSS THE TWO 7671 04:54:07,429 --> 04:54:11,000 CENTERS THAT WERE 67 AND 68.4% 7672 04:54:11,066 --> 04:54:13,335 FEMALE, SEX ASSIGNED AT BIRTH. 7673 04:54:13,402 --> 04:54:17,239 MEDIAN AGE 13 YEARS AND THE 7674 04:54:17,306 --> 04:54:18,907 DEMOGRAPHICS RACIAL AND ETHNIC 7675 04:54:18,974 --> 04:54:20,509 REFLECTED THE CATCHMENT AREAS 7676 04:54:20,576 --> 04:54:24,346 OF THE TWO INSTITUTIONS. 7677 04:54:24,413 --> 04:54:26,148 DUE IN PART TO REFERRAL 7678 04:54:26,215 --> 04:54:29,785 PATTERNS THERE WERE DIFFERENCES 7679 04:54:29,852 --> 04:54:32,488 IN OVERALL HEADACHE BURDEN 7680 04:54:32,554 --> 04:54:36,692 METRICS, HEADACHE SEVERITY, 7681 04:54:36,759 --> 04:54:38,394 AVERAGE SEVERITY, FREQUENCY OF 7682 04:54:38,460 --> 04:54:40,195 BAD HEADACHES AND DISABILITY 7683 04:54:40,262 --> 04:54:43,866 WERE OVERALL HIGHER AT 7684 04:54:43,932 --> 04:54:45,667 CINCINNATI CHILDREN'S THOUGH A 7685 04:54:45,734 --> 04:54:47,603 WIDE RANGE ACROSS THE TWO 7686 04:54:47,669 --> 04:54:50,005 INSTITUTIONS. 7687 04:54:50,072 --> 04:54:52,608 DIAGNOSIS, LOWEST AT CINCINNATI 7688 04:54:52,674 --> 04:54:55,644 WHERE AS 65% HAD PRIMARY 7689 04:54:55,711 --> 04:54:56,612 DIAGNOSIS AT C.H.O.P. AND ALL 7690 04:54:56,678 --> 04:54:58,580 CHILDREN WERE INCLUDED. 7691 04:54:58,647 --> 04:54:59,381 WE LOOKED AT 11 ASSOCIATED 7692 04:54:59,448 --> 04:55:03,218 SYMPTOMS. 7693 04:55:03,285 --> 04:55:07,689 THE ICHD FEATURES. 7694 04:55:07,756 --> 04:55:09,892 PHOTO PHOBIA, NAUSEA ARE COMMON 7695 04:55:09,958 --> 04:55:12,528 ACROSS ALL YOUTH WITH HEADACHE. 7696 04:55:12,594 --> 04:55:14,897 OTHER SYMPTOMS NOT INCLUDED 7697 04:55:14,963 --> 04:55:16,365 LIKE LIGHT HEADEDNESS AND 7698 04:55:16,432 --> 04:55:17,366 DIFFICULTY THINKING ARE ALSO 7699 04:55:17,433 --> 04:55:19,201 VERY PREVALENT. 7700 04:55:19,268 --> 04:55:21,537 WE REALLY WANTED TO UNDERSTAND 7701 04:55:21,603 --> 04:55:22,271 HOW THESE SYMPTOMS INTERACTED 7702 04:55:22,337 --> 04:55:26,675 WITH EACH OTHER. 7703 04:55:26,742 --> 04:55:29,278 WE USED MULTIPLE CORRESPONDENCE 7704 04:55:29,344 --> 04:55:30,379 INCIDENCE WHICH REDUCES 7705 04:55:30,446 --> 04:55:33,549 VARIANTS IN A SMALLER NUMBER OF 7706 04:55:33,615 --> 04:55:33,916 DEMENTIA. 7707 04:55:33,982 --> 04:55:35,350 TO GIVE INTUITION OF THIS 7708 04:55:35,417 --> 04:55:37,286 GRAPH, SO THE PRESENCE OF A 7709 04:55:37,352 --> 04:55:38,787 SYMPTOM IS REPRESENTED BY THE 7710 04:55:38,854 --> 04:55:41,890 BUBBLES, THE SIZE OF THE BUBBLE 7711 04:55:41,957 --> 04:55:43,759 IS OVERALL PROPORTION OF 7712 04:55:43,826 --> 04:55:44,359 RESPONDENTS WHO REPORTED THAT 7713 04:55:44,426 --> 04:55:45,894 SYMPTOM. 7714 04:55:45,961 --> 04:55:47,896 AND TWO SYMPTOMS BEING CLOSE 7715 04:55:47,963 --> 04:55:48,664 TOGETHER OVERLAPPING INDICATE 7716 04:55:48,730 --> 04:55:50,499 IF YOU REPORTED ONE OF THE 7717 04:55:50,566 --> 04:55:51,433 SYMPTOMS YOU WERE REALLY LIKELY 7718 04:55:51,500 --> 04:55:53,435 TO REPORT THE OTHER. 7719 04:55:53,502 --> 04:55:56,672 FOR INSTANCE YOU CAN SEE PHOTO 7720 04:55:56,738 --> 04:55:57,706 PHOBIA AND PHONOPHOBIA CLOSELY 7721 04:55:57,773 --> 04:55:58,907 OVERLAP. 7722 04:55:58,974 --> 04:56:00,509 THIS SUGGEST IF ONE WAS PRESENT 7723 04:56:00,576 --> 04:56:01,643 THE OTHER WAS PRESENT. 7724 04:56:01,710 --> 04:56:04,179 IF YOU LOOK AT X AXIS WHICH 7725 04:56:04,246 --> 04:56:07,182 CAPTURES THE MOST AMOUNT OF 7726 04:56:07,249 --> 04:56:09,084 VARIANCE YOU SEE IT SPLITS 7727 04:56:09,151 --> 04:56:09,785 RESPONDENT ANSWERS INTO TWO 7728 04:56:09,852 --> 04:56:11,220 MAIN CATEGORIES. 7729 04:56:11,286 --> 04:56:13,622 SO IF YOU HAD NO SYMPTOMS, YOU 7730 04:56:13,689 --> 04:56:15,357 KNOW, THEN YOU HAVE HAD NO 7731 04:56:15,424 --> 04:56:17,259 SYMPTOMS BUT IF YOU HAD ONE 7732 04:56:17,326 --> 04:56:18,527 SYMPTOM YOU WERE MORE LIKELY TO 7733 04:56:18,594 --> 04:56:19,394 REPORT MULTIPLE. 7734 04:56:19,461 --> 04:56:22,731 THERE WAS A RANGE WHERE YOU 7735 04:56:22,798 --> 04:56:25,033 COULD SEE VOMITING KIND IS IN 7736 04:56:25,100 --> 04:56:27,169 THE MIDDLE OF THE GRAPH. 7737 04:56:27,236 --> 04:56:30,405 EVEN THOUGH REPORTED AT SIMILAR 7738 04:56:30,472 --> 04:56:32,007 REPORTED CHANGES IT WAS A 7739 04:56:32,074 --> 04:56:34,643 SYMPTOM THAT COULD BE REPORTED 7740 04:56:34,710 --> 04:56:37,546 AS THE SOLE SYMPTOM AND 7741 04:56:37,613 --> 04:56:39,481 REPORTED BY ITSELF, VISION 7742 04:56:39,548 --> 04:56:43,652 CHANGES WERE MOST LIKELY TO 7743 04:56:43,719 --> 04:56:44,253 OCCUR IF OTHER SYMPTOMS WERE 7744 04:56:44,319 --> 04:56:46,755 PRESENT. 7745 04:56:46,822 --> 04:56:54,396 THIS MODEL HAD NO PRECONCEIVED 7746 04:56:54,463 --> 04:56:55,330 NOTION, AGNOSTIC TO PREEXISTING 7747 04:56:55,397 --> 04:56:58,433 ICHD SYMPTOMS. 7748 04:56:58,500 --> 04:57:00,002 BUT THEY SPLIT INTO ICHD. 7749 04:57:00,068 --> 04:57:01,870 THE BOTTOM PART ARE ALL OF THE 7750 04:57:01,937 --> 04:57:03,238 SYMPTOMS NOT INCLUDED. 7751 04:57:03,305 --> 04:57:05,574 SO THIS SUGGESTS THAT THE MOST 7752 04:57:05,641 --> 04:57:06,842 COMMON SYMPTOMS WE ACTUALLY ASK 7753 04:57:06,909 --> 04:57:11,513 ABOUT AS PART OF DIAGNOSIS DO 7754 04:57:11,580 --> 04:57:12,314 TEND TO CO-OCCUR. 7755 04:57:12,381 --> 04:57:14,516 AND ARE SOMEWHAT SEPARATE FROM 7756 04:57:14,583 --> 04:57:20,489 OTHER SYMPTOMS LIKE LIGHT 7757 04:57:20,556 --> 04:57:21,056 HEADEDNESS, VISION CHANGES, 7758 04:57:21,123 --> 04:57:24,459 SPINNING. 7759 04:57:24,526 --> 04:57:28,430 IT WASN'T A PRIMARY, THESE WERE 7760 04:57:28,497 --> 04:57:29,665 ALSO SYMPTOMS THAT HAPPENED 7761 04:57:29,731 --> 04:57:32,067 WHEN OTHER SYMPTOMS WERE 7762 04:57:32,134 --> 04:57:32,301 PRESENT. 7763 04:57:32,367 --> 04:57:34,369 THE THIRD DIMENSION IN COLOR, 7764 04:57:34,436 --> 04:57:36,371 IT SEPARATED INTO SENSORY HYPE 7765 04:57:36,438 --> 04:57:37,973 SENSITIVITIES AND SEPARATELY 7766 04:57:38,040 --> 04:57:45,147 WHAT I WOULD CONSIDER MORE VEST 7767 04:57:45,214 --> 04:57:47,549 IB LAR SYMPTOMS AND NAUSEA AND 7768 04:57:47,616 --> 04:57:50,219 VOMITING. 7769 04:57:50,285 --> 04:57:52,955 WE USED LINEAR MIX EFFECTS 7770 04:57:53,021 --> 04:57:57,593 MODEL WITH RANDOM MIX VARIABLE 7771 04:57:57,659 --> 04:57:58,360 AND COMPARED THESE THREE CAMS 7772 04:57:58,427 --> 04:57:59,795 DIMENSION. 7773 04:57:59,861 --> 04:58:02,564 WE FOUND THE FIRST THAT A 7774 04:58:02,631 --> 04:58:08,470 GREATER NUMBER OF MIGRAINE 7775 04:58:08,537 --> 04:58:11,540 ASSOCIATED SYMPTOMS CORRELATED 7776 04:58:11,607 --> 04:58:13,742 WITH GREATER HEADACHE. 7777 04:58:13,809 --> 04:58:16,578 THE PRESENCE OF ICHD VERSUS NON 7778 04:58:16,645 --> 04:58:19,748 SYMPTOMS IF YOU REPORTED MORE 7779 04:58:19,815 --> 04:58:22,851 NON ICHD SYMPTOMS YOU TENDED TO 7780 04:58:22,918 --> 04:58:24,353 REPORT MORE FREQUENCY BUT LESS 7781 04:58:24,419 --> 04:58:25,854 SEVERITY. 7782 04:58:25,921 --> 04:58:30,292 THE ICHD HAVE A ROT OF SENSORY 7783 04:58:30,359 --> 04:58:30,892 HYPERSENSITIVITY ASPECTS AND 7784 04:58:30,959 --> 04:58:33,362 REPORTING GREATER PAIN. 7785 04:58:33,428 --> 04:58:36,398 BUT OTHER PATIENTS WHO HAVE 7786 04:58:36,465 --> 04:58:37,899 DIZZINESS SYMPTOMS, LIGHT 7787 04:58:37,966 --> 04:58:39,701 HEADEDNESS, ROOM SPIN, OTHER 7788 04:58:39,768 --> 04:58:41,570 SYMPTOMS LIKE THAT, HIGHER 7789 04:58:41,637 --> 04:58:45,440 FREQUENCY BUT MAYBE NOT AS 7790 04:58:45,507 --> 04:58:45,774 INTENSE PAIN. 7791 04:58:45,841 --> 04:58:48,043 AND WE LOOKED AT THIS ALSO 7792 04:58:48,110 --> 04:58:49,444 ACROSS AGE AND SEX. 7793 04:58:49,511 --> 04:58:52,014 I THINK THIS IS A GOOD POINT TO 7794 04:58:52,080 --> 04:58:53,615 GIVE A PLUG FOR PEDIATRIC 7795 04:58:53,682 --> 04:58:54,082 RESEARCH. 7796 04:58:54,149 --> 04:58:56,685 YOU ASK SEE REALLY INTERESTING 7797 04:58:56,752 --> 04:58:57,286 CHANGES FOCUSING AT THIS 7798 04:58:57,352 --> 04:58:58,520 POPULATION LEVEL. 7799 04:58:58,587 --> 04:59:01,523 WHAT WE SEE IS WITH SYMPTOM 7800 04:59:01,590 --> 04:59:03,659 NUMBER, THE X AXIS IS AGE, AND 7801 04:59:03,725 --> 04:59:10,365 THE Y AXIS IN THIS CASE IS THE 7802 04:59:10,432 --> 04:59:12,501 CAMS WHETHER ABUNDANCE OF 7803 04:59:12,567 --> 04:59:14,703 SYMPTOMS OR NO SYMPTOMS 7804 04:59:14,770 --> 04:59:15,804 PRESENT, YOUNG CHILDREN 7805 04:59:15,871 --> 04:59:17,272 GENERALLY REPORT VERY FEW OR NO 7806 04:59:17,339 --> 04:59:18,840 SYMPTOMS. 7807 04:59:18,907 --> 04:59:21,109 AS THEY GET OLDER THE NUMBER OF 7808 04:59:21,176 --> 04:59:22,577 SYMPTOMS THEY REPORT INCREASES. 7809 04:59:22,644 --> 04:59:25,314 BUT AT THE AGE OF 12 THERE'S A 7810 04:59:25,380 --> 04:59:27,816 SPLIT WHERE FOR MALES THE 7811 04:59:27,883 --> 04:59:30,152 NUMBER OF SYMPTOMS THEY REPORT 7812 04:59:30,218 --> 04:59:33,355 PLATEAUS AND CONTINUES TO 7813 04:59:33,422 --> 04:59:36,825 INCREASE FOR FEMALES. 7814 04:59:36,892 --> 04:59:38,360 WE NEXT LOOKED AT THE SECOND 7815 04:59:38,427 --> 04:59:42,731 DIMENSION. 7816 04:59:42,798 --> 04:59:44,833 SO ICHD VERSES NON ICHD 7817 04:59:44,900 --> 04:59:46,902 SYMPTOMS AND YOUNGER CHILDREN 7818 04:59:46,968 --> 04:59:47,903 TENDED TO ONLY REPORT ICHD 7819 04:59:47,969 --> 04:59:50,339 SYMPTOMS. 7820 04:59:50,405 --> 04:59:52,140 OVERALL MALES REPORTED MORE 7821 04:59:52,207 --> 04:59:54,743 SYMPTOMS WHEREAS FEMALES COULD 7822 04:59:54,810 --> 04:59:57,379 REPORT ALSO SOME NON ICHD 7823 04:59:57,446 --> 04:59:57,646 SYMPTOMS. 7824 04:59:57,713 --> 05:00:00,282 THIS TREND TENDED TO MOVE 7825 05:00:00,349 --> 05:00:01,650 TOWARD MORE NON ICHD SYMPTOMS 7826 05:00:01,717 --> 05:00:03,352 AS CHILDREN GOT OLDER. 7827 05:00:03,418 --> 05:00:05,354 SO THERE WASN'T THE SAME DIE 7828 05:00:05,420 --> 05:00:06,621 VERGENCE WE SEE AT THE TIME THE 7829 05:00:06,688 --> 05:00:07,889 PUBERTY. 7830 05:00:07,956 --> 05:00:10,926 WHAT WE FIND INTERESTING ABOUT 7831 05:00:10,992 --> 05:00:12,227 THIS, IT ALMOST MIRRORS LINEAR 7832 05:00:12,294 --> 05:00:13,428 GROWTH. 7833 05:00:13,495 --> 05:00:15,230 I WOULD BE CURIOUS TO SEE WHAT 7834 05:00:15,297 --> 05:00:17,366 OTHER GROUPS ARE SEE IN THEIR 7835 05:00:17,432 --> 05:00:17,866 CHRONIC PAIN CONDITIONS. 7836 05:00:17,933 --> 05:00:19,701 BUT WE ARE SEEING A LOT OF 7837 05:00:19,768 --> 05:00:21,837 JOINT HYPER MOBILITY. 7838 05:00:21,903 --> 05:00:25,340 WE ARE WONDERING IF THIS MIGHT 7839 05:00:25,407 --> 05:00:27,175 BE MIRRORING JOINT HYPER 7840 05:00:27,242 --> 05:00:28,877 MOBILITY IN SOME WAY. 7841 05:00:28,944 --> 05:00:29,811 IT'S PURE SPECULATION BUT 7842 05:00:29,878 --> 05:00:31,513 SOMETHING WE ARE THINKING ABOUT. 7843 05:00:31,580 --> 05:00:35,784 WHEN WE LOOK AT FINAL CAMS, 7844 05:00:35,851 --> 05:00:39,788 THERE ACTUALLY ISN'T AN AGE OR 7845 05:00:39,855 --> 05:00:41,022 SEX DIFFERENCE OR DEPENDENCE, 7846 05:00:41,089 --> 05:00:43,091 SUGGESTING THESE MIGHT BE MORE 7847 05:00:43,158 --> 05:00:45,660 FIXED PROPERTIES OF MIGRAINE 7848 05:00:45,727 --> 05:00:46,862 THAT DON'T CHANGE ACROSS THESE 7849 05:00:46,928 --> 05:00:49,064 DIMENSIONS. 7850 05:00:49,131 --> 05:00:51,633 SO IN SUMMARY, WE FOUND THAT 7851 05:00:51,700 --> 05:00:55,971 LOOKING AT A BROADER RANGE OF 7852 05:00:56,037 --> 05:00:57,305 MIGRAINE ASSOCIATED SYMPTOMS 7853 05:00:57,372 --> 05:01:00,242 AND LOOKING AT UNDER LIE 7854 05:01:00,308 --> 05:01:01,443 RELATIONSHIPS, INFORMATIVE FOR 7855 05:01:01,510 --> 05:01:03,145 HEADACHE BURDEN AND REVEALED 7856 05:01:03,211 --> 05:01:04,846 DIFFERENCES ACROSS CHILD 7857 05:01:04,913 --> 05:01:05,280 DEVELOPMENT AND SEX. 7858 05:01:05,347 --> 05:01:06,281 WE ALSO FOUND, I THINK THIS IS 7859 05:01:06,348 --> 05:01:08,917 IMPORTANT TO NOTE, I SHOWED YOU 7860 05:01:08,984 --> 05:01:10,952 COMBINED DATA BUT WHEN WE RAN 7861 05:01:11,019 --> 05:01:12,220 SEPARATELY ON SITES WE SAW THE 7862 05:01:12,287 --> 05:01:13,989 SAME CLUSTERS. 7863 05:01:14,055 --> 05:01:16,191 THIS INDICATES THAT EVEN ACROSS 7864 05:01:16,258 --> 05:01:17,559 SITES THAT THESE SYMPTOM 7865 05:01:17,626 --> 05:01:20,128 CLUSTERS ARE INHERENT TO 7866 05:01:20,195 --> 05:01:20,395 MIGRAINE. 7867 05:01:20,462 --> 05:01:24,266 AND WE PROPOSE THIS MIGHT 7868 05:01:24,332 --> 05:01:25,667 REPRESENT SENT ENDOPHENONO 7869 05:01:25,734 --> 05:01:28,770 TYPIC SYMPTOM CLUSTERS THAT 7870 05:01:28,837 --> 05:01:30,872 INVOLVE OVERLAPPING NEURAL 7871 05:01:30,939 --> 05:01:35,076 NETWORKS, PERHAPS DISRUPTED TRY 7872 05:01:35,143 --> 05:01:37,312 GEM NAL CERVICAL COMPLEX, 7873 05:01:37,379 --> 05:01:37,913 BROADER DYSFUNCTION OF NEURAL 7874 05:01:37,979 --> 05:01:39,047 NETWORKS. 7875 05:01:39,114 --> 05:01:41,149 FURTHER RESEARCH IS NEEDED TO 7876 05:01:41,216 --> 05:01:43,752 UNDERSTAND ARE THERE ACTUALLY 7877 05:01:43,819 --> 05:01:47,722 UNDERLYING PATH THO PHYSIOLOGIC 7878 05:01:47,789 --> 05:01:48,523 DIFFERENCES LEADING TO THIS 7879 05:01:48,590 --> 05:01:50,425 RANGE OF SYMPTOMS. 7880 05:01:50,492 --> 05:01:54,663 WITH THE ULTIMATE GOAL OF 7881 05:01:54,729 --> 05:01:57,299 REALLY REFINING MIGRAINE 7882 05:01:57,365 --> 05:01:57,833 DIAGNOSIS AND SUPPORTING 7883 05:01:57,899 --> 05:01:58,500 TARGETED TREATMENTED. 7884 05:01:58,567 --> 05:02:00,836 WITH THAT, THAINKT YOU FOR YOUR 7885 05:02:00,902 --> 05:02:02,471 ATTENTION AND ALL THE PEOPLE 7886 05:02:02,537 --> 05:02:04,272 THAT MADE THIS WORK POSSIBLE. 7887 05:02:04,339 --> 05:02:14,082 AND HAPPY TO TAKE ANY QUESTIONS. 7888 05:02:14,149 --> 05:02:16,451 >> I DIDN'T HAVE SO MUCH A 7889 05:02:16,518 --> 05:02:17,552 QUESTION AS MAYBE I WASN'T PAY 7890 05:02:17,619 --> 05:02:20,422 ATTENTION. 7891 05:02:20,489 --> 05:02:22,224 YOU SHOWED THE BIG CIRCLE SMALL 7892 05:02:22,290 --> 05:02:23,692 CIRCLE SLIDE AND THE SLIDE 7893 05:02:23,758 --> 05:02:26,261 BEFORE THAT YOU WERE SHOWING 7894 05:02:26,328 --> 05:02:27,963 FREQUENCY WITH WHICH THE 7895 05:02:28,029 --> 05:02:29,598 DIFFERENT SYMPTOMS OCCUR. 7896 05:02:29,664 --> 05:02:31,399 AND I THOUGHT, COULD YOU SHOW 7897 05:02:31,466 --> 05:02:32,701 THOSE? 7898 05:02:32,767 --> 05:02:35,737 SORRY, MY THROAT. 7899 05:02:35,804 --> 05:02:37,138 >> NO WORRIES. 7900 05:02:37,205 --> 05:02:40,242 I THINK YOU ARE GETTING AT 7901 05:02:40,308 --> 05:02:41,610 THESE PERCENTAGES REPRESENT THE 7902 05:02:41,676 --> 05:02:43,712 BUBBLE SIZE ON THE NEXT GRAPH. 7903 05:02:43,778 --> 05:02:50,685 IF THAT'S -- 7904 05:02:50,752 --> 05:02:52,153 >> PRECEDING GRAPH. 7905 05:02:52,220 --> 05:02:54,022 >> WAS IT THIS ONE? 7906 05:02:54,089 --> 05:02:55,724 >> NOT WORKING, SORRY. 7907 05:02:55,790 --> 05:02:57,859 GO TO THE ONE BEFORE THAT. 7908 05:02:57,926 --> 05:02:58,460 >> GO BACK ONE? 7909 05:02:58,527 --> 05:02:59,861 >> YEAH. 7910 05:02:59,928 --> 05:03:04,432 SO THIS ONE. 7911 05:03:04,499 --> 05:03:05,100 OSMO PHOBIA WHICH IS LIGHT 7912 05:03:05,166 --> 05:03:06,968 SENSE TIFT? 7913 05:03:07,035 --> 05:03:08,904 >> SMELL SENSITIVITY. 7914 05:03:08,970 --> 05:03:09,471 >> IT'S FAIRLY RARE, RIGHT? 7915 05:03:09,538 --> 05:03:10,505 >> YEAH. 7916 05:03:10,572 --> 05:03:13,708 >> AND GO TO THE NEXT SLIDE. 7917 05:03:13,775 --> 05:03:17,546 SO HERE IT TENDS TO BE ONLY 7918 05:03:17,612 --> 05:03:19,681 ASSOCIATED WITH MANY SYMPTOMS. 7919 05:03:19,748 --> 05:03:21,049 IT'S RARE, TRYING TO UNDERSTAND 7920 05:03:21,116 --> 05:03:21,516 HOW THESE CORRELATE. 7921 05:03:21,583 --> 05:03:25,453 >> THAT'S RIGHT. 7922 05:03:25,520 --> 05:03:28,623 OSMO PHOBIA IS A NICE EXAMPLE, 7923 05:03:28,690 --> 05:03:29,791 PRIOR WORK FIND SPECIFIC BUT 7924 05:03:29,858 --> 05:03:32,727 NOT SENSITIVE. 7925 05:03:32,794 --> 05:03:34,095 THIS GRAPH KIND OF CONSISTENT 7926 05:03:34,162 --> 05:03:38,800 WITH THAT FINDING. 7927 05:03:38,867 --> 05:03:42,437 BECAUSE OSMOPHOBIA IS LIKELY TO 7928 05:03:42,504 --> 05:03:44,573 CORRELATE WITH THE OTHER 7929 05:03:44,639 --> 05:03:45,874 SYMPTOMS BUT LESS COMMON. 7930 05:03:45,941 --> 05:03:47,642 >> JUST WANTED TO MAKE SURE I 7931 05:03:47,709 --> 05:03:48,310 WAS UNDERSTANDING THAT. 7932 05:03:48,376 --> 05:03:49,110 >> YEAH, ABSOLUTELY. 7933 05:03:49,177 --> 05:03:52,747 THANK YOU. 7934 05:03:52,814 --> 05:03:54,883 >> YOUR COMMENT ABOUT JOINT 7935 05:03:54,950 --> 05:03:55,417 HYPER MOBILITY IS REALLY 7936 05:03:55,483 --> 05:03:56,384 INTERESTING. 7937 05:03:56,451 --> 05:03:58,286 I DON'T KNOW ABOUT CHILDREN BUT 7938 05:03:58,353 --> 05:04:02,257 CERTAINLY ADULTS THERE SEEMS TO 7939 05:04:02,324 --> 05:04:04,092 BE CO-OCCURRENCE BETWEEN 7940 05:04:04,159 --> 05:04:05,694 MIGRAINE AND MYOFACIAL PAIN. 7941 05:04:05,760 --> 05:04:08,396 I SEE YOU HAVE NECK PAIN IN 7942 05:04:08,463 --> 05:04:08,597 THERE. 7943 05:04:08,663 --> 05:04:10,098 WOULD THAT BE SOMETHING 7944 05:04:10,165 --> 05:04:13,168 INTERESTING TO PURSUE IN TERMS 7945 05:04:13,234 --> 05:04:15,604 OF LOOKING AT MUSCULAR TURE, 7946 05:04:15,670 --> 05:04:16,271 NOT JUST HEAD, NECK, SHOULDERS, 7947 05:04:16,338 --> 05:04:17,505 ET CETERA. 7948 05:04:17,572 --> 05:04:18,640 HAVE YOU THOUGHT ABOUT THAT? 7949 05:04:18,707 --> 05:04:20,442 DOING THAT? 7950 05:04:20,508 --> 05:04:22,043 >> IT'S A GREAT QUESTION. 7951 05:04:22,110 --> 05:04:24,679 AND WE ACTUALLY ARE FORTUNATE 7952 05:04:24,746 --> 05:04:25,513 TO WORK WITH MULTI-DISCIPLINARY 7953 05:04:25,580 --> 05:04:27,682 TEAM AND WE HAVE A HEADACHE 7954 05:04:27,749 --> 05:04:29,484 PHYSICAL THERAPIST I THINK FOR 7955 05:04:29,551 --> 05:04:32,621 ME EVEN DURING MY TRAINING 7956 05:04:32,687 --> 05:04:37,492 REALLY OPENED THE IMPORTANCE OF 7957 05:04:37,559 --> 05:04:39,427 THE WHOLE MUSCULAR SKELETAL AND 7958 05:04:39,494 --> 05:04:41,630 ITS RELATION TO HEAD PAIN, IT'S 7959 05:04:41,696 --> 05:04:45,600 A REALLY IMPORTANT DIRECTION TO 7960 05:04:45,667 --> 05:04:45,767 GO. 7961 05:04:45,834 --> 05:04:47,435 HEADACHE I HAVE NOTICED 7962 05:04:47,502 --> 05:04:49,504 SOMETIMES LIVES IN ITS OWN 7963 05:04:49,571 --> 05:04:50,238 SATELLITE FROM OTHER PAIN 7964 05:04:50,305 --> 05:04:52,540 CONDITIONS BUT WHEN I COME TO 7965 05:04:52,607 --> 05:04:53,975 THESE PAIN CONSORTIUMS I HEAR 7966 05:04:54,042 --> 05:04:55,577 HOW MUCH OVERLAP AND SIMILARITY 7967 05:04:55,644 --> 05:04:58,713 THERE IS. 7968 05:04:58,780 --> 05:05:00,248 SO I THINK IT'S A REALLY 7969 05:05:00,315 --> 05:05:01,750 IMPORTANT DIRECTION TO GO. 7970 05:05:01,816 --> 05:05:12,360 >> ADULTS A LOT OF PEOPLE WITH 7971 05:05:14,329 --> 05:05:16,064 MIGRAINE GET MYOFACIAL PAIN IN 7972 05:05:16,131 --> 05:05:16,931 BETWEEN MIGRAINE PAIN. 7973 05:05:16,998 --> 05:05:18,633 >> THANK YOU. 7974 05:05:18,700 --> 05:05:20,101 CAN YOU SPEAK THAT LIKELY MOST 7975 05:05:20,168 --> 05:05:22,737 OF THESE CHILDREN ARE 7976 05:05:22,804 --> 05:05:24,639 ADOLESCENTS ANSWERING THESE ARE 7977 05:05:24,706 --> 05:05:26,675 COMING TO THESE SPECIALIZED 7978 05:05:26,741 --> 05:05:28,043 TERTIARY PAIN CLINICS. 7979 05:05:28,109 --> 05:05:31,179 HOW DOES THAT INFORM THE LARGER 7980 05:05:31,246 --> 05:05:33,248 CONTEXT OF HEADACHE TREATMENT 7981 05:05:33,314 --> 05:05:36,117 IN GENERAL FOR CHILDREN SOLELY 7982 05:05:36,184 --> 05:05:38,186 GOING TO A PEDIATRICIAN OR 7983 05:05:38,253 --> 05:05:38,853 FAMILY MEDICINE DOCTOR. 7984 05:05:38,920 --> 05:05:40,321 >> ABSOLUTELY. 7985 05:05:40,388 --> 05:05:45,593 IT'S AN IMPORTANT QUESTION. 7986 05:05:45,660 --> 05:05:46,695 NOTABLE IT'S FOCUSED ON A 7987 05:05:46,761 --> 05:05:48,129 SPECIFIC POPULATION. 7988 05:05:48,196 --> 05:05:51,533 AND I THINK ONE OF THE, SOO WE 7989 05:05:51,599 --> 05:05:53,368 DO HAVE THE ADVANTAGE OF, THAT 7990 05:05:53,435 --> 05:05:58,640 AT LEAST WITHIN THE C.H.O.P. 7991 05:05:58,707 --> 05:05:59,808 DATASET CHILDREN COMING INTO 7992 05:05:59,874 --> 05:06:00,875 NEUROLOGY BUT STILL TALKING 7993 05:06:00,942 --> 05:06:02,377 ABOUT A SELECTIVE GROUP. 7994 05:06:02,444 --> 05:06:05,680 I WOULD LOVE TO EXPAND THIS 7995 05:06:05,747 --> 05:06:07,082 QUESTIONNAIRE TO LIKE THE 7996 05:06:07,148 --> 05:06:08,316 PEDIATRICIAN LEVEL TO SEE, ARE 7997 05:06:08,383 --> 05:06:09,551 WE SEEING THE SAME KIND OF 7998 05:06:09,617 --> 05:06:10,952 PATTERNS? 7999 05:06:11,019 --> 05:06:12,253 OR SOMETHING WITHIN JUST THE 8000 05:06:12,320 --> 05:06:13,254 PARTICULAR POPULATION WE ARE 8001 05:06:13,321 --> 05:06:14,789 SEEING THAT WE ARE SEEING THESE 8002 05:06:14,856 --> 05:06:15,123 RELATIONSHIPS. 8003 05:06:15,190 --> 05:06:16,424 >> RIGHT. 8004 05:06:16,491 --> 05:06:21,930 BECAUSE I THINK ABOUT LIKE 8005 05:06:21,996 --> 05:06:24,566 EARLY INTERVENTION. 8006 05:06:24,632 --> 05:06:26,901 TRYING TO PREVENT CHRONFICATION 8007 05:06:26,968 --> 05:06:29,571 OF THAT PAIN LATER ON. 8008 05:06:29,637 --> 05:06:30,638 >> THE CINCINNATI DATASET, I'M 8009 05:06:30,705 --> 05:06:33,241 STARTING TO LOOK AT THIS, WE 8010 05:06:33,308 --> 05:06:35,276 HAVE LONGITUDINAL INFORMATION. 8011 05:06:35,343 --> 05:06:37,078 ARE THESE, KNOW, THERE SEEMS TO 8012 05:06:37,145 --> 05:06:39,047 BE ON A CROSS SECTIONAL LEVEL 8013 05:06:39,114 --> 05:06:40,915 THERE'S A KHAIFRNG ACROSS AGE. 8014 05:06:40,982 --> 05:06:42,050 WE DON'T KNOW IN THE INDIVIDUAL 8015 05:06:42,117 --> 05:06:43,918 IS THERE A DIFFERENCE, RIGHT? 8016 05:06:43,985 --> 05:06:44,686 WE ARE STARTING TO LOOK AT 8017 05:06:44,753 --> 05:06:45,720 THOSE DATA. 8018 05:06:45,787 --> 05:06:47,255 BUT I THINK IT'S A REALLY 8019 05:06:47,322 --> 05:06:48,857 IMPORTANT QUESTION. 8020 05:06:48,923 --> 05:06:50,125 >> REALLY EXCITING WORK. 8021 05:06:50,191 --> 05:06:53,061 THANK YOU FOR SHARING. 8022 05:06:53,128 --> 05:06:58,399 >> MORE QUESTIONS? 8023 05:06:58,466 --> 05:06:59,334 DO YOU TRACK ABDOMINAL PAIN IN 8024 05:06:59,400 --> 05:06:59,934 THE KIDS? 8025 05:07:00,001 --> 05:07:01,136 >> WE DO. 8026 05:07:01,202 --> 05:07:02,871 SO WE DO HAVE -- I DON'T 8027 05:07:02,937 --> 05:07:05,073 THINK I HAVE LOOK AT IT 8028 05:07:05,140 --> 05:07:05,640 SPECIFICALLY WITH THE CAMS 8029 05:07:05,707 --> 05:07:08,243 ANALYSIS. 8030 05:07:08,309 --> 05:07:11,246 BUT WE TRACK CO-MORBID CHRONIC 8031 05:07:11,312 --> 05:07:12,447 ABDOMINAL PAIN AND ADDITIONAL 8032 05:07:12,514 --> 05:07:14,182 QUESTIONS IN ADDITION TO ASKING 8033 05:07:14,249 --> 05:07:18,586 BY NAUSEA AND VOMITING DO YOU 8034 05:07:18,653 --> 05:07:20,188 HAVE BELLY PAIN. 8035 05:07:20,255 --> 05:07:22,190 IT WOULD BE GREAT TO LOOK AT 8036 05:07:22,257 --> 05:07:25,093 THIS DATA IN THE CONTEXT OF 8037 05:07:25,160 --> 05:07:25,460 ABDOMINAL PAIN. 8038 05:07:25,527 --> 05:07:26,761 YEAH. 8039 05:07:26,828 --> 05:07:31,399 SO 8040 05:07:31,466 --> 05:07:32,634 POTENTIALLY WE SEE ABDOMINAL 8041 05:07:32,700 --> 05:07:33,535 MIGRAINE IN OUR CLINICS AND 8042 05:07:33,601 --> 05:07:35,136 WOULD HAVE THE ABILITY TO LOOK 8043 05:07:35,203 --> 05:07:45,680 AT THAT A BIT AS WELL, YEAH. 8044 05:07:59,828 --> 05:08:01,129 >> PLEASE JOIN ME IN THANKING 8045 05:08:01,196 --> 05:08:02,430 ALL THE SPEAKERS. 8046 05:08:02,497 --> 05:08:04,299 I WISH YOU ALL LUCK WITH THE 8047 05:08:04,365 --> 05:08:09,604 MITCHELL MAX AWARD. 8048 05:08:09,671 --> 05:08:11,406 I BELIEVE WE ARE ON BREAK. 8049 05:08:11,472 --> 05:08:13,441 YEAH, WE ARE ON BREAK RIGHT NOW 8050 05:08:13,508 --> 05:08:15,777 FOR THE NEXT 15 MINUTES. 8051 05:08:15,844 --> 05:08:17,679 SO ENJOY AND DON'T FORGET TO 8052 05:08:17,745 --> 05:08:18,179 CHECK OUT THE POSTERS. 8053 05:08:18,246 --> 05:08:21,583 THANKS. 8054 05:08:21,649 --> 05:08:22,584 NICU ADMISSION WHICH IS 8055 05:08:22,650 --> 05:08:28,456 SOMETHING WE TRY TO AVOID. 8056 05:08:28,523 --> 05:08:31,559 THIS IS DATA I WILL PRESENT 8057 05:08:31,626 --> 05:08:32,794 FROM A RECENT MULTI-CENTER 8058 05:08:32,861 --> 05:08:39,834 STUDY PERFORMED IN THE UNITED 8059 05:08:39,901 --> 05:08:48,443 STATES WITH THE SUPPORT OF 8060 05:08:48,509 --> 05:08:50,545 SOCIETY OF OBSTETRIC AND 8061 05:08:50,612 --> 05:08:50,812 NEONATAL. 8062 05:08:50,879 --> 05:08:53,882 WE WANTED TO TRY TO IDENTIFY 8063 05:08:53,948 --> 05:08:55,049 THE PREVALENCE OF INTRA 8064 05:08:55,116 --> 05:08:57,452 OPERATIVE BREAK THROUGH PAIN 8065 05:08:57,518 --> 05:09:00,255 AND TRY TO ALSO CHARACTERIZE 8066 05:09:00,321 --> 05:09:00,889 WHAT PATIENTS WERE EXPERIENCING. 8067 05:09:00,955 --> 05:09:04,192 SO WE KIND OF DID A BIT OF A 8068 05:09:04,259 --> 05:09:06,728 SNAPSHOT AUDIT LOOKING AT ALL 8069 05:09:06,794 --> 05:09:08,029 DELIVERIES ACROSS A 1-2 MONTH 8070 05:09:08,096 --> 05:09:10,465 PERIOD IN EACH INSTITUTION. 8071 05:09:10,531 --> 05:09:13,201 IN ANY PATIENT HAVING A 8072 05:09:13,268 --> 05:09:14,168 CAESARIAN UNDER NEUROAXIAL 8073 05:09:14,235 --> 05:09:16,204 ANESTHESIA. 8074 05:09:16,271 --> 05:09:17,238 WE EXCLUDED PATIENTS WHO 8075 05:09:17,305 --> 05:09:19,440 WEREN'T ABLE TO REPORT OR 8076 05:09:19,507 --> 05:09:21,376 DIDN'T HAVE ANY INTEROPERATIVE 8077 05:09:21,442 --> 05:09:21,576 PAIN. 8078 05:09:21,643 --> 05:09:23,778 BUT BASICALLY WE HAD ALL THE 8079 05:09:23,845 --> 05:09:26,714 PATIENTS WERE APPROACHED ON UP 8080 05:09:26,781 --> 05:09:28,750 TO 36 HOURS POSTPARTUM AND 8081 05:09:28,816 --> 05:09:30,451 ASKED THESE THREE QUESTIONS 8082 05:09:30,518 --> 05:09:31,653 ABOUT WHETHER THEY EXPERIENCED 8083 05:09:31,719 --> 05:09:33,454 PAIN, HOW THEY WOULD RATE THEIR 8084 05:09:33,521 --> 05:09:34,889 WORST PAIN AND IF THEY WERE 8085 05:09:34,956 --> 05:09:38,293 SATISFIED WITH THE ANESTHESIA 8086 05:09:38,359 --> 05:09:38,493 CARE. 8087 05:09:38,559 --> 05:09:40,461 AND IF THEY DID EXPERIENCE PAIN 8088 05:09:40,528 --> 05:09:43,264 THEY WERE INVITED TO TAKE PART 8089 05:09:43,331 --> 05:09:44,532 INTO A MORE DETAILED 8090 05:09:44,599 --> 05:09:46,968 CHARACTERIZATION STUDY WITH THE 8091 05:09:47,035 --> 05:09:50,104 USE OF A CRF AND MCGILL 8092 05:09:50,171 --> 05:09:53,841 QUESTIONNAIRE BASED ON WHAT 8093 05:09:53,908 --> 05:09:54,309 THEIR INTRO OPERATIVE 8094 05:09:54,375 --> 05:09:55,877 EXPERIENCE WAS. 8095 05:09:55,944 --> 05:09:58,112 THIS IS INTERIM DATA BECAUSE WE 8096 05:09:58,179 --> 05:09:59,814 ARE STILL WAITING FOR SOME 8097 05:09:59,881 --> 05:10:01,416 CENSUS TO SEND THEIR DATA. 8098 05:10:01,482 --> 05:10:04,085 BUT WE HAVE A PRETTY GOOD 8099 05:10:04,152 --> 05:10:06,321 COHORT FROM 11 SITES AND OVER 8100 05:10:06,387 --> 05:10:08,222 2,500 PATIENTS. 8101 05:10:08,289 --> 05:10:11,960 THE A PRETTY RACIALLY AND 8102 05:10:12,026 --> 05:10:13,328 ETHNICALLY DIVERSE POPULATION 8103 05:10:13,394 --> 05:10:15,096 KEEPING IN THE U.S. POPULATION 8104 05:10:15,163 --> 05:10:16,497 WE SERVE AND PRIMARY HLAING 8105 05:10:16,564 --> 05:10:19,600 SPOKEN IS PRETTY MUCH WHAT WE 8106 05:10:19,667 --> 05:10:20,134 ENCOUNTER IN THE CLINICAL 8107 05:10:20,201 --> 05:10:21,936 SETTING. 8108 05:10:22,003 --> 05:10:24,772 AND SIMILARLY, THE URGENCY OF 8109 05:10:24,839 --> 05:10:26,607 THE CAESARIAN DELIVERY 8110 05:10:26,674 --> 05:10:28,509 PERFORMED IS ALSO QUITE DIVERSE 8111 05:10:28,576 --> 05:10:29,610 AND KEEPING WITH WHAT WE SEE 8112 05:10:29,677 --> 05:10:32,313 CLINICALLY. 8113 05:10:32,380 --> 05:10:34,282 THE TAKE-HOME MESSAGE HERE IS 8114 05:10:34,349 --> 05:10:38,619 AROUND 10% OF PATIENTS HAVE 8115 05:10:38,686 --> 05:10:39,187 INTRA OPERATIVE PAIN BREAK 8116 05:10:39,253 --> 05:10:47,695 THROUGH. 8117 05:10:47,762 --> 05:10:49,931 LET'S DO A DEEPER DIVE IN WHAT 8118 05:10:49,998 --> 05:10:52,133 IS ASSOCIATED WITH PAIN. 8119 05:10:52,200 --> 05:10:55,203 IN OUR ADJUSTED MODEL WE FOUND 8120 05:10:55,269 --> 05:10:57,138 THAT ANESTHESIA MODE WAS THE 8121 05:10:57,205 --> 05:11:00,842 ONLY THING THAT WHEN ADJUSTED 8122 05:11:00,908 --> 05:11:02,844 FOR OTHER CONFOUNDERS WAS 8123 05:11:02,910 --> 05:11:03,444 SIGNIFICANTLY ASSOCIATED WITH 8124 05:11:03,511 --> 05:11:05,113 INTRA OPERATIVE PAIN. 8125 05:11:05,179 --> 05:11:08,282 PATIENTS ARE BEING TREATED IN A 8126 05:11:08,349 --> 05:11:10,418 VARIETY WAYS. 8127 05:11:10,485 --> 05:11:13,821 THERE ARE NO GUIDELINES HOW TO 8128 05:11:13,888 --> 05:11:14,389 BEST MANAGE INTRA-OPERATIVE 8129 05:11:14,455 --> 05:11:17,425 PAIN. 8130 05:11:17,492 --> 05:11:24,232 BUT 20% OF PATIENTS ARE BEING 8131 05:11:24,298 --> 05:11:26,501 TREATED WITH ANXIETITICS. 8132 05:11:26,567 --> 05:11:28,569 PAIN AND ANXIETY ARE DIFFERENT 8133 05:11:28,636 --> 05:11:28,870 CONSTRUCTS. 8134 05:11:28,936 --> 05:11:31,239 THERE'S LOTS OF WORK TO BE DONE 8135 05:11:31,305 --> 05:11:33,508 FOR INTRA OPERATIVE PAIN. 8136 05:11:33,574 --> 05:11:35,476 AND 16% OF THE PATIENTS THAT 8137 05:11:35,543 --> 05:11:36,978 EXPERIENCED PAIN WERE CONVERTED 8138 05:11:37,045 --> 05:11:40,548 TO GENERAL ANESTHESIA AND 8139 05:11:40,615 --> 05:11:41,749 DOCUMENTATION IN THE ANESTHESIA 8140 05:11:41,816 --> 05:11:44,052 RECORD WAS POOR WITH ONLY 8141 05:11:44,118 --> 05:11:46,187 AROUND 57% OF PATIENTS HAVING 8142 05:11:46,254 --> 05:11:49,424 THE PAIN DOCUMENTED ON THE 8143 05:11:49,490 --> 05:11:51,959 ANESTHESIA CHART BUT NOT 8144 05:11:52,026 --> 05:11:54,362 ASSOCIATED AS WE ORIGINALLY 8145 05:11:54,429 --> 05:11:55,696 HYPOTHESIZED WITH SPOKEN 8146 05:11:55,763 --> 05:11:58,533 LANGUAGE, RACE OR ETHNICITY. 8147 05:11:58,599 --> 05:11:59,834 FOR THE PATIENTS THAT CONSENTED 8148 05:11:59,901 --> 05:12:02,170 TO GIVING US MORE INFORMATION 8149 05:12:02,236 --> 05:12:03,371 ABOUT THE INTRA OPERATIVE BREAK 8150 05:12:03,438 --> 05:12:05,740 THROUGH PAIN WE HAD A HEAT MAP 8151 05:12:05,807 --> 05:12:06,741 OF WHERE THE PAIN WAS 8152 05:12:06,808 --> 05:12:09,644 EXPERIENCED AND YOU CAN SEE 8153 05:12:09,710 --> 05:12:11,279 HERE THAT ACTUALLY, 8154 05:12:11,345 --> 05:12:12,113 INTERESTINGLY THERE'S MORE PAIN 8155 05:12:12,180 --> 05:12:15,016 EXPERIENCED ON THE RIGHT SIDE 8156 05:12:15,083 --> 05:12:17,819 OF THE ABDOMEN KEEPING WITH THE 8157 05:12:17,885 --> 05:12:19,353 LEFT UTERINE DISPLACEMENT. 8158 05:12:19,420 --> 05:12:22,090 WE TEND TO PUT A WEDGE ON THE 8159 05:12:22,156 --> 05:12:23,624 RIGHT SIDE SO THE PATIENT IS 8160 05:12:23,691 --> 05:12:28,029 TILTED TO THE LEFT TO PREVENT 8161 05:12:28,096 --> 05:12:28,963 HYPOTENSION AND CABLE RENAL 8162 05:12:29,030 --> 05:12:29,664 COMPRESSION. 8163 05:12:29,730 --> 05:12:31,899 THAT'S AN INTERESTING FINDING. 8164 05:12:31,966 --> 05:12:36,237 AND THE OVERALL INTENSITY OF 8165 05:12:36,304 --> 05:12:37,972 PAIN AS PER NUMERICAL RATING 8166 05:12:38,039 --> 05:12:39,607 SCORE WAS 6 OUT OF 10 ACROSS 8167 05:12:39,674 --> 05:12:41,509 ALL SURGERIES. 8168 05:12:41,576 --> 05:12:43,111 BUT FOR URGENT SURGERIES THE 8169 05:12:43,177 --> 05:12:46,080 MEDIAN WAS 7 OUT OF 10. 8170 05:12:46,147 --> 05:12:48,416 THAT'S A SEVERE PAIN SCORE. 8171 05:12:48,483 --> 05:12:50,184 A QUARTER DESCRIBED PAIN 8172 05:12:50,251 --> 05:12:52,019 EXPERIENCE AS DISTRESSING BUT 8173 05:12:52,086 --> 05:12:54,689 82% WERE SATISFIED WITH THE 8174 05:12:54,755 --> 05:12:56,157 ANESTHESIA MANAGEMENT. 8175 05:12:56,224 --> 05:12:58,726 THIS IS A WORD CLOUD ANALYSIS 8176 05:12:58,793 --> 05:13:00,094 TAKEN FROM THE MCGILL 8177 05:13:00,161 --> 05:13:02,530 QUESTIONNAIRE THAT WAS ANSWERED 8178 05:13:02,597 --> 05:13:02,830 BY PATIENTS. 8179 05:13:02,897 --> 05:13:09,070 YOU CAN SEE THAT MANY OF THESE 8180 05:13:09,137 --> 05:13:10,404 ARE QUITE SEVERE-SOUNDING 8181 05:13:10,471 --> 05:13:12,006 DESCRIPTORS AND RESULT IN 8182 05:13:12,073 --> 05:13:13,374 SIGNIFICANT EVENTS OF PAIN THAT 8183 05:13:13,441 --> 05:13:14,842 PATIENTS ARE EXPERIENCING. 8184 05:13:14,909 --> 05:13:17,145 SO WHERE DO WE GO FROM HERE? 8185 05:13:17,211 --> 05:13:19,814 IT'S A SIGNIFICANT PROBLEM. 8186 05:13:19,881 --> 05:13:21,282 IT'S DISTRESSING FOR A 8187 05:13:21,349 --> 05:13:21,916 SIGNIFICANT NUMBER OF PATIENTS 8188 05:13:21,983 --> 05:13:23,618 AS WELL. 8189 05:13:23,684 --> 05:13:27,455 WE REALLY DON'T KNOW WHAT THE 8190 05:13:27,522 --> 05:13:31,425 LONG-TERM PSYCHIATRIC ARE FROM 8191 05:13:31,492 --> 05:13:32,460 THESE PAIN EXPERIENCES AND WE 8192 05:13:32,527 --> 05:13:34,829 DON'T KNOW HOW MANY GO ONTO 8193 05:13:34,896 --> 05:13:35,496 EXPERIENCE CHRONIC PAIN. 8194 05:13:35,563 --> 05:13:37,665 I WILL TALK A LITTLE BIT ABOUT 8195 05:13:37,732 --> 05:13:38,966 CHRONIC PAIN LATER ON IN THIS 8196 05:13:39,033 --> 05:13:40,868 TALK. 8197 05:13:40,935 --> 05:13:43,638 SO WE REALLY NEED OPTIMUM 8198 05:13:43,704 --> 05:13:46,073 TREATMENT STRATEGY AND 8199 05:13:46,140 --> 05:13:48,876 REGIMENTS FOR TREATING BREAK 8200 05:13:48,943 --> 05:13:50,845 THROUGH PAIN INTRA OPERATIVELY, 8201 05:13:50,912 --> 05:13:52,914 WHAT PORTION GO ONTO EXPERIENCE 8202 05:13:52,980 --> 05:13:54,749 POIFT TRAUMATIC STRESS DISORDER. 8203 05:13:54,815 --> 05:13:57,385 DATA FROM CHILD BIRTH FROM ALL 8204 05:13:57,451 --> 05:13:59,287 DELIVERY MODES, VAGINAL 8205 05:13:59,353 --> 05:14:01,122 DELIVERY AND C-SECTION AROUND A 8206 05:14:01,189 --> 05:14:02,523 THIRD OF PATIENTS DESCRIBE 8207 05:14:02,590 --> 05:14:05,159 THEIR EXPERIENCES AS TRAUMATIC. 8208 05:14:05,226 --> 05:14:07,195 AND THIS HAS BEEN BRUSHED UNDER 8209 05:14:07,261 --> 05:14:08,663 THE CARPET UNTIL RECENTLY AND 8210 05:14:08,729 --> 05:14:10,298 I'M GLAD WE ARE GETTING 8211 05:14:10,364 --> 05:14:11,365 ATTENTION AND RIGHTLY SO FOR 8212 05:14:11,432 --> 05:14:13,434 THIS IMPORTANT FIELD. 8213 05:14:13,501 --> 05:14:16,671 PSYCHIATRIC DISEASE IS NOW THE 8214 05:14:16,737 --> 05:14:17,371 LEADING CAUSE OF MATERNAL 8215 05:14:17,438 --> 05:14:19,173 MORTALITY IN THE UNITED STATES 8216 05:14:19,240 --> 05:14:21,542 TO ONE YEAR POSTPARTUM. 8217 05:14:21,609 --> 05:14:24,545 ANXIETY AND DEPRESSION ARE 8218 05:14:24,612 --> 05:14:25,713 CLOSELY RELATED TO PSYCHIATRIC 8219 05:14:25,780 --> 05:14:28,282 MORBIDITY AND MORTALITY. 8220 05:14:28,349 --> 05:14:31,686 AND IS INTRA-OPERATIVE PAIN, 8221 05:14:31,752 --> 05:14:33,721 DOES IT RESULT IN P.T.S.D., 8222 05:14:33,788 --> 05:14:34,355 ANXIETY, DEPRESSION AND CHRONIC 8223 05:14:34,422 --> 05:14:35,590 PAIN? 8224 05:14:35,656 --> 05:14:38,526 LOTS OF WORK TO BE DONE IN THIS 8225 05:14:38,593 --> 05:14:40,194 FIELD. 8226 05:14:40,261 --> 05:14:41,696 NOW UP UNTIL NOW 8227 05:14:41,762 --> 05:14:43,998 DISPROPORTIONATE AMOUNT OF 8228 05:14:44,065 --> 05:14:45,433 RESEARCHERS FOCUSED ON 8229 05:14:45,499 --> 05:14:47,268 INPATIENT SETTING WHERE 8230 05:14:47,335 --> 05:14:48,169 MAJORITY OF THE POSTPARTUM 8231 05:14:48,236 --> 05:14:49,537 PERIOD HAPPENS IN THE 8232 05:14:49,604 --> 05:14:50,871 OUTPATIENT SETTING. 8233 05:14:50,938 --> 05:14:55,142 AS I ELUDED TO THE MAJORITY OF 8234 05:14:55,209 --> 05:14:57,078 DEATHS ARE HAPPENING AFTER THE 8235 05:14:57,144 --> 05:14:59,680 PATIENT LEAVES HOSPITAL. 8236 05:14:59,747 --> 05:15:00,815 WE KNOW PATIENT MORTAL ITERATE 8237 05:15:00,881 --> 05:15:03,451 IS ON THE RISE AND THAT'S 8238 05:15:03,517 --> 05:15:05,319 BUCKING THE TREND COMPARED TO 8239 05:15:05,386 --> 05:15:06,554 OTHER DEVELOPED COUNTRIES. 8240 05:15:06,621 --> 05:15:13,060 ANYTHING WE CAN DO TO IMPROVE 8241 05:15:13,127 --> 05:15:16,364 OUTPATIENT RECOVERY IS LIKELY 8242 05:15:16,430 --> 05:15:18,566 TO IMPROVE MORTALITY AS WELL. 8243 05:15:18,633 --> 05:15:20,301 LET'S TALK ABOUT MATERNAL PAIN 8244 05:15:20,368 --> 05:15:22,703 WHICH IS A KEY PART OF 8245 05:15:22,770 --> 05:15:24,138 POSTPARTUM RECOVERY. 8246 05:15:24,205 --> 05:15:27,842 I SPENT THE YEAR AT STANFORD 8247 05:15:27,908 --> 05:15:29,176 INTERVIEWING DIFFERENT 8248 05:15:29,243 --> 05:15:30,611 STAKEHOLDERS INCLUDING PATIENTS 8249 05:15:30,678 --> 05:15:32,480 THAT EXPERIENCED DIFFERENT 8250 05:15:32,546 --> 05:15:36,751 DELIVERY MODES, OBSTETRICIANS. 8251 05:15:36,817 --> 05:15:38,552 FETAL SPECIALISTS, MIDWIFES AND 8252 05:15:38,619 --> 05:15:40,321 PATIENT PARTNERS ABOUT WHAT 8253 05:15:40,388 --> 05:15:42,923 POSTPARTUM RECOVERY IS. 8254 05:15:42,990 --> 05:15:45,459 THIS IS A WORD CLOUD ANALYSIS 8255 05:15:45,526 --> 05:15:48,796 OF 24 HOURS OF INTERVIEWS WHICH 8256 05:15:48,863 --> 05:15:50,798 WERE ANALYZED AND PAIN FEATURES 8257 05:15:50,865 --> 05:15:54,568 IN THE 100 TOP MOST SPOKEN 8258 05:15:54,635 --> 05:15:55,136 WORDS REGARDING POSTPARTUM 8259 05:15:55,202 --> 05:15:56,370 RECOVERY. 8260 05:15:56,437 --> 05:15:58,773 SO FROM THIS WE ACTUALLY WERE 8261 05:15:58,839 --> 05:16:00,541 ABLE TO DEVELOP A CONCEPTUAL 8262 05:16:00,608 --> 05:16:06,380 FRAMEWORK WHICH WE CAN USE TO 8263 05:16:06,447 --> 05:16:07,181 COMPREHENSIVELY DESCRIBE THE 8264 05:16:07,248 --> 05:16:08,482 COMPLEX PHENOMENON THAT IS 8265 05:16:08,549 --> 05:16:09,784 POSTPARTUM RECOVERY. 8266 05:16:09,850 --> 05:16:12,553 PAIN IS JUST ONE IMPORTANT 8267 05:16:12,620 --> 05:16:15,156 ASPECT OF THIS COMPLEX JIGSAW 8268 05:16:15,222 --> 05:16:15,956 PUZZLE WHICH CONSTITUTES 8269 05:16:16,023 --> 05:16:16,857 RECOVERY ALONG WITH OTHER 8270 05:16:16,924 --> 05:16:19,593 THINGS LIKE SLEEP AND HOW THE 8271 05:16:19,660 --> 05:16:22,430 BABY IS DOING, PSYCHOLOGICAL 8272 05:16:22,496 --> 05:16:24,031 OUTCOMES AND THE SUPPORT THE 8273 05:16:24,098 --> 05:16:26,734 MOTHER GETS AND ADAPTING TO THE 8274 05:16:26,801 --> 05:16:27,268 MATERNAL ROLE AND BREAST 8275 05:16:27,335 --> 05:16:29,170 FEEDING. 8276 05:16:29,236 --> 05:16:30,905 WE NOW HAVE THIS FRAMEWORK BUT 8277 05:16:30,971 --> 05:16:34,442 WE REALLY DON'T KNOW HOW THESE 8278 05:16:34,508 --> 05:16:36,177 DIFFERENT DOMAINS ARE 8279 05:16:36,243 --> 05:16:37,278 INTERRELATED AND THEN I 8280 05:16:37,345 --> 05:16:38,979 EMBARKED UPON TRYING TO 8281 05:16:39,046 --> 05:16:41,082 IDENTIFY THE BEST MEASURES FOR 8282 05:16:41,148 --> 05:16:43,184 EACH OF THESE DOMAINS. 8283 05:16:43,250 --> 05:16:45,619 AND WE DID THIS BY, FIRST OF 8284 05:16:45,686 --> 05:16:47,888 ALL, PERFORMING A MASSIVE 8285 05:16:47,955 --> 05:16:49,924 SCOPING REVIEW LOOKING AT 8,000 8286 05:16:49,990 --> 05:16:51,392 DIFFERENT ARTICLES TO IDENTIFY 8287 05:16:51,459 --> 05:16:53,761 WHAT MEASURES HAVE BEEN USED TO 8288 05:16:53,828 --> 05:16:56,797 EVALUATE THESE DOMAINS. 8289 05:16:56,864 --> 05:16:58,699 AND LOOKING SPECIFICALLY AT 8290 05:16:58,766 --> 05:17:00,401 GLOBAL RECOVERY AND PAIN TO 8291 05:17:00,468 --> 05:17:02,103 START WITH, WE IDENTIFIED THAT 8292 05:17:02,169 --> 05:17:05,139 ACTUALLY THE BEST MEASURE FOR 8293 05:17:05,206 --> 05:17:06,440 POSTPARTUM PAIN THAT'S 8294 05:17:06,507 --> 05:17:10,411 CURRENTLY AVAILABLE IS THE 8295 05:17:10,478 --> 05:17:12,713 SHORT FORM PAIN INVENTORY BUT 8296 05:17:12,780 --> 05:17:14,348 IT WAS ORIGINALLY DEVELOPED FOR 8297 05:17:14,415 --> 05:17:15,516 CANCER PATIENTS. 8298 05:17:15,583 --> 05:17:18,786 SO THIS IS A VERY DIFFERENT 8299 05:17:18,853 --> 05:17:19,920 CONSTRUCT TO POSTPARTUM PAIN 8300 05:17:19,987 --> 05:17:22,356 WHERE YOU HAVE A SECOND 8301 05:17:22,423 --> 05:17:23,724 PATIENT, THE INFANT THE MOTHER 8302 05:17:23,791 --> 05:17:25,359 IS TRYING TO LOOK AFTER. 8303 05:17:25,426 --> 05:17:28,462 YOU HAVE OTHER SOURCES OF PAIN, 8304 05:17:28,529 --> 05:17:30,631 FOR EXAMPLE, FROM BREAST 8305 05:17:30,698 --> 05:17:33,134 FEEDING AND FROM BACK PAIN, 8306 05:17:33,200 --> 05:17:35,836 PELVIC GIRDLE PAIN WHICH ARE 8307 05:17:35,903 --> 05:17:36,570 OFTEN NEGLECTED BY OTHER 8308 05:17:36,637 --> 05:17:38,172 EXISTING MEASURES. 8309 05:17:38,239 --> 05:17:40,708 WE ACTUALLY URGENTLY NEED A NEW 8310 05:17:40,775 --> 05:17:41,342 POSTPARTUM SPECIFIC MEASURE OF 8311 05:17:41,409 --> 05:17:42,643 PAIN. 8312 05:17:42,710 --> 05:17:44,245 AND IN ADDITION TO THIS, THERE 8313 05:17:44,311 --> 05:17:54,655 IS A HUGE AMOUNT OF 8314 05:18:01,128 --> 05:18:02,396 HETEROGENEITY. 8315 05:18:02,463 --> 05:18:06,233 THIS WILL HELP FACILITATE DATA 8316 05:18:06,300 --> 05:18:08,335 POOLING AND IMPROVE RESEARCH 8317 05:18:08,402 --> 05:18:09,970 EFFICIENCY IN THIS FIELD. 8318 05:18:10,037 --> 05:18:12,239 SO THIS IS THE SERIES OF 8319 05:18:12,306 --> 05:18:13,641 SYSTEMATIC REVIEWS THAT WE HAVE 8320 05:18:13,707 --> 05:18:16,143 DONE TO TRY TO IDENTIFY WHAT 8321 05:18:16,210 --> 05:18:17,378 THE BEST EXISTING MEASURES ARE. 8322 05:18:17,445 --> 05:18:19,046 AND ONE OF THE SHOCKING THINGS 8323 05:18:19,113 --> 05:18:21,582 IS THAT MOST OF THE 8324 05:18:21,649 --> 05:18:23,517 BESTISMISTING MEASURES ARE NOT 8325 05:18:23,584 --> 05:18:25,519 POSTPARTUM SPECIFIC BUT THERE 8326 05:18:25,586 --> 05:18:33,761 ARE THREE THAT ARE. 8327 05:18:33,828 --> 05:18:36,697 WE REALLY NEED TO DEVELOP A 8328 05:18:36,764 --> 05:18:39,099 POSTPARTUM SPECIFIC MEASURE FOR 8329 05:18:39,166 --> 05:18:39,733 PAIN, PATIENT REPORTED OUTCOME 8330 05:18:39,800 --> 05:18:40,401 MEASURE. 8331 05:18:40,468 --> 05:18:42,703 WE ARE IN PROCESS OF DEVELOPING 8332 05:18:42,770 --> 05:18:44,538 ONE FOR SLEEP AND ANXIETY AND 8333 05:18:44,605 --> 05:18:47,775 WE JUST DEVELOPED ONE FOR 8334 05:18:47,842 --> 05:18:49,310 GLOBAL POSTPARTUM RECOVERY I'M 8335 05:18:49,376 --> 05:18:50,311 VERY EXCITED ABOUT AND I WILL 8336 05:18:50,377 --> 05:18:52,947 TELL YOU MORE ABOUT IN THE NEXT 8337 05:18:53,013 --> 05:18:54,248 FEW SLIDES. 8338 05:18:54,315 --> 05:18:55,749 BUT AS I MENTIONED NOW WE ARE 8339 05:18:55,816 --> 05:18:57,651 IN THIS POSITION WHERE WE CAN 8340 05:18:57,718 --> 05:18:58,986 START TO TRACK WHAT RECOVERY IS. 8341 05:18:59,053 --> 05:19:01,856 AND IN THE SAME WAY THE BABY 8342 05:19:01,922 --> 05:19:06,794 HAS THEIR HEIGHT AND WEIGHT AND 8343 05:19:06,861 --> 05:19:07,995 HEAD CIRCUMFERENCE PLOTTED WE 8344 05:19:08,062 --> 05:19:10,498 CAN START DOING THIS FOR 8345 05:19:10,564 --> 05:19:11,098 DIFFERENT DOMAINS OF MATERNAL 8346 05:19:11,165 --> 05:19:11,732 RECOVERY. 8347 05:19:11,799 --> 05:19:14,335 THIS IS IMPORTANT BECAUSE IF A 8348 05:19:14,401 --> 05:19:15,469 MOTHER ISN'T RECOVERING WELL, 8349 05:19:15,536 --> 05:19:16,871 THEN YOU CAN NOW MEASURE IT AND 8350 05:19:16,937 --> 05:19:22,409 SAY YOU ARE IN THE BOTTOM FIFTH 8351 05:19:22,476 --> 05:19:22,710 PERCENTILE. 8352 05:19:22,776 --> 05:19:25,246 WE NEED TO REFER YOU TO A PAIN 8353 05:19:25,312 --> 05:19:27,681 SPECIALIST OR SLEEP SPECIALIST 8354 05:19:27,748 --> 05:19:29,283 OR PSYCHIATRIST DEPENDING WHERE 8355 05:19:29,350 --> 05:19:31,185 THE PATIENT IS NOT PERFORMING 8356 05:19:31,252 --> 05:19:35,856 WELL IN THEIR RECOVERY. 8357 05:19:35,923 --> 05:19:37,791 THIS IS A FOR MA WE CAN DO FOR 8358 05:19:37,858 --> 05:19:39,126 ANY OPERATION. 8359 05:19:39,193 --> 05:19:41,028 YOU CAN CHOOSE ANY OPERATION 8360 05:19:41,095 --> 05:19:45,165 AND IDENTIFY WHAT RECOVERY IS 8361 05:19:45,232 --> 05:19:48,502 AFTER A KNEE REPLACEMENT, HIP 8362 05:19:48,569 --> 05:19:50,604 REPLACEMENT, IDENTIFY THE BEST 8363 05:19:50,671 --> 05:19:52,506 DOMAINS AND MEASURES. 8364 05:19:52,573 --> 05:19:53,941 IF ANYONE IS INTERESTED IN DO 8365 05:19:54,008 --> 05:19:56,477 THAT, PLEASE DO REACH OUT. 8366 05:19:56,544 --> 05:19:57,978 OKAY, LET'S TALK A LITTLE BIT 8367 05:19:58,045 --> 05:19:59,813 ABOUT CHRONIC PAIN. 8368 05:19:59,880 --> 05:20:03,150 THIS IS DATA WE ARE ABOUT TO 8369 05:20:03,217 --> 05:20:03,951 PUBLISH FROM 27 DIFFERENT 8370 05:20:04,018 --> 05:20:06,053 PUBLISHED STUDIES. 8371 05:20:06,120 --> 05:20:08,088 OVER 9,000 PATIENTS. 8372 05:20:08,155 --> 05:20:10,925 WE WANTED TO IDENTIFY WHAT THE 8373 05:20:10,991 --> 05:20:12,560 PREVALENCE IS OF CHRONIC PAIN 8374 05:20:12,626 --> 05:20:15,429 DEFINED AS PAIN IN THE ABDOMEN 8375 05:20:15,496 --> 05:20:17,598 FROM BETWEEN THREE MONTHS TO 8376 05:20:17,665 --> 05:20:21,001 SIX MONTHS. 8377 05:20:21,068 --> 05:20:23,103 THE PREVALENCE WE FOUND WAS 15%. 8378 05:20:23,170 --> 05:20:25,306 WHAT WAS INTERESTING IS MOST OF 8379 05:20:25,372 --> 05:20:26,941 THE STUDIES FOCUSED ON 8380 05:20:27,007 --> 05:20:30,210 ABDOMINAL PAIN, BUT AS I 8381 05:20:30,277 --> 05:20:33,981 MENTIONED EARLIER, BACK PAIN, 8382 05:20:34,048 --> 05:20:37,351 PELVIC PAIN, HEADACHE ARE NOT 8383 05:20:37,418 --> 05:20:38,752 UNCOMMON FOLLOWING DELIVERY AND 8384 05:20:38,819 --> 05:20:42,323 REALLY UNDER STUDIED IN THE 8385 05:20:42,389 --> 05:20:42,790 OUTPATIENT POPULATION. 8386 05:20:42,856 --> 05:20:44,959 WE HAVE A HUGE AMOUNT OF WORK 8387 05:20:45,025 --> 05:20:45,626 TO DO UNDERSTANDING WHAT 8388 05:20:45,693 --> 05:20:46,894 CHRONIC PAIN IS IN THE 8389 05:20:46,961 --> 05:20:48,562 POSTPARTUM PERIOD. 8390 05:20:48,629 --> 05:20:51,365 UP UNTIL NOW THIS IS JUST AN 8391 05:20:51,432 --> 05:20:53,300 EXAMPLE HOW THERE ARE HUGE 8392 05:20:53,367 --> 05:20:54,134 DISPARITIES IN HEALTHCARE AND 8393 05:20:54,201 --> 05:20:56,103 IN RESEARCH AS WELL. 8394 05:20:56,170 --> 05:20:59,740 AND I THINK MATERNAL POSTPARTUM 8395 05:20:59,807 --> 05:21:02,176 RECOVERY IS AN UNDER FUNDED AND 8396 05:21:02,242 --> 05:21:09,149 UNDER STUDIED AREA. 8397 05:21:09,216 --> 05:21:12,019 THIS IS DATA FROM 107 CENTERS 8398 05:21:12,086 --> 05:21:14,455 IN THE UNITED KINGDOM WE 8399 05:21:14,521 --> 05:21:15,689 PUBLISHED LOOKING AT ETHNIC 8400 05:21:15,756 --> 05:21:17,891 DIFFERENCES IN PAIN OUTCOMES. 8401 05:21:17,958 --> 05:21:20,527 WE FOUND IN U.K., ASIAN 8402 05:21:20,594 --> 05:21:23,430 ETHNICITY WAS AN INDEPENDENT 8403 05:21:23,497 --> 05:21:25,766 RISK FACTOR FOR MODERATE TO 8404 05:21:25,833 --> 05:21:27,368 SEVERE PAGE DAY 30 FOLLOWING 8405 05:21:27,434 --> 05:21:30,037 CAESARIAN DELIVERY. 8406 05:21:30,104 --> 05:21:31,271 WE NEED TO REPLICATE STUDIES 8407 05:21:31,338 --> 05:21:33,774 LIKE THIS IN THE UNITED STATES 8408 05:21:33,841 --> 05:21:36,043 WITH DIFFERENT RACIAL AND 8409 05:21:36,110 --> 05:21:36,710 ETHNIC PROFILES AND DEMOGRAPHIC 8410 05:21:36,777 --> 05:21:37,978 GROUPS TO LOOK AT. 8411 05:21:38,045 --> 05:21:40,114 AND WE REALLY DON'T KNOW WHAT'S 8412 05:21:40,180 --> 05:21:42,383 HAPPEN IN THE OUTPATIENT 8413 05:21:42,449 --> 05:21:44,418 POSTPARTUM PERIOD IN TERMS OF 8414 05:21:44,485 --> 05:21:49,223 RISK FACTORS FOR CHRONIC PAIN. 8415 05:21:49,289 --> 05:21:52,292 NOW I ELUDED TO HOW WE CAN GO 8416 05:21:52,359 --> 05:21:53,861 ABOUT MEASURING GLOBAL RECOVERY. 8417 05:21:53,927 --> 05:21:55,295 I'M VERY EXCITED TO SHARE WITH 8418 05:21:55,362 --> 05:21:58,098 YOU A MEASURE I SPENT THE LAST 8419 05:21:58,165 --> 05:21:58,632 FIVE YEARS DEVELOPING AND 8420 05:21:58,699 --> 05:21:59,833 VALIDATING. 8421 05:21:59,900 --> 05:22:02,736 THIS IS CALLED THE STANFORD 8422 05:22:02,803 --> 05:22:08,275 OBSTETRIC RECOVERY CHECKLIST OR 8423 05:22:08,342 --> 05:22:10,644 THE ACRONYM IS STORC. 8424 05:22:10,711 --> 05:22:12,146 FOLLOWING THE SYSTEMATIC REVIEW 8425 05:22:12,212 --> 05:22:16,850 WE CONVENED A GROUP OF EXPERTS 8426 05:22:16,917 --> 05:22:17,685 MULTI-DISCIPLINARY STAKEHOLDERS 8427 05:22:17,751 --> 05:22:20,387 INCLUDING PATIENTS AND WE 8428 05:22:20,454 --> 05:22:21,955 DEVELOPED A COMPREHENSIVE 8429 05:22:22,022 --> 05:22:24,892 MEASURE USING VALIDATED 8430 05:22:24,958 --> 05:22:26,193 QUESTIONS FROM EXISTING 8431 05:22:26,260 --> 05:22:27,828 PATIENT-REPORTED OUTCOME 8432 05:22:27,895 --> 05:22:31,031 MEASURES AND WE FINALLY 8433 05:22:31,098 --> 05:22:33,434 WHITTLED THE 481 QUESTIONS TO 8434 05:22:33,500 --> 05:22:35,302 47 QUESTIONS IN THE STORK 8435 05:22:35,369 --> 05:22:37,504 MEASURE WHICH COVERS DIFFERENT 8436 05:22:37,571 --> 05:22:38,072 AS SUSPECTDS OF POSTPARTUM 8437 05:22:38,138 --> 05:22:39,206 RECOVERY. 8438 05:22:39,273 --> 05:22:44,845 AND THEN WE VALIDATED THIS IN A 8439 05:22:44,912 --> 05:22:50,918 LONGITUDINAL STUDY IN THREE 8440 05:22:50,984 --> 05:22:54,354 ACADEMIC, UNTIL WE HAD 100 8441 05:22:54,421 --> 05:22:56,757 COMPLETED SIX-WEEK RESPONSES 8442 05:22:56,824 --> 05:22:57,224 FROM EACH INSTITUTION. 8443 05:22:57,291 --> 05:22:58,625 PATIENTS WERE ASKED TO COMPLETE 8444 05:22:58,692 --> 05:23:00,327 THIS MEASURE AT FOUR DIFFERENT 8445 05:23:00,394 --> 05:23:01,862 TIME POINTS UP TO THREE MONTHS 8446 05:23:01,929 --> 05:23:05,265 POSTPARTUM. 8447 05:23:05,332 --> 05:23:05,999 AND WE RECRUITED 8448 05:23:06,066 --> 05:23:07,267 ENGLISH-SPEAKING PATIENTS IN 8449 05:23:07,334 --> 05:23:09,069 THE FIRST INSTANCE WHO 8450 05:23:09,136 --> 05:23:11,205 DELIVERED A LIVE FETUS. 8451 05:23:11,271 --> 05:23:12,639 PRIMARY OUTCOME POINT FOR 8452 05:23:12,706 --> 05:23:14,074 EVALUATING THIS MEASURE WAS AT 8453 05:23:14,141 --> 05:23:16,877 SIX WEEKS BECAUSE THIS IS WHEN 8454 05:23:16,944 --> 05:23:18,011 THE OBSTETRIC FOLLOW-UP VISIT 8455 05:23:18,078 --> 05:23:20,214 HAPPENS AND SIX WEEKS IS WHEN 8456 05:23:20,280 --> 05:23:21,982 INSURANCE TENDS TO CUT OUT IN 8457 05:23:22,049 --> 05:23:24,051 THE POSTPARTUM PERIOD. 8458 05:23:24,118 --> 05:23:27,588 WE EVALUATED OUR NEW MEASURE 8459 05:23:27,654 --> 05:23:29,556 ACCORDING TO CRITERIA LOOKING 8460 05:23:29,623 --> 05:23:32,760 AT LOTS OF DIFFERENT PSYCHO 8461 05:23:32,826 --> 05:23:34,094 METRIC MEASURES, VALIDITY, DOES 8462 05:23:34,161 --> 05:23:38,532 IT MEASURE WHAT IT IS SUPPOSED 8463 05:23:38,599 --> 05:23:41,235 TO MEASURE, RELIABILITY, IS IT 8464 05:23:41,301 --> 05:23:42,436 REPRODUCIBLE AND DOES IT CHANGE 8465 05:23:42,503 --> 05:23:43,604 OVER TIME. 8466 05:23:43,670 --> 05:23:45,439 I WON'T GO INTO A LOT OF DETAIL 8467 05:23:45,506 --> 05:23:48,909 ABOUT THIS BUT THIS IS THE MOST 8468 05:23:48,976 --> 05:23:49,476 VALID MEASURE OF POSTPARTUM 8469 05:23:49,543 --> 05:23:52,346 RECOVERY WE HAVE. 8470 05:23:52,412 --> 05:23:54,882 WE FOUND INTERESTINGLY AND 8471 05:23:54,948 --> 05:23:56,383 FIRST-TIME MOTHERS HAD WORSE 8472 05:23:56,450 --> 05:23:58,118 RECOVERY SCORES AT SIX WEEKS 8473 05:23:58,185 --> 05:24:01,355 COMPARED TO PATIENTS THAT HAD 8474 05:24:01,421 --> 05:24:03,557 BABIES THAT NEEDED A NIC-U STAY 8475 05:24:03,624 --> 05:24:06,794 HAD WORSE RECOVERY AT SIX WEEKS 8476 05:24:06,860 --> 05:24:08,829 AND PATIENTS WITH A PROLONGED 8477 05:24:08,896 --> 05:24:10,063 HOSPITAL STAY HAD WORSE SCORES 8478 05:24:10,130 --> 05:24:12,065 AT SIX WEEKS AS WELL. 8479 05:24:12,132 --> 05:24:13,967 THIS WAS A RELIABLE MEASURE AND 8480 05:24:14,034 --> 05:24:17,871 ABLE TO DETECT CHANGE UP TO 8481 05:24:17,938 --> 05:24:19,940 THREE MONTHS POSTPARTUM. 8482 05:24:20,007 --> 05:24:22,442 IT ONLY TAKES FIVE MINUTES TO 8483 05:24:22,509 --> 05:24:24,645 COMPLETE SO I THINK IT COULD BE 8484 05:24:24,711 --> 05:24:26,246 USED IN THE CLINICAL SETTING. 8485 05:24:26,313 --> 05:24:28,782 WE ARE ABLE TO TRACK RECOVERY 8486 05:24:28,849 --> 05:24:29,716 ACCORDING TO DIFFERENT DOMAINS. 8487 05:24:29,783 --> 05:24:32,886 YOU COULD SEE HOW A MOTHER 8488 05:24:32,953 --> 05:24:34,688 WOULD BE INTERESTED HOW AM I 8489 05:24:34,755 --> 05:24:36,623 DOING IN WEEK 2, HOW DO I 8490 05:24:36,690 --> 05:24:38,592 COMPARE TO MY PEERS. 8491 05:24:38,659 --> 05:24:41,562 I THINK THIS COULD BE USED TO 8492 05:24:41,628 --> 05:24:42,362 DEVELOP EARLY TARGETED 8493 05:24:42,429 --> 05:24:44,364 INTERVENTIONS NOT JUST FOR PAIN 8494 05:24:44,431 --> 05:24:47,100 BUT PHYSICAL THERAPY, SLEEP, 8495 05:24:47,167 --> 05:24:48,735 FATIGUE, BREAST FEEDING AND 8496 05:24:48,802 --> 05:24:50,137 PSYCHIATRIC INTERVENTIONS. 8497 05:24:50,204 --> 05:24:50,938 SO I'M VERY EXCITED ABOUT THIS 8498 05:24:51,004 --> 05:24:52,172 TOOL. 8499 05:24:52,239 --> 05:24:54,007 I COULD TALK ABOUT THIS AREA 8500 05:24:54,074 --> 05:24:55,843 ALL DAY BUT I'M AWARE I'M AT MY 8501 05:24:55,909 --> 05:24:57,377 20 MINUTES. 8502 05:24:57,444 --> 05:24:59,079 SO HAPPY TO TAKE ANY QUESTIONS 8503 05:24:59,146 --> 05:24:59,446 ABOUT THIS AREA. 8504 05:24:59,513 --> 05:25:09,823 THANK YOU SO MUCH. 8505 05:25:21,501 --> 05:25:23,403 >> WE WILL SEND THEM VIA EMAIL 8506 05:25:23,470 --> 05:25:24,671 THOSE WATCH US. 8507 05:25:24,738 --> 05:25:26,240 WE WILL HAVE ALL THE QUESTIONS 8508 05:25:26,306 --> 05:25:33,046 AFTER OUR THREE TALKS. 8509 05:25:33,113 --> 05:25:38,819 OUR NEXT SPEAKER IS DR. SZPERKA. 8510 05:25:38,886 --> 05:25:40,687 THINK ABOUT WHAT YOU DO. 8511 05:25:40,754 --> 05:25:42,522 PUT YOURSELF IN THAT MOMENT. 8512 05:25:42,589 --> 05:25:44,091 HAVE YOU HAD A HEADACHE TODAY. 8513 05:25:44,157 --> 05:25:46,627 MAYBE IT WAS BECAUSE YOU WERE 8514 05:25:46,693 --> 05:25:46,927 TRAVELING. 8515 05:25:46,994 --> 05:25:48,128 MAYBE YOU MISSED YOUR MORNING 8516 05:25:48,195 --> 05:25:49,529 CUP OF COFFEE. 8517 05:25:49,596 --> 05:25:50,964 IF YOU PUT YOURSELF, I WILL GO 8518 05:25:51,031 --> 05:25:52,466 BACKWARDS. 8519 05:25:52,532 --> 05:25:53,901 IF YOU PUT YOURSELF IN THAT 8520 05:25:53,967 --> 05:25:54,968 MOMENT, THINK ABOUT WHAT YOU 8521 05:25:55,035 --> 05:25:56,103 MIGHT DO, RIGHT. 8522 05:25:56,169 --> 05:25:57,004 MAYBE YOU WILL REACH FOR A 8523 05:25:57,070 --> 05:25:58,338 DRINK OF WATER. 8524 05:25:58,405 --> 05:25:59,940 MAYBE YOU WILL GO EAT 8525 05:26:00,007 --> 05:26:02,175 SOMETHING, MAYBE TAKE A MINUTE 8526 05:26:02,242 --> 05:26:05,078 AND DO A RELAXATION EXERCISE, 8527 05:26:05,145 --> 05:26:06,713 MAYBE MEDICATION. 8528 05:26:06,780 --> 05:26:08,048 WHICH OF THOSE THINGS 8529 05:26:08,115 --> 05:26:09,349 ESSENTIALLY ARE YOU DOING FOR 8530 05:26:09,416 --> 05:26:11,618 YOURSELF IN THAT MOMENT TO HELP 8531 05:26:11,685 --> 05:26:12,986 YOURSELF FEEL BETTER? 8532 05:26:13,053 --> 05:26:14,621 NOW, IF YOU THINK ABOUT MY 8533 05:26:14,688 --> 05:26:16,657 PATIENTS, SO NOW YOU HAVE A 8534 05:26:16,723 --> 05:26:18,358 13-YEAR-OLD WHO IS DOING THIS. 8535 05:26:18,425 --> 05:26:18,992 THEY ARE PRIMARILY IN SCHOOL, 8536 05:26:19,059 --> 05:26:21,128 RIGHT? 8537 05:26:21,194 --> 05:26:25,132 OR IF AT HOME THEY ASK THEIR 8538 05:26:25,198 --> 05:26:25,732 PARENT FOR HELP. 8539 05:26:25,799 --> 05:26:27,200 THE A VERY DIFFERENT EXPERIENCE 8540 05:26:27,267 --> 05:26:28,902 TO HAVE HEADACHE OR OTHER PAIN 8541 05:26:28,969 --> 05:26:33,740 AS A CHILD COMPARED TO AN ADULT. 8542 05:26:33,807 --> 05:26:35,142 YOU HAVE INHERENT BARRIERS TO 8543 05:26:35,208 --> 05:26:37,311 TAKE CARE OF YOURSELF AND TREAT 8544 05:26:37,377 --> 05:26:38,011 YOURSELF. 8545 05:26:38,078 --> 05:26:38,779 CERTAINLY BARRIERS TO DIAGNOSIS 8546 05:26:38,845 --> 05:26:39,613 AS WELL. 8547 05:26:39,680 --> 05:26:41,048 BUT THERE ARE THINGS THAT STAND 8548 05:26:41,114 --> 05:26:42,649 IN YOUR WAY THAT MAKE IT MORE 8549 05:26:42,716 --> 05:26:44,051 DIFFICULT FOR YOU TO TAKE CARE 8550 05:26:44,117 --> 05:26:45,185 OF YOURSELF AND DO THE THINGS 8551 05:26:45,252 --> 05:26:48,455 YOU NEED TO DO. 8552 05:26:48,522 --> 05:26:50,123 PEDIATRICS ESSENTIALLY CHILDREN 8553 05:26:50,190 --> 05:26:51,825 ARE VULNERABLE ACROSS, YOU 8554 05:26:51,892 --> 05:26:53,961 KNOW, ALL CHILDREN TO MANAGE 8555 05:26:54,027 --> 05:26:57,597 THEIR HEALTH CONDITIONS AND 8556 05:26:57,664 --> 05:26:58,632 OBVIOUSLY PAIN MAGNIFIES ALL 8557 05:26:58,699 --> 05:27:08,976 THESE PROBLEMS. 8558 05:27:11,278 --> 05:27:13,246 THAT'S FINE. 8559 05:27:13,313 --> 05:27:14,514 I WILL BRIEFLY TOUCH ON 8560 05:27:14,581 --> 05:27:15,449 DISCLOSURES. 8561 05:27:15,515 --> 05:27:17,985 SOME OF THE WORK PRESENTED IS 8562 05:27:18,051 --> 05:27:22,756 RELATED TO MIK AND SOME DONE BY 8563 05:27:22,823 --> 05:27:24,825 STUDENT I CO-MENTORED WITH MY 8564 05:27:24,891 --> 05:27:25,192 PRIMARY MENTOR. 8565 05:27:25,258 --> 05:27:28,195 TODAY WE WILL TALK ABOUT 8566 05:27:28,261 --> 05:27:29,997 ASPECTS OF HEADACHE UNIQUE TO 8567 05:27:30,063 --> 05:27:33,767 CHILDREN AND TEENS AND PLACEBO 8568 05:27:33,834 --> 05:27:35,535 IN TREATMENT AND HAID ACHE. 8569 05:27:35,602 --> 05:27:36,770 -- HEADACHE. 8570 05:27:36,837 --> 05:27:38,905 NEXT SLIDE, PLEASE. 8571 05:28:07,634 --> 05:28:09,336 IF WE THINK OF THE ENVIRONMENT, 8572 05:28:09,403 --> 05:28:10,270 TO THINK OF EXPERIENCE OF OUR 8573 05:28:10,337 --> 05:28:13,774 CHILDREN. 8574 05:28:13,840 --> 05:28:14,908 CHILDREN LIVE WITHIN SEVERAL 8575 05:28:14,975 --> 05:28:17,010 DIFFERENT LEVELS THEIR WORLD. 8576 05:28:17,077 --> 05:28:18,111 IN THE FAMILY STRUCTURE, WE 8577 05:28:18,178 --> 05:28:22,549 OFTEN HEAR FROM PARENTS THEY 8578 05:28:22,616 --> 05:28:24,985 WILL COME IN AND SAY DO KIDS 8579 05:28:25,052 --> 05:28:27,154 REALLY HAVE HEADACHE OR WORRY 8580 05:28:27,220 --> 05:28:29,523 ABOUT A TUMOR. 8581 05:28:29,589 --> 05:28:30,657 OR I HAVE HAD HEADACHES SINCE I 8582 05:28:30,724 --> 05:28:33,860 WAS A CHILD TOO. 8583 05:28:33,927 --> 05:28:34,594 AT SCHOOL CHILDREN FACE 8584 05:28:34,661 --> 05:28:36,830 SIGNIFICANT STIGMA. 8585 05:28:36,897 --> 05:28:38,799 THEY WILL ASK WHY ARE THEY 8586 05:28:38,865 --> 05:28:40,200 ABSENT OR LEAVING CLASS. 8587 05:28:40,267 --> 05:28:42,536 I'M HERE, I HAVE A HEADACHE, IS 8588 05:28:42,602 --> 05:28:42,969 IT REALLY THAT BAD? 8589 05:28:43,036 --> 05:28:45,272 THEY ARE DOUBTED. 8590 05:28:45,338 --> 05:28:46,173 WITHIN THE HEALTHCARE SYSTEM 8591 05:28:46,239 --> 05:28:49,142 THERE ARE A LOT OF WELL-MEANING 8592 05:28:49,209 --> 05:28:50,343 CLINICIANS WHO WILL SAY, I 8593 05:28:50,410 --> 05:28:52,846 DON'T KNOW HOW TO ASK THEM OR 8594 05:28:52,913 --> 05:28:55,148 WHAT TO DO, I DON'T WANT TO 8595 05:28:55,215 --> 05:28:57,717 HURT THEM OR CAUSE HARM, THEY 8596 05:28:57,784 --> 05:28:59,686 ARE AFRAID TO ACT AND FAIL TO 8597 05:28:59,753 --> 05:29:01,121 ACT BECAUSE THEY ARE AFRAID OF 8598 05:29:01,188 --> 05:29:03,457 CAUSING HARM. 8599 05:29:03,523 --> 05:29:06,059 THIS IS A 3-YEAR-OLD GIRL, NO 8600 05:29:06,126 --> 05:29:06,593 SIGNIFICANT PAST MEDICAL 8601 05:29:06,660 --> 05:29:12,766 HISTORY. 8602 05:29:12,833 --> 05:29:15,168 PARENTS REPORT. 8603 05:29:15,235 --> 05:29:20,140 HISTORY OF COLIC AS AN INFANT, 8604 05:29:20,207 --> 05:29:21,241 SEVERE VOMITING THAT SEEMED TO 8605 05:29:21,308 --> 05:29:23,376 COME OUT OF THE BLUE AND LAST 8606 05:29:23,443 --> 05:29:25,178 MANY HOURS. 8607 05:29:25,245 --> 05:29:30,617 SHOW OF HANDS WHO THINK THIS IS 8608 05:29:30,684 --> 05:29:32,452 MIGRAINE? 8609 05:29:32,519 --> 05:29:34,287 KEEP GOING. 8610 05:29:34,354 --> 05:29:37,591 BY THE TIME THEY ARE TEENAGERS, 8611 05:29:37,657 --> 05:29:39,726 THREE OUT OF FOUR WILL REPORT 8612 05:29:39,793 --> 05:29:41,094 THEY HAD A SIGNIFICANT HEADACHE 8613 05:29:41,161 --> 05:29:43,663 AT SOME POINT. 8614 05:29:43,730 --> 05:29:45,699 MIGRAINE IS THE MOST COMMON 8615 05:29:45,765 --> 05:29:46,766 DISABLING PRIMARY HEADACHE 8616 05:29:46,833 --> 05:29:48,602 DISORDER. 8617 05:29:48,668 --> 05:29:49,469 SECONDARY HEADACHE OR FROM 8618 05:29:49,536 --> 05:29:51,938 INFECTION OR TUMOR. 8619 05:29:52,005 --> 05:29:53,773 BUT PRIMARY HEADACHE DISORDER 8620 05:29:53,840 --> 05:29:56,576 THE HEADACHE IS THE PROBLEM 8621 05:29:56,643 --> 05:29:58,378 ITSELF, MIGRAINE IS THE MOST 8622 05:29:58,445 --> 05:30:00,313 COMMON DISABLING ONE. 8623 05:30:00,380 --> 05:30:02,649 IF YOU LOOK AT THE SLOPE, THE 8624 05:30:02,716 --> 05:30:04,851 LOWER RATES IN YOUNGER CHILDREN 8625 05:30:04,918 --> 05:30:07,921 AND ESSENTIALLY GOES UP 8626 05:30:07,988 --> 05:30:11,358 SUBSTANTIALLY AROUND THE TIME 8627 05:30:11,424 --> 05:30:12,492 OF ADOLESCENT AND SPLIT BETWEEN 8628 05:30:12,559 --> 05:30:14,060 GIRLS AND BOYS. 8629 05:30:14,127 --> 05:30:17,197 AND ABOUT TWO OUT OF 100 KIDS 8630 05:30:17,264 --> 05:30:19,799 WALKING AROUND HIGH SCHOOL HAVE 8631 05:30:19,866 --> 05:30:21,101 HAD HEADACHES MORE OFTEN THAN 8632 05:30:21,168 --> 05:30:23,203 NOT SO THE A VERY COMMON AND 8633 05:30:23,270 --> 05:30:24,437 DISABLING PROBLEMS. 8634 05:30:24,504 --> 05:30:28,408 ONE OF THE CONCERNS WE HEAR ON 8635 05:30:28,475 --> 05:30:30,510 THE CLINICAL SIDE, DOES MY 8636 05:30:30,577 --> 05:30:33,313 CHILD HAVE A TUMOR, PARENTS ARE 8637 05:30:33,380 --> 05:30:33,847 CONCERNED ABOUT SECONDARY 8638 05:30:33,914 --> 05:30:36,283 HEADACHE. 8639 05:30:36,349 --> 05:30:38,118 FROM PRIMARY CARE CLINICIANS. 8640 05:30:38,185 --> 05:30:43,657 THERE WE GO. 8641 05:30:43,723 --> 05:30:44,658 FROM PRIMARY CARE CLINICIANS, 8642 05:30:44,724 --> 05:30:46,693 AGAIN THEY ARE WORRIED ABOUT 8643 05:30:46,760 --> 05:30:47,494 TUMORS. 8644 05:30:47,561 --> 05:30:49,229 SO THIS IS SORT OF JUST A BRIEF 8645 05:30:49,296 --> 05:30:53,867 REVIEW. 8646 05:30:53,934 --> 05:30:55,869 IT'S A MNEMONIC DEVELOPED TO 8647 05:30:55,936 --> 05:30:57,437 THINK ABOUT SIGNS AND SYMPTOMS 8648 05:30:57,504 --> 05:30:58,905 THAT COULD BE SUBJECTIVE OF 8649 05:30:58,972 --> 05:31:00,407 SECONDARY HEADACHE. 8650 05:31:00,473 --> 05:31:02,242 THE QUESTION CAME UP EARLIER IN 8651 05:31:02,309 --> 05:31:03,243 TERMS OF FIGURING OUT WHETHER 8652 05:31:03,310 --> 05:31:05,779 WE COULD LOOK AT ALL THE 8653 05:31:05,845 --> 05:31:07,614 SYMPTOMS WE REPORT IN HEADACHE 8654 05:31:07,681 --> 05:31:08,848 IN PRIMARY CARE. 8655 05:31:08,915 --> 05:31:10,417 WE ARE DOING WORK TO THINK 8656 05:31:10,483 --> 05:31:13,987 ABOUT DIAGNOSIS AND TREATMENT. 8657 05:31:14,054 --> 05:31:14,654 MIGRAINE MAY LOOK DIFFERENT IN 8658 05:31:14,721 --> 05:31:15,589 CHILDREN. 8659 05:31:15,655 --> 05:31:19,025 WE SAY THIS COULD BE MIGRAINE. 8660 05:31:19,092 --> 05:31:22,462 HOW DO YOU DIAGNOSE MIGRAINE IN 8661 05:31:22,529 --> 05:31:23,463 CHILDREN VERSUS ADULT. 8662 05:31:23,530 --> 05:31:28,101 THE DIAGNOSTIC CRITERIA ACCOUNT 8663 05:31:28,168 --> 05:31:29,202 FOR THIS, INTERNATIONAL 8664 05:31:29,269 --> 05:31:29,703 CLASSIFICATION OF HEAD 8665 05:31:29,769 --> 05:31:30,370 DISORDERS. 8666 05:31:30,437 --> 05:31:33,006 CURRENT ATTACKS. 8667 05:31:33,073 --> 05:31:34,975 IN KIDS LAST AT LEAST TWO 8668 05:31:35,041 --> 05:31:36,643 HOURS, FOUR FOR ADULTS. 8669 05:31:36,710 --> 05:31:38,979 SPECIFIC CHARACTERISTICS. 8670 05:31:39,045 --> 05:31:43,350 ONE-SIDED PAIN. 8671 05:31:43,416 --> 05:31:43,783 PULSATING QUALITY, 8672 05:31:43,850 --> 05:31:46,486 MODERATE-SEVERE, AGGRAVATED BY 8673 05:31:46,553 --> 05:31:47,487 MOVEMENT. 8674 05:31:47,554 --> 05:31:48,521 IN CHILDREN OFTEN BILATERAL 8675 05:31:48,588 --> 05:31:54,861 WHICH IS ALLOWED. 8676 05:31:54,928 --> 05:31:55,962 NAUSEA, OR VOMITING, PHOTO OR 8677 05:31:56,029 --> 05:31:58,164 PHONOPHOBIA. 8678 05:31:58,231 --> 05:32:03,036 KIDS CAN BE OBSERVED. 8679 05:32:03,103 --> 05:32:06,673 IF WE THINK ABOUT THIS 8680 05:32:06,740 --> 05:32:07,307 SPECIFICALLY, WE LOOKED AT OUR 8681 05:32:07,374 --> 05:32:08,575 DATABASE. 8682 05:32:08,642 --> 05:32:11,311 WE'VE GOT ABOUT AT THIS POINT 8683 05:32:11,378 --> 05:32:13,546 14,000 CHILDREN HAVE COMPLETED 8684 05:32:13,613 --> 05:32:14,714 OUR NEW PATIENT QUESTIONNAIRE 8685 05:32:14,781 --> 05:32:16,950 ACROSS NEUROLOGY. 8686 05:32:17,017 --> 05:32:18,251 SUBSET OF 11,000 BETWEEN 5-17 8687 05:32:18,318 --> 05:32:20,287 AT THE TIME OF THE VISIT. 8688 05:32:20,353 --> 05:32:23,523 SO IF YOU LOOK, WE CAN LOOK 8689 05:32:23,590 --> 05:32:25,325 ESSENTIALLY AT THE PREVALENCE 8690 05:32:25,392 --> 05:32:26,459 OF REPORTING THESE SYMPTOMS AT 8691 05:32:26,526 --> 05:32:27,894 THE TIME OF THEIR NEW VISIT. 8692 05:32:27,961 --> 05:32:30,797 IF YOU LOOK FIRST AT THE 8693 05:32:30,864 --> 05:32:32,232 PURPLE, VOMITING, SOMETHING WE 8694 05:32:32,299 --> 05:32:33,967 TYPICALLY THINK OF ASSOCIATED 8695 05:32:34,034 --> 05:32:37,971 WITH MIGRAINE IN YOUNGER 8696 05:32:38,038 --> 05:32:39,205 CHILDREN AND ESSENTIALLY 8697 05:32:39,272 --> 05:32:40,006 YOUNGER CHILDREN REPORT 8698 05:32:40,073 --> 05:32:42,642 VOMITING WHEN THEY COME IN 8699 05:32:42,709 --> 05:32:44,644 YOUNGER AGES. 8700 05:32:44,711 --> 05:32:45,245 THAT DECREASES STEADILY OVER 8701 05:32:45,312 --> 05:32:47,280 TIME. 8702 05:32:47,347 --> 05:32:48,882 IN CONTRAST NAUSEA THE RED IS 8703 05:32:48,948 --> 05:32:50,583 MORE COMMON AND GOES UP VERY 8704 05:32:50,650 --> 05:32:53,453 SLIGHTLY OVER TIME. 8705 05:32:53,520 --> 05:32:57,957 PHOTO AND PHONOPHOBIA ON OTHER 8706 05:32:58,024 --> 05:32:58,958 HAND INCREASE MORSTEADLY 8707 05:32:59,025 --> 05:33:00,260 ESSENTIALLY HIGHER RATE OF 8708 05:33:00,327 --> 05:33:01,628 ADOLESCENCE. 8709 05:33:01,695 --> 05:33:04,331 IF YOU LOOK AT THEM 8710 05:33:04,397 --> 05:33:05,031 SPECIFICALLY INDIVIDUALLY AND 8711 05:33:05,098 --> 05:33:06,766 MALE VERSUS FEMALE. 8712 05:33:06,833 --> 05:33:08,968 IN THIS GRAPH THE MALE IS BLUE 8713 05:33:09,035 --> 05:33:12,505 AND FEMALE IS GREEN. 8714 05:33:12,572 --> 05:33:14,207 THE VOMITING IS SIMILAR ACROSS 8715 05:33:14,274 --> 05:33:16,343 MALES AND FEMALES BUT PERHAPS A 8716 05:33:16,409 --> 05:33:18,678 LITTLE MORE COMMON IN THE MALES 8717 05:33:18,745 --> 05:33:20,213 AT LEAST A OVERLAP OF THE 8718 05:33:20,280 --> 05:33:22,615 INTERVALS. 8719 05:33:22,682 --> 05:33:24,851 NAUSEA IS INCREASING. 8720 05:33:24,918 --> 05:33:27,587 AND YOU SEE A BIT OF A SPLIT 8721 05:33:27,654 --> 05:33:30,090 AROUND THE TIME OF PUBERTY, 8722 05:33:30,156 --> 05:33:31,358 MALES PLATEAU OUT AND FEMALES 8723 05:33:31,424 --> 05:33:34,728 INCREASE. 8724 05:33:34,794 --> 05:33:37,263 PHOTO PHOBIA AND PHONOPHOBIA. 8725 05:33:37,330 --> 05:33:39,065 SPLIT AND PLATEAU IN THE MALES, 8726 05:33:39,132 --> 05:33:40,834 GIRLS CONTINUE TO RISE 8727 05:33:40,900 --> 05:33:41,868 ESSENTIALLY THROUGH THE TIMES 8728 05:33:41,935 --> 05:33:43,670 OF ADOLESCENCE. 8729 05:33:43,737 --> 05:33:47,240 THIS IS AN EARLIER VERSION OF 8730 05:33:47,307 --> 05:33:50,977 DR. PATTERSON'S WORK, LOOKING 8731 05:33:51,044 --> 05:33:52,879 AT DIFFERENT CLUSTER-ASSOCIATED 8732 05:33:52,946 --> 05:33:54,381 ANALYSIS OF MIGRAINE SYMPTOMS 8733 05:33:54,447 --> 05:33:56,416 AND SHE SHOWED YOU THESE SLIDES 8734 05:33:56,483 --> 05:33:59,152 EARLIER SO I WON'T TAKE MUCH 8735 05:33:59,219 --> 05:34:01,955 TIME BUT SHOWS THE DIFFERENCE 8736 05:34:02,021 --> 05:34:02,589 BETWEEN AGE AND BOYS VERSUS 8737 05:34:02,655 --> 05:34:04,290 GIRLS. 8738 05:34:04,357 --> 05:34:06,593 WHAT ABOUT OTHER SYMPTOMS? 8739 05:34:06,659 --> 05:34:07,660 MIGRAINE ISN'T JUST THE 8740 05:34:07,727 --> 05:34:10,463 ASSOCIATED SYMPTOMS AT THE 8741 05:34:10,530 --> 05:34:14,200 MOMENT OF ATTACK. 8742 05:34:14,267 --> 05:34:17,604 OR NEUROLOGICAL SYMPTOMS, 8743 05:34:17,670 --> 05:34:18,138 VISUAL, SENSORY, NUMBNESS 8744 05:34:18,204 --> 05:34:19,272 TINGLING. 8745 05:34:19,339 --> 05:34:23,143 IN ABOUT A QUARTER CHILDREN. 8746 05:34:23,209 --> 05:34:25,845 INCREASES IN AGE. 8747 05:34:25,912 --> 05:34:26,479 IT'S COMMONLY BILATERAL IN 8748 05:34:26,546 --> 05:34:29,282 CHILDREN. 8749 05:34:29,349 --> 05:34:30,417 CHILDREN MAY REPORT VISUAL 8750 05:34:30,483 --> 05:34:33,219 DISTURBANCES THAT SOUNDS LIKE 8751 05:34:33,286 --> 05:34:35,955 AN AURA AN ADULT MIGHT REPORT 8752 05:34:36,022 --> 05:34:38,992 BUT ACROSS THE ENTIRE FIELD 8753 05:34:39,058 --> 05:34:41,728 INSTEAD OF A QUARTER. 8754 05:34:41,795 --> 05:34:42,662 MORE COMMON IN TEENS COMPARED 8755 05:34:42,729 --> 05:34:47,100 TO YOUNGER CHILDREN. 8756 05:34:47,167 --> 05:34:48,902 CRANIAL SYMPTOMS, EYE TEARING, 8757 05:34:48,968 --> 05:34:50,503 FLUSHING, PTOSIS ON ONE SIDE OF 8758 05:34:50,570 --> 05:34:52,705 THE FACE, WE THINK OF 8759 05:34:52,772 --> 05:34:55,442 ASSOCIATED WITH OTHER HEADACHE 8760 05:34:55,508 --> 05:34:56,776 DISORDERS BUT MIGRAINE IS 8761 05:34:56,843 --> 05:34:57,744 TYPICALLY BILATERAL AND THESE 8762 05:34:57,811 --> 05:35:00,213 ARE COMMON IN CHILDREN. 8763 05:35:00,280 --> 05:35:02,415 DIFFICULTY THINK, LIGHT 8764 05:35:02,482 --> 05:35:04,050 HEADEDNESS, FATIGUE, MORE 8765 05:35:04,117 --> 05:35:05,985 COMMON IN OLDER CHILDREN AND 8766 05:35:06,052 --> 05:35:08,488 PERSISTS HOURS BEYOND THE PAIN. 8767 05:35:08,555 --> 05:35:10,123 ABOUT 80% OF YOUTH REPORT 8768 05:35:10,190 --> 05:35:12,926 DEVELOPMENT OF NEW SYMPTOMS 8769 05:35:12,992 --> 05:35:14,461 AFTER THE PAIN HAS REVOLVED. 8770 05:35:14,527 --> 05:35:16,529 POINTS TO THE FACT THE MIGRAINE 8771 05:35:16,596 --> 05:35:18,698 ATTACK ISN'T JUST PAIN. 8772 05:35:18,765 --> 05:35:20,133 WHAT ABOUT OTHER SYMPTOMS SORT 8773 05:35:20,200 --> 05:35:21,434 OF FLOATED ABOUT THIS QUESTION 8774 05:35:21,501 --> 05:35:22,535 THROUGH SOME OF THE 8775 05:35:22,602 --> 05:35:26,706 CONVERSATIONS IN Q&A TODAY. 8776 05:35:26,773 --> 05:35:29,909 THESE EPISODIC SYMPTOMS 8777 05:35:29,976 --> 05:35:31,778 ASSOCIATED WITH MIGRAINE 8778 05:35:31,845 --> 05:35:35,515 PREDOMINANTLY G.I. OR OTHER 8779 05:35:35,582 --> 05:35:36,316 SYMPTOMSMENT INFANTILE COLIC 8780 05:35:36,382 --> 05:35:38,418 ASSOCIATED WITH MIGRAINE. 8781 05:35:38,485 --> 05:35:41,554 VERTIGO. 8782 05:35:41,621 --> 05:35:42,622 THESE ESSENTIALLY CHANGE ACROSS 8783 05:35:42,689 --> 05:35:43,556 AGE SPECTRUM. 8784 05:35:43,623 --> 05:35:45,992 WE THINK OF THESE AS PROBABLY 8785 05:35:46,059 --> 05:35:46,993 PRECURSORS AND OFTEN TIMES WE 8786 05:35:47,060 --> 05:35:49,062 WILL HAVE THE CHILDREN COME TO 8787 05:35:49,128 --> 05:35:51,831 THE CLINIC, SAY THEY ARE 13 8788 05:35:51,898 --> 05:35:52,732 YEARS OLD AND REPORTING 8789 05:35:52,799 --> 05:35:54,167 HEADACHE BUT YOU LOOK BACK AND 8790 05:35:54,234 --> 05:35:56,703 THEY HAVE HAD SOME OF THESE 8791 05:35:56,769 --> 05:35:56,970 SYMPTOMS. 8792 05:35:57,036 --> 05:35:57,971 IT'S IMPORTANT TO THINK OF THE 8793 05:35:58,037 --> 05:36:00,940 WHOLE CHILD. 8794 05:36:01,007 --> 05:36:01,508 MIGRAINE CAUSES SIGNIFICANT 8795 05:36:01,574 --> 05:36:04,878 DISABILITY, RIGHT? 8796 05:36:04,944 --> 05:36:07,113 HEADACHE DISORDERS INCLUDING 8797 05:36:07,180 --> 05:36:10,984 MIGRAINE, TENSION-TYPE HEADACHE 8798 05:36:11,050 --> 05:36:11,751 THE MOST COMMON NEUROLOGIC 8799 05:36:11,818 --> 05:36:14,888 DISABILITY WORLDWIDE. 8800 05:36:14,954 --> 05:36:17,056 AND YOUTH WITH HEADACHE HAVE 8801 05:36:17,123 --> 05:36:20,026 ALMOST THREE TIMES THE ODDS OF 8802 05:36:20,093 --> 05:36:22,595 ABSENCE FROM SCHOOL, HAS 8803 05:36:22,662 --> 05:36:23,129 ACADEMIC IMPLICATIONS AND 8804 05:36:23,196 --> 05:36:24,597 EMPLOYMENT. 8805 05:36:24,664 --> 05:36:26,299 QUALITY OF LIFE IS SIMILAR TO 8806 05:36:26,366 --> 05:36:28,468 CHILDREN WITH CANCER AND NUMBER 8807 05:36:28,535 --> 05:36:29,936 OF SIMILAR CO MORBIDITIES. 8808 05:36:30,003 --> 05:36:30,537 I DIDN'T PUT IT ON THE SLIDE 8809 05:36:30,603 --> 05:36:32,605 HERE. 8810 05:36:32,672 --> 05:36:33,506 THINKING ABOUT OUR 8811 05:36:33,573 --> 05:36:35,675 CONVERSATIONS THIS MORN, WE 8812 05:36:35,742 --> 05:36:36,309 TALKED ABOUT ADVERSE CHILDHOOD 8813 05:36:36,376 --> 05:36:36,843 EXPERIENCES. 8814 05:36:36,910 --> 05:36:39,178 THERE HAVE BEEN A COUPLE OF 8815 05:36:39,245 --> 05:36:40,980 DIFFERENT STUDIES LOOKING AT 8816 05:36:41,047 --> 05:36:42,282 AVERAGE CHILDHOOD EXPERIENCES 8817 05:36:42,348 --> 05:36:44,517 IN CLINICS AND OUR CLINIC, DR. 8818 05:36:44,584 --> 05:36:48,321 SANTOS HAS DONE THAT AND SHOWN 8819 05:36:48,388 --> 05:36:49,322 ESSENTIALLY FAIRLY SUBSTANTIAL 8820 05:36:49,389 --> 05:36:50,990 RATES CHILDREN REPORTING AT 8821 05:36:51,057 --> 05:36:53,192 LEAST THREE ACES ON THAT 8822 05:36:53,259 --> 05:36:54,427 STANDARDIZED ACE SCREENING. 8823 05:36:54,494 --> 05:36:58,798 AND WE ALSO DID A STUDY LOOKING 8824 05:36:58,865 --> 05:37:01,467 AT NORTH CAROLINA THERE WERE 8825 05:37:01,534 --> 05:37:04,904 ESSENTIALLY DATA COLLECTED, THE 8826 05:37:04,971 --> 05:37:05,305 ADD HEALTH STUDY, 8827 05:37:05,371 --> 05:37:08,942 POPULATION-BASED STUDY. 8828 05:37:09,008 --> 05:37:11,778 SHOWED WITH INCREASED REPORT OF 8829 05:37:11,844 --> 05:37:13,246 ACES INCREASED REPORTING OF 8830 05:37:13,313 --> 05:37:13,513 HEADACHES. 8831 05:37:13,580 --> 05:37:15,548 WE HAVE SEEN THIS IN ADULTS AND 8832 05:37:15,615 --> 05:37:17,550 EVEN NOW WITH CHILDREN. 8833 05:37:17,617 --> 05:37:19,752 SO WE GET BACK TO OUR CASE. 8834 05:37:19,819 --> 05:37:22,155 IT'S SPRING OF FIRST GRADE. 8835 05:37:22,221 --> 05:37:23,489 SHE HAS HAD SEVERAL HEADACHES 8836 05:37:23,556 --> 05:37:28,127 PER MONTH, EACH LAST A FEW 8837 05:37:28,194 --> 05:37:30,129 DAYS, NOW SHE IS IRRITABLE AND 8838 05:37:30,196 --> 05:37:33,099 TROUBLE FOCUSING. 8839 05:37:33,166 --> 05:37:43,710 SHE HAS GONE TO THE NURSE AFTER 8840 05:37:48,414 --> 05:37:52,285 NO BENEFIT FROM IBUPROFEN. 8841 05:37:52,352 --> 05:37:53,686 THEY DON'T JUMP RIGHT INTO 8842 05:37:53,753 --> 05:37:54,654 TREATMENT TO TALK ABOUT 8843 05:37:54,721 --> 05:37:56,222 DIAGNOSIS. 8844 05:37:56,289 --> 05:37:57,223 I CAN TALK ABOUT WHY THAT IS 8845 05:37:57,290 --> 05:37:58,324 IMPORTANT. 8846 05:37:58,391 --> 05:38:00,593 BUT THE SECOND THING THEY TALK 8847 05:38:00,660 --> 05:38:02,528 ABOUT HERE IS TREAT EARLY IN 8848 05:38:02,595 --> 05:38:03,896 THE ATTACK. 8849 05:38:03,963 --> 05:38:07,834 GIVE AN NSAID TO ALL CHILDREN 8850 05:38:07,900 --> 05:38:09,669 AND TRIPTAN TO ADOLESCENCE. 8851 05:38:09,736 --> 05:38:11,671 I REMEMBER READING THIS AND 8852 05:38:11,738 --> 05:38:12,672 SCRATCHING MY HEAD THINKING 8853 05:38:12,739 --> 05:38:13,539 THAT DOESN'T MAKE SENSE. 8854 05:38:13,606 --> 05:38:18,344 IF YOU LOOK AT THE LIST OF 8855 05:38:18,411 --> 05:38:19,679 TRIPTAN, FDA APPROVED TO THE 8856 05:38:19,746 --> 05:38:21,247 AGE OF 6. 8857 05:38:21,314 --> 05:38:25,418 OUR TRIALS HAVE BEEN FRAUGHT 8858 05:38:25,485 --> 05:38:27,020 WITH COMPLICATIONS IN MIGRAINE 8859 05:38:27,086 --> 05:38:29,956 BUT FDA CLEARANCE THEY HAD TO 8860 05:38:30,023 --> 05:38:30,923 HIT A PRETTY SUBSTANTIAL BAR TO 8861 05:38:30,990 --> 05:38:34,694 GET TO THAT. 8862 05:38:34,761 --> 05:38:36,396 WHY ONLY INCLUDING TRIPTANS FOR 8863 05:38:36,462 --> 05:38:46,673 ADOLESCENCE? 8864 05:38:48,975 --> 05:38:51,778 ONE OF THE MAJOR ISSUES HAS 8865 05:38:51,844 --> 05:38:59,152 BEEN THE HIGH PLACEBO GROUP 8866 05:38:59,218 --> 05:39:00,953 RESPONSE RATE -- THANK YOU. 8867 05:39:01,020 --> 05:39:02,488 IN TRIALS FOR CHILDREN WITH 8868 05:39:02,555 --> 05:39:03,623 MIGRAINE. 8869 05:39:03,690 --> 05:39:06,626 SO WHEN YOU PUT THINGS TOGETHER 8870 05:39:06,693 --> 05:39:07,727 ESSENTIALLY LOOKING ACROSS 8871 05:39:07,794 --> 05:39:10,663 MULTIPLE TRIALS, THE ESTIMATE 8872 05:39:10,730 --> 05:39:11,964 IN ADULT MIGRAINE TRIALS, THE 8873 05:39:12,031 --> 05:39:14,300 RESPONSE RATE IS 35%. 8874 05:39:14,367 --> 05:39:15,935 PEDIATRICS IT'S CLOSE TO 50%. 8875 05:39:16,002 --> 05:39:17,437 THERE ARE A NUMBER OF REASONS 8876 05:39:17,503 --> 05:39:19,539 WHY THIS MAY BE. 8877 05:39:19,605 --> 05:39:21,941 AS WE TALKED EARLIER THE 8878 05:39:22,008 --> 05:39:22,909 ATTACKS FOR MIGRAINE THIS 8879 05:39:22,975 --> 05:39:24,944 CHILDREN ARE SHORTER. 8880 05:39:25,011 --> 05:39:26,212 SO THERE'S A HIGHER CHANCE 8881 05:39:26,279 --> 05:39:28,848 PERHAPS THE CHILD WILL COME OUT 8882 05:39:28,915 --> 05:39:32,085 OF THE MIGRAINE, WHETHER IN THE 8883 05:39:32,151 --> 05:39:33,553 PLACEBO GROUP OR GETTING THE 8884 05:39:33,619 --> 05:39:36,422 ACTIVE MEDICATION. 8885 05:39:36,489 --> 05:39:37,323 SEASONAL VARIATION, KIDS WHO 8886 05:39:37,390 --> 05:39:41,260 ARE TERRIBLE IN THE FALL WHEN 8887 05:39:41,327 --> 05:39:42,895 SCHOOL IS STARTING AND 8888 05:39:42,962 --> 05:39:46,632 ADJUSTING BACK AND DO BETTER IN 8889 05:39:46,699 --> 05:39:46,866 WINTER. 8890 05:39:46,933 --> 05:39:50,770 ALSO ASPECT OF HIGHER 8891 05:39:50,837 --> 05:39:53,873 EXPECTANCY, IF I'M ENROLLING 8892 05:39:53,940 --> 05:39:54,807 FOR CLINICAL TRIALS FOR 8893 05:39:54,874 --> 05:39:56,042 MEDICATIONS YOU HAVE SEEN ON 8894 05:39:56,109 --> 05:39:59,545 TELEVISION FIVE YEARS. 8895 05:39:59,612 --> 05:40:01,848 I EXPLAIN MEDICATIONS THEY HAVE 8896 05:40:01,914 --> 05:40:03,249 SEEN SOME FAMOUS STAR TALK 8897 05:40:03,316 --> 05:40:06,586 ABOUT ON TELEVISION OR WRITTEN 8898 05:40:06,652 --> 05:40:08,187 IN A MAGAZINE. 8899 05:40:08,254 --> 05:40:09,322 THEY EXPECT THE MEDICATIONS ARE 8900 05:40:09,388 --> 05:40:13,926 GOING TO WORK BECAUSE THEY HAVE 8901 05:40:13,993 --> 05:40:14,827 SEEN THEM ADVERTISED AND HEARD 8902 05:40:14,894 --> 05:40:16,195 ABOUT THEM. 8903 05:40:16,262 --> 05:40:19,298 I THINK THAT INCREASES THE 8904 05:40:19,365 --> 05:40:22,668 PLACEBO RESPONSE. 8905 05:40:22,735 --> 05:40:25,071 CHILDREN ENTERING THE STUDIES 8906 05:40:25,138 --> 05:40:26,005 ARE RELATIVELY TREATMENT NAIVE, 8907 05:40:26,072 --> 05:40:30,376 THEY DON'T HAVE THE SORT OF 8908 05:40:30,443 --> 05:40:30,877 NEGATIVE RESPONSE RATE. 8909 05:40:30,943 --> 05:40:31,644 SO THIS THING DIDN'T WORK 8910 05:40:31,711 --> 05:40:33,346 BEFORE SO I DON'T THINK THIS 8911 05:40:33,412 --> 05:40:35,982 NEXT THING WILL WORK. 8912 05:40:36,048 --> 05:40:37,416 PROBABLY I'M GOING TO RESPOND, 8913 05:40:37,483 --> 05:40:37,884 RIGHT? 8914 05:40:37,950 --> 05:40:40,820 AND ALSO THERE IS SOME ASPECT 8915 05:40:40,887 --> 05:40:42,355 MAYBE SOME ELEMENT THEY ARE 8916 05:40:42,421 --> 05:40:44,290 REASSURED, RIGHT? 8917 05:40:44,357 --> 05:40:46,993 THEY ARE TYPICALLY USED TO SOME 8918 05:40:47,059 --> 05:40:48,427 OTHER AUTHORITY SAYING WE 8919 05:40:48,494 --> 05:40:49,462 EXPECT TO HAPPEN AND THEREFORE 8920 05:40:49,529 --> 05:40:50,429 IT HAPPENS. 8921 05:40:50,496 --> 05:40:52,765 THEY ARE REASSURED. 8922 05:40:52,832 --> 05:40:53,733 HERE IS YOUR DIAGNOSIS, WE 8923 05:40:53,800 --> 05:40:56,369 THINK YOU ARE LIKELY TO GET 8924 05:40:56,435 --> 05:41:00,439 BETTER, WHETHER SUBCONSCIOUS 8925 05:41:00,506 --> 05:41:02,041 THAT THEY WANT TO,LIKELY GET 8926 05:41:02,108 --> 05:41:03,776 BETTER, WANT TO PLEASE THEIR 8927 05:41:03,843 --> 05:41:04,977 PARENTS AND RESEARCHER. 8928 05:41:05,044 --> 05:41:06,813 THERE ARE A LOT OF REASONS. 8929 05:41:06,879 --> 05:41:09,215 I HAVEN'T TOUCHED ON ALL BUT 8930 05:41:09,282 --> 05:41:11,417 SEVERAL REASONS WHY WE HAVE 8931 05:41:11,484 --> 05:41:13,586 THIS HIGH PLACEBO RESPONSE. 8932 05:41:13,653 --> 05:41:19,125 THE PART OF THE REASON THE RISE 8933 05:41:19,192 --> 05:41:22,228 OF TRIPTAN WAS FDA APPROVED, 8934 05:41:22,295 --> 05:41:27,200 CROSS-OVER DESIGNS THAT LED TO 8935 05:41:27,266 --> 05:41:28,467 ESSENTIALLY A HIGHER SPLIT 8936 05:41:28,534 --> 05:41:31,237 BETWEEN THE ACTIVE AND PLACEBO 8937 05:41:31,304 --> 05:41:34,540 GROUPS WHICH IS LARGELY HOW WE 8938 05:41:34,607 --> 05:41:37,510 LED TO FDA APPROVAL. 8939 05:41:37,577 --> 05:41:39,512 PREVENTIVE STUDIES HAVE SHOWN 8940 05:41:39,579 --> 05:41:40,313 POSITIVE RESPONSES ACROSS 8941 05:41:40,379 --> 05:41:42,148 GROUPS WHICH IS GREAT WHEN ARE 8942 05:41:42,215 --> 05:41:44,650 YOU IN CLINICAL CARE BUT VERY 8943 05:41:44,717 --> 05:41:47,386 DIFFICULT IN CLINICAL TRIALS. 8944 05:41:47,453 --> 05:41:52,225 IN CLINICAL CARE, LACK OF 8945 05:41:52,291 --> 05:41:54,360 EFFICACY IN CLINICAL TRIALS 8946 05:41:54,427 --> 05:41:54,961 DOESN'T MEAN MEDICATIONS ARE 8947 05:41:55,027 --> 05:41:57,363 INEFFECTIVE. 8948 05:41:57,430 --> 05:41:58,731 WE BASE DOSING IN LIQUID FORMS 8949 05:41:58,798 --> 05:42:00,733 AND THINGS LIKE THAT. 8950 05:42:00,800 --> 05:42:01,801 BUT TREATMENTS WILL ONLY WORK 8951 05:42:01,868 --> 05:42:03,069 IF THEY ARE USED. 8952 05:42:03,135 --> 05:42:06,806 SO GETTING BACK TO OUR CASE, WE 8953 05:42:06,873 --> 05:42:08,808 GAVE HER RISE OF TRIPTAN AND 8954 05:42:08,875 --> 05:42:10,543 NAPROXEN, SHE DOES WELL. 8955 05:42:10,610 --> 05:42:16,482 WE GIVE HER A LETTER FOR SCHOOL. 8956 05:42:16,549 --> 05:42:20,319 HEADACHE ACTION PLAN, MEANT TO 8957 05:42:20,386 --> 05:42:22,722 LOOK LIKE THE ASTHMA ZONE TO BE 8958 05:42:22,788 --> 05:42:26,592 RECOGNIZED BY SCHOOL NURSES. 8959 05:42:26,659 --> 05:42:28,527 GREEN ZONE, YELLOW ZONE AND RED 8960 05:42:28,594 --> 05:42:28,728 ZONE. 8961 05:42:28,794 --> 05:42:31,030 THIS CONTINUES TO WORK FOR SOME 8962 05:42:31,097 --> 05:42:36,869 TIME, BUT AROUND TIME OF 8963 05:42:36,936 --> 05:42:37,436 MENSES, HEADACHES INCREASE, 8964 05:42:37,503 --> 05:42:39,038 LONGER DURATION. 8965 05:42:39,105 --> 05:42:40,640 IN HIGH SCHOOL, MISSED FOUR 8966 05:42:40,706 --> 05:42:44,577 DAYS. 8967 05:42:44,644 --> 05:42:46,012 MIGRAINE PERSISTED FOR AT LEAST 8968 05:42:46,078 --> 05:42:49,215 72 HOURS. 8969 05:42:49,282 --> 05:42:51,350 BUT OFTEN TIMES CLINICALLY IF 8970 05:42:51,417 --> 05:42:52,451 SOMETHING PERSISTS MORE THAN A 8971 05:42:52,518 --> 05:42:53,552 DAY WE TREAT IT WITH THE SAME 8972 05:42:53,619 --> 05:42:55,388 APPROACH. 8973 05:42:55,454 --> 05:42:56,389 IF IT'S NOT RESPONDED TO USUAL 8974 05:42:56,455 --> 05:42:58,024 MEDS. 8975 05:42:58,090 --> 05:43:00,526 THERE'S VERY LITTLE EVIDENCE 8976 05:43:00,593 --> 05:43:01,027 FOR COMMONLY USED ORAL 8977 05:43:01,093 --> 05:43:02,862 TREATMENTS. 8978 05:43:02,929 --> 05:43:05,064 WHEN COVID SHUT DOWN HAD WE 8979 05:43:05,131 --> 05:43:06,499 WERE NO LONGER ABLE TO BRING 8980 05:43:06,565 --> 05:43:08,634 CHILDREN TO THE HOSPITAL IF WE 8981 05:43:08,701 --> 05:43:09,635 NEEDED TO, NOT JUST CHILDREN, 8982 05:43:09,702 --> 05:43:10,870 ADULTS TOO. 8983 05:43:10,937 --> 05:43:13,906 WE PUT TOGETHER A PAPER WHERE 8984 05:43:13,973 --> 05:43:14,874 WE GAVE INSTRUCTIONS OF 8985 05:43:14,941 --> 05:43:15,608 SUGGESTIONS THESE ARE SOME 8986 05:43:15,675 --> 05:43:19,178 THINGS YOU CAN TRY. 8987 05:43:19,245 --> 05:43:23,115 INTERESTINGLY ONE OF MY MOST 8988 05:43:23,182 --> 05:43:23,716 HIGHLY CITED PAPERS BUT ALL 8989 05:43:23,783 --> 05:43:24,717 OPINION. 8990 05:43:24,784 --> 05:43:26,819 HERE ARE SOME THINGS YOU CAN 8991 05:43:26,886 --> 05:43:27,954 TRY BASED ON MY CLINICAL 8992 05:43:28,020 --> 05:43:29,422 EXPERIENCE, NOT EVIDENCE. 8993 05:43:29,488 --> 05:43:32,091 I THINK THAT WAS REALLY 8994 05:43:32,158 --> 05:43:35,728 TELLING, THERE ARE SO LITTLE 8995 05:43:35,795 --> 05:43:38,564 STUDIES IN STATUS MIGRAINEOSUS. 8996 05:43:38,631 --> 05:43:40,666 THERE HAVE BEEN STUHTIES OF 8997 05:43:40,733 --> 05:43:42,635 MEDICATION, PATHWAYS YOU CAN 8998 05:43:42,702 --> 05:43:42,835 WRITE. 8999 05:43:42,902 --> 05:43:49,075 BUT NERVE BLOCKS ARE SOMETHING 9000 05:43:49,141 --> 05:43:57,450 WE HAVE COMMONLY DONE, 9001 05:43:57,516 --> 05:44:04,991 LOCALIZED ANESTHETIC, THE 9002 05:44:05,057 --> 05:44:05,558 OCCIPITAL NERVE, TRIGEMINAL. 9003 05:44:05,624 --> 05:44:06,258 WHEN IT WORKS IT'S 9004 05:44:06,325 --> 05:44:07,960 SUBSTANTIALLY HELPFUL. 9005 05:44:08,027 --> 05:44:11,597 THIS IS MY K. 9006 05:44:11,664 --> 05:44:13,065 LIDOCAINE CREAM, WE ALLOW FOR 9007 05:44:13,132 --> 05:44:14,800 PATIENTS TO SIT FOR 30 MINUTES 9008 05:44:14,867 --> 05:44:17,536 TO SEE IF THEY HAD IMPROVED. 9009 05:44:17,603 --> 05:44:20,239 IN SOME WAYS THIS IS MEANT TO 9010 05:44:20,306 --> 05:44:22,608 MIMIC A PLACEBO LEAD-IN. 9011 05:44:22,675 --> 05:44:24,610 CAN WE HELP TO DIFFERENTIATE 9012 05:44:24,677 --> 05:44:28,881 THE TWO GROUPS BY USING THIS AS 9013 05:44:28,948 --> 05:44:29,281 INITIAL TREATMENT. 9014 05:44:29,348 --> 05:44:31,350 IF THEY DID BETTER WITH THE 9015 05:44:31,417 --> 05:44:35,154 CREAM ALONE GREAT, THEY DIDN'T 9016 05:44:35,221 --> 05:44:37,289 NEED INJECTION. 9017 05:44:37,356 --> 05:44:38,657 OUR PRIMARY OUTCOME WAS LOOK AT 9018 05:44:38,724 --> 05:44:41,394 THE CHANGE IN PAIN SCORE AT 30 9019 05:44:41,460 --> 05:44:41,627 MINUTES. 9020 05:44:41,694 --> 05:44:43,696 IF THEY DIDN'T HAVE SUFFICIENT 9021 05:44:43,763 --> 05:44:45,197 IMPROVEMENT BASED ON THE 9022 05:44:45,264 --> 05:44:47,233 CHILD'S DEFINITION THEY COULD 9023 05:44:47,299 --> 05:44:48,034 PROCEED TO ADDITION OPEN LABEL 9024 05:44:48,100 --> 05:44:50,369 INJECTION. 9025 05:44:50,436 --> 05:44:52,505 I WOULD GET LIDOCAINE OUT OF 9026 05:44:52,571 --> 05:44:53,672 THE CLOSET AND DO ADDITIONAL 9027 05:44:53,739 --> 05:44:56,842 SHOTS IF THEY WANTED IT. 9028 05:44:56,909 --> 05:44:59,278 WE PRESCREENED 438, WE 9029 05:44:59,345 --> 05:45:00,046 APPROACHED 148 BECAUSE THEY 9030 05:45:00,112 --> 05:45:03,816 SEEMED TO BE ELIGIBLE. 9031 05:45:03,883 --> 05:45:06,719 58 MET FULL CRITERIA FOR 9032 05:45:06,786 --> 05:45:08,054 ELIGIBILITY. 9033 05:45:08,120 --> 05:45:10,256 MOSTLY ESSENTIALLY OLDER 9034 05:45:10,322 --> 05:45:11,924 ADOLESCENTS AS YOU MIGHT EXPECT 9035 05:45:11,991 --> 05:45:15,828 FROM AN INJECTION TRIAL. 9036 05:45:15,895 --> 05:45:19,498 44 FEMALE, 11 MALE, 2 NOONE 9037 05:45:19,565 --> 05:45:23,235 BINARY AND ONE TRANSMASCULINE. 9038 05:45:23,302 --> 05:45:27,339 MOSTLY WHITE. 9039 05:45:27,406 --> 05:45:32,311 THE MIGRAINE FREQUENCY BEFORE 9040 05:45:32,378 --> 05:45:34,480 STATUS MIGRAINOSUS. 9041 05:45:34,547 --> 05:45:37,149 THEY HAVE HEADACHE AT LEAST 9042 05:45:37,216 --> 05:45:37,750 THREE MONTHS, EPISODIC, LOWER 9043 05:45:37,817 --> 05:45:42,688 FREQUENCY. 9044 05:45:42,755 --> 05:45:45,724 AND FLARE FOR MEDIAN OF 28 DAYS. 9045 05:45:45,791 --> 05:45:46,358 THESE WEREN'T TREATMENT ACROSS 9046 05:45:46,425 --> 05:45:49,962 THE GROUPS. 9047 05:45:50,029 --> 05:45:52,598 THE TOPICAL LIDOCAINE LEAD-IN 9048 05:45:52,665 --> 05:45:55,101 MUCH TO MY SURPRISE, MEAN 9049 05:45:55,167 --> 05:45:57,069 DECREASE IN PAIN WAS 0.2. 9050 05:45:57,136 --> 05:45:57,670 VERY LITTLE CHANGE FROM THE 9051 05:45:57,736 --> 05:46:02,174 CREAM. 9052 05:46:02,241 --> 05:46:03,142 AND ALL PARTICIPANTS PROCEEDED 9053 05:46:03,209 --> 05:46:05,177 TO INJECTION. 9054 05:46:05,244 --> 05:46:06,946 30 MINUTES SO WE LOOKED ATOLIDE 9055 05:46:07,012 --> 05:46:10,683 CANE HAD A DROP OF ABOUT 2.3 9056 05:46:10,749 --> 05:46:15,187 POINTS IN THE 0-10 SCALE, 9057 05:46:15,254 --> 05:46:16,188 SALINE WAS 0.1. 9058 05:46:16,255 --> 05:46:18,724 SO THIS WAS SIGNIFICANT. 9059 05:46:18,791 --> 05:46:20,259 WE LOOKED AT DIFFERENT 9060 05:46:20,326 --> 05:46:21,026 OUTCOMES, DIFFERENT WAYS OF 9061 05:46:21,093 --> 05:46:23,295 SLICING THE DATA. 9062 05:46:23,362 --> 05:46:32,805 FOR ALL THE LIDOCAINE WAS 9063 05:46:32,872 --> 05:46:34,573 SUPERIOR TO SALINE EXCEPT PAIN 9064 05:46:34,640 --> 05:46:36,041 FREEDOM. 9065 05:46:36,108 --> 05:46:37,042 VERY FEW CHILDREN WERE 9066 05:46:37,109 --> 05:46:38,511 COMPLETELY PAIN FREE AT THE END 9067 05:46:38,577 --> 05:46:40,279 OF THE 30 MINUTES. 9068 05:46:40,346 --> 05:46:42,581 I ACTUALLY TRAINED AT A CENTER 9069 05:46:42,648 --> 05:46:52,992 I WAS TAUGHT TO DO 9070 05:46:53,359 --> 05:46:59,765 CIRCUMFERENTIAL INJECTIONS. 9071 05:46:59,832 --> 05:47:00,900 YOU HAVE TO START SOMEWHERE 9072 05:47:00,966 --> 05:47:02,434 WITH THE TRIAL AND THIS WAS A 9073 05:47:02,501 --> 05:47:03,736 REASONABLE PLACE TO START. 9074 05:47:03,802 --> 05:47:05,137 SOMETHING THAT I KIND OF 9075 05:47:05,204 --> 05:47:06,872 STARTED TO PICK UP ON WHILE WE 9076 05:47:06,939 --> 05:47:11,177 WERE DOING THIS STUDY, THE 9077 05:47:11,243 --> 05:47:12,044 SALINE INJECTIONS HURT MORE 9078 05:47:12,111 --> 05:47:14,246 THAN LIDOCAINE. 9079 05:47:14,313 --> 05:47:15,447 AFTER PARTICIPANTS I STARTED 9080 05:47:15,514 --> 05:47:16,248 LEAVING THE ROOM IMMEDIATELY 9081 05:47:16,315 --> 05:47:17,983 AFTER DOING IS THE SHOTS IT 9082 05:47:18,050 --> 05:47:20,886 SEEMED TO ME THEIR REPORT OF 9083 05:47:20,953 --> 05:47:23,022 PAIN WAS THEN, SEEMED HIGHER IN 9084 05:47:23,088 --> 05:47:25,391 THOSE CHILDREN WHO WHERE I 9085 05:47:25,457 --> 05:47:28,794 LATER ESSENTIALLY SAID I THINK 9086 05:47:28,861 --> 05:47:31,030 THEY GOT SALINE SO THEY DIDN'T 9087 05:47:31,096 --> 05:47:34,333 GET NUMBNESS, SO I WAS AFRAID I 9088 05:47:34,400 --> 05:47:37,736 WAS BLINDING MYSELF SO I LEFT 9089 05:47:37,803 --> 05:47:39,905 THE ROOM. 9090 05:47:39,972 --> 05:47:41,640 IT WOULD BE A REASONABLE OPTION 9091 05:47:41,707 --> 05:47:43,642 FOR A PLACEBO. 9092 05:47:43,709 --> 05:47:46,946 BUT THEN, SEEING IT WAS 9093 05:47:47,012 --> 05:47:47,580 ACTUALLY CAUSING DISCOMFORT WAS 9094 05:47:47,646 --> 05:47:50,182 DISHEARTENING. 9095 05:47:50,249 --> 05:47:51,917 WE LOOKED AT 24-HOUR OUTCOMES. 9096 05:47:51,984 --> 05:47:56,622 AGAIN THE PAIN RELIEF AND 9097 05:47:56,689 --> 05:47:57,356 RELIEF FROM ASSOCIATED 9098 05:47:57,423 --> 05:47:58,824 SYMPTOMS, NAUSEA AND THAT SORT 9099 05:47:58,891 --> 05:48:03,028 OF THING WERE BOTH BETTER IN 9100 05:48:03,095 --> 05:48:05,364 THE LIDOCAINE GROUP. 9101 05:48:05,431 --> 05:48:07,833 WE HAVE SOME ADVERSE EFFECTS. 9102 05:48:07,900 --> 05:48:09,835 ONE THING TYPICALLY DONE IN 9103 05:48:09,902 --> 05:48:10,736 TRIALS YOU SAY DID ANYTHING 9104 05:48:10,803 --> 05:48:13,539 BOTHER YOU. 9105 05:48:13,606 --> 05:48:15,874 WE ASKED THEM, 57 OUT OF 58 SID 9106 05:48:15,941 --> 05:48:19,445 SOMETHING WAS NOT GREAT. 9107 05:48:19,511 --> 05:48:22,715 ALSO RELATED TO ANXIETY. 9108 05:48:22,781 --> 05:48:24,316 IT CLINICAL CARE I GET CONSENT 9109 05:48:24,383 --> 05:48:25,918 AND GO THROUGH THE PROCEDURE. 9110 05:48:25,985 --> 05:48:28,554 IN THIS CASE WE DID THAT, I PUT 9111 05:48:28,621 --> 05:48:30,522 CREAM ON THEIR HEAD AND ASKED 9112 05:48:30,589 --> 05:48:31,824 THEM TO FILL OUT QUESTIONNAIRES 9113 05:48:31,890 --> 05:48:33,993 BEFORE THE SHOTS SO THEY WERE 9114 05:48:34,059 --> 05:48:36,662 REALLY ANXIOUS. 9115 05:48:36,729 --> 05:48:37,329 NO DIFFERENCES BETWEEN THE 9116 05:48:37,396 --> 05:48:39,331 GROUPS. 9117 05:48:39,398 --> 05:48:40,966 ONE CHILD DEVELOPED CONFUSION 9118 05:48:41,033 --> 05:48:42,468 HOURS LATER, WE THINK DEVELOPED 9119 05:48:42,534 --> 05:48:43,802 MORE TO THE ORAL MEDICATIONS 9120 05:48:43,869 --> 05:48:51,410 AND ONE CHILD IN THE SALINE 9121 05:48:51,477 --> 05:48:53,012 GROUP DEVELOPED ANAPHYLAXIS 9122 05:48:53,078 --> 05:48:54,146 AFTER GIVEN THE LIDOCAINE 9123 05:48:54,213 --> 05:48:55,714 INJECTIONS, VERY UNCOMMON. 9124 05:48:55,781 --> 05:48:58,851 THE TIMING OF THE OUTCOME, IS 9125 05:48:58,917 --> 05:49:01,754 30 MINUTES TOO EARLY TO LOOK. 9126 05:49:01,820 --> 05:49:05,391 WE HAD THEM COLLECT DIARY DATA 9127 05:49:05,457 --> 05:49:07,926 FOR 28 DAYS. 9128 05:49:07,993 --> 05:49:11,063 DID YOU EXPECT TO GET BETTER? 9129 05:49:11,130 --> 05:49:12,598 DID YOUR PARENTS EXPECT YOU TO 9130 05:49:12,665 --> 05:49:13,732 GET BETTER AND DID THAT AFFECT 9131 05:49:13,799 --> 05:49:15,701 THE OUTCOME. 9132 05:49:15,768 --> 05:49:17,136 WE WENT INTO THIS PARTIALLY 9133 05:49:17,202 --> 05:49:18,537 TRYING TO UNDERSTAND HOW COULD 9134 05:49:18,604 --> 05:49:21,774 WE THINK ABOUT OF THE PLACEBO 9135 05:49:21,840 --> 05:49:23,475 GROUP AND DESIGN A STUDY. 9136 05:49:23,542 --> 05:49:26,211 MY LESSONS HAVE BEEN I DON'T 9137 05:49:26,278 --> 05:49:28,113 THINK THE LIDOCAINE CREAM HELPS 9138 05:49:28,180 --> 05:49:29,448 PARTICULARLY, THOUGH IT STILL 9139 05:49:29,515 --> 05:49:32,418 REMAINS TO BE SEEN IN TERMS OF 9140 05:49:32,484 --> 05:49:33,419 BLINDING AND ADDRESSED ISSUES 9141 05:49:33,485 --> 05:49:34,320 OF BLINDING. 9142 05:49:34,386 --> 05:49:38,724 BUT I DON'T THINK I WOULD USE 9143 05:49:38,791 --> 05:49:40,059 SALINE AS A PLACEBO. 9144 05:49:40,125 --> 05:49:40,793 WHAT ABOUT THE CONTEXT OF THE 9145 05:49:40,859 --> 05:49:43,195 CARE? 9146 05:49:43,262 --> 05:49:44,330 WHAT IF THIS CHILD DIDN'T GET 9147 05:49:44,396 --> 05:49:45,397 TO MY OFFICE? 9148 05:49:45,464 --> 05:49:46,532 WHAT IF THEY WENT TO THE 9149 05:49:46,598 --> 05:49:48,634 EMERGENCY DEPARTMENT. 9150 05:49:48,701 --> 05:49:49,768 CHILDREN OF COLOR 9151 05:49:49,835 --> 05:49:52,204 DISPROPORTIONATELY TREATED FOR 9152 05:49:52,271 --> 05:49:53,205 HEADACHE IN THE EMERGENCY 9153 05:49:53,272 --> 05:49:54,206 DEPARTMENT, RATHER THAN GOING 9154 05:49:54,273 --> 05:49:55,140 TO PRIMARY CARE FOR ANY NUMBER 9155 05:49:55,207 --> 05:49:56,141 OF REASONS. 9156 05:49:56,208 --> 05:49:58,110 THEY ARE TREATED FOR A NUMBER 9157 05:49:58,177 --> 05:50:03,682 OF DIFFERENT CONDITIONS. 9158 05:50:03,749 --> 05:50:05,918 THE EMERGENCY DEPARTMENT IS 9159 05:50:05,984 --> 05:50:08,520 GEARED TO ACUTE AND NOT FOR 9160 05:50:08,587 --> 05:50:09,888 GETTING TO ROOT CAUSES. 9161 05:50:09,955 --> 05:50:12,191 WE DID A NUMBER OF STUDIES TO 9162 05:50:12,257 --> 05:50:14,993 LOOK AT THE TREATMENT, THE 9163 05:50:15,060 --> 05:50:17,963 DIAGNOSIS OF MIGRAINE IN 9164 05:50:18,030 --> 05:50:20,766 EMERGENCY DEPARTMENT, THE 9165 05:50:20,833 --> 05:50:22,468 TREATMENT OF MIGRAINE PAIN IN 9166 05:50:22,534 --> 05:50:24,937 THE EMERGENCY DEPARTMENT. 9167 05:50:25,003 --> 05:50:28,340 WE KNOW NON HISPANIC WHITE 9168 05:50:28,407 --> 05:50:31,510 RECEIVE HIGHER RATE OF MIGRAINE 9169 05:50:31,577 --> 05:50:34,580 DIAGNOSIS, MORE IV MEDICATION, 9170 05:50:34,646 --> 05:50:36,048 AND MORE HEAD/BRAIN IMAGING. 9171 05:50:36,115 --> 05:50:39,585 BLACK CHILDREN AND MALES LESS 9172 05:50:39,651 --> 05:50:40,853 LIKELY TO HAVE NEUROLOGY VISIT 9173 05:50:40,919 --> 05:50:42,921 AFTER THE EMERGENCY DEPARTMENT. 9174 05:50:42,988 --> 05:50:44,523 SO WE ARE THINKING BROADLY 9175 05:50:44,590 --> 05:50:46,525 ABOUT HOW DO WE MANAGE KIDS IN 9176 05:50:46,592 --> 05:50:49,061 PRIMARY CARE AND GET THEM THE 9177 05:50:49,128 --> 05:50:49,795 APPROPRIATE DIAGNOSIS AND 9178 05:50:49,862 --> 05:50:50,462 APPROPRIATE FIRST LINE 9179 05:50:50,529 --> 05:50:51,296 TREATMENTS. 9180 05:50:51,363 --> 05:50:54,266 WHO NEEDS TO GET TO NEUROLOGY. 9181 05:50:54,333 --> 05:50:54,900 WHO NEEDS EMERGENCY DEPARTMENT 9182 05:50:54,967 --> 05:50:56,034 TREATMENT? 9183 05:50:56,101 --> 05:50:59,271 IF THEY ARE ENTERING THE SYSTEM 9184 05:50:59,338 --> 05:51:00,606 IN THE EMERGENCY DEPARTMENT HOW 9185 05:51:00,672 --> 05:51:04,042 DO THEY GET TO THE CLINICIAN. 9186 05:51:04,109 --> 05:51:06,478 HOW DO WE GET THESE KIDS TO THE 9187 05:51:06,545 --> 05:51:07,780 RIGHT DIFFERENT PLACES. 9188 05:51:07,846 --> 05:51:13,952 AND WHY DOES IT MATTER, WHY ARE 9189 05:51:14,019 --> 05:51:15,587 MALES LESS LIKELY TO GET 9190 05:51:15,654 --> 05:51:16,422 DIAGNOSIS OF MIGRAINE IN THE 9191 05:51:16,488 --> 05:51:17,923 E.D. 9192 05:51:17,990 --> 05:51:19,258 WHY ARE THEY LESS LIKELY TO GET 9193 05:51:19,324 --> 05:51:20,692 THAT FOLLOW-UP. 9194 05:51:20,759 --> 05:51:21,927 THROUGH THE SLIDES, THANK YOU 9195 05:51:21,994 --> 05:51:24,129 TO THE A.V. FOLKS. 9196 05:51:24,196 --> 05:51:25,697 THOUGHT ABOUT DIFFERENT ASPECTS 9197 05:51:25,764 --> 05:51:28,967 OF HEADACHE IN CHILDREN AND 9198 05:51:29,034 --> 05:51:31,437 TEENS AND PLACEBO. 9199 05:51:31,503 --> 05:51:37,109 THIS IS MY EMAIL. 9200 05:51:37,176 --> 05:51:44,016 HUGE THANKS TO MY TEAM. 9201 05:51:44,082 --> 05:51:45,284 >> THANK YOU. 9202 05:51:45,350 --> 05:51:47,052 THANK YOU SO MUCH FOR VERY 9203 05:51:47,119 --> 05:51:49,121 INTERESTING DATA. 9204 05:51:49,188 --> 05:51:51,156 NOW I AM PLEASED TO INTRODUCE 9205 05:51:51,223 --> 05:52:01,767 OUR THIRD SPEAKER FOR THE PANEL. 9206 05:52:04,703 --> 05:52:07,005 DR. ROGER FILLINGIM. 9207 05:52:07,072 --> 05:52:10,843 UNIVERSITY OF FLORIDA. 9208 05:52:10,909 --> 05:52:12,044 INVESTIGATE BIOLOGICAL AND 9209 05:52:12,110 --> 05:52:13,979 PSYCHOSOCIAL CONTRIBUTIONS TO 9210 05:52:14,046 --> 05:52:16,315 INDIVIDUAL DIFFERENCES IN PAIN, 9211 05:52:16,381 --> 05:52:18,350 INCLUDING THE INFLUENCES OF 9212 05:52:18,417 --> 05:52:19,651 SEX, GENDER, RACE, ETHNICITY 9213 05:52:19,718 --> 05:52:22,788 AND AGING ON THE EXPERIENCE OF 9214 05:52:22,855 --> 05:52:23,188 PAIN. 9215 05:52:23,255 --> 05:52:26,692 DR. FILLINGIM? 9216 05:52:26,758 --> 05:52:28,594 HIS RESEARCH HAS BEEN 9217 05:52:28,660 --> 05:52:31,029 CONTINUOUSLY FUNDED FOR 30 9218 05:52:31,096 --> 05:52:37,970 YEARS BY NIH, SINCE 1994, 9219 05:52:38,036 --> 05:52:40,105 INCLUDING CURRENT META AWARD 9220 05:52:40,172 --> 05:52:42,207 FOR UNIVERSITY OF AGING. 9221 05:52:42,274 --> 05:52:45,377 THE NEXT GENERATION OF PAIN 9222 05:52:45,444 --> 05:52:47,713 SCIENTISTS AND HE CURRENTLY 9223 05:52:47,779 --> 05:52:49,548 SERVES AS SECRETARY TREASURER 9224 05:52:49,615 --> 05:52:50,849 FOR THE INTERNATIONAL -- THE 9225 05:52:50,916 --> 05:52:55,087 TOPIC OF HIS TALK IS HOW AGE, 9226 05:52:55,153 --> 05:52:56,388 RACE AND ETHNICITY INTERSECT 9227 05:52:56,455 --> 05:52:57,656 WITH SEX AND GENDER TO 9228 05:52:57,723 --> 05:53:08,000 INFLUENCE PAIN. 9229 05:53:38,664 --> 05:53:41,166 >> THANK YOU SO MUCH, INNA AND 9230 05:53:41,233 --> 05:53:42,501 THE ORGANIZERS FOR THE 9231 05:53:42,568 --> 05:53:46,004 OPPORTUNITY TO BE HERE. 9232 05:53:46,071 --> 05:53:49,408 SUCCESS. 9233 05:53:49,474 --> 05:53:50,642 SO, AS YOU HAVE HEARD 9234 05:53:50,709 --> 05:53:52,244 THROUGHOUT THE DAY AND MANY OF 9235 05:53:52,311 --> 05:53:53,979 YOU KNOW THERE ARE INDEED SEX 9236 05:53:54,046 --> 05:53:54,580 DIFFERENCES IN THE EXPERIENCE 9237 05:53:54,646 --> 05:53:55,614 OF PAIN. 9238 05:53:55,681 --> 05:53:57,916 YOU JUST WANT TO LEVEL SET HERE 9239 05:53:57,983 --> 05:53:59,284 BEFORE WE START INTRODUCING 9240 05:53:59,351 --> 05:54:00,652 SOME OF THE OTHER FACTORS THAT 9241 05:54:00,719 --> 05:54:04,590 WE HAVE BEEN INTERESTED IN. 9242 05:54:04,656 --> 05:54:09,494 THIS IS SYSTEMATIC REVIEW OF 46 9243 05:54:09,561 --> 05:54:10,228 DIFFERENT GLOBAL 9244 05:54:10,295 --> 05:54:12,030 EPIDEMIOLOGICAL STUDIES SHOWING 9245 05:54:12,097 --> 05:54:16,668 THE FEMALE TO MALE PREVALENCE 9246 05:54:16,735 --> 05:54:18,470 OF CHRONIC PAIN, GENERALLY 9247 05:54:18,537 --> 05:54:18,704 DEFINED. 9248 05:54:18,770 --> 05:54:21,840 AND YOU CAN SEE THAT THERE ARE 9249 05:54:21,907 --> 05:54:23,742 MORE FEMALES THAN MALES WHO 9250 05:54:23,809 --> 05:54:25,510 HAVE CHRONIC PAIN. 9251 05:54:25,577 --> 05:54:26,545 WHICH IS NOT NEWS TO ANY OF US 9252 05:54:26,612 --> 05:54:32,351 HERE. 9253 05:54:32,417 --> 05:54:33,986 I WOULD SAY THOSE WERE STUDIES 9254 05:54:34,052 --> 05:54:36,221 OF ADULTS. 9255 05:54:36,288 --> 05:54:41,627 THE SEX DIFFERENCES DO TEND TO 9256 05:54:41,693 --> 05:54:43,161 EXTEND TO CHILDREN AS TALKED 9257 05:54:43,228 --> 05:54:45,797 ABOUT IN DIFFERENT TALKS TODAY. 9258 05:54:45,864 --> 05:54:47,633 MAYBE PREFERENTIALLY FOR SOME 9259 05:54:47,699 --> 05:54:49,935 PAIN CONDITIONS LIKE HEADACHE 9260 05:54:50,002 --> 05:54:52,371 AND MUSCULAR SKELETAL PAIN AND 9261 05:54:52,437 --> 05:54:54,940 THERE ALSO IS LIKELY AN AGE 9262 05:54:55,007 --> 05:55:00,312 EFFECT HERE WITH MANY OF THE 9263 05:55:00,379 --> 05:55:00,879 DIFFERENCES GETTING LARGER 9264 05:55:00,946 --> 05:55:11,189 AFTER PUBERTY. 9265 05:55:18,397 --> 05:55:19,931 LOOKING AT THE PREVALENCE OF 9266 05:55:19,998 --> 05:55:21,566 CHRONIC PAIN IN GENERAL, AS 9267 05:55:21,633 --> 05:55:24,569 WELL AS HIGH IMPACT PAIN, THAT 9268 05:55:24,636 --> 05:55:27,939 IS PAIN THAT INTERFERES WITH 9269 05:55:28,006 --> 05:55:29,608 LIFE-RELEVANT ACTIVITIES. 9270 05:55:29,675 --> 05:55:32,644 YOU CAN SEE THERE'S FAIRLY 9271 05:55:32,711 --> 05:55:33,812 MONCTONIC INCREASE IN DIFFERENT 9272 05:55:33,879 --> 05:55:35,881 TYPES OF PAIN ACROSS THE AGE 9273 05:55:35,947 --> 05:55:38,116 SPAN HERE. 9274 05:55:38,183 --> 05:55:48,527 AND YOU HEARD A LITTLE BIT 9275 05:55:48,593 --> 05:55:50,529 EARLIER, HER WORK WITH COVA 9276 05:55:50,595 --> 05:55:53,598 LOOKED AT DIFFERENCES IN THE 9277 05:55:53,665 --> 05:55:54,299 NATIONAL HEALTH INTERVIEW 9278 05:55:54,366 --> 05:55:56,702 SURVEYS AND WHAT WE SEE HERE IS 9279 05:55:56,768 --> 05:56:07,279 A BIT MORE NUANCED DEPICTURE. 9280 05:56:09,081 --> 05:56:10,382 PAIN PREVALENCE, HIGH FOR 9281 05:56:10,449 --> 05:56:12,684 NATIVE AMERICAN INDIVIDUALS AND 9282 05:56:12,751 --> 05:56:14,419 THOSE WHO IDENTIFY AS 9283 05:56:14,486 --> 05:56:16,421 MULTI-RACIAL, THERE ARE, IF 9284 05:56:16,488 --> 05:56:20,559 ANY, VERY SMALL DIFFERENCES 9285 05:56:20,625 --> 05:56:26,698 BETWEEN NON HISPANIC WHITE, NON 9286 05:56:26,765 --> 05:56:29,067 HISPANIC BLACK AND HISPANIC 9287 05:56:29,134 --> 05:56:31,737 ADULTS TENDING TOWARD SLIGHTLY 9288 05:56:31,803 --> 05:56:36,241 LOWER PREVALENCE OF PAIN. 9289 05:56:36,308 --> 05:56:39,044 IF YOU LOOK AT THE UPPER BARS 9290 05:56:39,111 --> 05:56:41,980 IN THE RED THERE WITH NON 9291 05:56:42,047 --> 05:56:42,981 HISPANIC BLACK INDIVIDUALS 9292 05:56:43,048 --> 05:56:44,783 STARTING TO INCH A LITTLE BIT 9293 05:56:44,850 --> 05:56:47,152 AHEAD WHEN IT COMES TO SEVERE 9294 05:56:47,219 --> 05:56:50,589 PAIN AND HIGH IMPACT PAIN WHICH 9295 05:56:50,655 --> 05:56:52,557 GIVES US A SIGNAL THAT CHRONIC 9296 05:56:52,624 --> 05:56:54,993 PAIN IN GENERAL MAY NOT BE MORE 9297 05:56:55,060 --> 05:57:03,935 COMMON IN SOME OF THESE 9298 05:57:04,002 --> 05:57:05,904 MINORITIZED POPULATIONS BUT 9299 05:57:05,971 --> 05:57:06,671 SEVERITY MAY BE MORE IN THIS 9300 05:57:06,738 --> 05:57:09,474 POPULATION. 9301 05:57:09,541 --> 05:57:11,243 YOU SEE THIS PICTURE. 9302 05:57:11,309 --> 05:57:14,179 SO FROM THE SAME 9303 05:57:14,246 --> 05:57:15,080 EPIDEMIOLOGICAL STUDY, THE 9304 05:57:15,147 --> 05:57:16,047 PREVALENCE OF CHRONIC PAIN 9305 05:57:16,114 --> 05:57:19,551 THERE ON THE LEFT IS SLIGHTLY 9306 05:57:19,618 --> 05:57:21,586 HIGHER IN NON HISPANIC WHITES, 9307 05:57:21,653 --> 05:57:23,288 THE PREVALENCE OF HIGH IMPACT 9308 05:57:23,355 --> 05:57:27,459 CHRONIC PAIN IS HIGHER IN 9309 05:57:27,526 --> 05:57:28,093 NON-HISPANIC BLACK AND HISPANIC 9310 05:57:28,160 --> 05:57:29,961 INDIVIDUALS. 9311 05:57:30,028 --> 05:57:32,631 SO THERE ARE SOME RACIAL AND 9312 05:57:32,697 --> 05:57:35,333 ETHNIC DIFFERENCES IN PAIN BUT 9313 05:57:35,400 --> 05:57:37,235 THEY TEND TOWARD THE SEVERITY 9314 05:57:37,302 --> 05:57:38,637 OF PAIN RATHER THAN PAIN 9315 05:57:38,703 --> 05:57:39,171 PREVALENCE. 9316 05:57:39,237 --> 05:57:41,473 IF WE START TRY TO PUT TOGETHER 9317 05:57:41,540 --> 05:57:44,943 SOME OF THESE OTHER DEMOGRAPHIC 9318 05:57:45,010 --> 05:57:48,146 FACTORS WITH SEX, WE CAN LOOK 9319 05:57:48,213 --> 05:57:53,218 AT, FOR EXAMPLE, SEX 9320 05:57:53,285 --> 05:57:54,820 DIFFERENCES ACROSS THE EARLY 9321 05:57:54,886 --> 05:57:55,787 ADULT TO LATE ADULT LIFE SPAN 9322 05:57:55,854 --> 05:57:57,856 HERE. 9323 05:57:57,923 --> 05:58:00,692 AND YOU CAN SEE THAT FEMALES 9324 05:58:00,759 --> 05:58:03,929 TEND TO HAVE HIGHER PAIN 9325 05:58:03,995 --> 05:58:06,531 PREVALENCE ACROSS THE LIFE SPAN. 9326 05:58:06,598 --> 05:58:09,367 INTERESTINGLY PAIN PREVALENCE 9327 05:58:09,434 --> 05:58:13,171 IN THIS STUDY PEAKED IN MIDDLE 9328 05:58:13,238 --> 05:58:14,573 AGES AMONG MEN, AND THEN CAME 9329 05:58:14,639 --> 05:58:17,242 DOWN A BIT. 9330 05:58:17,309 --> 05:58:21,179 WHEREAS IT SIMPLY PLATEAUED IN 9331 05:58:21,246 --> 05:58:24,616 WOMEN AND WOMEN PERSIST WITH 9332 05:58:24,683 --> 05:58:25,984 RELATIVELY HIGH PREVALENCE INTO 9333 05:58:26,051 --> 05:58:27,452 LATE LIFE. 9334 05:58:27,519 --> 05:58:28,987 YOU HAVE ALREADY SEEN THESE 9335 05:58:29,054 --> 05:58:35,260 DATA ON HEADACHE, RIGHT? 9336 05:58:35,327 --> 05:58:37,362 SO FAR I HAVE BEEN TALKING 9337 05:58:37,429 --> 05:58:38,864 ABOUT CHRONIC PAIN IN GENERAL, 9338 05:58:38,930 --> 05:58:39,698 AGNOSTIC TO WHAT KIND OF PAIN 9339 05:58:39,764 --> 05:58:44,536 YOU HAVE. 9340 05:58:44,603 --> 05:58:46,738 THE PATTERN OF SEX DIFFERENCES 9341 05:58:46,805 --> 05:58:49,074 ACROSS THE LIFE SPAN LOOKS 9342 05:58:49,140 --> 05:58:50,809 DIFFERENT WITH HEADACHE HERE. 9343 05:58:50,876 --> 05:58:58,049 AND YOU SAW THESE DATA FROM DR. 9344 05:58:58,116 --> 05:58:58,450 SZPERKA, I THINK. 9345 05:58:58,516 --> 05:59:00,585 SO THE SEX DIFFERENCES TEND TO 9346 05:59:00,652 --> 05:59:01,586 PEAK DURING THE REPRODUCTIVE 9347 05:59:01,653 --> 05:59:02,687 YEARS. 9348 05:59:02,754 --> 05:59:09,127 YOU GET A SIMILAR PATTERN WITH 9349 05:59:09,194 --> 05:59:11,630 ORAFACIAL PAIN. 9350 05:59:11,696 --> 05:59:12,797 WE DO SEE IMPORTANT 9351 05:59:12,864 --> 05:59:14,266 INTERSECTIONS BETWEEN AGE AND 9352 05:59:14,332 --> 05:59:15,734 SEX AND PAIN PREVALENCE. 9353 05:59:15,800 --> 05:59:19,971 HOWEVER, IF WE LOOK AT 9354 05:59:20,038 --> 05:59:21,006 OSTEOARTHRITIS, THE SEX 9355 05:59:21,072 --> 05:59:22,207 DIFFERENCE CONTINUES THROUGHOUT 9356 05:59:22,274 --> 05:59:25,277 THE LIFE SPAN AND THE 9357 05:59:25,343 --> 05:59:29,581 PREVALENCE CONTINUES TO GO UP 9358 05:59:29,648 --> 05:59:31,316 UNTIL DEATH, PRESUMABLY. 9359 05:59:31,383 --> 05:59:34,519 AND SO THAT'S LED MANY OF US TO 9360 05:59:34,586 --> 05:59:36,855 WONDER WHETHER THERE MIGHT BE 9361 05:59:36,922 --> 05:59:37,355 SEX DIFFERENCES IN PAIN 9362 05:59:37,422 --> 05:59:38,290 PROCESSING. 9363 05:59:38,356 --> 05:59:42,827 SO WE BRING PEOPLE IN THE LAB 9364 05:59:42,894 --> 05:59:43,728 AND PERPETRATE DIFFERENT TYPES 9365 05:59:43,795 --> 05:59:45,664 OF PAIN UPON THEM. 9366 05:59:45,730 --> 05:59:47,799 THIS IS A DATA SET FROM OUR 9367 05:59:47,866 --> 05:59:50,735 LABORATORY, I THINK SORT OF 9368 05:59:50,802 --> 05:59:52,737 RECAPITULATES THE LITERATURE. 9369 05:59:52,804 --> 05:59:54,973 I HAVE STANDARDIZED ALL OF 9370 05:59:55,040 --> 05:59:57,876 THESE DATA TO A Z SCORE SO THE 9371 05:59:57,943 --> 06:00:01,012 MEAN IS ZERO, BARS THAT GO UP 9372 06:00:01,079 --> 06:00:03,248 MEAN HIGHER THRESHOLD AND 9373 06:00:03,315 --> 06:00:05,016 HIGHER TOLERANCE, WHICH EQUATES 9374 06:00:05,083 --> 06:00:06,051 TO LOWER PAIN SENSITIVITY, IF 9375 06:00:06,117 --> 06:00:07,385 YOU WILL. 9376 06:00:07,452 --> 06:00:10,722 THE BARS THAT GO DOWN REFLECT 9377 06:00:10,789 --> 06:00:11,056 THE OPPOSITE. 9378 06:00:11,122 --> 06:00:12,924 CAN SEE ALL THE MALE BARS GO UP 9379 06:00:12,991 --> 06:00:16,695 AND ALL THE FEMALE BARS GO DOWN 9380 06:00:16,761 --> 06:00:19,064 SUGGESTING AS JEFF MOGUL SAID 9381 06:00:19,130 --> 06:00:21,099 EARLIER, NO MATTER HOW WE HURT 9382 06:00:21,166 --> 06:00:23,735 THESE INDIVIDUALS IN OUR 9383 06:00:23,802 --> 06:00:26,171 LABORATORY, WOMEN ARE 9384 06:00:26,237 --> 06:00:28,006 DISPLAYING GREATER SENSITIVITY 9385 06:00:28,073 --> 06:00:29,708 TO THESE SENSORY STIMULI. 9386 06:00:29,774 --> 06:00:30,809 YOU SEE THE BARS ARE OF 9387 06:00:30,875 --> 06:00:31,943 DIFFERENT HEIGHTS. 9388 06:00:32,010 --> 06:00:34,679 THAT MEANS SOME OF THE SEX 9389 06:00:34,746 --> 06:00:38,616 DIFFERENCES ARE SMALL AND 9390 06:00:38,683 --> 06:00:39,317 ARGUABLY NEGLIGIBLE AND SOME 9391 06:00:39,384 --> 06:00:43,555 ARE LARGER. 9392 06:00:43,621 --> 06:00:45,590 THAT'S A FAIR TOPIC FOR 9393 06:00:45,657 --> 06:00:47,058 RESEARCH BUT THE PATTERN IS 9394 06:00:47,125 --> 06:00:49,627 FAIRLY CONSISTENT. 9395 06:00:49,694 --> 06:00:50,695 THAT'S A SAMPLE OF HEALTHY 9396 06:00:50,762 --> 06:00:52,464 YOUNG ADULTS. 9397 06:00:52,530 --> 06:00:54,466 WHAT IF WE MOVE INTO 9398 06:00:54,532 --> 06:00:55,800 INDIVIDUALS WITH DIFFERENT AGE 9399 06:00:55,867 --> 06:01:01,039 RANGES AS THIS WORKED WITH MY 9400 06:01:01,106 --> 06:01:01,806 COLLEAGUE DR. RILEY OF 9401 06:01:01,873 --> 06:01:04,476 UNIVERSITY OF FLORIDA. 9402 06:01:04,542 --> 06:01:05,010 THIS IS CONDITIONED PAIN 9403 06:01:05,076 --> 06:01:06,111 MODULATION. 9404 06:01:06,177 --> 06:01:08,847 WE ARE TESTING WHETHER PAIN AT 9405 06:01:08,913 --> 06:01:12,751 ONE SITE OF THE BODY WILL 9406 06:01:12,817 --> 06:01:13,785 INHIBIT THE PAIN PERCEIVED AT 9407 06:01:13,852 --> 06:01:16,421 THE OTHER SITE OF THE BODY. 9408 06:01:16,488 --> 06:01:18,623 LABORATORY BASED MEASURE HOW 9409 06:01:18,690 --> 06:01:23,428 WELL YOUR PAIN INHIBITORY 9410 06:01:23,495 --> 06:01:26,731 CENTER IS FUNCTIONING. 9411 06:01:26,798 --> 06:01:28,633 MORE PAIN MODULATION WOULD MEAN 9412 06:01:28,700 --> 06:01:31,970 A LONGER DOWNWARD BAR HERE. 9413 06:01:32,037 --> 06:01:33,671 ONE PAIN REDUCED THE OTHER PAIN 9414 06:01:33,738 --> 06:01:35,073 TO A GREATER EXTENT. 9415 06:01:35,140 --> 06:01:37,242 YOU COULD SEE THE BARS FOR 9416 06:01:37,308 --> 06:01:38,843 YOUNGER ADULTS IN THEIR MID 9417 06:01:38,910 --> 06:01:40,812 20'S HERE ARE LARGER THAN THE 9418 06:01:40,879 --> 06:01:44,916 BARS FOR OLDER ADULTS. 9419 06:01:44,983 --> 06:01:47,452 BUT THE SEX DIFFERENCE IS 9420 06:01:47,519 --> 06:01:48,787 RELATIVELY SIMILAR BETWEEN 9421 06:01:48,853 --> 06:01:52,824 YOUNGER AND OLDER ADULTS. 9422 06:01:52,891 --> 06:01:54,192 THE MAGNITUDE OF PAIN 9423 06:01:54,259 --> 06:01:55,593 MODULATION IS DIFFERENCE BUT 9424 06:01:55,660 --> 06:01:58,096 THE PATTERN OF SEX DIFFERENCES 9425 06:01:58,163 --> 06:02:02,867 IN THIS PAIN INHIBITORY MEASURE 9426 06:02:02,934 --> 06:02:05,670 LOOKS SIMILAR IN YOUNGER AND 9427 06:02:05,737 --> 06:02:06,004 OLDER ADULTS. 9428 06:02:06,071 --> 06:02:08,173 WE HAVE FAR LESS INFORMATION 9429 06:02:08,239 --> 06:02:10,475 ABOUT INTERSECTIONS BETWEEN 9430 06:02:10,542 --> 06:02:12,744 RACE, ETHNICITY AND SEX. 9431 06:02:12,811 --> 06:02:15,547 THIS STUDY IS ONE OF OUR 9432 06:02:15,613 --> 06:02:20,085 STUDIES LOOKING AT MIDDLE AGED 9433 06:02:20,151 --> 06:02:20,819 AND OLDER ADULTS WITH 9434 06:02:20,885 --> 06:02:24,055 OSTEOARTHRITIS PAIN. 9435 06:02:24,122 --> 06:02:26,491 KNEE OSTEOARTHRITIS PAIN. 9436 06:02:26,558 --> 06:02:30,695 BARLEY LOOKED AT THIS DATA AND 9437 06:02:30,762 --> 06:02:31,329 LOOKING AT QUANTITATIVE TESTING 9438 06:02:31,396 --> 06:02:33,431 RESULTS. 9439 06:02:33,498 --> 06:02:34,966 INTERESTINGLY IN THIS STUDY 9440 06:02:35,033 --> 06:02:36,601 THERE WERE NO SEX DIFFERENCES 9441 06:02:36,668 --> 06:02:38,303 IN THE SEVERITY OF THEIR 9442 06:02:38,369 --> 06:02:40,338 ARTHRITIS PAIN. 9443 06:02:40,405 --> 06:02:42,040 WOMEN AND MEN REPORTED SIMILAR 9444 06:02:42,107 --> 06:02:46,478 LEVELS OF PAIN AND SIMILAR 9445 06:02:46,544 --> 06:02:47,112 LEVELS OF DISABILITY. 9446 06:02:47,178 --> 06:02:47,779 HOWEVER, WOMEN HAD 9447 06:02:47,846 --> 06:02:48,346 SIGNIFICANTLY MORE SITES OF 9448 06:02:48,413 --> 06:02:58,523 PAIN. 9449 06:03:07,332 --> 06:03:09,234 WE SEE SIMILAR PATTERN TO 9450 06:03:09,300 --> 06:03:11,970 HEALTHY YOUNG ADULTS, WOMEN ARE 9451 06:03:12,036 --> 06:03:13,071 REPORTING LOWER PAIN THRESHOLDS 9452 06:03:13,138 --> 06:03:14,672 NO MATTER WHERE WE ARE HURTING 9453 06:03:14,739 --> 06:03:17,075 THEM. 9454 06:03:17,142 --> 06:03:25,383 WOMEN ARE REPORTING GREATER 9455 06:03:25,450 --> 06:03:27,685 TEMPORAL WHEN THEIR AFFECTED 9456 06:03:27,752 --> 06:03:30,455 KNEE, NOT SO WHEN FOCUSED ON A 9457 06:03:30,522 --> 06:03:35,560 NON PAIN SITE. 9458 06:03:35,627 --> 06:03:37,629 GREATER TEMPORAL SUMMATION 9459 06:03:37,695 --> 06:03:40,765 WHICH SAY TRANSIENT FORM OF 9460 06:03:40,832 --> 06:03:41,966 SENSITIZATION IS RESTRICTED TO 9461 06:03:42,033 --> 06:03:43,668 THE PAINFUL SITE HERE IN TERMS 9462 06:03:43,735 --> 06:03:51,576 OF THE SEX DIFFERENCE. 9463 06:03:51,643 --> 06:03:53,878 TEMPORAL SUMMATION OF HEAT WAS 9464 06:03:53,945 --> 06:03:55,513 SIMILAR FOR WOMEN NO MATTER 9465 06:03:55,580 --> 06:03:56,814 WHERE WE WERE STIMULATING 9466 06:03:56,881 --> 06:03:58,316 THERE, AN AFFECTED KNEE OR 9467 06:03:58,383 --> 06:04:00,151 UNAFFECTED ARM. 9468 06:04:00,218 --> 06:04:02,754 THESE DATA WOULD SUGGEST THAT 9469 06:04:02,820 --> 06:04:07,091 MIDDLE AGE AND OLDER WOMEN WITH 9470 06:04:07,158 --> 06:04:09,127 NEOARTHRITIS PAIN ARE SHOWING 9471 06:04:09,194 --> 06:04:10,562 GREATER PAIN AMPLIFICATION THAN 9472 06:04:10,628 --> 06:04:12,664 THEIR MALE COUNTERPARTS. 9473 06:04:12,730 --> 06:04:14,699 THIS STUDY WAS DESIGNED HOWEVER 9474 06:04:14,766 --> 06:04:17,635 TO FOCUS ON RACIAL AND ETHNIC 9475 06:04:17,702 --> 06:04:19,504 DIFFERENCES IN PAIN AND TO TRY 9476 06:04:19,571 --> 06:04:23,074 TO UNDERSTAND THOSE DIFFERENCES. 9477 06:04:23,141 --> 06:04:25,310 AND SO WE HAVE RELATIVELY EQUAL 9478 06:04:25,376 --> 06:04:28,012 NUMBERS. 9479 06:04:28,079 --> 06:04:29,147 SLIGHTLY MORE NON-HISPANIC 9480 06:04:29,214 --> 06:04:35,520 BLACKS BUT LARGER NUMBERS OF 9481 06:04:35,587 --> 06:04:38,656 NON-HISPANIC BLACK AND 9482 06:04:38,723 --> 06:04:40,425 NON-HISPANIC WHITE ADULTS WITH 9483 06:04:40,491 --> 06:04:42,160 KNEE OSTEOARTHRITIS. 9484 06:04:42,227 --> 06:04:44,062 HERE ARE PAIN SCORE TESTS BEING 9485 06:04:44,128 --> 06:04:46,598 DONE, THE HIGHER THE SCORE THE 9486 06:04:46,664 --> 06:04:49,968 LOWER THE PAIN SENSITIVITY IN 9487 06:04:50,034 --> 06:04:51,369 OUR NON-HISPANIC WHITE ADULTS 9488 06:04:51,436 --> 06:04:53,705 ARE LESS SENSITIVE TO ALL OF 9489 06:04:53,771 --> 06:04:57,875 THESE SENSORY TESTS THAN OUR 9490 06:04:57,942 --> 06:04:59,377 NON-HISPANIC BLACK ADULTS. 9491 06:04:59,444 --> 06:05:03,982 IT DOESN'T MATTER IF WE ARE 9492 06:05:04,048 --> 06:05:07,252 APPLYING THE STIMULI TO AN 9493 06:05:07,318 --> 06:05:07,852 AFFECTED KNEE OR NON-AFFECTED 9494 06:05:07,919 --> 06:05:10,088 SITE. 9495 06:05:10,154 --> 06:05:13,625 WITH THE HEAT PAIN, AFRICAN 9496 06:05:13,691 --> 06:05:14,626 AMERICAN NON-HISPANIC BLACK 9497 06:05:14,692 --> 06:05:15,927 INDIVIDUALS ARE REPORTING NOT 9498 06:05:15,994 --> 06:05:18,596 ONLY MORE PAIN BUT INCREASE IN 9499 06:05:18,663 --> 06:05:20,164 SLOPE WITH REPEATED STIMULATION. 9500 06:05:20,231 --> 06:05:22,367 THAT'S THE MEASURE OF TEMPORAL 9501 06:05:22,433 --> 06:05:24,102 SUMMATION. 9502 06:05:24,168 --> 06:05:26,571 THEY ARE SHOWING GREATER PAIN 9503 06:05:26,638 --> 06:05:27,472 AMPLIFICATION HERE. 9504 06:05:27,538 --> 06:05:30,975 WE SEE A SIMILAR EFFECT WITH 9505 06:05:31,042 --> 06:05:32,577 TEMPORAL SUMMATION OF 9506 06:05:32,644 --> 06:05:34,512 MECHANICAL PAIN, WHEN WE POKE 9507 06:05:34,579 --> 06:05:36,848 THEM ONCE VERSUS WHEN WE POKE 9508 06:05:36,914 --> 06:05:45,556 THEM TEN TIMES WITH A NYLON 9509 06:05:45,623 --> 06:05:49,827 MONOFILAMENT. 9510 06:05:49,894 --> 06:05:50,695 AFRICAN AMERICAN PARTICIPANTS 9511 06:05:50,762 --> 06:05:55,300 ARE REPORTING MORE PAIN AND 9512 06:05:55,366 --> 06:05:58,236 GREATER TEMPORAL SUMMATION OF 9513 06:05:58,303 --> 06:05:58,803 MECHANICAL PAIN BOTH SITES 9514 06:05:58,870 --> 06:06:00,038 TESTED. 9515 06:06:00,104 --> 06:06:03,508 SO IF WE ARE WONDERING WHERE 9516 06:06:03,574 --> 06:06:10,181 SEX, GENDER AND AGE, AND 9517 06:06:10,248 --> 06:06:11,282 RACE/ETHNICITY INTERSECT, PART 9518 06:06:11,349 --> 06:06:13,384 OF THE ANSWER IS WE DON'T KNOW 9519 06:06:13,451 --> 06:06:13,651 FOR SURE. 9520 06:06:13,718 --> 06:06:16,354 I HAVE MADE THE MISTAKE OF 9521 06:06:16,421 --> 06:06:19,490 SAYING I'M STUDYING RACIAL AND 9522 06:06:19,557 --> 06:06:21,526 ETHNIC DIFFERENCES IN THIS 9523 06:06:21,592 --> 06:06:22,727 STUDY AND TEMPORARILY IGNORE 9524 06:06:22,794 --> 06:06:25,129 THE FACT PEOPLE BRING THEIR SEX 9525 06:06:25,196 --> 06:06:26,864 AND GENDER AND AGE WHEN THEY 9526 06:06:26,931 --> 06:06:28,266 SHOW UP AT THE LAB. 9527 06:06:28,333 --> 06:06:30,601 SO WE ARE INTERESTED IN 9528 06:06:30,668 --> 06:06:31,502 LEARNING MORE ABOUT THESE 9529 06:06:31,569 --> 06:06:32,870 INTERSECTIONS. 9530 06:06:32,937 --> 06:06:34,372 I DID FIND THIS RECENT PAPER 9531 06:06:34,439 --> 06:06:38,643 FROM BRAZIL. 9532 06:06:38,710 --> 06:06:41,346 IT'S EPIDEMIOLOGIC STUDY 9533 06:06:41,412 --> 06:06:43,314 LOOKING AT SOCIOECONOMIC AND 9534 06:06:43,381 --> 06:06:43,881 SEX-RELATED INEQUALITIES IN 9535 06:06:43,948 --> 06:06:46,517 CHRONIC PAIN. 9536 06:06:46,584 --> 06:06:50,154 AND WHAT THEY SHOWED WAS THAT 9537 06:06:50,221 --> 06:06:51,456 AMONG FEMALES BOTH UNFAVORABLE 9538 06:06:51,522 --> 06:06:53,891 LIVING CONDITIONS AND WHAT THEY 9539 06:06:53,958 --> 06:06:55,827 DESCRIBE AS BLACK BROWN RACE, 9540 06:06:55,893 --> 06:06:57,395 WERE ASSOCIATED WITH INCREASED 9541 06:06:57,462 --> 06:06:59,731 RISK OF CHRONIC PAIN. 9542 06:06:59,797 --> 06:07:01,499 WHEREAS IN MALES, LOWER 9543 06:07:01,566 --> 06:07:04,001 EDUCATIONAL ATTAINMENT AND LACK 9544 06:07:04,068 --> 06:07:05,803 OF FINANCIAL INDEPENDENCE WERE 9545 06:07:05,870 --> 06:07:06,704 ASSOCIATED WITH INCREASED RISK 9546 06:07:06,771 --> 06:07:09,040 OF CHRONIC PAIN. 9547 06:07:09,107 --> 06:07:12,643 SO SOME OF THESE SOCIOECONOMIC, 9548 06:07:12,710 --> 06:07:14,412 SOCIO DEMOGRAPHIC FACTORS SEEM 9549 06:07:14,479 --> 06:07:16,647 TO IMPACT CHRONIC PAIN RISK 9550 06:07:16,714 --> 06:07:17,515 DIFFERENTLY IN MALES AND 9551 06:07:17,582 --> 06:07:20,651 FEMALES IN THIS STUDY. 9552 06:07:20,718 --> 06:07:23,287 FROM OUR UPLOAD STUDY, DR. 9553 06:07:23,354 --> 06:07:26,090 ELLEN TERRY AT UNIVERSITY OF 9554 06:07:26,157 --> 06:07:27,725 FLORIDA LOOKED AT HOW 9555 06:07:27,792 --> 06:07:29,160 DISCRIMINATION MIGHT INFLUENCE 9556 06:07:29,227 --> 06:07:34,565 THE EXPERIENCE OF PAIN IN OUR 9557 06:07:34,632 --> 06:07:35,066 PARTICIPANTS WITH KNEE 9558 06:07:35,133 --> 06:07:36,334 OSTEOARTHRITIS. 9559 06:07:36,401 --> 06:07:39,537 SO WE HAVE A MEASURE, 9560 06:07:39,604 --> 06:07:40,772 SELF-REPORT MEASURE OF EVERY 9561 06:07:40,838 --> 06:07:42,106 DAY DISCRIMINATION. 9562 06:07:42,173 --> 06:07:45,410 YOU SEE THAT THERE IN THE TOP 9563 06:07:45,476 --> 06:07:47,912 ROW, OUR NON HISPANIC BLACK 9564 06:07:47,979 --> 06:07:50,548 INDIVIDUALS REPORTED HIGHER 9565 06:07:50,615 --> 06:07:51,115 DISCRIMINATION THAN OUR 9566 06:07:51,182 --> 06:07:54,118 NON-HISPANIC WHITE INDIVIDUALS. 9567 06:07:54,185 --> 06:07:56,687 BUT ALSO THE DIFFERENCE BETWEEN 9568 06:07:56,754 --> 06:08:00,258 MALES AND FEMALES WAS GREATEST 9569 06:08:00,324 --> 06:08:00,792 IN OUR NON-HISPANIC BLACK 9570 06:08:00,858 --> 06:08:03,461 INDIVIDUALS. 9571 06:08:03,528 --> 06:08:06,831 THE BOLDED MEASURES THERE IN 9572 06:08:06,898 --> 06:08:08,833 BLACK TYPE SHOWED A RACE 9573 06:08:08,900 --> 06:08:09,367 DIFFERENCE BUT NOT A SEX 9574 06:08:09,434 --> 06:08:12,503 DIFFERENCE. 9575 06:08:12,570 --> 06:08:14,205 SO OUR AFRICAN AMERICAN 9576 06:08:14,272 --> 06:08:17,742 INDIVIDUALS REPORTED HIGHER 9577 06:08:17,809 --> 06:08:20,111 LEVELS OF PAIN CATASTROPHIZING, 9578 06:08:20,178 --> 06:08:22,046 PAIN INTERFERENCE AND THEY 9579 06:08:22,113 --> 06:08:24,482 PERFORMED MORE POORLY ON OUR 9580 06:08:24,549 --> 06:08:25,049 SHORT PHYSICAL PERFORMANCE 9581 06:08:25,116 --> 06:08:26,551 BATTERY. 9582 06:08:26,617 --> 06:08:29,654 BUT DR. TERRY WANTED TO LOOK AT 9583 06:08:29,720 --> 06:08:30,888 HOW DISCRIMINATION MIGHT BE 9584 06:08:30,955 --> 06:08:31,789 RELATED TO SOME OF THESE 9585 06:08:31,856 --> 06:08:33,825 ENDPOINTS. 9586 06:08:33,891 --> 06:08:36,461 AND THESE ARE CORRELATIONS, NOT 9587 06:08:36,527 --> 06:08:37,261 LEVELS OF DISCRIMINATION, JUST 9588 06:08:37,328 --> 06:08:38,696 TO POINT THAT OUT. 9589 06:08:38,763 --> 06:08:43,868 BUT YOU CAN SEE THAT THE ONLY 9590 06:08:43,935 --> 06:08:44,402 SIGNIFICANT CORRELATIONS 9591 06:08:44,469 --> 06:08:44,969 EMERGED FOR FEMALES IN THIS 9592 06:08:45,036 --> 06:08:45,503 SAMPLE. 9593 06:08:45,570 --> 06:08:47,505 NOT MALES. 9594 06:08:47,572 --> 06:08:51,476 AND THAT WAS TO A LARGE DEGREE 9595 06:08:51,542 --> 06:08:54,545 REGARDLESS OF RACIAL GROUP. 9596 06:08:54,612 --> 06:08:57,248 AND SO DR. TERRY DID SOME 9597 06:08:57,315 --> 06:08:58,516 SERIAL MEDIATION MODELS. 9598 06:08:58,583 --> 06:09:00,318 AND THIS WAS THE ONE THAT FIT 9599 06:09:00,384 --> 06:09:03,588 THE DATA THE BEST. 9600 06:09:03,654 --> 06:09:05,089 DISCRIMINATION, WHICH IS 9601 06:09:05,156 --> 06:09:05,923 RELATED TO HIGHER LEVELS OF 9602 06:09:05,990 --> 06:09:08,025 PAIN. 9603 06:09:08,092 --> 06:09:10,328 AND THESE SERIAL MODELS ARE 9604 06:09:10,394 --> 06:09:11,662 ONLY IN WOMEN BECAUSE THEY WERE 9605 06:09:11,729 --> 06:09:15,566 THE ONLY PART OF THE GROUP THAT 9606 06:09:15,633 --> 06:09:16,334 SHOWED A LINK BETWEEN 9607 06:09:16,400 --> 06:09:19,570 DISCRIMINATION AND PAIN. 9608 06:09:19,637 --> 06:09:21,906 SO DISCRIMINATION IS RELATED TO 9609 06:09:21,973 --> 06:09:24,876 WOMAC PAIN. 9610 06:09:24,942 --> 06:09:29,146 AND IT DOES SO VIA THIS SERIAL 9611 06:09:29,213 --> 06:09:30,648 MEDIATION WHERE DISCRIMINATION 9612 06:09:30,715 --> 06:09:32,850 IS ASSOCIATED WITH INCREASED 9613 06:09:32,917 --> 06:09:34,352 STRESS, INCREASED STRESS IS 9614 06:09:34,418 --> 06:09:36,521 ASSOCIATED WITH INCREASED PAIN 9615 06:09:36,587 --> 06:09:38,523 CATASTROPHIZING WHICH THEN IS 9616 06:09:38,589 --> 06:09:39,357 ASSOCIATED WITH HIGHER LEVELS 9617 06:09:39,423 --> 06:09:42,226 OF PAIN. 9618 06:09:42,293 --> 06:09:45,830 AND WE SAW A SIMILAR PATTERN 9619 06:09:45,897 --> 06:09:48,699 WITH PAIN INTERFERENCE HERE. 9620 06:09:48,766 --> 06:09:50,167 SO DISCRIMINATION, ASSOCIATED 9621 06:09:50,234 --> 06:09:52,470 WITH HIGHER STRESS, HIGHER 9622 06:09:52,537 --> 06:09:53,671 STRESS WITH HIGHER 9623 06:09:53,738 --> 06:09:56,507 CATASTROPHIZING AND THEN HIGHER 9624 06:09:56,574 --> 06:09:57,742 LEVELS OF PAIN INTERFERENCE, 9625 06:09:57,808 --> 06:09:58,876 AGAIN, BUT ONLY IN WOMEN IN OUR 9626 06:09:58,943 --> 06:10:00,044 SAMPLE. 9627 06:10:00,111 --> 06:10:04,115 NOTHING IN MEN. 9628 06:10:04,181 --> 06:10:06,751 AND SO, IF WE ARE GOING TO 9629 06:10:06,817 --> 06:10:09,787 START THINKING MORE ABOUT HOW 9630 06:10:09,854 --> 06:10:11,255 THESE DIFFERENT DEMOGRAPHIC 9631 06:10:11,322 --> 06:10:12,690 FACTORS MIGHT INTERSECT, IT'S 9632 06:10:12,757 --> 06:10:14,458 FAIR TO WONDER WHAT DO THEY 9633 06:10:14,525 --> 06:10:15,626 HAVE IN COMMON? 9634 06:10:15,693 --> 06:10:18,462 AND WE HAVE HEARD A LOT ABOUT 9635 06:10:18,529 --> 06:10:19,397 THE BIO PSYCHO SOCIAL MODEL 9636 06:10:19,463 --> 06:10:22,900 ALREADY TODAY. 9637 06:10:22,967 --> 06:10:25,836 I WOULD ARGUE THAT SEX/GENDER, 9638 06:10:25,903 --> 06:10:27,171 AGE AND RACE/ETHNICITY ARE ALL 9639 06:10:27,238 --> 06:10:31,375 PROXIES FOR A VARIETY OF BIO 9640 06:10:31,442 --> 06:10:32,877 PSYCHO SOCIAL MECHANISMS, MANY 9641 06:10:32,944 --> 06:10:34,045 OF WHICH WE FRANKLY DON'T 9642 06:10:34,111 --> 06:10:35,713 UNDERSTAND YET, RIGHT? 9643 06:10:35,780 --> 06:10:38,049 SO WE NEED TO CERTAINLY AVOID 9644 06:10:38,115 --> 06:10:39,684 THE TEMPTATION TO THINK THAT 9645 06:10:39,750 --> 06:10:43,421 SEX OR GENDER OR AGE OR RACE 9646 06:10:43,487 --> 06:10:45,056 ARE THE CAUSAL DRIVER OF ANY 9647 06:10:45,122 --> 06:10:47,358 DIFFERENCES IN PAIN. 9648 06:10:47,425 --> 06:10:48,492 THEY ARE REFLECTING SOMETHING 9649 06:10:48,559 --> 06:10:49,427 ELSE THAT WE NEED TO LEARN MORE 9650 06:10:49,493 --> 06:10:53,397 ABOUT. 9651 06:10:53,464 --> 06:10:56,267 THESE GROUPS ALSO HAVE 9652 06:10:56,334 --> 06:10:57,902 HISTORICALLY BEEN EXCLUDED FROM 9653 06:10:57,969 --> 06:10:58,336 BIOMEDICAL RESEARCH. 9654 06:10:58,402 --> 06:10:59,203 RIGHT? 9655 06:10:59,270 --> 06:11:05,943 SO MUCH OF WHAT WE KNOW MAY NOT 9656 06:11:06,010 --> 06:11:15,853 APPLY TO WOMEN, TO INDIVIDUALS 9657 06:11:15,920 --> 06:11:16,487 FROM MINORITIZED BACKGROUNDS OR 9658 06:11:16,554 --> 06:11:17,888 CHILDREN. 9659 06:11:17,955 --> 06:11:19,290 THAT'S CHANGING NOW WITH NEW 9660 06:11:19,357 --> 06:11:21,759 POLICIES. 9661 06:11:21,826 --> 06:11:24,962 IT'S ALSO THE CASE THAT 9662 06:11:25,029 --> 06:11:26,964 INDIVIDUALS FROM THESE GROUPS 9663 06:11:27,031 --> 06:11:29,300 HAVE OFTEN BEEN TARGETS OF 9664 06:11:29,367 --> 06:11:31,002 DISCRIMINATION AND MISTREATMENT. 9665 06:11:31,068 --> 06:11:33,638 I SHOWED YOU SOME OF OUR DATA 9666 06:11:33,704 --> 06:11:33,838 HERE. 9667 06:11:33,904 --> 06:11:36,107 THEY ARE ALSO THE TARGETS OF 9668 06:11:36,173 --> 06:11:38,009 PROVIDER BIASES. 9669 06:11:38,075 --> 06:11:39,610 AND NOT JUST PROVIDERS. 9670 06:11:39,677 --> 06:11:41,312 ALL OF US, BY THE WAY. 9671 06:11:41,379 --> 06:11:44,015 BUT THOSE OF US WHO AREN'T 9672 06:11:44,081 --> 06:11:44,849 PROVIDERS AREN'T PROVIDING 9673 06:11:44,915 --> 06:11:45,349 MEDICAL CARE FOR THESE 9674 06:11:45,416 --> 06:11:46,984 INDIVIDUALS. 9675 06:11:47,051 --> 06:11:50,087 SO THESE PROVIDER BIASES CAN 9676 06:11:50,154 --> 06:11:50,621 CERTAINLY INFLUENCE THEIR 9677 06:11:50,688 --> 06:11:52,156 PAIN-RELATED OUTCOMES. 9678 06:11:52,223 --> 06:11:54,792 INCLUDING UNDER TREATMENT OF 9679 06:11:54,859 --> 06:11:55,126 PAIN. 9680 06:11:55,192 --> 06:11:59,096 AND IT'S CERTAINLY WELL 9681 06:11:59,163 --> 06:12:00,631 DOCUMENTED THAT INDIVIDUALS 9682 06:12:00,698 --> 06:12:01,832 FROM MINORITIZED RACIAL 9683 06:12:01,899 --> 06:12:05,569 BACKGROUNDS ARE AT GREAT RISK 9684 06:12:05,636 --> 06:12:06,570 FOR UNDER TREATMENT OF THEIR 9685 06:12:06,637 --> 06:12:06,837 PAIN. 9686 06:12:06,904 --> 06:12:10,541 I WOULD RECOMMEND TO MYSELF 9687 06:12:10,608 --> 06:12:13,611 AND TO THE REST OF US WE 9688 06:12:13,678 --> 06:12:15,613 ABANDON THE TEMPTATION TO FALL 9689 06:12:15,680 --> 06:12:19,083 PREY TO THE SINGLE CAUSE 9690 06:12:19,150 --> 06:12:21,886 FALLACY, SCIENCE IS 9691 06:12:21,952 --> 06:12:22,687 REDUCTIONISTIC AND HORRIBLY 9692 06:12:22,753 --> 06:12:24,355 REDUCTIONISTIC AT TIMES AND WE 9693 06:12:24,422 --> 06:12:27,024 NEED TO TRANSITION FROM 9694 06:12:27,091 --> 06:12:28,492 THINKING OF CAUSE AND EFFECT TO 9695 06:12:28,559 --> 06:12:30,561 CAUSES AND EFFECT. 9696 06:12:30,628 --> 06:12:33,864 AS THESE AUTHORS SAID WE NEED 9697 06:12:33,931 --> 06:12:36,567 TO REEVALUATE OUR RESEARCH 9698 06:12:36,634 --> 06:12:39,036 MODELS AND ALLOW EXPLORATION OF 9699 06:12:39,103 --> 06:12:40,471 THE CLINICALLY OBVIOUS CAUSES 9700 06:12:40,538 --> 06:12:42,473 AND EFFECT ON HEALTH AND 9701 06:12:42,540 --> 06:12:48,212 DISEASE. 9702 06:12:48,279 --> 06:12:52,583 SO TAKING THAT TO HEART, IN THE 9703 06:12:52,650 --> 06:12:54,585 FUTURE, WE SHOULD EMBARK UPON 9704 06:12:54,652 --> 06:12:58,122 STUDIES THAT ARE DESIGNED TO 9705 06:12:58,189 --> 06:13:00,958 EXPLORE THIS INTERSECTIONALITY, 9706 06:13:01,025 --> 06:13:05,663 NOT JUST DOING IT SORT OF 9707 06:13:05,730 --> 06:13:09,166 POSTHOC OR AD HOC. 9708 06:13:09,233 --> 06:13:10,901 PAIN IMPACT IS MORE IMPORTANT 9709 06:13:10,968 --> 06:13:12,369 THAN PAIN PREVALENCE. 9710 06:13:12,436 --> 06:13:18,876 WE WANT TO INVESTIGATE THE 9711 06:13:18,943 --> 06:13:19,543 BIOPSYCHOSOCIAL MECHANISMS 9712 06:13:19,610 --> 06:13:21,779 CONTRIBUTING TO THE INDEPENDENT 9713 06:13:21,846 --> 06:13:25,082 AND COMBINED EFFECTS OF THESE 9714 06:13:25,149 --> 06:13:26,917 FACTORS WE ARE INTERESTED IN 9715 06:13:26,984 --> 06:13:28,486 AND BANDON THE APPROACH OF 9716 06:13:28,552 --> 06:13:32,923 MAKING WHITE MEN THE GOLD 9717 06:13:32,990 --> 06:13:34,492 STANDARD AND INSTEAD LOOK AT 9718 06:13:34,558 --> 06:13:36,026 FACTORS THAT MIGHT BE DRIVING 9719 06:13:36,093 --> 06:13:38,229 PAIN IN A PARTICULAR GROUP, 9720 06:13:38,295 --> 06:13:39,864 IRRESPECTIVE OF WHAT MIGHT BE 9721 06:13:39,930 --> 06:13:45,703 HAPPENING IN OTHER GROUPS. 9722 06:13:45,770 --> 06:13:48,038 AND I CERTAINLY WANT TO 9723 06:13:48,105 --> 06:13:49,940 ACKNOWLEDGE MY COLLEAGUES AT 9724 06:13:50,007 --> 06:13:51,108 OUR PAIN RESEARCH AND 9725 06:13:51,175 --> 06:13:51,609 INTERVENTION CENTER OF 9726 06:13:51,675 --> 06:13:53,677 EXCELLENCE. 9727 06:13:53,744 --> 06:13:54,578 ACKNOWLEDGE THE N.I.H. AND 9728 06:13:54,645 --> 06:13:58,449 THANK YOU FOR THE SUPPORT OF 9729 06:13:58,516 --> 06:14:01,786 OUR WORK. 9730 06:14:01,852 --> 06:14:03,053 AND IT GOES TO OUR PANEL 9731 06:14:03,120 --> 06:14:08,626 DISCUSSION, I BELIEVE. 9732 06:14:08,692 --> 06:14:09,894 >> THANK YOU VERY MUCH FOR THIS 9733 06:14:09,960 --> 06:14:11,762 GREAT TALK. 9734 06:14:11,829 --> 06:14:12,830 AND THANKS TO ALL THREE 9735 06:14:12,897 --> 06:14:14,832 SPEAKERS. 9736 06:14:14,899 --> 06:14:18,235 AND HOPEFULLY WE WILL SEE DR. 9737 06:14:18,302 --> 06:14:19,770 SULTAN ON ZOOM PARTICIPATING IN 9738 06:14:19,837 --> 06:14:21,172 THIS PANEL DISCUSSION. 9739 06:14:21,238 --> 06:14:26,010 AND I WOULD LIKE TO ENCOURAGE 9740 06:14:26,076 --> 06:14:28,746 ALL OF YOU TO ASK QUESTIONS. 9741 06:14:28,813 --> 06:14:29,814 WE HAVE ABOUT 18 MINUTES FOR 9742 06:14:29,880 --> 06:14:30,147 THE QUESTIONS. 9743 06:14:30,214 --> 06:14:31,782 YES? 9744 06:14:31,849 --> 06:14:42,193 THE FIRST QUESTION? 9745 06:15:03,614 --> 06:15:05,850 >> TREATMENT DIFFERENCES 9746 06:15:05,916 --> 06:15:06,617 BETWEEN RACIAL AND ETHNIC 9747 06:15:06,684 --> 06:15:07,918 GROUPS, THERE'S BEEN A LITTLE 9748 06:15:07,985 --> 06:15:11,455 BIT OF WORK DONE IN OPIOIDS. 9749 06:15:11,522 --> 06:15:14,091 I BELIEVE THERE IS CERTAINLY 9750 06:15:14,158 --> 06:15:15,426 DATA SHOWING SOME ASIAN 9751 06:15:15,492 --> 06:15:18,229 POPULATIONS ARE AT GREATER RISK 9752 06:15:18,295 --> 06:15:21,365 FOR ADVERSE EFFECTS OF OPIOIDS. 9753 06:15:21,432 --> 06:15:24,702 THERE ARE SOME DATA SUGGESTING 9754 06:15:24,768 --> 06:15:26,503 THAT NON-HISPANIC BLACK 9755 06:15:26,570 --> 06:15:32,776 INDIVIDUALS MAY SHOW GREATER 9756 06:15:32,843 --> 06:15:35,212 ANALGESIC RESPONSE TO OPIOIDS, 9757 06:15:35,279 --> 06:15:35,813 ALTHOUGH THAT'S VERY LIMITED 9758 06:15:35,880 --> 06:15:37,248 DATA. 9759 06:15:37,314 --> 06:15:39,149 PROBABLY WHAT'S MORE STRIKING 9760 06:15:39,216 --> 06:15:42,486 IS THE FACT THAT AT LEAST IN 9761 06:15:42,553 --> 06:15:43,587 THIS COUNTRY, NON HISPANIC 9762 06:15:43,654 --> 06:15:46,624 BLACK INDIVIDUALS ARE MUCH MORE 9763 06:15:46,690 --> 06:15:48,626 LIKELY TO BE DENIED OPIOIDS 9764 06:15:48,692 --> 06:15:50,661 UNDER CONDITIONS WHEN THEY 9765 06:15:50,728 --> 06:15:59,336 WOULD BE APPROPRIATELY PROVIDED. 9766 06:15:59,403 --> 06:16:01,272 WE KNOW RELATIVELY LITTLE, AT 9767 06:16:01,338 --> 06:16:03,274 LEAST MY READING OF LITERATURE 9768 06:16:03,340 --> 06:16:04,408 ABOUT HOW DIFFERENT TREATMENTS 9769 06:16:04,475 --> 06:16:08,178 MAY OR MAY NOT BE MORE OR LESS 9770 06:16:08,245 --> 06:16:08,846 EFFECTIVE ACROSS GROUPS. 9771 06:16:08,913 --> 06:16:10,447 >> THANK YOU. 9772 06:16:10,514 --> 06:16:13,284 >> I WILL JUST ADD IN THE 9773 06:16:13,350 --> 06:16:14,618 MIGRAINE SPACE, IT'S A 9774 06:16:14,685 --> 06:16:18,122 RELATIVELY NEWER ANALYSIS TO BE 9775 06:16:18,188 --> 06:16:18,589 LOOKING AT SUBGROUPS. 9776 06:16:18,656 --> 06:16:20,758 AND QUITE FRANKLY NEW THAT WE 9777 06:16:20,824 --> 06:16:21,892 HAVE ENROLLED ENOUGH SUBJECTS 9778 06:16:21,959 --> 06:16:24,395 THAT ARE NOT JUST WHITE 9779 06:16:24,461 --> 06:16:28,666 ESSENTIALLY TO BE ABLE TO LOOK 9780 06:16:28,732 --> 06:16:31,502 AT THIS, IN THE CGRP STUDIES 9781 06:16:31,568 --> 06:16:33,304 THERE'S NOT AN ANALYSIS THAT'S 9782 06:16:33,370 --> 06:16:35,940 BEEN DONE, BUT TO WHOM WE OFFER 9783 06:16:36,006 --> 06:16:36,941 THERAPIES IS OFTEN VERY 9784 06:16:37,007 --> 06:16:37,207 DIFFERENT. 9785 06:16:37,274 --> 06:16:37,541 >> THANK YOU. 9786 06:16:37,608 --> 06:16:40,177 >> THANK YOU. 9787 06:16:40,244 --> 06:16:42,112 >> HANNAH? 9788 06:16:42,179 --> 06:16:44,415 >> HI, SO MY QUESTION IS 9789 06:16:44,481 --> 06:16:49,787 DIRECTED TOWARDS ROGER. 9790 06:16:49,853 --> 06:16:51,789 QUANTITATIVE SENSORY TESTING 9791 06:16:51,855 --> 06:16:53,424 HAS THE NAME QUANTITATIVE RIGHT 9792 06:16:53,490 --> 06:16:55,926 IN THE NAME AND HAS Z SCORES 9793 06:16:55,993 --> 06:16:58,095 AND COULD LOOK VERY OBJECTIVE. 9794 06:16:58,162 --> 06:16:59,129 BUT I WONDER SINCE GENDER IS 9795 06:16:59,196 --> 06:17:06,837 ONE OF THE THEMES OF THE 9796 06:17:06,904 --> 06:17:08,072 SYMPOSIUM WHETHER GENDER NORMS 9797 06:17:08,138 --> 06:17:12,876 COULD BIAS THE RESULTS OF QST 9798 06:17:12,943 --> 06:17:14,545 PEOPLE WHO HAVE SOCIAL 9799 06:17:14,611 --> 06:17:16,146 INCENTIVE TO LOOK TOUGH MIGHT 9800 06:17:16,213 --> 06:17:18,549 REALLY HOLD THAT AS LONG AS 9801 06:17:18,615 --> 06:17:20,584 POSSIBLE BEFORE THEY SAY 9802 06:17:20,651 --> 06:17:23,921 SOMETHING IS PAINFUL AND PEOPLE 9803 06:17:23,988 --> 06:17:24,722 LESS SEEMING TOUGH MAY REPORT 9804 06:17:24,788 --> 06:17:25,622 EARLIER. 9805 06:17:25,689 --> 06:17:27,558 WHAT DO WE KNOW ABOUT THAT 9806 06:17:27,624 --> 06:17:29,159 POTENTIAL SOURCE OF BIAS? 9807 06:17:29,226 --> 06:17:30,694 >> YEAH, THANKS, HANNAH. 9808 06:17:30,761 --> 06:17:36,667 AND YOU MAKE A GOOD POINT. 9809 06:17:36,734 --> 06:17:38,102 QUANTITATIVE SENSORY TESTING, 9810 06:17:38,168 --> 06:17:39,903 IT IS QUANTITATIVE AND PAIN 9811 06:17:39,970 --> 06:17:42,439 REPORTS ARE INDEED QUANTITATIVE. 9812 06:17:42,506 --> 06:17:43,440 QUANTITATIVE SENSORY TESTING IS 9813 06:17:43,507 --> 06:17:48,479 NOT OBJECTIVE, RIGHT? 9814 06:17:48,545 --> 06:17:50,314 THE SENSORY STIMULI ARE 9815 06:17:50,381 --> 06:17:52,549 OBJECTIVE BUT THE OUTPUT, THE 9816 06:17:52,616 --> 06:17:54,785 MEASURES ARE STILL SELF-REPORT 9817 06:17:54,852 --> 06:17:55,452 DATA. 9818 06:17:55,519 --> 06:17:58,455 AND SO THAT'S IMPORTANT TO 9819 06:17:58,522 --> 06:18:00,924 RECOGNIZE. 9820 06:18:00,991 --> 06:18:03,627 THERE ARE CERTAINLY GENDER 9821 06:18:03,694 --> 06:18:05,462 RELATED NORMS AND STEREOTYPES 9822 06:18:05,529 --> 06:18:08,198 HAVE CONSISTENTLY BEEN SHOWN TO 9823 06:18:08,265 --> 06:18:10,601 INFLUENCE QUANTITATIVE SENSORY 9824 06:18:10,667 --> 06:18:11,068 TESTING AND RESPONSES. 9825 06:18:11,135 --> 06:18:14,972 IF YOU GIVE A STANDARD GENDER 9826 06:18:15,039 --> 06:18:15,973 STEREOTYPE QUESTIONNAIRE, 9827 06:18:16,040 --> 06:18:17,808 INDIVIDUALS WHO IDENTIFY AS 9828 06:18:17,875 --> 06:18:22,212 MORE MASCULINE TEND TO HAVE 9829 06:18:22,279 --> 06:18:22,746 HIGHER PAIN THRESHOLD AND 9830 06:18:22,813 --> 06:18:25,049 TOLERANCE. 9831 06:18:25,115 --> 06:18:28,385 IF YOU MANIPULATE THE SEX 9832 06:18:28,452 --> 06:18:31,588 AND/OR GENDER OF THE 9833 06:18:31,655 --> 06:18:33,590 EXPERIMENTER, THAT AFFECTS THE 9834 06:18:33,657 --> 06:18:34,558 RESULTS WITH INDIVIDUALS 9835 06:18:34,625 --> 06:18:37,861 TENDING TO REPORT LESS PAIN TO 9836 06:18:37,928 --> 06:18:40,431 AN OPPOSITE SEX EXPERIMENTER 9837 06:18:40,497 --> 06:18:43,333 THAN THAT EFFECT TENDS TO BE 9838 06:18:43,400 --> 06:18:47,004 PARTICULARLY STRONG FOR MEN. 9839 06:18:47,071 --> 06:18:49,273 I DON'T THINK WE WANT TO FOOL 9840 06:18:49,339 --> 06:18:51,008 OURSELVES THINKING WE ARE 9841 06:18:51,075 --> 06:18:51,842 GETTING OBJECTIVE MEASURES OF 9842 06:18:51,909 --> 06:18:53,143 PAIN EVEN THOUGH WE ARE DOING 9843 06:18:53,210 --> 06:18:54,745 IT IN THE LABORATORY. 9844 06:18:54,812 --> 06:18:55,879 WE ARE REMOVING A SOURCE OF 9845 06:18:55,946 --> 06:18:58,048 VARIANCE, RIGHT? 9846 06:18:58,115 --> 06:19:01,151 IF TWO PEOPLE WITH A BROKEN ARM 9847 06:19:01,218 --> 06:19:02,753 REPORT TWO DIFFERENT AMOUNTS OF 9848 06:19:02,820 --> 06:19:04,488 PAIN, DON'T KNOW IF IT'S 9849 06:19:04,555 --> 06:19:07,424 BECAUSE ONE ARM IS BROKEN WORSE 9850 06:19:07,491 --> 06:19:09,460 THAN THE OTHER. 9851 06:19:09,526 --> 06:19:11,462 WITH THE STIMULI IN THE LAB I 9852 06:19:11,528 --> 06:19:13,697 HAVE REMOVED THAT VARIABLE. 9853 06:19:13,764 --> 06:19:15,365 IT'S STILL QUITE SUBJECTIVE AND 9854 06:19:15,432 --> 06:19:18,836 SUBJECT TO THE KINDS OF 9855 06:19:18,902 --> 06:19:19,470 GENDER-RELATED INFLUENCES THAT 9856 06:19:19,536 --> 06:19:20,537 YOU RAISE. 9857 06:19:20,604 --> 06:19:22,206 >> THANK YOU. 9858 06:19:22,272 --> 06:19:22,973 I HAVE TWO QUESTIONS IN THE 9859 06:19:23,040 --> 06:19:27,511 ROOM. 9860 06:19:27,578 --> 06:19:28,479 AND REMEMBER YOU CAN ASK DR. 9861 06:19:28,545 --> 06:19:29,713 SULTAN. 9862 06:19:29,780 --> 06:19:31,448 NOW WE HAVE THE FULL PICTURE. 9863 06:19:31,515 --> 06:19:33,050 >> YEAH, THANK YOU. 9864 06:19:33,117 --> 06:19:35,752 I JUST HAD A QUESTION, DO YOU, 9865 06:19:35,819 --> 06:19:38,322 WHEN WE ARE TALKING ABOUT 9866 06:19:38,388 --> 06:19:41,758 GENDER IN TERMS OF MALE/FEMALE 9867 06:19:41,825 --> 06:19:44,094 AND MORE PAIN THRESHOLDS HAS 9868 06:19:44,161 --> 06:19:47,030 THERE BEEN ANY INDICATION OF 9869 06:19:47,097 --> 06:19:47,631 WHAT TYPE OF INSURANCE THEY 9870 06:19:47,698 --> 06:19:49,266 HAVE? 9871 06:19:49,333 --> 06:19:52,269 LIKE IN TERMS OF, ARE MALES 9872 06:19:52,336 --> 06:19:53,704 MORE INSURED THAN WOMEN OR VICE 9873 06:19:53,770 --> 06:19:55,205 VERSA? 9874 06:19:55,272 --> 06:20:01,178 ANY OF THE STUDIES? 9875 06:20:01,245 --> 06:20:02,880 >> YEAH, ACTUALLY WE HAVE THOSE 9876 06:20:02,946 --> 06:20:04,715 DATA THOUGH I CAN'T SAY WE HAVE 9877 06:20:04,781 --> 06:20:06,517 EVER LOOKED AT THAT. 9878 06:20:06,583 --> 06:20:08,886 I DON'T KNOW OF ANY STUDIES 9879 06:20:08,952 --> 06:20:11,555 THAT HAVE LOOKED AT THAT 9880 06:20:11,622 --> 06:20:12,689 QUESTION IN RELATION TO 9881 06:20:12,756 --> 06:20:13,290 QUANTITATIVE SENSORY RESULTS. 9882 06:20:13,357 --> 06:20:14,124 YEAH. 9883 06:20:14,191 --> 06:20:18,762 >> OKAY, THANK YOU. 9884 06:20:18,829 --> 06:20:23,667 >> YES, SO I WAS WONDERING FOR 9885 06:20:23,734 --> 06:20:25,736 DIFFERENT VARIABLES THAT ARE 9886 06:20:25,802 --> 06:20:27,838 RELATED TO DISCRIMINATION IN 9887 06:20:27,905 --> 06:20:29,473 YOUR STUDIES, YOU KNOW WHETHER 9888 06:20:29,540 --> 06:20:34,411 IT BE RACE OR GENDER OR MAYBE 9889 06:20:34,478 --> 06:20:37,648 EVEN PREVIOUS LIVED EXPERIENCE, 9890 06:20:37,714 --> 06:20:40,284 YOU PREVIOUSLY TALKED ABOUT 9891 06:20:40,350 --> 06:20:41,852 LIKE, KNOW, RESEARCHER BIAS AND 9892 06:20:41,919 --> 06:20:44,288 YOU KNOW, PEOPLE ANSWERING 9893 06:20:44,354 --> 06:20:46,123 QUESTIONS AND FILLING OUT 9894 06:20:46,190 --> 06:20:46,490 QUESTIONNAIRES. 9895 06:20:46,557 --> 06:20:50,060 AND IT MADE ME THINK, YOU KNOW, 9896 06:20:50,127 --> 06:20:53,997 THERE MAY NOT BE ENOUGH 9897 06:20:54,064 --> 06:20:55,632 INDIVIDUALS FROM THESE SIMILAR 9898 06:20:55,699 --> 06:20:58,035 BACKGROUNDS LIKE ENOUGH BLACK 9899 06:20:58,101 --> 06:20:59,570 MALE RESEARCHERS OR MAYBE 9900 06:20:59,636 --> 06:21:03,607 RESEARCHERS WHO ARE TRANS OR 9901 06:21:03,674 --> 06:21:06,743 NON-BINARY OR HAVE HAD CERTAIN 9902 06:21:06,810 --> 06:21:08,345 LIVED EXPERIENCES LIKE 9903 06:21:08,412 --> 06:21:12,583 OBTAINING A C-SECTION. 9904 06:21:12,649 --> 06:21:14,484 SO I WONDER WHAT ARE YOUR 9905 06:21:14,551 --> 06:21:17,254 THOUGHTS ON HOW THOSE TYPES OF 9906 06:21:17,321 --> 06:21:18,388 DISPARITIES MAY BE IMPACTING 9907 06:21:18,455 --> 06:21:20,357 THE PAIN THAT IS BEING REPORTED 9908 06:21:20,424 --> 06:21:22,626 IN THESE SPECIFIC TYPES OF 9909 06:21:22,693 --> 06:21:22,859 GROUPS? 9910 06:21:22,926 --> 06:21:24,428 >> YES. 9911 06:21:24,494 --> 06:21:26,930 SO IF I'M GETTING YOUR QUESTION 9912 06:21:26,997 --> 06:21:29,433 RIGHT, IT'S SORT OF IF THE 9913 06:21:29,499 --> 06:21:31,568 EXPERIMENTERS DON'T SHARE THE 9914 06:21:31,635 --> 06:21:35,105 LIVED EXPERIENCE OF THE 9915 06:21:35,172 --> 06:21:37,074 PARTICIPANTS THAT COULD CREATE 9916 06:21:37,140 --> 06:21:38,875 AN INFLUENCE ON HOW OUR 9917 06:21:38,942 --> 06:21:39,843 PARTICIPANTS ARE REPORTING 9918 06:21:39,910 --> 06:21:40,310 THEIR PAIN EXPERIENCE. 9919 06:21:40,377 --> 06:21:41,578 YES. 9920 06:21:41,645 --> 06:21:43,213 >> EXACTLY. 9921 06:21:43,280 --> 06:21:49,353 >> THAT'S A GREAT POINT. 9922 06:21:49,419 --> 06:21:52,489 IT'S SOMETHING THAT I'VE HAD 9923 06:21:52,556 --> 06:21:53,490 DIFFICULTY FIGURING OUT HOW TO 9924 06:21:53,557 --> 06:21:57,027 MANAGE, RIGHT? 9925 06:21:57,094 --> 06:21:59,663 SO I AGREE WITH YOU. 9926 06:21:59,730 --> 06:22:01,698 BUT MY WORKFORCE IS NOT SUCH 9927 06:22:01,765 --> 06:22:03,900 THAT I CAN ADDRESS THAT, RIGHT? 9928 06:22:03,967 --> 06:22:05,902 NOW I WILL SAY IN OUR FIRST 9929 06:22:05,969 --> 06:22:08,572 STUDY IN THIS SPACE, WE ARE 9930 06:22:08,639 --> 06:22:09,673 STUDYING HEALTHY YOUNG 9931 06:22:09,740 --> 06:22:10,841 INDIVIDUALS FROM DIFFERENT 9932 06:22:10,907 --> 06:22:13,810 RACIAL AND ETHNIC GROUPS. 9933 06:22:13,877 --> 06:22:15,078 MOST THEM ARE COLLEGE-EDUCATED 9934 06:22:15,145 --> 06:22:17,214 OR ON THEIR WAY TO BEING SO. 9935 06:22:17,281 --> 06:22:20,284 AND WE WERE ABLE TO ENSURE THAT 9936 06:22:20,350 --> 06:22:22,919 IN EVERY TEST, WE HAD ONE 9937 06:22:22,986 --> 06:22:24,855 PERSON OF THEIR SAME RACE, 9938 06:22:24,921 --> 06:22:27,257 ETHNICITY AND ANOTHER PERSON OF 9939 06:22:27,324 --> 06:22:29,159 ANOTHER RACE, ETHNICITY. 9940 06:22:29,226 --> 06:22:32,129 BUT WE DIDN'T ADDRESS ANY OTHER 9941 06:22:32,195 --> 06:22:32,629 ASPECTS OF THEIR LIVED 9942 06:22:32,696 --> 06:22:35,966 EXPERIENCE, RIGHT? 9943 06:22:36,033 --> 06:22:38,502 SO THAT CAN CERTAINLY INFLUENCE 9944 06:22:38,568 --> 06:22:41,438 OUR RECRUITMENT INTO STUDIES 9945 06:22:41,505 --> 06:22:42,439 BUT CAN ALSO INFLUENCE THE 9946 06:22:42,506 --> 06:22:43,340 EXPERIENCE OF THE PARTICIPANT 9947 06:22:43,407 --> 06:22:44,374 IN THE STUDY. 9948 06:22:44,441 --> 06:22:47,511 I WISH I COULD TELL YOU HOW ITS 9949 06:22:47,577 --> 06:22:48,211 INFLUENCING THEIR EXPERIENCE 9950 06:22:48,278 --> 06:22:49,313 AND THEIR RESPONSE, BUT I JUST 9951 06:22:49,379 --> 06:22:54,651 DON'T KNOW. 9952 06:22:54,718 --> 06:22:56,887 >> I WOULD ADD IN OUR EMERGENCY 9953 06:22:56,953 --> 06:22:58,522 DEPARTMENT STUDIES WE WANTED TO 9954 06:22:58,588 --> 06:23:03,860 LOOK AT THIS, IF THERE'S 9955 06:23:03,927 --> 06:23:05,062 CONCORDANT VERSUS DISCONCORDANT 9956 06:23:05,128 --> 06:23:06,697 PAIRING OF THE PROVIDERS AND 9957 06:23:06,763 --> 06:23:07,431 PATIENTS. 9958 06:23:07,497 --> 06:23:10,067 IF YOU THINK OF E.D. CARE THERE 9959 06:23:10,133 --> 06:23:11,668 ARE SO MANY PROVIDERS THE CHILD 9960 06:23:11,735 --> 06:23:13,904 WOULD SEE ALONG THE WAY, EVEN 9961 06:23:13,970 --> 06:23:15,505 IF WE COULD IDENTIFY WHO HAS 9962 06:23:15,572 --> 06:23:18,308 TOUCHED THE CHART AND WHAT 9963 06:23:18,375 --> 06:23:19,876 THEIR RACIAL ETHNIC BACKGROUND 9964 06:23:19,943 --> 06:23:22,879 WOULD BE, GENDER, ET CETERA, 9965 06:23:22,946 --> 06:23:25,349 THERE WOULD BE TOO MANY PEOPLE 9966 06:23:25,415 --> 06:23:26,717 WE COULDN'T SORT IT OUT. 9967 06:23:26,783 --> 06:23:28,218 WE THOUGHT ABOUT IT BUT THOUGHT 9968 06:23:28,285 --> 06:23:29,619 IT WASN'T POSSIBLE TO BE ABLE 9969 06:23:29,686 --> 06:23:31,488 TO EXAMINE. 9970 06:23:31,555 --> 06:23:32,923 >> DR. SULTAN, WOULD YOU LIKE 9971 06:23:32,989 --> 06:23:35,158 TO ADD SOMETHING? 9972 06:23:35,225 --> 06:23:37,227 >> YEAH, OBVIOUSLY, THE GENDER 9973 06:23:37,294 --> 06:23:40,030 DIFFERENCE IN OUR POPULATION 9974 06:23:40,097 --> 06:23:41,198 ARE NOT REALLY APPLICABLE 9975 06:23:41,264 --> 06:23:43,100 BECAUSE MOST OF THE PEOPLE 9976 06:23:43,166 --> 06:23:46,036 DELIVER IDENTIFY AS FEMALE AND 9977 06:23:46,103 --> 06:23:49,139 IT'S A VERY UNDER EXPLORED AREA 9978 06:23:49,206 --> 06:23:51,074 OF PEOPLE THAT DELIVER THAT 9979 06:23:51,141 --> 06:23:53,276 DON'T IDENTIFY AS FEMALE IN 9980 06:23:53,343 --> 06:23:55,112 TERMS OF THEIR PAIN OUTCOMES. 9981 06:23:55,178 --> 06:23:57,647 IT'S JUST NOT BEEN EXPLORED. 9982 06:23:57,714 --> 06:23:59,349 SO HUGELY IMPORTANT AREA OF 9983 06:23:59,416 --> 06:24:00,117 RESEARCH THAT NEEDS SOME 9984 06:24:00,183 --> 06:24:02,486 ATTENTION. 9985 06:24:02,552 --> 06:24:05,522 BUT I THINK JUST PROFILING WHAT 9986 06:24:05,589 --> 06:24:10,861 A NORMAL PAIN RESPONSE AND 9987 06:24:10,927 --> 06:24:12,529 EXPERIENCE IS IN THE PERI AND 9988 06:24:12,596 --> 06:24:14,398 POSTPARTUM PERIOD. 9989 06:24:14,464 --> 06:24:19,569 WHAT WE NEED IS LARGE CLINICAL 9990 06:24:19,636 --> 06:24:20,971 EPIDEMIOLOGICAL STUDY TO 9991 06:24:21,037 --> 06:24:21,972 PROFILE PAIN EXPERIENCES AT 9992 06:24:22,038 --> 06:24:23,306 DIFFERENT TIME POINTS IN THE 9993 06:24:23,373 --> 06:24:25,542 POSTPARTUM PERIOD. 9994 06:24:25,609 --> 06:24:27,444 TRADITIONALLY, MOST PEOPLE ARE 9995 06:24:27,511 --> 06:24:28,745 TOLD YOUR RECOVERY AFTER CHILD 9996 06:24:28,812 --> 06:24:32,215 BIRTH WILL TAKE ABOUT SIX WEEKS 9997 06:24:32,282 --> 06:24:34,684 BUT THAT REALLY ISN'T 9998 06:24:34,751 --> 06:24:36,453 EVIDENCE-BASED AND CERTAINLY 9999 06:24:36,520 --> 06:24:37,220 DOESN'T ADEQUATELY DESCRIBE 10000 06:24:37,287 --> 06:24:38,455 RECOVERY FROM A PAIN 10001 06:24:38,522 --> 06:24:39,156 PERSPECTIVE. 10002 06:24:39,222 --> 06:24:41,992 THERE WAS A STUDY DONE FROM 10003 06:24:42,058 --> 06:24:43,393 STANFORD WHERE PATIENTS WERE 10004 06:24:43,460 --> 06:24:44,995 CALLED UP EVERY SINGLE DAY 10005 06:24:45,061 --> 06:24:46,730 AFTER THEIR CHILD BIRTH AND 10006 06:24:46,797 --> 06:24:48,632 ASKED THREE QUESTIONSMENT ONE, 10007 06:24:48,698 --> 06:24:50,867 ARE YOU STILL IN PAIN, TWO ARE 10008 06:24:50,934 --> 06:24:52,302 YOU STILL NEEDING PAIN KILLERS 10009 06:24:52,369 --> 06:24:54,938 AND THREE, DO YOU CONSIDER YOU 10010 06:24:55,005 --> 06:24:55,772 HAVE RECOVERED FOLLOWING YOUR 10011 06:24:55,839 --> 06:24:57,140 DELIVERY. 10012 06:24:57,207 --> 06:24:59,643 ABOUT 10% OF PATIENTS THAT HAD 10013 06:24:59,709 --> 06:25:04,114 A C-SECTION AND 5% THAT HAD A 10014 06:25:04,181 --> 06:25:05,482 VAGINAL DELIVERY ANSWERED NO TO 10015 06:25:05,549 --> 06:25:07,350 THOSE QUESTIONS OR NEGATIVELY. 10016 06:25:07,417 --> 06:25:08,985 WE ARE ACTUALLY DEALING WITH A 10017 06:25:09,052 --> 06:25:11,254 PUBLIC HEALTH CRISIS. 10018 06:25:11,321 --> 06:25:12,889 WE URGENTLY NEED TO KNOW WHAT 10019 06:25:12,956 --> 06:25:14,024 IS NORMAL IN THE POSTPARTUM 10020 06:25:14,090 --> 06:25:15,425 PERIOD. 10021 06:25:15,492 --> 06:25:19,863 HOW LONG IT CARRIES ON FOR. 10022 06:25:19,930 --> 06:25:23,300 SURVEY DATA FROM AUSTRALIA AND 10023 06:25:23,366 --> 06:25:24,734 UNITED KINGDOM, EVEN WHEN YOU 10024 06:25:24,801 --> 06:25:28,939 SURVEY PEOPLE UP TO 18 MONTHS 10025 06:25:29,005 --> 06:25:30,674 POSTPARTUM, 75% OF PATIENTS SAY 10026 06:25:30,740 --> 06:25:33,877 THEY ARE STILL SUFFERING FROM A 10027 06:25:33,944 --> 06:25:34,644 MORBIDITY RELATED TO THEIR 10028 06:25:34,711 --> 06:25:36,913 DELIVERY ONE AND A HALF YEARS 10029 06:25:36,980 --> 06:25:37,080 AGO. 10030 06:25:37,147 --> 06:25:40,350 SO YEAH, WE REALLY NEED TO 10031 06:25:40,417 --> 06:25:42,686 URGENTLY IMPROVE POSTPARTUM 10032 06:25:42,752 --> 06:25:44,621 RECOVERY. 10033 06:25:44,688 --> 06:25:48,158 >> DO I HAVE TIME FOR ONE MORE 10034 06:25:48,225 --> 06:25:51,595 QUESTION FOR DR. SULTAN? 10035 06:25:51,661 --> 06:25:56,032 I WANTED TO ASK, DID YOU FIND 10036 06:25:56,099 --> 06:25:57,434 ANY CORRELATION, OR DO YOU 10037 06:25:57,501 --> 06:25:59,469 THINK IT'S SOMETHING TO LOOK AT 10038 06:25:59,536 --> 06:26:01,304 IN TERMS OF, BECAUSE I KNOW YOU 10039 06:26:01,371 --> 06:26:03,139 ARE LOOKING AT CHRONIC PAIN 10040 06:26:03,206 --> 06:26:06,343 DURING POSTPARTUM TOO. 10041 06:26:06,409 --> 06:26:09,579 DOES HAVING, IS THERE A 10042 06:26:09,646 --> 06:26:11,081 CORRELATION BETWEEN HAVING 10043 06:26:11,147 --> 06:26:12,582 CHRONIC PAIN PRIOR TO GIVING 10044 06:26:12,649 --> 06:26:15,952 BIRTH AND THE DEVELOPMENT OF 10045 06:26:16,019 --> 06:26:17,754 POSTPARTUM DEPRESSION IN THESE 10046 06:26:17,821 --> 06:26:17,988 MOTHERS? 10047 06:26:18,054 --> 06:26:18,588 >> YEAH, THAT'S A VERY GOOD 10048 06:26:18,655 --> 06:26:20,490 QUESTION. 10049 06:26:20,557 --> 06:26:25,562 AND WAS ROGER WAS ELUDING TO, I 10050 06:26:25,629 --> 06:26:27,864 THINK PAIN IS SUCH A COMPLEX 10051 06:26:27,931 --> 06:26:30,033 CONSTRUCT IN ANY SETTING. 10052 06:26:30,100 --> 06:26:31,101 BUT PARTICULARLY IN THE 10053 06:26:31,167 --> 06:26:32,602 POSTPARTUM SETTING. 10054 06:26:32,669 --> 06:26:34,337 BECAUSE YOU'VE GOT THE BABY 10055 06:26:34,404 --> 06:26:35,272 WHICH INFLUENCES A LOT OF 10056 06:26:35,338 --> 06:26:36,740 THINGS GOING ON. 10057 06:26:36,806 --> 06:26:38,875 AND YOU HAVE NEW EXPERIENCES 10058 06:26:38,942 --> 06:26:41,211 LIKE BREAST FEEDING AND NORMAL 10059 06:26:41,278 --> 06:26:41,945 HORMONAL CHANGES WHICH CHANGE 10060 06:26:42,012 --> 06:26:44,047 MOOD AS WELL. 10061 06:26:44,114 --> 06:26:45,849 BUT FROM CLINICAL EXPERIENCE AS 10062 06:26:45,916 --> 06:26:50,320 AN ANESTHESIOLOGIST PATIENTS 10063 06:26:50,387 --> 06:26:52,422 WHO HAVE OPIOID MISUSE DISORDER 10064 06:26:52,489 --> 06:26:55,559 AND PATIENTS THAT HAVE CHRONIC 10065 06:26:55,625 --> 06:26:57,260 PAIN BEFORE THEIR CAESARIAN 10066 06:26:57,327 --> 06:27:04,534 BIRTH DELIVERY WILL HAVE 10067 06:27:04,601 --> 06:27:05,068 POSTPARTUM PAIN, AND 10068 06:27:05,135 --> 06:27:05,669 BREAK-THROUGH INTRA-OPERATIVE 10069 06:27:05,735 --> 06:27:07,304 PAIN AS WELL. 10070 06:27:07,370 --> 06:27:15,378 AS I ELUDED TO, THIS ANXIETY 10071 06:27:15,445 --> 06:27:17,280 AND PAIN, DIFFERENT CONSTRUCTS 10072 06:27:17,347 --> 06:27:18,582 BUT ANXIETY AND MOOD ARE OFTEN 10073 06:27:18,648 --> 06:27:20,216 RELATED. 10074 06:27:20,283 --> 06:27:22,152 THE PREVALENCE OF CHRONIC PAIN 10075 06:27:22,218 --> 06:27:24,754 IS PROBABLY MORE COMMON IN 10076 06:27:24,821 --> 06:27:27,991 PATIENTS THAT HAVE THESE 10077 06:27:28,058 --> 06:27:29,092 DISORDERS PRE-OPERATIVELY BUT 10078 06:27:29,159 --> 06:27:30,927 REALLY IT'S UNDER EXPLORED AND 10079 06:27:30,994 --> 06:27:33,863 HOW WE BEST DEFINE WHAT CHRONIC 10080 06:27:33,930 --> 06:27:35,065 PAIN IS AT THREE MONTHS. 10081 06:27:35,131 --> 06:27:36,633 IS IT JUST IF YOU HAVE A PAIN 10082 06:27:36,700 --> 06:27:39,436 SCORE OF ONE? 10083 06:27:39,502 --> 06:27:40,103 OR MODERATE TO SEVERE PAIN 10084 06:27:40,170 --> 06:27:41,638 SCORE? 10085 06:27:41,705 --> 06:27:42,839 OR ITS IMPACTING YOUR QUALITY 10086 06:27:42,906 --> 06:27:43,940 OF LIFE AND ABILITY TO GO BACK 10087 06:27:44,007 --> 06:27:45,775 TO WORK? 10088 06:27:45,842 --> 06:27:48,311 HOW CAN WE ACTUALLY BEST DEFINE 10089 06:27:48,378 --> 06:27:49,145 CHRONIC PAIN AFTER HAVING A 10090 06:27:49,212 --> 06:27:50,447 BABY? 10091 06:27:50,513 --> 06:27:52,616 >> THANK YOU. 10092 06:27:52,682 --> 06:27:54,184 >> THANK YOU VERY MUCH. 10093 06:27:54,250 --> 06:27:56,653 AND WE HAVE A COUPLE OF 10094 06:27:56,720 --> 06:27:57,253 QUESTIONS FROM OUR VIDEOCAST 10095 06:27:57,320 --> 06:27:57,988 AUDIENCE. 10096 06:27:58,054 --> 06:27:59,723 >> YES, WE DO. 10097 06:27:59,789 --> 06:28:00,957 THANK YOU, INNA. 10098 06:28:01,024 --> 06:28:03,560 THIS IS A QUESTION FROM ONLINE. 10099 06:28:03,627 --> 06:28:07,130 THIS QUESTION CONCERNS NEURAL 10100 06:28:07,197 --> 06:28:08,698 SUBSTRATES FOR SEX DIFFERENCES 10101 06:28:08,765 --> 06:28:12,535 AND NEURAL SENSIVITY. 10102 06:28:12,602 --> 06:28:14,704 CAN YOU COMMENT BEFORE DRG 10103 06:28:14,771 --> 06:28:16,906 SPINAL CORD CONTRIBUTE TO SEX 10104 06:28:16,973 --> 06:28:18,808 DIFFERENCES OR CONTRIBUTIONS 10105 06:28:18,875 --> 06:28:21,311 FROM HIGHER NERVOUS SYSTEM 10106 06:28:21,378 --> 06:28:22,612 REGIONS DOMINATE THE SEX 10107 06:28:22,679 --> 06:28:25,882 DIFFERENCE? 10108 06:28:25,949 --> 06:28:32,455 >> WOULD YOU LIKE TO START? 10109 06:28:32,522 --> 06:28:34,491 >> I CAN'T SAY WHERE THE SEX 10110 06:28:34,557 --> 06:28:35,859 DIFFERENCES RESIDE. 10111 06:28:35,925 --> 06:28:40,230 I CAN CERTAINLY SAY THAT 10112 06:28:40,296 --> 06:28:43,466 CONTRIBUTIONS FROM HIGHER 10113 06:28:43,533 --> 06:28:45,068 REGIONS, IF THAT INCLUDES 10114 06:28:45,135 --> 06:28:46,670 SOCIETY, HAVE AN INFLUENCE, 10115 06:28:46,736 --> 06:28:46,870 RIGHT? 10116 06:28:46,936 --> 06:28:51,941 SO WE KNOW A VARIETY OF 10117 06:28:52,008 --> 06:28:52,976 PSYCHOSOCIAL FACTORS CONTRIBUTE 10118 06:28:53,043 --> 06:28:56,179 TO SEX DIFFERENCES AND PAIN. 10119 06:28:56,246 --> 06:29:00,016 NOW ARGUABLY, THOSE COULD WORK 10120 06:29:00,083 --> 06:29:03,153 THEIR WAY INTO THE SPINAL CORD, 10121 06:29:03,219 --> 06:29:07,490 AND INTO THE PERIPHERY, 10122 06:29:07,557 --> 06:29:07,991 FRANKLY, BY INFLUENCING 10123 06:29:08,058 --> 06:29:09,426 SYSTEMIC INFLAMMATION. 10124 06:29:09,492 --> 06:29:12,162 SO WHERE THOSE SORT OF HOW 10125 06:29:12,228 --> 06:29:13,797 THOSE PSYCHO SOCIAL FACTORS GET 10126 06:29:13,863 --> 06:29:15,432 UNDER THE SKIN, WE DON'T 10127 06:29:15,498 --> 06:29:17,901 COMPLETELY KNOW. 10128 06:29:17,967 --> 06:29:20,737 THERE HAVE BEEN BRAIN IMAGING 10129 06:29:20,804 --> 06:29:22,972 STUDIES SHOWING SOME SEX 10130 06:29:23,039 --> 06:29:25,508 DIFFERENCES IN CEREBRAL 10131 06:29:25,575 --> 06:29:30,480 ACTIVATION AND RESPONSE TO 10132 06:29:30,547 --> 06:29:31,147 SENSORY STIMULI. 10133 06:29:31,214 --> 06:29:33,383 WHETHER THOSE DIFFERENCES IN 10134 06:29:33,450 --> 06:29:35,518 THE BRAIN STARTED IN THE 10135 06:29:35,585 --> 06:29:35,985 PERIPHERY. 10136 06:29:36,052 --> 06:29:37,821 I DON'T KNOW. 10137 06:29:37,887 --> 06:29:39,355 THAT MAY BE KNOWN BY SOMEONE. 10138 06:29:39,422 --> 06:29:43,159 BUT I'M NOT SURE. 10139 06:29:43,226 --> 06:29:45,895 I WOULD SAY ITS SAFE TO SAY 10140 06:29:45,962 --> 06:29:47,931 THAT SEX DIFFERENCES COULD 10141 06:29:47,997 --> 06:29:50,467 OCCUR AT ANY LEVEL OF THE PAIN 10142 06:29:50,533 --> 06:29:57,407 PROCESSING SYSTEM. 10143 06:29:57,474 --> 06:29:58,241 >> THERE'S NO MORE QUESTIONS, 10144 06:29:58,308 --> 06:29:58,441 RIGHT? 10145 06:29:58,508 --> 06:29:59,542 OKAY. 10146 06:29:59,609 --> 06:30:02,445 SO I HAVE ONE MORE QUESTION TO 10147 06:30:02,512 --> 06:30:05,715 ALL THE PANELISTS. 10148 06:30:05,782 --> 06:30:09,853 SO WE HAVE THE INTERESTING 10149 06:30:09,919 --> 06:30:11,221 INTERSECTION OF INFLUENCES OF 10150 06:30:11,287 --> 06:30:16,493 THESE FACTORS ON PAIN. 10151 06:30:16,559 --> 06:30:17,427 DR. FILLINGIM ALREADY STARTED 10152 06:30:17,494 --> 06:30:21,664 IDENTIFYING SOME OF THE COMMON 10153 06:30:21,731 --> 06:30:24,300 FACTORS THAT ALL THE AGE, RACE, 10154 06:30:24,367 --> 06:30:26,236 ETHNICITY AND SEX AND GENDER 10155 06:30:26,302 --> 06:30:30,173 MAY HAVE INFLUENCING PAIN. 10156 06:30:30,240 --> 06:30:32,909 SO COULD YOU POSSIBLY INDICATE 10157 06:30:32,976 --> 06:30:34,844 WHICH COMMON FACTORS ARE MORE 10158 06:30:34,911 --> 06:30:37,347 FOR PAIN PROCESSING AND WHICH 10159 06:30:37,413 --> 06:30:39,682 ARE FOR PAIN RECEPTION. 10160 06:30:39,749 --> 06:30:42,919 AND DO WE NEED TO DISTINGUISH 10161 06:30:42,986 --> 06:30:47,557 BETWEEN THOSE AND WHAT WOULD BE 10162 06:30:47,624 --> 06:30:50,593 THE BEST WAY TO IDENTIFY COMMON 10163 06:30:50,660 --> 06:30:53,530 FACTORS FOR PAIN ACROSS LIFE 10164 06:30:53,596 --> 06:30:54,798 SPAN AND AMONG THE DIFFERENT 10165 06:30:54,864 --> 06:31:01,304 GROUPS? 10166 06:31:01,371 --> 06:31:02,605 >> MAYBE I WILL START WITH A 10167 06:31:02,672 --> 06:31:04,207 COUPLE OF COMMENTS. 10168 06:31:04,274 --> 06:31:09,179 ONE IS, IF YOU ARE LOOKING AT 10169 06:31:09,245 --> 06:31:10,980 PAIN PREVALENCE OR PAIN IMPACT 10170 06:31:11,047 --> 06:31:15,652 AT KIND OF A CLINICAL OR 10171 06:31:15,718 --> 06:31:16,553 EPIDEMIOLOGICAL LEVEL, THAT 10172 06:31:16,619 --> 06:31:17,220 BRINGS TREATMENT INTO THE 10173 06:31:17,287 --> 06:31:21,191 PROCESS, RIGHT? 10174 06:31:21,257 --> 06:31:25,428 AND SO THERE, STRUCTURE OF 10175 06:31:25,495 --> 06:31:26,362 HEALTHCARE SYSTEMS. 10176 06:31:26,429 --> 06:31:27,764 OTHER SOCIAL INFLUENCES, 10177 06:31:27,831 --> 06:31:29,766 PSYCHOLOGICAL AND GENDER ROLE 10178 06:31:29,833 --> 06:31:32,101 RELATED INFLUENCES, FOR EXAMPLE. 10179 06:31:32,168 --> 06:31:36,172 OR OTHER SORT OF COGNITIVE 10180 06:31:36,239 --> 06:31:38,041 BIASES THAT ENTER IN, FOR 10181 06:31:38,107 --> 06:31:40,210 EXAMPLE, AS I GET OLDER I'M 10182 06:31:40,276 --> 06:31:42,712 TOLD I'M SUPPOSED TO HAVE PAIN, 10183 06:31:42,779 --> 06:31:44,447 SO WHY WOULD I GO GET TREATMENT 10184 06:31:44,514 --> 06:31:46,950 FOR THAT, RIGHT? 10185 06:31:47,016 --> 06:31:48,685 THESE SOCIAL AND PSYCHOLOGICAL 10186 06:31:48,751 --> 06:31:50,587 PROCESSES CAN INFLUENCE WHETHER 10187 06:31:50,653 --> 06:31:52,522 OR NOT WE SEEK TREATMENT, HOW 10188 06:31:52,589 --> 06:31:54,390 THAT TREATMENT IS PROVIDED TO 10189 06:31:54,457 --> 06:31:55,525 US, AND POTENTIALLY HOW WOULD 10190 06:31:55,592 --> 06:31:57,560 HE RESPOND TO THAT TREATMENT. 10191 06:31:57,627 --> 06:32:00,029 AND THAT'S ALL AFTER WE HAVE 10192 06:32:00,096 --> 06:32:02,198 DEVELOPED THE PAIN. 10193 06:32:02,265 --> 06:32:05,768 AND YOU KNOW, I CERTAINLY THINK 10194 06:32:05,835 --> 06:32:08,771 MANY OF THOSE PROCESSES CAN 10195 06:32:08,838 --> 06:32:09,272 ALSO INFLUENCE HOW WE 10196 06:32:09,339 --> 06:32:10,874 EXPERIENCE PAIN. 10197 06:32:10,940 --> 06:32:13,710 EITHER BECAUSE OF HOW WE 10198 06:32:13,776 --> 06:32:15,144 PROCESS IT CENTRALLY, OR 10199 06:32:15,211 --> 06:32:19,582 POTENTIALLY THROUGH SOME OF THE 10200 06:32:19,649 --> 06:32:21,584 PERIPHERAL INFLUENCES, THINGS 10201 06:32:21,651 --> 06:32:26,356 LIKE SYSTEMIC INFLAMMATION OR 10202 06:32:26,422 --> 06:32:27,257 MAYBE EVEN EPIGENETIC CHANGES 10203 06:32:27,323 --> 06:32:29,192 COULD PRODUCE. 10204 06:32:29,259 --> 06:32:30,693 SO THAT'S MAYBE SOME GENERAL 10205 06:32:30,760 --> 06:32:30,960 COMMENTS. 10206 06:32:31,027 --> 06:32:33,396 >> I WOULD LIKE TO ECHO WHAT 10207 06:32:33,463 --> 06:32:36,332 ROGER HAS BEEN TALKING ABOUT AS 10208 06:32:36,399 --> 06:32:39,903 WELL WITH THE PERCEPTIONS OF 10209 06:32:39,969 --> 06:32:41,170 SOCIETY AND THE IMPACT THAT HAS 10210 06:32:41,237 --> 06:32:43,206 ON PAIN. 10211 06:32:43,273 --> 06:32:46,209 A PERFECT EXAMPLE IS THAT 10212 06:32:46,276 --> 06:32:49,178 CHRONIC PAIN HAS ACTUALLY BEEN 10213 06:32:49,245 --> 06:32:50,580 DESCRIBED FOLLOWING CHILD BIRTH 10214 06:32:50,647 --> 06:32:51,180 FOR DECADES. 10215 06:32:51,247 --> 06:32:53,816 THERE WAS A LOT OF RESEARCH 10216 06:32:53,883 --> 06:32:54,918 PUBLISHED PROBABLY ABOUT 15 10217 06:32:54,984 --> 06:32:56,386 YEARS AGO IN THIS FIELD. 10218 06:32:56,452 --> 06:32:58,755 AT THAT TIME THE FINDING ISS 10219 06:32:58,821 --> 06:33:01,190 WERE THAT CHRONIC PAIN HAPPENS 10220 06:33:01,257 --> 06:33:02,492 IN 10-15% OF PATIENTS AND WE 10221 06:33:02,558 --> 06:33:06,329 NEED TO STUDY THIS. 10222 06:33:06,396 --> 06:33:07,263 IT WASN'T CONSIDERED A FUNDABLE 10223 06:33:07,330 --> 06:33:09,599 AREA. 10224 06:33:09,666 --> 06:33:12,936 AND REASON, I THINK, IS BECAUSE 10225 06:33:13,002 --> 06:33:14,404 M.D.'S AND PATIENTS ARE OFTEN 10226 06:33:14,470 --> 06:33:16,039 SAYING, WELL OF COURSE YOU HAVE 10227 06:33:16,105 --> 06:33:17,573 HAD A BABY, OF COURSE YOU ARE 10228 06:33:17,640 --> 06:33:18,775 GOING TO BE IN PAIN. 10229 06:33:18,841 --> 06:33:21,010 AND OF COURSE YOU HAVE HAD A 10230 06:33:21,077 --> 06:33:22,278 BABY, IT'S NOT A SURPRISE 10231 06:33:22,345 --> 06:33:23,212 YOU'RE NOT SLEEPING WELL. 10232 06:33:23,279 --> 06:33:26,149 OF COURSE YOU HAD A BABY, IT'S 10233 06:33:26,215 --> 06:33:27,884 NOT A SURPRISE THAT YOUR MOOD 10234 06:33:27,951 --> 06:33:29,686 IS LOW AFTER THE CHILD BIRTH. 10235 06:33:29,752 --> 06:33:32,121 BUT I THINK WE REALLY NEED A 10236 06:33:32,188 --> 06:33:34,424 PARADIGM SHIFT IN WHAT WE 10237 06:33:34,490 --> 06:33:36,659 PERCEIVE AS NORMAL AND 10238 06:33:36,726 --> 06:33:38,594 ACCEPTABLE LEVELS OF PAIN AND 10239 06:33:38,661 --> 06:33:41,531 SLEEP DISTURBANCE AND THINGS 10240 06:33:41,597 --> 06:33:41,798 LIKE THAT. 10241 06:33:41,864 --> 06:33:44,434 AND TAKING INTO ACCOUNT THE 10242 06:33:44,500 --> 06:33:46,336 FACT THAT THERE'S AN ENTIRE 10243 06:33:46,402 --> 06:33:48,304 GENERATION OF M.D.'S THAT ARE 10244 06:33:48,371 --> 06:33:49,605 PROBABLY SEEING PATIENTS IN 10245 06:33:49,672 --> 06:33:51,240 THEIR CLINICS IN TERMS OF 10246 06:33:51,307 --> 06:33:53,142 FAMILY PRACTICE CLINICS. 10247 06:33:53,209 --> 06:33:54,644 WHEN PATIENTS COME AND SAY, 10248 06:33:54,711 --> 06:33:56,946 I'VE STILL GOT PAIN AFTER MY 10249 06:33:57,013 --> 06:33:58,948 C-SECTION. 10250 06:33:59,015 --> 06:34:00,216 I'M NOT SLEEPING WELL, RATHER 10251 06:34:00,283 --> 06:34:01,718 THAN BRUSHING IT UNDER THE 10252 06:34:01,784 --> 06:34:04,921 CARPET, I THINK WE NEED TO 10253 06:34:04,988 --> 06:34:06,322 START MEASURING THIS AND 10254 06:34:06,389 --> 06:34:08,591 QUANTIFYING HOW PEOPLE ARE 10255 06:34:08,658 --> 06:34:11,127 COMPARING TO THEIR PEERS AND 10256 06:34:11,194 --> 06:34:12,795 OFFERING INTERVENTIONS AND 10257 06:34:12,862 --> 06:34:14,263 REFERRALS TO CHRONIC PAIN 10258 06:34:14,330 --> 06:34:17,667 CLINICS IF THERE IS PAIN, WHICH 10259 06:34:17,734 --> 06:34:22,005 IS IMPACTING LIFE AND FAMILY 10260 06:34:22,071 --> 06:34:22,705 INTERACTIONS, AND PREVENTING 10261 06:34:22,772 --> 06:34:23,473 PATIENTS GOING BACK TO WORK FOR 10262 06:34:23,539 --> 06:34:25,208 EXAMPLE. 10263 06:34:25,274 --> 06:34:27,110 THE INTERESTING THING IS, ONCE 10264 06:34:27,176 --> 06:34:29,779 AGAIN, WE DID THESE QUALITATIVE 10265 06:34:29,846 --> 06:34:30,713 INTERVIEWS WITH PATIENTS 10266 06:34:30,780 --> 06:34:31,481 REPORTING PAIN. 10267 06:34:31,547 --> 06:34:33,683 BUT THEY WERE REPORTING LOW 10268 06:34:33,750 --> 06:34:36,519 PAIN SCORES OF 1-2 OUT OF 10 10269 06:34:36,586 --> 06:34:39,222 BUT IN THE INTERVIEWS THEY WERE 10270 06:34:39,288 --> 06:34:41,190 SAYING ITS DEBILITATING BECAUSE 10271 06:34:41,257 --> 06:34:42,992 I CAN'T GET MY JEANS ON AND I'M 10272 06:34:43,059 --> 06:34:45,895 NOT GOING OUT OF THE HOUSE AS 10273 06:34:45,962 --> 06:34:46,095 MUCH. 10274 06:34:46,162 --> 06:34:47,930 THAT DOESN'T CORRELATE WHAT WE 10275 06:34:47,997 --> 06:34:49,165 WOULD CONSIDER A 1-2 PAIN. 10276 06:34:49,232 --> 06:34:52,402 I THINK WE NEED A PARADIGM 10277 06:34:52,468 --> 06:34:53,703 SHIFT HOW WE APPROACH THIS 10278 06:34:53,770 --> 06:34:54,804 PUBLIC HEALTH CRISIS. 10279 06:34:54,871 --> 06:34:57,140 >> THANK YOU VERY MUCH. 10280 06:34:57,206 --> 06:34:58,775 FINAL THOUGHT. 10281 06:34:58,841 --> 06:35:01,477 >> I AGREE WITH WHAT'S BEEN 10282 06:35:01,544 --> 06:35:02,612 SAID CERTAINLY. 10283 06:35:02,678 --> 06:35:04,680 AS I THINK ABOUT, LOOKING AT 10284 06:35:04,747 --> 06:35:06,749 THE GRAPHS THINKING OF SYMPTOMS 10285 06:35:06,816 --> 06:35:08,785 EMERGING AROUND THE TIME OF 10286 06:35:08,851 --> 06:35:11,354 PUBERTY, I THINK THAT IN MANY 10287 06:35:11,421 --> 06:35:15,324 WAYS POINTS TO BIOLOGICAL 10288 06:35:15,391 --> 06:35:15,925 UNDERPINNING, GROWTH, HORMONE 10289 06:35:15,992 --> 06:35:17,627 CHANGES ALL THOSE THINGS. 10290 06:35:17,693 --> 06:35:20,163 BUT AS SOMEONE BROUGHT UP THIS 10291 06:35:20,229 --> 06:35:24,600 MORNING, EXPRESSION OF PAIN, 10292 06:35:24,667 --> 06:35:26,569 MENSES AND GIRLS ARE 10293 06:35:26,636 --> 06:35:27,437 EXPERIENCING MONTHLY PAIN AND 10294 06:35:27,503 --> 06:35:28,538 CRAMPS AND HOW DOES THAT UP 10295 06:35:28,604 --> 06:35:30,473 REGULATE. 10296 06:35:30,540 --> 06:35:31,474 THERE'S THE LIVED EXPERIENCE 10297 06:35:31,541 --> 06:35:34,210 AND THE SHARED EXPERIENCE. 10298 06:35:34,277 --> 06:35:36,846 IN SOME OUR ANALYSES OF 10299 06:35:36,913 --> 06:35:39,582 EMERGENCY DEPARTMENT WE LOOKED 10300 06:35:39,649 --> 06:35:40,116 AT DISMISSIVENESS OF PAIN 10301 06:35:40,183 --> 06:35:42,919 SYMPTOMS. 10302 06:35:42,985 --> 06:35:44,520 SOME ESSENTIALLY BOYS ARE MORE 10303 06:35:44,587 --> 06:35:45,855 LIKELY TO HAVE MISSING 10304 06:35:45,922 --> 06:35:46,155 INFORMATION. 10305 06:35:46,222 --> 06:35:49,959 HOW MUCH IS FROM THE PROVIDER'S 10306 06:35:50,026 --> 06:35:50,927 PERSPECTIVE VERSUS BOY'S 10307 06:35:50,993 --> 06:35:52,628 PERSPECTIVE, ARE GIRLS ABLE TO 10308 06:35:52,695 --> 06:35:53,629 EXPRESS BETTER BECAUSE THEY 10309 06:35:53,696 --> 06:35:55,731 TALK TO THEIR FRIENDS ABOUT 10310 06:35:55,798 --> 06:35:57,433 GETTING THEIR PERIODS BUT BOYS 10311 06:35:57,500 --> 06:35:57,967 DON'T HAVE THAT SHARED 10312 06:35:58,034 --> 06:35:58,768 CONVERSATION YET. 10313 06:35:58,835 --> 06:36:02,105 IT'S COMPLEX. 10314 06:36:02,171 --> 06:36:02,839 >> THANK YOU VERY, VERY MUCH. 10315 06:36:02,905 --> 06:36:04,540 GREAT SESSION. 10316 06:36:04,607 --> 06:36:06,309 THANK YOU FOR YOUR INPUT, FOR 10317 06:36:06,375 --> 06:36:15,218 SHARING IDEAS. 10318 06:36:15,284 --> 06:36:16,886 IS IT A BRIEF QUESTION, WE WILL 10319 06:36:16,953 --> 06:36:18,054 ALLOW ONE MORE. 10320 06:36:18,121 --> 06:36:19,455 >> IT'S BRIEF. 10321 06:36:19,522 --> 06:36:21,591 DR. SULTAN, QUESTION. 10322 06:36:21,657 --> 06:36:23,993 DOES THE NUMBER OF DELIVERIES 10323 06:36:24,060 --> 06:36:26,996 IMPACT THE PAIN CHRONICITY AND 10324 06:36:27,063 --> 06:36:27,964 INTENSITY IN POSTPARTUM PAIN? 10325 06:36:28,030 --> 06:36:29,732 DO WE KNOW THAT? 10326 06:36:29,799 --> 06:36:34,437 >> THAT'S A FANTASTIC QUESTION. 10327 06:36:34,504 --> 06:36:35,138 SO THERE'S EVIDENCE THAT 10328 06:36:35,204 --> 06:36:38,674 HAVING, IF YOU ARE A FIRST-TIME 10329 06:36:38,741 --> 06:36:40,576 MOTHER YOUR OVERALL PAIN AND 10330 06:36:40,643 --> 06:36:41,377 RECOVERY EXPERIENCE TENDS TO BE 10331 06:36:41,444 --> 06:36:42,812 WORSE. 10332 06:36:42,879 --> 06:36:46,549 WHICH I THINK BRINGS INTO THIS 10333 06:36:46,616 --> 06:36:47,783 MULTI-DIMENSIONAL CONSTRUCT OF 10334 06:36:47,850 --> 06:36:49,986 PAIN AND OVERALL RECOVERY. 10335 06:36:50,052 --> 06:36:53,689 IF YOU ARE FAMILIAR YOU MAY BE 10336 06:36:53,756 --> 06:36:54,290 A LITTLE LESS ANXIOUS 10337 06:36:54,357 --> 06:36:55,558 SURROUNDING THE EXPERIENCE. 10338 06:36:55,625 --> 06:36:56,492 THAT'S PROBABLY AGAINST WHAT 10339 06:36:56,559 --> 06:36:57,460 YOU WOULD EXPECT. 10340 06:36:57,527 --> 06:37:00,296 IF YOU HAVE HAD A REPEAT 10341 06:37:00,363 --> 06:37:01,697 CAESARIAN DELIVERY, YOU ARE 10342 06:37:01,764 --> 06:37:09,172 LIKELY TO HAVE ADHESIONS AND 10343 06:37:09,238 --> 06:37:11,274 SCARRING, IT SHOULD BE MORE 10344 06:37:11,340 --> 06:37:13,576 PAINFUL BUT PATIENTS REPORT A 10345 06:37:13,643 --> 06:37:14,911 BETTER RECOVERY EXPERIENCE AND 10346 06:37:14,977 --> 06:37:16,512 PAIN EXPERIENCE A SECOND TIME 10347 06:37:16,579 --> 06:37:16,746 AROUND. 10348 06:37:16,812 --> 06:37:17,513 YEAH, FASCINATING QUESTION. 10349 06:37:17,580 --> 06:37:18,347 >> THANK YOU. 10350 06:37:18,414 --> 06:37:19,715 >> THANK YOU. 10351 06:37:19,782 --> 06:37:22,385 THANK YOU VERY MUCH. 10352 06:37:22,451 --> 06:37:24,554 AND NOW WE HAVE OUR FINAL 10353 06:37:24,620 --> 06:37:25,021 ACTION FOR TODAY. 10354 06:37:25,087 --> 06:37:35,264 THANK YOU. 10355 06:37:47,376 --> 06:37:51,480 >> SO THIS IS THE LAST ACTIVITY 10356 06:37:51,547 --> 06:37:53,349 OF THE DAY, AS INNA SAID AND IN 10357 06:37:53,416 --> 06:37:57,954 MY MIND IT'S BEST. 10358 06:37:58,020 --> 06:37:59,155 I'M LINDA PORTER, BEEN 10359 06:37:59,222 --> 06:38:02,558 ASSOCIATED WITH THE SYMPOSIUM 10360 06:38:02,625 --> 06:38:05,928 OVER THE YEARS, DECADES ALMOST. 10361 06:38:05,995 --> 06:38:08,364 ALWAYS SO HAPPY TO ACKNOWLEDGE 10362 06:38:08,431 --> 06:38:09,865 SOME EARLY STAGE CAREER 10363 06:38:09,932 --> 06:38:11,267 SCIENTISTS WHO HAVE REALLY 10364 06:38:11,334 --> 06:38:11,801 BRILLIANT FUTURES TO LOOK 10365 06:38:11,867 --> 06:38:13,002 FORWARD TO. 10366 06:38:13,069 --> 06:38:15,104 IT'S A DIFFICULT SITUATION FOR 10367 06:38:15,171 --> 06:38:23,779 US TO CHOOSE THREE PEOPLE FROM 10368 06:38:23,846 --> 06:38:25,915 AMONGST THE MANY POSTER 10369 06:38:25,982 --> 06:38:27,583 PRESENTERS IN THE ATRIUM AND 10370 06:38:27,650 --> 06:38:28,651 LIMIT THAT DOWN TO THREE WHO 10371 06:38:28,718 --> 06:38:29,952 WILL PRESENT. 10372 06:38:30,019 --> 06:38:31,887 IT'S A PROCESS THAT TAKES US 10373 06:38:31,954 --> 06:38:34,090 THROUGH LIKE A VOTING PROCESS 10374 06:38:34,156 --> 06:38:37,393 OF STAFF ACROSS THE N.I.H. PAIN 10375 06:38:37,460 --> 06:38:37,860 CONSORTIUM MEMBERSHIP. 10376 06:38:37,927 --> 06:38:40,162 AND THEN THEY COME AND THEY 10377 06:38:40,229 --> 06:38:42,198 LISTEN TO THE PRESENTATIONS AND 10378 06:38:42,265 --> 06:38:44,934 WE HAVE CRITERIA ON WHICH WE 10379 06:38:45,001 --> 06:38:48,137 SELECT THE TOP ONE OF THE THREE 10380 06:38:48,204 --> 06:38:50,339 FOR THE PRESENTATION MATERIALS. 10381 06:38:50,406 --> 06:38:52,308 IT'S ALWAYS HARD BECAUSE THEY 10382 06:38:52,375 --> 06:38:54,043 ARE ALWAYS GREAT, WE ARE ALWAYS 10383 06:38:54,110 --> 06:38:55,444 REALLY CLOSE TO TIES BUT WE DO 10384 06:38:55,511 --> 06:38:56,345 HAVE TO COME TO A DECISION ON 10385 06:38:56,412 --> 06:38:58,347 ONE. 10386 06:38:58,414 --> 06:39:00,182 SO BEFORE I MAKE THAT 10387 06:39:00,249 --> 06:39:01,284 ANNOUNCEMENT WHAT I WOULD LIKE 10388 06:39:01,350 --> 06:39:03,919 TO DO IS ADD A LITTLE BIT TO 10389 06:39:03,986 --> 06:39:05,821 WHAT DAVE THOMAS TOLD US ABOUT 10390 06:39:05,888 --> 06:39:08,758 MITCHELL MAX THIS MORNING. 10391 06:39:08,824 --> 06:39:12,828 SOME OF US, SOME OF YOU IN THE 10392 06:39:12,895 --> 06:39:15,264 AUDIENCE ARE PROBABLY TOO YOUNG 10393 06:39:15,331 --> 06:39:18,134 TO HAVE CROSSED PATHS WITH 10394 06:39:18,200 --> 06:39:18,467 MITCHELL MAX. 10395 06:39:18,534 --> 06:39:19,001 HE WAS A PRETTY AMAZING 10396 06:39:19,068 --> 06:39:20,436 SCIENTIST. 10397 06:39:20,503 --> 06:39:22,171 A VERY COMPASSIONATE CLINICIAN. 10398 06:39:22,238 --> 06:39:24,707 HE WAS A MENTOR TO MANY, MANY 10399 06:39:24,774 --> 06:39:24,940 PEOPLE. 10400 06:39:25,007 --> 06:39:31,147 AND THIS IS WHY HE WAS CHOSEN 10401 06:39:31,213 --> 06:39:33,282 TO ACTUALLY BE GIVEN THE TITLE 10402 06:39:33,349 --> 06:39:36,018 FOR THE MITCHELL MAX AWARD. 10403 06:39:36,085 --> 06:39:38,654 THERE WERE TWO OF HIS REALLY 10404 06:39:38,721 --> 06:39:40,556 CLOSE FRIENDS AFTER HE DIED 10405 06:39:40,623 --> 06:39:41,924 TRAGICALLY WROTE AN ARTICLE IN 10406 06:39:41,991 --> 06:39:43,626 THE JOURNAL OF PAIN. 10407 06:39:43,693 --> 06:39:45,094 I WILL READ YOU A TINY LITTLE 10408 06:39:45,161 --> 06:39:46,462 BIT TO GIVE YOU A SENSE OF 10409 06:39:46,529 --> 06:39:49,632 MITCHELL. 10410 06:39:49,699 --> 06:39:50,166 THIS IS CHUCK AND CATHY 10411 06:39:50,232 --> 06:39:55,638 SPEAKING. 10412 06:39:55,705 --> 06:39:56,472 BRILLIANT SCIENTIST, 10413 06:39:56,539 --> 06:39:58,941 COMPASSIONATE PHYSICIAN, TRUE 10414 06:39:59,008 --> 06:40:00,042 HEALER, GIFTED MUSICIAN, 10415 06:40:00,109 --> 06:40:00,743 PHILOSOPHER, LOYAL MENTOR, 10416 06:40:00,810 --> 06:40:02,078 LOVING HUSBAND AND FATHER AND A 10417 06:40:02,144 --> 06:40:04,580 DEAR FRIEND. 10418 06:40:04,647 --> 06:40:06,582 SO THEY GO ONTO MENTION THAT 10419 06:40:06,649 --> 06:40:10,119 TWO DAYS BEFORE HE PASSED AWAY, 10420 06:40:10,186 --> 06:40:12,655 THAT HE HAD GIVEN, I WAS LUCKY 10421 06:40:12,722 --> 06:40:14,990 ENOUGH TO BE AT HIS 10422 06:40:15,057 --> 06:40:16,625 PRESENTATION AT THE HARVARD 10423 06:40:16,692 --> 06:40:18,027 RESEARCH FORUM TALK ON HIS WORK 10424 06:40:18,094 --> 06:40:19,829 IN THE GENETICS OF PAIN. 10425 06:40:19,895 --> 06:40:22,998 JUST ONE LITTLE AREA OF ALL THE 10426 06:40:23,065 --> 06:40:25,000 AREAS OF PAIN RESEARCH, PAIN 10427 06:40:25,067 --> 06:40:28,938 CARE AND PAIN MANAGEMENT THAT 10428 06:40:29,004 --> 06:40:32,508 MITCHELL REALLY DOVE INTO, AND 10429 06:40:32,575 --> 06:40:33,275 MADE AN AMAZING CONTRIBUTION. 10430 06:40:33,342 --> 06:40:34,543 NOW TO THE BUSINESS OF THE 10431 06:40:34,610 --> 06:40:35,611 PRESENTATION. 10432 06:40:35,678 --> 06:40:39,548 WE HAVE A GIFT FOR THE WINNER. 10433 06:40:39,615 --> 06:40:40,549 I TOOK A LITTLE QUICK LOOK 10434 06:40:40,616 --> 06:40:42,485 THROUGH IT. 10435 06:40:42,551 --> 06:40:44,286 IT'S A REALLY BEAUTIFUL BOOK 10436 06:40:44,353 --> 06:40:47,223 CALLED "SEEING THE MIND". 10437 06:40:47,289 --> 06:40:48,224 LITTLE CHAPTERS ABOUT 10438 06:40:48,290 --> 06:40:51,026 NEUROSCIENCE OF THE BRAIN AND 10439 06:40:51,093 --> 06:40:53,062 IMAGES THAT GO ALONG WITH THE 10440 06:40:53,129 --> 06:40:55,898 PARTICULAR AREAS OF THE BOOK. 10441 06:40:55,965 --> 06:40:58,534 IT'S BEAUTIFULLY WRITTEN AND 10442 06:40:58,601 --> 06:40:59,034 BEAUTIFULLY ILLUSTRATED. 10443 06:40:59,101 --> 06:41:00,403 I'M ACTUALLY PUTTING IT ON MY 10444 06:41:00,469 --> 06:41:04,507 CHRISTMAS LIST. 10445 06:41:04,573 --> 06:41:10,279 WHAT I WOULD LIKE TO DO NOW IS 10446 06:41:10,346 --> 06:41:12,181 JUST TELL YOU, HOW WONDERFUL IT 10447 06:41:12,248 --> 06:41:15,384 WAS TO SEE THESE DIFFERENT 10448 06:41:15,451 --> 06:41:16,018 PRESENTATIONS AND GIVEN THE 10449 06:41:16,085 --> 06:41:17,820 BREADTH OF THE TYPE OF RESEARCH 10450 06:41:17,887 --> 06:41:20,656 THAT THEY TALKED ABOUT, I THINK 10451 06:41:20,723 --> 06:41:21,657 KIND OF HIGHLIGHTS THE 10452 06:41:21,724 --> 06:41:24,560 COMPLEXITY OF PAIN AND THE 10453 06:41:24,627 --> 06:41:26,429 COMPLEXITY OF PAIN RESEARCH. 10454 06:41:26,495 --> 06:41:30,366 AS A REMINDER WE HAD KENDRA 10455 06:41:30,433 --> 06:41:33,602 KAMP WHO TALKED ABOUT SEX AND 10456 06:41:33,669 --> 06:41:34,670 GENDER DIFFERENCE IN ABDOMINAL 10457 06:41:34,737 --> 06:41:38,374 PAIN, A GREAT PRESENTATION. 10458 06:41:38,441 --> 06:41:39,842 BRYAN McKIVER WHO TALKED ABOUT 10459 06:41:39,909 --> 06:41:41,377 THE MECHANISMS FOR THE 10460 06:41:41,444 --> 06:41:45,247 UNDERSTANDING AND PREVENTION OF 10461 06:41:45,314 --> 06:41:46,549 CHEMOTHERAPY INDUCED PAIN. 10462 06:41:46,615 --> 06:41:50,219 WE WOULD LIKE TO EXTEND OUR 10463 06:41:50,286 --> 06:41:51,954 CONGRATULATIONS TO BRYAN, WE 10464 06:41:52,021 --> 06:41:53,756 THINK WE FINISHED HIS Ph.D. IN 10465 06:41:53,823 --> 06:41:55,291 MAY, I CAN'T SEE IN THE 10466 06:41:55,357 --> 06:41:58,661 AUDIENCE, IS THAT CORRECT? 10467 06:41:58,727 --> 06:42:01,096 LIKE A WEEK OR TWO AGO? 10468 06:42:01,163 --> 06:42:04,400 CONGRATULATIONS, BRYAN. 10469 06:42:04,467 --> 06:42:08,237 AND THEN WE HAD CARLYN 10470 06:42:08,304 --> 06:42:11,006 PATTERSON GENTILE A HEADACHE 10471 06:42:11,073 --> 06:42:13,409 SPECIALIST AND TALKED ABOUT 10472 06:42:13,476 --> 06:42:17,613 CLUSTER ANALYSIS FOR MIGRAINE 10473 06:42:17,680 --> 06:42:21,917 ASSOCIATED SYMPTOMS. 10474 06:42:21,984 --> 06:42:26,355 MITCHELL MAX AWARD GOES TO 10475 06:42:26,422 --> 06:42:28,991 CARLYN PATTERSON GENTILE OF 10476 06:42:29,058 --> 06:42:30,526 CLUSTER ANALYSIS OF MIGRAINE 10477 06:42:30,593 --> 06:42:34,330 ASSOCIATED SYMPTOMS IN YOUTH. 10478 06:42:34,396 --> 06:42:44,840 CARLYN, COULD YOU COME UP? 10479 06:42:47,109 --> 06:42:48,611 HERE IS YOUR BOOK. 10480 06:42:48,677 --> 06:42:50,513 >> THANK YOU. 10481 06:42:50,579 --> 06:42:51,981 >> HERE IS YOUR PLAQUE, CAN PUT 10482 06:42:52,047 --> 06:42:53,048 THAT ON THE WALL. 10483 06:42:53,115 --> 06:42:54,950 THANK YOU SO MUCH FOR YOUR 10484 06:42:55,017 --> 06:42:56,151 PRESENTATION, ALL YOUR HARD 10485 06:42:56,218 --> 06:42:58,120 WORK AND BEST OF ALL IN THE 10486 06:42:58,187 --> 06:42:59,788 FUTURE FOR YOUR RESEARCH, IT'S 10487 06:42:59,855 --> 06:43:01,223 VERY MUCH APPRECIATED. 10488 06:43:01,290 --> 06:43:02,525 WE WILL MAKE YOU STAND UP HERE 10489 06:43:02,591 --> 06:43:12,935 AND TAKE A PICTURE. 10490 06:43:15,571 --> 06:43:16,572 SO THAT CONCLUDES THE DAY. 10491 06:43:16,639 --> 06:43:20,709 THANK YOU VERY MUCH. 10492 06:43:20,776 --> 06:43:22,645 WE WILL SEE YOU ALL TOMORROW 10493 06:43:22,711 --> 06:43:32,855 MORNING.